Meda Kondolot

Insulin Resistance in Obese Children and Adolescents: HOMA-IR Cut-Off Levels in the Prepubertal and Pubertal Periods

Objective: Childhood obesity is associated with an increased risk for insulin resistance. The underlying mechanism for the physiological increase in insulin levels in puberty is not clearly understood. The aim of the present study was to determine the cut−off values for homeostasis model assessment for insulin resistance (HOMA−IR) in obese children and adolescents according to gender and pubertal status. Methods: Two hundred and eight obese children and adolescents (141 girls, 127 boys) aged between 5 and 18 years were included in the study. The children were divided into prepubertal and pubertal groups. A standard oral glucose tolerance test (OGTT) was carried out in all children. A total insulin level exceeding 300 μU/mL in the blood samples, collected during the test period, was taken as the insulin resistance criterion. Cut−off values for HOMA−IR were calculated by receiver operating characteristic (ROC) analysis. Results: In the prepubertal period, the rate of insulin resistance was found to be 37% in boys and 27.8% in girls,while in the pubertal period, this rate was 61.7% in boys and 66.7% in girls. HOMA−IR cut−off values for insulin resistance in the prepubertal period were calculated to be 2.67 (sensitivity 88.2%, specificity 65.5%) in boys and 2.22 (sensitivity 100%, specificity 42.3%) in girls, and in the pubertal period, they were 5.22 (sensitivity 56%, specificity 93.3%) in boys and 3.82 (sensitivity 77.1%, specificity 71.4%) in girls. Conclusions: Since gender, obesity and pubertal status are factors affecting insulin resistance, cut−off values which depend on gender and pubertal status, should be used in evaluation of insulin resistance. Conflict of interest:None declared.

Neck circumference as a novel parameter to determine metabolic risk factors in obese children.

Eur J Clin Invest 2012; 42 (6): 623–630

Cyanide poisoning caused by ingestion of apricot seeds

Abstract Aim: To report diagnostic, clinical and therapeutic aspects of cyanide intoxication resulting from ingestion of cyanogenic glucoside-containing apricot seeds. Methods: Thirteen patients admitted to the Pediatric Intensive Care Unit (PICU) of Erciyes University between 2005 and 2009 with cyanide intoxication associated with ingestion of apricot seeds were reviewed retrospectively. Results: Of the 13 patients, four were male. The mean time of onset of symptoms was 60 minutes (range 20 minutes to 3 hours). On admission, all patients underwent gastric lavage and received activated charcoal. In addition to signs of mild poisoning related to cyanide intoxication, there was severe intoxication requiring mechanical ventilation (in four cases), hypotension (in two), coma (in two) and convulsions (in one). Metabolic acidosis (lactic acidosis) was detected in nine patients and these were treated with sodium bicarbonate. Hyperglycaemia occurred in nine patients and blood glucose levels normalised spontaneously in six but three required insulin therapy for 3–6 hours. Six patients received antidote treatment: high-dose hydroxocobalamin in four and two were treated with a cyanide antidote kit in addition to high-dose hydroxocobalamin. One patient required anticonvulsive therapy. All patients recovered and were discharged from the PICU within a mean (SD, range) 3.1 (1.7, 2–6) days. Conclusion: Cyanide poisoning associated with ingestion of apricot seeds is an important poison in children, many of whom require intensive care.

The endocrine disruptor bisphenol A may play a role in the aetiopathogenesis of polycystic ovary syndrome in adolescent girls

Experimental in vitro studies have shown that bisphenol A affects steroidogenesis, folliculogenesis and ovarian morphology. The aim of this study was to investigate the role of the endocrine disruptor bisphenol A in the aetiopathogenesis of polycystic ovary syndrome (PCOS) in adolescents and its relationship with metabolic parameters, insulin resistance and obesity in this population.

The effect of bovine colostrum on viral upper respiratory tract infections in children with immunoglobulin A deficiency

Introduction:  Immunoglobulin A (IgA)‐deficient patients predominantly suffer from respiratory and gastrointestinal infections since secretory IgA has important functions to protect mucosal surfaces.

Maternal uniparental isodisomy is responsible for serious molybdenum cofactor deficiency

Molybdenum cofactor (MoCo) deficiency is a rare autosomal recessive inherited metabolic disorder resulting in the combined deficiency of aldehyde oxidase, xanthine dehydrogenase, and sulfite oxidase. We report a male infant with MoCo deficiency whose clinical findings consisted of microcephaly, intractable seizures soon after birth, feeding difficulties, and developmental delay. Sequencing of MOCS1, MOCS2, and GEPH genes, and single nucleotide polymorphism genotyping array analysis showed, to our knowledge, unusual inheritance of MoCo deficiency/maternal uniparental isodisomy for the first time in the literature. At 10 months of age, he now has microcephaly and developmental delay, and his seizures are controlled with phenobarbital, clonozepam, and vigabatrin therapy.

Body mass index percentiles for Turkish children aged 0-84 months

Background: Reference body mass index (BMI) percentiles are needed to follow secular changes in Turkish children aged 0–84 months. Obesity prevalence in this age group is also not well documented. Aim: The aim of this study was to determine BMI percentiles and the prevalences of overweight and obesity in Turkish children aged 0–84 months. The authors also tried to compare actual BMI status with World Health Organization (WHO) standards. Subjects and methods: This study used data from the Anthropometry of Turkish Children aged 0–6 years (ATCA-06) study. This cross-sectional study, conducted from September 2009 to May 2010 in Kayseri, Turkey, included 2683 children (1359 girls, 1324 boys) aged 0–84 months. Centile curves were constructed using the LMS method. Results: It was found that BMI percentiles of Turkish children were higher than WHO standards in early childhood. The overweight and obesity prevalences were identical in both genders, 10.0% and 4.9%, respectively. Conclusion: This study provides both BMI reference values and prevalence figures for overweight and obesity in children aged 0–84 months, residing in Kayseri city, in Turkey. It is believed that these data can be of use in following secular changes as well as for comparisons with international standards.

Case series of mercury toxicity among children in a hot, closed environment.

Abstract Mercury poisoning is much more prevalent in the general population than possibly many physicians realize. We present data on 26 pediatric cases with mercury intoxication from exposure to mercury by inhalation or skin contact as a result of a broken thermometer in a school laboratory. This is the largest pediatric series in Turkey. During a 3-month period, the study team observed the children for clinical symptoms, physical findings, and blood and mercury levels. Of all patients, 21 inhaled, 3 inhaled and touched the element, and 2 took the mercury home. Sixteen children were symptomatic at admission, although blood mercury levels in the symptomatic children were higher than those in asymptomatic children (P = 0.003). The urine mercury levels were not statistically different between the groups at the admission (P > 0.05). The exposure times were 3.5 and 2 hours for symptomatic and asymptomatic children, respectively (P = 0.003). The 2 children who took the mercury home had the highest blood mercury levels and the most prolonged exposure time. N-acetylcysteine and chelation treatments were started in 21 children who had symptoms of mercury intoxication and high mercury levels in their blood or urine. No adverse effects were observed during chelation therapy. Prompt removal of children from contaminated environments and proper decontamination or elimination of devices containing large amounts of mercury from schools are necessary to prevent serious complications caused by exposure to mercury.

Is plasma exchange effective in prevention of hepatic transplantation in fulminant Wilson disease with hepatic failure

778 W ilson disease (WD) is an autosomal recessive disorder characterized by the accumulation of copper in the body, especially in the liver, brain, kidney, and cornea (1,2). Liver involvement can manifest itself as cirrhosis, chronic active hepatitis, or fulminant hepatic failure (2). Mortality is particularly high in patients in whom fulminant hepatic failure is accompanied by hemolytic crisis (3). Hepatic transplantation is the only treatment for these individuals when copper-chelating agents are insufficient (3,4). Chelating agents such as D-penicillamine and trientine are the primary medications used for treatment (3). Moreover, methods such as plasma exchange (PE) can be lifesaving in the early periods of fulminant hepatic failure when copper should be immediately eliminated from the circulation (3,5). PE is a procedure that involves the removal of patient’s plasma from the blood, substituting a plasma-replacement solution of fresh frozen plasma (FFP) and returning ‘‘treated’’ plasma to the blood circulation. By this procedure, unwanted plasma components are removed and the remaining plasma is returned to the body (6). This procedure can be performed on patients with WD and copper can be removed quickly from the blood. In this way, hemolysis that is caused by the oxidative effects of copper can be eliminated and hepatic functions can be stabilized (4,7,8). PE is effective in treating hepatic encephalopathy and clinical homeostasis in fulminant hepatic failure; it can also eliminate the need for urgent liver transplantation in some cases (5,7–9). We present data on a 9-year-old girl who presented with hemolytic crisis and jaundice. She was diagnosed with fulminant WD in the early phases and avoided having a liver transplant after the successful implementation of PE in our intensive care unit.

Organophosphate intoxication presenting as diabetic keto-acidosis

Abstract Organophosphate (OP) poisoning is common in developing countries. The presenting symptoms and signs of OP intoxication are multiple and may cause diffuculty in differential diagnosis, especially in children. A case of OP intoxication is reported who presented as diabetic keto-acidosis.