Journal of Comprehensive Pediatrics
Volume:8 Issue: 3, Aug 2017

High-fat content and carbohydrate restriction of the ketogenic diet (KD) increases the workload of some organs, especially the liver. Moreover, most of the antiepileptic drugs (AEDs) are metabolized in the liver; therefore, the function of the liver could be influenced during the treatment with KD. This study was undertaken to investigate the influence of the ketogenic diet on liver function.
A prospective, open-label study was carried out. A total of 28 patients with intractable epilepsy initiated the diet. All patients were children and adolescents who did not respond to at least 2 AEDs. Liver function tests including Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were analyzed before and after 3 months on the KD.
Fourteen patients with the median age of 4.12 (2.31 - 9.70) years completed the study. The serum levels of ALP and AST did not differ significantly before and after 3 months on the diet (P value > 0.05). There was a significant difference in the serum level of ALT before and after 3 months of treatment (13 vrs 20, P = 0.014).
Albeit, it seems that KD did not have any influence on the serum levels of AST and ALP; however, it had a significant effect on the serum level of ALT. More investigations with a larger sample size and longer follow-up duration are needed to approve abovementioned results.

In conjunction with the increasing obesity epidemic there are concerns that hypertension is increasing. Many argue that blood pressure measurement should be an essential part of all consultations.
This study sought to establish whether General Paediatricians were recognising hypertension.
The clinic letters of each patient attending general paediatric outpatient clinics at Tauranga Hospital for the month of March 2013 were reviewed for demographic data, diagnosis, blood pressure recording and BMI.
Three hundred and forty two patients were seen. Forty six percent of patients had a blood pressure taken. Sixteen percent had an elevated reading. Thirty nine percent of these patients had a plan to manage the elevated reading recorded in their notes. Forty five percent of patients were thought to have needed a blood pressure and 85% of these received one. Two thirds of patients who were overweight/obese had their blood pressure taken.
Hypertension is under recognised by General Paediatricians. Ensuring all children who are at increased risk get a blood pressure measurement should be the first priority.

The World Health Organization has recommended exclusive breastfeeding for 6 months. Breastfeeding success may be influenced by different factors.
The aim of this study was to determine the association between prepregnancy body mass index (BMI) and breastfeeding duration in Iranian mothers.
This prospective cohort study was conducted at Arash Women's Hospital in Tehran, Iran. The analysis included 593 women, followed from pregnancy until 6 months postpartum. A logistic regression model was used to determine the association between prepregnancy BMI and exclusive breastfeeding duration and initiation.
Women with prepregnancy BMI above 25 kg/m2 had a higher risk (almost twice) of not initiating breastfeeding or breastfeeding for less than 1 month after delivery, compared to pregnant women who had a normal weight. In this study, adjustments were made for confounding factors, such as age, education level, mode of delivery, mother's opinion of breastfeeding, and mother's occupation.
This study showed that women who had a normal prepregnancy weight were more likely to continue breastfeeding for 6 months, while obese and overweight women had a shorter duration of breastfeeding in comparison with normal-weight women.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency increases the vulnerability of red blood cells to oxidative damage. In this study, we aimed to evaluate the association of serum zinc level with the severity of G6PD deficiency in children with acute hemolysis.
This cross sectional study was performed on 40 children, admitted to hospital due to acute hemolysis of G6PD deficiency. Hemoglobin level, number of transfusions, severity of hemoglobinuria, duration of acute hemolysis, and severity of hemoglobin drop were recorded; moreover, serum zinc level was monitored. Statistical analyses were performed using SPSS version 18.
The serum concentration of zinc was higher in male patients compared to females (P = 0.044), while hemoglobin level upon admission was lower in male patients (P = 0.013). The serum level of zinc had no association with hemoglobin level (0.333), number of transfusions (P = 0.604), severity of hemoglobinuria (P = 0.569), duration of acute hemolysis (P = 0.908), and severity of hemoglobin drop (P = 0.932).
This study revealed that serum zinc concentration was not associated with the severity of acute hemolysis in G6PD-deficient children.

There are studies indicating the relationship between interleukin 13 and pathogenesis of nephrotic syndrome. To find this relationship, we measured serum IL13 concentration in acute and remission phases in children with steroid sensitive nephrotic syndrome.
The serum of 15 patients was achieved for measurement of IL-13 in two phases: acute phase and remission phase. To this end, we used Biofarm ELIZA kites.
The mean concentration of serum IL-13 was 430 ± 279 ng/mL (227 - 960 ng/mL) before starting steroid treatment. The mean concentration of serum IL-13 was 428 ± 259 ng/mL (215.6 - 960 ng/mL) after 4 weeks of steroid treatment. The difference between pre and post treatment of serum IL-13 levels was not significant (P = 0.91).
We showed serum IL13 does not significantly decrease after steroid treatment. Although the role of IL13 in increasing glomerular permeability has been shown in previous studies, the local IL13 may be more important than the systemic form. It also can be postulated that mediators other than IL13 also have primary roles in pathogenesis of proteinuria. However, we need more studies to determine the role of IL13 in the pathogenesis of nephrotic syndrome.

Cerebral palsy (CP) is the leading cause of childhood disability. Children with CP are at risk for growth and nutritional disorders. The current study aimed at evaluating the growth and nutritional status of children with CP and assessing the relationship between the studied variables, clinical presentation, disease severity, and functional level in these patients in Northwest Iran.
In the current cross sectional, descriptive study, 99 outpatient children with CP referring to the rehabilitation clinic of children’s Medical center in Tabriz, Iran, were studied for a 12-month period from June 2015 to June 2016. Demographic variables, CP type, anthropometric measures, and GMFCS (gross motor function classification system) were recorded. The patients’ weight and height were measured, and then, weight-for-age and height-for-age percentiles were calculated based on the percentile charts for all patients. Dietary intake of the children was determined by the 24-hour dietary recalls of 3 nonconsecutive days (2 weekdays and 1 weekend day) by asking their parents as reliable reporters.
Sixty-four patients had inadequate calorie intake, while 47 and 42 patients had abnormal weight and height percentiles. Quadriplegic and diplegic types CP, compared with the hemiplegic type (P = 0.003 and P = 0.043), and GMFCS III to V, compared with the classes I and II (P = 0.001), had significantly less normal weight percentiles, but there were no significant differences between normal and abnormal height percentiles, based on CP type and GMFCS level.
Abnormal growth was significantly common in children with quadriplegic and diplegic CP and high GMFCS level. About 64% of the children had inadequate calorie intake. Nutritional management should be arranged for the undernourished children to promote their nutritional status and improve their growth and functional capacities.

Hypercalciuria may be a sign of infrequent voiding; these symptoms may be treated if we get rid of hypercalciuria.
This paper is intended to get to the prevalence of hypercalciuria in girls (kids) with infrequent voiding.
80 patients with the index of infrequent voiding, who were admitted to Amir-Kabir hospital of Arak, and 80 children who were admitted without any particular disease just for a laboratory check were studied simultaneously. Urine sample (U/A-U/C), kidney, and bladder sonography was taken from both groups.
The prevalence of hypercalciuria in the normal group was 9.64% and in the case group was 53.18% (P = 0.003). Based on the chi-square test, hypercalciuria distribution between the 2 groups is not homogeneous. Mean calcium to creatinine ratios were 0.17 ± 0.18 (mg/mg) and 3.9 ± 0.34 (mg/mg) for control and case groups, respectively and significant difference is observed between the 2 groups (P = 0.0001). Based on the logistic regression test, there is a significant relationship between both case and control groups and the occurrence of hypercalciuria with 6.3 times more than the control group observed in the case group.
Based on the high prevalence of hypercalciuria in the case group, examination and treatment of hypercalciuria in patients with infrequent voiding may be effective.