Assessment of left ventricular mass index could predict metabolic syndrome in obese children

Background: childhood obesity is a major risk factor for cardiovascular diseases in children and adults

Objectives: the purpose of this study was to evaluate the serum leptin level and the cardiac changes in normotensive obese children and to study the relationship between left ventricular mass index [LVMI] and serum leptin with the parameters of metabolic syndrome [MS] in obese children

Methods: this study was conducted in al Jeddani Hospital and Ibn Sina College Hospital in Saudi Arabia in the period from July 2012 to December 2013, and included 82 obese children. Their mean age was 10.2 +/- 2.8 years; they were divided into 25 obese children with MS and 57 obese children without MS, and 40 healthy age- and sex-matched children were also included in the study as a control group. All children were subjected to clinical assessment including standing height, body weight, body mass index [BMI], waist circumference [WC], and blood pressure measurements. All children received an echocardiographic examination [2-dimensional, M-mode, Doppler, and tissue Doppler echocardiograpy] and laboratory assessment of serum leptin level, fasting glucose, fasting insulin, the homeostatic model assessment for insulin resistance [HOMA] index, total cholesterol, triglycerides, and high- and low-density lipoprotein profile

Results: BMI, BMI standard deviation score, WC, fasting glucose, fasting insulin, HOMA index and the serum leptin level were significantly higher in obese children compared to control group [p < 0.05]. The LVMI were increased in the obese compared to the control group [p < 0.001] while left ventricle systolic and diastolic functions did not differ in obese versus control group [p > 0.05]. There was a significant positive correlation between both LVMI and serum leptin level in comparison to BMI, WC, fasting glucose, fasting insulin, HOMA, triglycerides, and low-density lipoprotein in all obese children, especially the MS group. However, there was a significant negative correlation between both LVMI and serum leptin level in comparison to high-density lipoprotein

Conclusion: assessment of LVMI as routine echocardiographic examinations and serum leptin level might be a feasible and reliable method for the evaluation of obesity and its related cardiovascular risks during childhood that can predict metabolic syndrome and insulin resistance

Comparative evaluation between rapid antigen detection test for streptococcal pharyngitis and throat culture in children

Acute upper respiratory tract infections in children may result in overuse of antibiotics as throat culture cannot be performed in every setting and results cannot be obtained early. The sensitivity of a rapid antigen-detection test [RADT] for group A streptococcal [GAS] pharyngitis is critical to whether the test is cost-effective arid to whether a confirmatory throat culture is needed. To assess the diagnostic value of rapid antigen detection test [RADT] for streptococcal pharyngitis in children and to compare it with throat culture. 600 children with signs and symptoms of acute upper respiratory tract infections were included in the study. Throat culture and RADT were performed and prevalence of GAS pharyngitis was assessed. Diagnostic value of RADT was determined. Their mean ages was 5.4 +/- 4.1 years [ranges: 8 months-18 years, median: 8 years]. The patients were subdivided into four groups according to their ages-group 1: 0-4 years [n = 152]; group 2: 5-9 years [n = 236] and group 3: 10-14 years [n = 157] and group 4: 15 years and older [n = 55]. The prevalence of GAS pharyngitis was 45.1% [n = 270/600] with RADT, and was 34.1% [n = 205/600] with throat culture. With respect to the distribution of positive cases by age, the greatest level of occurrence was between 10-14 [51%] years of age and lowest in children between 0-4 [22.1%] years. Considering the culture as the "gold standard" and considering all patients, the RADT showed a sensitivity of 87.9%, a specificity of 93%, a positive predictive value or 90.9% and a negative predictive value of 90.7%. Symptoms like scarletiform rash, tonsiller exudate and absence of cough were more frequent among the subset of children with positive RADT, with statistical significance [p < 0.001]. Diagnostic value of RADT is high and can be used safely in populations where streptococcal pharyngitis is common and a negative RADT result in our pediatric practice still requires a confirmatory throat culture

Different modalities in early diagnosis of acute appendicitis in children

Acute appendicitis [AA] is a common surgical problem that is associated with an acute-phase reaction. Previous studies have shown that cytokines and acute-phase proteins are activated and may serve as indicators for the severity of appendicitis. During inflammation, enterochromaffin cells in the appendix secrete serotonin, and 5-hydroxy indole acetic acid [5-HIAA]; a serotonin metabolite excreted in urine, has been found to be elevated in patients presenting with acute appendicitis. As there is no reliable single laboratory marker to assist in diagnosis of acute appendicitis so the aim of this study was to compare diagnostic values of different serum inflammatory markers in acute appendicitis in children. A total of 90 children were admitted in the emergency unit with suspected acute appendicitis. Fourteen children were excluded as they were diagnosed with pneumonia [4], urinary tract infection [3], tonsillopharyngitis [5] and gastroenteritis [2]. According to required treatment, patients were divided into two groups. One group comprised 46 children with acute appendicitis who had surgical intervention while the other group comprised 30 children with non-specific abdominal pain. All patients were subjected to history, clinical examination, abdominal ultrasound, white cell count, C- reactive protein, interleukin-6 and urinary 5-hydroxy indole acetic acid. Ultrasonography and urinary 5-HIAA showed the highest diagnostic accuracy [91.1% and 87.8% respectively], followed by serum IL-6 concentration [70%], white blood cell count [67.8%], clinical signs [66.7%], and serum C-reactive protein concentration [61%]. Ultrasonography and 5-HIAA achieved also the highest specificity [90.9%] and positive [91.1% and 90.7%] and negative [88.9% and 85.1%] predictive values, whereas clinical signs showed the highest sensitivity [91.3%] followed by ultrasonography [89.1%] and urinary 5-HIAA [84.8%]. Combination of ultrasonography and urinary 5-HIAA increase the diagnostic accuracy of acute appendicitis and provide surgeons with complementary information in discerning the necessity for urgent operation

Growth measures, IGF-1 and IGFBP-3 before and after adenotonsillectomy

Adenotonsillar hypertrophy [ATH] is associated with growth interruption during childhood. Its pathophysiological mechanism is unclear. The purpose of this prospective study was to evaluate whether surgical treatment of adenotonsillar hypertrophy affects the circulating concentrations of insulin-like growth factor-1 [IGF-1] and IGF-binding protein 3 [IGFBP-3] along with their standard deviation scores [SDS] adjusted to age which are more important in evaluating growth in childhood. Prepubertal children [15 males and 10 females] aged 4-10 years [mean age 6.2 +/- 3.2 years] who had chronic recurrent hypertrophic adenotonsillitis with obstructive symptoms and 25 healthy children [12 boys and 13 girls] [range 3-10 years] with a mean age of 7.4 +/- 2.5 years as control had the same measurements including Weight, height, body mass index BMI [kg/m2], IGF-1 and IGFBP-3 levels and their standard deviation scores were evaluated before and 12 months after adenotonsillectomy but once during the first examination in the control group. All parameters showed significant difference between control and studied group except weight, BMI and IGFBP-3. Both weight and height SD scores of healthy children were higher than those of children with ATH before adenotonsillectomy [P < 0.05 for both], and were also significant after adenotonsillectomy. The preoperative and postoperative serum levels of IGF-I and IGFBP-3 were compared. There was highly significant increase in IGF-I. The mean serum IGF-1 level increased from 273.1 +/- 301.3 to 659.3 +/- 402 ng/ml [p < 0.001]. Mean pre- and postoperative IGFBP-3 levels did not differ between the control and study groups. Adenotonsillectomy is a curative way to treat children with faltering growth caused by ATH

Length of hospital stay and efficacy of nebeulized hypertonic saline 3% in infants with viral Bronchiolitis

To study the efficacy of nebeulized 3% hypertonic saline [HS] for treating viral bronchiolitis in moderately ill infants and its effect on their length of hospital stay. 50 patients with bronchiolitis divided into 2 groups: Group I: 25 infants mean age 7.2 +/- 2.5 months as control received 3ml normal saline [NS] 0.9 + [0.5 ml] 5 mg terbutaline. Group II: 25 infants mean age 6.9 +/- 3.2 months received 3ml HS 3% + [0.5 ml] 5mg terbutaline. Both groups received 3 times nebeulization everyday until discharge. There was significant reduction in clinical severity score in group II in comparison to group I during days of treatment from 6.5 +/- 1.2 to 3.8 +/- 1.1 [P<0.05] and significant reduction in hospital stay in group II [3.1 +/- 1.5 days] in comparison to group I [4.2 +/- 1.8 days] [P<0.05] by 24.4%. The use of nebeulized hypertonic saline 3% is effective in treatment of moderate bronchiolitis and reduces the length of stay in hospital

Evaluation of different phenotypic methods for detection of methicillin [oxacillin] resistance in coagulase-negative staphylococci

Coagulase-negative staphylococci [CNS] are one of the major causes of nosocomial infections. Methicillin [oxacillin] resistant strains are particularly important because they narrow therapeutic options. Detecting methicillin resistance among CNS has been a challenge for years. The objective of this study was to evaluate the ability and accuracy of four phenotypic methods, disk diffusion [DD]; agar screening plate with 6 micro g of oxacillin per ml [OXA]; E-test and the MRSA-Screen latex agglutination test [Denka-Seiken, Tokyo, Japan], to determine the susceptibility of CNS to oxacillin. The methods were evaluated by using the presence of the mecA gene, as detected by PCR, as the "gold standard". One hundred and ninety seven strains of CNS of 7 species were analysed. 49.2% were mecA positive. For the different methods evaluated, the sensitivities and specificities were as follows: for disk diffusion, 93.8 and 93%, respectively; for the agar screen test 95.9 and 98%, respectively; for E-test, 100 and 95%, respectively; and for the slide latex agglutination test, 96.9 and 100%, respectively. The latex agglutination test sensitivity was increased to 100% when retested after induction. In conclusion, all of the phenotypic methods evaluated in the present study appeared to perform very well for the detection of oxacillin resistance in CNS. The MRSA-Screen latex agglutination test was not only the most sensitive, specific and accurate method but also rapid and technically simple method to be applied in routine laboratories for the detection of oxacillin resistance which is mediated by the mecA gene

Hepatitis C virus and helicobacter pylori infections in pediatric non-hodgkin's lymphoma

It has been recently hypothesized that Hepatitis C virus [HCV] and Helicobacter pylori [H.pylori] might be involved in the pathogenesis of non-Hodgkin's lymphoma [NHL]. However, most of the studies were done on adult patients. So the objective of this study was to determine the prevalence of these infections in pediatric NHL patients and if there is any possible clinical or histopathologic picture linked to the presence of these infectious agents. The study was carried out on 40 pediatric NHL patients, either as new cases or with relapsing disease, presenting to the Hematology Unit of Pediatric Department. In addition, 20 apparently healthy children were studied as control group. Each child was investigated for the presence of H.pylori and HCV IgG antibodies using enzyme immuno-assay [EIA] and for the presence of HCV-RNA by the reverse transcriptase polymerase chain reaction [RT-PCR]. H.pylori IgG antibodies were detected in 19/40 of pediatric NHL patients [47.5%] and in none of the control group [P < 0.001]; whereas HCV antibodies were found in 8/40 of the patient group [20%] and in 1/20 of controls [5%] [P > 0.05]. HCV-RNA was detected by RT-PCR in 7/40 [17.5%] of the patients and in none of the controls. No specific histological subtype, extra-nodal presentation nor stage of disease was related to H.pylori or HCV positivity. Older age group was related to H.pylori positive NHL patients. Also a positive relation between the presence of H.pylori antibodies and the complaint of vomiting and diarrhea was observed in the patient group [P < 0.001]. In conclusion, a high prevalence of HCV and H. Pylori infections was reported in pediatric NHL patients. As regard the hypothesis of their pathogenetic role in lymphomagenesis it is still unclear, whether these agents have a direct role in malignant transformation in pediatric lymphoma since a typical NHL clinico-histological feature associated with HCV and H.pylori is deficient