The cause of severe hypercalcaemia resistant to pamidronate treatment: subcutaneous fat necrosis with no visible skin lesion.

Subcutaneous fat necrosis (SCFN) is an uncommon cause of neonatal hypercalcaemia. It is usually seen in neonates after a complicated delivery within the first month of life. While uncommon, hypercalcaemia can be fatal. It is characterised by red-purple plaques in fatty points along with firm subcutaneous nodules. Rarely, SCFN may cause severe hypercalcaemia with no visible skin lesion. In this rare case, we report severe infancy hypercalcaemia without characteristic skin lesion on first physical examination, unresponsive to hydration, diuretic, prednisolone and standard dose of pamidronate treatment. As timely diagnosis and treatment are so important, this complication should be kept in mind even in such clinical presentations.

Report of a Myocarditis Outbreak among Pediatric Patients: Human Herpesvirus 7 as a Causative Agent?

BACKGROUND: The etiology of myocarditis in children has not yet been completely elucidated. OBJECTIVE: Medical records of eight pediatric patients diagnosed with acute myocarditis within a 41-day period in a small-town hospital were retrospectively analyzed. METHODS: We examined antibody titers of adenovirus, Epstein-Barr virus, herpes simplex virus, respiratory syncytial virus, varicella-zoster virus and cytomegalovirus in peripheral blood. We used polymerase chain reaction (PCR) amplification to detect genetic sequences from Human herpesvirus (HHV) 7, HHV 6, enterovirus, measles or parvovirus in peripheral blood. RESULTS: The causative agent was HHV 7 in four patients. HHV 7 sequences were detected through PCR in one patient with rapid deterioration. Of four patients with HHV 7, two presented with dilated cardiomyopathy. CONCLUSION: To our knowledge, this is the first report to suggest HHV 7 as a causative agent for acute myocarditis. We believe HHV 7 should be considered as a possible etiologic pathogen for patients with suspected myocarditis.

The association between obesity, hypertension and left ventricular mass in adolescents.

BACKGROUND: Obesity and hypertension (HT) are well known cardiac risk factors. Our goal was to show that even if arterial blood pressure (BP) measurements of obese adolescents are normal during clinical examination, ambulatory blood pressure monitoring (ABPM) can be high, may include cardiac involvement and can also detect left ventricular mass indices (LVMI) value for obese adolescents to diagnose left ventricular hypertrophy (LVH). METHODS: This study included 130 children (57 obese hypertensive, 36 obese normotensive, 14 normal weight hypertensive and 23 normal weight normotensive). Adolescents whose BP was measured during clinical examination, after 24-h BP was detected using ABPM, were examined with echocardiography for calculation of LVMI to determine cardiac risk factors for LVH. RESULTS: There was a significant difference between the LVMI of obese-normotensive and obese-hypertensive adolescents, which showed the effect of obesity on LVMI independent of HT. Twenty (35.7%) of 56 obese adolescents with HT detected with ABPM had normal BP measurements during clinical examination. Dipper and nondipper features of obese adolescents were significantly higher in ABPM than those with normal body mass index. When the cutoff LVMI value for LVH was set at ≥38 g/m2.7, 38.9% of obese-normotensive and 50.9% of obese-hypertensive subjects had LVH; however, when the cutoff value was set at ≥51 g/m2.7, the rates were 2.8% and 19.3%, respectively. CONCLUSIONS: Obesity is a risk factor for LVH independent of HT. To identify masked HT, 24-h ABPM and cardiac examination should be routinely performed in obese adolescents. Using a limit of LVMI ≥38 g/m2.7 in evaluating LVH secondary to HT in obese individuals may lead to an overestimated diagnosis rate of LVH.

Investigation of Factors Affecting Frequency of Intestinal Parasites in Primary School Students in an Urban Region in Turkey.

AIM: The aim of the study was to determine the incidence of intestinal parasitic diseases (IPD) and associated factors in primary school students and to assess the knowledge and practices of mothers about these diseases. METHODS: This is a cross-sectional study carried out in January-March 2014 in 471 students aged 5-11 years, studying at 3 schools randomly selected from the city centre regions with different socioeconomic levels. Stratified sampling method was used in the present study and the data were collected in two stages. In the first stage, parents were informed about the study and pre-prepared questionnaire forms were used to collect the data about the students and parents. In the second stage, laboratory analyses of collected stool samples were performed. RESULTS: The total prevalence of IPD was 18.3%, it was higher in the primary school located in a region with a lower socioeconomic level compared to other two schools (27.6% vs. 14.4%, and 10%, respectively). Most commonly detected parasite was E. vermicularis (12.1%). The prevalence of IPD was not associated with the classroom, gender, number of siblings, and the use of purified drinking water at home, while it was found to decrease with the increasing maternal education level. The maternal knowledge level score was 12.01±4.29 vs. 13.41±3.94 in students with and without IPD, respectively. With regard to the methods used to treat IPD, 23% of the mothers reported that they are using conventional methods. CONCLUSION: The health education programmes about the associated risk factors are of great importance for early detection and treatment of childhood parasitic infections.