Managing burnout with lifestyle medicine principles.

Burnout in health professionals gained attention during the COVID-19 pandemic. There have been numerous strategies in addressing this issue proving there is no one silver bullet to mitigate it. We need to find solutions for our health and for the benefit of patients to provide best care. Lifestyle medicine strategies have been proven to be beneficial in the management of Burnout.

Can the Ketogenic diet lead to Wernicke's encephalopathy?

BACKGROUND: Wernicke's encephalopathy (WE), a neurological disorder due to the deficiency of thiamine, is often underdiagnosed in the pediatric population. The classic triad of mental status changes, oculomotor abnormality, and ataxia is observed in only 16-21% of all pediatric presentations. Wernicke's is most often associated with alcohol dependence, but also malignancy, parenteral nutrition, and gastrointestinal (GI) malformations. The correlation between following a Ketogenic diet and acquiring Wernicke's, however, has not previously been reported. CASE REPORT: A 16-year-old previously healthy male presented with an eleven-day history of neurological deficits and GI upset. The patient had recently lost one hundred pounds while following a "ketogenic" diet. He was subsequently diagnosed with Wernicke's, received intravenous thiamine, and was transferred to the inpatient rehabilitation, where he received extensive diet education. After making significant functional improvement, he was discharged home. RELEVANCE: This case illustrates the importance of including Wernicke's in the differential diagnosis when a pediatric patient presents with neurological deficits after rapid weight loss. Wernicke's encephalopathy may be fatal in the pediatric population, therefore, it must be treated immediately if clinically suspected. Children presenting with Wernicke's would benefit from early intervention, intensive inpatient rehabilitation, and comprehensive education regarding the role of food and exercise on weight loss and health.

Pediatric intrathecal baclofen management during the COVID-19 pandemic in the US and Canada.

The COVID-19 pandemic has been a challenge to healthcare systems around the world. Within pediatric rehabilitation medicine, management of intrathecal baclofen has been particularly challenging. This editorial reviews how programs in the US and Canada coped with the quickly changing healthcare environment and how we can learn from this pandemic to be prepared for future crises.

Drug reaction with eosinophilia and systemic symptoms in a child with N-methyl-d-aspartate receptor encephalitis.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening disorder that can be seen as a side effect of commonly used medications, particularly those in the anti-epileptic classes. Described here is a 10-year-old boy with newly diagnosed N-methyl-d-aspartate receptor encephalitis who presented for inpatient rehabilitation and developed a sudden-onset rash with coagulopathy. Cessation of the offending agents resulted in resolution of the symptoms.

Anterior spinal cord syndrome of unknown etiology.

A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome.

Patient safety in the rehabilitation of children with traumatic brain injury and cerebral palsy.

With the advent of newer and better therapies available, patient safety is emerging as a new topic. Pediatric patient safety is relatively new, in that there are few guidelines available. Safety in children with traumatic brain injury (TBI) given the incidence of TBI is very vital. This is an attempt to identify the key points in TBI.

Cardiac rehabilitation after heart transplantation in a patient with Becker's muscular dystrophy: a case report.

Becker's muscular dystrophy (BMD) is associated with abnormal cardiac findings in 75% of cases; up to one third will develop ventricular dilatation leading to congestive heart failure, at times necessitating cardiac transplant. Candidates are selected from a base of heart failure patients who are usually New York Heart Association (NYHA) class III or IV. Treatment in a phase II cardiac rehabilitation program after transplantation is associated with functional improvement in patients without BMD, but there are no reports of patients with this disorder. We present the case of a 38-year-old man diagnosed with BMD with associated dilated cardiomyopathy. The patient was a NYHA class IIIa and underwent orthotopic cardiac transplantation for intractable heart failure followed by treatment in a phase II cardiac rehabilitation program. At the end of cardiac rehabilitation, his 12-minute walking distance had improved from 716.28 to 929.64 m (30% improvement), he had increased his conditioning metabolic equivalent level from 3.5 to 5.5 (55% improvement), he had a weight loss from 81.65 to 78.93 kg, and his body mass index changed from 23 to 22 kg/m2. The patient now has returned to work, is using a stationary bicycle once a day for 30 minutes, and is walking 1 hour a day. This suggests that treatment in a cardiac rehabilitation program is effective in patients with BMD after cardiac transplant.

Rehabilitation of a child with a spinal cord injury.

The incidence and sex distribution of spinal cord injury (SCI) changes with age. Motor vehicle accidents, bicycle accidents, sports accidents, and violence are major causes in the pediatric population. Pulmonary complications may be severe and life-threatening in the acute phase. Chronically, the degree of ventilatory support needed depends on the level of the injury, with high cervical injuries typically requiring life-long ventilatory support. Deep venous thrombosis, autonomic dysreflexia, hypercalcemia, heterotopic ossification, spasticity, neurogenic bowel and bladder, scoliosis, and pain all may be secondary to SCI. Numerous orthotic aids are available for rehabilitation. An integrated rehabilitation program may also include spasticity management, a bowel and bladder program, and other features geared to the individual patient.