The clinical value of abdominal symptoms and sonography in gallstone disease

Gallstones are a very common finding in adults of Western industrialised countries. At age 60 almost 30% of women and 20% of men will have developed gallstones (Fig. 11-6). Gallstones are rare in children. The prevalence of gallstones is most probably equal between the sexes until puberty, whereafter prevalence increases faster with increasing age among women than men. Gallstones occur more among women than among men at almost every age. After the menopause, the increase seems fairly equal in the two sexes with a marked narrowing of the gender gap with advancing age

Point-of-care C-reactive protein testing in Febrile Children in General Practice

__Background:__ Point-of-care testing for C-reactive protein (CRP) may be helpful in differentiating viral from bacterial infection. Such a device should give results comparable to laboratory testing. The aim was to evaluate two point-of-care CRP tests (Nycocard and QuikRead) in febrile children in general practice, compared to a reference immunoturbidimetric assay. __Methods:__ Cross-sectional study of febrile children aged 3 months to 6 years presented to a general practice out-of-hours service. Children were visited at home, where blood was taken for the tests, within 24 hours of presentation. The Nycocard test was performed at home, whereas the QuikRead and reference test were performed in the laboratory. __Results:__ 76 children were enrolled. All three CRP tests were performed in 59 children. The mean difference between the reference test and Nycocard and QuikRead was 0.6 mg/L and –6.1 mg/L, respectively. The slopes of the Passing and Bablok regression were 0.95 (95% CI 0.9-1.0) and 0.83 (95% CI 0.81-0.85) for Nycocard and QuikRead, respectively. __Conclusion:__ Up to a concentration of 160 mg/L the Nycocard correlated well with the reference test, while the QuikRead underestimated concentrations above 60 mg/L. The Nycocard test seems a good candidate for CRP point-of-care testing in general practice

Alarming signs and symptoms in febrile children in primary care: An observational cohort study in The Netherlands

__Abstract__ Context: Febrile children in primary care have a low risk for serious infection. Although several alarming signs and symptoms are proposed to have predictive value for serious infections, most are based on research in secondary care. The frequency of alarming signs/symptoms has not been established in primary care; however, in this setting differences in occurrence may influence their predictive value for serious infections. Objective: To determine the frequency of alarming signs/symptoms in febrile children in primary care. Design: Observational cohort study. Clinical information was registered in a semi-structured way and manually recoded. Setting: General practitioners' out-of-hours service. Subjects: Face-to-face patient contacts concerning children (aged ≤16 years) with fever were eligible for inclusion. Main outcome measures: Frequency of 18 alarming signs and symptoms as reported in the literature. Results: A total of 10,476 patient contacts were included. The frequency of alarming signs/symptoms ranged from n = 1 (ABC instability; 40°C as reported by the parents; 12.9%) to 8,647 contacts (parental concern; 82.5%). Conclusion: Although the prevalence of specific alarming signs/symptoms is low in primary care, ≥50% of children have one or more alarming signs/symptoms. There is a need to determine the predictive value of alarming signs/symptoms not only for serious infections in primary care, but as well for increased risk of a complicated course of the illness

Human Bocavirus in Febrile Children Consulting a GP Service in the Netherlands

Human bocavirus (HBoV) was detected in nasopharyngeal swabs of 1.6% (95% CI 0.4% to 3.9%) of 257 febrile children presented to a GP center. Symptoms of respiratory tract infection, gastrointestinal symptoms and skin rash were reported. Our results suggest HBoV as a pathogen causing mild disease in non-hospitalized febrile children

The predictive value of the NICE "red traffic lights" in acutely ill children

Objective: Early recognition and treatment of febrile children with serious infections (SI) improves prognosis, however, early detection can be difficult. We aimed to validate the predictive rule-in value of the National Institute for Health and Clinical Excellence (NICE) most severe alarming signs or symptoms to identify SI in children. Design, Setting and Participants: The 16 most severe ("red") features of the NICE traffic light system were validated in seven different primary care and emergency department settings, including 6,260 children presenting with acute illness. Main Outcome Measures: We focussed on the individual predictive value of single red features for SI and their combinations. Results were presented as positive likelihood ratios, sensitivities and specificities. We categorised "general" and "disease-specific" red features. Changes in pre-test probability versus post-test probability for SI were visualised in Fagan nomograms. Results: Almost all red features had rule-in value for SI, but only four individual red features substantially raised the probability of SI in more than one dataset: "does not wake/stay awake", "reduced skin turgor", "non-blanching rash", and "focal neurological signs". The presence of ≥3 red features improved prediction of SI but still lacked strong rule-in value as likelihood ratios were below 5. Conclusions: The rule-in value of the most severe alarming signs or symptoms of the NICE traffic light system for identifying children with SI was limited, even when multiple red features were present. Our study highlights the importance of assessing the predictive value of alarming signs in clinical guidelines prior to widespread implementation in routine practice

Diagnostic test strategies in children at increased risk of inflammatory bowel disease in primary care

Background: In children with symptoms suggestive of inflammatory bowel disease (IBD) who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for referring children with suspected IBD to specialist care: 1) alarm symptoms alone, 2) alarm symptoms plus c-reactive protein, and 3) alarm symptoms plus fecal calprotectin. Methods: A prospective cohort study was conducted, including children with chronic gastrointestinal symptoms referred to pediatric gastroenterology. Outcome was defined as IBD confirmed by endoscopy, or IBD ruled out by either endoscopy or unremarkable clinical 12 month follow-up with no indication for endoscopy. Test strategy probabilities were generated by logistic regression analyses and compared by area under the receiver operating characteristic curves (AUC) and decision curves. Results: We included 90 children, of whom 17 (19%) had IBD (n = 65 from primary care physicians, n = 25 from general pediatricians). Adding fecal calprotectin to alarm symptoms increased the AUC significantly from 0.80 (0.67-0.92) to 0.97 (0.93-1.00), but adding c-reactive protein to alarm symptoms did not increase the AUC significantly (p > 0.05). Decision curves confirmed these patterns, showing that alarm symptoms combined with fecal calprotectin produced the diagnostic test strategy with the highest net benefit at reasonable threshold probabilities. Conclusion: In primary care, when children are identified as being at high risk for IBD, adding fecal calprotectin testing to alarm symptoms was the optimal strategy for improving risk stratification

Same-sign W pair production as a probe of double parton scattering at the LHC

We study the production of same-sign W boson pairs at the LHC in double parton interactions. Compared with simple factorised double parton distributions (dPDFs), we show that the recently developed dPDFs, GS09, lead to non-trivial kinematic correlations between the W bosons. A numerical study of the prospects for observing this process using same-sign dilepton signatures, including same-sign WWjj, di-boson and heavy flavour backgrounds, at 14 TeV centre-of-mass energy is then performed. It is shown that a small excess of same-sign dilepton events from double parton scattering over a background dominated by single scattering WZ(gamma*) production could be observed at the LHC.Comment: 14 pages, 8 figures. Added references, slight changes in the text

Fludarabine-Based Reduced Intensity Conditioning for Stem Cell Transplantation of Fanconi Anemia Patients from Fully Matched Related and Unrelated Donors

AbstractReduced intensity conditioning has been suggested as a desirable therapeutic modality for the treatment of patients with malignant and nonmalignant indications, but it seems particularly attractive for patients with Fanconi anemia due to their increased sensitivity to chemoradiotherapy. Between November 1996 and September 2003, 7 patients (1 male and 6 female; age range, 3-31 years; median age, 9.5) were conditioned with a fludarabine-based protocol for stem cell transplantation without radiation. In vivo T-cell depletion was accomplished with anti-thymocytic globulin or Campath-1H (alemtuzumab). Graft-versus-host disease prophylaxis consisted of low-dose cyclosporine alone. Eight transplantations were carried out for 7 patients using bone marrow, peripheral blood, and/or cord blood as sources of stem cells. All patients received transplants from HLA-A, -B, -C, and -DR matched donors, 5 from family members and 2 from matched unrelated donors. One patient did not engraft her first matched unrelated donor and underwent a second transplantation from another matched unrelated donor, after which she engrafted well. All 7 patients are alive and well, fully reconstituted with donor cells, and with 100% performance status. In conclusion, fludarabine-based preparative protocols are well tolerated, facilitate rapid engraftment with minimal toxicity, and should be considered an essential component of choice for patients with Fanconi anemia

Carriage of Mycoplasma pneumoniae in the Upper Respiratory Tract of Symptomatic and Asymptomatic Children: An Observational Study

Background:Mycoplasma pneumoniae is thought to be a common cause of respiratory tract infections (RTIs) in children. The diagnosis of M. pneumoniae RTIs currently relies on serological methods and/or the detection of bacterial DNA in the upper respiratory tract (URT). It is conceivable, however, that these diagnostic methods also yield positive results if M. pneumoniae is carried asymptomatically in the URT. Positive results from these tests may therefore not always be indicative of a symptomatic infection. The existence of asymptomatic carriage of M. pneumoniae has not been established. We hypothesized that asymptomatic carriage in children exists and investigated whether colonization and symptomatic infection could be differentiated by current diagnostic methods.Methods and Findings:This study was conducted at the Erasmus MC-Sophia Children's Hospital and the after-hours General Practitioners Cooperative in Rotterdam, The Netherlands. Asymptomatic children (n = 405) and children with RTI symptoms (n = 321) aged 3 mo to 16 y were enrolled in a cross-sectional study from July 1, 2008, to November 30, 2011. Clinical data, pharyngeal and nasopharyngeal specimens, and serum samples were collected. The primary objective was to differentiate between colonization and symptomatic infection with M. pneumoniae by current diagnostic methods, especially real-time PCR. M. pneumoniae DNA was detected in 21.2% (95% CI 17.2%-25.2%) of the asymptomatic children and in 16.2% (95% CI 12.2%-20.2%) of the symptomatic children (p = 0.11). Neither serology nor quantitative PCR nor culture differentiated asymptomatic carriage from infection. A total of 202 children were tested for the presence of other bacterial and viral pathogens. Two or more pathogens were found in 56% (63/112) of the asymptomatic children and in 55.5% (50/90) of the symptomatic children. Finally, longitudinal sampling showed persistence of M. pneumoniae in the URT for up to 4 mo. Fifteen of the 21 asymptomatic children with M. pneumoniae and 19 of the 22 symptomatic children with M. pneumoniae in this longitudinal follow-up tested negative after 1 mo.Conclusions:Although our study has limitations, such as a single study sit