A case of chronic recurrent multifocal osteomyelitis associated with Crohn's disease

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory bone disease of unknown etiology, most commonly affecting the metaphysis of long bones, especially the tibia, femur and clavicle. The clinical spectrum varies from self-limited uni-or multi-focal lesions to chronic recurrent courses. Diagnosis is based on clinical, radiologic and pathological findings, is probably under-diagnosed due to poor recognition of the disease. A dysregulated innate immunity causes immune cell infiltration of the bones with subsequent osteoclast activation leading to sterile bone lesions. The molecular pathophyiology is still incompletely understood but association with other auto-inflammatory diseases such as inflammatory bowel disease (IBD), psoriasis, Wegener's disease, arthritis and synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is interesting. CRMO can precede the symptoms of the associated disease by several years. The bone remodeling caused by CRMO can cause permanent disability. We report the case of a 10-year-old boy with CRMO in association with Crohn's disease

Drop-out bij de behandeling van kinderen met overgewicht

Probleemstelling. De behandeling van overgewicht bij kinderen kampt met problemen zoals vroegtijdig stoppen. Deze pilootstudie exploreert de redenen die gezinnen zelf aangeven om een behandeling te stoppen, gebaseerd op het ‘Barrières tot Behandeling’ model van Kazdin en collega’s (1997) en onderliggende mechanismen voorgesteld door Garcia en Weisz (2002). Methode. Kind- en gezinskarakteristieken werden verzameld van 72 gezinnen die behandeling zochten voor een kind met overgewicht, 47 van hen vulden ook na afloop vragenlijsten in m.b.t. waargenomen barrières. Resultaten. Barrièrescores verschilden weinig tussen gezinnen die de behandeling afwerkten en gezinnen die uitvielen. Kinderen die vroegtijdig stopten, waren ouder, hadden meer overgewicht, en vertoonden meer gewichtsverlies. Deze gezinnen ervaarden de behandeling als minder noodzakelijk. Gezinnen met een lage SES raporteerden meer problemen van praktische aard die het volgen van een behandeling bemoeilijkten. Discussie. Hindernissen in de motivatie worden besproken. Verder betekent voor sommige jongeren het stopzetten van een behandeling niet noodzakelijk een falen van de therapie

Perspectives of parents and health care providers about (non)medical treatment in infants with reflux

Background: Reflux occurs in 50% of healthy infants at some point. This is most often a physiological condition and does not require drug treatment. Various studies have shown that the use of drugs affecting gastric acidity (DAGAs) in infants is increasing. This entails disadvantages such as unnecessary exposure of infants to medication and their side effects and a higher cost to society. Objective: To get an image of the current practice in Flanders regarding diagnosis and treatment of gastro-oesophageal reflux disease (GORD) in infants and the associated use of DAGAs. To this end, we determined both parents' and health care providers' experiences and perceptions about these treatments. Method: An observational cross-sectional study was conducted in April and May 2019. We developed a questionnaire for parents and three different questionnaires for health care providers (HCPs), including midwives, general practitioners, paediatricians and community pharmacists (CPs). The questionnaire for parents was only available through an online platform. HCPs were questioned face-to-face and through an online platform. Results: This study made clear that the counselling of children with GORD is multidisciplinary as the median number of counselling HCPs is 3 (interquartile range (IQR) = 2-4). 63% of the included 251 parents also seek support through online forums and groups. 60% of parents report that no physical tests were performed before DAGAs were prescribed and 39% of parents additionally state they perceived no effect of the prescribed DAGAs. Although parents reported to understand HCPs well (average score 7.4/10), satisfaction with care and information provision was scored lower (between 4.8 and 6.1/10). On the other hand, 234 HCPs answered the questionnaire, of which 89 midwives, 78 community pharmacists and 67 physicians. Only 45 HCPs indicate that guidelines to diagnose or treat GORD are clear. Physicians confirm they perform very little physical testing before starting DAGAs. Provided nonmedical measures to patients are largely in line with the European guidelines, however perceived effectiveness is moderate. Conclusion: Parents are in need for more information about tests, nutrition and (non)medical measures. HCPs on the other hand are in need for clear guidelines on diagnosing and treating GORD