January 21, 2015   Vol. VI, Issue 3
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Clonal Hematopoisis and Blood cancer risk from blood DNA sequence  

"Cancers arise from multiple acquired mutations which presumably occur over many years. Early stages in cancer development might be present before cancers become clinically apparent".


A study of 12,380 unselected adults involved the genome DNA sequencing of peripheral-blood cells to identify somatic mutations previously implicated in hematologic cancers. Outcomes 2 to 7 years later indicate that hemopoetic mutations occur in 10% of people >65 years of age (and only in 1% younger than 50 years).


Clones of hematological cells with age-related mutations (predictive markers for subsequent hematologic cancers) may be readily detected by DNA sequencing in apparently healthy individuals.


New England Journal of Medicine
Detergent pod ingestion in children.  

Concentrated laundry detergent pods are a relatively new product and an emerging public health hazard especially for children. Ingestion is the most common route of exposure and data from the National Poison Data System indicates that 17,232 children younger than 6 years of age were investigated for this during 2012-2013. Many patients had moderate/major outcomes, 4.4% required hospitalization with one death.


Laundry detergent pods pose a serious poisoning risk especially for children <3 years of age.




Pediatric Emergency Care 

Inhaled corticosteroids (ICS) & bone mineral density (BMD) at school age.  

A study of 89 children, <24 months of age hospitalized for wheezing, treated with ICS's and followed to age 12.3 (median) years when BMD parameters were measured, indicates that ICS use for >6 months at age <6 years is associated with lower BMD of the lower spine &  femoral neck. All children should receive the lowest ICS dose that will control their asthma.


Pediatric Pulmonology 



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Management of heat stroke.


Heat stroke is a form of hyperthermia (which unlike heat cramps or heat exhaustion which are less severe), whose management requires emergency action. Infants, patients with heart, lung or kidney disease and others vulnerable to dehydration are more susceptible to body temperatures up to 106 F (41.1 C) or higher that may occur in heat stroke with or without exercise.

Treatments of a heat stroke victim include modifying environmental factors, applying cool/tepid water to the skin, fanning, administration (by mouth if possible) of cool liquids and ice packs to armpits and groin. Patients with multiple-organ failure may benefit from intravascular cooling.


American Journal of Emergency Medicine 

Preventive healthcare surveillance to prevent later school dropout.

School dropout is a multi-dimensional problem resulting in a lower socio-economic status for those affected. Adolescent risk factors include chronic somatic disease (and symptoms) psychological distress, insomnia, overweight and family-related factors, etc.


It appears that by using a child's early socio-medical health record, early externalizing behaviors (those behavior problems directed at the outside world; e.g. fighting, cursing, stealing, underage drinking, etc.) can be identified which are closely associated with subsequent school dropout. School dropout may be a preventive healthcare issue in addition to one being dealt with in the educational system.


Acta Paediatrica 

Video Feature 

(via YouTube)
Teens and alcoholism - Parental advice for adolescent alcohol treatment.
Teens and alcoholism - Parental advice for adolescent alcohol treatment.

Ebola virus disease (EVD) in children.


"EVD is a rare zoonotic disease caused by infection with one of five species of Ebola virus" (Zaire Ebola virus discovered in 1976 is the species responsible for the present outbreak). Transmission can occur through direct contact with bats, primates and duiker antelopes that have died from the infection. Spread among humans occurs primarily through unprotected direct contact of skin or mucus membranes with blood or body fluids of a person (or corpse and perhaps contaminated object) ill with EVD. Mean incubation period is 11.4 days (to 21 days). Focused non-specific support and the management of complications is all the treatment that is available at present.


Children infected with Ebola virus typically present with nonspecific signs and symptoms (fever, headache, myalgia, abdominal pain and weakness, followed by vomiting and diarrhea) presenting a challenge to pediatricians. The key diagnostic feature is a travel history to West Africa and/or recent contact with anyone suspected or infected with EVD.


JAMA Pediatrics

Ablative fractional laser (AFL) resurfacing helps treat restrictive pediatric scar contractures.


Conventional management of debilitating pediatric scars/contractures including hand therapy and surgery may give sub-optimal results and surgical morbidity.


"AFL removes/destroys microscopic columns of epidermal and dermal tissue in regularly spaced arrays over a fraction of the skin surface. This increases efficacy, safety with shorter recovery times."


A report of 2 pediatric patients with recalcitrant scar contractures treated with AFL and achieving rapid improvement in range of motion and function, indicates that this treatment modality may play an increasing role in the management of significant scar tissue in children.



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