Tuba Kasap

Association between vitamin D levels and cardiovascular risk factors in obese children and adolescents

BACKGROUND AND AIM Childhood obesity is associated with an increased risk of chronic disease. We aimed to determine the association between vitamin D deficiency and cardiovascular risks in obese children. METHOD The studied children were selected from obese children who were followed up at obesity clinic, aged 6-17 years. Basic demographic information and laboratory data were collected retrospectively from hospital records. RESULTS A total of 310 students (178 [57.4%] girls) were evaluated for 25-hydroxyvitamin D (25[OH] D) levels in late winter/spring. The prevalence rates of vitamin D deficiency, insufficiency, and sufficiency were 62.3%, 34.5%, and 3.2%, respectively. Insulin resistance was observed in 146 (47.1%) children; the frequencies of dyslipidemia and hypertension were 31% and 19.4%, respectively. The mean atherogenic dyslipidemia ratio was higher in the deficient group (p = 0.049). Inverse correlations of 25(OH) D levels were observed with homeostasis model assessment of insulin resistance values (r = -0.146, p = 0.010). The mean values of 25(OH) D (ng/mL) were lower in girls (12.15 ± 6.60) than in boys (16.48 ± 8.69) (p < 0.05) and in children with hypertension (11.92 ± 5.48) than in those without (14.50 ± 8.24) (p < 0.05). CONCLUSIONS Vitamin D deficiency is observed more frequently than expected in obese children and adolescents. Our findings indicate that low 25(OH) D levels are associated with insulin resistance. Vitamin D deficiency could contribute to the morbidities associated with childhood obesity, such as insulin resistance or diabetes mellitus, increased cardiovascular/cardiometabolic risks, atherogenic dyslipidemia, and hypertension.

Evaluation of Neonatal Brain Parenchyma Using 2-Dimensional Shear Wave Elastography

The aim of this study was to evaluate the stiffness of the neonatal brain using 2‐dimensional shear wave elastography in term and preterm neonates and to investigate possible stiffness differences between groups.

Clinical and Demographic Evaluation According to MEFV Genes in Patients with Familial Mediterranean Fever

The present study examined the relationship between clinical findings and mutation analyses in children with Familial Mediterranean Fever (FMF) in the inner Black Sea region of Turkey. This retrospective, cross-sectional study included patients with FMF who were evaluated between 2007 and 2015. FMF was diagnosed according to the Tel Hashomer criteria. FMF mutations were analyzed using a Real-time PCR System (Roche Diagnostics, Mannheim, Germany), and patients were classified into three groups according to allele status. The most common symptom was abdominal pain (99%, n = 197). The most frequent mutations were M694V and R202Q. Chest pain was reported more often in patients homozygous for M694V (61.4%). Although fever, abdominal pain, and arthritis were more commonly observed with the M694V mutation, chest pain was the most common symptom in R202Q carriers (n = 10, 32.3%). Proteinuria was observed in 42 (21.2%) patients, frequently accompanied by the M694V mutation (28.6%). The most common mutations in children with FMF in Turkey were M694V and R202Q. Recurrent abdominal pain and arthritis/arthralgia were commonly observed in patients with M694V and R202Q mutations. Moreover, chest pain was commonly seen with the R202Q mutation. Thus, R202Q might be a disease-causing mutation in FMF patients.

Prevalence of Proteinuria in School-Aged Turkish Children, and Its Association with Obesity and Hypertension

The Journal of Pediatric Research, published by Galenos Yayınevi. Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si Ali Gül MD, Gaziosmanpaşa University Faculty of Medicine, Department of Pediatrics, Tokat, Turkey Phone: +90 505 347 29 61 E-mail: draligul@yahoo.com ORCID ID: orcid.org/0000-0001-5350-2192 Re cei ved/Ge liş ta ri hi: 10.07.2017 Ac cep ted/Ka bul ta ri hi: 05.09.2017 Okul Çağı Türk Çocuklarında Proteinüri Sıklığı ve Obezite ve Hipertansiyonla İlişkisi

Spontaneous idiopathic bilateral adrenal hemorrhage in a pediatric patient

Adrenal kanama cogunlukla yenidogan doneminde gorulse de daha buyuk cocuklarda ve eriskinlerde de olabilmektedir. Etiyolojide bircok neden rol oynamakta ve klinik bulgu ve belirtiler cesitlilik gosterebilmektedir. Sunulan vakada masif adrenal kanamaya ragmen adrena yetersizlik gozlenmemis ve herhangi bir etiyolojik faktor bulunamamistir. Bilgilerimize gore literaturdeki cocukluk caginda spontan idyopatik bilateral masif adrenal kanamasi olan ancak adrenal yetersizlik gelismeyen ilk vaka olma ozelligini tasimaktadir.Öz Adrenal hemorrhage occurs most frequently in the newborn, but it has been also well documented in older children and adults. There are several reasons in etiology and clinical symptoms can vary widely depending on the residual adrenal function. In this case; despite bilateral massive adrenal hemorrhage, no etiologic factor had been found and adrenal insufficiency was not present. To our knowledge, our patient is a spontaneous idiopathic bilateral massive adrenal hemorrhage case without adrenal insufficiency which is the first one reported in a pediatric patient in literature. Adrenal kanama çoğunlukla yenidoğan döneminde görülse de daha büyük çocuklarda ve erişkinlerde de olabilmektedir. Etiyolojide birçok neden rol oynamakta ve klinik bulgu ve belirtiler çeşitlilik gösterebilmektedir. Sunulan vakada masif adrenal kanamaya rağmen adrena yetersizlik gözlenmemiş ve herhangi bir etiyolojik faktör bulunamamıştır. Bilgilerimize göre literatürdeki çocukluk çağında spontan idyopatik bilateral masif adrenal kanaması olan ancak adrenal yetersizlik gelişmeyen ilk vaka olma özelliğini taşımaktadır.

Prevalence of hypercalciuria and urinary calcium excretion in school-aged children in the province of Tokat

AIM Hypercalciuria is an important cause of urinary tract symptoms, and also frequently results in urolithiasis. Urinary calcium excretion varies for geographic areas. We aimed to assess percentiles of urinary calcium excretion and prevalence of hypercalciuria for school-aged children in Tokat (city located in inner northern region of Turkey). MATERIAL AND METHODS One thousand three hundred seventy-five children aged 6 to 18 years were enrolled in the study. Urine samples were obtained randomly. The childrens variables as sex, age, length, and weight were recorded. Urinary calcium and creatinine determined from the urine samples and urinary calcium/creatinine ratios (mg/mg) were calculated. Percentiles of urinary calcium/creatinine ratios were also assessed for each age of the children. RESULTS Six hundred eighty-three of the 1 375 children were girls and 692 were boys. The mean age of the children was 11.68±3.43 years. Some 23.9% of the children were living in rural regions and 76.1% were were living in urban regions. The mean urinary calcium/creatinine ratio was 0.080±0.24 and the 95th percentile value of the urinary calcium/creatinine ratio was 0.278. The hypercalciuria prevalence for school-aged children was 4.7% when the urinary calcium/creatinine ratio value for hypercalciuria was accepted as ≥0.21. The prevalence of hypercalciuria in rural and urban regions was 7.60% and 3.82%, respectively (p<0.05). Hypercalciuria was present in 7 of 141 patients who were obese (4.96%) and 58 of 1 234 patients who were not obese (4.70%) (p>0.05). CONCLUSION The prevalence of hypercalciuria and urinary calcium excretion vary for different geographic areas, not only for countries. The percentiles of urinary calcium excretion should be assesed for every geographic region and the prevalance of hypercalciuria should be determined with these values. There is controversy as to whether obesity is a risk factor for hypercalciuria.

Brucella abortus Causing Febrile Neutropenia Together with Epididymoorchitis.

To the Editor: Brucellosis, the commonest zoonotic infection worldwide, can affect individuals and immunocompromised patients in countries that are endemic for this infection [1]. In this report, we describe an unusual case of febrile neutropenia together with typhlitis and epididymoorchitis caused due to Brucella abortus. An 8-y-old boy, who had been treated for precursor B-cell lymphoma, presented 5 mo post-treatment completion with pain and purulent secretion from penis. He was diagnosed as relapse and local care for balanitis and chemotherapy protocol was initiated. On the fifth day of treatment, he developed neutropenic fever and meropenemwas started. On the third day of the treatment with meropenem, he had diarrhea, abdominal pain and distension in addition to scrotal pain and swelling (Fig. 1); a diagnosis of typhlitis and bilateral epididymoorchitis was considered. Vancomycin, amikacin, ornidazole and amphotericin-B were added. A few days later his blood culture was reported as Brucella abortus; doxycycline and rifampicin were initiated. Since he belonged to a rural region in the eastern part of Turkey where brucella infections are endemic, this result was meaningful. After 20 d of treatment with these two drugs, he almost completely recovered and was discharged with oral antibiotics for completing therapy to a total duration of 6 wk. Unfortunately, he died of progressive cancer. Brucellosis is characterized by the classic triad of fever, arthralgia/arthritis and hepatosplenomegaly; it is also known to cause anemia, thrombocytopenia, neutropenia or pancytopenia [2, 3]. However, febrile neutropenia caused by Brucella species is rare; Ozçay et al. [4] and Citak et al. [5] have reported febrile neutropenia caused by Brucella melitensis in children. To our knowledge, this is a unique case of neutropenic fever due to Brucella abortus. Since true antimicrobial agent and the time are very important in managing febrile neutropenia and Brucella species grow very slowly in blood cultures, brucellosis should be considered as a possible cause of febrile neutropenia and pancytopenia in immunocompromised hosts in endemic areas to prevent diagnostic delay, mortality and morbidity. Brucella is a rare causative agent of epididymoorchitis; it is more rarely seen in pediatric ages and is mostly unilateral [2] unlike our patient who had bilateral epididymoorchitis. In conclusion, in countries endemic for brucellosis, B. abortus must be kept in mind as an etiological agent for febrile neutropenia and epididymoorchitis. If there is a strong suspicion, Brucella agar or * Tuba Kasap tubaserdar06@hotmail.com