Gestational diabetes and its impact on the neonate

Gestational diabetes mellitus is a relatively common medical condition that was described as early as the nineteenth century. This article discusses the maternal and fetal pathophysiology and the impact of the maternal condition on the neonate. Fetal macrosomia and infant respiratory distress syndrome, cardiomyopathy, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, and hyperviscosity all can occur as a result of maternal hyperglycemia and are discussed in detail. Therapeutic approaches and treatment options for the mother, manifestations and diagnosis of the infant, and current research related to this condition are also included.     

THERAPIST-ASSISTED VERSUS SELF-HELP RELAXATION TREATMENT OF CHRONIC HEADACHES IN ADOLESCENTS: A SCHOOL-BASED INTERVENTION

This study compared the relative efficacy of a therapist-assisted relaxation treatment programme with a self-help approach and a self-monitoring condition in the treatment of chronic headaches in adolescents within a school setting. The subjects were 46 high school students, 16-18 years of age, who were randomly assigned to the three treatment conditions. The results indicated that the self-help approach was as effective as the therapist-assisted relaxation condition in reducing the students' headache, and that these findings were maintained at a 5-month follow-up evaluation. The results suggest that the self-help relaxation procedure is a potential low-cost alternative treatment to a more traditional therapist-based intervention condition.     

Spontaneous bilateral hemotympanum in idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura is a condition frequently encountered in childhood. Extensive literature currently exists on its etiology and management. Petechiae, ecchymoses and epistaxis are the usual manifestations of this condition, originating from the autoimmune destruction of platelets. Bleeding may occur spontaneously from any mucosal membrane. While bilateral hemotympanum has yet to be documented as a possible complication of this condition, immediate impact on the child’s hearing will require appropriate follow-up.     

Lemierre syndrome: a case report

Lemierre syndrome is a condition that can have high morbidity and mortality, but if it is diagnosed early in a patient's workup, that is, in the ED, the morbidity and mortality can be significantly decreased. First described by Dr Andre Lemierre in 1936, Lemierre syndrome is a clinical condition, which presents as septic emboli in the internal jugular vein after an untreated pharyngitis. This condition can have significant morbidity and mortality; therefore, although it is not common in today's era of antimicrobials, it should still be considered and thought of to prevent the significant consequences that may occur from it. In this article, we will present a child who was admitted for fever, neck pain, lymphadenopathy, and lung abscesses which was diagnosed as Lemierre syndrome. This syndrome will be discussed so as to heighten clinical awareness of it.     

Accessory soleus muscle: a case report and review of the literature

Accessory soleus muscle is a rare condition which presents as a soft-tissue mass medial to the calcaneum and distal Achilles tendon. Though congenital in origin, it manifests in the second and third decades of life as a soft-tissue mass due to muscle hypertrophy. Patients may be asymptomatic or present with a painful ankle mass. It is important to be aware of this condition when interpreting CT or MRI of the ankle, which show characteristic findings of a normal muscle in an abnormal location. Received: 6 October 1998 Accepted: 19 February 1999     

The Effect of Positional Support on Tolerance of Wakeful Prone in Infants

Supervised wakeful prone promotes motor milestones. Indications are that many infants do not receive adequate prone, with poor tolerance as a contributing factor. A common suggestion is the use of positional support. Aims: This study has two main purposes: (1) To determine whether varied levels of positional support affect the duration of time spent in prone, and (2) to determine the effect of positional support with respect to infant size. Methods: A convenience sample of 32 healthy infants ranging in size, aged 3.3 ± 0.04 months, were placed in prone in three counterbalanced randomized levels of positional support: a flat blanket (Blanket condition), a rolled blanket (Roll condition), and a pillow (Boppy condition). Results: There were significant differences in time spent in prone with the Boppy condition affording infants up to three more min in prone across three repeated trials. There were no significant interaction effects between condition and infant size measurements. Conclusions: These results provide evidence for increasing positional support, such as through use of a Mini Boppy®, to facilitate tolerance for prone for infants of all sizes.     

Epidemiology of childhood type 2 diabetes in the developing world

Type 2 diabetes in the young is an increasing problem with potentially serious outcomes. Our understanding of the worldwide burden of this condition is incomplete, with many studies adopting different methodologies to assess the condition and reporting on specific communities or ethnic groups. Most of the data come from developed nations, with few studies from developing nations. The purpose of this review is to bring together the available data on type 2 diabetes in the young from the developing world, in order to highlight deficiencies in the knowledge of the condition and also to promote strategies to deal with it. Noted also are some of the factors associated with the condition, such as family history, genetic influences, intrauterine environment as well as the importance of birth weight, insulin resistance, obesity, and development of complications. These are of relevance in both developed and developing nations.     

Controlled trial of imipramine in diurnal enuresis.

Twenty-seven children with diurnal enuresis were studied in a double-blind randomised controlled trial of imipramine. Outcome was not related to such features as age, gender, maximum functional bladder capacity, or evidence of psychiatric disturbance. Although the condition in several children improved, no evidence emerged to suggest that imipramine was superior to placebo in the treatment of the condition.     

Cerebral venous sinus thrombosis: report of a case and review of the literature

Cerebral venous sinus thrombosis is a condition that is well documented as a complication of the latter stages of pregnancy and with an even greater incidence during the puerperium. More recently this entity had been associated with the use of oral contraceptives. A case is presented of a 15-year-old girl with this condition, in whom the occurrence as well as the resolution of a superior sagittal sinus thrombosis was demonstrated with serial computed tomography (CT) scans and radionuclide studies. The discussion of this case, coupled with a review of the literature, describes the clinical presentation, explores the possible etiology, offers a noninvasive technique for confirming the diagnosis, and presents the medical management of this condition. It is postulated that cerebral venous sinus thrombosis occurs with a greater frequency than is currently recognized. Health professionals involved with monitoring the health care of adolescents during pregnancy and in the puerperium should be aware of this potential complications. In addition, association of this condition with oral contraceptive use should be recognized.     

Parasitic conjoined twins: a case report

Parasitic twins are a rare phenomenon and a challenge for caregivers. Occurring as a result of abnormal processes in the first several weeks of embryologic development, this condition is oftentimes diagnosed by prenatal ultrasound. This unusual condition may go undiagnosed until the time of delivery, however, despite the availability and use of advanced ultrasound techniques. The challenges presented by this condition are multiple and complex. The following case report demonstrates some of these challenges.     

The management of eczema in children

Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects 10–20% of children in developed countries. It is a relapsing and remitting condition, with episodes of disease exacerbation as frequently as two or three times per month. In severe cases it may become continuous. Some children with AE develop lifelong disease whilst others go on to develop asthma and allergic rhinitis, in a sequence referred to as the ‘atopic march’. This article details the current therapies available for treating children with AE, with practical advice on management and reference to the most recent guidelines.     

Discriminating pediatric condition falsification from chronic intestinal pseudo-obstruction in toddlers

Pediatric condition falsification may masquerade as chronic and serious digestive disease, including chronic intestinal pseudo-obstruction. The purpose of this study was to define clinical criteria to discriminate between these two conditions. We compared medical records of 8 pediatric condition falsification victims to those of 14 children with chronic intestinal pseudo-obstruction. Clinical features suggesting pediatric condition falsification in toddlers presenting with chronic and severe digestive complaints included (a) daily abdominal pain, (b) illness involving three or more organ systems, (c) an accelerating disease trajectory, (d) a reported history of preterm birth, (e) absence of dilated bowel on x-ray, (f) normal antroduodenal manometry, and (g) no urinary neuromuscular disease. These results suggest that a diagnosis of pediatric condition falsification may be suspected in toddlers presenting with a phenotype for enteric neuromuscular disorders by features in the clinical history, symptoms, and signs.     

Cochlear abnormality in a case of Pallister-Hall syndrome

Pallister-Hall syndrome (PHS) is a rare condition characterised by anomalies including hypothalamic hamartoma, bifid epiglottis and postaxial polydactyly. Hearing loss has been recognised in this condition. Cochlear abnormalities have been described in mouse models of PHS, but there are no reports of similar findings in humans to date. This report describes a case of PHS with bilateral cochlear hypoplasia as seen on MRI.     

Transient hyperphosphatasemia in infants

Striking transient increases in serum alkaline phosphatase in 2 infants are reported. Isoenzymes were studied in 2 infants and increased activity was found in bone as well as in liver fractions. Repeated serum determinations demonstrated a duration of about 4-6 weeks. The etiology is unknown but an infectious cause is discussed. The condition may be rather frequent but gives no obvious symptoms. It is important to know this condition to avoid unnecessary diagnostic procedures.     

Erythermalgia: a rare vascular acrosyndrome]

A case of erythermalgia with arterial hypertension that appeared in a 13 year-old boy is described. This condition led to a loss of weight of 10 kg within one month. None of the diseases known as a cause of this rare condition was found. Clinical manifestations were only improved when extremities were placed in cold water: treatment with pizotifene was also effective suggesting the role of serotonine in the mechanism of the crises.     

Editorial Perspective: Delivering autism intervention through development

Autism is a priority condition within global health and represents a significant public health challenge. In this Editorial, I argue for a new perspective on how this challenge might be met, based on the idea of autism as an enduring developmental condition and focused on the family as a key resource. Drawing on models from management of enduring conditions elsewhere in health and on recent autism intervention science, I make the case for a developmental sequence of pulsed interventions, initially focused on early family resilience and self-management, along with case management and timely step-up care to specialist management.     

Congenital adrenal hyperplasia with localized aggressive periodontitis and amelogenesis imperfecta

Congenital adrenal hyperplasia (CAH) is an inherited medical condition that implies defects in steroid biosynthesis. The dental findings of a female patient with CAH are reported. The patient suffered from severe periodontal tissue destruction, obvious enamel defects, as well as some occlusal problems. The management approach is presented and the possibility of interrelation of her dental findings with her medical condition is discussed.     

Nocturnal enuresis: What is happening?

Primary nocturnal enuresis is common and has considerable psychological ramifications for children as they get older. It is a familial condition with complex inheritance patterns. The pathophysiology of the condition appears to be related to poor arousal from sleep, nocturia due to deficient vasopressin release in sleep and possibly a decrease in functional bladder capacity especially at night. The mainstay of treatment is the bed-wetting alarm. In recent years, desmopressin nasal spray has found a clinical niche as a short-term solution for children attending school camps or sleeping over at friends' houses and as treatment in the medium term for those unresponsive to treatment with a bed-wetting alarm. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a real possibility.     

Microgeodic phalangeal syndrome in an infant

A new case is reported of the curious disease described by Maroteaux as Microgeodic phalangeal syndrome in infancy, of unknown etiology. The purpose of this communication is to describe an additional case of this rare condition, described for the first time by Maroteaux in 1970, and affecting the fingers of infants and children. The condition consists of a swelling of the fingers and multiple microgeodes in the phalanges. It is a benign disease and the lesions disappear totally after a few months.