Ayhan Pektas

Do toxic metals and trace elements have a role in the pathogenesis of conotruncal heart malformations

OBJECTIVE The aim of the present study was to determine the role of toxic elements and trace elements in the pathogenesis of conotruncal heart defects by measuring their concentrations in the first meconium specimens of the affected newborns. METHODS Concentrations of lead, cadmium, iron, zinc, and copper were measured in 1st-day meconium specimens that were collected from 60 newborns with conotruncal heart defects (Group I) and 72 healthy newborns (Group II). RESULTS The newborns with conotruncal defects and the healthy newborns had statistically similar demographic and clinical characteristics. When compared with healthy newborns, mean concentrations of lead, cadmium, iron, zinc, and copper were significantly higher in newborns with conotruncal heart defects (p=0.001 for each). In total, 51 newborns with conotruncal heart defects had normal karyotype. These newborns had significantly higher concentrations of lead, cadmium, iron, zinc, and copper when compared with healthy newborns. There were significant and positive correlations between the concentrations of lead and cadmium (r=0.618, p=0.001), lead and iron (r=0.368, p=0.001), lead and zinc (r=0.245, p=0.005), lead and copper (r=0.291, p=0.001), cadmium and iron (r=0.485, p=0.001), cadmium and zinc (r=0.386, p=0.001), and cadmium and copper (r=0.329, p=0.001). CONCLUSION Toxic metals and trace elements may disturb DNA repair mechanisms by impairing DNA methylation profiles, and thus have a role in the pathogenesis of conotruncal heart defects.

Evaluation of Neurodevelopment and Factors Affecting it in Children With Acyanotic Congenital Cardiac Disease

Background: The rate of congenital heart disease is 0.8% in all live births. The majority of this, however, is acyanotic congenital heart disease. The survival rate of children with cardiac disease has increased with the developments provided in recent years and their lifetime is extended. Objectives: This study aims to evaluate neurodevelopment of children with uncomplicated acyanotic congenital heart disease in preschool period and determine the factors affecting their neurodevelopmental process. Patients and Methods: 132 children with acyanotic congenital heart disease aged 6 - 72 months were involved in the study. Mental development and intelligence levels of patients under 2 years old were assessed by using Bayley Development Scale-III, and Stanford Binet Intelligence test was employed for patients over 2 years old. Denver Developmental Screening Test II was applied to all patients for their personal-social, fine motor, gross motor and language development. Results: The average age of patients (67 girls, 65 boys) included in the study was 35.2 ± 19.6 months. It was determined that there were subnormal mental level in 13 (10%) patients and at least one specific developmental disorder in 33 (25%) patients. Bayley Mental Development Scale score of patients who had received incubator care in perinatal period was found significantly low (88 ± 4.2) compared to those with no incubator care (93.17 ± 8.5) (P = 0.028). Low educational level of father was established to be linked with low mental development scores at the age of 2 and following that age (P < 0.05). Iron deficiency anemia was discovered to be related to low psychometric test scores at every age (P < 0.05). Conclusions: Neurodevelopmental problems in children with acyanotic congenital heart disease were found higher compared to those in society. Mental development and intelligence levels of patients were determined to be closely associated with receiving incubator care, father’s educational level and iron deficiency anemia.

Magnetic Resonance Imaging in Pediatric Pulmonary Hypertension

The present study aims to determine the efficacy and reliability of cardiovascular magnetic resonance imaging in establishing the diagnosis and prognosis of pulmonary hypertension in children. This is a retrospective comparison of 25 children with pulmonary hypertension and a control group comprising 19 healthy children. The diagnosis of pulmonary hypertension was made when the mean pulmonary artery pressure was ≥25 mmHg by catheter angiography. The children with pulmonary hypertension had significantly lower body mass indices than did the healthy children (P=0.048). In addition, the children with pulmonary hypertension had significantly larger main pulmonary artery diameters and ascending aortic diameters (both P=0.001) but statistically similar ratios of main pulmonary artery diameter-to-ascending aortic diameter. If the main pulmonary artery diameter was ≥25 mm, pediatric pulmonary hypertension was diagnosed with 72% sensitivity and 84% specificity. In the event that the ratio of main pulmonary artery diameter-to-ascending aorta diameter was ≥1, pediatric pulmonary hypertension was diagnosed with 60% sensitivity and 53% specificity. When compared with children who had New York Heart Association functional class II pulmonary hypertension, the children with functional class III pulmonary hypertension had significantly larger main (P=0.046), right (P=0.036), and left (P=0.003) pulmonary arteries. Cardiovascular magnetic resonance imaging is useful in the diagnosis of children with pulmonary hypertension. Pediatric pulmonary hypertension can be diagnosed with high sensitivity and specificity when the main pulmonary artery diameter measures ≥25 mm.

Sequential Transcatheter Closure of a Patent Ductus Arteriosus and a Muscular Ventriculer Septal Defect in a Child

Due to the developing technology in pediatric catheterization and increasing experience of pediatric cardiologists, currently transcatheter closure of multiple cardiac defects has become available. The present case report describes a patient who successfully underwent sequential transcatheter closure of patent ductus arteriosus (PDA) and muscular ventricular septal defect (VSD). Transcatheter closure of multiple defects is regarded as a reliable and efficient therapeutic option which can be an alternative to surgical treatment in appropriate cases.

Serum vitamin B-12 in children presenting with vasovagal syncope

BACKGROUND AND OBJECTIVES The present study aims to determine the serum vitamin B-12 in children presenting with vasovagal syncope. METHODS AND STUDY DESIGN This is a prospective review of 160 children presenting with vasovagal syncope. Subgroup analysis was done based on the results of head up tilt test. RESULTS Head up tilt test gave positive results in 80 children and yielded negative results in the remaining 80 children. The tilt test positive children had significantly lower thyroid stimulating hormone concentrations (p=0.06), total iron binding capacity (p=0.04) and serum vitamin B-12 (p=0.01). The prevalence of vitamin B-12 deficiency was significantly higher in the tilt positive group (80% vs 52.5%, p=0.001). Out of 80 children with positive tilt test, 8 children (10%) showed cardioinhibitory response, 22 children (27.5%) demonstrated a vasodepressor response, 24 children (30%) displayed mixed response and 26 children (32.5%) had the postural orthostatic tachycardia syndrome. Erythrocyte sedimentation rate was significantly lower in the mixed response group than in the vasodepressor group (6.2±0.8 mm/h vs 14.3±2.5 mm/h, p=0.001). Serum vitamin B-12 was significantly lower in the postural orthostatic tachycardia syndrome (POTS) group than in the vasodepressor group (240.8±38.2 pg/mL vs 392.7±27.1 pg/mL, p=0.001). The prevalence of vitamin B-12 deficiency was significantly higher in the POTS group than in the vasodepressor group (92.3% vs 45.5%, p=0.001). CONCLUSIONS Vitamin B-12 deficiency causes reduction in myelinization, deceleration in nerve conduction and elevation in serum concentrations of noradrenaline. These factors may contribute to the impairment of autonomic functions which are involved in the pathogenesis of vasovagal syncope.

Effects of resveratrol on diabetes-induced vascular tissue damage and inflammation in male rats

Abstract Objective: The present study aims to investigate the short-term effects of resveratrol on histopathological characteristics and inflammatory cytokines of the heart and thoracic aorta tissues in animal models of streptozotocin (STZ)-induced diabetes. Methods: Male Wistar rats were randomly divided into four groups; (1) control/vehicle, (2) control/20 mg/kg resveratrol, (3) diabetic/vehicle, (4) diabetic/20 mg/kg resveratrol. Heart and thoracic aorta were examined histopathologically and the levels of interleukin (IL)-1β, IL-18 and tissue necrosis factor (TNF)-α were analyzed by ELISA. Malondialdehyde (MDA) contents were determined with HPLC. Results: Diabetes group had significantly higher vascular MDA content (p<0.05) as compared with the control and resveratrol treated groups. Resveratrol significantly reduced vascular MDA level in diabetic animals (p<0.05). Significant elevation in IL-1β and TNF-α contents in thoracic aorta and IL-18 contents in cardiac and arterial tissues with diabetes were almost normalized with resveratrol treatment. Additionally, diabetic animals demonstrated significant endothelial damage, irregularities in smooth muscle fibers and degeneration of elastic fibers in thoracic aortas together with significant irregularities and hypertrophy in cardiac muscle fibers. Resveratrol significantly improved most of these histopathological alterations. Conclusion: Four-week-long intraperitoneal administration of resveratrol may restore the diabetes related inflammation and oxidative stress within the cardiovascular system. Özet Amaç: Bu çalışma, streptozotocin (STZ) ile oluşturulmuş diyabetin hayvan modellerinde resveratrolün kalp ve damar dokularında histopatolojik özellikler ve inflamatuar sitokinler üzerine kısa süreli etkilerini araştırmayı amaçlamıştır. Metod: Erkek Wistar sıçanları (1) kontrol, (2) kontrol/20 mg/kg resveratrol, (3) diyabetik, (4) diyabetik/20 mg/kg resveratrol olmak üzere dört gruba ayrılmıştır. Kalp ve damar dokuları histopatolojik olarak incelenmiştir. Buna ilave olarak, interleukin (IL)-1β, IL-18 ve doku nekroz faktör (TNF)-α düzeyleri ELISA yöntemiyle, malondialdehit (MDA) miktarı ise HPLC ile belirlenmiştir. Bulgular: Diyabet grubunda vasküler MDA miktarı kontrol ve resveratrol gruplarına göre anlamlı ölçüde (p<0,05) yükselmiştir. Diyabetik hayvanlarda resveratrol, vasküler MDA düzeylerini anlamlı derecede (p<0,05) düşürmüştür. Torasik aorta dokularındaki IL-1β ve TNF-α düzeylerinde meydana gelen anlamlı artış, kardiyak ve arterial dokularındaki IL-18 düzeylerindeki yükseliş, resveratrol uygulamasıyla büyük ölçüde normalize edilmiştir. Buna ilave olarak diyabetik hayvanların torasik aortlarında anlamlı ölçüde endotel hasar, düz kas liflerinde düzensizlikler ve elastik liflerinde dejenerasyon gösterilmiştir. Ayrıca kardiyak kas liflerinde belirginleşen düzensizlikler ve hipertropi gösterilmiştir. Diyabetik hayvanlara resveratrol tedavisi, bu olumsuz değişiklikleri kısmi olarak iyileştirmiştir. Sonuç: Dört hafta boyunca intraperitonal yoldan uygulanan resveratrol, kardiyovasküler sistemde diyabetle meydana gelen inflamasyon ve oksidatif stresi azaltacak potansiyele sahiptir.

The role of inflammatory biomarkers in CHD-associated pulmonary hypertension in children

OBJECTIVE The present study aims to identify the role of inflammatory markers such as C-reactive protein, interleukin-6, and fractalkine in CHD-associated pulmonary hypertension in children. METHODS This is a prospective review of 37 children with CHD-related pulmonary hypertension, 21 children with congenital heart defects, and 22 healthy children. RESULTS Serum C-reactive protein and interleukin-6 levels were significantly higher in the children with CHD-related pulmonary hypertension (respectively, p=0.049 and 0.026). Serum C-reactive protein concentrations correlated negatively with ejection fraction (r=-0.609, p=0.001) and fractional shortening (r=-0.452, p=0.007) in the pulmonary hypertension group. Serum fractalkine concentrations correlated negatively with ejection fraction (r=-0.522, p=0.002) and fractional shortening (r=-0.395, p=0.021) in the children with pulmonary hypertension. Serum interleukin-6 concentrations also correlated negatively with Qs (r=-0.572, p=0.021), positively with Rs (r=0.774, p=0.001), and positively with pulmonary wedge pressure (r=0.796, p=0.006) in the pulmonary hypertension group. A cut-off value of 2.2 IU/L for C-reactive protein was able to predict pulmonary hypertension with 77.5% sensitivity and 77.5% specificity. When the cut-off point for interleukin-6 concentration was 57.5 pg/ml, pulmonary hypertension could be predicted with 80% sensitivity and 75% specificity. CONCLUSION Inflammation is associated with the pathophysiology of pulmonary hypertension. The inflammatory markers C-reactive protein and interleukin-6 may have a role in the clinical evaluation of paediatric pulmonary hypertension related to CHDs.

An epidemiological study of paediatric pulmonary hypertension in Turkey.

OBJECTIVE The present study aims to evaluate the epidemiological characteristics of paediatric pulmonary hypertension within the entire Turkish population over a period of 5 years using the registry of the National Health Insurance System. METHODS All individuals aged <18 years who were admitted to a Turkish hospital for the first time between 2009 and 2013 with a discharge diagnosis of idiopathic pulmonary hypertension and secondary pulmonary hypertension were identified. RESULTS The overall annual incidence of idiopathic pulmonary hypertension during childhood was 11.7 cases/million, whereas the overall annual incidence of secondary pulmonary hypertension during childhood was 9.5 cases/million. There was a gradual and significant increase in the annual incidence of idiopathic pulmonary hypertension and that of secondary pulmonary hypertension during the 5-year study period (p=0.001 for both). In the years 2012 and 2013, idiopathic pulmonary hypertension was significantly more frequent in children aged <2 years when compared with children aged above 2 years (p=0.002 for both). The male to female ratio was 1.2:1 for idiopathic pulmonary hypertension, whereas the female to male ratio was 1.1:1 for secondary pulmonary hypertension during childhood. CONCLUSION The incidence of paediatric pulmonary hypertension in Turkey is higher than those reported for the Western populations. Moreover, no female dominance could be observed. These discrepancies may be attributed to the differences in the study design, study cohort, timing of the study, and the definitions adopted for pulmonary hypertension classification.

An Epidemiological Study Of Pulmonary Hypertension In Turkish Adults

Objective: The present study aims to evaluate the nationwide epidemiological characteristics of adulthood pulmonary hypertension (PH) within whole Turkish population over a period of five years using the registry of the National Health Insurance System. Methods: All individuals aged more than 18 years who were admitted to a Turkish hospital for the first time between 2009 and 2013 with a discharge diagnosis of primary PH (ICD-10 code I27.0) and secondary PH (ICD-10 code I27.2) were identified. Results: The overall annual prevalence of primary PH during adulthood was 9.6 cases per million. When compared with other age groups, the number of individuals aged more than 45 years was significantly higher in adults affected by primary PH during the study period (p=0.001 for all years). The female to male ratio was 2.2:1 for adulthood primary PH throughout the study period. The number of patients settled in the Northwestern Anatolia was significantly higher in the primary PH group (p<0.05 for all years). The overall annual prevalence of secondary PH in adults was 6.0 cases per million. When compared with other age groups, the number of individuals aged more than 45 years was significantly higher in adults affected by secondary PH during the study period (p=0.001 for all years). Conclusion: The prevalence of adulthood PH in Turkey may be higher than that of adulthood PH in Western countries and adulthood PH usually affects Turkish individuals aged over 45 years. Keywords: Adult; epidemiology; pulmonary hypertension

Erişkin Türk Toplumunda Pulmoner Hipertansiyon; Epidemiyolojik Çalışma

Objective: The present study aims to evaluate the nationwide epidemiological characteristics of adulthood pulmonary hypertension (PH) within whole Turkish population over a period of five years using the registry of the National Health Insurance System. Methods: All individuals aged more than 18 years who were admitted to a Turkish hospital for the first time between 2009 and 2013 with a discharge diagnosis of primary PH (ICD-10 code I27.0) and secondary PH (ICD-10 code I27.2) were identified. Results: The overall annual prevalence of primary PH during adulthood was 9.6 cases per million. When compared with other age groups, the number of individuals aged more than 45 years was significantly higher in adults affected by primary PH during the study period (p=0.001 for all years). The female to male ratio was 2.2:1 for adulthood primary PH throughout the study period. The number of patients settled in the Northwestern Anatolia was significantly higher in the primary PH group (p<0.05 for all years). The overall annual prevalence of secondary PH in adults was 6.0 cases per million. When compared with other age groups, the number of individuals aged more than 45 years was significantly higher in adults affected by secondary PH during the study period (p=0.001 for all years). Conclusion: The prevalence of adulthood PH in Turkey may be higher than that of adulthood PH in Western countries and adulthood PH usually affects Turkish individuals aged over 45 years. Keywords: Adult; epidemiology; pulmonary hypertension