pigmented naevus were irregularly shape macule, papules, and plaques of various colours.Multiple pigmented satellite lesions of size 4-5 cm were present over the body, head, face and extremities. Tufts of coarse hair were present over the satellite lesions, with finer hair covering the abdominal areas of pigmentation. Three nodular lesions were present in the perianal region. Areas of excoriation were noted on the flank areas. No other physical abnormalities were present. Neurological examination was unremarkable.MRI examination revealed extensive intracranial melanocytic infiltrate, confirming a diagnosis of CGMN with NCM. Discussion CGMN is an extremely rare condition with incidence estimated at 1/500000 births. Lesions are caused by genetic mutations which lead to defective proliferation, differentiation and migration of melanoblasts. Risk of transformation of GCMN to malignant melanoma varies between 0 and 3.8%, with 80% of this number symptomatic by the age of seven.CNN originates between the 5th-24th week of gestation and arises from gain of function mutations in either BRAF or NRAS. The protooncogenes c-met and c-kit have also been demonstrated to play a role in the formation of CMN. CMN are predominantly caused by sporadic de novo mutations.Neurocutaneous melanosis is a rare complication of CMN with just over 100 cases reported. Most patients with NCM are asymptomatic t birth with sequelae appearing later in development.Treatment of GCMN is both symptomatic and palliative, with surgical techniques including serial resection, excision and grafting and the use of tissue expanders. Non-excisional techniques include dermabrasion, laser ablation and curettage.
Background Vitamin D deficiency in children causes a failure of osteoid to calcify with deficient bone growth and clinical features of rickets. Vitamin D is produced by ultraviolet irradiation of inactive and avoidance of sunlight or poor oral intake in infants exclusively breastfed may contribute to the development of this pathology. Objective To study the compliance of vitamin D supplementation in children from birth to 12 months of age and to educate and create awareness among healthcare professionals and people regarding vitamin D supplementation. Standards of care The HSE policy supports vitamin D supplementation for all infants from birth to 12 months of age: all infants, whether breastfed or formula fed, should be given a daily supplement of 5mg (or 200 I.U) Vitamin D. This should be provided by a supplement containing vitamin D exclusively. Methodology In this re-audit we collected data prospectively using an anonymous structured collection form of all the children from birth to 1 year of age that attended our OPD and day cases clinics from august 2018 to January 2019. We then compared these recent results with 3 previous outcomes on a similar audit done in 2010 by our Team. The outcomes confronted are: children that received the vitamin D supplement, appropriateness and compliance to the therapy and education given to the families. Results Majority of children 80% (40) had received Vitamin D and among those the 61.2% (30) were receiving the correct dose. In the previous audit 75% had received Vitamin D and among these 59% were receiving it correctly.In this study the 85% of the parents were educated by healthcare providers, with a prevalence of Public Health Nurses 54,5% (31), 28% (16) by paediatricians and only 17.5% (10) by general practitioners, while in the previous results the 95% were educated by Health Care Providers.Doctors advised to administer Vitamin D during the last visit to the clinic in only the 34.8% (16) of cases. Conclusions The increased compliance of Vitamin D administration reflects a higher awareness of the importance of Vitamin D supplementation but the 41% of the population is still receiving a sub-optimal dose. Recommendation Healthcare providers should give more information to the mothers and especially they should encourage Vitamin D administration at every visit.
Background The accuracy of reporting electrocardiograms by trainees in paediatric emergency medicine has been shown to increase with experience. However, most paediatric trainees will only spend 3-6 months in the emergency department with limited opportunity to improve skills in electrocardiogram reporting.Interpretation in the emergency department has been shown to be relatively inaccurate and additional reporting of emergency department electrocardiograms by a consultant paediatric cardiologist increases the diagnostic accuracy. As a result, in many paediatric cardiac units the burden of electrocardiogram reporting is placed on the cardiology team, resulting in a significant workload. In addition, time taken for electrocardiograms to be reviewed by reporting teams may result in delay to clinic referral for patients with electrocardiogram abnormality.A previous study has shown that even amongst paediatricians, accuracy at interpreting paediatric ECGs is only around 60%. Although, there are accepted normal ranges and values for paediatric electrocardiograms, these are often presented in busy tables that can be complex and daunting to use, especially in a time pressured clinical environment.We hypothesised that a diagnostic aid, in the form of an electrocardiogram checklist, could assist in electrocardiogram interpretation, helping to screen for electrocardiograms that needed to be reviewed by a cardiologist and reducing the time to cardiology review for patients with electrocardiogram abnormalities. Objectives We set out to assess the use of a simple checklist and guideline to aid interpretation of paediatric electrocardiograms in the paediatric emergency department. Methods An electrocardiogram interpretation checklist and guideline were implemented in the emergency department. Abnormal electrocardiograms identified by the checklist were reviewed by a paediatric cardiologist and patients appointed to a cardiology outpatient clinic. The process was prospectively evaluated over six months to determine the ability of the checklist to detect abnormal electrocardiograms. The emergency department clinicians were sent a questionnaire to evaluate their experience with the checklist. Results Between May and November 2018, 600 electrocardiograms were performed in paediatric emergency department. 48 electrocardiograms of patients known to cardiology services or discussed with the on-call team were excluded. Of the remaining 552 electrocardiograms, 30 were identified by the emergency clinicians as abnormal and sent for cardiology review. 13/30 of these were considered normal by the consultant cardiologist and the patients discharged. The other 17 patients were allocated to cardiology outpatient clinic. Only 3/ 17 required ongoing follow-up. Of the 522 electrocardiograms deemed normal by the emergency department clinicians, cardiology disagreed in 8 (1.4%). In these cases, there was either incorrect lead placement or the checklist had been applied incorrectly. All 8 patients were seen in cardiology outpatient clinic but subs...
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