Sevim Karaaslan

Sydenham's chorea: a clinical follow-up of 65 patients.

Sydenhams chorea, the neurological manifestation of rheumatic fever, is the most common acquired chorea of childhood. In this retrospective study, the authors aim to present the clinical and laboratory findings of 65 Sydenhams chorea patients, followed up in a clinic over less than 7 years. The mean age at the onset of the symptoms was 11.7 ± 2.6 years (range, 6-17 years). Of the patients, 63% were female and 37% were male (male/female: 1.7/1). Chorea was generalized in 78.5% of the patients, right hemichorea in 12.3%, and left hemichorea 9.2%. There was a history of rheumatic fever in 30.8% of the patients. Echocardiographic study showed cardiac valve involvement in 70.5% of 61 patients. Brain magnetic resonance imaging, which was performed on only 18 patients, was evaluated as normal in all. Electroencephalography was also performed on only 18 patients and showed abnormal waves in 50% of them. Pimozide was mostly the first choice of drug therapy. Nevertheless, drug therapy was not needed in 18.5% of the patients. The recovery period of the first attack of the chorea was 1 to 6 months in 51.7% of the patients. The recurrence rate was 37.9%. In conclusion, Sydenhams chorea is still an important health problem in Turkey with respect to its morbidity.

Acute rheumatic fever in Konya, Turkey.

Abstract Background: Patients with acute rheumatic fever (ARF), who were admitted to Pediatric Cardiology Unit of Selçuk University Faculty of Medicine from July 1993 to 1998, were studied retrospectively to verify the clinical profile of the disease and to compare the results with those from other countries.

Echocardiographic measurements in infants of diabetic mothers and macrosomic infants of nondiabetic mothers

Abstract Aim: To compare echocardiographic findings of infants of diabetic mothers (IDMs), macrosomic infants of nondiabetic mothers and healthy full term appropriate-for-gestational-age (AGA) infants. Methods: Included in this study were 83 infants, admitted to our Neonatology Unit. Thirty-three IDMs, including both macrosomic and nonmacrosomic, comprised Group A, 25 macrosomic infants of nondiabetic mothers comprised group B, and 25 healthy full term AGA infants comprised group C. Echocardiographic measurements were performed in the first three days after birth and compared by using one-way ANOVA, Post Hoc Tukey HSD and Students t tests. Results: The left ventricular end-systolic/left ventricular end-diastolic diameter ratio of group A was significantly smaller than that of group C (P<0.05). The interventricular septum/posterior wall thickness ratios of groups A and B were greater than those of group C (P<0.05). The left ventricular mass index of group A was greater than those of groups B and C (P<0.05). The shortening fraction and ejection fraction of group A were increased in comparison to group C (P<0.05). When comparing the values of echocardiographic measurements of macrosomic IDMs (n=9) with nonmacrosomic ones (n=24), and infants of pregestational diabetic mothers (n=11) with those of gestational diabetes mothers (n=22), no statistical difference was found. Conclusion: The present study suggests that underlying mechanisms common to both macrosomic infants of nondiabetic mothers and IDMs lead to less cardiac alterations in the macrosomic infants of nondiabetic mothers than in IDMs.

Criteria for judging the improvement in subclinical rheumatic valvitis.

Recent technical improvements in cross-sectional echocardiography have made it possible to detect even mild organic regurgitation of the mitral and aortic valves in patients with acute rheumatic fever. To determine the prevalence and prognosis of subclinical valvitis, we have analyzed 104 patients with acute rheumatic fever referred to our institution. Of 53 patients who had no murmur, 22 of them with polyarthritis, 29 with chorea, and 2 with polyarthritis and chorea, 23 (43.4%) had subclinical valvitis. Isolated mitral regurgitation was the most common valvar lesion, seen in 82.6% of the patients. Isolated aortic regurgitation was detected in 4.4% of the cases, and combined mitral and aortic regurgitation in the remaining 13%. During follow-up, the degree of mitral regurgitation improved in 59.1%, decreased in 18.2%, and increased or remained unchanged in 22.7% according to the length of colour jet. According to criterions of velocity, mitral regurgitation improved in 86.4% of the patients, and increased or unchanged in the remaining 13.6%. Mitral regurgitation disappeared completely in 6 of the patients (27.3%) as judged according to both the length of colour jet and the velocity of regurgitation. Aortic regurgitation improved in all the patients with this problem, disappearing completely in two of the four. Based on this experience, we suggest that not only the disappearance of regurgitation, but also improvements in the echocardiographic diagnostic criterions of regurgitation, such as the length of the colour jet less than 1 cm, or velocity less than 2.5 m/s, or indicative of regurgitation that is either intermittent or of short duration, should also be considered as criterions indicating improvement in valvar regurgitation in patients with subclinical rheumatic valvitis.

PHACE syndrome with growth hormone deficiency and absence of bilateral internal carotid arteries: a case report.

Abstract:  PHACE syndrome is characterized by posterior fossa malformations (P), large facial hemangiomas (H), arterial anomalies (A), cardiac anomalies or coarctation of aorta (C), and eye anomalies (E) and has striking female predominance. Endocrine abnormalities have recently been described in these patients, involving the thyroid and pituitary glands. We report the case of a 2‐year‐old girl with the clinical features of PHACE with absence of bilateral internal carotid arteries and isolated growth hormone deficiency.

Prediction of Aortic Diameter Values in Healthy Turkish Infants, Children, and Adolescents by Using Artificial Neural Network

The aorta is the largest vessel in the systemic circuit. Its diameter is very important to guess for child before adult age, due to growing up body. Aortic diameter, one of the cardiac values, changes in time. Evaluation of the cardiac structures and generating a valid regional curve requires a large study group experience for accurate data on normal values. In this study, our aim is to estimate aortic diameter values without curve of charts. Using real sample of the all groups has been predicted using a hybrid system based on combination of Line Based Normalization Method (LBNM) and Artificial Neural Network (ANN) with Levenberg–Marquardt (LM) algorithm. In this study, aortic diameter values dataset divided into two groups as 50% training–50% testing of whole dataset. In order to show the performance of the proposed method, two fold cross validation and prevalent performance measuring methods, Mean Square Error (MSE), Absolute Deviation (AD), Root Mean Square Error (RMSE), statistical relation factor T and R2, have been used. The obtained MSE results from combination of Min–Max normalization and ANN, combination of Decimal Scaling and ANN, combination of Z-score and ANN, and combination of LBNM and ANN (the proposed method) are 0.00517, 0.001299, 0.006196, and 0.000145, respectively. For the suggested method, error’s results have been given discretely for every age up to adult age. The results are compared to real aortic diameter values by expert with nine year experiences in medical area. These results have shown that the proposed method can be confidently used in the prediction of aortic diameter values in healthy Turkish infants, children and adolescents.

Oxygen free radicals in children with acute rheumatic fever.

We have investigated the relationship between oxygen free radicals and acute rheumatic fever with regard to diagnosis of the disease process. At the time of diagnosis, we measured the levels of reactive oxygen molecules in the plasma, this being a parameter for oxygen free radicals, and discovered the levels to be significantly higher when compared with those measured in a control group (P<0.05). The levels measured in the plasma, however, were not statistically different among patients with and without carditis. We found a progressive decrease in the levels measured in the plasma when patients with acute rheumatic fever were tested on the 15th, 30th and 90th days subsequent to diagnosis. By the 90th day, levels measured in the plasma were still higher, but no longer significantly elevated, when compared with the control group. The present study is preliminary, but raises the possibility that measurement of oxygen free radicals in the plasma could be used as a laboratory test for active state of acute rheumatic fever. Further investigations will be needed, nonetheless, to determine the clinical application of this technique.

Release of N-terminal pro-brain natriuretic peptide in children with acute rheumatic carditis.

BACKGROUND Acute rheumatic carditis is still an important cause of cardiac failure in developing countries. B-type natriuretic peptides, especially N-terminal segment of its prohormone are now recognised as essential parts of cardiologic evaluation. Increased plasma concentrations of B-type natriuretic peptide and its prohormone are markers of cardiac failure and hypoxia in adults. AIM To measure the prohormone levels in children with acute rheumatic carditis and to determine whether its concentrations correlate with clinical and laboratory findings. METHODS A total of 24 children with acute rheumatic carditis and 23 age and sex-matched healthy subjects were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve insufficiency and cardiac dysfunction. The prohormone plasma levels were tested for correlation with cardiac dysfunction and other biochemical markers, such as C-reactive protein, erythrocyte sedimentation rate, and anti-streptolysin-O titter. RESULTS The prohormone plasma concentrations were significantly higher in children with acute rheumatic carditis than in control subjects at the time of diagnosis. A significant decrease of the plasma level was detected among patients after treatments (6-8 weeks). CONCLUSION We found increased plasma prohormone levels in children with acute rheumatic carditis in the acute stage of illness compared with healthy subjects. Another result is increased plasma prohormone levels as acute rheumatic carditis are reversible.

Prediction of cardiac end-systolic and end-diastolic diameters in m-mode values using adaptive neural fuzzy inference system

The cardiac, end-systolic and end-diastolic diameters values are very important m-mode cardiac parameters for infant, children, and adolescents, due to growing up body. These parameters, belonging to heart, must be known in order to make a decision about the subject. The expert decision occurs after comparing measured value to hard-copied charts. Hard-copied charts were prepared previously as a result of long statistical studies and these charts depend on a certain region. Our proposed method presents a valid virtual chart for the experts. The proposed method comprises of two stages: (i) data normalization based on euclidean distance (ii) normalized cardiac parameters predicting using adaptive neural fuzzy system. In order to present performance of the proposed method, mean absolute error, absolute deviation and two-fold cross-validation were used. In addition to performance criteria, different common normalization methods, z-score, decimal scaling and minimum-maximum normalization methods were used to compare. In this study, the aim is to create a valid virtual chart which helps the expert during making the decision about predicting end-systolic and end-diastolic cardiac m-mode values. The results were compared with real cardiac parameters by expert with 10years of medical experience.

Pulmonary arterial pressure in children with allergic rhinitis

Background Chronic upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Allergic rhinitis is one of the frequent causes of upper airway obstruction by nasal blockage. The aims of the study were to evaluate the pulmonary arterial pressures in children with allergic rhinitis and the effect of topical corticosteroid therapy. Methods Forty-nine children composed of 27 subjects with seasonal and 22 subjects with perennial allergic rhinitis were enrolled in this study. The pulmonary arterial pressures were measured by using Doppler echocardiography. Results The pretreatment pulmonary arterial systolic, mean, and diastolic pressures of study group were significantly higher than in healthy controls (p < 0.05). The pulmonary arterial systolic and mean pressures of the patient group significantly decreased at the end of study (p < 0.05), whereas the decrease of the diastolic pressure was not statistically significant (p > 0.05) after the treatment of a topical corticosteroid, mometasone furoate (100 μg per day), for 8 weeks. Conclusion Our results showed that children with allergic rhinitis have higher pulmonary arterial pressure levels compared with healthy controls and that increased pulmonary arterial pressure levels due to allergic rhinitis are reversible by using nasal topical corticosteroids. Further studies are needed to determine the clinical aspect of increased pulmonary arterial pressure.