Retropharyngeal abscess with atlanto-axial subluxation

We describe a case of a 4-year-old boy who presented with fever, neck pain and bilateral non-suppurative cervical lymphadenopathy. Torticollis, painful limitation of neck movements and nuchal tenderness were present. CT scan revealed a retropharyngeal abscess and rotatory subluxation of the atlanto-axial joint, consistent with Grisel’s syndrome. This is an important differential in children with fever and torticollis as if unrecognized, may potentially lead to serious neurological deficits from cervical cord compression.peer-reviewe

An audit on the practice of performing a chest X–Ray in infants with bronchiolitis

Introduction: Bronchiolitis is one of the most common medical emergencies in infancy. One in three infants will develop bronchiolitis in the first year of life. 2 - 3% of these require hospitalisation. Aim: To assess adherence to the National Institute for Health and Care Excellence (NICE) and American Academy of Paediatrics Clinical Practice Guidelines for Bronchiolitis regarding the practice of performing a chest X - ray in infants aged less than 6 months presenting with viral bronchiolitis. Methodology: Data was collected on infants aged less than 6 months presenting to the Accident and Emergency department (A&E), Mater Dei Hospital, Malta or admitted with bronchiolitis between January - April 2016 and October - February 2016 - 2017. The data was retrieved retrospectively from medical records, processed and compared to the guidelines. Approval was obtained from the Audit Committee and Data Protection Act Committee. Results: 148 patients were included in the study. 81 (54.7%) had a chest X - ray. 67 (82.7%) of the chest X - rays taken were normal. 28 (34.6%) of the chest X - rays taken were indicated according to the guidelines. Only 9 out of the 81 chest X - rays taken (11.1%) led to a change in management. Conclusion: Overall percentage compliance to the guidelines was 64.2%. Compliance may be improved by having an easily available local guideline, familiarising paediatric trainees with the guidelines and increasing awareness of the harmful effects of radiation.peer-reviewe

Cover crops increase N and P cycling and rice productivity in temperate cropping systems

Cover crops can determine positive benefits on soil fertility and rice productivity, although scant attention has been devoted to evaluating the effects of hairy vetch (Vicia villosa Roth) and the incorporation of rice straw with different N fertilization levels on soil N and P availability and crop yields in temperate cropping systems characterized by poorly developed soils. In this study, the effects of cover crops grown before rice in a temperate mono-cropping system (NW Italy) on: (i) crop yields and yield components; (ii) apparent N fertilizer recovery and optimal level of N fertilization with hairy vetch; and (iii) temporal variation of soil available N and P forms during the hairy vetch growth and rice cropping season, have been investigated. The cultivation and incorporation of hairy vetch in the rice cropping system increased grain productivity by 12%, while reducing N mineral fertilization requirements by 33%. Combined with the incorporation of crop residues, hairy vetch provided a N and P input of 178 and 18 kg ha−1, respectively, representing a readily available source for plant uptake over the whole rice cropping season, particularly under anaerobic conditions. This results in a better temporal synchronization of soil N and P availability with crop nutrient demand, leading to a better rice grain productivity and quality performance