Both decreased amplitude and prolonged latency of P300 are associated with IR in children with obesity, which shows the impairment of neural activity associated with sensory and cognitive information processing in these children. Further studies are necessary to strengthen the current findings and to determine the exact mechanism of cognitive impairment in obese children.

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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 patientsConflict of interest:None declared.

Monitoring of the urea level of patients with insufficient kidney function requires repetitive blood sampling. The potentially painful nature of blood sampling and the difficulty of venous access, particularly in premature neonates, as well as possible complications of needle injuries, create many disadvantages. A non-invasive technique needs to be developed for monitoring the urea level for these patients. Reverse iontophoresis has recently gained importance and the possibility of extracting some compounds from body fluids using reverse iontophoresis has been reported in the literature. Moreover, a small, watch-type device has been developed for the determination of blood glucose levels using a similar approach. The aim of the current study was to investigate the possibility of extracting urea from blood through skin using reverse iontophoresis to monitor blood urea levels without taking a blood sample. In vitro iontophoresis studies have indicated that urea may be successfully transferred through the full thickness of human skin. The reverse iontophoresis technique was applied to 17 patients with kidney insufficiency and urea was successfully extracted through their skin into the collection solution. A high correlation ( r(2)=0.878) between urea concentrations in collection solutions and urea levels in the blood was observed. These results suggest that it is possible to make a watch-type device for monitoring blood urea levels.

Hepatosteatosis is an important complication in children with T1DM as it indicates metabolic imbalance and development of peripheral insulin resistance. Lipoprotein is structurally impaired, and secondary to the hyperglycemia, glucose transporter 2-mediated glucose uptake from the circulation by the liver is increased. This results in increased fatty acid and lipoprotein synthesis, which is implied in the pathogenesis (2,3,4). Such hepatic disorders due to causes other than alcohol are termed as non-alcoholic fatty AbstractWhat is already known on this topic? What this study adds?Objective: Metabolic impairment in type 1 diabetes mellitus (T1DM) with poor glycemic control causes insulin resistance, non-alcoholic fatty liver disease (NAFLD), atherosclerosis, and increased carotid intima-media thickness (CIMT). Fetuin-A has a protective effect in cardiovascular disorders and is increased in hepatosteatosis. We aimed to investigate the reliability of fetuin-A levels in early detection of diabetic complications in children with T1DM and to identify a cut-off value that may show poor metabolic control. Methods: The study included 80 patients who had T1DM for at least 5 years and who had no chronic complications or an auto-immune disorder. Blood samples were drawn to measure hemoglobin A1c (HbA1c), biochemical parameters, and fetuin-A levels. Anthropometric parameters were also measured. Percent body fat was calculated. Hepatosteatosis and CIMT were assessed by sonography. Results: Mean age of the patients was 13.5 years. Grade 1 hepatosteatosis was detected in 10%. Patients were stratified into 2 groups based on presence of NAFLD. Fetuin-A level was increased in patients with NAFLD. We identified a fetuin-A cut-off value (514.28 ng/mL; sensitivity: 47.34; specificity: 96.72) that may predict NAFLD. HbA1c and total cholesterol levels were found to be higher in patients with fetuin-A levels above higher the cut-off value. Conclusion: Fetuin-A is a reliable parameter in the prediction of complications and poor glycemic control in patients with T1DM. Keywords: Non-alcoholic fatty liver disease, fetuin-a, type 1 diabetes mellitus, complication Fetuin-A levels could be useful in predicting complications such as hepatosteatosis and atherosclerosis in patients with type 1 diabetes mellitus.Hyperlipidemia and hyperglycemia lead to an increase in fetuin-A production.

Considering the role of autonomic imbalance in the pathogenesis of hypersensitivity reactions, we evaluated the autonomic system through time-domain analysis of heart rate variability (HRV) in patients with allergic rhinitis. Twenty-four patients with allergic rhinitis and 22 healthy subjects (mean age, 41 +/- 8 years and 37 +/- 9 years, respectively) were enrolled in the study. The diagnosis of allergic rhinitis was based on the history, symptoms, and skin prick tests results. Twenty-four-hour ambulatory electrocardiographic recordings were obtained, and the time-domain indices were analyzed. Analysis of HRV revealed that the SD of normal RR intervals, SD of successive differences in normal cycles, and HRV triangular index were not significantly different between the groups, but the root mean square successive difference, number of RR intervals exceeding 50 milliseconds, and percentage difference between adjacent normal RR intervals exceeding >50 milliseconds were significantly greater in the study group, compared with the control group. Our findings showed that HRV indices, which predict parasympathetic predominance, were increased in patients with allergic rhinitis. This finding shows that vagal activation is present not only in the nose but also in other systems, including the cardiovascular system.

Nonsteroidal anti-inflammatory ointment application for phimosis may be an alternative to surgery and steroid application.

Henoch-Schonlein purpura (HSP) is one of the most common types of vasculitis disorders seen in childhood and is characterized by a rash, arthritis, abdominal pain, and renal involvement. Although HSP is an immunoglobulin A (IgA) related immune complex disease, the pathogenesis has not been fully elucidated. Cytokines have been implicated in the pathogenesis, but endothelins (ET) - vasoconstrictor hormones produced by endothelial cells - have not been studied in patients with HSP. In a controlled study, we measured ET-1 levels in children with HSP during the acute and remission phases. ET-1 levels were significantly higher in the HSP patients during the acute phase compared with the control group and the HSP patients in the remission phase. There was no correlation between ET-1 levels and disease severity, acute phase reactant response, or morbidity. The role of endothelins and other cytokines in the pathogenesis of HSP needs to be further explored.