Effects of serum vitamin D level on ventricular repolarization in children and adolescents

OBJECTIVES

Low levels of vitamin D are known to increase cardiovascular mortality due to different risks. We aimed to examine whether low vitamin D levels in children and adolescents cause ventricular repolarization changes.

METHODS

Sixtyseven healthy cases aged between 3.5 and 17 years were included. According to levels of vitamin D, cases were grouped as sufficient (n=44), insufficient (n=13) and deficiency (n=10). Ventricular repolarization parameters were measured manually.

RESULTS

Levels of vitamin D were different for cases with insufficiency and deficiency compared to sufficiency ones (102±54.9 vs 24.4±7 ng/ml, p<0.001 and 102±54.9 vs 16.6±8.3 ng/ml, respectively, p<0.001). In the insufficient group the following parameters were different from sufficient group: QTmean (357.8±25.3 vs 332±29.9 ms, p=0.012), JTc (310.8±20.2 vs 331.6±21 ms, p=0.005) and Tpe/QT (0.2±0.02 vs 0.22±0.02, p=0.02). It was found that the level of serum vitamin D correlated with JTc (r=-0.37, p=0.002), Tp-e (r=-0.29, p=0.015) and Tp-e/QT (r=-0.24, p=0.047). In the linear regression analysis, it was found that dropping level of vitamin D below normal was an independent risk factor for prolonged duration of JTc (p=0.015).

CONCLUSIONS

Decline in vitamin D levels causes ventricular repolarization anomaly. As the decrease in vitamin D levels deepens, repolarization times become longer. These results could indicate that decrease in vitamin D levels can increase sensitivity to ventricular arrhythmias (Tab. 3, Ref. 45). Text in PDF www.elis.sk Keywords: adolescent, arrhythmia, child, vitamin D, ventricular repolarization.

The association of obesity and obesity-related conditions with carotid extra-medial thickness in children and adolescents

BACKGROUND

Carotid extra-medial thickness (EMT) and carotid intima-media thickness (cIMT) provide information concerning vascular changes.

OBJECTIVES

In this study, we aimed to evaluate the association between carotid EMT and obesity and its metabolic complications in children.

METHODS

The study included 38 obese subjects and 30 age-matched and sex-matched healthy controls aged between 7 and 17 years. For all subjects, complete blood count, fasting blood glucose, serum insulin, aspartate aminotransferase, alanine aminotransferase, HDL cholesterol, total cholesterol and triglyceride levels were measured. The carotid EMT and cIMT were measured by an expert radiologist in all patients.

RESULTS

Body mass index (BMI) (28.8 ± 3 vs. 18.1 ± 2.2, p < 0.001), total cholesterol (167.9 ± 34.8 mg dL^-1 vs. 150.5 ± 28.1 mg dL^-1 , p = 0.029), homeostatic model assessment of insulin resistance (HOMA-IR) (4.3 vs. 1.7, p < 0.001), cIMT (0.51 ± 0.08 mm vs. 0.45 ± 0.06 mm, p < 0.001) and carotid EMT (0.74 ± 0.11 mm vs. 0.64 ± 0.1 mm, p < 0.001) were significantly higher in obese subjects than in controls, while HDL cholesterol (41.6 ± 6.5 mg dL^-1 vs. 49.5 ± 7.5 mg dL^-1 , p < 0.001) was lower in obesity group. Among the obese subjects, the HOMA-IR values (4.7 vs. 3.6, p = 0.027), cIMT (0.54 ± 0.07 mm vs. 0.49 ± 0.07 mm, p = 0.039) and carotid EMT (0.79 ± 0.1 mm vs. 0.7 ± 0.1 mm, p = 0.013) were significantly higher in post-pubertal children compared with prepubertal children. BMI, cut-off values of HOMA-IR and cIMT were significantly associated with increased carotid EMT (p < 0.001, p = 0.023 and p < 0.001, respectively). The only independent risk factor affecting carotid EMT was BMI (p < 0.001).

CONCLUSION

We have found that carotid EMT is associated with cIMT, obesity and insulin resistance and the assessment of carotid EMT may provide additional information concerning early vascular disease.

Neutrophil-to-lymphocyte ratio and red blood cell distribution width is a practical predictor for differentiation of febrile seizure types

OBJECTIVE

Febrile seizures (FS) are the most common neurological emergency in childhood. They are divided into two groups accordingly clinical features, simple febrile seizure and complex febrile seizure. Until now laboratory tests have not been used as a parameter of classification of them. The objective of this study is to estimate the usefulness of the hematogical parameters especially neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in the differentiation of febrile seizure types.

PATIENTS AND METHODS

A retrospective review was conducted on patients from 6 months to 6 years old presenting with first febrile seizure admitted to a tertiary care hospital. Epidemiological and laboratory variables of the patients were collected.

RESULTS

The mean NLR in the simple FS and complex FS groups was 2.18±1.9 and 3.8±4.2 respectively, and the difference was significant (p=0.024). The mean serum red blood cell distribution width in the simple FS and complex FS groups was 16.1±1.1 and 16.6±0.8 respectively, and the difference was significant (p=0.019). NLR and RDW values in complex FS patients were statistically higher than simple febrile patients. ROC analysis showed that if the chosen cut-off point for NLR is 1.98 the sensitivity and specificity are 66.7% and 60.3% respectively. These were statistically significant (p=0.040 AUC 0.623, CI 0.503-0.743). If the chosen cut-off point for RDW is 16.350, the sensitivity and specificity are 59.0% and 58.6%, respectively. These were statistically significant (p=0.037 AUC 0.626, CI 0.515-0.736) too.

CONCLUSIONS

NLR and RDW were simple, effective and practical predictors for differentiation of FS types. They will have potential values in public health practice for management of FS patients.

Subclinical immune reactions to viral infections may correlate with child and adolescent diagnosis of attention-deficit/hyperactivity disorder: a preliminary study from Turkey

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders of childhood and adolescence. Studies focusing on the relationship of infectious agents and ADHD are scarce. It is also known that cerebellar injury may lead to hyperactive behavior. This study aimed to evaluate the relationship between viral agents of cerebellitis and the diagnosis of ADHD.

METHODS

The study group was formed of 60 consecutive ADHD patients and 30 healthy children. IgG levels for VZV; HSV-1, CMV, Measles, Mumps, Rubella and EBV were evaluated.

RESULTS

Males were significantly higher among patients with ADHD (65% vs. 40%, p=0.025). Patients with ADHD displayed significantly higher positivity for measles IgG (80% vs. 60%, p=0.044). When patients with ADHD were classified according to their pubertal status, adolescents with ADHD displayed higher positivity for mumps (100% vs. 74.4%, p=0.043). Most of the patients were diagnosed with ADHD-Combined or Hyperactive/Impulsive Subtypes (56.6%) while 43.3% were diagnosed with ADHD-predominantly inattentive type. When patients with subtypes of ADHD were compared in terms of seropositivity, it was found that patients with ADHD-Combined/ Hyperactive-Impulsive subtypes had significantly elevated reactions for Rubella (100% vs. 88.5%, p=0.044).

CONCLUSION

Although limited to a single center and may be prone to sampling biases, our results may support the notion that immune reactions may be related with ADHD among children and adolescents. Further, prospective studies from multiple centers are needed to support our findings and establish causality.

The Obstetrics Gynecology and Children's Hospital Emergency Room waiting time before hospitalization

BACKGROUND

One of the most substantial factors affecting patient satisfaction in the Obstetrics-Gynecology and Children's Hospital is the wait time in the emergency room.

OBJECTIVE

We retrospectively studied the waiting periods of patients visiting the emergency room patients in Bolu Izzet Baysal Obstetrics-Gynecology and Children's hospital.

METHOD

Using an automated documentation system for each patient that recorded the season in which the patients consulted the emergency room, the month, day, time, examination time, hospitalization decision time, the hospitalization clinic following the decision to hospitalize, and the time to hospitalization, we retrospectively studied the waiting periods of emergency room patients in Bolu Ýzzet Baysal Obstetrics-Gynecology and Children's Hospital.

RESULTS

A total of 15,004 patients who consulted the hospital emergency room between November 24, 2009, and August 25, 2011, and who were hospitalized in a clinic were included in this study. The highest frequency of emergency room patient visits occurred during the summer season (28.1%), in the month of July (10.2%), on Mondays (16.1%), and between 8 and 11 AM (22.1%; p < 0.05). The emergency room wait time of patients consulting the pediatric clinic was (55 ± 67 min), which was significantly shorter than the wait time of patients consulting other clinics (p < 0.05).

CONCLUSION

The majority of patients who were hospitalized in any clinic through the emergency room consulted the hospital during the daytime hours. The time to hospitalization for the admitted patients was within an acceptable time frame. We believe that conducting comprehensive research to determine whether it is possible to reduce wait times even further to increase patient satisfaction will be instructive.