Ahmet Zulfikar Akelma

Cooling for Newborns with Hypoxic Ischemic Encephalopathy

adverse effects of cooling and ‘early’ indicators of neurodevelopmental outcome. Data Collection and Analysis: Four review authors independently selected, assessed the quality of and extracted data from the included studies. Study authors were contacted for further information. Meta-analyses were performed using risk ratios (RR) and risk differences (RD) for dichotomous data, and weighted mean difference for continuous data with 95% confidence intervals (CI). Main Results: We included 11 randomized controlled trials in this updated review, comprising 1,505 term and late preterm infants with moderate/severe encephalopathy and evidence of intrapartum asphyxia. Therapeutic hypothermia resulted in a statistically significant and clinically important reduction in the combined outcome of mortality or major neurodevelopmental disability to 18 months of age (typical RR 0.75 (95% CI 0.68–0.83); typical RD –0.15, 95% CI –0.20 to –0.10); number needed to treat for an additional beneficial outcome (NNTB) 7 (95% CI 5–10) (8 studies, 1,344 infants). Cooling also resulted in statistically significant reductions in mortality (typical RR 0.75 (95% CI 0.64–0.88), typical RD –0.09 (95% CI –0.13 to –0.04); NNTB 11 (95% CI 8–25) (11 studies, 1,468 infants) and in neurodevelopmental disability in survivors (typical RR 0.77 (95% CI 0.63–0.94), typical RD –0.13 (95% CI –0.19 to –0.07); NNTB 8 (95% CI 5–14) (8 studies, 917 infants). Some adverse effects of hypothermia included an increase sinus bradycardia and a significant increase in thrombocytopenia. Cochrane Abstract

Hair zinc and selenium levels in children with recurrent wheezing

The prevalence of asthma and other allergic diseases has increased markedly in the last few decades. Oxidative stress plays a central role in asthma pathogenesis, and reduced daily consumption of antioxidants is positively correlated with increased risk of asthma. Zinc (Zn) and selenium (Se) are the main antioxidant elements. In our study, we aimed to investigate hair Zn and Se levels in children with recurrent wheezing. The study included 65 patients with recurrent wheezing (RW) and 65 healthy children (HC). The hair Zn and Se levels (µg/g) of the RW group were lower in comparison with the HC group (162.43 ± 91.52 vs. 236.38 ± 126.44, P < 0.001, and 217.37 ± 83.01 vs. 280.53 ± 122.73, P < 0.001, respectively). Total antioxidant capacity (TAC) (mmol/L) of the RW group was found to be significantly lower in comparison with the HC group (1.38 ± 0.14 vs. 1.53 ± 0.20, respectively; P < 0.001). Number of wheezing episodes in the last 6 months were negatively correlated with serum TAC, hair Zn, and Se levels in RW group (rp = −0.291, P = 0.001; rp = −0.209, P = 0.017; rp = −0.206, P = 0.019, respectively). The number of acute respiratory tract infection (ARTI) episodes in the last 6 months was negatively correlated with serum TAC and hair Zn levels (rp = −0.316, P < 0.001, and rp = −0.196, P = 0.025, respectively). In this study, we found that TAC, hair Zn, and hair Se levels were lower in children with RW than HC and negatively correlated with wheezing episodes in the last 6 months. Also body Zn and Se levels can be reliably measured in hair samples. Pediatr Pulmonol. 2012; 47:1185–1191.

The association of serum lipocalin-2 levels with metabolic and clinical parameters in obese children: a pilot study

Abstract Objective: We aimed to evaluate the association between serum lipocalin-2 level and clinical and metabolic parameters in obese children. Methods: The study included obese children with a body mass index (BMI) >95th percentile who presented to Kecioren Teaching and Research Hospital with the complaint of weight gain and healthy children with a BMI <85th percentile. The height and weight of the patients were measured for compartment of anthropometric data. Fasting blood glucose, insulin, lipid profile, and serum lipocalin-2 level were measured to evaluate the laboratory parameters. Results: The study included 33 obese and 34 healthy non-obese children. Comparison of data on the obese subjects with those of the healthy subjects shows differences in BMI, BMI-SDS, triglyceride, insulin, and homeostasis model assessment index-insulin resistance levels between the two groups were statistically significant (p<0.05), whereas serum lipocalin-2 was not statistically significant (p>0.05). There was no statistically significant difference in serum lipocalin-2 levels when obese and control groups were reclassified as prepubertal and pubertal (p>0.05). Conclusions: In this study, we did not find any relationships among serum lipocalin-2 level, anthropometric parameters, or metabolic parameters. According to the results of this study, we do not suggest routine investigation of serum lipocalin-2 level in obese subjects for risk stratification of the obesity-related complications.

Serum transaminase elevation in children with rotavirus gastroenteritis: Seven years’ experience

Abstract Background: There are no studies on clinically significant transaminase elevation due to rotavirus gastroenteritis in the literature. Also, there are significant discrepancies among previous studies regarding the prevalence of increased serum transaminase levels in rotavirus infection. Methods: Patients investigated for rotavirus by stool antigen testing, who were followed between January 2005 and May 2012, were retrospectively enrolled in this study. Patients were divided into 2 groups according to their rotavirus results: rotavirus-positive acute gastroenteritis (RPAG) and rotavirus-negative acute gastroenteritis (RNAG) groups. Results: A total of 4317 children who presented with acute gastroenteritis were assessed. The study was completed with 642 patients who met the inclusion criteria. In the RPAG group (n = 272), elevated alanine aminotransferase (ALT) was found in 42 (15.4%) patients and elevated aspartate aminotransferase (AST) in 69 (25.4%), while in the RNAG group (n = 370), these numbers were 25 (6.8%) and 44 (11.9%), respectively. The elevated ALT and AST levels were found to be significantly higher in the RPAG group than in the RNAG group (both p < 0.001). The prevalence of elevated transaminase levels was found to be similar with respect to gastroenteritis severity score (p > 0.05). The high serum transaminase levels normalized uneventfully in all patients in the RPAG and RNAG groups during follow-up. Conclusions: In this study, our results clearly signify a liver influence in rotavirus infections. Therefore, rotavirus infections should be kept in mind when evaluating the aetiology of transaminase elevation in patients with acute gastroenteritis.

Elevated level of serum osteopontin in school-age children with asthma.

BACKGROUND The role of osteopontin (OPN) has not been elucidated in childhood asthma. OBJECTIVE Our purpose was to investigate whether OPN levels change due to allergic inflammation in pre-school and school-age children. METHODS In this prospective, cross-sectional study, 42 healthy children and a total of 51 children with asthma were recruited. OPN levels and its association with clinical and laboratory parameters were investigated in the study population. The asthma group were divided into two groups with respect to age, ≤ 5-years (n = 23) and >5-years (n = 28), and labelled Asthma Group 1 and Asthma Group 2, respectively. OPN levels were compared between subgroups. RESULTS Serum OPN levels were significantly higher in the asthma group when compared to the control group (p = 0.004). OPN levels were similar in Asthma Group 1 and control groups, whereas it was found to be higher in Asthma Group 2 (p>0.025, p = 0.001, respectively). In the >5-years age asthmatic group, OPN levels of the patients with allergic rhinitis (n = 15) were higher than those of the patients (n=13) without allergic rhinitis (p = 0.021). CONCLUSION The study underscores the relationship between childhood asthma and OPN as the first study in the literature. In this study we found that OPN, which plays a role in Th2 mediated inflammation, may also play a role in childhood asthma. The fact that OPN levels do not increase in preschool-age children with asthma might be due to the transient wheezing in this group.

Is PFAPA syndrome really a sporadic disorder or is it genetic

Periodic fever syndromes are a group of disorders sharing similar symptoms, characterized primarily by regularly recurring fevers. PFAPA syndrome, one of the members of this group of disorders, is a clinical entity of unknown etiology which is frequently seen in the early childhood. Currently, the pathogenesis and the genetic basis of most of the disorders in the periodic fever spectrum are known, other than that of PFAPA syndrome. Although, classically PFAPA syndrome is known as a sporadic disease, we propose that it is not sporadic. We think that PFAPA syndrome may be an inherited disease and this hypothesis is supported by the clinical mimicry of PFAPA syndrome with other periodic fever syndromes with well-known genetic transmissions, frequent occurrence of the condition in members of the same family and emergence of common genetic mutations in the periodic fever syndrome spectrum. Moreover, our clinical observation that most of the patients diagnosed with PFAPA syndrome were of the same families strongly suggest a probable genetic transmission of this disorder. We have decided to discuss this hypothesis to contribute to the literature and assist our colleagues who are dealing with this commonly overlooked and often misdiagnosed disorder.

Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults.

INTRODUCTION The aim of this study was to evaluate the role of S100B protein and neuron-specific enolase (NSE) in children with carbon monoxide (CO) poisoning. METHODS In this prospective, case-controlled study, children with CO poisoning were recruited. Patient demographics features and Glasgow Coma Scale (GCS) were recorded. Blood samples were collected from all children with CO poisoning at their admission to the hospital and at 3 and 6 hours after admission. Levels of NSE and S100B were measured. The control group consisted of age-matched healthy children. RESULTS A total of 30 children with CO poisoning (mean age, 7.88 ± 3.75 years; 17 boys) and 30 healthy children (mean age, 8.16 ± 3.05 years; 7 boys) were enrolled in the study. Mean carboxyhemoglobin level (%) measured at admission was 30.05 ± 8.00. Serum NSE levels of the children with CO poisoning were significantly higher than those of children from the control group at 0 hour and also at 3 and 6 hours (P < .001, P = .001, and P = .005, respectively). Serum S100B protein levels were similar between the 2 groups at 0 and 3 and 6 hours (P > .05). Serum NSE levels of patients with CO poisoning demonstrated a negative correlation with the admission GCS scores. No correlation was found between GCS scores and S100B protein levels. CONCLUSION We have shown that NSE levels increase in CO-associated hypoxic brain damage in accordance with clinical findings. We have also found that, contrary to the studies conducted on adults, S100B protein levels do not increase in response to hypoxic brain damage.

Decreased mean platelet volume in children with acute rotavirus gastroenteritis.

Background: The contribution of platelets to the inflammatory response via several platelet derived mediators is well recognized. The role of mean platelet volume (MPV) in infectious and inflammatory disorders, however, has not yet been well-established. While some of the previous studies demonstrated that MPV acted as a positive acute phase reactant, several others suggested its role as a negative acute phase reactant. In the current study, we aimed to assess the role of MPV as an acute phase reactant in children with rotavirus gastroenteritis. Methods: We undertook a prospective, randomized, controlled, cross-sectional study and enrolled children diagnosed with acute rotavirus gastroenteritis and healthy controls (HC), between August and November 2012. Children with acute gastroenteritis were assigned either in the rotavirus-positive acute gastroenteritis (RPAG) or in the rotavirus-negative acute gastroenteritis (RNAG) group depending on their stool antigen results. Patients were also classified into two groups based on their Vesikari score (<11: non-severe and ≥11: severe). Complete blood count and C-reactive protein (CRP) levels were assessed for all patients. We compared MPV between RPAG, RNAG and HC groups and investigated the association, if any, among MPV, platelets, white blood count and CRP. Results: In total 100 RPAG (54 males; mean age: 38.74 ± 41.45 months), 100 RNAG (58 males; mean age: 32.84 ± 29.64 months) children and 100 HC (43 males; mean age: 33.21 ± 32.55 months) were enrolled into the study. Mean platelet counts were well-matched among groups (p > 0.05). We observed a steady decline in MPV (fL) in the HC, RPAG and RNAG groups (median 7.80, 7.35 and 7.30, respectively; p < 0.0001). We did not find an association between MPV and the clinical score of gastroenteritis (p > 0.05). Conclusion: We found that MPV could be used as an acute phase reactant in children with rotavirus gastroenteritis. We believe that the current study will contribute to our understanding of MPV as an inflammatory marker.

Cerebral sinovenous thrombosis associated with MTHFR A1298C mutation in the newborn: a case report

Although cerebral sinovenous thrombosis (CSVT) is a rare condition in the neonatal period, high rates of morbidity and mortality necessitate the establishment of an early diagnosis. Methylenetetrahydrofolate reductase (MTHFR) plays a central role in the folate cycle and mutations of MTHFR are associated with vascular disease. While the C677T common missense mutation is the most well-defined MTHFR polymorphism, another common missense mutation, A1298C also exists. There has been no reported case of CSVT associated with MTHFR A1298C mutation in the neonatal period. Herein, we report a neonate with CSVT who was found to have MTHFR A1298C homozygosity.

A stitched eye in the newborn: ankyloblepharon filiforme adnatum.

Figure 2. Thin fibrous band, vertically connecting the left eyelids. A 1660 g, male infant was born at 32 weeks gestation to a 34-year-old gravida 2 para 1 mother. Pregnancy was complicated by cervical incompetence, and the infant was born via cesarean delivery. The mother denied having taken any drugs or being exposed to radiographs. There was no family history of congenital anomalies or consanguinity. On admission to the Neonatal Intensive Care Unit, the infant was noted to have a thin, threadlike band of tissue vertically connecting the left upper and lower eyelids (Figures 1 and 2). The rest of the physical examination was perfectly normal and a detailed assessment, including cranial ultrasound, echocardiography, and otoacoustic emission screening failed to reveal any other congenital anomalies. Theophthalmologic examination revealed a single adhesion in the middle portion of the left eyelid margins. With manual retraction of the eyelids, the affected eye’s anterior segment and fundus seemed normal (Figure 3). An incision to the band tissue was made with a surgical scissors with minimal hemorrhage (Video; available at www.jpeds.com). The rest of this premature infant’s course was totally normal with unremarkable detailed ophthalmologic examinations in the follow-ups. Ankyloblepharon filiforme adnatum (AFA) is defined by partial eyelid fusion with an extensile band of fibrous tissue vertically attached to upper and lower eyelids. AFA, in isolation, is of unknown etiology with an incidence of 4.4 per 100 000 births. Nonsyndromic cases might be associated