Metabolic disturbances and cardiovascular risk factors in obese children with vitamin D deficiency.

OBJECTIVES: The prevalence of obesity among children and adolescents has been rapidly increasing in recent years. Obese individuals are at risk of vitamin D deficiency. The aim of this study was to investigate the relationship between vitamin D deficiency and anthropometric measurements, cardiovascular risk factors, and glucose homeostasis in obese children. METHODS: Between June 2011 and January 2012, 40 obese and 30 non-obese children (between 7 and 14 years of age) were evaluated at Tepecik Training and Research Hospital. The following characteristics were recorded: height; weight; body mass index (BMI); total body fat content; fasting glucose, insulin, and lipid levels; basic biochemical parameters; complete blood count; bilateral carotid intima media thickness; liver ultrasound results; and left ventricular wall thickness were recorded. 25-hydroxy (OH) vitamin D levels were measured from serum. RESULTS: The serum 25(OH) vitamin D level was low in 45 children (64.3%). The 24-h ambulatory blood pressure measurements, carotid intima-media thickness, and the prevalence of 25(OH) vitamin D deficiency were different between obese and non-obese children (P<0.05). The incidence of dyslipidemia was not statistically different between obese and non-obese children (P>0.05). Plasma 25(OH) vitamin D concentrations were negatively correlated with age, BMI, total body fat content, 24-h ambulatory blood pressure, and carotid intima-media thickness (P<0.05). Plasma 25(OH) vitamin D levels were not correlated with fasting plasma glucose, HOMA-IR, triglycerides, total cholesterol, low-density cholesterol, and high-density cholesterol (P>0.05). CONCLUSION: Vitamin D deficiency is more prevalent in obese children. Serum 25(OH)vitamin D was significantly associated with several cardiometabolic risk factors. There was no relationship between abnormal glucose homeostasis and dyslipidemia with vitamin D deficiency in obese children.

C-reactive protein levels in girls with lower urinary tract symptoms.

INTRODUCTION: Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. OBJECTIVE: This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. STUDY DESIGN: Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. RESULTS: There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). DISCUSSION: Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. CONCLUSION: The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.

Scorpion stings in pregnant women: an analysis of 11 cases and review of literature.

Scorpion sting is one of the most important public health problem in many regions of the world. But there is not enough medical data about scorpion stings in pregnant women in the literature. The aim of this study was to describe the clinical findings and treatment modalities of scorpion stings in pregnant women. This study was performed in the Southeast Region of Turkey, retrospectively. Eleven pregnants were studied, totally. All of the patients were detected as class I according to the scorpion envenomization system. They were in different weeks of gestation. Local pain, hyperemia, swelling, and itching were the most frequent complaint in these cases. None of our patients received antivenom, and all of them were treated, symptomatically. Complication of pregnancy was observed in none of them.

What is the relationship between type 2 diabetes mellitus and urolithiasis?

AIM: Despite the high incidence of urolithiasis in general population, the exact underlying pathology is unknown. Possible association between urolithiasis and parameters of physical health were assesed in the presented study. MATERIAL AND METHODS: The study was performed at an Internal Medicine out patient unit during routine check ups. Patients between the ages of 20 and 70 years were studied to prevent debility induced weight loss in elderly. Patients with devastating illnesses were excluded to avoid their possible effects on weight. Cases with urolithiasis were collected in one group, and age and sex-matched cases without urolithiasis were collected in other group. RESULTS: Eighty cases with urolithiasis and 120 cases without were studied. Mean age of urolithiasis cases was 49.0 years, and 52.5 % of them were female. Mean weight of the urolithiasis cases was 76.0 kg, whereas it was 80.8 kg in the group without urolithiasis (p=0.013). The prevalence of type 2 diabetes mellitus (DM) was significantly higher in the urolithiasis group with unknown reasons (17.5 % vs 7.5 %, p<0.01). There was no significant difference as for the height, body mass index, prevalence of hypertension, and mean values of low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglyceride between the groups. CONCLUSION: In spite of several terrible effects of excess weight on health, we could not detect any association with urolithiasis, but there is a highly significant association between urolithiasis and type 2 DM, and it may have hundreds of mechanisms with variable priorities, which must be explained with further studies (Tab. 1, Ref. 21). Full Text in free PDF www.bmj.sk.

Practical cut off values to determine body mass index.

We tried to understand whether there are significant cut off values simply determining body mass index (BMI). The study was performed in Internal Medicine Polyclinics on consecutive check up patients aged between 15 and 70 years to see possible consequences of excess weight on health and to avoid debility induced weight loss in elders. Insulin using diabetics and patients with devastating illnesses were excluded to avoid their possible effects on weight. Cases were subdivided into three groups according to their body weights as under 65, between 65 and 85, and above 85 kg groups and prevalences of underweight, normal weight, overweight, and obesity were determined. Sensitivity, specificity, and positive and negative predictive values of body weights to determine BMI were calculated. The study included 954 cases (566 females). Sensitivity of 65 kg as a cut off value to detect normal weight was 61.0%, specificity 94.3%, positive predictive value 82.9%, and negative predictive value was 97.6%. Similarly, sensitivity, specificity, and positive and negative predictive values of 65 and 85 kg to detect overweight cases were 71.5%, 63.3%, 56.2%, and 77.1% respectively. So both values were statistically significant to detect normal weight, overweight and obese individuals (p = 0.000 for both). Although BMI is probably a more valuable parameter to show weight status, the cut off values of 65 and 85 kg, as an easier way, have significant places, too.

A physiologic events' cascade: irritable bowel syndrome may even terminate with chronic gastritis.

When specifically asked, about one third of people report recurrent upper abdominal discomfort, and irritable bowel syndrome (IBS) and chronic gastritis (CG) maybe the most frequently diagnosed ones among all. Consecutive patients with upper abdominal discomfort applying to the Internal Medicine Polyclinic were included into the study. IBS was diagnosed according to Rome II criteria and CG was diagnosed histologically. All cases with IBS were compared with the age and sex-matched randomly selected cases without IBS. One hundred and fifty-six patients with IBS and 179 patients without IBS were studied. CG was detected in 72.4% (113 cases) of cases with IBS, and only 36.3% (65 cases) in patients without IBS (p < 0.001). IBS probably is a cascade of many physiological events, being initiated by infection, inflammation, psychological disturbances-like many stresses and eventually leading to dysfunctions of gut and other systems of the body via a low-grade inflammatory process. CG may be one of the terminating points of the physiological events' cascade, IBS. This may explain the high prevalence of IBS in society. Keeping in mind this association will be helpful during prevention, treatment, and follow up of these common pathologies in Primary Health Centers and Internal Medicine and Gastroenterology Polyclinics for physicians.

Acro-cardio-facial syndrome associated with neuroepithelial cyst: a case report.

Acro-cardio-facial syndrome (ACFS) is a very rare genetic syndrome. Only 5 patients have been reported in the literature so far. A female neonate presented with limb abnormalities, cleft palate and congenital heart disease was diagnosed as ACFS. Her cranial magnetic resonance imaging revealed a huge cerebral neuroepithelial cyst. To our knowledge, this is the first case of ACFS in the literature associated with a neuroepithelial cyst in the brain.

Effects of terlipressin on systolic pulmonary artery pressure of patients with liver cirrhosis: an echocardiographic assessment.

AIM: Portopulmonary hypertension is a serious complication of chronic liver disease. Our aim was to search into the effect of terlipressin on systolic pulmonary artery pressure among cirrhotic patients. METHODS: Twelve patients (6 males and 6 females) with liver cirrhosis were recruited in the study. Arterial blood gas samples were obtained in sitting position at rest. Contrast enhanced echocardiography and measurements of systolic pulmonary artery pressure were performed before and after the intravenous injection of 2 mg terlipressin. RESULTS: Of 12 patients studied, the contrast enhanced echocardiography was positive in 5, and the positive findings in contrast enhanced echocardiography were reversed to normal in two after terlipressin injection. The mean systolic pulmonary artery pressure was 25.5+/-3.6 mmHg before terlipressin injection, and was 22.5+/-2.5 mmHg after terlipressin (P=0.003). The systolic pulmonary artery pressure was above 25 mmHg in seven of these 12 patients. After the terlipressin injection, systolic pulmonary artery pressure was <25 mmHg in four of these cases (58.3% vs 25%, P=0.04). CONCLUSION: Terlipressin can decrease the systolic pulmonary artery pressure in patients with liver cirrhosis.

Hepatic expression of viral antigens, hepatocytic proliferative activity and histologic changes in liver biopsies of children with chronic hepatitis B after interferon-alpha therapy.

AIMS/BACKGROUND: The purpose of the present study was to evaluate the effects of interferon-alpha (IFNalpha) treatment on necro-inflammatory changes, viral antigen expression and hepatocytic proliferation rate assessed by Ki-67 protein in liver biopsies of children with chronic hepatitis B virus (HBV) infection. METHODS: The study included 18 children at prepubertal age. Histologic changes were assessed using a modified scoring system for grading of histological activity index and staging of fibrosis. The hepatocytic expression of Ki-67 and HBV antigens including HBV surface antigen (HBsAg) and HBV core antigen (HBcAg) were evaluated using a semi-quantitative immunohistochemical scoring system. RESULTS: We found a significant decrease in the scores of intralobular confluent and spotty necrosis, periportal piecemeal necrosis, and in Ki-67 immunopositivity after treatment. Serologic response with clearance of HBV e antigen in 9 patients (50%) was associated with this improvement. The extent of fibrosis and scoring of portal inflammation, however, did not show any difference. HBcAg expression showed a significant decrease after treatment, whereas HBsAg expression either increased or remained unchanged. CONCLUSION: We conclude that IFNalpha treatment might provide an improvement in hepatic histology with a reduction in hepatocytic injury. It might also provide a serologic response associated with a decrease in hepatocytic HBV replication.

Efficacy of interferon therapy on serum fibronectin levels in children with chronic hepatitis B infection.

BACKGROUND: Fibronectin (FN) is a glycoprotein, the major sources of which are hepatocytes, Kupffer cells and endothelial cells. It has many biological functions including adhesion between cells, immunity, blood coagulation and platelet aggregation. Serum FN levels are generally decreased in pathological blood coagulation and inflammation. In the present study, we evaluated the serum levels of FN in patients with chronic hepatitis B virus (HBV) infection treated with interferon-alpha 2b. METHODS: We studied serum levels of FN in a prospective trial between October 1995 and May 1997. The study included 16 patients with chronic HBV infection before and after interferon therapy, in a period of 6 months, and 17 healthy controls. In total, we had 40 patients with chronic HBV infection. We studied these 16 patients (40%) who recovered with interferon therapy. We could not study the other 24 patients because we did not have enough of the reagents for studying FN. RESULTS: Chronic hepatitis B infection was diagnosed serologically and histopathologically. In mean age and sex, no statistically significant differences were found between patients and healthy subjects. The serum FN concentration before treatment with interferon therapy appeared significantly lower in HBV patients than in healthy control subjects (P = 0.026 using the Mann-Whitney confidence interval and test). After treatment with interferon, serum levels of FN were significantly higher than levels obtained before interferon therapy (P = 0.004 using the Wilcoxon Test). CONCLUSIONS: These results suggest that a decreased level of serum FN in patients with chronic hepatitis before interferon treatment is related to hepatic injury and inflammation. Because of inflammation, the serum FN level is decreased due to the consumption of FN. Increased levels of serum FN in patients having interferon therapy is important and is related to the effects of interferon including antiviral, antiproliferative, anti-inflammatory and immunoregulatory properties in patients with chronic HBV infection. A Japanese study showed a correlation between development of hepatic fibrosis and decrease of plasma FN concentration in adult patients with chronic liver disease. Therefore, the serum level of FN may be a useful marker of hepatic fibrosis in chronic liver disease and interferon may be an important drug for prevention of liver fibrosis. Fibronectin may be also a useful marker in predicting IFN response.

Comparative efficacy of cefixime and ampicillin-sulbactam in shigellosis in children.

Shigellosis is still an important health problem in developing and underdeveloped countries as it is resistance to commonly used antibiotics including ampicillin, trimethoprim-sulfamethoxazole, chloramphenicol and tetracycline. Between May 1996 and October 1996, in a prospective randomized double-blind trial, cefixime was compared with ampicillin-sulbactam, both given orally for a period of 5 days, for the treatment of 80 children with acute bloody diarrhea. Forty patients were treated with a single-dose (8 mg/kg per day) of cefixime and the other 40 patients were given three doses of 100 mg/kg per day of ampicillin-sulbactam. After identification of Shigella organisms in stool specimens, nine patients in the cefixime receiving group and six patients in the ampicillin-sulbactam receiving group were excluded from the study. Differences in average age, sex and weight between the cefixime and ampicillin-sulbactam group were statistically meaningless (P > 0.05). Fever and bloody diarrhea were universal features. The efficacy of cefixime was found to be better than ampicillin-sulbactam. Patients given cefixime had a shorter duration of fever (P < 0.01), shorter duration to disappearance of blood in the stool (P < 0.01), reduced time with diarrhea (P < 0.01) and reduced hospitalization time during the 5 study days (P < 0.01) than patients given ampicillin-sulbactam. No adverse effects were observed in the two study groups. This controlled trial showed good efficacy with cefixime compared to ampicillin-sulbactam in the treatment of shigellosis. Single-dose daily oral therapy with cefixime also showed good tolerability. Cefixime should be considered as an alternative drug of choice for shigellosis in children.