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Growth Disorders 2007-12-10 14:51:00 The highest growth rate that occurs during life occurs in utero. You’ll all recall that an average birth length is 20 inches, or 51 centimeters, which is achieved in a nine-month period of fetal life, which translates out to 68 centimeters per year were it maintained. After birth the growth rate decreases rapidly over the first four years, such that between the ages of 4 and 10 - regardless of sex - a child normally grows 5 centimeters, or 2 inches, per year. If you like to break it down more carefully by different ages you can see the pattern here. You’ll notice in the first six months of life, 35 centimeters per year. The second six months of life slows down but it is still quite fast - 15 centimeters per year - just divide these numbers by 2.5 to get inches. And then in the remainder of the prepubertal window, about 5 centimeters or 2 inches per year.
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In our approach to a short child, which is really what the bulk of this first part of my talk is going to be about, Read more:Growth
Complementary Therapies for Depression. Conclusions 2 2007-12-05 09:44:14 A number of mechanisms by which exercise may improve mood have been proposed. (41, 46) These include physiological effects, such as changes in endorphin and monoamine levels; psychological effects, such as subject expectation, diversion from stressful stimuli, the effects of receiving attention, improved self-image, and feelings of control; and sociological factors, such as the benefits of social interaction and support. Although some longitudinal epidemiological evidence (89, 90) indicates that there may be a strong link between exercise and a reduction in depression levels, it is necessary to investigate this possibility further via high quality RCTs.
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Few clinical studies are available regarding the effectiveness of other CATs in the treatment of depression. The data that do exist are generally of poor methodological quality. There are some indications that aromatherapy, massage, music therapy, and relaxation techniques may be of value. These areas thus warrant fur Read more:Complementary
Complementary Therapies for Depression. Conclusions 2007-12-05 09:41:51 Because of the nature of the evidence relating to CAM and depression, a qualitative overview seemed preferable to a systematic review. Collectively, the above data suggest that exercise and H perforatum are effective symptomatic treatments for mild to moderate depression. The evidence for acupuncture, massage, and relaxation is promising, but not compelling.
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Acupuncture and electroacupuncture can stimulate the synthesis and release of the monoamines serotonin and noradrenaline-norepinephrine in animals. (85) This is the postulated mechanism for the perceived beneficial effect of acupuncture in depression. The evidence available on the efficacy of electroacupuncture in the treatment of depression has mainly come from 1 research group at the Institute of Mental Health, Beijing, China. The limited number of RCTs suggest a beneficial effect of a similar magnitude to that produced by amitriptyline hydrochloride. Electroacupuncture is reported to produce fewer and less-s Read more:Complementary
Massage therapy. Relaxation therapy 2007-12-05 09:38:36 MASSAGE THERAPY
There are several different forms and traditions of massage therapy. (72) In the context of this article, massage uses typically a gentle manual stroking technique over the body (usually the back). This has a number of complex physiological and psychological effects, not least of which is relaxation of both the musculature and the mind. (72) A treatment, usually carried out by an NMQT, would normally last for 20 to 30 minutes and a series of approximately 6 twice weekly sessions would constitute a typical prescription.
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Most publications relating to massage and depression were found to consist of anecdotal accounts and case studies. (73, 74) A recent review (75) of massage therapy uncovered only a few controlled trials. An RCT (76) allocated 122 intensive care unit patients to receive either massage, massage with 1% lavender (Lavendula vera) oil, or rest periods. Those who received the massage with lavender oil reported a greater improvement in mood Read more:Relaxation
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Now growth hormone deficiency 2007-12-21 12:53:42 Now growth hormone
deficiency, if present, can be an isolated phenomenon or a current combination with other pituitary hormone deficiencies. Its etiology is usually a hypothalamic deficiency, which really means that the patients aren't truly growth hormone deficient; they are deficient in the hypothalamic factor growth hormone releasing hormone which regulates growth hormone. But from a treatment perspective, we use growth hormone because it's easier to use and hence we say that the patients are growth hormone deficient. This can be idiopathic. It can be the result of tumors or their treatment. Most commonly craniopharyngioma. This can be due to congenital anomalies, including the things listed here that can be involved. The septum pellucidum and the optic nerve, septo-optic dysplasia. It can be a congenital transsection of the hypothalamic pituitary stalk, various gross midline syndromes described here. Trauma, surgery, radiation, the result of infection, pretty much anything has
Growth Disorders. Now here is a young lady 2007-12-21 12:50:37 Now here is a young
lady who doesn't look very happy, and you would probably have trouble telling - and I'm going to give you a better demonstration in the second talk about this - but she happens to have myxedema of her face, which you might not be able to tell, but I show her to you as a representative patient with long-standing acquired primary hypothyroidism. Alternatively, as another endocrine cause, which you could use that growth curve to show, this is a patient with endogenous Cushing's syndrome. You'll notice a sort of plethoric round face. There is a buffalo hump on the back that you can't see. He's got centralized obesity with lymph sparing. He's got a lot of acne and he has easy bruisability with a lot of ecchymoses and he has horizontal stria of his legs. So if one is considering hypothyroidism, the most common cause for hypothyroidism which can affect linear growth would be Hashimoto's thyroiditis. Much less common would be a form of central thyroidism, an Read more:Growth
Growth Disorders. Now only half of the patients 2007-12-20 10:18:51 Now only half of the patients
with Turner's syndrome have the classic 45 X karyotype. It used to be called 45 XO but technically there is no O chromosome, so we just call it 45 X. The remainder are mosaics, and contrary to popular opinion they are not necessarily less stigmatized. There is certainly no difference in final height outcome between straight 45 X patients and those with mosaics. The same thing would be true in the patient group with Turner's syndrome who have structural abnormalities of the X chromosome; that is to say, they have 46 chromosomes and two X's but not all of both X's. These patients too have Turner's syndrome and are not necessarily less stigmatized than the classic 45 X patients.
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The physical findings, as you know, in Turner's syndrome; the first patient demonstrated that. At least some of them include lymphedema, webbed neck - but I want to point out to you that webbed neck is only present 25% of the time - Read more:Growth
Growth Disorders. This is a child with Russell-Silver 2007-12-20 10:13:25 Cheap Canadian Pharmacy
This is a child
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syndrome who is about nine-months-old, who had intrauterine and postnatal growth retardation with a relative sparing of the head. That's why the face has sort of a triangular appearance to it. The brain is growing behind the forehead normally and causes this relative dysmorphism but that's actually a good thing. But the issue of asymmetry, I think you can see between the legs. This one, if you can imagine the circumference of this is wider than that one, so this leg is either bigger than that one, or that one is smaller than this one, but there is asymmetry. And if present, enables you to make this diagnosis. For the purposes of demonstration here is a child with achondroplasia. In case you are curious, a hyperchondroplasia is a milder variant of this, but these individuals end up frequently around four feet tall as adults.
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Another category of genetic disease, which is very important and actually quite comm Read more:Growth
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Growth Disorders. Let’s look at the opposite situation for just a moment. 2007-12-26 09:43:25 Let’s look at the opposite
situation for just a moment. That being tall stature. Causes of tall stature are as follows: the most common is familial tall stature, just like short parents tend to get short kids, tall parents tend to get tall kids. Another cause, which may not be well known to you, is [...] Read more:Growth
If one found growth hormone. Growth Disorders 2007-12-26 09:39:36 If one found growth hormone
deficiency and still needed to look further, the MRI is a very beautiful tool. What you see here is the hypothalamic-pituitary stalk, the nose is out here and there is a transection. You see where it is black in the middle and this is where the MRI has helped to [...]
Common triggers 2008-03-24 11:10:27 Human growth hormone
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triggers; most common trigger, under about 3-5 years of age, RSV. Most common trigger after five-years-of-age that’s viral, is actually rhinovirus. Interestingly, a virus that primarily affects the nose - for reasons that are not clear - leads to exacerbations of asthma. Most bacterial infections do not exacerbate asthma with one big [...]
A couple of terms from the allergy literature 2008-03-24 11:07:50 A couple
of terms from the allergy literature that you have to know about, the early response to asthma. If you are allergic to cats and I throw you into a room with cats, you are going to start wheezing pretty quickly, within about five or ten minutes. If I then take the cats out [...]
Asthma 2008-03-24 11:05:34 Asthma is an inflammatory disorder. Even in mild asthma there is inflammation. Recurrent episodes of wheezing, shortness of breath, chest tightness, coughing. The key symptom in kids is coughing. Not wheezing. Prolonged cough in children, especially at night or in the morning, is asthma until proven otherwise. Asthma obviously has three main components, and [...]
Leukotriene modifiers 2008-04-03 15:09:43 Leukotriene modifiers; this was real exciting when these first came out, and unfortunately they are not ending up quite as powerful as we had hoped. Leukotrienes are chemical mediators that are released by leukocyte’s mast cells. They break down products of arachidonic acid. And different leukotrienes will do different things. Certain ones will cause mucus [...]
Inhaled steroids 2008-04-03 15:06:26 Inhaled steroids; still far and away the best long-term preventive agent for asthma, period. The problem is potential side effects. If basically decreases the late response. It doesn’t stop the initial bronchoconstriction but also deals with the hyper-responsiveness and you can see improvement within a few days in lung function, on inhaled steroids. Maxing out [...]
Chronic asthma 2008-04-02 14:55:02 Okay, let’s talk real quickly about chronic asthma
. The National Heart/Lung Institute has had two documents out over the last about five or six years. The Expert Panel’s Report on Asthma. If you guys are actually general pediatricians and take care of asthmatics, get on their web site and download the Expert Panel II. A [...]
Oral steroids: these are the indications 2008-04-02 14:48:41 Oral steroids; these are the indications. These are pretty straightforward. If it’s a severe exacerbation, moderate to severe, you just go ahead and use them. If they are not responding well to the albuterol, if they are using steroids recently, the fourth one there. You always go home with one more medication than you came [...]
Risk factors for fatal asthma 2008-04-01 15:01:52 Okay, risk factors
for fatal asthma
. These things are pretty self-evident most of the time. Previous life-threatening exacerbation. In adults, if you had almost died from asthma, 10% of those adults die within the following year from their asthma. It’s a big time, important problem if somebody gets intubated with asthma. Hospitalized more than once; [...]
Lab studies 2008-04-01 14:58:54 Lab studies; one thing I try to tell our residents, don’t get a chest x-ray in kids with asthma, because then you will be forced to throw them on antibiotics because they are going to have mucus plugging and they are going to have infiltrates. The only reason to get an x-ray on a kid [...]
Alternative diagnosis. Asthma 2008-04-01 14:57:57 Alternative diagnosis
; if these things are present, you have to think of something other than asthma. There’s an old adage that “all that wheezes is not asthma.” Well, the corollary to that is, “Almost all that wheezes is asthma” and it’s only in rare cases that you have to worry about other things. But obviously [...] Read more:Alternative
This is not in your handout. Don’t panic 2008-04-04 10:16:21 Canadian pharmacy generic viagra
This is not in your handout. Don’t panic. I made up a new sheet that’s on the back table, but I thought you might need to know this. Symptoms; when do you start prophylaxis? These are the guidelines. If you need to use a beta agonist more than twice a week for [...]
Causes of iron deficiency 2008-04-08 11:55:37 Inadequate dietary iron for high physiologic requirements. Iron deficiency is the most common nutritional deficiency in the world. Infants, adolescents and women of child bearing age are at the highest risk of iron deficiency and may become iron deficient because of inadequate dietary iron to meet physiologic needs. Infants one to two years of age [...]
Iron Deficiency 2008-04-08 11:52:47 Iron deficiency is the most common cause of anemia in many parts of the world and is usually the result of blood loss, often combined with inadequate dietary iron. Iron deficiency occurs most commonly in menstruating women. When iron deficiency occurs in men or non menstruating women, the most likely site of blood loss is [...] Read more:Deficiency
The serum ferritin 2008-04-10 11:18:33 The serum ferritin is a very helpful measure of total body iron stores and a low level (<12 mg/L) is diagnostic of iron deficiency. The serum ferritin is a positive acute phase reactant and may not reflect iron deficiency in a patient with both lack of iron and an inflammatory process. Typically the transferrin saturation [...]
Symptoms. Iron Deficiency 2008-04-10 11:13:21 Symptoms. Even in the absence of anemia, iron deficiency may have adverse effects. Non-anemic children with prolonged iron deficiency in the second year of life were later found to have impaired mental and motor development at five years of age. In pregnancy, maternal iron deficiency may be associated with low fetal birth weight and increased [...] Read more:Deficiency
Management of iron deficiency. Part 2 2008-04-15 11:07:45 3. Parenteral iron. Parenteral iron in the form of iron-dextran may be given intramuscularly or intravenously, but does not lead to a more rapid hematologic response than oral iron and rare anaphylactic reactions have been reported. In general it should be reserved for individuals with malabsorption or intractable non-compliance with oral therapy.
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Management of iron deficiency 2008-04-15 11:05:17 1. Identify the cause. Iron deficiency as the cause of anemia is suspected on epidemiologic grounds. As discussed above, the condition is a common cause of low hemoglobin in infants, adolescents, women of childbearing age, individuals with hookworm infestation and patients with chronic blood loss from the gastrointestinal tract or other sites. Before treatment, consideration [...] Read more:Management
The pharmacokinetic drug interactions 2008-04-21 16:42:27 The pharmacokinetic drug/drug interactions
actually start over on this side, on the left side, and move all the way through to the right side. And that is when you have drugs administered simultaneously and because of something that happens - either through absorption or distribution or metabolism - you have a change in the plasma [...]
Drug Interactions 2008-04-21 16:40:00 Clinically important drug/drug interactions. A drug/drug interaction is a pharmacologic response which cannot be explained by the action of a single drug alone, but rather it is due to two or more drugs acting simultaneously. I made absolutely no comments as to whether or not it was beneficial or harmful. The reason for that is [...]
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