A 17-year-old male with pseudotumor cerebri secondary to performance-enhancing steroids triggering venous thrombosis in the brain.

This article is a case report of a 17-year-old male who presented with a headache and blurry vision. He subsequently was noted to have papilledema on a fundoscopic examination and an initial normal magnetic resonance imaging and computed tomography of his head; his condition was, therefore, diagnosed as pseudotumor cerebri. A subsequent magnetic resonance venography of his head revealed venous thrombosis, and other investigations revealed an elevated factor VIII level as well as a mutation at the MTHFR locus, consistent with an elevated risk for hypercoagulability. In addition, he admitted to steroid usage for purposes of performance enhancement in baseball. The patient's condition eventually improved with acetazolamide and serial lumbar punctures. Steroids have been linked to predisposition to hypercoagulable states, but there are no reports identified by these authors that link performance-enhancing steroids with pseudotumor cerebri as a result of a coagulation dyscrasia.

Nonemergent emergency room utilization for an inner-city pediatric population.

OBJECTIVE: To identify patient reasons for accessing an urban Pediatric Emergency Room (PER) for primary care and to explore attitudes and practice regarding alternative sources for their medical home. METHODS: A total of 210 questionnaires, consisting of 24 questions each, were completed in a face-to-face interview performed by trained interviewers. Questions asked included sources of medical care, frequency of use, and factors that went into caregiver decisions for using different sources of care. RESULTS: Caregivers choose the PER because of the short amount of time it takes for their child to be seen and discharged by a physician. Nearly 60% ranked wait time to see a doctor more important than seeing the same doctor every time (37.6%). About one-third of caregivers routinely brought their children to the PER for illness that is not serious. Only 77% of caregivers claimed that their children have a regular doctor. Many caregivers cited that they are seen more by their regular doctor for shots (well visits) than for ill visits and are seen in the PER for illness. In this study, 56% of children did not see the same regular doctor as their siblings. CONCLUSIONS: Efficiency and speed of health care delivery is of prime importance to this primarily Medicaid urban population. If strategies are to be implemented to attract these patients to a medical home that will strengthen their ties to their regular doctor, then the needs prioritized by the caregiver must be taken into consideration.

Prevalence, predictors, and attitudes toward cosleeping in an urban pediatric center.

Cosleeping is the normative practice in many of the world's societies but is not endorsed by the Consumer Products Safety Commission or by the American Academy of Pediatrics. A survey was performed on 101 caregivers in an urban setting, designed to assess the prevalence of cosleeping and parental attitudes for this practice. Cosleeping rate was 88% with predictors being as follows: single parent (p=0.006), high school or less education (p=0.035), 2 or fewer rooms used for sleeping (p=0.023). A majority (65%) stated that cosleeping was acceptable.