Jan. 25, 2017
Volume VIII |  Issue No. 4


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Portable screen-based media device access/use and sleep outcomes 
A systematic review and meta-analysis of multiple databases reporting sleep duration/quality and the use of cell phones, tablets, etc. in the sleep environment,
suggests (few studies, overlapping age groups, varying definitions, etc.) that there is a strong association between bedtime media use and inadequate sleep quantity, poor sleep quality and daytime sleepiness in children 6-19 years of age.

Intravenous (IV) ferric carboxymaltose (FCM) in children with refractory iron deficiency anemia (IDA)
Most children with iron deficiency anemia will respond to treatment with iron; relatively rarely however iron - refractory (resistant) anemia occurs from an inherited autosomal recessive mutation in the TMPRSS C gene which provides instructions (via matriptase-2) to regulate iron levels in the body.

FCM is form of injectable iron usually given ( slowly as two doses at least seven days apart) when insufficient iron is absorbed from food and/or from iron taken orally.

A retrospective cohort study of 116 IV FCM infusions administered to 72 patients (without a test dose) with IVA refractory to oral treatment, indicates that this treatment appears to be safe and highly effective.

Myositis Ossificans (MO) in children
MO frequently occurs in children in response to traumatic muscle injury; hematoma formation, and subsequent calcification. It occurs most commonly in the muscles of the arms and quadriceps of the thigh.

An interesting rare presentation of non-traumatic MO found in the popliteal fossa of a 12 year old child which required excision reminds us that MOs' pathophysiology is not clearly understood and that potentially, spontaneous genetic mutations may also play a role.

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Adolescent knowledge of HIV and risky sexual behavior 

Human immunodeficiency virus (HIV) remains a leading cause of death and disability, and adolescents are still frequently becoming infected.

A questionnaire study which assessed HIV knowledge, sexual risk behaviors and the sources of HIV knowledge in 240 adolescents (14-21 years of age) indicates that though adolescents appear HIV knowledgeable through inputs by school-based and medical professionals, age of first sexual encounter, number of partners and condom use appear unaffected by that knowledge. HIV education alone from expert sources appears insufficient to change adolescent sexual practices.

Parental cannabis use and children's outcomes

A prospective longitudinal study of 442 parent-child dyads which examined parental cannabis use and subsequent child cannabis abuse/dependence indicates:
  1. Fathers who begin cannabis use by age 15 years frequently continue to use throughout their lives.
  2. Offspring of fathers who abuse have a much higher likelihood of early cannabis use.
(Mothers' data unclear due to low rates of lifetime use.)

Video Feature
Health effects of marijuana use remain unclear
Health effects of marijuana use remain unclear
Updated guidelines of a diagnosis and treatment of cerumen (ear wax) impactation 
 
The American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO - HNS) has published an update on the diagnosis and management of excessive or impacted ear wax which occurs in approximately 10% of children. Impacted ear wax can cause ear pain, itching, feeling of fullness in the ear, tinnitus, hearing loss, discharge or odor from the ear and/or a change in hearing.

Recommendations include:
  1. Diagnosis of ear wax accumulation/impaction should only be made when symptoms are present and/or it prevents assessment of the ear or both.
  2. Without symptoms ears should not be routinely
    irrigated, or cleaned with cotton swabs (or many many other objects!) all of which have potential complications and/or force wax to impact further in the ear canal
  3. Individuals with wax impaction should be treated with irrigation, cerumenolytic agents or manual removal requiring instrumentation.
Circulating inflammatory - associated proteins in the first month of life in extremely preterm born infants and cognitive impairment at 10 years

While advances in neonatal intensive care has reduced mortality in extremely preterm born babies (<28weeks gestation), moderate/severe cognitive impairment still occurs in about 40% of survivors.

Concentrations of inflammatory proteins at 3-4 weeks of life are associated with 2 year cognitive outcomes however these correlate only moderately with school-age abilities (which in general are more closely associated with subsequent academic achievement and vocational/social competence).

A study with investigated the association between increased risk of cognitive deficit at 10 years of age and inflammatory-associated proteins (C-reactive protein, etc.), measured in the first two weeks of life indicates that extremely preterm children with elevated inflammatory proteins measured during the first month of life are more likely to have cognitive impairment at 10 years.
 
Did you know?
Nicklaus Children's Becomes First Pediatric Facility in Southeast- and Second in the World- To Use GPS-Like Technology During Cardiac Procedures

Miami based Nicklaus Children's Hospital is the second pediatric facility in the world to use new medical technology in cardiac procedures that is similar to global positioning systems (GPS) that motorists use to determine their vehicles' locations on a map. The new equipment is part of the hospital's new state-of-the-art cardiac catheterization lab, in which minimally invasive catheter-based procedures are performed to treat and evaluate children with congenital heart defects.
The MediGuide Technology allows physicians to see the precise location of specially designed delivery tools and catheters enabled with miniature sensors to navigate within the heart.
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