Nov 272010
 
Cutaneous adverse reactions to drugs are common in pediatric practice and often present a diagnostic challenge.
Pathogenesis:
The pathogenesis of most drug eruptions is not well understood. With few exceptions, eg, fixed drug eruption, the diagnosis cannot be based solely on the morphology of the eruption.

Clinical Features:
A drug rash may manifest as urticaria, a morbilliform exanthem, erythroderma, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), photosensitivity, lichen planus, or vasculitis, all of which have other potential causes. A high index of suspicion for drug causation is important so that an offending drug is discontinued and avoided in the future, particularly in the case of life-threatening reactions such as anaphylaxis, the drug (anticonvulsant) hypersensitivity syndrome, SJS, and TEN. Conversely, it is important not to err by labeling a child as “allergic” to a widely used medication, such as penicillin. There are no standardized laboratory investigations that are diagnostic for drug allergy, and the value of allergy testing is largely restricted to cases of IgE-mediated penicillin hypersensitivity. Therefore, a detailed history, evaluation of the morphology of the rash, consideration of a differential diagnosis, and careful clinical judgment are essential.
The timing of the reaction may be helpful. Medications begun recently, particularly within the past Continue reading »
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Nov 242010
 
Rhinitis is the most common manifestation of allergic disease, affecting 10 to 22% of adults and 10 to 42% of children.
Symptoms frequently become apparent during the first 5 years of life and may occur in a seasonal and/or perennial (year-round) pattern. Because sensitization to individual allergens requires repeated exposures, several seasons of exposure are necessary for the development of allergy to pollens or molds. This may explain why children with allergic rhinitis under the age of 5 years are typically sensitized to perennial indoor allergens, such as dust mites and animal danders, rather than seasonal allergens such as ragweed.
Pathophysiology:
The symptom complex of allergic rhinoconjunctivitis results from the biochemical mediators elaborated during a type I (IgE-mediated) hypersensitivity reaction. Following the inhalation of aeroallergens into the nose, water-soluble antigens enter and diffuse through the mucous blanket that covers the respiratory tract mucosa. Interaction of these allergens with allergen-specific IgE on the surface of mast cells initiates cellular activation, culminating in the release of a multitude of preformed and newly synthesized bioactive molecules, including histamine and prostaglandin D2. These mediators produce symptoms shortly after allergen exposure and remit relatively quickly. However, symptoms frequently recur several hours later, coincident with a rise in many of the same mediators seen in the early response, along with a rise in cytokines (eg, IL-4 and IL-5) and the influx of helper T cells and eosinophils. This late allergic response is responsible for the inflammation seen in allergic rhinitis and contributes to the chronicity of the condition.

Symptoms:
Nasal congestion is the most frequently reported symptom by patients with allergic rhinitis. Continue reading »
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Nov 242010
 
The objective of prenatal care is to optimize the outcome for both mother and baby. This is achieved through a series of visits with the mother during which history, physical examination, laboratory and other measurements, and patient education all are essential parts.
On the first visit, the last menstrual period is ascertained to date the current pregnancy. In addition, the patient is questioned about previous pregnancies, ethnic background, current problems, current medications, and medical, social, psychosocial, nutritional, and family history. Also on the first (or an early) visit, the mother is given a screening physical examination and a full pelvic examination including estimation of uterine size and clinical pelvimetry. Her weight and height are recorded, and blood pressure measured. Urine is examined for protein and glucose and may also be screened for bacteriuria. Standard blood studies include complete blood count, Venereal Disease Research Laboratory test (VDRL) for syphilis, rubella antibodies, hepatitis B surface antigen, blood type and Rh, and red cell antibodies.
During these early visits, education of the mother continues on such topics as promoting healthy behaviors, general knowledge of pregnancy, nutritional information, and information on the structure of prenatal care. This educational portion of the visit is supplemented by written materials appropriate to individual needs.
Referral to medical, social, or financial resources may begin at this time.
The frequency of prenatal visits is tailored to individual requirements.
The first visit is generally between 6 and 8 weeks of gestation.
The second visit, 6 weeks later, is at gestation greater than 10 weeks, when fetal heart tones can be Continue reading »
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