Imbalance In Children Research Articles

CD4+/CD8+ T lymphocytes imbalance in children with severe 2009 pandemic influenza A (H1N1) pneumonia

PurposeThis study was conducted to investigate the immune responses of children with moderate and severe novel influenza A virus (H1N1) pneumonia, and to compare their clinical and immunological findings with those of control subjects.MethodsThirty-two admitted patients with H1N1 pneumonia were enrolled in the study. The clinical profiles, humoral and cell-mediated immune responses of the 16 H1N1 pneumonia patients who were admitted to the pediatric intensive care unit (severe pneumonia group), 16 H1N1 pneumonia patients admitted to the pediatric general ward (moderate pneumonia group) and 13 control subjects (control group) were measured.ResultsTotal lymphocyte counts were significantly lower in patients with H1N1 pneumonia than in the control group (P=0.02). The number of CD4+ T lymphocytes was significantly lower in the severe pneumonia group (411.5±253.5/µL) than in the moderate pneumonia (644.9±291.1/µL, P=0.04) and control (902.5±461.2/µL, P=0.01) groups. However, the number of CD8+ T lymphocytes was significantly higher in the severe pneumonia group (684.2±420.8/µL) than in the moderate pneumonia (319.7±176.6/µL, P=0.02) and control (407.2±309.3/µL, P=0.03) groups. The CD4+/CD8+ T lymphocytes ratio was significantly lower in the severe pneumonia group (0.86±0.24) than in the moderate pneumonia (1.57±0.41, P=0.01) and control (1.61±0.49, P=0.01) groups. The serum levels of IgG, IgM and IgE were significantly higher in the severe pneumonia group than in the 2 other groups.ConclusionThe results of this study suggest that increased humoral immune responses and the differences in the CD4+ and CD8+ T lymphocyte profiles, and imbalance of their ratios may be related to the severity of H1N1 pneumonia in children.

Constitutional submicroscopic genome imbalances in children with both cancer and a congenital anomaly

Constitutional submicroscopic genome imbalances in children with both cancer and a congenital anomaly

Children's anthropomorphic and anthropocentric ideas about micro-organisms

Different views exist about whether anthropomorphic ideas assist or hinder learning in biology. This paper discusses the anthropomorphic and anthropocentric ideas children have about micro-organisms, and whether they affect their understanding. The research was carried out in primary and secondary schools in the South of England and involved 414 children aged 7,11 and 14 years. Three different research techniques were used to elicit their ideas. Anthropomorphic and anthropocentric ideas about micro-organisms are apparent in responses from all age groups. Anthropomorphic ideas seem to help children to explain their understanding of some aspects of micro-organisms but the imbalance in children's anthropocentric views of micro-organisms appears to prohibit them considering other aspects of micro-organisms; for example, the importance of their role in decomposition and cycling of matter, or their beneficial technological applications. The focus on the danger micro-organisms are thought to pose to human health creates a hostile view of micro-organisms and this may inhibit future learning.

Cardiac Autonomic Imbalance in Children with Allergic Rhinitis

The involvement of autonomic imbalance has been reported in the pathogenesis of hypersensitivity reactions. Allergic diseases are more frequent in children and some of predisposing factors may be changed according to the increasing age, but the involvement of autonomic imbalance has not been investigated in pediatric population. In this cross-sectional, case-control study, we evaluated the autonomic system by measuring heart rate variability (HRV) in pediatric patients with allergic rhinitis. Thirty-five pediatric patients with allergic rhinitis and 36 healthy children (mean age 11 +/- 2.7, and 12 +/- 3 years, respectively) were enrolled in the study. Age and gender were not different between the groups. The diagnosis of allergic rhinitis was based on the history, symptoms, and skin prick tests. Participants with acute infection, nasal polyposis, bronchial asthma, and any other medical problems, assessed by history, physical examination and routine laboratory tests, were excluded. Twenty-four hour ambulatory electrocardiographic recordings were obtained, and the time domain and frequency domain indices of HRV were analyzed. We found significant increase in calculated HRV variables in children with allergic rhinitis compared to controls, which reflect parasympathetic tones, such as number of R-R intervals exceeding 50 ms, root mean square of successive differences between normal sinus R-R intervals, the percentage of difference between adjacent normal R-R intervals, and high frequency. These results indicate that HRV is increased, which implies sympathetic withdrawal and parasympathetic predominance. We propose that autonomic imbalance may be involved in the pathophysiology of allergic rhinitis in pediatric patients.

Pediatric sleep apnea: Early onset of the ‘syndrome’?

Obstructive sleep apnea is a common disorder in childhood, particularly in the last decade when an increased prevalence of obesity has been documented. The neurocognitive and behavioral problems associated with this disorder have been known for a long time. However, the increased knowledge of cardiovascular and metabolic complications in adults with sleep apnea has been followed by a better understanding of the systemic effects of upper airway obstruction in children. Obstructive sleep apnea (OSA) has been shown to induce autonomic imbalance in children and to affect blood pressure, cerebral blood flow and cardiac function in an early phase. OSA may also induce chronic systemic inflammation and may contribute to the development of metabolic syndrome in obese children. Very recent research indicates that in children primary snoring, the mildest form of the sleep-disordered breathing spectrum, may also be associated with morbidity. It is, therefore, likely that these respiratory sleep disorders do not simply influence children's' performance in private and social life, but may more seriously affect children's' health. The aim of this review is to outline early systemic complications of obstructive sleep apnea and primary snoring in infants and children.

Recurrent CNVs Disrupt Three Candidate Genes in Schizophrenia Patients

Schizophrenia is a severe psychiatric disease with complex etiology, affecting approximately 1% of the general population. Most genetics studies so far have focused on disease association with common genetic variation, such as single-nucleotide polymorphisms (SNPs), but it has recently become apparent that large-scale genomic copy-number variants (CNVs) are involved in disease development as well. To assess the role of rare CNVs in schizophrenia, we screened 54 patients with deficit schizophrenia using Affymetrix's GeneChip 250K SNP arrays. We identified 90 CNVs in total, 77 of which have been reported previously in unaffected control cohorts. Among the genes disrupted by the remaining rare CNVs are MYT1L, CTNND2, NRXN1, and ASTN2, genes that play an important role in neuronal functioning but--except for NRXN1--have not been associated with schizophrenia before. We studied the occurrence of CNVs at these four loci in an additional cohort of 752 patients and 706 normal controls from The Netherlands. We identified eight additional CNVs, of which the four that affect coding sequences were found only in the patient cohort. Our study supports a role for rare CNVs in schizophrenia susceptibility and identifies at least three candidate genes for this complex disorder.

Validity of venous blood gas analysis for diagnosis of acid-base imbalance in children admitted to pediatric intensive care unit

Arterial blood gas (ABG) analysis is the major tool for proper diagnosis and treatment of acid-base imbalance, but the invasive nature of arterial puncture and its possible hazards such as arterial spasm have resulted in a worldwide trend toward less-invasive diagnostic methods including venous blood gas (VBG) analysis. This study aimed to evaluate the validity of VBG and its clinical agreement with ABG in the 10 most common diseases in pediatric intensive care unit (PICU), and to answer how far it can replace the ABG test. In a cross-sectional analytical study from September 2004 to September 2005, 200 patients in 10 disease categories received blood gas analysis. Results of blood-gas tests such as pH, PCO2 and HCO3 of both arterial and venous blood samples (simultaneously taken from each patient) were recorded and compared by statistical analysis (kappa statistics) to determine their validity and clinical agreement. In some diseases such as respiratory distress syndrome, neonatal sepsis, renal failure, pneumonia, diabetic ketoacidosis and status epilepticus, VBG analysis showed a good validity (high sensitivity and specificity) accompanied by a suitable clinical agreement (over 40%), but in other diseases such as neonatal seizure, shock, congestive heart failure and congenital heart disease, there was either an inappropriately low validity or a weak clinical agreement (under 20%). VBG can be used instead of ABG in some diseases such as respiratory distress syndrome, neonatal sepsis, renal failure, pneumonia, diabetic ketoacidosis and status epilepticus, but in other diseases such as neonatal seizure, shock, congestive heart failure and congenital heart diseases, ABG is preferable and must not be replaced by VBG. These results may be used for the formulation of future guidelines for PICU.

Coenzyme Q10 (Ubiquinol-10) Supplementation Improves Oxidative Imbalance in Children With Trisomy 21

Endogenous coenzyme Q10 is an essential cofactor in the mitochondrial respiratory chain, a potent antioxidant, and a potential biomarker for systemic oxidative status. Evidence of oxidative stress was reported in individuals with trisomy 21. In this study, 14 children with trisomy 21 had significantly increased (P < 0.0001) plasma ubiquinone-10 (the oxidized component of coenzyme Q10) compared with 12 age- and sex-matched healthy children (historical controls). Also, the mean ratio of ubiquinol-10 (the biochemically reduced component):total coenzyme Q10 was significantly decreased (P < 0.0001). After 3 months of ubiquinol-10 supplementation (10 mg/kg/day) to 10 patients with trisomy 21, the mean ubiquinol-10:total coenzyme Q10 ratio increased significantly (P < 0.0001) above baseline values, and 80% of individual ratios were within normal range. No significant or unexpected adverse effects were reported by participants. To our knowledge, this is the first study to indicate that the pro-oxidant state in plasma of children with trisomy 21, as assessed by ubiquinol-10:total coenzyme Q10 ratio, may be normalized with ubiquinol-10 supplementation. Further studies are needed to determine whether correction of this oxidant imbalance improves clinical outcomes of children with trisomy 21.

Whole-genome array-CGH for detection of submicroscopic chromosomal imbalances in children with mental retardation

Chromosomal imbalances are the major cause of mental retardation (MR). Many of these imbalances are caused by submicroscopic deletions or duplications not detected by conventional cytogenetic methods. Microarray-based comparative genomic hybridization (array-CGH) is considered to be superior for the investigation of chromosomal aberrations in children with MR, and has been demonstrated to improve the diagnostic detection rate of these small chromosomal abnormalities. In this study we used 1 Mb genome-wide array-CGH to screen 48 children with MR and congenital malformations for submicroscopic chromosomal imbalances, where the underlying cause was unknown. All children were clinically investigated and subtelomere FISH analysis had been performed in all cases. Suspected microdeletion syndromes such as deletion 22q11.2, Williams-Beuren and Angelman syndromes were excluded before array-CGH analysis was performed. We identified de novo interstitial chromosomal imbalances in two patients (4%), and an interstitial deletion inherited from an affected mother in one patient (2%). In another two of the children (4%), suspected imbalances were detected but were also found in one of the non-affected parents. The yield of identified de novo alterations detected in this study is somewhat less than previously described, and might reflect the importance of which selection criterion of patients to be used before array-CGH analysis is performed. However, array-CGH proved to be a high-quality and reliable tool for genome-wide screening of MR patients of unknown etiology.

Targeted Array CGH

Targeted Array CGH

Oligonucleotide Microarray Analysis of Genomic Imbalance in Children with Mental Retardation

The cause of mental retardation in one-third to one-half of all affected individuals is unknown. Microscopically detectable chromosomal abnormalities are the most frequently recognized cause, but gain or loss of chromosomal segments that are too small to be seen by conventional cytogenetic analysis has been found to be another important cause. Array-based methods offer a practical means of performing a high-resolution survey of the entire genome for submicroscopic copy-number variants. We studied 100 children with idiopathic mental retardation and normal results of standard chromosomal analysis, by use of whole-genome sampling analysis with Affymetrix GeneChip Human Mapping 100K arrays. We found de novo deletions as small as 178 kb in eight cases, de novo duplications as small as 1.1 Mb in two cases, and unsuspected mosaic trisomy 9 in another case. This technology can detect at least twice as many potentially pathogenic de novo copy-number variants as conventional cytogenetic analysis can in people with mental retardation.

Mineral Imbalance in Children with Autistic Disorders

ln order to investigate any role of rninerals in autistic disorders,we measured 24 Hlineral contents in scalp hair samples of 360 autistic children and compared with those of healthy controls.In the male autistic group aged 4‐9 years(N=200),the geOmetric means of many elemenl leVels,namely not only essential lninerals such as cobalt, chromium,iodine,molybdenum and phosphorus,but ttso nickel,boron,cadmium and lead were significantly lower than thOse in the control group(p〈 0.001).In cOntrast,selenium level was significantly higher in the autistic group. On the mercury levels,no significant difference was obsゃrved between the two groups,though with a tendency of low conlentration in the autistic group.Silnilar Hlineral imbalance profiles with a global rnineral deficiency were observed in the other autistic groups aged O‐3 and 10‐15 years(N=85 and 20)and also in the female autistic groups. In addition,high accumulation of a few elements such as iron,manganese,chromium,copper,sodium,aluminum, cadlnium,lead,or mercury was observed in some autistic individuals, These findings indicate that autistic children are suffered from a global lnineral deficiency in various trace elements,with sOme individuals being exposed to a marked accumulation of several elements,Autistic children may be classified to sub‐grOups,based on their Hlineral imbalance profile in hair.

Vertigo and Imbalance in Children

To determine medical characteristics of children with vertigo who visited an otorhinolaryngology (ENT) clinic during a 5-year period. A retrospective chart review carried out between 2000 and 2004. Helsinki University Central Hospital tertiary referral center ENT clinic. A total of 119 children (63 girls and 56 boys), ranging in age from 7 months to 17 years (mean age, 10.9 years at examination). Patients were identified from the ENT clinic database based on hospital discharge codes, with data stored in the database and the SPSS program applied for statistical analysis. Only 0.7% of children visiting the hospital during the 5-year period had vertigo. Benign paroxysmal vertigo of childhood, migraine-associated dizziness, vestibular neuronitis, and otitis media-related dizziness accounted for vertigo in most of the children. Vertigo is a rare primary complaint of children in an ENT clinic. In achieving a diagnosis, the most valuable tools are medical history, an otoneurologic examination, electronystagmography, and audiography.

Vertigo in children

Vertigo in children is a challenging complaint for which potentially numerous etiologies exist. The history, often obtained most reliably from the observations of parents or caretakers, contains key information that directs the diagnostic evaluation. Using this information, the clinician may then categorize the complaint of vertigo according to its quality (paroxysmal or unremitting), and its association with the following: hearing loss; loss of consciousness or postural control; or any neurologic symptoms. The differential diagnosis may then be approached in an algorithmic method and narrowed down to isolate the most common disease processes that may account for the specific symptomatology. Current studies support the growing evidence that otitis media is one of the leading causes of imbalance in children.

Technology, Narcissism, and the Moral Sense: Implications for Instruction

Numerous researchers (Kohn, 1994; Kottler, 1992; Katz, 1993a, 1995; Streibel, 1994; Tingle, 1992) have recently examined the rise of narcissism in American culture and especially its relationship to education. However, William Damon's (1995) analysis of narcissism, which he frames against the larger dynamic of related social and cultural realities, is particularly engaging, although somewhat ominous:“Our heightened concern with children's internal mental states has combined with the increased child‐centeredness of modern times to create crippling imbalances in children's views of themselves and the world. When we tell children that their first goal is self‐love, we are suggesting to them that they are the center of the universe. By contributing further to the already child‐centered orientation of modern culture, this emphasis can push a child toward a narcissistic insensitivity to the needs of others. We should not dispute the value of self‐love, but we should question its utility as a primary goal in raising and educating children.” (p. 77)Damon's assessment of child‐rearing practices offers compelling reasons to reconsider self‐love as the central focus of such practices. His comments are additionally significant because they suggest a causative connection between child‐centeredness and narcissism and between narcissism and social insensitivity. “In citing these connections, Damon is echoing Christopher Lasch's (1979) equally troubling warning made almost twenty years ago in The Culture of Narcissism—a warning linking the ‘culture of narcissism’ to numerous dysfunctions within social institutions, including a multiplicity of failings in schooling.” (Ryan, 1997, p. 233)

Plasma homocysteine and methionine concentrations in children with neural tube defects.

Mild to moderate homocysteinemia in women has been associated with an increased frequency of pregnancies with neural tube defects (NTD). Homocysteinemia is also an independent risk factor for premature vascular disease. In addition to folic acid, supplemental Vitamin B12, Vitamin B6 and betaine may normalize homocysteine metabolism, decrease the risk for NTD formation, and correct related metabolic imbalances in children with NTD. By means of automated amino acid analysis, we assessed total non-fasting homocysteine and methionine in plasma from 24 children with myelomeningocele. This study group (mean age 10.5 +/- 4.9 years) included 12 girls and 12 boys randomly selected from our Birth Defects Clinic. Homocysteine concentrations in our patients (4.7 +/- 1.8 mumol/L) did not differ from those of 20 randomly selected child controls (5.1 +/- 2.6 mumol/L). The mean homocysteine concentration for 36 adult controls (9.3 +/- 3.0 mumol/L) was significantly higher than the mean for either group of children (p < 0.0001). Linear regression analysis revealed negative correlation of total plasma homocysteine with serum folate (r = -0.53; p = 0.01), but not of homocysteine with either methionine or B12. Plasma methionine concentrations from our patients did not differ from adult reference values. Elevated homocysteine in some mothers of children with NTD has been attributed to defective methylation of homocysteine. These preliminary results do not indicate such a defect in the children themselves. A more comprehensive study of homocysteine, methionine and related metabolites in children with NTD and age-matched controls will be required to determine the clinical significance of these findings.

Fluid and Electrolyte Imbalances in Children With Chronic Renal Failure

URRENT under standing of water and elec­ trolyte handling in children with chronic re­ nal failure (CRF) often has been extrapolated from studies in human adults and mature experimental animals. It is accepted that, in general, the kidney retains a remarkabl e efficiency to maintain fluid and electrolyte homeosta sis and only when end­ stage renal disease (ESRD) is reached is body composition deranged. >' However, CRF-related symptoms, such as growth retardation, may ap­ pear in children long before symptoms of uremia are present. Although many biochemical, nutri­ tional , or hormonal feature s may contribute to slow growth in CRF, disturbed fluid and electro­ lyte homeostasis are factors that contribute While children with glomerular or tubulointerstitial dis­ eases may behave as adults in regard to water and salt metabolism, the largest single group of infants and children with CRF have renal dysplasia, with or without urinary tract obstruction, which has no disease counterpart in adults. Most renal diseases acquired following infancy affect all nephron s similarly, but the kidney that is dysplastic or ob­ structed in utero may have remnant nephron s that are relatively normal or have greater potential for compensatory response than residual nephrons in adult kidneys. At the same glomerular filtration rate (GFR) , for instance , the dysplastic kidney has fewer nephrons than the kidney with chronic glo­ merulonephritis ; therefore, single nephron filtra ­ tion rate is higher in the dysplastic kidney, and more water and sodium must be rejected from each nephron if water and sodium balances are to be maintained .

Evaluation of Clinical and Biological Parameters in Marastic Kwashiorkor Children Treated by Parenteral Nutrition

Reduction of hospital stay and mortality rate due to dehydration and electrolyte imbalance in children suffering from severe marasmic Kwashiorkor was attempted. A program of parenteral nutrition providing 70 to 100 milliliters water, 30 to 40 kilocalories, and 3 to 4 grams amino acids per kilogram daily was given. Seventy-seven African children suffering from protein deficiency and calorie deficiency were given an intravenous perfusion of casein hydrolysate or cristalloid amino acids for a mean period of 6 days. An oral supplement of tea and sugar, boiled rice, and palm oil was also given. The total mortality has not been modified in comparison with that in children given an oral diet (semi-liquid) consisting of low fat milk and locally available proteins. In more than half of the cases, the parenteral nutrition has favored water and salt retention and the development of cardiac failure possibly due to adynamic circulatory state. Weight curve, serum albumins, serum and urine amino acids were followed closely for 1 month. In eleven patients, nitrogen balance studies were done. All were positive independently of the coexisting infectious pathology. Correlating the increase in serum proteins with the cumulative nitrogen balance allowed us to consider casein hydrolysate as particularly useful for hepatic protein synthesis while cristalloid amino acids seem to favor muscular protein synthesis. The introduction of parenteral nutrition as a therapeutic regimen for standard use in the malnourished child seems less favorable than oral realimentation programs and does not seem desirable in developing countries.

Pulmonary perfusion abnormalities and ventilation-perfusion imbalance in children after total repair of tetralogy of Fallot.

The pulmonary perfusion of 25 children who had total surgical correction of tetralogy of Fallot was evaluated by radionuclide perfusion scans. In addition, 18 had 133Xe ventilation studies. Eighteen of the children previously had palliative systemic-pulmonary shunts; 14 had aortic-pulmonary shunts (Waterston or Potts-Smith) and four had Blalock-Taussig shunts. Seven children had single stage total corrections. An asymmetric perfusion pattern was found in 13 of 18 children who previously had systemic-pulmonary shunts, including 12 of 14 with previous aortic-pulmonary shunts (P less than 0.05). The most common finding was relative hypoperfusion of the lung which had received the palliative shunt (P less than 0.001). The distribution of ventilation remained relatively symmetric, even when perfusion was markedly abnormal, and this resulted in ventilation-perfusion imbalance in several patients. Asymmetric perfusion was significantly less common in patients who had undergone single stage corrections (P less than 0.05). The findings document the frequent occurrence of residual abnormalities of pulmonary perfusion and ventilation-perfusion imbalance in patients who have palliative aortic-pulmonary shunts prior to total repair, and support the position that single stage correction is preferable to aortic-pulmonary shunting in the surgical management of tetralogy of Fallot.

Interracial Children's Books: Problems and Progress

This article discusses why, in the middle 1960s, many writers, editors, and publishers became keenly aware that racial minority groups were very inadequately represented in children's books and considers some of what has happened in the past five years to redress this situation. The following four aspects of these subjects are treated: (1) factors which created interest in the problem of racial imbalance in children's books, with a brief history of racial attitudes in children's books published since the 1890s; (2) conditions which until recently have impeded publication of interracial children's books, descriptions of several recent series publications for teen-agers from minority groups, and reviews of the activities of the Council on Interracial Books; (3) the recent Black Power movement in the world of children's books; and (4) an evaluation of four recent interracial children's trade books.