Plasminogen activator inhibitor-1 (PAI-1) gene polymorphism (-675 4G/5G) associated with obesity and vascular risk in children.

UNLABELLED: Atherothrombotic complications in insulin resistance are partly attributed to impaired fibrinolysis caused by increased PAI-1 plasma levels, and 4G/5G promotor polymorphism of the PAI-1 gene may modulate PAI-1 transcription. OBJECTIVE: To investigate PAI-1-675 4G/5G allele gene polymorphism and its relationship with obesity in children. CHILDREN AND METHOD: The study participants were 133 apparently healthy non-obese children, 24 probable exogenously obese without family history (Group I), 66 probable familial obese (Group II), and 44 obese children who were referred to the pediatric endocrinology department with any complication of obesity (Group III). Group I and Group II obese children were gathered from a school-based epidemiological study. RESULTS: Incidence of obesity was 19% in a school with high socio-economic status, whereas it was 4% in a school with low socio-economic status. Frequencies of 4G/4G gene polymorphisms were 24.81%, 37.50%, 64.80% and 61.11% in the control group, and groups I, II, and III, respectively. In groups II and III, 4G/4G gene polymorphism, and in non-obese control children 5G/5G gene polymorphism, was common. In obese children in the presence of family history for obesity and metabolic syndrome (odds ratio [OR]: 4.48, 95% confidence interval [CI]: 1.26-15.82), carriage of the 4G allele either in heterozygous or homozygous state increased the risk of vascular disease (OR: 6.10, 95% CI 1.64-22.90). In patients with acanthosis nigricans, high HOMA-IR values, hypertriglyceridemia and elevated atherogenic index, 4G/4G genotype frequency was remarkably higher compared to patients with other features of metabolic syndrome. CONCLUSION: The increasing prevalence of childhood obesity in high socio-economic status is associated with health risks. In obese children with family history of obesity and cardiovascular disease or type 2 diabetes mellitus and in obese children who had any feature of metabolic syndrome, frequency of 4G/4G genotype was more than the 4G/5G and 5G/5G genotypes in the PAI-1 gene. These patients can be at increased risk for developing vascular disease. Acanthosis nigricans, high HOMA-IR value, hypertriglyceridemia and high atherogenic index can also reflect the high risk of vascular disease in metabolic syndrome.

The secular trends in height and weight of Turkish school children during 1993-2003.

BACKGROUND: Secular changes in growth and development can be considered as the changing pattern of somatic development of children in a particular population from one generation to another. Developing countries, which have many changes in socio-economical conditions, reveal various trends in growth. The aims of this study were to analyse growth trends in weight and height of Turkish children from a school in Ankara over the period 1993-2003 with 10-year time interval, and to determine the relation between secular trends. METHODS: Anthropometric measurements of 1214 children and adolescents (611 boys and 603 girls) aged between 7 and 15 years from Ankara, Turkey, obtained cross sectionally in 2003 were compared with measurements of 867 school children (451 boys and 416 girls) from a previous study which had been obtained in the same primary school in 1993. For 7-15 years of age the increments of weight and height were determined, and analysed statistically. RESULTS: In 2003 survey boys and girls were taller and heavier than their peers from previous study in all age groups. For all cohorts in boys from 7 to 15 years, weight increments between 2.7 and 6.3 kg/decade and height increments between 1.7 and 5.5 cm/decade were demonstrated. For girls in the same cohorts, weight increments between 2.8 and 6.5 kg/decade and height increments between 1.8 and 5.7 cm/decade were indicated. Both weight and height increments suggest an upward displacement of growth curves in this interval of 10 years. CONCLUSION: A significant secular increase in weight and height measurements were found in 7-15-year-old boys and girls in Ankara. These secular increases can be explained with improvements in social and health indicators that reflect the overall health status of the population. The secular increases in growth of Turkish school children may reveal updates of growth standards.

Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan.

OBJECTIVE: To investigate the attitudes and practices of breastfeeding mothers regarding fasting in Ramadan. DESIGN: Cross-sectional observational survey. SETTING: Well-child care clinic at Ankara University Medical School and a health station serving an impoverished population in Ankara, Turkey. PARTICIPANTS: Breastfeeding mothers of infants aged 12 months or younger. MAIN OUTCOME MEASURES: Fasting during Ramadan. RESULTS: Of the 164 participating mothers, 61 (37%) were from the health station and 103 (63%) from the university clinic. Most mothers were older than 25 years of age (55%), had more than primary school education (64%), a single child (53%), were living in a nuclear family setting (70%), supplementing breastfeeding (73%) and fasting (52%). Among the 129 mothers of infants aged 6 months or younger, 22% perceived a decrease in their breast milk and 23% an increase in the amount of solid supplements the infant was receiving. Belief that breastfeeding mothers should fast (RR = 6.45, 95% CI: 2.44-17.06), that fasting does not decrease breast milk (RR = 6.24, 95% CI: 1.85-21.05), receiving well-child care at the health station (RR = 3.14, 95% CI: 1.33-7.44), giving supplements (RR = 2.82, 95% CI: 1.09-7.27) and having multiple children (RR = 2.78, 95% CI: 1.23-6.28) were associated with fasting, in a logistic regression model. CONCLUSIONS: Fasting by breastfeeding mothers of infants is common during Ramadan, and rates are affected by beliefs of mothers on the effects of fasting on breastfeeding. We believe that child health care providers need to be knowledgeable about religious and cultural phenomena, study the effects of Ramadan fasting and form links with Islamic teachings to find religiously and culturally appropriate methods to combat the possible unfavourable effects for infants and children.

Socioeconomically advantaged infants attending a university well-child clinic in Ankara: are they breast-feeding optimally?

This longitudinal observational study aimed to determine the rates of initiation, duration and correlates of breast-feeding by mothers living in a socioeconomically advantaged urban environment in Turkey. Healthy, term infants born at Ankara University Faculty of Medicine Hospital who would be brought to the well-child clinic regularly for at least 12 months were enrolled. Data on feeding practices were obtained at the 1st, 2nd, 3rd, 4th, 5th, 6th, 9th and 12th month well child care visits. Breast-feeding outcome was categorized based on recommendations by the World Health Organization (WHO). The majority of the 295 participating mothers were older than 20 years, high school graduates, and lived in apartment housing, and 54.6% were employed. The rates of breast-feeding were 97.9%, 90.1%, 76.9% and 36.9% at 1, 4, 6 and 12 months, respectively, and rates of exclusive breast-feeding were 89.8%, 59.3% and 2.0% at 1, 4 and 6 months, respectively. At 6 months 69.8% of infants were receiving cow's milk and by 12 months only 23.4% of the infants had been breast-fed according to WHO recommendations. Neither gender; birth weight of infant; age, education, parity, previous breast-feeding experience of mother; nor the status of living as extended versus nuclear family were related to breast-feeding outcome. Mothers who were working (RR: 3.89, 95% CI: 1.42-10.65) and those who had less than 4 months postpartum leave from work (RR: 4.20, 95% CI: 2.16-8.17) were more likely to not breast-feed optimally. The results of this study indicate that even where breast-feeding is normative behavior, it may not be optimally practiced, leading to potentially detrimental nutrition for infants. Promotion of breast-feeding even in advantaged urban populations is needed.

Alternative diagnostic method for streptococcal pharyngitis: Breese scoring system.

This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.

Immunogenicity study of a combined diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis vaccine used to reconstitute a freeze-dried Haemophilus influenzae type b vaccine (DTaP-IPV//PRP-T) administered simultaneously with a hepatitis B vaccine at two, three and four months of life.

This study was designed to assess the immunogenicity of a vaccine combining diphtheria and tetanus toxoids, acellular pertussis vaccine, and inactivated poliovirus vaccine reconstituting Haemophilus influenzae type b polysaccharide conjugated to tetanus protein (DTaP-IPV//PRP-T; Pasteur Mérieux Connaught, Lyon, France) administered simultaneously in association with hepatitis B vaccine (RECOMBIVAX (¿trade mark omitted¿) Merck, Sharp & Dohme, West Point, PA, USA) for the primary immunization of infants. The vaccines were administered at two, three and four months of age. One hundred and sixty-two healthy infants, aged 8-10 weeks, were enrolled in the study. Blood samples were taken before the first dose and 4 weeks after the third dose. The infants were observed for 15 minutes after vaccination for any immediate reaction. Adverse events requiring a medical consultation were recorded by the parents in a diary over the 7 days following vaccination. Four weeks after the third immunization, the percentages of infants fulfilling seroconversion criteria were 98.9% for pertussis toxin, 95.9% for filamentous haemagglutinin, 100.0% for tetanus, 100.0% for diphtheria, 99.3% for poliovirus type 1, 100.0% for both poliovirus types 2 and 3, 98.0% for Haemophilus influenzae type b, and 100% for hepatitis B surface antigen. No vaccine-related serious adverse event was reported. The simultaneous administration of DTaP-IPV//PRP-T and hepatitis B vaccines at two, three and four months of age yielded clinically satisfactory immune responses to all antigens compared with historical controls and gave a good safety profile.

Assessment of the efficacy and safety of paracetamol, ibuprofen and nimesulide in children with upper respiratory tract infections.

OBJECTIVE: The aim of this study was to assess and compare the efficacy and tolerability of paracetamol, ibuprofen and nimesulide in children with upper respiratory tract infections (URTIs). METHODS: Ninety children with acute URTIs and fever were enrolled to the study. The patients were allocated to three groups. The first group was treated with paracetamol 10 mg/kg thrice daily; the second group with ibuprofen 10 mg/kg thrice daily; and the third group received nimesulide 2.5 mg/kg twice daily for 5 days. RESULTS: The anti-pyretic activity of nimesulide was greater and more rapid than either paracetamol or ibuprofen. The number of patients with normal temperature was significantly greater in the first 2 days for the nimesulide group. The improvement in cough for the paracetamol group was better than the others. CONCLUSION: The results of this study demonstrated that the anti-pyretic effectiveness of nimesulide is better than paracetamol and ibuprofen in febrile children with URTIs. However, new studies in larger paediatric populations are required to explore the anti-inflammatory effect of nimesulide.