Petterssonmcknight3940

The incidence of pediatric venous thromboembolism (VTE) has been increasing in the past few decades and can be associated with significant mortality and morbidity. There are known risk factors associated with VTE, including estrogen therapy. However, the relationship between testosterone and VTE remains unclear. Here, we present a 17-year-old female-to-male transgender patient without a history of inherited thrombophilia, who developed pulmonary embolism while receiving testosterone injections for gender dysphoria. Despite the limited data on testosterone and the risk of VTE, health care providers should counsel patients and family about the possible increased risk of VTE when starting testosterone.Inflammatory Bowel Disease (IBD) is a chronic disease causing inflammation of the gastrointestinal tract. Some patients require ostomy surgery to optimize their health. This study assessed perceived medical and psychosocial educational needs related to ostomy surgery in pediatric patients with IBD. This mixed-methods study included qualitative interviews of pediatric patients and caregivers with demographic/medical variables obtained from medical records. Participants (n = 8) had an average age of 15.62 years (SD = 2.97). Mean length of diagnosis was 4.5 years (SD = 3.6 years). Interviews were transcribed and coded. Qualitative coding of narratives identified main codes of Ostomy Surgery, Pre-Operative Concerns, Post-Operative Concerns, Education Preferences, and Social Concerns, with various sub-codes. Codes captured unfamiliarity with the ostomies, preferences for education from a medical provider, and psychosocial concerns. Results suggest pediatric patients with IBD have limited understanding of ostomies and limited insight into educational preferences. These findings highlight the importance of developmentally-appropriate information for accessible ostomy education.OBJECTIVES The accuracy of different bioelectrical impedance analysis (BIA) devices for assessing body composition in children with obesity is unclear. We determined the relative accuracy of two BIA devices compared to dual x-ray absorptiometry (DXA) in obese and severely obese children. METHODS We measured body composition in a cross-sectional study of 78 obese children by a handheld single frequency tetrapolar BIA device (Omron), a stationary multifrequency octopolar BIA device (InBody 370) and DXA. Inter-method agreement was assessed by intraclass correlations, paired t-tests, and Bland-Altman analyses. RESULTS Participants (37% female, age 14.8 ± 2.7 years) had mean (±SD) BMI of 36.7 ± 7.5 kg/m, body fat percentage of 46.4 ± 5.2% and appendicular lean mass of 22.5 ± 6.0 kg by DXA. Intraclass correlations with DXA for body fat percentage were 0.39 and 0.87 for single frequency tetrapolar and multifrequency octopolar BIA devices, respectively. The single frequency tetrapolar BIA underestimated body fat percentage by 5.5 ± 2.9% (p  less then  0.0001). Differences between the multifrequency octopolar BIA and DXA for body fat percentage (-1.1 ± 2.8%) and appendicular lean mass (-0.3 ± 1.4 kg) were small, and 95% limits of agreement were approximately ± 5%. CONCLUSIONS BIA machines vary in relative accuracy in measuring body composition in children who are obese and severely obese. The multifrequency octopolar BIA device accurately estimated body fat percentage and appendicular lean mass relative to DXA and has the advantage of point of care performance.OBJECTIVE To determine whether clinical characteristics and management of pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) differ across INSPPIRE (INternational Study Group of Pediatric Pancreatitis In Search for a CuRE) sites. STUDY DESIGN Data were collected from INSPPIRE and analyzed per US regions and "non-US" sites. Between-group differences were compared by Pearson Chi-Square test. Differences in disease burden were compared by Kruskal-Wallis test. RESULTS Of 479 subjects, 121 (25%) were enrolled in West, 151 (32%) Midwest, 45 Northeast (9%), 78 (16%) South and 84 (18%) at non-US sites. Hispanic ethnicity was more common in South (p  less then  0.0001); white race in Northeast (p = 0.009). CP was less common and time from diagnosis of first acute pancreatitis to CP was longer in children at non-US sites (p = 0.0002 and p = 0.011 respectively). Genetic mutations were most common among all groups; PRSS1 variants predominated in Midwest (p = 0.002). Gallstones were more frequent in South (p = 0.002). ERCP and CT imaging were more commonly utilized in US compared to non-US (p  less then  0.0001), but there were no differences in the use of MRI/MRCP. Disease burden was highest in the West and Midwest, possibly because total pancreatectomy and islet autotransplantation (TPIAT) referral sites were located in these regions. All therapies were less commonly administered in non-US sites (p  less then  0.0001). CONCLUSION This is the first study to describe geographical variations in the INSPPIRE cohort, which possibly reflect variations in practice and referral patterns. The underlying reason behind the lower frequency of CP and fewer treatments in non-US sites need to be further explored.OBJECTIVE Dietary lipid intake is associated with serum alpha-tocopherol levels; however, its impact on human milk is unknown. The objective of this study was to evaluate the relationship between maternal intake of vitamin E, lipids, and fatty acids and the concentration of alpha-tocopherol in human milk. METHODS We conducted a longitudinal observational study, including 143 lactating women on 7, 30, and 90 days postpartum. Dietary intake was collected using 24-hour recall. On day 90, a human milk sample was collected and analyzed for alpha-tocopherol concentration. The prevalence of inadequate vitamin E intake was determined by the Estimated Average Requirement (16 mg/day), and the alpha-tocopherol concentration was analyzed by high-performance liquid chromatography. RESULTS Dietary intake of vitamin E was associated with the intake of lipids (r = 0.237, P = 0.004) and fatty acids (P  less then  0.05), and 100% of the participants had inadequate vitamin intake. Mean alpha-tocopherol concentration in the human milk samples was 7.11 (SD 3.95) μmol/L and was correlated with lipid (r = 0.201, P = 0.042) and polyunsaturated fatty acid intake (r = 0.235, P = 0.017). Higher vitamin E levels were found in participants with the highest quartile of polyunsaturated fatty acid intake. CONCLUSIONS Alpha-tocopherol concentration was associated with the dietary intake of lipids and fatty acids, demonstrating that its bioavailability is associated with fats in the mammary gland. These results suggest development of appropriate strategies to increase the levels of vitamin E in breast milk that may help to prevent and treat vitamin E deficiency.INTRODUCTION Pediatric chronic pancreatitis (CP) is increasingly diagnosed. Endoscopic methods (endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP)) are useful tools to diagnose and manage CP. Pediatric knowledge and use of these modalities is limited and warrants dissemination. METHODS Literature review of publications relating to use of ERCP and EUS for diagnosis and/or management of CP with special attention to studies involving 0-18 years old subjects was conducted with summaries generated. Recommendations were developed and voted upon by authors. RESULTS Both EUS and ERCP can be used even in small children to assist in diagnosis of CP in cases where cross-sectional imaging is not sufficient to diagnose or characterize the disease. Children under 15 kg for EUS and 10 kg for ERCP can be technically challenging. These procedures should be done optimally by appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children. EUS and ERCP-related risks both include perforation, bleeding and pancreatitis. EUS is the preferred diagnostic modality over ERCP due to lower complication rates overall. Both modalities can be used for management of CP-related fluid collections. ERCP has successfully been used to manage pancreatic duct stones. CONCLUSIONS EUS and ERCP can be safely used to diagnose CP in pediatric patients and assist in management of CP-related complications. Procedure-related risks are similar to those seen in adults, with EUS having a safer risk profile overall. The recent increase in pediatric-trained specialists will improve access of these modalities for children.The incidence of gastroenteritis has greatly reduced due to improved hygiene conditions in developing countries and the use of Rotavirus vaccine. However, still thousands of children die from gastroenteritis, most of them in poor countries. Yet gastroenteritis management is simple, inexpensive, and effective and is largely the same all over the world. Universal guidelines for gastroenteritis guide the management and include simple interventions put forward early in the course of the disease. Treatment includes rehydration, continuing oral feeding, and anti-infective drugs in selected clinical conditions related to the symptoms or to host-related risk, and possible additional drug treatment to reduce the duration and severity of symptoms. There may be minor geographical differences in the treatment applied due to health care organizations that do not substantially change the standard universal recommendations. Prevention is recommended with sanitation interventions and Rotavirus universal immunization. Implementation of those interventions through educational initiatives and local programs in target areas are needed. A series of recommendations for interventions, education, and research priorities are included here with the aim of reducing the burden of gastroenteritis, to be pursued by scientists, physicians, policy makers, and stakeholders involved. They include the need of recommendations for the management of gastroenteritis in malnourished children, in those with chronic conditions, in neonates, and in emergency settings. A reference system to score dehydration, the definition of optimal composition of rehydration solution and the indications for anti-infective therapy are also included. Rotavirus immunization should be actively promoted, and evidence-based guidelines should be universally implemented. Research priorities are also indicated.Previous studies have indicated that neighborhood disorganization affects child-rearing beliefs in the United States, but few studies have focused on such influences among Asian American parents. Largely due to Asian American parents' immigration experiences, neighborhood disorganization factors inevitably intersect with their traditional cultures, which may lead to different patterns in their parental beliefs. https://www.selleckchem.com/products/cpi-203.html Using structural equation modeling, this study found that neighborhood disorganization factors directly influenced Asian American parents' beliefs toward physical punishment and parenting stress mediated this relationship. These findings suggest that the integration of family and neighborhood-level practices in social services may reduce the risk of physical abuse.