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Background: The aim of our study was to assess left and right ventricle systolic and diastolic functions in female adolescents with vitamin D deficiency using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotid intima media thickness and asymmetric dimethylarginine levels. Methods: Sixty-six female adolescents were enrolled in this study. The female adolescents were divided into a vitamin D deficiency group (n: 34) and a control group (n: 32). All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulse, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness. Results: The vitamin D-deficient female adolescent group had normal left and right ventricle systolic and diastolic functions and normal global systolic and diastolic myocardial performance. In the patients with vitamin D deficiency, the carotid intima-media thickness was higher than that in the controls. In the patients within the vitamin D deficiency group, vitamin D was found to be positively correlated with magnesium and negatively correlated with phosphorus and left atrial dimension. Conclusions: The results of this study demonstrate that vitamin D deficiency in female adolescence is associated with normal myocardial geometry and function. Although it has been associated with normal levels of asymmetric dimethyl arginine concentration, high measured carotid intima-media thickness may reflect endothelial dysfunction.

Objective: We aimed to retrospectively evaluate the clinical, demographic, clinical and echocardiographic findings of children diagnosed with chest deformity in the pediatric cardiology clinic. Material and Method: This study enrolled children under the age of 18 years who were referred with chest deformity to our pediatric cardiology unit, over a period of six years (January 2017-December 2022). Results: The mean age of the patients was 9.9 ± 5.2 years, median 11 years (0-18 years old). 89 patients with abnormal echocardiographic findings: 42 (9.56%) mitral valve prolapse, 18 (4.1%) atrial septal defect, 9 (2%) ventricular septal defect, 8 (1.82%) bicuspid without aortic valve stenosis aortic valve, 5 (1.1%) patent ductus arteriosus, 2 (0.45%) pulmonary stenosis, 2 (0.45%) great artery transposition, 2 (0.45%) hypertrophic cardiomyopathy, subaortic ridge 1 (% 0.27). Cardiac compression was present in 13.4% of the cases with pectus excavatum. 13(%3) patients were operated by a thoracic surgeon. Marfan Syndrome was diagnosed in 7 patients and Noonan Syndrome was diagnosed in 2 patients who applied to our clinic with chest deformity. Conclusion: We suggest that echocardiographic examination in patients with chest deformity is important in the diagnosis of congenital heart diseases, early diagnosis and treatment of heart compression finding.

Background. Dental caries and poor oral hygiene can affect the quality of life (QoL) of patients with con -genital heart disease (CHD). Information about the oral health-related quality of life (OHRQoL) of Turkish preschool children with CHD is scarce.Objectives. The aim of the present study was to assess the OHRQoL, and the presence of caries, plaque and gingivitis in Turkish preschool children with CHD as compared to children without CHD (control group).Material and methods. Children aged 3-6 years with CHD (n = 75) and a control group (n = 75) were included in the study. Examinations were conducted using the plaque index (PI), the gingival index (GI) and the World Health Organization (WHO) caries diagnostic criteria. The Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire was completed by the children's families.Results.The amount of caries and plaque, as well as the number of missing teeth were higher in children with CHD. The OHRQoL was lower in children with CHD. However, the differences between the 2 groups were not statistically significant (p > 0.05). The number of filled teeth was significantly higher in the con-trol group (p < 0.05).Conclusions. According to the findings of the present study, the high amount of caries and plaque in both groups demonstrates that caries continues to be a major public health problem. Although there was no significant difference in terms of QoL scale scores between the 2 groups, the study showed that OHRQoL was lower in children with CHD.

Objective The aims of this study were to determine the prevalence and clinical features of ophthalmic involvement in multisystem inflammatory syndrome in children (MIS-C) and to evaluate its association with other organ system involvement and the severity of the disease. Methods The demographic data and information on the ophthalmologic and other systemic organ manifestations, laboratory findings, treatment modalities, and clinical outcomes of 97 patients with MIS-C were retrospectively obtained from their hospital records. Sixty-two patients with MIS-C who were examined by ophthalmologists were included in the study. Statistical analysis was performed using R version 3.6.0, and a p-value Results The patients' median age was 82 months (range, 11–204 months). Of the patients, 62.9% were male. The most common systemic involvements were mucocutaneous (83.9%) and cardiovascular (82.3%). Kawasaki disease was clinically observed in 71% of the patients (incomplete form, 53.2%). Ophthalmic involvement was observed in 39 patients (62.9%). Thirty-two patients (51.6%) had conjunctival hyperemia; 29 (48.4%) lid edema; 7 follicular conjunctivitis; 3 uveitis; 2 subconjunctival hemorrhage; and 1 episcleritis. The patients with ophthalmic involvement were 6.4 times (95% confidence interval [CI], 1.49–27.48; p = 0.013) more likely to exhibit cardiac involvement and 3.53 times (95% CI, 1.35–9.63; p = 0.012) more likely to have severe disease. Conclusion Conjunctival hyperemia, lid edema, and follicular conjunctivitis were observed in at least half of the patients with MIS-C, and those with ophthalmic involvement had a higher risk of cardiac involvement or severe disease.

Amaç: Bu çalışmanın amacı hemanjiyom tanısı alan çocuklarda demografik ve klinik özellikleri ile tedavileri ve tedavi sonuçlarının incelenmesidir. Hastalar ve Yöntemler: Ekim 2017- Eylül 2019 tarihleri arasında hemanjiyom tanısı alan 100 çocuk hastanın dosyası geriye dönük olarak incelendi. Hastaların demografik ve klinik özellikleri, tedavi yaklaşımları ve sonuçları not edildi. Bulgular: Çalışmaya dâhil edilen 100 hastanın 66’sı (%66) kız, 34’ü (%34) erkekti. Hastaların yaş gruplarına göre, 0-3 ay, 3-6 ay, 6-12 ay, 12-24 ay ve >24 ay yaş gruplarında sırasıyla 35, 28, 23, 8 ve 6 hasta vardı. Atmış bir hastada (%61), hemanjiyom baş-boyun bölgesinde yerleşimli iken, baş-boyun dışı yerleşim 39 (%39) hastada saptandı. Tedavi yaklaşımları 71 hastada oral propranolol, 21 hastada topikal timolol damla ve 8 hastada oral propranolol + oral metilprednisolon idi. Oral propranolol ile tedavi edilen 37 hastada (%52), topikal timolol damla ile tedavi edilen 7 hastada (%33,3) ve oral propranolol + oral metilprednisolon ile tedavi edilen üç hastada (37,5) yanıt alındı. Stabil hastalık, oral propranolol alan hastaların 13'ünde (%45,1), topikal timolol damla uygulanan hastaların 13'ünde (%61,9) ve oral propranolol + oral kortikosteroid alan hastaların dördünde (%50) saptandı. Sonuç: çocuklarda, hemanjiyom tedavisinde özellikle oral propranolol tedavisinin etkili ve güvenilir bir tedavi yöntemi olduğu gözlemlenmiştir.

BACKGROUND Cornelia de Lange syndrome (CdLS) is a congenital multisystemic genetic disorder. The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years. However, they still more frequently undergo cardiac surgery. There are some challenges for clinicians when faced with CdLS patients. We present the perioperative management of a child with CdLS undergoing open-heart surgery. CASE SUMMARY Severe pulmonic and subpulmonic valvular stenosis, enlargement of the right side of the heart, mild tricuspid regurgitation, atrial septal defect, and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis, developmental delay, and malnutrition. Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve, therefore it was decided to perform an open surgical repair. Following a successful and uncomplicated intraoperative course, the patient was extubated on postoperative day 5, and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10, respectively. Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed, and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32. The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems. CONCLUSION This is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.

Background The aim of this study was to evaluate hematological parameters in children with COVID-19 and determine the effects of inflammatory biomarkers on the assessment of hospitalization. Methods This retrospective single-center study was performed on 633 children with COVID-19 between March 2020 and January 2021. The study population was separated into two groups: inpatients (n = 83) and outpatients (n = 550). Univariate and multivariate logistic regression was applied to identify risk factors for hospitalization. Results Lymphopenia (n = 228, 36%) was found mainly to be a hematological abnormality in all cases. Compared with outpatients, inpatients had significantly higher white blood cell (WBC) (p = 0.005), lymphocyte (p

Background Multisystem inflammatory syndrome in children (MIS-C) is a new clinical condition characterized by signs of inflammation and multiorgan dysfunction due to cytokine storm associated with SARS-CoV-2. The clinical spectrum of MIS-C ranges from mild to severe, and even to mortal multisystem involvement. To guide clinicians, we evaluated detailed demographic characteristics, clinical features, laboratory findings, and outcomes of MIS-C cases. Methods We performed a retrospective study of patients with MIS-C who were managed in the Department of Pediatric Infectious Disease in the Selcuk University Faculty of Medicine, Konya, Turkey. MIS-C patients were divided into three clinical severity groups (mild, moderate, and severe) and separated into three age groups ( 10 years). We compared the characteristics of MIS-C cases according to the severity of the disease and by age groups. Result Thirty-six children with MIS-C were evaluated (52.8% male, median age of 7.8 years). A clinical spectrum overlapping with Kawasaki disease (KD) was the most common presentation (69.4%) in all age groups. The most common clinical symptoms were fever (100%), mucocutaneous rash (69.4%), and gastrointestinal symptoms (66.6%). There was no statistically significant difference in echocardiographic abnormality between KD-like and the other clinical spectra (p > 0.05). All life-threatening rhythm disturbances were observed in severe cases. No patients died. Conclusion It is important to increase the awareness of physicians about the MIS-C disease, which can present with different combinations of different systemic findings, so that patients can be diagnosed and treated in a timely manner. Key Points• A single tertiary centre study shows that children with MIS-C can present with different clinic spectra other than Kawasaki diseases.• Electrocardiographic and echocardiographic evaluation is important in early diagnosis of children with MIS-C.• Pro-BNP can be used as a screening test in the emergency room for children with prolonged and unexplained fever for determine early cardiac involvement of MIS-C.• The lack of require biological agents and favourable outcomes in children with MIS-C may be related with administration of steroid therapy with IVIG in early stage of disease.

Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells x mu L, p = 0.028; platelet count 166 vs. 216 cells x 10(3)/mu L, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 mu g/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559). Conclusion: Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD., NA

Renovascular hypertension is one of the most common causes of secondary hypertension. Renovascular hypertension causes 5-10% of childhood hypertension. Renal artery stenosis is the most important cause of renovascular hypertension. Patients with renovascular hypertension may be asymptomatic or present with many symptoms such as headache, vomiting, convulsion, heart disease, and sudden death. In renovascular hypertension, surgical treatment may be required in severe high blood pressure that does not respond to medical treatment. In this study, we present a four-month-old infant who developed renovascular hypertension due to bilateral renal artery stenosis, which was controlled by angiotensin II receptor blockers.

Introduction: The present study aimed to determine the prevalence and distribution of congenital heart disease in patients who presented to the paediatric cardiology outpatient clinic in Turkey. Methods: File records of the children who underwent transthoracic echocardiography within the 3-year period between January 2013 and December 2015 at the paediatric cardiology outpatient clinic were retrospectively evaluated. Congenital heart diseases were grouped as follows: diseases with a left-to-right shunt, obstructive diseases, cyanotic diseases, cardiac malposition, vascular ring and unclassified diseases. Prevalence of the diseases, distribution among gender and age groups were investigated. Results: This study included 12,342 subjects; 6996 (56.7%) subjects were male and 5346 (43.3%) subjects were female. The subjects were aged between 1 day and 18 years, and the mean age was 6.86 ± 5.39 years; 27.7% of the subjects were determined to have congenital heart disease. The prevalence of congenital heart disease was higher in males and in the 0–1 month age group. Of the subjects with congenital heart disease, 87% had a disease with a left-to-right shunt, 21.2% had an unclassified disease, 7% had obstructive disease, 1.6% had cyanotic disease, 0.8% had a vascular ring and 0.7% had cardiac malposition. Conclusion: We recommend performing echocardiography on patients presenting to a paediatric cardiology outpatient clinic. Conducting echocardiographic examination on new-borns who are referred to the paediatric cardiology department within the first month of life would enable detecting, particularly the diseases with a left-to-right shunt and cyanotic congenital heart diseases, and ensure timely treatment planning.

Objective Lower respiratory tract infections (LRTI) are one of the most important causes of morbidity and mortality in childhood. Hypoxemia, pulmonary hypertension (PH) due to pulmonary vasoconstriction, and heart failure due to various causes are the most important risk factors for mortality in LRTI. The aim of this study was to investigate characteristics of the patients with LRTI and the frequency of PH that developed secondary to LRTI. Materials and Methods The study included 70 patients who were diagnosed as having LRTI clinically and radiologically between January 2012 and March 2013 at Department of Pediatrics, Konya Training and Research Hospital. Age, sex, risk factors for LRTI, symptoms and physical examination findings, laboratory tests, and Doppler echocardiography findings of the patients were retrospectively reviewed. Results Of the patients, 44 (62.9%) were male and 26 (37.1%) were female. Thirty-seven (52.9%) patients were younger than 1 year, and the mean age was 2.5 ± 3.11 years. The most common symptoms of the patients were cough and fever. Rhonchus, retraction, and crackles were found to be the most common findings in physical examinations. Heart failure was found in 10% of patients and PH was detected in 8.6% through Doppler echocardiography. Development of heart failure and the presence of bilateral patch infiltration on posteroanterior chest X-rays were significantly more frequent in patients with PH. Some 42.9% of patients had at least one viral agent in their nasopharyngeal swabs. The most common viral agents were respiratory syncytial virus and rhinoviruses. Conclusion PH may develop during the course of LRTI in children. Given that the development of PH can cause life-threatening complications such as heart failure, affected patients should be kept under close follow-up. It should be remembered that PH is more likely to develop in patients with bilateral patch infiltration on chest X-ray.

Background: Acute rheumatic fever (ARF) is a non-suppurative inflammatory disease that develops after group A Beta hemolytic streptococcal pharyngitis, primarily involving the heart, joint, central nervous system, skin and subcutaneous tissue. Today, Jones criteria; that were modified in 2015, are used for diagnosis. Our aim in this study is to examine the patients diagnosed with acute rheumatic fever in our clinic and presented with enthesitis. Methods: The type of study is case report. Five patients who were admitted to the Pediatric Rheumatology Clinic of Selcuk University Faculty of Medicine were diagnosed with acute rheumatic fever and presented with enthesitis, between 2017- 2019 were examined retrospectively. Their demographic, clinical laboratory and echocardiographic data were examined. The presence of enthesitis in all patients was established with one or more of the options of clinical examination, ultrasonography, magnetic resonance imaging, and/or orthopedics opinion. Results: While the clinic of the patients improved with the treatment for enthesitis, acute phase reactants did not fall and additional clinical findings appeared. Our observations suggested that acute rheumatic fever could apply to us not only with arthritis and arthralgia, but also with the enthesitis clinic. Therefore, we think that if the laboratory data are compatible among the differential diagnoses in patients presenting with enthesitis, acute rheumatic fever should also be considered, and careful physical examination and echocardiography should be performed for this purpose. Conclusion: In relation to the pathogenesis of the rheumatological diseases, new clinical situations are emerging day by day, and in this way, the diseases are better understood and classified. In conclusion, we think that ARF can be encountered not only with arthritis and arthralgia but also with enthesitis clinics, and echocardiographic imaging should not be ignored in patients with enthesitis clinic who have high acute phase reactants and who do not meet the enthesitis-related juvenile idiopathic arthritis criteria.

Purpose: The aim of this study was to review accompanied congenital anomalies to gastrointestinal pathologies. Materials and Methods: The medical records of patients who were admitted to neonatal intensive care unit with gastrointestinal system surgical pathologies during 2015-2018 were retrospectively evaluated for associated congenital anomalies.Results: 67 patients were identified during the study period. The most common gastrointestinal system pathology was anal atresia in 15 cases (22.4%), followed by diaphragmatic hernia in 14 cases (20.9%), esophageal atresia (n:10) and ileal atresia (n:10) (14.9%). Thirty two patients (48.8%) have had accompanied congenital anomalies to gastrointestinal system pathologies. Congenital heart disease was the most common anomaly and the most frequent one was atrial septal defect in 18 cases (26.8%). In addition, there was complex congenital heart disease in (n:13) 19.4%. In 12 patients (17.9%), accompanied extracardiac anomalies were detected. Hydronephrosis and sludge in gall bladder were detected in three patients (4.5%). Vesicoureteral reflux or ectopic kidney or polysplenia was detected as a separate anomaly in each case. In our cases, prematurity rate was found in 54%.Conclusion: Gastrointestinal system pathologies are frequently associated with multiple anomalies, especially with congenital heart diseases. In addition, these patients are likely to be preterm baby.

WOS: 000462638500019, PubMed: 30747788, Objective Carbon monoxide poisoning (COP) is the leading cause of mortality and morbidity due to poisoning worldwide. Because children are affected more quick and severely from COP, they may require a longer treatment period, even if carboxyhemoglobin (CO-Hb) and/or lactate levels return to normal. Therefore, a new marker that predicts the duration of treatment and the final outcomes of COP is needed. Methods This case control study was conducted on 32 carbon monoxide-poisoned patients younger than 18 years who had been admitted to pediatric emergency department. The control group included age- and sex-matched 30 healthy children. Blood samples were obtained for analysis of arterial blood gases, CO-Hb percent, methemoglobine, lactate, and asymmetric dimethylarginine (ADMA). Results Asymmetric dimethylarginine levels were significantly increased (P < 0.05) in patients with COP on admission and after the treatment when compared with controls (1.36 [0.89-6.94], 1.69 [0.76-7.81], 1.21 [0.73-3.18] nmol/L, respectively). There was no positive correlation between CO-Hb and ADMA levels on admission and at 6 hours (P = 0.903, r = 0.218, P = 0.231, r = 0.022, respectively). Positive correlation was found between lactate and CO-Hb levels on admission (P = 0.018, r = 0.423). Conclusions This study showed that ADMA levels were still high after 6 hours of 100% oxygen therapy in children with COP, even CO-Hb and/or lactate levels return to normal range. On the basis of these results, we consider that ADMA may be a useful biomarker in patient with COP.

Korumasız triküspid kapak nadir görülen bir malformasyondur. Triküspid kapak ve subvalvüler aparatın tam veya kısmi agenezisi ile karakterizedir. Triküspid kapak yapılarının tamamen yokluğu genellikle pulmoner atrezi ve sağlam ventriküler septum ile ilişkilidir. Korumasız triküspid kapak orifis tanısı konulan iki vaka bildiriyoruz. Korumasız triküspid kapak orifisi literatürde nadir bildirildiği için bu olgular sunuldu., Unguarded tricuspid valve orifice is a rare malformation. It is characterized by complete or partial agenesis of the tricuspid valvular and subvalvular apparatus. The complete absence of tricuspid valve structures is often associated with pulmonary atresia and intact ventricular septum. We report on two cases diagnosed as unguarded tricuspid valve orifice. These cases were presented because of unguarded tricuspid valve orifice is reported rare in the literature

WOS: 000517820600016, PubMed: 31984703, Infective endocarditis (IE) is a rare but a potentially life-threatening infectious disease. Atypical presentations cause delays in the diagnosis. Neurological involvement such as meningitis or meningismus, are especially common in mitral valve endocarditis, but unusual in tricuspid valve endocarditis. Although few cases of right-sided IE have been reported with neurological symptoms in adults, children have not been described in literature. A nine-year-old girl with congenital ventricular septal defect (VSD) was admitted with fever, headache and neck stiffness. Her clinical symptoms and cerebrospinal fluid findings supported the aseptic meningitis. On ceftriaxone therapy day 3, her complaints were resolved; nine days later she was admitted with fever and neck stiffness again. Further investigation for fever source with echocardiogram revealed a tricuspid valve endocarditis. Antibiotic therapy was completed after 6 weeks. Cardiac surgery was performed for VSD and tricuspid valvular insufficiency.

Introduction: Down syndrome (DS) which is defined as trisomy 21 is the most common chromosomal defect characterized by mental retardation, hypotonia, dysmorphic facial features, and other distinctive phenotypic characteristics. The prevalence of thyroid disorders in DS is 3% and is significantly higher than in the normal population. In this study we aimed to investigate hematologic parameters of children with DS who had and hadn’t subclinical hypothyroidism and compare them with healthy controls. Methods: This study included 184 patients who were followed up with genetically diagnosed DS. Complete blood count, levels of serum electrolytes, glucose, urea, liver function tests, thyroid function tests were reviewed. Results: 102 (55.4%) of the patients with DS were male and 82 (44.6%) were female. Mean age was 6.2 ± 4.0 years. Control group was constituted of outpatient healthy children. White blood cell count, hemoglobin, hematocrit, and neutrophil counts were found to be significantly lower in patients with DS. Platelet count and plateletcrit levels were found to be higher and platelet distribution width was lower in patients with DS than in the control group. Conclusion: We found significant differences among hematological parameters in patients with DS. Subclinical hypothyroidism influences red blood cell distribution width, platelet count and MPV. Knowing the incidence and severity of hematologic abnormalities in patients with DS will be beneficial during follow-up in clinical practice.

PubMed: 30887303, Acute mitochondriopathy and encephalopathy syndrome (AMES) is described differently by different authors in the literature. As a new clinical entity, we aimed to present the clinical signs and symptoms, diagnosis and treatment algorithm of our patients with AMES. 56 patients aged between 2 months and 18 years who were followed up in pediatric intensive care units of Konya Training and Research Hospital and Selcuk University Medical Faculty Hospital, between January 2010 and June 2017 were included. Patients’ data were obtained retrospectively from the intensive care unit patient files. 34 (60.7%) of the patients were male and 22 (39.3%) were female. The median age of our patients was 10.0 months. At the time of admission, 42 (75%) of the patients had fever, 35 (62.5%) vomiting, 27 (48.2%) abnormal behaviour and agitation and 28 (50%) convulsion. The etiological classification of patients with AMES was divided into four groups as infection, metabolic disorder, toxic, and hypoxic-ischemic. 39 (69.6%) patients were found to have infection, 10 (17.9%) patients hypoxia, 7 (12.5%) patients metabolic disorders. AMES occurs rarely, but should be kept in mind in the differential diagnosis of patients with any encephalopathy of unknown origin especially in those with a history of ingestion of drugs, previous viral infection and vomiting. Early recognition and treatment is imperative to reduce morbidity and mortality in children with AMES. © 2019, Belgian Neurological Society.

WOS: 000463109300010, PubMed: 30688191, Purpose: The aim of our study was to assess left ventricle and right ventricle systolic and diastolic functions in obese adolescents with metabolic syndrome using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotis intima-media thickness, and asymmetric dimethyl arginine levels. Methods: A total of 198 obese adolescents were enrolled in the study. The obese patients were divided into metabolic syndrome group and non-metabolic syndrome group. All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulsed, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness. Results: Obese adolescents were characterised by enlarged left end-diastolic, end-systolic and left atrial diameters, thicker left and right ventricular walls compared with non-obese adolescents. The metabolic syndrome group had normal left ventricle systolic function, impaired diastolic function, and altered global systolic and diastolic myocardial performance. In the metabolic syndrome obese group patients, left ventricle mass was found positively correlated with body mass index, waist and hip circumferences, diastolic blood pressure, age, and waist-to-hip circumference ratio. The carotid intima-media thickness was found positively correlated with waist and hip circumferences and total cholesterol levels. Asymmetric dimethyl arginine levels were found positively correlated with systolic blood pressure, waist-to-hip circumference ratio, and diastolic blood pressure. Conclusions: The results of this study demonstrate that metabolic syndrome in adolescence is associated with significant changes in myocardial geometry and function. In addition, it has been associated with a high level of asymmetric dimethyl arginine concentration and thicker carotid intima-media thickness reflecting endothelial dysfunction.

BackgroundP-wave dispersion is a new and simple electrocardiographic marker that has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we evaluated P-wave dispersion in obese adolescents and investigated the relationship between P-wave dispersion, cardiovascular risk factors, and echocardiographic parameters.MethodsWe carried out a case–control study comparing 150 obese adolescents and 50 healthy controls. Maximum and minimum P-wave durations were measured using a 12-lead surface electrocardiogram, and P-wave dispersion was calculated as the difference between these two measures. Echocardiographic examination was also performed for each subject. Multivariate linear regression analysis with stepwise variable selection was used to evaluate parameters associated with increased P-wave dispersion in obese subjects.ResultsMaximum P-wave duration and P-wave dispersion were significantly higher in obese adolescents than control subjects (143±19 ms versus 117±20 ms and 49±15 ms versus 29±9 ms, pConclusionsInsulin resistance is a significant, independent predictor of P-wave dispersion in obese adolescents.

Amaç: Bu çalışmanın amacı gastrointestinal sistemin cerrahi patolojilerine eşlik eden konjenital anomalileri değerlendirmektir.Gereç ve Yöntem: 2015-2018 yılları arasında yenidoğan yoğun bakım ünitesine gastrointestinal sistem cerrahi patolojileri nedeniyle başvuran hastaların tıbbi kayıtları retrospektif olarak ilişkili konjenital anomaliler açısından değerlendirildi.Bulgular: Çalışma süresince 67 hasta tespit edildi. En sık rastlanan gastrointestinal sistem patolojisi 15 olguda (% 22.4) anal atrezi, bunu 14 olguda (% 20.9) diyafragma hernisi, özofagus atrezisi (n: 10) ve ileal atrezi (n: 10) (% 14.9) izledi. Otuz iki hastada (% 48.8) gastrointestinal sistem patolojilerine eşlik eden konjenital anomali saptandı. Konjenital kalp hastalığı en sık görülen anomaliydi ve en sık birliktelik 18 olguda (% 26.8) atriyal septal defekt idi. Ek olarak, (n: 13)% 19.4'ünde kompleks konjenital kalp hastalığı vardı. On iki hastaya (% 17.9) ekstrakardiyak anomaliler eşlik etmekteydi. Üç hastada (% 4.5) hidronefroz ve safra kesesi çamuru vardı. Vezikoüreteral reflü, ektopik böbrek veya polispleni, her bir olguda ayrı bir anomali olarak tespit edildi. Olgularımızın % 54’ü prematüre olarak doğmuştu.Sonuç: Gastrointestinal sistem patolojileri sıklıkla konjenital kalp hastalıkları gibi çoklu anomaliler ile ilişkilidir. Ek olarak, GIS patolojilerinin prematüre bebeklerde daha sık görülmesi muhtemeldir., Purpose: The aim of this study was to review accompanied congenital anomalies to gastrointestinal pathologies. Materials and Methods: The medical records of patients who were admitted to neonatal intensive care unit with gastrointestinal system surgical pathologies during 2015-2018 were retrospectively evaluated for associated congenital anomalies.Results: 67 patients were identified during the study period. The most common gastrointestinal system pathology was anal atresia in 15 cases (22.4%), followed by diaphragmatic hernia in 14 cases (20.9%), esophageal atresia (n:10) and ileal atresia (n:10) (14.9%). Thirty two patients (48.8%) have had accompanied congenital anomalies to gastrointestinal system pathologies. Congenital heart disease was the most common anomaly and the most frequent one was atrial septal defect in 18 cases (26.8%). In addition, there was complex congenital heart disease in (n:13) 19.4%. In 12 patients (17.9%), accompanied extracardiac anomalies were detected. Hydronephrosis and sludge in gall bladder were detected in three patients (4.5%). Vesicoureteral reflux or ectopic kidney or polysplenia was detected as a separate anomaly in each case. In our cases, prematurity rate was found in 54%.Conclusion: Gastrointestinal system pathologies are frequently associated with multiple anomalies, especially with congenital heart diseases. In addition, these patients are likely to be preterm baby.

Asymmetric dimethylarginine (ADMA) is an analogue of l -arginine, a naturally occurring product of metabolism found in human circulation. It is an endogenous inhibitor of nitric oxide production. Acute rheumatic fever (ARF) is a delayed immunologically mediated autoimmune sequel of throat infection by group A β-hemolytic streptococci. As serum ADMA levels have not previously been assessed in patients with ARF, we aimed to investigate ADMA levels in patients with ARF during the acute stage and after anti-inflammatory treatment and compared results with healthy control subjects. The study population consisted of 34 children with ARF (30 patients with carditis and 4 patients without carditis) and 31 healthy control subjects. Erythrocyte sedimentation rate and C-reactive protein values were significantly higher and serum ADMA values were lower, but not statistically significant in patients with ARF during the acute stage when compared with controls. Serum C-reactive protein and erythrocyte sedimentation rate values were significantly decreased in patients with ARF after the treatment when compared with baseline and ADMA levels were increased after the treatment compared with baseline, but this change was not statistically significant. Our study has demonstrated that resolution of acute inflammation in patients with ARF may lead to a mild increase in serum concentration of ADMA. Comprehensive prospective and observational studies are required to confirm our findings and to assess potential interactions between ARF and ADMA levels.