Elvan Iseri

Prevalence and risk factors of monosymptomatic nocturnal enuresis in Turkish children.

Objectives To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. Methods After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. Results MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. Conclusions The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.

Increased Serum Levels of Epidermal Growth Factor in Children with Autism

The etiology of autism is unclear, however autism is considered as a multifactorial disorder that is influenced by neurological, environmental, immunological and genetic factors. Growth factors, including epidermal growth factor (EGF), play an important role in the celluler proliferation and the differentiation of the central and peripheral nervous system. In this study we hypothesized that EGF may play a role in the pathophysiology of autism and examined serum EGF levels in children with autism. We measured serum levels of EGF in the 27 autistic children and 28 age- matched normal controls. The serum levels of EGF in the subjects with autism were significantly higher than those of normal control subjects. However, there were no correlations between serum EGF levels and clinical variables in the subjects with autism. This is the first report demonstrating the increased serum levels of EGF in children with autism. This study suggests that increased levels of EGF might have an importance in the pathophysiology of autism.

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.

Attention Deficit Hyperactivity Disorder and oxidative stress: A short term follow up study.

In this study, we aimed to investigate total antioxidative status (TAS) and total oxidative status (TOS) of plasma and antioxidant enzymes such as paraoxonase (PON), stimulated paraoxonase (SPON), arylesterase (ARES) and thiols in plasma of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). In the second step. this study aimed to reveal the possible effects of ADHD treatment on these parameters. Fifty-six patients with ADHD and 52 healthy controls were involved in this study. Venous blood samples were collected and oxidative and antioxidative parameters were studied. In the second phase of the study, blood samples were taken from patients using medication. Pre-treatment oxidative stress index (OSI) values and the plasma TOS levels of the patients with ADHD were statistically higher than those of the control group. The plasma thiol levels of the patients with ADHD were significantly lower than the control group. The post-treatment plasma antioxidative parameters levels were significantly higher than the pre-treatment levels. The post-treatment oxidative stress index value was significantly lower than the pre-treatment value. Therefore, oxidative metabolism was found to be impaired in children and adolescents with ADHD. It was also determined that methylphenidate repairs the oxidative balance by increasing antioxidant defence mechanisms.

The Corr elation of Attention Deficit Hyperactivity Disorder with DRD4 Gene Polymorphism in Turkey

Abstract Attention Deficit Hyperactivity Disorder (ADHD) is a disorder with a strong genetic background, and genetic factors are thought to play a crucial role in its aetiology and developmental course. In this study the researchers investigated the correlation of ADHD with the dopamine receptor D4 (DRD4) gene. Fifty patients (6–10 years of age) diagnosed between 1994 and 2001 and followed up 7–14 years until their adolescence and young adulthood (16–25 years of age) were included in the study. Fifty healthy individuals of the same age were included as the control group. DRD4 gene analysis of patients was performed after detailed clinical evaluation. The researchers found that 88% of patients continued to meet the criteria of ADHD in adolescence and young adulthood. The most frequent DRD4 gene alleles among the ADHD and control groups were 4-, 8- and 2-repeat alleles. While the frequency of the 8-repeat allele was higher than reported global estimations, none of the three alleles were found to be significant for ADHD. However, in the presence of the 2-repeat allele for the combined subtype of ADHD diagnosed in childhood, the persistence ratio was found to be statistically significant in adolescence and young adulthood. The DRD4 gene may play a role in the developmental course of ADHD in the Turkish population.

Quality of life and anxiety in Turkish patients with anorectal malformation

The aim of this study was to investigate quality of life (QoL) and anxiety level in Turkish children with anorectal malformation as well as the anxiety level of their mothers and the support group effects on anxiety.

Serum neopterin levels in patients with autism

Abstract Objective: Autism is a chronic neurodevelopmental disorder with an aetiology that is not fully understood. Published findings have identified widespread changes in the immune systems of children with autism. The latest findings show that the pathophysiology of autism may be associated with cellular immunity. Neopterin is a good indicator of cellular immunity, and changes in neopterin may have diagnostic importance. Methods: The study group consisted of 23 patients with autism. An age- and gender-matched control group was composed of 21 healthy subjects. Venous blood samples were collected, and the levels of neopterin were measured. Results: The levels of neopterin were significantly higher in the autistic children than in the comparison subjects. Conclusions: Cellular immunity may have a role in the aetiopathogenesis of autism. Increased serum neopterin levels may have diagnostic importance in autism.

Genetic and Environmental Factors in Autism

Autism is a neurodevelopmental disorder characterized by impaired social interaction, and verbal and nonverbal communication as well as limited and repetitive behaviours. Although symptomatology of autism may be noticed around early months, diagnosis generally occurs around 24-36 months, however in some cases diagnosis may be delayed to adulthood [1]. Since behavioural symptoms and the degree of functional impairment are variable, the au‐ tistic disorder is described as a heterogenous symptom cluster of varying etiological and pathological basis [2]. Described as a multifactorial disorder created by interaction of neuro‐ logic, immunologic, environmental, and genetic factors, autistic disorder has no definite cause [3, 4]. In many cases in whom the etiology remains unclear are diagnosed as idiopath‐ ic autism or non-syndromic autism [5, 6]. Seventy percent of cases with idiopathic autism have basic symptoms without physical abnormalities whereas 30% have complex autism in which dysmorphic features are detected such as microcephaly and/or structural brain mal‐ formations [7]. Autism is associated with other syndromes such as Fragile X syndrome, Down Syndrome, and tuberosclerosis in 5-25% of the cases ([8, 9]. Although phenotypic het‐ erogeneity is the biggest challenge for research efforts directed to identify autism etiology [10], currently it is widely accepted that environmental and genetic factors play essential role in genesis of autistic disorder thanks to a recent advance in research techniques related to biological factors and widespread studies in this field [11, 12].

The Role of Environmental Factors in Etiology of Attention- Deficit Hyperactivity Disorder

Environmental factors in etiology of ADHD Attention deficit and hyperactivity disorder (ADHD) is one of the most common developmental disorders of childhood. It was reported that it is a disease that affects 5.29% of children and adolescents in the entire world. Although ADHD is a disorder with high inheritability, genetic factors are not the only explanation to ADHD etiology. ADHD is a disorder etiology which has genetic and environmental components and gene-environment interaction. In spite of the fact that many environmental factors are linked to ADHD, the number of environmental factors that are proven to be in significant cause-effect relation is too small. In other words, in presence of proper genetic basis, disease appears in presence of many environmental factors each of which have a slight effect, its severity or prognosis is variable. Environmental factors that are most commonly linked to ADHD pathophysiology are; complications during pregnancy, natal and postnatal period, several toxins and food substances. It has been considered that exposure to risk factors that may affect development of the brain in any of these periods will have long-term effects on behavior. Along with mother’s cigarette or alcohol use during pregnancy, emotional difficulties, medical diseases and complications of pregnancy; natal complications, low birth weight, premature birth, post mature birth, physical traumas that may affect brain development in early childhood, psychosocial difficulties are also found to be related to ADHD. Studies of gene-environment interaction also note the importance of environmental factors. For example, a study showed that in cases which carry 7 repeated alleles of DRD4, exposure to prenatal cigarettes causes more severe symptoms of ADHD. The purpose of this paper is to evaluate the role of

T102C and 1438 G/A Polymorphisms of the Serotonin 2A Receptor Gene in Etiology and Course of ADHD

Abstract The aim of this study was to investigate the -1438A>G and T102C polymorphisms of serotonin 2A (5-HT2A) receptor gene frequencies in patients with ADHD compared with a healthy control group, and to determine the effects of these polymorphisms on the course and outcome of ADHD. Fifty adolescents and young adults diagnosed with ADHD in childhood (between 1994 and 2001) were included in this study. The patients were followed in the Child and Adolescent Psychiatry Department of Gazi University Medical Faculty for 7–14 years, and they completed this follow-up period. The control group consisted of 50 adolescents and young adults who were healthy both physically and mentally. In adolescence and adulthood, a diagnosis was reached after a semistructured interview based on the DSM-IV criteria. A genetic evaluation was carried out using the Polymerase Chain Reaction method. 50 adolescents and young adults (39 males, 11 females; age range 16-25 years) who were diagnosed with ADHD during childhood (age range at the time of diagnosis 6–10 years) and 50 healthy adolescents and young adults (33 males, 17 females; age range 16-25 years) were evaluated. In adolescence and adulthood, the diagnosis of ADHD remained in 44 (88%) of the cases, whereas six (12%) were in remission after the 7–14-year follow-up.* No significant difference in the frequency of CC, CT and TT genotypes of T102C polymorphism (χ2=1.629, p=0.44) and AA, AG and GG genotypes of -1438A>G polymorphism (χ2= 0.065, p=0.96) was found between the ADHD and control groups. No significant difference was found between ADHD patients with CC, CT, or TT genotypes in terms of the outcome of the illness (χ2=0.114, p=0.94). Similarly, there was no difference between ADHD patients with AA, AG, and GG genotypes in terms of the outcome (χ2=0.530, p=0.76). No significant association between -1438A>G and T102C polymorphisms of the 5-HT2A receptor gene and ADHD was found in the present study. No significant effect of these two polymorphisms on the outcome of ADHD in adolescence was detected. The results of this study do not support a role for the serotonergic system in the development and course of ADHD.