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Sometimes I’m asked about an observational study from the news. Patients ask, Is coffee good for me? The usual answer: There isn’t enough data to know for sure. This week, if you’re asked about gluten intake during pregnancy and its diabetes risk, that’s how to answer—it’s the first Single Sentence Summary.

Warmly,

Dr. Joshua Landy
Co-founder, Figure 1

The Differential for Pediatrics is available as a free weekly email.
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Single-Sentence Summaries

1. A Danish observational study found that a high gluten intake during pregnancy increases the risk of having a child with Type 1 diabetes. The BMJ

2. In treating major depressive disorder in adolescents, a combination of cognitive behavioral therapy and fluoxetine appears to be more effective than either individual treatment. Journal of Affective Disorders

3. The American Academy of Pediatrics now recommends universal screening for fetal alcohol syndrome. AAP

4. The drug fingolimod cuts multiple sclerosis relapse rates in pediatric patients as compared to interferon beta-1a, though it is associated with a higher rate of adverse events. New England Journal of Medicine

5. Despite common belief, there is no evidence to suggest that milk increases mucus production in the aerodigestive tract. Archives of Disease in Childhood

Clinical Quiz

A five-year-old boy presents with a six-day history of a sore throat and fever. Examination reveals a bright red tongue, a flushed face, and a dry, rough erythematous rash on his neck. What is the most likely diagnosis?

A. Kawasaki disease
B. Scarlet fever
C. Measles
D. Influenza

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

Today’s pearl comes from Sportsdoc1, an orthopedic surgeon on Figure 1: 
“High index of suspicion for child abuse: 1. Long bone fracture in a child. 2. Near transverse fracture of long bone, which is usually caused by either blunt trauma or a pathologic fracture. 3. Less obvious, corner fractures of distal metaphysis which is almost pathonomonic for child abuse.”

CLINICAL QUIZ ANSWER:

B. Scarlet fever

A throat swab was positive for streptococcus pyogenes, and a diagnosis of scarlet fever can be made. Scarlet fever is an inflammatory reaction to streptococcal pharyngitis characterized by fever, a strawberry tongue, and a sandpaper-like rash which may begin on the face or neck and travel downwards. The diagnosis of scarlet fever can be made clinically and confirmed by a throat culture. Antibiotics—most commonly penicillin—are the most effective treatment. An important mimic of scarlet fever is Kawasaki disease. Both conditions can present similarly, but Kawasaki disease typically also presents with nonexudative conjunctivitis and cervical lymphadenopathy, and may lead to cardiovascular complications if untreated.

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