Particular Concern In Children Research Articles

Potentially Toxic Elements in Urban-Grown Lettuce: Effectiveness of Washing Procedures, Risk Assessment, and Isotopic Fingerprint

This study investigates the presence of potentially toxic elements (PTEs) in lettuce (Lactuca sativa L.) grown in urban gardens in a highly industrialized city in Brazil and evaluates the effectiveness of different washing methods in reducing contamination. Ten elements (arsenic (As), barium (Ba), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), nickel (Ni), lead (Pb), vanadium (V), and zinc (Zn)) were analyzed for their concentration, and a health risk assessment was performed. The results showed that Pb concentrations in lettuce from gardens near the Capuava Petrochemical Complex reached 0.77 mg kg−1, exceeding both national and international safety limits. The most effective washing procedure involved the use of sodium hypochlorite, which reduced As by 46%, Pb by 48%, and V by 52%. However, elements such as Ba, Cd, Cr, and Ni showed limited reductions of less than 10% across all washing methods. Health risk assessments revealed a particular concern for children, with the total cancer risk (TCR) exceeding acceptable limits in some gardens. Isotopic analysis of Pb revealed that atmospheric pollution from gasoline emissions and industrial activities were the primary sources of contamination. The elevated levels of Pb, Cr, and As highlight the need for targeted health education in local communities, especially regarding the importance of proper washing techniques. Risk management strategies, including improved contamination control and public awareness, are crucial to minimize exposure to these harmful elements, particularly in vulnerable populations like children.

Twitter Analysis of Health Care Workers' Sentiment and Discourse Regarding Post-COVID-19 Condition in Children and Young People: Mixed Methods Study.

The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post-COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post-COVID-19 condition on this demographic. With a social media analysis of the discourse surrounding the prevalence of post-COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post-COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post-COVID-19 condition and identify critical areas and future directions for researchers and policy makers. From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post-COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post-COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. The perceptions described on Twitter by HCWs concerning the presence of the post-COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post-COVID-19 condition.

MELHOR INTERESSE DA CRIANÇA E DO ADOLESCENTE: UMA ANÁLISE DESTA GARANTIA CONSTITUCIONAL E O PAPEL DO ESTADO E DA FAMÍLIA PARA SUA EFETIVAÇÃO

This article will deal with the role of the State and the family in guaranteeing children and adolescents the absolute priority and best interests of this public, since the 1988 Federal Constitution provides for such rights. Therefore, the objective of this research is to analyze how each institution, State and family, impact the life of minors in training. In addition to discussing the limits and scope of the State and the family. The methodology used in the present work was qualitative bibliographical research, both in doctrine and in national legislation, in an explanatory manner. Finally, it was concluded that national legislation is imperative regarding the rights of children and adolescents, with a particular concern for children and young people, in an attempt to ensure that the State and the family can carry out their duties in a full, supportive and supportive manner. dignified, however, the best interests are not always respected by both institutions.

Association of oral health knowledge, self-efficacy and behaviours with oral health-related quality of life in Chinese primary school children: a cross-sectional study

ObjectiveAchieving good oral health-related quality of life (OHRQOL) is of particular concern in children. The inter-relations among oral health knowledge, self-efficacy, behaviours and OHRQOL in children groups remain unclear. This...

COVID-19 in Immunocompromised Children and Adolescents.

COVID-19 in Immunocompromised Children and Adolescents.

Head and neck synthetic CT generated from ultra-low-dose cone-beam CT following Image Gently Protocol using deep neural network.

Image guidance is used to improve the accuracy of radiation therapy delivery but results in increased dose to patients. This is of particular concern in children who need be treated per Pediatric Image Gently Protocols due to long-term risks from radiation exposure. The purpose of this study is to design a deep neural network architecture and loss function for improving soft-tissue contrast and preserving small anatomical features in ultra-low-dose cone-beam CTs (CBCT) of head and neck cancer (HNC) imaging. A 2D compound U-Net architecture (modified U-Net++) with different depths was proposed to enhance the network capability of capturing small-volume structures. A mask weighted loss function (Mask-Loss) was applied to enhance soft-tissue contrast. Fifty-five paired CBCT and CT images of HNC patients were retrospectively collected for network training and testing. The output enhanced CBCT images from the present study were evaluated with quantitative metrics including mean absolute error (MAE), signal-to-noise ratio (SNR), and structural similarity (SSIM), and compared with those from the previously proposed network architectures (U-Net and wide U-Net) using MAE loss functions. A visual assessment of ten selected structures in the enhanced CBCT images of each patient was performed to evaluate image quality improvement, blindly scored by an experienced radiation oncologist specialized in HN cancer. All the enhanced CBCT images showed reduced artifactual distortion and image noise. U-Net++ outperformed the U-Net and wide U-Net in terms of MAE, contrast near structure boundaries, and small structures. The proposed Mask-Loss improved image contrast and accuracy of the soft-tissue regions. The enhanced CBCT images predicted by U-Net++ and Mask-Loss demonstrated improvement compared to the U-Net in terms of average MAE (52.41vs 42.85 HU), SNR (14.14vs 15.07dB), and SSIM (0.84vs 0.87), respectively ( , in all paired t-tests). The visual assessment showed that the proposed U-Net++ and Mask-Loss significantly improved original CBCTs ( ), compared to the U-Net and MAE loss. The proposed network architecture and loss function effectively improved image quality in soft-tissue contrast, organ boundary, and small structure preservation for ultra-low-dose CBCT following Image Gently Protocol. This method has potential to provide sufficient anatomical representation on the enhanced CBCT images for accurate treatment delivery and potentially fast online-adaptive re-planning for HN cancer patients.

Radon in Schools: A Review of Radon Testing Efforts in Canadian Schools.

Radon, a known carcinogen, becomes a health risk when it accumulates inside buildings. Exposure is of particular concern for children, as their longer life expectancy increases their lifetime risk of developing cancer. In 2016, 5.5 million students were enrolled in Canadian elementary and secondary schools. With no national policy on radon testing in schools, children may be at risk from radon exposure while attending school and school-based programs. This study explored radon testing efforts in publicly funded Canadian schools and summarizes where testing programs have occurred. Radon testing in schools was identified through a systematic qualitative enquiry, surveying members from different levels of government (health and education) and other stakeholders (school boards, research experts, among others). Overall, this research found that approaches to radon testing varied considerably by province and region. Responsibility for radon testing in schools was often deferred between government, school boards, building managers and construction parties. Transparency around radon testing, including which schools had been tested and whether radon levels had been mitigated, also emerged as an issue. Radon testing of schools across Canada, including mitigation and clear communication strategies, needs to improve to ensure a healthy indoor environment for staff and students.

Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy.

Impairments in cognition are common in epilepsy and may be caused or exacerbated by antiseizure medications (ASMs). Positive effects on cognition may also be seen with some ASMs. Cognitive outcomes are of particular concern in children who may be at an increased risk of cognitive adverse effects of treatment. A comprehensive literature search was conducted in PubMed in order to evaluate the evidence for cognitive changes associated with treatment with ASMs in paediatric epilepsy patients. The ASMs considered were those in the current edition of the British National Formulary (BNF). For most ASMs, remarkably few studies providing robust data on cognitive effects in paediatric patients were identified. The available evidence suggests cognitive impairments may be associated with treatment with phenobarbital. Topiramate and phenytoin are also associated with negative effects on cognition, in particular word-finding difficulties and other language deficits with topiramate, but there are few data available specifically on children. Lamotrigine, levetiracetam and fenfluramine are associated with improvements in some cognitive domains, although it is unclear whether these effects are directly attributable to the medications or are a result of improvements in seizures. Neutral effects on cognition (no substantial evidence of worsening) were suggested for carbamazepine, everolimus, lacosamide, oxcarbazepine, perampanel and valproate. There is limited data for cannabidiol, clobazam, eslicarbazepine acetate, ethosuximide, rufinamide, vigabatrin and zonisamide, although the available evidence suggests these drugs are not associated with severe cognitive impairment. There was too little information to reach conclusions about the effects of brivaracetam, felbamate, gabapentin, pregabalin, retigabine, stiripentol or tiagabine.

Abdominal Positron Emission Tomography Combined With Magnetic Resonance Imaging in Chronic Granulomatous Disease

Abdominal Positron Emission Tomography Combined With Magnetic Resonance Imaging in Chronic Granulomatous Disease

Genotype-Informed Versus Empiric Management Of VirEmia (GIVE MOVE): study protocol of an open-label randomised clinical trial in children and adolescents living with HIV in Lesotho and Tanzania

BackgroundGlobally, the majority of people living with HIV have no or only limited access to HIV drug resistance testing to guide the selection of antiretroviral drugs. This is of particular concern for children and adolescents, who experience high rates of treatment failure. The GIVE MOVE trial assesses the clinical impact and cost-effectiveness of routinely providing genotypic resistance testing (GRT) to children and adolescents living with HIV who have an unsuppressed viral load (VL) while taking antiretroviral therapy (ART).MethodsGIVE MOVE is an open-label randomised clinical trial enrolling children and adolescents (≥6 months to <19 years) living with HIV with a VL ≥400 copies/mL (c/mL) while taking first-line ART. Recruitment takes place at sites in Lesotho and Tanzania. Participants are randomised in a 1:1 allocation to a control arm receiving the standard of care (3 sessions of enhanced adherence counselling, a follow-up VL test, continuation of the same regimen upon viral resuppression or empiric selection of a new regimen upon sustained elevated viremia) and an intervention arm (GRT to inform onward treatment). The composite primary endpoint is the occurrence of any one or more of the following events during the 36 weeks of follow-up period: i) death due to any cause; ii) HIV- or ART-related hospital admission of ≥24 h duration; iii) new clinical World Health Organisation stage 4 event (excluding lymph node tuberculosis, stunting, oral or genital herpes simplex infection and oesophageal candidiasis); and iv) no documented VL <50 c/mL at 36 weeks follow-up. Secondary and exploratory endpoints assess additional health-related outcomes, and a nested study will assess the cost-effectiveness of the intervention. Enrolment of a total of 276 participants is planned, with an interim analysis scheduled after the first 138 participants have completed follow-up.DiscussionThis randomised clinical trial will assess if the availability of resistance testing improves clinical outcomes in children and adolescents with elevated viremia while taking ART.Trial registrationThis trial is registered with ClinicalTrials.gov (NCT04233242; registered 18.01.2020). More information: www.givemove.org.

1595. Comparative In Vitro Activity of Imipenem–Relebactam Against Drug-Resistant Gram-Negative Isolates from Pediatric Patients

BackgroundDrug resistance in Gram-negative bacteria is of particular concern in children. Relebactam, a novel diazabicyclooctane inhibitor, coupled with imipenem has broad-spectrum activity against β-lactamase producing organisms. Here, we compare the in vitro activity of imipenem-relebactam to 10 standard comparator drugs against resistant Gram-negative isolates from two US pediatric hospitals.MethodsWe tested 100 isolates (50 per site) from pediatric clinical specimens tested during 2015–2017. All isolates were extended-spectrum cephalosporin-resistant (ESC-R); more than half were multidrug resistant (67%). Selected ESC-R isolates included Escherichia coli (90), Klebsiella pneumoniae (8), Klebsiella oxytoca (1), and Enterobacter cloacae (1) that were resistant or intermediate to ≥1 cephalosporins and/or aztreonam. A 0.5 McFarland suspension was prepared from colonies grown on blood agar plates (Thermo Scientific) at 35 ± 1°C for 18–24 hours. A final inoculum of 5 × 105 CFU/mL was prepared in Mueller–Hinton broth. Sensititre plates (Thermo Fisher Scientific) containing graded concentrations of imipenem/relebactam and 10 comparator drugs were inoculated and incubated at 35 ± 1°C for 18–24 hours. The minimum inhibitory concentration (MIC) was determined using the Sensititre Vizion system (Thermo Fisher Scientific) and endpoints were interpreted using CLSI (2019) breakpoint criteria, with the exception of colistin (EUCAST 2019).ResultsSelected ESC-R isolates had high rates of resistance to cephalosporins (64%–97%), aztreonam (80%), and levofloxacin (61%). All isolates were susceptible to imipenem/relebactam, imipenem and meropenem (MIC, ≤1 μg/mL for all). The imipenem/relebactam MIC50 (0.06 μg/mL) and MIC90 (0.12 μg/mL) values for ESC-R isolates were within one dilution of MICs of imipenem alone (0.12 μg/mL and 0.25 μg/mL). Among the comparators, colistin, amikacin, and piperacillin/tazobactam demonstrated comparable activities with 100%, 99%, and 94% susceptibilities, respectively.ConclusionMeropenem, imipenem alone and in combination with relebactam exhibited 100% susceptibilities against ESC-R Enterobacteriaceae isolated from pediatric specimens, demonstrating the high potency of carbapenems. Disclosures All authors: No reported disclosures.

De-Policing America’s Youth: Disrupting Criminal Justice Policy Feedbacks That Distort Power and Derail Prospects

The standard account of policy feedback holds that social policy can be self-reinforcing: policies provide resources that promote economic security and well-being, and they also encourage beneficiaries to engage with government. Criminal justice policies have typically had the opposite effect: they embolden those with interests in a punitive policy agenda, while disempowering those most affected by the policies. This is of particular concern for children and adolescents in race-class subjugated communities (RCS), whose first encounters with government beyond public schooling often come through police contact and carry adverse social and political consequences at a critical developmental stage. In this article, we reimagine youth engagement with the state, arguing for substantial reductions in police surveillance of young people and for the promotion of youth attachment to civic life. We call for an investment in institutions, both state-based and community-based, that reinforce political inclusion and civic belonging.

Clinical Characteristics and Risk Factors of Long-term Central Venous Catheter-associated Bloodstream Infections in Children.

Central line-associated bloodstream infections (CLABSIs) account for significant morbidity and mortality in patients with long-term central venous catheters (CVCs). This study was performed to identify the characteristics and risk factors of CLABSIs among children with long-term CVCs. A retrospective review of children who had a long-term CVC in Seoul National University Children's Hospital between 2011 and 2015 was performed. Data on patient demographics, the isolated pathogens and the status of CVC placement were collected. Clinical variables were compared between subjects with and without CLABSIs to determine the risk factors for CLABSIs. A total of 629 CVCs were inserted in 499 children during the 5-year period. The median age at insertion was 6.0 years (14 days-17.9 years), and hemato-oncologic disease was the most common underlying condition (n = 497, 79.0%). A total of 235 CLABSI episodes occurred in 155 children, with a rate of 0.93 per 1,000 catheter days. The most common pathogens were Klebsiella pneumoniae (n = 64, 27.2%), coagulase-negative staphylococci (n = 40, 17.0%) and Staphylococcus aureus (n = 28, 12.0%). In the univariate analysis, the gender, underlying disease, catheter characteristics and insertion technique did not increase the risk for CLABSI. In both the univariate and logistic regression analyses, patients with prior BSIs (odds ratio 1.66; 95% confidence interval: 1.090-2.531; P = 0.018) were more likely to have a CLABSI. CLABSI prevention is of particular concern for children with a prior BSI. Furthermore, the antimicrobial resistance of major pathogens should be monitored to enable the empiric selection of appropriate antibiotics in patients with long-term CVCs.

Early Effects of a Low Fat, Fructose-Rich Diet on Liver Metabolism, Insulin Signaling, and Oxidative Stress in Young and Adult Rats.

The increase in the use of refined food, which is rich in fructose, is of particular concern in children and adolescents, since the total caloric intake and the prevalence of metabolic syndrome are increasing continuously in these populations. Nevertheless, the effects of high fructose diet have been mostly investigated in adults, by focusing on the effect of a long-term fructose intake. Notably, some reports evidenced that even short-term fructose intake exerts detrimental effects on metabolism. Therefore, the aim of this study was to compare the metabolic changes induced by the fructose-rich diet in rats of different age, i.e., young (30 days old) and adult (90 days old) rats. The fructose-rich diet increased whole body lipid content in adult, but not in young rats. The analysis of liver markers of inflammation suggests that different mechanisms depending on the age might be activated after the fructose-rich diet. In fact, a pro-inflammatory gene-expression analysis showed just a minor activation of macrophages in young rats compared to adult rats, while other markers of low-grade metabolic inflammation (TNF-alpha, myeloperoxidase, lipocalin, haptoglobin) significantly increased. Inflammation was associated with oxidative damage to hepatic lipids in young and adult rats, while increased levels of hepatic nitrotyrosine and ceramides were detected only in young rats. Interestingly, fructose-induced hepatic insulin resistance was evident in young but not in adult rats, while whole body insulin sensitivity decreased both in fructose-fed young and adult rats. Taken together, the present data indicate that young rats do not increase their body lipids but are exposed to metabolic perturbations, such as hepatic insulin resistance and hepatic oxidative stress, in line with the finding that increased fructose intake may be an important predictor of metabolic risk in young people, independently of weight status. These results indicate the need of corrective nutritional interventions for young people and adults as well for the prevention of fructose-induced metabolic alterations.

Monetary and Multidimensional Child Poverty: A Contradiction in Terms?

ABSTRACTAlthough the multidimensional nature of poverty is widely recognized, the extent to which monetary measures can serve as a proxy for non‐monetary measures remains unresolved. This is of particular concern for children given their dependence on others for fulfilment of basic needs and assumptions about intra‐household distribution that underpin monetary measures. This article adopts an innovative mixed‐methods approach to investigate child poverty overlap and mismatch in the low‐ and middle‐income countries of Ethiopia and Vietnam using secondary longitudinal survey data and primary qualitative data from adults and children. Findings indicate that monetary and multidimensional poverty are distinct constructs that are linked, but cannot serve as a proxy for one another. While the degree of dissonance depends on the types of indicators under consideration, poverty mismatch persists regardless of time, place and multidimensional measure under consideration.

Arsenic and Rice: Translating Research to Address Health Care Providers' Needs

From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; Department of Pediatrics, UCSF Benioff Children’s Hospital Oakland, Oakland, CA; Western States Pediatric Environmental Health Specialty Unit, University of California, San Francisco, CA; Children’s Environmental Health and Disease Prevention Research Center at Dartmouth; Department of Biological Sciences, Dartmouth College, Hanover, NH; Arsenic Health Effects Research Program, University of California, Berkeley, CA; and Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH A rsenic is a naturally occurring element and anthropogenic contaminant present in 2 general forms: inorganic and organic. Inorganic arsenic is considered highly toxic to humans. The International Agency for Research on Cancer, Agency for Toxic Substances and Disease Registry, and the US Environmental Protection Agency (EPA) all classify inorganic arsenic as a human carcinogen. The health effects of organic forms are not fully understood; however, some of the organic forms also may have toxic and potentially carcinogenic properties. Children can be exposed to arsenic in multiple ways. An important source of chronic exposure to inorganic arsenic worldwide is contaminated drinking water. However, because municipal water systems in the US are regulated to meet federal standards, the primary exposure to arsenic for most people in the US is food. One food known to be particularly high in arsenic is rice, a staple for much of the world’s population. Rice grown throughout the world contains arsenic, particularly US-grown rice. Though the amount and forms of arsenic found in different rice cultivars vary, the average levels of inorganic arsenic detected in rice are high enough to raise questions about potential health impacts, including for children. Dietary exposure to arsenic is of particular concern for children for several reasons. First, exposure to arsenic and other chemicals during critical windows of vulnerability in early childhood may result in greater health risks. Second, children typically have greater exposure to contaminants per unit body weight than adults in part because of their greater consumption rates and high caloric needs. Finally, children may also be more exposed to contaminants unique to certain foods because of their selective eating patterns and limited dietary choices. For example, rice is used in many first foods and is a key component of numerous processed foods marketed specifically to children. Thus, it is important for clinicians to become familiar with childhood arsenic exposure, potential health effects, and strategies to reduce exposure. Given the concern about children’s consumption of arsenic in rice, the US Food and Drug Administration (FDA) has published brief statements on this topic to

Identifying patterns of anxiety and depression in children with chromosome 22q11.2 deletion syndrome: Comorbidity predicts behavioral difficulties and impaired functional communications

BackgroundChromosome 22q11.2 deletion syndrome (22q11.2DS) is a complex genetic disorder with a variable clinical presentation that can include cardiac, neural, immunological, and psychological issues. Previous studies have measured elevated anxiety and depression in children with 22q11.2DS. Comorbity of anxiety and depression is well established in the pediatric literature but the nature of comorbidity patterns has not been empirically established in children with 22q11.2DS. Comorbidity of anxiety and depression has important implications for treatment and prognosis, and may be a marker of risk in this population of children at high-risk for developing schizophrenia. MethodParticipants were 131 boys and girls ages 8–14 with (n=76) and without (n=55) 22q11.2DS and their mothers. Children and mothers independently completed self- and parent-report measures of anxiety and depression. Mothers also completed measures of behavioral functioning including the Behavioral Assessment for Children, 2nd ed. (BASC-2). Cluster analyses were conducted to test if theoretically based groupings of anxiety and depression could be identified. We hypothesized four psychological profiles based on child- and mother-reports: low/no anxiety and low/no depression, higher depression and low/no anxiety, higher anxiety and no/low depression, and a comorbid profile of higher anxiety and higher depression. BASC-2 subscale scores were then compared across subgroups of children to determine if a comorbid profile would predict greater behavioral difficulties. ResultsIn the full sample of children both with and without 22q11.2DS, cluster analyses of self and maternal reported anxiety and depression revealed the expected subgroups: (1) a group of children with higher anxiety/lower depression (anxious); (2) a group with primary depression (lower anxiety/higher depression (depressed)); (3) a comorbid group with higher anxiety/higher depression (comorbid); and, (4) a lowest anxiety/lowest depression group (NP). Mothers’ reports produced highly similar groupings. Furthermore, the 22q11.2DS youth were more likely to be in anxiety, depressed or comorbid clusters than the typically developing (TD) youth. Children with 22q11.2DS comorbid for anxiety and depression exhibited the worst functional outcomes (e.g., poor poorer functional communication, and reduced daily life activities). ConclusionsAnxiety, comorbid with depression may be of particular concern in children with 22q11.2DS who arguably carry a greater burden on their stress coping resources than children without a complex genetic disorder. Furthermore, the manifestation of negative mood, anxiety and difficult behavior is likely to reverberate between the child and her or his environment. This can lead to negative interactions with family, peers, and teachers, which in turn further taxes coping resources. Comorbidity of anxiety and depression within a vulnerable population highlights the need for the development of tailored interventions.

The Incidence and Etiology of Anterior Cruciate Ligament Injuries in Patients under the Age of 18 in the State of Wisconsin

Background: ACL injuries can have long-term effects on the musculoskeletal system, causing early osteoarthritis, and are of particular concern in children and adolescents as competitive sports participation increases. Purpose: The objective of this paper was to determine the incidence and characteristics of Anterior Cruciate Ligament (ACL) reconstructions in children in the state of Wisconsin. Methods: Wisconsin Hospital Association inpatient and ambulatory surgery data from January 2006 through December 2010 was used to identify the number of ACL reconstructions performed in pediatric patients younger than 18 years of age in the State of Wisconsin. Incidence rates were computed using US Census Bureau Population Estimates. A retrospective chart review was performed on pediatric patients younger than 18 years of age who underwent an ACL reconstruction at a single tertiary care pediatric center to abstract injury causation information. Results: Between 2006 and 2010, 4059 ACL reconstructions occurred in pediatric patients younger than 18 years of age in Wisconsin. The incidence of ACL reconstructions averaged 56.7 per 100,000 children per year. The mean age over the five years of the study was 15.4-15.9 for both males and females. ACL reconstructions increased significantly by an average of 6% each year, with females 40% more likely than males to have had a reconstruction, and older children significantly more likely to have reconstruction than children 0-11 years old (12-13 years incidence rate ratio=20.1; 14-17 years incidence rate ratio=123.0). Among the chart reviewed cases, sixty-eight percent of ACL tears occurred during organized sporting activities and 68% were caused by a non-contact injury. Conclusion: ACL tears increased significantly in Wisconsin children from 2006 to 2010. Interventions to prevent ACL injuries in children need to be developed and tested and better tracking of injuries is needed to increase understanding of risk.

Quetiapine associated dyslipidemia and hyperglycemia in a pediatric overweight patient

Introduction: Atypical antipsychotics like quetiapine, can cause undesirable alterations in lipid profile and hyperglycemia. They are associated with metabolic and cardiovascular­ related adverse events in pediatric population, especially when multiple antipsychotics or classes of psychotropic medications are co­ prescribed. Case Report: A 15­year­old, overweight, Hispanic male child was referred to the endocrinology clinic by his primary care provider due to high serum cholesterol, triglyceride and glucose levels. Past history was significant for autism, anxiety with depression and attention deficit disorder for which he was getting psychiatric care and was receiving quetiapine 50 mg daily for more than two years. Physical examination was significant for increased adiposity and overweight. Fasting laboratory studies showed elevated cholesterol and triglycerides. In addition to lifestyle modification including diet and exercise, quetiapine was discontinued and replaced by aripiprazole. Repeat testing after four months showed normalized cholesterol and triglyceride levels. Conclusion: The use of atypical antipsychotics prescribed to children and adolescents with neuropsychiatric disorders has been associated with various adverse effects, including significant weight gain. These adverse effects are of particular concern in children and adolescents due to the immediate and long term health risks associated with weight gain, including obesity, diabetes mellitus and hyperlipidemia.

Model-based iterative reconstruction in pediatric chest CT: assessment of image quality in a prospective study of children with cystic fibrosis

The potential effects of ionizing radiation are of particular concern in children. The model-based iterative reconstruction VEO(TM) is a technique commercialized to improve image quality and reduce noise compared with the filtered back-projection (FBP) method. To evaluate the potential of VEO(TM) on diagnostic image quality and dose reduction in pediatric chest CT examinations. Twenty children (mean 11.4years) with cystic fibrosis underwent either a standard CT or a moderately reduced-dose CT plus a minimum-dose CT performed at 100kVp. Reduced-dose CT examinations consisted of two consecutive acquisitions: one moderately reduced-dose CT with increased noise index (NI = 70) and one minimum-dose CT at CTDIvol 0.14mGy. Standard CTs were reconstructed using the FBP method while low-dose CTs were reconstructed using FBP and VEO. Two senior radiologists evaluated diagnostic image quality independently by scoring anatomical structures using a four-point scale (1=excellent, 2=clear, 3=diminished, 4=non-diagnostic). Standard deviation (SD) and signal-to-noise ratio (SNR) were also computed. At moderately reduced doses, VEO images had significantly lower SD (P < 0.001) and higher SNR (P < 0.05) in comparison to filtered back-projection images. Further improvements were obtained at minimum-dose CT. The best diagnostic image quality was obtained with VEO at minimum-dose CT for the small structures (subpleural vessels and lung fissures) (P < 0.001). The potential for dose reduction was dependent on the diagnostic task because of the modification of the image texture produced by this reconstruction. At minimum-dose CT, VEO enables important dose reduction depending on the clinical indication and makes visible certain small structures that were not perceptible with filtered back-projection.