Thinning of the retinal nerve fiber and choroidal layers in adolescents with anorexia nervosa: A controlled study.

PURPOSE: We aimed to evaluate retinal nerve fiber and choroidal layer alterations in adolescents with anorexia nervosa using spectral-domain optical coherence tomography. METHODS: Thirty patients with anorexia nervosa and 30 healthy adolescents aged 12-18 years were included in this study. Their age, sex, body mass index, anorexia nervosa type, disease duration, and spectral-domain optical coherence tomography data were recorded. RESULTS: Central macular thickness and retinal nerve fiber layer thickness in the temporal and inferior regions were significantly lesser in patients with anorexia than in healthy controls (p<0.05). Moreover, significant choroidal thinning around the foveal and subfoveal regions in patients with anorexia was observed (p<0.05). In addition, a statistically significant relation between the increase in disease duration and the thinning of the inferior retinal nerve fiber layer was detected (p<0.05). CONCLUSION: The retinal nerve fiber layer and choroidal layer thicknesses were lesser in patients with anorexia than in healthy controls. Screening for retinal indices might prevent the development of irreversible retinal pathologies in adolescents with anorexia nervosa. In addition, thinning of the retinal nerve fiber and choroidal layers could reflect structural or functional changes in the brain of adolescents with anorexia nervosa.

Beliefs and Predictors of Negative Attitudes Toward Obesity Among Turkish Healthcare Professionals: Assessing the Bias with Sub-group Analysis.

AIM: This study aimed to examine Turkish healthcare professionals' beliefs and predictors of negative attitudes toward obesity and to investigate whether those beliefs and negative attitudes differ per their profession and sociodemographic and familial variables. METHOD: In this cross-sectional study, healthcare professionals (n = 495) working in four hospitals of Ankara completed a sociodemographic questionnaire and two self-report scales: the Attitudes Toward Obese Persons Scale and the Beliefs About Obese Persons Scale. Data were collected during May, 2018. RESULTS: Female healthcare professionals had significantly higher (p = 0.03) positive attitude scores than males, and nurses had significantly higher (p = 0.04) Beliefs About Obese Persons Scale scores than physicians, representing their belief that obesity is not under the control of the individual. The Attitudes Toward Obese Persons Scale scores of university hospital healthcare professionals were significantly higher (p = 0.00) than those of public hospital and private hospital healthcare professionals, and Attitudes Toward Obese Persons Scale scores of healthcare professionals who have a family member with a chronic disease were significantly higher (p = 0.027) than those who do not. CONCLUSION: The work experience, spending more time with a patient, and having a member of the family with a chronic illness lead to a more positive attitude toward people with obesity. This result emphasizes the importance of interventions that promote sensitive and empathic communication skills.

COVID-19 Quarantine Effects on Smoking Behavior and Mental Health of Smoking Adolescents.

OBJECTIVE: The world is struggling with the damage caused by the coronavirus disease 2019 pandemic. Most countries have applied quarantines to combat the spread of coronavirus disease 2019. The aim of this study was to determine the mental health of smoking adolescents and the change in smoking behavior compared to their peers during the coronavirus disease 2019 quarantine. MATERIALS AND METHODS: This study was conducted with adolescents registered in the adolescent outpatient clinic with no record of psychiatric illness. The mental health of smoking (n = 50) and non-smoking (n = 121) adolescents was evaluated using the Brief Symptom Inventory. Smoking adolescents have been questioned about the change in smoking behavior since quarantine began. RESULTS: The rates of depression and hostility symptoms were significantly higher in smoking than in nonsmoking adolescents. Male smokers had significantly higher depression and hostility symptoms than male non-smokers. However, no significant difference was observed between the rates of female smokers and non-smokers. It was determined that 54% (27) of the smokers reduced their smoking, while 14% (7) smoked more than before and 3.5% of former smokers stated that they quit smoking during quarantine and these people were included in the non-smoker group. CONCLUSION: It is not surprising that the mental health of adolescents was affected by the coronavirus disease 2019 quarantine. Our findings revealed the necessity to closely monitor the mental health of smoking adolescents, especially males smokers. The results of our study suggest that encouraging adolescents who smoke to quit during the coronavirus disease 2019 pandemic may be more effective than before quarantine.

Knowledge and Attitudes of Pediatric Residents to Smoking Intervention in Adolescents.

OBJECTIVE: Tobacco use is an important, preventable public health problem, and its use usually begins in adolescence. For this reason, smoking intervention for tobacco control is considered one of the fields of pediatrics. This study aims to examine the knowledge and attitudes of pediatric residents toward tobacco control and smoking intervention. MATERIALS AND METHODS: In this multicenter study, pediatric residents were asked about their knowledge and attitudes toward adolescent smoking intervention and tobacco control through an online questionnaire. RESULTS: A total of 271 pediatric residents participated in the study, and 56% of the residents stated that they asked adolescents with respiratory tract symptoms whether they smoked or not. However, 22% of pediatric residents stated that they asked the same question to adolescents regardless of their symptoms, 92% of residents were unaware of the International Diagnostic Code for tobacco use, and 86% of the participants reported that they did not receive any training on tobacco control. It was determined that the residents, who knew the national smoking cessation hotline, were female, smokers, and seniors. They asked the adolescents whether they smoked or not and the results were statistically significant (P < .05). CONCLUSION: The results show that pediatric residents have insufficient knowledge about tobacco control and cannot guide adolescents in smoking intervention. This research reveals that pediatric residents need a training program for adolescent smoking intervention in the pediatric resident curriculum. Pediatricians who are well trained in adolescent tobacco control can make important contributions to the prevention of tobacco use in adults.

Premature ovarian failure in juvenile systemic lupus erythematosus patient: A rare presentation.

A 16-year-old girl was admitted to the hospital for the absence of a menstrual bleeding over 10 mounts. She has had regular menstrual periods since she was 13 years old and no history of systemic disease. Laboratory tests showed low estrogen (<11.8 ng/L, range 16-238 ng/L), elevated FSH (follicle stimulating hormone) (138.3 U/L), low AMH (anti-Mullerian hormone) (<0.01 µg/L), normal prolactin (7 µg/L), and thyroid hormone levels (TSH: 1.5 mU/L). The ovaries were prepubertal in size and diagnosed with primer ovarian failure. ANA titers, antiphospholipid antibody, and direct coombs were positive. Microscopic hematuria and nephritic proteinuria (34 mg/m2/hour) were also detected and renal biopsy was revealed stage 3-5 lupus nephritis. Premature ovarian failure is an extremely rare disease in childhood. When POF is detected in the adolescent, it is important to investigate the etiology. In this way, it may be possible to diagnose diseases with high morbidity and mortality that may cause POF.

Validity of Serum miRNA 93 and miRNA 191 to Reduce Unnecessary Computed Tomography in Patients With Mild Head Trauma.

BACKGROUND: Indication for the appropriate use of cranial computed tomography (CCT) in patients with mild head trauma (MHT) based on history and physical examination alone remains unclear. Recent studies have been reported that 90% of patients with MHT who undergo CCT under the present clinical decision rules have no clinically important brain injuries. We aimed to investigate whether peripheral blood expression of microRNA 93 (miR93) and microRNA 191 (miR191) in patients with MHT can predict the presence or absence of intracranial injury, reducing the unnecessary use of CCT. METHODS: Fifty-nine consecutive adult patients with isolated MHT undergoing CCT based on the clinical decision guidelines of the New Orleans criteria and 91 age- and sex-matched controls were enrolled in this prospective observational cohort study. Patients were divided into two groups: those without or with traumatic intracerebral or extracerebral lesions identified by CCT. Patients were further divided into two subgroups based on the presence or absence of traumatic parenchymal lesions defined as traumatic brain injury (TBI). RESULTS: Mean serum miR93 and miR191 levels differed significantly between study groups. Of the 79 patients investigated, 16 exhibited trauma-relevant lesions on CCT scan (CCT+). With a cut-off limit of 0.15, miR191 had an area under the curve value of 0.765 (0.640 - 0.889), with sensitivity of 68.1% and specificity of 68.8% in CCT+ patients. Compared to MHT patients without TBI, mean serum miR191 levels were markedly elevated in patients with TBI. However, miR93 levels did not exhibit significant changes in either group. CONCLUSIONS: Circulating miRNA levels increased after MHT and differentiated patients with and without intracranial or extracranial lesions demonstrable on CCT. Adding the measurement of serum miRNAs particularly miR191 to the clinical decision rules for a CCT scan in patients with MHI could allow a reduction in scans.

Hepatitis A virus age-specific seroprevalence after the implementation of a Toddlers' Vaccination in Turkey: Shifting susceptibility to adolescents.

AIM: In Turkey, improvements in sanitation and the implementation of a vaccination program resulted in reduced rates of childhood exposure to hepatitis A virus. The incidence of symptoms and the complications of the disease are known to be increased in later ages. We aimed to describe changes in the seroprevalence of hepatitis A virus from the pre-vaccine era (2012) to the post-vaccine era (2018) in different age groups. MATERIAL AND METHODS: Levels of anti-hepatitis A virus immunoglobulin (Ig)-G of patients with no chronic disease and who were admitted to our hospital between 2013-2018 were obtained retrospectively from a single children's hospital database system. RESULTS: A total of 3238 subjects were enrolled in the study (2820 children, 418 adults). The overall percentage of seropositivity was 60.5% in group 1 (age ≤2 years), 57.9% in group 2 (age 2-6 years), 31.2% in group 3 (age 7-11 years), 32.7% in group 4 (age 12-18 years), 44.6% in group 5 (age 19-24 years), and 73.9% in group 6 (age >25 years). Between 2013-2018, the increase in the number of seropositive individuals in group 2 (p<0.01), and the decrease in groups 3 and 4 were statistically significant from 2013 to 2018 (p=0.028, p<0.01). CONCLUSION: According to the data of this single-center children's hospital in Turkey, hepatitis A virus seropositivity increases significantly in the preschool age group, but decreases in school-age children and adolescents after vaccination.

The effects of parental and peer factors on psychiatric symptoms in adolescents with obesity.

PURPOSE: The aim of this study was to examine the relationships among psychiatric symptoms, effect of beliefs and attitudes of parents about obese people and victimization or bullying in obese adolescents. METHODS: The study group included 110 obese or overweight adolescents and 55 adolescents of normal weight as the control group. All adolescents completed the Brief Symptom Inventory (BSI) and Traditional Bullying Scale. The parents completed the Attitudes Toward Obese Persons (ATOP) Scale and Beliefs About Obese Persons (BAOP) Scale. RESULTS: The BSI subscale scores for depression were significantly higher in the study group. There was no significant relationship found between psychiatric symptoms of obese or overweight adolescents and the ATOP and BAOP scores of parents. When victims, bullies/victims, bullies and those not included in any group among obese or overweight adolescents were examined, psychiatric symptoms of victims and bullies/victims were significantly higher. CONCLUSIONS: The results of this study suggest that the clinical treatment of obesity is not just a matter of diet and exercise but additionally dealing with issues of depression and anxiety. A very satisfactory result of the study was that parents of obese or overweight adolescents did not show an increased weight bias. This study has also shown the association between negative social and psychological ramifications, as the study group was more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. LEVEL OF EVIDENCE: Level III, case-control analytic study.

The Effects of Risk Behaviors and Orthorexic Behavior on Glycemic Control in Adolescents with Type 1 Diabetes

Objective: Adolescents with chronic disease are as likely to exhibit risk-taking behavior as their peers. The aim was to investigate the risk behaviors of adolescents with type 1 diabetes (T1D) and the effect of orthorexic eating behaviors (OEB) on glycemic control (GC). Methods: This cross-sectional study was conducted with 107 adolescents with T1D, aged between 13-18 years and attending high school. The Risk Behavior Scale (RBS) and Orthorexic Behavior Scale (ORTO-11) were administered. A high RBS score indicates risky behavior; a low ORTO-11 score suggests a tendency to OEB. Participants hemoglobin A1c (HbA1c) status was used to assess GC: optimal GC (HbA1c ≤7%); or poor GC (HbA1c >7%). Results: Among females, those with poor GC had significantly lower (p=0.031) ORTO-11 scores than those with optimal GC, which was not the case in males. A significant correlation (r=0.358, p<0.001) was found between HbA1c and total RBS, eating habits subscale, and suicidal tendency subscale scores. Participants with poor GC had significantly higher eating habits subscale, alcohol use, and tobacco use subscale scores (p<0.05). Among females, total RBS and suicidal tendency subscale score was found to be significantly higher in those with poor GC; among males, alcohol subscale score was found to be significantly higher in those with poor GC. Conclusion: This study is the first to show the effect of the tendency for OEB on GC among female adolescents with T1D. The study showed that, along with inappropriate eating behaviors, adolescents with T1D should also be assessed for other risk behaviors to help achieve optimal GC.

Bladder and voiding dysfunction in adolescents with anorexia nervosa: a novel finding and potential causes.

PURPOSE: This study aimed to investigate the bladder capacity (BC) and bladder dynamics of adolescents with anorexia nervosa (AN). METHODS: The participants consisted of 15 adolescents newly diagnosed with AN according to the DSM 5 criteria and in the acute weight loss period who were questioned about the symptoms of lower urinary tract (LUT) dysfunction. Functional bladder capacity (FBC) and voided volume with uroflowmetry were measured for each subject; the larger volume of the two was chosen for the bladder capacity. Uroflowmetry was used to obtain uroflow curves for the participants whose patterns were labeled as pathologic if they were outside the bell-shape. RESULTS: Fourteen (93.3%) of the patients exhibited at least one of the LUT dysfunction symptoms (pathologic voiding symptom/urinary incontinence/pathologic uroflow pattern). BC was observed to increase in 86.6% (n = 13) of the patients. Eighty% of the patients (n = 12) showed pathological uroflow patterns. In patients with pathological uroflow patterns, which showed insufficiency of bladder contraction, assistance of abdominal muscles was needed during voiding. CONCLUSION: The novel findings presented in this study are the increase of BC in adolescents with AN, the presence of at least one type of voiding or bladder dysfunction, and the pathology of uroflow patterns of most patients show that the bladder dynamics is affected in AN. The most important contribution of this study to the literature is that impaired bladder dynamics was determined to be a medical complication of AN. LEVEL OF EVIDENCE: Case-control analytic study, Level III.

The Effect of Pubertal Stage on the Concentrations of the Novel Adipomyokine, Irisin, in Male Adolescents

Objective: Irisin is a recently discovered protein and is defined as an adipomyokine. The relation of irisin with carbohydrate metabolism and other hormone parameters have been investigated. However, studies evaluating the relationship between irisin and puberty are limited and inconclusive. The aim was to evaluate serum concentrations of irisin during different pubertal stages in male adolescents. Methods: The study included normal weight pubertal male adolescents between the ages of 136/12-1411/12 who had entered puberty. Fasting serum irisin concentrations were evaluated, and bioelectrical impedance analysis was used to measure body fat ratio (BFR) and fat-free mass (FFM). BFR was also calculated by caliper measurement of subcutaneous fat at the triceps. Results: Sixty-eight adolescents were enrolled. The number of adolescents in pubertal stage 2, 3, 4 and 5 were n=17 (25%), n=13 (19.1%), n=21 (30.1%) and n=17 (25%), respectively. The median values of the irisin are 8.80, 8.20, 9.15 and 7.24 ng/mL according to the 2-5 pubertal stages, respectively. The levels of circulating irisin did not differ according to the pubertal stage. Additionally, there was no significant relationship between irisin levels and body fat percentage or FFM. Conclusion: Irisin levels do not differ after the onset of puberty or with progressing pubertal maturation. This study strengthens the evidence that there is no change in irisin concentration as puberty progresses. This may have important implications when using this adipomyokine in the future for diagnosis or treatment of obesity-related diseases.

A comparison of noninvasive methods for early detection of hemorrhage: Inferior vena cava ultrasonography and spectrophotometric hemoglobin levels.

OBJECTIVES: Blood hemoglobin concentration measurements using a spectrophotometric method (SpHb), and inferior vena cava ultrasonography (IVC-US) are noninvasive methods used to follow-up hemorrhages. We compared their efficacy using voluntary blood donation as a model of moderate (approx. 500 mL) blood loss. METHODS: In this prospective observational study enrolling blood-donor volunteers (BD) and matched controls, we recorded SpHb, IVC diameters, and vital signs. Changes in variables from baseline were compared between BD and controls using the paired t test and Wilcoxon signed rank test. RESULTS: We included 118 subjects in the BD group and 95 healthy subjects in the control group. Changes in IVC maximum diameter, IVC minimum diameter, pulse rate, mean arterial pressure, pulse pressure, and shock index, but not in other variables, were significantly different in the BD and the control group (P < 0.05). IVCmax ≥1.1 mm yielded a 74% sensitivity and 77% specificity (PPV 79.8%, NPV 70.2%) in detecting early hemorrhage. With these cutoff values, IVCmax or PR reached a 90% sensitivity, while IVCmin and PR reached 98% specificity. CONCLUSIONS: IVC ultrasound may be superior to SpHb in predicting blood loss and may be useful in addition to vital signs for its follow-up.

Does acupuncture have a positive effect on school success in children?

OBJECTIVE: To evaluate school success in pediatric patients undergoing acupuncture treatment for various indications. METHODS: The grades achieved during both school terms by children undergoing acupuncture treatment for various indications at the pediatric outpatient clinic of Ulus State Hospital were analyzed. Exam grades in mathematics, social studies, and Turkish was compared between the first and the second terms. Forty children were included in the study, with 22 male and 18 female, and their average age was 11.1 years. These patients were undergoing acupuncture treatment for attention deficit-hyperactivity disorder (ADHD), enuresis nocturna, migraine, obesity, atopic dermatitis, alopecia areata, and Tourette's syndrome. Treatments were done at the beginning of the second term. Four of the 25 patients with ADHD had borderline intelligence quotients. The report cards of all 40 patients were examined, and their grades in the first and the second school term were compared. RESULTS: There was a statistically significant increase in the grades obtained in mathematics, social studies, and Turkish (P < 0.005) by the students from the first to the second school term. When 4 ADHD patients with borderline deficiency in intelligence were excluded, and the grades among the 21 patients with ADHD were compared for both terms, there was also a statistically significant increase in mathematics, social studies, and Turkish grades (P < 0.05). CONCLUSION: Acupuncture contributed to the academic success of the children who underwent acupuncture treatment for their primary symptoms.

Acupuncture as a complementary treatment for cancer patients receiving chemotherapy.

BACKGROUND: Medical treatment for eliminating the side effects of cancer therapy may not always be efficacious. Acupuncture is one of the most widely accepted alternative and complementary therapies in use today. In this study, we investigated the efficacy of acupuncture in patients experiencing cancer treatment side effects, including nausea, vomiting, pain, poor sleep quality and anxiety. MATERIALS AND METHODS: A total of 45 inpatients who underwent chemotherapy between February and April 2013 in the Oncology Department of Numune Hospital were included in our study. Acupuncture was administered to the patients one day prior to chemotherapy, on the day of chemotherapy and one day after chemotherapy. The patients were evaluated on nausea, vomiting, pain, sleep quality and anxiety before the chemotherapy and on the 4th day of chemotherapy. RESULTS: Of the 45 patients included in the study, 18 (40%) were female and 27 (60%) were male. A total of 25 (55.6%) had an elementary school education; 32 patients (71%) had stage 4 cancer and were treated with palliative chemotherapy (the patient characteristics are shown in Table 1). Statistically significant decreases (p<0.001) in pain, nausea, vomiting, insomnia and anxiety scores were observed after the acupuncture treatment compared to baseline. There were no differences in the age, gender, education level, stage or metastasis levels between the patient groups whose symptoms improved or were unchanged. CONCLUSIONS: Our study showed that acupuncture has positive effects in cancer treatment patients who experience nausea, vomiting, pain, poor sleep quality and anxiety as side effects of chemotherapy. Chemotherapy-related side effects in cancer patients could be decreased by the concurrent use of acupuncture.