scholarly journals A Review on Medical Child Abuse and Child Protection

2021 ◽  
Vol 63 (3) ◽  
Author(s):  
Mustafa Hussein Ajlan Al-Jarshawi ◽  
Ahmed Al-Imam
Keyword(s):  
Child Abuse ◽  
Child Protection ◽  
Clinical Findings ◽  
Clinical Presentations ◽  
Medical Child Abuse ◽  
Three Stages ◽  
The Mean ◽  
One Year ◽  
The Uk ◽  
High Index Of Suspicion

Background Medical child abuse describes a child receiving unnecessary, harmful, or potentially harmful medical care at the caretaker's instigation. Objectives To focus on medical child abuse as an entity and emphasize its epidemiology, clinical presentations, prevention, and management. Results In the UK, the annual incidence of medical child abuse in children below one year increased to 3:100,000, while its prevalence in Arabs, including Iraq, is ambiguous due to lack of evidence and improper clinician's awareness. The mean age at diagnosis is 14 months to 2.7 years. Female caregivers are the most common offenders. Clinically, medical child abuse could fit into three stages; falsification of illness story, falsification of illness story and physical signs' fabrication, or induction of illness in children. A successful diagnosis mandates a comprehensive review of medical records to identify discrepancies between caregivers' stories versus clinical findings or investigations. Management requires recognizing abuse, halting it, securing the child's safety, maintaining the family's integrity when possible, and aborting unnecessary lateral referrals within the healthcare system. Conclusion Reported cases of medical child abuse are increasing steadily, while less severe ones go unrecognized. No diagnostic tool can help other than the physician's high index of suspicion. The management follows the same principles applied for other forms of child abuse, while good medical practice ensures its prevention.

Necrotising (malignant) otitis externa in the UK: a growing problem. Review of five cases and analysis of national Hospital Episode Statistics trends

2015 ◽  
Vol 129 (6) ◽  
pp. 600-603 ◽  
Author(s):  
G Chawdhary ◽  
N Liow ◽  
J Democratis ◽  
O Whiteside
Keyword(s):  
Otitis Externa ◽  
Severe Infection ◽  
Fold Increase ◽  
Antibiotic Resistant ◽  
Catchment Population ◽  
Malignant Otitis Externa ◽  
The Mean ◽  
The Uk ◽  
High Index Of Suspicion ◽  
Park Hospital

AbstractBackground:Necrotising (malignant) otitis externa is a severe infection causing temporal bone osteomyelitis. Although rare, our experience (reported herein) shows local doubling of cases in 2013. Hospital Episodes Statistics data for England over 14 years also indicate increased incidence nationally. Specific learning points in management are also discussed.Methods:A retrospective review was conducted of patients admitted in 2013 to Wexham Park Hospital, Slough, UK (catchment population, 450 000). In addition, the UK Government Hospital Episodes Statistics data were interrogated.Results:There were five cases of necrotising (malignant) otitis externa in 2013, representing a local doubling on previous years. The mean age of patients was 82 years. All cultures grew Pseudomonas aeruginosa; no isolates were antibiotic resistant. All patients responded to systemic anti-pseudomonals on clinical, biochemical and radiological parameters. Hospital Episodes Statistics data showed a six-fold increase in the number of cases from 1999 (n = 67) to 2013 (n = 421).Conclusion:Our experience suggests increasing necrotising (malignant) otitis externa incidence, and retrospective analysis of Hospital Episodes Statistics data supports this observation. Necrotising (malignant) otitis externa poses challenges in management, as exemplified in our cases, requiring a high index of suspicion and early aggressive treatment to achieve cure.

scholarly journals Aseptic meningitis in a large MMR vaccine campaign (590,609 people) in Curitiba, Paraná, Brazil, 1998

2001 ◽  
Vol 43 (5) ◽  
pp. 301-302 ◽  
Author(s):  
Walter Oleschko ARRUDA ◽  
Charles KONDAGESKI
Keyword(s):  
Aseptic Meningitis ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Mmr Vaccine ◽  
Rubella Vaccine ◽  
Serological Tests ◽  
Virus Identification ◽  
The Mean ◽  
One Year ◽  
Immunization Campaign

The aseptic meningitis after Measles-Mumps-Rubella vaccine (MMR) is a well recognized complication, and different incidences have been observed in several studies. We retrospectively analyzed forty cases of aseptic meningitis, during a large public immunization campaign (1998) in Curitiba, Southern Brazil (590,609 people), admitted in our Service. The vaccine utilized was Leningrad-3-Zagreb mumps strain, Edmonston-Zagreb measles strain, and RA 27#3 rubella strain. In all county, a total number of 87 cases were reported, resulting in a incidence of 1.7 cases per 10,000 given doses . The mean age was 23.7 ± 12.8 years. The female:male ratio was 1.35:1. Severe headache with meningismus (92.5%), fever (87.5%), nausea/vomiting (82.5%) were the most common clinical findings. Three cases (7.5%) developed mild mumps. All patients underwent cerebrospinal fluid (CSF) tap with the following findings: mononuclear pleocytosis from 100 to 500 cells/mm³ in 17 cases (42.5%; 257.5 ± 260.6 cells/mm³); increased protein 28 cases (67.5%; 92.1 ± 76.9 mg/dL); glucose was normal in all cases (56.8 ± 11.2 mg/dL) except in 4 (10%) cases, which presented less than 44 mg/dL. All serological tests (latex to bacterial meningitis, Cryptococcus, cysticercosis, VDRL) and bacteriological cultures were negative. Virus identification were also negative in 8 samples. None of the patients had neurological deficits or related symptoms after one year of onset. We believe the benefit of vaccination clearly outweights the incidence of benign vaccine-associated meningitis.

scholarly journals Child Abuse or Bleeding Disorder—An Interdisciplinary Approach

2019 ◽  
Vol 39 (01) ◽  
pp. 028-035
Author(s):  
Werner Streif ◽  
Irmina Watzer-Herberth ◽  
Gabriele Hahn ◽  
Uwe Schmidt ◽  
Ralf Knöfler
Keyword(s):  
Child Abuse ◽  
Child Protection ◽  
Bone Fractures ◽  
Critical Evaluation ◽  
Interdisciplinary Approach ◽  
Clinical Findings ◽  
Bleeding Disorder ◽  
Coagulation Disorder ◽  
Bleeding Tendency ◽  
Concomitant Injuries

AbstractChildren with an unexplained bleeding tendency are frequently referred to a haemostaseologist for further evaluation. Careful standardized history taking and clinical evaluation should allow for distinguishing bleeds after minor injury and trauma which are very common in all children. However, in two groups of children bleeding symptoms may be more significant than expected: those with an underlying coagulation disorder and those who have been subjected to physical child abuse. The coexistence of child abuse and a bleeding disorder must always be considered. An extended coagulation diagnostic is required if the morphology of bleedings is not clearly suspicious for child abuse and in the absence of typical concomitant injuries, e.g., bone fractures. An interdisciplinary approach involving a forensic pathologist and a paediatric haemostaseologist for assessment of bleeding symptoms, the explanation of the clinical findings, and the critical evaluation of laboratory results are essential in such cases. This review is focussed on symptoms in accidental and nonaccidental injuries in children assisting haemostaseologists in decision making in cases of child protection issues.

scholarly journals A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration

2019 ◽  
Author(s):  
Nachuan Liu ◽  
Peng Li ◽  
Erlei Zhi ◽  
Chencheng Yao ◽  
Chao Yang ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Clinical Findings ◽  
Good Choice ◽  
Distal Anastomosis ◽  
Obstructive Azoospermia ◽  
Proximal Anastomosis ◽  
Bilateral Surgery ◽  
The Mean ◽  
One Year

Abstract Background：To evaluate the clinical outcomes and the time of sperm returning to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods：From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. Results: The mean follow-up period was 17 months (range 3-36 months). Patency was assessed by the return of sperm in the ejaculate. The overall patency rate is 55.2 %, and the patency rates were 58.9%, 40.7%, 36.4%, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis and distal anastomosis, respectively. The average time it took to achieve patency is 4.11±2.74 months. And in the first six months, 87.8% (65/74) patency patients were reported to found sperm in the ejaculate. The overall pregnancy rate was 40.9 % (29/66) at the follow-up of 3 to 36 months, and the natural pregnancy rate was 30.3 % (20/66). The natural pregnancy rate was 32.1% for bilateral surgery, 33.3% for the site of distal anastomosis，but surprisingly, it was 0% for the site of proximal anastomosis. Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed ones may be a good choice. The expecting patency time is about within one year. Assisting with intraoperative sperm cryopreservation, patients can achieve better pregnancy outcomes. Moreover, the low natural pregnancy rate for the proximal anastomosis suggested that we should reconsider the indications of SA-LIVE for EOA patients. Key words: obstructive azoospermia; male infertility; vasoepididymostomy; patency; pregnancy

scholarly journals Clinical and Paraclinical Features of Wilson’s Disease in Children in Shiraz, Southern Iran

2014 ◽  
Vol 3 (3) ◽  
pp. 160-66
Author(s):  
Seyed Mohsen Dehghani ◽  
Asma Erjaee ◽  
Mohammad Hadi Imanieh ◽  
Mahmood Haghighat ◽  
Zohre Bajalli ◽  
...  
Keyword(s):  
Medical Records ◽  
Autosomal Recessive ◽  
Clinical Findings ◽  
Medical Sciences ◽  
Progressive Degeneration ◽  
Urinary Copper ◽  
The Mean ◽  
High Index Of Suspicion ◽  
Biochemical Abnormalities

Background: Wilson disease (WD) is an autosomal recessive progressive degeneration of hepatolenticular tissue that causes the increase of copper deposition in the liver and other organs, with resultant hepatic, neurologic and psychological manifestations. WD is fatal if left untreated. The aim of the current study was to evaluate the clinical and Para-clinical findings in children with WD in Shiraz, Southern Iran.Patients and Methods: The Medical records of all children less than 18 years of age with definite diagnosis of WD, who were admitted in Nemazee Teaching Hospital from 2001 to 2009, or were under follow up at the Pediatric Hepatology Clinic affiliated to Shiraz University of Medical Sciences, were reviewed.Results: Overall, 70 patients with WD (41 males, 29 females) were studied. The mean age at the onset of diagnosis was 10.3±3.2 years and the most common first presentation in our patients was hepatic (90%). The most common biochemical abnormalities were increased urinary copper content, increased liver enzymes (92.9%), and increased prothrombin time (71.4%). Wilson index was ≥11 in 44.3% of the patients.Conclusion: WD is a rare and fascinating disorder that often poses a diagnostic and therapeutic challenge for the physician. Maintaining a high index of suspicion is critical in diagnosing this readily treatable disease and early treatment can decrease its mortality rate.

scholarly journals Poverty, inequality, child abuse and neglect: Changing the conversation across the UK in child protection?

2019 ◽  
Vol 97 ◽  
pp. 127-133 ◽  
Author(s):  
Brid Featherstone ◽  
Kate Morris ◽  
Brigid Daniel ◽  
Paul Bywaters ◽  
Geraldine Brady ◽  
...  
Keyword(s):  
Child Abuse ◽  
Child Protection ◽  
Child Abuse And Neglect ◽  
Abuse And Neglect ◽  
The Uk

scholarly journals Why Cleveland Still Matters: Connections with a New Era

2021 ◽  
Author(s):  
Heather Bacon ◽  
Susan Richardson
Keyword(s):  
Sexual Abuse ◽  
Child Abuse ◽  
Child Protection ◽  
Sexually Abused ◽  
Abused Children ◽  
New Era ◽  
The Public ◽  
The Face ◽  
The Uk ◽  
Sexually Abused Children

This chapter explores the lasting impact of 1987 Cleveland child abuse crisis in the UK in which 127 children were diagnosed by two paediatricians as having been sexually abused. It highlights how this resulted in tensions, misunderstandings and stresses in the interface between the public and the child protection system, and persistent challenges of creating and sustaining a successful multidisciplinary approach to intervention and protection. It argues that the experience in Cleveland provided unique information about the effects of intervening in child sexual abuse, especially where children are trapped in silence and only come to light by way of a proactive intervention. These children remain difficult to help and the best way of intervening remains contentious. The authors challenge the ethos that leaves sexually abused children vulnerable in the face of investigative and evidential hurdles and suggest ways forward.

The Prevalence of Child Abuse and Neglect: A Study of Young People

2001 ◽  
Vol 43 (3) ◽  
pp. 1-34 ◽  
Author(s):  
Sue Brooker ◽  
Graham Kelly ◽  
Pat Cawson ◽  
Corrine Wattam
Keyword(s):  
Child Abuse ◽  
Young People ◽  
Child Protection ◽  
Social Research ◽  
Public Attitudes ◽  
Child Abuse And Neglect ◽  
Abuse And Neglect ◽  
Size Type ◽  
Physical Neglect ◽  
The Uk

Describes a survey among young people about experience of abuse or neglect, conducted by BBMRB Social Research for the NSPCC in connection with their Full Stop campaign. It was known that crimes against children tend to be underreported. A key objective was to provide robust and reliable benchmarks for the measurement of child abuse and neglect and public attitudes to them. Research challenges which had to be resolved were: how abuse should be defined; context, approach and presentation of the study; how to maximise response rate and minimise/account for bias; data collection method; size, type and composition of the sample (a crucial issue, discussed in some detail); questionnaire design; memory and recall; interviewer briefing and fieldwork issues; confidentiality and ethics. The very sensitive questionnaires had to be well piloted. CAPI was essential because of the complexity of potential interviews. Key results are summarised (a full report is available: ‘Child Maltreatment in the United Kingdom’, Cawson, Wattam, Brooker and Kelly, 2000), under the following heads: physical abuse, physical neglect, emotional or psychological maltreatment, sexual abuse. The results have suggested that the present child protection system in the UK is inadequate in several respects, and raises important questions for public policy, and for the need for continuing research in this area.

scholarly journals A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration

2020 ◽  
Author(s):  
Nachuan Liu ◽  
Peng Li ◽  
Erlei Zhi ◽  
Chencheng Yao ◽  
Chao Yang ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Patency Rate ◽  
Clinical Findings ◽  
Distal Anastomosis ◽  
Obstructive Azoospermia ◽  
Proximal Anastomosis ◽  
Bilateral Surgery ◽  
The Mean ◽  
One Year

Abstract Background: To evaluate the clinical outcomes and the duration required for the sperm to return to the ejaculate after a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE). Methods: From March 2015 to December 2018, 134 patients with epididymal obstruction azoospermia underwent the modified single-armed vasoepididymostomy at Shanghai General Hospital. The outcomes and clinical findings were documented and evaluated. The mean follow-up period was 17 (range: 3–36) months. Results: Patency was assessed by the return of sperm in the ejaculate. The overall patency rate was 55.2%, and the patency rates were 58.9%, 40.7%, 36.4%, and 58.9% for bilateral surgery, unilateral surgery, proximal anastomosis, and distal anastomosis, respectively. The average time to achieve patency was 4.11±2.74 months. In the first six months, 87.8% (65/74) patency patients reported sperm in the ejaculate. The overall pregnancy rate was 40.9% (29/66) at the follow-up of 3–36 months, and the natural pregnancy rate was 30.3% (20/66). The natural pregnancy rate was 32.1% post-bilateral surgery and 33.3% for the site of distal anastomosis; surprisingly, it was 0% for the site of proximal anastomosis. Conclusion: Modified SA-LIVE is safe and may achieve favorable patency and pregnancy rates. When double-armed sutures are not accessible, single-armed may be preferable. The expected patency time was within one year. Moreover, because of the low natural pregnancy rate for proximal anastomosis, sperm banking is preferred to SA-LIVE.

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