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  • ISSN: 2373-9312
    Volume 2, Issue 4
    Case Report
    Chris Scannell1, Abiola Olowoyeye2*, Daniel Castellanos2 and Alexander van Speybroeck3
    Abstract: A 7-year-old previously healthy male presented with sudden worsening of a chronic lower back pain that had been present intermittently for 7 months requiring ibuprofen. His review of systems was essentially negative. Family history was negative for malignancies. Physical examination was only positive for a limping gait with tenderness in the right lateral lumbar region. CT of the lumbar spine, CBC, ESR, and CRP were normal. A lumbosacral MRI with and without contrast demonstrated a cystic structure, at the level of L3. After surgical excision, histology revealed a squamous epithelium lined cyst consistent with an epidermoid cyst. Low back pain is an uncommon but often serious presentation in children with an extensive list of differential diagnoses including musculoskeletal, neurologic, rheumatologic, oncologic, renal and infectious etiologies. Intraspinalepidermoid cysts are rare thin-walled inclusions lined by stratified squamous epithelium. Low back pain is the most common presentation of intraspinalepidermoid cysts. MRI is the imaging modality of choice and can distinguish intraspinalepidermoid cysts from other pediatric intraduralextramedullary spinal cord tumors. Spinal surgery is the mainstay of treatment and complete resection is usually curative.
    Laura Stefanic* and Luis Maldonado
    Our patient was a one-day old male who was born at 36 weeks and six days by repeat cesarean without any complications. The mom was a 30 year-old Gravida 6, Parity 3 female with history of three miscarriages all around three months of gestation. She received normal prenatal care and reports all normal ultrasounds during pregnancy. She had influenza during the pregnancy. She was treated with Tamiflu. She also took prenatal vitamins but denied any other medication, illicit drug, alcohol, or tobacco exposure. She had an elevated one hour diabetes screening with a normal three hour testing. Maternal Toxoplasma, Rubella, Cytomegalovirus, and Herpes Simplex Virus titers were all negative.
    Charline S Boente and Faruk H Orge*
    Abstract: Brown syndrome is a special form of strabismus characterized by limited elevation of the eye in adduction resulting from an abnormality of the superonasal aspect of the orbit. The etiology may be congenital, inflammatory, or traumatic, and treatment approaches can vary. We report a case of Brown syndrome causing diplopia in a child after trauma to the lateral side of the face but with an unclear mechanism of injury to the superonasal orbit.
    Jahee Hong*, Lily B. Glater-Welt, Linda B. Siegel
    Abstract: Takotsubo cardiomyopathy is not infrequently encountered in adult populations, but has rarely been described in pediatric patients. Takotsubo cardiomyopathy is a form of stress-related cardiomyopathy, that usually occurs after significant emotional or physical stressors leading to autonomic storm, although this is not required for diagnosis. It is indistinguishable from an acute myocardial infarction and often times resolves without intervention. We report a case of a 23-month-old male who suffered traumatic brain injury, and Takotsubo cardiomyopathy 11 days after the initial injury. We propose either hypoglycemia or cessation of sedation as the possible cause of Takotsubo cardiomyopathy.
    Research Article
    KR Ledwaba, F Nkalanga, KD Monyeki* and M van Staden
    Abstract:
    Objectives: The prevalence of obesity and hypertension in sub-Saharan Africa are increasing to higher levels, even amongst children and adolescents.The aim of the study was to determine the relationship between Mid-upper arm circumference (MUAC), as a measure of obesity, and elevated blood pressure (BP) among Polokwane private school children.
    Study Design: A total of 1629 subjects (boys=821 and girls=808) aged 6-13 years attending three private schools in Polokwane participated in the survey. The receiver operating characteristics curve was used to discriminate children with high BP. Linear regression was used to assess the relationship between BP and MUAC.
    Results: The prevalence rate recorded for hypertension was 12.9% for girls and 9.3% for boys, whereas overweight was recorded as 47.9% for girls and 26.7% for boys. Area under curve (AUC) for hypertension, high systolic blood pressure (SBP) and high diastolic blood pressure (DBP) were significantly (P<0.05) higher in girls than boys. Linear regression showed a significant association for MUACand BP (SBP, b=1.6, 95% CI 3.0-7.0; DBP, b=1.2, 95% CI 2.3-4.7) after adjusted for age and gender.
    Conclusion: Polokwane private schoolgirls showed higher prevalence of overweight and hypertension than boys. There was a significant relationship between MUAC and BP. Thus MUAC can be used as an inexpensive and easy risk marker for the presence of hypertension in children. An investigation into the physical activity level of these children will assist in uprooting the dynamics of cardiovascular diseases.
    Rachel Y Goldstein, Elizabeth RA Joiner, and David L Skaggs*
    Abstract:
    Background: The American Academy of Pediatrics (AAP) recommends that patients with scoliosis with a Cobb angle over twenty degrees be referred for orthopedic care. The purpose of this study was to examine how referral patterns are related to curve magnitude at presentation and need for intervention in patients with idiopathic scoliosis.
    Methods: This study was a retrospective review of all patients presenting in an outpatient setting for evaluation of scoliosis over ten years of age. Exclusion criteria were non-idiopathic scoliosis or previous spine surgery. Data was collected on demographics, curve magnitude at presentation, referral source, treatment recommendations and whether surgery was eventually recommended.
    Results: Of 570 patients who met inclusion criteria, 52% were referred for evaluation by their primary care providers (PCPs), 18% were second opinions, 15% were referred by school screening, and 6% were primary self-referrals. There was a significant difference amongst the referral sources with regards to the Cobb angle at presentation (p<0.001), treatment recommendations (p<0.001), and likelihood of recommending surgery (p<0.001). Overall, 62% of patients met AAP criteria of 20 degrees for referral. No patient with a curve magnitude of less than 20 degrees at presentation had treatment recommended.
    Conclusions: Thirty-eight percent of patients presenting for scoliosis evaluation at our tertiary pediatric medical center did not meet AAP guidelines for referral, and none of these patients had treatment recommended for scoliosis. Second opinion and primary self-referred patients presented with larger curves and were significantly more likely to require treatment than those referred from school screening or PCPs.
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