Senol Coskun

Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweight.

Objective: Childhood obesity is associated with impaired endothelial function, insulin resistance and inflammation. Being at risk for overweight has been defined as having a body mass index (BMI) between the 85th and 94th percentile for age and sex. In this study, we looked for features linked to cardiovascular risk in children who are at risk for overweight. Design: Twenty-one children who were at risk for overweight (study group) and 20 children with a BMI between the 25th–74th percentiles (controls) were studied. Fasting blood levels of glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, uric acid, fibrinogen and high sensitive C-reactive protein (CRP) were assessed in both groups. LDL-cholesterol, HOMA-IR and QUICKI indices were calculated. Flow-mediated Vasodilatation (FMD) was determined for the evaluation of endothelial function. Results: Increased HOMA-IR was observed in children who were at risk for overweight. Waist circumference was the main predictor of insulin resistance in these children. Higher levels of CRP were found in the study group compared to controls, while plasma fibrinogen did not differ in the two groups. The children who were at risk for overweight had lower FMD values and slightly elevated lipids compared to controls; however, these differences were not statistically significant. Conclusion: Insulin resistance and inflammation indices were higher in children who were at risk for overweight as has been shown for obese children. The data suggest that appropriate treatment strategies for weight control are essential not only for obese children but also for those at risk for overweight.

Chloralhydrate in Children Undergoing Echocardiography

Transthoracic echocardiography (TTE) is a painless, noninvasive and risk-free diagnostic method in children with known or suspected congenital heart disease. Sedation is frequently required for an optimal achievement of this procedure. The purpose of this study was to determine the safety and efficacy of chloral hydrate (CH) sedation in undergoing TTE. The study population included 360 patients with a median age of 19 months. (2 weeks to 8 years). The median dosage of CH given was 75 mg/kg (ranging 50 and 100 mg), with either oral or rectal administration. Oral administration could not be achieved successfully in 90 patients (20%) because of the bitter taste of the drug, in the other 108 patients (30%), vomiting occurred immediately after drug administration. Prior to CH administration and until discharge; respiratory rate; heart rate, blood pressure and oxygen saturation were recorded. Sedation was successfully achieved in 342 (95%) of the patients. No child had a clinically significant change in heart rate, blood pressure and respiratory rate during sedation. There were also no significant differences in heart rate, respiratory rate, blood pressure and oxygen saturation before and after sedation. Although CH has a bitter taste and is a gastric irritant for oral medication, because of the minimal side effects and efficacy for sedation, it remains as a safe and successful drug for use in children for TTE.

Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children

Abstract Background : Beta‐2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of beta‐2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhytmogenic risk of these two treatment strategies in children with acute asthmatic attacks.

Lower arrythmogenic risk of low dose albuterol plus ipratropium

Objective : Wheezy infants are in need of urgent bronchodilatation owing to their intermittent bronchoconstriction. β2 agonists are frequently used in emergencies and have previously shown to increase the QT dispersion (QTd), which may be associate with high risk of cardiac arrhythmia, in asthmatics. However, effect of low dose β2 agonist therapy in combination with the anticholinergic agents on QTd in wheezy infants is not known. This study aimed to assess the effect of standard dose of nebulized albuterol (NAB) and low doses of NAB combined with ipratropium-bromide (NIB) on QTd in wheezy infants.Methods : Twenty-nine children, under 2 years old, with the diagnosis of wheezy infant with acute exacerbation were enrolled in the study. Thirteen were treated by standard dose of NA therapy (0.15 mg/kg) and low doses of NAB (0.075 mg/kg) plus NIB (250 ug/dose) therapy was given to the remaining subjects. Respiratory distress score, O2 saturation and side effects were studied and QTd were measured from the standard electrocardiograms at baseline and after treatment. Significant improvement was achieved in clinical score and oxygenation of both groups.Result : The evaluation of the corrected QTd (QTcd) showed that there was no significant difference between pretreatment values of both groups (p > 0.05). However, while there was no statistically significant difference in the pre and post-treatment values of QTcd of infants treated with combination therapy, QTcd was found to be significantly increased in NAB group after treatment (p < 0.05).Conclusion : Our results suggest that, while clinical improvement is same, the increase of the QT dispersion is more prominent with the use of standard dose of NAB compared to low dose NAB plus NIB therapy. So, low dose of β2 agonist in combination with anticholinergic agents may much safer than the use of standard dose of β2 agonists alone in regard to preventing the possibility of arrythmogenic effects in wheezy infants with acute exacerbation.

Is Helicobacter pylori related to endothelial dysfunction during childhood

Background: Helicobacter pylori infection has been proposed to have a role in the development of atherosclerosis preceded by endothelial dysfunction. The aim of the present study was to determine if a relationship exists between H. pylori infection in childhood and endothelial dysfunction and level of high‐sensitivity C‐reactive protein (hsCRP).

Ambulatory Blood Pressure Parameters in Office Normotensive Obese and Non-Obese Children: Relationship with Insulin Resistance and Atherosclerotic Markers

Objectives: To determine differences in ambulatory blood pressure (ABP) parameters between office normotensive obese and non-obese children and to evaluate correlations of ABP parameters with insulin resistance and the lipid profile. Subjects and Methods: Thirty-eight obese [body mass index (BMI) above the 95th percentile] and 38 non-obese children aged 9-17 years were recruited. All subjects who were normotensive during office visits and who underwent 24-hour ABP monitoring were evaluated. Insulin resistance and the lipid profile were also evaluated. Results: The mean daytime, night-time and 24-hour systolic blood pressure (SBP) and the daytime and 24-hour diastolic blood pressure (DBP) in normotensive obese children were significantly higher compared to the values in non-obese children (p < 0.05). There was no difference in the frequency of nocturnal non-dippers and nocturnal hypertension (night-time SBP at or above the 95th percentile) between the two groups (p > 0.05). Children with night-time SBP at or above the 95th percentile and non-dippers had higher atherosclerotic markers than children with night-time SBP below the 95th percentile and dippers (p < 0.05). In logistic regression analysis, the low-density lipoprotein cholesterol (LDL-C):high-density lipoprotein cholesterol (HDL-C) ratio and night-time SBP had significantly positive associations with being obese in adolescents (OR 6.54, 95% CI 1.15-37.07, p = 0.03, and OR 1.1, 95% CI 1.01-1.19, p = 0.02, respectively). Conclusion: Normotensive obese children had higher ABP parameters. A high LDL-C:HDL-C ratio and night-time SBP were associated with an increased risk of being obese. High LDL-C:HDL-C ratios and total cholesterol:HDL-C levels in children and adolescents may be risk factors for night-time hypertension.

A case of antenatal diagnosis and postnatal characteristics of ıdiopathic ınfantile arterial calcification (IIAC and prenatal diagnosis)

Idiopathic infantile arterial calcification (IIAC) is a very rare autosomal recessive disease characterised by hydroxyapatite deposition of internal elastic lamina and fibrous intimal proliferation of large and medium arteries (Nasrallah et al. 2009). The condition is mostly fatal (80%), and the clinical characteristics are extremely variable. It is mostly diagnosed in the early infancy or neonatal period as a cause of progressive heart failure and hypertension (Saigal 2002). Most infants die before six months, and few have survived more than one year. Mortality is caused by myocardial ischaemia due to coronary artery involvement or refractory cardiac failure (Pao et al. 1998). A few cases have been reported antenatally by ultrasonography (USG) (Nagar et al. 2003; Corbacioglu Esmer et al. 2015). This disorder can be mostly diagnosed as nonimmune hydrops fetalis at the beginning of the third trimester by USG after great vessel calcification, polyhydramnios and hypertrophic cardiomyopathy with pericardial effusion (Wax et al. 2001). We report a case of IIAC at 29 weeks of gestation. The aim of this report is to describe the prenatal diagnosis and postnatal characteristics of IIAC.