Ovarian vein thrombus in a pediatric patient: A case study.

Acute abdominal pain is a very common chief complaint in the pediatric population, accounting for 5-10% of emergency department (ED) visits. Etiology differentiation is determined by complete history and physical examination, basic laboratory studies, and a variety of imaging study options. In this case report, we present an 8-year-old female with an unusual etiology of acute lower abdominal pain. She presented with tachycardia, hypertension, and bilateral lower quadrant abdominal tenderness without peritonitis. Laboratory studies were unremarkable and appendix ultrasound was indeterminate. CT with contrast revealed right ovarian vein thrombosis. Hematology evaluation did not reveal hypercoagulability. She was discharged on rivaroxaban, which was discontinued after a 3 month course and negative follow-up MRI. Ovarian vein thrombosis (OVT) most commonly develops in the peripartum time frame, with an estimated 20%-40% of cases not related to pregnancies. However, patients with nonpregnancy related OVT were determined to be significantly older than patients with pregnancy related OVT. This case report demonstrates the youngest documented case of OVT. This patient was not in the peripartum period and did not have any identifiable risk factors. Given this unprovoked OVT in a pediatric patient, in patients presenting with abdominal pain with unspecified etiology, advanced imaging studies may be helpful in establishing a diagnosis.

Bottle mix-up: Ethanol intoxication in an infant.

Alcohol intoxication is a common ingestion in pediatrics with close to 10,000 reports to poison control centers annually. Hypoglycemia, neurological depression (ataxia, coma, nystagmus, etc.) and unstable vitals (hypothermia, hypotension, bradycardia, and respiratory depression) are common presentations. The patient is a 3 month old female who was brought into the Emergency Department (ED) for one day of decreased oral intake and inconsolability. Vital signs were reassuring. Physical exam revealed gaze preference to the right with inability to look left, dysconjugate gaze, and hypotonia. Work-up including CT of the head, and urinalysis was unremarkable. Urine drug screen was found to be positive for ethanol with follow up serum ethanol at 162 mg/dL. With conservative management the patient returned to her baseline. On follow-up with her pediatrician, it was elicited that the mother inadvertently used a water bottle of vodka to mix the patient's formula. This case adds to the paucity of literature of abnormal presentations of alcohol intoxication in an infant.

Classic Presentation of Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report.

Syncope is a common reason for children and adolescents to seek care in the emergency department. Often syncopal episodes are benign and most commonly due to a vasovagal event. Occasionally an underlying cardiac arrhythmia is responsible. We present a case report of a 17-year-old male who collapsed during an emotional event and went into cardiac arrest. Emergency department evaluation including imaging, laboratory studies, and EKG indicated the cause of cardiac arrest was likely a primary cardiac arrhythmia. An initial clinical diagnosis of catecholaminergic polymorphic ventricular tachycardia (CPVT) was made based on symptom onset during an emotional event, family history of sudden cardiac death, patient age, past episodes of chest pain and palpitations, absence of structural heart defect, and lack of EKG changes after the return of spontaneous circulation (ROSC). The diagnosis was later confirmed with genetic testing. The patient was started on a beta-blocker and a subcutaneous implantable cardioverter-defibrillator (S-ICD, Boston Scientific, Marlborough, MA) was placed. Given the rarity of this condition, this diagnosis is often missed, which contributes to increased mortality rates. In children and young adults presenting with syncope without clear etiology in the presence of high-risk features, further evaluation should be performed including referral to cardiology to rule out chronic cardiac arrhythmias.

The association between morning cortisol and adiposity in children varies by weight status.

OBJECTIVE: To examine the associations between morning cortisol and adiposity in children at baseline and 9-month follow-up. METHODS: Participants included 649 (301 males, 348 females) children (9.6 +/- 0.9 years) for the cross-sectional analysis and 316 (153 males, 163 females) for the longitudinal analysis. Body mass index (BMI, kg/m2) was calculated from measured height and weight and waist circumference (WC, cm) was measured at the superior border of the iliac crest. Cortisol was assessed via saliva samples collected on a single morning. Cross-sectional and longitudinal analyses were conducted to examine the relationships between cortisol and adiposity. RESULTS: Approximately 31% were overweight (17.7%) or obese (12.8%). The mean cortisol level was 9.36 +/- 5.64 nmol/L (0.34 +/- 0.20 microg/dL). At baseline, no significant correlations were found between cortisol and BMI or WC (r < 0.07). Baseline cortisol did not correlate with change in BMI z-score (r = -0.03) or WC (r < -0.01) over the follow-up period. When examined by weight status, baseline cortisol was significantly related to changes in WC (r = 0.32) and BMI z-score (r = 0.28) among overweight subjects. CONCLUSIONS: A positive relationship was found between morning cortisol and change in WC over 9 months in overweight children. Future studies should examine the association between 24-h cortisol patterns and direct measures of trunk fat.

Morning cortisol is not associated with truncal fatness or resting blood pressure in children: cross-sectional and 1-2 year follow-up analyses.

OBJECTIVE: To evaluate the cross-sectional and longitudinal relationships of morning cortisol with trunk fat and resting blood pressure (BP) in children. METHODS: Participants included 72 children aged 4-10 years (mean 7.4 yrs) for the cross-sectional analysis and 58 for the longitudinal analysis. Height, weight, waist circumference, body fat by dual x-ray absorptiometry, and resting BP measures were obtained during a laboratory visit. Saliva samples were collected at home on a single morning and assayed for cortisol. RESULTS: Approximately 21% were overweight (15.3%) or obese (5.6%). Mean morning cortisol was 0.25 +/- 0.12 microg/dL (6.99 +/- 3.46 nmol/L). There were no significant correlations between morning cortisol and any of the measures of fatness (r < -0.17) or BP (r < -0.10) at baseline. Cortisol at baseline was not associated with changes in body size parameters after the 1- and 2-year followup period. CONCLUSION: Morning cortisol was not associated with body fatness or BP. Future studies should examine the associations between the diurnal cortisol patterns, trunk fat, and BP by collecting samples throughout an entire day.

Sleep duration and emerging cardiometabolic risk markers in adolescents. The AFINOS study.

OBJECTIVE: To examine the associations between sleep duration and emerging inflammatory and endothelial function risk factors in adolescents. METHODS: This study included a total of 183 (88 girls) adolescents, aged 13-17 years, without diagnosed sleep-related disorders. White blood cell counts, C-reactive protein (CRP), complement factors 3 and 4, interleukin-6, adiponectin, leptin, inter-cellular adhesion molecule 1, vascular cell adhesion molecule-1, E-selectin, l-selectin, and plasminogen activator inhibitor-1 were measured. Sleep duration and sleep-related disorders were obtained by self-report and moderate-to-vigorous physical activity (MVPA) was objectively measured by accelerometer. Body mass index (BMI) was calculated from measured height and weight. RESULTS: A significant inverse association between sleep duration and CRP (ß=-0.17, P=0.024) existed only after controlling for sex, age, and pubertal status. The results did not change when MVPA was included into the model. However, the association of sleep duration with CRP was slightly attenuated when BMI was included in the model, though it remained significant (ß=-0.15, P=0.044). CONCLUSION: Short sleep duration during adolescence might play an important and independent role in cardiovascular and metabolic diseases through CRP.