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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

What Picky Eaters Really Don ’ t Eat?
Discussion Picky eating does not have one definition and is a broad term. In general, picky eaters are described as limiting the amount and types of food, and a refusal to eat novel foods. Normal healthy children often will reject different types of food they have accepted before in their second year of life. They tend to place more value on food properties such as the color or texture. Feeding problems occur in 25-45% of normally developing children and in up to 80% of developmentally delayed children. Most of the problems are acute issues and resolve within a short time with reasonable guidance and interventions. Most c...
Source: PediatricEducation.org - November 28, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Can You Do About Tinnitus?
Discussion Tinnitus is derived from the Latin word tinnire which means to ring but in general practice it means any perceived sound that is not generated externally. It is a common problem in adults. In children it is described as being commonly overlooked as children do not spontaneously report it. It is felt that children may consider the sound normal, or are easily distracted and therefore forget about it. Children can accurately describe the sounds they hear and use words such as buzz, ring, hum, swish, whish, blow or beep. Spontaneously reported tinnitus is ~6.5% and increases to 34% when children are specifically que...
Source: PediatricEducation.org - November 21, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is Post Traumatic Stress Disorder in Children?
Discussion “Exposure to traumatic stress events including physical abuse, sexual abuse, violence, witnessing violence in the home or community, severe family dysfunction/psychopathology, natural disasters, severe accidents and/or their own or their caregivers’ life-threatening illness are not uncommon in children and adolescents.” It is estimated that up to 60% of teens age 16-18 have experienced at least 1 traumatic event. Some children, teens and adults may experience transient psychological problems or distress which may cause physical complaints including pain, behavioral changes such as irritation o...
Source: PediatricEducation.org - November 14, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How is Swimmer ’ s Itch Diagnosed?
Discussion Cercarial Dermatitis (CD) is known by many names throughout the world, but is commonly known as swimmer’s itch. It is a water-borne, non-communicable infectious disease that is caused by the larval stage (cercariae) of parasitic schistosomatid flukes. The cercariae causes an allergic maculopapular skin rash in humans that is usually self-limited (usually 4-10 days) but can cause problems for up to 20 days. CD parasites are considered an emerging disease because of the increased distribution of the problem across the globe. Different parasite species cause the problem. In a normal life cycle that occurs ma...
Source: PediatricEducation.org - November 7, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Long Do Concussive Symptoms Last?
Discussion Concussion as defined by the International Conference on Concussion in Sport in 2012 is “Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.” It results in quick onset of signs and symptoms of physical and cognitive impairment. Concussion is sometimes referred to as mild traumatic brain injury (TBI) as mild TBI refers to “…concussions that are generally not life threatening despite the potential for short-term disability and serious ongoing sequelae.” Concussion symptoms are usually categorized as...
Source: PediatricEducation.org - October 31, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Can Parents Do To Help Their Junior High or High School Student Start Off Right?
Discussion Starting junior high and high school are big moments for teenagers. They are milestones on the way to adulthood. They require the student to take additional steps toward independence. The schools are usually physically larger at each step and require the student to interact with more teachers, school personnel and other students. Students start to independently engage within the larger community by participation in after school activities such as sports, music, volunteering, etc. Junior high and high school are excellent times to try different activities. Before junior high, many adult relationships the students...
Source: PediatricEducation.org - October 24, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Neonatal Mastitis?
Patient Presentation A 15-day-old full-term female came to clinic with left breast swelling. Her mother said that the baby had some symmetric breast swelling after birth but that it had been resolving. She noticed the left breast swelling about 12 hours before and said that it seemed tender as the infant fussed more when it was touched. She denied any nipple discharge, fever, irritability, or feeding problems. There were no sick contacts. The past medical history showed a full-term infant born after an uneventful pregnancy and delivery. Maternal laboratories were negative and the infant received all routine care after del...
Source: PediatricEducation.org - October 17, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Some Developmental Milestones for Solid Food Readiness?
This study and others found many poor feeding habits including excessive juice, inappropriate foods (i.e. french fries, pizza, macaroni and cheese, etc.), allergenic foods (i.e. eggs and peanut butter), and prechewing of table foods. Learning Point Breastfeeding or formula should be the main meals and calorie sources for infants during the first year. Solid food feeding is important for infant growth and development; they help the infant to learn about tastes and textures during the first year of life but initially should be used in small amounts like a dessert. There are development differences when infants are ready to ...
Source: PediatricEducation.org - October 10, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Creepy Crawlie Therapy?
Discussion Humans are only one species among the multitudes that inhabit the earth. While many species are used by humans for food, clothing or shelter, as a higher evolved organism, humans are particularly aware of other species that move as they could be a potential predator or cause injury. This wariness is protective, but moving animal species can be domesticated (e.g. dogs, horses), farmed (e.g. cattle, goats) or harvested (e.g. fish, silk) for human use for food, clothing or shelter and also for medicinal use. Learning Point Medical leeches have been used since ancient times. The most commonly used leech is Hirudo me...
Source: PediatricEducation.org - October 3, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Family Meals: They Do Everyone Good
Discussion Family meals (FM) are “…occasions when food is eaten simultaneously in the same location by more than 1 family member.” Overall, more frequent family meals are protective for healthy physical and psychosocial functioning across socioeconomic status, race/ethnicity and gender. Why FMs have these protective effects (possibly related to family connectedness) is unclear and additional research is ongoing. Factors associated with increased FMs include: Increased parental education Gender – adolescent boys report more FM than adolescent females Race/ethnicity – Asian-Americans have more...
Source: PediatricEducation.org - September 26, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common are Herniated Disks in Children?
Discussion Intervertebral disk herniation occurs at the same locations in pediatric patients as adults with L4-L5 and L5-S1 being the most common. Patients often (30-60% for lumbar disk patients) have a direct trauma or sports related injury that is identified before the onset of pain. There is also a group of morbidly obese patients who probably have degenerative disease. In adults and children, lumbar disk herniation is also seen with repetitive or excessive axial loading, poor conditioning, decreased range of motion and history of prior back injury. Disk herniation is caused by vertebral motion that causes increased int...
Source: PediatricEducation.org - September 19, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Hyperphosphatemia?
Discussion Constipation is a common problem in general pediatrics and its causes are numerous. It can cause acute and recurrent abdominal pain and is a cause of abdominal distention. Patients who are young, whose presentations are other than routine or who had complications should be invested for underlying causes of their constipation. This patient had undergone some evaluations in the past for constipation but because of the presentation of sepsis a more rigorous evaluation was undertaken. The differential diagnoses of the following can be found here: constipation, acute abdominal pain, recurrent abdominal pain, and abdo...
Source: PediatricEducation.org - September 12, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Effective is Oseltamivir?
Discussion Oseltamivir (Tamiflu®) is an oral neuraminidase inhibitor of influenza viruses types A and B. It first came on the market in Switzerland in 1999 and currently is used around the world along with other neuraminidase inhibitors to treat seasonal and pandemic influenza. Oseltamivir is easily absorbed from the gastrointestinal tract, and circulates to the liver where it is converted to its active metabolite oseltamivir carboxylate (OC). In adults approximately 75% of the oral medication is converted and it then travels to the upper and lower respiratory tracts. Unchanged oseltamivir is eliminated in the urine. ...
Source: PediatricEducation.org - September 5, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

In Klinefelter Syndrome Patients, What are the Common Behavioral Problems?
Discussion Klinefelter syndrome (KS) is a common genetic abnormaly with a prevalence of 1 in ~650 male births. It was first described in 1942 by Dr. Harry Klinefelter. It is associated with at least one extra X chromosome with the most common karyotype (~80% of patients) being 47 XXY. Other karyotypes are seen along with mosaicism. It is believed that although it is very prevalent, only about 25-33% of people with KS are identified. About 10% are identified before puberty with the rest usually identified because of hypogonadism and tall stature especially in teenage years or due to infertility in adulthood. KS is diagnosed...
Source: PediatricEducation.org - August 29, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is a Hydrocoele of the Spermatic Cord?
Discussion Hydrocoeles are common anatomic variations caused by the incomplete obliteration of the processus vaginalis. The processus vaginalis is a peritoneal remnant that follows the testis and spermatic cord into the scrotum as the testis descends into the scrotum during development. As the processus vaginalis traverses from the testis back to the peritoneum, a hydrocoele can occur at any point along its length. The obliteration of the processus vaginalis occurs with the closure at the internal inguinal ring, followed by closure just above the testes with atresia of the area in between. The closure of the area around th...
Source: PediatricEducation.org - August 22, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Medical Problems Can Patients with Turner Syndrome Have?
Discussion Turner Syndrome (TS) is one of the most common genetic disorders in females. It was first described by Dr. Henry H. Turner in 1938. It affects 1 in 2000-2500 births and ~70,000 girls and women have TS in the United States. It is caused by the absence of all or part of the second X chromosome. The most common variation is 45X which affects about 50% of TS patients and usually has the most complications, but there are other variations. Phenotypes vary and therefore the age of diagnosis varies. Mean age of diagnosis unfortunately is 15 years. Diagnosis is made by chromosomal analysis. Haploinsufficiency of the SHOX...
Source: PediatricEducation.org - August 15, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

When Is the Clinical Nadir for Guillain-Barr é Syndrome?
Discussion Guillian-Barré syndrome (GBS) is an acquired, acute, inflammatory, demyelinating polyneuropathy. It is the most common cause of acute and subacute flaccid paralysis in children. GBS causes about 0.4-1.3 cases per 100,000 persons/year in children. It can occur in any age group and the incidence increases among all age groups until a peak in the 50s. Both genders are affected and there may be a slight increase in males. GBS usually occurs 2-4 weeks after a prodromonal gastroenteritis or respiratory illness. It is most often associated with Campylobacter jejunae, Haemophilus infuenza, Mycoplasma pneumoniae,...
Source: PediatricEducation.org - August 8, 2016 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 8th. In the meantime, please take a look at the different Differential Diagnoses, Symptoms and Diseases 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 - August 1, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are the Complications and Treatment for Lymphedema?
Discussion Lymphedema occurs because of abnormal development or damage to the lymphatic structures. It is a chronic often progressive swelling of tissues starting distally and advancing more proximally. Extremities are the most common sites followed by genitalia. Fluid accumulation in the interstitial, superficial spaces causes adipose deposition and fibrosis. This causes the lymphedematous tissue to then enlarge. Edema is pitting early on and later is non-pitting. Causes of lymphedema can be primary (~1%) or secondary (~99%). Primary lymphedema has been associated with several genetic mutations. Milroy disease is a prima...
Source: PediatricEducation.org - July 25, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Look What I Got On Summer Vacation – Giardia!
Discussion People often don’t think that developed countries have parasitic diseases but this is not true. The major parasitic infections endemic in the United States can be thought of as: Intestinal parasitic infections Seen throughout the US but especially in the northern states during the summer Often occur through recreational water use Cryptosprodiosis, Dientamoebiasis and Giardiasis are the most common. Neglected tropical diseases Seen especially in the southern states (especially Texas) and are linked to extreme poverty Chagas disease, Cutaneous Leishmaniasis, Toxocariasis, and Toxoplasmosis are the most co...
Source: PediatricEducation.org - July 18, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Look What I Got On Summer Vacation – Giardia!
Discussion People often don’t think that developed countries have parasitic diseases but this is not true. The major parasitic infections endemic in the United States can be thought of as: Intestinal parasitic infections Seen throughout the US but especially in the northern states during the summer Often occur through recreational water use Cryptosprodiosis, Dientamoebiasis and Giardiasis are the most common. Neglected tropical diseases Seen especially in the southern states (especially Texas) and are linked to extreme poverty Chagas disease, Cutaneous Leishmaniasis, Toxocariasis, and Toxoplasmosis are the most co...
Source: PediatricEducation.org - July 18, 2016 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news