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  • ISSN: 2373-9312
    Current Issue
    Volume 5, Issue 4
    Case Report
    Rita Padoan, Piercarlo Poli*, Luca Tonegatti, and Diego Falchetti
    Recurrent intestinal obstructions are frequently reported in Cystic Fibrosis patients at any age. The most frequent diagnoses are constipation and distal ileal obstruction syndrome, however in previously operated patients, post-surgical adhesions must be considered in the differential diagnosis of recurrent abdominal pain. We report the case and the follow-up of a 4-years-old Cystic Fibrosis child with recurrent intestinal obstruction after neonatal abdominal surgery for meconium ileus. The decision making process to treat symptoms is described. The chosen surgical procedure proved to prevent any further occlusive episode in a ten years follow up.
    Baruch Goldberg*
    This case report highlights the importance of working through a differential diagnosis when a child presents with arthritis or enthesitis, as Juvenile Idiopathic Arthritis (JIA) is a diagnosis of exclusion. A twelve-year-old girl presented to clinic with chronic arthralgias, most notably in her ankles. Some of her symptomatology was characteristic of inflammatory arthritis - morning stiffness and limp. However, the pain was also worse with activity, better with rest, and with occasional night awakenings. Her physical exam revealed no arthritis but she did have enthesitis with swelling, warmth and tenderness over her posterior-lateral malleolus. Nonsteroidal anti-inflammatory drug (NSAID) therapy was started and she had blood work to further investigate the etiology of her enthesitis. Diagnostic considerations were concerning for HLA B27 associated enthesitis related arthritis, psoriatic JIA, Inflammatory bowel disease and chronic recurrent multifocal osteomyelitis. Laboratory findings showed elevated ESR and CRP consistent with inflammation. HLA B27, Rheumatoid Factor and ANA were negative. Her blood count showed mild leukocytosis and anemia. Her differential revealed 17% atypical lymphocytes and 30% blasts. LDH was 251 u/l [normal range 98-192u/l] and uric acid was 6.9 mg/dl [normal range 2.5-7.0mg/dl]. Her peripheral smear showed increased circulating blasts and flow cytometry was consistent with B cell Acute Lymphoblastic Leukemia. The importance of this case is to remember that musculoskeletal symptoms may precede constitutional symptoms in children with leukemia. Thus, it is essential to rule out other differentials prior to diagnosing JIA, especially prior to initiation of steroid or immunosuppressive therapies.
    Research Article
    Adriane Muller Nakato*, Regina PGV Cavalcante da Silva, and Nelson A. Rosario Filho
    Background: Capnometry can reduce arterial blood sampling and allow fast and noninvasive assessments using end-tidal of carbon dioxide (EtCO2).
    Objectives: The aims of this study were to evaluate the correlation of partial pressure of arterial CO2 (PaCO2)levels and EtCO2, and to verify whether capnometry would be useful for noninvasive monitoring of CO2 levels in intubated premature infants with and without diffuse parenchymal lung diseases (DPLD).
    Methods: This study was conducted in premature infants admitted to the Neonatal Intensive Care Unit (NICU) from August 2014 to November 2016. EtCO2 levels were compared with PaCO2 levels, in intubated premature infants with and without DPLD. Both parameters were obtained daily until tracheal extubation. The correlation coefficient and degree of bias between them was determined.
    Results: Overall, 221 measurements of EtCO2 and PaCO2 levels were obtained from 51 neonates. Twenty-eight were obtained from neonates without DPLD (12.7%) and 193 from those with DPLD (87.3%). The most frequent cause of DPLD was respiratory distress syndrome (RDS) in 86.5%. There was a positive correlation between PaCO2 and EtCO2 levels (n = 221; r = 0.853; p < 0.0001) in the overall cohort. Both groups showed a good correlation between both parameters, without DPLD (mean bias = 0.21, SD, 7.05; 95% CI -13.61 14.05), and with DPLD (mean bias = 0.37, SD, 7.66; 95% CI -14.65 15.39).
    Conclusions: Capnometry is a useful noninvasive technique to monitor intubated premature infants. EtCO2 measurement may be a valid adjunctive parameter when titrating ventilator support.
    Review Article
    Ana Carolina Lobor Cancelier*, Daisson Trevisol, and Fabiana Schuelter-Trevisol
    Background: Childhood obesity is growing worldwide and brings concerns that overweight or obese children are more likely to become obese as adults. Early diagnosis is of utmost importance, and for that purpose, WHtR is easy to use and interpret by the primary care physicians.
    Objective: To examine the validity of the waist-to-height ratio as a tool for obesity screening in the pediatric population.
    Data sources: The search for articles was conducted in the following databases: Medline (via PubMed), Scientific Electronic Library Online (SciELO), CAPES Bank of Theses and Dissertations, and Cochrane Library.
    Study selection: The authors independently selected the studies in two steps, first by assessing the title and abstract, and then by reading the full text. Disagreements were resolved through consensus.
    Data extraction: The data were summarized in a table covering the study site, year of publication, mean age and standard deviation, total sample size and percentage of boys, cutoff points and gender-related sensitivity and specificity, and risk of bias.
    Results: The weighted average cutoff points of the examined studies were 0.459 ( 0.017) for girls and 0.473 ( 0.019) for boys, in the 618 year age group.
    Limitations: There was one study from a single country responsible for the largest number of samples, which might have affected the results because of ethnic factors.
    Conclusions: The WHtR cutoff point for children and adolescents aged 6 to 18 years should be lower than that determined for adults. Studies involving children from several countries are still needed to validate the appropriate cutoff point for childhood obesity diagnosis.
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