Naci Öner

Neuron-specific enolase as a marker of the severity and outcome of hypoxic ischemic encephalopathy

The aim of this study was to evaluate serum concentrations of neuron-specific enolase (NSE) as a marker of the severity of hypoxic ischemic encephalopathy (HIE) and to elucidate the relation among the concentrations of NSE, grade of HIE and short-term outcome. Forty-three asphyxiated full-term newborn infants who developed symptoms and signs of HIE (Group 1) and 29 full-term newborn infants with meconium-stained amniotic fluid but with normal physical examination (Group 2) were studied with serial neurological examination, Denver developmental screening test (DDST), electroencephalogram and computerized cerebral tomography (CT) for neurological follow-up. Thirty healthy infants were selected as the control group. In the patient groups, two blood samples were taken to measure NSE levels, one between 4 and 48 h and the other 5-7 days after birth. Serum NSE levels were significantly higher in infants with HIE compared to those infants in Group 2 and control group. The mean serum concentrations of the second samples decreased in all groups studied but they were significantly higher in Group 1 compared to those in Group 2. Serum NSE concentrations of initial samples were significantly higher in patients with stage III HIE than in those with stages II and I. The sensitivity and specificity values of serum NSE as a predictor of HIE of moderate or severe degree (cut-off value 40.0 microg/l) were 79 and 70%, respectively, and as a predictor of poor outcome (cut-off value 45.4 microg/l) were calculated as 84 and 70%, respectively. The predictive capacity of serum NSE concentrations for poor outcome seems to be better than predicting HIE of moderate or severe degree. However, earlier and/or CSF samples may be required to establish serum NSE as an early marker for the application of neuroprotective strategies.

Obesity risk factors in Turkish children.

On the basis of the knowledge that the prevalence of obesity in children has increased steadily in recent years, this study aimed to assess the association between obesity and certain risk factors in a group of 6- to 14-year-old children living in Istanbul. The study was carried out at the Istanbul University School of Medicine Hospital. Data were collected from 592 children aged between 6 and 14 years who were examined in general pediatrics clinics. Weight and height measurements were performed on the children and their parents. The children were classified as obese and nonobese in accordance with the body mass index reference values for Turkish children. Energy intake of children was estimated with a 3-day food consumption recording form. A structured questionnaire was used to collect the information from the parents on possible risk factors causing obesity. The physical activity state of the children was assessed. A logistic regression model was developed to examine the relationships between obesity and possible risk factors. Almost 32% (n = 184) and 69% (n = 408) of children were assessed as obese and nonobese, respectively. Although there was no difference in daily energy intakes of obese and nonobese children, 13.6% of obese and 40.9% of nonobese children were reported to do physical activity regularly. Obesity was strongly associated with parental obesity. Furthermore, energy intake; having regular physical activity; presence of obesity in the mother, the father, and the mothers family; and having a mother working out of home were also significantly associated with obesity. Creating awareness in mothers on the importance of a healthy nutrition and encouraging families to participate in physical activities are important points in the prevention of childhood obesity.

Risk factors of status epilepticus in children.

Abstract Background : Although there is abundant literature about the morbidity and mortality rates of status epilepticus (SE), little is known about the risk factors of this medical emergency. The aim of the present study is to assess the risk factors of SE in children.

Personal characteristics of enuretic children: an epidemiological study from South-East Europe.

Introduction: This study examined the personal characteristics of enuretic children and investigated the risk factors of nocturnal enuresis among schoolchildren. Methods: It was a cross-sectional and descriptive questionnaire study and 2,000 children were stratified according to school population, age and gender. The questionnaire was designed for parents to collect information about the prevalence and associated factors as well. Results: Nocturnal enuresis was reported in 159 cases (9.8%). The parameters of bladder control after 2 years of age, urination more than 5 times a day, urinary infection history, history of psychological or physical trauma, siblings with health problems, large family size, lack of a private bedroom, and constipation were more frequent in enuretics (p < 0.05). The parameters of having fecal incontinence, parents and siblings with nocturnal enuresis, low educational level of the mother and poor school performance seem to be risk factors for nocturnal enuresis. However, the parental concern level was high, approximately half of the enuretic children did not visit a physician for management of the problem. Conclusion: Nocturnal enuresis could be a multifactorial problem originating from bladder dysfunction, deranged sleep patterns and psychological and hereditary predisposition. Hereditary disposition and having fecal incontinence may be important risk factors for enuresis.

Dietary Intakes of Adolescents Living in Edirne, Turkey

Objective: To assess the dietary intakes of the adolescents in the area of Edirne, Turkey. Design: Cross-sectional, prospective, epidemiological study. Settings and Subjects: Our study group consists of 1944 adolescents aged between 12 to 17 years; 940 females and 1004 males. Interventions: Three-day self-reported food records were collected from the subjects and evaluated by a nutrient database program. Reported nutrient intake data were analyzed for gender differences. Minitab statistical program was used to compare nutritional data of subjects. Results: Energy, calcium, magnesium, folic acid, vitamins A, E, thiamine, and fiber intakes of whole adolescents, and also iron intakes of female adolescents were most likely to be inadequate compared with the recommendations. Iron, calcium, folic acid, thiamine, and fiber intakes were below two thirds of RDA/DRI in a large proportion of the adolescents. The intakes of protein, riboflavin, vitamin C, phosphorus and zinc were found to be adequate in a large percentage of the subjects. Forty eight percent of females and 60.1 % of males were below 2/3 of the RDA for energy. Conclusion: Pediatricians and dietitians should train the adolescents living in our region and our country on practical strategies for making healthy food choices rich in nutrient content relative to energy value to ensure intakes that approach the recommendations.

Body mass index percentiles among adolescent girls living in Edirne, Turkey

Background :  Body mass index (BMI) is the simplest way to measure obesity; therefore, it is chosen by many authorities as a screening method for adolescent obesity. Body mass index is positively correlated with the complications of childhood and adolescent obesity, such as hypercholesterolemia, insulin resistance, hypertension and long‐term development of cardiovascular diseases. The aim of the present study was to produce percentile curves for bodyweight, height and BMI in a representative sample of adolescent girls living in urban and rural areas of Edirne, Turkey, and to compare these percentile curves with curves from other countries.

Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension.

Background: Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT). Methods: This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50). Fifty healthy children were also selected for the control group. Electrocardiography and echocardiography were used to evaluate cardiac functions. Corrected QT (QTc) ≥ 0.45 was accepted as prolonged on electrocardiography. The study group was divided into 3 groups: cirrhotic, noncirrhotic, and control. Then, the CCMP group was created according to the diagnostic criteria. Latent CCMP was diagnosed in the presence of prolonged-QTc along with a minor criterion (tachycardia). Manifest CCMP was diagnosed in the presence of at least 2 major criteria (prolonged-QTc along with abnormal echocardiographic findings). Moreover, in this study, the risk factors for CCMP were investigated. Results: The CCMP group included 10 cases (20%). Nine of these cases had latent CCMP (18%), and the remaining one (2%) had manifest CCMP. All of the cases with CCMP had cirrhosis and ascites. None of the patients with CCMP had severe cardiac symptoms, but they were already using some cardioprotective drugs such as propanolol and spironolactone. As risk factors for CCMP, pediatric end-stage liver disease scores, Child-Pugh scores, and ascites grades were found to be significant for the determination of CCMP. The most important risk factor was ascites severity (P = 0.001, odds ratio 9.4). Conclusions: Approximately 20% of children with PHT have CCMP. A detailed cardiac examination should be carried out periodically in children with cirrhotic PHT, especially in the presence of ascites and high Child-Pugh score.

The effects of surgical repair on P-wave dispersion in children with secundum atrial septal defect

IntroductionAtrial septal defect (ASD) is one of the most common congenital heart diseases in children. P-wave dispersion has been reported to be associated with non-homogeneous propagation of sinus impulses. The heterogeneity of atrial conduction time may predispose the atria to arrhythmias. The aim of this study was to determine the impact of surgical repair on P-wave indices in children with isolated secundum ASD.MethodsChildren with isolated secundum ASD undergoing surgical repair (n=50; mean age, 7.0±3.0 years) and healthy controls (n=51; mean age, 7.6±2.7 years) were compared. Maximum P-wave duration (Pmax), shortest duration (Pmin) and P-wave dispersion (Pd) were measured using 12-lead surface electrocardiography.ResultsMean Pmax was found to be significantly higher in children with ASD compared with controls (95.2±10.8 vs 84.1±9.2 msec; P<0.001), and Pd before surgery was significantly higher compared with controls (47.4±12.0 vs 38.8±9.7 msec; P<0.001). Both P-wave indices were significantly decreased within the first year after surgical closure — the values decreased to those comparable to healthy controls (Pmax, 86.2±9.7 msec; Pd, 39.8±10.7 msec; P>0.05).ConclusionSurgical closure of ASD in children decreases Pmax and P-wave conduction time. We speculate that earlier closure of the defect may play an important role in avoiding permanent changes in the atrial myocardium and atrial fibrillation in adulthood.

Segmental intestinal dilatation associated with omphalocele

A 2850 g, 1-day-old girl baby, was born after 38 weeks’ gestation via cesarean section. A small omphalocele was detected with ultrasound when her mother was examined at 38 weeks of her gestation, in a local obstetric clinic (Fig. 1a). Therefore, the mother was referred to our obstetric unit. In the ultrasound examination, there was a small omphalocele with a 3 cm diameter and 10 cm × 6 cm cystic mass in the fetal abdomen (Fig. 1b). The cyst was filled with thick fluid. Physical examination showed a healthy vigorous newborn with abdominal distention and a small omphalocele. A huge mobile mass was confirmed in the abdomen by palpation. A plain radiography of abdomen showed a gasless area in the lower quadrants. Laboratory findings were within normal limits. A gastrointestinal duplication was suspected and she was fed with mother’s milk because there were no gastrointestinal obstruction signs or symptoms and discharged meconium before the operation. Laparotomy was carried out on fourth day after birth. The omphalocele sac was resected and abdominal defect was enlarged. There was a huge dilatation of 10 cm × 6 cm × 6 cm in the ileal segment. Midgut rotation was normal but cecum was mobile (Fig. 2a). The ileal segment was resected, an ileoileostomy was performed and the abdominal defect was closed. The small bowel loops were 51 cm and the distance between the anastomosis and the cecum was 15 cm. The postoperative course was uneventful. The baby was discharged after her 17th day, and she is presently 17 months old and healthy. Microscopic examination of the resected ileal segment showed normal ganglion cells but there were edema, inflammatory cells, and large-caliber blood vessels, focal necrotic and bleeding areas. Muscular layer of some dilated segment became thick due to hypertrophy, whereas some of them became thin.

99mTc-HMPAO single photon emission computed tomography (SPECT) in both asphyxiated and epileptic children with or without status epilepticus.

In this study, technetium 99m hexamethylpropyleneamine oxime (99mTc-HMPAO) single photon emission computed tomography (SPECT) was performed on 18 asphyxiated and epileptic children who also had a status epilepticus episode, and the results were compared with those for 21 children without a status epilepticus episode. All patients underwent a detailed neurologic history, interictal electroencephalography, computed tomography, and/or magnetic resonance imaging. Visual evaluation of the SPECT study showed that 16 patients of group 1 had 56 hypoperfused regions in cerebral blood flow. However, in group 2, visual evaluation showed only six detectable hypoperfusion areas in five patients. When an asymmetric index value of 3 was considered as a cutoff point, 82 regions in group 1 and 57 regions in group 2 were above this value after the quantitative SPECT evaluation. The mean number of pathologic brain regions was found to be higher in group 1 (5.1 ± 4.3) than in group 2 (2.7 ± 2.4) (P = .014). The localization of hypoperfused regions that were observed in temporal and frontal regions was generally similar in both groups. In conclusion, the functional activities of the brain vary in both asphyctic and epileptic children, with and without status epilepticus. These children might be candidates for refractory convulsive disease, and interictal SPECT can be a reliable method for the detection of brain lesions in these patients. (J Child Neurol 2005;20:560—565).