Assessment of Cardiovascular Surgery Requirements in Children and Adolescents Admitted With Chest Pain To A Pediatric Emergency Clinic.

INTRODUCTION: Chest pain in children and adolescents is an important symptom in the pediatric emergency clinic. The aim of this study is to assess the characteristics of chest pain and cardiovascular surgery in the pediatric population. MATERIALS AND METHODS: There were 352 children who presented with chest pain to the pediatric emergency department between December 2007 and February 2017. These children were included in this study, which is a retrospective observational study. RESULTS: Among the 352 patients, six patients (1.7%) underwent cardiovascular surgery. Forty-eight patients (13.6%) were diagnosed with cardiac disease, and the most common cardiac causes were myocarditis and pericarditis. CONCLUSION: Only six patients (1.7%) who were admitted to the emergency department with chest pain needed cardiovascular surgery. The chest pain in children required less surgery, and mortality and morbidity were lower compared with adult cardiac chest pain.

Left ventricular mechanics are affected in children with celiac disease: A study based on two-dimensional speckle tracking echocardiography.

BACKGROUND: An association between cardiomyopathy and celiac disease has been reported, but not frequently. We examined the effects on cardiac mechanics in children with celiac disease (CD) by two-dimensional speckle tracking echocardiography (2DSTE). METHODS: Eighty-one children with CD were compared with a control group comprising 51 healthy children by echocardiographic examination. Children with CD who had been on gluten-free diet for more than 6 months were divided into two different groups: group 1 was positive for serum antitissue transglutaminase antibody (n=48), and group 2 was negative for serum antitissue transglutaminase antibody (n=33). Cardiac functions were evaluated in all children using conventional echocardiography, tissue Doppler imaging (TDI), and 2DSTE methods. RESULTS: For children with CD, the mean age and male:female ratio were 10.1±4.0 years and 26/55 (67% female), respectively, which did not differ from the controls. Patients were diagnosed at a mean age of 7.9±4.1 years, and the mean follow-up time was 2.37±2.98 years. Conventional echocardiography and TDI measurements did not differ between groups. The left ventricular longitudinal and radial strains, and strain rate values were significantly lower in patients with CD, particularly in those with positive antitissue transglutaminase antibody compared with the control group. CONCLUSIONS: Our results suggest that 2DSTE is superior to conventional and TDI echocardiography for evaluating subclinical carditis in children with CD.

Acquired partial lipodystrophy associated with varicella.

Acquired partial lipodystrophy (Barraquer-Simons syndrome) is a rare condition with onset in childhood, and it is characterized by progressive loss of subcutaneous fat in a cephalocaudal fashion. Although it is known that acquired partial lipodystrophy usually follows acute febrile illness, it is very rarely reported to occur in association with varicella. In this case report, we present a seven-year-old girl with progressive loss of fat in her face just after varicella who was diagnosed as acquired partial lipodystrophy.

A Study of Mortality in Cardiac Patients in a Pediatric Intensive Care Unit.

OBJECTIVE: One of the major causes of mortality in the pediatric intensive care unit (PICU) is heart disease. This study aimed to determine the causes of mortality in children with pre-existing cardiac abnormalities who were admitted into the PICU. METHODS: Data were collected through patient profile assessment and outcome and heart diseases affecting prognosis were analyzed. Medical records of children were reviewed retrospectively. The updated Pediatric Index of Mortality 2 (PIM2) scores were used. Exploratory data analysis was performed using descriptive measures. Kolmogorov-Smirnov tests were used to test the normality of data distribution. RESULTS: Out of 566 admissions into PICU, 76 (13.4%) had cardiac abnormalities. Median and range of PICU stay were 5.50 and 417.88 days. The mean PIM2 score on admission was found to be 31.05. The most common admission was due to atrioventricular septal defect (AVSD) (15.7%), cardiomyopathy (13.1%), ventricular septal defect (VSD) (11.8%), tetralogy of Fallot (10.5%) and others (48.9%). There were multiple cardiac anomalies in 3.9% of patients. The most important cause of cardiac mortality in PICU was septic shock (26.0%) followed by cardiogenic shock (20.6%), and cardiac failure (13.7%). The nosocomial infection rate of cardiac patients in PICU was 10.5%. CONCLUSIONS: Our study reconfirmed that the PIM2 score is a good indicator of cardiac diseases. Infections, nosocomial infections, pneumonia, and septic shock were the leading causes of mortality in cardiac patients. Better infection control in the PICU may have a significant impact on decreasing mortality rates.