GERD is a frequent problem in children with FC. Treatment of the constipation can improve the reflux symptoms and abnormal acid reflux in these cases. Physicians should bear in mind the co-occurrence of these two prevalent problems for better disease management.

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AIH type 1 prevails in children in a region of Turkey during the second decade of life. Low-dose corticosteroids combined with azathioprine are found.

Introduction: To compare the bioelectric impedance analysis (BIA) with indirect measurement methods in the evaluation of obese children. To determine the diagnostic value of BIA in the fatty liver and metabolic syndrome (MS) in obese children.  Population and methods: One hundred thirty-four obese children whom ≥10 years of age were prospectively assessment. All patients were evaluated by foot to foot BIA and indirect measurement methods. Blood biochemical parameters such as glucose, lipids and insulin levels were studied and oral glucose tolerance test was performed. Fatty liver was assessed by ultrasonography. Compared BIA records and indirect measurements findings according to fatty liver and MS. Results: The study included females/males: 77/57, mean age of 13.3 ± 2.2 years. Fatty liver was detected in 94 patients, MS was diagnosed in 58 cases. There were no gender difference in terms of fatty liver and MS. Fatty liver was seen more frequently in patients with metabolic syndrome than in those without metabolic syndrome (p < 0.001). Fat Mass (FM) of ≥ 97th percentile was observed in 63% of the 94 patients with fatty liver versus 37.5% of 40 patients without fatty liver. A FM of ≥97th percentile was observed in 72% (n=42) of the 58 patients with metabolic syndrome, 42% (n=33) of 76 patients without MS. Body mass index, upper mid-arm circumference, waist circumference (WC), and hip circumference values were significantly increased in patients with fatty liver. There was a better correlation was determined between FM and FM Index with fatty liver compared to indirect measurement methods. BIA records were found moderately correlated with indirect measurements. Conclusion: Our results revealed that FM and FMI have a better correlated in obese children with fatty liver and metabolic syndrome than indirect measurement methods. The measurement of body FM by BIA can be used together with the indirect measurement methods to detect the fatty liver. FMI may be an alternative diagnostic criterion instead of WC for diagnosis of MS in children.

Key words familial Mediterranean fever, protracted febrile myalgia, streptococcus.Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent self-limited attacks of fever and inflammatory serositis. It occurs most often in the Mediterranean region, affecting mainly people of Jewish, Turkish, Arabic and Armenian ancestry. 1 FMF is associated with several types of vasculitis, including polyarteritis nodosa (PAN), HenochSchönlein purpura (HSP) and Behçet's disease. The clinical spectrum of FMF has recently been expanded and protracted febrile myalgia (PFM) is now a frequently recognized component in these patients. [2][3][4] PFM is characterized by severe paralyzing myalgia, high fever, abdominal pain, arthritis/arthralgia, and transient vasculitic rashes mimicking HSP. PFM develops usually in patients with known FMF, even under colchicine prophylaxis. Sometimes, FMF can be diagnosed with PFM as a first manifestation. [2][3][4] We describe here two children with FMF-associated protracted febrile myalgia. The first patient presented with PFM and was subsequently diagnosed as having FMF based on clinical features and genetic analysis. The second was a patient with known FMF. Case Reports Case 1An 8-year-old boy was admitted with abdominal pain, high fever, arthralgia and myalgia for two weeks. He was unable to walk without help due to the myalgia. His medical history revealed abdominal pain attacks with fever and/or recurrent febrile episodes every three to four months for the last two years. His parents were not relatives and there was no family history of autoimmune or rheumatic diseases.Physical examination showed normal anthropometric development, normal blood pressure (100/60 mmHg), fever (38.7°C), tachycardia, diffuse abdominal tenderness and severe muscular tenderness in all extremities. The rest of the physical examination was normal.Laboratory investigations revealed normal urine analysis, leukocytosis (17 600/mm 3 ) with neutrophil predominance (76%), thrombocytosis (598 000/mm 3 ), hyperglobulinemia (2.76 g/dL), normal serum glucose, urea, creatinine, electrolytes, transaminases and creatine phosphokinase (CPK). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and antistreptolysin-O (ASO) were elevated to 98 mm/h, 260 mg/L (normal, <6 mg/L) and 509 Todd unit (normal, <166 TU), respectively. Serology for brucellosis, salmonellosis, hepatitis B (HBV), hepatitis C (HCV), toxoplasmosis and cytomegalovirus (CMV) were negative. Antinuclear antibody (ANA), anti-double stranded DNA (anti-ds DNA), C 3, C4, rheumatoid factor (RF), anti-cardiolipin IgG/IgM, perinuclear-antineutrophil cytoplasmic antibody (p-ANCA), and cytoplasmic-antineutrophil cytoplasmic antibody (c-ANCA) were normal. Blood, urine and throat cultures were negative for pathogenic bacteria. There was no occult blood in the stool. Chest X-ray and abdominal ultrasonography were normal.Severe abdominal pain persisted at the region of the epigastrium and an esophagogastroduodenoscopy was carried out. It r...