Mustafa Gülgün

Proanthocyanidin prevents methotrexate-induced intestinal damage and oxidative stress.

Mucositis is an important dose-limiting side effect of methotrexate for which there is no definitive prophylaxis or treatment. This study was designed to investigate whether proanthocyanidin had a protective effect on methotrexate-induced small intestine damage. Twenty-eight albino rats were randomized into four groups. To the first group, methotrexate was applied as a single dose (20mg/kg) intraperitoneally. To the second group, proanthocyanidin (100mg/kg) was given orally every day by gavage in addition to methotrexate application until the rats were killed. To the third group, only proanthocyanidin was administered. The fourth group was the control. All animals were sacrificed 4 days after the intraperitoneal injection of methotrexate for histopathological examination and the assay for tissue malondialdehyde, superoxide dismutase and glutathione peroxidase levels. Methotrexate caused jejunal injury and increased malondialdehyde levels. Administration of proanthocyanidin decreased the jejunal damage and malondialdehyde level, which were caused by methotrexate treatment and increased superoxide dismutase and glutathione peroxidase levels. These results suggest that proanthocyanidin may protect the small intestine of rats from methotrexate-induced damage. The effects of proanthocyanidin could result from its antioxidant properties.

Prevalence and risk factors of onychomycosis in primary school children living in rural and urban areas in Central Anatolia of Turkey

BACKGROUND Onychomycosis is a world-wide public health concern in children, requiring epidemiological data for different regions for control and prevention. AIM The aim of this study was to evaluate the predominant pathogens and risk factors for onychomycosis in school children living in Kayseri, Turkey. METHODS This study included 8122 school children, aged 5-16 years, living in the rural and urban areas around Kayseri. Onychomycosis was clinically classified as distal and lateral subungual (DLSO), proximal subungual, superficial white, endonyx and totally dystrophic onychomycosis. Nail samples from children with clinically diagnosed onychomycosis were collected, examined by direct microscopy and inoculated for culture study. The demographic features and possible risk factors were recorded and assessed by logistic regression models. RESULTS We clinically diagnosed onychomycosis in 152 out of 8,122 (0.18%) school children. DLSO was the most frequent clinical diagnosis (120/152, 78.9%). Culture-positive onychomycosis was detected in 27/152 (17.7%) children. The prevalence of culture-positive onychomycosis was determined as 0.33%. All culture-positive samples were only from toenails. The onychomycosis causative agents were dermatophytes in 17/27 cases (62.9%), including Trichophyton rubrum 12 (44.4%), Trichophyton mentagrophytes 1 (3.7%), Trichophyton tonsurans 1 (3.7%) and Trichophyton spp. 3 (11.1%) and yeasts in 10/27 cases (37.1%), including Candida glabrata 4 (14.8%), Candida parapsilosis 1 (3.7%), Trichosporon 2 (7.4%) and Rhodotorula 3 (11.1%). Age, fathers occupation, number of siblings and rooms were statistically associated with the frequency of onychomycosis. CONCLUSIONS Although to be prevalence of onychomycosis in school children in central Anatolia of Turkey seems very low degree, pediatric onychomycosis is a growing public health concern all over the world. Children having more siblings or unemployed fathers and children living in small house as well as older children should be examined carefully for onychomycosis.

The effect of melatonin on procarbazine induced testicular toxicity on rats

Abstract Procarbazine (P) is an effective chemotherapeutic drug especially used in lymphoma treatment; however testicular toxicity is a limiting factor. Various ways of treatment were tried to preserve testicular function including hormonal treatment, antioxidant treatment, and sperm cryopreservation but resulted with low rates of satisfaction. Procarbazine is a well known agent causing sterility even in the first doses of chemotherapy. Antioxidants such as N acetylcysteine and ascorbate have been used for protective purposes and were very successful. Melatonin (M) is another powerful antioxidant and we aimed to use M for the protection of P induced testicular toxicity in this study. Procarbazine was given peroral by gavage once a week at a dose of 62.5 mg/kg/week for 4 weeks (total dose: 250 mg/kg) (P group) and in procarbazine + melatonin (PM) group, 10 mg/kg melatonin was intraperitoneally administered daily for five days a week for 4 weeks (total 20 days). The experiment ended at day 90. In the P and PM groups the testicle width, length, and weight, sperm A and sperm AB properties (Sperm A: sperms straight line progressive, Sperm B: sperms straight slow progressive, Sperm AB: Sperm A + Sperm B), spermatogonia, Sertoli cells, seminiferous tubule, and germinative layer thickness were lowered as compared with the control group. However, there were no significant differences between the P and PM groups in regard to these parameters. Melatonin preserved Sertoli cell and spermatogonia function. The testosterone and follicle-stimulating hormone (FSH) levels were also preserved. Melatonin significantly decreased malondialdehyde (MDA) levels and preserved the antioxidant enzyme levels such as glutathione peroxidase (GPx) and nitrite nitrate (). Melatonin may protect testicular functions in P treated patients and is open to consideration during chemotherapy since it appears to be without any side effects.

Breath-holding spells may be associated with maturational delay in myelination of brain stem.

Purpose: To evaluate possible contribution of maturational delay of brain stem in the etiology of breath-holding spells in children using brain stem auditory evoked potentials. Methods: The study group included children who experienced breath-holding spells. The control group consisted of healthy age- and sex-matched children. Age, gender, type and frequency of spell, hemoglobin, and ferritin levels in study group and brain stem auditory evoked potentials results in both groups were recorded. Study group was statistically compared with control group for brain stem auditory evoked potentials. Results: The mean age of study and control groups was 26.3 ± 14.6 and 28.9 ± 13.9 months, respectively. The III–V and I–V interpeak latencies were significantly prolonged in the study group compared with the control group (2.07 ± 0.2 milliseconds; 1.92 ± 0.13 milliseconds and 4.00 ± 0.27 milliseconds; 3.83 ± 0.19 milliseconds; P = 0.009 and P = 0.03, respectively). At the same time, III–V and I–V interpeak latencies of patients without anemia in the study group compared with those of control group were significantly prolonged (2.09 ± 0.24 milliseconds; 1.92 ± 0.13 milliseconds and 4.04 ± 0.28 milliseconds; 3.83 ± 0.19 milliseconds; P = 0.007 and P = 0.01, respectively). Conclusions: Our results consider that maturational delay in myelination of brain stem may have a role in the etiology of breath-holding spells in children.

Metabolic and Histopathological Effects of Fructose Intake During Pregestation, Gestation and Lactation in Rats and their Offspring

Objective: Studies have demonstrated a significant relationship between maternal fructose intake and metabolic outcome in their offspring. However, there is a paucity of data about the long-term effects of fructose intake on the offspring of fructose-fed dams. Therefore, we planned a study to evaluate the long-term effects of fructose intake on the offspring of dam rats fed a high-fructose diet. Methods: Sixteen virgin female Sprague-Dawley rats were divided into two groups. Group 1 received a regular diet and Group 2 a high-fructose diet. Both groups received their experimental diets for 8 weeks before conception. They were mated and continued to feed with their experimental diet during mating and during their pregnancy and lactation periods. After weaning, the offspring from each group were divided into two groups. Group 1A received a regular diet, Group 1B - a fructose diet, Group 2A - a regular diet and Group 2B received a fructose diet. After weaning, the offspring were anesthetized and blood samples were collected for biochemical analysis. Liver, kidney and retroperitoneal adipose tissue were harvested for histopathological examination. Primary antibodies against inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) were determined as early inflammation markers. Results: After weaning, while daily water consumption was found to be significantly higher in Groups 2B and 1B (p<0.01), daily laboratory chow consumption was significantly lower in Groups 1A and 2A (p<0.01). Body weight was significantly higher in Groups 1B and 2B (p<0.01). Serum glucose, triglyceride, low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels were found to be increased and high-density lipoprotein cholesterol levels decreased in Group 2B (p<0.05). The intensities of iNOS staining in the retroperitoneal adipose tissue, COX-2 staining in the liver and both iNOS and COX-2 staining in the kidney were higher in Group 2B (p<0.05). Conclusion: Based on our findings, we believe that the offspring of dams which received a high fructose intake during their pregestation, gestation and lactation periods are at risk of developing metabolic syndrome in their later life only if they continue to receive a high intake of fructose. We therefore propose that the risk of developing metabolic syndrome can probably be reduced by modifying the diet of the offspring after weaning.

Midterm Results of Implantable Cardioverter Defibrillators in Children and Young Adults from a Single Center in Turkey

Despite concerns about complications with the implantable cardioverter defibrillator (ICD), it is effective for the prevention of sudden cardiac death (SCD). We aimed to analyze our midterm experience with ICD in children and young adults.

Assessment of autonomic functions in children with familial Mediterranean fever by using heart rate variability measurements.

The aim of this study is to analyze possible autonomic nerve system alterations and assess the efficacy of heart rate variability (HRV) analysis in anticipation of cardiovascular risks in pediatric patients with familial Mediterranean fever (FMF).

Heart rate variability can be affected by gender, blood pressure, and insulin resistance.

We really read with a great interest the paper by Durakoğlugil et al. (1) entitled “The effect of irritable bowel syndrome on carotid intimamedia thickness, pulse wave velocity, and heart rate variability” published in the September issue of Anatol J Cardiol 2014; 14: 525-30. They purposed to investigate a possible association between irritable bowel syndrome and autonomic dysfunction using heart rate variability (HRV) parameters in their study population. They concluded decreased parasympathetic modulation in patients with constipation-predominant irritable bowel syndrome. One of the best non-invasive methods to evaluate the autonomic dysfunction is to measure HRV, defined as the RR interval variability beat-by-beat, and provide us quantitative data about the autonomic nervous system (2). However, HRV parameters can be affected by various variables, including age, gender, nutrition, obesity, hyperlipidemia, diabetes mellitus, hypothyroidism, heart failure, hypertension, coronary artery disease, chronic obstructive pulmonary disease, renal failure, chronic liver disease, and drugs (2-5). It is well known that there is a relationship between gender and HRV measurements (3). Recently, Hillebrand et al. (5) reported an association between body fat and HRV and concluded that insulin resistance might be a reason for this relationship. In the study by Durakoglugil et al. (1), I think that it would be more helpful to present whether there was no statistically significant difference between the patients and control subjects in terms of gender, blood pressure, and insulin resistance, because the study population included overweight or obese people and the frequency of diabetes mellitus and hypertension is higher in the control group. We believe that the results of the study will be stronger with these additional data and whether irritable bowel syndrome really has an effect on autonomic dysfunction, which predicts survival, can be more comprehensible.

Transcatheter closure of antegrade pulmonary blood flow with Amplatzer muscular VSD occluder after Fontan operation.

The Fontan procedure refers to any operation that results in the flow of systemic venous blood to the lungs without passing through a ventricle. An accessory source of pulmonary blood flow in patients with the Fontan procedure may cause elevation of the pulmonary artery pressure, leading to ventricular failure (1). An 8-year-old-girl with double outlet right ventricle presented with marked pleural effusion on postoperative day 14 after a Fontan procedure with extracardiac conduit without ligation of the pulmonary trunk. Her immediate postoperative course was uneventful. She had prominent pleural effusion with 80% saturation. Echocardiography showed significant antegrade flow from the right ventricle into the pulmonary artery. The superior vena cava and main pulmonary artery pressures were markedly high [26/22 mm Hg (mean 25 mm Hg) and 27/23 mm Hg (mean 24 mm Hg), respectively]. The pulmonary artery angiogram showed normally branched pulmonary arteries with rapid wash-off of the contrast. The diameter of the stenotic pulmonary valve was measured as 11.2 mm. A 12 mm Amplatzer muscular VSD occluder (AGA Medical, MN, USA) device was deployed very close to the pulmonary valve at the infundibular stenotic region (Fig. 1). The pulmonary artery pressure was not decreased immediately [27/21 mm Hg (mean 24 mm Hg)] when compared with the pressure measured before the intervention. Antiaggregant and anticoagulant therapy were started. The patient recovered uneventfully, with an oxygen saturation >90%, and was discharged two weeks later. She has been symptom-free on sildenafil treatment for one year. Although several studies have reported that non-pulsatile pulmonary blood flow results in decreased capillary flow and increased vascular resistance (1), the preservation of antegrade pulmonary blood flow in a patient with a total cavopulmonary shunt may complicate the Fontan procedure, resulting in persistent pleural effusions or progressive ventricular failure (2). Therefore, the benefit of additional sources of systemic to pulmonary artery flow remains controversial. Desai et al. (2) and Petko et al. (3) showed that transcatheter closure of ventriculopulmonary artery communication was a safe and effective technique for the treatment of selected patients after cavopulmonary shunt. Our opinion is also that transcatheter closure of pulmonary flow is an alternative to surgery because it is less invasive, easy to perform, reliable, and more comfortable. Madan et al. (4) reported an 8 year-old boy with thrombus in the pulmonary artery stump after a Fontan operation that included ligation of the main pulmonary artery distally to the pulmonary valve. Devices can be placed across the pulmonary artery band, across pulmonary valve tissue, and above the valve in a relatively large homograft without any focal narrowing (3). However, a thrombus may form if a room remains between the pulmonary valve and the device that can create stasis after the intervention. In this case, our preference is to deploy the device in the infundibular area. Transcatheter closure of antegrade pulmonary blood flow seems a safe and effective alternative method to surgery in the treatment of selected patients who have undergone a Fontan procedure and show early complications such as pleural effusion due to excess pulmonary blood flow.

Transjugular approach for radiofrequency ablation of permanent junctional reciprocal tachycardia in a newborn with bilateral femoral vein thrombosis.

Although radiofrequency ablation is the first line therapy in some children with supraventricular tachycardia, its application in small children is still limited. Herein, we presented a premature newborn diagnosed as multidrug-resistant permanent junctional reciprocal tachycardia, and treated by radiofrequency ablation via the jugular vein approach because of bilateral femoral vein thrombosis. We think that when there is limited vascular access, the transjugular route for radiofrequency ablation might be considered as an alternative treatment in newborns with multidrug-resistant supraventricular tachycardia.