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Aim: We explored the diagnostic accuracy of the clinical dehydration scale (CDS), the World Health Organization (WHO) scale and the Gorelick scale for assessing dehydration in children admitted to a Tanzanian referral hospital.Methods: This was a prospective, observational study, carried out from April 2015 to January 2017 on children aged one month to five years admitted to the hospital with acute diarrhoea lasting less than five days. Before rehydration therapy, each patient's weight was recorded and the degree of dehydration was assessed based on the three scales. The reference standard was the percentage weight change between admission and discharge. The main outcomes were the sensitivity, specificity and positive and negative likelihood ratios (LRs) of the scales.Results: Data from 124 eligible patients were available. The CDS showed limited value for ruling in cases with some dehydration (LR 1.9, 95% confidence interval 1.1-2.8), but was of no value in assessing no and moderate to severe dehydration. The WHO and Gorelick scales were of no value in evaluating any degree of dehydration.Conclusion: The WHO and Gorelick dehydration scales were no use for assessing dehydration in small children, and the CDS was of limited use for predicting cases with some dehydration. [ABSTRACT FROM AUTHOR]

Aim of the current study was to evaluate the inter‐observer agreement between pathologists in the diagnosis of celiac disease (CD), in the qualified context of a multicenter study. Biopsies from the “PreventCD” study, a multinational‐ prospective‐ randomized study in children with at least one‐first‐degree relative with CD and positive for HLA‐DQ2/HLA‐DQ8. Ninety‐eight biopsies were evaluated. Considering diagnostic samples with villous atrophy (VA), the agreement was satisfactory (κ = 0.84), but much less when assessing the severity of these lesions. The use of the recently proposed Corazza‐Villanacci classification showed a moderately higher level of agreement (κ = 0.39) than using the Marsh‐Oberhuber system (κ = 0.31). 57.1% of cases were considered correctly oriented. A number of >4 samples per patient was statistically associated to a better agreement; orientation did not impact on κ values. Agreement results in this study appear more satisfactory than in previous papers and this is justified by the involvement of centers with experience in CD diagnosis and by the well‐controlled setting. Despite this, the reproducibility was far from optimal with a poor agreement in grading the severity of VA. Our results stress the need of a minimum of four samples to be assessed by the pathologist. [ABSTRACT FROM AUTHOR]

Aim: This study assessed the inter-rater variability of stool assessment, comparing the judgement of parents and a physician using the Amsterdam Infant Stool Scale (AISS) and the evaluation by another physician using photographs.Methods: The stools of children aged two to 18 months, who were not toilet-trained, were independently assessed in vivo using the AISS by the parents and the first physician. Another physician, unaware of the results of the in vivo evaluation, assessed two stool photographs taken by the first physician with a smartphone.Results: Having analysed 100 stools, we found excellent inter-rater agreement between the parents and the first physician for consistency (κ: 0.87; 95% confidence interval [95% CI] 0.78-0.95) and colour (κ: 0.81; 95% CI: 0.71-0.91) and good inter-rater agreement for the amount (κ: 0.79; 95% CI 0.7-0.88). We found moderate inter-rater agreement between the parents' in vivo assessment and the second physician's photographic assessment for stool consistency (κ: 0.5; 95% CI 0.36-0.64) and amount (κ: 0.44; 95% CI 0.29-0.59) and a fair inter-rater agreement for colour (κ: 0.33; 95% CI 0.21-0.45).Conclusion: When parents and a physician used the AISS under in vivo conditions, there was better inter-rater agreement than photographic evaluation by a second physician. [ABSTRACT FROM AUTHOR]

Objective: To investigate potential effects of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) on glycemic control in children with type 1 diabetes mellitus (T1DM). Study design: Meta-analysis and systematic review of randomized control studies (RCTs). The electronic databases MEDLINE, Cochrane Library, and EMBASE were searched through October 2007. Results: Six RCTs involving 165 participants with T1DM met our predefined inclusion criteria. Combined data from all trials showed that the CSII group compared with the MDI group experienced a significant reduction in the level of glycosylated hemoglobin. The pooled weighted mean difference (WMD) was −0.24% [95% confidence interval (95% CI) −0.41 to −0.07, p < 0.001] with a fixed model and remained significant in the random effect model. This effect was reached by slightly decreasing insulin requirement [three RCTs, n = 74, WMD −0.22 IU/kg/d (95% CI −0.31 to −0.14, p < 0.001)]. No differences in the incidences of ketoacidosis and severe hypoglycemic events were found. Conclusions: In short-term insulin therapy, CSII compared with MDI is a more effective form of metabolic control and allows reducing the daily insulin requirement. Yet, no conclusions have been made so far whether this effect holds in later years. These results should be approached with caution because of the methodological limitations of the analyzed studies. [ABSTRACT FROM AUTHOR]