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Öğe Assessment of magnesium status in newly diagnosed diabetic children: measurement of erythrocyte magnesium level and magnesium tolerance testing(Turkish J Pediatrics, 2005) Şimşek, Enver; Karabay, Meltem; Kocabay, KenanThe aim of this study was to investigate the relationship between serum, erythrocyte and urine magnesium levels and retained magnesium percentage in newly diagnosed diabetic children. In a cross-sectional study, 34 children with insulin dependent diabetes mellitus (IDDM) and 21 healthy age- and sex-matched control subjects were screened for their serum, erythrocyte, and urine magnesium levels. Magnesium tolerance test was performed on diabetic and control subjects: Serum and erythrocyte magnesium levels in diabetic children were significantly lower than in healthy controls (plasma magnesium, p < 0.05; erythrocyte magnesium, p < 0.001); however, serum magnesium level was in normal range in diabetics and controls. Erythrocyte magnesium levels in diabetic children showed an inverse correlation with percentage of retained magnesium load (r=-0.44, p < 0.01). Urine magnesium excretion in diabetic children (7.12 +/- 2.18 mmol/g creatinine/24-hr) was significantly higher than in healthy controls (4.0 +/- 1.35 mmol/g creatinine/24-hr) (p < 0.001). There was a negative correlation between erythrocyte magnesium (2.07 +/- 0.62 mmol/L) and urine magnesium (7.12 +/- 2.18 mmol/g creatinine/24-hr) (r=-0.68 p < 0.01) in diabetic children. Magnesium tolerance test showed that percentage of retained magnesium in diabetic children (66 +/- 26%) was significantly higher than in controls (16 +/- 7%) (p < 0.001). This study is the first study to simultaneously investigate serum, erythrocyte and urine magnesium levels and magnesium tolerance test in newly diagnosed diabetic children. In conclusion, erythrocyte magnesium levels decrease earlier than serum magnesium in diabetic children. The follow-up parameters in diabetics may include the policy of monitoring magnesium status. Erythrocyte magnesium measurement is preferred to serum magnesium. Magnesium tolerance test is a reliable and sensitive method, which may be used as an alternative to erythrocyte magnesium measurement or in combination with it in hospitalized diabetic children.Öğe Congenital hypothyroidism and iodine status in Turkey: A comparison between the data obtained from an epidemiological study in school-aged children and neonatal screening for congenital hypothyroidism in Turkey(2003) Şimşek, Enver; Karabay, Meltem; Şafak, Alper; Kocabay, KenanBackground: Congenital hypothyroidism and endemic iodine deficiency are the most common cause of mental retardation. However in both cases retardation is of non-preventable nature. Objective: The aim of the study was to investigate whether epidemiological study in school-aged children or neonatal screening of congenital hypothyroidism (CH) was useful to assess iodine status and monitor the preventive measures of iodine deficiency disorders (IDD). Subjects: To study the epidemiology, 1046 school children, aged 8 to 12 years from 23 primary schools in rural and urban areas from three cities in Turkey were included. Neonatal screening for congenital hypothyroidism (CH) was carried in. Methods: Goiter and thyroid volume were assessed by palpation and ultrasound, respectively. Thyroid stimulating hormone (TSH), total thyroxine (T4), and urinary iodine excretion (UIE) were measured. Neonatal screening for CH was adjusted according to the guidelines of Pediatric Endocrinology of the European Society for Pediatric Endocrinology. Results: There was no significant difference between the median TSH in school-aged children and the cities of Bolu and Düzce (p>0.05). Median TSH of Zonguldak was significantly different from the median TSH of Bolu (p=0.046) and Düzce (p=0.028). There was no significant difference between the median T4 levels of Bolu and Düzce (p>0.05). The median T4 of Zonguldak showed a significant difference from the median T4 value of Bolu (p=0.018), but an insignificant difference from the median T4 of Düzce (p>0.05). The overall goiter prevalence in 1046 children was 52%. In two years, 18606 newborns were screened. With a cut-off point at TSH >20 ?U/ml, the recall rate was 1.6% and the incidence of CH 1/2326. There was 26.7% children with TSH >5 ?U/ml. Both data of the epidemiological study in school-aged children and neonatal screening for CH indicated that the West Black Sea Region is affected by mild to moderate iodine deficiency. Conclusion: the implementation of neonatal screening for congenital hypothyroidism using TSH measurement has many advantages. It can detect congenital hypothyroidism and transient primary hypothyroidism, and can also be used for monitoring tools of preventive measures of IDD. Countries, such as Turkey, which has not begun national screening for CH yet, should make implementation of neonatal screening for CH using primary TSH measurement a political priority.Öğe Deprem bölgesindeki çocukluk çağı pnömonilerinin epidemiyolojik özellikleri(2004) Şimşek, Enver; Yılmaz, Ebru; Karabay, Meltem; Avşar, Yılmaz; Kocabay, KenanAmaç: İki büyük depreminin gerçekleştiği Düzce ve çevre illerde görülen çocukluk çağı pnömonileri üzerine etkili risk faktörlerinin irdelenmesi. Gereç ve Yöntem: Nisan 1998 ile Mart 2003 tarihleri arasında Düzce Tıp Fakültesi Çocuk Kliniği'nde alt solunum yolu infeksiyonu tanısı konulan 172 (98 [57%] erkek, 74 [43%] kız) çocuk hasta çalışmaya alındı. Alt solunum yolu infeksiyonu tanısı ve tedavisi Dünya Sağlık Örgütü kriterlerine göre yapıldı. Vakalar yaş, cinsiyet, getirildikleri bölge, yaşam koşulları, beslenme şekli, gelişim özelliklerine göre irdelendi. Bulgular: Yüz yetmiş iki hastanın 124'ü (%72) hastaneye yatırılarak, 48'i (%28) ayaktan tedavi edildi. Hastaneye yatırılan 124 hastanın 89'unu (%72) Bolu, Düzce, Adapazarı ve Zonguldak il merkezlerinden, 35'ini (%28) bu illerin kırsal kesimlerinden gelen hastalar oluşturuyordu. Ayaktan izlenen hastaların 32'sini (%66) kırsal kesimden gelen, 16'sını (%34) şehir merkezinden gelen hastalar oluşturuyordu. Hastaların tanı anındaki yaşları 2 hafta ile 17.4 yıl arasında olmak üzere, ortalama (± S.E.M) tanı yaşı 37 (± 7.4) hafta olarak bulundu. Yüz yetmiş iki çocuğun 54'ünde (%31) ağırlık yaşa göre ağırlığın %60 ile %75'i arasında, 26'sında (%15) ise yaşa göre ağırlığın %60'ın altında saptandı. Tanı konulan mevsimlere göre, 84 (%49) çocukta kış, 46 (%27) çocukta ilkbahar, 23 (%13) çocukta yaz ve 19 (%11) çocukta sonbahar mevsiminde tanı konuldu. Ortalama (± S.E.M) pnömoni tedavi süresi, plevral effüzyonu olmayan vakalarda 13 ± 5 gün, ampiyemi olan vakalarda ise 21 ± 8 gündü. Çalışmaya alınan hastalardan 19'u (%11) kaybedildi. Bu vakaların 17'sini (%89) 2 yaş altındaki çocuklar oluşturuyordu. Mortalite ile yaş arasında negatif korelasyon saptandı (r=-0.33, p<0.001). Yaşamın erken döneminde pnömoni olması yanında, annenin yaşlı olması, tanı anında lökosit sayısı ve sedimentasyon hızı yüksekliği ile birlikte akciğerlerde yaygın infiltrasyonun bulunması prognozun olumsuz olabileceğine işaret eden parametrelerdi. Sonuç: Sağlıksız yaşam koşulları, halen deprem bölgesinde çocukluk çağı pnömonileri için en önemli risk faktörü olma özelliğini korumaktadır. Deprem bölgesindeki çocukluk çağı pnömonilerinin prognozu üzerine olumsuz etkisi olan risk faktörlerinin çoğu önlenebilir özelliktedir. Sağlıksız ortamlardan kalıcı ve hijyenik ev koşullarına geçiş, bölgedeki çocukluk çağı pnömoni insidansının azalmasına etkili önemli faktörlerden birisidir. Aşılama programlarının düzenli yapılması, pnömoni gelişiminde önemli risk faktörü olan mikroorganizmalara karşı yeni jenerasyon aşıların da ülke rutin aşı programına alınması ve anne sütü kullanım oranının istenen seviyelere çıkarılması pnömoni sıklığını azaltabilecek diğer önemli faktörlerdir.Öğe Investigating for Insulin Resistance and Type 2 Diabetes Mellitus in Obese Children(Galenos Yayincilik, 2005) Simsek, Enver; Karabay, Meltem; Aras, Sukru; Kocabay, KenanThe incidence and prevalence of type 2 diabetes mellitus within the childhood period has increased in the worldwide, particularly among obese children. The aim of this study was to investigate impaired glucose tolerance and insulin resistance in obese children. Thirty-six children (18 girls and 18 boys) aged between 7.4 and 17 years with a body mass index (BMI) > 95th percentile and referred to our hospital between 1998 and 2003. Control group consisted of 30 children (13 girls and 17 boys) aged between 7.2 and 17.8 years with a body mass index between 5th and 95th percentile. Fasting and oral glucose tolerance test (OGTT) 120th min serum glucose and insulin levels were measured. The glucose results were characterized according to the World Health Organizations criteria. Insulin resistance (IR) was defined by homeostasis model assessment (HOMA) as IRHOMA. Fasting glucose levels were in normal limits in all obese and control subjects. OGTT revealed that 9 of 36 obese children (25 %) had diagnosed impaired glucose tolerance and 2 children (6%) diabetes mellitus. Plasma glucose levels in OGTT were in normal limits in all control subjects. IRHOMA revealed insulin resistance in 17 of 36 obese children (47%) and significantly correlated puberty (r=0.418, p=0.0217), BMI (r=0.507, p=0.002), age (r=0.513, p=0.001), and insulin level at 120th min of OGTT (r=0.821, p<0.001). Overall mean IRHOMA in obese and control subjects were 4,1 +/- 1.0 and 1,5 +/- 0.9, respectively. The difference of mean IRHOMA levels between obese and control subjects was significantly different (p<0,001). IRHOMA levels of 5 control subjects (16%) were above the level of cut-off point (2,5), however OGTT were normal in these subjects. In conclusion, the childhood obesity is one of the important risk factors for the early beginning of type 2 diabetes mellitus. An OGTT is more sensitive at identifying impaired glucose tolerance or diabetes mellitus than fasting glucose alone. Body-mass index (BMI) was strongest predictor of fasting and glucose stimulated insulin levels.Öğe Neonatal screening for congenital hypothyroidism in West Black Sea area, Turkey(Blackwell Publishing Ltd, 2005) Şimşek, Enver; Karabay, Meltem; Kocabay, KenanThe aim of this study was to investigate the incidence of congenital hypothyroidism (CH) in the West Black Sea Area, a mild-to-moderate iodine deficient area in Turkey. Neonatal screening for CH was performed using blood specimens collected onto filter paper. Thyrotropin [thyroid-stimulating hormone (TSH)] was measured by radioimmunoassay, and a value >20 mu U/ml was considered as cut-off point for re-examining. Venous serum was obtained to measure TSH, thyroxin (T4), free T4 (FT4) and thyroglobulin (TG). To determine the iodine status of the study area, median urinary iodine was measured in 212 randomly selected neonates and their mothers. A total of 18606 neonates were screened from three cities (Bolu, Duzce, and Zonguldak) between 2000 and 2002. With a cut-off point of TSH value >20 mu U/ml, the recall rate was found 1.6%. Eight cases of CH were diagnosed (incidence 1/2,326).There were three cases of transient hypothyroldism, with an incidence of 1/6202. Twenty-six percent of the TSH values was greater than 5 mu U/ml. Median urinary iodine concentrations in neonates and their mothers were 85 mu g/l and 40 mu g/l, respectively. The incidences of CH, transient hypochyroidism and the recall rate were higher in our study area than many countries in Europe. The study area has been affected by mild-to-moderate iodine deficiency. Neonatal screening for CH should be introduced in Turkey without delay. A national comprehensive infantile hypothyroidism and iodine prophylaxis policies should be developed.
