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  • ISSN: 2373-9312
    Volume 1, Issue 1
    October-December 2013
    Editorial
    Hanan Tanuos1* and Anthony Wassef2
    Human Papilloma Virus (HPV) affects approximately 20 million people in the US [1]. Roughly 7,000 males and 18,000 females acquire cancer yearly due to HPV [1]. HPV quadrivalent vaccine contains four serotypes, 6,11,16,18. 90% of genital warts are caused by serotypes 6 and 11 while oropharyngeal and anogenital warts are caused by serotypes 16 and 18 [2]. In 2009 the Advisory Committee on Immunization Practices (ACIP) recommended permissively to vaccinate males with HPV vaccine. Two years later, the ACIP affirmed its recommendations for routine vaccination of all males ages 11years – 12 years with catch up for males through the age of 26 years [3].
    Dayanand N Bagdure*
    Seasonal and pandemic influenza continue to be important causes of mortality and morbidity in children, especially younger ones [1-3]. Nair and colleagues published in 2011 estimating 90 million new cases of influenza in children younger in 5 years and 20 million cases of influenza associated acute lower respiratory tract infections [3].
    Cynthia Lewis*
    When asked to be a guest editor in this issue, I pondered what topic I would cover with the vast array of medical and psychosocial concerns we address from day to day in our practices. However with the shockingly violent acts involving youth that have made headline news of late from the Newton Massacre, to the teen sexual assault in Maryville, Mo, to the multiple teen victims of gun violence on a given night on the Southside of Chicago, it seemed appropriate to look again at ways we may address youth violence in primary care. While “Leave Out the ViolencE” is a catchy messaging phrase for youth, as PCP’s we cannot afford to leave it out during visits with our patients.
    Minireview
    Stephanie Nguyen* and Lavjay Butani
    Abstract: Antibody mediated rejection is increasingly being recognized as a significant player in contributing to long term graft injury and loss in renal transplant recipients. Due to the paucity to large and robust trials, much of what we know about this entity is based on small case series and reports. Our review discusses the importance of antibody mediated rejection in children with renal transplants and provides an overview of the diagnostic and therapeutic options available to clinicians caring for these children.
    Research Article
    Esther Y. Yoon1*, Julie S. Weber1,2, Brigitte McCool1, Albert Rocchini3, David Kershaw4, Gary Freed1, Frank Ascione5 and Sarah Clark1
    Abstract:
    Objective: To describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with hypertension.
    Methods: We conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each participant was asked to “think aloud” regarding their approach to a hypothetical patient - 12 year old boy with persistent hypertension for 6 months. Standardized open-ended questions about potential factors that could affect physicians’ diagnosis and treatment strategies (e.g., patient age) were used. Interviews were audio-recorded; transcribed verbatim; transcripts were independently coded by 2 investigators; emergent themes identified and inter-coder agreement achieved. Thematic analysis was performed based on grounded theory.
    Results: Nineteen participants included 5 general pediatricians, 5 pediatric cardiologists, 5 pediatric nephrologists and 4 family physicians. Five themes emerged: 1) Accuracy of blood pressure measurement and hypertension diagnosis, 2) Shift in the epidemiology of pediatric hypertension from secondary to primary hypertension, 3) Patient characteristics considered in the decision to initiate workup, 4) Obesity-centered choice of diagnostic tests and lifestyle modifications, and 5) Variable threshold for initiating antihypertensive pharmacotherapy vs. referral to hypertension specialists.
    Conclusions: There is variation across primary care and specialty physicians who provide care for children and adolescents with hypertension. Key areas of variability include the willingness to initiate antihypertensive medications, the use of diagnostic tests (e.g., ambulatory blood pressure monitoring), and the perceived need for specialty referral. Further study is needed to assess whether different treatment paradigms result in differential patient outcomes.
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