Hypertriglyceridaemia in adolescents may have serious complications.

Acute pancreatitis is an often-overlooked cause of acute abdominal pain in children and adolescents. Severe hypertriglyceridaemia is an important cause of recurrent acute pancreatitis. Monogenic causes of hypertriglyceridaemia, such as familial chylomicronaemia caused by lipoprotein lipase deficiency, are more frequently encountered in children and adolescents, but remain rare. Polygenic hypertriglyceridaemia is more common, but may require a precipitant before manifesting. With the global increase in obesity and type 2 diabetes, secondary causes of hypertriglyceridaemia in children and adolescents are increasing. We report two cases of severe hypertriglyceridaemia and pancreatitis in adolescent females. Hypertriglyceridaemia improved markedly with restriction of dietary fat. An inhibitor to lipoprotein lipase was found to be the cause in one patient, while in the other limited genetic investigation excluded chylomicronaemia owing to deficiency of lipoprotein lipase, its activators and processing proteins.

Children and adolescents with diabetes at Tygerberg Hospital ­ at risk of cardiovascular complications?

Objectives. To determine the prevalence of dyslipidaemia and HT in paediatric diabetic patients seen at Tygerberg Hospital (TBH) and establish whether either is associated with body mass index (BMI), glycosylated haemoglobin (HbA1c) or duration of diabetes. Further, to determine whether the prevalence differs between two specified periods.Methods. A retrospective study of 154 diabetic patients, aged 1 - 19 years, seen at TBH between 2007 and 2017, was undertaken. The following data were recorded: age; sex; duration of disease (time since diagnosis); height; weight; blood pressure; HbA1c; high-density lipoprotein cholesterol (HDL-C); triglycerides (TG); and low-density lipoprotein cholesterol (LDL-C). Results. More than half of the patients (57.8%; n=89/154; 95% confidence interval (CI) 51.7 - 65.0) had dyslipidaemia, 16.3% (n=24/147) had low HDL-C levels, 53.8% (n=78/145) had high LDL-C levels and 14.9% (n=22/148) had raised TG levels. Nearly half of the patients (48.7%; n=75/154; 95% CI 41.6 - 55.1) were hypertensive and 93.5% (n=144/154) were poorly controlled (HbA1c >7.5%). Dyslipidaemia was not associated with HT or BMI percentile and its prevalence did not change between the two specified periods. Prevalence of dyslipidaemia and HT was not associated with duration of diabetes. About one-third (30.8% (n=4/13); 95% CI 11.9 - 59.3) of the pre-adolescents and 60.3% (n=85/141; 95% CI 51.9 - 68.1) of the adolescents had dyslipidaemia (p=0.04). Dyslipidaemia was diagnosed in 62.6% (n=82/131) of adolescents with poorly controlled diabetes (p=0.04) and in 71.7% (95% CI 59.0 - 81.7) of patients ≥16 years of age (p=0.005). Conclusions. Poor glycaemic control, dyslipidaemia and HT are common in diabetic children, putting them at risk of cardiovascular complications in adulthood.S Afr J Child Health 2022;16(4):205-208. https://doi.org/10.7196/SAJCH.2022.v16i4.1862Children and adolescents with diabetes at Tygerberg Hospital ­ at risk of cardiovascular complications?L N Dookhony,1 MMed (Paeds); C J Lombard,2 MSc, PhD; E W Zöllner,3 MMed, PhD1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; and SSRN Hospital, Pamplemousses, Republic of Mauritius2Biostatistics Unit, South African Medical Research Council, Division of Biostatistics; and Department of Global Health, University of Stellenbosch, Cape Town, South Africa3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression.

A recently published approach to paediatric asthma management neither recommended screening for nor suggested any management of hypothalamic-pituitary-adrenal axis suppression in asthmatic children treated with corticosteroids. The existing literature on this topic was therefore reviewed and the quality of the evidence assessed. Recommendations for diagnosis, screening and management are made utilising the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children's Hospital

Background. A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients.Hence a DCT was introduced at Tygerberg Children's Hospital (TCH) in 2009.Hypothesis. A DCT for T1DM patients improves HbA1c, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications.Methods. In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbA1c) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared.Results. HbA1c levels increased from 9.0% (7.85 - 10.15) in P1 to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02).The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in P1 to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01)to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00).Conclusion. After the introduction of the DCT, HbA1c levels were less variable and hos

Is adrenal suppression in asthmatic children reversible? A case series.

BACKGROUND: Six hypocortisolaemic asthmatic children on steroids given at physiological doses were identified during a previous study. OBJECTIVES: To establish whether hypothalamic-pituitary-adrenal axis suppression (HPAS) could be reversed in hypocortisolaemic asthmatic children treated with steroids without sacrificing asthma control. METHODS: In this case series, treatment of six hypocortisolaemic patients was modified by introducing steroid-sparing asthma medications. Serum cortisol and repeat overnight metyrapone tests (ONMTPTs) were done until HPAS was reversed in all patients. A retrospective folder review was performed and the following data were extracted: body mass index standard deviation score (BMI SDS), adherence, daily steroid type and dose, treatment modification, serum cortisol, final ONMTPT result and time taken to achieve normalisation. RESULTS: The median serum cortisol level recovered to 311 nmol/L after 0.9 years (median). The ONMTPT normalised within 3.3 years (median). Steroid load decreased from 9.2 to 5.0 hydrocortisone equivalent mg/m2/d (medians), while asthma score improved from 1.42 to 0.85 (medians). Poor adherence was noted in two children before and four after treatment modification. BMI SDS decreased from -0.08 to -0.16 (medians). CONCLUSIONS: Hypocortisolaemia and HPAS could be reversed in asthmatic children treated with physiological doses of steroids by reducing steroid load by 40% and supplementing therapy with steroid-sparing medication. Poor adherence may have either contributed to or retarded HPA recovery. Simultaneously, asthma control improved. Confirmation by a prospective study would be ideal, but may not be feasible.

Abnormal thyroid function tests in children on ethionamide treatment.

Ethionamide (ETH) treatment may cause hypothyroidism. Clinical data, serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels were retrospectively assessed in 137 children receiving anti-tuberculosis treatment including ETH. Abnormal thyroid function tests (TFTs) were recorded in 79 (58%) children: elevated serum TSH and suppressed fT4 (n = 30), isolated elevated serum TSH (n = 20), isolated low serum fT4 (n = 28) and isolated low TSH (n = 1). The risk for biochemical hypothyroidism was higher for children on regimens including para-aminosalicylic acid and in human immunodeficiency virus infected children. TFT abnormalities are frequent in children on ETH and are mainly due to primary hypothyroidism or euthyroid sick syndrome.

Protein energy malnutrition and its recognition in outpatient departments in Venda hospitals.

Between April and June 1988 the number of children under 5 years old attending outpatient departments of Venda hospitals who had protein energy malnutrition (PEM) was determined, the proportions at 3 Venda hospitals were compared, and what percentage of these children was detected by attendant health workers was determined. Approximately 6% had severe PEM; this finding was consistent for all 3 hospitals. The rates for mild PEM were 22% for Tshilidzini and Donald Fraser Hospitals and 33% for Siloam Hospital. This statistically significant difference has not been explained. Health workers failed to recognise about 25% of children with severe PEM and 50% of children with mild PEM. It is suggested that certain interventions and activities are essential if PEM is to be adequately managed: these are efficient monitoring; pre-employment and in-service education for health workers; a breast-feeding and weaning survey; and an investigation of the variation of malnutrition among Venda hospitals.

Congenital lymphoedema in a child--an unusual diagnosis of ankle oedema seen at a peripheral hospital. A case report.

A patient with congenital lymphoedema--the clinical picture being that of Milroy's disease--is presented. The diagnosis, differential diagnosis and treatment are discussed and the modified autosomal dominant mode of inheritance with sex influence and variable expressivity is described.