Dolunay Gürses

Epidemiology and symptomatology of migraine among school children: Denizli urban area in Turkey

Objective.—This study was aimed at finding the prevalence, associated factors, and symptomatology of migraine among 5 to 8 grades of secondary and 9 to 11 grades of high school children (age range between 11 and 18 years old) in the Denizli urban area in the western part of Turkey.

Effects of hyperbilirubinemia on cerebrocortical electrical activity in newborns

In our study, cerebrocortical electrical activity was recorded as an indicator of bilirubin neurotoxicity. Bilirubin especially affects the thalamus and cerebral cortex. Inasmuch as rhythmic oscillations on the EEG arise from the interaction between cortex and thalamus, electrophysiologic effects of bilirubin on the rhythmic oscillations with long-term postnatal age were investigated. Brain maturation was also analyzed with power spectral analysis quantitatively. For this purpose, 141 EEG records were taken (in the first week, 15th d, at the end of the first month, and at the third month) from 17 infants with hyperbilirubinemia and 22 healthy infants. In all records, the major frequency component was formed by the delta frequency in both groups. In the first records of the hyperbilirubinemia group, the delta frequency was higher than the control group; however the theta, alpha, and beta frequencies and the amplitude levels were lower (p < 0.001). These changes were found to be significantly correlated with the bilirubin levels (p < 0.001). On the 15th d the amplitude of the hyperbilirubinemia group increased to similar levels as the control group. At the frequency bands of delta and theta, there were significant changes related to postnatal age (p < 0.001). In all cerebral regions, the delta frequency decreased and the theta frequency increased with age. However, in the hyperbilirubinemia group the delta frequency was higher, the theta frequency was lower, and the changes between the groups disappeared in the third month despite the differences at all regions of the brain. In terms of the vertex, k complex, and sleep spindle, there were no differences between both groups in the third month (p > 0.05). We conclude that hyperbilirubinemia affects the cerebrocortical electrical activity but appears to be time limited.

Stiffness of the abdominal aorta in beta-thalassemia major patients related with body iron load.

Objectives Increased iron stores have been implicated in the association with increased risk of cardiovascular events. We evaluated whether the abdominal aortic stiffness was altered in the patients with β-thalassemia major in relation with body iron load. Methods Sixty-two (32 males and 30 females) β-thalassemia major patients aged 16.47±4.8 years were enrolled into the study. Healthy 52 subjects matched for age and sex were recruited as controls. In all subjects, hemoglobin, fasting glucose, cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol levels were measured. The average serum ferritin level and liver iron concentration (LIC) were assessed in thalassemia patients. Left ventricular function and mass were evaluated echocardiographically and aortic strain (S), pressure strain elastic modulus (Ep), and normalized Ep (Ep*), aortic distensibility (DIS), and β stiffness index (β index) were calculated in all subjects. Results There was no statistically significant difference between the study and control groups in sex, mean age, body mass index, heart rate, and systolic blood pressure (P>0.05). However, pulse pressure and left ventricular mass index (LVMI) were found higher in thalassemia major patients compared with the control group. In β-thalassemia major patients S (0.21±0.027 vs. 0.26±0.017, P<0.0001) and DIS (1.07±0.25 vs. 1.56±0.37, P<0.0001) were significantly lower compared with the control group. However, Ep (196.9±44.86 vs. 134.20±29.10, P<0.0001), Ep* (3.26±0.98 vs. 2.04±0.60, P<0.0001), and β index (2.44±0.58 vs. 1.61±0.37, P<0.0001) were significantly higher in β-thalassemia patients than controls. There was a statistically significant negative correlation between LIC and S, DIS. There was also negative correlation between LVMI and S. However, there was a statistically significant positive correlation between LIC and Ep, Ep*. Conclusions Increased abdominal aortic stiffness was detected in β-thalassemia major patients and this increase in arterial stiffness correlated with LIC and LVMI.

Detection of Early Cardiac Dysfunction in Patients with β-Thalassemia Major and Thalassemia Trait by Tissue Doppler Echocardiography

Cardiac complications are the leading cause of death in β-thalassemia major (TM) patients. The aim of this study was to investigate the impact of iron overload on ventricular functions using conventional and tissue Doppler imaging (TDI) in patients with TM and compare them with children with thalassemia trait (TT) and healthy controls. This prospective study includes 3 groups: group 1: 29 patients with β-TM; group 2: 28 patients with TT; group 3: 29 healthy controls. Peak late relaxation velocity determined by conventional echocardiography for the right ventricle was significantly higher and the E/A ratio for the right ventricle and left ventricle were significantly lower in TM patients than the other groups (P < .05). Peak late relaxation velocity determined by TDI for the left ventricle, interventricular septum, and right ventricle were significantly higher in TM patients than the TT subjects and controls (P < .001). The E/A ratio determined by TDI for the left ventricle, interventricular septum, and right ventricle were significantly lower in group 1 than the other 2 groups (P < .001). There was a negative correlation between the ferritin level and E/A ratio for the left ventricle, interventricular septum, and right ventricle using TDI (P < .05). Conventional echocardiographic techniques have failed to distinguish ventricular functions of asymptomatic patients with TM from the subjects with TT and from normal controls when global functions were examined. The present study indicates that TDI should be used for screening of TM and TT subjects’ cardiac functions.

Evaluation of cardiac systolic and diastolic functions in small for gestational age babies during the first months of life: a prospective follow-up study.

OBJECTIVE The purpose of this study was to evaluate the cardiac functions and age-related changes of these functions in full-term small for gestational age infants during the first 3 months of life. METHODS Cardiac functions of 20 term small for gestational age and 20 term appropriate for gestational age infants were studied using conventional and tissue Doppler echocardiography on postnatal day 5 and at 1 and 3 months. RESULTS Ventricular diameters, ventricular wall thicknesses, and left ventricular mass significantly increased with age in both groups. All these parameters were significantly lower in small for gestational age infants. No differences were detected by conventional echocardiography between the groups in systolic and diastolic functions. Systolic velocity, early diastolic and atrial contraction velocities, and the ratio between early diastolic and atrial contraction velocities determined by tissue Doppler echocardiography increased with age. Systolic velocity was lower in the small for gestational age babies for all myocardial regions on the 5th day. Peak early diastolic velocity was decreased in the small for gestational age babies at the first and second evaluations for all myocardial regions. The ratio between early diastolic and atrial contraction velocities was significantly lower in the small for gestational age babies for the interventricular septum and right ventricle. Significant positive correlations were detected between the Ponderal index and systolic and early diastolic velocities. CONCLUSION The present findings suggest that systolic and diastolic function indices including tissue Doppler measures are significantly affected in small for gestational age babies during the first 3 months of life.

Elastic properties of the abdominal aorta in the children with bicuspid aortic valve: an observational study

OBJECTIVE Abnormalities of the aortic root and ascending aorta are common in patients with a bicuspid aortic valve (BAV). The aim of this study was to evaluate the stiffness of the abdominal aorta in children with BAV. METHODS In this cross-sectional observational study, we evaluated 35 children with normally functioning or mildly regurgitant BAV and 35 healthy children as controls. All children were noninvasively evaluated with transthoracic echocardiography. Annulus of aorta and abdominal aorta diameters were measured. Aortic strain (S), pressure strain elastic modulus (Ep), pressure strain normalized by diastolic pressure (Ep*), aortic stiffness β index (βSI) and, aortic distensibility (DIS) were calculated using the measured data. In evaluation of the data Students t-test, Chi-square test, Pearsons correlation and multivariate linear regression analysis were used. RESULTS Diameter of the aortic annulus was found significantly larger in the children with BAV than the control group (p<0.05). The abdominal aorta systolic and diastolic diameters were similar in the two groups (p>0.05). The children with BAV exhibited significantly lower S (0.210 ± 0.04/0.267 ± 0.07, p<0.001) and DIS (1.04 ± 0.2/1.4 ± 0.4 10(-6) cm(2) dyne(-1), p<0.001); and higher Ep (200 ± 39/153 ± 47 N/m(-2), p<0.001), Ep* (3.42 ± 0.9/2.5 ± 0.9, p<0.001) and βSI (1.1 ± 0.3/0.84 ± 0.3, p<0.001) than the control group. There was no correlation between the systolic and diastolic diameters of abdominal aorta and aortic elasticity parameters (p>0.05). CONCLUSION Bicuspid aortic valve is associated with an increased abdominal aortic stiffness in children. However, impaired abdominal aortic elasticity is not due to abdominal aortic dilatation. These findings require validation by further studies.

[Four Hydatid Cysts in One Family: Is Family Screening Necessary?].

Hydatid cyst is a parasitic infection mostly caused by Echinococcus granulosus. As transmission occurs from infected dogs, it is endemic in animal husbandry regions. Here four patients within the same family are presented. The first patient is a 10 year-old girl admitted with nausea, vomiting, and fever. On her physical examination, there were decreased respiratory sounds in the right lung, rales, and hepatomegaly. In the radiological examination, cysts were seen in both her lung and liver. After the confirmation of the diagnosis with a serological examination, surgical resection was performed, and albendazole treatment was given. On family screening, cysts were detected in the liver and spleen in her asymptomatic 6-year-old brother; in the lung, liver, spleen, and right kidney in her 33-year-old mother who had repeating abdominal pain; and in the liver and left kidney in her 33-year-old asymptomatic father. Hydatid cyst infection was serologically confirmed in all patients, and they were given albendazole and were surgically treated. In this case report, four patients in the same family and diagnosed as having hydatid cysts were presented. It was emphasized that once a hydatid cyst was diagnosed, family screening became important, in endemic regions in particular.

A Rare Complication of Epstein-Barr Virus Infection: A Case Report with Myopericarditis

Acute myocarditis usually develops after viral infections and is often asymptomatic. However, pericarditis can accompany it. Myopericarditis due to Epstein-Barr virus (EBV) infection is very rare. A 16-year-old male presented with severe chest pain. Cardiac enzymes were elevated and electrocardiographic examination revealed widespread decreased voltage and ST-T changes on the DII, DIII, aVF, V5, and V6 leads. Left ventricular systolic functions were normal and pericardial effusion was present on echocardiographic evaluation. EBV-VCA IgM and EBV-PCR were positive; EBV myopericarditis was diagnosed in the patient. The patient responded well to intravenous immunoglobulin (IVIG) and nonsteroidal antiinflammatory therapy and recovered completely. Myopericarditis should be considered in the differential diagnosis while evaluating patients with chest pain. The Epstein-Barr virus should be kept in mind even though it rarely causes myopericarditis.

Giant coronary artery fistula diagnosed in newborn period.

Coronary artery fistulas are rare cardiac anomalies which are connections between coronary arteries and the lumen of cardiac chambers or great arteries. They can be seen in all ages. They can be diagnosed during investiagation of abnormal murmurs, dyspnea, angina, fatigue, and palpitations. In this case report, a four days old newborn is reported who was admitted to our department with heart murmur. A giant fistula originating from left main coronary artery and draining into the right atrium was diagnosed. With this case report, we wanted to emphasize the importance of echocardiography in the diagnosis of coronary artery fistulas. Although rarely observed they should be considered in the differential diagnosis of infants with murmur. Pam Med J 2017;10(1):73-76

A New Problem of Adolescents: “Bonsai”

Asya kökenli bir bitki olan “Cannabis sativa”dan (kendirHint keneviri-esrar) elde edilen kannabis (esrar-marihuana) maddesinin sıtma ve romatizmaya karşı etkili olduğu tarihte ilk olarak Çin İmparatoru Shen-Nung (M.Ö. 2737) tarafından bahsedilmiştir (1). Kannabis maddesinden laboratuvar ortamında üretilen sentetik kannabinoidlerin (SK) tüm dünyada olduğu gibi ülkemizde de kullanım sıklığı artmaktadır. SK içeren maddeler genel olarak, Avrupa’da “spice”, Amerika Birleşik Devletleri’nde (ABD) “K2”, Türkiye’de ise “bonzai” ya da “Jamaika” olarak adlandırılmaktadır (1). Dozaj ve içerik açısından yapıları tam olarak bilinmeyen bu maddelerin yaygın kullanımı ve artan tüketimi halk sağlığı için ciddi bir problem haline gelmektedir. “Bonzai”, doğal esrar benzeri etki göstererek, görsel ve işitsel algıyı etkiler. Duygu durum yükselmesi, anksiyete, psikoz, halüsinasyon, panik reaksiyonlar, ajitasyon, ataksi, konvülsiyon, analjezi, motor fonksiyonda azalma, bellekte ve zaman algısında bozulmaya neden olur (1). Bununla birlikte nefes darlığı, taşikardi, bradikardi, hipertansiyon, göğüs ağrısı, miyokard enfarktüsü gibi kardiyovasküler etkilere de neden olabilmektedir (2). Bu olgu sunumunda “bonzai” kullanımına bağlı kardiyovasküler etkilenmelerin görüldüğü üç ergen erkek olgu sunuldu. Synthetic cannabinoids have been increasingly used by adolescents in the recent years. In our country, synthetic cannabinoids are known as “bonsai”. They may cause neuropsychiatric effects such as psychosis, agitation, ataxia, convulsion, hallucinations, and may also cause cardiovascular symptoms such as tachycardia, systolic hypertension, postural hypotension and chest pain. In this article, three adolescent males are reported, who were admitted to the emergency department with severe chest pain and significantly higher cardiac enzymes, and who claimed to have used “bonsai”.