Journal of Pediatric Biochemistry - Volume 3, issue 2

Authors: Sedky, Karim | Nazir, Racha | Carvalho, Karen S. | Lippmann, Steven

Article Type: Research Article

Abstract: Children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) and/or sleep disordered breathing (SDB) may present with similar symptoms, including inattention, irritability, and hyperactivity. SDB is under-diagnosed in young people and is not often recognized in patients with ADHD; we hypothesize that treating sleep disordered breathing in ADHD patients may diminish symptoms and reduce ADHD-focused pharmacotherapy. A Medline search was performed using the criteria for ADHD and SDB. English language publications …through January, 2012 were surveyed. Correlation between these two disorders is confounded due to methodological errors in research. The investigations lack consistency due to studies with small sample size, a dearth of diagnostic polysomnography (PSG) to detect SDB, varying definitions for the apnea/hypopnea index, and lack of uniform evaluations to diagnose ADHD. Despite methodological inconsistencies, the data suggests that treating SDB may have a productive impact on treatment outcomes in children with mild ADHD. Patients with ADHD symptomatology should receive SDB screening. In those with comorbid SDB and ADHD, an adenotonsillectomy (AT) may improve the prognosis. Treatment of SDB coexisting with ADHD aims to decrease clinical symptoms, reduce pharmacotherapy, and promote better health. Show more

Keywords: Attention deficit hyperactivity disorder, ADHD, sleep disordered breathing, SDB, obstructive sleep apnea, OSA

DOI: 10.3233/JPB-130075

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 61-67, 2013

Authors: Vitaliti, Giovanna | Lanzafame, Angela | Di Dio and, Giovanna | La Rosa, Mario

Article Type: Research Article

Abstract: The term "Allergy" actually includes a variety of different diseases (rhinitis, conjunctivitis, asthma, urticaria, and dermatitis) with a common pathological basis linked to the release of chemical mediators such as histamine, platelet-activating factor, arachidonic acid metabolites, and chemotactic factors secreted by mastocytes, basophils, and eosinophils. The key-role of leukotrienes (LTs) as mediators in allergic and inflammatory response justifies possible therapeutic use of leukotriene antagonists in other allergic diseases beyond asthma. LTs modifiers …reduce asthma symptoms, short-acting beta2-antagonist (SABA) use, and asthma exacerbations, and improve all indexes of pulmonary function, as measured by the increases in forced expiratory flow at one second (FEV1), peak expiratory flow (PEF), quality of life, and indices of bronchial inflammation (blood eosinophils, inflammatory cells in the bronchial mucosa, exhaled nitric oxide, substance P, neurokinin A, eosinophil cationic protein, and serum myeloperoxidase). Anti-LTs have also been successfully used by some authors to control allergic diseases such as rhinitis, atopic dermatitis, chronic urticaria and allergic conjuncitivitis. Moreover, recently, new reports have been published concerning other conditions (migraine prophylaxis, sleep disorders, inflammatory bowel disease, and nasal polyposis) that broaden the future range of clinical applications. Topical ocular montelukast can be a potential therapeutic drug with a new route of administration that can be used for treatment of allergic conjunctivitis. Show more

Keywords: Antileukotriene drugs, children, atopic diseases

DOI: 10.3233/JPB-130076

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 69-78, 2013

Authors: Chiabi, Andreas | Mbuagbaw, Lawrence | Monebenimp, Francisca | Obadeyi, Bolaji | Bissohong, Grace | Obama, Marie-Thérèse

Article Type: Research Article

Abstract: C-reactive protein (CRP) is a biological marker currently used in the diagnosis of several infectious diseases. It has been widely used in the diagnosis and follow-up of treatment in neonatal sepsis. With the recent development of newer diagnostic markers, especially procalcitonin (PCT) that are more specific and sensitive though more expensive, the role of CRP requires appraisal. We sought to re-examine its use in low resource settings that carry the highest burden and mortality from neonatal …sepsis. We argue that it is easy to perform, cost-effective and is still a valuable tool for making quick decisions in the diagnosis and management of neonatal sepsis, despite new emerging biological markers. Show more

Keywords: C-reactive protein, procalcitonin, neonatal sepsis, diagnosis, low resource settings

DOI: 10.3233/JPB-130077

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 79-83, 2013

Authors: Watanabe, Toru

Article Type: Research Article

Abstract: Kawasaki disease (KD) is an acute febrile vasculitis that predominantly affects children ⩽ 5 years of age. The cause of KD remains unknown, but it is thought that the immune system is activated by an infectious trigger in a genetically susceptible host. Because KD is systemic vasculitis, multiple organ involvement can develop, including hyponatremia. Hyponatremia is common in patients with KD, occurring in 29%–70% of patients. Although hyponatremia is usually mild and asymptomatic …in nearly all patients with KD, profound hyponatremia contributes to the development of central nervous system dysfunction in some patients. KD patients with hyponatremia have clinical and laboratory findings that are consistent with severe inflammation, including higher C-reactive protein levels and an increased incidence of coronary artery lesions. While the pathogenesis underlying the development of hyponatremia in KD is incompletely understood, several possible mechanisms have been proposed, including hypovolemic hyponatremia, the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ingestion of fluid that is hypo-osmolar relative to the fluid loss. Hypovolemic hyponatremia may be caused by gastrointestinal loss of fluid and sodium, and renal loss of fluid and sodium secondary to renal parenchymal injury and/or cytokine-induced renal tubular dysfunction. SIADH occurs in approximately 40% of KD patients with hyponatremia and may be a major cause of hyponatremia in KD. Although the pathogenesis underlying the development of SIADH in patients with KD is unclear, cerebral vasculitis or ADH secretion stimulated by cytokines, including interleukin (IL)-1β and IL-6, may contribute to the development of SIADH in patients with KD. Show more

Keywords: Kawasaki disease, hypovolemic hyponatremia, renal salt wasting, syndrome of inappropriate secretion of antidiuretic hormone, cytokine, pathogenesis

DOI: 10.3233/JPB-130078

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 85-91, 2013

Authors: Lanzafame, Angela | Parisi, Giuseppe | Di Dio, Giovanna | La Rosa, Mario

Article Type: Research Article

Abstract: Specific sublingual immunotherapy (SLIT) represents an approach currently available to redirect inappropriate immune response in atopic patients. Since oral mucosal tissue displays high affinity for allergens, it is conceivable that the sublingual administration route might induce immunological tolerance towards allergens involving cells and mediators specific of oral and intestinal mucosa. The presence in oral mucosa of dendritic cells (DCs) which express the high-affinity receptor for immunoglobulin (Ig)E (FceRI) seems to suggest that …the generation of T regulatory cells in periphery is orchestrated by a particular subset of DCs. It seems that repeated stimulation of naïve CD4 T cells with allogenic immature DCs induce Tr1 cell maturation. Nevertheless, other cells are involved in this process, such as Toll Like Receptors (TLR), Major Histocompatibility Complex I and II (MHC I and II) and costimulatory molecules, such as CD40, CD 80/B7.1 and CD 86/B7.2. An increase of serum IgG4 and IgA, a reduced number of inflammatory cells infiltrating target organs, as well as a reduction of eosinophilic cationic protein and a T cell suppression in the peripheral blood also occur with SLIT. All these molecules orchestrate the immune network within the regional immune system, recreating a favourable environment for the induction of tolerance operated by SLIT. Show more

Keywords: Oral mucosa, dendritic cells, Sublingual immunotherapy (SLIT), Immunological tolerance

DOI: 10.3233/JPB-130079

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 93-97, 2013

Authors: Schulpis, Kleopatra H. | Gioni, Vassiliki | Platis, Dimitris | Kalogerakou, Maria | Karikas, George A. | Afordakou, Despoina | Papassotiriou, Ioannis

Article Type: Research Article

Abstract: Replacement of natural protein intake, low total antioxidant status (TAS) and DNA oxidation and high phenylalanine (Phe) blood levels are implicated with poorly controlled patients with PKU. In this study we aimed to investigate the effect of diet on the main Protein Energy Wasting (PEW) along with other metabolic parameters in patients with phenylketonuria (PKU). Twenty-four poorly controlled patients (group A) and thirty patients who strictly adhered to their diet (group B) as well as controls …(n=50) underwent laboratory tests: complete blood count, concentrations of ferritin, lipid, lipoprotein, TAS, as well as Phe levels with appropriate methodology. Phe levels differed significantly among the groups. Lipids lipoproteins, except HDL, were higher in group A than those measured in group B and controls. TG was not higher in any group. TAS (386 ± 30 vs 204 ± 23 μmol/L, p < 0.001), ferritin (65 ± 12 vs 52 ± 10 μg/L, p < 0.01) were significantly higher in group B. In contrast, White Blood Cell count (WBC) (6.1 ± 1.0 vs 8.3 ± 1.2 × 10^3 /μL, p < 0.01), the absolute number (1.9 ± 0.6 vs 2.9 ± 0.7 × 10^3 /μL, p < 0.001) and percentage of lymphocytes (18.5 ± 3.0 vs 39.3 ± 4.0%, p < 0.01) were lower in group A than those in group B, whereas total protein and albumin levels were similar among the groups. Most main PEW biomarkers, the low WBC, the low absolute and percentage of lymphocytes in poorly controlled patients may be directly and/or indirectly affected by their high Phe levels and/or low TAS levels in children with PKU on "loose diet". Show more

Keywords: PKU, diet, biomarkers, phenylalanine, oxidation, PEW

DOI: 10.3233/JPB-130080

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 99-106, 2013

Authors: Sharma, Pradeep K. | Yadav, Sangeeta | Marwaha, Raman K.

Article Type: Research Article

Abstract: Adolescence is a critical time for peak bone mass accrual. During puberty the skeletal growth results in the process of bone modeling, remodeling and longitudinal growth which leads to considerable changes in the levels of bone formation and resorption markers. The study was aimed to analyze the levels of bone markers, bone density and their relation to puberty amongst our population. Eighty four healthy boys with a mean age of 14.36+1.97 years (range 11–18 yrs) were …evaluated. The bone metabolism markers measured by ELISA were serum osteocalcin (BGP), bone-specific alkaline phosphatase (BALP), carboxyterminal propeptide of type I collagen (CICP), deoxypyridinoline (DPD). Bone density at forearm and calcaneum were measured by Dual Energy X-ray Absorptiometry. Bone formation and resorption markers were raised during all stages of puberty, peaking at stage 3 and declining gradually from stages 4 and 5 onwards whereas the mean bone density continued to increase even beyond stage 3 of puberty. We observed a positive correlation between age, height and weight and bone density. Significant inverse correlations were seen between bone formation markers and bone density at both sites. No correlation was observed between bone density and bone resorption markers. During puberty bone mineral density increases significantly. Though significant positive correlation was observed between age, height and weight, bone density, age and weight remain the best predictors of bone mineral density at distal forearm and calcaneum. Show more

Keywords: Bone markers, bone mineral density, puberty, dual energy X-ray absorptiometry (DXA)

DOI: 10.3233/JPB-130081

Citation: Journal of Pediatric Biochemistry, vol. 3, no. 2, pp. 107-112, 2013