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Christian CW, Binenbaum G. The eye in child abuse. Childs Nerv Syst 2022; 38:2335-2344. [PMID: 35871261 DOI: 10.1007/s00381-022-05610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
Child physical abuse may result in a range of injuries to the globe and surrounding tissues. These injuries have varying degrees of specificity for abuse, and no pattern of injury is unique to abuse. Easily overlooked eye injuries in non-ambulatory infants often portend more severe abuse and require careful evaluation for occult injury when they are unexplained. Retinal hemorrhages are most often a sign of significant trauma and the severity of the hemorrhages generally parallels the severity of neurological trauma. Ophthalmologists contribute important data that more easily distinguish medical disease from trauma, but caution is needed in differentiating accidental from inflicted trauma. This distinction requires careful consideration of the complete clinical data and occasionally on additional law enforcement or child welfare investigation.
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Affiliation(s)
- Cindy W Christian
- The Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA.
| | - Gil Binenbaum
- The Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Ophthalmology, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
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Abusive head injuries in infants corroborated versus non-corroborated cases: more answers to more questions. Childs Nerv Syst 2022; 38:2051-2053. [PMID: 36100685 DOI: 10.1007/s00381-022-05670-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
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Unusual eye injury related to abusive head trauma. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractOphthalmological examination is an essential component in clinically diagnosing abusive head trauma (AHT). Typical of AHT injuries is retinal bleeding, with other parts of the eye sometimes also being affected. Visual impairment and blindness are long-term complications in this context. We present a case with unusual eye injuries after a diagnostically confirmed AHT.The ophthalmological findings on admission day showed a massive subhyaloid hemorrhage at the posterior pole and extensive flame-shaped intraretinal hemorrhages accented on the right side., A centrally localized vitreous hemorrhage appeared on both sides 3 weeks later, obscuring the optic disc and macula most probably due to a breakthrough of a sub-internal limiting membrane (ILM) hemorrhage into the vitreous cavity. Follow-up 4 weeks later revealed a dense and organized vitreous hemorrhage occupying the optic disc and macula so that a pars plana vitrectomy was performed on both eyes.The bilateral bleeding in different retinal layers, the vitreous hemorrhage and the proliferative vitreoretinal reaction (PVR) indicated massive damage caused by a significant acceleration-deceleration trauma. A two-phase vitreous hemorrhage in a child with AHT does not yet appear to have been described in the literature.
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Sidpra J, Chhabda S, Oates AJ, Bhatia A, Blaser SI, Mankad K. Abusive head trauma: neuroimaging mimics and diagnostic complexities. Pediatr Radiol 2021; 51:947-965. [PMID: 33999237 DOI: 10.1007/s00247-020-04940-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/13/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
Traumatic brain injury is responsible for approximately half of all childhood deaths from infancy to puberty, the majority of which are attributable to abusive head trauma (AHT). Due to the broad way patients present and the lack of a clear mechanism of injury in some cases, neuroimaging plays an integral role in the diagnostic pathway of these children. However, this nonspecific nature also presages the existence of numerous conditions that mimic both the clinical and neuroimaging findings seen in AHT. This propensity for misdiagnosis is compounded by the lack of pathognomonic patterns and clear diagnostic criteria. The repercussions of this are severe and have a profound stigmatic effect. The authors present an exhaustive review of the literature complemented by illustrative cases from their institutions with the aim of providing a framework with which to approach the neuroimaging and diagnosis of AHT.
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Affiliation(s)
- Jai Sidpra
- University College London Medical School, London, UK
| | - Sahil Chhabda
- Department of Radiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Adam J Oates
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Susan I Blaser
- Department of Radiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
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Ali SMA, Ossuetta I, Dahlmann-Noor A, Jayaram H, Kozak I. Comprehensive Ocular Examination of Healthy Newborns in the Middle East. Ophthalmic Epidemiol 2020; 28:306-311. [PMID: 33213247 DOI: 10.1080/09286586.2020.1849740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To report the prevalence of the perinatal ocular disease in healthy infants referred to a referral eye centre in the Middle East region for comprehensive ocular examinations.Methods: All healthy full-term babies born at a tertiary care women's and children hospital were referred to Moorfields Eye Hospital Centre in Abu Dhabi (MEHCAD), the United Arab Emirates for comprehensive ocular examination between January 2018 and April 2019. The examination included red-reflex testing, external, anterior and dilated posterior segment examination, and refraction.Results: Out of 6836 newborns, 4719 (69%) were not referred due to lack of national insurance (n = 3089), out of network referral (n = 1405), required ROP screening (n = 220) and identification of systemic diagnosis (n = 5). Of 2117 eligible referrals 897 (42%) babies were not examined because they either did not attend (890) or had a double booking for ROP screening (7); hence, 1220 babies (56%) were examined. Their mean age was 39 ± 16 days, and 48.8% were male, 51.2% were female. One hundred and sixty-four (13.4%) babies had an ocular abnormality in 249 (10.2%) eyes. The commonest abnormalities were nasolacrimal duct obstruction (36%) and refractive errors in 53 patients (32.3%). Congenital cataract and ptosis were present in four (0.3%) and three (0.2%) babies, respectively. The commonest retinal findings were intra-retinal haemorrhages (1.4%). Other posterior pole abnormalities included optic disc pit (0.08%) and myelinated nerve fibers (0.08%). One eye (0.08%) had a congenital macular hole.Conclusion: Comprehensive ocular examinations of healthy infants identifies a number of ocular abnormalities that would not be detected using red-reflex testing by a paediatrician or nurse.
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Affiliation(s)
- Syed M A Ali
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates.,Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iviano Ossuetta
- Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates
| | | | | | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates.,Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Chen F, Cheng D, Pan J, Huang C, Cai X, Tian Z, Lu F, Shen L. The efficacy and safety of Retcam in detecting neonatal retinal hemorrhages. BMC Ophthalmol 2018; 18:202. [PMID: 30126460 PMCID: PMC6102910 DOI: 10.1186/s12886-018-0887-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To investigate the ability of characterizing neonatal retinal hemorrhage (RH) using RetCam in healthy newborns and the systemic effects during the procedure. METHODS This prospective study enrolled 68 healthy newborns aged 2 to 4 days old. The RH was imaged and classified according to the location and numbers of hemorrhages. The heart rate (HR), respiration rate (RR), and oxygen saturation (OS) were recorded at 4 time points before (Phase 1, P1), during (P2 and P3) and after the examination (P4). RESULTS The median exam time was 151 s. RH was present in 15 infants and 23 eyes. All 23 eyes had hemorrhage in Zone II. Grade II and III hemorrhages were present in 5 and 18 eyes, respectively. The HR increased to 168 beats per minute (bpm) in P3 and recovered to 122.5 bpm in P4. The RR increased to 38 bpm in P3 and recovered to 25 bpm in P4. The OS was reduced to 83% in P2 and recovered to 96% in P4. CONCLUSIONS RH in healthy newborns, mostly present in Zone II with grade II and III, can be characterized in detail by RetCam. Systemic effects during the process are mild and can be revolved spontaneously.
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Affiliation(s)
- Feng Chen
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Dan Cheng
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Jiandong Pan
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Chongbin Huang
- Neonate Department, Yueqing Maternal and Child Health Hospital, Yueqing, China
| | - Xingxing Cai
- Neonate Department, Yueqing Maternal and Child Health Hospital, Yueqing, China
| | - Zhongxu Tian
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Fan Lu
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China
| | - Lijun Shen
- School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University, Number 270, West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, China.
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Abstract
Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.
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Abstract
PURPOSES OF REVIEW This review summarizes new findings in the field of maltreatment, addressing epidemiology, physical abuse, abusive head trauma, sexual abuse, sequelae, and prevention. RECENT FINDINGS Many articles this year focus on establishing a framework for thinking about how to evaluate a child for maltreatment, the consequences of maltreatment, and the current understanding of prevention efforts. Interestingly, some research has helped to reinforce some concepts that were clinically appreciated, especially related to retinal hemorrhages. SUMMARY The volume, quality, and breadth of research relating to child maltreatment continue to improve and expand our understanding of child abuse pediatrics. These authors summarize notable advances in our understanding of child maltreatment over the past year.
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Re-evaluation of cytostatic therapies for meningiomas in vitro. J Cancer Res Clin Oncol 2014; 140:1343-52. [PMID: 24816784 DOI: 10.1007/s00432-014-1683-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose was to re-evaluate in cell culture models the therapeutic usefulness of some discussed chemotherapies or targeted therapies for meningiomas with a special emphasis on the role of the neurofibromatosis type 2 (NF2) tumor suppressor, which had been neglected so far. In addition, the study intended to evaluate a potential benefit from a treatment with drugs which are well established in other fields of medicine and have been linked recently with tumor disease by epidemiological studies. METHODS Meningioma cell lines corresponding to various subtypes and pairs of syngenic meningioma cell lines with or without shRNA-induced NF2 knockdown were analyzed for their dose-dependent response to the drugs in microtiter tetrazolium assays, BrdU assays and for selected cases in ELISAs measuring nucleosome liberation to specifically separate cell death from pure inhibition of cell proliferation. RESULTS We confirmed a moderate efficacy of hydroxyurea (HU) in clinically relevant concentrations. Under appropriate dosing, we neither detected major responses to the alkylating compound temozolomide nor to various drugs targeting membrane receptors or enzymes (tamoxifen, erlotinib, mifepristone, losartan, metformin and verapamil). Only concentrations far beyond achievable serum levels generated significant effects with the exception of losartan, which showed no effects at all. Chemosensitivity varied markedly among meningioma cell lines. Importantly, cells with NF2 loss exhibited a significantly higher induction of cell death by HU. CONCLUSIONS Alternative chemotherapeutic or targeted approaches besides HU have still to be evaluated in further studies, and the role of NF2 must be taken into account.
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Longmuir SQ, McConnell L, Oral R, Dumitrescu A, Kamath S, Erkonen G. Retinal hemorrhages in intubated pediatric intensive care patients. J AAPOS 2014; 18:129-33. [PMID: 24698608 DOI: 10.1016/j.jaapos.2013.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/14/2013] [Accepted: 12/22/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To define the diagnoses associated with the presence of retinal hemorrhages, to clarify the association between retinal hemorrhages, cardiopulmonary resuscitation (CPR), and coagulopathy, and to describe the type of retinal hemorrhages found in intubated critically ill patients <4 years of age. METHODS This was a prospective observational study of intubated patients <4 years of age admitted to the pediatric intensive care unit of a tertiary care center from March 2010 to May 2012. The presence and description of retinal hemorrhages was recorded along with diagnoses, international normalized ratio (INR), CPR (in minutes), and mortality. RESULTS A total of 85 intubated, critically ill patients (37 females) were included; average patient age was 8.2 months (range, 0.1-46.8 months). Of the 85 patients, 6 (7%) had retinal hemorrhages (95% CI, 0.029-0.153). Of the 6 patients with RH, abusive head trauma (AHT) was diagnosed in 4 patients, 1 patient had direct head trauma, and 1 had CPR. There were 8 patients with CPR out of the 85. AHT was highly associated with severe multilayered retinal hemorrhages (P = 0.0001) but coagulopathy (P = 0.2671) and CPR (P = 0.5342) were not. CONCLUSIONS Severe multilayered retinal hemorrhages were associated with AHT in this cohort of patients. Without a history of trauma, retinal hemorrhages occurred in only 1 of 85 patients; in this case the hemorrhages were mild, confined to the posterior pole, and found only in the retinal layer.
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Affiliation(s)
- Susannah Q Longmuir
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | | | - Resmiye Oral
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alina Dumitrescu
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sameer Kamath
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gwen Erkonen
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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