Nicotine Dependence: Diagnosis, Chemistry, And
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Nicotine Dependence: Diagnosis, Chemistry, and Pharmacologic Treatments - Miller and (ocorcs Giardiasis - Seidel ii’ Pediatrics in Review Vol 14 No 7 July 1993 EDITOR Robert J. Haggerty Univ&s14’ of Rochester School of Medicine and Dentistiy Rochester, NY Editorial Office: Department of Pediatrics University of Rochester CONTENTS School of Medicine and Dentistr 601 Elmwood Aye, Box 777 Rochester, NY 14642 ASSOCIATE EDITOR ARTICLES Lawrence F. Nazanan Panorama Pediatric Group Rochester, NY 251 Is It Bacterial or Viral? Laboratory Differentiation ABSTRACTS EDITOR James C. Overall, Jr Steven P. Shelov, Bronx, NY MANAGING EDITOR 262 Consultation with the Specialist: Jo Largent, Elk Grove Village, IL Sepsis in the Newborn EDITORIAL CONSULTANT Victor C. Vaughan, III, Stanford, CA Ronald L. Poland and Kristi L. Watterberg EDITORIAL BOARD Moris A. Angulo, Mineola, NY 265 The Pediatrician’s Role in Infant Feeding Decision- Russell W. Chesney, Memphis, TN Making Cathenne DeAngelis, Baltimore, MD Peggy C. Ferry, Tucson, AZ Ruth A. Lawrence Richard B. Goldbloom, Halifax, NS John L Green, Rochester, NY 273 The Acute Management of Paroxysmal Robert L Johnson, Newark, NJ Jan M. Lake, Glen Arm, MD Supraventricular Tachycardia in Children Frederick H. Lovejoy, Jr, Boston, MA John T. McBnde, Rochester, NY Lars C. Erickcon and Mark W. Cocalis Vincent J. Menna, Doylestown, PA Lawrence C. Pakula, Timonium, MD 275 Nicotine Dependence: Diagnosis, Chemistry, and Ronald L Poland, Hershey, PA James E. Rasmussen, Mn Arbor, MI Pharmacologic Treatments James S. Seidel, Torrance, CA Norman S. Miller and James A. Cocores Richard H. Sills, Newark, NJ Laurie J. Smith, Washington, DC Wdliam B. Strong, Augusta, GA 281 Index of Suspicion Jon Tingelstad, Greenville, NC Bradley J. Bradford, Hany S. Miller, Walter L. Gilbert Vernon T.. Tolo, Los Angeles, CA Robert J. Touloukian, New Haven, CT 284 Giardiasis Terry Yamauchi, Little Rock, AR Moritz M. Ziegler, Cincinnati, OH James Seidel EDITORIAL ASSISTANT Sydney Sutherland PUBUSHER ABSTRACTS American Academy of Pediatrics Errol R. Alden, Director, Department of Education Jean Dow, Director 263 Atypical Tuberculosis Division of PREP/PEDIATRICS Deborah Kuhlman, Copy Editor 264 Cough Medicines: When Should They Be Prescribed? PEDIATRICS IN REVIEW (ISSN 0191-9601) is owned and controlled by the American Academy 272 New Manifestations of Rheumatic Fever of Pediatrics. It is published monthly by the American Academy of Pediatrics, 141 Northwest Point BIvd, P0 Box 927, Elk Grove Village, IL 280 Rabies 60009-0927. Statements and opons expressed m Pediatrics 286 Infant Walkers in Review are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees. Recommendations included in this publication do not indicate an exdusive course of treatment or serve as a standard of medical care. Subscription price for 1993: AAP Fellow $95; COVER MP Candidate Fellow $70; MFP $115; Allied Health or Resident $70; Nonmember or Institution “Sara Handing a Toy to the Baby” was painted by Mary Cassatt (1845 - $125. Current single price is $10. Subscription 1925). Cassatt, an American artist, was the daughter of a wealthy daims will be honored up to 12 months from the Philadelphia businessman. She went to Pans to study and never returned. publication date. Second-class postage paid at ARLINGTON Most of her paintings are of mothers and children, although she herself HEIGHTS, IWNOIS 60009’0927 and at additional never married. This lovely painting shows an older sibling handing a toy to mailing offices. her younger brother. We all know that sibling relations are never this CAMERICAN ACADEMY OF PEDIATRICS, 1993. All rights reserved. Printed in USA. No part serene at all times, but we can always eiicourage the sharing and love so may be duplicated or reproduced without beautifully shown here. (This painting is reproduced with the permission of permission of the American Academy of Pediatrics. the Hill-Stead Museum, Farmington, CT). POSTMASTER: Send address changes to PEDIATRICS IN REVIEW, American Academy of Pediatrics, P0 Box 927, Elk Grove Village, IL ANSWER KEY 60009-0927. The printing and production 1. C; 2. D; 3. D; 4. C; 5. E; 6. D; 7. C; 8. E; 9. D; 10. B; 11. A; 12. E; of Pediatrics in Review is 13. A; 14. E; 15. E; 16. B; 17. D; 18. E; 19. D; 20. D; 21. B; 22. A; 23. C; made possible, in part, by iRO8Si 24. B an educational grant from T Ross Laboratories. ucATIoNj Printed in the USA INFECTIOUS DISEASE Laboratory Diagnosis Shulman ST. Streptococcal phaiyngitis: LIiII IIIIiIIiiIIIIIiIi iIIIIiiIEi clinical and epidemiologic factors. Pediatr Infect Dis J. 1989;8:816-819 RUBELLA HI TITERS (I9G) Todd JK. The sore throat: pharyngitis and SERUM MOTHER BABY MOTHER BABY epiglottitis. Inftct Dis Clin North Am. 1988;2:149-162 At exposure 128 - <8 - Turner RB, Lande AE, Chase P, Hilton N, At birth 128 256 1024 1024 Weinberg D. Pneumonia in pediatric 6 months 256 <8 1024 2048 outpatients:cause and clinical manifestations.J Pediatr. 1987;1 11:194- postpartum 200 Comment Passive transfer Congenital Wildin S, Chonmaitree T. The importance of the virology laboratory in the diagnosis and of antibody rubella management of viral meningitis. Am I Dis No congenital Child. 1987;141:454-457 rubella Yogev R. Advances in diagnosis and treatment of childhood meningitis. Pediatr Infect Dis I. 1985;4:321-325 PIR QUIZ 1 . A true statement regarding labora- 3. A tnie statement regarding the use C. Mycoplasma pneumoniae and tory techniques useful for diagnos- of antibody titers for viral diagnosis CIZIamydJa pneumoniae are the ing bacterial pneumonia is: is: two organisms most likely to be A. Accurate diagnosis of chlamy- A. Currently, there is no serologic the cause of a nonconsolidated dial infections requires that pu. test to diagnose parvovirus B19 right lower lobe infiltrate in an rulent material be obtained. infection. acutely ill 15-year-old boy. B. Chiamydia pnewnoniae infec- B. Given the sensitivity of current D. Testing for Chiamydia pneumo- tions are best diagnosed by rapid methods, serodiagnosis is no niae is essential for proper diag- antigen detection methods. longer fully dependent on the nosis of pneumonia in a 2- C. Rapid antigen detection methods immune competence of the host. month-old infant who does not for diagnosing Chlamydia tra- C. Specific Epstein Barr virus anti- have a fever. chomatis infections are at least body tests are most useful in E. Viral cultures are likely to alter as sensitive as culture. children less than 5 years of age. the therapy of a 2-month-old D. Serologic techniques are less re- D. The time required to diagnose child who has pneumonia with liable than culture for diagnosing arboviral infection makes the pleural effusion. Mycoplasma pnewnoniae infec- technique less valuable for the 5. A true statement regarding the diag- tion. individual patient, but may pro- nosis of perinatal infections is: E. Urine antigen detection tech. vide useful epidemiologic infor- A. An elevated cord blood level of niques for Haemophilus influen- mation. virus-specific serum IgO is diag- we are especially helpful E. A virus-specific immunoglobulin nostic of congenital infection. because of high specificity. o (IgO) test is more likely to in- B. For best results, specimens for fluence the diagnosis of acute in- 2. Of the following viruses, the one for viral culture should be frozen in fection than is a virus-specific which antibody titer is the preferred a regular freezer before trans- 1gM test. method of diagnosis is: port. A. Cytomegalovirus 4. A true statement regarding the diag- C. Human immunodeficiency virus B. Enterovirus nosis of pediatric pneumonia syn- infection characteristically mani- C. Herpes simplex virus dromes is: feats clinical findings shortly D. Human herpesvirus type 6 A. Bacterial culture of nasopharyn- after birth. E. Respiratory adenovirus geal secretions in a 2-year-old D. Immunoglobulin 0 (IgO) titers girl who has lobar consolidation are important for the rapid diag- is likely to provide useful diag- nosis of acute perinatal viral nostic information. disease. B. Collection of nasophatyngeal se- E. In an acutely ill neonate who has cretions for viral antigen detec- both pneumonia and hepatitis, tion and culture is inappropriate the differential diagnosis should in a febrile 2-month-old infant include herpes simplex virus and who has pneumonia and severe enterovirus infection. respiratory distress. Pediatrics in Review VoL 14 No. 7 July 1993 261 riiii. T11 ABSTRACT Serious symptoms of failure to New Manifestations of Rheumatic Fever thrive, with few stools and infrequent voidings, deserve a full evaluation. The Resurgence of Acute Rheumatic Fever 3) fever, 4) an elevated erythrocyte in the United States. Congeni BL. Pediatr sedimentation rate, 5) a positive C- SUGGESTED READING Ann. 1992;21:816-820 Committee on Drugs, American Academy of Acute Rheumatic Fever in Western reactive protein, 6) leukocytosis, and Pediatrics. Transfer of drugs and other Pennsylvania: A Persistent Problem into 7) a prolonged PR interval or other chemicals into human milk. Pediatrics. the 1990s. Zangwill KM. Wald ER, electrocardiographic changes. Either 1989;924-936 Londino AV Jr. JPediatr. 1991;118:501- two major criteria on one major and Huggins K. The Nursing Mother’s Companion. 503 two minor criteria are required to Revised Edition. Boston, MA: The Harvard A resurgence of acute rheumatic Common Press; 1990 make the diagnosis of ARF in the Lawrence RA. Breastfeeding: A Guide for the fever (ARF) occurred in the mid- presence of supporting evidence of a Medical Profession. 3rd ed. St. Louis, MO: 1980s, as evidenced by several preceding streptococcal infection (eg, CV Mosby; 1989 reports of outbreaks in various elevated titer of antistreptococcal regions of the United States. Around antibodies, positive throat culture for the same period, some reports GABHS, or recent scarlet fever). described a dramatic increase in the Canditis and arthritis remain the PIR QUIZ virulence of Group A Beta-hemolytic most commonly encountered clinical 6.