DTR CRSS LOAD NO RELF

 A

LET BR SYSTEM TK OVER 

NHS - JBS PLUS ETC

A

the most common specific etiology diagnosed in pediatric patients with a systemic febrile illness after international travel is malaria. More than half of the world's population lives in areas where malaria is endemic

a

CARER 16GBP/HOUR 

A

What are the indications for bariatric surgery in adolescents? 

Surgery can be considered when adolescents have a BMI35 kg/m2 with a severe comorbid condition (i.e., type 2 diabetes mellitus, severe obstructive sleep apnea (OSA), pseudotumor cerebri, or severe steatohepatitis) or a BMI >40 kg/m2 with mild comorbidities (mild OSA, hypertension, insulin resistance, dyslipidemia, impaired quality of life). The patient must be Tanner stage IV or V; have completed at least 95% of skeletal maturity; be able to understand diet and lifestyle changes after surgery; and have evidence of mature decision making, social support, and motivation to comply with preoperative and postoperative treatments. Many experts also recommend that before surgery a patient should have failed sustained organized efforts through lifestyle intervention to lose weight. Assent from the adolescent should always be obtained separately from the parents to avoid coercion.

A

What is the likelihood of chronic hepatic disease developing after acute infections with hepatitis viruses A to G?

 • Hepatitis A: 95% recover within 1 to 2 weeks of illness; chronic disease is unusual 

• Hepatitis B: >90% of perinatally infected infants develop chronic hepatitis B infection; 25% to 50% of children who acquire the virus between 1 and 5 years of age develop chronic infection; in older children and adults, only 6% to 10% develop chronic infection 

• Hepatitis C: 50% to 60% develop persistent infection

 • Hepatitis D: Occurs only in patients with acute or chronic hepatitis B infection; 80% develop viral persistence

 • Hepatitis E: Does not cause chronic hepatitis 

• Hepatitis G: Unknown

A

How is the cause of hypernatremia established? Hypernatremia is either due to excess salt administration or excess free water loss. A combination of history, clinical assessment of the patient’s volume status, and measurement of urine sodium concentration measurement is required to establish the diagnosis.

 • If the patient is hypovolemic and urine sodium concentration is <20 mEq/L, consider extrarenal water losses—diarrhea, excessive perspiration. • If the urinary sodium concentration is >20 mEq/L, consider renal losses—renal dysplasia, obstructive uropathy, and osmotic diuresis

. • If the patient is euvolemic and the urine sodium concentration is variable, consider extrarenal losses (insensible: dermal, respiratory) and renal losses (central diabetes insipidus, nephrogenic diabetes insipidus).

 • If the patient is hypervolemic and the urine serum concentration is [usually] >20 mEq/L, consider— improperly mixed formula in tube feeding, excess sodium bicarbonate administration, excess salt administration, salt poisoning, and primary hyperaldosteronism (rare in children)