bluuebunny/crossref_metadata_2025 huggingface dataset:
AFRICANIZED HONEY BEES FOUND IN ARIZONA
Authors: Hawthorne S.
Published: December 2021

Washington, DC, July 13, 1993—Africanized honey bees have been found in Arizona, the second state where the "killer bees" have migrated into this country, according to the Agriculture Department.

A swarm was found in a state Department of Agriculture trap 2 miles north of Sasabe, AZ. The bees were destroyed.

The fierce and unmanageable bees are descendants of honey bees imported from Africa to Brazil in 1956. They have been spreading north and south from Brazil since their release in 1957.

They tend to sting with less provocation and in greater numbers than other honey bees.

They migrated for the first time into the United States in 1990, near Hildago, TX, in the Rio Grande Valley. They have also entered the country on ships.
‘KILLER BEES’ BLAMED IN TEXAS MAN'S DEATH
Authors: L. J. F.
Published: December 2021

Harlington, TX, July 19 (AP)—Federal agricultural officials say that the honey bees that killed an 82-year-old rancher last week were the Africanized variety known as "killer bees."

"Our lab has confirmed that the bees are Africanized," said Kim Kaplan, a Spokeswoman for the Federal Department of Agriculture in Greenbelt, MD. Final autopsy results are not yet available, but the pathologist who did the autopsy listed the preliminary cause of death as acute fluid buildup in the lungs caused by insect stings.

If the cause of death is confirmed, the rancher, Lino Lopex, would be the first person killed by Africanized bees in the United States since the aggressive variety migrated into Texas in 1990. Harlington, TX, in South Texas, is about 15 miles from the Mexican border.

Mr. Lopez apparently tried to drive the bees out of a wall in an abandoned house by poking the hive with a stick wrapped with a burning burlap sack. He was dead on arrival at the hospital, with about 40 stingers still attached to his body, officials said.
Letter to the Editor
Authors: Merenstein Gerald B.
Published: December 2021

We thank Drs Arroll and Thompson for their interest and comments on the American Academy of Pediatrics Vitamin K Task Force statement. They raise two concerns—the validity of the Golding1 paper suggesting an increased risk of cancer and the appropriateness of recommending the use of oral vitamin K.

In both the task force statement2 and in response3 to a previous letter to the editor, we have clearly stated that the risks of cancer from intramuscular vitamin K are unproven and unlikely.
Who Do You Want to Care for Your Sick Newborn?
Authors: Katzman Gerald H.
Published: December 2021

In a previous letter to the editor entitled "Neonatal Person-power,"1 I presented my view as to how the need for neonatologists should be addressed. My conclusion and approach differed from the American Academy of Pediatrics Committee on Fetus and Newborn2 but was in agreement with Dr Robertson's position.3 The reason for the differences in the conclusions related to using calculated ratios of neonatologists to live births or lengths of stay without an orientation to the around-the-clock critical care needs of physiologically unstable neonates.
Letter to the Editor
Authors: Silverman William A.
Published: December 2021

I am delighted to see that my comments have provoked at least three of your readers. But I was hoping that those who were skeptical about the rough estimates I obtained would support my plea for reliable numbers based on formal surveys in each of the seven countries.

If I understand your correspondents correctly ("... we are right on target"), they seem to know the answers to all the questions I raised. But I can't agree that an international comparison is irrelevant.
Nitric Oxide and Bleeding Time
Authors: Gaston Benjamin , Keith Julian F.
Published: December 2021

Abman, Kinsella, and co-workers caution against the widespread use of nitric oxide (NO) gas in the neonatal intensive care unit.1,2 However, like other leading advocates of NO therapy, they limit their remarks concerning toxicology to a discussion of the risks of acute lung injury and methemoglobinemia. It must be remembered that NO may have other important side effects as well.

In particular, NO inhalation in concentrations of 30 ppm prolongs bleeding time in rabbits and humans,3 making it a uniquely dangerous agent for use in preterm infants at risk for intraventricular hemorrhage.
A 20-Year Population-Based Study of Postdiarrheal Hemolytic Uremic Syndrome in Utah
Authors: Siegler Richard L. , Christofferson Ryan D. , Milligan Mark K. , Pavia Andrew T.
Published: December 2021

Objective. To determine epidemiologic features, trends in frequency, and predictors of clinical outcome of postdiarrheal hemolytic uremic syndrome (HUS) in Utah.

Design. A 20-year population-based study of HUS with a review of the HUS registry, hospital records, transplant registry, and a survey of pediatricians and pediatric nephrologists to ensure completeness of ascertainment.

Population. All Utah residents under 18 years of age with HUS occurring after a diarrheal prodrome between 1971 and 1990.

Outcome measures. Incidence of HUS, severity, complications, and long-term sequelae.

Results. There were 157 cases during 20 years; 140 (89%) occurred after a diarrheal prodrome. The mean annual incidence was 1.42/100 000 children (range 0.2 to 3.4/100 000 children/year). Periods of high incidence occurred; however, there was no overall sustained increase in incidence. Escherichia coli O157:H7 was isolated from the stool of 62% of children who had specimens submitted. There were no differences between the first and second decade in the proportion with diarrheal prodrome, bloody diarrhea, most abnormal laboratory values, hospital course, or outcome. However, admission laboratory abnormalities were more severe during the first decade suggesting a delay in diagnosis. Age <2 years, anuria before admission, and higher white blood cell counts on admission predicted severe disease. Bad outcome (death, end-stage renal disease, or stroke) occurred in 11%; 5% died. Chronic renal sequelae, usually mild, were found on follow-up (median 6.5 years) in 51% of survivors.

Conclusions. HUS has been an important clinical and public health problem in Utah for 20 years. The consistency of the clinical and epidemiologic features over 2 decades suggests that a common etiologic agent has accounted for most cases of HUS in this region since 1971.
Effect of Immediate Resuscitation on Children With Submersion Injury
Authors: Kyriacou Demetrios N. , Arcinue Edgardo L. , Peek Corinne , Kraus Jess F.
Published: December 2021

Study objective. To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury.

Design. A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio.

Participants. The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California.

Measurements and main results. All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 < OR < 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy.

Conclusion. Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.
Epileptic Seizure-Induced Hypoxemia in Infants with Apparent Life-Threatening Events
Authors: Hewertson John , Samuels Martin P. , Southall David P. , Poets Christian F. , Boyd Stewart G. , Neville Brian G. R.
Published: December 2021

Objective. To describe the physiologic changes that occur during epileptic seizure (ES)-induced apparent life-threatening events (ALTE) and to provide an explanation for the mechanism whereby the hypoxemia characterizing these events occurred.

Patients and design. Six infants were retrospectively selected from a group of 17 because they had ALTE documented on physiologic recordings where the first change in signals was in the electroencephalogram (EEG). The 17 infants had clinical features suggestive of partial seizures (but normal standard EEGs) and were from a sample of 172 infants with recurrent ALTE. All 17 infants underwent continuous recordings of breathing, electrocardiogram (ECG), oxygenation, and EEG, but only in 6 was an ES-induced ALTE recorded and the physiologic changes described.

Results. Twenty-three ALTE were documented in six infants. Events commenced with an abnormality in the EEG, followed by a decrease in SaO2 after a median interval of 27 seconds (range 2 to 147). Despite resuscitation, the median duration of severe hypoxemia (SaO2 ≤60%) was 40 seconds (range 8 to 74). In 18 events (five infants) there was a median of four apneic pauses (range 1 to 9) preceding the decrease in SaO2 by a median duration of 24 seconds (range 3 to 48). The longest apneic pause per event lasted a median of 19 seconds (range 8 to 47). Breathing movements continued in five events (four infants), and expiratory airflow in one. Sinus tachycardia was found in 19 of the 23 events (six infants), but there were no cardiac arrhythmias.

Conclusions. ES in infants can manifest as ALTE and be accompanied by potentially life-threatening episodes of severe hypoxemia and apnea, despite a normal EEG between events.
Enteroviral Meningitis in Infancy: Potential Role for Polymerase Chain Reaction in Patient Management
Authors: Schlesinger Yechiel , Sawyer Mark H. , Storch Gregory A.
Published: December 2021

Study objective. To evaluate the performance characteristics and potential clinical utility of a polymerase chain reaction (PCR) assay for enteroviral RNA in comparison to viral culture in infants under 3 months of age with meningitis.

Specimens and testing. Specimens were obtained from a collection of cerebrospinal fluid specimens from infants under 3 months of age (excluding those in the neonatal intensive care unit) undergoing lumbar puncture at St. Louis Children's Hospital during a 12-month period. Those tested by PCR included all 27 with pleocytosis, 8 others from infants without pleocytosis but from whom an enterovirus was cultured, and 10 from infants who did not have pleocytosis and had a negative viral culture of cerebrospinal fluid. Viral cultures were performed at the discretion of physicians caring for individual patients.

Results. PCR was positive for enteroviral RNA on cerebrospinal fluid (CSF) specimens from 11 of 12 patients with definite or probable enteroviral meningitis, as well as on 6 of 13 with possible enteroviral meningitis, and was negative on all 10 with absence of pleocytosis and negative enteroviral cultures. CSF viral cultures were negative in 6 of the patients in whom PCR was positive. Viral cultures had minimal impact on patient management. In contrast, under study assumptions, PCR could have saved an average of 1.2 days of hospitalization per patient in the 27 patients with CSF pleocytosis.

Conclusions. Enterovirus PCR performed on CSF is a sensitive and specific method for the diagnosis of enteroviral meningitis. This method has the potential for improving the accuracy of diagnosis in young infants and for saving costs by allowing earlier diagnosis and discharge from the hospital when clinically appropriate.
Colonic Transit and Anorectal Manometry in Children With Severe Brain Damage
Authors: Staiano Annamaria , Del Giudice Ennio
Published: December 2021

Objective. This study was conceived to determine the physiologic abnormalities in distal gastrointestinal motility that are responsible for constipation in brain-damaged children.

Design. Colonic transit and anorectal manometry were evaluated in 16 children with severe brain damage and constipation (mean age ± SD; 5.1 ± 3.5 years) and the results were compared with findings in 15 age- and sex-atched children with functional fecal retention and normal mental development. Anorectal motility findings also were compared with those from 11 asymptomatic children. The progress of radiopaque markers, as determined by sequential plain abdominal radiographs, was used to evaluate segmental colonic transit times.

Results. In children with brain damage, colonic transit was prolonged at the level of left colon in 18.8% of the patients, at both left colon and rectum in 56.2%, and at rectum only in 25% These findings differed (P < .05) from those in children with functional fecal retention wherein transit was prolonged in the left colon and rectum in 20% of the patients and the rectum only in 80%. By anorectal manometry, no significant intergroup differences were detected in anal pressures and in the anorectal motor responses to rectal distention. The rectal compliance in children with severe brain damage was similar to the asymptomatic controls, whereas children with functional fecal retention had increased rectal compliance.

Conclusions. This study shows that colonic transit abnormalities in both the left colon and rectum may be responsible for constipation in children with severe brain damage.
Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States
Authors: Harper Rita G. , Sia Concepcion G. , Spinazzola Regina , Wapnir Raul A. , Orner Shahnaz , Harper Robin
Published: December 2021

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States.

Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States.

Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged.

Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.
Changing Attitudes and Practices Regarding Local Analgesia for Newborn Circumcision
Authors: Ryan C. Anthony , Finer Neil N.
Published: December 2021

Study objective. To change physician attitudes and practices regarding the routine use of local and regional anesthesia for newborn circumcision.

Design. Interventional study, followed by an audit of physician practice over a 1-month period, 1 year following interventions.

Setting. The newborn nurseries of the Womens' Pavilion, Royal Alexandra Hospital, Edmonton.

Interventions. A broad range of awareness and educational programs were directed at physicians who perform newborn circumcisions, including posters, newsletters, presentations at grand rounds, video recordings, and practical "hands-on" demonstration of the techniques of local anesthesia to the prepuce and dorsal penile nerve block.

Results. Only one physician was using local analgesia for newborn circumcision prior to the introduction of the educational program. The audit, performed 12 months later, documented 46 circumcisions performed by 22 physicians, each performing between 1 and 6 circumcisions (median = 1). Sixteen of the 22 physicians (73%) used either local anesthesia to the prepuce (19 cases) or dorsal penile nerve block (13 cases) during circumcisions. Thus, local analgesia was used in 66% (32/48) of all circumcisions. Six physicians, performing 16 circumcisions, did not use any form of analgesia.

Conclusions. This simple educational program has been associated with a remarkable change in attitudes and practice regarding local analgesia for neonatal circumcision. Our ideal objective, which we hope to achieve through repeated education and practical demonstrations of the techniques to interested physicians, is that all newborn circumcisions are performed under local or regional anesthesia in our institution.
Capillary Refill?
Authors: Harris Glenn D. , Saavedra Jose M. , Finberg Laurence
Published: December 2021

Gorelick et al1 in their article "Effect of Ambient Temperature on Capillary Refill in Healthy Children" report that cool ambient temperature can prolong capillary refill time (CRT) in children with normal circulatory status. This suggests to them a limitation of the use of CRT in the assessment of ill or injured children. In the accompanying editorial2 entitled "Capillary Refill: Is It a Useful Clinical Sign?," Dr Baraff takes the aforementioned limitation one quantum step further to completely dismiss the use of CRT, stating it "adds nothing" in the evaluation of circulation.
Letter to the Editor
Authors: Lederman Sally Ann
Published: December 2021

I am writing regarding some problems I noted in the article "Adolescent Gestational Weight Gain and Birth Weight" (Stevens-Simon et al, Pediatrics 1993;92:805-809). Several of the procedures used in the reported study are either inadequately described or improperly done. Some of these may affect the major points of the article.

One concern is the description of the study as opposed to the report of the findings. The data collection section describes a variety of "psychosocial data" including a measure of "stress" (Newton's scale) and of "environmental stressors" (also citing Newton et al), both measured twice during pregnancy.
Bilirubin Measurements and Long-Term Neurologic Outcome
Authors: Rhine William D. , Benitz William E. , Dennery Phyllis A. , Stevenson David K. , Seidman Daniel S.
Published: December 2021

We wonder whether certain factors were considered in Newman and Klebanoff's retrospective analysis of bilirubin measurements and long-term neurologic outcome.1 The enrollment period of 1959 to 1966 was at a time when intensive care support such as mechanical ventilation was just being introduced for neonates. Did some of the 391 infants who died before their first birthday have severe kernicterus? Patients with immediately life-threatening bilirubin encephalopathy may not have had mechanical ventilation available or even offered in light of presumed neurologic injury.
THE EFFECT OF VACUUM CLEANERS ON THE CONCENTRATION AND PARTICLE SIZE DISTRIBUTION OF AIRBORNE CAT ALLERGEN
Authors: Graft David F.
Published: December 2021

Purpose of the Study. To define the types and models of vacuum cleaners releasing the least amount of cat allergen.

Methods. Nine vacuum cleaner models were loaded with dust containing 50 mg of Fel d I (the major cat allergen) and run for 15 minutes in a laboratory room (volume = 18 m2). The airborne concentration of Fel d I was measured.

Results. Vacuum cleaners using a double-thickness dust bag had much less leakage than those with a single-thickness bag. Two water-filter vacuum cleaners emitted high concentrations of Fel d I; furthermore, 90% of the allergen was in particles of less than 2.5 µm. Taping electrostatic filter paper over the air outlets controlled this.

Reviewer's Comments. It is obviously important that individuals who have cat allergy and have cats in the home use a vacuum cleaner that reduces cat allergen exposure rather than increase it. This study demonstrates that certain types of vacuum cleaners may actually increase airborne cat allergen and furthermore, that certain refinements may improve their function.
ACROLEIN INCREASES AIRWAY SENSITIVITY TO SUBSTANCE P AND DECREASES NEP ACTIVITY IN GUINEA PIGS
Authors: Kinberg Kirk , Kobayashi Roger H.
Published: December 2021

Purpose of the Study. Airway hyper-responsiveness is a consistent observation seen in asthmatic patients. In asthma, inflammatory cellular influx and mediator release results in epithelial damage, vascular leak, and alterations in mucus production and secretion. Studies suggest that C-fibers which innervate airway epithelium may be more densely packed with substance P in asthmatic patients than in normal subjects. Damage to the epithelium may increase stimulation of the C-fibers and subsequent tachykinin release including substance P. Tachykinins are metabolized by neutral endopeptidase (NEP) which are found in airway epithelium and smooth muscle. Airway damage may cause enhanced tachykinin-induced effect. The purpose of this study was to investigate the inter-relationship between tachykinins and reduced NEP on the effects of pulmonary functions as well as bronchoalveolar lavage findings.

Methods. Guinea pigs were given an aerosolized solution of acrolein, a component of cigarette smoke and smog, which is known to cause epithelial cytotoxicity and increased sensitivity to acetylcholine. Pulmonary functions were measured via body box. Dose response curves were calculated from subject guinea pigs given the acrolein as well as the control group following substance P administration. Subsequently, subject as well as control guinea pigs were exposed to thiorphan to inhibit NEP. They were then given subsequent challenges of either IV or aerosolized substance P and pulmonary testing as well as bronchoalveolar lavage was performed. NEP activity was measured at 1, 7, and 28 days after exposure.

Results. Pulmonary intonation and epithelial damage were prominent on the day after acrolein exposure showing influx of monocytes, neutrophils, and epithelial damage.
METERED-DOSE INHALERS: DO HEALTH CARE PROVIDERS KNOW WHAT TO TEACH?
Authors: Adinoff Allen A.
Published: December 2021

This study confirms that a large percentage of patients use MDI improperly. It also demonstrates a significant lack of understanding by health care providers of the proper use of MDI. Furthermore, this study supports the use of respiratory care practitioners in the outpatient setting, since they were the most proficient among all the health care providers in the proper use of MDI.
THERAPEUTICAL DOSES OF SALBUTAMOL INHIBIT THE SOMATOTROPIC RESPONSIVENESS TO GROWTH HORMONE-RELEASING HORMONE IN ASTHMATIC CHILDREN
Authors: Mehta Hemalini , Lemanske Robert F.
Published: December 2021

Purpose of the Study. To determine the effects of therapeutic β2 agonists (specifically salbutamol) on growth hormone (GH) response to growth hormone releasing hormone (GHRH) in children with asthma.

Study Population. Fifteen prepubertal children with asthma, ages 6-11 (average age of 9) with normal or normal short stature were studied. Those with an endocrine abnormality, nutritional deficiency, psychological deprivation, or other systemic disease were excluded. Only those children with known bronchial asthma, who showed a 15% decrease of the 1-second forced expiratory volume (FEV1) with methacholine challenge were included. All patients were asymptomatic, and had not experienced an asthma exacerbation, respiratory infection or allergen exposure in the month preceding the study. No child was on medications.

Methods. Subjects were divided into two groups. Both groups had baseline GH response to GHRH determined. After an overnight fast, GH levels were obtained the following morning at -60, 0, and then every 15 minutes until 120 minutes after GHRH administration. Two days following this, Group A received salbutamol (0.125 mg/kg) orally at -60 minutes and GH response to GHRH was remeasured. Group B received aerosolized salbutamol (2 mg over 15 minutes) (details of administration were not specified by the authors). All serum GH levels were measured in duplicate by immunoradiometric assay (sensitivity of 0.1 µg/L).

Findings. Basal GH levels were similar in both groups. Orally administered salbutamol (Group A) markedly inhibited GH response to GHRH (peak of 3.7 ± 0.6 vs. 18.6 ± 4.7 g/L). Inhaled salbutamol (Group B), although blunting the GHRH-induced GH response, did so to a lesser extent (peak of 20.0 ± 7.5 vs. 35.8 ± 9.4 g/L, P < .02).
HOSPITALIZED TREATMENT OF ASTHMA: LACK OF BENEFIT OF THEOPHYLLINE GIVEN IN ADDITION TO NEBULIZED ALBUTEROL AND INTRAVENOUSLY ADMINISTERED CORTICOSTEROID
Authors: Kaplan Michael S.
Published: December 2021

Theophylline does not provide additional benefit when added to the combination of inhaled albuterol and intravenous methylprednisolone for the treatment of children with non life-threatening asthma.
BECLOMETHASONE GIVEN AFTER THE EARLY ASTHMATIC RESPONSE INHIBITS THE LATE RESPONSE AND THE INCREASED METHACHOLINE RESPONSIVENESS AND CROMOLYN DOES NOT
Authors: Graft David F.
Published: December 2021

Purpose of the Study. To investigate whether beclomethasone or cromolyn provides any protection from the late asthmatic response if given after the allergen exposure.

Methods. Ten patients with mild, stable, atopic asthma with late asthmatic responses entered a double blind, double dummy trial comparing a single dose of inhaled beclomethasone (500 µg), cromolyn (20 mg), and placebo administered 2 hours after allergen challenge on the severity of the late asthmatic response and the change in the log of PC20 methacholine.

Findings. The late asthmatic response after beclomethasone of 7.3% ± 6.1% decrease in FEV1 was significantly less than that experienced after cromolyn (20.4% ± 15.2%) or placebo (26.4% ± 8.2%); cromolyn was not different than placebo. There was a trend for the change in log PC20 methacholine to be less following beclomethasone administration than that seen with placebo or cromolyn.

Reviewer's Comments. It is well known that a single dose of cromolyn given before allergen exposure inhibits both the early and late phase response, whereas beclomethasone given prior to exposure will only prevent the late phase response. However, many individuals don't plan ahead well enough and need to know what medication should be taken if they have forgotten to take any pretreatment. This study indicates that, if bedomethasone, albeit in a dose equal to 12 puffs of the U.S. concentration, is taken even as late as 2 hours after the exposure, it can significantly inhibit the development of the late phase response. Cromolyn given at that time provides only minimal benefit.
AEROSOL BECLOMETHASONE DIPROPIONATE COMPARED WITH THEOPHYLLINE AS A PRIMARY TREATMENT OF CHRONIC, MILD TO MODERATELY SEVERE ASTHMA IN CHILDREN
Authors: Galant Stanley P. , Randolph Christopher
Published: December 2021

Although beclomethasone appeared to be somewhat superior to theophylline in clinical efficacy, the decrease in growth velocity, particularly in males, was of considerable concern.
BIOCHEMICAL ACTIVITY, PHARMACOKINETICS, AND TOLERABILITY OF MK-886, A LEUKOTRIENE BIOSYNTHESIS INHIBITOR, IN HUMANS
Authors: Kamada Alan
Published: December 2021

MK-886 can partially inhibit LTB4 synthesis ex vivo at doses that produce only mild adverse effects.
HERPES SIMPLEX VIRUS-2 (HSV-2) TYPE-SPECIFIC ANTIBODY CORRELATES OF PROTECTION IN INFANTS EXPOSED TO HSV-2 AT BIRTH
Authors: Nimmagadda Sai , Spahn Joseph
Published: December 2021

Purpose of the Study. Accurate identification of infants at risk for developing HSV-2 after exposure remains difficult. Acquired maternal HSV-2 antibody may play an important role in protection of the neonate soon after birth. To identify potential HSV-2-specific antibodies that confer protection, the authors examined HSV-2 antibody profiles of 40 infants and mothers infected with genital HSV-2 at the time of delivery.

Methods. Screening viral cultures of cervical and vulvar specimens were obtained over a 7-year period. All infants exposed to HSV-2 infection had sera and viral cultures obtained. Maternal serum was also drawn at delivery and 6 weeks after delivery. Western blot analysis was utilized to detect HSV-2-specific antibody from all exposed infants. Serum from all infants were coded so that the bands were scored in a blinded manner.

Findings. Of more than 15 000 mothers who had cultures performed, 51 had HSV-2 diagnosed from genital tract cultures; 40 had serum available for testing. Of these 40 mothers, 13 were classified with a first episode of infection, while the other 27 were classified as having recurrent episodes of infection. Of the 13 women who had seroconverted, four had "primary infection" and nine had "non-primary first episode of HSV-2 infection (ie, HSV-1-positive, new onset of HSV-2 infection). Four infants developed neonatal herpes, one of the four was born to a mother with primary HSV-2, and the other three were born to mothers with "non-primary first episode of HSV-2." When the prevalence values of the four infected and 36 uninfected infants were compared, the most dramatic difference was seen in the prevalence of antibody to gG-2, an HSV-2 glycoprotein.
INTERLEUKIN-2 RECEPTOR γ CHAIN MUTATION RESULTS IN X-LINKED SEVERE COMBINED IMMUNODEFICIENCY IN HUMANS
Authors: Jeppson John D. , Liu Andrew
Published: December 2021

Purpose of the Study. Interleukin-2 (IL-2) and IL-2 receptors play a critical role in the regulation of the T cell immune response. IL-2 receptors are made of combinations of three different chains a, β, and γ. Different combinations of these chains result in the formation of three different classes of IL-2 receptors. The authors of this paper were interested in the interleukin-2 receptor γ chain (IL-2Rγ) gene and its relationship to X-linked severe combined immunodeficiency (XSCID).

Findings. The IL-2Rγ gene was localized to the X chromosome in the same region as the XSCID locus. The IL-2Rγ gene from three patients with XSCID were found to have point mutations leading to premature stop codons and truncated IL-2Rγ chains. These shortened IL-2Rγ chains lack the cytoplasmic domain required for cell signal transduction.

Reviewers' Comments. This is the first article showing the XSCID is associated with mutations in the IL-2Rγ gene. This suggests that IL-2Rγ plays a critical role in the early development of T-cells and their function in the immune system. These results also suggest that other genetic defects in components of the IL-2/IL-2R system could be responsible for other forms of SCID or other immunodeficiency syndromes. The fact that all three patients had different mutations suggests that there is no single dominant mutation. These findings have important implications for prenatal and postnatal diagnosis, carrier identification, and possibly gene therapy for XSCID.
Familial Hirschsprung's Disease: Study of a Texas Cohort
Authors: Reyna Col Troy M.
Published: December 2021

Objective. To better define the types of transmission of Hirschsprung's disease (HD) in order to allow for earlier diagnosis and treatment and reduction of attendant morbidity.

Methods. A proband with HD was identified. A detailed family history was obtained and a 54-member, five-generation family pedigree constructed and analyzed.

Results. Six members of the kindred presented with classic biopsy-proven HD. Two of the six members were a pair of dizygotic twins. Three additional members had symptoms reminiscent of HD or HD variant (neuronal intestinal dysplasia) and were managed nonoperatively. There was one death related to HD. Hirschsprung's disease was manifested in offspring of both affected parent(s) and unaffected parents. Symptom manifestation was noted to skip generations.

Conclusions. Analysis of this kindred lends strong evidence to the possibility of autosomal dominant inheritance. This inheritance has a variable penetrance (expression) that may be a factor of mutation or of a spectrum of the disease, ie a type of neural crestopathy. Kindreds of this sort need to be identified to allow for a complete data collection and understanding of the vagaries of HD transmission. This detailed documentation will allow for earlier diagnosis and effective treatment and possible gene localization of the specific defect.
Primary Pediatric Care in the Emergency Department
Authors: Barton Leslie L. , Binkiewicz Anna , Ey John , Eicher Martha
Published: December 2021

We read with interest the article by Bell et al1 regarding using the emergency department (ED) as a site for routine childhood immunizations. Although we strongly advocate universal, complete immunization of children (to do otherwise would be to profess ignorance of recent major outbreaks of measles, mumps, rubella, and pertussis),2 we do not support the concept of using the ED as the major "modus operandi." We believe that administering catch-up immunizations in an ED setting would be expensive, inefficient, and would reinforce the negative behavior of seeking incomplete, episodic, rather than comprehensive, medical care.
Children as Victims of Violence: A National Survey
Authors: Finkelhor David , Dziuba-Leatherman Jennifer
Published: December 2021

Objective. The goal of this study was to gain a more comprehensive perspective on the scope, variety, and consequences of child victimization, which has been obscured by a fragmentation into specific problems like sexual abuse or kidnapping.

Methods. Two thousand children aged 10 to 16 years were interviewed in a national telephone survey of children.

Results. In the previous year, a quarter of the children had experienced a completed victimization, one in eight had experienced an injury, and one in a hundred required medical attention as a result Nonfamily physical assaults were the most numerous. Contact sexual abuse occurred to 3.2% of girls and 0.6% of boys. There were also substantial numbers of incidents of attempted kidnappings and violence directed to children's genitals.

Conclusion. The victimization of children occurs to a greater extent than has been previously reported and is poorly represented in official statistics. Implication. The authors argue for a more comprehensive interest in children's victimization including better national statistics about the problem.
GOVERNMENT-MANDATED CIGARETTE WARNING LABELS ARE HAZARDOUS TO HEALTH
Authors: L. J. F.
Published: December 2021

The 1964 official government report... triggered a cascade of events aimed at discouraging smoking. Now, 30 years later... it is time to acknowledge that our current policies to curb smoking simply are not working.

The warning labels, while presumably well intentioned, have done nothing to discourage smoking. Instead, they have provided extraordinary legal protection for the tobacco industry.

Industry attorneys can rely on the label for their nonsequitur defense in liability suits. They argue, in essence, that, "Cigarettes are not dangerous, but if they were, which they are not, the government `preempted' our responsibility to warn of those dangers."

If free market forces and an unfettered judicial system had prevailed, the cigarette would now be an anachronism simply because it would be too expensive to buy and too unprofitable to produce.
The Effect of Phosphate Supplementation on Linear Growth in Children with X-Linked Hypophosphatemia
Authors: Seikaly Mouin G. , Browne Richard H. , Baum Michel
Published: December 2021

Background. X-linked hypophosphatemia is the most common inherited cause of rickets. Current therapy for this disorder includes vitamin D and phosphate supplementation; however, phosphate therapy has been associated with nephrocalcinosis. The purpose of this study is to evaluate the effect of oral phosphate therapy on growth in patients with X-linked hypophosphatemia treated with either calcitriol or dihydrotachysterol (vitamin D).

Methods. We retrospectively evaluated the prepubertal growth of 36 children with X-linked hypophosphatemia. The height standard deviation score (Z-score) of patients initially treated with vitamin D alone and the Z-scores of patients treated with vitamin D and phosphate therapy were compared. In addition, the growth of patients treated with vitamin D was compared with that of patients treated with vitamin D and phosphate from the outset of therapy.

Results. Patients treated with vitamin D alone for 5.36 ± 2.18 years had an improvement in Z-score from -3.18 ± 1.10 to -2.49 ± 0.66 SDS, ,P < .05. Adding phosphate therapy for patients initially treated with vitamin D alone for 4.83 ± 2.99 years did not further improve Z-score (-2.49 ±0.66 vs -2.35 ± 0.83). Initial therapy with vitamin D and phosphate for 4.33 ± 2.19 years also improved Z-score, (-2.84 ± 1.02 vs -1.98 ± 0.82, P < .05). The change in Z-score was similar to the group treated with vitamin D alone compared with the group treated initially with vitamin D and phosphate (0.65 ± 0.54 vs 0.85 ± 0.65, respectively).

Conclusion. These data demonstrate that both vitamin D alone and in combination with phosphate improved linear growth. Adding oral phosphate for children initially treated with vitamin D alone did not improve Z-score. Initial therapy with vitamin D and vitamin D plus phosphate produced similar changes in linear growth.
High Prevalence of Antiphospholipid Antibodies in Children With Idiopathic Cerebral Ischemia
Authors: Angelini Lucia , Ravelli Angelo , Caporali Roberto , Rumi Viviana , Nardocci Nardo , Martini Alberto
Published: December 2021

Background. The presence of circulating antiphospholipid antibodies (aPLs) is frequently associated with thromboembolic phenomena.

Objective. To investigate the prevalence of aPLs, detected as lupus anticoagulant (LA) or anticardiolipin antibody (aCL), in a group of unselected children with idiopathic cerebral ischemia.

Design. Prospective, case series.

Setting. A pediatric neurology department.

Patients. Thirteen children with cerebral ischemia (eight with stroke, three with transient ischemic attacks, and two with ocular ischemia). Age-matched apparently healthy children served as controls.

Measurements. LA and aCL determination was performed within 3 days after the occurrence of the ischemic event and was repeated after 3 to 6 months. To be defined as aPL-positive, patients had to have either a positive LA test or positive IgG and/or IgM aCL at moderate/high level in both determinations.

Main results. Ten (76%) of the 13 patients were positive for either LA or aCL. No differences were found between aPL-positive and aPL-negative patients with respect to clinical manifestations or radiological features. Six (46%) of the 13 patients had a history of multiple ischemic events.

Conclusions. Our results show a very high prevalence of aPLs in children with idiopathic cerebral ischemia. Because the presence of these antibodies has relevant therapeutic implications, their determination in children with cerebral ischemia is recommended.
Advocacy Training During Pediatric Residency
Authors: Lozano Paula , Biggs Vincent M. , Sibley Barbara J. , Smith Terri M. , Marcuse Edgar K. , Bergman Abraham B.
Published: December 2021

Despite broad concerns about the welfare of children, most pediatric residents are not able to engage in child advocacy during their busy training years. Yet residency can provide an opportunity for young pediatricians to learn valuable advocacy skills by undertaking an independent project with an experienced mentor. We describe the University of Washington Pediatrics Residency Program's experience in training interested residents in child advocacy. Basic requirements are that advocacy projects must not interfere with clinical training, resident participation must be voluntary, and faculty with advocacy skills must be available to help guide the residents. Four resident projects are outlined and guidelines for instituting such programs are presented.
Silicone Breast Implants and Breast-Feeding
Authors: BERLIN CHESTON M.
Published: December 2021

Breast implants made of silicone material have been used for three decades. It is estimated that by 1989 between 850 000 and 1 million women received these implants (60% for cosmetic reasons, 40% for reconstruction) (R.R. Cook, oral communication, 1994). There are no data on the incidence of breast-feeding in these women. Because of concerns about illnesses in women who have breast implants, especially connective-tissue disease (termed by some human adjuvant disease), in April 1992 the Food and Drug Administration declared that implants would be available only through controlled clinical trials. Questions have been raised about the health of the offspring of those women, especially those infant who are breast-fed.
In Reply: Scalding Water Temperatures
Authors: FELDMAN KENNETH W.
Published: December 2021

When we published our original description of tap water burn injuries in 1978, we were aware that detergent manufacturers recommended water temperatures above 60°C (140°F) for automatic dishwashing. However, personal communication from one detergent manufacturer indicated that such high temperatures were not required. Further, Kanecko found that four of six detergents performed adequately at 38 to 49°C (100 to 120°F).

Goldwasser suggested then (and it has become more common) that dishwashers be built with booster heaters that will raise the temperature of incoming water to the desired cycle temperature. This is much more energy-efficient and safety-conscious approach to automatic dishwashing than maintaining high water heater temperatures.
Aspartame and Attention Deficit Disorder (ADD)
Authors: KROHN JACQUELINE A.
Published: December 2021

In a recent article Shaywitz et al conclude that aspartame at greater than 10 times usual dose does not affect the behavior and cognition of children with attention deficit disorder (ADD). Accardo and Lindsay note that the study refutes an effect of aspartame on behavior.

This study has a type II statistical error. A study of this size cannot answer the question of whether aspartame affects the behavior of children with ADD. The authors chose a group of children who possibly would be more sensitive to aspartame than the general population, but it is unknown if any of the children were sensitive and likely to respond adversely to the aspartame.
Television Viewing and Violence in Children: the Pediatrician as Agent for Change
Authors: Sege Robert , Dietz William
Published: December 2021

Three decades of research suggest a causal link between exposure of children to violent images on television and subsequent violent behavior. The epidemic of violence in American society mandates a critical reappraisal of the televised images that children see. To slow the cycle of violence, pediatricians can: (1) Help shape parental attitudes toward children's viewing habits; (2) lobby for school systems to adopt curricula that include critical viewing skills; and (3) work with Congress, Federal regulators, television producers, and broadcasters to reduce the exposure of children to televised violence.
Prevention of Peer and Community Violence: The Pediatrician's Role
Authors: Slaby Ronald G. , Stringham Peter
Published: December 2021

Pediatric practitioners can play a pivotal preventative role in helping their young patients to lower their risk of becoming involved in peer and community violence by developing a sound program and implementing specific preventative treatments. The recommendations presented here are derived from the integration of two sources: (1) research evidence on children's involvement with peer violence as aggressors, victims, bystanders who support violence, nonviolent problem-solvers, gender-role-related participants, or witnesses to community violence; and (2) the practical experience of developing a pediatric violence prevention program in a neighborhood health center over the last 12 years.

To develop a sound violence prevention program, it is recommended that pediatricians (1) define violence as a major health problem that can be prevented, (2) develop a thorough knowledge of both the factors underlying violence and the misleading popular myths regarding violence, (3) adopt a clear strategy by which to organize and focus these findings in the service of creating behavioral change, and (4) build collaborative partnerships with community leaders and violence prevention researchers to enhance the value of their clinical interventions.

To implement specific treatments to reduce children's risk of involvement with violence, it is recommended that pediatricians (1) take a thorough history of children's involvement with violence as an aggressor, a victim, a bystander, a nonviolent problem-solver, a participant in gender-role-related violence, and a witness to violence in the community; (2) educate children and their parents about the ways of reducing their risks by helping them to develop habits of thought and behavior patterns that lead to effective and nonviolent problem solving; (3) provide follow-up support for the changes children and their parents make to help prevent violence; and (4) engage in community outreach activities designed to change community norms about violence. By intervening early, systematically, and repeatedly in the lives of young children and their communities, pediatricians can help children develop the habits of thought they need to protect themselves from violence and to take active measures to prevent future involvement with violence.
Reducing Violent Injuries: Priorities for Pediatrician Advocacy
Authors: Dolins Judith Cohen , Christoffel Katherine Kaufer
Published: December 2021

A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps:

• Setting policy objectives by narrowing the scope of policy, by reviewing policy options, and by examining options against selected criteria.

• Developing strategies for educating the public and for approaching legislative/regulatory bodies.

• Evaluating the effectiveness of the advocacy action plan as a process and as an agent for change.

To illustrate the variety of ways in which pediatricians can be involved in the policy process to reduce violent injuries among children and adolescents, we apply this systematic approach to three priority areas.

• Prohibiting the use of corporal punishment in schools is intended to curb the institutionalized legitimacy of violence that has been associated with future use of violence.

• Efforts to remove handguns from the environments of children and adolescents are aimed at reducing the numbers of firearm injuries inflicted upon and by minors.

• Comprehensive treatment of adolescent victims of assault is intended to decrease the reoccurrence of violent injuries.