What Are Underlying Risk Factors for Liver Abscesses?
This study specific excluded patients with ALA or candidemia.
LA treatment is usually antibiotics and less invasive surgical techniques such as aspiration or percutaneous catheter drainage, but other treatment including resection is sometimes needed Overall mortality from LA has decreased from 15-40% to as low as 0.8% in the pediatric populations as noted above.
Learning Point
LA can occur solely because of exposure to infectious organisms but is also commonly associated with hepatobiliary pathology as well.
In Northern India study, the “[m]ajority of …children had no predisposing factors for development of LA ...
Source: PediatricEducation.org - August 21, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Can ’ t You Just Do a Hydrogen Breath Test?
Discussion
Lactose is a sugar that is commonly found in dairy products. It is digested by the enzyme lactase mainly found on the brush border of the small bowel. Lactase production varies by age and genetics, with infants and young children having a generally higher amount than older children and adults, presumably as they have a more dairy-based diet. There is decreased production starting around 2-3 years of age (i.e. lactase non-persistence). Some people continue to produce lactase at the same levels as infants (i.e. lactase-persistence. “Lactase persistence (lactose tolerance) is seen predominantly in individuals...
Source: PediatricEducation.org - August 14, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Is this a Harlequin Skin Change?
Discussion
Harlequins are comic characters originally from the Italian Commedia dell’arte who wore characteristic masks and brightly colored, well-demarcated (outlined) costumes. The comic’s or clown’s costumes vary and many are depicted with diamond shaped patterns. Colors can be predominantly bi-colored or multi-colored. Some costumes will divide the body in half or quarters with each section in a contrasting color or pattern. Pablo Picasso famously painted and sculpted harlequin performers many times in various costumes. Some examples can be seen here.
There are at least 3 entities in medicine which us...
Source: PediatricEducation.org - August 7, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are Treatments for Recurrent Respiratory Papillomatosis?
Discussion
Human papilloma virus (HPV) is a member of the Papillomaviridae virus family with over a 150 different subtypes. HPV can cause cervical, genital and respiratory tract papillomas. HPV is often benign but can cause anogenital, cervical and head and neck cancers.
Recurrent respiratory papillomatosis (RRP) is uncommon but can cause significant morbidity while awaiting the body’s immune system to respond. There is a juvenile and adult form, and the incidence varies between 2-4/100,000 in the pediatric population. The juvenile form frequently occurs between 3.6-6 years of age and in general the younger the patie...
Source: PediatricEducation.org - July 31, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Can Patent Foramen Ovales Cause Problems?
Discussion
During fetal development, the heart primum and secundum septa grow and overlap leaving a small but important channel between the two atria. The foramen ovale is a flap valve moving blood from the right atrium into the left atrium directly and bypassing the high pressure pulmonary system. After birth and breathing air, the neonate’s lungs open up and the pulmonary vascular resistance decreases. The left atrium now has a relatively higher pressure than the right atria, and therefore pressure on the flap valve closes the foramen ovale. Usually within 6-12 months, the fusion of the primum and secundum of the f...
Source: PediatricEducation.org - July 24, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
How Are Keloids Treated?
Discussion
Wound healing is a complex process and abnormalities are common. Hypertrophic or keloid scarring are the two types of excessive scarring with both having excessive scar tissue that is elevated above the normal skin. Hypertrophic scarring occurs usually only within the wound and can regress. They are common after burns and develop within 3 months of skin injury. Keloid scarring spreads beyond the original wound and does not regress, and often recur. They can occur even 1 year after injury.
Keloids have an incidence of 5-15%. “Compared to normal fibroblasts, keloidal fibroblasts have longer lives, higher pro...
Source: PediatricEducation.org - July 17, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What is the Diagnostic Yield for Genetic Testing of Children with Neurodevelopmental Delays?
Discussion
Children having significant neurodevelopmental disabilities are common with 17% of 3-17 year olds children having some type of such disability. Many are recommended to have genetic testing. Three main reasons for testing are determining the etiology, potential availability of targeted treatment or intervention, and determination of recurrence risk. But there are other pros and some cons to genetic testing which include:
Pros
Diagnosis is determined
Improved understanding of diagnosis, natural history and prognosis for patient and family including decreased anxiety/guilt
“Can end the diagnostic odyssey...
Source: PediatricEducation.org - July 10, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Summer Break
PediatricEducation.org is taking a short break. The next case will be published on July 10th. 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 3, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Can Boric Acid Be Used For?
Discussion
Boron is possibly an essential trace element for humans and is found in water and plants. Common sources are apples, beans (cooked and dried), coffee, fruits, milk, and potatoes. Borates are used as cleaning agents, fertilizers, greasing agents, food preservatives, in fiberglass production, as an insecticide, and even to help prevent wet and dry rot in wood. They can be used to acidify or thicken fluids.
Toxic borate exposure can occur through inhalation, or oral and dermal routes with non-intact skin being a bigger problem. Borate toxicity can cause abdominal pain, diarrhea, emesis, fever, irritability, seizure...
Source: PediatricEducation.org - June 26, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are Potential Problems of Using Povidone-Iodine?
Discussion
Povidone-iodine (polyvinylpyrrolidone iodine or PVP-I) is one of the most common antiseptics for more than 150 years. It is used for antisepsis mainly topically but also in mucosal cavities (i.e. mouth, nose, throat, vagina, etc.) or surfaces (i.e. umbilical cord). It has been used to treat chronic mucosal infections such as adult chronic rhinosinusitis. It’s irritant properties are used for chemical pleurodesis.
A common trade solution is Betadine® which contains “90% water, 8.5% PVP and 1% available iodine and iodine with a free iodine concentration of 1 parts-per-million.” PVP-I is a brown/...
Source: PediatricEducation.org - June 19, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Are Some High or Low FODMAPs Foods?
Discussion
FODMAPs is an acronym standing for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. It is a diet strategy which has shown improvement for some adult patients with functional abdominal pain including some with irritable bowel syndrome. The evidence in pediatrics is murky and more well-designed studies are needed; however such studies are difficult to complete. In general, there are 3 phases to this dietary strategy:
Avoidance of all high FODMAP foods for 2-6 weeks. In some adult studies there has been improvement in 1 week. Especially in the pediatric age group, some people will only res...
Source: PediatricEducation.org - June 12, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
When Do Congenital Dermal Melanocytosis Lesions Resolve?
This study also had 1 patient with superimposed skin findings. This has been reported in other studies.
Questions for Further Discussion
1. What are common skin lesions for major phakomatoses? A review can be found here
2. When is jaundice abnormal? Additional cases can be reviewed here
3. What is the natural history of capillary hemangiomas?
Related Cases
Disease: Congenital Dermal Melanocytosis or Mongolian Spots | Skin Pigmentation Disorders
Symptom/Presentation: Pigmentary Lesions
Specialty: Dermatology
Age: Newborn
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-...
Source: PediatricEducation.org - June 5, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Late Spring Break
PediatricEducation.org is taking a short break. The next case will be published on June 5th. 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 - May 30, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
Why Does He Rock His Body?
Discussion
Stereotypies are “…patterned, repetitive, purposeless, involuntary movements that are also rhythmic and continual and tend to change little over time.” They occur at all times of the day, and can get worse with stress or heightened emotions including happiness. Stereotypies more often occur in children with developmental disabilities (up to 61%), sensory impairments (e.g. blindness) or social deprivation. They can be present more often in patients with autism (up to 88%). They can be seen in ~7% of normally developing children too. Their onset is before age 3 years and tend to improve over year...
Source: PediatricEducation.org - May 22, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
What Causes Pulmonary Edema?
Discussion
Pulmonary edema is a potentially life threatening condition due to accumulation of excess fluid in the alveolar spaces and walls of the lung.
Patients show increased respiratory effort or distress (e.g. tachypnea, dyspnea or difficulty talking, use of excessory muscles, nasal flaring, tracheal tugging, etc.) and clinicians should beware signs of tiring (e.g. bradypnea and decreased effort) as the patient may be failing. Patients may have rales or rhonchi on pulmonary examination, and pallor or color changes may be noted. Blood gas analysis shows evidence of hypoxemia and often hypercapnia depending on the severi...
Source: PediatricEducation.org - May 15, 2023 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news
