Evaluation of visceral adipose tissue thickness in precocious puberty.

OBJECTIVE: Although there is a relationship between earlier onset of puberty and increased adiposity tissue. Publications in the literature on adiposis in patients with central precocious puberty (CPP) and visceral fat thickness (VFT) have conflicting results. So, in this study, we aimed to evaluate the relationship between sexual maturation and obesity in the development of early puberty and to examine their relationship with pelvic sonographic parameters. PATIENTS AND METHODS: A total of 126 girls [patients - premature thelarche (PT) and CPP - and controls] were included in this study. Anthropometric and ultrasonographic evaluations were made by the same pediatric endocrinologist and pediatric radiologist, respectively. Pubertal stages were made according to the Tanner stages. Height, weight, and body mass index were measured as anthropometric measurements, and visceral, subcutaneous, and transabdominal fat thicknesses were measured in sonographic evaluation. RESULTS: The study population was divided into three groups: 44 healthy subjects to Group 1, 23 patients with PT to Group 2, and 59 patients with CPP to Group 3. When we evaluated the anthropometric and ultrasonographic parameters according to pubertal status, significant differences, especially between Group 1 and Group 3, were observed in all data. In the multiple logistic regression analysis, the endometrial thickness (OR = 7.521, p < 0.001) and VFT (OR = 1.530, p < 0.001) were found to be independent predictors of precocious puberty. CONCLUSIONS: It has been found that VFT and endometrial thickness measurements, which are evaluated quickly and accurately by USG, are important predictors of prepubertal precociousness.

Clinical Study of Decompressive Craniectomy in Children.

AIM: To evaluate the clinical characteristics of children who recently underwent decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) correlated to head trauma or other causes, such as ischemic insult. MATERIAL AND METHODS: Twelve patients aged ≤17 years who underwent DC due to elevated ICP between 2013 and 2018 were included in the study. The clinical status of the participants, radiological characteristics, type and timing of surgery, and outcomes were recorded. RESULTS: Three female and nine male patients with a mean age of 10 years were included. The initial average Glasgow Coma Scale score was 6 (3-12). All patients presented with signs of diffuse cerebral edema and subdural hematoma of various sizes along with other intracranial pathologies. Only one patient required bilateral frontal craniectomy. In the postoperative period, three patients died, and three had severe disability. CONCLUSION: With the increasing use and success of DC in adults, this procedure can also be effective in children. Considering brain differences in children, large and well-structured clinical trials must be conducted to prevent complications and to identify the best technique, timing, and benefits of DC for children.

Ascorbic acid and beta-carotene reduce stress-induced oxidative organ damage in rats.

Antioxidants are potential therapeutic agents for reducing stress-induced organ damage. We investigated the effects of ascorbic acid and ß-carotene on oxidative stress-induced cerebral, cerebellar, cardiac and hepatic damage using microscopy and biochemistry. Male Wistar albino rats were divided into five groups: untreated control, stressed, stressed + saline, stressed + ascorbic acid and stressed + ß-carotene. The rats in the stressed groups were subjected to starvation, immobilization and cold. The histopathological damage scores for the stressed and stressed + saline groups were higher than those of the control group for all organs examined. The histopathological damage scores and mean tissue malondialdehyde levels for the groups treated with antioxidants were lower than those for the stressed and stressed + saline groups. Mean tissue superoxide dismutase activities for groups that received antioxidants were higher than those for the stressed + saline group for most organs evaluated. Ascorbic acid and ß-carotene can reduce stress-induced organ damage by both inhibiting lipid oxidation and supporting the cellular antioxidant defense system.

Predictive factors and clinical biomarkers for treatment in patients with chronic pain caused by osteoarthritis with a central sensitisation component.

AIMS: The aim of this non-systematic review was to provide a practical guide for clinicians on the evidence for central sensitisation in chronic osteoarthritis (OA) pain and how this pain mechanism can be addressed in terms of clinical diagnosis, investigation and treatment. METHODS: The authors undertook a non-systematic review of the literature including a MEDLINE search (search terms included central sensitisation, osteoarthritis, osteoarthrosis) for relevant and current clinical studies, systematic reviews and narrative reviews. Case reports, letters to the editor and similar literature sources were excluded. Information was organised to allow a pragmatic approach to the discussion of the evidence and generation of practical recommendations. RESULTS: There is good evidence for a role of central sensitisation in chronic OA pain in a subgroup of patients. Clinically, a central sensitisation component in chronic OA pain can be suspected based on characteristic pain features and non-pain features seen in other conditions involving central sensitisation. However, there are currently no diagnostic inventories for central sensitisation specific to OA. Biomarkers may be helpful for confirming the presence of central sensitisation, especially when there is diagnostic uncertainty. Several non-pharmacological and pharmacological treatments may be effective in OA patients with central sensitisation features. Multimodal therapy may be required to achieve control of symptoms. DISCUSSION: Clinicians should be aware of central sensitisation in patients with chronic OA pain, especially in patients presenting with severe pain with unusual features.

Validation and reliability of the Turkish version of the fear avoidance beliefs questionnaire in patients with low back pain.

AIM: The aim of this study was to translate the questionnaire into Turkish and to investigate the test-retest reliability, construct validity and its sensitivity to change following physical therapy. METHODS: The questionnaire was translated into Turkish using the forward and backward translation technique. Test-retest reliability was assessed with the correlation coefficients. Scale analysis for internal validity, the Cronbach's alpha score was calculated. Construct validity was tested with principal components analysis and was also tested with divergent validity. Following three weeks of treatment, sensitivity to change and responsiveness of the questionnaire was assessed. RESULTS: The questionnaire was applied on 55 patients and high correlations were found on the repeated items 48 hours later. In the scale analysis, the Cronbach's alpha score was found as 0.911 for the total questionnaire. Two factors were found compatible with the original questionnaire with principal components analysis. These two factors explain 61.647% of the total variance in the questionnaire performed on 150 patients. In divergent validity, the fear avoidance beliefs were found in low correlation with the clinical variables. Sensitivity to change and responsiveness of the FABQ was found to be low. CONCLUSIONS: FABQ has sufficient psychometric features for its applicability in the Turkish population with subacute and chronic low back pain.

Congenital cutis laxa associated with growth retardation / Cutis laxa congénita aociada con retardo del crecimiento

Congenital cutis laxa is a rare, clinically and genetically heterogeneous group of inherited disorders. It is characterized by degenerative changes in elastic fibres and manifests with skin laxity. Here we presented a six-month old boy with congenital cutis laxa associated with growth retardation. We reveal ultrastructural findings and discussed the differential diagnosis.

El laxa del cutis es un grupo raro, clínica y genéticamente heterogéneo de desórdenes heredados. Esta afección se caracteriza por cambios degenerativos en las fibras elásticas y se manifiesta en la hiperlaxitud de la piel. Aquí presentamos el caso de un niño de seis meses con cutis laxa congénita asociada con retardo del crecimiento. Se revelan los hallazgos ultra-estructurales y se discute el diagnóstico diferencial.

Hand strengths in carpal tunnel syndrome.

The purpose of this study was to determine whether a measurable decrease in isokinetic (dynamic) and isometric (static) hand strengths occurs in carpal tunnel syndrome (CTS) patients. Eighteen CTS patients and 20 healthy controls were included in the study. Isokinetic (eccentric and concentric) and isometric grip and pinch strengths were measured with a Biodex System 3 dynamometer (Biodex Medical System, Inc. New York). All strength measurements, except isometric and isokinetic (concentric/eccentric) three-point pinch and isokinetic (concentric) tip pinch, revealed statistically significant differences between CTS patients and controls. Measurable decrease in hand strengths may exist in CTS despite normal manual assessments. Although both isokinetic (dynamic) and isometric (static) dynamometers are capable of detecting this decrease, neither technique seems better than the other.

Congenital Cutis laxa associated with growth retardation.

Congenital cutis laxa is a rare, clinically and genetically heterogeneous group of inherited disorders. It is characterized by degenerative changes in elastic fibres and manifests with skin laxity. Here we presented a six-month old boy with congenital cutis laxa associated with growth retardation. We reveal ultrastructural findings and discussed the differential diagnosis.

Cataract surgery in previously vitrectomized eyes.

PURPOSE: To evaluate the results of extracapsular cataract extraction (ECCE) and phacoemulsification (PHACO) performed in previously vitrectomized eyes. MATERIAL AND METHOD: In this retrospective study, 56 vitrectomized eyes that had ECCE and 60 vitrectomized eyes that had PHACO were included in the study group while 65 eyes that had PHACO in the control group. The evaluated parameters were the incidence of intra-operative and postoperative complications (IPC) and visual outcomes. Chi-squared, independent samples and paired samples tests were used for comparing the results. RESULTS: Deep anterior chamber (AC) was significantly more common in the PHACO group of vitrectomized eyes (PGVE) and observed in eyes that had undergone extensive vitreous removal (p < 0.05). Except for this there were no significant differences in the rate of IPC between the ECCE group and the PGVE (p > 0.05). Some of the intra-operative conditions such as posterior synechiae, primary posterior capsular opacification (PCO) and postoperative complications such as retinal detachment (RD), PCO were significantly more common in vitrectomized eyes than the controls (p < 0.05). There was no significant difference in the visual acuity gain between the ECCE group and the PGVE (p > 0.05). CONCLUSION: Deep AC is more common in eyes with extensive vitreous removal during PHACO than ECCE. Decreasing the bottle height is advised in this case. Except for this, the results of ECCE and PHACO are similar in previously vitrectomized eyes. Posterior synechiaes, primary and postoperative PCO and RD are more common in vitrectomized eyes than the controls.

Dry eye syndrome in diabetic children.

PURPOSE: To compare the symptoms, signs, and results of objective tests for dry eye syndrome (DES) in type 1 diabetes mellitus (T1DM) patients and controls. METHODS: A total of 104 children with T1DM and 104 age- and sex-matched controls were compared in terms of the symptoms, signs, and results of objective tests for DES. Duration of T1DM, presence of diabetic retinopathy, mean hemoglobin A1c level, pubertal status, and a history of accompanying autoimmune disease were noted in T1DM group. Analysis of variance, multivariate regression analysis, Student t, Mann-Whitney U, and chi-square tests were used for statistical analysis. RESULTS: A total of 15.4% of diabetic children complained of dry eye symptoms, versus 1.9% of the controls (p=0.029). Dry eye signs were detected in 7.7% of diabetic children, versus 0.96% of controls (p=0.034). Tear break-up time (TBUT) and Schirmer test results were significantly lower in T1DM group than controls (p=0.018, p=0.024, respectively). A total of 7.7% of diabetic children had definite and 0.96% had probable diagnosis of DES, versus none of the controls (p=0.03). TBUT and Schirmer test results were significantly lower in patients with more than 10 years duration of T1DM (p<0.001 for both). CONCLUSIONS: The prevalence of symptoms, signs, and definite diagnosis of DES are higher and basal tear secretion and tear film stability are lower in diabetic children than controls. Duration of T1DM is the only disease-related variable which is associated with basal tear secretion and tear film stability.

Brain MR spectroscopy findings in neonates with hypothyroidism born to mothers living in iodine-deficient areas.

BACKGROUND AND PURPOSE: Iodine deficiency and hypothyroxinemia have a negative effect on the development of the central nervous system during fetal and early postnatal life. MR spectroscopy is a sensitive technique for detecting the changes of brain metabolites in various neurodevelopmental disorders. By using MR spectroscopy, we aimed to show the decrease in N-acetylaspartate (NAA) levels in neonates with hypothyroidism who were born in iodine-deficient areas and its normalization with early thyroxine therapy. METHODS: Eight congenital hypothyroid and 8 healthy full-term neonates were chosen as study and control groups, respectively. Serum thyroid hormones and median urinary iodine concentration of the neonates and their mothers were measured. Measurements of NAA, choline (Cho), and creatine (Cr) were made in frontal white matter, parietal white matter (PWM), and the thalamus with MR spectroscopy, first at 5-7 days of life and after 8 weeks of thyroxine therapy in the study group and at the same time in the control group. RESULTS: The patient group had significantly lower NAA/Cr ratios in PWM and the thalamus (P < .05, for each), whereas the difference between Cho/Cr ratios of the 2 groups before therapy was not significant. After 8 weeks of thyroxine therapy, measurements did not show significant difference between study and control groups. CONCLUSION: MR spectroscopy performed in neonates with hypothyroidism reveals that intrauterine hypothyroxinemia due to iodine deficiency results in significant decrease in NAA levels in PWM and the thalamus and that the normalization of NAA levels is achieved with early thyroxine therapy.

High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors.

INTRODUCTION: The aim of the study was to determine the prevalence of vitamin D deficiency, secondary hyperparathyroidism (sHPT), generalized bone pain and predictors of vitamin D deficiency in a cohort of 994 healthy adult urban residents (589 males, 405 females; age range: 16-69 years) consisting of 101 Germans, 327 Turkish residents of Turkey and 566 Turkish immigrants living in Germany. METHODS: The mean (+/- standard deviation) for 25-hydroxyvitamin D [25(OH)D] and biointact parathyroid hormone (BioPTH) for the German men and women was 68.4 nmol/l and 26.7 pg/ml, respectively. Turkish residents of Turkey had a mean 25(OH)D and BioPTH of 40.6 nmol/l and 27.5 pg/ml, respectively, whereas Turkish residents of Germany had a 25(OH)D of 38.1 nmol/l and a BioPTH of 35.6 pg/ml. RESULTS: Vitamin D insufficiency was common among Turkish nationals independent of whether they lived in Turkey or Germany; 75% had 25(OH)D levels of <50 nmol/l. Turkish females had a higher prevalence of 25(OH)D deficiency (<25 nmol/l) than Turkish males: 30 and 19% of Turkish females living in Germany and Turkey were severely vitamin D deficient compared to 8% and 6% of Turkish males living in Germany and Turkey, respectively. With respect to BioPTH levels, 31% of Turkish females and 21% of Turkish males had elevated BioPTH levels in contrast to only 15% of females and 4% of males living in Turkey. Unconditional logistic regression analysis identified the most important predictors for low 25(OH)D levels as sex, body mass index, lack of sun exposure and living at a higher latitude. Additionally, wearing a scarf and number of children were found to be an independent risk factor for vitamin D deficiency in Turkish women living in Turkey and Germany. A strong correlation between low 25(OH)D levels and higher rates and longer duration of generalized bone and/or muscle aches and pains (often diagnosed as fibromyalgia) was observed. CONCLUSION: Secondary hyperparathyroidism and vitamin D deficiency was found to be common among Turkish immigrants living in Germany, especially in veiled women. Therefore, the monitoring of vitamin D status--i.e. 25(OH)D and PTH--in Turkish immigrants is warranted and once a deficiency is identified, it should be appropriately treated.

Robinow Syndrome: a case report.

We report a case with Robinow syndrome which has been rarely reported in the literature. A male newborn who had fetal face appearance (broad and prominent forehead, hypertelorism, small saddle nose, anteverted nostrils, glabellar nevus flammeus, malar hypoplasia, down-turned mouth and retrognathia), mesomelic limb shortening, hemivertebra and genital hypoplasia was diagnosed as Robinow syndrome. Elevated levels of both basal and stimulated testosterone and dihydrotestosterone were found along with normal baseline levels of gonadotropins. These endocrinologic studies were suggestive for an androgen insensitivity. Mental and motor development of the infant were normal at 3 and 6 months of age. Because of the high level of consanguineous marriages in Turkey, we may expect a higher incidence of the autosomal recessive form of the syndrome. This gives a high recurrence risk and makes prenatal diagnosis an important option for future pregnancies in the families.

[Pyruvate kinase M2 (tumor M2-PK) as a screening tool for colorectal cancer (CRC). A review of current published data]. / Pyruvatkinase M2 (Tumor M2-PK) im Stuhl als Screeningparameter für kolorektale Neoplasien. Eine Ubersicht über bisher publizierte Daten.

INTRODUCTION: Colonoscopy is currently supposed to be the best screening tool for colorectal cancer. However, the acceptance of the population is very poor although it has been included in screening programs in the German health system since 2002. Therefore, evaluation of additional screening tools seems to be of great interest. Recently testing for fecal occult blood (FOBT), genetic alterations or alterations in tumor metabolism (e.g., tumor M2-PK) are under investigation. METHODS: The use of M2-PK measurement in the feces has been reported in 6 studies until today. The data of these studies were analyzed and critically reviewed. RESULTS: The overall sensitivity of M2-PK is 77.9% concerning CRC. Specificity ranges from 74.3-83.3%. Overall sensitivity for adenomas is 45.9%, increasing to 61.1% for adenomas > 1 cm. A high percentage of positive results (90.4%) was also observed in patients with chronic inflammatory bowel disease. CONCLUSIONS: Compared to FOBT or genetic testing the M2-PK test seems to be superior for CRC screening. Concerning handling, effectiveness and analysis, M2-PK seems to be a good possibility for large scale-screening of colorectal carcinoma. It might even be used to detect larger adenomas. Elevated levels of M2-PK in patients with acute and/or chronic inflammatory bowel diseases are probably due to proliferation of epithelial cells and leucocytes in the inflammatory area.

A reappraisal on the management of lumbosacral plexopathies in gynecological malignancies: where do the physiatrists stand?

Two patients are reported here with gynecological malignancies--an ovarian and a cervical carcinoma--who had suffered from lumbar plexopathies during their follow-up. Their management is discussed with an emphasis on the collaboration of the gynecologists and the rehabilitation physicians.

Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus.

The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9 +/- 3.4 (8.2-19.4). The average number of keto-acidosis episodes was 1.9 +/- 2.2 (0-9) and the average number of daily insulin injections was 2.8 +/- 0.97 (2-4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.

Cardiovascular risk factor levels in a lower middle-class community in Ankara, Turkey.

STUDY OBJECTIVE: To assess the prevalence of risk factors for coronary heart disease (CHD) in a lower middle-class urban community of Turkey. DESIGN: Cross-sectional study in an age- and sex-stratified random community sample with equal sample size per stratum. Direct age-standardization using the standard world population to allow international comparison of findings. Logistic regression modelling to identify risk factors for obesity. SETTING: Gülveren, a residential area in Ankara, total population 23,000 persons. PARTICIPANTS: A total of 1672 adults aged 25-64 years and resident in the study community were interviewed, 1272 (76.1%) of those came for physical examination. MAIN RESULTS: The age-standardized prevalence of hypertension according to WHO MONICA criteria was 18.6% (95% confidence interval: 16.1-21.1%) among women and 12.3% (9.7-14.9%) among men; of obesity (body mass index, BMI > or =30 kg/m2) 51.0% (47.6-54.3%) among women and 15.1% (12.0-18.2%) among men; of current smoking 20.1% (17.5-22.6%) among women and 64.8% (61.4-68.2%) among men; of hypercholesterolaemia 20.1% (17.4-22.9%) among women and 13.8% (10.8-16.8%) among men; and of low high density lipoprotein (HDL) 48.4% (44.8-52.1%) among women and 40.6% (36.0-45.2%) among men. In the regression model, age, female sex, non- and ex-smoking were associated with obesity. CONCLUSIONS: The prevalence of smoking, obesity and low HDL is high in this urban, lower middle-class population, even in comparison with industrialized countries. Unexpectedly, women have less favourable CHD risk profiles than men, except for smoking. Preventive action should be community-wide and address the common risk factors simultaneously to avoid replacement effects such as becoming obese after quitting smoking.

Analysis of an outbreak due to Chryseobacterium meningosepticum in a neonatal intensive care unit.

The aim of this study was to describe the epidemiological and clinical features of an outbreak due to Chryseobacterium meningosepticum. During a 11-day period, the outbreak was observed among four newborns in a neonatal intensive care unit (NICU) in a teaching hospital. All patients yielded C. meningosepticum in their blood cultures, in addition one was colonised in the throat. Antimicrobial susceptibility assay showed complete resistance to penicillins, cephalosporins, aminoglycosides, imipenem, aztreonam, and tetracycline, sensitivity to ciprofloxacin and trimethoprim-sulfamethoxazole. All patients were empirically treated with amikacin and meropenem. The neonate who was the first to develop sepsis died before the culture result. When C. meningosepticum was identified, antimicrobial therapy was changed to a combination of ciprofloxacin, rifampicin and vancomycin, and three neonates were treated successfully. Environmental screening recovered C. meningosepticum from two venous catheter lines and one nutritional solution that was opened by health care staff and used for two neonates. Arbitrary primed polymerase chain reaction and antibiogram typing indicated that all isolates were epidemiologically related. This study demonstrates that rapid selection of appropriate antibiotics is critical for clinical cure and standard precautions should be reconsidered to limit the spread of this bacterium on the NICU in our hospital.

Bell's palsy as an early manifestation of acute lymphoblastic leukemia.

A 20-year-old man with the complaints of malaise, fever, and tooth gum bleeding presented at a hospital. He was found to have generalized lymphadenopathy, thrombocytopenia, and leukocytosis. Ensuing bone marrow biopsy led to a diagnosis of acute lymphoblastic leukemia (ALL). He also had a sense of "facial stretching" and difficulty during eating. After clinical examination, he was diagnosed with right-sided peripheral type facial nerve paralysis (Bell's palsy). The magnetic resonance imaging studies demonstrated bilateral facial nerve involvement, predominantly on the right side. The patient received steroid treatment and local facial radiotherapy for Bell's palsy. A concurrent facial exercise program was ordered. Seemingly a less significant diagnosis in a leukemia patient, we considered our case notable since an ALL patient presenting with Bell's palsy, especially at the very beginning of the disease, is not that common. The cases of relapsing ALL reported in the literature initially presenting with the same scenario further strengthen the significance.