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If you find yourself meeting parents who hesitate to vaccinate, a new study about vaccine allergies adds another arrow to your quiver. It’s No. 2 in our Single-Sentence Summaries this week.

Warmly,

Dr. Joshua Landy
Co-founder, Figure 1

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Single-Sentence Summaries

1. Metformin has shown success in treating obese teenagers, but these results taper off after 6 months. Nutrition and Diabetes, Sept 2018 

2. Most patients with even moderate adverse reactions to immunization can be safely re-immunized. The Pediatric Infectious Disease Journal, Sept 20, 2018

3.  Early defibrillation in pediatric in-hospital cardiac arrests does not significantly affect survival. JAMA Network Open, Sept 21, 2018

4. Pediatricians who have used value-based payments are twice as likely to view them positively. Pediatrics, Sept 2018

5. Neonatal phototherapy for jaundice may increase risk of seizures, especially in boys. Pediatrics, Sept 2018

Clinical Quiz

A 7-year-old Syrian refugee presents to the emergency room with deep, rapid breathing and blue lips. His mother mentions he has a history of these episodes and usually finds relief by sitting close to the ground. Examination reveals a prominent right ventricular heave and an occasional systolic thrill. What is the most likely diagnosis?

A. Aortic stenosis
B. Ventricular septal defect
C. Tetralogy of Fallot
D. Atrial septal defect

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 Dr. Philippe Chouinard, a Canadian pediatrician who shared the following advice on Twitter: “Valuable questions physicians forget to ask (myself included) when seeing pediatric patients: What are you good at? What makes you happy? What do YOU think about this? (To parents) What makes you proud of him/her?”

CLINICAL QUIZ ANSWER:

C. Tetralogy of Fallot

An ECG demonstrates right ventricular hypertrophy with an incomplete right bundle branch block and an echocardiogram reveals a ventricular septal defect, pulmonary stenosis, and an overriding aorta. These four features are characteristic of tetralogy of Fallot, a congenital defect involving four abnormalities of the heart. Patients with tetralogy of Fallot can present with hypercyanotic episodes which may be acutely managed with oxygen, morphine, and a tucked knee position to increase systemic vascular resistance. Corrective heart surgery is typically recommended for symptomatic patients.

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