scholarly journals The Deconstruction of a Complex Case of Medical Child Abuse

2016 ◽  
Vol 3 (1) ◽  
pp. 202-211
Author(s):  
Reena Isaac ◽  
Lisa Creamer ◽  
Mike Trent
Keyword(s):  
Child Abuse ◽  
Chronically Ill ◽  
Complex Case ◽  
Illustrative Case ◽  
Healthy Children ◽  
Surgical Interventions ◽  
Risk Of Death ◽  
Medical Child Abuse ◽  
Pain And Suffering ◽  
Definition Of

Background: Medical child abuse (MCA) is a serious and potentially fatal form of child abuse. The condition of medical child abuse has historically been regarded as a “rare” entity. However, the lack of a standardized definition of medical child abuse may have limited our understanding of the true scope of the problem. Cases may straddle the elements of physical abuse, medical neglect, and psychological abuse. Many cases may have been overlooked as medical child abuse or categorized under another form of child maltreatment, when identified as abuse or neglect. There is no one typical presentation. Medical investigations into suspected cases must be carefully and conservatively conducted. Method and Result: An illustrative case is described involving three young chronically-ill siblings with various degrees of medical dependencies, medical and surgical interventions, and multiple subspecialists and is deconstructed with the final outcome of three physically healthy children and a criminal conviction of the perpetrating caregiver. Conclusion: Cases of child medical abuse can be complex and challenging. Potential complications and sequelae of unidentified cases are vast, including: pain and suffering from multiple, unnecessary procedures, diminished quality of life and life potential, and ultimately risk of death. Challenges to medical and social investigations can hinder early identification and protection of the children at risk.

scholarly journals Post Partum Hemorrhage – Mini Review

2020 ◽  
Vol 19 (3) ◽  
pp. 109-114
Author(s):  
Charalampos Voros ◽  
Kalliopi Pappa
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Absolute Risk ◽  
Post Partum ◽  
Low Income Countries ◽  
Surgical Interventions ◽  
Risk Of Death ◽  
Obstetric Emergency ◽  
Prolonged Labor ◽  
Definition Of

Postpartum hemorrhage (PPH) is an obstetric emergency. It is one of the top causes of maternal mortality in both high and low income countries, although the absolute risk of death from PPH is much lower in high-income countries. Several risk factors predispose to the development of PPH including prolonged labor, precipitous labor, uterine distension. In 2017, the American College of Obstetricians and Gynecologists revised the definition of PPH to help guide its management. In the present mini-review we focus on specific medical and minimally invasive interventions, and surgical interventions at laparotomy.

Nutritional Status of Pediatric Patients in Ramathibodi Hospital Using the WHO Child Growth Standard and the Thai Growth Reference

2020 ◽  
Vol 103 (10) ◽  
pp. 1099-1106
Keyword(s):  
Nutritional Status ◽  
Pediatric Patients ◽  
Chronically Ill ◽  
Child Growth ◽  
World Health ◽  
Healthy Children ◽  
Growth Standard ◽  
Growth Reference ◽  
Child Growth Standard

Background: The appropriate assessment of nutritional status in children is an essential aspect of health supervision. Currently, there are two references used for growth assessment in Thailand. The WHO child growth standard, which has been widely used since 2007, and the Thai growth reference developed by the Ministry of Public Health, which has been used since 1998. However, there were very few studies that made a direct comparison between both tools. Objective: To compare the nutritional status of healthy pediatric patients in Ramathibodi Hospital assessed by the World Health Organization (WHO) child growth standard and the Thai growth reference. Materials and Methods: The present study was a cross-sectional study. The data were collected from all pediatric patients registered in the outpatient department (OPD) of Faculty of Medicine, Ramathibodi Hospital between January 2013 and December 2018. All healthy children (aged 0 to 15 years) were included. Exclusion criteria of possibly chronically ill children were defined by those who were 1) visiting subspecialty clinics, 2) OPD and emergency room (ER) visits more than ten times per year, 3) having ICD-10 of chronic conditions, or 4) had been admitted in the hospital during the study. The weight and height or length data were extracted from the Electronic Medical Record system. All data were analyzed by the Stata Statistical Software focusing on age and sex-specific Z-scores, which references the WHO child growth standard and the Thai growth reference. Results: Sixty-two thousand one hundred four OPD visits were divided into 31,662 OPD visits for boys and 30,442 OPD visits for girls. Percent of weight for age and height or length for age more than +2 Z-score of both boys and girls when using the Thai growth reference was greater than that using the WHO child growth standard, especially for children aged 0 to 12 months. The Thai growth reference classified as overweight were approximately 10.26% to 31.12% more than using the WHO child growth standard. There was no difference in classification of height by both standards. Conclusion: There was a difference in classification of nutritional status between the Thai growth reference and the WHO child growth standard. Keywords: Nutritional status, Pediatric growth reference, Assessment tool, Overweight

scholarly journals ‘A transverse scar on the neck’ – psychosomatic approach in the differential diagnosis and surgical treatment of hyperthyroidism in post-war Finland

2021 ◽  
Vol 65 (2) ◽  
pp. 140-156
Author(s):  
Eve-Riina Hyrkäs
Keyword(s):  
Surgical Treatment ◽  
Psychiatric Patients ◽  
Differential Diagnostics ◽  
Historical Study ◽  
Complex Nature ◽  
Surgical Interventions ◽  
Somatic Illness ◽  
Post War ◽  
Definition Of ◽  
The Mind

AbstractIn the Finnish medical discussion during the middle decades of the twentieth century, the challenging differential diagnostics between hyperthyroidism and various neuroses was perceived to yield a risk of unnecessary surgical interventions of psychiatric patients. In 1963, the Finnish surgeon Erkki Saarenmaa claimed that ‘the most significant mark of a neurotic was a transverse scar on the neck’, a result of an unnecessary thyroid surgery. The utterance was connected to the complex nature of thyroid diseases, which seemed to be to ‘a great extent psychosomatic’. Setting forth from this statement, the article aims to decipher the connection between hyperthyroidism, unnecessary surgical treatment and the psychosomatic approach in Finnish medicine. Utilising a wide variety of published medical research and discussion in specialist journals, the article examines the theoretical debate around troublesome diagnostics of functional complaints. It focuses on the introduction of new medical ideas, namely the concepts of ‘psychosomatics’ and ‘stress’. In the process, the article aims to unveil a definition of psychosomatic illness that places it on a continuum between psychological and somatic illness. That psychosomatic approach creates a space with interpretative potential can be applied to the historiography of psychosomatic phenomena more generally. Further inquiry into the intersections of surgery and psychosomatics would enrich both historiographies. It is also argued that the historical study of psychosomatic syndromes may become skewed, if the term ‘psychosomatic’ is from the outset taken to signify something that is all in the mind.

SMOKING ISSUE IS HEATING UP CUSTODY SUITS

PEDIATRICS ◽  
1993 ◽  
Vol 92 (4) ◽  
pp. A78-A78
Author(s):  
B. H.
Keyword(s):  
Child Abuse ◽  
Cigarette Smoke ◽  
Secondhand Smoke ◽  
Healthy Children ◽  
Medical Problems ◽  
Parental Concern ◽  
Middle Ear Infection ◽  
Medical Reports ◽  
Almost All ◽  
Heating Up

Parental concern about secondhand smoke is adding a new wrinkle to some custody and divorce battles. Estranged spouses are taking an increasingly aggressive court stance when a child is exposed to cigarette smoke of one parent. Secondhand smoke has become a point of contention in custody cases in more than a dozen states, almost all involving children with respiratory ailments such as asthma and allergies. And smoking may become an issue in many more custody cases, according to some lawyers. Recent medical reports have cited the heightened likelihood of respiratory disease and middle-ear infection even in healthy children exposed to secondhand smoke. In at least one case a judge has been asked to rule that exposing a child with medical problems to cigarette smoke constitutes child abuse.

Medical Child Abuse and Homicide

Poisons ◽  
2017 ◽  
pp. 291-296
Author(s):  
David J. George
Keyword(s):  
Child Abuse ◽  
Medical Child Abuse

scholarly journals Revised World Health Organization (WHO)’s causality assessment of adverse events following immunization—a critique

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 243 ◽  
Author(s):  
Jacob Puliyel ◽  
Pathik Naik
Keyword(s):  
Heart Disease ◽  
Adverse Events ◽  
Vaccine Safety ◽  
World Health Organisation ◽  
Epidemiological Studies ◽  
World Health ◽  
Causal Association ◽  
Risk Of Death ◽  
Post Marketing Surveillance ◽  
Definition Of

The World Health Organisation (WHO) has recently revised how adverse events after immunization (AEFI) are classified. Only reactions that have previously been acknowledged in epidemiological studies to be caused by the vaccine, are classified as a vaccine-product–related-reaction. Deaths observed during post-marketing surveillance are not considered as “consistent with causal association with vaccine”, if there was no statistically significant increase in deaths recorded during the small Phase 3 trials that preceded it. Of course, vaccines that caused deaths in the control-trials stage would not be licensed. After licensure, deaths and all new serious adverse reactions are labelled as ‘coincidental deaths’ or ‘unclassifiable’, and the association with vaccine is not acknowledged. The resulting paradox is evident. The definition of causal association has also been changed. It is now used only if there is “no other factor intervening in the processes.” Therefore, if a child with an underlying congenital heart disease (other factor), develops fever and cardiac decompensation after vaccination, the cardiac failure would not be considered causally related to the vaccine. The Global Advisory Committee on Vaccine Safety has documented many deaths in children with pre-existing heart disease after they were administered the Pentavalent vaccine. The WHO now advises precautions when vaccinating such children and this has reduced the risk of death. Using the new definition of causal association, this relationship would not be acknowledged and lives would be put at risk. In view of the above, it is necessary that the AEFI manual be revaluated and revised urgently. AEFI reporting is said to be for vaccine safety. Child safety (safety of children) rather than vaccine safety (safety for vaccines) needs to be the emphasis.

scholarly journals The key role of pancreatic fibrosis severity in the surgical treatment algorithm of patients with chronic pancreatitis

2020 ◽  
Vol 73 (2) ◽  
pp. 235-238
Author(s):  
Oleh E. Kanikovskiy ◽  
Ihor V. Pavlyk ◽  
Iryna V. Oliinyk ◽  
Vasyl V. Mosondz
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Pathological Process ◽  
The Body ◽  
Nutrition Status ◽  
Tissue Pressure ◽  
Surgical Interventions ◽  
Computer Morphometry ◽  
Definition Of

The aim of the work was to improve the results of surgical treatment of complicated forms of chronic pancreatitis. Materials and methods: The results of surgical treatment of 181 patients with complicated forms of chronic pancreatitis have been analyzed. All these patients were treated in surgical clinic of 2 nd medical faculty of National Pyrogov Memorial Medical University in Vinnytsya. Results: It is possible preoperative indirectly assess the severity of fibro- degenerative changes in pancreas, that includes 1 – the definition of pain type; 2 – CT or MRI (Marseilles- Rome classification); 3 – assessment of the stage of chronic pancreatitis (Büchler classification); 4 – patient's nutrition status and preoperative differential diagnosis with pancreatic cancer; 5 – assessment of the fibrosis severity (elastomers). The key point in treatment depended on intraoperative examination: detection of strictures of the main pancreatic duct (pacemaker of chronic pancreatitis); the tissue pressure resistance to the liquid, which is the maximum value> 200 mmHg, in the region of stricture and falls in other parts of the pancreas; pressure in the main pancreas duct, which rises only in 59.5% of patients. The head of the pancreas was involved in the pathological process in 83.8%, in 16.2% it was isolated in the isthmus or the body and tail of the pancreas. In general, the distal pancreas was involved in 37.8%. At computer morphometry of histological samples, the area of connective tissue fields reached 81.4 ± 6.62%, preserved exocrine part in 4.87 ± 1.62%, endocrine – 1.92 ± 0.12%, total area of ducts – 6 , 47 ± 1.12%. Conclusions: The combined Frey-Izbickiy local resection provides a wide excision of the pacemaker (stricture) of chronic pancreatitis. In case of extrapancreatic complications or repeated surgical interventions on the pancreas due to chronic pancreatitis, this effect can be achieved by pancreatoduodenal resection.

CHRONIC ILLNESS IN CHILDHOOD: PART I. EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS

PEDIATRICS ◽  
1971 ◽  
Vol 47 (2) ◽  
pp. 405-414 ◽  
Author(s):  
Ivan Barry Pless ◽  
James W. B. Douglas
Keyword(s):  
Chronic Illness ◽  
Chronically Ill ◽  
Social Consequences ◽  
Physical Disorder ◽  
Healthy Children ◽  
Total Prevalence ◽  
Motor Activities ◽  
National Cohort ◽  
Health And Development ◽  
Psychological Educational

In 1946 a random sample (N = 5,362) of all children born in England, Wales, and Scotland during 1 week in March were selected for a longitudinal study of health and development. Educational, clinical, and psychological information were obtained from this national cohort at repeated intervals. At age 15, all children who had experienced a chronic physical disorder were identified. Their clinical profiles were defined and the social, psychological, and educational data on this group (N = 528) were compared with the remaining physically healthy children (N = 4,196). A total prevalence rate of 111 chronically ill children per thousand under age 16 was found. This figure is of the same order as those reported for other studies of a similar kind. Most of the children (58%) suffered from a condition which primarily affected motor activities; 20% involved vision, speech or hearing, and 20% affected appearance. Most disorders were mildly disabling and over 60% were still present at age 15. The composition of this population was compared with that of the remaining healthy children with respect to sex, social class, family size, and parents' health. These comparisons provide a background for subsequent reports describing the psychological, educational, and social consequences of chronic illness during childhood.

Medical Child Abuse

2008 ◽  
Author(s):  
Thomas A. Roesler ◽  
Carole Jenny
Keyword(s):  
Child Abuse ◽  
Children And Families ◽  
Comprehensive Description ◽  
University Of Toronto ◽  
Medical Environment ◽  
Bioethics Education ◽  
Medical Child Abuse ◽  
The University ◽  
Important Form ◽  
Sydney Australia

Powerful new detailed and comprehensive resource for diagnosing and treating medical child abuse. Thomas A. Roesler, MD and Carole Jenny, MD, MBA, FAAP make the case that the term Munchausen syndrome by proxy should be retired permanently and replaced with a commonsense appreciation that children can be abused by their parents in the medical environment. Physicians who find themselves providing unnecessary and harmful medical care can see the abuse for what it is, another way parents can harm children. The book offers the first detailed and comprehensive description of treatment for this form of child maltreatment. “At last. A clear, logical, and immensely practical book, showing that this is not a syndrome at all, but rather another important form of child abuse…and one which is completely preventable.” Kim Oates, Emeritus Professor of Pediatrics, The University of Sydney, Australia. “A fantastic book that will revolutionize, in a much needed way, the way we think about this disorder.” Alex V. Levin, MD, MHSc, FAAP, FAAO, FRCSC, Professor, Department of Paediatrics, Genetics, and Ophthalmology and Vision Sciences Director, Postgraduate Bioethics Education University of Toronto. “Drs. Roesler and Jenny have finally mapped the terrain of child abuse showing where medical child abuse stands in the overall landscape.” Thomas L. Dwyer, Director of Foster Care, Department of Children and Families, State of Connecticut.

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