Ambulatory blood pressure parameters in office normotensive obese and non-obese children: relationship with insulin resistance and atherosclerotic markers

To determine differences in ambulatory blood pressure [ABP] parameters between office normotensive obese and non-obese children and to evaluate correlations of ABP parameters with insulin resistance and the lipid profile. Thirty-eight obese [body mass index [BMI] above the 95th percentile] and 38 non-obese children aged 9-17 years were recruited. All subjects who were normotensive during office visits and who underwent 24-hour ABP monitoring were evaluated. Insulin resistance and the lipid profile were also evaluated. The mean daytime, night-time and 24-hour systolic blood pressure [SBP] and the daytime and 24-hour diastolic blood pressure [DBP] in normotensive obese children were significantly higher compared to the values in non-obese children [p < 0.05]. There was no difference in the frequency of nocturnal non-dippers and nocturnal hypertension [night-time SBP at or above the 95th percentile] between the two groups [p > 0.05]. Children with night-time SBP at or above the 95th percentile and non-dippers had higher atherosclerotic markers than children with night-time SBP below the 95th percentile and dippers [p < 0.05]. In logistic regression analysis, the low-density lipoprotein cholesterol [LDL-C]:high-density lipoprotein cholesterol [HDL-C] ratio and night-time SBP had significantly positive associations with being obese in adolescents [OR 6.54, 95% CI 1.15-37.07, p = 0.03, and OR 1.1, 95% CI 1.01-1.19, p = 0.02, respectively]. Normotensive obese children had higher ABP parameters. A high LDL-C: HDL-C ratio and night-time SBP were associated with an increased risk of being obese. High LDL-C: HDL-C ratios and total cholesterol: HDL-C levels in children and adolescents may be risk factors for night-time hypertension

case of Henoch-Schonlein purpura with P369S mutation in MEFV gene

Henoch-Schonlein purpura [HSP] is the most common vasculitis of childhood. HSP can affect multiple organs presenting with a characteristic rash in most of the patients. Familial Mediterranean Fever [FMF] is an inherited inflammatory disease common in mediterranean populations. HSP is the most common vasculitis seen in children with FMF. A 16 year old boy was referred with history of abdominal pain lasting for 20 days. He was hospitalized and had appendectomy. Due to the persistence of his abdominal pain after surgery he was admitted to our hospital. His physical examination showed palpable purpuric rashes symmetrically distributed on lower extremities. Abdominal examination revealed periumbilical tenderness. Laboratory tests showed elevated erythrocyte sedimentation rate, C-reactive protein and fibrinogen. Urinalysis revealed microscopic hematuria and severe proteinuria. The fecal occult blood testing was positive. Based on these clinic findings, the patient was diagnosed as HSP with renal, gastrointestinal tract and skin involvement. We performed DNA analysis in our patient because he had diagnosis of vasculitis with severe symptoms and found that he was carrying heterozygote P369S mutation. Our case is noteworthy as it indicates that it may be important not to overlook presence of FMF mutations in patients with a diagnosis of severe vasculitis