Does gluten-free diet protect children with celiac disease from low bone density?

We aimed to assess the effect and duration of gluten-free diet on bone health in children with celiac disease in our study. Sixty three patients with celiac disease [CD] formed the study group. They were divided into two subgroups according to their dietary compliance. Bone mineral density [BMD] values of the patients at two and five years of gluten-free diet [GFD] were determined. The relationship between BMD and compliance to GFD was found to be statistically significant [P<0.01]. BMD z-scores were increased [0.12 +/- 0.15 and 0.10 +/- 0.14 units respectively] [P<0.01]. The patients in group 1 and 2 had mean -1.18 +/- 0.83 and -2.06 +/- 0.73 z-scores in the first DXA. In the second DXA, these values were -1.10 +/- 0.73 and-1.94 +/- 0.93 respectively. Dietary compliance is important for bone health, and the time needed to normalize the BMD is not known. Patients with positive anti-endomysium antibody [EMA], poor dietary history and history of bone pain should be evaluated with DXA during follow-up

Solitary Rectal Ulcer Syndrome in Children: A Report of Six Cases

Solitary rectal ulcer syndrome (SRUS) is a rare, benign disorder in children that usually presents with rectal bleeding, constipation, mucous discharge, prolonged straining, tenesmus, lower abdominal pain, and localized pain in the perineal area. The underlying etiology is not well understood, but it is secondary to ischemic changes and trauma in the rectum associated with paradoxical contraction of the pelvic floor and the external anal sphincter muscles; rectal prolapse has also been implicated in the pathogenesis. This syndrome is diagnosed based on clinical symptoms and endoscopic and histological findings, but SRUS often goes unrecognized or is easily confused with other diseases such as inflammatory bowel disease, amoebiasis, malignancy, and other causes of rectal bleeding such as a juvenile polyps. SRUS should be suspected in patients experiencing rectal discharge of blood and mucus in addition to previous disorders of evacuation. We herein report six pediatric cases with SRUS.

Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer

Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination may be affected by suppression of the immune system due to cancer therapy. Children with cancer have a high risk of hepatitis B virus [HBV] infection. We aimed to assess the pretreatment immunization status against HBV infection and the rate of continuity of immunization after therapy in children with cancer. Retrospective case review of patients treated from 2004 to 2008. We reviewed the medical records of patients treated in the departments of pediatric hematology and oncology and collected data on immunization history and hepatitis B serology. Anti-HBs antibody titers were compared before and after treatment. This study included 159 [99 males, 60 females] children who had a serologic examination. Antineoplastic therapy had been given for acute leukemia [n=66], non-Hodgkin lymphoma [n=27], Hodgkin lymphoma [n=20], and solid tumors [n=46]. Fifty-one patients had not been immunized against HBV prior to the therapy; HBV serology was negative in 49 of these patients and HBsAg was positive in 2 patients. Anti-HBs antibody positivity was present in 99 of 108 patients with an immunization history, whereas no vaccination response was present in 9 patients. The titer of anti-HBs antibody was decreased below the protection level in 33 [33%] patients with positive anti-HBs antibody, whereas the protection level was found to be maintained in 66 [67%] patients. The most significant decrease [63.6%] was observed in leukemia patients. Posttreatment HBsAg and HBV DMA positivity was detected in two of the patients with negative pretreatment serology, whereas no HBV infection developed in the group with positive anti-HBs antibody. This study demonstrated the importance of routine childhood vaccination in reducing the risk of HBV infection in patients with cancer

Hepatitis A with pleural effusion, ascites and acalculous cholecystitis

Hepatitis A virus [HAV] infection constitutes an important health problem in developing counties. It is usually a benign self-limiting disease, but may present with atypical clinical findings. A twelve-year-old male with ascites, pleural effusion, and acalculous cholecystitis during the course of HAV infection is reported. He was managed conservatively and clinical improvement was observed with resolution of HAV infection. To our knowledge, this is the first case in which all these three rare complications were observed in a single patient in the early period of disease