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I enjoy reading about the microbiome. Its biodiversity, dysfunction, and response to medical interventions are fascinating topics. This week, summary number 2 covers a pediatric part of this landscape: its relationship to later health.

Warmly,

Dr. Joshua Landy
Co-founder, Figure 1

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Single-Sentence Summaries

1. Children and adolescents who used screens for 7+ hours a day were more than twice as likely to have a diagnosis of anxiety or depression compared to those with an hour or less of daily screen time. Preventative Medicine Reports, December 2018

2. Antibiotics, acid suppressants and the combination of multiple medications in the first two years of life are associated with a diagnosis of childhood obesity. Gut, October 30, 2018

3.  After adjustment for maternal age, infants born to fathers aged 45 years or older had 18% higher odds of seizures compared to those with fathers between ages 25-35. The BMJ, October 31, 2018

4. High-protein wheat flour oral immunotherapy induced desensitization in a majority after 1 year and sustained unresponsiveness in 13% of child/adolescent subjects after 2 years. Journal of Allergy and Clinical Immunology, October 2018

5. Maternal prenatal use of most medications that target specific neurotransmitter systems, such as antidepressants and antipsychotics, is not associated with offspring autism. JAMA Psychiatry, October 2018

Clinical Quiz

A 19-year-old female presents to her family physician with a six-month history of worsening acne, irregular menses, and difficulty sleeping. She mentions her last menstrual period was 45 days ago. On examination, she is overweight and excess hair is seen on her upper lip and chin. Laboratory tests reveal normal follicle-stimulating hormone (FSH) levels, elevated luteinizing hormone (LH) levels, and elevated testosterone levels. An ultrasound demonstrates the findings seen here. Based on this patient’s presentation, which of the following malignancies is she at greatest risk for as she ages?

A. Ovarian

B. Thyroid

C. Breast

D. Blepharitis

Answer at the bottom of this post, or click here to see the full case and discussion on Figure 1, a free physician community for viewing medical cases.

Editor’s Pearl

This week’s pearl comes from the radiology department of Cincinnati Children’s Hospital. They regularly share cases on Figure 1, and it was in the discussion of one of these cases that they shared the following:

We teach that small bubbly lucencies are not normal in babies because they do not have formed stool. Therefore, if you see them, think #Pneumatosis-intestinalis. The only caveat is in the setting of obstruction. Obstructed bowel can have more formed stool up stream.

CLINICAL QUIZ ANSWER:

C. Endometrial.

This patient has polycystic ovarian syndrome (PCOS), a set of symptoms characterized by ovulatory dysfunction and excess androgen production. Patients with PCOS are at an increased risk of endometrial carcinoma and hyperplasia due to prolonged unopposed estrogen. Patients with PCOS are also at increased risk of type 2 diabetes, metabolic syndrome, and cardiovascular disease.

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