Secondary hyperlipidemia - Causes

From Pediatrics 2011;128:S213-S256

Causes of Secondary Hyperlipidemia
(i) Exogenous:
   Drug therapy: Steroids, Isotretinoin, Beta-blockers, some OCPs, select chemotherapy agents, select anti-retroviral agents.
(ii) Endocrine/metabolic:
   Type 1 and 2, DM
   Polycystic ovarian syndrome
   Acute intermittent porphyria
(iii) Renal:
   Chronic renal disease
   Nephrotic syndrome
(iv) Infectious:
   Acute viral/bacterial infections
(v) Hepatic:
   Obstructive liver disease
   Biliary cirrhosis 
   Alagile syndrome
(vi) Inflammatory diseases:
(vii) Storage diseases:
   Glycogen Storage disease
   Gaucher disease
   Cystine-storage disease
   Juvenile Tay-Sachs disease
   Nieman-Pick disease
(viii) Other causes:
   Anorexia nervosa
   Post-solid organ transplant
   Childhood cancer survivors
   Idiopathic hypercalcemia
   Klinefelter syndrome
   Werner syndrome

Lipid - Elevated Triglyceride Treatment Algorithm

From Pediatrics 2011;128:S213-S256
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Lipid - Elevated LDL treatment algorithm

From Pediatrics 2011;128:S213-S256.
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Lipid Levels - Cut-off Values

From Pediatrics;2011:128:S213-S256.
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Ectopy: Atrial vs. Ventricular?

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Atrial ectopy with aberrant conduction. Note: Small P wave is noticeable at the end of T wave preceding the ectopies.

EKG Quiz: Pacemaker

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Assuming the pacemaker is working appropriately, guess the pacemaker mode and set-rate.
Comparison of atrial rate to paced rate holds a clue to the answer.
What could be the indication for pacemaker?
What are the reasons for a 17-yr old to have this mode of pacing?


Nutrition: Idaho Plate Method (CDC 2007)

Link to Idaho Plate Method from CDC:

Food Pyramid Transformation

2012 We Can campaign sponsored by NIH
(Ways to Enhance Children's Activity &Nutrition)

2010 Dietary Guidelines Link

DASH Eating Plan
(Dietary Approaches to Stop Hypertension) - NIH ?1999
PDF handout for parents from NIH
Standby for details on DASH...
1992 Guidelines

Physical Activity Guidelines for Americans 2008

Published by HHS.
Link to a PDF version of booklet.
Or, visit http:/www.health.gov/paguidelines

How to Read Food Labels

Learning how to read food labels is an important step, to teach patients and families.
Link to AHA website (Food label page):

Guidelines for reduction of CV risk for children

AAP Guidelines - Nov 2011. (Pediatrics 2011;128 (Suppl 5): S213). Published in print Dec 2011.
This provides guidelines for management of multiple cardiovascular risk factors in children including - Weight, Diet, Lipd disorders and Hypertension.

Cardiovascular Health and Risk Reduction in Children - NHLBI & HHS publication October 2012 (Booklet - PDF version, 89 pages).

These two guidelines are the same!

Dietary Guidelines for Americans 2010

This is an useful reference - also included guidelines from children. Click here for a PDF version
Or visit the website: www.dietaryguidelines.gov

Choose My Plate compaign (Jun 2011): http://www.choosemyplate.gov/


Nutrition: Salty Six

According to American Heart Association:
The "Salty Six"
1) Breads & Rolls (230 mg per piece)
2) Cold cuts and cured meat (1 g per pre-packaged turkey)
3) Pizza (760 mg per slice)
4) Chicken (amount depends on type of processing)
5) Soup (940 mg per cup)
6) Sandwiches (Ketchup, mustard,..) (1.5 g per sandwich)

Problem with this list is that it is not memorable! And, the items in the list are not mutually exclusive. For example, a sandwich contains breads/rolls, cold cut/cured meat or chicken. Thus, 1, 2 and 4 are actually the 6!

Angiotensin receptor blocker (ARB) in Marfan syndrome

NEJM 2008;358:2787-95.

Losartan started at 0.6 mg/kg/day x 3 weeks. Increased gradually to 1.4 mg/kg/day.
Ibesartan started at 1.4 mg/kg/day. Increased to 2.0 mg/kg/day

Link to posting about this article in Journal Club blog.


MRI Safety & Devices

Website with information regarding safety of MRI in patients with implanted devices.

Incomplete Kawasaki - Algorithm

Algorithm for diagnosis of Incomplete Kawasaki Disease
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