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Objective: The present study aimed to investigate the relation between abdominal aorta calcium score and renal stones (RS) using computed tomography (CT). Methods: This study comprised 352 subjects who underwent CT of urinary system in our clinic. One hundred and seventy-six subjects with RS were assigned to Group 1 and 176 subjects without RS were assigned to Group 2 (control group). The likely relation of calcium score, an indicator of atherosclerosis of abdominal aorta, with renal stone formation and stone volume, which has not been investigated previously, was investigated using multislice CT (MSCT). Results: Age distribution of the study subjects ranged from 19 years to 87 years (mean, 44.3±15.1 years). Of the study subjects, 224 (63.6%) were male and 128 (36.4%) were female. According to Agatston scoring, the mean aortic calcium score was 348.7±665.7 Agatston unit (AU) in Group 1 and 212.2±486.9 AU in Group 2. Stone volume was 38.1±25.7 cubic millimeter (mm3) in Group 1. Conclusions: Independently from RS volume, the frequency of abdominal aortic atherosclerosis was observed to be higher in the some aged patients with urolithiasis than in the normal subjects. The result was significant (p<0.05, p=0.029). [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to compare the rate of wound site infection in patients <1 year of age who underwent sternotomy using electrocautery, a routinely performed procedure in our clinic, with those reported in the literature.Methods: This double-center study included patients <1 year of age who underwent cardiac surgery via sternotomy performed with electrocautery for congenital heart disease between January 2017 and June 2019. Patient's data were retrospectively obtained from the hospital records.Results: In our study, seven patients developed SSI, which was superficial in six (1.3%) patients and in the form of mediastinitis in one (0.2%) patient.Conclusion: Sternotomy with electrocautery, which we consider an easy and safe method, was also not found to be statistically different from the other methods in terms of SWI. [ABSTRACT FROM AUTHOR]

Acute fulminant myocarditis (AFM) is a clinical condition that can lead to sudden onset of rapidly progressing cardiogenic shock with significant arrhythmia and possible cardiac arrest. Mechanical circulation support has been reported to provide effective cardiac support in patients with AFM. In this article, we aimed to present the case of a 14-year-old girl with AFM who experienced a cardiogenic shock and resistant ventricular tachycardia unresponsive to medical treatment; however, she could be successfully treated with veno-arterial extracorporeal membrane oxygenation and discharged without neurological sequelae from the hospital. [ABSTRACT FROM AUTHOR]

Aim: We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis and to evaluate the relation of the changes with serum electrolyte levels and ketosis. Material and Methods: This study was performed in Istanbul Medical Faculty, Pediatric Emergency and Intensive Care Department between May 2008 and May 2009. The electrocardiographic parameters and QT length of children with diabetic ketoacidosis and ketosis were evaluated at diagnosis and after the treatment. Results: Forty patients were included in the study; 16 (40%) were diagnosed as having diabetic ketosis and 24 (60%) had diabetic ketoacidosis. Twenty-four (60%) patients were male and 16 (40%) were female and the mean age was 9.21±4.71 years (range, 1-16 years). Twelve (30%) cases of diabetic ketoacidosis were mild, three (7.5%) were moderate, and nine (22.5%) were severe. One patient had premature ventricular beats, and four had ST depression. The electrocardiographic parameters were all normal beyond the QTC length prolongation. The mean QTC length was 447±45 ms (380-560 ms) at diagnosis and 418±32 ms (350-500 ms) after treatment. The change in the QTC length was statistically significant. None of the patients had significant electrolyte disturbance and the prolongation of QTc length was not correlated with serum electrolyte levels. The prolongation of QTc length was statistically correlated with anion gap (r=0.33, p=0.03). Conclusions: In our study, we showed QTc length prolongation and the importance of performing electrocardiography during the diagnosis of diabetic ketoacidosis and ketosis. We also demonstrated that ketosis was responsible for the prolongation of QTc length. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the effect of L-arginine on hemodynamic, biochemical, and histopathological changes in a rabbit model with renal ischemia. Methods: Forty white New Zealand rabbits were used. The rabbits were divided into two groups as the control group (n=20) and L-arginine group (n=20). They were monitored by cannulating the auricular and femoral arteries. An aortic occlusion catheter was inserted through the contralateral femoral artery and was extended to the distal aspect of the left subclavian artery; it was then inflated, and occlusion was performed for 30 min. All rabbits received 4 mL/kg/h of NaCl infusion during the course of occlusion and within the first 60 min of reperfusion. In the L-arginine group, L-arginine was infused at a dosage of 3 mg/kg/h through the auricular vein during the first 60 min of occlusion and perfusion. Blood samples for biochemical parameters [glucose, lactate, hematocrit, blood urea nitrogen (BUN), and serum creatinine] were obtained in the peri-ischemic period, in the 20th minute of reperfusion, and just before sacrificing (48th hour). A histopathological examination was performed in both renal tissues. Histopathological scoring was performed by taking tubular epithelial cell flattening, brush border loss, cytoplasmic vacuolization, cell necrosis, and tubular lumen obstruction into consideration. All animals were sacrificed 48 h after the procedure. Results: A significant difference was found between the L-arginine and control groups in terms of the hemodynamic outcomes and 48th hour BUN and serum creatinine levels (p<0.05). The histopathological examination revealed a mean score of 3.2±0.89 in the control group and 2.60±0.68 in the L-arginine group (p<0.05) (p=0.022). Conclusion: It can be suggested that L-arginine reduces renal ischemia-reperfusion injury and in particular, the histopathological effects. (JAREM 2016; 6: 24-30) [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to investigate the association of neutrophil/ lymphocyte ratio (NLR) with coronary artery calcium score (CACS) and obstructive coronary artery disease (CAD) detected by multislice computed tomography (MSCT) angiography in type 2 diabetes mellitus (T2DM) patients. Methods: Two hundred and ninety-two T2DM patients, who were either asymptomatic or symptomatic (but noncharacteristic) for coronary artery disease (CAD) and underwent MSCT angiography in our clinic between May 2009 and June 2014, were enrolled. All patients were divided into two groups according to their mean NLR values. Patients with NLR ⪡2.05 were assigned to Group 1 and patients with NLR >2.05 were assigned to Group 2. The association of NLR with CACS and obstructive CAD, which were detected by MSCT angiography, was investigated in T2DM patients. Results: According to the Agatston scoring method, the mean CACS was 129.5±209.8 Au in Group 1 and 290.3?±99.6 Au in Group 2 (P<0.001). Obstructive CAD was detected in 40 (26.8%) patients in Group 1 and in 56 (39.2%) patients in Group 2 (P<0.05, P=0.021). Conclusion: The rate of obstructive CAD was significantly higher in the T2DM patients with NLR >2.05 than that in the T2DM patients with NLR ⪡2.05. In addition, the CACS was also significantly higher in the T2DM patients with NLR >2.05 than that in the T2DM patients with NLR ⪡2.05. [ABSTRACT FROM AUTHOR]

Hypercalcemia is a rarely seen medical emergency in children compared with adults who present with nonspecific symptoms such as loss of appetite, nausea, vomiting, weight loss. Severe hypercalcemia is a rare complication of malignancy in children which can result in a life threatening condition. Herein, we report a H-year -old girl presenting with a mass on her neck and hypercalcemia. Her serum calcium level was 18.4 mg/dL which necessitated biochemical analysis with resultant establishment of diagnosis of pre B acute lymphoblastic leukemia (ALL) and ensuing venovenous hemofiltration treatment for her acute hypercalcemia. Our aim is to remind that malignancies should not be overlooked in the differential diagnosis of pediatric hypercalcemia. [ABSTRACT FROM AUTHOR]

The mechanism and causes of sudden infant death syndrome (SIDS) is still remains its mystery. The pathophysiology of SIDS is not clear. Sleeping in prone position is thought to contribute to pathophysiology. Schwartz was the first physician suggesting that SIDS can be associated with heart and autonomic nervous system. Congenital long QT syndrome may trigger SIDS by causing ventricular tachycardia. Normal cardiac rhythm is regulated by ion channels and specific proteins, but genetical analyses clearly demonstrated that 5 ion channel genes were responsible for rare arrhythmias. The infections, fever and sleeping in prone position can increase the risk of long QT syndrome in babies having mutations in cardiac ion channels. In this review we tried to draw attention to SIDS as an important cause of death in childhood period and association of SIDS with long QT syndrome which is not necessarily noticed by physicians. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the thyroid function alterations in a group of epileptic children taking antiepileptic drugs (AEDs). Patients demographic data and the free throxine (fT4) and thyroid-stimulating hormone (TSH) levels at the beginning of the treatment and at the third, sixth and ninth months of AED treatment were recorded retrospectively. A total of 106 children, 59 males and 47 females, were enrolled in the study. Mean patient age was 3.7 years, ranging between 3 months and 14 years. In total, 54%% of patients were on valproic acid (VPA), 16%% phenobarbital (PB), 14%% were on carbamazepine (CBZ), 6%% were on oxcarbazepine (OXC), 5%% were on levetiracetam, and 5%% were on topiramate therapy. There were no significant differences in average fT4 values between the drug groups. But the mean fT4 levels of the patients on VPA therapy showed a clear decrease within the observation period. No significant difference in average TSH values between the groups was detected in the beginning and in the third and sixth month. However, in the ninth month, a significant increase in TSH values was found in the VPA group ( p == 0.007). In the patients taking VPA, average TSH values rose progressively while staying within normal limits. During follow-up, thyroid dysfunction were found in 21 patients (19.6%%). A statistically significant relationship was found between severe electroencephalography (EEG) findings and thyroid dysfunction ( p == 0.041). It was concluded that epileptic children with severe EEG findings and using VPA could have thyroid dysfunction. These patients should be followed up closely by thyroid function tests during treatment. [ABSTRACT FROM AUTHOR]

Methylmalonic acidemia (MMA) is an inherited metabolic disorder that results from deficiency of a vitamin B12- dependent enzyme methylmalonyl-CoA mutase. Lack of this enzyme which converts methylmalonil-CoA to succinyl-CoA and hydrolization to methylmalonic acid leads to increased methylmalonic acid levels in blood and urine. Onset of the clinical manifestations can onset in different ages, and forms. Asymptomatic cases up to adulthood have been reported. The most common clinical forms can be enumerated as acute metabolic decompensation state beginning in the neonatal period, acute intermittant form with asymptomatic intervals between acute episodes and chronic progressive form characterized by hypotonus, developmental, and neuromotor retardation. Herein, we report a 18 month-old female patient diagnosed as late- onset methylmalonic acidemia presenting with neuromotor retardation and convulsion. [ABSTRACT FROM AUTHOR]

Candidemia is emerging as a significant concern in children, particularly among those with underlying conditions like malignancies or prematurity. The interpretation of epidemiological data on candidemias and their antifungal resistance plays a vital role in aiding diagnosis and guiding clinicians in treatment decisions. From 2014 to 2021, a retrospective analysis was conducted in İstanbul, Turkey; comparing Candida albicans and non-albicans (NAC) spp in both surviving and deceased groups. Furthermore, an examination of Candida parapsilosis and other species was performed, assessing various clinical and laboratory parameters. Among 93 patients, with a median age of 17 months, C. parapsilosis emerged as the predominant isolated species (44%), followed by C. albicans (34.4%). Resistance to fluconazole, voricanozole, and echinocandins, along with a history of broad-spectrum antibiotic use were found to be significantly higher in the non-albicans Candida group compared to C. albicans group. In the C. parapsilosis group, statistically lower age was identified in comparison to the other groups (P  = .018). In addition, high fluconazole and voriconazole resistance was detected in Candida parapsilosis spp. Our study highlights a notable prevalence of C. parapsilosis, particularly in younger children, which is different from similar studies in childhood. This trend may be attributed to the common use of total parenteral nutrition and central venous catheter in gastrointestinal disorders and metabolic diseases. Furthermore, as anticipated, high azole resistance is noted in C. parapsilosis and other non-albicans Candida species. Interestingly, resistance to both amphotericin B and echinocandins within this group has been notably high. It is crucial to emphasize the considerable antifungal resistance seen in C. parapsilosis isolates. [ABSTRACT FROM AUTHOR]

In recent years there are threatening reports about allergic reactions and frequent usage of cephalosporins Fatal anaphylaxis after first exposure to cephalosporin is very rare (I ; 100 000). Herein, we report development of anaphylaxis after the first intravenous injection of ceftriaxone in a 8 year- old- male patient who was healthy and did not use ceftriaxone before. We reported this case in order to warm clinicians against the possible risk of anaphylaxis even after the first dose of ceftriaxone and to avoid administration of the drug without indication. [ABSTRACT FROM AUTHOR]

Objective: The complete blood count (CBC) parameters and the ratios regarding these parameters have been demonstrated to be useful diagnostic biomarkers for many infectious diseases. Herein, we aimed to evaluate and compare the usefulness of the predictive role of the CBC in the differential diagnosis of pulmonary tuberculosis (TB) from community-acquired pneumonia (CAP) in children. We also compared serum electrolyte levels between the 2 diseases. Materials and Methods: In this retrospective study, we analyzed the efficacy of CBC parameters and neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), plateletto-lymphocyte ratio (PLR), neutrophil-to-monocyte-plus-lymphocyte ratio (NMLR), and serum electrolyte levels in the differential diagnosis of pulmonary TB from CAP in children. We also classified patients with TB into 2 groups according to the microbiologic confirmation. We investigated whether there is any difference regarding these parameters in patients with positive microbiologic results. Results: A total of 163 patients diagnosed with TB and CAP were included in this study. The WBC, neutrophil and monocyte counts, NLR, MLR, NMLR, mean platelet volume (MPV), and C-reactive protein (CRP) values were higher in CAP. There was statistical significance among serum sodium and phosphorus (P) levels between the 2 groups. Microbiologic confirmation was determined in 37 (35.5%) patients with the diagnosis of TB. The NLR, MLR, NMLR, CRP, and P values were significantly higher in patients with microbiologic confirmation. Conclusion: The results of the present study suggest that complete blood count parameters, NLR, MLR, NMLR, and CRP can be useful and cost-effective markers in differentiating pulmonary TB from CAP in the early stages of diagnosis. [ABSTRACT FROM AUTHOR]

Background: Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has caused a serious epidemic in our country and all over the world since December 2019 and has become a global health problem. The disease caused by the SARS‐CoV‐2 virus has been named as coronavirus disease 19 (COVID‐19). Methods: We report on the epidemiological and clinical features of 37 children diagnosed with COVID‐19. Results: The median age was of the children was 10 years and 57.1% were male. In addition, 78.3% of the children had a history of contact with adult patients who had been diagnosed with COVID‐19, and 27.0% had coexisting medical conditions. We found that 40.5% of our patients had mild infection, while 32.4% had moderate infection, and 27.1% had developed severe or critical illness. The most common abnormal laboratory findings in our patients were decreased lymphocytes (45.9%) and increased D‐dimer values (43.2%), while abnormal radiological findings were detected in 56.7% of the children. In addition, 64.8% of the children had received azithromycin, 59.4% had received oseltamivir, and hydroxychloroquine was used in combination with azithromycin in 35.1% of the children. Non‐invasive mechanical ventilation was required in 27.0% of the children. Conclusions: Although COVID‐19 infection is usually mild in children, severe illness can be seen in children with comorbidities, or even in children who were previously healthy. [ABSTRACT FROM AUTHOR]

Predictors of early diagnosis and severe infection in children with coronavirus disease 2019 (COVID-19), which has killed more than 4 million people worldwide, have not been identified. However, some biomarkers, including cytokines and chemokines, are associated with the diagnosis, pathogenesis and severity of COVID-19 in adults. We examined whether such biomarkers can be used to predict the diagnosis and prognosis of COVID-19 in pediatric patients. Eighty-nine children were included in the study, comprising three patient groups of 69 patients (6 severe, 36 moderate and 27 mild) diagnosed with COVID-19 by real-time polymerase chain reaction observed for 2–216 months and clinical findings and 20 healthy children in the same age group. Hemogram, coagulation, inflammatory parameters and serum levels of 16 cytokines and chemokines were measured in blood samples and were analyzed and compared with clinical data. Interleukin 1-beta (IL-1β), interleukin-12 (IL-12) and interferon gamma-induced protein 10 (IP-10) levels were significantly higher in the COVID-19 patients (p = 0.035, p = 0.006 and p < 0.001). Additionally, D-dimer and IP-10 levels were higher in the severe group (p = 0.043 for D-dimer, area under the curve = 0.743, p = 0.027 for IP-10). Lymphocytes, C-reactive protein and procalcitonin levels were not diagnostic or prognostic factors in pediatric patients (p = 0.304, p = 0.144 and p = 0.67). Increased IL-1β, IL-12 and IP-10 levels in children with COVID-19 are indicators for early diagnosis, and D-dimer and IP-10 levels are predictive of disease severity. In children with COVID-19, these biomarkers can provide information on prognosis and enable early treatment. [ABSTRACT FROM AUTHOR]

Objective: Enhanced external counterpulsation (EECP) is a noninvasive treatment that is proven safe and effective in patients with coronary artery disease (CAD) and heart failure (HF). The aims of this study are to investigate the clinical effects of EECP therapy in patients with symptomatic CAD and chronic HF, and to find out an answer to the question: Does EECP therapy have any effect on the prognostic markers of HF? Methods: This study was designed as a prospective cohort study. A total of 68 consecutive patients with symptomatic CAD and chronic HF referred to EECP therapy were enrolled in this study between November 2007 and December 2010; 47 patients (39 males and 8 females, 65±7, years), have undergone EECP treatment, and 21 patients (20 males and 1 female, 62±10 years), who did not want to participate in the EECP program comprised the control group. Statistical analysis was performed using t tests for dependent and independent samples, Mann-Whitney U test, Chi-square and Fischer exact tests. Results: EECP therapy resulted in significant improvement in post-intervention New York Heart Association functional class (p<0.001), left ventricular ejection fraction (p<0.001), B-type natriuretic peptide levels (p<0.003), uric acid levels (p<0.05), free-T3/free-T4 ratio (p<0.034) and mitral annular E (p<0.05) velocity, compared with baseline, a finding not evident in the control group. Conclusion: EECP treatment significantly improved clinical and some biochemical parameters, which are mostly prognostic markers in patients with symptomatic CAD and chronic HF. [ABSTRACT FROM AUTHOR]

Objective: Enhanced external counterpulsation (EECP) is a noninvasive treatment that is proven safe and effective in patients with coronary artery disease (CAD) and heart failure (HF). The aims of this study are to investigate the clinical effects of EECP therapy in patients with symptomatic CAD and chronic HF, and to find out an answer to the question: Does EECP therapy have any effect on the prognostic markers of HF? Methods: This study was designed as a prospective cohort study. A total of 68 consecutive patients with symptomatic CAD and chronic HF referred to EECP therapy were enrolled in this study between November 2007 and December 2010; 47 patients (39 males and 8 females, 65 ± 7, years), have undergone EECP treatment, and 21 patients (20 males and 1 female, 62 ± 10 years), who did not want to participate in the EECP program comprised the control group. Statistical analysis was performed using t tests for dependent and independent samples, Mann-Whitney U test, Chi-square and Fischer exact tests. Results: EECP therapy resulted in significant Improvement in post-intervention New York Heart Association functional class (p<0.001), left ventricular ejection fraction (p<0.001), B-type natriuretic peptide levels (p<0.003), uric acid levels (p<0.05), free-T3/free-T4 ratio (p<0.034) and mitral annular E (p<0.05) velocity, compared with baseline, a finding not evident in the control group. Conclusion: EECP treatment significantly improved clinical and some biochemical parameters, which are mostly prognostic markers in patients with symptomatic CAD and chronic HF. [ABSTRACT FROM AUTHOR]

The usage of endovascular stent-graft in the treatment of abdominal aorta aneurysm has been increasing in the abdominal surgery. This paper presents the case of a patient with right iliac artery aneurysm who was treated with the application of endovascular stent-graft. [ABSTRACT FROM AUTHOR]