Tugcin Bora Polat

A comparative study: The efficacy of liquid paraffin and lactulose in management of chronic functional constipation

Abstract Objectives : To determine and compare efficacy, safety and optimal dose of two laxatives, liquid paraffin and lactulose, in 40 children with chronic functional constipation.

Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children

Background : Intervention trials have shown that zinc may be efficacious in treating acute diarrhea in children of developing countries. A double‐blind placebo‐controlled study was designed to evaluate the effects of zinc supplementation on the clinical course and duration of diarrhea in malnourished Turkish children.

Correlation of abdominal fat accumulation and stiffness of the abdominal aorta in obese children.

AIM To evaluate abdominal adipose tissue accumulation in obese children by ultrasound measurement and compare with the elastic properties of the abdominal aorta. CHILDREN AND METHODS A total of 56 obese children and a control group of 30 non-obese children had an ultrasound examination for measurements of thickness of visceral, preperitoneal, and subcutaneous fat as well as abdominal aorta stiffness parameters. Anthropometric measurements and metabolic risk profile were assessed by physical examination and blood tests. RESULTS Abdominal aorta stiffness parameters were all significantly higher in the obese children than in the controls. Among the adipose tissue compartments, visceral fat thickness was the strongest correlate of abdominal aorta stiffness parameters. Similarly, the correlation between visceral abdominal adipose tissue and fasting insulin levels, HOMA score, and pulse pressure also approached significance. CONCLUSIONS This study suggests that abdominal adipose tissue accumulation is closely associated with cardiovascular risk factors in obese children, and among abdominal adipose tissue compartments, visceral fat thickness was strongly correlated with the elastic properties of the abdominal aorta.

Cardiac functions in children with coeliac disease during follow-up: insights from tissue Doppler imaging.

BACKGROUND The identification of a coeliac disease in patients with idiopathic dilated cardiomyopathy raises critical questions on the relationship between the two entities. But cardiac functions have not been studied in patients with coeliac disease. The present study was undertaken to assess cardiac functions by Tissue Doppler Echocardiography in patient with coeliac disease. METHODS We studied 45 clinically stable patients; twenty-five patients with positive serum IgA Antiendomysial Antibody levels (Group 1), twenty patients with negative serum IgA Antiendomysial Antibody levels (Group 2) at the time of echocardiographic study. Control group consisted of 30 healthy children free of any disease. RESULTS Myocardial systolic wave velocity of the mitral annulus was significantly lower (p<0.001), myocardial precontraction and contraction time were slightly longer in Group 2 when compared control group (p=0.015, p=0.044, respectively). There was a negative correlation between the serum IgA Antiendomysial Antibody levels titers and myocardial systolic wave levels of all patients included in the study (r = -0.633; p<0.001). A myocardial systolic wave velocity of <8.9 cm/s had a 92% sensitivity and 80% specificity in predicting serum IgA Antiendomysial Antibody levels positive patients. CONCLUSIONS We detected subclinical systolic dysfunction of the left ventricle in children with coeliac disease in whom serum IgA Antiendomysial Antibody reactivity is prominent. Tissue Doppler echocardiography provides a quantifiable indicator useful for cardiac monitoring of disease during follow up.

Can analysis of the bispectral index prove helpful when monitoring titration of doses of midazolam and ketamine for sedation during paediatric cardiac catheterization.

OBJECTIVE We investigated the use of the bispectral index for monitoring sedation during cardiac catheterization. The scores for the bispectral index may not reflect correct values in children, but may be helpful during titration of sedatives such as midazolam and ketamine. METHODS We conducted a prospective randomized clinical trial in 126 patients scheduled for cardiac catheterization in a teaching hospital. They ranged in age from 4 months to 15 years. In 66 patients, sedation was performed without use of the bispectral index, while the index was used in the other 60 patients. The data collected included heart rate, mean arterial pressure, respiratory rate, saturation of oxygen, amount of sedatives, awakening time and adverse effects. We subdivided the patients into age-related groups for each parameter. RESULTS The demographic data were not statistically different. Monitoring with the bispectral index in those aged from 1 to 3 years revealed use of lower doses of midazolam, at 2.09 mg per kg per hr, with standard deviation of 0.36, and similarly lowers doses of ketamine, at 2.07 mg per kg per hr, with standard deviation of 0.22, the values in those not monitored being 2.93, with standard deviation of 0.45, and 2.96 with standard deviation of 0.51 respectively, these difference being statistically significant (p = 0.001 and p = 0.04, respectively). In those aged from 3 to 6 years of age, dosage of midazolam was 2.09, with deviation of 0.36, and of ketamine 1.78, with deviation of 0.27, following use of the bispectral index, compared to 2.89 with deviation of 0.28, and 2.62 with deviation of 0.69 respectively, when the bispectral index was not used, these again being significant differences (p = 0.033 and p = 0.04). The requirements for respiratory support and adverse effects were also significantly lower when using the bispectral index (p less than 0.05). No significant difference was found regarding dosages at the ages of 4 months to 1 year, and 6 to 15 years. The awakening time, however, was shorter with use of the index in those aged from 1 to 6 years. CONCLUSIONS When using the bispectral index for monitoring sedation during catheterization in children, we noted decreased need for doses of midazolam and ketamine, a lower need for respiratory support and less adverse effects.

Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma.

Background: The aim of the present study was to evaluate the role of tissue Doppler echocardiography in assessment of ventricular function in pediatric patients with bronchial asthma (BA).

Wall motion velocities of ascending aorta measured by tissue Doppler imaging in obese children

Background:  Obesity is associated with the development of early cardiovascular abnormalities such as atherosclerotic lesions. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The objective of the current study was to screen aortic elastic properties with tissue Doppler imaging in obese children.

Lung perfusion studies after transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder

Background: Reduced left lung perfusion has been described after transcatheter closure of the patent ductus arteriosus (PDA) with several prostheses. Although the Amplatzer ductal occluder (ADO) device is currently the most widely used occluder for closure of large‐sized PDAs, the potential consequences of flow distribution to the lungs of this device have not been completely clarified. We evaluated lung perfusion following occlusion of PDA with the ADO device. Methods: Forty‐seven patients underwent successful transcatheter PDA occlusion using the ADO device were included in this study. Lung perfusion scans were performed 6 months after the procedure. Results: Decreased perfusion to the left lung (defined as < 40% of total lung flow) was observed in 17 patients (36%), 5 of whom were low‐weight symptomatic infants. Ductal ampulla length was significantly shorter and minimal ductal diameter to ampulla diameter ratio was significantly higher in patients with decreased left lung perfusion and correlated well with left lung perfusion values (r = 0.516 and r = −0.501, respectively). A cut‐off value of ≤5.8 mm for the ductal ampulla length and ≥1.9 for ampulla diameter to ampulla length ratio showed high sensitivity and specificity for reduced lung perfusion. Conclusions: The incidence of abnormal left lung perfusion is high 6 months after transcatheter closure of PDA with the ADO, more likely in the low weight symptomatic infants and in patients with a short duct or a relatively shallow duct having abrupt narrowing of a large ampulla.

QT dispersion in acute rheumatic fever

BACKGROUND Disturbances of conduction are well known in the setting of acute rheumatic fever. The aim of this study is to investigate the QT dispersion as seen in the surface electrocardiogram of children with acute rheumatic fever. METHODS QT dispersion was quantitatively evaluated in 88 children with acute rheumatic fever. Patients were divided into two groups based on the absence or presence of carditis. As a control group, we studied 36 healthy children free of any disease, and matched for age with both groups. Repeat echocardiographic examinations were routinely scheduled in all patients at 3 months after the initial attack to study the evolution of valvar lesions. RESULTS The mean QT dispersion was significantly higher in children with rheumatic carditis. But there was no statistical difference between children without carditis and normal children. Among the children with carditis, the mean dispersion was higher in those with significant valvar regurgitation. Dispersion of greater than 55 milliseconds had a sensitivity of 85%, and specificity of 70%, in predicting rheumatic carditis, while a value of 65 milliseconds or greater had sensitivity of 81% specificity of 85% in predicting severe valvar lesions in acute rheumatic carditis. At follow-up examination, a clear reduction on the QT dispersion was the main finding, reflecting an electrophysiological improvement. CONCLUSIONS These observations suggest that QT dispersion is increased in association with cardiac involvement in children with acute rheumatic fever.

[Closure of patent ductus arteriosus with duct occluder device in adult patients: evaluation of the approaches to facilitate the procedure].

OBJECTIVE The anatomic changes of the patent ductus arteriosus (PDA) in adult patients can complicate its transcatheter occlusion. The aim of the study was to determine procedural approaches to facilitate transcatheter closure of PDA in adult patients using the Amplatzer duct occluder (ADO). METHODS In this prospective study, 33 consecutive adult patients with a moderate to large-sized PDA underwent transcatheter closure. Conventional antegrade approach was used in 14 patients, while retrograde wire-guided assisted approach in remaining 18 patients to access the PDA antegrade. If the initial procedure failed, snare-assisted technique was used to pass through the ductus antegradely. For comparative statistics, the Students t-test, Mann-Whitney U test and Chi-square test were used as appropriate. RESULTS Thirty-two patients had successful PDA occlusion. PDA ostium could be engaged in 10 of 14 patients by conventional approach, while 17 of remaining 18 patients by retrograde wire-guided assisted approach (p=0.07). PDAs could be passed antegradely using the snare-assisted technique in those five patients in whom the initial procedure failed. The mean size of implanted devices was 3.76 mm larger than the narrowest size of the PDA. Spontaneous embolization occurred in one patient in whom smaller device implanted due to his short ductus. All patients attained complete occlusion and there were no complications encountered during follow-up. CONCLUSION The retrograde wire-guided technique is an effective approach and offers an alternative to access the PDA antegradely in adult patients. Larger than recommended size ADO device can be used safely in all adult patients with feasible ductal ampulla and may prevent device migration.