Effects of glucagon as a neurohormone on the central nervous system and glucose homeostasis

OBJECTIVE

This study aimed to elucidate the possible effects of the acute/long-term infusion of glucagon in the brain as the regulatory role on the endocrine secretions of the pancreas.

MATERIALS AND METHODS

Ninety male Wistar albino rats were divided as Control, artificial Cerebrospinal Fluid (aCSF) (120 min), Glucagon (120 min), pancreatic denervation (PD)+aCSF (120 min), PD+Glucagon (120 min), aCSF (7 days), Glucagon (7 days), PD+aCSF (7 days) and PD+Glucagon (7 days). Glucagon and solvent (aCSF) were administered after pancreatic denervation (PD) by Hamilton syringe and osmotic mini pump (1 µg/10 µl/min) in the third ventricle of the brain.

RESULTS

Acute intracerebroventricular (icv) administration of glucagon resulted in an elevation of glucagon levels and a concurrent reduction in blood glucose levels. Furthermore, in both the PD+aCSF (7 days) and PD+Glucagon (7 days) groups, there was a notable decrease in propiomelanocortin (POMC) and agouti-related protein (AgRP). Significant changes were observed in feed consumption and body weight, as well as pancreatic glucagon levels, with a simultaneous decrease in insulin levels in the PD (7 days), Glucagon (7 days), and PD+Glucagon (7 days) groups. These alterations were statistically significant when compared to the control group (p<0.05).

CONCLUSIONS

The research outcomes established that pancreas-secreted glucagon functions as a neurohormone within the brain, activating central pathways linked to blood glucose regulation. The presence of glucagon led to a decrease in POMC levels. Surprisingly, this reduction in POMC resulted in the suppression of AgRP. Contrary to expectations, the suppression of AgRP led to an increase in food intake rather than a decrease. As already highlighted in the results section, it was emphasized that POMC may play a more significant role than AgRP in influencing feeding behavior.

EVALUATION OF THE ASSOCIATION OF PLASMA PENTRAXIN-3 LEVELS WITH CAROTID INTIMA-MEDIA THICKNESS AND HIGH-SENSITIVE CRP IN PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM

Context

Inflammation-related markers may predict cardiovascular diseases.

Objective

In this study, it was aimed to assess pentraxin-3 (PTX-3) levels and its relationship with carotid intima-media thickness (CIMT) and high-sensitive C-reactive protein (hsCRP) in patients with subclinical hypothyroidism.

Design

Prospective cross-sectional study.

Methods

This study included 60 patients (aged 30-60 years) with subclinical hypothyroidism and 30 healthy volunteers as controls. The demographic characteristics and anthropometric measurements were performed in all patients and controls. In addition, sonographic carotid artery examination, thyroid functional tests, lipid profile, hsCRP, and PTX-3 levels of the participants were investigated.

Results

The PTX-3, hsCRP levels and CIMT were higher in patients with subclinical hypothyroidism when compared to controls (p=0.008, p=0.001, p<0.001, respectively). The PTX-3 level was strongly correlated with hsCRP (r=0.865; p<0.001), but no such correlation was detected with CIMT (r=-0.255; p=0.50). In binominal logistic regression analysis, it was found that CIMT and serum uric acid levels were independent parameters associated with subclinical hypothyroidism. In ROC analysis, a cut-off value of >3.75 ng/mL for serum PTX-3 level predicted subclinical hypothyroidism with a sensitivity of 60% and specificity of 60.7% (AUC: 0.672, p=0.004).

Conclusion

Showing inflammation and endothelial dysfunction, the PTX-3 may be a helpful marker in patients with subclinical hypothyroidism associated with increased risk for cardiovascular disease.

Maternal and perinatal outcomes of COVID-19 vaccination during pregnancy

Objective

To investigate maternal adverse effects and perinatal and neonatal outcomes of women receiving coronavirus disease-2019 (COVID-19) vaccination during pregnancy.

Material and Methods

Seven hundred and sixty pregnant women who were followed up in obstetrics outpatients were included in this prospective cohort study. COVID-19 vaccination and infection histories of the patients were recorded. Demographic data, including age, parity, and presence of systemic disease and adverse events following COVID-19 vaccination were recorded. Vaccinated pregnant women were compared with unvaccinated women in terms of adverse perinatal and neonatal outcomes.

Results

Among the 760 pregnant women who met study criteria, the data of 425 pregnant women were analyzed. Among these, 55 (13%) were unvaccinated, 134 (31%) were vaccinated before pregnancy, and 236 (56%) pregnant women were vaccinated during pregnancy. Of those who were vaccinated, 307 patients (83%) received BioNTech, 52 patients (14%) received CoronaVac, and 11 patients (3%) received both CoronaVac and BioNTech. The local and systemic adverse effect profiles of patients who received COVID-19 vaccination either before or during pregnancy were similar (p=0.159), and the most common adverse effect was injection site pain. COVID-19 vaccination during pregnancy did not increase the ratio of abortion (<14 wk), stillbirth (>24 wk), preeclampsia, gestational diabetes mellitus, fetal growth restriction, second-trimester soft marker incidence, time of delivery, birth weight, preterm birth (<37 wk) or admission to the neonatal intensive care unit compared to the women who were not vaccinated during pregnacy.

Conclusion

COVID-19 vaccination during pregnancy did not increase maternal local and systemic adverse effects or poor perinatal and neonatal outcomes. Therefore, regarding the increased risk of morbidity and mortality related to COVID-19 in pregnant women, the authors propose that COVID-19 vaccination should be offered to all pregnant women.

Antenatal Hyperechogenic Colon and Cystinuria

A male newborn was investigated for history of antenatal hyperechogenic colon (HEC) detected at 32 weeks of gestation. In the first week of life, urinary ultrasonography showed nephrolithiasis. Urinary amino acid analysis expressed increased excretion of dibasic amino acids, and high urinary cystine levels were detected in both spot and 24-hour urine specimens. He was diagnosed as cystinuria, and genetic analysis of the patient revealed a heterozygous mutation in SLC7A9 gene. Antenatal presentation of cystinuria with HEC is rare and reported to be associated with a more severe disease course.

Long-term outcomes of fetal posterior fossa abnormalities diagnosed with fetal magnetic resonance imaging

Objective

The diagnosis of posterior fossa abnormalities (PFA) in the intrauterine period and association with pregnancy outcomes are still controversial. PFA is generally referred to maternal-fetal medicine specialists. The primary purpose of PFA diagnosis is to screen for other accompanying abnormalities, provide prognostic information to families, and discuss the termination option.

Material and Methods

This retrospective study was conducted in patients diagnosed with PFA between January 2013 and September 2020 in a tertiary perinatology clinic. All patients underwent routine second-trimester ultrasound screening and definitive diagnosis was made by fetal magnetic resonance imaging (MRI) in the presence of a suspected anomaly.

Results

There were 164 fetal MRIs for fetal abnormalities during the study period and 22 (13.4%) were diagnosed with a PFA on fetal MRI. Indications for fetal MRI included four (18%) with Mega Cisterna Magna, two (9.1%) with rhomboencephalosynapsis, and thirteen (59.1%) with Vermian Hypoplasia-Dandy-Walker variant. Two patients, with neural tube defects and lumbosacral neural-tube defect are still alive. However, iniencephaly was detected in last patient who died in the postnatal period.

Conclusion

Diagnosis of PFA abnormalities is complex, and the prognosis in PFA is often unclear. The prognosis is not affected by maternal and fetal factors and allows the recognition of additional accompanying abnormalities. Fetal MRI is an imaging method that can provide retrospective examination and research, especially in pregnancies with poor prognoses.

Comparison of Oocyte and Embryo Quality Between Random Start and Controlled Ovarian Stimulation Cycles in Cancer Patients Undergoing Fertility Preservation

Conventional assisted reproductive technology (ART) cycles may delay cancer treatment and compromise survival, and also increase patients' psychological burden as a result of delayed chemotherapy. The aim of this study was to compare the success rates of random start and conventional start GnRH antagonist protocols in terms of oocyte and embryo outputs in cancer patients. Data of 111 patients with a newly diagnosed cancer who underwent ART for fertility preservation at a university-based infertility clinic between January 2010 and September 2019 were reviewed. The study group underwent random start controlled ovarian hyperstimulation (RS-COH) and the control group underwent conventional start COH (CS-COH). The main outcome measures were the number of total oocytes, MII oocytes, and embryo yield. A total of 46 patients (41.5%) underwent RS-COH and 65 (58.5%) underwent CS-COH. Baseline characteristics were similar between the groups. The most common cancer type in both groups was breast cancer (60.9% vs. 52.3%, respectively). The median duration of stimulation was significantly longer in RS-COH than in CS-COH (12 vs. 10 days; P = 0.005). The median number of MII oocytes was significantly higher in RS-COH than in CS-COH (7 vs. 5 oocytes, respectively; P = 0.020). The MII/AFC ratio was significantly higher in the RS-COH group compared to the CS-COH group (74% and 57% respectively; p = 0.02). In the linear regression analyses, RS-COH protocol did not have a significant impact on MII/AFC (standardized ß coefficient - 0.514; P = 0.289 {adjusted R² for the model = 0.779}), oocyte yield (standardized ß coefficient - 0.070; P = 0.829 {adjusted R² for the model = 0.840}), and MII rate (standardized ß coefficient - 0.504; P = 0.596 {adjusted R² for the model = 0.271}). In conclusion, RS-COH protocol is as effective as CS-COH protocols for fertility preservation in cancer patients.

Evaluation of trabecular bone microstructure of mandibular condyle in edentulous, unilateral edentulous and fully dentate patients using cone-beam computed tomography

BACKGROUND

The aim of this study was to compare the trabecular bone microstructure of the mandibular condyle in edentulous, unilateral edentulous (Kennedy Class II), and fully dentate patients.

MATERIALS AND METHODS

The study used the cone-beam computed tomography (CBCT) images of 17 fully dentate (34 condyles), 16 edentulous (32 condyles), and 17 unilateral edentulous patients (34 condyles) aged 19 to 80 years. The trabecular bone microstructure of the mandibular condyle was evaluated on 8 consecutive cross-sectional images of these patients. In the microstructure analysis, structural model index (SMI), ellipsoid factor (EF), bone volume fraction (BV/TV), trabecular thickness (Tb.Th) and trabecular seperation (Tb.Sp) were measured.

RESULTS

There was no significant difference between the mean SMI, BV/TV, EF and Tb.Th microstructure values of each group (p = 0.243, p = 0.095, p = 0.962, p = 0.095, respectively). However, there was significant difference in terms of mean Tb.Sp between the groups (p = 0.021). The trabecular structure in all three groups was more rod-shaped. No correlation was found between age factor and microstructure values.

CONCLUSIONS

Considering the in vivo microstructure analysis of CBCT images, it can be said that teeth loss does not have a significant effect on the microstructure parameters excluding Tb.Sp of mandible condyles and does not affect mandibular condyle trabecular endurance.

Neural and cardiac injury markers in fetal growth restriction and their relation to perinatal outcomes

Objective:

To compare the levels of umbilical cord blood Neuron-Specific Enolase (NSE) and troponin T and venous blood gas samples between healthy newborns and growth-retarded fetuses with impaired Doppler velocity or low APGAR scores.

Materials and Methods:

This study was a prospective cohort study. The study group comprised 26 patients with intrauterine growth restriction and pathologic Doppler symptoms, and the control group included 24 healthy fetuses. Umbilical cord blood and blood gas samples were taken from all patients. The blood samples were centrifuged and sent to a laboratory to study NSE and troponin T Perinatal outcomes were evaluated from the medical records of the newborns.

Results:

Both groups were similar in terms of demographic characteristics. Fetuses with fetal growth restriction (FGR) were born earlier and had lower APGAR scores than the study group. Chronic hypoxemic fetuses in the study group had lower cord pH and HCO₃ levels. Further, troponin T levels were higher in the study group than in the control group. There were no major differences in Doppler velocity measurements.

Conclusion:

It has been understood that cardiac and neuronal injury detection on fetuses with FGR, troponin T, and NSE are indicators that can be used. In the literature there are studies with heterogeneous paradigms using different indicators to find neuronal injury. As a result of this study, it is clear that to assess neonatal prognosis, wider-scoped and comparative studies will provide more information about the subject.

Efficacy of second-trimester termination procedure; medical, mechanic, or combine?

Objectives

During mid-trimester, it is necessary to terminate pregnancy due to some fetal anomalies and intrauterine death. Therefore, in this study, we aimed to compare abortion induction methods and combined use retrospectively.

Methods

About 112 out of 223 pregnant patients were included in the study. The groups were determined as follows: Group 1 including pregnant patients who were administered misoprostol only (50 patients), Group 2 including pregnant patients who were administered single dose misoprostol (according to FIGO) and subsequently received cervical Foley catheter (30 patients), and Group 3 including pregnant patients who received Foley catheter only (32 patients). These three groups were compared in terms of effectiveness of the method, side effects, and complications as well as their characteristics.

Results

In terms of characteristic of the groups, the average age of the women in the Group 1 was significantly higher than other two groups (p < 0.001). In terms of effectiveness of the method, the termination period in Groups 1 and 2 was significantly lower than Group 3 (p < 0.001). However, in terms of complications, it was observed that uterine rupture was developed in Group 1.

Conclusions

Although medical methods may seem to be more effective in the process of termination, mechanical methods seem more reliable in terms of reliability. Especially combined methods can be used to increase effectiveness and also to reduce complications.

Extraction and physicochemical characterization of broiler (Gallus gallus domesticus) skin gelatin compared to commercial bovine gelatin

Gelatin was extracted from broiler (Gallus gallus domesticus) skins and analyzed to compare its physicochemical properties with those of commercial bovine gelatin. The average yield of broiler skin gelatin was 6.5% on a wet weight basis. Broiler skin gelatin had more α1-and α2-chains than β-chain and contained high molecular weight (γ-chain) polymers. Glycine was the dominant amino acid in broiler skin gelatin (20.26%), followed by proline (Pro) (15.12%) then hydroxyproline (Hyp) (11.36%). Compared to commercial bovine gelatin, broiler skin gelatin had less total imino acids (Pro and Hyp) but a higher (33.65 vs. 31.38°C) melting temperature (P < 0.01). The differences in physical properties between the broiler and commercial bovine gelatins appeared to be associated with differences in their amino acid composition and molecular weight distribution. The sensory evaluation results revealed that broiler skin gelatin could be a potential alternative to commercial bovine gelatin, useful in various food products.

The views of nulliparous pregnant women on the types of delivery

OBJECTIVE

To evaluate the relevant thoughts of nulliparous pregnant women in the second trimester without an absolute indication for cesarean on delivery preferences.

MATERIALS AND METHODS

This study was conducted on pregnant women who presented to the Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology Pregnant Outpatients Department for antenatal follow-up between May 2014 and February 2015. A total of 237 nulliparous patients voluntarily completed the survey form and the data were evaluated using various parameters. Parameters consistent with normal distribution were evaluated using the t-test, and parameters that were not normally distributed were evaluated using the Mann-Whitney U test. Parameters with a p value <0.05 were considered significant.

RESULTS

We found that 221 (93.2%) of the 237 nulliparous pregnant women preferred vaginal delivery and the remaining 16 (6.8%) preferred delivery by cesarean section.

CONCLUSION

Women should be informed on the type of birth and both methods should be explained in a realistic and scientific manner in terms of benefit and risk. An effort is being made to increase vaginal birth rates worldwide and the same effort should be made in Turkey.

Is omitting the 3rd hour measurement in the 100 g oral glucose tolerance test feasible?

BACKGROUND

To evaluate the diagnostic value of the 3rd hour plasma glucose level in the 100 g oral glucose tolerance test (OGTT).

METHODS

Records of all pregnant patients with abnormal 50 g glucose challenge test (GCT) between January 2005 and December 2013 were reviewed (n=1963). The 100 g OGTT results were analyzed separately for both Carpenter & Couston (CC) and National Diabetes Data Group (NDDG) criteria.

RESULTS

The number of patients diagnosed with gestational diabetes mellitus (GDM) was 297 (15.1%) according to CC criteria and 166 (8.4%) according to NDDG criteria. The 1st hour plasma glucose level showed the highest correlation with GDM diagnosis (ρ=0.595 for CC and ρ=0.567 for NDDG). However, the 3rd hour plasma glucose level showed the weakest correlation with GDM diagnosis (ρ=0.216 for CC and ρ=0.213 for NDDG). The 3rd hour value of 100 g OGTT was one of the two elevated measurements in 10.8% of patients when CC criteria are used and in 13.8% of patients when NDDG criteria are used.

CONCLUSION

Omitting 3rd hour plasma glucose measurement in 100 g OGTT results in unacceptable rates of underdiagnosed patients.

Non-invasive prenatal testing for sex chromosome abnormalities: a source of confusion

Cell-free fetal DNA has received significant attention for the purposes of prenatal genetic testing in the past decade. Fetal DNA testing is a new method and promising for many applications such as aneuploidy screening, prenatal diagnosis, prediction of preeclampsia and more. A 37-year-old primigravida, with a pregnancy conceived by intracytoplasmic sperm injection (ICSI), was offered non-invasive prenatal testing (NIPT) due to advanced maternal age. NIPT performed at 23 weeks' gestation reported a diagnosis of monosomy X. She was offered an amniocentesis, which revealed a euploid fetus with no sex chromosome abnormalities. Even with single nucleotide polymorphism-based NIPT, positive predictive value for detection of sex chromosome abnormalities is around 50%. Positive results of NIPT should be heeded with caution and an invasive diagnostic procedure should be performed, especially for rare chromosomal abnormalities and sex chromosome abnormalities where NIPT performs subpar compared to its performance for detection of trisomy 21.

Cell free fetal DNA in the plasma of pregnant women with preeclampsia

OBJECTIVE

Insufficient cytotrophoblast invasion to the myometrium is associated with preeclampsia, especially with the early-onset preeclampsia (before 34 gestational weeks). Several investigations have marked changes in the concentration of cell free fetal DNA in the maternal circulation of women with preeclampsia. However, these studies were not performed for early or late preeclampsia subgroups individually. The present authors planned to determine the levels of the cell free both fetal and maternal DNA in the maternal circulation in early preeclampsia subgroup and compare it with normotensive control cohort.

MATERIALS AND METHODS

A total of 16 women; eight of these with preeclampsia and eight normotensive control cohorts with singleton male pregnancy between 28 and 32 gestational weeks were included in the study. Real-time PCR analysis was performed for determining the circulating cell free DNA levels.

RESULTS

Cell free fetal DNA concentrations were higher in early preeclamptic women than control subjects. The authors found no statistically significant difference in each levels of maternal and total DNA between hypertensive and normotensive groups.

CONCLUSIONS

The present findings suggest that the levels of cell free fetal DNA in maternal circulation were higher in pregnancies which are complicated with early preeclampsia than normotensive controls.

The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion

OBJECTIVE

To assess the effects of ultrasonographically detected subchorionic hematomas on pregnancy outcomes in patients with vaginal bleeding within the first half of pregnancy.

MATERIAL AND METHODS

Patients diagnosed with threatened abortion due to painless vaginal bleeding and who were followed up in an in-patient service during the first vaginal bleeding between January 2009 and December 2010 were included in this retrospective cohort study. Patients were divided into two groups according to the presence of subchorionic hematoma. Miscarriage rates and pregnancy outcomes of ongoing pregnancies were compared between the groups.

RESULTS

There were no statistically significant differences between the groups regarding demographic parameters, including age, parity, previous miscarriage history, and gestational age at first vaginal bleeding. While 13 of 44 pregnancies (29.5%) with subchorionic hematoma resulted in miscarriage, 25 of 198 pregnancies (12.6%) without subchorionic hematoma resulted in miscarriage (p=.010). The gestational age at miscarriage and the duration between first vaginal bleeding and miscarriage were similar between the groups. The outcome measures of ongoing pregnancies, such as gestational week at delivery, birth weight, and delivery route, were also similar between the groups.

CONCLUSION

Ultrasonographically detected subchorionic hematoma increases the risk of miscarriage in patients with vaginal bleeding and threatened abortion during the first 20 weeks of gestation. However, it does not affect the pregnancy outcome measures of ongoing pregnancies.

A case of dup(3q) syndrome

Duplication of 3q is an extremely rare disorder characterized by "intellectual disability, deficiency of growth, broad nasal root and hypertrichosis". Although it is generally accepted that the duplication of the 3q25-qter region corresponds with a characteristic face, there is a debate about the critical region. In this report, we present a case with dup(3q) syndrome with 46,XY,der(7)ins(7;3)(p13; q22.1q26.31) karyotype and discuss the clinical findings.

Closure vs non-closure of peritoneum at caesarean section: evaluation of pain

We evaluated the effect of closure or non-closure of parietal and visceral peritoneum during caesarean section (CS) on post-caesarean pain and analgesic requirement. A total of 94 primigravidas planned for elective CS were prospectively enrolled into closure (n = 46) and non-closure (n = 48) groups. Analgesia was provided by a patient-controlled analgesia pump (PCA) postoperatively. Pain was evaluated using a visual analogue scale (VAS) and verbal rating scale (VRS). Total dose of analgesics administered through PCA and times of analgesia demand and additional analgesics were also assessed. VAS and VRS scores were similar between the groups. The total dose of analgesics administered were similar (p = 0.095) between groups, however the mean number of analgesic demand (p = 0.020) and the additional analgesics (p < 0.001) were higher in the closure group. As a conclusion, the closure or non-closure of the peritoneum does not have any impact on postoperative pain intensity, however the analgesia demand and additional analgesia requirement decreases with non-closure.

New phenotype with generalized platyspondyly, large mandible, hypoplastic teeth, strabismus, hyperopia and low cholesterol levels

A sporadic, adult male patient with generalized platyspondyly, large mandible, hypoplastic teeth, strabismus, and low serum cholesterol levels is presented. Some of the patient's features resemble brachyolmia, Spondylo-epiphyseal dysplasia tarda, Kenny-Caffey and Stickler syndromes. Based on literature review, possible diagnoses are discussed. In conclusion, this patient can have a variant of brachyolmia or Spondylo-epiphyseal dysplasia tarda. However, we cannot exclude that this constellation of clinical features may represent a new syndrome.

Some factors influencing milk somatic cell count of Holstein Friesian and Brown Swiss cows under the Mediterranean climatic conditions

Abstract. The aim of this study was to determine the influencing factors on somatic cell count (SCC) in the milk of Holstein Friesian (HF) and Brown Swiss (BS) cows raised on three dairy farms under the Mediterranean climatic conditions in Turkey. For a two-year period, farms were visited monthly to measure daily milk yield (DMY) and collect milk samples from each cow during the morning and evening milking. Total of 1 429 SCC readings from 67 HF and 16 BS cows were analyzed by using repeated measures. Breed (P<0.01), lactation number (LN) (P<0.01), milking time (MT) (P<0.05), lactation month (LM) (P<0.01) and the interactions of breed-LM (P<0.05), herd-LM (P<0.01) and LN-LM (P<0.01) effects on SCC were statistically significant as did the co-variable DMY effect (P<0.01). The effect of herd and herd-MT interactions on SCC were statistically insignificant (P>0.05). The SCC means for BS and HF cows were 5.464±0.060 (291 072 cells/ml) and 5.654±0.029 (450 817 cells/ml), respectively. The SCC mean for morning milking (338 065 cells/ml) was 25 850 cells/ml lower than that of evening milking. The LN4 had the highest SCC mean (490 908 cells/ml) and was statistically different from those of LN1 (P<0.01) and LN2 (P<0.05). The SCC level was the highest in the first LM (601 174 cells/ml) and this level then decreased in the later months. Possible reasons for the difference in SCC means between the breeds are different resistance mechanisms against mastitis, different morphological conformations of udders and different milk yields between these two breeds. The insignificant differences found among herds show the similarities of management, milking hygiene and barn conditions. In order to decrease SCC in milk and increase udder health, some precautions need to be taken like improving milking management, hygiene and barn conditions, milking the cow at uniform intervals, feeding the cows after the milking and applying a mastitis control program.

A case with bilateral radio-ulnar synostosis

Congenital radio-ulnar synostosis may be an isolated abnormality or additional abnormalities may accompany it. It may also be found as a part of well-known syndromes. We present a case with bilateral congenital radio-ulnar synostosis, speech delay, dimple on shoulders, café au lait spot and characteristic facial appearance. The proband has a brother with similar clinical findings with the exception of congenital radio-ulnar synostosis. We discuss the possible relationship between our case and previously described syndromes with congenital radio-ulnar synostosis, and distinct phenotypic features of the presented case.

A boy with small supernumerary marker chromosome X identified by FISH

Marker or ring X chromosomes are frequently seen in Ullrich-Turner Syndrome with 46,X,r(X) karyotype, but only 8 children were reported with an extra marker X chromosome in at least some of their cell lines, we describe a 5 years old male patient who is mosaic (17%) for a cell line with an extra ring shaped marker X chromosome in addition to a normal 46,XY cell line. He had mild motor mental retardation, a dysmorphic face, dysplastic ears, high arched palate, cryptorchidism and brachydactyly. G-banding showed 46,XY[83]/47,XY,+r?[17] karyotype. NOR banding revealed no satellite region but its centromere was intact in C-banding. By fluorescent in situ hybridization (FISH) technique, dual X/Y alpha-satellite probes were used to detect the origin of ring shaped marker chromosome and 17% of his cells had two X chromosome signals due to marker X; hybridization with X chromosome inactivation center (XIST) specific probe revealed the absence of the locus on the ring chromosome. In this report, clinical features of our patient are compared with previously reported cases and the cytogenetic and molecular cytogenetic techniques used to detect origin of marker chromosome are discussed.

Effect of atorvastatin on ocular blood flow velocities in patients with diabetic retinopathy

AIM

To investigate blood flow velocities in the ophthalmic and central retinal arteries (CRAs) in patients with diabetic retinopathy before and after atorvastatin treatment.

METHODS

45 patients with type 2 diabetes were included in this double-blind, placebo-controlled study. The patients with diabetes were divided into three subgroups: group 1 (n = 15) included patients with non-proliferative diabetic retinopathy (NPDR); group 2 (n = 15) had patients with proliferative diabetic retinopathy (PDR); and group 3 (n = 15; placebo group) included 8 patients with NPDR and 7 patients with PDR. The patients in groups 1 and 2 (atorvastatin group) received 10 mg atorvastatin daily for 10 weeks. Pre-treatment and post-treatment serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride were recorded before and after treatment. Ocular blood flow velocities of the ophthalmic artery and CRA were evaluated by colour Doppler imaging before and after treatment in each group.

RESULTS

The baseline haemodynamic parameters were similar between atorvastatin and placebo groups (p>0.05 for both). Atorvastatin significantly decreased serum levels of total cholesterol, low-density lipoprotein cholesterol and triglycerides in groups 1 and 2 compared with pretreatment levels (p<0.001 for both). The mean peak systolic flow velocities (PSVs) of the ophthalmic artery in group 2, and the mean PSV and resistive indices of the CRA in groups 1 and 2 decreased significantly after atorvastatin treatment (p<0.05 for both), whereas the mean end diastolic flow velocity of the ophthalmic artery and CRA did not change (p>0.05). There was no significant difference in ocular blood flow velocities in the placebo group (p>0.05).

CONCLUSION

Atorvastatin may have a role in reducing diabetic retinal complications, with improvement in vascular resistance and decrease in the mean PSVs of the ophthalmic artery and CRA. However, further studies with large numbers of patients are needed to obtain the long-term results of this drug.

A new case of hairy elbows syndrome (hypertrichosis cubiti)

Hairy Elbows Syndrome (Hypertrichosis Cubiti; OMIM# 139600) is a rare syndrome, and characterized by the presence of long vellus hair localized on the extensor surfaces of the distal third of the arms and proximal third of the forearm bilaterally. Occasionally hypertrichosis of other body regions may accompany hairy elbows. About half of the reported patients have short stature. Aside from short stature other relatively rare abnormalities related with this syndrome were also described. Most of the reported cases were sporadic, but autosomal dominant as well as autosomal recessive inheritance patterns have also been postulated. In this report, we present a girl with Hairy Elbows syndrome who has both characteristic and uncommon findings of the syndrome. She has excessive hair on her elbows, along with short stature, microcephaly, joint hyperlaxity, thin-long-webbed neck, dysmorphic facial features and mental retardation.

Acardiac acephalic twin gestation with transposition of great arteries in pump twin

We report here a case of twin reversed arterial perfusion sequence with transposition of great arteries in the pump twin. Color Doppler and fetal echocardiographic examination revealed an acardiac, anencephalic twin without upper limbs and a pump twin with transposition of great arteries. To our knowledge despite multiple anomalies reported in the acardiac twin, major anomalies, especially of a cardiac type are extremely rare and not reported in the pump twin, which maintains circulation. Management is directed at saving the pump fetus; therefore, we believe that during sonographic exam, emphasis should be placed on associated organ anomalies or complications that may hamper viability of the pump.

Benefit of high-dose methylprednisolone in comparison with conventional-dose prednisolone during remission induction therapy in childhood acute lymphoblastic leukemia for long-term follow-up

Eight-year event-free survival (EFS) was evaluated in 205 patients with acute lymphoblastic leukemia (ALL), to consider the efficacy of high-dose methylprednisolone (HDMP) given during remission induction chemotherapy between 1 and 29 days. The St Jude Total XI Study protocol was used after some minor modifications in this trial. Patients were randomized into two groups. Group A (n = 108) received conventional dose (60 mg/m(2)/day orally) prednisolone and group B (n = 97) received HDMP (Prednol-L, 900-600 mg/m(2) orally) during remission induction chemotherapy. Complete remission was obtained in 95% of the 205 patients who were followed-up for 11 years; median follow-up was 72 months (range 60-129) and 8-year EFS rate was 60% overall (53% in group A, 66% in group B). The EFS rate of group B was significantly higher than of group A (P = 0.05). The 8-year EFS rate of groups A and B in the high-risk groups was 39% vs 63% (P = 0.002). When we compared 8-year EFS rate in groups A and B in the high-risk subgroup for both ages together </=2 or >/=10 years, it was 44% vs 74%, respectively. Among patients in the high-risk subgroup with a WBC count >/=50 x 10(9)/l, the 8-year EFS was 38% in group A vs58% in group B. During the 11-year follow-up period, a total of 64 relapses occurred in 205 patients. In group A relapses were higher (39%) than in group B (23%) (P = 0.05). These results suggest that HDMP during remission-induction chemotherapy improves the EFS rate significantly for high-risk patients in terms of the chances of cure.

Bernard-Soulier Syndrome Like Platelet Defect in a Patient with Noonan Syndrome; A Case Report

Noonan's Syndrome (NS) is characterized by dismorphic facial features, short stature, short or webbed neck, congenital heart defects and testicular abnormalities. Various bleeding disorders in Noonan Syndrome have been reported. Bernard-Soulier Syndrome (BSS) is a rare congenital bleeding disorder characterized by thrombocytopenia and giant platelets. There is not any reported case of Noonan syndrome associated with BSS in literature. We report here a four-year-old male patient with Noonan Syndrome and BSS like platelet defect.

Evaluation of children with myelodysplastic syndrome: importance of extramedullary disease as a presenting symptom

Thirty-three children diagnosed with primary myelodysplastic syndrome (MDS) in a single institution over an 8 year period were evaluated with special emphasis on children who presented with extramedullary disease (EMD). EMD was present at diagnosis in 12 (36%) of the 33 children with MDS. Three patients with juvenile myelomonocytic leukemia (JMML) and 2 patients with chronic myelomonocytic leukemia (CMML) presented with pleural effusion. Pericardial effusion was present in 3 of these patients, two of whom also had thrombosis. Pyoderma gangrenosum, relapsing polychondritis were the initial findings in another two cases with JMML. Lymphadenopathy (n=1), gingival hypertrophy (n=2), orbital granulocytic sarcoma (n=1) and spinal mass (n=1) were the presenting findings in 5 patients with refractory anemia with excess of blasts in transformation. Since high-dose methylprednisolone (HDMP, 20-30 mg/kg/day) has been shown to induce differentiation and apoptosis of myeloid leukemic cells in children with different morphological subtypes of acute myeloid leukemia in vivo and in vitro, 25 children with de novo MDS were treated with combined HDMP and cytotoxic chemotherapy. Dramatic improvement of EMD and decrease in blast cells both in the peripheral blood and bone marrow were obtained following administration of short-course HDMP treatment alone as observed in children with AML. HDMP, combined with low-dose cytosine arabinoside and mitoxantrone were used for the remission induction. Remission was achieved in 8 (80%) of 10 children who presented with EMD and in 9 (60%) of 15 children without EMD. Long-term remission (>6 years) was obtained in 4 (two with JMML and two with CMML), three of whom presented with EMD. In conclusion EMD can be a presenting finding in childhood MDS as observed in adults. In addition, the beneficial effect of HDMP combined with more intensive chemotherapy should be explored as alternative therapy in children with MDS not suitable for bone marrow transplantation.

Two booster dose hepatitis B virus vaccination in patients with leukemia

The aim of this study was to interpret the antibody response to hepatitis B (HB) vaccination following a two booster dose schedule in 94 acute lymphoblastic leukemia (ALL) patients. All patients were between 1-16 years of age with negative hepatitis B virus (HBV) serology and normal hepatic function. Fifty patients were vaccinated with Engerix B vaccine, and 44 patients were vaccinated with GenHevac B vaccine, with a schedule of 0, 1, 6 and 0, 1, 2, as well as booster doses, in 12 and 6 months respectively. A second booster was given as a fifth dose to 16 unresponsive patients in each vaccine group, 3 and 6 months after the first booster for Engerix B and GenHevac B vaccines respectively. Dosage was 20 microg HbsAg for all patients. Seroconversion rates with protective level antibody were 35.1% (n=33/94). The figures were 32.1% (n=16/50) and 38.6% (n=17/44) for Engerix B and GenHevac B vaccines, respectively. Seroconversion rate in patients younger than 10 years old was found to be higher (39.11%) than older patients (24%), but this was not statistically significant. This study indicates that one third of the leukemic children undergoing maintenence chemotherapy responded to HB vaccine with protective titers of anti-HBs. We recommend HB vaccination especially in developing countries.

Juvenile rheumatoid arthritis presented with thrombocytopenia

Leukopenia and thrombocytopenia are rare findings in systemic onset juvenile rheumatoid arthritis (S-JRA), and if present, bone marrow (BM) examination is necessary to exclude malignant diseases. We report here a 13.5-year-old boy with S-JRA who had severe thrombocytopenia and mild leukopenia, without arthritis, at the onset of the disease. BM was hypercellular with increased numbers of myeloid precursors and megakaryocytes. After treatment with acetylsalicylic acid, leukocyte and platelet counts returned to normal levels, and after two months chronic arthritis developed.

The frequency and etiology of anemia among children 6-16 years of age in the southeast region of Turkey

The frequency and etiology of anemia were investigated in 2,913 children between six and 16 years of age in Sanliurfa, in the southeast region of Turkey. Anemia was found in 142 (7.8%) children in the 6-11 years of age group, and in 16 (1.5%) in the 12-16 years of age group; in total, in 158 (5.4%) children. Causes were iron deficiency in 93 (58.9%) children, beta-thalassemia heterozygosity in 10 (6.3%) children, chronic disease that causes anemia of inflammation in 30 (19.0%) children, and intestinal parasitic infections in 17 (10.8%) children. In eight (5.1%) children, the cause of anemia could not be determined. The study's results showed that iron deficiency anemia and chronic and parasitic disease are important problems in schoolchildren of Sanliurfa, while beta-thalassemia and hemoglobinopathies have less importance.

A case of hemophilia A associated with Hodgkin's disease

Lymphoreticular malignancies are more common in patients with hemophilia, but it is usually attributed to human immunodeficiency virus (HIV) infection associated with repeated use of blood products. However, there are a couple of hemophiliac patients with malignancies but without HIV infection in the literature. We report a case of a hemophiliac patients who had Hodgkin's disease at 2.3 years old without any congenital or acquired immunodeficiency and without use of any blood products. This patient showed that malignancy can develop in hemophiliacs without HIV infection, but further studies are needed to clarify whether hemophiliacs are more susceptible to malignancies.

Myelodysplastic syndrome (MDS) associated with increased hemoglobin F and trisomy 8: presentation of a patient

A 7.5 year old boy with myelodysplastic syndrome (MDS) of CMML type associated with trisomy 8 and elevated hemoglobin F (Hb F) value is presented. Hematological evaluation of the patient revealed that the Hb was 10 g/dl, MCV 110 FL, platelets 58 X 10(9)/l, WBC 5.4 X 10(9)/l with 24% atypical monocytes. Karyotype analysis revealed 47, XY, +8. Hb F value was 21% which was distributed heterogeneously among red cells. PCR amplified cDNA copies of circulating reticulocyte mRNA were used to measure the relative amounts of alpha-, beta-, and gamma- globin. There was marked increases in both alpha/beta mRNA ratio (20%) and gamma/(gamma+beta) mRNA ratio (35%) in the patient compared to normal subjects. The study indicated that increased transcription of alpha and gamma genes are partly responsible for the elevation of Hb F in MDS.

Effects of topical otic preparations on hearing in chronic otitis media

Most of the topical otic preparations have been shown to cause ototoxicity. In this study ciprofloxacin hydrochloride, a relatively new topical agent, and gentamicin sulfate were studied in two groups of 20 patients with chronic otitis media. Patients were randomly selected to receive either ciprofloxacin (200 microg/ml) or gentamicin sulfate (5 mg/ml) locally, five drops three times a day for 10 days. Clinical response was seen in 20 of 20 patients in the ciprofloxacin group compared with 6 of 20 patients in the gentamicin group. Audiometric evaluation revealed no significant ototoxic effect in either group. In fact, hearing thresholds were slightly better than pretreatment levels in both groups.