August 19, 2015
Volume VI, Issue No. 33

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Risk of adult asthma following severe wheezing in early life.
Infants (<24 months of age) hospitalized for severe wheezing ( & re-investigated at 27 years of age for bronchial hyperactivity ) appear to have a tenfold increased risk of adult asthma (compared to age-matched control groups ) independent of gender, hereditary, allergic rhinitis or smoking.

Pediatric Pulmonology
Oral salbutamol (or albuterol) to treat acute asthma in resource-poor settings.
While it is generally recommended and accepted that repetitive (every 10-20 mins. for three doses) inhalations of racemic albuterol, ( an inhaled short-acting beta 2 agonist ) can safely and rapidly reverse airflow obstruction in acute childhood asthma, it should be remembered that historically only oral bronchodilators were available. Infants under 2 years of age and children particularly in low-resource areas will still benefit from oral bronchodilator therapy though response times are longer than by inhalation.

Use of automated external defibrillators (AED's) in infants
"While ventricular fibrillation and pulseless ventricular tachycardia are more prevalent in adults, these arrhythmias do occur in infants".
A retrospective evaluation of a number of studies on the accuracy of AED's in recognizing arrhythmias in infants and their use to improve out-of-hospital cardiac arrest indicates that in the absence of a trained rescuer, AED's (with or without pediatric pads) should always be used. Energy doses >2-4Jkg may be required for many children.
Visual inspection/
anthropometry in screening for nutritional status and growth in sick children.
A study which compared visual inspection to numerical data by nurses and physicians of the nutritional status of 195 sick children (median age 7.6 years) in a Children's Hospital measuring body mass index (BMI), height and risk of malnutrition indicates that clinical visual inspection on its own is inadequate for screening growth and the nutritional of status of hospitalized children.



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"Dabbing"; Mere marijuana or harmful new trend?
"Dabbing" is an old, but now recently proliferating way of smoking concentrated marijuana. Smoking the oil (BHO) rather than the buds off the plant gives a greater "high" for curious adolescents and adults.

The health outcomes following BHO inhalation compared to flower cannabis are unknown, though some have stressed (with little data) that smoking a more potent form of marijuana may result in increased loss of consciousness, accidents and falls. As research is lacking, pediatricians should remind their patients that "dabbing" and smoking pot are not the same in terms of strength and potential serious long-term deleterious effects.


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Soccer "heading" and concussion

Many recent studies of head injuries / concussion during sports have focused on brain injuries associated with athletic football and/or boxing
A retrospective analysis of concussion data from high schools (where school sanctioned soccer is played), indicates that boys are at greater risk than girls, and the most common mechanism of head injury is due to "player to player" head contact. "Heading the ball" head injuries (less common) also appear to result primarily from "player to player" head contact (ball contact or goal post injuries are the least likely mechanisms of injury).

Dental caries in young children
A.   Prevalence and measurement of dental caries.
The term "early childhood caries" (ECC) was coined in 1999 along with a classification system to facilitate research.
From 87 articles (from a systematic search through four periods of time from 1988 to 2012) of the Medline database, studies indicate that the prevalence of caries in preschool children (younger than 6 years of age) is difficult to assess as the term is used with a variety of criteria and definitions.

B.     Effect of physician-based preventive oral health services on dental caries.
A retrospective study of 29,173 kindergarten students who had access to physician "pediatric comprehensive oral health services" (POH's) indicates that POH's provided by non-dental providers reduces caries in young children (unfortunately this is not associated with subsequent improved utilization of available dental treatments in a dental setting).

C.     Effectiveness of current therapies to prevent and treat Early Childhood Caries (ECC).
There is only limited quality of evidence to support fluoride toothpaste and fluoride varnish for ECC prevention. Data for all other caries preventive treatments advertised appears equally insufficient to assess efficacy.

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