Bahri Elmas

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children

OBJECTIVE Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Dynamic thiol/disulphide homeostasis as a novel indicator of oxidative stress in obese children and its relationship with inflammatory-cardiovascular markers

Objective: Childhood obesity is an important cause of cardiovascular risk with chronic inflammation. Oxidative stress may contribute to the pathogenesis of obesity-related cardiovascular pathologies. We aimed to evaluate thiol/disulphide homeostasis as a novel and sensitive marker of oxidative stress and to evaluate its relationship with some inflammatory and cardiovascular markers in obese children. Methods: In this case-controlled study, 65 children with exogenous obesity and 64 healthy children, as a control group, were included. In both groups, thiol/disulphide homeostasis parameters and inflammatory (white blood cells, platelets, mean corpuscular volume, neutrophil/lymphocyte ratio, and high-sensitivity C-reactive protein) and cardiovascular (epicardial adipose tissue thickness and left ventricular mass index) markers were studied. Correlation analyses of thiol/disulphide homeostasis parameters with body mass index standard deviation scores (BMI SDS) and inflammatory and cardiovascular markers were performed. Receiver-operating characteristic analysis was performed to determine the sensitivity, specificity, and optimal cut-off values of thiol/disulphide homeostasis parameters. Results: Native thiol, total thiol, and native thiol/total thiol ratios (antioxidant parameters) were lower (p<0.05) and disulphide/native thiol and disulphide/total thiol ratios (oxidant parameters) were higher in the obese group than in the control group (p<0.01). A positive correlation of oxidant parameters with BMI SDS and inflammatory markers was found. However, a negative correlation of antioxidant parameters with BMI SDS and inflammatory markers was found. The specificities of disulphide/native thiol and disulphide/total thiol ratios were higher in the obese group. Conclusion: The impairment in thiol/disulphide homeostasis, which is indicative of oxidative stress, is associated with inflammation in obesity. In addition, cardiovascular involvement may also contribute to this impairment.

Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis.

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.

A Rare Cause of Chylothorax in Children: Gorham-Stout Syndrome

Gorham-Stout disease is a complex disease in which lytic lesions of bone tissue are accompanied by chylothorax and abdominal lymphangioma. The etiology is still unknown. The diagnosis is made by the patient’s clinical and laboratory findings and biopsy results. It may be fatal depending on the organs involved. Although many treatments have been described, successful results have been reported with interferon alpha 2b in recent years. We discuss the clinical diagnosis and treatment of a 5-year-old female patient with osteolytic lesions in the bones after she was referred with chylothorax.

ÇOCUKLUK ÇAĞI ASTIMININ KONTROL VE ŞİDDET DÜZEYİ İLE SERUM ÇİNKO DÜZEYLERİ ARASINDAKİ İLİŞKİ

AMAC: Cocukluk cagi astimi multifaktoriyel bir hastaliktir. Patogenezinde anti-inflamatuvar ve anti-oksidan ajanlarin onemli rol oynadigi bilinir. Bununla birlikte anti oksidan cinko gibi eser elementlerin rolu ile ilgili farkli gorusler mevcuttur. Bizim calismamizin amaci astim kontrol ve siddeti ile serum cinko duzyleri arasindaki iliskiyi belirlemekti. GEREC VE YONTEM: Calismaya Temmuz 2014 ile Nisan 2015 tarihleri arasinda 3-17 yas arasi astim tanisi almis 56 hasta ve 26 saglikli cocuk alindi. Astim kontrol duzeyleri GINA 2014 kriterlerine gore belirlendi. Serum cinko duzeyleri atomic absorbsiyon spektroskopi metodu ile calisildi. Yapilabilen hastalara solunum fonksiyon testleri uygulandi. BULGULAR: Astim ve kontrol grubu serum cinko duzeyleri arasinda anlamli fark bulunmadi. Serum cinko duzeyleri tam kontrollu astim grubuna gore kismi kontrollu astim grubunda anlamli sekilde yuksek bulundu (p=0.023). Astim kontrol duzeyi ile serum cinko duzeyleri arasinda anlamli negative korelasyon izlendi (r: -0.437, p=0.001). FVC %80 altinda olan grupta serum cinko duzeyleri anlamli sekilde yuksek bulundu (p=0.001). Astim siddet duzeyine gore serum cinko duzeyleri arasinda fark bulunmadi (p=0.228). Astim siddeti ile serum cinko duzeyleri arasinda anlamli korelasyon saptanmadi (r=0.168, p=0.217). SONUC: Serum cinko duzeyleri cocuklarda astim kontrolu ile iliskili idi. Serum cinko duzeyleri astim kontrol duzeylerini belirlemede diger parametrelere destekleyici olarak dusunulebilir.

Omalizumab’s role in the treatment of steroid dependent malignant idiopathic anaphylaxis

If an anaphylaxis episode is not caused by an identifiable trigger, it is defined as idiopathic anaphylaxis. Although it is rarely observed, idiopathic anaphylaxis is clinically significant because of its morbidity and fatality risk. No effective treatment has been demonstrated to date. We report a girl aged 16 years who had had malignant idiopathic anaphylaxis since the age of 12 years who was treated successfully with omalizumab. Although she avoided allergic trigger foods such as tomato and seafood, she used to have these attacks twice a week. Attacks were averted by taking 60 mg prednisone. When prednisone was tapered down to 5 mg on every alternate day, the episodes recurred. Later, attacks could not be controlled on <30 mg of prednisone daily. After being steroid-dependent for 4 years, subcutaneous omalizumab 225 mg every two weeks was started. Under omalizumab therapy, the attacks disappeared and prednisone was discontinued.

Prevalence and Clinical Manifestations of Hereditary Angioedema in Untested Close and Distant Blood Relatives of Hereditary Angioedema Index Patients in a City, Turkey

Objective: Hereditary angioedema (HAE) is a rare autosomal-dominant disease characterized by recurring attacks of nonpruritic, nonpitting edema caused by an inherited deficiency or dysfunction in the C1 esterase inhibitor (C1 INH). Symptoms present years before an accurate diagnosis is made. Our aim was to determine the prevalence and clinical manifestations of HAE in untested blood relatives of HAE index patients in a city of Düzce province, Turkey. Methods: Overall, 4 index patients with HAE and 60/118 blood relatives enrolled in the study. The mean age of the enrolled untested subjects (29 female+31 male) was 41 years. The enrolled subjects underwent complement testing (C4, C1 INH antigen, and functional C1 INH). If the laboratory tests were abnormal, the enrolled subjects were questioned on clinical manifestations and scheduled for a follow-up visit. Results: Except for 4 index cases, 60 relatives enrolled in the study underwent complement testing, and 36.6% of them were diagnosed Type 1 and 1.6% Type 2. HAE could not be ruled out in 6.6% of the subjects. In 55% of the untested blood relatives, the HAE disorder was ruled out. Of 23 (22; type 1+ 1; type 2) newly diagnosed subjects, 9 (39%) reported having experienced symptoms that may have been related to HAE, such as swelling in the face, genitourinary region, extremities or abdominal pain. The median age of 9 symptomatic patients was 42 (25-75) years, whereas newly diagnosed asymptomatic subjects had a median chronological age of 17 (9-74) years. Conclusions: This study’s findings reinforce the importance of screening family members and relatives of index patients with HAE to detect this hereditary condition.

KÜF MANTARI ALLERJİSİ VE İMMÜNOTERAPİ

The genera of molds that most often cause allergic symptoms are Alternaria, Aspergillus, Cladosporium and Penicillium. The most frequently implicated genera in children are Cladosporium in Nordic countries, and Alternaria in the Mediterranean region and North America. Although the prevalence of sensitization to commercial fungal extracts is approximately 3% in epidemiologic studies, the sensitization rate may increase up to 80% in selected patients, particularly in those with asthma. Alternaria has been increasingly recognized as a risk factor for the development and persistence of asthma, asthma severity, and potentially fatal asthma exacerbations. Additionally, mold allergy could result in a more severe course of asthma or rhinoconjunctivitis. Presently, the diagnosis and allergen immunotherapy of mold allergy is hindered by the poor quality of most of the commercially available extracts. There are only a few randomized double-blind placebo-controlled studies that have evaluated the efficacy of immunotherapy with Alternaria extracts against mold allergy in patients with respiratory allergic diseases (rhinitis and asthma). Current reviews demonstrate that the clinical efficacy of immunotherapy with fungal extracts has been shown in actively treated patients in at least 4 controlled trials, with two fungal species including Alternaria alternata and Cladosporium herbarum.

Arteriovenous fistula between descending aorta and left inferior pulmonary vein: Closure with vascular plugs.

Echocardiography revealed systemic artery to pulmonary venous fistula, a rare vascular anomaly, in a 20-month-old girl, and multislice computed tomography angiography (CTA) was performed to rule out congenital heart disease. Normal bronchial connection and pulmonary vasculature were observed in the lung. The fistula drained through the left inferior pulmonary vein to the left atrium leading to a left-to-left shunt. Percutaneous intervention was performed in 2 stages using Amplatzer vascular plugs to close successfully.

Mad Honey Poisoning Associated with Hypotension and Bradycardia in the Late Period: Case Report

Poisoning with mad honey is clinical status that seen with ingestion of contaminated honey produced by bees fed with pollens of the Rhododendron types of flowers containing grayanotoxin. Life-threatening symptoms such as syncope, bradycardia and hypotension can be seen in addition to general symptoms of poisoning with mad honey such as nausea, vomiting and abdominal pain. While a boy, 16 years old, eaten with mad honey is seen with clouding of consciousness, nausea and abdominal pain at the beginning of clinical period, bradycardia and hypotension at twelfth hours are observed and is recovered with intravenous normal saline treatment in first 24 hours; not need atropine and chlorpromazine treatment. In this case report, it is aim to discuss clinical findings and treatment approach of rare poisoning with literature, emphasizing on need of examining ingestion of mad honey in story of patients who come with cholinergic symptoms. ( Sakarya Med J 2016, 6(3):166-169 )