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Abstract: Rheumatic diseases form an important group of diseases in children, since early and correct diagnosis and management are important for their growth and development. Diagnosis of these conditions is highly supported buy laboratory investigations. This article provides an overview of the laboratory investigations that are useful in the management of rheumatic diseases in general with special emphasis on their interpretation in children. [Copyright &y& Elsevier]

Total anomalous systemic venous connection (TASVC) to the left atrium (LA) is a rare congenital anomaly. An 11-year-old girl presented with complaints of palpitations and cyanosis. TASVC with left isomerism and noncompaction of LV was diagnosed after contrast echocardiogram and computed tomography angiogram. The knowledge of anatomy and pathophysiology is essential for the successful management of these cases. Anesthetic concerns in this case were polycythemia, paradoxical embolism and rhythm abnormalities. The patient was successfully operated by rerouting the systemic venous connection to the right atrium. [ABSTRACT FROM AUTHOR]

Objective Diagnosis of medically unexplained symptoms (MUS) occurs after thorough evaluations have failed to identify a physiological cause for symptoms. However, families and providers may wonder if something has been missed, leading to reduced confidence in behavioral treatment. Confidence may be improved through the use of technology such as covert video monitoring to better assess functioning across settings. Methods A 12-year-old male presented with progressive neurological decline, precipitated by chronic pain. After thorough evaluation and the failure of standard treatments (medical, rehabilitative, and psychological) covert video monitoring revealed that the patient demonstrated greater abilities when alone in his room. Negative reinforcement was used to initiate recovery, accompanied by positive reinforcement and a rehabilitative approach. Covert video monitoring assisted in three subsequent cases over the following 3 years. Results and Conclusions In certain complex cases, video monitoring can inform the assessment and treatment of MUS. Discussion includes ethical and practical considerations. [ABSTRACT FROM AUTHOR]

Objectives To validate a three-factor model for the Pediatric Symptom Checklist-17 (PSC-17) and evaluate its diagnostic accuracy with African-American and Caucasian children with and without a chronic illness. Methods Mothers of 723 youth diagnosed with either type I diabetes (n = 210) or sickle cell disease (n = 191) and a nonill peer group (n = 322) completed a demographic questionnaire, the PSC-17, and the Child Behavior Checklist (CBCL). Results Confirmatory factor analyses and tests of measurement invariance validated a three-factor structure for the PSC-17 with African-American and Caucasian youth with and without a chronic illness. Receiver operating characteristic curves revealed optimal cut-off scores that are similar to published reports. Conclusions A three-factor solution was replicated for the PSC-17 with African-American and Caucasian children with and without a chronic illness. Cut-off scores for identifying children at risk for emotional/behavioral problems were evaluated using the CBCL as the gold standard and are discussed. [ABSTRACT FROM AUTHOR]

Choroid plexus carcinomas are rare and arise from the choroid plexus, with invariably poor prognosis. We report an unusual case of an 8-year old male who presented with symptoms of increased intracranial pressure with radiological evidence of brain intraventricular lesion which was proved to be choroid plexus carcinoma on histopathology and immunohistochemistry. Treatment consisted of limited surgery followed by craniospinal irradiation and boost to the local tumor. Post treatment there was evidence of residual disease with no significant clinical improvement for which patient was managed conservatively with steroids along with chemotherapy with poor outcome. Hence aggressive surgical resection of the tumor is the most relevant prognostic predictor for survival, and is associated with poor prognosis if not completely excised irrespective of adjuvant treatment. [ABSTRACT FROM AUTHOR]

Summary Purpose: Psychogenic nonepileptic seizure (PNES) is an important differential diagnostic problem in patients with or without epilepsy. There are many studies that have analyzed PNES in adults; currently, however, there is no systematic assessment of purely childhood PNES semiology. Our study based on a large pediatric video-electroencephalography (EEG) monitoring (VEM) cohort, provides a detailed analysis of childhood PNES and assesses the usability of the current classification system described in adults. Methods: Medical and video-EEG records of 568 consecutive children (younger than 18 years) who underwent video-EEG monitoring (VEM) at our hospital were reviewed. Aura, type of movement, anatomic distribution, synchrony, symmetry, eye movement, responsiveness, vocalization, hyperventilation, vegetative and emotional signs, presence of eyewitness, and duration of the event were recorded among children with the diagnosis of PNES. We also compared our data with those of earlier adult studies. Key Findings: Seventy-five archived PNES of 27 children (21 girls; age 8-18 years) were reanalyzed. Nine children (33%) had the diagnosis of epilepsy currently or in the past. Mean age at the time of PNES onset was 11.6 (standard deviation 3.2) years. Mean duration of PNES was longer (269 s) compared to seizures of the epileptic group (83 s; p = 0.002). Eyewitnesses (mostly parents) were present in 89% of cases. Eighty percent of PNES had an abrupt start, with 68% also ending abruptly. In only 15% of events were the patients eyes closed at the beginning of the attack. Patients were unresponsive in 34%. The most frequent motor sign was tremor (25%) with the upper, rather than lower limbs more frequently involved. Pelvic thrusting was seen in only two attacks. Emotional-mostly negative-signs were observed during 32 PNES (43%). Based on Seneviratne et al.'s classification, 18 events (24%) were classified as rhythmic motor PNES, only half the frequency of that previously described in adults. No hypermotor PNES was found. The frequency of complex motor PNES (13%) and mixed PNES (4%) showed similar frequency in children as in adults. Dialeptic PNES was found more frequently among younger children. All PNES belonged to the same semiologic type in 23 patients (85%). Significance: Because homogeneity of PNES within a patient was high in the pediatric population, we found it useful to classify PNES into different semiologic categories. Dialeptic PNES seems to be more frequent among younger children. Tremor is the most frequent motor sign and usually accompanied by preserved responsiveness in childhood. Negative emotion is commonly seen in pediatric PNES, but pelvic thrusting is a rare phenomenon. We, therefore, suggest a modification of the present classification system in which PNES with motor activity is divided into minor and major motor PNES, and the latter group is subdivided into synchron rhythmic motor and asynchron motor PNES. We believe that our study, a detailed analysis on the semiology and classification of purely childhood PNES might assist the early and precise diagnosis of nonepileptic paroxysmal events. [ABSTRACT FROM AUTHOR]

Background:This study investigated the risk of cancer in children with alert symptoms identified in current UK guidance, or with increased consultation frequency in primary care.Methods:A population-based, nested case-control study used data from the General Practice Research Database. In all, 1267 children age 0-14 years diagnosed with childhood cancer were matched to 15 318 controls. Likelihood ratios and positive predictive values (PPVs) were calculated to assess risk.Results:Alert symptoms recorded in the 12 and 3 months before diagnosis were present in 33.7% and 27.0% of cases vs 5.4% and 1.4% of controls, respectively. The PPV of having cancer for any alert symptom in the 3 months before diagnosis was 0.55 per 1000 children. Cases consulted more frequently particularly in the 3 months before diagnosis (86% cases vs 41% controls). Of these, 36% of cases and 9% of controls had consulted 4 times or more. The PPV for cancer in a child consulting 4 times or more in 3 months was 0.13 per 1000 children.Conclusion:Alert symptoms and frequent consultations are associated with childhood cancer. However, individual symptoms and consultation patterns have very low PPVs for cancer in primary care (e.g., of 10 000 children with a recorded alert symptom, approximately 6 would be diagnosed with cancer within 3 months). [ABSTRACT FROM AUTHOR]

Abstract: Anxiety and depression are highly prevalent and frequently comorbid classes of disorder associated with significant impairment in youth. While current transdiagnostic protocols address a range of potential anxiety and depression symptoms among adult and adolescent populations, there are few similar treatment options for school-aged children with symptoms of these emotional disorders. Such a protocol could be of particular benefit to children experiencing emergent anxiety and depressive symptoms prior to adolescence, as these youth may be at risk for a more severe and protracted course of illness. For this reason, Emotion Detectives, a cognitive behavioral group treatment program, was developed as a downward extension of existent transdiagnostic protocols for emotional disorders in older populations (e.g., Barlow et al., 2010; Ehrenreich et al., 2008) for use with children ages 7 to 12 and their families. This paper will discuss the theoretical basis for Emotion Detectives and provide a description of its 15-session protocol, its unique and developmentally sensitive features, and case studies of 2 children enrolled in an ongoing open trial. [Copyright &y& Elsevier]

Objective: To determine the risk factors associated with poor outcome among under-five children with severe anemia in sub Saharan Africa. Design: Cross-sectional. Setting: University Teaching Hospital, Nigeria. Participants: Under-five children presenting with severe anemia (PCV ≤15%, Hb ≤5g/dL). Methods: Between January and June 2006, children admitted with severe anemia were recruited. The biodata, socio-economic status, signs and symptoms were documented for each child after the initial stabilization. Laboratory investigations using blood, stool and urine samples were carried out. Data were analyzed using SPSS version 11.0. Results: 140 out of the 1,450 patients admitted during the period of study had severe anemia (prevalence 9.7%). Malaria either alone or in combination was the most common cause of severe anemia [n=90 (64.3%)]. 117 patients (83.6%) recovered, while 4(2.8%) left against medical advice and 19 died (case fatality rate 13.6%). The variables associated with mortality were malnutrition (P=0.02), tachycardia (P= 0.03), coma (P<0.001), and absence of blood transfusion (P=0.001). On logistic regression analysis coma (P=0.002), not receiving blood transfusion (P=0.002) and female gender (P=0.04) predicted poor outcome. Conclusions: The study revealed high mortality rates among under-five children with severe anemia. Coma, malnutrition, female gender and absence of blood transfusion were associated with higher mortality in severe anemia. [ABSTRACT FROM AUTHOR]

In our study we analysed the prescription and consumption of medicines in children and adolescents. A total of 5200 medical prescriptions realized by a community pharmacy were evaluated. By selection of medical prescriptions prescribed to patients in the age group of up to 18 years of age a study group of 233 prescriptions was made. The group was identified by age and sex of the patients. In the group of prescriptions we analysed the incidence of individual diagnoses and consumption of medicines from different points of view, according to age, sex and rate of individual diagnoses according to the ATC system. Based on our analysis it was concluded, that the most frequent diseases affecting children and adolescents are diseases of the respiratory system, diseases of the ear and mastoid process, digestive system and skin diseases. With the exception of diseases of the skin and subcutaneous tissue, the incidence of all diseases is quite similar in both sexes. In the present, the consumption of prescription medicines used by children and adolescents is still very high mainly in the age group from 7 to 15 years of age. [ABSTRACT FROM AUTHOR]

Renal disease is a major cause of morbidity and mortality. Pediatric patients with renal disease, especially younger ones may present with nonspecific signs and symptoms unrelated to the urinary tract. Pediatricians, therefore, should be familiar with the modes of presentation of renal disease and should have a high index of suspicion of these conditions. Affected patientsmay present with signs and symptoms of the disease, abnormal urinalysis, urinary tract infection, electrolyte and acid-base abnormalities, decreased renal function, renal involvement in systemic disease, glomerular and renal tubular diseases, congenital abnormalities, and hypertension. Pediatricians may initiate evaluation of renal disease to the extent that they feel comfortable with. The role of the pediatrician in the management of the child with renal disease and guidelines for patient referral to the pediatric nephrologist are presented. [ABSTRACT FROM AUTHOR]

Abstract: A 9-year-old girl born to healthy parents showed manifestations suggestive of ataxia telangiectasia (AT), such as short stature, sudden short bouts of horizontal and rotary nystagmus, a weak and dysarthric voice, rolling gait, unstable posture, and atactic movements. She did not show several cardinal features typical of AT such as frequent, severe infections of the respiratory tract. In contrast, she showed symptoms not generally related to AT, including microcephaly, profound motor and mental retardation, small hands and feet, severely and progressively reduced muscle tone with slackly protruding abdomen and undue drooling, excess fat on her upper arms, and severe oligoarthritis. A cranial MRI showed no cerebellar hypoplasia and other abnormalities. In peripheral blood samples she carried a de novo duplication of 3.14Mb in chromosomal region 19q12 containing six annotated genes, UQCRFS1, VSTM2B, POP4, PLEKHF1, CCNE1, and ZNF536, and a de novo mosaic inversion 14q11q32 (96% of metaphases). In a saliva-derived DNA sample only the duplication in 19q12 was detected, suggesting that the rearrangements in blood lymphocytes were acquired. These findings reinforced the suspicion that she had AT. AT was confirmed by strongly elevated serum AFP levels, cellular radiosensitivity and two inherited mutations in the ATM gene (c.510_511delGT; paternal origin and c.2922-50_2940del69; maternal origin). This case suggest that a defective ATM-dependent DNA damage response may entail additional stochastic genomic rearrangements. Screening for genomic rearrangements appears indicated in patients suspected of defective DNA damage responses. [Copyright &y& Elsevier]

Objectives: To present the main mechanisms that cause gastrointestinal symptoms in patients with diabetes mellitus, their frequency, and controversies as to their occurrence in children and adolescents. Sources: Non-systematic review of the literature conducted in the MEDLINE/PubMed and SciELO databases (1983-2011), as well as relevant book chapters. The most relevant and up-to-date articles on the topic were selected. Summary of the findings: Prevalence of diabetes mellitus has been increasing over the years in many countries. The complications caused by this disease in the digestive system, such as gastrointestinal symptoms (nausea, vomiting, abdominal pain, heartburn, dysphagia, constipation, diarrhea, and fecal incontinence) are well known. The pathogenesis of changes in the gastrointestinal functions in patients with diabetes mellitus is still being investigated at the same time as the role of the enteric nervous system and its neurotransmitters has gained significance. As a consequence of the complications in the digestive system, which damage the enteric nervous system, patients with diabetes mellitus may have specific gastrointestinal motility disorders, some of which may be of great relevance, such as diabetic gastroparesis, constipation, and diarrhea. Gastrointestinal dysfunction increases the morbidity of diabetes mellitus and worsens the quality of life of diabetic individuals. Conclusions: There are few studies addressing these problems in childhood and adolescence. Diabetes mellitus affects the digestive system over the years. Because this condition worsens the quality of life of diabetic individuals and leads to complications, attention must be paid to gastrointestinal symptoms when treating patients with diabetes mellitus. [ABSTRACT FROM AUTHOR]

To cite this article: Koster ES, Raaijmakers JAM, Vijverberg SJH, Koenderman L, Postma DS, Koppelman GH, van der Ent CK, Maitland-van der Zee A-H. Limited agreement between current and long-term asthma control in children: the PACMAN cohort study. Pediatr Allergy Immunol 2011: 22: 776-783 Abstract Background: Several studies have shown that predictors of asthma treatment outcomes differ depending on the definition of the outcome chosen. This provides evidence that different outcomes studied may reflect distinct aspects of asthma control. To assess predictors of asthma control, we need firm outcome phenotypes. The aim of this study was to investigate the association between measurements of current and long-term asthma control. Methods: We included 527 children using inhaled corticosteroids participating in the Pharmacogenetics of Asthma medication in Children: Medication with ANti-inflammatory effects cohort. Current asthma control (previous week) was defined using the Asthma Control Questionnaire. Long-term asthma control was based on Global Initiative for Asthma guidelines. Not well-controlled asthma in a season was defined as ≥3 of the following items present in a season: (i) day-time or (ii) night-time symptoms, (iii) limitations in activities, and (iv) rescue medication use. Asthma control during (i) the previous season and (ii) the year preceding the pharmacy visit was used as long-term asthma control definitions. Current and long-term asthma control were compared to investigate agreement. Results: Long-term uncontrolled asthma rates were highest in autumn and winter (50%) and lowest in summer (32%) (p < 0.05). Overall agreement between current and long-term asthma control was limited (66% for previous season and 68% for previous year). Conclusion: Congruence between current and long-term asthma control was limited. Furthermore, we showed significant seasonal differences. It is therefore important to calculate asthma control over a longer period of time, instead of using current asthma control as indicator. [ABSTRACT FROM AUTHOR]

The distinctiveness of anxiety and depressive symptoms in children has previously been questioned based on their high degree of comorbidity, shared risk factors, and treatment response. Developing children may show an unstable presentation of anxiety and depressive symptoms that would complicate interpretation of studies of comorbidity. The present study examined the measurement stability of anxiety and depressive symptoms across time and sex using a large epidemiologic sample of children. A nationally representative cohort of 1329 children (624 girls and 705 boys) aged four to seven in 1994 were drawn from the National Longitudinal Survey of Youth (NLSY). Using eight years of prospective data we examined whether a one or two factor structure of anxiety (five items) and depressive (four items) symptoms would be invariant across time and sex. Despite item variability within each factor across time, confirmatory factor analysis revealed distinct factors for anxiety and depression that were stable across time and sex. Results provide support that covariation between anxiety and depression is not likely the result of measurement overlap. However, items indicating factors of anxiety and depression in the NLSY may not be sufficient to permit developmentally-sensitive measurement of these factors. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this article, the authors describe the rationale for the way they work with troubled infant-parent relationships. They focus on two approaches developed at the Hincks-Dellcrest Children's Mental Health Centre (Toronto, Canada), a publically funded agency where they work and teach. One approach is Watch, Wait and Wonder, and the other is Infant-Parent Psychotherapy. The authors share a common philosophy that directs the way they think about the way they work. Two clinical case studies are presented to illustrate the treatment process of each approach. The presenting symptoms in both cases are similar (sleep difficulties), but the meaning, ages, and family compositions are different. The interventions unlocked the difficulties that each relationship was experiencing in a brief period of time. [ABSTRACT FROM AUTHOR]

The article describes the case of a four-year-old boy who was diagnosed with septic arthritis of the shoulder with massive abscess formation and axillary nerve lesion. His symptoms included right shoulder pain, swelling and restricted shoulder movement. For an emergency treatment, the patient underwent arthrotomy of his right shoulder. His postoperative management included intravenous amoxicillin with clavulanic acid, initial shoulder immobilization and physiotherapy.

The article describes the case of a nine-year-old boy who complained of right elbow pain. His physical examination showed a swollen right distal humeral region that was also tender to palpation. After a month, the patient returned to the clinic and complained of worsening elbow pain and intermittent low-grade fevers. He was diagnosed with primary musculoskeletal Langherhans cell histiocytosis (LCH). Differential diagnosis include osteomyelitis, Ewing's sarcoma, osteosarcoma and lymphoma.

To clarify the cause of deaths associated with pandemic (H1N1) 2009 among children in Japan, we retrospectively studied 41 patients <20 years of age who had died of pandemic (H1N1) 2009 through March 31, 2010. Data were collected through interviews with attending physicians and chart reviews. Median age of patients was 59 months; one third had a preexisting condition. Cause of death was categorized as unexpected cardiopulmonary arrest for 15 patients, encephalopathy for 15, and respiratory failure for 6. Preexisting respiratory or neurologic disorders were more frequent in patients with respiratory failure and less frequent in patients with unexpected cardiopulmonary arrest. The leading causes of death among children with pandemic (H1N1) 2009 in Japan were encephalopathy and unexpected cardiopulmonary arrest. Deaths associated with respiratory failure were infrequent and occurred primarily among children with preexisting conditions. Vaccine use and public education are necessary for reducing influenza-associated illness and death. [ABSTRACT FROM AUTHOR]

Malaria-specific antibody responses in children often appear to be short-lived but the mechanisms underlying this phenomenon are not well understood. In this study, we investigated the relationship between the B-cell activating factor (BAFF) and its receptors expressed on B cells with antibody responses during and after acute malaria in children. Our results demonstrate that BAFF plasma levels increased during acute malarial disease and reflected disease severity. The expression profiles for BAFF receptors on B cells agreed with rapid activation and differentiation of a proportion of B cells to plasma cells. However, BAFF receptor (BAFF-R) expression was reduced on all peripheral blood B cells during acute infection, but those children with the highest level of BAFF-R expression on B cells maintained schizont-specific immunoglobin G (IgG) over a period of 4 months, indicating that dysregulation of BAFF-R expression on B cells may contribute to short-lived antibody responses to malarial antigens in children. In summary, this study suggests a potential role for BAFF during malaria disease, both as a marker for disease severity and in shaping the differentiation pattern of antigen-specific B cells. [ABSTRACT FROM AUTHOR]

Objectives. To present the needs and psychological treatment options for offenders with ADHD. Methods. Key papers are discussed in relation to this topic. Results. Research suggests there is a disproportionately high number of individuals with ADHD involved with the Criminal Justice System. UK studies among offenders have indicated around 45% of youths and 24% of male adults screen positive for a childhood history of ADHD, 14% of whom have persisting symptoms in adulthood. Those with persisting symptoms have a significantly younger onset of offending and higher rate of recidivism. ADHD was the most powerful predictor of violent offending, even above substance misuse. They accounted for 8-fold more institutional aggressive behavioural disturbances (critical incidents) than other non-ADHD prisoners. Critical incidents have also been associated with personality disordered patients screening positive for ADHD and detained under the Mental Health Act. It is the impulsive symptoms and mood instability associated with ADHD that most likely increase the risk of critical incidents within institutional settings. Conclusions. There are international guidelines available for the treatment of ADHD; however, serious offenders with ADHD will require more complex and comprehensive interventions than their non-offending peers. In particular psychological interventions need to be provided that contain a prosocial competence component. One such programme, the R&R2 for ADHD Youths and Adults, has demonstrated improvement in ADHD symptoms, anxiety, depression, antisocial behaviour and social functioning at three month follow-up with medium to large effect sizes. [ABSTRACT FROM AUTHOR]

Objectives. If the cardinal symptoms of ADHD - hyperactivity, impulsivity and inattention - are combined with a learning disability (70 ≥ IQ < 85), the question arises whether a child shows hyperkinetic behaviour because of intellectual overload in a challenging situation, for example at school. Perhaps, this behaviour is not a primary attention deficit disorder but an impulse control disorder, determined by the primarily intelligence level. It raised the question whether attention deficit and impulse control regarded as behavioural inhibition deficit may depend on intelligence and therefore should be separated into distinct clinical entities. Methods. A total of 45 children (15 with ADHD, 15 with learning disabilities (LD), 15 with ADHD and learning disabilities) were compared in a matched-pair design with 42 control children using a go/no go paradigm (visual continuous performance test, CPT). The dependent variable was the target P3 amplitude, averaged from a 10-20 EEG measurements under distinct trigger conditions. For statistical analysis, a three-factor analysis of variance (MANOVA) with repeated measurements was used. In a subsequent regression analysis with residuals, the influence of intelligence (IQ) was calculated and a 'parallel analysis of variance' was conducted. Results. No differences in the P3 amplitudes in the comparison ADHD-control group were found. Reduced P3 amplitudes as main effects in the LD group compared with controls were found and a significant group-dependent interaction on reduced P3 amplitudes comparing ADHD ++ LD versus control group. Using residuals (IQ), this interaction was not longer verifiable. Conclusion. Impulsivity and attention deficit as the cardinal symptoms of ADHD, regarded as behavioural inhibition deficit, are essentially moderated by the primary intelligence, rather than by an attention deficit. The lower the IQ, the more ADHD surfaces as a disturbed impulsivity and lesser as an attention deficit. [ABSTRACT FROM AUTHOR]

Pediatric gastrointestinal disorders are commonly experienced by youth and have been shown to be associated with increased rates of psychosocial difficulties. Aim of the current study was to extend development of the Pediatric Symptom Checklist (PSC), a brief parent-completed measure designed to assess children's behavioral and emotional functioning, by examining its factor structure in a pediatric gastroenterology sample. Parents of 176 children ages 4-16 years visiting a pediatric gastroenterologist completed the PSC. The factor structure of the PSC was examined using principal component analysis. Parallel analysis was utilized to determine the number of factors to retain and indicated that three factors existed within the data. A principal component analysis with varimax rotation identified factors measuring internalizing, externalizing, and attention difficulties. The three factors that emerged on the PSC provide initial support for the utility of the PSC in pediatric gastroenterology clinics. [ABSTRACT FROM AUTHOR]

Abstract: Sleep disturbances are common among youth with anxiety disorders, yet objective assessments of sleep in children with obsessive compulsive disorder (OCD) have been the focus of scant research. We therefore compared a small group of non-medicated, non-depressed children with primary OCD (ages 7–11 years) to matched healthy controls using home-based actigraphy during a 7-day prospective assessment. Validated parent and child sleep measures also were collected, and associations among objective sleep variables and severity of obsessions and compulsions were examined. We found significantly fragmented sleep patterns in the OCD group compared to controls including reduced total sleep time (TST) and longer wake periods after sleep onset. Severity of compulsions showed a significant negative correlation with TST. These preliminary findings indicate the presence of sleep abnormalities in pre-pubescent OCD patients with potential implications for future examinations of early developmental processes and features of the disorder. [Copyright &y& Elsevier]

This study examined the relationship between the developmental trajectories of neuropsychological functioning and ADHD symptomatology in a longitudinal sample of children ages 9 to 14. Participants and measures were derived from the Multimodal Treatment Study for ADHD including 534MTA participants and 254 normal controls. Despite improvement over time, MTA participants continued to receive higher ratings of ADHD symptomatology and exhibit greater difficulties across the majority of neuropsychological outcomes. No relations were found between improvements in neuropsychological functioning and ADHD symptomatology over time. Findings provide support for the persistence of neuropsychological functioning and ADHD symptomatology. Findings did not support the hypothesized relation between improvements in frontally-mediated neuropsychological functioning and ADHD symptomatology possibly due to the brief 1-year lag and limited assessment battery. Findings are discussed in relation to neuropsychological development including recommendations for future research. [ABSTRACT FROM AUTHOR]

Objective: Previous studies suggest that comorbid anxiety and depressive disorders in youth are associated with more severe symptomatology and family dysfunction than either disorder alone. Our aim was to replicate and extend past findings by expanding the definition of comorbidity to include comorbid subthreshold symptoms (i.e., symptoms fall below the diagnostic criteria cut-off of a disorder). Method: A clinic-based sample of 193 youth (aged 4-18) and maternal caregivers completed measures assessing the youth's internalizing symptoms and family functioning. Results: Comorbid youth endorsed more severe anxiety symptoms and family dysfunction than anxiety-only youth. By contrast, comorbid youth did not endorse more severe depression symptoms or family dysfunction compared to youth with depression only. Similar results were found for maternal reports of internalizing symptoms, but maternal reports of family functioning yielded no group differences. Conclusions: This study replicates past findings that the presence of comorbid depression in anxious youth is associated with severe anxiety and family dysfunction. Our findings also suggest that subthreshold depressive symptoms in anxious youth relate to the severity of symptomatology and family dysfunction reported, but subthreshold anxiety symptoms in depressed youth do not. Longitudinal studies are needed to further clarify the etiology and developmental course of this comorbidity. [ABSTRACT FROM AUTHOR]

Objective Exercise-in duced bronchoconstriction (EIB) is defined as acute, reversible bronchoconstriction induced by physical exercise. It is widely believed that EIB occurs after exercise. However, in children with asthma the time to maximal bronchoconstriction after exercise is short, suggesting that the onset of EIB in such children occurs during exercise. Aim In this study the authors investigate pulmonary function during exercise in cold air in children with asthma. Methods 33 Children with asthma with a mean age of 12.3 years and a clinical history of exercise induced symptoms, underwent a prolonged, submaximal, exercise test of 12 min duration at approximately 80% of the predicted maximum heart rate. Pulmonary function was measured before and each minute during exercise. If EIB occurred (fall in forced expiratory volume in 1 s >15% from baseline), exercise was terminated and salbutamol was administered. Results 19 Children showed EIB. In 12 of these children bronchoconstriction occurred during exercise (breakthrough EIB), while seven children showed bronchoconstriction immediately after exercise ( non-breakthrough EIB). Breakthrough EIB occurred between 6 and 10 min of exercise (mean 7.75 min). Conclusion In the majority of children with EIB in this study (ie, 12 out of 19), bronchoconstriction started during, and not after, a submaximal exercise test. [ABSTRACT FROM AUTHOR]

The article offers information about pediatric gastro-oesophageal reflux (GOR), which is the passage of gastric contents into the oesophagus. In most infants with GOR the outcome is benign & self-limiting. It discusses the symptoms, causes and treatment of GOR. It causes include the transient, inappropriate relaxation of the lower oesophageal sphincter, which allows the stomach contents to pass into the oesophagus. It symptoms in children include severe neurological impairment, prematurity, cystic fibrissi and hiatus hernia. Complicate cases of GORD should be referred to a paediatrician while investigating for causes and establishing simple management.

Arvaniti F, Priftis KN, Papadimitriou A, Papadopoulos M, Roma E, Kapsokefalou M, Antracopoulos MB, Panagiotakos DB. Adherence to the Mediterranean type of diet is associated with lower prevalence of asthma symptoms, among 10-12 years old children: the PANACEA study. Pediatr Allergy Immunol 2011; : 283-289. Epidemiological studies have shown several associations between asthma symptoms and dietary factors. The aim of this work was to evaluate the relationship between adherence to the Mediterranean diet and childhood asthma. A cross-sectional analysis was performed on 700 children (323 boys), 10-12 yr old, selected from 18 schools located in Athens greater area. Children and their parents completed questionnaires, which evaluated, among others, dietary habits. Asthma was defined according to ISAAC II criteria. Adherence to the Mediterranean diet was evaluated using the KIDMED score (theoretical range 0-12). Higher KIDMED score corresponds to greater adherence to the Mediterranean diet. Greater adherence to the Mediterranean diet was inversely associated with ever had wheeze (p = 0.001), exercise wheeze (p = 0.004), ever had diagnosed asthma (p = 0.002) and with any asthma symptoms (p < 0.001). One-unit increase in the KIDMED score was associated with 14% lower likelihood of having asthma symptoms (odds ratio = 0.86, 95% confidence interval 0.75-0.98), after adjusting for various confounders. No significant associations were found between asthma symptoms and consumption of fruits (p = 0.25), vegetables (p = 0.97), legumes (p = 0.76), cereals (p = 0.71), dairy (p = 0.61), salty snacks (p = 0.53), or margarine/butter (p = 0.42) consumption, while increased fish and meat intake was associated with less asthma symptoms (p = 0.04 and p = 0.01, respectively). Our findings suggest an inverse relationship between level of adherence to the Mediterranean diet and prevalence of asthma in school-aged children. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is highly prevalent in children. Olopatadine, 0.6% nasal spray (olopatadine) is approved for the relief of seasonal allergic rhinitis (SAR) symptoms in children 6 years of age and older. The objective of this study is to provide a comprehensive report of all clinical studies conducted with olopatadine in children with SAR. A pooled analysis was conducted of 2 randomized, double-blind, 2-week, IRB-approved studies that compared olopatadine with placebo (1 spray/nostril twice-daily) in patients 6-11 years of age with SAR. Assessments included the reflective total nasal symptom score (rTNSS) and total ocular symptom score (rTOSS), the Pediatric Rhinoconjunctivitis Quality-of-Life Questionnaire (PRQLQ), and the Caregiver Treatment Satisfaction Questionnaire for Allergic Rhinitis (CGTSQ-AR). Safety results were reported for these studies in combination with a pediatric pharmacokinetic study. Olopatadine was superior to placebo for mean decrease in rTNSS (p = 0.0012) and rTOSS (p = 0.0094), mean decrease in overall PRQLQ score (p = 0.0003), and mean summary CGTSQ AR score (p = 0.0013); (n = 944). The most frequently reported treatment-related events in the olopatadine group were epistaxis and dysgeusia (bad taste) (n = 1,046). For SAR treatment in patients 6-11 years of age, olopatadine was superior to placebo in reducing the symptoms of SAR, improving quality of life, and satisfying caregivers. Olopatadine is a safe and effective treatment for SAR patients as young as 6 years of age and it has been demonstrated to reduce disease impact on the lives of these children and their families. [ABSTRACT FROM AUTHOR]

Previous studies have reported that patients with mitral valve prolapse (MVP) may display autonomic dysfunction. Measurement of heart rate variability (HRV) and P-wave dispersion (PWD) may provide insights into the functional state of the autonomic nervous system. Heart rate variability (HRV) has been used as a noninvasive marker of autonomic activity. However, to the authors' knowledge, PWD has not been studied in the context of MVP. This study aimed to examine HRV and PWD in patients with MVP and to determine whether differences exist between symptomatic and asymptomatic patients. The study population consisted of 54 healthy children (17 boys and 37 girls) ages 6-18 years and 76 patients with MVP (20 boys and 56 girls) ages 6-18 years. The duration and dispersion of the P-wave were measured by surface 12-lead electrocardiograms (ECGs). Heart rate variability was quantified using both time-domain and frequency-domain analyses of Holter ECGs. The minimum duration of the P-wave was significantly lower in the MVP patients (42.4 ± 10.0 ms) than in the control subjects (54.4 ± 12.8 ms) ( p < 0.01), and the PWD was significantly increased in the MVP group (42.7 ± 10.8 ms) compared with the control subjects (31.8 ± 10.9 ms) ( p < 0.01). However, no significant differences were found between the symptomatic and asymptomatic patients. In addition, the HRV parameters were not statistically different between the two groups. In conclusion, although HRV parameters were not significantly different between the MVP and control groups, the findings show that PWD was increased for the children with MVP. However, no relationship could be established between PWD and clinical symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the effectiveness of urotherapy in children with lower urinary tract dysfunction, according to the new definitions of the International Children’s Continence Society. Material and methods: We performed a retrospective review of 122 children (aged 8.8±2.0 years) treated in an outpatient program for lower urinary tract dysfunction. Exclusion criteria included all neurologic abnormalities. In 98 children (80%) daytime urinary incontinence was a predominant symptom. Therapy consisted of an individually adapted drinking and voiding schedule, pelvic floor relaxation, instructions on toilet behavior, biofeedback uroflowmetry and if necessary recommendations for regulation of defecation. Before and at the end of training, patients were evaluated for number and severity of daytime wet accidents per week, using a scoring system to grade the severity of incontinence. Secondary measurements of accompanying voiding symptoms were performed. Results: Of the 90 children with daytime urinary incontinence for whom sufficient objective data were collected, 42% became completely dry during the daytime and 36% showed a 50% or greater level of response. Secondary measurements showed a significant reduction in daily voiding frequency (mean 7.0±1.3, P <0.0001) and mean post-void residual (P <0.003), and an improvement in flow pattern (P <0.05). Conclusions: Urotherapy is successful for the treatment of daytime urinary incontinence in children. Additional benefit was evident in improvement of accompanying voiding symptoms. A combination of the definitions of the International Children’s Continence Society and a scoring system to grade severity improved the evaluation method. Further research into long-term efficacy will be performed. [Copyright &y& Elsevier]

Abstract: Anxiety symptoms are one of the most common mental health conditions in childhood. Children and adolescents with Autism Spectrum Disorders (ASD) are at risk for developing mental health symptoms and anxiety in particular, especially when compared with their peers - both in the general population as well as when compared to youth with other developmental disabilities. Cognitive behavior therapy (CBT) has been identified as the treatment of choice in addressing anxiety symptoms in the general population, and an emerging body of literature indicates that modified CBT for youth with ASD can be effective in reducing anxiety symptoms. In a review of these modified treatment protocols, parent involvement is emphasized as an important component of interventions for youth with ASD and anxiety. However, the majority of these studies only briefly describe the parent''s role, and little mention is made with regard to how the parent''s role evolves over time as children age into adolescence. In this paper, the parent''s role in the treatment of anxiety symptoms in children and adolescents with high-functioning ASD will be discussed with a particular emphasis on considerations for parents of teenagers. Specific recommendations for parent involvement will be provided. [Copyright &y& Elsevier]

Aim: To evaluate the effectiveness of levothyroxine therapy in benign thyroid nodules in pediatrics. Methods: Data from 78 euthyroid children and adolescents with benign thyroid nodules were retrospectively collected. Subjects were divided into 2 groups: levothyroxine treated (n = 36) and nontreated (n = 42), and the clinical, laboratory and sonographic features of the 2 groups were compared. Nodules were considered benign according to histology, fine-needle aspiration biopsy or by features suggestive for benignity. The groups were followed up for 2.4 ± 1.3 years, and treated patients received a mean dose of levothyroxine of 1.69 ± 0.66 μg/kg/day. Results: Patients in the treated and nontreated groups were comparable for age, sex and follow-up. A reduction in nodule diameter from 2.24 ± 0.94 to 1.86 ± 1.17 cm (p = 0.039) was observed in treated patients, whereas the nodule diameter increased from 1.66 ± 0.86 to 1.78 ± 0.91 cm in nontreated patients (p = 0.024). In the treatment group, 11 patients (30.6%) had a reduction greater than 50% and significantly decreased palpable nodules (p < 0.001). A nonsignificant reduction in reported symptoms was observed, too. The change in nodule size was directly correlated with thyroid-stimulating hormone levels (r = 0.640, p < 0.001) and inversely with levothyroxine dose (r = -0.389, p = 0.009). In nontreated subjects, both palpable nodules and symptoms increased. Conclusion: This study supports levothyroxine treatment effectiveness in shrinking benign nodules. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Previous research has shown that fine motor control (MC) performance, measured with a computerized task, was less accurate in children with ADHD and in their unaffected siblings, compared to healthy children. This might indicate a shared genetic etiology between MC and ADHD; it was therefore suggested that MC could serve as endophenotype for ADHD. We examined the association between ADHD symptoms (AS) and MC in a genetically informative design that can distinguish between a genetic and a nongenetic familial etiology for the association. Participants were 12-year-old twins and their siblings (N = 409). AS were rated on a continuous scale with the Strengths and Weaknesses of ADHD and Normal behavior scale (SWAN). MC accuracy and stability was measured with the computerized pursuit task of the Amsterdam Neuropsychological Tasks (ANT). Analyses were performed with Structural Equation Modelling. AS were weakly associated with MC accuracy of the left and right hand (r = -.10/-.10). No association with MC stability was found (r = -.01/-.03). AS were highly heritable (75%), while MC accuracy of the right hand and MC stability showed no genetic influences. For MC accuracy of the left hand, variance was explained by genetic (10%), common environmental (23%), and unique environmental variances. The association between MC accuracy of the left hand and AS was explained by a shared genetic influence but the genetic correlation was low (r = -.14). The phenotypic and genetic associations between AS and computerized MC were weak, suggesting that fine MC is not a proper endophenotype for ADHD. [ABSTRACT FROM AUTHOR]

Abstract: The clinical course and laboratory findings initially strongly suggested the presence of acute poststreptococcal glomerulonephritis in a 15-year-old boy. However, during the search for the origin of the infection, the otorhinolaryngological examination revealed mucosal abnormalities of the nose and paranasal sinuses, which, together with the histopathology of the renal biopsy and the presence of antineutrophilic cytoplasmic antibodies in the serum, were consistent with Wegener''s granulomatosis. The differential diagnostic process and the difficulties encountered in the management of the case are presented. Wegener''s granulomatosis is not a common diagnosis in children, and may easily be overlooked in young patients, being misinterpreted as an infectious disease of the respiratory tract followed by acute poststreptococcal glomerulonephritis. [Copyright &y& Elsevier]

To examine the association of the severity of congenital heart defects (CHDs) with internalizing problems in 18-month-olds and to explore the extent to which the internalizing problems are influenced by maternal distress and emotional reactivity in the child at age 6 months. We linked prospective data from the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health, with a nationwide CHD registry and identified 198 18-month-olds with CHDs in a cohort of 47 692 toddlers. Maternal reports on the children's emotional reactivity at age 6 months, the children's internalizing problems (anxiety, sleep problems, emotional reactivity) at age 18 months and maternal distress were assessed by questionnaires. We found an association at age 18 months between the severity of the CHD and anxiety but not sleep problems or emotional reactivity. Children with severe but not with mild or moderate CHDs were twice as likely to experience the symptoms of anxiety compared with controls. These symptoms are not merely sequelae of earlier psychological reactions or concurrent maternal distress. Should these findings be replicated, future studies ought to investigate the mechanisms leading to elevated anxiety in toddlers with CHDs. In addition, clinical interventions should address the child's anxiety as well as the interaction between the parents and the child. [ABSTRACT FROM AUTHOR]

Background: Early onset of allergic rhinitis (AR) is poorly described, and rhinitis symptoms are often attributed to infections. This study analyses the relations between AR-like symptoms and atopy in infancy in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort. Methods: Data on AR-like symptoms (runny nose, blocked nose, sneezing apart from a cold) were collected using a standardized questionnaire administered during the health examination at age 18 months included in the follow-up of the PARIS birth cohort. Parental history of allergy and children's atopy blood markers (blood eosinophilia ≥470 eosinophils/mm3, total immunoglobulin E ≥45 U/ml and presence of allergen-specific IgE) were assessed. Associations were studied using multivariate logistic regression models adjusted for potential confounders. Results: Prevalence of AR-like symptoms in the past year was 9.1% of the 1850 toddlers of the study cohort. AR-like symptoms and dry cough apart from a cold were frequent comorbid conditions. Parental history of AR in both parents increased the risk of suffering from AR-like symptoms with an OR 2.09 (P = 0.036). Significant associations were found with the presence of concurrent biological markers of atopy, especially blood eosinophilia and sensitization to house dust mite (OR 1.54, P = 0.046 and OR 2.91, P = 0.042) whereas there was no relation with sensitization to food. Conclusions: These results support the hypothesis that AR could begin as early as 18 months of life. Suspicion of AR should be reinforced in infants with parental history of AR or biological evidence of atopy, particularly blood eosinophilia and sensitization to inhalant allergens. [ABSTRACT FROM AUTHOR]

Background: We assessed referral patterns of children with hematological malignancies (HM) in North India. Materials and Methods: The parents/guardians were interviewed at presentation, in the period between October 2001 and November 2002. Patient delay (symptom-contact), health system delay (contact-diagnosis), total delay (symptomdiagnosis), and number of contacts were compared between high- and standard-risk disease group. Results: Of the 79 children (55 boys; 69.6%) with HM, 47 (59.5%) had Acute Lymphoblastic Leukemia (ALL). Forty-four children had high-risk disease. The patient, system and total delay were a median of 2 days (with Interquartile range IQR of 1-6), 37 days (IQR 13-55), and 38 days (IQR 15-60) respectively. Majority of patients (64/79; 81%) went to private sector (non governmental health care providers) for health care. Number of contacts, which was the most significant, correlate with system delay. Conclusions: Sensitizing the private sector practitioners about cancer in symptomatic children (pallor, bleeding, fever) may be effective. [ABSTRACT FROM AUTHOR]

AbstractIntroduction:Telemedicine options for symptom assessment include both telephonic means (call centers) and Internet sites. Although symptom assessment call centers have been available for decades, symptom assessment over the Internet is relatively new. It is not well known what types of symptoms Internet users are seeking assessment for and whether extant telephone triage algorithms would be applicable to Internet users. Methods:Symptom assessments on a heavily used Internet site (MayoClinic.com) were compared with symptom calls to a U.S. call center (Ask Mayo Clinic). Results:Internet users sought symptom assessments about adult symptoms 13 times more often than children's symptoms. In contrast, over the telephone, adult symptoms were addressed 2.1 times more frequently than children's symptoms. Despite the differences in frequencies of adult and child symptom assessments, users of the Internet and telephone callers asked about specific symptoms with similar relative frequencies. Analysis of 20 adult symptom types shared by the Web and call center revealed that by excluding only 2 assessments (nasal symptoms and leg pain) the remaining 18 showed a significant correlation in counts of use (r2= 0.68,p< 0.001 for linear trend). Conclusions:Internet users have symptoms assessed in similar proportions to callers, with a few exceptions. Compared with callers, Web users are much more likely looking for information about adult symptoms. Callers are proportionally asking more about acute symptoms, whereas Internet users appear more interested in symptom assessment of chronic conditions. [ABSTRACT FROM AUTHOR]

Abstract: Autism Spectrum Disorders (ASD) is a topic receiving great attention from researchers and clinicians in the field. However, many of these studies focus on children or adults, with research on infants and toddlers evincing ASD being virtually non-existent. Even more scant is information pertaining to the assessment of symptoms of comorbid psychopathology in this young population. Nonetheless, it is essential to identify comorbid conditions in addition to the symptoms associated with the core features of ASD. Building on the effectiveness of early intervention with children with ASD, comprehensive evaluations and individualized treatment goals are necessary and may enhance treatment efficacy. The Baby and Infant Screen for Children with aUtIsm Traits-Part 2 (BISCUIT-Part 2) is a new assessment, specifically designed to examine symptoms of psychopathology in infants and toddlers with ASD. The purpose of this study was twofold. First, the factor structure of the BISCUIT-Part 2 was established. Second, group differences in the endorsement of symptoms of psychopathology were examined between infants and toddlers with and without ASD. [ABSTRACT FROM AUTHOR]

The study assess whether links exist between maternal characteristics - maternal trait anxiety (STAI-T), maternal depressive symptomatology (BDI-II) and maternal self-esteem (MSRI-s) - and perceived infant crying. Maternal psychological characteristics was evaluated by selfreport questionnaires in the third trimester of pregnancy. Mothers fill out the reports about infant crying between the 4th and 8th week after the infant's birth. The links were found between maternal trait anxiety and maternal self-esteem (after the infant's birth) and subjective level of infant crying. No links were found between maternal characteristics and perceived time of infant crying. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Dehydration is an important complication for sick children. The Clinical Dehydration Scale for children (CDS) measures dehydration based on 4 clinical signs: general appearance, eyes, saliva, and tears. Objective: To validate the association between the CDS and markers of dehydration in children aged 1 month to 5 years visiting emergency departments (EDs) for vomiting and/or diarrhea. Method: An international prospective cohort study conducted in 3 university-affiliated EDs in 2009. Participants were a convenience sample of children aged 1–60 months presenting to the ED for acute vomiting and/or diarrhea. Following triage, a research nurse obtained informed consent and evaluated dehydration using the CDS. A few days after recovery, another research assistant weighed participants at home. The primary outcome was the percentage of dehydration calculated by the difference in weight at first evaluation and after recovery. Secondary outcomes included proportion of blood test measurements, intravenous use, hospitalization, and inter-rater agreement. Results: During the study period, 264 children were recruited and data regarding weight and dehydration scores were complete for 219 (83%). According to the CDS, 88 had no dehydration, 159 some dehydration, and 15 moderate or severe dehydration. A Chi-square test showed a statistical association between CDS and weight gain, the occurrence of blood tests, intravenous rehydration, hospitalization, and abnormal plasmatic bicarbonate. Good inter-rater correlation was found among participants (linear weighted Kappa score of 0.65; (95% CI, 0.43–0.87). Conclusion: CDS categories correlate with markers of dehydration for young children complaining of vomiting and/or diarrhea in the ED. [Copyright &y& Elsevier]

The objective of the present study was to estimate the prevalence and relative risk of symptoms suggestive of childhood periodic syndrome in migraine, migraine subtypes, and tension-type headache, relative to control subjects. The target population was all children (age 5-12 years) enrolled in public elementary schools in one Brazilian city (n = 2173). Consent was obtained for 1994 children; analyzable data were available for 1906 children, for a final sample of 1113 children with migraine, tension-type headache, or no headache. Parents were interviewed using validated questionnaires. Headache diagnosis was assigned according to the International Classification of Headache Disorders, 2nd edition. Relative risk of symptoms was drawn by headache categories relative to controls. For episodic migraine, the relative risk of all symptoms except nocturnal enuresis was significantly increased: motion sickness, recurrent limb pain, recurrent abdominal pain, and parasomnias, such as sleep talking, somnambulism, and bruxism. For tension-type headache, only nocturnal enuresis and motion sickness were not more common than in controls. In multivariate analyses, any interictal symptom was independently associated with any headache (P < 0.001), migraine headaches (P < 0.001), and tension-type headaches (P < 0.01). These findings indicate that interictal symptoms suggestive of childhood periodic syndromes are common in the population, and are associated with migraine and specific migraine subtypes, but also with tension-type headache. [ABSTRACT FROM AUTHOR]

Abstract: Attention deficit is one of the most frequent symptoms in children with idiopathic generalized epilepsy (IGE). However, it is unknown whether this is a global attention deficit or a deficit in a specific attention network. We used the attention network test (ANT) in children with IGE, who were not being treated with antiepileptic drugs (AEDs), to determine the efficiencies of three independent attention networks (alerting, orienting, and executive control). Children with IGE showed a significant deficit in their executive control network and in overall reaction time. However, they did not show any deficit in their alerting or orienting networks. These results suggest that IGE specifically affects the executive control network. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the utility of symptoms of conduct disorder (CD), oppositional defiant disorder (ODD), attention-deficit hyperactivity disorder (ADHD) and callous-unemotional traits as predictor of psychosocial maladjustment in a community sample of 1517 boys. The study assessed several behavior outcomes including conduct problems, criminal charges, and peer conflict. Results reveal that the most robust predictor is CD while CU were linked with criminal behavior.

Abstract: Background: Neonatal abstinence syndrome (NAS) is a constellation of symptoms resulting from in utero exposure to opioids that appears in 30–80% of opioid exposed infants. Variability in NAS symtomatology is not well understood, and recently it has been suggested that the sex of the infant may play a role in predicting NAS severity. The current study examines the relationship of sex to need for NAS treatment, length of NAS treatment, and peak dose of medication required to treat NAS symptoms. Methods: Retrospective chart review of 308 infants was conducted to determine whether significant differences exist between male and female neonates in need for NAS treatment, length of treatment and peak dose of medication required. Chi-square, multiple ordinary least squares regression, and analysis of variance (ANOVA) analyses were conducted. Results: No significant differences were found in need for NAS treatment, length of treatment or peak dose of medication required between male and female neonates. Conclusions: Results suggest that no significant differences exist in NAS severity between male and female infants. [Copyright &y& Elsevier]

Abstract: Objective: The goal of this study is to determine the correlation of clinical symptoms of UAO (upper airway obstruction) with radiographic evaluation of adenoidal obstruction and tonsil size in children with adenotonsillar hypertrophy and to evaluate the usefullness of lateral neck radiography. Study design: Prospective study. Setting: Haydarpaşa Numune Research and Education Hospital, Istanbul, Turkey. Subjects and methods: This study analyses 95 children with one or more of the symptoms of UAO. Clinical symptoms were assessed by a standardized questionnaire evaluating the severity of symptoms. All patients underwent otolaryngologic examination and their tonsil sizes were graded. 74 of 95 patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. Results: We did not find statistically siginificant correlation between symptom scores and radiologic measurements according to Johanneson (r =0.072, p =0.544, p >0.05) and Crepeau (r =0.034, p =0.773, p >0.05). The correlations between OSA score and Cohen and Konak''s method and AN ratio were weak and not statistically siginificant (p =0.133, r =0.176; p =0.290, r =0.125 respectively; p >0.05). But, we found a statistically siginificant correlation between the tonsil grade and symptom scores (r =0.216, p =0.036, p <0.05). Conclusion: Our results have demonstrated that radiologic measurements of the nasopharyngeal obstruction do not correlate with clinical symptoms of UAO, but clinical assessment of tonsil size does. [Copyright &y& Elsevier]

Abstract: Objective: To compare the range of medical and surgical therapies for children with PFAPA syndrome. Methods: A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1987 and 2010 that compared PFAPA treatment in children (surgical versus medical). Random-effect meta-analytical techniques were conducted for the outcome measures. Results: The use of antibiotics and cimetidine in PFAPA syndrome are ineffective. However, there is evidence that the use of steroids is effective in the resolution of symptoms. Tonsillectomy (+/− adenoidectomy) as a treatment of PFAPA was found to be an effective intervention for resolution of symptoms (P <0.00001). Meta-analysis of surgery versus cimetidine and surgery versus antibiotics demonstrated that surgery is a significantly more effective treatment for PFAPA syndrome. A comparison of treatment with steroids or surgery did not show any statistically significant difference, confirming the effectiveness of both therapies for the resolution of PFAPA syndrome (P =0.83). Conclusions: The most effective non-surgical therapy is corticosteroids. However, they do not prevent future fever cycles. The results of this meta-analysis showed that tonsillectomy (+/− adenoidectomy) is the most effective intervention for long-term resolution of PFAPA syndrome symptoms. [ABSTRACT FROM AUTHOR]