Restless leg syndrome in children with celiac disease.

Isikay S, Isikay N, Per H, Çarman KB, Kocamaz H. Restless leg syndrome in children with celiac disease. Turk J Pediatr 2018; 60: 70-75. Celiac disease (CD) is an immune-mediated enteropathy triggered by ingestion of dietary gluten in genetically predisposed individuals. The aim of the study was to determine the prevalence of restless leg syndrome (RLS) in children with CD and to investigate the associated factors for RLS. Totally 494 children with the ages ranging between 11-18 years were included. Among those, 226 were under follow-up with CD and constituted the study group while other 268 children did not have any symptoms or signs associated with CD and established the control group. The demographic data, educational status and routine laboratory data of children including complete blood count, ferritin, vitamin B12, foliate and 25 (OH) vitamin D levels were recorded. The RLS prevalence and associated symptoms of children were defined with a questionnaire. There was no statistically significant difference between the 2 groups regarding the age and gender. Moreover, RLS prevalence was also similar in both groups (3.5% vs 3.0% in CD and control groups, respectively, p=0.98). However, interestingly, in CD group, the mean age of the patients at the onset of RLS symptoms was statistically significantly younger (p=0.02) and the disease was more severe (p=0.026) than the control group. In correlation analysis in CD group, the RLS severity significantly negatively correlated with serum ferritin, folic acid or 25 (OH) vitamin D levels in Celiac disease group. In this study we did not determine an increased prevalence of RLS in children with CD. However, in CD group, the age at the onset of RLS symptoms was significantly younger and the disease was more severe in CD group compared with the control cases.

Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients.

OBJECTIVES: To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP). METHODS: In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Results: Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A. CONCLUSION: Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination.

Peripheral neuropathy electrophysiological screening in children with celiac disease.

BACKGROUND: The involvement of the peripheral nervous system in children with celiac disease is particularly rare. OBJECTIVE: The aim of this study was to assess the need for neurophysiological testing in celiac disease patients without neurological symptoms in order to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. METHODS: Two hundred and twenty consecutive children with celiac disease were screened for neurological symptoms and signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 167 asymptomatic patients as well as 100 control cases were tested electro-physiologically for peripheral nervous system diseases. Motor nerve conduction studies, including F-waves, were performed for the median, ulnar, peroneal, and tibial nerves, and sensory nerve conduction studies were performed for the median, ulnar, and sural nerves with H reflex of the soleus muscle unilaterally. All studies were carried out using surface recording electrodes. Normative values established in our laboratory were used. RESULTS: Evidence for subclinical neuropathy was not determined with electrophysiological studies in any of the participants. CONCLUSION: In this highly selective celiac disease group without any signs, symptoms as well as the predisposing factors for polyneuropathy, we did not determine any cases with neuropathy. With these results we can conclude that in asymptomatic cases with celiac disease electrophysiological studies are not necessary. However, larger studies with the electrophysiological studies performed at different stages of disease at follow-ups are warranted.

The Frequency of Epileptiform Discharges in Celiac Disease.

BACKGROUND: We studied patients with celiac disease to define the frequency of epileptiform discharges on electroencephalography. METHODS: A total of 307 children with a diagnosis of celiac disease (study group) and 197 age- and sex-matched healthy children as controls (control group) were included in this study. The study group was further divided into newly diagnosed celiac disease patients (n = 216) and patients who were on a gluten-free diet (n = 91) for at least 6 months. Medical histories of all children including age, sex, symptoms, weight, height, physical examination findings, and laboratory data were recorded. All patients underwent an electroencephalograph in a pediatric neurology electroencephalograph laboratory with a 32-channel electroencephalograph for 30 minutes. RESULTS: Twenty-five patients were defined to have epileptiform discharges (spike/sharp-wave discharges); 24 (7.8%) of those patients were in the celiac disease group and 1 (0.5%) was in the control group (P = 0.001). Among those 24 patients, 21 (9.7%) were in newly diagnosed celiac disease group and 3 (3.3%) were in the gluten-free diet group (P = 0.03). CONCLUSIONS: Patients diagnosed with celiac disease are prone to epileptiform activities on electroencephalography and should be evaluated carefully. Moreover, strict adherence to a gluten-free diet early should be advised in those patients with epileptiform activities because it may effectively decrease the occurrence of epileptiform activities.

The prevalence of celiac disease among patients with familial mediterranean Fever.

BACKGROUND: Familial Mediterranean Fever and celiac disease are both related to auto-inflammation and/or auto-immunity and they share some common clinical features such as abdominal pain, diarrhea, bloating and flatulence. Objectives We aimed to determine the association of these two diseases, if present. METHODS: Totally 112 patients diagnosed with Familial Mediterranean Fever and 32 cases as healthy control were included in the study. All participants were examined for the evidence of celiac disease, with serum tissue transglutaminase IgA levels (tTG IgA). RESULTS: Totally 144 cases, 112 with Familial Mediterranean Fever and 32 healthy control cases were included in the study. tTG IgA positivity was determined in three cases with Familial Mediterranean Fever and in one case in control group. In that aspect there was no significant difference regarding the tTG IgA positivity between groups (P=0.81). Duodenum biopsy was performed to the tTG IgA positive cases and revealed Marsh Type 3b in two Familial Mediterranean Fever cases and Marsh Type 3c in the other one while the biopsy results were of the only tTG IgA positive case in control group was Marsh Type 3b. In HLA evaluation of the celiac cases; HLA DQ2 was present in two celiac cases of the Familial Mediterranean Fever group and in the only celiac case of the control group while HLA DQ8 was present in one celiac case of the Familial Mediterranean Fever group. CONCLUSIONS: We did not determine an association of Familial Mediterranean Fever with celiac disease. Larger studies with subgroup analysis are warranted to determine the relationship of these two diseases.

Ultrasound-guided transversus abdominis plane block in children: a randomised comparison with wound infiltration.

CONTEXT: The transversus abdominis plane (TAP) block is a new regional anaesthesia technique applicable to infants and children. OBJECTIVE(S): The present study was designed to evaluate the analgesic efficacy of ultrasound-guided TAP block with high volume local anaesthetic (0.5  ml kg) during the first 24 h after surgery in children undergoing inguinal hernia repair. DESIGN: Randomised comparative study. SETTING: Gaziantep University Hospital between December 2010 and May 2011. PATIENTS OR OTHER PARTICIPANTS: Fifty-seven children between 2 and 8 years of age undergoing unilateral inguinal hernia repair were randomised to TAP block (group T, n = 29) or to wound infiltration (group C, n = 28). INTERVENTION(S): A TAP block using ultrasound guidance with 0.25% levobupivacaine 0.5  ml kg(-1) or wound infiltration with 0.2  ml kg(-1) 0.25% levobupivacaine, was performed on the same side as the hernia under general anaesthesia. MAIN OUTCOME MEASURES: Time to first analgesic, cumulative number of doses of analgesic, pain scores and adverse effects were assessed over the course of 24  h. RESULTS: The time to first analgesic (mean ±â€ŠSD) was significantly longer in group T than in group C (17 ±â€Š6.8 vs. 4.7 ±â€Š1.6 h, respectively; P < 0.001). Thirteen (45%) patients in group T did not require any analgesic within the first 24 h. The cumulative number of doses of analgesic was significantly lower in group T than in group C (1.3 ±â€Š1.2 vs. 3.6 ±â€Š0.7, respectively, P < 0.001). Pain scores were significantly different between the groups at all time points except at 1, 20 and 24  h (P < 0.001). CONCLUSION: Ultrasound-guided TAP block with high volume (0.5 ml kg) 0.25% levobupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after unilateral hernia repair in children. TRIAL REGISTRATION: ACTRN12611000585921 (7/06/2011) from Australian New Zealand Clinical Trials Registry.