Efficacy of Prednisone in Children with Acute Nonspecific Mesenteric Lymphadenitis: A Pilot Study.

BACKGROUND: Acute nonspecific mesenteric lymphadenitis (ANML) is a common cause of acute abdominal pain in children with no specific treatment. METHODS: A total of 13 patients (6 boys, 7 girls) aged 7.3 (5-13.5) years with severe acute abdominal pain were evaluated using ultrasonography and laboratory tests to establish the diagnosis of ANML. They were treated with prednisone 1 mg/kg (max 40 mg daily) for a maximum of 5 days. The intensity of abdominal pain was evaluated before and after treatment using a numeric rating scale. RESULTS: All patients had pain scores above 6/10 before, and below 4/10 after treatment with prednisone. Intensity of abdominal pain after treatment for 1-5 days decreased significantly (p < 0.001), with no recurrence at follow-up within 3 months. All other pre-existing signs and symptoms, such as nausea, vomiting, anorexia, fever, diarrhea, and constipation were found to disappear with no adverse effects of corticosteroid therapy. CONCLUSION: These results suggest that the treatment with prednisone in selective patients with ANML can reduce the duration of abdominal pain.

[Nutritional status and body composition of the erderly at the Geriatric Center in Subotica]. / Az idosek tápláltsági állapota és testösszetétele a szabadkai Gerontológiai Központban.

INTRODUCTION: Nutritional assessment is the most effective way of preventing obesity and malnutrition in the elderly. AIM: The aim of our study was to assess the nutritional status of people living in the nursing home, and to determine blood glucose and arterial blood pressure. METHOD: In November 2017, thirty-six people aged over 60 were included in the study. The body composition was determined by bioimpedance scale 'In Body 230'. The fasting blood glucose level was determined by a digital blood glucose meter and the arterial blood pressure was determined by a digital blood pressure monitor. RESULTS: Body composition of the participants showed that 36.1% are classified as overweight (body mass index [BMI] 25-29.9 kg/m2) and 36.1% as obese (BMI≥30.0 kg/m2). Obesity (50%) is predominantly recorded at the age of 75-84 years. 44% of the subjects did not have a glycemic response, with an average fasting blood sugar of 7.27 ± 2.03 mmol/L. The mean arterial blood pressure was 143.6/79.5 mmHg. Nearly 60% of the examined elderly people are hypertensive. CONCLUSIONS: Obesity was diagnosed in more than one third of the elderly and 70% had high cardiovascular comorbidity. According to these findings, nursing homes need to pay more attention to the amount and quality of meals in order to avoid complications. Orv Hetil. 2019; 160(9): 349-358.

Screening of celiac disease in Down syndrome - Old and new dilemmas.

Celiac disease (CD) is a common and well defined autoimmune disorder caused by gliadin and related proteins of wheat, rye, and barley. Epidemiologic studies confirmed that CD is highly associated with other autoimmune diseases and with Down syndrome (DS). The symptomatic form of CD in patients with DS is more frequent than asymptomatic forms. However, growth impairment, anemia, intermittent diarrhea, and constipation are symptoms and signs typically of children with DS without CD. Late identification of the disease can lead to various complications, sometimes even very severe. Therefore, systematic screening for CD is essential in the management of children and adolescents with DS. Many medical organizations recommend screening in this group of patients. However, current policy statements vary in their recommendations for screening and there is still a need for establishing uniform diagnostic criteria.

When to screen children with Down syndrome for celiac disease?

The coexistence of Down syndrome (DS) and celiac disease (CD) has been reported in many studies. In our study, we examined 82 children with DS aged 8 months to 8.6 years for the existence of CD using serological markers immunoglobulin A (IgA) and immunoglobulin G (IgG) transglutaminase antibodies, followed by follow-up determination of total IgA levels. In four children who were positive for one of the above-mentioned antibodies, enteric biopsy has been performed that showed absence of CD. Our findings raise doubt about the need for obligatory serological screening of children with DS aged <8 years.

Coeliac disease as the cause of resistant sideropenic anaemia in children with Down's syndrome: case report.

INTRODUCTION: Coeliac disease (CD) is a permanent intolerance of gluten, i.e., of gliadin and related proteins found in the endosperm of wheat, rye and barley. It is characterized by polygenic predisposition, autoimmune nature, predominantly asymptomatic or atypical clinical course, as well as by high prevalence in patients with Down's syndrome (DS) and some other diseases. OUTLINE OF CASES: We are presenting a girl and two boys, aged 6-7 (x = 6.33) years with DS and CD recognized under the feature of sideropenic anaemia resistant to oral therapy with iron. Beside mental retardation, low stature and the morphological features characteristic of DS, two patients had a congenital heart disease; one ventricular septal defect and the other atrioventricular canal. In two patients, trisomy on the 21st chromosome pair (trisomy 21) was disclosed in all cells, while one had a mosaic karyotype. All three patients had classical laboratory parameters of sideropenic anaemia: blood Hb 77-89 g/l (x = 81.67), HCT 0.26-0.29% (x = 0.28), MCV 69-80 fl (x = 73), MCH 24.3-30 pg (x = 26.77) and serum iron 2-5 micromol/L (x = 4.0). Beside anaemia and in one patient a mild isolated hypertransaminasemia (AST 67 U/l, ALT 62 U/l), other indicators of CD were not registered in any of the children. In addition, in all three patients, we also detected an increased level of antibodies to tissue transglutaminase (atTG) of IgA class (45-88 U/I) so that we performed endoscopic enterobiopsy in order to reliably confirm the diagnosis of CD. In all three patients, the pathohistological finding of the duodenal mucosa specimen showed mild to moderate destructive enteropathy associated with high intraepithelial lymphocyte infiltration, cryptic hyperplasia and lympho-plasmocytic infiltration of the stroma. In all three patients, the treatment with a strict gluten-free diet and iron therapy applied orally for 3-4 months resulted in blood count normalization and the correction of sideropenia. Serum level of the atTG-IgA, repeated after a 12-month diet, was also normal. CONCLUSION: CD should be taken into consideration in all cases of sideropenic anaemia resistant to iron oral therapy in children with DS.The diagnosis of CD implicates corresponding pathohistological confirmation, while the treatment of sideropenic anaemia and its complications, beside iron preparations, also requires compliance with a gluten-free diet.

[Comparison of different methods of temperature measurment in children].

INTRODUCTION: The consequences of failing to notice fever in children can be serious. On the other hand, false positive reading can result in unnecesery investigation or diagnostic approach. The aim of this study was to compare different ways of body temperature measurement. MATERIAL AND METHODS: This prospective study was carried out on Pediatric Department of General Hospital in Subotica during 10 months (March-December 2006). In 263 children aged 1 month to 18 years of age, the body temperature was obtained from 4 measurement sites: tactile assesment, forehead and ear by electronic thermometer, rectal temperature in small children (up to 2 years of age) or axillar temperature in older children by mercury thermometer. Tympanic thermometry was considered as a standard for fever detection. RESULTS: The sensitivity of rectal temperature to detect fever is 46.67%, while specificity is 92.19%. The sensitivity of fever detection by electronic thermometry on the forehead is lower according to rectal thermometry - 36.08%, while specificity is 95.18%. The lowest values ofsensitivity are recorded in axillar thermometry (35.82%), specificity is 90.20%. The correlation coefficient is higher between tympanic and rectal temperature measurement (r=0.5076, p<0.0005), than between tympanic and forehead measurements (r=0.5076, p<0,0005), while the lowest was between tympanic and axillar mesurement sites (r=0.4933, p<0.0005). CONCLUSIONS: The results of our study and literature data show that the most accurate methods of thermometry are rectal measurement of body temperature in small children and tympanic thermometry in children over 2 years of age.

[Corticosteroid therapy in Henoch-Schönlein gastritis].

INTRODUCTION: Henoch-Schönlein purpura (HSP) is the most common vascular disease of childhood. It is a multisystem disease most commonly affecting the skin,joints, gastrointestinal tract, and kidneys, but other organs may be affected, too. Gastrointestinal involvement occurs in approximately 65-90% of patients, ranging from mild symptoms such as abdominal pain, nausea, and vomiting, to more severe manifestations such as gastrointestinal bleeding and intussusception. In most cases, HSP spontaneously resolves without treatment. The use of corticosteroids is controversial and usually reserved for severe systemic manifestations. Some authors suggest that the abdominal pain and gastrointestinal hemorrhage of HSP may respond to steroids, with some suggesting that there is a benefit in their use and describing a regimen. CASE OUTLINE: This is a case report of HSP in a fourteen-year-old boy with abdominal pain and hematemesis. Upper endoscopy showed an edematous and erythematous change in the body of the stomach and purpuric lesions in the duodenum, while multiple erosions were found in the antral area. Parenteral corticosteroid therapy with gastric acid secretion inhibitor administration led to regression of gastrointestinal symptoms on the seventh day, with relapses on the fourth and sixth day. Peroral administration of corticosteroids and gradual decrease of daily doses started on the eighth day of abdominal symptoms. New purpuric skin rashes appeared during six weeks. CONCLUSION: Corticosteroid therapy with gastric acid secretion inhibitors showed a positive effect in our patient with a severe form of HSP accompanied by abdominal pain and gastrointestinal hemorrhage.

[Erythromycin in therapy of cyclic vomiting syndrome].

Cyclic vomiting syndrome is an insufficiently understood disorder which manifests itself in stereotypical episodes of vomiting with no detectable organic cause. Considering its unknown aetiology, drugs borrowed from various medication classes are applied in the therapy of this disorder, with variable success. Among other medicaments, erythromycin is also used in treatment of cyclic vomiting syndrome. This is a case study in which the application of erythromycin led to the prevention of attacks of cyclic vomiting syndrome. Our case report presents how periodical erythromycin therapy in two-week intervals at expected attack periods in a girl led to disappearance of cyclic vomiting. Adverse effects of erythromycin did not show up.