Hypertriglyceridaemia in adolescents may have serious complications.

Acute pancreatitis is an often-overlooked cause of acute abdominal pain in children and adolescents. Severe hypertriglyceridaemia is an important cause of recurrent acute pancreatitis. Monogenic causes of hypertriglyceridaemia, such as familial chylomicronaemia caused by lipoprotein lipase deficiency, are more frequently encountered in children and adolescents, but remain rare. Polygenic hypertriglyceridaemia is more common, but may require a precipitant before manifesting. With the global increase in obesity and type 2 diabetes, secondary causes of hypertriglyceridaemia in children and adolescents are increasing. We report two cases of severe hypertriglyceridaemia and pancreatitis in adolescent females. Hypertriglyceridaemia improved markedly with restriction of dietary fat. An inhibitor to lipoprotein lipase was found to be the cause in one patient, while in the other limited genetic investigation excluded chylomicronaemia owing to deficiency of lipoprotein lipase, its activators and processing proteins.

Children and adolescents with diabetes at Tygerberg Hospital ­ at risk of cardiovascular complications?

Objectives. To determine the prevalence of dyslipidaemia and HT in paediatric diabetic patients seen at Tygerberg Hospital (TBH) and establish whether either is associated with body mass index (BMI), glycosylated haemoglobin (HbA1c) or duration of diabetes. Further, to determine whether the prevalence differs between two specified periods.Methods. A retrospective study of 154 diabetic patients, aged 1 - 19 years, seen at TBH between 2007 and 2017, was undertaken. The following data were recorded: age; sex; duration of disease (time since diagnosis); height; weight; blood pressure; HbA1c; high-density lipoprotein cholesterol (HDL-C); triglycerides (TG); and low-density lipoprotein cholesterol (LDL-C). Results. More than half of the patients (57.8%; n=89/154; 95% confidence interval (CI) 51.7 - 65.0) had dyslipidaemia, 16.3% (n=24/147) had low HDL-C levels, 53.8% (n=78/145) had high LDL-C levels and 14.9% (n=22/148) had raised TG levels. Nearly half of the patients (48.7%; n=75/154; 95% CI 41.6 - 55.1) were hypertensive and 93.5% (n=144/154) were poorly controlled (HbA1c >7.5%). Dyslipidaemia was not associated with HT or BMI percentile and its prevalence did not change between the two specified periods. Prevalence of dyslipidaemia and HT was not associated with duration of diabetes. About one-third (30.8% (n=4/13); 95% CI 11.9 - 59.3) of the pre-adolescents and 60.3% (n=85/141; 95% CI 51.9 - 68.1) of the adolescents had dyslipidaemia (p=0.04). Dyslipidaemia was diagnosed in 62.6% (n=82/131) of adolescents with poorly controlled diabetes (p=0.04) and in 71.7% (95% CI 59.0 - 81.7) of patients ≥16 years of age (p=0.005). Conclusions. Poor glycaemic control, dyslipidaemia and HT are common in diabetic children, putting them at risk of cardiovascular complications in adulthood.S Afr J Child Health 2022;16(4):205-208. https://doi.org/10.7196/SAJCH.2022.v16i4.1862Children and adolescents with diabetes at Tygerberg Hospital ­ at risk of cardiovascular complications?L N Dookhony,1 MMed (Paeds); C J Lombard,2 MSc, PhD; E W Zöllner,3 MMed, PhD1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; and SSRN Hospital, Pamplemousses, Republic of Mauritius2Biostatistics Unit, South African Medical Research Council, Division of Biostatistics; and Department of Global Health, University of Stellenbosch, Cape Town, South Africa3Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression.

A recently published approach to paediatric asthma management neither recommended screening for nor suggested any management of hypothalamic-pituitary-adrenal axis suppression in asthmatic children treated with corticosteroids. The existing literature on this topic was therefore reviewed and the quality of the evidence assessed. Recommendations for diagnosis, screening and management are made utilising the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children's Hospital

Background. A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients.Hence a DCT was introduced at Tygerberg Children's Hospital (TCH) in 2009.Hypothesis. A DCT for T1DM patients improves HbA1c, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications.Methods. In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbA1c) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared.Results. HbA1c levels increased from 9.0% (7.85 - 10.15) in P1 to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02).The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in P1 to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01)to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00).Conclusion. After the introduction of the DCT, HbA1c levels were less variable and hos

Is adrenal suppression in asthmatic children reversible? A case series.

BACKGROUND: Six hypocortisolaemic asthmatic children on steroids given at physiological doses were identified during a previous study. OBJECTIVES: To establish whether hypothalamic-pituitary-adrenal axis suppression (HPAS) could be reversed in hypocortisolaemic asthmatic children treated with steroids without sacrificing asthma control. METHODS: In this case series, treatment of six hypocortisolaemic patients was modified by introducing steroid-sparing asthma medications. Serum cortisol and repeat overnight metyrapone tests (ONMTPTs) were done until HPAS was reversed in all patients. A retrospective folder review was performed and the following data were extracted: body mass index standard deviation score (BMI SDS), adherence, daily steroid type and dose, treatment modification, serum cortisol, final ONMTPT result and time taken to achieve normalisation. RESULTS: The median serum cortisol level recovered to 311 nmol/L after 0.9 years (median). The ONMTPT normalised within 3.3 years (median). Steroid load decreased from 9.2 to 5.0 hydrocortisone equivalent mg/m2/d (medians), while asthma score improved from 1.42 to 0.85 (medians). Poor adherence was noted in two children before and four after treatment modification. BMI SDS decreased from -0.08 to -0.16 (medians). CONCLUSIONS: Hypocortisolaemia and HPAS could be reversed in asthmatic children treated with physiological doses of steroids by reducing steroid load by 40% and supplementing therapy with steroid-sparing medication. Poor adherence may have either contributed to or retarded HPA recovery. Simultaneously, asthma control improved. Confirmation by a prospective study would be ideal, but may not be feasible.

Observation and Structure Determination of an Oxide Quasicrystal Approximant.

We report on the first observation of an approximant structure to the recently discovered two-dimensional oxide quasicrystal. Using scanning tunneling microscopy, low-energy electron diffraction, and surface x-ray diffraction in combination with ab initio calculations, the atomic structure and the bonding scheme are determined. The oxide approximant follows a 3^{2}.4.3.4 Archimedean tiling. Ti atoms reside at the corners of each tiling element and are threefold coordinated to oxygen atoms. Ba atoms separate the TiO_{3} clusters, leading to a fundamental edge length of the tiling 6.7 Å.

Abnormal thyroid function tests in children on ethionamide treatment.

Ethionamide (ETH) treatment may cause hypothyroidism. Clinical data, serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels were retrospectively assessed in 137 children receiving anti-tuberculosis treatment including ETH. Abnormal thyroid function tests (TFTs) were recorded in 79 (58%) children: elevated serum TSH and suppressed fT4 (n = 30), isolated elevated serum TSH (n = 20), isolated low serum fT4 (n = 28) and isolated low TSH (n = 1). The risk for biochemical hypothyroidism was higher for children on regimens including para-aminosalicylic acid and in human immunodeficiency virus infected children. TFT abnormalities are frequent in children on ETH and are mainly due to primary hypothyroidism or euthyroid sick syndrome.

Enhanced biological carbon consumption in a high CO2 ocean.

The oceans have absorbed nearly half of the fossil-fuel carbon dioxide (CO2) emitted into the atmosphere since pre-industrial times, causing a measurable reduction in seawater pH and carbonate saturation. If CO2 emissions continue to rise at current rates, upper-ocean pH will decrease to levels lower than have existed for tens of millions of years and, critically, at a rate of change 100 times greater than at any time over this period. Recent studies have shown effects of ocean acidification on a variety of marine life forms, in particular calcifying organisms. Consequences at the community to ecosystem level, in contrast, are largely unknown. Here we show that dissolved inorganic carbon consumption of a natural plankton community maintained in mesocosm enclosures at initial CO2 partial pressures of 350, 700 and 1,050 microatm increases with rising CO2. The community consumed up to 39% more dissolved inorganic carbon at increased CO2 partial pressures compared to present levels, whereas nutrient uptake remained the same. The stoichiometry of carbon to nitrogen drawdown increased from 6.0 at low CO2 to 8.0 at high CO2, thus exceeding the Redfield carbon:nitrogen ratio of 6.6 in today's ocean. This excess carbon consumption was associated with higher loss of organic carbon from the upper layer of the stratified mesocosms. If applicable to the natural environment, the observed responses have implications for a variety of marine biological and biogeochemical processes, and underscore the importance of biologically driven feedbacks in the ocean to global change.

Fatal liver failure due to ketoconazole treatment of a girl with Cushing's syndrome.

A patient is reported who developed fatal liver failure on ketoconazole treatment for Cushing's syndrome. It is recommended that metyrapone be used when hypercortisolism has to be controlled as a temporary measure in childhood and adolescence.

Breast-feeding and weaning practices in Venda, 1990.

A stratified random cluster survey, using a structured interview schedule, was performed to determine the prevalence, frequency and duration of breast-feeding among Venda mothers as well as the foods that Venda children commonly ate in their first 2 years of life. Nearly all children under 2 years old were being breast-fed and virtually all of these were fed on demand. Approximately 60% of infants under 3 months of age and virtually all others under 2 years old received supplementary foods daily. A further 30% of infants under the age of 3 months were given supplementary water daily. Forty per cent of infants under 3 months old and virtually all in the other age groups were given carbohydrates daily. Protein foods, vitamin/mineral and high-energy sources were given less frequently. Only 12% in the 6-11-month age group and 21% in the 12-23-month age group received a balanced diet daily. A significant proportion of children in all age groups received only carbohydrates over and above breast-milk. Traditional mixes were infrequently given. More research is needed to assess actual breast-milk production by mothers whose children are being fed supplementary foods. The effect of socio-economic status on weaning practices and that of weaning practices on nutritional status need to be investigated. Food supplementation and nutrition education programmes need to be intensified.

Protein energy malnutrition and its recognition in outpatient departments in Venda hospitals.

Between April and June 1988 the number of children under 5 years old attending outpatient departments of Venda hospitals who had protein energy malnutrition (PEM) was determined, the proportions at 3 Venda hospitals were compared, and what percentage of these children was detected by attendant health workers was determined. Approximately 6% had severe PEM; this finding was consistent for all 3 hospitals. The rates for mild PEM were 22% for Tshilidzini and Donald Fraser Hospitals and 33% for Siloam Hospital. This statistically significant difference has not been explained. Health workers failed to recognise about 25% of children with severe PEM and 50% of children with mild PEM. It is suggested that certain interventions and activities are essential if PEM is to be adequately managed: these are efficient monitoring; pre-employment and in-service education for health workers; a breast-feeding and weaning survey; and an investigation of the variation of malnutrition among Venda hospitals.

Congenital lymphoedema in a child--an unusual diagnosis of ankle oedema seen at a peripheral hospital. A case report.

A patient with congenital lymphoedema--the clinical picture being that of Milroy's disease--is presented. The diagnosis, differential diagnosis and treatment are discussed and the modified autosomal dominant mode of inheritance with sex influence and variable expressivity is described.

Characterisation of cryptic plasmids in clinical isolates of Bacteroides fragilis.

A screening method for plasmids in the fragilis group of Bacteroides spp. was developed, taking account of the lysozyme resistance of these species; 26 strains, 24 of them B. fragilis, were investigated by this method. Eleven strains contained plasmids and up to three different plasmids were found in individual strains. The plasmids belonged to five different size classes of mol. wt (10(6] 2.8, 3.5, 3.6, 4.2 and 19. Plasmids of equal size showed homology; no homology was found between plasmids of different sizes. Plasmids of equal size showed identical restriction patterns with 17 restriction endonucleases. Restriction maps were constructed for the five classes of plasmid.

Isolation and purification of plasmids from Bacteroides fragilis using rubidium trichloroacetate density gradient centrifugation.

A rapid and easy final purification method is described for the isolation of plasmids from B. fragilis. Using RbTCA density gradient centrifugation in an airfuge ultracentrifuge ccc plasmid DNA can be separated from RNA, residual chromosomal DNA, linear and oc plasmid DNA. Pure ccc plasmid DNA is obtained from cultures of between 1 ml and 2 l in less than one day.

Microdisc-electrophoretic study of deoxyribonucleases in cow snout epidermis.

Acid and neutral deoxyribonucleases (DNases) of the cow snout epidermis were investigated by the microdisc-electrophoresis of polyacrylamide gels containing highly polymerized DNA and by isoelectric focusing techniques. The nucleases were characterized with respect to their pH optimum. An acid DNase at pH 5.0 was detected as a single distinct band after the electrophoretic separation. After isoelectric focussing also, only one acid DNase activity with an isoelectric point (IP) of 6.2 was detectable. Neutral DNases at pH 7.4 were demonstrated as major and minor bands by their different electrophoretic mobilities. In the isoelectric focusing system also, two neutral DNases, a major one (IP, 4.6) and a minor one (IP, 6.4), were found. Characterization with respect to their histologic location showed acid and neutral DNases across the epidermal layers with the highest activities in the upper layers, where DNA concentration had been shown to be lowest. In correlation with their subcellular distribution, the highest activities of both acid and neutral DNase were found in the 105,00 X g supernatant of the subcellular fractions.

[Local rheumatoid therapy. Indomethacin level in the synovia and serum after application of Amuno ointment]. / Lokale Rheumatherapie. Indometacin-Spiegel in Synovia und Serum nach Applikation von Amuno-Salbe.

9 patients with rheumatoid arthritis and one with activated gonarthrosis were treated by means of application of Amuno ointment to one knee in a dosage of 3 X 5 cm ribbon of ointment, rubbed in on an area of approximately 200 cm2, over a period of 3 days. After this interval in 8 patients the knee-joints not treated with ointment were punctured, and synovial fluid was won. In all 10 cases serum level determinations were carried out. The obtained average values in serum ranged from 114.4 - 134.3 ng/ml, the average value found in the synovial fluid was ascertained at 235.6 ng/ml. Although this report is presenting only intermediate results these may nevertheless serve as evidence for a systemic effect of Amuno ointment at the synovium.

Purification of a nuclease from human serum.

The purification procedure for a nuclease from human serum is described. It includes ammonium sulfate precipitation, chromatography on DEAE-Sephadex and on Sephacryl-S 200, and preparative electrophoresis. The enzyme purified about 2000-fold, is homogeneous in a sodium dodecyl sulfate electrophoretic system, where it has a mol. wt of 78,000. The pH optimum lies around pH 6.5; it is a sugar-nonspecific endonuclease.