Hüseyin Bilgin

Association between insulin resistance and oxidative stress parameters in obese adolescents with non-alcoholic fatty liver disease.

Objective: Non-alcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases in children. The aim of this study was to investigate the associations of oxidative stress with insulin resistance and metabolic risk factors in obese adolescents with NAFLD. Methods: Forty-six obese adolescents (23 girls and 23 boys, mean age: 12.8±2.2 years) and 29 control subjects (15 girls and 14 boys, mean age: 12.7±2.7 years) were enrolled in the study. The obese subjects were divided into two groups (NAFLD group and non-NAFLD group) based on the elevated alanine aminotransferase levels (>30 IU/L) and the presence or absence of liver steatosis detected by ultrasonography. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples. Plasma total antioxidant status (TAS) and total oxidant status (TOS) level measurements (REL Assay Diagnostics) were done in all participants. The ratio of TOS to TAS was regarded as an oxidative stress index (OSI), an indicator of the degree of OS. Results: Fasting insulin levels and HOMA-IR values in the NAFLD group were significantly higher than in the non-NAFLD and control groups. TAS measurements were decreased in both obese groups (NAFLD and non-NAFLD) in comparison with the control group. TOS and OSI measurements were higher in the NAFLD group than in the non-NAFLD and control groups. OSI was positively correlated with fasting insulin (r=0.67, p=0.01) and HOMA-IR (r=0.71, p=0.02) in the NAFLD obese group. Conclusions: In this cross-sectional study, elevated OS markers in obese adolescents with NAFLD were associated with insulin resistance. This data suggest that an antioxidant therapy might have a potential for treating NAFLD associated with insulin resistance. Conflict of interest:None declared.

Correlation of insulin sensitivity with bone mineral status in obese adolescents with nonalcoholic fatty liver disease.

Aim  The aim of this study was to investigate the relationships between bone mineral density (BMD) vs insulin resistance and metabolic risk factors in obese adolescents with nonalcoholic fatty liver disease (NAFLD).

An unusual cause of fever in a neonate: influenza A (H1N1) virus pneumonia.

The 2009 flu outbreak in humans, known as H1N1 influenza A, refers to influenza A due to a new H1N1 strain called swine‐origin influenza virus A. The signs and symptoms of novel influenza A (H1N1) virus infection are similar to those of seasonal influenza, and specific diagnostic testing is required to distinguish novel influenza A (H1N1) virus from seasonal influenza virus. It results in various degrees of infection, ranging from mild to severe to fatal. For the treatment of swine‐origin influenza virus A oseltamivir and zanamivir are effective in most cases. Influenza A (H1N1) pneumonia in the newborn has not been yet reported in the literature. To our knowledge, this is the first report of a neonate of pneumonia in which influenza A (H1N1) virus was isolated. Pediatr Pulmonol. 2010; 45:734–736.

Low 25-hydroxyvitamin D level is associated with insulin sensitivity in obese adolescents with non- alcoholic fatty liver disease

AIM The aim of this study was to investigate the relationships between 25-hydroxy-vitamin D (25(OH)D) and insulin resistance in obese adolescents with non-alcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS Eighty-seven obese adolescents (45 girls and 42 boys, mean age: 12.7 ± 1.3 years, mean body mass index standard deviation score (BMI-SDS): 2.1 ± 0.3) and 30 lean subjects (15 girls and 15 boys, mean age: 12.3 ± 1.45 years, mean BMI-SDS: 0.5 ± 0.7) were enrolled for the study. The obese subjects were divided into two subgroups based on the presence or absence of fatty liver with high transaminases (NAFLD group and non-NAFLD group). Fasting blood samples were assayed for 25(OH)D, transaminases, glucose, and insulin levels. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR). RESULTS 25(OH)D measurements were decreased in both obese groups (NAFLD and non-NAFLD) in comparison with the lean group (29.5 ± 18.4 vs. 41.0 ± 17.9 vs. 48.1 ± 22.2 ng/mL). However; the NAFLD group had significantly lower measurements of 25(OH)D than the non-NAFLD group (p < 0.001) and lean group (p < 0.001). 25(OH)D was negatively correlated with HOMA-IR (r = 0.158, p = 0.01) and with alanine aminotransferase (r = 0.794, p = 0.03) in the NAFLD obese group. There was no significant associations between fasting insulin, BMI-SDS and 25(OH)D in obese groups. CONCLUSION We suggest that low 25(OH)D occurs commonly in obese adolescents with NAFLD and we demonstrated an association between insufficient vitamin D status and low insulin sensitivity in obese adolescents with NAFLD.

Thyroid Function in Obese Children with Non-Alcoholic Fatty Liver Disease

Objective: To investigate the relationships between thyroid function and metabolic risk factors in obese adolescents with non-alcoholic fatty liver disease (NAFLD). Methods: One hundred sixty obese adolescents and 40 control subjects were enrolled in the study. The obese subjects were divided into two groups based on presence or absence of liver steatosis (NAFLD group and non-NAFLD group). Serum samples were assayed for glucose, insulin, cholesterol, alanine aminotransferase, aspartate aminotransferase, free thyroxine (fT4), free triiodothyronine (fT3) and thyroid-stimulating hormone (TSH). The ratio of fT3 to fT4 was evaluated as an indirect index of deiodinase activity. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples. Results: NAFLD and non-NAFLD groups had slightly higher fasting blood glucose values than the control group. Fasting insulin levels in the NAFLD group were significantly higher than those in the non-NAFLD and control groups. The NAFLD group had significantly greater HOMA-IR values compared with the non-NAFLD group and also with the control group. The NAFLD group had significantly higher fT3/fT4 ratio values compared to both non-NAFLD and control groups. fT3/fT4 was positively correlated with serum insulin levels in the NAFLD group. Conclusion: This study showed that obese adolescents with hepatosteatosis had elevated values for fT3/fT4 ratio. This finding suggested a high conversion of T4 to T3 due to increased deiodinase activity as a compensatory mechanism for fat accumulation.

Social anxiety, depression and self-esteem in obese adolescent girls with acanthosis nigricans.

Objective: To assess the impact of acanthosis nigricans (AN) on depression symptoms, related quality of life and self-esteem scores in obese adolescent girls. Methods: Fifty-nine obese adolescent girls (mean age: 13.19±1.3 years, age range: 12-17 years, mean body mass index: 29.89±3.30) were enrolled in this study. The obese adolescent girls were divided into two groups based on presence or absence of AN. Non-obese healthy adolescents constituted the control group (30 girls, mean age: 13.5±1.4 years). All subjects were evaluated using the Children’s Depression Inventory (CDI), the State-Trait Anxiety Inventory for Children (STAI-C), and the modified Rosenberg Self-Esteem Scale (SES). Higher scores indicated more severe depression and anxiety, as well as low self-esteem status. Results: The AN and non-AN obese groups showed significantly higher CDI, STAI-C and SES scores than the control group, and the two obese groups demonstrated no significant differences for these scores. The AN obese group with higher total testosterone levels (>50 ng/dL) had higher scores for SES (2.55±1.8 vs. 1.42±1.2; p=0.03) than the AN obese group with low total testosterone levels. SES scores significantly correlated with total testosterone levels (r=0.362; p=0.03) and fasting insulin (r=0.462; p=0.03) in the AN obese group. Conclusion: Higher SES scores (low self-esteem status) were determined in obese adolescents with acanthosis and were related to hyperandrogenism. This study also showed that a high testosterone level may be one of the important indicators of low self-esteem status in obese girls with AN.

Clinical Presentation, Treatment and Prognosis in Children with Reye-like Syndrome

DOI: 10.4328/JCAM.3083 Received: 14.11.2014 Accepted: 09.12.2014 Publihed Online: 10.12.2014 Corresponding Author: Pinar Eroglu, Physical Medicine and Rehabilitation Clinic, Ankara Occupational Diseases Hospital, Ankara, Turkiye. GSM: +905055670317 E-Mail: pinarkucukeroglu@yahoo.com.tr Ozet Ailesel Akdeniz Atesi (AAA) febril serozit ataklari ile karakterize bir otozomal resesif hastaliktir. En sik gorulen semptom abdominal ve ikincisi artikuler ataktir. Eklem tutulumu genellikle alt ekstremitelerde akut monoartrit ve kronik monooligoartrit olarak gorulmektedir. AAA olan hastalarda spondiloartrit nadiren gorulmektedir. Burada biz seronegative spondiloartrit iliskili AAA olan bir vakayi sunuyoruz.

Achondroplasia Presenting with Pneumonia in a Two Months Old Boy

Achondroplasia is one of the common chondrodysplasias with an inheritance is autosomal dominant, but in around 85% the phenotype is the result of a new mutation. Achondroplasia develops as a result of dysplasia of enchondral formation due to the mutation of fibroblast growth factor receptor 3. A 2-month-old boy was referred to the our hospital with cough and fever. Craniofacially the head appeared large and also frontal bossing and depressed nasal bridge was demonstrated. Narrow lumbar interpedicular distances, normal trunk length, short-wide pelvis, micromelic upper extremities and rhizomelic lower extremities were seen on x-ray examination. The clinically and radiographically diagnosis of achondroplasia with heart failure secondary to pneumonia was performed. Achondroplasia, presenting with respiratory disorders and short limb should be differentiated from metatropic dysplasia and campomelic dysplasia. Achondroplasia may had similar findings with other dwarfism and differentiate diagnosis from other achondroplasia like diseases needs team work which includes pediatry, radiology and medical genetic for better patient care and family counseling.

Response to letter to the editor (10‐0227)

We thank Dr. Kanmaz et al. for their interest in case report. They have pointed out several important issues, although some of them are not directly related to our case report. Influenza A (H1N1) pneumonia in the newborn has not been yet reported in the literature. In the case of human influenza A, oseltamivir can be used for treatment in children aged <1 year and for prevention in children aged 3 months to 1 year. We isolated our case in a separate room after diagnosed as influenza A (H1N1). Our patient, the fifth day of the hospitalization, received treatment with oseltamivir. Even though clinical studies have shown that these medications are the most effective when started within the first 48 h of symptom onset, our patient was treated successfully from the fifth day of the admission. We should emphasize that this is the first report of a neonate of pneumonia in which influenza A (H1N1) virus was isolated. — AHMET SERT, MD* ABDULLAH YAZAR, MD DURSUN ODABAS, MD HUSEYIN BILGIN, MD Department of Pediatrics Konya Training and Research Hospital Konya, Turkey