The association of urinary BDNF, ATP, and MMP-2 with bladder compliance in children with myelodysplasia.

AIM: The purpose of our study was to evaluate the relationship of urinary brain-derived neurotrophic factor (BDNF), adenosine triphosphate (ATP), matrix metallopreteinase-2 (MMP-2) with urodynamic findings and upper urinary tract deterioration (UUTD) in children with myelodysplasia. MATERIALS AND METHODS: Children with myelodysplasia evaluated in outpatient clinic between 2022 and 2023 were included. All patients underwent urinary ultrasonography, voiding cystourethrography, urodynamics, and DMSA scintigraphy. Urine samples were collected before urodynamics. Control urine was collected from 10 healthy children. Urinary biomarker values of patients and controls were compared, and subgroup analysis was performed. RESULTS: The median age of 40 children (26 girls) included in the study was 108 (8-216) months, and the control group (six girls) was 120 (60-154) (p = 0.981). Urinary BDNF, MMP-2, and ATP were found to be significantly higher in children with myelodysplasia compared to the control (p = 0.007, p = 0.027, p = 0.014, respectively). The three biomarker values were similar in children with bladder compliance below or above 10 cmH2O/mL (p = 0.750, p = 0.844, p = 0.575). No difference was found in terms of UUTD in all three biomarkers (p = 0.387, p = 0.892, p = 0.705). A negative correlation was found between urinary ATP and compliance (p < 0.05). CONCLUSION: In this study, all three biomarkers were found to be higher in children with myelodysplasia than in controls. There was a negative correlation between urinary ATP and compliance. Urinary biomarkers may contribute the follow-up of children with neurogenic lower urinary tract deterioration in future with their noninvasive features. However, the lack of standardization and the inability to reliably predict risky groups are important shortcomings of urinary biomarkers.

Investigation of Thiol/Disulfide Homeostasis and Ischemia-Modified Albumin Levels in Children with Wilson Disease.

BackgroundThe aim of the present study was to assess thiol/disulfide homeostasis (TDH) parameters and ischemia-modified albumin (IMA) levels in children with Wilson Disease (WD) and to compare them to healthy controls. Methods: Based on the inclusion and exclusion criteria, fifteen children with WD and twenty-nine healthy children were enrolled, and serum thiol/disulfide and IMA levels were compared between groups. Results: The mean values of native and total thiols were significantly lower in the WD group than in the control group. The mean value of disulfide was significantly higher in the WD group than in the control group. The mean percentages of disulfide/total thiol and native thiol/total thiol were higher in the WD group than in the control group. The IMA value was also higher in the WD group than in the control group. Conclusion: The present study demonstrating altered thiol/disulfide parameters indicates increased oxidative stress in children with WD.

Pediatric and Maternal Anxiety at First Visit to a Turkish Gastroenterology Clinic Compared to Anxiety Prior to Pediatric Endoscopy Procedure.

The aim of this study was the prospective comparison of pediatric and maternal anxiety at the first visit to a gastroenterology clinic with anxiety prior to a pediatric endoscopy procedure. A total of 101 children aged 4-18 years plus their mothers who were referred to an outpatient pediatric gastroenterology clinic were included in the first group. The second group consisted of 101 different children aged 4-18 years undergoing pediatric endoscopy. The Hospital Anxiety and Depression Scale (HADS) was administered to mothers. Visual analog scale scores were obtained from the children to measure anxiety. The demographic characteristics of the groups were similar. The mean HADS anxiety score was 3.83 in mothers of the first group. The same score was significantly higher as (6.96) in the mothers whose children underwent an endoscopy (p < .001). The comparison of the depression scores revealed significantly higher scores in the endoscopy group. Visual analog scale values of the children revealed remarkably higher anxiety scores in the endoscopy group. About 5% of mothers in the first group and almost half of the mothers in the endoscopy group developed remarkable anxiety (>8 HADS anxiety). The rate of significant depression (>8 HADS depression) was 2% and 17.82% in the first and second groups, respectively. The current prospective trial concluded that particularly anxiety is a major concern for mothers and children when endoscopy is required.

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

Altered thiol/disulfide homeostasis and ischemia-modified albumin levels in children with irritable bowel syndrome.

BACKGROUND: In this study, we assessed thiol/disulfide homeostasis (TDH) parameters and ischemia-modified albumin (IMA) levels in children with irritable bowel syndrome (IBS) compared with healthy children. METHODS: Fifty-six children with IBS and 53 healthy children were included in the study after assessment of inclusion and exclusion criteria. Plasma thiol/disulfide and IMA levels were compared between children with and without IBS. RESULTS: The mean values of native thiol, total thiol, and disulfide were 343.779 ± 138.654 µmol/L, 365.398 ± 140.148 µmol/L, and 23.190 ± 4.978 µmol/L, respectively, in the IBS group and 409.908 ± 69.288 µmol/L, 433.481 ± 76.891 µmol/L, and 20.090 ± 4.252 µmol/L, respectively, in the control group. Native thiol and total thiol values were significantly reduced in the IBS group compared with the control group. The mean IMA values were 0.835 ± 0.083 (g/L) and 0.778 ± 0.072 in the IBS and control groups, respectively. The IMA value was significantly increased in the IBS group. CONCLUSION: Impaired thiol/disulfide homeostasis and increased IMA levels can be considered etiological factors in children with IBS.

The role of N-acetylcysteine in preventing hepatic injury associated with systemic oxidative stress after extracorporeal shock wave treatment.

BACKGROUND: Systemic oxidative stress may cause detrimental consequences for the liver, leading to hepatic fibrogenesis. OBJECTIVES: To investigate histopathological changes in liver tissues due to the increased systemic oxidative stress associated with rat extracorporeal shock wave lithotripsy (SWL) model and to document the consequences of N-acetylcysteine (NAC) administration. MATERIAL AND METHODS: In this experimental SWL model, 18 Wistar albino rats were randomly assigned into 3 groups. The control group (group I) had no intervention. Group II underwent SWL treatment with intraperitoneal saline injection. Group III also had SWL with intraperitoneal NAC and was divided into short-term (group III-14 days) and long-term (group III-28 days) subgroup. Hepatectomy was performed for histopathological examinations. Histopathological alterations were evaluated with light microscopy. Immunohistological staining for p53 and myeloperoxidase was also performed. RESULTS: Blood samples revealed a significant increase in plasma oxidative stress index (OSI) after plasma total antioxidant status (TAS) and total oxidant status (TOS) had been measured. It was shown that this increased systemic oxidative stress adversely affected liver tissues. Predominantly, sinusoidal dilatation was remarkably observed in rats with significantly high OSI values (p = 0.043). Similarly, periportal necrosis significantly increased in rats with high OSI values (p = 0.033). p53 positivity was also remarkable in rats with systemic oxidative stress (p = 0.049). N-acetylcysteine administration provided a significant decrease in OSI. N-acetylcysteine also improved all these alterations, including p53 staining. Particularly, sinusoidal dilatation was significantly protected in the long-term NAC group (group III-28 days). CONCLUSIONS: We demonstrated that SWL-induced systemic oxidative stress causes histological alterations in liver tissues. Increased p53 and myeloperoxidase staining as markers of oxidative damage were also detected. N-acetylcysteine may protect from these histological and ultra-structural alterations related to oxidative stress.

Alteration in Hepatitis B Serology in Children Receiving Chemotherapy.

Chemotherapy-induced immunosuppression can lead to hepatitis B virus (HBV) reactivation in cancer patients. Both HBV carriers and individuals with serological signs of previously resolved HBV exposure are under the risk of severe hepatitis and liver failure during and after chemotherapy. The objective of this largest retrospective study was to analyze the consequences of HBV status in children receiving chemotherapy. A total of 479 patients (273 boys and 206 girls) aged 1-211 months diagnosed with acute hematologic malignancies and solid tumors were included in the study. Serological markers for HBV before and after chemotherapy and clinical data of the patients were evaluated retrospectively. Two hundred thirty-four of the participants were found to have protective antibody titers to HBV at admission. Five children were carrying HBV before chemotherapy. They received antiviral therapy during treatment and no reactivation was detected. Antibody against hepatitis B surface antigen (antiHBs) remained positive in 194 patients after chemotherapy. However, 17.09% (40/234) lost antiHBs positivity. In this group, three patients (1.28%) who initially had positive antiHBs and antihepatitis B core antibody experienced HBV reactivation and lost their protective antiHBs at the end of the therapy. Median antiHBs titer significantly decreased after chemotherapy (213.14 [range: 24-888] vs. 180.85 [range: 0-850]) (p = 0.0094). The current relatively large trial demonstrated that protective antibody titers remarkably altered after chemotherapy, and at least 17% of the pediatric oncology cases lost antiHBs positivity. Therefore, vaccine prevention and close monitoring of serology should be considered during chemotherapy.

Increased serum BDNF and ProBDNF levels in children with irritable bowel syndrome.

OBJECTIVE: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders among the pediatric population. Recently, neurotrophins have been suggested to be etiological factors or causes of symptoms of IBS. In the present study, the aim was to research the serum brain-derived neurotrophic factor (BDNF) and proBDNF levels in children with IBS. METHODS: The study group was selected from pediatric gastroenterology outpatient clinic and control group was recruited from healthy children outpatient clinic. Based on the inclusion and exclusion criteria, 29 children with IBS and 55 healthy children were included in the study. The data were obtained from all participants, and if needed, from their parents. All participants were assessed in terms of anthropometric measurements. The serum (BDNF) and proBDNF levels were compared between the groups. RESULTS: The proBDNF levels in IBS patients were higher compared with the control group in covariance analysis (IBS patients group mean 492.4, SD 534.1; control group mean 332.8, SD 406.7) (p = 0.02; Cohen's d = 0.45). The serum BDNF levels of IBS patients were also higher compared with the control group (IBS patients group mean 3.1, SD 4.3; control group mean 1.7, SD 2.7) (p = 0.02; Cohen's d = 0.51). CONCLUSIONS: The present study is the first to demonstrate that there is a higher level of serum BDNF in children with IBS. Moreover, it is the first to demonstrate an increased level of proBDNF in IBS. Additional research is needed to confirm the preliminary results.

Impact of sleep behaviors on social and emotional problems in three-year-old children born prematurely.

BACKGROUND: Childhood sleep problems have been associated with a number of negative health outcomes, but there is limited data on the relationship between sleep problems and social and emotional problems in preterm babies. OBJECTIVE: The aim of this study was to investigate sleep habits and the relationship between sleep problems and social and emotional problems in preterm infants with a corrected age of three years old. METHOD: The study included 40 preterm children and 40 full-term children. In order to evaluate the sleep habits and social and emotional problems of the children, their mothers completed the Brief Infant Sleep Questionnaire (BISQ) and the Brief Infant Toddler Social Emotional Assessment Scale (BITSEA) form. RESULTS: It has been found that preterm children had longer sleeplessness at night than full-term children and the frequency of night awakening was also higher in full-term children. There was no difference between preterm and full-term children in terms of sleep duration, sleep location and methods of falling asleep. Although there was no difference between the two groups in the BITSEA problem scores, the BITSEA competence scores were significantly lower in preterm children compared to full-term children. In addition, considering the relationship between sleep behaviors and social and emotional problems in preterm infants, a significant correlation was found between short sleep duration at night, total sleep duration, and lower BITSEA competence scores. A late sleep time and social and emotional subclinical problem scores were also found to be correlated. CONCLUSION: According to the results of this study, no significant difference was found in terms of sleep behaviors between preterm and full-term three-year-old children. However, BITSEA competence scores were lower in preterm children and an association has been found between sleep behaviors and social and emotional problems.

Risk of gastric cancer in children with Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) is the most common chronic infectious agent in the stomach. Most importantly, it may lead to atrophy, metaplasia and cancer. The aim of this study was to investigate the incidence of H. pylori infection and to detect early mucosal changes that may lead to malignant degeneration in children. MATERIALS AND METHODS: Children who underwent upper gastrointestinal endoscopy were included. Familial history of gastric cancer was noted. Endoscopic examinations were performed by a single pediatric gastroenterologist. A minimum of three biopsy samples were collected during endoscopy. The patients were accepted as H. pylori infected if results of biopsies and rapid urease test were both positive. Biopsies were evaluated for the presence and degree of chronic inflammation, the activity and severity of gastritis, glandular atrophy and intestinal metaplasia. RESULTS: A total of 750 children (388 boys, 362 girls) were evaluated in our study, with a mean age of 10.1 years. A total of 390 patients (52%) were found to be infected with H. pylori. Among the H. pylori infected patients, 289 (74%) were diagnosed to have chronic superficial gastritis, 24 (6.2%) had gastric atrophy. Most strikingly, intestinal metaplasia was observed in 11 children, all were in the H. pylori positive group. There was no difference in the mean of age, gender and socioeconomic class between H. pylori infected and non-infected groups. The frequency of gastric cancer in family members (4 in number) was higher in patients with H. pylori infection. No gastric cancer case was reported from the parents of non-infected children. The worst biopsy parameters (atropy and metaplasia) were improved after H. pylori eradication on control endoscopy. CONCLUSIONS: The current study shows a higher prevalence of familial history of gastric cancer in H. pylori infected children. Intestinal metaplasia was also higher in the infected children. Eradication of H. pylori infection for this risk group may prevent subsequent development of gastric cancer.

The interaction between Helicobacter pylori and atopy: does inverse association really exist?

AIM: To date, cross-sectional and case-control studies suggest an inverse association between Helicobacter pylori infection and atopic diseases, whereas the immunologic basis has not been studied yet. In this study we investigated T helper (Th) cell function in H. pylori-infected children and compared cytokine responses in atopic and non-atopic groups. METHODS: The study groups was recruited from a cohort of 327 healthy children evaluated and followed-up for 6 years to assess the natural history of H. pylori infection. Seventy-four of 136 healthy children who underwent (13)C urea breath test were eligible and accepted to participate. All participants were evaluated by a questionnaire, and skin-prick testing. According to the results, children were divided into four groups with respect to the presence or absence of H. pylori and atopy. Peripheral blood mononuclear cells isolated from 34 of 74 children were cultured with H. pylori, Der p 1, and phytohemagglutinin (PHA). Interferon-gamma (IFN-gamma), interleukin (IL)-4 and IL-10, transforming growth factor-beta (TGF-beta) levels were measured in supernatants. RESULTS: The frequency of atopy was lower in H. pylori-infected group (31.9% vs. 48.1, p = .22), while atopic symptoms were similar between infected and non-infected children. While PHA and H. pylori induced IFN-gamma levels were significantly higher in H. pylori-infected children, concomitant presence of both atopy and H. pylori decreased the level of PHA and H. pylori induced IFN-gamma production. PHA and Der p 1-induced IL-4 levels were higher in atopic children, and IL-4 production was suppressed when they were concomitantly infected with H. pylori. The production of TGF-beta was found to be suppressed in atopic children irrespective of the presence of H. pylori infection. CONCLUSION: The results of the current study demonstrated a counteractive Th1 and Th2 cytokine interaction between H. pylori infection and atopy. However, this counteractive immunologic balance did not protect against atopy.

Hepatitis A virus infection presenting with seizures.

Hepatitis A infection rarely causes extrahepatic manifestations. Here we present a 5-year-old patient with an initial complaint of nuchal rigidity and convulsions during the course of hepatitis A infection. Because hepatitis A virus RNA was demonstrated in the cerebrospinal fluid, it was thought that convulsions might be related to this viral infection.