Comparison of cognitive and behavioural problems and psychiatric diagnoses in preterm born children between 6-13 years old / Comparación de problemas cognitivos y conductuales y diagnósticos psiquiátricos en niños prematuros entre 6 y 13 años

Introduction: Despite the increased survival rates follow up studies of preterm born children have documented increased prevalence of neurodevelopmental disabilities and cognitive deficits. By using psychiatric assessment, we aimed to evaluate cognitive functions by comparing preterm born babies according to the week of gestation by comparing the scores of the Wechsler Intelligence Scale for Children-Revised Form (WISC-R) in childhood. Material and methods: Children with a history of birth as preterm babies between 1998-2004 were included in the study. The children born between 27-36 weeks, currently 6-13 years old were admitted to the study. The controls consisted of healthy children chosen from the nearest primary school. The WISC-R test was administered to all children. Classification was made according to gestational age. The comparison of cognitive functions was performed by comparing the WISC-R scores of the preterm group and the control group. Results: 238 children were included in our prospective study. (case group: 175 children, control group: 63 children). Because of the comparison of the WISC-R scores of the preterm and control groups, the WISC-R verbal score and WISC-R total score were found to be statistically significant between the preterm and control groups. In the analysis made according to the gestation age, no statistical significance was found between the WISC-R Verbal, WISC-R performance, and WISC-R total scores according to the week of gestation. No statistically significant difference was found in terms of previous and current psychiatric diagnoses. Conclusions: While the WISC-R score was, found to be statistically significantly higher in the case group compared to controls. Our results differed from those in the literature that preterm children had a lower WISC-R score and it indicates the need to investigate this situation by further studies, even by different tests (AU)

Introducción: A pesar del aumento de las tasas de supervivencia, los estudios de seguimiento de niños prematuros han documentado una mayor prevalencia de discapacidades del neurodesarrollo y déficits cognitivos. Mediante el uso de la evaluación psiquiátrica, nuestro objetivo fue evaluar las funciones cognitivas comparando los bebés prematuros según la semana de gestación comparando los puntajes de la Escala de inteligencia de Wechsler para niños-Forma revisada (WISC-R) en la infancia. Material y métodos: Se incluyeron en el estudio niños con antecedentes de parto prematuro entre 1998-2004. Los niños nacidos entre 27 y 36 semanas, actualmente de 6 a 13 años, fueron admitidos en el estudio. Los controles consistieron en niños sanos elegidos de la escuela primaria más cercana. La prueba WISC-R se administró a todos los niños. La clasificación se hizo de acuerdo a la edad gestacional. La comparación de las funciones cognitivas se realizó comparando las puntuaciones WISC-R del grupo de prematuros y el grupo control. Resultados: 238 niños fueron incluidos en nuestro estudio prospectivo. (grupo de casos: 175 niños, grupo de control: 63 niños). Debido a la comparación de las puntuaciones de WISC-R de los grupos de control y de prematuros, se encontró que la puntuación verbal de WISC-R y la puntuación total de WISC-R eran estadísticamente significativas entre los grupos de control y de prematuros. En el análisis realizado según la edad de gestación, no se encontró significancia estadística entre las puntuaciones del WISC-R Verbal, WISC-R de rendimiento y WISC-R total según la semana de gestación. No se encontraron diferencias estadísticamente significativas en términos de diagnósticos psiquiátricos previos y actuales. Conclusiones: Si bien la puntuación WISC-R fue estadísticamente significativamente mayor en el grupo de casos en comparación con los controles (AU)

Pseudomonas aeruginosa colonization in cystic fibrosis: Impact on neutrophil functions and cytokine secretion capacity.

BACKGROUND: Chronic colonization with Pseudomonas (P.) aeruginosa worsens the prognosis of cystic fibrosis (CF) patients. This study aims to analyze the functional properties of neutrophils in CF patients with P. aeruginosa colonization. METHODS: Patients with CF (n = 16) were grouped by positivity of P. aeruginosa in sputum culture, as positive (P.+) or negative (P.-), then compared with age and sex matched healthy controls (n = 8). Adhesion molecules, apoptotic index, intracellular CAP-18, interleukin 8 (IL-8), and tumor necrosis factor α (TNF-α) levels of neutrophils, following P. aeruginosa and lipopolysaccharides (LPS) stimulation, were analyzed by flow cytometry. IL-1ß, IL-6, TNF-α, and IL-17 plasma levels were determined by Luminex. RESULTS: Patients with CF had increased phagocytosis of Escherichia coli and P. aeruginosa, upregulated oxidative burst and chemotaxis. Increased neutrophil apoptosis was noted in CF patients. In unstimulated conditions, higher levels of CD16+ TNF-α+ and CD16+ IL-8+ neutrophils were determined, whereas bacteria and LPS stimulation significantly decreased secretion of CAP-18 from CD16+ neutrophils of CF patients. Plasma levels of IL-1ß, TNF-α and IL-17 in P.+ patients were higher than in P.- group. CONCLUSION: Our findings confirm inadequate neutrophil defense towards pathogens in CF. A significant difference in migration, phagocytosis, oxidative burst, percentage of IL-8 producing neutrophils, IL-1ß, TNF-α, and IL-17 secretions were noted among CF patients according to their colonization status, which might induce a further destructive effect on airways, resulting in an unfavorable prognosis for children with CF who also have colonization.

Synthesis, Characterization, Molecular Docking, and Biological Activities of Some Natural and Synthetic Urolithin Analogs.

Urolithins (that is, hydroxy substituted benzo[c]chromen-6-one derivatives) are formed within the gastrointestinal tract following to the exposure to various ellagitannin rich diet, particularly involving pomegranate, nuts, and berries. Regarding the bioavailability deficiency of ellagitannins, the biological activities obtained through the extracts of these dietaries are attributed to the urolithin compounds, since they are bioavailable. Particularly, there are studies indicating the importance of ellagitannin-rich food for protective and alternative treatment of Alzheimer's Disease (AD). From this perspective, within this study, the major urolithins (that is, urolithins A and B), their methyl ether metabolites, as well as some synthetic urolithin analogs have been synthesized and screened for their biological activities in various enzyme inhibition (acetylcholinesterase, butyrylcholinesterase, monoamine oxidase B, cyclooxygenase 1, and cyclooxygenase 2) and antioxidant (DPPH radical scavenging) assay systems. The results pointed out the potential of urolithins to act as inhibitors on these receptors. Docking studies were also performed to investigate the possible interactions.

Predictive Value of Slow and Fast EEG Oscillations for Methylphenidate Response in ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder and is characterized by symptoms of inattention and/or hyperactivity and impulsivity. In the current study, we obtained quantitative EEG (QEEG) recordings of 51 children aged between 6 and 12 years before the initiation of methylphenidate treatment. The relationship between changes in the scores of ADHD symptoms and initial QEEG features (power/power ratios values) were assessed. In addition, the children were classified as responder and nonresponder according to the ratio of their response to the medication (>25% improvement after medication). Logistic regression analyses were performed to analyze the accuracy of QEEG features for predicting responders. The findings indicate that patients with increased delta power at F8, theta power at Fz, F4, C3, Cz, T5, and gamma power at T6 and decreased beta powers at F8 and P3 showed more improvement in ADHD hyperactivity symptoms. In addition, increased delta/beta power ratio at F8 and theta/beta power ratio at F8, F3, Fz, F4, C3, Cz, P3, and T5 showed negative correlations with Conners' score difference of hyperactivity as well. This means, those with greater theta/beta and delta/beta powers showed more improvement in hyperactivity following medication. Theta power at Cz and T5 and theta/beta power ratios at C3, Cz, and T5 have significantly classified responders and nonresponders according to the logistic binary regression analysis. The results show that slow and fast oscillations may have predictive value for treatment response in ADHD. Future studies should seek for more sensitive biomarkers.

Perforated appendicitis in children: antimicrobial susceptibility and antimicrobial stewardship.

OBJECTIVES: For perforated appendicitis in children, microbiological cultures should always be sought if an adequate sample is available. Knowledge of local epidemiology is important for optimal selection of antimicrobial therapy. The aim of this study was to evaluate the aetiology and susceptibility of pathogens in paediatric patients with perforated appendicitis. METHODS: Microbiological results of tissue samples obtained at surgery from children with acute appendicitis over 24 months were evaluated retrospectively. RESULTS: Among 209 children operated for acute appendicitis, 62 (29.7%) were perforated appendicitis. Intraperitoneal culture results were available for 42 patients, of which 41 (97.6%) had positive microbiological growth (57 pathogens). The male:female ratio was 1.8 and the mean age at presentation was 11 years (range 4-18 years). The most common pathogen was Escherichia coli (66.7%), among which 57.9% produced an extended-spectrum ß-lactamase (ESBL). All patients received initial treatment with intravenous antibiotics (ampicillin, gentamicin and metronidazole). The antibiotic regimen was modified in 22 patients (52.4%). Seven patients (16.7%) developed a post-operative complication. No significant difference was observed for development of complications between patients with ESBL-positive and -negative E. coli growth (P=0.698). CONCLUSION: The high rate of ESBL-positive E. coli may indicate bowel colonisation with resistant bacteria even in the community setting. Prospective studies will show whether treatment options should be directed according to identified pathogens.

Oxidant and antioxidant levels and DNA damage in tuberous sclerosis.

OBJECTIVE: The pathogenesis of inherited diseases is thought to involve oxidative stress and the associated DNA damage, which are also implicated in many other conditions including cancer. Tuberous sclerosis is a genetic disease with autosomal dominant inheritance pattern that is characterized by the development of hamartomas in multiple organ systems. Oxidative stress and the related DNA damage are also likely to play a significant role in the pathogenesis of this condition. Thus, our study aimed to assess total oxidant-antioxidant level, oxidative stress index and DNA damage in patients diagnosed with tuberous sclerosis. METHODS: The study included 30 patients with tuberous sclerosis between the ages of 0 and 16 years. The control group consisted of 29 age-matched healthy children. Blood samples obtained from each subject were centrifuged to separate the sera. The Total Antioxidant Status (TAS) and Total Oxidant Status (TOS) were measured in serum samples with a Thermo Scientific Multiscan plate reader (FC, 2011-06, USA) at wavelengths of 240 nm and 520 nm, respectively. The measured TAS and TOS values were used to calculate the Oxidative Stress Index (OSI). In addition, the Comet Assay Method was used to determine DNA damage in the samples. Data were analyzed using SPSS software. RESULTS: Patients with tuberous sclerosis complex (TSC) and controls were compared with respect to TAS, TOS, and OSI. TAS was significantly lower (p < 0.01), while TOS and OSI were significantly higher (p < 0.01, for both) in patients as compared to controls. In addition, patients had significantly higher DNA damage as shown by the Comet Assay (p < 0.01). CONCLUSIONS: Increased oxidative stress and DNA damage may contribute to the pathogenesis of tuberous sclerosis.

The value of nasopharyngeal aspirate, gastric aspirate and bronchoalveolar lavage fluid in the diagnosis of childhood tuberculosis.

Çakir E, Özdemir A, Daskaya H, Umutoglu T, Yüksel M. The value of nasopharyngeal aspirate, gastric aspirate and bronchoalveolar lavage fluid in the diagnosis of childhood tuberculosis. Turk J Pediatr 2018; 60: 10-13. Pulmonary tuberculosis (TB) is an important cause of morbidity and mortality especially in developing countries. A definitive microbiologic confirmation of Mycobacterium tuberculosis is important in the diagnosis of childhood TB. We aimed to compare the diagnostic value of nasopharyngeal aspirate (NPA), gastric aspirate (GA) and bronchoalveolar lavage (BAL) specimens in children with highly suspected pulmonary tuberculosis (TB). NPA, GA and BAL samples were obtained from forty patients. The mean age was 9.2±4.7 years. Sixty-eight percent of children had a history of household contact and 82% had tuberculin skin test positivity. Acid-fast bacilli (AFB) stain was positive in 22.5% (N=9) of BAL, 17.5% (N=7) of GA, and 10% (N=4) of NPA samples. Positive Lowenstein-Jensen culture was 27.5% (N=11) in BAL, 22.5% (N=9) in GA, and 12.5% (N=5) in NPA samples. Positive AFB stains and growth in TB cultures from BAL fluid and GA samples were both higher than NPA samples (p < 0.006 and p < 0.004, respectively GA). We conclude that NPA specimen fails to determine Mycobacterium tuberculosis in children with highly suspected pulmonary TB when compared to GA or BAL fluid.

The altered promoter methylation of oxytocin receptor gene in autism.

Autism spectrum disorder (ASD) is one of the lifelong existing disorders. Abnormal methylation status of gene promoters of oxytonergic system has been implicated as among the etiologic factors of ASDs. We, therefore, investigated the methylation frequency of oxytocin receptor gene (OXTR) promoter from peripheral blood samples of children with autistic features. Our sample includes 66 children in total (22-94 months); 27 children with ASDs according to the DSM-IV-TR and the Childhood Autism Rating Scale (CARS) and 39 children who do not have any autistic like symptoms as the healthy control group. We investigated the DNA methylation status of OXTR promoter by methylation specific enzymatic digestion of genomic DNA and polymerase chain reaction. A significant relationship has been found between ASDs and healthy controls for the reduction of methylation frequency of the regions MT1 and MT3 of OXTR. We could not find any association in the methylation frequency of MT2 and MT4 regions of OXTR. Although our findings indicate high frequency of OXTR promoter hypomethylation in ASDs, there is need for independent replication of the results for a bigger sample set. We expect that future studies with the inclusion of larger, more homogeneous samples will attempt to disentangle the causes of ASDs.

Psychiatric disorders and their association with burn-related factors in children with burn injury.

BACKGROUND: The aim of this study was to assess psychiatric disorders and their association with burn-related factors in a population of Turkish children with burns. METHODS: Thirty-one children admitted to the Cerrahpasa Medical Faculty Burn Unit between January 2013 and August 2013 were first assessed by the plastic surgeon, and then those with psychological symptoms were referred to a child psychiatrist, and the records were analyzed retrospectively. RESULTS: The percentage of burned area to Total Body Surface Area (TBSA) ranged between 2-60% (mean, 17.3%). Nineteen patients (61.3%) had a psychiatric diagnosis, which included acute stress disorder (ASD) (n=15), depression (n=3), posttraumatic stress disorder (n=2, comorbid with depression), and delirium (n=1). The percentage of burned area to TBSA was associated with the presence of psychopathology and ASD. Further, psychopathology was associated with the number of burned major body regions. CONCLUSION: Pediatric burn patients are at risk of developing psychopathology. The children with a greater percentage of burned area to TBSA and more burned body regions have the greatest risk of psychopathology. Surgeons have an important role in patient referral for psychiatric interventions, so that psychiatric disorders can be prevented as early as possible.