The effect of probiotics on prevention of upper respiratory tract infections in the paediatric community - a systematic review.

Prevention of acute upper respiratory tract infections (URTIs) is becoming an increasingly important concept in public health application due to the increase in antibiotic resistance. Probiotics have been shown to have some effect on prevention in various reviews. In this study we aimed to re-asses the effect of probiotics as there has been a substantial increase in literature regarding the effects and safety of probiotics in the paediatric population. Two major databases were systematically searched to identify clinical trials eligible for inclusion. Study selection, data extraction and quality assessment were carried out by two reviewers. This review comprises 33 randomised controlled trials (RCTs) applied to a paediatric population with high-quality methodology. The primary outcome for this review was the incidence of respiratory tract infections. Secondary outcomes were severity of symptoms, missed days of school, incidence of antibiotic use and safety of prebiotic use. This review showed that probiotics have an impact on decreasing the incidence of URTIs and the severity of symptoms. The use of probiotics is extremely safe and as studies increase in evaluation of the effect of probiotics more and more show a significant beneficiary effect. Although still a long way from becoming a unanimous treatment modality, the small positive changes that probiotics have on URTIs is important to consider and the use of probiotics should be encouraged more.

Octreotide therapy for control of acute gastrointestinal bleeding in children.

OBJECTIVES: To evaluate the outcomes of octreotide use in children with gastrointestinal bleeding with or without portal hypertension. METHODS: The medical charts of children who received continuous octreotide infusion for the indication of gastrointestinal bleeding from January 1995 to December 2000 were retrospectively reviewed. RESULTS: Twenty-one children with portal hypertension received octreotide infusions (1-2 microg/kg/h) during 35 gastrointestinal bleeding episodes. The duration of infusion ranged from 19 hours to 7 days. Bleeding ceased in 71% of children. Post-treatment rebleeding occurred in 52%, and the mortality was 19%. Response to octreotide, rebleeding, and mortality did not differ significantly between patients with or without intrinsic liver disease. Twelve children with gastrointestinal bleeding unrelated to portal hypertension received octreotide during 14 episodes. The duration of octreotide ranged from 3 hours to 36 days. Fifty percent of children had resolution of bleeding during the infusion. Post-treatment rebleeding occurred in 29%, and the mortality was 50%. No major adverse events were observed in either group. CONCLUSIONS: A high rate of bleeding control was achieved with octreotide during acute gastrointestinal bleeding in children with portal hypertension. However, controlled studies are needed for more definitive description of its clinical effects. The role of octreotide is less clear in gastrointestinal bleeding unrelated to portal hypertension.

Determination of genistein in the Turkish Genista L. species by LC-MS.

In this study, Genista species growing in Turkey were analysed for their total and free genistein content by using LC-MS method. The highest amount of total and free genistein was found in Genista tinctoria as 1.05% and 0.27% respectively and trace amount in G. libanotica. Total and free genistein content of the aerial parts of other Genista species varied from 0.01 to 0.18% and from 0.01 to 0.13% respectively.

Renal, gastric and thyroidal amyloidosis due to familial Mediterranean fever.

Chronic renal failure developed in a 10-year-old girl due to renal amyloidosis secondary to familial Mediterranean fever (FMF). During management of the chronic renal failure by hemodialysis and of FMF with colchicine, goiter and hypothroidism were observed. Thyroid fine-needle aspiration and gastric endoscopical biopsies, performed when recurrent abdominal pain could not be controlled, revealed amyloid deposits in both thyroid and gastric tissues. After 6 months' therapy with colchicine and levothyroxine, there was no significant change in the thyroid volume. This is the first case in which gastric amyloidosis secondary to FMF in childhood has been demonstrated. Patients with amyloidosis secondary to FMF who have thyroid enlargement and unexplained gastrointestinal symptoms despite adequate therapy should be evaluated with imaging studies and biopsy examinations.

A case of juvenile ankylosing spondylitis and Crohn's disease.

Juvenile ankylosing spondylitis (JAS) is a chronic inflammatory arthritis of the peripheral and axial skeleton, frequently accompanied by enthesitis. About four percent of patients with JAS have ulcerative colitis or Crohn's disease. Crohn's disease is the more common of the two and is diagnosed in 26 percent of patients with chronic spondyloarthropathy. In this paper, a 14-year-old male patient is presented as a typical case of juvenile ankylosing spondylitis and Crohn's disease with low back pain, morning stiffness, limited motion in anterior and lateral flexion and extension, left sacroiliitis, ankylosis in the apophyseal joints of the lumbar vertebrae, abdominal pain, bloody diarrhea, characteristic histopathologic changes of colonic involvement such as lymphoid follicles, fissures, submucosal polymorphonuclear cell infiltration and definite ganglion cells. The current therapy with mesalazin, having fewer side effects than sulfosalazin, and its applicability in combination with naproxen sodium is also discussed.

Combination of steroid with azathioprine in treatment of giant cell autoimmune hepatitis.

Giant cell hepatitis is a rare disorder after the newborn period. Drugs, autoimmunity, and viruses (lately, paramyxovirus infection) have been implicated in its etiology. Without treatment, liver dysfunction is progressive and fatal. Immunosuppression with steroids and azathioprine has been demonstrated to sustain improvement in the disease. In this report, a one-year-old boy who has giant cell hepatitis with Coombs' positive hemolytic anemia and anti-smooth muscle antibodies is presented, and the course of the disease and the patient's response to treatment with steroid and azathioprine is reviewed.

Tricho-rhino-phalangeal syndrome type I.

Tricho-rhino-phalangeal syndrome type I (TRPS I) is characterized by a bulbous nose, sparse hair and epiphyseal coning. Autosomal dominant and recessive transmission are suggested. The presence of cone-shaped epiphyses, the major complaint of patients due to swelling over the phalangeal joints, requires differential diagnosis among various syndromes. This paper, describing a ten-year-old girl with TRPS I, aims to bring the features of the syndrome to medical attention.

Single photon emission computed tomography in adrenoleukodystrophy. A case report.

Adrenoleukodystrophy (ALD) is a genetic disorder leading to progressive dysfunction of the adrenal cortex and nervous system white matter. Accumulation of fatty acids in cerebral white matter results in some anatomical and functional changes which are detectable by imaging studies. Lately, single photon emission computed tomography (SPECT) has been suggested for evaluation of cerebral perfusion changes. In this report, magnetic resonance imaging (MRI) and SPECT neurolmaging of an eight-year-old boy with ALD are presented. SPECT revealed more extensive involvement than that demonstrated by MRI. Its role in early prediction of the extention of disease is stressed.

Mcardle's disease. A case report.

McArdle's disease is a hereditary, metabolic myopathy characterized by weakness and muscle cramps after exercise, appearing mostly in the second or third decade of life. Due to myophosphorylase deficiency in skeletal muscle, glycogen cannot be used and deposited in the sarcolemmal spaces, leading to lack of endurance to sustained work. The ischemic exercise test is a screening procedure for muscle energy disorders, and the diagnosis is confirmed by reduced enzyme activity in muscle biopsy. In this report, a family with one child having enzyme assay-proven McArdle's disease and two other children demonstrating a positive ischemic exercise test is presented.

Anthropometric and nutritional evaluation of short statured children from low socio-economic class.

The objective of this study was to evaluate the anthropometric parameters of short statured children examined in our outpatient clinic. 367 children were evaluated. Body weight for age, weight for height, height for age and body mass index of subjects were expressed as percent of standards. Wasting and stunting were established according to Waterlow's criteria /4/. Of 367 children, 27.8% were wasted and stunted; 59.1% were stunted; 3.8% had constitutional delay of growth and 9.3% had growth hormone deficiency. Ninety-seven percent of growth hormone deficient children had deficiency in weight as well as height. This study indicates that most short statured children and some growth hormone deficient children present with anthropometric indices of chronic nutritional deficiency in a country where nutritional deprivation is frequent.

Maroteaux-Lamy syndrome associated with growth hormone deficiency.

Growth retardation is a common feature of mucopolysaccharide storage disorders, mostly considered to be a consequence of skeletal changes, Maroteaux-Lamy disease is a subtype of mucopolysaccharidosis, demonstrating somatic changes and skeletal deformities. We present a case with Maroteaux-Lamy disease associated with growth hormone deficiency. Magnetic resonance imaging study revealed marked signal changes in white matter due to the storage in brain and empty sella appearance in sellar region. In the presence of empty sella syndrome, hypothalamic-pituitary dysfunction due to the storage material may have led to growth hormone deficiency in this patient. Therefore, we recommend patients with mucopolysaccharidosis, especially those who have growth retardation, to be evaluated by hormonal and radiological studies.

True precocious puberty associated with phenylketonuria.

We studied a girl with phenylketonuria who demonstrated signs of precocious puberty. At the age of 7.5 years she had premature telarche. Her height age was 7-9/12 years and her bone age was 9 years. Gonadotropin responses to LHRH administration were consistent with central precocious puberty. Elevated serum phenylalanine levels in this patient, due to poor compliance with the phenylalanine restricted diet, may be related to the early onset of puberty.

Height and weight measurements of male Turkish adolescents according to biological maturation.

Eight hundred and seventy-nine Turkish male adolescents aged between 11 and 19 years were investigated with respect to their physical development. Bone ages were considered as well as chronological ages in determining biacromial (BAC), biiliac lengths (BIC) and chest circumference (CC). Different bone and chronological ages were obtained at the same chronological age (CA) and bone age (BA) columns. The importance of bone ages in evaluating an adolescent's physical development was shown to be as important as the chronological ages. In this study, the mean BAC, BIC and CC values between the same CA but different BA groups showed statistically significant differences (P < 0.001). When the measurements of two consecutive age groups who had the same CA and BA and who were found to be statistically significant (P < 0.05) were compared, the maximum increments in BAC and BIC values which were between 13 and 14 years of age (2 and 1.4 cm, respectively) were similar to the maximum increment in height and weight of Turkish male adolescents found between 13 and 14 years of BA. The maximum increment in CC values which were between 14 and 15 years and 15 and 16 years (4.1 cm each) was 1 year after the maximum increment in height and weight for BA of Turkish male adolescents (13-14 years) and was similar to maximum weight increment for CA which was between 15 and 16 years.

Biacromical and biiliac length and chest circumference measurements of male Turkish adolescents according to biological maturation.

Adolescence is a period which is characterized by rapid physical growth and development of secondary sex characteristics. Male adolescence begins at 11-12 years of age and lasts approximately 5 years. During this interval, there is a growth spurt period which is observed any time between 11 and 16 years of age, lasting 2-3 years. Some authors claim that a male may have nearly 20-25% of his adult height and 50% of his adult weight during adolescence. When evaluating the maturational aspects of adolescence, it is essential to consider bone age (BA) as well as chronological age (CA). Bone age is the mean CA at which the skeletal maturation is normally attained. It is influenced by genetic, endocrinological and nutritional factors. An adolescent may not demonstrate the expected maturational steps if his BA is retarded. This report examines the relationship between CA, biological maturation and some anthropometrical measurements.