Kathryn Moffett

Pediatric Infectious Disease: Unusual Head and Neck Infections

Infections in children in the head and neck regions are common, leading to frequent use and overuse of antibiotics. This review includes common as well as diverse and unusual infectious diseases, such as PFAPA (Periodic Fever Aphthous stomatitis, Pharyngitis, Adenitis) syndrome, Lemierre Syndrome, Arcanobacterium infection, and tuberculous and nontuberculous adenitis, which occur in infants, children, and adolescents. In addition, the first pediatric vaccines available with the potential to prevent oropharyngeal cancers are reviewed.

A Token Economy for Exercise Adherence in Pediatric Cystic Fibrosis: A Single-Subject Analysis

OBJECTIVE In cystic fibrosis (CF), adherence to airway clearance techniques (e.g., chest physiotherapy and exercise) is poor. Exercise is important because pulmonary difficulties are associated with the highest mortality rate. Despite this, very little research has focused on exercise adherence in CF. This study examined a token economy for increasing exercise in children with CF. METHODS An ABAB single-subject design evaluated a token economy for increasing and maintaining exercise in three children with CF. Patient report, parent report, and physiological measures were used to assess treatment integrity, medical stability, and changes in exercise. RESULTS Measures suggested that treatment integrity was strong. Results indicated strong treatment effects for all participants without negative medical side effects. Follow-up of 1 and 3 months supported continued exercise for all participants. CONCLUSIONS A token economy effectively increased exercise in children with CF, and the single-subject design highlighted some of the intricacies of individualized treatment of adherence. Implications and recommendations for further research are discussed.

Efficacy and Safety of a New Formulation of Pancrelipase (Ultrase MT20) in the Treatment of Malabsorption in Exocrine Pancreatic Insufficiency in Cystic Fibrosis

Background. Pancreatic enzyme replacement therapy is the standard of care for treatment of malabsorption in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (PI). Aim. To evaluate efficacy and safety of a new formulation of pancrelipase (Ultrase MT20) in patients with CF and PI. Coefficients of fat absorption (CFA%) and nitrogen absorption (CNA%) were the main efficacy parameters. Safety was evaluated by monitoring laboratory analyses, adverse events (AEs), and overall signs and symptoms. Methods. Patients (n = 31) were randomized in a crossover design comparing this pancrelipase with placebo during 2 inpatient evaluation periods (6-7 days each). Fat and protein/nitrogen ingestion and excretion were measured from food diaries and 72-hour stool collections. CFA% and CNA% were calculated for each period and compared. Results. Twenty-four patients provided analyzable data. This pancrelipase increased mean CFA% and CNA% (+34.7% and +25.7%, resp., P < .0001 for both), reduced stool frequency, and improved stool consistency compared with placebo. Placebo-treated patients reported more AEs, with gastrointestinal symptoms being the most frequently reported AE. Conclusions. This pancrelipase is a safe and effective treatment for malabsorption associated with exocrine PI in patients with CF.

Congenital Herpes Simplex Virus in the Newborn: A Diagnostic Dilemma.

Although congenital herpes simplex virus (HSV) infection is rare, it is associated with severe morbidity. We report a 36-week gestational age infant who presented with atypical skin lesions, presumably mitigated by exposure to maternal antiviral suppressive therapy. The initial absence of typical herpetic vesicles and lack of viral detection in skin lesions delayed the correct diagnosis, highlighting the importance of differentiating HSV from other neonatal rashes.