Are adolescents with premenstrual disorder at risk for cardiac arrhythmias?

BACKGROUND: One of the most commonly experienced symptoms of premenstrual disorder (PMD) is anxiety, and there is a notable rise in sympathomimetic activity in this patient group. Studies have linked fluctuations in systemic autonomic tone to electrocardiography (ECG) changes. This study aims to investigate the relationship between anxiety, a common symptom of PMD, and alterations in QT dispersion (QTd) and P-wave dispersion (Pd) in adolescent females. METHODS: This cross-sectional study included female adolescents aged 12-18 with regular menstruation for at least 3 months. Participants completed the premenstrual syndrome scale (PMSS) and were divided into two groups, PMD and control, according to the PMSS score. A standard 12-lead body surface ECG was performed and QTd and Pd values were determined in each participant. RESULTS: Of the 43 participants, 27 were categorized into the PMD group, with a mean age of 15.15 ± 1.43 years. Age at menarche and menstrual cycle patterns were comparable between the PMD and control groups. Statistical analysis revealed significantly higher Pmin (p = 0.010) and Pd values (p < 0.001) in the PMD group compared to controls. A positive correlation between PMSS scores and Pd (p = 0.049) was also observed. CONCLUSIONS: Changes in atrial conduction and ventricular repolarization due to the pathophysiology of PMD may increase the risk of developing atrial and ventricular tachyarrhythmias over time. Screening patients with PMD using an ECG may be useful in identifying potentially at-risk adolescents.

Plasma renin, aldosterone, and urinary prostaglandin E2 levels in children with hypocalcemia due to vitamin D deficiency rickets.

We investigated the effect of hypocalcemia on plasma renin, aldosterone, and urine PGE2 levels in children with vitamin D deficiency rickets (VDDR). In the study group, 25 patients with VDDR-induced hypocalcemia were treated with a single dose of 150,000-300,000 IU cholecalciferol and 50 mg/kg/day elemental Ca for 10 days. On any day between 21th and 30th days after the treatment, the patients' clinical, biochemical and radiologic findings were re-evaluated. The healthy children with the same sex and similar age as the study group comprised the control group. Plasma sodium (Na), potassium (K), calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (PTH), 25- hydroxy vitamin D (25OHD), renin, aldosterone; and urinary Ca, creatinine (Cr) and prostaglandin E2 (PGE2) levels were measured in both the study (pre-treatment and post-treatment) and the control group. Plasma Ca, P, 25OHD and renin levels and urinary PGE2/Cr ratio in the post-treatment group were significantly higher than those in the pre-treatment group while K, ALP, and PTH concentrations were significantly lower. Plasma ALP and PTH levels in pre-treatment group were significantly higher than in the control group while Ca, P, 25OHD, aldosterone and renin concentrations and urinary PGE2/Cr ratio were significantly lower. Post-treatment plasma Ca level was significantly decreased in normal limits compared to the control group while other biochemical parameters were not different from the control group. Plasma Ca concentration was positively correlated with renin level and urinary PGE2/Cr ratio. The findings suggest that hypocalcemia may inhibit the production of renin, aldosterone and PGE2 and a blunt aldosterone secretion may develop even after recovery from hypocalcemia.

Sounds unrealistic: an adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: what happens to the physiology?

BACKGROUND: Adolescents with eating disorders (EDs) may present not only with abnormal eating behaviors but also with abnormal drinking behaviors varying widely. These behaviors include water loading to cheat on weight measurements, to feel full and suppress appetite and/or to induce vomiting; as well as restricting fluid intake in addition to food. METHOD: We present a 16-year-old female adolescent with anorexia nervosa restrictive type and major depressive disorder who was hospitalized due to acute food refusal and developed generalized seizures due to dilutional hyponatremia in consequence of consuming excessive amount of water. Psychiatric diagnoses were made according to 'The Diagnostic and Statistical Manual of Mental Disorders' (5th ed.; DSM-5) criteria. RESULTS: After starting nutritional rehabilitation with a low calorie meal plan to avoid refeeding syndrome, a weight gain of 2 kg was noted in the second day of hospitalization. At the bedside visit, she was observed in a disoriented manner and consecutively in seconds, lost consciousness with a generalized tonic-clonic seizure lasting 2 min. Her serum sodium level was measured as 116 mEq/L, which was normal at the time of admission. It was later learned that she secretly ingested 19 L of water in a short amount of time. She regained consciousness and no further seizures were observed after intravenous sodium deficit correction and fluid restriction therapy. Her serum sodium level was normalized (137 mEq/L) within 12 h. CONCLUSION: A thorough clinical assessment of hydration and drinking behaviors as well as eating behaviors is essential for patients with EDs to avoid serious medical complications with high mortality and morbidity during follow-up. It is interesting that this amount of fluid consumption in such a short period of time did not present to the clinic with vomiting, gastric dilatation or bowel irrigation symptoms in a case with acute food refusal and restriction for a year, instead absorbed very quickly causing acute and severe symptomatic hyponatremia with generalized seizures.

Prevalence of premenstrual syndrome in adolescent girls.

BACKGROUND: Premenstrual syndrome (PMS) is characterized by physical, cognitive, emotional, and behavioral symptoms that appear during the luteal phase of the menstrual cycle, disappear after menstruation, and are recurrent in every cycle. PMS significantly affects the social and academic lives of adolescents, and historically, it has been neglected by healthcare professionals. We aimed to evaluate the current point prevalence of PMS in Turkish adolescents presented to a tertiary adolescent medicine clinic. MATERIAL AND METHOD: Adolescent girls between the ages of 12 and 18 and who had regular menstrual cycles for at least three months without any mental or chronic illness were assessed. A clinic information form and the 'Premenstrual Syndrome Scale' (PMSS) questionnaire were completed. Those with a PMSS total score of more than 50% of the total score (>110 out of 220) were classified as PMS (+). Those classified as PMS were further classified as mild-moderate (score: 110-150) and severe (>150). RESULTS: The study included 417 adolescents. The point prevalence of PMS was found to be 61.2% (n:255). Of those with PMS, 49.4% had mild-moderate and 50.6% had severe PMS. The mean PMSS score was 154.56 ± 30.43 in the PMS group and 76.17 ± 20.65 in the non-PMS group (p<0.001). The mean age was 15.41 ± 1.3 years in the PMS group and 14.88 ± 1.35 years in the non-PMS group (p=0.029). None of the youth in our study applied to our clinic due to any premenstrual complaints. CONCLUSION: PMS is frequently observed in youth, as indicated by our study. Adolescents have little awareness of PMS and their need for healthcare services. During the evaluation of adolescents, it is important for health care providers to acquire knowledge regarding the features of menstrual cycles and conduct a comprehensive psychosocial assessment.

Immunity Rates of Live Viral Vaccines in Pediatric Renal Transplant Candidates: A Single-Center Experience.

OBJECTIVES: Solid-organ transplant recipients are at an increased risk of severe infections due to their immunosuppressed state. Despite the recommendation of routine screening and vaccination before transplant to mitigate this danger, vaccination rates in these patients are still below desirable levels. We aimed to investigate the prevalence of positive antibody rates for measles, mumps, rubella, and varicella among children who are candidates for renal transplant. MATERIALS AND METHODS: This retrospective study was conducted at a single center and included 144 pediatric kidney transplant patients for the past 7 years. We reviewed the medical records of all participants to evaluate their serologic status for measles, mumps, rubella, and varicella viruses before kidney transplant. RESULTS: In this study, 144 pediatric kidney transplant candidates (mean age 11.5 years, 56.9% male) were enrolled, and the most frequent causes of the chronic renal disease were congenital anomalies of the kidney and urinary tract and glomerular diseases (32.6%). Seropositivity rates for measles, mumps, rubella, and varicella were 59.0%, 31.9%, 46.5%, and 43.6%, respectively, and all patients who tested negative for antibodies were vaccinated before transplant. Younger age at transplant (OR = 0.909, 95% CI = 0.840-0.923; P = .017) and congenital anomalies of the kidney and urinary tract (OR = 3.46, 95% CI = 1.1548-7.735; P = .002) were significantly associated with increased measles seropositivity, although no significant associations were observed for the other viruses. CONCLUSIONS: We observed lower seropositivity rates for measles, mumps, rubella, and varicella in pediatric kidney transplant patients versus healthy children and other previous studies. It is essential to address these suboptimal rates to protect the health of these vulnerable patients. Future research should focus on targeted interventions to improve vaccination rates and outcomes in this population.