March 2, 2016
Volume VII | Issue No. 9

Hepatic dysfunction as a complication of combined valproate and ketogenic diets
Ketogenic diets have long been used in medically-refractory epilepsy. Most complications are short-lived, while less commonly hepatic abnormalities, pancreatitis, kidney stones, short-stature and bone fractures are among the more serious side-effects. Anticonvulsant drugs are frequently prescribed with the diet.

An interesting case description of a child with refractory seizures treated with a combination of a ketogenic diet and valproate, in whom significant hepatic dysfunction was noticed which improved after discontinuing the valproate, reminds us that liver abnormalities with combined treatments do not preclude the subsequent use of a ketogenic diet for refractory seizure control.

Acute Mastoiditis - related to delayed antibiotic treatment of acute otitis media (AOM)?
"Delayed antibiotic treatment for AOM is recommended for children >6 months with non-severe illness, no risk factors for complications or history of recurrent AOM".
A prospective study of 216 children, 0-14 years, who presented with acute mastoiditis and a history of AOM examined outcomes in those treated with immediate vs. delayed antibiotics.
Delayed antibiotic treatment for AOM does not appear to be associated with an increased severity of subsequent mastoiditis.
Are recommended doses of acetaminophen (APAP) effective for children ages 2-3 years?
From a pharmacokinetic study of acetaminophen in various doses given to children 2-3 years of age, it appears "that dosages for APAP in children should be weight-based and manufacturers should review their dosage recommendations".
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Non-operative treatment of acute appendicitis

Non-operative treatment of acute appendicitis has been suggested for both adult and pediatric patients.

A study of 24 children, 5-18 years with < 48 hours symptoms of acute appendicitis offered two doses of piperacillin IV, then ampicillin/clavulanate for one week or operative management (in 50 control patients) evaluated (at follow up; mean: 14 months) failure of antibiotic therapy and/or recurrent appendicitis.

71% of children with acute appendicitis treated with antibiotics never require surgical treatment with no further increase in perforation or other complications. Antibiotic-only treatment of early appendicitis in children appears feasible, cost-effective and safe.

Video Feature
Acute Appendicitis
Acute Appendicitis
Therapeutic breast massage for engorged breasts, plugged ducts and mastitis

A study of a group of 42 breast feeding women who presented with engorgement, plugged ducts, mastitis and pain followed pre and post treatment with therapeutic breast massage in lactation (TBML) indicates that following treatment there is significant improvement in breasts involved and nipple pain. "Mothers found TBML helpful both immediately in-office and for home management of future episodes".

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Lactobacillus reuteri DSM 17938 (L. reuteri) for the prevention of nosocomial diarrhea in children

Multiple studies of probiotics to prevent nosocomial diarrhea have given conflicting results; probably due to differences in probiotic strain and/or dosage.

A multicenter, randomized, double-blind, placebo-controlled trial in 184 children (1-48 months) hospitalized for conditions unrelated to diarrhea and given L. reuteri daily (1 x 109 colony forming units) during hospitalization, compared to those given a placebo indicates that probiotic L. reuteri in this dose/schedule is not effective in preventing nosocomial diarrhea in children.

Pediatric Infectious Disease Journal
Clinical and serologic response to 23-valent Polysaccharide pneumococcal vaccine (PPV23) in children with recurrent upper respiratory tract infection (RURI)
Children/adolescents with low anti-pneumococcal immunity and RURI's following PCV 7 (Prevnar 7) & given PPV23 appear at 1, 3 and 6 months post-immunization to have improved clinical and serologic responses (patients who are unable to respond to pneumococcal and other bacterial polysaccharide vaccines do well following intravenous IgG).

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