Burcin Nalbantoglu

Indices Used in Differentiation of Thalassemia Trait from Iron Deficiency Anemia in Pediatric Population: Are They Reliable?

Background: Iron deficiency (IDA) and beta thalassemia trait (TT) are the most common causes of hypochromia and microcytosis. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood cell analyzers. However, studies in the pediatric age group are scarce and their results are controversial. Methods: We calculated eight discrimination indices [Mentzer Index (MI), England and Fraser Index (E&F), Srivastava Index (S), Green and King Index (G&K), Shine and Lal Index (S&L), red blood cell (RBC) count, RBC distribution width, and red blood cell distribution width Index (RDWI)] in 100 patients. We calculated sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV and NPV), and Youdens Index (YI) of each discrimination index. Results: None of the discrimination indices showed a SENS and SPEC of 100%. The highest SENS was obtained with S&L (87.1%), while the highest SPEC was obtained with E&F formula (100%). The highest YI value was obtained with E&F formula (58.1%). Conclusion: In our study, none of the formulas appears reliable in discriminating between TT and IDA patients. The evaluation of iron status and measurement of hemoglobin A2 (HbA2) remain the most reliable investigations to differentiate between TT and IDA patients.

Protective effect of infliximab on ischemia/reperfusion injury in a rat ovary model: biochemical and histopathologic evaluation

OBJECTIVE The aim of this study was to investigate the effect of infliximab on experimentally induced ovarian ischemia/reperfusion injury (IRi). STUDY DESIGN A total of 42 female rats were equally divided into 6 experimental groups; group 1: sham operation, group 2: 3-h ischemia, group 3 and 4: 3-h ischemia, 3-h reperfusion, group 5 and 6: 3-h ischemia, 24h reperfusion. In group 4 and group 6, 30 min before reperfusion, infliximab was administered intraperitoneally at a dose of 5mg/kg. Bilateral ovaries were removed for histopathologic and biochemical analysis. Serum MDA (sMDA), tissue MDA (tMDA), serum NO (sNO), tissue NO (tNO) and serum catalase concentrations were analyzed. Tissue damage of ovarian tissue was scored by histological examination. RESULTS The infliximab administration significantly lowered the sNO, tNO and sMDA concentrations in group 4 compared to group 3 (p=0.041, p=0.025 and p=0.035, respectively). sNO, tNO and sMDA concentrations were also lower in group 6 when compared to group 5, but this differences were not significant (p>0.05). On the other hand, tMDA concentrations were lower in infliximab-applied groups when compared to ischemia/reperfusion groups (group 3 vs. 4 and 5 vs. 6) (p=0.045 and p=0.048, respectively). Moreover, histopathologic tissue damage scores in infliximab administration groups were significantly lower than in ischemia/reperfusion groups (p<0.001). CONCLUSION Infliximab attenuates I/R-induced ovarian tissue injury in rats subjected to ischemia/reperfusion.

Copeptin as a Novel Biomarker in Nocturnal Enuresis

OBJECTIVE To investigate the relation between copeptin, arginine vasopressin (AVP), and nocturnal enuresis (NE). METHODS Forty-four patients with NE and 44 healthy children aged between 6 and 14 years were enrolled. Patients with nonmonosymptomatic and secondary NE were excluded from the study. A small questionnaire, filled by parents, collected information about sociodemographic characteristics. Blood was obtained for plasma AVP and copeptin concentrations. RESULTS Copeptin levels were significantly lower in patient group (3.74 ± 1.44 pg/mL) than the control group (16.57 ± 3.91 pg/mL), whereas AVP levels were not significantly different between groups. Copeptin levels were significantly lower in patients (3.17 ± 1.15 pg/mL) who had bed-wetting 2 or more nights a week, which is considered as severe bed-wetting, than the patients (4.95 ± 1.24 pg/mL) who had bed-wetting 1 night or less than 1 night a week. CONCLUSION This study demonstrates the presence of decreased levels of copeptin in patients with NE compared with healthy patients. AVP levels were not different between groups. To our knowledge, this is the first report assessing the relationship between copeptin and NE.

Correlation between transient tachypnea of the newborn and wheezing attack.

Background:  Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. Although associated with some morbidity, it is generally believed that once TTN resolves, there is no further increased risk for respiratory disease. However, in limited studies frequency of wheezing attacks is found to be increased in patients who had TTN diagnosis during the newborn period, in comparison to patients who had no respiratory problem. Thus, the question arises as to whether TTN is an innocent disease.

Is Overweight a Risk of Early Atherosclerosis in Childhood

We measured brachial artery flow-mediated dilatation (FMD) and common carotid intima-media thickness (cIMT) in overweight (n = 67) and normal weight children (n = 115, controls). Age at examination ranged from 72 to 182 months (mean 123 ± 27). Compared to controls, the overweight children had increased weight, waist and hip circumference, systolic and diastolic blood pressures (all P < .001), right and left mean cIMT (mm; 0.58 [0.42-0.68] vs 0.44 [0.3-0.64], P < .001 and 0.56 [0.32-0.70] vs 0.44 [0.3-0.60], P < .001), respectively, and decreased FMD (%; 6.25 [3.33-19.05] vs 7.69 [3.45-16], P < .001). The cIMT and FMD were closely related to the serum insulin concentrations. Age, waist circumferences, and serum triglycerides were independent predictive risk factors for increased cIMT, and fasting glucose and BMI were independent predictive variables for decreased FMD. Overweight children are also potentially at risk of early atherosclerosis as much as obese children.

Alkaline phosphatase as an early marker of hemolysis in newborns.

Background:  Early diagnosis and appropriate management of neonatal hyperbilirubinemia are very important in order to prevent bilirubin encephalopathy and kernicterus. Several diagnostic tests may be used for this purpose, including bilirubin level itself. The aim of the present study was to investigate whether serum alkaline phosphatase (ALP), which is an intracellular enzyme found abundantly in red blood cells, could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns.

Ovarian Volume in Turkish Women with Normal and Polycystic Ovaries

Aim: We aimed to investigate possibility of different ovarian volume threshold and to study diagnostic thresholds for polycystic ovary in Turkish women, since the literature on this subject is very limited. Material and Method: Clinical study carried out Namik Kemal University School of Medicine, Tekirdag, Turkey.This case-control study included 132 patients with polycystic ovary syndrome (PCOS), diagnosed according to Rotterdam criteria and 75 controls. Comparison of ovarian volumes between PCOS patients and control group. Results: We found a mean ovarian volume of 9.44 ± 4.3 cm3 in PCOS cases and 7.63 ± 3.66 cm3 in control cases. The area under curve (AUC) for mean ovarian volume (MOV) was 0.633. The analysis showed that setting the threshold of MOV at 8.2 cm3 offered the best compromise between specific ity (61.3%) and sensitivity (53.8%). Discussion: Optimum threshold of ovarian volume to distinguish the PCOS from normal women and the mean ovarian volume in Turkish PCOS patients remain beneath the criteria by Rotterdam.

Can Frequency of Nocturnal Enuresis in Bladder Diary Predict the Efficacy of Urotherapy

Aim: Nocturnal enuresis is one of the most common urinary system disorders of childhood. Urotherapy(behavioral therapy) is the primary method for treatment of nocturnal enuresis. In this study, we aimed to evaluate the efficacy of nocturnal enuresis frequency during 3 days bladder diary for esti mating the success of urotherapy. Material and Method: Patients with monosymptomatic nocturnal enuresis in an age group of 5 to 18 years were prospectively included to study. They were given a 3 days bladder diary and reevaluated 1 week later and urotherapy strategies were told to both patients and parents. They were evaluated after 3 months later and success rate of urotherapy was compared with the nocturnal enuresis frequency in 3 days bladder diary. Results: A total of 66 patients were evaluated. There were 26(39.4%) patients with nocturnal enuresis in >3 nights/week and 40(60.6%) patients with nocturnal enuresis in every night. At the end of the third month of urotherapy, 50(75.7%) patients had >%50 decrease in clinical nocturnal enuresis frequency, whereas 16(24.3%) had no clinical improvement. Among the patients who did not have enuresis during bladder diary, 21(91.3%) had improvement with urotherapy. All of the patients with 1 day nocturnal enuresis in bladder diary had improved by conservative strategies, whereas 53.3% with 2 days enuresis and 22.2% with 3 days enuresis was able to improve by urotherapy. Discussions: We observed a direct relation between nocturnal enuresis frequency in bladder diary and urotherapy success. Clinician may predict urotherapy success by an attentive bladder diary evaluation.

Endothelial dysfunction in children with low birth weight, born at term -

The aim of our study was to assess whether endothelial function of the brachial artery is normal or impaired in children born at term with low birth weight (LBW) compared with their normal birth weight (NBW) peers, because there are still few data on this subject in children born at term with LBW. We compared brachial artery flow mediated dilatation (FMD) in children with LBW (n= 55, 30 male) and NBW (n= 45, 24 male) who were born at term. Age, gender, weight, height, waist and hip circumference, body mass index, body mass Z score, fasting glucose, total cholesterol, triglycerides, low density lipoprotein-cholesterol, high density lipoproteincholesterol, calcium, C-reactive protein, hemoglobin, serum insulin concentration, homeostatic model assessment index, creatinine values, brachial artery baseline diameter and brachial artery post dilatation diameter were similar in both groups (all p values >0.05). Compared with the NBW group, the LBW group had lower FMD (%) (6.68 ± 2.1 vs. 7.8 ± 1.9, p = 0.004). Brachial artery FMD was negatively correlated with waist circumferences (r = 0.521, p < 0.001). A general linear analysis model, FMD as the dependent variable revealed significant effect of waist circumference (β ± SE:0.07±0.02, p<0.001) and LBW controlling for age (β ± SE: -0.028±0.01, p = 0.004). LBW closely affects to FMD. Therefore, the children with LBW born at term may be potentially at risk for early atherosclerosis compared with their peers.