Adolescent renal function and blood pressure following preterm birth
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A cross-sectional analysis of 96, 14 year olds born preterm assessed the association between preterm birth, kidney function, compared those to infants born at term and examined any related effects of sex and obesity.
It appears that compared to those born at term, pre-term born adolescents have a higher blood pressure (systolic and diastolic), lower estimated glomerular filtration rate (eGFR), and higher urinary albumin-to-creatine ratios, with being female and overweight decreasing the strength of these relationships.
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The impact of
adenotonsillectomy
(T&A) on pediatric asthma
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A study of 80 children with diagnosed asthma (aged 4-11 years) and sleep disordered breathing undergoing T&A, (and appropriately matched 62 normal controls), in which parents and children completed the Childhood Asthma Control Test (C-ACT) and the Pediatric Sleep questionnaire prior to and after six months of T&A indicates that T&A in children with sleep disordered breathing and asthma improves asthma outcomes.
Pediatric Pulmonology
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Incidental findings on brain magnetic imaging (MRI) in preterm infants
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Many neonatal units are apparently routinely performing brain MRIs on extremely preterm (EP: <28 weeks gestation) infants at term equivalent age (TEA).
A retrospective review of brain MRIs on 165 EP infants at TEA indicates that 9.7% of infants have incidental findings, most being clinically insignificant. 4.6% have significant clinical issues requiring treatment.
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Idiopathic purpura with Gray platelets (IPGP)
Gray platelet syndromes (GPS) are a group of rare
genetic disorders (mutations in the NBEAL 2 gene) in which biosynthesis of platelet alpha granules (these assist in platelet plug formation which seal damaged vessels preventing further bleeding), or cytoplasmic trafficking, is defective. These platelets appear ghost-like or gray on stained blood smears.
Gray platelets as a hallmark of an
acquired transient bleeding disorders has only recently been described. These have been named idiopathic purpura with gray platelets (IPGP) or "acquired platelet dysfunction with eosinophilia" (APDE). In Asia this has been thought to be associated with an allergic response to intestinal helminthic infection.
An 8-year retrospective review from a private clinic identified 10 children with IPGP (mean age 8.4 years). While grey platelets were found in 40-80% of children, eosinophilia was absent in one. All children recovered spontaneously and completely 1-4 months after diagnosis with no specific therapy.
IPGP appears to be another acquired form of Gray platelet syndrome - eosinophilia not being mandatory for diagnosis. Pathogenesis remains obscure.
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Childhood head and neck lymphadenopathy
Palpably enlarged head and cervical lymph nodes occur in 38-45% of normal children due to the relative increase in lymphoid tissue, associated congenital abnormalities and infectious diseases (plus occasionally, malignancies).
A retrospective investigation utilized data over a 15-year period (392 children) from a Pediatric Hematology-Oncology Department which analyzed the causes of childhood head and neck lymphadenopathy indicates that most (56.1%) have a history of infection, 16.8% have a diagnosis of neoplasia and 24.9% have non-specific inflammatory changes.
The presence of supraclavicular lymphadenopathy carries a high risk of malignancy.
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Video Feature
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Patellar Dislocations - Everything You Need To Know - Dr. Nabil Ebraheim
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Recurrent patella instability (RPI)
While patella instability following patellar dislocation is not frequent, occurring in 2-3% of all knee injuries, it is a disabling condition that has a major day-to-day impact (pain and anxiety) and results in short/long-term knee function problems (arthrosis and arthritis). RPI has a variety of anatomic etiologies and management remains controversial, though with a common goal for both non-surgical and surgical treatments to provide relief of knee pain during normal and athletic use, and to eliminate further patellofemoral (PF) instability episodes.
A single-surgeon PF surgical database (148 knees) of children who underwent knee arthroscopy for at least 2 episodes of PF instability, quantified the frequency, severity and location of PF articular cartilage changes in children with recurrent patella instability.
PF articular damage is present in 63% of knees which are unstable with patella cartilage being involved in 61%, and the femoral trochlea (the articular portion of the anterior surface of the distal femur) in 20%. Crepitation in the knee (20%) is associated with larger and more severe lesions and warrants pre-operative visualization.
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Is excision of a testicular nubbin necessary in vanishing testes syndrome (VTS)?
A "vanishing testes" (or Testicular Regression Syndrome - TRS) is a common cause of an impalpable testes in children and is a condition which is considered to be due to atrophy and subsequent disappearance in fetal life of an initial normal testes. Residual testicular tubules are found in <10% of children. TRS theoretically carries a risk of malignant degeneration and removal is therefore a common practice.
A retrospective review of 48 consecutive children (mean age 2.4 years) with a clinical diagnosis of impalpable testes who underwent laparoscopy under anesthesia to assess the presence of testicular tissue and therefor the possibility of subsequent testicular malignancy, indicates that 69% have VTS and a testicular nubbin, with
virtually none having any viable testicular tissue.
Surgical removal of a testicular nubbin to exclude malignant potential might not be required.
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| Dr. Joshua Tarkoff Explains Type 2 Diabetes |
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