ABSTRACT Objective: The aim of this study was to investigate the effect of childhood Type 1 diabetes (DM) on ocular parameters. Subjects and methods: Forty-six children with Type 1 DM without diabetic retinopathy (Group 1) and 76 healthy children (Group 2) were included in the study. Routine eye examinations and fundus photography were performed. Central corneal thickness (CCT), contract ultrasonic pachymetry and intraocular pressure (IOP) were measured. Retinal nerve fibre layer (RNFL) thickness was measured in four separate quadrants. Central 1-mm maximum retinal thickness and minimum full retinal thickness at the foveal pit (MFRT) were measured with the same Fourier-domain optical coherence tomography. Data for the two groups were then compared. Results: One hundred thirty-five children were included. Mean CCT and IOP values did not differ significantly between the groups (p > 0.05). Minimum foveal thickness (p < 0.05) and MFRT (p = 0.008) measurements in Group 1 were significantly lower compared to those in Group 2. No significant difference was determined between the groups in terms of mean, inferior, superior, nasal or temporal MFRT (p > 0.05). Conclusion: Variations may arise in IOP and CCT in children with Type 1 DM. Neurodegenerative processes in the retina may begin before the onset of diabetic retinopathy.

RESUMEN Objetivo: El objetivo de este estudio fue investigar el efecto de la diabetes tipo 1 (DM) en los parámetros oculares en la niñez. Sujetos y métodos: En el estudio se incluyeron cuarenta y seis niños con DM tipo 1 sin retinopatía diabética (Grupo 1) y 76 niños sanos (Grupo 2). Se realizaron exámenes oculares de rutina y fotografías de fondo de ojo. Se midieron el espesor corneal central (ECC), paquimetría ultrasónica y la presión intraocular (PIO). El espesor de capa de fibras ner-viosas de la retina (CFRN) se midió en cuatro cuadrantes separados. El espesor foveal central mínimo (EFCM) de 1 mm y el espesor retiniano completo mínimo en el pozo foveal (ERCM) se midieron con la misma tomografía de coherencia óptica en el dominio de Fourier. Luego se compararon los datos de los dos grupos. Resultados: Se incluyeron treinta y cinco niños. Los valores promedio de ECC y PIO no difirieron significativamente entre los grupos (p > 0.05). Las mediciones del espesor foveal mínimo (p < 0.05) y ERCM (p = 0.008) en el Grupo 1 fueron significativamente más bajas en comparación con las del Grupo 2. No se determinaron diferencias significativas entre los grupos en términos de ERCM medio, inferior, superior, nasal o temporal (p > 0.05). Conclusión: Pueden presentarse variaciones en la PIO y el ECC en los niños con DM tipo 1. Los procesos neurodegenerativas en la retina pueden comenzar antes de la aparición de la retinopatía diabética.

ABSTRACT Diaphragmatic hernia originates from insufficient closure of the pericardioperitoneal canals and pleuroperitoneal membranes. It is seen in one in every 4000 births. The general finding in the newborn period is respiratory difficulty. Mortality is 40–50%. There may be other accompanying organ anomalies. Congenital diaphragmatic hernias diagnosed after the newborn period are known as late-presenting congenital diaphragmatic hernias. This group is seen at a level of 5–20% and poses difficulty in diagnosis. This report describes a case under observation and receiving treatment for gastrointestinal haemorrhage, diagnosed as Bochdalek hernia.

RESUMEN La hernia diafragmática se produce a causa del cierre insuficiente de los canales pericardioperitoneales y las membranas pleuroperitoneales. Se la encuentra en uno de cada 4000 nacimientos. El hallazgo general en el período neonatal es la dificultad respiratoria. La mortalidad es del 40-50%. Pueden presentarse otras anomalías acompañantes en los órganos. Las hernias diafragmáticas congénitas diagnosticadas después del período de recién nacido, se conocen como hernias diafragmáticas congénitas de presentación tardía. Este grupo se observa en un nivel de 5 – 20% y plantea dificultades de diagnóstico. El presente reporte describe un caso bajo observación y tratamiento por hemorragia gastrointestinal, diagnosticada como hernia de Bochdalek.

ABSTRACT Aim: Leuprolide acetate is a gonadotropin-releasing hormone (GnRH) analogue frequently used in the treatment of central precocious puberty. Research is currently taking place into its effects on endocrine systems. The aim of this study is to investigate the effect of leuprolide acetate on vitamin D and bone mineral density. Methods: Twenty-three children diagnosed with central precocious puberty and receiving leuprolide acetate therapy for at least 12 months, and a control group of 17 healthy children were enrolled. In the study group, calcium, phosphorus, alkaline phosphatase, parathormone and 25-hydroxy vitamin D levels and bone mineral density were measured. The results were compared with those of the control group. Results: 25-Hydroxy vitamin D levels in the study and control groups were 15.17 ± 7 mg/dL and 22.2 ± 6.1mg/dL, respectively (p < 0.05). In terms of bone mineral density, osteopenia was determined in 13 (56.5%) patients in the study group and osteoporosis in one (4.3%), while osteopenia was identified in seven patients in the control group, with no osteoporosis being identified (p > 0.05). Conclusion: Gonadotropin-releasing hormone agonists may have an adverse effect on bone health. They may exhibit these effects by impacting on vitamin D levels. These levels should be periodically monitored in patients receiving treatment, and vitamin D support should be given in cases where the deficiency is identified.

RESUMEN Objetivo: El acetato de leuprolide es un análogo de la hormona liberadora de la gonadotropina (GnRH) utilizado con frecuencia en el tratamiento de la pubertad precoz central. Actualmente se investigan sus efectos sobre el sistema endocrino. El objetivo de este estudio fue investigar el efecto del acetato de leuprolide sobre la vitamina D y la densidad mineral ósea. Métodos: Veintitrés niños diagnosticados con pubertad precoz central, que recibieron terapia de acetato de leuprolide durante al menos 12 meses, y un grupo control de niños sanos 17, fueron los sujetos de la investigación. En el grupo de estudio, se midieron los niveles de calcio, fósforo, fosfatasa alcalina, parathormona, y 25-hidroxivitamina D, así como la densidad mineral ósea. Los resultados fueron comparados con los del grupo control. Resultados: Los niveles de 25-hidroxivitamina D en los grupos de estudio y control fueron 15.17 ± 7 mg/dL y 22.2 ± 6.1 mg/dL, respectivamente (p < 0.05). En términos de la densidad mineral ósea, se de-terminó la existencia de osteopenia en 13 pacientes (56.5%) en el grupo de estudio, y osteoporosis en uno (4.3%), en tanto que se identificó osteopenia en siete pacientes en el grupo control, sin que se identificara osteoporosis (p > 0.05). Conclusión: Los agonistas de la hormona liberadora de la gonadotropina pueden tener efectos adversos sobre la salud ósea, por su impacto sobre los niveles de vitamina D. Estos niveles deben vigilarse periódicamente en los pacientes que reciben tratamiento, y debe apoyarse el suministro de vitamina D en los casos en que se detecte su deficiencia.

The purpose of this study was to investigate the effect of supplementary vitamin D therapy in addition to amitriptyline on the frequency of migraine attacks in pediatric migraine patients. Fifty-three children 8-16 years of age and diagnosed with migraine following the International Headache Society 2005 definition, which includes childhood criteria, were enrolled. Patients were classified into four groups on the basis of their 25-hydroxyvitamin D [25(OH)D] levels. Group 1 had normal 25(OH)D levels and received amitriptyline therapy alone; group 2 had normal 25(OH)D levels and received vitamin D supplementation (400 IU/day) plus amitriptyline; group 3 had mildly deficient 25(OH)D levels and received amitriptyline plus vitamin D (800 IU/day); and group 4 had severely deficient 25(OH)D levels and was given amitriptyline plus vitamin D (5000 IU/day). All groups were monitored for 6 months, and the number of migraine attacks before and during treatment was determined. Calcium, phosphorus alkaline phosphatase, parathormone, and 25(OH)D levels were also determined before and during treatment. Results were compared between the groups. Data obtained from the groups were analyzed using one-way analysis of variance. The number of pretreatment attacks in groups 1 to 4 was 7±0.12, 6.8±0.2, 7.3±0.4, and 7.2±0.3 for 6 months, respectively (all P>0.05). The number of attacks during treatment was 3±0.25, 1.76±0.37 (P<0.05), 2.14±0.29 (P<0.05), and 1.15±0.15 (P<0.05), respectively. No statistically significant differences in calcium, phosphorus, alkaline phosphatase, or parathormone levels were observed (P>0.05). Vitamin D given in addition to anti-migraine treatment reduced the number of migraine attacks.

ABSTRACT Epstein-Barr virus (EBV) infection causes a wide spectrum of illness in humans including subclinical infection, infectious mononucleosis, and is associated with some malignancies. This report presents the clinical findings of an unusual case of EBV encephalitis in a 10-month old infant who presented with a febrile infection and seizures. The clinical manifestations, serologic study and a dynamic change of EBV DNA in cerebrospinal fluid with spontaneous recovery confirmed the diagnosis of EBV infection of the nervous system.

RESUMEN La infección por el virus de Epstein-Barr (EBV) causa un amplio espectro de enfermedades en los seres humanos, incluyendo infecciones subclínicas y mononucleosis infecciosa, y se asocia con algunas enfermedades malignas. Este reporte presenta los resultados clínicos de un caso poco usual de encefalitis por EBV en un niño de 10 meses que presentó una infección febril y convulsiones. Las manifestaciones clínicas, un estudio serológico y un cambio dinámico del ADN de EBV en el líquido cerebroespinal con recuperación espontánea, confirmaron el diagnóstico de infección del sistema nervioso por EBV.

Familial Mediterranean fever (FMF) is a periodic autoinflammatory disease characterized by chronic inflammation. This study investigated the relationship between acute-phase reactants and gene mutations in attack-free periods of childhood FMF. Patients diagnosed with FMF were divided into four groups based on genetic features: no mutation, homozygous, heterozygous, and compound heterozygous. These groups were monitored for 2 years, and blood samples were collected every 6 months during attack-free periods. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and white blood cell count were measured. A disease severity score was determined for each patient. Mean values for erythrocyte sedimentation rate and fibrinogen were significantly different in the homozygous group. White blood cell count and C-reactive protein were similar between the groups. Disease severity score was higher in patients with the M694V mutation than in individuals without the mutation, as well as in those with other mutation groups. Periodic follow-up of patients with FMF MEFV mutations in subjects with acute-phase reactants may be useful in the prevention of morbidity.