Williams综合征儿童早期运动发育特征

目的 分析Williams综合征（Williams syndrome,WS）儿童的早期运动发育情况,为临床早期干预提供依据。 方法 对2018年9月至2021年8月间59例0~24月龄的WS儿童的临床资料进行回顾性分析,其中男40例,女19例。根据Peabody运动发育量表（Peabody Developmental Motor Scale Ⅱ）测试结果,分析不同年龄患儿的运动发育情况。 结果 男女儿童月龄和运动商的比较差异均无统计学意义（P>0.05）。<6月龄组、6~<12月龄组、12~<18月龄组和18~24月龄组的粗大运动商分别为94±5、78±11、71±8、63±8,精细运动商分别为94±5、80±10、74±9、65±9,粗大运动商和精细运动商随着月龄增长逐渐下降（P<0.05）。<6月龄组、6~<12月龄组、12~<18月龄组和18~24月龄组的粗大运动发育异常率分别为0%、53%、87%、93%,精细运动发育异常率分别为0%、47%、67%、93%,粗大运动和精细运动发育异常率均随月龄增长而上升（P<0.05）。 结论 6个月以内WS儿童未表现出明显的运动能力落后,但随年龄增长其运动能力逐渐降低,运动发育迟缓率逐渐增加。因此必须做好该人群运动能力的随访工作,早期制订干预策略以减少运动发育迟缓的发生。 中国当代儿科杂志,2022,24（9）：984-987］     

Thyroid dysfunction associated with increased low-density lipoprotein cholesterol in epileptic children treated with carbamazepine monotherapy: A causal relationship?

OBJECTIVE: Lipid abnormalities and thyroid dysfunction have been reported in patients treated with antiepileptic drugs. The aim of this study was to evaluate prospectively the association between thyroid and lipid profile in children treated with carbamazepine (CBZ) monotherapy. MATERIALS AND METHODS: Thyroid function was evaluated in 18 epileptic children, previously reported with CBZ-induced changes in serum lipid profile, before and at 6, 12 and 24 months of CBZ monotherapy. RESULTS: All children had normal thyroid function before the initiation of CBZ treatment. During CBZ therapy thyroid dysfunction, with increased thyrotropin (TSH) and decreased thyroxine (T4), free thyroxine (FT4) and triiodothyronine (T3) was found, while, significant association was revealed between serum low-density lipoprotein cholesterol (LDL-C) and TSH levels at 6 (r=0.469; p=0.043) and 12 (r=0.730; p=0.001) months of treatment. CONCLUSION: Lipid abnormalities may be associated with thyroid hormone disturbance in children treated with CBZ monotherapy. Since thyroid dysfunction and hypercholesterolemia are both associated with a higher atherosclerotic risk special attention and further studies are needed in epileptic patients treated with CBZ monotherapy.     

Thyroid function and volume in epileptic children using carbamazepine, oxcarbazepine and valproate

BACKGROUND: The aim of the present study was to investigate the effects of carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid (VPA) on thyroid function and volume in epileptic children. METHODS: Fifty-three epileptic children (age, 3-17 years) treated with OXC (n = 10), CBZ (n = 12), or VPA (n = 31) at least for 1 year were evaluated in terms of thyroid hormones, thyroid-stimulating hormone (TSH) levels, response to thyrotropin-releasing hormone (TRH) stimulation test, and thyroid volumes. RESULTS: The patients in the OXC and CBZ groups had similar total thyroxin (TT4) and free T4 (fT4) median levels that were significantly lower than those of the VPA group (P < 0.016). Total tri-iodothyrosin median levels were lower in the CBZ group compared to the VPA group (P < 0.016). Basal TSH levels and thyroid volumes were similar in all groups (P > 0.016). One child from the OXC group (10%), one from the CBZ group (%8.3), and six from the VPA group (19.3%) had hypothyroidic status according to the TRH stimulation test. No statistically significant correlations were found between thyroid gland volume and thyroid function variables and between anti-epileptic drug receiving time and thyroid function or thyroid volume, respectively, in any of the groups (P > 0.05). CONCLUSIONS: Thyroid function should be evaluated periodically in children using CBZ, OXC or VPA. The children taking VPA seems to be at greater risk compared to children onr CBZ or OXC therapy. Except for the basal TSH values in the VPA group, the parameters predictive for the subclinical hypothyroid status remain to be evaluated in further studies.     

The effects of antiepileptic drugs on the relationships between leptin levels and bone turnover in prepubertal children with epilepsy

Antiepileptic drugs (AED) had an effect on bone metabolism in children. This study was conducted in order to determine the relationships between serum leptin levels, bone mineral density (BMD) and bone turnover markers in epileptic children. Fifty-three patients were treated with valproic acid (VPA) and 23 with carbamazepine (CBZ) monotherapy; 50 healthy children were included in the study as controls. Serum alkaline phosphatase (ALP) and cross-linked C-telopeptide (CTx) levels were statistically significantly higher in the CBZ group than in the VPA group and the control group (p < 0.0001, p < 0.010, respectively). Serum osteocalcin and ALP levels were significantly lower in the VPA group than in the control group (P < 0.012, P < 0.030, respectively). Although we found slightly higher serum leptin levels in both the CBZ and VPA groups, they were not significantly different from the control group (P > 0.05). We demonstrated that the markers of bone formation and resorption increased with CBZ and decreased with VPA treatment without affecting BMD and vitamin D levels in prepubertal epileptic children.     

卡马西平、丙戊酸钠、托吡酯对3～12岁癫癎儿童骨代谢的影响

目的探讨抗癫癎(EP)药物(AEDs)卡马西平(CBZ)、丙戊酸钠(VPA)、托吡酯(TPM)对EP患儿骨代谢影响。方法实验组为90例3～12岁原发性EP患儿,根据治疗药物不同随机分为CBZ、VPA、TPM组各30例。除口服上述药物外未予其他任何药物治疗,疗程6～12个月。于治疗前和治疗后3、6个月分别测定骨密度(BMD)、骨碱性磷酸酶(BAP)、血钙、磷、碱性磷酸酶(ALP)。对照组为30例未治疗原发性EP患儿,同期检测上述指标。对上述骨代谢指标进行评价。结果实验组治疗前后BMD、BAP、钙、磷、ALP与对照组比较无显著性差异(Pa>0.05)。实验组CBZ、VPA、TPM治疗前后5种骨代谢指标比较亦无显著性差异(Pa>0.05)。结论短期服用CBZ、VPA、TPM对3～12岁EP患儿骨代谢无影响。     

The assessment of Bruininks-Oseretsky test of motor proficiency in children

OBJECTIVE: The primary objective is to research the relationship between motor abilities and demographic characteristics such as age and sex, in healthy children aged 4-11 years. METHODS: One hundred and twenty children in kindergarten (n = 30) and primary school (n = 90) were included in the study and evaluated by the Occupational Therapy Unit. All children were divided into four groups according to age, 4-5, 6-7, 8-9 and 10-11 years. The primary school children were classified according to academic learning, being successful or unsuccessful. In this study, Bruininks-Oseretsky test of motor proficiency was used to assess the gross motor skills and fine motor skills. These tests are running speed and agility (subtest 1/item 1), balance/walking forward heel-to-toe on walking line (subtest 2/item 6), bilateral coordination/tapping-foot and finger on same side synchronized (subtest 3/item 2), strength/standing broad jump (subtest 4/item 1), response speed (subtest 6/item 1), visual motor control/cutting out a circle with preferred hand (subtest 7/item 1), upper-limb speed and dexterity/pacing pennies in two boxes with both hands (subtest 8/item 2). RESULTS: When the children were classified according to sex, there were significant differences in subtests 6 and 7. According to academic learning, there were significant differences in subtests 2 and 8. When the results were evaluated due to age, important differences were found in subtests 1, 2, 4 and 8. CONCLUSION: It was seen that gross and fine motor skills in early childhood showed variety between age, sex and academic learning. The scores of motor abilities were better in successful children than unsuccessful children. The outcome of this study revealed that the Bruininks-Oseretsky test can be useful to investigate unexplored aspects of motor development.     

Test-retest and inter-rater reliability for the Comprehensive Developmental Inventory for Infants and Toddlers diagnostic and screening tests

BACKGROUND: Reliability information for the Comprehensive Developmental Inventory for Infants and Toddlers diagnostic (CDIITDT) and screening tests (CDIITST) is inadequate. AIM: To assess the test-retest and inter-rater reliability of the CDIITDT and CDIITST. STUDY DESIGN: A repeated measures design was selected. SUBJECTS: Non-disabled term (n=15; mean age 8.4+/-1.6 months) and preterm infants (n=16; mean age 9.3+/-2.9 months), and children with developmental disabilities (n=15; mean age 24.7+/-11.8 months) were recruited. A single rater assessed the children twice in 3 days to examine the test-retest reliability; and a second rater observed and scored performance while the same rater conducted the first assessment for the inter-rater reliability analysis. OUTCOME MEASURES: The raw score, developmental age (DA) and developmental quotient (DQ)/Z score for the six subtests, two motor subdomains and the whole test were used as outcome measures for the CDIITDT and CDIITST. RESULTS: The test-retest reliabilities for the CDIITDT were rated good for the three pediatric groups (ICC 0.76-1.00), with the exception of moderate ratings for the self-help subtest for the term infants and for the social, self-help and fine-motor DQs for the preterm group. The CDIITDT inter-rater reliabilities were good for the three groups (ICC 0.76-1.00), with the exception of only moderate reliability for the cognitive DQs for the preterm infants. The reliabilities for the whole CDIITST for the three groups were high (ICC 0.93-1.00). CONCLUSION: The reliabilities for the whole CDIITDT and its various subtests and the whole CDIITST are acceptable for clinical use.     

Placebo Controlled Trial of Systemic Corticosteroids in Acute Childhood Asthma

ABSTRACT. In a randomised controlled trial 38 asthmatic children aged 2-11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p < 0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p < 0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze-free when they left hospital compared with 3 in the placebo group, p < 0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat 'non steroid dependent' children hospitalised with acute severe asthma.     

Clinical characteristics of transient glucose intolerance during acute diarrhoea

Transient glucose intolerance (TGI) is an important cause of WHO G-ORS (Glucose-Oral Rehydration Solution) treatment failure and hospitalization in dehydrated children during acute diarrhoea. This retrospective case-control study was designed to determine some risk and predictive factors for developing TGI among moderately dehydrated patients with acute diarrhoea while under G-ORS therapy. Among moderately dehydrated patients, files of 22 patients with TGI and 66 other dehydrated patients without intolerance were reviewed. Patients with TGI were younger (9.7+/-10.5 mo and 11.6+/-7.8 mo, respectively, p < 0.05), the median age being 6 mo in the TGI group and 10 mo in non-TGI group. There was no difference between groups for sex, admission season, history of fever or vomiting, frequency of vomiting, presence of blood, mucous or leukocyte in stool, presence of associated disease and duration of diarrhoea on admission. The admission haemoglobin, white blood cell, blood pH, sodium and potassium levels were similar in both groups. The mean serum chloride level (116.8+/-6.9, 109.6+/-7.9 mEq/l, respectively, p<0.05) was higher in the TGI group and the bicarbonate level was lower (12.9+/-3.8, 15.3+/-6.0, respectively, p < 0.05). Stool frequency was also higher in patients with TGI (11.2+/-5.3/24 h, 5.9+/-4.4/24 h, respectively, p < 0.05). No difference was found between the nutritional status of children in both groups. More children were breastfed in the group without TGI (34/56, 61%, 6/18, 33% respectively, p=0.079, OR=0.32, 95% CI [0.09-1.11]). It was concluded that patients with TGI are younger and have high stool frequency. Although statistical significance could not be shown, breastfeeding seems to protect children from TGI, as it protects from diarrhoea.     

The effects of grass pollen allergoid immunotherapy on clinical and immunological parameters in children with allergic rhinitis

Allergoid immunotherapy is a new form of allergen immunotherapy allowing safe administration of high allergen doses. There is limited information on the effects of allergoid immunotherapy in children with allergic rhinitis. To investigate the immunological and clinical effects of allergoid immunotherapy in children with allergic rhinitis due to grass pollen allergy. Children with allergic rhinitis were assigned to allergoid immunotherapy (n = 27) or control (n = 26, no immunotherapy) groups. Children in the immunotherapy group received seven injections of grass pollen allergoid immunotherapy before grass pollen season and continued to receive maintenance immunotherapy for 27 months. All patients were offered a pharmacotherapy regimen to be used on demand during the pollen seasons. Clinical and laboratory parameters were compared between the immunotherapy and control groups. The rhinoconjunctivitis symptom-medication score and asthma symptom score were lower in the immunotherapy group after 1 yr of maintenance immunotherapy (p < 0.01 for both). Skin test reactivity and nasal reactivity as determined by nasal provocation testing for grass pollen were significantly decreased after 1 yr of immunotherapy (p < 0.001 for both). The seasonal increase in bronchial reactivity and nasal lavage eosinophil cationic protein levels were prevented after the first year of immunotherapy (p < 0.05 for both). The seasonal increase in immunoglobulin (Ig)E decreased (p < 0.05) and grass-specific IgG, IgG(1) and IgG(4) increased significantly already at the end of the seven-injection build-up therapy (p < 0.001, for all). Interleukin (IL)-4 levels in the culture supernatants showed a steady decline from baseline at first and second year of immunotherapy (p < 0.001) but remained unchanged in the control group. Allergoid immunotherapy is an effective method in the treatment of grass pollen-induced allergic rhinitis in children and prevents the seasonal increase in bronchial hyper-reactivity. Changes in specific IgE and IgG levels and decreased IL-4 production in peripheral blood mononuclear cell culture supernatants may account for the observed clinical effects.     

Evaluation of a maize-cowpea-palm oil diet for the dietary management of Nigerian children with acute, watery diarrhea

A randomized clinical trial was carried out to compare a locally available maize-cowpea-palm oil diet (group MCP) with a commercially produced lactose-free, soy protein isolate formula (group SF) for the dietary management of 69 Nigerian boys, 6–24 months of age, hospitalized for acute, watery diarrhea. Although the treatment groups were generally similar initially, the children in group SF had slightly lower mean weight-for-age z scores ( p = O.OS), lower serum bicarbonate levels ( p = 0.04) and greater stool outputs during the period of rehydration before the diets were initiated ( p = 0.01). Rates of treatment failure in group MCP (5.7%) and group SF (8.8%) were similar ( p = 0.67). There were no significant differences in the adjusted mean stool outputs by study group on days 1–5, but the children in group SF had slightly lower fecal weights on day 6 ( p = 0.05). Children in group MCP had a substantially reduced duration of liquid stool excretion (estimated median duration 42 h versus 140 h; p < 0.001). On the other hand, children in group SF consumed considerably more of their diet, had greater net absorption of macronutrients and greater rates of weight gain than those in group MCP. We conclude that children can safely consume the MCP diet during acute, watery diarrhea without increasing their risk of treatment failure or augmenting stool output. However, the diet may not be adequate as a sole source of nutrients beyond the period of acute illness.     

经皮电神经刺激对痉挛型脑性瘫痪患儿运动功能影响的对照研究

目的观察经皮电神经刺激（TENS）结合功能训练对痉挛型脑性瘫痪（脑瘫）患儿运动功能的影响。方法78例脑瘫患儿,年龄36—58个月[（45．6±8．5）个月],通过计算机分层（性别、年龄）后随机分为TENS组（加例）和对照组（38例）。2组患儿均接受功能训练。TENS组使用2台TENS治疗仪（每台2个输出通道）,8个表面电极放在下肢痉挛肌群的两端肌腱和拮抗肌肌腹给予电刺激,每次20min。以上治疗每日1次,每周5次,共治疗30次。之后指导家长实施家庭康复治疗。治疗前,治疗后的6、12、24周随访时进行以下评定：①综合痉挛量表（CSS）,②粗大运动功能量表（GMFM）中的D和E两项,③步行速度。结果两组患儿的CSS评分、GMFM评分及步行速度治疗前差异无统计学意义（P〉0．05）,治疗后6、12、24周组内差异均有统计学意义（P均〈0．05）。2组患儿的CSS评分、GMFM评分及步行速度在治疗后6、12、24周组间差异均有统计学意义（治疗后24周：t值分别为8．96、3．14、2．35,P均〈0．05）。结论与对照组比较,在痉挛型脑瘫患儿的患侧肢体上给予TENS治疗6周,能明显降低息儿下肢痉挛,提高其站立、步行功能和步行速度。     

注意缺陷多动障碍患儿药物治疗前后microRNA表达量与临床症状的关系

目的 探讨注意缺陷多动障碍（ADHD）儿童药物治疗前后microRNA表达量与临床症状的关系。方法 选取2017年5月至2018年10月初诊为ADHD儿童80例为研究对象，将愿意接受药物治疗的儿童随机分为盐酸哌甲酯治疗组（n=31）和盐酸托莫西汀治疗组（n=33），不愿接受治疗的作为未治疗组（n=16），随访中盐酸哌甲酯组脱落10例，盐酸托莫西汀组脱落13例。另随机选取同时期行健康体检儿童60例作为健康对照组。ADHD儿童在首诊、随访3个月、6个月时进行SNAP-V评分，并采集ADHD及健康对照组儿童血清样本以荧光定量PCR法检测miR-4655-3p和miR-7641的相对表达量。结果 重复测量方差分析结果显示，注意力不足症状SNAP-V评分在两治疗组和未治疗组中，以及两种miRNA相对表达量在两治疗组和健康对照组中均存在分组与时间因素差异，且分组与时间因素均存在交互作用（P < 0.05）。多动冲动症状SNAP-V评分在两治疗组和未治疗组中存在时间因素差异（P < 0.05），而分组因素差异无统计学意义，且时间因素与分组因素无交互作用（P > 0.05）。经药物治疗的ADHD儿童注意力不足症状SNAP-V评分与miRNA-4655-3p和miRNA-7641相对表达量均呈负相关（分别r=-0.314、-0.495，P < 0.05）。结论 药物治疗可显著改善ADHD儿童的临床症状；血清中miR-4655-3p和miR-7641的表达水平可能作为ADHD的诊断及疗效评估的分子指标。     

超低频经颅磁刺激对痉挛型脑瘫患儿运动功能的影响

目的：探讨超低频经颅磁刺激（TMS）对痉挛型脑瘫患儿的治疗效果。方法：将75例痉挛型脑瘫患儿随机分为对照组（33例）和治疗组（42例）,对照组只接受常规的综合康复训练进行治疗,治疗组则在综合康复训练的同时,进行超低频TMS治疗。应用粗大运动功能测试量表(GMFM)和精细运动功能测试量表（FMFM）对两组患儿进行评价,比较两组患儿治疗1个月和3个月后运动功能的变化。结果：治疗1个月后,治疗组患儿坐位能区的改善优于对照组（P<0.05）。治疗3个月后,治疗组患儿坐位能区、爬与跪能区及GMFM总分的改善均优于对照组（P<0.05）;上肢关节活动能力、抓握能力、操作能力的改善亦均优于对照组（P<0.05）。结论：超低频TMS可以有效改善痉挛型脑瘫患儿的运动功能。     

Impaired neuromotor outcome in school-age children with congenital hypothyroidism receiving early high-dose substitution treatment

Congenital hypothyroidism (CH) can lead to intellectual deficits despite early high-dose treatment. Our study aimed to determine whether motor impairments can occur despite early high-dose treatment. Sixty-three children with CH and early (median age of onset of treatment 9 d), high-dose treatment (median starting dose of levothyroxine 14.7 μg/kg/d) were tested with the Zurich Neuromotor Assessment (ZNA) at a median age of 13.8 y (range 7.0-14.2 y). Median z-scores in the children with CH were -0.95 in the pure and -0.56 in the adaptive fine motor component, significantly lower than in the ZNA test norms (p < 0.001 and p = 0.01, respectively). The 26 children with athyreosis were more affected than the 33 children with dysgenesis, particularly in the pure motor (-1.55 versus -0.76, p = 0.03), adaptive fine motor (-1.31 versus 0.13, p < 0.01), and static balance task (-0.47 versus 0.67, p = 0.01). Boys performed worse than girls. Older age at onset of treatment was related to poorer adaptive fine motor performance. Movement quality (assessed by associated movements) was not affected. We conclude that severe CH can cause neuromotor deficits persisting into adolescence. These deficits cannot completely be reversed by postnatal treatment, but earlier age at treatment may reduce the degree of impairment.     

Sensory integration and activities of daily living in children with developmental coordination disorder

ABSTRACT: OBJECTIVE: The aim of our study was to evaluate sensory integration and activities of daily living in children with developmental coordination disorder Subjects and methods 37 cases with developmental coordination disorder and 35 healthy age-matched peers were included in this study. Ayres Southern California Sensory Integration Test was used for evaluating the sensory integration and Functional Independence Measure for Children (WeeFIM) was used for evaluating the activities of daily living. RESULTS: Significant differences were found in the visual shape perception, position in space, and design copying (p < 0.05). According to the results of somatosensory perception tests, significant differences were found in kinesthesia, manual form perception, finger identification, figure-ground perception, localization of tactile stimuli, double tactile stimuli perception (p < 0.05). Control group was better in motor planning (p < 0.05). Comprehension, expression, social communication, problem solving, and memory skills were significant in favor of the control group (p < 0.05). Graphestesia and self-care domain was found to be correlated (r = 0,491, p = 0.002) between the groups. DISCUSSION: Special education and rehabilitation programs including sensory integration therapy and motor performance will increase independence in the activities of daily living in children with developmental coordination disorder.     

达良好控制哮喘患儿停用低剂量吸入性糖皮质激素的临床随访研究

目的 通过随访达良好控制哮喘患儿停用低剂量吸入性糖皮质激素（ICS）后哮喘急性发作情况,以及实验室指标的动态变化,以期为哮喘患儿的长期控制最佳方案提供依据。方法 根据家长意愿,将63例达到良好控制的哮喘患儿分为ICS治疗组（n=35）和停药组（n=28）,进行18个月随访,每3个月进行评估,观察哮喘急性发作情况,并动态监测两组患儿肺功能和呼出气一氧化氮（FeNO）浓度,以及儿童哮喘控制测试（C-ACT）评分等指标进行分析。结果 随访第3、6、9、12个月时,FeNO在两组间比较差异无统计学意义（P > 0.05）;但在随访第15、18个月时,停药组FeNO显著高于治疗组（P < 0.05）。6次随访时点内C-ACT在两组间比较差异无统计学意义（P > 0.05）。随访第3、6、9、12个月时,第1秒用力呼气容积占预计值的百分比（FEV1%）、第1秒用力呼气量占用力肺活量比值（FEV1/FVC%）、最大呼气中期流速占预计值百分比（MMEF%）、最大呼气50%肺活量的瞬间流速（MEF50%）等指标在两组间比较差异无统计学意义（P > 0.05）;但在随访第15、18个月时,治疗组MMEF%、MEF50%显著高于停药组（P < 0.05）。治疗组随访期间有3例（9%）患儿哮喘发作,停药组有8例（29%）患儿哮喘发作,停药组哮喘复发率高于治疗组（P=0.0495）。结论 持续吸入低剂量ICS可维持哮喘患儿肺功能稳定,减少哮喘发作。     

Epidemiological studies of the very high prevalence of asthma and related symptoms among school children in Costa Rica from 1989 to 1998

The aim of our study was to determine the prevalence of asthma and related respiratory symptoms in school children from Costa Rica during the last 10 years, from 1989 to 1998. Using nationally representative samples of school children from Costa Rica during the last 10 years we have performed three studies. Altogether 9931 children were investigated. The age groups: study I, 5–17 years (n = 2682), study II, 6–7 years (n = 2944), 13–14 years (n = 3200) and study III, 10 years (n = 1105). The diagnostic criteria for asthma used in these studies was as follows: study I (1989), diagnosis by a doctor in combination with the presence of four kinds of respiratory symptoms; studies II (1995) and III (1998), history of wheeze in the past 12 months. The two latter were part of the International Study of Asthma and Allergies in Childhood (ISAAC). A very high prevalence of a history of wheezing was found in the three studies (46.8%, 42.9%, and 45.1%) as well as a diagnosis of asthma (23.4%, 27.7% and 27.1%). The physician's diagnosis of asthma reported in the first study (23%) increased from 23.1 in study II to 27.7% in study III (p = 0.004). This increment could be a real increase in asthma prevalence, or be due to a better awareness about asthma. In study II the group of 6–7‐year‐olds had respiratory symptoms significantly more often than 13–14‐year‐olds (p < 0.001). Boys more often had a history of wheezing (p = 0.001), wheeze during the previous 12 months (p = 0.01) and an asthma diagnosis at the age of 6–7 years (p = 0.002) than girls, but girls had more respiratory symptoms than boys at the age of 13–14 years (p < 0.005). Wheezing in the past 12 months was more common for those living in urban areas aged 6–7 years (p = 0.04), and there was an increase of wheeze after exercise (p = 0.01). For the 13–14‐year‐olds the risk of wheezing was higher during the previous 12 months if they lived in temperate areas (<20°C) and at a high altitude (>1000 m). Living in a rural area and in a warm region (>20°C), increased the risk of dry cough during the previous 12 months in the group of 13–14‐year‐olds. In conclusion, Costa Rica is located in the tropics with a very high humidity, an enormous variety of flora and fauna and a very high prevalence of mite and cockroach allergens, which provide important risk factors that may explain the high prevalence of asthma and asthma‐related symptoms. Further possible factors, such as the change towards a more Western life style, resulting in fewer infections and parasitic diseases in the first years of life and changes in bedding material, may also be unresolved. Increased environmental pollution may add to the very high prevalence of asthma and related respiratory symptoms. The very extensive exposure to mites and cockroaches in bed material and in homes with poor ventilation may be an important factor, but many asthmatic children behave as non atopic, with a viral respiratory infection as a major precipitating factor.     

Lower HbA1c after 1 year, in children with type 1 diabetes treated with insulin glargine vs. NPH insulin from diagnosis: a retrospective study

Salemyr J, Bang P, Örtqvist E. Lower HbA1c after 1 year, in children with type 1 diabetes treated with insulin glargine vs. NPH insulin from diagnosis: a retrospective study. Objective: Insulin glargine offers sustained insulin delivery for 24 h. Change to glargine treatment consistently results in lower fasting glucose and fewer hypoglycemic episodes in children with type 1 diabetes compared to continuation of NPH, although glargine has not been shown to improve HbA1c in randomized trials. Studies comparing glargine and NPH in multiple injection therapy in children treated from diagnosis of type 1 diabetes are lacking. Methods: HbA1c and insulin requirement were compared in a retrospective study of children (7–17 yr of age) with type 1 diabetes treated from diagnosis with basal insulin glargine (n = 49) or NPH (n = 49) in a multiple injection therapy (MIT) regimen with a rapid‐acting insulin analogue. Patients were followed every third month for 1 yr. HbA1c, insulin dose, and weight data were retrieved. Results: HbA1c (mean ± SD) was lower at 3–5 months (5.5 ± 0.89 vs. 6.2 ± 0.89%, p < 0.05) and 6–9 months (5.6 ± 1.14 vs. 6.6 ± 0.99%; p < 0.001) in glargine treated. After 12 months, HbA1c was significantly lower in glargine treated (6.3 ± 1.56 vs. 7.1 ± 1.28; p < 0.01). Reported total insulin doses were similar at nadir (0.5 U/kg BW × 24 h), but significantly lower at 12 months in glargine treated (0.64 ± 0.23 vs. 0.86 ± 0.3 U/kg BW × 24 h; p < 0.001). Conclusions: HbA1c 1 yr from diagnosis was lower in children treated with glargine from start as compared with those on NPH. This observation should be viewed in the light of a significantly lower dose of total daily insulin in the glargine group.     

武汉地区12125例呼吸道感染患儿非细菌病原体IgM抗体检测结果分析

目的检测武汉地区住院呼吸道感染患儿非细菌病原体IgM抗体,为临床诊疗提供依据。方法取诊断为呼吸道感染的12 125例住院患儿的血清,采用间接免疫荧光法检测9种呼吸道感染非细菌病原体的IgM抗体。结果 3 597份标本(29.7%)非细菌病原体IgM抗体检测阳性,其中肺炎支原体(MP)的阳性率最高为21.6%,其次为腺病毒(ADV)和乙型流感病毒(Flu B),阳性率最低为肺炎衣原体(CP)和Q热立克次体(COX);混合感染563例,其中主要是2种病原体的混合感染。各年龄组(0～30 d、～6个月、～1岁、～3岁、～9岁)的总检出率分别为30.4%、18.7%、35.4%、68.4%、55.2%,各组间差异有统计学意义(χ2=89.5,P<0.05)。冬季非细菌病原体检出率最高(53.4%),秋季最低(24.9%),差异有统计学意义(χ2=760.3,P<0.05)。结论武汉地区呼吸道感染患儿的非细菌病原体主要是MP、ADV和Flu B;MP和其他非细菌病原体的混合感染比较普遍;1～3岁幼儿感染率较高;冬季更易感。