Sept. 18, 2019 
Volume X | Issue No. 38
State gun laws and pediatric firearm-related mortality
"Firearms are the second leading cause of pediatric death in the USA." As state laws vary in firearm legislation, a web-based cross-sectional study over 5 years of 21,241 childhood firearm-related deaths, evaluated the association between pediatric deaths and (1) strictness of firearm legislation and (2) universal background and ammunitions checks and (3) identification requirement for firearm purchase.

Stricter state gun laws requiring universal background checks and stricter gun laws for firearm purchases are directly related to decreased pediatric firearm deaths.

See related video HERE & HERE.
Neuropsychiatric sequelae in adolescents with acute synthetic cannabinoids (SC) toxicity
"SCs are human-made mind-altering chemicals that are either sprayed on dry or shredded plant material so that they can be smoked (or sold as liquids) to be vaporized and inhaled in e-cigarettes and other devices." They are similar to chemicals found in marijuana plants and are marketed as safe and legal alternatives. Their effects however are neither safe nor predictable and may be life-threatening.
A multicenter analysis of a cohort of 415 adolescents (13-19 years of age) reported to the Toxicology Investigators Consortium (ToxIC) examined clinical presentation to an Emergency Department plus a variety of other parameters including neuropsychiatric symptoms.
SC-exposed adolescents (compared to cannabis) have a distinct neuropsychiatric profile (higher odds of coma and/or Central Nervous System symptoms including depression, seizures, hallucinations, delirium and/or toxic psychosis and extrapyramidal signs).
Risk of recurrent fractures
A population-based retrospective cohort study of approximately 2.5 million children 0 to 15 years of age of whom 43,154 suffered a fracture and were followed for 7 years indicates that a pediatric fracture (particularly before age 8 years) results in a 60% higher rate of subsequent future fracture (adjusted for sex, history of previous fracture, environmental setting and the presence of other injuries).

Childhood Obesity Facts 
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Office-based educational handout for Influenza vaccination
Approximately 8% of children are infected with influenza each year in the USA, many are hospitalized and on average 113 die. In spite of this and the American Academy of Pediatrics' recommendations that all children over 6 months of age receive yearly influenza vaccine, only 58% of children are vaccinated.
A randomized control study assessed whether providing parents with an educational handout ( about influenza and its vaccines), while waiting for a routine well visit, (compared to usual care), would enhance immunization rate.
Children of parents who received educational material on influenza and its vaccines have greater odds of being vaccinated. This is one method of enhancing childhood influenza vaccination rates.  
Metered-dose inhaler (MDI) with a spacer for newborns inhalation therapy 
A study of 117 well, normal and low-risk newborns (age 12-48 hours) measured the inspiratory pressure of each breath (during a 10 second period) to assess whether newborns are capable of generating sufficient negative pressure to allow for successful aerosol therapy using a spacer and face mask.
Only 37% of low-risk newborns generate a negative pressure sufficient to open a spacer valve. In neonates MDI aerosol therapy with a spacer chamber and face mask is unlikely to be beneficial . 
Pediatric Pulmonology 
Nicolau syndrome - uncommon but worth remembering! 
"Nicolau syndrome in an iatrogenic syndrome caused usually by intra-muscular injection (though can also occur with subcutaneous, intravenous and intraarticular injections) leading to variable degrees of tissue necrosis including skin and deeper tissues." It presents with immediate intense post-injection pain with a blue/purplish discoloration at the injection site. While etiology is unknown the ischemic necrosis is thought to be due to either vasospasm and/or embolization of injected material. Diagnosis is clinical and treatment includes maneuvers to improve vascularity/tissue oxygenation and antibiotics. Lesions heal with scarring and deformity and systemic complications (renal failure) and death may result.  
Journal of Pediatrics
Video Feature
Synthetic Cannabinoids: How to Manage Intoxication and Withdrawal
Synthetic Cannabinoids: How to Manage Intoxication and Withdrawal
Fluoride varnish application by primary care providers (PCP) - caries prevention and cost-savings/reimbursements
"Fluoride varnish is highly effective at reducing tooth decay if it is applied twice a year." The varnish is a pleasant tasting, fruity smelling pale yellow gel that sets quickly when applied using a soft toothbrush.
A systematic study of recent literature examined tooth decay and cost-benefits of fluoride varnish application by a PCP during a pediatric well-visit.
PCP application of fluoride varnish to the teeth of children <3 years of age reduces long term (to 7.5 years) tooth decay significantly averting restoration costs with good PCP reimbursement rates.
Journal of Pediatrics  
See related video HERE & HERE
Important Message from the Florida Department of Health
On August 16, 2019, the Centers for Disease Control and Prevention (CDC) issued an alert urging clinicians to report cases of unexplained pulmonary illness possibly linked to e-cigarette use, or "vaping," to their local health department. To date, 215 possible cases of severe pulmonary illness have been reported nationwide. Most have been hospitalized; in some cases, intubation, mechanical ventilation, and ICU care was required. Symptom onset was gradual, presenting with cough, shortness of breath, chest pain, fever, fatigue, nausea and diarrhea. Patients were negative for any infectious disease etiology and did not improve with antibiotic therapy. Some have improved significantly with corticosteroid therapy. All cases report a history of e-cigarette use or vaping prior to hospital admission.
Recommendations for Health Care Providers:  
1. Report cases of significant pulmonary illness of unclear etiology and a history of e-cigarette use or vaping to your local county health department:
Florida Department of Health in Miami-Dade County, Epidemiology, Disease Control and Immunization Services 305-470-5660 (Phone) and 305-470-5533 (Fax).
2. Ask patients presenting with pulmonary illness with an unclear etiology about the use of e-cigarette or vaping products or any inhalational method of drug use. Document the available details in the medical record.
3. For questions about treatment and clinical management of these patients, contact the Florida Poison Information Center Network (FPICN) at 1-800-222-1222.
The Bureau of Tobacco Free Florida in the Florida Department of Health has a Team Up To Quit initiative to engage health care providers, encouraging them to use the "2As+R" (Ask, Advise, Refer) protocol and to refer patients to Tobacco Free Florida's free, proven-effective cessation tools and services. Providers can use these tangible resources to refer their patients to Tobacco Free Florida, increasing their patients' chances of successfully quitting tobacco or vaping. For more information, visit
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