Search

Introduction. Otitis media with effusion is a common pediatric disease whose diagnosis is based on pneumatic otoscopy, pure-tone audiometry, and tympanometry. The aim of this study was to evaluate transiently evoked otoacoustic emissions in the diagnosis of otitis media with effusion as compared to tympanometry.Patients and Methods. 38 children with bilateral otitis media with effusion were studied. 40 normal children of similar age and sex were used as controls. All subjects underwent pneumatic otoscopy, standard pure-tone audiometry, tympanometry, and transiently evoked otoacoustic emissions.Results. In the group of children with bilateral otitis media, transiently evoked otoacoustic emissions were absent in 51 ears (67%). In the remaining 25 ears (33%) the mean emission amplitude was reduced, as compared to the mean value of the control group.Conclusions. Transiently evoked otoacoustic emissions should be included in the diagnostic workup of otitis media with effusion because it is a fast, reliable, and objective test. Transiently evoked otoacoustic emissions should always be used in conjunction with tympanometry, because a more meaningful interpretation of transiently evoked otoacoustic emissions measures is possible.

Objectives: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. Methods: Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids’ Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids’ Inpatient Database, and cost was calculated using the hospital's cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. Results: In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were $66.3 million and $10,176 (95% confidence interval [CI] $9647–$10,705), and for UC were $48.6 million and $11,836 (95% CI $10,760-$12,912). For CD, 0- to 5-year-old patients had the highest mean LOS (8.10, 95% CI 5.53–10.67, days) and mean cost ($13,894, 95% CI $9053–$18,735), whereas, for UC, 11- to 15-year-old patients had the highest mean LOS (7.49, 95% CI 6.88–8.10, 95% CI 5.53–10.67, days) and mean cost ($13,407, 95% CI $11,704–$15,110). Conclusions: For a pediatric disease with a rather low prevalence rate, the estimated annual inpatient pediatric burden of IBD is a sizeable $152.4 million (2010 US$) and 64,985 days spent in the hospital. As medications and outpatient treatments improve for the treatment of IBD, there is an opportunity for significant reduction in inpatient burden.

In its nearly 5 decades of existence, the Eunice Kennedy Shriver National Institute of Child Health and Human Development has expended $23 billion in conducting and supporting research and translating discoveries to practice. The resulting dramatic impact on peoples' lives and improved health for children and families, chronicled herein, are a testament to the benefits of having this institute at the National Institutes of Health.

Publisher Summary The global increase in pediatric obesity has contributed to an increase in the diagnosis of type 2 diabetes mellitus (T2DM), which has now been reported worldwide. Diabetes is defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/l (126 mg/dl)or 2-hourpost glucose challenge plasma glucose ≥ 11.1 mmol/l (200 mg/dl). Recently, glycosylated hemoglobin (HbA1c) ≥ 6.5% has been recommended to diagnose diabetes in adults. Estimating prevalence of diabetes in youth is difficult because many studies report center-based results and may not report comparable information. Many large population-based studies included both type 1 (T1DM) and type 2 (T2DM). With T2DM clearly now a pediatric disease, providers of children are charged with screening at-risk youth for not only T2DM but dyslipidemias and NAFLD in addition to multiple other comorbidities of obesity. With a clearer understanding of risk factors for T2DM in youth, pediatric providers have in important role in identifying these young people in an attempt to modulate the long-term complications of this chronic disease.

Magnetic resonance imaging is an excellent technique for evaluation of pediatric pathology. When combined with other imaging modalities, MRI represents a powerful addition to the radiologist's diagnostic armamentarium. Magnetic resonance imaging has demonstrated great potential for noninvasively characterizing physical and chemical properties of various tissues and in some cases has provided information not available by any other technique. Future developments may result in much faster scan times, better biochemical characterization (magnetic resonance spectroscopy), and improved images. Certainly, the full potential of this extraordinary imaging technique has not been reached. As prospective studies of MRI evolve, this technique will play an increasing role in assessing pediatric disease.

Background CCR5 using HIV-1 variants are preferentially transmitted and have an intrinsic phenotypic variability playing an important role in AIDS pathogenesis. This variation confers a different susceptibility to CC-chemokines as well as a different capacity to infect ad hoc engineered cell lines expressing CCR5/CXCR4 chimeric receptors. In this study we explored the predictive value of R5 variability in mother-to-child transmission (MTCT) of HIV-1 and pediatric disease progression.

Background Acute infectious enteritis is one of the more common childhood diseases worldwide, especially in the first three years of life. Every year, in Germany, one in six children under age 5 is taken to a physician at least once because of infectious diarrheal disease. 10% of the children presenting with rotavirus infection are admitted to hospital. The existing national and international recommendations for the treatment of acute infectious diarrheal disease are inadequately followed, despite the high level of evidence on which they are based.

Summary Objectives To determine the resource utilization and national variation in the management of pediatric retropharyngeal abscesses. Methods The Kids’ Inpatient Database (KID) 2003 was analyzed. International Classification of Diseases, Ninth Revision code 478.24 was the inclusion criteria. Results One thousand three hundred and twenty-one admissions with retropharyngeal abscess were sampled from the KID in 2003; there were no deaths. The mean age of patients was 5.1 years (S.D. 4.4 years); 63% were male. Of all admissions, 563 (43%) patients underwent surgical drainage of their infection; surgical patients had longer length of stays and total charges than patients managed medically. The average state spending per admission varied from $5126 (Utah) to $27,776 (California). There was seasonal variation in admissions with the highest percentage of admissions occurring in March (10.7%) and lowest in August (3.8%). Indicators of increased resource utilization included age (older patients), increased length of stay, non-elective admission, discharge quarter, and number of other diagnoses on record. There is a statistically significant decrease in the length of stay and total charges in patients admitted in the Midwest compared to other regions of the country. Conclusions This study demonstrates national demographics and normative data on a commonly treated pediatric disease process, retropharyngeal space infections. The average demographic of such a patient is a 5-year-old male from an urban location admitted in a non-elective fashion via the emergency department. The mean total charges were $16,377; 90% of admissions had total charges less than $28,511. Patients who underwent surgical procedures had mean total charges of $22,013. There exists significant national variation in resource utilization for this commonly treated disease process.

Prevalence rates for depression in children and adolescents are estimated up to 8.9%. Symptoms in this age group are different from those of depression in adults. Both neurobiological and psychosocial factors are involved in its development.Selective literature review.Of note are both the high rate of spontaneous remissions in childhood (33%), and the high rate of depressions continuing into adulthood (80%). In addition far fewer evidence based treatments are available than for adults. Fluoxetine is currently the only medication licensed for use in children and adolescents for this indication. Tri- and tetracyclic antidepressants have not been shown in meta-analyses to be effective in children and adolescents. Most antidepressants lead to age related side effects, including attention deficit and in particular behavioral toxicity, which has to be taken seriously wherever there is a suicide risk.The treatment of depression in childhood and adolescence should be based on multimodal interventions including psychotherapy, including cognitive behavioral therapy, which has proven effectiveness, psychosocial interventions and medications in severe cases. Patients with severe depression, especially suicidal minors, should be treated in patients units.

Although some previous studies have reported that genetic and immunological factors play important roles in the pathogenesis of Kawasaki disease (KD), the etiological factors of this enigmatical pediatric disease are still poorly understood.This study aims to investigate whether polymorphisms of the CD40 ligand (CD40L) gene are associated with KD and the development of coronary artery lesions (CAL) in the Taiwanese children.The CD40L -3459 A/G and IVS4+121 A/G single nucleotide polymorphisms (SNPs) were genotyped in 167 children with KD and 1,010 ethnically matched healthy controls by TaqMan assay.None of the CD40L polymorphisms was associated with susceptibility or CAL development of KD, and this finding was supported by the haplotype analysis.In summary, these results provide little support for specific CD40L SNPs in the susceptibility or CAL development of KD in Taiwanese children. However, it will be necessary to validate or replicate this association in other independent large-size ethnic groups.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:10Z No. of bitstreams: 1 S0004-27302006000100015.pdf: 147678 bytes, checksum: 90993f49f14dbd5a1aeb97b232ccf46b (MD5) Made available in DSpace on 2013-08-22T18:58:10Z (GMT). No. of bitstreams: 1 S0004-27302006000100015.pdf: 147678 bytes, checksum: 90993f49f14dbd5a1aeb97b232ccf46b (MD5) Previous issue date: 2006-02-01 Made available in DSpace on 2013-09-30T19:53:38Z (GMT). No. of bitstreams: 2 S0004-27302006000100015.pdf: 147678 bytes, checksum: 90993f49f14dbd5a1aeb97b232ccf46b (MD5) S0004-27302006000100015.pdf.txt: 41983 bytes, checksum: 3bb0c0c1c68befbf360d796320865a83 (MD5) Previous issue date: 2006-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:37:53Z No. of bitstreams: 2 S0004-27302006000100015.pdf: 147678 bytes, checksum: 90993f49f14dbd5a1aeb97b232ccf46b (MD5) S0004-27302006000100015.pdf.txt: 41983 bytes, checksum: 3bb0c0c1c68befbf360d796320865a83 (MD5) Made available in DSpace on 2014-05-20T13:37:53Z (GMT). No. of bitstreams: 2 S0004-27302006000100015.pdf: 147678 bytes, checksum: 90993f49f14dbd5a1aeb97b232ccf46b (MD5) S0004-27302006000100015.pdf.txt: 41983 bytes, checksum: 3bb0c0c1c68befbf360d796320865a83 (MD5) Previous issue date: 2006-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Considerada um grave problema de saúde pública, estudos indicam que a osteoporose é uma doença pediátrica com manifestações clínicas apresentadas na senilidade. O diagnóstico de osteopenia/ osteoporose é normalmente feito na prática clínica através da densitometria óssea por atenuação de raio-x de dupla energia (DXA). O exame é de alto custo e de difícil aplicação em populações pediátricas em virtude do emprego de aparelhagem específica e software especial. O presente estudo propõe equações preditivas para avaliação da densidade mineral óssea (DMO) em adolescentes do sexo masculino. Foram recrutados 61 adolescentes saudáveis na faixa de 10 a 19 anos e obtidos a idade óssea (através do raio-x de mão e punho esquerdo), maturação sexual, o peso, a estatura, a DMO na coluna lombar e no fêmur proximal total. A estruturação dos modelos de predição foi realizada pela análise de regressão múltipla stepwise. Os resultados indicaram modelos de predição para DMO com coeficientes de correlação de 0,87 para região da coluna e 0,80 para região femoral. Esses resultados confirmam que a DMO depende da idade esquelética e do crescimento físico durante a adolescência. As equações propostas são de fácil aplicação, baixo custo operacional e com poder explicativo superior a 75% e 65%, respectivamente para a DMO da coluna lombar e fêmur proximal total. Osteoporosis is considered one of the most serious public health diseases and studies show that it is a pediatric disease that manifests during senility. It is usually diagnosed in clinical practice by dual-energy x-ray absorptiometry (DXA). This exam has a high cost and it is difficult to apply to a pediatric population because specific equipment and special software are required. This study presents predictive equations to evaluate the bone mineral density (BMD) among male adolescents. To better predict the equations, some parameters were used as the bone age (by left hand and wrist x-ray), pubertal stages, weight, height and the lumbar spine and femur BMD from 61 healthy adolescents, ages 10 through 19 years. The prediction models were carried through analysis of multiple regressions stepwise. The results have indicated a prediction model for BMD with a coefficient of 0.87 and 0.80, respectively for the spine and the femoral regions. In conclusion, the results have confirmed that BMD depends on the skeletal age and the physical growth during adolescence. The proposed equations are easy to use, has a low operational cost, and the clarification rate is 75% and 65% for lumbar spine and femoral BMD, respectively. UNESP Faculdade de Medicina de Botucatu Universidade Estadual de Londrina (UEL) UNESP Faculdade de Medicina de Botucatu

Intracranial hydatidosis is mainly a pediatric disease. Surgical evacuation of the mass in toto is the gold standard of therapy. No concise data related to the requirement of diversion procedures after uncomplicated hydatid cyst removal is encountered in the literature. The aim of this report is to focus on this idea and estimate the necessity of a diversion procedure beforehand. A 6-year-old girl both with intracranial and renal involvement of hydatidosis underwent surgery. Intact removal of the intracranial cyst harboring daughter vesicles was achieved. A persistent porencephalic cyst at the operative site required a shunt 6 months after surgery. Thick pericyst formation was blamed for this specific progress and the pathophysiology is discussed.

Learning Objectives After completing this course, the reader will be able to: Review the key aspects of ERBB2 signal biology in normal and cancer cells.Outline available evidence for the involvement of ERBB2 signaling in different pediatric solid cancers.Describe the key challenges associated with translating molecular targeted therapies of adult cancers to pediatric patients. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com Adult oncologists and their research colleagues have “led the charge” in the war on cancer. Their efforts have generated effective new chemotherapies that target cancer causing molecular alterations. It is hoped that these successes will be repeated within the pediatric oncology community. Testing whether molecular targeted therapies of adult cancers are also effective against childhood cancers might allow the rapid introduction of these exciting new agents into the pediatric clinic. However, it is imperative that we do not introduce blindly these agents into the pediatric population. We must ensure that molecular targets in adult cancers also fulfill a number of important criteria within the pediatric disease. This review addresses the issues surrounding the identification of molecular targets in pediatric cancers by focusing on studies of the ERBB2 oncogene.

Craniosynostosis is a serious and common pediatric disease caused by the premature fusion of the sutures of the skull. Early fusion results in severe deformities in skull shape due to the restriction of bone growth perpendicular to the fused suture and compensatory growth in unfused skull plates. Calvarial (skull) abnormalities are frequently associated with severe impaired central nervous system functions due to brain abnormalities, increased intra-cranial pressure and abnormal build-up of cerebrospinal fluid. In this work, we develop a novel approach to efficiently classify skull deformities caused by metopic and sagittal synostoses using our newly introduced symbolic shape descriptors. We demonstrate the efficacy of our methodology in a series of large-scale classification experiments that compare the performance of our symbolic-signature-based approach to those of traditional numeric descriptors that are frequently used in clinical research. We also demonstrate an application of our symbolic descriptors in shape-based retrieval of skull morphologies.

Gene therapy for pediatric diseases

INTRODUCTION Otitis media (OM) is a common problem worldwide. It carries a large disease burden and is associated with numerous complications. In Australia, 793,535 children aged 14 or younger were affected by acute otitis media (AOM) in 2003, and 73% of those children experienced their first episode by age 1 year. Indigenous Australians are disproportionately affected and have the highest recorded rates of otitis media-related disease. In view of the high prevalence of this pediatric disease entity, we undertook a multidisciplinary investigation into its genetic, immunologic, and microbiological components. A summary of this research is described below.

Tobacco use among youth remains an epidemic problem in the United States. Despite advances over the last two decades in the areas of prevention and cessation, the onset of use remains a pediatric disease. New research has provided new strategies to prevent young people from taking up the habit, and studies suggest that cessation therapy can be as effective for youth as it is for adults. The approach to decreasing tobacco use must be comprehensive, beginning at the broadest levels and extending into the community, the school and the pediatrician's office.

Background Urinary infections are a common type of pediatric disease, and their treatment and prognosis are closely correlated with infection location. Common clinical manifestations and laboratory tests are insufficient to differentiate between acute pyelonephritis and lower urinary tract infection. This study was conducted to explore a diagnostic method for upper and lower urinary tract infection differentiation. Methods The diagnostic values of procalcitonin (PCT) and C-reactive protein (CRP) were analyzed using the receiver operating characteristic curve method for upper and lower urinary tract infection differentiation. PCT was determined using chemiluminescent immunoassay. Results The PCT and CRP values in children with acute pyelonephritis were significantly higher than those in children with lower urinary tract infection (3.90 ± 3.51 ng/ml and 68.17 ± 39.42 mg/l vs. 0.48 ± 0.39 ng/ml and 21.39 ± 14.92 mg/l). The PCT values were correlated with the degree of renal involvement, whereas the CRP values failed to show such a significant correlation. PCT had a sensitivity of 90.47% and a specificity of 88% in predicting nephropathia, whereas CRP had sensitivity of 85.71% and a specificity of 48%. Conclusions Both PCT and CRP can be used for upper and lower urinary tract infection differentiation, but PCT has higher sensitivity and specificity in predicting pyelonephritis than CRP. PCT showed better results than CRP. PCT values were also correlated with the degree of renal involvement.

The Family Smoking Prevention and Tobacco Control Act, signed by President Obama in June 2009, granted the US Food and Drug Administration (FDA) broad regulatory authority over tobacco products. It also explicitly charged the FDA with protecting children and adolescents from the dangers of tobacco use. In drafting the Tobacco Control Act, Congress noted that “[t]he use of tobacco products by the nation's children is a pediatric disease of considerable proportions that results in new generations of tobacco-dependent children and adults.” To begin to address this pattern of addiction and disease, the Tobacco Control Act required the FDA to implement a range of provisions aimed at restricting access to tobacco products by youth, reducing the appeal of tobacco products to youth, and limiting tobacco-product marketing to youth. Our first regulatory initiative banned the manufacture and sale of all cigarettes with characterizing fruit, candy, and clove flavors as of September 22, 2009. Youth and young adults not only use … Address correspondence to Marisa L. Cruz, MD, Center for Tobacco Products, Food and Drug Administration, 9200 Corporate Blvd, Room 100B, Rockville, MD 20850. E-mail: marisa.cruz{at}fda.hhs.gov

El síndrome pulmonar por hantavirus (SPH) ha estado presente en Chile desde 1993 y ha sido detectado desde 1997 en la IX Región. Es una grave zoonosis con alta mortalidad, que afecta a gente joven incluyendo niños. Se ha estimado oportuno dar a conocer nuestra experiencia en la atención de 6 pacientes pediátricos, atendidos en las unidades de Cuidados Intensivos y Aislamiento en el Hospital Regional de Temuco, entre enero de 1998 y enero de 2000 mediante un estudio descriptivo de la experiencia del equipo de salud en la atención de estos pacientes. La información clínico-epidemioló-gica se extrajo de las fichas clínicas y visitas a terreno. Se efectuó la confirmación etiológica por detección de anticuerpos específicos -IgM e IgG- mediante tests de ELISA y la pesquisa de genoma viral por reacción de polimerasa en cadena (TR RPC). Edad promedio 6 años 5 meses (rango: 2-10 años). relación varón/mujer: 4/2. Procedencia: de área rural cordillerana (n: 4), costera (n:2). Todos tuvieron exposición en casas deshabitadas o galpones. Período de incubación promedio: 14 días (rango: 7-21). Todos los pacientes tuvieron fiebre elevada, dolor abdominal intenso, vómitos, mialgias, compromiso respiratorio clínico y radiológico. Hallazgos hematológicos constantes: trombocito-penia, leucocitosis, inmunoblastos o linfocitosis con formas atípicas. La confirmación etiológica (IgM e IgG positivas) se alcanzó en todos. En dos pacientes se detectó en sangre la secuencia genética viral de hantavirus cepa Andes. Dos pacientes en los cuales se requirió ventilación mecánica y manejo del shock, finalmente fallecieron; los otros enfermos tuvieron una recuperación rápida. No existe una terapia específica conocida para el SPH, la prevención, una sospecha y diagnóstico oportunos y el tratamiento agresivo son las estrategias actuales para luchar contra esta enfermedad Hantavirus Pulmonary Syndrome (HPS) has been present in Chile since 1993 and it was first detected during 1997 in our region. It is a particularly serious zoonosis with a high mortality rate that affects young people including children. We refer our experience with 6 pediatric patients admitted into the Intensive Care and Pediatric Isolation units at Hospital Regional de Temuco (January 1998 to January 2000) including a description of our experience assisting these patients based on information obtained from clinical files and epidemiological visits. The hantavirus infection was confirmed by positive specific IgM and IgG ELISA tests. Search of viral genome was done by RT-PCR. The average age was 6 yrs - 5 ms (range: 2-10 yrs). The ratio of male/females was 4/2. The origin of the patients was: rural areas near the Andes Mountains (n: 4) and rural coast (n: 2). The exposure to infection was in uninhabited houses or barns. The average incubation period was: 14 days (range: 7-21). The symptoms were: high fever, intense abdominal pain, vomiting, myalgias, clinical and Rx respiratory distress in all. The main hematological findings were: thrombocytopenia, high leukocytes count, immunoblasts and atypical lymphocytic cells. All cases were confirmed by IgM and IgG positive tests. The Andes virus genomic sequence was found in blood of one pediatric patient and in his uncle. Two patients who required mechanical ventilation and shock management finally died, the other patients recovered rapidly. Hantavirus Pulmonary Syndrome has no specific treatment. Prevention, an opportune diagnostic suspicion and aggressive treatment are the current strategies to control this disease

Interventional therapy of congenital heart lesions at cardiac catheterization has greatly increased during the past decade. At the authors' institution, the frequency of such procedures among catheterizations has increased from 5% to more than 60%. The variety of lesions so treated continues to expand and equipment continues to improve. These procedures may be divided into 2 groups, namely (1) those involving balloon dilation of stenotic valves and vessel obstructions with stent placement being increasingly used in the latter and (2) those involving occlusion of lesions with (a) coils, such as aortopulmonary collaterals, patent ductus arteriosi and coronary artery fistulae and (b) umbrella devices, such as atrial and ventricular septal defects. These have replaced surgery as the initial procedure of choice in many lesions including valvar pulmonary and aortic stenoses, and postoperative aortic coarctation in young patients. In addition, use of the double-umbrella device even in noncongenital lesions appears promising.

Sherin Devaskar, MD, is the Guest Editor for this annual review issue on Basic Mechanisms of Pediatric Disease. Dr Devaskar is a Distinguished Professor of Pediatrics and Mattel Executive Endowed Chair, Department of Pediatrics, at the David Geffen School of Medicine at the University of California, Los Angeles. Ofer Levy, MD, PhD, served as a contributor to this issue. Dr Levy is a physician in the Division of Infectious Diseases and a Principal Investigator at Children’s Hospital Boston, Boston, Massachusetts. Dr Levy is also a faculty member in the Department of Human Biology & Translational Medicine and Associate Professor at Harvard Medical School, Boston, Massachusetts.

In their Policy Forum "The complexities of genomic identifiability" (18 January, p. [275][1]), L. L. Rodriguez et al. correctly point out that in view of the intriguing recent demonstration of the identifiability of donors participating in genomic studies ("Identifying personal genomes by surname inference," M. Gymrek et al. , Reports, 18 January, p. [321][2]), the research community needs to optimize the balance between the need for data sharing and respect for the privacy of research participants. In our 2009 Science Policy Forum ([ 1 ][3]), we proposed specific measures to improve the current policies and provide greater protection for children. Children are among the most vulnerable populations whose DNA samples are being collected in large numbers for epidemiologic studies. Sadly, it seems that our suggestions have not led to distinct biobanking policies for children. We reiterate our 2009 call for the scientific research community to agree on extra safeguards, particularly restrictions on sharing the individual genome sequences of children, unless they are contacted again as adults and provide their own consent at that time. In the case of fatal pediatric disease research (when obtaining adult and consented donor samples is implausible), conditions for sharing the personal genome sequences of children could be eased. In spite of the current genetic nondiscrimination legislation widely enacted, our duty remains to ensure extra privacy protections for children, balanced with the need to continue research on pediatric diseases. 1. [↵][4] 1. D. Gurwitz, 2. I. Fortier, 3. J. E. Lunshof, 4. B. M. Knoppers , Science, 325, 818 (2009). [OpenUrl][5][Abstract/FREE Full Text][6] [1]: /lookup/doi/10.1126/science.1234593 [2]: /lookup/doi/10.1126/science.1229566 [3]: #ref-1 [4]: #xref-ref-1-1 "View reference 1 in text" [5]: {openurl}?query=rft.jtitle%253DScience%26rft.stitle%253DScience%26rft.issn%253D0036-8075%26rft.aulast%253DGurwitz%26rft.auinit1%253DD.%26rft.volume%253D325%26rft.issue%253D5942%26rft.spage%253D818%26rft.epage%253D819%26rft.atitle%253DChildren%2Band%2BPopulation%2BBiobanks%26rft_id%253Dinfo%253Adoi%252F10.1126%252Fscience.1173284%26rft_id%253Dinfo%253Apmid%252F19679798%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEyOiIzMjUvNTk0Mi84MTgiO3M6NDoiYXRvbSI7czoyNToiL3NjaS8zMzkvNjEyMy8xMDMzLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9

This discussion of the pathogenesis of infant human immunodeficiency virus (HIV) type 1 infection emphasizes features unique to pediatric disease and provides general insights into HIV illness in all populations. Therapies designed to interrupt transmission of HIV can be most efficiently addressed through studies of maternal-infant transmission. The rapid progression of disease in children constantly emphasizes the urgent need for continued progress in treatment of HIV infection and presents a unique opportunity optimally to assess effects of early intervention.

Congenital defects and inheritable diseases are a leading cause of childhood morbidity and death. Often these conditions have associated visual diagnostic clues that lead the clinician to a diagnosis and thus earlier preventive treatment of associated complications. Pediatric nurse practitioners can broaden their visual senses by reviewing pictorial compendiums of pediatric disease to gain experience in visual recognition and having a keen eye while examining patients. This article identifies by category and pictorial illustration several birth defects and genetic disorders that are readily identified by observation. Even minor anomalies may portend significant underlying internal problems.

These few subjects are only a small fragment of the scope of pediatric medicine but are critical in their impact. The depth of material needed to cover the subject adequately should fill a textbook. If, however, aviculturists could master these seven areas, the numbers of babies requiring medical or surgical therapy would decrease dramatically. The entire purpose of preventive medical management is actually the elimination of medicine as it is practiced today. That goal, as desirable as it is, is quite some time off, and education remains the key to improving the quality of the lives and future of our patients. Attention to detail and the comprehension of normal physiology of these nondomestic (and generally tropical zone origin) birds will lead to great inroads in understanding the true underlying cause of pediatric problems; improved patient recovery rates; and a better appreciation of the nebulous but critical relationships among potential pathogens, infection, disease, performance, and productivity. Given our truly limited technical position, the veterinarian who learns to use the environment for the patient's health is light years ahead of what you can purchase for the purpose of actively forcing the direction of a complex situation.

Tuberculosis is becoming a more prominent pediatric disease, but there are few recent reports of endobronchial involvement. We have presented the case of a 4-month-old infant with symptomatic obstructive airway disease due to Mycobacterium tuberculosis. Endobronchial tuberculosis usually follows 2 to 3 months of antituberculous therapy. This case is especially unusual because the endobronchial disease developed before diagnosis or therapy. Endobronchial tuberculosis should be considered in any patient with symptoms or roentgenographic findings of obstructive airway disease. Bronchoscopy is the best technique for diagnosis and follow-up of endobronchial tuberculosis.

1. Robert J. Haggerty In this issue of Pediatrics in Review ( PIR ), we emphasize several aspects of prevention. The article by Belay and colleagues on pediatric precursors of adult diseases emphasizes a new and challenging part of pediatric practice: Identifying children who have no evidence of disease but who are at risk for developing certain diseases as adults and initiating interventions to prevent such problems. The article on smoking prevention, with the linkage to a PREP self-assessment question and critique on the same topic, deals with the single most important modifiable factor in adult health. However, smoking also can be considered a pediatric disease because nearly all who become addicted to tobacco do so before age 18 years, even though the consequences do not appear until later adult life. Our Index of suspicion (IOS) section continues to be valued highly by our readers. However, we receive many more good cases for IOS …

Background: We report three eyes of two patients with rubella retinopathy which were associated with choroidal neovascularization in the macula.Cases: A 7-year-old girl (case 1) and a 12-year-old girl (case 2) whose mothers had suffered rubella during their pregnancy revealed typical rubella retinopathy in both eyes and neovascular maculopathy in one eye at their initial visit to our clinic. Neovascular maculopathy developed in another eye of case 1 after a follow-up of 10 months.Results: The clinical characteristics indicated that (1) sudden visual loss occurs in children, (2) there is no external trigger such as eye injury, and (3) the visual prognosis appears relatively good.Conclusion: Although neovascular maculopathy is rare in pediatric disease, the rubella retinopathy may have the potential to cause neovascular maculopathy.

David A. Kessler, MD, JD, commissioner of the Food and Drug Administration, calls smoking a pediatric disease. He says that seeing smoking as simply an adult problem is a dangerously short-sighted view. “Nicotine addiction begins when most tobacco users are teenagers, so let's call this what it really is: a pediatric disease,” says Kessler. Dr Kessler goes on to say that if we could affect the smoking habits of just one generation, we could radically reduce the incidence of smoking-related death and disease. And a second generation could see nicotine addiction go the way of smallpox and polio. More than 3 million children in the United States currently smoke cigarettes. Every day, 3000 kids become regular smokers, and most of them will become addicted to nicotine before they are adults. Nearly 1000 of them will eventually die from a smoking-related disease. More than 80% of all adult smokers started smoking before they were 18 years of age. If a person has not started smoking by age 18, they are …