Aust Fam Physician
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Febrile convulsions, or febrile seizures, are frequently encountered in paediatrics, and despite often being self limiting, these seizures strike fear in the hearts of patients' carers. ⋯ The initial assessment of a child who convulses with fever should be directed at finding a cause for the fever, rather than the seizure itself, once the seizure has abated. A lumbar puncture should be performed if there is clinical suspicion of meningitis. Electroencephalograms and neuroimaging studies are not routinely indicated. Overall, febrile seizures carry a good prognosis, although one-third of children have recurrent attacks. Febrile seizures are genetic in origin. The risk of later epilepsy is small but increased if the child has a complex febrile seizure, neurological deficit, or a family history of epilepsy. Carers should be counselled in the management of seizures. The effectiveness of prophylactic treatment with medication remains controversial.
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Exposure to air pollution (both indoor and outdoor) has many potential adverse effects on human health. ⋯ Motor vehicle and industrial emissions are the primary contributors to outdoor air pollution in Australia. High levels of ozone and other pollutants can cause respiratory symptoms in susceptible individuals. Air quality advisory systems exist in most states. Clinicians can incorporate the health effects of air pollution, and awareness of advisory systems in the education of their susceptible patients and their carers. Asthma and chronic airways disease management plans should include provision for possible exposure to high pollution events and steps that can be taken to reduce exposure.
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Providing high quality pre- and peri-operative care to patients with diabetes, renal disease and hypertension requires forethought and planning. General practitioners can play a vital role in this process. A preoperative assessment provides an opportunity to support the patient, communicate accurate and relevant clinical information to the procedural team, and make therapeutic adjustments that aid a successful recovery.
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Serum creatinine concentration is an unreliable and insensitive marker of chronic kidney disease (CKD). To improve CKD detection, Australasian guidelines have recently recommended that laboratories calculate and report an estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula with every request for serum creatinine concentration. ⋯ The accuracy and precision of eGFRs are reasonable in most adults in whom calculated values are ENTITY lt 60 mL/min/1.73 m2. However, eGFRs should be interpreted with caution in some settings (particularly patients with eGFRs ENTITY gt 60 mL/min/1.73 m2 and children). Automatic laboratory reporting of eGFR will enhance early detection of CKD, allow the timely institution of appropriate reno- and cardio-protective therapies, and better inform decisions regarding the prescription of renally excreted medications.
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While many children presenting with apparent disorders of growth will be short or tall children growing normally, it is important to identify those children who have an underlying pathological cause. Parental expectation and anxiety will often accompany growth issues and this needs to be addressed. ⋯ Pathological short stature can be distinguished from normal variants by careful history and examination followed by accurate assessment of the growth parameters of height, weight, body proportions and growth velocity, and judicious use of investigations. Growth is a dynamic process that requires multiple measurements over time. If the patient has a nonpathological cause of short stature, explanation and reassurance are critical--for both the parents and child--to feel supported and comfortable with their height outcome.