Nicotine and cotinine levels in pericardial fluid in victims of SIDS

Milerad J, Rajs J, Gidlund E. Nicotine and cotinine levels in pericardial fluid in victims of SIDS. Acta Paediatr 1994;83:59–62. Stockholm. ISSN 0803–5253
We have analyzed the levels of nicotine and cotinine in pericardial fluid in 24 consecutively autopsied cases of sudden unexpected death in infants aged one to six months. Our aim was to determine to what extent victims of sudden infant death may have been exposed to passive smoking near the time of death. Sixteen of the decreased infants were classified as SIDS at autopsy. Other contributing causes of death, predominantly infections, were found in eight cases. Eight infants (30%) had cotinine levels less than 2 ng, indicating that no significant exposure to nicotine had occurred near the time of death. Of the remaining 70%, five had been moderately exposed, seven markedly exposed and four heavily exposed (cotinine levels 2–10 ng, 10–50 ng and more than 50 ng, respectively). Since only 18% of Swedish women smoke after childbearing we conclude that nicotine exposure in infants who died suddenly was much higher than one would otherwise expect. It is hypothesized that high concentrations of nicotine and nicotine metabolites around the heart may affect cardiac function and thus play a role in the mechanisms causing SIDS or other categories of sudden unexpected death.     

Use of nicotine replacement therapy in adolescent smokers and nonsmokers

BACKGROUND: Assessing whether and how adolescents use nicotine replacement therapy (NRT) will be important given recent recommendations to make NRT more accessible by lowering its price, increasing its distribution, and advising health care professionals to suggest its use for smoking cessation. OBJECTIVES: To report the prevalence, ease of access, and reasons for NRT use and describe inappropriate use in adolescent smokers and nonsmokers. DESIGN: Cross-sectional survey of 4078 high school students during the school term of 1998. SETTING: City schools in Memphis, Tenn. MAIN OUTCOME MEASURES: Community-based self-reported prevalence of NRT use and characteristics of those using NRT. RESULTS: Approximately 5% of adolescents reported trying or using nicotine gum or patches. Females were less likely than males and African Americans were less likely than others to use NRT. For African American smokers, NRT use was highest at lower smoking levels, while other smokers showed the opposite pattern. Almost 40% of former smokers reported using NRT to try to quit smoking; however, 75% of current smokers endorsed using NRT for reasons other than trying to quit smoking. Other inappropriate use of NRT was reported; 18% of NRT users reported themselves as never smokers. More than 50% of students reported that it would be easy for them to get NRT. CONCLUSIONS: Nicotine replacement therapy is used by adolescent smokers and nonsmokers, is easily accessible, and is used for reasons other than trying to quit smoking. Efforts are needed to discourage NRT use in nonsmoking youth and to encourage appropriate use of NRT in young smokers to maximize its potential for successful cessation.     

Nicotine and cotinine concentrations in the milk of smoking mothers: influence of cigarette consumption and diurnal variation

The relationship between nicotine and cotinine concentrations in mother's milk (including 24 h profiles) and the number of cigarettes consumed was studied. A total of 206 milk samples were collected from 34 nursing, smoking mothers. The mothers were distributed into three groups: Group I (1–10 cigarettes/day), group II (11–20 cigarettes/day) and group III (21–40 cigarettes/day). Milk samples from all nursing periods of a 24 h interval were collected. Nicotine and cotinine concentrations were measured by specific gas chromatographic techniques.The average milk nicotine and cotinine concentrations over a 24 h interval in the three groups were as follows: group I, 18±16 and 76±33 ng/ml; group II, 28±21 and 125±60 ng/ml; group III, 48±25 and 230±62 ng/ml (means ± SD).Over a time interval of 24 h the nicotine concentrations varied greatly in the milk of smoking mothers, while the cotinine concentrations remained relatively constant. Because of the great intra- and inter-individual variations in the nicotine concentrations, the influence of the number of cigarettes smoked on the nicotine concentration in milk was most apparent if nicotine concentrations were measured repeatedly over a prolonged time interval. Our results indicate that the exposure of the nursed infant to nicotine and cotinine via milk depends on the daily cigarette consumption but also on individual smoking habits; the time of smoking, smoking frequency prior to nursing, and the time interval between nursing and the last cigarette.     

Propranolol therapy of infantile hemangiomas: efficacy, adverse effects, and recurrence

Objective

To evaluate the efficacy, adverse effects, and recurrence of oral propranolol for treatment of infantile hemangioma.

Methods

Participants were treated with oral propranolol three times daily, with inpatient monitoring of adverse effects. The starting dosage was 2 mg/kg per day, which had been for the remaining duration of treatment. Therapy duration was planned for 4–6 months; if there was significant relapse, the period of treatment was extended. A photograph based severity scoring assessment was performed by three observers to evaluate efficacy by visual analog scale (VAS).

Results

Sixty-one infants [median age 3.3 (1.2–8.1) months] were included in the study. The median follow-up-time was 15 (6–20) months and 53 patients completed treatment at a median age of 10.3 (8.4–18.1) months, after a duration of 8.5 (4.5–14) months. In all patients, there was significant fading of color [with a VAS of ?9 (?6 to ?9) after 6 months] and significant decrease in size of the infantile hemangiomas [with a VAS of ?8 (?3 to ?10) after 6 months]. We did not observe any life-threatening adverse effects. The therapy was interrupted due to temporary aggravation of pre-existing bronchial asthma in one child. Four cases presented partial recurrences.

Conclusions

Oral propranolol 2 mg/kg per day was a well-tolerated and effective treatment, mild adverse effects, and low recurrence for infantile hemangiomas. Propranolol should now be used as a first-line treatment in hemangiomas when intervention is required. Also, prospective studies should be needed in determining the most effective treatment dosage, optimum treatment duration, and exact mechanism of action of propranolol in future.     

Health‐related quality of life,treatment adherence,symptom experience and depression in adolescent renal transplant patients

Dobbels F, Decorte A, Roskams A, Van Damme‐Lombaerts R. Health‐related quality of life, treatment adherence, symptom experience and depression in adolescent renal transplant patients.
Pediatr Transplantation 2010:14:216–223. © 2009 John Wiley & Sons A/S. Abstract: Few studies comprehensively assessed psychological and behavioral functioning in adolescent kidney transplant patients. The purpose of this cross‐sectional study was to evaluate depression, QOL, treatment adherence and presence of side effects from the perspective of the patient and his parents, and to compare scores with norm data. All patients (age 10–18 yr) and their parents completed the following instruments: KIDSCREEN‐27 (QOL), a treatment adherence interview, the MTSOSD‐59R (side effects) and the Beck Depression Inventory (depression). Twenty‐three of 26 patients and 22 parents agreed to participate (70% male; median age 15 yr). Adolescents rated their QOL as satisfactory, but parents reported significant problems on several QOL dimensions. Depressive symptoms occurred in 17.4%, and 75% were non‐adherent with their immunosuppressive drugs (confirmed by their parents) and show other problematic health behavior, including smoking, illicit drug use, dietary non‐adherence, and suboptimal exercise levels. The most frequently occurring side effects were increased appetite, fatigue and headache; the most distressing ones were hair loss or thinning of hair, warts on hands or feet, and sores in the mouth or on the lips. Our results underscore the need for regular screening and adequate treatment of the above‐mentioned aspects.     

Transcutaneous oxygen and carbon dioxide levels and a clinical symptom scale for monitoring the acute asthmatic state in infants and young children

Measurement of transcutaneous PO2 and PCO2 in addition to a clinical symptom grading system was used to monitor the acute asthmatic attack in children under two years of age. tcPO2 was lowered already at signs of mild obstruction and decreased in parallel with clinical deterioration. tcPCO2 was almost unchanged at mild to moderate obstructive symptoms. With clinical deterioration tcPCO2 rose steadily. An increase of the oxygen concentration to 30-40% in the inspired air increased tcPO2, on the average by 70%, but did not change the tcPCO2, level. Continuous recording of tcPO2 and tcPCO2 as well as the clinical grading system are valuable tools when monitoring severely obstructive infants and young children.     

Age-related decrease in plasma levels of gastrin, cholecystokinin and somatostatin

Newborn babies have higher concentrations of gastrointestinal hormones than adults. The aim of the present study was to investigate the relationship between age and plasma levels of the three peptides gastrin, cholecystokinin and somatostatin in healthy children aged 1–15 years. Gastrin, cholecystokinin and somatostatin concentrations were twice as high at 1–2 years of age compared with children older than 10 years. Significant negative correlations between age and hormone concentrations were established. It is suggested that these age-dependent differences are related to the growth rate and relative energy consumption during the early years of life.     

Rationale for use of Tdap booster vaccines for adolescent immunization: overview of efficacy, safety, and clinical use

Pertussis is one of the only vaccine-preventable diseases with increasing incidence in the United States. The incidence of pertussis infection in adolescents is a growing concern; it can be a severe disease that may lead to significant morbidity and mortality when transmitted to susceptible populations (eg, infants). Experts have conceded that booster vaccination of adolescents may considerably decrease the incidence of pertussis infections in previously immunized, partially immunized, and nonimmunized populations. Studies in 2 tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccines licensed by the Food and Drug Administration (FDA) have shown efficacy against pertussis disease and have demonstrated a safety profile comparable to tetanus and diphtheria vaccine (Td) in adolescents. Immunization schedules now include use of Tdap vaccines for preadolescent and adolescent populations to counter the increase in pertussis outbreaks. Challenges for clinicians include prompt recognition of pertussis symptoms, proper diagnosis using appropriate tools, and timely reporting of pertussis infections to surveillance bodies. Additional studies are needed to monitor trends of pertussis incidence after implementing the new vaccination schedule for adolescents.     

Empty sella, growth hormone deficiency and pseudotumour cerebri: effect of initiation, withdrawal and resumption of growth hormone therapy

An 11- year-old boy with normal visus and eye fundus, but with empty sella, growth hormone (GH) deficiency and central diabetes insipidus was found to have intracranial hypertension with papilloedema after 6 months of catch-up growth under recombinant human GH (rhGH) replacement therapy. Withdrawal of rhGH therapy was associated with normalisation of intra‐cranial␣pressure within 1 week. Three months later, resumption of rhGH therapy at a lower dose was again followed by pronounced growth acceleration, but now without papilloedema. Conclusion Children with empty sella and GH deficiency may be prone to rhGH-induced pseudotumour cerebri which appears to be rapidly reversible and dose-dependent. Received: 4 August 1995 / 26 October 1995     

Empty sella, growth hormone deficiency and pseudotumour cerebri: effect of initiation, withdrawal and resumption of growth hormone therapy

An 11- year-old boy with normal visus and eye fundus, but with empty sella, growth hormone (GH) deficiency and central diabetes insipidus was found to have intracranial hypertension with papilloedema after 6 months of catch-up growth under recombinant human GH (rhGH) replacement therapy. Withdrawal of rhGH therapy was associated with normalisation of intra‐cranial?pressure within 1 week. Three months later, resumption of rhGH therapy at a lower dose was again followed by pronounced growth acceleration, but now without papilloedema. Conclusion?Children with empty sella and GH deficiency may be prone to rhGH-induced pseudotumour cerebri which appears to be rapidly reversible and dose-dependent.     

Developmental processes in early adolescence: relationships between adolescent adjustment problems and chronologic age, pubertal stage, and puberty-related serum hormone levels

Relations between adolescent psychosocial adjustment problems and markers of biologic development, including chronologic age, pubertal status, and serum hormone levels, were examined in 56 normal boys and 52 normal girls, ages 9 to 14 years. Adolescent psychosocial adjustment was assessed by adolescent self-ratings of various aspects of self-image (Offer Self-Image Questionnaire for Adolescents) and parent ratings of adolescent behavior problems (Child Behavior Checklist). The pubertal status measure used in the analyses was Tanner genital stage for boys and Tanner breast stage for girls. The hormone measures, determined by radioimmunoassay, were serum levels of gonadotropins (luteinizing hormone and follicle stimulating hormone), sex steroids (testosterone and estradiol), and adrenal androgens (dehydroepiandrosterone and its sulfate, and androstenedione). The testosterone/estradiol ratio also was computed. Overall, findings were stronger, more consistent, and more generalized for boys than for girls. For boys, adjustment problems typically were associated with a multivariate profile that may be characteristic for later maturers: relatively low sex steroid levels, or lower pubertal stage, and relatively high adrenal androgen (androstenedione) levels, frequently in conjunction with higher chronologic age. Univariate relations predominated for girls; that is, associated with adjustment problems for girls were relatively high levels of gonadotropins, relatively low levels of dehydroepiandrosterone sulfate, and relatively high levels of androstenedione on their own or in conjunction with lower pubertal stage. Higher levels of androstenedione, a steroid particularly responsive to stress, were associated with adjustment problems in both boys and girls. This relation may reflect the stress of later maturation, which could result from environmental factors, such as adolescent self-comparisons with same-age peers, or endogenous effects of hormones.