Practices of family physicians and pediatricians in administering poliovirus vaccine.

BACKGROUND: When the Advisory Committee on Immunization Practices added the sequential schedule to the poliovirus vaccine (PW) recommendations in 1997, primary care physicians expressed concern about its implementation. This study examines the practices and factors influencing the administration of sequential, oral, or inactivated PW schedules by family physicians and pediatricians. METHODS: A random sample of Ohio family physicians and pediatricians was surveyed between January and April 1998. Primary outcome measures included physicians' awareness of the 1997 recommendations, their recommendations to parents and caregivers, administration of current PW options, and the factors influencing their practices. RESULTS: All physicians who immunize children (n = 263) reported awareness of the 1997 PW recommendations. Family physicians were more likely to recommend and administer oral polio vaccine than pediatricians (50% and 63% vs 17% and 28%; P < .001). Pediatricians were more likely to recommend and administer the sequential schedule than family physicians (66% and 67% vs 31% and 28%; P < .001). Choice of sequential schedule was related to the risk of vaccine-associated paralytic poliomyelitis and liability (P < or = .05). Choice of an all oral polio vaccine schedule was related to cost of inactivated PW and increased number of injections (P < or = .05). One hundred eighty-two physicians (69%) indicated that they personally discuss PW options with parents or caregivers; only 41% have them read the required vaccine information sheets. CONCLUSIONS: Differences exist between family physicians' and pediatricians' implementation of the 1997 PW recommendations. Physician choice of PW schedule is influenced by the risk of vaccine-associated paralytic poliomyelitis, increased number of injections, liability concerns, and vaccine cost. Physicians need to inform parents of vaccine benefits and risks to comply with federal regulations.

Hypoglycemia in children with insulin-dependent diabetes mellitus.

The promotion of normal growth and development and the avoidance of acute and long-term complications are overall goals in the management of a child with insulin-dependent diabetes mellitus. Recent studies provide new and pertinent information about the acute effects of hypoglycemia on such cognitive functioning as learning, memory, reading, and visuospatial skills. The effects of early onset diabetes on school performance are also discussed. This information should be incorporated by diabetes educators into the educational plan for children with IDDM, their families, and schools.

Segmental cord atrophy. Unusual case report in an infant.

We describe an unusual case of paraplegia in infancy. Radiographs of the spine were unable to detect any anomalies. An MRI demonstrated segmental atrophy of the spinal cord.

Effect of a hypoglycemic episode on neuropsychological functioning in diabetic children.

The present study investigated neuropsychological functioning in school-age children at various points in time surrounding a hypoglycemic episode using 13 tasks drawn from age-appropriate, standard neuropsychological tests. The results demonstrate the effects of a hypoglycemic episode on neuropsychological functioning even after detectable physical symptoms have subsided. Although we are unable to delineate clearly their temporal course, it appears that the impact of such episodes is transient. In general, the pattern exhibited by these children who have presumably recovered from their mild hypoglycemic episode involved reduced motor performance, attention, and memory. The observed prolonged recovery time of these functions presents important implications for the child in both school and social settings.

Mental efficiency and hypoglycemia.

Cognitive functioning after a mild hypoglycemic episode (MHE) was studied in 24 school-age children with insulin-dependent diabetes mellitus (IDDM). All children were administered a battery of neuropsychological tests which included digit spans, trailmaking tasks, Klove Mathews Maze test, and finger-tapping and handwriting tasks. The experimental group (n = 14) consisted of children who were tested initially after resolution of hypoglycemic symptoms following a documented MHE (Chemstrip bG less than or equal to 60 mg/dl with symptoms). The comparative group (n = 10) consisted of children who were initially evaluated after documentation of euglycemia. Comparison of the comparative group scores with test scores of the experimental group after recovery from the MHE demonstrated statistically significant differences (p less than 0.05 by dependent t-tests) in five of 12 tasks. No differences were noted when second trial scores of both groups were compared when they were retested after documentation of euglycemia. This study suggests that a discrepancy exists between the recovery rate of physical symptoms and cognitive function in children following a MHE.

Self-treatment with antibiotics.

Two hundred seventy patients who presented with symptoms assumed to be infectious in origin were evaluated for self-treatment with antibiotics. Urine was tested for the presence of antimicrobials by agar diffusion assay using Bacillus subtilis as the test organism. Seventeen patients (6%) were found to have antibiotic activity in their urine, but only five admitted to self-medication. Age, sex, and duration of symptoms were unrelated to the incidence of self-medication. Self-medication was seen more frequently in patients presenting with upper respiratory infection symptoms (12%) when compared to other symptom complexes (P less than .002). This study suggests that self-medication with antibiotics can be an important problem in patients who present to emergency departments, as this practice could have an impact on clinical diagnosis and bacterial cultures.

Single dose amoxicillin treatment of acute otitis media.

A double blind study comparing a single dose of amoxicillin versus a 10-day course of amoxicillin in the treatment of acute otitis media (AOM) was undertaken. All children diagnosed with AOM in a pediatric clinic were requested to participate. After tympanocentesis was performed, patients were randomly assigned to receive either amoxicillin (100 mg/kg) followed by placebo every 8 hours for 10 days or placebo followed by amoxicillin (40 mg/kg/D) for 10 days. Patients returned to clinic on days 3 and 10 post-treatment. Seventeen patients were enrolled: 7 received single dose therapy and 10 received 10 days of therapy. There were no failures in the control group and 3 failures in the single dose group (day 5, day 6, and 11) (p = 0.05). Middle ear isolates included: S. pneumoniae 7, H. influenzae 4, B. catarrhalis 1, and no pathogen in 5. Due to the significant number of failures in the treatment group, the study was prematurely terminated.

Mucocutaneous lymph node syndrome mimicking acute coalescent mastoiditis.

Mucocutaneous lymph node syndrome (Kawasaki's disease) is an acute febrile, exanthomatous illness in which massive lymphadenopathy may occur in the cervical area. This lymphadenopathy may mimic other conditions and present a diagnostic dilemma. We present a case report of a child whose initial clinical signs, symptoms, and laboratory findings were compatible with acute coalescent mastoiditis; however, the child was found after close observation to have Kawasaki's disease. The case demonstrates the similarity between the two diseases and how close observation can prevent unnecessary surgery. When considering the rare diagnosis of mastoiditis, other entities need to be considered in the differential diagnosis before surgical intervention is undertaken. If the patient is unstable or a threatened complication of mastoiditis is apparent, however, immediate mastoidectomy is required.

Cardiopulmonary arrest due to misuse of viscous lidocaine.

A 30-month-old female infant had a cardiopulmonary arrest due to viscous lidocaine. The protective airway mechanisms were blunted by this drug, resulting in aspiration, hypoxia, seizures, and death. Lidocaine has also been associated with respiratory depression, psychosis, methemoglobinemia, and toxic cardiovascular reactions. We do not recommend the use of viscous lidocaine for minor oral irritation in infants and young children.

Sinus histiocytosis with massive lymphadenopathy: skeletal involvement.

A 9-year-old girl with known sinus histiocytosis with massive lymphadenopathy (SHML) has been followed since infancy. At age six, she developed swelling and pain in several joints. Subsequently, bone lesions were identified by scintigraphy and radiographs. Biopsy of the bone showed typical features of SHML. Bone lesions in this disease are rare. The lesions in this patient were followed for 3 years and remained unchanged despite chemotherapy.

Osteomyelitis of the great toe secondary to phlebotomy.

A premature infant developed Staphylococcus osteomyelitis secondary to multiple punctures of the great toe for drawing blood. The infection responded well to antibiotic therapy.