Eddy Bodart

Is procalcitonin a good marker of renal lesion in febrile urinary tract infection

Four recent prospective studies have suggested that procalcitonin (PCT), a polypeptide produced by the macrophage-monocyte system during severe bacterial infection, might be more specific than leukocyte count or C-reactive protein (CRP) in predicting acute renal involvement during an episode of febrile urinary tract infection (UTI) [1, 2, 3, 5]. The aim of our prospective study was to confirm such findings.

Psychometric properties of the emotion awareness questionnaire for children in a French-speaking population.

In this study, we investigated the psychometric properties of the French version of the Emotion Awareness Questionnaire (EAQ30; Rieffe et al., 2008). The EAQ30 was administered to 707 French-speaking children aged 8 to 16 years old. The original 6-factor structure was replicated in our data. The internal consistency coefficients of the EAQ30 subscales were satisfactory. We found small significant differences for gender and age. Regarding convergent validity, we found positive correlations between EAQ30 scores and emotional intelligence and negative correlations between EAQ30 scores and alexithymia. There was preliminary evidence of discriminant validity, with EAQ30 scores being weakly related to school performance, and concurrent validity, with EAQ30 scores being negatively related to somatic complaints, depression, and anxiety. Finally, except for 1 dimension, EAQ30 scores were not susceptible to social desirability. Although some weaknesses of the scale remain to be addressed, these findings support the use of the EAQ30 for research and clinical purposes.

Unifocal cervical Castleman disease in two children.

Abstract Castleman disease (CD) is a benign lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. Most observations focus on adult patients. In children the disease is rare, usually localized and may be symptomatic or asymptomatic. We reported two children, 7 and 14 years old respectively, affected by unifocal cervical CD of the hyaline vascular type. Conclusion Two cases illustrate that CD may mimic a neoplasm and should be considered in presence of a solitary neck mass with specific features on CT and MRI.

Prediction of Lyme Meningitis Based on a Logistic Regression Model Using Clinical and Cerebrospinal Fluid Analysis: A European Study.

Background: A prediction model based on clinical and cerebrospinal fluid (CSF) analysis has been proposed for the differentiation of Lyme meningitis (LM) from non-Lyme aseptic meningitis (NLAM) in the United States. No similar model has ever been proposed for European patients. The objective of our study was to develop a prediction model to differentiate LM from NLAM based on clinical and CSF biologic data. Methods: The medical charts of all children older than 2 years of age admitted to our hospital from 1996 through 2006 with a definite diagnosis of LM were analyzed and compared retrospectively with those having a diagnosis of NLAM. Chart review included the duration of symptoms, the presence of cranial neuropathy, and CSF analysis. Results: A total of 93 patients were included (LM: 26 patients; NLAM: 67 patients) in the study. Patients with LM had statistically more frequent cranial neuropathy (73% vs. 4%), displayed a longer duration of symptoms before admission (8.8 vs. 1.8 days), had a higher CSF protein (71 vs. 38 mg/d), and had a lower percentage of neutrophil cells in the CSF (3.4% vs. 51%) than patients with NLAM. A predicted probability was derived from these 4 variables. At a cutoff point of >0.432, the model had a negative predictive value of 100% and a positive predictive value of 92.3%, with a sensitivity of 100% and a specificity of 97%. Conclusions: We report the first European prediction model for LM. Owing to its high negative predictive value, this model may assist physicians in managing aseptic meningitis (AM) while awaiting serologic tests, especially in Lyme endemic regions.

Foreign body aspiration in childhood: management algorithm

Foreign body inhalation is still a major cause of morbidity and even mortality in the under-fives. To reduce its frequency, more severe preventative measures must be imposed and to allow for early diagnosis, a low threshold for bronchoscopy is necessary. This retrospective study is based on 33 children referred to us for suspicion of inhaled foreign body. Symptomatology, clinical and paraclinical data are reviewed. Based on our practice and on the experience gained from the literature, we propose a management algorithm which will need to be further assessed by a prospective study.Foreign body inhalation is still a major cause of morbidity and even mortality in the under-fives. To reduce its frequency, more severe preventative measures must be imposed and to allow for early diagnosis, a low threshold for bronchoscopy is necessary. This retrospective study is based on 33 children referred to us for suspicion of inhaled foreign body. Symptomatology, clinical and paraclinical data are reviewed. Based on our practice and on the experience gained from the literature, we propose a management algorithm which will need to be further assessed by a prospective study.

Optimal assessment of the ability of children with recurrent respiratory tract infections to produce anti-polysaccharide antibodies

Specific anti‐polysaccharide antibody deficiency (SPAD) is an immune disorder. Diagnostic criteria have not yet been defined clearly. One hundred and seventy‐six children evaluated for recurrent respiratory tract infections were analysed retrospectively. For each subject, specific anti‐pneumococcal antibodies had been measured with two enzyme‐linked immunosorbent assays (ELISAs), one overall assay (OA) using the 23‐valent pneumococcal polysaccharide vaccine (23‐PPSV) as detecting antigen and the other purified pneumococcal polysaccharide serotypes (serotype‐specific assay, SSA) (serotypes 14, 19F and 23F). Antibody levels were measured before (n = 176) and after (n = 93) immunization with the 23‐PPSV. Before immunization, low titres were found for 138 of 176 patients (78%) with OA, compared to 20 of 176 patients (11%) with the SSA. We found a significant correlation between OA and SSA results. After immunization, 88% (71 of 81) of the patients considered as responders in the OA test were also responders in the SSA; 93% (71 of 76) of the patients classified as responders according to the SSA were also responders in the OA. SPAD was diagnosed in 8% (seven of 93) of patients on the basis of the absence of response in both tests. Thus, we propose to use OA as a screening test for SPAD before 23‐PPSV immunization. After immunization, SSA should be used only in case of a low response in OA. Only the absence of or a very low antibody response detected by both tests should be used as a diagnostic criterion for SPAD.

Bronchiolitis management by the Belgian paediatrician: discrepancies between evidence-based medicine and practice.

Abstract There is no therapy with proven effect on bronchiolitis outcome. This leads to large variations in its management between different countries. In order to evaluate how this disease was managed in our country, a questionnaire was sent to all Belgian paediatricians. With a response rate above 40% of active paediatricians, we found that bronchodilators (74.7% vs. 77.2%), physiotherapy (76.2% vs. 85.6%) and antibiotics (63.8% vs. 74.4%) were still largely prescribed in in- and outpatient settings respectively, corticosteroids (orally or intravenously) being prescribed more often in hospitals (54.3% vs. 17.0%). There were also some variations in admission criteria (minimal age 2 months (75%) to 6 months (8.2%), lower limit for oxygen saturation : 90% (21.5%) to 95% (26.5%)) and 1/3 of the respondents did not use pulse oxymetry to evaluate hypoxaemia in infants with bronchiolitis. Logistic regression analyses allowed us to identify patterns of prescription based on age, type and level of activity and language. Conclusion : Many therapies with no proven effect are still used by Belgian paediatricians to treat children with bronchiolitis. Based on these results, we believe that publishing national guidelines will allow a reduction in the cost associated with this disease.

Use of the CO2-laser micropoint micromanipulator for the treatment of laryngomalacia.

Between September 1989 and June 1994, 21 children (17 boys, 4 girls) with moderate to severe symptoms due to laryngomalacia underwent endoscopic surgery using the CO2-laser micropoint manipulator (shot-by-shot, 0.1 s, super-pulse, 2–3 W power; 280 μm beam; 400 mm working distance). Mean age of the children was 5 months (range, 1–11 months). The procedure was performed under high-frequency jet ventilation and consisted in the resection and/or vaporization of the aryepiglottic folds. This tissue removal could be extended to the laryngeal mucosa of the arytenoids and the lateral edge of the epiglottis. Results of surgery were excellent with normalization (8 patients) or, at worst, a very definite improvement of symptoms (4 patients). Furthermore, no complications occurred due to the technique used. These results have convinced us that the CO2-laser micropoint manipulator technique, with the “super-pulse” shooting mode and high-frequency jet ventilation, is by far superior to microsurgery with cold instruments when endoscopic treatment of laryngomalacia is indicated.

Pneumococcal psoas pyomyositis associated with complement deficiency.

A 4.5-year-old boy with complement deficiency developed infection of the psoas caused by Streptococcus pneumoniae. Pyomyositis of the psoas muscle is uncommon but should be included in the differential diagnosis of fever and lameness. The most useful diagnostic test is computed tomography guided needle aspiration, and underlying conditions should be sought.

Emotional competence and quality of life of children with asthma: The mediating effect of coping strategies

This study explored the mediating effect of coping strategies on the relationship between emotional competence (EC) and quality of life (QOL) among children with asthma. Participants were 87 children (M age = 11.72, SD = 2.58) with controlled and partially controlled asthma, undergoing everyday treatment. They filled in questionnaires assessing EC, coping strategies and QOL. Results showed that the association between some ECs and the QOL of children with asthma was fully mediated by two maladaptive cognitive coping strategies. Among children with asthma, a greater ability to differentiate their emotions, a reduced attention to bodily signals of emotions and a reduced analysis of their current emotional state were related to decreased engagement in two coping strategies (‘Ignoring Asthma’ and ‘Worrying about Asthma’), which in turn increased their QOL. These findings show that EC has an indirect effect on QOL through very specific coping strategies. They also emphasise the importance of screening EC in children with asthma and the importance of developing and using multidisciplinary interventions for them.