Timur Meşe

Are Mean Platelet Volume and Platelet Distribution Width Useful Parameters in Children With Acute Rheumatic Carditis

Rheumatic fever (RF) is an inflammatory disease caused by autoimmune response to a preceding group A streptococcal infection. Mean platelet volume (MPV) reflects the platelet size and the rate of platelet production in bone marrow, and it may be used as an indicator of platelet activation and severity of inflammation. Fifty-three consecutive patients diagnosed with acute rheumatic carditis and 53 control subjects were enrolled into this study. Leukocyte and platelet counts were significantly higher in patients with acute carditis before treatment compared with controls, whereas MPV and platelet distribution width (PDW) values were not significantly different between groups. Platelet counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values were decreased significantly in patients with RF after treatment. There was not a significant difference in terms of platelet count between the controls and the patient group after treatment. ESR was found to be correlated with CRP in patients before and after treatment. In conclusion, the results of our study showed that MPV and PDW levels do not change during acute rheumatic carditis before and after treatment.

The Short-Term Effect of Ketogenic Diet on Carotid Intima-Media Thickness and Elastic Properties of the Carotid Artery and the Aorta in Epileptic Children

The aim of this prospective study is to investigate the effect of a 6-month-long ketogenic diet on carotid intima-media thickness, carotid artery, and aortic vascular functions. Thirty-eight drug-resistant epileptic patients who were being treated with ketogenic diet were enrolled. Fasting total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol, and glucose concentrations were measured and echocardiography was performed in all patients before the beginning of ketogenic diet and at the sixth month of treatment. The body weight, height, body mass index, serum levels of triglyceride, total cholesterol, and low-density lipoprotein increased significantly at month 6 when compared to baseline values (P < .05). Carotid intima-media thickness, elastic properties of the aorta, and carotid artery did not change at the sixth month of therapy compared to baseline values. A 6-month-long ketogenic diet has no effect on carotid intima-media thickness and elastic properties of the carotid artery and the aorta.

Usefulness of Neutrophil to Lymphocyte Ratio in Prediction of Coronary Artery Lesions in Patients with Kawasaki Disease

BACKGROUND Kawasaki disease is an inflammatory condition. Neutrophil to lymphocyte ratio is a marker reflecting inflammation. AIMS The aim of the study is to evaluate usefulness of neutrophil to lymphocyte ratio in diagnosis of Kawasaki disease and in prediction of coronary artery lesions. STUDY DESIGN Retrospective cross-sectional study. METHODS Seventy-five children with Kawasaki disease and 66 controls were retrospectively enrolled. Their leukocyte, neutrophil, and lymphocyte counts were recorded. Abnormally distributed data were shown as median (interquartile range). Cases having coronary artery diameter two standard deviation above mean were diagnosed to have coronary artery lesions. RESULTS Median age of Kawasaki disease patients was 34 months. Twentyfive of those (33.33%) had incomplete Kawasaki disease and twenty-six (34.66%) had coronary artery lesions. Leukocyte [12.61 (6.09)×10(3)/µL vs. 8.48 (5.58)×10(3)/µL], neutrophil [6.73 (4.10) ×10(3)/µL vs. 4.62 (5.47)×10(3)/µL], and lymphocyte [4.04 (2.91)×10(3)/µL vs. 3.02 (2.57) ×10(3)/µL] counts were significantly higher in Kawasaki disease patients compared to controls (all p values <0.01). However, there was not significant difference between patients and controls regarding neutrophil to lymphocyte ratio [1.72 (1.22) vs. 1.71 (1.88)]. Findings of Kawasaki disease and incomplete Kawasaki disease cases did not differ, while comparison of patients with and without coronary artery lesions revealed significantly higher neutrophil to lymphocyte ratio values in former group [2.02 (1.63) vs. 1.50 (1.28), p=0.01]. The cut-off neutrophil to lymphocyte ratio value for prediction of coronary artery lesions was determined as 1.32. CONCLUSION Neutrophil to lymphocyte ratio values in Kawasaki patients with coronary lesions were significantly higher than the ones without and values greater than 1.32 were useful in prediction of coronary lesions.

Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents

OBJECTIVE: Vitamin B12 is involved in the production of adrenaline from noradrenaline. It is the cofactor involved in catecholamine degradation and plays a role in myelin synthesis. The current study aimed to investigate the association between vitamin B12 levels and postural orthostatic tachycardia syndrome (POTS) during adolescence when accelerated myelin synthesis increases the vitamin B12 need. METHODS: One hundred twenty-five patients (mean age 11.1 ± 2.3 years; 60% female) reporting short-term loss of consciousness and diagnosed with vasovagal syncope based on anamnesis with a normal distribution and 50 control subjects (mean age 10.94 ± 2.5 years, 62% female) were included in this study. Serum vitamin B12, folic acid, and ferritin levels were measured prospectively in addition to other tests. We defined vitamin B12 deficiency as a serum level <300 pg/mL.1–4 RESULTS: Vitamin B12 levels were significantly lower in the patient group compared with the control group (47.2% vs 18%, P < .001). In the patient group, children with the POTS pattern had significantly lower vitamin B12 levels compared with children without the POTS response (P = .03). CONCLUSIONS: Vitamin B12 deficiency in patients with POTS may lead to sympathetic nervous system baroreceptor dysfunction.

Impact of haemodialysis on QTc dispersion in children

Background:  The purpose of the present paper was to investigate the corrected QT (QTc) interval and QTc dispersion value, and the impact of haemodialysis on these parameters in children with chronic renal failure.

Risk Factors for Thrombosis, Overshunting and Death in Infants after Modified Blalock-Taussig Shunt

BACKGROUND The Modified Blalock-Taussig shunt procedure can provide increased flow of blood to the lungs for babies born with certain congenital heart defects. We evaluated 44 subjects under 2 years of age who had a Modified Blalock-Taussig shunt (MBTS) procedure performed from 2009-2013, to investigate risk factors for thrombosis, overshunting and death. METHODS The study subjects included in our investigation were severely cyanotic newborns with pulmonary stenosis or atresia and duct dependent circulation, and infants having Tetralogy of Fallot with small pulmonary arteries who underwent a MBTS procedure in our facility from 2009-2013. We duly noted patient preoperative characteristics such as hemoglobin, hematocrit, mean platelet volume, prothrombin time and partial thromboplastin time. Our study investigated the risk factors for post-operative overcirculation, thrombosis and death. RESULTS The age and weight of patients in our study at the time of procedure ranged from 1 day to 20 months old (median 12 days), and 2.4 kg to 12 kg (mean 4.6 kg), respectively. A total of 8 patients died following surgery, and. 4 (9.1%) had shunt thrombosis, of which one died during shunt revision. Partial thromboplastin time was 28.7 seconds in patients with thrombosis, and 35 in all other patients (p = 0.04). Overcirculation was detected in 5 patients; shunt size/body weight was 1.25 in patients who had overcirculation, and 1.06 in all other patients. CONCLUSIONS It is important to assess risk factors associated with the MBTS operation. The results of our study suggest that a preoperative low aPTT value may be an indicator for thrombosis in infants who have undergone MBTS surgery.

Incomplete (atypical) Kawasaki disease in a young infant with remarkable paucity of signs

We read with great interest the case report by Thapa et al. [1] entitled “Atypical Kawasaki disease with remarkable paucity of signs and symptoms” Kawasaki disease (KD) is an acute febrile vasculitis that was seen predominantly in infants and young children. It is the predominant cause of pediatric acquired heart disease in the developing world. The etiology remains unknown, but clinical and epidemiological features strongly suggest an infectious cause or trigger factor plus a genetic predisposition [2, 3]. The conventional diagnostic criteria should be viewed as guidelines that are particularly useful in diagnosis of complete form but may result in failure to recognize incomplete forms of illness. Unlike KD, in cases of incomplete Kawasaki disease (iKD), coronary artery disease was present in children with fever lacking the suYcient number of criteria to fulWll the epidemiologic case deWnition [3]. Thus, iKD diagnosis often depends on echocardiographic Wndings of coronary artery abnormalities (CAA). But according to the Japanese guidelines [4], iKD deWned as the presence of four or fewer of the principal Wndings of KD regardless of the presence or absence of CAA. No matter which diagnostic criteria was preferred, it complications were as severe as KD. In this letter, an 8-month-old infant referred to our pediatric cardiology clinic with high-grade fever for 19 days and lacking associated symptoms was diagnosed as iKD, since she had saccular aneurysm on her echocardiography is described. Her physical examination revealed no speciWc Wndings except fever (39.5°C). There was no history of conjunctivitis, rash, erythema of the lips, extremity changes or cervical lymphadenopathy. Until her reference to our clinic, patient had a history of multiple antibiotic usage with diVerent clinical diagnosis. Laboratory tests revealed the following: hemoglobin, 9.2 gm/dl; leukocyte count, 12,100/mm; (peripheral smear revealed neutrophils, 30%; lymphocytes, 60%; reactive lymphocytes, 8%; eosinophils, 2%); platelets, 988,000/mm. On admission erythrocyte sedimentation rate was 125 mm/h and C-reactive protein level was 22.3 mg/dl (normal range 0–0.5), respectively. Since the patient had persistent fever for 19 days despite antimicrobial therapy, echocardiography was performed. Twodimensional echocardiography revealed saccular aneurysm at left main coronary artery with a diameter of 6 mm (Fig. 1). Intravenous immunoglobulin (IVIG) (2 g/kg per total dose) and high-dose (100 mg/kg per day, divided into 4 doses/day) acetylsalicylic acid was applied to the patient with diagnosis of iKD and her fever recovered on the fourth hour of IVIG administration. Periungual desquamation of the Wnger tips emerged 1 day after the IVIG therapy. He was discharged from the hospital with low-dose acetylsalicylic M. M. Yilmazer (&) · T. Mese · S. Demirpençe · B. Guven · T. Öner Department of Pediatric Cardiology, Behcet Uz Children’s Hospital, Alsancak, 35210 Izmir, Turkey e-mail: drmuratmuhtar@hotmail.com

An observational study on peripheral blood eosinophilia in incomplete Kawasaki disease

OBJECTIVE To investigate the peripheral blood eosinophilia (PBE) in the acute stage of incomplete Kawasaki disease (iKD). METHODS Twenty-four patients with iKD (median age; 31.5 months, range; 7-88 months) and 25 with complete Kawasaki disease (cKD) (median age; 37 months, range; 9-140 months) were evaluated between 2004 and 2010 from İzmir Dr. Behçet Uz Childrens Hospital records retrospectively. We determined the eosinophil counts and rates from the complete blood count in two study groups before the IVIG treatment and 30 febrile age-matched controls and 30 control cases with congenital heart disease (control Group 1 and 2 respectively). Kruskal-Wallis test was performed in detecting the differences of eosinophil rates and counts between four subgroups. RESULTS In iKD group, the mean value of eosinophil rates and median value of eosinophil counts were 4.39±2.5% and 377 cells/mm(3), respectively, which did not significantly different with cKD group (mean eosinophil rates; 5.47±4.8% and median eosinophil counts 525 cells/mm(3)) (p>0.05). The median values of eosinophil cell counts and mean value of eosinophil rates were 220 cell/mm(3) and 2.83±2.65% in the control group 1 and 165 cell/mm(3) and 1.63±1.43% in the control Group 2 respectively, which were statistically significant lower compared to both study groups (p< 0.001). CONCLUSION The rate of PBE was found significantly higher in iKD patients compared to the controls. Since the diagnosis of iKD is difficult, unexplained eosinophilia may be helpful in the presence of suggestive clinical findings of KD.

Isolated abducens palsy in adolescent girl with Kawasaki disease

Here, we present a case of classic KD with right abducens palsy that developed during the subacute phase of the illness. A 12-year-old Caucasian girl with an unremarkable medical history was referred to our hospital with a 4-day history of fever, weakness and a rash. On the second day of fever, she developed rash in the lower extremities, vomiting, headache and complete blood count revealed leukocytosis (19 000/mm 3 ). Physical

Assessment of myocardial involvement using cardiac troponin-I and echocardiography in rheumatic carditis in İzmir, Turkey

Background: Acute rheumatic carditis is still a major problem in developing countries. Cardiac troponin‐I (cTnI) has been identified as a sensitive and specific marker in the diagnosis of myocarditis in children and adults.