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Stray-Pedersen A.,University of Oslo | Omland S.,University of Oslo | Nedregaard B.,University of Oslo | Klevberg S.,Paediatric Clinic | Rognum T.O.,University of Oslo
Forensic Science, Medicine, and Pathology | Year: 2011

An 11-month-old girl presented to hospital with a massive subdural haematoma and bilateral retinal haemorrhages following an allegedly minor fall. There were no external signs of bruising and no prior bleeding tendency was reported. Although initial analyses were normal, repeated testing of the coagulation-fibrinolysis system led to a diagnosis of mild von Willebrand disease (vWD) Type 1. It was concluded that minor head trauma as described by the parents, in the presence of such a coagulation disorder, could explain the findings. Police charges against the parents, initially accused of child abuse, were withdrawn. Retinal haemorrhages in infants with vWD have not been previously reported. This case highlights the importance of considering vWD as a possible contributory factor in cases of infant head injury. © 2010 Springer Science+Business Media, LLC.

Palumbo E.,Paediatric Clinic
Therapeutic Advances in Chronic Disease | Year: 2011

In patients affected by chronic hepatitis C (CHC) infection, viral eradication can be achieved by antiviral therapy based on the use of a combination of pegylated interferon a-2a or 2b and ribavirin that yields a sustained eradication in 40-50% of cases. The aim of this review is to evaluate the efficacy of pegylated interferon a-2a or a-2b plus ribavirin in the treatment of CHC infection. Treatment must be started in patients with detectable serum hepatitis C virus (HCV) RNA independently by serum alanine aminotransferase levels. In patients infected with genotype 1 or 4 HCV before treatment, a histological evaluation is required. These patients can be treated if stage is >2 according to the Knodell index. The treatment must be for 1 year duration and current guidelines allow treatment to be continued if patients remain HCV RNA positive at week 12 if a 2-log drop in viral load has been achieved. In patients with genotype 2 or 3 HCV, therapy must be prolonged for 6 months and histological evaluation pretreatment is not necessary. © The Author(s), 2011.

Lind A.,Skane University Hospital | Ramelius A.,Skane University Hospital | Olsson T.,Karolinska Institutet | Arnheim-Dahlstrom L.,Karolinska Institutet | And 8 more authors.
Journal of Autoimmunity | Year: 2014

Narcolepsy is a lifelong sleep disorder related to hypocretin deficiency resulting from a specific loss of hypocretin-producing neurons in the lateral hypothalamic area. The disease is thought to be autoimmune due to a strong association with HLA-DQB1*06:02. In 2009 the World Health Organization (WHO) declared the H1N1 2009 flu pandemic (A/H1N1PDM09). In response to this, the Swedish vaccination campaign began in October of the same year, using the influenza vaccine Pandemrix®. A few months later an excess of narcolepsy cases was observed. It is still unclear to what extent the vaccination campaign affected humoral autoimmunity associated with narcolepsy. We studied 47 patients with narcolepsy (6-69 years of age) and 80 healthy controls (3-61 years of age) selected after the Pandemrix vaccination campaign. The first aim was to determine antibodies against A/H1N1 and autoantibodies to Tribbles homolog 2 (TRIB2), a narcolepsy autoantigen candidate as well as to GAD65 and IA-2 as disease specificity controls. The second aim was to test if levels and frequencies of these antibodies and autoantibodies were associated with HLA-DQB1*06:02.Invitro transcribed and translated [35S]-methionine and -cysteine-labeled influenza A virus (A/California/04/2009/(H1N1)) segment 4 hemagglutinin was used to detect antibodies in a radiobinding assay. Autoantibodies to TRIB2, GAD65 and IA-2 were similarly detected in standard radiobinding assays. The narcolepsy patients had higher median levels of A/H1N1 antibodies than the controls (p=0.006). A/H1N1 antibody levels were higher among the <13 years old (n=12) compared to patients who were older than 30 years (n=12, p=0.014). Being HLA-DQB1*06:02 positive was associated with higher A/H1N1 antibody levels in both patients and controls (p=0.026). Serum autoantibody levels to TRIB2 were low overall and high binders did not differ between patients and controls. We observed an association between levels of A/H1N1 antibodies and TRIB2 autoantibody levels particularly among the youngest narcolepsy patients (r=0.819, p<0.001).In conclusion, following the 2009 influenza pandemic vaccination, A/H1N1 antibody levels were associated with young age-at-onset narcolepsy patients positive for HLA-DQB1*06:02. The possibility that TRIB2 is an autoantigen in narcolepsy remains to be clarified. We could verify autoantibody responses against TRIB2 which needs to be determined in larger patient cohorts and control populations. © 2014 Elsevier Ltd.

Kunesova M.,Institute of Endocrinology | Vignerova J.,National Institute of Public Health | Parizkova J.,Institute of Endocrinology | Prochazka B.,Paediatric Clinic | And 6 more authors.
Obesity Reviews | Year: 2011

The objective of this paper was an evaluation of change in prevalence of overweight and obesity in Czech children, and a comparison of cut-off points for body mass index references from the Czech Republic (CzR), International Obesity Task Force and WHO. The authors conducted a survey in 7-year-old children, and compared data from 1951, 1981, 1991, 2001 and 2008 (WHO cut-offs). 2008 data were evaluated according to different cut-offs. Results showed that since 1951 in boys, overweight prevalence increased from 13.0% in 1951 to 26.8% in 2001, in girls from 10.9% to 22.9%. Obesity increased in boys from 1.7% to 8.3%, in girls from 1.7% to 6.9%. From 2001 to 2008 obesity in boys increased; obesity in girls and overweight in both genders decreased. In 2008 cohort the following values were found: overweight and obesity: CzR criteria, percentage was lowest (14.8% boys and 11.1% girls); WHO criteria, highest prevalence (23.5% boys and 19.5% girls); obesity: lowest ratio International Obesity Task Force criteria (4.4% boys, 3.3% girls), highest ratio boys WHO criteria (10.0%), girls CzR criteria (5.0%). Overweight and obesity prevalence increased in 7-year-old Czech children since 1951; since 2001 prevalence is plateauing with exception of boys. Using different body mass index references resulted in marked differences in overweight and obesity prevalence. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

Muckelbauer R.,Charite - Medical University of Berlin | Kalhoff H.,Paediatric Clinic | Muller-Nordhorn J.,Charite - Medical University of Berlin | Kersting M.,University of Bonn
Current Nutrition and Food Science | Year: 2011

Childhood overweight and obesity is a global epidemic with rising trends in both developed and developing countries. Overweight and obesity are major causes of morbidity during childhood and are important early risk factors for several adult morbidities and mortality. Although the mechanism of overweight development is not fully understood, it is confirmed that overweight occurs as a consequence of imbalance between individual energy intake and energy expenditure. Besides genetic factors, modifiable factors such as family behavior, cultural environment, personal lifestyle choices such as a sedentary lifestyle and unhealthy dietary habits influence the development of obesity resulting in an increased 'obesogenic' risk in specific groups of children. So far, previous intervention programs have had limited success in tackling the rising prevalence of obesity. Thus, in addition to treatment and individual approaches, prevention programs targeting the obesogenic environment could be the key strategy for controlling the epidemic of obesity. This article is aimed to present definitions as well as the epidemiology of overweight and obesity. Furthermore, it describes the current knowledge on the multifactorial etiology involving interactions among genetic background and different social and environmental factors. The article critically reviews the current body of evidence regarding the effectiveness of previous interventions to prevent the development of overweight and obesity during childhood. Finally, recommendations for future research are provided which is needed to improve and enable the prevention of obesity in children and adolescents. © 2011 Bentham Science Publishers.

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