Early common infections may play a protective role in the aetiology of childhood leukaemia

This British Journal of Cancer paper suggests that childhood infections may prevent leukemia. 

The study was deigned to determine risks .. so we can't really draw any conculsions about prevention.  But it's an interesting idea.  We'll keep our ears open …

… and it seems intuitively related to the literature on allergies .. and the observation that the cleaner we live … the more likely we are to develop allergies. 

 

Thalassemia – diagnosis in 5 seconds or less

We family physicians don't know everything … and if we knew it once .. we may have forgotten.  Clincial problems that we don't see often will cause us to make referrals to specialists – and this teamwork is often a good model for patient care.  Yesterday's call to a local pediatric hematologist reminded me of a simple formula I learned in medical school, but hadn't used in 10 years. 

Mentzer Index = MCV/RBC
Ratio < 13 then the patient most likely has Thalassemia
Ratio >13 then the patient most likely has iron deficiency anemia

Though we often look at a low h/h and low MCV and think iron deficiency right away … recall that ferretin is a better measure of iron deficiency … and the Mentzer Index can always help us to identify Thalassemia.  Remind me of this in 2014 …

omphalitis

I missed the article last year that I've exerpted below. It's a good one to know about.  A few observations:

  1. I found it on findarticles.com - which has free full text of many journals -  including some medical journals.
  2. This study is interesting, since it brings up the issue (again) of whether prophylaxis of the cord is appropriate.  In our area, we have good representation of both of the study arms.  One hospital stopped applying triple-dye a few years ago – and the other still uses triple-dye as a component of routine neonatal care.

    In the group of kids who don't get the trople-dye .. I am seeing far more cords that seem to last for a very long time.  The kid who comes in a at two weeks of age with a cord still on is not so rare as it once was.  These cords often have an umbilical granuloma at the base, and are often "sealed" with the abdominal skin .. so the base of the cord never dries out and just sits there … barely viable yet .. rotting slowly. 

    A little alcohol and some manipluation (for drying .. not necessarily for antibacterial effect) seems to work well to dry these out in another day or so .. though I sometimes have to tie off the granulomas if they continue to weep.

Pediatrics: To dye or not to dye: a randomized, clinical trial of a triple dye/alcohol regime versus dry cord care.

Our study suggests that omphalitis remains a clinical entity and that there is potential risk in discontinuing bacteriocidal treatment of the umbilical cord stump. Cessation of bactericidal care of the umbilical stump must be accompanied by vigilant attention to the signs and symptoms of omphalitis. In our study, some infants were treated after discharge with local antibiotics in response to developing symptoms of infection The initial presentation of NF is one of foul-smelling umbilical discharge, erythema, and induration around the umbilicus, with rapid progression to frank gangrene

More on otitis

Enoch's post on medmusings makes a good point about avoiding antibiotics in the context of a prolonged fever in his child. I think that those of us with kids have an advantage over physicians without kids. We've been there. We've worried about the fever that won't go away. We've been up all night with the crying baby (?Is it the ear? Is it teething .. or is it just … behavior?)

Working with patients in a similar predicament – we have much more credibility than even the most knowledgable, thoughtful, compassionate physician in the world.

Slipped Capital Femoral Epiphysis

It's been a very long week or two. 

The boy I saw last week with hip pain turned out to have Slipped Capital Femoral Epiphysis.  This is a diagnosis that is easy to miss .. and I didn't know that he had it when I saw him.  The x-ray didn't show anything .. which was reassuring .. though his pain persisted .. which prompted a referral to orthopaedics. 

The orthopod ordered more views of the hip .. one of which showed the SCFE .. prompting surgery.

 

 

toy safety

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More Pertussis

In this month's Cortlandt
Forum
is a good little review on pertussis. We continue to see it in the office this week. Many kids on erythromycin – though I gather that some physicians in the area are using azithromycin for 5 days. Not much research to support this – so I'm sticking with erythro for 14 days.