Author Affiliations: Section of Trauma Studies, Institute of Psychiatry, King's College London & Istanbul Center for Behavior Research and Therapy (ICBRT/DABATEM) (Şalcıoğlu E, Başoğlu M)

Corresponding Author: Ebru Şalcıoğlu, Istanbul Center for Behavior Research and Therapy (ICBRT/DABATEM), Meşelik Sok. 26/5, Sıraselviler, Beyoğlu, Istanbul 80060, Turkey (Tel: +90-212-249 6949; Fax: +90-212 245 2385; Email: Ebru.Salcioglu@iop.kcl.ac.uk)

Background: Treatment of child earthquake survivors is a relatively less investigated issue in disaster research. A review of the evidence on the mental health effects of earthquakes, risk factors, and findings from treatment studies may provide useful insights into effective treatment of traumatized children.

Data sources: Studies of child and adolescent earthquake survivors included the PILOTS database (electronic index for literature on psychological trauma) and relevant evidence from various studies of adult earthquake survivors.

Results: Evidence points to elevated rates of posttraumatic stress disorder (PTSD), depression, and earthquake-related fears in children and adolescents. Traumatic stress appears to be mediated by loss of control over fear induced by exposure to unpredictable and uncontrollable earthquakes. This implies that interventions enhancing sense of control over fear are likely to be most effective. Recent studies indeed show that a control focused behavioral treatment (CFBT) involving mainly encouragement for self-exposure to feared situations is highly effective in facilitating recovery from earthquake trauma. Evidence also suggests that CFBT can be delivered through booklets and similar media.

Conclusions: Pilot studies suggest that CFBT has promise in effective treatment of PTSD in children. Further research is needed to confirm these preliminary findings and to develop self-help tools for children.

Key words: behavioral treatment; children; disasters; earthquakes; posttraumatic stress disorder

World J Pediatr 2008;4(3):165-172

Author Affiliations: Hospital Universitario S. Juan/ Universidad M. Hernández, Alicante, Spain (Moya M)

Corresponding Author: Manuel Moya, Pediatric Department, Carretera Valencia s/n, 03550 San Juan, Alicante, Spain (Tel: +34 965 938 24; Fax: +34 965 91 94 29; Email: manuel.moya@umh.es)

Background: Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This "globesity" also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood.

Data sources: Identification of pediatric population at risk which is the one with an rBMI of 111%-120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach.

Results: A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual

Conclusions: Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.

Key words: obesity; prevention; relative body mass index; treatment

                   World J Pediatr 2008;4(3):173-185

Author Affiliations: IRCCS Istituto G. Gaslini, Pediatria II, Reumatologia and University of Genoa, Genoa, Italy (Ruperto N, Martini A)

Corresponding Author: Nicolino Ruperto, IRCCS Istituto G. Gaslini, Pediatria II-PRINTO Largo Gaslini, 516147, Genova, Italy (Tel: +39-010- 382854/+39-010-3393425; Fax: +39-010-393324/+39-010-3393619; Email: nicolaruperto@ospedale-gaslini.ge.it)

Background: Pediatric rheumatic diseases (PRDs) are rare conditions associated with significant sequelae affecting the quality of life and long-term outcome. The research aimed at studying new therapeutic approaches is difficult because of logistic, methodological and ethical problems.

Data sources: To address these problems, two international networks, the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Pediatric Rheumatology International Trials Organization (PRINTO) were established. The two networks share the goal to promote, facilitate and conduct high quality research for PRDs.

Results: The PRINTO and PRCSG networks have standardized the evaluation of response to therapy in juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus, and juvenile dermatomyositis, drafted clinical remission criteria in JIA, and provided cross-cultural adapted and validated quality of life instruments including the Childhood Health Assessment Questionnaire and the Child Health Questionnaire into 32 different languages. In this paper we reviewed how the networks of the PRINTO and PRCSG have created the basic premises for the best future assessment of PRDs.

Conclusions: The PRINTO and PRCSG networks can be regarded as a model for international cooperation or collaboration in other pediatric subspecialties.

Key words: collaborative research; clinical trials; pediatric rheumatic diseases; quality of life

                   World J Pediatr 2008;4(3):186-191

Guangzhou, China

Author Affiliations: Department of Neonatology, Guangzhou Children's Hospital, Guangzhou Medical College, Guangzhou 510120, China (Zhou W, Liu W)

Corresponding Author: Wei Zhou, MD, Department of Neonatology, Guangzhou Children's Hospital, Guangzhou Medical College, Guangzhou 510120, China (Tel: 86-20-81330577; Fax: 86-20-81861650; Email: zhouwei_pu002@126.com)

Background: The arterial partial pressure of carbon dioxide (PaCO₂) represents the balance between CO₂ production and consumption. Abnormal increase or decrease in PaCO₂ can affect the body's internal environment and function. Permissive hypercapnia has aroused more attention as a novel ventilatory therapy. The aim of this study was to elucidate the effects of hypercapnia and hypocapnia on the functions of such neonatal organs as the lung and brain.

Data sources: The PubMed database was searched with the keywords "hypocapnia", "hypercapnia" and "newborn".

Results: Hypocapnia is a risk factor for potential damage to the central nervous system, such as periventricular leukomalacia, intraventricular hemorrhage, cerebral palsy, cognition developmental disorder, and auditory deficit. Hyperventilation can lessen pulmonary artery hypertension to certain extent, but hypocapnia can aggravate ischemia/reperfusion-induced acute lung injury. Severe hypercapnia can induce intracranial hemorrhage, even consciousness alterations, cataphora, and hyperspasmia. Permissive hypercapnia can improve lung injury caused by diseases of the respiratory system, lessen mechanical ventilation-associated lung injury, reduce the incidence of bronchopulmonary dysplasia and protect against ventilation-induced brain injury. In addition, permissive hypercapnia plays a role in expanding cerebral vessels and increasing cerebral blood flow.

Conclusions: Severe hypercapnia and hypocapnia can cause neonatal brain injury and lung injury. Permissive hypercapnia can increase the survival of neonates with brain injury or respiratory system disease, and lessen the brain injury and lung injury caused by mechanical ventilation. However, the mechanism of permissive hypercapnia needs further exploration to confirm its safety and therapeutic utility.

Key words: hypercapnia; hypocapnia; newborn infant

                                                                                                           World J Pediatr 2008;4(3):192-196

Author Affiliations: The First Hospital of Lanzhou University, Lanzhou 730000, China (Jin Y, Ye XH, Li YN, Yang XM, Dong QL, Huang X); National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China (Fang ZY)

Corresponding Author: Zhao-Yin Fang, MD, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China (Tel: 86-10-63539776; Fax: 86-10-83548065; Email: fangzhyn@263.net)

Background: Human rotavirus (HRV) is the most common pathogen causing severe diarrhea among infants and young children worldwide. This study aims to understand rotavirus epidemiology and its variation in the period of 2001-2006 in Lanzhou, Gansu Province, China, and to provide an epidemiological basis for the development of rotavirus vaccine.

Methods: A total of 1019 stool specimens were collected from patients with acute diarrhea admitted to the First Hospital of Lanzhou University from 2001 to 2006, who were younger than 5 years old. Dako IDEIATM kits were used for detection of rotavirus, and RT-PCR was performed for determination of G serotype and P genotype of the rotavirus.

Results: Rotavirus was present in 51.6% (526) of the 1019 specimens. G serotype identified G3 at 40.9%, G2 14.6%, G1 22.2% and G9 1.9%. Mixed-G infection was observed in 4.4% and non-typeable infection 16.0%. P genotype was observed in 372 samples, of which P[8] accounted for 186 cases (50.0%), P[4] 72 cases (19.4%), mixed-P infection 2 cases (0.5%), and non-typeable cases 112 (30.1%). G3 was the most prevalent G serotype found in this study from 2001 to 2004, G2 was the most prevalent G serotype (34.4%) from 2004 to 2005, and G1 (61.5%) was the most prevalent strain from 2005 to 2006. G9 was detected in 10 cases (1.9%) and G4 was not detected during this 5-year period. P[8] was the most prevalent P genotype found over the 5 consecutive years of this study, although there was a significant transition of P genotype from 2004 to 2005 with P[4] (45%) identified as the predominant P genotype, followed by P[8] (22.1%). The predominant G-P combination was P[8]G1 (33.6%), followed by P[8]G3 (32.1%) and P[4]G2 (17.2%). Rotavirus diarrhea admissions peaked between October and December. Continuous surveillance showed that the incidence rate of rotavirus was the highest in infants aged 6-23 months, averaging 11.0-11.9 months.

Conclusions: Five years of continuous surveillance showed that rotavirus remains the most significant viral agent causing diarrhea hospitalization among children under 5 years old in Lanzhou, China although the predominant strain of rotavirus varies between years. Mixed-G serotype infection also appears to occur at a relatively high rate in Lanzhou.

Key words: diarrhea; epidemiology; genotype; rotavirus; variation

                   World J Pediatr 2008;4(3):197-201

Tokyo, Japan

Author Affiliations: Department of Pediatrics and Child Health, Nihon University School of Medicine, Japan (Haruyama W, Fuchigami T, Noguchi Y, Endo A, Hashimoto K, Inamo Y, Fujita Y, Takahashi S, Mugishima H)

Corresponding Author: Tatsuo Fuchigami, MD, PhD, Department of General Pediatrics, Nihon University Nerima Hikarigaoka Hospital, Nihon University School of Medicine, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo 179-0072, Japan (Tel: +81-3-3979-3611; Fax: +81-3-3979-3787; Email: tfuchi@med.nihon-u.ac.jp)

Background: Drugs such as theophylline, antihistamines, and antiallergics with anti-histaminic actions have been shown to induce febrile seizures. The relationship between febrile seizures and medications has not been actively investigated. The present study aimed to investigate the relationship between the clinical characteristics of febrile seizures and the use of medications.

Methods: Two hundred and sixty-five children treated at our emergency room due to febrile seizures were studied to investigate the relationship between the clinical characteristics of febrile seizures, such as the type and duration of convulsions, and the drug treatment.

Results: The duration of convulsions was longer among children who took theophylline and antihistamines than among children who did not take these medications. Of the antihistamines, mequitazine did not prolong the duration of convulsion.

Conclusions: Theophylline should not be used in febrile children, particularly infants. Cautions should be taken in using histamine H1 antagonists in young infants because such drugs could potentially disturb the anticonvulsive central histaminergic system. However, mequitazine appears to be a suitable antihistamine for use in children with febrile seizures, since it does not prolong convulsions.

Key words: antihistamine; febrile seizures; mequitazine; theophylline

                 World J Pediatr 2008;4(3):202-205

Author Affiliations: Department of Pediatric Surgery and Urology (Schmiedeke E, Lorenz C); Department of Clinical Psychology (Busch M); Department of Physiotherapy (Stamatopoulos E), Children's Hospital, Klinikum Bremen-Mitte, Bremen, Germany

Corresponding Author: Eberhard Schmiedeke, Klinik für Kinderchirurgie und Kinderurologie, Klinikum Bremen Mitte, 28177 Bremen, Germany (Tel: 0049-421-497-5410; Fax: 0049-421-497-3766; Email: eberhard.schmiedeke@klinikum-bremen-mitte.de)

Background: Fecal incontinence and constipation are major problems after correction of anorectal malformation (ARM), caused not only by the somatic defects but also by a psychosomatic dysfunction of defecation. To better release patients from this dysfunction we offered a multidisciplinary, psycho- and physiotherapeutic therapy according to an approach developed in Nijmegen (Netherlands). We herein summarize the preliminary results to evaluate whether the approach can be adopted with similar success.

Methods: Since January 2002 multidisciplinary behavioural treatment (MBT) has been offered to children above 3 years of age and suffering from fecal incontinence and constipation after surgical correction of ARM in our department or elsewhere. Prerequisites included no anal stenosis, regulation of stool consistency, and a suitable defecation diary over 2 weeks. MBT contained regular consultations by a pediatric psychologist and a physiotherapist, teaching the child to establish a regular defecation pattern and how to push while relaxing the pelvic floor. The entry- and post-treatment situation was prospectively monitored by means of defecation and constipation scoring systems.

Results: Complete data were available in 10 patients (9 males, 1 female) with high (8 patients) and low (2) forms of anal atresia initially, who finished MBT 2-36 months ago (mean: 13 months). The average amount of stool reaching the toilet was 27% before and 90% after therapy. Clean days were absent before, reaching 3.7 days on average after therapy. Constipation was present in 6 patients before (3 of them on enemas) and in 2 after therapy (no enemas needed). The duration of MBT was 7 months on average, range 3-23 months, with 8-9 sessions per patient, each lasting 60-90 minutes. An observation period of 7 months after treatment confirmed stable results. MBT turned out to improve body-consciousness and self-confidence.

Conclusions: MBT is effective in reducing incontinence and constipation in patients after ARM. It helps the children and their families to relieve psychosocial stress. The approach can be successfully adopted, if a team of committed specialists is available and sufficient compliance of patients and families is given.

Key words: anorectal malformation; behavioural therapy; constipation; fecal incontinence;   physiotherapy; psychotherapy

                  World J Pediatr 2008;4(3):206-210

Author Affiliations: Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India (Taksande A, Jain M, Vilhekar K, Chaturvedi P)

Corresponding Author: Amar M Taksande, Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra 442102, India (amar_bharti2000@yahoo.co.uk)

Background: Peak expiratory flow rate (PEFR) recording is an essential measure in the management and evaluation of asthmatic children. The PEFR can be measured by a simple instrument—­peak expiratory flow meter. The aim of this study was to determine the normal PEFR in rural school children from Wardha district of Maharashtra state, India.

Methods: The PEFR was measured in 1078 healthy rural school children, living in Wardha district, Maharashtra using the Mini-Wright peak flow meter. All measurements were obtained in a standing position and the best out of three trials was recorded. Anthropometric measurements, weight, height, and mid-upper-arm circumference (MAC) were recorded, and body surface area (BSA) and body mass index (BMI) were calculated.

Results: Positive correlation was seen between age, height, weight and PEFR. The regression equations for PEFR were determined for boys and girls separately. The boys had higher values than the girls at all heights. The prediction equation for PEFR based on height was PEFR = 3.64 height (cm) – 257.86 (R=0.47, R²=0.22) for female; PEFR = 4.7 height (cm) – 346.51 (R=0.62, ² =0.38) for male.

Conclusion: PEFR is a reliable measurement, which can be used routinely and regularly in rural areas for assessment of airway obstruction and prediction formula derived for use in this population.

Key words: asthma; peak expiratory flow rate; respiratory function tests

                 World J Pediatr 2008;4(3):211-214

Linköping, Sweden

Author Affiliations: Division of Pediatrics and Diabetes Research Centre, Department of Molecular and Clinical Medicine (Samuelsson U, Ludvigsson J) and Division of Drug Research/Pharmacology, Department of Medical and Health Sciences (Whiss PA), Linköping University, Sweden; Department of Pediatrics, Uddevalla Hospital, Sweden (Hanas R)

Corresponding Author: Ulf Samuelsson, Division of Pediatrics, Department of Molecular and Clinical Medicine, University Hospital, SE-581 85 Linköping, Sweden (Tel: +4613222000; Fax: +4613148265; Email: ulf.samuelsson@lio.se)

Background: HbA_1c levels are influenced by the glycemic control of previous 2-3 months. Sometimes patients have surprisingly low HbA_1c in spite of many correctly measured high blood glucose values, which is difficult to explain. As glucose sensors give an objective picture based on glucose readings several times per minute over 24 hours, we used the area under the curve (AUC) of such subcutaneous glucose profiles to evaluate their relationship with HbA_1c.

Methods: Thirty-two patients were randomized into two study arms, one open and the other blinded. Both arms had 8 pump users and 8 patients with multiple daily injections (MDI). After three months the two arms crossed over. Both study arms wore a continuous glucose monitoring system (CGMS) for 3 days every 2 weeks. HbA_1c was determined before and after each 3-month study period.

Results: There was no relationship between HbA_1c and s.c. glucose AUC or between HbA_1c and the number of peaks >15.0 mmol/L when all CGMS profiles during the 6 months were taken together. Children on MDI showed a positive relationship between HbA_1c and AUC (P<0.01) as well as the number of peaks (P<0.01). Children with a negative relationship between HbA_1c and AUC generally had fewer fluctuations in blood glucose values, whereas children with a positive relationship had wide fluctuations.

Conclusions: Although there was no relationship between s.c. glucose AUC and HbA_1c, the results indicate that wide blood glucose fluctuations may be related to high HbA_1c values. Therefore, complications and therapeutic interventions should aim at reducing such fluctuations.

Key words: blood glucose; diabetes; HbA_1c; multiple daily injections

                                                                                                             World J Pediatr 2008;4(3):215-221

Author Affiliations: Department of Pediatrics (Nikolajev K) and Department of Pulmonary Medicine (Koskela H), Kuopio University and University Hospital, Finland; Paediatric Research Centre, Tampere University and University Hospital, Finland (Korppi M)

Corresponding Author: Matti Korppi, Pediatric Research Centre, Tampere University and University Hospital, Finland (Tel: +358-3-3551-8407; Fax: +358-3-3551-8420; Email: matti.korppi@uta.fi)

Background: The aim of the study was to evaluate whether there is any association between intrauterine growth and later lung function or bronchial reactivity in early adulthood in line with Barker's hypothesis.

Methods: Nineteen twin pairs with disproportionate intrauterine growth pattern were followed up from birth: either one of the pairs had intrauterine growth retardation (birth weight <2 SD) or the within-pair birth weight difference was >1.3 SD. Flow-volume spirometry, followed by isocapnic hyperventilation of cold air, was performed at the ages of 8-16 and 14-22 years in 1993 and 1999. Wilcoxon's matched-pairs analysis was used to compare smaller and larger twin pairs.

Results: In 1993, there were no significant differences between the groups in either spirometry or cold air challenge. In 1999, such a difference was found in forced expiratory volume % (FEV%) and forced expiratory flow (FEF) at 25%-75%, the smaller twin pairs having lower values. In 1993, nine subjects reacted to cold air (>9% decrease in FEV in 1 second). In 1999, only four subjects reacted to cold air, and they all belonged to the group of smaller twins (P=0.04).

Conclusion: Lung function evaluated by FEV% and FEF25-75 was lower and responses to cold air were more common at the median age of 16 years in twins with impaired intrauterine growth.

Key words: birth weight; bronchial reactivity; intrauterine growth retardation; lung function

                 World J Pediatr 2008;4(3):222-226

Shanghai, China 

Author Affiliations: Hematology/Oncology Department (Tang JY, Chen J, Pan C); Pathology Department (Yin MZ); Diagnostic Radiology Department (Zhu M), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China

Corresponding Author: Jing-Yan Tang, MD, Hematology/Oncology Department, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China (Email: yantfk@online.sh.cn)

Background: Most cavernous hemangiomas in the spleen are small lesions that are found incidentally and patients usually present with no symptoms. Imaging is able to detect the lesions that are considered as diagnostic evidence. But some patients with diffuse cavernous hemangioma may present with anemia, thrombocytopenia, coagulopathy and bleeding, which might be misdiagnosed as idiopathic thrombocytopenia with disseminated intravascular coagulation (DIC). Splenectomy is the most effective therapy for diffuse cavernous hemangiomas with symptoms.

Methods: The history, imaging results, pathologic findings, diagnosis and treatment of a 34-month-old boy with severe petechiae were reviewed.

Results: The boy was diagnosed as having refractory idiopathic thrombocytopenia (ITP) because of low platelet count and bleeding at a local hospital. He had no response to a full-dose of corticosteroid and a high-dose of immuno-globulin (2 g/kg). Huge splenomegaly and DIC were found after 7 months. Diffuse cavernous hemangioma of the spleen was highly suspected, but it was not confirmed by B ultrasound, enhanced CT or MRI. DIC and bleeding were solved by low molecular weight heparin, supplement of fibrinogen and prothrombin complex. A diffuse cavernous hemangioma involving the whole spleen was confirmed pathologically following a successful splenectomy. The boy recovered completely without any complication after the operation.

Conclusions: Diffuse cavernous hemangioma of the spleen should be differentiated from ITP associated with splenomegaly. Radiological and overall physical examination should be emphasized for refractory ITP cases.

Key words: diffuse cavernous hemangioma; idiopathic thrombocytopenia; Kasabach-Merritt syndrome; misdiagnosis

                  World J Pediatr 2008;4(3):227-230

Cape Town, South Africa

Author Affiliations: Trauma Unit, Department of Pediatric Surgery, Trauma Unit Red Cross War Memorial Children's Hospital, 6th floor, ICH Building, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch 7701, Cape Town, South Africa (Gill HS, van As AB)

Corresponding Author: Prof AB van As, MBChB, FCS(SA), MMed, MBA, PhD (UCT), Trauma Unit, Department of Pediatric Surgery, Trauma Unit Red Cross War Memorial Children's Hospital, 6th floor, ICH Building, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch 7701, Cape Town, South Africa (Tel: +27-21-6585012; Fax: +27-21-6856632; Email: Sebastian.vanas@uct.ac.za)

Background: To report a case of fatal tension pneumocephalus in a 9-year-old boy following a severe motor vehicle accident.

Methods: A young boy with a serious closed head injury was resuscitated in the emergency room and underwent CT scan of the head and orbits.

Results: The CT-scan revealed a fracture of the orbital roof with extensive bilateral pneumocephalus.

Conclusions: A high index of suspicion for tension pneumocephalus is required in patients with severe head injuries presenting with periorbital swelling and perioccular trauma. A prompt CT scan and neurosurgical intervention are indicated.

Key words: head injuries; peri-ocular trauma; pneumocranium; trauma

                                                                                                        World J Pediatr 2008;4(3):231-233

Author Affiliations: Department of Pediatrics, Hamamatsu University School of Medicine, Japan (Iijima S, Ohzeki T)

Corresponding Author: Shigeo Iijima, MD, Department of Pediatrics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan (Tel/Fax: +81 53 435 2312; Email: sige_pd@yahoo.co.jp)