Is suppression of hypothalamic-pituitary-adrenal axis significant during clinical treatment of phimosis?

PURPOSE: Corticoids have been an option for phimosis treatment since 1993. However, long-term use or repeated cycles pose a concern regarding drug absorption and consequent systemic effects. The aim of this study was to investigate the effect of topical corticoids used in treating phimosis on the hypothalamus-pituitary-adrenal axis in children. MATERIALS AND METHODS: A total of 31 children were included in the study. Cortisol secretion was evaluated by the measurement of salivary cortisol in saliva samples collected at 9:00 a.m. before starting treatment and after 8 weeks of topical treatment with 0.05% clobetasol propionate. Salivary cortisol was determined by radioimmunoassay. To confirm that use of clobetasol propionate was not detected by the assay, the presence of cortisol circadian rhythm was checked by an extra saliva sample obtained at 11:00 p.m. from 10 children, and was observed to be maintained in all of them. RESULTS: No significant difference in salivary cortisol levels was observed between samples obtained at 9:00 a.m. before starting treatment and after completing treatment when the entire group was analyzed. However, in 2 children the salivary cortisol levels after treatment were lower than the cutoff value (358 ng/dl) assumed to be suggestive of hypothalamus-pituitary-adrenal axis suppression. CONCLUSIONS: Topical clobetasol propionate used twice daily for clinical treatment of phimosis does not affect the hypothalamus-pituitary-adrenal axis in most patients. However, salivary cortisol level should be considered as a laboratory marker in long-term treatment or during repeated cycles to detect possible hypothalamus-pituitary-adrenal axis suppression.

Detection of vitamin A deficiency in Brazilian preschool children using the serum 30-day dose-response test.

BACKGROUND: Vitamin A deficiency (VAD) is endemic in Brazil and health professionals have difficulty in recognizing its subclinical form. In addition, serum retinol concentrations do not always represent vitamin A status in the organism. OBJECTIVE: To identify VAD in preschool children by the serum 30-day dose-response test (+S30DR) and to examine its potential as a tool for the assessment of vitamin A status in the community. DESIGN: A prospective transverse study in which blood samples were obtained from 188 preschool children for the determination of serum retinol concentrations and the children were submitted to ocular inspection and anthropometric measurements. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. The children received an oral dose of 200,000 IU vitamin A immediately after the first blood collection. A second blood sample was obtained 30-45 days after supplementation in order to determine the +S30DR. RESULTS: In all, 74.5% (140/188; 95% confidence interval: 68.3-80.7%) of the children presented +S30DR values indicative of low hepatic reserves. The mean serum retinol concentration was significantly lower before supplementation (0.92 and 1.65 micromol/l, respectively; P < 0.0001). No child presented xerophthalmia; 3.7% (7/188) of the children were malnourished. The presence of fever and/or diarrhea during the 15 days preceding the first blood collection did not affect the +S30DR value. CONCLUSIONS: The prevalence of VAD in the study group was elevated. +S30DR proved to be a good indicator of subclinical VAD in children from an underdeveloped country.

Focusing on dissociated motor development in Brazilian children.

Dissociated motor development (DMD) is considered when the baby starts independent walking late, with normality of the other fields of development. There is evidence that babies with DMD present an atypical crawling pattern and hypotonia. To investigate the frequency and characteristics of DMD, neurological examination was performed monthly in 177 healthy full-term babies from 6 months age, in urban and rural zone samples in Brazil. Among 20 children with atypical crawling, none presented hypotonia neither did they start independent walking late. The means of the ages at the beginning of atypical crawling and independent walking acquisitions, 7.40 mo (SD 1.4) and 12.76 mo (SD 2.5) respectively, did not differ from the group with crossed crawling pattern. Thus, in this sample of Brazilian healthy children we did not find cases with DMD.

[Influence of the different types of room on newborns during breastfeeding]. / Influências dos diferentes tipos de alojamento sobre recém-nascidos na prática do aleitamento materno.

The present study was developed in the CMSCVL, which is a primary medical attendment clinic for children and pregnant women, during the period of 01/10/1980 to 31/12/1984, containing 132 children. The study was longitudinal and respective and the two distinct groups of children may be established, differing in accordance to the hospital stay period of postpartum, in rooming-in or traditional nursery. After the statistic analysis of all the variables involved in the study, the only variable that really resulted was the site of internation during the postpartum period. Although these exist a tendency to the greater frequency of breast feeding in the group that utilized the rooming-in, the statistics analysis showed that this difference is not significant. However should consider the important paper carried out by the CMSCVL, in the encouragement of the practice of the breast-feeding, what may have homogenized the two groups. The medium time of weaning found for the population of 132 children studied was 8 months, while for those children that utilized the rooming-in is system was 10 months and for those that stayed in the traditional nursery it took 9 months. The motives of weaning were also identified for the studied population that showed similarity to other published projects.

Growth of exclusively breast-fed infants from a poor urban population.

The growth of two groups of infants were evaluated, one of them exclusively breast-fed (105 infants) and the other exclusively bottle-fed (61 infants), and compared with one another and with international standards (NCHS). All infants were evaluated by anthropometry at 1, 2, 3, 4, 5 and 6 months of age. A fourth order polynomial was adopted for each infant and for each anthropometric measurement in order to estimate individual growth, and the 5th, 50th and 95th percentiles for weight and length were obtained. For the age of 6 months, the weights of breast-fed boys and girls were always statistically equal to or higher than those of infants fed cow's milk or those of NCHS standards. Breast-fed boys presented significantly longer length than bottle-fed boys but shorter than NCHS standards, and breast-fed girls presented significantly shorter length than both bottle-fed girls and than NCHS standards. The greater weight of exclusively breast-fed infants when compared to NCHS standards at six months of age, which differentiates the present study from several other ones carried out in developing countries, was probably due to the association of the beneficial effects of breast-feeding with those of pediatric follow-up.

Impact of maternal vitamin A supplementation on the mother-infant pair in Brazil.

BACKGROUND/OBJECTIVES: Vitamin A deficiency (VAD) is a major public health problem. The supplementation of lactating women could be an effective strategy to combat it. The objective of this study was to assess the impact of maternal vitamin A supplementation on the mother-infant pair. SUBJECTS/METHODS: This was a double blind, placebo-controlled randomized clinical assay in which 33 women received 200 000 IU of vitamin A and 33 women received soy oil between 20th and 30th postpartum days. Maternal blood and milk samples were collected immediately before supplementation and 3 months after delivery, when blood was also collected from the babies. Retinol concentrations 0.70 µmol/l in serum and 1.05 µmol/l in milk were considered to indicate VAD. RESULTS: Increase in serum retinol level was observed in the supplemented group compared with the pre-supplementation levels (1.05 and 1.17 µmol/l, respectively; P=0.026) and to the post-supplementation levels of the control group (1.02 µmol/l; P=0.032). Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 µmol/l, respectively; P<0.0001) and to the post-supplementation levels of the supplemented group (1.56 µmol/l; P=0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P=0.002). VAD was present in 66.1% (39/59) of infants, with mean serum retinol levels of 0.64±0.30 µmol/l in the control group and of 0.69±0.26 µmol/l in the supplemented group. CONCLUSIONS: Supplementation had a positive impact on maternal vitamin A status. No effect on infant status was detectable 2 months after supplementation with a single dose.

Vitamin A deficiency among Brazilian school-aged children in a healthy child service.

BACKGROUND/OBJECTIVES: Vitamin A deficiency (VAD) is a world public health problem contributing to the increase in childhood morbidity and mortality in developing countries and severe deficiency of vitamin A may lead to xerophthalmia and blindness. The objective of this study was to determine the prevalence of VAD among Brazilian school-aged children attended at a primary health unit and to verify if some considered risk factor was associated with VAD in this group. SUBJECTS/METHODS: A descriptive prospective transverse study was conducted on 103 randomly selected children. A total of 54 boys and 49 girls aged 5.5-11 years had the relative dose-response (RDR) test performed on. Possible ocular alterations related to vitamin A and the status of anemia, serum zinc, some acute-phase proteins, and anthropometric situation were determinate by an analytic design. RESULTS: No child presented xerophthalmia. Serum retinol values lower than 1.05 and 0.7 micromol l(-1), respectively were found in 26.2 and 5.8% of the children. The prevalence of hypovitaminosis detected by RDR test was 20.4%. The following variables and their relationship with VAD were evaluated: sex (P=0.33; 95% confidence interval 0.61-4.34), weight and height (P> or =0.5), hemoglobin (P=0.15), C-reactive protein (P=0.56; 95% confidence interval 0.75-18.26), alpha-1-acid-glycoprotein (P=0.56; 95% confidence interval 0.15-15.42) and serum zinc (P=0.31). None of these variables was related to VAD. CONCLUSIONS: In this population, the prevalence of VAD detected could be considered a public health problem. School-aged children can be considered at risk for VAD mainly of a subclinical level, even without some associated risk factors.

[Prevalence of asthma in schoolchildren] / Prevalência de asma em escolares.

OBJECTIVE: To assess the prevalence of asthma symptoms and of asthma in children due to the high frequency of pediatrics patients with symptoms suggestive of the disease and to the lack of data regarding prevalence of asthma in this population. METHODS: We carried out a cross-sectional study with 2,735 school-age children aged 6-7 years and 3,509 adolescents aged 13-14 years selected by random sampling. Data were collected between 1998 and 1999 using a translated version of the questionnaire of the International Study of Asthma and Allergies in Children, which has been previously tested and approved. Guardians were responsible for answering the questionnaire of younger children, whereas adolescents answered their own, in classroom. The data were computed and analyzed using EPI-info software. RESULTS: The response rates for questionnaires were 73.2% (6-7-years old) and 94% (13-14 years old). The prevalence of symptoms in children and adolescents were, respectively: wheezing ever 46.7% and 44.3% (P<0.05); wheezing in the last 12 months 22.7% and 21.2%; speech limited due to wheezing 4.7% and 4.0%; wheezing following exercise 6.3% and 18.2% (P<0.05); nighttime cough in the last 12 months 38.5% and 45.8% (P<0.05); asthma (bronchitis) ever 28.2% and 26.4% (P=0.11). CONCLUSIONS: The prevalence of asthma symptoms and of asthma of the two groups are among the highest results ever reported in Brazil; these results were compatible with those of high prevalence results reported worldwide using ISAAC questionnaires. The high prevalence of symptoms suggests a high prevalence of the disease, which makes asthma an important problem for public health in the region.

Salivary cortisol for screening of Cushing's syndrome in children.

OBJECTIVE: Cushing's syndrome (CS) is characterized by changes in diurnal cortisol variation and total or partial resistance to cortisol suppression by dexamethasone (DEX). Diagnosing CS is a challenge especially in childhood and requires differentiation from primary obesity. The aim was verify the efficacy of salivary cortisol in differentiating primary obesity from CS in children. SUBJECTS AND METHODS: We studied 11 patients with CS confirmed by standard laboratory investigation and surgical findings aged 1-16 years, and 21 age-matched primary obese controls. Salivary samples were collected at 0900 h, 2300 h, and after an overnight DEX suppression test (20 microg/kg up to 1 mg). Salivary cortisol was measured by RIA. RESULTS: Diurnal variation of salivary cortisol levels was observed in all controls, as opposed to only 5 of 11 patients with CS. Suppression of salivary cortisol was detected in all controls but in no CS patient after the overnight DEX test. Mean salivary cortisol levels were higher in the CS than in the control group both at 2300 hours and at 0900 hours after DEX but no difference was observed at 0900 hours of the first day. The sensitivity and specificity of salivary cortisol at 0900 h, 2300 hours and after-DEX in diagnosing CS were 27% and 95.2%, 100% and 95. 2%, and 100% and 95.2%, respectively. Sensitivity and specificity of 100% were obtained by combining the data for 2300 hours and after-DEX. CONCLUSION: The combination of salivary cortisol determination at 2300 hours and after-Dexamethasone is an easily performed and noninvasive method with high specificity and sensitivity for diagnosing Cushing's syndrome in children.