Why nut? The aspiration of hazelnuts has become a public health problem among small children in the central and eastern Black Sea regions of Turkey

Rigid bronchoscopy: a consultant survey

INTRODUCTION

Inhalation of foreign bodies represents a potentially fatal emergency in both adults and children. Chest x-ray, in isolation, is neither sensitive nor specific. Rigid bronchoscopy represents the gold standard to diagnose and retrieve paediatric foreign bodies. Cases are encountered infrequently, creating anxieties about their management. Little is known about the confidence in, and maintenance of, rigid bronchoscopy skills by ear, nose and throat teams.

METHODS

A 15-question survey was completed by 50 practising otolaryngology consultants in England.

RESULTS

Results show that almost 40% of otolaryngology consultants covering rigid bronchoscopy have not performed bronchoscopy in more than 5 years. Consultants raised concerns about the anaesthetic support and the speed of equipment assembly. Questions on clinical practice showed disparities in practice in the same scenario.

CONCLUSIONS

The authors advocate addressing many of the issues raised by the study with a greater availability of simulation courses and regular scheduled intradepartmental teaching days for all professionals involved. National guidelines on criteria for transfer to tertiary centres would improve the consistency of practice.

Perception of Choking Injury Risk Among Healthcare Students

Choking injuries in children represent a severe public health burden. Although most choking injuries are due to food, parents have often been found to be unaware of the choking hazards presented by food. In this context, healthcare professionals may play an important role in choking prevention by educating families. We investigate the perception of choking injury risk among healthcare profession students by comparing their awareness and knowledge of choking hazards with those of people without a specific health education. A survey was conducted among a sample of final year healthcare profession students from two universities in northern Italy and a sample of adults from the general population without any health education. Respondents were asked to look at ten pictures and identify the items that pose the greatest choking hazard to children of different age groups. Seventy-one students and 742 adults without any health education responded to the survey. A higher percentage of the adults without a health education identified a food item as posing the greatest choking hazard in comparison to the percentage of healthcare profession students. The results of this study suggest that there is a need to include specific educational modules on choking prevention in healthcare-related degree programs.

Review of tracheobronchial foreign body aspiration in the South African paediatric age group

Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children's Hospital in Cape Town is the only children's hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13. This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.

Association between Adherence to the Mediterranean Diet and Presence of Nonalcoholic Fatty Liver Disease in Children

OBJECTIVE

The study's objective was to analyze the association between the adherence to the Mediterranean diet (MD) and the presence of nonalcoholic fatty liver disease (NAFLD) in children.

METHODS

The study consisted of three groups of children. Group 1 included obese/overweight children with recent diagnosis of NAFLD (n = 106, 12.4 ± 2.6 years). Group 2 included obese children without NAFLD (n = 21, 11.3 ± 2.6 years). Group 3 included the healthy children (without known chronic disease) with normal BMI (n = 54, 11.8 ± 2.9 years). Compliance to the MD was assessed by the KIDMED index score.

RESULTS

KIDMED index score in obese children with NAFLD, without NAFLD, and healthy children were 2.6 ± 2.4, 4.6 ± 1.2, and 6.2 ± 1.9, respectively (p < 0.05 for group 1 versus 2, 1 versus 3, and 2 versus 3). Diet compliance was good in only 4.7% of the patients with NAFLD, whereas it was 31.5% in healthy children. KIDMED index score was negatively correlated with BMI (p < 0.05, r = -0.53), but no correlation was found with other parameters. The area under the receiver operation curve (AUROC) for predicting fatty liver disease in obese children (n = 127) with BMI and KIDMED index score was 0.78 (p < 0.05) and 0.24 (p < 0.05), respectively. BMI >26 has a sensitivity of 79.2% and specificity of 52.4%, and KIDMED index score ≤3 has a sensitivity of 66.9% and specificity of 76.1%.

CONCLUSIONS

MD is an inexpensive and nontoxic dietary regimen and may be used as a therapeutic option in obese children with NAFLD.

Foreign body aspiration in childhood: evaluation of diagnostic parameters

BACKGROUND

Foreign body aspiration (FBA) is one of the most important preventable causes of childhood mortality and morbidity.

OBJECTIVE

The aim of this study was to define the clinical and radiological features of FBA and investigate the diagnostic value of various parameters used to diagnose FBA.

METHODS

The medical records of 147 children who were admitted to the hospital with a diagnosis of suspected FBA were examined. The sensitivity and specificity of the parameters used for the diagnosis of FBA and their predictive values were calculated.

RESULTS

Of the patients, 75.5% were younger than 3 years, and 61.2% were male. Peak incidence was found in 18 months. A negative bronchoscopy rate of 19.7% was found, and 92.6% of these patients were younger than 3 years. The parameter with the highest diagnostic value was the presence of aspiration history (the sensitivity and positive and negative predictive values were 97%, 89%, and 80%, respectively). No significant difference was found in the classic triad of FBA (sudden onset of cough, wheezing, and unilaterally decreased breath sounds) between patients with and without FBA. The specificity and positive predictive value of the classic triad were high, and the sensitivity and negative predictive value were low (85% and 78%, and 13% and 19%, respectively).

CONCLUSIONS

Especially, male children younger than 3 years have an increased risk of FBA. Neither clinical symptoms nor the radiological findings alone are sufficiently specific and sensitive in diagnosing FBA. The most important factor for diagnosis is the presence of aspiration history.

Bilateral airway foreign body aspiration as a cause of recurrent pneumonia

Foreign body aspiration (FBA) into the lower airway requires a high index of suspicion. Identification of the problem can be difficult as it has a broad range of clinical presentation and often mimics other medical conditions. A delay in diagnosis and management can result in serious complications. The authors report the case of a middle aged man with bilateral airway FBA who had a history of six hospitalisations over the previous 10 years with recurrent pneumonias.

Foreign Bodies Causing Asphyxiation in Children: The Experience of the Buenos Aires Paediatric ORL Clinic

Inhalation or aspiration of a foreign body (FB) occurs relatively frequently in young children. The size, shape, type and site of arrest of the FB lead to variability in the clinical picture. The present study included data from 65 cases of FB inhalation presenting over 1 year at the Children's Hospital Gutierrez, Buenos Aires, Argentina, compared with information from four well-known published case series chosen as representative of other cultural and geographical backgrounds: the USA, Europe, North Africa (Egypt) and Asia (India). The mean age of children studied was 4.03 years. Injuries happened mainly at home (53 cases [81.54%]) and under adult supervision (59 cases [90.77%]). The most frequently inhaled FB was nuts, however, in contrast to previous reports, the majority of incidents involved inhalation of an inorganic, rather than an organic (food) FB. Complications included pneumonia (three cases), atelectasis (two cases) and pneumonitis (one case). No deaths were recorded. These data suggest that children play with objects inappropriate for their age, such as pins and nails, that adults may not be aware of the choking risks, and that more effort is required in educating caregivers about these risks.

Management of tracheobronchial foreign body in children

To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at São Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. The most common clinical manifestations were coughing (68.3%) and choking (54.9%). The most common FBs were seeds (peanut, bean, maize) and also small metal or plastic objects. Radiography was normal in 21.3%, atelectasis was present in 40.9%, hyperinsufflation in 17.1% and the FB was radio-opaque in 20.7%. FB time in the bronchial tree varied from hours to years. The most serious complications, as fibroatelectasis and difficult resolution pneumonia, were caused by the long time that the FB remained in the bronchial tree. FB extraction was by endoscopy in 89% of cases, while 6% required surgical extraction or resection of destroyed part of lung, and 5% spontaneously eliminated the FB. There was no mortality in this series. Coughing and choking were the commonest clinical findings. Most FBs were dried seeds. Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated.