Disorders In Pediatric Population Research Articles

Eating disorders in pediatric population, analysis of some of the most common risk factors

Introduction: This article reviews a number of studies that have sought to determine what are risk factors that may cause eating disorders in the pediatric population, taking into account the age and gender of the subjects. This study focuses on issues related to purging, bulimic behaviors, and psychological orthorexia and what impact the most common risk factors for these behaviors have in the pediatric population. Aim of study: The aim of the study is to present a comprehensive review of some of the most common risk factors predisposing to the development of eating disorders in the pediatric population, and how these factors have a direct impact on each other and are intertwined, by using available knowledge, paying particular attention to a new potential risk factor - social media. Materials and methods: Materials used in this study were found in the PubMed database, using the following keywords: ,,Social media”, ,,Mass media”, ,,Peers”, ,,Family”, ,,Orthorexia nervosa”, ,,Social media”, ,,Children”, ,,Adolescence”. Conclusion: Eating disorders are a growing problem. Our research focuses on potential risk factors, with the greatest emphasis on a relatively new risk factor: social media and screen time, and how these two factors influence young minds, what impact they have on the eating habits of children and adolescents, and what can be done to prevent eating disorders in the pediatric population.

Endoscopic retrograde cholangiopancreatography in pancreatic disorders in pediatric population: Experience from tertiary referral centre in western India

Endoscopic retrograde cholangiopancreatography in pancreatic disorders in pediatric population: Experience from tertiary referral centre in western India

Allergy and autoimmunity in children: non-mutually exclusive diseases. A narrative review.

In last decades a simultaneous increase in the prevalence of atopic and autoimmune disorders in pediatric population has been observed. Despite the Th1-Th2 paradigm, supporting the polarization of the immune system with Th1 response involved in autoimmune diseases and Th2 response leading to hypersensitivity reactions, recent evidence suggests a possible coexistence of common pathogenic pathways as result of shared immune dysregulation. Similar genes and other mechanisms such as epithelial barrier damage, gut microbiota dysbiosis and reduced number of T regs and IL-10 contribute to the onset of allergy and autoimmunity. IgA deficiency is also hypothesized to be the crosslink between celiac disease and allergy by lowering gut mucous membrane protection from antigens and allergens. The present narrative review aims to give an overview of the co-occurrence of allergic and autoimmune disorders (celiac disease, inflammatory bowel diseases, type 1 diabetes mellitus, thyroid disease, juvenile idiopathic arthritis) in pediatric population, based on the available evidence. We also highlighted the common pathogenic pathways that may underpin both. Our findings confirm that allergic and autoimmune diseases are commonly associated, and clinicians should therefore be aware of the possible coexistence of these conditions in order to ameliorate disease management and patient care. Particular attention should be paid to the association between atopic dermatitis or asthma and celiac disease or type 1 diabetes and vice versa, for therapeutic interventions. Further studies are needed to better clarify mechanisms involved in the pathogenesis and eventually identify new therapeutic strategies.

The relationship between functional constipation and overweight/obesity in children: a systematic review and meta-analysis.

Studies have reported the relationship between functional constipation and obesity in pediatric population. However, the results are contradictory. The purpose of this study is to evaluate the possible association between these two disorders in pediatric population. Four databases including PubMed, Embase, CENTRAL, and Web of Science were searched until 30 September 2022. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD42022328992) RESULTS: Nine studies met the eligibility criteria, including 7444 participants. Studies showed the risk of obesity was significantly increased in boys with functional constipation (CI: 1.12, 3.07; P = 0.016). Such an association was also observed in girls (CI: 1.42-4.47; P = 0.00). A statistically significant association was observed between overweight/obesity and increased risk of functional constipation in children and adolescents (CI: 1.14-3.97; P = 0.02). Especially in developed countries (CI: 1.49-3.46; P = 0.00); however, no significant association was observed in developing countries (CI: 0.81-5.3; P = 0.13). There is a risk of obesity in either boys or girls with functional constipation. An association exists between the risk of functional constipation and children/adolescents with obesity, especially in developed countries, but not in developing countries. Our study encourages further research in this field because early detection and intervention are crucial for both functional constipation and overweight/obesity in children, to better identify its complex biology and possibly optimize the treatment approaches.

Pediatric Cholelithiasis Single Center Experience Results of the Clinic for Pediatric Surgery kcu Sarajevo in Period 2010.-2022

Introduction: Cholelithiasis is occurance of one or several gallstones in the gallbladder. It can be complicated with choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. Causes for this disorder in pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, sickle cell anemia) or non hemolytic - other hereditary disorders as cystic fybrosis, Wilson's disease or ileum disordes, total parenteral nutrition, usage of certain medicaments, choledochal cysts, organ transplantation and, in adolescency, those similar to adult patients (obesity). Mostly gallstones found in children are cholesterol ones or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and its complications (as choledocholithiasis that requires ERCP). There is also some differential dyagnoses that should be taken in consideration before the tretment (billary dyskinesion, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts as well as pediatric pyelonephritis). First line of treatment of cholelithiasis is with diet, saline infusions and medicaments and if cholelithiasis is symptomatic and/or complicated then cholecystectomy is recomended. Having in mind operative approach it can be open procedure of laparascopic one. Some study show that injuries of bile ducts are more common in laparascopic tretment of pediatric cholelithiasis but nevertheless it is shown that with experienced team and good preparation this is the golden standard in the treatment of pediatric cholelithiasis. Objectives. Hereby we present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in pediatric population. Methods: Between 2010. and 2022, retrospectively, we explored data points of children who underwent laparoscopic cholecystectomy reviewed with included demographics properties, indication for cholecystectomy, used surgical technique, operative time, complications, and length of hospital stay. We performed 37 laparoscopic cholecystectomies (due to cholelithiasis and one case of cholecystitis without calculi) with 2 conversions to open procedures and via open approach we treated 3 cholecystes in this period. Male to female distribution was: 12 male patients and 25 female patients Results: Thirty-seven children (12 male patients and 25 female patients with ages ranging from 7 to 18 years, mean: 11,9 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic cholelithiasis in almost all patients. The surgery was performed under general anesthesia and classical 4-port approach was done in twenty-two patients, and 2-port approach in combination with 2 portless 2.3-mm percutaneous graspers was used in two patients. The operating time ranged between 45 and 120 minutes (mean: 77 minutes). Two patients were treated by open surgery. Only one patient had leakage due to choledocholithiasis, and open surgery and ERCP had to be performed. Median of hospital stay for all patients was 3-4 days. Conclusion: Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adult series.

The Role of Intranasal Corticosteroid Therapy in Pediatric Adenoidal Hypertrophy: A Randomized Clinical Trial Study

Background: Adenoidal hypertrophy (AH) is a common disorder in pediatric population with severe complications due to nasal air way obstruction. Adenoidectomy is a choice treatment for children with severe symptoms due to AH; however, it is accompanied by several side effects such as complication of surgery and emotional distress. We evaluated the efficacy of intranasal corticosteroid therapy in size and symptoms of Adenoid Hypertrophy especially in atopic patients.
 Methods: In this clinical trial 45 children aged 2 to 14 years old with AH were enrolled. All of them underwent 8-week course of intranasal Fluticasone therapy and their symptoms before and after treatment were scored and compared by questionnaires. Also they were divided into Atopic and non- Atopic groups based on history, physical examination and positive skin prick test. Then the two groups were compared after the treatment according to their response to therapy.
 Results: After 8 weeks’ treatment with intranasal corticosteroid, improvement in all symptoms score of AH including (Snoring, Sleep Apnea, Mouth breathing and Nasal congestion) was statistically significant (P = 0.000). The improvement in clinical symptoms of AH after treatment was observed in 92% of atopic patients in comparison with non-atopic patients was 50%, which was also statistically significant (P = 0.024).
 Conclusion: Our study demonstrated that 8-week intranasal corticosteroid was associated with a decrease in size of AH and all symptoms of obstruction. As a result, it can be suggested that intranasal corticosteroid therapy can prevent adenoidectomy especially in atopic patients.

The DIAMOND-KID: Psychometric Properties of a Structured Diagnostic Interview for DSM-5 Anxiety, Mood, and Obsessive-Compulsive and Related Disorders in Children and Adolescents.

The objective of the present study was to examine the reliability and validity of a new semi-structured interview for pediatric psychiatric disorders, which is needed as existing interviews do not cover the full range of anxiety, mood, and obsessive-compulsive disorder (OCD)-related disorders. Three hundred eleven child patients (aged 10-17) were administered the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders-Child and Adolescent Version (DIAMOND-KID). Of these, 65 provided interrater reliability data and 59 provided test-retest reliability data. Participants also completed self-report measures that assessed symptoms of anxiety, mood, and OCD and related disorders. Although parents/guardians could participate in the interview at the clinician's discretion, most of the initial interviews and all of the reliability interviews were based on the child's self-report. Test-retest reliability ranged from very good to excellent. Interrater reliability was more variable, with estimates for generalized anxiety disorder and major depressive disorder in the questionable range; the other interrater reliability estimates ranged from good to very good. Convergent validity was established by significant between-group comparisons on applicable self-report measures for all diagnoses. The results of the present study indicate that the DIAMOND-KID is a promising semi-structured diagnostic interview for 5th edition of the Diagnostic and Statistical Manual of Mental Disorders in pediatric populations.

SMALL ROUND CELL TUMORS PRESENTING AS ORBITAL PROPTOSIS IN CHILDREN WITH BONE MARROW INVOLVEMENT: A STUDY OF HAEMATO- MORPHOLOGICAL FEATURE.

Introduction: Childhood proptosis is an interesting clinical presentation of underlying hematological and non-hematological disorders. Malignant proptosis is most commonly caused by retinoblastoma, rhabdomyosarcoma, leukemia/lymphomas and other metastatic tumors such as neuroblastoma. Bone marrow examination is a commonly used diagnostic and staging modality in the evaluation of hematological and non- hematological disorders in pediatric population. Patients with proptosis present with subtle changes in hemogram which point towards metastatic or hematologic etiology and hence a detailed hematologic work-up is mandatory. A descriptive cross-sectional study wasAim/objective: conducted to study the clinical, hematological and pathological data of interesting pediatric malignancies presenting as orbital proptosis with or without bone marrow involvement at the time of diagnosis from July 2020 to June 2021. All cases of orbital proptosis presenting withMethods: cytopenias referred for bone marrow examination were included in the study. Primary diagnosis of was made on histopathology/ne needle aspiration cytology combined with clinico-radiological features. Bone marrow procedure was done from posterior superior iliac spine. The informed consents were taken from the patients in the vernacular language after explaining the procedures. All procedures performed in the current study were approved by Institutional ethical committee. Aspirate smears and biopsy sections were stained by May-Grunwald-Giemsa and Hematoxylin and eosin respectively as per standard protocols. Special stains Myeloperoxidase (MPO), Alcin blue, PAS (perioidic acid and Schiff) and reticulin were performed when required. Samples were also processed for molecular genetics studies in acute leukaemias. The descriptive analysis of the data was done, and the results were presented as mean, frequencies, and percentages. Results: Of total 20 cases presenting as orbital-proptosis, only 11 cases showed bone marrow involvement as acute myeloid leukemia (45%) and as a metastatic site (55%). The most common cause of bilateral orbital proptosis was metastatic malignancies followed by acute myeloid leukaemias. Anaemia and thrombocytopenia were signicantly (p<0.05) associated with marrow inltration. The present analysis showedConclusion: different types of pattern bone marrow inltration had prognostic implications. Pancytopenias/bicytopeinias were most commonly seen in association with solid malignancies. Acute leukaemias presented with leukocytosis along with reduction in red cells and megakaryocytic lineages. Some cases primary diagnosis was initially made from bone marrow examination only. The present study highlights the signicance of bone marrow examination in patients with proptosis wherein subtle changes in hemogram point toward metastatic or hematologic etiology.

Benign anorectal disease in children: What do we know?

Benign anorectal disease refers to a diverse group of frequent anorectal complaints that cause considerable discomfort, disability, and often constitute a significant problem for the child and his or her family. Hemorrhoids, fissures, rectal prolapse, and perianal abscess and fistulas are the most common anorectal disorders in pediatric population and their appearance may be age-specific. Although they generally follow a benign course, a careful examination must be performed in order to exclude other serious and complicated underlying pathology. Their diagnosis is based on the patient's medical history, physical examination, endoscopy, and imaging. Moreover, the management of these disorders includes medical and surgical treatment options, and if they are treated promptly and properly may be limited and short lived. This review presents the currently available data in the literature on the diverse aspects of these disorders, including the definition, epidemiology, clinical presentation, pathogenesis, diagnosis, indications for surgery, and long-term outcomes.

A New Treatment Option for Children With Refractory Chronic Paroxysmal Hemicranias: Occipital Nerve Stimulation

Chronic paroxysmal hemicrania (CPH) is a rare primary headache disorder in pediatric population: 32 cases are described. 1 Evers S. Summ O. Frese A. Very young age of onset in trigemino-autonomic cephalalgias - case report and review of the literature. Cephalalgia. 2020; 40: 1385-1388 Crossref Scopus (3) Google Scholar , 2 Mauritz M.D. Enninger A. Wamsler C. Wager J. Zernikow B. Long-term outcome of indomethacin treatment in pediatric patients with paroxysmal hemicrania-a case series. Children (Basel). 2021; 8: 101 Google Scholar , 3 Ishii R. Fukazawa R. Takezawa H. Fujii A. Case report: shortest course of pediatric paroxysmal hemicrania. Headache. 2019; 59: 1084-1087 Crossref Scopus (4) Google Scholar It responds to indomethacin, but one-third of patients have dose-limiting side effects and one-fifth have to discontinue owing to drug intolerability. More than two-third of patients suffer from a chronic form. Occipital nerve stimulation (ONS) could be considered as alternative in medically refractory chronic primary headache. 4 Martelletti P. Jensen R.H. Antal A. et al. Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain. 2013; 14: 86 Crossref PubMed Scopus (140) Google Scholar ,5 Lambru G. Matharu M.S. Occipital nerve stimulation in primary headache syndromes. Ther Adv Neurol Disord. 2012; 5: 57-67 Crossref PubMed Scopus (28) Google Scholar The first adult case has been published in 2017. 6 Miller S. Lagrata S. Watkins L. Matharu M. Occipital nerve stimulation for medically refractory chronic paroxysmal hemicrania. Headache. 2017; 57: 1610-1613 Crossref Scopus (9) Google Scholar We describe the first pediatric patient with CPH to undergo ONS.

Genetic and acquired blistering disorders of pediatric age group: An experience from Eastern India.

Blistering or vesiculobullous disorders in pediatric population are either immunobullous or mechanobullous. Spectrum was analyzed using demographic details, clinical features, histopathology, direct immunofluorescence (DIF) and Immunofluorescence mapping (IFM). This was a single institution based observational study in children below 18 years. The demographic details were collected using proforma containing particulars of the patient, history, complaints, and other parameters. Punch biopsy of the skin lesion was done. Biopsy samples were examined under light microscope followed by DIF using fluorescent conjugated polyclonal antibody against immunoglobulins IgG, IgM, IgA, and complement C3. The salt-split technique was also used in particular cases. IFM was done using anticytokeratin (CK) 5 & 14, antilaminin 332, anticollagen VII, and anticollagen IV antibodies. Out of total 50 cases, linear IgA bullous dermatosis (LABD) was the commonest. The average concordance between clinical and final diagnosis (histopathological examination + DIF) was 87.5% and discordance was 12.5%. The agreement between histopathological examination and DIF was found to be substantially significant (κ = 0.6892). IFM depicted epidermolysis bullosa simplex with reduced CK 14 expression, dystrophic epidermolysis bullosa with reduced Collagen VII expression and junctional epidermolysis bullosa with absent laminin 5 expression. The spectrum of bullous lesions in childhood was properly delineated and subcategorization of EB was done. Histopathological examination showed the hallmarks that were conclusive in most of the cases except in LABD and EB. DIF and IFM proved indispensable in those cases. Thus, DIF is not a substitute for histopathology but complementary to it.

Urinary tract infection in nephrotic syndrome in pediatric age group: a hospital based cross-sectional study

Background: Nephrotic syndrome, characterized by the presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population. Aim of this study were to find out the prevalence of Urinary Tract Infection (UTI) in nephrotic syndrome, bacterial etiologies and antibiotic sensitivity pattern.Methods: After matching the criteria, 82 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture. This is an institution based cross-sectional descriptive observational study. All newly diagnosed and relapse cases of nephrotic syndrome based on inclusion exclusion criteria was included in this study. Respondent was either of the parents or caregiver of the study subjects. Analysis of all data was done by appropriate statistical software (SPSS-23).Results: Among 82 participants evaluated with nephrotic syndrome 29.3% participants had UTI, majority 66.7% were asymptomatic and 33.3% were symptomatic. Significant microscopic hematuria were found in 20.7% study subjects and significant pyuria were found in 58.54% study subjects. Majority of UTI caused by E.coli 33.3% followed by Klebsiella 25%, Proteus 16.7%, Staphylococcus aureus 12.5%, Citrobacter, Acinetobacter and mixed growth were found in 4.2% each. Mean serum cholesterol of group with UTI was 422.13±34.65 and group without UTI was 307.43±26.13. The variation amongst the two groups were found to be significant (p=0.0001).Conclusions: The children with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic, often undiagnosed. Higher serum cholesterol level may predispose the nephrotic child for UTI.

Indications and Complications of Flexible Fiberoptic Bronchoscopy in Children: A 5-Year Experience at a Tertiary Care Hospital in Iran

Background: Flexible fiberoptic bronchoscopy (FFB) is known as an important diagnostic and therapeutic modality in the evaluation of respiratory disorders in pediatric population. Objectives: The study aims to highlight common indications and risk of complications associated with bronchoscopy in our population. Methods: This retrospective evaluation was performed in all patients that underwent flexible bronchoscopy at Children's Medical Center (affiliated to Tehran University of Medical Sciences) between April 2011 and September 2016. Results: Of 800 bronchoscopies, 574 (71.7%) were performed for diagnostic and 226 (28.2%) for therapeutic purposes. Major indications included radiographic abnormalities (30%), a foreign body or suspected foreign body (28.5% of all FFBs) and stridor or wheezing (25% of all FBB). The incidence of major complications associated with FFBs was 0.87%. The most frequent complication was pneumothorax, followed by lung hemorrhage, and respiratory failure. Conclusions: Our findings support early intervention and utilization of bronchoscopy in the pediatric population with variable respiratory complaints.

Physical growth and body adiposity patterns in children and adolescents at high altitudes in Peru: Proposed percentiles for assessment.

This study's purpose was to compare physical growth (PG) patterns of children and adolescents living at high elevations with those of other geographic regions, relate body adiposity indicators, and develop percentile reference tables for assessing physical growth and body adiposity. The sample included 1536 children and adolescents ages 5.0 to 17.9 years from Puno (Peru) located between 3821 and 4349 m above sea level. Weight, height, arm and waist circumferences (WC), and three skinfolds measurements were recorded. Body mass index (BMI) and waist-height Index (WHI) were calculated. PG patterns for children living at a high altitude reflected similar values for weight, height, and arm circumference (AC) to those of their counterparts living in Puno (Peru) and La Paz (Bolivia). When compared with children living at moderate altitudes in Peru, they showed slightly lower PG values. BMI explained between 41% and 64% of the variance in sum of the skinfolds, while WC explained between 47% and 66%. HWI was not a strong predictor of variation in sum of skinfolds. Percentiles were generated for WC and the sum of skinfolds. Weight, height, and, arm and waist circumference patterns for children and adolescents living at high altitudes were similar to those of La Paz (Bolivia). WC and the sum of the skinfolds were better indicators for analyzing abdominal obesity compared to BMI and WHI. The percentiles proposed may be a useful tool for identifying high risk of developing overweight disorders in pediatric populations living at high altitudes.

Prevalence of Lower Extremities’ Postural Deformities in Overweight and Normal Weight School Children

Background: The increasing trend of both obesity and postural disorders in pediatric population. Objectives: We aimed to determine the prevalence of lower extremities' postural disorders among school children in Qom province, Iran. Methods: In this cross-sectional study, a representative sample of schoolchildren aged 6 - 7 years was selected by multi-stage clustering method from all urban and rural regions of Qom province. Presence of postural deformities of lower limbs, including genu valgum, genu varum and flat foot were evaluated and recorded. Prevalences of deformities in different categories of weight status (underweight, normal and overweight) were compared. Results: Out of 20000 school children 1450 students were randomly selected. Genu valgum, genu varum and flat foot was present in 256 (17.7%), 351 (24.2%) and 194 (13.38%) of studied population. 1021 (70.41%), 161 (11.1%) and 268 (18.48%) students were normal weight, underweight and overweight/obese, respectively. Prevalence of flat foot and genu valgum was significantly higher in obese/overweight students (P < 0.01). Mean of skin fold thickness was significantly higher in students with genu valgum (P < 0.001). A significant relation existed only between occurrence of lower limb postural deformities and body mass index [OR = 1.89, CI (95%) = 1.18 - 3.03]. Conclusions: The findings of this study indicate that prevalence of genu valgum and flat foot are higher in overweight/obese children. In addition to early diagnosis and timely treatment of the deformities, developing and validation of a multidisciplinary care for obese and overweight children to reduce the occurrence of obesity related musculoskeletal complications is of importance.

Pierwotna małopłytkowość immunologiczna u dzieci

In this article we present current investigation on primary immune thrombocytopenia in children. There are described pathomorphology, clinical symptoms, diagnosis and treatment. We also present current data from literature about genetic tests and latest data on treating options in children. Primary immune thrombocytopenia (ITP) is one of the most frequent hematological disorders in pediatric population. Although the majority of children have a self-limited and short duration of the disease. However, approximately 20-30% of those patients can develop chronic ITP, which can cause significant complications and higher mortality and reduced quality of life. Especially regarding to long-term immunosupression or surgical interventions, such like splenectomy and restrictions on daily activities to avoid trauma. Over the past decades a lot of informations has been reported about pathogenic features of ITP. Nowdays, we know that it is not only caused by increased platet destruction and decreased platet production, but also complex, multifactorial immune dysregulation, like loss of immune tolerance and generation of platelet autoantibodies. In this article we present current investigation on ITP including clinical symptoms, diagnosis, pathomorphology and latests options on treatment in children. We also present current data about genetic biomarker, such as Vanin-1 (VNN-1) which has been suggested as one of predictors of chronic disease and potentially can offer early prognosis estimation.

Predictors and Moderators of Antipsychotic-Related Weight Gain in the Treatment of Early-Onset Schizophrenia Spectrum Disorders Study.

Antipsychotic-related weight gain is a common clinically relevant side effect when treating psychotic disorders in pediatric populations, yet few predictors and no moderators of antipsychotic-related weight gain are known. The Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study randomized 119 youths (age 8-19 years) with schizophrenia or schizoaffective disorder to 8 weeks of antipsychotic treatment with molindone, risperidone, or olanzapine and assessed treatment response and side effects. In this secondary analysis, we used multivariable linear regression and receiver operating characteristic analysis to investigate predictors and moderators of weight change and percent weight change from baseline to week 8. Treatment assignment was the most discriminant predictor of weight change [F(2, 66) = 17.00, p < 0.001] and percent weight change [F(2, 66) = 16.85, p < 0.001]. Mean weight gain was 0.74 (standard deviation ±3.51) kg for molindone, 4.13 ± 3.79 kg for risperidone, and 7.29 ± 3.44 kg for olanzapine. After adjusting for treatment assignment, lower pretreatment hemoglobin A1C (HgbA1C) predicted more weight gain [F(1, 55) = 4.71, p = 0.03]. Diagnosis (schizoaffective vs. schizophrenia) moderated weight change [F(2, 63) = 6.02, p = 0.004] and percent weight change [F(2, 63) = 5.26, p = 0.008] such that schizoaffective diagnosis predicted larger weight gain for youths in the risperidone treatment arm. Age, sex, family income, baseline weight, and symptoms neither predicted nor moderated weight change or percent weight change. We identified prognostic subgroups and novel risk factors for antipsychotic-related weight gain. We confirmed that antipsychotic choice is extremely important for predicting future weight gain. We also found that younger age did not predict greater weight gain, in contrast to prior studies. Our findings require replication in an independent sample because we did not adjust for multiple comparisons to minimize false negatives. ClinicalTrials.gov Identifier: NCT00053703.

The Impact of Prolonged, Selective, Serotonin Reuptake Inhibitor Treatment on Serum Lipid and Glucose Levels in Children and Adolescents: A Preliminary Prospective Study.

Treatment with selective serotonin reuptake inhibitors (SSRIs) is common and is considered safe and effective in the treatment of anxiety and depressive disorders in pediatric populations. SSRI administration, however, is associated with adverse metabolic effects. The aim of this preliminary study was to evaluate the possible influence of a 6-month SSRI treatment on metabolic parameters in children and adolescents with depressive and/or anxiety disorders. Metabolic parameters (glucose, cholesterol, triglycerides, low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) were monitored in 22 children and adolescents (16 boys and 6 girls, aged 8-18 years) at baseline and after 6 months of SSRI treatment for depression and/or anxiety. Six months of SSRI treatment did not affect serum glucose, cholesterol, or triglycerides significantly, but a tendency (p = 0.06) toward elevation in serum LDL accompanied by a parallel reduction in HDL levels was detected. It appears that the 6-month SSRI treatment is metabolically safe in children and adolescents and does not affect the glucose or lipid profile. Long-term large-scale studies in pediatric populations focusing on the possible impact of long-term SSRI treatment (>6 months) on metabolic parameters are warranted.

Sleep: important considerations for the prevention of cardiovascular disease.

Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities. Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.

Autoimmune Hemolytic Anemia in Children: Mayo Clinic Experience.

We studied 35 pediatric patients with autoimmune hemolytic anemia seen at Mayo Clinic from 1994 to 2014. The median age was 10.0 years and 65.7% were males. Most had warm antibodies (80.0%) and some secondary to viral (14.3%) or autoimmune disorders (31.4%). Seven (20.0%) patients presented with Evans syndrome, 3 of whom also had common variable immunodeficiency. The median hemoglobin at diagnosis was 6.1 g/dL and 62.8% patients required red cell transfusions. The severity of anemia was worse among children below 10 years (median 5.5 vs. 7.0 g/dL, P=0.01). Steroid was the initial treatment for 88.5% patients, with overall response rate of 82.7% (68.5% complete, 14.2% partial) and median response duration of 10.7 months (range, 0.2 to 129.7+ mo). After median follow-up of 26.6 months, 8 (22.8%) patients relapsed. Salvage treatments included splenectomy, intravenous immunoglobulin, rituximab, and mycophenolate mofetil. Infectious complications occurred in 9 (25.7%) patients and 1 patient died of cytomegalovirus infection. Four patients had cold agglutinin disease and 3 (75.0%) responded to steroids. Autoimmune hemolytic anemia is a rare disorder in pediatric population and most respond well to steroids regardless of the type of antibody. Infectious complications are common and screening for immunodeficiency is recommended among those with Evans syndrome.