Correlations between Direct and Calculated Low-Density Lipoprotein Cholesterol Measurements in Children and Adolescents.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C), as a modifiable risk factor for atherosclerotic cardiovascular disease, should be assessed and monitored. This study compared directly measured and Friedewald-estimated LDL-C values in children and adolescents. METHODS: Blood samples were collected from 464 children and adolescents. Calculated LDL-C (CLDL-C) levels were estimated using the Friedewald formula for any triglyceride value below 4.6 mmol/L. Direct LDL-C (DLDL-C) levels were measured on an ARCHITECT c8000 Abbott Clinical Chemistry Analyzer. The differences in LDL-C were then calculated. RESULTS: The correlation coefficients (R) between DLDL-C and CLDL-C were 0.978 (P = .148) and R = 0.970 (P = .052) for children and adolescents, respectively. Children with LDL-C values above 4.92 mmol/L had a correlation value of 0.971 (P = .419). The correlation and agreement between DLDL-C and CLDL-C in adolescents were moderate for LDL-C below 2.85 mmol/L (R = 0.806; 84.1%) and improved above 2.85 mmol/L (R = 0.978; 91.5%). In children, good correlations between DLDL-C and CLDL-C were observed for normal (<0.85 mmol/L), borderline (0.85-1.12 mmol/L), and abnormal (≥1.13 mmol/L) triglyceride levels (R = 0.9782, 0.990, and 0.951, respectively). The rates of agreement were better for normal (80.5%) and borderline (82.9%) but not abnormal (68.2%) triglyceride levels. CONCLUSION: We observed good agreement between DLDL-C and CLDL-C in both children and adolescents. The Friedewald formula provided an adequate estimate of LDL-C for most fasting specimens. LDL-C difference percentage can also be used as a quality indicator to check laboratory analyzer performance in healthy subjects.

The value of renal ultrasound in children with a first episode of urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) is a common pediatric problem. Guidelines recommend obtaining a renal ultrasonogram (RUS) for young children after a first UTI. Our aim was to assess the value of routine RUS in the management of children hospitalized with a first episode of UTI. METHODS: We conducted a retrospective review of the medical records of 130 children 12 years of age or younger admitted with a first UTI. Children were excluded if they had a urinary tract abnormality before admission and/or had been treated with an antibacterial agent within 7 days before admission. The yield of RUS was measured by ability to detect renal abnormalities, by the sensitivity and specificity for detecting vesicoureteral reflux (VUR) using voiding cystourethrogram (VCUG) as a gold standard, and by its influence on UTI management. RESULTS: RUS was conducted in 130 children, but only 118 returned for a VCUG and were included in the study. The findings were positive for VUR in 20 of 40 patients (50%) with a confirmed VUR on VCUG and positive in 18 of 78 patients (23.1%) without VUR on VCUG. Of the 20 patients with a normal RUS who showed VUR, 2 had grade I reflux, 8 had grade II reflux, 7 had grade III reflux and 3 had grade IV reflux. The sensitivity, specificity, positive and negative predictive value of ultrasound in suggesting VUR was 50% and 76.9%, 52.6% and 75%, respectively. Except for one, the result of an abnormal RUS did not alter the management of our patients. CONCLUSION: The results of our study show that the RUS has a little value in the management of children with a first UTI.

Characteristics and risk factors of hospital acquired - Methicillin-resistant Staphylococcus aureus (HA-MRSA) infection of pediatric patients in a tertiary care hospital in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVES: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections has been steadily increasing. These infections are considered to be either hospital-acquired MRSA (HA-MRSA) or community-acquired MRSA (CA-MRSA). Children are at higher risk of infection than adults. HA-MRSA has been reported to have more serious outcomes than CA-MRSA. However, there are not enough studies in Saudi Arabia to study the characteristics of HA-MRSA in children. We aim to describe the characteristics of HA-MRSA infection, including risk factors, culture site, clinical manifestations, complications, and outcomes among pediatric patients in a tertiary care hospital in Riyadh, Saudi Arabia. DESIGN AND SETTINGS: This is a retrospective chart review study. It was conducted in King Abdulaziz medical city in Riyadh. PATIENTS AND METHODS: The study included all patients 14 years of age or younger who were culture-positive from any site in the body during the period from January 1, 2009 to December 31, 2011. The time of culture compared to admission time was used to differentiate between CA-MRSA (within 72 h of admission) and HA-MRSA (more than 72 h after admission). The final sample size was 39 patients. RESULTS: We found HA-MRSA to be more common in males and those with risk factors such as previous surgery and previous hospitalization. Patients had a high Pediatric intensive care unit (PICU) admission rate and were commonly septic with positive blood cultures. Seventy-four percent of patients fully recovered, 10% recovered with complications and 15% died. CONCLUSION: HA-MRSA is an infection that can cause serious complications and a high rate of PICU admissions. Clinical manifestations such as shock are associated with higher mortality and morbidity rates. Special care should be given to those admitted to PICU, as they have high rates of mortality and morbidity.

Cardiometabolic risk among Saudi children and adolescents: Saudi childrens overweight, obesity, and lifestyles (S.Ch.O.O.Ls) study.

BACKGROUND AND OBJECTIVES: Diabetes and atherosclerotic cardiovascular disease are major contributors to the global burden of disease, with a high reported prevalence of risk factors among different populations. Early and efficient assessment of cardiometabolic risk is important to identify target groups for preventive interventions. The aims of Saudi children's overweight, obesity, and lifestyles study were to estimate the prevalence of the metabolic syndrome and to compare the different paradigms of assessing such risk among children and adolescents. The study was funded by National Guard Health Affairs and approved by the ethics committee. DESIGN AND SETTINGS: A cross-sectional study of students from primary, middle, and secondary schools located in the residential areas for the Saudi National Guard employees in Riyadh. METHODS: A random sample of 2149 students, clustered by school and stratified by grade, was selected from a sampling frame of 16 812 students from 10 schools in the residential areas for Saudi National Guard employees. Informed consent was taken from children and parents. Blood pressure, height, weight, waist circumference, and hip circumference were documented. Fasting blood samples were taken for blood glucose and lipid profile. RESULTS: The prevalence of metabolic syndrome ranged from 2% to 18%, according to the sensitivity of the 6 different definitions. Systolic blood pressure and triglycerides-to-HDL (high-density lipoprotein) ratio showed a dose-response increase with the quartiles of waist circumference and body mass index (BMI). Assessment of cardiometabolic risk by diagnosing the metabolic syndrome would lead to missed opportunity of intervention in 94% to 95% of children identified to be in need of intervention by waist circumference and BMI above 75th percentile. CONCLUSION: Relying on the diagnosis of the metabolic syndrome can harm primary preventive initiatives. BMI and waist circumference for age should be used for assessing cardiometabolic risk in children and adolescents.

Bacillus Calmette-Guérin-related cold thigh abscess as an unusual cause of thigh swelling in infants following BCG vaccine administration: a case series.

INTRODUCTION: Thigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis. CASE PRESENTATIONS: We performed a retrospective review of five infants (four boys and one girl) who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60%) received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients. CONCLUSIONS: Technical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.