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The document attached to this e-mail is a Q&A Session

with Dr John Halamka.  Dr Halamka is one of the most

widely know physicians involved in IT in the

healthcare industry.

Dr Halamka's background is included in the Q&A

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Download the attached document and open it to read Dr

Halamka's comments on the use of ASP services in

physician practices.

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Jim DiGiorgio

JJD7754@...

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http://162.129.72.40/cpr/drips2.cfm

I would like to add these web sites to the web sites list:
www.pediatricradiology.comn
www.dermis.net
thank for taking time time looking at them

Sent By: santosh kondekar

a must read !

Read the article at the following web address:

<http://pediatrics.medscape.com/Medscape/FamilyMedicine/Journal/2001/v01.n04/mfm\
1108.cash/mfm1108.cash-04.html>
Double click on this Web address. If your Web browser doesn't launch and
open the article, see the instructions below.

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INSTRUCTIONS FOR READING THE ARTICLE
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If double clicking on the Web address above launches your browser but you get a
form for entering your member name and password then you need to log in (or
register) to read the article. Registration is free and there is no cost for
reading articles on Medscape. Click the cancel button on the log in window and
follow the instructions to register.

If double-clicking doesn't launch your browser do the following:
(1) Highlight and copy the Web address below.
http://pediatrics.medscape.com/Medscape/FamilyMedicine/Journal/2001/v01.n04/mfm1\
108.cash/mfm1108.cash-04.html
(2) Open your browser and select "Open Location" from the File Menu.
(3) Paste the Web address into the entry field and hit the return key.

If you get an a message saying "Error. The file you requested is not available
at this location", then your email program broke up the web address into 2 lines
(inserted a line break).  You will need to remove the line break to use the web
address.

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This article notification service provided by
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       MEDSCAPE, http://www.medscape.com,
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mobile professional.

New Growth Charts for Children Released
By Suzanne Rostler

NEW YORK (Reuters Health) - The charts against which the growth and
development of America's kids have been measured for more than two
decades will be replaced by newer versions that more accurately
reflect the diverse ethnic and economic makeup of the country, the
American Academy of Pediatrics (AAP) announced on Monday.

The new charts, developed by the US Centers for Disease Control and
Prevention (news - web sites) (CDC) in 2000, also take into account
differences in the growth rates of breast-fed and formula-fed infants
during the first year of life.

Another major change is the use of body mass index (BMI), a measure
of weight in relation to height, for people aged 2 to 20 years. BMI
is thought to more accurately define whether a person is overweight
or obese than weight alone, thereby providing a better gauge of the
risk of medical problems associated with excess weight. In the
previous growth charts, weight for height measurements stopped at age
10 for girls and age 11 for boys.

``BMI-for-age provides a tool to evaluate weight in relation to
height and is recommended for screening overweight in children and
adolescents,'' Dr. Cynthia L. Ogden, the report's lead author, told
Reuters Health in an interview. ``Children between the 85th and 95th
percentiles of BMI-for-age are considered at risk for overweight and
children above the 95th percentile are considered overweight.''

The updated charts are based on data from a cross-section of children
living in the US between 1971 and 1994. Just over 14% of children
were black, reflecting the percentage of black children in the US
during that period, according to the report in the January issue of
Pediatrics. Roughly one third of infants on which information is
based were breast-fed for at least 3 months. Average birth weights
are also higher compared with those in the earlier charts.

The previous set of growth charts, in use since 1977, were derived
from data on white, middle-class, mostly formula-fed infants living
in southwestern Ohio.

``The 2000 CDC growth charts are recommended for use in the United
States,'' the report states. ``Pediatric clinics should make the
transition...for routine monitoring of growth in infants, children
and adolescents.''

The new growth charts can be found on the CDC's Web site at
www.cdc.gov/growthcharts.

SOURCE: Pediatrics 2002;109:45-60.

Hi,

We do sit down rounds first thing in the morning, where we discuss the new

admissions (all of them, with simpler cases requiring les detail).  Then we

have a 15-20 minute teaching session if time allows.  Walk rounds are with

the attending, but the seniors run the show (at least theoretically).  These

walk rounds are helpful to write orders as we go along, so the interns have

less to worry about (and less to forget) during their busy day.

A. Tarik Shinaishin, M.D.

Dept. of Pediatrics

Metrohealth Medical Center, Case Western Reserve University

> From: Colson_E@...

> Reply-To: pedch@yahoogroups.com

> Date: Mon, 21 Jan 2002 11:39:28 -0600

> To: pedch@yahoogroups.com

> Cc: pedch@yahoogroups.com

> Subject: Re: [Peds.Chief.Res]

> 

> 

> Hi,

> 

> We are interested in learning new ways to run work rounds in the morning.

> Ideas???  Do you stand at the bedside, utilize a conference room, or

> discuss the patients in the hallway?  How do you examine patients with a

> large group (ex. med students, interns, senior resident, etc.)?  Do the

> floor attendings join work rounds?

> 

> Thanks for your input,

> St. Louis Children's Hospital Chief Residents

> Liz, Alan and Jen

> 

> 

> 

> To unsubscribe from this group, send an email to:

> pedch-unsubscribe@yahoogroups.com

> 

> 

> 

> Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/

> 

To unsubscribe from this group, send an email to:

pedch-unsubscribe@yahoogroups.com

Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
Dear Patrons,

Over 100 links have been added to GeneralPediatrics.com  since our
last newsletter.

Over the past couple of months,  eMedicine has added a number of new
topics for professionals.
(http://www.emedicine.com/ped/contents.htm).  It seems that their
offerings have increased exponentially since this past summer and
fall.  The University of South Carolina has also put their Mycology
Online Textbook online (http://www.med.sc.edu:85/book/mycol-sta.htm)

There are a number of guidelines that were added from around the world.
  From Canada there is the Canadian Task Force on Preventive Health
Care - Evidenced-based Clinical Prevention ( http://www.ctfphc.org/).
Others are from Finland, Singaporem Scotland and the US.

For patients, the American Academy of Child and Adolescent Psychiatry
has added information on Teen Alcohol Abuse
(http://www.aacap.org/publications/factsfam/teendrug.htm) and
Substance Abuse Questions to Ask
(http://www.aacap.org/publications/factsfam/subabuse.htm). The
American Dental Association has added information on Fluoride
(http://www.ada.org/public/topics/fluoride/fluoride.html)  and Tooth
Decay (http://www.ada.org/public/faq/decay.html).

This past summer we completed a study that showed that the reading
level of pediatric patient education materials on the Internet are
written at approximately the 12th grade level. Unfortunately almost
half of all adults in the US read at the 8th grade or lower.  We
therefore have embarked on creating patient education handouts that
are specifically written at the 8th grade level or below. They are
entitled "Common Questions, Quick Answers." We currently have over 50
topics written and they can be found at
http://www.vh.org/Patients/IHB/Peds/CQQA/index.htm  and of course are
linked to the appropriate problem on the Patients page. Over time we
hope to have all of all the problems in GeneralPediatrics.com covered.

Thank you again for using GeneralPediatrics.com. We welcome your
feedback and comments at http://www.generalpediatrics.com/Comment.html

Respectfully yours,

Donna M. D'Alessandro, M.D.
Curator, GeneralPediatrics.com
January 28, 2002

--
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Donna M. D'Alessandro, MD                Email: donna-dalessandro@...
Associate Professor of Pediatrics
Department of Pediatrics
University of Iowa Hospitals and Clinics
2617 JCP
200  Hawkins Dr.
Iowa City, IA 52246
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

_______________________________________________
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Journal of Pediatrics
Table of Contents for January 2002, Vol. 140, No. 1
http://www.mosby.com/scripts/om.dll/serve?db=c&id=pd
--------------------------------------------------------------
The Editors' Perspective

This Month in the Journal
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401abs001

Association of Medical School Pediatric Department Chairs, Inc.

Challenges in the development of pediatric health services research
Gary L. Freed, MD, MPH
Ann Arbor, Michigan
http://www.mosby.com/scripts/om.dll/serve?article=a121211

Editorials

GERD and crying: Cause and effect, or unhappy coexistence?
Philip E. Putnam, MD
Cincinnati, Ohio
http://www.mosby.com/scripts/om.dll/serve?article=a121692

Managing the child with fever and neutropenia in an era of increasing
microbial resistance
David B. Haslam, MD
St Louis, Missouri
http://www.mosby.com/scripts/om.dll/serve?article=a120266

Dexamethasone and bronchiolitis: A new look at an old therapy?
John T. McBride, MD
Akron, Ohio
http://www.mosby.com/scripts/om.dll/serve?article=a121691

Organochlorine chemicals and children's health
Mary S. Wolff, PhD, Philip J. Landrigan, MD, MSc, FAAP
New York City
http://www.mosby.com/scripts/om.dll/serve?article=a121690

Original Articles

Esophagitis in distressed infants: Poor diagnostic agreement between
esophageal pH monitoring and histopathologic findings
Ralf G. Heine, MD, FRACP, Donald J.S. Cameron, FRACP, Chung W. Chow, MD,
FRCPA, David J. Hill, FRACP, Anthony G. Catto-Smith, MD, FRACP
Melbourne, Australia
http://www.mosby.com/scripts/om.dll/serve?article=a120695

High incidence of penicillin resistance among alpha-hemolytic
streptococci isolated from the blood of children with cancer
Lauren B. Bruckner, MD, PhD, David N. Korones, MD, Timothy Karnauchow,
PhD, Dwight J. Hardy, PhD, Francis Gigliotti, MD
Rochester, New York
http://www.mosby.com/scripts/om.dll/serve?article=a118886

Efficacy of oral dexamethasone in outpatients with acute bronchiolitis
Suzanne Schuh, MD, FRCP(C), Allan L. Coates, MD, CM, Rosemary Binnie,
RN, Tracey Allin, RN, Cristina Goia, MSc, Mary Corey, PhD, Paul T. Dick,
MD, CM, MSc, FRCP(C)
Toronto, Ontario, Canada
http://www.mosby.com/scripts/om.dll/serve?article=a120271

Childhood growth and exposure to dichlorodiphenyl dichloroethene and
polychlorinated biphenyls
Wilfried Karmaus, MD, MPH, Scott Asakevich, BSc, Alka Indurkhya, PhD,
Jutta Witten, Dr.rer.nat, Hermann Kruse, Dr.rer.nat
East Lansing, Michigan and Hesse, Wiesbaden, and Kiel, Germany
http://www.mosby.com/scripts/om.dll/serve?article=a120764

Environmental lead exposure during early childhood
Bruce P. Lanphear, MD, MPH, Richard Hornung, DRPH, Mona Ho, MS, Cynthia
R. Howard, MD, MPH, Shirley Eberle, MS, Karen Knauf, BS
Cincinnati, Ohio, and Rochester, New York
http://www.mosby.com/scripts/om.dll/serve?article=a120513

Effects of prenatal PCB and dioxin background exposure on cognitive and
motor abilities in Dutch children at school age
Hestien J.I. Vreugdenhil, MSc, Caren I. Lanting, PhD, Paul G.H. Mulder,
PhD, E. Rudy Boersma, PhD, Nynke Weisglas-Kuperus, PhD
Rotterdam, The Netherlands
http://www.mosby.com/scripts/om.dll/serve?article=a119625

Prognostic value of the neurologic optimality score at 9 and 18 months
in preterm infants born before 31 weeks' gestation
Maria Flavia Frisone, MD, Eugenio Mercuri, MD, Sabrina Laroche, MD,
Christine Foglia, MD, Elia F. Maalouf, MD, Leena Haataja, MD, Frances
Cowan, PhD, Lilly Dubowitz, MD
London, United Kingdom
http://www.mosby.com/scripts/om.dll/serve?article=a119626

Multiple congenital contractures: Birth prevalence, etiology, and
outcome
Niklas Darin, MD, PhD, Eva Kimber, MD, Anna K Kroksmark, PT, MSc, Mar
Tulinius, MD, PhD
Goteborg, Sweden
http://www.mosby.com/scripts/om.dll/serve?article=a121148

Prevalence and specificity of antigastric autoantibodies in adolescents
infected with Helicobacter pylori
Gerhard Faller, MD, Klaus-Michael Keller, MD, Dirk Claeys, PhD, Stephan
Buderus, MD, Doris K�hlwein, Nicole Reiche, Thomas Kirchner, MD
Nuremberg and Bonn, Germany, and Lausanne, Switzerland
http://www.mosby.com/scripts/om.dll/serve?article=a120270

Evaluation of oral budesonide for treatment of mild and moderate
exacerbations of Crohn's disease in children
Arie Levine, MD, Efrat Broide, MD, Michal Stein, MD, Yoram Bujanover,
MD, Zvi Weizman, MD, Gabriel Dinari, MD, Avi Pacht, MD, David Branski,
MD, Ilan Zahavi, MD
Tel Aviv, Israel
http://www.mosby.com/scripts/om.dll/serve?article=a119992

Factors associated with physical activity in preschool children
Kevin Finn, PhD, Neil Johannsen, Bonny Specker, PhD
Cedar Falls, Iowa, and Brookings, South Dakota
http://www.mosby.com/scripts/om.dll/serve?article=a120693

Patterns and energy expenditure of free-living physical activity in
adolescents with sickle cell anemia
Maciej S. Buchowski, PhD, Karen M. Townsend, MS, Ruth Williams, RD, EdD,
Kong Y. Chen, PhD
Nashville, Memphis, Tennessee
http://www.mosby.com/scripts/om.dll/serve?article=a120689

Sudden death in patients with right isomerism (asplenism) after
palliation
Mei-Hwan Wu, MD, PhD, Jou-Kou Wang, MD, PhD, Hung-Chi Lue, MD
Taipei, Taiwan
http://www.mosby.com/scripts/om.dll/serve?article=a120510

Symptoms of sleep disturbances among children at two general pediatric
clinics
Kristen Hedger Archbold, RN, PhD, Kenneth J. Pituch, MD, Parviz Panahi,
MD, Ronald D. Chervin, MD, MS
Ann Arbor, Michigan
http://www.mosby.com/scripts/om.dll/serve?article=a119990

Antibiotic treatment-induced tubular dysfunction as a risk factor for
renal stone formation in cystic fibrosis
Hansjosef B�hles, MD, Boris Gebhardt, MD, Thomas Beeg, MD, Adrian C.
Sewell, PhD, Eivind Solem, PhD, Georg Posselt, MD
Frankfurt am Main, Germany
http://www.mosby.com/scripts/om.dll/serve?article=a120694

Grand Rounds

Clinicopathologic conference: Neurologic dysfunction in a premature
infant
David S. Brink, MD, Glen A. Fenton, MD, Akihiko Noguchi, MD, Anantha N.
Manepalli, MD, Carole Vogler, MD
St Louis, Missouri
http://www.mosby.com/scripts/om.dll/serve?article=a120515

Clinical and laboratory observations

Correlation between plasma and salivary cortisol levels in preterm
infants
Cristina Calixto, MD, Francisco E. Martinez, MD, Salim M. Jorge, MD,
Ayrton C. Moreiran, MD, Carlos E. Martinelli, Jr, MD
Sao Paulo, Brazil
http://www.mosby.com/scripts/om.dll/serve?article=a120765

FIC1 and BSEP defects in Taiwanese patients with chronic intrahepatic
cholestasis with low gamma-glutamyltranspeptidase levels
Huey-Ling Chen, MD, Pei-Shin Chang, MD, Hey-Chi Hsu, MD, Yen-Hsuan Ni,
MD, PhD, Hong-Yuan Hsu, MD, PhD, Jyh-Hong Lee, MD, Yung-Ming Jeng, MD,
Wen-Yi Shau, MD, Mei-Hwei Chang, MD
Taipei, Taiwan
http://www.mosby.com/scripts/om.dll/serve?article=a119993

Thalidomide therapy for recalcitrant systemic onset juvenile rheumatoid
arthritis
Thomas J.A. Lehman, MD, Kim H. Striegel, FNP, Karen B. Onel, MD
New York City
http://www.mosby.com/scripts/om.dll/serve?article=a120835

Peroxisomal acyl CoA oxidase deficiency
Yasuyuki Suzuki, MD, Mizue Iai, MD, Atsushi Kamei, MD, Yuzo Tanabe, MD,
Shoichi Chida, MD, Seiji Yamaguchi, MD, Zhongyi Zhang, PhD, Yasuhiko
Takemoto, MD, Nobuyuki Shimozawa, MD, Naomi Kondo, MD
Gifu, Chiba, Kanagawa, Iwate, and Shimane, Japan
http://www.mosby.com/scripts/om.dll/serve?article=a120511

Accuracy of doppler echocardiography for the diagnosis of thrombosis
associated with umbilical venous catheters
Madan Roy, MD, Sophronia Turner-Gomes, MB, ChB, Gerald Gill, MD, Clifton
Way, MD, John Mernagh, MD, PhD, Barbara Schmidt, MD, MSc
Hamilton, Ontario, Canada
http://www.mosby.com/scripts/om.dll/serve?article=a119591

Insights

Rapidly increasing stridor in a 12-week-old infant
Carmen Casaulta, MD, Maura Zanolari, MD, Bendicht Wagner, MD, Valerie
Oesch, MD, Georges Kaiser, MD
Berne, Switzerland
http://www.mosby.com/scripts/om.dll/serve?article=a119623

Current Literature and Clinical Issues

Abstracts from the literature
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401abs

Letters

Screening for Turner's syndrome by chromosome analysis of all girls with
short stature
Carl-Joachim Partsch, MD, Uta Raffenberg, cand.med., Wolfgang G.
Sippell, MD
Kiel, Germany
http://www.mosby.com/scripts/om.dll/serve?article=a119172

Reply
Marsha L. Davenport, MD, Lars Svendahl, MD, PhD
Chapel Hill, North Carolina, and Stockholm, Sweden
http://www.mosby.com/scripts/om.dll/serve?article=a119171

Reply
Guy G. Massa, MD, PhD, F. Verlinde, MD, C. Heinrichs, MD, PhD
Brussels, Belgium
http://www.mosby.com/scripts/om.dll/serve?article=a119173

Celiac disease and microcephaly
Pablo Lapunzina, MD, MSc
Madrid, Spain
http://www.mosby.com/scripts/om.dll/serve?article=a120826

Reply
Howard E. Bostwick, MD
Valhalla, New York
http://www.mosby.com/scripts/om.dll/serve?article=a120825

50 Years Ago in the Journal of Pediatrics

Mononuclear pneumonia in sudden death or rapidly fatal illness in
infants
Susanna A. McColley, MD
Chicago, Illinois
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ye

Uses of play in the treatment of children
James D. Myers, PhD
Cincinnati, Ohio
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ye01

Psychologic aspects of pediatrics: Discipline in children
Lori J. Stark, PhD
Cincinnati, Ohio
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ye02

Cardiac enlargement of unknown etiology in infancy and childhood
Rae-Ellen W. Kavey, MD
Chicago, Illinois
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ye03

Reader Services

Instructions to authors
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ia

Information for readers
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ir

Scheduled meetings
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401ca

News and notes
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401nw

Editorial board
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401eb

Fellowships: Pediatric subspecialities and general academic pediatric
training
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401fe

Fellowships
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401fe01

Receive tables of contents by e-mail
http://www.mosby.com/scripts/om.dll/serve?article=jpd021401re

_______________________________________________________________________
Copyright (c) 2002 by Mosby, Inc.
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Journal of Pediatrics
Table of Contents for February 2002, Vol. 140, No. 2
http://www.mosby.com/scripts/om.dll/serve?db=c&id=pd
--------------------------------------------------------------
The Editors' Perspective

This Month in the Journal
http://www.mosby.com/scripts/om.dll/serve?article=jpd021402abs001

Association of Medical School Pediatric Department Chairs, Inc.

Career development for physician-scientists: The model of the pediatric
scientist development program
Margaret K. Hostetter, MD
New Haven, Connecticut
http://www.mosby.com/scripts/om.dll/serve?article=apd121584

Editorials

Cord serum ferritin levels, fetal iron status, and neurodevelopmental
outcomes: Correlations and confounding variables
Robert E. Fleming, MD
St Louis, Missouri
http://www.mosby.com/scripts/om.dll/serve?article=a121931

The impact of molecular genetics on the clinical management of pediatric
sensorineural hearing loss
Daniel Choo, MD
Cincinnati, Ohio
http://www.mosby.com/scripts/om.dll/serve?article=a122671

Medical Progress

Current status of radiofrequency ablation for common pediatric
supraventricular tachycardias
Robert M. Campbell, MD, Margaret J. Strieper, DO, Patricio A. Frias, MD,
David A. Danford, MD, John D. Kugler, MD
Atlanta, Georgia and Omaha, Nebraska
http://www.mosby.com/scripts/om.dll/serve?article=a121823

Grand Rounds

Cystic fibrosis: A 2002 update
David M. Orenstein, MD, Glenna B. Winnie, MD, Harold Altman, MD
Pittsburgh, Pennsylvania
http://www.mosby.com/scripts/om.dll/serve?article=a120269

Original Articles

Cord serum ferritin concentrations and mental and psychomotor
development of children at five years of age
Tsunenobu Tamura, MD, Robert L. Goldenberg, MD, Jinrong Hou, MD, Kelley
E. Johnston, BS, Suzanne P. Cliver, BA, Sharon L. Ramey, PhD, Kathleen
G. Nelson, MD
Birmingham, Alabama
http://www.mosby.com/scripts/om.dll/serve?article=a120688

Chorioamnionitis, mechanical ventilation, and postnatal sepsis as
modulators of chronic lung disease in preterm infants
Linda J. Van Marter, MD, MPH, Olaf Dammann, MD, MS, Elizabeth N. Allred,
MS, Alan Leviton, MD, MS, Marcello Pagano, PhD, Marianne Moore, BA,
Camilia Martin, MD, MS
Boston, Massachusetts, Cincinnati, Ohio, East Lansing, Michigan, New
York City, New Brunswick and Piscataway, New Jersey
http://www.mosby.com/scripts/om.dll/serve?article=a121381

Acute respiratory failure and short-term outcome after premature rupture
of the membranes and oligohydramnios before 20 weeks of gestation
Wolfgang Lindner, MD, Frank Pohlandt, MD, PhD, Dieter Grab, MD, Felix
Flock, MD
Ulm, Germany
http://www.mosby.com/scripts/om.dll/serve?article=a121697

Randomized trial of dobutamine versus dopamine in preterm infants with
low systemic blood flow
David Osborn, MM, FRACP, Nick Evans, MRCPCH, DM, Martin Kluckow, FRACP,
PhD
Sydney, Australia
http://www.mosby.com/scripts/om.dll/serve?article=a120834

Preterm infants born at less than 31 weeks' gestation have improved
growth in cycled light compared with continuous near darkness
Debra H. Brandon, RN, PhD, Diane Holditch-Davis, RN, PhD, FAAN, Michael
Belyea, PhD
Chapel Hill, North Carolina
http://www.mosby.com/scripts/om.dll/serve?article=a121932

Risks of congenital anomalies in large for gestational age infants
Pablo Lapunzina, MD, MSc, Jorge S. Lopez Camelo, PhD, Monica Rittler,
MD, PhD, Eduardo E. Castilla, MD, PhD
Rio de Janeiro, Brazil, La Plata and Buenos Aires, Argentina
http://www.mosby.com/scripts/om.dll/serve?article=a121696

Lung tissue concentrations of nicotine in sudden infant death syndrome
(SIDS)
Kristen I. McMartin, MSc, Marvin S. Platt, MD, Richard Hackman, MD,
Julia Klein, MSc, John E. Smialek, MD, Robert Vigorito, MS, PA, Gideon
Koren, MD, FABMT, FRCPC
Toronto, Ontario, Canada and Baltimore, Maryland
http://www.mosby.com/scripts/om.dll/serve?article=a121937

Effects of nutritional status on diarrhea in Peruvian children
William Checkley, PhD, Robert H. Gilman, MD, Robert E. Black, MD, MPH,
Andres G. Lescano, MHS, Lilia Cabrera, RN, David N. Taylor, MD, Lawrence
H. Moulton, PhD
Baltimore, Maryland and Lima, Peru
http://www.mosby.com/scripts/om.dll/serve?article=a121820

Allergy to soy formula and to extensively hydrolyzed whey formula in
infants with cow's milk allergy: A prospective, randomized study with a
follow-up to the age of 2 years
Timo Klemola, MD, Timo Vanto, MD, Kaisu Juntunen-Backman, MD, Kirsti
Kalimo, MD, Riitta Korpela, PhD, Elina Varjonen, MD
Helsinki, Finland
http://www.mosby.com/scripts/om.dll/serve?article=a121935

Effect of hydroxyurea on growth in children with sickle cell anemia:
Results of the HUG-KIDS study
Winfred C. Wang, MD, Ronald W. Helms, PhD, Henry S. Lynn, PhD, Rupa
Redding-Lallinger, MD, Beatrice E. Gee, MD, Kwaku Ohene-Frempong, MD,
Kim Smith-Whitley, MD, Myron A. Waclawiw, MD, Elliott P. Vichinsky, MD,
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50 Years Ago in the Journal of Pediatrics

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Paul M. Fernhoff, MD
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         <p><font size="4"><strong><u>Nutritional Assessment in
         Children</u></strong></font><br>
         Jeanie Smith, RD </p>
         <ol type="I">
             <li><a href="#High Risk">High Risk
                 Diseases/Conditions</a></li>
             <li><a href="#Growth">Growth Charts/Growth Velocity<br>
                 </a>     <a
                 href="#Weight Gain">Average Rate of Weight Gain
                 for Healthy Children</a></li>
             <li><a href="#Malnutrition Classification">Classification
                 of Malnutrition</a></li>
             <li><a
                 href="#Energy, Protein, Fluid, Vitamin and Mineral
Requirements">Energy,
                 Protein, Fluid, Vitamin and Mineral Requirements<br>
                 </a>     <a
                 href="#Recommended Dietary Allowances">Recommended
                 Dietary Allowances (1989)</a><br>
                      <a
                 href="#Maintenance Fluid">Maintenance Fluid
                 Requirements Based on Weight</a><br>
                      <a
                 href="#Disability Calorie Requirements">Calorie
                 Requirements for Specific Developmental
                 Disabilities</a></li>
         </ol>
         <ol type="I">
             <li><p align="left"><a name="High Risk"><b>High Risk
                 Diseases/Conditions</b></a></p>
             </li>
             <li><ol type="A">
                     <li>Bronchopulmonary Dysplasia (BPD)</li>
                     <li>Cardiac anomalies</li>
                     <li>Cerebral palsy</li>
                     <li>Chronic pancreatitis</li>
                     <li>Congenital abnormalities of GI tract
                         (i.e. tracheoesophageal fistula,
                         esophageal or intestinal atresias)</li>
                     <li>Congenital abnormalities of head and neck
                         (i.e. cleft palate)</li>
                     <li>Cystic Fibrosis</li>
                     <li>Failure to thrive</li>
                     <li>Gastrointestinal disorders and prolonged
                         diarrhea</li>
                     <li>Inborn errors of metabolism</li>
                     <li>Inflammatory Bowel Disease</li>
                     <li>Major body burns (>20% of body surface
                         area)</li>
                     <li>Malignancies</li>
                     <li>Necrotizing enterocolitis</li>
                     <li>Oral motor dysfunction</li>
                     <li>Prematurity</li>
                     <li>Renal anomalies and failure</li>
                     <li>Short bowel syndrome</li>
                 </ol>
             </li>
             <li><p align="left"><a name="Growth"><b>Growth
                 Charts/Growth Velocity</b></a></p>
             </li>
             <li><ol>
                     <li><p align="left">Plot weight, height and
                         weight for height to determine growth
                         percentile.</p>
                     </li>
                     <li>If child is overweight, may need to
                         determine</li>
                     <li><ol type="a">
                             <li>Ideal Body Weight (IBW) for
                                 height (same as median weight for
                                 height)</li>
                             <li>Ideal Body Weight for age (same
                                 as median weight for age)</li>
                             <li>Median height for age</li>
                         </ol>
                     </li>
                     <li>Correction for prematurity</li>
                     <li><ol type="a">
                             <li>Subtract the number of weeks
                                 premature based on 40 weeks
                                 gestational age of a full-term
                                 infant from the actual
                                 gestational age before plotting
                                 on the NCHS growth chart. (e.g.
                                 an infant born at 28 weeks
                                 gestation is 12 weeks premature
                                 and would be plotted on the graph
                                 3 months behind chronological
                                 age).</li>
                             <li>When using NCHS charts,
                                 correction for prematurity should
                                 continue until the infant is 2
                                 years of age.</li>
                         </ol>
                     </li>
                     <li>Adequacy of growth is best determined
                         through assessment of serial
                         measurements.</li>
                 </ol>
                 <p align="center"><a name="Weight Gain"><b>Average
                 Rate of Weight Gain for Healthy Children</b><font
                 face="Symbol"><b>*</b></font></a></p>
                 <div align="center"><center><table border="1"
                 cellpadding="5" cellspacing="0" width="440"
                 bordercolor="#000000">
                     <tr>
                         <td valign="top" width="25%"><p
                         align="center"><b>Age</b></p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center"><b>Gm/day</b></p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center"><b>Age/year</b></p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center"><b>Gm/month</b></p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%"><p
                         align="center">0-3</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">25-39</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">2-7</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">38</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%"><p
                         align="center">3-6</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">20</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">7-9</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">56-62</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%"><p
                         align="center">6-9</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">15</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">9-11</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">67-77</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%"><p
                         align="center">12-18</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">8</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">11-13</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">85-110</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%"><p
                         align="center">18-24</p>
                         </td>
                         <td valign="top" width="25%"><p
                         align="center">6</p>
                         </td>
                         <td valign="top" width="25%"> </td>
                         <td valign="top" width="25%"> </td>
                     </tr>
                 </table>
                 </center></div><blockquote>
                     <blockquote>
                         <p><font size="1"
face="Symbol"><i>*</i></font><font
                         size="1"><i> Chart based on growth
                         velocity of the 50</i><sup><i>th
</i></sup><i>percentile
                         for weight for age from the National
                         Center for Health Statistics growth
                         charts.<br>
                         From: Hohenbrink K, Nicol JJ. Pediatrics.
                         In Gottschlich MM, Matarese LE, Shronts
                         EP (eds.); Nutrition Support Dietetics
                         Core Curriculum. 2</i><sup><i>nd</i></sup><i>
                         edition. Silver Spring, Md.: A.S.P.E.N.;
                         1993: 163-187.</i></font></p>
                     </blockquote>
                 </blockquote>
             </li>
             <li><p align="left"><a
                 name="Malnutrition Classification">Classification
                 of Malnutrition</a></p>
             </li>
             <li><ol>
                     <li><p align="left">Plot IBW for height (same
                         as median weight for height), median
                         height for age, and IBW for age (same as
                         median weight for age) and compare to
                         tables below.</p>
                     </li>
                     <li>Gomez and Waterlow Criteria for
                         assessment of nutritional status.</li>
                 </ol>
                 <p align="center"><b>Classification of Severity
                 of Wasting and Stunting</b> (Waterlow, 1976)</p>
                 <div align="center"><center><table border="1"
                 cellpadding="5" cellspacing="0" width="540"
                 bordercolor="#000000">
                     <tr>
                         <td valign="top" width="33%"><p
                         align="center"><b>Grade of<br>
                         Malnutrition</b></p>
                         </td>
                         <td valign="top" width="33%"><p
                         align="center"><b>Percent of Median<br>
                         Weight-For-Height<br>
                         (wasting)</b></p>
                         </td>
                         <td valign="top" width="33%"><p
                         align="center"><b>Percent of Median<br>
                         Height-For-Age<br>
                         (stunting)</b></p>
                         </td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="33%">Normal</td>
                         <td align="center" valign="top"
                         width="33%">90-110</td>
                         <td align="center" valign="top"
                         width="33%">95</td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="33%">Mild</td>
                         <td align="center" valign="top"
                         width="33%">80-89</td>
                         <td align="center" valign="top"
                         width="33%">90-94</td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="33%">Moderate</td>
                         <td align="center" valign="top"
                         width="33%">70-79</td>
                         <td align="center" valign="top"
                         width="33%">85-89</td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="33%">Severe</td>
                         <td align="center" valign="top"
                         width="33%">< 70</td>
                         <td align="center" valign="top"
                         width="33%">< 85</td>
                     </tr>
                 </table>
                 </center></div><p align="center"><b>Classification
                 of Severity of Underweight</b> (Gomez, 1956)</p>
                 <div align="center"><center><table border="1"
                 cellpadding="5" cellspacing="0" width="440"
                 bordercolor="#000000">
                     <tr>
                         <td valign="top" width="50%"><p
                         align="center"><b>Grade of <br>
                         Malnutrition</b></p>
                         </td>
                         <td valign="top" width="50%"><p
                         align="center"><b>Percentile of Median<br>
                         Weight-For-Age</b></p>
                         </td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="50%">Normal</td>
                         <td valign="top" width="50%"><p
                         align="center">90-110</p>
                         </td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="50%">Mild</td>
                         <td valign="top" width="50%"><p
                         align="center">75-89</p>
                         </td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="50%">Moderate</td>
                         <td valign="top" width="50%"><p
                         align="center">60-74</p>
                         </td>
                     </tr>
                     <tr>
                         <td align="center" valign="top"
                         width="50%">Severe</td>
                         <td valign="top" width="50%"><p
                         align="center">< 60</p>
                         </td>
                     </tr>
                 </table>
                 </center></div></li>
             <li><p align="left"><a
                 name="Energy, Protein, Fluid, Vitamin and Mineral
Requirements">Estimation
                 of Energy, Protein, Fluid, Vitamin and Mineral
                 Requirements</a></p>
             </li>
             <li><ol>
                     <li><p align="left">The Recommended Dietary
                         Allowances (RDA) is the most frequently
                         used tool to estimate daily nutrient
                         needs for healthy infants and children.</p>
                     </li>
                     <li>Adjustments of the RDA's are necessary in
                         the following cases:</li>
                     <li><ol type="a">
                             <li>Undernutrition or overnutrition</li>
                             <li>Chronic or acute diseases that
                                 increase or decrease energy needs</li>
                             <li>Markedly increased or decreased
                                 physical activity.</li>
                         </ol>
                     </li>
                     <li>Fluid requirements may be necessary if
                         insensible losses are increased.</li>
                 </ol>
                 <p align="center"><a
                 name="Recommended Dietary Allowances"><b>Recommended
                 Dietary Allowances (1989)</b></a></p>
                 <p align="center"><b>Energy and Protein Needs</b></p>
                 <div align="center"><center><table border="0"
                 cellpadding="5" cellspacing="0" width="440">
                     <tr>
                         <td valign="top" width="25%"> </td>
                         <td align="center" valign="top"
                         width="25%"><u>Age</u></td>
                         <td align="center" valign="top"
                         width="25%"><u>Calories/kg</u></td>
                         <td align="center" valign="top"
                         width="25%"><u>Protein gm/kg</u></td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%">Infants</td>
                         <td align="center" valign="top"
                         width="25%">0-0.5<br>
                         0.5-1.0</td>
                         <td align="center" valign="top"
                         width="25%">108<br>
                         98</td>
                         <td align="center" valign="top"
                         width="25%">2.2<br>
                         1.6</td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%">Children</td>
                         <td align="center" valign="top"
                         width="25%">1-3<br>
                         4-6<br>
                         7-10</td>
                         <td align="center" valign="top"
                         width="25%">102<br>
                         90<br>
                         70</td>
                         <td align="center" valign="top"
                         width="25%">1.2<br>
                         1.2<br>
                         1.0</td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%">Males</td>
                         <td align="center" valign="top"
                         width="25%">11-14<br>
                         15-18</td>
                         <td align="center" valign="top"
                         width="25%">55<br>
                         45</td>
                         <td align="center" valign="top"
                         width="25%">1.0<br>
                         0.9</td>
                     </tr>
                     <tr>
                         <td valign="top" width="25%">Females</td>
                         <td align="center" valign="top"
                         width="25%">11-14<br>
                         15-18</td>
                         <td align="center" valign="top"
                         width="25%">47<br>
                         40</td>
                         <td align="center" valign="top"
                         width="25%">1.0<br>
                         0.8</td>
                     </tr>
                 </table>
                 </center></div><p align="center"><a
                 name="Maintenance Fluid"><b>Maintenance Fluid
                 Requirements Based on Weight</b></a></p>
                 <div align="center"><center><table border="1"
                 cellpadding="5" cellspacing="0" width="450"
                 bordercolor="#000000">
                     <tr>
                         <td valign="top" width="33%"><p
                         align="center"><b>Weight</b></p>
                         </td>
                         <td valign="top" width="67%"><p
                         align="center"><b>Fluid</b></p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="33%"><p
                         align="center">1-10 kg</p>
                         </td>
                         <td valign="top" width="67%"><p
                         align="center">100 ml/kg/day</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="33%"><p
                         align="center">10-20 kg</p>
                         </td>
                         <td valign="top" width="67%"><p
                         align="center">1000 ml + 50 ml for each
                         kg over 10 kg</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="33%"><p
                         align="center">> 20 kg</p>
                         </td>
                         <td valign="top" width="67%"><p
                         align="center">1500 ml + 20 ml for each
                         kg over 20 kg</p>
                         </td>
                     </tr>
                 </table>
                 </center></div><p align="center"><a
                 name="Disability Calorie Requirements"><b>Estimation
                 of Calorie Requirements for Specific<br>
                 Developmental Disabilities Based on Height</b></a></p>
                 <div align="center"><center><table border="1"
                 cellpadding="5" cellspacing="0" width="540"
                 bordercolor="#000000">
                     <tr>
                         <td valign="top" width="50%"><p
                         align="center"><b>Developmental
                         Disability</b></p>
                         </td>
                         <td valign="top" width="50%"><p
                         align="center"><b>Guide for Caloric
                         Intake</b></p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="50%"><b>Down's
                         Syndrome: </b>Results from an extra #21
                         chromosome, causing developmental
                         problems such as congenital heart
                         disease, mental retardation, small
                         stature and decreased muscle tone.</td>
                         <td valign="top" width="50%"><ul>
                             <li>Boys = 16.1 kcal/cm (40.9
                                 kcal/inch)</li>
                             <li>Girls = 14.3 kcal/cm (36.3
                                 kcal/inch)</li>
                         </ul>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="50%"><b>Prader-Willi
                         Syndrome: </b>A disorder characterized by
                         uncontrollable eating habits, inability
                         to distinguish hunger from appetite,
                         severe obesity, poorly developed
                         genitalia and moderate to severe mental
                         retardation.</td>
                         <td valign="top" width="50%"><ul>
                             <li>10-11 kcal/cm (26.7 kcal/inch)
                                 for maintenance</li>
                             <li>8-9 kcal/cm (21.6 kcal/inch) for
                                 weight loss</li>
                         </ul>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="50%"><b>Spina
                         Bifida (Myelomeningocele): </b>Results
                         from a midline defect of the skin, spinal
                         column and spinal cord, characterized by
                         hydrocephalus, mental retardation and
                         lack of muscle control. May result in
                         obesity, constipation, urinary tract
                         infection, feeding problems.</td>
                         <td valign="top" width="50%"><ul>
                             <li>7 kcal/cm (17.78 kcal/inch) for
                                 weight loss</li>
                             <li>500 kcal/day for severely
                                 immobilized</li>
                         </ul>
                         <p>The above are very restrictive. As a
                         general recommendation, use 50% of the
                         kcal level of a normal child of same age.
                         Energy needs may need to be increased for
                         frequent shunt infections or for mobile
                         children.</p>
                         </td>
                     </tr>
                     <tr>
                         <td valign="top" width="50%"><b>Cerebral
                         Palsy: </b>A disorder of muscle control
                         or coordination resulting from injury to
                         the brain during its early (fetal,
                         perinatal and early childhood) stages of
                         development. There may be associated
                         problems with intellectual, visual or
                         other functions.</td>
                         <td valign="top" width="50%"><ul>
                             <li>5-11 years, mild to moderate
                                 activity level: 13.9 kcal/cm
                                 (35.3 kcal/inch)</li>
                             <li>5-11 years, severe restrictions
                                 in activity: 11.1 kcal/cm (28.2
                                 kcal/inch).</li>
                         </ul>
                         </td>
                     </tr>
                 </table>
                 </center></div><p align="left"><font size="1"><i>From:
                 Heinrichs E & Rokusek C. Nutriton and Feeding
                 for the Developmentally Disabled. South Dakota
                 Universit Affiliated Program (SDUAP) University
                 of South Dakota School of Medicine from the South
                 Dakota Department of Education & Cultural
                 Affairs-Child/Adult Nutrition Services. Pierre,
                 SD. 1985</i></font></p>
                 <p align="center">Vanderbilt University Medical
                 Center<br>
                 Pediatric Clinical Dietitians 1997-98</p>
                 <ul>
                     <li>Martha Ballew, MA, RD, CNSD.: Pediatric
                         GI, Nutrition Support and PICU. Beeper:
                         923-3810. </li>
                     <li>Dana Bricker, RD.: 5 North, 5 South,
                         Diabetes Clinics. Beeper: # 1958</li>
                     <li>Malina Magee, RD: 6 South Adolescent
                         Unit, Myelosuppresion, Hematology
                         Clinics. Beeper: # 1770.</li>
                     <li>Jeanie Smith, RD: Neonatal Nutrition
                         Support, NICU and PICU. Beeper # 1036</li>
                     <li>Cathy Tillery, RD: relief dietitian at
                         present. </li>
                     <li>Susan Van Slyke RD: 6 South, Diabetes
                         Clinics and Genetics. Beeper: # 3908</li>
                 </ul>
             </li>
         </ol>
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Introduction
First case of pediatric AIDS was diagnosed in 1982, in India first
seropositive infant was diagnosed in 1987. In India, 85,000 HIV
infected persons and 7012 AIDS cases were reported by NACO in March
1999. Maharashtra accounted for approximately 50% of all reported
cases. The end of 1999 reported all over world 11.2 million AIDS
orphans. AIDS orphan is the term used for the child who has lost
his/her mother to HIV/AIDS before the age of 15.
Transmission: - 1. Vertical - In absence of maternal anti-retroviral
treatment, the risk for HIV infection among infants range from 10 -
45%. Risk factors for perinatal transmission of HIV - Clinical:
Premature delivery  4 hours chorioamnionitis, non-receipt of
caesarean section before onset of labour. 2. Blood - HIV transmission
rate from receipt of infected blood products is approximately 100%.
Serology could be negative in cases with window period, in such cases
screening by p24 antigen or HIV RNA assays might be warranted. 3.Body
fluids - HIV replicates only within cells that it infects, especially
those that express the CD4 antigen, such as some helper T
lymphocytes, monocytes and macrophages. It is likely that because
blood and semen have larger quantity of CD4 antigen expressing cells,
they are the body fluids most often associated with transmission of
HIV infection. HIV is recovered from other body fluids but exposure
to these fluids has not been documented to result in HIV infection
unless these fluids are contaminated with blood. 4. i/v drugs, 5.
Sexual Abuse, 6. Breast Feeding Pediatric
HIV Classification - Category N - Not Symptomatic, Category A -
Mildly symptomatic (i.e. children with two or more of the following:
lymphadenopathy, hepatomegaly, splenomegaly, dermatitis, parotitis,
recurrent/persistent URI), Category B - Moderately symptomatic (i.e.
anemia, neutropenia, pneumonia, oropharyngeal candidiasis,
cardiomyopathy, lymphoid interstitial pneumonia, etc). Category C -
Severely symptomatic (i.e. children with any of the conditions listed
in the surveillance case definition of AIDS).
Clinical Manifestations - 1. Rapid Progressors -approximately 20% of
patients, these children progress very rapidly to AIDS defining
conditions, rapid loss of CD4 cells within the first two years of
life. 2. Intermediate Progressors: 60 -75% of children develop severe
immunosuppression by 7 -8 years of age, with a much more gradual loss
in CD4 cells. 3. Long term Survivors - 5 -10%, minimal to no symptoms
of HIV disease and a normal to minimally decreased CD4 cells count by
8 years of age.
Diagnosis of HIV infection in Children - The diagnosis of HIV
infection among children begins with the identification of HIV
infection in women before and during each pregnancy by voluntary
screening during pre natal care. The rapid and early diagnosis of HIV
infection in exposed infants is difficult because of transplacental
passage of maternal IgG antibodies to the virus that are present in
infants up to 18 months of age. The diagnosis of HIV infection among
young infants now relies exclusively on virologic assays. Virologic
assays are also helpful to confirm infection in patients with
advanced stage of disease who have inadequate specific antibody
production. Infants born to HIV positive mothers - Infants who
initially have negative virologic tests should be re-evaluated at 1 -
2months and 4 -6 months. Laboratory diagnosis Detection of specific
antibodies: Screening tests - ELISA/Rapid test/Simple test.
Supplemental tests - Western blot/IFA/RIPA. Detection of specific
antigens: p24 antigen detection, reverse transcriptase. Detection of
viral nucleic acid: In situ hybridization, PCR a. genotyping of HIV,
b. viral load assay. Isolation or culture of virus.
HIV Testing Strategies - Strategy I - All samples are tested with one
ELISA or rapid /simple. Strategy II - All samples are first tested
with one test. Any reactive samples are subjected to second test
based on a different principle and/or different antigenic
preparations. Strategy III - All samples are first tested with one
test. Any reactive samples are tested with a different test. Samples
found reactive by the second test are subjected to a third and
different test.
Opportunistic Infections: - Pneumocystis Carinii Pneumonia, S.
pneumoniae, Salmonella, Staph, H. influenzae, Pseudomonas.
Management - 1) HAART: Highly Active Anti-Retroviral Therapy, 2)
Prophylaxis against opportunistic infections. 3) Supportive and
symptomatic treatment.
Principles of antiretroviral therapy: 1) Monotherapy is
contraindicated because it results in suppression of HIV replication
thereby allowing the emergence of drug resistance. 2) All children
with HIV infection should be offered specific ART irrespective of
their clinical status, CD4 counts or HIV RNA copy number. 3) All
drugs approved for adults can be used for children. 4) Early
initiation of therapy is advantageous because it slows deterioration
of immune function, delays progression of disease, reduces incidence
of opportunistic infections and prolongs patient survival. 5)
Treatment has to continue even after the CD4 T lymphocyte counts have
reached normal level.
Prevention: 1) Perinatal transmission- prevented by giving zidovudine
(100mg five times a day during T2, T3) i/v bolus of 2mg/kg at start
of labour, 1mg/kg/hour thereafter caesarean section, zdv (2mg/kg/dose
6 hourly) to baby for 6 weeks and avoidance of breast feeding. 2)
Safe transfusion of blood. 3) Post-exposure prophylaxis

Introduction
Dengue virus is an arthropod borne virus belonging to genus
flavivirus, family flaviviridae. There are four serotypes called DEN-
1, DEN-2, DEN-3 and DEN-4. Infection with one serotype provides
lifelong immunity for homologous infection but no cross protection
against infection with other serotypes. Aedes aegypti is the
principle vector in India. It is a small black and white tropical
mosquito. It rests indoors and bites humans in daytime. It lay eggs
in water collected in artificial containers like buckets, coolers,
flower pots. Its incubation period is about 10 -12days.
Pathophysiology
Exact mechanism of DHF/DHS is not clear, two theories, one, the
secondary infection or immune enhancement hypothesis. This hypothesis
implies that patient experiencing a second infection with a
heterogeneous dengue virus serotype has a significantly higher risk
for developing DHF and DSS. Preexisting heterologous dengue antibody
recognizes the infecting virus and forms an antigen antibody complex,
which is then bound to and internalized by immunoglobulin Fc
receptors on the cell membrane of leukocytes, especially macrophages
where virus is free to replicate. This antibody dependent enhancement
(ADE) enhances the infection and replication of dengue virus in cells
of the mononuclear cell lineage. These cells produce and secrete
vasoactive mediators in response to dengue infection, which causes
increased vascular permeability leading to hypovolemia and shock.
Second, phenotypic expression of genetic changes in the virus genome
may include increased virus replication and viremia, virulence
(severity of disease), and epidemic potential.Cytokines and chemical
mediators such as tumor necrosis factor (TNF), interleukin-1 (IL-1),
IL-2, IL-6, platelet activation factor (PAF), complement activation
products C3a and C5a, and histamine may play a role.
Manifestations
A. Asymptomatic-
B. Symptomatic -(i) Undifferentiated Fever, (ii) Dengue Fever (a)
Without Hemorrage (b) With Unusal Hemorrage.(i) DHF without shock
(ii) DHF with Shock.
Symptoms
Fever usually starts after 2 -7 days after mosquito bite. It is
associated with macular or maculopapular rash. Vomiting, diarhoea,
abdominal pain, convulsions, altered sensorium, headache, retro-
orbital pain, arthralgia are usually associated. Hepatomegaly,
splenomegaly, bradycardia, lymphadenopathy is usual findings.
In DHF the hemorrhage starts by third day. It is characterised by
positive torniquet test (Hess Test), epistaxis, hematemesis,
skin/mucosal bleeds, melana. Thrombocytopenia (less than 1,00,000 per
cmm) and evidence of plasma leak are characteristic of DHF. The
plasma leak is to be monitored by more than 20% rise in hematocrit
for age, more than 20% drop in hematocrit following treatment with
fluids as compared to base line. DSS includes all above and signs of
circulatory failure manifested by rapid and weak pulse, narrow pulse
pressure, hypotension for age, restlessness.
Grading the severity

DF/DHF Grade Symptoms Laboratory
DF  Fever with two or more :- headache, retro-orbital pain, myalgia,
arthralgia Thrombocytopenia, Occ Leukopenia, No plasma loss.
DHF I Above plus Tourniquet test Plat less than 100000, Hct rise >
20%
DHF II Above plus Bleed Plat less than 100000, Hct rise > 20%
DHF III Above plus circulatory failure Plat less than 100000, Hct
rise > 20%
DHF IV Profound shock Plat less than 100000, Hct rise > 20%
DHF Grade III and IV are also called as Dengue Shock Syndrome (DSS).

Diagnosis
Laboratory diagnosis is made on demonstration of fourfold or greater
rise in specific antibodies which can be detected. By various
serological tests. e.g. hemagglutination inhibition, complement
fixation, neutralization test, ELISA or G-ELISA Virus isolation
methods such as mammalian cell culture and mosquito inoculation are
very expensive and time consuming and are not routinely available.
Reverse transciptase PCR, hybridization probes for nucleic acids and
immunohistochemistory are newer techniques for diagnosis.
Prevention
In the absence of effective vaccine, prevention is largely dependent
on vector control.
Treatment
There is no specific antiviral therapy, supportive therapy is only
important. Antipyretics, good diet, fluid and rest is to be taken
care. Paracetamol is preferred antipyretic.

Volume replacement flow chart - DSS

  Unstable vital signs urine output falls signs of shock

    I Immediate rapid volume replacement : Initiate IV therapy 1- 20
ml/kg/h crystalloid solution for 1 hour.

no Improvement     :

IV therapy by crystalloid successively reducing from 20 to 10, 10 to
6 and 6 to 3 ml/kg/hr
    Oxygen

   Further Improvement
   Hematocit rises
   Hematocrit Falls

Discontinue IV therapy after 24-48hr
   IV colloid iv bolus
(Dextran or Plasma)
   Blood transfusion

   Improvement:

   IV therapy by crystalloid, successively reducing the flow from 10
to 6, 6 to 3ml/kg/hr, Discontinue after 24-48 hr.

Could someone please let me know how to register for this list serv.
Thankyou
Lesley

> >Importance: High
> >
> >
> >"HELP SAVE A SRI LANKAN CHILD" COULD YOU PLEASE HELP THIS CHILD - NOT
> >WITH
> >MONEY - ONLY BY FORWARDING  THIS MAIL TO AS MANY  PEOPLE  Dear Friends,
> >This has nothing to do with donating money from your pocket!!!
> >
> >
> >Hi, I am a 29 year old father. Me and my wife have had a wonderful life
> >together. God blessed us with a child too. Our daughter's name is Rachel
> >and
> >she's 10 years old. Not long ago did the doctors detect brain cancer in
> >her
> >little body. There is only one way to save her: an operation. Sadly, we
> >don't have enough money to pay the price. AOL and Zdnet have  agreed to
> >help
> >us.  The only way they can help us is this way: I send this e-mail to
> >you
> >and you send it to other people. AOL will track this e-mail and count
> >how
> >many people get it.  EVERY PERSON THAT OPENS THIS E-MAIL AND SENDS IT TO
> >AT   LEAST 3 PEOPLE WILL GIVE US 32 CENTS. PLEASE HELP US.
> >  Dept. of Civil Engineering, Faculty of Engineering, University of
> >Peradeniya, Sri Lanka  Tel. (0)8-388029 Ext. 534/530 Fax.
> >(0)8-388158 with attn e-mail jayalath_edirisinghe@...

kempeds, pediatrics:

OUR COLLECTION OF LINKS...

              SUGGEST US !

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MED PORTAL: http://www.medportal.com/medlinks.html/

DRUG DIRECTORY: http://health.yahoo.com/health/drugs_tree/medication_or_drug

CDC : http://www.cdc.gov/mmwr/mmwr.html

MEDSCAPE : http://pediatrics.medscape.com/Home/Topics/pediatrics/pediatrics.html

MEDEXPLORER:   http://www.medexplorer.com/center.dbm?Template=ChildrensHealth

EMEDICINE: http://www.emedicine.com/

YAHOO DIRECTORY: http://dir.yahoo.com/Health/Medicine/Pediatrics/

http://dir.yahoo.com/Health/Medicine/Pediatrics/Journals/

PEDSNET: http://www.pedsnet.org/

PEDINFO: http://www.pedinfo.org/

PEDTALK: http://www.pcc.com/lists/pedtalk/

       PEDSCAPE: http://imavja.20m.com/LinksPed.htm
       Emergency drugs: http://www.who.int/medicines/topics.htm

MEDEXACT: http://www.medexact.com/medexact/validateLogin.jsp

http://www.acgme.org/ http://pgimer.nic.in/

http://www.lib.uchicago.edu/e/su/med/gme.html

    http://www.aamc.org/students/eras/

http://www.chd.nic.in/pgimer/intrain.htm

http://www.jipmer.org/jipmernet/links.html

http://www.mayo.edu/education/education.html

http://www.gahec.org/

http://www.AHEConnect.com.

http://www.cmecourses.com/Gateway/index.cfm?PID=484

http://www.med.nyu.edu/cme/

http://webct.ucis.dal.ca/public/medical/

http://www.medicalcomputingtoday.com/0listcme.html

http://www.medicalcomputingtoday.com/0listcmes.html#PEDSECTION

http://www.mcsindia.org/education/pg_education/index_pg.asp

http://www.medindia.net/Medindia-Full-Version/education.htm

http://www.amc.edu/index.cfm

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Table 1. New Concepts in ATP III

Table 2. Classification of LDL-C Concentrations

Table 3. Classification of Triglycerides

Table 4. Initial Classification of Hyperlipidemia Patients

Table 5. Major Risk Factors for CHD Other Than LDL-C

Table 6. Goals of LDL-C Therapy by Risk Category

Table 7. Nutritional Composition of the TLC Diet

TLC == therapeutic lifestyle changes.
^[a]Trans fatty acids also raise LDL-C and should also be restricted.
^[b]Daily energy expenditure should occur through at least moderate physical activity (i.e., enough to consume approximately 200 cal/day). Table 9. Diagnosis of the Metabolic Syndrome

Table 10. Treatment Goals for Patients with Fasting Triglycerides > 200 mg/dL after LDL-C Goal Has Been Achieved

Welcome to the PAEDIATRIC-LINKS.co.uk website!

On-line Journals textbooks

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Welcome to the PAEDIATRIC-LINKS.co.uk website!

Dr. Reddy's Pediatric Office on the Web ^TM

Pediatric Resources on the Web

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Dr. Reddy's Pediatric Office on the Web ^TM

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Table 1. New Concepts in ATP III

Table 2. Classification of LDL-C Concentrations

Table 3. Classification of Triglycerides

Table 4. Initial Classification of Hyperlipidemia Patients

Table 5. Major Risk Factors for CHD Other Than LDL-C

Table 6. Goals of LDL-C Therapy by Risk Category

Table 7. Nutritional Composition of the TLC Diet

TLC == therapeutic lifestyle changes.[a]Trans fatty acids also raise LDL-C and should also be restricted.[b]Daily energy expenditure should occur through at least moderate physical activity (i.e., enough to consume approximately 200 cal/day). Table 9. Diagnosis of the Metabolic Syndrome

Table 10. Treatment Goals for Patients with Fasting Triglycerides > 200 mg/dL after LDL-C Goal Has Been Achieved

Welcome to the PAEDIATRIC-LINKS.co.uk website!

On-line Journals textbooks

Teaching Reference

Welcome to the PAEDIATRIC-LINKS.co.uk website!

Dr. Reddy's Pediatric Office on the Web TM

Pediatric Resources on the Web

Search the Office for:

Dr. Reddy's Pediatric Office on the Web TM

Fun Sites for Kids

Search the Office for:

TLC == therapeutic lifestyle changes.
^[a]Trans fatty acids also raise LDL-C and should also be restricted.
^[b]Daily energy expenditure should occur through at least moderate physical activity (i.e., enough to consume approximately 200 cal/day). Table 9. Diagnosis of the Metabolic Syndrome

Dr. Reddy's Pediatric Office on the Web ^TM

Dr. Reddy's Pediatric Office on the Web ^TM