'Nodding disease' - Sudan and Uganda's incurable child disease with unknown cause

AlJazeeraEnglish: Hundreds of children in southern Sudan have died from a mysterious illness that they have called the "nodding disease". The mentally and physically disabling disease, which has no cure yet and affects only children, first emerged in Sudan in 1980s.

"We have no clue as what is causing this. It's like a detective novel and a murder mystery, because it's fatal," says a tropical disease specialist from UNICEF.

Bizarrely, the seizures occur when the sufferers start to eat, or when it is particularly cold. When a bowl of sorghum is placed in front of Susannah, the "nodding" begins almost immediately, and stop when she has finished eating.

Some villagers say the disease is a curse, others blame the country's long civil war and suspect that government forces have been dropping chemical weapons.

93% of those surveyed are infected with a parasitic worm which causes Onchocerciasis (also known as river blindness). However, the level of infection among children without "nodding" is 63%. The worm is carried by black flies which breed near fast-flowing rivers.



A team of CDC experts conducts a multifaceted investigation in northern Uganda. An Epidemic Intelligence Service Officer tells the story about Nodding Disease, a neurologic syndrome which is devastating to afflicted children.

References:
'Nodding disease' hits Sudan. BBC, 2003.

U-shaped link between Internet use and children health - beware of heavy use or very little/none

Study participants were categorized into 4 groups according to their intensity of Internet use:

- heavy Internet users (HIUs; >2 hours/day)

- regular Internet users (RIUs; several days per week and 2 hours/day)

- occasional users (1 hour/week)

- and non-Internet users (NIUs; no use in the previous month)

Health factors examined were:

- perceived health

- depression

- overweight

- headaches

- back pain

- insufficient sleep

U-shaped link

Heavy Internet users of both genders were more likely to report higher depressive scores.

Only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep.

Non-Internet users (NIUs) and occasional users also were found at increased risk of higher depressive scores.

Back-pain complaints were found predominantly among male non-Internet users.

There was a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. Heavy Internet users were confirmed at increased risk for somatic health problems.

Regular Internet use (up to 2 hours per day) is OK

Health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Regular Internet use as a normative behavior without major health consequences.

Take home point

Whatever the intensity of your Internet use is (if you are reading this, my guess is that the "intensity" of you sedentary lifestyle is high), don't forget the benefits of regular exercise:


"Health Promotion" video: Benefits of exercise.

References:
A U-Shaped Association Between Intensity of Internet Use and Adolescent Health. PEDIATRICS Vol. 127 No. 2 February 2011, pp. e330-e335 (doi:10.1542/peds.2010-1235)

Image source: Wikipedia, public domain.

Bullying: What parents can do (CNN video)

Related:
Targeted student: 'It's hard not to say something'. CNN

Another CNN video.

Investigating easy bruising in a child

From BMJ:

In a child, unusual bruising or bleeding out of proportion to the injury sustained should be investigated.

All children under investigation for easy bruising or a bleeding tendency should have:

- full blood count
- blood film (peripheral smear)
- coagulation screen including a thrombin time, in addition to a Von Willebrand factor assay and assays of factors VIII and IX

This is to ensure that mild forms of haemophilia are excluded even if the activated partial thromboplastin time is normal

In 30% of cases of haemophilia, there is no family history: it arises secondary to new genetic mutations


The coagulation cascade. Black arrow - conversion/activation of factor. Red arrows - action of inhibitors. Blue arrows - reactions catalysed by activated factor. Grey arrow - various functions of thrombin. Image source: Wikipedia

References:
Investigating easy bruising in a child. Anderson and Thomas 341, BMJ.

Current school system is failing boys - how to re-engage them in learning - TED video

At TEDxPSU, Ali Carr-Chellman pinpoints 3 reasons boys are tuning out of school in droves, and lays out her bold plan to re-engage them: bringing their culture into the classroom, with new rules that let boys be boys. The first part of the talk points to some eye-opening facts about how the current school system is failing boys.

Laptop Computer-Induced Erythema ab Igne

Erythema ab igne is a skin reaction caused by exposure to heat. It is also known as hot water bottle rash, fire stains, and toasted skin syndrome. Ignis is the latin word for "fire".

In this case report a 12-year-old boy presented with erythema ab igne on his left thigh caused by the use of a laptop computer. This is the youngest of the 10 reported patients with this laptop-induced dermatosis since its first description in 2004.

Erythema ab igne is a reticular, pigmented, sometimes telangiectatic dermatosis that is caused by prolonged exposure to a heat or infrared source (see pictures from different cases at DermNet).

In laptop-induced erythema ab igne, the localization on the thighs and asymmetry are characteristic. The heat originates from the optical drive, the battery, or the ventilation fan of the computer.

References:
Laptop Computer–Induced Erythema ab Igne in a Child and Review of the Literature. PEDIATRICS Vol. 126 No. 5 November 2010, pp. e1227-e1230 (doi:10.1542/peds.2010-1390)
Erythema Ab Igne. eMedicine Specialties > Dermatology > Environmental.
Image explanation:  I was not able to find online photos of erythema ab igne labeled for reuse, hence the image of a laptop from Amazon.com.

Updates in Pediatrics

You can find this information on PubMed but this is a nice summary from UpToDate (only brief highlights are posted below, check the source link for full text):

Sexually transmitted infections

25% of urban adolescent females (14-17 years of age) were diagnosed with a sexually transmitted infection (STI) within one year of first intercourse.

Attention deficit hyperactivity disorder (ADHD)

ECG screening should not be required before initiating stimulant therapy for patients with ADHD.

Autism prevalence

The prevalence of autism spectrum disorders (ASD) among eight-year-old children in the United States increased from 1 in 150 children in 2000 to 2002 to approximately 1 in 111 in 2006. No clear reason for increase has been found.

The choking game

5.7% of eighth-graders had participated in the self-strangulation activity known as "the choking game". Recognize signs of these activities: bruising or red marks on the neck; wearing high-necked shirts, even in warm weather; bloodshot eyes or pinpoint bruising around the eyes; petechiae on the face, especially the eyelids or conjunctiva.

HPV vaccine

The US Food and Drug Administration (FDA) approved the use of quadrivalent human papillomavirus vaccine in males aged 9 through 26 years to reduce their likelihood of acquiring genital warts.

13-valent PCV

The FDA approved a 13-valentpneumococcal conjugate vaccine (PCV13). PCV13 adds serotypes 1, 3, 5, 6A, 7F, and 19A to those contained in the PCV7, the 7-valent vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F). The six additional serotypes accounted for 63% of invasive pneumococcal disease among children younger than five years of age.

References:
What's new in pediatrics. UpToDate.
Pediatrics and Medicine

Image source: OpenClipArt.org, public domain.

Pediatrician retires at 89, enjoys seeing 40-50 patients a day, will become an artist

From Scripps Interactive Newspapers Group:

"How are you? Have you retired?"

"No," said Dr. Segal, "I need to keep practicing until I get it right."

"You took care of my baby for me."

"Wonderful. How old is your baby now?"

"He's 58."

Dr. Segal laughed when he recounted this story. But, then, Segal laughs a lot. Maybe that's how he practiced medicine for more than six decades. Because he found pleasure in his work. So many people are in a hurry to retire so they can start having fun. Segal never understood the reason to wait.

He had fun going to the office every day, had fun saying hello to children and making them well.

Segal got an art degree from Memphis State. When World War II broke out, there wasn't much demand for artists. So Segal went to medical school.

Six decades later, he's not one of those doctors who will tell you how much better things used to be. Sitting in his office during his last week of work, Segal mostly wanted to talk about how good we have it now."

References:
Geoff Calkins: Retiring Dr. Segal didn't wait to have fun — he worked at it. Scripps Interactive Newspapers Group, 2010.

Pediatrics and Medicine

Image source: Wikipedia, GNU Free Documentation License.

Ethosuximide and valproic acid are more effective than lamotrigine in childhood absence epilepsy

Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine.

Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.



References:
Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy. NEJM, 2010.

Oral ivermectin superior to topical malathion lotion in eradicating difficult-to-treat head-lice infestation

Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old.

Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure.

For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment.

Why does head louse not infest body and vice versa?

Possible explanation: Body lice lay their eggs on clothing fibers instead of hair fibers (http://emedicine.medscape.com/article/1108991-overview).

References:
Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice. NEJM, 2010.

Updated: 06/24/2010

Gendercide or the worldwide war on baby girls

From The Economist:

"Gendercide" is often seen as an unintended consequence of China’s one-child policy, or as a product of poverty or ignorance. The surplus of bachelors—called in China guanggun, or “bare branches”— seems to have accelerated between 1990 and 2005, in ways not obviously linked to the one-child policy, which was introduced in 1979. And, as is becoming clear, the war against baby girls is not confined to China.

The use of sex-selective abortion was banned in India in 1994 and in China in 1995. It is illegal in most countries. But since it is almost impossible to prove that an abortion has been carried out for reasons of sex selection, the practice remains widespread. An ultrasound scan costs about $12, which is within the scope of many—perhaps most—Chinese and Indian families. In one hospital in Punjab, in northern India, the only girls born after a round of ultrasound scans had been mistakenly identified as boys, or else had a male twin.

References:

Gendercide: The worldwide war on baby girls. The Economist.

Image source: Wikipedia, GNU Free Documentation License.

New Treatment Effective in Killing Head Lice - benzyl alcohol lotion 5% (Ulesfia)

From WebMD:

A new prescription lotion (Ulesfia) with benzyl alcohol treats head lice and is effective and safe for children as young as 6 months. The study shows it works by suffocating lice, a method that has long been tried with limited success using messy substances like petroleum jelly, olive oil, and even mayonnaise.

Overnight "home remedies" such as mayonnaise merely appear to kill lice, but don't because the bugs are able to close their spiracles long enough to survive. This is called the "resurrection effect" because, after rinsing, the lice thought to be dead are able to open their breathing spiracles and start biting again.

Existing over-the-counter head lice treatments contain neurotoxic pesticides as active ingredients, resulting in potential toxicity and other problems, including lengthy applications, odor and ineffectiveness.

References:

New Treatment Effective in Killing Lice. WebMD.

Losing the Lice Without Losing Your Wallet. NYTimes, 2010.

Image source: Benzyl alcohol, Wikipedia, public domain.

Updated: 05/28/2010

Metabolic pathway plays a role in susceptibility to stuttering

Stuttering is a disorder of unknown cause characterized by repetitions, prolongations, and interruptions in the flow of speech. Genetic factors have been implicated in this disorder, and previous studies of stuttering have identified linkage to markers on chromosome 12.

This study shows that variants of proteins that guide hydrolases to the lysosome are associated with stuttering. This unexpected finding implies a metabolic pathway in susceptibility to stuttering.


Video: Biology Homework about Lysosomes.

References:

Mutations in the Lysosomal Enzyme–Targeting Pathway and Persistent Stuttering. NEJM, 2010.

Childhood diabetes associated with increasing birth weight - 7% increase in risk for every 1000 g in weight

Childhood onset diabetes is associated with increasing birth weight, equivalent to a 7% increase in risk for every 1000 g in weight.

Caesarean section increases the risk by around 20%.

The risk of childhood onset diabetes increases with maternal age: 5% for each five years of age.

References:
Maternal age and diabetes in childhood. BMJ 2010;340:c623.

Image source: Wikipedia, GNU Free Documentation License.

17% of food-related asphyxiations were caused by hot dogs - "the perfect plug for a child's airway"

From Consumer Reports health blog:

Small toys and foods that are choking hazards should carry warning labels - and some hot dog brands already do.

About 17% of food-related asphyxiations were caused by hot dogs. In total, 41% were caused by food items including:

- hot dogs

- grapes

- carrots

- hard candy

Food manufacturers should design new foods and redesign existing foods to avoid shapes, sizes, textures and other characteristics that increase choking risk to children, to the extent possible.

"If you were to take the best engineers in the world and try to design the perfect plug for a child's airway, it would be a hot dog," says statement author Gary Smith. "I'm a pediatric emergency doctor, and to try to get them out once they're wedged in, it's almost impossible."

References:

Hot dogs under fire: Doctors push for stronger labeling
http://www.aap.org/advocacy/releases/feb2210studies.htm

Image source: Wikipedia, GNU Free Documentation License.

Related:

Kinder Surprise egg seized at U.S. border - banned by law as a choking hazard to young children http://goo.gl/UNUoG - Sold around the world.

Better Sleep, Better Learning? Obstructive sleep apnea can reduce a child’s IQ by 10 points

From Science Life Blog at the University of Chicago:

Pediatric obstructive sleep apnea, or OSA, can have long-term, detrimental effects on a child’s cardiovascular and respiratory health. But it can also create neurocognitive effects, such as a reduced ability to learn and retain information.

OSA can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve grades.

References:

Better Sleep, Better Learning? « Science Life Blog « University of Chicago.
http://sciencelife.uchospitals.edu/2010/02/15/better-sleep-better-learning

Sleep duration is shorter in obese children http://goo.gl/z5JFs

Taking charge of your toddler's vaccination record is the best way to ensure they don't miss any shots

From Reuters:

"In our country, we think the doctor should have all the medical records," said Dr. James McElligott, a pediatrician at the Medical University of South Carolina who worked on the study. "I like the idea of putting the ownership back in Mom's hands and empowering her a little bit."

When parents kept a so-called shot card, their child's odds of being up-to-date on vaccinations rose by more than half.

40 percent of the toddlers had a shot card, and 84 percent of these had up-to-date vaccinations. By contrast, only 79 percent of the children without a card had all their shots.

Use the card: it doesn't have a downside and it's cheap."

References:

Want kids' vaccinations up to date? Keep the record | Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E37I20100215

FDA: Rotarix rotavirus vaccine contains DNA from a "harmless" pig virus and should not be used

GlaxoSmithKline confirmed that the pig virus, porcine circovirus type 1 or PCV-1, has been in the vaccine since it was developed.

75% of U.S. doctors prescribe the three-dose RotaTeq vaccine, made by Merck, which was approved in 2006.

Electron micrograph of Rotaviruses. Image source: Wikipedia, Environmental Protection Agency, public domain.

Rotavirus-related diarrhea used to cause 70,000 hospitalizations per year in the U.S. before the introduction of the vaccines. The first vaccine against the virus called RotaShield was withdrawn from the market due to reports of an intestinal blockage (intussusception) associated with its use.

References:
Pig Virus DNA Found in Rotavirus Vaccine. WebMD.

Image source: GSKsource.com.

Now There’s Pig Virus DNA in Merck’s Rotavirus Vaccine, Too. WSJ, 2010.

Updated: 05/06/2010

5.7% of teenagers have participated in "choking game"

From the NYTimes:

During "choking game" adolescents try to achieve a high by briefly depriving the brain of oxygen through strangulation. The "game" is extremely dangerous and could lead to brain damage, long-term neurological disability and death.

According to the recent survey of more than 10,642 eighth graders in Oregon, 36.2 percent reported having heard of the choking game, 30.4 said they had heard of someone participating in it and 5.7 percent said they had participated themselves.

Many adults are unaware of the many names the game goes by — including “Knock Out,” “Space Monkey,” “Flatlining” or “The Fainting Game” — and the warning signs:

- bloodshot eyes
- marks on the neck that may look like hickies
- frequent severe headaches
- disorientation after spending time alone
- ropes, scarves and belts discarded on the floor or tied to bedroom furniture and doorknobs



References:
Choking Game No Mystery to Children, Oregon Study Finds. NYTimes, 2010.

Small Town Story: Nebraska Boy Dies Playing 'The Choking Game' http://goo.gl/gy5V

Choking game claims lives of two Chicago girls - chicagotribune.com http://goo.gl/AOgU
Image source: The vulnerable carotid artery, (large, red tube), and the vagus nerve running parallel on its left. Wikipedia, public domain.

Updated: 08/12/2010

Let kids be kids: unstructured play time may be more important than homework

From Half Full: Science for Raising Happy Kids:

Let Kids Just Play: unstructured play time is actually more important than homework.

Children have lost 8 hours per week of free, unstructured, and spontaneous play over the last 2 decades due to homework.

Decrease in unstructured play time is in part responsible for slowing kids’ cognitive and emotional development. Today’s 5-year-olds had the self-regulation capability of a 3-year-old in the 1940s; the critical factor seems to have been not discipline, but play.

Pretend play is particularly beneficial, so make sure kids have ample time for it.

Related:

The Case for Saturday School - WSJ.com http://goo.gl/6IBT - We tend to choose the "more" approach when often the smarter one works better.

Image source: Child playing with bubbles. Wikipedia, Steve Ford Elliott, Creative Commons Attribution 2.0 License.

Updated: 03/22/2010