CFS in Children and Adolescent: Ten Years of Retrospective Clinical Evaluation.

CFS in Children and Adolescent: Ten Years of Retrospective Clinical Evaluation.

Int J Pediatr. 2013; 2013: 270373
Elgen I, Hikmat O, Aspevik TN, Hagen EM

Aim. To estimate number of children being diagnosed with chronic fatigue syndrome (CFS). Methods. For a period of 10 years (2002-2011) data from children being referred for fatigue symptoms were collected retrospectively. Results. Thirty-seven children were referred. Four were excluded due to incorrect coding. Six (18%) patients received other diagnoses at the end of evaluation time. Of the 27 who received the diagnosis G93.3, four had a previous chronic illness, while 23 patients were previously healthy. All patients reported onset of fatigue symptom in relation to an infection, and all tested positive for IgG to either Epstein-Barr virus, cytomegalovirus or borrelia, indicating previous infection. There were 16 (59%) boys among the 27 patients. The mean age at the debut of fatigue symptoms was 141 months (SD 30) for boys and 136 months (SD 31) for girls, respectively. Being underweight, defined as BMI < 17.5, was found in 12 (44%) patients. Conclusion. An increasing number of children and adolescents are evaluated for CFS. The clinical assessment of children and adolescents with possible CFS need systematically evaluation. Nutritional status, possible eating disorder, and psychosocial issues need to be addressed and evaluated carefully. A multidisciplinary approach is essential when assessing CFS in children and adolescents. There is a need for European guidelines. HubMed – eating

Child sexual abuse and the pathophysiology of suicide in adolescents and adults.

Int J Adolesc Med Health. 2013 Jul 10; 1-5
O’Brien BS, Sher L

Abstract Background: Child sexual abuse (CSA) is widespread and is associated with various psychopathologies, including Axis I and II disorders, maladaptive and impulsive behaviors, and suicidal behavior in adolescence and adults. The pathophysiology of this association is not well understood; however, it is clear that suicidal behavior in individuals with a history of CSA is a significant social and medical problem that warrants further investigation. Methods: An electronic search of the major behavioral science databases (limited to the most recent studies in the last 20 years) was conducted to retrieve studies detailing the social, epidemiological, and clinical characteristics of child sexual trauma and their relation to suicidal behavior in adolescents and adults. Results: Studies indicate that CSA is related to an increase in Axis I and II diagnoses, including depression, post-traumatic stress disorder, conduct disorders, eating disorders, alcohol and drug abuse, panic disorders, and borderline personality disorder. CSA not just related to an increase in impulsivity and risky behaviors, it has also been linked to an increase in suicidality as well. Conclusion: CSA makes both direct and indirect contributions to suicidal behavior. It is a complex process involving multiple variables, which include psychopathology, maladaptive personality features and the direct contribution of CSA itself. Psychopathologies, such as impulsivity and mood and personality disorders, may modulate the relationship between CSA and suicidal behavior. Some preventive measures for decreasing the prevalence of CSA and suicidality may include education as well as increased access to mental health services. HubMed – eating

Non-trisomic homeobox gene expression during craniofacial development in the Ts65Dn mouse model of down syndrome.

Am J Med Genet A. 2013 Jul 10;
Billingsley CN, Allen JR, Baumann DD, Deitz SL, Blazek JD, Newbauer A, Darrah A, Long BC, Young B, Clement M, Doerge RW, Roper RJ

Trisomy 21 in humans causes cognitive impairment, craniofacial dysmorphology, and heart defects collectively referred to as Down syndrome. Yet, the pathophysiology of these phenotypes is not well understood. Craniofacial alterations may lead to complications in breathing, eating, and communication. Ts65Dn mice exhibit craniofacial alterations that model Down syndrome including a small mandible. We show that Ts65Dn embryos at 13.5 days gestation (E13.5) have a smaller mandibular precursor but a normal sized tongue as compared to euploid embryos, suggesting a relative instead of actual macroglossia originates during development. Neurological tissues were also altered in E13.5 trisomic embryos. Our array analysis found 155 differentially expressed non-trisomic genes in the trisomic E13.5 mandible, including 20 genes containing a homeobox DNA binding domain. Additionally, Sox9, important in skeletal formation and cell proliferation, was upregulated in Ts65Dn mandible precursors. Our results suggest trisomy causes altered expression of non-trisomic genes in development leading to structural changes associated with DS. Identification of genetic pathways disrupted by trisomy is an important step in proposing rational therapies at relevant time points to ameliorate craniofacial abnormalities in DS and other congenital disorders. © 2013 Wiley Periodicals, Inc. HubMed – eating

Radiology of Eating Disorders: A Pictorial Review.

Radiographics. 2013 Jul; 33(4): 1171-1193
Bowden DJ, Kilburn-Toppin F, Scoffings DJ

Eating disorders are a major challenge for health professionals, with many patients receiving ineffective care due to underdiagnosis or poor compliance with treatment. The incidence of eating disorders is increasing worldwide, producing an increasing burden on healthcare systems, and they most often affect young patients, with significant long-term complications. The effects of long-term malnutrition manifest in almost every organ system, and many can be detected radiologically, even without overt clinical findings. Musculoskeletal complications including osteoporosis result in a high incidence of insufficiency fractures, with long-term implications for bone health and growth, while respiratory complications are often recognized late due to disordered physiologic responses to infection. Gastrointestinal complications are numerous and in extreme cases may result in fatal outcomes after acute gastric dilatation and rupture subsequent to binge eating. In patients with severely disordered eating, in particular anorexia nervosa, marked derangement of electrolyte levels may result in refeeding syndrome, which requires emergent management. Recognition of such complications is critical to effective patient care and requires radiologists to be aware of the spectrum of imaging abnormalities that may be seen. Since many patients are reluctant to disclose their underlying condition, radiologists also play a critical role in identifying previously undiagnosed eating disorders. ©RSNA, 2013. HubMed – eating

Mycobacterium avium subsp. avium and Mycobacterium neoaurum detection in an immunocompromised patient.

Epidemiol Infect. 2013 Jul 10; 1-4
Kaevska M, Sterba J, Svobodova J, Pavlik I

SUMMARY Non-tuberculous mycobacteria are increasingly described as infectious agents in immunocompromised patients. A 17-year-old male patient suffering from secondary non-Hodgkin’s lymphoma and treated with chemotherapeutic agents was admitted to hospital due to pleuropneumonia. Mycobacterium neoaurum was cultured repeatedly from his sputum and, Mycobacterium avium subsp. avium (M. a. avium) was detected by IS901 qPCR from detached fragments of his intestinal mucosa. We attempted to determine the possible sources of infection by analysing environmental samples from the closed oncology unit and conventional unit in the hospital, and from the patient’s home residence and places which he frequented. The environment of the patient harboured mycobacteria (41 isolates in total); however, M. neoaurum was not recovered. M. a. avium was detected by qPCR in the environmental samples from a small flock of hens kept by his neighbour. Although it was not confirmed by DNA fingerprinting methods, the M. a. avium infection could have been acquired through the eating of incompletely cooked eggs. HubMed – eating