Rusen Dundaroz

Cardiac Autonomic Functions in Obese Children

Objective: The autonomic nervous system is assumed to have a role in the pathophysiology of obesity. In this study, we evaluated the autonomic system by measuring heart rate variability (HRV) in obese children. Methods: Thirty-two obese and 30 healthy children (mean ages: 11.6±2.0 years and 11.0±2.9 years, respectively) were enrolled in the study. Obesity was defined as a body mass index higher than 97th percentile for age- and gender-specific reference values. All participants were free of any disease and none of them was receiving any medication. Twenty-four-hour ambulatory electrocardiographic recordings were obtained and the time-domain and frequency-domain indices of HRV were analyzed. The study group was evaluated with respect to insulin resistance by HOMA-IR values. Results: A significant decrease in calculated HRV variables was observed in obese children as compared to controls. The HRV alteration was found in both time-domain and frequency-domain parameters. The subgroup analysis of the study group revealed a significant decrease in all investigated HRV parameters in the insulin-resistant obese children compared to the non-insulin-resistant obese ones. Conclusions: Our results indicate that HRV is decreased in obese children, which implies parasympathetic withdrawal and sympathetic predominance. A marked decrease in HRV was observed in insulin-resistant obese children compared to their non-insulin-resistant counterparts. We propose that autonomic imbalance pertaining especially to insulin resistance may be involved in the pathogenesis of obesity in pediatric patients Conflict of interest:None declared.

A Nonsurgical Approach to the Treatment of Phimosis: Local Nonsteroidal Anti-Inflammatory Ointment Application

PURPOSEnWe evaluated the effectiveness of topical application of nonsteroidal anti-inflammatory ointment for phimosis.nnnMATERIALS AND METHODSnA total of 52 children with phimosis was included in this study. Phimosis was graded according to severity. Of the patients 32 were given locally a nonsteroidal anti-inflammatory ointment prepared in ophthalmic usage form from sterile diclofenac sodium ampules (not commercially available). The control group comprised 20 patients given sterile petrolatum ointment. Patients were seen before and after treatment, and graded according to retractibility and appearance of the foreskin. Treatment continued for 4 weeks with 3 applications daily.nnnRESULTSnOf the 32 patients 24 responded to therapy and 8 remained unchanged or had insufficient improvement. Three controls responded to therapy and 17 did not. There were no side effects.nnnCONCLUSIONSnNonsteroidal anti-inflammatory ointment application for phimosis may be an alternative to surgery and steroid application.

Reverse iontophoresis: a non-invasive technique for measuring blood urea level

Monitoring of the urea level of patients with insufficient kidney function requires repetitive blood sampling. The potentially painful nature of blood sampling and the difficulty of venous access, particularly in premature neonates, as well as possible complications of needle injuries, create many disadvantages. A non-invasive technique needs to be developed for monitoring the urea level for these patients. Reverse iontophoresis has recently gained importance and the possibility of extracting some compounds from body fluids using reverse iontophoresis has been reported in the literature. Moreover, a small, watch-type device has been developed for the determination of blood glucose levels using a similar approach. The aim of the current study was to investigate the possibility of extracting urea from blood through skin using reverse iontophoresis to monitor blood urea levels without taking a blood sample. In vitro iontophoresis studies have indicated that urea may be successfully transferred through the full thickness of human skin. The reverse iontophoresis technique was applied to 17 patients with kidney insufficiency and urea was successfully extracted through their skin into the collection solution. A high correlation (r2=0.878) between urea concentrations in collection solutions and urea levels in the blood was observed. These results suggest that it is possible to make a watch-type device for monitoring blood urea levels.

Reversible nephrotoxicity after overdose of colloidal bismuth subcitrate.

Abstractu2002Although toxicity due to acute and chronic use of bismuth salts is well known, nephrotoxicity after ingestion of colloidal bismuth has been reported in few cases so far. Here we report the first case of acute renal failure (ARF) due to colloidal bismuth subcitrate overdosage in childhood. A 2-year-old boy was admitted to the hospital 6 h after ingestion of 28 De-Nol tablets (colloidal bismuth subcitrate 8.4 g). On admission, physical examination was unremarkable and he showed no signs of encephalopathy. Initially gastric lavage was performed then appropriate fluid therapy was started. ARF associated with uremia and oliguria developed on day 2 and peritoneal dialysis therapy was prescribed on day 4 for 10 days. Blood and urine bismuth levels were 739 µg/l and 693 µg/l, respectively, 10 days after the pills had been taken. His urine volume gradually increased and plasma BUN and creatinine levels decreased during peritoneal dialysis. On day 20 post-admission, plasma BUN and creatinine were 14 mg/dl and 0.7 mg/dl, respectively. Blood bismuth levels were 96 µg/l on day 60 and 12 µg/l on day 105. Now the patient is well and has no problem. This case suggests that ARF may develop in children following colloidal bismuth subcitrate overdosage; the prognosis is good, and peritoneal dialysis may be useful in these cases.

Endothelin levels in Henoch-Schonlein purpura

Abstract. Henoch-Schonlein purpura (HSP) is one of the most common types of vasculitis disorders seen in childhood and is characterized by a rash, arthritis, abdominal pain, and renal involvement. Although HSP is an immunoglobulin A (IgA) related immune complex disease, the pathogenesis has not been fully elucidated. Cytokines have been implicated in the pathogenesis, but endothelins (ET) – vasoconstrictor hormones produced by endothelial cells – have not been studied in patients with HSP. In a controlled study, we measured ET-1 levels in children with HSP during the acute and remission phases. ET-1 levels were significantly higher in the HSP patients during the acute phase compared with the control group and the HSP patients in the remission phase. There was no correlation between ET-1 levels and disease severity, acute phase reactant response, or morbidity. The role of endothelins and other cytokines in the pathogenesis of HSP needs to be further explored.

P300 auditory event‐related potentials in children with obesity: is childhood obesity related to impairment in cognitive functions?

Tascilar ME, Turkkahraman D, Oz O, Yucel M, Taskesen M, Eker I, Abaci A, Dundaroz R, Ulas UH. P300 auditory event‐related potentials in children with obesity: is childhood obesity related to impairment in cognitive functions?

Heart Rate Variability in Patients with Allergic Rhinitis

Considering the role of autonomic imbalance in the pathogenesis of hypersensitivity reactions, we evaluated the autonomic system through time-domain analysis of heart rate variability (HRV) in patients with allergic rhinitis. Twenty-four patients with allergic rhinitis and 22 healthy subjects (mean age, 41 +/- 8 years and 37 +/- 9 years, respectively) were enrolled in the study. The diagnosis of allergic rhinitis was based on the history, symptoms, and skin prick tests results. Twenty-four-hour ambulatory electrocardiographic recordings were obtained, and the time-domain indices were analyzed. Analysis of HRV revealed that the SD of normal RR intervals, SD of successive differences in normal cycles, and HRV triangular index were not significantly different between the groups, but the root mean square successive difference, number of RR intervals exceeding 50 milliseconds, and percentage difference between adjacent normal RR intervals exceeding >50 milliseconds were significantly greater in the study group, compared with the control group. Our findings showed that HRV indices, which predict parasympathetic predominance, were increased in patients with allergic rhinitis. This finding shows that vagal activation is present not only in the nose but also in other systems, including the cardiovascular system.

Importance of Plasma N-Terminal Pro B-Type Natriuretic Peptide, Epicardial Adipose Tissue, and Carotid Intima-Media Thicknesses in Asymptomatic Obese Children

This study aimed to analyze the variations of N-terminal pro B-type natriuretic peptide, epicardial adipose tissue thickness, and carotid intima-media thickness in childhood obesity. The study participants consisted of 50 obese children in the study group and 20 nonobese children referred for evaluation of murmurs who proved to have an innocent murmur and were used as control subjects. All the subjects underwent transthoracic echocardiographic examination for determination of left ventricular systolic function and mass index, myocardial tissue rates, and myocardial performance index. Epicardial adipose tissue thickness and carotid intima-media thickness also were measured during echocardiography. Serum N-terminal pro B-type natriuretic peptide levels were measured at the time of evaluation. The left ventricle mass index was 40.21xa0±xa010.42xa0g/m2 in the obese group and 34.44xa0±xa04.51xa0g/m2 in the control group (pxa0>xa00.05). The serum N-terminal pro B-type natriuretic peptide level was 109.25xa0±xa048.53xa0pg/ml in the study group and 51.96xa0±xa022.36 pg/ml and in the control group (pxa0=xa00.001). The epicardial adipose tissue thickness was 5.57xa0±xa01.45 mm in the study group and 2.98xa0±xa00.41 mm in the control group (pxa0=xa00.001), and the respective carotid intima-media thicknesses were 0.079xa0±xa00.019 cm and 0.049xa0±xa00.012 cm (pxa0=xa00.001). The left ventricular systolic and diastolic functions showed no statistically significant correlations with N-terminal pro B-type natriuretic peptide levels, carotid intima-media thickness, or epicardial adipose tissue thickness values. The results show that measurement of serum N-terminal pro B-type natriuretic peptide level, carotid intima-media thickness, and epicardial adipose tissue thickness in asymptomatic obese children is not needed.

Investigation of DNA damage in lymphocytes exposed to benzathine penicillin G

Abstract Background :u2002Benzathine penicillin G (BPG) is a widely used antibiotic for treatment or prophylaxis of certain infectious diseases. Previous in vivo studies using sister chromatid exchange (SCE) frequency and comet assay, had showed that long‐term administration of benzathine penicillin G may cause some degree of DNA damage in children with rheumatic fever.

The use of the corpus cavernosum for the administration of phenobarbital: an experimental study in dogs

Status epilepticus (SE) is classically defined as a generalized tonic-clonic seizure lasting longer than 30 min. Prolonged seizure activity can be resulted in irreversible cerebral injury. In addition, the existence evidence suggests that the longer the duration of the seizure activity is less likely to be controlled. The intravenous (IV) access is frequently difficult during SE, especially in infants and neonates. On the other hand, it has been demonstrated that high volumes of fluid can be injected into the corpora cavernosa. In this study, phenobarbital (PB) was administered to dogs using both IV and intracavernous (IC) routes with a dose of 20 mg/kg. The time period required to establish the IC route was less than 5 s. The levels of PB in the blood were measured and all results were compared. There was no statistically significant difference between the IV and IC administration with regard of the blood PB levels. Within 48 h of the experiment, none of animals demonstrated any evidence of infection or disability. Our findings suggest that the IC route may be an alternative route for the administration of PB when venous access is not immediately available or if it is not possible to achieve.