Plasma levels of neurogenic inflammation related neuropeptides in pediatric patients with community-acquired pneumonia and their potential diagnostic value in distinguishing viral and bacterial pneumonia.

Neurogenic inflammation is involved in the development and progression of respiratory inflammatory diseases. However, its role in community-acquired pneumonia (CAP) remains unclear. We therefore aimed to investigate plasma levels of neurogenic inflammation-related neuropeptides, calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY), and procalcitonin (PCT) in pediatric patients with CAP and to assess their diagnostic value in viral and bacterial/mixed pneumonia. A total of 124 pediatric patients with CAP (1 month-18 years old) and 56 healthy children of similar ages were prospectively enrolled. The patients were classified as viral (n = 99) and bacterial/mixed (n = 25) pneumonia. Plasma levels of the peptides were quantified by ELISA. ROC analysis was performed to evaluate possible diagnostic value of the peptides. While plasma levels of CGRP, VIP and PCT were significantly higher in patients with CAP than in the control group, respectively, NPY levels were significantly lower. Moreover, plasma levels of all neuropeptides and PCT were significantly higher in bacterial pneumonia patients compared to viral pneumonia patients. ROC analysis revealed that CGRP, SP and NPY had a diagnostic value in distinguishing viral and bacterial/mixed pneumonia. CONCLUSIONS: Our findings suggest that these neuropeptides may be implicated in pediatric CAP. CGRP, SP and NPY together may be a promising candidate in distinguishing viral and bacterial/mixed pneumonia, however, for this, further studies are needed. WHAT IS KNOWN: • Neurogenic inflammation contributes to the development and progression of respiratory inflammatory diseases such as chronic obstructive pulmonary disease and bronchial asthma. WHAT IS NEW: • Plasma levels of neurogenic inflammation related neuropeptides calcitonin gene-related peptide, substance P, vasoactive intestinal peptide and neuropeptide Y are changed in pediatric community-acquired pneumonia. Calcitonin gene-related peptide, substance P and neuropeptide Y are promising candidates in distinguishing viral and bacterial/mixed pneumonia.

Protective and therapeutic effects of okra seed in acute nontraumatic brain injury.

AIM: The purpose of this study was to examine the protective and therapeutic effects of okra (Abelmoschus esculentus [AE]) seed extract, with its known antioxidant, immunomodulatory, and anti-inflammatory properties, in an acetaminophen (paracetamol, N-acetyl- para-aminophenol)-induced model of hepatotoxicity and subsequent acute non-traumatic brain damage. MATERIAL AND METHOD: Forty male Wistar rats were randomly divided into five equal groups, control, paracetamol (P), okra seed extract (AE), okra seed extract + paracetamol (P + AE), and okra seed extract + paracetamol + N-acetyl cysteine (NAC) (P + AE + N). AE was administered by oral gavage through a gastric tube at 600 mg/kg/day for seven days. On the eighth day of the procedure, a single 1 g/kg dose of paracetamol and 300 mg/kg NAC were injected via the intraperitoneal route 1.5 h after AE administration. Rat tissue specimens were subsequently subjected to biochemical and histopathological analyses. Levels of markers such as S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), and matrix membrane metalloproteinase-9 (MMP-9) were investigated from rat serum specimens. Malondialdehyde (MDA) and superoxide dismutase (SOD) were also measured to determine oxidant-antioxidant status. RESULTS: S100B, NSE, MMP-9, MDA levels, and SOD enzyme activities were examined using biochemical methods. MDA levels were significantly lower in the P + AE group and MMP-9 levels in the AE, P + AE, and P + AE + N groups compared to the P group. Histopathological examination results supported the biochemical findings. CONCLUSION: Okra seed extract exhibits a protective and therapeutic effect against non-traumatic brain damage resulting from acute paracetamol intoxication. We think that this benefit of AE derives from its antioxidant property.

Combination of Novel c.3484G> T/p.Glu162Ter Variant in ABCB11 and c.208G> A/p.Asp70Asn Variant in ATP8B1 Are Associated with Severe Symptoms in Progressive Family Intrahepatic Cholestasis.

Progressive family intrahepatic cholestasis (PFIC) is an autosomal recessive disease that causes chronic cholestasis. It is associated with pathogenic variants in genes that encode proteins involved in bile secretion to canaliculus from hepatocytes. In this study, we present a 16-year-old boy who presented with severe pruritus and cholestatic jaundice. All possible infectious etiologies were negative. A liver biopsy was consistent with intrahepatic cholestasis and portal fibrosis. DNA was isolated from a peripheral blood sample, and whole exome sequencing was performed. A novel c.3484G > T/p.Glu162Ter variant in the ABCB11 gene and a c.208G> A/p.Asp70Asn variant in the ATP8B1 gene were detected. Despite traditional treatment, the patient's recurrent severe symptoms did not improve. The patient was referred for a liver transplantation. This novel c.3484G > T/p.Glu162Ter variant is associated with a severe and recurrent presentation, and the two compound variants could explain the severity of PFIC.

An interesting case of childhood brucellosis with unusual features.

Brucellosis is a zoonotic infection, which is still a major public health concern worldwide. Common clinical findings are usually nonspecific involving fever, arthralgia, myalgia, weakness and malaise. Since none of the symptoms of brucellosis is pathognomonic, it may have a similar course with various multisystemic diseases. In terms of focal involvement, sacroiliitis is the most common musculoskeletal manifestation in adult patients, while it is quite rare in pediatric patients. Blood culture is the gold standard in the diagnosis of brucellosis. In the absence of culture facilities, the diagnosis traditionally relies on serologic testing with a variety of agglutination tests such as the Rose Bengal test and the serum agglutination test. However, these agglutination tests are accompanied by frequent false negative results such as seen in prozone phenomenon, which may lead to diagnostic delays. In this article we present a rarely encountered pediatric brucellosis patient who had sacroiliitis-spondylitis, which are rarely reported in children, and exhibited prozone phenomenon in agglutination tests.

Tear and serum vitamin D levels in children with allergic rhinoconjunctivitis.

BACKGROUND: Although solid cohort studies confirmed a preventative role for the anti-oxidant vitamin D in allergic asthma, a limited number of studies focused on allergic rhinoconjunctivitis (ARC). Here, we aimed to determine 25-hydroxycholecalciferol levels in tear and serum in young allergic rhinoconjunctivitis patients as compared to their apparently healthy matched controls. METHODS: In total, 22 children with allergic rhinoconjunctivitis and 31 healthy control subjects underwent serum total IgE and 25-hydroxycholecalciferol measurements. Tear levels of 25-hydroxycholecalciferol were also determined in both groups. RESULTS: The mean serum total IgE level in the ARC group (143.6±132.8IU/ml) was significantly higher than that in the control group (54.8±44.1IU/ml; p=0.03). Serum 25(OH)D levels were significantly higher in the ARC group (34.1±12.7ng/ml) than in the healthy controls (21.8±11.3ng/ml; p=0.001). CONCLUSIONS: To our knowledge, this is the first reported study to show an association between serum 25-hydroxycholecalciferol and ARC in a childhood group. Higher levels of serum 25-hydroxycholecalciferol in children with allergic rhinoconjunctivitis may indicate a possible aetiopathogenic mechanism in the development of allergic rhinoconjunctivitis. This is also the first report to examine tear fluid vitamin D levels in paediatric ARC patients.

Metabolic acidosis in an infant associated with permethrin toxicity.

Pyrethroids are broad-spectrum insecticides. Permethrin intoxication due to topical application has not been documented in humans. We report a 20-month-old infant who had used 5% permethrin lotion topically for scabies treatment. Approximately 60 mL (20 mL/day) was used and after the third application he developed agitation, nausea, vomiting, respiratory distress, tachycardia, and metabolic acidosis. His clinical symptoms and metabolic acidosis normalized within 20 hours. His follow-up was unremarkable. Toxicity of permethrin is rare, and although permethrin is a widely and safely used topical agent in the treatment of scabies and lice, inappropriate use may rarely cause toxicity. Moreover, in cases of unexplained metabolic acidosis, topically applied medications should be carefully investigated.

Subclinical immune reactions to viral infections may correlate with child and adolescent diagnosis of attention-deficit/hyperactivity disorder: a preliminary study from Turkey.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders of childhood and adolescence. Studies focusing on the relationship of infectious agents and ADHD are scarce. It is also known that cerebellar injury may lead to hyperactive behavior. This study aimed to evaluate the relationship between viral agents of cerebellitis and the diagnosis of ADHD. METHODS: The study group was formed of 60 consecutive ADHD patients and 30 healthy children. IgG levels for VZV; HSV-1, CMV, Measles, Mumps, Rubella and EBV were evaluated. RESULTS: Males were significantly higher among patients with ADHD (65% vs. 40%, p=0.025). Patients with ADHD displayed significantly higher positivity for measles IgG (80% vs. 60%, p=0.044). When patients with ADHD were classified according to their pubertal status, adolescents with ADHD displayed higher positivity for mumps (100% vs. 74.4%, p=0.043). Most of the patients were diagnosed with ADHD-Combined or Hyperactive/Impulsive Subtypes (56.6%) while 43.3% were diagnosed with ADHD-predominantly inattentive type. When patients with subtypes of ADHD were compared in terms of seropositivity, it was found that patients with ADHD-Combined/ Hyperactive-Impulsive subtypes had significantly elevated reactions for Rubella (100% vs. 88.5%, p=0.044). CONCLUSION: Although limited to a single center and may be prone to sampling biases, our results may support the notion that immune reactions may be related with ADHD among children and adolescents. Further, prospective studies from multiple centers are needed to support our findings and establish causality.

¿Existe una relación entre la gastroenteritis rotavirus positivo y los grupos sanguíneos ABO? Estudio retrospectivo de cohorte / Is there a relationship between rotavirus positive gastroenteritis and ABO blood groups?: A retrospective cohort study

Introducción. El rotavirus es la causa más frecuente de diarrea grave en los niños. Son pocos los estudios clínicos sobre la relación entre la gastroenteritis por rotavirus y los grupos sanguíneos ABO. Objetivo. La meta de este estudio fue investigar la función de los grupos sanguíneos, en la incidencia de la gastroenteritis por rotavirus y la gravedad de la gastroenteritis. Métodos. Se realizó la investigación retrospectiva de las historias clínicas de los bebés que nacieron en nuestro hospital y a quienes, durante el seguimiento, se les diagnosticó gastroenteritis aguda. Resultados. En el estudio, se incluyeron 219 (36,3%) pacientes rotavirus positivos y 383 (63,6%) pacientes rotavirus negativos. El grupo sanguíneo A se detectó más frecuentemente en el grupo rotavirus positivo que en el grupo rotavirus negativo (50,6% frente a 42,2%, p= 0,047). Las tasas de hospitalización de los casos con gastroenteritis por rotavirus en los niños con el grupo sanguíneo A (30,6% frente a 8%, p < 0,001) fueron significativamente más altas. Conclusiones. Se determinó que la gastroenteritis por rotavirus fue más frecuente en los niños con el grupo sanguíneo A. Se detectó que las tasas de hospitalización de estos pacientes fueron más altas. Por lo tanto, en los niños con el grupo sanguíneo A, podría ser necesario estudiar cuidadosamente la gastroenteritis por rotavirus.

Introduction. Rotavirus is the most common cause of severe diarrhea in children. There is only a few clinical studies about the relationship between rotavirus gastroenteritis and ABO blood groups. Objective. The aim of this study was to investigate the role of blood groups, if any present, in the incidence of rotavirus gastroenteritis, and the severity of the gastroenteritis. Methods. The file records of babies born in our hospital and diagnosed with acute gastroenteritis in their follow up were investigated retrospectively. Results. The study was conducted with 219 (36.3%) rotavirus positive and 383 (63.6%) rotavirus negative patients. The A blood group was detected more commonly in the rotavirus positive group compared to the rotavirus negative group (50.6 vs. 42.2%, p= 0.047). Hospitalization rates of the cases with rotavirus gastroenteritis among children with the A blood group (30.6 vs. 8%, p=˂0.001) were significantly higher. Conclusions. Rotavirus gastroenteritis was determined to be more common in children with A blood group. The hospitalization rates of such patients were detected to be higher. Therefore, rotavirus gastroenteritis among children with blood group A should be monitored closely.

Retinal and choroidal thickness in children with familial Mediterranean fever.

PURPOSE: The aim of the present study was to evaluate retinal and choroidal thicknesses in children with familial Mediterranean fever (FMF). METHODS: Thirty patients with FMF and 28 healthy controls were included in the study. The thicknesses of the retina and choroid of each subject's right eye were measured at the fovea and horizontal nasal and temporal quadrants at 500-µm intervals to 1500 µm from the foveal center using spectral-domain optic coherence tomography. RESULTS: Retinal and choroidal thicknesses at the fovea did not differ between groups (p = 0.32 and p = 0.39, respectively). Horizontal nasal and temporal retinal and choroidal thickness measurements at 500-µm intervals to a distance of 1500 µm from the foveal center were also similar between the groups (all p > 0.05). CONCLUSIONS: The retinal and choroidal thicknesses of children with FMF do not differ from those of age- and sex-matched healthy controls.

Is there a relationship between rotavirus positive gastroenteritis and ABO blood groups?: a retrospective cohort study.

INTRODUCTION: Rotavirus is the most common cause of severe diarrhea in children. There is only a few clinical studies about the relationship between rotavirus gastroenteritis and ABO blood groups. OBJECTIVE: The aim of this study was to investigate the role of blood groups, if any present, in the incidence of rotavirus gastroenteritis, and the severity of the gastroenteritis. METHODS: The file records of babies born in our hospital and diagnosed with acute gastroenteritis in their follow up were investigated retrospectively. RESULTS: The study was conducted with 219 (36.3%) rotavirus positive and 383 (63.6%) rotavirus negative patients. The A blood group was detected more commonly in the rotavirus positive group compared to the rotavirus negative group (50.6 vs. 42.2%, p= 0.047). Hospitalization rates of the cases with rotavirus gastroenteritis among children with the A blood group (30.6 vs. 8%, p= 0.001) were significantly higher. CONCLUSIONS: Rotavirus gastroenteritis was determined to be more common in children with A blood group. The hospitalization rates of such patients were detected to be higher. Therefore, rotavirus gastroenteritis among children with blood group A should be monitored closely.

Neutrophil/lymphocyte and C-reactive protein/mean platelet volume ratios in differentiating between viral and bacterial pneumonias and diagnosing early complications in children.

OBJECTIVE: To test the usability of neutrophil/lymphocyte (N/L) and C-reactive protein/mean platelet volume (CRP/MPV) ratios for the differential diagnosis of bacterial versus viral pneumonia, and the early diagnosis of complications related to pneumonia. METHODS: This retrospective study was conducted on 31 patients diagnosed with bacterial pneumonia and 21 patients diagnosed with viral pneumonia from January 2011 to December 2012 in the Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey. We investigated the clinical characteristics, radiological, and laboratory findings of patients from their medical records. RESULTS: The female/male ratio of patients with bacterial was 1.0/1.8, and with viral pneumonias was 1.0/2.0. The mean patient age was 59+/-51 months. There was a statistically significant difference in the neutrophil/lymphocyte ratio (2.7 versus 0.6, p<0.001) and CRP/MPV ratio (11.0 versus 9.3, p<0.001) in the cases with bacterial pneumonia versus those who had viral pneumonia. Nine of the patients were identified as having complications. There was a statistically significant difference in the N/L ratio (3.5 versus 1.2, p=0.01) and CRP/MPV ratio (11.1 versus 3.9, p=0.001) in the cases that developed complications compared with those that did not. When the neutrophil/lymphocyte and CRP/MPV ratios were used jointly, the diagnosis of bacterial pneumonia could be correctly estimated in 28 (90.3%) cases (odds ratio [OR]=0.06, 95% confidence interval [CI]: 0.01-0.29, p<0.001) and pneumonia-related complications were predicted in 8 (88.9%) cases (OR=13.5, 95% CI: 1.5-118.1, p=0.005). CONCLUSION: It was observed that the combined use of N/L and CRP/MPV ratios might be used in both the differential diagnosis of bacterial versus viral pneumonia, and the prediction of complications.

Serum hepcidin levels and iron metabolism in obese children with and without fatty liver: case-control study.

UNLABELLED: Hepcidin is a regulator of iron balance that is increased in obesity. It reduces the absorption of iron, reduces the transfer of iron from macrophages to the plasma and/or prevents mobilisation of stored iron. Obese patients with non-alcoholic fatty liver disease (NAFLD) demonstrate adipokine and cytokine release promoting inflammatory response. We aimed to analyse the hepcidin levels and iron metabolism in obese children with and without NAFLD and non-obese healthy controls. The study population consisted of 110 children aged 7-18 years in three groups: 50 obese patients without NAFLD, 30 obese patients with NAFLD, and 30 non-obese healthy controls. Serum hepcidin, ferritin, and iron levels, iron-binding capacity, lipid profile, and liver function tests were measured, and hepatic ultrasonography was performed in all participants. Obese patients' white blood cell counts, total cholesterol, triglyceride levels, and homeostatic model assessment of insulin resistance (HOMA-IR) were significantly higher than those of the control group. Iron-binding capacity was significantly higher in obese patients without NAFLD compared with obese patients with NAFLD (p = 0.002). Hepcidin levels were not significantly different between obese patients and the control group. However, hepcidin levels in obese patients with NAFLD were significantly higher than those in obese patients without NAFLD (p < 0.001). CONCLUSIONS: Hepcidin levels were significantly higher in obese children with NAFLD than those without NAFLD. Obese children with NAFLD should receive attention regarding iron metabolism disorders. Serum hepcidin could be a marker of iron metabolism status and NAFLD in these groups of patients.

Vitamin D status in children with attention-deficit-hyperactivity disorder.

BACKGROUND: Attention-deficit-hyperactivity disorder (ADHD), one of the most common psychiatric disorders of childhood, has an early onset, affecting 2-18% of children worldwide. The etiopathogenesis of ADHD is obscure. In recent studies, a low level of vitamin D has been found in association with many disorders as well as in neuropsychiatric diseases. The aim of this study was therefore to investigate serum vitamin D level in pediatric ADHD patients. METHODS: A total of 60 ADHD patients and 30 healthy controls were included in the study. The age of both groups was in the 7-18-year-old range. Serum 25-OH-vitamin D, calcium, phosphorus and alkaline phosphatase were investigated. RESULTS: Serum 25-OH-vitamin D was found to be significantly lower in children and adolescents with ADHD compared to healthy controls, and no significant differences were found between the groups in terms of other variables. 25-OH-vitamin D level in the ADHD group and control group was, respectively, 20.9 ± 19.4 ng/mL and 34.9 ± 15.4 ng/mL (P = 0.001). CONCLUSION: There is an association between lower 25-OH-vitamin D concentration and ADHD in childhood and adolescence. To the authors' knowledge this is the first study to investigate the relationship between vitamin D and ADHD in children.