Nutritional B12 deficiency in infants of vitamin B12-deficient mothers.

AIM: Nutritional vitamin B12 deficiency in infants may occur because the maternal diet contains inadequate animal products. Clinical presentations of the infants who had nutritional vitamin B12 deficiency were analyzed in this study. SUBJECTS AND METHODS: Patients with nutritional vitamin B12 deficiency were enrolled in the study between 2003 and 2010. The diagnosis was based on a nutritional history of mothers and infants, clinical findings, hematological evaluation, and low level of serum vitamin B12. RESULTS: Thirty children aged 1 - 21 months constituted the study group. Poverty was the main cause of inadequate consumption of animal products of the mothers. All infants had predominantly breastfed. The most common symptoms were developmental delay, paleness, apathy, lethargy, anorexia, and failure to thrive. Hematological findings were megaloblastic anemia (83.3 %), thrombocytopenia (30 %), and severe anemia (13.3 %). All of the mothers had low serum B12 levels; eight of them had megaloblastic anemia. CONCLUSION: The unusual clinical manifestations of vitamin B12 deficiency may also be seen apart from neurological and hematological findings. Nutritional vitamin B12 deficiency due to maternal deficiency might be a serious health problem in infants. Therefore, screening and supplementation of pregnant and lactating women to prevent infantile vitamin B12 deficiency should be considered.

Physiological periostitis in a 2.5-month-old baby.

Periosteal reaction has different etiologies in early infancy. Physiological periostitis is a well-documented X-ray finding seen in both preterm and term babies aged between 1-6 months and can easily be misdiagnosed as child abuse or pathological periostitis. Here, we present a 2.5-month-old infant admitted with a history of fever, swollen right upper arm after vaccination and X-rays findings revealing periosteal reactions on both sides of the humeri, radii, tibiae and femora. Initial diagnosis was child abuse or congenital syphilis. Due to the normal physical findings and normal serological-biochemical data, physiological periostitis was diagnosed. Physiological periostitis should also be considered in patients with periosteal reactions of the long bones in infants aged between 1-6 months.

Allergen variability and house dust mite sensitivity in pre-school children with allergic complaints.

Yazici S, Günes S, Kurtulus-Çokboz M, Kemer Ö, Baranli G, Asik-Akman S, Can D. Allergen variability and house dust mite sensitivity in pre-school children with allergic complaints. Turk J Pediatr 2018; 60: 41-49. The increase in the prevalence of allergic diseases in pre-school children who are often at home may be due to an increase in house dust mite sensitivity, which is rarely expected in this age group. In our study, it was aimed to investigate allergen sensitivities, especially house dust mite sensitivity in pre-school children with allergic disease complaints by skin prick test (SPT). Two hundred and twenty children admitted to the Pediatric Allergy and Asthma Clinic of Balikesir University between October 2015 and October 2016 diagnosed with asthma, allergic rhinitis, food allergy, atopic dermatitis or urticaria were involved in the retrospective cross-sectional study. Allergen groups used in SPT were Dermatophagoides farina (Derf), Dermatophagoides pteronyssinus (Der p), Alternaria alternata, cat epithelium, pollen mixture and food mixture. Average age of the 220 patients was 2.98 years (2.75-3.21). SPT was positive in 55.9% of patients. Sixteen percent were monosensitized and 73.8% were polysensitized. Seventy two children (32.7%) were sensitive to Der f and 67 (30.4%) were sensitive to Der p. There was no difference between SPT positivity and gender (p > 0.05). Ninty-five children were diagnosed with asthma, 38 with asthma and allergic rhinitis, 63 with food allergy and 24 with urticaria and/or atopic dermatitis. SPT positivity was significantly higher in the asthma and allergic rhinitis group than other groups. As the age increased, significant increases in the sensitivities of Der f (p < 0.01), Der p (P < 0.01) and A. alternata (p < 0.05) and a significant decrease for food panel sensitivity (p < 0.01) were detected. Even though skin and food allergies were included in our study, house dust mite sensitivity was found much higher than other studies reporting ranges between 3.5-23% in children of the same age group with mainly respiratory complaints. It is concluded that the probable reasons for this increase, especially geographical features, should be investigated in different areas and in larger number of studies.

[Preliminary results of interferon alpha-2a and lamivudine combination therapy regimen in children with chronic hepatitis B]. / Kronik hepatit B tanisi alan çocuklarda interferon-alfa 2a ve lamivudin kombinasyonu tedavisinin erken dönem sonuçlari.

The combination therapy regimen of interferon (IFN)-alpha and lamivudine (LAM), a nucleoside analogue, is lately in use in chronic hepatitis B (CHB) infections. The aim of this study was the evaluation of the efficacy of IFN-alpha 2a and LAM combination therapy in children with CHB infection. Twenty-seven cases (mean age 10.4 +/- 3.7 years, 20 males) who were followed up between 2002 and 2005 in Pediatric Gastroenterology Department, were included in the study. IFN-alpha 2a (5 MU/m2 SC, three times a week for 6 months) and LAM (4 mg/kg/d PO, maximum 100 mg/d for one year) were given simultaneously. LAM medication was extended to two years in non-responders. Alanine aminotransferase (ALT) levels, hepatitis markers and HBV-DNA were monitored once in three months. "Partial" response was defined as normal levels of ALT and negative HBV-DNA, and "complete" response was defined as seroconversion of HBeAg/anti-HBe. The cases whose HBV-DNA not getting negative and whose ALT levels did not decrease to the normal values were defined as "non-responders". In our study, one case (4.3%) was found non-respondant, "partial" response was seen in 13 (56.5%) cases, whereas "complete" response was seen in 9 cases (39.1%) out of 23 cases who have got the medications as long as a year. There was no significant difference between the response to the therapy regimen and the age, sex, ALT levels, hepatic activity indices (HAI) and HBV-DNA levels (p>0.05). As a result, IFN-alpha 2a and LAM combination therapy regimen is an effective alternative therapy in childhood, and the efficacy of the therapy was not influenced by age, sex, initial ALT levels, HBV-DNA and HAI in our study group.

Clinical and genetic analysis of pediatric patients with Wilson disease.

BACKGROUND/AIMS: Wilson disease (WD, MIM# 277900) is an autosomal recessive disorder of copper transport resulting from the defective function of a copper transporting P-type ATPase. Detecting mutations and single nucleotide polymorphisms (SNPs) of the ATP7B gene in Turkish pediatric WD patients (n=32) and controls (n=52) is the aim of this research. MATERIALS AND METHODS: For screening mutations and SNPs of the ATP7B gene, sequencing was performed. RESULTS: Mutations were determined in the ATP7B gene in 23 out of the 32 pediatric patients. The mutation detection rate in the ATP7B gene of the pediatric Turkish WD patients was 71.875%. Fifteen different mutations were determined in the ATP7B gene. These mutations were distributed throughout the ATP7B gene and were as follows: 2 deletion, 1 insertion, 3 nonsense, and 9 missense mutations. Four of these, including c.3111delC (1 deletion) and c.2363C>T, c.3733C>A, and c.3451C>T (3 missense) mutations, were detected in the Turkish WD patients. Eleven polymorphisms were detected in both groups. Among these, c.3727G>A (SNP) was reported in the Wilson Disease Mutation Database by our group. Nine out of the thirty-two pediatric Turkish WD patients had no mutations in the ATP7B gene. CONCLUSION: To find the cause of WD in pediatric patients who have no mutation in ATP7B, additional research is necessary.

Vitamin B12 and folate statuses are associated with diet in pregnant women, but not with anthropometric measurements in term newborns.

OBJECTIVE: To investigate the frequencies of vitamin B12 and folate deficiencies in pregnant women in low socioeconomic group, the relation between the animal-source foods consumption and maternal vitamin B12-folate statuses, and their impacts on anthropometric measurements of the infants. METHODS: A total of 208 pregnant women in the last trimester were included in the study. A questionnaire about socio-demographic status, consumption of meat, egg, milk-dairy products, multivitamin supplementation was used. Vitamin B(12) and folate concentrations were studied by chemiluminescence method. The babies of Vitamin B(12) deficient mothers were evaluated after birth. RESULTS: The rate of vitamin B(12) deficiency was 47.6% and folate deficiency was 17.3% of pregnant women. Animal food consumption was inadequate about half of pregnant women and vitamin B(12) levels in these women were significantly low. There were no statistically significant relationships between the birth weight, birth length and head circumference measurements, and maternal vitamin B(12) and folate concentrations. CONCLUSION: The rate of vitamin B12 deficiency in pregnant women in low socioeconomic population is high. Although there were no significant effects of the vitamin B12 and folate deficiencies on birth size, additional studies are required to elucidate the subsequent effects.