bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aluminum Toxicity in Infants and Children
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

Dialysis encephalopathy and fracturing osteomalacia, which occur in hemodialysis units that use dialysis fluid contaminated with aluminum, have largely disappeared. This has been accomplished by establishing standards for safe concentrations of aluminum in dialysates. Infants, children, and adults with chronic renal failure who are not receiving dialysis have been shown to be at risk for aluminum intoxication from the oral administration of aluminum-containing phosphate binders. This complication should be avoided with the use of phosphate binders that do not contain aluminum and the use of other measures to control hyperphosphatemia.
A number of substances commonly administered intravenously, including calcium and phosphorus salts and albumin, have high levels of aluminum. Premature infants receiving intravenous fluid therapy may accumulate aluminum and show evidence of aluminum toxicity. Efforts are being made to reduce the levels of aluminum in products added to intravenous solutions; these efforts must continue.
Some infant formulas may contain relatively high concentrations of aluminum. The reported concentrations of aluminum in soy formulas and premature infant formulas are higher than those in other infant formulas. The potential impact of these formulas on the aluminum intake of premature infants and infants with impaired renal function should be recognized, although it is not clear that toxic effects result from the use of the formulas in these situations.
The Critical Role of Provider Practices in Undervaccination
Authors: Grabowsky Mark , Orenstein Walter A. , Marcuse Edgar K. 
Published: December 2021

There are five principal ways providers can raise immunization coverage levels among their patients. First, assure that all appropriate opportunities for vaccination are taken. Second, give patients all vaccines for which they are eligible. Third, use only valid contraindications. Fourth, assess immunization status and immunize at all visits, regardless of the reason the parent is seeking care. Fifth, implement aggressive reminder systems to notify parents when immunizations are due.
The information presented here suggests that some changes in the way physicians deliver vaccinations are needed. Vaccination is one of the most beneficial services providers can give their patients. In addition to avoiding unnecessary suffering through prevention of disease, disability, and death, vaccination saves society from $6 for every $1 spent on oral poliovirus vaccine19 to $29.00 for every $1.00 spent on diphtheria-tetanus-pertussis vaccine.20 As health care providers, we have an opportunity to assure that our patients get the full benefit of this service. These results suggest that, once motivated, physicians and nurses should be able to determine the best way to get their patients vaccinated using a variety of techniques.
Acute Renal Failure Secondary to Pyelonephritis
Authors: Turner Mary Ellen , Weinstein Jonathan , Kher Kanwal 
Published: December 2021

Pyelonephritis is an unusual cause of acute renal failure in children with an anatomically normal urinary tract and no other predisposing conditions. On the other hand, acute renal failure due to acute pyelonephritis has been reported in adults, and is often associated with pregnancy, solitary kidney, indwelling catheter or use of nonsteroidal medications.1-3 We report the case of a 12-year-old girl with normal renal anatomy and no known predisposing conditions who developed acute renal failure during the course of acute bacterial pyelonephritis, and who recovered completely after appropriate antibiotic therapy.
CASE REPORT
A previously healthy 12-year-old female was admitted to the Children's National Medical Center with a 1-week history of vomiting, diarrhea, and abdominal cramping.
Markers for Primary Care: Missed Opportunities to Immunize and Screen for Lead and Tuberculosis by Private Physicians Serving Large Numbers of Inner-city Medicaid-eligible Children
Authors: Fairbrother Gerry , Friedman Stephen , DuMont Kimberly A. , Lobach Katherine S. 
Published: December 2021

Objective. This study examines coverage levels for immunization, missed opportunities to immunize, and extent of lead and tuberculosis screening in inner-city storefront physician offices and then relates child, visit, and physician characteristics to missed opportunities.
Methodology. With the use of a nested sampling strategy, 232 charts were selected for review in 31 physician's offices. Charts selected were for children 0 to 35 months of age who had three or more visits in more than 3 months. Physicians were selected from those in specific low-income New York inner-city neighborhoods who submitted large volumes of Medicaid billing claims. Variables examined were missed opportunities to immunize, immunization coverage levels, lead, and tuberculosis screening. The outcome measure was missed opportunities to immunize.
Results. Only 26% of the children were up to date for their age for diphtheria, tetanus, pertussis (DTP), oral polio vaccine (OPV), and measles, mumps, rubella (MMR) compared with a city-wide coverage level of 49%. Children who were not up to date for immunization coverage were more likely not to be up to date for lead (RR = 1.24, CI 0.96 to 1.60) or tuberculosis (RR = 1.54, CI 1.14 to 2.08) screening. Physicians miss opportunities to immunize in 84% of the eligible visits. Opportunities to immunize are missed more frequently at sick care or follow-up visits (95% and 91% missed opportunities) than at well care visits (41% missed opportunities).
Conclusions. The quality Of pediatric primary care given by these inner-city storefront physicians is suboptimal. Sick and follow-up visits predominate; well care visits are infrequent. If care is to be improved, Medicaid reimbursement policies, which make delivery of well care unprofitable, will need to be changed. In addition, monitoring the quality of care will need to be more aggressive. In the near future children who receive Medicaid in New York will be in managed care. If reimbursement and monitoring policies that provide incentives for delivering pediatric primary care are to be in place, it will be the managed care plans that implement this.
Partial Amputation of Glans Penis During Mogen Clamp Circumcision
Authors: Strimling Bruce S. 
Published: December 2021

Although no numerical data are available, the most common techniques for performing newborn circumcision in the United States involve the use of the Plastibell, the Gomco clamp, and the Mogen clamp, likely in that order. The Mogen clamp (see Fig 1 and 2) is the least familiar to most pediatricians. It has a number of advantages when compared with the other techniques:
1. the one size of the Mogen fits all;
2. it is the most rapid;
3. the Mogen instrument allows full visualization of exactly how much prepuce to remove.
In Mogen circumcision however, the glans is not visualized before removal of the prepuce.
Three-Versus Four-week Administration of Benzathine Penicillin G: Effects on Incidence of Streptococcal Infections and Recurrences of Rheumatic Fever
Authors: Lue Hung-Chi , Wu Mei-Hwan , Wang Jou-Kou , Wu Fen-Fen , Wu Yu-Nian 
Published: December 2021

Objective. To investigate the effects of 3-week versus 4-week administration of benzathine penicillin G (BPG) on the incidence of Group A streptococcal infections and the recurrences of rheumatic fever (RF).
Study Design. We started, in 1979, randomly allocating all patients with RF to a 3-week or 4-week BPG prophylaxis program. They were examined at the RF clinic, every 3 to 6 months, and at any time they did not feel well. During 1979 to 1989, throat cultures and sera for antistreptolysin O and streptozyme titers were obtained at each clinic visit. Chest radiographs, electrocardiogram, color Doppler echocardiograms, and acute phase reactants were obtained.
Subjects. Two hundred forty-nine patients fulfilled the revised Jones criteria and were followed until December 1991: 124 in the 3-week and 125 in the 4-week program. Their age, sex, weight, percentage with history of RF, severity of cardiac involvement, follow-up duration, and compliance to program were comparable. Eight hundred eighty throat cultures were collected in the 3-week program and 770 were collected in the 4-week program. Six hundred sixteen and 627 sera were determined in each program for antistreptolysin O, and 582 and 592 sera for streptozyme titers.
Results. True streptococcal infections occurred in both programs: 39 infections in the 3-week program, and 59 infections in the 4-week program (7.5 vs 12.7 per 100 patient-years). Four infections with no antibody response occurred in the 3-week program, and three such infections in the 4-week program. Nine RF recurrences occurred in 8 patients in the 3-week program, and 16 recurrences in 16 patients in the 4-week program. Prophylaxis failure occurred in 2 of 124 patients in the 3-week program, and in 10 of 125 patients in the 4-week program (0.25 vs 1.29 per 100 patient-years). The overall recurrences/infections rate in each program was comparable, 13.6% vs 15.5%, but the recurrences/infections rate due to prophylaxis failure was higher in the 4-week program than in the 3-week program, 3.0% versus 9.7%.
Conclusions. This 12-year prospective and controlled study documented that streptococcal infections and RF recurrences occurred more often in the 4-week program than in the 3-week program. The risk of prophylaxis failure was fivefold greater in the 4-week program than in the 3-week program.
Practice Variations by Population: Training Significance
Authors: Feigin Ralph D. , Drutz Jan E. , Smith E. O'Brian , Collins Carol Ritter 
Published: December 2021

Objective. This study sought to examine variations in the frequency of procedures performed and patterns of care of sick infants and older children by general pediatricians in different sized communities. The results of the study will be considered in developing relevant educational experiences for postgraduate trainees.
Methodology. Questionnaires were sent to 1412 Texas pediatricians requesting frequency information for 29 procedures and whether they provided various levels of care to sick infants and older children. Responses were tabulated by the size of the community in which each pediatrician practiced.
Results. Fifty-four percent of the questionnaires were returned. The proportion of pediatricians performing each procedure was significantly different for all but 8 of the 29 procedures between communities of less than 100 000 and more than 100 000 population. For all procedures with significant differences, the proportion of physicians performing the procedures was significantly greater for pediatricians practicing in communities of less than 100 000 population. No significant difference was found between the proportion of pediatricians providing newborn level II and III care; however, more than 65% of both groups provided level II care. Physicians in communities of less than 100 000 population were more likely to provide intermediate and intensive care beyond the newborn period.
Conclusion. The general practice rotation in the community setting will not provide adequate training experiences for many of the procedures currently being performed by general pediatricians.
Influenza Vaccination of Children During Acute Asthma Exacerbation and Concurrent Prednisone Therapy
Authors: Park C. Lucy , Frank Arthur L. , Sullivan Myrtis , Jindal Parveen , Baxter Barbara D. 
Published: December 2021

Objectives. The influenza vaccination rate is very low among children with moderate to severe asthma. This may be partly because of poor patient motivation and failure to visit clinics for vaccination. Another important factor may be health care providers' deferral of vaccination because of concern about the efficacy and safety of influenza vaccination during asthma exacerbations and concurrent prednisone therapy. We therefore examined the safety and immunogenicity of influenza vaccination during acute asthma exacerbation with concomitant prednisone therapy.
Setting. A pediatric allergy and pulmonology clinic and a pediatric emergency department.
Design. Children (n = 109) with a known diagnosis of asthma 6 months to 18 years of age were recruited. All participating patients, 59 without asthma symptoms (no prednisone, control group) and 50 with acute asthma exacerbation requiring prednisone burst therapy (prednisone group) received trivalent subvirion influenza vaccine. Fifteen children in the control group and 12 in the prednisone group received a booster dose according to American Academy of Pediatrics guidelines. Serum antibody titers to influenza A/Beijing/32/92 (H3N2), influenza A/Texas/36/91 (H1N1), and influenza B/Panama/45/90 were measured before and 2 weeks after vaccination. Adverse effects noted within 48 hours after vaccine dose were ascertained during the follow-up visit.
Results. The antibody response was analyzed by comparing mean postvaccine titers, the percentage of patients achieving protective antibody levels (≥5log2), and the percentage of patients achieving rises in titers of 2log2 or greater. Antibody responses to influenza A/Beijing/32/92 (H3N2) and influenza A/Texas/36/91 (H1N1) in the prednisone-treated and control groups were not different. A significantly better response to the influenza B/Panama/45/90 antigen was seen in the prednisone group for all three parameters. Children who received a booster dose and the subgroup of children with low prevaccination titers (≤3log2) showed similar patterns. Adverse effects, including asthma exacerbation, local swelling at the injection site, fever, rash, and headache were not different in the two groups.
Growth Hormone Increases Breast Milk Volumes in Mothers of Preterm Infants
Authors: Gunn Alistair J. , Gunn Tania R. , Rabone Diana L. , Breier Bernhard H. , Blum Werner F. , Gluckman Peter D. 
Published: December 2021

Aims. To determine the galactopoietic response to recombinant human growth hormone (hGH) in mothers of premature infants with inadequate lactation.
Study Design. Prospective placebo-controlled, double-blind trial.
Subjects. Twenty healthy mothers on no concurrent medication, with infants born between 26 and 34 weeks' gestation with insufficient milk production for their infants' needs.
Interoentions. Ten mothers received hGH, .2 IU/kg/day subcutaneously to a maximum of 16 IU/day, for 7 days, while 10 mothers received the same volume of placebo. One mother from each group withdrew from the study.
Outcome Measures. Maternal milk production and plasma concentrations of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), and growth hormone (GH) were determined before starting treatment and 1 day after stopping therapy. A nurse measured the amount of milk expressed (5 to 6 times daily) plus, if the infant was suckling, weighed the infant before and after feeding.
Results. The mothers were enrolled 35 ± 26 days after birth; at this time the infants weighed 1.89 ± .64 kg. Milk production in hGH-treated mothers increased from 139 ± 49 mL/day to 175 ± 46 mL/day after 7 days of treatment (arise of 31%). Placebo-treated mothers showed no significant change from 93 ± 50 mL/day to 102 ± 69 mL/day (arise of 7.6%, not significant). Milk production increased in all treated mothers but decreased in 4 of 9 placebo mothers. Plasma concentrations of IGF-1 and IGFBP-3 increased in hGH-treated mothers but not placebo-treated mothers; there was no change in plasma GH levels in either group. No adverse effects were seen with hGH treatment in the mothers or infants.
Conclusions. hGH therapy in mothers with lactational insufficiency can improve breast milk volumes.
MOLECULAR IDENTIFICATION OF AN IMMUNOGLOBULIN E (IgE)-DEPENDENT HISTAMINE-RELEASING FACTOR
Authors: Sicherer Scott H. , Wood Robert A. 
Published: December 2021

Purpose of the Study. The late-phase allergic response depends in part on histamine release from immunoglobulin E (IgE)-bearing basophils that collect at the site of allergic inflammation at a time when allergen has been metabolized. This phenomenon lead to the search for cytokines that can cause histamine release from basophils. Although several cytokines can cause basophil histamine release, only one histamine-releasing factor (HRF), which has been found in late-phase response fluids, causes histamine release only from basophils bearing IgE. In fact, this HRF only releases histamine from basophils bearing a particular type of IgE (termed IgE+) that is only produced by a subset of allergic individuals. This study sought to identify this HRF molecule.
Methods/Results. Fifty liters of supernatant containing HRF from a human macrophage line was concentrated and the proteins were separated by electrophoresis. Protein sequencing was performed on a 23-kD band and revealed extensive homology to a mouse protein, p21. and its human homologue, p23. Both of the genes for these proteins had been previously cloned because of extensive expression in tumor cells but no function had been ascribed to them. Both recombinant proteins caused histamine release from the human basophils of a subpopulation of donors, and this release was dependent on IgE. Polyclonal antibodies to the recombinant proteins were raised and were capable of removing the biologic activity of recombinant and native HRF. RNA blot analysis and reverse transcription polymerase chain reaction indicated that the HRF mRNA was ubiquitous and found in T cells, B cells, fibroblasts, and mononuclear cells.
Ingestion of a Blister Beetle (Mecoidae Family)
Authors: Mallari Rolando Q. , Saif Mohammed , Elbualy Musallem S. , Sapru Anil 
Published: December 2021

Cantharidin, the most important active principle of Cantharis vesicatoria (Spanish fly), has a long history. It is a medieval medicine, considered over a hundred years ago as the most powerful medicine on the Materia Medica. It has been used as a skin irritant, vessicant, and abortifacient, and has long been wrongly considered an aphrodisiac.1
The following cases appear exceptional in that the source of the poison—the blister beetle itself—was ingested, resulting in the manifestations of cantharidin poisoning.
CASE REPORT
Two siblings were referred to the Royal Hospital in Muscat on March 30, 1994, for repeated episodes of blood-stained vomitus and passage of reddish-colored urine after ingestion of a beetle they caught in a garden.
The Medium/The Message: Corporal Punishment, an Empirical Critique
Authors: Polite Kenneth 
Published: December 2021

Before formally responding to Dr Graziano's article, it seems prudent to familiarize the reader with certain contextual elements pertinent to the conference, Dr Graziano's paper, and my critique. The American Academy of Pediatrics (AAP) invited a group of nationally known researchers and scholars to take an objective look at the empirical literature on the short- and long-term consequences of corporal punishment. Both the invitation to attend and the preconference materials made it clear that the conference was dedicated to objectivity, rather than an emotional debate. Consequently, any conclusions coming out of the conference were to be data-driven. Although such a commitment to empiricism is a commendable value, many reasonable professionals also hold the opinion that culture and experience shape the realities that individuals both perceive and attend to. All the reviews of the relevant literature on discipline and corporal punishment are shaped by the experiential and cultural baggage of the reviewers.
The present author is not excepted. Although personal musings are not often instructive in scholarly discourse, if the reader will bear with me, I would like to share a brief bit of personal experience and cultural background that may provide additional context for considering Dr Graziano's article, my critique, and the conference in question. In graduate school I was profoundly impacted by reading a philosophy of science book by Thomas S. Kuhn called The Structure of Scientific Revolutions (1962).1 Succinctly, it is Kuhn's thesis that science does not progress in the logical positivistic manner that we usually talk about.
Medical Decisions: An Appeal for Reasonableness
Authors: Silverman William A. 
Published: December 2021

Lewis Thomas wrote that when his father attended the College of Physicians and Surgeons of Columbia University at the turn of this century, medical teaching was just beginning to be influenced by the assertions of "therapeutic nihilism." This revolutionary thesis was a reaction to long-standing over-treatment by doctors with bleeding, cupping, violent purging, and the use of prescriptions compounded from long lists of bizarre substances and botanical extracts mixed together under the influence of nothing more than pure whim. The new teaching, led by William Osler at Johns Hopkins, argued that most of the remedies in common use were more likely to do harm than good: "There are only a small number of genuinely therapeutic drugs-digitalis and morphine the best of all." When Thomas himself entered medical school in 1933, very little had changed: "We were taught," he remembered, "that we could do nothing to change the course of the great majority of diseases we were so busy analyzing."
Despite this confession of helplessness (and unlike earlier times when physicians were regularly criticized for their pretensions and their greed), the profession began to enjoy unprecedented social esteem. Burnham labeled the first half of this century "American medicine's golden age." Publicity about medicine became increasingly favorable. It came to be regarded as a model profession; opinion polls from the 1930s to the 1950s consistently ranked doctors equal to or higher than Supreme Court justices. In 1952, an elderly doctor remembered that when he was young, the townspeople of Worcester, Massachusetts, customarily tipped their hats, in a gesture of respect to the physician as he passed by.
Impact of Music Lyrics and Music Videos on Children and Youth (RE9144)
Authors:   COMMITTEE ON COMMUNICATIONS
Published: December 2021

Music lyrics have undergone dramatic changes since the introduction of rock music more than 40 years ago. This is an issue of vital interest and concern for parents and pediatricians.
During the past four decades, rock music lyrics have become increasingly explicit—particularly with reference to sex, drugs, and violence. Recently, heavy metal and "gangsta rap" music lyrics have elicited the greatest concern. In some cases lyrics communicate potentially harmful health messages. Such lyrics are of special concern in today's environment, which poses unprecedented threats to the health and well-being of adolescents. Pregnancy, drug use, acquired immunodeficiency syndrome (and other sexually transmitted diseases), injuries, homicide, and suicide have all become part of the landscape of everyday life for many American teens.
At the same time, music is important to teenagers' identity and helps them define important social and subcultural boundaries. The results of one survey of 2760 14-to 16-year-olds in 10 different southeastern cities showed that that they listened to music an average of 40 hours per week. One Swedish study found that adolescents who developed an early interest in rock music were more likely to be influenced by their peers and less influenced by their parents than older adolescents.
To date, no studies have documented a cause-and-effect relationship between sexually explicit or violent lyrics and adverse behavioral effects. A possible explanation for this lack of finding is that teenagers often do not know the lyrics or fully comprehend their meaning. For example, in one study only 30% of teenagers knew the lyrics to their favorite songs, and their comprehension varied greatly.