April 28, 2021 | Volume 12 | Issue 17
SARS-CoV-2 surface transmission
The latest CDC update (4/5/21) on SARS-CoV-2 transmission states “The principle mode by which people are infected with SARS-CoV-2 is through exposure to respiratory droplets carrying infectious virus. It is possible for people to be infected through contact with contaminated surfaces or objects but the risk is generally low” (<1 in 10,000 contacts with a contaminated surface causes infection). Surface disinfection has been shown to be effective for preventing transmission of SARS-CoV-2 within households (there is little scientific support for routine use of disinfectants in the community setting) however disinfection is recommended for indoor settings where there has been a suspected or confirmed case of COVID-19 within the previous 24 hours.

Hand/contaminated surface transmission of SARS-CoV-2 is low; overall transmission can be reduced by wearing masks, practicing hand hygiene, cleaning surfaces where appropriate etc.
Osteomyelitis and septic arthritis in children
Septic arthritis (infection in the joint fluid and tissues) occurs more frequently in children than adults, usually as a result of blood borne infection by bacteria, viruses or fungi (but may be secondary to local infection, surgery or trauma) and most commonly affects the knee, hip, shoulder, elbow and wrist joints. Septic arthritis and osteomyelitis while frequently presenting acutely may often present with a sub-acute course and vague signs and symptoms. Both diagnoses require emergency management to avoid detrimental adverse consequences. There is at present no consensus agreement on the risk factors that are predictive of concomitant septic arthritis and osteomyelitis.

A retrospective review of 71 children (mean age 6 years) with septic joints which reviewed information on symptoms, diagnosis of osteomyelitis, serum laboratory studies, joint fluid analysis, imaging results and treatment indicates that:

  1. Septic arthritis with concomitant osteomyelitis occurs in 61% of patients
  2. Blood/serum inflammatory markers are unhelpful in diagnosing concomitant osteomyelitis
  3. Only a positive joint fluid bacterial culture and pain > 4 days before admission are independent risk factors for concomitant osteomyelitis in children with septic arthritis


See related video HERE and below:
Septic Arthritis - Overview
Proton pump inhibitor (PPI) use and risk of asthma in children
A matched nationwide cohort of 80,870 pairs of children (<17 years of age) who were/were not new users of PPIs investigated whether PPI use is associated with risk of asthma in children.

It appears that children who use PPIs have a 57% increased risk of developing asthma and is one of several adverse events that should be considered when prescribing a PPI in childhood.


See related video HERE.
Simple sugar and sugar-sweetened beverage intake during adolescence and the risk of colorectal cancer precursors
The prevalence of colorectal cancer (CRC) is increasing, particularly in high-income countries where the burden is rapidly shifting to younger individuals. Sugar-sweetened beverage intake in the US has risen dramatically particularly among adolescents with high sugar intake promoting colorectal carcinogenesis through insulin resistance, obesity and type 2 diabetes. Information is lacking on the association between high sugar intake during early life and CRC.

A prospective study investigated in 33,106 adolescents who subsequently underwent lower gastro-intestinal endoscopy, the association between adolescent simple sugar (fructose, glucose, total sugar) and sugar-sweetened beverage (SSBs) intake and CRC.

High intake of simple sugars and/or SSBs during adolescence (but not during adulthood) is associated with an increased risk for conventional non-malignant adenomata (non-serrated lesions) especially of the rectum.


See related video HERE.
Hemolacria
Hemolacria describes a rare clinical condition that presents with blood in tears. The source of the blood may be from the conjunctiva (trauma, inflammation, vascular lesions, vicarious menstruation, foreign body, chemical injury, etc.), lid margin, lacrimal puncta, tear gland, orbit, plus hematological diseases, vascular disorders, systemic diseases, medications (methacholine and systemic drugs like aspirin, heparin, warfarin, and clopidogrel, etc.) and other causes including “idiopathic.”

An interesting case presentation of a 12-year—old boy with a 2-day history of bilateral blood-stained tears and an underlying beta-thalassemia trait/type 2 von Willebrand disease, describes the differential diagnosis and management approach.
Surgical strategy for benign pediatric sacral tumors
Sacral tumors are most often found in the newborn period with sacrococcygeal teratomas being most frequent. Other common benign congenital tumors of the sacrum include lipomas, dermoids, and epidermoids.

In older children (while primary benign sacral osseous tumors and tumor-like lesions are rare) the differential diagnosis is extensive and in this age group no predominant pathology exists.

A study of 49 children (mean age 14 years) with sacral benign tumors or tumor-like lesions evaluated the 6.2 year outcomes following surgical management.

Preoperative selective arterial embolization (SAE) and intraoperative aortic balloon occlusion (ABO) provide “excellent therapeutic effect” as part of the surgical strategy for highly vascular pediatric benign tumors and tumor-like lesions of the sacrum.


See related video HERE and below:
Is Celiac Disease (CD) testing necessary in Functional Abdominal Pain Disorders (FAPDs) in childhood?
Childhood Functional abdominal pain disorder, is common and as a group includes “Functional abdominal pain (FAP),” “Irritable bowel syndrome (IBS),” “Function dyspepsia (FD)” and “Abdominal migraine (AM).” They are all characterized by the absence of any identifiable organic cause for their symptoms. The Rome IV criteria presently recommends testing for CD in children with IBS and diarrhea based on a single Italian study. It is unknown whether this data can be extrapolated to other populations.

From a study of 181 children (mean age 12.9 years) with FAPDs who underwent Celiac testing of whom 46.4% had a diagnosis of IBS it appears that the prevalence of CD among children with FAPDs is similar to that of the general population. It appears that it may not be necessary at this time for all children with a diagnosis of FAPDs to be tested for CD.

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Featured Video
Meet Luis Caicedo Oquendo, MD
Pediatric Gastroenterologist

Nicklaus Children's Hospital
via YouTube
COVID-19 - Current Situation in Florida
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Florida's COVID-19 Data and Surveillance Dashboard
Florida Department of Health, Division of Disease Control and Health Protection
Dear Reader:

Though there may be many among you who have undergone immunization against COVID-19, this pandemic may by no means be over. We should be cautious as new mutant strains have arisen which make certainty about the absolute protection afforded by vaccination unclear, their response to treatment uncertain and there is the possibility that the variant viruses may spread even from those who are immunized.

Please continue to take care, wear a mask whenever in public, wash hands well and often, use sanitizer if available, cough or sneeze into elbow and socially distance yourself (preferably at least 6 feet from any person), outdoors, or in a well ventilated area whenever and where ever possible.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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