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Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians

WHO estimated that of 9.4 million cases of tuberculosis (TB) worldwide in 2008, 440,000 (3.6%) had multidrug-resistant (MDR)-TB. Childhood TB is estimated at 10-15% of the total burden, but little is known about the burden of MDR-TB in children.

Children in close contact with MDR-TB cases are likely to become infected with the same resistant strains and are vulnerable to develop disease. Although MDR-TB is a microbiological diagnosis, children should be treated empirically according to the drug susceptibility result of the likely source case, as often cultures cannot be obtained from the child. MDR-TB treatment in children is guided by the same principles, using the same second-line drugs as in adults, with careful monitoring for adverse effects. Co-infection with HIV poses partic...

Treatment of paediatric TB: revised WHO guidelines

The World Health Organization has recently revised the recommended dosages of the main first-line anti-tuberculosis drugs for use in children. The recommended dosages and range of isoniazid, rifampicin, pyrazinamide and ethambutol have been increased from the previous recommended dosages. Ethambutol is now recommended for use in children of all ages including those of less than 5 years of age.

This review explains the rationale for these recent revisions. Children require higher dosages than adults to achieve the same serum concentrations. Available data in HIV-uninfected children suggest that the revised dosages are within limits that have a very low risk of toxicity. An important challenge will be to examine the impact of higher dosages on clinical response, drug-drug interactio...

The Management of Pre-School Wheeze

Wheeze, a common symptom in pre-school children, is a continuous high-pitched sound, with a musical quality, emitting from the chest during expiration. A pragmatic clinical classification is episodic (viral) wheeze and multiple-trigger wheeze.

Diagnostic difficulties include other conditions that give rise to noisy breathing which could be misinterpreted as wheeze. Most preschool children with wheeze do not need rigorous investigations. Primary prevention is not possible but avoidance of environmental tobacco smoke exposure should be strongly encouraged.

Bronchodilators provide symptomatic relief in acute wheezy episodes but the evidence for using oral steroids is conflicting for children presenting to the Emergency Department [ED]. Parent initiated oral steroid courses cannot be ...

Intrapleural urokinase versus surgical management of childhood empyema

Conclusions:  Both large bore surgical drains and “pigtail catheter” drains with the instillation of urokinase lead to similarly favourable treatment outcomes. Either treatment could be recommended depending on local expertise and preferences.

International Classification of Functioning, Disability and Health (ICF) Core Sets for persons with sleep disorders: Results of the consensus process integrating evidence from preparatory studies

Conclusion: A formal consensus process integrating evidence and expert opinion led to the first version of the ICF Core Sets for persons with sleep disorders. Further validation of the Core Set is needed.

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