Peripheral Expression of ADORA2A Is Increased and Is Correlated with Autism Spectrum Disorder Severity in a Sample of Turkish Children.

Background: The aim of this study was to evaluate the peripheral expression of ADORA2A (Adenosine A2A receptor gene) in young subjects with autism spectrum disorder compared with healthy controls and its relationship with clinical characteristics. Method: This study included 93 children and adolescents with a diagnosis of autism spectrum disorder as the study group and 105 healthy age- and gender-matched controls. Blood samples were obtained from all participants, and a real-time quantitative polymerase chain reaction was performed. Parent- and clinician-rated assessment instruments were used to assess and rate the severity of autism spectrum disorder and other emotional/behavioral problems. Results: The mean age of the study group was 9.06 ± 3.57 and 86% were male (n = 83), whereas the mean age of the control group was 9.22 ± 3.86 and 86.7% were male (n = 91). We have found a higher level of peripheral expression of ADORA2A in children and adolescents with autism spectrum disorder compared with healthy controls (fold change = 1.33, P = .001). We also found a weak negative correlation with autism spectrum disorder severity (r = -0.216; P = .038) and stereotyped behaviors (r = -0.207, P = .046). Conclusion: ADORA2A genes may have a role in the pathophysiology of autism spectrum disorder. Further studies are needed to evaluate whether peripheral expression of ADORA2A genes may be among the biomarkers for diagnosing or measuring the severity of autism spectrum disorder.

Social media video analysis methodology for sarin exposure.

As social media becomes increasingly ubiquitous, many events are recorded and released on social media platforms, including chemical weapon attacks. We develop an objective tool in order to evaluate brief and unstructured social media videos for analysing sarin exposure from a civilian medical pathology perspective. We developed and validated this new questionnaire using a standardized procedure that includes content domain specification, item pool generation, content validity evaluation, a pilot study, and assessment of reliability and validity. In total, 51 sarin attacks and 48 matched videos were analysed. Cronbach's α for all 20 items was 0.75, which indicates adequate internal reliability. The test-retest reliability was 0.96, which indicates good internal reliability. The inter-observer intraclass correlation coefficient was 0.97. After verifying sampling adequacy with the Kaiser-Meyer-Olkin measure and the factorability of the items with Barlett's test of sphericity, a factor analysis was performed. According to the principal axis factoring, a six-factor solution explained 51.86% of the total variance. The receiver-operating characteristic curve analysis showed that the Video Score Questionnaire has a sensitivity of 0.817, a specificity of 0.478, and an efficiency of 65.3. Therefore, the Video Score Questionnaire is reliable and valid for evaluating sarin attacks from brief and unstructured social media videos.Key pointsChemical weapons are still used as a method of warfare.Social media videos are an important source of information.We developed a validated scale which can analyse sarin exposure in short and unstructured videos.

Foreign Body Reaction Due to a Forgotten Rubber Band on the Neck of a Toddler Girl.

ABSTRACT: In the presence of an unhealed granulation tissue-like wound, a possibility of abuse and neglect along with a foreign body should come to mind. However, it may be difficult to recognize a foreign body in patients with atypical clinical presentations. We demonstrated delayed diagnosis of a rubber band embedded into subcutaneous tissue in a 2½-year-old girl who presented with a circumferential scar with 2 granulation tissue-like wounds on her neck due to a foreign body reaction developed over years. With this rare case presentation, we remind the possibility of abuse/neglect along with foreign bodies in neck lesions of children.

A case of hypomelanosis of Ito accompanied by unilateral abnormal limb overgrowth and delayed speech.

Hypomelanosis of Ito (HI) is characterized by unilateral or bilateral hypopigmented skin lesions and usually presents as a multisystemic disorder. Skin lesions may develop in different textures, such as linear, whorled, or patchy, and are often accompanied by abnormalities of the central nervous system, skeletal system, eyes, and teeth. HI is associated with sporadic gene mutations but not gender. Presentation of the current case may be of use in reminding practitioners of the common extracutaneous findings of HI, along with some rare manifestations, such as delayed speech and asymmetric limb growth.

The Impact of Early Postpartum Maternal Pertussis Vaccination on the Protection of Infants: A Randomized Clinical Trial.

BACKGROUND: Despite primary vaccination, infants under six months run a risk of infection with pertussis. OBJECTIVE: To determine the impact of early postpartum maternal pertussis vaccination on protecting infants from the disease. METHODS: All mothers (n=405) who gave birth to healthy term infants were educated on the cocoon strategy. The mothers who consented were immunized with the tetanus-diphtheria-acellular pertussis vaccine within the first three postpartum days. All infants received their pertussis vaccines according to the national schedule. The anti-pertussis IgG titers of infants of thirty vaccinated mothers were compared with those of thirty unvaccinated mothers. RESULTS: The pertussis antibody levels in the infants of vaccinated mothers were significantly higher than those of unvaccinated mothers at the mean infant age of 5.6 ± 1.2 months. Only 6 infants of vaccinated mothers exhibited pertussis-like symptoms, none of whom had positive pertussis PCR. Seventeen infants of unvaccinated mothers had pertussis-like symptoms, and 4 tested positive for pertussis PCR. CONCLUSION: Our results showed that maternal pertussis vaccination, administered within the first three postpartum days, may protect infants against pertussis in their first ten months.

Association Between Rapid Antigen Testing and Antibiotic Use and Accuracy of Peripheral Blood Parameters in Detecting Group A Streptococcus in Children With Tonsillopharyngitis.

Objectives: To investigate the effect of rapid antigen testing (RAT) on the practice of antibiotic prescription as well as the accuracy of peripheral blood neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) values in detecting group A beta-hemolytic Streptococcus (GABHS) in children with tonsillopharyngitis. Methods: In a multicenter study performed in Turkey, we retrospectively analyzed data from 668 consecutive pediatric patients under 17 years of age, who presented with signs and symptoms of tonsillopharyngitis and underwent RAT. The rates of positive and negative RAT results were determined and patients' antibiotic prescriptions were examined in relation to RAT results. In addition, the accuracy of peripheral blood NLR and CRP values was examined for 212 patients whose laboratory data were available, with RAT as the reference standard. Results: Positive RAT results were observed in 190 of 668 (28.4%) patients. Antibiotics were prescribed to all 190 patients with positive RAT results and to 8 of 478 patients with negative RAT results. Overall, the rate of antibiotic prescription was 29.6%. Patients with positive and negative RAT results did not differ significantly with regard to NLR and CRP values. In ROC analysis, the area under the ROC curve (AUC) of NLR and CRP were 0.54 (95% confidence interval [CI] 0.45-0.64), and 0.55 (95% CI 0.45-0.65), respectively. Conclusion: RAT results proved highly associated with antibiotic prescribing, suggesting that RATs could be of great value in preventing unnecessary antibiotic use. Our findings also suggest that NLR and CRP are poorly accurate to identify GABHS in children with tonsillopharyngitis.

Evaluation of using pediatric emergency rooms.

OBJECTIVE: The overload of pediatric emergency units around the world has become an increasing problem for patients and health care professionals alike. Researching the features of pediatric emergency services will provide the necessary information for creating an effective emergency medical system, increasing patient satisfaction, and reducing the treatment costs. In this study; we aimed to check the admissions in pediatric emergency rooms, evaluate the effectiveness of emergency service, and develop suitable strategies to increase the amount and quality of medical service given in pediatric emergency rooms. METHODS: In this retrospective study, the records of 296,858 (51.2% female, 48.8% male) patient admissions in the emergency rooms and 384,171 (46.3% female, 53.7% male) admissions in the outpatient clinics of eight hospitals between January 2015 and June 2015 were scanned. Out of these hospitals, two facilities were research and training hospitals. RESULTS: The average age of patients who were admitted to the emergency room was 89.1 (±21.3) months and the average age of patients admitted to the outpatient clinics was 87.2 (±18.7) months. Upper respiratory tract infection was the most frequent (44.23%) diagnosis in the emergency rooms and most of these infected patients (63.67%) had been admitted to the two training and research hospitals that provide an advanced level of health care. Also, the patient requests for diagnosis were determined to be significantly high in emergency rooms. CONCLUSION: Proper understanding of the scope of emergency services is very important in order to provide fast and effective healthcare to the patients who get admitted to emergency rooms and maintain appropriate and judicious use of the resources of emergency rooms.

The relationships between video game experience and cognitive abilities in adolescents.

Objectives: Video games are especially popular among adolescents and young adults as a form of entertainment and the amount of time spent playing video games has increased rapidly. The main objective of this study is to assess the effect of video games on cognitive functions in adolescents. Methods: An exploratory, cross-sectional study was employed to investigate cognitive function in adolescent video game players. Cognitive functions, including memory, attention, and executive functions, were evaluated in 46 adolescents who had been playing video games regularly for at least 1 h per day, 5 days per week, for at least a year, and 31 adolescents (who played video games <5 h per week) using cognitive function assessment tests. Other data, such as demographics, medical information, video game types, and time spent playing video games were collected by questionnaires. Results: No significant difference was detected between the groups in terms of age, gender, IQ levels, and sociodemographic variables. Our findings show that visual memory results were slightly better in the playing group. Moreover, in the group that plays video games regularly, the increase in daily time spent playing games significantly increased the total error value in the Stroop Test and total interference value in California Verbal Learning Test-Children's Version test. We also found that more time is spent on online games compared with traditional games. Conclusions: In this study, we emphasize the pathological and uncontrolled consumption of video games and the possible consequences of time spent playing games. Our findings indicate the need for more extensive research. Future research should address the various implications of video game play, especially between the potentially positive and negative effects of video games.

The effect of peripheral blood eosinophilia on inflammatory markers in asthmatic patients with lower respiratory tract infections.

BACKGROUND: To investigate the behaviour of the inflammatory marker neutrophil-to-lymphocyte ratio (NLR) in the presence of peripheral blood eosinophilia (PBE) in paediatric asthma patients with lower respiratory tract (LRT) infections. METHODS: This retrospective study enrolled consecutive patients aged ≥5 years who were diagnosed with asthma and whose haemogram values were available. The patients were further subdivided based on the presence or absence of LRT infections and allergies. NLR and C-reactive protein (CRP) were evaluated in relation to the presence or absence of PBE (≥4% eosinophils). RESULTS: A total of 991 patients were enrolled in the study. Patients with LRT infections had significantly higher leucocyte and neutrophil counts, a greater NLR and a higher level of CRP compared with patients without LRT infections. Overall, patients with PBE had significantly lower NLRs and CRP regardless of the presence or absence of an LRT infection. The PBE percentage showed moderate inverse correlations with NLR ( r = -0.34) and CRP ( r = -0.20). CONCLUSION: The presence of PBE was significantly associated with lower NLR and CRP regardless of the presence or absence of an infectious condition.

Thyroid function in healthy and unhealthy preterm newborns.

BACKGROUND: The thyroid gland and hormonal regulation are among the most important systems to be investigated in pre-term infants. This study sought to investigate thyroid hormone levels of healthy and unhealthy pre-term infants. METHODS: The prospective study included 53 consecutive premature infants admitted to the neonatal intensive care unit within a duration of one year. Of these preterm babies, 20 were healthy, while 33 had problems such as asphyxia or RDS. Venous blood samples were collected at baseline 0-24 hours, 7 and 14 days and FT3, FT4, and TSH levels were determined. Other data recorded included demographic characteristics of the patients and clinical variables. RESULTS: The most frequent health problems were RDS (87.9%), sepsis (30.3%), and retinopathy of prematurity (24.2%). The mean TSH levels showed a consistent decline at three consequent measurements in both groups, which were always significantly lower in unhealthy pre-terms. In both groups, TSH levels showed significant decreases on Day 7 and Day 14 compared to the baseline levels (p<005). The levels of FT3 and FT4 consistently showed significant correlations with gestational week and birth weight at each of the three measurements. CONCLUSION: Pre-term infants, especially those having problems, have significant hypothyroxinemia that may require thyroid hormone replacement therapy.

The role of plasmapheresis in organophosphate poisoning: Case reports of three pediatric patients.

Yükselmis U, Özçetin M, Çag Y, Yildizdas D, Yilmaz HL. The role of plasmapheresis in organophosphate poisoning: Case reports of three pediatric patients. Turk J Pediatr 2017; 59: 491-496. The aim of the study was to assess the impact of plasmapheresis treatment in the management of three pediatric patients with organophosphate poisoning who did not respond to standard treatment. The treatment of signs and symptoms, and supportive treatment has been evaluated in this paper. Patients were initially given atropine infusion and 0.05 mg/kg atropine with five-minute intervals. Despite pralidoxime loading and three consecutively infusions clinical symptoms did not respond to the treatment and plasma pseudocholinesterase levels did not decrease. At this point, plasmapheresis was used on three consecutive days. Accordingly, the clinical signs improved and mechanical ventilation was no longer necessary. Patients were discharged on the sixteenth day after their admission to the hospital. Plasmapheresis may be an option for the patients who do not respond to atropine and pralidoxime treatment in organophosphate poisoning.

A pediatric case of pituitary macroadenoma presenting with pituitary apoplexy and cranial nerve involvement: case report.

Pituitary adenomas usually arise from the anterior lobe of the pituitary gland and are manifested with hormonal disorders or mass effect. Mass effect usually occurs in nonfunctional tumors. Pituitary adenomas may be manifested with visual field defects or rarely in the form of total oculomotor palsy. Visual field defect is most frequently in the form of bitemporal hemianopsia and superior temporal defect. Sudden loss of vision, papilledema and ophthalmoplegia may be observed. Pituitary apoplexy is defined as an acute clinical syndrome characterized with headache, vomiting, loss of vision, ophthalmoplegia and clouding of consciousness. The problem leading to pituitary apoplexy may be decreased blood supply in the adenoma and hemorrhage following this decrease or hemorrhage alone. In this article, we present a patient who presented with fever, vomiting and sudden loss of vision and limited outward gaze in the left eye following trauma and who was found to have pituitary macroadenoma causing compression of the optic chiasma and optic nerve on the left side on cranial and pituitary magnetic resonance imaging.

Relationship between newborn craniotabes and vitamin D status.

OBJECTIVE: In recent studies, vitamin D deficiency during pregnancy and early infancy has been reported to predispose children to many chronic diseases, except those of the skeletal system. The aim of this study was to investigate whether craniotabes in otherwise healthy newborns is physiological, its relationship to vitamin D deficiency and whether or not it requires treatment. METHODS: A total of 150 healthy newborns with a weight of over 2000 g were included. Newborns were divided into two groups during postnatal discharge (1-3.'s day): those with and without craniotabes. The 25-hydroxy (OH) vitamin D levels of the newborns' mothers were measured, and all infants were re-evaluated for craniotabes, as well as tested to determine levels of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25(OH) vitamin D, urine calcium and creatinine. RESULTS: Craniotabes was present in 45 (30%) of newborns enrolled in the study. Craniotabes of the newborns born during the winter months was significantly higher. PTH level was significantly higher in 1-month-old newborns with craniotabes than those without craniotabes. No relationship was observed between diet and craniotabes, but in exclusively breastfed infants, vitamin D level was statistically significantly lower. No statistically significant difference was found in the occurrence of craniotabes in newborns with or without vitamin D support. CONCLUSION: The relationship between newborn craniotabes and maternal vitamin D deficiency is not clear. However, the present study illustrates that maternal vitamin D deficiency is still a major problem. Therefore, measures to prevent maternal vitamin D deficiency should be strengthened.

Acute Kidney Injury Complicated Epstein-Barr Virus Infection in Infancy.

Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies) and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination.

Analyses of C-Reactive Protein, Endothelial Nitric Oxide Synthase and Interleukin-6 Gene Polymorphisms in Adolescents with a Family History of Premature Coronary Artery Disease: A Pilot Study.

BACKGROUND: Family history of premature atherosclerosis imposes a high risk to people. The relationship between atherosclerosis and gene polymorphisms of various biomarkers such as Endothelial Nitric Oxide Synthase (eNOS), C-Reactive Protein (CRP), and Interleukin-6 (IL-6) has shown in previous studies. AIMS: The major aim of the study was to evaluate the CRP, eNOS, and IL-6 gene polymorphisms in a group of adolescents who have a parental history of early coronary artery disease (CAD). STUDY DESIGN: Case-control study. METHODS: Thirty-six volunteers with a father with obstructive CAD during the first four decades and 46 subjects with a father with normal coronary arteries documented with coronary angiography were included in the study. Polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze CRP, eNOS, and IL-6 polymorphisms. RESULTS: We did not find any differences between the two groups with regard to age, sex, body mass index, renal functions, systolic and diastolic blood pressures, lipid profile, and fasting glucose, hemoglobin, and high sensitivity CRP. A significant difference was only observed in IL-6-572 G/C genotype distribution and allele frequency between two groups (Pc=0.036 OR=3.48 CI (95%) 1.17-10.32). CONCLUSION: The present study showed a significant association between the IL-6-572 G/C gene polymorphism (presence of C allele) and adolescents with a parental history of premature CAD.

Assessment of color Doppler ultrasonography findings in gynecomastia.

AIM: To evaluate the color Doppler ultrasound (US) findings of gynecomastia and compare them with sonographic Tanner staging to determine an additional diagnostic tool. PATIENTS AND METHODS: Eighteen male (mean age 13.87 ± 1.72) patients (36 breasts) with breast enlargement were examined with gray-scale and color Doppler ultrasound (US), and these were used to determine the Tanner stages. In addition, the arterial and venous flow scores were assessed. The resistivity index (RI) values were also measured at the medial, lateral, and retroareolar regions of the breasts, and the mean RI values for each breast were then calculated. RESULTS: Gynecomastia was detected in 30 breasts, and the mean retroareolar thickness was 8.03 mm. Furthermore, arterial and venous flows were detected in 73.3% and 56.7% of the breasts, respectively. However, there was no correlation between the arterial and venous flows and the retroareolar glandular tissue thickness. The average of the mean RI values of the three regions of the breast was 0.62, and there was a statistically significantly positive correlation between the mean RI values of the breasts and the Tanner stages as established by US. Furthermore, there was a strongly significant positive correlation between the arterial and venous flow scores and the Tanner stages. CONCLUSIONS: Our research indicates that vascularity is correlated with breast development in patients with gynecomastia. Additionally, we determined that RI values might be as important as Tanner stages on US.

How does parents' visual perception of their child's weight status affect their feeding style?

INTRODUCTION: Eating style is one of the prominente factors that determine energy intake. One of the influencing factors that determine parental feeding style is parental perception of the weight status of the child. AIM: The aim of this study is to evaluate the relationship between maternal visual perception of their children's weight status and their feeding style. METHOD: A cross-sectional survey was completed with only mother's of 380 preschool children with age of 5 to 7 (6.14 years). Visual perception scores were measured with a sketch and maternal feeding style was measured with validated "Parental Feeding Style Questionnaire". RESULTS: The parental feeding dimensions "emotional feeding" and "encouragement to eat" subscale scores were low in overweight children according to visual perception classification. "Emotional feeding" and "permissive control" subscale scores were statistically different in children classified as correctly perceived and incorrectly low perceived group due to maternal misperception. CONCLUSION: Various feeding styles were related to maternal visual perception. The best approach to preventing obesity and underweight may be to focus on achieving correct parental perception of the weight status of their children, thus improving parental skills and leading them to implement proper feeding styles.

Introducción: El estilo de alimentación es uno de los factores prominentes que determina la ingesta de energía. Uno de los factores que influyen en el estilo de alimentación paterna es la percepción de los padres del estado de peso del niño. Objetivo: El propósito de este estudio fue evaluar la relación entre la percepción visual de la madre del estado de peso de su hijo y su estilo de alimentación. Método: Se realizó un estudio transversal con madres de 380 niños preescolares de 5 a 7 (6,14 años). Las puntuaciones de la percepción visual se midieron mediante unos dibujos y el estilo de alimentación materna se medió con el cuestionario validado "Parental Feeding Style Questionnaire". Resultados: Las puntuaciones de las subescalas de las dimensiones de alimentación parental "alimentación emocional" y "animar a comer" eran bajas en niños con sobrepeso de acuerdo con la clasificación de la percepción visual. Las puntuaciones de las subescalas "alimentación emocional" y "control permisivo" eran estadísticamente distintas en los niños clasificados como correctamente percibidos e incorrectamente percibidos bajos por una mala percepción materna. Conclusión: Diversos estilos de alimentación se relacionaban con la percepción visual materna. El mejor abordaje para evitar la obesidad y el peso bajo podría estar en centrarse en conseguir una correcta percepción parental del estado de peso de sus hijos, mejorando así las habilidades paternas y conllevando la implantación de unos estilos de alimentación adecuados.

Severe childhood amitriptyline intoxication and plasmapheresis: a case report.

Tricyclic antidepressant intoxication is one of the most frequently encountered and life-threatening causes of intoxication among referrals to emergency departments due to drug intoxication. There is no known antidote against any of the tricyclic antidepressants. The American Society for Apheresis (ASFA) recommends plasmapheresis to support primary treatment in this type of drug poisoning, which does not respond to certain and traditional treatments. We present a 15-year-old girl who ingested amitriptyline with suicidal intent. On admission, she was in a comatose state (Glasgow Coma Scale score: 5), with no spontaneous respiration and presence of pathological reflexes. Due to the intake history of lethal doses and the severe clinical picture, plasmapheresis was performed. She was discharged on her fifth day of hospitalization.Due to the high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life-saving therapeutic modality.

An achondroplasic case with foramen magnum stenosis, hydrocephaly, cortical atrophy, respiratory failure and sympathetic dysfunction.

BACKGROUND: Achondroplasia is a relatively frequent genetic disorder that may lead to limb weakness, motor-mental retardation, hydrocephaly, and respiratory disorders. In this pathology, foramen magnum stenosis and accompanying disorders like respiratory depression is well documented. CASE PRESENTATION: A 2.5 year-old child with the diagnosis of achondroplasia admitted to our clinic with severe respiratory depression, limb weakness, and motor mental retardation as well as sympathetic dysfunction. In radiologic evaluations, severe foramen magnum stenosis was detected. The patient was operated and posterior fossa decompression was accomplished to prevent compression of respiratory centers and neurons. CONCLUSION: This case is unique with the narrowest foramen magnum reported up to date and the sympathetic dysfunction which is not reported as a complication in achondroplasic patients. The authors review the relevant literature, focusing on the indications for cervicomedullary decompression in infants with achondroplasia.

The importance of carotid artery stiffness and increased intima-media thickness in obese children.

BACKGROUND: Atherosclerosis that starts in childhood invariably advances during adulthood. Aim. We aimed to study the effect of obesity on main carotid artery intima-media thickness and arterial stiffness. MATERIAL AND METHODS: A total of 78 children were studied from October 2010 to February 2011. They were divided into obese (42 - group 1) and normal (36 - group 2). All the children were subjected to physical examination, routine biochemical and haematological analysis, carotid ultrasonography and echocardiographic measurements. A detailed medical history was obtained. Body mass index (BMI) was calculated by dividing participants' weight in kilograms by the square of their height in metres. Stiffness index ß was calculated using blood pressure and diameter of the systolic and diastolic artery. Intima-media thickness was also measured. RESULTS: The mean age of the obese and normal (control) groups were 10.12±2.12 years and 9.78±1.78 years respectively. Weight, BMI, and systolic and and diastolic blood pressure values were significantly higher in the obese group (all p<0.001). In terms of arterial stiffness and carotid intima-media thickness (CIMT) measurements, all parameters were higher in the obese group than the control (p<0.001). There was a relationship between the degree of obesity and CIMT or stiffness index ß. In addition, dilatation and hypertrophy levels in the left ventricle were higher in obese children. CONCLUSIONS: Obese children with risk factors for multiple atherosclerosis could have increased CIMT dimensions and consequently should be screened for these risks. Ultrasonographic CIMT and arterial stiffness measurements can detect vascular damage at an early stage of development in children with cardiovascular risk factors.