Mustafa Ozcetin

Increased aortic pulse wave velocity in obese children.

OBJECTIVES Obesity may start in childhood and obese children are more likely to grow up to be obese adults. Atherosclerosis is one of the most important complications of obesity. Pulse wave velocity (PWV), a noninvasive measure of arterial stiffness, is accepted to be an indicator of subclinical atherosclerosis. The aim of the study was to determine PWV in obese children. STUDY DESIGN The study included 30 obese (12 boys, 18 girls; mean age 13 ± 2 years) and 30 lean children (13 boys, 17 girls; mean age 12.5 ± 1.7 years). Weight and height were measured and obesity was defined as body mass index (BMI) of greater than the 95th percentile for age. All the subjects underwent echocardiographic evaluation and blood samples were obtained. Pulse-wave velocity was calculated using the following equation: PWV (m/sec) = height-based aortic length (cm)/(100xtransit time [sec]). The latter was measured as the difference in the time of onset of two flows at the diaphragm and the aortic valve. RESULTS Obese subjects had significantly higher blood pressure levels compared to the control group (p<0.001). The two groups were similar with respect to fasting glucose, hemoglobin, serum creatinine, and lipid levels. Among echocardiographic parameters, left ventricular end-diastolic dimension, interventricular septum thickness, posterior wall thickness, left ventricular mass index, left atrium dimension, and aortic root dimension were significantly increased in obese subjects compared to controls (p<0.01). Obese children had significantly higher PWV values than the controls (4.0 ± 0.8 vs. 3.3 ± 0.7 m/sec, p<0.001). A positive significant correlation was found between PWV and BMI (r=0.391, p=0.002). CONCLUSION Our findings show that aortic PWV is increased in obese children, suggesting that obesity may cause subclinical atherosclerosis even at early ages.

The effect of adenotonsillectomy on right ventricle function and pulmonary artery pressure in children with adenotonsillar hypertrophy

OBJECTIVES Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Severe upper airway obstruction may have an effect on chronic alveolar hypoventilation, which consequently may lead to right ventricle (RV) dysfunction induced by hypoxemic pulmonary vasoconstriction. The investigators aimed to study RV function and mean pulmonary artery pressure (mPAP) in patients with ATH who were undergoing adenotonsillectomy by using tissue Doppler echocardiography (TDE). METHODS The study examined 27 children with ATH who had a mean age of 8 ± 2 years. The subjects were comprised 17 (63%) males and 10 (37%) females. Hypertrophy of the tonsils was graded according to the Brodsky scale. Children having either grade 3 or 4 hypertrophied adenotonsils were recruited for the study. Adenotonsillectomy was performed on all subjects in the study group and echocardiographic examination was repeated 3 months postoperatively. RESULTS Tricuspid Em significantly increased after adenotonsillectomy (17.7 ± 3.6 vs. 19.1 ± 5.5, p=0.04). The RV myocardial performance index (MPI) and mPAP significantly decreased after adenotonsillectomy (RV MPI: 0.57 ± 0.13 vs. 0.40 ± 0.12, p<0.001 and mPAP (mmHg): 31 ± 9 vs. 25 ± 7, p=0.001). CONCLUSION The results of this study, evaluated with the results of previous studies, demonstrated that adenotonsillectomy improved RV performance and reduced mPAP in children with ATH.

Evaluation of possible subclinical atherosclerosis in adolescents with a family history of premature atherosclerosis

OBJECTIVE To evaluate possible subclinical atherosclerosis using biomarkers and ultrasound-guided methods in a group of adolescents having fathers with premature atherosclerosis. METHODS Thirty-three subjects whose fathers had a history of premature coronary artery disease and 30 counterparts whose fathers had no history of coronary artery disease were included in the study. RESULTS The homocysteine levels, high-sensitivity C-reactive protein levels, and cardiac chamber sizes and functions did not differ between the two groups. The carotid stiffness index β (CSI), the intima-media thickness (CIMT) and aortic pulse wave velocity (PWV) values were higher in the group with a family history of coronary artery disease, but only the difference in the CSI was statistically significant (CSI 3.07±1.33 vs 3.88±1.25, P=0.015; CIMT 0.53±0.09 mm vs 0.57±0.08 mm, P=0.068; PWV 3.49±0.53 m/s vs 3.78±0.63 m/s, P=0.053). CONCLUSION Among several markers of subclinical atherosclerosis, the CSI was significantly higher in adolescents who had a family history of premature atherosclerosis. The small sample size, the multifactorial nature of atherosclerosis or the insufficient power of these methods may explain these results.

Analyses of C-Reactive Protein, Endothelial Nitric Oxide Synthase and Interleukin-6 Gene Polymorphisms in Adolescents with a Family History of Premature Coronary Artery Disease: A Pilot Study

BACKGROUND Family history of premature atherosclerosis imposes a high risk to people. The relationship between atherosclerosis and gene polymorphisms of various biomarkers such as Endothelial Nitric Oxide Synthase (eNOS), C-Reactive Protein (CRP), and Interleukin-6 (IL-6) has shown in previous studies. AIMS The major aim of the study was to evaluate the CRP, eNOS, and IL-6 gene polymorphisms in a group of adolescents who have a parental history of early coronary artery disease (CAD). STUDY DESIGN Case-control study. METHODS Thirty-six volunteers with a father with obstructive CAD during the first four decades and 46 subjects with a father with normal coronary arteries documented with coronary angiography were included in the study. Polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze CRP, eNOS, and IL-6 polymorphisms. RESULTS We did not find any differences between the two groups with regard to age, sex, body mass index, renal functions, systolic and diastolic blood pressures, lipid profile, and fasting glucose, hemoglobin, and high sensitivity CRP. A significant difference was only observed in IL-6-572 G/C genotype distribution and allele frequency between two groups (Pc=0.036 OR=3.48 CI (95%) 1.17-10.32). CONCLUSION The present study showed a significant association between the IL-6-572 G/C gene polymorphism (presence of C allele) and adolescents with a parental history of premature CAD.

Rare cause of cerebral damage: child with heatstroke found inside an enclosed vehicle

Many children suffer from preventable diseases. Heat stress is one of the neglected causes of mortality and morbidity. We report here the clinical features of a 3-year-old boy who suffered from near-fatal heatstroke in an enclosed car. He developed multiple organs failure, including neurological insult, acute renal failure, and disseminated intravascular coagulation. Although life-threatening complications were treated with supportive measures and conventional external cooling in the intensive care unit, neurological sequelae persisted. This type of heatstroke is almost always preventable. Similar to many other pediatric emergencies, it can be life-threatening and may result in severe untoward outcomes.

A Neonatal Pneumonia Presented with Spontaneous Pneumothorax Due to Listeria Monositogenes

Listeria Monositogenes is a facultative anaerob gram(+) agents that presents in soil, water, plants and in many mammals intestinal system. Listeria Monositogenes is one of the most common factors of early neonatal sepsis and neonatal pneumonia during the perinatal period. Maternal obstetric complications are frequently seen in patients. Patients are often premature and have low birth weight. Responsible microorganisms frequently originate from maternal. The disease involes multisystems and the prognosis is usually fulminant. In the congenital pneumonia, respiratory distress syndrome is prominent. Symptomatic spontaneous pneumothorax brings about serious morbidity and mortality in newborns. The cause and risk factors of symptomatic pneumothorax in term newborns are not completely understood. The risk factors were reported as prematurity, male sex, high birth weight and birth the use of vacuum. We aimed to present a case with neonatal pneumonia associated with symptomatic spontaneous pneumothorax due to Listeria Monositogenes.

Presence of Toxic Heavy Metals in Human Breast Milk

1 Mustafa Özçetin1, Resul Yılmaz2, Durali Mendil3, Rasim Koçyiğit4, Deniz Kulak Gedik5 1Zonguldak Karaelmas Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları AD, Zonguldak, 2Gaziosmanpaşa Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları AD, 3Gaziosmanpaşa Üniversitesi Fen Edebiyat Fakültesi, Kimya Bölümü, 4Gaziosmanpaşa Üniversitesi Ziraat Fakültesi, Toprak Bölümü, Tokat, 5Trabzon Vakfıkebir Devlet Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, Trabzon, Türkiye Anne Sütü ve Toksik Ağır Metal / Breast Milk and Toxic Heavy Metals Presence of Toxic Heavy Metals in Human Breast Milk

A case of congenital muscular dystrophy similar to Fukuyama-type with a missense mutation in the fukutin gene

The term congenital muscular dystrophy (CMD) refers to a group of inherited disorders in which muscle weakness is present at birth. The Fukuyama-type CMD is an independent subtype of progressive muscular dystrophy in Japan. This report presents the case of a 13-year-old male who applied to our clinic and was diagnosed as CMD similar to the Fukuyama-type based on the results of the genetic analysis. The most frequently defined mutation in these patients is on the fukutin-related protein gene whereas in the present case, one missense mutation in the fukutin gene has been detected. To our knowledge, the case described in this report is the first reported case of one missense mutation in the fukutin gene c.1336A>G (p.Asn446Asp) producing a phenotype similar to the Fukuyama-type.

Konjenital Kalp Hastalığı Olan Hastalarda Anormal Koagülasyon Test Sonuçlarının Oranı

Introduction: Coagluation abnormalities are expected in patients with congenital heart disease. We searched the rate of abnormal coagulation test in children with both cyanotic and non-cyanotic heart disease and investigated the clinical relevance of these abnormal tests. Material and Method: 49 children who have congenital heart disease and needed surgical intervention were prospectively enrolled to this study. Demographic data, primary diagnosis, bleeding complication during and after the intervention and prognosis of the patients were recorded. Platelet counts, prothrombin time, activated partial thromboplastine time and blood fibrinogen levels were measured prior to intervention. Results: 16 patients had prolonged PT, 13 patients had low fibrinogen level, 10 patients had prolonged aPTT and 5 patients had low platelet count. Conclusion: There was no increased complication risk in patients with abnormal test results, but caution must be taken during operation of these patients.Key words:

Ektodermal displazi: nadir görülen ve tekrarlayan ateş nedeni

Taskin N, Akcay T, Akcay A, Aldemir H, Arslan M, Dogangun E, Dogandemir A. Yenidoganda Nadir Bir Ates Nedeni: Hipohidrotik Ektodermal Displazi. Istanbul Tip Dergisi 2004; 2: 45-7