The association of angiopoietin-like peptide 4 levels with obesity and hepatosteatosis in adolescents.

INTRODUCTION: Angiopoietin-like peptide 4 (ANGPTL-4) is an adipocytokine that regulates plasma lipoprotein levels by inhibiting the lipoprotein lipase enzyme. Changes in lipid profile can be seen in obese adolescents. Nonalcoholic fatty liver disease may also be a complication of obesity. Based on this information, in this study we aimed to evaluate the relationship between serum ANGPTL-4 levels and obesity and hepatosteatosis in adolescents. MATERIALS AND METHODS: A total of 85 volunteer adolescents, 55 of them were obese and 30 of them were normal weight, were included in our study. The adolescents having body mass index (BMI) 95% percentile and over according to age and sex was defined as obese. Thirty patients with grade 2-3 hepatosteatosis in abdominal ultrasound (USG) were included in 'obese adolescents with hepatosteatosis' subgroup and 25 obese cases with no hepatosteatosis in the USG were included in the 'obese adolescents without hepatosteatosis' group. Thirty patients with no hepatosteatosis in the abdominal USG and having BMI in normal percentiles according to their age and sex constituted the 'healthy control adolescents' group. Serum ANGPTL-4 levels were measured by Enzyme Linked Immunosorbent Assay. Laboratory tests, gender, age and BMI levels were compared statistically between groups. Correlations between ANGPTL-4 and other laboratory parameters were examined statistically in obese adolescent group. RESULTS: The BMI, ANGPTL-4, HbA1c, AST, ALT, total cholesterol, triglyceride, LDL-cholesterol, HOMA-IR and insulin levels of the obese adolescent group were found to be significantly higher than the healthy control group (p < 0.05). We found no statistically significant difference in BMI, ANGPTL-4, triglyceride, insulin and HOMA-IR levels among obese adolescents with or without hepatosteatosis (p > 0.05). In all obese adolescent groups and in obese adolescent group with hepatosteatosis; there was no statistically significant relationship between ANGPTL-4 and other variables (p > 0.05). CONCLUSIONS: We found that the levels of ANGPTL-4 increases in obesity in adolescents. However, our results make it difficult to establish a relationship between hepatosteatosis and ANGPTL-4. Targeting ANGPTL-4 may be beneficial for the pathogenesis and associated complications of obesity.

Association of depression and social anxiety symptom scores with disease characteristics in pediatric patients with chronic immune thrombocytopenia: a cross-sectional study.

Patients with ITP have been reported to experience higher levels of depression and anxiety than their healthy counterparts. The limited research conducted on this subject in the pediatric age group has demonstrated that patients have psychosocial difficulties, and their quality of life is adversely affected. The correlation of depressive symptoms with disease characteristics of cITP has never been investigated. This was a cross-sectional study in patients being treated for cITP. Communication with participants was done during routine outpatient visits or by telephone or e-mail, and a survey about demographics and the Children's Depression Inventory (CDI) and the Social Anxiety Scale for Children-Revised (SAS-CR) was administered prospectively. A total of 56 children with cITP were recruited. The mean CDI score was 17 (SD: ± 9.44). Approximately half of the patients had higher CDI scores than healthy Turkish children. Older age, time since diagnosis, a number of hospitalizations (both total and within the last year) were positively correlated with CDI scores. There was no significant correlation between SAS-CR scores and disease characteristics. Depressive symptom scores were higher in children with cITP compared with healthy children in this study. Psychological needs may be overlooked in the medical management of children with cITP.

Assessing Psychological Disorders in Turkish Adolescents with Transfusion-Dependent Thalassemia.

We investigated depression and anxiety levels and related psychological disorders in adolescents with transfusion-dependent thalassemia (TDT) in this study. The study was conducted in two pediatric hematology outpatient clinics and included adolescents with TDT (14.8 ± 2.4 years, n = 40) in the study and compared them with the healthy age-matched control group (14.3 ± 2.3 years, n = 62). The Turkish version of the Revised Child Anxiety and Depression Scale (RCADS) was used to determine depression, anxiety, and related psychologic disorders (obsession, panic disorder, social phobia). Depression, anxiety, obsession, panic disorder, and social phobia scores were significantly higher in the patient group compared with the control (all p < 0.05). Ferritin levels were positively correlated with total depression, general anxiety, separation anxiety, and social phobia scores, but transfusion frequency and young age were the confounding factors. Patients in early adolescence and those who require more frequent blood transfusions are at higher risk of developing psychological disorders; routine screening for mood disorders should be warranted. Serum ferritin level may be a good warning indicator for early recognition of psychologic disorders in TDT patients.

Atherogenic Index of Plasma (AIP) and Its Association with Fatty Liver in Obese Adolescents.

BACKGROUND: The atherogenic index of plasma (AIP) is the base-10 logarithmic conversion of the triglyceride to high-density lipoprotein cholesterol ratio [AIP = log10 (triglyceride/HDL cholesterol)]. Some studies have found a link between low serum vitamin D levels, AIP, and fatty liver. This study was conducted to evaluate the relationship between AIP levels, fatty liver, and vitamin D levels in obese adolescents aged 10-17 years. METHODS: This study included 136 adolescents, including 83 obese and 53 healthy controls, in the age range of 10-17 years. Thirty-nine of the obese adolescents had fatty livers. Those with ultrasonography grades 2 or 3 of fat were in the fatty liver group. The AIP value was calculated as the logarithmic conversion of the ratio (triglyceride/HDL cholesterol) at the base of 10. Vitamin D and other laboratory tests were analyzed biochemically. Statistical evaluations were made with the SPSS program. RESULTS: The AIP, body mass index (BMI), homeostatic model assessment for insulin resistance (HOMA-IR), and insulin averages of obese adolescents with fatty liver were significantly higher than those of obese adolescents without fatty liver and the healthy control group (p < 0.05). Again, the mean AIP of obese patients without fatty liver was pointedly higher than that of the healthy control group (p < 0.05). There was a positive, moderate relationship between AIP and BMI, AIP and HOMA-IR, and AIP and insulin levels (p < 0.05), whereas there was a negative, moderate (37.3%) relationship between AIP and vitamin D (p = 0.019). CONCLUSION: AIP levels were higher in obese adolescents, and this increase was higher in obese adolescents with fatty liver in this study. Moreover, we detected a negative correlation between AIP and vitamin D levels and a positive correlation with BMI, insulin resistance, and insulin levels. Based on our data, we concluded that AIP can be a useful predictor of fatty liver in obese adolescents.

The Association of Serum Uric Acid Levels and Various Uric Acid-Related Ratios with Insulin Resistance and Obesity: A Preliminary Study in Adolescents.

BACKGROUND: Studies have shown that serum uric acid levels and uric acid-related ratios, such as uric acid-to-albumin ratio (UAR), uric acid-to-creatinine ratio (UCR), uric acid-to-high-density lipoprotein cholesterol (HDL cholesterol) ratio (UHR), and uric acid-to-lymphocyte ratio (ULR), are associated with various diseases and their complications, and that these ratios can be used as biomarkers. In the current study, we aimed to investigate uric acid levels in obese adolescents and the relationship of uric acid-related ratios with insulin resistance and obesity for the first time in the literature. METHODS: A total of 100 adolescents (60 obese and 40 healthy) aged 10-17 years were retrospectively included. Participants were assigned to two groups: the obese group and the healthy control group. Obesity was defined as a body mass index (BMI) >the 95th percentile for age and gender. Demographic and laboratory data (serum glucose, urea, creatinine, uric acid, albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP), total cholesterol, triglyceride, HDL cholesterol, thyroid-stimulating hormone (TSH), free T4 (fT4), insulin levels, and complete blood count) were obtained from the laboratory information management system. A homeostatic model of assessment for insulin resistance (HOMA-IR), low-density lipoprotein cholesterol (LDL cholesterol), and uric acid-related ratios were calculated. RESULTS: Uric acid, UAR, UCR, and UHR levels of obese adolescents were significantly higher than the healthy group (p < 0.05). We found that HOMA-IR was positively correlated with uric acid, UAR, and UHR. No correlation was found between BMI and uric acid or uric acid-related ratios. We did not find any difference between the two groups in terms of ULR levels, and we did not find any correlation between BMI and HOMA-IR. CONCLUSION: High levels of serum uric acid, UAR, UCR, and UHR were associated with obesity. Furthermore, we found that uric acid, UAR, and UHR were positively correlated with insulin resistance.

Knowledge, attitude and response of mothers about fever in their children.

AIM: This study was conducted to determine mothers' knowledge about fever, and their attitudes and responses to fever in children, along with the influence of demographic characteristics on the level of knowledge, and to identify occurrences of fear of fever. MATERIALS AND METHODS: The study consisted of 4500 mothers with children 0-12 years of age who were referred to the pediatric health and disease polyclinic and primary care polyclinic over a period of 24 months. Data were collected using a questionnaire containing 32 open-ended, multichoice questions, and assessed using number, percentage and χ(2) analyses. RESULTS: In this study, 36% of mothers regarded body temperatures lower than 37°C as fever; 83% believed that fever was harmful for their children, and 92.3% experienced fear and concern due to their child's fever. The most significant reason for fear was the belief that the child may have a seizure. Moreover, 12% of mothers feared that their child would die due to fever. The level of fear triggered by fever was lower as the education level of the mothers increased. Meanwhile, when their child had a fever, 28.9% of mothers used antifebrile drugs without consulting a physician, while 19% applied cold water and 7.7% applied water with alcohol or vinegar, among other inappropriate practices. CONCLUSION: Increased information about fevers geared towards the caregivers of children, particularly mothers, would prevent the unnecessary treatment of children, as well as minimising delayed and insufficient responses to fever.

Children's only profession: Playing with toys.

The concepts of games and toys have a very important role in children's lives. It contributes to the development of cognitive, motor, psychosocial, emotional, and linguistic skills. It also plays a key role in raising self-confident, creative, and happy children. Therefore, attention should be paid to the concepts of games and toys, which are so important for the child to be a part of society as a healthy individual at every stage of his development. On the other hand, providing playgrounds where children can play comfortably and safely are essential in reducing the risk of accidents related to toys. All health-care components, especially pediatricians and family physicians, should take an active role in ensuring that these play processes, which are the most beautiful parts of childhood, are healthy and safe.

A Child Abuse: Marriage at Childhood Age.

Child marriage, which is seen as both a global public health and social problem, is defined as marriage before the age of 18 years. Gender inequality, migration and wars, economic problems, lack of education, and non-deterrent laws are the main causes of child marriage. Child marriage in our country, and other places where child marriage is still commonplace, is a breach of the widely recognized human rights of the child. Prevention of this breach requires effective and target-oriented counter-measures. At the same time, to achieve sustainable change, problems should be analyzed and solutions should be provided with programmed and multi-layered components. It should not be forgotten that "the child is not a bride, the place for the child is in school and the playground."

Comparison of Tumor Infiltrating Lymphocyte Density with Histopathological Parameters and Effect on Prognosis in Head and Neck Squamous Cell Cancers.

OBJECTIVES: The study aims to determine the ratio of the tumor-infiltrating lymphocytes (TIL) in the tumor microenvironment in squamous cell carcinoma of head and neck and its effect on prognosis using histopathological parameters. METHODS: The patients who underwent head and neck surgery with the diagnosis of squamous cell carcinoma of head and neck at Cerrahpasa medical faculty ENT Clinic between January 2010 and November 2013 were included in this study. The age, gender, smoking status, alcohol use, radiologic images, and operation technique were analyzed for all patients. TNM pathologic staging, histologic differentiation grade, desmoplastic stromal reaction, vascular and perineural invasion, and lymph node metastasis were also evaluated. Representative hematoxylin-eosin stained slides from each block were cut and the ratio of tumor-infiltrating lymphocytes in tumor tissue was examined by an expert to confirm histology. RESULTS: In this study, 114 patients (105 males and 9 females) met inclusion criteria and were included. The mean age was 60.3±9.7 (ranging from 27 to 85 years). TIL and desmoplastic stromal reaction were compared statistically to the extent of primary tumor, vascular and perineural invasion, lymph node metastasis and histological grade of the tumor. While there was no statistically significant difference between TIL and these parameters, there was a statistically significant correlation between desmoplastic stromal reaction and these parameters. Considering five years of patient survival, although TIL had a positive impact on the prognosis of the tumor, there was no statistically significant difference. CONCLUSION: We suggest that besides TNM pathologic staging and histologic parameters, immune cells reacting to the tumor will be a distinctive factor in determining the prognosis and new treatment methods. We believe that TIL will affect the current cancer treatments by increasing its anti-tumor effects and will give promising results in cancer immunotherapy.

Epidemiology, pathophysiology, clinical evaluation, and treatment of carbon monoxide poisoning in child, infant, and fetus.

Carbon monoxide (CO) poisoning is one of the most common types of poisoning causing death worldwide. In our country, it occurs particularly during winter as a result of leak from stove or water heater, or as result of inhalation during a fire. Although most poisonings occur accidentally, some cases are suicide attempt. As CO is a substance that is not visible and has no taste or smell and is therefore difficult to detect, the gas can be a "silent killer" that is not noticed until effects develop. CO reacts with oxygen, creating carboxy hemoglobin (COHb), which leads to tissue hypoxia. In addition, it has direct effect of causing cellular damage. Although symptoms of acute poisoning are most commonly observed in patients admitted to emergency rooms, effects of chronic exposure to CO can also seen. Clinically, although it affects all organ systems, involvement of central nervous system (CNS) and cardiovascular system is predominant. Most common poisoning symptoms are weakness, dizziness, headache, nausea, and nonspecific flu-like symptoms, like vomiting. Depending on severity of exposure, seizures, syncope, and arrhythmia may also be observed. In pregnant women, fetus can be harmed with relatively low level of COHb. Poisoning in infants has a more severe course than seen in other age groups. Symptoms must be associated with cause of poisoning, and careful anamnesis and treatment must be conducted quickly. Oxygen is the antidote for CO. It is administered through a mask in the form of normobaric oxygen therapy or through specific devices in the form of hyperbaric oxygen therapy. In this review, clinical data and current diagnostic and therapeutic approaches concerning CO poisoning are discussed.

Alpha-B-crystallin expression in human laryngeal squamous cell carcinoma tissues.

BACKGROUND: Laryngeal squamous cell carcinoma (SCC), being an aggressive malignancy, is one of the most commonly diagnosed malignant types of head and neck SCC worldwide. The recent studies suggested that αB-crystallin might play an important role in tumorigenesis. The purpose of this study was to investigate the αB-crystallin expression level in metastatic and nonmetastatic laryngeal SCC tissues and to determine its prognostic significance. METHODS: Alpha-B-crystallin expression status in metastatic, nonmetastatic laryngeal SCC, and normal tissue samples was investigated by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: We demonstrated that the expression of αB-crystallin was significantly upregulated in laryngeal SCC tumor tissue samples in comparison with the corresponding normal tissues (p < .001), although no significant association has been found between αB-crystallin expression and either the metastatic potential or the T classification of the specimens. CONCLUSION: Although expression of αB-crystallin is not statistically correlated with neck metastases, we demonstrated that αB-crystallin is significantly overexpressed in laryngeal cancer.

Beta-ketothiolase deficiency brought with lethargy: case report.

Beta-ketothiolase deficiency is a rare autosomal recessive disorder of isoleucine and ketone body metabolism. This disorder is clinically characterized by ketoacidotic attacks. Ketoacidosis, vomiting, and dehydration, lethargy and coma may be seen during attacks. A 9-month-old girl was admitted to our hospital with acidosis and dehydration. The patient was lethargic. Ketoacidosis was suspected because of acetone odor on her breath. Her blood glucose level was 262 mg/dL and urine ketone was (++++). Branched chain amino acid levels were elevated in her blood sample. Organic acid analysis of urine revealed 2-methylacetoacetyl-CoA thiolase deficiency. This was reported because of rarity of the disease and we should consider it in the differential diagnosis of ketoacidotic episodes.

Serum zinc levels in children of 0-24 months diagnosed with pneumonia admitted to our clinic.

AIM: We have planned to study the relationship between zinc (Zn) plasma levels, as well as pneumonia criteria, and zinc in healthy children younger than 2 years of age compared to pediatric patients diagnosed with pneumonia and admitted to a hospital. MATERIALS AND METHODS: The study enrolled 25 patients of 0-24 months referring to our hospital's pediatric clinic, who were then diagnosed with bronchopneumonia based on the World Health Organization diagnostic criteria and admitted to suckling children clinic due to inability to receive out-patient treatment, and 10 healthy children of the same age group, whose physical examinations revealed no pathological findings. RESULTS: There was no difference between the groups in terms of age and gender distribution (p> 0.05). The control group included in the study showed a significantly higher mean duration of breast milk intake compared to the patient groups (p<0.001). WBC values obtained from the patient group was significantly higher than that of the control group (p<0.001). Zn and iron (Fe) values as determined in the control group enrolled in the study were significantly higher compared to the patient group (p<0.01). Mean total protein in the control group was found to be significantly higher versus that of the patient groups (p<0.05). With regard to the r values of correlation coefficients of the subjects enrolled in the study, a slightly positive correlation was observed between Zn levels and iron levels (r=0.457). CONCLUSION: It was concluded that infections, particularly pneumonia, which present a serious issue both in our country and developing countries, may be developed more commonly among children with zinc deficiency.