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Background and Aim: It has been reported that leptin receptors have been also shown in mammary epithelial cells, and it has been suggested that leptin is involved in the control of the proliferation of both normal and malignant breast cells. The aim of this study was to measure the leptin levels in girls with early breast development and to determine if leptin levels were associated with the clinic, anthropometric characteristics and other sex steroids in girls with premature thelarche (PT)., Methods: In this cross-sectional study; we examined 26 girls (mean age, 7.1 ± 0.8 years; and mean body mass index standard deviation score [BMI-SDS], 0.45 ± 0.9) referred for evaluation because of the appearance of breast buds before the age of 8 years and judged clinically to have PT, as well as 21 healthy age-matched prepubertal girls who served as controls. Breasts and pubic hair development were assessed by visual inspection and palpation using the rating scales of Tanner., Results: There were significant differences between the PT and control groups regarding leptin (2.7 ± 2.4 vs 1.1 ± 1.1 ng/mL; P: 0.007) and androstenedione (0.44 ± 0.2 vs 0.29 ± 1.1 ng/mL; P = 0.019) levels despite their similar age and BMI-SDS. Leptin measurements were positively correlated with BMI-SDS (r = 0.378; P = 0.03) and androstenedione (r = 0.438; P = 0.025) levels., Conclusions: Our study demonstrated that serum leptin levels were consistently higher in children with PT than in healthy children. Our findings also support an association between increased leptin levels in PT and adrenal androgens such as androstenedione. We suggest that the increased adrenal androstenedione, observed in our patients, may serve as a precursor for the peripheral conversion to estrogens by the stimulating effect of leptin on aromatase enzyme activity in breast tissues.

The aims of this study were to evaluate left ventricular (LV) systolic and diastolic function in obese adolescents with nonalcoholic fatty liver disease (NAFLD) using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate the relations between LV function and carotid intima-media thickness (CIMT). LV remodeling, tissue Doppler-derived LV velocities, and cardiovascular risk profiles in obese adolescents with NAFLD were also studied. One hundred eighty obese adolescents and 68 healthy controls were enrolled in the study. LV end-diastolic and end-systolic and left atrial diameters and LV mass were higher in the 2 obese groups compared with controls. By pulsed-wave Doppler echocardiography and pulsed-wave tissue Doppler imaging, the NAFLD group had normal LV systolic function, impaired diastolic function, and altered global systolic and diastolic myocardial performance. In patients with NAFLD, LV mass was positively correlated with homeostasis model assessment of insulin resistance and serum alanine aminotransferase. CIMT was positively correlated with homeostasis model assessment of insulin resistance, alanine aminotransferase, and LV mass. By multiple stepwise regression analysis, alanine aminotransferase (β = 0.124, p = 0.026), homeostasis model assessment of insulin resistance (β = 0.243, p = 0.0001), LV mass (β = 0.874, p = 0.0001) were independent parameters associated with increased CIMT. In conclusion, insulin resistance has a significant independent impact on CIMT and LV remodeling in the absence of diabetes in patients with NAFLD. Pulsed-wave tissue Doppler imaging is suggested to detect LV dysfunction at an earlier stage in obese adolescents with NAFLD for careful monitoring of cardiovascular risk., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Aim: The aim of this study was to investigate the relationships between 25-hydroxy-vitamin D (25(OH)D) and insulin resistance in obese adolescents with non-alcoholic fatty liver disease (NAFLD)., Patients and Methods: Eighty-seven obese adolescents (45 girls and 42 boys, mean age: 12.7 ± 1.3 years, mean body mass index standard deviation score (BMI-SDS): 2.1 ± 0.3) and 30 lean subjects (15 girls and 15 boys, mean age: 12.3 ± 1.45 years, mean BMI-SDS: 0.5 ± 0.7) were enrolled for the study. The obese subjects were divided into two subgroups based on the presence or absence of fatty liver with high transaminases (NAFLD group and non-NAFLD group). Fasting blood samples were assayed for 25(OH)D, transaminases, glucose, and insulin levels. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR)., Results: 25(OH)D measurements were decreased in both obese groups (NAFLD and non-NAFLD) in comparison with the lean group (29.5 ± 18.4 vs. 41.0 ± 17.9 vs. 48.1 ± 22.2 ng/mL). However; the NAFLD group had significantly lower measurements of 25(OH)D than the non-NAFLD group (p < 0.001) and lean group (p < 0.001). 25(OH)D was negatively correlated with HOMA-IR (r = 0.158, p = 0.01) and with alanine aminotransferase (r = 0.794, p = 0.03) in the NAFLD obese group. There was no significant associations between fasting insulin, BMI-SDS and 25(OH)D in obese groups., Conclusion: We suggest that low 25(OH)D occurs commonly in obese adolescents with NAFLD and we demonstrated an association between insufficient vitamin D status and low insulin sensitivity in obese adolescents with NAFLD., (© Crown Copyright 2013 Published by Elsevier Ltd on behalf of Asia Oceania Assoc. for the Study of Obesity. All rights reserved.)

No data are available on the relationship between subclinical hypothyroidism and risk factors for the development of cardiovascular disease in obese adolescents with nonalcoholic fatty liver disease (NAFLD). This study aimed to determine whether an association exists between subclinical hypothyroidism and risk factors for the development of cardiovascular disease in obese adolescents with NAFLD. The study enrolled 111 obese adolescents and 42 lean subjects. The obese subjects were divided into two subgroups based on the presence or absence of fatty liver with high transaminases: a NAFLD group and a non-NAFLD group. Subclinical hypothyroidism was defined as a thyroid-stimulating hormone (TSH) level higher than 4 mIU/l and a normal free-thyroxine level (0.6-1.8 ng/dl). Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR). Left ventricular mass (LVM), LVM index measurements, carotid intima media thickness (IMT), and HOMA-IR values were higher in the NAFLD obese group with TSH levels higher than 4 mIU/l than in the NAFLD obese group with TSH levels lower than 4 mIU/l. Elevated TSH values in the NAFLD obese group were positively correlated with most of the metabolic and cardiovascular risk parameters such as total cholesterol (r = 0.606, p = 0.001), triglycerides (r = 0.476, p = 0.016), low-density lipoprotein cholesterol (r = 0.461, p = 0.004), insulin (r = 0.607, p = 0.001), HOMA-IR (r = 0.596, p = 0.002), carotid IMT (r = 0.894, p < 0.0001), and LVM (r = 0.563, p = 0.003). The findings demonstrated that the obese adolescents with NAFLD and subclinical hypothyroidism had a more adverse cardiovascular risk profile and a higher carotid IMT and LVM.

Aim: The purpose of our study was to determine the relationship between liver ultrasound scores and insulin sensitivity in a population of obese children with nonalcoholic fatty liver disease (NAFLD) and the relationships between other metabolic features and ultrasound scores., Methods: One hundred sixty-nine obese adolescents, 96 girls, and 73 boys (mean age: 12.7 ± 1.3 years, mean body mass index: 26.3 ± 4.6) were enrolled the study. The obese subjects were divided into 2 groups based on their pubertal status. Ultrasonography findings were scored in this study included hepatorenal echo contrast, liver brightness, deep attenuation, and vascular blurring. Scores ranged from 0 to 6 points, and NAFLD was defined if ultrasound score was ≥ 1. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples., Results: Prevalence of NAFLD in pubertal children (61.9%) had significantly higher than pre-pubertal children (40.8%) (P=.008). Transaminases ratio was significantly correlated in both prepubertal (r=0.231; P=.03) and pubertal (r=0.628, P=0.017) groups. HOMA-IR values were elevated in both groups; however, liver ultrasound score was positively correlated with HOMA-IR (r=0.735, P=.014) in pubertal children., Conclusion: NAFLD prevalence among obese children is quite high, especially pubertal adolescents than prepubertal children. We demonstrated an association between insulin resistance and NAFLD ultrasound scoring in pubertal obese children. We suggested that ultrasound examination of the liver be included in the routine check-up of the pubertal obese children with insulin resistance to allow the detection of NAFLD at an early stage., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Bamforth syndrome is a rare inherited condition whose main features are congenital hypothyroidism due to thyroid dysplasia, cleft palate, and spiky hair, with or without choanal atresia and bifid epiglottis. This syndrome is caused by mutations in the gene encoding thyroid transcription factor 2 (TTF-2). Here we report on a newborn with facial dysmorphism, cleft palate, spiky hair, congenital hypothyroidism and that are observed with Bamforth syndrome. This is the first case with Bamforth syndrome in which porencephaly has been observed.

Aim: We hypothesized that circulating apelin concentrations in preterm babies might be linked with retinopathy of prematurity (ROP), similar to IGF-1 levels., Patients & Methods: A total of 97 infants born with a gestational age before 32 weeks in 2007-2009 were screened for ROP at the Gata Haydarpasa Hospital (Turkey). Fourteen of them with classified ROP stage 3-5 comprised our study group., Results: The non-ROP group had higher apelin and IGF-1 levels than ROP neonates at birth. After 4-6 weeks, postnatal ROP subjects had lower apelin and IGF-1 levels than non-ROP controls. At the end of the study, the change in apelin levels was positively correlated with the change in IGF-1 levels (r = 0.852; p = 0.01)., Conclusion: We suggested that the pathogenesis of ROP, which is regarded as a neovascular retinal disorder, includes variations in the levels of apelin and IGF-1.

Cystic hygroma, also known as lymphangioma, are unusual congenital malformations of the lymphatic system. Cystic lymphangioma is a rare lesion in the breast of children. Only a few cases have been documented in literature. We report a rare case of a 5-year-old boy presented with a gradually enlarging, painless breast mass which was identified sonographically and histologically as a breast lymphangioma and treated by surgical excision. A local excision of the lump was performed and a diagnosis of cystic lymphangioma was made. Cyst was surgically removed, with preservation of normal tissue, and histopathologic findings showed a lymphangioma. The patient is well, after one year of follow-up, with no complaints or recurrence.

Objective: To investigate the relationship between adipokines (visfatin, adiponectin) and 25-hydroxyvitamin D (25(OH)D), and markers of insulin sensitivity in large for gestational age (LGA) infants., Patients and Methods: Forty LGA infants (25 LGA born to diabetic mothers and 15 LGA born to non-diabetic mothers) and 34 appropriate for gestational age (AGA) infants were recruited., Results: FGIR, QUICK-I, adiponectin and 25(OH)D levels were significantly lower in LGA with diabetic mother group than AGA and LGA with non-diabetic mother group. HOMA-IR, fasting insulin, visfatin and parathormone (PTH) levels were significantly higher in LGA with diabetic mother group than AGA and LGA with non-diabetic mother group., Conclusion: Based on the findings of this study, visfatin, adiponectin and 25(OH)D levels can be used as specific markers for insulin sensitivity and may help advance new therapies for glucose intolerance spectrum., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: The authors hypothesized that circulating visfatin concentrations in preterm infants might be linked with retinopathy of prematurity (ROP)-like insulin-like growth factor I (IGF-I) levels., Methods: The study group comprised 88 children born with a gestational age younger than 32 weeks between 2007 and 2009 who were screened and/or treated for ROP. The authors collected fetal cord blood (sample 1) and a blood sample at 4 to 6 weeks postnatal age (sample 2) for laboratory investigations., Results: The non-ROP group had higher visfatin-1, visfatin-2, insulin-1, insulin-2, (IGF-I)-1, and (IGF-I)-2 levels than the ROP group (P < .001 for all levels). Change in visfatin was positively correlated with change in IGF-I and change in insulin (P < .001 and P < .001, respectively). Change in IGF-I was positively correlated with change in insulin (P < .001)., Conclusion: Similar to IGF-I levels, determination of visfatin levels can be a predictive marker of ROP, but more studies are needed., (Copyright 2012, SLACK Incorporated.)

Background/aims: No data are available examining the relationship between carotid intima media thickness (IMT) and left ventricular mass (LVM) in obese adolescents with non-alcoholic fatty liver disease (NAFLD). Therefore, we investigated LVM and carotid IMT in obese adolescents with NAFLD., Methods: Eighty obese adolescents and 37 lean subjects were enrolled in the study. The obese subjects were divided into two subgroups based on the presence or absence of fatty liver with high transaminases (NAFLD group and non-NAFLD group). Fasting blood samples were assayed for serum transaminases, glucose and insulin levels. Insulin resistance was calculated by the homeostasis model assessment (HOMA-IR)., Results: LVM measurements were higher in both NAFLD and non-NAFLD obese patients in comparison with the lean children. The NAFLD group had significantly higher LVM measurements than the non-NAFLD and lean groups. Carotid IMT was higher in both the NAFLD and non-NAFLD obese patients in comparison with the lean group. The NAFLD group had significantly higher carotid IMT measurements than the non-NAFLD and lean groups. LVM was positively correlated with HOMA-IR and serum alanine aminotransferase levels in the NAFLD obese group. Carotid IMT was positively correlated with HOMA-IR, serum alanine aminotransferase levels and LVM in the NAFLD obese group., Conclusions: We demonstrated that obese adolescents with NAFLD have increased LVM and carotid IMT and low insulin sensitivity. Obese adolescents with NAFLD and increased carotid IMT may demonstrate a more adverse cardiovascular risk profile and higher LVM. Therefore, assessment of carotid IMT, in addition to echocardiography, may assist in risk stratification in obese adolescents with NAFLD with elevated cardiovascular risk factor levels.

Objective: The aim of the study was to determine whether metformin or vitamin E treatment for six months is effective in reducing body weight, blood pressure, and also ameliorating insulin resistance, adiponectin, and tumor necrosis factor (TNF)-alpha in obese adolescents with non-alcoholic fatty liver disease (NAFLD)., Methods: Sixty-seven obese adolescents with liver steatosis (age range, 9 - 17 years) were included in the study. The metformin group received an 850-mg dose of metformin daily and the vitamin E group received 400 U vitamin E /daily, in capsule form for 6 months, plus an individually tailored diet, exercise, and behavioral therapy., Results: After 6 months later, there was a significant decline in body mass index, and fasting insulin and homeostatic model assessment (HOMA) values in all three groups. Moreover, in comparingson of changes in HOMA among the groups, the metformin- treated group showed significantly improved metabolic control and insulin sensitivity (HOMA) at the end of the study. There were no significant differences for changes of adiponectin, TNF-alpha, in all three groups after 6 months study., Conclusion: These data suggest that metformin treatment is more effective than dietary advice and vitamin E treatment in reducing insulin resistance, and also in ameliorating metabolic parameters such as fasting insulin and lipid levels, in obese adolescents having NAFLD.

Objective: To investigate the relation of circulating four adipokines (apelin, vaspin, visfatin, adiponectin) with markers of insulin sensitivity in large for gestational age (LGA) infants., Patients and Methods: Forty LGA infants (20 LGA born from diabetic mothers and 20 LGA born from non-diabetic mothers) and 34 appropriate for gestational age (AGA) infants were recruited. Hyperinsulinism and insulin resistance was evaluated using the homeostasis model assessment (HOMA-IR), fasting glucose-to-insulin ratio (FGIR), quantitative insulin-sensitivity check index (QUICK-I) from fasting samples. Plasma adiponectin and vaspin levels were determined by radioimmunoassay. Determination of visfatin and apelin levels was performed by enzyme immunoassay., Results: HOMA-IR, apelin and visfatin levels (p<0.001, p<0.001, p<0.001, respectively) were significantly elevated and adiponectin levels, FGIR and QUICK-I values. (p<0.001, p<0.001, p<0.05, respectively) were significantly lower in the LGA group. Vaspin levels were higher in the LGA group than AGA neonates without a significance. The LGA infants with diabetic mother had significantly higher visfatin, apelin, HOMA-IR values, fasting insulin levels and significantly lower adiponectin, FGIR, QUICK-I values. Apelin and visfatin were correlated positively, and adiponectin was correlated negatively with birthweight, HOMA-IR values and fasting insulin levels., Conclusion: Based on the findings of this study, it is too difficult to explain relation between birthweight and these adipocytokines, but findings of high insulin, HOMA-IR, visfatin, apelin and low adiponectin levels in the LGA neonates showed that these adipocytokines can be used as a good predictor for metabolic syndrome., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to investigate the relationships between bone mineral density (BMD) vs insulin resistance and metabolic risk factors in obese adolescents with nonalcoholic fatty liver disease (NAFLD)., Patients and Methods: Eighty-two obese adolescents [45 girls and 37 boys, mean age: 12·3 ± 1·7 years, mean body mass index-standard deviation score (BMI-SDS): 1·9 ± 0·2] and 30 control subjects (15 girls and 15 boys, mean age: 12·3 ± 1·45 years, mean BMI-SDS: 0·5 ± 0·7) were enrolled the study. The obese subjects were divided into two groups based on the presence or absence of liver steatosis with high transaminases (NAFLD group and non-NAFLD group). Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples. BMD was determined by dual-energy X-ray absorptiometry., Results: Fasting insulin levels in the NAFLD group were significantly higher than in the non-NAFLD obese (32·3 ± 24·0 vs 11·02 ± 2·95 mU/l, P < 0·001) and control groups (8·4 ± 2·4 mU/l, P< 0·001). The NAFLD group had higher values of HOMA-IR than the non-NAFLD obese (7·3 ± 0·1 vs 2·3 ± 0·7, P < 0·001) and control groups (1·8 ± 0·5, P < 0·001). BMD-SDS measurements were lower in the NAFLD group than in the non-NAFLD (0·56 ± 0·3 vs 1·02 ± 0·9, P < 0·001) and control groups (0·56 ± 0·3 vs 1·37 ± 1·04, P < 0·001). BMD-SDS was positively correlated with BMI-SDS (r = 0·530, P = 0·004) and negatively correlated with HOMA-IR (r = -0·628, P = 0·017) in the NAFLD obese group., Conclusion: This study reports the association between BMD-SDS and insulin resistance in obese adolescents both with and without NAFLD, although the NAFLD group had a lower BMD-SDS than the non-NAFLD group. We suggest that NAFLD has a detrimental effect on bone health in adolescents, and it is correlated with increased insulin resistance., (© 2011 Blackwell Publishing Ltd.)

Aim: To investigate the relationship between the newly discovered adipocytokines and increasing body weight (paralleled by increased insulin resistance), and antiepileptic drug therapy with valproic acid (VPA)., Design and Methods: 44 children with idiopathic, generalized epilepsy treated with valproic acid (VPA), and 40 control group children were included in this study., Results: Both the VPA-treated group and the control group showed no significant difference in terms of age, total cholesterol and LDL-cholesterol. Subjects in the VPA group had significantly higher BMI-SDS than control subjects (2.3±0.15 vs -0.04±0.8, p<0.001). HOMA-IR, apelin and visfatin levels were significantly increased (4.95±2.07 vs 1.46 vs 0.6, p<0.001; 2.21±1.14 vs 0.57±0.15, p<0.001; 31±12 vs 18.4±10.4, p<0.001; respectively), and adiponectin levels were significantly lower in the VPA group (2.02±1.03 vs 12.4±6.1, p<0.001). Triglyceride levels were significantly increased (126±70 vs 80±40 mg/dL, p=0.001), and HDL-cholesterol levels were significantly lower in the VPA group. Vaspin levels were higher in the VPA group than the control group, but the difference was not significant., Conclusion: Based on the findings of this study, apelin, visfatin and adiponectin levels may be considered as potential regulators of glucose and fat metabolism during valproic acid therapy.

Obesity and overweight are among the most serious health problems in western societies and an increasing problem in developing countries. Recent studies indicate an important role of adipose tissue hormones, or "adipokines", in obesity-associated complications. To investigate the relation of two circulating adipokines (visfatin, adiponectin) with markers of insulin sensitivity and obesity in children, 40 obese children and 40 control children were recruited. Homeostasis model assessment for insulin resistance (HOMA-IR) and visfatin levels (4.99 +/- 2.08 vs. 1.47 vs. 0.7, p < 0.001; 31.3 +/- 11.1 vs. 18.5 +/- 10.7, p < 0.001, respectively) were significantly elevated and adiponectin levels (2.01 +/- 1.02 vs. 12.5 +/- 6.2, p < 0.001) were significantly lower in the obese group. Comparisons of the clinical and metabolic characteristics between insulin-resistant and noninsulin-resistant groups in obese children are summarized. The insulin-resistant group had higher visfatin levels (36 +/- 9.7 vs. 22.9 +/- 7.6, p < 0.001) and lower adiponectin levels (1.7 +/- 1.05 vs. 2.5 +/- 0.77, p: 0.016). Visfatin was correlated positively and adiponectin was correlated negatively with body mass index standard deviation score (BMI-SDS) and HOMA-IR. The role of various adipokines as connectors between obesity and diabetes mellitus has been better elucidated in recent years. Based on the findings of this study, visfatin and adiponectin levels can be used as specific markers for insulin sensitivity.

Aim: The aim of this study was to investigate the relationship between four circulating adipocytokines (apelin, vaspin, visfatin, adiponectin) and markers of insulin sensitivity, in the context of polycystic ovary syndrome (PCOS) in adolescents., Subjects and Methods: 48, obese, adolescent girls (mean age: 15.6±3.4 years, mean body mass index standard deviation score (BMI-SDS): 2.31±0.1), and 37 control subjects (mean age: 16.2±3 years, mean BMI-SDS: 2.17±0.05) were enrolled the study. The diagnosis of PCOS was established according to the Rotterdam criteria. Hyperinsulinism and insulin resistance was evaluated using the homeostasis model assessment (HOMA-IR) from fasting samples. Plasma adiponectin and vaspin levels were determined by radioimmunoassay. Determination of visfatin and apelin levels was performed by enzyme immunoassay., Results: HOMA-IR, apelin and visfatin levels (4.9±2 versus 1.4±0.7, p<0.001; 2.2±1.1 versus 0.58±0.16, p<0.001; 31.3±11.1 versus 18.5±10.7, p<0.001; respectively) were significantly elevated, and adiponectin levels (2.01±1.02 versus 12.5±6.2, p<0.001) were significantly lower in the PCOS group. Vaspin levels were higher in the PCOS group than in the control group, but the differences were not significant. Apelin and visfatin correlated positively and adiponectin correlated negatively with BMI-SDS and HOMA-IR., Conclusion: Based on the findings of this study, apelin, visfatin and adiponectin levels can be used as specific markers for insulin sensitivity, and these adipocytokines might play a part in the pathogenesis of PCOS.

Aim: The aim of this study was to assess the adiponectin and visfatin concentrations in small-for-gestational age (SGA), appropriate-for-gestational age (AGA), and large-for-gestational age (LGA) newborns and their mothers. Sixty parturients giving birth to 20 term AGA singleton infants, 20 term singleton SGA infants, and 20 term singleton LGA infants were included into the study., Results: Mean visfatin levels were found significantly higher in the SGA (p < 0.001) and LGA (p < 0.001) groups, and adiponectin levels were found significantly lower in the SGA group (p < 0.001) when compared with the AGA group. The SGA and LGA groups had higher insulin concentrations and HOMA-IR in comparison with the AGA group. The visfatin, glucose levels, and HOMA-IR (p < 0.001, p < 0.001, and p: 0.002, respectively) were higher in the LGA group than SGA group., Conclusion: We found significantly higher insulin and visfatin levels in LGA neonates and lower adiponectin levels in SGA neonates. We concluded that the relationship between adiponectin and visfatin and insulin sensitivity (metabolic disturbances) is very complex with little evidence of correlation in SGA and LGA neonates.

A 10-year-old girl with Down syndrome and alopecia areata was admitted with severe ketoacidosis. She had high blood glucose level: 615 mg/dL and her HbAlc level was 13.3 %. After the control of ketoacidosis and reduction of the plasma glucose level, we found low free T4 level and high TSH levels. Thyroid peroxidase antibodies titer was 1383 IU/mL and both gliadin and endomysial antibodies were negative. This was the first report of a child with Down syndrome showing type 1 diabetes combined with alopecia areata and autoimmune thyroid disease.

Neonatal genital prolapse usually occurs during the first few days of life and presents as a tumor mass protruding from the vulva. We present a 15-day-old female neonate who developed neonatal genital prolapse following the operation of sacral teratoma. We suggest that sacral teratoma operation may be a significant predisposing factor for genital prolapse in neonates and the neonatal vaginal prolapse may be one of the differential diagnoses of interlabial mass during the late neonatal period.

Objective: The aims of this study were to examine the relationships between adiponectin, insulin, visfatin and weight at birth in healthy term infants., Design and Methods: Anthropometric parameters including weight, length were measured and plasma lipid profiles, insulin, visfatin and adiponectin concentrations in cord blood samples from 50 LGA and 50 AGA singleton infants born at term after uncomplicated pregnancies were assayed., Results: Mean visfatin and adiponectin levels were significantly higher in the LGA group than AGA group (11.8 ± 8 vs. 6.3 ± 5.5 ng/ml, p<0.001; 28.4 ± 3.9 vs. 25.7 ± 3.6 μg/ml, p=0.001; respectively). Insulin, triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol levels did not differ significantly between LGA and AGA infants. Cord plasma adiponectin, visfatin and insulin levels correlated significantly and positively with birthweight (p=0.01, p<0.001, p<0.001; respectively) and with birthlength (p=0.01, p<0.001, p=0.01; respectively). Cord plasma adiponectin concentration correlated positively with visfatin level (p=0.005), but not with insulin level (p=0.8), and cord plasma visfatin concentration correlated positively with insulin level (p<0.001)., Conclusion: High adiponectin and visfatin levels are present in the cord blood in LGA group. Cord plasma adiponectin and visfatin levels are positively correlated with birthweight. This suggests that adiponectin and visfatin may be involved in regulating fetal growth.

Aim: The aim of this study was to assess the vaspin and adiponectin concentrations on markers of insulin sensitivity and obesity in pubertal obese children and adolescents., Material and Methods: Plasma vaspin and adiponectin level and its relationships with body mass index standard deviation score (BMI-SDS), insulin sensitivity and lipids were analyzed in 33 pubertal obese children (19 girls and 14 boys) and 36 healthy control children (18 girls and 18 boys) aged 11-16 years. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) and fasting glucose-to-insulin ratio (FGIR). Plasma vaspin and adiponectin concentrations were determined with radioimmunoassay., Results: Mean vaspin levels were found significantly higher and inversely, adiponectin levels were found significantly lower in obese pubertal group than control subjects. Vaspin levels were positively correlated with BMI-SDS, triglycerides, fasting insulin and HOMA-IR and negatively correlated with adiponectin levels and FGIR. Adiponectin levels were positively correlated with high density lipoprotein-chloesterol, FGIR and negatively correlated with vaspin, BMI-SDS, fasting insulin and HOMA-IR., Conclusion: We found higher vaspin and lower adiponectin levels in obese children and these adipokines were significantly correlated with insulin sensitivity indices in this age.

Unlabelled: Streptococcus pneumonia is an increasing problem worldwide and nasopharyngeal colonization plays an important role in pneumococcal infections. The aims of this study were to assess the nasopharyngeal colonization rate, investigate the risk factors for nasopharyngeal colonization with S. pneumonia, serogroup and penicillin susceptibility patterns of Streptococcus pneumoniae strains isolated from healthy children. A single swab was obtained over the nasopharyngeal walls of the 500 healthy children, of which 25 (5%) were found to be carriers. The carrier rate was significantly higher in the seven-nine years-old age group. Upper respiratory tract infection within the last month (OR=1.1, p>0.001), day-care attendance (OR=3.1, p: 0.02), and the presence of more than five people living in the house of the child (OR=0.2, p: 0.003) have been determined to be risk factors for S. pneumoniae carriage. The most prevalent serogroups in descending order were 9, 19, 23, 6, 10 and 18 and these are in accordance with conjugated pneumococcal vaccine (PCV7). No penicillin-resistant S. pneumoniae were obtained., Conclusion: after conjugated vaccine we have seen benefits of vaccine in especially colonization rate and penicillin-resistance.

Primary hyperparathyroidism is a rare endocrine disease in children and young adults. The early detection and treatment of primary hyperparathyroidism led to a marked decrease in classical bone and renal manifestations of the disease. Osteitis fibrosa cystica and brown tumors have become extremely rare clinical entities. Moreover, the skeletal involvement in primary hyperparathyroidism secondary to parathyroid adenoma is extremely rare. We report on an adolescent girl with multiple brown tumors and a history of recurrent fractures as the manifestation of primary hyperparathyroidism associated with a parathyroid adenoma. The patient's clinical presentation mimicked parathyroid carcinoma. She had a large tumor associated with marked elevation in the parathyroid hormone and serum calcium levels. Skeletal manifestations were also atypical for benign primary hyperparathyroidism, with widespread brown tumors in the patient.

We demonstrated previously that receiving long-term phototherapy was associated with early impairment of growth plate structure in neonatal rats, and oxidative stress may be the main risk factor for growth plate injury. The purpose of this study was to examine the histomorphometric effects of pentoxifylline treatment on the growth plate. Sixty weanling Sprague-Dawley rats were randomly separated into three equal groups. Group A, the control group, did not receive phototherapy and pentoxifylline. Groups B and C were exposed to phototherapy for 7 d. In addition to phototherapy, group C was also given pentoxifylline during the study period. Compared with zonal lengths on d 7 after initiation of phototherapy, group B had significantly lower values than group A for all zonal lengths (p < 0.001). Zonal lengths of growth plate were increased significantly with pentoxifylline treatment in group C for 7 d compared with group B (p < 0.001). After phototherapy, group B had significantly higher values than groups A and C for plasma malondialdehyde levels (p < 0.001). The pentoxifylline was found here to have some potential to reduce the effects of phototherapy on growth plate in neonatal rats at a relatively low dose.

46,XX maleness is a rare abnormality of gonadal differentiation. We present dizygotic twins, one having ambiguous genitalia due to 2-hydroxylase deficiency, and the other having normal male genitalia with 46,XX maleness. One of the twins was referred to the endocrinology unit at 2 days old because of ambiguous genitalia. The other twin with bilateral undescended testes located in the inguinal canal was diagnosed with 46,XX maleness. The karyotype was 46,XX. Molecular analysis revealed the presence of SRY in the latter twin without Müllerian structures. Association of congenital adrenal hyperplasia (46,XX 21-hydroxylase deficiency) and 46,XX maleness in twins has not been previously reported.

The present study was undertaken to determine the presence and predictors of the subclinical atherosclerosis in obese children. Fifty obese children [mean age: 11.7 +/- 2.5 y, mean body mass index (BMI): 28.2 +/- 4.0 kg/m] and 50 age- and sex-matched healthy nonobese controls (mean age: 11.4 +/- 3.73 y, mean BMI: 17.6 +/- 3.0 kg/m) were enrolled in the present study. Oral glucose tolerance test was performed to all obese subjects. Common carotid artery intima-media thickness (IMT) was measured by high-resolution B-mode ultrasonography. Carotid artery IMT was significantly increased (0.0476 +/- 0.007 versus 0.033 +/- 0.011 cm; p < 0.001) in the obese group. There were significant relations between carotid artery IMT and insulin sensitivity indexes derived from fasting samples (fasting glucose to insulin ratio (FGIR; p = 0.004, r = -0.404), quantitative insulin-sensitivity check index (QUICK-I; p = 0.002, r = -0.401) and homeostasis model assessment of insulin resistance (HOMA-IR; p = 0.034, r = 0.300) in the obese group. In a multivariate regression model, QUICK-I emerged as independent correlates for mean IMT in obese children with the total variance explained being 20.7% (beta = -0.58, p < 0.001). We concluded that insulin resistance is an independent risk factor for increased carotid artery IMT in obese children.

Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. Extra-hepatic manifestations of acute hepatitis A virus are rare in pediatric age group. We report a case of a 16-year-old, otherwise healthy adolescent who had viral hepatitis A with cardiac manifestations. The patient is the first pediatric case of hepatitis A with a combination of hypotension, persistent bradycardia and progressive cholestasis.

Our aim was to establish whether independent relationships exist between either anthropometric parameters or insulin-like growth factor-I (IGF-I) and cord blood lead levels in newborns. Umbilical cord blood samples and anthropometric data were obtained at delivery. Cord blood lead levels were analyzed by atomic absorption spectrophotometer. IGF-I levels were measured using RIA. Blood lead levels >or=100 microg/l were considered elevated in accordance with CDC guidelines. Data on all variables of interest were obtained for 54 term neonates. The mean cord blood lead level was 144+/-89 microg/l with a range of 51-355 microg/l. Twenty-nine (53.7%) neonates had blood lead levels >or=100 microg/l. However, only 5 (9.2%) of the neonates had blood lead levels of >or=250 microg/l. No statistically significant difference was found in case of anthropometric parameters and IGF-I levels between neonates with high lead levels (>or=100 microg/l) and with low lead levels (<100mug/l) in cord blood (p>0.05). There was a significant correlation between lead and birth weight in neonates with high lead levels (r: -0.49, p=0.01) but not other anthropometric data and IGF-I levels. A multivariate regression analysis using the full range of lead values adjusted for the relevant confounders such as gestational age and socioeconomic status was performed. In the model birth weight (p: 0.01, beta: -0.81), birth length (p: 0.05, beta: 0.41) and midarm circumferences (p: 0.05, beta: 0.30) were the best predictors of lead levels, with the total variance explained being 36%. Significant relationship was found between birth weight and lead burden in newborns. Whether serum lead level predicts the development of failure to thrive in these children remains to be determined in follow-up studies.

Sjögren-Larsson syndrome is a rare hereditary metabolic disorder characterized by congenital ichthyosis, mental retardation, and spastic diplegia or tetraplegia. This genetic disease is caused by fatty acid aldehyde dehydrogenase deficiency, leading to an accumulation of long-chain alcohols. The role of enzyme in the degradation of leukotrienes paved the way to the development of a new therapeutic strategy for Sjögren-Larsson syndrome, leukotriene antagonists. We describe a 3-year-old boy with Sjögren-Larsson syndrome who had a lipid peak on proton magnetic resonance spectroscopy despite normal findings on cerebral magnetic resonance imaging. He benefited from treatment with montelukast sodium, especially with respect to the agonizing pruritus.

Objective: We evaluated structural and functional characteristics of the common carotid artery (CCA), a marker of early carotid atherosclerosis, and investigated their relation to metabolic and anthropometric parameters in children and adolescents with type 1 diabetes., Materials and Methods: Non-invasive ultrasonographic measurements were made in 45 type 1 diabetic patients and 33 controls. Age, sex, and body mass index were matched between patients and controls. We investigated intima-media thickness (IMT), compliance, distensibility, diastolic wall stress (DWS) and incremental elastic modulus (IEM) of the CCA. Metabolic and anthropometric parameters such as serum lipids, plasma glycated haemoglobin, body mass index, waist-hip ratio and blood pressure were assessed., Results: The diabetic patients had significantly higher CCA-IMT than the controls (0.48+/-0.06mm versus 0.33+/-0.07mm; p<0.001). The diabetic children had significantly higher values than the controls for DWS (1.18+/-0.29mmHgx10(2) versus 0.81+/-0.25mmHgx10(2); p<0.001) and for IEM (1.26+/-0.57mmHgx10(3) versus 0.77+/-0.28mmHgx10(3); p<0.001). The difference was not significant between patients and controls for arterial compliance and for distensibility (p>0.05). In a multivariate regression model for all subjects, diabetic state was the best predictor of IMT (p<0.001), DWS (p<0.001) and IEM (p=0.001)., Conclusion: Our results suggested that children and adolescent patients with type 1 diabetes are associated with early impairment of CCA structure and function and that diabetic state may be the main risk factor for CCA wall stiffening and thickening, which are of considerable concern as possible early events in the genesis of atheroma.

The presence of enlarged, echogenic kidneys in a newborn with generalized macrosomia points toward diagnosis of an overgrowth syndrome. These include Beckwith-Wiedemann, Perlman and Simpson-Golabi-Behmel syndromes. Perlman syndrome is an autosomal recessively inherited overgrowth syndrome characterized by fetal gigantism, visceromegaly, unusual face, bilateral renal hamartomas with nephroblastomatosis, and Wilms tumor. We report a male infant who exhibits typical features of Perlman syndrome with an unusual presentation. In this report, it is emphasized that hemangioma in neonatal period may be an unusual finding in Perlman syndrome.

Objective: The aim of our study was to assess the prevalence of metabolic syndrome and the other metabolic features in obese children., Methods: We have studied 169 obese children and adolescents (body mass index>95th percentile), 100 prepubertal and 69 pubertal, aged between 7 and 18 years. Each subject was submitted to an oral glucose tolerance test. The diagnosis of impaired glucose tolerance, type 2 diabetes and metabolic syndrome were defined according to modified WHO criteria adapted for children., Results: Metabolic syndrome was found in 27.2%, with a significantly higher rate among adolescents aged 12-18 years (37.6%) than among children aged 7-11 years (20%) (p < 0.001). There were no significant differences in the prevalence of metabolic syndrome by sex. The prevalences of insulin resistance, glucose intolerance and type 2 diabetes were 29, 19 and 2% among prepubertal children and 56.5, 27.5 and 4.3% among pubertal group, respectively. The prevalence of fasting hyperinsulinemia in pubertal group was significantly higher than prepubertal children (p < 0.001). Hyperinsulinemia was also more frequent in pubertal children with significant difference (20% versus 43.7%, p < 0.001). Hypertension was significantly more common in adolescents (31.8%) than children (15%) with obesity, as expected (p < 0.013). Overall, dyslipidaemia in prepubertal and pubertal groups was identified in 42 and 55%, respectively, with no significant differences (p = 0.085)., Conclusions: Type 2 diabetes mellitus and metabolic syndrome prevalences among adolescents are quite high in the urban area of Konya, central Anatolia, with abnormal lipid profiles, obesity and nutritional mistakes.

We report on sporadic cases that have the proposed diagnostic criteria for Cohen syndrome associated with metabolic syndrome. The patients, aged 14 and 16 years, had truncal obesity, mild mental retardation, hypotonia, narrow hands and feet, a high-arched palate, prominent upper central incisors, a high nasal bridge, and ocular abnormalities. Both had impaired glucose tolerance, with marked hyperinsulinemia exhibited by an oral glucose tolerance test. Moreover, they had the other metabolic syndrome features of hyperlipidemia and hypertension. We suggest that it is necessary to consider the possibility of metabolic syndrome in a case of Cohen syndrome.

Objective: Hyperhomocysteinemia has been established as a risk factor for cardiovascular disease. The objective was to investigate total plasma homocysteine concentrations in children and adolescents with type 1 diabetes and a control group., Method: Twenty-seven children with type 1 diabetes and 27 subjects of an age- and sex-matched control group were recruited. Fasting samples were collected for plasma total homocysteine, serum vitamin B12, folate, and creatinine., Results: Fasting total homocysteine concentrations showed no difference between patients and controls (5.6 +/- 2.9 micromol/L vs 5.7 +/- 2.2 micromol/L; p greater than 0.05). The diabetic patients had significantly higher serum folate than the healthy controls (11.4 +/- 3.3 ng/mL vs 9.4 +/- 4.1 ng/mL; P = 0.02 and higher serum B12 than the control group (282.8 +/- 119 pg/mL vs 228.5 +/- 50.9 pg/mL; P = 0.03). Total plasma homocysteine concentration correlated with age (r = 0.44, P = 0.02), weight (r = 0.56, P = 0.002), body mass index (r = 0.57, P = 0.002), folate (r = -0.48, P = 0.01), and creatinine (r = 0.41, P = 0.03) in diabetic patients. In stepwise multivariate regression model for diabetics, the independent correlates for total plasma homocysteine concentration was folate (P = 0.002)., Conclusion: We concluded that fasting plasma total homocysteine concentrations were within normal limits in children and adolescents with type 1 diabetes who were without any clinical evidence of microvascular and macrovascular complications.

Hypomagnesemia and sub-clinical atherosclerosis are common in type 1 diabetic patients, and are especially common in poorly controlled and chronically treated diabetics. The aim of this study was to evaluate the relationships between serum magnesium (Mg) and intima-media thickness (IMT), and functions of common carotid artery (CCA), accepted as markers of early carotid atherosclerosis in type 1 diabetic patients. Serum magnesium levels were measured in 51 diabetic patients (26 girls and 25 boys). Age, duration of diabetes as well as major cardiovascular risk factors, including anthropometric and metabolic parameters were matched between girls and boys. CCA structure and functions were measured by ultrasonography as IMT, cross-sectional compliance (CSC), cross-sectional distensibility (CSD), diastolic wall stress (DWS), and incremental elastic modulus (IEM). The difference for serum Mg was significant between diabetic girls and boys (0.75+/-0.09 mmol/l versus 0.86+/-0.14 mmol/l; p=0.02). Mg levels were correlated with IMT (r=-0.58, p=0.004) and DWS (r=-0.49, p=0.01) in girls and with IMT (r=-0.55, p=0.007) and DWS (r=-0.46, p=0.03) in boys. In a multivariate regression model, Mg, systolic blood pressure and waist-hip ratio emerged as independent correlates for mean IMT in girls with the total variance explained being 63%, and Mg and triglycerides emerged as independent correlates for mean IMT in boys with the total variance explained being 68%. Mg did not emerge as independent correlates for mean DWS in both girls and boys. Serum magnesium levels in children and adolescent patients with type 1 diabetes are associated with early atherosclerosis.

Objective: Osteopenia is a frequent condition in preterm infants. This prospective study was designed to assess the relationship between cord blood insulin-like growth factor-I (IGF-I) levels and bone mineralization in healthy premature infants., Methods: Twenty preterm infants (ten males and ten females) were studied. We determined the bone mineral density (BMD) and bone mineral content (BMC) of healthy premature infants by dual-energy X-ray absorptiometry and also studied the correlation between IGF-I and other parameters and the influence of cord blood IGF-I concentrations on bone mineralization in these infants., Results: The mean concentration of IGF-I was 13.6 +/- 16.9 ng/ml and BMD and BMC were 0.249 +/- 0.06 g/cm2 and 3.09 +/- 1.18 g, respectively. Cord serum levels of IGF-I had significantly positive correlations with BMD (r = 0.605, p = 0.008), but not BMC (r = 0.242, p = 0.367). In stepwise regression analysis, IGF-I emerged as a significant predictor of BMD (beta = 0.595, p = 0.015) contributing to 35.4% of its variability., Conclusion: We found a relationship between cord blood IGF-I and BMD in preterm neonates, suggesting that even within an unremarkable population, IGF-I might be important to ensuring bone health.

The aim of the present study was to evaluate the effect of phototherapy and oxidative stress on the growth plate of newborn rats. Forty newborn Sprague-Dawley rats were randomized into a phototherapy group and a control group. Twenty of the rats received phototherapy for 7 days. All zones of the growth plate were assessed with quantitative histomorphometric analysis. Individual zonal lengths were measured for the reserve zone (RZ), the proliferative zone (PZ), the hypertrophic zone (HZ), ossifying cartilage (OC), and total zone (TZ) of the growth plate. Levels of plasma malondialdehyde (MDA), an index of oxidative stress, were also evaluated. Compared with zonal lengths on day 7 after phototherapy between the two groups, the phototherapy group had significantly lower values than those of controls for RZ (5.13 +/- 0.36 vs. 6.4 +/- 0.85 mm x 10(-2); P < 0.001), PZ (20.6 +/- 3.0 vs. 29.25 +/- 1.68 mm x 10(-2); P < 0.001), HZ (15.4 +/- 1.44 vs. 20.87 +/- 1.12 mm x 10(-2); P < 0.001), OC (47.08 +/- 4.25 vs. 62.06 +/- 3.7 mm x 10(-2); P < 0.001), and TZ (88.15 +/- 6.56 vs. 118.48 +/- 4.50 mm x 10(-2); P < 0.001). Plasma MDA levels were correlated with the size of the PZ in the phototherapy group (r = -0.53, P = 0.01). In a multivariate regression model for all rats, being in the phototherapy group was the best predictor of the size of the TZ (beta = -0.94, P < 0.001), with the total variance explained being 88%. These results suggest that in newborn rats, receiving phototherapy is associated with early impairment of growth plate structure, and oxidative stress may be the main risk factor for growth plate injury.

Zimmermann-Laband syndrome is an inherited disorder that is characterized by abnormalities of the head, face, hands, and feet. Most children with this disorder have generalized hypertrichosis, large gingivae, and hypoplasia of the fingernails and toenails. We report a male infant who exhibited typical features of Zimmermann-Laband syndrome with an unusual histopathologic finding. Excised tissue from the infant's gingivae showed papillary projections that were composed of hyperplastic stratified squamous epithelium with different amounts of keratinization.

Perimesencephalic nonaneurysmal hemorrhage is a benign form of subarachnoid hemorrhages. This entity is well recognized as a distinct type of subarachnoid hemorrhage in adults. However, perimesencephalic nonaneurysmal subarachnoid hemorrhage in pediatric patients is not well recognized. Angiographic changes such as vasospasm are uncommon in patients, especially in pediatric patients suffering from this type of hemorrhage. This case study reports a 12-year-old male who suffered from perimesencephalic nonaneurysmal subarachnoid hemorrhage. Cerebral carotid angiography performed on the tenth day of the posthemorrhagic period revealed severe vasospasm affecting the basilar artery. The patient, treated symptomatically, was discharged after improvement. One year later, magnetic resonance angiography revealed completely normal features.