bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cat Scratch Disease
Authors: Klein Joel D. 
Published: December 2021

Introduction
Cat scratch disease (CSD), a regional lymphadenitis affecting those lymph nodes draining dermal and/or conjunctival sites of inoculation, probably is the most common cause of chronic lymphadenopathy among children and adolescents. Adults account for only 10% to 20% of cases. It usually presents as a benign, self-limited disease involving tender regional lymphadenopathy that frequently has been present for 3 weeks or longer.
In most cases the infection is preceded by a cat scratch or other close contact with a cat (generally an immature one). This infection's association with cat scratches was described first by Robert Debre in 1931. Since then, the spectrum of CSD has been expanded to include the presence of various skin rashes, such as erythema nodosum and erythema multiforme, ocular involvement, and constitutional symptoms such as fatigue and fever. In addition, many case reports of CSD have included descriptions of atypical clinical manifestations such as central nervous system involvement, arthritis, osteomyelitis, and severe chronic systemic disease.
Most recently, two possible etiologic agents of CSD have been identified: a fastidious, pleomorphic gram-negative bacillus, Afipia felis, and a rickettsial pathogen named Rochalimaea henselae.
Epidemiology
CSD appears to occur worldwide and is seen in all regions of the United States. Cases may be seen sporadically all year long, but it appears to have a seasonal preference.
Acute Renal Failure: Diagnosis
Authors: Sehic Azra , Chesney Russell W. 
Published: December 2021

Introduction
Although acute renal failure (ARF) is relatively uncommon, its mortality rate is potentially so high that it is important to recognize this condition in children. Rapid deterioration of renal function is caused by numerous insults and results in typical findings, including extracellular volume expansion, hyperkalemia, hypertension, metabolic acidosis, and azotemia. It usually is reversible, with the majority of patients recovering completely. However, ARF can lead to residual impairment of renal function and progress to end-stage renal disease and death. Conservative medical treatment often is life-saving.
Definition
ARF represents the rapidly progressive (within several hours or days) cessation of renal function, which results in the inability of the kidney to control body homeostasis, manifesting in retention of nitrogenous waste products (azotemia) and fluid and electrolyte imbalance. On the basis of pathophysiologic process, ARF has been divided broadly into three diagnostic categories: prerenal, intrarenal (organic-intrinsic), and postrenal failure (Table 1). Prerenal and early postrenal failures are renal functional disorders and responses of a structurally intact kidney to extrarenal processes. These forms of renal dysfunction recover rapidly as soon as the cause is reversed. However, if these two disorders are not recognized in time, persist too long, or are treated inadequately, they can result in intrinsic renal failure.
Formulas for the Healthy Term Infant
Authors: Greer Frank R. 
Published: December 2021

Human milk remains the gold standard for infant nutrition. As a nutritional source, it shows a relatively large degree of both intra- and inter-individual variability in composition. It can be said that the more we learn about the unique compositional qualities of human milk, the more there is to learn. Although it is unreasonable to expect any artificial formula to duplicate this mammary gland secretion, this has remained an elusive goal of nutritionists and formula companies throughout the 20th century.
Infant formulas have changed substantially since the burgeoning of the modern formula industry in the 1950s. Many of these changes, such as the additions of iron, vitamin D, and perhaps vitamin K, addressed specific well-documented deficiencies and actually moved infant formula away from the composition of human milk. However, the majority of the changes made in recent years have been attempts to bring formulas closer in composition to human milk. The additions of taurine and carnitine, further reductions in sodium content, and increases in the percent of whey protein, though advantageous theoretically, have remained of questionable benefit when subjected to rigorous scientific methods. Much of the supporting research for formula modifications is sponsored by the formula industry, the results of which are then widely advertised in circulars aimed at practitioners involved in the care of infants.
Penicillin Update
Authors: Goldstein Stuart L. , Kaplan Sheldon L. , Feigin Ralph D. 
Published: December 2021

Penicillin was discovered serendipitously by Alexander Fleming in 1928 while he was examining Staphylococcus variants. The first trials of penicillin in humans who had serious staphylococcal infections were undertaken more than I decade later and yielded impressive therapeutic results. Despite the introduction of numerous other antimicrobial agents and the emergence of many organisms resistant to penicillin, this agent remains a powerful and essential antibiotic 50 years after its first clinical application.
Pharmacology
The basic structure of the penicillins consists of the thiazolidine ring, a beta-lactam ring, and a side chain (Figure 1). The antimicrobial activity of all penicillins is produced by the thiazolidine/beta-lactam nucleus, and the organism-specific activity of a particular penicillin is determined by the side chain derivative. There are many naturally occurring side chain derivatives, but penicillin G is the most potent of these and, therefore, the only one used clinically. Semisynthetic penicillins are constructed from the basic penicillin nucleus with a side chain added. Each side chain alters the susceptibility of a particular penicillin to inactivating enzymes.
MECHANISM OF ACTION
All pencillins work by inhibiting bacterial cell wall synthesis, thereby affecting the stability of the cell wall and subsequent bacterial development. The cell wall is made of a peptidoglycan that is synthesized in three stages.
MECHANISM OF ACTION
Normal Speech and Language Development: An Overview
Authors: Coplan James 
Published: December 2021

Normal Speech and Language Development
Language consists of any symbol system for the storage and exchange of information. It commonly is described in terms of auditory expressive and receptive ability (speech and listening comprehension, respectively). However, language also is conveyed visually. Normal infants attend to gestures and initiate various gestures to make their needs known; visual language development in deaf infants exposed to a formal sign system, such as American Sign Language (ASL), parallels the stages of oral language development in hearing infants;1 and reading and writing are obvious manifestations of visual language in older children and adults. Precursors to auditory and visual language are readily observable from earliest infancy. Because these precursors lack symbolic value, they are termed prelinguistic.
AUDITORY EXPRESSIVE LANGUAGE
Human infants produce a uniform sequence of prelinguistic utterances, regardless of the language spoken by their adult caretakers. The earliest of these utterances is cooing, which consists of musical, open vowel sounds. Cooing should be well established within the first 4 to 6 weeks of life. This is followed in the first few months of life by bilabial sounds: blowing bubbles or the "raspberry." By 5 months, laughing and a variety of monosyllables appear, such as "ba" or "ga." Between 6 and 8 months, infants produce polysyllabic babbling, which consists of the same syllable repeated over and over: "lalalalala," "mamamamama," "dadadadada," and so forth.
Behavioral Side Effects of Medications Used to Treat Asthma and Allergic Rhinitis
Authors: Milgrom Henry , Bender Bruce 
Published: December 2021

Parents, teachers, and physicians are concerned that medicines may alter children's mood, behavior, and ability to learn. In clinical practice, adverse reactions to drugs and the perceptions associated with them influence prescribing patterns and undermine compliance. In the treatment of chronic disorders such as asthma, where successful management requires that patients take medications consistently over prolonged periods of time, factors affecting compliance become profoundly important.
Asthma medications have been associated with behavioral, affective, and neuropsychological changes in children. Oral corticosteroids exacerbate depression and impair verbal memory, and there are anecdotal reports of severe reactions to inhaled steroids among children, including psychotic behavior. Oral beta agonists have been reported to cause psychotic reactions in adult patients. In children, inhaled albuterol frequently induces a short-term hand tremor, but does not compromise more complex psychomotor functions. Theophylline improves concentration and results in slightly increased hand tremor and feelings of anxiety.
Medicines for allergic rhinitis and those used for cough and colds frequently are administered by parents without the supervision of physicians. Many of these preparations, given not only to children who have allergic disease but also to those who have self-limiting respiratory symptoms, are available over the counter (OTC). This confusing array of combination antihistamines, decongestants, expectorants, and anticholinergic agents constitutes the largest group of drugs taken by children.
Lice
Authors: Sonnenblick Howard C. 
Published: December 2021

Three forms of pediculosis affect the human host, each with a predilection for certain parts of the body.
Pediculosis capitis. or head lice, is the most common type and is seen primarily in preschool and school-age children, especially girls. Transmission occurs by coming into direct contact with lice or by sharing infested brushes, combs, and hats. Adult lice and their eggs (nits) are found principally in the occipital region and behind the ears. Symptoms include severe itching, often resulting in excoriation and secondary bacterial infection.
Pediculosis pubis is seen most commonly in sexually active adolescents and young adults, although occasionally it may be found on the eyelashes of small children who come in contact with infected individuals.
Consultation with the Specialist
Authors: Tingelstad Jon 
Published: December 2021

A 7-year-old boy complains of left upper quadrant pain following a fall from a tree 4 hours earlier. A 3-year-old girl has a spreading hemorrhagic rash and a temperature of 40.6°C (105.2°F). An 18-month-old boy returned to the pediatric intensive care unit 3 hours ago following prolonged open heart surgery for repair of a complex congenital heart defect. What do these three pediatric patients have in common? Each is a potential candidate for the development of shock.
Discussion
Shock is a complex pathophysiologic state that results from circulatory dysfunction and leads to failure to provide adequate quantities of oxygen and other nutrients to meet the metabolic requirements of the body's tissues. The etiologies of shock are numerous. Hypovolemic shock results from the loss of effective blood volume. For example, it may follow trauma to the spleen with unrecognized massive hemorrhage or it may be the result of severe dehydration caused by acute, explosive gastroenteritis. Septic shock, often the combination of multiple factors, follows the release of a series of mediators that cause peripheral vasodilation, myocardial depression, hypotension, ventilatory insufficiency, and anemia. Cardiogenic shock may occur after surgical repair of congenital heart defects, especially if the procedure is prolonged and difficult, or it may be associated with severe myocarditis, cardiomyopathy, or prolonged tachyarrhythmias. Decreased myocardial contractility leads to low cardiac output and hypotension.
Hymenoptera Reactions
Authors: Mendez Elvin , Sicklick Marc J. 
Published: December 2021

The order Hymenoptera comprises a group of insects that has a true stinger. Only the female of the species can sting because the stinger itself is a modified ovipositor.
Insect bites and stings are common and usually cause mild localized reactions. However, Hymenoptera stings are of greater concern, with reactions ranging from mild local irritation to fatal anaphylaxis. The incidence of systemic reactions to stings reported in the literature ranges from 0.4% to 0.8%. More recent studies have shown that up to 5% of the population is at risk of anaphylaxis laxis from insect stings. Fewer than 50 deaths from insect stings are necorded in the United States every year, but many more are unreported or undiagnosed.
Physiologic Anemia
Authors: Curtis Jane A. 
Published: December 2021

The changes in levels of hemoglobin and hematocrit in the first weeks of life are dramatic. O'Brien and Pearson, in a classic article, demonstrated that these levels drop from an average hemoglobin of 17 g/dL and a hematocrit of 52% in cord blood to a hemoglobin of 11.4 g/dL and a hematocrit of 33% at 75 days of age. The reasons for this drop and the physiologic mechanisms involved in causing it have fascinated a number of researchers.
When considering the results of blood values, the first step is to be sure of the validity of the measurements. Early researchers in this area, such as Oettinger and Mills, noted a wide range of quoted normal values for hemoglobin and hematocrit of the newborn.
Vancomycin
Authors: Goldman David L. 
Published: December 2021

Vancomycin, a glycopeptide antibiotic first isolated from the organism Amycolatopsis orientalis in 1956, was used initially to treat penicillin-resistant staphylococcal infections prior to the development of methicillin. It is selectively bactericidal against most gram-positive organisms, with almost no activity against gram-negative organisms. Several mechanisms of antimicrobial activity have been described for vancomycin, the primary one being interference with cell wall synthesis. Other mechanisms of action include alteration of bacterial cell membrane permeability and interference with messenger RNA synthesis. Because vancomycin and betalactam antibiotics act at different sites and stages of cell wall synthesis, no cross-resistance occurs.
Vancomycin is not absorbed well following oral administration and should be administered intravenously except for the treatment of Clostridium difficile colitis.
Cold, Cough, and Allergy Medications: Uses and Abuses
Authors: Katcher Murray L. 
Published: December 2021

Separately or in combination, antihistamines, decongestants, antitussives, and expectorants are used to treat the cough and rhinitis symptoms of the common cold and of allergies. Each year, Americans spend 1 to 2 billion dollars on cough and cold remedies and lose more than 26 million school days and 23 million work days because of rhinitis and associated symptoms. Studies have shown that antihistamines and decongestants are efficacious in the treatment of allergy symptoms, but the results of studies are mixed regarding their efficacy in the treatment of symptoms of the common cold, and studies show no effect in prevention or treatment of otitis media.
Some review articles and consensus opinions do not recommend the use of these drugs in the common cold (especially in preschool children), although some studies have demonstrated symptomatic relief, and physicians continue to prescribe or recommend these drugs for respiratory illness more than 36 million times annually.
The Common Cold
More than 200 million cases of acute upper respiratory infection (URI) occur each year in the United States, and more than 75 million are seen by physicians. URIs account for 23 million missed work days and 26 million missed school days. This is the second most common diagnosis made by office-based pediatricians, second only to otitis media.
Fluid Management of Diabetic Ketoacidosis
Authors: Finberg Laurence , Roberts Kenneth B. 
Published: December 2021

In last August's issue (16:304, 1995), Roberts commented on recent recommendations for the fluid management of diabetic ketoacidosis (DKA). This issue has great importance because the older recommendations or "traditional" therapy begun in the 1960 to 1990 era was associated with occasional serious and sometimes fatal outcomes because of central nervous system (CNS) damage. One pedagogical problem results from calling the complication "cerebral edema"; a more accurate term is cerebral swelling because the excess water from therapy is largely in cells, not the interstitial fluids, as is true of edema. Imaging studies show the ventricles to be small, similar to the situation in lead poisoning or cerebral hypoxia. Understanding the mechanism for the swelling will make it easier for the therapist to monitor the administration of fluid.
The initial swelling may occur before therapy for reasons we can only surmise or that are unknown. We do know that osmoprotective molecules (myoinositol, taurine, and perhaps others) will enter or be produced in cells in a hyperosmolar state such as DKA. This increase in cellular solute will attract water by osmosis. When fluid that has a lower sodium chloride concentration than interstital fluid (Na, 150 mEq/L; Cl, 118 m/Eq/L) is administered rapidly, either intravenously or orally, the tight junctions of the CNS vasculature admit water molecules by diffusion more rapidly than sodium and chloride ions; there is about a 4-hour lag time in equilibrium.
INDEX OF SUSPICION
Authors: Toledo-Valido Martha , Neal M. Joyce , Duelge John T. , Kalyanaraman Meena , Patterson Maria 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 3-year-old girl is brought to the emergency department because of 24 hours of fever, nonproductive cough, and shortness of breath that has worsened progressively. She has no history of significant illness. She has been taking amoxicillin for 1 week to treat otitis media and pharyngitis.
On physical examination, the child appears in obvious respiratory distress. She has a temperature of 101°F (38.3°C), pulse of 150 beats/min, respiratory rate of 46 breaths/min, and blood pressure of 137/72 mm Hg. She is breathing with subcostal and intercostal retractions and nasal flaring. Her breath sounds are diminished in the area of the right upper lobe, and generalized inspiratory and expiratory wheezing is heard. Both tympanic membranes are red and distorted.
Hypotonia in Infants
Authors: Stiefel Laurence 
Published: December 2021

Neonatal hypotonia can have many different etiologies. Floppiness in an infant can be caused at various levels of the nervous system from disorders of the brain to spinal cord lesions, neuropathies, neuromuscular junction disorders, and myopathies. A variety of diagnostic tools are available for defining the source of the hypotonia, but before any serum values, muscle biopsies, electromyelograms (EMGs), or nerve conduction studies are ordered, a thorough neurologic examination is essential for determining the diagnosis.
The first goal in diagnosing the source of neonatal hypotonia is to ascertain if it is central on peripheral. Infants who have central hypotonia from a brain source usually have other central deficits.
Posthemorrhagic Anemia in the Newborn
Authors: Pearson Howard A. 
Published: December 2021

Anemia in the newborn infant may result from many pathophysiologic processes. Because of the complex interrelations involving both mother and fetus, there is a broader list of causes of anemia in the neonatal period than is found at any other time of life. Anemia may be a consequence of three fundamental mechanisms: (1) loss of RBCs (hemorrhage); (2) rapid destruction of RBCs (hemolysis); or (3) underproduction of RBCs. The purpose of this review is to describe the mechanisms, clinical and laboratory features, and management of posthemorrhagic anemia in the newborn.1,2 Hemolytic and aregenerative anemias will be mentioned only briefly as differential diagnostic considerations.
CLASSIFICATION OF PERINATAL HEMORRHAGE
Although perinatal hemorrhage may occur in many ways, its causes can be conveniently divided into two general groups (Table 1). First: external hemorrhage, usually from the umbilical cord or placenta, in which an external bleeding site is obvious. Second: occult hemorrhage into closed compartments. In these cases bleeding is usually suspected because of clinical signs of blood loss such as pallor and shock.
EXTERNAL PERINATAL HEMORRHAGE
During uncontrolled or "precipitous" deliveries, a normal umbilical cord may rupture close to its attachment to the fetus. Rupture may also occur when the cord is abnormally short or excessively stretched by wrapping around the fetal neck or body.
Urogenital Tract Infections in Male Adolescents
Authors: Rosenfeld Walter D. , Litman Nathan 
Published: December 2021

Urogenital tract infections in the pediatric and adolescent populations vary depending on both age and sex. Pediatricians are quite familiar with the infant with a bacterial urinary tract infection who had a congenital anatomic anomaly or the pre-school-aged or adolescent girl with cystitis. Similarly, adolescent boys who present with cystitis or pyelonephritis will almost always have one of several predisposing conditions such as a congenital anomaly, a neurogenic bladder, an obvious systemic disease such as diabetes mellitus, or an immunodeficiency disorder. The urinary tract infection that occurs under these circumstances is managed in the traditional manner by obtaining a specimen for culture and sensitivity testing and tailoring antibiotic and other appropriate therapy according to the patient's clinical status and the organism involved. The male adolescent with pyuria and/or dysuria without any of these predisposing conditions most likely has a sexually transmitted disease. If, however, a documented bacterial urinary tract infection is found, the patient should have a full urologic evaluation including an intravenous pyelogram, voiding cystourethrogram, and possibly cystoscopy, if these procedures have not been previously performed. Cystitis and pyelonephritis that occur without underlying problems in male adolescents are quite rare and will not be discussed further in this review.
Between 1971 and 1979 sexual activity among adolescent girls aged 15 to 19 years increased by 66%, with 38% having had a first sexual experience by age 16 years.1
Self-Assessment Quizzes
Authors: MILBURN WILLIAM H. 
Published: December 2021

Since the inception of Pediatrics in Review, readers have been invited to write comments on the back of their self-assessment quiz computer cards. These comments have been helpful in pointing out the strengths and weaknesses of both the articles and the questions. The self-assessment quizzes have been an area of concern and controversy. The questions have varied a great deal in quality and clarity.
The primary purpose of the quizzes is to encourage the readers to review the articles critically and thus enhance the learning experience. In addition, by answering the questions and returning the cards, PREP and AMA Category I credit can be received.