Fish oil supplementation improves left ventricular function in children with idiopathic dilated cardiomyopathy

Fish oil has a cardioprotective effect in adults with ischemic heart disease. The authors examined the effects of fish oil in children with idiopathic dilated cardiomyopathy (DCM). Eighteen DCM patients (group I) and 12 healthy children (group III) were given fish oil (10 mL/d). Their cardiac findings were compared with those of 11 patients with DCM who did not receive fish oil (group II). After 6.62+/-1.70 months, left ventricular ejection fraction had increased by 8.44%+/-3.80% (P<.05), in group I; 2.48%+/-3.85% (not statistically significant) in group II; and 0.84%+/-2.34% (not statistically significant) in group III. Left ventricular internal diastolic diameter (mm) was reduced by 4.36+/-4.86 (P=.001) in group I and 1.92+/-5.37 (P=.263) in group II, but increased by 0.22+/-2.54 (not statistically significant) in group III. The results suggest that fish oil leads to accelerated improvement of left ventricular function. The authors believe that if these results are confirmed in larger studies, fish oil should be added to the standard anticongestive therapy of children with DCM.     

Does red-man reaction stimulate macrophage activation syndrome in children with systemic juvenile idiopathic arthritis?

Macrophage activation syndrome (MAS) is a major cause of death in patients with systemic juvenile idiopathic arthritis (JIA). We describe 4 patients who developed MAS during or after vancomycin treatment. Vancomycin should be used with great care in patients with systemic JIA.     

The use of darbepoetin in infants with chronic renal impairment

Darbepoetin is a newer analogue of epoetin, with a longer half-life, that allows less frequent administration. There are currently no published data available for its use in infants. We report our experience with this drug in infants with chronic renal impairment, weighing less than 8 kg. Infants had baseline haemoglobin (Hb), iron, ferritin and transferrin levels measured. They were started on approximately 0.5 μg/kg per week of darbepoetin. Hb levels were checked every 2–4 weeks, and iron studies were performed every 4 weeks. Iron supplementation was prescribed to maintain ferritin levels >100 μg/l and transferrin saturation levels >20%. Follow up was for 20 weeks. Six infants with a mean weight of 4.08 kg and a mean creatinine of 259 μmol/l were included. Three infants were medically stable throughout the study, and the mean darbepoetin dose was decreased to 0.25 μg/kg per week. Their dosing interval was increased to every 3–4 weeks. The other three infants were less stable and had multiple medical problems, including periods of haemodialysis and surgery. These infants failed to reach target Hb level, despite an increase in the mean dose of darbepoetin to 1.2 μg/kg per week. In conclusion, darbepoetin can be successfully administered to infants with chronic renal insufficiency, but the dose needs to be tailored to each individual. Administration would be facilitated by smaller unidose syringes.     

Effect of At‐Home Whitening Strips on the Surface Roughness and Color of a Composite and an Ormocer Restorative Material

Purpose: Oxygenating agents like carbamide peroxide or H₂O₂ are commonly used whitening agents. They have varying influence on the color and surface roughness of resin‐based restorative materials and teeth. The aim of this study was to evaluate the effect of an at‐home peroxide whitening agent applied through a whitening strip on the color and surface roughness of a nanofilled composite resin and an ormocer‐based resin. Materials and Methods: Disc‐shaped (2 mm thick, 10 mm diameter) nanofilled resin composite (n = 10) and ormocer (n = 10) specimens were prepared. All specimens were treated with a whitening strip. Whitening procedures were performed applying a 6.5% hydrogen peroxide whitening strip (Crest White Strips Professional) for 30 minutes twice each day for a period of 21 consecutive days. During the test intervals, the specimens were rinsed under running distilled water for 1 minute to remove the whitening agents and immersed in 37°C distilled water until the next treatment. Surface roughness and color of the specimens were measured with a profilometer and a colorimeter, respectively, before and after whitening. Color changes were calculated (ΔE) using L*, a*, and b* coordinates. Repeated measures of variance analysis and Duncan test were used for statistical evaluation (α= 0.05). Results: The average surface roughness of composite increased from 1.4 Ra to 2.0 Ra, and from 0.8 Ra to 0.9 Ra for the ormocer material; however, these changes in roughness after whitening were not significant (p > 0.05). Also, when two materials were compared, the surface roughness of restorative materials was not different before and after whitening (p > 0.05). L* and b* values for each material changed significantly after whitening (p < 0.05). ΔE values (before/after whitening) calculated for composite (11.9) and ormocer (16.1) were not significantly different from each other (p > 0.05). Conclusions: The tested whitening agent did not affect the surface roughness of either resin‐based restorative material. Both materials became brighter after whitening. The behavior of the materials in the yellow/blue axis was opposite to each other after whitening. Each material had clinically unacceptable color change after whitening (ΔE > 5.5); however, the magnitude of the color change of materials was similar (p > 0.05). According to the results of this study, with the use of materials tested, patients should be advised that existing composite restorations may bleach along with the natural teeth, and replacement of these restorations after whitening may not be required.     

Disordered eating behaviors among Turkish adolescents with and without Type 1 diabetes

The aim of this comparative study was to determine the prevalence of disordered eating behaviors (DEBs) and its affecting factors among adolescents with Type 1 diabetes. Subjects were 45 diabetic adolescents and 55 nondiabetic healthy control subjects. The main outcome measures used were the Eating Attitudes Test and the Body Image Scale (BIS). Findings suggest that DEBs are almost four times as common in diabetic adolescents as in their nondiabetic peers (p < .001). Strict diet restriction and insulin misuse (p < .01) were related to DEBs. Disordered eating behaviors make a significant contribution to menstrual problems (p < .001) and poor metabolic control (p < .001). There was a nonsignificant negative correlation between DEBs and the BIS score. Health care professionals should be aware of the potential effect of subclinical and clinical DEBs including insulin misuse and strict diet in weight-conscious people with Type 1 diabetes who have poor metabolic control and menstrual problems.     

Quality of Life in Turkish Haemodialysis Patients

The aim of the study was to assess quality of life (QOL) in Turkish haemodialysis patients and to identify related socio-demographic and clinical variables. To measure QOL 100 patients completed SF-36 during regularly scheduled haemodialysis. We found that patients’ QOL was substantially impaired. Age was negatively related to physical components of QOL. Duration of haemodialysis was negatively correlated with most of QOL dimensions. EPO treatment, education on disease and haemodialysis, and compliance to prescribed diet had great positive effects on QOL. Among the factors we have found to be related with the QOL in this study, probably the most important were education on disease and haemodialysis, and compliance to prescribed diet, in which we have influence, as nurses, on improving the QOL in patients receiving haemodialysis. The priority of renal nursing services should therefore be addressed to provide support in these areas.     

ATLANTIC DIP: Pregnancy Outcome for Women With Pregestational Diabetes Along the Irish Atlantic Seaboard

OBJECTIVE

Prospective evaluation of pregnancy outcomes in pregestational diabetes along the Atlantic seaboard 2006–2007.

RESEARCH DESIGN AND METHODS

The Atlantic Diabetes in Pregnancy group, representing five antenatal centers in a wide geographical location, was established in 2005. All women with diabetes for >6 months before the index pregnancy were included. Results were collected electronically via the DIAMOND Diabetes Information System. Pregnancy outcome was compared with background rates.

RESULTS

There were 104 singleton pregnancies. The stillbirth rate (25/1,000) was 5 times, perinatal mortality rate (25/1,000) 3.5 times, and congenital malformation rate (24/1,000) 2 times that of the background population. A total of 28% of women received prepregnancy care, 43% received prepregnancy folic acid, and 51% achieved an A1C ≤7% at first antenatal visit.

CONCLUSIONS

Women are not well prepared for pregnancy, and outcomes are suboptimal. A regional prepregnancy care program and centralized glucose management are urgently needed.Robust information is lacking on pregnancy outcomes in women with diabetes in the Republic of Ireland. Along the Atlantic seaboard, there are five centers and 11,000 deliveries annually. A partnership occurred in 2005 with a focus on research, audit, clinical care, and professional and patient education (ATLANTIC DIP). This partnership is facilitating a number of projects, the results of which will shape future care. This report outlines the current position regarding pregnancy outcomes in women with established diabetes.