No abstract available.
Child ; Male ; Female ; Humans

Lots of cases relating Helicobacter pylori infection to iron-deficiency anemia have been described in the literature and H. pylori infection has emerged as a cause of refractory iron-deficiency anemia which is unresponsive to oral iron therapy. H. pylori-associated iron-deficiency anemia can be treated by H. pylori eradication. It is not thought to be attributable to gastrointestinal blood loss, such as duodenal ulcer. The mechanism by which H. pylori infection contributes to iron-deficiency anemia remains unclear. However, four possible explanations can be posited for this relationship; occult blood loss secondary to chronic gastritis, reduced iron absorption due to hypo- or achlorhydria, increased iron consumption by H. pylori, and iron sequestration in gastric mucosa. H. pylori- associated iron-deficiency anemia seems to develop in populations at increased risk for iron depletion. When pubescent girls, including athletes, are found to have iron-deficiency anemia refractory to iron administration, they should be evaluated for H. pylori infection.
Absorption ; Achlorhydria ; Anemia, Iron-Deficiency* ; Athletes ; Duodenal Ulcer ; Female ; Gastric Mucosa ; Gastritis ; Helicobacter pylori ; Humans ; Iron ; Occult Blood

Helicobacter pylori(H. pylori) infection is mainly acquired in childhood. The prevalence of infection is still highest in children in the developing world. There has been a need for clinical guidelines for H. pylori infection in children. Therefore, the North American Society for Pediatric Gastroenterology and Nutrition and the European Paediatric Task Force on H. pylori achieved consensus and developed clinical practice guidelines for the child with H. pylori infection, respectively. Although gastroduodenal endoscopy remains the diagnostic standard method for this infection, noninvasive tests, including serology, urea breath test and stool antigen test, showed good results in the different age groups. All children with a duodenal ulcer who have H. pylori infection should receive treatment for the infection. Children with iron-deficiency anemia which is refractory to iron therapy should be screened for H. pylori infection and if infected, treatment may be of benefit. In children, so far, there is no evidence demonstrating a link between H. pylori-associated gastritis and recurrent abdominal pain. In H. pylori-infected children with nonulcer gastritis, treatment of the infection has shown no proven benefit in symptom relief. Compliance and antibiotic resistance are main factors affecting the outcome of treatment.
Abdominal Pain ; Advisory Committees ; Anemia, Iron-Deficiency ; Breath Tests ; Child* ; Compliance ; Consensus ; Diagnosis* ; Drug Resistance, Microbial ; Duodenal Ulcer ; Endoscopy ; Gastritis ; Gastroenterology ; Gastrointestinal Diseases ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron ; Prevalence ; Urea

PURPOSE: Leptin is the product of the ob gene secreted by adipocyte. This study investigated whether leptin concentrations were elevated in obese children and the relationship between leptin concentrations and gender, and age in Korean children. METHODS: We measured serum concentrations of leptin in 124 subjects (10 to 18 years, 62 girls and 62 boys). Height, weight, obesity index, and body mass index were measured in 124 subjects. Radioimmunoassay for serum leptin was performed using Human Leptin RIA Kit. Data analysis was done according to the gender, age and obesity. RESULTS: The mean serum concentration of leptin was 5.3 +/- 4.9 ng/ml. The mean leptin level in girls was 7.6 +/- 5.2ng/ml compared with 2.9 +/- 3.3ng/ml in boys (P<0.001). Leptin concentrations were highly increased during the period of 14 to 17 years in girls. The mean serum concentration of leptin in obese group (obesity index>120%) was 8.7 +/- 6.0 ng/ml compared with 4.8 +/- 4.6ng/ml in non-obese group (P<0.01). Serum leptin concentrations were correlated with the body mass index (Pearsons coefficient r=0.42, P<0.001). When boys and girls with equivalent values of body mass index were compared, there was significant difference between the sexes (P<0.001). CONCLUSION: Serum leptin concentrations were significantly higher in girls and obese children. Increased adipose tissue in children was associated directly with serum leptin concentration. Because leptin concentrations were highly increased during the period of 14 to 17 years in girls, it was speculated that central leptin resistance in developing girls may be necessary for the accumulation of the adipose tissue stores.
Adipocytes ; Adipose Tissue ; Body Mass Index ; Child* ; Female ; Humans ; Leptin* ; Obesity ; Radioimmunoassay ; Statistics as Topic

PURPOSE: Leptin is the product of the ob gene secreted by adipocyte. This study investigated whether leptin concentrations were elevated in obese children and the relationship between leptin concentrations and gender, and age in Korean children. METHODS: We measured serum concentrations of leptin in 124 subjects (10 to 18 years, 62 girls and 62 boys). Height, weight, obesity index, and body mass index were measured in 124 subjects. Radioimmunoassay for serum leptin was performed using Human Leptin RIA Kit. Data analysis was done according to the gender, age and obesity. RESULTS: The mean serum concentration of leptin was 5.3 +/- 4.9 ng/ml. The mean leptin level in girls was 7.6 +/- 5.2ng/ml compared with 2.9 +/- 3.3ng/ml in boys (P<0.001). Leptin concentrations were highly increased during the period of 14 to 17 years in girls. The mean serum concentration of leptin in obese group (obesity index>120%) was 8.7 +/- 6.0 ng/ml compared with 4.8 +/- 4.6ng/ml in non-obese group (P<0.01). Serum leptin concentrations were correlated with the body mass index (Pearsons coefficient r=0.42, P<0.001). When boys and girls with equivalent values of body mass index were compared, there was significant difference between the sexes (P<0.001). CONCLUSION: Serum leptin concentrations were significantly higher in girls and obese children. Increased adipose tissue in children was associated directly with serum leptin concentration. Because leptin concentrations were highly increased during the period of 14 to 17 years in girls, it was speculated that central leptin resistance in developing girls may be necessary for the accumulation of the adipose tissue stores.
Adipocytes ; Adipose Tissue ; Body Mass Index ; Child* ; Female ; Humans ; Leptin* ; Obesity ; Radioimmunoassay ; Statistics as Topic

Besides H. pylori's well-known roles in gastroduodenal diseases, some authors have proposed a link between H. pylori and a number of extragastric diseases involving the cardiovascular, pulmonary, hepatobiliary, hematologic, and other systems. Most of these reports are epidemiological or eradication trials. Idiopathic thrombocytopenic purpura and iron-deficiency anemia are the diseases that show the strongest link with H. pylori infection. According to American College of Gastroenterology Guideline on the Management of H. pylori Infection, unexplained iron-deficiency anemia belongs to controversial indications for diagnosis and treatment of H. pylori. Many cases relating H. pylori infection to iron-deficiency anemia have been described in the literature and H. pylori infection has emerged as a cause of refractory iron-deficiency anemia which is unresponsive to oral iron therapy. H. pylori-associated iron-deficiency anemia can be treated by H. pylori eradication. The mechanism by which H. pylori infection contributes to iron-deficiency anemia remains unclear. H. pylori-associated iron-deficiency anemia seems to develop in populations at increased risk for iron depletion. When pubescent girls, including athletes, are found to have iron-deficiency anemia refractory to iron administration, they should be evaluated for H. pylori infection.
Aluminum Hydroxide ; Anemia, Iron-Deficiency ; Athletes ; Carbonates ; Gastroenterology ; Helicobacter pylori ; Humans ; Iron ; Purpura, Thrombocytopenic, Idiopathic

PURPOSE: The purpose of this study is to investigate whether there is a difference in leptin concentrations between those of children of normal weight and extremely obese children. METHODS: We measured serum concentrations of leptin in 70 extremely obese subjects(7 to 12 years, 20 girls and 50 boys), whose serums had been frozen at -70degrees C. Height, weight, obesity index, and body mass index were measured. Radioimmunoassay for serum leptin was performed using Human Leptin RIA Kit. RESULTS: The mean age was 10.1 years old. The mean serum concentration of leptin in extremely obese children was 15.0+/-6.8ng/ml. The mean leptin level in girls was 15.2+/-6.7ng/ml compared with 15.0+/-6.7ng/ml in boys(P=0.91). The mean obesity index in girls was 58.7+/-8.1% compared with 62.1+/-11.2% in boys. The mean body mass index in girls was 25.6+/-1.9 compared with 26.8+/-2.1 in boys. Serum leptin concentrations correlated with the body mass index(r=0.38, P=0.001). The mean leptin level in the extremely obese group was significantly higher than that in the normal group of the same age(range, 10 to 12 years, P<0.001). CONCLUSION: Serum leptin concentrations highly correlated with body mass indices in extremely obese children. Because serum leptin levels in extremely obese children were remarkably high compared to those in normal group and there was no difference in leptin levels between girls and boys, it is speculated that obese children are resistant to endogenous leptin production.
Body Mass Index ; Child ; Female ; Humans ; Leptin* ; Obesity ; Radioimmunoassay

The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn's disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn's disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increasing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up process by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn's disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive discussion with each patient and guardian.
Arthritis, Rheumatoid ; Biological Products ; Crohn Disease ; Humans ; Medical Overuse ; Pediatrics

It is necessary to reflect on the question, “How to prepare for medical education after coronavirus disease 2019 (COVID-19)?” Although we are preparing for the era of Education 4.0 in line with the 4th industrial revolution of artificial intelligence and big data, most measures are focused on the methodologies of transferring knowledge; essential innovation is not being addressed. What is fundamentally needed in medicine is insightful intelligence that can see the invisible. We should not create doctors who only prescribe antispasmodics for abdominal pain, or antiemetic drugs for vomiting. Good clinical reasoning is not based on knowledge alone. Insightology in medicine is based on experience through Bayesian reasoning and imagination through the theory of mind. This refers to diagnosis of the whole, greater than the sum of its parts, by looking at the invisible using the Gestalt strategy. Identifying the missing process that links symptoms is essential. This missing process can be described in one word: context. An accurate diagnosis is possible only by understanding context, which can be done by standing in someone else’s shoes. From the viewpoint of medicine, Education 4.0 is worrisome because people are still clinging to methodology. The subject we should focus on is “human”, not “artificial” intelligence. We should first advance the “insightology in medicine” as a new paradigm, which is the “essence” that will never change even when rare “phenomena” such as the COVID-19 outbreak occur. For this reason, we should focus on teaching insightology in medicine, rather than teaching medical knowledge.