Acute Appendicitis in a Diabetic Child with Salmonella Infection

Acute appendicitis is the most frequent and challenging condition requiring emergent intrabdominal surgery in children. The diagnosis of appendicitis becomes more difficult and challenging in children, especially with other medical problems. Computed tomography is the primary tool for diagnosing or excluding appendicitis in cases with atypical presentation. Salmonella infections may present as acute abdominal problems in children. We present a clinical combination that has never been previously reported, of a diabetic girl with non-typhoid Salmonella infection, diagnosed with acute appendicitis. We wonder about the causal correlation of these diseases, versus their simple coexistence.

Mental health and parenting stress in mothers of children with diabetes treated in a patient-centred medical home

Background Mothers of children with diabetes are at-risk for experiencing parenting stress and diminished mental/emotional health. To the best of our knowledge, no studies to date have examined whether there are differences in these outcomes between mothers whose diabetic child is managed in a patient-centred medical home or not. Objective The objective of the present study was to assess whether there were differences in mental health and parenting stress among mothers whose diabetic child was managed in a patient-centred medical home or not. Methods Two hundred fifty-three mothers of children with diabetes (mean age = 12.50 years; SD = 3.90) from the 2011–2012 National Survey of Children’s Health were included in this study. Hierarchical multiple regression was conducted to determine the amount of variance that having a patient-centred medical home contributed to maternal emotional/mental health and parenting stress. Results After controlling for child sex, age, race/ethnicity and family poverty level, patient-centred medical home status was associated with better mental health for mothers and less parenting stress. Effective care coordination was the only subcomponent of the patient-centred medical home that significantly contributed to the variance in mother’s mental/emotional health and parenting stress. Conclusions Receiving care in a patient-centred medical home, particularly the care coordination component, may mitigate some of the negative maternal effects of managing a child’s diabetes.

The Diabetic Patient

The perioperative management of diabetic patients is complex and requires knowledge of the patients’ pathophysiology, current regimen, and proposed surgical procedure. This chapter addresses perioperative risks, as well as the formulation of both goals of management and perioperative plan in the pediatric patient with diabetes. This chapter will enable the reader to differentiate appropriate preoperative metabolic control from nonoptimal control in a diabetic child, define the perioperative risks and complications for diabetic patients, describe perioperative goals in the management of children with diabetes and conceptualize a perioperative plan to meet these goals, and learn how to effectively manage life-threatening complications such as severe hypoglycemia.