Accidental Burn by Intentional Laxative Use.

OBJECTIVE: The purpose of this study was to present a case report and review the relevant literature on laxative-induced dermatitis being mistaken for scald injury and child abuse. CASE: A 33-month-old girl presented with partial thickness burn to the buttocks and perineum, which were suspected to be caused by child abuse. On further investigation, the parents had been administering large doses of laxatives to the child for chronic constipation. DISCUSSION: Child abuse by burning has characteristic physical examination findings, which differ from the pattern of laxative-induced dermatitis that has been reported in the literature. Diapers appear to be a risk factor for laxative-induced dermatitis. Surprisingly, the dose of laxative does not correlate with the severity of the burn injury. All physicians must be aware of the possibility of laxative-induced dermatitis mimicking scald burn injury to the buttocks. Parents should be educated about the risk of administering over-the-counter laxatives to children.

Using patient characteristics to predict usefulness of abdominal computed tomography in children.

OBJECTIVE: The study goal was to determine whether clinical symptoms, physical findings, or laboratory values predict the usefulness of abdominal computed tomography (CT) scans in children. METHODS: We conducted a retrospective review of pediatric patients who received an abdominal CT scan between June 2009 and November 2011 at an urban medical center. A panel of pediatric hospitalists independently categorized each CT read as: (1) necessary for diagnosis; (2) unnecessary but helpful for diagnosis; or (3) neither necessary nor helpful for diagnosis. Two multiple logistic regression models examined 21 clinical variables to assess their ability to differentiate between: (1) necessary and unnecessary CT scans; and (2) helpful and unhelpful CT scans. RESULTS: A total of 399 CT scans were analyzed. Seventy (18%) of these were categorized as necessary, 103 (26%) as unnecessary but helpful, and 226 (57%) as neither necessary nor helpful. Three variables were strongly correlated with necessary CT scans: leukocytosis, peritoneal signs, and male gender. The probability of a CT scan being necessary was 57% in patients with all 3 findings and 8% in those with none. Three variables were also strongly correlated with unnecessary but helpful CT scans: history of abdominal surgery, tachypnea, and leukocytosis. The probability of a CT scan being helpful was 84% in patients with all 3 findings and 35% in those with none of the 3 findings. CONCLUSIONS: The majority of abdominal CT scans were unnecessary and unhelpful. Knowing which clinical variables correlate strongly with necessary or helpful abdominal CT scans may assist clinicians in deciding whether to order this test; however, the predictive power of these variables remains relatively low.

The use of complementary and alternative medicine among refugees: a systematic review.

Little is known about the use of Complementary and Alternative Medicine (CAM) among refugees, despite the common practice of CAM in many non-Western countries. We performed a systematic review of peer-reviewed literature using nine electronic databases. We included articles pertaining to refugees and CAM (whole medical systems, mind body medicine, herbal remedies, manipulative therapies, energy medicine). Qualitative and quantitative data were compiled and analyzed through descriptive statistics and chi square distribution tables. We reviewed 237 abstracts, and 47 publications met our inclusion criteria. Twenty-six papers documented whole medical systems; 11 mind-body medicine; 5 biologically based practices; 4 manipulative and body-based therapies; and 1 study documented the use of energy medicine. There were 3 clinical trials, 20 surveys, 12 case reports, 2 participant-observer qualitative papers, and 10 review papers. Most studies focused on Asian refugee populations (66%; n = 31). Mental problems related to trauma accounted for 36% of CAM use (17). Among included articles, methodological quality was extremely low. Our results show evidence that type of CAM used by refugees may vary based on ethnicity, yet this is most likely due to a bias in the medical literature. Efforts are needed to further explore these results and expand research within this field.