The spectrum of HNF1A gene mutations in patients with MODY 3 phenotype and identification of three novel germline mutations in Turkish Population

BACKGROUND

Maturity-onset diabetes of the young (MODY) is a monogenic form of diabetes mellitus characterized by autosomal dominant inheritance, early age of onset, and pancreatic beta cell dysfunction. Heterozygous mutations in several genes may cause MODY.

METHODS

In the present study, we investigated the molecular spectrum of HNF1A (hepatocyte nuclear factor 1a) mutations, in the individuals referred to a reference center for molecular genetic analysis. Mutations screening was performed in a group of 136 unrelated patients (average age 17.22 years) selected by clinical characterization of MODY. Mutation screening involved direct sequencing of the HNF1A gene.

RESULTS

Among 136 individuals analyzed, 10 were carrying heterozygous HNF1A mutations, 3 of them being novel. Clinical features, such as age of diabetes at diagnosis or severity of hyperglycemia, were not related to the mutation type or location. No clear phenotype - genotype correlations were identified.

CONCLUSIONS

As a conclusion MODY resulted from HNF1A mutations shows heterogeneity at both phenotypic and molecular levels in Turkish population.

Determination of iodine concentration in urine by isotope dilution analysis and thyroid volume of school children in the west coast of Turkey after mandatory salt iodization

OBJECTIVE

This study was designed to evaluate iodine deficiency status in children 6-12 years in the west coast (Aegean Region) of Turkey after 5 years of mandatory iodine prophylaxis. A total of 2300 children from 72 populations (rural and urban area) were evaluated with urinary iodine excretion and thyroid volume.

DESIGN

Cross-sectional, observational study designed and performed according to surveillance methods for iodine deficiency disease (IDD) prevalence recommended by WHO/UNICEF/ICCIDD.

SUBJECTS

The study population consisted of 2300 school children age ranging from 6 to 12 years. The children were selected by multiple stage randomization from 91 primary schools of 76 zones (91 clusters). Information about the use of iodized salt was obtained from the families.

MEASUREMENTS

Data on the following were collected: birth date, sex, weight, height, thyroid size by palpation and ultrasonography; and urinary iodine by isotope dilution analysis method. Thyroid volumes above 97th percentile according to the WHO/ICCIDD by age and body surface area (BSA) were accepted as goitre.

RESULTS

Iodized salt consumption was 51.7%. The prevalence of goitre determined by palpation was 12.1% and by ultrasound based on BSA and age were 9.8% and 5.5%, respectively. Median urinary iodine was 53 (2-142) microg/l.

CONCLUSION

Mild to severe degree of iodine deficiency was detected in the west coast of Turkey.

Should hemophiliac patients be circumcised?

Social and cultural integration of hemophilic boys into society is one of the most important cornerstones of modern hemophilia therapy. Circumcision, a traditional procedure, is an important ritual for Muslims and Jews and an important social problem for the hemophiliac patient and his family. The aim of this study was to evaluate the psychosocial dimension of circumcision and the opinions of parents and children. A total of 105 hemophiliac patients and parents were interviewed and surveyed. Of these, 94% of the parents of uncircumcised patients wanted circumcision for their children. Most parents saw circumcision as a mandatory procedure. Hemophilic boys (60%) and their parents (82%) have an inferiority complex because the boys are unable to be circumcised. Bleeding risk is the primary reason of anxiety (70%). The parents of all the circumcised patients were happy after circumcision. In conclusion, circumcision is an important social problem of hemophilic patients that needs to be solved.

Increased gastric production of platelet-activating factor, leukotriene-B4, and tumor necrosis factor-alpha in children with Helicobacter pylori infection

The concentrations of platelet-activating factor (PAF), leukotriene-B4 (LTB4), and tumour necrosis factor-alpha (TNF-alpha) in homogenate supernatants of gastric mucosal biopsy specimens and in gastric juice from Helicobacter pylori-positive (N = 21) and -negative children (N = 14) were investigated in order to determine whether these lipid mediators and the cytokine are involved in the inflammatory reaction of H. pylori-associated gastritis. PAF and LTB4 concentrations were measured after high-performance liquid chromatography (HPLC) purification by specific radioimmunoassay, and TNF-alpha concentrations were determined by using an enzyme-linked immunosorbent assay. The concentrations of PAF, LTB4, and TNF-alpha measured in gastric juice and biopsy homogenate supernatants of children with H. pylori-positive gastritis were found to be statistically elevated and in positive correlation with each other. This study suggested that increased local mucosal production of potent proinflammatory agents such as PAF, LTB4, and TNF-alpha may be implicated in the pathogenesis of H. pylori-associated gastritis in childhood.

Increased mucosal inflammatory cytokines in children with Helicobacter pylori-associated gastritis

The concentrations of tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-1-beta in tissue homogenates of gastric mucosal biopsy specimens, and in gastric juice samples from Helicobacter pylori-positive and -negative children, were determined. The study population comprised 30 children with recurrent abdominal pain attending upper gastrointestinal endoscopy. Of these patients 18 were infected with H. pylori. Cytokine concentrations in gastric biopsy homogenate supernatants and in gastric juice were measured by enzyme-linked immunosorbent assay (ELISA). TNF-alpha levels in gastric juice and in gastric biopsy homogenate supernatants in patients with H. pylori-positive gastritis were found to be significantly higher than those in children without H. pylori infection. IL-6 levels were also higher in H. pylori-infected subjects, but the difference in IL-6 concentrations measured in gastric juice and biopsy homogenate supernatants did not reach statistical significance. IL-1-beta concentrations in both specimens showed no significant difference between the two groups of children. It was suggested that increased levels of inflammatory cytokines, especially TNF-alpha and IL-6 generated locally within the gastric mucosa might be implicated in the pathogenesis of H. pylori-associated gastritis in childhood.