Pediatrics

The goal of the present study is to propose the use of global connectivity measures as quantitative indicators of long-term medication in pediatric patients with Attention-Deficit-Hyperactivity Disorder, combined type (ADHD-C). For this purpose, graph theoretical brain connectivity indices are computed from connectivity estimations across eyes-opened resting-state EEG recordings measured before and after the treatment with osmotic release oral system-methylphenidate for a month in 18 boys (aged between 7–12 years). In order to present the reliable results, neurofunctional correlations are firstly estimated in time (Pearson Correlation (PC), Spearman Correlation), frequency (Directed Transfer Function, Partial Directed Coherence) and phase (Phase Locking Value, Phase Lag Index) domains in between short segments of
2 sec over single trials of 1 min. Later, transitivity, clustering coefficients, assortativity, global efficiency and modularity are computed from EEG based connectivity matrices produced by each approach. Since the highest classification accuracy of 83.79%
is provided by PC, statistical tests (one-way Anova, pair-wise multiple comparison) and step-wise logistic regression modelling are all examined to detect significant differences between pre- and post- treatment relevant connectivity measures. Statistical boxplots are also shown, as well. Overall results reveal that global brain connectivity can be increased by long-term medication in pediatric ADHD-C in terms of increased segregation & resilience. This is the first study to demonstrate that long-term medication can normalize the functional brain connectivity in ADHD, which is characterized by decreased connectivity compared to controls

Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate—or even encourage—what the authors regard as ‘de minimis’ forms of female genital mutilation (as defined by the World Health Organization). In this commentary, I argue that many serious problems would be likely to follow from a policy of increased tolerance for female genital mutilation, and that it may therefore be time to consider a less tolerant attitude toward non-therapeutic infant male circumcision. Ultimately, I suggest that children of whatever sex or gender should be free from having healthy parts of their most intimate sexual organs either damaged or removed, before they can understand what is at stake in such an intervention and agree to it themselves.

Lev Semyonovich Vygotsky menjadi sosok yang dikenal luas dalam Psikologi Amerika sejak publikasi atas monografnya pada tahun 1962, yakni Thought and Language. Lima tahun yang lalu (1973), atas desakan seorang murid Vygotsky, Alexander Luria, kami sepakat untuk mengedit kumpulan esai Vygotsky yang mencerminkan karya teoretis umum yang mengkaji hubungan antara Pikiran dan Bahasa sebagai salah satu aspek penting. Luria mengerjakan terjemahan kasar untuk kami atas dua tulisan Vygotsky. Tulisan pertama, "Tool and Symbol in Children's Development" (1930) yang tidak pernah diterbitkan. Tulisan kedua, merupakan penerjemahan atas monograf yang berjudul “The History of the Development of the Higher Psychological Functions, yang muncul pada volume kedua tulisan Vygotsky yang diterbitkan di Moskow pada tahun 1960. Kajian sambil lalu atas esai ini secara cepat meyakinkan kami bahwa lingkup karya Vygotsky jauh melampaui Thought and Language. Terlebih lagi, kami mulai percaya bahwa citra Vygotsky sebagai “semacam neo-behavioris awal” bidang perkembangan kognitif−kesan yang dipegang oleh banyak rekan kami−sangat sudah terbantah lewat dua karya ini.

Is the non-therapeutic circumcision of infant males morally permissible? The most recent major developments in this long-simmering debate were (a) the 2012 release of a policy statement and technical report on circumcision by the American Academy of Pediatrics (AAP), and (b) the decision of a German court that ritual circumcision is an unconstitutional form of bodily injury. In this editorial I address the AAP's claims as well as evaluate religious motivations more specifically. I suggest that the AAP's "health benefits" arguments are weak, and that religious circumcision is in tension with post-Enlightenment ethical and legal norms--the root of much of the current controversy. I conclude by asking how this tension might begin to be resolved.

In previously healthy subjects, vulvar ulcers are mostly caused by sexually transmitted microorganisms. Lipschütz's acute vulvar ulceration, first reported in 1912, is a non-sexually acquired condition characterized by sudden onset of a few genital ulcers. We systematically review presentation, underlying causes, and disease duration of Lipschütz's ulceration. A comprehensive source of Excerpta Medica, National Library of Medicine, and Web of Science databases was performed. Reports including cases of apparently previously healthy females affected by Lipschütz's ulceration were selected. A predefined database was used to extract data on demographics, history, clinical and microbiological findings, and treatment. The search disclosed 158 cases. Almost 90% of cases were ≤ 20 years of age and sexually inactive. Lesions were usually one to about three, painful, ≥ 10 mm large, well-delimited, with a fibrinous and necrotic center and a symmetric distribution. Voiding disorders and enlarged inguinal lymph nodes were observed in a large subset of cases. Canker sores were noted in 10% of patients. Lipschütz's vulvar ulceration occurred concomitantly with an infectious disease in 139 cases. Infectious mononucleosis syndrome (N = 40) was the most frequently detected well-defined infection, followed by mycoplasma species infections (N = 11). The disease resolved after ≤ 3 weeks. Conclusions: Lipschütz's ulceration mainly affects both sexually inactive and, less frequently, sexually active subjects ≤ 20 years of age, presents with ≤ 3 vulvar ulcers, resolves without recurrences within 3 weeks and is temporarily associated with an infection, most frequently a flu-like illness or an infectious mononucleosis syndrome.

In this chapter, an infringement of bodily integrity (BI) is defined as any penetration into a bodily orifice, breaking of the skin, or alteration of a person’s physical form. A violation of a person’s right to BI is any infringement of their BI that wrongs them. An autonomous person is wronged by an infringement of their BI if they did not consent to it. If a person is incapable of consenting because they are temporarily non-autonomous – as in the case of an intoxicated adult or a pre-autonomous child – the infringement should be delayed until the individual becomes autonomous and can make their own decision. It is only when the infringement cannot be delayed without putting the person into a situation they would be even less likely to consent to (if they were autonomous) that the infringement does not wrong them. Given the seriousness of violating anyone's right to BI, and especially that of the most vulnerable persons, the appropriate likelihood-of-consent for proceeding with a BI infringement on a child is argued to be at or near the ‘medically necessary’ threshold.

The presented review was an attempt to share the contribution of Greco Arabic Muslim scientists in the field of medicine. In this regard, al-Andalusi, al-Antaki, al-Baghdadi, al-Jawhari, al-Kindi, al-Nafis, al-
Razi, al-Tabari, al-Zahrawi, Ibn Abdallah Ibn Idris al Qurtubi, Ibn al-Jazzar, Ibn al-Baitar, Ibn al- Haitham, Ibn El-Quff, Ibn Haiyan, Ibn Sina, Ibn Wahshiyyah and Ibn Zuhr with their contribution has discussed.

Button batteries can be lethal if ingested and not promptly excreted or removed. These batteries are present in a multitude of household items including car remotes, IT devices, and many consumer items targeted at children. There are various technologies available for button batteries and they are produced in various sizes. Lithium button batteries with a diameter of 20mm or more pose the greatest risk. Most at risk are children of 0-5 years. At this age, there is a propensity to put foreign objects in the mouth. These batteries once swallowed, rather than passing through the alimentary canal and being excreted, may lodge in the oesophagus where they will burn through tissue, sometimes trough to the trachea, sometimes through to the aorta. This will be fatal for the child if the problem is not promptly identified and the battery then promptly extracted. Death will follow within several weeks of ingestion, following episodes of ill health, if the problem is not recognised. The presenting symptoms of ill health by the child can be misdiagnosed as food poisoning, a virus, an infection, or some common malady. Three child deaths in Australia from ingested button batteries (all 20mm lithium) are reported in the present paper. In each case, after prior misdiagnoses, the ingested battery was detected by X-ray, and, in each case, too late for successful intervention. Ingested button batteries can be detected by X-ray or ultrasound, but they may be indistinguishable from an ingested coin, which present less risk and are not actively corrosive. A new safety standard in Australia seeks to reduce the access of children to button batteries. The standard accepts the design status quo of button batteries, and seeks to avoid their misuse, in particular to stop them being ingested by young children. This is a safety-by-regulation approach. The alternative is a safety-by-design approach where the onus is on product designers to engineer safety into and danger out of the product. The twin problems of lithium button batteries are, firstly, their size where they are small enough to be easily swallowed by children but large enough to lodge in the oesophagus (where they are ≥20mm in diameter), and secondly, their bio-reactivity with flesh, which is partly a matter of chemistry but also partly a matter of the surface areas of the electrodes (which are extensive surfaces rather than point electrodes).

Varicella-zoster virus (VZV) can cause severe disease in premature neonates. The fetus receives protective maternal VZV-immunoglobulin G (IgG) mainly in the third trimester of pregnancy. Therefore, premature neonates are considered at risk for VZV infection. Administration of varicella-zoster immunoglobulin (VZIG) within 96 hours after exposure effectively prevents severe illness in susceptible patients. The objectives of this study were to define the major determinants of the neonatal VZV-IgG titer and to determine the half-life of transplacentally acquired VZV-IgG. Guidelines provided by the Centers for Disease Control and Prevention for the use of VZIG in (premature) neonates were evaluated. VZV-IgG titers were measured in sera of 221 neonates and 43 mothers using a quantitative enzyme-linked immunosorbent assay. In 27 neonates, VZV-IgG titers were followed for up to 14 weeks. In a linear regression model, the maternal antibody titer was the major determinant of the neonatal tite...

Four members of the Dawoodi Bohra sect of Islam living in Detroit, Michigan have recently been indicted on charges of female genital mutilation (FGM). This is the first time the US government has prosecuted an “FGM” case since a federal law was passed in 1996. The world is watching to see how the case turns out. A lot is at stake here. Multiculturalism, religious freedom, the limits of tolerance; the scope of children’s—and minority group—rights; the credibility of scientific research; even the very concept of “harm.” To see how these pieces fit together, I need to describe the alleged crime.

To develop a North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) international consensus on the diagnosis and management of gastroesophageal reflux and gastroesophageal reflux disease in the pediatric population. An international panel of 9 pediatric gastroenterologists and 2 epidemiologists were selected by both societies, which developed these guidelines based on the Delphi principle. Statements were based on systematic literature searches using the best-available evidence from PubMed, Cumulative Index to Nursing and Allied Health Literature, and bibliographies. The committee convened in face-to-face meetings 3 times. Consensus was achieved for all recommendations through nominal group technique, a structured, quantitative method. Articles were evaluated using the Oxford Centre for Evidence-based Medicine Levels of Evidence. Using the Oxford Grades of Re...

Quality improvement (QI) is becoming a central part of the work of clinicians throughout healthcare. Continuous quality improvement (CQI), Lean Management Systems (LMS) and Lean Six Sigma (LSS) are management philosophies as well as management methods. They offer an approach, a set of tools, and a way of thinking about how to more effectively assess and study clinical flow, including addressing variation in clinical process and operations. We define CQI as the daily use of QI methods as a regular part of practice engaging all practice staff, constantly measuring structure, processes, outcomes against effective practices (benchmarking), moving from one QI project to the next, pursuing the goal of " The right care for every child every time ". It is based on clear scientific principles, a valid way of measuring change and has theories of reliability and human factors that underpin the interventions. Significant variations in quality of care provided to patients leading to substandard care have been well documented. For example, in antibiotic prescribing for community acquired pneumonia; pediatric secondhand smoke reduction; screening for diabetes in cystic fibrosis program; and, in depression screening in Type 1 Diabetes. Despite this, not enough practices are performing continuous quality improvement (CQI) as part of their daily activities. All health care professionals caring for patients should consider incorporating quality measurement into their practice. However, we need to focus on what is the right approach to take and the right questions to ask and address the challenges of aggregating scientifically imperfect tests of change. Increasingly, colleagues, patients, payers and certifying agencies expect such measurement to achieve the Triple Aim of better health, better care and lower cost. In addition, new payment models increasingly pay providers for demonstrated value rather than volume, and they expect participation in continuous improvement. Quality Improvement (QI) is a critical component of the  Maintenance of Certification (MOC) Part 4. This requires clinicians to participate in a meaningful manner in two data-driven QI projects every five years. Clinicians can select quality measures to evaluate whether patient outcomes and experience improve, and if not, identify and overcome barriers. In this paper we discuss performance improvement using CQI and related methods, suggest approaches to help clinicians ask the right questions when seeking to drive improvement, and consider the implications of measurement theory and complexity science for QI and CQI.

The inspiration of this thesis comes from two severe cases that took place in the
Netherlands during the past seven years. In 2005, a baby died in the hospital after
treatment by a Cranio Sacral therapist. In 2009, a baby of three months, died after a
manipulative treatment by a Manual Therapist (Micha Holla 2009). The technique
which has been used in both cases, is the "folding technique” taught in the training of
Upledger in the Netherlands, in which the baby is forced in a fetal position with a full
flexion of the neck.
In subsequent media hype osteopathy was included in the list of practitioners who work
on the necks of children. This resulted in a negative association with osteopathy and
subsequent fewer referrals by physicians to osteopaths. Physicians, especially
pediatricians, rated osteopathy as a harmful form of treatment. The incentive of this
thesis is that osteopathy, even though both treatments were no osteopathic treatments,
was accused and found guilty, while the "folding technique" (Micha Holla 2009) is in
fact not even taught to osteopaths. Osteopathy is not a technique but encompasses
both a philosophy ,which is different from regular medicine, and a skill which is holistic
mostly in its diagnosis.
The current study into adverse events in pediatric osteopathy is done through an
inventory of pediatric background of osteopaths and pediatric osteopaths in the
Netherlands. A comparison is made between the training of pediatric and regular
osteopaths with pediatricians and pediatric physiotherapists. Thereafter an analysis
was made to see if there was a difference in amount of adverse events between
regular osteopaths and pediatric trained osteopaths. This was not the case (Micha
Holla 2009). The effect of pediatric osteopathic treatment in children is assessed by a
literature study. There are, for example, studies that have investigated the effect of
osteopathic manual treatment for certain symptoms in children. These studies are
inventoried. It is about finding the best evidence for clinical questions (Hawk, Schneider
et al. 2009).
In this study the safety of osteopathic treatment in the Netherlands in patients aged
zero to fourteen is investigated by a questionnaire about side effects and adverse
events. This was performed in twenty seven practices of osteopaths across the
country. 785 treatments were analyzed. The results show that there were no serious or
mild but just minor adverse events in only twenty percent, which lasted on average not
more than three days. Recommendations are made to further improve osteopathy in
pediatric patients and to make sure that osteopathic treatments remain safe.

Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommended for children in the United States. Data sources included PubMed, Advisory Committee on Immunization Practices statements, package inserts, existing reviews, manufacturer information packets, and the 2011 Institute of Medicine consensus report on vaccine safety. We augmented the Institute of Medicine report with more recent studies and increased the scope to include more vaccines. Only studies that used active surveillance and had a control mechanism were included. Formulations not used in the United States were excluded. Adverse events and patient and vaccine characteristics were abstracted. Adverse event collection and reporting was evaluated by using the McHarm scale. We were...

Penyakit jantung bawaan (PJB) adalah penyakit jantung berupa kelainan pada struktur atau fungsi sirkulasi jantung yang dibawa dari lahir, terjadi akibat adanya gangguan atau kegagalan perkembangan struktur jantung pada fase awal perkembangan janin. Kelainan ini bisa terjadi di katup, otot/ dinding, pembuluh darah jantung, ataupun kombinasi dari ketiganya.

Secara garis besar penyakit jantung bawaan dibagi menjadi 2, yaitu PJB asianotik (tidak biru) dan sianotik (biru). Contoh dari PJB asianotik antara lain adalah Ventricel Septal Defect (VSD), Patent Ductus Arteriosus (PDA), Atrial Septal Defect (ASD) dan Aorta Stenosis (AS). Sedangkan contoh PJB sianotik antara lain adalah Transposition Great Artery (TGA), Tetralogy of Fallot (TOF), Tricuspid Atresia, Ebstein’s Anomaly, Pulmonal atresia.

Abses serebri merupakan penyakit infeksi supuratif lokal pada parenkim otak. Abses serebri merupakan salah satu komplikasi yang timbul dari PJB sianotik (pirau kanan ke kiri).

Sajian pengalaman kasus ini membahas terjadinya abses serebri pada anak berusia 3 tahun penderita kelainan jantung bawaan yang dirawat di RS Sentra Medika Cibinong yang masuk dengan keluhan diare namun juga mengalami kelumpuhan separuh tubuh.

Dari kasus di atas dapat disimpulkan bahwa diagnosis abses serebri harus dipikirkan, jika ditemukan gejala defisit neurologis pada penderita pasien PJB sianotik. Terlambatnya diagnosis ditegakkan membuat prognosis semakin buruk. (Tabloid MD, edisi Maret 2015. Dr Siudi Rustandi, ; Dr. Ade Meidian Ambari SpJP  ; Dr. Martinus M. Leman, DTMH, Sp.A)

Background: Type 1 diabetes mellitus (T1DM) and dyslipidemia (DLP) are serious metabolic disorders, and their coexistence has been associated with dangerous outcomes. Objective: The purpose of the present study is to investigate dyslipidemia and its association with glycosylated hemoglobin (HbA1c) in Type 1 diabetes mellitus children. Methods: In a cross-sectional study design included 118 patients with Type 1 diabetes mellitus aged between 5-13 years. Serum glycosylated hemoglobin (HbA1C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL), and triglyceride (TG) were measured. Results: The results showed that there was a significant relationship between all lipid profiles expects HDL-C with glycosylated hemoglobin (p=0.0001). Conclusion: The current study concludes that Poor glycemic control plays a role as a risk factor for the development of dyslipidemia in children with Type 1 diabetes mellitus.

In December of 2014, an anonymous working group under the United States’ Centers for Disease Control and Prevention (CDC) issued a draft of the first-ever federal recommendations regarding male circumcision. In accordance with the American Academy of Pediatrics’ circumcision policy from 2012 – but in contrast to the more recent 2015 policy from the Canadian Paediatric Society as well as prior policies (still in force) from medical associations in Europe and Australasia – the CDC suggested that the benefits of the surgery outweigh the risks. In this article, we provide a brief scientific and conceptual analysis of the CDC’s assessment of benefit versus risk, and argue that it deserves a closer look. Although we set aside the burgeoning bioethical debate surrounding the moral permissibility of performing non-therapeutic circumcisions on healthy minors, we argue that, from a scientific and medical perspective, current evidence suggests that such circumcision is not an appropriate public health measure for developed countries such as the United States.