Purpose: The tests to estimate aerobic fitness among children require substantial space and maximum effort, which is often difficult for children. We developed a simple submaximal step test (Step Test of Endurance for Pediatrics, or STEP) and assessed its reliability, validity, and ability to estimate aerobic fitness among elementary school children. Method:Children aged 5–10 years completed the STEP with a protocol consisting of 0.1-, 0.2-, and 0.3-metre (4, 8, and 12 in.) step heights. Participants underwent treadmill testing with open circuit spirometry to determine actual maximal oxygen consumption (V̇o2max). Intra-class correlation coefficients (ICCs) assessed test–retest reliability of the STEP and its component tests. Multivariate linear regression assessed the associations between the STEP and V̇o2max, adjusting for potential covariates such as age, sex, BMI, and comorbidity count. Results: The STEP showed excellent reliability (ICC ≥ 0.92; N = 170), irrespective of effort level during testing. Significant effort issues and collinearity among the independent variables led us to exclude children aged 5–6 years ( n = 45) from the regression analysis. The final regression model for children aged 7–10 years with adequate effort ( n = 111), as defined by a respiratory exchange ratio of 1.0 or more, showed that the STEP, sex, and BMI were significantly predictive of V̇o2max ( R 2 = 0.51). Conclusions: This new, effort-independent step test can estimate the aerobic fitness of children aged 7–10 years. Regression equations to estimate V̇o2max from the STEP were provided.
This is a case report of a 16-year-old patient with DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) associated with vancomycin who improved with systemic steroid treatment. DRESS syndrome is a life-threatening disease process typically secondary to medications, such as anticonvulsants, sulfonamides, and allopurinol. Vancomycin has also been associated with this condition. Apart from discontinuation of the offending agent, there are no clear treatment guidelines, but reports of improvement with systemic corticosteroids are described. We present a case of a 16-year-old male who had been on vancomycin for greater than 4 weeks before developing symptoms consistent with the diagnosis of DRESS syndrome. Our patient demonstrated marked improvement with systemic corticosteroids.
Basal cell carcinoma (BCC), one of the most common malignancies, is rarely associated with follicular and apocrine differentiation patterns. This case presents a case of BCC with atypical gross presentation and features of aberrant differentiation. Clinicians should maintain a high level of clinical suspicion for BCC in atypical lesions. Click here for the corresponding questions to this CME article.
Nevus sebaceus most commonly presents as a yellow, alopecic plaque on the head or neck in childhood and evolves into a verrucous plaque at puberty. Numerous secondary tumors may arise within nevus sebaceus lesions. Tumors of mesenchymal origin have been rarely documented. We present a unique case of a patient who presented with a nevus sebaceus on the scalp. Excision of the tumor and subsequent histopathology of the lesion revealed a nevus sebaceus with a desmoplastic trichilemmoma, a tumor of follicular infundibulum, and a neurofibroma. This case highlights a rare finding of a mesenchymal tumor, and the first reported neurofibroma, arising in association with a nevus sebaceus.
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