Pediatric uveitis: Role of the pediatrician.

The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.

Natal and neonatal teeth: Clinically relevant findings in a retrospective analysis.

BACKGROUND: Teeth present at the time of birth are called natal teeth while the teeth which erupt within 30 days of birth are neonatal teeth. The natal and neonatal teeth are an uncommon occurrence causing extreme anxiousness among the parents because of various myths related to their occurrence in our society. METHODS: A retrospective analysis of 12 patients who reported to the dental center between 2012 and 2015 with natal or neonatal teeth was carried out. RESULTS: Our study sample comprised of 12 patients. The age group ranged from 4 to 27 days in which there were eight male and four female infants. Out of 12 cases, eight cases had history of a physiologic delivery, while four were delivered by C-section. All the teeth were white to yellowish white in color, grade III mobile, and were devoid of roots. Except difficulty in feeding, only one case had a complication because of the tooth which was the development of a small lingual ulcer. Eleven cases were managed by extraction of the natal or neonatal teeth, and in one case, the parents did not consent for extraction. Six infants below 10 days of age were administered inj Vit K prior to the extraction. On follow-up of all the patients families reported that the child was feeding much better after the treatment and there were no complications. CONCLUSION: Natal and neonatal teeth have been causing dilemmas in the minds of pediatricians and dentists world over. Thus, it is important to know the basics about such teeth so that proper guidance can be given to parents and a suitable case specific treatment plan can be formulated.

Factors impacting referral of JIA patients to a tertiary level pediatric rheumatology center in North India: a retrospective cohort study.

BACKGROUND: JIA studies demonstrate that there is a "window of opportunity" early in the disease course during which appropriate management improves outcomes. No data is available regarding patients' pathway, before first pediatric rheumatology (PR) evaluation in India, a country where health-care costs are self- paid by patients and where a significant shortage of pediatric rheumatologists (PRsts) is known. This study aimed to describe time from onset of symptoms to first PR visit of JIA patients to a tertiary center in India and factors that impact this. METHODS: This retrospective study is from data collected at the PR center, Sir Ganga Ram Hospital (SGRH) in New Delhi. JIA patients fulfilling ILAR 2004 criteria and seen at least twice from 1st October 2013 to 30th September 2018 were included. Data collected were: demographic details, history of disease, referral practitioner, clinical and laboratory features, treatments. Mann-Whitney U-test, Chi square and logistic regression were used as appropriate to study factors that determined time to first PR visit. RESULTS: Five hundred and twenty patients were included: 396 were diagnosed at this PR center (group A), 124 were previously diagnosed as JIA and managed by non PRsts before first PR visit (group B). Median time from symptom onset to first PR visit was 4.1 months and median distance travelled 119.5 km. Despite ongoing treatment, group B patients had more aggressive disease and resided further away as compared to Group A patients. On univariate analysis, factors that predicted PR visit within 3 months were private patients, short distance to travel, family history of inflammatory disease, history of fever, history of acute uveitis or high ESR. On multivariate analysis all these factors were significant except high ESR and acute uveitis. CONCLUSION: Time to first PR assessment at this center was comparable to that seen in western countries. Cost of care and long distance to the center delayed consultation; acuity of complaints and family history of rheumatologic condition hastened referral. Possible solutions to improve referral to PR centers would be to increase the number of PRsts and to improve medical insurance coverage.

Childhood Obesity: Review of a growing Problem.

The consequences of obesity in adulthood are well known. Obesity has a direct influence on mortality and acts as a risk factor for various diseases and health problems. It is associated with nonfatal but debilitating illnesses, such as respiratory difficulties, musculoskeletal disorders, skin problems and infertility. The association with fatal chronic diseases includes cardiovascular diseases, conditions related to insulin resistance and noninsulin-dependent diabetes. There has been a marked increase in the number of obese children coming for treatment to dentists, thus it is the moral responsibility of the dentists to educate both the patient and the parents of the problems of obesity and its control. A dentist may actually be the first person to inform the patient about this problem thus, a basic knowledge about it is important. How to cite this article: Shivpuri A, Shivpuri A, Sharma S. Childhood Obesity: Review of a growing Problem. Int J Clin Pediatr Dent 2012;5(3):237-241.