Cord blood thyroid-stimulating hormone and free T4 levels in Turkish neonates: is iodine deficiency still a continuing problem?

BACKGROUND: The objectives of this study were to determine the cord blood thyroid-stimulating hormone (TSH) and free T(4) (FT(4) ) levels in Turkish neonates and to determine whether these variables reveal iodine deficiency. METHODS: We collected 818 cords from healthy mothers at parturition and measured levels of FT(4) and TSH. We also measured cord blood FT(4) and TSH levels in different stages of gestation and gender. We grouped the neonates according to cord serum TSH levels, either being less (Group A) or greater (Group B) than 10 mIU/L. Group A included 589 neonates (300 girls [51%] and 289 boys [49%]) and Group B included 229 neonates (105 girls [45%] and 124 boys [55%]). RESULTS: The percentage of subjects with cord blood TSH < 10 mIU/L and >10 mIU/L was 72% and 28%, respectively. Although cord TSH levels in Group B were greater than those in Group A (P < 0.001), cord blood FT(4) levels in Group B were lower than those in Group A (P < 0.05). There was no difference between both sex in terms of birthweight and maternal age. TSH and FT(4) levels did not vary according to neonate sex during gestation, except for from week 37 to 41. TSH levels of male neonates at the 41st week of gestation were higher than those of female neonates (P < 0.05). There were no effects of birthweight on TSH and FT(4) levels if the neonate was lighter than 2500 g at birth. TSH levels of male neonates were higher than those of female neonates when their birthweights were <2500 g (P < 0.05). There was no significant difference in TSH levels according to birthweights in male neonates. CONCLUSION: Our data provide the normative data for cord blood TSH and FT(4) levels in Turkish neonates and show that iodine deficiency is a still a public health problem in Turkey. These measurements can be useful for detection and verification of hypothyroidism in a screening program for congenital hypothyroidism as well as evaluation of the success of the iodination program.

Acute pancreatitis: a rare presenting feature of Henoch Schonlein purpura.

Pancreatitis is a rare manifestation of Henoch Schonlein purpura (HSP). Herein we report a 3-year-old girl presented with acute pancreatitis that developed characteristic rash for HSP at the fifth day of clinical onset. Abdominal pain which is the most frequent sign of gastrointestinal involvement can be also explained by acute pancreatitis. Although clinical features of pancreatitis may be encountered after the onset of the typical rash, pancreatitis can also occur as a presenting feature. This rare presentation of HSP is discussed to emphasise the clinical features, presentation and outcome of pancreatic involvement.

Early but prolonged gallbladder hydrops in a 7-month-old girl with Kawasaki syndrome: Report of a case.

Kawasaki syndrome (KS) is a self-limiting childhood disease. Gallbladder hydrops is an uncommon manifestation of this syndrome, found rarely in infants. We report the case of a 7-month-old girl with KS manifesting as gallbladder hydrops, which resolved spontaneously during follow-up. To our knowledge, this represents the youngest such case ever reported. We discuss the clinical characteristics, radiological features, and outcome of gallbladder hydrops in KS during infancy to help understand this rare complication.

A novel mutation for TAP deficiency and its possible association with Toxoplasmosis.

We describe two siblings (a male patient and his older sister) with a novel mutation in the peptide transporter associated to antigen processing (TAP). The index case presented with not only granulomatous skin lesions and recurrent sino-pulmonary infections, often associated with this deficiency, but also a severe pulmonary toxoplasmosis. His toxoplasmosis and skin lesions were successfully treated.

Obesity and type 2 diabetes mellitus: a population-based study of adolescents.

A cross-sectional, population-based study was conducted on 1,647 Turkish adolescents to determine the prevalence of obesity, impaired fasting glucose (IFG) and type 2 diabetes mellitus (DM2), and to determine whether the recent increase in DM2 prevalence in some countries is applicable to this population. Information was gathered through a questionnaire. All children were screened with physical examination and fasting plasma glucose. 10.7% of adolescents were overweight (BMI 85-95th percentile) and 3.6% were obese (BMI > or =95th percentile). Mean BMI was 20.25 +/- 3.31 kg/m2 with maximum BMI 35.88 kg/m2. No child was diagnosed with DM2; 1.96% had IFG (110-126 mg/dl). No significant relationship was found between IFG and obesity, socio-economic status (SES) or family history of DM. The risk of obesity was increased among children with family history of DM or obesity, and among those who had low physical activity and were of high SES level. This analysis represents the population-based data upon which future studies will be based.

Two siblings with tyrosinaemia type 2.

UNLABELLED: We report on two siblings with tyrosinaemia type 2, a 6-year-old girl and her 3.5-year-old brother with a main complaint of painful palmo-plantar hyperkeratosis. The boy presented also conjunctival injection, photophobia, lacrimation and conjunctivitis. Blood tyrosine levels were increased in both patients, 150.6 and 202.3 micro mol/dl, respectively (reference value: 5.8+/-2.2 micro mol/dl). After 1 month of dietary treatment with low protein, low phenylalanine and tyrosine, tyrosine levels decreased to 37.7 and 65.6 micro mol/dl, respectively; the cutaneous lesions improved in both of them, and conjunctivitis disappeared. CONCLUSION: the association of bilateral ulcero-conjunctivitis with photophobia and palmo-plantar hyperkeratosis since early infancy is the clue to the diagnosis of tyrosinaemia type 2.

Nerve conduction in children suffering insulin dependent diabetes mellitus.

OBJECTIVE: To determine the incidence of peripheral neuropathy in children suffering Insulin Dependent Diabetes Mellitus (IDDM) as well as to determine the relationship between other criteria of the disease and neuropathy. METHODS: 40 children (17 males, mean age 11.9 years) suffering IDDM and receiving insulin therapy involving two injections a day and 30 healthy children (17 males, mean age 11.7 years) were included in the study. They were inquired about their demographical characteristics as well as the presence of neurological symptoms. Their detailed neurological examinations were conducted. Their glycemic control values (Hb A1C) were recorded, and their nerve conduction studies were performed from right upper and lower extremities. RESULTS: All nerve conduction values of children with IDDM were found to be significantly lower (p<0.0001) as compared to the control group. 60% of diabetic children (n=24) were found to suffer peripheral neuropathy. Statistically significant relationships were found between the glycemic control values and the peroneal, sural, tibial, ulnar and median nerve conduction velocities, and also between the duration of disease and the peroneal, sural, tibial and median nerve conduction velocities. CONCLUSION: The peripheral neuropathy is rather a frequently observed complication in diabetic children. The duration of disease and impaired glycemic control play an important role in the development of neuropathy. The introduction of new methods designed to ensure better glycemic control will reduce the incidence of the complication.

Cardiovascular changes in children with pneumonia.

Pneumonia is an important cause of death in childhood, especially in the infancy period. Since the respiratory and cardiovascular systems cannot be thought of independently, it is important to detect cardiovascular changes during pneumonia. We prospectively studied 50 children aged 2-24 months admitted to the hospital because of pneumonia in order to evaluate their cardiovascular findings with noninvasive methods. Patients were classified according to the World Health Organization (WHO) criteria of pneumonia, and evaluated by obtaining complete blood counts, serum electrolytes, renal and liver function tests, blood gases, creatinine kinase MB fraction (CK-MB), chest X-ray, electrocardiography (ECG) and echocardiography at the admission and after clinical recovery. Right ventricular systolic pressure (RVSP) was found to be high in 70% of patients and there was a correlation between the severity of the pneumonia and RVSP All patients had normal left ventricular dimensions and functions, but in 68% of them CK-MB was elevated. In these infants, T voltages in D1 derivation showed a significant rise with clinical recovery. Seven cases developed congestive heart failure, and three died. CK-MB was found to be high in all patients who died and in six of seven patients with congestive heart failure. Our findings suggest that myocarditis incidence in children with pneumonia may be higher than previously known. Since myocarditis can be a fatal disease, its detection is important by noninvasive techniques like ECG, echocardiography and cardiac enzyme measurements.

Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study.

In this study, the effects and side effects of rectal diazepam and intranasal midazolam were compared in the treatment of acute convulsions in children to develop a practical and safe treatment protocol. In the diazepam group, the seizures of 13 (60%) patients terminated in 10 minutes; however, 9 (40%) patients did not respond. In the midazolam group, 20 (87%) patients responded in 10 minutes, but 3 (13%) patients did not respond. Regarding the anticonvulsant effect, midazolam was found to be more effective than diazepam, and the difference was statistically significant (P < .05). The necessity of a second drug for the seizures that did not stop with the first drug was higher in the diazepam group than the midazolam group, and the difference was statistically significant (P < .05). We conclude that as an antiepileptic agent, intranasal midazolam is more effective than rectal diazepam. After administration, we did not observe any serious complications. Further investigations are necessary; however, intranasal administration is easy, so if the nasal drop and spray forms used in some European countries and the United States are available worldwide, it will be very useful for physicians in the emergency room.