April 22, 2015   Vol. VI, Issue 16
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Vitamin D and allergy development

Amongst its many functions, Vitamin D appears to play a role in reducing inflammation and regulating the immune system. There appears to be some evidence that both high and low serum levels of Vitamin D may play a role in the development of allergies.

 

A study of adolescents (age 13 years) examined the relationship between serum 25-hydroxy Vitamin D (25-OHD) and atopic eczema, respiratory allergy or no allergy.

 

There appears to be NO association between serum 25 OHD levels in patients with or without allergies.

 

Acta Paediatrica  

Allergy & Vitamin D
Allergy &
Vitamin D

 

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Acute Otorrhea in Children with Tympanostomy Tubes

A randomized post-PCV 7 study of 230 children (aged 1 - 10 years) with untreated, uncomplicated acute tympanostomy -tube otorrhea indicates that H. influenza, S. aureus and P. aeruginosa are the most common organisms found. When S. pneumoniae are found they are mostly non-vaccine serotypes.

 

Pediatric Infectious Disease Journal 

Medical augmentation of labor and the risk of ADHD in offspring

A large study of 546,146 deliveries which examined the role of medical augmentation of labor and the subsequent development of ADHD in children reveals NO association between them.

 

Pediatrics 

Intellectual and academic outcomes in children with single suture craniosynostosis

"Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant's skull prematurely fuse by turning into bone". It occurs in 1 in 2,000 births as an isolated condition or as part of a syndrome.

 

A study which examined the developmental status of school-age children with single-suture craniosynostosis  

(compared to normal children), indicates Full-Scale IQ scores to be lower (particularly in mathematics): 58% appears to have no increase in specific learning problems and children with an isolated sagittal suture closure developmentally do better than those with other sites of suture closure.

 

Pediatrics 

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Diurnal and seasonal occurrence of febrile seizures. 

 

"Febrile seizures are the most common seizures in children". As their pathogenesis remains unclear and there are some suggestions that light-dependent melatonin secretion may play a role, a study evaluated the diurnal and seasonal occurrence of a first febrile seizure in 461 children (adjusted for population based epidemiology of febrile seizure episodes in 1,522 children).

 

While first febrile seizures most frequently occur in winter (though occur irregularly throughout the year), the evening (peak: 6pm - 10pm) and between 2am and 6am in the morning, no clear relationship exists between them and the amount of daylight.

 

Pediatric Neurology 

Idiopathic Systemic Capillary Leak Syndrome (SCLS or Clarkson's disease) in children

 

SCLS is a rare, life-threatening (from organ perfusion failure) medical condition (first described in 1960) characterized by recurrent self-reversing episodes of vascular leakage in which capillary cells are thought to separate for 1-3 days. It presents as severe generalize interstitial edema, hypotension, hypoalbuminemia, hemoconcentration following flu-like or gastrointestinal symptoms and is frequently misdiagnosed as sepsis or polycythemia vera.

 

A study of 6 SCLS children (ages 5-11 years) vs. a matched control group of healthy children examined their serum cytokine profiles and analyzed treatments.

 

Children with SCLS have elevated levels of chemokine, ligand 2, interleukin 8 and TNF-?. Regular high dose intravenous or subcutaneous immunoglobulin therapy (or theophylline plus verapamil) may prevent recurrences and appear safe.

 

Pediatrics 

Video Feature 

(via YouTube)
Clarkson's Disease
Clarkson's Disease

Diagnosis of appendicitis in children

 

Three recent articles examined methodologies involved in diagnosing acute pediatric appendicitis.

 

1.   Two clinical scoring systems: Alvarado score vs. Pediatric Appendicitis Score (PAS).

The Alvarado score utilizes elements from the patients' history, physical examination and laboratory tests and assigns points to each; total score separates "compatible with diagnosis", "probable diagnosis" and "very probable" a diagnosis of acute appendicitis.

 

The PAS similarly assigns a point for a similar group of clinical/laboratory findings in the child presenting with acute abdominal pain.

 

Both the Alvarado scoring system and PAS are helpful, but not predictive in assessing acute appendicitis in children.

 

2.    Bedside ultrasound (BUS).

While computed tomography (CT) appears to have become the "standard of care" for diagnosing appendicitis, it exposes the patient to radiation, is expensive and takes time to perform.

 

67.6% of 34 adults who underwent BUS for suspected appendicitis where positively diagnosed on pathology reports. BUS may be an appropriate initial test in the Emergency Department to evaluate patients with suspected acute appendicitis.

 

3.    CT diagnosis.

A retrospective review of 154 CT examinations with multiplanar information indicates that the coronal plane is best to identify the appendix. No enteric contrast is required.

 

Pediatric Emergency Care 

 

Pediatric Emergency Care 

 

American Journal of Emergency Medicine 

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