The association of obesity and obesity-related conditions with carotid extra-medial thickness in children and adolescents.

BACKGROUND: Carotid extra-medial thickness (EMT) and carotid intima-media thickness (cIMT) provide information concerning vascular changes. OBJECTIVES: In this study, we aimed to evaluate the association between carotid EMT and obesity and its metabolic complications in children. METHODS: The study included 38 obese subjects and 30 age-matched and sex-matched healthy controls aged between 7 and 17 years. For all subjects, complete blood count, fasting blood glucose, serum insulin, aspartate aminotransferase, alanine aminotransferase, HDL cholesterol, total cholesterol and triglyceride levels were measured. The carotid EMT and cIMT were measured by an expert radiologist in all patients. RESULTS: Body mass index (BMI) (28.8 ± 3 vs. 18.1 ± 2.2, p < 0.001), total cholesterol (167.9 ± 34.8 mg dL-1 vs. 150.5 ± 28.1 mg dL-1 , p = 0.029), homeostatic model assessment of insulin resistance (HOMA-IR) (4.3 vs. 1.7, p < 0.001), cIMT (0.51 ± 0.08 mm vs. 0.45 ± 0.06 mm, p < 0.001) and carotid EMT (0.74 ± 0.11 mm vs. 0.64 ± 0.1 mm, p < 0.001) were significantly higher in obese subjects than in controls, while HDL cholesterol (41.6 ± 6.5 mg dL-1 vs. 49.5 ± 7.5 mg dL-1 , p < 0.001) was lower in obesity group. Among the obese subjects, the HOMA-IR values (4.7 vs. 3.6, p = 0.027), cIMT (0.54 ± 0.07 mm vs. 0.49 ± 0.07 mm, p = 0.039) and carotid EMT (0.79 ± 0.1 mm vs. 0.7 ± 0.1 mm, p = 0.013) were significantly higher in post-pubertal children compared with prepubertal children. BMI, cut-off values of HOMA-IR and cIMT were significantly associated with increased carotid EMT (p < 0.001, p = 0.023 and p < 0.001, respectively). The only independent risk factor affecting carotid EMT was BMI (p < 0.001). CONCLUSION: We have found that carotid EMT is associated with cIMT, obesity and insulin resistance and the assessment of carotid EMT may provide additional information concerning early vascular disease.

Neutrophil-to-lymphocyte ratio and red blood cell distribution width is a practical predictor for differentiation of febrile seizure types.

OBJECTIVE: Febrile seizures (FS) are the most common neurological emergency in childhood. They are divided into two groups accordingly clinical features, simple febrile seizure and complex febrile seizure. Until now laboratory tests have not been used as a parameter of classification of them. The objective of this study is to estimate the usefulness of the hematogical parameters especially neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in the differentiation of febrile seizure types. PATIENTS AND METHODS: A retrospective review was conducted on patients from 6 months to 6 years old presenting with first febrile seizure admitted to a tertiary care hospital. Epidemiological and laboratory variables of the patients were collected. RESULTS: The mean NLR in the simple FS and complex FS groups was 2.18±1.9 and 3.8±4.2 respectively, and the difference was significant (p=0.024). The mean serum red blood cell distribution width in the simple FS and complex FS groups was 16.1±1.1 and 16.6±0.8 respectively, and the difference was significant (p=0.019). NLR and RDW values in complex FS patients were statistically higher than simple febrile patients. ROC analysis showed that if the chosen cut-off point for NLR is 1.98 the sensitivity and specificity are 66.7% and 60.3% respectively. These were statistically significant (p=0.040 AUC 0.623, CI 0.503-0.743). If the chosen cut-off point for RDW is 16.350, the sensitivity and specificity are 59.0% and 58.6%, respectively. These were statistically significant (p=0.037 AUC 0.626, CI 0.515-0.736) too. CONCLUSIONS: NLR and RDW were simple, effective and practical predictors for differentiation of FS types. They will have potential values in public health practice for management of FS patients.

The effect of feto-maternal blood type incompatibility on development of gestational diabetes mellitus.

OBJECTIVE: To assess the relation between fetal and maternal blood type (ABO, Rh) incompatibility and development of gestational diabetes mellitus (GDM). MATERIALS AND METHODS: A total of 500 pregnant women underwent diagnostic test for GDM by a 100-g oral glucose tolerance test (OGTT) after an 8 to 12-h overnight fast participated in this study. OGTT was performed between the 24-28 weeks of gestation, but participants who were at high risk for GDM were tested after the first prenatal visit. In the postpartum period, maternal and infant blood types were determined. Presence of GDM was evaluated in terms of matched and unmatched fetal and maternal ABO and Rh blood types separately. RESULTS: GDM was detected in 235 participants. Unmatched ABO blood types between the mother-infant pairs were present in 44.7% (n=105) of GDM (+) and 35.8 % (n=95) of GDM (-) patients. Incompatible feto-maternal ABO blood type was positively correlated with development of GDM which was marginally significant. (p=0.045; R=1.2;95% CL; 1.004-1.48). However, Rh feto-maternal blood type incompatibility was not related with development of GDM. CONCLUSIONS: Feto-maternal ABO blood type incompatibility may be a weak risk factor for the development of GDM.

The Obstetrics Gynecology and Children's Hospital Emergency Room waiting time before hospitalization.

BACKGROUND: One of the most substantial factors affecting patient satisfaction in the Obstetrics-Gynecology and Children's Hospital is the wait time in the emergency room. OBJECTIVE: We retrospectively studied the waiting periods of patients visiting the emergency room patients in Bolu Izzet Baysal Obstetrics-Gynecology and Children's hospital. METHOD: Using an automated documentation system for each patient that recorded the season in which the patients consulted the emergency room, the month, day, time, examination time, hospitalization decision time, the hospitalization clinic following the decision to hospitalize, and the time to hospitalization, we retrospectively studied the waiting periods of emergency room patients in Bolu Ýzzet Baysal Obstetrics-Gynecology and Children's Hospital. RESULTS: A total of 15,004 patients who consulted the hospital emergency room between November 24, 2009, and August 25, 2011, and who were hospitalized in a clinic were included in this study. The highest frequency of emergency room patient visits occurred during the summer season (28.1%), in the month of July (10.2%), on Mondays (16.1%), and between 8 and 11 AM (22.1%; p < 0.05). The emergency room wait time of patients consulting the pediatric clinic was (55 ± 67 min), which was significantly shorter than the wait time of patients consulting other clinics (p < 0.05). CONCLUSION: The majority of patients who were hospitalized in any clinic through the emergency room consulted the hospital during the daytime hours. The time to hospitalization for the admitted patients was within an acceptable time frame. We believe that conducting comprehensive research to determine whether it is possible to reduce wait times even further to increase patient satisfaction will be instructive.