February 11, 2015   Vol. VI, Issue 6
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The relationship between asthma, bronchiolitis and pro-inflammatory polymorphisms

"Asthma is a complex genetic disorder that is associated with both genetic and environmental factors".


A large survey study of elementary and nursery school children where parental history of asthma or past history of bronchiolitis was related to polymorphisms of three protein-encoded genes (TLR4-CD14-interleukin-13 (IL-13)) which act as proinflammatory mediators, indicates that a family history of asthma or allergic rhinitis and a past history of bronchiolitis appear to be independent risk factors for the development of childhood asthma, and that polymorphisms of TLR4, CD14 and IL-13 modify the relationship between asthma and bronchiolitis.


Pediatric Pulmonology 

Hidden formaldehyde in E-cigarette aerosols 

"E-cigarette liquids are typically solutions of propylene glycol, glycerol or both, plus nicotine and flavorant chemicals".


During the "vapping" process formaldehyde releasing hemiacetals appear to be produced which can reach levels higher than that of the nicotine concentration. These may give rise to substantial amounts of formaldehyde (a group 1 carcinogen); 3ml/day e-cigarette solution inhalation is equivalent to inhaling approximately 10% of a 20 cigarette pack.


Lifetime consumption of e-cigarettes may increase by 5-15 times the risk associated with cigarette smoking and lung cancer.


New England Journal of Medicine 

Best practice for idiopathic nephrotic syndrome: Recommendations vs. reality

"The optimal therapeutic regimen for managing childhood idiopathic nephrotic syndrome (INS) is still under debate".


A multicenter, retrospective study of 231 children, 6 months - 15 years of age evaluated the steroid treatment of INS by pediatricians and pediatric nephrologists. The total duration and cumulative steroid dose given by pediatricians appears significantly higher to that given by nephrologists, with albumen and diuretic use being similar for the 2 groups of treating physicians.


Differences in steroid and symptomatic treatment of INS may influence efficacy and safety. Shared guidelines are necessary.


Journal of Pediatric Nephrology 

HHS, Industry Leaders Announce Shift to Value-Based Payment Models

Kathy McCoy | HealthFusion


The transition to value-based payment models picked up speed last week on both the Medicare and private payer fronts. First, the Obama administration announced on Jan. 26 that it wants to tie 50% of fee-for-service Medicare reimbursements to quality-based payment methods by the end of 2018, with an immediate goal of making 30% of reimbursements quality-based by the end of 2016.


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End of expiration (end-tidal) CO2 measurements (capnography) during sedation in a pediatric Emergency Department (ED) setting.


Capnography is a method of measuring the partial pressure-PETCO2, of exhaled carbon dioxide following an inspiration, while at the same time measuring the respiratory rate. When a "plateau" reading is reached on expiration, the C02 measured is a reflection of the C02 content of the alveolus. A measured increase in PETCO2 suggests hypoventilation and detects respiratory depression before hypoxemia occurs.


A study of 154 children receiving procedural sedation in an ED in which "standard monitoring" for hypoventilation and decreased oxygen saturation was compared to "capnography",  indicates that hypoventilation is common (45%) during sedation; it is difficult to detect by current "standard monitoring", and access to "capnography" results in fewer and earlier interventions.


American Journal of Emergency Medicine 

Video Feature 

(via YouTube)
E-Cigarettes Toxins Examined
E-Cigarettes Toxins Examined

Predictors of low milk volume among mothers who deliver preterm infants in a neonatal ICU


Independent risk factors for low milk volume in day four post-partum infants <32 weeks gestation appear to include:


1.    Caesarian section delivery.

2.    Pregnancy-induced hypertension.

3.    Delayed milk expression initiation.

4.    Low pump frequency.


Low milk volume on day 4 post-partum is dependent on a number of factors and correlates with subsequent lack of breast feeding at discharge.


Journal of Human Lactation 

Prevalence of a history of overweight and obesity in adolescents with Restrictive Eating Disorders


"Avoidant/Restrictive Food Intake Disorders (ARFID or Selective Eating Disorders - SED) is a disorder where

Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant/Restrictive Food Intake Disorder (ARFID)

children/adolescents limit their eating amounts and are affected by related physiological and/or psychological problems, but who do NOT fall under the definition of another eating disorder" (anorexia nervosa or bulimia nervosa). Sufferers frequently only eat certain "safe" foods and usually manifest with weight loss/absence of weight gain.


In a retrospective study of 179 adolescents with ARFID, 36.7% where found to have a BMI history >85 percentile. This represents a substantial proportion of adolescents seeking treatment for restrictive eating disorders. This emphasizes the fact that extreme weight loss is not healthy, independent of the outcome.


Journal of Adolescent Health 

Interferon- γ release assays for diagnosing childhood tuberculosis (TB)


Latent tuberculosis (LTB) is defined as a patient infected with Mycobacterium tuberculosis who has no "active" disease". While LTB patients are asymptomatic and non-infectious/contagious their main risk is that approximately 10% of them will eventually develop active TB. "The identification and treatment of patients with LTB is an important part of controlling the disease." Unfortunately skin testing in this population frequently yields variable results.


Interferon- γ release assays (IGRA's) are blood tests that measure T-lymphocyte release of interferon- γ after stimulation with antigens SPECIFIC for M. tuberculosis. It is most usefully used for children who have received BCG vaccine, to enhance sensitivity in patients with LTB infection and to help in the diagnosis of TB disease.





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