Correction to: Global dietary calcium intake among adults: a systematic review.

The original Electronic Supplementary Material file 3 contained an erroneous reference for Mali. A link to the corrected file is provided here.

Global dietary calcium intake among adults: a systematic review.

Low calcium intake may adversely affect bone health in adults. Recognizing the presence of low calcium intake is necessary to develop national strategies to optimize intake. To highlight regions where calcium intake should be improved, we systematically searched for the most representative national dietary calcium intake data in adults from the general population in all countries. We searched 13 electronic databases and requested data from domain experts. Studies were double-screened for eligibility. Data were extracted into a standard form. We developed an interactive global map, categorizing countries based on average calcium intake and summarized differences in intake based on sex, age, and socioeconomic status. Searches yielded 9780 abstracts. Across the 74 countries with data, average national dietary calcium intake ranges from 175 to 1233 mg/day. Many countries in Asia have average dietary calcium intake less than 500 mg/day. Countries in Africa and South America mostly have low calcium intake between about 400 and 700 mg/day. Only Northern European countries have national calcium intake greater than 1000 mg/day. Survey data for three quarters of available countries were not nationally representative. Average calcium intake is generally lower in women than men, but there are no clear patterns across countries regarding relative calcium intake by age, sex, or socioeconomic status. The global calcium map reveals that many countries have low average calcium intake. But recent, nationally representative data are mostly lacking. This review draws attention to regions where measures to increase calcium intake are likely to have skeletal benefits.

KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary

The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression and graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research. This summary includes a brief description of methodology and the complete guideline recommendations but does not include the rationale and references for each recommendation, which are published elsewhere.

Congenital leptin deficiency is associated with severe early-onset obesity in humans.

The extreme obesity of the obese (ob/ob) mouse is attributable to mutations in the gene encoding leptin, an adipocyte-specific secreted protein which has profound effects on appetite and energy expenditure. We know of no equivalent evidence regarding leptin's role in the control of fat mass in humans. We have examined two severely obese children who are members of the same highly consanguineous pedigree. Their serum leptin levels were very low despite their markedly elevated fat mass and, in both, a homozygous frame-shift mutation involving the deletion of a single guanine nucleotide in codon 133 of the gene for leptin was found. The severe obesity found in these congenitally leptin-deficient subjects provides the first genetic evidence that leptin is an important regulator of energy balance in humans.

A distinctive syndrome of brachycephaly, deafness, cataracts and mental retardation.

A boy with brachycephaly without craniosynostosis, raised intracranial pressure, deafness, cataracts, and global developmental delay is described.

Microcytosis, iron deficiency, and thalassaemia in preschool children.

To investigate the possible causes of an increased incidence of red cell microcytosis in Asian children, 204 Gujarati Asian children and 88 European children attending community infant welfare clinics underwent initial screening tests for determination of red cell indices. Seventy six Asian (37%) and nine European (12%) children had microcytic red cells (mean corpuscular volume less than 74 fl). Further investigation showed that 16 of the Asian children (21%) with microcytosis had thalassaemia trait (eight were heterozygous for alpha thalassaemia and eight for beta thalassaemia), and 50 (66%) had suspected iron deficiency (confirmed by a response to oral iron in 41 cases): the remaining 'microcytic' children were aged less than 2 years, when mean corpuscular volume between 70 and 74 fl may be normal. Increased values for serum total iron binding capacity were more sensitive in detecting iron deficiency than reduced serum ferritin concentrations. Enthusiastic screening for microcytic anaemia in young children may mean that a substantial minority with thalassaemia genes are given unnecessary iron supplements. The response to a short course of oral iron should therefore be carefully monitored, and the possibility of thalassaemia trait as well as non-compliance with treatment should be reconsidered in all those in whom there is little or no response.

Pneumococcal arthritis mimicking juvenile chronic arthritis.

Two young children referred as pauciarticular juvenile chronic arthritis were subsequently found to have pneumococcal septic arthritis.

Triamcinolone into the knee joint in juvenile chronic arthritis.

Sixty children aged less than 10 years with pauci-articular onset juvenile chronic arthritis and knee joint involvement received local injections with triamcinolone hexacetonide into the knee (total 83 knees). One year after injection, 77% of knees were excellent with no soft tissue swelling, no deformity and full range of movement, or good with slight swelling or deformity, but functioning well. Eleven knees which had relapsed within one year improved after a second injection and 2 after a third. Complications were limited to small areas of subcutaneous tissue atrophy in 2 patients. Intra-articular injection of long-acting steroids is a useful means of controlling disease activity in the knee joints of young children with pauci-articular juvenile chronic arthritis.

Blood pressure and effect of exercise in children before and after surgical correction of coarctation of aorta.

Systolic blood pressure was measured at rest and during exercise in 43 children who had undergone operation for correction of coarctation of the aorta, five children awaiting surgery for coaractation, and 22 control children. Ages ranged from 2 to 15 years, mean 7-6 years. The mean blood pressure of children with coarctation in both the pre- and postoperative groups was significantly higher at rest than in the controls. Of 43 postoperative patients, 15 (35%) were hypertensive (systolic blood pressure more than 95th centile), and 12 of these had a gradient between the upper and lower limb. Seven of the 28 normotensive patients also had a gradient postoperatively. Exercise increased the blood pressure more in children with coarctation than in controls, but there was much individual variability and this difference was not significant. Some children with coarctation developed very high blood pressures on exercise, but this was not related to the presence of a gradient. The mean interval after operation was significantly shorter in the hypertensive group, independent of the age at operation. Hypertension with or without a gradient commonly persists despite apparent successful surgical correction, but exercise is of limited value in its assessment in this age group.

Blood pressure in the first 6 weeks of life.

Systolic blood pressure was measured at frequent intervals during the first 6 weeks of life in 99 normal neonates. Blood pressure rose from a mean of 70 mmHg at age 2 days, to 93 mmHg at age 6 weeks in babies awake; the majority of this rise (14 mmHg) took place in the first 2 weeks of life. The blood pressure measured when infants were asleep was lower than in those awake, but increased in a similar manner. Blood pressure of infants at 2 days was not significantly affected by method of delivery, or by the anaesthesia or analgesia that the mothers received in labour. It was not related to the Apgar score at one or five minutes.