bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex Differences in Iron Stores of Adolescents
Authors: Bergström Erik , Kernell Olle , Lönnerdal Bo , Åke Persson Lars 
Published: January 2024

SummaryWe evaluated iron status and its determinants in healthy adolescents. Fasting morning blood samples from a school‐based cross‐sectional study were analyzed for serum ferritin (SF), serum iron, total iron‐binding capacity, and circulating transferrin receptors. Physical development, chronic disease, medication, dietary intake, and physical activity were assessed using clinical examination, questionnaires, and 7‐day records. The risk of having low serum ferritin values was estimated using bivariate and multivariate regression. Subjects were 867 healthy Swedish adolescents, 14− and 17‐year‐olds (472 boys and 395 girls). SF values increased with pubertal stage in boys but not in girls. Five percent of the boys and 15% of the girls had SF values <12 μg/L. Of the 17‐year‐old boys, 7% compared to 1% of the 17‐year‐old girls had SF values > 100 μg/L. Forty‐one percent of cases with SF values >12 μg/L had serum iron values < 15 μM, and 22% had transferrin saturation values <16%. Mean total iron intakes of the boys were high [1.6 times recommended daily allowance (RDA)] and mean intakes of the girls were adequate (0.9 times RDA). Low heme iron intakes increased the risk of low iron stores (<12 μg/L) in girls but not in boys. Total iron intake or other dietary factors, physical development, or level of physical activity did not influence the risk of low SF. The findings of this study suggest that the differences in iron status between boys and girls in adolescence results primarily from biological differences other than menstrual bleeding or insufficient iron intake. Furthermore, the results question the role of SF as an indicator of iron deficiency in adolescence, in particular if age and sex are not taken into consideration. We suggest that different reference values for SF, including the cut‐off limit for low SF, adjusted for age and sex, should be considered. The high iron intakes and corresponding high SF values found in the older boys are noticeable in light of the possible negative health consequences of iron overload.
Improvement of Growth After Growth Hormone Treatment in Children Who Undergo Liver Transplantation
Authors: Rodeck Burkhard , Kardorff Ruedigor , Melter Michael , Ehrich Jochen H. H. 
Published: January 2024

ABSTRACTBackgroundChronic liver insufficiency in children is frequently associated with growth retardation. Growth resumes after successful orthotopic liver transplantation in the majority of children with previous chronic liver failure. However, a subgroup of children demonstrates stunted growth even after orthotopic liver transplantation. The current study was conducted to determine whether administration of recombinant human growth hormone might benefit these patients.MethodsTen children were identified who met the criteria of growth failure despite normal transplant function in a cohort of 60 transplantation patients: height standard deviation score (hSDS) for chronological age less than −2, and growth velocity SDS (gvSDS) for chronological age equaling 0. Seven of these patients were treated with subcutaneous injections of recombinant human growth hormone at 4.0 U/m2 body surface area per day for at least 1 year. Two patients in this group showed insufficient growth hormone response to stimulation (arginine, clonidine) before therapy. Treatment was begun after a median time of 4.6 years after liver transplantation (2.55–8.4 years). Five children were treated with cyclosporin A and prednisolone and two with tacrolimus and prednisolone for maintenance immunosuppression.ResultsWithin 3 months of treatment, median serum levels of insulin‐like growth factor (IGF)‐I increased from 0.05 to 0.71 (P < 0.02). Within 1 year, median hSDS improved from −2.7 (range, −5.6 to −2.3) to −2.1 (−4.5 to −1.4;P < 0.03). Median annual growth rate increased from 3.9 cm/year (range, 3–6) in the year before treatment to 8.2 cm/year (range, 6.1–10.4;P < 0.02) after the beginning of recombinant human growth hormone therapy. All patients tolerated treatment without side effects. During the cumulative treatment time of 14 years no rejection episode was observed.ConclusionsShort‐statured prepubertal liver transplant recipients who do not show sufficient compensatory growth after transplantation benefit from treatment with recombinant human growth hormone. Treatment with the hormone was safe without any side effects.
Partially Hydrolyzed Guar Gum–Supplemented Oral Rehydration Solution in the Treatment of Acute Diarrhea in Children
Authors: Alam Nur H. , Meier Remy , Schneider Heinz , Sarker Shafiqul A. , Bardhan Pradip K. , Mahalanabis Dilip , Fuchs George J. , Gyr Niklaus 
Published: January 2024

ABSTRACTBackgroundPartially hydrolyzed guar gum (Benefiber; Novartis Nutrition, Minneapolis, MN, U.S.A.) is fermented by colonic bacteria liberating short‐chain fatty acids (SCFAs), which accelerate colonic absorption of salt and water. The purpose of this study was to evaluate the effect of Benefiber (BF)‐supplemented World Health Organization Oral Rehydration Solution (WHO ORS) in the treatment of acute noncholera diarrhea in children.MethodsA double‐blind, randomized, controlled clinical trial was performed at ICDDR,B in 150 male children aged 4 to 18 months who had watery diarrhea of less than 48 hours' duration. After admission, children were assigned to receive either WHO ORS or BF‐supplemented WHO ORS until recovery. Major outcome measures, such as duration of diarrhea and amount of stool output, were compared between the treatment groups.ResultsPatients receiving BF‐supplemented WHO ORS had significantly reduced duration of diarrhea compared with the control group (mean ± SD, 74 ± 37 vs. 90 ± 50 hours, P = 0.03). Survival analysis for duration of diarrhea also showed a reduction the BF‐supplemented WHO ORS–treated group (P = 0.025, log rank test). There was also less stool output daily from days 2 through 7 in the patients treated with BF‐supplemented WHO ORS compared with that in the children treated with WHO ORS; the reduction was significant on day 7 only.ConclusionBenefiber added to standard WHO ORS substantially reduces the duration of diarrhea and modestly reduced stool output in acute noncholera diarrhea in young children, indicating its potential as a new antidiarrheal therapy for acute diarrhea in children.
Free Glutamine and Glutamic Acid Increase in Human Milk Through a Three‐Month Lactation Period
Authors: Agostoni Carlo , Carratù Brunella , Boniglia Concetta , Lammardo Anna Maria , Riva Enrica , Sanzini Elisabetta 
Published: January 2024

ABSTRACTBackgroundPrevious short observational studies on the free amino acid (FAA) content of human milk have shown that glutamine and glutamic acid increase in the first 4 to 6 weeks of life.MethodsChanges in human milk content of free amino acids (FAAs) was determined at colostrum, 1 month, and 3 months of lactation in 16 healthy lactating women after delivery of full‐term infants. Milk was collected at the end of each feeding (hindmilk) during 24 hours.ResultsGlutamic acid and taurine were the most abundant FAAs at colostrum. Although taurine remained stable throughout lactation, glutamic acid (the prevalent FAA) and glutamine increased approximately 2.5 and 20 times, respectively, with progressing lactation representing more than 50% of total FAA at 3 months. The content of essential FAA was also stable, so the change in total FAA content was almost entirely due to the changes in glutamic acid and glutamine.ConclusionsBreast‐fed infants are supplied with progressively increasing amounts of glutamine and glutamic acid throughout lactation. The increasing intake of glutamic acid and glutamine could benefit breast‐fed infants with molecules that are likely to protect the enteral mucosa and act as neurotransmitters and as a source of nitrogen.
Comparative Evaluation of Serologic Tests for Celiac Disease: A European Initiative Toward Standardization
Authors: Stern Martin ,   Working Group on Serologic Screening for Celiac Disease
Published: January 2024

ABSTRACTBackgroundSerologic methods have been used widely to test for celiac disease and have gained importance in diagnostic definition and in new epidemiologic findings. However, there is no standardization, and there are no reference protocols and materials.MethodsThe European working group on Serological Screening for Celiac Disease has defined robust noncommercial test protocols for immunoglobulin (Ig)G and IgA gliadin antibodies and for IgA autoantibodies against endomysium and tissue transglutaminase. Standard curves were linear in the decisive range, and intra‐assay variation coefficients were less than 5% to 10%. Calibration was performed with a group reference serum. Joint cutoff limits were used. Seven laboratories took part in the final collaborative study on 252 randomized sera classified by histology (103 pediatric and adult patients with active celiac disease, 89 disease control subjects, and 60 blood donors).ResultsIgA autoantibodies against endomysium and tissue transglutaminase rendered superior sensitivity (90% and 93%, respectively) and specificity (99% and 95%, respectively) over IgA and IgG gliadin antibodies. Tissue transglutaminase antibody testing showed superior receiver operating characteristic performance compared with gliadin antibodies. The κ values for interlaboratory reproducibility showed superiority for IgA endomysium (0.93) in comparison with tissue transglutaminase antibodies (0.83) and gliadin antibodies (0.82 for IgG, 0.62 for IgA).ConclusionsBasic criteria of standardization and quality assessment must be fulfilled by any given test protocol proposed for serologic investigation of celiac disease. The working group has produced robust test protocols and reference materials available for standardization to further improve reliability of serologic testing for celiac disease.
Bone Marrow Failure in Children With Acute Liver Failure
Authors: Tung John , Hadzic Nedim , Layton Mark , Baker Alastair J. , Dhawan Anil , Rela Mohamed , Heaton Nigel D. , Mieli‐Vergani Giorgina 
Published: January 2024

ABSTRACTBackgroundAplastic anemia is a rare but well‐recognized complication of acute hepatitis and acute liver failure. The cause is unknown, and the condition is fatal without bone marrow recovery. Treatment includes immunosuppression regimens or bone marrow transplantation. The purpose of this study was to investigate the incidence, cause, treatment, and outcomes of this disorder in children.MethodsRetrospective chart review of 75 patients with acute liver failure in a major pediatric liver center.ResultsEight patients had evidence of bone marrow failure. Of those, six had aplastic anemia, and two had transient bone marrow suppression. There were five boys, median age 57 months (range, 36–132 months). Two had parvovirus B19, six had non‐A, non‐B, non‐C hepatitis. Five underwent liver transplantation: auxiliary in one, orthotopic in four. The interval between initial symptoms and development of aplastic anemia and/or bone marrow suppression was 21 to 99 days (median, 39 days). Four patients with aplastic anemia received intravenous antithymocyte globulin (ATG) or antilymphocyte globulin (ALG). Median recovery period of granulopoiesis was 62 days (range, 27–115 days). Two made a full recovery, one had myelodysplasia, and one with unresponsive disease died of septic complications. Four did not receive ATG/ALG, two had aplastic anemia, and two had bone marrow suppression. Three underwent liver transplantation, and all four resumed granulopoiesis. One child who underwent liver transplantation died of sepsis with chronic rejection. Median recovery of granulopoiesis was 99 days (range, 20–153 days).ConclusionsBone marrow failure occurs in 10.7% of children with acute liver failure. It sometimes occurs in association with non‐A, non‐B, non‐C hepatitis and parvovirus B19 infection. Treatment with ATG/ALG is successful and is well tolerated in most cases.
Is Esophagogastroduodenoscopy Necessary in all Caustic Ingestions?
Authors: Gupta Sandeep K. , Croffie Joseph M. , Fitzgerald Joseph F. 
Published: January 2024

ABSTRACTBackgroundIt is unclear whether symptoms alone can identify patients with caustic ingestion who will benefit from esophagogastroduodenoscopy (EGD). The published data are contradictory. The purpose of the current study was to determine the relationship between initial symptoms and EGD findings in patients with caustic ingestion.MethodsChart review of all caustic ingestions who underwent EGD during a 4‐year period (December 1993 through November 1997).ResultsTwenty‐eight patients (15 girls; mean age, 2.7 years (range, 0.92–13.33) underwent EGD after caustic ingestion. Fourteen percent (4/28) of patients were asymptomatic, and findings on endoscopy were normal. Another 57% (16/28) had normal endoscopic findings, although all were symptomatic. Twenty‐nine percent (8/28) of patients had esophageal injury on EGD, and all were symptomatic. Esophageal injury was graded as 1 (mucosal erythema), 2 (superficial burns; noncircumferential) or 3 (deep burns; circumferential). The injury was grade 1 in three of eight patients and grade 2 in two; all had one symptom each. Grade 3 injury was found in three of eight patients: two had two symptoms (drooling and vomiting, drooling and stridor), and one had one symptom (dysphagia). All patients with grade 3 injury subsequently underwent esophageal dilations. Follow‐up information was secured for two of the three patients with grade 1 injury and both patients with grade 2 injury at 34.3 months (range, 24–50) after the ingestion, and all were asymptomatic. Of the 20 patients with absence of esophageal mucosal damage, follow‐up data were available for l5 patients at 37.2 months (range, 7–63) after the event and all were well.ConclusionsAll patients with clinically significant injury (grades 2 and 3) were symptomatic at initial assessment. No single symptom or combination of symptoms could identify all patients with esophageal injury. All asymptomatic patients had normal findings on endoscopic examinations. Esophagogastroduodenoscopy seems unnecessary in asymptomatic patients with alleged caustic ingestion. A larger, prospective study would be necessary to unequivocally answer this clinically important question.
Atypical Morphologic Presentation of Biliary Atresia and Value of Serial Liver Biopsies
Authors: Azar Georgia , Beneck Debra , Lane Bernard , Markowitz James , Daum Fredric , Kahn Ellen 
Published: January 2024

ABSTRACTBackgroundLiver biopsy findings are important in diagnosing extrahepatic biliary atresia. Diffuse ductular proliferation is a characteristic finding. We describe four patients with conjugated hyperbilirubinemia in whom the initial liver biopsy findings showed a lack of ductular proliferation, despite subsequent development of biliary atresia.ResultsOn initial biopsy, paucity of intrahepatic bile ducts was present in three of four patients, with a bile duct to portal space ratio of 0.3 to 0.4 (normal, 0.9–1.8). A normal bile duct to portal space ratio of 1.0 was observed in the fourth patient. Ductular proliferation became apparent in three subjects between 9 and 12 weeks of age, and biliary atresia was noted at the time of a Kasai portoenterostomy. The fourth child had well‐developed biliary cirrhosis at liver transplantation.ConclusionsChanges characteristic of biliary atresia may appear even after 9 weeks of age. Bile duct paucity and normal bile duct to portal space ratio do not preclude the subsequent development of biliary atresia. Infants with unexplained conjugated hyperbilirubinemia and acholic stools should undergo sequential liver biopsies until clinical improvement occurs or until biliary atresia can be excluded from the differential diagnosis.
The IMPACT Questionnaire: A Valid Measure of Health‐Related Quality of Life in Pediatric Inflammatory Bowel Disease
Authors: Otley Anthony , Smith Claire , Nicholas David , Munk Marla , Avolio Julie , Sherman Philip M. , Griffiths Anne M. 
Published: January 2024

ABSTRACTBackground and aimsIMPACT is a disease‐specific health‐related quality‐of‐life questionnaire developed for use in pediatric inflammatory bowel disease through a process of patient interviews and analysis of patient responses to an item‐reduction questionnaire. This study sought to assess the feasibility, reliability, and validity of the instrument.MethodsThe readability statistics and number of unanswered questions were assessed among 147 patients (97 CD, 50 UC) with mean age 14.4 ± 2.2 years (range 9.2–18.0 years) using the self‐administered questionnaire. Internal consistency was assessed with Cronbach's α and test‐retest reliability using intraclass correlation coefficient (ICC). Construct validity was based on a priori hypotheses. Mean total scores were compared by ANOVA among patients grouped according to disease activity and disease severity within the past year.ResultsThe readability statistic showed a Flesch‐Kincaid Grade level of 4.5. Only 0.68% of questions were left blank. Reliability was excellent with Cronbach's α = 0.96, and an ICC of 0.90 in patients with stable disease over a two‐week period (n = 32). The mean total IMPACT score for patients with quiescent disease (180 ± 32) was significantly higher (better QOL) than for those with active disease (146 ± 31 for mild, 133 ± 34 for moderate/severe) (P < 0.005).ConclusionsThe IMPACT questionnaire is a valid and reliable reflection of health‐related quality of life of older children and adolescents with both ulcerative colitis and Crohn's disease.
Hydrolyzed Versus Nonhydrolyzed Protein Diet in Short Bowel Syndrome in Children
Authors: Ksiazyk Janusz , Piena Marjolein , Kierkus Jaroslaw , Lyszkowska Malgorzata 
Published: January 2024

ABSTRACTBackgroundThere is no consensus regarding the optimal enteral formula in patients with neonatal short bowel syndrome. The common practice in many centers is to give a semielemental diet.MethodsTo test the hypothesis that hydrolyzed protein is not superior to standard formula in promoting growth and development of children with short bowel syndrome, 10 children aged 4.08 ± 2.45 months (mean ± SD) underwent a prospective, randomized, crossover, double‐blind study lasting 60 days (with crossover on day 31). Two enteral formulas, which differed only with respect to the nitrogen form—hydrolyzed and nonhydrolyzed whey protein—were used. The endpoints of the study were nitrogen balance and intestinal permeability measured by the sugar absorption test (lactulose/mannitol excretion ratio).ResultsEnergy intake from enteral formula in patients fed hydrolyzed and nonhydrolyzed formula was the same and amounted to about 31% of total intake. The ratio of total energy intake (enteral and parenteral) to resting energy expenditure was 1.7 ± 0.5 and 1.5 ± 0.3 in patients fed hydrolyzed and non hydrolyzed formula respectively. Nitrogen balance was 0.28 ± 0.05 g/kg/d and 0.29 ± 0.05 g/kg/day, respectively. Lactulose/mannitol ratio before the study was 0.85 ± 0.85 and after hydrolyzed and nonhydrolyzed formula was 0.59% ± 0.51% and 0.69% ± 0.72%, respectively.ConclusionIntestinal permeability, energy, and nitrogen balance in short bowel syndrome were not influenced in the short term by hydrolysis of the enteral nitrogen source.
The Role of Esophagogastroduodenoscopy in the Initial Evaluation of Childhood Inflammatory Bowel Disease: A 7‐Year Study
Authors: Abdullah Bisher A. , Gupta Sandeep K. , Croffie Joseph M. , Pfefferkorn Marian D. , Molleston Jean Pappas , Corkins Mark R. , Fitzgerald Joseph F. 
Published: January 2024

ABSTRACTObjectivesTo assess the role of esophagogastroduodenoscopy in the evaluation of children with suspected inflammatory bowel disease.MethodsAll children with inflammatory bowel disease who underwent esophagogastroduodenoscopy during their initial evaluation at our institution during a 7‐year period (December 1993 to November 2000) were included in the study.ResultsThe study included 115 patients: 81 with Crohn disease (mean age, 11.34 years; 42 males) and 34 with ulcerative colitis (mean age, 11.79 years; 20 males). Abnormal findings on esophagogastroduodenoscopy were noted in 64% of patients with Crohn disease and 50% of children with ulcerative colitis; histologic abnormalities were found in 81.6% and 70.6% of the patients, respectively. Granulomas were found in the upper gastrointestinal tracts of 23 of 81 patients (28.4%), with the most common site being the gastric mucosa. Nine of these 23 patients had granulomas solely in the upper gastrointestinal tract. Additional unsuspected pathology noted included: candidiasis, hiatal hernia, Helicobacter pylori infection, and giardiasis.ConclusionsEndoscopic and histologic abnormalities were found in the upper gastrointestinal tracts of a significant number of children with inflammatory bowel disease. While the mechanism(s) underlying these abnormalities in patients with ulcerative colitis is unclear, the pathology can contribute to the patient's clinical condition. Pathology in the upper gastrointestinal tract should not exclude a diagnosis of ulcerative colitis. Granulomas, confirming the diagnosis of Crohn disease, were found in the upper gastrointestinal tracts of 28% of our patients with Crohn disease. In some cases, granulomas were found solely in the upper gastrointestinal tracts. Based on our data, esophagogastroduodenoscopy with biopsy should be performed in all pediatric patients with suspected inflammatory bowel disease.
Endoscopic Nodular Gastritis: An Endoscopic Indicator of High‐Grade Bacterial Colonization and Severe Gastritis in Children With Helicobacter pylori
Authors: Bahú Maria da Graça Soares , da Silveira Themis Reverbel , Maguilnick Ismael , Ulbrich‐Kulczynski Jane 
Published: January 2024

ABSTRACTObjectiveTo investigate the significance of endoscopic nodular gastritis associated with Helicobacter pylori infection.MethodsThis prospective study included 185 children (50.8% boys) aged 1 to 12 years (mean, 6.9 ± 3.0 years) who underwent upper intestinal endoscopy during evaluation of chronic abdominal pain. The authors assessed the endoscopic appearance of the stomach, noting those patients with endoscopic nodular gastritis. Urease activity of gastric mucosal biopsies was measured. With histologic examination, the presence and density of H. pylori organisms, the presence of follicular gastritis, the nature of inflammation, and the gastritis activity grade and overall gastritis score were assessed.ResultsH. pylori infection was identified in 50 children (27%). Endoscopic nodular gastritis was significantly associated with active chronic gastritis and follicular gastritis. Nodularity in the stomach showed a high specificity (98.5%) and positive predictive value (91.7%) for the diagnosis of H. pylori infection and was observed in 22 of 50 (44%) H. pylori‐positive patients and in 2 of 135 (1.5%) H. pylori‐negative patients. A significant association was observed between older age and the prevalence of this finding (P < 0.001). There was a significant increase in endoscopic nodular gastritis with increased H. pylori density and a positive correlation (Pearson coefficient = 0.97) with increased gastritis score on histologic examination. Increase in gastritis score was dependent on increased H. pylori density in patients with gastric nodularity; this finding was independent of age.ConclusionsEndoscopic findings of antral nodularity in children suggest the presence of H. pylori infection and follicular gastritis and may identify cases of severe gastritis and marked bacterial colonization.