Pediatrics
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Comparative Study
Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents.
Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus. ⋯ Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, beta-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux-en-Y gastric bypass is not known, these findings suggest that Roux-en-Y gastric bypass is an effective option for the treatment of extremely obese adolescents with type 2 diabetes mellitus.
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Comparative Study
Attention-deficit/hyperactivity disorder: how much responsibility are pediatricians taking?
Attention-deficit/hyperactivity disorder, the most common childhood behavioral condition, is one that pediatricians think they should identify and treat/manage. ⋯ Taking responsibility for treating attention-deficit/hyperactivity disorder and practice characteristics seem to be important correlates of pediatrician self-reported behavior toward caring for children with attention-deficit/hyperactivity disorder.
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Oral rehydration therapy is underused by physicians treating children with acute infectious enteritis. To guide management, we hypothesized that clinical variables available at the initial assessment could be identified that will predict the need for intravenous fluid administration. ⋯ Among children with enteritis and mild-to-moderate dehydration, the presence of large urine ketones or an altered mental status is associated with intravenous rehydration after a 60-minute oral rehydration therapy period. Caution should be exercised before discharging children with either tachycardia or a history of significant vomiting before presentation, because they are more likely to require future emergency department care.
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Comparative Study
Trends in the diagnosis of overweight and obesity in children and adolescents: 1999-2007.
Pediatric overweight and obesity are increasingly prevalent problems and have received much attention in recent years, but it is unclear whether this publicity has affected diagnosis by clinicians. We undertook the current study to assess trends in diagnosis rates of overweight and obesity in children. ⋯ Although clear BMI definitions of pediatric weight problems exist, a large percentage of overweight and obese patients remain undiagnosed. Diagnosis increased during the study period but remained low among overweight children, for whom early intervention may be more effective. Identification of overweight and obese patients is the first step in addressing this growing epidemic.