Antibiotic prophylaxis of pertussis

Altunaiji S, et al. Antibiotics for whooping cough (pertussis). Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004404. (Edited (no change to conclusions), comment added to review in Issue 3, 2013.)

“This systematic review of RCTs examining the treatment of whooping cough has found that antibiotic treatment is effective in eliminating B. pertussis from the nasopharynx and thus rendering participants non-infectious, but does not alter the clinical course of the illness. Prophylaxis with antibiotic was significantly associated with side effects; it did not significantly improve clinical symptoms, prevent the development of culture-positive B. pertussis, nor paroxysmal cough for more than two weeks, in contacts older than six months of age.”

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Staphylococcal scalded skin syndrome

Mishra AK, et al. A Systemic Review on Staphylococcal Scalded Skin Syndrome (SSSS): A Rare and Critical Disease of Neonates. Open Microbiol J. 2016 Aug 31;10:150-9.

The symptoms of Staphylococcal scalded skin syndrome (SSSS) include blistering of skin on superficial layers due to the exfoliative toxins released from Staphylococcus aureus. After the acute exfoliation of skin surface, erythematous cellulitis occurs. The SSSS may be confined to few blisters localized to the infection site and spread to severe exfoliation affecting complete body. The specific antibodies to exotoxins and increased clearance of exotoxins decrease the frequency of SSSS in adults. Immediate medication with parenteral anti-staphylococcal antibiotics is mandatory. Mostly, SSSS are resistant to penicillin. Penicillinase resistant synthetic penicillins such as Nafcillin or Oxacillin are prescribed as emergency treatment medicine. If Methicillin-resistant Staphylococcus aureus (MRSA) is suspected), antibiotics with MRSA coverage (e.g., Vancomycin or Linezolid) are indicated. Clindamycin is considered as drug of choice to stop the production of exotoxin from bacteria ribosome. The use of Ringer solution to to balance the fluid loss, followed by maintenance therapy with an objective to maintain the fluid loss from exfoliation of skin, application of Cotrimoxazole on topical surface are greatly considered to treat the SSSS. The drugs that reduce renal function are avoided. Through this article, an attempt has been made to focus the source, etiology, mechanism, outbreaks, mechanism, clinical manifestation, treatment and other detail of SSSS.

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Braunstein I, et  al. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014 May-Jun;31(3):305-8.

Historical resistance patterns often guide empiric antibiotic choices in staphylococcal scalded skin syndrome (SSSS), but little is known about the difference in susceptibility between SSSS and other childhood staphylococcal infections. A retrospective chart review of culture-confirmed cases of SSSS seen in the inpatient dermatology consultation service at the Children’s Hospital of Philadelphia between 2005 and 2011 was performed. Most cases of SSSS at our institution are due to oxacillin-susceptible Staphylococcus aureus, and approximately half of the cases are due to clindamycin-resistant strains. Clindamycin and a penicillinase-resistant penicillin are suggested as empiric treatment for SSSS until culture susceptibility data are available to guide therapy.

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The utility of blood cultures in pyelonephritis

Kim Y, et al. Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis. Infect Chemother. 2017 Mar;49(1):22-30.

APN is diagnosed by clinical signs and symptoms of upper urinary tract infection, and isolation of the pathogen from urine [4]. In clinical practice, blood cultures and radiologic imaging studies such as CT are commonly used [5,6,13]. Although these tests have been performed on a substantial number of patients, there has been controversy as to their accuracy and usefulness. The purpose of this study was to evaluate the impact of blood cultures and radiologic tests on the management of CA-APN patients.

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Polymicrogyria

Shain C, et al. Polymicrogyria-associated epilepsy: a multicenter phenotypic study from the Epilepsy Phenome/Genome Project. Epilepsia. 2013 Aug;54(8):1368-75.

Polymicrogyria (PMG) is an epileptogenic malformation of cortical development. We describe the clinical epilepsy and imaging features of a large cohort with PMG-related epilepsy.

Participants with PMG had both focal and generalized onset of seizures. Our data confirm the involvement of known topographic patterns of PMG and suggest that more extensive distributions of PMG present with an earlier age of seizure onset and increased prevalence of developmental delay prior to seizure onset.

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Barkovich AJ. Current concepts of polymicrogyria. Neuroradiology. 2010 Jun;52(6):479-87.

Polymicrogyria is one of the most common malformations of cortical development. It has been known for many years and its clinical and MRI manifestations are well described. Recent advances in imaging, however, have revealed that polymicrogyria has many different appearances on MR imaging, suggesting that is may be a more heterogeneous malformation than previously suspected. The clinical and imaging heterogeneity of polymicrogyria is explored in this review.

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Neonatal hyperbilirubinemia

Itoh S, et al. Phototherapy for neonatal hyperbilirubinemia. Pediatr Int. 2017 May 31.

About 60 years ago in England, phototherapy for neonatal hyperbilirubinemia was actually used in clinical practice. It was introduced in Japan about 50 years ago. However, the mechanism of how the serum bilirubin concentration was decreased by the phototherapy was still unknown. The mechanism was identified by chemists, biochemists, and pediatricians. Clarification started with the report that unconjugated bilirubin was excreted into bile after the photoirradiation of Gunn rats. After the molecular conformation of bilirubin by X-ray analysis, the mechanism for bile excretion of unconjugated bilirubin was verified based on geometric configurational photoisomers in the Gunn rat. Finally, the reaction and excretion of structural bilirubin photoisomers was proved to be the main mechanism for the decrease in serum bilirubin during phototherapy for neonatal hyperbilirubinemina, which differs from the mechanism in the Gunn rat. However, the most effective and safest light source and the optimal method to evaluate phototherapy remain unknown. Moreover, as for bronze baby syndrome which is a well-known adverse reaction to phototherapy, the substances as the etiological origin are unclear. Hence, we review phototherapy for hyperbilirubinemia including a fundamental understanding of the bilirubin photochemical reactions, and discuss the subclinical carcinogenic risk of phototherapy and the increased mortality rate of extremely very low birth weight infants due to aggressive phototherapy, which is becoming a problem an increasing.

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Maisels MJ. Managing the jaundiced newborn: a persistent challenge. CMAJ. 2015
Mar 17;187(5):335-43.

“In this review, I present an approach to managing the jaundiced newborn that is based on published guidelines. [2-5] The aim is to help clinicians identify and manage jaundice in the newborn, intervene when appropriate and, when possible, prevent bilirubin-induced brain damage. It would be ideal if the published guidelines for the management of hyperbilirubinemia, including treatment with phototherapy and exchange transfusion, were based on estimates of when the benefit of these interventions exceeded their risks and costs. These estimates should come from randomized trials or high-quality, systematic observational studies, but such studies are rare. Guidelines must therefore rely on relatively uncertain estimates of risk and benefits, often from conflicting results.”

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Adverse events associated with antipsychotic medications

See also: Lithium toxicity.


Garcia G, Logan GE, Gonzalez-Heydrich J. Management of psychotropic medication side effects in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2012
Oct;21(4):713-38.

“An evidence-based review of the published literature on the side effects of psychotropic medications on children and adolescents is provided. Due to the large scope of side effects, some of the most commonly presenting side effects are focused on and the rare but serious effects where controversy still exists around monitoring and management (eg, suicidality and metabolic syndrome) are highlighted. Emphasis is placed on the presentation of side effects, prevalence, treatment, and management of the adverse effects associated with psychotropic medication.”

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Complementary therapies of irritable bowel syndrome (focus on hypnotherapy)

Leiby A, Vazirani M. Complementary, integrative, and holistic medicine: integrative approaches to pediatric irritable bowel syndrome. Pediatr Rev. 2016 Apr;37(4):e10-5.

“Once a diagnosis of IBS is established, a suggested approach is to help the family understand that coping strategies are important for symptom management because psychological and environmental factors play a role in the disease. Validation and reassurance may be sufficient treatment for many children and families, but psychological, pharmacologic, or dietary treatment may also be needed for some. Strong evidence supports the efficacy of CBT, and emerging data suggest that clinical HT and yoga also may be beneficial. Probiotics and certain herbs may be useful adjuncts to biobehavioral therapy. Above all, acknowledging that the patient’s symptoms are genuine is most important for strengthening the patient-parent-physician bond, assuring the patient of the physician’s belief in the patient’s pathology, and initiating discussions about the “brain – gut” connection.”

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Concurrent viral infections and Kawasaki disease

Song E, et al. Clinical and virologic characteristics may aid distinction of acute adenovirus disease from Kawasaki disease with incidental adenovirus detection. J Pediatr. 2016 Mar;170:325-30.

Incidental adenovirus detection in Kawasaki disease (KD) is important to differentiate from acute adenovirus disease. Twenty-four of 25 children with adenovirus disease and mimicking features of KD had <4 KD-like features, predominance of species B or E, and higher viral burden compared with those with KD and incidental adenovirus detection.

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Turnier JL, et al. Concurrent respiratory viruses and Kawasaki disease. Pediatrics. 2015 Sep;136(3):e609-14.

“Overall, our study supports earlier evidence that a large number of patients with KD have respiratory symptoms and evidence of viral nucleic acid in the nasopharynx. This study showed that a large percentage of patients with KD have a concurrent or recent history of respiratory viral infections and suggests that clinicians should not dismiss the diagnosis of KD based on the presence of respiratory or gastrointestinal symptoms or solely on the results of a positive respiratory viral PCR test. Furthermore, our data support the recommendation that a positive respiratory virus test result, regardless of the virus detected, should not be used to exclude the diagnosis of KD.4,16 Continued research is needed to elucidate the etiology and/or discover a more sensitive and specific diagnostic test for this important pediatric disease.”

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Practice Based Learning: Sharp Object Ingestion

David Greenky

 

 

 

 

By David Greenky MD (PGY1)

Foreign body Ingestion: General

  • At least 80% of foreign object ingestions will pass on their own
  • Surgical intervention is needed ~12% of the time
  • Vast majority of cases are pediatric, and most between ages of 6 m – 6 y
  • Trouble happens most often at GI angles or narrowing
  • Previous surgery and congenital malformations = greater risk

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