June 21, 2017
Volume VIII |  Issue No. 25

Adolescent and young adult (AYA) use of social media for health, and its implications
A cross-sectional study of AYAs, 12 years and older who participated in an anonymous survey about health-related social media use, personal health and communications with their health team indicates that AYAs with self-perceived poor health are more likely to share health information, but do not use social media as a useful source of heath information. This potentially limits the value of public health messages through this platform (and diminishes its value for patient-healthcare team communication).

Budesonide (BUD) and hospital admission rates in young children with acute wheezing
Budesonide (Pulmicort) is a corticosteroid available as an inhaler, pill, nasal spray or by rectal insertion. A double blind, placebo controlled parallel group trial examined whether the addition of Budesonide (3ml by inhalation) vs. placebo to a standard acute asthma treatment protocol of salbutamol and a single dose of methylprednisolone modifies hospitalization rates.

Budesonide nebulization in addition to a standard regimen appears to decrease hospitalization rates of preschool children who present with moderate to severe acute wheezing.

Dexamethasone (DXM) for parapneumonic plural effusion
From a clinical trial of 60 children, 1 month - 14 years with a community acquired pneumonia and pleural effusion, it appears that an intravenous dose of 0.25ml/kg/dose of DXM every six hours for 48 hours (with appropriate antibiotics) significantly improves (by 2.8 days) recovery time, without an increase in complications or adverse events.

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Prevention of Migraine Headaches

Patients with frequent, severe or refractory migraine headaches should receive preventive treatment. Available drugs include:
  1. Beta blockers (contraindicated in asthmatics and those with comorbid depression or during pregnancy).
  2. Anti-epileptic drugs - valproate (depakote) and topiramate (topamax) are FDA-approved for migraine preventions (contraindicated during pregnancy).
  3. Antidepressants.
    • Amitriptyline is the only tricyclic antidepressant apparently shown to be effective in preventing migraine in adults; does not appear to be of value in children. Side effects are common.
    • SNRI's (serotonin - norepinephrine reuptake inhibitors may be effective).
    • Both above groups have deleterious neonatal effects if taken during pregnancy.
Other preventive treatments include:
  • Non-steroidal anti-inflammatory drugs.
  • ACE (angiotensin - converting enzyme, e.g. lisinopril) and ARB's (angiotensin receptor blockers, e.g. candesartan) have reduced migraine frequency by 30-35%.
  • Calcium channel blockers (e.g. verapamil) may be of value.
  • Dietary supplements and other drugs (e.g. melatonin, riboflavin, magnesium, etc.) have been effective in small trials.
  • Transcutaneous electrical nerve stimulation device worn on the forehead is approved by the FDA for preventing recurrent migraines.
Video Feature
Preventing Migraines
Preventing Migraines
Eggs in early complementary feeding and child growth in developing countries

An interesting randomized controlled trial of 163 infants (6-9 months of age) conducted in Ecuador investigated the feeding of one medium size egg per day with complementary feeds (or no intervention) for six months on morbidity symptoms and anthropometry.

An egg/day as part of complementary feeding in vulnerable children increases weight and length, reduces stunting and consumption of sugar-sweetened foods with no reported allergic reactions.

Medical treatment of pediatric appendicitis?

In adults it appears that short term non-surgical treatment of acute non-complicated appendicitis as a first-line therapy seems safe and effective. A meta-analysis of data of 404 children 5-18 years of age comparing safety and efficacy of antibiotics vs. appendectomy indicates a success rate for antibiotics of 90.5%. However children with appendicoliths are at great risk for treatment failure.

An accompanying Editorial however comments not only on the high risk of failure but also suggests a longer follow-up period and correction of other issues associated with the study prior to universal acceptance.

JAMA Pediatrics
Antenatal predictors of poor outcomes for congenital diaphragmatic hernia (CDH)

"Pulmonary hypoplasia is the main cause of mortality in isolated CDH" identifying antenatal prognostic parameters is of value in counseling parents.

A database search was undertaken of systematic reviews to identify poor antenatal prognostic parameters for infants with CDH data indicates, observed to expected lung-to-head ratio; observed to expected total fetal lung volume and liver herniation are all good antenatal predictors of mortality in CDH.

Did You Know?
Pediatric Heart Surgery | Innovations in Pediatric Healthcare
Pediatric Heart Surgery | Innovations in Pediatric Healthcare
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