Donate here to get more books. Kerry C. Cho, MD HIV Infection & AIDS patients are less than 90 CURRENT Medical Diagnosis & Treatment CURRENT. Diagnosis & Treatment. Pediatrics. NINETEENTH EDITION. Edited by. William W. Hay, Jr., MD. Professor, Department of Pediatrics. Section of. Current Diagnosis & Treatment: Pediatrics, 24e. William W. Hay, Jr., Myron J. Levin, Robin R. Deterding, Mark J. Abzug. Search Textbook Autosuggest Results.
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Current Diagnosis & Treatment Pediatric 22nd Edition () [PDF]. December 14, Medical books Current Diagnosis &Treatment, Pediatric 0. Sharing is. a LANG E medical book Current Diagnosis & Treatment Pediatrics T w ent y- S above related to “just medical-site.info: Third Edition (Current Pediatric Diagnosis Treatment). ID twenty third | lebook pdf download current diagnosis and treatment | current.
Essential for pediatricians, family practitioners, physician assistants, nurses and nurse practitioners, and other health care providers who work with children. Written by experienced pediatricians to ensure that every chapter reflects the needs and realities of real-world practice.
All topics thoroughly updated with the latest research and findings. Table of contents. The Newborn Infant 2. Child Development and Behavior 3.
Adolescent Substance Abuse 5. Eating Disorders 6.
Child and Adolescent Psychiatric Disorders 7. Child Abuse and Neglect 8. Immunization Travel Medicine Normal Childhood Nutrition and Its Disorders Emergencies and Injuries Poisoning Critical Care Skin Eye Oral Medicine and Dentistry Ear, Nose, and Throat Respiratory Tract and Mediastinum Sleep Medicine Cardiovascular Diseases Gastrointestinal Tract Liver and Pancreas Kidney and Urinary Tract Neurologic and Muscular Disorders Orthopedics Sports Medicine A more intensive study of the etiology and pathophysiological processes underlying MS began before World War II, when an autoimmune theory was proposed, later followed by the discovery of the genetic basis of the disease [ 5 — 7 ].
The implementation of immunomodulatory therapy took place in the early nineties and it still is the first line of treatment in MS patients [ 5 ]. One of the main characteristics of MS is its geographic distribution [ 8 ], which is best illustrated by the fact that 50 percent of all MS patients are from Europe [ 9 ]. Results of different studies indicate an increase in the number of patients with MS since , especially among women [ 9 ], although this can be partially explained by rapid advances in making the diagnosis of MS during recent decades.
The assumption is that 2. Sardinia is the place with the highest prevalence of the pediatric MS in the world [ 12 ]; however, the area with the highest prevalence of per , is the Orkney Islands, including both adult and pediatric MS [ 8 ].
If we observe the American continent, MS is most common in non-Hispanic white individuals. Furthermore, in the last few years, pediatric MS becomes more common in African Americans than adult MS in the same population. African Americans have more severe clinical presentation compared to the white population if the disease starts early [ 13 ].
In the United States, the prevalence varies from 58 to 95 per , In pediatric hospitals in Canada, MS is increasingly diagnosed in ethnic populations, such as Caribbean, Asian, central and eastern European [ 14 ], more likely caused by genetics, environmental factors, infections, as well as inadequate exposure to sunlight, and consequently vitamin D deficiency.
Namely, vitamin D deficiency or a polymorphism of vitamin D receptor gene diminishes its optimal function on the immune system that consequently could lead to increasing risk of MS [ 15 ].
However, its role in development and modulating the course of MS remains to be further elucidated. Early onset of MS, i.
The sex ratio varies depending on the age, which could indicate that sex hormones play an important role in the pathogenesis of MS [ 17 ]. In early onset MS, the male to female ratio is almost 0.
Following the growth and the development of children, the ratio increases to after the age of 10 years [ 3 ]. Etiology The exact etiology of MS is still not known, although autoimmune, genetic, and environmental factors play important roles in its development, making it a multifactorial disease [ 18 ].
Although more than genes may impact the occurrence of MS, the most significant genetic factors contributing to the development of MS are changes in the human leukocyte antigen HLA DRB 1 gene [ 19 ]. In addition to the genetic background, the development of MS is also associated with Epstein-Barr virus EBV infection [ 20 ], low vitamin D levels [ 21 ], and smoking [ 22 ].
These cells may later differentiate into T helper Th17 with the help of interleukin 23 IL , which regulates the production of IL The active cell can pass through the blood—brain barrier BBB and reacts with autoantigens, myelin antigens, or oligodendrocytes through the mechanism of molecular mimicry [ 23 ].
Th17 cells lead to the inflammation within the central nervous system CNS , followed by migration of other T cells through the BBB, and subsequent activation of macrophages.
The production of pro-inflammatory cytokines during this immunological response damages myelin and oligodendrocytes, causing plaques of inflammatory demyelination, a hallmark of this disease [ 23 , 24 ].
The various courses of MS are based on its clinical characteristics. Between these relapses, neurological status may normalize or there may be still neurological sequelae [ 26 ]. The acquired demyelinating syndromes in the pediatric population were classified and defined in [ 31 ], and then updated in [ 26 ] by an international consensus group.