Ediz Yesilkaya

Importance of Plasma N-Terminal Pro B-Type Natriuretic Peptide, Epicardial Adipose Tissue, and Carotid Intima-Media Thicknesses in Asymptomatic Obese Children

This study aimed to analyze the variations of N-terminal pro B-type natriuretic peptide, epicardial adipose tissue thickness, and carotid intima-media thickness in childhood obesity. The study participants consisted of 50 obese children in the study group and 20 nonobese children referred for evaluation of murmurs who proved to have an innocent murmur and were used as control subjects. All the subjects underwent transthoracic echocardiographic examination for determination of left ventricular systolic function and mass index, myocardial tissue rates, and myocardial performance index. Epicardial adipose tissue thickness and carotid intima-media thickness also were measured during echocardiography. Serum N-terminal pro B-type natriuretic peptide levels were measured at the time of evaluation. The left ventricle mass index was 40.21xa0±xa010.42xa0g/m2 in the obese group and 34.44xa0±xa04.51xa0g/m2 in the control group (pxa0>xa00.05). The serum N-terminal pro B-type natriuretic peptide level was 109.25xa0±xa048.53xa0pg/ml in the study group and 51.96xa0±xa022.36 pg/ml and in the control group (pxa0=xa00.001). The epicardial adipose tissue thickness was 5.57xa0±xa01.45 mm in the study group and 2.98xa0±xa00.41 mm in the control group (pxa0=xa00.001), and the respective carotid intima-media thicknesses were 0.079xa0±xa00.019 cm and 0.049xa0±xa00.012 cm (pxa0=xa00.001). The left ventricular systolic and diastolic functions showed no statistically significant correlations with N-terminal pro B-type natriuretic peptide levels, carotid intima-media thickness, or epicardial adipose tissue thickness values. The results show that measurement of serum N-terminal pro B-type natriuretic peptide level, carotid intima-media thickness, and epicardial adipose tissue thickness in asymptomatic obese children is not needed.

Penile anthropometry of normal prepubertal boys in Turkey

Aim:u2002 The age‐related values of penile length must be known to determine abnormal penis sizes and to follow the treatment of underlying diseases. The aim of this study is to evaluate abnormal penile length in Turkish children by establishing novel reference values for Turkish population and to compare the mean penile length and other parameters with alternates from different ethnic populations and geography.

Effect of scrotal incision orchiopexy on serum inhibin B levels and comparison with classic inguinal orchiopexy.

OBJECTIVESnInhibin B reveals Sertoli cell activity. After our previous findings of an increase in inhibin B succeeding classic inguinal orchiopexy, we sought to determine the changes in endocrine parameters after scrotal orchiopexy in patients with cryptorchidism and to compare these findings with the results of classic orchiopexy.nnnMETHODSnA total of 50 boys with an undescended testis, 32 unilateral and 18 bilateral, were included in the present study. Scrotal orchiopexy was performed in all of them. Before and 6 months after orchiopexy, the serum basal inhibin B and other serum hormonal levels were measured in all patients.nnnRESULTSnThe mean serum basal inhibin B levels had significantly increased and the other reproductive hormonal levels had not changed at 6 months after successful scrotal orchiopexy in our 50 patients (P = 0.016). Within the subgroups, the increase in inhibin B levels was significant in only those 2-9 years old with a unilateral undescended testis. The increase in inhibin B in those 10-12 years old with unilateral or bilateral undescended testis resulted from the start of puberty. No significant difference was found in terms of an increase in inhibin B after classic and scrotal orchiopexy.nnnCONCLUSIONSnThe measurement of inhibin B levels could be used as a follow-up parameter after orchiopexy. The serum inhibin B level increases after scrotal incision orchiopexy just as after classic inguinal orchiopexy. The increased level of inhibin B might indicate that the orchiopexy has been beneficial.

Association of nerve conduction impairment and insulin resistance in children with obesity.

AimThe objective of our study was to investigate nerve conduction in normoglycemic obese children.MethodsA total of 60 children with obesity (30 female and 30 male) and 30 healthy children (15 female and 15 male) were enrolled in the study. Insulin resistance (IR) and other metabolic disturbances were investigated and nerve conduction was measured in all participants. Obese children were divided into groups according to the presence of IR. All results were compared between these subgroups.ResultsThe nerve conduction velocity (NCV) of motor median nerves in the IR+ group was significantly higher than that in the IR− group and lower than that in the control group. The NCV of the motor peroneal nerve in the IR+ group was significantly lower than that in the IR− group. The sensory nerve action potential (SNAP) of the sensory median nerve was significantly lower in the IR+ group compared to that in the IR− group. The sensory sural nerve’s SNAP was significantly lower in the IR+ group than that in the control group.ConclusionNerve conduction tests may help to detect early pathologies in peripheral nerves and to decrease morbidities in obese children.

Visual and brainstem auditory evoked potentials in children with obesity

AIMSnThe aim of our study is to investigate alterations in visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with obesity.nnnMETHODSnA total of 96 children, with a mean age of 12.1±2.0 years (range 9-17 years, 63 obese and 33 age and sex-matched control subjects) were included in the study. Laboratory tests were performed to detect insulin resistance (IR) and dyslipidemia. The latencies and amplitudes of VEP and BAEP were measured in healthy and obese subjects.nnnRESULTSnThe VEP P100, BAEP interpeak latency (IPL) I-III and IPL I-V averages of obese children were significantly longer than the control subjects. When the obese group was divided into two subgroups, those with IR and without IR, BAEP wave I, wave III and P100 wave latencies were found to be longer in the group with IR. A statistically significant correlation was observed between BAEP wave I latency, IPL I-V, IPL I-III and the homeostatic model assessment insulin resistance (HOMA IR) index and fasting insulin level.nnnCONCLUSIONSnOur findings suggest that VEP and BAEP can be used to determine early subclinical on auditory and visual functions of obese children with insulin resistance.

The Effects of Oxcarbazepine and Valproate Therapies on Growth in Children with Epilepsy

Aim. This study aimed to evaluate the effects of monotherapy with valproate or oxcarbazepine on the linear growth of children with idiopathic epilepsy. Methods. Antiepileptic treatment with valproate or oxcarbazepine was initiated in 76 patients. These were evaluated at baseline and at 6 and 18 months after commencement of therapy to determine height standard deviations (height z-scores). Serum ghrelin, insulin-like growth factor-1, and insulin-like growth factor-binding protein-3 levels were measured. Results. In prepubertal patients receiving oxcarbazepine, height z-scores were elevated after 6 and 18 months of therapy (p = 0.008 and p = 0.001, respectively); in pubertal patients, a significant increase was noted at the 18th month of therapy (p = 0.004). In prepubertal patients receiving oxcarbazepine, serum standardized insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 levels were significantly higher at the 18th month of therapy compared with baseline (p = 0.005 and p = 0.004, respectively). In puber-tal patients receiving valproate, serum ghrelin levels were significantly decreased at the 18th month of therapy compared with baseline (p = 0.006). Conclusion. Exposure to oxcarbazepine stimulated linear growth in epileptic patients through mechanisms involving the release of insulin-like growth factor-1 and insulin-like growth factor-binding protein-3. In contrast, expo-sure to valproate did not affect linear growth, but did lead to a decrease in serum ghrelin levels.

The effects of oxcarbazepine treatment on vitamin B12 and folate levels, thyroid functions, sex hormones, and bone mineral density in epileptic patients

The aim of this study was to evaluate vitamin B12 and folate levels, thyroid functions, sex hormones and bone mineral density in idiopathic epileptic patients taking oxcarbazepine as monotherapy. Newly diagnosed pediatric patients with idiopathic partial epilepsy taking oxcarbazepine (OXC) as monotherapy were enrolled in this study. The pre-treatment and 6 months post-treatment values of vitamin B12, folate, thyroid functions, sex hormones, and bone mineral density (BMD) were obtained from all patients. A total of 32 patients (22 (68.8%) males and 10 (31.2%) females) were included in this study. The mean age was 7.4 ± 3.2 years (range: 2–14 years). There were no significant differences between the pre-treatment and 6 months post-treatment values of vitamin B12, folate, thyroid functions, sex hormones, and BMD. However, the 6 month post-treatment sex hormone binding globulin (SHBG) values (159.92 ± 48.14 nmol/L) were significantly higher than the pre-treatment values (137.88 ± 43.12 nmol/L) (p=0.009). We found that OCX treatment in children did not have an effect on serum folate and vitamin B12 levels, thyroid functions, sex hormones and BMD but caused increased SHBG. Over time, the increase in serum SHBG levels may lead to diminished bioactivity of sex steroids, and thus to reduced fertility. The further studies are needed to demonstrate the clinical importance of increased SHBG levels.

Evaluation of Plasma Melatonin Levels in Children With Afebrile and Febrile Seizures

BACKGROUNDnMelatonin modulates central nervous system neuronal activity. We compared the melatonin levels of patients with febrile and afebrile seizures during and after seizure with those of healthy controls.nnnMETHODSnWe enrolled 59 individuals with afebrile and febrile seizures (mean age, 6.09xa0±xa04.46xa0years) and 28 age-, sex-, and weight-matched healthy children. Melatonin levels were measured near the time of a seizure (0 to 1xa0hour) and at 12 and 24xa0hours post-seizure, and control melatonin levels were measured from a single venous blood sample.nnnRESULTSnPlasma melatonin levels increased during seizures in the study group (Pxa0<xa00.001). Post-seizure plasma melatonin levels were significantly lower in the study group than in the control group (Pxa0<xa00.05). Plasma melatonin levels did not differ between patients with afebrile seizures who had and had not used antiepileptic drugs. Daytime (8 AM to 8 PM) and nighttime (8 PM to 8 AM) post-seizure melatonin levels were not significantly different.nnnCONCLUSIONSnMelatonin levels were lower in pediatric patients prone to seizures than in healthy children and increased during seizures. Further research is needed to test the role of melatonin in the pathophysiology and treatment of epilepsy.

Selenium, zinc, and copper levels and their relation with HbA1c status in children with type 1 diabetes mellitus

In recent years, the oxidative stress-induced free radicals have been implicated in the pathogenesis of type 1 diabetes mellitus (DM). It has been also reported that elements like selenium (Se), zinc (Zn), and copper (Cu) involved in lipid peroxidation may play a role in the pathogenesis and exacerbation of this disease. The aim of the present study was to evaluate the antioxidant status and micronutrient levels in children with type 1 DM. The study included 35 children with type 1 DM (16 girls and 19 boys) with a mean age of 13.8u2009±u20094.5xa0years and a mean disease duration of 3.6u2009±u20092.8xa0years and 26 age-matched healthy children (11 girls and 15 boys) with a mean age of 12.8u2009±u20093.3xa0years. The Se and Zn levels of children with type 1 DM were significantly lower than those of controls. Glycosylated hemoglobin (HbA1c) levels were found to be inversely correlated with Se and Zn levels. There was no any statistically significant difference between serum Cu levels of patients with type 1 DM and controls. Glutathione peroxidase (GSH-Px) levels were lower in patients with type 1 DM when compared with those of controls, and there was a negative correlation between HbA1c and GSH-Px levels. We believe that the increased oxidative stress may be originated from low levels of glutathione peroxidase resulted from decreased levels of Se. The negative correlation between Se, Zn, GSH-Px, and HbA1c levels may show poor metabolic control of the disease and effect of oxidative injury. Those elements should be closely monitored during the course of type 1 DM, and supplementation of these elements may be beneficial both for controlling diabetes and preventing long-term oxidative injury related to diabetic complications.

Metabolic acidosis mimicking diabetic ketoacidosis after use of calorie-free mineral water

To the Editor, We have read with interest the article concerning a metabolic acidosis after use of calorie-free mineral water by Dahl et al. [2] that was recently published in your journal. Although their patient is of interest, we have a few comments regarding the diagnostic process. As it is known, the biochemical criteria for the diagnosis of diabetic ketoacidosis are hyperglycemia (blood glucose >11 mmol/L [≈200 mg/dL]) and venous pH <7.3 or bicarbonate <15 mmol/L, ketonemia, and ketonuria [4]. However, the patient had only ketoacidosis and no hyperglycemia neither before nor after the diagnosis. For this reason, it is not an imitation of diabetic ketoacidosis because of the absence of the major criteria, hyperglycemia. For these reasons, it is not suitable to present the case with the title as “mimicking diabetic ketoacidosis”. Metabolic acidosis and ketosis may be the consequence of a variety of etiologies. During fasting, in response to stress, insulin secretion decreases, lipolysis and ketongenesis increase and this may lead to easily metabolic acidosis and ketosis. Development of ketoacidosis is for instance to be expected in a child who cannot eat because of herpes stomatitis due to physiologic stress combined with starvation. Diet products are so dangerous especially for young children because they reduces food intake [1, 3]. Furthermore, diet products contain cyclamates, aspartame, and acesulfame potassium which are not suitable for the pediatric age group. These substances may be a factor reducing the appetite in a small child who cannot eat or be fed orally and has a risk of catabolic process. Aspartame, one of the sweeteners in diet products, may be dangerous for children because it may cause metabolic acidosis. The low-calorie sweetening agent, aspartame, is degraded in the small intestine into three moieties: aspartic acid, methanol, and phenylalanine. Aspartic acid is the responsible product for the acidosis. Also methanol may lead to severe acidosis (http://rense.com/general70/aasp.htm) [5]. The use of diet products may have exacerbated the clinical symptoms in this case. The use of diet products does not provide enough calories for children. Also it causes loss of appetite and acceleration in the development of ketoacidosis and may lead to serious complications and death. We would appreciate that the authors comment on these points.