An Examination of the Relationship Between Exposure to Bisphenol A and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.

OBJECTIVES: Exposure to environmental toxic agents in the prenatal and/or postnatal periods may play in the acquired development of attention-deficit/hyperactivity disorder (ADHD) in groups with genetic risks. Bisphenol A (BPA) is a widely used industrial chemical with neurotoxic effects. This study examined the relationship between exposure to BPA and clinical ADHD. METHODS: This cross-sectional, case-controlled clinical study compared 45 drug-naive children and adolescents with ADHD and 30 healthy controls in terms of serum BPA levels. Psychiatric comorbidities in the ADHD group were determined using the "Schedule for Affective Disorders and Schizophrenia for school-aged children, lifetime version." The Child Behavior Checklist (CBCL) was also administered to all participants. RESULTS: Serum BPA levels were significantly higher in the ADHD group than in the healthy control group. In addition, significant, weak positive correlation was found between BPA levels and CBCL attention and CBCL total problem scores. CONCLUSIONS: Our results show that BPA may be an environmental toxic agent with a potential role in the etiology of ADHD and particularly attention deficiency. Preventive interventions can be developed if this can be confirmed with longitudinal studies and repeated measurements.

Aeroallergen sensitization in school-age children with allergic rhinitis: What has changed during the COVID-19 pandemic?

BACKGROUND: Pandemic period may affect aeroallergen sensitization. OBJECTIVE: The study aimed to investigate changes in allergen sensitivities of skin prick test (SPT) in patients with allergic rhinitis (AR) during pandemic and to evaluate relationship with disease severity. METHODS: In all, 164 AR patients with or without asthma, aged 6-17 years, who have undergone SPTs prior to the pandemic and after October 1, 2021 (18th month of the pandemic), were evaluated retrospectively. The wheal size of allergens in performed SPTs during and prior to the pandemic were compared. Detected changes in allergen sensitivities via SPT results were compared with changes in the disease severity parameters (AR severity, asthma severity, and the number of asthma exacerbations per year), frequency of upper respiratory tract infections and antibiotic use, laboratory parameters, demographic characteristics, and visual analogue scores (VAS). RESULTS: House dust mites (HDMs), cat, pollen, Artemisia, and Cupressus sensitization increased in AR patients during the Coronavirus disease 2019 (COVID-19) pandemic. HDM, mold, and pollen wheal diameters increased in SPTs. Proportion of polysensitization increased during the pandemic, compared to pre-pandemic period (9.1% vs 3%; P < 0.001), and number of non-sensitized patients decreased during the pandemic period compared to the pre-pandemic period (7.9% vs 22.6%; P < 0.001). An increase in HDM sensitivity in SPTs was correlated with VAS for nasal blockage, and an increase in cat sensitivity was correlated with VAS for all nasal symptoms. CONCLUSION: We believe that inhalant allergen sensitization might have been affected by the lifestyle changes of patients during the pandemic. Hence, it is important to evaluate patients for allergen sensitization, especially patients with moderate/severe AR, to revise disease control measurements.

Aeroallergen sensitization in school-age children with allergic rhinitis: What has changed during the COVID-19 pandemic?

Background: Pandemic period may affect aeroallergen sensitization. Objective: The study aimed to investigate changes in allergen sensitivities of skin prick test (SPT) in patients with allergic rhinitis (AR) during pandemic and to evaluate relationship with disease severity. Methods: In all, 164 AR patients with or without asthma, aged 6–17 years, who have undergone SPTs prior to the pandemic and after October 1, 2021 (18th month of the pandemic), were evaluated retrospectively. The wheal size of allergens in performed SPTs during and prior to the pandemic were compared. Detected changes in allergen sensitivities via SPT results were compared with changes in the disease severity parameters (AR severity, asthma severity, and the number of asthma exacerbations per year), frequency of upper respiratory tract infections and antibiotic use, laboratory parameters, demographic characteristics, and visual analogue scores (VAS). Results: House dust mites (HDMs), cat, pollen, Artemisia, and Cupressus sensitization increased in AR patients during the Coronavirus disease 2019 (COVID-19) pandemic. HDM, mold, and pollen wheal diameters increased in SPTs. Proportion of polysensitization increased during the pandemic, compared to pre-pandemic period (9.1% vs 3%; P < 0.001), and number of non-sensitized patients decreased during the pandemic period compared to the pre-pandemic period (7.9% vs 22.6%; P < 0.001). An increase in HDM sensitivity in SPTs was correlated with VAS for nasal blockage, and an increase in cat sensitivity was correlated with VAS for all nasal symptoms. Conclusion: We believe that inhalant allergen sensitization might have been affected by the lifestyle changes of patients during the pandemic. Hence, it is important to evaluate patients for allergen sensitization, especially patients with moderate/severe AR, to revise disease control measurements (AU)

Assessment of intracellular zinc levels in infants with food protein-induced allergic proctocolitis.

BACKGROUND: Food protein-induced allergic proctocolitis (FPIAP) is characterized by bloody stools in well-appearing infants. Zinc is a micronutrient that plays a crucial role in immune modulation and is essential for cellular function during immune response. Although there are studies on the assessment of intracellular zinc levels in allergic diseases, no data is available on erythrocyte zinc levels of patients with FPIAP. OBJECTIVE: This study aimed to assess the erythrocyte zinc levels of children with allergic proctocolitis and compare zinc levels with clinical and demographic characteristics. METHODS: This was a case-control study that prospectively compared 50 patients with FPIAP and 50 healthy children without malnutrition. The erythrocyte zinc levels of children were determined using atomic absorption spectrophotometry. RESULTS: Fifty patients with FPIAP, including 28 (51%) girls, with median age of 7.1 ± 2.9 (3-14) months and 50 healthy children, including 26 (53.1%) girls, with median age of 7.7 ± 2.8 (3-13) months were included in the study. Seventy percent (n = 35) of the patients with FPIAP started to have symptoms while they were exclusively breastfeeding. Offending allergen foods were cow's milk (78%), egg (40%), sesame (10%), hazelnut (8%), almond (6%), beef (6%), and peanuts (6%, n = 3). Intracellular (erythrocyte) zinc levels in patients with FPIAP were lower than in the healthy control group (495.5 ± 134 µg/dL, 567.3 ± 154.4 µg/dL, respectively, P = 0.01). Patients with FPIAP aged younger than 6 months had lower intracellular zinc levels compared with those aged above 6 months (457 ± 137 µg/dL; 548 ± 112 µg/dL, respectively, P = 0.01). There was no relationship between zinc levels and time of symptom onset, presence of concomitant disease, being allergic to multiple foods, and family history of atopy (P > 0.05). CONCLUSIONS: FPIAP is a food allergy with limited information on its pathogenesis. Considering the beneficial effects on gastrointestinal system epithelia, zinc may be involved in the pathogenesis of FPIAP. Future comprehensive prospective research on this subject is of importance.

Assessment of sleep in children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome.

BACKGROUND: Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome is the most common cause of periodic fever in childhood. This study aimed to investigate sleep patterns and possible factors that are associated with sleep disturbances among children with PFAPA syndrome. METHODS: Sixty-two patients with PFAPA and 68 age and sex matched healthy controls were enrolled in the study. Patients who had an attack during the former 2 weeks were not included. Demographic and anthropometric data, duration of fever episodes, laboratory results, and clinical manifestations of patients were recorded. The Children`s Sleep Habits Questionnaire was administered. RESULTS: The total sleep scores of patients with PFAPA were significantly higher than the control group (49.6 ± 10.7 vs. 38.3 ± 7.5, p = 0.002 ). Children with PFAPA had significantly higher scores regarding sleep-onset delay, sleep anxiety and night wakening (p=0.003, p=0.007, and p=0.014, respectively). Total sleep durations were similar between children with PFAPA and the control group. There was a significant positive correlation between the total sleep score and disease duration (r=0.425, p=0.002). Also there was a significant positive correlation between disease duration and sleep onset delay (r=0.561, p < 0.001) and night wakening (r=0.327, p=0.003). CONCLUSION: This study showed for the first time that patients with PFAPA have significantly disturbed sleep when compared to otherwise normal children. This study emphasized the need to assess sleep problems in children with PFAPA.

Increased Carotid Intima-Media Thickness and Endothelial Cell-Specific Molecule-1 (Endocan) Levels in Obese Children.

Obesity in children appears to be associated with increased risk of cardiovascular and metabolic diseases later in life. Early development of insulin resistance (IR) may lead to endothelial dysfunction and increased carotid intima-media thickness (cIMT) even in childhood. We compared endothelial cell-specific molecule-1 (endocan) levels in pediatric obese patients with those in healthy controls to determine whether endocan could be used as a biological marker of complications caused by endothelial damage. In 80 obese pubertal children (44 males [M] and 36 females [F], mean age: 12.8 ± 2.5 years), anthropometric measurements, cIMT, endocan levels, and IR indices (homeostasis model assessment of insulin resistance [HOMA-IR]) were evaluated and compared with 80 healthy pubertal patients (42M/38F, mean age: 12.3 ± 3.2 years). High-resolution ultrasound was used to measure the cIMT. Obese children had higher levels of endocan compared with the controls (P < .001). Fasting insulin levels and HOMA-IR were also higher in obese children (P < .001 for both). In addition, obese children had an increased cIMT (P < .001). In obese children, there was a significant correlation between cIMT and HOMA-IR (ß = -1.314, P = .002) and between cIMT and endocan (ß = .483, P = .004). Measuring cIMT and endocan levels (noninvasive investigations) in obese children, together with early preventive measures, could significantly decrease morbidity and mortality in adulthood.

Vitamin D Levels in Children With Recurrent Aphthous Stomatitis.

BACKGROUND: Recurrent aphthous stomatitis is one of the most prevalent oral mucosa diseases and the etiology is unclear. As a potent anti-inflammatory and immunomodulating agent, vitamin D can significantly affect oral cavity homeostasis. However, to the best of our knowledge, no study has been conducted in pediatric population on the potential role of vitamin D in recurrent aphthous stomatitis to date. The aim of the present study is to determine the vitamin D status in recurrent aphthous stomatitis in children. METHODS: This study is conducted retrospectively. Seventy-two patients with minor recurrent aphthous stomatitis and 70 age-matched healthy controls included in the study. 25-Hydroxyvitamin D levels were measured in all patients using enzyme immunoassay. RESULTS: Serum vitamin D levels were 16.4 (8.6) ng/mL in patient group and 23.1 (11.5) ng/mL in healthy controls. There was a statistically significant difference between the groups in terms of serum vitamin D levels (P = .002). There was no significant correlation between serum vitamin D levels and the severity of the recurrent aphthous stomatitis (r = 0.54, P = .76). CONCLUSIONS: Our study showed a significant difference in vitamin D levels between patients with recurrent aphthous stomatitis and the healthy control group. We also found no correlation between vitamin D status and the severity of the disease.

Vitamin D deficiency as a risk factor for PFAPA syndrome.

OBJECTIVE: The periodic fever, aphthous stomatitis, pharangytis and cervical adenitis (PFAPA) syndrome, is an idiopathic chronic disease of non-hereditary origin, primarily affecting pre-school children and is the most common periodic fever disorder in children. Rapid response to corticosteroid treatment suggest an immune dysregulation. Recently, emerging evidence suggest that vitamin D plays an important role in immunity regulation. The aim of our study was to assess the vitamin D levels in children with PFAPA syndrome. METHODS: This study was conducted prospectively. We have consecutively evaluated 50 patients after having excluded other causes of recurrent fever between May 2017 and May 2018 in addition to age-matched 50 patients as control group. All patients has complete physical examination and laboratory tests. Laboratory tests included complete blood count, C-reactive protein (CRP), and vitamin D levels. Serum 25 (OH) vitamin D levels were measured in all patients twice yearly. RESULTS: Vitamin D levels was 18 ±â€¯10 ng/ml in the patient group and 35 ±â€¯13 ng/ml in the control group. There was statistically significant difference between the groups (p < 0.001). 38 patients from the PFAPA group and 20 patients from the control group had low vitamin D levels. Multivariate logistic regression analysis showed that CRP (odd ratio (OR) = 2.7, 95% confidence interval (CI) = 2.4-4.1) and serum 25 (OH) vitamin D levels <30 ng/ml OR = 2.1, 95% CI = 1.8-2.5) were associated with PFAPA occurrence. CONCLUSION: We found strong correlation between PFAPA and vitamin D insufficiency. Hypovitaminosis D can be a significant risk factor for PFAPA episode recurrence.

Altered methyltetrahydrofolate reductase gene polymorphism in mothers of children with attention deficit and hyperactivity disorder.

Attention Deficit and Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders in childhood and causes significant functional impairments in children. Behavioral genetic and molecular genetic studies have provided significant evidence in terms of highlighting the etiology of ADHD. Folate deficiency during pregnancy is an established risk factor for ADHD. Polymorphisms in the Methyltetrahydrofolate Reductase (MTHFR) encoding gene, such as A1298C and C667T, are associated with the decreased bioavailability of folate, and this condition can act like folate deficiency. In the literature, no study has investigated MTHFR polymorphisms in mothers of children with ADHD. Sixty-four children diagnosed with ADHD and their mothers as well as 40 healthy children and their mothers participated in this study. MTHFR polymorphisms were investigated in all participants. Comparison of the C677C and A1298C MTHFR polymorphisms in children with and without ADHD revealed no significant differences. We found that the maternal C677C_CT genotype counts, both observed and expected values, were significantly different from those based on Hardy-Weinberg Principle Analysis in the ADHD group. The most important result of this study was that maternal C677C MTHFR gene polymorphisms are significant risk factors in for ADHD, and we argue that children with ADHD are exposed to folate deficiency, even if their mothers received a sufficient amount of folate during pregnancy. This result also highlights one of the genetic factors of ADHD. Further studies should be performed to confirm this finding.

Anxiety and depression states of adolescents with polycystic ovary syndrome

Background/aim: Various studies have shown that adult patients with polycystic ovary syndrome (PCOS) have higher levels of anxiety and depression compared to their normal counterparts. However, it is still unclear whether these mood disorders already exist in adolescents affected by PCOS. The aim of the present study is to assess differences in anxiety and depression levels between adolescents with PCOS and age- and body mass index (BMI)-matched controls and to determine the possible factor(s) impacting these psychological parameters in adolescents with PCOS. Materials and methods: The study included 80 adolescents with PCOS and 50 age- and BMI-matched controls. All participants completed standardized questionnaires assessing anxiety and depression. A multiple linear regression model was used to analyze the impact of potential variables on anxiety and depression scores of the adolescents with PCOS. Results: Significantly higher levels of anxiety, specifically generalized and social anxieties, as well as depression were found in adolescents with PCOS compared to controls. Higher BMI was found to be associated with higher levels of depression and generalized anxiety, and higher modified Ferriman-Gallwey score with higher level of panic disorder in adolescents affected by PCOS. Conclusion: Adolescents with PCOS experience significantly more emotional distress compared to adolescents without PCOS. This emotional distress may be related, at least in part, to certain clinical features of PCOS including obesity and hirsutism. PCOS in adolescents should be assessed not only for the gynecological and metabolic aspects but also for the emotional aspects of the disease.

Copeptin as a novel biomarker in nocturnal enuresis.

OBJECTIVE: To investigate the relation between copeptin, arginine vasopressin (AVP), and nocturnal enuresis (NE). METHODS: Forty-four patients with NE and 44 healthy children aged between 6 and 14 years were enrolled. Patients with nonmonosymptomatic and secondary NE were excluded from the study. A small questionnaire, filled by parents, collected information about sociodemographic characteristics. Blood was obtained for plasma AVP and copeptin concentrations. RESULTS: Copeptin levels were significantly lower in patient group (3.74 ± 1.44 pg/mL) than the control group (16.57 ± 3.91 pg/mL), whereas AVP levels were not significantly different between groups. Copeptin levels were significantly lower in patients (3.17 ± 1.15 pg/mL) who had bed-wetting 2 or more nights a week, which is considered as severe bed-wetting, than the patients (4.95 ± 1.24 pg/mL) who had bed-wetting 1 night or less than 1 night a week. CONCLUSION: This study demonstrates the presence of decreased levels of copeptin in patients with NE compared with healthy patients. AVP levels were not different between groups. To our knowledge, this is the first report assessing the relationship between copeptin and NE.

Shifting epidemiology of hepatitis a infection and vaccination status of children aged 6 months-12 years: time for mass vaccination.

OBJECTIVE: This study was designed to determine the current age-related hepatitis A virus (HAV) seroprevalance, vaccination status of children and to evaluate the epidemiological shift in HAV serostatus living in Tekirdag, which is located in Thrace region, the European part of Turkey. METHODS: Children 6 months-12 years of age with simple health problems were included. Blood samples were studied for HAV IgM and IgG collectively. A questionnaire addressing several characteristics of subjects was administered to obtain basic descriptive data on HAV epidemiology. Vaccination status of the children was recorded according to the immunization cards. FINDINGS: The overall anti-HAV IgM and anti-HAV IgG prevalance in children aged 6 months - 12 years was 3.3% and 25.4% respectively. Maximum hepatitis A IgM positivity was in the 7-12 years age group 4.8% (n= 12; P<0.001) and maximum hepatitis A IgG positivity in the same age group was 34% (n = 85; P<0.001). HAV vaccination rate among patients aged more than 2 years was 11.03%. HAV IgG seroprevalance was higher in children of low monthly income families (36.1%, n = 78; P<0.001) than in the intermediate (17%, n = 31) and high income families (11.1%, n = 6). CONCLUSION: These results indicate a shift in Hepatitis A seroprevalance when compared with the previous studies. As HAV infection in childhood is decreasing, the pool of susceptible adolescents and young adults is increasing. Introduction of hepatitis A vaccination into the national immunization schedule of Turkey should be considered.

Indices used in differentiation of thalassemia trait from iron deficiency anemia in pediatric population: are they reliable?

BACKGROUND: Iron deficiency (IDA) and beta thalassemia trait (TT) are the most common causes of hypochromia and microcytosis. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood cell analyzers. However, studies in the pediatric age group are scarce and their results are controversial. METHODS: We calculated eight discrimination indices [Mentzer Index (MI), England and Fraser Index (E&F), Srivastava Index (S), Green and King Index (G&K), Shine and Lal Index (S&L), red blood cell (RBC) count, RBC distribution width, and red blood cell distribution width Index (RDWI)] in 100 patients. We calculated sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV and NPV), and Youden's Index (YI) of each discrimination index. RESULTS: None of the discrimination indices showed a SENS and SPEC of 100%. The highest SENS was obtained with S&L (87.1%), while the highest SPEC was obtained with E&F formula (100%). The highest YI value was obtained with E&F formula (58.1%). CONCLUSION: In our study, none of the formulas appears reliable in discriminating between TT and IDA patients. The evaluation of iron status and measurement of hemoglobin A(2) (HbA(2)) remain the most reliable investigations to differentiate between TT and IDA patients.

Effect of Fluid Supplementation on Serum Bilirubin Level During Phototherapy of Exclusively Breastfed Term Infants with Hyperbilirubinemia.

Abstract Background: This study compared the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy. Methods: A randomized controlled study was carried out in the neonatal intensive care unit of Zeynep Kamil Maternity and Children Hospital (Istanbul, Turkey) over a 4-month period. Two hundred fifty healthy term infants with hyperbilirubinemia were randomized to receive either solely breastmilk (n=125) or both breastmilk and intravenous fluid (n=125) during phototherapy. Results: There were no significant differences (p>0.05) in the mean birth weight, mean gestastional age, modes of delivery, mean time of admission age, mean serum osmolality, and hematocrit and reticulocyte count between the two groups. Similarly, there was no significant difference (p>0.05) in the mean indirect serum bilirubin level at the time of admission to the neonatal intensive care unit and at 4, 8, 12, 24, and 48 hours after commencement of phototherapy between the two groups. There was no significant difference (p>0.05) in the mean duration of phototherapy or in the median duration of hospitalization between the two groups. Conclusions: Based on our results, intravenous fluid support has no effect on the rate of decrease in serum bilirubin and decrease in duration of phototherapy in healthy term newborns with no dehydratation. However, using the oral route avoided the need for intravenous cannulae and their attendant complications. Insensible fluid loss is increased during phototherapy, so protection of hydration status with oral feeding is important for newborns.

Alkaline phosphatase as an early marker of hemolysis in newborns.

BACKGROUND: Early diagnosis and appropriate management of neonatal hyperbilirubinemia are very important in order to prevent bilirubin encephalopathy and kernicterus. Several diagnostic tests may be used for this purpose, including bilirubin level itself. The aim of the present study was to investigate whether serum alkaline phosphatase (ALP), which is an intracellular enzyme found abundantly in red blood cells, could be used for the early diagnosis and prediction of hyperbilirubinemia in newborns. METHODS: A total of 100 babies were evaluated, starting from the sixth hour after birth, and serum ALP and bilirubin levels were analyzed. RESULTS: ALP levels were significantly higher in babies requiring therapy such as phototherapy or exchange transfusion (247.01 ± 67.44 IU/L vs 154.25 ± 56.07 IU/L). ALP levels rose significantly with rising total bilirubin level. CONCLUSION: ALP levels at the sixth hour of life may be a significant predictor of developing hemolysis and hyperbilirubinemia requiring treatment.

Correlation between transient tachypnea of the newborn and wheezing attack.

BACKGROUND: Transient tachypnea of the newborn (TTN) is the most common cause of respiratory distress in newborns. Although associated with some morbidity, it is generally believed that once TTN resolves, there is no further increased risk for respiratory disease. However, in limited studies frequency of wheezing attacks is found to be increased in patients who had TTN diagnosis during the newborn period, in comparison to patients who had no respiratory problem. Thus, the question arises as to whether TTN is an innocent disease. METHODS: This study was done retrospectively. We recorded the demographic characteristics of 103 infants born between 17 October 2003 and 17 October 2004 at Zeynep Kamil Hospital and hospitalized because of TTN in the neonatal intensive care unit. In the second phase, we telephoned the parents of the 103 infants and asked about wheezing attacks. A total of 103 other infants, born during the same period, with no health problems during the newborn period, were included in the study as the control group and the same procedures were applied to them. RESULTS: The rate of wheezing attack among patients with TTN diagnosis was found to be significantly higher than that in patients who had no TTN diagnosis (P < 0.01). TTN was found to be an independent risk factor for wheezing attack (OR, 2.378; 95% CI, 1.20-4.70). CONCLUSION: In conclusion, we established that TTN is an independent risk factor for wheezing. In addition we also hypothesized that genetic and environmental interactions synergistically predisposed these children for future wheezing.