Özben Ceylan

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 heart rate variability in breath holding children by 24 hour Holter monitoring.

PURPOSE Previous studies have shown that the underlying pathophysiologic mechanism in children with breath holding may be generalised autonomic dysregulation. Thus, we performed cardiac rhythm and heart rate variability analyses using 24-hour Holter monitoring to evaluate the cardiac effects of autonomic dysregulation in children with breath-holding spells. METHODS We performed cardiac rhythm and heart rate analyses using 24-hour Holter monitors to evaluate the cardiac effects of autonomic dysregulation in children during a breath-holding spell. Our study group consisted of 68 children with breath-holding spells - 56 cyanotic type and 12 pallid type - and 39 healthy controls. RESULTS Clinical and heart rate variability results were compared between each spell type - cyanotic or pallid - and the control group; significant differences (p<0.05) in standard deviation of all NN intervals, mean of the standard deviations of all NN intervals for all 5-minute segments, percentage of differences between adjacent RR intervals >50 ms, and square root of the mean of the sum of squares of the differences between adjacent NN intervals values were found between the pallid and cyanotic groups. CONCLUSIONS Holter monitoring for 24 hours and heart rate variability parameters, particularly in children with pallid spells, are crucial for evaluation of cardiac rhythm changes.

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.

Persistent left superior vena cava accompanying congenital heart disease in children: Experience of a tertiary care center

This study focuses on determining concomitant persistent left superior vena cava (SVC) in patients with congenital heart disease (CHD).

Hypertrophic Cardiomyopathy After a Single Dose of Dexamethasone in a Preterm Infant

Dexamethasone is widely used in preterm infants with severe pulmonary disease. Hypertrophic cardiomyopathy (HCM) is a transient side effect observed after multiple doses of dexamethasone. We report a preterm infant with myocardial hypertrophy after a single dose of dexamethasone (0.5 mg/kg) used to treat laryngeal edema secondary to prolonged intubation. A benign course was observed without left ventricular outflow tract obstruction and with recovery within 4 weeks. Myocardial effects of dexamethasone may be independent of dose and duration of treatment. The risk/benefit ratio must be carefully considered before using even a single dose of dexamethasone in preterm infants.

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.

Kalbin Sol Tarafinin Multipl Obstrüktif Doğumsal Lezyonlari

Congenital multiple obstructive lesions of the left heart Objective: To investigate the localization, type, associations, other accompanying abnormalities and treatment methods. Material and Methods: The study included 24 cases presenting to the Pediatric Cardiology Unit of our Hospital with more than one left heart lesion, evaluated with two-dimensional color Doppler echocardiography (Vivid 7 Pro); 18 underwent cardiac catheterization and angiography. Complaints at admission, lesion site, type and associations, additional abnormalities and treatment were evaluated. Results: Multiple obstructive left heart lesions were more frequent (79%) in males, at an average age of 6.3. Most frequent symptoms at admission were dyspnea, fatigability and cyanosis. The most frequent associations of obstructive abnormalities were: mitral and aortic stenosis in 29%, mitral stenosis with aortic coarctation in 17% and aortic valve stenosis with aortic coarctation in 37%. Mitral stenosis associated to both aortic valve stenosis and aortic coarctation was seen in 17%. The most frequent associated non-obstructive abnormality was a bicuspid aortic valve (62%). Following diagnosis, 5 of the patients did not show up for follow-up, while the decision for one patient was observation. The remaining 18 cases underwent cardiac catheterization and angiography. Six patients had successful coarctation angioplasty and one angioplasty plus aortic valvuloplasty. We lost 2 of the patients who had undergone coarctation angioplasty. Conclusion: It was observed that the lesion most significantly contributing to mortality due to congenital obstructive lesions of left heart outflow are mitral valve obstruction and pulmonary hypertension, and that early invasive intervention is life-saving.

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.