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AIM: The aim of the present study was to analyze the relationship between epicardial adipose tissue thickness (EATT) and echocardiographic parameters, such as carotid intima-media thickness (cIMT), myocardial performance index (MPI), left ventricular (LV) systolic and diastolic function, and LV mass index in adolescents with obesity. PATIENTS AND METHODS: One hundred and thirty eight obese adolescents and 63 lean subjects were enrolled in the study. The body mass index standard deviation scores (BMI-SDS) between 1.65-2.49 and 2.50-2.99 were considered as mild-moderate and severe obesity, respectively. All of the subjects underwent transthoracic echocardiographic examination for determination of LV function, LV structure, LV mass index, and MPI. Epicardial adipose tissue thickness and cIMT were also measured during echocardiography. RESULTS: The EATT measurements were increased significantly in patients with severe obesity compared to lean subjects (7.38±1.76 vs 4.28±0.79 mm, respectively; p = 0.001), but there was no significant difference between the obesity groups. The average LV mass index measurements were higher in both mild-moderately and severely obese patients in comparison with the lean children (87.5±34.8, 88.5±23.0, and 62.4±18.2 g/m², respectively; p < 0.01), but there was no significant difference between the obesity groups. EATT was positively correlated with BMI-SDS, waist and hip circumference, blood pressure, fasting glucose, insulin, HOMA-IR, hs-CRP (high-sensitivity C-reactive protein), triglyceride levels, cIMT, LV mass index, and MPI in the severe obesity group. EATT was the only independent predictor of cIMT in the multivariate analysis (standardized β coefficient = 0.70, p < 0.001). CONCLUSIONS: The present study demonstrates a close relationship between EATT and cIMT, and LV functions and LV mass index in obese adolescents. Assessments of EATT and cIMT in particular during routine echocardiographic examinations might be used as a feasible and reliable method for the evaluation of obesity and its related cardiovascular risks during childhood. [ABSTRACT FROM AUTHOR]

Background and Aim: Children with type 1 diabetes mellitus are susceptible to arrhythmias and sudden cardiac death. In this study, we aimed to explore the arrhythmia risk among children with type 1 diabetes mellitus by assessing electrocardiographic parameters., Methods: A total of 165 children diagnosed with type 1 diabetes mellitus, aged 10-18 years, and 154 healthy children matched for age and gender without any chronic diseases, were included in the study. The electrocardiographical ventricular depolarization-repolarization parameters of both groups and the correlation of these parameters with length of time since diagnosis of type 1 diabetes mellitus, metabolic control, and the presence of additional complications were evaluated., Results: The groups were similar in terms of age, gender, weight, height, and BMI (p>0.05). The median length of time since diagnosis of diabetes was 5 years. QT (maximum), QTc (minimum and maximum), QT and QTc dispersion, Tp-e (minimum and maximum), Tp-e dispersion, Tp-e/ QTc-max values were significantly higher in the diabetic group compared with controls although QTc intervals are within normal ranges. No statistically significant correlation was observed between electrocardiographic findings and length of time since diagnosis of type 1 diabetes mellitus, HbA1c levels, or complications., Conclusion: As children with type 1 diabetes mellitus are at high risk of impaired ventricular depolarization and repolarization, they should undergo cardiac assessment and regular electrocardiographic monitoring.

Objective: Atropa belladonna, known as the deadly nightshade, is one of the most poisonous plants in the world. Deadly nightshade poisoning in both children and adults has been rarely reported and is mostly in the form of case reports. The aim of this study was to illuminate the findings of weed poisoning in childhood., Materials and Methods: Clinical and laboratory findings of 54 children with acute deadly nightshade and other weed poisoning followed in our center between January 2010 and January 2022, were retrospectively reviewed., Results: In the study analyzing 54 children admitted to the pediatric intensive care unit for poisoning, 24 cases (44.4%) were attributed to deadly nightshade, with the remaining cases involving other weed poisonings. The most common symptoms were flushing, vomiting, mydriasis, gibberish, dry mouth, and tachycardia. Three patients required mechanical ventilation. No patient was dead. Patients were categorized into 2 groups: mild/moderate (no encephalopathy, n : 46) and severe poisoning (with encephalopathy, n : 8). The severe poisoning group had a higher incidence of urinary retention, incoherent speech, dry mouth, agitation, lethargy, convulsions, and coma, which led to longer intensive care unit (ICU) stays and an increased need for respiratory support (P < .05). Furthermore, a statistically significant difference was observed between deadly nightshade poisoning and other weed poisonings, particularly in the presence of symptoms such as headache, flushing, mydriasis, incoherent speech, encephalopathy, convulsions, and coma, all of which contributed to extended ICU stays and elevated respiratory support requirements (P < .05). Notably, neostigmine was administered in all cases of deadly nightshade poisoning due to the unavailability of physostigmine. Our findings showed that the first signs and symptoms of acute deadly nightshade and other weed poisoning may be severe in some children, but no death was observed. Meaningless speech, mydriasis, coma, and lachrymation were negative prognostic signs in childhood weed poisoning. We believe that neostigmine may be an alternative for deadly nightshade poisoning in cases when physostigmine is unavailable., Conclusions: Our study highlights the severity of poisonings involving deadly nightshade and other weeds in pediatric patients. Despite the significant clinical manifestations observed, no fatalities were recorded. The findings underscore the importance of early recognition and appropriate management, emphasizing the need for heightened awareness among healthcare professionals and caregivers.

Objective: The aim was to assess postoperative outcomes in pediatric thyroid nodules with atypia of undetermined significance (AUS/FLUS) or suspicious for a follicular neoplasm (SFN) and their respective the European-Thyroid Imaging Reporting and Data System (EU-TIRADS) scores., Methods: Forty-four pediatric patients at a single center with thyroid nodules classified as AUS/FLUS or SFN from August 2019 to December 2022 were retrospectively reviewed. Data on demographics, thyroid function, nodule size, and ultrasonographic features were collected. Postoperative pathologies were categorized into benign, low-risk, and malignant neoplasms according to the World Health Organization 2022 criteria, and EU-TIRADS was used for retrospective radiological scoring., Results: Among 21 (47.7%) of patients who had surgical intervention, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Post-surgical histopathological classifications were 43% benign, 19% low-risk, and 38% malignant. Of note, EU-TIRADS 3 and 5 scores were present in 44% and 56% of the benign cases, respectively. Malignant cases tended to produce higher EU-TIRADS scores, with 64% rated as EU-TIRADS 5. Bethesda category 4 nodules had a 66% malignancy rate, significantly higher than the 27% in category 3., Conclusion: A substantial proportion of histologically benign cases were classified as EU-TIRADS 5, suggesting that EU-TIRADS may lead to unnecessary biopsies in benign cases. Malignant cases were more likely to have a higher EU-TIRADS score, indicating a positive correlation with malignancy risk, particularly in Bethesda 4 cases. However, the EU-TIRADS system’s predictive value for malignancy in Bethesda 3 cases was poorer., (©Copyright 2024 by Turkish Society for Pediatric Endocrinology and Diabetes / The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

Objectives: Alkaline phosphatase (ALP) can be increased in a benign condition known as benign-transient hyperphosphatasemia (BTH). We aimed to evaluate the demographic, and clinical characteristics of infants and children with BTH., Methods: In our retrospective study, infants and children diagnosed with BTH between September 2019 and September 2023 were included., Results: Of 249 children with elevated ALP levels, 95 (38.1 %) had BTH. The mean age at diagnosis of children with BTH was 2.4 ± 1.3 years (min 0.6 - max 6.2 years). ALP mean value was 2,587 ± 1252 U/L (min 972 - max 5757 U/L). ALP value was an average 7.4 ± 3.6 times higher than the corresponding upper limit of normal. The second measurement was made after an average of 13.2 ± 6 days, and a statistically significant difference was detected compared to the first value, with a decrease of 61 ± 23 % in the ALP value (p<0.001). ALP value returned to normal in an average of 44 ± 29.2 days. Elevated ALP was detected during infection in 49 (51.6 %) children. When the sample was divided into those under 2 years of age and aged 2 and over, no statistical difference was observed in ALP levels in the time it took for ALP levels to return to the normal range (p=0.480)., Conclusions: BTH should be kept in mind if high serum ALP is detected in children without clinical or laboratory suspicion of bone or liver disease. In the follow up detecting a significant decrease trend compared to the first value may be guiding for BTH., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Purpose: The aim of this study was to investigate the frequency and distribution of intracranial pathologies in female patients between 8 and 9 years of age who were diagnosed with early puberty (rapidly progressive) through the evaluation of MRI images., Materials and Methods: A total of 74 female patients diagnosed with central precocious puberty (CPP) (6-8 years) and rapidly progressive early puberty (RPEP) (8-9 years) were included in the study. The patients were categorized into two groups, normal and abnormal, based on the findings from their MRI scans. Recent literature has classified abnormal MRI findings into three groups: pathological findings, findings with a questionable relationship to CPP, and incidental findings. Furthermore, the patients were divided into four groups based on their MRI findings and whether they had CPP or RPEP : CPP (6-8 years) +Normal MRI, RPEP (8-9 years) + Normal MRI, CPP (6-8 years) +Abnormal MRI, RPEP (8-9 years) +Abnormal MRI., Results: Out of the 74 girls included in the study, 54% (n=40) showed normal MRI results, while abnormal MRI findings were detected in 46% (n = 34) of the cases. No malignant lesions were identified among cases with abnormal MRI findings. The occurrence of abnormal MRI findings was observed in 46% of the PP group and 45% of the RPEP group. Incidental findings were the most common MRI findings in both groups. The proportion of cases with pathological findings and findings with a questionable relationship to CPP was similar in both groups (p = 0.06). Basal luteinizing hormone (LH) concentration was found to be higher in the RPEP (8-9 years) +Abnormal MRI group compared to the CPP (6-8 years ) +Normal MRI group (p = 0.01)., Conclusion: Our study is the first to investigate MRI findings in cases of rapidly progressive early puberty in the age range of 8-9 years. Our study demonstrates that there is no difference in terms of intracranial findings between cases of precocious puberty at the age of 6-8 years and cases of rapidly progressive early puberty aged 8-9., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kılınç Uğurlu, Özdemir Gökce, Çakır Gündoğan, Ekşioğlu and Boyraz.)

Intraoral injuries are frequently encountered in emergency departments due to children's desire and curiosity to put objects in their mouths. However, forward falls with objects in children's mouths can cause impalement injuries to soft palate, retropharyngeal-peritonsillar, and retromolar tissues, leading to serious morbidity and even mortality. These transoral (soft palate, pharynx-tonsil, retromolar region) penetration injuries can especially result in damage to major vascular structures like the Internal Carotid Artery (ICA) due to their close proximity. Dissection, thrombosis, and subsequent stroke can occur in the delicate ICA as a result. In the presented case, a 3-year-old male child experienced internal carotid artery dissection following penetrating injury with a pen, as demonstrated by imaging studies. A literature review is provided along with the case of this child, who developed a reduction in middle cerebral artery (MCA) flow due to thrombosis in the ICA. The study encompasses all penetrating oropharyngeal traumas reported in individuals aged 0-18 years from 1936 to 2023. A search in PubMed and Google Scholar using keywords such as 'internal carotid artery injury,' 'penetrating trauma,' and 'children' yielded 78 case reports from a pool of 36,000 studies. The analysis excludes injuries in areas like tongue, cheek, gums, lips, and floor of the mouth, post-tonsillectomy injuries, and those from sudden braking vehicles. This review encompasses the evaluation, diagnosis, and treatment of penetrating injuries to the soft palate, pharyngeal wall, tonsil, and retromolar regions., Competing Interests: Declaration of competing interest I, Servet Yuce, MD, am one of the authors of this manuscript and hereby affirm that there are no conflicts of interest that could potentially influence or bias the outcomes presented in the manuscript. To the best of my knowledge, there are no affiliations, financial involvements, or any other relationships that could be perceived as having a potential conflict of interest regarding the content of this manuscript. Furthermore, I wish to disclose that any sources of funding, research grants, or financial contributions relevant to the research presented in this manuscript have been properly acknowledged within the text and adhered to the journal's guidelines. I affirm that all information provided in this declaration is accurate and truthful to the best of my knowledge. Should any potential conflicts of interest arise after the publication of this manuscript, I am committed to promptly informing the editorial board and the readership. Please consider this letter as an official declaration of no conflict of interest on my part, pertaining to the manuscript mentioned above. I sincerely believe that the content presented in the manuscript is valuable to the scientific community and aligns with the ethical standards and policies of “International Journal of Pediatric Otorhinolaryngology"., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: Poisonings constitute an important part of preventable morbidity and mortality in pediatric intensive care units (PICUs) and hospitalizations. However, information on poisoning requiring intensive care is limited. This study aimed epidemiological evaluation of poisoning cases treated in the PICU in a single center., Methods: The records of 504 patients admitted to the PICU due to acute poisoning between 2010 and 2022 were retrospectively reviewed. Data were evaluated using descriptive methods and the χ 2 test, and statistical differences with P value <0.05 were considered significant., Results: The age range of the patients ranged from 1 month to 216 months (18 years), and the rate of girls was 53.2% (n = 268), whereas the rate of boys was 46.8% (n = 236). The mean age was 4.4 ± 4.3 years for boys, 6.7 ± 5.8 years for girls, and 5.6 ± 5.3 years for all patients. It was determined that 79.6% of the cases were poisoned by accident and 20.4% by suicide. A total of 76.7% of the patients who were poisoned for suicide were girls and 23.3% were boys. The mean age of these patients was 14.3 ± 3.0 years. On the other hand, 47.1% of the children who were accidentally poisoned were girls and 52.9% were boys, and the mean age of these children was 3.4 ± 2.9 years. Although 79.9% of poisonings occurred at home, the causative agent was oral poisoning in 97.4% of the cases. Approximately two thirds (69.2%) of the cases were drug-related, whereas 30.8% were related to nondrug substances. In drug-related poisonings, central nervous system drugs (35.8%) were the most common agent, followed by analgesic/antipyretic (20.9%) agents, whereas among the nonpharmaceutical factors, insecticides (agricultural pesticides, rat poison, pesticides, etc) were the most common, followed by poisonous herbs (beetleweed, widow's weed, cannabis, etc). The mean admission time of the patients to the hospital was 6.3 ± 8.4 hours, and the mean length of stay in the intensive care unit was 1.6 ± 1.3 days. In the 12 years of our study, only 3 patients died due to poisoning, and our mortality rate was 0.5%. Four patients (0.7%) were referred to the Alcohol and Drug Addicts Treatment and Research Center., Conclusions: In this study, in which we retrospectively analyzed the profiles of poisoning cases hospitalized in the PICU for 12 years, we determined that poisonous weeds were the major factor in accidental poisonings, and suicidal poisonings were above the expected rates even at the young age group such as 8-12 years old. These results show the importance of determining the poisoning profile of the health care service area., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Gonadotropin-releasing hormone agonist (GnRHa) has been used for central precocious puberty (CPP) or early and fast puberty. It was aimed to assess changes in body mass index (BMI), polycystic ovary syndrome (PCOS) frequency, and anti-Müllerian hormone (AMH) in girls who had been treated with GnRHa., Methods: Fifty-eight adolescent girls treated with GnRHa for CPP or early and fast puberty (3.75 mg/28 days), between 2011 and 2015, were re-evaluated in 2020-2022 at least 2 years after menstruation. Hormonal analyses were compared with 51 healthy adolescents., Results: In the GnRHa-treated group, a statistically significant increase was observed when the BMI standard deviation score (SDS) at the beginning of the treatment was compared with the BMI SDS at the end of the treatment (p=0.038). A statistically significant decrease was observed when the BMI SDS at the end of the treatment was compared with the BMI SDS in late adolescence (p=0.012). When the BMI SDS at the beginning of the treatment was compared with the BMI SDS in late adolescence, it was observed that there was no statistically significant difference (p=0.196). Of the 58 girls in the GnRHa-treated group, 8 (14 %) had PCOS. Serum AMH levels did not differ between the GnRHa-treated and the control group., Conclusions: GnRHa treatment causes no adverse effect on BMI, at least in late adolescence. Girls treated with GnRHa were not found to be prone to developing PCOS. AMH levels were similar in the GnRHa-treated group as in the control group., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction: Malnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies., Material and Method: In this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined., Results: Of the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% ( n  = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% ( n  = 533) of the patients achieved the target calorie intake, and 81.65% ( n  = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p  = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h ( p  = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week ( p  = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p  = 0.024)., Conclusion: Timely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Misirlioglu, Yildizdas, Ekinci, Ozgur Horoz, Tumgor, Yontem, Talay, Kangin, Tufan, Kesici, Yener, Kinik Kaya, Havan, Tunc, Akçay, Sevketoglu, Durak, Ozel Dogruoz, Ozcan, Perk, Duyu, Boyraz, Uysal Yazici, Ozturk, Çeleğen, Bukulmez, Kacmaz, Dinleyici, Dursun, Koker, Bayraktar, Talip Petmezci, Nabaliyeva, Agin, Hepduman, Akkuzu, Kendirli, Ozen, Topal, Ödek, Ozkale, Ozkale, Atay, Erdoğan, Konca, Yapici, Arslan, Besci, Yilmaz, Gumus, Oto, Dalkiran, Mercan, Çoban, Ipek, Gungor, Arslankoylu, Alakaya, Sari, Yucel and Yazar.)

4H syndrome is a rare progressive hypomyelinating leukodystrophy. Hypomyelination, hypodontia, and hypogonadotropic hypogonadism are the 3 classic features of 4H syndrome. Biallelic pathogenic variants in POLR3A, POLR3B, POLR1C, and POLR3K gene cause 4H leukodystrophy. Herein, we present clinical features in two siblings with 4H syndrome. The first patient (16 years) presented hypogonadotropic hypogonadism, euthyroid Hashimoto's thyroiditis and type 1 diabetes mellitus. The second patient (13.5 years) showed normal physical, biochemical and hormonal examination at presentation. It was learned that he was followed up for epilepsy between the ages of 6 months and 6 years, his epilepsy medication was discontinued at the age of 6, and he did not have seizure again. T2-weighted magnetic resonance images showed increased signal intensity secondary to hypomyelination at patients. They were subsequently found to have homozygous mutation in the POLR3A gene. 4H syndrome may present with neurological and non-neurological findings in addition to classic features of 4H syndrome. Progressive neurological deterioration may occur and endocrine dysfunction may be progressive. Although multipl endocrine abnormalities associated with this disorder have been reported to date, a case accompanied by type 1 DM has not been seen in the literature. We do not know exactly whether this is coinsidans or the expansion of the phenotype. So that reporting such cases helps to determine the appropriate genotype-phenotype correlation in patients.

Introduction: There have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection., Methods: This is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year., Results: The percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic ( p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic ( p < 0.0001) and also higher among children with new onset Type 1 diabetes ( p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission., Discussion: The frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemic; however, need to evaluate the potential effects of SARS-CoV-2 on the increased percentage of new onset Type 1 diabetes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kiral, Kirel, Havan, Keskin, Karaoglan, Yildirim, Kangin, Talay, Urun, Altug, Kesici, Tufan, Kacmaz, Bozan, Azapagasi, Uysal Yazici, Ozturk, Yesilbas, Karaguzel, Kaya, Barlas, Duyu, Boyraz, Sevketoglu, Akcay, Hancili, Guven, Dursun, Ulgen Tekerek, Ozcifci, Yazici, Turanli, Kendirli, Kahveci, Yetimakman, Citak, Şik, Bingol, Aygun, Durak, Yilmaz, Bugrul, Sari, Tekguç, Albayrak, Yener, Agin, Soydan, Yildizdas, Dilek, Yalindag, Incekoy-Girgin, Alacakir, Tutunculer, Arslanaoglu, Aydin, Bilgin, Simsek and Dinleyici.)

Introduction: Gonadotropin releasing hormone analogues (GnRHa) are commonly used to treat central precocious puberty (CPP). Generally, they are well-tolerated; however adverse reactions have been reported. Local adverse events occur in 10-15% of the patients who were treated with GnRHa. Anaphylactoid reactions with GnRHa are very rarely seen. The aim of this study is to report our clinical experience with hypersensitivity reactions seen in pediatric patients receiving leuprolide acetate (LA) and triptorelin acetate (TA) in CPP at the single pediatric tertiary medical center and to evaluate the incidence rate of hypersensitivity reactions., Methods: This retrospective study included children with CPP who were treated with GnRHa (LA and TA) at our hospital between January 2013 and December 2020. We analyzed clinical characteristics of patients who experienced adverse reactions and analyzed the incidence rate., Results: Seven side effects (adverse reactions) (0.69%) were observed among total of 1010 CPP patients who were treated with TA and LA. Sterile abscesses were observed in 3 patients (0.29%). None of the patients had an anaphylaxis. Tremors of both hands, a vomiting episode, an urticarial rash, and musculoskeletal stiffness were observed in one patient each., Conclusion: In our study, mild reactions were seen in 7 patients. GnRHa can be safely used and well-tolerated medications; but exceedingly rare, severe reactions can be developed., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Endocrinology and Metabolism.)

Objective: Although the initial reports of COVID-19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow-up of patients with MIS-C., Methods: The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback., Conclusion: Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C., (© 2021 John Wiley & Sons Ltd.)

Purpose: Hemodialysis (HD) patients are known to have high cardiovascular mortality rate. Sudden cardiac death (SCD) due to arrhythmias causes most of the cardiac deaths. HD per se may lead to ECG abnormalities and ventricular arrhythmias. Monitoring ECG parameters such as corrected QT interval, QT dispersion (QTd), Tpe interval may be useful to stratify the patients with high risk of arrhythmia and SCD. Herein we aimed to investigate the effects of changes in serum electrolyte levels and pH on ECG parameters before and after the HD., Methods: A total of 50 chronic HD patients (mean age 58 ± 19; male 27) were enrolled. Patients with unmeasurable T waves; atrial fibrillation; bundle branch block; use of class I or class III antiarrhythmic drugs were excluded. Serum potassium, magnesium, calcium, urea, creatinine and pH were measured before and after HD treatment. Standard surface 12-lead ECGs were recorded before and after HD. QTc, QTd, Tpe, JT interval, P-wave-duration, P-wave dispersion were determined., Results: Serum potassium and magnesium decreased, and calcium, pH and bicarbonate levels increased; QRS and Tpe interval were increased after HD. Basal Tpe was correlated with urea (r = 0.31, p = 0.02). Tpe interval was higher in hypocalcemic compared to normocalcemic patients (77 ± 11 vs 70 ± 9 ms, p = 0.02). ∆Tpe was correlated with ∆calcium (r = -0.32, p = 0.02). Basal QTc was correlated with calcium (r = -0.62, p < 0.001). ∆QTc was correlated with basal calcium (r = 0.39, p = 0.005) and ∆calcium (r = -0.46, p < 0.001). Basal JT was correlated with calcium (r = -0.55, p < 0.001). ∆JT was correlated with pH (r = 0.35, p = 0.01), ∆calcium (r = -0.53, p < 0.001) and ∆magnesium (r = -0.30, p = 0.03). Before HD, 12 patients (12%) were hypermagnesemic of whom JT intervals were lower (314 ± 20 vs 332 ± 23 ms, p = 0.02). Ultrafiltration per body weight was associated with ∆QTc (r = -0.40, p = 0.007) and ∆JT (r = -0.36, p = 0.01)., Conclusion: QRS and Tpe intervals were increased after HD. Tpe interval was longer in hypocalcemic patients. Change in Tpe was negatively associated with the change in calcium. Ultrafiltration was associated with ∆QTc and ∆JT. Calcium and ultrafiltration seem to be the most important determinants of ECG parameters of HD-induced repolarization abnormalities.

Objective: Although polymorphisms in suppressor of cytokine signaling 3 (SOCS3) was reported to be related to obesity, Metabolic syndrome (MS), and type 2 diabetes mellitus in various adult studies, there is a lack of data in children. In this study, we examined eight reported polymorphisms of SOCS3 in obese Turkish children and adolescent with and without MS and compared the results with that of controls., Methods: One hundred and forty eight obese and 63 age- and sex-matched control subjects were enrolled in the study. Obesity classification was carried out according to body mass index. World Health Organization and National Cholesterol Education Program criteria were used for the diagnosis of MS. Genotyping procedure was carried out by polymerase chain reaction and Sanger sequencing protocol., Results: The frequency of rs2280148 polymorphism was significantly higher in obese subjects with MS than in the control group, whereas the frequency of rs8064821 polymorphism was significantly higher in obese subjects with MS than in obese children without MS., Conclusion: The significant associations of certain SOCS3 polymorphisms with obesity parameters in both MS and MS -related insulin resistance, hypertension, and fatty liver suggest that polymorphisms in this gene may play a role in the pathogenesis of MS and also that they can be potentially used as a marker for attenuated or aggressive disease., Competing Interests: Financial Disclosure: The authors declared that this study received no financial support.

Objective: To investigate the efficacy and safety of n-3 polyunsaturated fatty acids (PUFA) treatment in obese children with nonalcoholic fatty liver disease (NAFLD)., Methods: One hundred and eight obese (body mass index (BMI) >95th percentile for age and sex) adolescents with NAFLD were included in the study. Mean age of the subjects was 13.8 ± 3.9 years (9-17 yrs). The diagnosis of NAFLD was based on the presence of liver steatosis with high transaminases. The subjects were randomly divided into two groups. Group 1 (PUFA group, n=52) received a 1000 mg dose of PUFA once daily for 12 months and lifestyle intervention. Group 2 (placebo group, n=56) received a recommended diet plus placebo and lifestyle intervention for 12 months. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR) from fasting samples., Results: BMI, fasting insulin levels and HOMA-IR values in both groups decreased significantly at the end of the study. In group 1, 67.8% of the patients had a decrease from baseline in the prevalence of steatosis (p<0.001). Frequency of elevated alanine aminotransferase (ALT) levels (39.2% to 14.2%; p<0.01) and elevated aspartate aminotransferase (AST) levels (25% to 17.8%; p=0.01) decreased significantly in the PUFA group. Following a 12-month diet plus placebo and lifestyle intervention treatment, 40.3% (21) of the patients in the placebo group also showed a decrease in frequency of steatosis (p=0.04) and slight decreases in frequency of elevated ALT levels (38.4% to 28.8%; p=0.01) and AST levels (30.7% to 28.8%; p>0.05)., Conclusion: Our results indicated that n-3 PUFA treatment is safe and efficacious in obese children with NAFLD and can improve ultrasonographic findings and the elevated transaminase levels.

Aim: To investigate metabolic syndrome (MetS) and MetS criteria, and to establish whether metabolic syndrome criteria were associated with non-alcoholic fatty liver disease (NAFLD) in obese children., Methods: A total of 451 pubertal obese children (8-18 years old) were enrolled in the study. Patients were divided into three groups according to the degree of steatosis. Antropometric and laboratory measurements of the participants were recorded., Results: Of 451 obese children, 217 (48.1%) were diagnosed as having NAFLD and 96 (21.3%) as having MetS. The frequency of abdominal obesity, hypertension, impaired fasting glucose, hyperinsulinemia, dyslipidemia and type 2 diabetes mellitus (T2DM) were 61.8% (279), 25.7% (116), 4.4% (20), 54.3% (245), 41% (185) and 2.2% (10), respectively. The prevalence of NAFLD among patients with MetS [73% (70/96)], was significantly higher than the frequency of hypertension [55% (53/96)] and abnormalities of glucose metabolism [23% (22/96)], but almost equal to the frequency of dyslipidemia [78% (75/96)]. The prevalence of MetS criteria were higher in patients with NAFLD than those without NAFLD. Except impaired fasting glucose, blood pressure and T2DM significant difference was found between groups for all. It was observed that the number of MetS criteria increased in parallel with the severity of steatosis., Conclusion: NAFLD in obese children is strongly associated with multiple MetS criteria. In addition to NAFLD is not only a liver disease, but also early mediator that reflects metabolic disorder, and liver ultrasound can be a useful tool for MetS screening., (Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Aim: To investigate the relationship of adiponectin, leptin, resistin and RBP4 levels in obese and metabolic syndrome children with nonalcoholic fatty liver disease (NAFLD)., Patients & Methods: Group I consisted of 63 obese children with liver steatosis, group II consisted of 12 obese children with elevated serum ALT activity from group I, and group III included 85 obese children without liver steatosis., Results: Leptin levels were higher in the NAFLD children than in the control group. Serum RBP4 levels in obese children with NAFLD were higher than those in obese children without NAFLD and controls. Adiponectin and resistin levels were negatively correlated and RBP4 levels positively correlated with ALT activity and ultrasonographic grading., Conclusion: These data suggest that adiponectin, resistin and RBP4 may have a role in the pathogenesis of NAFLD in obese children. Adiponectin, leptin, resistin and RBP4 may be suitable markers for predicting metabolic syndrome and NAFLD.

Objective: Epicardial adipose tissue thickness (EATT) is suggested as a new cardiometabolic risk factor. Carotid intima-media thickness (IMT) is a potential indicator of subclinical atherosclerosis in patients with metabolic syndrome (MS). We investigated the association of EATT with carotid IMT and cardiac functional changes in obese adolescents with MS., Methods: One hundred thirty-eight obese adolescents and 63 lean subjects were enrolled in the study. The obese subjects were divided into two subgroups based on the presence or absence of MS (MS group and non-MS group). All subjects underwent transthoracic echocardiographic examination for determination of left ventricular (LV) function, LV mass index (LVMI), and myocardial performance index (MPI). EATT and carotid IMT were also measured during echocardiography., Results: The average LVMI measurements were higher in both MS and non-MS obese patients in comparison with the lean children. The MS group had significantly higher LVMI measurements than the non-MS and lean groups (88.5±23.0, 67.5±24.8 g/m2, and 62.4±18.2 g/m2, respectively; p<0.01). Carotid IMT was higher in both the MS and non-MS obese patients in comparison with the lean group. The MS group had significantly higher carotid IMT measurements than the non-MS and lean groups (0.91±0.23, 0.78±0.18, and 0.52±0.08 mm, respectively; p<0.01). The EATT was also increased significantly in patients with MS compared to lean adolescents (7.42±1.55 vs. 4.28±0.79mm; p=0.001). EATT was positively correlated with body mass index-SDS, waist circumference, fasting glucose, insulin, homeostasis model assessment-insulin resistance, triglyceride levels, LV thickness, LVMI, and MPI in the MS obese group. EATT was the only independent predictor of carotid IMT in the multivariate analysis (β= 0.69, p<0.001)., Conclusion: The findings of the present study demonstrate a close relationship of EATT with carotid IMT and early cardiac dysfunction in obese adolescents with MS. Assessment of EATT and carotid IMT in routine echocardiographic examinations is suggested as a feasible and reliable method for the evaluation of obesity with MS and its related cardiovascular risks in children and adolescents.

Objective: The aim of this study was to evaluate the effects of using ACE inhibitors on insulin resistance, glucose metabolism, body fat composition, and lipid profile in children over 10 years of age with obesity-associated metabolic syndrome (MS)., Methods: A total of 53 children with MS, who had been followed for at least one year were included in the study. The sample was divided into two groups: Group 1-30 obese children (13 female, 17 male) who were not using an ACE inhibitor and Group 2-23 obese children (13 female, 10 male) who were using an ACE inhibitor. Anthropometric and laboratory data obtained at baseline and at the 3rd, 6th, and 12th months of follow-up were compared in the two groups., Results: Comparison of the data in the two groups at 3rd, 6th, and 12th months revealed no statistically significant differences in terms of weight standard deviation score (SDS), body mass index SDS, weight for height percentile, body fat percentage, and very low-density lipoprotein (VLDL)values. However, there were statistically significant differences in mean glucose and insulin levels, homeostasis model assessment for insulin resistance, LDL and high-density lipoprotein values, and highly significant differences in mean triglyceride values., Conclusions: The positive effects of ACE inhibitor drugs, particularly on hypertriglyceridemia and insulin resistance, might bring them forth as first-line drugs in the treatment of obese and hypertensive children. Randomized, controlled, double-blind, and long-term studies are needed for a definitive conclusion.

Mutations in PROP1 are the most frequent defect detected in patients with combined pituitary hormone deficiency (MIM #262600), characterized by a clinical phenotype of proportionate growth deficit due to impaired production of growth hormone in combination with deficiency of one or more of the additional anterior pituitary hormones. Approximately one third of patients with PROP1 inactivating mutations present with abnormal development of the anterior lobe of the pituitary gland as revealed by MRI. We report on the clinical and molecular characterization of the fourth complete PROP1 deletion in a girl with proportional short stature, combined pituitary hormone deficiency and a suprasellar mass mimicking a hypothalamic glioma. The proband, born to consanguineous parents, presented with proportional growth failure (height 108.8 cm, -3.48 SDS), combined pituitary hormone deficiency (GH, TSH, PRL and gonadotropins) and a suprasellar mass with optic chiasm invasion, compatible with a diagnosis of chiasmatic hypothalamic glioma, as revealed by MRI. PROP1 mutation screening by PCR and MLPA detected a homozygous deletion of the entire PROP1. The deletion was delimited to at least 7.7 kb upstream of PROP1 and more finely to ∼541-74 bp downstream from PROP1 by aCGH and PCR mapping. We describe the fourth case with a complete PROP1 deletion in homozygosis. The apparent location of the respective 5' (within a highly repetitive region, rich in Alu sequences) and 3' (within an Alu sequence) breakpoints, suggests that the deletion may have arisen through homologous recombination. The differentiation between PROP1 mutation associated pituitary enlargements from craniopharyngioma, pituitary adenoma, dys-germinoma, or Rathke's pouch cyst, is critical for the correct patient management. It is important to recognize that PROP1 mutations can present associated with evolving pituitary masses and/or other MRI alterations of the pituitary during early childhood and that surgery is not indicated in these patients. Therefore, in the presence of combined pituitary hormone deficiency and a pituitary or hypothalamic mass, PROP1 analysis should be considered before referring the patient to a neurosurgeon., (© 2013 Published by Elsevier Masson SAS.)

Aim: To investigate the relationship between serum adiponectin, resistin and RBP4 levels and the components of metabolic syndrome., Patients & Methods: Serum adiponectin, resistin and RBP4 levels were detected and analyzed in 148 8-18-year-old Turkish obese pubertal children with/without metabolic syndrome., Results: Adiponectin and resistin concentrations were significantly inversely correlated with BMI standard deviation score, homeostatic model assessment insulin resistance, waist circumference, triglyceride levels and diastolic and systolic blood pressure, and were directly correlated with high-density lipoprotein cholesterol. RBP4 concentrations were directly correlated with homeostatic model assessment insulin resistance, waist circumference, triglyceride levels and diastolic and systolic blood pressure, and inversely correlated with high-density lipoprotein cholesterol., Conclusion: Adiponectin, RBP4 and, in particular, resistin levels may be used as suitable predictive biomarkers of metabolic syndrome.

Neonatal diabetes mellitus (NDM) is a rare form of diabetes that presents within the first six months of life. Nearly 70% of these cases have loss of methylation at the differentially methylated region on chromosome 6q24. To describe the findings in a Turkish male patient with NDM caused by a loss of methylation at chromosome 6q24 and three novel homozygous mutations in the ZFP57 gene, methylation-specific PCR was carried out at 6q24 and mutation analysis of ZFP57 gene was maintained by direct sequencing. Sequencing of ZFP57 gene revealed the hypomethylation of chromosome 6q24 and three novel mutations (chr6:29.641.413 A>T, 29.641.073 C>T, and 29.640.855 G>C), respectively. The latter mutation seems to display the patient's condition due to a highly conservative amino acid substitution in the protein. We suggest the ZFP57 gene as a causative factor for NDM and it should be considered in genetic testing. Further studies including functional analysis of the detected mutations will provide precise information regarding the effect of the mutations.

Background: In obese populations, oxidative stress plays a major role in the pathogenesis of serious diseases such as diabetes, coronary heart disease, and atherosclerosis. In this study, we investigated the status of oxidative stress in obese children as to nitrite/nitrate and glutathione peroxidase levels, and their relation with insulin resistance (IR)., Methods: A total of 63 obese children were enrolled in the study. Each was relegated to one of three groups: 20 obese children without IR (11 adolescents, 9 prepubertal; mean age 10.27 +/- 2.36 years; 10 males, 10 females), 22 obese children with IR (13 adolescents, 9 prepubertal; mean age 11.26 +/- 2.52 years; 10 males, 12 females), and a control group of 21 children (14 adolescents, 7 prepubertal; mean age 11.41 +/- 2.00 years; 10 males, 11 females)., Results: Glutathione peroxidase levels were lower in the obese group with IR than in either the control group or the obese group without IR (0.032 +/- 0.01 vs. 0.048 +/- 0.01 and 0.042 +/- 0.01, respectively). Nitrite/nitrate levels were higher in the obese group with IR than in the control group or the obese group without IR (89.83 +/- 25.00 vs. 66.00 +/- 21.75, and 68.65 +/- 28.98, respectively) and compared by pubertal status, adolescents' results were similar. However, in prepubertal children, nitrite/nitrate and glutathione peroxidase levels were not significantly different between groups. Multiple regression analysis revealed that nitrite/nitrate levels were positively correlated with the homeostasis model assessment of IR (HOMA-IR) independent of body mass index, age, gender, serum lipids, and pubertal stages, and that glutathione peroxidase levels were negatively correlated with body mass index and HOMA-IR independent of age, gender, pubertal status, and serum lipids., Conclusion: This study demonstrates that oxidative stress exists even in populations of obese children, and that oxidative stress markers have a relation with the HOMA-IR, which was used as a surrogate marker of IR.

Aim: The age-related values of penile length must be known to determine abnormal penis sizes and to follow the treatment of underlying diseases. The aim of this study is to evaluate abnormal penile length in Turkish children by establishing novel reference values for Turkish population and to compare the mean penile length and other parameters with alternates from different ethnic populations and geography., Methods: This cross-sectional study was conducted on a voluntary basis between November 2008 and November 2009 from four centres in Turkey and comprised of 1278 healthy volunteered prepubertal children. Complete stretched penile length and penis circumference measurements were used for penile length and penis circumference evaluations, respectively. All measurements were taken twice by only one investigator, and mean values were recorded., Results: Penile length and penis circumference for every age group were obtained, percentile curves were established and these findings were compared with the results of previous studies. Significant differences were found between penile length of Turkish children and recently used reference values., Conclusion: With this study, novel reference values for penile length in prepubertal children were presented to the literature., (© 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.)

Objective: The autonomic nervous system is assumed to have a role in the pathophysiology of obesity. In this study, we evaluated the autonomic system by measuring heart rate variability (HRV) in obese children., Methods: Thirty-two obese and 30 healthy children (mean ages: 11.6±2.0 years and 11.0±2.9 years, respectively) were enrolled in the study. Obesity was defined as a body mass index higher than 97th percentile for age- and gender-specific reference values. All participants were free of any disease and none of them was receiving any medication. Twenty-four-hour ambulatory electrocardiographic recordings were obtained and the time-domain and frequency-domain indices of HRV were analyzed. The study group was evaluated with respect to insulin resistance by HOMA-IR values., Results: A significant decrease in calculated HRV variables was observed in obese children as compared to controls. The HRV alteration was found in both time-domain and frequency-domain parameters. The subgroup analysis of the study group revealed a significant decrease in all investigated HRV parameters in the insulin-resistant obese children compared to the non-insulin-resistant obese ones., Conclusions: Our results indicate that HRV is decreased in obese children, which implies parasympathetic withdrawal and sympathetic predominance. A marked decrease in HRV was observed in insulin-resistant obese children compared to their non-insulin-resistant counterparts. We propose that autonomic imbalance pertaining especially to insulin resistance may be involved in the pathogenesis of obesity in pediatric patients., (©Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.)

The most devastating complication of familial Mediterranean fever (FMF) is amyloidosis which is capable of resulting in chronic renal failure. Although amyloid deposits are frequent in adrenal glands based on the autopsies of FMF patients however; to our knowledge, symptomatic adrenal insufficiency has not been reported yet. We describe a 21-year-old-FMF amyloidosis case with a well-functioning allograft who presented to the emergency clinic with the complaints of abdominal pain, vomiting and diarrhea mimicking FMF attack. adrenocorticotrophic hormone stimulation test was performed due to resistant hyponatremia and disclosed Addison disease. In countries with a high prevalence of FMF, adrenal crisis should be borne in mind in long standing FMF patients.

Background/aims: Plant growth regulators are considered to leave minimal amounts of remnants and therefore cause no significant side effects in humans. In this study, we aimed to investigate the hormonal and histopathological effects of 4-chlorophenoxy acetic acid (4-CPA), a commonly used plant growth regulator, on the gonadal functions of rats., Methods: The study was implemented on 64 Wistar albino rats (20 days old). Forty-eight rats received 4-CPA every day until 50 days of age. The rats were randomized into 4 groups (a control group and three 4-CPA groups with doses of 25, 50 and 100 mg/kg/day); each group was further divided into males and females, making a total of 8 groups. The levels of FSH, LH, testosterone, estradiol, leptin, inhibin-B and neuropeptide-Y were measured. Histopathological examination of the testes and ductus deferens in male rats, and ovaries and uterus of female rats (caspase-3 and -9 immunoreactivity) was performed., Results: Although hormone levels were similar between the groups, rats that received 4-CPA showed significantly higher degrees of apoptosis compared to the control group (p < 0.001) and increased doses of 4-CPA were directly correlated with the amount of apoptosis (p < 0.001)., Conclusion: 4-CPA induced apoptosis in the gonads of rats without concurrent changes in plasma hormone levels.

Two common forms of autoimmune thyroid diseases are Graves' disease and Hashimoto's thyroiditis. Cytotoxic T lymphocyte antigen 4 (CTLA4) encoded by the CTLA4 gene on chromosome 2q33 plays a role in susceptibility to Graves' disease and is probably important also for Hashimoto's thyroiditis as well as for the other endocrine autoimmune disorders. The CTLA4 locus is the only nonhuman leukocyte antigen locus that has been found in association with Graves' disease repeatedly. Particularly, association of three polymorphic markers of CTLA4 gene, namely, C(-318)T, A49G, and (AT)n dinucleotide repeat, with Graves' disease was demonstrated in most of the population-based investigations. On the other hand, there are few studies to reveal the association of these markers with Hashimoto's thyroiditis. A49G polymorphism was proposed to be associated with Hashimoto's thyroiditis, and C(-318)T was suggested to be not associated. The patient groups consisted of 88 patients (10 males and 78 females; mean age: 14.5 +/- 3.2 years [4.6-21.0 years]) with a previous diagnosis of Hashimoto's thyroiditis and 112 euthyroid volunteers (51 males and 61 females; mean age: 14.1 +/- 2.9 years [5.2-18 years]). The frequency of A/G (A49G) genotype was high and statistically significant in patients with Hashimoto's thyroiditis in comparison with the control group. Although the frequency of C/T [C(-318)T] genotype is not significantly high in children with Hashimoto's thyroiditis according to the control group, the risk of Hashimoto's thyroiditis in A/G genotype group was 4.66 times greater than the group with A/A genotype. In this study, we documented that the A49G polymorphism might increase the susceptibility for Hashimoto's thyroiditis.

Background: The frequency doubling technology perimetry predominantly tests the magnocellular visual pathway (M-cells) whereas the achromatic standard automated perimetry examines magno- and parvocellular ganglion cells. The aim of this study was to investigate whether patients with migraine without aura are conspicuous in these perimeters., Materials and Methods: Thirty-two patients with migraine without aura (f:m = 2:30, mean age 40.4 +/- 11.34 years) were compared with nineteen controls (f:m = 1:18, mean age 40.15 +/- 12.5 years). Subjects with systemic health problems or ocular diseases were excluded from the study. Beside the ophthalmological examinations (visual acuity, refraction, intraocular pressure, slit lamp and fundus examination) quantitative analysis of visual field by Octopus 1 - 2 - 3 perimeter and Humphrey frequency doubling technology perimeter (FDT) were performed. Different parameters (mean deviation [MD] and pattern standard deviation [PSD]) were statistically compared using non-parametric tests., Results: The clinical ophthalmological examinations were inconspicuous in all migraine sufferers and controls. Statistical analysis showed no significant difference of MD and PSD between the patients with migraine and controls in the frequency doubling perimetry. However, there was a significant difference of MD using the achromatic standard perimetry in migraine sufferers in comparison to the controls (migraine - right eye MD 0.4 +/- 1.33 dB, migraine - left eye MD 0.2 +/- 1.47 dB, controls-right eye MD -1.4 +/- 0.76, controls - left eye -1.4 +/- 0.84; Mann-Whitney U test: p < 0.001 with Bonferoni-Holms-correction)., Conclusion: In migraine sufferers without aura we found a reduction of contrast sensitivity in the achromatic standard perimetry but not in the frequency doubling technology perimetry. This can be indicative of a stronger involvement of the parvocellular pathway in migraine without aura patients. These results should be take into consideration in further perimetric examinations.

A 5-year-old child with precocious puberty and complete masculinization of the genitalia was diagnosed to have 21-hydroxylase deficiency. The patient was also found to have a prostate gland and increased prostate-specific antigen. The presence of a prostate and its relation to prostate-specific antigen and prostate adenocarcinoma are discussed in the light of the relevant literature.