Vaccine Adherence and Postvaccination Serological Status of Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients: A Single-center Experience.

Despite developing consensus guidelines addressing immunization after hematopoietic stem cell transplantation (HSCT), studies showed deviations from recommended immunization practices commonly occur. Difference between the ideal scenario presented in guidelines and real-life scenarios is one of the most recognized barriers to implementing recommended practices. Therefore, this study aimed to evaluate pediatric allogeneic HSCT recipients' adherence to revaccination schedule and evaluate the serological status after immunization. Transplant and vaccination records of children who were followed up at least 2 years after HSCT, postvaccination antibody results of vaccine-preventable diseases were evaluated retrospectively. Total of 173 patients have enrolled in this study. Median revaccination onset time was post-transplant 15 months. Adherence to revaccination program was 30% for inactive and 11.4% for live vaccines. Oral polio vaccine was given to 22 patients, and Bacille-Calmette-Guerin vaccine was applied to 3. Seropositivity after revaccination was >90% for Hepatitis B, Hepatitis A, pertussis, and measles, and it was 88.5% for rubella, 80% for mumps and varicella. Measles seropositivity was low in children with hemoglobinopathy. In subgroup assessments of pertussis, patients vaccinated with low antigen-containing pertussis vaccine (Tdap) had higher seropositivity of adenylate cyclase toxin. Our findings revealed the importance of careful monitoring of current practices in pediatric HSCT recipients.

Faecal calprotectin levels during the first year of life in healthy children.

AIM: A high faecal calprotectin (FC) level is a non-invasive marker for inflammatory bowel disease. Nevertheless, healthy infants have elevated levels of FC with large variations. The aim of our study was to determine the levels of FC and associated factors in healthy infants aged 0-12 months. METHODS: Infants younger than 1 year of age were in the follow-up programme of the Well Child Unit. Data on the clinical characteristics, including birth, anthropometric measurements and feeding types of infants in the unit, were obtained from their personal health records. One fresh stool sample was collected from each infant. ELISA was used to measure FC. RESULTS: We included 84 infants younger than 1 year of age. The median FC value was 313 µg/g. The FC levels were greater in the youngest (0-30 days) group of infants than in the oldest (181-365 days) group (P < 0.001). The FC levels were higher in infants delivered by caesarean section than in those delivered vaginally (P = 0.016). The levels were also higher in infants who were solely breastfed than in those who received mixed feeding (breast milk and formula) during the first 6 months of life (P = 0.030). CONCLUSION: The FC levels in this group of infants were high, especially in the first month of life. Several birth and environmental factors influenced the FC values. Further studies with a larger cohort of infants and serial assessment of FC over time are required to better understand the patterns of this biomarker during infancy.

Copper, zinc and iron levels in infants and their mothers during the first year of life: a prospective study.

BACKGROUND: Essential micronutrients are important for maintenance of life. Deficiency of micronutrients is more likely to be encountered in children, and women studies are required to investigate the status of micronutrients in children and women. This study aimed to longitudinally evaluate changes in zinc, copper, and iron levels in breastfed infants and their mothers during the first year of life. METHODS: Serum and hair samples were obtained from 35 healthy breastfed infants (51% males, 49% females) and their mothers 2, 6, and 12 months after delivery. All of the samples were assessed using an atomic absorption spectrophotometer. Serum iron levels were determined by a Roche/Hitachi/Modular analyzer. Statistical analyses were performed using SPSS-PC (Version 21.00) software. RESULTS: Hair zinc (p < 0.05) and serum iron (p < 0.001) levels of infants were significantly decreased towards the end of the first year. Infants' serum copper levels were increased towards the end of the first year. Maternal serum and hair copper levels and serum iron levels were significantly decreased towards the end of the first year. There were no significant correlations between dietary zinc, copper, iron intake, and trace element levels of infants and their mothers. CONCLUSIONS: Infants' hair zinc levels, maternal and infants' hair copper levels, and infants' and maternal serum iron levels declined towards the end of the first year. Infants need more zinc after 6 months of age. Infants' and mothers' daily iron intake was less than the recommended intake.

Serum level of vitamin D and trace elements in children with recurrent wheezing: a cross-sectional study.

BACKGROUND: We aimed to show the relationship between recurrence of wheezing and serum levels of vitamin D, zinc, and copper in wheezy children compared with a healthy group. METHODS: In this cross sectional study, seventy-three children with wheezing and seventy-five controls were included without a follow-up period. The clinical characteristics of the children were assessed, the asthma predictive index and temporal pattern of wheeze were determined. The serum levels of vitamin D, zinc, and copper were measured. Pearson correlation analysis was used to evaluate the relationship between homogeneously distributed variables. RESULTS: Thirty-two of the seventy-three children (43.8%) had more than three wheezing attacks (recurrent wheezing). The Asthma Predictive Index index was positive in 26 patients (35.6%). When classified to temporal pattern of wheeze, fifty-three of the study group (72.6%) had episodic wheezing and the remainder (27.4%) was classified as multiple-trigger wheezing. We found no overall significant difference between the study and control group in terms of vitamin D and trace elements . The vitamin D and zinc levels were significantly lower and serum copper and copper/zinc ratio was significantly higher in patients with recurrent wheezing (p =0.03, p <0.01, p =0.013, p <0.01, respectively) positive Asthma Predictive Index and multiple-trigger temporal pattern of wheeze compared with patients with non- recurrent wheezing, negative Asthma Predictive Index and episodic temporal pattern of wheeze. CONCLUSION: It may be postulated that for the determination of asthma risk in patients with recurrent wheezing, the serum level of vitamin D, copper and zinc can be used as a routine biomarker alongside the Asthma Predictive Index and temporal pattern of wheeze.

Are metabolic syndrome antecedents in prepubertal children associated with being born idiopathic large for gestational age?

INTRODUCTION: Being born large for gestational age (LGA) is a risk factor for development of metabolic syndrome (MS) in adolescents and adults. OBJECTIVE: To evaluate prepubertal children born idiopathic LGA to non-obese mothers without gestational diabetes or glucosuria with respect to the presence of MS antecedents. PATIENTS AND METHODS: We conducted a cross-sectional study to compare 40 (19 F) LGA-born prepubertal children of a mean age of 6.1 ± 2.5 yr and 49 (25 F) appropriate for gestational age (AGA)-born body mass index (BMI)-matched peers of a mean age of 5.4 ± 1.8 yr with respect to their anthropometric data, blood pressure measurements, fasting serum glucose and insulin levels, homeostasis model assessment-insulin resistance (HOMA-IR), and lipids and atherogenic index (AI) [triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)]. HOMA-IR > 2.5 was used to define IR. HDL-C ≤ 40 mg/dL and TG ≥ 110 mg/dL were used to define dyslipidemia. Both groups were further divided into subgroups as obese and non-obese according to their BMI percentiles and the analyses were repeated. RESULTS: Non-obese LGA children had higher waist circumference (WC) standard deviation scores (SDSs) than BMI-matched AGA-born peers (p = 0.024). There were no significant differences between pooled, obese and non-obese subgroups of LGA-born children and their AGA counterparts with respect to dyslipidemia and IR. AI was higher in non-obese LGA children than in AGA counterparts (p = 0.028). CONCLUSIONS: Non-obese idiopathic LGA-born children have higher AIs than AGA-born counterparts in the absence of IR. WC seems to be a good clinical screening tool in identifying at risk of non-obese LGA children. Further studies are needed to evaluate MS antecedents in idiopathic LGA-born children.

Effect of maternal and infant vitamin D supplementation on vitamin D levels of breastfed infants.

The aim of our study was to investigate the effect of maternal vitamin D3 (400 U/day) supplementation on breastfed infants at 6 months of age. Mothers (n=96) were enrolled within 1 month after birth and assigned to the 400 IU/day regimen or no vitamin D3 supplementation for 6 months. All infants received 400 IU/day of vitamin D3 and were exclusively breastfed until 4 months of age. Of all mothers, 22.2% had vitamin D levels above 20 ng/ml initially. At the end of the study, vitamin D levels of mothers and their infants were similar in both groups. Thirteen percent of the infants in the intervention group and 20.5% in the control group had vitamin D levels below 12 ng/ml. Serum 25-hydroxyvitamin D (25(OH)D) concentrations at 6 months had increased significantly in mothers in the intervention group. Lactating mothers and their children need vitamin D supplementation but further studies are required with higher doses.

Effect of iron supplementation on development of iron deficiency anemia in breastfed infants.

This trial aimed to investigate the effect of iron supplementation on the development of iron deficiency anemia. The study encompassed 6-month-old infants who had been exclusively breastfed in the first 4 months of life. Infants in the supplemented group were given 1 mg kg(-1 )day(-1) ferrous sulfate for 6 months starting at 6 months of age. Blood samples were taken at age 12 months. A 3-day-diet was evaluated at 1 year of age. Data of 51 infants in the supplemented and 54 infants in the control group were analyzed. Mean hemoglobin values were similar in the two groups at the age of 12 months. Mean ferritin level of the supplemented group was significantly higher than that of the control. There was a significant positive correlation between dietary iron intake and hemoglobin levels. Nutrition might be more important than iron supplementation in preventing iron deficiency anemia during infancy.

Elevated hair levels of cadmium and lead in school children exposed to smoking and in highways near schools.

OBJECTIVES: Heavy metal pollution has become a serious health concern in recent years. Cadmium (Cd) and Lead (Pb) are toxic heavy metals. This study was aimed to determine the risk factors for high cadmium and lead levels in school children. DESIGN AND METHODS: The scalp hair samples were obtained from 760 children at 13 schools in Istanbul. A questionnaire was prepared to gather information about demographic and socioeconomic characteristics of the children. Hair cadmium and lead concentrations were determined by atomic absorption spectrophotometer. RESULTS: Household exposure to smoking and attending a school near to Main Streets were found to be the most important risk factors for the high hair cadmium and lead levels in our study. CONCLUSION: These findings support the public health recommendations that children should not have household exposure to smoking, schools should not be near to the main streets and unleaded gasoline use should be promoted.

Relationship between plasma Cystatin C and creatinine in chronic renal diseases and Tx-transplant patients.

OBJECTIVES: Glomerular filtration rate (GFR) is the best overall index of renal function in health and disease. Recently, Cystatin C (Cyst C), a low molecular weight protein freely filtered through the glomerulus, and almost completely reabsorbed and catabolized by tubular cells, has been proposed as a new and very sensitive serum marker of change in GFR. This study investigated the relationship between Cyst C and creatinine (CR) in renal disease patients. METHODS: Serum Cyst C was determined by particle-enhanced immunoturbidimetry using the Cyst C PET-kit. The results could be obtained within 1 h. Cuvettes were washed before the Cyst C assay as recommended. Serum CR, BUN and albumin were determined by auto-analyzer. RESULTS: A strong correlation was observed between Cyst C and CR (P = 0.001, r = 0.764 and P = 0.0001, r = 0.888, respectively) in prehemodialysis (pre-HD) and kidney transplantation (Tx-kidney), whereas there was a weak correlation in continuous ambulatory peritoneal dialysis (CAPD) (P = 0.05, r = 0.535). CONCLUSION: These findings suggest that serum Cyst C may be considered as a sensitive predictive parameter for reduced GFR. It is of value for the laboratory diagnosis of chronic renal failure and should be preferentially used for CR clearance.

The evaluation of lipid peroxidation and acute effect of octreotide on lipid peroxidation in patients with active acromegaly.

BACKGROUND: Although lipid peroxidation has been suggested to play a role in the etiology of many diseases, there is no report about its role in acromegaly in the literature. In the present study, we analyzed the basal levels of lipid peroxides (LPO) in newly diagnosed acromegalic patients, and to evaluate whether octreotide (OCT) has any effect on lipid peroxidation in these patients. METHODS: Plasma lipid peroxide levels before and after acute OCT administration were measured in 12 newly diagnosed acromegalic patients. Blood samples were drawn at basal and 4, 8, and 24 h after octreotide injection (100 microg s.c.). Plasma concentrations of lipid peroxides were estimated from measurement of thiobarbituric acid reactive substance (TBARS), using 1,1,3,3-tetra-ethoxypropane as a standard. RESULTS: This study shows that acromegalic patients have significantly higher basal plasma lipid peroxides levels compared to hours after OCT injection (p<0.001). Although a significant decrease was observed after 8 and 24 h in comparison to basal level (p<0.001), the lipid peroxide levels tended to increase at 24 h though still low when compared to basal level. CONCLUSION: Acromegalic patients have high basal lipid peroxide levels, which was significantly decreased after OCT administration.

Helicobacter pylori infection in Turkish children with gastrointestinal symptoms and evaluation of serology.

Helicobacter pylori infection is a common etiopathogenetic factor in children with gastrointestinal symptoms in the developing world. Although serology offers an easy noninvasive method of diagnosis, its sensitivity and specificity are reported to be low among children. In this prospective study, we investigated the frequency and endoscopical and morphological findings of H. pylori infection in 180 Turkish children who underwent upper gastrointestinal endoscopy either for peptic symptoms or on a routine basis and in asymptomatic pediatric patients who underwent endoscopy for other reasons, and then evaluated the diagnostic accuracy of serology in our population. Overall H. pylori infection was diagnosed in 77 of the 180 patients (42.7%) by histology and urease test. The sensitivity of H. pylori specific IgG antibody assay by ELISA was determined to be 100%, while the specificity was 98%, the positive predictive value 97.4%, the negative predictive value 100%. Frequency of H. pylori infection is high in Turkish pediatric patients without gastrointestinal symptoms as well as in children with gastrointestinal complaints. H. pylori specific antibody assay is a noninvasive and sensitive method for the diagnosis of H. pylori infection in the Turkish pediatric population.

Serum and hair zinc levels of infants and their mothers.

OBJECTIVES: This cross-sectional study aimed to investigate the zinc status of mothers and their infants attending a well-child clinic. METHODS: Blood and hair samples were collected from infants and their mothers at 2nd, 6th,12th month after delivery. Information on infant and their mothers' dietary habits was gathered. RESULTS: Of all infants and their mothers, 54.6% and 12.6% had low hair zinc levels; 17% and 4.6% low serum zinc levels respectively. There was a positive relationship between mother's hair zinc level and her meat consumption at 2 and 6 months after delivery. CONCLUSION: A significant number of infants and mothers had low hair zinc levels. Hair zinc concentrations of infants decreased significantly towards the end of first year. This may be due to low zinc intake of mothers. The main contribution of our study to the literature was the positive relationship between the red meat intake and maternal hair zinc levels.

Effect of hypo-and euthyroid status on serum cystatin C levels.

OBJECTIVE: The aim of this study was to investigate the effect of hypo- and euthyroid status on serum cystatin C (CysC) levels in children and to explore whether CysC can be used as a marker of the thyroid status. METHODS: Twenty five patients with hypothyroidism (10M, 15F; mean age:8.7±4.9 years) and 21 healhty age-matched controls (9M, 12F; mean age: 9.7±5.0 years) were included in this study. Serum thyrotropin (TSH), free thyroxine (fT4), serum CysC and creatinine levels were studied in patients with hypothyroidism twice, i.e. in the euthyroid (on L-T4) and hypothyroid state, and in controls. RESULTS: No significant differences in creatinine, glomerular filtration rate (GFR) and CysC levels were observed between the study group in the euthyroid status and the control group. CysC (mg/dL) level was found to be lower in the hypothyroid status(0.6±0.1) than in the euthyroid status (0.66±0.1) (p=0.01). In hypothyroid status, CysC levels showed a positive correlation with GFR (r=0.463, p=0.02) and GFR had positivecorrelation with fT4 (r=0.563, p=0.012). CONCLUSIONS: We demonstrated a significant effect of thyroid dysfunction on CysC levels, but the changes in serum CysC levels in hypo- and euthyroid status did not exceed the reference interval. It may be concluded that serum CysC levels have limited use in evaluating the peripheral effects of thyroid hormones.

The effects of hyperbaric oxygen treatment on oxidant and antioxidants levels during liver regeneration in rats.

The effects of hyperbaric oxygen (HBO) therapy on oxidant/antioxidant metabolism are controversial and its effects on hepatic regeneration are not known. In this study, we investigated a possible beneficial effect of HBO therapy on oxidant and antioxidants levels during liver regeneration. To conduct this study, seventy percent hepatectomy was performed on forty-eight Spraggue-Dawley rats and the rats were divided into two equal groups: HBO-treated group and untreated group (non-HBO group). We determined the levels of malondialdehyde (MDA), an oxidative stress marker, and the levels of antioxidant enzymes/reagents, including glutathione (GSH), superoxide dismutase (SOD) activity, copper (Cu) and zinc (Zn), in the remnant liver samples. We also measured mitotic index (MI) and proliferating cell nuclear antigen (PCNA) levels to assess the degree of liver regeneration. HBO treatment significantly decreased MDA levels, whereas it increased SOD activity, GSH and Zn levels. In contrast, Cu levels were lower in the HBO-treated livers than the levels in the untreated remnant livers. The effect of HBO treatment may be mediated by the suppression of certain enzymes that are responsible for lipid peroxidation. In addition, HBO treatment may induce the production of antioxidant enzymes/reagents by remnant liver tissues. The HBO-treated rats maintained their body weights but the untreated rats lost body weights. HBO treatment also increased MI and PCNA levels, indicating HBO treatment enhances liver regeneration. These results indicate that HBO treatment has beneficial effects on liver regeneration by decreasing MDA and by increasing antioxidant activities. We therefore suggest that HBO therapy may be useful after liver resection.