Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study.

BACKGROUND: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. METHODS: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. RESULTS: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. CONCLUSIONS: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. IMPACT: MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

Clinical characteristics of firearm-related injuries in children in Turkey.

BACKGROUND: A significant number of children are injured by or die from firearm-related incidents every year, although there is a lack of global data on the number of children admitted to pediatric emergency departments (PEDs) and pediatric intensive care units (PICU) with firearm injuries. This study is the most comprehensive analysis of firearm injuries sustained by children in Turkey to date. METHODS: This multicenter, retrospective, cohort study was conducted between 2010 and 2020 with the contributions of the PEDs, PICUs, intensive care units, and surgery departments of university hospitals and research hospitals. RESULTS: A total of 508 children were admitted to hospital with firearm-related injuries in the research period, although the medical records of only 489 could be obtained. Of the total admissions to hospitals, 55.0% were identified as unintentional, 8.2% as homicide, 4.5% as self-harm, and 32.3% as undetermined. The Glasgow Coma Scale (GCS) and ventilation support were found to be the most significant predictors of mortality, while head/neck injury, length of stay (LOS) in the hospital and surgical interventions were found to be the most significant predictors of disability. The overall mortality of firearm-related injuries was 6.3%, and the mortality for children admitted to the PICU was 19.8%. The probability of disability was calculated as 96.0% for children hospitalized with firearm injuries for longer than 75 days. CONCLUSIONS: Head/neck injury, LOS in the hospital, and surgical interventions were found to be the most significant parameters for the prediction of disability. Hospitalization exceeding 6 days was found to be related to disability.

Confirmation of Brain Death with Positron Emission Tomography.

After recent advances regarding organ transplantation, accurate and timely diagnosis of brain death has gained importance. In the diagnosis of brain death, in addition to clinical findings, various ancillary tests are very crucial. In this study, the scintigraphic imaging of the brain death of an 8-year-old girl with both Tc-99m diethylenetriaminepentaacetic and 18F-fluorodeoxyglucose (FDG) has been presented. This case study shows that 18F-FDG positron emission tomography-computed tomography imaging can be a useful technique in evaluating brain death in patients.

Investigation of Blood Betatrophin Levels in Obese Children with Non-Alcoholic Fatty Liver Disease.

PURPOSE: The prevalence of obesity has significantly increased among children and adolescents worldwide and is becoming an important health care problem in parallel with the increased prevalence of obesity pediatric non-alcoholic fatty liver disease. Betatrophin is a newly define hormone that is commonly secreted by liver and plays role in glucose tolerance. This study aimed to investigate the relationship between serum betatrophin levels and non-alcoholic fatty liver disease in obese children. METHODS: The study included 40 obese children with a body mass index (BMI) above 95th centile, and 35 non-obese subjects with a BMI 3-85th centile, whose age and gender were similar to those of the patient group. For the evaluation of metabolic parameters fasting serum glucose, insulin, alanine aminotransferase, aspartate aminotransferase, lipid profile and serum betatrophin levels were measured. Total cholesterol: high-density lipoprotein cholesterol and low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratios were calculated as "atherogenic indices." RESULTS: Serum betatrophin levels of the obese subjects were similar to that of non-obese subjects (p=0.90). Betatrophin levels were not correlated with the metabolic parameters. CONCLUSION: In the present study, levels of betatrophin are not different between obese and insulin resistant children and non-obese subjects, and they are not correlated with atherogenic indices. To elucidate the exact role of betatrophin in obesity, further studies are required to identify the betatrophin receptor and/or other possible cofactors.

Does intrauterine tobacco exposure increase the pain perception of newborns?

BACKGROUND: This study aimed to assess whether there was a difference in the pain-perception levels of newborns born to mothers who smoked during pregnancy and newborns born to mothers who were not exposed to active or passive smoking during pregnancy. MATERIALS AND METHODS: A total of 60 newborns born by normal spontaneous vaginal birth between June 2013 and June 2014 were included in the study: 30 born to mothers who smoked during pregnancy, and 30 born to mothers not exposed to smoking. Mothers or newborns who had taken analgesics or sedative medications in the previous 24 hours, newborns not born at term, and sick newborns were not included in the study. During the routine hepatitis B-vaccination injection given at postnatal 48 hours, the newborns' behavior was monitored and recorded by video camera. The data obtained from the recordings were evaluated according to the Neonatal Pain, Agitation, and Sedation Scale and analyzed with SPSS 20. RESULTS: The median pain score of the group exposed to tobacco smoke in utero was 8.5, while the median pain score of the unexposed group was 6 (P<0.001). CONCLUSION: Exposure to tobacco smoke in utero may increase the pain-perception levels of newborns.

Do we really ponder about necessity of intravenous hydration in acute bronchiolitis?

OBJECTIVE: The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis. METHODS: This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting ß2-agonist (salbutamol) +hydration; nebulized short-acting ß2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure. RESULTS: A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital. CONCLUSIONS: IV hydration is not effective on length of stay in hospital in mild acute bronchiolitis patients.

OBJETIVO: Establecer la función de la terapia de hidratación intravenosa leve. MÉTODOS: Estudio retrospectivo de casos y controles. En el estudio fueron reclutados niños entre 1 mes y 2 años de edad atendidos en la sala de pediatría general entre junio 2012 y junio 2013, con diagnóstico de bronquiolitis aguda no complicada. Se revisaron historias médicas de los niños para obtener datos personales, síntomas de la enfermedad, grado de severidad y el manejo instaurado. Los pacientes fueron clasificados en cuatro grupos de cuerdo al manejo: hidratación + nebulización de corta acción con ß2-agonista (salbutamol); nebulización de corta acción con ß2-agonista (salbutamol); hidratación; o sin hidratación y broncodilatador. Se determinó la duración de la estancia hospitalaria como medida resultado. RESULTADOS: Un total de 94 niños fueron estudiados. No hubo diferencia significativa entre los grupos en términos de duración de la estancia en el hospital. CONCLUSIONES: La hidratación IV no es efectiva en la duración de la estancia hospitalaria en pacientes con bronquiolitis aguda leve.

Relation between QT Variables and Left Ventricular Geometry in Athletes and Obese Children.

INTRODUCTION: We aimed to evaluate the relation between QT variables and left ventricular geometry in athletes and obese children. MATERIAL AND METHODS: This study included 209 children and adolescents. Thirty-eight of them were obese, 140 were athletes and 31 were normal weighted. Children with history of functional and structural cardiovascular diseases (acquired and congenital), chronic systemic diseases, hypertension, sleep apnea, endocrinological disorders were excluded. All subjects underwent detailed electrocardiographic and echocardiographic examination. RESULTS: QT dispersion was significantly higher in obese children, basketball players, football players and swimmers compared to control group (p < 0.05, p < 0.001, < 0.001 and < 0.01 respectively). Basketball players had the highest QT dispersion. Left ventricular endsystolic diameter (mm/m2) was higher in footballers, swimmers, wrestlers and tennis players compared to obese subjects. Interventricular septal thickness at diastole was highest in swimmers compared to control group (p < 0.001) and left ventricular posterior wall thickness was significantly higher in footballers and swimmers compared to healthy subjects (p < 0.01 and p < 0.001 respectively). Left ventricular geometry was normal in 84 patients (47.1%), but 34 patients (19.1%) had concentric remodelling, 20 (22.4%) had concentric hypertrophy and 40 (28.6%) had eccentric hypertrophy. No concentric and eccentric hypertrophy was observed in obese subjects. Left ventricle hypertrophy was prominent in dynamic and combined groups but it was not statistically significant (p = 0.204). QT dispersion was statistically higher in obese, dynamic sports and combined sports compared to control group (p < 0.05, p < 0.001 and p < 0.001 respectively). DISCUSSION: In this study we determined that QT dispersion is elevated in dynamic and combined sports types and obese children. CONCLUSION: QT dispersion is prolonged in obese and athletes who participate dynamic and combined sports.

Introdução: O objetivo deste trabalho foi avaliar a relação entre variáveis QT e geometria do ventrículo esquerdo em atletas e crianças obesas. Material e Métodos: Foram incluídos no estudo 209 crianças e adolescentes. Trinta e oito deles eram obesos, 140 foram atletas e 31 tinham peso normal. Crianças com antecedentes funcionais e estruturais de doenças cardiovasculares (adquiridas e congénitas), doenças sistémicas crónicas, hipertensão arterial, apneia do sono, doenças endocrinológicas foram excluídos. Todos os sujeitos rea-lizaram detalhados exames eletrocardiográficos e ecocardiográficos. Resultados: A dispersão do QT foi significativamente maior em crianças obesas, jogadores de basquete, jogadores de futebol e nadadores, por comparação com o grupo controlo (p < 0,05, p < 0,001, < 0,001 e < 0,01, respetivamente). Os jogadores de basquetebol tiveram a maior dispersão do QT. O di'metro ventricular esquerdo endosistólico (mm/m2) foi maior nos jogadores, nadadores, lutadores e jogadores de ténis por comparação com indivíduos obesos. A espessura do septo interventricular na diástole foi maior em nadadores por comparação com o grupo controlo (p < 0,001) e a espessura da parede posterior do ventrículo esquerdo foi significativamente maior nos jogadores e nadadores por comparação a indivíduos saudáveis (p < 0,01 e p < 0,001, respetivamente). A geometria do ventrículo esquerdo foi normal em 84 pacientes (47,1%), mas 34 pacientes (19,1%) tinham remodelação concêntrica, 20 (22,4%) apresentaram hipertrofia concêntrica e 40 (28,6%) apresentaram hipertrofia excêntrica. Não foi observada hipertrofia concêntrica e excêntrica em indivíduos obesos. A hipertrofia do ventrículo esquerdo era proeminente nos grupos din'mico e combinado mas a diferença não foi estatisticamente significativa (p = 0,204). A dispersão do QT foi significativamente maior nos obesos e praticantes de desporto din'mico e combinado em relação ao grupo controlo (p < 0,05, p < 0,001 e p < 0,001, respetivamente). Discussão: Neste estudo determinámos que a dispersão do QT é elevada em tipos de desporto din'mico e combinado, e em crianças obesas. Conclusão: A dispersão do QT é prolongada em pacientes obesos e atletas que participam em desporto din'mico e combinado.

Serum ischemia-modified albumin levels in adolescent smokers.

BACKGROUND: It is known that the biochemical marker linked to tissue ischemia, ischemia-modified albumin (IMA), is related to oxidative stress. Cigarette smoking is a situation with increased oxidative stress causing cell damage and it is thought that many of the negative effects linked to smoking may occur after the biological material in the body is exposed to oxidative damage. This study aimed to identify variability in serum IMA levels in adolescents who smoke. METHODS: This case-control study comprised 60 adolescents without any chronic disease. The smoking group was 30 adolescents between the ages of 14 and 17 years who smoked, while the control group was 30 healthy adolescents who did not smoke. Blood samples were collected from all subjects and serum IMA levels and serum nicotine metabolites were determined. RESULTS: The serum IMA levels in the adolescents who smoked were 0.452±0.094 absorbance unit (ABSU), while the control group had ASBU levels of 0.427±0.054. There was no significant difference between the groups in terms of serum IMA levels (p=0.210). There was a significant difference between the control and smoking groups in terms of serum nicotine metabolite levels (p<0.001). CONCLUSIONS: Among adolescents who smoke, serum IMA levels may not be a good marker for oxidative stress.

Do we really ponder about necessity of intravenous hydration in acute bronchiolitis? / Debemos reflexionar sobre la necesidad de una hidratación intravenosa en la bronquiolitis aguda?

Objective: The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis. Methods: This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting β2-agonist (salbutamol) +hydration; nebulized short-acting β2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure. Results: A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital. Conclusions:IV hydration is not effective on length of stay in hospital in mild acute bronchiolitis patients.

Objetivo: Establecer la función de la terapia de hidratación intravenosa leve. Métodos: Estudio descriptivo retrospectivo. En el estudio fueron reclutados niños entre 1 mes y 2 años de edad atendidos en la sala de pediatría general entre junio 2012 y junio 2013, con diagnóstico de bronquiolitis aguda no complicada. Se revisaron historias médicas de los niños para obtener datos personales, síntomas de la enfermedad, grado de severidad y el manejo instaurado. Los pacientes fueron clasificados en cuatro grupos de cuerdo al manejo: hidratación + nebulización de corta acción con β2-agonista (salbutamol); nebulización de corta acción con β2agonista (salbutamol); hidratación; o sin hidratación y broncodilatador. Se determinó la duración de la estancia hospitalaria como medida resultado. Resultados: Un total de 94 niños fueron estudiados. No hubo diferencia significativa entre los grupos en términos de duración de la estancia en el hospital. Conclusiones: La hidratación IV no es efectiva en la duración de la estancia hospitalaria en pacientes con bronquiolitis aguda leve.

Noninvasive assessment of the retina and the choroid using enhanced-depth imaging optical coherence tomography shows microvascular impairments in childhood obesity.

PURPOSE: To evaluate the retinal vascular diameters and macular and subfoveal choroidal thicknesses of obese and nonobese children using enhanced-depth imaging spectral domain optical coherence tomography (EDI SD-OCT). METHODS: The retinal vascular diameters of the 4 largest retinal arterioles and venules and macular and subfoveal choroidal thickness measurements of 40 obese children (body mass index [BMI] z score above +2.0 standard deviations) were obtained by EDI SD-OCT and compared with those of 40 age- and sex-matched nonobese children. Anthropometric measures, including weight and height, were also obtained. BMI z score was defined using standardized protocols. RESULTS: The mean BMI z scores of obese children were 2.59 ± 0.62; of nonobese children, -0.20 ± 0.92. The mean diameter of retinal arterioles was significantly smaller (P = 0.002) in obese children compared to nonobese children, whereas the mean diameter of retinal venules was larger (P = 0.008). The macular and subfoveal choroidal thicknesses were significantly thinner (P = 0.031 and 0.014, resp.) in obese children compared to nonobese children. CONCLUSIONS: The narrower retinal arterioles, wider retinal venules, and thinner macular and subfoveal choroidal thicknesses in obese children seem to be associated with microvascular impairments in childhood obesity.

Relationship between Abdominal Aortic Intima Media Thickness and Central Obesity in Children.

BACKGROUND: Childhood obesity is one of the important risk factors for early atherosclerosis. We aimed to evaluate the effect of obesity on abdominal aortic intima media thickness (aaIMT) in children. METHODS: We consecutively recruited 60 obese and 28 healthy children from the outpatient clinic of pediatrics. In all patients, BMI, waist circumference (WC) and hip circumference (HC) were measured, and fasting serum lipid profile, plasma glucose and plasma insulin were studied. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated for the obese group. All children underwent ultrasonography to evaluate hepatosteatosis and to measure aaIMT. RESULTS: There was a significant difference between the groups in terms of aaIMT, insulin, glucose, HOMA-IR, total cholesterol, low-density lipoprotein, triglyceride and hepatosteatosis. aaIMT was 1.12 ± 0.25 and 0.61 ± 0.18 mm in the obese and nonobese groups, respectively (p < 0.001). In the obese group, there was a positive correlation between aaIMT and WC, WC/height ratio, BMI, HC and hepatosteatosis (p < 0.05 for all), with the highest significance for WC. CONCLUSIONS: This study showed that aaIMT was significantly higher in obese children than in nonobese children, and that WC was a strong predictor for aaIMT. Early detection of an increased aaIMT in obese children may guide the follow-up of these patients in terms of developing atherosclerosis and its complications.

Effect of delivery mode on postpartum neonatal body temperatures.

OBJECTIVE: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section. METHODS: We performed a prospective study of 106 term newborn - 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers' temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth. RESULTS: Environmental temperature was maintained at 22-24 °C. Pre-operative mother temperatures were 36.31 ± 0.30 °C in group 1, 36.36 ± 0.26 °C in group 2 and 36.39 ± 0.19 °C in group 3 (p = 0.414). Post-operative mother temperatures were 36.39 ± 0.27 °C in group 1, 36.29 ± 0.31 °C in group 2 and 36.25 ± 0.28 °C in group 3 (p = 0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5 ± 0.6 °C, 37.2 ± 0.2 °C and 36.8 ± 0.4 °C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p < 0.001). CONCLUSIONS: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.

Prenatal maternal risk factors for infantile colic.

AIM: To examine maternal prenatal risk factors for infantile colic (IC). METHODS: Mothers were asked to complete a standard pre-coded questionnaire form. Inclusion in the study consisted of four criteria. The case group comprised healthy children with infantile colic according to Wessel's definition. The control group comprised healthy children with no history of IC. Prenatal period characteristics of mothers were examined to determine associations with IC. RESULTS: Children with mothers who had prophylactic iron supplementation therapy during pregnancy suffered more from IC. Postpartum depression was found to be more frequent in the case group than in the control group. Gynaecological history, including suffering from migraine, presence of any premenstrual symptoms, dysmenorrhea and high pre-pregnancy body mass index, was associated with development of IC. CONCLUSION: Pre-gestational gynaecological complaints and pregnancy characteristics may point to IC. These characteristics should be investigated and families should be informed.

Nuclear morphometric and morphological analysis of exfoliated buccal and tongue dorsum cells in type-1 diabetic patients.

BACKGROUND: Diabetes mellitus type 1 that results from immunologically mediated damage to the ß-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells. AIM: The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients. MATERIALS AND METHODS: We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica™). RESULTS: The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006). CONCLUSION: The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.

The effects of passive smoking on the six-minute walk test in obese pediatric cases.

OBJECTIVE: The aim of this study was to evaluate whether exposure to second-hand smoke affected the six-minute walk test (6 MWT) of obese non-asthmatic pediatric cases. METHODS: Obese pediatric patients (body mass index >95th p) with no existing co-morbidities were included in the study. Smoke exposure was assessed with a self-reported questionnaire completed by the parents. The subjects were divided into two groups: Group 1 consisting of obese children exposed to passive smoking and Group 2 of obese children not exposed to passive smoking. In addition to 6 MWT, spirometric flow and volume, including forced expiratory volume in 1 s and peak expiratory flow rate, were also measured in all subjects. The results of the 6 MWT were assessed to determine any association with passive smoking. RESULTS: The study included 75 obese pediatric cases (40 male, 35 female) with a mean age of 9.06 ± 0.97 years. The 6 MWT results in Group 1 was 501.88 ± 62.12 meters and in Group 2 559.63 ± 72.93 meters. The difference was statistically significant (p=0.001). CONCLUSIONS: Passive smoking may negatively affect the respiratory and cardiovascular capacity in obese children, who are already at risk of lower cardiopulmonary function. The evaluation of 6 MWT in these pediatric patients may be useful for monitoring and families should be warned about potential problems due to smoking.

Early cardiac abnormalities and serum N-terminal pro B-type natriuretic peptide levels in obese children.

OBJECTIVE: The aim of this study was to evaluate early cardiac abnormalities in obese children by the conventional echocardiography and to verify whether N-terminal pro B-type natriuretic peptide (NT-proBNP) differ between obese and healthy children. METHODS: We started this study with 68 obese children and 35 healthy controls matched for age and sex. Body mass index (BMI) was calculated. Children with a BMI > or = 95th percentile were considered obese. Thirty children in the obese group were also diagnosed with metabolic syndrome, according to the International Diabetes Federation criteria. Standard echocardiographic study was performed on each patient and control subject. Diastolic filling parameters were evaluated using pulsed-wave tissue Doppler method. Blood samples were taken at 8 a.m. to study blood biochemistry tests, including insulin, lipids, glucose, and NT-proBNP. Serum NT-proBNP levels were measured by a solid-phase, enzyme-labeled chemiluminescent immunometric assay. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Children with HOMA-IR > 3.16 were considered insulin-resistant. RESULTS: There were diastolic filling abnormalities in obese children, as shown by a decreased mitral valve early filling (E) wave/late filling (A) ratio and a prolongation in E-wave deceleration time. The levels of NT-proBNP were not statistically different among the groups. The levels of NT-proBNP were not different between obese children with and without metabolic syndrome, those with and without hypertension, and those with and without insulin resistance, respectively. CONCLUSION: Although there were diastolic filling abnormalities in obese children, their NT-proBNP levels were not different from healthy controls. It seems that there is no diagnostic value in NT-proBNP levels between obese children and healthy controls.

The local vasoconstriction of infant's skin following instillation of mydriatic eye drops.

BACKGROUND: Systemic absorption of eye drops is known to occur via the nasal mucosa, cornea, and conjunctiva. Diffusion of eye drops through the skin is previously unrecognized. Here, two cases are presented in which we observed skin pallor around the eyes after instillation of phenylephrine 2.5% drops. CASE 1: A 32-week gestational age premature infant had mydriatic eye drops instilled as part of retinopathy of prematurity screening. CASE 2: A term newborn dysmorphic infant underwent fundus examination to rule out ocular pathology. In both cases, discoloration of periorbital skin was observed 45 min following administration of drops. CONCLUSION: The risks of percutaneous toxicity must always be considered in children, especially in premature neonates, in whom the epidermal permeability barrier is frequently incompetent. Application of smaller drop size or wiping of overflowed drop from the skin may be useful to decrease the risk of systemic side effects.