Management of outpatient pediatric burns at a pediatric burn center

Burn injuries are a serious emergency. Most burn injuries in children can be treated as outpatients. The aim of this study was to present the clinical and epidemiologic characteristics of pediatric burn injuries treated in our outpatient burn clinic. This study included pediatric patients treated in an outpatient burn clinic over an eight-year period. The demographic and clinical characteristics of the patients were retrospectively analyzed. The patients were divided into four groups according to their age groups, and the differences between the groups were investigated. Statistical analysis was performed using IBM SPSS Statistics, Version 25.0. P<0.05 was accepted as statistically significant. Of the total 5,167 patients, 2,811 (54.4%) were male. Scald burns were the most common cause of burns (81.4%). Contact burns accounted for 12.2% of all burns. There were no differences between sexes for any variable. The highest incidence was seen in children in the 2-5-year-old age group (28.3%). There were differences between age groups in terms of sex, burn area, burn visit, burn type, burn location, need for wound dressing under anesthesia, and need for grafting. Among the patients, 4.9% were hospitalized due to the need for wound dressing under anesthesia. However, most of the patients (95.1%) were treated as outpatients. In conclusion, the majority of pediatric burn patients can be treated as outpatients. This allows pediatric patients to complete treatment in a psychologically comfortable environment and have low complication rates. Outpatient treatment should become the standard for children who are suitable for outpatient follow-up and who have home support.

Cognition as a parameter in monitoring the effect of multiple sclerosis relapse treatment: A prospective controlled study

BACKGROUND

Cognitive evaluation was considered to be very important in the relapse period, on the basis of the presence of isolated cognitive attacks and the necessity of monitoring the patient both physically and cognitively.

MATERIALS AND METHODS

People with MS (pwMS) who were hospitalized during relapse were included in the study. All MS patients were evaluated by the neurologist with Expanded Disability Status Scale (EDSS), The 9 Hole Peg Test (9HPT) and the Timed 25-Foot Walk Test (T25-FWT). Additionally, all participants were examined cognitively with the Turkish version of the Brief International Cognitive Assessment for MS (BICAMS) battery. Also, schedules were indicated as during relapse before the treatment (pre-treatment) and the first month after relapse (1-month follow-up).

RESULTS

A total of 140 MS patients (mean age; 34.98±10.09, mean disease duration; 6.05±5.29 years) and 86 healthy controls (mean age; 36.94±10.83) were included to the present study. The mean EDSS scores in pre-treatment in MS patients was 2.74±1.14 and decreased significantly in the 1-month follow-up (1.74±1.24; p<0.001). The mean SDMT score was lower by 8.76 points in MS patients than in HCs) in pre-treatment and 7.66 points in 1-month follow-up (p<0.001). The mean SDMT scores of all participants increased with measurement time gradually (p<0.001).

CONCLUSION

In this study, it was detected which cognitive domains were affected after relapse treatment and cognitive changes in pwMS during relapse and remission periods compared to the healthy controls. All three BICAMS test scores significantly increased in one-month follow-up than the pre-treatment period. The results showed that CVLT-II and BVMT-R scores improved more in pwMS than in HCs, and also SDMT scores of pwMS showed a trend of increase, but was not a significant improvement.

Evaluation of the origin and educational quality of youtube videos on adrenaline auto-ınjectors

Summary

Background. Guidelines highlight the pivotal role of adrenaline auto-injector (AAI) training. However, the standards of visual training platforms has not been determined. Our aim was to evaluate the reliability and quality of the AAI related videos on YouTube. Methods. After a search on YouTube about AAI, all videos were categorized into groups based on their origin and the aim of the content. The quality, reliability, understandibility, and actionability of the videos were evaluated using the Global Quality Scale (GQS), Patient Education Materials Assessment Tool Audovisiual (PEMAT-A/V), Quality Criteria for Consumer Health Information (DISCERN), and a modified DISCERN. In each video, the application steps of AAI were evaluated according to a scale of correct usage. Results. 107 YouTube videos in English were included. No significant difference in terms of views, likes, duration and uploading time was observed between the health and non-health groups whereas the GQS (p=0.001), DISCERN (total: p=0.02, and overall: p=0.094), modified DISCERN (p=0.001) scores were higher in the health group. It was found that scores tended to be higher in educational videos. AAI use was mentioned in 85% videos. The median number of mentioned steps was 6. Conclusions. YouTube is an effective platform for visual learning for the use of AAIs. Although the visibility of the videos is equal independent of the origin, the ones recorded by medical professionals seem to provide the most qualified and reliable information.

Variables predicting clinical remission among adults with severe asthma treated with biologic agents

Summary

Background. Although biologic agents promise a short- to medium-term remission in asthma, it is unclear whether they can fundamentally alter disease course and achieve long-term remission. We aimed to investigate the clinical remission success of biologics in patients with severe asthma and the factors associated with remission. Methods. Adults followed-up due to severe asthma who were treated with mepolizumab or omalizumab were included in the study. Sociodemographic and clinical characteristics were reviewed. Subjects with and without clinical remission at 12 and 36 months were identified. Comparisons between the groups were made with univariate and multivariable analyses. Results. Seventy-four patients were included in the study. The mean age of subjects was 51.85 (standard deviation: 11.43) years, and 50 (67.57%) were females. The 12- and 36-month remission rates were 72.97% and 51.79%, respectively. Patients with and without remission were similar in terms of age and gender distribution. FEV1% predicted (p = 0.009) and FEV1/FVC ratio (p = 0.039) were significantly higher in those with remission at 12 months compared to those without. FEV1 (p less than 0.001), FEV1% predicted (p less than 0.001) and FEV1/FVC ratio (p = 0.004) were significantly higher in those with remission at 36 months compared to those without. Multivariable logistic regression revealed that higher FEV1% predicted was the only factor independently associated with remission for both time points. Conclusions. Omalizumab and mepolizumab provide significant clinical remission rates in severe asthma. FEV1% predicted is a variable that can independently predict clinical remission among severe asthmatics receiving biologic agents.

Oral immunotherapy in alpha-gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management?

BACKGROUND

Oral immunotherapy (OIT) is a promising treatment for food allergies. Our aim was to establish the long-term safety and efficacy of a novel red meat (RM) OIT in galactose-alpha-1,3-galactose (alpha-gal) allergy in adults.

METHODS

Out of 20 patients with confirmed RM allergy, five (41.66%) underwent an early OIT, seven (58.33%) underwent a delayed protocol and eight patients who were not desensitized formed the patient control group. 15 and 27 day RM OIT for early-onset and delayed-onset alpha-gal allergy were administered, respectively. Desensitized patients were recommended to continue eating at least 100 g RM every day for 6 months and every other day in the following 6 months. After a year, the consumption was recommended 2/3 times in a week. Patients were followed up with skin tests with commercial beef and lamb extracts, fresh raw/cooked beef and lamb and cetuximab and also with serum alpha-gal specific Immunoglobulin-E (sIgE) in the first and fifth years.

RESULTS

All patients who underwent OIT became tolerant to RM. During the 5 year follow-up, the median alpha-gal sIgE concentration gradually decreased in nine patients who consumed RM uneventfully while remained unchanged in the control group (p = .016). In two patients, rare tick bites acted as inducers of hypersensitivity reactions with concomitant elevation of alpha-gal sIgE concentrations whereas one patient with low follow-up alpha-gal sIgE concentrations consumed RM uneventfully after frequent tick bites.

CONCLUSIONS

Our study showed the long-term safety and efficacy of alpha-gal OIT. Additionally, alpha-gal sIgE seems to be a potential biomarker to monitor OIT.

Challenges, expectations, and cultural care experiences of nurses regarding migrant children receiving burn treatment and their caregivers: A qualitative study

BACKGROUND

Burn injuries in childhood create serious trauma for both children and their caregivers. Burn injuries require extensive nursing care to reduce complications and to restore optimal functional health conditions. When children receive burn treatment and their caregivers are migrants with different languages, religions, and habits, nurses must adopt a cultural approach while caring for such patients.

AIM

This descriptive qualitative study aimed to reveal the challenges, expectations, and cultural care experiences of nurses regarding migrant children receiving burn treatment and their caregivers.

METHOD

Purposive sampling was used to recruit the nurses (n = 12). Semi-structured face-to-face interviews were conducted with nurses using an interview guide, and the interviews were recorded. Thematic analysis was used to create themes in the study.

RESULTS

The data were gathered around three main themes: "challenges" with the subcategories "communication," "trust relationship," and "care burden"; "expectations for better care" with the subcategories "translator support" and "hospital environment"; and "intercultural care" with the subcategories "cultural-religious differences" and "intercultural sensitivity."

CONCLUSIONS

The results of this study provide a novel insight into nurses' experiences with migrant child patients and their caregivers, and can be used to develop action plans to provide effective cultural care for patients receiving burn treatment and their caregivers.

Is social appearance anxiety a reason for rejecting a hearing aid in geriatric patients?

OBJECTIVE

Hearing impairment is a global health problem due to its impact on quality of life and communication problems between individuals. Hearing aids are the recommended intervention, but use of hearing aids is low. In this study, the effect of social appearance anxiety on the decision to use a hearing aid was investigated.

PATIENTS AND METHODS

The study comprised 107 individuals aged 65-81 years who were offered hearing aids due to bilateral severe or moderate sensorineural hearing loss. The patients were divided into three groups, according to their hearing aid preferences and usage decisions. Social appearance anxiety scale was applied to all patients.

RESULTS

The mean age of the 107 patients included in the study was 70.19±5.35 years. The social appearance anxiety scores of those who did not want to use a hearing aid were much higher than those of whom desired to use a behind-the-ear or in-canal hearing aid. The social appearance anxiety scores of the patients who wanted to use in-canal hearing aids were also higher than the group who wanted to use behind-the-ear hearing aids.

CONCLUSIONS

In this study, which focused on the hearing aid candidate group who had never obtained a device, rather than why they stopped using a hearing aid, it was assumed that social appearance concern was relevant in the phase of receiving a hearing aid.

Weber's gland immune/histopathology in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases

OBJECTIVE

Recurrent tonsillitis and obstructive tonsillar hypertrophy are very common in childhood and constitute the two major causes of tonsillectomy in this age group. There is no study in the literature on the immune/histopathological changes in the recurrent and obstructive tonsillar hypertrophy of Weber's glands. In this study, we aimed to histopathologically and immunohistochemically examine the Weber's glands of pediatric patients with recurrent.

PATIENTS AND METHODS

A total of 63 patients, with 31 patients aged 6-9 who had surgery for recurrent tonsillitis, and 32 patients aged 6-11 years who had surgery for obstructive tonsillar hypertrophy, were included in the study. The removed Weber's glands were included in the obstructive tonsillar hypertrophy or recurrent tonsillitis group according to the patient's clinical diagnosis. All specimens were coded with a numbering method, where only the surgeon knew which patient was in which group. All specimens were evaluated in the same histology center and by the same histologist, unaware of the clinical diagnosis of the patients (blind).

RESULTS

The comparison of Weber's gland immunohistochemical parameter scores of the groups revealed that the scores of the RT group were significantly higher for all three parameters (VEGF: t=6.777; p<0.001), (EGFR: t=4.386; p<0.001), (IL-6: t=5.072; p<0.001). The comparison of the groups in terms of inflammation, basement membrane thickening, myoepithelial cell and glycoprotein accumulation revealed significantly higher Weber's gland evaluation scores in the RT group for all four parameters. (inflammation: t=7.794; p<0.001), (basement membrane thickening: t=6.582; p<0.001), [myoepithelial cell: t=3.693; p<0.001), (glycoprotein accumulation: t=5.287; p<0.001)].

CONCLUSIONS

Histopathological and immunohistochemical examination of Weber's gland in pediatric recurrent tonsillitis and obstructive tonsillar hypertrophy cases revealed inflammatory changes in both disease groups. As expected, inflammatory manifestations were more common in the recurrent tonsillitis group. Besides, inflammatory changes detected in Weber's glands of obstructive tonsillar hypertrophy cases without a history of tonsillitis may contribute to the Weber's gland hypothesis, which attempts to explain the etiology of peritonsillar abscess.

The cultural adaptation and validation of Turkish version of the satisfaction with appearance scale (SWAP-TR)

AIM

The aim of this study was to translate, culturally adapt and validate the Satisfaction with Appearance Scale (SWAP) into Turkish to be used in the context of pediatric burn care.

METHOD

This methodological study was conducted in two stages as Language Adaptation and Psychometric study. In the first stage, the Turkish scale was obtained after expert translations. A pilot study was conducted. After back-translation, and the scale was finalized. In the second stage, the scale was administered to 145 children with burns. Body Appreciation Scale for Children (BASC) was applied to the same group for correlation analysis with the scale.

RESULTS

A structure explaining 65.98 % of the total variance was obtained. Cronbach's alpha values in the range of 0.995-1000 were quite reliable. A statistically significant correlation was determined between the test and retest applications for all the items (0.99-1.00) in the positive direction (p < 0.001). There is a linear negative moderate correlation between BASC scores and the scores of the SWAP-TR scale (r = -0.621 p<0.001). The dissatisfaction scores of children with face, hand and leg burns are significantly higher than the other groups.

CONCLUSIONS

SWAP-TR is a reliable and valid instrument for use in a Turkish speaking children with burns. It is recommended to study the validity of this scale in other age groups with burns in Turkey.

Determination of Factors to Distinguish MIS-C from Acute Appendicitis in Children with Acute Abdominal Pain

INTRODUCTION

 The aim of this study was to make the differential diagnosis between acute appendicitis and multisystem inflammatory syndrome in children (MIS-C) for patients presenting with the complaint of acute abdominal pain (AAP) and to identify the determining factors for the diagnosis of MIS-C.

MATERIALS AND METHODS

 Eighty-one children presenting with AAP/suspected AAP were evaluated. Of these, 24 (29.6%) were included in the MIS-C group (MIS-C/g) and 57 were included in the suspected appendicitis group (S-A/g), which consisted of two subgroups: appendicitis group (A/g) and control observation group (CO/g).

RESULTS

 Comparing MIS-C/g, A/g, and CO/g, duration of abdominal pain (2.4, 1.5, 1.8 days), high-grade fever (38.8, 36.7, 37°C), severe vomiting, and severe diarrhea were higher in MIS-C/g. Lymphocytes count (LC) was lower, while values of C-reactive protein (CRP), ferritin, and coagulopathy were higher in MIS-C/g (p < 0.05). The optimal cutoffs for the duration of abdominal pain was 2.5 days; the duration of fever, 1.5 days; peak value of fever, 39°C; neutrophil count, 13,225 × 1,000 cell/µMoL; LC, 600 × 1,000 cell/µMoL; ferritin, 233 µg/L; and D-dimer, 16.4 mg/L (p < 0.05). The optimal cutoff for CRP was 130 mg/L (sensitivity 88.9, specificity 100%, positive predictive value 100%, NPV, negative predictive value 92.5%, p < 0.001). All patients in MIS-C/g tested positive by serology by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

CONCLUSION

 The duration of abdominal pain, presence of high-grade and prolonged fever, and evaluation of hemogram in terms of high neutrophil count and low LC exhibit high sensitivity and negative predictive value for MIS-C presenting with AAP. In case of doubt, inflammatory markers such as CRP, ferritin, D-dimer, and serology for SARS-CoV-2 should be studied to confirm the diagnosis.

POS0166 POLYARTICULAR JIA HAS A DISTINCT CO-INHIBITOR RECEPTOR PROFILE AMONG OTHER JIA SUBTYPES

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory joint disease in children, driven by continuous T-cell activation.[1] T cell activation is counter-balanced by signals generated by co-inhibitory receptors (co-IRs) such CTLA-4, PD-1, LAG-3, and TIM-3.[2]

Objectives

We aimed to identify the role of co-IRs in the pathogenesis of different subtypes of JIA.

Methods

In total, we included 107 patients with oligoarticular JIA (n=67), polyarticular JIA (n=12), enthesitis related arthritis (n=17), systemic JIA (n=11) and healthy controls (HC, n=10). We collected plasma samples from the patients during the active phase of their disease. We measured the soluble plasma levels of co-IRs by commercial pre-defined cytometric bead array kits and their cellular expression by flow cytometry in blood mononuclear cells. We compared the plasma levels and cellular expressions of different coIRs within different JIA subgroups.

Results

IL-2 levels were lower than HC in all JIA subgroups. The polyarticular JIA group distinguished from the four different JIA subgroups, by having different co-IR pattern. In this specific subgroup, CTLA4, PD-1 and 4-1BB levels were higher than other groups. Polyarticular JIA is the more chronic and severe form of JIA, especially when compared to oligoarticular JIA. (Figure 1).

Figure 1.

We investigated the correlations between disease activity markers and plasma co-IRs. Plasma TIM3 levels correlated with erythrocyte sedimentation rate, C-reactive proteins and JADAS in the polyarticular JIA group. In oligoarticular JIA group, JADASs correlated with plasma PD-1 levels, C-reactive protein with PD-L1 plasma levels. Erythrocyte sedimentation rates correlated with IL-2, CD86, PD-L1 and PD-1 plasma levels. There was no correlation between disease activity markers and co-IRs levels in the systemic JIA group and enthesitis related arthritis group.

Finally, we analysed the cellular surface expression of different co-IRs on the PBMCs of different JIA subtypes. Similar to plasma levels, both the percentage and the MFI (mean fluorescence intensity) of CTLA4 expression was higher in polyarticular JIA subgroup.

Conclusion

This is the first report studying the effects of different co-IRs in different subtypes of JIA. Polyarticular JIA patients had a different coIR profile, having more CTLA-4, PD-1 and 4-1BB in their plasma than the other subtypes of JIA

References

[1]Wedderburn, L.R., et al., Int Immunol, 2001. 13(12): p. 1541-50.

[2]Wherry, E.J. and M. Kurachi, Nat Rev Immunol, 2015. 15(8): p. 486-99.

Acknowledgements

This work was supported by a research grant from FOREUM Foundation for Research in Rheumatology

Disclosure of Interests

None declared

Analysis of risk factors of mortality for pediatric burned patients with inhalation injury and comparison of different treatment protocols

BACKGROUND

We present our approach of pediatric burned patients with the suspicion of inhalation injury.

METHODS

This retrospective study was conducted on children with the suspicion of inhalation injury admitted to our burn center from December 2009 to December 2019. We collected data on patient demographics, total burn surface area (TBSA), presence of inhalation injury, level of carboxyhemoglobin, grade of inhalation injury, duration of mechanical ventilation, reintubation rate, total length of hospital stay, and the mortality rate. We also reviewed the required treatment of patients with inhalation injury.

RESULTS

A total of sixty pediatric burn patients were suspected inhalation injury were included in this retrospective study. 40 pa-tients included in the study were male. Age average of the patients was 87.7 months. Total burned surface area average was 32%. 46 of these patients had inhalation injury. Patients with larger cutaneous burn and needed early intubation have a higher risk of inhalation injury. There was no significant relation between inhalation injury grades and mortality and treatment protocols. Higher levels of car-boxyhemoglobin and larger TBSA are the risk factors for mortality at univariate analysis. Pediatric patient with inhalation injury whose TBSA is higher than 47.5% has a 5 times higher risk of mortality at multivariate analysis.

CONCLUSION

This study demonstrated that TBSA is the risk factor that independently affects the mortality in pediatric patients with inhalation injury. Among the patients with higher than 47.5% burn surface area, the mortality rate rises 5 times.

The impact of bone marrow-derived mesenchymal stem cells on experimental testiculartorsion in rats

BACKGROUND

The aim of this study was to investigate the healing effects of bone marrow-derived mesenchymal stem cells (BMMSCs) on experimental testicular torsion in rats.

METHODS

Three groups consisting of 10 Wistar albino rats were created. In Group I, the left testicle was explored and relocated in the scrotum without any attempt to modify it. In Group II, the left testicle underwent torsion for three h and then was detorsed and relocated. In Group III, in addition to torsion and detorsion, BM-MSCs were administered intratesticularly. The rats were sacrificed on the seventh day, and the healing status of the testicles was investigated with histopathological and biochemical analyses. BM-MSC involvement was investigated by immunofluorescence microscopy. Statistical analysis was performed using SPSS 15.0. A p-value < 0.05 was considered statistically significant for all variables.

RESULTS

Immunofluorescence microscopy showed that BM-MSCs were located around the Leydig cells in Group III. Under light microscopy, the mean Johnsen Score of Group III was significantly higher than that of Group II (p = 0.035). The interleukin-10 (IL-10) level was significantly higher in Group III compared to Group II (p = 0.003). While the malondialdehyde (MDA) values in Group I (the control group) were lower than in the other groups (p = 0.037), the superoxide dismutase (SOD) values were similar (p = 0.158). Although there was no statistically significant difference between Group II and Group III in terms of MDA, it was lower in Group III. Although the tissue SOD levels were higher in Group III than in Group II, the difference was not statistically significant.

DISCUSSION

: This study has demonstrated that BM-MSCs significantly corrected the Johnsen Score and increased anti-inflammatory cytokine levels after testicular torsion. BM-MSCs can be used in testicular torsion as supportive therapy to minimize tissue damage.

A case report of antineutrophil cytoplasmic antibody-associated vasculitis and glomerular immune depositions

BACKGROUND

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disease leading to renal complications of pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN).

CASE DESCRIPTION

We present a 57-year-old female patient with rapidly progressive glomerulonephritis, multiple systemic infections [candidiasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], severe weight loss, arthralgia, positive myeloperoxidase ANCA, acute deterioration of cardiac function and NCGN with heavy deposition of immunoglobulin (Ig) A and complement 3 (C3) in kidney biopsy. After two months of follow-up and appropriate treatments [methylprednisolone (60 mg/day), cyclophosphamide (15 mg/kg)], our patient recovered from multiple life-threatening infections, including candidiasis treated by fluconazole and SARS-CoV-2 treated by methylprednisolone and acute cardiac failure. In addition, she was saved from dialysis despite all poor prognostic factors.

CONCLUSION

AAV might lead to immune complex deposition in kidneys due to different pathogenetic mechanisms like complement activation and immune complex formation, apart from losing tolerance to neutrophil proteins. HIPPOKRATIA 2022, 26 (2):86-88.

Approaches of 112 ambulance service staffers to children with burns: A survey assessment

BACKGROUND

We aimed to evaluate the knowledge of 112 ambulance service staffers (doctors, nurses, emergency medical technicians [EMTs], and paramedics [PMs]) who were the first intervention to pediatric patients with burn injuries regarding first intervention and patient transfer.

METHODS

The study included 373 personnel working in 112 ambulance services in Ankara province. Participants were asked 17 questions to measure their knowledge of burns in children. Statistical analysis was performed with the Statistical Package for Social Sciences 21.0.

RESULTS

Of the participants, 26 (7%) were doctors, 25 (6.7%) nurses, 180 (48.3%) EMTs, and 142 (35.3%) PMs. Of the participants, 118 stated that they always calculate the burn surface area, while only five (1.3%) marked the correct choice of the Lund Browder scheme to the question by which method they calculated. One hundred twenty one personnel (32.4%) use the Parkland formula to calculate the amount of fluid to be given during transfer while only 7 (1.9%) use the Galveston formula, which is more suitable for chil-dren. Of the participants, 56 (15%) answered as lactated Ringer's solution which is the correct fluid to the question of which fluid do you give at the scene and during the transfer. One hundred fifty-three participants (41%) responded correctly to the scenario question expected to recognize inhalation damage while only 138 (37%) responded correctly as 'I do immediately intubate' to the inhalation injury described scenario question. One out of 373 (0.3%) participants marked the appropriate procedure for a patient who had a 50% scald burn during the first intervention and transfer. The rate of topical lidocaine use of participants was high (70.8%). Of the 373 participants, only 33 (8.8%) thought themselves competent for first aid and transfer of children with burns. If training on the subject was held, 333 personnel (89.3%) wanted to participate.

CONCLUSION

It is expected that the knowledge of 112 ambulance services who see pediatric burn patients first, perform the first intervention, and provide transfer would be suitable. However, our questionnaire shows that these personnel have insufficient knowledge and need to be trained.

Comparison of Optical Forceps-Assisted Single-Port Laparoscopic PIRS and Open Surgery in Morgagni Hernia Repair

INTRODUCTION

 This study aimed to compare the results of classical surgery (CS) and optical forceps-assisted single-port laparoscopic percutaneous internal ring suturing (SP-PIRS) repair for the treatment of Morgagni hernia.

MATERIALS AND METHODS

 Patients with Morgagni hernia who were operated on between January 2005 and July 2020 were included in the study. Patients were divided into two groups (CS or SP-PIRS) and compared retrospectively in terms of demographic data, defect size, duration of hospitalization, costs, postoperative complications, and recurrence.

RESULTS

 Thirty-two patients were included in this study. There were no statistically significant differences between the groups in terms of gender, defect size, postoperative complications, and recurrence (p > 0.05). The SP-PIRS group had a shorter operation time (p < 0.01), shorter hospital stay (p = 0.02), and lower cost (p < 0.01) than the CS group. The average follow-up was 24 months, and recurrence was detected in two patients in each group.

CONCLUSION

 SP-PIRS repair is recommended because it is practical to perform and reduces the duration of surgery, hospital stay, and cost. It is superior to other laparoscopic techniques, as there is no need to use additional study forceps, except in extreme cases, and the surgeon can perform the procedure without an assistant to hold the laparoscope.

A unique case of a newborn with a hemangioma on the omphalocele sac

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The impact of bone marrow-derived mesenchymal stem cells on experimental testicular torsion in rats

BACKGROUND/AIM

The aim of this study was to investigate the healing effects of bone marrow-derived mesenchymal stem cells (BM-MSCs) on experimental testicular torsion in rats.

MATERIALS AND METHODS

Three groups consisting of 10 Wistar albino rats each were created. In Group I, the left testicle was explored and relocated in the scrotum without any attempt to modify it. In Group II, the left testicle underwent torsion for three hours and then was detorsed and relocated. In Group III, in addition to torsion and detorsion, BM-MSCs were administered intratesticularly. The rats were sacrificed on the seventh day, and the healing status of the testicles was investigated with histopathological and biochemical analyses. BM-MSC involvement was investigated by immunofluorescence microscopy. Statistical analysis was performed using SPSS 15.0. A p-value < 0.05 was considered statistically significant for all variables.

RESULTS

Immunofluorescence microscopy showed that BM-MSCs were located around the Leydig cells in Group III. Under light microscopy, the mean Johnsen Score of Group III was significantly higher than that of Group II (p = 0.035). The interleukin-10 (IL-10) level was significantly higher in Group III compared to Group II (p = 0.003). While the malondialdehyde (MDA) values in Group I (the control group) were lower than in the other groups (p = 0.037), the superoxide dismutase (SOD) values were similar (p = 0.158). Although there was no statistically significant difference between Group II and Group III in terms of MDA, it was lower in Group III. Although the tissue SOD levels were higher in Group III than in Group II, the difference was not statistically significant.

Evaluation of dynamic/thiol disulphide balance and ischaemia modified albumin in children with trauma

AIM

Trauma is the most common cause of death in childhood. Tissue damage, ischaemia-reperfusion injury and inflammatory response are mainly responsible for increasing free oxygen radicals. In this study, we aimed to investigate the use of thiol-disulphide and ischaemia-modified albumin levels as a diagnostic laboratory parameter in trauma children.

METHODS

Of 202 children, 101 were hospitalised in the paediatric surgical intensive care unit with trauma, and 101 were healthy children. Levels of native thiol (-SH), total thiol (SH + SS), dynamic disulphide (SS), dynamic disulphide (SS)/total thiol (SH + SS), albumin and ischaemic modified albumin (IMA) were measured from the sera of patients and healthy volunteers. For statistical analyses, SPSS 17.0 was used. Mann-Whitney U and paired correlation tests were used where appropriate. P < .05 was considered significant.

RESULTS

The mean age of the patients in the trauma group (boys: 61 girls: 40) was 7.88 years and the control group was 8.00 years. In the trauma group, 86 children were exposed to blunt trauma, 15 children had penetrating trauma and 54 patients had multiple trauma. Surgical procedures were performed on 17 patients. In the trauma group, native thiol, total thiol, dynamic disulphide/total thiol, albumin and IMA levels were significantly lower than that of the control (P < .001), and their dynamic disulphide (P = .001) was higher compared with the control. There was no difference thiol-disulphide parameters in trauma groups sub-division as surgery (n = 17) vs follow-up (n = 84) groups or multiple trauma (n = 54) vs isolated organ trauma (n = 47) groups or penetrating (n = 15) or blunt trauma (n = 86) groups.

CONCLUSION

Thiol-disulphide balance and IMA levels show changes in favour of oxidative stress in children with trauma; however, it cannot be used as a laboratory marker that helps to show the system and organ affected by the trauma and to decide the surgical intervention.

Management of a pediatric burn center during the covid-19 pandemic

The aim of this study was to evaluate the results of an algorithm that was created to prevent coronavirus disease-2019 (COVID-19) transmission during the management of children with burns in a tertiary pediatric burn center. Children admitted to the burn center between May 2020 and November 2020 were prospectively evaluated for cause, burn depth, total body surface area (TBSA), length of stay, symptoms suggesting COVID-19, suspicious contact history, history of travel abroad, and COVID-19 polymerase chain reaction (PCR) test results. Patients were divided into two groups: unsuspected (Group 1) and suspected (Group 2), depending on any history of suspicious contact, travel abroad, and/or presence of symptoms. A total of 101 patients were enrolled in the study, which included 59 boys (58.4%) and 42 girls (41.6%). Group 1 included 79 (78.2%) patients, and Group 2 consisted of 22 (21.8%) patients. The most common cause of the burns was scald injuries (74.2%). The mean age, TBSA, and length of stay were 4.5 years, 12.0%, and 13.2 days, respectively. Four patients (3.9%) had a positive PCR test (two patients in each group). Comparing groups, males were more commonly found in Group 2 (p=0.042), but no differences were found for the other variables. No patients or burn center staff members developed COVID-19 during the course of hospitalization. In conclusion, every child should be tested for COVID-19 upon admission to a burn unit, and a modified algorithm should be constructed for the handling and management of pediatric burn patients.

Approaches of Emergency Department Physicians to Pediatric Burns: A Survey Assessment

Burned children generally arrive at emergency departments before referring to specialized burn centers. Their initial treatments are performed by non-burn doctors who work in emergency departments. The aim of this study was to evaluate emergency department doctors' knowledge regarding the initial interventions and transfer of pediatric burn patients. There were 196 participants who completed the survey: 59 were emergency medicine specialists, 46 were general practitioners, and 91 were emergency medicine residents. Sixty-five stated that they always calculate the burn surface areas, and 144 stated that the Parkland formula should be used to calculate the fluid requirements for the first 24 hours. Of all participants, only 21 marked the correct choice as the Lund-Browder scheme to calculate the total burned surface area in children. Only 52 participants marked the correct choice as the Lactated Ringer's of the fluid given in the first 24 hours. Only 108 correctly recognized inhalation injury. To the question "What is the first intervention that doctors should do at the emergency room to burned children?," 127 participants stated correctly as the assessment of airway maintenance. Among the participants, 124 stated that they use lidocaine pomades when covering burned children's wounds. Incorrect interventions with burned children increase morbidity and mortality. This survey shows that non-burn doctors working in emergency departments have insufficient knowledge about pediatric burns and require further training. Therefore, they should be trained continuously and regularly on the approach to both adult and childhood burns.

OP0195 PLASMA CHECKPOINT PROTEIN LEVELS AND GALECTIN-9 IN JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic Lupus Erythematosus (SLE) is the prototype for a systemic autoimmune disease. SLE is a disease of the adaptive immune system where T lymphocyte dysfunction has an important role as well. Checkpoint proteins have become an important topic in the study of Tcell. The balance of T cell co-stimulatory and co-inhibitory receptors is important for the regulation of the adaptive immune system response.

Objectives:

In this study we aimed to assess the checkpoint proteins in childhood SLE patients

Methods:

Fourty-nine jSLE patients together with 15 age- and gender- matched controls were included. Clinical features, disease activity scores and laboratory parameters were recorded both retrospectively and at the time of samplimg. Patient samples were collected at their last visit, Plasma CD25 (IL-2Rα), 4-1BB, B7.2 (CD86), TGF-β1, CTLA-4, PD-L1, PD-1, Tim-3, LAG- 3, Galectin-9 levels were studied by the cytometric bead-based multiplex assay panel according to manufacturer’s instruction (LEGENDplex HU Immune Checkpoint Panel 1 (10-plex); catalogue number 740962, Biolegend) and analysed by Novocyte 3005 flow cytometer. Two-step cluster analysis procedure was conducted over the chosen 7 symptom status and 3 clusters were chosen for the final analysis

Results:

A total of 49 patients (71.4% female) diagnosed with SLE according to the SLICC criteria and 15 healthy controls (73.3% female) were included in the study. The mean age of the patients was 17.7 ± 2.6 years and the controls was 13.3±1.4 years. The median disease duration was 5.7 years. At the time of sampling fifteen of the patients had a SLEDAI score of zero (no activity), 21 of them had between 1-5 (mild activity), 7 of them had between 6-10 (moderate activity), 5 of them had between 11-19 (high activity), 1 of them had >20 (very high activity).

Galectin-9 and PD-L1 were significantly higher in SLE patients. Other checkpoint proteins and IL-2Rα were also higher but did not reach statistical significance. There were significant correlations between SLEDAI and IL-2Rα, Galectin-9 and PDL1. (Figure 1) There were three clinical clusters: Cluster 1 included patients with no major organ involvement, cluster 2 had predominantly haematological involvement (n=16) and cluster 3 (n=11) had predominantly renal involvement. Checkpoint proteins were not different among these three clusters.

Figure 1.Table 1.

Demographic, Clinical and Laboratory Features of Patients (n=49)

Female gender, n (%)35 (%71.4)Mean age at diagnosis, years (mean±SD)12.5±3.3Mean age at the time of inclusion, years (mean±SD)17.7±2.6Duration of illness, years (median/IQR)5.7 (3.0-7.0) yearsActive system involvement at study,n (%) Renal14 (28.5) Skin11 (22.4) Musculoskeletal9 (18.3) Hematologic9 (18.3) Neurologic1 (2.0) Serositis1 (2.0)Laboratory findings (median/minimum-maximum) Hemoglobin, gr/dl12.7 (7.3-18.3) WBC, /mm36.900 (2.600-26.200) Platelet, /mm3252.000 (39.000-529.000) Erythrocyte sedimentation rate, mm/hour10 (1-71) C-reactive protein, mg/dl0.1 (0-21.1) Complement 3, mg/dl87.6 (25.4-186.0) Complement 4, mg/dl15.3 (0-45.8) Anti-ds DNA, IU/ml12.8 (0-741.7) SLEDAI score (mean±SD)4.69±6.69

Conclusion:

Our data supports that Galectin 9 and IL-2Rα are good markers for disease activity in childhood SLE. We need larger series to evaluate differences between disease clusters in SLE. We failed to show a significant correlation with checkpoint proteins and SLEDAI except for PDL1.

References:

[1]Sharabi A and Tsokos GC. T cell metabolism: new insights in systemic lupus erythematosus pathogenesis and therapy. Nature reviews Rheumatology 2020; 16: 100-112

[2]Nishimura H, Nose M, Hiai H, et al. Development of lupus-like autoimmune diseases by disruption of the PD-1 gene encoding an ITIM motif-carrying immunoreceptor. Immunity 1999; 11: 141-151.

[3]McKinney EF, Lee JC, Jayne DR, et al. T-cell exhaustion, co-stimulation and clinical outcome in autoimmunity and infection. Nature 2015

[4]Wherry EJ and Kurachi M. Molecular and cellular insights into T cell exhaustion. Nat Rev Immunol 2015; 15: 486-499

Disclosure of Interests:

None declared

POS0074 CAN WE PREDICT THE DEVELOPMENT OF NEPHRITIS IN PEDIATRIC IGA VASCULITIS PATIENTS?

Background:

IgA vasculitis (IgAV) is the most common systemic vasculitis of childhood, characterized by palpable purpura, arthritis, gastrointestinal and renal involvement 1. It is a relatively self-limited disease apart from the renal involvement which is associated with the long term morbidity.

Objectives:

We aimed to define a marker at disease onset to predict the renal involvement.

Methods:

In this pilot study, we analyzed a targeted panel of vascular inflammation markers (sT2, RAGE, TIE-2, sCD40L, TIE-1, sFlt-1, LIGHT, TNF-a, PlGF, IL6, IL18, IL10 and MCP-1) in the plasma samples of eight patients IgAV at the onset of the disease, before any treatment was initiated. At the time of sample collection, none of the patients had renal involvement; four of these patients subsequently developed nephritis and were defined as the IgAVN group. The levels of the markers were studied by a cytometric bead-based multiplex assay panel according to manufacturer’s instruction (LEGENDplex HU Vascular Inflammation panel 2 (13-plex); catalogue number 740966, Biolegend) and analyzed by Novocyte 3005 flow cytometer.

Results:

There were no significant differences in gender, age, clinical manifestations, and laboratory findings between IgAV and IgAVN patients (Table 1). sCD40L levels were higher (median 1938.1 vs 754.9 pg/mL, p=0.04) whereas sST2 levels were lower (median 862.8 vs 2302.8 pg/mL, p=0.02) in the patients who developed IgAV nephritis (Figure 1). sRAGE levels were higher and IL18 levels were lower in IgAVN patients but did not reach statistical significance, probably due to the low number of patients. The other parameters did not show any specific pattern.

Table 1.IgAV (n=4)IgAVN (n=4)p valueGender2F, 2M1F, 3M0.49Age at disease onset9.0±5.410.3±3.40.68Arthralgia/arthritis50%75%0.49GIS involvement75%50%0.49Haemoglobine (gr/dL)12.4±2.312.3±0.60.95White blood cells, x109/L11150±19338525±14970.08Platelets x109/L290250±87328269250±387410.68Erythrocyte sedimentation rate (mm/hr)10.5±9.121.0±140.26C-reactive protein (mg/dL)0.63±0.031.16±0.960.39

Data are given as mean±SD

Figure 1.

Soluble CD40 ligand (sCD40L) is expressed on platelets and released on activation. It is proinflammatory for endothelial cells and promotes coagulation by inducing expression of tissue factor on monocytes and endothelial cells 2. It was investigated in acute coronary syndrome and was suggested as a risk factor for vascular damage. 2. Furthermore, the levels of sCD40L were shown to be correlated with disease activity in ANCA-associated vasculitis3. Thus in IgAV, sCD40L may be associated with the involvement of the kidney vasculature, which represents the more severe form of the disease. Receptor for advanced glycation end-products (RAGE) is another marker for endothelial damage and vasculitis which was higher in IgAVN, as well.

IL33 is expressed by epithelial and endothelial cells and overexpression of IL33 have been shown in large vessel vasculitis 4. sST2 acts as a decoy receptor and inhibits IL33 signalling4. It was interesting to see that the levels of the IL-18 and sST2, which are members of IL-1 family, were lower in IgAVN patients.

Conclusion:

Although the number of the patients were limited in this pilot study, we suggest that sCD40L and sRAGE might be used to predict the development of renal disease in IgAV patients. Further studies with larger number of patients are needed to confirm our findings.

References:

[1]Sag E, Batu ED, Ozen S. Childhood systemic vasculitis. Best practice & research Clinical rheumatology 2017;31(4):558-75.

[2]Heeschen C, Dimmeler S, Hamm CW, et al. Soluble CD40 ligand in acute coronary syndromes. The New England journal of medicine 2003;348(12):1104-11.

[3]Tomasson G, Lavalley M, Tanriverdi K, et al. Relationship between markers of platelet activation and inflammation with disease activity in Wegener’s granulomatosis. The Journal of rheumatology 2011;38(6):1048-54.

[4]Desbois AC, Cacoub P, Leroyer AS, et al. Immunomodulatory role of Interleukin-33 in large vessel vasculitis. Sci Rep 2020;10(1):6405.

Disclosure of Interests:

None declared.

Predictors of adequate intraprocedural premature ventricular complex (pvc) frequency during idiopathic pvc ablation

Funding Acknowledgements

Type of funding sources: None.

Background

The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs.

Methods

A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00–06:00) over day time (06:00–22:00) PVC burden was calculated. Patients were classified into three groups based on the relationship between hourly PVC number and HR. If there was a significant positive correlation between hourly PVC number and corresponding hourly HR, patients were classified into the fast HR-PVC group. If there was a significant negative correlation between hourly PVC number and corresponding hourly HR, patients were classified into the slow HR-PVC group. Patients were classified into the independent HR-PVC group if there was no significant correlation between hourly PVC number and corresponding hourly HR. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping.

Results

In all, 74 patients had frequent intraprocedural PVC that permitted activation mapping (Group 1) and 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure (Group 2). PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate (Fast HR-PVC 42 (56.8%) vs 18 (66.6%); slow HR-PVC  4(5.4%) vs 3 (11.1%); independent HR PVC 28 (37.8%) vs 6 (22.2%) in the respective order for group 1 and group 2; p: 0.26) or the ratio of night/day PVC burden (median 0.99 (IQR 0.4) vs median 0.83 (IQR 0.54) in the respective for group 1 and group 2 ; p: 0.53). Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. A Holter PVC burden ≥ 19.43% had 72% sensitivity and 60% specificity for the prediction of sufficient intraprocedural PVCs that permitted activation mapping and ablation (area under the curve: 0.65; p: 0.02)

Conclusion

The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.

Contribution of Bone Marrow-Derived Mesenchymal Stem Cells to Healing of Pulmonary Contusion-Created Rats

BACKGROUND

The most common thoracic injury in children, resulting in trauma, is pulmonary contusion (PC). Bone marrow-derived mesenchymal stem cells (BM-MSCs) are used in wound healing and many other diseases. This study aims to examine the effects of BM-MSCs on PC healing in rats.

MATERIALS AND METHODS

A total of 45 male Wistar albino rats were used. Four groups were formed. BM-MSCs were labeled with the green fluorescent protein. PC was observed in the control group. In group II, PC occured and left to spontaneous healing. In group III, PC formed and BM-MSCs were given. In group IV, BM-MSCs were given without PC formation. Subjects were sacrificed 1 week later. Whether there was any difference in terms of BM-MSC involvement and lung injury score was investigated. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 17.0, software (SPSS Inc., Chicago, IL), and p value of <0.05 was considered statistically significant.

RESULTS

BM-MSCs were collected much more in the lungs in group III than in group IV. Group III had a lower lung injury score value than group II.

CONCLUSION

The greater involvement of the BM-MSCs in the injury site, and further reductions in lung injury score suggest that BM-MSCs are contributing to the healing of the injury. The use of BM-MSCs in risky patients with diffuse PC may be an alternative treatment to conventional methods.

Electrical Injuries in Children: A 10-Year Experience at a Tertiary Pediatric Burn Center

Electrical injuries comprise 4% of cases but have higher morbidity and mortality. This study aims to share our experiences with pediatric electrical injuries and propose strategies to prevent them. The files of pediatric electrical injuries between 2010 and 2020 were reviewed retrospectively. The following were investigated: age, gender, cause, length of stay in the pediatric burn center, total burned surface area, voltage-type, and surgical procedures performed. The patients from low- and high-voltage groups were compared. Eighty-five patients were treated in the last 10 years. Seventy were males, the mean age was 9.9 years, the average length of stay in pediatric burn center was 18.2 days, and the average total burned surface area was 11.7%. Forty-three patients were injured with high-voltage and 42 with low-voltage electricity. Fasciotomy was performed in 25 patients, grafting in 40 patients, and amputation in 12 patients. The most often amputated limb was the right arm/forearm. Psychiatric disorders developed in 24 patients. One patient died. In conclusion, the incidence of high-voltage electrical injuries increases with age. They are more prevalent in males, more often accompanied by additional trauma, and have higher total burned surface area, surgical procedures are performed more often, and hospitalization times are longer. For prevention, precautions should be taken by governments and families, and education is critical.

Carbonic anhydrase I and II autoantibody levels in primary hypertension: our preliminary results

OBJECTIVE

The pathogenesis of primary hypertension (HT) is still not completely clear, although autoimmunity has been implicated in recent years. Carbonic anhydrase (CA) is an enzyme involved in a number of important metabolic processes. CA I and II autoantibodies have been linked to various autoimmune diseases. However, CA I and II autoantibody levels in primary HT have not been previously investigated. The purpose of this study was, therefore, to investigate levels of CA I and II autoantibodies in primary HT.

PATIENTS AND METHODS

Fifty-six patients newly diagnosed with primary HT and 33 healthy individuals were included in the study. Twenty-four-hour ambulatory blood pressure monitoring was performed following office controls. Blood specimens were collected under appropriate conditions for CA I and II autoantibody level investigation and biochemical tests. Urine sodium and protein excretion were measured after 24 h. Demographic and biochemical parameters and CA I and II autoantibody levels were then compared between the patient and healthy groups.

RESULTS

CA II autoantibody and uric acid levels were significantly higher in the hypertensive group than in the control group (p=0.005, and p<0.001, respectively). CA II autoantibody (exp ß: 79.06 CI: 4.44-1407.02) (p=0.003) and uric acid elevation (exp ß: 2.10 CI: 1.31- 3.34) (p=0.002) were identified as independent predictors of HT development at logistic regression analysis.

CONCLUSIONS

CA II autoantibody levels were higher in hypertensive patients, and this elevation is an independent predictor of HT development.

Preliminary report of in vitro and in vivo effectiveness of dornase alfa on SARS-CoV-2 infection

Dornase alfa, the recombinant form of the human DNase I enzyme, breaks down neutrophil extracellular traps (NET) that include a vast amount of DNA fragments, histones, microbicidal proteins and oxidant enzymes released from necrotic neutrophils in the highly viscous mucus of cystic fibrosis patients. Dornase alfa has been used for decades in patients with cystic fibrosis to reduce the viscoelasticity of respiratory tract secretions, to decrease the severity of respiratory tract infections, and to improve lung function. Previous studies have linked abnormal NET formations to lung diseases, especially to acute respiratory distress syndrome (ARDS). It is well known that novel coronavirus disease 2019 (COVID-19) pneumonia progresses to ARDS and even multiple organ failure. High blood neutrophil levels are an early indicator of COVID-19 and predict severe respiratory diseases. Also it is reported that mucus structure in COVID-19 is very similar to that in cystic fibrosis due to the accumulation of excessive NET in the lungs. In this study, we showed the recovery of three individuals with COVID-19 after including dornase alfa in their treatment. We followed clinical improvement in the radiological analysis (two of three cases), oxygen saturation (Spo₂), respiratory rate, disappearance of dyspnoea, coughing and a decrease in NET formation and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load after the treatment. Also here, we share our preliminary results suggesting that dornase alfa has an anti-viral effect against SARS-CoV-2 infection in a green monkey kidney cell line, Vero, and a bovine kidney cell line, MDBK, without determined cytotoxicity on healthy peripheral blood mononuclear cells.

SAT0497 A PILOT PROTEOMIC ANALYSIS OF PLASMA BIOMARKERS IN IgA VASCULITIS

Background:

IgA vasculitis/ Henoch Schönlein Purpura (IgAV/HSP) is the most common vasculitis of childhood, characterized by the IgA1 immune deposits in the small vessels. Although it is very common, the understanding of its molecular pathogenesis is still very limited.

Objectives:

We aimed to analyse plasma proteomes of IgAV/HSP patients using nano liquid chromatography – tandem mass spectrometry (nLC-MS/MS) to investigate the disease pathogenesis.

Methods:

IgAV/HSP was diagnosed according to the Ankara criteria in 2008 (1). Five active IgAV/HSP patients and two age and gender-matched health controls were enrolled in this pilot study. Serum samples from subjects were collected on the same day of IgAV/HSP diagnosis and before steroid or other immunosuppressive treatment initiated. Sample preparation was carried out using PreOmics İST Kit. We investigated the alteration of serum proteome using the nano LC-MS/MS approach. Bruker raw files were analyzed using the proteomics software Max Quant (1.6.7.0). The human reference proteome set from UniProt was used to identify proteins. Proteomic data were analyzed with Perseus 1.6.7.0.

Results:

The data file includes peptide and protein identification, accession numbers, protein and gene names, sequence coverage and label free quantification (LFQ) values of each sample. 345 proteins were reported per sample. Identifications from the reverse decoy database, identified by site only and known contaminants were excluded. Data were log transformed. Two sample T-test was performed between groups. We identified 23 significantly different expressed proteins (Table 1). Mainly the differentially expressed proteins were in the Ig and complement pathway, innate immune inflammatory, and were among the structural cytoskeletal filaments. The levels of Complement C3, Apolipoprotein E, Glyceraldehyde-3-phosphate dehydrogenase, Filamin-A, Alpha-1B-glycoprotein, Tubulin beta-1 chain, Lipopolysaccharide-binding protein, Ig mu chain C region were significantly higher in IGAV patients.

Table 1.

List of differentially expressed proteins identified in IgAV compared to healthy controls

Majority protein IDsProtein namesGene namesp-valueO75822Eukaryotic translation initiation factor 3 subunit JEIF3J0,004P05106;H3BM21Integrin beta-3ITGB30,008P02743Serum amyloid P-componentAPCS0,015A0A0J9YX35unknown0,015A2NJV5;A0A075B6S2unknownIGKV A18;IGKV2D-290,021P02679Fibrinogen gamma chainFGG0,022A0A0C4DH36unknownIGHV3-380,024P0DP03;P01768Ig heavy chain V-III region CAM0,024O14791Apolipoprotein L1APOL10,025P01024Complement C3C30,030P02675Fibrinogen beta chain; Fibrinopeptide BFGB0,030P01860Ig gamma-3 chain C regionIGHG30,031A0A075B7D8unknownIGHV3OR15-70,034P02649Apolipoprotein EAPOE0,035P04406Glyceraldehyde-3-phosphate dehydrogenaseGAPDH0,037A0A075B6R2;A0A087WW49unknownIGHV4-40,039P21333Filamin-AFLNA0,043P04217Alpha-1B-glycoproteinA1BG0,045P02790HemopexinHPX0,046A0A0C4DH25unknownIGKV3D-200,047Q9H4B7Tubulin beta-1 chainTUBB10,049P18428Lipopolysaccharide-binding proteinLBP0,049P01871Ig mu chain C regionIGHM0,050

Conclusion:

This pilot proteomic study may provide us a perspective in the pathogenesis of IgAV (HSP).

References:

[1]Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis 2010;69(5):798e806.

Disclosure of Interests:

Selcan Demir: None declared, Melis Sardan: None declared, Idil Yet: None declared, Erdal Sag Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Yelda Bilginer Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Ömür Celikbicak: None declared, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis

SAT0203 SINGLE LAC POSITIVITY VERSUS DOUBLE AND TRIPLE POSITIVITY FOR THROMBOSIS IN SLE

Background:

The antiphospholipid syndrome (APS) is defined by the development of venous and/or arterial thromboses, and pregnancy morbidity, in the presence of antiphospholipid antibodies (aPL); lupus anticoagulant, moderate-to-high titer anticardiolipin (aCL) and anti-β2-glycoprotein (aB2GPI). It has been suggested that the incidence of thromboembolic events were significantly higher in the triple positive subjects, and the rate of pregnancy loss was also significantly much higher in double positive subjects (1). On the other hand several studies showed that LAC is more highly associated with thrombosis risk (2).

Objectives:

We aimed to investigate the risk of thrombosis in Systemic Lupus Erythematosus (SLE) patients with single LAC positivity versus double and triple positivity in Hopkins Lupus Cohort.

Methods:

The Hopkins Lupus Cohort is a prospective longitudinal cohort of SLE patients ongoing since 1987. This analysis was based on cohort experience from 2003 through October 2019. Anticardiolipin and anti-Beta2 glycoprotein were defined as positive when the antibody titer exceeded 20 units. The lupus anticoagulant was determined by dilute Russell’s viper venom time (dRVVT) and confirmatory mixing studies, if prolonged. It is defined as positive if a patient had a dRVVT of 45 or more second and a positive confirm ratio of more than 1.4. For each aPL, we defined the patient as positive at a given month of follow up if they ever had a positivity in previous measures. The relationships between thrombosis and aPL were adjusted for number of prior aPL assessment.

Results:

There were 805 patients with a complete profile of 7 antiphospholipid antibodies, with a total of 73417 person months (6118 person years) of follow up. For any thrombosis when compared to patients with LAC positivity only, double positivity with any isotypes [1.15(0.50, 2.66) p=0.7484] and triple positivity with any isotypes [1.68(0.74, 3.80), p=0.2145] showed a higher point estimates but statistically not significant (Table 1).

Table 1.

Single, double and triple positive patterns and the risk of any thrombosis.

PatternNumber of eventsPerson-yearsRate per 1000 person-yearsadjusted RR (95% CI)p-valueLAC positivity only1063315.81.00 (Ref)Never any aPL33258112,80.73(0.36, 1.47)0.3819any aCL positivity only67937,60.43(0.16, 1.18)0.1028any aB2GPI positivity only751713,50.78(0.30,2.05)0.6195any aCL and aB2GPI positivity only540412,40.71(0.24,2.04)0.5211LAC and ACL positivity740617,31.15(0.50,2.66)0.7484LAC and aB2GPI positivity1249024,5Triple positivity01470,01.68(0.74,3.80)0.2145

Conclusion:

We found that triple or double positive aPL profiles are not superior to single LAC positivity in their association with any thrombosis in SLE patients.

References:

[1]Pengo V, Ruffatti A, Del Ross T, Tonello M, Cuffaro S, Hoxha A, Banzato A,Bison E, Denas G, Bracco A, Padayattil Jose S. Confirmation of initial antiphospholipid antibody positivity depends on the antiphospholipid antibody profile. J Thromb Haemost. 2013 Aug;11(8):1527-31.

[2]Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003; 101(5):1827-32.

Disclosure of Interests:

Selcan Demir: None declared, Jessica Li: None declared, Laurence Magder: None declared, Michelle A Petri Grant/research support from: GSK, Eli Lilly and Company, Consultant of: Eli Lilly and Company

P1371Catheter-induced premature ventricular complexes (pvc) may aid in the determination of optimal timing for clinical pvc ablation

Background

There is significant interpatient variability regarding the timing of the earliest local activation relative to surface QRS during premature ventricular complex (PVC) ablation. The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs.

Methods

Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 01/07/2018 and 01/07/2019 constituted our study population.  Catheter-induced PVCs were generated at the site with presumptive PVC origin according to the ECG criteria during the procedure of PVC ablation. Five PVCs were induced by mechanical stimulation in separate points, and the time interval between the beginning of EGM at catheter tracing and the beginning of the QRS complex of each catheter-induced PVC was noted. The mode of five time intervals (Cath EGM-ECG) was used in the analysis. The time interval between the beginning of local EGM of clinical PVCs at the earliest site and the beginning of the QRS complex of clinical PVCs (PVC earliest EGM-ECG) was also noted. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG.

Results

Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG (Table 1). A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population (Figure 1).

Conclusion

The results of the present study indicate that catheter-induced PVCs generated at the site of the presumptive source of origin of clinical PVCs may guide the timing of the earliest site during clinical PVC ablation. Further studies are required to validate our results and test the predictive value of Cath EGM- ECG interval for long-term success of PVC ablation.

Table 1 PVC earliest EGM-ECG &lt; Cath EGM- ECG PVC earliest EGM-ECG ≥ Cath EGM- ECG Ablation successful (n:52) 9 (17.3%) 43 (82.7%) Ablation not successful (n:11) 11 (100.0%) 0 (0%) Outcome of ablation in general patient population according to the relationship between PVC earliest EGM-ECG and Cath EGM- ECG

Abstract Figure 1

P1507Experience in chronical lead extraction with ablation catheter and snare via femoral route

Background

  Transvenous lead extraction may become a complicated process and special sheath systems used for extraction may not be available in the laboratory. Transvenous lead extraction from femoral vein by using ablation catheter and snare may be an alternative and cost-effective method to transvenous lead extraction with specialized lead extraction sheaths. The aim of the present study is to evaluate the factors that may be associated with the use of transfemoral technique during extraction of chronically implanted leads.

Methods

We retrospectively analyzed consecutive patients who underwent transvenous extraction of pacemaker, cardiac resynchronization therapy (CRT) and intracardiac defibrillator (ICD) leads in our institution in between 01.01.2016 and 01.01.2019. The indications for lead extraction were based on the European Heart Rhythm Association recommendations.  Manual traction was applied to all leads at the beginning of each case. If manual traction was not successful, a subclavian approach by using locking stylet (Liberator Universal Locking Stylet, Cook Medical)  or femoral approach was used. Femoral approach was performed using the flexible 13F long sheath and a second sheath for ablation catheter. Ablation catheter was wrapped around the lead and the tip of the ablation catheter was caught with gooseneck snare. Downward traction was applied on the body of the lead by using ablation catheter and gooseneck snare complex to release either end of the lead.

Results

A total of 160 leads in 94 patients were extracted during the time interval between 01.01.2016 and 01.01.2019. The indications for extraction were cardiac device related pocket erosion and infection  in 71 (75.6%) and lead failure in the 23 (24.4%) cases. Extracted system was ICD in 48 (51.1%), CRT in 9 (9.6%) and pacemaker in 37  (39.3%) cases. The median time from the preceding procedure was 62.5 (IQR:32.3- 95.3) months. Lead extraction was performed by manual traction in 35 (37.2%) patients, by locking stylet method in 7 (7.4%) and by femoral approach in 52 (55.3%) patients. Clinical success was achieved in  93 (98.9%) cases and all of the patients discharged uneventfully without a major complication as death, cardiac avulsion or tear requiring pericardiocentesis or emergent surgery. Procedural success with femoral approach was achieved in 51/52 (98%) patients (99 leads). Ordinal regression revealed  the time from the preceding procedure as the only parameter that was significantly associated with the usage of femoral approach (OR:1.065 ( 95% CI 1.039-1.100) p &lt; 0.001).

Conclusion

Based on our experience, transfemoral approach by using ablation catheter and gooseneck snare seems to be an effective and safe method for chronically implanted lead extraction. It may be particularly be useful when manual traction is unsuccessful and special toolkids are not available for extraction.

SAT0487 PREDICTIVE BIOMARKERS OF I IgA VASCULITIS WITH NEPHRITIS BY METABOLOMIC ANALYSIS

Background:

IgA vasculitis/ Henoch Schönlein Purpura (IgAV/HSP) is the most common vasculitis of childhood and renal involvement is the most serious long-term complication. A better understanding of the pathophysiology of the progression to kidney disease is required for better treatment to be achieved and current biomarkers of Ig A vasculitis with nephritis (IgAVN) lack the predictive value.

Objectives:

In this study, an untargeted metabolomics approach was performed to reveal the underlying molecular mechanism of disease pathogenesis and to find potential biomarkers of plasma samples from patients with IgAV and IgAVN.

Methods:

IgAV/HSP was diagnosed according to the Ankara criteria in 2008 (1). Forty-five patients, including 39 active IgAV patients (H), 6 IgAVN (N), and 6 age- and gender-matched healthy controls (C), were enrolled in the study. Plasma samples from subjects were collected on the same day of IgAV(HSP) diagnosis and before steroid or other immunosuppressive treatment initiated. This study has utilized liquid chromatography-mass spectrometry (LC-MS/ Q-TOF) to investigate the alterations in plasma metabolomic profiles. Three separate pools, health controls, active IgAV, and IgAVN were created. Peak picking, grouping, and comparison parts were performed (metabolite profiling) via XCMS (https://xcmsonline.scripps.edu/) software.

Results:

Totally 2618 peaks were detected for group H, N and C. Among them 355 peaks were found to be statistically significant and reliable (p<0.05) and 155 of these peaks were found to be changed (fold change >1.5) between the groups C and H. On the other hand, 66 peaks were found to be changed (fold change >1.5) between the groups H and N. The number of the peaks on the intersection of the peaks found to be changed between the groups (C and H) and (H and N) was 39. This situation was illustrated in Figure 1. Based on putative identification results, 15 peaks were matched with 24 metabolites. The list of these metabolites is given in Table 1.

Table 1.

Putative identification of 15 peaks found to be statistically different and having fold changes.

PeakPutative IdentificationKEGG Codesrt (min)N/H15-AminopentanamideC009902,100,3615-Aminopentanoic acidC004312,100,3612-Keto-6-aminocaproateC032392,100,361(S)-5-Amino-3-oxohexanoateC036562,100,361D-1-Piperideine-2-carboxylic acidC040922,100,362OxalureateC0080215,520,503PorphobilinogenC0093114,789,624(+)-cis-3,4-Dihydrophenanthrene-3,4-diolC0446815,520,025(-)-trans-CarveolC0096412,691,826DHAP(18:0)C0380512,701,926N-Acetyl-b-glucosaminylamineC0123912,701,9275-Methyltetrahydrofolic acidC0044014,882,418N2-Succinyl-L-ornithineC0341515,520,058N6-Acetyl-LL-2,6-diaminoheptanedioateC0439015,520,059EstroneC0046812,711,9010N-Acetyl-4-O-acetylneuraminic acidC0401514,892,4110N-Acetyl-7-O-acetylneuraminic acidC0401614,892,4111Oleoyl-CoAC0051015,520,2612SaccharopineC0044915,520,2613Prostaglandin D2C0069617,812,0513Prostaglandin I2C0131217,812,0514Glycocholic acidC0192113,780,6115GalactosylsphingosineC0174724,410,4515GlucosylsphingosineC0310824,410,45Figure 1.

The number of the peaks found on datamining process

Conclusion:

Certain differences in metabolites were identified between controls and IgAV patients and between those with and without kidney involvement.

References:

[1]Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria. Ann Rheum Dis 2010;69(5):798e806.

Disclosure of Interests:

Selcan Demir: None declared, Mustafa Çelebier: None declared, Ozan Kaplan: None declared, Erdal Sag Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Yelda Bilginer Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis

OP0288 ANTI-IL1 TREATMENT IN COLCHICINE RESISTANT PEDIATRIC FMF PATIENTS-REAL LIFE DATA FROM THE HELIOS REGISTRY

Background:

FMF is a prototype of autoinflammatory diseases associated with excess IL1 production. Anti-IL1 treatments are the first-line alternatives in colchicine resistant/intolerant FMF patients.

Objectives:

We aimed to investigate the efficacy and safety of anti-IL1 treatment in pediatric FMF patients in our local (HELIOS) registry.

Methods:

HELIOS (Hacettepe univErsity eLectronIc research fOrmS) is a web-based biological drug registry for pediatric rheumatology patients (helios.hacettepe.edu.tr). Data were recorded at biological treatment onset (month 0), at month 6 and yearly thereafter in patients. We have analysed the clinical features, disease activity parameters, treatment responses and safety outcomes in FMF patients treated with anti-IL1 agent.

Results:

Forty pediatric FMF patients were included to the study group (67% female).

Thirty-four patients received continous anti-IL1 treatment. The mean age at the start of the colchicine was 5.55±3.87 years. Age at onset of the anti-IL1 treatment was 11.47±5.41 with a mean follow-up duration of 3.87±1.96 years. Apart from two patients, all of them had biallelic exon-10 mutations.

We have also given anti-IL1 treatment on an on-demand basis in six adolescent patients. Five of them were having very severe attacks during menstrual periods and one was having attacks during extreme stress periods along with very high CRP levels. The quality of life has markedly improved and these patients no longer reveal any CRP elevation.

Anakinra was used as the first-line anti-IL1 treatment. During the last visit, six patients were treated with anakinra and 28 patients were treated with canakinumab. Anti-IL1 treatment decreased the CRP levels, number and severity of the attacks. (Figure 1.) There were three hospitalizations reported due to mild infections. Eleven patients had local skin reactions, two patients had leukopenia with anakinra and one patient had thrombocytopenia with canakinumab. We have discontinued anti-IL1 treatment until the cytopenia subsided. We have switched to on-demand therapy in one patient, started the same treatment and gradually increased the dose in the other two patients. There were no malignancy or other severe adverse reactions.

Figure 1.

Conclusion:

Anakinra and canakinumab are efficient and safe alternatives in colchicine resistant and intolerant pediatric FMF patients. We also for the first time, report on-demand use of anti-IL1 in pediatric FMF patients. We suggest that on-demand treatment should be considered under certain circumstances where the trigger is known and short-lasting (such as menstruation and periods of extreme stress)

Acknowledgments:

Authors would like to thank Elif Arslanoglu Aydin, Armagan Keskin, Kubra Yuksel and Emil Aliyev for their contribution to the HELIOS registry

Disclosure of Interests:

Erdal Sag Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Fuat Akal Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Erdal Atalay Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Ummusen Kaya Akca Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Selcan Demir Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Dilara Demirel Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Ezgi Deniz Batu Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Yelda Bilginer Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis

FRI0163 ANTIPHOSPHOLIPID PATTERNS PREDICT THE RISK OF THROMBOSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

It is well known that Lupus anticoagulant (LAC) positivity is more strongly associated with both arterial and venous thrombosis than either anticardiolipin (aCL) or anti-β2glycoprotein (aB2GPI) antibodies (1). An unanswered question is the contribution of which combinations of positive aPLs to thrombosis risk.

Objectives:

We aimed to evaluate which aPL combinations increase the risk of future thrombosis in patients with Systemic Lupus Erythematosus (SLE).

Methods:

This prospective analysis included SLE patients who had been tested for all 3 aPLs in Hopkins Lupus Cohort. We constructed a dataset with one record per month of follow up for each patient. Rates of thrombosis for each aPL or each combination of aPL were calculated as the number of thromboses divided by the number of person months at risk and the results are converted to rates per 1000 person-years.

Results:

There were 805 patients with a complete profile of 7 aPLs with a total of 73417 person months of follow up. LAC was the most predictive of any [3.47 (1.96, 6.14) p<0.0001], venous [4.3 (1.99, 9.25) p=0.0002], and arterial [3.37 (1.51, 7.53) p= 0.0029] thrombosis. In individual models, aB2GPI positivity was a significant risk factor for any [1.90 (1.16, 3.13) p=0.0113] and venous [2.3(1.23, 4.61) p=0.0103] thrombosis. When we looked at patients who were LAC positive, and asked if having another positive aPL increase the risk ratio for any/venous/arterial thrombosis, we found that having aB2GPI IgA appeared to add significant risk to any [1.68 (1.01, 2.79) p=0.044], and venous [2.01 (1.02, 3.97) p=0.043] thrombosis among those with or without LAC (Table 1).

Table 1.

Additive effect of other aPLs adjusting for LAC

ANY thrombosisVENOUS thrombosisARTERIAL thrombosisage adjusted RR 95%(CI)P-valueage adjusted RR 95%(CI)p-valueage adjusted RR 95%(CI)p-valueModel 1: LAC + aCL-GLAC (+) vs (-)3.78 (2.08, 6.85)<.00015.03 (2.25, 11.24)<.00013.32 (1.43, 7.73)0.0053aCL-G (+) vs (-)0.64 (0.22, 1.83)0.40450.48 (0.11, 2.14)0.33511.09 (0.31, 3.77)0.8962Model 2: LAC + aCL-MLAC (+) vs (-)3.82 (2.13, 6.87)<0.00014.57 (2.07, 10.08)0.00023.69 (1.61, 8.46)0.0021aCL-M (+) vs (-)0.51 (0.16, 1.65)0.25760.68 (0.16, 2.93)0.60190.61 (0.14, 2.64)0.5075Model 3: LAC+ aCL-ALAC (+) vs (-)3.34 (1.88, 5.96)0.00014.14 (1.9, 9)0.00033.29 (1.47, 7.38)0.0038aCL-A (+) vs (-)2.33 (0.56, 9.70)0.24592.44 (0.32, 18.4)0.38582.2 (0.29, 16.49)0.4415Model 4: LAC+ aB2GPI-GLAC (+) vs (-)3.52 (1.94, 6.39)0.00014.21 (1.85, 9.57)0.00063.4 (1.48, 7.79)0.0038aB2GPI-G (+) vs (-)0.91 (0.32, 2.61)0.86551.1 (0.31, 3.88)0.88490.96 (0.22, 4.18)0.957Model 5: LAC+ aB2GPI-MLAC (+) vs (-)3.53 (1.97, 6.31)0.00214.17 (1.9, 9.14)0.00043.58 (1.58, 8.1)0.0023aB2GPI-M (+) vs (-)0.91 (0.49, 1.73)0.77821.17 (0.51, 2.68)0.71010.74 (0.29, 1.9)0.5285Model 6: LAC+ aB2GPI-ALAC (+) vs (-)3.16 (1.77, 5.65)0.00013.68 (1.68, 8.08)0.00123.19 (1.41, 7.2)0.0052aB2GPI-A (+) vs (-)1.68 (1.01, 2.79)0.04412.01 (1.02, 3.97)0.04341.4 (0.67, 2.91)0.3738

Conclusion:

Our study shows that LAC is still the best predictor of risk of any, arterial and venous thrombosis in SLE. Moreover, aB2GPI IgA positivity appeared to add also a significant risk to any and venous thrombosis. Therefore, the clinical significance of IgA anti-β2GPI deserves further investigation in SLE patients.

References:

[1]Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003;101(5):1827-32.

Acknowledgments:

The Hopkins Lupus Cohort was funded by NIH grant number RO1 AR069572.

Disclosure of Interests:

Selcan Demir: None declared, Jessica Li: None declared, Laurence Magder: None declared, Michelle A Petri Grant/research support from: GSK, Eli Lilly and Company, Consultant of: Eli Lilly and Company

A serious complicatıon of liver hydatid cysts in children: cystobiliary fistulas

AIM

We aimed to determine predictive factors for predicting cystobiliary fistulas (CBF) in children after treatment of liver hydatid cyst (LHD).

METHODS

The records of patients who were treated for LHD between 01.06.2009 and 1.06.2019 were retrospectively reviewed. Age, sex, laboratory test results, size and number of cysts, method of first intervention (percutaneous or surgery), whether or not CBF developed and how it was treated were investigated. Among findings, those could be predictive were investigated. Data were evaluated with SPSS 21.0 program, p < 0.05 was considered significant.

RESULTS

Of the 97 patients, 48 (49.5%) were male, 49 (50.5%) female, the mean age was 11.2 years, Eighty patients had right (82.5%), 13 had left, and 4 had bilobar involvement. As first intervention, surgery was performed in 39 (40.2%); percutaneous treatment was performed in 58 (59.8%) patients. In 8 patients (20.5%) in surgery group and in 6 patients (10.3%) in percutaneous group, totally in 14 patients (14.4%), CBF developed. The mean cyst diameter of CBF-developed group was 114.36 mm, and of CBF-undeveloped group was 74.30 mm. There was no statistically significant differences between groups in terms of age, sex, involved lobe, other organ involvement, and preoperative results (p > 0.5). There was a significant relationship between the cyst diameter and the rate of CBF development in both surgical and percutaneous groups (p < 0.05). ROC analysis was performed, and the cut-off value for the development of CBF detected as 69 mm for children. Since obstructive jaundice seen in adults is not common in children, an increase in liver function tests and bilirubin levels were not seen in our patients.

CONCLUSION

A significant correlation was found only between the size of the cyst and developing CBF. Cysts greater than 69 mm have a higher risk of developing CBF after both percutaneous and surgical treatment and should be closely monitored.

Is there an association between NC_012920.1: m.8277T> C mitochondrial variation the mt-NC7 locus, and migraine with aura?

BACKGROUND

The molecular basis of migraines is still not completely understood. Over the last 30 years, mitochondrial dysfunction has been postulated as a potential mechanism in migraine pathogenesis. This study aimed to determine whether maternal mitochondrial variation was associated with migraines with aura.

METHODS

In this cross-sectional study, 50 individuals, who had been diagnosed with migraines with aura between January 2016 and July 2018 in the Neurology Department of the University Medical Faculty, and 50 healthy controls were recruited. Genomic DNA was isolated from the Ethylenediaminetetraacetic acid (EDTA) blood samples of the patients and the controls using the Easy One automated DNA isolation system. Mitochondrial DNA (mtDNA) libraries were prepared according to the Nextera XT DNA library-preparation protocol, and they were sequenced on the MiSeq platform (Illumina Inc., San Diego, CA, USA).

RESULTS

In the patient and control groups' analysis, 13 mtDNA variations were determined to be significantly different (p <0.05). The CC genotype for NC_012920.1: m.8277T>C variation was found to be higher in the patient group than the control group (p =0.001). The mtDNA NC_012920.1: m.8277T>C variation was significantly associated with the presence of neurological disease in the patient's family (p =0.043).

CONCLUSIONS

The present study is the first to demonstrate an association between mitochondrial dysfunction and the susceptibility to migraine with aura in individuals carrying the NC_012920.1: m.8277T>C variation. Knowing the level of cytochrome C oxidase and oxidative phosphorylation corruption in these patients may be predictive in understanding the phenotype/genotype relationship. Thus, mtDNA variations may contribute to the pathogenesis of migraines with aura. HIPPOKRATIA 2020, 24(2): 59-65.

Susac Syndrome: Clinical characteristics, diagnostic findings and treatment in 19 cases

Susac's Syndrome (SS), which was first described in 1979, is a rare and presumably autoimmune disorder characterized by encephalopathy, hearing loss, and visual disturbance resulting from branch retinal artery occlusion (BRAO). This study reports 19 SS patients' clinical characteristics, MRI features, CSF analysis, treatment strategies and outcomes. At initial presentation, only three of 19 patients demonstrated the complete clinical triad. Clinic presentation varied from isolated hemiparesis to the full triad (encephalopathy, hearing loss and visual disturbances). Corpus callosum (CC) involvement was noted in the MRI of 18 patients (97%) and BRAO was detected in 17 (95%) patients. All patients were treated with intravenous methylprednisolone after the initial assessment. This case series is presented to emphasize the differences in clinical presentation of SS and the importance of MRI and FFA in diagnosis.