Mahmut Keskin

An evaluation of heart rate variability and its modifying factors in children with type 1 diabetes

OBJECTIVE To evaluate heart rate variability by Holter monitoring in type 1 diabetic children compared with a healthy control group and determine the factors modifying heart rate variability. METHODS This was designed as a prospective study comparing 28 patients, diagnosed with type 1 diabetes and under follow-up, with 27 healthy control group subjects. RESULTS The patients were aged 9.9 ± 4.2 years in the diabetic group, including 13 (46.5%) girls and 15 (53.5%) boys. The healthy control group comprised 20 (74%) girls and seven boys (26%) with an average age of 8.6 ± 3.7 years. The search for factors modifying heart rate variability yielded the following correlations: for the time-dependent variables, negative between age and both average and maximal heart rate (r = -0.263 and -0.460, respectively), negative between haemoglobin A1c and percentage of differences between adjacent RR intervals >50 ms, positive between diabetes duration and square root of the mean of the sum of squares of differences between adjacent NN intervals. The average heart rate and percentage of differences between adjacent RR intervals >50 ms was significantly higher in the girls than the boys in all groups. With regard to the frequency-dependent factors affecting heart rate variability, correlations were found between haemoglobin A1c level and both total power and very low frequency (r = -0.751 and -0.644) and between very low frequency and diabetes duration. CONCLUSION A reduction in heart rate variability parameters was observed in type 1 diabetes mellitus patients who had a long disease duration or were poorly controlled, as compared with healthy controls.

Assessment of left ventricular functions with tissue Doppler, strain, and strain rate echocardiography in patients with familial Mediterranean fever.

Objective: This study assessed the early changes in regional and global systolic and diastolic myocardial functions in patients with familial Mediterranean fever without any cardiovascular symptoms using tissue Doppler and strain and strain rate echocardiography and compared them to the results of a control group. Methods: This study has a cross-sectional and observational design. FMF patients with normal left ventricular function were included in the study. We excluded patients who had arrhythmia, acquired/congenital heart disease, pericarditis, or acute attack. We compared 45 children with familial Mediterranean fever on colchicine therapy and 45 age- and sex-matched healthy children. Results: The 45 patients with familial Mediterranean fever included 24 (55.3%) girls and 21 (46.7%) boys with a mean age of 11.3±3.7 (range 2-18) years. The mean disease duration was 4.6±2.4 (range 0.5-10) years. In the patient group, the homozygous M694V mutation was the most common (64.4%) mutation. The patients with familial Mediterranean fever had statistically lower longitudinal global strain, radial global strain, and strain rates (-14.44±4.77%, 14.80±6.29%, and 0.59±0.24 s, respectively) than the controls (-17.40±1.79%, 17.53±4.63%, and 0.83±0.51 s) (p<0.05). The circumferential global strain did not differ significantly between the groups. Conclusion: Patients with familial Mediterranean fever who are subclinical from a cardiac aspect might have normal left ventricular function as measured by conventional echocardiography. However, the disease affects their myocardial tissue, and these patients should be followed with conventional, strain, and strain rate echocardiography techniques regularly.

Evaluation of the epidemiological findings of acute rheumatic fever between 1981 and 2012

Background: The aim of this study was to determine the incidence of acute rheumatic fever (ARF) in Turkish children. Material and Methods: Our data was collected from the population and hospital based studies in Turkey between 1981 and 2012. We examined 12 studies reported from Turkey between these dates. Results: Between 1981-1990, 1991-2000, 2001-2012; 573, 1677, 1688 patients had been followed up, respectively. In these three periods of follow up time carditis was observed in (51, 62 and 71% of patients), arthritis in (67, 68, 56% of patients), Sydenhams chorea in (13, 13 and 13% of patients) and erythema marginatum in (2, 0.1, 1% of patients), respectively. Between 1981-1990, 1991-2000 and 2001-2012 the incidence of ARF was detected 1.1/100.000, 2.6/100.000 and 2.3/100.000, respectively. Conclusion: While ARF incidence in Turkey had remained at a constant rate until 1980, a rapid decline occurred after this time, and this decline remained almost unchanged until 2012.

Multiple Gallstone Formation due to Ceftriaxone Treatment in a Child Diagnosed with Infective Endocarditis

Ceftriaxone, a third-generation cephalosporin, has been known to cause reversible sludge in the gallbladder. This sludge is referred to as biliary pseudolithiasis. In this article, a six-year-old child diagnosed with infective endocarditis is presented. He suffered from abdominal pain during the treatment with ceftriaxone and we performed an abdominal ultrasonographic examination that revealed multiple stones in the gallbladder. His symptoms quickly disappeared after the cessation of the treatment with ceftriaxone and we observed a significant decrease in size and number of the gallstones. Ceftriaxone is a commonly used drug in childhood and may cause gallstone formation. These gallstones usually resolve spontaneously and do not necessitate any surgical procedure.

OP-136 CLINICAL ANALYSIS OF 204 CASES WITH ACUTE RHEUMATIC FEVER

Objective: This retrospective study aimed to identify clinical findings, etiologies, diagnosis, treatments and prognosis of 316 patients (age range:1 month-18 years) with pericarditis. Methods: The patients with echocardiographically detected pericarditis were admitted to our center between 1996 and 2008. These patients were reviewed according to physical examinations, blood chemistry results, microbiological, radiological and cardiological studies. Results: The mean age was 7.5±4.3 years. There were 156 (49.3%) boys and 160 (50.7%) girls. Although the most common symptoms were dyspnea (58.8%), fever (51.2%), chest pain (39.8%) and cough (35.1%), the physical examination revealed tachypnea (50.9%), hepatomegaly (44.9%), fever (39.5%), murmur (38.9%), tachycardia (34.1%), peripheral edema (21.8%), distant heart sounds (16.7%), ascites (15.2%) and frotman (5.6%). The most frequent causes of the pericarditis were viral/idiopathic (22.2%), malignancy (18.3%) and cardiac diseases (15.5%). Anemia was detected in 54.1% of patients. Cardiomegaly was seen in 55.7% of the cases.Echocardiographic study showed mild pericardial effusion in 45.9% of the patients. Twenty-seven (45%) of 60 patients (19%) who underwent pericardiosentesis had purulent pericarditis. In addition to medical treatment, dialysis, pericardial tube drainage and pericardiectomy were performed in 35, 25, and 7 patients,respectively. Ten patients developed constrictive pericarditis. Conclusions: We emphasized that early diagnosis and treatment is very important in patients who have signs and symptoms of pericarditis.Also echocardiography is essential for the diagnosis. Our study demonstrated that the viral/idiopatic etiology is the most common cause of pericarditis. We considered that improvement of socioeconomic status, preventive health care services, and effective antibiotherapy can decrease the prevalence of the pericarditis.