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Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project
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Christa L Ice, Emily Murphy, Valerie Evans Minor, William A Neal |
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Morgantown, USA
Author Affiliations: Department of Pediatrics, West Virginia University, USA (Ice CL, Murphy E, Neal WA); Department of Nursing, Alderson-Broaddus College, USA (Minor VE)
Corresponding Author: Christa L Ice, PhD, Department of Pediatrics, WVU Health Sciences, PO Box 9214, Morgantown, WV 26506, USA (Tel: 1-304-293-6515; Fax: 1-304-293-1409; Email: cice@hsc.wvu.edu)
Background: A number of cardiovascular disease (CVD) risk factors have been linked to obesity and associated negative health outcomes in children. However, no consistent definition of metabolic syndrome exists for children. In addition, research is needed to systematically examine the prevalence of metabolic syndrome in high-risk children, including those with insulin resistance. This study explores several definitions of metabolic syndrome and determines the prevalence of metabolic syndrome in a large sample of children with acanthosis nigricans (AN).
Methods: The study used results from a large-scale screening of fifth-grade students in West Virginia to explore the prevalence of metabolic syndrome among 676 male and female participants who had mild to severe AN.
Results: In this high-risk sample of students who had AN, 49% met the criteria, i.e., three risk factors including insulin resistance, high body-mass index, and elevated blood pressure or dyslipidemia, when tested for metabolic syndrome. Children with AN who were classified as obese or morbidly obese were at significantly increased odds of having metabolic syndrome.
Conclusions: Results are discussed in terms of systematically defining metabolic syndrome for high-risk children, as well as public health and clinical interventions targeting children who are overweight or obese. The presence of AN and morbid obesity might be easily observed markers for metabolic syndrome.
Key words: acanthosis nigricans; children; metabolic syndrome; obesity; risk factors
World J Pediatr 2009;5(1):23-30 |
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[Abstract] [Full Text] [PDF]
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Melamine-contaminated milk products induced urinary tract calculi in children
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Li Zhang, Ling-Ling Wu, Ya-Ping Wang, Ai-Min Liu, Chao-Chun Zou, Zheng-Yan Zhao |
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Hangzhou, China
Author Affiliations: Department of Children's Health Care (Zhang L, Wu LL, Zou CC, Zhao ZY) and Department of Nephrology (Wang YP, Liu AM), The Children's Hospital of Zhejiang University School of Medicine and Zhejiang Key Laboratory for Diagnosis and Therapy of Neonatal Diseases, Hangzhou 310003, China
Corresponding Author: Chao-Chun Zou, The Children's Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou 310003, China (Tel: +86-15067123060; Fax: +86-571-87033296; Email: zou108cc@yahoo.com)
Background: Melamine is an industrial chemical used primarily as plastics stabilizer and fire retardant. On September 11, 2008, melamine-contaminated milk products were reported to be responsible for urinary tract calculi in infants and children in China. This study aimed to investigate the prevalence, lesions, risk factors, clinical features, and management of children fed with the melamine-contaminated milk products.
Methods: A total of 15 577 infants and children fed with the milk products were screened at our hospital. Ultrasonography was performed in all the infants and children. For those found with urinary tract calculi on ultrasonography, urnalysis was done. Among them, 846 with detailed data screened from September 17 to 25 were enrolled for further analysis in this study. They were divided into calculus group (326 children) and non-calculus group (520 children) according to the results of ultrasonography. They included 429 boys and 417 girls, aged from 1 month to 5 years (median, 18 months). Their clinical and laboratory data, ultrasonograms, and treatment results were analyzed.
Results: Of the 15 577 children screened, 562 (3.61%) had urinary tract calculi. The rate was closely related to the melamine concentration in patients fed with formula. In 846 children with detailed data enrolled in this analysis, weight and head circumference Z scores in the calculus group were lower than those in the non-calculus group (P=0.048, P=0.046). Long duration of formula feeding, high melamine contained formula, and minimal water intake were the risk factors for calculi (P<0.05, respectively). Of 326 children with calculi, 281 had small calculi less than 0.5 cm in diameter, 227 had multiple calculi, and 34 had urinary tract distention. Moreover, diffuse renal lesions, renal failure and ascites were noted in 4, 3 and 2 patients, respectively. After 1-month treatment with sodium bicarbonate and Chinese traditional medicine, calculi disappeared in 49 of 54 outpatients. In 41 inpatients, 5 had calculi removed operatively and 36 had calculi minimized.
Conclusions: Melamine-contaminated milk products induced urinary tract calculi, which have a good response to conservative therapy. Long-term follow-up of infants and children fed with melamine-contaminated milk products is required, and food safety should be supervised increasingly for the health of children.
Key words: food contamination; infant; infant formula; melamine; urinary caculi
World J Pediatr 2009;5(1):31-35 |
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[Abstract] [Full Text] [PDF]
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Breast-feeding history and overweight in 11 to 13-year-old children in Iran
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Hossien Fallahzadeh, Motahareh Golestan, Taybeh Rezvanian, Zahra Ghasemian |
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Yazd, Iran
Author Affiliations: Department of Biostatistics and Epidemiology, Yazd Shahid Sadoughi University of Medical Sciences (Fallahzadeh H); Department of Pediatrics, Yazd Shahid Sadoughi University of Medical sciences, Iran (Golestan M, Rezvanian T, Ghasemian Z)
Corresponding Author: Fallahzadeh H, PhD, Department of Biostatistics and Epidemiology, School of health, Yazd Shahid Sadoughi University of Medical sciences, Yazd, Iran (Email: hofaab@yahoo.com)
Background: The relationship between breast-feeding history and risk of overweight in pre-adolescent children was investigated.
Methods: Children's breast-feeding history and demographics were obtained in interviewer-administered questionnaires of a multistage cluster sample survey of 800 parents of children aged 11-13 years living in Yazd, Iran. Height and weight were measured in the children. Overweight was defined as body mass index ¡Ý90th age- and sex-specific percentile of the 2000 Centers for Disease Control reference values.
Results: One hundred and four (13.0%) of 800 children were overweight. A total of 783 (97.9%) of the children had been breast fed. There was a markedly lower overweight prevalence among breast-fed than non breast-fed children. Controlling for age and sex, children breast fed for at least 24 months were substantially less likely to be overweight than children breast fed for less than 12 months (OR 0.56, 95% CI 0.31-0.9). A longer overall duration and duration of exclusive breast-feeding were associated significantly with the decreasing prevalence of overweight.
Conclusion: This sample of Iranian children shows high rates of overweight at young ages but also high rates of breast-feeding. The duration of breast-feeding is inversely related with the prevalence of overweight in pre-adolescent children.
Key words: body mass index; breast-feeding; epidemiology; overweight; pre-adolescent World J Pediatr 2009;5(1):36-41 |
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[Abstract] [Full Text] [PDF]
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Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection
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Ioannis Xinias, Vasiliki Demertzidou, Antigoni Mavroudi, Konstantinos Kollios, Panagiotis Kardaras, Fotis Papachristou, Georgios Arsos, Ioannis Tsiouris |
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Author Affiliations: 3rd Department of Pediatrics (Xinias I, Demertzidou V, Mavroudi A, Kollios K, Kardaras P, Papachristou F, Tsiouris I); Department of Nuclear Medicine (Arsos G), Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
Corresponding Author: Ioannis Xinias, 3rd Department of Pediatrics, Hippocration Hospital, Konstantinoupoleos 49, GR 546 42 Thessaloniki, Greece (Tel: +302310-892481; Fax: +302310-992981; Email: xinias@auth.gr)
Background: This study was undertaken to determine the incidence of urinary tract infection (UTI) and the frequency of anatomical abnormalities in newborns with unexplained jaundice and to find out if there is any correlation between bilirubin level and renal damage.
Methods: We studied 462 full-term neonates for UTI. They were aged 3-25 days, with either high (>10 mg/dL) or prolonged (>10 days) hyperbilirubinemia, with or without manifestations such as fever, vomiting, diarrhea, poor feeding, lethargy, and irritability. Neonates positive for UTI were further investigated with ultrasound, cystourethrography, and acute phase renal scintigraphy with technetium-99m dimercaptosuccinate acid (DMSA).
Results: Thirty neonates (6.5%) were found to have UTI. Twenty-eight of them had indirect hyperbilirubinemia and two had direct hyperbilirubinemia, with total bilirubin levels of 11.8-20.1 mg/dL. None of the neonates was found to have jaundice because of other reasons such as infection. Vesicoureteral reflux was found in 5 neonates and one of them was combined with hydronephrosis. Renal scintigraphy with technetium-99m DMSA showed renal cortex changes in 14 (46.7%) of the 30 neonates with UTI. These 14 neonates also had increased levels of bilirubin in comparison to those with normal findings of DMSA.
Conclusions: The incidence of UTI in uncomplicated neonatal jaundice is relatively high. Anatomical abnormalities of the urinary tract are not rare in infected children. Increased bilirubin levels are related to pathological findings in renal scintigraphy.
Key words: hyperbilirubinemia; neonates; urinary tract infection
World J Pediatr 2009;5(1):42-45 |
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[Abstract] [Full Text] [PDF]
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A practical screening model for hearing loss in Iranian school-aged children
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Mozafar Sarafraz, Khashayar Ahmadi |
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Ahwaz, Iran
Author Affiliations: Department of Otorhinolaryngology and Head and Neck Surgery, Ahwaz University of Medical Sciences, Ahwaz, Iran (Sarafraz M, Ahmadi K)
Corresponding Author: Khashayar Ahmadi, MD, Flat 1, No 51, Siami Alley, Sattarkhan Avenue, Tehran, Iran (Tel: +982166919206; Fax:+9821 66423304; Email: dr.khashayar.ahmadi@gmail.com)
Background: Hearing loss is a common and considerable disability that harms educational performance of school children in developing countries like Iran. Lack of a simple and practical screening protocol often deters routine and systematic hearing screening at school entry.
Methods: This study was to establish a practical screening model for hearing loss in school-aged children based on a community-based, retrospective case-control study in Ilam, the capital of Ilam province in Iran. Results from the audiologic and non-audiologic examination of 785 children in primary schools were selected and examined. The non-audiologic evaluation consisted of medical history, general physical examination, while the audiologic assessment consisted of otoscopy, audiometry and tympanometry.
Results: Univariate analysis of non-audiologic variables showed an association between hearing loss and male gender (P<0.05) and the grade of study (P<0.05). The frequency of impaired hearing in the first grade of primary schools was significantly higher than the children in the second grade (P<0.05). In audiologic factors related to impaired hearing, otitis media with effusion (OME) was diagnosed significantly (P<0.05).
Conclusion: Routine screening based on the identification of OME will facilitate the detection of a major amount of hearing impaired school-aged children.
Key words: hearing loss; otitis media; screening; students
World J Pediatr 2009;5(1):46-50 |
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[Abstract] [Full Text] [PDF]
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Why we are still doing so many exchange blood transfusion for neonatal jaundice in Nigeria
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Joshua Aderinsola Owa, Titus A Ogunlesi |
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Ilesa, Nigeria
Author Affiliations: Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria (Owa JA); Department of Paediatrics, Adebisi Onabanjo University Teaching Hospital, Sagamu, Nigeria (Ogunlesi TA)
Corresponding Author: Joshua Aderinsola Owa, Obafemi Awolowo University, PO Box 617, Ile-Ife, 220005, Nigeria (Email: jowa@oauife.edu.ng; jaowa2001@yahoo.co.uk)
Background: Since exchange blood transfusion (EBT) is associated with serious complications, phototherapy has been made more powerful to reduce the need for EBT in the developed world. This study was undertaken to determine the indications for EBT in neonatal jaundice (NNJ) at our unit and what proportion of EBTs was possibly avoidable.
Methods: All the babies who had EBT for hyperbilirubinemia over a three-year period were included. Age, sex, weight, place of delivery, blood group of baby and mother, other investigations, management, and the outcome of the babies were recorded.
Results: Of the 1686 babies admitted to the neonatal unit, 90 (5.3%) had EBT. Fourteen (15.6%) were inborn while 76 (84.4%) were out-born babies. Fifty-six (62.2%) babies were admitted primarily for NNJ while 34 (37.8%) developed NNJ during admission. Thirty-six (40.0%) of the babies had phototherapy for more than 24 hours prior to EBT either because they were of very low birthweight or NNJ was detected very early and therapy was so commenced. Sixty-eight (75.6%) babies had single EBT while the remaining 22 (24.4%) had two sessions of EBT. Factors associated with severe NNJ in babies requiring EBT included low birthweight (<2500 g, 44.4%), ABO incompatibility (30.0%), glucose-6-phosphate dehydrogenase deficiency (34.4%) and septicemia (26.1%). Twenty-seven (30.0%) of the neonates developed features of kernicterus: 26 before admission while 1 during admission; all except one were delivered outside the hospital.
Conclusions: The EBT rate in our center was high. With more effective phototherapy, EBT could be avoided in most of the babies who initially had phototherapy for more than 24 hours before EBT and repeated EBT sessions. Health education of the population at risk, especially pregnant women, and early referral at the primary health care level will reduce the burden of severe NNJ.
Key words: exchange blood transfusion; hyperbilirubinemia; neonatal jaundice; phototherapy
World J Pediatr 2009;5(1):51-55 |
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[Abstract] [Full Text] [PDF]
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Diagnosis and management of esophageal achalasia in children: analysis of 13 cases
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Yin Zhang, Chun-Di Xu, Abdehaman Zaouche, Wei Cai |
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Shanghai, China
Author Affiliations: Department of Pediatrics, Shanghai Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China (Zhang Y, Xu CD); Digestive Functional Exploration Department, Necker Children's Hospital, Paris, France (Zaouche A); Department of Pediatric Surgery, Shanghai Xinhua Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai, China (Cai W)
Corresponding Author: Chun-Di Xu, Department of Pediatrics, Shanghai Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China (Tel: +86-21-64370045; Email: chundixu@hotmail.com)
Background: Esophageal achalasia is a rare disease and there have been very few reports about it, especially in children. We reviewed our experience in dealing with esophageal achalasia in 13 children.
Methods: Thirteen children (6 boys and 7 girls), who had been diagnosed with achalasia over a 12-year period between May 1993 and October 2005, were analysed with regard to clinical manifestations, esophageal manometry, endoscopic findings, and treatment. Their age ranged from 3 years to 14 years and 5 months (average 10.3 years) at the time of diagnosis.
Results: In the 13 children, 3 had a family history of esophageal achalasia, 2 of them were sisters. All the 3 children suffered from achalasia/alacrimia/ACTH deficiency. Dysphagia was the most common symptom in the affected children. Vomiting/regurgitation, retrosternal pain, retarded growth, and respiratory symptoms were also observed in some patients. Heller's esophagocardiomyotomy was performed in 9 (69.23%) children, among whom 3 had an antireflux operation at the same time. In the remaining 4 children, 3 received a pneumatic dilatation and 1 received regular administration of nifedipine. Twelve patients were followed up: 8 patients by surgery were cured and have been in perfect condition until now, 3 patients recovered fairly, and 1 patient showed improvement.
Conclusions: Esophageal manometry combined with X-ray examination proves to be an effective diagnostic method for achalasia. It is also effective in evaluating the result of treatment. Heller's esophagocardiomyotomy is a treatment of choice for children with achalasia because of its safety and long-term effective results after surgery.
Key words: dysphagia; esophageal achalasia; esophageal manometry; Heller's esophagocardiomyotomy; pneumatic dilatation
World J Pediatr 2009;5(1):56-59 |
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[Abstract] [Full Text] [PDF]
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