AIM： To evaluate the prevalence of autoantibodies in chronic hepatitis C virus （HCV）-infected children focusing on thyroid autoimmunity.METHODS： We investigated the prevalence of autoantibodies in ...123 chronic HCV-infected children before, during and after monotherapy with interferon-alpha （IFN-α） or combined treatment with interferon-α or peginterferon-α and ribavirin. Besides antibodies against smooth muscle （SMA）, nuclei （ANA）, and liver/kidney microsomes （1KM）, the incidence of antithyroid peroxidase antibodies as well as thyroid function parameters （TSH, FT3 and FT4） were determined.RESULTS： We found that 8% of children had autoantibodies before treatment. During treatment, 18% of children were found positive for at least one autoantibody; 15.5% of children developed pathologic thyroid values during IFN-α treatment compared to only one child before therapy. Six children had to be substituted while developing laboratory signs of hypothyroidism.CONCLUSION： Our data indicate a strong correlation between interferon-α treatment and autoimmune phenomena, notably the emergence of thyroid antibodies. The fact that some children required hormone replacement underlines the need of close monitoring in particularly those who respond to therapy and have to be treated for more than 6 mo.
Background
When evaluating child welfare risk, recognition of abuse-related injuries and knowledge of risk factors for child abuse are important aspects. The purpose of this study was to evaluate ...child-related risk factors and particularities of injuries in cases of physical child abuse, to use the results for preventive child protection.
Methods
This retrospective case control study evaluated case files of 368 physically abused children (age range 0–14 years) referred to forensic medicine in 2004–2015. Death cases and cases that could not be separated from sexual abuse and neglect were excluded and 363 controls without suspicion of abuse were recruited from a pediatric clinic. Demographic data, state of care and previous illnesses were compared in both groups by determining χ
2
-test and Fisher’s exact test. Concerning injuries, specified mechanism of origin, type of violence, localization on the body and frequency of life-threatening and repeated abuse were evaluated.
Results
Male gender and age group of infants/toddlers were identified as significant child-related risk factors. In over 90%, injuries resulted from blunt trauma, with the skin (86%) and skeletal system (22%) most commonly involved. Injuries were located in almost 60% on obvious parts of the body. Reported causes for trauma were mostly accident mechanisms. Repeated abuse was found in over half and life-threatening injuries in nearly 20% of the cases.
Conclusion
As part of the daily work pediatricians and other child protection workers are able to identify suspected cases early. Therefore, good understanding of typical risk factors and injuries including plausibility check of the reported origin are important aspects. Periodic reassessment of child well-being and mandatory visit to pediatricians could avoid repeated and severe child maltreatment with life-threatening consequences.
Current treatment for pediatric inflammatory bowel disease (IBD) patients is often ineffective, with serious side effects. Manipulating the gut microbiota via fecal microbiota transplantation (FMT) ...is an emerging treatment approach but remains controversial. We aimed to assess the composition of the fecal microbiome through a comparison of pediatric IBD patients to their healthy siblings, evaluating risks and prospects for FMT in this setting. A case-control (sibling) study was conducted analyzing fecal samples of six children with Crohn's disease (CD), six children with ulcerative colitis (UC) and 12 healthy siblings by metagenomic sequencing. In addition, lifetime antibiotic intake was retrospectively determined. Species richness and diversity were significantly reduced in UC patients compared with control Mann-Whitney
-test false discovery rate (MWU FDR) = 0.011. In UC, bacteria positively influencing gut homeostasis, e.g.,
and
, were significantly reduced in abundance (MWU FDR = 0.05). Known pathobionts like
were enriched in UC patients (MWU FDR = 0.084). Moreover,
abundance correlated positively with that of several virulence genes (SCC > 0.65, FDR < 0.1). A shift toward antibiotic-resistant taxa in both IBD groups distinguished them from controls MWU Benjamini-Hochberg-Yekutieli procedure (BY) FDR = 0.062 in UC, MWU BY FDR = 0.019 in CD). The collected results confirm a microbial dysbiosis in pediatric UC, and to a lesser extent in CD patients, replicating associations found previously using different methods. Taken together, these observations suggest microbiotal remodeling therapy from family donors, at least for children with UC, as a viable option.
In this sibling study, prior reports of microbial dysbiosis in IBD patients from 16S rRNA sequencing was verified using deep shotgun sequencing and augmented with insights into the abundance of bacterial virulence genes and bacterial antibiotic resistance determinants, seen against the background of data on the specific antibiotic intake of each of the study participants. The observed dysbiosis, which distinguishes patients from siblings, highlights such siblings as potential donors for microbiotal remodeling therapy in IBD.
Zusammenfassung
Hintergrund
Kindliche Gewalterfahrungen können schwerwiegende Schädigungen hervorrufen. Durch frühzeitiges Erkennen von familiären Risikofaktoren können Hilfen zielgerichtet angeboten ...werden. Die Studie untersucht familiäre Risikofaktoren in Misshandlungsfällen, um die Ergebnisse für den präventiven Kinderschutz heranzuziehen.
Methoden
Es erfolgte eine retrospektive Auswertung von 368 rechtsmedizinischen Fallakten misshandelter Kinder (0 bis 14 Jahre) im Vergleich zu einer Kontrollgruppe von Kindern ohne Misshandlungsverdacht (
n
= 336). Erhoben wurden demografische und soziale Faktoren, die psychische Gesundheit der leiblichen Eltern und die angeschuldigten Personen. Zudem wurden vorherige Kontakte der Familien zu Jugendämtern ausgewertet.
Ergebnisse
Ein junges Alter der Eltern und von der traditionellen Familienform abweichende Familienkonstellationen wurden als signifikante Risikofaktoren für Kindesmisshandlung identifiziert. Die Auswertung der Anzahl der Geschwister und der Position in der Geschwisterreihe ergab keine signifikanten Unterschiede. Bei niedrigen Erfassungsquoten (2–22 %) wurden auch für die Faktoren Drogenmissbrauch, Vorstrafen, Migrationshintergrund, psychische Gesundheit, Arbeitslosigkeit und Bildungsstatus der leiblichen Eltern keine signifikanten Unterschiede festgestellt. In über einem Drittel der Misshandlungsfälle waren die Familien bereits beim Jugendamt bekannt (36 %). Am häufigsten wurden Mutter (24 %), Vater (22 %) oder beide Elternteile (31 %) beschuldigt, die Misshandlung begangen zu haben.
Schlussfolgerung
Bei ärztlichen Untersuchungen von Kindern und misshandlungsverdächtigen Verletzungen sollte immer die soziale Anamnese erhoben und in die Beurteilung einbezogen werden, um bei erhöhtem Misshandlungsrisiko frühzeitig Hilfen aufzuzeigen.
Peginterferon plus ribavirin is standard therapy for adults with chronic hepatitis C. As no data are available for children, the aim of the study was to evaluate the efficacy and tolerability of ...peginterferon alfa-2b in combination with ribavirin in chronically infected children. Genotypes, alanine aminotransferase levels, and different routes of viral transmission were considered. In an open-labeled, uncontrolled pilot study, 62 children and adolescents (range, 2-17 years) were treated with subcutaneous peginterferon alfa-2b at a dose of 1.5 microg/kg body weight once per week plus oral ribavirin (15 mg/kg x day) for 48 weeks. Sixty-one patients completed the study. Twenty-three children discontinued therapy after 6 months according to study protocol. Sustained viral response was documented in 22 (47.8%)of 46 patients with genotype 1, in 13 (100%) of 13 with genotype 2 or 3, in 1 of 2 with genotype 4, in 19 (70.4%) of 27 children with parenteral, in 12 (48%) of 25 with vertical, and in 5 of 9 with unknown route of infection. Overall, treatment was well tolerated. Nevertheless, some side effects were present in all treated patients. Eighty-three percent had leucopenia, but only 3 individuals required dose reduction and 10.3% developed thyroid autoantibodies and thyroid dysfunction. In conclusion, combination treatment of peginterferon alfa-2b with ribavirin showed encouraging results and was well tolerated in children and adolescents with chronic hepatitis C. Weekly dosing of peginterferon alfa-2b is a considerable advance for this age group. The treatment is not approved for children. Further controlled trials are needed.
Background & Aims Pegylated interferon (PEG-IFN) alfa-2b plus ribavirin (RBV) is the standard of care for adults with chronic hepatitis C but was not approved for the treatment of children at the ...time of this study. The aim of this study was to evaluate the efficacy and safety of PEG-IFN alfa-2b plus RBV in children. Methods Children and adolescents ages 3–17 years were treated with PEG-IFN alfa-2b (60 μg/m2 /week) plus RBV (15 mg/kg/day). The duration of therapy was 24 weeks for genotype (G) 2 and G3 patients with low viral load (<600,000 IU/ml) and 48 weeks for G1, G4, and G3 with high viral load (⩾600,000 IU/ml). The primary end point was sustained virologic response (SVR), defined as undetectable hepatitis C virus (HCV) RNA 24 weeks after completion of therapy. Results SVR was attained by 70 (65%) children. Genotype was the main predictor of response: G1, 53%; G2/3, 93%; G4, 80%. SVRs were similar in younger and older children. Baseline viral load was the main predictor of response in the G1 cohort. No new safety signals were identified, and adverse events (AEs) were generally mild or moderate in severity. Dose was modified because of AEs in 25% of children; 1 child discontinued because of an AE (thrombocytopenia). No serious AEs related to study drugs were reported. Conclusion Therapy with PEG-IFN alfa-2b plus RBV in children and adolescents with chronic hepatitis C offers favorable efficacy, reduced injection frequency, and an acceptable safety profile.
Values for all other variables were within the reference intervals. ... the patient experienced recurrent abdominal pain, mild diarrhea, and occasional nausea. In retrospect, the patient's strict ...avoidance of fructosecontaining food, combined with recurrent episodes of fatigue and apathy, persistent enuresis and encopresis, delayed language development, and the fact that the symptoms started at the time of weaning, suggests HFI as the most probable diagnosis in this patient (1). Because only limited information was available about the details of the patient's history and because the main complaints were abdominal pain, bloating, and diarrhea (symptoms typical for fructose malabsorption), the fructose breath hydrogen test was performed.
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