Elif Özmert

Plasma Phthalate Levels in Pubertal Gynecomastia

OBJECTIVE: Several untoward health effects of phthalates, which are a group of industrial chemicals with many commercial uses including personal-care products and plastic materials, have been defined. The most commonly used, di-(2-ethylhexyl)-phthalate (DEHP), is known to have antiandrogenic or estrogenic effects or both. Mono-(2-ethylhexyl)-phthalate (MEHP) is the main metabolite of DEHP. In this study, we aimed to determine the plasma DEHP and MEHP levels in pubertal gynecomastia cases. PATIENTS AND METHODS: The study group comprised 40 newly diagnosed pubertal gynecomastia cases who were admitted to Hacettepe University Ihsan Doğramacı Childrens Hospital. The control group comprised 21 age-matched children without gynecomastia or other endocrinologic disorder. Plasma DEHP and MEHP levels were measured by using high-performance liquid chromatography. Serum hormone levels were determined in some pubertal gynecomastia cases according to the physicians evaluation. RESULTS: Plasma DEHP and MEHP levels were found to be statistically significantly higher in the pubertal gynecomastia group compared with the control group (P < .001) (DEHP, 4.66 ± 1.58 and 3.09 ± 0.90 μg/mL, respectively [odds ratio: 2.77 (95% confidence interval: 1.48–5.21)]; MEHP, 3.19 ± 1.41 and 1.37 ± 0.36 μg/mL [odds ratio: 24.76 (95% confidence interval: 3.5–172.6)]). There was a statistically significant correlation between plasma DEHP and MEHP levels (r: 0.58; P < .001). In the pubertal gynecomastia group, no correlation could be determined between plasma DEHP and MEHP levels and any of the hormone levels. CONCLUSIONS: DEHP, which has antiandrogenic or estrogenic effects, may be an etiologic factor in pubertal gynecomastia. These results may pioneer larger-scale studies on the etiologic role of DEHP in pubertal gynecomastia.

Long-term follow-up of indirect hyperbilirubinemia in full-term Turkish infants.

Objective: This retrospective follow‐up study was performed to evaluate the suitability of the recently reported exchange transfusion limits (serum indirect bilirubin level of 428‐496 μmol/1, 25‐29 mg/dl) for Turkey. Material and methods: The study groups totalled 102 children, 8‐13 years of age, who had been born at term with birthweights greater than 3000 g and had been treated for indirect hyperbilirubinemia during their newborn period; the control group consisted of 27 children of the same age‐group without indirect hyperbilirubinemia. Children were grouped according to their maximum serum indirect bilirubin levels and direct Coombs’test results. Physical and neurological examinations, visual and brainstem auditory evoked potentials and the Wechsler Intelligence Scale for Children—Revised for Turkish Children were performed. Results: There was no difference between the groups with regard to mean visual and brainstem auditory evoked potential latencies. Children whose direct Coombs’tests were positive had significantly lower IQ scores and more prominent neurological abnormalities (p < 0.05). IQ scores and prominent neurological abnormalities did not differ among the other groups. Nine children had prominent neurological abnormalities associated with abnormal brainstem auditory evoked potentials. An important risk factor was the duration that the infants serum indirect bilirubin level remained greater than 342 μmol/1 (20 mg/dl). Conclusion: The current limit of 342 μmol/1 should continue to be used for infants whose direct Coombs’tests are positive in our country. Until better criteria for exchange transfusion other than the indirect bilirubin level are established, the current limits should also still be followed for infants whose direct Coombs’tests are negative in Turkey, where regular neonatal follow‐up examinations are not satisfactory.

Priming effect, immunogenicity and safety of an Haemophilus influenzae type b-tetanus toxoid conjugate (PRP-T) and diphtheria-tetanus-acellular pertussis (DTaP) combination vaccine administered to infants in Belgium and Turkey.

To evaluate the priming effect, immunogenicity and safety of an Haemophilus influenzae type b (Hib) tetanus toxoid conjugate (PRP-T) and diphtheria-tetanus-acellular (two component) pertussis (DTaP) combination vaccine, a randomized, comparative study was conducted in two centers, one in Belgium and one in Turkey. A total of 410 healthy infants, 160 in Belgium and 250 in Turkey, randomly received DTaP and PRP-T vaccines in one of three fashions. One group (N = 138) received DTaP and PRP-T vaccines reconstituted immediately prior to injection at 3, 4 and 5 months of age, and are referred to as the combined, short schedule group (Co-S). A second group (N = 135) received DTaP + PRP-T simultaneously but injected at different sites according to the same schedule, and are referred to as the associated, short schedule group (As-S). The third group (N = 137) also received DTaP + PRP-T at separate sites, but at 2, 4 and 6 months, and are referred to as the associated, long schedule group (As-L). The As-L group allowed for serological bridging with a Senegalese two-component pertussis vaccine efficacy trial, using the same batch of DTaP vaccine. Children of both short-schedule groups (Co-S and As-S) received, at the age of 12-14 months, a booster dose of DTaP vaccine associated with unconjugated PRP vaccine. Mixing of the vaccines did not affect the immune response to the antigens included in the DTaP vaccine. The immune response to Hib capsular polysaccharide, however, was significantly lower after combined administration (Co-S group) than after associated (As-S group) administration (P < 0.0001), with a similar trend among both countries (GMTs, 1.78 microg/ml and 6.19 microg/ml in Belgium, and 5.02 microg/ml and 11.67 microg/ml in Turkey). Booster vaccination with the unconjugated PRP induced a vigorous and similar anamnestic response in both groups. Belgian infants showed a significantly lower immune response to all antigens than Turkish infants (P < or = 0.001 for all antigens), with a similar trend among each study group. In all groups, the incidence of adverse events was lower than that usually reported after DTwP(whole-cell) vaccine. Higher rates of systemic reactions were observed in the Belgian population, possibly due to differences in reporting practice. Our results indicate (1) that the combination vaccine, DTaP//PRP-T, represents an important improvement over the existing uncombined vaccines; (2) that immunogenicity studies should include at least one booster injection to evaluate priming effects by combined vaccines; and (3) that it is feasible and valuable to co-randomize combination vaccine studies in sufficiently different geographical areas and child populations.

Effect of aluminum adjuvants on safety and immunogenicity of Haemophilus influenzae type b-CRM197 conjugate vaccine

Abstract Objective : The present study was carried out to evaluate the safety and immunogenicity of the Haemophilus influenzae type b‐CRM197 (Hib‐CRM197) conjugate vaccine in relation to the change of adjuvant from aluminum hydroxide to aluminum phosphate (AlPO4).

Immunogenicity study of a combined diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis vaccine used to reconstitute a freeze-dried Haemophilus influenzae type b vaccine (DTaP-IPV//PRP-T) administered simultaneously with a hepatitis B vaccine at two, three and four months of life

This study was designed to assess the immunogenicity of a vaccine combining diphtheria and tetanus toxoids, acellular pertussis vaccine, and inactivated poliovirus vaccine reconstituting Haemophilus influenzae type b polysaccharide conjugated to tetanus protein (DTaP-IPV//PRP-T; Pasteur Mérieux Connaught, Lyon, France) administered simultaneously in association with hepatitis B vaccine (RECOMBIVAX (¿trade mark omitted¿) Merck, Sharp & Dohme, West Point, PA, USA) for the primary immunization of infants. The vaccines were administered at two, three and four months of age. One hundred and sixty-two healthy infants, aged 8-10 weeks, were enrolled in the study. Blood samples were taken before the first dose and 4 weeks after the third dose. The infants were observed for 15 minutes after vaccination for any immediate reaction. Adverse events requiring a medical consultation were recorded by the parents in a diary over the 7 days following vaccination. Four weeks after the third immunization, the percentages of infants fulfilling seroconversion criteria were 98.9% for pertussis toxin, 95.9% for filamentous haemagglutinin, 100.0% for tetanus, 100.0% for diphtheria, 99.3% for poliovirus type 1, 100.0% for both poliovirus types 2 and 3, 98.0% for Haemophilus influenzae type b, and 100% for hepatitis B surface antigen. No vaccine-related serious adverse event was reported. The simultaneous administration of DTaP-IPV//PRP-T and hepatitis B vaccines at two, three and four months of age yielded clinically satisfactory immune responses to all antigens compared with historical controls and gave a good safety profile.

Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children

Objective: To determine the effect of zinc supplementation on behaviour in low‐income school aged children.

Short-term developmental outcome of iron prophylaxis in infants.

Background : Previous studies on the cognitive effects of iron treatment have focused on anemic or non‐anemic iron‐deficient infants. The effect of iron supplementation on cognitive development among iron‐sufficient infants has not been studied. The aim of the present study was to examine the effect of iron supplementation on performance in the Bayley Scales of Infant Development (BSID) and anthropometric measurement in 6‐month‐old iron‐sufficient healthy infants.

Clinical characteristics and antibiotic resistance of Shigella gastroenteritis in Ankara, Turkey between 2003 and 2009, and comparison with previous reports.

OBJECTIVES The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002. METHODS A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics. RESULTS The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p<0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p<0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively). CONCLUSIONS There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases.

Shigella gastroenteritis: clinical and epidemiological aspects, and antibiotic susceptibility.

The epidemiology and antibiotic sensitivity of Shigella species is changing worldwide. The present study surveyed the changing clinical and epidemiological characteristics and antibiotic susceptibility of Shigella gastroenteritis in Hacettepe University Ihsan Dogramaci Childrens Hospital Diarrhoea Training and Treatment Unit between 1987 and 1994. Among 19 812 diarrheal admissions, 618 (3.2%) patient files with Shigella gastroenteritis were reviewed retrospectively. Shigella soneii has been the commonest isolate (64%) since 1987 followed by S. flexineri (30%), S. boydii (5%) and S. dysenteriae (1%), the latter having not been isolated since 1990. The isolate rate of S. sonnei has increased whereas the isolation rate of S. flexineri has decreased concomitantly since 1987 (r = −0.94; P< 0.001). The majority of cases (365/618, 59%) were between 1 and 5 years of age. On admission bloody diarrhea was present in 36%, seizures in 3% and mild‐moderate dehydration in 11% of cases. No case had severe dehydration. Only six patients (1%) were hospitalized. No deaths were recorded. The resistance rate for trimethoprim‐sulfamethoxazole has increased from 27% in 1990 to 66% in 1994 (P < 0.05) while the resistance rate for ampicillin has decreased from 81% in 1987 to 32% in 1993 (P< 0.001). Shigella flexineri was found to have higher resistance rates to ampicillin, sulbactam‐ampicillin, chloramphenicol and gentamicin than S. sonnei. Changing Shigella sp. over the years may be the reason for the mild course of Shigella gastroenteritis. Further regional epidemiological studies are necessary to develop more appropriate management guidelines, especially in developing countries.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.