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PubMed2005

[Trachoma is still a pediatric disease].

Trachoma is a chronic granular conjunctivitis due to Chlamydia trachomatis serotypes A to C. The primary infection arises in the childhood while vision threatening complications occur in the adulthood. Vision decrease is mostly related to the opacification of the cornea which is due to the chronic friction of eyelashes on its surface (trichiasis), itself being a consequence of the conjunctival scarring secondary to relapsing infections. The trachoma rages in developing countries, not only in Africa but also and especially in Southeast Asia and in the region of the western Pacific. Even if the number of cases of trachoma in the world is now 6-fold lower than twenty years ago, still 83 millions of patients are affected by active trachoma, leading to the estimation that 490 millions of people should be treated in a curative or a preventive way. The fight against trachoma is based on the S.A.F.E. strategy, an acronym for surgery of trichiasis, antibiotics for patients and contact subjects, facial hygiene and environmental improvement. Concerning antibiotics, oral azithromycin is now considered as the gold standard for mass distribution against trachoma, but costs remain a major problem in developing countries. However, application of the four large-scale measures of the S.A.F.E. strategy should allow ending in the purpose fixed by the WHO organization, namely the Global Elimination of Trachoma by the year 2020.

Africa↗
PubMed1995

Antibiotic-resistant pneumococci in pediatric disease.

The surveillance of pneumococcal resistance in nasopharyngeal isolates is a practical way to determine the prevalence of resistant strains and is a reasonable predictor of resistance in systemic isolates. The increasing prevalence of resistance is shifting the distribution of invasive pneumococcal serotypes toward those included in conjugate vaccines. If these vaccines reduce carriage, they may eliminate or greatly reduce the prevalence of resistant strains. Meningitis is the most important infection caused by PRP for which penicillin or ampicillin therapy is inappropriate. Although the extended spectrum cephalosporins will be effective for most cases of PRP meningitis, it is clear that such therapy is not foolproof. It is important for the laboratory to test CSF isolates not only for penicillin resistance but also for resistance to the cephalosporins. beta-Lactam antibiotics can still be considered appropriate empiric therapy for otitis media, pneumonia, or sepsis. However, occasional treatment failures with these agents may necessitate use of alternative therapeutic strategies.

Anti-Bacterial Agents↗
PubMed2001

Management of chronic pediatric diseases with interactive health games: theory and research findings.

In randomized clinical trials, children and adolescents improved their self care and reduced their emergency clinical utilization after playing health education and disease management video games. A diabetes game reduced diabetes-related urgent and emergency visits by 77 percent after diabetic youngsters had the game at home for six months, compared to no reduction in clinical utilization in a control group of diabetic youngsters who took home an entertainment video game that had no health content. Positive impacts were also found in clinical trials of games for asthma self-management and smoking prevention.

Adolescent↗
PubMed2001

Upper gastrointestinal mucosal disease in pediatric Crohn disease and ulcerative colitis: a blinded, controlled study.

BACKGROUND: Upper gastrointestinal endoscopic biopsies often show histologic abnormalities in Crohn disease. Consequently, it has been proposed that routine endoscopy could help to distinguish Crohn disease from ulcerative colitis. Surprisingly, however, recent case reports and an uncontrolled study suggested that similar abnormalities may occur in ulcerative colitis. Therefore, a blinded, controlled study was performed. METHODS: Esophageal, gastric antral, and duodenal biopsies from children with Crohn disease (n = 28) and ulcerative colitis (n = 14) were compared with those from controls undergoing endoscopy for suspected reflux esophagitis (n = 22). Two pathologists, unaware of patient identity and diagnosis, agreed on a consensus report. Severity of inflammation was scored semiquantitatively. Helicobacter pylori colonization was an exclusion criterion. RESULTS: Inflammation was reported as follows: esophagitis: controls 91%; Crohn disease: 72%; ulcerative colitis: 50%; gastritis: controls: 27%; Crohn disease: 92% (P < 0.001); ulcerative colitis: 69%; duodenitis: controls: 9%; Crohn disease: 33%; ulcerative colitis: 23%. In Crohn disease, granulomas were noted in 40% of patients (P = 0.001). Duodenal cryptitis was noted in 26% of patients with Crohn disease but not ulcerative colitis. In one patient with ulcerative colitis, neutrophilic infiltration of gastric glands was seen. Abnormalities seen in Crohn disease and ulcerative colitis included gastroduodenal ulceration (Crohn disease, 7%; ulcerative colitis, 8%), villus atrophy (Crohn disease, 11%; ulcerative colitis, 15%), and increased intraepithelial lymphocytes (Crohn disease, 15%; ulcerative colitis, 31% [P < 0.05]). None of these abnormalities was noted in the controls. CONCLUSION: Although the presence of granulomas can support a diagnosis of Crohn disease, severe inflammation and other abnormalities occur in the proximal gastrointestinal tract in Crohn disease and ulcerative colitis.

Adolescent↗
PubMedDate not supplied

Osteoporosis: pediatric disease with geriatric consequences.

Osteoporosis affects 28 million Americans. The National Osteoporosis Foundation estimates this number will increase to 41 million by 2015. Ninety percent of bone growth occurs between the ages of 10 and 20. Present lifestyles of adolescents leave them predisposed to osteoporosis because they are producing lower peak bone mass. If teenagers can be taught to build their bones as strong as possible with diet and exercise, many cases of this disease may be prevented. This article outlines a method of teaching teens about osteoporosis that has been used with 250 junior high and high school students with favorable results.

Adolescent↗
PubMed1994

New approaches to the study of human pediatric disease.

The intestinal epithelium may modulate childhood gastrointestinal disease activity, particularly in chronic inflammatory bowel disease. The epithelium is in direct contact with the intestinal lumen and is ideally placed to act as a communication between the intestinal environment and the immune cells of the mucosa. Interaction is possible through the production of cytokines by enterocytes and the expression of surface molecules on the basolateral membrane. The study of how luminal contents can modulate enterocyte gene expression is central to this process, but the molecular mechanisms by which such interactions occur are not well understood. This review discusses possible molecular pathways between the intestinal lumen and the enterocyte and how they can be examined experimentally. Finally, the importance of enterocyte gene expression in human health and disease is reviewed.

Animals↗