bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infantile Spasms: Current Therapy and Progress
Authors: Wolf Steven M. , Ballaban-Gil Karen 
Published: December 2021

Infantile spasms represent an age-dependent epileptic syndrome that usually begins between 4 and 6 months of life; onset is before the age of 12 months in about 90% of cases. The spasms are characterized by symmetric, bilateral, brief, and sudden contractions of the flexor or extensor muscle groups. The seizures may be resistant to treatment, and the syndrome frequently is associated with mental retardation.
In 14% to 38% of cases, infantile spasms are "cryptogenic," without identifiable underlying cause. However, the majority of patients have so-called "symptomatic" infantile spasms, with some identifiable pre-, peri-, or postnatal factor that underlies the syndrome: hypoxemiaischemia, intrauterine infection, a cerebral malformation or degenerative disorder, tuberous sclerosis, a genetic abnormality, an inborn error of metabolism, an intracranial hemorrhage, traumatic delivery, head injury, or a central nervous system infection.
Clindamycin
Authors: Rosenberg Michael G. 
Published: December 2021

Clindamycin (CM) is a chemically synthesized derivative of lincomycin, which originally was isolated from the soil actinomycete Streptomyces lincolnesis in 1962. CM essentially has replaced lincomycin therapeutically because of its broader antimicrobial spectrum and enhanced gastrointestinal absorption.
CM inhibits bacterial protein synthesis by binding to the 50S subunit of the bacterial ribosome, thereby blocking peptide chain initiation and elongation. CM functions as a bacteriostatic agent; however, in certain clinical situations, it can be considered bactericidal. Interestingly, the ribosomal binding sites of macrolide antibiotics (erythromycin, clarithromycin, etc) and chloramphenicol appear to overlap, leading to the theoretic concern of drug antagonism should these medications be used in combination.
Consultation with the Specialist
Authors: Rosenfeld Ron G. 
Published: December 2021

Multiple hormones participate in the endocrine regulation of growth, including thyroid hormone, androgens, and estrogens. Growth hormone (GH), the major hormone involved in postnatal skeletal growth, is a protein having an approximate molecular weight of 21 000 d and produced by the anterior pituitary.
Interestingly, GH appears to play little part in fetal growth. An infant who has congenital GH deficiency typically has a normal birth length and weight. Congenital hypoplasia of the anterior pituitary is suggested more commonly by the presence of neonatal hypoglycemia or microphallus in the male. An abnormal growth pattern in children who have congenital GH deficiency becomes apparent, however, by 3 to 6 months of age.
Although congenital GH deficiency results from hypoplasia of the hypothalamus or anterior pituitary, acquired GH deficiency may be the first clinical manifestation of a variety of clinically significant disorders. Central nervous system tumors, most classically craniopharyngiomas and histiocytosis X, may cause GH (and other pituitary) deficiency. Other etiologies include cranial trauma, infiltrative disorders, and cranial irradiation. Sometimes, congenital disorders causing partial GH deficiency may not become apparent until late childhood and will present as if they are "acquired" disorders. Familial forms of GH deficiency and septo-optic dysplasia (absence of the septum pelucidum, hypoplasia of the optic chiasm, and pituitary insufficiency) are congenital disorders that may become evident clinically beyond the neonatal period.
Evaluation of Renal Function During Childhood
Authors: Atiyeh Bassam A. , Dabbagh Shermine S. , Gruskin Alan B. 
Published: December 2021

There are several methods to evaluate renal function during childhood. The use of serum creatinine, either alone or in combination with the Schwartz formula, is reliable and quick, but requires knowledge of conceptual age. A plasma creatinine concentration of 88.4 µmol/L (1.0 mg/dL), for example, represents normal renal function in an adolescent but more than 50% loss of renal function in a 5-year-old child. A timed urine collection for creatinine clearance is another evaluative method, but the adequacy of the urine collection always should be determined first. Urea clearance rarely is used to measure GFR because of the complex factors that influence urea excreation. Measurement of the disappearance of radioactive-labeled substances in plasma can be used to determine GFR. Radionuclide renal scans also can be used and offer the advantage of estimating the GFR of each kidney.
Although infants and newborns have an intact urine diluting ability, their concentrating ability is impaired. The maximal urinary concentration in the neonatal period is less than 700 mOsm/kg, but reaches adult values of 1200 mOsm/kg by 6 to 12 months of life. Similarly, the infant kidney has a limited capacity for salt regulation, predisposing the infant to salt disturbances.
Gastroesophageal Reflux in Infants and Children Who Have Neurodevelopmental Disabilities
Authors: Roberts Kenneth B. 
Published: December 2021

Infants and children who have neurodevelopmental disabilities are at risk of additional compromise due to malnutrition. Poor nutrition may result from motor difficulties, which makes those affected difficult to feed. Oropharyngeal abnormalities may predispose to recurrent aspiration pneumonia. Gastroesophageal reflux (GER) is present in the majority of those who are affected severely and adds to malnutrition by limiting intake and, if chronic esophagitis develops, by expending energy in painful movements and by creating a catabolic state.
Although most of the attention to GER has centered on the control of vomiting and esophagitis, nutrition also must be a major consideration. Indeed, recent evidence suggests that GER may resolve if normal nutrition is attained.
Child Sexual Abuse
Authors: Hymel Kent P. , Jenny Carole 
Published: December 2021

Multiple obstacles can hinder the medical evaluation of suspected child sexual abuse in pediatric primary care. The need for diagnostic accuracy is high. Knowledge of sexual abuse risk factors, an understanding of the victimization process, and awareness of the varied clinical presentations of sexual abuse can be of assistance.
Open-ended questioning of the suspected victim is the most critical component of the evaluation. Skillful medical interviewing requires time, training, patience, and practice. Pediatricians lacking any of these four requirements should defer interviewing in sexual abuse cases to other professionals.
Abnormal physical findings from sexual abuse are uncommon. Colposcopy has assisted pediatricians greatly in reaching consensus regarding diagnostic physical findings. Cases of acute sexual assault require familiarity with the forensic rape examination, STD screening and prophylaxis, and pregnancy prevention. Victimization from sexual abuse continues long after the abusive acts end, often requiring long-term therapeutic intervention.
An emerging standard of care for medical evaluations of suspected child sexual abuse recognizes the requirement for patience and compassion while retaining objectivity. The pediatrician's primary concern must be for the child's physical and emotional well-being.
Strokes in Children
Authors: Rivkin Michael J. , Volpe Joseph J. 
Published: December 2021

Stroke denotes the sudden onset of a focal neurologic deficit and most often includes the abrupt appearance of weakness. Interruption of blood flow to a part of the central nervous system (CNS) usually underlies the resultant weakness. Because most strokes in children are related to focal cerebral involvement, the most common clinical manifestation is the abrupt appearance of hemiparesis. Less frequently, the cause of stroke involves the brain stem, cerebellum, or spinal cord. The functional consequences always reflect the neuroanatomic features of the affected CNS region.
Epidemiology
Childhood stroke occurs with an annual incidence of 2.5 cases per 100,000 population and has been reported in all racial and ethnic groups. The sequelae are not trivial. In addition to lasting lateralized weakness, cognitive deficits, disturbances of language, visual deficits, and seizures may persist long after the acute event has concluded.
The causes of stroke in children differ from those in adults. Stroke in adults is associated largely with hypertension or atherosclerosis and their respective hemorrhagic and ischemic consequences. Stroke in children more commonly is caused by or related to congenital heart disease, infection, metabolic disorders, hematologic diatheses, and vasculitic disorders, frequently due to autoimmune processes (Table 1). Nonetheless, despite the most thorough of evaluations, etiology escapes detection in approximately 30% of the pediatric patients in whom stroke occurs.
Pediatricians and Gay and Lesbian Youth
Authors: Perrin Ellen C. 
Published: December 2021

The Epidemiology of Adolescent Homosexuality
PREVALENCE
Sexual orientation refers to an individual's pattern of physical and emotional arousal toward other persons. It is not synonymous with gender identity (the knowledge of being male or female) or gender role (outward expression of maleness or femaleness). Gender identity and gender role generally are defined by anatomic and chromosomal gender in both heterosexual and homosexual individuals. Sexual orientation also is not synonymous with sexual activity; many homosexual individuals, especially during adolescence, participate in heterosexual behavior and relationships,1,2 and many adults who identify themselves as heterosexual report homosexual activity during adolescence.3-5
It is difficult to know with certainty the number of people who identify themselves as exclusively or predominantly homosexual. It is more difficult still to estimate the number who have questions about their sexual orientation during adolescence because of the well-known fluidity and complexity of sexual attractions and activities during this period. The original Kinsey study of sexuality reported that from puberty to age 20, 28% of boys and 17% of girls had one or more homosexual experiences. The same survey reported that 37% of adults have had homosexual experiences and that 10% consider themselves to be predominantly homosexual.3,4 In a somewhat more recent cross-sectional study of 13- to 19-year-olds, 11% of boys and 6% of girls reported at least one homosexual experience, with 17% of boys aged 16 to 19 reporting such activities.6
Use of Nephrosonography in Evaluation of Renal Disease in Infants
Authors: Kelsch Robert C. , Oliver William J. 
Published: December 2021

Indications and contraindications for nephrosonography in infants include:
1. Nephrosonography should be the initial procedure used in evaluating renal structure in infants with renal failure.
2. Nephrosonography may be the initial procedure used in evaluating an abdominal mass or urinary tract infection in infants under 2 weeks of age. Intravenous urography can follow at the appropriate time if indicated.
3. Intravenous urography should be the initial procedure in evaluating abdominal masses or urinary tract infection in infants more than 2 weeks of age.
4. Nephrosonography is a suitable screening procedure when the presence of certain congenital anomalies suggests the possibility of abnormal development of upper urinary tracts. Abnormalities found may require resolution by intravenous urograms.
5. Nephrosonography offers decreased risk in terms of hypersensitivity reactions and radiation exposure in the follow-up evaluation of certain diagnoses and treatment.
The Pediatrician and Psychometric Testing
Authors: Rosenberger Peter B. 
Published: December 2021

Because of the importance of developmental disabilities in today's pediatric practice, familiarity with psychometric testing is essential to the modern pediatrician. It is unfortunate that pediatric training programs include so little instruction in this area. However, the subject is largely relevant to outpatient practice, and perhaps better taught at the postgraduate level.
Psychometric tests are essentially observations of behavior, a proper part of the clinical examination. The pediatrician should develop a repertoire of office tests of intellectual aptitude and achievement, using simple materials and readily available developmental norms.
Indications for formal psychometric testing have been discussed. Representative tests in each major category were reviewed briefly with a comparison of relative strengths and weaknesses, and the proper uses of psychometric test results as laboratory data in the diagnostic workup have been presented.
Genetic Counseling and Congenital Anomalies
Authors: Feingold Murray 
Published: December 2021

As the role of the pediatrician changes, less time will be devoted to routine care and more time will be spent in other areas such as genetics and birth defects. Approximately 5% of all newborn babies have a significant birth defect requiring the care of a pediatrician. Structural abnormalities such as meningomyelocele, cleft palate, limb abnormalities, and other obvious defects usually do not present any diagnostic problems. However, there may be difficulty in diagnosis of the child who has nonspecific findings such as an unusual facial appearance and/or minor congenital anomalies. In this situation, the pediatnician must first decide whether the child is normal or abnormal; at times this may be difficult. If abnormal, then the correct diagnosis must be ascertained in order to provide the family with genetic counseling, a prognosis, and treatment when available.
Complicated medical gadgetry may be helpful in making a diagnosis, but a thorough history and physical examination remain the clinician's key to unlocking a diagnostic dilemma. A family pedigree should be constructed listing any significant illnesses, birth defects, chromosomal abnormalities, consanguinity, and mental retardation. A complete pregnancy history should always be obtained; what took place during the mother's pregnancy also affected the boarding fetus. Queries should be made concerning exposure to drugs, alcohol, infections, environmental contaminants, and radiation.
Hair Loss in Children
Authors: Rasmussen James E. 
Published: December 2021

PHYSIOLOGY OF NORMAL HAIR1,2
Unlike the hair of most animals, human hair usually follows a random pattern of growth, rest, and shedding, followed by the growth and emergence of a new hair from the follicle. This cycle is related to histologic changes in the follicle: The anagen phase involves active growth (long follicle); the telogen phase is resting (short follicle); and the catagen phase is a transition between anagen and telogen.
The duration of the growing phase (anagen) determines the ultimate length of the hair: normally longest on the scalp, followed in descending order of length by the hairs of the beard, pubis, axillae, body, eyebrows, and eyelid margins. Longer hair is associated with a higher ratio (10:1) of anagen to telogen follicles. Hair plucking is the most rapid, convenient path to examine this relationship: anagen hairs have a glistening, cylindrical proximal sheath, approximately 3 mm long (Fig 1) whereas the telogen follicle yields a hair with a short, 1-mm knob, appropriately called a club (Fig 2).
The shape and color of hair are usually determined genetically. Straight hair is round in cross section, with curly and kinky (spiral) varieties becoming progressively more ellipsoid. Hair color may normally darken and shape change for the first five to ten years of life; this tendency is most commonly seen in the transformation of a curly haired blond child into a tow-headed or brunette adolescent.
Syndromes and Eponyms
Authors: V. V. C. 
Published: December 2021

A reader has recently questioned dropping the possessive when referring to conditions described by individuals, that is, Down syndrome vs Down's syndrome. He notes that this practice has made him uncomfortable. Since my mentor regarding this matter was Dr Vaughan, I referred the question on to him and his informative comment follows.
"This raises a point of style about which many physicians have strong feelings, which are rooted in the comfort we have in ways in which we first, as medical students, learned about syndromes and eponyms. Medicine has always been inconsistent in this style: we never gave two people possession of a syndrome (Niemann-Pick disease, Smith-Lemli-Opitz syndrome); nor have we always given possessive credit to other innovations (McBurney incision, Trendelenburg position, Charcot joint); nor, in fact, do all syndromes or conditions belong to the person who first described them—some belong to the patient (Christmas disease, Hartnup syndrome).
In light of these inconsistences, the style manual of the American Medical Association (Stylebook) in its 1976 revision (6th edition) recommended (page 26) that eponyms no longer be given the possive form. It takes an emotional wrench to make the change, and a little time to get used to it (Wilms tumor, Hodgkin disease), but after a while it flows remarkably easily and comfortably, conserves apostrophes, esses, paper, and space, and often comes to seem eminently reasonable (Vaughan contention). I would be pleased to see the style adopted universally.(V.C.V.
Pelvic Examination of the Adolescent Patient
Authors: Emans S. Jean 
Published: December 2021

Providing health care to adolescent girls in the 1980s involves knowledge of many topics. A thorough understanding of the gynecologic problems that may occur during adolescence as well as comfort with the normal pelvic examination allows the pediatrician to provide this aspect of primary care. Not only does the physician need the technical skills which include speculum examination of the vagina and bimanual rectovaginal-abdominal palpation, but the practitioner seeing adolescents also needs the interpersonal skills, sensitivity, and time to establish a primary relationship with the adolescent herself. Principles of caring for adolescents and their families are not discussed here but are of obvious importance in dealing with a pelvic examination.
Pamphlets on a variety of gynecologic and nongynecologic subjects should be readily available in the office. Education for the young teenager should discuss leukorrhea, normal development, menses and menstrual cramps, and the use of tampons. The intermittent use of conventional tampons changed frequently allows the adolescent girl more freedom in activities and athletics, makes her more comfortable with her body, and makes the routine pelvic examination simpler and less anxiety provoking. The use of tampons is especially helpful in preparing the young adloescent exposed in utero to diethylstilbestrol for speculum examination. The adolescent should be encouraged to discuss boyfriends and peer relations.
Visual System Screening in Infants and Young Children
Authors: Gammon J. Allen 
Published: December 2021

Many abnormalities of the visual system in infants and young children respond to treatment when instituted at an early age. Ocular abnormalities that require early recognition and therapy include congenital cataracts, congenital glaucoma, intraocular tumors, intraocular inflammation, large errors of refraction, strabismus, and corneal opacities (Figs 1 to 6). The visual prognosis for children with these problems is often directly related to early detection and treatment of the visual disorder.
Visual deprivation of young laboratory animals can permanently damage their developing central nervous system. Diseases once believed hopeless, such as monocular congenital cataracts, can now be treated.1 Technologic advances, such as extended-wear contact lenses which are useful for infants who have had cataract surgery during the first few weeks of life, have facilitated visual rehabilitation of young eyes.
Corneal opacities, complete ptosis, prolonged patching, and eyelid or orbit abnormalities such as large hemangiomas can cause amblyopia if the vision is obstructed. Even brief occlusion can result in irreversible amblyopia during the early months of life.2 Unilateral disruptions of vision are generally more damaging to the eye than are bilateral ocular abnormalities. Each of the young child's eyes must enjoy a clear, focused retinal image for visual development to progress normally.
Early diagnosis and treatment of congenital glaucoma is important so that intraocular pressure can be lowered, thereby, avoiding irreversible anatomic damage to the eye.
Therapy of Petit Mal (Absence) Seizures
Authors: Holmes Gregory L. 
Published: December 2021

Although petit mal or typical absence seizures are not life threatening, it is important for the pediatrician to recognize the disorder because untreated they can affect school performance, increase the risk of accidental injury, and lead to the victim's being ridiculed by classmates for being "spacey."
CLASSIFICATION
Unfortunately, petit mal is probably the most misused term in epileptology. In 1969, The International League Against Epilepsy published a classification of epileptic seizures entitled The International Classification of Epilepsy. This classification, which has recently undergone revision, categorizes seizures into two groups: partial, seizures in which the first clinical and electroencephalographic changes indicate initial activation of a system of neurons limited to a part of one cerebral hemisphere, and generalized, those in which the first clinical changes indicate initial involvement of both hemispheres. In absence seizures, as in all primary generalized seizures, the ictal EEG patterns are bilateral and reflect neuronal discharge which is widespread. Absence seizures can be further subdivided into typical and atypical absences (Table 1).
Although the term petit mal has been eliminated from the revised International Classification of Seizures, the term is still widely used by physicians. Most physicians use it to describe a simple absence with impairment of consciousness only, and with a rhythmic, three cycles per second, spike and wave discharge on the electroencephalogram in a child between age 3 years and puberty who has normal intelligence and in whom a neurologic examination prduces normal findings.
Lactic Acidosis in Children—Pathophysiology, Diagnosis, and Treatment: A Workbook Exercise
Authors: Yudkoff Marc , Burg Fred 
Published: December 2021

This article is designed to give you an opportunity to learn how lactic acidosis affects children, and how to diagnose and treat a child with this disorder. The process we have utilized is an interactive one in which you will be presented with questions commingled with problems and discussion.
CASE REPORT
A 3-month-old male infant had been well until two days prior to admission, when he had developed fever, vomiting, and diarrhea. Initially the vomiting and diarrhea were mild, and a pediatrician recommended administration of clear liquids. On the day of admission the infant ate nothing at all, vomited every one to two hours, and had more than ten stools, all of which consisted primarily of water. The parents reported that by 5 PM the child became suddenly pale and his skin seemed cool, although when they took the rectal temperature it was 37.7 C(100 F). The baby became increasingly lethargic and limp. By 6 PM, when the parents rushed the child to the emergency room, he could not be awakened at all.
The receiving physician in the emergency room found an unresponsive flaccid baby with a respiratory rate of 62 breaths per minute. A feeble pulse was 154 beats per minute and the rectal temperature was 38.1 C. The odor of acetone was apprent in the baby's breath.