Presence of melamine in human milk and the evaluation of the effects on mother-infant pairs in a cohort study.

Melamine contamination is a recent public health problem emerging globally. Present study aimed to detect the rate of melamine presence in human milk in a cohort study and to evaluate any possible differences in maternal-infant pair characteristics such as breastfeeding status, crying and sleep problems of infants, maternal postpartum depression, maternal-infant bonding, infant and maternal anthropometry, and maternal complete blood count caused by the melamine exposure. Mothers of infants born in Sanliurfa were invited to participate in 'Urfa Child Cohort Survey'. Overall, two breast milk samples were taken between 5 days and 15 days postpartum and between 4 weeks and 10 weeks. Randox Food's InfiniPlex array was used to analyse the presence of melamine. Melamine was detected in 32.2% and 24.4% of the first and the second milk samples; 16.7% of mothers had two positive samples. z Scores for birth weight and z scores for height for age were detected to be significantly lower in cases with two positive samples compared to cases with negative samples. Mean maternal white blood cells counts were found to be lower in cases with repeated melamine contact. Melamine might have a detrimental effect on birth weight, infant height and maternal blood count. Further studies should be done to detect environmental contamination in different regions and countries.

Dynamics in children and adolescents who experience varicella zoster virus infections after haematopoietic stem cell transplantation: a case-control study.

We evaluated the incidence of varicella-zoster virus (VZV) infections, including herpes zoster (HZ), and investigated the associated risk factors for HZ and compared lymphocyte subsets of these patients at 1, 3 and 6 months following haematopoietic stem cell transplantation (HSCT) in a case-control study in children and adolescents. The incidence of HZ infection at the first year after HSCT was 17/125 (13·6%). The cumulative incidence of HZ infection was 22/125 (17·6%). Sixteen (73%) cases with HZ and 11 (32%) cases in the control group had a diagnosis of malignant disorder. No significant difference was noted between the HZ group and the control group in absolute lymphocyte number and subsets (except WBC) at the pre-transplant evaluation. Pre-transplant WBC count was statistically lower in the HZ group (P<0·05). The CD4/CD8 ratios were lower in the HZ group during the first 6 months after HSCT, and the decrease was statistically significant at 6 months compared to the control group. In conclusion, patients undergoing HSCT for a malignant disorder had a significantly higher risk of VZV infection than those with non-malignant disorders and pretransplant donor characteristics were not helpful in predicting risk of post-transplant VZV infection.

Naturally acquired hepatitis A antibodies after haematopoetic stem cell transplantation.

Haematopoietic stem cell transplant (HSCT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated throughout their lifetime and therefore need to be revaccinated. We aimed to evaluate the influence of different factors on hepatitis A virus (HAV) immunity in both child and adult HSCT recipients living in an intermediate endemic region, Turkey. Eighty patients (age range 2·5-57 years) who had HAV serology prior to HSCT were evaluated. The prevalence of HAV seropositivity was 85% (n=68) before HSCT. There was no history of HAV vaccination before HSCT in children and HAV vaccine was not available in Turkey 10 years ago, so it was assumed that all seropositive patients reflected natural immunity. After the exclusion of six patients with autologous HSCT, the remaining 62 seropositive and allogeneic patients were included in this retrospective study. The duration of HAV seropositivity was estimated using the Kaplan-Meier method, log-rank analysis and Cox regression models. Estimated mean time to loss of HAV seropositivity was 48·6 months after transplantation. Patients who were older (⩾18 years) at transplantation and who had older (⩾18 years) donors became seronegative later (P<0·05). Cox backward-stepwise regression confirmed that older age of recipient at transplantation was the only significant parameter for HAV seropositivity (P<0·05). HAV-inactivated vaccine might be recommended later to older HSCT recipients in intermediate endemic regions.

The factors that have a role in variability for temperature.

Our objective was to determine the factors that affect (i) the rectal-axillary temperature measurement difference (RATD) for digital and mercury-in-glass thermometers and (ii) the difference between mercury-in-glass and digital thermometer readings taken by the rectal and axillary routes. Children (between the ages of 2 and 48 months) who were admitted to Hacettepe University Children Hospital and Corum Children's Hospital in 2 months period were included in this study. Two measurements were taken from each patient within 2 days at two different occasions including day/night and sleep/awake by the same physician. A total of 135 patients were enrolled. RATD was 0.61 + 0.54 degrees C in the mercury-in-glass thermometer, and 0.81 +/- 0.57 degrees C in the digital thermometer. The mean differences between digital and mercury-in-glass thermometers were 0.16 degrees C for rectal routes and -0.02 degrees C for axillary routes. Children at older age with hypoalbuminemia and children exposed to higher ambient temperatures had lower values of RATD than others. Temperature recordings from different sites might change with ambient temperature and individual characteristics of children.

The effect of oral L-carnitine supplementation on the lipid profiles of hyperlipidaemic children.

AIM: To investigate the carnitine status and the effect of carnitine supplementation on serum lipid profiles in children with hyperlipoproteinaemia, a clinical open trial was conducted at Hacettepe University Ihsan Dogramaci Children's Hospital, Section of Nutrition and Metabolism. METHODS: Patients were given carnitine at a dose of 100 mg/kg/d for 12 wk. Blood samples for the determination of lipid profile and carnitine levels and urine samples for carnitine levels were obtained on admission, at week 4 and week 12 of the study period. RESULTS: A total of 41 children were enrolled in the study: 20 patients had type II heterozygotes, eight patients had type II homozygotes, three patients had type III, six patients had type V and four patients had secondary hyperlipidaemias. Serum and urine carnitine levels were within normal limits on admission. No significant correlations were found between serum carnitine levels and serum lipid profiles. Serum HDL and apolipoprotein A-I decreased significantly during the 12 wk of intervention in type II heterozygotes. In type II homozygotes, total cholesterol and LDL levels at weeks 4 and 12 increased significantly compared to initial levels. No significant change was noted for lipid parameters in hyperlipoproteinaemia type V. CONCLUSION: The results of this trial demonstrated that carnitine supplementation was of no benefit for children with hyperlipidaemias, especially in primary hyperlipoproteinaemia type II heterozygotes, homozygotes and type V.

Effects of supplementary iodine on the performance and egg traits of laying hens.

1. This experiment was carried out to determine the effects of dietary iodine supplementation on the performance and egg traits of laying hens. A total of 600 SHSY type brown layers aged 21 weeks of age were chosen at random from a large flock. They were randomly distributed into 30 pens at 20 hens per pen. Each treatment comprised 6 replicates of 20 layers in groups of 5 birds. The diets were supplemented with 0, 3, 6, 12 and 24 mg/kg iodine as calcium iodate. The experimental period lasted 30 weeks. 2. There were no significant differences among the groups in body weight, food consumption, egg production, food consumption per kg eggs, eggshell index, eggshell breaking strength, shell thickness or egg yolk index. 3. Supplementation of the diet with 12 mg/kg iodine increased food consumption per dozen eggs compared to the groups fed on diets supplemented with 0 and 6 mg/kg iodine. 4. Egg weight was less in groups fed on diets supplemented with 12 and 24 mg/kg iodine than in the group receiving no iodine supplementation. 5. Iodine supplementation to provide 12 and 24 mg/kg reduced egg albumen index and egg Haugh units. 6. There were no significant differences among the groups in egg cholesterol and egg yolk cholesterol contents. 7. The iodine concentrations in egg yolk, egg albumen and whole egg increased with increased iodine supplementation. 8. As a result, the 3 and 6 mg/kg iodine supplementation of diet could be used to enrich the eggs with iodine without any adverse effect on performance and egg traits.

Vitamin A supplementation in acute diarrhea.

BACKGROUND: Vitamin A supplementation reduces the severity of subsequent diarrheal episodes. This study was conducted to examine the effect of single oral high-dose vitamin A supplementation on the duration of acute diarrhea in 6- to 12-month-old infants who are not malnourished. METHOD: In this double-blind, randomized, placebo-controlled study, infants who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Training and Treatment Unit with acute diarrhea were randomly assigned either to a group receiving a single oral dose of 100,000 IU vitamin A or placebo. There were 60 infants in each group. All infants were followed up until the diarrheal episode ended. Serum vitamin A levels were determined both at admission and 2 weeks later. RESULTS: No effect of vitamin A supplementation could be demonstrated on either the total duration of diarrhea (7.4 +/- 3.2 days in the treatment group vs. 7.8 +/- 3.1 days in the placebo group) or on its duration after intervention (3.8 +/- 2.3 days in the treatment group vs. 3.9 +/- 1.9 days in the placebo group; P > 0.05 for both comparisons). Serum vitamin A levels were not significantly different at admission (23.5 +/- 9.7 microg/dL in the treatment group vs. 24.1 +/- 9.7 microg/dL in the placebo group; P > 0.05) nor at the end of a follow-up period of 2 weeks (treatment: 33.3 +/- 13.7 microg/dL, placebo: 35.2 +/- 11.2 microg/dL; P > 0.05). However, the increase in serum vitamin A levels at the end of the 2-week follow-up interval for infants in both the treatment and placebo groups were found to be significant compared with levels at admission (P < 0.01). The mean weight gain in both groups were similar by the end of the first month (6.9 +/- 5.0% in the treatment group vs. 6.3 +/- 4.2% in the placebo group; P > 0.05). CONCLUSION: No effect of oral vitamin A supplementation on serum vitamin A levels, duration of diarrhea, or weight gain during an acute diarrheal episode could be demonstrated in our study group of infants between 6 and 12 months of age who had no malnutrition.

Clinical trial to evaluate immunogenicity and safety of inactivated hepatitis A vaccination starting at 2-month-old children.

Active immunization with hepatitis A vaccine has been shown to provide long-term protection against hepatitis A virus (HAV) infection. However, few data are available regarding use of the hepatitis A vaccine in children under two years of age. The present study was conducted to test the safety and immunogenicity of inactivated hepatitis A vaccine administered to infants, and to evaluate the correlation between mother and infant anti-HAV antibodies. A total of sixty healthy children, two months of age, were enrolled in this study and immunized with 360 EU of inactivated hepatitis A vaccine (Havrix) according to the two, four and six months of age schedule. Blood sampling was performed prior to the first vaccination and one month after the third vaccination at seven months. Venipuncture was also done on mother on admission. The reactogenicity was expressed as the percentage of reported local and systemic reactions. The most common side effects were erythema on the injection site and fever. Infants with passively transferred maternal anti-HAV antibodies had a reduced anti-HAV GMT after vaccination. On admission, only one infant and his mother were seronegative and seroconversion was only detected in this infant. One month after the third dose seven infants (12.3%) were found to be seronegative. The infant without passively acquired maternal anti-HAV had the protective levels with a GMT of 3176 mIU/ml one month following the third dose. There was a significant positive correlation between the titers of mother and infant anti-HAV antibodies (n = 0.96, p < 0.001) on admission. Hepatitis A vaccine showed no immunogenicity in infants with presence of maternal antibodies. Hepatitis A vaccine is safe but it should be used after the disappearance of maternal antibodies.

Short-term developmental outcome of iron prophylaxis in infants.

BACKGROUND: Previous studies on the cognitive effects of iron treatment have focused on anemic or non-anemic iron-deficient infants. The effect of iron supplementation on cognitive development among iron-sufficient infants has not been studied. The aim of the present study was to examine the effect of iron supplementation on performance in the Bayley Scales of Infant Development (BSID) and anthropometric measurement in 6-month-old iron-sufficient healthy infants. METHODS: Healthy, iron-sufficient infants who were 6 months of age and were attending the Well Baby Clinic were considered for enrollment. Infants were randomly assigned to take ferrous sulfate supplementation (1 mg/kg per day) or no supplementation and were followed for 3 months. Anthropometric measurement, hematologic status and BSID were evaluated on admission and after 3 months. RESULTS: Seven infants in the intervention group and nine in the control group completed the study. No significant differences were observed in anthropometric measurements and complete blood counts between the two groups after the 3 month study period. The mean transferrin saturation (TS) level decreased significantly in the control group during the study period (from 15.3+/-2.6 to 7.8+/-5.1%; P = 0.0117), but no such reduction was seen in the intervention group. At the end of the study, the TS of the control group was found to be significantly lower than that of the intervention group (7.8+/-5.1 vs. 19.9+/-7.9%, respectively; P = 0.0033). The BSID scores of infants in both groups were within the normal range on admission and at the end of the study period. CONCLUSIONS: Short-term iron supplementation did not change developmental test scores despite the hematologic response in iron-sufficient healthy infants. The high prevelance of iron-deficiency anemia and its relationship with adverse developmental outcome suggests that prevention of iron-deficiency anemia with prophylaxis needs to be emphasized, rather than treatment.

Clinical characteristics of transient glucose intolerance during acute diarrhoea.

Transient glucose intolerance (TGI) is an important cause of WHO G-ORS (Glucose-Oral Rehydration Solution) treatment failure and hospitalization in dehydrated children during acute diarrhoea. This retrospective case-control study was designed to determine some risk and predictive factors for developing TGI among moderately dehydrated patients with acute diarrhoea while under G-ORS therapy. Among moderately dehydrated patients, files of 22 patients with TGI and 66 other dehydrated patients without intolerance were reviewed. Patients with TGI were younger (9.7+/-10.5 mo and 11.6+/-7.8 mo, respectively, p < 0.05), the median age being 6 mo in the TGI group and 10 mo in non-TGI group. There was no difference between groups for sex, admission season, history of fever or vomiting, frequency of vomiting, presence of blood, mucous or leukocyte in stool, presence of associated disease and duration of diarrhoea on admission. The admission haemoglobin, white blood cell, blood pH, sodium and potassium levels were similar in both groups. The mean serum chloride level (116.8+/-6.9, 109.6+/-7.9 mEq/l, respectively, p<0.05) was higher in the TGI group and the bicarbonate level was lower (12.9+/-3.8, 15.3+/-6.0, respectively, p < 0.05). Stool frequency was also higher in patients with TGI (11.2+/-5.3/24 h, 5.9+/-4.4/24 h, respectively, p < 0.05). No difference was found between the nutritional status of children in both groups. More children were breastfed in the group without TGI (34/56, 61%, 6/18, 33% respectively, p=0.079, OR=0.32, 95% CI [0.09-1.11]). It was concluded that patients with TGI are younger and have high stool frequency. Although statistical significance could not be shown, breastfeeding seems to protect children from TGI, as it protects from diarrhoea.

Rehydration of moderately dehydrated children with transient glucose intolerance using rice oral rehydration solution.

Following the successful rehydration of two moderately dehydrated patients with transient glucose intolerance (TGI) using rice-oral rehydration solution (R-ORS), R-ORS has been used in Hacettepe University Ihsan Dogramaci Children's Hospital Diarrhea Training and Treatment Unit (DTTU) to rehydrate moderately dehydrated children with TGI. The files of children with moderate dehydration and glucose intolerance admitted to the unit were reviewed retrospectively within two periods according to the availability of R-ORS. The clinical and laboratory findings were analysed where available. Before R-ORS became available (September 1993) 6 patients were admitted, all of whom deteriorated with glucose (G)-ORS treatment in 7.0 +/- 3.8 h and were hospitalized for i.v. fluid treatment. During the second period 22 moderately dehydrated children with TGI were admitted. The clinical and laboratory characteristics on admission of the children in the two periods were not statistically different (p > 0.05). Among the 22 patients admitted during the second period 10 were administered G-ORS in the unit and 12 had already received G-ORS at home. Clinical and laboratory deterioration was observed in these 10 patients while receiving G-ORS in the unit within 6.3 +/- 3.7 h and rehydration was continued with R-ORS. Clinical and laboratory improvement were demonstrated in 8 patients within 18.2 +/- 6.5 h. Overall, 17 patients were rehydrated successfully with R-ORS, with a mean time of 18.0 +/- 7.2 h. Five patients were hospitalized. The overall success rate of R-ORS was 77.3%. R-ORS may be considered as an alternative mode of therapy to i.v. treatment in the rehydration of moderately dehydrated children with TGI.

Multimedia and children in Turkey.

Multimedia will be regarded as essential tools for children to create their new world. The effects of television on young children's life have been well studied. Television differs, however, from other media, including the movies, in its pervasive impact on children. Children spend more time watching television than any other activity except sleeping. Overall 31% of children spent at least 4 hours a day watching television during weekday and 71.7% during weekend in Turkey. Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. Television may be a cause as well as a solution for many serious childhood problems. Excessive viewing of television has also been linked to aggressive behavior, violence, childhood obesity. On the other hand, television may act as a socializing agent and as a learning tool if the recommendations of American Academy of Pediatrics is learned by pediatricians, parents and broadcasters. The use of home personal computers in urban residence increased from 3.2% in 1993 to 6.5% by January 1998 in Turkey. Around 20% of computer households reported owing a modem. Internet has been using only for 5 years in Turkey. Nearly 40% of computer households also used CD-ROM equipment. The percentage of schools that have a computer laboratory is only 2.64%. On the other hand, multimedia allows students to move away from a uniform education for everyone to assert individual identity, liberalize education and management. It seems likely that, within the next few years, most of the countries with substantial internet infrastructure will use the internet as the major medium for disseminating information, including information on children. To prepare students for such a world demands that educational systems make the best possible use of all knowledge and technologies currently available.

The impact of the sexual maturation stage on body mass index in adolescent girls.

Body mass index (BMI) is used in the clinical assessment of adiposity in children and adolescents. Population-based, race-specific and age-specific curves of BMI for children and adolescents exist, but there are noknown sexual maturation-based BMI curves. The aim of this study was to investigate the effects of pubertal development (assessed according to the Tanner breast stage) on BMI in adolescent girls in a cross-sectional study. The study group comprised 167 healthy girls, between the ages of nine and 16 years, attending school near a hospital in Gerede, Bolu. A significant positive correlation was found between the Tanner stage of breast development and BMI (r = 0.79, p < 0.001). Age also had a significant influence on BMI (r = 0.69, p < 0.001). After controlling the effects of age, BMI was highly correlated with weight (r = 0.82, p < 0.001) and the Tanner breast stage (r = 0.49, p < 0.001), but not with height. The correlation between BMI and the sexual stage was also found to increase with increasing age. But when breast development was taken as a control parameter, BMI was not statistically associated with age or height. As a result, there was a significant variation in BMI with the Tanner breast stage in addition to the well known change with increasing age in adolescent girls. Developmental differences occurring in the same age may require that BMI be evaluated only within the same sexual stages in adolescence. This study indicates that the curves of BMI need to take into account the sexual maturation stage of adolescents.

The effect of live measles vaccines on serum vitamin A levels in healthy children.

OBJECTIVE: Serum retinol levels have been shown to be depressed during measles infection. This study aims to demonstrate whether there is any decrease in serum vitamin A level following immunization with live viral vaccine and its relation with vaccine seroconversion in children with measles. Since many children receive measles vaccine alone or in combination with measles-mumps-rubella vaccine, we studied serum vitamin A levels and antibody levels in healthy, well-nourished children before and after immunization with monovalent and combined live attenuated measles vaccine. METHODS: The first group included 21 healthy children between the ages of 9-11 months who received live measles (Schwarz) vaccine. There were also 21 healthy children (range 14-20 months of age) who received measles-mumps-rubella Trimovax (Pasteur Merieux) vaccine. All children were tested for serum vitamin A levels before vaccination, on days 9-14 and 30-42 following both vaccinations. Measles specific antibody levels were also measured on admission and 30-42 days following vaccinations. RESULTS: In both vaccination groups, mean serum vitamin A levels reduced significantly on days 9-14, but increased slightly on days 30-42 in the measles-mumps-rubella vaccinated group (P < 0.05). The baseline and follow-up levels of mean serum vitamin A did not differ between seroconverted and nonseroconverted cases within the measles vaccinated group. CONCLUSION: Serum vitamin A levels are reduced following vaccination with monovalent and combined live attenuated measles vaccines.

Clinical value of glycated hemoglobin and fructosamine in the long-term glycemic control of children with acute lymphoblastic leukemia.

Hyperglycemia in children with acute lymphoblastic leukemia (ALL) has been well documented in the literature. The purpose of the present study was to evaluate the clinical value of glycated hemoglobin (GHb) and fructosamine (Frc) in the long-term glycemic control of ALL patients. An attempt was made to identify the risk factors for hyperglycemia in ALL patients. The study group comprised 26 newly diagnosed ALL patients admitted to hospital during 1995-96. Patients with a history of blood transfusion or infection within the past 3 months were excluded from the study. White blood cell (WBC) counts, fasting blood glucose (FBG), GHb and Frc levels were analyzed in venous blood on screening day 0, before induction of chemotherapy. Frc analysis was repeated on the 21st day and GHb level on the 60th day of chemotherapy. FBG tests were performed before each dose of L-asparaginase, on days 21 and 60. None of the patients was obese. Although six children (23%) had hyperglycemia during the induction therapy, four of them had a GHb level higher than normal on admission. Only one patient who developed hyperglycemia had a family history of diabetes mellitus. Patients with a high initial WBC count (> 20 x 10(9)/L) had a significantly higher baseline GHb than patients with a WBC count below this level. GHb values returned to normal after achievement of complete remission. It is suggested that the leukemic process could impair glucose metabolism and baseline GHb may be used to monitor possible small changes in glucose homeostasis of ALL patients, prior to chemotherapy.

Experience with oral rehydration therapy in moderately dehydrated children due to diarrhea.

Additional reports on oral rehydration therapy (ORT) in the management of moderately dehydrated patients may convince practitioners to convert from high-cost intravenous treatment to low-cost and efficient ORT in moderately dehydrated patients. Therefore, the failure rate and its association with admission serum sodium, potassium and bicarbonate levels of 162 moderately dehydrated children with diarrhea treated with ORT were analyzed retrospectively. The overall failure rate was found to be 17.6 percent. This rate did not differ significantly among normonatremic, hyponatremic and hypernatremic patients (16%, 25% and 28%, respectively; p > 0.05), nor did the rate differ among normokalemic, hypokalemic and hyperkalemic patients (16%, 33% and 25%, respectively; p > 0.05). Only moderately and severely acidotic patients had higher failure rates than non-acidotic and mildly acidotic cases (21%, 38%, 4% and 14% respectively; p < 0.05). Severely acidotic patients were also rehydrated over a longer time (10.4 +/- 6.6 hours) than were nonacidotic patients (6.7 +/- 2.3 hours, p < 0.001). Thus the degree of acidosis, which is closely related to the clinical severity of dehydration, was found to be much more predictive of ORT failure and the duration of rehydration than were other electrolyte disturbances. Besides correcting dehydration, ORT was safe and effective in treating various electrolyte disturbances.