Miami, FL
July 24, 2019
Volume X | Issue No. 30
Environmental mild traumatic brain injury (mTBI) and psychopathology in adolescence  
A study of longitudinal data from adolescent youth (n: 1,827) aged 10-18 years of age from Chicago neighborhoods assessed the association between environmental mTBI and risk of subsequent psychopathology.
mTBI is an important environmental risk factor (correcting for confounding influences) for the development of aggressive behavior, anxiety/depression, attention problems, somatic symptoms and delinquency during adolescence.
Journal of Adolescent Health 

See related video HERE & HERE.
Adherence to medication 
An English postal survey of 180 parents of children receiving ongoing medication investigated current prescribed medication (and duration), medication changes made/altering dose without physician input, compliance with instructions, delay in starting new medication and others.
50% of parents make changes to their child's medication without physician consultation, most commonly adjusting medication regimens to fit their daily lives. 20.6% delay initiating a new medication and 17.6% indicate failure to follow medication instructions.
Long term adherence to medication for pediatric patients is a complex endeavor and pediatricians need to both be aware of the difficulties encountered and work with parents to ensure compliance.  
Archives of Disease in Childhood
Metformin treatment to augment low milk supply in obese mothers with insulin resistance 
A small randomized pilot clinical trial of 15 obese mothers/infant (healthy term) dyads 1-8 weeks postpartum exclusively breast feeding with low milk production and insulin resistance assigned to receive either oral metformin or placebo for up to 28 days indicates that metformin increases (non-statistically) milk production in some obese insulin resistant lactating mothers with poor milk output.  
Childhood Obesity Facts 
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The accuracy of home-performed fecal calprotectin (FC) test in pediatric inflammatory bowel disease (IBD) 
Calprotectin is a protein found in body fluids when an inflammation is present. It is released by neutrophilic degranulation and when detected in the stool has a direct relationship to the bowel mucosal damage characteristically seen with inflammatory bowel disease.
As endoscopy is invasive, the use of FC (measured by enzyme-linked immunosorbent assay - ELISA) as a biomarker of IBD remission has become standard practice. IBDoc® is the first in-vitro diagnostic home testing device measuring FC. The CalApp® turns a smart phone into a test cassette reader allowing for direct reporting to a gastroenterologist.
A prospective study which compared bowel endoscopy results to parallel performed stool FC-ELISA and FC-IBDoc® in 89 children with IBD indicates that the standard FC-ELISA stool test is a more reliable predictor of mucosal healing in children with IBD.
 Journal of Pediatric Gastroenterology and Nutrition 
Prediction of recurrence in idiopathic clubfoot treated by the Ponseti method
While overall the Ponseti method of treating idiopathic infantile clubfoot (congenital talipes equinovarus) produces good results, recurrence occurs in 40% of children (in spite of excellent compliance of serial foot manipulation and bracing). Poor evertor muscle activity (the peroneus muscles which turn the foot outwards) has recently been found to be a specific and significant predictor for recurrence of idiopathic clubfoot.
A study of 104 children (172 feet) treated for clubfoot by the Ponseti method in which children were identified as having good or poor evertor activity (with follow up for 5 years), indicates that poor activity is highly associated with recurrence rate. Measuring evertor muscle activity should be a routine part of clubfoot management.
 Journal of Pediatric Orthopaedics 
Video Feature
What is medication non-adherence?
What is medication non-adherence?
Methylprednisolone (MP) or Cyclosporine (CyA) to treat Henoch-Schönlein nephritis (HSN) 
Henoch-Schönlein purpura (HSP) is an inflammatory disease of unknown (immune related) cause, involving small blood vessels (vasculitis) which primarily affects the skin (purpuric rash), intestines (abdominal pain, bloody stools), joints (arthralgia/arthritis) and kidneys (nephritis). It is most commonly seen in children 2-6 years of age.
Henoch-Schonlein nephritis (acute episodes of glomerular inflammation presenting either as an acute nephritis and/or nephrotic syndrome) occurs in approximately 30% of children with HSP, and in 5% of those it leads to chronic disease. The prognosis of HSP primarily depends on its renal component and chronic kidney disease may only be diagnosed 20 years later. Treatment of Henoch-Schönlein nephritis remains unclear. 
A study of 62 children (97% having nephrotic range proteinuria before treatment) initially treated with either MP pulses or CyA and followed for 10.8 years (mean) indicates that long-term outcomes are relatively good for both treatments. Early treatment enhances proteinuria resolution.
Pediatric Nephrology
High altitude sickness/pulmonary edema
Dr. Paul Auerbach speaks about high altitude sickness, HAPE and HACE at Redpoint
Dr. Paul Auerbach speaks about high altitude sickness 
In outline, altitude sickness is due to decreasing amounts of oxygen associated with rapid (<1 day) ascent to higher altitudes. It presents 12-24 hours after reaching high altitudes and depends on a number of factors which include how quickly one ascends, how high the altitude achieved, the altitude one sleeps at, the presence of acute or chronic illness and others. Three main types occur:
  1. Acute (mild) altitude sickness or acute mountain sickness (AMS)
  2. High altitude pulmonary edema (HAPE)
  3. High altitude cerebral edema (HACE)
A retrospective chart review of 50 children who presented to the Children Hospital of Colorado with a clinical
High Altitude Illness
High Altitude Illness 
diagnosis of HAPE reminds us that this may develop below 2,500 meters and that structural cardiac abnormalities and pulmonary hypertension increase the risk.
Journal of Pediatrics
Video Feature Brought to You by Nicklaus Children's Hospital
Alanis' Story
Alanis' Story
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