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Impact of childhood obesity treatment on body composition and metabolic profile
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Marja Kalavainen, Pauliina Utriainen, Esko Vanninen, Matti Korppi, Outi Nuutinen |
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Author Affiliations: Departments of Pediatrics and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland (Kalavainen M); Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Finland (Utriainen P); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Finland (Vanninen E); Pediatric Research Center, Tampere University and University Hospital, Tampere, Finland (Korppi M); Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Nuutinen O)
Corresponding Author: Matti Korppi, Pediatric Research Center, Tampere University and University Hospital, FinMed-3 building, FIN-33014 Tampere University, Finland (Tel: +358-3-35518407; Fax: +358-3-35538420; Email: matti.korppi@uta.fi)
Background: Childhood obesity is associated with adverse changes in cardiometabolic risk factors. A family-oriented group program stressing a health-promoting lifestyle has been more effective than routine counselling in the treatment of obesity in school children. The aim of the present study was to compare the impact of group program and routine councelling on body composition and metabolic profile, and to evaluate the associations of changes in adiposity with levels of cardiometabolic risk factors.
Methods: Seventy obese prepubertal children were randomized into family-oriented group program (15 sessions for parents and children) and routine counselling (2 appointments for children). Body mass index (BMI), body composition and different metabolic risk factors were assessed before and after the 6-month intervention.
Results: Waist/height decreased more in the children attending the group treatment, but there were no significant differences between treatment arms in the changes of metabolic risk factors. When the arms were analyzed as combined, serum triglycerides decreased significantly if BMI standard deviation score (BMI-SDS) decreased ≥0.5. Serum fasting insulin decreased if BMI-SDS decreased ≥0.25.
Conclusions: Obesity-related metabolic risk factors reduced in prepubertal children if BMI-SDS decreased substantially. This result was not dependent on which intervention, family-oriented group program or routine counselling, was used.
Key words: body composition; childhood obesity; metabolism
World J Pediatr 2012;8(1):31-37 |
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[Abstract] [Full Text] [PDF]
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Cross-cultural adaptation and reliability of pediatric sleep questionnaire in assessment of sleep-disordered breathing in the Malay speaking population
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AL Hasniah, AR Jamalludin, AW Norrashidah, MZ Norzila, K Asiah, A Rus Anida, A Ahmad Fadzil, Z Ramli, H Samsinah |
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Author Affiliations: Pediatric Department, Universiti Kebangsaan Malaysia Medical Centre, Malaysia (Hasniah AL); Department of Community Health, International Islamic University Malaysia (Jamalludin AR); Pediatric Department, Serdang Hospital, Malaysia (Norrashidah AW); Pediatric Institute, Kuala Lumpur Hospital, Malaysia (Norzila MZ, Asiah K); Pediatric Department, Penang Hospital, Malaysia (Rus Anida A); Pediatric Department, Tengku Ampuan Afzan Hospital, Malaysia (Ahmad Fadzil A); Institute for Health Systems Research, Malaysia (Ramli Z); University of Malaya, Kuala Lumpur, Malaysia (Samsinah H)
Corresponding Author: Assoc. Prof. Dr Abdul Latif Hasniah, Pediatric Department, Universiti Kebangsaan Malaysia Medical Centre, Jln Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia (Tel: +6 03 91455395/91455380; Fax: +603-91456637; Email: hasniah@ppukm.ukm.my)
doi: 10.1007/s12519-011-0279-3
Background: Sleep-disordered breathing (SDB) is common but often underdiagnosed in children. The Pediatric Sleep Questionnaire developed by University of Michigan, USA (English UM PSQ) has high sensitivity and specificity in identifying children with sleep-disordered breathing. This study aimed to translate and adapt the English UM PSQ into Malay language as a screening tool to assess SDB among the Malay speaking population. The second objective was to determine the psychometric measurements of the translated UM PSQ (Malay UM PSQ).
Methods: The Malay UM PSQ was translated through forward-backward translation techniques by two independent accredited bodies and reviewed by a panel of experts. The questionnaire was tested in two phases. The respondents were from hospital staffs with children and parents of primary school children aged 6-10 years. The reliability of questionnaires was measured by Cronbach's α and Kappa (κ) statistics.
Results: The overall scale of internal consistency of the Malay UM PSQ was good, i.e., Cronbach's α = 0.760 (α = 0.457, 0.608 and 0.688 for snoring, sleepiness and behavioral domains respectively). The English UM PSQ also had good internal consistency at α = 0.753 (α = 0.589, 0.524, to 0.793 for snoring, sleepiness and behavioral domains respectively). Test-retest reliability for most items was good with correctness of >85.0% in all items. Only one item was seen in the Malay UM PSQ with κ=0.348, while the remaining ranged from κ=0.489 to 0.811. For the English UM PSQ, κ ranged from 0.660 to 0.945.
Conclusion: Both English and Malay UM PSQ have acceptable psychometric measurement properties as screening tools to assess SDB in the Malay speaking population.
Key words: pediatric; questionnaire; reliability; sleep-disordered breathing
World J Pediatr 2012;8(1):38-42 |
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[Abstract] [Full Text] [PDF]
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Epidemiological features and risk factor analysis of children with acute lung injury
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Yan Li, Quan Wang, Hui Chen, Heng-Miao Gao, Tong Zhou, Su-Yun Qian |
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Author Affiliations: Department of PICU, Beijing Children's Hospital of Capital Medical University, No. 56 Nan Li Shi Road, Beijing 100045, China (Li Y, Wang Q, Chen H, Gao HM, Qian SY); Department of Nuclear Medicine, Dongzhimen Hospital affiliated to Beijing University of Traditional Chinese Medicine, Beijing 100700, China (Zhou T)
Corresponding Author: Su-Yun Qian, MD, Department of PICU, Beijing Children's Hospital of Capital Medical University, No. 56 Nan Li Shi Road, Beijing 100045, China (Tel: +86-010- 59612765; Fax: +86-010-59718726; Email: syqian@yahoo.com.cn)
doi: 10.1007/s12519-012-0334-8
Background: Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) represents a devastating complication observed in critical care medicine. The purpose of this study is to investigate the epidemiological aspects of ALI/ARDS in pediatric intensive care unit (PICU) and risk factors of mortality.
Methods: Patients with ALI/ARDS in PICU of Beijing Children's Hospital, a tertiary medical center from November 1, 2005 to October 31, 2006 were included in this prospective study. We identified the risk factors for underlying diseases and mortality during a 3-month follow-up using multivariate logistic regression analysis.
Results: In 562 critically ill patients admitted to PICU of Beijing Children's Hospital, there were 15 ALI-non ARDS patients and 29 ARDS patients, resulting in an incidence of 7.8% (44/562). The mortality rate of ARDS was 24.1% (7/29) and that of ALI/ARDS was 18.2% (8/44). At a 3-month follow-up, 12 patients died after being discharged from PICU and the total mortality rate was 45.5% (20/44). ALI/ARDS patients with pulmonary disease had better outcomes than those with extra-pulmonary involvements (P<0.05). Discharge against medical advice, low PaO2/FiO2 during hospital stay and high PaCO2 on PICU admission were risk factors of mortality.
Conclusions: ARDS has a high mortality rate in PICU, especially in those with extra-pulmonary diseases. In addition to aggressive medical management of comorbidity, lung protection and avoidance of discharge against medical advice will decrease the mortality.
Key words: acute lung injury; acute respiratory distress syndrome; children; epidemiology; risk factor
World J Pediatr 2012;8(1):43-46 |
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[Abstract] [Full Text] [PDF]
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The course of early-onset multiple sclerosis in Iraqi children
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Hasan A. Al-Hamadani, Atheer S. Abdalla, Atheer J. Al-Saffar |
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Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that is increasingly recognized worldwide in children and adolescents. The current study aimed at identifying the clinical characteristics of MS with onset under 18 years of age.
Methods: This cross-sectional study was conducted in the Multiple Sclerosis Center archive system in Baghdad Teaching Hospital during the period from March 1 to May 15, 2008. The records of 1125 MS patients from 2000 to 2008 were reviewed. Among them 77 patients had the onset of MS under 18 years of age.
Results: Two thirds of the patients were female (a female/male ratio of 1.6:1). The mean age of the patients at the onset of the disease was 14.95±3.21 years, and the mean time between the first and second attacks was 3.06±4.09 years. Seventy patients (90.9%) had an initial course of relapse remitting MS. Among them 9 (12.9%) progressed to secondary progressive MS after a mean duration of 9.87±4.14 years. The remaining 7 patients had primary progressive MS associated with optic neuritis and brain stem lesion. Fifty-nine (76.6%) patients had monofocal signs and 18 (23.4%) had polyfocal signs. The mean extended disability status scale score was 4.15±2.17 and the mean progression index was 1.44±2.31. There was a strong inversed correlation between the progression index and interval between the first and second attacks (P=0.0001).
Conclusions: The results of the present study show that the course of MS in Iraqi children and adolescents is more aggressive than in children from other countries. This finding needs to be evaluated by further studies.
Key words: clinical presentation; early-onset; multiple sclerosis
World J Pediatr 2012;8(1):47-51 |
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[Abstract] [Full Text] [PDF]
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Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection
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Nikoleta Printza, Evagelia Farmaki, Kalliopi Piretzi, George Arsos, Konstantinos Kollios, Fotios Papachristou |
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Author Affiliations: 1st Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece (Printza N, Farmaki E, Piretzi K, Papachristou F); Department of Nuclear Medicine, Hippokration General Hospital, Greece (Arsos G); 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece (Kollios K)
Corresponding Author: Nikoleta Printza, MD, 1st Pediatric Department, Aristotle University, Hippokration Hospital, 49 Konstantinoupoleos St., GR-546 42 Thessaloniki, Greece (Tel: +30-2310-892425; Fax: +30-2310-865189; Email: nprintza@in.gr)
doi: 10.1007/s12519-012-0335-7
Background: 99mTc-dimercaptosuccinic acid (DMSA) scan is the golden standard for the diagnosis of acute pyelonephritis and renal scaring. We investigated the use of acute phase DMSA scan in infants presented promptly to the hospital because of the first episode of their febrile urinary tract infection (UTI).
Methods: Ninety-eight infants with microbiologically confirmed first episode of febrile UTI were studied. DMSA scans were carried out within 7 days in these infants after admission. Infants with an abnormal acute DMSA scan underwent a second DMSA scan 6-12 months later.
Results: Overall, acute DMSA scan was abnormal in 16 (16.3%) of the 98 patients. There were no differences in sex, age, fever over 38.5°C, blood inflammation indices, or evidence of vesicoureteral reflux (VUR) between patients with normal and abnormal acute DMSA scan (P>0.05). However, infants with grade III to V VUR as well as those with delayed treatment presented significantly increased renal involvement by acute DMSA scan (P<0.05). The sensitivity and specificity of abnormal acute DMSA scan to predict grade III to V VUR were 50% and 88% respectively. Its positive and negative likelihood ratios were 4.16 and 0.57, respectively. Of 16 children with abnormal initial DMSA scan results, 14 underwent a second DMSA scan. Follow-up DMSA scans were normal in 12 of the 14 children.
Conclusions: Parenchymal damage found in a minority of infants with febrile UTI presented promptly to the hospital. Acute phase DMSA scan should be carried out only in selected patients. An abnormal acute DMSA scan is a moderate predictor for dilated VUR and its ability to exclude VUR is restricted.
Key words: 99mTc-dimercaptosuccinic acid; infants; pyelonephritis; vesicoureteral reflux; urinary tract infection
World J Pediatr 2012;8(1):52-56 |
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[Abstract] [Full Text] [PDF]
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Laparoscopic pyloromyotomy: is a knife really necessary?
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Vishesh Jain, Subhasis Roy Choudhury, Rajiv Chadha, Archana Puri, |
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Author Affiliations: Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi-110001, India (Jain V, Roy Choudhury S, Chadha R, Puri A, Naga AS)
Corresponding Author: Vishesh Jain, D-9, Green Park extension, New Delhi, India-110016 (Tel: 91-011-32531393; Email: dr.vishesh79@gmail.com) This work was presented at the 22nd Congress of the Asian Association of Pediatric Surgeons held on February 22-24, 2010, Kaula Lampur, Malaysia.
doi: 10.1007/s12519-011-0278-4
Background: Laparoscopic pyloromyotomy (LP) is currently accepted as a suitable treatment modality for infantile hypertrophic pyloric stenosis (IHPS). In this report, we describe some technical modifications of LP using a 3- or 5-mm hook with electrocautery as a substitute for a knife for incising the pylorus. The outcomes of LP using a standard retractable pyloromyotomy knife are compared with those of LP using a hook electrocautery.
Methods: The patients with ultrasound proven IHPS who had undergone LP in a single institution from December 2008 to April 2010 were retrospectively analyzed. Incision on the pylorus was made with a 3-mm pyloromyotomy knife in the initial 12 cases. However, in the latter part of the study, a 3- or 5-mm hook with electrocautery was used for the incision. A Maryland dissector was used for completing the pyloromyotomy. The results were compared in terms of duration of surgery, complications, time taken to establish the first full feed, requirement of analgesics, postoperative emesis, and postoperative stay in the hospital. Independent sample t test and the Chi-square test were used for statistical analysis.
Results: Of the 27 patients analyzed, 12 underwent LP using a pyloromyotomy knife and the remaining 15 patients were operated on using a hook with electrocautery instead of the knife. The operating time, time taken to establish the first full feed, and duration of hospital stay were comparable among the two groups with no statistically significant difference. No complications were recorded in either group.
Conclusions: Use of hook electrocautery for incising the pylorus provides a bloodless field without affecting the postoperative recovery and outcome. It also obviates any need of specialized instruments like a pyloromyotomy knife or other sharp instruments for pyloric incision.
Key words: infantile hypertrophic pyloric stenosis; laparoscopy; pyloromyotomy World J Pediatr 2012;8(1):57-60 |
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[Abstract] [Full Text] [PDF]
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Niemann-Pick disease type C: analysis of 7 patients
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Hui Xiong, Xin-Hua Bao, Yue-Hua Zhang, You-Ning Xu, Jiong Qin, Hui-Ping Shi, Xi-Ru Wu |
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Author Affiliations: Department of Pediatrics, Peking University First Hospital, Beijing 100034, China (Xiong H, Bao XH, Zhang YH, Qin J, Wu XR); Department of Pediatrics, Beijing Changping District Hospital, Beijing, China (Xu YN); Department of Genetics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Shi HP)
Corresponding Author: Xi-Ru Wu, MD, Department of Pediatrics, Peking University First Hospital, Beijing 100034, China (Tel: 0086-10-83573238; Fax: 0086-10-66530532; Email: xh_bjbj@yahoo.com.cn)
doi: 10.1007/s12519-011-0284-6
Background: Niemann-Pick disease type C (NP-C), derived from mutation of the NPC1 or NPC2 gene, is one of the recessive lysosomal lipid storage disorders that are difficult to diagnose and treat. Since NP-C has been rarely reported in China, we reviewed 7 patients with NP-C.
Methods: The 7 patients had been diagnosed with NP-C from 2007 to 2010 at our department and their laboratory and clinical data were analyzed.
Results: The 7 patients, 5 males and 2 females, included 4 patients of late infantile subtype and 3 patients of juvenile subtype, in which patients 2 and 3 were siblings. Their clinical symptoms occurred from 4 to 10 years of age, exhibiting as progressive cognitive and language impairment as well as motor retrogression. Six patients were caught by focal or generalized seizures from 1 to 4 years after the onset of the disease. Vertical supranuclear gaze palsy, dysarthria, dysphagia, internal rotation and adduction of bilateral hands and splenomegaly occurred following the progress of clinical symptoms. Five patients had laughter-cataplexy. MRI showed mild brain atrophy in 6 patients. Reduction of total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol occurred in 6 patients. Sea-blue cells and Niemann-Pick cells were found in bone marrow smears. The activity of acid sphingomyelin enzyme was normal or only slightly lower. Supporting or symptomatic treatment improved common clinical symptoms.
Conclusions: NP-C is a rare autosomal recessive inherited lysosomal storage disease that affects the intellectual development of children and may lead to dementia, vegetative state or death. Clinical features of this disease include vertical supranuclear gaze palsy, seizures and cataplexy. Laboratory features include abnormal plasma cholesterol level, and sea-blue cells and Niemann-Pick cells in bone marrow smears. The treatments of the disease include supporting or symptomatic administration.
Key words: Niemann-Pick disease type C; sea-blue cells; vertical supranuclear gaze palsy
World J Pediatr 2012;8(1):61-66 |
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[Abstract] [Full Text] [PDF]
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A novel heterozygous NR1H4 termination codon mutation in idiopathic infantile cholestasis
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Xiu-Qi Chen, Lin-Lin Wang, Qing-Wen Shan, Qing Tang, Ya-Nan Deng, Shu-Jun Lian, Xiang Yun |
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Author Affiliations: Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021 Guangxi, China (Chen XQ, Wang LL, Shan QW, Tang Q, Deng YN, Lian SJ, Yun X)
Corresponding Author: Lin-Lin Wang, Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021 Guangxi, China (Tel: +86-771-5356505; Fax: +86-771-5356781; Email: WLL276@yahoo.com.cn)
doi: 10.1007/s12519-011-0299-z
Background: This study aimed to evaluate the genetic effect of the NR1H4 gene in the pathogenesis of idiopathic infantile cholestasis of Chinese subjects in Guangxi, China.
Methods: Seventy-eight patients with idiopathic infantile cholestasis served as a study group and 95 infants without cholestasis as controls. Genomic DNA was extracted from peripheral venous blood leucocytes by phenol chloroform procedures. Polymerase chain reaction (PCR) was used to amplify all coded exons of NR1H4, and single-strand conformation polymorphism (SSCP) was used to analyze all amplification fragments. The PCR products with abnormal bands in SSCP were sequenced using an ABI 3100 sequencer.
Results: A novel heterozygous termination codon mutation in NR1H4 exon 5 (NR1H4 R176X, CGA-TGA) was found in one of the 78 patients. The patient with mutation R176X had high levels of bilirubin, alanine aminotransferase, γ-glutamyltransferase, cirrhosis and ascites despite biliary tract flushing procedures and drug therapy. In the other patients and controls, no mutation was detected.
Conclusions: Heterozygous termination codon mutation of NR1H4 R176X was found in idiopathic infantile cholestasis. The novel mutation is useful to establish particular characteristics for differential diagnosis of idiopathic infantile cholestasis and to determine the influence of such gene defects in the prognosis.
Key words: cholestasis; farnesoid X receptor; infant; mutation; NR1H4
World J Pediatr 2012;8(1):67-71 |
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[Abstract] [Full Text] [PDF]
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