Yasar Sen

Presence of obestatin in breast milk : Relationship among obestatin, ghrelin, and leptin in lactating women

OBJECTIVE The peptide hormones ghrelin and leptin have been found in blood and breast milk. This study was undertaken to investigate whether breast milk also contains obestatin, which is derived from the same gene as ghrelin but has opposite actions, and to characterize the relations among serum and milk ghrelin, obestatin, and leptin levels in lactating mothers. METHODS Venous blood, colostrum, and mature milk were obtained from healthy lactating women (n = 31) just before suckling. The ghrelin and obestatin concentrations were determined by radioimmunoassay. Leptin levels were measured by enzyme-amplified sensitivity immunoassay. RESULTS Obestatin levels in colostrum (538.9 pg/mL) and mature milk (528.5 pg/mL) were more than twice the corresponding blood levels (270.3 and 289.4 pg/mL, respectively). In contrast, leptin levels in colostrum (2.01 ng/mL) and mature milk (2.04 ng/mL) were more than five-fold lower than the corresponding blood levels (11.54 ng/mL). There was no correlation between breast milk ghrelin levels and leptin (r = -0.18, P > 0.05). However, there was a positive correlation between leptin levels in breast milk and blood (r = 0.369, P < 0.05). CONCLUSION The origin of milk obestatin is not currently known, but it comes from the blood or breast and may drain through the mammary glands into the milk. Ghrelin, obestatin, and leptin in the milk may directly affect appetite and their levels may be related to the regulation of energy balance and the pathogenesis of obesity.

The Levels of Ghrelin, TNF-α, and IL-6 in Children with Cyanotic and Acyanotic Congenital Heart Disease

Background/Aim. Ghrelin has effects on nutrient intake and growth. The cause of growth retardation in congenital heart disease is multifactorial. The aim of the present study is to investigate the ghrelin in congenital heart disease and the association of ghrelin with TNF-α and IL-6. Materials and methods. We measured serum ghrelin, TNF-α, and IL-6 levels using spesific immunoassay in 68 patients (47 acyanotic, 21 cyanotic with congenital heart disease) and in 25 control subjects. Results. In comparison to controls, serum ghrelin, TNF-α levels were significantly higher in acyanotic patients and cyanotic patients with congenital heart disease (P<.0001). In acyanotic and cyanotic patients with congenital heart disease, there was a positive correlation between ghrelin and TNF-α (r=.485, P<.05 and r=.573, P<.01, resp.). Conclusion. Serum ghrelin levels is elevated in acyanotic and cyanotic patients with congenital heart disease. Increased ghrelin levels represents malnutrition and growth retardation in these patients. The relation of ghrelin with cytokines may be explained by the possible effect of chronic congestive heart failure and chronic shunt hypoxemia.

Plasma ghrelin levels in various stages of development of iron deficiency anemia.

Objectives Ghrelin stimulates food intake and induces metabolic changes leading to an increase in body weight and body fat mass. Iron-deficiency anemia (IDA) is the most frequently seen cause of nutritional anemia, that is a type of starvation. There is no available study related to levels of ghrelin in IDA. The aim of this study is to show an association with ghrelin levels and iron deficiency and to demonstrate whether changes seen in iron deficiency (ID) are explained by ghrelin, as opposed to whether ghrelin levels correlate with ID. Materials and Methods The study group was consisted of children who were admitted in the outpatient clinic of pediatrics. Control group (C) was defined as cases with normal hemoglobin (Hb), serum iron (SI), transferrin saturation (TS), and ferritin (F) (>12 ng/mL) values; group hypoferritinemia (IDec) Hb: N, SI: N, TS: N, F<12 ng/mL; group iron deficiency (IDef), Hb: N, SI: decreased, TS ≤16%, F<12 ng/mL, and group IDA, Hb and SI decreased, TS ≤16%, F<12 ng/mL. The patients were categorized into 4 groups [group 1 (C), n=25, age=82.4±16.56 mo, F=40.87±6.17 ng/mL; group 2 (IDec), n=30, age=57.5±20.71 mo, F=29.95±3.77 ng/mL; group 3 (IDef), n=28, age=50.21±19.87 mo, F=14.82±3.41 ng/mL; group 4 (IDA), n=25, age=31.55±13.21 mo, F=11.75±4.01 ng/mL]. Results Mean value of ghrelin was detected to be 396.53±85.56 pg/mL, 332.26±74.35 pg/mL, 309.66±68.62 pg/mL, and 177.66±27.81 pg/mL in control, groups IDec, IDef, and IDA, respectively. A statistically significant difference was detected between groups control and IDef (P<0.01), control and IDA, IDec and IDA, IDef and IDA (P<0.001). Conclusions A significant positive correlation was demonstrated between iron status of the body and levels of ghrelin. Decrease in ghrelin levels in IDA can lead to loss of appetite, desire to eat diverse foods with resultant delay in growth and development.

Sturge-Weber syndrome in a 14-year-old girl without facial naevus

Sturge-Weber syndrome (SWS) is a neuroectodermal disease characterised by facial port-wine naevus, unilateral seizures (usually controlateral to the side of the facial naevus), and mental retardation with accompanying ocular, skeletal or cutaneous abnormalities [6]. A 14-year-old girl was admitted to hospital with partial seizure, secondarily generalised. Her first generalised tonic-clonic seizure had apparently occurred at the age of 1 year. Soon thereafter, she had suffered a febrile, secondary generalised tonic-clonic seizure several times and subsequently, a right hemiparesis had developed. She had been treated with several anti-epileptic drugs. On neurological examination, a right-sided central facial paralysis and right hemiparesis grade 4/5 were noted. No facial naevus was seen. Her ocular examination was normal. Intellectual impairment was apparent (IQ score was 69 according to Stanford Binet). An X-ray film of the skull showed ‘‘railroad calcification in the parieto-occipital region’’. An EEG revealed spike-wave activities over the left parieto-occipital area. A cranial CT scan showed cortical atrophy and gyriform calcification in the left parieto-occipital region (Fig. 1). A T2-weighted axial MRI scan demonstrated left parietooccipital atrophy and a contrast-enhanced scan revealed gyral contrast accumulation in the left parieto-occipital region. She still receives valproate (20 mg/kg per day) and phenytoin (7 mg/kg per day) orally and has been free of seizures for 2 months. SWS is the fourth most frequent neuroectodermal disorder [4]. It is characterised by a facial port-wine naevus and ipsilateral leptomeningeal haemangiomatosis. Encephalofacial angiomatosis has been sub classified into three groups: type I (both facial and leptomeningeal angiomas, glaucoma possible), type II (facial angioma without evidence of intracranial disease) and type III (isolated leptomeningeal angioma) [6]. In our case, facial angioma and glaucoma were not present and, according to this classification, she was considered as having type III. Epileptic seizures and intellectual impairment and glaucoma are common, whereas hemiparesis, hemiatrophy and visual field defects occur less often [4]. Most patients with SWS have normal neurological function for several months or even years after birth. Epileptic seizures and hemiparesis are often noted in conjunction with a febrile illness during the first 2 to 3 years, as in this case. Focal motor seizures or generalised tonicclonic seizures predominate initially; older children develop complex partial seizures [4,6]. In this case, initially generalised tonic-clonic seizures began at 1 year of age with febrile illness and thereafter, febrile seizures and hemiparesis developed. The presence of facial angioma in an epileptic patient usually gives a diagnostic clue to SWS. Only about 10% of patients with facial angioma have an intracranial lesion and the diagnosis of SWS should be reserved for these children [3,6]. Patients who have typical clinical and radiological findings of SWS but no facial angioma have previously been reported [1, 2, 3,5]. In the absence of facial angioma, diagnosis is based on the radiological confirmation of the leptomeningeal angiomatosis and demonstration of the intracranial calcification on the CT scan [3]. Enlargement and/or calcification of the choroid plexus, thickening of the calvarium, and focal brain atrophy can also be observed [3]. Gyriform calcification Eur J Pediatr (2002) 161: 505–506 DOI 10.1007/s00431-002-1033-6

Serum thyroid hormones levels are significantly decreased in septic neonates with poor outcome

The aim of this prospective study was to investigate the effects of thyroid hormone levels on the sepsis criteria and mortality in septic newborns. This study was performed at the Firat University Hospital Neonatal Intensive Care Unit. A group of septic newborns and a control group of healthy non-infected newborns were evaluated. Blood samples were obtained at onset from septic and healthy newborns and at 10th day of the antibiotic therapy from only septic newborns, and thereafter serum total T3 (TT3), total T4 (TT4), and TSH levels were determined. A total of 292 newborns were included in the study. Serum TT3 levels at onset and at 10th day of the antibiotic therapy were 163.8±63.4 and 178.3±33.1 ng/dl, TT4levels were 6.9±2.2 and 11.0±2.6 mg/ml, and TSH levels were 3.8±2.1 and 4.0±2.5 μU/ml, respectively in septic newborns. Serum TT3 levels were 180.3±47.6 ng/dl, TT4 levels were 10.9±2.3 mg/ml, and TSH levels were 4.1 ±2.2 μU/ml in healthy newborns. Serum TT3, TT4 levels of septic newborns were significantly decreased with respect to those of healthy newborns at onset and serum TT4 levels was increased significantly after antibiotic therapy. To the best of our knowledge, this report is the first study to compare thyroid hormone levels in a large number of septic newborns and a healthy group. Our findings suggest that before and after treatment of neonatal sepsis a significant change is realized in thyroid hormone levels.

Pediatric Idiopathic Pulmonary Hemosiderosis Diagnosed by Sputum Analysis: Plain Radiography and Computed Tomography Findings

Objective: Idiopathic pulmonary hemosiderosis (IPH) is an uncommon disorder, which is characterized by recurrent hemoptysis, iron deficiency anemia and diffuse parenchymal infiltration on chest radiographs in pediatric patients. We wish to present clinical and radiological (plain radiography and CT) findings of this rare pathology. Clinical Presentation and Intervention: A 14-year-old girl was admitted to the pediatric emergency department with complaints of cough, dyspnea, fatigue and bloody sputum for 6 months. She had been hospitalized 3 times during this period and received antibiotics and blood transfusion. Chest X-rays revealed prominent perihilar and bibasilar consolidation. CT showed a ground glass pattern and consolidated areas with increased density. Sputum analysis yielded hemosiderin-laden macrophages. With presumptive diagnosis of IPH, prednisolone was administered. Her symptoms improved on the 5th day of treatment and 1 month later, plain chest radiography demonstrated marked improvement. Conclusion: Although IPH is a rare condition, the diagnosis of IPH should be considered, among others, in a patient with hemoptysis and bilateral infiltration in the chest X-ray. This may prevent antibiotic misuse and risk of death due to severe hemorrhage.

Multiseptate gallbladder in a child with chronic abdominal pain: ultrasonography, magnetic resonance imaging and magnetic resonance cholangiography findings

Abstract Multiseptate gallbladder is a very rare congenital malformation of the gallbladder. We present the magnetic resonance imaging, ultrasonography and magnetic resonance cholangiography appearance of a multiseptate gallbladder in a 9-year-old boy. To our knowledge, this is the first description of the magnetic resonance imaging and magnetic resonance cholangiography appearance of a multiseptate gallbladder.

Calcaneal Apophysitis due to Brucellosis

Brucellosis is still a major health problem in many geographical areas. Osteoarticular complications are important owing to their high prevalence. We report an unusual case of childhood brucellosis presenting with septic apophysitis of the calcaneus and abscess formation in a 12-year-old boy. The patient was successfully treated with a combination of antibiotics. The importance of early recognition of the disease and differential diagnosis is emphasized. Early recognition of infection, prolonged treatment, and long-term follow-up may improve the outcome.

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.

Deep vein thrombosis associated with protein C and protein S deficiency: an unusual cause of acute abdomen.

Deep venous thrombosis is an extremely rare cause of acute abdomen and is often difficult to diagnose. Protein C and protein S deficiencies are rare genetic abnormalities that predispose the patient to thrombophilia and lead to thrombosis. We report the case of a previously healthy 7‐year‐old boy with iliofemoral thrombosis due to protein C and protein S deficiencies mimicking acute abdomen.