Ahdi Amer

The Natural History of Pityriasis Rosea in Black American Children: How Correct Is the “Classic” Description?

Objectives: To delineate the natural history of pityriasis rosea in black children and to compare our findings with those of the American, European, and African literature on pityriasis rosea. Textbook and journal article descriptions of pityriasis rosea usually offer informationaboutthepresentationandclinicalcourseofthiscondition in white patients. Design: Prospective observational study.

Emergence of human rotavirus genotype G9 in metropolitan Detroit between 2007 and 2009

Between January 2007 and April 2009, rotavirus (RV)-positive stool samples from 238 children with acute gastroenteritis, seen at Childrens Hospital of Michigan in Detroit, USA, were collected and RV genotyping was performed. G and P genotypes were determined by RT-PCR and nucleotide sequencing was conducted on selected G9 and P[6] strains. Correlation between the severity of gastroenteritis episode and the infecting G genotype was done using a 14-point scoring system. The predominant G genotype was G9 (39.5 %), followed by G1 (35.3 %) and G4 (15.5 %), while P[8] was the most prevalent P genotype (66.5 %), followed by P[4] (21.9 %) and P[6] (11.2 %). The gene combinations G1P[8] and G9P[8] were the most prevalent (21.4 % and 20.6 %, respectively), followed by G4P[8] (13 %) and G9P[6] (8.8 %). Immunization data showed that only 17/238 (7.1 %) children received ≥one dose of RV vaccine (the pentavalent vaccine RotaTeq or the monovalent vaccine Rotarix) and that 10/17 were infected with G4P[8] strains. Severity of RV gastroenteritis episodes was not related to the infecting G genotype. Our results suggest a high proportion of genotype G9 strains in combination with P[8], P[6] and P[4] specificity circulating in the metropolitan Detroit area. While the protective efficacy of the RV vaccines has been demonstrated against G9P[8] strains, the level of cross-protection offered by the vaccines against G9 strains with P[6] and P[4] genotypes in the Detroit paediatric population remains to be determined.

“Don’t Call Me ‘Mom’”: How Parents Want to Be Greeted by Their Pediatrician

Background. Physician—patient interaction during the medical interview is essential in establishing the rapport necessary for a successful relationship. Physicians are generally encouraged to shake hands with patients, address patients by name, and identify themselves. Objective. To define parents expectations for greetings by pediatricians and to determine the frequency with which these expectations are met. Design and methods. A total of 100 parents visiting the General Pediatric Clinic at Childrens Hospital of Michigan were recruited. Parents were interviewed at the end of their medical encounter to determine expectations for greeting by their doctor. They were questioned about preferences for shaking hands, the doctors’ use of their names, and the way doctors should introduce themselves. They were then asked if the experience at this visit conformed to these expectations. Results. Overall, 81% of the parents were the childrens mother and 86% were African-American. Over 80% of parents expected physicians to shake hands; 70% of residents and 66% of attendings did. 88% of parents wanted to be addressed by their names; only 14% of residents and 24% of attending physicians did so. All of the parents wanted the physicians to introduce themselves; 84% of residents and 93% of attendings did so. Conclusions. Physicians neither shook hands with many parents who expected it, nor did they address parents by their last names. About 90% of physicians introduced themselves. These disappointingly low results may predispose to parent dissatisfaction. Attending physicians need to teach these small, but important features, and to model them as well.

Prurigo Nodularis in a 9-Year-Old Girl:

A 9-year-old African-American female with a known history of atopic dermatitis presented for evaluation of an intensely pruritic nodular rash on both upper and lower extremities, buttocks, and lower abdomen for more than 1 year. The patient had been treated with several medium-potency topical steroids and antipruritics without appreciable improvement. After considering and excluding other differential diagnoses, the diagnosis of prurigo nodularis (PN) in association with atopic dermatitis was made. Prurigo nodularis usually occurs in middle-aged and older persons and is rarely seen in the pediatric population. The onset of PN in the case presented is considerably earlier than what has been described in literature. The etiology of the disorder is unknown. The management of prurigo nodularis is usually challenging for both patients and treating physicians. Frequently, combinations of several medications or modalities are used in an attempt to control disease activity. Overall, PN is a benign condition in children, particularly when it is associated with atopic dermatitis. It does not increase mortality; however, it can cause significant morbidity in untreated patients.

Does Pacifier Use in Infancy Decrease the Risk of Obesity

Background. Nonnutritive sucking using a finger or pacifier is a natural reflex for infants. We hypothesized that infants may overfeed if the bottle or breast is constantly offered. Our goal was to determine whether pacifier use in early infancy is associated with lower incidence of obesity at later age. Methods. Parents of 399 infants, 9 to 15 months old, were interviewed and asked whether a pacifier was used consistently for ≥9 months. Body mass indexes at birth, 6 months, and on the day of interview were calculated. Results. In all, 204 (51%) infants used a pacifier, and 195 (49%) were nonusers. More infants in the nonuser group were either overweight—40 (21%)—or obese—32 (16%)—than in the user group—22 (11%) and 22 (11%), respectively (P = .003). Conclusions. Pacifier use in infancy was associated with lower incidence of obesity at 9 to 15 months of age. Offering a pacifier can be protective against infantile obesity.

Giant Congenital Melanocytic Nevi

Giant or large congenital melanocytic nevi (CMNs) measuring more than 20 cm in diameter are present in 1 out of 20 000 newborns, with an estimated 6.3% lifetime risk of developing malignant melanoma. Approximately half of all melanomas that arise within a giant congenital nevus do so by 5 years of age. They occur most commonly on the posterior trunk but may also appear on the head or the extremities. Congenital pigmented nevi have been categorized by size: Giant congenital nevi are more than 20 cm in diameter; small congenital nevi are less than 2 cm in diameter; and intermediate nevi are in between in size. Giant nevi frequently lie in the distribution of a dermatome and will cover areas like an arm, leg, or a significant part of the trunk. These lesions are usually termed in a descriptive manner, for example, coat-sleeve, stocking, bathing-trunk, or giant hairy nevi. Giant hairy nevi are associated with neurological disorders. Nevi on the scalp and neck are associated with an increased incidence of leptomeningeal melanocytosis, epilepsy, and other focal neurological abnormalities. Those located over the vertebral column are associated with increased risk of spina bifida and meningomyelocele. The presence of ‘‘satellite’’ melanocytic nevi increases the risk of leptomeningeal involvement, particularly when located on the head or midline on the trunk. Nevus cells within the leptomeninges may cause increased intracranial pressure with subsequent hydrocephalus, seizures, and motor deficits. We describe a newborn with a bathing-trunk giant congenital pigmented nevus. Case Report

Possible Impact of Yearly Childhood Vaccination With Trivalent Inactivated Influenza Vaccine (TIV) on the Immune Response to the Pandemic Strain H1N1

Background. Annual vaccination of children against seasonal influenza with trivalent inactivated influenza vaccine (TIV) has shown to be beneficial. However, this yearly practice may have unintended effect. Studies have shown that infection with wild type influenza A viruses can stimulate protective heterotypic immunity against unrelated or new influenza subtypes. We hypothesized that a consequence of yearly TIV vaccination is lack of induction of heterotypic immunity against the recent H1N1 pandemic. Methods. This was a retrospective case-control study. We reviewed the medical records of polymerase chain reaction–confirmed cases of 2009 H1N1 influenza infection in children 6 months to 18 years and a matched control group seen during the pandemic. Results. We identified 353 polymerase chain reaction–confirmed H1N1 cases and 396 matching control subjects. Among the H1N1 group, 202/353 (57%) cases received a total of 477 doses of seasonal TIV compared with 218/396 (55%) in the control group who received a total of 435 doses. Seasonal TIV uptake was significantly higher in the H1N1 group 477/548 (87%) than in the control group, 435/532 (81%) (P = .017). Conclusion. Seasonal TIV uptake was significantly higher in H1N1-infected group. The finding suggests that the practice of yearly vaccination with TIV might have negatively affected the immune response against the novel pandemic H1N1 strain. Given the rarity of pandemic novel influenza viruses, and the high predictability of seasonal influenza occurrence, the practice of yearly influenza vaccination should be continued. However, the use of live attenuated intranasal vaccine, as opposed to TIV, may allow for the desirable development of a vigorous heterotypic immune response against future pandemics.

Azithromycin for Pityriasis: In Reply

fever. To date, 11 cases of secondary bacteremia after rotavirus gastroenteritis have been reported from different locations.1,3–5 It can be concluded that this complication of rotavirus gastroenteritis is uncommon but real, especially in neonates and young infants, and can be complicated by sepsis3,4 or even septic shock.5 Pediatricians should be aware of this rare but potentially serious complication of rotavirus gastroenteritis. When suspected, blood cultures should be obtained and empiric antibiotic therapy should be considered.