The importance of carotid artery stiffness and increased intimamedia thickness in obese children

Background. Atherosclerosis that starts in childhood invariablyadvances during adulthood.Aim. We aimed to study the effect of obesity on main carotidartery intima-media thickness (CIMT) and arterial stiffness.Material and methods. A total of 78 children were studied fromOctober 2010 to February 2011. They were divided into obese (n=42,group 1) and normal (n=36, group 2). All children were subjectedto physical examination, routine biochemical and haematologicalanalysis, carotid ultrasonography and echocardiographicmeasurements. A detailed medical history was obtained. Bodymass index (BMI) was calculated by dividing participants’ weight inkilograms by the square of their height in metres. Stiffness index âwas calculated using blood pressure and diameter of the systolicand diastolic artery. Intima-media thickness was also measured.Results. The mean age of the obese and normal (control) groupswas 10.12±2.12 years and 9.78±1.78 years, respectively. Weight, BMI,and systolic and diastolic blood pressure values were significantlyhigher in the obese group (all p<0.001). In terms of arterial stiffnessand CIMT measurements, all parameters were higher in the obesegroup than the control (p<0.001). There was a relationship betweenthe degree of obesity and CIMT or stiffness index â. In addition,dilatation and hypertrophy levels in the left ventricle were higherin obese children.Conclusions. Obese children with risk factors for multipleatherosclerosis could have increased CIMT dimensions and,consequently, should be screened for these risks. UltrasonographicCIMT and arterial stiffness measurements can detect vasculardamage at an early stage of development in children withcardiovascular risk factors

An achondroplasic case with foramen magnum stenosis, hydrocephaly, cortical atrophy, respiratory failure and sympathetic dysfunction

Background: Achondroplasia is a relatively frequent genetic disorder that may lead to limb weakness, motormental retardation, hydrocephaly, and respiratory disorders. In this pathology, foramen magnum stenosis and accompanying disorders like respiratory depression is well documented. Case Presentation: A 2.5 year-old child with the diagnosis of achondroplasia admitted to our clinic with severe respiratory depression, limb weakness, and motor mental retardation as well as sympathetic dysfunction. In radiologic evaluations, severe foramen magnum stenosis was detected. The patient was operated and posterior fossa decompression was accomplished to prevent compression of respiratory centers and neurons. Conclusion: This case is unique with the narrowest foramen magnum reported up to date and the sympathetic dysfunction which is not reported as a complication in achondroplasic patients. The authors review the relevant literature, focusing on the indications for cervicomedullary decompression in infants with achondroplasia. © 2012 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, All rights reserved

What is the diagnosis?

[No abstract available

Assessment of color Doppler ultrasonography findings in gynecomastia

Aim: To evaluate the color Doppler ultrasound (US) findings of gynecomastia and compare them with sonographic Tanner staging to determine an additional diagnostic tool. Patients and methods: Eighteen male (mean age 13.87 ± 1.72) patients (36 breasts) with breast enlargement were examined with gray-scale and color Doppler ultrasound (US), and these were used to determine the Tanner stages. In addition, the arterial and venous flow scores were assessed. The resistivity index (RI) values were also measured at the medial, lateral, and retroareolar regions of the breasts, and the mean RI values for each breast were then calculated. Results: Gynecomastia was detected in 30 breasts, and the mean retroareolar thickness was 8.03 mm. Furthermore, arterial and venous flows were detected in 73.3% and 56.7% of the breasts, respectively. However, there was no correlation between the arterial and venous flows and the retroareolar glandular tissue thickness. The average of the mean RI values of the three regions of the breast was 0.62, and there was a statistically significantly positive correlation between the mean RI values of the breasts and the Tanner stages as established by US. Furthermore, there was a strongly significant positive correlation between the arterial and venous flow scores and the Tanner stages. Conclusions: Our research indicates that vascularity is correlated with breast development in patients with gynecomastia. Additionally, we determined that RI values might be as important as Tanner stages on US

Rare cause of cerebral damage: Child with heatstroke found inside an enclosed vehicle

Many children suffer from preventable diseases. Heat stress is one of the neglected causes of mortality and morbidity. We report here the clinical features of a 3-year-old boy who suffered from near-fatal heatstroke in an enclosed car. He developed multiple organs failure, including neurological insult, acute renal failure, and disseminated intravascular coagulation. Although life-threatening complications were treated with supportive measures and conventional external cooling in the intensive care unit, neurological sequelae persisted. This type of heatstroke is almost always preventable. Similar to many other pediatric emergencies, it can be lifethreatening and may result in severe untoward outcomes

Free oxygen radicals associated with growth in coeliac disease

Introduction: Coeliac Disease (CD) is an immune- mediated chronic inflammatory disease of upper small intestine in genetically permanent gluten-sensitive individuals. Oxidative stress was reported to play an important role in the pathogenesis of coeliac disease. The aim of this study was to investigate the frequency of the polimorphisms in the structures of the enzymes SOD and GSHPx with changing levels depending on increased oxidative stress and whether there is an association with the mutations DQA1*0501, DQB1*0201, DRB1*04 reported frequently in coeliac disease. Methods: This study has investigated SOD and GSH-PX polymorphisms and the frequently reported mutations DQA1*0501, DQB1*0201 and DRB1*04 in the patients with CD. Height and weight measurements of the patients were obtained to evaluate their growth and development, also correlation between polymorphisms SOD and GSH-PX and concerned mutations were investigated. Results: This study involved total 56 cases, 35 female (62.5%) and 21 male (37.5%), with a mean age 6.66 ± 4.18 years. Polymorphisms SOD and GSH-PX were found in homozygote, heterozygote and wild-type patients. At least one of the mutations DQA1*0501, DQB1*0201 and DRB1*04 were found in 41 patients. Conclusion: Although etiology of coeliac disease is not entirely clear, many mechanisms have been suggested. It may be observed that the retardation of growth and development in the patients with coeliac disease may be associated with oxidative stress and decreased antioxidant capacity

Public Knowledge and Attitude toward Crimean Congo Hemorrhagic Fever in Tokat Turkey

"nBackground: The World health Organization (WHO) declares Crimean Congo hemorrhagic fe­ver (CCHF) endemic in Turkey. Despite the magnitude of problem, no documented evi­dence exists in Turkey, which reveals the aware­ness and practices of the country's adult popula­tion regarding CCHF, its spread, symptoms, treatment, and preven­tion. This study was conducted to assess the level of knowledge, attitudes, and practices regarding CCHF in people visit­ing terti­ary care hospital in Tokat, Turkey."nMethods: This questionnaire based cross-sectional survey was conducted among patients' rela­tives or guardians who ad­mitted pediatric outpatient clinics during May-July 2008. The question­naire was composed of 25 questions."nResults: A total of 1034 respondents participated in the survey. Sufficient knowledge about CCHF was not found in 28.9% of the sample. Literate individuals were relatively better informed about CCHF as compared to the illiterate peo­ple. Television and radio were con­sidered as the most important and useful source of information on the disease."nConclusion: We have found insufficient knowledge on CCHF in our population. It is thought to have no chance of suc­cess against a fatal disease such as CCHF, which has serious consequences, without the contribution of commu­nity. It is clear that there are important tasks for health, agri­culture, and media sectors to improve public knowledge and awareness about CCHF. "n Keywords: Crimean Congo hemorrhagic fever, Public knowledge, Survey, Turke

Effects of parent's presence on pain tolerance in children during venipuncture: A randomised controlled trial

Introduction: The aim of this study is to determine whether presence of parents can change tolerance of pain and distress in children. Materials and Methods: A hundred thirty five children (62 girls, and 73 boys) between 3-6 years who were admitted to the paediatric outpatient clinic were included in the study. The cases were randomised into two groups: those who were accompanied by a parent (group 1), and those who were accompanied by a hospital staff member (group 2). We used the Wong-Baker FACES Pain Rating Scale to evaluate pain. Analyses were performed using commercially software (PASW ver. 18, ID:33478001 SPSS inc. Chicago, IL). A p-value 0.05). Conclusion: As a result, our study showed that parental presence had a minimal positive effect on pain tolerance, additional randomised and controlled studies with larger groups are required before a conclusion about the issue can be reached

The importance of carotid artery stiffness and increased intima-media thickness in obese children

Background. Atherosclerosis that starts in childhood invariably advances during adulthood. Aim. We aimed to study the effect of obesity on main carotid artery intima-media thickness (CIMT) and arterial stiffness. Material and methods. A total of 78 children were studied from October 2010 to February 2011. They were divided into obese (n=42, group 1) and normal (n=36, group 2). All children were subjected to physical examination, routine biochemical and haematological analysis, carotid ultrasonography and echocardiographic measurements. A detailed medical history was obtained. Body mass index (BMI) was calculated by dividing participants' weight in kilograms by the square of their height in metres. Stiffness index ß was calculated using blood pressure and diameter of the systolic and diastolic artery. Intima-media thickness was also measured. Results. The mean age of the obese and normal (control) groups was 10.12±2.12 years and 9.78±1.78 years, respectively. Weight, BMI, and systolic and diastolic blood pressure values were significantly higher in the obese group (all p<0.001). In terms of arterial stiffness and CIMT measurements, all parameters were higher in the obese group than the control (p<0.001). There was a relationship between the degree of obesity and CIMT or stiffness index ß. In addition, dilatation and hypertrophy levels in the left ventricle were higher in obese children. Conclusions. Obese children with risk factors for multiple atherosclerosis could have increased CIMT dimensions and, consequently, should be screened for these risks. Ultrasonographic CIMT and arterial stiffness measurements can detect vascular damage at an early stage of development in children with cardiovascular risk factors