Prenatal, perinatal, postnatal risk factors, and excess screen time in autism spectrum disorder.

BACKGROUND: The aim of this study was to investigate pre-, peri-, and postnatal factors, screen time in a group of patients with autism spectrum disorder (ASD) and age and sex-matched clinical controls to evaluate risk factors specific to ASD. METHODS: The study included 211 ASD patients (177 boys, 34 girls; mean age 44.3 ± 13.0 months) and 241 (190 boys, 51 girls; mean age 44.6 ± 14.1 months) age and sex group matched clinical controls. Non-ASD diagnoses were expressive language disorder (n = 135, 56.0%), intellectual disability (n = 15, 6.2%), attention deficit-hyperactivity disorder (n = 6, 2.4%), oppositional disorder (n = 6, 2.4%), and other behavioral or emotional problems (no diagnosis; n = 79, 32.8%). A sociodemographic data form was used to collect data regarding pre-, peri-, and postnatal factors and total daily screen exposure. RESULTS: According to our findings, maternal severe psychological stress and depression during pregnancy, and maternal postpartum depression were more frequent in the ASD group (p = 0.005, p = 0.035, and p = 0.001 respectively). There was a statistically significant difference between groups with regards to maternal any medication use during pregnancy (p = 0.004). The mean duration of daily screen exposure was higher in the ASD group (9.90 ± 5.10 h) compared to non-ASD children (4.46 ± 3.40 h; p < 0.001). A ROC curve showed that 8.5 h and above total daily screen exposure (AUC = 0.808 [95% CI: 0.769-0.848], p < 0.001; 55% sensitivity, 90.5% specificity) is likely to be associated with increased risk for ASD. CONCLUSION: Our study suggests that prenatal maternal psychological stress, prenatal and postpartum depression, and excess exposure to screen might be related to an increased risk for ASD.

Reproducibility in Human-Robot Interaction: Furthering the Science of HRI.

Purpose of Review: To discuss the current state of reproducibility of research in human-robot interaction (HRI), challenges specific to the field, and recommendations for how the community can support reproducibility. Recent Findings: As in related fields such as artificial intelligence, robotics, and psychology, improving research reproducibility is key to the maturation of the body of scientific knowledge in the field of HRI. The ACM/IEEE International Conference on Human-Robot Interaction introduced a theme on Reproducibility of HRI to their technical program in 2020 to solicit papers presenting reproductions of prior research or artifacts supporting research reproducibility. Summary: This review provides an introduction to the topic of research reproducibility for HRI and describes the state of the art in relation to the HRI 2020 Reproducibility theme. As a highly interdisciplinary field that involves work with technological artifacts, there are unique challenges to reproducibility in HRI. Biases in research evaluation and practice contribute to challenges in supporting reproducibility, and the training of researchers could be changed to encourage research reproduction. The authors propose a number of solutions for addressing these challenges that can serve as guidelines for the HRI community and related fields.

The landscape of facial processing applications in the context of the European AI Act and the development of trustworthy systems.

This work focuses on facial processing, which refers to artificial intelligence (AI) systems that take facial images or videos as input data and perform some AI-driven processing to obtain higher-level information (e.g. a person's identity, emotions, demographic attributes) or newly generated imagery (e.g. with modified facial attributes). Facial processing tasks, such as face detection, face identification, facial expression recognition or facial attribute manipulation, are generally studied as separate research fields and without considering a particular scenario, context of use or intended purpose. This paper studies the field of facial processing in a holistic manner. It establishes the landscape of key computational tasks, applications and industrial players in the field in order to identify the 60 most relevant applications adopted for real-world uses. These applications are analysed in the context of the new proposal of the European Commission for harmonised rules on AI (the AI Act) and the 7 requirements for Trustworthy AI defined by the European High Level Expert Group on AI. More particularly, we assess the risk level conveyed by each application according to the AI Act and reflect on current research, technical and societal challenges towards trustworthy facial processing systems.

Long-Term Effects of Lithium Use on Children and Adolescents: A Retrospective Study from Turkey.

Background: The aim of this study was to evaluate the long-term effects of lithium treatment on white blood cell (WBC) count, serum creatinine, and thyroid-stimulating hormone (TSH) levels in children and adolescents with bipolar disorder (BD) and non-BD in a Turkish children and adolescent sample. Methods: The study is based on retrospective chart review. Children and adolescent patients with BD and non-BD prescribed lithium in a mental health and neurological disorders hospital between 2012 and 2017 were included in the study. Data were collected from the electronic medical files. Laboratory values for WBC count, serum creatinine, and TSH levels at baseline within the week before the onset of lithium, and at 1st, 3rd, 6th, and 12th month of treatment were recorded. Results: A total of 143 patients (82 females, 61 males; 100 BD, 43 non-BD) aged 9-18 were included. Non-BD diagnoses were psychotic and schizoaffective disorders, unipolar depression, attention-deficit/hyperactivity disorder, conduct disorder, severe mood dysregulation syndrome, borderline personality disorder, and autism. Mean age of the participants were 15.90 ± 1.16 years for the bipolar group and 14.88 ± 1.79 years for the nonbipolar group. Patients with BD reported more adverse effects. There was a statistically significant increase in WBC counts and TSH levels at any time point. A statistically significant elevation in serum creatinine was found at 3rd and 12th month of treatment. During the course of lithium treatment, WBC counts exceeded 13,000 in 14 (9.8%) patients, and TSH levels exceeded 5.5 mU/L in 41 patients (28.6%). Twenty-one (14.68%) patients were started on thyroxin replacement. Basal TSH levels and duration of the lithium treatment were higher in the participants with TSH levels exceeding 5.5 mU/L. Lithium maximum dose, lithium blood level, basal TSH level, and duration of treatment were higher in the participants receiving thyroxin replacement. No patients had serum creatinine levels exceeding the normal reference values. Conclusion: Our study suggests that lithium is a generally safe and tolerable agent for children and adolescents with BD and non-BD; however, close monitoring of thyroid functions particularly in patients with a higher basal TSH level and longer duration of lithium use is important.

Mind Your Manners! A Dataset and a Continual Learning Approach for Assessing Social Appropriateness of Robot Actions.

To date, endowing robots with an ability to assess social appropriateness of their actions has not been possible. This has been mainly due to (i) the lack of relevant and labelled data and (ii) the lack of formulations of this as a lifelong learning problem. In this paper, we address these two issues. We first introduce the Socially Appropriate Domestic Robot Actions dataset (MANNERS-DB), which contains appropriateness labels of robot actions annotated by humans. Secondly, we train and evaluate a baseline Multi Layer Perceptron and a Bayesian Neural Network (BNN) that estimate social appropriateness of actions in MANNERS-DB. Finally, we formulate learning social appropriateness of actions as a continual learning problem using the uncertainty of Bayesian Neural Network parameters. The experimental results show that the social appropriateness of robot actions can be predicted with a satisfactory level of precision. To facilitate reproducibility and further progress in this area, MANNERS-DB, the trained models and the relevant code are made publicly available at https://github.com/jonastjoms/MANNERS-DB.

Affect-Driven Learning of Robot Behaviour for Collaborative Human-Robot Interactions.

Collaborative interactions require social robots to share the users' perspective on the interactions and adapt to the dynamics of their affective behaviour. Yet, current approaches for affective behaviour generation in robots focus on instantaneous perception to generate a one-to-one mapping between observed human expressions and static robot actions. In this paper, we propose a novel framework for affect-driven behaviour generation in social robots. The framework consists of (i) a hybrid neural model for evaluating facial expressions and speech of the users, forming intrinsic affective representations in the robot, (ii) an Affective Core, that employs self-organising neural models to embed behavioural traits like patience and emotional actuation that modulate the robot's affective appraisal, and (iii) a Reinforcement Learning model that uses the robot's appraisal to learn interaction behaviour. We investigate the effect of modelling different affective core dispositions on the affective appraisal and use this affective appraisal as the motivation to generate robot behaviours. For evaluation, we conduct a user study (n = 31) where the NICO robot acts as a proposer in the Ultimatum Game. The effect of the robot's affective core on its negotiation strategy is witnessed by participants, who rank a patient robot with high emotional actuation higher on persistence, while an impatient robot with low emotional actuation is rated higher on its generosity and altruistic behaviour.

Transcultural differences in suicide attempts among children and adolescents with and without migration background, a multicentre study: in Vienna, Berlin, Istanbul.

While suicide can occur throughout the lifespan, worldwide suicide is the second leading cause of death among young people aged between 15 and 29 years. The aim of this multicentre study, conducted in Austria, Germany and Turkey, is to investigate the transcultural differences of suicide attempts among children and adolescents with and without migration background. The present study is a retrospective analyses of the records of 247 young people, who were admitted after a suicide attempt to Emergency Outpatient Clinics of Departments of Child and Adolescent Psychiatry of the collaborating Universities including Medical University of Vienna, Charité University Medicine Berlin and Cerrahpasa School of Medicine and Bakirkoy Training and Research Hospital for Mental Health in Istanbul over a 3-year period. The results of the present study show significant transcultural differences between minors with and without migration background in regard to triggering reasons, method of suicide attempts and psychiatric diagnosis. The trigger event "intra-familial conflicts" and the use of "low-risk methods" for their suicide attempt were more frequent among patients with migration background. Moreover among native parents living in Vienna and Berlin divorce of parents were more frequent compared to parents living in Istanbul and migrants in Vienna. These results can be partly explained by cultural differences between migrants and host society. Also disadvantages in socio-economic situations of migrants and their poorer access to the healthcare system can mostly lead to acute and delayed treatments. Larger longitudinal studies are needed to understand better the impact of migration on the suicidal behaviour of young people.

The protective effects of Anakinra in a neonatal rat model of necrotizing enterocolitis.

BACKGROUND: Necrotizing enterocolitis (NEC) is a commonly seen life-threatening condition in newborns characterized by ischemic necrosis. This study aimed to investigate anakinra's effects, an interleukin-1 receptor antagonist, on oxidative stress, inflammation, and tissue necrosis in an NEC rat model. METHODS: Forty Wistar albino pups were divided into four groups randomly as follows; group 1, control group; group 2, anakinra-treated control group; group 3, NEC group; and group 4, NEC and anakinra treatment group. The rats were given hyperosmolar formula feeding, and they were exposed to hypoxia after cold stress at +4 °C and oxygen in order to create the NEC model. On the 4th day of the experiment, the pups were decapitated, and the intestinal tissues were resected for biochemical and histopathologic examination. RESULTS: Microscopic injury scores and apoptotic indexes were higher in group 3 than the control group (p < 0.001, p = 0.002, respectively), and there was a significant decrease after anakinra. Interleukin 1ß and caspase-3 levels increased with NEC and decreased significantly after administration of anakinra (p = 0.006, p = 0.004, respectively). Malondialdehyde and glutathione peroxidase levels also increased compared with the control group (p = 0.019, p = 0.002, respectively). DISCUSSION: In this experimental study, we found that anakinra had antiinflammatory and antioxidant effects and was protective against intestinal injury and apoptosis.

CRP/albumin ratio: A promising marker of gram-negative bacteremia in late-onset neonatal sepsis.

OBJECTIVE: Neonatal sepsis is a clinical condition that results in serious morbidity and mortality unless urgently diagnosed and treated. Obtaining the results of blood cultures to determine the causative agent in sepsis is a time-consuming process. The CRP/albumin ratio is an inflammatory marker that has started to be used in recent years. The aim of our study was to investigate the relationship between CRP/albumin and Gram-negative bacterial sepsis in neonates. MATERIAL AND METHODS: This study was conducted on 112 premature neonates with sepsis. The patients were divided into two groups according to culture results as Gram-negative and Gram-positive bacterial sepsis. The laboratory and demographic features of the patients were obtained from the hospital records. A receiver operating characteristic curve was plotted to evaluate the predictive value of the CRP/albumin ratio for Gram-negative sepsis. RESULTS: CRP/albumin was significantly higher in the Gram-negative group (p<0.001). According to the receiver operating characteristic curve, the optimal cut-off value of CRP/albumin for the prediction of Gram-negative sepsis was >35.17, which had a specificity of 97% and sensitivity of 56% (AUC=0.839; 95% CI: 0.743-0.944; p<0.001). A multivariate logistic regression analysis revealed that CRP/albumin (OR=1.082, 95% CI: 1.033-1.134, p=0.001) and absolute neutrophil count (OR=1.145, 95% CI: 1.000-1.312, p=0.049) were still associated with Gram-negative sepsis after adjustment for variables found to be statistically significant in univariate analysis and correlated with Gram-negative sepsis. CONCLUSION: The CRP/albumin ratio is independently related to Gram-negative sepsis in neonatal sepsis and may be useful in predicting Gram-negative bacteremia.

What chances do children have against COVID-19? Is the answer hidden within the thymus?

A new type of coronavirus named as SARS-CoV-2 pandemic has begun to threaten human health. As with other types of coronaviruses, SARS-CoV-2 affects children less frequently, and it has been observed that the disease is mild. In the pathogenesis of a standard viral infection, the pathogen's contact with the mucosa is initially followed by an innate immunity response. T cells are the primary decisive element in adaptive immunity capability. For this reason, the adaptive immune response mediated by the thymus is a process that regulates the immune response responsible for preventing invasive damage from a virus. Regulatory T cells (T-reg) are active during the early periods of life and have precise roles in immunomodulation. The thymus is highly active in the intrauterine and neonatal period; it begins to shrink after birth and continues its activity until adolescence. The loss of T-reg function by age results in difficulty with the control of the immune response, increased inflammation as shown in coronavirus disease (COVID-19) as an inflammatory storm. Also, the thymus is typically able to replace the T cells destroyed by apoptosis caused by the virus. Thymus and T cells are the key factors of pathogenesis of SARS-CoV-2 in children.Conclusion: We speculated that thymus activity and T lymphocyte function in children protect them against the virus effects. Stimulating and preventing the inhibition of the thymus can be possible treatment components against COVID-19. What is Known: • The SARS-CoV-2 infection does not often progress with an invasive clinic in children. • Thymus activity and T lymphocyte functions are highly active in children. What is New: • Effective thymus activity and T lymphocyte function in children protect them against the invasive SARS-CoV-2 infection. • Stimulating and preventing the inhibition of the thymus can be possible treatment components against COVID-19.

Audio-Driven Robot Upper-Body Motion Synthesis.

Body language is an important aspect of human communication, which an effective human-robot interaction interface should mimic well. Human beings exchange information and convey their thoughts and feelings through gaze, facial expressions, body language, and tone of voice along with spoken words, and infer 65% of the meaning of the communicated messages from these nonverbal cues. Modern robotic platforms are, however, limited in their ability to automatically generate behaviors that align with their speech. In this article, we develop a neural-network-based system that takes audio from a user as an input and generates upper-body gestures, including head, hand, and torso movements of the user on a humanoid robot, namely, Softbank Robotics' Pepper. Our system was evaluated quantitatively as well as qualitatively using Web surveys when driven by natural speech and synthetic speech. We compare the impact of generic and person-specific neural-network models on the quality of synthesized movements. We further investigate the relationships between quantitative and qualitative evaluations and examine how the speaker's personality traits affect the synthesized movements.

Lessons Learned About Designing and Conducting Studies From HRI Experts.

The field of human-robot interaction (HRI) research is multidisciplinary and requires researchers to understand diverse fields including computer science, engineering, informatics, philosophy, psychology, and more disciplines. However, it is hard to be an expert in everything. To help HRI researchers develop methodological skills, especially in areas that are relatively new to them, we conducted a virtual workshop, Workshop Your Study Design (WYSD), at the 2021 International Conference on HRI. In this workshop, we grouped participants with mentors, who are experts in areas like real-world studies, empirical lab studies, questionnaire design, interview, participatory design, and statistics. During and after the workshop, participants discussed their proposed study methods, obtained feedback, and improved their work accordingly. In this paper, we present 1) Workshop attendees' feedback about the workshop and 2) Lessons that the participants learned during their discussions with mentors. Participants' responses about the workshop were positive, and future scholars who wish to run such a workshop can consider implementing their suggestions. The main contribution of this paper is the lessons learned section, where the workshop participants contributed to forming this section based on what participants discovered during the workshop. We organize lessons learned into themes of 1) Improving study design for HRI, 2) How to work with participants - especially children -, 3) Making the most of the study and robot's limitations, and 4) How to collaborate well across fields as they were the areas of the papers submitted to the workshop. These themes include practical tips and guidelines to assist researchers to learn about fields of HRI research with which they have limited experience. We include specific examples, and researchers can adapt the tips and guidelines to their own areas to avoid some common mistakes and pitfalls in their research.

Effects of metformin on epicardial adipose tissue and atrial electromechanical delay of obese children with insulin resistance.

INTRODUCTION: Obesity is usually related to insulin resistance and glucose metabolism disorders. The relationship between insulin resistance and epicardial adipose tissue and atrial electromechanical delay has been described in previous studies. AIM: This study aims to demonstrate the effects of metformin on epicardial adipose tissue and electromechanical delay in patients using metformin for insulin resistance. MATERIALS AND METHODS: A total of 30 patients using metformin for insulin resistance were included in the study. Pre-treatment and post-treatment epicardial adipose tissue and electromechanical delay were evaluated. RESULTS: There was a statistically significant decrease in epicardial adipose tissue thickness after 3 months of metformin therapy (6.4 ± 2.1 versus 4.7 ± 2.0; p = 0.008). Furthermore, the inter-atrial and intra-atrial electromechanical delay also significantly decreased after 3 months of metformin monotherapy (23.6 ± 8.2 versus 18.1 ± 5.8; p < 0.001, 9.1 ± 2.9 versus 6.3 ± 3.6; p = 0.003, respectively). CONCLUSION: In this study, we show that metformin monotherapy significantly decreases epicardial adipose tissue thickness and electromechanical delay in obese children.

The assessment of skin sebum and moisture content of infants with atopic dermatitis

Background/aim: Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterized by dry skin, pruritus and eczematous lesions. The aim of this study is to evaluate the skin moisture and sebum content of the infants with AD and its relationship between the disease severity. Materials and methods: For this cross-sectional and case-control study we included 49 infants with AD aged between 2 and 24 months and 34 healthy infants with the same age and sex as a control group. Skin moisture and sebum content were measured by the bio- impedance method and recorded. Skin prick tests, total IgE levels and food-specific (milk, egg) IgE levels were performed. Results: There was a significant difference between the groups in terms of mean skin moisture and sebum content percentage (P < 0.001, both). The mean skin moisture and sebum content were correlated with CRP in patients with AD (P < 0.01, r = ­1.00, both), but we did not find any correlation between these parameters with the disease severity. Conclusion: We found that skin moisture and sebum content were low even in unaffected areas in AD. The skin structure of these patients may contribute to the pathogenesis of the disease.

Relação entre o Tecido Adiposo Epicárdico e Resistência à Insulina em Crianças Obesa / The Relationship Between Epicardial Adipose Tissue and Insulin Resistance in Obese Children

Resumo Fundamentos A resistência à insulina (RI) é um distúrbio importante em crianças obesas, pois está intimamente relacionado a doenças cardiovasculares. O tecido adiposo epicárdico (TAE) desempenha um papel no desenvolvimento da RI devido a moléculas bioativas secretadas, sendo que o processo inflamatório dessas moléculas pode causar atraso eletromecânico atrial (AEA). Objetivo O objetivo do nosso estudo foi determinar a relação entre o TAE e o AEA com a RI em crianças obesas. Métodos O estudo incluiu 94 pacientes obesos. A IR foi calculada usando o Modelo de Avaliação da Homeostase da Resistência à Insulina (HOMA-IR) e definida como HOMA-IR maior que o percentil 90 em uma curva de percentil específica para idade e sexo. Os pacientes foram divididos em dois grupos de acordo com sua RI. Todos os pacientes foram submetidos a exames ecocardiográficos. A significância estatística foi estabelecida como valor de < 0,05 bicaudal. Resultados A TAE encontrava-se significativamente maior no grupo RI (p < 0,001). O valor de corte ideal para que o TAE previsse a RI foi > 3,85 mm, com especificidade de 92,5% e sensibilidade de 68,5% (p = 0,002). No modelo de regressão logística multivariada, o TAE (OR = 1.256, IC de 95%: 1.016-1.53, p = 0.035) esteve associado à RI após o ajuste para as variáveis estatisticamente significativas na análise univariada. O AEA inter e intra-atrial mostrou-se significativamente prolongado no grupo RI em comparação com o grupo sem RI (p < 0,010; p = 0,032, respectivamente). Conclusão No nosso estudo, revelamos que o TAE esteve positivamente correlacionada com a RI e foi preditor independente de RI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Insulin resistance (IR) is an important disorder in obese children because it is closely related to cardiovascular diseases. Epicardial adipose tissue (EAT) plays a role in the development of IR due to secreted bioactive molecules, and the inflammatory process of these molecules may cause atrial electromechanical delay (EMD). Objective The objective of our study was to determine the relationship between EAT and EMD with IR in obese children. Methods Ninety-four obese patients were included in the study. IR was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and defined as HOMA-IR greater than the 90thpercentile in an age- and sex-specific percentile curve. Patients were divided into two groups according to their IR. All patients underwent echocardiographic examinations. Statistical significance was set to a two-sided p-value < 0.05. Results EAT was significantly higher in the IR group (p < 0.001). The optimal cut-off value for EAT to predict IR was found to be > 3.85 mm, with 92.5% specificity and 68.5% sensitivity (p = 0.002). In the multivariate logistic regression model, EAT (OR = 1.256, 95% CI: 1.016-1.53, p = 0.035) was also associated with IR after adjustment for variables found to be statistically significant in univariate analysis. Inter- and intra-atrial EMD was significantly prolonged in the IR group compared to the group without IR (p < 0.010; p = 0.032 respectively). Conclusion: In our study, we revealed that EAT was positively correlated with IR and was an independent predictor of IR. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

The Relationship Between Epicardial Adipose Tissue and Insulin Resistance in Obese Children. / Relação entre o Tecido Adiposo Epicárdico e Resistência à Insulina em Crianças Obesa.

Background Insulin resistance (IR) is an important disorder in obese children because it is closely related to cardiovascular diseases. Epicardial adipose tissue (EAT) plays a role in the development of IR due to secreted bioactive molecules, and the inflammatory process of these molecules may cause atrial electromechanical delay (EMD). Objective The objective of our study was to determine the relationship between EAT and EMD with IR in obese children. Methods Ninety-four obese patients were included in the study. IR was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and defined as HOMA-IR greater than the 90thpercentile in an age- and sex-specific percentile curve. Patients were divided into two groups according to their IR. All patients underwent echocardiographic examinations. Statistical significance was set to a two-sided p-value < 0.05. Results EAT was significantly higher in the IR group (p < 0.001). The optimal cut-off value for EAT to predict IR was found to be > 3.85 mm, with 92.5% specificity and 68.5% sensitivity (p = 0.002). In the multivariate logistic regression model, EAT (OR = 1.256, 95% CI: 1.016-1.53, p = 0.035) was also associated with IR after adjustment for variables found to be statistically significant in univariate analysis. Inter- and intra-atrial EMD was significantly prolonged in the IR group compared to the group without IR (p < 0.010; p = 0.032 respectively). Conclusion: In our study, we revealed that EAT was positively correlated with IR and was an independent predictor of IR. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Can Nesfatin-1 Predict Hypertension in Obese Children?

Objective: The prevalence of childhood obesity is increasing and leads to co-morbidities such as hypertension. However, it is still not clear why some obese individuals are hypertensive and others not. Nesfatin-1 is a recently discovered anorexigenic peptide which also has effects on blood pressure (BP). Our aim was to evaluate the relationship between obesity-related hypertension and Nesfatin-1. Methods: This cross-sectional study comprised 87 obese children. The patients were divided into two groups; hypertensive (n=30) and normotensive (n=57) obese. The American Academy of Pediatrics guidelines were used to diagnose hypertension. Blood samples were collected after 12 hours of fasting to investigate Nesfatin-1 concentrations. We also evaluated serum trace elements in addition to the routine blood tests. Results: Body mass index (BMI), weight and serum Nesfatin-1 concentrations were higher in the hypertensive group (p=0.002, p=0.001, and p=0.007, respectively). There was no difference between serum zinc levels, but Copper (Cu) levels were significantly lower in the hypertensive group (p=0.248, p=0.007, respectively). There were positive correlations between BP and BMI and weight Z-scores and a negative correlation with Cu. The optimal cut-off value of Nesfatin-1 to predict hypertension was found to be >1.8 ng/mL, with a specificity of 71.9% and a sensitivity of 96.7% [area under the curve=0.703, 95% confidence interval (CI): 0.577-0.809; p=0.002]. In multiple logistic regression analysis Nesfatin-1 [Odds ratio (OR)=1.103, 95% CI: 1.039-1.171; p=0.001], Cu (OR=0.947, 95% CI: 0.915-0.979; p=0.001) and BMI for age Z-score (OR=56.277, 95% CI: 5.791-546.907; p=0.001) still remained significant predictors of hypertension. Conclusion: Nesfatin-1 levels are higher and are an independent predictor of hypertension in obese subjects.

Cerebral atrophy in 21 hypotonic infants with severe vitamin B12 deficiency.

AIM: Nutritional B12 deficiency is a treatable cause of neurodevelopmental delay in infants. We report 21 infants with developmental regression and brain atrophy as revealed using cranial magnetic resonance imaging (MRI), secondary to severe vitamin B12 deficiency. METHODS: Twenty-one infants aged 4-24 months with B12 deficiencies who were admitted to our clinic between May 2013 and May 2018 were included in the study. MRI, bone marrow aspiration and the Denver-II Developmental Screening Test were performed in all infants. RESULTS: The mean age of the infants was 12.3 months, and the mean B12 level was 70.15 ± 32.15 ng/L. Hypotonia and neurodevelopmental retardation, and anaemia were present in all patients. Their bone marrow examinations were compatible with megaloblastic anaemia. Twelve patients had microcephaly, seven had tremor and one patient died of severe sepsis. Almost all patients were fed with breast milk and their mothers were also malnourished. Nine (42.9%) of the patients were Turkish and 12 (57.1%) were Syrian. All patients had abnormal Denver-II Developmental Screening Test scores. Most patients had severe cortical atrophy, cerebral effusion, thinning of the corpus callosum and delayed myelinisation in cranial MRI. Treatment with B12 resulted in dramatic improvement in general activity and appetite within 72 h. Tremors resolved in all cases. CONCLUSION: Neurological findings and developmental delay related to nutritional B12 deficiency can be prevented without sequelae if diagnosed early. Screening and treating of mothers for this deficiency will contribute to the health of both the mother and their feeding infant.

Assessment of retinal thickness as a marker of brain masculinization in children with congenital adrenal hyperplasia: a pilot study.

Objective To investigate the relationship between brain masculinization and retinal thickness in children with congenital adrenal hyperplasia (CAH). Methods Forty-five patients with CAH aged between 4 and 18 years and 30 age-matched healthy controls were included in this prospective study. Macular area was examined with optical coherence tomography (OCT); central subfield thickness (CST), cube volume (CV) and macular retinal thickness (MT) were measured in each subject. A gender identity questionnaire (GIQ) was used for the evaluation of gender happiness index. Results Girls with CAH had a higher CV (p = 0.002) and MT (p = 0.003) than healthy girls. No significant difference was found between boys with CAH and healthy boys regarding the retinal thickness measurements. Mean CST, CV and MT were significantly higher in boys than in girls in the control group (p = 0.013, p < 0.001, respectively), but there was no significant difference in those parameters between girls and boys with CAH. The gender happiness index was not different between healthy boys and boys with CAH, but was significantly lower in girls with CAH than healthy girls (p = 0.01). Conclusions As retina is part of the brain, our finding appears to be a morphological evidence of the excess androgen exposure on brain structures in girls with CAH. In addition, we suggest using retinal thickness measurements as a marker of prenatal excess androgen exposure in future studies.