April 9,  2014   Vol. V, Issue 15
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Long-term outcomes of adolescents with Juvenile -onset Fibromyalgia.

JF is wide spread musculo-skeletal pain syndrome (with a prevalence of 6%) and multiple discrete tender points (occurring usually in 13-15 year olds; girls > boys) with fatigue, skin tenderness, joint stiffness, sleep disturbances and many other associated features. It is part of a proposed class of inflammatory disorders called "central sensitivity syndromes". A multidisciplinary approach to its treatment appears optimal.


A prospective longitudinal study of the physical and psychosocial outcomes of adolescents with JF indicates that they are highly likely to have the disease continue into adulthood with significant levels of physical and emotional impairments.


Editor's Note: Medscape subscribers can view an excellent chart detailing JF's component clinical features by clicking HERE.  


"Breast milk is best milk"- one more time!  

An in-depth review of the role of human milk glycoproteins (HMGP) which protect against bacterial infection (more than 400 proteins in human milk) once again reminds us that human milk is best for infants (other animals' glycoproteins are tailored to their offspring!). In addition, it appears that HMGP modulates the intestinal mucosa and its responses to inflammation.

(As an aside, while discontinuing breast feeding is frequently blamed on mothers perceiving a decreasing milk supply, breast feeding in fact becomes more efficient over six months with infant milk intake remaining constant).


Breast Feeding Medicine 



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Infant health impact of fever during early pregnancy.

A systematic review of a variety of data bases, indicates that fever occurring during the first trimester of pregnancy is a significant risk factor for the infant. Neural tube and congenital heart defects, and oral clefts appear most common.



Dexamethasone for Acute Asthma Exacerbations in children.

A systematic review aimed at determining whether intramuscular or oral dexamethasone is equivalent or superior to a five day course of oral prednisone/prednisolone, indicates that a single or 2-dose regimen of dexamethasone provides equivalent benefit.


Video Feature  
Inhaled Steroids Risks
Inhaled Steroids Risks
via YouTube

Pertinent data for the practicing Pediatrician on Autism Spectrum Disorder.  


In an outstanding, comprehensive and simple way, this article from the American Academy of Child and Adolescent Psychiatry gives the most up-to-date outline on ASD.


The following few items culled from the article may be of special interest to the practicing pediatrician:


a.   Various theories exist regarding etiology.

b.   Post-mortem studies show abnormalities within the limbic   system.

c.   Functional MRI has identified difficulties in tasks involving social, affective judgment and the processing of facial and non-facial stimuli.

d.   Structural MRI suggests a brain size increase.

e.   Diffusion Tensor Imaging indicates aberrations in white matter tract development.

f.   Neurochemical studies find high blood levels of serotonin, and a role for dopamine hasn't been excluded.

g.   For vaccines (in particular MMR) and thiomerosol, the preponderance of evidence does not support either as an etiological factor.

h.   A role for the immune system has not been excluded.

i.   There is a high risk for ASD in siblings and an even higher one for identical twins, providing strong support for a genetic (multiple) involvement.

j.   Identified risk factors include: Closer spacing of pregnancies, advanced maternal or paternal age and extremely premature birth (<26 weeks).

k.   Comorbidities include intellectual disability (only 25% are in normal range), behavioral difficulties and "affect" symptomatology, plus others.


Journal of the American Academy of Child and Adolescent Psychiatry 

Sexual Minority ("Gay") boys & anabolic-androgenic steroid (AAS) use.


A Youth Risk Behavior Survey of 17,250 adolescent boys that assessed sexual orientation and AAS misuse indicates that minority sexual boys are 5.8 times more likely to misuse AAS as compared to their heterosexual counterparts. Associated contributing factors include increased depression/suicidality, victimization and "substance use".



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