HealthFusion June 2014 B  

July 2, 2014   Vol. V, Issue 27
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Measles in the USA.

A CDC press release (May 29, 2014) reports that between January 1 and May 23, 2014, 288 cases of measles were reported - the highest number over this time period for 20 years. Most cases have been associated with international travel by unvaccinated people.


Measles is a highly contagious, potentially serious respiratory disease. Many young pediatricians may never have seen or treated a patient and may therefore not be familiar with its signs and symptoms.


All cases should be immediately isolated and reported to the local health department.


Vaccination of infants and young children with 2 doses of MMR (Measles, Mumps and Rubella) starting at 12 moths is recommended. If traveling internationally all residents > 6 months of age should receive MMR prior to departure if needed.


Centers for Disease Control and Prevention 

 Conventional pulmonary rehabilitation (CPR) vs. high-frequency chest wall oscillation (HFCWO) in Primary ciliary dyskinesia (PCD).

Primary ciliary dyskinesia (PCD) is a rare genetic condition that results in poor ciliary function, diminishing the airways' ability to move mucus centrally. Half of PCD children have situs inverses and many (because they present clinically like many childhood illnesses) are diagnosed late.

A study of 2 different modalities (CPR vs. HFCWO) of pulmonary rehabilitation in PCD examined efficacy and safety of postural drainage, percussion and vibration in enhancing pulmonary function. Both methodologies improve pulmonary function with no differences found between them. Patients find HFCWO more comfortable.


Pediatric Pulmonology



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- George Bernard Shaw  


H1N1 virus & MERS-CoV infections - "still around & what's new "!  


A strong resurgence of H1N1 virus infection has been noted during this past flu season which peaked during late December, early January 2013. Among 9,500 influenza-related hospitalizations (57% between ages 18 - 64 years; 96 pediatric deaths), 88% were due to the same H1N1 virus that caused the major worldwide epidemic in 2009. Flu vaccine apparently reduces the risk of spread by 60% and the same type of vaccines available should be effective for next flu season.


To date approximately 401 confirmed cases of Middle East Respiratory Syndrome (MERS), caused by the Corona virus (CoV) (MERS-CoV), first reported in Saudi Arabia in September 2012, & probably initiated by exposure to infected camels (via respiratory secretions, and/or milk-with possible person to person spread), have been reported. It has now spread to at least 12 countries (reported in the USA in April 2014) in adults (mean 51 years) mostly, though children as young as 2 years of age have been reported. It presents after an incubation period of 2-14 days as a severe acute respiratory illness with fever, cough and shortness of breath - 30% of symptomatic patients die.


Pediatricians be aware! Ed.

Video Feature  
Autism Spectrum Disorder
Autism Spectrum Disorder
via YouTube

Genetic bases for Autism Spectrum Disorder (ASD).  


"Epigenetics ("around the gene") is the study of heritable changes in gene activity that are NOT caused by changes in the DNA sequence". These changes may be the mediators of environmental factors which alter cell function. Frequently the abnormalities arise in DNA methylation.


As DNA mutations are increasing being identified in ASD, & an increased maternal age appears to be associated with an increased risk of having a child with ASD, a study of infants with ASD from mature mother (> 35 years of age) was undertaken to assess the role that DNA methylation plays.


Epigenetic DNA methylation abnormalities of expression in children born to older women in conjunction with many already identified genes associated with ASD, appear to be involved in the clinical expression of ASD. Epigenetics may partly explain how environmental factors affect gene expression in ASD.


PLOS Genetics 

Skin cancer risk - children & all beware!


"Skin cancer is the most common malignancy in fair-skin populations in many countries". Both constitutional (family history, red hair color, sun exposure sensitivity, melanocytic nevi) and environmental (solar UV radiation) factors are important in etiology.


A study 108,916 women followed from early life to adulthood over 20 years, indicates that the greater the cumulative UV exposure, the greater the risk of developing melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Young adults who have had > 5 blistering sunburns between ages of 15 and 20 years are most likely (68% increased risk) to develop SCC and BCC with an 80% increased risk for developing melanoma. 


American Association for Cancer Research 

Incidence of differentiated thyroid carcinoma among children & adolescents.


A study of differentiated thyroid carcinomas from cancer registries in patients < 30 years of age, conducted over a 26 year period, indicates that these carcinomas are increasing in both children and adolescents and are tending to be larger at diagnosis. Environmental, dietary and genetic factors require investigating. 


Journal of Pediatrics

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