Mustafa Kösecik

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children

OBJECTIVE Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Dynamic thiol/disulphide homeostasis as a novel indicator of oxidative stress in obese children and its relationship with inflammatory-cardiovascular markers

Objective: Childhood obesity is an important cause of cardiovascular risk with chronic inflammation. Oxidative stress may contribute to the pathogenesis of obesity-related cardiovascular pathologies. We aimed to evaluate thiol/disulphide homeostasis as a novel and sensitive marker of oxidative stress and to evaluate its relationship with some inflammatory and cardiovascular markers in obese children. Methods: In this case-controlled study, 65 children with exogenous obesity and 64 healthy children, as a control group, were included. In both groups, thiol/disulphide homeostasis parameters and inflammatory (white blood cells, platelets, mean corpuscular volume, neutrophil/lymphocyte ratio, and high-sensitivity C-reactive protein) and cardiovascular (epicardial adipose tissue thickness and left ventricular mass index) markers were studied. Correlation analyses of thiol/disulphide homeostasis parameters with body mass index standard deviation scores (BMI SDS) and inflammatory and cardiovascular markers were performed. Receiver-operating characteristic analysis was performed to determine the sensitivity, specificity, and optimal cut-off values of thiol/disulphide homeostasis parameters. Results: Native thiol, total thiol, and native thiol/total thiol ratios (antioxidant parameters) were lower (p<0.05) and disulphide/native thiol and disulphide/total thiol ratios (oxidant parameters) were higher in the obese group than in the control group (p<0.01). A positive correlation of oxidant parameters with BMI SDS and inflammatory markers was found. However, a negative correlation of antioxidant parameters with BMI SDS and inflammatory markers was found. The specificities of disulphide/native thiol and disulphide/total thiol ratios were higher in the obese group. Conclusion: The impairment in thiol/disulphide homeostasis, which is indicative of oxidative stress, is associated with inflammation in obesity. In addition, cardiovascular involvement may also contribute to this impairment.

Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis.

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.

Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study

Abstract We examined the foetal cardiac structural and functional characteristics in diabetic pregnancies versus non-diabetic, healthy pregnancies. Between August 2015 and April 2016, 32 pregnant women with pregestational diabetes, 36 pregnant women with gestational diabetes, and 42 healthy pregnant women were scheduled to have foetal echocardiograms to assess cardiac structure and function. In the diabetic groups, the foetal interventricular septum (IVS) thickness was significantly greater than in non-diabetics (p < .05) but none had an IVS >2 SD from normal. The peak velocity of tricuspid E, and the E/A ratio were significantly lower in the diabetic groups (p < .05). Tricuspid valve Ea values and the Ea/Aa ratio were lower in the diabetic group than in the control group (p < .05) but there was no significant difference between the pre-GDM and GDM groups (p > .05). Interventricular septal hypertrophy is the most common structural abnormality in diabetic pregnancies. These changes do not pose a risk to the foetal unless they cause functional impairment. Thus, we believe that it is important for diabetic pregnant women to be monitored for foetal cardiac diastolic dysfunction. Impact statement What is already known on this subject? Pregestational insulin-dependent diabetes mellitus is a relatively common condition in pregnancy, affecting up to 0.5% of the pregnant population. Foetuses of diabetic mothers are at an increased risk of perinatal morbidity and death. Gestational diabetes mellitus is under-recognised and affects up to 4% of pregnancies. Although diabetes mellitus is known to increase the risk of cardiovascular defects and structural changes (myocardial hypertrophy and diastolic dysfunction) due to foetal hyperglycaemia and hyperinsulinism, similar data in women with gestational diabetes is scarce. Moreover, the effect of maternal hyperglycaemia on foetal cardiac structure and function is unclear because of discordant results from previous studies. What do the results of this study add? In this study, we have used foetal echocardiography, two-dimensional US, pulsed wave Doppler and TDI to characterise the foetal cardiac structure and function in normal pregnancies as well as in the pregnancies complicated by GDM, and pregestational DM. Interventricular septum thickness is increased in women with pregestational diabetes mellitus and impaired diastolic function. The dominant right ventricle of the foetal circulation was affected earlier than the left ventricle. What are the implications of these findings for clinical practice and/or further research? Large population-based studies are required to establish the absolute risk of congenital heart defects in patients with pregestational diabetes and pregestational diabetes in the utility of routine screening.

Arteriovenous fistula between descending aorta and left inferior pulmonary vein: Closure with vascular plugs.

Echocardiography revealed systemic artery to pulmonary venous fistula, a rare vascular anomaly, in a 20-month-old girl, and multislice computed tomography angiography (CTA) was performed to rule out congenital heart disease. Normal bronchial connection and pulmonary vasculature were observed in the lung. The fistula drained through the left inferior pulmonary vein to the left atrium leading to a left-to-left shunt. Percutaneous intervention was performed in 2 stages using Amplatzer vascular plugs to close successfully.

Evaluation of the patients admitted to the pediatric cardiology department with chest pain: a single center experience

received: 10.10.2016 accepted: 11.11.2016 1Sakarya University Medical Faculty Department of Pediatric Cardiology 2Sakarya University Medical Faculty Department of Pediatrics Yazışma adresi: Pınar Dervişoğlu, Sakarya University Medical Faculty Department of Pediatric Cardiology, Sakarya e-mail: pdervisoglu@hotmail.com This study was presented during the 15th National Pediatric Cardiology and Cardiac Surgery Congress, 13-16 April, 2016, Antalya, Turkey GİRİŞ

Biventriküler Kalp Yetmezliği ile Karışımıza Çıkan Aritmojenik Sağ Ventrikül Kardiyomiyopatisi (ASVK)

Aritmojenik sag ventrikul kardiyomiyopatisi (ASVK), farkindaligi giderek artan bir klinik tablodur. Seyrek gorulmesine ragmen genclerde beklenmedik olumlerin sik karsilasilan nedenlerindendir. Sag ventrikulun baskin tutulumu nedeniyle aritmojenik sag ventrikul kardiyomiyopatisi olarak adlandirilmis olmasina ragmen, son yillarda ciddi bir sol ventrikul tutulumunun eslik ettigi tablolar da tanimlanmistir. Bu yazida, daha oncesinde herhangi bir klinik belirti vermeyen, iki kardesinde de ani olum oykusu olan, ani konjestif kalp yetmezligi nedeniyle kaybedilen on bes yasinda bir erkek hastayi sunduk. Erken tani sayesinde istenmeyen sonuclarin onune gecebilme sansimiz oldugunu, bir kez daha hatirlatmak istedik

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Presenting with Biventricular Heart Failure / Biventriküler Kalp Yetmezliği ile Karışımıza Çıkan Aritmojenik Sağ Ventrikül Kardiyomiyopatisi (ASVK)

Abstract Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder which is attracting increased awareness in clinical practice. Despite being an uncommon disease, it is a frequent cause of unexpected death in young persons. Although the term ARVC used for this cardiomyopathy suggests that it involves the muscle of the right ventricle, in recent years there were cases reported in which the left ventricle was severely affected. The current study reports an ARVC-diagnosed fifteen-year-old male patient who had no clinical features previously and died from sudden congestive heart failure; he had two siblings with a history of sudden unexpected death. We would like to bring to mind once again the important role of early diagnosis for ARVC to avoid undesirable consequences of the disease. Key Words: arrhythmogenic right ventricular cardiomyopathy (ARVC); biventricular heart failure; adolescent Ozet Aritmojenik sag ventrikul kardiyomiyopatisi (ASVK), farkindaligi giderek artan bir klinik tablodur. Seyrek gorulmesine ragmen genclerde beklenmedik olumlerin sik karsilasilan nedenlerindendir. Sag ventrikulun baskin tutulumu nedeniyle aritmojenik sag ventrikul kardiyomiyopatisi olarak adlandirilmis olmasina ragmen, son yillarda ciddi bir sol ventrikul tutulumunun eslik ettigi tablolar da tanimlanmistir. Bu yazida, daha oncesinde herhangi bir klinik belirti vermeyen, iki kardesinde de ani olum oykusu olan, ani konjestif kalp yetmezligi nedeniyle kaybedilen on bes yasinda bir erkek hastayi sunduk. Erken tani sayesinde istenmeyen sonuclarin onune gecebilme sansimiz oldugunu, bir kez daha hatirlatmak istedik. Anahtar Kelimeler: aritmojenik sag ventrikul kardiyomiyopatisi (ASVK); biventrikuler kalp yetmezligi; adolesan