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Cohen W, Wynne DM. Paediatric voice disorder: who to refer and how to assess? A summary of recent literature. Curr Opin Otolaryngol Head Neck Surg 2024; 32:156-165. [PMID: 38547363 DOI: 10.1097/moo.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders. RECENT FINDINGS Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance. SUMMARY We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.
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Affiliation(s)
- Wendy Cohen
- University of Strathclyde, Department of Psychological Sciences and Health
| | - David M Wynne
- Royal Hospital for Children, Ear, Nose and Throat Department NHS Greater Glasgow and Clyde, Glasgow, UK
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Burns JC. The etiologies of Kawasaki disease. J Clin Invest 2024; 134:e176938. [PMID: 38426498 PMCID: PMC10904046 DOI: 10.1172/jci176938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Kawasaki disease (KD) is a systemic vasculitis that affects young children and can result in coronary artery aneurysms. The etiology is currently unknown, but new clues from the epidemiology of KD in Japan, the country of highest incidence, are beginning to shed light on what may trigger this acute inflammatory condition. Additional clues from the global changes in KD incidence during the COVID-19 pandemic, coupled with a new birth cohort study from Japan, point to the potential role of person-to-person transmission of an infectious agent. However, the rising incidence of KD in Japan, with coherent waves across the entire country, points to an increasing intensity of exposure that cannot be explained by person-to-person spread. This Review discusses new and historical observations that guide us toward a better understanding of KD etiology and explores hypotheses and interpretations that can provide direction for future investigations. Once the etiology of KD is determined, accurate diagnostic tests will become available, and new, less expensive, and more effective targeted therapies will likely be possible. Clearly, solving the mystery of the etiologies of KD remains a priority for pediatric research.
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Narayan HK, Lizcano A, Lam-Hine T, Ulloa-Gutierrez R, Bainto EV, Garrido-García LM, Estripeaut D, Del Aguila O, Gómez V, Faugier-Fuentes E, Miño-León G, Beltrán S, Cofré F, Chacon-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Dueñas L, Luciani K, Rodríguez-Quiroz FJ, Camacho Moreno G, Viviani T, Alvarez-Olmos MI, Marques HHDS, López-Medina E, Pirez MC, Tremoulet AH. Clinical Presentation and Outcomes of Kawasaki Disease in Children from Latin America: A Multicenter Observational Study from the REKAMLATINA Network. J Pediatr 2023; 263:113346. [PMID: 36775190 DOI: 10.1016/j.jpeds.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To describe the clinical presentation, management, and outcomes of Kawasaki disease (KD) in Latin America and to evaluate early prognostic indicators of coronary artery aneurysm (CAA). STUDY DESIGN An observational KD registry-based study was conducted in 64 participating pediatric centers across 19 Latin American countries retrospectively between January 1, 2009, and December 31, 2013, and prospectively from June 1, 2014, to May 31, 2017. Demographic and initial clinical and laboratory data were collected. Logistic regression incorporating clinical factors and maximum coronary artery z-score at initial presentation (between 10 days before and 5 days after intravenous immunoglobulin [IVIG]) was used to develop a prognostic model for CAA during follow-up (>5 days after IVIG). RESULTS Of 1853 patients with KD, delayed admission (>10 days after fever onset) occurred in 16%, 25% had incomplete KD, and 11% were resistant to IVIG. Among 671 subjects with reported coronary artery z-score during follow-up (median: 79 days; IQR: 36, 186), 21% had CAA, including 4% with giant aneurysms. A simple prognostic model utilizing only a maximum coronary artery z-score ≥2.5 at initial presentation was optimal to predict CAA during follow-up (area under the curve: 0.84; 95% CI: 0.80, 0.88). CONCLUSION From our Latin American population, coronary artery z-score ≥2.5 at initial presentation was the most important prognostic factor preceding CAA during follow-up. These results highlight the importance of early echocardiography during the initial presentation of KD.
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Affiliation(s)
- Hari K Narayan
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
| | - Anel Lizcano
- Department of Biology, San Francisco State University, San Francisco, CA
| | - Tracy Lam-Hine
- School of Public Health, University of California Berkeley, Berkeley, CA; Department of Epidemiology & Public Health, Stanford University, Stanford, CA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
| | - Emelia V Bainto
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA
| | | | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr. José Renán Esquivel, Ciudad Panamá, Panamá
| | - Olguita Del Aguila
- Unidad de Infectología Pediátrica, Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Virgen Gómez
- Servicio de Infectología, Centro Médico Universidad Central del Este Hospital y Hospital Infantil "Dr. Robert Reid Cabral", Santo Domingo, Dominican Republic
| | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Greta Miño-León
- Servicio de Infectología, Hospital del Niño "Francisco de Icaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología Pediátrica, Clínica Pediátrica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | - Enrique Chacon-Cruz
- Servicio de Infectología Pediátrica, Hospital General de Tijuana, Tijuana, México
| | | | | | - Lourdes Dueñas
- Servicio de Infectología, Hospital de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panamá
| | | | - Germán Camacho Moreno
- Servicio de Infectología, HOMI, Fundación Hospital Pediátrico La Misericordia & Universidad Nacional de Colombia, Bogotá, Colombia
| | - Tamara Viviani
- Servicio de Infectología, Hospital Sotero del Río, Santiago, Chile
| | - Martha I Alvarez-Olmos
- Servicio de Infectología Pediátrica, Fundación Cardioinfantil & Universidad El Bosque, Bogotá, Colombia
| | | | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Departamento de Pediatría, Universidad del Valle y Centro Médico Imbanaco, Cali, Colombia, 25 Servicio de Infectología, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - María C Pirez
- Departamento de Pediatría, Facultad de Medicina, Universidad de la República, Hospital Pediátrico Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Adriana H Tremoulet
- University of California, San Diego / Rady Children's Hospital San Diego, San Diego, CA.
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Chen YC, Pan HG, Jia DS, Wang HC, Li L, Teng YS. Clinical features of Kawasaki disease initially mimicking retropharyngeal abscess: a retrospective analysis. Pediatr Rheumatol Online J 2022; 20:115. [PMID: 36514104 PMCID: PMC9749284 DOI: 10.1186/s12969-022-00778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Incomplete Kawasaki disease (IKD) initially presenting as retropharyngeal abnormality is very rare and is prone to misdiagnosis and missed diagnosis, often leading to poor prognosis. Most patients were misdiagnosed with retropharyngeal abscesses. Here, we describe and compare IKD patients initially presenting with retropharyngeal abnormalities, typical KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients. METHODS We performed a retrospective case-control study comparing IKD patients initially presenting with retropharyngeal abnormalities to both KD patients without retropharyngeal abnormalities and retropharyngeal abscess patients admitted to Shenzhen Children's Hospital between January 2016 and December 2021. RESULTS We evaluated data from 10 IKD patients initially presenting with retropharyngeal abnormalities (Group A), 20 typical KD patients (Group B) and 16 surgical drainage confirmed retropharyngeal abscess patients (Group C). Compared to Group B, we observed that Group A was older and had a more intense inflammatory response. On the day of admission, Groups A and C had similar early clinical presentations, and there were no significant differences in any major signs or symptoms. Close observation for the development of new KD signs and symptoms and unresponsiveness to empirical antibiotic therapy after 3 days is extremely important. The CRP (p = 0.011), AST (p = 0.002) and ALT (p = 0.013) levels were significantly higher and the WBC (P = 0.040) levels were significantly lower in Group A than in Group C. Neck radiological findings, such as the presence of ring enhancement (p = 0.001) and mass effects on the airway, are also useful tools for distinguishing these two diseases. CONCLUSION The careful observation of the signs and symptoms of this disease and the comprehensive analysis of the laboratory tests and neck radiological findings may help clinicians become aware of retropharyngeal abnormality as an atypical presentation of KD. Then, unnecessary treatments could be reduced, and the occurrence of serious complications can be avoided.
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Affiliation(s)
- Yong-chao Chen
- grid.452787.b0000 0004 1806 5224Department of Otorhinolaryngology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong China ,grid.412449.e0000 0000 9678 1884Department of Otorhinolaryngology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, Guangdong China
| | - Hong-guang Pan
- grid.452787.b0000 0004 1806 5224Department of Otorhinolaryngology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong China
| | - De-sheng Jia
- grid.452787.b0000 0004 1806 5224Department of Otorhinolaryngology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong China ,grid.412449.e0000 0000 9678 1884Department of Otorhinolaryngology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, Guangdong China
| | - Hao-cheng Wang
- grid.452787.b0000 0004 1806 5224Department of Otorhinolaryngology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong China ,grid.412449.e0000 0000 9678 1884Department of Otorhinolaryngology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, Guangdong China
| | - Lan Li
- grid.452787.b0000 0004 1806 5224Department of Otorhinolaryngology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong China
| | - Yi-shu Teng
- grid.452787.b0000 0004 1806 5224Department of Otorhinolaryngology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong China
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Abstract
The many forms of vasculitis are characterized by inflammation of blood vessels, leading to potentially long-term sequelae including vision loss, aneurysm formation and kidney failure. Accurate estimation of the incidence and prevalence has been hampered by the absence of reliable diagnostic criteria and the rarity of these conditions; however, much progress has been made over the past two decades, although data are still lacking from many parts of the world including the Indian subcontinent, China, Africa and South America. Giant cell arteritis occurs in those aged 50 years and over and seems to mainly affect persons of northern European ancestry, whereas Takayasu arteritis occurs mainly in those aged under 40 years. By contrast, Kawasaki disease mainly occurs in children aged under 5 years and is most common in children of Asian ancestry, and IgA vasculitis occurs in children and adolescents. Although much less common than giant cell arteritis, the different forms of antineutrophil cytoplasmic antibody-associated vasculitis are being increasingly recognized in most populations and occur more frequently with increasing age. Behçet syndrome occurs most commonly along the ancient silk road between Europe and China. Much work needs to be done to better understand the influence of ethnicity, geographical location, environment and social factors on the development of vasculitis.
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Affiliation(s)
- Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology and Behçet's Disease Research Centre, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Division of Rheumatology, Lund University and Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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