Parental acceptability of pediatric forearm manipulations in a UK district hospital emergency department

PURPOSE

Pediatric forearm fractures are a common presentation to Accident and Emergency departments. Standard treatment for the majority of these is manipulation under sedation within the department, followed by cast application. Concerns have been raised about the acceptability of such interventions, and reluctance to perform these procedures has led to increased admissions and manipulations performed under general anesthetic.

METHODS

A prospective case series of all pediatric patients with forearm fractures who underwent a manipulation under sedation in the Accident and Emergency department was collected over 12 months. All parents were invited to complete an acceptability questionnaire, adapted from the Swedish Pyramid Questionnaire for Treatment, based on their experiences.

RESULTS

A total of 77 patients were included and their parents were asked to complete a Swedish Pyramid Questionnaire of Treatment. Forty-four parents (55%) agreed to fill out the questionnaire. Patient demographics and fracture characteristics were compared between the group that responded and those that did not, with no significant differences. Average level of satisfaction was 9.4/10 (range = 7-10). 98% of respondents were satisfied with the level of analgesia provided, but only 86% with the timeliness of administration.

CONCLUSION

This parent-focused evaluation of treatment confirms high levels of parental satisfaction with the management of pediatric forearm fractures in Accident and Emergency, with regard to care, analgesia, and information. It provides insights about parental concern relating to the injury and their anxiety as information useful to further improving care, a template for assessing quality improvement and should be considered as part of further studies in this field.

LEVEL OF EVIDENCE

Level IV case series.

Saint Roch and Social Distancing During Pandemics: Lessons to be Remembered

Surprisingly, Catholic hagiography can teach us a lot about medicine. As an example, we present here the history of Saint Roch who is considered, along with Saint Sebastian, one of the two main Saints who act as protectors against plagues and have often been invoked by Catholic people during the recent COVID-19 pandemic. Whereas Saint Sebastian is associated with plagues only symbolically, Catholic tradition considers Saint Roch to have had real contact with the bubonic plague. Indeed, during his pilgrimage to Rome, Saint Roch helped people suffering from the plague and was, subsequently, himself infected. He was then forced to retire in solitary confinement to avoid the plague's spread and followed scrupulously the necessary restrictive measures. Saint Roch's story provides useful lessons about the importance of social responsibility by respecting the restrictive rules during difficult times such as the COVID-19 epidemic.

The first description of cholesteatoma by Hippocrate

INTRODUCTION

Although otolaryngology became a subspecialty only since the middle of the nineteenth century, many diseases of ENT system, their clinical symptoms, universality and potential seriousness have been described since over 3000 years ago. Texts of the medical school of Cos and its founder Hippocrates (460-370 BC) collected in the Corpus Hippocraticum also contain multiple case reports and treatments for ear diseases. The aim of this study is to analyse an extract of one of Hippocrates' treatise, which apparently describes the first case of cholesteotoma.

MATERIAL AND METHODS

We analysed a case from Epidemic by Hippocrates (VII, V, 1-9) from its English translation.

RESULTS

Analysis of the description of symptoms allows us to diagnose a complicated cholesteatoma with facial palsy and neuro-meningitis manifestation.

CONCLUSION

The meticulously detailed observations of the corpus give us a precious insight into the early perception of diseases and their evolution. The study of its history is of high interest to the fields of medicine, especially otorhinolaryngology. It also highlights the diseases and the suffering the diseases have inflicted on mankind since antiquity.

Poland syndrome before Alfred Poland: the oldest medical description (Paris, France, 1803)

Here, we present a description of Poland syndrome from the second session of the Anatomical Society (Paris, France) on 11 December 1803 of congenital mammary absence and muscular atrophy on the right side. This case report predates the first official description of the disease published by Alfred Poland in Guy's Hospital Reports (London, 1841). Consequently, perhaps would it be necessary to do justice to its French discoverer, and to name from now on this nosological entity the "syndrome of Marandel"?

Radioguided occult lesion localization and sentinel node and occult lesion localization in breast cancer: The future beckons

Wire Guided Localisation has been the traditional technique for occult breast lesions. However, ROLL has emerged as a safer alternative to WGL approach. ROLL provides an improvement on margin positive rates and offers better pain and cosmetic advantages to the patient combined with a shorter learning curves for both radiologists and surgeons. SNOLL adds to the advantages of the procedure by combining SLNB with ROLL hence offering an economic advantage. The use of ROLL as primary modality for occult lesion localisation is bound to increase with potential to replace WGL as the primary modality for such lesions.

Computer-Aided Facial Reconstruction of "Mary-Magdalene" Relics Following Hair and Skull Analyses

The supposed relics of “Mary-Magdalene” are preserved in Provence (France) in an ancient tradition. They consist of a dry skull and a lock of hair. For the first time, they were officially subjected to an extensive medico-surgical examination by photogrammetry, high-magnification binocular lenses, scanning electron microscope, and energy-dispersive X-ray elemental analysis, to propose a full computer-aided facial reconstruction. The preliminary results are presented here.

Schizophrenia: four examples of historical retrospective diagnosis

It is difficult to know precisely the history of a functional disease, unlike the natural history of infectious agents, tumour processes or poly-malformative syndromes. In the case of psychiatry, and especially schizophrenia and psychotic disorders, a retrospective look at artistic productions (writings and drawings) makes it possible to reconstitute a whole section of this pathological context. Through four medieval and modern examples, we will see how it is possible to do a paleo-psychiatry: Opicinus de Canistris (14th c.), the Voynich manuscript (15th c.), Hieronymus Bosch (15th-16th c.), and the Codex Seraphinianus (20th c.).

Mudslide and/or animal attack are more plausible causes and circumstances of death for AL 288 ('Lucy'): A forensic anthropology analysis

Following a global morphological and micro-CT scan examination of the original and cast of the skeleton of Australopithecus afarensis AL 288 ('Lucy'), Kappelman et al. have recently proposed a diagnosis of a fall from a significant height (a tree) as a cause of her death. According to topographical data from the discovery site, complete re-examination of a high-quality resin cast of the whole skeleton and forensic experience, we propose that the physical process of a vertical deceleration cannot be the only cause for her observed injuries. Two different factors were involved: rolling and multiple impacts in the context of a mudslide and an animal attack with bite marks, multi-focal fractures and violent movement of the body. It is important to consider a differential diagnosis of the observed fossil lesions because environmental factors should not be excluded in this ancient archaeological context as with any modern forensic anthropological case.

Re-emerging infectious diseases from the past: Hysteria or real risk?

BACKGROUND

Work on human remains and old biological samples is a potential source of contamination by conventional or atypical infectious agents. Similarly, current and future environmental changes are a source of resurgence of ancient epidemic diseases. To what extent are anthropologists sorcerer apprentices (especially those working on ancient samples, i.e. paleo-anthropologists)? Are ancient skeletons, palaeosols and museum objects with a biological component at risk for current populations? Unless there are unfounded fears and undue risk… What can be learned from the recent scientific literature and the common sense of the researchers?

METHODS

We have attempted to compile data from the literature and from our personal experience in the fields of anthropology, clinical medicine and epidemiology, in order to grasp the reality of the risk to the human population.

RESULTS

It appears that the risk is real, but extremely limited. Specific and simple protective measures must be taken in terms of overall and individual health, both in the field and in the laboratory.

CONCLUSION

These data are important for the internist, due to the possibility of atypical infections, both in specialized workers and in populations at risk (environmental context).

["Palimpsest scar" lesions in a context of torture (Darfur, Sudan)]

BACKGROUND

As a result of the current exponentially growing refugee population from the Middle-East and East Africa (Sudan, Darfur, Eritrea), clinicians (including forensic pathologists) are seeing atypical skin lesions, mainly of a traumatic nature, but in some cases associated with long-standing lesions related to ethnic practices.

PATIENTS AND METHODS

A case of torture sequelae is presented herein in a patient originally from Darfur (Sudan): cutaneous incisions were made on old scars several times using a knife.

DISCUSSION

The clinical presentation of scarification lesions and that of atypically healed wounds (presumably an effect of inflammation induced by the introduction of irritating foreign bodies such as sand, salt, etc.) are completely different: in all cases they indicate a relative timeframe of the facts, which the clinician should not overlook in reconstructing the patient's course and the injuries to which he has been subjected (hence the proposed designation of "palimpsest scar", in the sense that a palimpsest is a manuscript on a parchment that previously contained writing but has been scratched clean to be overwritten). Thus, a "palimpsest scar" constitutes a fresh scar on top of and hiding another (ritual) scar in a context of ethnic cleansing. The diagnostic and clinical significance comes from the importance of differentiating between ethnic-type lesions and those induced by physical violence and abuse in a context of war.