Plasma B-type natriuretic peptide (BNP) has been reported to be helpful in differentiating cardiac from pulmonary etiologies of dyspnea in adults. We investigated whether BNP concentration could be applied similarly in children with respiratory distress. BNP levels were measured using a rapid immunoassay in 49 infants and children presenting with acute respiratory distress. The patient's history, symptoms, physical exam, chest x-ray, and an echocardiogram were used to identify patients with congestive heart failure (CHF) from noncardiac causes of respiratory distress. Results are reported as mean+/-SD. Patients with CHF (n = 23) had BNP levels of 693.0+/-501.6 pg/ml, significantly higher than those of the group of patients with lung disease (n = 26), whose BNP was 45.2+/-64.0 pg/ml (p < 0.001). There was no significant difference in age between the two groups (29.7+/-59.3 vs 13.1+/-22.6 months; p = 0.12). A BNP level of 40 pg/ml was 84% accurate in differentiating CHF from pulmonary disease. Fifteen of 23 CHF patients had ventricular volume overload from left-to-right shunting congenital heart defects and 8/23 had left ventricular systolic dysfunction. Age-adjusted comparison of the two subgroups of CHF patients revealed that children with left ventricular systolic dysfunction had significantly higher mean BNP levels than those with left-to-right shunts (1181+/-487 vs 433+/-471 pg/ml, p = 0.0074). We conclude that BNP level is of value in differentiating cardiac from pulmonary causes of respiratory distress in children.
A 10-year-old patient with known coccidioidomycosis relapsed and had dysrrhythmias and a right atrial mass. Histopathology and culture after surgical removal revealed that this was a vegetative mass infected with Coccidioides spp. We believe that this is the first case of coccidioidal endocarditis to be reported.
Interrupted aortic arch with an aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality, especially in premature low-birth-weight infants, and the proper timing of surgical correction remains a matter of debate. We present the case of a premature infant weighing 1.6 kg who successfully underwent one stage surgical repair to treat interrupted aortic arch with an aortopulmonary window. The therapeutic management of this patient is described below, and a review of the literature is presented.
Effortful control (EC) is a temperamental self-regulatory capacity, defined as the efficiency of executive attention [1], which is related to individual differences in self-regulation. Although effortful control covers some dispositional self-regulatory abilities important to cope with social demands of successful adaptation to school, such as attention regulation, individual differences in EC have recently been associated with school functioning through academic achievement including the efficient use of learning-related behaviors, which have been found to be a necessary precursor of learning and they refer to a set of children's behaviors that involve organizational skills and appropriate habits of study. Therefore, the aim of this study is to review the literature on EC's relationship to academic achievement via learning-related behaviors, which reflect the use of metacognitive control processes in kindergarten and elementary school students. The findings indicate that EC affects academic achievement through the facilitation of the efficient use of metacognitive control processes.
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