Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus.

BACKGROUND: The relationship between hemoglobin A1c (HbA1c) and iron status in type 1 diabetes mellitus (DM) has not been adequately studied. In this prospective investigation, we aimed to determine the effect of iron deficiency on HbA1c in diabetic patients who also had insufficient iron stores. METHODS: Thirty-seven patients with type 1 DM were included in the study. Eleven of them were also iron deficient (ID) and the remaining 26 were iron-sufficient (IS). Two non-diabetic control groups were selected for the ID and IS groups. All patients with ID were treated with iron at 6 mg/kg per day for 3 months. Glycemia in diabetic patients was monitored at home before breakfast and supper by a glycometer. Hemoglobin A1c was measured in all subjects at the beginning and the end of the study. RESULTS: Patients with ID DM had higher levels of HbA1c than those in the control group (P < 0.001). There were no significant differences in the weekly average glucose concentration of the patients with ID DM before and after iron supplementation. In contrast, HbA1c decreased from a mean of 10.1 +/- 2.7% to a mean of 8.2 +/- 3.1% (P < 0.05). Additionally, HbA1c in ID non-diabetic patients decreased from a mean of 7.6 +/- 2.6% to 6.2 +/- 1.4% after iron therapy (P < 0.05). CONCLUSIONS: We conclude that among type 1 DM patients with similar level of glycemia, iron deficiency anemia is associated with higher concentrations of HbA1c. In addition, iron replacement therapy leads to a drop in HbA1c in both diabetic and non-diabetic patients. The iron status of the patient must be considered during the interpretation of HbA1c concentrations in type 1 DM.

Serum prolactin in neonatal seizures.

BACKGROUND: Prolactin is the most specific neurohormone that is elevated after seizures. This study was undertaken to determine the clinical usefulness of plasma prolactin as a diagnostic aid in differential diagnosis of neonatal convulsions. METHODS: Forty-five patients followed for seizures were included in the study. Postictal serum prolactin levels were obtained 30 min after the onset of the seizures. A second sample obtained 24 h later was used to measure an unstimulated serum prolactin level. RESULTS: The most common cause of seizure was hypoxic ischemic encephalopathy (HIE) followed by sepsis. In patients with HIE, postictal serum prolactin levels were significantly higher than the unstimulated levels (P < 0.0002). Additionally, postictal prolactin levels were significantly higher than the unstimulated levels in clonic (P < 0.02) and tonic convulsions (P < 0.001). CONCLUSIONS: We conclude that the postictal serum prolactin level may be a marker in the differentiation of seizures as well as providing important information about their etiology. Further studies are needed to assess the normal range of serum prolactin levels in unstressed newborns.

Delayed hemopericardium due to trivial chest trauma.

We report two cases of hemopericardium occurring in seven-month-old and 12-year-old boys, who had no history of major trauma. The possible cause of the hemopericardium for the infant was falling from a bed which was 75 cm high two weeks prior to the admission. The 12-year-old boy had fallen from a chair and damaged his chest 4 weeks previously. Their coagulation tests were all normal. By means of pericardiotomy, we drained 120 ml and 1200 ml of blood, respectively. The boys have now been well over follow-up periods of 24 and 18 months, respectively.

Systemic candidiasis with acute Epstein-Barr virus infection.

Systemic Candida infections are usually encountered as opportunistic infections in a setting of immunologic depression. Sepsis or arthritis due to Candida is not expected in healthy people. Epstein-Barr virus may infect B cells, but does not cause immunosuppression of any clinical significance. As far as we know, invasive non-albicans Candida infection complicating Epstein-Barr virus infection has not been reported in previously healthy children. In this report, two previously healthy children, one with sepsis due to Candida species and the other sepsis and arthritis due to Candida parapsilosis are described. Both patients were male and were aged 2 and 9 y. The diagnosis was confirmed by culture. Both children also had coincidental acute Epstein-Barr virus infection, confirmed by Epstein-Barr virus viral capside antigen-IgM. They were both cured with fluconazole given for 21 days and 48 days, respectively.

Effects of hypothermia on blood endogenous endotoxin levels during cardiopulmonary bypass.

Endotoxin activates white blood cells and complement and produces a spectrum of clinical syndromes ranging from fever to septic shock. Although production of endogenous endotoxemia during cardiopulmonary bypass (CPB) has recently been reported, the role of hypothermia on endotoxemia is not clear. In this study, we evaluated the effects of moderate (24-28 degrees C) and mild (32-34 degrees C) hypothermia on blood endotoxin levels. The study population consisted of 20 patients who underwent coronary artery bypass grafting (CABG) with CPB. Moderate systemic hypothermia was applied during aortic cross-clamping in ten patients (group 1) and mild hypothermia in the remaining ten patients (group 2). The mean rectal temperatures were 26.8 +/- 1.2 degrees C in group 1 and 33.8 +/- 0.8 degrees C in group 2. The blood samples for endotoxin level measurements were obtained before CPB, during aortic cross-clamping, immediately after the release of the cross-clamp, 20 minutes after the release of the cross-clamp, after CPB, and 2 hours postoperatively. There were no endotoxins in any of the samples before CPB, but it was detected after CPB in both groups. The endotoxin levels were significantly higher in group 1 than in group 2. The present study suggests that when hypothermia is the technique of choice, the deleterious effects of endotoxemia on patients with comorbidity must be considered.

Evaluation of differential effects of carbohydrate and fat intake on weight gain, serum IGF-1 and erythrocyte Na+K+ATPase activity in suboptimal nutrition in rats.

OBJECTIVE: Suboptimal nutrition leads to growth delay, frequently without over clinical or biochemical signs. We hypothesize that changes in serum IFG-1 and erythrocyte sodium-potassium ATPase activity (ENKA) may be indices of suboptimal nutrition. METHODS: Male Sprague-Dawley rats were pair-fed for 4 weeks with balanced diets of different carbohydrate (CHO) to fat (FAT) ratios (3:1, 2:1, and 1:1) and three levels of energy intake (ad-libitum, 80%, and 60%), corrected for actual body weight). Daily weight gain and weekly tail growth were monitored while ENKA, serum total protein, T3, insulin and IGF-1 were measured after four weeks. Refeeding experiments were also performed with the 3:1 and 1:1 CHO:FAT diets, including 4 weeks of dietary restriction and one week of ad-libitum feeding. RESULTS: Weight gain, tail growth, and IGF-1 decreased (p < 0.05) in all groups after 1 week of dietary restriction. A decrease in ENKA (p < 0.05) was found in rats that consumed 60% of ad-libitum energy intake only after 4 weeks. At the end of dietary treatment, weight gain was higher (p < 0.05) in rats fed the 3:1 CHO:FAT diet. In contrast, when energy was restricted to 80% or 60% of ad-libitum intake, rats fed the 1:1 CHO:FAT diet gained more weight (p < 0.05) compared to the 3:1 and 2:1 CHO:FAT diets. After 1 week of refeeding body weight, tail growth and ENKA returned to control values while serum IGF-1 levels remained depressed. CONCLUSIONS: Acute nutritional changes are clearly detected by a reduction of serum IGF-1 while ENKA may be a useful index for assessing chronic suboptimal nutrition.

Considerations about dietary fat restrictions for children.

Expert panels recommend reduction of dietary fat and cholesterol, because excessive fat intake may lead to known health hazards. However, there are no data demonstrating beneficial effects of such diets starting in childhood for all children, including those with normal serum cholesterol levels. Dietary restrictions in early life may not necessarily induce a long-lasting decrease in blood cholesterol levels in children persisting into adulthood or reduce disease incidence. On the other hand, the result of such diets may be suboptimal growth and development. Furthermore, low fat diets may lower high density lipoprotein cholesterol levels and not specifically low density lipoprotein cholesterol. In addition, low serum cholesterol levels may be associated with increased mortality, including deaths due to accidents, which is most important in children. Recently, increased attention has been drawn to the association between short stature and/or nutritional status and deficiencies in intrauterine and early life with coronary artery disease in adulthood. Also, the problems of associated psychological consequences, family conflicts and cost should not be ignored while implementing a low fat diet. In this review, we discuss the controversies on dietary fat restrictions for children.

Nutrition in adolescence.

Adolescence is often considered a nutritionally vulnerable period because of its characteristic rapid physical and psychological changes. Nutritional risks for both undernutrition and overnutrition are present and may be increased during physiologic stress such as athletics and pregnancy. Appropriate nutrition is important for maintaining optimal health and normal growth and development, as well as for preventing future chronic disease.

Thiamine-responsive megaloblastic anemia with diabetes mellitus and sensorineural deafness.

This study introduces a patient who has thiamine and thiamine pyrophosphokinase (TPKase) enzyme deficiency associated with diabetes mellitus, sensorineural deafness and thiamine-responsive megaloblastic anemia. Diabetes mellitus was diagnosed when she was 20 months old. After 1 year, macrocytic anemia developed and the thiamine therapy was started at 75 mg/day. During the follow-up, the insulin requirement decreased and even ceased, and macrocytic anemia improved with thiamine treatment. After thiamine therapy was ceased an increase in insulin requirement was observed and macrocytic anemia developed again.

Congenital hypothyroidism in Turkey: a retrospective evaluation of 1000 cases.

In this retrospective investigation, 1000 cases of congenital hypothyroidism followed-up in the Pediatric Endocrinology Unit at Hacettepe University Children's Hospital between 1964-1989 were evaluated with respect to age at diagnosis, main complaints, symptoms and physical findings. The mean age at diagnosis was 49.22 months, with 55.4 percent of patients diagnosed after two years of age and only 3.1 percent during the neonatal period. The main complaints of the patients were growth failure (26.7%), inability to speak (21.4%), and inability to walk (18.1%). The physical signs and symptoms most commonly detected by the physician were hypotonia (72%), constipation (66.8%), cretinoid face (64.6%), and macroglossia (64.6%). These results emphasize the necessity for routine neonatal screening programs to be established in Turkey, with the aim of detecting congenital hypothyroidism.

Sulbactam/ampicillin in the treatment of pediatric infections.

Seventy eight pediatric patients (43 males, 35 females) aged 34 days to 17 years were treated with intravenous or intramuscular sulbactam/ampicillin 3 or 4 times daily for skeletal system infection (10 cases), systemic salmonellosis (2 cases), intrathoracic infection (12 cases), and soft tissue or miscellaneous infections (54 cases). The dose used to treat the majority of patients was 200 mg of ampicillin plus 100 mg of sulbactam per kg/day. The duration of treatment ranged from 8 to 23 days. Sulbactam/ampicillin alone was used in 68 patients. Ten patients were treated with an additional antibacterial agent. The overall cure rate was 98.7% for all 78 study patients. One patient with an abscess in the neck was shown to be infected with a strain of Escherichia coli resistant to sulbactam/ampicillin. Only one patient experienced a rash, but it did not necessitate discontinuation of therapy. This study shows that sulbactam/ampicillin is a safe and effective agent in the treatment of various pediatric infections.

[A clinical trial with ampicillin and sulbactam in various infections]. / Cesitli enfeksiyonlarda ampisilin ve sulbaktamin klinik etkinligi.

Eighty four patients with various infections were treated with parenteral ampicillin and sulbactam. Twenty seven patients had meningitis five septic arthritis and osteomyelitis, two systemic salmonellosis, nine intrathoracic infections, five of which were complicated with pleural empyema; thirty patients had infection of the deep tissues of the neck, and the remaining eleven had soft tissue infection in different localizations. The clinical and microbiological results were interpreted together and the overall rate of success in treatment with ampicillin and sulbactam was found to be 98.8%.