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Oncolog, Volume 61, Number 04, April 2016, Joe Munch, Bryan Tutt, K Werner

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Aggressive Multimodality Salvage Therapy for Locally Recurrent Rectal Cancer Offers Hope to Patients: For patients with locally recurrent rectal cancer, multimodality salvage therapy presents the only chance for a cure. Such therapy is offered at just a handful of specialized referral institutions, including The University of Texas MD Anderson Cancer Center.
• Rapid Assessment, Clinical Trials Could Improve Outcomes for Anaplastic Thyroid Cancer Patients: Anaplastic thyroid cancer is extremely aggressive-only 20% of patients survive 1 year after their diagnosis-so patients require immediate assessment and treatment. A program at The University of Texas MD Anderson Cancer Center expedites the care of patients …

Intimin Likely Used To Cause Disease During Competition With Commensal Escherichia Coli, Dominique J. Richburg

Senior Honors Theses

The intimin gene in the Locus of Enterocyte Effacement (LEE) island of pathogenicity is the primary attachment mechanism in Citrobacter rodentium. Intimin is a bacterial adhesin (protein) that attaches to obtain a niche/nutrient and thrive within the intestine. Intimin was deleted within C. rodentium to study colonization and pathogenesis in the murine intestine. Additionally, C. rodentium is an attaching/effacing pathogen, and a useful murine model in understanding Enterohemorrhagic Escherichia coli (EHEC) infection in humans. E. coli and C. rodentium cause gastroenteritis in humans and mice, respectively. C. rodentium is a murine pathogen commonly used to model gastrointestinal disease because …

Labrad : Vol 42, Issue 1 - April 2016, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Biochemical Bone Profiles Available at Clinical Laboratoryof Aga Khan University Hospital
• Ionized Calcium Determination in Clinical Labortory
• Parathyroid Hormone Disorders and Issues of Testing
• Tubular Maximum Reabsorption Rate of Phosphate to Glomerular Filtration Rate (TmP/GFR)
• Renal Osteodystrophy: A Disturbed Metabolic Aspect of Renal Failure
• Update on Microbiological Diagnosis of Bone and Joint Disorders
• Classification of Tumours of Bone : An Update Based on the 2013 World Health Organization Classification of Tumours of Soft Tissue and Bone
• Recent Developments in Benign Bone Tumours
• Role of Clinical and Radiological Correlation in Orthopaedic Pathology
• CME Seminar on ‘World Osteoporosis Day’

Reliability And Validity Of An Observational Measure Of Client Decision-Making: The Client Language Assessment - Proximal/Distal (Cla-Pd)., Molly Magill, Timothy R. Apodaca, Mitchell Karno, Jacques Gaume, Ayla Durst, Justin Walthers, Robert L. Stout, Carlo Diclemente

Manuscripts, Articles, Book Chapters and Other Papers

OVERVIEW: The Client Language Assessment - Proximal/Distal (CLA-PD) is a language rating system for measuring client decision-making in interventions that target a specified behavior change (e.g., alcohol or other drug use). In the CLA-PD, there are five dimensions of change language (Reason, Ability, Commitment, Taking Steps, Other) adapted from the client portion of the Motivational Interviewing Skill Code (MISC). For the CLA-PD, language codes are sub-divided to discriminate statements regarding the primary, or target behavior change (distal change) from the intermediate coping activities (proximal change) that are prescribed to facilitate that target behavior change. The goal of the CLA-PD is …

Obstetric Violence Within The Brazilian Healthcare System: A Critical Analysis Of The Childbirth Narratives Of Tupinambá Indigenous Women From The Olivença, Ilhéus Community, Cassandra Fareira

Independent Study Project (ISP) Collection

The objective of this research project is to hear the personal narratives of Tupinambá Indigenous Brazilian women living in the Olivença community in Ilheus, Bahia regarding their experiences giving birth in order to discern the prevalence of various forms of obstetric violence within their experiences. In the context of this study the term "obstetric violence," derived from an extensive literature review, encompasses 1) physical abuse, 2) the unethical imposition of medical interventions, 3) the denial or lack of privacy, 4) undignified care which includes verbal abuse, 5) discrimination, 6) abandonment, neglect or the refusal to grant assistance, 7) detention in …

Hypertensive Disorders Of Pregnancy In Rural Maharashtra: A Preventative Approach To Risk Factor Reduction Through Lifestyle Interventions, Jess Wiken

Independent Study Project (ISP) Collection

The primary purpose of this study is to assess the contribution and correlation between lifestyle behaviors and modifiable risk factors (MRF) established in adolescence and during pregnancy with development of hypertensive disorders of pregnancy (HDP) exclusive to preeclampsia (PE), eclampsia, and pregnancy induced hypertension (PIH). MRF include but are not exclusive to diet and nutrition, physical activity, and Mishri use. Associations of HDP with increased premature cardiovascular risk in the affected woman and child indicate the importance of healthy lifestyle modifications that promote cardiovascular health and longevity and reduction of risk factors through prevention. While cardiac conditions are primarily associated …

The Changing Roles And Reputations Of Dais In Rural Uttarakhand: An Investigation Into The Maternal Health Services Of Villages In Okhalkanda Block In Nainital, Jenna Davis

Independent Study Project (ISP) Collection

The dai, once a prominent figure in Indian maternal health, now faces marginalization as the government of India adopts the goal of universal institutional delivery. Under pressure from international discourse that Skilled Birth Attendants (SBAs) were more effective at lowering Maternal Mortality Rate (MMR) than Traditional Birth Attendants (TBAs) like dais (World Health Organization), dai training was discontinued and left in the hands of NGOs, while concurrently women and ASHAs were monetarily incentivized for every institutional birth (Park, 419). Yet in rural, isolated, or hilly areas like Okhalakanda block in Uttarakhand, institutional delivery is a long way from universal—only …

Correlation Between Spiritual Aspect And Serum Interleukin-6level In Chronic Hemodialysis Patients, Wika Hanida, E Mudjaddid, Habibah Hanum Nasution, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during hemodialisis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors. Methods. Cross sectional study on 51 chronic hemodialisis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immune sorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACIT …

Right Ventricular Systolic And Diastolic Function Profile Inpatient With Stable Chronic Obstructive Pulmonary Disease, Dina Oktavia, Sally Aman Nasution, Anna Uyainah Zn, C Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Right ventricular dysfunction is one of the common complication of chronic obstructive pulmonary disease (COPD). Right ventricular assessment is importance, since it related with exercise intolerance and poor prognosis. Methods. Thirty stable COPD men (mean age: 65 ± 6 yr) underwent spirometry. In addition to conventional echocardiographic parameters, TAPSE, right heart chambers, and trans tricuspid inflow were determined. Results. The mean value of FEV1 was 28 ± 8% of the predicted value. There was no subject with mild airflow limitation, 57% subjects were with very severe airflow obstruction. All of pulmonary function test showed mixed restrictive-obstructive pattern. Mean of …

Almond Supplementation Reduces Serum Uric Acid In Coronary Artery Disease Patients: A Randomized Controlled Trial., Humaira Jamshed, Anwar Gilani, Fateh Ali Tipoo Sultan, Faridah Amin, Jamshed Arslan Arslan, Sumaira Ghani, Madiha Masroor

Department of Biological & Biomedical Sciences

Objective

Elevated serum uric acid (UA), a biomarker of renal insufficiency, is also an independent prognostic marker for morbidity in coronary artery disease (CAD) and poses serious health risks. This study reports the effect of almond consumption on UA in CAD patients.

Study design

A randomized controlled clinical trial was conducted with three groups: no-intervention (NI), Pakistani almonds (PA) or American almonds (AA). Patients were recruited from the Cardiology Clinics, Aga Khan University Hospital. Two follow-ups were scheduled at week-6 and week-12. 150 patients were randomly divided in three groups (50 per group). NI was not given almonds, whereas the …

Ectopic Mineralization Of Cartilage And Collagen-Rich Tendons And Ligaments In Enpp1asj-2j Mice., Jieyu Zhang, Nathaniel A Dyment, David W Rowe, Sarah Y Siu, John P Sundberg, Jouni Uitto, Qiaoli Li

Department of Dermatology and Cutaneous Biology Faculty Papers

Generalized arterial calcification of infancy (GACI), an autosomal recessive disorder caused by mutations in the ENPP1 gene, manifests with extensive mineralization of the cardiovascular system. A spontaneous asj-2J mutant mouse has been characterized as a model for GACI. Previous studies focused on phenotypic characterization of skin and vascular tissues. This study further examined the ectopic mineralization phenotype of cartilage, collagen-rich tendons and ligaments in this mouse model. The mice were placed on either control diet or the "acceleration diet" for up to 12 weeks of age. Soft connective tissues, such as ear (elastic cartilage) and trachea (hyaline cartilage), were processed …

Proteome And Protein Network Analyses Of Memory T Cells Find Altered Translation And Cell Stress Signaling In Treated Human Immunodeficiency Virus Patients Exhibiting Poor Cd4 Recovery, Sausan Azzam, Daniela M. Schlatzer, Sean Maxwell, Xiaolin Li, Douglas Bazdar, Yanwen Chen, Robert Asaad, Jill S. Barnholtz-Sloan, Mark R. Chance, Scott F. Sieg

Faculty Scholarship

Background. Human immunodeficiency virus (HIV) patients who experience poor CD4 T-cell recovery despite viral suppression during antiretroviral therapy (ART) are known as immunological nonresponders. The molecular mechanism(s) underlying incomplete immune restoration during ART is not fully understood. Methods. Label-free quantitative proteomics on single-cell type central memory T cells were used to reveal relative protein abundance changes between nonresponder, responder (good CD4 recovery during ART), and healthy individuals. Proteome changes were analyzed by protein pathway and network analyses and verified by selected reaction monitoring mass spectrometry. Results. Proteomic analysis across groups detected 155 significant proteins from 1500 nonredundant proteins. Pathway and …

Systematic Review On Human Resources For Health Interventions To Improve Maternal Health Outcomes: Evidence From Low- And Middle-Income Countries, Zohra S. Lassi, Nabiha B. Musavi, Blerta Maliqi, Nadia Mansoor, Andres De Francisco, Kadidiatou Toure, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and …

The Association Between Vitamin A Status Or Supplementation And Hiv/Aids, Mikaela Kathleen Curtis

Food Science and Nutrition

The human immunodeficiency virus (HIV) has infected millions of people since the start of the epidemic in the early 1980s. HIV is the etiologic agent of the acquired immunodeficiency syndrome (AIDS), which has taken millions of lives. It is extremely difficult for particular populations to receive medication to treat HIV infection and prevent the progression of HIV to AIDS. Multiple studies have examined the effect of vitamin A on HIV infection, due to its immune stimulating effects. It is unclear whether an association exists between vitamin A and different aspects of HIV. This review examined the effect of vitamin A …

Physician Quality Reporting System Program Updates And The Impact On Emergency Medicine Practice., Jennifer L Wiler, Michael Granovsky, Stephen V Cantrill, Richard Newell, Arjun K Venkatesh, Jeremiah D Schuur

Emergency Medicine Faculty Publications

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, …

Iron Deficiency Anemia Among Women Of Reproductive Age, An Important Public Health Problem: Situation Analysis, Minaz Mawani, Savera Aziz Ali, Gulshan Bano, Sumera Aziz Ali

Section of Internal Medicine

Background: Iron deficiency is a major cause of anemia and is more prevalent in developing countries, posing additional burden on health care systems, in the presence of scarcity of resources. The high-risk group consists of females and children but comparatively it is higher in females due to physiological reasons. Multiple factors can predict anemia, which in turn leads to various adverse outcomes.

Objective: The purpose of this literature review was to review and synthesize the findings from literature about the burden, causes, outcomes and important interventions of iron deficiency anemia for developing countries.

Methods: An extensive literature review was carried …

Health And Psychosocial Outcomes Of A Telephonic Couples Behavior Change Intervention In Patients With Poorly Controlled Type 2 Diabetes: A Randomized Clinical Trial, Paula M. Trief, Lawrence Fisher, Jonathan G. Sandberg, Donald A. Cibula, Jacqueline Dimmock, Danielle M. Hessler, Patricia Forken, Ruth S. Weinstock

Faculty Publications

To compare glycemic control and secondary outcomes of a 4-month telephonic couples behavioral intervention to individual intervention, and to education, for adults with type 2 diabetes.

When A Surgical Colleague Makes An Error., Ryan M. Antiel, Thane A. Blinman, Rebecca M. Rentea, Katherine W. Gonzalez, E Marty Marty Knott, David Juang, Tolulope A. Oyetunji, G W. Holcomb Iii, Peter Angelos, John D. Lantos

Manuscripts, Articles, Book Chapters and Other Papers

Professionalism requires that doctors acknowledge their errors and figure out how to avoid making similar ones in the future. Over the last few decades, doctors have gotten better at acknowledging mistakes and apologizing to patients when a mistake happens. Such disclosure is especially complicated when one becomes aware of an error made by a colleague. We present a case in which consultant surgeons became aware that a colleague seemed to have made a serious error. Experts in surgery and bioethics comment on appropriate responses to this situation.

Diagnostic Methods To Determine Microbiology Of Postpartum Endometritis In South Asia: Laboratory Methods Protocol Used In The Postpartum Sepsis Study: A Prospective Cohort Study, Sadia Shakoor, Megan E. Reller, Amnesty Lefevre, Aneeta Hotwani, Shahida M. Qureshi, Farheen Yousuf, Mohammad Shahidul Islam, Nicholas Connor, Iftekhar Rafiqullah, Fatima Mir

Department of Paediatrics and Child Health

Background: The South Asian region has the second highest risk of maternal death in the world. To prevent maternal deaths due to sepsis and to decrease the maternal mortality ratio as per the World Health Organization Millenium Development Goals, a better understanding of the etiology of endometritis and related sepsis is required. We describe microbiological laboratory methods used in the maternal Postpartum Sepsis Study, which was conducted in Bangladesh and Pakistan, two populous countries in South Asia.
Methods/Design: Postpartum maternal fever in the community was evaluated by a physician and blood and urine were collected for routine analysis and culture. …

Development Of A Spirometry T-Score In The General Population, Sei Won Lee, Hyun Kuk Kim, Seunghee Baek, Ji-Ye Jung, Young Sam Kim, Jae Seung Lee, Sang-Do Lee, David M. Mannino, Yeon-Mok Oh

Preventive Medicine and Environmental Health Faculty Publications

Background and objective: Spirometry values may be expressed as T-scores in standard deviation units relative to a reference in a young, normal population as an analogy to the T-score for bone mineral density. This study was performed to develop the spirometry T-score.

Methods: T-scores were calculated from lambda-mu-sigma-derived Z-scores using a young, normal age reference. Three outcomes of all-cause death, respiratory death, and COPD death were evaluated in 9,101 US subjects followed for 10 years; an outcome of COPD-related health care utilization (COPD utilization) was evaluated in 1,894 Korean subjects followed for 4 years.

Results: The …

Differential Expression Of Pancreatic Protein And Chemosensing Receptor Mrnas In Nkcc1-Null Intestine, Emily M. Bradford, Kanimozhi Vairamani, Gary E. Shull

Internal Medicine Faculty Publications

AIM: To investigate the intestinal functions of the NKCC1 Na⁺-K⁺-2Cl cotransporter (SLC12a2 gene), differential mRNA expression changes in NKCC1-null intestine were analyzed.

METHODS: Microarray analysis of mRNA from intestines of adult wild-type mice and gene-targeted NKCC1-null mice (n = 6 of each genotype) was performed to identify patterns of differential gene expression changes. Differential expression patterns were further examined by Gene Ontology analysis using the online Gorilla program, and expression changes of selected genes were verified using northern blot analysis and quantitative real time-polymerase chain reaction. Histological staining and immunofluorescence were performed …

AΒ40 Reduces P-Glycoprotein At The Blood-Brain Barrier Through The Ubiquitin-Proteasome Pathway, Anika M. S. Hartz, Yu Zhong, Andrea Wolf, Harry Levine Iii, David S. Miller, Björn Bauer

Sanders-Brown Center on Aging Faculty Publications

Failure to clear amyloid-β (Aβ) from the brain is in part responsible for Aβ brain accumulation in Alzheimer's disease (AD). A critical protein for clearing Aβ across the blood–brain barrier is the efflux transporter P-glycoprotein (P-gp) in the luminal plasma membrane of the brain capillary endothelium. P-gp is reduced at the blood–brain barrier in AD, which has been shown to be associated with Aβ brain accumulation. However, the mechanism responsible for P-gp reduction in AD is not well understood. Here we focused on identifying critical mechanistic steps involved in reducing P-gp in AD. We …

Therapeutic Effect Of Melatonin On Pediatric Functional Dyspepsia: A Pilot Study., Katherine Zybach, Craig A. Friesen, Jennifer V. Schurman

Manuscripts, Articles, Book Chapters and Other Papers

AIM: To study the effectiveness of melatonin vs placebo in children with functional dyspepsia (FD).

METHODS: The study was conducted as a double blind, randomized, placebo controlled crossover trial. Subjects were aged 8-17 years and diagnosed with FD based on Rome III criteria. All subjects had failed to respond to 4 wk of acid suppression. Subjects receive a continuous two weeks of placebo and a continuous two weeks of melatonin in an order blinded to the participant and the study team. A Global Clinical Score was obtained to assess changes in abdominal pain. Pain was self-reported to be worse (grade …

Structural And Evolutionary Analyses Show Unique Stabilization Strategies In The Type Iv Pili Of Clostridium Difficile, Kurt H. Piepenbrink, Grace A. Maldarelli, Claudia F. Martinez De La Pena, Tanis C. Dingle, George L. Mulvey, Amanda Lee, Erik Von Rosenvinge, Glen D. Armstrong, Michael S. Donnenberg, Eric J. Sundberg

Food for Health: Publications

Type IV pili are produced by many pathogenic Gram-negative bacteria and are important for processes as diverse as twitching motility, biofilm formation, cellular adhesion and horizontal gene transfer. However, many Gram-positive species, including C. difficile, also produce Type IV pili. Here, we identify the major subunit of the Type IV pili of C. difficile, PilA1, and describe multiple three-dimensional structures of PilA1, demonstrating the diversity found in three strains of C. difficile. We also model the incorporation of both PilA1 and a minor pilin, PilJ, into the pilus fiber. Although PilA1 contains no cysteine residues, and therefore cannot form the …

Adherence To Lifestyle Advice And Reatments In Pakistani Patients With Type 2 Diabetes Mellitus., Sarwar Malik, Rabia Basit, Sabahat Naz, Minaz Mawani, Qamar Masood, J. Akhter

Section of Diabetes, Endocrinology and Metabolism

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy are shown to improve blood glucose levels, lipid abnormalities and blood pressure. It is not known how many patients adhere to advice and drugs prescribed. This study aimed to determine adherence to lifestyle and therapeutic advice. Methods: A cross sectional hospital based study was conducted among patients attending the diabetic clinic at the Aga Khan University Hospital, using a structured questionnaire. Adult patients with T2DM and with at least one year …

A Nursing Approach To Self-Management Education For Individuals With Mental Illness And Diabetes, Edna Fuentes-Casiano, Martha Sajatovic

Faculty Scholarship

Patients with serious mental illness (SMI) and diabetes often seek care in primary care settings and have worse health outcomes than patients who have either illness alone. Individual, provider, and system-level barriers present challenges to addressing both psychiatric and medical comorbidities. This article describes the feasibility, acceptability, and implementation of Targeted Training and Illness Management (TTIM), a self-management intervention delivered by trained nurse educators and peer educators to groups of individuals with SMI and diabetes to improve self-management of both diseases. TTIM is intended to be delivered in a primary care setting. Findings are intended to support the future development …

Fracture Burden And Risk Factors In Childhood Ckd: Results From The Ckid Cohort Study., Michelle R. Denburg, Juhi Kumar, Thomas Jemielita, Ellen R. Brooks, Amy Skversky, Anthony A. Portale, Isidro B. Salusky, Bradley A. Warady, Susan L. Furth, Mary B. Leonard

Manuscripts, Articles, Book Chapters and Other Papers

Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter. We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponding to 395 (95% confidence …

Modified Appleby Procedure With Arterial Reconstruction For Locally Advanced Pancreatic Adenocarcinoma: A Literature Review And Report Of Three Unusual Cases., Jessica A. Latona, Kathleen M. Lamb, Michael J. Pucci, Warren R. Maley, Charles J. Yeo

Department of Surgery Faculty Papers

BACKGROUND: Pancreatic body and tail ductal adenocarcinomas are often diagnosed with local vascular invasion of the celiac axis (CA) and its various branches. With such involvement, these tumors have traditionally been considered unresectable. The modified Appleby procedure allows for margin negative resection of some such locally advanced tumors. This procedure involves distal pancreatectomy with en bloc splenectomy and CA resection and relies on the presence of collateral arterial circulation via an intact pancreaticoduodenal arcade and the gastroduodenal artery to maintain prograde hepatic arterial perfusion. When the resultant collateral circulation is inadequate to provide sufficient hepatic and gastric arterial inflow, arterial …

Long-Term Velaglucerase Alfa Treatment In Children With Gaucher Disease Type 1 Naïve To Enzyme Replacement Therapy Or Previously Treated With Imiglucerase., Laurie Smith, William Rhead, Joel Charrow, Suma P. Shankar, Ashish Bavdekar, Nicola Longo, Rebecca Mardach, Paul Harmatz, Thomas Hangartner, Hak-Myung Lee, Eric Crombez, Gregory M. Pastores

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Gaucher Disease type 1 (GD1) often manifests in childhood. Early treatment with enzyme replacement therapy (ERT) may prevent disease complications. We report the assessment of velaglucerase alfa ERT in pediatric GD1 patients who participated in a long-term extension study (HGT-GCB-044, ClinicalTrials.gov Identifier NCT00635427).

METHODS: Safety and efficacy were evaluated in pediatric patients receiving velaglucerase alfa 30-60U/kg by intravenous infusion every other week. In addition to key hematological and visceral efficacy assessments, exploratory assessments conducted specifically in pediatric patients included evaluation of height, bone age, bone marrow burden, and Tanner stage of puberty.

RESULTS: The study included 24 pediatric patients. …

Physical Examination Findings Among Children And Adolescents With Obesity: An Evidence-Based Review., Sarah Armstrong, Suzanne Lazorick, Sarah Hampl, Joseph A. Skelton, Charles Wood, David Collier, Eliana M. Perrin

Manuscripts, Articles, Book Chapters and Other Papers

Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. …