Children Of Various Age Groups Research Articles

Rhinosurgery in Children: Basic Concepts

In newborns, the main supporting structure of the nose is the dorsoseptal cartilage, a T-bar-formed complex of septum and upper lateral cartilages, which is essentially an external extension of the cartilage of the anterior cranial base. Later the anatomic situation gradually changes -- a potential pitfall for surgeons and radiologists. The vulnerability of various processes underlying postnatal development of the facial skeleton is discussed. The cartilaginous septum is the dominant growth center. Loss of septal cartilage at different ages leads to different facial syndromes involving nose, maxilla, and orbita. The septal cartilage in children demonstrates thinner fracture-prone areas next to thicker growth zones. Septum fractures have a preference for the thinner regions, corresponding with the most frequent septum deviations observed in growing children. The essential problem in pediatric rhinosurgery is not the age-specific anatomy but the poor wound-healing capacity: fractured or transected septum cartilage will not heal, and disconnected ends tend to overlap, resulting in increasing or recurrent deviations. Based on clinical and experimental evidence, indications and "safe" and "unsafe" techniques of rhinosurgery are presented for children of various age groups.

Parental Ability to Discriminate the Weight Status of Children: Results of a Survey

In this study we aimed to explore parents' weight perceptions of their children and of unrelated children. Parents of children < or = 18 years of age who were attending pediatric clinics throughout San Diego County, California, were surveyed concerning their children's weight status and the weight status of unrelated children in various age groups. Height and weight were measured, and weight status was determined for both the parent and child. The influence of various demographic variables on parents' weight perceptions and the relationship between parents' perceptions of weight of their children and parents' perceptions of weight of unrelated children were evaluated. Multivariate regression modeling was applied to identify predictors of parents' perceptions of weight of their own children. Of 1098 parents surveyed, 87% were women, 74% were white, and 46% reported Hispanic ethnicity. Seventy percent of the parents surveyed were overweight or obese, and 39% of their children were at risk for overweight or overweight. Sixty-one percent of parents correctly identified their children's weight status, and parents were able to correctly identify the weight status of unrelated children in 58% of reviewed photographs. Parents' weight perceptions of their children were not related to their ability to determine the weight status of unrelated children or to their ideal weight selections among unrelated children. In a multivariate logistic regression analysis, parental ability to correctly assess their child's weight status was associated with their child's age and weight status. Parents' perceptions of their own children's weight status are influenced by their children's characteristics and do not seem to correspond with their weight perceptions of unrelated children. Parental recognition of weight issues in their offspring may be impeded by their inability to apply criteria used to ascertain the weight status of unrelated children to their own children.

Effect of Therapy on Serum Zinc and Copper in Primary Complex of Children

Tuberculosis is a global problem especially in children, more so because of the difficulty in the diagnosis of the disease. There are about 0.5 million deaths every year by this disease, worldwide. There are some reports that, during the disease, there are changes in serum concentrations of zinc and copper, which reach towards normal levels during treatment. Such data for children are scarce, especially in reference to India. Our study indicates that there is an insignificant to significant rise in serum zinc levels in various age groups of children after antitubercular therapy (mean 61.89 +/- 3.21 to 65.24 +/- 3.60 microg/dl) and significant fall in serum copper levels in different age groups of children (mean 129.96 +/- 3.18 to 124.91 +/- 3.48 microg/dl). The Cu/Zn ratio also changed significantly from 2.11 +/- 0.12 to 1.92 +/- 0.12. Because evaluation of available diagnostic criteria for primary complex in children has been found to have high sensitivity, and although this criterion is presently not recommended for diagnosis of primary complex of children, further research can prove its utility in diagnosis and treatment of this disease.

Exposure of the population of the Slovak Republic to dietary polychlorinated biphenyls

The aim of this paper has been to assess the exposure of the Slovak Republic population to polychlorinated biphenyls from food within 1994–2004. A total of 61 167 samples of food of animal origin, including fats, were analyzed for the content of six PCB congeners (the sum of: PCB-28, PCB-52, PCB-101, PCB-138, PCB-153 and PCB-180); the commodities were divided into 48 basic groups. The exposure dose values based on actual and model consumption were calculated for an average inhabitant as well as for children of various age groups, and compared with the Tolerable Daily Intake value (TDI; 0.4 μg kg −1 body weight per day). Knowledge and experience from a variety of projects running since 1991, as well as the database of food contaminants of the Centre for Evaluation of Contaminant Occurrence established at the Food Research Institute were utilized. The results of the evaluation suggested, that during the period of observation, the exposure of the Slovak Republic population to PCBs was relatively low. Taking actual consumption and mean findings as the basis, the daily exposure doses of PCBs ranged between 3.1% and 6.5% TDI, the corresponding figures for median value and the 95th percentile being between 1.4% and 4.0%, and between 7.5% and 20.0%, respectively.

SPATIAL AND TEMPORAL VARIATIONS IN LOCAL TRANSMISSION OF SCHISTOSOMA HAEMATOBIUM IN MSAMBWENI, KENYA

As part of an extensive study of the eco-epidemiology of urinary schistosomiasis along the southern coast of Kenya, spatial and temporal transmission patterns were associated with various ponds infested with Bulinus snails. The household-level spatial pattern of infection for children of various age groups in 2000 was contrasted with historical data from 1984. Significant local clustering of high and low infection levels among school age children was detected, and the spatial extent of clusters and their direction from specific water sources were measured. High infection levels were clustered around ponds known to contain Bulinus nasutus snails that shed Schistosoma haematobium cercariae, and low infection levels were concentrated near a river where intermediate host snails were rarely found. The spatial patterns of infection varied between 2000 and 1984 and between age groups. High levels of infection were clustered around different transmission foci in the two study periods, and, for younger children in 2000, were clustered nearer to the transmission foci than for the older children. Simultaneous consideration of the effects of different foci on transmission will allow for targeted application of control measures aimed at interrupting S. haematobium transmission at a local level.

Measuring children’s participation in recreation and leisure activities: construct validation of the CAPE and PAC

There is a need for psychometrically sound measures of children's participation in recreation and leisure activities, for both clinical and research purposes. This paper provides information about the construct validity of the Children's Assessment of Participation and Enjoyment (CAPE) and its companion measure, Preferences for Activities of Children (PAC). These measures are appropriate for children and youth with and without disabilities between the ages of 6 and 21 years. They provide information about six dimensions of participation (i.e. diversity, intensity, where, with whom, enjoyment and preference) and two categories of recreation and leisure activities: (i) formal and informal activities; and (ii) five types of activities (recreational, active physical, social, skill-based and self-improvement). This paper presents information about the performance of the CAPE and PAC activity type scores using data from a study involving 427 children with physical disabilities between the ages of 6 and 15 years. Intensity, enjoyment and preference scores were significantly correlated with environmental, family and child variables, in expected ways. Predictions also were supported with respect to differences in mean scores for boys vs. girls, and children in various age groups. The information substantiates the construct validity of the measures. The clinical and research utility of the measures are discussed.

Transient evoked otoacoustic emissions

The purpose of this study was to collect parametric measures of TEOAEs in normal hearing children of various age-groups and to establish a normative baseline for Transient Evoked Otoacoustic Emissions (TEOAEs). Sixty subjects were investigated in three age-groups: neonates, 0-1 month; infants, 1 month-1 year; and children, 1-6 years. Each group comprised of 20 subjects. All the subjects underwent medical examination by a pediatrician and an ENT surgeon. Screening for hearing was done by immittance testing, behavior observation and conditioned play audiometry. The TEOAEs were analyzed for the parameters of amplitude, cross-correlation (wave reproducibility) and signal-to-noise ratio (SNR). There was no difference between the mean amplitudes of the right and left ears in the groups. The females in the neonates group had higher emission amplitudes than the males. The mean amplitude of the subjects in the neonates group was significantly higher than the subjects in the infants or children groups. The cross correlation (wave reproducibility) was constant across the age. The mean SNR for all the subjects were well above 3 dB at frequencies 1.5 k, 2 k, 3 k and 4 kHz. The neonates group showed the lowest SNR ranging between 3.47 to 9.62 dB. The infants group showed the highest SNR ranging between 6.13 to 13.11 dB. The TEOAEs response measures of SNR and cross correlation, at frequency bands 1.5, 2, 3 and 4 kHz, may provide more reliable outcomes than TEOAEs amplitude. Subjects in the age range of 0-1 month show lower SNRs than those in higher age ranges. The values can be used as normative data for screening and diagnostic purposes in the pediatric population.

Modeling interchild differences in pharmacokinetics on the basis of subject-specific data on physiology and hepatic CYP2E1 levels: A case study with toluene

The objective of the present study was to evaluate the magnitude of interindividual variability in the internal dose of toluene in children of various age groups, on the basis of subject-specific hepatic CYP2E1 content and physiology. The methodology involved the use of a previously validated physiologically based pharmacokinetic (PBPK) model, in which the intrinsic clearance for hepatic metabolism (CL(int)) was expressed in terms of the CYP2E1 content. The adult toluene PBPK model, with enzyme content-normalized CL(int), facilitated the calculation of child-specific CL(int) based on knowledge of hepatic CYP2E1 protein levels. The child-specific physiological parameters, except liver volume, were computed with knowledge of age and body weight, whereas physicochemical parameters for toluene were kept age-invariant based on available data. The actual individual-specific liver volume (autopsy data) was also included in the model. The resulting model was used to simulate the blood concentration profiles in children exposed by inhalation, to 1 ppm toluene for 24 h. For this exposure scenario, the area under the venous blood concentration vs. time curve (AUC) ranged from 0.30 to 1.01 microg/ml x h in neonates with low CYP2E1 concentration (<3.69 pmol/mg protein). The simulations indicated that neonates with higher levels of CYP2E1 (4.33 to 55.93 pmol/mg protein) as well as older children would have lower AUC (0.16 to 0.43 microg/ml x h). The latter values were closer to those simulated for adults. Similar results were also obtained for 7 h exposure to 17 ppm toluene, a scenario previously evaluated in human volunteers. The interindividual variability factor for each subgroup of children and adults, calculated as the ratio of the 95th and 50th percentile values of AUC, was within a factor of 2. The 95th percentile value of the low metabolizing neonate group, however, was greater than the mean adult AUC by a factor of 3.9. This study demonstrates the feasibility of incorporating subject-specific data on hepatic CYP2E1 content and physiology within PBPK models for evaluating the age, interchild and population variability of internal dose for use in risk assessment of inhaled volatile organics.

Effects of hospital stay on nutritional anthropometric data in Turkish children.

We evaluated the effects of hospital stay on nutritional anthropometric data in children of various age groups and investigated the effects of admission undernutrition on nutritional anthropometric data in children who were hospitalized in our university hospital in Turkey. The adverse effect of hospitalization on nutritional status was shown to be most obvious on the 2-6-year age group with undernourished children. We also found reduced anthropometric parameters in all patients with mild malnutrition at admission (p < 0.05). A significant number of pediatric patients in Turkey are at nutritional risk at the time of hospital admission (31.8 per cent). The well-nourished children do not carry nutritional risk due to hospitalization for other medical reasons. Since undernutrition has an adverse effect on morbidity and mortality, careful nutritional evaluation of children on admission is essential. Special attention should be given to patients who had mild malnutrition on admission since this population of patients seem to be at higher risk of adverse effect of hospitalization.

Physiological Modeling of Age-Specific Changes in the Pharmacokinetics of Organic Chemicals in Children

Age-specific changes in the pharmacokinetics of chemicals are primarily due to differences in physiological and biochemical factors. For integrating the available information on the age-dependent changes in the physiological and biochemical factors, and for evaluating their combined influence on the pharmacokinetics of chemicals, physiologically based pharmacokinetic (PBPK) models are potentially useful. The objectives of this study were, therefore, (1) to assemble information on age-specific differences in physiological parameters such as alveolar ventilation rate, cardiac output, tissue volumes, tissue blood flow rates, and tissue composition for children of various age groups, and (2) to incorporate these data within a PBPK model for simulating the inhalation pharmacokinetics of a highly metabolized, volatile organic chemical (furan) in children of specific age groups (6, 10, and 14 yr old). The age-specific data on various physiological parameters were assembled following a review of the relevant literature and the hepatic metabolism rate of furan was set equal to the liver blood flow rate in adults and children. The blood:air and tissue:blood partition coefficients were calculated using molecular structure information along with the data on the blood and tissue composition (lipid and water contents) in children and adults. The PBPK model was used to simulate the pharmacokinetics of furan in adults and children (6, 10, and 14 yr old) exposed continuously for 30 h to 1 w g/L of this chemical in inhaled air. The model simulations suggest that, for the same exposure conditions, the blood concentration of furan is likely to be greater in children by a factor of 1.5 (at steady state) than in adults, and the maximal factor of adult-children differences in liver concentration of furan metabolite is about 1.25. The PBPK model framework developed in this study should be useful for predicting the adult-children differences in internal dose of chemicals for risk assessment applications.

Hearing screening.

Hearing screening.

Nasal septum deformities in children and adolescents: a cross sectional study of children from Zagreb, Croatia

Objective: Numerous epidemiologic studies on the prevalence of nasal septum deformities in children have been performed over the last three decades. As these studies were performed in children of various age groups and used different classifications of septal deformities (without detailed morphologic systematization), it is no surprise that the results differ greatly from study to study. The purpose of the study was to evaluate clinical data on the total prevalence of nasal septum deformities and particular types of deformity in children and adolescents. Methods: The study population consisted of 1797 randomly selected subjects divided into pre-school (aged 2–6), primary school (aged 7–14), secondary school (aged 15–18) and university (aged 19–22) groups. The native state was determined by means of anterior rhinoscopy without previous application of vasoconstrictive drugs. The observed pathologic septal deformities were classified into seven types according to Mladina's classification. A straight septum was designated as S. The prevalence of septum deformities in the population was calculated with 95% probability. Differences with respect to sex and types of deformity were tested by χ 2-test. Results: The prevalence of nasal septum deformities according to age groups was 28.0% in the 2–6 group, 21.1% in the 7–14 group, 40.6% in the 15–18 group and 41.8% in the 19–22 group. The distribution of the seven types of septal deformity was 51.1, 23.5, 5, 0.8, 10.0, 9.0 and 0.6%, respectively. The mean values (%) and 95% confidence intervals for the seven types of septal deformity were 14.7 (13.1–16.4%), 6.8 (5.6–7.9%), 1.4 (0.9–1.9%), 0.2 (0.0–0.4%), 2.9 (2.1–3.7%), 2.6 (1.9–3.4%) and 0.2 (0.0–0.4%), respectively. Total distribution in gender showed no difference ( P=0.102). Conclusions: In the youngest age group (2–6 years), types 1 and 2 (deformities of anterior septal segments) were exclusively found, whereas types 5 and 6 were found in older age groups (become visible during and after the puberty). Types 1 and 2 are characteristic septal deformities for small children. Since, septal deformities can affect the growth and development of the maxilla and vice versa, the authors recommend examination of the nasal septum by an rhinologist who will be a part of a team performing the regular systematic health examination of children.

Lactose‐[13C]Ureide Breath Test: A New, Noninvasive Technique to Determine Orocecal Transit Time in Children

ABSTRACTBackgroundThe lactose‐[13C]ureide breath test (LUBT) is a novel, noninvasive test to determine orocecal transit time. Lactose ureide resists the action of brush border enzymes and is metabolized by colonic bacteria. The purpose of the present study was to adapt this breath test for children of various age groups and to determine whether it can be applied in infants, newborns, and preterms to study the development of small intestinal motility.MethodsIn a group of 20 children (3–17 years) in vitro stool analysis and in vivo LUBT results were compared. From each subject a blank stool sample and a sample produced after induction with unlabeled lactose ureide were incubated with 10 mg lactose‐[13C]ureide in small, closed bottles. Ten‐milliliter CO2 samples were aspirated from the bottles using a needle and a syringe every 30 minutes for 24 hours. All children performed the breath test after induction of 500 mg unlabeled lactose ureide three times the prior day. A liquid test meal (chocolate milk) with 250 mg lactose‐[13C]ureide was ingested. Breath samples were collected every 15 minutes for 10 hours. In a second group of 32 children (age range, 0–3 years) consisting of 6 children between 1 and 3 years of age, 6 infants between 6 and 12 months, 13 infants between 0 and 6 months, and 7 preterm infants, only the in vitro stool analysis was performed. Stools were collected for stool incubation, as described.ResultsThe mean orocecal transit time in the group of 20 children aged 3 to 17 years was 255 minutes (range, 165–390 minutes). Stool incubations demonstrated a clear 13CO2 peak in all infants aged more than 8 months, indicating that their colonic bacterial enzymic activity hydrolyses lactose ureide. However, in all infants aged less than 6 months and in preterm infants, the 13CO2 signal was absent, indicating that those subjects were unable to hydrolyze lactose ureide.ConclusionInfants aged less than 6 months do not host the appropriate bacterial enzymic activity for splitting lactose ureide. The authors conclude that the LUBT can be applied in infants aged more than 8 months, after weaning to solid foods, to determine orocecal transit time.

Lactose-[13C]ureide breath test: a new, noninvasive technique to determine orocecal transit time in children.

The lactose-[13C]ureide breath test (LUBT) is a novel, noninvasive test to determine orocecal transit time. Lactose ureide resists the action of brush border enzymes and is metabolized by colonic bacteria. The purpose of the present study was to adapt this breath test for children of various age groups and to determine whether it can be applied in infants, newborns, and preterms to study the development of small intestinal motility. In a group of 20 children (3-17 years) in vitro stool analysis and in vivo LUBT results were compared. From each subject a blank stool sample and a sample produced after induction with unlabeled lactose ureide were incubated with 10 mg lactose-[13C]ureide in small, closed bottles. Ten-milliliter CO2 samples were aspirated from the bottles using a needle and a syringe every 30 minutes for 24 hours. All children performed the breath test after induction of 500 mg unlabeled lactose ureide three times the prior day. A liquid test meal (chocolate milk) with 250 mg lactose-[13C]ureide was ingested. Breath samples were collected every 15 minutes for 10 hours. In a second group of 32 children (age range, 0-3 years) consisting of 6 children between 1 and 3 years of age, 6 infants between 6 and 12 months, 13 infants between 0 and 6 months, and 7 preterm infants, only the in vitro stool analysis was performed. Stools were collected for stool incubation, as described. The mean orocecal transit time in the group of 20 children aged 3 to 17 years was 255 minutes (range, 165-390 minutes). Stool incubations demonstrated a clear 13CO2 peak in all infants aged more than 8 months, indicating that their colonic bacterial enzymic activity hydrolyses lactose ureide. However, in all infants aged less than 6 months and in preterm infants, the 13CO2 signal was absent, indicating that those subjects were unable to hydrolyze lactose ureide. Infants aged less than 6 months do not host the appropriate bacterial enzymic activity for splitting lactose ureide. The authors conclude that the LUBT can be applied in infants aged more than 8 months, after weaning to solid foods, to determine orocecal transit time.

Formation of humoral immune response in atopic dermatitis in children

The examination results of the humoral immune response in children with allergodermatosis and in healthy children of various age groups are presented. The following immune diagnosis methods are used: the determination of the basic class immunoglobulins content, complement activity and general Ig E level. The markers for the immune status estimation and atopic type response prediction taking into account the immune system ontogenesis are proposed.

17α-Hydroxyprogesterone, 4-Androstenedione, and Testosterone Profiled by Routine Stable Isotope Dilution/Gas Chromatography-Mass Spectrometry in Plasma of Children

Using stable isotope dilution/gas chromatography-mass spectrometry (ID/GC-MS), a physicochemical method, we have profiled the plasma steroids 17 alpha-hydroxyprogesterone, 4-androstenedione, and testosterone in normal children of various age groups. Comparison of our values with those obtained by direct immunologic assays and those using an extraction or purification step showed that immunoassays in general overestimate steroid concentrations. This was especially true for plasma samples in the neonatal period and was most expressed for the concentrations of 17 alpha-hydroxyprogesterone. Our study demonstrated the applicability of ID/GC-MS to routine clinical steroid analysis. The application of ID/GC-MS is recommended whenever problems from matrix effects or cross-reactivity are likely to arise or suspicious results by immunoassays need to be rechecked.

Epidermal growth factor prohormone is secreted in human urine.

Examination of adult human urine by immunoblot analysis with antiserum specific to human recombinant 6-kDa epidermal growth factor (EGF) reveals the presence of an immunoreactive protein with a molecular mass of 165 kDa. This protein is consistently found in the morning (first) but not in day urine of adult males and females. Day urine contains variable proportions of four other high-molecular-weight EGFs with approximate molecular masses of 97, 66, 50, and 42 kDa. The 165-kDa EGF immunoreactive protein reacts with mouse amino-terminal EGF prohormone (proEGF) antiserum and comigrates with mouse urinary proEGF, suggesting that the protein is the human EGF prohormone. The 165-kDa human proEGF exhibits strong binding affinity to concanavalin A, indicating that it is glycosylated. Immunoblotting of urine in infants and children of various age groups demonstrates the presence of proEGF in all age groups, but its concentration is highest in children 2-4 yr of age. These findings, taken together with secretion of proEGF of similar molecular mass in mouse and rat urine, suggest that renal proEGF secretion is an evolutionarily conserved phenomenon and may have an important function or functions distal to the site of its synthesis.

Elevated HbA1 due to foetal haemoglobinaemia in children. A common artifact of certain ion-exchange chromatography methods

Foetal haemoglobin (HbF) is known to elute with glycosylated haemoglobins (HbA1) in mini-column ion-exchange chromatography, thus producing falsely elevated values for HbA1 in subjects with foetal haemoglobinaemia. We studied the occurrence of this methodological artifact in 266 patients with suspected or known insulin-dependent diabetes mellitus (IDDM) and in 205 healthy children of various age groups. HbA1 was measured using ion-exchange chromatography with prefabricated mini-columns and HbA1c and HbF by high-performance liquid chromatography (HPLC). In healthy children of over 5 years of age, the HbA1 values were usually within the reference limits for adults. However, 69% of the children younger than 1 year of age and 7% of those 1–5 years of age had HbA1 levels above 10%. Their HbA1c values were normal but the HbF values were high. Six of the 223 patients with IDDM (2.7%) and three of the 43 patients with stress glucosuria (7%) had much higher HbA, than HbA1c values. The discrepancy was again related to the presence of raised concentrations of HbF. We conclude that foetal haemoglobinaemia is more prevalent than was previously known, especially among children younger than 5 years of age. Presence of HbF will bias the use of HbA1 as a diagnostic aid or as an index of metabolic control in children with IDDM. Methods specific for HbA1c, such as HPLC, should be used in paediatric patients.

Elevated HbA1 due to foetal haemoglobinaemia in children. A common artifact of certain ion-exchange chromatography methods.

Foetal haemoglobin (HbF) is known to elute with glycosylated haemoglobins (HbA1) in mini-column ion-exchange chromatography, thus producing falsely elevated values for HbA1 in subjects with foetal haemoglobinaemia. We studied the occurrence of this methodological artifact in 266 patients with suspected or known insulin-dependent diabetes mellitus (IDDM) and in 205 healthy children of various age groups. HbA1 was measured using ion-exchange chromatography with prefabricated mini-columns and HbA1c and HbF by high-performance liquid chromatography (HPLC). In healthy children of over 5 years of age, the HbA1 values were usually within the reference limits for adults. However, 69% of the children younger than 1 year of age and 7% of those 1-5 years of age had HbA1 levels above 10%. Their HbA1c values were normal but the HbF values were high. Six of the 223 patients with IDDM (2.7%) and three of the 43 patients with stress glucosuria (7%) had much higher HbA1 than HbA1c values. The discrepancy was again related to the presence of raised concentrations of HbF. We conclude that foetal haemoglobinaemia is more prevalent than was previously known, especially among children younger than 5 years of age. Presence of HbF will bias the use of HbA1 as a diagnostic aid or as an index of metabolic control in children with IDDM. Methods specific for HbA1c, such as HPLC, should be used in paediatric patients.

Serum Carotene Concentrations in Normal Infants and Children

The blood of 444 healthy Canadian children (246 males and 198 females) aged 6 days to 18 years was analyzed to determine the concentration of serum carotene. The serum carotene concentration was very low in the first six months of life. In the first three months of life, breast fed infants had significantly higher serum carotene concentration than infants who were formula fed. Infants 7 to 12 months of age had the highest serum carotene concentration. The serum carotene concentration dropped off after the age of one year and remained low until two years of age. After two years of age, the serum carotene concentration showed a progressive and small rise until the age of six to seven years and then fell until the age of 14 to 18 years. The serum carotene concentration did not appear to vary according to the sex of the child except for infants 7 to 12 months of age. In infants 7 to 12 months of age, girls had a higher serum carotene concentration. The measurement of the serum carotene concentration is a simple screening test for fat malabsorption. Our study provides the normal range of serum carotene concentration for children of various age groups.