February 10, 2021 | Volume XII, Issue 6
Monthly malaria prophylaxis and child death in sub-Saharan Africa
While >2000 cases of malaria occur each year in the USA (local USA mosquito borne spread has resulted in the >60 limited outbreaks in the USA) most cases here are associated with returning travelers.

In sub-Saharan Africa Malaria is far more common resulting in thousands of children dying yearly. To address this problem the feasibility of rolling out a massive malaria prevention campaign (during malaria season, 2 antimalarial drugs administered monthly to more than 3.6 million sub-Saharan children) was assessed.

Treating children in sub-Sahara Africa malaria endemic areas monthly with an intensive preventive drug program for children ages 3-59 months indicates that such a program is feasible (average cost of treatment per season per child is $3.63) and reduces deaths from malaria by 42-57%.

JAMA

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Risk of hematologic malignant neoplasms from abdominopelvic computed tomography (CT) radiation in patients who underwent appendectomy
"Imaging is not warranted in most children who are unlikely to have appendicitis based upon the clinical examination and laboratory studies." For children who have atypical or equivocal findings of appendicitis ultrasonography (US) and CT (separately or in combination) are the investigative modalities most frequently used. Magnetic resonance imaging (MRI) is often recommended instead of CT as it is as accurate, without the risks associated with radiation exposure. Whether CT is truly carcinogenic remain controversial. 
 
A nationwide population-based cohort of 825,820 patients (interquartile range: 15-41 years of age) evaluated the risk of hematologic malignant neoplasms associated with perioperative abdominopelvic CT radiation in patients who underwent appendectomy for acute appendicitis.
 
Perioperative abdominopelvic CT is associated with a 26% increased risk of all hematologic malignant neoplasms (especially acute leukemia - most pronounced in the 0-15 year age group). There does not appear to be an increased risk for abdominopelvic organ cancers.
SARS-CoV-2 transmission from people without COVID-19 symptoms
From a decision-analytic model (a systematic approach to decision making under uncertainty) which assessed the relative percentages of transmission of SARS-CoV-2 from pre-symptomatic, never symptomatic and symptomatic individuals it appears that infected but asymptomatic individuals account >50% of all transmissions.
Effective control of the COVID-19 pandemic requires isolation of persons with COVID-19 symptoms plus measures such as wearing masks, hand hygiene and social distancing, etc.

JAMA Network Open

How contagious are people with asymptomatic SARS-CoV-2?
How contagious are people with asymptomatic SARS-CoV-2?
COVID-19 - Current Situation in Florida
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Pediatric Seymour (SEE moor) fractures of the toe
A Seymore fracture is an uncommon but clinically important distal epiphyseal fracture (the Salter Harris classification of fractures involving the epiphyseal plate includes 5 types of fractures which stratifies the risk of growth arrest based on injury pattern (Types I and II make up 80% of cases) to the third toe joint, usually with a concomitant nail bed injury. As the nail bed overlies the cortex of the distal phalanx it results in the fracture being an "open fracture."

Without appropriate treatment these fractures can result in pain, osteomyelitis (32%), epiphyseal arrest (21%) and nail dystrophy (5%).

A retrospective review of 19 children with Salter Harris types I/II fractures of the toe with associated nail bed
Seymour Fracture - Everything You Need To Know
Seymour Fracture - Everything You Need To Know
injury/laceration examined clinical outcomes.

Osteomyelitis following a Salter Harris fracture of the toe occurs most frequently in children whose fracture diagnosis is delayed and/or who do not receive acute definitive treatment.

Journal of Pediatric Orthopaedics
Comparison between 2 newborn screening strategies for Cystic Fibrosis (CF) - IRT/IRT (2 stage immunoreactive trypsinogen) vs. IRT/PAP (pancreatitis associated protein)
"The benefits of early CF detection using newborn screening (NBS) has led to widespread use in NBS programs." A study in the city of Buenos Aires, Argentina, prospectively examined and compared 2 separate screening strategies (IRT/IRT vs. IRT/PAP) in 69,827 births (dried blood samples) collected  at 48-72 hours after birth to assess efficacy (at <25 days of life) in diagnosing CF.

The IRT/PAP blood test for screening newborns to diagnose CF is more sensitive and has similar specificity to IRT/IRT. "It avoids a second visit and unnecessary sweat testing."


Pediatric Pulmonology
Featured Video
Via YouTube
Cystic Fibrosis Newborn Screening
Cystic Fibrosis Newborn Screening
Cystic Fibrosis Newborn Screening Info
Cystic Fibrosis Newborn Screening Info
Comparison of saliva and nasopharyngeal swab nucleic acid amplification testing (NAAT) for the detection SARS-CoV2 
From a systematic review and search of multiple databases (385 references and 16 unique studies) which compared the diagnostic accuracy of saliva NAAT to the current noninvasive standard test (nasopharyngeal NAAT) to identify SARS-Cov-2 virus, it appears that saliva NAAT has similar sensitivity and specificity to that of nasopharyngeal NAAP. "Given the ease of use and good diagnostic performance, these findings suggest that saliva NAAT represents an attractive alternative to nasopharyngeal NAAT...." in screening for the virus that causes COVD-19.

JAMA Internal Medicine
Pediatric eye injuries by hydroalcoholic gel in the context of the coronavirus disease 2019 pandemic 
Regular hand disinfection with an alcohol-based hand sanitizer (ABHS) is central to the prevention of transmission of SARS-CoV-2. Current literature documents the potential harms to skin and mucosal surfaces (especially to the eyes) with unintentional use. Many ABHS dispensers are unfortunately installed at the waist level height of an adult which in general is at eye-level or above that of a child. This juxtaposition enhances the risk that a squirt of liquid will enter the eye of a child potentially causing significant injury.

An interesting report (with photos) describes the corneal damage, prompt treatment and outcome of 2 children who sustained significant eye damage following eye exposure to an ABHS, fortunately with good recovery.

Children should be encouraged to wash hands with soap and water (rather than use an ABHS especially at home) to prevent SAR-Cov-2 exposure. Children should be taught about, and trained to safely use hand sanitizers. Hand sanitizer dispensers specifically for children should be ubiquitous, and should be clearly labeled with a "caution" sign.

JAMA Ophthalmology
Featured Video 
Nicklaus Children's Hospital via YouTube
Syncope in Children and Adolescents wtih Dr. Martinez
Syncope in Children and Adolescents with Dr. Martinez
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Dear Reader:
With COVID-19 among us, please take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area where possible.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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