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621. Pervasive Developmental Disorder: Autism (Treatment)

-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet . 2010 Feb 6. 375(9713):445. . Dobbs M. What the autism studies show isn't reflected in what the candidates say. The Washington Post . April 22, 2008;A: A8: Blaxill MF. What's going on? The question of time trends in autism. Public Health Rep . 2004 Nov-Dec. 119(6):536-51. . . Newschaffer CJ, Falb MD, Gurney JG. National autism prevalence trends from United States special education data (...) . Pediatrics . 2005 Mar. 115(3):e277-82. . Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study. Arch Pediatr Adolesc Med . 2005 Jan. 159(1):37-44. . Rutter M. Aetiology of autism: findings and questions. J Intellect Disabil Res . 2005 Apr. 49:231-8. . Rutter M. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr . 2005 Jan. 94(1):2-15. . Baio J, Wiggins L

2014 eMedicine Pediatrics

622. Anxiety Disorders (Diagnosis)

& Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) patients. J Affect Disord . 2010 Jul. 124(1-2):215-8. . Kendler KS, Karkowski LM, Prescott CA. Fears and phobias: reliability and heritability. Psychol Med . 1999 May. 29(3):539-53. . Fyer AJ, Mannuzza S, Chapman TF, Liebowitz MR, Klein DF. A direct interview family study of social phobia. Arch Gen Psychiatry . 1993 Apr. 50(4):286-93. . . Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States


623. Amyotrophic Lateral Sclerosis (Diagnosis)

of a faulty regulatory gene product responsible for motor network maintenance, or failure to regulate such a product, may account for the specific disintegration of the motor network. MicroRNAs are particularly attractive candidates for this role. The affirmation of spread substantiates the concept of a biologic focal onset for ALS. This in turn lends credibility to the concept of a focal trigger for ALS onset that generates the production of 1 or more agents of spread. [ ] Under this hypothesis, disease (...) , and the level of knowledge of the person being interviewed. [ ] In addition, first-degree relatives of patients with apparently sporadic disease have an increased risk of ALS. The overall lifetime risk of ALS in these relatives is low, however (approximately 1 in 50). [ ] Familial cases A family history of ALS is obtained in about 5% of cases and is often consistent with a Mendelian autosomal dominant pattern of inheritance. While most cases of familial ALS are indistinguishable from sporadic disease


624. Bipolar Affective Disorder (Diagnosis)

with susceptibility to bipolar disease in a cohort of 41 Finnish families. [ ] MAFD5 is located at 2q22-q24, and MAFD6 is located at 6q23-24. Interestingly, evidence suggests a strong interaction between genes located in these 2 regions. It has been concluded that the candidate gene in the MAFD5 locus shows epistatic interaction with the MAFD6 risk locus. [ ] MAFD7 is located at 22q12.1 and was detected using microsatellite markers in a North American population; a large region on 22q12 was associated (...) %), bipolar disorder type II (BPII) (1.1%), and subthreshold bipolar disorders (2.4–4.7%). [ ] International statistics Globally, the lifelong prevalence rate of bipolar disorder is 0.3–1.5%. In cross-sectional, face-to-face household surveys of more than 61,000 adults across 11 countries, Merikangas et al, using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, determined that the aggregate lifetime prevalences were 0.6% for BPI


625. Cancer and Rehabilitation (Diagnosis)

provide services to patients throughout the course of illness, during all stages. Treatment plans must be individualized to meet each patient's unique and specific needs. Physicians Professional clinicians composing the interdisciplinary team include physicians from several specialties. Primary care physicians, surgeons, radiation oncologists, and medical oncologists make active and concurrent contributions to rehabilitation efforts to manage the disease process. The physiatrist, a specialist in PM&R (...) of the disease are simultaneous. Cancer rehabilitation is an emerging field within PM&R and it has many unique characteristics that may require specialized fellowship training. Fellowship training programs teach physicians to evaluate the functional needs of cancer patients during treatment and follow-up. Cancer rehabilitation is a challenging and rewarding field since it combines many aspects of medicine, such as inpatient and outpatient care, patient continuity of care, clinical assessment, diagnostic


626. Follow-up of the NICU Patient (Overview)

, videotapes, and Web sites. The information below is provided without any endorsement of the resources. Articles in medical journals are usually peer reviewed (ie, evaluated and accepted by experts in the field) before publication. The accuracy of information provided in lay journals and on Web sites can be suspect. Consultant experts may not have reviewed information from these sources. Physicians should always investigate the particular sites that caregivers are using to obtain information. Because (...) through the NICU , 2013, Authors: Deborah L. Davis, PhD, Mara Tesler Stein, PsyD; Fulcrum Publishers, Golden, CO. The Preemie Primer , 2010, Author: Jennifer Gunter, MD; Da Capo Press, Perseus Book Group, Philadelphia, PA. For the Love of Babies: One Doctor’s Stories about Life in the Neonatal ICU , 2011, Authror: Sue L. Hall, MD; WorldMaker Media, Newton, MA. The following books, pamphlets, and videotapes may assist parents and health care professionals in the care of high-risk infants during

2014 eMedicine Pediatrics

627. Hearing Impairment (Overview)

858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) in the care of children with hearing loss. In the past two decades, recommendations for universal neonatal hearing screening resulted in numerous articles regarding the tests, the efficacy of testing, the role of the audiologist in amplification, and the importance of early intervention programs. [ , , , , , , , , , , , ] The role of the primary care physician cannot be overemphasized. In many instances, the otolaryngologist develops a long-term relationship with patients and their families, caring

2014 eMedicine Pediatrics

628. Anxiety Disorder: Social Phobia and Selective Mutism (Overview)

Diseases & Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) of social anxiety disorder as measured by the World Health Organization Composite International Diagnostic Interview 3.0, and 5.2% of adolescents who did not identify as having shyness had social phobia. [ ] There is significant comorbidity of social phobia with anxiety disorders, major depressive disorder, and drug use disorders, without regard to the presence or absence of shyness. Adolescents with shyness were more likely to report agoraphobia compared with the no-shyness group. Adolescents

2014 eMedicine Pediatrics

629. Anxiety Disorder: Obsessive-Compulsive Disorder (Overview)

had some tendencies or subclinical OCD symptoms prior to infection. Previous Next: Epidemiology Incidence In the United States, obsessive-compulsive disorder (OCD) is substantially more common in children and adolescents than was once believed. It has a 6-month prevalence of approximately 1 in 200 children and adolescents, while the prevalence of OCD occurring at any time during childhood is assumed to be 2–3 per 100 children. [ ] Among adults with OCD, interview data indicate that one third (...) existence of an early-onset group and a second group with onset in adolescence. [ ] Previous Next: Prognosis No specific predictors of treatment outcome have been identified for pediatric obsessive-compulsive disorder (OCD). Children who can identify their obsessions as senseless and their rituals as useless and distressing are more motivated and better candidates for cognitive-behavioral therapy (CBT). A calm, supportive family environment in which parents and/or caregivers actively can support

2014 eMedicine Pediatrics

630. Kidney Transplantation (Treatment)

interferes with the immune cascade at a point beyond IL-2 production; therefore, it has been used to advantage in combination with cyclosporine. A microemulsion form of cyclosporine (Neoral) was developed to provide more predictable and consistent absorption. Although the microemulsion increases intestinal absorption, some patients ultimately have higher peak blood levels and/or lower trough levels on this form of cyclosporine. Some transplant physicians believe that the trough level is most important (...) consent is not ethical. Hence, few such transplants are performed in children. Parents, adult siblings, or other blood relatives serve as the most common donors for children. With improvement in immunosuppression, even donation from HLA-mismatched individuals can be successful. Carefully interview potential living donors to assess their motivation and their understanding of the ramifications of donor nephrectomy. Obtain a thorough medical history and perform a physical examination, including a careful

2014 eMedicine Pediatrics

631. Gonorrhea (Treatment)

patients, seeking specialist help (in the form of specialist nurses or physicians) to interview and collect specimens (if necessary) for testing is prudent. Careful documentation of physical findings, even if apparently normal, is crucial for medicolegal reasons. Notification of child-protective services is required if abuse is suspected. Previous Next: Monitoring Per the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, a test-of-cure is no longer needed for patients with uncomplicated (...) & Perspective Tools Slideshow Most Popular Articles According to Infectious Disease Physicians Recommended 2002 218059-overview Diseases & Conditions Diseases & Conditions 2002 782913-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/895833 News News 2001 /viewarticle/895915 Journal Article Journal Article Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine Pediatrics

632. Psychosocial and Environmental Pregnancy Risks (Diagnosis)

shown to have environmental and genetic components. Two determinations must be made when a physician responds to a patient's concerns about a specific exposure: (1) whether any quantity of the toxicant has known adverse effects on reproduction in humans and (2) whether the substance is present in sufficient quantity to affect the patient or population exposed. This issue is complicated in humans by the high natural spontaneous abortion rate of 15-30%, which makes determining the specific (...) in the pregnant woman is usually associated with a high level of anxiety for the woman, her family, and, often, the physician. 2014 study also showed that there is a deficiency in both emergency department (ED) and obstetric/gynecologic physicians' knowledge when counseling women about the risks of diagnostic imaging in pregnancy. [ ] A number of modalities may be required for diagnosis and treatment of exposures in pregnancy. It is necessary to balance the benefits of such procedures with an accurate


633. Sudden Unexpected Death in Epilepsy (Diagnosis)

-overview Diseases & Conditions Diseases & Conditions 2002 1181649-overview Diseases & Conditions Diseases & Conditions 2002 1138154-overview Diseases & Conditions Diseases & Conditions 2002 1140724-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) vulnerability to cardiac arrhythmia. [ ] Seizure threshold also might diminish, leading to rebound effect and increase in seizure frequency. Patients on multiple antiepileptic drugs had a significantly higher rate of SUDEP than patients with epilepsy who were not on multiple antiepileptic drugs. Also, a questionable role has been attributed to recent sudden changes in medication regimen of patients. Genetic predisposition The following genes have been studied in SUDEP autopsy cases: KCNQ1 , SCN1A , LQTS


634. Lung Cancer, Non-Small Cell (Diagnosis)

, but in older patients or those with significant comorbidities, carboplatin may be substituted. Radiation In the treatment of stage I and stage II NSCLC, radiation therapy alone is considered only when surgical resection is not possible. [ ] Radiation is a reasonable option for lung cancer treatment among those who are not candidates for surgery. [ ] Beta blockers have been found to improve overall survival, disease-free survival, and distant metastasis–free survival, though not locoregional progession–free (...) care is an important part of the treatment of patients with NSCLC. (See .) The American College of Chest Physicians (ACCP) updated its comprehensive set of lung cancer guidelines in 2013. The guideline set includes an executive summary of current recommendations for diagnosis and treatment. [ ] For a summary of guidelines issued by major organizations, see . Go to for complete information on this topic. Previous Next: Pathophysiology Both exposure (environmental or occupational) to particular


635. Pathophysiology of Chronic Back Pain (Diagnosis)

. If diagnostic studies do not reveal a structural cause, physicians and patients alike question whether the pain has a psychological, rather than physical, cause. Physical and nonphysical factors, interwoven in a complex fashion, influence the transition from acute to chronic LBP. The identification of all contributing physical and nonphysical factors enables the treating physician to adopt a comprehensive approach with the greatest likelihood of success. Epidemiology LBP is the most expensive, benign (...) common cause of disability in Americans younger than 45 years. [ , ] Each year, 3-4% of the US population is temporarily disabled, and 1% of the working-age population is totally and permanently disabled. [ , , ] LBP has been cited as the second most frequent reason to visit a physician for a chronic condition [ , , , ] , the fifth most common cause for hospitalization [ , , , ] , and the third most frequent reason for a surgical procedure. [ , , , ] The socioeconomic impact of cLBP is massive


636. Obsessive-Compulsive Disorder (Diagnosis)

cases and questions with Physicians on Medscape consult. (...) already have OCD will not necessarily experience worsening of their symptoms during pregnancy. Women commonly experience worsening of their OCD symptoms during the premenstrual time of their periods. Women who are pregnant or breastfeeding should collaborate with their physicians in making decisions about starting or continuing OCD medications.Age preference in OCD Symptoms of OCD usually begin in individuals aged 10-24 years. Previous Next: Prognosis OCD is a chronic disorder with a wide range


637. Nutritional Management in the Rehabilitation Setting (Diagnosis)

from oral to enteral to parenteral, as follows: Oral nutrition This is the starting point of all interventions. It consists of dietary change, as well as the addition of between-meal snacks and nutritional supplements. Enteral nutrition A patient with a functional gastrointestinal (GI) tract is a candidate for enteral support when he or she will not, should not, or cannot take nutrition orally. Enteral feeding can be nasogastric or nasoduodenal/nasojejunal or can be administered via gastrostomy (...) practice. It is often necessary at a minimum to do a mini-nutritional assessment of the patient at the point of admission into a rehabilitation unit, since poor nutritional status could lead to greater debility and an inability to fully participate in intensive in-patient rehabilitation therapies. Assessments include the following: Nutrition Screening Initiative (NSI) (1990): This tool offers bilevel screening, using the Body Mass Index (BMI) and a subjective interview on level I. Anthropometric data


638. Primary Biliary Cirrhosis (Diagnosis)

-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/909476 News News 2002 104439-overview Procedures Procedures 2002 936591-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) frequently a disease of women and occurs between the fourth and sixth decades of life. The symptoms may strongly affect patients' quality of life and may induce incapacitation. Various therapeutic approaches have been implemented with variable results; in selected candidates, liver transplantation is the only treatment option for the terminal stages of the disease. After the procedure, the disease has a relatively high recurrence rate despite immunosuppressive therapy. The image below demonstrates


639. Preoperative Evaluation and Management (Diagnosis)

herbal substances to be medications, and they consequently neglect to report them during routine preoperative questioning. For these reasons, physicians need to specifically seek out a history of herbal medicine use in patients before surgery. Despite many uncertainties in commercial preparations, herbal medications adhere to modern pharmacologic principles. A single herbal medication may adversely affect the patient during the perioperative period through a number of different mechanisms (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTEyNzA1NS1vdmVydmlldw== processing > Dermatologic Preoperative Evaluation and Management Updated: Mar 13, 2018 Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Dermatologic Preoperative Evaluation and Management Overview Overview The preoperative consultation and evaluation is an important interaction between the patient and the physician. This process allows the surgeon to carefully assess the medical condition, evaluate the patient's overall


640. Penile Prosthesis Implantation (Diagnosis)

& Perspective Tools Slideshow Most Popular Articles According to Urologists Recommended 2002 444220-overview Diseases & Conditions Diseases & Conditions 2001 2001 /viewarticle/883199 News News 2001 /viewarticle/903420 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) be counseled that penile prostheses do not achieve the full length achieved by natural erections. Previous Next: Epidemiology Frequency Studies regarding the incidence of ED have proven difficult. Many experts believe that currently available data are often unreliable, especially when based on patient self-reporting. One study by Massey et al (1984) mentions ED incidence as 17 new cases per 100,000 man-years. [ ] In other studies, as many as 40% of men interviewed reported some kind of sexual dysfunction


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