Şamil Hızlı

Sensorineural hearing loss in pediatric celiac patients

OBJECTIVE Celiac 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. METHODS A 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). RESULTS In 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). CONCLUSION The 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

BACKGROUND Cadmium (Cd) is a toxic heavy metal and the components of tobacco and scalp hair effectively reflect a long-term environmental exposure. OBJECTIVE The 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. METHODS In 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. RESULTS Median (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). CONCLUSION We 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.

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.

Frequency of coeliac disease in children with breath-holding spells

Iron deficiency anaemia (IDA), which is reported very commonly among patients with breath holding spells (BHS), is the most common presentation of coeliac disease (CD). In that aspect, IDA may be a common pathway linking these two diseases. The aim of this study was to evaluate the frequency of CD in patients with BHS.

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

OBJECTIVE Left 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. METHODS The 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. RESULTS The 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. CONCLUSION We 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.

Relation of fetuin A levels with cardiac, subcutaneous lipid accumulation and insulin resistance parameters in Turkish obese children.

Abstract Background: Fetuin A is an inhibitor of insulin action and have been found to be related with subcutaneous lipid accumulation and insulin resistance. The relation of cardiac lipid accumulation, fetuin A and insulin resistance parameters in obese children is not well-known. The aim of the study was to evaluate the relation of serum fetuin A levels with subcutaneous and cardiac lipid accumulation, and insulin resistance parameters in Turkish obese children. Methods: Serum fetuin A levels, cardiac and subcutaneous lipid accumulation parameters of 42 obese (10.9±2.3 years, 19 female) and 40 control group subjects (11.2±2.7) were compared. Cardiac lipid accumulation measured by subepicardial adipose tissue thickness. Insulin resistance was assessed using homeostasis model assessment (HOMA-IR) index. Results: There were significant correlations serum fetuin A levels with BMI-SDS, circumferences of waist, hip and midarm, SATT and HOMA-IR (r=0.362, p=0.018, r=0.728, p=0.001, r=0.662, p=0.0001, r=0.713, p=0.0001, r=0.477, p=0.001, and r=0.330, p=0.038 as, respectively). Conclusions: Fetuin A was correlated well with cardiac and subcutaneous lipid accumulation, insulin resistance parameters, which may be related with early pathogenetic mechanisms of metabolic obesity complications in children.

Çocuk Hastada Rüptüre Pulmoner Kist Hidatik

Yogun oksuruk ve balgam ile basvuran hastalarda ozellikle bulgularinin uygun ilaclarla duzelmeme durumunda rupture kist hidatigin akilda tutulmasi hayati onem tasimaktadir.

Follow-up of patients with tick bite in terms of Crimean Congo hemorrhagic fever: Is tick bite enough for diagnosis? -

Crimean-Congo hemorrhagic fever (CCHF) is a multi-systemic tick born viral disease caused by a Nairovirus of the Family Bunyaviridae. Findings of disease are with fever, myalgia, chills, headache, vomiting and hemorrhagic manifestations. Infection is transmitted to humans by tick bite or by close contact with freshly slaughtered meat or blood from viremic animals. Since the tests of virus load consume much time, we preferred to study whether the findings obtained from anamnesis and physical exams of patients would be beneficial in predicting the clinical courses of patients. Files of 13 cases, who admitted to our clinic in the years 2006-2007 with the complaint of tick bite, were examined in this study. Anamnesis, physical and laboratory findings were recorded. Eleven of the cases were male. The age average was found to be 8.4 years (3-15). The period of first reference to our clinic was 3.4 days (1-8) on average. Bite size were 0.7 mm (0.4-1.4). The biggest bite was related to an adult tick. While serologic tests from the cases were found to be negative in twelve cases (92.3%), CCHF Immunoglobulin M taken on the third day was positive in one case (7.7%).This case was the one with biggest bite. In conclusion, the severity of the findings of CCHF is in correspondence with the size of virus load transferred. According to this study findings, size of tick and tick bite may be informative about the virus load and indirectly about the clinical outcome. Recording these findings for the future cases would be advised.