Richard H. Schwartz

Alcohol and drug use in teenagers with diabetes mellitus

Alcohol and drug use in adolescents with diabetes mellitus was assessed by an anonymous self-administered questionnaire with verification by urine drug screening. Approximately 50% of these adolescents report having tried alcohol and 25% report ongoing use. Almost 25% have tried drugs of abuse and 5% report ongoing use. One of 97 consecutive urine specimens was positive for marijuana. In general, the frequency of alcohol and drug use was less than expected based on other studies of different clinical groups of patients in the same age range. Patients with diabetes who reported drug use or who reported they live in an environment of substance abuse had poorer diabetes control than patients who did not.

Bacteriology of Otitis Media: A Review:

This article reviews the microbiology of acute otitis media and otitis media with effusion. Emphasis is given to the method of specimen collection and the technique of office bacteriology. Several long-held beliefs are reexamined in the light of current information, particularly the expanded role of Haemophilus influenzae in older children and the diminished role of Mycoplasma in bullous myringitis. Information is presented on anaerobes and Chlamydia trachomatis as pathogens in otitis media.

Children Less Than Three-Years-Old With Pharyngitis Are Group A Streptococci Really That Uncommon?

During a 15-month period, 148 infants and children less than 3-years-old who presented with signs and/or symptoms of pharyngitis were monitored in a private pediatric practice. Clinical signs included fever (95 or 64%), tonsillar exudate (16 or 11%), and cervical adenopathy (5 or 3%). Beta-hemolytic streptococci (BHS) from group A were isolated from throat swabs in 37 (25%) instances. These isolations were more common among children 25-35 months old than among children less than 2 years old (35% vs. 19%, p < 0.05), and were significantly more likely when overnight anaerobic culture techniques were used rather than conventional aerobic methods (23 % vs. 11%, p < 0.01). Group A BHS may be isolated relatively frequently from symptomatic children under 3-years-old. Whether these isolations reflect invasive infection or asymptomatic carriage is uncertain.

Approach to the Management of Pediatric-Onset Anti-N-Methyl-d-Aspartate (Anti-NMDA) Receptor Encephalitis: A Case Series.

Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is a treatable cause of autoimmune encephalitis. It remains unclear if the natural history of this disease is altered by choice of acute therapy or the employment of chronic immunotherapy. Chart review was undertaken for pediatric patients diagnosed with anti-NMDA receptor encephalitis. Data obtained included patient demographics, disease manifestations, treatment course, and clinical outcomes. Ten patients with anti-NMDA receptor encephalitis were identified. All patients were treated with immunotherapy in the acute period, and all patients experienced good recovery. Neurologic relapse did not occur in any patient. All patients received varied forms of chronic immunosuppression to prevent relapses. Complications of chronic immunotherapy occurred in 50% of patients. The benefits of chronic immunotherapy and the duration of use should be carefully weighed against the risks. Complications from immunotherapy are not uncommon and can be serious. Clinical trials assessing the benefit of long-term immunotherapy in this population are needed.

Persistent Purulent Otitis Media

Of 429 children with acute otitis media who returned for follow-up evalu ation, 49 (11%) were unresponsive to a 10- to 14-day course of ampicillin, amoxicillin, or erythromycin/sulfisoxazole. Patients with persistent purulent otitis media were noted to have immobile, bulging, yellow or grey, abscessed tympanic membranes at the follow-up visit. A myringotomy was performed on 45 children. Cultures of middle-ear exudate yielded ampicillin-resistant Haemophilus influenzae in 14 (31%), ampicillin-susceptible pathogens ( H. in fiuenzae or Streptococcus pneumoniae) in 23 (51%), and no growth in 8 (18%).

Office myringotomy for acute otitis media: Its value in preventing middle ear effusion†

Middle ear effusion (MEE) as a residual of treated acute otitis media was found in 49% of 776 children studied. No antibiotic, singly or in combination, demonstrated superiority in reducing the incidence of MEE. Simple myringotomy, as a therapeutic modality in 415 children who presented with an acutely bulging painful eardrum, did not facilitate adequate drainage as 51% of such children, treated with simple myringotomy in addition to antibiotics, had MEE detected 10 days later. The incidence of MEE also occurred independently of the middle ear pathogen. Within six weeks, spontaneous resolution of the effusion occurred in 85% of the 382 children with MEE that was detected 10 days after acute otitis media.

Acute otitis media in children eight years old and older: A reappraisal of the role of Hemophilus influenzae

The bacteriology of acute otitis media in 18 children eight to 17 years of age was investigated through the use of culture of middle ear exudate obtained by tympanic membrane puncture. Equal numbers of children had either Hemophilus influenzae (six) or Streptococcus pneumoniae (six) in the middle ear exudate. Acute otitis media in children through adolescence should be treated with antibiotics known to be effective against H. influenzae.

Otitis Media with Effusion: Results of Treatment with a Short Course of Oral Prednisone or Intranasal Beclomethasone Aerosol

A short course of prednisone suspension given in a decreasing dosage schedule for up to ten days was often effective (68%) in resolving mucoid otitis media with effusion (OME, middle ear effusion). No significant side effects were noted. Concommitant administration of sulfisoxazole suspension may have reduced the likelihood of activation of a quiescent infection of the middle ear. During an eight-month mean follow-up period, reaccumulation of the effusion was detected in 21% of the successfully treated children. Preliminary results of an unrelated, pilot project using intranasal beclomethasone dipropionate aerosol suggests that this novel method also may be efficacious in the treatment of OME.

The bifid uvula: is it a marker for an otitis prone child?

All children seen by a pediatrician in a suburban practice during an 18‐month interval were examined carefully for the presence of an abnormal uvula. Isolated bifid uvula, without overt cleft palate, was detected among 44 children who had been followed in the practice during the first three years of life. A chart review was performed to determine the frequency of acute otitis media (AOM) and of insertion of tympanostomy tubes among these study patients and among age‐matched controls with normal uvulas. Compared to control children, a slightly higher proportion of children with bifid uvulas had experienced more than one episode of AOM (64% vs. 49%) and more than three episodes of AOM (16% vs. 8%) during the first year of life, but these differences were not statistically significant. By age 3 years, the incidences of AOM in the compared groups were more nearly equal. Insertion of tympanostomy tubes during the first three years of life for persistent middle ear effusion was slightly more common among the bifid uvula group than among the controls (14% vs. 10%), but this difference again was not statistically significant. Children with bifid uvula may be at slightly increased risk of middle ear problems during the first years of life, but the magnitude of this increase, if any, appears small.

Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric‐mental health training to nurse practitioners

BACKGROUNDnThere is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems.nnnPURPOSEnTo ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs.nnnMETHODSnA survey was sent to 151 CAP and DBP training directors in the United States.nnnRESULTSnThe return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded.nnnCONCLUSIONSnThere is support for advanced training for NPs, but funding is needed to make this a reality.nnnIMPLICATIONS FOR PRACTICEnExpansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents.Background nThere is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. n nPurpose nTo ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. n nMethods nA survey was sent to 151 CAP and DBP training directors in the United States. n nResults nThe return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. n nConclusions nThere is support for advanced training for NPs, but funding is needed to make this a reality. n nImplications for practice nExpansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents.