Fikri Demir

Usefulness of Neutrophil to Lymphocyte Ratio in Prediction of Coronary Artery Lesions in Patients with Kawasaki Disease

BACKGROUND Kawasaki disease is an inflammatory condition. Neutrophil to lymphocyte ratio is a marker reflecting inflammation. AIMS The aim of the study is to evaluate usefulness of neutrophil to lymphocyte ratio in diagnosis of Kawasaki disease and in prediction of coronary artery lesions. STUDY DESIGN Retrospective cross-sectional study. METHODS Seventy-five children with Kawasaki disease and 66 controls were retrospectively enrolled. Their leukocyte, neutrophil, and lymphocyte counts were recorded. Abnormally distributed data were shown as median (interquartile range). Cases having coronary artery diameter two standard deviation above mean were diagnosed to have coronary artery lesions. RESULTS Median age of Kawasaki disease patients was 34 months. Twentyfive of those (33.33%) had incomplete Kawasaki disease and twenty-six (34.66%) had coronary artery lesions. Leukocyte [12.61 (6.09)×10(3)/µL vs. 8.48 (5.58)×10(3)/µL], neutrophil [6.73 (4.10) ×10(3)/µL vs. 4.62 (5.47)×10(3)/µL], and lymphocyte [4.04 (2.91)×10(3)/µL vs. 3.02 (2.57) ×10(3)/µL] counts were significantly higher in Kawasaki disease patients compared to controls (all p values <0.01). However, there was not significant difference between patients and controls regarding neutrophil to lymphocyte ratio [1.72 (1.22) vs. 1.71 (1.88)]. Findings of Kawasaki disease and incomplete Kawasaki disease cases did not differ, while comparison of patients with and without coronary artery lesions revealed significantly higher neutrophil to lymphocyte ratio values in former group [2.02 (1.63) vs. 1.50 (1.28), p=0.01]. The cut-off neutrophil to lymphocyte ratio value for prediction of coronary artery lesions was determined as 1.32. CONCLUSION Neutrophil to lymphocyte ratio values in Kawasaki patients with coronary lesions were significantly higher than the ones without and values greater than 1.32 were useful in prediction of coronary lesions.

Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization

Akın A, Bilici M, Demir F, Yılmazer MM, İpek MŞ, Kara H. Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization. Turk J Pediatr 2018; 60: 191-193. Umbilical vein catheterization is frequently preferred and a safe route of venous access especially in newborns. However, some cases with breaking and embolization of those catheters have been rarely reported. Herein we present a two-and-a-half-month-old infant being catheterized within first postnatal week and diagnosed to have embolization of the catheter fragment to conjunction of hepatic vein and right atrium. Percutaneous withdrawal of broken catheter was achieved despite several months after the embolization took place. We suggest that transcatheter removal of catheter fragment embolizations may be safe even in late diagnosis cases.

Myocardial infarction in an 11-year-old child with systemic lupus erythematosus.

SLE is a chronic autoimmune disease that can affect almost every organ (1). Risk of cardiovascular diseases such as pericarditis, myocarditis, valvular heart disease, and myocardial infarction is increased in SLE, but the latter is observed rarely in childhood. An 11-year-old girl who had been followed-up at our pediatric nephrology clinic for SLE was admitted to our emergency room with chest pain followed by cardiac arrest. We detected 2–3 mm ST elevations in the DII, DIII, aVF, V5, and V6 leads of electrocardiography. Creatine kinase MB fraction (CKMB) was 7.75 ng/mL (range, 0.6–6.3) and troponin I level was 0.88 ng/mL (range, 0–0.04). Transthoracic echocardiography revealed areas of dyskinesia in the left ventricular apical region, paradoxical movement in the interventricular septum, and minimal aortic insufficiency. Coronary angiography revealed total occlusion of the Anatol J Cardiol 2016; 16: 364-8 Letters to the Editor 367

Biküspid aort kapağı ve sol taraf kardiyovasküler anomalilerde kalıtım incelemesi

Amac: Bikuspid aort kapagi (BAK) veya diger sol taraf kardiyovaskuler anomalisi (STKA) olan hasta ailelerinde benzer anomalilerin sikliginin belirlenmesi ve hastalar ile ailelerinde saptanan kardiyak anomalilerin ekokardiyografik ozelliklerinin degerlendirilmesidir.Gerec ve Yontem: Ekim 2010 – Agustos 2011 tarihleri arasinda Ankara Universitesi Tip Fakultesi Cocuk Sagligi ve Hastaliklari Anabilim Dali, Cocuk Kardiyolojisi Bilim Dali’nda BAK ve/veya bikuspid olmayan aort kapak darliklari, aort koarktasyonu (AK), kesintili arkus aorta ve izole cikan aorta genislemesi (CAG) gibi diger STKA’lar nedeniyle degerlendirilen hastalar ve bu hastalarin yakinlari calismaya alindi. Genetik bozuklugu olan hastalar ve yakinlari calisma disi birakildi. Hastalar ve birinci derece yakinlarina ekokardiyografik inceleme yapildi. Inceleme ile sol taraf kardiyovaskuler anomali saptanan her yeni bireyin yakinlari da kademeli ornekleme yontemiyle calismaya katildi. Hastalar BAK, BAK + AK ve diger STKA’lar olmak uzere uc gruba ayirilarak incelendi. Hasta yakinlari da ailelerindeki probandin kardiyak anomalisine gore gruplanarak degerlendirildi. Hastalar ve kardeslerinin ekokardiyografik olcumleri, Z skorlari hesaplanarak standardize edildi ve gruplarin bulgularinin karsilastirmasinda bu skorlar esas alindi. P<0.05 olan sonuclar istatistiksel olarak anlamli kabul edildi.Bulgular: Degerlendirilen 263 BAK ve diger STKA’li hasta yakinindan, 19’unda (%7.2) STKA saptandi. Bunlarin 14’unde (%5.3) aort genislemesi, 5’inde (%1.9) BAK mevcuttu. Calismaya alinan 86 aileden 11’inde (%12.8) ikinci bir bireyde patoloji saptandi. Bikuspid aort kapagi olan 66 hastanin%81.8’i erkek idi ve bu BAK’li hastalarin 14’une (%21.2) AK eslik ediyordu. Bikuspid aort kapakli hastalar arasinda aort darligi (AD) sikligi %37.9, aort yetersizligi (AY) sikligi %53, AD+AY sikligi %25.8, aort genislemesi sikligi %48.5 bulundu. Bikuspid kapagi olan hastalarin aort olcumleri, saglikli kardeslerinin olcumlerinden fazla idi. Adolesan BAK’li hastalarda CAG ve AD sikligi, preadolesan hastalardan fazla bulundu. Sag koroner-nonkoroner yaprakcik yapisikligi olan hastalarda kapak disfonksiyonu ve aort genislemesine daha sik rastlandi. Bikuspid aort kapakli hastalarda saptanan CAG sikligi ile aort anulusu ve cikan aort Z skorlari STKA grubundakilerden; STKA’li bireylerde gozlenen sol atrium genisligi ve sol ventrikul arka duvar kalinlik Z skorlari ile ventrikuler septal defekt (VSD) ve patent duktus arteriosus eslik etme sikligi BAK grubundaki hastalardan anlamli olarak fazla idi. VSD eslik eden AK’li hastalarin aort genislikleri etmeyenlerden kucuk bulundu.Sonuc: Bikuspid aort kapagi ve diger STKA’larin yol actigi enfektif endokardit, aort disseksiyonu, aort rupturu ve ani olum komplikasyonlarinin neredeyse tamaminin ciddi sorun olusturmadan onlenebilir olmasi, hastalarin zamaninda taninip, gerektiginde mudahale edilmesini zorunlu kilar. Calismamiz sirasinda yeni tani alan hasta yakinlarinin izleme alinmasi ve hastaliklari ile ilgili bilgilendirilmeleri saglandi. Anomali saptanan ailelerdeki bireylerden bir kisminin DNA’ lari ayirtildi, hastalar kontrole geldikce geri kalanlarin da ayirtilmasi planlandi. Bikuspid aort kapagi ve diger STKA’larin dominant kalitilabilmesi, bazi ailelerde kumelendiklerinin gosterilmesi ve bu hastalarin yakinlarinda kapak anomalisi olmadan aort anevrizmasi gelisebilmesi nedeniyle en azindan BAK’li, mumkun olursa tum STKA’li hasta yakinlarinin benzer anomaliler acisindan taranmasi gerektigini dusunmekteyiz. Bu arastirma, ulkemizde yapilan ve STKA’li hasta yakinlarinin kardiyovaskuler anomaliler acisindan tarandigi ilk calismadir.