Ahmet Arvas

Enuresis: Prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey

Abstract Background : Enuresis is a common problem among children and adolescents, and can lead to important social and psychological disturbances. The aim of the present study was to establish the prevalence of enuresis among school children and determine the risk factors associated with this disorder.

Influence of Bacillus Calmette-Guèrin vaccination at birth and 2 months old age on the peripheral blood T-cell subpopulations [gamma/delta (γδ) and alpha-beta (αβ) T cell]

The neonatal immune system is immature and may be affected by Bacillus Calmette‐Guèrin (BCG) vaccine. We investigated the influence of BCG given at two different ages on the peripheral blood (PB) T‐cell subpopulations. Forty full term healthy newborns were randomly chosen. Twenty of them were vaccinated with BCG at birth (group I) and the remaining at the age of 2 months (group II). The cell analysis were carried out before (pre‐BCGI and pre‐BCGII), and 2 months after (post‐BCGI and post‐BCGII) the vaccination. The analysis of the gamma/delta and alpha/beta T‐cell receptor (TCR) antigens was done by two‐colour flowcytometer. The purified protein derivative (PPD) response was investigated 2 months after vaccination. The results showed that although T‐cell (TCR+ cell) counts showed no difference in PB before and after vaccination in both study groups, the total lymphocyte and non‐T cell (TCR− cell) populations increased significantly whereas αβT‐cell population significantly decreased after vaccination. On the contrary, γδT‐cell counts in PB increased significantly 2 months after vaccination in group I but not in group II. Total lymphocyte and non‐T cell counts in vaccinated infants at 2 months of age (post‐BCGI) were significantly higher than in unvaccinated infants of the same age whereas αβT‐cell count in vaccinated infants was significantly low. However, total T‐cell and γδT‐cell counts showed no difference. PPD positivity was similar in both study groups (61% in group I, 66% in group II). Neither αβT‐ nor γδT‐cell counts were different in PPD positive and PPD negative infants. Our study shows that BCG causes marked quantitative changes in the PB T‐cell subpopulations in young infants.

Prevalence and risk factors of iodine deficiency among schoolchildren.

The aim of this study was to demonstrate the prevalence of iodine deficiency among schoolchildren and the risk factors influencing it. One thousand five hundred and seventy-three schoolchildren were chosen from 14 schools in seven different regions in Istanbul. After all data relating to sociodemographic factors and the use of iodized salt were recorded, iodine contents of urine samples were determined by the Sandell Kolthoff reaction. Chi-squared and multiple regression analysis were used for the investigation of the correlation between iodine deficiency and risk factors. The prevalence of goitre (> or = 2 grade) was 1.9 per cent. The median urine iodine level was in the normal range (10.5 microg/dl). In 46.2 per cent of the students the urine iodine levels were below 10 microg/dl and 13.9 per cent of the students had urine iodine levels below 5 microg/dl. The prevalence of iodine deficiency was significantly higher in younger (< or = 10 years) children, in children with less educated mothers and fathers, and with poorer and more crowded families (p < 0.01, p < 0.01 and p < 0.01, p < 0.001, respectively). The rate of iodine deficiency was significantly higher in females than in males and also higher in children who lived on the European side of Istanbul than on the Anatolian side of Istanbul (p < 0.0001, p < 0.0001, respectively). The rate of use of iodized salt was 44.4 per cent and the iodine deficiency rate was not affected by the use of iodized salt (p > 0.05). Although the median urine iodine level was in the normal range, in 46.2 per cent of the students urine iodine levels were low (< 10 microg/dl). As there seems to be no effect from the use of iodized salt in iodine deficiency, the use of a more stable potassium iodate for the fortification of salt may be required.

Haemophilus influenzae type b antibodies in vaccinated and non‐vaccinated children

Background: Invasive Haemophilus influenzae type b (Hib) infection has a high morbidity among young children, but the burden of disease and rate of Hib are different in different regions. The aim of the present study was to investigate the levels of Hib antibodies and the oropharyngeal Hib prevalence in young children.

Vaccination in patients with immunosuppression.

In congenital or aqcuired immune deficiencies, infectious diseases which can be prevented by vaccination have a severe course because of supression of the immune system by the disease itself or the treatment methods used. Therefore, vaccination is important in immune deficiency. Although the protective antibody levels achieved in healthy individuals can not be provided in patients with immune deficiency, there is no drawback in administering inactive vaccines in accordance with the vaccination program. On the other hand, live viral and bacterial vaccines should not be administered during periods of immunosupression in conditions where the immune system is strongly supressed by diseases or drugs, since they would cause to systemic infection. Physicians should have sufficient knowledge about contraindications of vaccination in individuals with immune deficiency and in people who live in the same house with these individuals.

Çocukluk çağı kronik nörogelişimsel hastalıklar ile kan kurşun ve cıva düzeyleri arasındaki ilişki

Ad dress for Cor res pon den ce: Dr. Ahmet Arvas, İstanbul University, Cerrahpaşa Medical Faculty, Department of Pediatrics, Division of Social Pediatrics, İstanbul, Turkey E-mail: aarvas@istanbul.edutr Re cei ved: 09.27.2012 Ac cep ted: 04.18.2013 Türk Pediatri Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. / Turkish Archives of Pediatrics, published by Galenos Publishing The relation between blood lead and mercury levels and chronic neurological diseases in children Original Article

Comparison of Different Iron Preparations in the Prophylaxis of Iron-deficiency Anemia

We compared the efficacy of ferrous sulfate (divalent) and ferric polymaltose (trivalent) compounds for the prophylaxis of iron-deficiency anemia (IDA). Study infants included exclusively breast milk-fed term infants. Subjects were divided randomly into 2 groups at 4 months of age and group 1 (n=56) received divalent and group 2 (n=56) received trivalent iron (Fe) preparation at a dose of 2 mg/kg/d for 5 months. At 9 months of age, after a 5-month prophylaxis, a significant increase was observed in hemoglobin (Hb), hematocrit, serum Fe levels, and transferrin saturation in both groups. However, group 1 had significantly higher Hb, hematocrit, mean corpuscular volume, Fe, and transferrin saturation than group 2 (11.7±0.6 g/dL, 34.6%±1.7%, 76.2±2.9 fL, 55.5±1.8 mcg, 20.8±3.9 g/L, respectively in group 1 vs. 11.3±0.5 g/dL, 33.5%±1.5%, 74.7±3.2 fL, 42.5±1.8 mcg, 14.1±7.5 g/L, respectively in group 2). No significant difference was found in ferritin values between the groups. Fe deficiency was found in 17 (30.3%) of the subjects in group 1, and 23 (41%) of subjects in group 2 whereas 5 (8.9%) subjects had IDA in group 1 and 12 (12%) in group 2 which were insignificant between groups. No significant difference was found with regard to side effects between 2 Fe preparations. Although divalent Fe therapy led to a higher Hb and serum Fe level, both ferrous and ferric Fe preparations were effective for prophylactic use in the prevention of Fe deficiency and IDA with comparable side effects.

Pneumococcal Nasopharyngeal Carriage in Young Healthy Children After Pneumococcal Conjugate Vaccine in Turkey

AIMS The purpose of this study was to determine the prevalence of nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged 0-6 years who were vaccinated with pneumococcal conjugate vaccine. METHODS The cross-sectional study was conducted on 150 healthy Turkish children aged between 1 month and 6 years of age. Serotyping was performed and risk factors of carriage were evaluated. RESULTS The overall carriage rate was 14%. Vaccine type serotypes were determined in 17 (12.6%) children received full dose vaccinated pneumococcal conjugate vaccine 13. The highest carriage rate was observed among children younger than 24 months with 76.2%. The risk factors such as respiratory infection in the last months, age, attendance daycare center, and antibiotic usage were not found for the carriage compared with the multivariate analysis. Overall S. pneumoniae strains were considered as penicillin susceptible and antimicrobial resistance was limited. CONCLUSION We observed low rate of pneumococcal carriage in children after pneumococcal conjugate vaccine 13 implementation compared to children receiving pneumococcal conjugate vaccine 7. Although reduction of vaccine serotypes colonization in pneumococcal conjugate vaccine 13 vaccinated children was observed, it continues.Aims: To determine the prevalence of nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged 0-6 years who were vaccinated with pneumococcal conjugate vaccine. Methods: This cross-sectional study was conducted on 150 healthy Turkish children between 1 month and 6 years of age. Serotyping was performed and risk factors of carriage were evaluated. Results: The overall carriage rate was 14%. Vaccine type serotypes were determined in 17 (12.6%) children who received full-dose PCV13 vaccine. The highest carriage rate was observed among children younger than 24 months (76.2%). In multivariate analysis, respiratory infection in recent months, age, attendance at a day-care center and antibiotic usage were not statistically significant risk factors for carriage. Overall, S. pneumoniae strains were considered as penicillin susceptible and antimicrobial resistance was limited. Conclusion: We observed a low rate of pneumococcal carriage in children after PCV13 implementation compared with that of children receiving PCV7. Although it was reduced, vaccine serotype colonization in PCV13-vaccinated children remains persistent.

P175 Vitamin d levels in early childhood

Background and aims Vitamin D deficiency has been associated with growth failure and rickets during childhood period. Turkish Ministery of Health recommends 400 IU of vitamin D supplementation during the first year of life in order to prevent rickets and vitamin D deficiency. Vitamin D has been started to be supplemented free of charge to all infants under 1 year of age since 2005. The aim of our study was to determine the serum 25-(OH) vitamin D (25-OHD) levels, the prevalence of vitamin D deficiency and insufficiency and the factors that influence the vitamin D status among healthy children aged 3–36 months. Methods The study group consisted of healthy children who admitted to the outpatient Healthy Child Clinics of Istanbul University, Cerrahpasa Medical Faculty for their routine control and vaccination between 1.9.2013 and 31.11.2013. A questionaire regarding the duration of vitamin D prophylaxis, dose, duration of sun exposure, duration of breastfeeding, consumption of Vitamin d-rich foods, maternal vitamin D prophylaxis during pregnancy and lactation, the educational status and clothing style of the mother, was given to the parents of each child. The levels of 25-OHD, paratyhroid hormone (PTH), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) were determined in every child. Results A total of 190 healthy children (102/88: male/female) with a mean age of 15.9±10.4 months were enrolled. The mean 25-OHD level was 38.1±16.2 ng/ml. 25-OHD level was<30 ng/ml in 33.2% of children of which 13.6% were in the deficiency range (<20 ng/ml) and 19.5% were in the insufficiency range (20–29 ng/ml). Of the enrolled children who were≤1 year of age, 89.2% were on vitamin D prophylaxis while 20.2% of those>1 year of age were on prophylaxis. The percentage of children with 25-OHD levels in the sufficiency range was significantly higher in children receiving vitamin D than those not receiving it (p=0.04). 25-OHD levels were in the sufficiency range (≥30 ng/ml) in 64.9%, 81.4% and 100% of children who received vitamin D at a dose of 400 IU, 400–800 IU and>800 IU, respectively. The PTH and ALP levels were found to be higher in children with 25-OHD levels<30 ng/ml than those with levels≥30 ng/ml. The only variables that had an effect on the vitamin D status were to receive vitamin D prophylaxis and the dose of vitamin D for prophylaxis. Conclusions Vitamin D deficiency and insufficieny remain a serious public health concern worldwide. Not only the deficiency but also the insufficiency of vitamin D can be associated with many health related issues given the proposed role of vitamin D in many systems as vitamin D receptor (VDR) is expressed in various organs and tissues of the human body other than bone cells such as the kidney, the colonic mucosa and immune cells. Our study showed that vitamin D prophylaxis and dose of vitamin D had an influence on vitamin D status of the child. However, further studies are needed to determine the optimal dose and duration of vitamin D prophylaxis among healthy children.

AB1006 Serum Vitamin D Levels During Activation and Remission Periods of Patients with Juvenile Idiopathic Arthritis and Familial Mediterranean Fever

Background Juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF) are the most common chronic inflammatory rheumatic disorder in children and is a significant cause of both short- and long-term disabilities. The fact that vitamin D inactivates Th1 and Th17, both of which are thought to have a role in JIA pathophysiology, supports the claim that there may be a relationship between vitamin D deficiency and JIA. However, data are limited regarding the association between disease activity and serum 25(OH)D levels in children with JIA. In the few studies serum 25(OH)D levels were found to correlate inversely with disease activity in patients with FMF. Objectives The aims of this study were to determine the frequency of vitamin D deficiency and/or insufficiency of children with JIA and FMF and to assess the relationship between vitamin D and disease activity for JIA and FMF. Methods 64 patients with JIA, 36 patient with FMF and 100 healthy children were included in this prospective cross-sectional study. The children with JIA were diagnosed according to classification criteria of the International League of Associations for Rheumatology (ILAR), and children with FMF according to the criteria set by Livneh. Serum 25-hydroxyvitamin D levels [25(OH)D] of children with JIA and FMF during activation and remission periods were measured using chemiluminescence immunoassay (CLIA). The serum levels of <20 ng/ml was defined as vitamin D deficiency. Results Mean serum 25(OH)D levels of patients with JIA during activation and remission periods of disease were 18,9±11 ng/ml and 18,6±9,2 ng/ml respectively. Mean serum 25(OH) D levels of patients with FMF during attack and attack-free periods were 16±8,5 ng/ml and 13,1±6,4 ng/ml respectively. Mean serum 25(OH)D levels of healthy children were 26,7±10,5 ng/ml. Serum Vitamin D levels of patients with JIA and FMF both during active and remission periods of diseases were lower than control group (p<0,001). There was no significant difference between 25(OH)D levels of patients with JIA during activation and remission periods, whereas serum vitamin D levels during remission period of patients with FMF lower than activation period (p<0.05). No significant relationship was found between disease activity and serum vitamin D levels. During activation period, vitamin D deficiency and insufficiency were found in 57,9% and 29,7% of patients with JIA and during remission period, 58,4% and 33,9% of them, respectively. During activation period, vitamin D deficiency and insufficiency were found in 69,5% and 19,4% of patients with FMF and during remission period, 83,3% and 16,6% of them, respectively. Vitamin D deficiency and insufficiency were found in 26% and 33% of control group, respectively. Conclusions Serum 25(OH)D levels of children with JIA and FMF were significantly lower than healthy children. Frequency of vitamin D deficiency and insufficiency were quitely high among patients with JIA and FMF. There was no relationship between disease activity and serum vitamin D levels. References Gowdie PJ, Tse SM. Juvenile idiopathic arthritis. Pediatr Clin North Am 2012;59(2): 301-2. Hewison M. Vitamin D and the immune system: new perspective on an old theme. Endocrinol Metab Clin North Am 2010;39(2):365-79. Disclosure of Interest None declared