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Risk of developing coeliac disease is low for children with potential coeliac disease
The CELIPREV (Celiac Disease Risk Prevalence and natural history of potential celiac disease in at family-risk infants prospectively investigated from birth) study1 prospectively followed up 553 children in Italy from birth with coeliac disease (CD)–predisposing human leucocyte antigen (HLA) genes. Children with a diagnosis of potential CD continued to receive a normal diet and repeated the serological screening for CD every year. Potential CD was defined in the presence of (1) a CD-compatible HLA genotype, (2) a Marsh 0–1 lesion at the biopsy, and (3) IgA tissue transglutaminase antibody and endomysial antibody positivity or IgG tissue transglutaminase antibody positivity in presence of IgA deficiency. A small-intestinal biopsy was taken in presence of persistent positive serology. Overall, 26 (4.7%) children received a diagnosis of potential CD (50% females, median age 24 months). All children were symptom-free. Twenty-three children continued a gluten-containing diet; at 10 years from the first biopsy, three children developed overt CD (13%), 19 (83%) became antibodies negative at 1 year from the first biopsy and remained negative up to 10 years of follow-up, and one subject (4%) had fluctuating antibody course with transiently negative values and persistently negative biopsy.
Children with appendicular abscess and appendicular phlegmon reported better results in terms of complication rate and re-admission rate if treated with non-operative management
Fugazzola and colleagues performed this meta-analysis including 14 studies of 1288 patients.2 The complication rate was significantly favourable to the initial non-operative arm for the appendicular abscess/appendicular perforation (Aab/AP) subgroup (relative risk (RR)=0.07, 95% CI 0.02 to 0.27) and to the operative management arm for the free perforated appendix (FPA) subgroup (RR=1.86, 95% CI 1.20 to 2.87); the re-admission rate was significantly favourable to the initial non-operative arm for the AAb/AP subgroup (RR=0.35, 95% CI 0.13 to 0.93) and to the operative management arm for the FPA subgroup (RR=1.49, 95% CI 1.49 to 7.44). The pooled proportion rate of non-operative management success was 90%, and the pooled relapse rate of appendicitis was 15.4%.
Routine supplementation of vitamin D may not be needed for children with low vitamin D levels in northern latitudes
In this prospective double-blinded randomised intervention study, children 5 to 7 years old (n=206) with fair and dark skin in Sweden (55°N–63°N) received daily vitamin D supplements of 25 µg, 10 µg or placebo (2 µg) during three winter months.3 Bone mineral density (BMD) and bone mineral content (BMC) for total body (TB), total body less head (TBLH), femoral neck (FN), and spine at baseline and 4 months later were measured. Despite lower serum 25(OH) vitamin D in dark-skinned than fair-skinned children, BMD of TB (p=0.012) and TBLH (p=0.002) and BMC of TBLH (p=0.04) were higher at baseline and follow-up in those with dark skin. Delta (Δ) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN-BMC increased more among dark-skinned children in the 25 µg (p=0.038) and 10 µg (p=0.027) groups compared with placebo. BMD and BMC remained higher in dark-skinned than fair-skinned children despite lower vitamin D status.
Emergency admission rates were significantly higher in the post-transition groups for patients in England with long-term health conditions
Wijlaars and colleagues performed a cross-sectional study using universal standard hospital episode statistics from National Health Service (NHS) England analysed over a million admissions to hospitals in England, involving over 760 000 young people aged 10–24 years, between 2009 and 2011.4 The emergency admission rates (excluding pregnancy-related) were significantly higher in the post-transition groups, more so in those with long-term conditions (LTCs) (adjusted incidence rate ratios for those with no LTC 1.21 (95% CI 1.18 to 1.23), those with LTC 1.55 (95% CI 1.47 to 1.63)). Lengths of stay increased progressively post-transition: in girls from a mean 2.2 days at 10 years to 4.5 days at 24 years, and in boys from 1.9 to 9.2 days. Post-transition, a disproportionately higher number of patients presented directly to emergency departments, rather than through a referral from primary care, even in those with LTCs. The evidence from this study of why and how young people present to emergency care suggests that the transition care in NHS is not working well for them.
Contributors I am the sole contributor to this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.
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