Effect of early corticosteroid therapy on development of Henoch-Schönlein nephritis

BACKGROUND: Henoch-Sch?nlein purpura (HSP) is a systemic, small vessel vasculitis, which is very common among pediatric population. Findings of previous reports addressing the preventive effect of corticosteroid treatment in HSP nephritis have been inconsistent. The aim of this study was to determine whether corticosteroid therapy was effective in preventing Henoch-Sch?nlein nephritis. METHODS: The medical records of 216 children with HSP, seen in 2 tertiary care pediatric nephrology centers, were reviewed retrospectively. The effect of corticosteroid therapy on preventing nephritis was assessed in 157 patients who had no evidence of nephritis at the initial urinalysis. The treatment group (n=61) had received oral corticosteroids for gastrointestinal symptoms and/or arthritis. The dosage of prednisone was 1 mg/kg per day for 1-2 weeks, with weaning over a week. We compared the rate of renal involvement during follow-up between the groups who were treated with corticosteroids and not. RESULTS: Nephritis developed in 17 of the 61 (27.8%) corticosteroid-treated patients and 18 of the 96 (18.7%) untreated patients during follow-up. CONCLUSION: There was no evidence that corticosteroids reduced the risk of renal involvement in HSP, and these results do not support the use of corticosteroids in early HSP to prevent renal injury.     

Effects of repeated administered ghrelin on chronic constriction injury of the sciatic nerve in rats

Chronic constriction injury (CCI) is a peripheral mononeuropathic pain model that is caused by an injury to the peripheral nervous system and refractory to available conventional treatment. Mechanisms involved in neuropathic pain are still unclear. Previous studies reveal that proinflammatory cytokines contribute to CCI-induced peripheral nerve pathology. Ghrelin, a novel identified gastric peptide, has been shown to have antinociceptive activity and also anti-inflammatory properties by decreasing proinflammatory cytokines. Therefore, the aim of the present study was to investigate the effects of ghrelin on the CCI and its relationship with proinflammatory cytokines in rats. Wistar rats underwent sciatic nerve ligation to induce CCI fallowed by repeated ghrelin administrations (50 and 100 μg/kg i.p., once daily) for a period of 14 days. Mechanical hyperalgesia was assessed before surgery and at day 14 after CCI. TNF-α, IL-1β and IL-6 were measured in blood and spinal cord. The changes of sciatic nerve was assessed histologically by both light and electron microscopy. Ghrelin attenuated mechanical hyperalgesia, reduced spinal TNF-α and IL-1β levels and enhanced sciatic nerve injury with correlated morphometric recovery. These results indicate that the protective effect by ghrelin in the spinal cord is mediated through the suppression of TNF-α and IL-1β. Thus ghrelin may be a promising peptide in the management of neuropathic pain.     

Autism in visually impaired individuals

The aim of the present study was to assess the prevalence and associated risk factors of autism in a sample of visually impaired children and adolescents. A total of 257 blind children and adolescents (age range: 7-18 years) were examined for autism using a three-stage process. The first stage estimated probable cases of autistic disorder based on the Autism Behavior Checklist and the second stage by direct observation of the subjects in different settings. In the third stage, subjects with the probable diagnosis of autistic disorder were asked to undergo psychiatric examination. A final diagnosis of autistic disorder (based on the criteria in DSM-IV) was given after interviewing the caregivers and clinical observation. Thirty of 257 subjects met the criteria for autistic disorder. Comparison of the characteristics of the two groups (autistic and non-autistic) with chi2-squared and independent sample t-tests revealed a statistically significant difference in terms of severity of blindness (P = 0.015), cerebral palsy (P = 0.02) and intellectual level (P = 0.001). The results of the present study suggest that subjects with blindness plus autism have greater neurological impairment (as suggested by the presence of lower intellectual level and cerebral palsy), and more severe visual impairment than the subjects with blindness only.     

Posttraumatic Stress Disorder in individuals with diagnosis of Autistic Spectrum Disorders

Although children and adolescents with developmental disabilities are said to have higher risks of abuse than those without, trauma and Posttraumatic Stress Disorder (PTSD) are little examined in those diagnosed with Autistic Spectrum Disorders (ASDs). Our study aims to assess trauma types, prevalence, risk factors and symptoms; and PTSD in individuals with diagnosis of ASD. Participants were 69 children and adolescents (53 males, 16 females) who were consecutively followed-up at our clinic and met DSM-IV criteria for ASD. Assessment was done using semi-structured interview forms. 18 had trauma history and 12 were diagnosed with PTSD. Witnessing or being a victim of accidents/disasters/violence was the most common type of trauma. Interestingly, the rate of sexual and/or physical abuse was less than in the general population. Trauma history and PTSD rates were higher in girls than boys. Deterioration in social and communicative abilities, increase in stereotypes, aggression, distractibility, sleep disorders, agitation, hyperactivity, self-injury, and loss of self-care skills were the most common symptoms detected following trauma. These results underscore the importance of detailed assessment of behavioral and emotional problems in this group by ruling out any trauma history at periods which might otherwise be misdiagnosed as an exacerbation of symptoms of ASD.