Promising link between selenium and peroxisome proliferator activated receptor gamma in the treatment protocols of obesity as well as depression

Considerable interest has been given to the significance of peroxisome proliferator activated receptors (PPARs) in macronutrient metabolism, however, there is not sufficient data concerning the interactions between PPARs and micronutrients. Investigations performed on PPARγ and one of the essential micronutrients selenium (Se) have shown that both parameters may lead to alterations in obesity-related or mood disorders. Therefore, it is plausible to consider PPARγ and Se together as a powerful combination during the treatment of two associated diseases; obesity and depression. PPARγ has been shown to be involved in the antidepressant-like activity. It is also an important parameter to be considered in obesity as the master regulator of adipogenesis. The mechanism of action of PPARγ is initiated by ligand binding which induces a conformational change in the receptor. Se is capable of alleviating inflammatory signaling pathways. Obesity is associated with chronic low-grade inflammation. Depression is also defined as an inflammatory disorder. Inflammatory mediators such as tumor necrosis factor-alpha (TNFα) participate in the progression of depression. They are also obesity-associated parameters. Due to TNFα induced depressive-like behaviors and the positive association between this proinflammatory cytokine and obesity, TNFα-activated signaling pathways and those inhibiting them have recently gained importance as potential targets and therapeutic tools, respectively. More studies are necessary to develop compounds with therapeutic nature against depressive disorders and obesity. PPARγ is an important signaling pathway that occurs at the crossroads of depression and obesity. Se, aside from its anti-inflammatory, anticarcinogenic and antioxidative nature, affects also the way of PPARγ action. Se supplementation or fortification as well as the development of the partial agonists of PPARγ in which lipophilic Se compounds are used as ligand followed by experimental trials and human studies using the newly developed compounds will be promising approaches for future hope during the treatment of these diseases.

Jacobsen syndrome without thrombocytopenia: a case report and review of the literature

Jacobsen syndrome (JS), a rare disorder with multiple dysmorphic features, is caused by the terminal deletion of chromosome 11q. Typical features include mild to moderate psychomotor retardation, trigonocephaly, facial dysmorphism, cardiac defects, and thrombocytopenia, though none of these features are invariably present. The estimated occurrence of JS is about 1/100,000 births. The female/male ratio is 2:1. The patient admitted to our clinic at 3.5 years of age with a cardiac murmur and facial anomalies. Facial anomalies included trigonocephaly with bulging forehead, hypertelorism, telecanthus, downward slanting palpebral fissures, and a carp-shaped mouth. The patient also had strabismus. An echocardiogram demonstrated perimembranous aneurysmatic ventricular septal defect and a secundum atrial defect. The patient was <3rd percentile for height and weight and showed some developmental delay. Magnetic resonance imaging (MRI) showed hyperintensive gliotic signal changes in periventricular cerebral white matter, and leukodystrophy was suspected. Chromosomal analysis of the patient showed terminal deletion of chromosome 11. The karyotype was designated 46, XX, del(11) (q24.1). A review of published reports shows that the severity of the observed clinical abnormalities in patients with JS is not clearly correlated with the extent of the deletion. Most of the patients with JS had short stature, and some of them had documented growth hormone deficiency, or central or primary hypothyroidism. In patients with the classical phenotype, the diagnosis is suspected on the basis of clinical findings: intellectual disability, facial dysmorphic features and thrombocytopenia. The diagnosis must be confirmed by cytogenetic analysis. For patients who survive the neonatal period and infancy, the life expectancy remains unknown. In this report, we describe a patient with the clinical features of JS without thrombocytopenia. To our knowledge, this is the first case reported from Turkey.

Indices used in differentiation of thalassemia trait from iron deficiency anemia in pediatric population: are they reliable?

BACKGROUND

Iron deficiency (IDA) and beta thalassemia trait (TT) are the most common causes of hypochromia and microcytosis. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood cell analyzers. However, studies in the pediatric age group are scarce and their results are controversial.

METHODS

We calculated eight discrimination indices [Mentzer Index (MI), England and Fraser Index (E&F), Srivastava Index (S), Green and King Index (G&K), Shine and Lal Index (S&L), red blood cell (RBC) count, RBC distribution width, and red blood cell distribution width Index (RDWI)] in 100 patients. We calculated sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV and NPV), and Youden's Index (YI) of each discrimination index.

RESULTS

None of the discrimination indices showed a SENS and SPEC of 100%. The highest SENS was obtained with S&L (87.1%), while the highest SPEC was obtained with E&F formula (100%). The highest YI value was obtained with E&F formula (58.1%).

CONCLUSION

In our study, none of the formulas appears reliable in discriminating between TT and IDA patients. The evaluation of iron status and measurement of hemoglobin A(2) (HbA(2)) remain the most reliable investigations to differentiate between TT and IDA patients.

Metal speciation, phytochemicals and Helicobacter pylori infection

Helicobacter pylori (HP) acquired in childhood is an important risk factor for gastric carcinoma. Once colonization is established, infection may be carried for life. The relationship between food intake and HP infection, the presence of metals and phytochemicals closely associated with oxidative stress within everyday diet are important topics to be considered. The possible anti-HP effects of phytochemicals, prooxidant effects exerted in the presence of metal species, intimate relations between some metals and HP, bivalent effects of some metal species in cancer, interactions between metal species and phytochemicals in HP infection are the topics, which require further research. Formulas or diets enriched with phytochemicals and metals against HP and, which are devoid of metals known to favour the growth of HP, may be suggested as the supplements to the classical treatment regimens. The importance of collective consideration of HP, metal species and phytochemicals should be emphasized.

Cadmium, lead and phytochemicals

Some metals are essential, others are found as contaminants in foodstuffs. There is some doubt on the antioxidant nature of foods or beverages containing phytochemicals because of cadmium and lead in foods. Evidence from epidemiological and experimental data has found an association between high fruit and vegetable intake and low cancer risk. However, these foods may also contain high amounts of carcinogenic metals, e.g., cadmium and lead shown to interfere with the repair of DNA damage. In this context, healthy and harmful effects of some nutrients are debated. As the benefits of a diet rich in fruits and vegetables are emphasized, attempts for regular mass administration of single food should be done prudently.

Low birth weight: a possible risk factor also for liver diseases in adult life?

Birth weight is a popular topic, because it is precisely recorded, a major determinant of infant survival, associated with infant mortality, and health outcomes later in life. Low birth weight (LBW) is a predisposing factor for metabolic abnormalities such as atherosclerosis, renal disease, non-insulin diabetes mellitus, asthma, low IQ, hypertension, obesity, psychological distress. They have all been reported to be more common among those who were small at birth. Due to lack of studies suggesting a linkage between LBW and diseases of liver; evidences, which support the hypothesis on the creation of a link between LBW, an indicator of unfavourable intrauterine environment, and liver diseases emerging in the adult life, and possible direct associations of LBW with liver diseases, e.g., hepatitis, non-alcoholic fatty liver disease, cirrhosis, hepatoblastoma, or hepatocellular carcinoma were discussed. The associations between LBW and hepatitis vaccination as well as paediatric parental nutrition were also noted.

Relationship of senescence of pulmonary system to chronic obstructive pulmonary disease in the advanced life

Chronic obstructive pulmonary disease (COPD) is a major worldwide health problem. There exists a relationship between COPD and increased oxidative stress, and oxidants may be involved in lung damage during the course of COPD. Polymorphonuclear (PMN) cell recruitment at lung level plays an important role in free radical overproduction, impact inflammatory processes and may alter oxidant-antioxidant balance. Biological aging is thought to be influenced by free radical generation, aging, and the diseases. All the components of the respiratory system are affected by aging. Nutrition, smoking habits and sleep-related disorders also affect the respiratory system. Whether these changes are due to aging or associated with aging is a matter of debate. Since alterations caused by aging and cigarette smoke in lungs of various species were informed to be partly simulated with age-related alterations in human lung, the effects of oxidative agents and antioxidative parameters on both COPD and aging were evaluated.

Association of headaches and the metals

Lack of specific markers constitutes a problem during diagnosis of headache syndromes. Recently, some metals have gained importance as biological parameters for the diagnosis and during treatment. Low-ionized Mg and high-ionized Ca/Mg in patients with daily migrainous headaches were noted. The blood Na level was shown to increase before and during headache. Headache is also a symptom of the common cold for which zinc may be an effective therapy. The existing relationship between genetic markers of the cluster headache and the efficacy of lithium salts therapy was noted. Headache was also found to be associated with toxic metals. When the health effects of mercury were investigated, the most frequently observed symptom was cephalalgia. Continuous exposure to lead was concomitant with the appearance of symptoms such as headache. In relation to some metabolic links, metals may be introduced as possible biological markers for the diagnosis and during the therapy of different headache syndromes in future clinical trials and laboratory measurements.

Infant feeding and growth: a study on Turkish infants from birth to 6 months

BACKGROUND

To evaluate the impact of various feeding patterns on the physical growth and mental development of infants, particularly during the first 6 months of life, and to compare growth patterns of Turkish infants with those of infants living in various countries.

METHODS

One hundred and seventy-two healthy newborn infants were included in the study and were divided into three feeding groups: (i) 62 infants were exclusively breast-fed (BF); (ii) 58 infants were mixed-fed (MF) with both breast milk and formula; and (iii) 52 infants were formula-fed (FF). Infants were assessed at birth and at 1, 2, 3, 4, 5 and 6 months of age. Anthropometry was repeated on each occasion. The weight and length of the infants was also recorded. Analysis of variance and modified t-test were used for statistical evaluation of the results.

RESULTS

Values in the BF group were the closest to the tabular norms for weight. Infants in the FF group tended towards a lower weight during the first 3 months (P < 0.05). During the second 3 months, weight gain observed in the FF group was significantly higher than that of BF infants. In comparison with MF infants, a significant progressive weight gain was detected in BF infants (P < 0.05). The values obtained for length increments were consistent with those for weight (P < 0.05 for BF vs FF). No significant difference was found between the length increments detected for BF and MF infants from birth to 6 months.

CONCLUSIONS

These results suggest that exclusive breast-feeding is the most appropriate feeding pattern for newborn infants in Turkey and is sufficient during the first 6 months, the most important fraction of life.

Clinical efficacy of piracetam in treatment of breath-holding spells

To evaluate the efficacy of piracetam therapy, 76 children with breath-holding spells admitted to the Outpatient Clinic of Dicle University Medical Faculty Paediatrics Department and Bakirköy State Hospital, Paediatrics Department between 1988 and 1990 and 1991 and 1996, respectively, were included in this placebo-controlled trial. Diagnosis of breath-holding spells was made for all cases by medical history, pediatric physical examination, electroencephalogram, and laboratory findings. Placebo or piracetam as suspension was administered to patients on a randomized basis; piracetam was administered to children in suspension 40 mg/kg/day in 2 divided doses for a period of 2 months. Of the 76 children enrolled, 39 received piracetam and 37 received placebo. Overall, control of breath-holding spells was observed in 92.3% of the patients in the group taking piracetam as compared with 29.7% in the group taking placebo (P < .05). No differences between the 2 groups in adverse events or side effects were observed. Complete blood count, biochemical profile, and urine analysis taken before and after treatment revealed no change from beginning to end and no difference between the 2 groups. It is suggested that piracetam is a safe and effective drug, with an incidence of side effects no different from that of placebo, for the treatment of breath-holding spells.

The influence of feeding patterns on head circumference among Turkish infants during the first 6 months of life

The influence of various feeding patterns on physical growth and mental development of the infant, particularly during the first 6 months of life, is an important subject. Head circumference values of 172 healthy new-born infants were included in the study; 62 were exclusively breast-fed (BF), 58 were mixed-fed (MF) and 52 were formula-fed (FF). No significant differences were found in head circumference values between the groups at birth (BF 35.2+/-0.1, MF 35.1+/-0.1, FF 35.0+/-0.1 cm for boys and BF 35.0+/-0.1, MF 34.9+/-0.1, FF 34.8+/-0.1 cm for girls). At the end of the first month, the infants in the BF group (38.3+/-0.1 cm and 37.9+/-0.1 cm for boys and girls, respectively) had strikingly greater head circumference measurements than the others (MF 36.7+/-0.1, FF 36.6+/-0.1 cm for boys and MF 36.5+/-0.1, FF 36.4+/-0.1 cm for girls) (P < 0.05). However, in the subsequent 4-month period, the values detected in each group were almost the same. At the sixth month, head circumference-for-age values of infants in MF (42.6+/-0.1 cm for boys, 41.4+/-0.1 cm for girls) and FF (42.5+/-0.1 cm for boys, 41.5+/-0.1 cm for girls) were well below those of BF group (43.7+/-0.1 cm and 42.9+/-0.1 cm for boys and girls, respectively) and the standard curve (P < 0.05). These results suggest that exclusive breast feeding is sufficient during the first 6 months, the most important period of life.

Evaluation of various aspects of paediatric malignancies in Turkey and Turkey's status in health statistics

Geographic differences in childhood cancer occurrence have been of great interest and have contributed to the current notion that most cancer cases are caused by environmental and cultural factors. The toxins, some of which are encountered by the general population, such as commonly used drugs, household products, solvents, pesticides, and insecticides, have been implicated as carcinogens and are factors that may add to the childhood cancer incidence in Turkey. Lack of information relevant to the disease, low family income, low educational status of parents, cessation of therapy, uncertainty about the child's future, fear for the child's survival, anxiety over the treatment and its effect as well as some cultural and traditional factors, are the basic individual characteristics of the population that interfere with the successful treatment of children with cancer in Turkey. Because the child with cancer is under enormous physical and emotional stress, appropriate psychosocial resources for the patient and family are important for optimal therapy. Community resources, healthcare services, income maintenance, medical insurance, financial assistance for treatment expenditures for the families who have children with cancer are extremely limited. These parameters are the unanswered needs which cancer patients and families face in our society. Despite impressive improvements, major problems remain to be solved.

Hair zinc and copper concentrations and zinc: copper ratios in pediatric malignancies and healthy children from southeastern Turkey

Twenty-eight healthy and forty-six children with malignancy admitted to the Pediatrics Oncology Clinic and Outpatient Clinic of Dicle University, Medical Faculty, Department of Pediatrics in 1989-1990 were included into this study. The children under investigation were divided into three groups. Group 1 consisted of 28 healthy children. Twenty-eight children with newly diagnosed malignant disease, before the start of treatment, formed Group 2. Group 3 consisted of eight of these 28 children together with 18 other children with malignancy in complete remission. 1. Mean hair zinc and copper levels, and zinc/copper values for Group 2 were found to be 100.7 +/- 6.8 micrograms/g, 11.0 +/- 0.8 micrograms/g, and 10.0 +/- 0.8, respectively. 2. The corresponding values for Group 3 were obtained as 143.5 +/- 6.3 micrograms/g, 7.6 +/- 0.4 micrograms/g, and 20.2 +/- 1.4. 3. The values for Group 1 were 142.6 +/- 4.5 micrograms/g, 8.4 +/- 0.5 micrograms/g, and 19.0 +/- 1.4, respectively. 4. The differences between control-active-phase and active-phase-remission groups were statistically significant (p < 0.01), whereas almost the same values were obtained for the control and remission groups (p > 0.05). These results were valid in cases where the comparisons of these three groups were performed also for the subgroups. It was shown that hair zinc and copper levels and zinc/copper values are useful parameters for the diagnosis and treatment of the children with malignancy because of the fact that hair reflects the integrated trace element concentrations of the body, not the present one.

Serum fructosamine and lipid profile in children with malignant diseases

Serum levels of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and fructosamine (FA) were determined in thirty-three children with malignant diseases and twenty healthy controls aged 1-14 years. Of them, FA was the parameter measured in children with malignancy for the first time. Mean serum TC, HDL-C, LDL-C and FA showed statistically significant decreases in malignancy compared to healthy children, whereas a statistically significant increase was observed for TG concentrations in serum. From these data, we conclude that significant relations between serum lipids and lipoproteins and the state of malignancy exist in the children studied, and it should be remembered that serum FA concentrations are affected by abnormal serum protein turnover when one deals with any type of neoplastic disease.

Serum fructosamine and lipid profile in type I diabetic children in Turkey

Serum levels of total cholesterol (TC), triglycerides (TG), lipoprotein cholesterol fractions (HDL-C and LDL-C) and fructosamine (FA) were determined in twenty-three children with Type I diabetes and twenty healthy children aged 4-14 years. Mean serum TC and HDL-C did not differ significantly between diabetic and nondiabetic children. Mean serum TG and FA showed a statistically significant increase in the diabetic group compared to healthy children. It is interesting to note that extremely high FA values had never been reported in the literature before were obtained for the Turkish diabetic children. Although we have observed relatively higher values for LDL-C/HLD-C ratio in diabetics, the difference between two groups was not statistically significant.

Zinc, copper, and magnesium concentrations in hair of children from southeastern Turkey

Zinc, copper, and magnesium concentrations in hair were measured in groups of children varying in one condition--protein-energy malnutrition, ricketts, thalassemia, malignancy, cardiac failure, or after prolonged infection and in healthy controls. As compared with controls, copper and magnesium concentrations were low in all groups, whereas higher values were obtained for hair zinc. These results showed that a generalized copper and magnesium deficiency were observed in the southeastern part of Turkey. However, zinc deficiency couldn't be detected as far as the hair zinc values were concerned, although all of the subjects fell within the 50 percentile limits for their age-appropriate weights and heights.

Serum copper and zinc values compared with serum iron, total iron-binding capacity, and transferrin saturation in sickle cell trait : A preliminary report

Reliable data for the trace element values of the biological systems in some diseases are still very rare. Sickle cell trait is one of them.For this purpose, serum iron, zinc, and copper values, together with the total iron binding capacity and saturation percent, were determined in cases with sickle cell trait, eliminating all the sources contributing to deviations from the normal values by choosing a control group from the relatives of the cases.In this study, the values of two groups were compared on the basis of the difference in hemoglobin type, which was the only parameter affecting the trace element analysis.