Integrating Household Water Treatment, Hand Washing, and Insecticide-Treated Bed Nets Into Pediatric HIV Care in Mombasa, Kenya: Impact on Diarrhea and Malaria Risk.

Introduction: In developing countries, HIV-infected children are at higher risk of morbidity and mortality from opportunistic infections than HIV-uninfected children. To address this problem, the Healthy Living Initiative (HLI) in Mombasa, Kenya distributed basic care packages (BCPs) containing improved water storage vessels, water treatment solution, soap, and insecticide-treated bed nets to prevent diarrhea and malaria in children, and had community health workers (CHWs) make bimonthly home visits to encourage adherence to HLI interventions and antiretroviral (ARV) medicine use.

Methods: To evaluate HLI, we enrolled 500 HIV-infected children from Bomu Hospital.

Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma.

OBJECT At presentation, children who have experienced abusive head trauma (AHT) often have subdural hemorrhage (SDH) that is acute, chronic, or both. Controversy exists whether the acute SDH associated with chronic SDH results from trauma or from spontaneous rebleeding. The authors compared the clinical presentations of children with AHT and acute SDH with those having acute and chronic SDH (acute/chronic SDH).

A Perplexing Case of Child Abuse: Oral Injuries in Abuse and Physician Reporting Responsibilities.

The following case presents a pediatric patient with an oral foreign body secondary to intentional injury. This patient had presented several previous times for medical care, first with thigh bruises, then mouth bleeding, and finally with the unusual finding of a sharp foreign body embedded in the tongue. This case illustrates the importance of considering physical abuse in the differential of orofacial injuries.

Three-Dimensional Computed Tomography Skull Reconstructions as an Aid to Child Abuse Evaluations.

Objectives: Skull fractures can be difficult to recognize on radiographs and axial computed tomography (CT) bone windows. Missed findings may delay abuse diagnosis. The role of three-dimensional (3-D) reconstructions in child abuse evaluations was retrospectively evaluated.

Additional injuries in young infants with concern for abuse and apparently isolated bruises.

Objective: To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.

Study Design: This was a prospectively planned secondary analysis of an observational study of children<10 years (120 months) of age evaluated for possible physical abuse by 20 US child abuse teams. This analysis included infants<6 months of age with apparently isolated bruising who underwent diagnostic testing for additional injuries or bleeding disorders.

Fractures in infants and toddlers with rickets.

Background: Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients.

Objective: To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets.

Pediatric tramadol ingestion resulting in seizurelike activity: a case series.

Tramadol has been reported to cause seizures in therapeutic dosing and in overdose. We present a series of 2 infants poisoned with tramadol, both presenting with abnormal neurologic findings: either seizures or seizurelike activity. Tramadol poisoning should be considered in the differential diagnosis of dystonia and seizures.

Older victims of sexual assault: an underrecognized population.

Objective: We performed this study to determine if sexual assault characteristics differ in women presenting for evaluation as women age.

Study Design: All females 20 years or older presenting after sexual assault to an urban emergency department during a nine year period underwent standardized evaluation. Analysis was performed by chi(2).

Pubic ramus radiolucencies in infants: the good, the bad, and the indeterminate.

Objective: The purpose of this study was to examine imaging findings that differentiate inflicted injuries from developmental variants of the superior pubic ramus in healthy and abused infants.

Conclusion: A superior pubic ramus fracture and a developmental variant can be difficult to differentiate radiographically. A smoothly marginated vertical radiolucency of the superior pubic ramus detected without other features suggesting infant abuse should not be interpreted as a fracture.

Cervical spinal cord injury in abused children.

Five infants and toddlers who sustained cervical spinal cord injury as the result of child abuse are described. Three cases are previously unreported. Diagnosis was complicated by coexistent brain injuries and their treatments, subtle and/or evolving paralysis, and central cord syndrome, in which arm function is diminished but leg function is preserved.

Oral surgical aspects of child abuse and neglect.

Oral trauma is a frequent manifestation of child abuse. Injuries to the oral hard and soft tissues are common in active children, but any oral injury in a young preambulatory infant should raise concern for abuse. Oral-facial trauma may be the primary presenting injury, or may accompany other severe inflicted injuries such as head injury, fractures, or abdominal trauma.

Perineal impalements in children: distinguishing accident from abuse.

Unlabelled: Perineal impalements are uncommon and potentially life-threatening injuries. Medical providers must evaluate the risk of child abuse in all cases of genital or anal trauma. Determination of abuse depends on medical assessment of the mechanism of injury and statements by the child and witnesses, and may require collaboration with police or child protection agencies for scene investigation.

Into hot water head first: distribution of intentional and unintentional immersion burns.

Introduction: Experience with several, previously unreported, intentional face-first immersion burns led us to evaluate the distribution of inflicted and unintentional immersion scald burns in a hospital series.

Setting: (1) Authors' clinical and legal practices; (2) Burn center at regional Level 1 trauma hospital.

Subjects: : (1) Case series of face-first, inflicted immersion burn victims; (2) Consecutive hospitalized scald burn victims younger than 5 years old, 1/3/1996 to 3/25/2000.

Legal outcomes of sexual assault.

Objective: The study was undertaken to better describe the assault characteristics and examination findings in sexual assault victims who pursue legal action.

Study Design: A case-control study of consecutive women older than 15 years who came to an urban hospital after sexual assault over a 32-month period was conducted. All the women underwent a standardized history and physical examination by a resident in obstetrics and gynecology.

Characteristics of sexual assault in women with a major psychiatric diagnosis.

Objective: In a previous study of women who had been sexually assaulted, we reported a 26% prevalence of a major psychiatric diagnosis. The purpose of this study was to better characterize sexual assaults in women with a major psychiatric diagnosis.

Study Design: All female patients >or=15 years old with a complaint of sexual assault underwent a standardized history and physical examination by an upper-level resident in obstetrics and gynecology.