RESUMO
Lymphadenopathy is a common finding on physical examination in the pediatric population. Although it is often physiologic, lymphadenopathy can also be associated with more serious illnesses and has many possible etiologies. A broad differential diagnosis can be narrowed with a thorough clinical history, physical examination, laboratory studies, and imaging. The goal of this review is to provide a framework for understanding normal physiology, identify when enlarged lymph nodes may be associated with pathology, develop differential diagnoses associated with lymphadenopathy, and apply a systematic approach for diagnostics and appropriate management, with a focus on findings concerning for malignancy and the initial evaluation.
Assuntos
Linfadenopatia , Humanos , Diagnóstico Diferencial , Linfadenopatia/diagnóstico , Linfadenopatia/etiologia , Criança , Exame Físico , Linfonodos/patologiaRESUMO
Background: The "September epidemic" is a well-described phenomenon of increased pediatric asthma-related health care utilization from August to September each year. The coronavirus disease 2019 (COVID-19) pandemic has brought about significant changes in health care utilization, warranting an investigation into its impact on the September epidemic. Objective: Our aim was to identify the impact of COVID-19 in asthma-related health care utilization, specifically in the September epidemic. Methods: Our study involved a retrospective analysis of data from a Children's Hospital in New York City. We compared the change in asthma-related health care utilization during August and September 2020 with the average change in utilization during the same period in 2017-2019 and 2021-2022. Stratified analyses based on age and sex were conducted by using chi-square tests to determine variations in health care utilization. Results: During September 2020, there was a marked reduction in emergency department (ED) visits related to asthma, with only a 6% rise from the preceding month. This stands in contrast to the observed increases from 89% to 193% in the other years studied (P < .05 for all). This pattern was seen in both sexes and in children under 13 years old (P < .05). No significant variation was found for those older than 13 years (P > .05). Conclusions: Despite an overall reduction in health care utilization over the first year of the COVID-19 pandemic, the decline in ED visits related to asthma during the September epidemic was significantly more pronounced. These results suggest that there may be remediable risk factors contributing to the September epidemic that can be used to guide future interventions for managing pediatric asthma.