Onur Akın

Association of wider neck circumference and asthma in obese children

BACKGROUND Obesity is a well-established risk factor for asthma. Previous studies have reported that central obesity is associated with asthma. OBJECTIVE To investigate the association between fat distribution, which is determined by anthropometric measures, including neck circumference (NC), and asthma in school-aged children. METHODS Children diagnosed as having asthma were enrolled along with controls who were admitted to our outpatient department with allergic symptoms, such as rhinitis, urticaria and atopic dermatitis. Anthropometric measures, including height, weight, NC, waist circumference, and hip circumference, were obtained. Skin prick tests, blood eosinophil counts, and serum total IgE level measurements were performed. RESULTS A total of 196 children (92 male [46.9%]) were included. Asthma was present in 102 patients (52.1%). Ninety-one of the patients (46.4%) were overweight, and 45 patients (22.9%) were obese. The NC of children with asthma was significantly higher than that of children in the control group. Grades defined according to NC percentiles were also significantly different between groups. In children with asthma, the prevalence of children with an NC higher than the 90th percentile (grade 6) was more frequent when compared with controls. The median NC of obese-overweight children with asthma was significantly higher compared with obese-overweight controls without asthma. Results of multivariable logistic regression analysis revealed that the presence of an NC in the greater than 90th percentile was associated with asthma in obese-overweight children. CONCLUSION This study found that NC, which is a simple anthropometric measure, is associated with asthma in obese children.

Anaphylaxis to gonadorelin acetate in a girl with central precocious puberty.

Abstract Gonadotropin-releasing hormone analogues are generally regarded as safe drugs. Gonadorelin acetate has been widely used for the diagnosis of central precocious puberty, and life-threatening reactions to gonadorelin acetate are extremely rare. Herein, we described – to the best of our knowledge – the first pediatric case in which severe anaphylaxis was encountered after intravenous gonadorelin acetate administration. An 8-year-old girl who was diagnosed with central precocious puberty was receiving triptorelin acetate treatment uneventfully for 6 months. In order to evaluate the efficacy of the treatment, an LH-RH stimulation test with gonadorelin acetate was planned. Within 3 min after intravenous administration of gonadorelin acetate, she lost consciousness and tonic seizures began in her hands and feet. She was immediately treated with epinephrine, diphenhydramine, and fluids. Her vital signs recovered within 30 min. Based on the results, anaphylaxis should be anticipated and the administration of these drugs should be performed in a setting that is equipped to deal with systemic reactions.

Association of nerve conduction impairment and insulin resistance in children with obesity.

AimThe objective of our study was to investigate nerve conduction in normoglycemic obese children.MethodsA total of 60 children with obesity (30 female and 30 male) and 30 healthy children (15 female and 15 male) were enrolled in the study. Insulin resistance (IR) and other metabolic disturbances were investigated and nerve conduction was measured in all participants. Obese children were divided into groups according to the presence of IR. All results were compared between these subgroups.ResultsThe nerve conduction velocity (NCV) of motor median nerves in the IR+ group was significantly higher than that in the IR− group and lower than that in the control group. The NCV of the motor peroneal nerve in the IR+ group was significantly lower than that in the IR− group. The sensory nerve action potential (SNAP) of the sensory median nerve was significantly lower in the IR+ group compared to that in the IR− group. The sensory sural nerve’s SNAP was significantly lower in the IR+ group than that in the control group.ConclusionNerve conduction tests may help to detect early pathologies in peripheral nerves and to decrease morbidities in obese children.

Visual and brainstem auditory evoked potentials in children with obesity

AIMS The aim of our study is to investigate alterations in visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with obesity. METHODS A total of 96 children, with a mean age of 12.1±2.0 years (range 9-17 years, 63 obese and 33 age and sex-matched control subjects) were included in the study. Laboratory tests were performed to detect insulin resistance (IR) and dyslipidemia. The latencies and amplitudes of VEP and BAEP were measured in healthy and obese subjects. RESULTS The VEP P100, BAEP interpeak latency (IPL) I-III and IPL I-V averages of obese children were significantly longer than the control subjects. When the obese group was divided into two subgroups, those with IR and without IR, BAEP wave I, wave III and P100 wave latencies were found to be longer in the group with IR. A statistically significant correlation was observed between BAEP wave I latency, IPL I-V, IPL I-III and the homeostatic model assessment insulin resistance (HOMA IR) index and fasting insulin level. CONCLUSIONS Our findings suggest that VEP and BAEP can be used to determine early subclinical on auditory and visual functions of obese children with insulin resistance.

Relation of insulin resistance to neurocognitive function and electroencephalography in obese children.

Abstract Background: Childhood obesity may lead to neuronal impairment in both the peripheral and the central nervous system. This study aimed to investigate the impact of obesity and insulin resistance (IR) on the central nervous system and neurocognitive functions in children. Methods: Seventy-three obese children (38 male and 35 female) and 42 healthy children (21 male and 21 female) were recruited. Standard biochemical indices and IR were evaluated. The Wechsler Intelligence Scale for Children-Revised (WISC-R) and electroencephalography (EEG) were administered to all participants. The obese participants were divided into two groups based on the presence or absence of IR, and the data were compared between the subgroups. Results: Only verbal scores on the WISC-R in the IR+ group were significantly lower than those of the control and IR– groups. There were no differences between the groups with respect to other parameters of the WISC-R or the EEG. Verbal scores of the WISC-R were negatively correlated with obesity duration and homeostatic model assessment-insulin resistance (HOMA-IR) values. EEGs showed significantly more frequent ‘slowing during hyperventilation’ (SDHs) in obese children than non-obese children. Conclusions: Neurocognitive functions, particularly verbal abilities, were impaired in obese children with IR. An early examination of cognitive functions may help identify and correct such abnormalities in obese children.

Autoimmune Limbic Encephalitis Associated with Type 1 Diabetes Mellitus

A 16-year-old boy was admitted to our emergency department with confusion and headache. Electroencephalography revealed temporal slowing, cerebral magnetic resonance imaging demonstrated hyperintense signal of the right mesiotemporal lobe, and positron emission tomography demonstrated increased activity in the right temporal lobe. Blood glutamic acid decarboxylase antibody (anti-GAD) level was 2114 IU/mL (0–10) and the cerebrospinal fluid anti-GAD level was 4.07 nmol/L (<0.02). These findings led to a consideration of autoimmune LE as a possible diagnosis. Pulse methylprednisolone was administered over five days. After steroid treatment, symptoms improved, but hyperglycemia occurred on the third day of treatment. Glycemia level reached 502 mg/dL. Concurrent insulin level was 42 μIU/mL. Hyperglycemia improved after cessation of steroid treatment. Glycated hemoglobin was 5.6%. The possibility of a steroid-induced hyperglycemia was considered. Six months later, the patient was readmitted with dyspnea and abdominal pain. The family reported occurrence of polyuria and polydipsia during the previous two months. Blood anti-GAD level was >2000 IU/mL. The patient was diagnosed to have T1D. With treatment, the ketoacidosis improved in 10 h. After being educated for diabetes, the patient was discharged. Two months later, he presented with a headache and confusion again. Intravenous immunoglobulin (IVIG) 1 g/kg/d for two days every month was administered. Neurological symptoms improved and the daily insulin dose was decreased.

Association of neck circumference and pulmonary function in children

BACKGROUND Childhood obesity leads to many complications including impaired respiratory function. There are various anthropometric parameters related to obesity. OBJECTIVE To investigate the correlation between anthropometric indices and pulmonary function test results in children without asthma. METHODS Children without any respiratory disorders were enrolled in this study. Anthropometric measurements, such as height, weight, neck circumference (NC), and waist circumference, were obtained from the enrollees and body mass index was calculated. Afterward, pulmonary function tests were performed using spirometry. RESULTS A total of 178 children (106 boys, 59.5%) with a mean age of 9.7 years were included the study. NC was above the 90th percentile in 65 children. Importantly, pulmonary parameters, such as forced expiratory volume during the first second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC), were lower in subjects with a large NC. Similarly, waist circumference was above the 90th percentile in 67 children, and FEV1/FVC was significantly lower in children with a large waist circumference. Moreover, there was a statistically significant negative correlation among FEV1, FEV1/FVC, and body mass index SD score. Also, multivariable linear regression analysis showed that an NC above the 90th percentile was associated with lower FEV1 and FEV1/FVC values. CONCLUSION We identified NC as a novel anthropometric index that is strongly correlated with respiratory functions in children. Therefore, close monitoring of respiratory symptoms, particularly in children with obesity and a large NC, could help with early and prompt determination of respiratory complications of obesity.

A Rare Reason of Hyperinsulinism: Munchausen Syndrome by Proxy

Hyperinsulinism, one of the most important causes of hypoglycaemia, can be congenital or acquired. Rarely, drug toxicity can be a reason for hyperinsulinism. In the context of Munchausen syndrome by proxy (MSP), toxicity usually occurs in children due to drug administration by a parent or caregiver. A 7-year-old girl was referred to our department due to a hyperglycaemic period and hypoglycaemic episodes. On admission, gliclazide was initiated due to her hyperglycaemia, which we attributed to maturity onset diabetes of the young. However, during follow-up, hypoglycaemic levels were detected. Despite cessation of gliclazide, hypoglycaemic seizures occurred. Even with the medications administered, hypoglycaemia could not be prevented. During follow-up, the mothers affect, characterized by anxiety and interest in her daughters medical care, appeared discordant with the situation. Due to our suspicion of MSP, we discovered toxic levels of gliclazide in the blood and urine samples which had been sent to the toxicology laboratory to search for hypoglycaemic agents. The patient was isolated, and all medications were stopped. After isolation, her hypoglycaemia disappeared, and she became hyperglycaemic (250 mg/dl). Physicians should consider the possibility of MSP in hyperinsulinaemic patients with discordant laboratory results and clinical symptoms, even if the childs parents display great concern.

Comparison of anthropometric and biochemical parameters in obese children with or without primary headache

Gereç ve Yöntem: 2013-2018 yılları arasında pediatrik endokrinoloji ve pediatrik nöroloji polikliniklerine başvurmuş, primer baş ağrısı olan 8-18 yaş arası 161 obez çocuğun (90 kız, 71 erkek) dosyaları retrospektif olarak incelendi. Hastalar gerilim tipi baş ağrısı ve migren baş ağrısı olan çocuklar olmak üzere iki gruba ayrıldı. Primer baş ağrısı olmayan obez çocuklar ise kontrol grubuna dâhil edildi. Gruplar arasında laboratuvar ve oksolojik tüm veriler karşılaştırıldı.

Morning vs. bedtime levothyroxine administration: what is the ideal choice for children?

Abstract Background The present study compared the administration of levothyroxine (LT4) before breakfast and bedtime in school children diagnosed with hypothyroidism and analyzed the effects of timing on thyroid functioning and patient satisfaction. Methods A total of 163 children with acquired hypothyroidism (125 females and 38 males) between 8 and 18 years of age and taking LT4 for at least 3 months were enrolled in the study. The timing of administration of the drug of all subjects was shifted to bedtime. The levels of thyroid hormone and blood lipid, anthropometric measurements, Pediatric Quality of Life Inventory, Morisky Medication Adherence Scale and hypothyroidism symptoms scores were analyzed and compared at the beginning of the study and 3 months later after the shift in the timing of drug administration. Results There was no difference between the bedtime and morning regimens of LT4 with respect to thyroid hormone levels, quality of life, drug adherence and symptoms of hypothyroidism. At the end of the study, 45 of 70 new-onset treated subjects preferred the bedtime regimen. Also, drug adherence was found to be better in these patients. Conclusions We found no difference between the bedtime and morning regimens in both new-onset and long-standing treated patients. In naive patients, consideration of patient’s preference for timing of drug administration may increase their adherence to medication. Therefore, we suggest that choice of drug administration timing should be based on the preference of patients.