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Purpose of review Childhood obesity is escalating globally. Lifestyle and behavioral changes, which are the frequently used interventions in clinical practice, lead to only modest improvements in children with established obesity. Bariatric surgery is currently the most effective obesity treatment but has very limited utilization in pediatric obesity and is preferentially used for children with worsening comorbidities. There exists a massive treatment gap for children suffering with obesity especially after the failure of lifestyle modifications. Pharmacotherapy that is an established management tool in adults is very infrequently used in children. Only two medications, Phentermine and Orlistat are approved by the Food and Drug Administration (FDA) for use in adolescent obesity. Herein, we discuss the current landscape and available literature on the use of antiobesity pharmacotherapy in children. Recent findings There are emerging pediatric data about the efficacy of the many weight loss medications that are FDA approved in adults. Moreover, more clinical trials are underway on the rarer, intractable forms of obesity such as monogenic, syndromic, and hypothalamic obesity. Summary Weight loss medications in children, like adults, have variable efficacy and similar side effect profiles. Rigorous research and improved education of providers about weight loss medications may address the huge treatment gap in severe pediatric obesity.

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is a condition characterized by lack of interest in eating or food, sensory sensitivity, and/or fear of aversive consequences of eating; as opposed to the body image disturbance and fear of weight gain that characterize anorexia nervosa (AN). While appetite regulating hormones and their associations with bone mineral density (BMD) have been well studied in AN, little is known regarding BMD and its association with appetite regulating hormones in ARFID. Peptide YY (PYY), a gut derived anorexigenic hormone, acts via the Y2 receptor to inhibit osteoblastic activity in mammals. In AN, levels of PYY are higher than in healthy controls (HC) and are negatively associated with BMD. We hypothesized that similar to AN, low-weight female adolescents with ARFID would have lower BMD and higher PYY levels than in HC and that PYY levels would be inversely associated with BMD. Methods: We studied 24 adolescent females (10 low weight with ARFID and 14 HC). BMD variables were measured by Dual-Energy X-ray Absorptiometry. We performed cross sectional analysis to compare BMD and fasting PYY levels between low weight ARFID and HC and to determine the relationship between BMD and PYY levels. Results: ARFID and HC were 15.1±2.9 (mean ± SEM) and 17.1±3.8 years old, respectively (p=0.178), with mean BMI Z-scores of -1.74±0.88 kg/m2 and 0.24±0.51 kg/m2, respectively (p Conclusion: Female adolescents with low-weight ARFID have lower BMD and a trend toward higher levels of PYY compared with HC. Increased PYY levels may contribute to the lower BMD observed in ARFID. These findings are an initial step in understanding the neuroendocrine dysregulation in low weight adolescents with ARFID, which may predict bone outcomes in this condition.

Studies indicate that gestational diabetes mellitus (GDM) prevalence is increasing worldwide. We aimed to examine secular trends in GDM prevalence and screening practices over the last decade in Israel, and to identify changes in GDM risk factors.We collected data on all 367,247 pregnant women who were screened for GDM between 2000 and 2010 in Israel's second largest healthcare organization. Multivariable logistic regression analysis was used to identify risk factors for GDM.GDM prevalence increased by 12%, from 3.8% in 2000 to 4.3% in 2010 and was accompanied by a 37% rise in the proportion screened directly by 100-gram oral glucose tolerance test without a prior 50-gram glucose challenge test (from 6.5% to 8.9%). During the study period there was an on-going increment in the proportion of pregnant women with one or more GDM risk factor, such as older age, low socioeconomic level, history of polycystic ovary syndrome or in vitro fertilization, which was all significantly (p0.05) associated with the risk of GDM.The increasing risk of GDM in Israel can be explained by both rising prevalence of women with established risk factors, as well as shifting screening practices.

WHAT'S KNOWN ON THIS SUBJECT: Antibiotics-induced rash in Epstein-Barr virus acute infectious mononucleosis, especially the aminopenicillins-induced type, was first described during the 1960s, with a reported incidence of 80% to 100%. This phenomenon was not further investigated but is well-established in pediatric textbooks. WHAT THIS STUDY ADDS: The main observation of this study is that rash induced by amoxicillin in confirmed Epstein-Barr virus acute infectious mononucleosis was found at a rate of ∼30%, which is much lower than previously reported. abstract "Ampicillin rash," a phenomenon unique to patients with Epstein-Barr virus acute infectious mononucleosis (AIM) treated with ampicillin, was first reported in the 1960s. The incidence was estimated as being between 80% and 100%, and the figures have not been reviewed since those first accounts. We sought to establish the current incidence of rash associated with antibiotic treatment among children with AIM. RESULTS: Of the 238 children who met the study entry criteria during the study period, 173 were treated with antibiotics. Fifty-seven (32.9%) of the subjects treated with antibiotics had a rash during their illness compared with 15 (23.1%) in untreated patients (P = .156; not significant). Amoxicillin was associated with the highest incidence of antibiotic-induced rash occurrence (29.5%, 95% confidence interval: 18.52-42.57), but significantly lower than the 90% rate reported for ampicillin in past studies. Age, gender, ethnicity, and atopic or allergic history were not associated with the development of rash after antibiotic exposure. Among the laboratory data, only increased white blood cell counts were more prevalent among subjects who did not develop an antibiotic-induced rash. CONCLUSIONS: The incidence of rash in pediatric patients with AIM after treatment with the current oral aminopenicillin (amoxicillin) is much lower than originally reported. Pediatrics 2013;131:e1424- e1427

Golimumab is a fully human monoclonal antibody targeting tumor necrosis factor-alpha (TNFalpha), an important cytokine in the pathogenesis of rheumatoid arthritis (RA) and other arthritides. Golimumab was approved for the treatment of rheumatoid arthritis with methotrexate (MTX) and with or without MTX for psoriatic arthritis and ankylosing spondylitis. Administration is by monthly subcutaneous injection. In this review we present some of the major clinical trials evaluating the efficacy of golimumab with or without concomitant MTX in RA patients, including patients resistant to previous biologic treatments. In addition, we collected data on safety and adverse effects encountered in clinical trials. Current data show golimumab to be an effective and safe choice for the treatment of various inflammatory arthritides.