bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term Administration of Orlistat Reduced Daytime Triglyceridemia in Obese Women With the Metabolic Syndrome
Authors: Tzotzas Themistoklis , Samara Martha , Constantinidis Theodoros , Tziomalos Konstantinos , Krassas Gerasimos
Published: June 2007

The objective of this prospective, controlled, randomized study was to evaluate the effect of orlistat administration for 10 days on daytime capillary triglyceridemia in obese women with metabolic syndrome (MetSyn). Thirty-two obese, nondiabetic women with MetSyn were evaluated. The presence of MetSyn was defined according to the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATP III) criteria. Patients were randomized into 2 similar groups: group A (orlistat), mean age 50.1 ∓8.2 years, received a low-calorie diet combined with orlistat 120 mg tid for 10 days and group B (control), mean age 51.2 ∓9.1 years, received only the low-calorie diet for the same period of time. Anthropometric, lipids, and parameters of insulin resistance were measured before and after 10 days of intervention. Capillary triglycerides (TGc) were measured at 6 different time points during the day and daytime triglyceridemia was expressed as area under the curve of TGc (AUC-TGc). Most anthropometric measurements (body weight, body mass index, waist circumference, and percentage of fat mass) and most metabolic parameters (total cholesterol [TC], fasting venous triglycerides [TGfv], high-density lipoprotein cholesterol [HDL-C] levels, fasting glucose [FG], fasting insulin [FI], and homeostasis model for assessment [HOMA] for insulin resistance index) decreased significantly in both groups, while waist-to-hip ratio (WHR) and systolic (SBP) and diastolic blood pressure (DBP) did not change significantly in both groups and low-density lipoprotein cholesterol (LDL-C) levels decreased only in the orlistat group. Following minimal weight loss, TGc at most time points and AUC-TGc were significantly reduced only in group A. In group A, AUG-TGc decreased by 17% from 36.4 ∓11.8 to 30.2 ∓9.9 mmol/Lxh-1 (p<0.001), and this reduction was significantly greater compared with the control group (p<0.05) and remained significant after percentage of weight loss was taken into account. This decrease of AUC-TGc significantly correlated with the decrease of HOMA index (p<0.05, r =0.39) and the decrease of TGfv (p<0.001, r =0.62). The tolerability of orlistat was very good and side effects were transient and of minimal intensity. In conclusion, short-term administration of orlistat significantly reduced daytime triglyceridemia in obese, nondiabetic women with MetSyn. This reduction could offer cardiovascular benefits in these high-risk patients. Long-term studies with more patients are needed to reach definite conclusions.
The Impact of a Pediatric Medical Home on Immunization Coverage
Authors: Ortega Alexander N. , Stewart Denice C. L. , Dowshen Steven A. , Katz Solomon H.
Published: June 2007

This study assessed whether having access to provisions in the American Academy of Pediatrics “medical home” concept was associated with being age-appropriately immunized at 3, 12, and 24 months. Cross-sectional data on 495 Delaware children were collected fromJune 1994 to June 1995. Immunization status was determined with the Delaware immunization registry. The medical home was not significantly associated with immunization coverage. This study confirms that race, insurance status, maternal education, and family incomes are predictive of having poor immunization outcomes. Simply providing medical homes may not be an effective strategy to improve use of preventive services.
Neurologic Manifestations of Mycop lasma pneumoniae Infections: Diverse Spectrum of Diseases
Authors: Smith Robin , Eviatar Lydia
Published: June 2007

Mycoplasma pneumoniae is a common cause of upper and lower respiratory tract infections of varying severity. It is also responsible for producing a wide spectrum of nonpulmonary manifestations including neurologic, hepatic, cardiac, and hematologic diseases. The neurologic manifestations are reported to be the most common nonpulmonary manifestations. We describe six patients demonstrating the protean neurologic manifestations of Mycoplasma pneumoniae infections. Four patients presented with the central nervous system manifestations of pyramidal and extrapyramidal tract dysfunction, seizures, cognitive abnormalities, and cerebellar dysfunction. Two patients presented with transverse myelitis. The outcome of this condition ranges from normal to severe residual deficits. Increased awareness of this disease entity may facilitate early diagnosis and thereby expedite starting appropriate therapy that may modify the outcome.
Infant Colic Syndrome—Maternal Fantasies of Aggression and Infanticide
Authors: Levitzky Susan , Cooper Robyn
Published: June 2007

This study examined the impact of infant colic on the emotional state of the mother. Subjects were 23 pairs of mothers and their colicky infants. Structured interviews were conducted with mothers to elicit details around the colic episode and included (1) the emotional state experienced by the mother, (2) the quality and content of the mother's fantasies in response to her infant, and (3) the emotional impact on the parents. Explicit aggressive thoughts and fantasies were revealed by 16 (70%) of the mothers while six (26%) admitted thoughts of infanticide during their infant's colic episodes, a finding notable because previously this has not been documented in medical literature. All mothers experienced physical and psychological symptoms in response to their infant's colic. More than 90% of the mothers with a colicky infant experienced significant marital tension and disruption in their social contacts. The findings suggest that physician receptivity and skill in uncovering the physical and psychological impact of colic on parents is essential for the physical and emotional well-being of the family. Active support and counseling by physicians is critical to diminish any potential for abuse and infanticide in these infants.
Outcome of Very-Low-Birth-Weight Infants at 1 and 2 Yearse of Age
Authors: Kohlhauser C. , Fuiko R. , Panagl A. , Zadra C. , Haschke N. , Brandstetter S. , Weninger M. , Pollak A.
Published: June 2007

The developmental and neurologic outcome of very-low-birth-weight infants (n=76) at 1 and 2 years, corrected for postconceptional age, and variables predicting outcome were assessed. At 1 year 24% of the children were neurologically normal and at 2 years 61%. Developmental status was evaluated by use of the Griffiths Developmental Scales. The rate of cognitively normal children remained constant (58% at 1 year and 59% at 2 years) indicating that developmental status at 1 year was predictive for the second year. This early period is important, therefore, for the identification of developmental deficits and for establishing early, adequate interventions.
Altered Sleeping Arrangements in Pediatric Patients with Epilepsy
Authors: Williams Jane , Lange Bernadette , Sharp Greg , Griebel May , Edgar Terence , Haley Tonya , Frindik Paul , Casey Sean , Dykman Roscoe
Published: June 2007

Parental fears concerning seizure occurrence may be associated with behavioral changes within the home environment. One possible change involves sleeping arrangements. Questionnaires concerning demographics, medical history, and sleeping arrangements were completed by parents of 179 children with epilepsy and by parents of 155 children with diabetes for comparison purposes. Based on parental response, 40 (22%) children with epilepsy changed to less independent sleeping arrangements. Logistic regression suggested that parental concern over seizure occurrence was highly associated with this change (p=<0.001). In contrast, 13 (8%) of the children with diabetes changed to a less independent sleep pattern. Results suggest changes in sleeping arrangements may alert the pediatrician to possible parental anxiety that may need to be addressed.
Thyroid Function in Very-Low-Birth-Weight Infants with Intraventricular Hemorrhage
Authors: Paul David A. , Leef Kathleen H. , Stefano John L. , Bartoshesky Louis
Published: June 2007

The objective of this investigation was to study the natural course of thyroid function in infants with intraventricular hemorrhage (IVH). A cohort of infants <1,500 grams birth weight, n=247, were included in the analysis. Total T4 and thyrotropin from newborn screening during the 1st week of life (Test 1) and from repeat screening at 2-4 weeks postnatal age (Test 2) were compared in infants with IVH (n=43) and a group of infants without UH. Fifty-nine percent of infants still had transient hypothyroxinemia at the time of Test 2. After multivariate analysis, infants with IVH had an increased odds of having a T4 &le6 μg/dL on Test 1 (OR 2.8, 95% CI 1.2-6.5), but at the time of Test 2 IVH was not associated with an increased odds of having a low T4. Only gestational age (OR 1.6, 95% CI 1.1-2.5) remained associated with an increased odds of having an extremely low T4 (&le4 μg/dL) at this time. Transient hypothyroxinemia remains common at 2-4 weeks of age in preterm infants. IVH is not independently associated with having a low T4 at this time.
Frequent Breastfeeding and Food Refusal Associated with Failure to Thrive
Authors: O'Connor Mary E. , Szekely Laura J.
Published: June 2007

This paper acquaints pediatricians and health care personnel with the triad of poor weight gain, frequent breastfeeding, and food refusal in infants during the second 6 months of life. The histories of six infants aged 8-11 months, with failure to thrive, food refusal, and frequent breastfeeding, are presented. All the mothers were facing significant stresses, which may have decreased their breast milk supply, and were leading them to use breastfeeding for their comfort and/or the comfort of their infant. The infants responded with continued frequent breastfeeding, refusal of complementary foods, and decreased weight gain. These infants fit the characteristics of the vulnerable child syndrome. Treatment of these infants required evaluation and treatment of the mothers' psychosocial issues along with a behavioral feeding program. Even with this multidisciplinary approach, these infants showed very slow catch-up growth. Pediatricians and health care personnel should use and build on this information in the evaluation and treatment of infants with similar problems.
Behavioral and Cognitive Status in School-Aged Children With a History of Failure to Thrive During Early Childhood
Authors: Dykman Roscoe A. , Casey Patrick H. , Ackerman Peggy T. , McPherson W. Brian
Published: June 2007

Twenty-seven school children (aged 8-12 years) earlier diagnosed with nonorganic failure to thrive (FTT) were compared with a normal socioeconomically matched control group (N=17) on current height and weight parameters as well as cognitive, achievement, and behavioral measures from the Child Behavior Checklist (CBCL). The former FTT children were, on average, smaller, less cognitively able, and more behaviorally disturbed than the control children and national normative samples. Sixty percent of former FTT children were below the 20th percentile in height and 48% were below the 20th percentile in weight; 52% had IQs below 80 and 30% had reading standard scores below 80; 48% had clinically adverse attention ratings and 30% had clinically adverse aggression ratings on the CBCL. Within the FTT sample, however, there were no significant associations between current growth measures and cognitive/achievement outcome measures. Mothers' IQs provided the strongest prediction of the FTT children's reading scores. The mothers of the FTT children had not achieved as high levels of education as the mothers of the control children, and more of them were single parents. Early growth problems put children at high risk for multiple adverse sequelae in middle childhood, especially if mothers are poorly educated. Careful ongoing follow-up of such children by pediatricians is encouraged.
Telehealth for Children with Special Health Care Needs: Promoting Comprehensive Systems of Care
Authors: Farmer Janet E. , Muhlenbruck Laura
Published: June 2007

This study identified ways that telehealth systems are used to enhance service delivery for children with special health care needs. Various health professionals utilize telehealth to provide physical and behavioral health care, to conduct developmental evaluations, and to address family/social concerns. Telehealth is used most for follow-up visits after in-person specialty care and for child evaluation with treatment recommendations to local care providers. Telehealth systems have the potential to increase access to specialized services and to enhance community-based services for rural and underserved children. However, inadequate reimbursement poses a significant barrier to the development of these services.
Congenital Adrenal Hyperplasia: From Genetics and Biochemistry to Clinical Practice, Part 2
Authors: Collett-Solberg Paulo Ferrez
Published: June 2007

Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders with defects in the synthesis of cortisol. The synthesis of other steroids such as mineralocorticoids and adrenal/ gonadal sex steroids may also be affected. The clinical presentation of the various forms of CAH depend on the following: (1) the affected enzyme, (2) the residual enzymatic activity, (3) the physiologic consequences of deficiencies of the end-products and excess of precursors. The second part of this two-part review discusses the diagnosis and the management of CAH. Although methods for the diagnosis of CAH have not changed over the past few years, new therapeutic approaches are changing the management of CAH. In particular, new drugs and new drug combinations are being tested and old dogmas are being questioned. Early diagnosis, careful discussion with family members of newborns with CAH during the early decision-making process, and close management will decrease the mortality rate and improve the long-term psychological/physical outcome of these children.
Ear Temperature Measurements in Healthy Children Using the Arterial Heat Balance Method
Authors: Powell Keith R. , Smith Kristen , Eberly Shirley W.
Published: June 2007

This study was undertaken to determine the upper limit of normal ear temperatures, defined as the 95th percentile for infants, children, and adolescents, using the arterial heat balance method for measuring ear temperatures. Ear temperatures were measured in 62 infants, 0-2 months of age; 346 children, 3-47 months; 226 children, 48-119 months; and 172 adolescents, 120-227 months using the Ligh Touch Pedi-Q (Exergen Corp, Watertown, MA) ear thermometer. The 95th percentiles for the four age groups were 100.1°F (37.8°C), 100.3°F (37.9°C), 99.8°F (37.7°C), and 99.8°F (37.7°C), respectively. Temperatures above 100.0°F (37.8°C) using the Ligh Touch Pedi-Q ear thermometer should be considered elevated.
A Simple Provider-Based Educational Intervention to Boost Infant Immunization Rates: A Controlled Trial
Authors: Stille Christopher J. , Christison-Lagay Joan , Bernstein Bruce A. , Dworkin Paul H.
Published: June 2007

We sought to determine if a simple educational intervention initiated at the first wellchild care visit, with reinforcement at subsequent visits, can improve inner-city infant immunization rates. We conducted a controlled trial involving 315 newborn infants and their primary caregivers in 3 inner-city primary care centers. Child health care providers gave caregivers in the intervention group an interactive graphic card with verbal reinforcement. At later visits, stickers were applied to the card when immunizations were given. Routine information was given to controls. After the trial, age-appropriate immunization rates at 7 months were 58% in each group. Intervention infants had 50% fewer missed opportunities to immunize (p=0.01) but cancelled 77% more appointments (p=0.04) than controls. We conclude that a brief educational intervention at the first well-child care visit did not boost 7-month immunization rates, although it was associated with fewer missed opportunities to immunize.
The CGHA Asthma Management Program and Its Effect Upon Pediatric Asthma Admission Rates
Authors: Martin Elmer
Published: June 2007

Asthma is the most common reason for admission to the hospital for children nationally. This hospitalization rate is stable despite availability of appropriate outpatient treatments. Our Cincinnati Group Health Associates (CGHA) asthma management program has evolved since 1989. We have measured our pediatric population along with asthma admissions since 1993. Our admission pattern is compared to the community in general and to our managed care population in particular. Our urban center's admission pattern is also studied. Our CGHA pediatric asthma admissions have been declining steadily over the 1993-2000 period by 60%. This decrease is in contrast to national trends in this time period. Comparison to total admissions from 1993 through 2000 still shows a 50% decline whether 0-18 years or 0-5 years is studied. Our urban pediatric center also had a fall in pediatric asthma admission rates of 80% in this time frame; all of these results are statistically significant. Our major managed care network also showed a decline of 55% in pediatric asthma admissions from 1996 to 1999. Our CGHA asthma management program has had a positive influence on our pediatric asthma admission rates. This effect is favorable in comparison to national trends in pediatric asthma admissions. This trend is independent of disease acuity, region of the city where patients live, insurance selection, or age.
Use of Propofol Sedation in a Pediatric Emergency Department: A Prospective Study
Authors: Skokan Elisabeth Guenther , Pribble Charles , Bassett Kathlene E. , Nelson Douglas S.
Published: June 2007

The purpose of this study was to determine the efficacy and safety of propofol sedation for pediatric procedures in the emergency department. For patients needing painful procedures, propofol was administered intravenously. Vital signs, complications, and time to recovery were recorded. Patient amnesia and parent, patient, and operator satisfaction with sedation were assessed. The mean age was 7.4 years; 65% were male. Most underwent fracture reduction. Mean total dose was 3.3 mg/kg. Thirty percent experienced desaturation. One required assisted ventilation. Most had decreases in blood pressure. Mean recovery time was 18 minutes. Satisfaction with sedation was rated “excellent.” Propofol was an effective sedation with minimal complications in the emergency department setting.
Perceptions of Physicians and Pediatric Patients About Atopic Dermatitis, Its Impact, and Its Treatment
Authors: Paller Amy S. , Mcalister Robert O. , Doyle Joseph J. , Jackson Archi
Published: June 2007

The National Eczema Association for Science and Education surveyed 429 patients with atopic dermatitis or their parents and 303 physicians about atopic dermatitis, its effect on quality of life (QOL), and the adequacy of available treatments. The physician survey focused on disease severity and management; the patient survey, on disease severity, impact on QOL, and treatment preferences. Physician and patient/parent respondents generally agreed about their assessments of disease severity, poor effectiveness of over-the-counter products, and the need for more patient support groups and toll-free phone information. Atopic dermatitis significantly impacts QOL in children, particularly in those with moderate-to-severe disease. New treatments should offer enhanced efficacy, less frequent application, and fewer adverse effects.
Apparent Life-Threatening Episodes as the First Manifestation of Epilepsy
Authors: Nunes Magda Lahorgue , Appel Carla Calcagnoto , da Costa Jaderson Costa
Published: June 2007

Apparent life-threatening episodes (ALTE) can be the first manifestation of an epileptic seizure in children. However, the diagnosis of ALTE is generally delayed because the interictal EEG often appears normal and the presence of gastroesophageal reflux may mislead the diagnosis of the epileptic manifestation. We report 6 children with epilepsy who presented an ALTE as their first seizure manifestation. The retrospective analysis of our cases demonstrated that ictal EEGs, when available, appeared to be the most helpful test to confirm the diagnosis, although an abnormal-appearing cerebral imaging was also contributive in the patients when only interictal EEGs were available.
Vaccine Interchangeability
Authors: Greenberg David P. , Feldman Sandor
Published: June 2007

The recommended childhood immunization schedule is complex, with multiple doses of vaccines required to complete the series. For a variety of reasons, a single manufacturer's product may not be available for all of the doses needed. In addition, combination products may become available, allowing for fewer injections to be administered but resulting in a change of vaccine components. To ensure the timely immunization of children and to avoid missed opportunities to vaccinate, it is important to be familiar with data documenting the interchangeability of vaccines. Although clear evidence is available to demonstrate the interchangeability of some vaccines (i.e., hepatitis B vaccines and Haemophilus influenzae type b vaccines), it is more difficult to evaluate the interchangeability of others (i.e., diphtheria-tetanus-acellular pertussis [DTa P] vaccines). Limited data support the interchangeability of some DTa P products when necessary. This article presents the safety and immunogenicity data for immunization regimens that use vaccines from different manufacturers.
Efficacy of Penicillin vs. Amoxicillin in Children with Group A Beta Hemolytic Streptococcal Tonsillopharyngitis
Authors: Curtin-Wirt Correne , Casey Janet R. , Murray Patrick C. , Cleary Carolyn T. , Hoeger William J. , Marsocci Steven M. , Murphy Marie Lynd , Francis Anne B. , Pichichero Michael E.
Published: June 2007

The purpose of this study was to compare the bacteriologic and clinical efficacy of oral penicillin versus amoxicillin as first-line therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. The prospective observational study was conducted over 18 months (January 2000-June 2001). Children enrolled had acute onset of symptoms and signs and a laboratory-documented GABHS tonsillopharyngitis illness. Follow-up examination and laboratory testing occurred 10 ± 4 days following completion of treatment. In total, 389 patients were enrolled (intent-to-treat group): 195 received penicillin V and 194 received amoxicillin. Fifty-six of the penicillin-treated and 57 amoxicillin-treated patients refused to take the drug, or were noncompliant, or did not return for the follow-up visit, leaving 276 patients in the per-protocol group: 139 penicillin-treated and 137 amoxicillin-treated. Bacteriologic cure for amoxicillin-treated children occurred in 76% versus 64% in the penicillin-treated children (p=0.04). The clinical cure rate for amoxicillin-treated children was 84% compared to 73% in the penicillin-treated children (p=0.03). Since treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. The odds ratio (OR) estimate for cure for patients in the amoxicillin versus penicillin V treatment group remained significant (OR=1.84, 95% confidence interval 1.02-3.29); the same was true for clinical cure (OR=1.99, 95% CI=1.02-3.87). Amoxicillin may be superior to penicillin for bacteriologic and clinical cure of GABHS tonsillopharyngitis.
Accelerated Intravenous Rehydration
Authors: Kanaan Usama , Dell Katherine Mac Rae , Hoagland Jason , O'Riordan Mary Ann , Furman Lydia
Published: June 2007

To determine whether accelerated intravenous (IV) rehydration using a new Isotonic Dehydration Worksheet results in: (1) complications in serum sodium or volume status, and (2)decreased duration of IV fluid therapy or length of hospital stay, we conducted a retrospective cohort study utilizing chart review. An intervention group of 98 children, ages 1 month to 12 years, treated with the Isotonic Dehydration Worksheet from December 2000 through March 2001 was compared to a control group of 61 children treated from December 1999 through March 2000 before introduction of the Worksheet. Complication rates were low and did not differ between the 2 groups. Mean unadjusted lengths of IV therapy (35.3 vs. 33.7 hours) and of hospital stay (47.0 vs. 49.3 hours) were not significantly different between the 2 groups. Introduction of an accelerated rehydration protocol was well-tolerated by patients but did not result in a significant decrease in the outcome variables examined. Other factors may have a greater impact on the outcome variables, and a prospective study to address these questions is planned.
Concurrent and Predictive Validity of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and the Mental Developmental Index of the Bayley Scales of Infant Development
Authors: Voigt Robert G. , Brown Frank R. , Fraley J. Kennard , Liorente Antolin M. , Rozelle Judith , Turcich Marie , Jensen Craig L. , Heird William C.
Published: June 2007

The Cognitive Adaptive Test/ Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was designed for use by primary pediatric health care providers to identify children with developmental delays. This study assesses the concurrent and predictive validity of CAT/CLAMS developmental quotient (DQ) scores and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development in healthy children without risk factors for developmental delay. Overall CAT/CLAMS DQ scores correlated significantly with Bayley MDI scores at both 12 (r=0.393; p=0.008) and 30 months (r=0.742; p=0.0001) of age. Overall CAT/CLAMS DQ scores at 12 months of age also correlated modestly with Bayley MDI scores at 30 months of age (r=0.181; p=0.036). Despite its modest predictive validity at 12 months, its satisfactory concurrent validity plus its ease and speed of administration make the CAT/CLAMS a reasonable choice for assessment of early development by primary pediatric health care providers.
Simultaneous Occurrence of Diabetes Mellitus and Juvenile Dermatomyositis: Report of Two Cases
Authors: Singh Ranju , Cuchacovich Raquel , Gomez Ricardo , Vargas Alfonso , Espinoza Luis R. , Gedalia Abraham
Published: June 2007

The simultaneous occurrence of juvenile dermatomyositis (JDMS) and diabetes mellitus is described in 2 pediatric patients. Both these patients presented with significant weight loss, polyuria, and polydypsia within a short time of being diagnosed with JDMS, while these patients were taking oral prednisone (40-60 mg/day in divided doses). Laboratory evaluation detected ketonuria, significant hyperglycemia (696 and 913mg/d L) and low serum levels of insulin and Cpeptide. Both these patients were treated with high doses of insulin. Islet cell and GAD65 antibodies were found to be positive in 1 of the patients, pointing toward a diagnosis of insulin-dependent diabetes mellitus. The other patient tested negative for these antibodies and required insulin therapy for approximately 6 months. Steroid-induced diabetes mellitus seemed highly likely in this case. We hypothesize that a common environmental trigger possibly a viral infection might have been responsible in causing 2 different autoimmune pathologies in these genetically predisposed individuals.
Efficacy of Cephalexin Two vs. Three Times Daily vs. Cefadroxil Once Daily for Streptococcal Tonsillopharyngitis
Authors: Curtin Correne D. , Casey Janet R. , Murray Patrick C. , Cleary Carolyn T. , Hoeger William J. , Marsocci Steven M. , Murphy Marie Lynd , Francis Anne B. , Pichichero Michael E.
Published: June 2007

The purpose of this study was to compare the bacteriologic and clinical efficacy of oral cephalexin twice vs. three times daily vs. cefadroxil once daily as therapy for group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis. A prospective open-label, observational cohort study was conducted over 18 months (January 2000-June 2001). Children enrolled had an acute onset of symptoms and signs of a tonsillopharyngeal illness and a laboratory-documented GABHS infection. Follow-up examination and laboratory testing occurred 21 ± 4 days following enrollment. Two hundred seventy-one patients were enrolled (intent to treat group): 63 received cephalexin twice daily, 124 received cephalexin three times daily, and 84 received cefadroxil once daily. Fifty-three children did not return for the follow-up visit, leaving 218 patients in the per-protocol group: 54 cephalexin twice daily treated, 94 cephalexin 3-times daily treated, and 70 cefadroxil once-daily treated. In the per-protocol group, bacteriologic cure for those treated with cephalexin twice daily was 87%, for cephalexin 3 times daily, it was 81% and for cefadroxil once daily it was 81% (p=0.61). The clinical cure rate for cephalexin twice-daily treatment was 91%; for three-times daily, it was 86%; and for cefadroxil once daily, it was 84% (p=0.56). Because treatment allocation was not randomized, logistic regression analysis was used to adjust for treatment group differences. Younger age of patient was significantly associated with bacteriologic (p=0.04) and clinical (p=0.01) failure independent of treatment group but in the adjusted logistic model no differences were found among the 3 treatment regimens. Cephalexin dosed twice daily or three times daily and cefadroxil dosed once daily appear equivalent in bacteriologic and clinical cure of GABHS tonsillopharyngitis.
Neonatal Behavioral Characteristics and Later Behavioral Problems
Authors: Ohgi Shohei , Takahashi Tatsuya , Nugent J. Kevin , Arisawa Kokichi , Akiyama Tomitaro
Published: June 2007

The purposes of this study were (1) to evaluate the usefulness of the Neonatal Behavioral Assessment Scale (NBAS) as a tool to assess the risk of later behavioral problems, (2) to analyze the relationship between neonatal behavioral characteristics and behavioral problems in childhood. Subjects were 77 very-low-birth-weight infants admitted to the NICU at the Nagasaki University Hospital, Nagasaki, Japan. The results suggest that behavioral characteristics such as poor motor performance, poor state regulation, and poor interaction ability in the neonatal period are risk factors for behavioral problems in childhood. The NBAS could help clinicians to identify neonates at risk of later behavioral problems.
Snoring in Preschoolers: Associations with Sleepiness, Ethnicity, and Learning
Authors: Montgomery-Downs Hawley E. , Jones V. Faye , Molfese Victoria J. , Gozal David
Published: June 2007

Sleep-disordered breathing (SDB) in children is associated with poor school performance, with minority children being at increased risk for both conditions. The latter have been attributable to low socio-economic status (SES). To further study these relationships, the contribution of SES to SDB and learning was examined in 1,010 validated questionnaires collected from parents of both white and African-Arnerican low-SES preschoolers. Twenty-two percent of disadvantaged preschoolers were reported to be at risk for SDB. These children were more likely to be African American, and had a higher incidence of daytime sleepiness, lower academic performance, and hyperactivity. Maternal education level did not account for these differences.
Comparison of Intelligence, School Readiness Skills, and Attention in In-Utero Drug-Exposed and Nonexposed Preschool Children
Authors: Butz Arlene M. , Pulsifer Margaret B. , Leppert Mary , Rimrodt Sheryl , Belcher Harolyn
Published: June 2007

Children with in-utero drug exposure (IUDE) may be at risk for poor neurodevelopmental outcomes. The objective of this study was to determine the association between IQ school readiness skills, and self-regulation behavior in IUDE children (n=103) and non IUDE-exposed children (n=33) at age 4 years. Mean IQ or school readiness scores did not significantly differ by IUDE exposure; however, both groups scored approximately 1 standard deviation below the mean for both IQ and school readiness skills. The IUDE group earned a significantly higher mean score (thereby performing poorer) than the nonexposed group on focusing and inattentive behavior. Factors associated with poor school readiness skills for all children (IUDE exposed and nonexposed) were not attending a preschool program and lower caregiver education level. Assuring high-risk children are identified and referred for early intervention services as well as treated for inattention behavior is crucial for their academic success.
Effectiveness of an Intervention for Colic
Authors: Keefe Maureen R. , Lobo Marie L. , Froese-Fretz Ann , Kotzer Anne Marie , Barbosa Gail A. , Dudley William N.
Published: June 2007

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.
Mental Development of Infants With Congenital Hypothyroidism: A Longitudinal Study
Authors: Nakamizo Makiko , Toyabe Shin-ichi , Asami Tadashi , Akazawa Kouhei
Published: June 2007

The purpose of this study was to assess the relationship between the clinical findings before starting treatment and the development quotient in children treated for congenital hypothyroidism. Patients with congenital hypothyroidism (n = 129) were divided into favorable and unfavorable groups according to intellectual performance. Children with congenital hypothyroidism generally have a similar intellectual outcome to that of healthy children. However, a low birth weight, the presence of complications, and a high serum thyroid-stimulating hormone value are the risk factors for unfavorable cases, who consistently have a development quotient score of less than 100.
Physicians’ Attitudes and Practices Regarding Adherence to Medical Regimens by Patients with Chronic Illness
Authors: Patel Uptal D. , Davis Matthew M.
Published: June 2007

Health professionals often do not detect nonadherence despite substantial adverse impacts on health-care delivery and costs. We sought to determine how physicians assess and manage adherence among patients with chronic illness, and whether approaches to nonadherence differ by level of clinical training or prior training regarding adherence. Two-hundred seventeen pediatricians and internists completed an Internet-based survey. Responses demonstrated that few had previous formal training regarding patient adherence. Physicians’ assessment of nonadherence and knowledge and skills regarding strategies for improving adherence appeared significantly more advanced among physicians with more clinical experience and among those with formal training in adherence assessment and management. Formal educational interventions may improve adherence-related knowledge and skills.
Extreme Thrombocytosis Predicts Kawasaki Disease in Infants
Authors: Nigrovic Lise E. , Nigrovic Peter A. , Harper Marvin B. , Chiang Vincent W.
Published: June 2007

Infants with Kawasaki disease are at high risk of developing life-threatening coronary complications, yet may elude timely diagnosis because they often lack the full complement of classic clinical features. We retrospectively studied 26,540 children 1 year of age or less who were evaluated at a tertiary care pediatric emergency department in whom a platelet count was performed. Among those infants with fever without a source identified, 8.5% with platelet counts of 800,000 cells/mm3 or greater had Kawasaki disease compared to 0.4% with platelet counts of less than 800,000 cells/mm3 (likelihood ratio for Kawasaki disease was 17 [95% confidence interval, 8-34]). Because many infants present atypically, Kawasaki disease should be considered in all children of 1 year or less with prolonged fever, extreme elevation of the platelet count, and no compelling alternative diagnosis.
Absence of Tooth Staining With Doxycycline Treatment in Young Children
Authors: Volovitz Benjamin , Shkap Ronit , Amir Jacob , Calderon Shlomo , Varsano Izhak , Nussinovitch Moshe
Published: June 2007

The aim of the study was to determine if doxycycline causes tooth staining in young children. A dentist examined 31 randomized children who had been treated with doxycycline and 30 children who had not received doxycycline. Mean age of the children was 10.4 ∓ 2.1 years. Mean age at receipt of the first doxycycline treatment was 4.1 ∓ 1.6 years, and mean number of doxycycline courses was 2.0 ∓ 1.3. No tooth staining was detected by the dentist in any of the children in either group. These findings indicate that treatment with doxycycline in children aged 2 to 8 years is not associated with tooth staining.
Pathogen Shifts and Changing Cure Rates for Otitis Media and Tonsillopharyngitis
Authors: Pichichero Michael E.
Published: June 2007

Pneumococcal conjugate vaccine use has caused a decrease in the incidence of recurrent and refractory acute otitis media in the United States and a shift in the predominant pathogens. Now Haemophilus influenzae is the most commonly isolated organism (about 60% of the total), and more than half the strains make β-lactamase, rendering them resistant to amoxicillin. Penicillin nonsusceptible pneumococci, the main target of antibiotic therapy in the 1990s, has become a much less common isolate (10%- 25% of the total). These changes impact antibiotic selection for acute otitis media. Penicillin treatment of group A streptococcal tonsillopharyngitis does not meet the minimum United States Food and Drug Administration standards for first-line treatment, which is 85% or greater eradication at the end of therapy. Recent results with amoxicillin suggest its efficacy is also waning. Cephalosporins have the highest bacteriologic and clinical efficacy. This has implications for optimal antibiotic therapy.
Ethyl Vinyl Chloride Vapocoolant Spray Fails to Decrease Pain Associated with Intravenous Cannulation in Children
Authors: Costello Mary , Ramundo Maria , Christopher Norman C. , Powell Keith R.
Published: June 2007

The purpose of the study was to determine the effect of ethyl vinyl chloride vapocoolant spray on pain reported by children undergoing intravenous cannulation. A randomized, double-blinded, placebo-controlled trial was conducted on eligible children between the ages of 9 and 18 years seen in a pediatric emergency department and requiring intravenous cannulation. Informed consent was obtained, and children were randomized to receive ethyl vinyl chloride spray, isopropyl alcohol spray, or no spray (control group). Patient demographics and information pertaining to each intravenous cannulation were recorded. Children indicated the degree of pain associated with intravenous cannulation on a 100-mm visual analog scale (VAS) compared to a baseline pain score of “zero.” Statistical analysis was performed by using Stata version 7. One hundred twenty-seven subjects were enrolled: 37 received ethyl vinyl chloride vapocoolant spray, 48 received isopropyl alcohol spray (placebo), and 42 received no pretreatment. Mean VAS scores for pain experienced during cannulation were 34, 33, and 31 mL for each group, respectively. Ethyl vinyl chloride vapocoolant spray failed to measurably reduce pain associated with intravenous cannulation when compared to those pretreated with isopropyl alcohol spray or receiving no intervention.
Pill Swallowing Ability and Training in Children 6 to 11 Years of Age
Authors: Meltzer E. O. , Welch M. J. , Ostrom N. K.
Published: June 2007

Despite the widespread view that children have difficulty swallowing pills, data are limited. In an observational cohort study, pill swallowing ability (small oral tablet) was assessed in children age 6 to 11 years. A total of 113 of 124 subjects (91%) swallowed a tablet using an ordinary cup or a patented pill cup. All 57 subjects who initially said they could swallow a pill were capable. Forty-seven learned with an ordinary cup and nine with the pill cup. Eleven did not learn. The majority of children (91%) age 6 to 11 years were able to successfully swallow a small oral tablet.
Studying Injury Prevention: Practices, Problems, and Pitfalls in Implementation
Authors: Sangvai Shilpa , Cipriani Lynne , Colborn D. Kathleen , Wald Ellen R.
Published: June 2007

This prospective, randomized, controlled trial was conducted to determine feasibility and effectiveness of a chronic care model approach to injury prevention compared with standard anticipatory guidance. Enrolled caregivers of children aged 0 to 5 years received focused counseling from a physician and health assistant, educational handouts, phone follow-up, and access to free safety devices and automobile restraint evaluations. Only 35.1% of eligible parents participated. Home visits were completed at 6 months to observe safety practices. Injuries were gleaned from parent report and medical record review. Safety practices were evaluated in 27 households. Chart review showed no significant difference in the number of medically attended injuries between groups ( P = 0.6). The impact of the chronic care model on injury prevention in primary care could not be determined with certainty. Evaluating effectiveness of injury prevention strategies on actual safety practices with direct observation is challenging.
The Attitude of Physicians Toward Cold Remedies for Upper Respiratory Infection in Infants and Children: A Questionnaire Survey
Authors: Cohen-Kerem Raanan , Ratnapalan Savithiri , Djulus Josephine , Duan Xu , Chandra Rahul V. , Ito Shinya
Published: June 2007

Over-the-counter cold remedies are widely used for symptomatic relief of upper respiratory tract infections. The safety of these drugs is not well established in infants and their efficacy is questionable. Our aim was to study the attitude of family physicians and pediatricians toward the use of cold remedies in infants and children. A questionnaire was sent to 400 family physicians and 100 pediatricians randomly selected across Ontario. The overall response rate was 53.2%. Sixteen percent of family physicians recommended cold remedies for infants 0 to 6 months of age compared to 4% of the pediatricians (P = 0.01). For infants 6 to 12 months of age, the difference between pediatricians and family physicians persisted (14% and 38% of, respectively; P < 0.001). Despite that cold remedies are not proven to be effective and some safety issues are associated with their use in the pediatric age group, physicians still recommend them. Continuing medical education programs should address the issue.
Parental Presence During Lumbar Puncture
Authors: Haimi-Cohen Yishai , Amir Jacob , Harel Liora , Straussberg Rachel , Varsano Yizhak
Published: June 2007

We evaluated the anxiety state of 57 parents whose children required lumbar puncture (LP) as part of a diagnostic workup. We also examined parental attitude about their presence during the procedure. The parents were randomly divided into two groups: 29 (51%) were present during the LP (group A) and 28 (49%) remained outside (group B). There were no differences in the anxiety scores between the two groups. All parents in group A and seven in group B (25%) reported a preference for staying with the child should he/she need LP in the future. The results also showed that allowing the parents to be present during LP does not aggravate their anxiety compared with controls.
Gastrointestinal Symptoms and Diabetes Mellitus in Children and Adolescents
Authors: Vogiatzi Maria G. , Gunn Sheila K. , Sherman Lori D. , Copeland Kenneth C.
Published: June 2007

Because it may be difficult to evaluate gastrointestinal diseases in children with insulindependent diabetes mellitus (IDDM), this report highlights several clinical features unique to diabetes and emphasizes the relationship between gastrointestinal pathology and glycemic control. Two children with IDDM are described whose hyperglycemia, ketosis, and abdominal pain were the presenting features of H. pylor-positive duodenal ulcer disease and acute appendicitis, respectively. A third nondiabetic child developed persistent postprandial hyperglycemia as the initial manifestation of dumping syndrome. These patients illustrate the relationship between glycemic control and gastrointestinal pathology in children with diabetes and the effects of gastrointestinal dysfunction on glucose regulation in nondiabetic children. In children with IDDM, gastrointestinal pathology can be confused with ketoacidosis and complicate diabetes control and management. Early recognition and treatment of the underlying gastrointestinal disease often improves glycemic control. Furthermore, severe gastrointestinal dysfunction in nondiabetic children may deleteriously influence glycemic regulation and may be confused with childhood diabetes.
Increased Creatine Kinase Brain Isoenzyme Concentration in Cerebrospinal Fluid with Meningitis
Authors: Nussinovitch M. , Klinger G. , Soen G. , Magazanik A. , Volovitz B. , Varsano I. , Nussinovitch A.
Published: June 2007

CPK-BB (CK-BB) isoenzyme is an intracellular enzyme released in various neurologic conditions, including central nervous system (CNS) infections. Activity of CK-BB in cerebrospinal fluid (CSF) was determined in 80 children by electrophoresis and densitometry. The possible correlation between CNS infection and CK concentrations was assessed. Significantly elevated concentrations of CK activity (P <0.01) in the CSF were found in children with bacterial meningitis as compared with children with either aseptic meningitis or normal CSF findings. The data suggest the possibility of utilizing CSF CK activity to differentiate between bacterial and viral meningitis in situations where a routine CSF examination is inconclusive.
Pyomyositis: Report of Three Patients and Review of the Literature
Authors: Akman Ipek , Ostrov Barbara , Varma B. K. , Keenan Gregory
Published: June 2007

Pyomyositis is the primary infection of skeletal muscles, accompanied by abscess formation in the suppurative phase but may be without a focal fluid collection in the presuppurative phase. We describe three patients, one with insulin-dependent diabetes mellitus, another with sickle cell disease, and the third a previously healthy child with varicella infection who developed pyomyositis. Ultrasound or magnetic resonance imaging suggested the diagnosis in each case. The patients were treated with intravenous antibiotic therapy and two required abscess drainage. The infection in the third resolved without surgical drainage. None of our patients had residual functional limitations. We believe that a high index of suspicion and prompt diagnosis can prevent complications from pyomyositis.