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

Can Organic P Inputs Alleviate P Limitation Effects on Nutrient Uptake and Biological N2‑Fixing Capacity of Hairy Vetch (Vicia villosa)?

Phosphorus (P) is a limiting nutrient in many agroecosystems and, apart from affecting plant growth, can also limit biological N2 fixation (BNF) by leguminous plants. Thus, increasing P supply can have a positive effect on BNF particularly in P-deficient soils. Here, we provide new insights into the response of hairy vetch (Vicia villosa), widely adopted as a legume cover crop, to P limitations, by comparing the effects of inorganic (Pi) and organic (Po) P supply on plant growth and BNF capacity. This was achieved by means of a greenhouse experiment in which rhizobia-inoculated hairy vetch was grown in a P-limited agricultural soil and changes in plant growth, nitrogen (N) and P uptake, BNF capacity, and soil phosphatases activities were evaluated as a function of Pi and Po inputs, in the form of orthophosphate or phytic acid, respectively. When compared to P-deficient conditions where BNF was primarily limited by plant growth rather than directly due to the high P costs of symbiotic N fixation, Pi addition substantially enhanced plant growth (threefold), nodule formation (16-fold), P acquisition (sixfold), and BNF efficiency (sevenfold). In contrast, even with the addition of the highest dose of Po, the increase in plant growth, nodule formation, P acquisition, and BNF capacity (1.7, 3.5, 2.4 and 2.1-fold, respectively) was much less expressed, indicating that hairy vetch could only minimally access Po sources over the growth period in order to alleviate the P limitation effect on N2 fixation in under P-deficient conditions. These findings suggest that hairy vetch will not be able to provide sufficient BNF for improving soil N inputs in low-fertility cropping systems that rely on organic inputs.Universita degli Studi di Torino within the CRUI-CARE AgreementCassa di Risparmio di Torin