Cognitive disengagement syndrome in children with type 1 diabetes: important implications for clinical outcomes

AIMS

Children with type 1 diabetes (T1D) are prone to a variety of psychiatric disorders, however, to date, no study has examined cognitive disengagement syndrome (CDS) in children with T1D. The present study aimed to evaluate the frequency of CDS symptoms in children with T1D and whether it is related to glycemic control.

METHODS

This cross-sectional study included 74 children with T1D and 88 healthy (control) children, aged 8-14 years. All children were evaluated through a semi-structured psychiatric interview, the Kent-EGY test, porteus maze test, stroop test TBAG form, Barkley child attention scale, and Conners' parent rating scale-revised-short form.

RESULT

Children with T1D had considerably higher rates of elevated CDS symptoms than control children (35.1% vs. 10.2%, p < 0.001). Children with T1D performed poorly on attention and cognitive tests. High levels of CDS symptomatology were strongly associated with earlier diabetes onset age, longer disease duration, a higher percentage of diabetic ketoacidosis at diagnosis, higher HbA1c levels, and higher daily insulin dosages. Also, T1D patients with elevated CDS symptoms had lower IQ and attention scores and worse cognitive function performance compared to participants with low levels of CDS symptomatology.

CONCLUSIONS

Elevated CDS symptoms are significantly higher in children with T1D and are associated with poorer diabetes control. The routine psychiatric examination of children with T1D should also include a screening for CDS, particularly in patients with poor glycemic control.

The Turkish version of the problem areas in diabetes-parents of teens (P-PAID-T): Cross-cultural adaptation, reliability, and validity

OBJECTIVE

To examine the Turkish validity and reliability of the Problem Areas in Diabetes- Parents of Teens (P-PAID-T) scale and its psychometric properties for determining the parents' diabetes-related distress.

METHODS

The study included the parents of 200 adolescents with T1DM for at least a year. P-PAID-T and a demographic data form were used for data collection. Davis technique was used for the content validity of the scale. The scale's reliability was tested using test-retest, and its internal reliability was analyzed with Cronbach's alpha test. Exploratory Factor Analysis (EFA) was used to analyze the factor structure. Confirmatory Factor Analysis (CFA) was used to evaluate the fit of the scale.

RESULTS

69.5% (n = 139) of the participants were mothers. Compared to the fathers, the mothers' mean P-PAID-T score was significantly higher. Parents of sons, who used insulin injections for their children, and had a college degree or higher education level had higher P-PAID-T scores. The test-retest correlation coefficient of the scale was 0.977. The Cronbach α value of the scale was 0.901. The results of confirmatory factor analysis were x2/df = 2.931, GFI = 0.736, CFI = 0.711, NFI = 0.628, NNFI = 0.660, RMSEA = 0.141.

CONCLUSION

The Turkish version of P-PAID-T was a valid and reliable screening tool for measuring diabetes stress in parents of adolescents with T1DM.

PRACTICE IMPLICATIONS

Nurses could use the Turkish version of P-PAID-T to monitor parental diabetes distress and organize interventions; also Turkish P-PAID-T could facilitate research on diabetes distress for parents of adolescents with T1DM.

Machine learning models for estimating contamination across different curbside collection strategies

Contaminated recyclables, which are frequently discarded as waste, pose a significant challenge to the implementation of a circular economy. These contaminated recyclables impede the circulation of resources, resulting in higher processing costs at material recovery facilities (MRFs). Over the past few decades, machine learning (ML) models such as linear regression (LR), support vector machine (SVM), and random forest (RF) have evolved to provide new methods for predicting inbound contamination rates in addition to traditional statistical models. In this study, we applied ML models to predict inbound contamination rates using demographic features from 15 counties in the U.S. with different curbside collection strategies. In general, we found that ML models outperformed linear mixed models. Specifically, SVM models had the highest performance (R² = 0.75; mean absolute error (MAE) = 0.06), which may be due to their ability to model nonlinear relationships between features and inbound contamination rates. The key predictor was population, with poverty rate being positively correlated and median age negatively correlated with inbound contamination rates. To improve the management of contamination and enhance the implementation of a circular economy, better models are needed to understand and estimate inbound contamination rates as well as identify critical factors in the present and future.

Impact of body mass index and vitamin D on serum AMH levels and antral follicle count in PCOS

OBJECTIVE

To investigate the effects of body mass index (BMI) values and 25(OH) vitamin D levels determined by Endocrine Society on serum Anti Mullerian Hormone (AMH) and antral follicle count (AFC) in women with polycystic ovary syndrome (PCOS).

PATIENTS AND METHODS

Sixty infertile women with PCOS and 30 age-matched women with unexplained infertility (UEI), were included. Patients in PCOS and control groups were divided into three subgroups according to their BMI values as normal, overweight and obese. Each BMI group was divided into three subgroups according to vitamin D levels. While AMH and vitamin D levels were determined at first admission, AFC was measured on the third day of cycle.

RESULTS

BMI, AFC, and AMH levels of women with PCOS were significantly higher than the UEI group. AMH values of women with PCOS with normal BMI were found to be significantly higher than UEI controls with normal BMI. AMH values of overweight and obese PCOS patients and controls were similar. As BMI values of the PCOS group increased, vitamin D levels decreased significantly. Vitamin D levels of the patients in the PCOS group were found to be significantly lower than the control group. When evaluated according to BMI, the vitamin D levels of normal, overweight and obese women with PCOS were significantly lower than the UEI.

CONCLUSIONS

Rising BMI in PCOS leads to a significant decrease in vitamin D and AMH. Deficiency, insufficiency or normality of vitamin D do not affect the main markers of ovarian reserve.

High serum AMH inhibits pathological growth of the low biomass endometrial microbiome

OBJECTIVE

Although host microbiome play a role in both hormonal status and fertility, this issue has not yet been clarified. Since the endometrium is a sterile tissue, it is accepted that microbiota does not grow under normal conditions. The aim of the study was to reveal the characteristics of endometrial microbiota according to serum AMH levels in women with implantation failure.

PATIENTS AND METHODS

Forty-five women aged 20-30 years with two or more implantation failures were included in the study. They were divided into 3 groups according to their serum AMH values: Group 1 -AMH <1.3 ng/ml; Group 2 - AMH between 1.3-2.6 ng/ml; Group 3 - AMH >2.6 ng/ml. Twenty-two healthy fertile women who were the same age as the infertile group and applied for cervical smear screening were accepted as the control group. Following the embryo transfer, the tip of the catheter was inserted into the transport medium under sterile conditions. Sowing was carried out by touching the tips of the catheter to the blood agar medium. After the evaluation of the petri dishes at the end of 48 hours of incubation, colonies were stained with Gram stain. Microorganisms in the colonies were identified with the Vitek-2 device according to their gram-staining characteristics and their antibiograms were made.

RESULTS

A negative correlation was detected between low AMH values and the microbiome detection rates in endometrial cultures. In patients with low serum AMH levels, the chance of endometrial microbiota growth was higher in the endometrial culture medium. The most common bacteria were found to be MSSA, MRKNS and lactobacillus. Clinical pregnancy rates were found to be significantly higher in the group with high AMH levels. As AMH levels increased, positive flora detection rates decreased, while clinical pregnancy rates increased.

CONCLUSIONS

Low serum AMH level increases the rate of positive endometrial microbiome in culture and decreases clinical pregnancy rates.

Fertility protective effect of taxifolin in cisplatin-induced ovarian damage

OBJECTIVE

The aim of our study was to investigate the protective effect of taxifolin on ovarian damage and reproductive dysfunction created by cisplatin administration.

MATERIALS AND METHODS

A total of 36 albino Wistar female adult rats were equally divided into 3 groups as cisplatin administered only (CIS), taxifolin+cisplatin (T+C) and healthy control group (HG). Taxifolin 50 mg/kg was administered orally by gavage in the T+C (n=12) group. In the HG (n=12) and CIS (n=12) groups, the same volume of distilled water as a solvent was orally administered. One hour after administration of taxifolin or distilled water, animals in the T+C and CIS groups were injected with cisplatin at a dose of 2.5 mg/kg intraperitoneally. This procedure was repeated once a day for 14 days. Six animals from each group were sacrificed on day 15, and their ovaries were removed for histopathological and biochemical analysis. Ovarian tissue malondialdehyde (MDA), total Glutathione (tGSH), Nuclear Factor-Kappa B (NF-kB), Tumor Necrosis Factor-α (TNF-α), Interleukin 1 beta (IL-1β), and Interleukin-6 (IL-6) levels were measured. The remaining animals (n=6 in each group) were kept in the laboratory with mature male rats for two months to breed.

RESULTS

CIS administration led to an increase in inflammatory molecules and membrane lipid peroxidation products, and decreased the synthesis of antioxidant molecules. Compared to the CIS group, the ovarian tissue MDA, NF-kB, TNF-α, IL-1β and IL-6 levels were found to be significantly decreased in the T+C group (p<0.001 for all comparisons). On the other hand, the tGSH levels of the T+C group were significantly higher than the CIS group (p<0.001). Milder ovarian necrosis, fibrosis and follicle damage were detected in animals which were given taxifolin. Four out of the six rats (67%) treated with taxifolin gave birth within 27 days.

CONCLUSIONS

We demonstrated, for the first time, that taxifolin ameliorates cisplatin-induced ovarian injury by decreasing MDA and proinflammatory cytokines and increasing the antioxidant enzyme. The fact that more than half of the animals receiving taxifolin became pregnant suggests that the cytoprotective effect of taxifolin is strong enough to preserve fertility.

Body Perception, Self-Esteem, and Comorbid Psychiatric Disorders in Adolescents Diagnosed with Polycystic Ovary Syndrome

STUDY OBJECTIVE

To investigate adolescents with polycystic ovary syndrome (PCOS) in terms of body perception, self-esteem, and comorbid psychiatric diseases by comparing them with their healthy peers.

DESIGN

Cross-sectional design.

SETTING

The Department of Child and Adolescent Psychiatry and the Department of Pediatric Endocrinology outpatient clinic of Cumhuriyet University in Sivas, Turkey.

PARTICIPANTS

Fifty female adolescents aged 12-18 years who were diagnosed as having PCOS and 37 healthy adolescents aged 12-18 years.

INTERVENTIONS AND MAIN OUTCOME MEASURES

All adolescents were evaluated by a child and adolescent psychiatrist using a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children) and asked to complete the Rosenberg Self-Esteem Scale, Children's Depression Inventory, and Body Image Scale.

RESULTS

The rate of psychiatric disorders in the PCOS group was significantly higher than in the control participants (16/50 (32%) vs 5/37 (13.5%), respectively; P = .046). The most common disorder was major depressive disorder. The Rosenberg Self-Esteem Scale and Body Image Scale scores of the PCOS group were lower (P = .03; P < .001, respectively), and Children's Depression Inventory scores were higher (P = .03) than in the control group. There was no significant relationship between obesity, hirsutism, and insulin resistance with any psychiatric disorders in the PCOS group.

CONCLUSION

Adolescents with PCOS had more psychopathology than their peers. Moreover, their self-esteem was lower and their body perceptions were more dissatisfied compared with their peers.

Recovering value from single stream material recovery facilities - An outbound contamination analysis in Florida

The single stream recycling (SSR) program is a process in which all recyclable materials are deposited into a single collection bin. SSR has gained popularity in the U.S. due to its inherent abilities in waste collection, and specifically, in Florida, more than twenty counties have recently switched their recycling program from dual stream recycling (DSR) to SSR. Despite a more efficient collection process, mixing all recyclable materials into a single bin can lead to cross contamination even before reaching material recovery facilities (MRFs). This study aims to provide a better understanding of the sorting process and equipment in MRFs, and the impact of the SSR program on contamination rates in outbound materials that were processed through Florida's recycling systems. First, we investigate the audit data obtained from a currently operating MRF in Florida using mass flow analysis to identify the most problematic recyclable streams and the processes with low efficiency and high false separation rates. According to our results, the sorting rates of mixed paper, glass and plastics are under the industry standards. Moreover, we investigate the outbound contamination rates of 35 old corrugated cardboard (OCC) and 266 old newsprints (ONP) samples obtained from four currently operating MRFs in Florida. Based on the results, only 31.4% of OCC samples and none of the ONP samples were within the accepted mills' standards for contamination rates. This study provides valuable insights for lowering contamination and raising the end-product quality by identifying the problematic contaminants and processes in sorting and separation in MRFs.

Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis

Aim: To analyze the frequency of pleural effusion and theeffect on prognosis in children with acute bronchiolitis. Methods: A total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients’age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3rd and 7th day of the treatment. Results: Mean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors. Conclusions: This study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis.

[Electronic vision aids : New options for rehabilitation of the visually impaired]

Due to technical advances, there has been an enormous improvement of electronic vision aids in recent years. New developments are especially small portable devices which can be easily carried. The majority of electronic vision aids serve as a reading aid. Electronic magnifiers are a portable alternative to conventional screen readers. In addition, there are mobile reading devices and special computer tools. Color recognition devices and barcode scanners are helpful in everyday life. Ultrasonic orientation systems enable the recognition of obstacles also at head height. Mechanisms incorporated in shoes even comprise a navigation system. A brand new development is OrCam (OrCam Technologies Ltd., Israel), a small, inconspicuous camera system which is attached to the spectacles. It transmits vision information as a text. Smart phones and tablet personal computers have meanwhile been developed to such an extent that they replace more expensive special vision aids. Due to the immense technical progress, electronic vision aids provide visually impaired people with many elegant functions and new possibilities for ophthalmological rehabilitation. Besides the technical, mobile and financial aspects, the social acceptance of the devices, which should be as unobtrusive as possible, plays an essential role.

Relationship between obesity and iron deficiency anemia: is there a role of hepcidin?

OBJECTIVES

Iron deficiency is common in obese children although the underlying mechanism is unclear. The aim of this study was to investigate the associations between iron parameters, leptin, hepcidin and adiponectin levels in obese children.

METHODS

A total of 237 children, ranging in age from 5 to 18 years, 180 with primary obesity and 57 healthy children and adolescents, were enrolled. Complete blood count, serum iron levels, iron-binding capacity, ferritin levels, leptin, hepcidin and adiponectin levels were studied.

RESULTS

White blood cell and platelet count, iron-binding capacity, high-sensitive C-reactive protein, leptin and hepcidin values in the obese group were higher than those of the control group (p < 0.001, p = 0.002, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). However, mean corpuscular volume, adiponectin and transferrin saturation values in the obese group were lower than in the control group (p = 0.026, p = 0.003, and p < 0.001, respectively). No significant differences were found in terms of hemoglobin, serum ferritin, iron and IL-6 levels.

CONCLUSIONS

Our study suggests that hepcidin levels do not contribute to the development of iron deficiency anemia in pediatric obese individuals.

AFC vs. AMH: prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation

OBJECTIVE

To assess the clinical value of antral follicle count (AFC) and anti-Mullerian hormone (AMH) for the prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation for IVF using GnRH antagonist treatment.

PATIENTS AND METHODS

Fifty patients with endometrioma who underwent their first IVF/ICSI cycle with GnRH antagonist treatment were included in the study. The average AMH values were recorded as 1.5-2 ng/mL. Fifty infertile women are not suffering from endometrioma were selected from those with male factor infertility as control. They were matched according to both serum AMH levels and age. Serum samples have been collected before the IVF treatment for determining AMH levels in both groups of subjects. Likewise, each group of subject underwent ultrasound scan for AFC on day 3. Total number of oocytes retrieved during OPU, the number of transferred embryo, implantation and clinical pregnancy rates, live birth and abortion rates, total dose of rhFSH were noted in both groups of subjects.

RESULTS

Day 3 AFC was significantly higher in the control group compared to women with endometrioma. Both the number of retrieved oocytes during oocyte pick-up, MII oocytes and 2 PN embryo were significantly lower in the endometrioma. Likewise, the fertilization, implantation, clinical pregnancy and live birth rates of endometrioma group were significantly lower than those in the control group. The total rFSH dose was higher in the endometrioma group than those in control. The percentage of abortion in the endometrioma group was found to higher compared to those with controls.

CONCLUSIONS

AFC is more sensitive than the AMH in detecting ovarian response in women with ovarian endometrioma. The individualization of GnRH antagonist protocols in subjects having endometrioma might be improved by using an AFC-tailored approach instead of AMH.

Disulfiram, as a candidate NF-κB and proteasome inhibitor, prevents endometriotic implant growing in a rat model of endometriosis

OBJECTIVE

Disulfiram (DSF) exerts its therapeutic effects through oxidative, proteasome, and nuclear factor kappa beta (NF-κB) pathways. The study was planned to test the impact of DSF on growing of endometriotic implants in rats with experimentally induced endometriosis.

PATIENTS AND METHODS

Thirty rats were labeled as the control (n = 8), sham (n = 6), GnRH-agonist (n = 8) and the DSF (n = 8) groups. The rats in the group 3 exposed to single dose leuprolide acetate. The rats in group 4 were treated with DSF for 21 days. The serum activity of oxidant and antioxidant markers, total oxidant status (TOS), total antioxidant status (TAS), interleukin-1β, and tumor necrosis factor-α (TNF-α) were determined. Implants were processed for NF-κB, PCNA, and CD34 immunostaining.

RESULTS

The serum concentration of malondialdehyde in the DSF group was significantly higher than those in other groups. The concentration of TAS, TNF-α, and interleukin-1β in the DSF group considerably decreased compared to control group. Following treatment with DSF while the percentage of Grade 1 and 2 implants increased the percentage of Grade 3 and 4 implants decreased. The implants disappeared totally in two cases in the DSF group and one case in the GnRH-agonist group. The mean H-Scores of implant NF-κB and PCNA in DSF treated animals were found to significantly lower than those of the control group.

CONCLUSIONS

By decreasing NF-κB expression, angiogenesis, and cell proliferation DSF prevents the growth of endometriotic implants.

Serum and follicular fluid irisin levels in poor and high responder women undergoing IVF/ICSI

OBJECTIVE

We examined the follicular fluid (FF) and serum levels of irisin in high and poor responders undergoing IVF/ICSI to test whether irisin has a role in the metabolic regulation of energy homeostasis in growing follicle.

PATIENTS AND METHODS

Twenty infertile women with PCOS and 20 poor responder participants undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol for IVF/ICSI treatment were allocated. Blood was obtained at the time of oocyte retrieval. The follicular fluid content of mature follicles was collected from both high and poor responder women. Irisin levels were measured by using EIA.

RESULTS

There was no significant difference between serum and FF-irisin levels in women with PCOS. (11.18 ± 5.14 µg/mL vs. 11.06 ± 4.93 µg/mL, p < 0.96). In contrast, serum levels of irisin in poor responders were significantly higher than in the FF-irisin levels (13.13 ± 4.27 µg/mL vs. 10.09 ± 4.14 µg/mL, p < 0.01). FF-irisin levels of PCOS subjects were positively and significantly correlated with serum levels of irisin (r: 0.81, p < 0.00). Serum irisin was positively associated with serum levels of total testosterone but was negatively associated with HOMA-IR in the overall patient population. FF-irisin levels were also noted to be negatively correlated with HOMA-IR. Although there is no correlation between serum irisin and AMH levels, FF irisin levels were negatively correlated with serum AMH levels in PCOS subjects. Contrary to PCOS group there were no significant correlation between serum and FF-irisin levels in poor responder group (r: 0.21; p < 0.35).

CONCLUSIONS

The present study is the first attempt to explore the role of irisin in oocyte development by measuring FF and serum levels of this molecules in patients with poor and high responders undergoing IVF/ICSI.

Effect of plasma NOx values on cardiac function in obese hypertensive and normotensive pediatric patients

BACKGROUND

Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NOx) values on cardiac function, while demonstrating the role of plasma NOx in HT in obese pediatric patients.

METHODS

The study population consisted of 62 patients (27 boys, 35 girls), aged 13-18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NOx and biochemical values were studied in both patient groups separately.

RESULTS

Plasma NOx levels were found to be lower in the OHT group than in the ONT and control groups (p < 0.001) and to be negatively correlated with left ventricular mass index values (p < 0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart.

CONCLUSIONS

Plasma NOx plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.

Octreotide-induced long QT syndrome in a child with congenital hyperinsulinemia and a novel missense mutation (p.Met115Val) in the ABCC8 gene

BACKGROUND/AIMS

Congenital hyperinsulinism (CHI) denotes an inappropriate secretion of insulin from pancreatic β-cells in the presence of a low blood glucose level due to various genetic causes. Diazoxide is the first-line medical treatment for CHI. In case of failure, a somatostatin analogue called octreotide is used. A prolonged QT interval is an unusual side effect of octreotide which can be lethal if unrecognized.

CASE PRESENTATION

We report on a 35-day-old infant who was diagnosed with CHI on the 3rd day of his life and underwent pancreatectomy due to failure of medical treatment at 8 months. His genetic analysis revealed a compound heterozygosity for a novel missense mutation (p.Met115Val) and a nonsense mutation (p.Trp1339X) in the ABCC8 gene. Furthermore, at the 6th month of follow-up, a long QT (0.49 s) was determined by ECG examination, which was normalized following discontinuation of octreotide treatment after pancreatectomy. Thus, the long QT was considered to be secondary to octreotide medication.

CONCLUSION

We recommend ECG monitoring before and during octreotide treatment in order to recognize a prolonged QT interval and to prevent related complications in cases with congenital hyperinsulinemia.

[Full depth imaging: a new imaging technique using optical coherence tomography (OCT)]

PURPOSE

The aim of this study was to evaluate the full depth imaging (FDI) mode as a new acquisition technique with spectral domain (SD) optical coherence tomography (OCT) from Heidelberg Engineering for illustrating vitreoretinal and choroidal structures with high contrast.

METHODS

Patients with different diseases such as age-related macular degeneration, chorioretinopathia centralis serosa, diabetic retinopathy and epiretinal gliosis were examined with the FDI mode. For comparison, we also examined healthy probands with conventional OCT and the enhanced depth imaging (EDI) mode. FDI images were obtained with a manual acquisition technique. First, 100 conventional OCT scans of the vitreoretinal interface were averaged. After manual switching to the EDI mode the previous averaged image was overlayed with EDI images until vitreous, retina and choroid were projected in one comparably sharp image.

RESULTS

The FDI mode enables SD-OCT images showing the vitreoretinal interface and deep choroid structures with a high contrast. The new acquisition mode has a few limitations: it is only possible to perform a single linear scan, a raster scan is not possible. The FDI mode is a manual acquisition technique and not automated yet.

CONCLUSION

By a combination of averaged images of the vitreoretinal interface with the help of conventional SD-OCT scans with EDI OCT scans the FDI mode exhibits a simultaneous contrast image of the posterior vitreous, the retina and the choroid. Whereas the application of OCT was focused to evaluate the retina-retinal pigment epithel complex, the routine reinforcement of FDI scans could additionally show potential vitreous and choroidal pathologies. As the FDI mode is not an automated application yet it may be too complex to use for routine diagnostics at the moment.

[Adjuvant stereotactic low energy radiation therapy of exudative age-dependent macular degeneration (Oraya system)]

With respect to the increasing number of patients and the risk and burden for patients caused by injections, a reduction in the number and frequency of injections with vascular endothelial growth factor (VEGF) inhibitors in exudative age-related macular degeneration (ARMD) is desirable. Stereotactic low-voltage x-ray irradiation seems to be a promising approach. For this purpose the Oraya system is available and has shown positive results in initial studies. Pending presentation of phase II and III study data this adjuvant irradiation should only be used in clinical trials.

Changes in growth pattern, leptin ghrelin and neuropeptide Y levels after adenotonsillectomy in prepubertal children

AIM

The purpose of this prospective study was to evaluate whether surgical treatment of adenotonsillar hypertrophy has an effect on growth patterns and circulating concentrations of leptin, ghrelin and neuropeptide Y, which are all significant in energy balance.

MATERIALS AND METHODS

The study group consisted of 20 children who underwent tonsillectomy with or without adenoidectomy due to chronic adenotonsillar hypertrophy. The ages ranged from 4.3 to 9.2 years with normal weight. The healthy control subjects consisted of 30 age- and sex-matched children (control group) with ages between 3.2 and 8.1 years. Serum levels of leptin ghrelin and neuropeptide Y were measured in the preoperative period and at the end of the postoperative period, which was 6 months in the study group, serum levels were only measured during the first examination in the control group.

RESULTS

When the study group (preoperative) is compared with the control group, it is observed that the leptin and ghrelin levels were higher in the study group and that the neuropeptide Y levels were similar (p=0.01, p=0.005, p=0.19, respectively). When the preoperative and postoperative anthropometric data were compared, it was observed that weight, height, body mass index (BMI) and BMI-standard deviation score (SDS) values increased in the 6th month postoperatively (p<0.001, p<0.001, p=0.01, p=0.03, respectively). However, the leptin, ghrelin and neuropeptide Y levels were similar (p=0.70, p=0.12, p=0.60, respectively).

CONCLUSION

Following adenotonsillectomy, an increase in weight and height occurred in the children. In the postoperative period, dietary and lifestyle suggestions as well as growth monitoring might be useful.

Adrenomedullin: possible predictor of insulin resistance in women with polycystic ovary syndrome

The aim of the study was to investigate adrenomedullin (ADM) levels and its relation with insulin resistance in women with polycystic ovary syndrome (PCOS). Twenty-nine women with PCOS and 29 age- and body mass index (BMI)- matched control subjects were included in the study. PCOS was defined according to criteria by the Rotterdam European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM)-sponsored PCOS consensus workshop group. A full clinical and biochemical examination including basal hormones and metabolic profile was performed. Insulin resistance was calculated by using the homeostasis model assessment of insulin resistance index (HOMA-IR). Plasma ADM levels were measured by high performance liquid chromatographic (HPLC) method. Plasma ADM, fasting insulin levels and HOMA-IR were significantly higher in patients with PCOS than the control group. ADM levels were positively correlated with insulin levels and HOMA-IR index. The best cut-off value of ADM levels to identify the presence of insulin resistance (HOMA-IR≥2.7) was 30.44 ng/ml. Calculated odds ratio of insulin resistance by using logistic regression analysis, as predicted by ADM, was 0.15 (95% confidence interval, 0.037-0.628; p=0.009). In multiple regression analysis, ADM level was an independent predictor of HOMA-IR index. Our finding indicated that ADM levels increased in women with PCOS in accordance with HOMA-IR. ADM could be a significant independent determinant of insulin resistance in women with PCOS.

A perspective from the practice of swaddling by Turkish mothers

AIM

The purpose of this study was to investigate the practice of swaddling by Turkish mothers residing in different areas of the country (rural or urban), and determine to their level of knowledge on its positive and negative effects on children's health.

MATERIAL AND METHODS

A total of 632 mothers with an infant aged 0-3 months who presented to our University Hospital volunteered their participation and 598 mothers were included in the study. The study was based on a questionnaire form given to the mothers.

RESULTS

Two hundred eighty three (283) mothers swaddled their infants (47.3 %), while 315 mothers did not swaddle (52.7%). The mothers that swaddled their baby cited tradition ("That's what I learned from my elders") as the most common reason (38%) for swaddling. The most important reason (32%) for not swaddling was the mothers' belief "that it would prevent normal development".

CONCLUSION

In Turkey, the swaddling tends to decrease with the increase of maternal education level and socio-economic situation.The level of Turkish mother's knowledge about beneficial and adverse effect of swaddling were insufficient.We think that the information about properly swaddling should be given to mothers In order to benefit from it's positive effects and at the same time and avoid its adverse effects.

Comparison of clinical and microbiological features of vulvovaginitis in prepubertal and pubertal girls

BACKGROUND/PURPOSE

Vulvovaginitisis the most common gynecological problem of childhood. The aim of the study was to determine and compare clinical and microbiological features of vulvovaginitis in prepubertal and adolescent girls.

METHODS

In this retrospective study, the records of patients who were diagnosed with vulvovaginitis between January 2005 and December 2010 in the pediatric outpatient clinic at Fatih University Hospital were retrieved. Information regarding age, symptoms, history of antibiotic use within 1 month prior to presentation, findings on urinalysis, serum antistreptolysin-O levels, and results of urine/vaginal cultures was collected.

RESULTS

The records of 112 patients were evaluated, 72 of which were prepubertal (64.2%) and 40 were pubertal (35.7%) at the time of diagnosis. Thirty-eight prepubertal patients (52.7%) had a positive result on vaginal culture, the most commonly encountered microorganism being group A beta-hemolytic streptococcus (15.2%). Culture positivity rate in the pubertal group was 47.5% (19 patients), with Candida albicans being the most frequently isolated microorganism (27.5%).

CONCLUSION

The etiopathogenesis and culture results differ between prepubertal and adolescent girls with vulvovaginitis, which should be taken into consideration in the treatment approach of this disorder.

Prevalence of oral mucosal lesions from birth to two years

OBJECTIVE

The purpose of this study was to determine the prevalence of lesions of the oral mucosa from birth to two years in Turkish pediatric patients .

MATERIALS AND METHODS

A total of 299 infants from newborn to two years of age were evaluated from the Outpatient Clinics of the Pediatric Department, in the Fatih University Hospital, Ankara, Turkey. The mucosal lesions were documented. The data were presented as percentages and for categorical comparisons Chi-square or Fisher's Exact test were used. A P-value less than 0.05 was considered statistically significant.

RESULTS

Of the 299 infants, mucosal lesions were seen in only 65 (21.27%). In the study, the most common lesions were candidiasis (10.70%), Ebstein's pearls (2.68%), and geographic tongue (2.68%). The frequency of children with mucosal alterations was higher in the group of children from two to twelve months.

CONCLUSIONS

Although the lesions that were found the most in our study were benign lesions, unrelated to systemic diseases, we still believe that oral mucosal lesions can be a sign of a systemic or dermatological disease in infants, which affects the oral feeding of the infants. Routine examination of the oral mucosa should be a part of the pediatric examination.

Vitamin D status in children with Hashimoto thyroiditis

OBJECTIVE

To investigate vitamin D status in children with Hashimoto thyroiditis.

SUBJECTS AND METHODS

The study group consisted of 78 children recently diagnosed as Hashimoto thyroiditis and 74 subjects as the control group. Parameters of calcium metabolism, thyroid function tests, and 25-hydroxyvitamin D [25(OH)D] levels were measured.

RESULTS

Vitamin D deficiency rate was significantly higher in the Hashimoto group compared with the control subjects (73.1% vs. 17.6%, p < 0.0001). In the Hashimoto group, mean 25(OH)D levels were significantly lower compared with the control group (31.2 +/- 11.5 versus 57.9 +/- 19.7 nmol/L, p < 0.001) and was inversely correlated with the anti-thyroid peroxidase (anti-TPO) levels (r = -0.30, p = 0.007).

CONCLUSION

The higher vitamin D deficiency rates besides lower vitamin D levels in the Hashimoto group together with the inverse correlation between vitamin D and anti-TPO suggest that vitamin D deficiency may have a role in the autoimmune process in Hashimoto thyroiditis in children.

Fatty liver disease in an autopsy series of children and adolescents

BACKGROUND AND AIMS

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adolescents. Obesity is a major risk factor for NAFLD; however, it has been shown that NAFLD is not rare in non-obese adults. The aim of this study was to determine the prevalence of NAFLD in obese and non-obese children and adolescents.

METHODS

The medical records of 340 subjects (aged 2-20 years) in whom autopsy was performed were retrospectively reviewed. Of those, 10 subjects were excluded due to insufficient data. The remaining 330 subjects were included in the study, of whom 264 were normal weight and 66 were obese. All liver biopsy sections were evaluated by two pathologists in a blinded fashion.

RESULTS

The prevalence of fatty liver was 6% among all the subjects and was higher in the overweight group than in the normal-weight group (10.6% vs 4.9%; p<0.001). The prevalence of NAFLD increased concomitant with age. There was no significant difference between sexes in cases with NAFLD. Simple steatosis was detected in 7 subjects. Steatohepatitis was determined as type 1 in 5 subjects, type 2 in 7 subjects, and as overlap in 1 subject.

CONCLUSIONS

This study demonstrated that NAFLD is an important public health problem not only in obese but also in non-obese children and adolescents. This suggests that whereas obesity may be a risk factor, other pathogenic factors may exist that could contribute to the NAFLD.

Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis

AIM

To analyze the frequency of pleural effusion and the effect on prognosis in children with acute bronchiolitis.

METHODS

A total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients'age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3rd and 7th day of the treatment.

RESULTS

Mean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors.

CONCLUSIONS

This study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis.

Radiological characterisation of Artvin and Ardahan provinces of Turkey

Indoor radon concentration measurements were carried out and corresponding annual effective doses due to exposure to indoor radon were determined in Artvin and Ardahan provinces located in the eastern part of Turkey. The measurements were performed for four seasons in order to determine the seasonal fluctuations mostly observed in indoor environments. Indoor radon concentration values were observed to range from 21 to 321 Bq m⁻³ for the Artvin province and from 53 to 736 Bq m⁻³ for the Ardahan province. It was observed that minimum indoor radon concentration values were obtained in summer, while the highest ones were observed in winter. Indoor radon concentration values of the current study were compared with those of other provinces in Turkey. As elevated indoor radon concentrations are mostly correlated with high ²³⁸U activity concentrations in soil, a total of 57 and 33 soil samples were collected from the Artvin and Ardahan provinces, respectively, to determine ²³⁸U activity concentration as well as the concentration of ²³²Th and ⁴⁰K--naturally occurring radionuclides. It was also observed that soil samples collected from the study areas contained ¹³⁷Cs as an artificial radionuclide.

The relationship between serum magnesium levels with childhood obesity and insulin resistance: a review of the literature

BACKGROUND

Magnesium, the second most abundant intracellular cation, plays a major role in regulating insulin effect and insulin mediated glucose uptake. It has been shown that serum magnesium levels were negatively correlated with HOMA-IR (homeostasis model of insulin resistance) index.

AIM

To investigate the relationship between serum magnesium levels with obesity and insulin resistance in childhood.

METHODS

Two hundred and three children and adolescents (117 obese children and 86 controls) were included. Obese cases were also subgrouped according to the presence or absence of insulin resistance (IR) as "IR (+) obese" and "IR (-) obese", respectively. Serum glucose, insulin and magnesium levels were measured after a 12-h fasting at 8-8.30 a.m. We assessed insulin sensitivity by using HOMA-IR index as a surrogate marker of insulin resistance.

RESULTS

Serum levels of magnesium were significantly lower in the IR (+) obese group than controls (p = 0.014). At the same time, there was a positive correlation between serum magnesium levels and body mass index-standard deviation score (BMI-SDS) (r = -0.28, p = 0.03) in the IR (-) obese group.

CONCLUSIONS

Low serum magnesium levels may contribute to the development of insulin resistance in obese children.

Homozygosity for two missense mutations in the leptin receptor gene (P316:W646C) in a Turkmenian girl with severe early-onset obesity

Leptin receptor gene mutations are a very rare cause of severe early-onset obesity. They are also associated with lack of pubertal development and intense hyperphagia. Presented here is a case of a 6-year-old Turkmenian girl with monogenic obesity due to a congenital deficiency of the leptin receptor. She was born from a consanguineous marriage of second cousins after 40 gestational weeks following an uncomplicated pregnancy. Her birth weight was 3500 g. However, rapid weight gain was observed after 6 months. On presentation she was 130 cm tall [> 97th percentile; standard deviation score (SDS): +2], with a weight of 90 kg (> 97th percentile; SDS: +5.3) and a body mass index (BMI) of 53.2 kg/m2 (SDS: +3.6). Results of genetic evaluation revealed the patient to be homozygous for two missense mutations in the leptin receptor gene (P316T;W646C) resulting in complete loss of leptin receptor function. Both parents were heterozygous for the same pair of missence mutations.

The relationship between serum phosphate levels with childhood obesity and insulin resistance

AIM

To investigate the relationship between serum phosphate levels with obesity and insulin resistance in childhood.

METHODS

A total of 298 children and adolescents (190 obese subjects and 108 controls) were included in the study. Serum glucose, insulin, phosphate, calcium and alkaline phosphatase levels were measured after 12 h fasting at 08:00-08:30 h. We assessed insulin sensitivity by using the HOMA-IR (homeostasis model of insulin resistance) index as a surrogate marker of insulin resistance.

RESULTS

Serum levels of phosphate were significantly lower in the 6- to 12-year-old obese subjects than controls (p = 0.02, p < 0.05). At the same time, there was a moderate negative correlation between serum phosphate levels and the HOMA-IR index in the 6- to 12-year-old IR (-) obese children (r = -0.26, p = 0.02).

CONCLUSIONS

Low serum phosphate levels could contribute to the development of insulin resistance in 6- to 12-year-old obese children.

Radiation dose estimation and mass attenuation coefficients of cement samples used in Turkey

Different cement samples commonly used in building construction in Turkey have been analyzed for natural radioactivity using gamma-ray spectrometry. The mean activity concentrations observed in the cement samples were 52, 40 and 324 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The measured activity concentrations for these radionuclides were compared with the reported data of other countries and world average limits. The radiological hazard parameters such as radium equivalent activities (Ra(eq)), gamma index (I(gamma)) and alpha index (I(alpha)) indices as well as terrestrial absorbed dose and annual effective dose rate were calculated and compared with the international data. The Ra(eq) values of cement are lower than the limit of 370 Bq kg(-1), equivalent to a gamma dose of 1.5 mSv y(-1). Moreover, the mass attenuation coefficients were determined experimentally and calculated theoretically using XCOM in some cement samples. Also, chemical compositions analyses of the cement samples were investigated.

Radioactivity and heavy metal levels in hazelnut growing in the Eastern Black Sea Region of Turkey

The Eastern Black Sea Region of Turkey is one of the main hazelnut producers in Turkey and in the world. Since this region was contaminated by the Chernobyl accident in 1986, a comprehensive study was planned and carried out to determine the radioactivity level in hazelnut growing region. The dose due to consumption of hazelnut by the public was estimated and it was shown that this dose imposes no threat to human health. In addition, heavy metal analysis was performed in the samples and the amount of Cr, Mn, Fe, Ni, Cu, Zn, and Pb were also detected. The results showed that the concentrations of heavy metal are below the daily intake recommended by the international organizations.

Assessment of natural radioactivity of sand used in Turkey

The natural radioactivity due to the presence of (226)Ra, (232)Th and (40)K in sand samples used as building materials in Turkey was measured by gamma spectrometry. The measured activity in the sand samples ranged from 17 to 97 Bq kg(-1), 10 to 133 Bq kg(-1) and 116 to 955 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The concentrations of these natural radionuclides were compared with the reported data for other countries. The radium equivalent activity (Ra(eq)), the external hazard index (H(ex)), the internal hazard index (H(in)), the indoor absorbed dose rate in air and the annual effective dose rate were evaluated to assess the radiation hazard for people living in dwellings made of the materials studied. The Ra(eq) values of sand samples are lower than the limit of 370 Bq kg(-1), equivalent to a gamma dose of 1.5 mSv yr(-1). This study shows that the measured sand samples do not pose any significant source of radiation hazard and are safe for use in building materials. Moreover, the experimental mass attenuation coefficients (mu/rho) of seven different sand samples were determined in the energy range 80-1332 keV photons by using the gamma ray transmission method. Experimental values of mass attenuation coefficient were compared with theoretical values obtained using the program XCOM. The calculated values and the experimental results of this work and the other results in the literature are found to be in good agreement. Chemical and structural analyses (XRD) of the sand samples were also undertaken.

Natural and artificial radioactivity measurements in Eastern Black Sea region of Turkey

In the present work, naturally occurring radionuclides of (226)Ra, (232)Th and (40)K were measured in soil samples collected from the Eastern Black Sea region of Turkey. It was found that the activity concentrations ranged from 12 to 120Bqkg(-1) for (226)Ra, from 13 to 121Bqkg(-1) for (232)Th and from 204 to 1295Bqkg(-1) for (40)K. Besides naturally occurring radionuclides, (137)Cs activity concentration was measured in soil, lichen and moss samples and it was found that (137)Cs activity concentration ranged from 27 to 775Bqkg(-1) with for soil, from 29 to 879Bqkg(-1) for lichen and from 67 to 1396Bqkg(-1) for moss samples. Annual effective doses due to the naturally occurring radionuclides and (137)Cs were estimated. Ecological half-lives of (137)Cs in lichen and moss species were estimated. The decrease of the activity concentrations in the present measurements (2007) relative to those in 1993 indicated ecological half-lives between 1.36 and 2.96 years for lichen and between 1.35 and 2.85 years for moss species.

Expression of cyclooxygenase-2 in ovarian serous carcinoma: correlation with angiogenesis, nm23 expression and survival

OBJECTIVE

To evaluate the expression of cyclooxygenase (COX)-2 in ovarian serous carcinomas (OSC) and its correlation with microvessel density (MVD), nm23 expression, clinicopathologic prognostic factors and survival.

METHODS

Specimens from 44 patients with OSC were evaluated by immunohistochemistry for COX-2 and nm23 expression. Tumor MVD was assessed with CD34 immunostaining. The survival data of the patients were found from data files.

RESULTS

40 specimens (90.1%) showed positive COX-2 staining. Patients with high COX-2-expressed tumors had shorter overall survival, but it was not statistically significant. No correlation was found between COX-2 expression and clinicopathologic variables. There was no significant correlation between COX-2 and nm23 expression or MVD.

CONCLUSIONS

COX-2 is frequently expressed in OSC. Although we could not confirm the prognostic significance of Cox-2 expression in the present cohort of OSC patients, the p value for overall survival was just slightly greater than alpha, and this result can be referred as almost significant. We considered that the limited number of cases in our study might affect the statistical analysis of our results. Further studies involving a larger number of patients are needed to clarify the prognostic significance of COX-2 expression in ovarian carcinomas.

Determination of indoor radon and soil radioactivity levels in Giresun, Turkey

Indoor radon survey and gamma activity measurements in soil samples were carried out in the Giresun province (Northeastern Turkey). The result of analysis of variance showed a relationship between indoor radon and radium content in soil (R(2)=0.54). It was found that indoor radon activity concentration ranged from 52 to 360 Bq m(-3) with an average value of 130 Bq m(-3). A model built by BEIR VI was used to predict the number of lung cancer deaths due to indoor radon exposure. It was found that indoor radon is responsible for 8% of all lung cancer deaths occurring in this province. (137)Cs activity concentration was measured 21 years after the Chernobyl accident. The results showed that (137)Cs activity concentration ranged from 41 to 1304 Bq kg(-1) with an average value of 307 Bq kg(-1). The indoor radon results and the geology of the studied area were discussed. Annual effective doses to the both radionuclides of natural origin and (137)Cs were estimated.

Analysis of mosses along Sarp-Samsun highway in Turkey

The elemental analysis of mosses along Sarp-Samsun highway in Turkey was determined using energy dispersive X-ray fluorescence method. A radioisotope excited X-ray fluorescence analysis using the method of multiple standard additions is applied for the elemental analysis of mosses. An annular 50 mCi (241)Am radioactive source and annular 50 mCi (55)Fe radioactive source were used for excitation of characteristic K X-rays. An Si(Li) detector which has a 147 eV full width at half maximum for 5.9 keV photons was used for intensity measurements. A qualitative analysis of spectral peaks showed that the samples contained phosphates, potassium, calcium, titanium, iron, strontium, tin and barium. Since this study is the elemental analysis along the highway, one can expect to detect Pb. Due to the detection limit of EDXRF, elements were analyzed with Atomic Absorption Spectroscopy (AAS) for Pb. Evaluation of these elements with their potential hazards for ecology and human is briefly discussed.

Maternal serum mannose-binding lectin in severe preeclampsia

PURPOSE

We aimed to investigate the level of serum mannose-binding lectin (MBL) in severe preeclamptic patients, women with uncomplicated pregnancies, and healthy reproductive-age females and its impact on gestational age at delivery and birth weight.

METHODS

Serum MBL levels were measured in 27 severe preeclampsia patients (Group 1), 27 patients with uncomplicated pregnancies (Group 2), and 25 healthy reproductive-age women (Group 3).

RESULTS

The mean serum MBL was significantly higher (p < or = 0.05) in Group 1 than in Groups 2 and 3, while the levels in Groups 2 and 3 did not significantly differ. The mean gestational age at delivery and mean birth weight were significantly lower in Group 1. In Group 1, serum MBL was negatively correlated (p < or = 0.05) with the gestational age at delivery and birth weight.

CONCLUSION

Serum MBL increased in preeclampsia and was negatively correlated with the gestational age at birth and birth weight, indicating an underlying immunopathogenesis.

Indoor radon survey in dwellings of the Kars province, Turkey

Makrofol Solid State Nuclear Track Detectors were used to study the 222Radon concentration in dwellings of the Kars province in Turkey. Radon measurements were done for 3 months in 87 houses, selected as uniformly distributed in the area as possible. All values were seasonally corrected. In order to define the seasonal correction factors, the readings were taken in 12 homes for a 12-month period. A 1:100.000 scale geologic map of the region, prepared and published by the Institute of Mineral Research and Exploration (Ankara, Turkey), was used to present the radon results. Digitising, processing and integrating of the data were performed by using ArcView GIS. The results of the radon measurements in the study area range from 20 to 600 Bq/m3, with 114 Bq/m3 as average value. The results showed that the number of lung cancer deaths attributable to indoor radon exposure was estimated to be approximately 5.

Marjolin's ulcer of the scalp: report of 5 cases and review of the literature

The formation of neoplastic changes in the scar tissue of chronically ulcerating wounds is a well-known process. This condition is most commonly seen after the postburn scars, but it may be seen after many kinds of scars. The term "Marjolin's ulcer" is used to describe this type of carcinoma. Although many different cell types can be seen in these lesions, the most commonly seen is squamous cell carcinoma. Squamous cell carcinomas resulting from the Marjolin's ulcer have a much greater tendency to metastasize than squamous cell carcinomas resulting from the other causes. Confusion continues about the precise pathophysiology of this lesion and the clinical behavior of this neoplasm, and the mortality and morbidity rates are also conflicting. As would be expected, there is a wide variety of suggested treatment protocols for this disease. This article, through case reports and review of the literature, offers criteria for the treatment of the Marjolin's ulcers that arise on the scalp, which is an uncommon site.