bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Renal Failure: Therapy
Authors: Sehic Azra , Chesney Russell W. 
Published: December 2021

General Therapy for Acute Renal Failure In most cases of ARF without complication, treatment should be conservative and largely supportive. It requires careful and precise management. All patients will require close monitoring, many of them within intensive care settings.
Supportive care includes stabilizing the patient, monitoring input and output strictly weighing daily, determining electrolyte values frequently, preventing sepsis via reducing the number of intravenous lines and removing an indwelling urinary catheter, culturing periodically, and using antibiotics when indicated clinically. It is important to adjust medication dosage according to renal function and to avoid nephrotoxins whenever possible. Because serum creatinine values increase daily, it is best to calculate drug doses based on GFR &lt;10 mL/min per 1.73 m2, rather than on the serum creatinine level.
Conservative therapy may be symptomatic or specific. Symptomatic therapy consists of treating the underlying prerenal conditions that led to renal failure; maintaining the fluid and electrolyte balance; initiating therapy for complications such as hyperkalemia, hypertension, acidosis, and infection; and instituting appropriate nutrition. Specific therapy consists of using medications for specific underlying causes and may include steroids (conventional or high-dose pulse steroid therapy) and other immunosuppressive agents, anticoagulation agents, plasmapheresis, or intravenous immunoglobulin.
THERAPY FOR PRERENAL FAILURE
Rapid volume replacement and treatment of the underlying condition that resulted in prerenal failure are the cornerstones of therapy.
Diaper Dermatitis
Authors: Singalavanija Srisupalak , Frieden Ilona J. 
Published: December 2021

Epidemiology
Diaper rashes are among the most common skin disorders of infancy. In one survey of 1089 infants, diaper dermatitis occurred in 50%; however, only 5% had severe rash. The peak incidence of diaper dermatitis is between 9 and 12 months of age. The relation between age and the frequency of diaper dermatitis may result from several factors, including dietary changes from breast milk to formula milk and solid foods during the first 12 months of life. Breastfed infants have fewer diaper rashes than do formula-fed infants. The incidence of diaper dermatitis is 3 to 4 times higher in infants who have diarrhea.
The frequency and severity of diaper dermatitis are significantly lower when the mean number of diaper changes per day is eight or more, regardless of diaper type. Infants using superabsorbent disposable diapers have a significantly lower frequency and severity of diaper rash when compared with infants using cloth diapers.
Diaper Types
There currently are two types of diapering systems: reusable cloth diapers and single use (disposable) diapers. Cloth diapers provide containment through multiple layers of cotton fabric, usually aided by the use of plastic or cloth overpants. Nearly all disposable paper diapers now contain an absorbent gelling material within the cellular core.
Infective Endocarditis
Authors: Danilowicz Delores 
Published: December 2021

A high level of suspicion is of utmost importance in the diagnosis of endocarditis, particularly in the patient at risk who may have received antibiotic treatment for the prodrome. Treatment with adequate levels of a bactericidal drug based on an identified organism will give the highest percentage of cures. Early treatment may prevent damage to cardiac structures and lessen further complications related to emboli or progressively enlarging vegetations. The combination of a high-risk patient with either resistant bacterial endocarditis or fungal
[See table in the PDF file]
endocarditis carries a higher morbidity and will account for most of the mortality. Although not an ideal answer, SBE prophylaxis is justified from observations in animals and should be recommended strongly to the parents and to the patient as she or he gets older.
Because an increasing number of children survive their congenital heart defects but remain at risk for acquiring SBE and because an increasing number of preterm infants and neonates are exposed to indwelling catheters, the pediatrician will continue to see IE presenting as both a diagnostic dilemma and an acute treatment problem. The emergence of children who are human immunodeficiency virus-positive or who have acquired immunodeficiency syndrome has increased the group at immunologic risk, as has an increasing population of children surviving organ transplants. These children can present more often with infections caused by nosocomial, resistant agents because of their frequent hospitalizations, and they may have a variety of opportunistic infections from organisms that normally are not pathogens. Unfortunately, a higher mortality rate can be expected among these children.
The diagnosis of IE is made even more of a challenge because it accounts for only about 1/1000 to 1/4500 hospital admissions to pediatric services. In tertiary care hospitals that have an active pediatric cardiac service, the numbers may be higher. The most important element in diagnosing endocarditis remains its early consideration as a possibility in any child who has a persistent unexplained febrile illness and its being the first consideration in a high-risk child.
Orbital and Periorbital Cellulitis
Authors: Powell Keith R. 
Published: December 2021

The acute onset of eyelid redness and swelling in a child usually results in a quick visit to the doctor's office or an emergency room. The differential diagnosis for these signs ranges from relatively innocuous problems, such as allergy or an insect sting, to potentially vision-affecting or even life-threatening diseases, such as orbital cellulitis or cavernous vein thrombosis. The orbital contents often are protected from an inflammatory process by the orbital septum, a continuation of the periosteum of the bony orbit to the margins of both the upper and lower eyelids (Figure 1). An inflammatory process occurring in the structures superficial to the orbital septum is defined as preseptal or periorbital cellulitis; an inflammatory process in structures deep to the orbital septum is defined as orbital cellulitis of a specific complication thereof. Bacterial infection can cause both periorbital and orbital cellulitis.
Another anatomic feature of importance is that the skin of the eyelid is the thinnest skin of the body. The subcutaneous tissue of the eyelid is composed of musculofibrous tissue and no fat. This combination of thin skin and loose subcutaneous tissues makes it possible for the eyelid to swell dramatically as it fills with edematous fluid.
Epidemiology and Pathogenesis of Periorbital Cellulitis
Autism and the Pervasive Developmental Disorders: Part 2
Authors: Bauer Stephen 
Published: December 2021

Differential Diagnosis
The differential diagnosis of autism includes many other conditions and will depend on the age of the child at the time of evaluation, the child's developmental level, and the type of symptom that is most prominent.
For a child found to fall within the spectrum of autism, the category most applicable along that spectrum is an additional differential diagnostic issue. The lines of division are not clear, although DSM-IV provides some help. In general, the term pervasive developmental disorder (PDD) is more likely to be used when cognitive, communicative, and social skills are high relative to other children who are autistic. Some studies have shown that the clinical criterion most useful in separating the two categories is the degree of socialization and relatedness shown by the child. Children who display an active social interest, a degree of empathy, and a better ability to sustain interactions tend to be placed in the PDD category. If they have particularly strong language skills along with the milder socialization difficulties, Asperger disorder is likely to be diagnosed.
For the child who has significant developmental delays in all areas, the primary differential diagnosis will be mental retardation without autism. Many children who are severely mentally retarded exhibit some of the behaviors seen in autism, such as stereotyped behaviors and perseveration, emotional lability, and self-injurious behavior.
Sports-related Injuries Among Adolescents: When Do They Occur, and How Can We Prevent Them?
Authors: Rome Ellen S. 
Published: December 2021

Sports injuries, as causes of frequent morbidity but infrequent mortality among teens, receive less attention than do more dramatic motor vehicle accidents, homicides, and suicides. Injury to adolescents caused by both organized and informal athletics occurs commonly, yet the precise frequency, severity, and predisposing risk factors of such injuries have not been defined well. Unlike mortality data, which can be obtained readily from death certificates or through the National Center for Health Statistics, nonfatal sports injuries often go unrecognized among injury statistics because adolescents frequently do not seek health care or tell a coach or family member about the injury. Moreover, data on injuries can exist in a variety of places outside of physicians' offices, including emergency department or hospital records, school-based health centers, or trainers' logs. Different studies also have defined injury differently, with little standardization between studies and variances in sources used for data collection. Hospital or emergency department data may differ in the degree of severity of the injury from office-based data or data on those injuries treated solely by a coach or athletic trainer. Despite these difficulties, a plethora of data exists on the topic of sports injuries and their prevention.
Common Causes of Sports Injury
In a Massachusetts study by Gallagher and colleagues in the 1980s, sports injuries were found to be the most common cause of injury and, overall, the second leading cause of emergency department visits and hospital admissions in the 13- to 19- year-old age group.
Management of Urinary Tract Infections: Children Are Different
Authors: Todd James K. 
Published: December 2021

Urinary tract infection (UTI) is a common problem in infants and children and may have serious consequences leading to chronic renal failure. In spite of its frequency and potential severity, UTI often is felt to be a simple problem. Nothing could be further from the truth; there are many dynamic issues related to its proper diagnosis and appropriate treatment. Especially important are the differences in UTI between adults and children that emphasize that children are not "little adults."
Epidemiology
The prevalence of UTI varies by age and sex. In the newborn period, approximately 1% to 2% of both girls and boys (usually uncircumcised) have UTIs. In infancy and childhood, UTI is more common in girls than in boys; approximately 1% of school-age girls develop symptomatic infection each year. This incidence increases even further when adolescent girls become sexually active. Risk factors for UTI in females include sexual intercourse, sexual abuse, use of bubble bath, constipation, pinworms, and infrequent or incomplete voiding. In either sex, risk factors include ureteric reflux in a sibling, urologic abnormalities, indwelling urethral catheterization, and neurogenic bladder.
Pathogenesis
Although cystitis may be caused by adenovirus, UTI usually is caused by bacteria that commonly are found on the perineum and ascend up the urethra into the bladder.
Consultation with the specialist
Authors: Johnson Robert L. 
Published: December 2021

The wide array of therapeutic responses to substance use/abuse suggests that there is not one best approach to solve the problems of any one adolescent or young adult. Indeed, most young people require a variety of therapeutic interventions, which may include inpatient treatment, ambulatory therapeutic groups, and individual counseling, as well as self-help groups.
In choosing a therapeutic program, the physician must be circumspect when interpreting the reported success or "cure" rates of any of these modalities. Such citations often are misleading because frequently they fail to reflect accurately the therapeutic influence of several important patient population variables that distinguish the programs. For example, an outpatient program may report better "cure" rates than an inpatient program because the ambulatory program may have enrolled clients who have more limited substance use patterns and who are more committed to abstinence. Furthermore, there is no standard methodology for reporting "rates of success." Some programs simply report a compliance rate for clients who attend meetings or scheduled therapeutic sessions, some report the numbers of clients who complete the program without any reference to recidivism, and some report the numbers of clients who are "drug-free" after 1 year.
Given these caveats, the experience of most clinicians suggests that many adolescents who experiment with the traditional "gateway" drugs (eg, tobacco, alcohol, marijuana) respond well to outpatient group and individual therapy, those adolescents committed to a substance use/abuse pattern respond best to inpatient or residential programs, and adolescents who have a psychiatric/behavioral problem complicated by substance use/abuse require formal psychiatric treatment. Single-drug programs such as methadone maintenance or Alcoholics Anonymous have limited applicability for treatment of most adolescents who suffer from substance abuse.
Common Respiratory Disorders of the Newborn
Authors: Kopelman Arthur E. , Mathew Oommen P. 
Published: December 2021

Respiratory distress is a frequently encountered problem in the first few days of life. The general pediatrician must assess the infant's condition, make a tentative diagnosis, institute appropriate care, and decide whether to transfer the infant to a neonatal intensive care unit. The decision to transfer an infant should be based on the interest and training of the physician as well as on readily available resources for optimal management. In general, any infant who needs mechanical ventilation for more than a few hours should be transferred to a regional intensive care nursery.
An infant who is in respiratory distress of any cause may present with tachypnea, nasal flaring, sternal and intercostal retractions, cyanosis, and even apnea. The differential diagnosis of respiratory disorders in the newborn is extensive and includes disorders of the major airways, diseases of the pulmonary parenchyma, and rib cage abnormalities. Review of the history of pregnancy, labor, delivery, and resuscitation; careful physical examination; analysis of laboratory tests such as blood gases, hematocrit, and blood glucose; and evaluation of a chest radiograph usually permit a tentative diagnosis. Additional challenges arise when an infant who has chronic lung disease is returned to the community hospital for continuing care.
This review covers three of the most common forms of neonatal respiratory distress: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and bronchopulmonary dysplasia (BPD).
INDEX OF SUSPICION
Authors: McCarthy Dennis J. , Tuite Robert J. , Conners Gregory P. 
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 5-year-old girl is brought to your office because she has been unable to walk since awakening this morning. Last night her family returned from a 4-day summer camping trip during which she was active and healthy. Her past medical history is unremarkable and she is fully immunized. There is no evidence of infectious, drug, or toxic exposures.
On examination, the child is alert and cooperative but unable to stand or walk, although she denies pain. Deep tendon reflexes cannot be elicited in her lower extremities. Hercranial nerve function is normal, as are her vital signs and the rest of her physical examination.
Case 2 Presentation
A 4-year-old girl is brought to the office because of a swollen, tender 3.0-cm mass under her left mandible that has been present for 2 weeks.
PERIPHERAL BRAIN
Authors: Baren Jill M. , Seidel James S. 
Published: December 2021

This section of Pediatrics in Review is designed to be clipped or duplicated and filed in a handy place in the office, clinic, or emergency department, providing a convenient and concise reference.
All offices in which children are examined should have pediatric emergency equipment, supplies, drugs, policies, and procedures. The equipment, supplies, and drugs kept in the office will depend on the spectrum of ill or injured children seen in the practice. However, a source of oxygen, basic resuscitation drugs (suited to the patient population and experience of the health-care providers), and a dosage chart or weight-based dosing tape (Figure 1) should be available in all offices. The following list of drugs is fairly comprehensive and is organized according to sign or symptom needing treatment. Health-care providers should become familiar with the information regarding specific drugs that they use commonly, eg, choose a short-acting benzodiazepine such as diazepam or lorazepam for treating status epilepticus.
The intraosseous (IO) route of drug administration can be used for the majority of emergency drugs listed in the chart that suggest administration by the intramuscular (IM) or intravenous (IV) routes. The IO route is appropriate for children age 6 years and younger and should be reserved for those circumstances where failure to achieve vascular access might result in loss of life or limb (ie, anaphylaxis, cardiopulmonary arrest).
Peptic Ulcer Disease in Children
Authors: Mezoff Adam G , Balistreri William F 
Published: December 2021

The term peptic ulcer disease describes a group of disorders, rather than a single pathologic process. It is recognized increasingly in children, often with long-term ramifications. In the past decade, management of patients who have peptic ulcer disease has changed dramatically. Antacid therapy has given way to treatment with histamine (H2) receptor antagonists, a new class of pharmacologic agents that has fostered a billion dollar industry. Other modalities of treatment have been developed as well, such as cytoprotective agents (sucralfate) and proton pump inhibitors (omeprazole), which are based on research into the pathophysiology of gastric acid disorders. In addition, the discovery of an infectious agent (Helicobacter pylori) that contributes to the formation of peptic ulcers has led to a reevaluation of the traditional approach to diagnosis and treatment of abdominal pain in children.
Duodenal ulcers are defined as mucosal defects penetrating the mucosa, submucosa, and muscularis mucosa of the duodenum. Gastric ulcers are defined as mucosal defects that penetrate the muscularis mucosa of the stomach. Primary ulcers are those that have no known underlying cause. Secondary ulcers are associated with a known ulcerogenic event such as stress, burns, or ingestion of nonsteroidal anti-inflammatory medications. A discussion of peptic inflammation that typically does not cause ulceration, such as esophagitis, is beyond the scope of this review.
Another Year, Another Volume!
Authors: H R J 
Published: December 2021

Link to Recertification Examination
From the first issue in 1978, Pediatrics in Review has been tied closely to the American Board of Pediatrics' program of recertification. Since 1988, this program has been called the Program for Renewal of Certification in Pediatrics (PRCP), and it requires that each pediatrician who has been Board-certified since that date participate in this program to be recertified.
The American Board of Pediatrics has developed a list of more than 4000 core content statements prepared by practitioners and academicians in all phases of pediatrics as the basis of the examination. Each year the Board selects some 900 of these as the basis for the recertification examination the next year.
Reactions to Iodinated Contrast Media
Authors: Farkas Jeffrey , Liebling Melissa S. , Pritzker Henry A. 
Published: December 2021

The exact mechanism responsible for adverse reactions to iodinated contrast administered intravenously during radiologic evaluation is not known. However, through work that has been performed both in the laboratory and in clinical trials, we do know that the types of reactions are variable and the underlying etiologies multifactorial. Moreover, reactions can be prevented in many cases through careful choice of contrast agent and pretreatment with corticosteroids and antihistamines.
Adverse contrast reactions can be separated into two broad categories: chemotoxic and anaphylactoid. Chemotoxic reactions are dose-dependent and related to direct chemical effects of the contrast medium. Pain at the injection site and flushing belong in this category; a combination of hypertonicity and calcium binding results in vasodilatation.
Herpes Simplex Virus Infections
Authors: Annunziato Paula W. 
Published: December 2021

Case Report
A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).
Serologic Tests: Utility in Clinical Pediatric Practice
Authors: Krilov Leonard R. 
Published: December 2021

Despite clinical microbiologic advances in the isolation and/or detection of bacterial pathogens, determination of infection with a number of clinically important bacteria relies on serologic testing. When a reliable specific immunoglobulin (Ig) M test is available or when a significant (ie,≥4 fold) change in titer is obtained in acute and convalescent serologies, these tests can be used to make a definitive diagnosis. A single elevated titer in the face of a compatible clinical scenario also may help support a given diagnosis.
Infection with a number of infrequently encountered bacteria, when suspected, can be documented well by serologic testing. Examples include the primarily zoonotic organisms Brucella, Leptospira, and Francisella tularensis.