Miami, FL
April 25, 2018
Volume IX | Issue No. 17
Can low dose ketamine with morphine (MK) reduce the need for morphine in renal colic?
Patients with renal colic commonly report the pain being the most severe ever experienced. Intravenous non-steroidal anti-inflammatory drugs, anti-spasmodics and opioids are frequent treatments.

A double blind, randomized clinical trial on 106 patients with severe renal colic pain which compared pain at 10-120 minutes after injection of morphine plus a placebo, to morphine plus low-dose ketamine indicates that this combination enhances pain reduction, reduces morphine consumption and should be considered as an alternative treatment for renal colic pain.
Montelukast treatment of acute asthma exacerbations (AAEs) 
Montelukast (Singulair) is an oral leukotriene (a family of inflammatory mediators) receptor antagonist that is usually used in the chronic management of asthma and seasonal allergic rhinitis. Its efficacy in AAE's is not fully known.

A study of 120 Chinese children (2-5 years of age) with AAE; 60% of whom received standard therapy with Montelukast, the others with a placebo, indicates NO benefit to Montelukast therapy over a placebo in AAE children.

More on pilonidal sinus (PS) disease in children
PS is an inflammatory condition involving hair follicle in the crease between the buttocks (update in Pediatrics April 18 2018). Many treatments exist, most involving surgical excision (with a number of options).

A first, though retrospective study of 117 children (mean age 15.6 years) with PS treated either with surgical excision or phenyl application indicates that phenyl treated children are discharged on the same day (for surgery: mean 2.7 days) with lower recurrence and complication rates.

Did You Know? 
Sports Health Center at Pinecrest
Sports Health Center at Pinecrest
Childhood Obesity Facts 
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-This is a "Must Have" (Ed.) 

Online problem solving for adolescent traumatic brain injury (TBI) 

"Teen Online Problem Solving (TOPS)" is a structured 16 session program with 10 "core" sessions covering executive functioning, communication and social/skills problem solving training and 6 sessions addressing the stressing issue. The program relies on the teen (with parental and on-line therapist support) to change and monitor their own behavior.

A randomized clinical trial of children (11-18 years of age) with mild-to-severe TBI (in the previous 18 months) compared the TOPS program with family, to TOPS with teen only and to a control group ( Internet Resource Comparison ), to assess enhanced post-TBI mental/behavioral functioning.

It appears that online TOPS/family problem solving is of value to improve executive dysfunction and decrease externalizing behaviors in children with TBI. In high-stress families, TOPS with teen only may be indicated.

Result of casting in severe curves in infantile scoliosis

"Best results for casting in infantile scoliosis is when the curves are small and the child begins casting under 2 years of age."

A study which examined whether casting can delay the need for growth friendly instrumentation in severe curves (50-106 degrees) indicates that even with severe curves many children will benefit from casting; delaying surgery for up to 3 years after cast application (27% have curve resolution).

Video Feature
Pediatric Scoliosis - Mayo Clinic
Pediatric Scoliosis - Mayo Clinic
Contrast enhanced ultrasound (CEUS) for the evaluation of blunt pediatric abdominal trauma

Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are incorrectly diagnosed and CT carries a risk of radiation-induced cancer.

A study of 18 children (7-18 years) with a CT-diagnosed abdominal solid organ injury compared CT results to conventional Doppler ultrasound and CEUS within 48 hours of injury.

CEUS identifies confirmed injuries in 85.7% with a specificity of 98.6% with a negative predictive value of 95.8%. "CEUS is a promising imaging modality that can detect most abdominal solid organ injuries while eliminating exposure to ionizing radiation". A larger trial is warranted.

Alveolar capillary dysplasia (ACD) 

ACD is a rare, frequently genetic congenital abnormality of the pulmonary capillaries which causes an increase in pulmonary artery blood pressure with associated hypoxia and hypercarbia. Two forms exist; (1) Typical ACD which presents with severe hypoxia and refractory pulmonary hypertension within hours of birth and rapidly progresses to respiratory failure and death. (2) Atypical ACD infants who present either with mild neonatal respiratory distress or have no symptoms at birth but present at 2-3 months of age with hypoxemia and pulmonary hypertension. Misalignment of pulmonary veins occur in both forms (ACDMPV). Treatment is bilateral lung transplantation.

Though a rare condition this article reviews the clinical history, diagnostic studies, histology, genetic sequencing results and post-transplant course of ACDMPV. (It is worth reading - Ed).
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