Nazan Kaymaz

Mean Platelet Volume and Ischemia Modified Albumin Levels in Cord Blood of Infants of Diabetic Mothers

BACKGROUND Gestational diabetes mellitus (GDM) is a risk for the health of both the pregnant women and her infant. Its unfavorable effects start in utero and continue after birth. It is known that GDM increases oxidative stress and decreases antioxidant enzyme activities. In this study we aimed to investigate cord blood mean platelet volume (MPV) and ischemia-modified albumin (IMA) levels of infants of diabetic mothers (IDM). METHODS Twenty-nine pregnant women with GDM between 37 and 41 gestational weeks who gave birth by spontaneous vaginal delivery were enrolled as study participants together with 20 healthy pregnant women as a control group. Weight, length, and head circumference of babies were measured by the same standard tape immediately after birth. Five milliliters of umbilical venous blood were obtained to study MPV and IMA levels. RESULTS There was statistically significant difference in levels of MPV (p = 0.037) and IMA (p < 0.001) between groups. They increased in IDM compared with their healthy peers. CONCLUSION Evaluation of MPV and IMA together is useful for representing the potential oxidative stress of IDM.

Early detection of myocardial deformation by 2D speckle tracking echocardiography in normotensive obese children and adolescents

Objective: To evaluate the left venticular myocardial deformation parameters in normotensive obese children and adolescents by using 2-D speckle tracking echocardiography. Methods: This observational cross-sectional study included 69 children and adolescents (aged between 10-18), 38 were normotensive obese and 31 were normal weighted. All children underwent detailed two- dimentional, Doppler and two-dimentional speckle tracking echocardiography. Student t-test, Mann-Whitney U test, chi-square test and Pearson’s correlation were used in statistical analysis. Multiple linear regression analysis was used the determine independent variables on global longitudinal strain (GLS). Results: While in normal limits, diastolic blood pressure was significantly higher in obese group. Left ventricular end-diastolic diameter (LVDd) and end-systolic diameter (LVDs), interventricular septal thickness (IVSd), left ventricular posterior wall thickness (LPWD) and left ventricular mass index (LVM)/height2.7 were significantly higher in obese group compared to healthy peers (p=0.004, p=0.011, p<0.001, p=0.001, p<0.001) respectively. Obese subjects had reduced global longitudinal strain (GLS) values (p=0.001). Multiple linear regression analysis using the step-wise method were performed to assess the independent variables (age, body mass index, insulin resistance, systolic blood pressure, diastolic blood pressure, left ventricular diameters and LVM index (g/m2.7) affecting the dependent variable GLS. GLS was found significantly correlated with body mass index (BMI) (β:0.440, p:0.001; 95% CI: 0.104-0.311). Conclusion: Left ventricular strain parameters obtained by two dimentional speckle tracking echocardiography were diminished in obese children compared to normal subjects indicating that obesity in childhood is linked to decreased myocardial deformation even in the absence of comorbidities in early stages.

Isovaleric acidemia presenting as diabetic ketoacidosis: a case report.

Isovaleric acidemia (IVA) is characterized by periodic vomiting, lethargy, coma, ketoacidosis and a ‘sweaty feet’ odor. Hyperglycemia, ketonemia, ketonuria and metabolic acidosis are the main clinical features of diabetic ketoacidosis (DKA) and these same symptoms can also be seen in acute attacks of metabolic diseases. We report a 2-year-old patient who presented with acute encephalopathy, hyperglycemia, metabolic acidosis, increased anion gap, ketosis and a preliminary diagnosis of DKA. Further investigation revealed IVA. This case is of interest because of the rarity of this presentation and detection of a splicing mutation in the isovaleryl-CoA dehydrogenase gene.

Prolonged rooming-in in infancy is associated with generalized anxiety disorder in the adolescent period.

Abstract Objective: This study aims to investigate whether anxiety disorders in adolescents have a link with the separation time of bed/bedroom sharing with parents. It also aims to raise awareness in society about the issue of minimizing anxiety disorders in childhood. Methods: A case-control study was conducted in Şevket Yılmaz Training and Research Hospital between June 2013 and May 2014. The participants included 51 adolescents who were diagnosed as generalized anxiety disorder (GAD) with no-comorbidity and 71 healthy adolescents as the control group, who were chosen randomly. Diagnosis of GAD was based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed) by child and adolescent psychiatry doctors. The Turkish version of the State-Trait Anxiety Inventory (STAI) was used for the control group. A special survey about demographics and bed-sharing statements was constructed for the purpose of the study. The groups were analyzed in terms of duration of co-sleeping (bed-sharing) and rooming-in (keeping the mother and the baby in same room) with parents during infancy and the development of anxiety disorders in later period. Results: Mean duration of rooming-in was significantly longer in the case group than in the control group (p=0.009). Similarly, mean duration of co-sleeping in the case group was longer than that of the control group. However, this difference was not statistically significant (p=0.529). Conclusion: Sleeping in the same room with children for a long time may result in anxiety disorders in later period due to possible difficulties in bonding and/or less self-confidence.

Does intrauterine tobacco exposure increase the pain perception of newborns

Background This study aimed to assess whether there was a difference in the pain-perception levels of newborns born to mothers who smoked during pregnancy and newborns born to mothers who were not exposed to active or passive smoking during pregnancy. Materials and methods A total of 60 newborns born by normal spontaneous vaginal birth between June 2013 and June 2014 were included in the study: 30 born to mothers who smoked during pregnancy, and 30 born to mothers not exposed to smoking. Mothers or newborns who had taken analgesics or sedative medications in the previous 24 hours, newborns not born at term, and sick newborns were not included in the study. During the routine hepatitis B-vaccination injection given at postnatal 48 hours, the newborns’ behavior was monitored and recorded by video camera. The data obtained from the recordings were evaluated according to the Neonatal Pain, Agitation, and Sedation Scale and analyzed with SPSS 20. Results The median pain score of the group exposed to tobacco smoke in utero was 8.5, while the median pain score of the unexposed group was 6 (P<0.001). Conclusion Exposure to tobacco smoke in utero may increase the pain-perception levels of newborns.

Relationship between Abdominal Aortic Intima Media Thickness and Central Obesity in Children

Background: Childhood obesity is one of the important risk factors for early atherosclerosis. We aimed to evaluate the effect of obesity on abdominal aortic intima media thickness (aaIMT) in children. Methods: We consecutively recruited 60 obese and 28 healthy children from the outpatient clinic of pediatrics. In all patients, BMI, waist circumference (WC) and hip circumference (HC) were measured, and fasting serum lipid profile, plasma glucose and plasma insulin were studied. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated for the obese group. All children underwent ultrasonography to evaluate hepatosteatosis and to measure aaIMT. Results: There was a significant difference between the groups in terms of aaIMT, insulin, glucose, HOMA-IR, total cholesterol, low-density lipoprotein, triglyceride and hepatosteatosis. aaIMT was 1.12 ± 0.25 and 0.61 ± 0.18 mm in the obese and nonobese groups, respectively (p < 0.001). In the obese group, there was a positive correlation between aaIMT and WC, WC/height ratio, BMI, HC and hepatosteatosis (p < 0.05 for all), with the highest significance for WC. Conclusions: This study showed that aaIMT was significantly higher in obese children than in nonobese children, and that WC was a strong predictor for aaIMT. Early detection of an increased aaIMT in obese children may guide the follow-up of these patients in terms of developing atherosclerosis and its complications.

Relation between QT Variables and Left Ventricular Geometry in Athletes and Obese Children

INTRODUCTION We aimed to evaluate the relation between QT variables and left ventricular geometry in athletes and obese children. MATERIAL AND METHODS This study included 209 children and adolescents. Thirty-eight of them were obese, 140 were athletes and 31 were normal weighted. Children with history of functional and structural cardiovascular diseases (acquired and congenital), chronic systemic diseases, hypertension, sleep apnea, endocrinological disorders were excluded. All subjects underwent detailed electrocardiographic and echocardiographic examination. RESULTS QT dispersion was significantly higher in obese children, basketball players, football players and swimmers compared to control group (p < 0.05, p < 0.001, < 0.001 and < 0.01 respectively). Basketball players had the highest QT dispersion. Left ventricular endsystolic diameter (mm/m2) was higher in footballers, swimmers, wrestlers and tennis players compared to obese subjects. Interventricular septal thickness at diastole was highest in swimmers compared to control group (p < 0.001) and left ventricular posterior wall thickness was significantly higher in footballers and swimmers compared to healthy subjects (p < 0.01 and p < 0.001 respectively). Left ventricular geometry was normal in 84 patients (47.1%), but 34 patients (19.1%) had concentric remodelling, 20 (22.4%) had concentric hypertrophy and 40 (28.6%) had eccentric hypertrophy. No concentric and eccentric hypertrophy was observed in obese subjects. Left ventricle hypertrophy was prominent in dynamic and combined groups but it was not statistically significant (p = 0.204). QT dispersion was statistically higher in obese, dynamic sports and combined sports compared to control group (p < 0.05, p < 0.001 and p < 0.001 respectively). DISCUSSION In this study we determined that QT dispersion is elevated in dynamic and combined sports types and obese children. CONCLUSION QT dispersion is prolonged in obese and athletes who participate dynamic and combined sports.

Benign Acute Childhood Myositis due to Toxoplasmosis

To the Editor : A previously healthy 5-y-old boy was admitted to the emergency department with the complaint of leg pain and refusal to walk. Ten days ago he had a period of low-grade fever and fatigue that recovered spontaneously. Twenty-four hours before the admission the leg pain began and then he refused to walk. He was living in a village and had a history of contact with cats. On physical examination, he was well, afebrile and other vital signs were within normal limits. There was no lymphadenopathy or hepatosplenomegaly. Neurologic examination was normal. Extremity examination revealed bilateral calf tenderness on palpation. His gait was stiff-legged and flat-footed; he had difficulty in walking. Complete blood count and basic metabolic profile were normal. Creatine kinase (CK) increased to 809 U/L, three times normal (26–308 U/L). Urinalysis was normal and negative for myoglobin. Serology was performed to establish the etiology. It supported the acute toxoplasma infection and no other agent. His serologic results for T.gondii were as following; IgG Dye test was 6000 (positive ≥16), IgM ELISA was 10 (positive ≥2) and IgG avidity was 1.8 (low ≤20). He completely recovered and could walk independently on the 5th day of follow up. His CK returned to normal (126 U/L) and was diagnosed as benign childhood acute myositis (BCAM) after a toxoplasma infection. Benign childhood acute myositisis is a muscle syndrome that is most commonly seen after a viral infection [1]. The most common presentation of the disease is acute refusal to walk or altered gait during walking. Although the most common etiologic agents are influenza type A and B viruses, the other agents are also reported in the literature [2, 3]. Toxoplasmosis is mostly subclinical or asymptomatic infectious disease in healthy children. Myocarditis and myositis are reported as rare clinical findings [4]. The other clinical findings of BCAM are male predominance and serum CK increase. If the CK levels are too high, patient should be monitored in terms of rhabdomyolysis and renal failure [5]. Duration of symptoms are short and the recovery is spontaneous; therefore, further investigations are unnecessary unless the diagnosis is suspected [3]. In patients with acute gait disturbances if there are no alarming symptoms, BCAM should be considered certainly before unnecessary and invasive investigations. Viral serologic investigations are helpful in supporting the diagnosis.

The MEFV gene pathogenic variants and phenotype-genotype correlation in children with familial Mediterranean fever in the Çanakkale population

Abstract The aim of the current study was to determine the frequency of the Mediterranean fever (MEFV) gene pathogenic variants in 60 children diagnosed with familial Mediterranean fever (FMF) and to compare the phenotype-genotype correlation. Genomic DNA was isolated by the spin-column method from peripheral blood samples (collected in vacutainers containing EDTA) and buccal smears. The MEFV gene profiles for the current FMF cohort were genotyped by pyrosequencing and direct Sanger sequencing techniques for the target pathogenic variants. The most prominent clinical symptoms were abdominal pain (53.4%), fever (23.4%) and arthritis (23.3%). Eighteen different pathogenic variants were identified and the most frequent were p.Met694Val (20.0%), p.Glu148Gln (13.3%), p.Met680 Ile (11.7%) and p.Arg202Gln (11.7%). Abdominal pain, fever and arthritis were the most common presenting clinical characteristics. Results showed that not only clinical characteristics, but also genotyping of the MEFV gene is needed to establish the correct diagnosis of FMF in children and other family members.

An uncommon cause of anterior knee pain: patellar chondroma.

A 16-year-old boy presented with a patellar mass and anterior knee pain without any trauma. On physical and radiologic assessment, a mass at the superolateral edge of the patella and a hyperintense lesion on T2 sequences of magnetic resonance imaging was detected. Excisional biopsy revealed a chondroma of patella. Primary bone tumors of the patella are extremely rare and occurence of chondroma in this localization is very uncommon. Although anterior knee pain is a very frequent and usually harmless, it is essential to consider the more severe disorders such as bone tumors.