Comparison of effects of quercetin and ascorbic acid on inflammatory cytokines and antioxidant biomarkers in infant rats using an experimental sepsis model.

OBJECTIVE: There is ongoing research on treatments that promote antioxidant and anti-inflammatory mechanisms, which will reduce mortality in sepsis. In this study, we compared the anti-inflammatory and antioxidant activities of quercetin and ascorbic acid using a sepsis model induced in infant rats. METHODS: A total of 28 infant rats 21-days-old that had just completed the lactation period were divided into four groups: control, sepsis, sepsis + quercetin, and sepsis + ascorbic acid. The sepsis model was created with an intraperitoneal injection of bacterial lipopolysaccharide. After 24 hours, blood samples were collected for analysis of serum levels of inflammatory cytokines (IL-1ß, IL-6, TNF-α, and CRP) and antioxidants (CAT, GPx, SOD, and GST). RESULTS: The superoxide dismutase levels were significantly higher in the sepsis + ascorbic acid group compared to the sepsis and sepsis + quercetin groups. The levels of the most active cytokines in sepsis were significantly lower in the serum samples of the septic subjects who received quercetin and ascorbic acid. CONCLUSION: The antioxidant activity, which is impaired in sepsis, was increased by both molecules. We observed that these two molecules, which are free of side effects, have a positive influence on the progression of sepsis to severe and fatal sepsis in childhood (Tab. 2, Ref. 38).

Ambulatory arterial stiffness index is increased in obese children.

BACKGROUND AND OBJECTIVES: One way to measure arterial stiffness is the ambulatory arterial stiffness index (AASI), which is the relationship between diastolic and systolic ambulatory blood pressure (BP) over 24-hours. METHODS: We studied the difference in AASI between obese and lean children. AASI was calculated from 24- hour ambulatory blood pressure monitoring in 53 obese children (33 girls) and compared with age-matched 42 healthy subjects (20 girls). Hypertension was defined according to the criteria of the American Heart Association. To evaluate inflammation, the blood level of high-sensitive C-reactive protein was measured. RESULTS: The mean age was 10.6 ± 2.83 years in obese children and 11.3 ± 3.17 years in healthy subjects. Hypertension was determined in three (5.6%) obese children. The median heart rate-SDS, pulse pressure and blood pressure values did not differ between the two groups. The mean AASI was significantly higher in obese children compared to healthy subjects (0.42 ± 0.15 vs. 0.29 ± 0.18, p < 0.001). AASI significantly correlated with nighttime SBP-SDS, nighttime SBP-load, systolic and diastolic nocturnal dipping, with no independent predictor. CONCLUSION: This study confirms that AASI is increased in obese children. AASI calculation is a useful, costeffective, and an easy method to evaluate arterial stiffness. Early detection of increased arterial stiffness can help clinicians come up with preventive measures in the management of patients.

Serum osteoprotegerin levels in school-aged children with asthma.

BACKGROUND: Various inflammatory biomarkers have been used in asthma cases for evaluating inflammation, however it has been determined that the majority of these biomarkers are insufficient for putting forth the course and severity of the disease. Osteoprotegerin is a glycoprotein mediator in the lung and macrophages. As far as we know, there are no studies about the role played by osteoprotegerin in child patients with asthma. OBJECTIVE: It was planned to examine the relationship between osteoprotegerin levels in childhood asthma and respiratory functions and airway inflammation and to assess its use as a biomarker. METHODS: The study included patients aged 6-16 years who were diagnosed with asthma at the pediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. The correlation analyses for the osteoprotegerin levels of asthma patients and their respiratory functions were examined. RESULTS: The age average of asthma cases was 10.61±3.04 years and 51.2 % were female. No statistically significant difference was observed between the osteoprotegerin levels of the groups (p>0.05). A negative and statistically significant correlation was observed between the FEV1 and FVC values and osteoprotegerin levels (p=0.015, p=0.003). CONCLUSIONS: This was the first study to examine the relationship between osteoprotegerin levels and airway inflammation in children with asthma. We believe that there is a need for wider scale studies in which clinical symptoms and more parameters are evaluated for defining the role played by osteoprotegerin level in children with asthma and for determining its usability as a biomarker.

Pentoxifylline Treatment of Very Low Birth Weight Neonates with Nosocomial Sepsis.

Objective The objective of this study was to assess the result of intravenous pentoxifylline as an adjunct to antibiotic therapy on mortality and morbidity in very low birth weight (VLBW) preterm neonates with nosocomial sepsis. Methods For the 18 VLBW preterm neonates, as an adjunct therapy to antibiotics regimens, pentoxifylline (5 mg/kg/h for 6 hours) was administered to premature infants with sepsis on 3 successive days. Clinical and laboratory parameters were recorded before and after treatment. Results Following pentoxifylline therapy, the immature-to-total neutrophil ratio and C-reactive protein (CRP) levels were significantly decreased, while the blood pH and base excess were significantly increased (p < 0.05). The axillary temperature, noninvasive blood pressure, hemoglobin, leukocyte, and thrombocyte values did not significantly differ after treatment (p > 0.05). Coagulase-negative staphylococci (CoNS) (32%), Streptococcus hominis (7.3%), Pseudomonas aeruginosa (5.3%), and Candida parapsilosis (3.1%) were identified in the blood cultures. There were no short-term morbidities (intraventricular hemorrhages, necrotizing enterocolitis, periventricular leukomalacia, and patent ductus arteriosus), no adverse effects, and no mortalities during or after the pentoxifylline therapy in the preterm neonate participants. Conclusion The CRP levels and heart rate both decreased, while the pH and base excess parameters of the blood gas analysis changed positively after pentoxifylline treatment in VLBW preterm neonates with nosocomial sepsis.

A Case of Homocystinuria Misdiagnosed as Moyamoya Disease: A Case Report.

INTRODUCTION: Homocystinuria is a hereditary disease caused by a defect in the enzymes involved in metabolizing methionine. Homocystinuria can influence many systems and may be mistaken for other diseases, including Moyamoya disease. Here, we report the case of a 10-year-old male patient with a diagnosis of Moyamoya disease who had been monitored for that for an extended period. The patient's diagnosis was changed to homocystinuria as a result of lens subluxation and cataract findings. CASE PRESENTATION: A 10-year-old male patient presented with vomiting, headache, lethargy, muscular weakness, and eye redness. The patient was mentally retarded, his right pupil was hyperemic, and he had muscle weakness on his left side. In addition, his blood pressure was high. The patient's history included a diagnosis of Moyamoya. A neck and cranial computed tomography (CT) angiography showed no flow bilaterally past the bifurcation of the carotid artery. The patient's bilateral internal carotid arteries were determined to be occluded. It was considered that his eye findings could be compatible with a metabolic disease. On metabolic screening, the patient's homocysteine level was very high. In addition, a heterozygous A1298C mutation was identified in MTHFR. Therefore, the patient was started on a diet free from homocysteine and methionine. In addition, his treatment regimen included vitamins B12 and B6. With these treatments, the patient's complications regressed. CONCLUSIONS: In cases of unusual vascular lesions, metabolic diseases must be considered. In homocystinuria, early diagnosis and treatment are important. Blood homocysteine levels can be returned to normal, and some complications can be prevented.

The Relationship of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Gastrointestinal Bleeding in Henoch-Schonlein Purpura.

OBJECTIVES: Henoch-Schonlein Purpura (HSP) is the most widespread systemic vasculitis during childhood. Gastrointestinal tract retention and gastrointestinal bleeding are among its major complications. Neutrophil-Lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are indicators related to inflammatory diseases. This study evaluated the relationship between NLR or PLR and gastrointestinal bleeding in HSP. METHODS: The study consisted of 119 patients and 40 healthy children in the same age group. White Blood Cell (WBC) count, hemoglobin level, platelet count, mean platelet volume (MPV), neutrophil count and lymphocyte count were recorded. The NLR and PLR were calculated based on the results of complete blood count tests performed during the first visit to the hospital. RESULTS: The average neutrophil count and NLR of the patients with HSP were found to be significantly increased compared to the control group (P = 0.0001). No significant difference was observed between the PLR average of HSP and control groups (P = 0.053). Platelet count average (P = 0.0001) and PLR (P = 0.001) of the patients with gastrointestinal system (GIS) bleeding were found to be statistically significantly increased compared to those who did not have gastrointestinal bleeding. No significant difference was found in the NLR of the patients with and without gastrointestinal bleeding (P = 0.060). CONCLUSIONS: While the NLR was significantly increased in patients with HSP in this study, the PLR was found to be more significant in patients with gastrointestinal bleeding. Similar to NLR, PLR may also be used as an inflammatory indicator among children with HSP, who have gastrointestinal bleeding.