Treatment of Pediatric Obesity in Rural Settings: Identifying and Overcoming Barriers to Care.

The purpose of this study is to review the current data regarding implementing pediatric obesity treatment recommendations in rural areas. Data considering barriers to care, challenges as well as opportunities, including leveraging telemedicine, provider training, e-consults to improve pediatric obesity care are provided. Given the pediatric obesity prevalence, particularly in rural settings, a multipronged approach is needed to provide equitable access to vital care.

Hematuria in adolescents.

Hematuria is not a rare finding during adolescence. The high prevalence of microscopic hematuria is not surprising when one considers the vast number of ways in which RBC can end up in the urine. The adolescent presenting with gross hematuria, proteinuria, or microscopic hematuria in combination with other symptoms of genitourinary disease is more likely to require a therapeutic intervention than is the individual found incidentally to have microscopic hematuria.

Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome.

Most cases of diarrhoea-associated haemolytic uraemic syndrome (HUS) are caused by Shiga-toxin-producing bacteria; the pathophysiology differs from that of thrombotic thrombocytopenic purpura. Among Shiga-toxin-producing Escherichia coli (STEC), O157:H7 has the strongest association worldwide with HUS. Many different vehicles, in addition to the commonly suspected ground (minced) beef, can transmit this pathogen to people.

Antioxidant therapy in uremia: evidence-based medicine?

Because of correlations between cardiovascular disease, inflammation, and renal failure, many investigators are pursuing nontraditional risk factors and therapies in order to reduce cardiovascular morbidity and mortality in the end-stage renal disease (ESRD) population. Despite the disappointing lack of clinical effects with antioxidative therapies seen in large studies of the general population, some studies suggest a diminished cardiovascular risk in individuals with renal failure. This expanding new line of evidence is promising as a method to help alleviate the more than 20-fold increase in risk of cardiovascular events in the ESRD population.

Cardiac ischemia during hemolytic uremic syndrome.

Increased thrombin generation and impaired fibrinolysis during Escherichia coli O157:H7-associated hemolytic uremic syndrome (HUS) plausibly diminish myocardial blood flow, but the frequency of cardiac ischemia during HUS is unknown. We identified a 9-year-old boy with HUS in whom myocardial diastolic dysfunction was demonstrated by echocardiography, who also had elevated serum troponin-I and creatine kinase MB mass. However, eight additional patients with HUS did not have elevated markers of cardiac injury.