Necla Çevik

Nutrition, immunity and infections: T lymphocyte subpopulations in protein-energy malnutrition

Protein energy malnutrition (PEM) is one of the most frequent causes of secondary immune deficiency states. Alterations either in cellular or humoral immune mechanisms increase the susceptibility to infections in the malnourished organism. Infections aggravate the interrelationship of malnutrition to immune deficiency and infections, resulting in future adverse effects of malnutrition on humoral and cellular immune systems, IgG, IgM, IgA, C3, and T lymphocyte subpopulations were identified in 29 patients with PEM and 15 healthy infants serving as the control group, ranging between 3 and 24 months of age. Patients with PEM demonstrated elevated levels of IgG, IgM and IgA when compared to the control group (P < 0.01, P < 0.01, P < 0.01), C3 levels were significantly lower than the values of the control group (P < 0.01).

Urinary Nitrite Excretion in Low Birth Weight Neonates with Systemic Inflammatory Response Syndrome

Increased nitric oxide (NO) levels are thought to play an important role in the pathophysiology of the systemic inflammatory response syndrome (SIRS) which is caused by disseminated vascular endothelial damage. Clinical studies have shown that urinary nitrite (NO2-) and nitrate (NO3-) excretions can be utilized as indexes of NO formation. The SIRS and NO relationship was investigated in 15 neonates with SIRS, gestational age 32.5 +/- 4.4 weeks and weight 1,737 +/- 753 g. The control group comprised 18 neonates with a gestational age of 32.8 +/- 3.5 weeks and a weight of 1,778 +/- 538 g. There was no significant difference in birth weights and gestational ages between the two groups (p > 0.05 and p > 0.05). The urinary nitrite levels obtained in the subjects were normalized for urinary creatinine concentrations. The mean urinary nitrite levels in the control group neonates were found to be 4.22 +/- 1.8 micromol/mmol creatinine on the 1st day, 4.09 +/- 2.28 on the 2nd, 3.62 +/- 1.6 on the 3rd, and 4.01 +/- 1.12 micromol/mmol creatinine on the 7th day. There were no statistically significant differences between these levels (p > 0.05). We determined urinary levels of nitrite in neonates in the study group within the first 24 h of SIRS symptoms and found these levels (18.35 +/- 11.16 micromol nitrite/mmol creatinine) to be elevated as compared with those of the control subjects on the 7th day of life (p < 0.0005). In conclusion, urinary nitrite excretion is significantly elevated in neonates with SIRS due to septic events, and these results suggest that NO might play a part in SIRS.

Breast milk versus infant formulas: Effects on intestinal blood flow in neonates

The differences between breast milk and infant formulas have been a popular subject of many recent studies. Most concern the chemical and biological characteristics of breast milk and infant formulas, but little work has been done about hemodynamic changes in the splanchnic circulation. In term neonates (n=22) we evaluated the effect of breast milk, adapted cow’s milk formula, and nucleotide supplemented cow’s milk formula on intestinal blood flow. To determine the blood flow velocity and estimate volume flow, pulsed Doppler ultrasound of the superior mesenteric artery (SMA) was performed prefeeding and 15, 45, and 90 minutes following feeding. When pre-and postprandial blood flow features of babies were compared among in their groups according to nutrition post prandial blood flow velocity and volume flow were increased significantly over baseline in all three groups. While there was no significant difference between the postprandial blood flow parameters of the breast milk and adapted cow’s milk formula-fed groups, the nucleotide supplemented cow’s milk formula-fed group had significantly higher postprandial blood flow velocity and volume flow.

Platelet Activation during the Early Neonatal Period

The first week of life is a time when hereditary or more frequently acquired factors lead to some important differences in the hemostatic mechanism of the newborn. It has been well known that ill neonates are prone to both hemorrhage and thrombosis. The aim of this study was to answer the question of whether there is a difference in platelet activation in healthy neonates during the first days of life that may contribute to both hemorrhage and thrombosis in the presence of additional pathologic insults. Platelet activation was determined with flow cytometry using monoclonal antibodies in 63 healthy children (29 neonates, 17 infants, and 17 older children). There was no significant difference in platelet activation among these three age groups (p > 0.05). In addition, platelet activation did not show any significant relationship to age, sex, mode of delivery, or blood bilirubin concentration (p > 0.05). It has been previously reported that platelet activation occurs at the time of birth. We could not find any evidence that healthy newborns during the first 3 days of life exhibit increased platelet activation. Further studies on platelet activation in ill neonates will help to clarify whether platelet activation plays a role in the pathogenesis of thrombotic and/or hemorrhagic disorders.

Landau-Kleffner syndrome : Relation of clinical, EEG and Tc-99m-HMPAO brain SPECT findings and improvement in EEG after treatment

Landau-Kleffner syndrome (LKS) is a rare childhood disorder characterized by acquired aphasia with seizures and electroencephalogram (EEG) abnormalities. Tc-99m-HMPAO SPECT was performed in three right handed children with LKS. A relative decrease in perfusion was found in the left temporal cortex of all three patients and also in the left frontoparietal cortex of one patient with hyperkinetic behavior. Degree of regional cerebral perfusion impairment did not correlate with the severity of clinical and EEG abnormalities. Asymmetrical temporoparietal perfusion appears characteristic of LKS. SPECT findings in LKS were evaluated as useful in elucidating the pathogenic features of the disorder in the brain.

SERUM CORTISOL AND PROLACTIN LEVELS IN CHILDHOOD PAROXYSMAL DISORDERS

Postictal serum prolactin and Cortisol levels were measured in 37 children having either epilepsy, febrile seizure or syncopal attack and in 37 normal controls. Blood samples were obtained within 1.5 h following the seizure episode. All serum levels were compared between each group and the control groups. Significantly higher (P < 0.005) prolactin levels (56.64 ± 34.78 ng/mL) were found in the epileptic group, compared to the levels in children with febrile seizures (21.72 ± 12.92 ng/mL), syncope attacks (13.88 ± 5.27 ng/mL) and the control group (14.32 ± 5.05 ng/mL). In contrast, serum Cortisol levels were non‐specifically elevated in children with epilepsy, febrile seizures and syncopal attacks. Cortisol secretion appears to be non‐specifically elevated in all stressful events. Elevated prolactin levels may be helpful in differentiating epilepsy from febrile seizures and syncope.

Relationship between serum unconjugated bilirubin levels and the autofluorescence of white blood cells in neonatal jaundice.

In this study, using flow cytometry, we investigated the autofluorescence emitted by lymphocytes, monocytes and neutrophils exposed to different unconjugated bilirubin concentrations and investigated the relationship between these parameters. Different unconjugated bilirubin concentrations were prepared from a newborn serum with an unconjugated bilirubin concentration of 800 m mumol/l. The same concentrations of unconjugated bilirubin have been prepared from pure bilirubin. 10 microliters of cord blood were incubated at room temperature for 15 min with 90-microliter solutions with different bilirubin concentrations prepared from both serum and pure bilirubin. After incubation, cells were washed three times with PBS, erythrocytes were lysed by lysing buffer and run through flow cytometry immediately. Autofluorescence was measured by recording mean fluorescence channels for lymphocytes, monocytes and neutrophils. There was a good correlation between serum concentrations of unconjugated bilirubin that cells were exposed to and the autofluorescence intensity of neutrophils (r = 0.904, p < 0.005), monocytes (r = 0.759, p < 0.05) and lymphocytes (r = 0.766, p < 0.01). Results obtained with pure bilirubin were also similar. Autofluorescence emitted by lymphocytes was lower than that of monocytes (p < 0.01) or neutrophils (p < 0.0005).

Transient right sided hypertrophic cardiomyopathy in an infant born to a diabetic mother

Hypertrophie cardiomyopathy (HCM) is a rare primary myocardial disease, characterized by hypertrophy of the left and/or right ventricle. Infants of diabetic mothers (IDM) are at risk for development of HCM, respiratory distress and persistent pulmonary hypertension. A case of severe right sided HCM in an infant born to a diabetic mother is presented. The patient’s findings were complementary to the previous observations reporting HCM in IDM. The presence of disproportionate septal hypertrophy in the echocardiography of an infant born to a diabetic mother is highly suggestive of HCM in IDM. In our opinion, further cardiac evaluation is not indicated unless other cardiac abnormalities are suspected.

Effects of high‐dose intravenous methylprednisolone in children with acute rheumatic carditis

In order to measure the effects of high‐dose intravenous methylprednisolone (HIVMP) and compare its efficiency with that of oral prednisolone (OP), 18 patients with active rheumatic carditis were studied. Ten patients received OP, while eight patients were treated with HIVMP. Clinical and laboratory responses to treatment were followed by sleeping pulse rate, systolic blood pressure, erythrocyte sedimentation rate (ESR), cardiothoracic ratio (CTR), PR interval on electrocardiogram, spectral and color flow imaging and Doppler echocardiographic findings; mitral and aortic regurgitant jet flow area, left atrial area, proximal width of mitral regurgitant jet area and regurgitation fractions.

The importance of pulmonary function tests in adenotonsillectomy indications.

Children who had undergone adenotonsillectomy for recurrent adenotonsillitis showing no signs of clinical or radiological obstructive manifestations were evaluated with pulmonary function tests before, and one month after the operation. In relation to the result obtained by function tests, 60% of 45 cases (27) had the findings of mild obstructive pulmonary disease whereby these findings were in transient character that vanished after the operation. The following parameters were measured and found that they were all increased, mean FVC from 82.22±6.82 to 93.11±7.81 (p<0.01), mean PEF from 77.60±8.38 to 88.60±5.57 (P<0.01), mean FEVI from 74.28±11.68 to 90.15±7.28 (p<0.01), mean FEF 25 from 71.44±11.53 to 83.53±6.40 (p<0.01), mean FEF 50 from 69.53±14.53 to 84.37±7.72 (p<0.01), mean FEF 75 from 70.08±12.15 to 85.48±7.15 (p<0.01). In conclusion, pulmonary function tests could reveal the obstructive effects of adenotonsillar hypertrophy with no clinical or radiological obstructive findings, and could be useful in surgical indications of adenotonsillar hypertrophy dur to recurrent infections in children.