Diet and physical activity interventions do have effects on body composition and metabolic syndrome parameters in overweight and obese adolescents and their mothers.

To determine the effects of lifestyle intervention and diet on body composition, anthropometric measurements, and metabolic syndrome (MS) in obese and overweight adolescents and their mothers, a diet and lifestyle intervention program was administered for 16 weeks to 19 9-17-year-old (12.52 ± 2.85 years) adolescents (female/male, 8/11) with a body mass index (BMI) value over the 90th percentile; hemoglobin (Hb)A1C, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fibrinogen, and C-reactive protein levels of the adolescents and anthropometric measurements of the mothers were compared. In some of the anthropometric values (body weight (BW), BMI, waist circumference (WC), skinfold thicknesses, body fat tissue, and lean tissue mass), a statistically significant difference was observed in pre- and post-application measurements (p<0.05). There was a significant difference in pre- and post-application values of systolic and diastolic blood pressure and some biochemical parameters (uric acid, total cholesterol, high density lipoprotein, low density lipoprotein, triglyceride, and HOMA-IR) (p<0.05); however, there was no significant difference in pre- and post-application values of fasting blood glucose, aspartate transaminase, alanine transaminase, albumin, HbA1C, fasting insulin, and fibrinogen (p>0.05). MS was observed in 52.6% of the participants at baseline, and this rate was found as 15.8% based on the measurements carried out at week 16, which is a statistically significant decrease (p<0.05). There was a statistically significant difference in pre- and post-study values of BW, BMI, body fat mass, basal metabolic rate, WC, hip circumference, hip/waist, and skinfold thickness in mothers. A 16-week diet and lifestyle intervention program for overweight and obese adolescents involving their mothers resulted in significant improvement in obesity and MS treatment.

Cardiac chest pain in children.

OBJECTIVE: Chest pain (CP) is a common cause of referral to hospital, not always directly related with cardiac diseases (CD). We investigated the causes for cardiac CP in children. METHODS: A hundred and twenty children, admitted consecutively to pediatric cardiology clinic with CP, were evaluated in two groups (5-12 and 13-16 age-group) in a cross-sectional and a retrospective way. Chest X-ray, electrocardiography, and echocardiography were performed. In case of necessity, 24-hour Holter monitoring, exercise stress test, tilt-table test were performed, and hemogram, serum glucose, electrolytes were evaluated. Statistical analysis was performed using Chi-square test and risk ratio [(Odds-ratio (OR, (95% CI)] in groups were evaluated. RESULTS: Most children with CP were older. Cardiac diseases were established in 52 (42.5%) patients. Cardiac diseases, which may cause CP (aortic stenosis, mitral valve prolapse, arrhythmias, etc.) were found in 23.3% (n=28) of patients. Compared with the younger, the risk of structural CD was found to be 2.84 times higher (OR=2.84, 95%CI 1.24-6.48, p=0.011) and risk of arrhythmia was 3.53 times higher in the elder age group (OR=3.53, 95%CI 0.93-13.38, p=0.051). When all CD were evaluated, elder children were found to have 4.12 times more risk of having CD (OR=4.12, 95%CI 1.89-9.01, p<0.0001). CONCLUSION: Most children with CP were older than 12 years old. CDs were frequent and about half of them were thought to directly cause pain. So, further investigations according to standard algorithms are needed in the evaluation of children with CP. Other important result is the increased risk of CD found in elder children.

Glucocorticoid-induced diabetic ketoacidosis in acute rheumatic fever.

Glucocorticoids are used as anti-inflammatory agents and are associated with many side effects including hyperglycemia, hypertension, pancreatitis, peptic ulcer, and so on. Hyperglycemia is a common side effect, but ketoacidosis is observed rarely. We present a girl who developed diabetic ketoacidosis after the administration of methylprednisolone during the treatment of acute rheumatic fever. She did not have diabetes and was not obese. She developed ketoacidosis after glucocorticoid therapy. Glucocorticoid-induced insulin resistance, lipolysis, and ketogenesis were likely to have precipitated ketoacidosis. During the treatment of ketoacidosis, the insulin need of the patient was gradually decreased by reducing glucocorticoid dose. In addition to the gradual reduction in glucocorticoid dose, salicylate therapy could be considered the treatment for insulin resistance. In this patient, screening for blood gases and urine was diagnostic in the diagnosis of ketoacidosis. The risk of ketoacidosis as well as hyperglycemia should be considered in the course of glucocorticoid therapy.

Community-acquired pneumonia and parapneumonic effusions in developing countries.

Ninety-eight patients with diagnosis of community-acquired pneumonia and parapneumonic effusion were retrospectively evaluated in order to determine the demographic properties of the patients, etiologic microorganism and the resistance patterns. Ages of study groups were between 2 to 16 years (mean 6.5 +/- 3.5 years) and 56 of 98 patients (56%) were male. There were four groups: Pneumonia (Group 1, n: 57), pleural effusion-medical treatment (Group 2, n: 18), pleural effusion-tube thoracostomy (Group 3, n: 19), and pleural effusion-operative treatment (Group 4, n: 4). Pre-admission antibiotic use was up to 84% in study groups. Evaluation of seasonal dispersion revealed that 86.7% of patients were admitted to hospital in the October-May period. Blood cultures were positive in 4 of 98 patients (4%). Nine of 27 (33.3%) pleural effusion cultures were positive and 4 of them revealed Streptococcus pneumoniae. Intermediate penicillin resistance was found in 1/4 of S. pneumoniae isolates (25%). Our study illustrates the problems in the diagnosis and management of pediatric respiratory tract infections in developing countries. Chest X-ray together with erythrocyte sedimentation rate (ESR) was also shown to be important in classifying lower respiratory tract infections. Increase in the usage of specific viral serologic studies will probably lower the percentage of antibiotic usage and lower the costs of cultures.

Axenfeld-Rieger syndrome and pseudotruncus arteriosus.

Axenfeld-Rieger syndrome (ARS) is an autosomal dominant disorder. It is described as the association of malformation of the anterior chamber of the eye with extraocular anomalies. Cardiovascular defects are considered an occasional findings with this syndrome. We present a patient having the features of Axenfeld-Rieger syndrome with pseudotruncus arteriosus as a different cardiac association.

Treatment of massive cardiac thrombi in a patient with protein C and protein S deficiency.

Myocarditis and dilated cardiomyopathy is characterized by dilatation of all four cardiac chambers and decreased systolic function of the heart, especially in the left ventricle. In this report we presented a patient with myocarditis or dilated cardiomyopathy and deficiency of protein C and protein S with biventricular multiple intracardiac thrombi. Standard heparin infusion and acetyl salicylic acid was begun. On the 10th day of hospitalization the right ventricular thrombus disappeared, and on the 24th day all thrombi in the left ventricle disappeared. During the treatment we did not observe any complication such as hemorrhagia or embolism. We think that patients with dilated cardiomyopathy or myocarditis should be evaluated for hemostatic disorders, and should be anticoagulated if any of these disorders are presented.

Left main coronary artery and aortic root compression associated with atrial septal defect and pulmonary hypertension.

The extrinsic compression of left main coronary artery (LMCA) by dilated pulmonary artery is rarely reported. Various congenital and acquired diseases were shown to cause extrinsic LMCA compression. Here we present a child with aortic root and LMCA compression due to dilated pulmonary trunk and causing angina like chest pain. The patient had also electrocardiographic evidence of myocardial ischemia. This case report will be a guide for the evaluation and surgical treatment of the patients with pulmonary hypertension and LMCA compression.

Familial Mediterranean fever and mesangial proliferative glomerulonephritis: report of a case and review of the literature.

In familial Mediterranean fever (FMF), a genetically inherited disease characterized by fever and serositis, renal involvement is mainly AA amyloidosis. We report a patient with FMF who developed mesangial proliferative glomerulonephritis; presumably in response to colchicine treatment, the activity of the disease decreased and renal function tests and urinary findings normalized. This report emphasizes the concurrent existence of mesangial proliferative glomerulonephritis with FMF in the absence of renal amyloidosis. Due to increased inflammatory response observed in FMF, immunologic glomerular injury, a common cause of glomerulonephritis, may occur more frequently in patients with FMF.