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O'Gorman C.S.,Hospital for Sick Children Research Institute | O'Gorman C.S.,University of Limerick | Simoneau-Roy J.,Hospital for Sick Children Research Institute | Simoneau-Roy J.,Universite de Sherbrooke | And 3 more authors.
International Journal of Pediatric Obesity | Year: 2011

Ghrelin, released from the stomach, acts at the hypothalamus and is associated with initiation of food intake. We hypothesised that patients with craniopharyngioma and hypothalamic obesity (CRHO) would have ghrelin abnormalities. Fifteen CRHO patients and 15 BMI-matched controls underwent oral glucose tolerance test with dynamic ghrelin measurement. From 030 minutes, ghrelin (pg/ml) decreased less (43.4 ± 38.8 vs. 70.8 ± 35.8, p < 0.05) and insulin (pmol/l) increased more (1 669.2 ± 861.7 vs. 1 049.1 ± 560.4, p = 0.04) in CRHO compared with controls, respectively. Insulin area-under-the-curve was a weak negative predictor of the 030 minutes ghrelin decrease (r2 = 0.29, p = 0.02). Delayed ghrelin suppression may contribute to obesity in CRHO. © 2011 Informa Healthcare.

Jones K.C.,Hospital for Sick Children | Hawkins C.,Pediatric Laboratory Medicine | Armstrong D.,University of Toronto | Deveber G.,Hospital for Sick Children | And 3 more authors.
Developmental Medicine and Child Neurology | Year: 2013

Aim Wallerian degeneration is a radiological finding thought to reflect corticospinal tract degeneration. This finding on magnetic resonance imaging (MRI) is routinely used as a predictor of poor prognosis in childhood stroke. However, its validity has never been established. Our objective was to correlate Wallerian degeneration seen on MRI with histopathology. Method We searched the databases of the Department of Pathology and Children's Stroke registry at the Hospital for Sick Children, Toronto for autopsy specimens exhibiting focal infarcts from children born at term who underwent MRI after a stroke. The specimens were examined for Wallerian degeneration and then correlated with the pre-mortem MRI findings. Results Seven children (four females, three males) with a median age of 11years (1-17y) at the time of stroke met the inclusion criteria for this study. Of the seven children included in the study with ischaemic or haemorrhagic infarcts, six had concordant Wallerian degeneration findings on both MRI and post-mortem histopathological examination. The median time between stroke and death was 20days (3-1825d). Interpretation Our results show for the first time that the radiographic finding of Wallerian degeneration is a valid biomarker of corticospinal tract degeneration in children who have had ischaemic or haemorrhagic stroke. © 2012 Mac Keith Press.

O'Gorman C.S.,University of Toronto | O'Gorman C.S.,University of Limerick | Simoneau-Roy J.,University of Toronto | Simoneau-Roy J.,Universite de Sherbrooke | And 12 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: Retrospective studies suggest that adolescents with craniopharygnioma and hypothalamic obesity have increased sleep-disordered breathing (SDB). Objectives: The objectives of this study were to compare the prevalence of SDB in adolescents with craniopharyngioma-related obesity compared with body mass index (BMI)-matched controls and to explore possible relationships between SDB, insulin resistance, and adipocytokines. Design: This was a cross-sectional study of obese craniopharyngioma and obese control adolescents. Setting: Subjects were evaluated in the clinical investigation unit at the Hospital for Sick Children, Toronto. Patients: Fifteen patients with craniopharyngioma-related obesity and 15 BMI-matched controls were recruited and tested. Interventions: Each subject underwent fasting blood work, frequent sampled iv glucose tolerance test, polysomnography, and abdominal magnetic resonance imaging with calculation of visceral and sc adipose tissue. Main Outcome Measures: Main measures included insulin sensitivity, sleep efficiency, and fragmentation. Results: Insulin sensitivitywaslower in craniopharyngioma subjectscomparedwith control subjects (0.96 ± 0.34 vs. 1.67 ± 0.7, P = 0.01). Sleep-onset latency (19.3 ± 27.8 vs. 31.9 ± 23.4, P = 0.03) and oxygen saturations (rapid eye movement sleep: 89.0 ± 5.1 vs. 94.2 ± 2.3, P < 0.001; non-rapid eye movementsleep: 88.4 ± 5.6 vs. 94.3 ± 1.5, P < 0.001) were lower in craniopharyngioma. Obstructive apnea-hypopnea index (OAHI) (7.5 ± 9.0 vs. 1.5 ± 1.5, P = 0.03) was higher in craniopharyngioma. Respiratory distress index and OAHI correlated negatively with adiponectin concentrations (r = -0.61, P = 0.03, r = -0.71, P = 0.006, respectively) in craniopharyngioma. On multiple regression, TNF-α and craniopharyngioma were independent positive predictors of sleep-onset latency and adiponectin and craniopharyngioma were significant predictors (negative and positive, respectively) of OAHI. Conclusions: SDB is increased in adolescents with craniopharyngioma-related obesity compared with BMI-matched controls. Routine polysomnography should be considered in obese patients with craniopharyngioma and appropriate treatment initiated. Copyright © 2010 by The Endocrine Society.

Balma-Mena A.,Hospital for Sick Children | Lara-Corrales I.,Hospital for Sick Children | Zeller J.,Hospital for Sick Children | Richardson S.,Pediatric Laboratory Medicine | And 3 more authors.
International Journal of Dermatology | Year: 2011

Background Bacterial infection with Staphylococcus aureus is a common complication of atopic dermatitis (AD). The incidence of community-acquired methicillin-resistant S. aureus infection (MRSA) in the AD population is unknown. Objectives This study aimed to assess the prevalence of S. aureus and MRSA in pediatric patients with AD, to compare disease severity, and to characterize the clonal diversity of the isolates. Methods We carried out a prospective, cross-sectional study of 200 patients with AD. The severity of AD was defined as mild, moderate, or severe depending on a composite AD severity score. A swab was taken from the nares of each patient and another from affected skin or folds. Genotyping of all S. aureus isolates was conducted by polymerase chain reaction (PCR) amplification of the S. aureus protein A (spa) gene. Results According to the severity score, 66.5% of subjects were ranked as having mild AD, 29.5% as having moderate and 4% as having severe AD. Staphylococcus aureus colonization was seen in 61.5% of all patients, represented by 43.7% of skin swabs and 48% of nares swabs. Only one of the isolations represented MRSA. Older age and higher AD severity scores were associated with S. aureus colonization (P=0.03 and P<0.001, respectively). No significant associations were noted for attendance at day care, family members with frequent skin infections, or family members working in healthcare. Isolates from spa CC015 were cultured in 19.2% of patient samples. The single MRSA culture showed a new spa type that belonged to CC127. Conclusions The results of this study confirm a high rate of S. aureus colonization of pediatric patients with AD. The low rate of MRSA requires further proof from larger prospective studies. © 2011 The International Society of Dermatology.

Alexander A.J.,University of Toronto | Richardson S.E.,Pediatric Laboratory Medicine | Sharma A.,University of Toronto | Campisi P.,University of Toronto
Canadian Journal of Infectious Diseases and Medical Microbiology | Year: 2011

OBJECTIVE: To retrospectively review trends in clindamycin resistance among Staphylococcus aureus head and neck abscesses between January 2000 and June 2008. METHODS: Between January 2000 and June 2008, inpatient and outpatient S aureus isolates were reviewed for antibiotic susceptibility. In particular, cultures from 153 abscesses in the head and neck region were assessed for clindamycin and methicillin resistance patterns. RESULTS: Annual clindamycin resistance rates for all S aureus isolates, and specifically for S aureus head and neck abscesses, revealed concerning levels of clindamycin and methicillin resistance. After 2002, the mean clindamycin resistance rate in head and neck abscesses was approximately 27%. The number of new cases of methicillinresistant S aureus per year increased from four cases in 2000 to 44 cases in 2007. CONCLUSION: Antibiotic resistance should be considered following failed empirical therapy of head and neck abscesses with clindamycin. ©2011 Pulsus Group Inc. All rights reserved.

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