Cytokines in human milk and late-onset breast milk jaundice.

BACKGROUND: Maternal milk plays an important role in the development of late-onset breast milk jaundice (BMJ), possibly due to the unique characteristics of breast milk. The aim of this study was to investigate whether there is a relation between cytokine concentrations in the milk of nursing mothers and BMJ. METHODS: Breast milk samples were collected from breast-feeding mothers of healthy full-term neonates, 40 with BMJ and 40 without jaundice. Milk samples were taken between the second and the fourth postpartum week. The concentrations of interleukin (IL)-1 ß, IL-6, IL-8, IL-10, and tumor necrosis factor-α were measured by flow cytometric bead array. RESULTS: There were significant differences between the study groups in terms of IL-1 ß concentrations (P= 0.013). Not statistically significant but similar trends were also seen for IL-10 (P= 0.067) and tumor necrosis factor-α (P= 0.053) concentrations. However, no significant differences were noted in IL-6 (P= 0.174) and IL-8 (P= 0.285) concentrations. CONCLUSIONS: IL-1 ß concentration seems to be increased in milk of mothers whose infants had BMJ. Although the effect of these cytokines on BMJ is unknown, it may cause prolonged jaundice via hepatic uptake, hepatic excretion, conjugation and intestinal absorption.

Leptin receptor gene Gln223Arg polymorphism is not associated with obesity and metabolic syndrome in Turkish children.

The aim of the study was to investigate the relationship between leptin receptor gene (LEPR) Gln223Arg polymorphism and obesity in Turkish children. Ninety-two obese and 99 lean children (between 5-15 years) were included in the study. Twenty-three of the obese children were diagnosed with metabolic syndrome. Blood samples were collected for morning fasting blood glucose, insulin, leptin, and lipid level measurements. LEPR Gln223Arg polymorphism was analyzed by restriction fragment length polymorphism. Significant differences were observed in anthropometric measurements, fasting blood glucose, insulin, leptin, and lipid levels between obese and lean children. Serum leptin levels were markedly higher in obese children. No significant association was noted between Gln223Arg polymorphism and serum leptin, insulin and lipid levels. There were no differences in the genotype frequencies or allele distribution for Gln223Arg polymorphism among obese, obese with metabolic syndrome and lean children. Our findings suggest that there is no association between Gln223Arg polymorphism and obesity in Turkish children.

Early cardiac abnormalities and serum N-terminal pro B-type natriuretic peptide levels in obese children.

OBJECTIVE: The aim of this study was to evaluate early cardiac abnormalities in obese children by the conventional echocardiography and to verify whether N-terminal pro B-type natriuretic peptide (NT-proBNP) differ between obese and healthy children. METHODS: We started this study with 68 obese children and 35 healthy controls matched for age and sex. Body mass index (BMI) was calculated. Children with a BMI > or = 95th percentile were considered obese. Thirty children in the obese group were also diagnosed with metabolic syndrome, according to the International Diabetes Federation criteria. Standard echocardiographic study was performed on each patient and control subject. Diastolic filling parameters were evaluated using pulsed-wave tissue Doppler method. Blood samples were taken at 8 a.m. to study blood biochemistry tests, including insulin, lipids, glucose, and NT-proBNP. Serum NT-proBNP levels were measured by a solid-phase, enzyme-labeled chemiluminescent immunometric assay. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Children with HOMA-IR > 3.16 were considered insulin-resistant. RESULTS: There were diastolic filling abnormalities in obese children, as shown by a decreased mitral valve early filling (E) wave/late filling (A) ratio and a prolongation in E-wave deceleration time. The levels of NT-proBNP were not statistically different among the groups. The levels of NT-proBNP were not different between obese children with and without metabolic syndrome, those with and without hypertension, and those with and without insulin resistance, respectively. CONCLUSION: Although there were diastolic filling abnormalities in obese children, their NT-proBNP levels were not different from healthy controls. It seems that there is no diagnostic value in NT-proBNP levels between obese children and healthy controls.

The local vasoconstriction of infant's skin following instillation of mydriatic eye drops.

BACKGROUND: Systemic absorption of eye drops is known to occur via the nasal mucosa, cornea, and conjunctiva. Diffusion of eye drops through the skin is previously unrecognized. Here, two cases are presented in which we observed skin pallor around the eyes after instillation of phenylephrine 2.5% drops. CASE 1: A 32-week gestational age premature infant had mydriatic eye drops instilled as part of retinopathy of prematurity screening. CASE 2: A term newborn dysmorphic infant underwent fundus examination to rule out ocular pathology. In both cases, discoloration of periorbital skin was observed 45 min following administration of drops. CONCLUSION: The risks of percutaneous toxicity must always be considered in children, especially in premature neonates, in whom the epidermal permeability barrier is frequently incompetent. Application of smaller drop size or wiping of overflowed drop from the skin may be useful to decrease the risk of systemic side effects.

Influence of smoking on human milk tumor necrosis factor-alpha, interleukin-1beta, and soluble vascular cell adhesion molecule-1 levels at postpartum seventh day.

BACKGROUND: The aim of this study was to investigate the effect of maternal smoking during pregnancy on human milk interleukin-1beta, tumor necrosis factor-alpha (TNF-alpha) and soluble vascular cell adhesion molecule-1 levels at the postpartum seventh day. METHODS: Forty-four mothers (age range: 21-34 years) were enrolled in the study. Mothers were interviewed and classified according to their smoking status into one of two groups: the smoking mothers (n= 21) and the nonsmoking mothers (n= 23). RESULTS: There were no significant differences between study groups with respect to human milk interleukin-1beta (P= 0.12) and soluble vascular cell adhesion molecule-1 levels (P= 0.83). However, TNF-alpha levels were found to be significantly lower in the smoking mothers compared with the controls (P= 0.002). CONCLUSION: This study shows that maternal smoking during pregnancy affects the levels of TNF-alpha in milk. The protective effect of human milk against infections seems to be impaired in smoking mothers.

Supernumerary nostrils together with oesophageal atresia and patent ductus arteriosus.

Supernumerary nostril is an extremely rare congenital anomaly. It can be unilateral or bilateral and it sometimes occurs in association with other congenital abnormalities. We describe a newborn infant with bilateral supernumerary nostrils together with oesophageal atresia and patent ductus arteriosus, an association that has not been reported previously in the literature.

Bilateral multicystic renal dysplasia with potter sequence. A case with penile agenesis.

Hereditary renal adysplasia (HRA) is a rare autosomal dominant condition. Patients have several other anomalies including Potter facies, thoracic, cardiac, and extremity deformities. The case present dysmorphic facial features such as hypertelorism, prominent epicanthic folds, a flat and broad nose, choanal stenosis, low-set ears, and a receding chin. He had femoral bowing, hypoplastic right tibia and agenesis of the right foot. He had rich and thick skin. He had also a dysplastic empty scrotum, penile agenesis, and anal atresia. The autopsy revealed pulmonary hypoplasia, ventricular septal defect, bilateral multicystic renal dysplasia, agenesis of both ureter and bladder, intraabdominal testicles, and a single umbilical artery. The penile agenesis was first reported, and including the consanguinity in the parents might further delineate the bilateral multicystic HRA. Vater/caudal regression anomalies, Mullerian duct/aplasia, unilateral renal agenesis, and cervicothoracic somite anomalies association, and Coloboma, heart anomaly, choanal atresia, retardation, genital and ear anomalies syndrome has been considered in differential diagnosis.

Influence of smoking on serum and milk malondialdehyde, superoxide dismutase, glutathione peroxidase, and antioxidant potential levels in mothers at the postpartum seventh day.

The aim of the study was to investigate simultaneously serum and milk malondialdehyde (MDA) levels, superoxide dismutase (SOD), glutathione peroxidase (GPx) activities, and antioxidant potential (AOP) in active-smoking, passive-smoking, and nonsmoking mothers and to search if there is any difference between serum and milk oxidant/ antioxidant status caused by smoking. According to their smoking status, 60 mothers (age range: 20-35 yr) were classified into one of three groups: the active-smoking mothers (n=15), the passive-smoking mothers (n=22), and the nonsmoking mothers (n=23). Serum and milk MDA, SOD, GPx, and AOP values were determined in mothers on the postpartum seventh day by the spectrophotometric method. Serum Zn and Cu concentrations were determined by atomic absorption spectrophotometry (AAS). There was no significant difference in serum samples with respect to MDA (p=0.17), SOD (p=0.51), and AOP (p=0.36) levels, but there was a significant difference in serum GPx (p=0.002) levels among the study groups. The significant differences were also found in milk samples in terms of MDA (p=0.002) and SOD (p=0.011), but not in GPx (p=0.11) and AOP (p=0.29) levels among the study groups. No significant difference was seen in serum zinc concentration (p=0.49), but copper concentration differed significantly among the groups (p=0.005). These observations suggest that human milk is more vulnerable to oxidative stress and lipid peroxidation than serum samples in smoking mothers, even if they are passive smokers.

A randomized placebo-controlled trial of mebendazole for halitosis.

OBJECTIVE: To test whether mebendazole, an antiparasitic drug, would affect recovery from halitosis. DESIGN: We conducted a randomized, double-blind, placebo-controlled trial between April 1999 and September 2001. SETTING: A referral medical center. PATIENTS: One hundred sixty-two children aged 5 to 16 years whose parents complained about their chronic bad breath. INTERVENTIONS: Children were randomly assigned to receive mebendazole (n = 82) or placebo (n = 80). MAIN OUTCOME MEASURE: Parents whose children had halitosis were evaluated for halitosis at 2 months of treatment by questionnaire. The microbiologist investigated the stool samples of children for parasitosis at the beginning of the trial and also at the end of the trial in children who were treated with mebendazole. RESULTS: Among those children who had evidence of parasites in stool samples at the beginning of the trial, 18 of 28 who were treated with mebendazole recovered from halitosis, compared with 2 of 24 who received placebo (relative risk [RR] for recovery, 7.7; 95% confidence interval [CI], 2.0-29.9). Among those who did not have stool parasites, 14 of 52 improved with mebendazole, compared with 10 of 48 taking placebo (RR, 1.3; 95% CI, 0.6-2.6). Mebendazole intake made a significant difference whether or not the children had parasites (P =.002). CONCLUSIONS: Parasitosis should be considered as a possible cause of halitosis in the pediatric patient population. Mebendazole therapy seems to offer benefit to those children with parasites as a potential cause of their halitosis.

Severe congenital factor X deficiency with intracranial bleeding in two siblings.

Congenital factor X deficiency is a rare autosomal recessive disorder that usually presents with variable bleeding tendency, prolonged prothrombin time and partial thromboplastin time. Therefore, it may be misdiagnosed as hemorrhagic disease of the newborn. Factor X level should be investigated for the definite diagnosis. We first report a new family whose two infants presented with severe intracranial bleeding at different times and were found to have congenital factor X deficiency. Plasma replacement therapy was not found to be efficacious in these infants. In conclusion, a possible factor X deficiency should be considered when a newborn presents with intracranial bleeding.

Influence of smoking on maternal and neonatal serum malondialdehyde, superoxide dismutase, and glutathione peroxidase levels.

This cohort study investigated postnatal serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels in 14 active-smoking, 14 passive-smoking, and 15 non-smoking mothers and their newborns on day 7 post-partum. No significant differences were noted among the study groups with respect to MDA (p = 0.63) or SOD levels (p = 0.98) in either the mothers or their infants. However, there were significant differences among the study groups with respect to serum GPx activities in both the mothers (p = 0.028) and the infants (p = 0.039). When GPx activities were analyzed separately in both mothers and infants, a significant difference was noted only between the infants of smoking mothers and the infants of non-smoking mothers (p = 0.015). In conclusion, there was a significant increase in GPx activities of smoking mothers and their infants, suggesting that they may have been exposed to more oxidant stress.

A giant cystic hygroma on the leg of a newborn infant complicated by hyponatremia.

Cystic hygromas are large cystic masses resulting from failure of lymph drainage. The vast majority occur in the neck or axilla. Cases of cystic hygroma of the extremity are extremely rare. We present a newborn infant with a giant cystic hygroma on her left leg, complicated by severe hyponatremia.

Pulmonary endarteritis and subsequent embolization to the lung as a complication of a patent ductus arteriosus--a case report.

The authors describe a case of pulmonary endarteritis and subsequent embolization to the lungs as a complication of a patent ductus arteriosus (PDA). Although 2-dimensional echocardiography has been shown to be of great value in the diagnosis of patients with infective endocarditis, echocardiographic detection of vegetation within the pulmonary artery and subsequent embolization to the lung is extremely rare and, to our knowledge, has been previously reported only in a few cases. In brief, our case not only shows the importance of echocardiography in making this rare diagnosis but also emphasizes the role of echocardiography as an effective means of following up such a case.

Nuclear morphometric and morphological analysis of exfoliated buccal and tongue dorsum cells in type-1 diabetic patients.

BACKGROUND: Diabetes mellitus type 1 that results from immunologically mediated damage to the ß-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells. AIM: The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients. MATERIALS AND METHODS: We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica™). RESULTS: The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006). CONCLUSION: The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.

Maternal and neonatal urinary iodine status and its effect on neonatal TSH levels in a mildly iodine-deficient area.

OBJECTIVE: Iodine deficiency and excess are the most important factors that affect screening and recall rates of congenital hypothyroidism. The purpose of this study was to investigate the urinary iodine status in newborns and their mothers and its effects on neonatal thyroid-stimulating hormone (TSH) levels in a mildly iodine-deficient area. METHODS: A total of 116 newborns and their mothers were included in the study. Urinary iodine levels were measured from healthy mothers and their babies on the 5th day following birth. Neonatal TSH levels were screened, and TSH and free thyroxine (fT4) levels were measured on the 15th day in the recall cases. T4 treatment was started in infants with high TSH and low fT4 levels. These measurements were repeated on the 30th day in these newborns. RESULTS: Ninety-nine percent of the mothers included in the study were using iodized salt. The median urinary iodine level in the newborns was 279 µg/L, while it was 84 µg/L in their mothers. The rate of iodine deficiency among the mothers was 56.8%, and the rate of iodine excess was 8.6%. This rate was 10.3% for iodine deficiency and 61.2% for iodine excess in the newborns. The recall rate at the screening was 9.5% (n=11). The urinary iodine levels were above 200 µg/L in three newborns who had transient hyperthyrotropinemia. CONCLUSIONS: Iodine deficiency was more frequently observed in nursing mothers, and iodine excess was more frequently seen in their newborns. The iodine excess noted in the newborns was attributed to the use of antiseptics containing iodine. The iodine excess leads to increases in recall rates, screening costs, and frequency of transient hyperthyrotropinemia.

Effect of maternal smoking on colostrum and breast milk cytokines.

BACKGROUND: Breast milk contains several immune modulator components. The transfer of numerous cytokines via mother's milk may add to an active stimulation of the infant's immune system. There are many factors in breast milk that could either facilitate or inhibit cytokine activities. Smoking negatively influences the immune system and changes the concentrations of important cytokines. OBJECTIVE: The objective of this study was to assess the effect of smoking during pregnancy on the cytokines found in colostrum and mature human milk. METHODS: The study population included 25 smoker and 27 non-smoker nursing mothers who gave birth to a term healthy infant via cesarean section. Breast milk was collected from the mothers on the 2(nd)-3(rd) and 21(st)-25(th) days postpartum during visits to examine the newborns. Samples were analyzed for IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF-α and TNF-ß cytokines by flow cytometric bead array. RESULTS: We first saw that concentrations of IL-1 ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IFN-γ, TNF-α, and TNF-ß cytokines, but not IL-12, were measurable both in colostrum and in mature milk, being higher in colostrum. Next we observed that IL-1ß and IL-8 levels were significantly lower in colostrum, and IL-6 was found to be significantly lower in the mature milk of smoking mothers. No significant effects of maternal smoking on breast milk concentrations of IL-2, IL-4, IL-5, IL-10, IFN-γ, TNF-α, and TNF-ß were observed. CONCLUSIONS: These findings indicate that maternal smoking alters the colostrum and mature milk levels of some cytokines. Therefore, it is thought that active smoking during pregnancy decreases the concentration of certain cytokines in breast milk, which might account for the newborn's increased susceptibility to infections.