Osman Özdemir

The immunostimulant OM-85 BV prevents wheezing attacks in preschool children

BACKGROUNDnNo reagents have been shown to be effective in preventing wheezing attacks provoked by acute respiratory tract illnesses (ARTIs) in preschool children. New therapeutic agents and preventive strategies are needed.nnnOBJECTIVESnWe assessed the effect of OM-85 BV (Broncho-Vaxom; OM Pharma, Geneva, Switzerland) in preventing ARTI-provoked wheezing attacks in preschool children with recurrent wheezing.nnnMETHODSnA randomized, double-blind, placebo-controlled, parallel-group study was carried out between August 2007 and September 2008. The study included 75 children with recurrent wheezing who were 1 to 6 years old. Participants were randomly assigned to groups given either OM-85 BV or a placebo (1 capsule per day for 10 days each month for 3 consecutive months) at the start of the trial. Participants were followed for 12 months, which included the administration period of the test article.nnnRESULTSnSubjects given OM-85 BV had a lower rate of wheezing attacks. The cumulative difference in wheezing attacks between the 2 groups was 2.18 wheezing attacks per patient in 12 months; there was a 37.9% reduction in the group given OM-85 BV compared with the group given placebo (Pxa0< .001). Stepwise multiple (linear) regression analysis showed that the main difference between the OM-85 BV and placebo groups was a reduction the number of ARTIs (Rxa0= -0.805, Pxa0< .001). The duration of each wheezing attack was 2 days shorter in the group given OM-85 BV than in the group given placebo (Pxa0=xa0.001).nnnCONCLUSIONnAdministration of OM-85 BV significantly reduced the rate and duration of wheezing attacks in preschool children with ARTIs.

Echocardiographic measurement of epicardial adipose tissue in obese children.

The echocardiographic measurement of epicardial adipose tissue (EAT) has been suggested as an easy method for evaluation of the visceral adipose tissue and its related cardiovascular risks in adults. However, a direct effect of obesity on cardiac function is not well established, and echocardiographic EAT thickness has not been studied in children. The aims of this study were to evaluate cardiac function and echocardiographic EAT thickness and to correlate EAT with the other echocardiographic findings in obese children. The study population included 106 obese and 62 lean children. Echocardiographic indexes of systolic and diastolic function were obtained. We measured EAT thickness on the free wall of the right ventricle from parasternal long-axis views. The septal and posterior wall thicknesses, relative wall thickness, left atrial diameter, and left ventricular mass were increased (pxa0=xa00.001) in obese children. However, systolic and diastolic functions of the left ventricle were normal in the patients. The obese children had a significantly thicker EAT (pxa0=xa00.001) compared to the lean subjects. EAT thickness correlated significantly with body mass index (rxa0=xa00.50, pxa0=xa00.001), left atrial diameter (rxa0=xa00.37, pxa0=xa00.001), and left ventricular mass (rxa0=xa00.33, pxa0=xa00.001). In conclusion, the present study demonstrates a close relationship between EAT thickness and obesity in children. Assessment of EAT thickness in routine echocardiographic examinations might be used as a feasible and reliable method for the evaluation of obesity and its related cardiovascular risks during childhood.

Neonatal Diabetes Mellitus Accompanied by Diabetic Ketoacidosis and Mimicking Neonatal Sepsis: A Case Report

Neonatal diabetes mellitus (DM) develops within the first six weeks of life with basic findings including dehydration, hyperglycaemia, and mild or no ketonemia/ketonuria. It can be either transient or permanent. Here, we report a case of a one-month-old infant with permanent neonatal diabetes, due to pancreatic hypoplasia, accompanied by diabetic ketoacidosis (DKA). The hyperglycaemia and ketoacidosis resolved by the 14(th) hour of treatment, consisting of IV insulin and rehydration. Subsequently, insulin treatment was continued with neutral protamine hagedorn (NPH) insulin. Breastfeeding was started and was continued at intervals of three hours. Following initiation of breastfeeding, the stools became watery, loose, yellow-green in color, and frequent (8-10 times a day). They contained no blood or mucus. Replacement of pancreatic enzymes resulted in decreased stool frequency. Neonatal DM due to pancreatic hypoplasia and associated with DKA may mimic sepsis and should be kept in mind in all newborns who present with fever, dehydration, and weight loss.

The association of serum lipocalin-2 levels with metabolic and clinical parameters in obese children: a pilot study

Abstract Objective: We aimed to evaluate the association between serum lipocalin-2 level and clinical and metabolic parameters in obese children. Methods: The study included obese children with a body mass index (BMI) >95th percentile who presented to Kecioren Teaching and Research Hospital with the complaint of weight gain and healthy children with a BMI <85th percentile. The height and weight of the patients were measured for compartment of anthropometric data. Fasting blood glucose, insulin, lipid profile, and serum lipocalin-2 level were measured to evaluate the laboratory parameters. Results: The study included 33 obese and 34 healthy non-obese children. Comparison of data on the obese subjects with those of the healthy subjects shows differences in BMI, BMI-SDS, triglyceride, insulin, and homeostasis model assessment index-insulin resistance levels between the two groups were statistically significant (p<0.05), whereas serum lipocalin-2 was not statistically significant (p>0.05). There was no statistically significant difference in serum lipocalin-2 levels when obese and control groups were reclassified as prepubertal and pubertal (p>0.05). Conclusions: In this study, we did not find any relationships among serum lipocalin-2 level, anthropometric parameters, or metabolic parameters. According to the results of this study, we do not suggest routine investigation of serum lipocalin-2 level in obese subjects for risk stratification of the obesity-related complications.

Sensorineural hearing loss in pediatric celiac patients

OBJECTIVEnCeliac disease (CD) is an immune-mediated chronic inflammatory gluten-dependent intestinal disease affecting 0.5-1% of the general population worldwide. CD is underdiagnosed even with sophisticated health care; approximately 10% of people affected by CD are now diagnosed. The recognition of the atypical extra-intestinal manifestations, including neurological disorders increased the diagnosis of CD. At present, no data are available on the presence of sensorineural hearing loss in pediatric CD patients. The aim of this study was to determine the incidence and severity of sensorineural hearing loss (SNHL) in different frequencies in pediatric CD patients.nnnMETHODSnA sample of 32 biopsies and serologically proven newly diagnosed pediatric CD patients (CD group) (64 ears) and 32 sex and age-matched healthy subjects (64 ears) as control group (C group) were included in this study. Anthropometric measurements, physical examinations including ear nose and throat and pure-tone audiometry at frequencies 250-8000 Hz were performed in all subjects in both groups. Slight/mild SNHL was defined as a loss of detection of sound within the 16-40 dB range. The mean age of patient and control group was 11.9 and 11.3, respectively (p>0.05).nnnRESULTSnIn CD group, sensorineural hearing loss was found in 13 (40.6%) patients (group A) as it was bilateral in six and unilateral in seven patients. In control group (group C), slight/mild SNHL was found in one (3.1%) subject. The frequency of hearing loss was significantly higher in CD group than in group C (p<0.001).nnnCONCLUSIONnThe present study showed a higher prevalence of sensory neural hearing loss in pediatric celiac patients than in healthy controls, suggesting an association between CD and SNHL. The findings of this study suggest that hearing impairment should be searched in newly diagnosed pediatric CD patients. Further longitudinal investigations on a larger sample size will be necessary to confirm the present data and to search the immunological processes which could be the basis of the association between CD and SNHL.

Relationship between hair cadmium levels, indoor ETS exposure and wheezing frequency in children

BACKGROUNDnCadmium (Cd) is a toxic heavy metal and the components of tobacco and scalp hair effectively reflect a long-term environmental exposure.nnnOBJECTIVEnThe aim of this study was to assess the concentration of Cd levels in the hair of children with recurrent wheezing, and to evaluate the predictors of elevated Cd levels with a focus on anthropometric, environmental, and dietary factors.nnnMETHODSnIn this case-control study, scalp hair was obtained from 65 children with recurrent wheezing (RW) and from 65 healthy children (HC). Hair Cd concentrations were determined by ICP-MS.nnnRESULTSnMedian (IQR) hair Cd levels were 0.22 μg/kg (0.10-0.35) in RW group and 0.12 μg/kg (0.04-0.23) in HC group (p = 0.013). Multivariable logistic regression model results showed that being a child with RW (OR = 6.28; p = 0.001), ETS exposure at home (OR=22.56; p < 0.001), and mothers education level (OR = 0.49; p = 0.020), are the major predictor variables for elevated hair Cd levels (cut off >0.17 μg/kg). In RW group, multivariable logistic regression results showed that hair Cd levels of >0.17 μg/kg was significantly predictive of having three or more wheezing episodes in RW group after adjustment for ETS exposure at home (OR = 5.48; p = 0.012).nnnCONCLUSIONnWe demonstrated that the more children are exposed to ETS at home, the more they are exposed to heavy metals like Cd. Especially children who have had three or more wheezing attacks over the last six months are much more susceptible than the other asthmatic and non-asthmatic children, and Cd exposure aggravates their asthmatic status.

Cardiac Functions in Children With Growth Hormone Deficiency Before and During Growth Hormone–Replacement Therapy

Childhood growth hormone deficiency (GHD) decreases left-ventricular (LV) mass, but impairment of cardiac function has never been documented. The objective of this study was to assess the cardiac effects of GHD and recombinant human growth hormone (rhGH) treatment using conventional echocardiography and tissue Doppler imaging. Complete two-dimensional, M-mode, pulse-wave Doppler echocardiography and pulse-wave tissue Doppler imaging were performed in 12 children (6 male and 6 female patients) with GHD at baseline and at 5.86xa0±xa01.61xa0months after rhGH therapy. Recombinant human growth hormone treatment was associated with a significant increase in LV mass index (63.8xa0±xa027.1 to 79.3xa0±xa030.3xa0g/m2; Pxa0<xa00.01) and LV internal dimensions (21.4xa0±xa02.63 to 24.0xa0±xa04.13xa0mm in systole [Pxa0=xa00.03] and 36.5xa0±xa03.90 to 39.5xa0±xa04.94xa0mm in diastole [Pxa0<xa00.01]). There were statistical differences of parameters, such as deceleration time of early peak velocity of mitral, isovolumic relaxation time, and myocardial performance index (103xa0±xa015.4 to 139xa0±xa021.2xa0ms [Pxa0<xa00.01], 55.5xa0±xa09.24 to 69.2xa0±xa03.74xa0ms [Pxa0<xa00.01], and 37.8xa0±xa04.46 to 44.9xa0±xa05.44% [Pxa0<xa00.01], respectively). Before and during rhGH therapy, there were no significant differences in fractional shortening of the left ventricle, peak mitral, and tricuspid wave velocities with ratios determined using conventional echocardiography and tissue Doppler imaging. In children, GHD affects heart morphology by inducing a decrease in cardiac size, but it does not modify cardiac function. Recombinant human growth hormone treatment increases cardiac mass, deceleration time of early peak velocity of the mitral valve, isovolumic relaxation time, and myocardial performance index, but it does not make a difference in other parameters of conventional echocardiography and tissue Doppler imaging.

Audiological findings in celiac disease.

Objective: Celiac disease (CD) is a gluten-triggered immune enteropathy caused by a genetic predisposition. Recent papers suggest that CD is increasingly recognized by extraintestinal findings. The aim of this study was to investigate the effect of CD on hearing pathway including the olivocochlear efferent system in children. Methods: Forty-one pediatric CD patients and 31 controls were included in the study. Both groups were evaluated with audiometry, tympanometry, transiently evoked otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE), and contralateral suppression of the TEOAE. Results: The threshold at 250 Hz of the patients with CD was significantly higher (p < 0.05 in CD compared to control group, p < 0.0001). The signal to noise ratio (SNR) amplitudes in DPOAE testing and the SNR amplitudes with and without contralateral acoustic stimulus in TEOAE testing were significantly lower at 1,000 Hz in the CD compared to the control group. There was no significant difference between the CD and the control group regarding contralateral suppression amplitudes. Conclusion: CD seems to have an important impact on the auditory system, and results in an elevation of the thresholds at 250 Hz on audiometry and a decrease in the amplitudes of DPOAE and linear TEOAE at 1,000 Hz in children.

Factors associated with left atrial size in obese children: an observational study.

OBJECTIVEnLeft atrial size can be considered an independent risk factor for cardiovascular diseases. The measurements of left atrium may be used to assess obesity, which is an important risk factor of cardiovascular diseases. It is aimed to determine the factors that effect to the left atrial size, which is an indicator of cardiac risk in obese children without hypertension.nnnMETHODSnThe cross-sectional observational study was performed between April 2008 and September 2009 at the clinic of Pediatric Cardiology. Eighty obese and 82 lean children were studied. Diagnosis of obesity was defined according to the World Health Organization classification as the standard deviation score of body mass index being over + 2 standard deviation of the same gender and age. All subjects underwent two-dimensional, M-mode, and Doppler echocardiographic studies. Students t-test, Chi-square test, Pearson correlation analysis, and multiple stepwise regression analyses were used to compare the subjects, differences in group proportions, evaluate the relation of variables with the left atrial size, and examine the effects of significant independent variables, respectively.nnnRESULTSnThe mean age of obese patients was 11.7±2.2 years and it of lean subjects was 11.7±2.2 years. Body weight, body mass index, standard deviation score of body mass index, waist circumference, systolic and diastolic blood pressure, fasting insulin, and insulin resistance statistically increased in obese children (p<0.05). The left atrial size statistically correlated (p<0.05) with age (r=0.523), body mass index (r=0.394), waist circumference (r=0.421), diastolic blood pressure (r=0.230), insulin resistance (r=0.350), and left ventricular mass (r=0.535). It was determined that age (beta=0.491; 95% CI=0.091-0.892; p=0.001) and left ventricular mass (beta=0.055; 95% CI=0.026-0.085; p=0.017) were the most effective independent factors associated with left atrial size among other independent factors in multiple regression analysis.nnnCONCLUSIONnWe found that left atrial size was mostly influenced by age and left ventricular mass in obese children. Therefore, it is important that left atrial size is follow up in childhood obesity.

Relation of subepicardial adipose tissue thickness and clinical and metabolic parameters in obese prepubertal children

HızlıŞ, Özdemir O, Abacı A, Razi CH and Kabakuş N. Relation of subepicardial adipose tissue thickness and clinical and metabolic parameters in obese prepubertal children.