Inner-city Pediatric Population Research Articles

Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

This case series details seven pediatric cases of nutritional rickets in an inner-city population of New Jersey. Eighty six percent of these patients were exclusively breast fed, and all self-identified as black or African American. Patients ranged in age from 8 months to 3 years at the time of initial diagnosis. All seven patients were male. Five patients were presented in an office setting, while two were found to have nutritional rickets in an emergency setting. Patients demonstrated classic pathognomonic findings of rickets, including three patients with rachitic rosary. The aim of this case series is to emphasize the importance of surveillance and high clinical suspicion for nutritional rickets, particularly in children with darker skin complexions and who were exclusively breast-fed during infancy. Rapid diagnosis and intervention may delay or negate the need for orthopedic surgical intervention.

Genetic variants in the vitamin D pathway and their association with vitamin D metabolite levels: Detailed studies of an inner-city pediatric population suggest a modest but significant effect in early childhood

ObjectivesIn a large cohort of healthy infants and toddlers 6–36 months of age (n = 776), we have been exploring the potential role of genetic variation in predisposition to vitamin D insufficiency. The genes encoding the key cytochrome P450 hydroxylases (CYP2R1, CYP24A1, and CYP27B1) harbour recurrent mutations of uncertain effect. This study was undertaken to look for biochemically relevant associations of these variants with inter-individual differences in vitamin D metabolism in an at-risk pediatric population. MethodsGenotyping for CYP2R1-CT (c.–1127 C>T, rs10741657), CYP24A1-AG (c.–686A>G, rs111622401), and CYP27B1-CA (c.–1261 C>A, rs10877012) mutations were performed using SNaPshot assay, followed by Sanger sequencing confirmation. Vitamin D metabolites and vitamin D binding protein (DBP) were measured by established methods. ResultsIn a multivariate regression model, with corrections for co-variates, subjects with the homozygous CYP2R1-TT variant had significantly higher concentrations of 25(OH)D, free 25(OH)D, and 24,25(OH)2D levels. In subjects with the CYP24A1-AG mutation, concentrations of 25(OH)D were significantly higher. ConclusionsThe CYP2R1-TT and CYP24A1-AG variants have measurable effects on the vitamin D pathway. It seems unlikely that they will be clinically relevant in isolation, but they may be members of the large pool of infrequent mutations contributing to different risks for the vitamin D deficiency phenotype.

A traumatic pandemic: High acuity pediatric trauma in the COVID19 era

ObjectiveGaps remain in our understanding on how COVID19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. MethodsWe compared high acuity trauma visits (requiring admission, surgery, or fatality) presenting between March through February 2021 to corresponding months in 2017-2019. We evaluated the differences in mechanisms of injury, age, and Area Deprivation Index (ADI), a measure of socioeconomic disadvantage, during this time period. Data were analyzed using longitudinal time series analyses and t-tests. ResultsOf 687 traumas presenting from March 2020 through February 2021, 322 were high acuity traumas. High acuity traumas declined significantly to a nadir of 16 in April 2020. High acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 and from October through December 2020. There were more visits for high acuity assaults and confirmed or suspected physical child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 and from October through December 2020 compared to prior years. High acuity assaults and physical child abuse cases on average were from the most disadvantaged areas, and physical child abuse patients were younger during the peak of the Pandemic compared to Pre-Pandemic months. ConclusionThis analysis provides insight into how the COVID19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues.

Adherence to Lead Screening Guidelines in an Inner-City Pediatric Population.

Adherence to Lead Screening Guidelines in an Inner-City Pediatric Population.

Endotypes of difficult-to-control asthma in inner-city African American children.

African Americans have higher rates of asthma prevalence, morbidity, and mortality in comparison with other racial groups. We sought to characterize endotypes of childhood asthma severity in African American patients in an inner-city pediatric asthma population. Baseline blood neutrophils, blood eosinophils, and 38 serum cytokine levels were measured in a sample of 235 asthmatic children (6–17 years) enrolled in the NIAID (National Institute of Allergy and Infectious Diseases)-sponsored Asthma Phenotypes in the Inner City (APIC) study (ICAC (Inner City Asthma Consortium)-19). Cytokines were quantified using a MILLIPLEX panel and analyzed on a Luminex analyzer. Patients were classified as Easy-to-Control or Difficult-to-Control based on the required dose of controller medications over one year of prospective management. A multivariate variable selection procedure was used to select cytokines associated with Difficult-to-Control versus Easy-to-Control asthma, adjusting for age, sex, blood eosinophils, and blood neutrophils. In inner-city African American children, 12 cytokines were significant predictors of Difficult-to-Control asthma (n = 235). CXCL-1, IL-5, IL-8, and IL-17A were positively associated with Difficult-to-Control asthma, while IL-4 and IL-13 were positively associated with Easy-to-Control asthma. Using likelihood ratio testing, it was observed that in addition to blood eosinophils and neutrophils, serum cytokines improved the fit of the model. In an inner-city pediatric population, serum cytokines significantly contributed to the definition of Difficult-to-Control asthma endotypes in African American children. Mixed responses characterized by TH2 (IL-5) and TH17-associated cytokines were associated with Difficult-to-Control asthma. Collectively, these data may contribute to risk stratification of Difficult-to-Control asthma in the African American population.

Outdoor exposure and vitamin D levels in urban children with asthma

BackgroundThe inner-city pediatric population in the United States has a disproportionate burden of asthma. Recent attention has focused on the immunomodulatory role of vitamin D, which may be protective against disease morbidity. As the primary determinant of vitamin D status in humans is exposure to sunlight, we aimed to determine if 25-OH vitamin D levels in urban preschool children with asthma were low, influenced by time spent outdoors, and associated with asthma morbidity.MethodsSerum 25-OH vitamin D levels were measured at baseline in a cohort of 121 inner-city children ages 2–6 years with asthma in Baltimore, MD. Participants were followed longitudinally at 3 and 6 months to assess time spent outdoors, asthma symptoms through questionnaires and daily diaries, and allergic markers.ResultsIn a predominantly black population of preschool children, the median 25-OH vitamin D level was 28 ng/mL (IQR 21.2-36.9), with 54% of the children below the traditionally sufficient level of 30 ng/mL and 7.4% in the range associated with risk of rickets (< 15 ng/mL). The median time spent outdoors was 3 hours/day (IQR 2–4), and greater time spent outdoors was not associated with higher vitamin D levels. 25-OH vitamin D did not show seasonal variation in our cohort (p = 0.66). Lower 25-OH levels were correlated with higher IgE levels.ConclusionsUrban African-American preschool children with asthma have high rates of vitamin D insufficiency, and increased outdoor exposure is unlikely to correct these low 25-OH vitamin D levels. Repletion in this population may require dietary supplementation.

High Prevalence of Asthma, Obesity and Hypertension in Children from Pittsburgh's Inner-City

RATIONALE: Inner-city children are at risk for a variety of health problems inculding asthma, obesity and hypertension. The objective of this study was to determine the prevalence of possible asthma, obesity and hypertension in an inner-city pediatric population from Pittsburgh, PA.

High Prevalence of Asthma and Obesity in Children from Pittsburgh's Inner-City

RATIONALE: Inner-city children are at risk for a variety of health problems including asthma and obesity. The objective of this study was to determine the prevalence of asthma and obesity in an inner-city pediatric population from Pittsburgh, PA.

Application Of Shotokan Karate Exercises In An Obese Inner-city Pediatric Population Who Participated In The Downstart Healthy Lifestyle Program

Application Of Shotokan Karate Exercises In An Obese Inner-city Pediatric Population Who Participated In The Downstart Healthy Lifestyle Program

Ability to Control Persistent Asthma in Obese Versus Non-Obese Children Enrolled in an Asthma-Specific Disease Management Program (Breathmobile)

To determine if asthma control was more difficult to achieve in obese versus non-obese asthmatic children, retrospective analysis was performed on obese and non-obese Los Angeles inner-city children (2 to 18 years of age) with persistent asthma. No difference in time required to achieve control of asthma, ability to maintain control of asthma, baseline pulmonary functions, and number of controllers prescribed was found between the two groups. We conclude that in a Los Angeles inner-city pediatric population, obesity is not a factor in the ability to control asthma.

Nonemergent Emergency Room Utilization for an Inner-City Pediatric Population

To identify patient reasons for accessing an urban Pediatric Emergency Room (PER) for primary care and to explore attitudes and practice regarding alternative sources for their medical home. A total of 210 questionnaires, consisting of 24 questions each, were completed in a face-to-face interview performed by trained interviewers. Questions asked included sources of medical care, frequency of use, and factors that went into caregiver decisions for using different sources of care. Caregivers choose the PER because of the short amount of time it takes for their child to be seen and discharged by a physician. Nearly 60% ranked wait time to see a doctor more important than seeing the same doctor every time (37.6%). About one-third of caregivers routinely brought their children to the PER for illness that is not serious. Only 77% of caregivers claimed that their children have a regular doctor. Many caregivers cited that they are seen more by their regular doctor for shots (well visits) than for ill visits and are seen in the PER for illness. In this study, 56% of children did not see the same regular doctor as their siblings. Efficiency and speed of health care delivery is of prime importance to this primarily Medicaid urban population. If strategies are to be implemented to attract these patients to a medical home that will strengthen their ties to their regular doctor, then the needs prioritized by the caregiver must be taken into consideration.

Continued Increase in the Prevalence of Asthma and Atopy

Purpose of the Study. The purpose of this study was to evaluate the effect of a comprehensive care program for asthma on emergency department visits and hospital admission rates in an inner-city pediatric population. Study Population. Three hundred asthma patients ages 2 to 17, who presented to an inner-city emergency department. Methods. Patients were randomized to obtain asthma care in a specialty clinic or to continue to receive care by other health resources. The specialty clinic provided medical treatment, environmental control, education, close monitoring, and 24-hour availability. Monthly questionnaires on use of hospital facilities for asthma care were sent to the caregivers of the …

Cholesterol Screening in a Black Inner-City Pediatric Population

A screening for total blood cholesterol levels was conducted by the University of Louisville Department of Family Practice in association with the National Youth Sports Program in Louisville, Kentucky. On May 30, 1987, 224 inner-city children between 10 and 16 years of age were tested; 109 (49%) were girls and 115 (51%) were boys. All participants were black. Of the entire population, the girls had a slightly lower mean level of cholesterol than the boys (160 mg/dL vs 165 mg/dL, respectively). Because of the large number of participants aged 10 to 14 years (211), this subset of children was studied more closely. In this age group, 47 (22%) of the children were at moderate risk for future cardiovascular disease and 48 (23%) were at high risk. The serum cholesterol levels were relatively constant in all children until age 12, after which a slight reduction occurred. This decrease is more evident in boys. Our study also showed a correlation between increased blood cholesterol and above normal weight/height indices (ie, Quetelet scores), with nearly 70% of all children having elevated cholesterol levels also exhibiting above normal Quetelet scores. We observed no correlation between high cholesterol levels and high blood pressure in this study population. Dietary intervention is recommended as the initial treatment for elevated cholesterol levels in children.

Safe Home Use of the Compressor-Driven Nebulizer-Reply

In Reply .—Dr Plaut describes a pattern of use that places him in accord with the majority of the other experts I interviewed. The efficacy and safety of using nebulized sympathomimetic bronchodilators at home have been addressed recently. In an inner-city pediatric population Zimo et al 1 found that emergency department visits and hospital admissions were significantly reduced after the institution of home nebulizers, especially for younger children. Their use was not associated with increased respiratory failure or other morbidity, despite probable divergence between the instructions and the actual use. Although the use of inhaled bronchodilators obliges the physician to train parents and children in the techniques of their use and, as Dr Plaut correctly emphasizes, in monitoring the effectiveness of such treatment, the results seem to justify the effort. I am dismayed by the widespread neglect of elementary monitoring, even in children admitted to the hospital for acute, severe