Unintended Consequences: Mandatory Tuberculin Skin Testing and Severe Isonia...

WHy we need to be judicious with tb testing

 

 

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Unintended Consequences: Mandatory Tuberculin Skin Testing and Severe Isoniazid Hepatotoxicity

via PEDIATRICS current issue by Lobato, M. N., Jereb, J. A., Starke, J. R. on 6/2/08

After mandatory school-enrollment tuberculin skin testing, a 4-year-old girl who was at low risk for Mycobacterium tuberculosis infection had severe isoniazid hepatotoxicity that was managed with a liver transplant. Although severe isoniazid hepatotoxicity is very uncommon in children, this case emphasizes the need to limit skin testing to persons who have a risk factor for infection and to educate parents on how to monitor for adverse effects during treatment.

 

 

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Effects of Prolonged and Exclusive Breastfeeding on Child Behavior and Mater...

 

 

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Effects of Prolonged and Exclusive Breastfeeding on Child Behavior and Maternal Adjustment: Evidence From a Large, Randomized Trial

via PEDIATRICS current issue by Kramer, M. S., Fombonne, E., Igumnov, S., Vanilovich, I., Matush, L., Mironova, E., Bogdanovich, N., Tremblay, R. E., Chalmers, B., Zhang, X., Platt, R. W., for the Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group on 2/29/08

OBJECTIVE. The objective of this study was to assess the long-term effects of breastfeeding on child behavior and maternal adjustment.

METHODS. We followed up children who were in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. A total of 17046 healthy, breastfeeding mother–infant pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics; 13889 (81.5%) were followed up at 6.5 years. Mothers and teachers completed the Strengths and Difficulties Questionnaire and supplemental questions bearing on internalizing and externalizing behavioral problems. Mothers also responded to questions concerning their relationships to their partner and child and their breastfeeding of subsequently born children.

RESULTS. The experimental intervention led to a large increase in exclusive breastfeeding at 3 months (43.3% vs 6.4%) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. No significant treatment effects were observed on either the mother or the teacher Strengths and Difficulties Questionnaire ratings of total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, or prosocial behavior or on the supplemental behavioral questions. We found no evidence of treatment effects on the parent's marriage or on the mother's satisfaction with her relationships with her partner or child, but the experimental intervention significantly increased the duration of any breastfeeding, and mothers in the experimental group were nearly twice as likely to breastfeed exclusively the next-born child for at least 3 months.

CONCLUSIONS. On the basis of the largest randomized trial ever conducted in the area of human lactation, we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior. Breastfeeding promotion does, however, favorably affect breastfeeding of the subsequent child.

 

 

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Pediatric Heel Pain - FootPhysicians.com

Avoid wearing cleated shoes for heel pain

 

 

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Pediatric Heel Pain - FootPhysicians.com

via www.footphysicians.com on 6/4/08

Home > Foot & Ankle Information > Pediatric Heel Pain Print this page Email this page Pediatric Heel Pain  What is Pediatric Heel Pain? What is the Difference Between Pediatric and Adult Heel Pain? Causes of Pediatric Heel Pain Diagnosis of Pediatric Heel Pain Treatment Options Can Pediatric Heel Pain Be Prevented? If Symptoms Return    Download a short podcast on pediatric heel pain. What is Pediatric Heel Pain? Heel pain is a symptom, not a disease. In other words, heel pain is a warning sign that a child has a condition that deserves attention. Heel pain problems in children are often associated with these signs and symptoms: Pain in the back or bottom of the heel Limping Walking on toes Difficulty participating in usual activities or sports The most common cause of pediatric heel pain is a disorder called calcaneal apophysitis (see below), which usually affects 8- to 14-year olds. However, pediatric heel pain may be the sign of many other problems, and can occur at younger or older ages. What is the Difference Between Pediatric and Adult Heel Pain? Pediatric heel pain differs from the most common form of heel pain experienced by adults (plantar fasciitis) in the way pain occurs. Plantar fascia pain is intense when getting out of bed in the morning or after sitting for long periods, and then it subsides after walking around a bit. Pediatric heel pain usually doesn't improve in this manner. In fact, walking around typically makes the pain worse. Heel pain is so common in children because of the very nature of their growing feet. In children, the heel bone (the calcaneus) is not yet fully developed until age 14 or older. Until then, new bone is forming at the growth plate (the apophysis), a weak area located at the back of the heel. Too much stress on the growth plate is the most common cause of pediatric heel pain. Causes of Pediatric Heel Pain There are a number of possible causes for a child's heel pain. Because diagnosis can be challenging, a foot and ankle surgeon is best qualified to determine the underlying cause of the pain and develop an effective treatment plan. Conditions that cause pediatric heel pain include: Calcaneal apophysitis. Also known as Sever's disease, this is the most common cause of heel pain in children. Although not a true "disease," it is an inflammation of the heel's growth plate due to muscle strain and repetitive stress, especially in those who are active or obese. This condition usually causes pain and tenderness in the back and bottom of the heel when walking, and the heel is painful when touched. It can occur in one or both feet. Tendo-Achilles bursitis. This condition is an inflammation of the fluid-filled sac (bursa) located between the Achilles tendon (heel cord) and the heel bone. Tendo-Achilles bursitis can result from injuries to the heel, certain diseases (such as juvenile rheumatoid arthritis), or wearing poorly cushioned shoes. Overuse syndromes. Because the heel's growth plate is sensitive to repeated running and pounding on hard surfaces, pediatric heel pain often reflects overuse. Children and adolescents involved in soccer, track, or basketball are especially vulnerable. One common overuse syndrome is Achilles tendonitis. This inflammation of the tendon usually occurs in children over the age of 14. Another overuse syndrome is plantar fasciitis, which is an inflammation of the band of tissue (the plantar fascia) that runs along the bottom of the foot from the heel to the toes. Fractures. Sometimes heel pain is caused by a break in the bone. Stress fractures—hairline breaks resulting from repeated stress on the bone—often occur in adolescents engaged in athletics, especially when the intensity of training suddenly changes. In children under age of 10, another type of break—acute fractures—can result from simply jumping 2 or 3 feet from a couch or stairway. Diagnosis of Pediatric Heel Pain To diagnose the underlying cause of your child's heel pain, the foot and ankle surgeon will first obtain a thorough medical history and ask questions about recent activities. The surgeon will also examine the child's foot and leg. X-rays are often used to evaluate the condition, and in some cases the surgeon will order a bone scan, a magnetic resonance imaging (MRI) study, or a computerized tomography (CT or CAT) scan. Laboratory testing may also be ordered to help diagnose other less prevalent causes of pediatric heel pain. Treatment Options The treatment selected depends upon the diagnosis and the severity of the pain. For mild heel pain, treatment options include: Reduce activity. The child needs to reduce or stop any activity that causes pain. Cushion the heel. Temporary shoe inserts are useful in softening the impact on the heel when walking, running, and standing. For moderate heel pain, in addition to reducing activity and cushioning the heel, the foot and ankle surgeon may use one or more of these treatment options: Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed tissue. Orthotic devices. Custom orthotic devices prescribed by the foot and ankle surgeon help support the foot properly. For severe heel pain, more aggressive treatment options may be necessary, including: Immobilization. Some patients need to use crutches to avoid all weight-bearing on the affected foot for a while. In some severe cases of pediatric heel pain, the child may be placed in a cast to promote healing while keeping the foot and ankle totally immobile. Follow-up measures. After immobilization or casting, follow-up care often includes use of custom orthotic devices, physical therapy, or strapping. Surgery. There are some instances when surgery may be required to lengthen the tendon or correct other problems. Can Pediatric Heel Pain be Prevented? The chances of a child developing heel pain can be reduced by following these recommendations: Avoid obesity Choose well-constructed, supportive shoes that are appropriate for the child's activity Avoid, or limit, wearing cleated athletic shoes Avoid activity beyond a child's ability If Symptoms Return Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of the initially diagnosed condition, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.

 

 

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Bright futures evidence base

13-Rationale and Evidence bright futures - Upload a doc

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On Pneumonia PIR

Measles Infections in United States - Medicine and Health - New York Times

Measles Infections in United States - Medicine and Health - New York Times
Measles on the rise.

Injuries Among Infants Treated in Emergency Departments in the United States, 2001-2004 -- Mack et al. 121 (5): 930 -- Pediatrics

Injuries Among Infants Treated in Emergency Departments in the United States, 2001-2004 -- Mack et al. 121 (5): 930 -- Pediatrics
1. falls leading cause of injuries in infants, beds in particular below 12 months
2. stairs most common source of injury at 12months

eMedicine - Pneumonia, Community-Acquired : Article by Burke A Cunha

eMedicine - Pneumonia, Community-Acquired : Article by Burke A Cunha
Adult oriented bottom line Levaquin 500 daily for 7 days for 750 for 5 days have to add macrolide, if you worried about atypicals. Macrolides themselves are probably not helpful if your concerned about strep pneumo.

aap original peds article on aom and judicious use 2004

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Adhd summer camp resources CAMP STAR

Specialist In Neurodevelopmental Pediatrics Dear Colleague:	4801 West Peterson Avenue • Suite 204 • Chicago, IL 60646 Phone: 773-481-1818    Fax: 773-481-1919 April 4, 2008

 

I am excited to invite you to an open house to learn more about Chicago's first ever comprehensive evidence-based summer treatment program for your patients with ADHD and other behavioral and social difficulties.

Camp STAR (Summer Treatment for ADHD and Related Issues) is a collaborative effort between the University of Illinois at Chicago ADHD clinical and research group (HALP Clinic) and the Jewish Council for Youth Services. The program combines the clinical and academic authority of UIC with the camping expertise of JCYS to meet a tremendous need in the Chicago community.

Camp STAR is modeled after the behavioral therapy used in the Multimodal Treatment Study of ADHD (MTA), the largest clinical trial of children with ADHD funded by the National Institute of Mental Health. The study showed that children who participated in a summer treatment program obtained a high level of success with lower doses of medication than children who did not receive behavioral treatment (NIMH 2006)*. Parents and teachers of participants rated higher levels of satisfaction in the outcome compared to non-participants who only received medication management.

Psychologists and physicians provide direct treatment to campers and parents as well as supervision of counselors and teachers. Camp STAR counselors are undergraduate and graduate students in psychology, education, or mental health related fields who undergo intensive training. The 1-to-2 counselor to camper ratio allows for constant monitoring of children's behavior as well as constant positive reinforcement. The counselors help the children improve social skills, rule following, problem solving, self-esteem, anger management, academic aptitude, and sports competence.

Children ages 6-12 with ADHD, oppositional disorders, aggression, learning problems, and social challenges associated with high-functioning Autism/ Asperger's syndrome may be eligible to attend Camp STAR.

This summer Camp STAR will take place weekdays from 8:00AM to 4:00PM June 16^th -August 1^g at Wayne Thomas School in Highland Park. Please contact 312-996-6923 for more information.

Please join me at an open house on Tuesday, April 29^th from 6:30-7:30 PM at the JCYS George W. Lutz Family Center, 800 Clayey Road, Highland Park, IL 60035. RSVP to 847-433-6001 x0.

Sincerely,

 

Alan I. Rosenblatt, M.D.

Specialist in Neurodevelopmental Pediatrics

* National Institute of Mental Health, lutp://tnnv.nitnh.nih.gowhealthltrials/nimh-research-on-treatment-

for-attention-deficit-hyperactivitv-disorder-adhd-questions-and-answers-about-the-multiniodal- treatmen.shtml

Ortho referral list bone and joint

ILLINOIS BONE & JOINT INSTITUTE, LLC

ACCESS LIST

ORTHOPAEDICS n PODIATRY n RHEUMATOLOGY
PHYSICAL AND OCCUPATIONAL THERAPY • MRI

(847) 998-5680 Phone • (847) 998-6365 Fax

2401 Ravine Way    2350 Ravine Way, Suite 600    1144 Wilmette Avenue

Glenview, IL 60025    Glenview, IL 60025    Wilmette, IL 50091

 

David F. Beigler, M.D.

Hip, Knee & Shoulder Surgery Sports Medicine, Trauma Surgery Medical Assistant: (847) 724-4588 Secretary: (847) 832-1569

C. Andrew Hunt, M.D.

Primary Care Sports Medicine Adult & Pediatric Orthopaedics Medical Assistant: (847) 724-4669 Secretary: (847) 724-4384

Gregory H. Portland, M.D. Sports Medicine, General Orthopaedic Surgery Nurse:    (847) 724-4074
Secretary: (847) 724-4978

 

 

 

Alfonso E. Bello, M.D. Rheumatology

Nurse:    (847) 724-4783

Secretary: (847) 724-4686

James C. Kudrna, M.D., Ph.D Hip Surgery

Nurse:    (847) 724-4093

Secretary: (847) 724-4197

Amy Jo Ptaszek, M.D.

Foot & Ankle Surgery,

General Orthopaedic Surgery Medical Assistant: (847) 724-4671 Secretary: (847) 832-1569

Merck letter re safety of proquad, increased risk of febrile seizures. Wait until 4 yrs

Select Safety Information

ProQuad' (Measles, Mumps, Rubella and Varicella Virus Vaccine Live) should not be administered to certain individuals, including those with any of the following: a history of anaphylactic reactions to neomycin; a history of hypersensitivity to gelatin or any other component of the vaccine; blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic system; an immunodeficient condition or receiving immunosuppressive therapy; active untreated tuberculosis; an active febrile illness (>101.3°F); or those who are pregnant.

In clinical trials with ProQuad involving children 12 to 23 months of age, the most frequently reported injection-site adverse experiences (>1% of children) were pain/tenderness/soreness, erythema, swelling, ecchymosis, and rash. The most frequently reported systemic vaccine-related adverse experiences (1% of children) were fever (102°F), irritability, measles-like rash, varicella-like rash, rash (not otherwise specified), upper respiratory infection, viral exanthema, and diarrhea.

In these trials, the only systemic vaccine-related adverse experiences that were reported at a significantly greater rate in individuals who received ProQuad than in individuals who received M-M-R₁₁ (Measles, Mumps, and Rubella Virus Vaccine Live) and VARIVAX'' [Varicella Virus Vaccine Live (Oka/Merck)] were fever (102°F f38.9°CJ oral equivalent or abnormal) (21.5% versus 14.9%, respectively), and measles-like rash (3.0% versus 2.1%, respectively).

Febrile seizures have been reported in children receiving ProQuad. Consistent with clinical study data on the timing of fever and measles-like rash, an interim analysis of a postmarketing observational study in children (N=14,263) receiving their first dose of vaccine has shown that febrile seizures occurred more frequently 5 to 12 days following vaccination with ProQuad (0.5 per 1000) when compared with data from children in a historical, age- and gender-matched, control group vaccinated with M-M-R'₁₁ and VARIVAX (N=14,263) concomitantly (0.2 per 1000). In the 0- to 30-day time period following vaccination, the incidence of febrile seizures with ProQuad (1.0 per 1000) was not greater than that observed in children receiving M-M-R"^-₁₁ and VARIVAX concomitantly (1.3 per 1000).

The duration of protection from measles, mumps, rubella, and varicella infections after vaccination with ProQuad is unknown.

Vaccination with ProQuad may not offer 100% protection from measles, mumps, rubella, and varicella infection.

Before administering ProQuad, VARIVAX, or _M-M-R'11, please read the enclosed appropriate Prescribing Information. For additional copies of the Prescribing Information, call 1-800-672-6372, visit MerckVaccines.com', or contact your Merck representative.

If you have further questions, please visit MerckVaccines.com', call 1-877-VAX-MERCK (1-877-829-6372) or contact your Merck representative.

Sincerely,

Dennis A. Brooks, MD, MPH

 

Dennis A. Brooks, MD, MPH    Merck & Co.. Inc.

Senior Director    770 Sumneytown Pike

Pediatric Medical Affairs    P.O. Box 250

Policy, Public Health & Medical Affairs    West Point PA 19486-0250

0 MERCK

March 7, 2008

Dear Health Care Practitioner:

I am writing to inform you thatthe Advisory Committee on Immunization Practices IACIP), at its meeting on

February 27, 2008, after reviewing preliminary data from two postlicensure safety studies on febrile seizures following administration of MMRV vaccine compared with MMR and varicella vaccines, voted to change the language regarding the use of combination measles, mumps, rubella, varicella vaccine (marketed by Merck & Co., Inc., as ProQuad- (Measles, Mumps, Rubella and Varicella Virus Vaccine Live). As stated on the Web site of the Centers for Disease Control and Prevention (CDC) at http://www.cdc.goviod/science/iso/vsdimmrv.htm, the ACIP recommends that there is no preference for use of combination MMRV vaccine over separate administration of MMR and varicella vaccines.

Preliminary results from an MMRV vaccine safety study among children aged 12 to 23 months implemented by the CDC found that the rates of febrile seizures during the 7 to 10 days after vaccine was about 2 times higher in children who received MMRV vaccine I9/10,000 children vaccinated) compared with children who received mumps, measles, and rubella (MMR) and varicella vaccines separately at the same visit (4/10,600 children vaccinated).

An interim analysis of a postmarketing observational study conducted by Merck in children (N=14,253) receiving their first dose of vaccine has shown that febrile seizures occurred more frequently 5 to 12 days following vaccination with ProO.uad (0.5 per 1000) when compared with data from children in a historical, age- and gender-matched, control group vaccinated with M-M-R^-₁₁ (Measles, Mumps, and Rubella Virus Vaccine Live) and VARIVAX' [Varicella Virus Vaccine Live (Oka/Merck)) IN.14,263) concomitantly (0.2 per 1000). In the 0- to 30-day time period following vaccination, the incidence of febrile seizures with ProGuad (1.0 per 10001 was not greater than that observed in children receiving M-M-R'₁₁ and VARIVAX concomitantly (1.3 per 1000).

The interim results from the Merck observational study have been recently added to the Adverse Reactions section of the label for ProGuad. A copy of the label for ProQuad is included with this letter.

Merck supports the recommendations of the ACIP on the use of ProCluad, M-M-19₁₁ and VARIVAX for appropriate patients in the United States and supports the appropriate use of ProGuad as an option for simultaneous vaccination against measles, mumps, rubella, and chickenpox in children 12 months through 12 years of age.

I would also like to take this opportunity to remind you that the current unavailability of ProQuad is due to a manufacturing issue and is unrelated to these postmarketing analyses or any safety or efficacy issue with the vaccine. Merck remains committed to resupplying ProQuad as soon as possible and, as previously stated, expects to bring ProQuad back to the US market in early 2009.

About ProQuad

ProGuad is indicated for simultaneous vaccination against measles, mumps, rubella, and varicella in children 12 months through 12 years of age. ProGuad may be used in children 12 months through 12 years of age if a second dose of measles, mumps, and rubella vaccine is to be administered.

• At least 1 month should elapse between a dose of a measles-containing vaccine such as M-M-R _II and a dose of ProQuad.
  
• If for any reason a second dose of varicella-containing vaccine is required, at least 3 months should elapse between administration of the 2 doses.
  

Group Urges Ban on Medical Giveaways - New York Times

Group Urges Ban on Medical Giveaways - New York Times
we had implemented this for quite awhile for all practical purposes at univ of Chicago; the interesting thing was that I was pretty ignorant on a lot of the newer medications when I came out into private practice, so this kind of muzzling of pharma; has its deleterious affects. what the article speaks to specifically will probably affect some of the academic doc's incomes, and a few fairly substantially. It will be interesting to see how those folks respond as it is extremely difficult to fore go income once already earned.

AAP chaperone policy

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Once-Daily Oral Amoxicillin Effective for Strep Pharyngitis in Children

Once-Daily Oral Amoxicillin Effective for Strep Pharyngitis in Children
once daily amoxicillin may be just as beneficial as b.i.d. or t.i.d. penicillin. The interesting thing about this study was that failure rate to relatively high this population of true strep pharyngitis. 6 to 12% in both penicillin as well as once daily amoxicillin group. the other interesting thing is the dose is relatively high 1.5 g if over 30 kg and 750 mg if less than 30 kg. Optimal per kilo dose has not been adequately defined.

eMedicine - Streptococcus Group A Infections : Article by Sat Sharma

eMedicine - Streptococcus Group A Infections : Article by Sat Sharma
resistance rates for macrolides are increasing or group A strep.

AHA on Ecg with ADHD and stimulants

gerd handout peds

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CHILDREN’S DIGESTIVE HEALTH & NUTRITION FOUNDATION NORTH AMERICAN SOCIETY FOR PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION

Probiotics and diarrhea aap - Google Docs

Probiotics and diarrhea aap - Google Docs
Lactobacillus and Florastor probably effective for antibiotic associated diarrhea and watery diarrhea. Probably not as effective for other kinds of diarrhea.

eMedicine - Lymphadenitis : Article by Ulfat Shaikh

eMedicine - Lymphadenitis : Article by Ulfat Shaikh
usually infectious Staphylococcus, strep group A, viral.
clinical pearls if nontender and unilateral think Kawasaki,
travel think atypical mycobacterium or TB,
cat think Bartonella does not usually need to be treated however infectious disease needs to be involved.
Mono although usually bilateral and involves liver and spleen
immunodeficiency, Job's CGD
if not improving on antibiotics consider viral, loculation, atypical Mycobacterium, lymphoma consider ultrasound and chest x-ray.

on synagis, risks benefits and cost

The Informed Patient - WSJ.com