Fetal cerebral and cardiac hemodynamics in postdate pregnancy.

Objective: We aimed to determine the fetal cerebro-placental Doppler indices and modified myocardial performance index (Mod-myocardial performance index (MPI)) in this homogenous group of postdated pregnancies. Methods: A total of 92 singleton pregnant women were included in this prospective study. The study involved three groups; full term control (Group 1, n = 42, 39 0/7 to 40 6/7 week' gestation), late term (Group 2, n = 34, 41 0/7 to 41 6/7 week' gestation) and post term (Group 3, n = 16, ≥ 42 0/7 weeks' gestation). Each participant underwent a Doppler assessment of the fetal umbilical artery (UA), middle cerebral artery (MCA), Mod-MPI. We determined the correlation of the Doppler indices and mod-MPI in patients with unfavorable outcome. Results: MCA pulcatility indices (PI), cerebroplacental ratio (CPR) values were significantly higher in the control group than those in the late-term and post-term groups (Group 1: 1.63 ± 0.3, Group 2: 1.27 ± 0.51, Group 3: 1.13 ± 0.22, respectively, p < .001). The Mod-MPI was significantly higher in the late-term and post-term groups than in the control group (Group 1:0.38 ± 0.1, Group 2: 0.59 ± 0.09, Group 3: 0.60 ± 0.08, respectively, p < .001. MCA PI and CPR were only significantly lower in patients with unfavorable outcome). The threshold value for CPR levels for predicting unfavorable outcome in postdate pregnancies was calculated as 1.11 (area under curve [AUC] 0.762, confidence interval [CI] 0.575-0.95) with 72.7% sensitivity and 71.8% specificity. Conclusions: Fetal Mod-MPI does not differ in postdate pregnancies with favorable and unfavorable outcome. The monitorization of fetal well-being with CPR may help to clinicians to select patient for expectant management in postdate pregnancies.

Investigation of Blood Betatrophin Levels in Obese Children with Non-Alcoholic Fatty Liver Disease.

PURPOSE: The prevalence of obesity has significantly increased among children and adolescents worldwide and is becoming an important health care problem in parallel with the increased prevalence of obesity pediatric non-alcoholic fatty liver disease. Betatrophin is a newly define hormone that is commonly secreted by liver and plays role in glucose tolerance. This study aimed to investigate the relationship between serum betatrophin levels and non-alcoholic fatty liver disease in obese children. METHODS: The study included 40 obese children with a body mass index (BMI) above 95th centile, and 35 non-obese subjects with a BMI 3-85th centile, whose age and gender were similar to those of the patient group. For the evaluation of metabolic parameters fasting serum glucose, insulin, alanine aminotransferase, aspartate aminotransferase, lipid profile and serum betatrophin levels were measured. Total cholesterol: high-density lipoprotein cholesterol and low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratios were calculated as "atherogenic indices." RESULTS: Serum betatrophin levels of the obese subjects were similar to that of non-obese subjects (p=0.90). Betatrophin levels were not correlated with the metabolic parameters. CONCLUSION: In the present study, levels of betatrophin are not different between obese and insulin resistant children and non-obese subjects, and they are not correlated with atherogenic indices. To elucidate the exact role of betatrophin in obesity, further studies are required to identify the betatrophin receptor and/or other possible cofactors.

A Case With Short Stature, Growth Hormone Deficiency and 46, XX, Xq27-qter Deletion.

We report a case of 11-year-old girl with growth retardation and 46, XX, Xq27-qter deletion. The endocrinologic evaluation revealed growth hormone deficiency. In karyotype analysis  46, XX, Xq27-qter deletion was determined. The deletion of terminal region of chromosome 27 is most commonly being detected during the evaluation of infertility, premature ovarian insufficiency or in screening for fragile X carrier status. To our knowledge, this is the first reported case with 46, XX, Xq27-qter deletion and growth hormone deficiency. Furthermore, this case might facilitate future search for candidate genes involved in growth hormone deficiency.

Application of a Mixed Material Graft to Posterior Intravaginal Slingoplasty Procedure: Preliminary Pilot Series.

Good anatomic outcomes have been achieved with transvaginal synthetic materials in pelvic organ prolapse, but mesh-related complications are a major health concern. Therefore, developing new synthetic or biological materials with increased tissue strength and decreased complications are major challenges. This paper presents preliminary pilot series of Posterior Intravaginal Slingoplasty (PIVS) procedure performed with mixed material graft containing both autologous tissue and a synthetic material. Six women with symptomatic Utero-Vaginal Prolapse (UVP) ≥ stage 2 underwent the PIVS procedure. Pelvic floor symptoms were assessed with the Pelvic Organ Prolapse Quantification (POP-Q) system, Pelvic Floor Distress Inventory (PFDI), and the Pelvic Floor Impact Questionnaire (PFIQ) both before the procedure and 36 months after the surgery. There were no mesh-related complications or recurrence and all the patients had good functional and anatomic outcomes. These preliminary results are promising, but further long-term studies with a larger series are needed.

Protective effects of ursodeoxycholic acid in experimental corrosive esophagitis injury in rats.

Accidental caustic ingestions are serious medical problems especially in childhood. Various treatment modalities are being used for the complications of caustic injuries such as stricture formation. The aim of this study is to establish whether ursodeoxycholic acid (UDCA) has protective effects on experimental corrosive esophagitis in rats. Twenty four Wistar-albino rats, weighing 220-240 g, were used in the study. Experimental animals were divided in three groups randomly: UDCA treatment group (Group T, n:8), control group (Group K, n: 8) and sham group (Group S, n: 8). In group T and S corrosive esophagitis was induced. UDCA (5 mg/kg) was performed to the group T for 10 days orally. All animals were sacrificed at the end of procedures and histopathological changes in esophageal tissue were scored by a single investigator who was blind to the groups. In group T inflammation was present in two rats, muscularis mucosa injury in two rats, grade 1 collagen deposition in six rats and grade 2 in two rats. In comparison with group S these were statistically significant (p value was 0.003, 0.003 and 0.015, respectively). UDCA has protective effect in experimental corrosive esophagitis. KEY WORDS: Corrosive esophagitis, Rat, Stricture, Ursodeoxycholic acid.

Influence of body mass index on mindfulness awareness and coping methods for stress in adolescents.

OBJECTIVE: Psychological state may affect the body weight through the hypothalamus and vice versa. The goal of this study is to investigate whether body mass index affect mindfulness awareness (MA) levels and type of coping with stress. METHODS: Healthy adolescents were included in the study. The mindfulness attention awareness scale (MAAS), indicating the ways of coping checklist inventory was performed and body mass index (BMI) (kg/m2) of adolescents were calculated. The influence of BMI on MA and ways of coping with stress was tested. According to BMI percentiles the study population was grouped as obese (including overweight), normal-weighted and underweight. RESULTS: A total of 270 adolescents (mean age: 13.63±2.07 years; 165 female/105 male) participated in the study. No significant correlation was found between BMI and MA scores (r=-0.085; p=0.161) and coping strategies were not different between the groups. When MA scores are compared with stress coping methods, it appeares that participants with high awareness levels chose positive coping styles. CONCLUSION: BMI is not effective on MA levels and choice of stress coping methods. But the higher MA levels are associated with positive coping styles.

Does intrauterine tobacco exposure increase the pain perception of newborns?

BACKGROUND: This study aimed to assess whether there was a difference in the pain-perception levels of newborns born to mothers who smoked during pregnancy and newborns born to mothers who were not exposed to active or passive smoking during pregnancy. MATERIALS AND METHODS: A total of 60 newborns born by normal spontaneous vaginal birth between June 2013 and June 2014 were included in the study: 30 born to mothers who smoked during pregnancy, and 30 born to mothers not exposed to smoking. Mothers or newborns who had taken analgesics or sedative medications in the previous 24 hours, newborns not born at term, and sick newborns were not included in the study. During the routine hepatitis B-vaccination injection given at postnatal 48 hours, the newborns' behavior was monitored and recorded by video camera. The data obtained from the recordings were evaluated according to the Neonatal Pain, Agitation, and Sedation Scale and analyzed with SPSS 20. RESULTS: The median pain score of the group exposed to tobacco smoke in utero was 8.5, while the median pain score of the unexposed group was 6 (P<0.001). CONCLUSION: Exposure to tobacco smoke in utero may increase the pain-perception levels of newborns.

Do we really ponder about necessity of intravenous hydration in acute bronchiolitis?

OBJECTIVE: The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis. METHODS: This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting ß2-agonist (salbutamol) +hydration; nebulized short-acting ß2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure. RESULTS: A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital. CONCLUSIONS: IV hydration is not effective on length of stay in hospital in mild acute bronchiolitis patients.

OBJETIVO: Establecer la función de la terapia de hidratación intravenosa leve. MÉTODOS: Estudio retrospectivo de casos y controles. En el estudio fueron reclutados niños entre 1 mes y 2 años de edad atendidos en la sala de pediatría general entre junio 2012 y junio 2013, con diagnóstico de bronquiolitis aguda no complicada. Se revisaron historias médicas de los niños para obtener datos personales, síntomas de la enfermedad, grado de severidad y el manejo instaurado. Los pacientes fueron clasificados en cuatro grupos de cuerdo al manejo: hidratación + nebulización de corta acción con ß2-agonista (salbutamol); nebulización de corta acción con ß2-agonista (salbutamol); hidratación; o sin hidratación y broncodilatador. Se determinó la duración de la estancia hospitalaria como medida resultado. RESULTADOS: Un total de 94 niños fueron estudiados. No hubo diferencia significativa entre los grupos en términos de duración de la estancia en el hospital. CONCLUSIONES: La hidratación IV no es efectiva en la duración de la estancia hospitalaria en pacientes con bronquiolitis aguda leve.

Correlation of ischemia-modified albumin levels and histopathologic findings in experimental ovarian torsion.

OBJECTIVES: Ischemia modified albumin (IMA) levels significantly increased and may be used as a diagnostic marker in ovarian torsion. The aim of this study is to investigate whether there was any correlation between IMA levels and histopathologic changes in experimental ovarian torsion. MATERIAL AND METHODS: Fourteen Sprague-Dawley rats, each weighing 220-250 g were divided randomly into 2 groups; in Group 1, the control group (n = 7), only laparotomy was performed and in Group 2, the experimental group (n = 7), ovarian torsion was performed. Ischemia was performed for 3 h; following the ischemia period, the torsion was relieved by detwisting the adnexa and then the ovarian I/R protocol was applied for 3 h. Blood samples were taken from all of the rats to measure the IMA levels and the ovaries were surgically removed for histologic examination. A blinded pathologist examined and scored the samples. RESULTS: The median (minimum-maximum) IMA values were 921.00 (870.00-966.00) ABSUs in the ovarian torsion group and 853.00 (782.00-869.00) ABSUs in the control group. The difference was statistically significant. In the correlation analysis, a significant and strong correlation was found between IMA levels and histopathologic changes (Spearman's rho = +0.987, p < 0.001). CONCLUSION: Positive correlation was found between the IMA levels and the histopathologic severity of the disease. This finding is important for both diagnosis of the disease and patient follow-up. As a new marker in ovarian torsion, IMA may also indicate the severity of the ovarian histopathology.

Relation between QT Variables and Left Ventricular Geometry in Athletes and Obese Children.

INTRODUCTION: We aimed to evaluate the relation between QT variables and left ventricular geometry in athletes and obese children. MATERIAL AND METHODS: This study included 209 children and adolescents. Thirty-eight of them were obese, 140 were athletes and 31 were normal weighted. Children with history of functional and structural cardiovascular diseases (acquired and congenital), chronic systemic diseases, hypertension, sleep apnea, endocrinological disorders were excluded. All subjects underwent detailed electrocardiographic and echocardiographic examination. RESULTS: QT dispersion was significantly higher in obese children, basketball players, football players and swimmers compared to control group (p < 0.05, p < 0.001, < 0.001 and < 0.01 respectively). Basketball players had the highest QT dispersion. Left ventricular endsystolic diameter (mm/m2) was higher in footballers, swimmers, wrestlers and tennis players compared to obese subjects. Interventricular septal thickness at diastole was highest in swimmers compared to control group (p < 0.001) and left ventricular posterior wall thickness was significantly higher in footballers and swimmers compared to healthy subjects (p < 0.01 and p < 0.001 respectively). Left ventricular geometry was normal in 84 patients (47.1%), but 34 patients (19.1%) had concentric remodelling, 20 (22.4%) had concentric hypertrophy and 40 (28.6%) had eccentric hypertrophy. No concentric and eccentric hypertrophy was observed in obese subjects. Left ventricle hypertrophy was prominent in dynamic and combined groups but it was not statistically significant (p = 0.204). QT dispersion was statistically higher in obese, dynamic sports and combined sports compared to control group (p < 0.05, p < 0.001 and p < 0.001 respectively). DISCUSSION: In this study we determined that QT dispersion is elevated in dynamic and combined sports types and obese children. CONCLUSION: QT dispersion is prolonged in obese and athletes who participate dynamic and combined sports.

Introdução: O objetivo deste trabalho foi avaliar a relação entre variáveis QT e geometria do ventrículo esquerdo em atletas e crianças obesas. Material e Métodos: Foram incluídos no estudo 209 crianças e adolescentes. Trinta e oito deles eram obesos, 140 foram atletas e 31 tinham peso normal. Crianças com antecedentes funcionais e estruturais de doenças cardiovasculares (adquiridas e congénitas), doenças sistémicas crónicas, hipertensão arterial, apneia do sono, doenças endocrinológicas foram excluídos. Todos os sujeitos rea-lizaram detalhados exames eletrocardiográficos e ecocardiográficos. Resultados: A dispersão do QT foi significativamente maior em crianças obesas, jogadores de basquete, jogadores de futebol e nadadores, por comparação com o grupo controlo (p < 0,05, p < 0,001, < 0,001 e < 0,01, respetivamente). Os jogadores de basquetebol tiveram a maior dispersão do QT. O di'metro ventricular esquerdo endosistólico (mm/m2) foi maior nos jogadores, nadadores, lutadores e jogadores de ténis por comparação com indivíduos obesos. A espessura do septo interventricular na diástole foi maior em nadadores por comparação com o grupo controlo (p < 0,001) e a espessura da parede posterior do ventrículo esquerdo foi significativamente maior nos jogadores e nadadores por comparação a indivíduos saudáveis (p < 0,01 e p < 0,001, respetivamente). A geometria do ventrículo esquerdo foi normal em 84 pacientes (47,1%), mas 34 pacientes (19,1%) tinham remodelação concêntrica, 20 (22,4%) apresentaram hipertrofia concêntrica e 40 (28,6%) apresentaram hipertrofia excêntrica. Não foi observada hipertrofia concêntrica e excêntrica em indivíduos obesos. A hipertrofia do ventrículo esquerdo era proeminente nos grupos din'mico e combinado mas a diferença não foi estatisticamente significativa (p = 0,204). A dispersão do QT foi significativamente maior nos obesos e praticantes de desporto din'mico e combinado em relação ao grupo controlo (p < 0,05, p < 0,001 e p < 0,001, respetivamente). Discussão: Neste estudo determinámos que a dispersão do QT é elevada em tipos de desporto din'mico e combinado, e em crianças obesas. Conclusão: A dispersão do QT é prolongada em pacientes obesos e atletas que participam em desporto din'mico e combinado.

Serum ischemia-modified albumin levels in adolescent smokers.

BACKGROUND: It is known that the biochemical marker linked to tissue ischemia, ischemia-modified albumin (IMA), is related to oxidative stress. Cigarette smoking is a situation with increased oxidative stress causing cell damage and it is thought that many of the negative effects linked to smoking may occur after the biological material in the body is exposed to oxidative damage. This study aimed to identify variability in serum IMA levels in adolescents who smoke. METHODS: This case-control study comprised 60 adolescents without any chronic disease. The smoking group was 30 adolescents between the ages of 14 and 17 years who smoked, while the control group was 30 healthy adolescents who did not smoke. Blood samples were collected from all subjects and serum IMA levels and serum nicotine metabolites were determined. RESULTS: The serum IMA levels in the adolescents who smoked were 0.452±0.094 absorbance unit (ABSU), while the control group had ASBU levels of 0.427±0.054. There was no significant difference between the groups in terms of serum IMA levels (p=0.210). There was a significant difference between the control and smoking groups in terms of serum nicotine metabolite levels (p<0.001). CONCLUSIONS: Among adolescents who smoke, serum IMA levels may not be a good marker for oxidative stress.

Scintigraphic Evaluation of the Stump Region After Extremity Amputation and the Effect of Scintigraphy on Treatment.

BACKGROUND: We evaluated the stump region with scintigraphy and compared the correlation of treatment modalities and scintigraphic results. METHODS: Sixty-eight cases with extremity amputation were included in the study. Amputation applied cases underwent four-phase Tc-99m hydroxymethylene diphosphonate scintigraphy. Groups were performed according to the scanning time after amputation and amputation regions. After scintigraphic evaluation, results were recorded into five groups: osteomyelitis, soft-tissue infection, reactive changes secondary to surgery, chronic osteomyelitis, and normal. Post-surgical treatment modalities of the patients were determined and compared with scintigraphic results. RESULTS: In the scintigraphic evaluation of stump regions of the 68 amputated cases, 34 patients had acute osteomyelitis, one had chronic osteomyelitis, 16 had soft-tissue infection, and eight had changes secondary to the surgery. Nine of 68 cases had normal scintigraphic features. In the scintigraphic evaluation, 43 patients took antibiotic treatment and 16 had surgery. There was a strong correlation between scintigraphic results and treatment approach (P < 0.0001, r = 0.803) by means of preferred therapy and effectiveness of the therapy according to the scintigraphic results. Scintigraphy need increases with age after amputation and a negative correlation between patient age and scintigraphic need was found (P < 0.02, r = -0.339). There was no pathology in the follow-up in the cases that were scintigraphically normal. CONCLUSION: Bone scintigraphy is a cost-effective, non-invasive, and efficient method that directs treatment in the evaluation of the stump region after amputation.

Relationship between Abdominal Aortic Intima Media Thickness and Central Obesity in Children.

BACKGROUND: Childhood obesity is one of the important risk factors for early atherosclerosis. We aimed to evaluate the effect of obesity on abdominal aortic intima media thickness (aaIMT) in children. METHODS: We consecutively recruited 60 obese and 28 healthy children from the outpatient clinic of pediatrics. In all patients, BMI, waist circumference (WC) and hip circumference (HC) were measured, and fasting serum lipid profile, plasma glucose and plasma insulin were studied. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated for the obese group. All children underwent ultrasonography to evaluate hepatosteatosis and to measure aaIMT. RESULTS: There was a significant difference between the groups in terms of aaIMT, insulin, glucose, HOMA-IR, total cholesterol, low-density lipoprotein, triglyceride and hepatosteatosis. aaIMT was 1.12 ± 0.25 and 0.61 ± 0.18 mm in the obese and nonobese groups, respectively (p < 0.001). In the obese group, there was a positive correlation between aaIMT and WC, WC/height ratio, BMI, HC and hepatosteatosis (p < 0.05 for all), with the highest significance for WC. CONCLUSIONS: This study showed that aaIMT was significantly higher in obese children than in nonobese children, and that WC was a strong predictor for aaIMT. Early detection of an increased aaIMT in obese children may guide the follow-up of these patients in terms of developing atherosclerosis and its complications.

Effect of delivery mode on postpartum neonatal body temperatures.

OBJECTIVE: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section. METHODS: We performed a prospective study of 106 term newborn - 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers' temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth. RESULTS: Environmental temperature was maintained at 22-24 °C. Pre-operative mother temperatures were 36.31 ± 0.30 °C in group 1, 36.36 ± 0.26 °C in group 2 and 36.39 ± 0.19 °C in group 3 (p = 0.414). Post-operative mother temperatures were 36.39 ± 0.27 °C in group 1, 36.29 ± 0.31 °C in group 2 and 36.25 ± 0.28 °C in group 3 (p = 0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5 ± 0.6 °C, 37.2 ± 0.2 °C and 36.8 ± 0.4 °C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p < 0.001). CONCLUSIONS: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.

Prenatal maternal risk factors for infantile colic.

AIM: To examine maternal prenatal risk factors for infantile colic (IC). METHODS: Mothers were asked to complete a standard pre-coded questionnaire form. Inclusion in the study consisted of four criteria. The case group comprised healthy children with infantile colic according to Wessel's definition. The control group comprised healthy children with no history of IC. Prenatal period characteristics of mothers were examined to determine associations with IC. RESULTS: Children with mothers who had prophylactic iron supplementation therapy during pregnancy suffered more from IC. Postpartum depression was found to be more frequent in the case group than in the control group. Gynaecological history, including suffering from migraine, presence of any premenstrual symptoms, dysmenorrhea and high pre-pregnancy body mass index, was associated with development of IC. CONCLUSION: Pre-gestational gynaecological complaints and pregnancy characteristics may point to IC. These characteristics should be investigated and families should be informed.