Fatih Demircioglu

Vitamin D status in children with attention‐deficit–hyperactivity disorder

Attention‐deficit–hyperactivity disorder (ADHD), one of the most common psychiatric disorders of childhood, has an early onset, affecting 2–18% of children worldwide. The etiopathogenesis of ADHD is obscure. In recent studies, a low level of vitamin D has been found in association with many disorders as well as in neuropsychiatric diseases. The aim of this study was therefore to investigate serum vitamin D level in pediatric ADHD patients.

Retinal and Choroidal Thickness in Children with Familial Mediterranean Fever

Abstract Purpose: The aim of the present study was to evaluate retinal and choroidal thicknesses in children with familial Mediterranean fever (FMF). Methods: Thirty patients with FMF and 28 healthy controls were included in the study. The thicknesses of the retina and choroid of each subjects right eye were measured at the fovea and horizontal nasal and temporal quadrants at 500-µm intervals to 1500 µm from the foveal center using spectral-domain optic coherence tomography. Results: Retinal and choroidal thicknesses at the fovea did not differ between groups (p = 0.32 and p = 0.39, respectively). Horizontal nasal and temporal retinal and choroidal thickness measurements at 500-µm intervals to a distance of 1500 µm from the foveal center were also similar between the groups (all p > 0.05). Conclusions: The retinal and choroidal thicknesses of children with FMF do not differ from those of age- and sex-matched healthy controls.

Tear and serum vitamin D levels in children with allergic rhinoconjunctivitis

BACKGROUND Although solid cohort studies confirmed a preventative role for the anti-oxidant vitamin D in allergic asthma, a limited number of studies focused on allergic rhinoconjunctivitis (ARC). Here, we aimed to determine 25-hydroxycholecalciferol levels in tear and serum in young allergic rhinoconjunctivitis patients as compared to their apparently healthy matched controls. METHODS In total, 22 children with allergic rhinoconjunctivitis and 31 healthy control subjects underwent serum total IgE and 25-hydroxycholecalciferol measurements. Tear levels of 25-hydroxycholecalciferol were also determined in both groups. RESULTS The mean serum total IgE level in the ARC group (143.6±132.8IU/ml) was significantly higher than that in the control group (54.8±44.1IU/ml; p=0.03). Serum 25(OH)D levels were significantly higher in the ARC group (34.1±12.7ng/ml) than in the healthy controls (21.8±11.3ng/ml; p=0.001). CONCLUSIONS To our knowledge, this is the first reported study to show an association between serum 25-hydroxycholecalciferol and ARC in a childhood group. Higher levels of serum 25-hydroxycholecalciferol in children with allergic rhinoconjunctivitis may indicate a possible aetiopathogenic mechanism in the development of allergic rhinoconjunctivitis. This is also the first report to examine tear fluid vitamin D levels in paediatric ARC patients.

The association of obesity and obesity-related conditions with carotid extra-medial thickness in children and adolescents.

Carotid extra‐medial thickness (EMT) and carotid intima‐media thickness (cIMT) provide information concerning vascular changes.

Pregnancy Outcome in Women of Advanced Maternal Age: A Cross-Sectional Study in a Turkish Maternity Hospital

Abstract Background: There is a current trend towards delayed childbearing around the world. This is considered to increase the risk for poor maternal and neonatal outcomes. In this study, we evaluated pregnancy outcomes in women of advanced maternal age in a single maternity hospital in Turkey. Methods: Medical records of 517 women aged 35 years and older that gave birth between 2009 and 2010 were examined retrospectively. The chi-squared, Mann-Whitney U, and Student t tests were used for statistical analyses. Results: In total, 462 (89.3%) women aged 39 years or less and 55 (10.6%) women aged 40 years and older were included in the analysis. Cesarean sections, and neonatal mortality were more common in women of advanced maternal age (p = 0.004 and p=0.002, respectively). Neonatal mortality (OR: 0.1; 95% CI 0.02-1; p = 0.032), premature birth (OR: 0.4; 95% CI 0.2-0.8; p = 0.008), and low birth weight (LBW) (OR: 0.2; 95% CI 0.1-0.5; p < 0.001) were significantly higher in women 40 years and older. Respiratory distress syndrome (RDS) developed in 26% of babies with LBWs. All patients of neonatal death were diagnosed with asphyxiation or RDS. Conclusions: At the Bolu Izzet Baysal Maternity and Children’s Hospital, advanced maternal age was associated with increased adverse fetal and neonatal outcomes.

Prevalence of Depression in Patients with β-Thalassemia as Assessed by the Beck’s Depression Inventory [Hemoglobin. 2014;38(4):289–291.]

We read with great interest the recent article by Shafiee et al. (1) in which the authors examined the prevalence of depression in patients with b-thalassemia as assessed by the Beck’s Depression Inventory. They concluded that the noticeable rate of depression in thalassemic patients signifies the necessity for improving psychosocial care in this specific group of patients. To add to the clear discussion provided by the authors, we wish to emphasize an important factor that should be taken into consideration when evaluating the prevalence of depression and/or anxiety symptoms. Antidepressants are highly effective and widely used drugs in the treatment of both anxiety and depression. Various studies and treatment guidelines have proposed different lengths of time for assessing the response to antidepressant treatment or full recovery. The Texas Medication Algorithm specifies a period of 6 weeks, while the American Psychiatric Association specifies a period of 4 weeks (2,3). Thus, an unknown history of antidepressant use within the 2-month period of time previous to the study may have had an unnoticed effect on the study results. We recommend that future studies assessing the prevalence of anxiety and/or depression symptoms in a specific population should consider the history of antidepressant use at least 2 months before the study is begun.

Çocuk hastada kolşisin zehirlenmesine bağlı rabdomiyoliz

Sayin Editor Kolsisin Colchicum Autumnale bitkisinden ele edilmis enflamasyon karsiti etkisi olan dogal bir alkaloiddir Behcet hastaligi gut artriti skleroderma ve ozellikle Ailevi Akdeniz Atesi rsquo;nin AAA akut ataklarini ve amiloidoz gelisimini onlemede kullanilan bir ilactir 1 Ailevi Akdeniz Atesi hastaliginin yayginligina bagli olarak kolsisinin sik kullanimi zehirlenme olgularinin sayisinin artisini da beraberinde getirmistir Ozellikle yuksek dozlarda alindiginda olume neden olmaktadir Ozdemir ve ark 2 1985 2011 yillari arasinda kolsisin zehirlenmesi saptanan 23 cocuk hasta uzerinde yaptiklari calismada kolsisini 0 5 mg kg rsquo;dan dusuk dozda alan 16 hastadan hicbirinde olum gorulmezken 0 5 0 8 mg kg dozunda ilac alan uc hastadan birinde ve 0 8 mg kg rsquo;dan fazla dozda ilac alan dort hastadan ikisinde olum gelismistir Kolsisine bagli ortaya cikan rabdomiyoliz nadir olarak bildirilmis olup hastalik riski nedeniyle onemlidir 3 Biz yanlislikla yuksek doz kolsisin alimi sonrasi rabdomiyoliz ve kemik iligi baskilanmasi gelisen bir cocuk olguyu sunuyoruz Uc yasinda kiz hasta 0 5 mg kolsisin tabletlerden 10 tane 0 4 mg kg aldiktan bir saat sonra bir hastaneye basvurmus Mide yikamasi ve aktif komur verildikten sonra taburcu edilmis Kirk sekiz saat sonra baslayan kusmalari ve halsizligi olmasi nedeniyle hastanemize basvurdu Fizik incelemesinde ates: 37 1 oC koltuk alti nabiz: 95 dak solunum: 28 dak kan basinci: 90 60 mmHg olup diger fizik muayene bulgulari normal idi Laboratuvar tetkiklerinde kanda aspartat transaminaz AST : 826 U L ve alanin aminotransferaz ALT : 146 U L 5 50 degerlerinde ve trombositopeni 50 000 mm3 vardi Hasta izlem amacli yatirildi Ertesi gun muayenesinde yaygin kas agrisi saptanmasi uzerine yinelenen tetkiklerinde AST: 395 U L ve ALT: 132 U L laktat dehidrogenaz LDH : 2094 U L 150 500 kreatin kinaz CK : 6530 U L 35 235 miyoglobin:117 ng mL 21 58 sodyum 131 mEq L potasyum 2 9 mEq L klor 101 mEq L ve fosfat 1 7 mg dL olarak saptandi Yatisinin ikinci gununde tromositopenisine lokopeni eklendi 3600 mm3 Kan ure azotu kreatinin kan gazi kalsiyum fibrinojen protrombin zamani ve aktive parsiyel tromboplastin zamani normal bulundu Oykude rabdomiyoliz yapabilecek diger nedenler acisindan enfeksiyon travma kas icine enjeksiyon kolsisin disinda ilac kullanimi oykusu yoktu Mevcut tablonun kolsisine bagli rabdomiyoliz oldugu dusunuldu Sivi destegi 2500 cc m2 gun ve alkalinizasyon tedavisi uygulandi Izleminde baska patoloji saptanmayan hasta yakinma fizik muayene ve laboratuvar bulgularinin duzelmesi nedeniyle dort gun sonra taburcu edildi Kolsisin zehirlenmesi seyrek gorulen ancak yasami tehdit eden acil bir durumdur Yuksek dozda alindiginda olumculdur Tedavi edici dozlarda bile zehirlenme gorulebilir Kolsisin zehirlenmesi klinik bulgularina gore uc evreye ayrilmaktadir: Evre 1: Yuksek bolunme hizina sahip bagirsak mukoza hucrelerinin etkilendigi donemdir Buna bagli olarak siklikla ortaya cikan ilk bulgular bulanti kusma karin agrisi ve ishaldir Evre 2: Kolsisin alimindan 24 saat sonra ortaya cikar Bazi sistemlerin tutulumuna bagli coklu organ yetersizliklerine ait bulgular gorulmeye baslar Kemik iligi baskilanmasi karaciger hasari bobrek yetersizligi sikintili solunum sendromu aritmiler yaygin dama ici pihtilasmasi metabolik asidoz hiponatremi ve hipokalsemi bu evrede gorulur Evre 3: Ucuncu evre iyilesme evresi olup bu evrede tipik olarak gecici alopesi ve ldquo;rebound rdquo; lokositoz gorulmektedir 4 Olum erken donemde ilk 48 saat hipovolemik sok merkezi sinir sistemi hasari veya kardiyopulmoner yetersizlikten meydana gelebildigi gibi 5 siklikla gec donemde yedi ile 10 gun sonra kardiyojenik kollaps veya kemik iligi baskilanmasina bagli meydana gelebilmektedir 6 Rabdomiyoliz degisik etiolojilere bagli olarak gelisebilen yaygin kas hasari ile belirgin bir tablodur Akut tubuler nekroza neden olabilen miyoglobin plazmaya salinan onemli bir kas yikim urunudur 7 8 Eriskinlerde gorulen kas agrisi kas gucsuzlugu ve koyu renkli idrar birlikteligi cocuklarda nadir olup kas agrisi ve yaygin kas gucsuzlugu en sik gorulen yakinmalardir Teshis kas agrilarina eslik eden CK seviyelerindeki yukselme ve miyoglobulinuri varligi ile konulur Hayati tehdit eden bobrek yetersizligi ve yaygin damar ici pihtilasma gibi komplikasyonlar eriskinlerde daha siktir 9 10 Bizim hastamizda da artmis kas hassasiyeti ve halsizlik vardi Kolsisin zehirlenmesi cocukarda rabdomiyolizin nadir bir nedenidir Melli ve ark 11 calismasinda ilac alimina bagli gelisen rabdomiyoliz olgularinin 7 rsquo;sinin kolsisin zehirlenmesine ikincil oldugu saptanmistir Bu olgularin cogunda birlikte antipsikotik statin ve serotonin geri alim inhibitorleri gibi ikinci bir ilac alimi da soz konusudur Literaturde dort cocuk hastada kolsisine bagli rabdomiyoliz bildirilmistir 12 14 Olgularin kullandiklari doz 07 1 3 mg kg arasinda degismekte olup en sik klinik basvurunun kusma ishal oldugu saptanmistir Klinik olarak en sik sepsis septik sok yaygin damar ici pihtilasma alopesi saptanmis ve bir cocuk olmustur Bizim olgumuzda 0 4 mg kg kolsisin alimindan 48 saat sonra baslayan kas agrilari nedeniyle bakilan CK ve miyoglobulin degerlerinin yuksek saptanmasi nedeniyle rabdomiyoliz teshisi konulmustur Kolsisin zehirlenmesi suphesi olan tum olgular sonucun nasil olacaginin tahmin edilememesi nedeniyle yakindan izlenmelidir Hastanin klinik ve laboratuvar bulgulari yakindan izlenmeli ciddi kas agrisi olan olgularda rabdomiyoliz olabilecegi dusunulmelidir Ya shy;zisma Ad shy;re shy;si Ad shy;dress for Cor shy;res shy;pon shy;den shy;ce: Dr Fatih Demircioglu Abant Izzet Baysal Universitesi Tip Fakultesi Cocuk Sagligi ve Hastaliklari Anabilim Dali Bolu Turkiye E pos shy;ta: fatih_demircioglu@yahoo com Ge shy;lis Ta shy;ri shy;hi Re shy;cei shy;ved: 18 04 2012 Ka shy;bul Ta shy;ri shy;hi Ac shy;cep shy;ted: 28 08 2012 Kay shy;nak shy;lar 1 Ben Chetrit E Bergmann S Sood R Mechanism of the anti inflammatory effect of colchicine in rheumatic diseases: a possible new outlook through microarray analysis Rheumatology Oxford 2006; 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