Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection.

AIM: To evaluate the predictive value of various clinical and laboratory parameters on the identification of acute extensive and/or multifocal renal involvement in children with febrile urinary tract infections (UTI). METHODS: The medical records of 148 children (median age: 2.4 months, range: 11 days-24 months), who were admitted during a 3-year period with a first episode of febrile UTI, were analysed. Acute dimercaptosuccinic acid scintigraphy (DMSA), clinical and laboratory parameters were evaluated. RESULTS: Seventy six children (51%) had abnormal findings on the acute DMSA. Of them, 20 had DMSA grade 2, while 56 had grade 3 and 4. Patients with a DMSA grade 3 and 4 were more likely to have shivering (OR 3.4), white blood count (WBC) ≥ 18 000/µL (OR 2.4), absolute neutrophil count (ANC) ≥ 9300/µL (OR 4.4), C-reactive protein (CRP) ≥ 50 mg/L (OR 2.7) and procalcitonin (PCT) ≥ 1.64 ng/mL (OR diagnostic). There was a significant difference of WBC (p = 0.004), ANC, CRP and PCT levels (p < 0.001) between children with normal and grade 2 aDMSA versus those with aDMSA grade 3 and 4. CONCLUSIONS: Shivering and elevated inflammatory markers increase the risk of acute extensive and/or multifocal kidney involvement in children with febrile UTI. Procalcitonin seems to be an excellent marker of the severity of acute parenchymal involvement.

Comparative study of tolerability and efficacy of iron protein succinylate versus iron hydroxide polymaltose complex in the treatment of iron deficiency in children.

One-hundred children, 48 males and 52 females, mean age +/- SD 39.9 +/- 28.2 months (range 12 to 113) with sideropenia or sideropenic anemia were randomly divided into 2 groups of 50 patients each (groups A and B) and were treated with iron protein succinylate (group A) or iron hydroxide polymaltose complex (group B). Patients of both groups received 4 mg/kg elemental iron, maximally 80 mg daily, for 2 months. Side-effects of therapy and laboratory values (RBC, hematocrit, hemoglobin, MCV, serum iron, total iron binding capacity, and ferritin) were registered before treatment, 30 days after the beginning of therapy as well as after 60 days in order to evaluate tolerability and efficacy of the drugs. Both drugs were well tolerated and showed only few adverse reactions, which were comparable in severity and frequency. Iron protein succinylate led not only to a faster increase of hemoglobin, hematocrit, MCV, serum iron, and ferritin than iron hydroxide polymaltose complex, but the laboratory values remained higher in group A than in B even after 2 months of treatment.

Use of tolfenamic acid in febrile children with and without glucose-6-phosphate dehydrogenase deficiency.

The purpose of this study was to evaluate the antipyretic action of tolfenamic acid, as well as its possible adverse reactions, especially in children with severe or partial form of glucose-6-phosphate dehydrogenase (G6PD) deficiency. In the study 55 febrile children were included, whose mean age was +/- SD 3.5 +/- 3.3 years, range 0.5-15. Ten of them had severe or partial form of G6PD deficiency. Fifty-three of the patients responded with a decrease of temperature which lasted at least 6 hours, though in 2 of them the temperature decrease lasted less than 6 hours. The tolerance of the drug was good and no side-effects were noted. None of the patients with or without G6PD deficiency showed symptoms, signs, or laboratory findings indicating hemolysis before administration of the drug and 4 days thereafter. In conclusion, tolfenamic acid is a strong antipyretic agent with excellent tolerance and high safety in children.

beta-Thalassaemia and factors affecting the metabolism of lipids and lipoproteins.

Total cholesterol, triglycerides (TG), LDL-cholesterol, HDL-cholesterol, alpha-lipoprotein (LP) (HDL-LP), pre-beta-LP (VLDL-LP) and beta-lipoprotein (LDL-LP) were measured in the blood of 104 patients with major and intermedia form of beta-thalassaemia and 112 control subjects, mean age +/- SD 10.2 +/- 3.5 and 9.1 +/- 3.8 years, respectively. Cholesterol, LDL- and HDL-cholesterol were significantly decreased and TG was significantly increased in the patients compared to the control subjects. TG values in male patients were significantly higher than in male control subjects, but no differences were found in females. Patients with major and intermedia forms of beta-thalassaemia and chronic hepatitis C have significantly lower values of cholesterol and beta-LP and higher values of HDL-cholesterol than patients without hepatitis C. An increase of HDL-cholesterol and alpha-LP was found in patients with diabetes mellitus or impaired glucose tolerance (IGT) compared to patients without IGT. In the thalassaemic patients there was an increase of TG and pre-beta-LP and a decrease of HDL-cholesterol and alpha-LP with increasing ferritin values. There was a positive correlation of the patients' age with TG and pre-beta-LP whereas no such correlation was found in the control subjects. It appears, therefore, that many factors as iron overload, liver injury, hormonal disturbances and aging affects lipids and LP pattern in patients with major and intermedia form of beta-thalassaemia.

Cefuroxime axetil in the treatment of acute otitis media in children.

Cefuroxime axetil was evaluated for clinical efficacy and tolerance in the treatment of acute otitis media in children. Fifty-five children, 5.0 to 10.8 years, were randomly assigned to receive 250mg cefuroxime axetil every 12 hours or 50mg/kg/day amoxicillin in three divided doses. Both treatment schemes lasted for 10 days. Acute otitis media was diagnosed by the presence of erythema and/or opacity with bulging of the tympanic membrane. A tympanogram was obtained upon enrollment to the study, as well as within 2 days after completion of therapy. Fifty-one children completed the treatment protocol. The cure rate was 74.1% for cefuroxime axetil and 75.0% for amoxicillin. Clinical improvement was noted in 25.9% of children treated with cefuroxime axetil and in 25.0% of those treated with amoxicillin. There was no clinical failure in the two treatment groups. None of the children experienced relapse of acute otitis media during the month following completion of therapy. The findings indicate that cefuroxime axetil given twice daily has comparable efficacy to amoxicillin given three times daily in the treatment of children with acute otitis media.