The effect of serum magnesium levels and serum endothelin-1 levels on bone mineral density in protein energy malnutrition.

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

Adverse reaction of topical etofenamate: petechial eruption.

Etofenamate is a non-steroidal anti-inflammatory drug (NSAID). Clinical findings caused by etofenamate are uncommon. Allergic contact dermatitis is the most common cutaneous reaction reported. But petechial eruption due to etofenamate had not been reported yet. This report concerns an 11-year old male with petechial eruption after application of topical etofenamate. Physicians need to be aware that patients can develop an asymptomatic purpuric eruption when etofenamate is ordered.

Penicillin V-induced drug rash with eosinophilia and systemic symptoms.

DRESS syndrome (drug reaction with eosinophilia and systemic symptoms), previously named "drug hypersensitivity syndrome", is a severe adverse drug reaction characterized by skin rash, fever lymph node enlargement and internal organ involvement. We report on a 7-year old girl who developed DRESS syndrome caused by penicillin V treatment.

Congenital rickets presenting with hypocalcaemic seizures.

At Ataturk University Hospital, eight infants who presented with hypocalcaemic seizures were subsequently found to have rickets. Their mothers had osteomalacia. Neither mothers nor infants received vitamin D supplementation. Maternal vitamin D deficiency and non-supplementation in the infants were causes of rickets in these patients. It is recommended that neonatal hypocalcaemia may be due to maternal vitamin D deficiency and all unsupplemented vitamin D infants presenting with seizures should be investigated for rickets.

The relationship between Apgar score and umbilical arterial blood gas values in newborns.

The data for this report were derived from 61 newborns and their mothers. Of the newborns 45.9 percent had one-minute Apgar scores of less than seven, and 54.1 percent had Apgar scores of seven or greater. The five-minute Apgar score was less than 7 in 6.6 percent of cases. While 23 percent of newborns had pH values of less than 7.20, 77 percent had pH of 7.20 or greater. Only 39.3 percent of the 28 newborns with one-minute Apgar score of less than 7 and 75 percent of the four newborns with five minute Apgar scores of less than 7 had pH values less than 7.20. Of 33 newborns, 9.1 percent who had Apgar scores of seven or more had pH of less than 7.20. We determined the sensitivity of the one minute Apgar score in acidemia to be 78 percent, the specificity to be 63 percent, the positive predictive value as 39 percent, and the negative predictive value as 90 percent. The one minute score is very poor for detecting acidosis when present but is rarely misleading when acidosis is absent. There was a positive correlation between the Apgar score and pH (p < 0.001). The best correlation with umbilical artery pH values was observed with base excess (-BE) values (p < 0.001). Severe acidosis (pH < 7.11) was detected in eight cases. As delta pH increases, pH, pO2 and HCO3 decrease and pCO2 increases. Of 11 infants with delta pH > or = 0.20, 63.6 percent were sick infants and only one (9%) had normal Apgar scores.

Ultrasonographic evaluation of urinary tract in children with chronic functional constipation.

Urinary tract anomalies were prospectively investigated with ultrasound in 31 children with chronic functional constipation. These children were compared with 29 healthy controls without constipation both before and after treatment. Bladder residue and upper renal tract dilatation after micturition were significantly more common in the group with constipation than in the improved after-treatment and control groups.

Urinary calcium excretion of children living in the east region of Turkey.

We screened 1647 randomly selected Turkish primary school children to detect the prevalence of hypercalciuria. Ninety-seven children had hypercalciuria, with a prevalence of 5.88 percent. Mean Uca/Ucr ratio was 0.135 +/- 0.108; mean Uca/Ucr value for girls was 0.139 and for boys 0.130 (p > 0.05). Mean Uca/Ucr of boys with hypercalciuria was 0.341 +/- 0.09 and of girls 0.327 +/- 0.08 (p > 0.05). Of these 97 children all investigations could be completed in only 40 and these cases were considered to be idiopathic. Twelve children (21%) had a family history of consanguinity and 17 (29.8%) of renal stones. The relation between blood parathormone and Uca/Ucr ratio was not statistically important (p > 0.05).

The effect of serum magnesium levels and serum Endothelin-1 levels on bone mineral density in protein energy malnutrition / Efecto de los niveles séricos de magnesio y los niveles séricos de Endotelina-1 sobre la densidad mineral osea en la malnutrición calórico-proteica

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

El consumo inadecuado y desbalanceado de proteínas y calorías energía conduce a la malnutrición calórico-proteica (MCP). Se sabe que la densidad mineral ósea y los niveles séricos de magnesio son bajos en los ninos malnutridos. Sin embargo, no está claro el papel que desempenan los niveles séricos de magnesio y los niveles séricos de endotelina-1 (ET-1) en la patofisiología de la mineralización del hueso. Por consiguiente, las relaciones entre los niveles séricos de magnesio y los niveles séricos de ET-1, y los cambios en la densidad mineral ósea, constituyen el objeto de investigación de este estudio. Hubo un total de 32 sujetos; 25 de ellos tenían DCP y 7 eran considerados. Si bien los niveles séricos promedios de ET-1 de los ninos con kwashiorkor y marasmo no mostraron diferencia estadística significativa, los niveles séricos promedio de ET-1 de ambos grupos fueron significativamente más altos que los del grupo de control. Los niveles séricos de magnesio estuvieron por debajo del valor normal en 9 (36%) de 25 ninos malnutridos. Los ninos malnutridos incluidos en este estudio fueron divididos en dos sub-grupos según sus niveles de magnesio en suero. Mientras que los niveles séricos promedio de ET-1 en el grupo con niveles bajos de magnesio fueron significativamente más altos que los del grupo con niveles normales de magnesio (p < 0.05), la densidad mineral ósea promedio y los niveles promedio del contenido mineral óseo fueron significativamente más bajos (p < 0.05). En conclusión, muchos factores juegan un papel en la patofisiología de los cambios en la densidad mineral ósea por la malnutrición. Nuestro estudio sugirió niveles más bajos de magnesio y niveles más altos de ET-1 podrían ser factores importantes en los cambios de densidad mineral ósea en la malnutrición. Se recomienda que los pacientes malnutridos, especialmente a causa de hipomagnesemia, sean tratados con magnesio lo más pronto posible.

Adverse reaction of topical etofenamate: petechial eruption / Reacción adversa del etofenamato tópico: erupción petequial

Etofenamate is a non-steroidal anti-inflammatory drug (NSAID). Clinical findings caused by etofenamate are uncommon. Allergic contact dermatitis is the most common cutaneous reaction reported. But petechial eruption due to etofenamate had not been reported yet. This report concerns an 11-year old male with petechial eruption after application of topical etofenamate. Physicians need to be aware that patients can develop an asymptomatic purpuric eruption when etofenamate is ordered.

El etofenamato es un antiinflamatorio no esteroideo (AINE). Los hallazgos clínicos sobre los efectos del etofenamato son poco comunes. La dermatitis alérgica por contacto es la reacción cutánea más comúnmente reportada. En cambio, la erupción petequial a causa del etofenamato no se había reportado hasta ahora. Este reporte trata de un varón de 11 años de edad con erupción petequial tras la aplicación del etofenamato tópico. Es necesario que los médicos tomen conciencia de que los pacientes pueden desarrollar una erupción púrpura asintomática, a la hora de prescribir el etofenamato.

Bone mineral density in children with cerebral palsy.

BACKGROUND: The purpose of the present study was to evaluate the severity of and factors related to osteopenia in children with cerebral palsy (CP). METHODS: Bone mineral density (BMD), calcium (Ca), phosphate (P), alkaline phosphatase (ALP), creatinine, parathyroid hormone (PTH) and 25-hydroxy vitamin D3 (25OHD3) concentrations were determined in 24 children with CP (15 ambulant, nine non-ambulant), aged between 10 months and 12 years (mean (+/-SD) 4.1+/-2.9 years). These vaules were compared with data obtained from a control group. RESULTS: Adjusted mean BMD values were lower in the patient group than in controls (P<0.05). However, there was no difference between BMD values of ambulant and non-ambulant patients. The Ca and P levels of the patient group were significantly higher than those of controls (P<0.05). CONCLUSIONS: The present study showed that BMD was decreased in all children with CP, but to a greater extent in non-ambulant children with CP, and immobilization is the major effective factor on bone mineralization.

Reference limits for routine haematological measurements in 7-14-year-old children living at an intermediate altitude (1869 m, Erzurum, Turkey).

In order to obtain reference limits, complete blood counts were performed using an automated haematology analyser (Cell-Dyn 1500) on venous blood samples from 718 healthy children living at 1869 m altitude. At first, to obtain appropriate populations for obtaining reference values, the factors of per capita income, parental educational status and antecedent infection(s) were assessed with respect to their effects on each parameter. Of the subgroups classified according to these factors, those which were affected in terms of haematological values were excluded. The effects of age and sex on the parameters were evaluated, and reference values were arranged according to age groups to facilitate clinical use. Among the reference values which we suggest for children living at about 2000 m altitude, those of haemoglobin, haematocrit, red blood cell count and mean cell volume are significantly higher than sea-level values. In addition, our results indicate that intermediate altitude has no effect on other routine haematological values.

Efficacy and safety of rectal thiopental: sedation for children undergoing computed tomography and magnetic resonance imaging.

PURPOSE: We evaluated the clinical safety, effectiveness, efficiency and potential side effects of rectally administered thiopental in 30 children undergoing computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: The doses of thiopental used were 50 mg/kg for infants under 6 months of age, 35 mg/kg for infants between 6 and 12 months of age and 25 mg/kg for older children. After administration of the sedative, oxygen saturation was continuously monitored and vital signs were recorded every 20 min during the imaging procedure and then every 20 min until discharge. RESULTS: Successful sedation and adequate imaging were obtained in 29 of 30 (96.7%) patients. Respiratory depression was not observed in any patient. However, oxygen saturation dropped below 90% transiently (to 88%) in three patients (10.0%) and this was immediately corrected by repositioning the child's neck to open the upper airway. All successfully sedated patients were asleep within 15 min (mean +/- SD 7.3 +/- 2.7 min) and sedation was sufficient for at least 30 min. Prolonged sedation was observed in two patients. CONCLUSIONS: We believe that rectal thiopental is a safe, effective and efficient form of sedation for pediatric imaging.

Congenital rickets presenting with hypocalcaemic seizures

At Ataturk University Hospital, eight infants who presented with hypocalcaemic seizures were subsequently found to have rickets. Their mothers had osteomalacia. Neither mothers nor infants received vitamin D supplementation. Maternal vitamin D deficiency and non-supplementation in the infants were causes of rickets in these patients. It is recommended that neonatal hypocalcaemia may be due to maternal vitamin D deficiency and all unsupplemented vitamin D infants presenting with seizures should be investigated for rickets.