Salivary Sex Steroid Levels in Infants and Their Relation with Infantile Colic.

Background: Hypothalamic-pituitary-gonadal axis is active during minipuberty, timing of which coincides with infantile colic. To the best of our knowledge, the relationship between these entities has not been investigated yet. Methods: Saliva samples were collected from 15- to 60-day-old term infants (n=139) between 9 am and 5 pm. Group 1 included infants with infantile colic (n=68, 54.4% female). Remaining healthy infants constituted Group 2 (n=71, 47.9% female). The salivary levels of estradiol (Esal) in females and testosterone (Tsal) in males were studied in duplicate by using the ELISA method. Results: The median (25th-75th centile) age and birth week for all infants were 33 (29-43) days and 39 (38.1-40) weeks, respectively. Levels of Tsal in males [Group 1, 73.35 (59.94-117.82) pg/mL vs Group 2, 77.66 (56.49-110.08) pg/mL, p=0.956] and Esal in females [Group 1, 3.91 (2.76-5.31) pg/mL vs Group 2, 4.03 (1.63-12.1) pg/mL, p=0.683] were similar among the groups. However, only in subjects with infantile colic (Group 1), Esal and body mass index (BMI) standard deviation scores of females were slightly correlated (Group 1, rs= 0.393, p=0.016 vs. Group 2, rs= 0.308, p=0.076) and there was a significant correlation between the sampling time and Tsal in males (Group 1, rs= 0.469, p=0.009 vs. Group 2, rs= -0.005, p=0.976). Conclusions: Random salivary sex steroid levels were similar among groups. However, only in subjects with infantile colic, salivary estradiol levels in females were positively correlated with BMI and salivary testosterone levels were higher later in the day among males. Thus, sex steroid production might be altered during minipuberty in subjects with infantile colic.

Assessment of utero-cervical angle and cervical length as predictors for threatened preterm delivery in singleton pregnancies.

OBJECTIVES: The aim of this study was to evaluate the relationship between the cervix and the threat of preterm labor in singleton pregnancies between gestational weeks less than 37 and greater than 37 weeks in correlation with utero-cervical angle (UCA) and cervical length (CL) measurements. MATERIALS AND METHODS: We conducted a prospective cohort study with UCA and CL measurements in patients with threatened preterm labor (TPL). Primary outcome was differences in UCA and CL measurements in relationship to maternal characteristics and perinatal outcome between groups. Secondary outcome evaluated measurement results and influencing factors for delivery within 7 days, between 1 and 4 weeks and beyond 4 weeks. RESULTS: Overall 152 patients were divided into as study/preterm group (<37 weeks; n = 56) and the control/term group (≥37 weeks; n = 96). Mean gestational age at admission was similar in both groups (30.98 ± 2.83 vs. 30.36 ± 2.63 weeks, p = 0.149) with similar CL (33.9 ± 6.34 vs. 32.02 ± 8.88 mm, p = 0.132), but wider UCA in the preterm group (81.65 ± 16.81° vs. 99.21 ± 22.33°, p < 0.001). Multivariate logistic regression analysis for preterm delivery was significant for nulliparity and UCA measurement. The factor for delivering before 37 gestational weeks within 7 days was the gestational week at admission (p = 0.046). UCA and CL measurements were statistically significant for distinguishing patients for delivery within 7 days and beyond 4 weeks (p = 0.001 for CL and p = 0.0001 for UCA). NPV was found 92.5, 92.2, and 92.3 for UCA >105°, CL ≤30 mm, and Bishop score >3, respectively. CONCLUSION: Combined measurement of TV UCA and CL represents stronger predictors for sPTB ultrasonographically, demonstrating the uterocervical sub-segment maturation before the active onset of labor.

The subclinical effect of celiac disease on the heart and the effect of gluten-free diet on cardiac functions.

This study aimed to investigate the effects of celiac disease (CD) on cardiac function in children by using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Forty-nine patients diagnosed with CD were enrolled into the study. Group 1 consisted of 26 (53%) patients who had recently been diagnosed and had not been on gluten-free diet whereas Group 2 consisted of 23 (47%) patients who had been on regular gluten-free diet for at least 10 months. 20 healthy children were enrolled into the study as the control group. The deceleration time (DT) and the left ventricle (LV) isovolumetric relaxation time (IVRT) were significantly shorter in Group 1 compared to Group 2 and the control group (p=0.002, p=0.015). Mitral valve E/E' ratio was significantly lower in Group 1 and 2 when compared to the control group (p < 0.001). The study demonstrated that evaluation of these parameters by using TDE could be beneficial in the early diagnosis of cardiac involvement in children with CD.

Abusive head trauma: two case reports.

Abusive head trauma is a serious form of child abuse and mostly seen in infants below the age of two years as a result of a strong shaking by the caregiver who aims to stop the infant's crying. Characteristic symptoms include subdural hematomas, encephalopathy, retinal hemorrhages and fractures of the long bones. When physically examined, there are generally no externally visible signs. For this reason, it can be underdiagnosed, if it is not considered in the differential diagnosis. When the information provided from the parents is inconsistent and contradictory with the clinical picture of the patient, this form of abuse must be suspected and retinal hemorrhages should be searched. In this article, two patients who were admitted to our emergency department and diagnosed with physical child abuse are reported. One of these patients had a history of minor head trauma after falling down from the sofa and the other one had a history of breathlessness and loss of consciousness as a result of excessive crying.

Salmonella gastroenteritis in children (clinical characteristics and antibiotic susceptibility): comparison of the years 1995-2001 and 2002-2008.

We document herein the prevalence and serotype distribution among Salmonella enterica strains isolated from children treated for diarrhea over two seven-year periods spanning 14 years. Four hundred and eight (1.38%) S. enterica cases were isolated among 29,601 diarrheal admissions. Among the Salmonella isolates, 63.7% were serogroup D and 29.9% were serogroup B. Overall, 21.7% of cases were under one year of age, with 2.1% being younger than three months. Bloody diarrhea was found in 18.8% of the cases. The resistance rates were 25.8%, 18.2%, 7.0%, 4.7%, and 0.3%, to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin, respectively. In conclusion, our study has revealed that the predominance of Salmonella serogroup D continues. The clinical features of our patients were mostly mild, with no deaths or severe complications. While resistance to antimicrobial agents changes constantly, it is important to keep these strains under surveillance in order to formulate policies for the rational use of antimicrobial agents.

Clinical characteristics and antibiotic resistance of Shigella gastroenteritis in Ankara, Turkey between 2003 and 2009, and comparison with previous reports.

OBJECTIVES: The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002. METHODS: A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics. RESULTS: The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p<0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p<0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively). CONCLUSIONS: There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases.

Hepatitis A seroprevalence among infants aged 12 months in Ankara.

Seroprevalence studies in various age groups contribute to a better understanding of hepatitis A infection and response to hepatitis A immunization. Hepatitis A seroprevalence in 12-month-old infants from Ankara was studied. Among 601 healthy infants, overall hepatitis A seropositivity was found to be 23.5%. There were no gender differences in seropositivity (22.6% for male and 24.5% for female infants). Although vaccination of infants would be an ideal prevention strategy, presence of maternal anti-hepatitis A virus (HAV) antibody interferes with the immune response to hepatitis A vaccine in infants and young children. Therefore, further knowledge about decay of maternal antibody in infants is important in determining the optimal age for vaccination against hepatitis A. There is no recommendation for routine hepatitis A vaccination in Turkey. However, we need more seroprevalence studies in different age groups to decide the appropriate timing/age of vaccination.