Optic neuritis

Ramdas S, et al. Acute onset blindness: a case of optic neuritis and review of childhood optic neuritis. BMJ Case Rep. 2016 Oct 4;2016.

Optic neuritis (ON) is an acquired disorder of the optic nerve due to inflammation, demyelination or degeneration. We report a child who presented with acute onset bilateral visual loss who, following a diagnosis of ON, was treated and had excellent visual recovery. Paediatric ON is considered to be different clinical entity to adult ON. Although in children ON is usually parainfectious or postinfectious, it can be the first presenting feature of multiple sclerosis or neuromyelitis optica spectrum disease. In this paper, we discuss the literature on treatment of ON and prediction of risk of recurrence.

Children’s and Emory users, request article from Emily Lawson. 

Yeh EA, et al. Pediatric optic neuritis. Neurology. 2016 Aug 30;87(9 Suppl 2):S53-8.

Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions.

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Myasthenia gravis

Della Marina A, et al. Juvenile myasthenia gravis: recommendations for diagnostic approaches and treatment. Neuropediatrics. 2014 Apr;45(2):75-83.

Juvenile myasthenia gravis (JMG) is an autoimmune disorder of neuromuscular transmission caused by production of antibodies against components of the postsynaptic membrane of the neuromuscular junction. Ethnicity has influence on incidence, clinical presentation, and the course of the disease. The patients present with a wide range of symptoms-from isolated intermittent ocular symptoms to general muscle weakness with or without respiratory insufficiency. Compared with adults and adolescents, the clinical signs and course of disease in children exhibit differences and occasionally untypical symptoms. Therefore, JMG is often missed and the diagnosis delayed. Isolated ocular symptoms are frequent at onset, spontaneous remission or intermittent symptoms over the longer period of time can occur. Very young children may present with generalized muscle weakness already during the second year of life and in this patient group, specific antibodies can only be slightly increased or even negative. Existing therapeutic options include immunosuppressive therapy and thymectomy but potential long-term side effects on the growing organism and possible influence on immune response in very young children should be considered. Specific clinical symptoms, diagnostic procedures, and a therapeutic approach with consideration of this age group’s specificities are discussed.

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Dosing of dexamethasone for treatment of croup

Narayanan S, Funkhouser E. Inpatient hospitalizations for croup. Hosp Pediatr. 2014 Mar;4(2):88-92.

“There is a strong association between receiving inpatient racemic epinephrine and receiving repeat doses of systemic corticosteroids, but larger studies would be helpful to determine patient outcomes for repeat dexamethasone dosing by using objective criteria for inpatient racemic epinephrine administration.”

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Coexistence of psoriasis and systemic lupus erythematosus

Varada S, et al. Treatment of coexistent psoriasis and lupus erythematosus. J Am Acad Dermatol. 2015 Feb;72(2):253-60.

  • The coexistence of psoriasis with lupus erythematosus is rare and presents a therapeutic challenge.
  • We present a review of 96 patients with coexistent disease and analyze treatment regimens in this population.
  • The TNF-α inhibitors, and the newer biologics, ustekinumab and abatacept, may represent valid treatment options with little risk for clinical lupus flare.

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Leukocyte adhesion deficiencies

National Organization for Rare Disorders (NORD). Leukocyte Adhesion Deficiency Syndromes. (2015).

“Leukocyte adhesions deficiency (LAD) syndromes are a group of rare disorders affecting the immune system. LAD syndromes are characterized by defects affecting how white blood cells (leukocytes) respond and travel to the site of a wound or infection. Three distinct types of leukocyte adhesion syndrome have been identified. The specific symptoms and the severity of LAD syndromes vary from one person to another. All affected individuals develop an increased susceptibility to developing recurrent bacterial and fungal infections. Additional symptoms may occur depending upon the specific subtype present. LAD syndromes are caused by mutations of specific genes that contain instructions for creating certain proteins that are necessary for white blood cells to travel from the bloodstream to the site of an infection or inflammation. Individuals with severe forms of LAD may have near complete absence of these proteins. Individuals who have milder forms of LAD syndromes have deficient levels of these proteins, but retain some residual protein activity.”

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15th Annual Donald Schaffner, MD Conference: Developmental social neuroscience meets public health challenge – A new system of healthcare delivery for infants and toddlers with autism spectrum disorder.


7:30 a.m. to 8:30 a.m.
Tuesday, Nov. 15, 2016


Scottish Rite hospital
Main Auditorium
1001 Johnson Ferry Rd NE
Atlanta, GA 30342

Register online or call Abby Freeman 404-785-7532 to register.

To attend via WebEx, click here.

Keynote Speaker:





Ami Klin, Ph.D.

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Practice Based Learning: Radiographic evidence of non-accidental trauma in femur fractures

Soohee Cho MD





Presented by Soohee Cho MD (PGY2)

Clinical questions:

  • What are some objective risk factors that can predict high likelihood of non-accidental trauma in children with femur fracture?
  • Specifically, is there a radiographic finding more consistent with non-accidental trauma in femur shaft fracture?

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Emory AAP Fall 2016 Newsletter


We would like to introduce you to our new quarterly newsletter for all things Emory AAP!

The Emory chapter is a part of District X and we are your AAP representatives for the 2016-2017 year. This newsletter will provide information about local, regional and national upcoming events. We will also highlight our outstanding residents and faculty representing Emory with the AAP. There will be websites providing resources for educational opportunities, advocacy activities, scholarships and more. We hope you find this newsletter informative and enjoyable.

Feel free to share your thoughts on information you would like to see in upcoming newsletters.

Your AAP Class Reps 2016-2017

Multifocal osteomyelitis

Sreenivas T, et al. Acute multifocal haematogenous osteomyelitis in children. J Child Orthop. 2011 Jun;5(3):231-5.

We conclude that acute multifocal haematogenous osteomyelitis in children needs early diagnosis by a high index of clinical suspicion and adequate treatment with timely intervention. The predominance of MRSA in our study shows the changing trend in its association with multiple bone involvement.

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