bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Novel Mediators of Inflammation in Left Ventricular Remodeling in Patients With Acute Myocardial Infarction: Do They Affect the Outcome of Patients?
Authors: Oren Hüseyin , Erbay A. Rıza , Balç Mustafa , Çehreli Sengül
Published: June 2007

Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is a major mechanism for cardiovascular death and disability. A significant number of post-MI patients develop progressive left ventricular enlargement and heart failure and many require heart transplantation and ventricular assist devices. Understanding of the basic mechanisms regulating the reaction to injury is crucial for the development of site-specific cell biological strategies of intervention to both reduce injury and promote repair. To determine whether there are new inflammatory markers having a role in structural remodeling after AMI in patients who applied to the emergency department of this hospital with severe chest pain at the first 12 hours, the authors measured the levels of C-reactive protein (CRP), macrophage colony-stimulating factor (M-CSF) and interleukin-3 (IL-3) in patients with AMI at hospital admission and on day 5. They measured plasma CRP concentrations by using highly sensitive CRP reagent with the immunonephelometric method, and plasma M-CSF and IL-3 concentrations with the help of a commercial enzyme-linked immunoassay test in 30 patients with AMI. Mean plasma CRP, M-CSF, and IL-3 concentrations at admission to the hospital were significantly higher than those on day 5 (5.0 ∓3.1 mg/dL, 119.4 ∓103.6 pg/mL, and 155.1 ∓83.4 ng/mL, respectively, p<0.001 for each value). CRP, M-CSF, and IL-3 were all increased in patients with AMI. These findings suggest that these are new inflammatory markers, which may have important roles in LV remodeling after AMI.
Coagulation, Fibrinolytic System Activation and Endothelial Dysfunction in Patients With Mitral Stenosis and Sinus Rhythm
Authors: Topaloglu Serkan , Boyacı Ayca , Ayaz Selime , Yilmaz Sevinç , Yanık Oya , Ozdemir Ozcan , Soylu Mustafa , Demir Ahmet Duran , Aras Dursun , Kısacık Halil Lutfi , Korkmaz Sule
Published: June 2007

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p<0.05). Whether the rhythm was sinus or AF, fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly higher in patients with LASEC than in the control group (p<0.05). Only PF 4 was higher in the AF group than in those with sinus rhythm (p<0.05). As to plasminogen activator and PAI-I levels, only tissue plasminogen activator levels were found to be higher in the AF group than in those with sinus rhythm and the control group (p<0.05). In patients with mitral stenosis and sinus rhythm, if LASEC is present, coagulation activation, platelet activation, and endothelial dysfunction are similar in patients with AF, and anticoagulation should be considered in these patients.
P-Wave Durations in Patients Experiencing Atrial Fibrillation During Exercise Testing
Authors: Ozdemir Ozcan , Soylu Mustafa , Demir Ahmet Duran , Topaloğlu Serkan , Alyan Omer , Geyik Bilal , Kutuk Emine
Published: June 2007

Augmented sympathoadrenal activity during exercise may contribute to occurrence of various arrhythmias including atrial fibrillation (AF). The prolongation of intraatrial and interatrial conduction times and inhomogeneous propagation of sinus impulses are well-known characteristics of the atrium prone to fibrillate and are evaluated by maximum P-wave duration (P max), P-wave dispersion (PWD). To show the increased P max and PWD values in patients experiencing AF during exercise testing and the role of beta blockade on treatment of exercise-induced AF, 22 of these patients were compared with a control group consisting of 41 patients without AF attacks. P max (p=0.001) and PWD (p=0.001) values were significantly higher in patients with AF compared to those without AF. The development of AF during exercise testing was found to be positively correlated with P max (r =0.87, p<0.001), PWD (r =0.83, p=0.001), and work load (r =0.34, p=0.002) and negatively correlated with ejection fraction (r =-0.26, p=0.02). After the treatment with beta-blocking agents for 2 weeks, the decrease in P max and PWD values was accompanied by a much lower prevalence of exercise-induced AF. Consequently, the patients with AF had greater P max and PWD values compared to control subjects, and these simple parameters were well correlated with the occurrence of AF during exercise testing. Furthermore, treatment of these patients with beta blockers would appear to decrease the recurrence of exercise-induced AF and to be associated with a decrease in P-wave durations.
The Effect of Ephedra and High Fat Dieting: A Cause for Concern!
Authors: Fleming R. M.
Published: June 2007

The increased incidence of obesity in the world has resulted in more and more people attempting to lose weight through a variety of diets. Many of these diets employ caloric reduction through the elimination of certain food groups. These diets may initially be associated with weight loss (including water weight) but follow up reports of these diets show high drop out rates, proinflammatory changes which can precipitate heart disease and weight gain following cessation of these diets. Efforts to use prescription anorexic medications have been associated with valvular disease and other health concerns. Dissatisfaction with the medical community and a subsequent increase in the availability of information on the Internet, are only two of the reasons why people are looking at alternative medicine to assist with health care issues. This includes the use of herbal supplements for appetite suppression. A review of the literature reveals several problems with some of these supplements, including Ephedra. Potentially serious adverse effects include dysrhythmias, heart failure, myocardial infarction, changes in blood pressure, and death have occurred. Unfortunately, one half of all patients experiencing a myocardial infarction have total cholesterol levels below 150 mg/dL and/or no prior cardiac symptoms. This means that the development of inflammatory changes which can precipitate myocardial infarction may go unnoticed by conventional testing and unless markers of inflammation and coronary perfusion are looked for, changes which can precipitate myocardial infarction may go unnoticed until cardiac injury occurs. The following case presentation shows how an individual with exertional dyspnea and concerned about her weight was affected by both the ingestion of a low-carbohydrate diet and ephedra.
A Pilot Study of Methyiphenidate, Clonidine, or the Combination in ADHD Comorbid with Aggressive Oppositional Defiant or Conduct Disorder
Authors: Connor Daniel F. , Barkley Russell A. , Davis Heather T.
Published: June 2007

A pilot comparison of the safety and efficacy of methylphenidate (MPH) combined with clonidine, clonidine monotherapy, or MPH monotherapy in 6to 16-year-old children diagnosed with attention deficit hyperactivity disorder (ADHD) and comorbid aggressive oppositional defiant disorder or conduct disorder was completed. Study design was a 3-month, randomized, blinded, group comparison with eight subjects per group. No placebo comparison was used. All three treatment groups showed significant improvements in attention deficits, impulsivity, oppositional, and conduct disordered symptoms as assessed by parent and teacher rating scales and laboratory measures. Significant differences among treatment groups were found only on a few measures. Only the clonidine monotherapy group showed significantly decreased fine motor speed. These results suggest the safety and efficacy of clonidine alone or in combination with MPH for the treatment of ADHD and aggressive oppositional and conduct disorders.
Applying Outpatient Protocols in Febrile Infants 1-28 Days of Age: Can the Threshold Be Lowered?
Authors: Kadish Howard A. , Loveridget Brian , Tobeyt John , Bolte Robert G. , Corneli Howard M.
Published: June 2007

The purpose of this study was to determine the applicability of two accepted outpatient management protocols for the febrile infant 1-2 months of age (Boston and Philadelphia protocols) in febrile infants 1-28 days of age. We retrospectively reviewed charts of patients 1-28 days of age with a temperature greater than or equal to 38.00C. Criteria from each of the above-cited management protocols were applied to the patients to determine their applicability in screening for serious bacterial infection (SBI). An SBI was defined as bacterial growth in cultures from blood, urine, cerebrospinal fluid (CSF), stool, or any aspirated fluid. Overall, 372 febrile infants were included in the study. Ages ranged from 1 to 28 days of age. The mean age was 15 days. SBI occurred in 45 patients (12%). The mean age of the patients with an SBI was 13 days. Thirty-two infants (8.6%) had a urinary tract infection; 12 (3.2%), bacteremia; five (1.3%), bacterial meningitis; three (0.8%), cellulitis; one (0.3%), septic arthritis; one (0.3%), bacterial gastroenteritis; and one (0.3%), pneumonia. Ten infants had more than one SBI. Of 372 patients, 231 (62%) met the Boston's laboratory low-risk criteria; eight (3.5%) would have been sent home with an SBI with these criteria. Philadelphia's laboratory low-risk criteria would have been met by 186 patients (50%); six (3.2%) would have been sent home with an SBI with these criteria. The negative predictive value of both the Boston and Philadelphia protocols for excluding an SBI was 97%. We conclude that current management protocols for febrile infants 1-2 months of age when applied to febrile infants 1 to 28 days of age would allow 3% of febrile infants less than 28 days of age to be sent home with an SBI. Current guidelines recommending admitting all febrile infants less than 28 days of age should be followed until the outcome of those 3% of febrile infants with an SBI treated as outpatients can be determined.
Assessing Growth Patterns—Routine but Sometimes Overlooked
Authors: Chen Roland S. , Shiffman Richard N.
Published: June 2007

We performed a retrospective chart review for 149, randomly selected well-child encounters to evaluate the frequency with which clinicians; plot growth measurements and document growth abnormalities during health maintenance visits. Providers failed to plot at least one measurement of height, weight, and/or head circumference in 31 of 149 encounters (21%, 95% CI=14.5% to 27.5%). Growth abnormalities in size, velocity, and/or disproportion were not documented in 22 of 40 relevant encounters (55%, 95% CI=40% to 70%). Overall, 52 of 149 encounters (35%) were associated with an unplotted measurement and/or an undocumented growth abnormality. We feel that both documentation and assessment of growth represent potential areas for quality improvement.
Group B Streptococcal Infection Early Onset Disease Controversies in Prevention Guidelines, and Management Strategies for the Neonate
Authors: Turow Judith , Spitzer Alan R.
Published: June 2007

Group B streptococcus (GBS) has been a major pathogen that is particularly devastating to the newborn for more than two decades. Initial guidelines were promoted by the AAP in 1992 to help deal with this organism, but these recommendations were poorly accepted and not widely used. In 1996-1997 the AAP, CDC, and ACOG created new guidelines for the management of the mother and infant at risk for GBS. Though usually in agreement, these three sets of recommendations still have some differences that may be confusing to the pediatrician. This paper looks at the acquisition, intrapartum treatment, and postnatal management of GBS, along with some of the controversies associated with the management of this disease.
Current Options in the Management of Apnea of Prematurity
Authors: Bhatia Jatinder
Published: June 2007

Apnea of prematurity (AOP) is a common problem that affects premature infants and, to a lesser degree, term infants. Apnea of prematurity appears to be due to immaturity of the infant's neurologic and respiratory systems. Apnea of prematurity is a diagnosis of exclusion that can be made only when other possible infectious, cardiologic, physiologic, and metabolic causes of apnea have been ruled out. The fundamental principles for managing apnea of prematurity include monitoring the infant closely while instituting supportive care measures such as tactile stimulation, continuous positive airway pressure, or mechanical ventilation. When necessary, pharmacologic therapy may be used to stimulate breathing. The first-line agents of choice for the management of AOP are the methylxanthines. And, for second-line therapy, a switch to a different class of agent, such as the respiratory stimulant doxapram, is an option. Of the methylxanthines, theophylline is the most extensively used. However, a review of the literature suggests that caffeine citrate may be the agent of choice for AOP. Comparative clinical studies have demonstrated that caffeine is at least as effective as theophylline, has a longer half-life, is associated with fewer adverse events, and, in addition, has a greater ease of administration. Caffeine stimulates the respiratory and central nervous systems more effectively and penetrates into the cerebrospinal fluid more readily than theophylline. In addition, because of stable plasma levels, caffeine has a wide therapeutic margin and few side effects. In contrast, theophylline plasma levels may fluctuate widely, which necessitates frequent monitoring and has a higher incidence of adverse events than caffeine. Before the FDA approval of caffeine citrate (Cafcit®) for administration either intravenously and/or orally, caffeine preparations were “homemade.” A few studies suggest that use of pharmacotherapy to treat AOP is not generally associated with long-term sequelae, although more data are needed before this can be definitively concluded.
Effectiveness of Treatments for Nocturnal Enuresis in a Heterogeneous Population
Authors: Schulman Seth L. , Colish Yosef , von Zuben F. Christian , Kodman-Jones Christine
Published: June 2007

The objective of this study was to determine the effectiveness of various treatments for nocturnal enuresis in a large, diverse population of children. A retrospective cohort review of patients with nocturnal enuresis was undertaken. All patients selected treatment after a single visit that included a history, examination, and demonstration of treatments. Families were contacted 1 year later to determine what treatment they chose and whether their child still wet. Families primarily chose an alarm (31%), followed by desmopressin acetate (22%) and oxybutynin (9%). Some preferred no treatment (23%). Fifty-six percent of patients using the alarm were completely dry compared to 18% using desmopressin acetate (p<0.0001), 16% using oxybutynin, and 28% receiving no treatment. In a heterogeneous population 1 year after a single visit, children whose parents chose the nocturnal enuresis alarm were most likely to be completely dry.
UTI: Diagnosis and Evaluation in Symptomatic Pediatric Patients
Authors: Heidrich Fred J. , Barone Michael A. , Spiegler Ethan
Published: June 2007

We retrospectively reviewed data on 260 hospitalized pediatric patients with symptomatic urinary tract infection (UTI). To ascertain the colony-forming units (CFU) /mL compatible with the diagnosis of UTI, a culture from a catheterized urine specimen containing >1,000 CFU/mL was considered diagnostic of UTI and resulted in imaging by renal ultrasound, voiding cystourethrography, and renal nuclear scan with Tc99m dimercaptosuccinic acid (DMSA). A positive DMSA renal scan is indicative of pyelonephritis. We used logistic regression analysis to determine which patient characteristics were predictive of pyelonephritis. We determined that, in hospitalized pediatric patients, the colony count of the positive urine culture, the type of organism grown in culture, and the voiding cystourethrography (VCUG) result (positive or negative for vesicoureteral reflux) did not predict which patients had pyelonephritis. In females, advancing age of the patient and positive renal ultrasound results were predictive of which patients had pyelonephritis when we controlled for other factors. We feel this emphasizes the importance of a thorough evaluation of hospitalized symptomatic patients, including patients with colony counts of 1,000 to 50,000 CFU/mL, to locate the level of infection and plan appropriate therapy.
The Academic Children's Hospital Primary Care Clinic: Responding to tie Challenges of a Changing Health Care Environment
Authors: Berman Brian
Published: June 2007

Academic medical centers have encountered increasing fiscal challenges as the paradigm in health care has shifted from traditional fee-for-service reimbursement to systems of managed care. Most academic centers have maintained primary care clinics, which have served as “educational laboratories” for students and trainees. Largely providing care to underserved patients, academic primary care clinics have been heavily dependent on Medicaid reimbursement for support. Given the realities of a rapidly changing health care environment, academic primary care clinics have been challenged to respond with innovation and creativity in order to remain viable. The pediatric primary care clinic at Rainbow Babies & Children's Hospital of University Hospitals of Cleveland initiated a reorganization program with the goal of ensuring that patients receive quality, cost efficient care and that students and pediatric residents receive first-rate ambulatory education in a fiscally responsible setting. Fundamental was the setting of priorities for patient care and service while promoting an environment conducive to medical education. Educational programs were segregated into a well-defined educational “module,” and various initiatives were advanced emphasizing patient access, consistency of care, efficient use of space and personnel resources, limitation of inappropriate use of costly after-hours resources, and identification and coordination of care for patients with chronic illness and/or at high risk for medical complications. Three years after the instituting of fundamental organizational change, objective measures of cost efficiency and selected quality measures compare quite favorably with a broad range of primary care providers throughout the region. If academic medical centers are to remain leaders in ambulatory pediatric education, energetic, proactive, and thoughtful responses to the rapidly changing global health care environment will be necessary.
Radiologic Differentiation Between Bacterial and Viral Lower Respiratory Infection in Children: A Systematic Literature Review
Authors: Swingler George H.
Published: June 2007

A systematic literature review was performed to quantify the accuracy of chest radiography in differentiating bacterial from viral lower respiratory infection in children. Relevant studies were identified in a systematic literature search and were included in the review according to predetermined criteria. Five of 13 relevant identified studies met the inclusion criteria. No clinically useful degree of accuracy was demonstrated, but great caution is needed in interpreting the findings because of the suboptimal nature of the reference standards, even in included studies. It is recommended that future surveys of the microbial etiology of pneumonia that employ a credible reference standard (such as lung aspiration) be used as opportunities to perform studies of diagnostic accuracy.
Palpable Spongy Mass Over the Clavicle, an Underutilized Sign of Clavicular Fracture in the Newborn
Authors: Reiners Charles H. , Souid Abdul-Kader , Oliphant Michael , Newman Nancy
Published: June 2007

This prospective study emphasizes the importance of an early physical finding of neonatal clavicular fracture, termed “the palpable spongy mass sign.” Of the 1,661 term neonates examined at our tertiary center over a 20-month period, 24 had clinical signs of a clavicular fracture. In 22 of the 24 neonates, the fractures were documented by positive radiographs or callus formation. None of the fractures was recognized because of an asymmetric Moro reflex, visible swelling, or bruising. The palpable spongy mass was present in 18 of the 22 fractures (82%), crepitus in 10 (45%), angulation deformity in two (9%), and localized tenderness in one (5%). Any combination of crepitus, deformity, and localized tenderness was detected in 11 of the 22 (50%) fractures. When the palpable spongy mass sign was added to these three signs, all but one fracture was clinically detected (95%), emphasizing the importance of using all physical findings. We conclude that “the clavicular spongy mass sign” is highly sensitive and predictive of neonatal clavicular fractures.
The Growth and Development of a Specialty: The History of Pediatrics
Authors: Mahnke C. Becket
Published: June 2007

Spanning less than two centuries, pediatrics is a relatively young medical specialty. Prior to the development of pediatrics, the medical needs of infants and children were provided by families, friends, and midwives; physicians rarely contributed to the health of this population. However, events beginning in the 19th century resulted in the development of physicians who specifically addressed the medical problems of infancy and childhood; thus the pediatric specialty was born. This article presents a summary of the cumulative forces responsible for the development of pediatrics as a distinct branch of medical practice.
Congenital Adrenal Hyperplasia: From Genetics and Biochemistry to Clinical Practice, Part 1
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 first part of this two-part review discusses the genetics, biochemistry, and clinical presentation of the different forms of CAH. Understanding the genetics and pathophysiology of each of the various enzyme mutations is essential for the evaluation and management of the different clinical forms of CAH.
Effectiveness of Inhaled Corticosteroids in Controlling Acute Asthma Exacerbations in Children at Home
Authors: Volovitz Benjamin , Nussinovitch Moshe , Finkelstein Yaron , Harel Liora , Varsano Itzhak
Published: June 2007

Many clinicians advise their patients to increase the dose of inhaled corticosteroids during acute asthma exacerbations, without strong clinical evidence supporting this treatment. This study investigates the effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home. The study population consisted of children with mild intermittent, mild and moderate persistent asthma aged 1 to 14 years who were treated in our outpatient clinic with inhaled budesonide for 1 year. After participating in an asthma education session, the parents were instructed to initiate treatment with inhaled budesonide at the first signs of asthma exacerbation, starting with 200 to 400 pg budesonide, in combination with beta-2 agonists 4 times a day and followed by a decrease in the dose in 4 to 8 days. Asthma status and peak expiratory flow rates were measured in the 3 monthly follow-up visits. Only children who complied with the treatment regimen and came for follow-up visits regularly were included in the final analysis. One hundred fifty children used our treatment protocol with inhaled budesonide to control their asthma attacks. Clinical improvement of asthma symptoms was achieved after a mean of 1.8 +0.7 days from the beginning of treatment. The parents were able to control 94% of the 1,061 episodes of asthma exacerbation occurring during a cumulative follow-up period of 239 years. In the 3-month period before enrollment, 101 children (67%) had used oral corticosteroids to control their asthma attacks and 50 (33%) were hospitalized. During the entire follow-up period, only 11 children (7%) used oral corticosteroids, and none of the children were hospitalized. The present study demonstrates that children with asthma can control their exacerbations at home using inhaled corticosteroids (budesonide). Treatment, starting with relatively high doses followed by a rapid reduction in dose over 4-8 days, resulted in a decrease in the use of oral steroids and in hospitalization. To achieve good results, patient compliance is essential.
Medical Causes of Pneumomediastinum in Children
Authors: Damore Dorothy T. , Dayan Peter S.
Published: June 2007

The purpose of this study was to determine the possible causes, clinical findings, and associated complications of pneumomediastinum in children. Medical records fromJanuary 1985 to December 1994 were retrospectively reviewed at Children's Hospital Medical Center of Akron using International Classification of Diseases, ninth revision, codes to identify cases of pneumomediastinum. The medical causes, nontraumatic and noniatrogenic, of pneumomediastinum were studied; intubated or trauma patients and patients having undergone procedures were excluded. Neonates were also excluded. Twenty-nine cases of pneumomediastinum were identified. Two patients (7%) had recurrent pneumomediastinum. Only the first episode of pneumomediastinum was included in the data analysis. Twenty males (69%) and nine females (31%) were affected. The most common medical causes of pneumomediastinum were asthma exacerbations (17/59%) and infections (8/28%). Over the 10-year period, the prevalence of pneumomediastinum in children with asthma exacerbations was 0.2% (21/10,472); 1% (1/126) in children with airway foreign bodies and 0.2% (1/351) in children with esophageal foreign bodies. The most common signs and symptoms were subcutaneous emphysema (22/76%), sore throat or neck pain (11/38%), and Hamman's crunch (3/10%). The most common complication was pneumothorax with small pneumothoraces in 2 patients (7%) and a tension pneumothorax in 1 asthmatic with recurrent pneumomediastinum. Patients without sore throat or neck pain and patients admitted to the intensive care unit had greater hospital lengths of stay. Pneumomediastinum appears to be uncommon in children. The most common medical causes were asthma and infections. The most common signs and symptoms were subcutaneous emphysema, sore throat or neck pain, and Hamman's crunch. The most common complication was pneumothorax. The clinical significance of pneumomediastinum is its cause and association with significant complications.
Adolescents with ASCUS: Are They a High Risk Group?
Authors: Arora Catherine D. , Schmidt Dana S. , Rader Ann E. , Abdul-Karim Fadi , Lazebnik Rina
Published: June 2007

Population demographics, risk behaviors, and compliance rates for the management of an ASCUS (atypical squamous cells of undetermined significance) diagnosis are not well studied in the adolescent population. From June 1994 to December 1996, 1175 Papanicalou (pap) smears were performed in an urban adolescent clinic on patients age 12 to 18. Of these, 124 (10.5%) were diagnosed with ASCUS or ASCUS with a qualifying statement. A retrospective chart review (n=83) and telephone interview was performed on patients with ASCUS. Ninety-nine percent of enrollees were African American. Comparisons were made between those patients with normal pap smears and those with ASCUS. No statistically significant difference existed pertaining to age at pap smear, age at menarche, age at first coitus, and education level. A positive association was found in the ASCUS group for the presence of sexually transmitted diseases (P<0.001), number of sexual partners (P<0.0007), and pregnancy (P<0.001). Of the 80% of patients who had an ASCUS diagnosis and were referred for colposcopy (n=62), only 61% attended their appointment (n=38). Thirty-nine percent of these patients were aware of an abnormal diagnosis after colposcopy. For those that attended colposcopy, 56% were accompanied by a parent. For those who were not compliant with attendance, none cited parental consent for the procedure as a barrier to obtaining treatment. Adolescent females in an urban setting with multiple sexual partners, history of sexually transmitted diseases, and prior pregnancy are at a greater risk for ASCUS on cervicovaginal smear when compared to their age-matched controls. In addition, the adolescent compliance rate for colposcopy is low. We, therefore, recommend that these adolescent females be observed diligently.
Serum Homocysteine and Lipoprotein (a) Concentrations in Hypercholesterolemic and Normocholesterolemic Children
Authors: Laskowska-Klita T. , Szymczak E. , Radomyska B.
Published: June 2007

The relationship between lipids, lipoproteins, total homocysteine, and lipoprotein (a) was studied in hypercholesterolemic and normocholesterolemic children. In hypercholesterolemic children, concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglycerides were significantly higher compared to levels in controls, whereas concentrations of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I were lower compared to those in the control group. Total serum homocysteine concentrations in children with a positive family history for cardiovascular disease CHD (+) (7.28 pmol/L) were significantly higher than those in the control group (5.45 pmol/L), and in the group of CHD(-) children (5.25 pmol/L). The median value of lipoprotein (a) in patients was 31.5 mg/dL (range, 11-209 mg/dL) and in the control group, 19 mg/dL (range, 11-95 mg/dL). Concentrations of Lp (a), exceeding 30 mg/dL, were present in 45% of CHD (+) children, in 29% of CHD (-) children, and in only 11% of the control group.
Evaluation of Occult Acetaminophen Hepatotoxicity in Hospitalized Children Receiving Acetaminophen
Authors: James Laura P. , Wilson John T. , Simar Renee , Farrar Henry C. , Kearns Gregory L. , Simpson Pippa M. , Hinson Jack A. , Pumford Neil R. ,   Pediatric Pharmacology Research Unit Network
Published: June 2007

The safety of repeated doses of acetaminophen in ill children with the potential of reduced glutathione stores has been questioned. This study measured hepatic transaminases in children and adolescents (n=100) who received >6 therapeutic doses of acetaminophen over a 48-hour period of hospitalization. Acetaminophen-protein adducts were measured in a cohort of subjects with hepatic transaminase elevation (n=8) and in those (n=10) receiving concurrent drug therapy with agents that induce the cytochrome P450 enzymes involved in acetaminophen metabolism. Acetaminophen-protein adducts were not detected in this cohort of 18 subjects. Based on this pilot study, the routine use of acetaminophen at therapeutic doses in ill, hospitalized children and adolescents appears safe.
A Program Description of Health Care Interventions for Homeless Teenagers
Authors: Steele Russell W. , O'Keefe Mary Allyce
Published: June 2007

This prospective review was designed to determine the effectiveness of a broad-spectrum health intervention program for homeless and runaway youth. Diagnosis, treatment, and counseling for drug use, sexually transmitted diseases (STDs), and other health issues were provided all new admissions to a residential care facility during a 2-month enrollment. Education was continued during a 9-month follow-up period based on the program entitled Bright Futures, previously developed and published by the National Center for Education in Maternal and Child Health. Sixty percent of the 106 study residents had STDs on admission and 7% developed new STDs after completing therapy and undergoing counseling. Drug dependence was reduced from 41% to 3%, and 42% achieved full-time or part-time employment. Fifty-nine percent completed hepatitis B immunization with the 3-dose series. This experience suggests that an organized program of interventions in a residential care facility for homeless teenagers can significantly reduce drug dependence and STDs.
The Use of Dietary Supplements in Pediatrics: A Study of Echinacea
Authors: Mark John D. , Grant Kathryn L. , Barton Leslie L.
Published: June 2007

Alternative medical therapies are commonly used and have increased in popularity. Although patients may not always disclose the use of alternative therapies, they may seek advice regarding their use, especially for children. Regulation and standardization of these modalities, especially botanicals, is incomplete. The University of Arizona has initiated a study of the use of echinacea in the prevention of recurrent otitis media. A review of echinacea preparations was undertaken, and this report discusses the complexities surrounding the use of this dietary supplement. The number and diversity of echinacea preparations are detailed; the role of the physician as “botanical” advisor to patients and families is examined.
Hypocalcemia in Children: Pathogenesis and Management
Authors: Umpaichitra Vatcharapan , Bastian William , Castells Salvador
Published: June 2007

Hypocalcemia can be devastating if unrecognized. Neuromuscular dysfunction occurs in severe cases. A review and an update on the topic may assist general pediatricians. The authors provide a general overview of pathogenesis and management of hypocalcemia in children.
Externalizing Behaviors and Television Viewing in Children of Low-Income Minority Parents
Authors: Gupta Vidya B. , Nwosa Nkemdilim M. , Nadel Traci A. , Inamdar Sarla
Published: June 2007

The parents of 151 children, ages 4-16 years, attending the pediatric outpatient clinic of an urban hospital were surveyed to determine if aggressive behavior among children of low literacy and low-income parents is related to excessive television viewing or to sociological variables such as ethnicity/race, education, occupation, and parents' marital status. The survey consisted of 22 questions about the ethnicity, marital status, education, and occupation of the parent, the television viewing behavior of the child, and the externalizing behavior scale of the Child Behavior Checklist of Achenbach (CBC). The television viewing habits of children in this study were not significantly different from viewing habits reported in national surveys of the US population. T scores in the aggression scale of CBC were unrelated to the hours of television watched by children and the control of viewing by the parent but were significantly associated with the employment and marital status of the mother. Children of unemployed and single mothers had higher externalizing-behavior scores, suggesting that family ecological variables may have more influence on children's behavior than the duration of television viewing.
Daily Multivitamins with Iron to Prevent Anemia in Infancy: A Randomized Clinical Trial
Authors: Geltman Paul L. , Meyers Alan F. , Bauchner Howard
Published: June 2007

This study assessed the effectiveness of multivitamins (MV) with iron as prophylaxis against iron deficiency (ID) and anemia in infancy. The study was a double-blind, randomized trial at 2 urban primary care clinics. Subjects included healthy, full-term infants enrolled at their 6-month well-child visit. Parents administered MV, either with iron or without iron, by mouth daily for 3 months. At 9 months of age, 28.3% of 310 had either anemia or ID without anemia. Among infants with any adherence, anemia was found in 11.1% of the iron group and 21.7% in the noniron group (RR=0.5, 95% CI=0.3-1.0). Iron deficiency without anemia was found in 18.5% of the iron group; 14.4% of the noniron group (p=0.46). When administered daily starting at age 6 months, standard-dose multivitamins with iron appear to reduce anemia prevalence at 9 months of age.
Lactobezoars: A Patient Series and Literature Review
Authors: DuBose V Theodore M. , Southgate W. Michael , Hill Jeanne G.
Published: June 2007

Lactobezoar is a compact mass of undigested milk concretions located within the gastrointestinal tract. Most often found in infants, they can precipitate gastric outlet obstruction, mimicking a variety of medical and surgical conditions. A common etiology and method of cure have yet to be elucidated. A review of the literature provides some insight into causes, clinical presentations, diagnosis, and management. Data from the Medical University of South Carolina further help dispel the belief that lactobezoars are isolated to pre-term infants on caloric-dense formulas. Findings suggest bezoar formation may be more common than previously thought and a high index of suspicion could help avoid costly evaluations for obstructive symptoms.
Early Newborn Discharge: A Tale of Two Hospitals
Authors: Feinberg Arthur N. , Lowry Mark , Koelsch Rachel
Published: June 2007

This study reviews physician documentation of compliance with The American Academy of Pediatrics (AAP) policy RE9539 regarding early newborn hospital discharge and follow-up. All pediatricians in Kalamazoo, MI, were educated at a grand rounds regarding the AAP early newborn discharge policy. Newborns are seen at 2 community hospitals. One of them simultaneously instituted a Quality Improvement/Feedback (QI/F) program regarding early newborn discharge, (intervention) and the other 1 did not (control). This is a retrospective chart analysis that compares performance of 4 pediatric practices seeing newborns at each hospital. Each practice was compared at each hospital for appropriateness of discharge orders before and after the educational grand rounds and the QI/F initiative. Statistical analysis was done using the chi square test and the Breslow-Day test for homogeneity, and the Fisher's Exact Test. Odds ratios with a 95% confidence interval based on Taylor's approximation were used. There were no significant differences between the pediatric practices' performance before and after the educational initiative at the control hospital. There were significant differences before and after the educational initiative in the intervention hospital with the QI/F initiative. There was a significant reduction in variation among the practices after the QI/F initiative at the intervention hospital. When both hospitals were compared after the educational initiative, there was a significant difference between compliance among the same practices at each hospital, with better compliance at the intervention hospital with the QI/F initiative. There were significant differences in physicians' performance at the intervention hospital before and after the educational and QI/F initiatives. However, it was noted that the very same physicians did not comply as well in the control hospital without the QI/F initiative, thus still raising questions as to whether QI measures alter physician “culture.” It is possible that the driving force for change in physician behavior was more intragroup peer pressure than an external QI/F initiative.
Child Care Program Directors' Level of Knowledge About Asthma and Factors Associated with Knowledge
Authors: Juhn Young J. , Sauver Jennifer St. , Shapiro Eugene D. , McCarthy Paul L.
Published: June 2007

Although asthmatic children spend a significant amount of time in child care programs, little is known about child care program directors' knowledge about asthma and what factors influence directors' level of knowledge about asthma. A telephone interview was conducted with directors of a randomly selected sample of all licensed child care centers and group day care homes in Connecticut. Directors of most child care programs were willing to admit asthmatic children to their programs, but their knowledge about asthma needs to be improved. Directors who have served for long periods of time may be a target group for additional education about asthma.
The Pediatric Use of Bilevel Positive Airway Pressure Therapy for Obstructive Sleep Apnea Syndrome: A Retrospective Review with Analysis of Respiratory Parameters
Authors: Padman Raj , Hyde Christopher , Foster Paul , Borkowski Winslow
Published: June 2007

The purpose of this study was objective documentation of clinical benefits of bilevel positive airway pressure in pediatric patients with obstructive sleep apnea. We performed a retrospective chart review and data collection/analysis in a suburban tertiary care children's hospital. The study consisted of 10 pediatric patients (age range: 3 to 18 years); 3 patients had craniofacial abnormalities, 1 patient had neuromuscular disease, and 6 patients were obese. Eleven-channel polysomnography and support with bilevel positive airway pressure were used. We measured obstructive sleep apnea indices, lowest oxygen saturation rate, and average breath lengths before and after bilevel positive airway pressure use. We found that the apnea index decreased from 19.7 ±26.46 to 0.82 ±1.01, the lowest oxygen saturation increased from 75.60% ±14.93% to 89.50% +5.50%, and breath length increased from 3.22 +0.95 to 3.68 ±0.82. Bilevel positive airway pressure may be considered as a treatment modality for pediatric patients with obstructive sleep apnea.
Compound Heterozygosity for the Common Sulfonylurea Receptor Mutations Can Cause Mild Diazoxide-Sensitive Hyperinsulinism
Authors: Dekel Benjamin , Lubin Daniel , Modan-Moses Dalit , Quint Jacob , Glaser Benjamin , Meyerovitch Joseph
Published: June 2007

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a disorder characterized by dysregulation of insulin secretion and prolonged hypoglycemia. Mutations in the genes of both subunits of the P-cell KATP channel, Kir 6.2 (potassium channel) and SUR1 (sulfonylurea receptor) have been associated with the autosomal recessive form of this disorder. It was previously demonstrated that patients harboring SURI mutations often do not respond well to diazoxide. A patient is reported of compound heterozygosity for the 2 most common mutations previously reported to be associated with PHHI in Ashkenazi Jews; splice mutation of intron 32 (3993-9G->A) and deletion of phenylalanine at position 1388. Relatively low glucose utilization (<10 mg/kg/min) was needed to maintain blood glucose concentrations. In addition, treatment with diazoxide was highly effective. We suggest that diazoxide unresponsiveness is not always present in patients with SURI mutations and that the probable cause of the milder phenotype in this compund heterozygote state is the splice mutation.
Well-Child Care: Effectiveness of Current Recommendations
Authors: Dinkevich Eugene , Ozuah Philip O.
Published: June 2007

Well-child care is the main source of preventive health care for children in the United States. Repeated examinations of healthy children during health supervision visits are used to assess biomedical health, development, behavior, and family functioning. In addition, well-child care serves to provide parent education through age appropriate counseling referred to as anticipatory guidance. Recommendations for well-child care are found in the Health Supervision Guidelines III, published by American Academy of Pediatrics, last revised in 1993, and a publication from the National Center for Education in Maternal and Child Health, The Bright Futures, Guidelines for Health Supervision of Infants, Children and Adolescents, revised in 2000. This article reviews the evidence for the effectiveness of the current recommendation for well-child care including the recommendations for the number of visits, history and physical examination as a screening technique, observation of parent-child interaction, and the recommendation for provision of anticipatory guidance. This article also summarizes the recent advances in well-child care and identifies an agenda for future research.
The Assessment and Management of the Respiratory Complications of Pediatric Neuromuscular Diseases
Authors: Birnkrant David J.
Published: June 2007

Respiratory complications are a major cause of morbidity and mortality in the pediatric neuromuscular diseases. Weakness of the muscles of respiration results in shallow breathing and ineffective cough, making patients vulnerable to atelectasis, pneumonia, and tracheal obstruction by retained respiratory tract secretions. Assessment of the risk of respiratory complications includes evaluating the patient's history and respiratory physical examination and measuring pulmonary function and gas exchange. Treatment options include methods of assisted cough and mechanical ventilation. This review emphasizes the use of noninvasive respiratory aids to optimize duration and quality of life in these potentially fatal diseases.
Weight and Height Deficits in Children with Brain Stem Tumors
Authors: Lehman Ralph A. W. , Krishnamurthy Satish , Berlin Cheston M.
Published: June 2007

Weight deficit is common among children with brain stem tumors and is often accompanied by height deficit. Among 22 consecutive children (≤18 years) with brain stem tumor, 16 had weight deficit (≤20th percentile) (p<1.4e-7). Eleven were at or less than the 5th percentile, and 5 were less than the 1st weight percentile. Eight also had height deficit (≤20th percentile) (p<0.06). Misdiagnoses occurred: failure to thrive in 5, growth retardation in 2, and anorexia nervosa in 2. Delay between these diagnoses and that of brain tumor averaged 4.5 years. Detailed neuroradiologic study seems worthwhile if weight deficit is extreme and either unexplained or uncorrectable, or if the weight deficit is accompanied by an abnormality suggestive of intracranial disease.