Ozlem Elkiran

The association between intima media thickness, central obesity and diastolic blood pressure in obese and owerweight children: A cross-sectional school-based study

OBJECTIVE To examine relationship between carotid intima-media thickness (IMT) and central obesity, cardiovasculary risk factors, and chronic inflammation markers in overweight and obese schoolchildren in Eastern Turkey. METHODS A cross-sectional school-based survey on 2765 schoolchildren was performed. We collected the clinical data (age, sex, percentage of body fat, and measured systolic blood pressure [BP] and diastolic BP, triglycerides, high- and low-density lipoprotein cholesterol, glucose, insulin, homocysteine and high-sensitivity C-reactive protein) in 67 obese and 24 overweight children. The control group was composed of nonobese children of similar age and sex. RESULTS Mean systolic and diastolic BP values in the cases of overweight and obese groups were higher than those in the control group cases (p=0.001). Obese and overweight children demonstrated a significantly thicker intima media as compared with the control group (p=0.001). Carotid IMT was significantly correlated to the body mass index (r=0.396, p=0.001), fat mass percentage (r=0.257, p=0.036), waist circumference (r=0.390, p=0.001), diastolic BP (r=0.266, p=0.030), glucose (r=0.250, p=0.042), and high-sensitivity C-reactive protein levels (r=0.269, p=0.001) in the obese group. In multiple linear regression analysis, carotid IMT correlated significantly to waist circumference (p=0.045), and diastolic BP (p=0.031) in obese group. CONCLUSIONS Obesity is related to cardiovascular risk factors leading to early atherosclerosis in schoolchildren. There is a relationship between atherosclerosis, and central obesity, diastolic BP, and chronic inflammation. Waist circumference measurement is more sensitive than other anthropometric measurements in predicting obesity and associated complications.

Tissue Doppler, strain, and strain rate measurements assessed by two-dimensional speckle-tracking echocardiography in healthy newborns and infants

OBJECTIVES To evaluate cardiac maturational and haemodynamic alteration in healthy newborns and infants and determine reference values in this period using tissue Doppler, strain, and strain rate echocardiography. MATERIAL AND METHODS The study included 149 healthy subjects. Babies from 1 day to 3 months were selected from the well-baby nursery department, and infants were selected from paediatric clinics during routine visits for health maintenance. Subjects were allocated to four groups: preterm (36-37 weeks, n = 32), term (≥ 38 weeks, n = 32), 1 month of age (n = 47), and 3 months of age (n = 38). Standard echocardiographic evaluations, pulsed wave Doppler, tissue Doppler echocardiography, strain, and strain rate studies were applied by the same person using a MyLab50 echo machine. Longitudinal and circumferential systolic strain and strain rate measurements were assessed by two-dimensional speckle-tracking echocardiography in all subjects. RESULTS The longitudinal systolic velocity, strain, and strain rate values derived from left ventricle apical four-, three-, and two-chamber images, and circumferential systolic velocity, strain, and strain rate values derived from left ventricle short-axis images decreased from the base to the apex in all subjects (p < 0.001). CONCLUSION Significant cardiac haemodynamic alterations occurred during the newborn and early infancy periods and were detected by tissue Doppler, strain, and strain rate echocardiography. Although two-dimensional speckle-tracking echocardiography is useful and can produce improved, reliable results in clinical practice, it has some limitations. Therefore, more studies on this issue are required.

Brucella myocarditis in a 3-month-old: probable transplacental transmission

Abstract A 3-month-old girl presented with myocarditis owing to brucellosis. Her mother had been diagnosed with brucellosis at 28 weeks gestation but did not receive treatment until after delivery. The infant had intrauterine retardation and had gained little weight since birth. It is considered likely that the brucellosis was transmitted transplacentally.

Human milk banking and milk kinship: Perspectives of mothers in a Muslim country

AIM The present study aims to determine the knowledge, attitudes and views of mothers regarding infant feeding, breast milk, wet-nursing, milk kinship and human milk banks. METHODS This descriptive cross-sectional study was composed of 1042 mothers who delivered at two different hospitals in Turkey. RESULTS Almost half of the participating mothers, 49.9%, agreed with the establishment of alternative HMBs in Turkey. Only 7.7% of the mothers in this study expressed views in favour of the establishment of Western-style HMBs. Approximately half of the mothers (42.4%) indicated that they were against the establishment of any kind of HMBs in Turkey. Only 9.2% of the mothers in this study stated that they would volunteer to donate their breast milk to the Western-style HMBs, and only 6.9% of the mothers approved obtaining milk from this type of HMB. Finally, 44.2% of the mothers stated that they would donate their breast milk to the alternative HMBs, and 31.9% of the mothers approved obtaining milk from this type of HMB. CONCLUSION This is the first study conducted among mothers in a Muslim community about issues such as infant feeding, breast milk, wet-nursing, milk kinship and HMBs. The majority of the mothers in this study are against the establishment of Western-style HMBs, whereas they have a more positive response to an alternative HMB when their religious concerns are relieved.

An Unexpected Cause of Respiratory Distress and Cyanosis: Cardiac Inflammatory Myofibroblastic Tumor

Inflammatory myofibroblastic tumor is an uncommon spindle cell tumor, occurring mainly in children and young adults. It is an extremely rare cardiac tumor especially patients under 1 year. Although it is benign, the tumor may be very aggressive locally. The diagnosis of this unusual pediatric cardiac tumor without pathologic specimens is difficult. We report a rare case of inflammatory myofibroblastic tumors of the right ventricle in a 7-month-old girl presenting with respiratory distress and cyanosis.

Aplasia cutis congenita and epidemolysis bullosa: Bart syndrome

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Malignant Infantile Osteopetrosis: A Rare Cause of Neonatal Hypocalcemia

Malignant infantile osteopetrosis is a rare autosomal recessive disorder characterized by presentation in the first few months of life with manifestations relating to an underlying defect in osteoclastic bone resorption. This report describes a 10 day-old boy in whom neonatal hypocalcemia was present and whose brother had died with the diagnosis of osteopetrosis.

Report of seven children with hepatopulmonary syndrome

Hepatopulmonary syndrome is an important pulmonary vascular complication of liver disease. Its diagnosis is based on the presence of hypoxaemia and the demonstration of intrapulmonary shunting by contrast-enhanced echocardiography or perfusion lung scanning. Awareness of this condition is critical to improve the outcomes of patients with chronic liver disease and/or portal hypertension because hepatopulmonary syndrome receives additional priority on the waiting list for transplantation. A non-invasive measurement of the blood oxygen saturation with pulse oximetry is recommended as a screening tool for this syndrome. The aim of this report was to present clinical and laboratory findings and follow-up of seven paediatric patients who were diagnosed with HPS at our centre.

Primary idiopathic chylopericardium presenting with cardiac tamponade

Primary idiopathic chylopericardium is an extremely rare condition especially in children and young adults. Although the exact pathophysiology of primary chylopericardium has not been established, the reflux of chylous fluid into the pericardial space was suggested as the etiology. Damage to the thoracic duct valves and the communication of the thoracic duct to the pericardial lymphatics or abnormally elevated pressure in the thoracic duct could cause chylous fluid reflux. In this report, we described the case of a 4-year-old boy with primary idiopathic chylopericardium presenting as cardiac tamponade who was treated with video-assisted thoracoscopic window and then surgical duct ligation.ZusammenfassungEin primäres idiopathisches Chyloperikard ist eine äußerst seltene Erkrankung, insbesondere bei Kindern und jungen Erwachsenen. Obwohl die genaue Pathophysiologie des primären Chyloperikards bisher nicht bekannt ist, soll der Reflux chylöser Flüssigkeit in den perikardialen Raum ätiologisch relevant sein. Eine Schädigung der Klappen des Ductus thoracicus und eine Verbindung des Ductus thoracicus mit den perikardialen Lymphwegen oder abnorm erhöhter Druck im Ductus thoracicus könnten einen Reflux chylöser Flüssigkeit verursachen. Im vorliegenden Artikel wird der Fall eines 4-jährigen Jungen beschrieben, bei dem ein primäres idiopathisches Chyloperikard, das sich als Herzbeuteltamponade manifestierte, vorlag und die Behandlung über eine videoassistierte thorakoskopische Fensterung mit anschließender chirurgischer Duktusligatur erfolgte.

Prenatal Diagnosis of a Patient With Tetralogy of Fallot and an Absent Pulmonary Valve

A 34-week-gestation fetus of a gravid 3 mother 29 years of age was referred to our hospital due to an abnormal vascular image on obstetric ultrasonographic examination. The family history of congenital heart disease was negative. The mother had been using valproate due to epilepsy. Fetal echocardiography showed aneurysm of the pulmonary artery and rudimentary pulmonary valve and pulmonary regurgitation (Figs. 1, 2, movie 1). Tetralogy of Fallot and an absent pulmonary valve was diagnosed (Figs. 3, 4, 5). At birth, the patient was symptomatic with severe respiratory failure. Postnatal echocardiography confirmed the diagnosis of dextroversion due to right lung atelectasia in addition to tetralogy of Fallot and an absent pulmonary valve. The aneurysm of the pulmonary artery was measured as 3.5 cm. Clinical examination showed no extra cardiac malformations or dysmorphic findings. Genetic testing for 22q11.2 deletion was not possible. The chest tomography showed a right lung compression due to an aneurysmatically dilated pulmonary artery. The patient’s condition deteriorated while on the ventilator due to bilateral pneumothorax. He died on the day 6 after the delivery due to severe respiratory distress while awaiting cardiac surgery. Tetralogy of Fallot and an absent pulmonary valve are a rare congenital malformation characterized by an absent or rudimentary valve, typically both stenotic and regurgitant,