Actitud de los pediatras sobre el uso de andadores para los bebés / Pediatricians' attitude about the use of infant walkers

Los andadores se utilizan frecuentemente a pesar de que su uso puede ocasionar lesiones. Se realizó una encuesta para obtener información sobre las actitudes y el abordaje de los pediatras respecto del uso de andadores. Se invitó a 247 pediatras que asistieron al 44° Congreso Turco de Pediatría y Europediatría (2008) a responder un cuestionario preparado por los autores. Se incluyeron en el análisis 226 cuestionarios respondidos en forma completa. La mediana de edad de los participantes (119 mujeres) fue de 39 años (29 a 58). De ellos, 4% recomendaban el uso de andadores, 32,3% dejaban la decisión a criterio de los padres y 63,7% no lo recomendaban. Ciento cinco habían tratado con anterioridad a un bebé que sufrió una lesión relacionada con el uso del andador; de ellos, 73,3% no recomendaron su uso y 57,1% opinaron que la producción y el uso de andadores deberían prohibirse. Conclusiones. El 4% de los pediatras encuestados recomiendan el uso de andadores para bebés y más del 30% dejan la decisión a los padres. Los pediatras que atendieron a un bebé que sufrió una lesión por el uso del andador fueron menos proclives a recomendarlo.

Infant walkers are still very popular even though their use might cause injuries. A survey was carried out to obtain information about attitudes and pediatricians' approach regarding the use of infant walkers. Two hundred and forty seven pediatricians who attended the 44th Turkish Congress of Pediatrics and Europediatrics (2008) were invited to reply to a questionnaire prepared by the authors. Two hundred and twenty six questionnaires replied in full were included. The median age of participants (119 women) was 39 years old (range: 29-58 years old). Out of the total, 4% recommended the use of a walker; 32.2% left the decision to parents' judgment, and 63.7% did not recommend its use. A hundred and five had previously treated an infant who had an injury associated to the use of the walker; out of them, 73.3% did not recommend its use and 57.1% stated that there should be a ban on the sale and manufacture of walkers. Conclusions. Out of the total number of surveyed pediatricians, 4% recommend the use of infant walkers and over 30% leave this decision to parents. Those pediatricians who took care of babies who had an injury associated to the use of a walker were less prone to recommending it.

Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus / A rare cause of afebrile convulsion: rotavirus gastroenteritis

La gastroenteritis por rotavirus es la más frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los niños pequeños, además de deshidratación grave y desequilibrios electrolíticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatía, deshidratación, desequilibrio electrolítico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infección habitual en nuestro país (Turquía), con diversas manifestaciones clínicas, entre ellas, las convulsiones, que pueden verse no sólo en los niños con enfermedades neurológicas o sistémicas sino también en los niños sanos.

Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.

Nitric oxide affects serum ferritin levels in children with iron deficiency.

In iron deficiency, serum levels of ferritin decrease. The lack of iron has been thought to be the main factor in this decrease, but another potential factor is nitric oxide, which has been shown to affect ferritin metabolism in vitro. The aim of this study was therefore to evaluate in children with iron deficiency the relation of serum ferritin, nitric oxide degradation products (nitrate and nitrite), and endothelin-1, a protein closely related to nitric oxide function. A total of 80 children were included in the study (39 with iron deficiency, 41 controls). Serum levels of ferritin, nitrate, nitrite, and endothelin-1 were measured in all participants. In children with iron deficiency, nitrate and nitrite levels were significantly higher (p < .009 and .01, respectively). Also, serum ferritin was negatively correlated with serum levels of nitrate and nitrite (p = .034, r = -.254 for nitrate and p = .01, r = -.593 for nitrite). No statistical relationship was found between serum ferritin and endothelin-1.

Kawasaki disease onset during concomitant infections with varicella zoster and Epstein-Barr virus.

Kawasaki disease is an acute systemic vasculitis that predominantly affects preschool-aged children. It has a predilection to coronary arteries, and its precise etiology is still unknown. Many infectious agents, including viruses and bacteria, have been suggested as potential causes of the disease. Here, we report a patient who met the diagnostic criteria of Kawasaki disease during concomitant Epstein-Barr virus and varicella-zoster virus infections, and we discuss the possible roles of these viruses in etiology.

Blastocystis hominis--an emerging and imitating cause of acute abdomen in children.

Two children aged 12 and 11 years with a similar history of abdominal pain, nausea, vomiting and fever with abdominal tenderness, and muscle guarding at the right lower quadrant for few days were admitted to our hospital. They subsequently developed diarrhea but without clinical relief. Just before the decision of laparotomy, both patients were diagnosed as having Blastocystis hominis infection with light microscopic examination of the stools and were treated uneventfully with the appropriate antibiotics.

Assessment of cardiac function in iron-deficient children without anemia.

Iron deficiency anemia may lead to impairment of many vital functions, including those in the cardiovascular system. However, the effects of iron depletion on cardiac function in the absence of anemia are not well known. In this study the authors examined the effects of iron deficiency without overt anemia on cardiac function in 59 children. Complete blood count, serum iron, serum iron-binding capacity, and serum ferritin levels were measured in all children. The children were divided into two groups according to serum ferritin levels: an iron-depleted group (n = 28) and a non-iron-depleted control group (n = 31). Echocardiographic examinations were performed using M mode and Doppler echocardiographic methods in all children to assess cardiac function. No statistically significant difference was found between the two groups in terms of echocardiographic indices. Although the number of subjects in this study was small, the authors conclude that iron deficiency in the absence of overt anemia does not lead to important changes in cardiac function.

Woolly hair, palmoplantar keratoderma and arrhythmogenic dilated cardiomyopathy in a 7-year-old Turkish girl: Carvajal syndrome.

Carvajal syndrome (OMIM 605676) is a familial syndrome consisting of woolly hair, palmoplantar keratoderma and heart disease. It leads to dilated cardiomyopathy that affects predominantly the left ventricle. It is caused by a recessive mutation in desmoplakin, an intracellular protein that links desmosomal adhesion molecules to intermediate filaments of the cytoskeleton. Very few patients with this syndrome have been reported, and all have been from Equador or India. We report a 7-year-old Turkish girl with Carvajal syndrome.