Aydın Ece

Serum leptin levels in asthmatic children treated with an inhaled corticosteroid.

BACKGROUND Recent observations suggest the presence of an interaction between leptin and the inflammatory system; however, there is no adequate knowledge about the role of leptin in atopic states such as asthma. OBJECTIVES To evaluate the potential role of leptin in relation to bronchial asthma and inhaled corticosteroid therapy. METHODS Twenty-three children with mild-to-moderate, newly diagnosed asthma enrolled in this 2-period trial. The control group consisted of 20 age- and sex-matched children. Serum leptin levels were measured in patients at initiation and after 4 weeks of budesonide treatment and were compared with control group measurements. RESULTS Asthmatic children had higher mean +/- SD serum leptin levels at admission (19.3 +/- 5.1 ng/mL) than after budesonide treatment (10.6 +/- 1.6 ng/mL) and vs control group measurements (9.8 +/- 1.6 ng/mL) (P < .001). There was a significant correlation between serum leptin levels before and after budesonide treatment (r = 0.68; P = .007). Mean +/- SD body mass indices in patients and controls were 16.7 +/- 2.1 and 16.9 +/- 2.6 kg/m2, respectively. Serum leptin levels did not correlate with body mass indices before budesonide treatment in the study group (r = -0.13; P = .65) but correlated well after budesonide treatment (r = 0.58; P = .009) and in the control group (r = 0.65; P = .008). CONCLUSIONS The role of leptin elevation in children with asthma might be a regulatory mechanism rather than being etiologic, but a question may be raised whether it is possible that leptin may contribute to poor patient outcomes. Further research, both basic and clinical, is essential to explain the exact mechanism.

Scorpion Sting Envenomation in Children in Southeast Turkey

Abstract Background.—Scorpion sting envenomation is a life-threatening emergency and a common public health problem in many regions of the world, particularly in children. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications. Objectives.—The aims of this study were to evaluate demographic, clinical, laboratory, treatment, and outcome characteristics for pediatric patients with scorpion sting envenomation in southeast Turkey and to describe features that may be predictive of the need for pediatric intensive care unit (PICU) care. Methods.—A total of 52 charts of children (mean age: 7.7 ± 2.8 years; age range: 1.5–15 years) presenting with scorpion sting envenomation to a single hospital in southeastern Turkey were investigated. General characteristics of the children, species of the scorpions, anatomic site of the sting, clinical and laboratory findings, treatment approaches, complications, and outcomes were recorded. Results.—Twenty-four stings (46.2%) were inflicted by Androctonus crassicauda, 1 (1.9%) by Leiurus quinquestriatus, and the sources of the other stings were not known. Thirty-one patients (59.6%) were admitted from rural areas. Admission from a rural area was a significant risk factor for severe envenomation. Foot-leg was the most frequently stung part of the body (48%). The greatest number of stings occurred in the summer (78.8%). Cold extremities and tachycardia were the most frequently seen clinical findings (38.4% for both). Twenty patients (38.5%) had signs of serious envenomation and required admission to the PICU. Hemoglobin, white blood cell count, activated prothrombin time, aspartate aminotransferase, alanine aminotransferase, and creatine phosphokinase levels were higher in severely envenomed children compared to levels in those with mild-moderate stings. Antivenom was given at a primary or secondary health center before arrival to our hospital in 44 (84.6%) patients, without any apparent difference in the number of patients presenting with mild-moderate and severe envenomed stings. All patients recovered after treatment except for 1 child who died with severe pulmonary edema. Conclusions.—We found no clinically useful demographic or epidemiological data to guide decision making regarding the need for PICU admission for pediatric victims of scorpion sting in our area. Decisions on transfer and admission to a PICU should be based on the development of systemic findings of envenomation.

Oxidative stress, inflammation and early cardiovascular damage in children with chronic renal failure

The relationship between inflammation, oxidant stress and cardiovascular damage in children with chronic renal failure (CRF) has not previously been investigated. The aim of this study was to investigate markers of oxidative stress, inflammation and early cardiovascular abnormalities. Therefore, erythrocyte superoxide dismutase (SOD) and catalase (CAT) activities; blood glutathione (GSH) and serum malondialdehyde (MDA) levels; C-reactive protein (CRP) and proinflammatory cytokines (IL-6, TNF-α,); and left ventricular masses (LVM) and intima media thicknesses (IMT) were measured in children with CRF. A total of 29 children with CRF (19 nondialysis, 10 peritoneal dialysis) were included. The control group consisted of 25 healthy subjects. CRF children had significantly increased IL-6, TNF-α, CRP and MDA concentrations and decreased SOD, CAT and GSH levels compared with controls (P<0.05). Nondialysis and peritoneal dialysis subgroups had similar oxidative stress and inflammation biomarkers (P>0.05). Erythrocyte CAT was positively correlated with CRP, TNF-α, and IL2-R in the study group. Positive correlations were found between cytokine concentrations, CRP and urea/creatinine levels. Significantly increased LVM and IMT values were found in CRF children (P<0.05). In conclusion, increased oxidant stress and inflammation together with early cardiovascular damage were found in CRF children. Further studies with more patients are needed to verify these results.

Clinical review of tuberculous peritonitis in 39 patients in Diyarbakir, Turkey

Abstract  Abdominal tuberculosis (TB) is a rare manifestation, which can be overlooked on long‐lasting and non‐specific findings unless a high index of suspicion is maintained. The purpose of the present study was to investigate the diagnostic features of 39 patients hospitalized with tuberculous peritonitis (TBP) in Dicle University Hospital, Turkey between January 1994 and August 2003. Twenty‐two patients were male; patient age ranged between 1 and 59 years (mean: 16.2 ± 14.4 years). There were 21 patients (54%) under 15 years of age. Thirteen children had a history of familial TB and seven adults had prior history of TB. Six (29%) of 21 pediatric cases had bacille Calmette‐Guerin (BCG) scars and results of 5‐tuberculin units (TU) tuberculin test were positive in seven children (18%). Of all cases, the most common presenting findings were abdominal pain (95%), ascites (92%) and abdominal distention (82%). Five of the patients had accompanying pulmonary TB, and six patients (15%) had intestinal TB who were admitted to emergency service with acute abdomen, of whom three (8%) had perforation and three (8%) had ileus. Histopathologically 20 cases (51%) were proven on abdominal ultrasonography, and computed tomography revealed most commonly ascites and thickening of peritoneum. No microbiologic evidence was obtained except three positive culture results for Mycobacterium tuberculosis. As a result, TBP should be considered for diagnosis, in patients with non‐specific symptoms of abdominal pain, wasting, fever, loss of appetite, abdominal distension and even symptoms of acute abdomen, because early diagnosis and effective treatment will decrease morbidity and mortality.

Characteristics of pediatric urolithiasis in south‐east Anatolia

Abstract Background : Urolithiasis is endemic in Turkey and characteristics of urolithiasis vary in different regions of the world. The aim of the present study was to evaluate the etiological and clinical characteristics and course of pediatric urolithiasis in south‐east Turkey.

Therapeutic vaccination in the immunotolerant phase of children with chronic hepatitis B infection

Aim. Hepatitis B virus (HBV) infection is a major global health concern and is the most common cause of chronic liver disease worldwide. Our aim was to investigate the efficacy of specific HBV vaccination as active immunotherapy in treating chronic hepatitis B (CHB) infection during the immunotolerant phase of children with normal aminotransferase values and high viral load. Materials and methods. Seventy-four patients never vaccinated before were randomly and prospectively recruited into two groups. Group 1 included 43 patients vaccinated with three standard injections of the GenHevac B vaccine at 30-day intervals. Group 2 contained 31 patients who did not receive any medication or vaccination (control group). Postvaccination serologic and virologic evaluation was performed 6 months after the first injection and at the end of the 12th month. Response to therapy was defined as loss of HBV DNA in serum and hepatitis B e antigen (HBeAg) seroconversion (loss of HBeAg), development of hepatitis B e antibody (anti-HBe). Results. The mean baseline alanine aminotransferase (ALT) value in Group 1 was 33.0 ± 9.6 IU/l, 34.6 ± 13.9 IU/l at 6 months after first injection and 34.3 ± 17.1 IU/l at end of 12 months (P > 0.05). In Group 1 the HBV DNA load at the start of immunization was 3571 ± 1292 pg/ml; this value was 3220 ± 1217 pg/ml at the 6th month and 2931 ± 1292 pg/ml at the 12th month (P > 0.05). In Group 2 the mean ALT values at the beginning of therapy and at the 6th and 12th months were 32.6 ± 7.8, 32.3 ± 8.0 and 30.3 ± 7.3 IU/l, respectively (P > 0.05), and the mean viral load HBV DNA values were 3909 ± 1378, 3546 ± 869 and 3106 ± 718 pg/ml, respectively (P > 0.05). There was no statistically significant difference between Group 1 and Group 2 at the end of the 6th and 12th months in the mean ALT values and mean viral load of HBV DNA (P > 0.05). Except for one patient in each group, hepatitis B surface antigen and HBeAg clearance or hepatitis B surface antibody and anti-HBe seroconversion were not observed during follow-up (P > 0.05). Conclusion. In this multicentered study comparison of vaccinated and unvaccinated groups of immunotolerant children with CHB infection showed no difference in the clearance of HBV DNA or seroconversion from HBeAg to anti-HBe. Different immunization protocols should be considered for future investigations in the immunotolerant phase of children with CHB infection.

Combination therapy for children with chronic hepatitis B virus infection

Background and Aim: To compare the therapeutic efficacy of two different interferon (INF)‐α and lamivudine (LAM) combination therapy regimens in childhood chronic hepatitis B (CHB) infections.

Serum Levels of IL-1 beta, sIL-2R, IL-6, IL-8, and TNF-alpha in Febrile Children with Cancer and Neutropenia

Serum levels of interleukin-1 beta (IL-1β), soluble interleukin 2 receptors (sIL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) were measured to predict some characteristics of febrile episodes in children with cancer and neutropenia. Forty-eight episodes of febrile neutropenia were determined in 23 pediatric cancer patients, including 35 febrile episodes without identifiable source, 7 episodes of bacteremia due to Gram-negative organisms and 4 due to Gram-positive organisms, and 2 fungal infections. Interleukin-6, sIL-2R, and IL-8 levels were significantly higher at the beginning of the febrile episodes than those of controls (p<0.001, p<0.001, and p<0.001). Interleukin-6, sIL-2R, and IL-8 levels were higher in patients with bacteremia due to Gram-negative organisms than in those with Gram-positive ones (p=0.042, p=0.006, and p=0.023, respectively). TNF-α and IL-1β levels were similar in febrile episodes and controls (p>0.05). In conclusion, sIL-2R, IL-6, and IL-8 levels may be helpful in the prediction of infection in febrile cancer patients with neutropenia and measurements of IL-1β and TNF-α were not useful for identifying the presence and the type of infection in febrile neutropenic episodes in children.

Paraoxonase, anti-oxidant response and oxidative stress in children with chronic renal failure

Increased oxidative stress is believed to contribute to an increased risk of cardiovascular disease in uraemia. In children with chronic renal failure (CRF), an anti-oxidant enzyme, paraoxonase (PON), that inhibits oxidation of LDL-cholesterol, has not been previously investigated. In this study we aimed to investigate PON activity, total anti-oxidant response (TAR), total peroxide (TPX), oxidative stress index (OSI) and some pro-oxidant cytokines in 29 children with CRF [mean age 10.2±3.5 years; 19 pre-dialysis, ten on continuous ambulatory peritoneal dialysis (CAPD)] and in 25 control subjects. Children with CRF had lower PON and TAR and higher TPX and OSI values than did controls (P<0.05). Except for lower TAR and serum albumin levels of the CAPD subgroup (P<0.05), other parameters were similar in non-dialysis and CAPD patients (P>0.05). Patients had significant positive correlation between TAR and serum albumin (P<0.05). Serum urea had significant positive correlation with TPX and OSI (P<0.05). Increased oxidative stress and decreased anti-oxidants measured by serum PON activity and TAR were found in children with CRF. We can hypothesize, on the basis of statistical correlations, that low levels of serum albumin and high levels of uraemic metabolites might be responsible for increased oxidative stress in children with CRF. Further studies with larger sample sizes are needed to verify these results.

Acoustic radiation force impulse (ARFI) elastography for detection of renal damage in children

BackgroundAcoustic radiation force impulse (ARFI) imaging is a promising method for noninvasive evaluation of the renal parenchyma.ObjectiveTo investigate the contribution of ARFI quantitative US elastography for the detection of renal damage in kidneys with and without vesicoureteral reflux (VUR).Materials and methodsOne hundred seventy-six kidneys of 88 children (46 male, 42 female) who had been referred for voiding cystourethrography and 20 healthy controls were prospectively investigated. Patients were assessed according to severity of renal damage on dimercaptosuccinic acid (DMSA) scintigraphy. Ninety-eight age- and gender-matched healthy children constituted the control group. Quantitative shear wave velocity (SWV) measurements were performed in the upper and lower poles and in the interpolar region of each kidney. DMSA scintigraphy was performed in 62 children (124 kidneys). Comparisons of SWV values of kidneys with and without renal damage and/or VUR were done.ResultsSignificantly higher SWV values were found in non-damaged kidneys. Severely damaged kidneys had the lowest SWV values (P < 0.001). High-grade (grade V-IV) refluxing kidneys had the lowest SWV values, while non-refluxing kidneys had the highest values (P < 0.05). Significant negative correlations were found between the mean quantitative US elastography values and DMSA scarring score (r = −0.788, P < 0.001) and VUR grade (r = −0.634, P < 0.001). SWV values of the control kidneys were significantly higher than those of damaged kidneys (P < 0.05).ConclusionOur findings suggest decreasing SWV of renal units with increasing grades of vesicoureteric reflux, increasing DMSA-assessed renal damage and decreasing DMSA-assessed differential function.