Clinical and Echocardiographic Outcome in Patients Receiving Carvedilol for Treatment of Dilated Cardiomyopathy

Objective

To determine outcome of children receiving carvedilol in addition to other standard drug therapy for treatment of dilated cardiomyopathy.

Methods

Children receiving carvedilol for treatment of dilated cardiomyopathy with moderate to severe ventricular dysfunction were included into the study. Data on history, clinical examination and investigations were obtained and detailed echocardiography findings were recorded for the initial and all subsequent visits.

Results

Thirty-three children, mean age 26?±?30 mo (range 7 mo to 138 mo) were enrolled. Carvedilol was initiated at a mean dose of 0.14?±?0.03 mg/kg/d and the maintenance dose was 0.46?±?0.14 mg/kg/d. At a follow up of 6–90 mo (mean of 28?±?23 mo), functional class using Ross classification for pediatric heart failure improved from 2.7 to 1.3. The left ventricular ejection fraction rose from a basal value of 22 %?±?7 % (10–40 %) to 42 %?±?15 % (15–65 %) (p?<?0.0001). Similarly, left ventricular fractional shortening increased significantly from 16?±?6 % (8–34 %) to 21?±?7 % (10–44 %) (p?<?0.0001). One patient deteriorated and died of refractory heart failure. Carvedilol was discontinued in two more patients temporarily due to bronchospasm during respiratory infection.

Conclusions

The present study suggests that improvement in ventricular function and clinical symptoms is seen on oral carvedilol added to standard drug therapy in pediatric patients with dilated cardiomyopathy and moderate to severe ventricular dysfunction. The drug is well tolerated with minimal side effects but close monitoring is required as it may worsen heart failure and bronchospasm.     

Serum Procalcitonin in Septic Meningitis

Objective

To evaluate the role of serum procalcitonin (PCT) in diagnosis of septic meningitis in children and its efficacy in differential diagnosis.

Methods

The study included 40 children of septic meningitis admitted in pediatric ward with fever, headache, vomiting and seizure, up to 14 y of age. The diagnosis of septic meningitis was based on clinical features; physical examination, blood and cerebrospinal fluid (CSF) cytochemical findings, gram’s stain and bacterial culture. Fifteen cases of aseptic meningitis admitted during same period were also included in the study, and 15 children with normal CSF were taken as control. Serum PCT was measured by ELISA Kit.

Results

Serum PCT level was significantly higher in children with septic meningitis than those with aseptic meningitis or in controls (p?<?0.001). In culture and gram’s stain positive 7 cases, serum procalcitonin was significantly elevated (24,768.21?±?6,567.45 pg/mL) than aseptic meningitis(14,451.24?±?4,266.15 pg/mL) (p?<?0.001). Further its level was found significantly elevated in partially treated septic meningitis as compared to aseptic meningitis cases (p?<?0.001). At optimum cut off value of ≥ 5,000 pg/mL, based on area under ROC curve, PCT showed sensitivity, specificity, positive predictive value and negative predictive value of 98.5 %, 93.5 %, 98.6 % and 93.3 % respectively. Serum PCT with cut off level of 15,000 pg/ml showed sensitivity, specificity, PPV and NPV of 92 %, 67 %, 91.4 % and 71.4 % respectively for the differentiation of septic from aseptic meningitis.

Conclusions

Serum PCT may be used as diagnostic marker for septic meningitis and its differentiation from aseptic meningitis.     

Evaluation of the impact of organ-specific dose reduction on image quality in pediatric chest computed tomography

Background

Organ-specific dose reduction significantly reduces the radiation exposure of radiosensitive organs.

Objective

The purpose of this study was to assess the impact of a novel organ-specific dose reduction algorithm on image quality of pediatric chest CT.

Materials and methods

We included 28 children (mean age 10.9?±?4.8 years, range 3–18 years) who had contrast-enhanced chest CT on a 128-row scanner. CT was performed at 100 kV using automated tube current modulation and a novel organ-specific dose-reduction algorithm (XCare?; Siemens, Forchheim, Germany). Seven children had a previous chest CT performed on a 64-row scanner at 100 kV without organ-specific dose reduction. Subjective image quality was assessed using a five-point scale (1-not diagnostic; 5-excellent). Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were assessed in the descending aorta.

Results

Overall mean subjective image quality was 4.1?±?0.6. In the subgroup of the seven children examined both with and without organ-specific dose reduction, subjective image quality was comparable (score 4.4?±?0.5 with organ-specific dose reduction vs. 4.4?±?0.7 without it; P?>?0.05). There was no significant difference in mean signal-to-noise ratio and contrast-to-noise ratio with organ-specific dose reduction (38.3?±?10.1 and 28.5?±?8.7, respectively) and without the reduction (35.5?±?8.5 and 26.5?±?7.8, respectively) (P?>?0.05). Volume computed tomography dose index (CTDI_vol) and size-specific dose estimates did not differ significantly between acquisitions with the organ-specific dose reduction (1.7?±?0.8 mGy) and without the reduction (1.7?±?0.8 mGy) (P?>?0.05).

Conclusion

Organ-specific dose reduction does not have an impact on image quality of pediatric chest CT and can therefore be used in clinical practice to reduce radiation dose of radiosensitive organs such as breast and thyroid gland.     

Does Mesenchymal Stem Cell Population in Umbilical Cord Blood Vary at Different Gestational Periods?

Objective

To identify and quantitatively determine Mesenchymal stem cells (MSCs) in the umbilical cord blood (UCB) of neonates born at different gestational periods.

Methods

UCB was collected at birth in neonates of three different gestational groups. The mononuclear cells (MNCs) were phenotypically analyzed by flow cytometer.

Results

The yield of total MNCs did not differ much with gestation; the average values were 22.6?±?6.48?×?106 cells/ml. The MSCs were significantly higher in the lower gestation group. These were 0.0219?±?0.012 %, 0.0044?±?0.003 % and 0.0022?±?0.003 % in 28 to 31 wk, 32 to 35 wk and >36 wk, respectively (P?=?0.00). There was a significant inverse correlation between the gestational age and the presence of MSCs with a correlation co-efficient of ?0.54 (P?=?0.0001).

Conclusions

The MSCs population was significantly higher in infants born at lesser gestation than those born at term gestation.     

Soft Plastic Bag Instead of Hard Plastic Container for Long-term Storage of Breast Milk

Objective

To compare the fat content and contamination of expressed breast milk (EBM) before and after storage (30 d) in hard polypropylene containers (HC) and soft polyethylene bags (SB) containers.

Methods

Ninety specimens of EBM were collected into HC and separated into two HC and two SB. The fat content of each specimen of EBM in HC and SB was measured and cultures were performed. The specimens in the second HC and SB containers were kept frozen for 30 d before thawing and then measuring the fat content and performing cultures.

Results

The means ± SD of the fat content of fresh and thawed EBM in HC were 2.98?±?0.97 and 2.66?±?0.88 g/100 ml, respectively, with a loss of 0.32 g/100 ml (p?<?0.001). The means ± SD of the fat content of fresh and thawed EBM in SB were 3.06?±?1.00 and 2.77?±?0.91 g/100 ml, respectively, with a mean loss of 0.29 g/100 ml during storage (p?<?0.001). The loss of fat content during frozen storage did not differ significantly between the two types of containers (p?=?0.53). All bacterial cultures of fresh and thawed EBM in HC and SB showed only nonpathogenic organisms.

Conclusions

SB can replace HC for the long-term storage of frozen EBM of up to 30 d without deleterious effects on fat loss or contamination.     

Effect of Oil Massage on Growth in Preterm Neonates Less than 1800 g: A Randomized Control Trial

Objective

To study the effect of oil massage on growth in preterm babies less than 1800 g.

Methods

This randomised controlled trial was conducted in Neonatal intensive care unit of a level II hospital. Neonates with birth weight?<?1800 g, gestation?<?35 wk and?<?48 h of age at enrolment were included in the studies. Eligible neonates were randomized to one of the two groups (a) Oil massage along with standard care of low birth weight (b) Standard care of low birth weight without massage. Weight, length and head circumference was measured in the two groups at 7 d intervals. Serum triglyceride levels were measured at enrolment and at completion of study. Primary outcome variable was weight gain at 28 d after enrolment.

Results

A total of forty-eight neonates were randomisd to either oil massage group (n?=?25) or standard care of low birth weight without massage group (n?=?23). Mean (SD) weight of babies in the two groups was 1466.4?±?226.8 g in oil massage group and 1416.6?±?229.9 g in the control group. At 28 d, weight gain in the oil massage group (476.76?±?47.9 g) was higher compared to the control group (334.96?±?46.4 g) (p?<?0.05). At 7 d, less weight loss (7.80?±?9.8 g) was observed in babies in oil massage group compared to control group (21.52?±?19.4 g) (p?=?0.003). However, there was no significant difference in serum triglycerides and other anthropometric parameters.

Conclusions

Oil application has a potential to improve weight gain and cause less weight loss in first 7 d in low birth weight neonates     

Estimation of radiation dose and risk to children undergoing cardiac catheterization for the treatment of a congenital heart disease using Monte Carlo simulations

Background

Children diagnosed with congenital heart disease often undergo cardiac catheterization for their treatment, which involves the use of ionizing radiation and therefore a risk of radiation-induced cancer.

Objective

The purpose of this study was to calculate the effective and equivalent organ doses (H_T) in those children and estimate the risk of exposure-induced death.

Materials and methods

Fifty-three children were divided into three groups: atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). In all procedures, the exposure conditions and the dose-area product meters readings were recorded for each individual acquisition. Monte Carlo simulations were run using the PCXMC 2.0 code and mathematical phantoms simulating a child's anatomy. The H_T values to all irradiated organs and the resulting E and risk of exposure-induced death values were calculated.

Results

The average dose-area product values were, respectively, 40?±?12 Gy·cm² for the ASD, 17.5?±?0.7 Gy·cm² for the VSD and 9.5?±?1 Gy·cm² for the PDA group. The average E values were 40?±?12, 22?±?2.5 and 17?±?3.6 mSv for ASD, VSD and PDA groups, respectively. The respective estimated risk of exposure-induced death values per procedure were 0.109, 0.106 and 0.067%.

Conclusion

Cardiac catheterizations in children involve a considerable risk for radiation-induced cancer that has to be further reduced.     

Fat-Soluble Antioxidant Vitamins,Iron Overload and Chronic Malnutrition in β-Thalassemia Major

Objective

To assess the antioxidant vitamins A (retinol) and E (α-tocopherol) levels, iron status and growth retardation in children with β-thalassemia major in Odisha, an eastern state of India.

Methods

Forty three children aged 1–15 y diagnosed with β-thalassemia major (28 males and 15 females) and 42 age-matched healthy controls (22 males and 20 females) were studied. β-thalassemia was detected by using Bio-rad variant assay. Measurement of blood hemoglobin (Hb), hematocrit, serum vitamins (A and E) and ferritin was carried out by standard methods.

Results

Mean hemoglobin (6.60?±?1.84 vs. 11.8?±?2.29 g/dL, p?<?0.01), serum retinol (28.0?±?17.67 vs. 54.4?±?36.56 μg/dL, p?<?0.001) and α-tocopherol (0.2?±?0.34 vs. 1.1?±?0.82 mg/dL, p?<?0.001) were significantly lower in children with thalassemia compared with control group, however, serum ferritin (storage iron) was elevated in thalassemia patients (553.7?±?176.80 vs. 57.3?±?40.73 ng/mL, p?<?0.001). Vitamin E had significantly correlated with hemoglobin and hematocrit values in the patients. Growth retardation in terms of stunting (79 % vs. 24 %, p?<?0.0001) and thinness (32.6 % vs. 9.5 %, p?<?0.05) was significantly higher in thalassemic children compared with normal children.

Conclusions

This study shows that children with β-thalas-semia major are in a state of oxidative stress of hyperfer-ritinemia with deprived antioxidant vitamins (A and E) and poor growth status suggesting a possible need for reduction in iron overload and additional antioxidant supplementation.     

Computed tomography measurements of the normal and the pathologic cochlea in children

Background

Radiological investigation is frequently undertaken to assess the aetiology of sensorineural hearing loss (SNHL).

Objective

To establish the CT measurements of the normal cochlea in children and to determine radiological criteria correlated with SNHL.

Materials and methods

A retrospective study of temporal bone CT performed in 159 children, age range from 3 days to 16 years between February 1999 and July 2004. A control group (n?=?88) comprised children without SNHL; the SNHL group comprised 71 children. The width of the second turn of the cochlea (CW), the cochlear height (CH), and the width of the bony canal for the cochlear nerve (WCN) were measured on a reference plane containing the modiolus, the posterior semicircular canal, the footplate, and the stapes arch.

Results

Width of the canal measurements ≤1.7 mm or ≥2.5 mm supported the diagnosis of SNHL with a specificity of 97% and 91%, respectively. Cochlear width was found to be significantly smaller in the SNHL group (5.61?±?0.51 mm) than in the control group (5.75?±?0.31 mm, P?<?0.02), a size <5.4 mm being highly suggestive of SNHL with a specificity of 90%. No significant variations of all measurements were found with age.

Conclusion

Appropriate measurements of WCN and CW are highly correlated with SNHL.     

Hyperbilirubinemia in Healthy Newborns Born to Immigrant Mothers from Southeastern Asia Compared to Italian Ones

Objective

To compare the characteristics of jaundice and hyperbilirubinemia in the newborn population of both immigrant and Italian mothers.

Methods

The authors studied a group of 1,680 infants born at “A. Gemelli” hospital during 1 y. All were with appropriate weight for gestational age, weighting more than 2,500 g, born to low-risk pregnancy. Maternal ethnicity, clinically evident jaundice (that is total serum bilirubin (TSB)?>?7 mg/dL), hyperbilirubinemia (TSB?>?12 mg/dL), the duration of hospital stay and their need of phototherapy were evaluated.

Results

In infants born to Asian mothers, hyperbilirubinemia was significantly more frequent (48.8 % vs. 26.5 %, p?=?0.003) and they reached mean TSB peak significantly later (86.5?±?38.5 vs. 74.5?±?20.6 h, P?=?0.0001) compared with Italian infants. The average length of hospitalization of infants of Asian and Latin American mothers is significantly longer compared to Italian newborns (4.5?±?1.9 vs. 3.6?±?1.1, p <0.0001 and 4.2?±?1.6 vs. 3.6?±?1.1, p?=?0.0004). With regard to the use of phototherapy, and to its duration, there are no significant differences between the populations studied.

Conclusions

Having studied all infants at low risk, the greater length of hospitalization is due to later peak and the higher frequency of jaundice in newborns of immigrant mother, especially in Asia. Therefore, as it happens to the Italian newborns, it would be desirable to build forecasting nomograms in these populations, to reduce the length of hospitalization and facilitate protected discharge.     

Pediatric chest CT at 70 kVp: a feasibility study in 129 children

Background

Before introducing 70-kVp settings in the low-kilovoltage strategies for pediatric examinations, it was mandatory to demonstrate, at similar dose levels, an equivalence of image quality at 70 kVp and 80 kVp.

Objective

To assess image quality of chest CT examinations acquired at 70 kVp in comparison with standard scanning at 80 kVp.

Materials and methods

We prospectively evaluated 129 children with a 70-kVp scanning protocol (group 1). All scanning parameters were kept similar to those usually selected for pediatric standard 80-kVp protocols, except the milliamperage increased by a factor of 1.6 to maintain comparable radiation dose. Image quality of group 1 examinations was compared to that of a paired population scanned at 80 kVp (group 2). The noninferiority hypothesis was fixed at 10% of the mean level of image noise.

Results

There was no significant difference in the mean dose length product (DLP) and the volume computed tomography dose index (CTDI_vol) between the groups (DLP: 20.5?±?5.8 mGy.cm [group 1] vs. 19.7?±?7.6 mGy.cm [group 2]; P?=?0.06) (CTDI_vol: 0.8?±?0.1 mGy [group 1] vs. 0.8?±?0.18 mGy [group 2]; P?=?0.94). The mean of differences in image noise between group 1 and group 2 examinations was ?1.38 (?2.59; ?0.18), verifying the noninferiority hypothesis. Subjective image quality did not significantly differ between group 1 and group 2 examinations (P?=?0.18).

Conclusion

At equivalent radiation dose levels, 70-kVp protocols provide similar image quality to that achievable at 80 kVp.     

Prevalence and Predictors of Decreased Glomerular Filtration Rate in Tibetan Children with Congenital Heart Disease

Objectives

To assess the prevalence of decreased glomerular filtration rate (GFR) in Tibetan children with congenital heart disease (CHD) and its associated risk factors.

Methods

A total of 207 Tibetan children attending authors’ center for treatment of CHD from May 2012 through November 2012, were included in the study. GFR was estimated with the Schwartz formula (eGFR).

Results

The mean eGFR was 104.3?±?16.6 mL/min/1.73 m², and decreased in 21 children (10.1 %). In the cyanotic category, eGFR was decreased only in severely cyanotic individuals. In the acyanotic category with left ventricular overload, children with decreased eGFR were younger, more commonly lived in areas above 4,700 m, and had higher left ventricular internal dimensions indexed by body surface areas (LVID/BSA) (53.8?±?6.9 vs. 40.1?±?6.8 mm/m², P?P?P?2 (sensitivity: 75.0 %, specificity: 93.9 %). In the remaining category, decreased eGFR was only observed in those living above 4,700 m.

Conclusions

One tenth of Tibetan children with CHD had decreased eGFR. The risk factors included severe cyanosis, younger age, living above 4,700 m and higher LVID/BSA.     

Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major

Objective

To evaluate the changes in the LV systolic and diastolic function in children with beta-thalassemia major (β-TM) using pulsed wave tissue doppler (TD) echocardiography.

Methods

Clinical, conventional echo doppler and pulsed wave tissue doppler imaging parameters were compared in 40 beta-thalassemia major patients (mean age, 6.52?±?3.5 y) and 25 age and sex matched normal subjects (mean age, 6.5?±?2.7 y).

Results

There were no significant statistical differences between mean fractional shortening (FS) and ejection fraction (EF) of left ventricle (LV) of the patients and control group. Children with beta-thalassemia had significantly lower E′ wave velocities measured at the left ventricular septal annulus (8.1?±?3.3 vs. 13?±?2.5, P?<?0.001), lateral margin of the mitral annulus (9.1?±?5.4 vs. 13.3?±?2.5, P?<?0.001) and lateral margin of the tricuspid annulus (9.3?±?3.9 vs. 13.3?±?2.5, P?<?0.001) when compared to the control group. Furthermore children with beta-thalassemia had significantly lower E′/A′ wave ratio at the left ventricular septal annulus (0.76?±?0.34 vs. 1.36?±?0.23), lateral margin of the mitral annulus (0.83?±?0.17 vs. 1.28?±?0.22), and lateral margin of the tricuspid annulus ((0.90?±?0.27 vs. 1.26?±?0.23, (P?<?0.05) when compared to the control group.

Conclusions

This study showed that patients with beta-thalassemia major and normal conventional echo doppler parameters had statistically significant changes detected by pulsed wave tissue doppler imaging.     

Clinical Profile of Pediatric Patients with Long QT Syndrome Masquerading as Seizures

Objective

To study the clinical profile of patients with long QT syndrome presenting as seizures.

Methods

Retrospective analysis of six pediatric patients admitted at authors’ institute between October 2008 and January 2013 with seizures and a presumptive diagnosis of long QT syndrome (LQTS) was done. The diagnosis was made on the basis of updated Schwartz diagnostic criteria. Clinical data, investigation profile and follow up of patients was recorded in a standard format and analysed.

Results

All the 6 patients in the study were boys with a mean age of 10.3?±?2.8 y at the time of diagnosis. The lag period between symptom onset and diagnosis was 5.6?±?3.14 y. All patients had history of seizures with a history of precipitating event in 4 patients. Average baseline QTc interval was 556?±?41.31 ms. Mean Schwartz score was 6.66?±?1.16. Polymorphic VT was documented in 4 patients. After initiating standard treatment with betablockers, nicorandil, spironolactone or pacemaker, all the six patients were asymptomatic at a mean follow up period of 17.5 mo, with no recurrence of seizures.

Conclusions

LQTS can cause seizures due to prolonged ventricular arrhythmias in high risk subgroup. Children, who present with LQTS and seizures, generally have a precipitating event causing seizures, and they respond well to drug therapy.     

Serum Fructosamine and Retinopathy of Prematurity

Objective

To determine whether serum fructosamine which is a good marker for detecting hyperglycemia during the previous 2 to 3 wk in infants could predict the development of retinopathy of prematurity in very low birth weight infants.

Methods

One hundred sixty seven premature infants who had a birth weight of <1500 g and a gestational age of less than 32 wk were investigated in the present study. Blood glucose was measured at the bedside and infants were recorded as hyperglycemic if their mean blood glucose levels were higher than 150 mg/dL. Serum corrected fructosamine level was obtained from the cord blood at birth and after the first month of life. The infants’ eyes were examined by ophthalmologists to detect retinopathy of prematurity at the gestational age of 32 wk or at four wk after birth, whichever came first.

Results

Corrected fructosamine was 319.6?±?59.6 and 272.8?±?50.6 mmol/l for group1 on 1^st and 30^th day respectively; 320?±?61.7 and 268.2?±?47.3 mmol/l for groups 2?+?3 on 1^st and 30^th day respectively which did not differ between groups (p?=?0.766 and p?=?0.665), whereas duration of hyperglycemia was 1.69?±?1.1 day in group 1 compared with 3.05?±?2.4 day in groups 2?+?3 which was significantly different (p?=?0.019). The multivariate regression analysis indicated that the duration of hyperglycemia in days was significantly correlated with the development of retinopathy of prematurity (OR 3.26; 95% CI 1.09–9.80; p?=?0.035).

Conclusions

Although the duration of hyperglycemia may contribute to the development of retinopathy of prematurity, serum corrected fructosamine does not have a good predictive value in developing retinopathy of prematurity in very-low-birth-weight (VLBW) infants.     

Implications of non-accidental trauma on resource utilization and outcomes

Purpose

The purpose was to compare the resource utilization and outcomes between patients with suspected (SUSP) and confirmed (CONF) non-accidental trauma (NAT).

Methods

The institutional trauma registry was reviewed for patients aged 0–18 years presenting from 2007 to 2012 with a diagnosis of suspicion for NAT. Patients with suspected and confirmed NAT were compared.

Results

There were 281 patients included. CONF presented with a higher heart rate (142?±?27 vs 128?±?23 bpm, p?<?0.01), lower systolic blood pressure (100?±?18 vs 105?±?16 mm Hg, p?=?0.03), and higher Injury Severity Score (15?±?11 vs 9?±?5, p?<?0.01). SUSP received fewer consultations (1.6?±?0.7 vs 2.4?±?1.1, 95% CI ? 0.58 to ? 0.09, p?<?0.01) and had a shorter length of stay (1.6?±?1.3 vs 7.8?±?9.8 days, 95% CI ? 4.58 to ? 0.72, p?<?0.01). SUSP were more often discharged home (OR 94.22, 95% CI: 21.26–417.476, p?<?0.01). CONF had a higher mortality rate (8.2 vs 0%, p?<?0.01).

Conclusions

Patients with confirmed NAT present with more severe injuries and require more hospital resources compared to patients in whom NAT is suspected and ruled out.

     

Evaluation of carotid intima-media thickness, a marker of subclinical atherosclerosis, in children with cerebral palsy

Background

Respiratory and cardiovascular diseases are the most common causes of death in children with cerebral palsy.

Objective

To evaluate sonographic carotid intima-media thickness, an early marker of atherosclerosis, in children with cerebral palsy and in healthy controls.

Materials and methods

One hundred children with cerebral palsy (65 boys), mean age 6.2 (SD, 2.1) years, and 35 age-matched and sex-matched healthy controls were included. Common carotid artery intima-media thickness was measured sonographically. Differences between patients and controls were evaluated with an independent samples t-test.

Results

Age, sex distribution and levels of serum lipids were comparable between patients and controls. Average, right and left carotid artery intima-media were thicker in patients compared with controls (mean ± SD, 0.61?±?0.13 mm vs 0.40?±?0.03 mm; 0.61?±?0.14 mm vs 0.40?±?0.03 mm; 0.61?±?0.13 mm vs 0.40?±?0.03 mm, respectively; all P?Conclusion Carotid intima-media is sonographically thicker in children with cerebral palsy compared with healthy controls, which may express an increased risk of atherosclerotic diseases.     

Etiological Evaluation of Adolescents with Primary Amenorrhea

Objectives

To determine causes of amenorrhea in adolescents with primary amenorrhea and to emphasize general approach to primary amenorrhea.

Methods

Thirty-nine patients, evaluated between January 2007 and May 2011, were divided into normogonadotropic hypogonadism, hypergonadotropic hypogonadism and hypogonadotropic hypogonadism groups. Means of age, height, weight, body mass index and standard deviation scores, gonadotropin levels, and accompanying diseases were evaluated.

Results

Mean values of age, height, height standard deviation score, weight and, weight standard deviation score were 15.54?±?1.52 y. 152.0?±?1.1 cm, ?1.37?±?1.3, 48.2?±?14.3 kg, 0.96?±?1.75, respectively. There were no statistical significances in the auxological parameters. Patients were distributed as 18 cases (46.1 %) with normogonadotropic hypogonadism, 12 cases (30.8 %) with hypergonadotropic hypogonadism, 9 cases (23.1 %) with hypogonadotropic hypogonadism. In the group of normogonadotropic hypogonadism, there were 6 patients with chronic diseases, 5 patients with insulin resistance, 4 patients with prolactinomas, 3 patients with müllerian agenesis. Of the hypergonadotropic hypogonadic patients, 3 were idiopathic primary ovarian failure, 3 were 46,XY disorders of sex development, 2 were Turner syndrome, 2 were ovarian insufficiency due to drug, one was 17 alpha-hydroxylase deficiency and one was autoimmune oophoritis. The group of hypogonadotropic hypogonadism included 5 patients with normosmic hypogonadism, 2 patients with constitutional delay of growth and puberty, 1 patient with panhypopituitarism and 1 patient with anosmic hypogonadism.

Conclusions

Chronic diseases, prolactinoma, and insulin resistance may lead to hypogonadism without altering gonadotropin levels. Turner syndrome, primary ovarian failure, and autoimmune oophoritis should be investigated in cases with hypergonadotropic hypogonadism. 46, XY disorders of sex development also should be elucidated. Constitutional delay of growth and puberty should be distinguished from isolated hypogonadotropic hypogonadism.     

Evaluation of knowledge-based reconstruction for magnetic resonance volumetry of the right ventricle in tetralogy of Fallot

Background

Cardiac magnetic resonance using the Simpson method is the gold standard for right ventricular volumetry. However, this method is time-consuming and not without sources of error. Knowledge-based reconstruction is a novel post-processing approach that reconstructs the right ventricular endocardial shape based on anatomical landmarks and a database of various right ventricular configurations.

Objective

To assess the feasibility, accuracy and labor intensity of knowledge-based reconstruction in repaired tetralogy of Fallot (TOF).

Materials and methods

The short-axis cine cardiac MR datasets of 35 children and young adults (mean age 14.4?±?2.5 years) after TOF repair were studied using both knowledge-based reconstruction and the Simpson method. Intraobserver, interobserver and inter-method variability were assessed using Bland-Altman analyses.

Results

Knowledge-based reconstruction was feasible and highly accurate as compared to the Simpson method. Intra- and inter-method variability for knowledge-based reconstruction measurements showed good agreement. Volumetric assessment using knowledge-based reconstruction was faster when compared with the Simpson method (10.9?±?2.0 vs. 7.1?±?2.4 min, P?Conclusion In patients with repaired tetralogy of Fallot, knowledge-based reconstruction is a feasible, accurate and reproducible method for measuring right ventricular volumes and ejection fraction. The post-processing time of right ventricular volumetry using knowledge-based reconstruction was significantly shorter when compared with the routine Simpson method.     

Treatment of Iron Deficiency Anemia in Children: A Comparative Study of Ferrous Ascorbate and Colloidal Iron

Objective

To compare the efficacy of ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia in children.

Methods

Eighty one children, aged 6 mo to 12 y, were screened for iron deficiency anemia (IDA) and those diagnosed with IDA were randomized to receive ferrous ascorbate or colloidal iron for a period of 12 wk, such that each child received elemental iron 3 mg/kg body weight/d. Increase in hemoglobin (Hb) level was the primary outcome measure. Assessment was performed at baseline, wk 4, wk 8 and wk 12.

Results

Of 81 children screened, 73 were included in the study. The mean rise in Hb at the end of the 12 wk was significantly higher in ferrous ascorbate group than the colloidal iron group [3.59?±?1.67 g/dl vs. 2.43?±?1.73 g/dl; P?<?0.01]. Significantly higher proportion of children receiving ferrous ascorbate (64.86 % vs. 31.03 %; P?<?0.01) became non-anemic in comparison to colloidal iron.

Conclusions

Ferrous ascorbate provides a significantly higher rise in hemoglobin levels in comparison to colloidal iron. The study supports the use of ferrous ascorbate in the pediatric age group, providing evidence for its role as an efficient oral iron supplement in the treatment of iron deficiency anemia.