Miami, FL
Oct. 3, 2018
Volume IX | Issue No. 40
Painless injured tongue 
An interesting case report of a 7 year old boy who presented with a large painless blister on his tongue (whose mother diagnosed it as a burnt tongue from hot food), a history of a previous significant tongue bite and parents who are first cousins with a relative having being diagnosed with sensory and autonomic neuropathy type 4 (HSAN IV, also known as congenital insensitivity to pain with anhydrases-CIPA) reminds us that HSAN IV is a rare autosomal recessive condition which causes problems with pain sensation and temperature control. (A mutation in the NTRK 1 gene results in an abnormal neurotropic receptor which affects the subsequent transition of nerve signals causing the affected neurons to die prematurely).

Archives of Disease in Childhood
Dangers associated with "Dragon's Breath"
Dragon's Breath is the mythical description of the dragon's ability to emit fire from their mouths. Eating "Dragon's Breath", a snack covered with liquid nitrogen which allows a diner to breath our "smoke" is the latest innovative way teens are risking their health.
A snack food (e.g. cheese puffs, doughnuts, etc.) covered with poured liquid nitrogen which freezes instantly at around -320 F if ingested or held incorrectly can lead to serious skin and mouth and tongue burns, damage to eyes, trigger an asthma attack and cause death from asphyxiation. The practice should be strongly discouraged.
Gut microbiota and growth in infancy 
It has become increasingly apparent that the genetic pool of the trillions of microbiota that live in the gut play an important role in body physiology, metabolic health and the immune system. Having a high diversity of gut microbes is usually associated with good health, while disruption has been linked to asthma, diabetes, heart disease and obesity (in adults and adolescents). Their influence on weight gain is unknown.
A study of gut and oral microbiota examined its relationship in 226 two-year-olds to weight and length and rapid infant weight gain (a strong indicator for childhood obesity).
Growth curves in young children are directly influenced by the diversity of oral and gut microbiota. By age 2 years the oral microbiota profile of children experiencing rapid weight gain has already begun to establish patterns often seen in obese adults.
See related video HERE & HERE
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Pigmented villonodular synovitis (PVNS) of the knee as a cause of pain in children

"PVNS is a benign proliferative synovial disorder most commonly seen in adults."

A 16 year retrospective review of 17 pediatric patients (average age: 11 years) treated for PVNS of the knee describes its presentation and management.
Results indicate:
  1. >50% of children are misdiagnosed with a variety of rheumatologic or orthopedic conditions, though magnetic resonance imaging (MRI) in 71% includes PVNS as a potential diagnosis.
  2. All children require surgery (single or staged) and 30% require >2 operations.
  3. 89% of procedures are orthoscopic synovectomies.
  4. 59% have nodular disease, 24% diffuse and 18% a mixed picture.
  5. At 15 months follow-up 88% are disease free.
"PVNS should be considered in pediatric patients with an insidious inset of joint swelling with or without pain."

See related video HERE.    
Chest x-rays to exclude diagnosis of pneumonia in young children

A prospective study to assess the negative predictive value of a chest radiograph to exclude children with suspected pneumonia enrolled 683 infants/children 3 months - 18 years over a 2 year period. X-ray chest results were radiologically reported as positive, equivocal or negative. Children with negative x-ray chests were subsequently followed for 2 weeks.
Of 411 children with clinically suspected pneumonia whose chest x-rays were negative, only 1% was subsequently diagnosed with pneumonia.
"A negative chest x-rays excludes pneumonia in the majority of children. It appears that children with a negative chest x-ray and low clinical suspicion of pneumonia can be safely observed without antibiotic therapy."
Video Feature
Is Dragon's Breath Snack Safe to Eat?
Is Dragon's Breath Snack Safe to Eat?
Pro-inflammatory effects of e-cigarette vapor on human alveolar macrophages
Apparently e-cigarette vapor contains more than 250 chemical substances (like benzene, toluene and formaldehyde) which differ qualitatively from those found in e-cigarette liquids. A study which examined the cytotoxic effects of un-vaped e-cigarette liquid (ECL) and e-cigarette vapor (ECVC) indicates that macrophage culture with either ECL or ECVC results in a dose dependent reduction in cell viability with ECVC being cytotoxic at lower concentrations.
ECVC is significantly more toxic than ECL and enhances the excessive production a number of inflammatory cytokines, chemokines and antioxidants, which enhance cell apoptosis and necrosis and impairs cellular phagocytosis.
The widely held view that e-cigarettes are safe may be contrary to emerging information
Maternal and infant obesity 
Results of a study on obese women and growth/weight trajectories of their singleton offspring randomly assigned to receive antenatal dietary and lifestyle advice, or standard antenatal care indicates that a comprehensive lifestyle intervention program (provided during pregnancy) for overweight/obese women has NO beneficial effect on measures of child weight, growth or neurodevelopment at 18 months of age.

Meet Luis Gonzalez-Mendoza, MD - The Division of Endocrinology at Nicklaus Children's Hospital
Meet Luis Gonzalez-Mendoza, MD - The Division of Endocrinology at Nicklaus Children's Hospital
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