Efficacy, Tolerability, and Acceptability of Iron Hydroxide Polymaltose Complex versus Ferrous Sulfate: A Randomized Trial in Pediatric Patients with Iron Deficiency Anemia

Iron polymaltose complex (IPC) offers similar efficacy with superior tolerability to ferrous sulfate in adults, but randomized trials in children are rare. In a prospective, open-label, 4-month study, 103 children aged >6 months with iron deficiency anemia (IDA) were randomized to IPC once daily or ferrous sulfate twice daily, (both 5 mg iron/kg/day). Mean increases in Hb to months 1 and 4 with IPC were 1.2 ± 0.9 g/dL and 2.3 ± 1.3 g/dL, respectively, (both P = 0.001 versus baseline) and 1.8 ± 1.7 g/dL and 3.0 ± 2.3 g/dL with ferrous sulfate (both P = 0.001 versus baseline) (n.s. between groups). Gastrointestinal adverse events occurred in 26.9% and 50.9% of IPC and ferrous sulfate patients, respectively (P = 0.012). Mean acceptability score at month 4 was superior with IPC versus ferrous sulfate (1.63 ± 0.56 versus 2.14 ± 0.75, P = 0.001). Efficacy was comparable with IPC and ferrous sulfate over a four-month period in children with IDA, but IPC was associated with fewer gastrointestinal adverse events and better treatment acceptability

Main rules for rational antibiotics use in pediatrics

The spectrum of antibiotics and diseases which are treated with antibiotics are increasing. Antibiotics should be used in correct diagnosis, indication, dose, and way of consumption. Antibiotics should be started after pending the cultures. Empiric choosing of antibiotics could be preferred in emergency and severe conditions. (Turk Arch Ped 2010; 45: 80(th) Year: 50-2

EVALUATING RASH IN FEBRILE CHILDREN

Fever accompanied by rash is a common complaint in pediatric practice. Mostly these conditions are caused by different viruses and self-limited. But, it may also be the first and only sign of serious and life-threatening bacterial infections, like meningococcemia and bacterial sepsis. The most important step in the diagnostic process is a detailed clinical examination. A detailed physical examination can easily lead the physician to the correct diagnosis. The rash in children is often maculopapular and nonspecific. However a petechial rash should be evaluated as meningococcemia until the contrary is proven. Most common diseases presenting with fever and rash are measles, rubella, scarlet fever, erythema infectiosum, roseola infantum, Epstein-Barr virus infection, cytomegalovirus (CMV) infections, Kawasaki disease and for our country Crimean-Congo hemorrhagic fever

MANAGEMENT OF LYMPHADENOPATHY IN CHILDHOOD

Lymphadenopathy is a common symptom in children. Although, the most common causes are infection and autoimmune diseases, most dangerous are malignancies. It can be local or generalized. In local lymphadenopaties infections are prominent causes but in generalized forms systemic diseases should be considered. The rate of malignancy is 1-3 % and lymphomas are most common. Ultrasonography can be helpful with some of the findings to the physician for differential diagnosis and malignancy. If diagnosis could not be confirmed or malignancy is suspected, biopsy is essential

UP-TO DATE APPROACH TO ACUTE BRONCHIOLITIS

Acute viral bronchiolitis is a very common disease of infancy, characterized by the respiratory distress caused usually by Respiratory Syncytial Virus (RSV). Lungs are diffusely affected and no spasm occurs in bronchial smooth muscles. High fever is unusual. Following rhinorrhea and coughing; prolonged expirium, tachypnea and respiratory distress occur. Diffuse wheezing is typical. Because of the risk of hypoxemia oxygen saturation must be closely followed and oxygen support should be provided if necessary. Patients are under the risk of dehydratation owing to insufficient oral intake. The diagnosis of acute bronchiolitis is based on the clinical findings, so laborotary studies are unnecessary. The main steps of the treatment are maintaining sufficent oxygenation, securing the liquid and electrolyte balance and drug therapy. Nebulized adrenalin can be partially helpful by reducing the airway edema. Nebulized salbutamol may be tried although its effect is questionable because of the absence of bronchospasm. However, it should not be continued if there is no benefit. The benefits of inhaled and oral corticosteroids are controversial. Antibiotics are unnecessary. The preventive measures include general infectious precautions, hand washing, environmental hygienic precautions, use of a mask if necessary, withholding sick kids from school, continuation of breastfeeding and preventing passive smoking. RSV vaccine is not available yet

Atypical lung involvement in a patient with systemic juvenile xanthogranuloma

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis characterized by xanthoma-like cutaneous lesions. It is a benign condition that is generally asymptomatic. Visceral involvement is uncommon, but when present may occur in various locations and in different combinations. Pulmonary involvement has been reported as bilateral, multiple micro- or macronodular lesions. We present a 10-year-old boy with systemic (skin, lung, liver and kidney) JXG who showed lung involvement with mainly an interstitial pattern. Bilateral multiple micronodules in both lungs and mediastinal adenopathy were also present

Effects of iron deficiency anemia on cognitive function in children

Objective: To examine the effects of iron deficiency anemia on cognitive function and intelligence in children

Different clinical presentation of infectious mononucleosis in children: a retrospective analysis of 369 cases

Aim: The aim of this study was to investigate the clinical findings and serologic test results of the patients diagnosed with Epstein-Barr virus (EBV)-induced infectious mononucleosis

A case with quadriparetic cerebral palsy and cyanosis: Congenital methemoglobinemia

The recessive form of congenital methemoglobinemia, caused by a defect of nicotinamide adenine dinucleotide-cytb5 reductase enzyme (cytb5r), is a rare disorder clinically presenting with cyanosis. Two different forms of recessive congenital methemoglobinemia have been described: In type I, cyanosis is the only major symptom and enzyme deficiency is restricted to erythrocytes. In type II, observed in 10-15% of all patients, enzyme deficiency occurs in the entire body and cyanosis is associated with severe, progressive neurologic impairment. This report presents a 10-year-old female with recessive congenital methemoglobinemia type II. She was admitted with quadriparetic cerebral palsy, mental retardation, convulsions, swallowing difficulty, and cyanosis. Etiology of cyanosis was not clarified exactly but was readily but erroneously attributed to uncontrolled, repetitive convulsions and aspiration of excessive oral secretions. Her methemoglobin level was measured as 51%, and a diagnosis of congenital methemoglobinemia was established. Oral ascorbic acid 500 mg/day was initiated. She responded well to therapy. Interestingly, neurologic deficits improved after ascorbic acid treatment. In conclusion, cyanosis and repetitive convulsions associated with neurologic deficits may be explained by congenital methemoglobinemia, a potentially treatable condition. (c) 2005 by Elsevier Inc. All rights reserved