July 13, 2016
Volume VII | Issue No. 28


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Kawasaki disease and cardiovascular risk
Kawasaki disease (acute vasculitis of unknown origin though probably an immune reaction triggered by an infection) is the leading cause of acquired heart disease in all aged children living in the "developed" world (more frequently in those <5 years of age), & in all races and ethnicities (though Asian children appear at greater risk). 5% develop coronary aneurisms with early treatment (vs. 20% without).

To minimize carotid intima-media thickness, endothelial dysfunction and arterial stiffness,  meticulous attention to decreasing elevated cholesterol & blood pressure levels plus avoiding smoking, appears prudent in post Kawasaki patients.
Risk of febrile seizures (FS) after vaccination  
It appears that administering trivalent inactivated influenza vaccines on the same day as either pneumococcal conjugate vaccine (PCV) or a diphtheria-tetanus-acellular-pertussis (DTaP) containing vaccine in children 6-23 months of age increases the risk of a seizure during the following 24 hours (absolute risk however is small; 30 FS per 100,000 persons vaccinated).
Current use on the diagnosis and management of hypokalemia in children
"Hypokalemia is a common electrolyte disorder in children caused by decreased potassium intake, increased gastrointestinal/ urinary loses or transcellular shift". Mild hypokalemia is frequently symptomless (though can result in an increased blood pressure and abnormal heart rhythm). Severe hypokalemia may cause life-threatening cardiac arrhythmias, muscle weaknesses, constipation going on to flaccid paralysis and hyporeflexia, etc. in very severe cases. EKG findings include a flattened or inverted Twave, a Uwave, ST depression and wide PR interval.

A diagnostic algorithm which includes pathophysiology, history, physical examination and laboratory tests is outlined. Management is discussed.

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  Long-term neurodevelopmental and psychological outcomes of gastroschisis

Gastrochisis is a small defect (usually) in the anterior abdominal wall which occurs (probably due to a lack of blood supply) around 5-8 weeks after conception. The defect is located on the right side of the junction of the umbilicus and normal skin, and results in the bowel herniating (without covering peritoneum) freely outside the abdominal cavity. Antenatal abdominal ultrasound and maternal serum alpha-fetoprotein screening usually diagnoses the defect in the second trimester of pregnancy.

A longer term (median 10 years) study of the neurodevelopmental, intellectual and behavioral outcomes of 99 gastroschisis survivors indicates that while overall intellectual abilities are within normal range, working memory and behavioral scores are significantly impaired.

MyPectus: A remote compliance monitoring and dynamic compression bracing system to correct Pectus Carinatum (PC) in adolescents.

PC is a condition of the chest wall (more often in boys) in which the sternum and rib cartilage protrude outward". Treatment options include non-surgical bracing and the minimally invasive Nuss surgical procedure. The "Dynamic Compression Brace" is a more recent brace that avoids the discomfort and skin breakdown which may result from traditional braces.

From a small study of 8 patients using the "MyPectus" compression brace and monitoring system (to assess temperature and pressure) via Bluetooth it appears that data provided improves patients' acceptance and compliance.
Video Feature 

Pectus Carinatum - Bracing
Pectus Carinatum - Bracing
Compartment pressures in children with normal and fractured forearms
 
"Acute compartment syndrome (ACS) may lead to irreversible damage if fasciotomy is not performed in a timely manner". Needle manometry is the tool used to assess muscle group pressure, however the danger pressure threshold for ACS in children has been debated.

A prospective study of 41 children with forearm fractures which measured the pressures in the superficial, deep flexor and dorsal surfaces of both healthy and injured forearms indicates mean injured arm pressures of 14.88mm, 19.2mm and 15.56mm Hg respectively with normal compartment pressures of 9.66mm, 10.22mm and 12.9mm Hg respectively.

Some children with forearm fractures have high pressures (>30mm Hg; adult pressure limit) without clinical signs of ACS. Close observation prior to fasciotomy is required.
Respiratory complications following hydrocarbon aspiration in children
 
Aspiration ammonia during ingestion of low-viscosity hydrocarbons (e.g. kerosene and mineral oils) occurs early (evolving over the first 6-8 hours) in approximately 15% of ingestions, reaching its zenith in 48 hours. Up to 5% progress towards respiratory failure. Chest x-ray abnormalities may be seen 4-8 hours after ingestion but do not always predict clinical pneumonitis. Most hospitalized patients have a benign course and pneumatoceals on chest x-ray may appear 6-10 days after ingestion (usually resolving spontaneously within 6 months). Steroids are of no benefit.

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