Does Serum R-Spondin-1 Play a Role in PCOS Pathophysiology?

Objective: Many new inflammatory and metabolic markers are considered to be involved in etiology of Polycystic ovary syndrome (PCOS). R-spondin-1 (Rspo1) is a member of the roof plate-specific spondin protein family. Rspo1 levels have been associated with obesity and insulin resistance. We aimed to investigate whether Rspo1 has a role in the pathophysiology of PCOS. Materials and Methods: This cross-sectional study was planned with newly diagnosed and untreated PCOS cases and a control group without PCOS. Patients with PCOS and healty participants were compared for Rspo1 levels. In addition, the PCOS group was also grouped according to body mass index (BMI) and Ferriman Gallwey scores (FGS) and compared in terms of Rsop1 levels. Results: A total of 47 patients in the PCOS group and 36 participants in the control group, as total 83 participants were included in the study. PCOS and control groups had similar age and BMI. As compared to the control group, PCOS patients had significantly higher FGS, homeostasis model assessment of insulin resistance scores, Rspo1, and total testosterone levels (

Çocuklarda romatizmal mitral yetmezliğinin kantitatif değerlendirilmesinde proksimal izovelosite yüzey alanı

Romatizmal mitral yetmezliği (MY) olan çocuklarda proksimal izovelosite yüzey alanı (PISA) metodunun uygulanabilirliğini araştırmak. Metot: Yaş ortalaması 12.3±3.1 yıl olan kronik izole romatizmal MY'li 31 çocuk (14 erkek, 17 kız) yarı kantitatif, kantitatif Doppler, kantitatif iki boyutlu ekokardiyografı ve PISA yöntemi ile MY'nin ağırlık derecesi açısından değerlendirildi. Ayrıca hastalar grup I (bir ve ikinci derece MY) ve grup II (üçüncü ve dördüncü derece MY) olmak üzere ikiye ayrıldı ve gruplar regürjitan orifıs alanı (ROA), regürjitan volüm (RV), sistolik, diyastolik sol ventrikül fonksiyonları ve volüm yüklenmesini gösteren değişkenler açısından birbiri ile karşılaştırıldı. Sonuçlar: PISA ve kantitatif Doppler yöntemi ile elde edilen ROA ve RV sonuçları arasında istatistiksel anlamlı bir fark saptanmadı (t=0.421, p=0.677 ve t=0.720, p=0.477). Fakat her iki metodun ROA ve RV değerleri iki boyutlu ekokardiyografi ile elde edilen ROA ve RV sonuçlarından farklı bulundu (t=5.024, t=3.992, p=0.000). ROA, RV ve PISA yarıçapı arasında mükemmel bir bağlantı saptandı (r=0.882, r=0.925, r=0.880, p=0.000). ROA(pisa) ve sol ventrikül diyastol sonu çapı (r=0.763, p^O.OOO), sol atriyum volümü (r=0.751, p=0.000), jet alanı/sol atriyum alanı oranı (r=0.745, p=0.000) arasında çok iyi bir bağlantı mevcuttu. ROA(pisa) ve sol ventrikül kitle indeksi, Doppler haritalama ile saptanan mitral jet alanı derecelendirilmesi, maksimal jet uzunluğu ve kardiyak indeks arasında iyi bir bağlantı olduğu görüldü. Tartışma: MY değerlendirmesinde PISA metodu, çocuklarda en az Doppler yöntemi kadar kullanılabilecek bir yöntemdir.The purpose of this study was to determine the feasibility and significance of the proximal isovelocity surface area (PISA) method in children with rheumatic mitral regurgitation (MR). Methods: Thirty one patients (14 boys and 17 girls, mean aged of 12.3±3.1 years old), with chronic isolated rheumatic MR were evaluated concomitantly by semiquantitative and quantitative Doppler, quantitative two-dimensional echocardiography and PISA methods. Also we compared regurgitant orifice area (ROA), regurgitation volume (RV), systolic and diastolic left ventricular functions and variables reflecting volume overload in group I (grade 1 and 2 MR) and group II (grade 3 and 4 MR). Results: There were no statistically significant differences in ROA and RV values obtained by PISA method and the quantitative Doppler (t=0.421, p=0.677 and t=0.720, p=0.477) but they were different from the same values obtained by two dimensional echocardiography (t=5.024 and t=3.992, p=0.000). There were excellent correlations between ROA, RV and the radii of the PISA hemisphere (r=0.882, r=0.925, r=0.880, p=0.000). We found a very good correlation between ROA(pisa) and left ventricle end- diastolic diameters (r=0.763, p=0.000), left atrial volume (r-0.751, p=0.000), ratio of the jet area and left atrial area (r=0.745, p=0.000). There was a good correlation between left ventricle mass index, mitral jet area color flow Doppler mapping at the MR, maximal jet length, cardiac index. Conclusion. It is concluded that MR can be accurately predicted in children by using the PISA method as like as the Doppler method

Assessment of factors related to the understanding of education and knowledge of self-care among patients with diabetes mellitus: A cross-sectional prospective study

The prevalence of diabetes mellitus is rapidly increasing particularly in developing countries. The aim of this study was to assess the knowledge and self-care practices of diabetes patients and to assess the contribution of the education to this knowledge level and glycemic control. We formed patient groups consisting of 15-30 diabetic patients. First, patients were surveyed using a diabetes self-care knowledge questionnaire (DSCKQ-30). Sunsequently, a standard PowerPoint presentation about diabetes self-management was made to the patients who were then surveyed again using DSCKQ-30. All patients were invited to hospital to measure their control glycated hemoglobin (HbA1c) level 3 months later. Of the total 364 participants, 62.9% were females. Significant increases in the percentage of correct responses were determined in all components between, before and after education. There was a significant decline of 1.1 in HbA1c levels after 3 months of education. Married or active working patients had a better understanding of the education about diabetes and had a greater knowledge of self-care management regardless of their level of education or income. Education about diabetes can significantly improve knowledge of self-care management and can help in achieving glycemic control. Continuing education about self-care management and complications is crucial and this should be accompanied by a regular assessment of pateients' diabetic knowledge

The Cardiac effect of Rapid Maxillary expansion Patients with Maxillary Deficiency

<p><strong>Background:</strong> The aim of this study is to evaluate the affect of rapid maxillary expansion (RME) on cardiologic parameter.</p><p><strong>Methods:</strong> 12 patients (4 male and 8 females) with maxillary deficiency and bilateral cross-bite were selected to this study group. Before RME 24 h Holter monitoring of electrocardiography was used on patients. The prevalence analysis of arrhythmias, mean heart rate (MHR) and ventricular premature contraction (VPC) analysis was assessed over a 24-h period. Six months after achieving successfully expansion the Holter procedure was repeated again on patients.</p><p><strong>Results:</strong> VPC count per day and MHR, detected on 24 h ambulatory electrocardiography, showed significant statistical difference was present in pre and post-treatment periods. (VPC; 54.25±69.56/day, 6.50±5.98/day p&lt;0.05; MHR; 108±12/day, 82±8/day p&lt;0.05: respectively)</p><p><strong>Conclusion:</strong> The patients with maxillary deficiency may have been a potential with cardiologic abnormalities. The expansion may improve the cardiac problems by expansion.</p

Kardiyomiyopatinin tedavi edilebilir bir nedeni: Vitamin D eksikliği

Dilated cardiomyopathy is an important cause of heart failure in children. Medical therapy rarely results in complete improvement of the disease, treatment of which usually requires transplantation. Herein, we present a patient with cardiomyopathy and rickets. Case report: A 3-month-old boy was referred to Pediatric Endocrinology Clinic due to low calcium level. On his physical examination, enlarged wrists and large anterior fontanel were remarkable. Results of laboratory analyses revealed a calcium level of 6.8 mg/dL, phosphorus level of 4.9 mg/dL, alkaline phosphatase level of 1637 U/L, parathyroid hormone level of 191.2 pg/ mL, and 25-hydroxyvitamin D level of 5.7 ng/mL. Hand-wrist radiograph revealed signs consistent with rickets. Echocardiogram revealed dilated left ventricle, hypokinetic myocardium, an ejection fraction of 42%, and fractional shortening by 20%. Oral calcium lactate was started and then vitamin D treatment was added. At the 3rd month of the therapy, laboratory tests completely returned to normal and signs of rickets disappeared. Echocardiogram findings returned to normal. Since cardiac functions began to improve after the therapy, dilated cardiomyopathy associated with vitamin D deficiency was considered. Vitamin D deficiency should be considered while evaluating dilated cardiomyopathy in the regions that are endemic for nutritional rickets and it should be kept in mind that the therapy may provide dramatic improvement.Dilate kardiyomiyopati (KMP) çocuklarda kalp yetmezliğinin önemli bir nedenidir. Çoğunlukla transplantasyon ihtiyacı duyulan bu hastalıkta nadiren medikal tedavi ile tam iyileşme sağlanabilir. Burada KMP ve rikets tanılarıyla izlenen bir olgu sunulmuştur. Olgu Sunumu: Üç aylık olgu çocuk endokrin polikliniğine kalsiyum (Ca) düşüklüğü nedeniyle yönlendirilmişti. Fizik muayenede el bileklerinde genişleme, geniş ön fontanel dikkati çekiyordu. Laboratuvar değerlendirmede, Ca 6,8 mg/dl, fosfor 4,9 mg/dl, alkalin fosfataz 1637 U/L, paratiroid hormon 191,2 pg/ ml, 25 hidroksi vitamin D düzeyi 5,7 ng/ml saptandı. El bilek grafisinde raşitizmle uyumlu bulgular vardı. Ekokardiyogramda geniş sol ventrikül, hipokinetik kalp kası, ejeksiyon fraksiyonu %42, fraksiyonel kısalma %20 idi. Vitamin D eksikliği tanısıyla önce Ca laktat tedavisi ardından D vitamin tedavisi başlandı. Tedavinin 3. ayında radyolojik bulguların düzeldi ve rikets bulguları kayboldu. Ekokardiyogram bulguları normale döndü. Tedaviden sonra kardiyak fonksiyonların düzelmeye başlaması nedeniyle olguda vitamin D eksikliğine bağlı dilate KMP düşünüldü. Nutrisyonel riketsin endemik olduğu bölgelerde dilate KMP’nin etyolojik değerlendirmesinde vitamin D eksikliği tanısı düşünülmeli, tedavinin dramatik iyileşme sağlayabileceği akılda tutulmalıdır

Hipogonad Hastalarda Lipid Profili ve Oksidatif Stres Markerlarının Tedavi ile Değişimi

Amaç: İdiyopatik Hipogonadotropik Hipogonadizm (İHH) hastalarında kardiyovasküler riski artıranoksidatif stres ve dislipidemi varlığını ve gonadotropin replasman tedavisinin bu parametrelerüzerindeki etkisini araştırmak.Materyal ve Metod: Çalışmamız faz IV, randomize olmayan, vaka kontrollü bir çalışmaydı. Çalışmaya,İHH tanılı erkek hastalar (n=30) ile benzer yaş ve vücut kitle indeksine (VKİ) sahip sağlıklı kontrol grubu(n=20) dahil edildi. Oksidatif stres belirteçleri, lipidler ve apolipoprotein seviyeleri, gonadotropintedavisinden önce ve sonra ölçüldü ve sağlıklı kontrollerle karşılaştırıldı.Bulgular: Tedavi sonrası yüksek dansiteli lipoprotein (HDL), düşük dansiteli lipoprotein (LDL), ilerioksidasyon protein ürünleri (AOPP), malondialdehit (MDA) ve nitrik oksit (NO) seviyelerinde dramatik birdüşüş görülürken tiyol seviyesinde önemli bir artış tespit edildi (p&lt;0.05).Sonuç: Elde edilen veriler hipogonadizm olgularında dislipidemi varlığına ve oksidatif stres artışınaişaret etmiştir ve gonadotropin tedavisinin bu hastaların oksidatif stresini azalttığını ve lipid profiliniolumlu yönde etkilediğini göstermiştir. </jats:p

Serum Pentraxin 3 and hs-CRP Levels in Children with Severe Pulmonary Hypertension

Background: Pulmonary arterial hypertension secondary to untreated left-to-right shunt defects leads to increased pulmonary blood flow, endothelial dysfunction, increased pulmonary vascular resistance, vascular remodelling, neointimal and plexiform lesions. Some recent studies have shown that inflammation has an important role in the pathophysiology of pulmonary arterial hypertension. Aims: The aim of this study is to evaluate serum pentraxin 3 and high sensitive (hs)-C reactive protein (hs-CRP) levels in children with severe pulmonary arterial hypertension (PAH) secondary to untreated congenital heart defects and evaluate the role of inflammation in pulmonary hypertension. Study Design: Cross sectional study. Methods: After ethics committee approval and receiving consent from parents, there were 31 children were selected for the study with severe PAH, mostly with a left-to-right shunt, who had been assessed by cardiac catheterisation and were taking specific pulmonary vasodilators. The control group consisted of 39 age and gender matched healthy children. After recording data about all the patients including age, gender, weight, haemodynamic studies and vasodilator testing, a physical examination was done for all subjects. Blood was taken from patients and the control group using peripheral veins to analyse serum Pentraxin 3, N-terminal pro-Brain Natriuretic Peptide (NT-ProBNP) and hs-CRP levels. Serum Pentraxin-3 levels were measured by enzyme linked immunosorbent assay (ELISA) and expressed as ng/mL. Serum hs-CRP levels were measured with an immunonephelometric method and expressed as mg/dL. The serum concentration of NT-proBNP was determined by a chemiluminescent immunumetric assay and expressed as pg/mL. Results: Serum Pentraxin- 3 levels were determined to be 1.28±2.12 (0.12-11.43) in the PAH group (group 1) and 0.40±0.72 (0.07-3.45) in group 2. There was a statistically significant difference between the two groups (p<0.01). Serum hs-CRP levels were measured as 2.92±2.12 (0.32-14.7) mg/dL in group 1 and 0.35±0.16 (0.07-3.45) mg/dL in group 2. The hs-CRP level was increased in the PAH group to a significant degree (p<0.01). Conclusion: Our study showed that pentraxin 3 and hs-CRP levels were increased significantly in the PAH group. We consider that inflammation plays an important role in severe pulmonary hypertension and progressive pulmonary arterial hypertension in children with PAH