Current Pediatric Reviews - Volume 11, Issue 1, 2015

Chronic active Epstein-Barr virus infection (CAEBV) is characterized mainly by prolonged or intermittent fever, lymphadenopathy and hepatosplenomegaly without definite underlying diseases at the diagnosis. Patients with CAEBV also may have various life-threatening conditions including hematological, neurological, pulmonary, cardiac, digestive tract, ocular and/or dermal disorders. Additionally, during the course of illness, they often develop hematological malignancies such as T cell, NK cell or B cell lymphoproliferative disorder (LPD) and/or lymphoma. No causative pathogenetic mechanisms have been sufficiently clarified, and additionally no promising efficacious treatment was demonstrated except for the hematopoietic stem cell transplantation (HSCT) in cases who develop T cell or NK cell LPD or lymphoma. This minireview outlines the recent development for the comprehensive viewpoints of CAEBV mainly regarding to virological, immunological, pathological and therapeutical progresses.

Psoriasis is a chronic, immune-mediated, inflammatory systemic disease which targets primarily the skin. It presents a genetic basis, affecting 1 to 3% of the white population. Nevertheless, the existence of two psoriasis incidence peaks has been suggested (one in adolescence before 20 years of age and another in adulthood) onset may occur at any age, including childhood and adolescence, in which its prevalence ranges between 0.7% and 1.2%. As for adult psoriasis, pediatric psoriasis has recently been associated with obesity, metabolic syndrome, increased waist circumference percentiles, and metabolic laboratory abnormalities, warranting early monitoring and lifestyle modifications. In addition, due to psoriasis chronic nature and frequently occurring relapses, psoriatic patients tend to have an impaired quality of life, often requiring long-term treatment. Therefore, education of both pediatric patients and their parents is essential to successful and safe disease management. However, systemic treatment of children is challenging as the absence of standardized guidelines and the fact that evidence-based data form randomized controlled trials are very limited. This review shows an overview of the current understanding of the pathogenesis, comorbidities, differential diagnosis, treatment and prevention of pediatric psoriasis, also presenting with an emphasis on the necessity of an integrated treatment approach involving different specialists such as dermatologist, pediatricians, rheumatologists, etc.

A review of gender role (GR) differentiation from early childhood through adulthood was conducted on males and females in general, as well as on females affected by congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency or complete androgen insensitivity syndrome (CAIS). Additionally, retrospective and current, self-rated GR assessments were evaluated from women with CAH (n = 9) or CAIS (n = 12), and unaffected women and men ranging in age from 16 to 59 years. Overall, GR differentiation occurs in early childhood and persists through adulthood. With advanced age, this differentiation may evolve into androgyny or even become undifferentiated for the general population. While more studies of GR exist for girls and women with CAH compared to those affected by CAIS, some developmental patterns can be observed from the limited data that exist. First, girls and women with CAIS report a female GR that persists through adulthood. Second, girls and women with CAH are more likely to report less feminine/ more masculine play in childhood followed by interests in male-typical leisure activities and career choices in adulthood. However, our data indicate that women with CAH report more feminine/ less masculine patterns of GR with age. Self-reported GR for women with CAH was indistinguishable from that of women with CAIS at the time of study participation in adulthood. With the availability of effective medications for treating hormone deficiencies associated with CAH, affected women are expected to live a full lifespan. Thus, our understanding of psychosexual development into older age is warranted.

Background: Obesity in children/adolescents is a major public health problem worldwide. In Brazil there is great variability in published data on the prevalence of obesity among children/adolescents. Aims: To show a systematic review with meta-analysis of cross-sectional studies, conducted in Brazil between 2008 and 2014. Methods: A systematic review and meta-analysis was conducted the outcome of which was obesity (Body Mass Index ≥ 95th percentile for sex/age). A graphical presentation was done separately (Forest plot) for the results. Global and dichotomous outcomes were presented by employing, respectively the gross rates of prevalence and prevalence ratio (PR) and its confidence intervals at 95% (95% CI). The degree of heterogeneity was calculated employing the Q Cochran, while the I2 test was used to describe the variation between studies. Results: Twenty-one studies with a sample of 18,463 children/adolescents were included; the overall prevalence of obesity was 14.1%. Among boys it was 16.1% and in girls it was 14.95%. There was no difference in obesity prevalence between sexes (PR 1.06; 95%CI: 0.81 to 1.40; p>0.05). Conclusions: The prevalence of obesity among children and adolescents in Brazil is high and urgently needs measures to prevent consequences associated with the disease, as well as measures to reduce the impact, in the short term, the overweight and childhood obesity.

This review will describe the biological and behavioral aspects of nicotine addiction as it develops during adolescence and advances over a lifetime. Symptoms of physical nicotine dependence typically appear when adolescents are smoking only a few cigarettes each month. Physical dependence develops through a set sequence of symptoms that correlate with changes in brain structure in addiction circuits. Smokers often describe their symptoms of physical dependence as “wanting,” then “craving,” and eventually “needing” to smoke. These symptoms appear whenever the smoker goes too long without smoking. The intensity of abstinence-induced craving correlates with spontaneous activation of addiction-related networks in the brain as illustrated in the graphical abstract of this article. Initially, smoking a single cigarette can keep withdrawal symptoms at bay for weeks, but as tolerance develops, cigarettes must be smoked at progressively shorter intervals to suppress withdrawal symptoms. The physiologic need to repeatedly self-administer nicotine at shorter intervals explains a full spectrum of addictive symptoms and behaviors.

Low aerobic performance levels have been considered one of the risk factors for premature mortality, regardless of presence of other health problems. The critical analysis of studies on the prevalence of low aerobic performance and associated factors may contribute to the epidemiological knowledge and analysis / discussion of socio-cultural aspects that influence low aerobic performance. The aim of this systematic review was to identify studies on the prevalence of low aerobic performance levels and possible associations between low aerobic performance and demographic/ biological factors, lifestyle and excess body fat in adolescents (11-19 years). The search was conducted in PubMed and SciELO databases using descriptors "aerobic capacity" or "aerobic fitness", "cardiorespiratory capacity" or "cardiorespiratory fitness", "aerobic power" or "aerobic endurance" or "cardiorespiratory endurance" and "adolescents". After the search and exclusion criteria, 33 articles were selected. Factors that were associated with low aerobic performance levels were female gender, low income, low consumption of dairy products and/or bread/cereals, increased consumption of sweetened beverages, insufficient physical activity level, excessive screen time and excess body fat. The heterogeneity of factors related to low aerobic performance levels demonstrates the complexity of this topic and the need for further studies to obtain definitive conclusions.