bluuebunny/crossref_metadata_2025_split huggingface dataset:
Avian Mite Dermatitis
Authors: Baselga Eulalia , Drolet Beth A. , Esterly Nancy B. 
Published: December 2021

Avian mites are known to infest humans accidentally, causing a dermatitis characterized by widespread pruritic papular lesions. Because of the lack of awareness of this phenomenon and the small size of the mite, this diagnosis is often missed. We report two siblings with a papular eruption secondary to contact with avian mites identified as Dermanyssus gallinae.
CASE REPORT
A young college student awakened one morning in August with severe pruritus and a generalized eruption. On examination in the clinic, she was noted to have numerous wheals (50 to 100), most densely distributed on her waist, thighs, shoulders, and ankles, but involving most areas of the body.
Promotion of Healthy Weight-control Practices in Young Athletes
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Many athletes engage in unhealthy weight-control practices. This new policy statement urges pediatricians to attempt to identify and help these athletes and provides information about how to support sound nutritional behavior.
Athletes may engage in unhealthy weight-control practices, particularly in sports in which thinness or "making weight" is judged important to success, such as body building, cheerleading, dancing (especially ballet), distance running, diving, figure skating, gymnastics, horse racing, rowing, swimming, weight-class football, and wrestling.1-3 Some athletes may use extreme weight-loss practices that include overexercising; prolonged fasting; vomiting; using laxatives, diuretics, diet pills, other licit or illicit drugs, and/or nicotine; and use of rubber suits, steam baths, and/or saunas. The majority of these disordered eating behaviors do not meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria4 for anorexia nervosa or bulimia nervosa.
In two surveys of 208 female collegiate athletes, 32% and 62% practiced at least one of the following unhealthy weight-control behaviors: self-induced vomiting, binge eating more than twice weekly, and using laxatives, diet pills, and/or diuretics.5,6 Of 713 high school wrestlers in Wisconsin, 257 (36%) demonstrated two or more behaviors related to bulimia nervosa.7 In a survey of 171 collegiate Indiana wrestlers concerning their behaviors in high school, 82% had fasted for more than 24 hours, 16% had used diuretics, and 9.4% had induced vomiting at least once a week.8 Many athletes are secretive about these potentially harmful practices.
Disordered eating may have a negative short-term impact on athletic performance. Athletes who lose weight rapidly by dehydration are probably impairing their athletic performance, especially if it involves strength or endurance,9 and these strength deficits may persist even after rehydration.10
To the Editor
Authors: Milburn Michael A. 
Published: December 2021

I am writing concerning Sampson and London's article, "Analysis of Homeopathic Treatment of Childhood Diarrhea" (Pediatrics November 1995) that critically reviewed the article by jacobs et al, "Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua" (Pediatrics May 1994).
The primary problem with the criticisms that Sampson and London raise is that they have not thought through the implications of their arguments. Thus, plausible sounding objections that they offer often lead, upon careful scrutiny, to the opposite conclusion that the authors proclaim.
Reappraisal of Lytic Cocktail/Demerol, Phenergan, and Thorazine (DPT) for the Sedation of Children
Authors: Parks Bruce R. , Snodgrass S. Robert 
Published: December 2021

We were disappointed in the AAP statement by the Committee on Drugs entitled Reappraisal of Lytic Cocktail/Demerol, phenergan, and Thorazine (DPT) for the Sedation of Children (Pediatrics 1995;95:598-602). The Committee identified many problems associated with this traditional drug mixture but refused to bite the bullet and acknowledge that its time is past. Their unqualified endorsement of ketamine and propofol use by nonanesthesiologists also concerns us.
The lytic cocktail contains a long-acting opiate with a tendency to activate seizures and two long-acting neuroleptics.
Prevention of Traumatic Deaths to Children in the United States: How Far Have We Come and Where Do We Need to Go?
Authors: Rivara Frederick P. , Grossman David C. 
Published: December 2021

Objective. To describe the changes in injury mortality from 1978 to 1991 and determine the number of preventable deaths with currently available intervention strategies.
Methods. Comparison of injury mortality data for children and adolescents 0 to 19 years in 1978 and 1991. Review of the literature to determine the effectiveness of currently available prevention strategies and application of these to deaths in 1991.
Results. The injury death rate declined by 26% over the 14-year period. Death rates of unintentional injuries decreased by 39%, with declines in all categories of unintentional injuries. Homicides increased by 67% and suicides by 17%; nearly all of this increase was in deaths from firearms. If currently available prevention strategies were fully used, 6640 deaths could have been prevented, a further 31% decrease.
Conclusions. Although great strides have been made in preventing deaths from trauma, the application of currently available prevention strategies could save a large number of additional lives. However, the increasing problem of intentional injury will partly counterbalance the success in unintentional injury control.
Normal Birth Weight Intensive Care Unit Survivors: Outcome Assessment
Authors: Gray James E. , McCormick Marie C. , Richardson Douglas K. , Ringer Steven 
Published: December 2021

Rationale/Objective. Although the short-and long-term outcome of low birth weight neonatal intensive care unit (NICU) survivors has been extensively studied, much less information is available for normal birth weight (NBW) infants (greater than or equal to 2500 g) who require NICU care.
Methods. To address this issue, we retrospectively examined the neonatal hospitalizations and 6-month health status of 521 consecutive NBW admissions to a single NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone survey techniques.
Results. NBW infants comprised 88.1% of births in this hospital and 35.4% of NICU admissions during the study period. The in-hospital mortality rate for this group was 2%. The median length of stay was 7.7 days (range 1 to 110 days) with median hospital charges of $5222 (range $565 to $317,820). Only 59% of infants required active intensive care therapy; the remainder received only intensive monitoring. The need for intensive therapy on admission day along with the presence of prematurity and congenital anomalies were significant predictors of hospital charges (R2 = 0.31, P &lt; .01). After initial discharge, 10.1% of these infants required rehospitalization in the first 6 to 8 months of life. The rate of readmission among infants with congenital anomalies was over 30%. In addition to its association with neonatal resource consumption, the presence of congenital anomalies along with low 5-minute Apgar scores was associated with higher postdischarge resource use, as measured by frequency of physician visits, need for special medical items, and rate of rehospitalization (P &lt; .05).
Conclusions. NBW infants represent a significant percentage of NICU admissions, but for many of these patients NICU admission could be avoided if alternative care settings that provided intensive monitoring were available. In addition, these infants also incur higher rates of postdischarge use of medical care.
Phenylketonuria: Plasma Phenylalanine Responses to Different Distributions of the Daily Phenylalanine Allowance Over the Day
Authors: van Spronsen Francjan J. , van Dijk Theo , Smit G. Peter A. , van Rijn Margreet , Reijngoud Dirk-Jan , Berger Ruud , Heymans Hugo S. A. 
Published: December 2021

Objective. To achieve smooth control of plasma phenylalanine concentrations in phenylketonuric patients, it is advocated to divide the daily intake of natural protein and amino acid supplements equally over the meals. However, this may be quite an encumbrance for the patient. We, therefore, investigated whether a breakfast with an unequal daily distribution results in an undue rise in the plasma phenylalanine concentration.
Design. Plasma phenylalanine concentrations were measured in seven patients with phenylketonuria in response to three tests with breakfast and lunch, representing an equally or unequally divided daily distribution of the individually tailored phenylalanine intake. Breakfast contained 25%, 50%, or 75%, whereas lunch contained 30% or 10% of the individual daily phenylalanine allowance, respectively.
Results. Plasma phenylalanine concentrations showed postprandial increases of up to 26% above baseline. Generally, phenylalanine returned to baseline during the test and remained within the target range if baseline phenylalanine was within that range. Two patients having baseline values in the upper target range showed a rise just above the target range for 60 minutes on an unequal daily distribution of phenylalanine. In another patient treated similarly, plasma phenylalanine did not return to baseline during the test.
Conclusions. Unequal distributions of the daily phenylalanine allowance are justified, provided that the patient is in good clinical condition, adjusted to the diet adequately, and the daily allowance is not exceeded. At this time, however, we cannot recommend this unequal daily distribution for daily practice.
Policy on the Development of Immunization Tracking Systems
Authors:   Committee on Practice and Ambulatory Medicine
Published: December 2021

The American Academy of Pediatrics in its role as advocate for children supports public and private cooperation in the development of immunization tracking systems (ITSs) insofar as they benefit children. All ITSs as they are developed:
• Should prospectively articulate their goals and desired outcomes, including documenting immunization status and the mechanics of immunization, increasing rates of immunization, decreasing cost of immunization, and facilitating immunization opportunities;
• Must accurately document each child's current immunization status;
• Must preserve children's and their health care provider's right to confidentiality;
• Should ensure that data will be available to health care providers 24 hours a day, 7 days a week, so that health care providers can take advantage of all opportunities to immunize;
• Should ensure that data will not be used for sanctions against health care providers;
• Must ensure that data input and access mechanisms enable providers to supply and access data easily, without having to purchase specialized hardware or expensive software; input and access software mechanisms need to enable all providers to supply data to and retrieve data from the ITS;
• Should entitle health care providers to be reimbursed or the cost of providing data to the ITS;
• Must ensure that data reflecting evidence of incomplete immunizations will not be used to deny a child access to care or eligibility for benefits by any insurance plan;
• Must be studied and/or evaluated to determine their effectiveness at increasing immunization rates and decreasing costs; if such systems do not fulfill these goals, they should be eliminated; and
Antibiotic Resistance: Relationship to Persistence of Group A Streptococci in the Upper Respiratory Tract
Authors: Gerber Michael A. 
Published: December 2021

Despite the use of penicillin for more than 40 years in treating GABHS infections, there has been no significant change in the in vitro susceptibility of GABHS to penicillin. Reported failures to eradicate GABHS from the upper respiratory tracts of patients with pharyngitis and the apparent resurgence of serious Group A streptococcal infections and their sequelae probably are not related to the emergence of penicillin resistance. Although erythromycin resistance in GABHS had been a major problem in Japan and continues to be a major problem in Finland, it has not been a problem in this country. The susceptibility of GABHS to the newer macrolide antibiotics appears to be similar to that of erythromycin. Comprehensive, community-wide programs to continuously monitor for erythromycin resistance in GABHS would be difficult to justify. However, because little is known about how erythromycin resistance in GABHS is acquired or spread, it would be reasonable to periodically monitor isolates of GABHS for erythromycin resistance. A substantial proportion of GABHS are currently resistant to tetracyclines and these agents are inappropriate for treating GABHS infections. Although little recent information is available about the susceptibility of GABHS to sulfonamides, these agents have been shown to be ineffective in eradicating GABHS from the upper respiratory tract regardless of the in vitro sensitivities. GABHS have not been shown to be resistant to any of the commonly used oral cephalosporins; however, there is a great deal of variability among these agents in their activity against GABHS. Clindamycin resistance in GABHS has remained unusual. This agent is an alternative for treating GABHS infections due to macrolide-resistant strains in patients who cannot be treated with beta-lactam antibiotics.
There is no reason, based on the in vitro susceptibilities of GABHS, to change the current recommendations for treating GABHS infections with penicillin and for using erythromycin for patients who are allergic to penicillin.
Are the Currently Recommended Doses of Benzathine Penicillin G Adequate for Secondary Prophylaxis of Rheumatic Fever?
Authors: Currie Bart J. 
Published: December 2021

Objective. To review the literature on dose and regimens of intramuscular benzathine penicillin G (BPG) for secondary prophylaxis of recurrent rheumatic fever.
Setting. For over 40 years BPG has been the gold standard for secondary prophylaxis, usually as a dose of 1 200 000 U (900 mg). Although studies have suggested that BPG injections every 3 weeks are superior to injections every 4 weeks, implementation of an every 3 weeks regimen can be problematic with regards to both patient compliance (adherence) and an increased burden on health resources.
Findings. Some of the earliest studies of BPG suggested that larger doses resulted in prolongation of detectable penicillin levels. A recent study assessing plasma penicillin levels after BPG doses of 1 200 000 U, 1 800 000 U, and 2 400 000 U suggested there may be benefits in a BPG regimen every 4 weeks with doses higher than the standard 1 200 000 U.
Conclusions. Further studies of higher dose BPG regimens seem justified. In addition, further work is needed on quality and storage options for different BPG preparations; location and method of BPG injections; the importance of weight differences between individuals; and ways of improving access to and compliance with BPG regimens.
Rheumatic Fever Prevention in Industrializing Countries: Problems and Approaches
Authors: Snitcowsky Rachel 
Published: December 2021

Editor's Note The problems resulting from Group A streptococcal infections remain largely unsolved in many of the industrialized countries of the world at the close of the 20th century. The fact that Group A streptococcal infections had assumed almost the role of a nuisance in the United States and Europe, before the beginning of the mid-1980s and 1990s resurgence, stands in marked contrast to the spectrum of streptococcal-related diseases in other parts of the world. Confirmatory epidemiologic data are often difficult to locate, but there is little doubt about the existence and the general magnitude of the problem.
Because of this, the World Health Organization (WHO) has targeted Group A streptococcal infections and their sequelae for additional attention. During the last decade the WHO has invested considerable effort toward their control. The need for cost-effective primary and secondary rheumatic fever public health prevention programs is greater in those countries where the magnitude of the problem may be inversely proportional to available resources. Approaches considered routine in North America, in Europe, and in some countries of Latin America and Asia often are nonexistent in industrializing countries where as little as less than $5 per person per year may be reserved for total health care.
With these issues in mind, the following perspective was invited to bring these unique problems related to Group A streptococcal infections and their sequelae into focus and to offer suggestions for realistic approaches under less than ideal conditions. We are grateful to Dr Snitcowsky for her comments.
INTRODUCTION
Authors: Kaplan Edward L. 
Published: December 2021

During the second World War, and even almost a decade later at the conclusion of the Korean Conflict during the 1950s, infections caused by the Group A beta hemolytic streptococcus and their nonsuppurative sequelae were major problems for practicing physicians as well as for public health authorities. Epidemics of scarlet fever were ever present; quarantine signs could be seen prominently displayed in the windows of the homes of schoolchildren. Many schoolchildren had at least one schoolmate who was homebound and bedridden for months with rheumatic fever. The perceived threat of Group A streptococcal infections was of concern to the lay public, especially to parents of schoolchildren. For the medical community the presence of rheumatic fever hospitals in many cities, institutions like the Harriet Lane Home in Baltimore, the Irvington House in New York, the House of the Good Samaritan in Boston, and La Rabida Hospital in Chicago, served to reinforce the need for increasing the understanding and control of these infections. If those facts about Group A streptococci and children were not sufficiently impressive, the large numbers of individual cases and even outbreaks occurring in military troops during the second World War and during the Korean Conflict further emphasized the issue.
In fact, before the second World War, relatively little was understood about the epidemiology and pathogenesis of these infections and their sequelae. The laboratory studies of Rebecca Lancefield and others, which allowed more precise identification and characterization of Group A streptococci, and the accompanying clinical observations provided the foundation for early control measures.
Ketorolac-induced Acute Renal Failure in a Previously Healthy Adolescent
Authors: Buck Marcia L. , Norwood Victoria F. 
Published: December 2021

Ketorolac has become an important component of analgesic regimens for children as well as adults because of its lack of adverse effects on respiratory, cardiovascular, and neurologic function. Although initially used parenterally in hospitalized patients, the development of an oral ketorolac dose form extended its use to the outpatient setting, where its potency has been considered an advantage over traditional therapies.1-3
Several cases of hyperkalemia and oliguric acute renal failure associated with ketorolac use have been reported in the medical literature.4-12 Elderly hospitalized patients receiving large doses of ketorolac intramuscularly (IM) after major surgery seem to be at greatest risk.
Health Supervision for Children With Fragile X Syndrome
Authors:   Committee on Genetics
Published: December 2021

This set of guidelines is designed to assist pediatricians in caring for children with fragile X syndrome confirmed by DNA analysis (Table). Occasionally pediatricians are called on to advise a pregnant woman who has been informed of a prenatal diagnosis of fragile X syndrome. Therefore, guidelines are also offered for this situation.
Fragile X syndrome is usually diagnosed during childhood and is characterized by developmental delay or mental retardation, characteristic physical features, and abnormal behavioral patterns.1,2 The distinctive fragile site on the X chromosome was first described in 1969 as a discontinuous site on the long arm of the X chromosome present after cell culture under folate-deficient conditions. In 1977 the relationship of this site to X-linked mental retardation was noted, and fragile X syndrome began to be defined. Since that time, the cytogenetic, molecular, and clinical features of the condition have been more clearly defined,3 and it is now recognized as the most common hereditary cause of mental retardation. Its frequency has been estimated to be approximately per 2500 to 1 per 1250 males and 1 per 5000 to 1 per 1600 females.
The phenotype of fragile X syndrome in males often has a number of distinctive, recognizable features, including developmental delay or mental retardation, a prominent forehead, a long, thin face and a prominent jaw that appear late in childhood or early adolescence, large protuberant and slightly dysmorphic ears, and the presence of or ultimate development of macro-orchidism. This phenotype can be very subtle, is not always apparent, and becomes more identifiable with age.2
Comments From Another Student of Gamble and Darrow on Fluids
Authors: Schwartz Robert 
Published: December 2021

Holliday's historical review of fluid and electrolyte pathophysiology represents thoughtful and timely comments. I agree with his thoughts as applied to diarrheal dehydration. However, his strong advocacy of oral rehydration therapy (ORT) in diarrheal dehydration should not be interpreted as relevant to other disorders of fluid and electrolyte pathophysiology.
The successful use of ORT in the third world, coincident with scientific understanding of cholera toxin effects on sodium-glucose transport in the intestine, has provided both a scientific and practical basis for practical recommendations.
EFFICACY OF FREQUENT NEBULIZED IPRATROPIUM BROMIDE ADDED TO FREQUENT HIGH-DOSE ALBUTEROL THERAPY IN SEVERE CHILDHOOD ASTHMA
Authors: Joos Thad H. 
Published: December 2021

Purpose of the Study. High-dose nebulized albuterol has become the standard of treatment for the severely wheezing asthmatic child. The role, dose, and frequency of administration of ipratropium bromide in this same group of children requires further definition.
Methods. From the Emergency Department of the Hospital for Sick Children in Toronto, Ontario, Canada, 120 children 5 to 17 years of age with severe asthma as determined by a forced expiratory volume in 1 second (FEV1) of less than 50% predicted normal were equally divided and entered into a double-blinded, placebo-controlled treatment protocol. All groups received 0.15 mg albuterol/kg/dose nebulized every 20 minutes χ3. Group 1 had 250 µg of ipratropium bromide added to each treatment. Group 2 had the same amount of ipratropium bromide added to only the initial aerosol with a like amount of saline added to aerosols 2 and 3. Group 3 had only saline added to each aerosol. No corticosteroids were administered to any patient in the first hour. The entire cohort was meticulously monitored for oxygen saturation, heart rate, respiratory rate, accessory muscle use, cyanosis, wheezing and pulmonary function test parameters by a skilled research nurse.
Results. As expected, all patients improved to a degree but those with the lowest FEV1s who were treated with ipratropium in each aerosol responded the best and were admitted to the hospital less frequently. No serious untoward side effects were observed in any patient.
Reviewer's Comment. I feel the article is a must read for all physicians caring for acutely wheezing asthmatic children.