Background Childhood migraines are a common source of morbidity. Purpose To assess the comparative effectiveness and side effects of migraine prophylactic medications in children. Data Sources PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 25 April 2012. Study Selection Randomized trials of children with migraine headaches. Data Extraction Extracted independently in duplicate, including quality (JADAD, Cochrane Risk of Bias). We pooled headache frequency per month using random effects methods. Data Synthesis Among 21 included trials, there were 13 placebo controlled and 11 comparative effectiveness trials (3 included placebo arms. Drugs more effective than placebo for episodic migraines (<15 headaches/month) included topiramate (−0.71 headaches/month, 95 % CI: −1.19 to −0.24, Q= 1.58, df=1, I2=0.0%) and trazodone (−0.60 headache/month, 95% CI: −1.09 to −0.11, 1 study, Figure 2). Ineffective drugs included clonidine, flunarizine, pizotifen, propranolol and valproate. A single trial of fluoxetine for chronic daily headaches found it ineffective. Patients given placebo experienced a significant (p=0.027) decline in headaches from 5.6 (95% CI: 4.52–6.77 Q=8.14, df=8, I2=1.7%) to 2.9 headaches/month (95% CI: 1.66–4.08, Q-4.72, df=10, I2=0.0%). Among the 10 comparative effectiveness trials, flunarizine was more effective than piracetam (−2.2 headaches/month, 9 CI: −3.93 to −0.47), but no better than aspirin, dihydroergotamine, and propranolol. Propranolol was compared to valproate as well as behavioral treatment and two studies compared different doses of topiramate; none of these trials showed a significant difference. Limitations Few trials, lack of patient level data, changing definitions of migraine over time, few comparative effectiveness trials. Conclusion Topiramate and trazodone have limited evidence supporting efficacy for episodic migraines. Placebo was effective in reducing headaches. Other commonly used drugs have no evidence supporting their use in children. Research in pediatric headaches is needed.

BackgroundThere is increasing evidence that intestinal inflammation plays a major role in gastrointestinal symptoms in cystic fibrosis (CF). Fecal calprotectin is a marker that is elevated in several gastrointestinal inflammatory diseases, but little is known about its value in CF. We aimed to look for associations of elevated fecal calprotectin among CF patients and whether its level correlates with the clinical manifestations of CF.MethodsA single stool specimen was collected from 62 patients with CF. Fecal calprotectin was measured using the commercially available ELISA kits (PhiCal™ test). Clinical data were collected from patients’ records and CF registry.ResultsThere were no significant differences between CF patients with normal and abnormal fecal calprotectin levels. However, patients who were not receiving inhaled antibiotics had higher fecal calprotectin levels than those who were.ConclusionElevated fecal calprotectin may not accurately predict intestinal inflammation in CF. However, the fact that it was elevated in both pancreatic sufficient and insufficient groups supports the concept of “cystic fibrosis enteropathy” regardless of the pancreatic status.

A large proportion of patients with CAP have deficiencies in disaccharidases. Bowel frequency, vomiting, or location of pain was no different between groups, suggesting that these clinical features cannot be used to predict disaccharidase deficiencies.

SGNA ratings of well nourished, moderately malnourished, or severely malnourished demonstrated moderate to strong correlation with several standard anthropometric measurements (P < .05). The laboratory markers did not demonstrate any correlation with SGNA. Interrater agreement showed moderate reliability (κ = 0.671). Length of stay, pediatric logistic organ dysfunction, and Pediatric Risk of Mortality III were not significantly different across the groups and did not correlate with SGNA.

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Gram-negative organisms are persistently predominant in our center. In a developing country like Lebanon with limited resources, lower mortality rates commensurate with worldwide reports were successfully achieved in this high-risk patient population. Protocols and guidelines should be adapted to the characteristics of individual institutions to ensure delivery of appropriate care to febrile neutropenic patients.

A gluten-free diet (GFD) is commonly recognized as the treatment for celiac disease. It also has been investigated as a treatment option for other medical conditions, including dermatitis herpetiformis, irritable bowel syndrome, neurologic disorders, rheumatoid arthritis, diabetes mellitus, and HIV-associated enteropathy. The strength of the evidence for the use of a GFD in these nonceliac diseases varies, and future research may better define the benefits of a GFD for those conditions with weak existing evidence.

Background Percutaneous electrical nerve field stimulation (PENFS) improves symptoms in adolescents with functional abdominal pain disorders (FAPDs). However, little is known about its impact on sleep and psychological functioning. We evaluated the effects of PENFS on resting and evoked pain and nausea, sleep and psychological functioning, and long‐term outcomes. Methods Patient ages 11–19 years with FAPD requiring PENFS as standard care were recruited. Evoked pain was elicited by a Water Load Symptom Provocation Task (WL‐SPT) before and after four weeks of treatment. Pain, gastrointestinal symptoms, sleep, somatic symptoms, and physical and psychological functioning were assessed. Actigraphy was used to measure daily sleep–wake patterns. Key Results Twenty patients (14.3 ± 2.2 years old) with FAPD were enrolled. Most patients were females (70%) and white (95%). During pain evoked by WL‐SPT, visual analog scale (VAS) pain intensity and nausea were lower following PENFS compared with baseline (p = 0.004 and p = 0.02, respectively). After PENFS, resting VAS pain unpleasantness (p = 0.03), abdominal pain (p < 0.0001), pain catastrophizing (p = 0.0004), somatic complaints (0.01), functional disability (p = 0.04), and anxiety (p = 0.02) exhibited significant improvements, and some were sustained long‐term. Self‐reported sleep improved after PENFS (p's < 0.05) as well as actigraphy‐derived sleep onset latency (p = 0.03). Conclusions and Inferences We demonstrated improvements in resting and evoked pain and nausea, sleep, disability, pain catastrophizing, somatic complaints, and anxiety after four weeks of PENFS therapy. Some effects were sustained at 6–12 months post‐treatment. This suggests that PENFS is a suitable alternative to pharmacologic therapy.