recommendations for treating hypoglycaemic episodes with 0.3 g/kg of fast acting carbohydrates. Aim The aim of this audit was to evaluate patients' management of hypoglycaemia in accordance to BSPED guidance and to assess the impact of standardising advice on patient management and patients' HbA1c. Patient population The target population was children and young people managed for Type 1 diabetes mellitus in the NHS trust. Method Between January and March 2018, patients' management of hypoglycaemia was reviewed with a questionnaire when they attended a multidisciplinary clinic. They were educated and given a patient leaflet including an individualised plan in line with BSPED guidance. Their management of hypoglycaemic episodes was subsequently re-evaluated at future clinic appointments. Results Of the 121 patients initially assessed, 83% used the correct threshold of blood glucose <4 mmol/L to treat hypoglycaemia and 34% managed hypoglycaemic episodes appropriately. After education in clinic and the provision of a patient leaflet this improved to 90% of patients using the correct threshold. For the 52 patients who were assessed pre and post education, initially 23% had appropriate management of hypoglycaemic episodes and this improved to 60%. Over the audit period the average HbA1c dropped from 66.6 to 64.7 mmol/ mol on one site and 70 to 66 mmol/mol on the other. Conclusion This audit shows that verbal and written education on management of hypoglycaemic episodes in paediatric patients with T1DM is effective in improving the diagnosis and treatment of hypoglycaemic episodes and therefore can enhance patient care.Aim To detect the frequency of sonographic fatty liver changes among overweight and obese children and adolescent in the local population. To study the association between anthropometric measurements and biochemical profile and occurrence of NASH. Methods A cross-sectional study, conducted from June 2015 to May 2017 in a tertiary care hospital in South India. Anthropometric data, blood pressure, Ultrasonographic grading for fatty liver, fasting blood sugar, fasting Insulin, Fasting lipid profile, Liver function test, TSH and FT4 were collected for all subjects. HOMA-IR and Fasting glucose insulin ratio (FGIR) were calculated for insulin resistance. SGOT and SGPT>40 IU/ml was considered as abnormal. Height, weight, BMI and waist circumference was converted to SD scoring for analysis. Data was analysed using SPSS v16. Results Twenty seven (25%) children had ultrasonographic evidence of NASH. No significant differences were observed in the occurrence of NASH with age, gender, pubertal status, impaired fasting glucose, abnormal lipid profile, hypertension and metabolic syndrome. Twenty five (92.6% Vs 7.4%; P 0.007) out of twenty seven children with NASH had high waist circumference (according to Indian waist circumference charts). Among children with NASH, only ten had elevated liver enzymes (37%). Children with NASH had significantly higher mean weight SDS (2.35 Vs 1.69, p<0.001), higher mean BMI SDS (2.54 V...
The aim is to measure the effectiveness of a novel clinical nurse specialist (CNS) and blood borne virus (BBV) pharmacist led hepatitis C virus (HCV) treatment pathway in a paediatric setting.The most common mode of acquisition of HCV in children is mother to child transmission (MTCT) during the perinatal period with genotype 1 and genotype 3 the most common genotypes seen in this paediatric setting.Treatment for HCV has evolved rapidly with the advent of direct acting antiviral (DAA) and has transformed the therapeutic landscape providing a cure in over 90% of cases. The availability of DAA's licenced for use in patients aged 12-18 years has extended these treatment options the paediatric setting.Nine young people 12-18 years with HCV infection attending a paediatric setting were offered treatment following the CNS and BBV pharmacist led treatment pathway. Eight had aquired HCV by mother to child transmission in one young person the mode of transmission was unclear. Eight young people had HCV genotype 1 and one young person had HCV genotype 3The pathway incorporates a pre-treatment assessment of blood tests fibroscan and counselling carried out by the CNS and BBV pharmacist. During treament telephone follow up and home visit if required. End of treatment blood test and counselling and follow up 12 weeks after treatment ends to determine if a sustained viral response (SVR) has been achieved.Fibroscan measures the level of liver fibrosis in HCV infection, it is a non invasive alternative to liver biopsy and provides a score on which to base DAA duration. Nine young people had a score of F1-F2kpa. Fibroscan requires a skilled operator it is offered by the CNS in this paediatric setting and is the only paediatric trained operator in the region.Eight young people with HCV genotype 1 were treated with 8 weeks Harvoni and one young person with HCV genotype 3 was treated with 8 weeks Epclusa. Six young people had an undetected hepatitis C virus at end of treatment (2 are mid treatment). One young person had an SVR at 12 weeks post treatment, one failed to attend for SVR 12. Seven young people are still within 12 weeks of treatment end.A CNS and BBV pharmacist led HCV treatment pathway in the paediatric setting is a safe and effective and encourages engagement.Background and aims Bacillus Calmette-Guérin (BCG) vaccination is the most commonly given vaccine in human history. A small proportion of infants receiving it develop adverse events, including BCG lymphadenitis. However, incidence of such events remains unclear and it is poorly understood why some children develop a reaction.This study aims to describe the incidence and nature of BCG adverse events in infants, whilst determining whether those affected possess subtle immune defects.
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