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Can Fish Oil Help Reading?
Discussion Fats and fatty acids are essential for good human health. Saturated fats have hydrogen pairs linked to each carbon on the carbon backbone. They are solid or semi-solid at room temperature. Common examples are butter, lard, or hardened vegetable shortening. They are linked to higher cholesterol and triglycerides and only a small amount of them are recommended to be consumed in the diet. Unsaturated fats have one or more hydrogen atoms missing from the carbon backbone. They are liquid at room temperature. Monounsaturated fatty acids have one hydrogen pair that is missing from the carbon backbone. They are liq...
Source: PediatricEducation.org - November 20, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Long Do Late Preterm Infants Need Supplemental Feedings?
Discussion Premature infants have many problems to overcome because they just aren’t ready to live outside the uterine environment. Late premature infants are defined as birth between 34 0/7 weeks and 36 6/7 weeks gestation. In the U.S. this gestational age accounts for ~70% of all preterm births or ~300,000 births/year. Late preterm infants can have delayed oral feeding skills and failure to thrive along with increased hospital readmissions. Breastfeeding can be difficult as infants can have poor coordination and poor tone, along with decreased lactation in the mother. Learning Point Weight gain lags behind intraut...
Source: PediatricEducation.org - November 13, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes White Nails?
Discussion The nail matrix covers the area of the nail plate, and extends proximally in a crescent moon shape with the edges of the crescent extending proximally and inferiorly toward the underlying bone. The nail matrix is a multilayered epithelium that physiologically produces keratinization and gives rise to the nail plate. The distal matrix forms the lower 2/3s of the nail plate and the proximal matrix forms the upper 1/3 of the nail plate. the thickness of the nail plate is proportion to the matrix’s thickness. The nail plate’s free edge contour follows the shape of the nail’s lunula. Melanocytes occ...
Source: PediatricEducation.org - November 6, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Hypernatremia?
Discussion Hypernatremia is a serum sodium of> 150 mEq/L. Basic causes are too much sodium or too little free water. If body weight is normal or increased, there is an increase in total body sodium without an appropriate increase in total body water. Normally when the serum sodium is increased there is transient hypertonicity of the plasma which causes the thirst center to be stimulated and antidiuretic hormone (ADH) to be released. The thirst center tells the person to drink more water and ADH causes the kidney to retain free water. This normally will allow the plasma tonicity to go back to normal. Treatment is by tr...
Source: PediatricEducation.org - October 30, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Usher Syndrome?
Discussion Over 7000 diseases are considered rare disorders according to the National Organization for Rare Disorders® (NORD, rarediseases.org). NORD is a patient advocacy organization dedicated to individuals with rare diseases and the organizations that serve them. They have information on about 1200 rare diseases on their website (https://rarediseases.org/for-patients-and-families/information-resources/rare-disease-information/). Hearing loss (HL) is not rare and is a common problem across the ages. It affects 360 million people worldwide which is about 5% of the population. There are many causes of hearing loss an...
Source: PediatricEducation.org - October 23, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are the Health Needs of Incarcerated Youth?
Discussion In the US during 2011, ~60,000 youth were incarcerated at some time in a correctional facility. Boys are detained more than girls (86% vs 14% respectively in the US, 95% male in the United Kingdom in 2014) but girls have more health issues. There are racial and ethnic differences with 38-40% of detainees being black, 23% being Hispanic/Latino and 32% being white, and 5% other. For detained youth, 5% are for violent crimes, 22% for non-violent property crimes and the majority of the rest are for non-violent offices such as substance use. The average length of detainment is 3-4 months and unfortunately the rates o...
Source: PediatricEducation.org - October 16, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Is Hereditary Angioedema?
Discussion Angioedema is edema that is non-pitting, self-limited occurring in non-dependent areas usually in an asymmetric distribution usually on the lips, face, hands, feet, genitals and also in the bowel. It usually develops over minutes to hours (often 1-2 hours) with resolution usually within 24-48 hours. Angioedema often occurs with urticaria but 20% of patients may have isolated angioedema. Acute allergic angioedema is often caused by drugs (including antibiotics and non-steroidal anti-inflammatory drugs), foods, infections, insects, various organic substances (i.e. latex, preservatives, formaldehyde, etc.), and oth...
Source: PediatricEducation.org - October 9, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Clinical Signs Can Be Associated With Benign External Hydrocephalus?
Discussion Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles and/or subarachnoid spaces. External hydrocephalus is a communicating hydrocephalus often defined as the patient having a rapidly enlarging head circumference (HC) and enlargement of the subarachnoid spaces especially over the frontal lobes with normal or moderately enlarged ventricles. Benign external hydrocephalus (BEH) is a self-limited external hydrocephalus that occurs during infancy and resolves spontaneously in childhood, usually by age 2 years, that is felt to not cause significant problems. It was first described by...
Source: PediatricEducation.org - October 2, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Microcephaly?
Patient Presentation A 5-month-old male came to clinic for his health supervision visit and followup from his neonatal intensive care stay. He was born prematurely at 28 weeks gestation and his stay was complicated by a right sided Grade III intraventricular hemorrhage, a left-sided Grade IV intraventricular hemorrhage, neonatal seizures, respiratory distress and bronchopulmonary dysplasia, retinopathy of prematurity, acute kidney injury that had resolved, possible necrotizing enterocolitis incidents x 2, and herpes simplex encephalitis. He was on home oxygen, a nasogastric feeding tube because of aspiration risk and mult...
Source: PediatricEducation.org - September 25, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Are Twins?
Discussion Twinning is the conception and development of more than one zygote during one pregnancy. Monozygotic (MZ) twins arise from one zygote that then splits to form two embryos so that the twins are necessarily of the same gender (male-male or female-female). Dizygotic (DZ) twinning arises from the development of two independent zygotes and therefore the genders may be the same or different (male-male, female-female or male-female). Increased risks of spontaneous DZ twinning includes increased maternal age, parity and gravity, family history including familial clustering, maternal obesity and overweight and smoking. ...
Source: PediatricEducation.org - September 18, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Publishing Our 600th Case Today
This week we are publishing our 600th Case for PediatricEducation.org! We started in September 2004 to write a case of the week and it is amazing to see how all the information adds up. We cannot have done it without you our patrons, so we thank you for all of your feedback and support. A very special, thank you to each of you. Donna M. D’Alessandro, M.D. and Michael P. D’Alessandro, M.D. Curators, PediatricEducation.org (Source: PediatricEducation.org)
Source: PediatricEducation.org - September 11, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Proteins Cause Cow ’ s Milk Protein Allergy?
Discussion Cow’s milk protein allergy (CMPA) is one of the most common food allergies. It is estimated to have an incidence of 2-7.5% in infants and a prevalence of 0.5% in breastfeed infants. The prevalence decreases with age at 1% in children> or = 6 years. CMPA does not have a laboratory test and therefore is a clinical diagnosis. It is defined as a “hypersensitivity reaction brought on by specific immunologic mechanisms to cow’s milk.” Generally symptoms present within the first month of life and involve 2 of more systems with 2 or more symptoms. Systems are dermatologic (including atopic der...
Source: PediatricEducation.org - September 11, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Internet Gaming Disorder?
This study also found that “Internet gaming disorder, …, affects a small subset of the population exposed to online games, and does not appear to have increased in prevalence to the extent the [I]nternet usage has increased.” Data shows “[s]ignificant overlap in the neurobiology underlying both [gaming and Internet] addictions and substance use disorders have been found in animal models and human brain imaging studies.” People with IGD can have similar symptoms to people with substance abuse disorders including building tolerance for the activity (i.e. needing more) and having withdrawal sym...
Source: PediatricEducation.org - September 4, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Genetic Inheritance of Alport Syndrome?
Discussion Alport Syndrome is a genetic disease classically associated with progressive renal disease often leading to end stage renal disease, variable sensory neuronal deafness and ocular findings (perimacular retinopathy). A. Cecil Alport built on the work of others evaluating families with nephritis and/or hematuria. However he very clearly describes the third generation of a family with an X-linked dominant pattern and also emphasizes the syndrome’s associated deafness. Alport writes: “It will be seen from this that nearly all the children of three generations of one family suffer from hematuria or nep...
Source: PediatricEducation.org - August 28, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

At What Height Do You Consider Preventative Treatment for Acute Mountain Sickness?
Discussion Acute mountain sickness (AMS) is a well-known problem for some people who travel to high altitude, especially altitudes> 2500 m (~8200 feet). Symptoms include headache, nausea or emesis, shortness of breath, dizziness, fatigue, difficulty sleeping and poor appetite. The incidence in adults ranges from 25% at 2975 m to up to 75% at 5896 m. The incidence in children is less clear but it appears that children are more susceptible at 45% for 16-19 year olds for similar altitudes. Risk factors are numerous including age, gender, obesity, ascent rate, altitude for sleeping, previous exposure to high altitude, previ...
Source: PediatricEducation.org - August 21, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Should Parents Teach Their Children About Stranger Safety?
Discussion Fortunately, when a child goes missing it is usually for short periods of time and is often because of miscommunication or expectations. Familiar examples are a child wandering away, or not returning at the proper time. Unfortunately, child abduction does occur. Data from the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention provides the statistics below. Problems with definitions and reporting make these statistics more difficult to gather. ~340,500 children (43%) reported in 1999 as missing, were because of benign causes and no harm occurred to the child. Most were becau...
Source: PediatricEducation.org - August 14, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Can Parents Do To Promote Literacy?
Discussion Positive parenting has been shown to improve the overall health and well-being of children. Positive parenting includes: Respecting the individuality of the child and the adult in the relationship – accept the child for their strengths and weaknesses, encourage children to take risks, encourage their confidence in themselves Respecting that the individuals are part of a family and community – help children understand that they cannot have everything their way, that other people and the world they live in must be considered too. Even in a resource poor environment, data shows that positive parenting ...
Source: PediatricEducation.org - August 7, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Summer Break
PediatricEducation.org is taking a summer break. The next case will be published in on August 7th. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - July 31, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Conditions is Erythema Nodosum Associated With?
Patient Presentation A 12-year-old male came to clinic with a history of 3-4 days of painful bruising on his shin and lower arms. He had Streptocococcal pharyngitis diagnosed by rapid strep testing approximately 4 weeks previously and had taken all of his amoxicillin antibiotic per his parents. He had recovered without any problems until 3-4 days ago when his legs and arms started to have painful bruises along the shins and lower arms. They were raised, red/purple and painful mainly in the center of the lesions. He denied pain elsewhere nor any fever (Tmax was 99.5F), chills, sweats, weight loss, joint stiffness, abdomina...
Source: PediatricEducation.org - July 24, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Are STIs?
Discussion Of the 30 different microbes which can be transmitted by sexual contact, 8 have the greatest incidence of transmitting disease. Four are curable (Chlamydia, Gonorrhea, Syphilis and Trichomoniasis) and 4 are incurable at present (Hepatitis B, Herpes simplex virus (HSV), Human immunodeficiency virus (HIV) and Human papillomavirus (HPV)). Sexually transmitted infections (STIs) are important as they can cause: Increased rates of acquisition of other STIs (ie HSV and syphilis increase the rate of HIV infection acquisition) Pelvic inflammatory disease and infertility Stillbirth and neonatal death Neonatal morbidity i...
Source: PediatricEducation.org - July 17, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Do Children Grow Overnight?
Discussion Growth is an important vital sign for children. Normal growth patterns usually indicate healthy children and can be reassuring for both the parents and health care providers alike. Children are not usually measured very often by parents or health care providers and therefore the actual growth occurrence is not identified until after the event. Measuring small increments accurately also makes data collection difficult, along with the inconvenience of frequent serial measurements. A review of various growth parameters in children can be found here. Learning Point There is evidence that children do grow over very...
Source: PediatricEducation.org - July 10, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Summer Break
PediatricEducation.org is taking a summer break. The next case will be published in on July10. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease Cases listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - June 26, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Urinary Hesitancy?
Discussion “Hesitancy” denotes difficulty in initiating voiding when the child is ready to void,” according to the International Children’s Continence Society. It is not seen that often in pediatrics in isolation, but is commonly associated with other symptoms such as dysuria, frequency, abdominal or anal pain which may indicate common problems such as a urinary tract infection, vaginal/perineal irritation, or constipation. Communication problems can also confound the accuracy of the history as patients and families can have a difficult time describing the urinary problem they are experiencing or ma...
Source: PediatricEducation.org - June 19, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What are Indications for Continuous Positive Airway Pressure (CPAP)?
DiscussionObstructive sleep apnea syndrome (OSAS) is defined as a “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns.” It is different than primary snoring which is snoring without apnea, sleep arousals, or problems with gas exchange. OSAS symptoms include snoring (often with snorts, gasps or pauses), disturbed sleep (often frequent arousals) and daytime neurobehavioral problems. Sleepiness during the day can occur but is less common in...
Source: PediatricEducation.org - June 12, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Do I Keep My Prescription Stimulant Safe At College?
Discussion Going away to college presents new and exciting opportunities for young adults. It also is an important time for transitioning many adult responsibilities to the young adult too. Keeping safe is important and safety tips for college can be reviewed here. Any medication can be abused. Prescription stimulants are no different. Normally prescription stimulants are used for treatment of attention deficit disorder, narcolepsy and treatment resistant depression. They can help increase alertness, attention, and energy, cognition, learning and memory. However for these reasons and because they are easy to obtain and r...
Source: PediatricEducation.org - June 5, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Adult Problems Can Start with Fetal Undernutrition?
Discussion Developmental origins of health and disease (DOHaD) is a scientific hypothesis that proposes that fetal nutrition has permanent effects on growth, metabolism, and structure. These changes, or biological programming, are felt to occur at critical periods in fetal development “…when developmental changes in the organism towards increasing complexity, greater plasticity, and more efficient functioning occurs rapidly and may be most easily modified either in favorable or unfavorable directions.” Fetal undernutrition has been studied more than overnutrition, and various nutritional components (prot...
Source: PediatricEducation.org - May 29, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Much Peanut Butter Should He Take?
Discussion Peanut allergy is an increasing problem with ~2% prevalence in the United States. It is also the leading cause of food-related death. The LEAP trial (Learning Early about Peanut Allergy trial) was a randomized trial of early introduction of peanut foods to try to prevent peanut allergy. It found a significant decrease in peanut allergy at 60 months of age with early introduction of peanut foods to infants. This finding occurred in participants with baseline negative skin testing (13.7% in peanut avoidance group versus 1.9% in peanut consumption group) or those with measureable peanut skin testing at study entry ...
Source: PediatricEducation.org - May 22, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Anemia?
Discussion One of the most common problems in pediatrics is anemia. It is defined as “a lower than normal value for the related measurements of hemoglobin, hematocrit, and number of red blood cells”, usually 2 standard deviations below the normal for age. Normal hematological values change with age. For a discussion of which values are used click here. The most common type of anemia in childhood is iron deficiency which is commonly caused by inadequate stores (e.g. premature infant), inadequate intake (e.g. poor nutrition) or blood loss (e.g. menses). Anemia screening is recommended at age 9-12 months, and for...
Source: PediatricEducation.org - May 15, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes School Absenteeism?
Discussion School within society is an institution designed to provide learning opportunities to students under the direction of teachers. The curriculum is usually designed to provide academic content in formal subjects necessary for the adult world (such as instruction in mathematics, language, science, social studies, arts, physical education) but also other knowledge and skills for the adult world (i.e. personal safety, communication skills, working in teams, etc.). Specific schools may or may not offer specific courses of instruction such as religious education, learning disability education, gifted/talented education...
Source: PediatricEducation.org - May 8, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Good Are Ankle Rules for Determining If a Patient Needs An X-Ray?
This study supports that if the clinical examination indicates a low risk injury, then radiographs are not indicated. If the examination indicates a potential high risk injury, then the radiographs would be indicated because the clinical examination cannot discern well enough if a fracture is present or not. Use of the Low Risk Ankle Rule was evaluated in a Canadian study of 3-16 year old children. The study found a decrease in radiographs by 22% using the Low Risk Ankle Rules. Overall the sensitivity was 100% and the specificity was 53.1%. This study supports that if the examination indicates a low risk injury, then rad...
Source: PediatricEducation.org - May 1, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is α -1-Antitrypsin Deficiency?
Discussion α-1-Antitrypsin Deficiency (A1AT) is a common single-gene mutation disease that is homozygous recessive. The normal allele is called M and the most common abnormal allele is Z. There are other alleles though. The gene codes for one of the primary protease inhibitors in the serum, thus those who are homozygous for the Z gene are sometimes referred to as “PIZZ” or “PIZ.” α-1-Antitrypsin is found in all body tissues but is especially important in the serum and lung. As noted it is one of the primary neutrophil protease inhibitors in the serum, and acts to neutralize these enzymes...
Source: PediatricEducation.org - April 24, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Short Spring Break
PediatricEducation.org is taking a short spring break. The next case will be published in on April 24. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease Cases listed at the top of the page. Maybe even a few spring flowers outside your window too. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - April 17, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are the Clinical Symptoms Associated with Friedreich Ataxia?
Discussion Friedreich ataxia (FRDA) was first extensively described in a series of papers from 1863-1877 by Nikolaus Friedreich at the University of Heidelberg, Germany. In 1996 the genetic mutation was described. It is an autosomal recessively inherited, homologous expansion of the GAA repeat in intron 1 of the frataxin gene on chromosome 9q13. It causes a transcription error leading to a decrease in frataxin which is a mitochondrial protein involved in iron metabolism and other cell functions. Frataxin is seen mainly in the central and peripheral nervous systems, heart, pancreas and skeleton. Frataxin is produced but in ...
Source: PediatricEducation.org - April 10, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Uveitis?
Discussion Inflammation of the middle layer of the eye, or uvea, is termed uveitis. Uveitis can be divided into anterior, intermediate or posterior uveitis by involving the anterior (iris and ciliary body), intermediate (vitreous) or posterior (choroid and usually retina) compartments. Panuveitis involves all 3 compartments. Duration can also be used to classify uveitis. Acute is 6 weeks and> 3 months is chronic persistent uveitis. Episodic periods of inactivity and reactivity that last more than 3 months are called recurrent uveitis. A third way to characterize uveitis is if it is granulomatous or not. Uveitis increase...
Source: PediatricEducation.org - April 3, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Is the Mole Alphabet Again?
Discussion Melanocytic nevi or moles are pigmented nevi that are extremely common in children with ~ 98% of Caucasian children having at least 1 by early childhood. They are caused by benign melanocyte growth. These nevi reside in the epidermis or dermis, whereas regular melanocytes that produce general skin pigmentation reside in the basal layer. Moles are very often uniform – they basically look the same within the individual. The number of moles increases in the first 2-3 decades of life. Teens having 15-25 moles. They can also disappear. Congenital melanocytic nevi are found in 1-3% of newborns and grow in prop...
Source: PediatricEducation.org - March 27, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Where is the Greatest Risk of Infectious Disease Transmission While Onboard an Airplane?
Discussion Airplanesare a global transportation mechanism for the world for passengers and cargo. It is an engine which helps to fuel the global economy. In 2014, over 3.3 billion people traveled to more than 41,000 airports and 50,000 routes across the world. It is possible to travel around the world within about 24 hours. This is shorter than most infectious disease incubation periods. Although entry screening into countries is done, exit screening closer to the source is a better model as noted with the recent Ebola outbreak in west Africa in 2014. Individual infectious disease risk includes the generation rate of the ...
Source: PediatricEducation.org - March 20, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Spring Break
PediatricEducation.org is taking a short Spring break. The next case will be published on March 20. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - March 13, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Health Risks Does Climate Change Pose?
Discussion Japanese encephalitis virus (JEV) is a Flavivirae, arbovirus that is endemic to many areas of Asia and the Pacific. It is estimated to affect ~70,000 people/year with ~10-15,000 deaths yearly in 20 countries, with a fatality rate of 35-40%. It can cause encephalitis and irreversible neurological morbidity. JEV is spread by Culex mosquitos which feed on swine. Increased environmental temperature and increased humidity (warm air is more moist) increases mosquito numbers, their survivability and ultimate dissemination. China has the highest rates of JEV with particular areas being more prone, as some areas co-farm ...
Source: PediatricEducation.org - March 6, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Safety Risks of Baltic Amber Teething Necklaces and Similar Cultural Practices?
Discussion Amber is fossilized tree resin that is prized for its beautiful colors from deep brown to caramel, yellow, green or even white. It is promoted for its “healing properties” although there is not scientific evidence that supports the many potentiated mechanisms of these properties. One of the most consistent is that amber contains succinic acid which proponents believe is absorbed through the skin and is a pain reliever. Succinic acid was actually first purified from amber in 1546 by a German chemist. Succinic acid in humans is an important part of the Krebs cycle and acts as an important metabolite in...
Source: PediatricEducation.org - February 27, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Hyperammonemia?
Discussion Reye’s syndrome (RS)is named for Dr. Douglas Reye who along with Drs. G. Morgan and J. Baral described encephalopathy and fatty accumulation and degeneration in children in a 1963 Lancet article. RS usually affects children but can occur at all ages. All organs can be affected but the liver and brain are primarily affected causing liver failure and encephalopathy as toxic metabolites (especially ammonia) accumulate, and intracranial hypertension and cerebral edema occurs. As the ammonia levels begin to rise (> 100 mg/dL) patients lose their appetite, have nausea and emesis and mental status changes whic...
Source: PediatricEducation.org - February 20, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

At What Radon Level Should Mitigation Be Considered?
Discussion Radon is a naturally occurring, radioactive gas that is colorless, odorless and tasteless. It is produced from the normal radioactive decay of uranium into radium and then into 222R-Radon. Radon gas escapes from soils and rocks into the air and generally concentrates in enclosed spaces such as buildings, mines and caves. The general ionizing radiation dose received by the general public is caused by radon in large part. In homes and other buildings, soil gas is the most important source of residential radon, but other sources which are less important includes building materials and well water sources. Indoor ra...
Source: PediatricEducation.org - February 13, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Can Families Do for Fire Safety?
Discussion Home fire safety is important. Prevention safeguards life and property. In 2014, the U.S. Fire Administration reported there were 3,428 deaths caused by fires. The most common pediatric age group is 0-4 years, with decreasing risk with advancing age. In the adult age group, the rates hold steady until the 40-50’s when there starts to be an increasing risk in the older population again. Other groups at risk are those with disabilities, and people living in rural areas. Intentional fires or arson are highest obviously in urban environments. The leading cause of fire deaths in the US is because of smoking. ...
Source: PediatricEducation.org - February 6, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Black Spot Poison Ivy?
Discussion Poison ivy (PI, Toxicodendron radicans) is a common plant in North America that causes allergic contact dermatitis. Poison oak and sumac also cause similar problems. The rash usually appears as linear erythematous papules or vesicles occurring soon after exposure. Patients often do not identify the exposure specifically but will say they were walking/playing in gardens, fields or woods. PI can be a small plant, vine or even a shrub. The coloring changes over the growing season. Fires may also be a source as burning the plants and being in the smoke can cause extensive lesions on the body. The plant has 3 leaves...
Source: PediatricEducation.org - January 30, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is in the Differential Diagnosis of Fatigue?
Discussion Fatigue is a subjective feeling of decreased energy, tiredness or feeling of exhaustion. Lethargy is often used synonymously, but lethargy is a state of being drowsiness or sleepy, and implies mental status changes. Both can cause the person to be apathetic or less active. Fatigue is a common state that almost everyone experiences multiple times in his or her lifetime. For most people it is a relatively acute or short-term chronic problem, often with a relatively easily identifiable problem cause, such as inadequate sleep, acute illness, or overexertion. For some, it can be less readily identifiable such as dep...
Source: PediatricEducation.org - January 23, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Options for Acne Treatment?
Discussion Acne vulgaris or acne is a problem of the pilosebaceous follicle. It occurs most prominently where sebaceous glands are abundant especially the face, neck, and upper back. Sebum production increases because of androgens. Keratin and sebum clog the pores of the pilosebaceous unit causing hyperkeratosis (clogged pilosebaceous unit = clogged pores = comedomes). Propionibacterium acnes, a gram-negative anaerobe, multiplies in the sebaceous unit causing an inflammatory reaction resulting in moderate or severe acne. Skin lesions include: Comedomal acne has comedomes White heads = closed comedomes Black heads = open...
Source: PediatricEducation.org - January 16, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Precautions Should A Childcare Center Take For A Child with Hepatitis C Infection?
Discussion It is estimated that 180 million people worldwide are infected with Hepatitis C (HCV) which includes ~11 million children. In the United States it is estimated that there were 30,500 acute HCV cases in 2014, and 2.7-3.9 million people with chronic HCV. Many infections are not identified. It is estimated that “…only 5-15% of HCV-infected children in the United States are identified.” Problems associated with HCV include acute hepatitis (including fever, malaise, dark-urine, abdominal pain, jaundice, appetite loss, nausea, emesis, clay-colored stools), acute fulminant hepatitis (not common in c...
Source: PediatricEducation.org - January 9, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Mid-Winter Break
PediatricEducation.org is taking a mid-winter break. The next case will be published in the new year on January 9th. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We wish you a Happy New Year, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - December 26, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Medical Problems Do Laundry Pods Cause?
Discussion Laundry detergent capsules are small, single-use pod, liquidtab or sachets with concentrated cleaning product encased in a water dissolvable membrane. They are brightly colored and promote use by being conveniently single-use. They are used mainly for laundry and dishwashers, and look similar to candy or toys which encourages ingestion by children. They were first used in Europe in 2001, and then were marketed in the U.S. in 2010. Not long afterwards, there was an increase in Poison Control Center calls regarding exposure to the products particularly by small children. An analysis from 2012-2013 found the number...
Source: PediatricEducation.org - December 19, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Some Criteria For Varicocele Evaluation?
Discussion Varicoceles are caused by high venous back pressure which causes a tortuous dilatation of the testicular veins (pampiniform plexus) of the spermatic cord. They occur more on the left than right because the left renal vein has a higher pressure than the inferior vena cava which drain the left and right gonadal veins respectively. Varicoceles are not very common in young children (3% in
Source: PediatricEducation.org - December 12, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What are Potential Health Problems Associated with Polycystic Ovary Syndrome?
DiscussionPolycystic ovary syndrome (PCOS) affects 6-8% of reproductive-age women making it the most common endocrinopathy in this age group. There is no consensus on the specific diagnostic criteria for PCOS in adolescents as many of the characteristics overlap with normal adolescent physiology. However, patients should have evidence of hyperandrogenism, oligo- or amenorrhea, and potentially polycystic ovaries. PCOS has a genetic component although a specific gene has not been identified. Incidence of PCOS is 20-40% for a woman with a family history. Hyperandrogenism Androgen levels change during puberty therefore actual ...
Source: PediatricEducation.org - December 5, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news