Sunday, August 18, 2013

1. Salmonella gastroenteritis is usually self-limited and will resolve in a day or two. It requires a large inoculum and is rarely transmitted person to person. In addition to the gastroenteritis symptoms, it can be associated with neurological symptoms (headaches, seizures, drowsiness, confusion). It can cause transient bacteremia (1-5%) and seed distant sites, causing osteomyelitis, meningitis, pneumonia, arthritis; this is more likely in people who are immunocompromised/asplenic and infants. Except in these vulnerable groups, we don't use antibiotics. Do not use anti-motility agents. It is ubiquitous in the animal kingdom, including notably in many reptiles, like iguanas and turtles.
2. Shigella gastroenteritis will resolve without treatment, but it takes 1-2 weeks, so we usually treat it to speed up resolution. It requires a small inoculum, and is usually transmitted person to person. WBC will be low, but have a significant left shift. Can also be associated with neurological symptoms (headaches, confusion, seizure, hallucinations). Rarely associated with complications: HUS (with strains that make shigatoxin), meningitis, cholestatic hepatitis, toxic megacolon, rectal prolapse, cystitis, Ekiri syndrome (toxic, fever, seizures, rapidly progressive brain edema/death within 8-48 hours of symptom onset, extremely rare), arthritis/conjunctivitis/urethritis 2-5 weeks after especially in HLA-B27.
3. Gibert's syndrome is associated with at 66% ARR of heart disease (determined using Framingham heart study data). Apparently UCB is an anti-oxidant. (credit: SMG)
4. Use of walkers in children should be strongly discouraged. They do not make any difference in the age kids learn to walk, and in fact, age of walking is not an indication of intelligence. The age of first walking in 95% of kids is 9-17 mos. Walkers are dangerous because if a kid falls off the stairs in a walker, he'll sustain significant injury to his neck--- whereas if a kid falls off the stairs not in a walker, they rarely hurt their c-spines. Kids' c-spines (up to 8 years) are much more elastic than that of adults. Experiments in cadavers show that the vertebral column can stretch up to 2 inches without disruption. Additionally, the facet joints are shallower and more horizontal, the ligaments of the neck are more elastic, the neck muscles are weaker-- all of which decrease the incidence of fracture/serious injury. (http://www.medscape.com/viewarticle/527718_3)
5. Questions to evaluate language development in an toddler: 
--General: Concerns about hearing? Does he try to imitate speech? Is he interested in people?
--Receptive language: Can he understand commands (give it to me), name body parts you point to, make sounds of animals you name
--Expressive language: Does he gesture/point/shake or nod head? How does he express himself? What words does he say, and does he use them correctly?
Language Milestones:
--7 days: can differentiate mom's voice from other females
--2 weeks: can differentiate dad's voice from other males
--6 mos: coos
--9 mos: nonspecific mama/dada
--1 year: specific mama/dada, one-step commands
--15 mos: ~10 words
--18 mos: knows nouns (cup, ball), and names. Can follow two-step commands.
--2 years: making 2-3 word sentences.
6. CP: non-progressive disorders of movement and posture
=Spastic quadriplegia: spasticity in all 4 limbs, due to global cerebral injury
=Spastic diplegia: spasticity worse in LE than UE, due to perivernticular white matter damage (i.e. hemorrhage), often seen in premature infants
=Dyskinetic (athetoid: constant motion of head/eyes/limbs, dystonic: fixed posture): damage to BG, thalamus, cerebellum. Assoc with kernicterus, perinatal asphyxia.
=Spastic Hemiplegic: stroke, dmg to UMN.
=Ataxic: damage to cerebellum.
7. Risk factors for CP identified in a case-series (n=213) in Australia: Prematurity (78%), IUGR (34%), intrauterine infection (28%), perinatal hypoxia (10%).
8. APGAR scores are predictive of neonatal survival, but not of development later on in the child's life.
9. Interesting research about near-death experiences in rats. EEG data of high-frequency activity in the 30 seconds immediately following cardiac arrest suggest a "hyperconscious" state, which would mesh with humans who claim they experience vivid hallucinations/visions that "feel more real than reality". http://www.pnas.org/content/early/2013/08/08/1308285110 (c/o NPR shots blog)
10. A great TED talk about self-assembling materials on a human scale http://www.ted.com/talks/skylar_tibbits_the_emergence_of_4d_printing.html

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