Association between waist circumference and childhood-masked hypertension: A community-based study.

AIM: The aim of this study is to determine the association between waist circumference (WC) and childhood-masked hypertension. METHODS: A territory-wide, school-based cohort of 1385 Hong Kong students (672 boys and 713 girls) aged 8-17 years was analysed. The ambulatory blood pressure-monitoring assessment was performed using validated oscillometric recorders (A&D TM-2430 (A&D Inc., Tokyo, Japan)) following American Heart Association's recommendations. Subjects were considered normotensive if their casual blood pressure, 24-h daytime and night-time average systolic blood pressure and diastolic blood pressure (DBP) were <95th percentile. If one or more of the ambulatory blood pressure parameters was ≥95th percentile, subjects would be considered suffering from masked hypertension (MH). Subjects who had three successive casual blood pressure measurements above the 95th percentile were excluded. RESULTS: By body mass index, 148 (10.7%) subjects were obese, 182 (13.1%) overweight and 359 (25.9%) having larger WC (≥85th percentiles). MH was diagnosed in 217 subjects (15.7%). Subjects with larger WC or obesity were significantly associated with higher 24-h daytime and night-time systolic blood pressure (≥95th percentile) (odds ratios from 1.84 to 2.09 and from 2.07 to 3.54 for larger WC and obese respectively, all P < 0.05) as well as 24-h DBP for larger WC (odds ratio = 2, P = 0.015) than normal subjects adjusted by sex, age and height. CONCLUSION: Waist circumference and body mass index are independent risk factors of childhood and adolescent MH. WC appears a significant associated factor of elevated 24-h DBP in children aged 8-17 years.

Evaluating different imaging strategies in children after first febrile urinary tract infection.

We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100-94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies-DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively.

Membranous lupus nephritis in Chinese children--a case series and review of the literature.

We retrospectively reviewed the cases of 13 lupus nephritis children with pure membranous glomerulonephritis (MGN; Group A) and ten children with mixed proliferative and membranous nephritis (Group B). The children were identified through a territory-wide survey of patients between 1990 and 2003. All were ethnic Chinese. Age at diagnosis ranged from 3.7 to 18.6 years (Group A) and from 9.6 to 22.1 years (Group B). Female-to-male ratios were 12:1 (Group A) and 9:1 (Group B). Group A patients were more often nephrotic than Group B patients (11/13 vs. 5/10, p = 0.17). The glomerular filtration rate (GFR) at presentation was normal in all but two patients (one from each group). For induction, Group B patients consistently received prednisolone and cyclophosphamide; in contrast, the cytotoxic regimens in Group A patients varied from cyclophosphamide (five patients), mycophenolate mofetil (two patients), azathiorpine plus cyclosporine (one patient), and azathioprine alone (one patient). After a median follow-up of 7.6-7.8 years, one Group A patient had died of fulminant lupus. One survivor in Group B had a GFR < 90 ml/min per 1.73 m(2). Proteinuria persisted in five Group A patients and two Group B patients. In conclusion, Group B patients had good prognosis in terms of survival and proteinuria control. The only death occurred in Group A, and five of the 12 survivors in this group had persistent proteinuria. Further studies are needed to define the best treatment for pure lupus MGN.

Validation of three oscillometric blood pressure devices against auscultatory mercury sphygmomanometer in children.

AIM: To validate Welch-Allyn Vital Sign Monitor, Dinamap Procare-120 and Datascope Accutorr Plus against auscultatory mercury sphygmomanometer in children aged 5-15 years old according to the International Protocol of European Society of Hypertension adapted for validation in children. METHOD: One hundred and thirty two children were studied (44 for each device; 67 boys, 65 girls). Each underwent seven sequential BP measurements on the right arm resting in the sitting position, alternately with the mercury sphygmomanometer read simultaneously by two independent, trained observers and the test device by a third observer. RESULTS: For the Welch-Allyn monitor, the mean+/-SD of differences (device minus auscultatory BP) were -4.39+/-4.82 mmHg for systolic blood pressure and -4.1+/-7.07 mmHg for diastolic blood pressure. The device failed phase 2.1 for both systolic blood pressure (55, 91 and 98% were within 5, 10 and 15 mmHg, respectively) and diastolic blood pressure measurements (46, 82 and 95% were within 5, 10 and 15 mmHg, respectively). For the Dinamap device, the mean+/-SD of differences were -3.08+/-5.21 mmHg for systolic blood pressure and -4.61+/-9.35 mmHg for diastolic blood pressure. The device passed phase 2.1 for systolic blood pressure (71, 96 and 98% were within 5, 10 and 15 mmHg, respectively) but failed for diastolic blood pressure (51, 72 and 91% were within 5, 10, and 15 mmHg, respectively). For the Datascope device, mean+/-SD of differences were -0.9+/-4.33 mmHg for systolic blood pressure and -1.20+/-6.48 mmHg for diastolic blood pressure. The device passed phase 2.1 in that 84, 97 and 99% of systolic blood pressure, and 61, 89 and 97% of diastolic blood pressure readings were within 5, 10 and 15 mmHg, respectively. It also passed phase 2.2 for both systolic blood pressure and diastolic blood pressure. CONCLUSION: We performed an independent validation of three oscillometric BP devices in children. Overall Datascope Accutorr Plus passed, whereas Welch-Allyn Vital Sign Monitor and Dinamap Procare-120 failed an adapted IP-ESH.