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Resumo Fundamento A doença valvar mitral reumatismal (DVMR) é a apresentação mais comum das doenças cardíacas reumáticas (DCR). Os processos de inflamação e fibrose também têm papéis significativos em sua patogênese. Estudos recentes demonstram que os tióis e o tiol-dissulfeto são marcadores de stress oxidativo inéditos e promissores. Objetivos O objetivo deste estudo foi avaliar diferenças entre os níveis de tiol sérico e de tiol-dissulfeto em pacientes com DVMR e no grupo de controle. Métodos Noventa e dois pacientes com DVMR foram cadastrados no estudo. Cinquenta e quatro sujeitos saudáveis, e com correspondência de sexo e idade em relação ao grupo de estudo, também foram incluídos no estudo como um grupo de controle. Foram investigados os níveis de tiol nos pacientes com DVMR e o grupo de controle. Os p-valores menores que 0,05 foram considerados estatisticamente significativos. Resultados Os pacientes com DVMR apresentaram pressão sistólica da artéria pulmonar (PSAP) e níveis de diâmetro do átrio esquerdo (AE) mais altos que os do grupo de controle. Os níveis de tiol nativo (407±83 μmol/L vs. 297±65 μmol/L, p

Background Probiotics and prebiotics have strain-specific effects on the host. Synbiotics, a mixture of probiotics and prebiotics, are proposed to have more beneficial effects on the host than either agent has alone. Purpose We performed a randomized controlled trial to investigate the effect of Lactobacillus and Bifidobacterium together with oligosaccharides and lactoferrin on the development of necrotizing enterocolitis (NEC) or sepsis in very low birth weight neonates. Methods Neonates with a gestational age ≤32 weeks and birth weight ≤1,500 g were enrolled. The study group received a combination of synbiotics and lactoferrin, whereas the control group received 1 mL of distilled water as placebo starting with the first feed until discharge. The outcome measures were the incidence of NEC stage ≥2 or late-onset cultureproven sepsis and NEC stage ≥2 or death. Results Mean birth weight and gestational age of the study (n=104) and the control (n=104) groups were 1,197±235 g vs. 1,151±269 g and 29±1.9 vs. 28±2.2 weeks, respectively (P>0.05). Neither the incidence of NEC stage ≥2 or death, nor the incidence of NEC stage ≥2 or late-onset culture-proven sepsis differed between the study and control groups (5.8% vs. 5.9%, P=1; 26% vs. 21.2%, P=0.51). The only significant difference was the incidence of all stages of NEC (1.9% vs. 10.6%, P=0.019). Conclusion The combination of synbiotics and lactoferrin did not reduce NEC severity, sepsis, or mortality.

Adrenal incidentalomas (AIs) are usually discovered incidentally after imaging unrelated to adrenal glands. We aimed to evaluate standard risk factors for systemic atherosclerosis and echocardiographic changes in patients with nonfunctioning AIs and compare them with normal subjects. We evaluated 70 patients diagnosed with AIs and 51 healthy controls. Mean levels were determined for HbA1c, LDL, uric acid, fasting plasma insulin, HOMA, and neutrophil-to-lymphocyte ratio (NLR), and these values were found to be significantly higher in the patients than the controls. The mean left atrial diameter, interventricular septum thickness, posterior wall thickness, left ventricular mass, E-wave deceleration time, isovolumetric relaxation time, and the median ratio of the early transmittal flow velocity to the early diastolic tissue velocity (E/Em) were higher in patients with AIs compared to controls. The mitral annular early diastolic velocity was lower in patients with AIs. The mean aortic diastolic diameter, stiffness index (SI), and aortic strain were higher, and aortic distensibility was lower in the patients. The mean right ventricular diameter, right atrial major-axis diameter, and right atrial minor-axis diameter were statistically higher in the patient group than the controls. A negative correlation was found between the NLR and aortic strain and aortic distensibility, while a positive correction was found between the NLR and SI. We found altered left ventricular (LV) and right ventricular (RV) echocardiographic findings in patients with AIs without known cardiovascular disease. Aortic stiffness was also increased. These changes may be related to an increase in cardiovascular risk factors in AI patients.

ObjectiveTo investigate the early neonatal outcomes of very-low-birth-weight (VLBW) infants discharged home from neonatal intensive care units (NICUs) in Turkey.Material and methodsA prospective cohort study was performed between April 1, 2016 and April 30, 2017. The study included VLBW infants admitted to level III NICUs. Perinatal and neonatal data of all infants born with a birth weight of ≤1500 g were collected for infants who survived.ResultsData from 69 NICUs were obtained. The mean birth weight and gestational age were 1137±245 g and 29±2.4 weeks, respectively. During the study period, 78% of VLBW infants survived to discharge and 48% of survived infants had no major neonatal morbidity. VLBW infants who survived were evaluated in terms of major morbidities: bronchopulmonary dysplasia was detected in 23.7% of infants, necrotizing enterocolitis in 9.1%, blood culture proven late-onset sepsis (LOS) in 21.1%, blood culture negative LOS in 21.3%, severe intraventricular hemorrhage in 5.4% and severe retinopathy of prematurity in 11.1%. Hemodynamically significant patent ductus arteriosus was diagnosed in 24.8% of infants. Antenatal steroids were administered to 42.9% of mothers.ConclusionThe present investigation is the first multicenter study to include epidemiological information on VLBW infants in Turkey. Morbidity rate in VLBW infants is a serious concern and higher than those in developed countries. Implementation of oxygen therapy with appropriate monitoring, better antenatal and neonatal care and control of sepsis may reduce the prevalence of neonatal morbidities. Therefore, monitoring standards of neonatal care and implementing quality improvement projects across the country are essential for improving neonatal outcomes in Turkish NICUs.

AIM:To evaluate the central corneal thickness (CCT) measurements of premature infantsMETHODS: The premature infants who were born between 25-34wk of gestational age (GA) were retrieved for the study. All CCT measurements were performed within the first 2d of their life under topical anesthesia by using an ultrasonic pachymeter.RESULTS: The mean CCT of 200 eyes was 647.79±63.94 µm. The mean CCT of the right and left eyes were similar (647.30±64.72 µm and 648.29±63.47 µm consecutively). The mean CCT of the girls was 642.08±54.89 µm and the boys was 653.07±71.14 µm, with no statistically significant difference (P>0.05). But there was a negative correlation of the CCT with GA and birth weight (BW) (P<0.01).CONCLUSION:The CCT values of premature babies were negatively correlated with GA and BW.

OBJECTIVE: This study aims to investigate the associations between celiac disease (CD) and children’s life quality and empathy level. METHODS: In this study, all participants aged 8–14 years completed the Turkish version of the Pediatric Quality of Life Inventory and Index of Empathy for Children and Adolescents. Parents were also applied to the structured survey. RESULTS: This study included a study group consisting of 45 children with celiac disease and a control group with 48 healthy children. The total scores of PedsQL were significantly lower for children with celiac disease when compared to the control group (p<0.05). When the sub-scores of PedsQL were evaluated, scores except the school functioning score (ScFS) were significantly lower in the study group (p<0.05). When IECA was analyzed, total empathy scale scores (TESS) were measured significantly higher in the study group (p<0.05). CONCLUSION: This study supports the argument that the quality of life decreases in children with CD. Future studies should aim to develop support models to improve the life quality of celiac patients. To our knowledge, this is the first study proving the increased empathy levels of children with CD. The determinants of the increased empathy levels should be focussed on future studies. [ABSTRACT FROM AUTHOR]

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p

Background: Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. Methods: A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. Results: The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p = 0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p = 0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p = 0.005). Conclusions: Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.

Celiac disease is an autoimmune disease characterized by inflammation of the small intestinal mucosa due to gluten exposure in individuals with genetic predisposition. Gastrointestinal symptoms such as abdominal pain, diarrhea, loss of appetite and weight loss are seen in majority of the patients. The number of patients presenting with extraintestinal complaints for instance electrolyte disorders, hematologic, muscle, bone, and joint involvement is also considerably high. In this case, we discuss a 12-year-old girl who was recovered from the clinic at 4 months with a gluten-free diagnosis of celiac disease as she presented with complaints of clubbing, developmental delay, and fatigue.Celiac disease is an autoimmune disease characterized by inflammation of the small intestinal mucosa due to gluten exposure in individuals with genetic predisposition. Gastrointestinal symptoms such as abdominal pain, diarrhea, loss of appetite and weight loss are seen in majority of the patients. The number of patients presenting with extraintestinal complaints for instance electrolyte disorders, hematologic, muscle, bone, and joint involvement is also considerably high. In this case, we discuss a 12-year-old girl who was recovered from the clinic at 4 months with a gluten-free diagnosis of celiac disease as she presented with complaints of clubbing, developmental delay, and fatigue.

Patients with Down syndrome are predisposed to autoimmune disease and have a higher risk for type 1 diabetes, autoimmune thyroid disorders, alopecia, vitiligo, hypoparathyroidism and celiac disease. Diarrhea and malabsorption represent the typical presentation of celiac disease, while obesity or weight gain are uncommon in young children. We report an 8-year-old obese girl with Down syndrome who was diagnosed as celiac disease in the absence of signs and symptoms. We would suggest that even in absence of signs and symptoms, the children with Down syndrome should be screened annually for celiac disease even owing to obesity. [ABSTRACT FROM AUTHOR]

Background: Late preterm infants have increased rates of morbidity and mortality compared to term infants. Determining the risk factors in these infants leads to more comprehensive preventive and treatment strategies. Aims: Our aim was to analyse the morbidity rates such as respiratory system diseases, infections, congenital anomalies, hypoglycemia and hematologic abnormalities and mortality rates in a large group of patients at a referral center. Study Design: Retrospective cross-sectional study. Methods: Medical records of late preterm and term infants who were managed at the referral center were analysed. Results: 41752 births were analysed in 3 years. 71.9% of all births were between 37-42 gestational weeks (i.e. term) and 16.1% were between 34-37 weeks (i.e. late preterm). Compared to term infants, late preterm infants had increased rates of short-term problems. The rate of mortality increased with decreased gestational age. The duration of hospitalization was significantly higher in the smallest late preterm infants. Conclusion: This study demonstrated the need that late preterm infants who have higher risk for morbidity and mortality, compared to term infants require close monitoring. The rate of mortality and hospitalization increased with decreased gestational age.

To investigate the efficacy and safety of recombinant human granulocyte colony-stimulating factor, recombinant human granulocyte-macrophage colony-stimulating factor (rhG-CSF) to treat sepsis in neutropenic preterm infants. Methods: Fifty-six neutropenic preterm infants with suspected or culture-proven sepsis hospitalized in Zeynep Kamil Maternity and Children's Educational and Training Hospital, Kozyatağı/Istanbul, Turkey between January 2008 and January 2010 were enrolled. Patients were randomized either to receive rhG-CSF plus empirical antibiotics (Group I) or empirical antibiotics alone (Group II). Clinical features were recorded. Daily complete blood count was performed until neutropenia subsided. Data were analyzed using SPSS version 11.5. Results: Thirty-three infants received rhG-CSF plus antibiotic treatment and 23 infants received antibiotic treatment. No drug-related adverse event was recorded. Absolute neutrophil count values were significantly higher on the 2nd study day and 3rd study day in Group I. Short-term mortality did not differ between the groups. Conclusion: Treatment with rhG-CSF resulted in a more rapid recovery of ANC in neutropenic preterm infants. However, no reduction in short-term mortality was documented.

Sepsis is an important cause of neonatal death and perinatal brain damage, particularly in preterm infants. It is thought that activation of the inflammatory cascade triggered by cytokine might play a role in the pathogenesis of sepsis. Recent evidence supports a role for resistin in inflammation. There are no data in the literature on resistin levels of premature newborns with sepsis, which can also cause inflammatory response. The objective of this study was to evaluate whether resistin can be used as an indicator in neonatal sepsis of preterm babies. Materials and methods: Forty-three premature newborns considered to have sepsis were included in the study. Forty-three gestational and postnatal age- and sex-matched premature newborns without premature prolonged rupture of membrane or sepsis served as controls. Results: The median resistin and interleukin-6 (IL-6) levels of the premature babies with sepsis were 85.9 ng/mL and 342.7 pg/mL, respectively, and were higher than those of the control group (29.9 ng/mL and 17.7 pg/mL, respectively). The sensitivity, specificity, positive, and negative predictive values for resistin were 73.7%, 45.8%, 68.3%, and 52.4%, respectively. Conclusion: Resistin levels were higher in premature newborns with sepsis and correlated with IL-6 levels, which is an indicator of neonatal sepsis. This suggests that resistin may also be used in the diagnosis of neonatal sepsis. However, it has limited value when compared with the other inflammatory markers including C-reactive protein, procalcitonin, and IL-6.

In this clinical vignette, we describe a case of a patient with windsock-like posterior mitral annulus perforation at the site of annular calcification caused by infective endocarditis. Three-dimensional transesophageal images of the perforation resembling an “alien’s mouth” are very striking for how 3-dimensional imaging can improve visualization of anatomy of the heart. (Level of Difficulty: Intermediate.)

Background and Aim: Catheter-based atrial fibrillation (AF) ablation primarily for pulmonary vein isolation (PVI) has become a significant therapeutic alternative for symptomatic and drug-refractory AF patients. It is evident that AF time and left atrium diameter (LAD) have the most critical impact on AF recurrence. In this study, we aimed to evaluate the role of coronary artery dominance for predicting AF recurrence after cryoballoon PVI. Methods: We retrospectively analyzed clinical, laboratory, and angiographic data from consecutive patients who underwent coronary angiography and successful cryoballoon PVI. Images of the coronary angiography were retrospectively reviewed for the coronary artery dominance by two experienced observers. The coronary artery system was classified as right dominant (RD) and left dominant. Results: A total of 140 patients without coronary artery disease and structural heart disease who underwent successful cryoballoon PVI were included in the study. There were 101 RD (72%) and 39 left-dominant (28%) patterns. A total of 26 patients (22%) had developed AF recurrence during follow-up. AF recurrence rates were 41% in the left coronary-dominant group and 15% in the right coronary-dominant group (P = 0.001). According to AF recurrence after cryoballoon PVI, only follow-up time (15.7 ± 2.4 vs. 14 ± 1.8 months, P = 0.001), LAD (41.8 ± 2 vs. 40.6 ± 1.8 mm, P = 0.003) and coronary artery disease (CAD) (left CAD, 51.6% vs. 21.1%, P = 0.001) were significantly associated with AF recurrence. AF recurrence rates in multivariable logistic regression analysis according to AF recurrence after cryoballoon PVI, follow-up time, LAD, and CAD were independent predictors of AF recurrence. Conclusions: Our findings suggested that left CAD may be related to AF recurrence after cryoballoon PVI. Coronary artery dominance may be an additional predictor of AF recurrence if supported by larger prospective studies.