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This statement defines physical restraint and provides recommendations for its use in children and adolescents.
As a result of the expanding human immunodeficiency virus (HIV) infection epidemic and recently published recommendations for routine HIV testing with consent for all pregnant women in the United States, pediatricians are becoming increasingly involved in providing care to infants born to HIV-infected women. This article provides guidelines about counseling the parent or care giver of the infant, use of antiretroviral therapy to reduce the risk of infection in the infant, medical treatment of the HIV-exposed infant, laboratory testing to determine the infection status of the infant, laboratory monitoring of hematologic and immunologic parameters, prophylaxis for Pneumocystis carinii pneumonia, and recommendations for immunizations and tuberculosis screening.
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The pathological examination and assessment of inflicted head injuries in infants and young children are often complicated by the subtle nature of the injuries, the non-specificity of lesions, and the lack of experimental data that can be used to clarify possible forces and mechanisms of damage. Opinions often have to be given on a number of issues, with a paucity of information in the literature and lack of specific individual experience. The following paper reviews some of the problems that are currently found in the medicolegal evaluation of infants and young children with inflicted craniocerebral trauma and issues that consequently arise in court.
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Neutropenia is the dose-limiting toxicity of docetaxel in children. This Phase I trial was designed to determine the maximum tolerated dose, the dose-limiting toxicities, and the incidence and severity of other toxicities of docetaxel with filgrastim (G-CSF) support in children with refractory solid tumors. Docetaxel was administered as an i.v. infusion for 1 h every 21 days with a starting dose of 150 mg/m2 and an escalation to 185 mg/m2 and 235 mg/m2 in subsequent patient cohorts. G-CSF (5 microg/kg/day) was administered s.c., starting 48 h after docetaxel and continuing until the post-nadir neutrophil count reached 10,000/microl. Seventeen patients received 27 courses of docetaxel with G-CSF support. Generalized erythematous desquamating skin rash and myalgias were dose-limiting at 235 mg/m2. Localized and generalized rashes were seen at all of the three dose levels. Neutropenia (median nadir, 95/1microl) occurred at all of the dose levels but was brief in duration and not dose-limiting. Thrombocytopenia was minimal (median platelet count nadir, 139,000/microl), and the severity of neutropenia and thrombocytopenia did not seem to be related to the docetaxel dose. Other docetaxel-related toxicities included hemorrhage (associated with mucositis), sepsis, hypersensitivity reaction, transient elevation of liver enzymes, stomatitis, back pain, asthenia, and neuropathy. One minor response was observed in a patient with colon cancer. The maximum tolerated dose of docetaxel with G-CSF support in children is 185 mg/m2, which is 50% higher than the maximum tolerated dose of docetaxel alone in children and 85 % higher than the recommended adult dose.
Children infected with human immunodeficiency virus (HIV) have had high rates of mortality attributable to measles, but until recently, measles vaccine was assumed to be safe for these children. A single fatal case of pneumonia attributable to vaccine type-measles virus has been documented in a young adult with acquired immunodeficiency syndrome. Because a protective immune response often does not develop in severely immunocompromised HIV-infected patients after immunization and some risk of severe complications exists, HIV-infected children, adolescents, and young adults who are severely immunocompromised (based on age-specific CD4 lymphocyte enumeration) attributable to HIV infection should not receive measles vaccine. All other HIV-infected children, adolescents, and young adults who are not severely immunocompromised should receive measles-mumps-rubella vaccine.
In all states, physicians and dentists recognize their responsibility to report suspected cases of abuse and neglect. The purpose of this statement is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This statement also addresses the oral manifestations of sexually transmitted diseases and bite marks, including the collection of evidence and laboratory documentation of these injuries.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.