Towards a Rational and Efficient Diagnostic Approach in Children Referred for Growth Failure to the General Paediatrician

Based on a recent Dutch national guideline, we propose a structured stepwise diagnostic approach for children with growth failure (short stature and/or growth faltering), aiming at high sensitivity for pathologic causes at acceptable specificity. The first step is a detailed clinical assessment, aiming at obtaining relevant clinical clues from the medical history (including family history), physical examination (emphasising head circumference, body proportions and dysmorphic features) and assessment of the growth curve. The second step consists of screening: a radiograph of the hand and wrist (for bone age and assessment of anatomical abnormalities suggestive for a skeletal dysplasia) and laboratory tests aiming at detecting disorders that can present as isolated short stature (anaemia, growth hormone deficiency, hypothyroidism, coeliac disease, renal failure, metabolic bone diseases, renal tubular acidosis, inflammatory bowel disease, Turner syndrome [TS]). We advise molecular array analysis rather than conventional karyotyping for short girls because this detects not only TS but also copy number variants and uniparental isodisomy, increasing diagnostic yield at a lower cost. Third, in case of diagnostic clues for primary growth disorders, further specific testing for candidate genes or a hypothesis-free approach is indicated; suspicion of a secondary growth disorder warrants adequate further targeted testing.Horm Res Paediatr
Source: Hormone Research in Paediatrics - Category: Endocrinology Source Type: research

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Skin and intestinal epithelial barriers play a pivotal role in protecting underlying tissues from harsh external environments. The protective role of these epithelia is, in part, dependent on a remarkable capacity to restore barrier function and tissue homeostasis after injury. In response to damage, epithelial wounds repair by a series of events that integrate epithelial responses with those of resident and infiltrating immune cells including neutrophils and monocytes/macrophages. Compromise of this complex interplay predisposes to development of chronic nonhealing wounds, contributing to morbidity and mortality of many d...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
ConclusionThe use of radiography was satisfactory in identifying incomplete atypical femoral fractures, and the level of interobserver agreement was found to be good. As radiographs are associated with low positive predictive values, an advanced imaging method should be used when an increase in femoral cortical thickness is the only contributory factor to suspicion of an incomplete atypical femoral fracture.
Source: Skeletal Radiology - Category: Radiology Source Type: research
ConclusionHip steroid/anesthetic injection patients are more likely to demonstrate osteoarthritis progression and femoral head collapse than HC and GIPs in the injected joint 3 –12 months after steroid and anesthetic injection. Further evaluation of hip injectates and the injection population is warranted.
Source: Skeletal Radiology - Category: Radiology Source Type: research
ConclusionsIn patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.
Source: Skeletal Radiology - Category: Radiology Source Type: research
AbstractProgressive pseudorheumatoid dysplasia (PPD) is a rare disorder of postnatal skeletal and cartilage development that often presents with similar clinical findings to juvenile idiopathic arthritis. Patients with PPD display findings of progressive cartilage loss and secondary osteoarthritis over serial imaging studies and have an absence of elevation of inflammatory markers. Awareness of the imaging features of PPD on radiographs and magnetic resonance imaging (MRI) may be important for early diagnosis and surveillance of the disease.
Source: Skeletal Radiology - Category: Radiology Source Type: research
ABSTRACT Objective: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. Case description: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute ...
Source: Revista Paulista de Pediatria - Category: Pediatrics Source Type: research
CONCLUSION This case demonstrates that, similarly to Graves ’ disease, Hashitoxicosis can also be triggered by stressful life events.RESUMO OBJETIVO Mesmo que o estresse seja conhecido h á muito tempo como um fator provocativo para a doença de Graves, sua relação com a tireoidite de Hashimoto é mais controversa. Estudos sobre esse tema são escassos. O objetivo deste artigo é relatar um caso de Hashitoxicose induzida por estresse. RESULTADOS Aqui nós relatamos um caso de Has hitoxicose induzido por um evento psicológico estressante em uma mulher de 28 anos...
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
Thyroid hormone is essential for pregnancy and ensuring fetal development. Pregnancy also places substantial demands on the thyroid axis. Overt hypothyroidism is associated with substantial adverse obstetric and offspring outcomes and requires treatment. Borderline thyroid dysfunction is common in women and associated with adverse obstetric and offspring outcomes, although benefits of screening for and treating borderline thyroid function are unclear. Many women are established on thyroid hormone replacement before pregnancy and doses need increasing during pregnancy. Care is taken to prevent overreplacement. Universal thy...
Source: Endocrinology and Metabolism Clinics of North America - Category: Endocrinology Authors: Source Type: research
ConclusionA course of chiropractic care, following the AMCT protocol, was associated with remission of anosmia.
Source: EXPLORE: The Journal of Science and Healing - Category: Complementary Medicine Source Type: research
A UCLA-led research team has  found that giving mice antibiotics for 10 days prior to a liver transplant leads to better liver function after the surgery.After concluding the experiment mice, the scientists discovered data from liver transplants performed between October 2013 and August 2015 at the Ronald Reagan UCLA Medical Center, revealing that the same phenomenon appears to hold true in humans. The statistics from human patients even demonstrated that the people who were in worse health prior to their surgeries but received pre-surgery antibiotics fared better after their transplants than the patients who wer...
Source: UCLA Newsroom: Health Sciences - Category: Universities & Medical Training Source Type: news
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