Pediatrics
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Subtle neuropsychological deficits have been found in some children with type 1 diabetes. However, these data have been inconsistent, and it is not clear what the impact of these deficits might be on the learning of children with diabetes over time. The purpose of this study was to determine whether type 1 diabetes significantly interferes with the development of functional academic skills. It was hypothesized that 1) children with type 1 diabetes would demonstrate deficits in academic performance and behavior when compared with sibling or classmate control subjects and 2) that academic performance in children with type 1 diabetes would decline slightly but significantly over time whereas the performance of siblings or classmates would not. ⋯ For most children, type 1 diabetes is not associated with lower academic performance compared with either siblings or classmates, although increased behavioral concerns are reported by parents. The results of this study suggest that the subtle cognitive deficits often documented in children with type 1 diabetes may not significantly limit the functional academic abilities of these children over time. However, careful monitoring is still needed to ensure that episodes of hypoglycemia associated with seizures are not adversely affecting learning.
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Comparative Study
Does Abciximab enhance regression of coronary aneurysms resulting from Kawasaki disease?
Acute Kawasaki disease can result in the development of large coronary artery aneurysms that may persist. Abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, is associated with resolution of thrombi and vascular remodeling in adults with acute coronary syndromes. The purpose of this study was to compare changes in aneurysm diameter at early follow-up in patients who had Kawasaki disease and received abciximab in addition to standard therapy with those who were treated with standard therapy alone. ⋯ Patients who were treated with abciximab demonstrated greater regression in aneurysm diameter at early follow-up than patients who received standard therapy alone. These findings suggest that treatment with abciximab may promote vascular remodeling in this population and warrants further study.
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Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. ⋯ The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.