Influence of gender and malnutrition on QT dispersion in a north-Malagasy children population.

BACKGROUND: Children malnutrition involves simultaneous deficiency of nutrients, leading to cardiac morphological and functional alterations. In this complex condition repolarization abnormalities can evolve. Also, sexual dimorphism is a well-established phenomenon, but its influence on ventricular repolarization varies tremendously among races. No data are available about African children, so the aim of our work was to study the correlation between malnourishment and electrocardiographic repolarization parameters and evaluating the sex influence. METHODS: Three hundred seven children (mean age 7.6±3 years old) were consecutively enrolled in the north of Madagascar. The QT interval was measured and corrected (QTc) following the Bazett formula (QT/√RR). QT dispersion (QTcd) was defined as the difference between maximum and minimum QTc. Malnutrition was defined in relation to age and sex specific BMI values. Grade mild, moderate and severe were defined as the value to pass through BMI of 16, 17 and 18.5 at the age of 18. RESULTS: One hundred twenty-six children (41%) were malnourished, 42 (13%) with mild, 61 (20%) moderate and 23 (7%) with a severe grade. No differences were found between normal weight and malnourished regarding the gender, age, height, or heart rate. They had similar QT and QTc intervals (respectively 362.4±36 ms vs. 365.1±47 ms for QT, P=0.59 and 476.9±43 ms vs. 470±53 ms for QTc, P=0.70). QTcd was statistically higher in malnourished children (53.2±16 ms vs. 44.4±15 ms, P<0.001). QTcd progressively increased from normal weight to severe malnutrition (P<0.001). At multivariate analysis, independently from sex category, children with moderate (C.I. 3.94-13.1, P<0.001) and severe (C.I. 8.38-22.0, P<0.001) malnutrition had a higher risk to have a higher QTcd). 146 children (48%) were male. Prolonged QTcd was found more frequently in male children (58% vs. 44%, P=0.04), showing also longer QTc and QTcd (respectively 475.8±52 ms vs. 462.3±42 ms, P=0.01; and 50.1±16 ms vs. 46.2±16 ms, P=0.03). At the multivariate analysis, males had a higher risk (C.I. 0.28-7.35, P=0.03) to have higher QTc dispersion with respect to female children, independently to the nutrition state. CONCLUSIONS: Moderate to severe malnourishment and male sex independently influence ventricular repolarization, with higher QTc dispersion times and eventually higher risk of future arrhythmic complications. In these children, precaution must be taken with intensive correction of malnutrition and a strict ECG follow-up.

Beneficial therapeutic effects of vitamin C on recurrent respiratory tract infections in children: preliminary data.

BACKGROUND: The aim of this study was to demonstrate whether supplementation of vitamin C has a beneficial effect in the prevention of recurrent respiratory tract infections (RTIs) in children. Moreover, we evaluate the main risk factors that predispose to the development of this disease. METHODS: Sixty children have been enrolled in the study and randomized into two groups: the control group (G1 N.=33) and the group at risk of recurrent RTIs (G2 N.=27). To G2 group was administered every day 100% orange juice with the content of vitamin C 70 mg. RESULTS: Significant reduction in the incidence rate of RTIs (episodes pre-treatment: 182-6.75 episodes/child, after-treatment: 71-2.62 episodes/child, P<0.05), were observed in G2 group. CONCLUSIONS: The administration of vitamin C had a beneficial effect in our group of children with recurrent RTIs, reducing the number of infective episodes.

Impact of Ethnicity on the Prevalence of Early Repolarization Pattern in Children: Comparison Between Caucasian and African Populations.

The patterns and prevalence of early repolarization pattern (ER) in pediatric populations from ethnic backgrounds other than Caucasian have not been determined. Black African children (ages 4-12) from north-west Madagascar were prospectively recruited and their ECGs compared with those of age- and sex-matched Caucasian ethnicity individuals. ER was defined by ≥ 0.1 mV J-point elevation in at least two contiguous inferior and/or lateral ECG leads. A total of 616 children were included. There was a trend toward a higher frequency of ER in the Africans compared to the Caucasians (23.3% vs. 17.1%, respectively, p = 0.053). The subtype (slurred vs. notched) and location of ER (lateral, inferior, or inferior-lateral) were significantly different in the two groups (p < 0.001 and p = 0.020, respectively). There was no significant difference in the number of high-risk ECG features of ERP (i.e., horizontal/descendent pattern, inferior or inferior-lateral location or J-waves ≥ 2 mm) between African and Caucasian children. On the multivariate analysis, African ethnicity was an independent predictive factor of ER (OR 3.57, 95% CI 2.04-6.25, p < 0.001). African children have an increased risk of ER compared to Caucasian counterparts. Future studies should clarify the clinical and prognostic significance of ER in the pediatric population, and whether ethnicity has an impact on the outcomes.

Association among nocturnal enuresis, body weight and obstructive sleep apnea in children of south Italy: an observational study.

BACKGROUND: To evaluate the rate of nocturnal enuresis (NE), body weight and obstructive sleep apnea in children 5 to 10 years of age in South Italy and the possible association among these disorders. METHODS: We have administered 1100 validated questionnaires, in Italian language, to parents and we have analyzed data with a logistic regression. RESULTS: Forty-two percent of children had a BMI≥85th (group 1) vs 58.0% normal weight children at the same age (group 2). There is a higher number of overweight males compared to females without statistically differences. In group 1 there was a higher number of children with NE and obstructive sleep disorders and some children present with the association among these three disorders. CONCLUSIONS: There are no statistically differences between two study groups for the association body weight-NE, body weight-NE-obstructive sleep disorders.

Bipolar sealing devices in video-assisted thoracic surgery.

Intraoperative bleeding is one of the main severe complications in complete video-assisted thoracic surgery (c-VATS) and post-operative air-leaks prevention still represents an important challenge. Usually, hemostasis is often difficult and unsafe when the VATS approach is performed and the potential role of bipolar sealing devices is still undefined, as proven by limited experiences reported in the literature. By introducing endostaplers in VATS surgery, it was possible to perform safe thoracoscopic resections of lung. On the other hand, several diathermy techniques have been proposed to reduce intraoperative blood loss in surgery. In particular, standard bipolar technology has proven to effect coagulation in small vessels. The aim of this study is to compare bipolar electro thermal devices to endostapler in VATS lung resections concerning intraoperative bleeding and post-operative air leaks.

ECG is an inefficient screening-tool for left ventricular hypertrophy in normotensive African children population.

BACKGROUND: Left ventricular hypertrophy (LVH) is a marker of pediatric hypertension and predicts development of cardiovascular events. Electrocardiography (ECG) screening is used in pediatrics to detect LVH thanks to major accessibility, reproducibility and easy to use compared to transthoracic echocardiography (TTE), that remains the standard technique. Several diseases were previously investigated, but no data exists regarding our study population. The aim of our study was to evaluate the relationship between electrocardiographic and echocardiographic criteria of LVH in normotensive African children. METHODS: We studied 313 children (mean age 7,8 ± 3 yo), in north-Madagascar. They underwent ECG and TTE. Sokolow-Lyon index was calculated to identify ECG-LVH (>35 mm). Left ventricle mass (LVM) with TTE was calculated and indexed by height(2.7) (LVMI(2.7)) and weight (LVMI(w)). We report the prevalence of TTE-LVH using three methods: (1) calculating percentiles age- and sex- specific with values >95th percentile identifying LVH; (2) LVMI(2.7) >51 g/m(2.7); (3) LVMI(w) >3.4 g/weight. RESULTS: 40 (13%) children showed LVMI values >95th percentile, 24 children (8%) an LVMI(2.7) >51 g/m(2.7) while 19 children (6%) an LVMI(w) >3.4 g/kg. LVH-ECG by Sokolow-Lyon index was present in five, three and three children respectively, with poor values of sensitivity (ranging from 13 to 16%), positive predictive value (from 11 to 18%) and high values of specificity (up to 92%). The effects of anthropometrics parameters on Sokolow-Lyon were analyzed and showed poor correlation. CONCLUSION: ECG is a poor screening test for detecting LVH in children. In clinical practice, TTE remains the only tool to be used to exclude LVH.

Effects of Malnutrition on Left Ventricular Mass in a North-Malagasy Children Population.

BACKGROUND: Malnutrition among children population of less developed countries is a major health problem. Inadequate food intake and infectious diseases are combined to increase further the prevalence. Malnourishment brings to muscle cells loss with development of cardiac complications, like arrhythmias, cardiomyopathy and sudden death. In developed countries, malnutrition has generally a different etiology, like chronic diseases. The aim of our study was to investigate the correlation between malnutrition and left ventricular mass in an African children population. METHODS: 313 children were studied, in the region of Antsiranana, Madagascar, with age ranging from 4 to 16 years old (mean 7,8 ± 3 years). A clinical and echocardiographic evaluation was performed with annotation of anthropometric and left ventricle parameters. Malnutrition was defined as a body mass index (BMI) value age- and sex-specific of 16, 17 and 18,5 at the age of 18, or under the 15th percentile. Left ventricle mass was indexed by height2.7 (LVMI). RESULTS: We identified a very high prevalence of children malnutrition: 124 children, according to BMI values, and 100 children under the 15th percentile. LVMI values have shown to be increased in proportion to BMI percentiles ranging from 29,8 ± 10,8 g/m2.7 in the malnutrition group to 45 ± 15,1 g/m2.7 in >95th percentile group. LVMI values in children < 15th BMI percentile were significantly lower compared to normal nutritional status (29,8 ± 10,8 g/m2,7 vs. 32,9 ± 12,1 g/m2,7, p = 0.02). Also with BMI values evaluation, malnourished children showed statistically lower values of LVMI (29,3 ± 10,1 g/m2,7 vs. 33,6 ± 12,5 g/m2,7, p = 0.001). CONCLUSION: In African children population, the malnourishment status is correlated with cardiac muscle mass decrease, which appears to be reduced in proportion to the decrease in body size.

A focus on recent cases of suicides among Italian children and adolescents and a review of literature.

Suicidal behaviors are among the leading causes of death worldwide. The large spread of suicide suggests that educational programs and literature to parents or guardians should include information about the potential risks and potential consequences of the onset of the idea of suicide in children. We identified 55 cases of suicide among children and young adults <18-year-old occurring in Italy between 1st January, 2011 and 31st December, 2013. The results point to the need to increase our understanding of the dramatic rise in suicidal behaviors during childhood/adolescence and of the causal pathways linking these behaviors to child-adolescent mental disorders. During routine care visits, pediatricians should be skilled to recognize risk factors for adolescent suicide in order to intervene appropriately.