Adrenomedullin predicts high risk and culture positivity in children with solid tumors suffering from neutropenic fever.

AIM OF STUDY: Neutropenic fever is a source of morbidity and mortality in children with cancer. It is not possible to detect the causative agent in cultures in most cases; the research for a marker that can show the severity of the disease is ongoing. We evaluated the role of adrenomedullin (ADM) at predicting prognosis on patients with febrile neutropenia, which has been proven to be a good prognostic marker for diseases with high morbidity and mortality, such as heart failure, ischemic ventricular dysfunction, sepsis, and systemic inflammatory response syndrome. MATERIALS AND METHODS: We recorded the 36 febrile episodes of 14 children receiving chemotherapy due to solid tumors. There were 10 events with unknown origin in the low-risk group, while in the high-risk group, there were 17 events with unknown origin, 8 events with microbiological origin and 1 event with clinically proven infection. Cultures were positive only in the high-risk group. However, the changes of ADM levels through time periods (first, second, third, and seventh days) were not significant. RESULTS: The first-day plasma ADM levels significantly predicted the presence of culture positivity (AUC 0.628, 95% CI 0.40-0.85, p = 0.303) and high-risk patients with neutropenic fever (AUC 0.76, 95% CI 0.56-0.97, p = 0.016). CONCLUSION: Our study showed that increased plasma ADM was correlated with high-risk neutropenic fever and culture positivity. The ADM levels in the high-risk group were clearly high at the diagnosis and continued to the end of the treatment.

Pediatric reference intervals for plasma and urine essential amino acids in a Turkish population.

AIM: To establish age- and sex-specific reference intervals for essential amino acids in a healthy Turkish pediatric population. MATERIALS AND METHODS: A total of 945 clinically healthy children (531 boys and 414 girls, ranging in age from birth to 14 years) were enrolled. Plasma and urine amino acids' concentrations were measured by high-performance liquid chromatography. RESULTS: Concentrations of essential amino acids in plasma were higher in girls than in boys in the age groups of 0-1 months and 7-14 years; however, there was no difference in the other age groups. Concentrations of essential amino acids in urine were higher in girls than in boys in the age group of 0-1 months; however, there was no difference in the other age groups. Our results demonstrated the sex-related differences in concentrations ofleucine, isoleucine, valine, phenylalanine, lysine, and histidine in plasma, which increased with age in boys but not in girls. The concentrations of leucine, tryptophan, methionine, and lysine in urine declined with age in girls but not in boys, which were sex-related differences, too. CONCLUSION: We defined essential amino acids' reference intervals in a Turkish pediatric population.

Endothelial dysfunction and insulin resistance in young women with polycystic ovarian syndrome.

BACKGROUND/AIM: To evaluate whether there is a correlation between insulin resistance and nitric oxide-related endothelial dysfunction in patients with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: The study was conducted with 25 young women with PCOS and 25 young healthy women, between 18 and 35 years of age. Plasma asymmetric dimethylarginine (ADMA) levels, serum nitric oxide (NO) levels, and homeostatic model assessment of insulin resistance (HOMA-IR) rates were measured in both the patient and control groups. RESULTS: Plasma ADMA levels were significantly higher in PCOS patients than in the controls (P = 0.001). Serum NO levels were significantly lower in patients than in the controls (P = 0.008). The HOMA-IR rates, accepted as an insulin resistance parameter, were significantly higher in patients than in the controls (P = 0.001). CONCLUSION: Results of the present study indicate that, independent of age, body mass index, and blood lipid profile, there is significant insulin resistance in PCOS patients. However, no correlation was found between HOMA-IR as an insulin resistance determinant and altered ADMA and NO levels. This finding may indicate that there are additional mechanisms of cardiovascular risks in PCOS patients other than insulin resistance.

Red cell distribution width and nonalcoholic steatohepatitis.

Red cell distribution width is a measure of deviation of the volume of red blood cells. It is a marker of anisocytosis and often used to evaluate the possible causes of anemia. Elevated red cell distribution width levels are also associated with acute and chronic inflammatory responses. In nonalcoholic steatohepatitis, inflammation is accompanied with steatosis. For assuming red cell distribution width as a marker of nonalcoholic steatohepatitis, intervening factors such as levels of inflammatory markers should also be evaluated.