Ali Atas

Serum prolidase activity and oxidative status in patients with bronchial asthma.

Asthma is a disease where there is an accumulation of collagen in the reticular basal membrane of the airway leading to chronic inflammation. The enzyme prolidase plays an important role in the breakdown of collagen and the breakdown of intracellular protein especially in the final stage when peptides and dipeptides contain a high level of proline. To evaluate the relationship between prolidase activity and oxidative status in asthma patients. Comparison was made between 42 patients diagnosed with bronchial asthma and 32 healthy children of similar age and gender. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total antioxidant capacity (TAC) and total oxidant status (TOS) measurement. The prolidase activity of the asthma patient group was statistically significant compared with the control group (P≤0.001). TAC and TOS levels in the asthma patient group were higher than the control group (P≤0.001, P≤0.002, respectively). No correlation was found between the prolidase and oxidative levels of the two groups. A positive correlation was determined between the prolidase activity and TAC in the asthma patient group (P≤0.001, r=0.501). The prolidase enzyme activity, which plays a role in the collagen turnover, was low in the asthma patients; therefore, their collagen metabolism had undergone a change and this indicates that there may be an effect on the accumulation of collagen in the reticular basal membrane. Moreover, the high level of TOS indicates that these patients were exposed to severe oxidative stress with an increased TAC response. J. Clin. Lab. Anal. 23:132–138, 2009.

DNA damage in children with asthma bronchiale and its association with oxidative and antioxidative measurements

Increased production of reactive oxygen species leading to an imbalance between the oxidative forces and the antioxidant defense systems favoring an oxidative injury has been implicated in the pathogenesis of asthma. The aim of the study was to investigate the peripheral DNA damage, and its association with oxidative and antioxidative measurements in children with asthma bronchiale. The study population contained 42 children with asthma bronchiale and 32 healthy controls. DNA damage was assessed by alkaline comet assay in peripheral lymphocytes. Plasma levels of total antioxidant status (TAS), total peroxide concentration (LOOHs), and total oxidant status (TOS) were determined. In asthma bronchiale patients, DNA damage was significantly higher than in controls (17.9 ± 11.8 AU vs. 1.2 ± 2.0 AU, p < 0.001). Plasma TOS and LOOHs were higher in patients than in healthy controls (13.4 ± 7.0 vs. 9.0 ± 3.5, p = 0.002; 9.9 ± 3.4 vs. 4.4 ± 1.5, p < 0.001, respectively). Plasma TAS level in patients was higher than in healthy controls (5.5 ± 2.5 vs. 1.0 ± 0.6, p < 0.001). DNA damage was correlated with TOS (r = 0,616, p < 0.001). The findings indicated that lymphocyte DNA damage level increases in children with asthma bronchiale. Elevated DNA damage may be related to increased oxidative stress. However, the mechanism of this association, and whether it is direct or indirect, remains to be explored.

A Comparison of Multiple Daily Insulin Therapy with Continuous Subcutaneous Insulin Infusion Therapy in Adolescents with Type 1 Diabetes Mellitus: A Single-Center Experience From Turkey

AIM To compare the long-term outcomes of continuous subcutaneous insulin infusion (CSII) pump therapy with the clinical and metabolic parameters recorded during multiple daily insulin (MDI) therapy. PATIENTS AND METHODS CSII pump was used by volunteer adolescents, who had a duration of diabetes mellitus (DM) longer than one year, regularly attended periodic examinations for the last year, measured and recorded blood glucose levels on average 3 to 4 times a day, and did not achieve the preferred metabolic control even though the use of MDI therapy. Carbohydrate counting and flexible MDI therapy was taught to these patients before CSII pump implantation. The metabolic and clinical parameters of the patients for the post-CSII pump period were compared with the data of flexible and non-flexible MDI periods. RESULTS The mean CSII pump implantation age of the 17 adolescents enrolled in the study was 15.53 +/- 1.8 years, duration of DM 6.77 +/- 4.05 years, flexible MDI injection duration 0.70 +/- 0.20 years, and duration of CSII pump use 2.07 +/- 1.12 years. A decrease was detected in HbA(1c) levels of the patients with transition to CSII pump compared to flexible and non-flexible MDI injection periods; however, this decrease was not statistically significant (7.71%, 8.21%, and 8.71%, respectively, p = 0.105). No statistically significant difference was detected in frequency of hypoglycemia, lipid profiles, total daily insulin requirement, and BMI SDS values of the patients when data of the post-CSII pump state were compared with that of flexible and non-flexible MDI therapy groups. CONCLUSION In adolescents, it was found that CSII pump therapy is efficient and safe without any increased risk for weight gain and hypoglycemia compared to flexible and non-flexible MDI injection periods. The present study also demonstrated that flexible MDI injection therapy might be efficiently and safely used in patients who cannot receive CSII pump therapy due to social and/or financial factors.

Can haptoglobin be an indicator for the early diagnosis of neonatal jaundice

Neonatal jaundice is the result of an imbalance between bilirubin production and elimination. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute to the development of hyperbilirubinemia. Hemolysis has a significant role in bilirubin increase in newborns. Intrauterine is tolerated by the maternal metabolism in life. When hemolysis takes place, a decrease is accepted in the haptoglobin and hemopoexin blood levels binding hemoglobin in the environment. Therefore, it may be considered that haptoglobin and hemopoexin from the early period umbilical cord (UC) blood in newborns may be an indicator in determining jaundice likely to develop in later stages. Babies were called to the control polyclinic in the third and fifthdays. Eighty‐four babies with normal termbirth were included in the study. Gestational age of the mothers was 39.5±1.5 weeks in average. A significant negative correlation was found between the haptoglobin level from the UC taken during delivery and the bilirubin value in the fifth day (r=−0.345; P=0.001). The haptoglobin value from the blood of the UC can be used as a guiding indicator to demonstrate the future occurrence of jaundice in newborns. This way, the babies with high jaundice risk may be detected earlier and closer follow‐up of these babies can be obtained. As a result, the haptoglobin level of the blood from the UC during delivery allows us to make an early prediction on whether neonatal jaundice will occur. J. Clin. Lab. Anal. 22:409–414, 2008.

Turner syndrome and associated problems in turkish children: A multicenter study

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto’s thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan.

Comparative study between the Ves‐matic and microerythrocyte sedimentation rate method

In this study, Ves‐matic erythrocyte sedimentation rate and micro‐erythrocyte sedimentation rate methods were compared on 96 subjects mean age 4.9±4.3 years. Ves‐matic erythrocyte sedimentation rate an automated method, and micro‐erythrocyte sedimentation rate method required minimal bloods are various approaches on the erythrocyte sedimentation rate. An important relationship between that the Ves‐matic and micro‐erythrocyte sedimentation rate was revealed. Although there was significantly correlation between these two methods, they are different to use interchangeably. Our study implies that “Micro‐Automated Erythrocyte Sedimentation Rate Systems” could be developed which require a few amounts of blood and study automatically. J. Clin. Lab. Anal. 22:70–72, 2008.

Anthropometric findings from birth to adulthood and their relation with karyotpye distribution in Turkish girls with Turner syndrome

To evaluate the anthropometric features of girls with Turner syndrome (TS) at birth and presentation and the effect of karyotype on these parameters. Data were collected from 842 patients with TS from 35 different centers, who were followed‐up between 1984 and 2014 and whose diagnosis age ranged from birth to 18 years. Of the 842 patients, 122 girls who received growth hormone, estrogen or oxandrolone were excluded, and 720 girls were included in the study. In this cohort, the frequency of small for gestational age (SGA) birth was 33%. The frequency of SGA birth was 4.2% (2/48) in preterm and 36% (174/483) in term neonates (P < 0.001). The mean birth length was 1.3 cm shorter and mean birth weight was 0.36 kg lower than that of the normal population. The mean age at diagnosis was 10.1 ± 4.4 years. Mean height, weight and body mass index standard deviation scores at presentation were −3.1 ± 1.7, −1.4 ± 1.5, and 0.4 ± 1.7, respectively. Patients with isochromosome Xq were significantly heavier than those with other karyotype groups (P = 0.007). Age at presentation was negatively correlated and mid‐parental height was positively correlated with height at presentation. Mid‐parental height and age at presentation were the only parameters that were associated with height of children with TS. The frequency of SGA birth was found higher in preterm than term neonates but the mechanism could not be clarified. We found no effect of karyotype on height of girls with TS, whereas weight was greater in 46,X,i(Xq) and 45,X/46,X,i(Xq) karyotype groups.

Growth curves for Turkish Girls with Turner Syndrome: Results of the Turkish Turner Syndrome Study Group.

Objective: Children with Turner syndrome (TS) have a specific growth pattern that is quite different from that of healthy children. Many countries have population-specific growth charts for TS. Considering national and ethnic differences, we undertook this multicenter collaborative study to construct growth charts and reference values for height, weight and body mass index (BMI) from 3 years of age to adulthood for spontaneous growth of Turkish girls with TS. Methods: Cross-sectional height and weight data of 842 patients with TS, younger than 18 years of age and before starting any therapy, were evaluated. Results: The data were processed to calculate the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile values for defined ages and to construct growth curves for height-for-age, weight-for-age and BMI-for-age of girls with TS. The growth pattern of TS girls in this series resembled the growth pattern of TS girls in other reports, but there were differences in height between our series and the others. Conclusion: This study provides disease-specific growth charts for Turkish girls with TS. These disease-specific national growth charts will serve to improve the evaluation of growth and its management with growth-promoting therapeutic agents in TS patients.

A 2-year-old Boy with a Testicular Mass

androsterone sulfate (DHEAS), 17-OH progesterone levels, and ultrasonographic fi ndings consistent with bilateral testicular mass, Leydig cell tumor (LCT) had been considered. Bilateral orchiectomy had been offered in another tertiary medical center. His clinical history revealed a normal delivery at 37th gestational week, with a birth weight of 2,750 g, more remarkable weight and height gain compared with his peers since birth, presence of acne for 1 year, and normal motor-mental development, except delay in Tolga Unuvar, MD, is Assistant Professor; Korcan Demir, MD, is Resident Fellow; Ayhan Abaci, MD, is Assistant Professor; Ali Atas, MD is Assistant Professor; and Ece Bober, MD is Professor, Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. Handan Cakmakci, MD, is Professor, Department of Radiology, Faculty of Medicine, Dokuz Eylul University. Address correspondence to: Prof. Dr. Ece Bober, Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; or e-mail ece.bober@deu.edu.tr. Dr. Unuvar; Dr. Demir; Dr. Abaci; Dr. Atas; Dr. Cakmakci; and Dr. Bober have disclosed no relevant fi nancial relationships. doi: 10.3928/00904481-20100726-04 Figure 1. Initial scrotal ultrasound examination revealed (a) two nodular mass lesions (arrows) within the left testis and (b) one mass lesion within the right testis (arrows).

Evaluation of Pre-Treatment and Post-Treatment S100B, Oxidant and Antioxidant Capacity in Children with Diabetic Ketoacidosis.

Objective: The study aimed to evaluate the pre-treatment and post-treatment oxidant capacity, antioxidant capacity and S100B protein levels in cases of diabetic ketoacidosis (DKA). Methods: The study included 49 pediatric patients diagnosed with DKA and a control group comprising 49 healthy children. Blood samples were obtained after confirmation of the DKA diagnosis and also after treatment. S100B, total oxidant (TOL) and total antioxidant levels (TAL) were measured and the oxidative stress index (OSI) was calculated. Results: When the pre-treatment and post-treatment values of patients with DKA were compared with those of the healthy control group, the S100B level, TOL, TAL and OSI were found to be significantly higher in the diabetes group (p<0.001). Pre-treatment TOL and TAL were also significantly higher than post-treatment levels (p<0.001), while no statistically significant difference was found in the S100B levels or the OSI (p>0.05). Conclusion: We believe that long-term exposure to high blood glucose concentrations leads to an increase in TOL in patients with DKA and that the neurotransmitter changes that develop in response to this exposure lead to an increase in S100B levels, which is an indicator of neuronal damage.