Oct. 21, 2015
Volume VI, Issue No. 42

Fecal occult blood (FOB) and perianal examination in the diagnosis of pediatric inflammatory bowel disease (IBD)
"IBD often presents insidiously and standard blood tests are normal in 20% of patients".
The medial records of 335 patients (85 IBD and 250 non-IBD) undergoing ileocolonoscopy for IBD were reviewed with 61.2% having FOB and perianal examinations prior to the procedure.

It appears that the best predictive model to diagnose  IBD includes measuring serum C-reactive protein level, platelet count, FOB and a perianal examination.
Translating Atopic Dermatitis (AD) Management Guidelines into practice for Primary Care Providers
It is estimated that AD affects 12.5% of children in the USA; the vast majority (67%) having mild disease.

A 2013 Roundtable with a wide variety of participants met to discuss challenges in AD management and to reconcile a broad array of approaches among differing specialties.

A consensus approach to enhance AD management by primary care physicians recognizes that each patient is different; individualizes treatment plans & establishes clear communications between caregiver and patient/family. While no definitive laboratory test is available to diagnose AD, a combination of clinical signs and symptoms is usually sufficient for diagnosis.

Basic AD management includes proper skin care, antiseptic measures, and trigger avoidance. Treatment for acute flares is outlined for both mild & moderate to severe AD, and for ongoing maintenance therapy. (A long article well worth reading & keeping for reference. Ed.)

Risk factors for acute kidney injury (AKI) during aminoglycoside (AG) therapy in patients with Cystic Fibrosis (CF)
Multivariable analysis of high risk factors associated with AKI in hospitalized CF patients include:

1.    AG treatment 90 days prior to admission.
2.    Longer duration of AG therapy.
3.    Low serum albumin.
4.    Treatment with trimethoprim/sulfamethoxazole

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Cryptorchidism - is ultrasound (US) overused?

Cryptorchidism (undescended or malpositioned testis) is a common genital problem of boys which should be addressed by 6 months of age. While orchioplexy is the treatment of choice to relocate the testes into the scrotum (inguinal testicular migration occurs between 28-40 weeks gestation) successful repositioning does not entirely eliminate the long-term effects (infertility and testicular cancer).

From an analytical study of trends data over time, it appears that US is used in 33-50% of infants/children referred for
undescended testes which results in an approximate 3 month delay of surgical management and correct diagnosis in only 54% of patients.

US is of limited value in the management of undescended testes.

Pediatric humeral osteomyelitis 
A 10 year retrospective review of childhood osteomyelitis reveals the following: 
  1. Average age; 4.2 years.
  2. Distal humerus frequently affected.
  3. 55% are febrile.
  4. 78% have loss of movement.
  5. 70% present with pain.
  6. 73%-79% have elevated WBC, C-reactive protein level and ESR.
  7. MRI appears particularly useful in diagnosis.
  8. Blood/tissue cultures; most frequent organism - Staph.aureus.
  9. 53% require surgery.
  10. Treatment is by IV followed by oral antibiotics for 2-3 weeks each, respectively.
  11. Patients may in addition present with clinical signs of septic arthritis.

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Atopic Dermatitis
Atopic Dermatitis
Obesity and atopic asthma at school age
In a prospective longitudinal study of 5,044 children on asthma and obesity parents answered questionnaires at children's ages 6 months, and 1, 4.5 and 8 years with obesity being defined as a BMI >85th percentile.

A persistently elevated BMI from infancy increases the risk of doctor-diagnosed asthma at school age.
Sensorineural hearing loss (SNHL) and hyperbilirubinemia
It appears from a large study of infants born at >35 weeks gestation that SHNL occurs only with total bilirubin levels well above the AAP exchange transfusion thresholds or with bilirubin >35mg/dl.

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