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Long-acting beta agonists (LABA) and serious asthma-related event risks
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There appear to be no advantages to using LABA plus steroids (fluticasone propionate plus salmeterol) vs. fluticasone alone in 4-11 year old asthmatic children.
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Patella tendon rupture in a pre-adolescent male
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Patella rupture in preadolescents is extremely rare, primarily because the force needed to rupture the tendon is 1705 times body weight (fractures therefore occur more commonly).
An interesting case presentation of an 11-year-old boy presenting to an Emergency Department with knee pain following a fall reminds us that trauma as well as inflammatory disease, degenerative change, repetitive steroid injections and other medications (e.g. fluoroquinolones) are all risk factors for patella tendon rupture.
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The risk of recurrent anaphylaxis
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Through the Cross-Canada Anaphylaxis Registry, 200 parents of children who had had a medical attended anaphylaxis were identified prospectively annually and questioned on subsequent reactions.
23.5% of patients experience a recurrent episode of anaphylaxis during 369 patient-years of follow-up, with food being the trigger in 84.6% of cases ("patients whose initial reaction was triggered by peanuts were less likely to have a recurrent reaction").
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Irritable bowel syndrome (IBS), sex and puberty
IBS is a common pediatric and adult gastrointestinal disorder, characterized by chronic abdominal pain and stool disturbances. While pathophysiological mechanism(s) remain unclear, IBS tends to occur more frequently in females while studies examining the relationship between pain-related symptoms and sex show conflicting results.
A prospective cross-sectional study of children 7-17 years diagnosed with IBS in which pain and stool characteristics, pubertal development and psychological profile (somatization, depression and anxiety) were examined indicates that pubertal development and/or sex appears to be associated with abdominal pain severity, stool form and somatization. Boys with higher Tanner scores have increased pain while females have increased somatic complaints and report more hard stools.
Pubertal development and specific sex hormonal variations may play a significant role in IBS symptomatology.
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Video Feature
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Irritable Bowel Syndrome (IBS) and Functional Abdominal Pain (FAP) in Children and Adolescents
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Video Feature
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Managing abdominal pain in
kids and teens |
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Acute ataxia in children; differential diagnosis and evaluation
"Ataxia is a neurological disorder in which coordination of motor activity is impaired....". Children with ataxia usually present with difficulty walking (often described as a "wide-based gate with truncal instability") and younger children may refuse to walk.
While ataxia frequently has a benign cause, stroke, toxic ingestion, infection, neuro-inflammatory disorders and cerebellar lesions often present as ataxia (as do abnormalities of the inner ear and eighth cranial nerve). Evaluation approach is clearly outlined in the article.
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Foreskin morbidity in uncircumcised males
The benefits and risks associated with circumcision have been outlined for some time. In 2012 the American Academy of Pediatrics issued a policy statement indicating that "the benefits of newborn circumcision outweigh the risks".
While the risks/benefits of circumcision have been vigorously debated, a study of 181 patients who had
medical
reasons for foreskin surgery before 18 years of age (excluding patients with hypospadias, ritual circumcision and redo-surgery) indicates that 1.7% of children require circumcision for phimosis, frenulum breve, and balanitis xerotica obliterans. Prior to surgery voiding problems and balanitis are common.
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Ultrasound-guided percutaneous catheter drainage of a large breast abscess in lactating women
Breast abscesses frequently develop (usually at 3-8 weeks postpartum) as a result of inadequately treated infectious mastitis; typically S. aureus. A mass may not be palpable if an abscess is located deep within a large breast. Management in lactating women remains controversial.
A prospective study of 34 lactating women with a diagnosis of unilateral breast abscess treated with ultrasound (US) - assisted pigtail catheter drainage with a 3 way stop-cock to allow drainage and irrigation of the cavity until resolution, indicates that this technique can avoid surgery, preserve breast feeding and is safe, well-tolerated and cost-effective.
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