Constipation is very common phenomenon during childhood that accounts approximately 3% of general pediatric outpatient visits and up to 25% of visit to the pediatric gastroenterologist. The diagnosis of functional constipation is based on the historical features and absence of physical abnormalities. Most infants and children with chronic constipation require no diagnostic tests. Constipation and subsequent fecal retention behavior often... |
Headache is a common complaint in pediatric office practices as well as in children presenting to emergency departments. Children who complain of headache usually are brought to medical attention by their parents, who seek reassurance that the headaches are not a sign of a serious illness. The etiologies of headache range from school problems to brain tumors. A history taking,... |
Atopy is a highly prevalent and serious health problem. The prevalence and severity of asthma and allergic diseases have increased over recent decades, particularly in industrialized nations. Early life infections may protect against the development of atopy and allergic diseases like asthma. The inverse relationship between the incidence of atopy and childhood infections has led to the 'hygiene hypothesis', which... |
Acute diarrhea is one of the most common diseases that are seen in pediatric patients. In the management of acute diarrhea, several differential diagnostic criteria should be considered based on clinical and/or laboratory findings. These criteria include : ① normal variant stool versus diarrhea ② infectious versus non-infectious condition and ③ bacterial versus non-bacterial etiology. The use of antibiotics should... |
New insights in the complex metabolic pathways and its control mechanism for energy homeostasis have refined our understanding of the pathophysiology of obesity. It is now recognized that there are several additional regulatory mechanism such as peripheral signals including leptin, ghrelin, GLP-1 and PYY and cellular signals including uncoupling proteins and β Adrenergic receptors, which contribute to the regulation of... |
Anemia can be defined as a reduction in blood hemoglobin concentration or red cell mass relative to age matched normal values. Clinical presentation may range from obviously pale and lethargy to an incidental finding during screening of an otherwise well appearing child. The differential diagnosis of anemia in each instance is broad with numerous possible etiologies. A careful history and... |
In the last few years, a spectrum of dendritic cells(DCs), including toll like receptors(TLRs), might play a critical role in regulating allergy and asthma. DC plays a central role in initiating immune responses, linking innate and adaptive responses to pathogen. Human peripheral blood has three non- overlapping dendritic subset that expressed various 11 TLRs. These dendritic subsets and TLR contribute... |
Pediatricians often encounter some electrocardiographic abnormalities in infants and children. However, treatment or referral to pediatric cardiologist is not indicated for all arrhythmias. Many of them are benign in nature. Benign arrhythmias can be defined as the arrhythmias that no serious problem currently exists and no treatment is needed. The prognosis of benign arrhythmias is so good that the condition... |
Childhood immune thrombocytopenic purpura(ITP) is a typically benign self-limiting bleeding disorder of not fully known autoimmune etiology. Chronic ITP, which is defined by duration of more than 6 months, occurs in approximately 20% of children. Neither the risk of bleeding nor the type of disease, acute or chronic, can be predicted at initial presentation. The indication of treatment, choice... |
The detection of even microscopic amounts of blood in a child's urine, whether accompanied by symptoms or asymptomatic, alarms the patient, parents, and physician, and often prompts the performance of many laboratory studies. Hematuria is one of the most important signs of renal or bladder disease, but proteinuria is a more important diagnostic and prognostic finding, except in the case... |
The children should not be regarded as miniature adults since they are in the dynamic process of growth and development. Among many pediatric problems, the developmental delay may be central to them. For this reason, primary care physicians, especially pediatricians should be able to manage children with probable developmental delays because early detection and treatment of developmental delay or neurological... |
Mast cells play a key role in elicitation of the early-phase and late-phase IgE-mediated allergic inflammatory reactions. Mast cells are derived from pluripotent stem cells from the bone marrow. These cells migrate through circulation into connective tissues and mucosal surfaces where they mature. On the cell surfaces, mast cells have high affinity IgE receptor(FcεRI), which react with specific IgE to... |
This review deals with the coagulation deficiencies which are due to the abnormality in one of three hemostatic systems. It explains about the diagnostic examinations that should be done to differentiate for patients with bleeding tendency and the things to consider when preoperative screening tests for coagulation are abnormal. |
Lung development is a sum of processes that involve harmonized orchestration of expressions of various factors in time and space. The mastermind governing these phenomena is not known, but cumulative efforts so far have helped us gain some insights as to what are involved in and how complex the developmental process is. Beginning as primitive foregut, lungs undergo processes called... |
Thyroid hormones influence growth and development, oxygen consumption, heat production, nerve function, and metabolism, thus play a critical role as a regulator of nervous system myelination, of growth and of puberty. Disorders affecting thyroid function may cause irreversible and permanent nervous system damage and developmental delay, especially in early infancy. Appropriate medical care of children with thyroid disorders requires refined... |
Allogeneic organ or hematopoietic stem cell transplantation(HSCT) is the treatment of choice for end-stage organ diseases or various hematologic disorders. The induction of alloantigen specific T cell tolerance and its maintenance are critical for preventing immune responses, including graft rejection or graft-versus-host disease(GVHD) in allogeneic transplantation. CD4+ T cells are classified as immune functions : Th1 CD4+ cells for cellular... |
Epilepsy is one of the most common and disabling neurologic disorders in childhood. The primary goal of epilepsy treatment is to choose the treatment modality that provides the best chance of improving the patient's quality of life. In addition to classic antiepileptic drugs, newly developed antiepileptic drugs ketogenic diet, epilepsy surgery, and vagal nerve stimulation have improved the ability to... |
The generation of a draft sequence of the human genome has lead to an opportunity to characterize human diversity, including the differences in host response to numerous pathogens. Host responses upon exposure to a pathogen can determine the wide spectrum of illness from subclinical or mild to severe diseases. Host factors, particularly genetic backgrounds, influence the pathogenesis of infectious diseases.... |
Concerning our medical history, the importance of medical terms has been neglected for a long time. In addition, medical terminologies are unaccustomed to the patients including the public. The separation of communications between the public and medical participants has been enlarged more and more. The importance of terms which can be easily recognized, comfortable to the ear, and familiar to... |
Persistent pulmonary hypertension of the newborn(PPHN) is a disorder characterized by persistence of the pattern of fetal circulation after birth due to a sustained elevation of pulmonary vascular resistance. The two primary events in the pathophysiology of neonatal pulmonary hypertension are hypoxic pulmonary vasoconstriction(HPV) and hypoxic pulmonary vascular remodeling(HPR). Chronic hypoxemia may cause increased muscularity of the pulmonary arteries and... |
The immature brain differs from the adult brain in its susceptibility to seizures, seizure characteristics, and responses to antiepileptic drugs. Gamma(γ)-aminobutyric acid(GABA) is the predominant inhibitory neurotransmitter in the adult brain. GABA exerts its main action through GABAA receptors, which are coupled to a ligand-gated chloride channel. The receptor protein is a pentameric structure composed of multiple subunits of different... |
A primary cardiac arrest is rare in children. The usual course begins with respiratory arrest and culminates in profound bradycardia or asystole and cardiovascular collapse, so it is vitally important to quickly restore ventilation in pediatric patients(phone-fast). Children over 8 years of age follow the same sequence as adults; that is calling emergency medical services before providing rescue breathing(phone-first). |
Renal tubule and vasa recta are arranged in complex but specific anatomic relationships and the production of a concentrated urine is achieved by countercurrent multiplication mechanism in the renal medulla. This model requires that the ascending thin limb is highly permeable to NaCl but impermeable to water, while the descending thin limb is impermeable to NaCl but highly permeable to... |
Primary immunodeficiency diseases result from innate defects of immune system. As a consequence, recurrent viral, bactrial, fungal, and protozoal infections of varying severity ensue. Although primary immunodeficiency diseases are relatively rare, intensive study of these disorder has expanded our understanding of immunity. Recent progress in immunobiology and genetics has identified the causes of many of the primary immunodeficiency diseases. Diagnosis... |
Failure to thrive is a term used to describe growth failure in infants and young children that may be accompanied by retarded social and motor achievements. The three categories of failure to thrive is based on anthropometric measurements of weight, length, and head circumference for age. Type 1 category, inadequate growth or loss of body weight with relatively normal height... |
Cognition is a broad term that include a range of abilities such as memory, perception, attention, organization, planning, problem solving abilities and the perception of another person's unconscious motivation. Cognitive dysfunction is an abnormality of the central nervous system, manifest during the developmental period, which result significant life long impairment. The neurologic assessment of the delayed or retarded child emphasizes... |
Food allergy is one of the clinical clusters due to food-induced allergic inflammation against dietary proteins which induced by IgE-mediated and/or non-IgE mediated mechanisms. Food allergic reactions are responsible for a variety of clinical symptoms involving the skin, gastrointestinal tract, and respiratory tract. Sometimes the life threatening anaphylactic reactions would be induced, especially by peanuts, tree nuts and buckwheat allergy.... |
Helicobacter pylori(H. pylori) infection is mainly acquired in childhood. The prevalence of infection is still highest in children in the developing world. There has been a need for clinical guidelines for H. pylori infection in children. Therefore, the North American Society for Pediatric Gastroenterology and Nutrition and the European Paediatric Task Force on H. pylori achieved consensus and developed clinical... |
Despite the 5-10% prevalence of developmental disability, the early identification for such problems remains difficult. Pediatricians tried to diagnose developmental delay early to promote early intervention and thus to reduce long-term disability in these patients. Identification of a delayed young child by routine pediatric screening mandates a careful search for an underlying etiology. Accurate etiologic determination, despite the fact that... |
Perinatal hepatitis B virus(HBV) infection may occur despite combined immunoprophylaxis with hepatitis B immunoglobulin and vaccines. Although the mechanism of perinatal prophylaxis still has been obscure, it could be due to : in utero infection; host factors as the personal immunological differences of HLA or cytokine gene; viral factors as a high maternal HBV-DNA level or the presence of surface... |