Does low birth weight affect P-wave and QT dispersion in childhood?

BACKGROUND: The aim of our study is to investigate the effects of low birth weight (LBW) on atrial conduction and ventricular repolarization in children by using P-wave dispersion (Pw-d) and QT dispersion (QT-d) analyses. These effects have not yet been studied in detail in LBW children. METHODS: Fifty LBW children and 70 normal birth weight (NBW) children were enrolled in this cross-sectional controlled study. The Pw-d and QT-d of the LBW and NBW children were investigated. Independent Student's t-test, Mann-Whitney U test, and χ(2) test were performed to compare these two groups. Stepwise multiple regression analysis was performed to investigate whether there was a relationship between P-wave indices, QT derivatives, anthropometric and clinical features, and echocardiographic parameters. RESULTS: Age, gender, body mass index, waist circumferences, systolic and diastolic blood pressure, and echocardiographic measurements were similar between the LBW group and the NBW group (all P values > 0.05). The following findings were recorded for the LBW and NBW groups, respectively: the Pw-d (30 [10-50] ms vs 30 [10-50] ms, P = 0.977), QT-d (20 [10-50] ms vs 30 [15-50] ms, P = 0.561), and QTc-d (26 [14-54] ms vs 33 [17-62] ms, P = 0.866). No significant difference was found in Pw-d, QT-d, and QTc-d in comparison between the groups (all P values > 0.05). Pw-d was related to left atrial diameter and QTc-d was associated with left ventricle mass index even though they were within the normal range. CONCLUSION: Compared with the NBW group, no significant difference was found in both atrial conduction and ventricular repolarization features in LBW children.

Jacobsen syndrome without thrombocytopenia: a case report and review of the literature.

Jacobsen syndrome (JS), a rare disorder with multiple dysmorphic features, is caused by the terminal deletion of chromosome 11q. Typical features include mild to moderate psychomotor retardation, trigonocephaly, facial dysmorphism, cardiac defects, and thrombocytopenia, though none of these features are invariably present. The estimated occurrence of JS is about 1/100,000 births. The female/male ratio is 2:1. The patient admitted to our clinic at 3.5 years of age with a cardiac murmur and facial anomalies. Facial anomalies included trigonocephaly with bulging forehead, hypertelorism, telecanthus, downward slanting palpebral fissures, and a carp-shaped mouth. The patient also had strabismus. An echocardiogram demonstrated perimembranous aneurysmatic ventricular septal defect and a secundum atrial defect. The patient was <3rd percentile for height and weight and showed some developmental delay. Magnetic resonance imaging (MRI) showed hyperintensive gliotic signal changes in periventricular cerebral white matter, and leukodystrophy was suspected. Chromosomal analysis of the patient showed terminal deletion of chromosome 11. The karyotype was designated 46, XX, del(11) (q24.1). A review of published reports shows that the severity of the observed clinical abnormalities in patients with JS is not clearly correlated with the extent of the deletion. Most of the patients with JS had short stature, and some of them had documented growth hormone deficiency, or central or primary hypothyroidism. In patients with the classical phenotype, the diagnosis is suspected on the basis of clinical findings: intellectual disability, facial dysmorphic features and thrombocytopenia. The diagnosis must be confirmed by cytogenetic analysis. For patients who survive the neonatal period and infancy, the life expectancy remains unknown. In this report, we describe a patient with the clinical features of JS without thrombocytopenia. To our knowledge, this is the first case reported from Turkey.

[Effect of overweight on cardiac function in children]. / Çocuklarda kilo fazlaliginin kalp fonksiyonlarina etkisi.

OBJECTIVES: It is known that obesity is related to heart failure. Asymptomatic left ventricular diastolic dysfunction (LVDD) is associated with the development of heart failure. The relationship between subclinical LVDD and overweight in children is not clear. The purpose of this study was to evaluate the effect of body mass index (BMI) and waist circumference on left ventricular mass index (LVMI) and LVDD in overweight children. STUDY DESIGN: A total of 153 children were enrolled in the study. Of these, 91 were normal weight (age-adjusted BMI: 15-85 percentile), and 62 were overweight (age-adjusted BMI: 85-95 percentile). After measuring two-dimensional and M-mode echocardiographic variables, left and right ventricle diastolic functions were assessed by conventional and tissue Doppler imaging. RESULTS: Compared to controls, overweight children had increased left atrium, aortic and left ventricular diameters, left ventricular wall thickness, LVM and LVMI, and septal mitral annulus e', septal e'/a', lateral e', lateral e'/a', lateral tricuspid annulus e', and e'/a' values. There were negative correlations between tissue Doppler diastolic parameters (septal mitral annulus e', lateral mitral annulus e', lateral tricuspid annulus e', septal mitral annulus e'/a', lateral mitral annulus e'/a', and lateral tricuspid annulus e'/a') and BMI, waist circumference, insulin, HOMA index, as well as systolic and diastolic blood pressure. Positive correlations were found between LVMI and BMI and between LVMI and waist circumference. BMI was found to be the predictor of decreased mitral anulus septal e', septal e'/a', lateral e', lateral e'/a'. CONCLUSION: Compared with normal-weight children, overweight children have decreased LV diastolic function. BMI is associated with a reduction in LV diastolic function in overweight children.

Indices used in differentiation of thalassemia trait from iron deficiency anemia in pediatric population: are they reliable?

BACKGROUND: Iron deficiency (IDA) and beta thalassemia trait (TT) are the most common causes of hypochromia and microcytosis. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood cell analyzers. However, studies in the pediatric age group are scarce and their results are controversial. METHODS: We calculated eight discrimination indices [Mentzer Index (MI), England and Fraser Index (E&F), Srivastava Index (S), Green and King Index (G&K), Shine and Lal Index (S&L), red blood cell (RBC) count, RBC distribution width, and red blood cell distribution width Index (RDWI)] in 100 patients. We calculated sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV and NPV), and Youden's Index (YI) of each discrimination index. RESULTS: None of the discrimination indices showed a SENS and SPEC of 100%. The highest SENS was obtained with S&L (87.1%), while the highest SPEC was obtained with E&F formula (100%). The highest YI value was obtained with E&F formula (58.1%). CONCLUSION: In our study, none of the formulas appears reliable in discriminating between TT and IDA patients. The evaluation of iron status and measurement of hemoglobin A(2) (HbA(2)) remain the most reliable investigations to differentiate between TT and IDA patients.

CD4(+), CD25(+), FOXP3 (+) T Regulatory Cell Levels in Obese, Asthmatic, Asthmatic Obese, and Healthy Children.

The aim of this prospective case control study is to determine CD4(+), CD25(+), and FoxP3(+) T regulatory cells (Tregs) and T helper cells (Ths) in obese, asthmatic, asthmatic obese, and healthy children. Obese (n = 40), asthmatic (n = 40), asthmatic obese (n = 40), and healthy children (n = 40) were included in this study. Blood samples collected from children were marked with CD4, CD25, ve Foxp3 in order to detect Tregs and Ths by flow cytometric method. Statistical analyses were performed. p ≤ 0.05 was chosen as meaningful threshold. Tregs exhibiting anti-inflammatory nature were significantly lower in obese (0.16 %; p ≤ 0.001), asthmatic (0.25 %; p ≤ 0.01), and asthmatic obese (0.29 %; p ≤ 0.05) groups than control group (0.38 %). Ths were counted higher in asthma group than control (p ≤ 0.01) and obese (p ≤ 0.001) groups. T cell immunity plays important roles in chronic inflammatory diseases such as obesity and asthma pathogeneses. Decreased numbers of Tregs found in obese, asthmatic, and asthmatic obese children might represent a challenge of these cells.

Shifting epidemiology of hepatitis a infection and vaccination status of children aged 6 months-12 years: time for mass vaccination.

OBJECTIVE: This study was designed to determine the current age-related hepatitis A virus (HAV) seroprevalance, vaccination status of children and to evaluate the epidemiological shift in HAV serostatus living in Tekirdag, which is located in Thrace region, the European part of Turkey. METHODS: Children 6 months-12 years of age with simple health problems were included. Blood samples were studied for HAV IgM and IgG collectively. A questionnaire addressing several characteristics of subjects was administered to obtain basic descriptive data on HAV epidemiology. Vaccination status of the children was recorded according to the immunization cards. FINDINGS: The overall anti-HAV IgM and anti-HAV IgG prevalance in children aged 6 months - 12 years was 3.3% and 25.4% respectively. Maximum hepatitis A IgM positivity was in the 7-12 years age group 4.8% (n= 12; P<0.001) and maximum hepatitis A IgG positivity in the same age group was 34% (n = 85; P<0.001). HAV vaccination rate among patients aged more than 2 years was 11.03%. HAV IgG seroprevalance was higher in children of low monthly income families (36.1%, n = 78; P<0.001) than in the intermediate (17%, n = 31) and high income families (11.1%, n = 6). CONCLUSION: These results indicate a shift in Hepatitis A seroprevalance when compared with the previous studies. As HAV infection in childhood is decreasing, the pool of susceptible adolescents and young adults is increasing. Introduction of hepatitis A vaccination into the national immunization schedule of Turkey should be considered.

Copeptin as a novel biomarker in nocturnal enuresis.

OBJECTIVE: To investigate the relation between copeptin, arginine vasopressin (AVP), and nocturnal enuresis (NE). METHODS: Forty-four patients with NE and 44 healthy children aged between 6 and 14 years were enrolled. Patients with nonmonosymptomatic and secondary NE were excluded from the study. A small questionnaire, filled by parents, collected information about sociodemographic characteristics. Blood was obtained for plasma AVP and copeptin concentrations. RESULTS: Copeptin levels were significantly lower in patient group (3.74 ± 1.44 pg/mL) than the control group (16.57 ± 3.91 pg/mL), whereas AVP levels were not significantly different between groups. Copeptin levels were significantly lower in patients (3.17 ± 1.15 pg/mL) who had bed-wetting 2 or more nights a week, which is considered as severe bed-wetting, than the patients (4.95 ± 1.24 pg/mL) who had bed-wetting 1 night or less than 1 night a week. CONCLUSION: This study demonstrates the presence of decreased levels of copeptin in patients with NE compared with healthy patients. AVP levels were not different between groups. To our knowledge, this is the first report assessing the relationship between copeptin and NE.