Acquired von Willebrand syndrome in children with aortic and pulmonary stenosis

INTRODUCTION

This prospective study was planned to investigate the frequency and relationship of acquired von Willebrand syndrome (AVWS) with aortic and pulmonary stenosis in patients.

METHODS

A total of 84 children, ranging from two to 18 years of age, were enrolled in this study. Of these, 28 had isolated aortic stenosis, 32 had isolated pulmonary stenosis and 24 were healthy. Children with aortic and pulmonary stenosis associated with other congenital heart diseases were excluded. Children with hypothyroidism, renal or liver disease, malignancy or autoimmune disease were also excluded. Wholeblood count, blood group, factor VIII level, prothrombin time (PT), activated partial thromboplastin time (aPTT), von Willebrand factor antigen (VWF:Ag), ristocetin co-factor (VWF:RCo), and bleeding time using a platelet-function analyser (PFA-100) were performed in all patients. All of the children in the study underwent a detailed physical examination and echocardiographic evaluation.

RESULTS

A history of bleeding was positive in 18% of the aortic stenosis group, 9% of the pulmonary stenosis group, and 4% of the control group. Seven of 60 (12%) patients had laboratory findings that implied a diagnosis of AVWS, and two of these (28%) had a history of bleeding. The frequency of AVWS was 14% in patients with aortic stenosis and 9% in those with pulmonary stenosis.

CONCLUSION

AVWS is not rare in stenotic obstructive cardiac diseases. A detailed history of bleeding should be taken from patients with valvular disease. Even if the history is negative, whole blood count, PT and aPTT should be performed. If necessary, PFA-100 closure time and further tests should be planned for the diagnosis of AVWS.

Relationship between Abdominal Aortic Intima Media Thickness and Central Obesity in Children

BACKGROUND

Childhood obesity is one of the important risk factors for early atherosclerosis. We aimed to evaluate the effect of obesity on abdominal aortic intima media thickness (aaIMT) in children.

METHODS

We consecutively recruited 60 obese and 28 healthy children from the outpatient clinic of pediatrics. In all patients, BMI, waist circumference (WC) and hip circumference (HC) were measured, and fasting serum lipid profile, plasma glucose and plasma insulin were studied. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated for the obese group. All children underwent ultrasonography to evaluate hepatosteatosis and to measure aaIMT.

RESULTS

There was a significant difference between the groups in terms of aaIMT, insulin, glucose, HOMA-IR, total cholesterol, low-density lipoprotein, triglyceride and hepatosteatosis. aaIMT was 1.12 ± 0.25 and 0.61 ± 0.18 mm in the obese and nonobese groups, respectively (p < 0.001). In the obese group, there was a positive correlation between aaIMT and WC, WC/height ratio, BMI, HC and hepatosteatosis (p < 0.05 for all), with the highest significance for WC.

CONCLUSIONS

This study showed that aaIMT was significantly higher in obese children than in nonobese children, and that WC was a strong predictor for aaIMT. Early detection of an increased aaIMT in obese children may guide the follow-up of these patients in terms of developing atherosclerosis and its complications.

Prolonged rooming-in in infancy is associated with generalized anxiety disorder in the adolescent period

OBJECTIVE

This study aims to investigate whether anxiety disorders in adolescents have a link with the separation time of bed/bedroom sharing with parents. It also aims to raise awareness in society about the issue of minimizing anxiety disorders in childhood.

METHODS

A case-control study was conducted in Şevket Yılmaz Training and Research Hospital between June 2013 and May 2014. The participants included 51 adolescents who were diagnosed as generalized anxiety disorder (GAD) with no-comorbidity and 71 healthy adolescents as the control group, who were chosen randomly. Diagnosis of GAD was based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed) by child and adolescent psychiatry doctors. The Turkish version of the State-Trait Anxiety Inventory (STAI) was used for the control group. A special survey about demographics and bed-sharing statements was constructed for the purpose of the study. The groups were analyzed in terms of duration of co-sleeping (bed-sharing) and rooming-in (keeping the mother and the baby in same room) with parents during infancy and the development of anxiety disorders in later period.

RESULTS

Mean duration of rooming-in was significantly longer in the case group than in the control group (p=0.009). Similarly, mean duration of co-sleeping in the case group was longer than that of the control group. However, this difference was not statistically significant (p=0.529).

CONCLUSION

Sleeping in the same room with children for a long time may result in anxiety disorders in later period due to possible difficulties in bonding and/or less self-confidence.

Does intrauterine tobacco exposure increase the pain perception of newborns?

Background

This study aimed to assess whether there was a difference in the pain-perception levels of newborns born to mothers who smoked during pregnancy and newborns born to mothers who were not exposed to active or passive smoking during pregnancy.

Materials and methods

A total of 60 newborns born by normal spontaneous vaginal birth between June 2013 and June 2014 were included in the study: 30 born to mothers who smoked during pregnancy, and 30 born to mothers not exposed to smoking. Mothers or newborns who had taken analgesics or sedative medications in the previous 24 hours, newborns not born at term, and sick newborns were not included in the study. During the routine hepatitis B-vaccination injection given at postnatal 48 hours, the newborns’ behavior was monitored and recorded by video camera. The data obtained from the recordings were evaluated according to the Neonatal Pain, Agitation, and Sedation Scale and analyzed with SPSS 20.

Results

The median pain score of the group exposed to tobacco smoke in utero was 8.5, while the median pain score of the unexposed group was 6 (P<0.001).

Conclusion

Exposure to tobacco smoke in utero may increase the pain-perception levels of newborns.

Serum ischemia-modified albumin levels in adolescent smokers

BACKGROUND

It is known that the biochemical marker linked to tissue ischemia, ischemia-modified albumin (IMA), is related to oxidative stress. Cigarette smoking is a situation with increased oxidative stress causing cell damage and it is thought that many of the negative effects linked to smoking may occur after the biological material in the body is exposed to oxidative damage. This study aimed to identify variability in serum IMA levels in adolescents who smoke.

METHODS

This case-control study comprised 60 adolescents without any chronic disease. The smoking group was 30 adolescents between the ages of 14 and 17 years who smoked, while the control group was 30 healthy adolescents who did not smoke. Blood samples were collected from all subjects and serum IMA levels and serum nicotine metabolites were determined.

RESULTS

The serum IMA levels in the adolescents who smoked were 0.452±0.094 absorbance unit (ABSU), while the control group had ASBU levels of 0.427±0.054. There was no significant difference between the groups in terms of serum IMA levels (p=0.210). There was a significant difference between the control and smoking groups in terms of serum nicotine metabolite levels (p<0.001).

CONCLUSIONS

Among adolescents who smoke, serum IMA levels may not be a good marker for oxidative stress.

Do we really ponder about necessity of intravenous hydration in acute bronchiolitis?

OBJECTIVE

The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis.

METHODS

This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting β2-agonist (salbutamol) +hydration; nebulized short-acting β2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure.

RESULTS

A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital.

CONCLUSIONS

IV hydration is not effective on length of stay in hospital in mild acute bronchiolitis patients.

Relation between QT Variables and Left Ventricular Geometry in Athletes and Obese Children

INTRODUCTION

We aimed to evaluate the relation between QT variables and left ventricular geometry in athletes and obese children.

MATERIAL AND METHODS

This study included 209 children and adolescents. Thirty-eight of them were obese, 140 were athletes and 31 were normal weighted. Children with history of functional and structural cardiovascular diseases (acquired and congenital), chronic systemic diseases, hypertension, sleep apnea, endocrinological disorders were excluded. All subjects underwent detailed electrocardiographic and echocardiographic examination.

RESULTS

QT dispersion was significantly higher in obese children, basketball players, football players and swimmers compared to control group (p < 0.05, p < 0.001, < 0.001 and < 0.01 respectively). Basketball players had the highest QT dispersion. Left ventricular endsystolic diameter (mm/m2) was higher in footballers, swimmers, wrestlers and tennis players compared to obese subjects. Interventricular septal thickness at diastole was highest in swimmers compared to control group (p < 0.001) and left ventricular posterior wall thickness was significantly higher in footballers and swimmers compared to healthy subjects (p < 0.01 and p < 0.001 respectively). Left ventricular geometry was normal in 84 patients (47.1%), but 34 patients (19.1%) had concentric remodelling, 20 (22.4%) had concentric hypertrophy and 40 (28.6%) had eccentric hypertrophy. No concentric and eccentric hypertrophy was observed in obese subjects. Left ventricle hypertrophy was prominent in dynamic and combined groups but it was not statistically significant (p = 0.204). QT dispersion was statistically higher in obese, dynamic sports and combined sports compared to control group (p < 0.05, p < 0.001 and p < 0.001 respectively).

DISCUSSION

In this study we determined that QT dispersion is elevated in dynamic and combined sports types and obese children.

CONCLUSION

QT dispersion is prolonged in obese and athletes who participate dynamic and combined sports.

Do we really ponder about necessity of intravenous hydration in acute bronchiolitis?

Objective: The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis. Methods: This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting β2-agonist (salbutamol) +hydration; nebulized short-acting β2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure. Results: A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital. Conclusions: IV hydration is not effective on length of stay in hospital in mild acute bronchiolitis patients.

Prenatal maternal risk factors for infantile colic

AIM

To examine maternal prenatal risk factors for infantile colic (IC).

METHODS

Mothers were asked to complete a standard pre-coded questionnaire form. Inclusion in the study consisted of four criteria. The case group comprised healthy children with infantile colic according to Wessel's definition. The control group comprised healthy children with no history of IC. Prenatal period characteristics of mothers were examined to determine associations with IC.

RESULTS

Children with mothers who had prophylactic iron supplementation therapy during pregnancy suffered more from IC. Postpartum depression was found to be more frequent in the case group than in the control group. Gynaecological history, including suffering from migraine, presence of any premenstrual symptoms, dysmenorrhea and high pre-pregnancy body mass index, was associated with development of IC.

CONCLUSION

Pre-gestational gynaecological complaints and pregnancy characteristics may point to IC. These characteristics should be investigated and families should be informed.

Attention deficit and hyperactivity disorder and infantile colic

AIM

Attention deficit and hyperactivity disorder (ADHD) and infantile colic (IC) are heterogeneous diseases which's cause are unknown. Besides the different hypotheses in the etiology of both disorders maldevelopment in the metabolism of neurotransmitters in the central nervous system have been implicated. The goal of this study is to investigate the relationship between IC and ADHD due to possible common etiological factor as maldevelopment in neurochemical process.

METHODS

A case-control study was carried out. The sample included 114 (77.2% male) children who were medically diagnosed with AD/HD and 149 (67.1% male) healthy children who were chosen from the same hospital's pediatric clinic as the control group. Parents and teachers completed the Conners Parent Rating Scale (CPRS), Conners Teacher Rating Scale (CTRS) and the patients were evaluated with The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The parents were asked questions on a survey form filled out. IC was defined according to Wessel's modified criteria.

RESULTS

The mean age of AD/HD group was 10.14±2.48 years and 9.94±2.34 years in the non-AD/HD group. The rate of IC in AD/HD and non-AD/HD groups were 50.0% and 30.2%, respectively and the difference was statistically significant between two groups (P=0.001). Duration of IC was similar in the groups (P=143).

CONCLUSION

IC may be a postnatal risk factor and marker for AD/HD during childhood. Both diseases may have a common mechanism. Such infants need to be examined and followed up more intensively.

Prolonged pacifier usage in infancy does not cause eating behavior problem later

The objective of this study conducted in children aged 3-7 years was to determine whether pacifier use during infancy is associated with eating problems in later periods. A total of 85 children (55.2 ±12.3 months) admitted to hospital with eating problems and with no organic pathology in scans, and 97 healthy children (52.24±10.97 months) without eating problems, were assigned to case and control groups, respectively. Eating problems were classified into five groups and investigated via a questionnaire. The presence of eating problems was analyzed for association with pacifier use. There was no significant difference between the two groups in terms of pacifier use (chi-square test: 0.141, p=0.707), and pacifier use is not related to a poor appetite in later periods. Pediatric healthcare providers and parents should be informed with regard to the subject.

Diagnosis, treatment and follow up of neonatal arrhythmias

Objective

This study aimed to evaluate the aetiology, spectrum, course and outcomes of neonates with arrhythmias observed in a tertiary neonatal intensive care unit from 2007 to 2012.

Methods

Neonates with rhythm problems were included. The results of electrocardiography (ECG), Holter ECG, echocardiography and biochemical analysis were evaluated. The long-term results of follow up were reviewed.

Results

Forty-five patients were male (68%) and 21 (32%) were female. Fifty-five patients (83.3%) were term, 11 (16.6%) were preterm, and 34% were diagnosed in the prenatal period. Twenty cases (30.3%) had congenital heart disease. Twenty-three patients (34.8%) were diagnosed during the foetal period. The most common arrhythmias were supraventricular ectopic beats and supraventricular tachycardia (SVT) at 39.3 and 22.7%, respectively. SVT recurred in five patients after the neonatal period.

Conclusion

Supraventricular ectopic beats and SVT were the most common arrhythmias during the neonatal period. Although the prognosis of arrhythmias in the neonatal period is relatively good, regular monitoring is required.

Association between teething and independent walking in healthy children

Developing teeth provide a reliable indication of maturation and biological age. The objective of this study was to establish whether there is any association between the time of emergence of the first primary tooth and the time when independent walking occurs. A cross-sectional study was conducted with a sample of 206 healthy children (95 girls and 111 boys) aged 12 to 60 (mean: 29.79±0.66) months who were able to walk independently. The study was conducted using a questionnaire that was filled out by the parents. The first primary tooth emerged at 6.86±0.14 (min: 3-max: 13) months; the mean independent walking time was 12.58±2.15 (min: 8.50-max: 24.00) months. There was no correlation between the first teething and independent walking times (r=0.045, p=0.523). Factors such as breastfeeding status, intake of vitamins, walker usage and body mass index were found not to affect the time of either emergence of the first deciduous tooth or independent walking. To the best of our knowledge, this is the first paper in literature to have researched the relationship between the time of emergence of the first deciduous tooth and that of independent walking. It should be explained to parents that there is no relationship between the two in order to resolve anxiety when their child acquires a tooth but does not walk, or vice versa.

Early detection of myocardial deformation by 2D speckle tracking echocardiography in normotensive obese children and adolescents

Objective:

To evaluate the left venticular myocardial deformation parameters in normotensive obese children and adolescents by using 2-D speckle tracking echocardiography.

Methods:

This observational cross-sectional study included 69 children and adolescents (aged between 10-18), 38 were normotensive obese and 31 were normal weighted. All children underwent detailed two- dimentional, Doppler and two-dimentional speckle tracking echocardiography. Student t-test, Mann-Whitney U test, chi-square test and Pearson’s correlation were used in statistical analysis. Multiple linear regression analysis was used the determine independent variables on global longitudinal strain (GLS).

Results:

While in normal limits, diastolic blood pressure was significantly higher in obese group. Left ventricular end-diastolic diameter (LVDd) and end-systolic diameter (LVDs), interventricular septal thickness (IVSd), left ventricular posterior wall thickness (LPWD) and left ventricular mass index (LVM)/height^2.7 were significantly higher in obese group compared to healthy peers (p=0.004, p=0.011, p<0.001, p=0.001, p<0.001) respectively. Obese subjects had reduced global longitudinal strain (GLS) values (p=0.001). Multiple linear regression analysis using the step-wise method were performed to assess the independent variables (age, body mass index, insulin resistance, systolic blood pressure, diastolic blood pressure, left ventricular diameters and LVM index (g/m^2.7) affecting the dependent variable GLS. GLS was found significantly correlated with body mass index (BMI) (β:0.440, p:0.001; 95% CI: 0.104-0.311).

Conclusion:

Left ventricular strain parameters obtained by two dimentional speckle tracking echocardiography were diminished in obese children compared to normal subjects indicating that obesity in childhood is linked to decreased myocardial deformation even in the absence of comorbidities in early stages.

Effects that different types of sports have on the hearts of children and adolescents and the value of two-dimensional strain-strain-rate echocardiography

Whether the hypertrophy found in the hearts of athletes is physiologic or a risk factor for the progression of pathologic hypertrophy remains controversial. The diastolic and systolic functions of athletes with left ventricular (LV) hypertrophy usually are normal when measured by conventional methods. More precise assessment of global and regional myocardial function may be possible using a newly developed two-dimensional (2D) strain echocardiographic method. This study evaluated the effects that different types of sports have on the hearts of children and adolescents and compared the results of 2D strain and strain-rate echocardiographic techniques with conventional methods. Athletes from clubs for five different sports (basketball, swimming, football, wrestling, and tennis) who had practiced regularly at least 3 h per week during at least the previous 2 years were included in the study. The control group consisted of sedentary children and adolescents with no known cardiac or systemic diseases (n = 25). The athletes were grouped according to the type of exercise: dynamic (football, tennis), static (wrestling), or static and dynamic (basketball, swimming). Shortening fraction and ejection fraction values were within normal limits for the athletes in all the sports disciplines. Across all 140 athletes, LV geometry was normal in 58 athletes (41.4 %), whereas 22 athletes (15.7 %) had concentric remodeling, 20 (14.3 %) had concentric hypertrophy, and 40 (28.6 %) had eccentric hypertrophy. Global LV longitudinal strain values obtained from the average of apical four-, two-, and three-chamber global strain values were significantly lower for the basketball players than for all the other groups (p < 0.001).

Congenital left ventricular diverticulum associated with congenital ileo-jejunal atresia

Congenital left-ventricular diverticulum (CVD) is a rare cardiac malformation. Echocardiography, magnetic resonance imaging, multislice computed tomography, and left-ventricular angiography are diagnostic tools. In this case report, we present a 5-month-old infant with CVD associated with congenital ileal atresia. The diverticulum appears to be of the left-ventricular type.