Changing climate both increases and decreases European river floods.

Climate change has led to concerns about increasing river floods resulting from the greater water-holding capacity of a warmer atmosphere1. These concerns are reinforced by evidence of increasing economic losses associated with flooding in many parts of the world, including Europe2. Any changes in river floods would have lasting implications for the design of flood protection measures and flood risk zoning. However, existing studies have been unable to identify a consistent continental-scale climatic-change signal in flood discharge observations in Europe3, because of the limited spatial coverage and number of hydrometric stations. Here we demonstrate clear regional patterns of both increases and decreases in observed river flood discharges in the past five decades in Europe, which are manifestations of a changing climate. Our results-arising from the most complete database of European flooding so far-suggest that: increasing autumn and winter rainfall has resulted in increasing floods in northwestern Europe; decreasing precipitation and increasing evaporation have led to decreasing floods in medium and large catchments in southern Europe; and decreasing snow cover and snowmelt, resulting from warmer temperatures, have led to decreasing floods in eastern Europe. Regional flood discharge trends in Europe range from an increase of about 11 per cent per decade to a decrease of 23 per cent. Notwithstanding the spatial and temporal heterogeneity of the observational record, the flood changes identified here are broadly consistent with climate model projections for the next century4,5, suggesting that climate-driven changes are already happening and supporting calls for the consideration of climate change in flood risk management.

Impact of climate change and land cover dynamics on nitrate transport to surface waters.

The study investigated the impact of climate and land cover change on water quality. The novel contribution of the study was to investigate the individual and combined impacts of climate and land cover change on water quality with high spatial and temporal resolution in a basin in Turkey. The global circulation model MPI-ESM-MR was dynamically downscaled to 10-km resolution under the RCP8.5 emission scenario. The Soil and Water Assessment Tool (SWAT) was used to model stream flow and nitrate loads. The land cover model outputs that were produced by the Land Change Modeler (LCM) were used for these simulation studies. Results revealed that decreasing precipitation intensity driven by climate change could significantly reduce nitrate transport to surface waters. In the 2075-2100 period, nitrate-nitrogen (NO3-N) loads transported to surface water decreased by more than 75%. Furthermore, the transition predominantly from forestry to pastoral farming systems increased loads by about 6%. The study results indicated that fine-resolution land use and climate data lead to better model performance. Environmental managers can also benefit greatly from the LCM-based forecast of land use changes and the SWAT model's attribution of changes in water quality to land use changes.

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.

Transseptal Suturing Reduce Patient Anxiety after Septoplasty Compared to Nasal Packing.

BACKGROUND: We measured postoperative anxiety in patients who underwent transseptal suturing or nasal packing after septoplasty. MATERIALS AND METHODS: Transseptal suturing was performed on Group 1 patients and nasal splints with airway were placed after septoplasty in Group 2 patients. Postoperative 48-h anxiety levels of both groups were measured using the State-Trait Anxiety Inventory (STAI) clinical assessment scale, prior to removal of nasal packing in Group 2. RESULTS: Transseptal suturing was performed after septoplasty in 28 patients and nasal packing in 34 patients. The State-Trait Anxiety Inventory clinical assessment state (STAI-S) and trait (STAI-T) instruments were used to measure postoperative anxiety. The STAI-S scores were found 35.00 in the transseptal suturing group and 43.8 in the nasal packing group; the difference was found significant (p < 0.05). The STAI-T scores were found 42.6 in the transseptal suturing group and 45.7 in the nasal packing group; the difference was not found significant (p > 0.05). The rate of minor hemorrhage was found 10.7% in Group 1 patients. CONCLUSIONS: Transseptal suturing is simple and reliable when performed after septoplasty. The technique is painless and comfortable, and reduces patient anxiety (compared to that associated with nasal packing) with only a minor increase in operating time and hemorrhage.

Mannose-binding lectin (MBL) levels in children with Hashimoto's thyroiditis.

OBJECTIVE: Hashimoto's thyroiditis (HT) was described many years ago, but the etiopathogenesis remains unclear. Mannose-binding lectin (MBL) initiates complement activation in the lectin pathway. We determined MBL levels in children with HT and the associations thereof with thyroid hormone and thyroid autoantibody levels. METHODS: Thirty-nine patients with HT and 41 controls were enrolled from the pediatric outpatient clinics. Subjects were grouped according to their thyroid functions: Euthyroid, marked hypothyroidism and clinical/subclinical hyperthyroidism. MBL levels were compared among these groups. Serum MBL levels of the subjects were determined using MBL Human ELISA kit. RESULTS: Serum MBL levels were studied in serum samples from the 80 subjects (48 (60.0%) females). MBL levels in HT and control groups were 50.787±34.718 and 50.593±44.28 ng/ml (p=0,983), respectively. In HT group, there was no significant difference in MBL levels between thyroid function groups (p=0.869). In addition, gender was not detected as a factor for serum MBL levels. Also we found negative correlation between WBC and serum MBL levels (r=-0.532; p=0.050). Otherwise there was no correlation between TSH, anti-TPO and anti-TG with serum MBL levels. CONCLUSION: MBL levels did not decrease in HT patients. Further research is needed to elucidate more fully any role for MBL in the development of autoimmune thyroid disease.

Investigation of zinc, copper, lead and cadmium accumulation in the tissues of Sander lucioperca (L., 1758) living in Hirfanli Dam Lake, Turkey.

This study, some metals (zinc, copper, lead and cadmium) were analyzed in liver, muscle and gills of Sander lucioperca (Linnaeus, 1758) caught from the Hirfanli Dam Lake in December 2007. The highest concentrations were found in liver (zinc:32.5 µg/g, lead:10.73 µg/g, copper:5.85 µg/g, cadmium:0.76 µg/g) of Sander lucioperca. It was seen that the accumulation of zinc, lead and cadmium primarily took place in liver followed by muscles and gills. It was observed that copper is mainly accumulated in liver followed by gill and mucsles.

Safety and efficacy of lodoxamide in vernal keratoconjunctivitis.

OBJECTIVE: To observe the safety and efficacy of topical Lodoxamide eye drops in patients with diagnosed vernal keratoconjunctivitis (VKC). METHODS: This study was conducted at Department of Pharmacology and Therapeutics, BMSI, JPMC, Karachi in collaboration with Department of Ophthalmology, JPMC, Karachi, from April to October, 2009. A total of forty patients with diagnosed vernal keratoconjunctivitis were selected and enrolled consecutively from the out patient department (OPD) of Ophthalmology. Each patient received two drops of Lodoxamide eye drops topically in each eye four times daily. Patients were examined with a torch and slit lamp at baseline and follow-up visits. RESULTS: Out of 40 patients included, 39 completed the study and there was a significant effect of the drug on symptoms and signs of the disease. At the end of the study, 38 (97.4%) were cured, with few side effects. The cure criteria was based on patient's history of becoming symptom-free and resolution of ocular signs. CONCLUSION: Topical lodoxamide eye drops, when used for treatment of VKC, are effective with fewer adverse effects.

Ursodeoxycholic acid protects neonatal rats from necrotizing enterocolitis: a biochemical, histopathological, and immunohistochemical study.

BACKGROUND: The pathophysiology of necrotizing enterocolitis (NEC) includes the massive production of endogenous cytokines with exaggerated activation of inflammatory pathways. Ursodeoxycholic acid (UDCA) has been used as an anti-inflammatory, antioxidant, and anti-apoptotic agent. We investigated the possible protective effects of UDCA in a neonatal rat pup model of NEC. METHODS: We randomly divided rat pups into three groups: a control group, a non-treated NEC group, and a UDCA-treated NEC group. We induced NEC by feeding formula enterally and via hypoxia/reoxygenation. Intestinal samples were collected for histopathological and immunohistochemical evaluation. Blood samples were taken for biochemical analyses. RESULTS: UDCA significantly reduced the extents of terminal ileal and jejunal injuries compared to the NEC group (p < .01), reduced Bax and caspase-3 immunoreactivities (both p < .01), and lowered serum levels of platelet-activating factor and intestinal fatty acid-binding protein (p < .01, p = .023, respectively). CONCLUSIONS: In a rat model of NEC, UDCA protects against adverse intestinal histological, immunohistochemical, and biochemical changes. UDCA significantly reduces the effects of NEC on the rat pup intestine.

Analysis of late-onset neonatal sepsis cases in a level three neonatal intensive care unit.

OBJECTIVE: Newborns in neonatal intensive care units (NICUs) are at high risk for developing nosocomial infections (NIs), which may result in morbidity and mortality. In this study, we aimed to ascertain the bacteriological profiles and their antimicrobial susceptibility patterns in NIs. METHODS: We conducted a cross-sectional study in the NICU. Late-onset sepsis (LOS) cases confirmed with blood cultures were evaluated retrospectively. Laboratory parameters, demographics, and clinical data were collected and analyzed from hospital records retrospectively. RESULTS: Of the 1210 infants in the NICU, 76 (6.3%) had LOS. A total of 86 episodes of LOS were documented; in 10 infants, two pathogens were identified. The mean gestational age (GA) of the infants with LOS was 33.2±4.8 weeks (23 to 42 weeks). Gram-positive cocci (GPC) caused most of the LOS episodes (65.8%, 50/76), with coagulase-negative Staphylococcus (CoNS) as the most common cause of LOS (50%, 38/76). Gram-negative rod species (GNRs) accounted for 32.9% (25/76) of the LOS cases, and fungi accounted for 1.3% (1/76). The mortality rates for GNR and GPC were 17.9% and 6.4%, respectively (p>0.05). The mean CRP and conjugated bilirubin levels for the GPC and GNR groups were 37.5 vs. 29.5 mg/dl and 0.7 vs 1.5 mg/dl, respectively (p>0.05). GNRs had a 20-25% ceftriaxone resistance. Two (4%) GPC species were resistant to linezolid, while all were susceptible to vancomycin. All of the GNRs were susceptible to carbapenems. CONCLUSION: These results underscore the recent emergence of CoNS in NICUs. LOS due to GNRs seems to display higher C-reactive protein and conjugated bilirubin values than those due to GPC. Clinical monitoring of NIs and bacterial resistance profiles are required in all NICUs.

Case Report: A Case of Intellectual Disability with Inappropriate and Challenging Sexual Behavior that was Treated with GNRH Analogues.

Intellectual Disability starts within the course of developmental stages and covers both intellectual and adaptive deficiencies in conceptual, social and applied fields. Individuals with intellectual disability experience many difficulties in social life due to challenging and inappropriate sexual behaviour. Suchdifficulties need to be addressed, reduced or treated. Traditional treatments often fail to treat and improve suchbehavior. Alternative treatment options need to be explored with studies conducted in this field. With this paper, we aimed to show and touch on alternative treatments for challenging and inappropriate behaviors of a 15-year old boy with intellectual disability, who was treated with GNRH analogues.

Assessment of renal function in obese and overweight children with NGAL and KIM-1 biomarkers.

INTRODUCTION: Aim and background: the incidence of obesity has increased among children, and obesity has been considered an independent risk factor for chronic kidney disease. We aimed to determine the degree of kidney function impairment by evaluating urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels. Materials and methods: in total, 15 obese, 26 overweight, and 26 control adolescents aged 10 to 16 years were enrolled into the study. Urine samples were evaluated for NGAL and KIM-1 levels using enzyme-linked immunosorbent assay kits. We investigated the association between obesity and related comorbidities with urinary NGAL and KIM-1 excretion. Results: no significant differences were noted between the obese, overweight, and control groups in urinary NGAL and KIM-1 excretion (p = 0.327 and p = 0.917, respectively). In the obese and overweight groups urinary NGAL levels were 50.39 [30.88-74.22] in females and 26.67 [23.24-45.59] in males (p = 0.013). Also, urinary NGAL levels were increased in obese and overweight adolescents with LDL dyslipidemia at 64.12 [30.98-114.32] as compared to those without LDL dyslipidemia: 39.51 [25.59.56.37] (p = 0.024). Furthermore, a correlation was observed between insulin and homeostasis model assessment of insulin resistance levels with the NGAL/creatinine ratio in the overweight group (r = 0.515; p = 0.008, and r = 0.483; p = 0.014, respectively). Such correlation was not found in the obese group. Conclusion: the effect of obesity on renal function could not be determined in children. A longer exposure may be required for obesity-induced disruption of renal function in children. Renal function may be disrupted by dyslipidemia in obese adolescents. Furthermore, obesity impaired renal function in female adolescents. The normalization of these urinary markers as related to urine creatinine should be discussed.

INTRODUCCIÓN: Introducción: la incidencia de la obesidad en la edad infantil ha aumentado. Se considera la obesidad como un factor de riesgo independiente para el desarrollo de la enfermedad renal crónica. El objetivo de este estudio fue valorar el grado de alteración de la función renal evaluando los niveles urinarios de NGAL y KIM-1. Material y métodos: el estudio incluyó a 15 adolescentes con obesidad, 26 con sobrepeso y 26 controles sanos.Edades de los participantes entre los 10 y los 16 años. Los niveles de NGAL y KIM-1 en orina se determinaron mediante kit ELISA. Se investigó asociación entre obesidad y su comorbilidad con excreción urinaria de NGAL y KIM-1. Resultados: no se encontraron diferencias significativas en la excreción urinaria de NGAL y KIM-1 entre los sujetos con obesidad, los sujetos con sobrepeso y los controles sanos (p = 0,327 y 0,917, respectivamente). En el grupo con sobrepeso y obesidad, los niveles de NGAL en las niñas fueron de 50,39 (30,88-74,22), mientras que en los niños fueron de 26,67 (23,24-45,59) (p = 0,013). Para los sujetos con dislipemia de LDL, el nivel de NGAL fue de 64,12 (30,98-114,32) frente a 39,5 (25,59-56,37) entre los que no la tenían (p = 0,024). Se encontró correlación entre los nivles de insulina, el HOMA-IR y la ratio NGAL/creatinina en el grupo con sobrepeso (r = 0,515; p = 0,008, y r = 0,483; p = 0,014, respectivamente). En el grupo con obesidad no se encontró dicha correlación. Conclusiones: se precisa una duración más prolongada para encontrar alterada la función renal en los niños con exceso de peso. La función renal puede alterarse por la dislipemia en el caso de los adolescentes con obesidad. La función renal se afecta más en las adolescentes femeninas.

Neonatal Thrombocytopenia and the Role of the Platelet Mass Index in Platelet Transfusion in the Neonatal Intensive Care Unit

Background: Neonatal thrombocytopenia is a common hematological abnormality that occurs in 20­35% of all newborns in the neonatal intensive care unit. Platelet transfusion is the only known treatment; however, it is the critical point to identify neonates who are really at risk of bleeding and benefit from platelet transfusion as it also has various potential harmful effects. Aims: To investigate the prevalence and risk factors of neonatal thrombocytopenia and its relationship to intraventricular hemorrhage in the neonatal intensive care unit and to determine whether the use of platelet mass index-based criteria could reduce the rate of platelet transfusion. Study Design: Retrospective cohort study. Methods: This study was conducted in the neonatal intensive care unit of a tertiary university hospital. The medical records of neonates in the neonatal intensive care unit with platelet counts <150×109/L between January 2013 and July 2016 were analyzed. Results: During the study period, 2,667 patients were admitted to the neonatal intensive care unit, and 395 (14%) had thrombocytopenia during hospitalization. The rate of intraventricular hemorrhage was 7.3%. Multiple logistic regression analysis showed that although lower platelet counts were associated with a higher intraventricular hemorrhage rate, the effects of respiratory distress syndrome, sepsis, and patent ductus arteriosus were more prominent than the degree of thrombocytopenia. Thirty patients (7%) received platelet transfusion, and these patients showed a significantly higher mortality rate than their non-platelet transfusion counterparts (p<0.001). In addition, it was found that the use of platelet mass index-based criteria for platelet transfusion in our patients would reduce the rate of platelet transfusion by 9.5% (2/21). Conclusion: Neonatal thrombocytopenia is usually mild and often resolves without treatment. As platelet transfusion is associated with an increased mortality rate, its risks and benefits should be weighed carefully. The use of platelet mass index-based criteria may reduce platelet transfusion rates in the neonatal intensive care unit, but additional data from prospective studies are required.

Association Between Trp64arg Polymorphism of the ß3 adrenoreceptor Gene and Female Sex in Obese Turkish Children and Adolescents.

PURPOSE: The ß3-adrenergic receptor (ADRB3) is expressed in visceral adipose tissue and has been speculated to contribute to lipolysis, energy metabolism, and regulation of the metabolic rate. In this study, we aimed to investigate the association of polymorphism of the ADRB3 gene with the sex of children with obesity and related pathologies. METHODS: ADRB3 gene trp64arg genotyping was conducted in 441 children aged 6-18 years. Among these subjects, 264 were obese (103 boys; 161 girls) and 179 were of normal weight (81 boys; 98 girls). In the obese group, fasting lipids, glucose and insulin levels, and blood pressure were measured. Metabolic syndrome (MS) was defined according to the modified World Health Organization criteria adapted for children. RESULTS: The frequency of trp64arg genotype was similar in obese and normal weight children. In obese children, serum lipid, glucose, and insulin levels; homeostasis model assessment of insulin resistance (HOMA-IR) scores; and MS were not different between arg allele carriers (trp64arg) and noncarriers (trp64trp). In 264 obese children, genetic analysis results revealed that the arg allele carriers were significantly higher in girls than in boys (p=0.001). In the normal weight group, no statistically significant difference was found between genotypes of boys and girls (p=0.771). CONCLUSION: Trp64arg polymorphism of the ADRB3 gene was not associated with obesity and MS in Turkish children and adolescents. Although no relationships were observed between the genotypes and lipids, glucose/insulin levels, or HOMA-IR, the presence of trp64arg variant was frequent in obese girls, which can lead to weight gain as well as difficulty in losing weight in women.

Effects of intermittent and long-term glucose-insulin-potassium infusion in patients with systolic heart failure.

BACKGROUND: Although single dose and short-term glucose-insulin-potassium (GIK) infusions are known to have positive cardiac effects, the effects of repeated and long-term GIK infusion on left ventricular (LV) systolic function and brain natriuretic peptide (BNP) levels are unknown. OBJECTIVE: To investigate the effects of repeated and long-term GIK infusion on LV systolic function and BNP levels. METHODS: Thirty-three patients diagnosed with ischemic cardiomyopathy were included in the study. Patients were divided into two groups: the GIK group (n=19) and the control group (n=14). GIK solutions (1000 mL 20% dextrose, 60 U insulin and 50 mmol/L KCl) were administered at 1 mL/kg/h for 24 h on the first, third and fifth days. The patients were examined by echocardiography at 24 h, one week and one month after the start of treatment. BNP levels were measured before and after GIK infusion. RESULTS: In the GIK group, baseline ejection fraction (EF) was 29.2+/-10.3%. After one week, EF elevated to 40.8+/-10.8% (P=0.001). The EF after one month (37.1+/-10.9%) was less than the EF in the first week, but it was significantly higher than baseline in the GIK group (P=0.01). However, no significant changes in EF were observed after one week and one month in the control group (P=0.1 and P=0.2, respectively). BNP levels after GIK infusion was significantly lower than baseline level in the GIK group (P=0.01). CONCLUSION: Intermittent and long-term GIK infusion has beneficial effects on LV systolic function in a short and intermediate amount of time. Decrease in BNP levels may indicate effective GIK treatment. Intermittent and long-term GIK infusion could be a promising treatment option in patients with systolic heart failure.

Use of ischemia-modified albumin in diagnosis of coronary artery disease.

OBJECTIVE: The diagnosis of coronary artery disease (CAD) is an important clinical problem. Ischemia-modified albumin (IMA) has been demonstrated to be a helpful marker in detecting myocardial ischemia. In this study, we have investigated the diagnostic importance of IMA in CAD. METHOD AND RESULTS: Fifty patients with chest pain were enrolled in the study. IMA levels were measured on admission and within 30-60 min after exercise by albumin cobalt-binding test. Coronary angiography was performed in all patients after the exercise test. The mean preexercise IMA level was 83+/-27 U/ml in the patient group. IMA levels before the exercise test were similar in both patient and control groups (P>0.05). The mean IMA level in the patient group was, however, higher than in the control group after the exercise test (P=0.001). The sensitivity, specificity and positive and negative predictive values of the postexercise IMA levels >85 in diagnosis of CAD were 78, 73, 0.81 and 0.73%; respectively. Postexercise IMA levels were higher in patients with chest pain, ST depression and downsloping and horizontal ST depression of 2 mm or more. CONCLUSION: IMA levels after the exercise test increased in patients with CAD. Our study results indicate that postexercise IMA levels can be helpful markers in the diagnosis of stable CAD in clinical practice.

A Serial Munchausen Syndrome by Proxy.

Munchausen syndrome by proxy (MSBP) is a form of child abuse that describes children whose parents or caregivers invent illness stories and substantiate the stories by fabricating false physical signs. Through this case report, a serial MSBP case is presented along with psychiatric evaluation of the perpetrator mother who was sent to the Forensic Psychiatric Observation Department of the Council of Forensic Medicine to assess whether she has any mental disorder. Although there are several studies on MSBP, we present this case because the perpetrator mother was caught on the camera surveillance system of the hospital while closing the nose and mouth of the victim for fabricating the illness, and she also said that she had done the same thing to her two elder children to exclude their illnesses. Her two children had died and could not be diagnosed. Moreover, we discuss the psychopathology of the perpetrators, which is a less known area of MSBP. This is a very serious form of child abuse, with a high risk of repetition, and failure to diagnose might result in the death of the child.

Role of the Polymorphisms of Uncoupling Protein Genes in Childhood Obesity and Their Association with Obesity-Related Disturbances.

BACKGROUND: Obesity, one of the most common disorders observed in clinical practice, has been associated with energy metabolism-related protein genes such as uncoupling proteins (UCPs). Herein, we evaluated UCPs as candidate genes for obesity and its morbidities. METHODS: A total of 268 obese and 185 nonobese children and adolescents were enrolled in this study. To determine dyslipidemia, hypertension, and insulin resistance, laboratory tests were derived from fasting blood samples. UCP1-3826 A/G, UCP2 exon 8 deletion/insertion (del/ins), and UCP3-55C/T variants were also genotyped, and the relationships among the polymorphisms of these UCPs and obesity morbidities were investigated. RESULTS: The mean ages of the obese and control groups were 11.61 ± 2.83 and 10.74 ± 3.36 years, respectively. The respective genotypic frequencies of the AA, AG, and GG genotypes of UCP1 were 46.3%, 33.2%, and 20.5% in obese subjects and 46.5%, 42.2%, and 11.4% in the controls (p = 0.020). G alleles were more frequent in obese subjects with hypertriglyceridemia (42.9%; p = 0.048) than in those without, and the GG genotype presented an odds ratio for obesity of 2.02 (1.17-3.47; p = 0.010). The polymorphisms of UCP2 exon 8 del/ins and UCP3-55C/T did not influence obesity risk (p > 0.05). The I (ins) allele was associated with low HDL cholesterolemia (p = 0.023). CONCLUSION: The GG genotype of the UCP1-3826 A/G polymorphism appears to contribute to the onset of childhood obesity in Turkish children. The GG genotype of UCP1, together with the del/del genotype of the UCP2 polymorphism, may increase the risk of obesity with synergistic effects. The ins allele of the UCP2 exon 8 del/ins polymorphism may contribute to low HDL cholesterolemia.

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.

Changing climate shifts timing of European floods.

A warming climate is expected to have an impact on the magnitude and timing of river floods; however, no consistent large-scale climate change signal in observed flood magnitudes has been identified so far. We analyzed the timing of river floods in Europe over the past five decades, using a pan-European database from 4262 observational hydrometric stations, and found clear patterns of change in flood timing. Warmer temperatures have led to earlier spring snowmelt floods throughout northeastern Europe; delayed winter storms associated with polar warming have led to later winter floods around the North Sea and some sectors of the Mediterranean coast; and earlier soil moisture maxima have led to earlier winter floods in western Europe. Our results highlight the existence of a clear climate signal in flood observations at the continental scale.

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 children's 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.