[Show abstract][Hide abstract] ABSTRACT: The study aimed to evaluate the pre-treatment and post-treatment oxidant capacity, antioxidant capacity and S100B protein levels in cases of diabetic ketoacidosis (DKA).
The study included 49 pediatric patients diagnosed with DKA and a control group comprising 49 healthy children. Blood samples were obtained after confirmation of the DKA diagnosis and also after treatment. S100B, total oxidant (TOL) and total antioxidant levels (TAL) were measured and the oxidative stress index (OSI) was calculated.
When the pre-treatment and post-treatment values of patients with DKA were compared with those of the healthy control group, the S100B level, TOL, TAL and OSI were found to be significantly higher in the diabetes group (p<0.001). Pre-treatment TOL and TAL were also significantly higher than post-treatment levels (p<0.001), while no statistically significant difference was found in the S100B levels or the OSI (p>0.05).
We believe that long-term exposure to high blood glucose concentrations leads to an increase in TOL in patients with DKA and that the neurotransmitter changes that develop in response to this exposure lead to an increase in S100B levels, which is an indicator of neuronal damage.
No preview · Article · Jun 2015 · Journal of Clinical Research in Pediatric Endocrinology
[Show abstract][Hide abstract] ABSTRACT: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population.
Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014.
The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%.
This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan.
Full-text · Article · Mar 2015 · Journal of Clinical Research in Pediatric Endocrinology
[Show abstract][Hide abstract] ABSTRACT: In this study, the etiological factors, diagnostic approaches, dose, and duration of treatment were compared between cases with transient and permanent congenital hypothyroidism (CH) with respect to prognosis. One hundred and twenty-two patients who received treatments with the diagnosis of CH in the last 10 years were included in the study. The records of the patients were reviewed retrospectively. Serum thyroid- stimulating hormone (TSH) levels at the time of diagnosis were found to be significantly higher, and total thyroxine (TT4) levels were found to be significantly lower in the permanent CH group in comparison to the transient CH group. A statistically significant difference was present between the groups regarding treatment doses, the time needed for TSH decrease to <5 mIU/ml and the TSH and free thyroxine (FT4) levels obtained one month after discontinuation of the treatment. The association between age at the time of initiation of treatment and results of Denver Developmental Test was noted to be statistically significant. The high frequency of transient CH in our region leads to the result that some of the patients had to be unnecessarily treated with L-thyroxine for a long time.
No preview · Article · Dec 2013 · The Turkish journal of pediatrics
[Show abstract][Hide abstract] ABSTRACT: Objective: To examine the findings of magnetic resonance imaging (MRI) in newborns with indirect hyperbilirubinemia and disclose any relationship between high levels of bilirubin and increased in signal intensity on T1-weighted images. Material and Methods: The study included 35 newborns with indirect hyperbilirubinemia. Clinical findings, bilirubin levels and MRI images were evaluated. Results: Of the study population, 20 (57.1%) were females and 15 (42.9%) were males. According to the gestational age, 30 cases were defined as term and five as preterm. An abnormal and bilaterally symmetrical increase in signal intensity was observed in the globus pallidus of 26(74.3%) newborns on T1-weighted images. A statistically significant relation was determined between the peak value of bilirubin and increased signal intensity on the T1-weighted images (1) 0.004). Jaundice, lethargy, hypertonia, hypotonia and poor feeding were among the clinical findings. The mean serum bilurubin level was found as 38.6 +/- 8.9 mg/dl (Range between 25 to 58 mg/dl). Major group incompatibility was detected in seven (20%) and Rh subgroup incompatibility in four (11.4%) of the cases. Glucose 6 phosphate dehydrogenase enzyme activity was reduced in eight (22.8%) cases. The Mill studies were performed between the days 5 and 30, following parturition. Conclusion: There seem to be a relationship between the peak levels of indirect bilirubin and higher T1-weighted signal intensity on MM of the central nervous system. No relationship was determined between the levels of indirect bilirubin and the area of the central nervous system with increased signal intensity.
No preview · Article · Oct 2010 · Turkiye Klinikleri Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to evaluate the effects of short-term exercise on total antioxidant status (TAS), lipid hydroperoxide (LOOHs), total oxidative status (TOS) and oxidative stress index (OSI) in adolescent athletes. A total of 62 adolescent participated in the study. Athletes were trained regularly 3 days a week for 2 hours. All subjects followed a circuit exercise program. Blood samples were collected just before and immediately after the exercise program. Antioxidant status was evaluated by measuring the TAS level in the plasma. Oxidative status was evaluated by measuring the total peroxide level. The percentage ratio of TAS to total peroxide level was accepted as the OSI. Plasma triglyceride, total cholesterol, LDL, HDL and VLDL were measured by automated chemical analyzer using commercially available kits.There was a significant increase in TOS (p<0.05) and OSI (p<0.01) levels and a significant decrease in TAS levels (p<0.01) compared to the resting state. There were no significant changes in LOOHs levels before and after the short-term exercise. After short-term exercise, the balance between oxidative stress and antioxidant status moves towards oxidative stress as a result of increasing oxidants and decreasing antioxidants.
[Show abstract][Hide abstract] ABSTRACT: Regular physical activity may play a protective role against cardiovascular disease in adults, and paraoxonase activity may serve to mediate this effect. This study compared paraoxonase activity and that of other antioxidative agents in adolescent athletes compared with inactive youth. Paraoxonase level was 177.32 +/- 100.10 (U/L) in children with regular physical activity and 98.11 +/- 40.92 (U/L) in the control group (P < 0.0001). The levels of total antioxidative capacity, total oxidative status, oxidative stress index, and lipid hydroperoxide were significantly higher in the athlete group compared with controls (P < 0.0001). Paraoxonase activity was found to be greater in adolescent athletes, suggesting that regular exercise might provide a cardio-protective effect by this means.
No preview · Article · Feb 2010 · Pediatric exercise science
[Show abstract][Hide abstract] ABSTRACT: Osteogenesis imperfecta, commonly known as "brittle bone disease", is a dominant autosomal disorder characterized by bone fragility and abnormalities of connective tissue. It is seen in 1 in 20,000 births. Osteogenesis imperfecta type II is a fatal hereditary skeletal dysplasia characterized by abnormal synthesis of collagen type I which develops due to the structural or defective synthesis of type I collagen and exhibits as widespread childhood osteoporosis with related brittle bones, frac tu res and de for mi ti es. It is se en in 1 in 60.000 births worl dwi de. The majority of cases are lost due to respiratory problems in the intrauterine or neonatal period. Excessive shortness of the long bones shown by ultrasonography, depression of the skull by ultrasound probe, a short or narrow thorax and various bone fractures can all be diagnosed in the intrauterine period. Since there is no specific therapy for osteogenesis imperfecta type II, the patients almost invariably die in the perinatal period. In this article, a case with osteogenesis imperfecta is presented due to its rare association with patent ductus arteriosus, bilateral choanal artresia, accessory spleen, and stony the gall bladder.
No preview · Article · Jan 2010 · Turkiye Klinikleri Pediatri
[Show abstract][Hide abstract] ABSTRACT: To compare paraoxonase activity and changes in oxidative status in asthmatic children and healthy children by determining serum paraoxonase activity and total oxidative status, total antioxidant capacity and lipid hydroperoxidation.
Forty two asthmatic children were compared with 32 healthy children of similar age and sex. To evaluate the paraoxonase and oxidative status, total antioxidant capacity and lipid hydroperoxidation were examined. Serum paraoxonase activity was evaluated by measuring the rate of paraoxon hydrolosis. Oxidative status was evaluated by the method developed by Erel. Lipid hydroperoxide was measured by an iodometric method.
In comparison with the healthy control group, the paraoxonase activity of the asthmatic children was found to be low (163.7 +/- 73.0 (U/L) and 349.2 +/- 153.9 (U/L), P = 0.002) and total oxidant status (9.0 +/- 3.5 micromol H2O2 Eq/L and 13.4 +/- 7.0 micromol H2O2 Eq/L, P =0.002), total antioxidant capacity (5.5 +/- 2.5 micromol Trolox Eq/L and 1.0 +/- 0.6 micromol Trolox Eq/L, P < 0.001), and lipid hydroperoxidation values (9.9 +/- 3.4 micromol H2O2 Eq/L and 4.4 +/- 1.5 micromol H2O2 Eq/L, P < 0.001) were found to be high. The high density lipoprotein (HDL) concentration of the asthmatic children was lower than that in the control group (40.1 +/- 9.2 mg/dl and 54.5 +/- 15.9 mg/dl, P < 0.001)
In asthmatic children, when total oxidant status, total antioxidant capacity and lipid hydroperoxidation levels increase, paraoxonase activity decreased.
Preview · Article · Oct 2009 · Clinical and investigative medicine. Medecine clinique et experimentale
[Show abstract][Hide abstract] ABSTRACT: Osteoporosis in children is rare and mostly secondary to such conditions as prolonged immobilization, malabsorption syndromes, corticosteroid excess, osteogenesis imperfecta, celiac disease, Turner syndrome, and malignancy. Idiopathic juvenile osteoporosis (IJO) is a very rare condition of primary bone demineralization that presents in childhood. IJO, a disease of unknown etiology, manifests typically by pain, bone deformities, and fractures. Diagnosis of IJO was made by excluding other common causes of osteoporosis in this age. Bisphosphonates, calcitriol, fluoride, and calcitonin have been administered therapeutically, but the results were equivocal. Usually the disease remits by itself. Patient that has serious osteoporosis and high thyroid stimulating hormone level was diagnosed as IJO by eliminating secondary reasons. We report this case, whose symptoms were disappeared after parenteral pamidronat treatment, and he was reexamined owing to anemia and trombositopenia, and diagnosed as B-cell acute lymphoblastic leukemia, just to emphasis the importance of close follow-ups of IJO patients.
No preview · Article · Sep 2009 · Journal of Pediatric Hematology/Oncology
[Show abstract][Hide abstract] ABSTRACT: To compare the long-term outcomes of continuous subcutaneous insulin infusion (CSII) pump therapy with the clinical and metabolic parameters recorded during multiple daily insulin (MDI) therapy.
CSII pump was used by volunteer adolescents, who had a duration of diabetes mellitus (DM) longer than one year, regularly attended periodic examinations for the last year, measured and recorded blood glucose levels on average 3 to 4 times a day, and did not achieve the preferred metabolic control even though the use of MDI therapy. Carbohydrate counting and flexible MDI therapy was taught to these patients before CSII pump implantation. The metabolic and clinical parameters of the patients for the post-CSII pump period were compared with the data of flexible and non-flexible MDI periods.
The mean CSII pump implantation age of the 17 adolescents enrolled in the study was 15.53 +/- 1.8 years, duration of DM 6.77 +/- 4.05 years, flexible MDI injection duration 0.70 +/- 0.20 years, and duration of CSII pump use 2.07 +/- 1.12 years. A decrease was detected in HbA(1c) levels of the patients with transition to CSII pump compared to flexible and non-flexible MDI injection periods; however, this decrease was not statistically significant (7.71%, 8.21%, and 8.71%, respectively, p = 0.105). No statistically significant difference was detected in frequency of hypoglycemia, lipid profiles, total daily insulin requirement, and BMI SDS values of the patients when data of the post-CSII pump state were compared with that of flexible and non-flexible MDI therapy groups.
In adolescents, it was found that CSII pump therapy is efficient and safe without any increased risk for weight gain and hypoglycemia compared to flexible and non-flexible MDI injection periods. The present study also demonstrated that flexible MDI injection therapy might be efficiently and safely used in patients who cannot receive CSII pump therapy due to social and/or financial factors.
No preview · Article · Jul 2009 · Journal of pediatric endocrinology & metabolism: JPEM
[Show abstract][Hide abstract] ABSTRACT: Congenital adrenal hyperplasia is a disease which results in autosomal recessive transition with deficiency of the necessary enzymes for cortisole synthesis from cholesterol. The most frequently deficient enzyme is 21-hydroxylase and the second most common is 11-beta hydroxylase. A deficiency of 11-beta hydroxylase is seen in 5 -8% of congenital adrenal hyperplasia cases. An increase in androgyny develops depending on the clinical findings. Neonatal meningitis is an important central nervous system infection because of morbidity and mortality. Of all age groups, meningitis is most commonly seen in neonates. This study presents the case of a 20-day old baby who presented at our emergency department with neonatal sepsis and meningitis, then on physical examination was seen to have ambiguous genitalia and investigative tests resulted in a diagnosis of 11-beta hydroxylase deficiency.
No preview · Article · Jan 2009 · Internet Journal of Pediatrics and Neonatology
[Show abstract][Hide abstract] ABSTRACT: Asthma is a disease where there is an accumulation of collagen in the reticular basal membrane of the airway leading to chronic inflammation. The enzyme prolidase plays an important role in the breakdown of collagen and the breakdown of intracellular protein especially in the final stage when peptides and dipeptides contain a high level of proline. To evaluate the relationship between prolidase activity and oxidative status in asthma patients. Comparison was made between 42 patients diagnosed with bronchial asthma and 32 healthy children of similar age and gender. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total antioxidant capacity (TAC) and total oxidant status (TOS) measurement. The prolidase activity of the asthma patient group was statistically significant compared with the control group (P< or =0.001). TAC and TOS levels in the asthma patient group were higher than the control group (P< or =0.001, P< or =0.002, respectively). No correlation was found between the prolidase and oxidative levels of the two groups. A positive correlation was determined between the prolidase activity and TAC in the asthma patient group (P< or =0.001, r=0.501). The prolidase enzyme activity, which plays a role in the collagen turnover, was low in the asthma patients; therefore, their collagen metabolism had undergone a change and this indicates that there may be an effect on the accumulation of collagen in the reticular basal membrane. Moreover, the high level of TOS indicates that these patients were exposed to severe oxidative stress with an increased TAC response.
No preview · Article · Jan 2009 · Journal of Clinical Laboratory Analysis
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate the effect of carbohydrate counting on metabolic and clinical parameters in patients with type 1 diabetes mellitus (DM) who were on flexible multiple daily insulin therapy. Nine volunteer adolescent patients using intensive insulin treatment (short acting insulin before meal plus two doses of long acting insulin (NPH) per day) were enrolled in the study. Clinical and metabolic parameters of these patients were retrospectively recorded from their files. The mean diabetes duration and age were 4.23±3.53 years and 15.45±1.47 years, respectively. Median HbA1C levels before and after carbohydrate counting were 9.26% and 8.26%, respectively. Total insulin dose, total cholesterol, HDL cholesterol and triglyceride levels were not different between before and after carbohydrate (CH) counting. However the LDL cholesterol levels decreased significantly with the treatment (p=0.036). The differences in the frequency of hypoglycemia and mean body mass index standard deviation scores were not significant before and after CH counting. The present study suggests that treatment with CH counting and two doses of intermediate-acting NPH plus short-acting insulin analogues may be an alternative treatment method for type 1 DM patients who are unable to use insulin pump due to financial problems also providing flexibility in meal-planning especially for adolescent type 1 DM patients.
No preview · Article · Jan 2009 · Gulhane Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Objective: Physical exercise in athletes creates various changes in the oxidant-antioxidant balance. Regularly performed, moderate exercise has many beneficial effects, whereas intense exercise can produce damage in skeletal muscle and other tissues. Material and Methods: To investigate and compare the oxidative-antioxidative status and oxidative stress index in amateur adolescent athletes with those of a healthy control group of similar age and sex but with a normal lifestyle, and to determine any relationship between total oxidative status (TOS), total antioxidative capacity (TAC), oxidative stress index (OSI) and regular exercise. The study group consisted of 64 adolescent amateur athletes who for 2 years had regularly undertaken 2 hours of training per day at least 3 days per week. Results: Significantly high levels of total antioxidative capacity, total oxidative status, oxidative stress index and lipid hydroperoxide were found in the athlete group in comparison to the control group (p< 0.0001). Conclusion: We suggest that there is a dual effect associated with amateur adolescent athletes taking regular exercise over a long time in that oxidative stress appears with the development of oxidants, and at the same time induces antioxidant enzymes thus increasing antioxidant synthesis.
No preview · Article · Jan 2009 · Turkiye Klinikleri Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Objective: Neonatal Jaundice (NNJ) is a symptom in which the recognition, treatment and prognosis depend on the mother's beliefs, attitudes and behavior. Mothers may play an important role in the management of this disease. Particularly in developing regions, some traditional healing methods (THMs) are used by mothers or other caregivers. In this study, we described the regional healing methods and mothers' beliefs and attitudes for NNJ. Material and Methods: Between 01 May 2005 and 13 December 2007, all mothers of infants with NNJ were interviewed using a questionnaire to collect demographic data and information regarding their beliefs and attitudes for NNJ. Frequency distributions and Chi square analyses were used to compare mothers who used THMs with those who did not. Results: A THM was used by 41.9% of the mothers. Of the mothers under 25 years of age, 62.9% had used a THM, although there was no significant difference between the age groups. There were invasive and harmful THMs known or used by mothers such as "cutting the infant's post auricular area", "puncturing the infant's earlobe", "cutting the infant's palate" and "burning the infant's body". There were also some non-invasive methods like "sunning the infant" and "placing yellow cloths on the infant's face or bed". Conclusion: Application of harmful THMs for NNJ was revealed in the study population. Recognition of those THMs may enable health professionals to develop preventive methods of avoidance.
No preview · Article · Jan 2009 · Turkiye Klinikleri Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Increased production of reactive oxygen species leading to an imbalance between the oxidative forces and the antioxidant defense systems favoring an oxidative injury has been implicated in the pathogenesis of asthma. The aim of the study was to investigate the peripheral DNA damage, and its association with oxidative and antioxidative measurements in children with asthma bronchiale. The study population contained 42 children with asthma bronchiale and 32 healthy controls. DNA damage was assessed by alkaline comet assay in peripheral lymphocytes. Plasma levels of total antioxidant status (TAS), total peroxide concentration (LOOHs), and total oxidant status (TOS) were determined. In asthma bronchiale patients, DNA damage was significantly higher than in controls (17.9 +/- 11.8 AU vs. 1.2 +/- 2.0 AU, p < 0.001). Plasma TOS and LOOHs were higher in patients than in healthy controls (13.4 +/- 7.0 vs. 9.0 +/- 3.5, p = 0.002; 9.9 +/- 3.4 vs. 4.4 +/- 1.5, p < 0.001, respectively). Plasma TAS level in patients was higher than in healthy controls (5.5 +/- 2.5 vs. 1.0 +/- 0.6, p < 0.001). DNA damage was correlated with TOS (r = 0,616, p < 0.001). The findings indicated that lymphocyte DNA damage level increases in children with asthma bronchiale. Elevated DNA damage may be related to increased oxidative stress. However, the mechanism of this association, and whether it is direct or indirect, remains to be explored.
No preview · Article · Oct 2008 · Pediatric Allergy and Immunology
[Show abstract][Hide abstract] ABSTRACT: Purpose : We report a case of acute isoniazid intoxication presented with convulsions, and coma. Case : An 8-year-old boy had taken 10 isoniazid tablets (100mg/tb) which had been started as a prophylactic. A nasogastric catheter was administered and gastric lavage was performed followed by the administration of activated charcoal. Immediately after the procedure, sudden convulsions began, which subsided within five minutes of the administration of diazepam infusion. As an antidote, Pyridoxine 1.5 gr ( 50 mg/kg/day),was administered intravenously. After 8 hours the patient regained consciousness, his general condition normalized and oral nutrition was started. Conclusions : Pyridoxine administration is the best way of treating convulsions. Parenteral pyridoxine administration is an effective method in isoniazid intoxication.