Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: a comparative study about the hidden part of the iceberg.

Chest pain in adolescents is rarely associated with cardiac disease. Adolescents with medically unexplained chest pain usually have high levels of anxiety and depression. Psychological stress may trigger non-cardiac chest pain. This study evaluated risk factors that particularly characterise adolescence, such as major stressful events, in a clinical population. The present study was conducted on 100 adolescents with non-cardiac chest pain and 76 control subjects. Stressful life events were assessed by interviewing patients using a 36-item checklist, along with the Children's Depression Inventory and Spielberger's State-Trait Anxiety Inventory for children, in both groups. Certain stressful life events, suicidal thoughts, depression, and anxiety were more commonly observed in adolescents with non-cardiac chest pain compared with the control group. Moreover, binary logistic regression analysis showed that trouble with bullies, school-related problems, and depression may trigger non-cardiac chest pain in adolescents. Non-cardiac chest pain on the surface may point to the underlying psychosocial health problems such as depression, suicidal ideas, or important life events such as academic difficulties or trouble with bullies. The need for a psychosocial evaluation that includes assessment of negative life events and a better management have been discussed in light of the results.

Brain natriuretic peptide: the reason of respiratory distress is heart disease or lung disease?

OBJECTIVES: The aim of this study was to determine whether plasma levels of amino-terminal brain natriuretic peptide (BNP) could differentiate between heart failure and lung disease among infants with acute bronchiolitis. METHODS: Sixty-eight infants (age range, 1-26 months; median age, 5.9 ± 5.0 months) who presented with respiratory distress underwent physical examination, plasma BNP measurement, and echocardiography within 24 hours after admission. Nineteen (28%) patients had congenital heart disease. The control group was consisted of 30 healthy infants. RESULTS: Although mean plasma BNP levels were 118.9 ± 219.5 pg/mL in patients with isolated bronchiolitis (n = 49), it was 841.2 ± 1475.8 pg/mL in patients with congenital heart disease (n = 19). Plasma BNP levels were significantly higher in infants with congenital heart disease (P = .001). CONCLUSION: It was shown that plasma BNP levels were affected much more in cardiac disease rather than lung disease. Among infants with respiratory distress, plasma BNP measurements can differentiate congenital heart disease and lung disease and can be used to monitor the effects of treatment for infants with heart failure. RESPONSE TO REVIEWERS: The comments were taken for consideration. The patient groups control BNP levels were attached to the results. As it was a clinical study and multiple factors (respiratory score, respiratory rate, treatment, etc) may effect on BNP levels, the tables could not be decreased to 1 table.

Bullous skin lesions in a jaundiced infant after phototherapy: a case of congenital erythropoietic porphyria.

Congenital erythropoietic porphyria is a rare autosomal recessive disorder of porphyrin metabolism in which the genetic defect is the deficiency of uroporphyrinogen III cosynthase (UIIIC). Deficiency of this enzyme results in an accumulation of high amounts of uroporphyrin I in all tissues, leading to hemolytic anemia, splenomegaly, erythrodontia, bone fragility, exquisite photosensitivity, and mutilating skin lesions. We discuss a female infantile case who was admitted for jaundice; bullous lesions appeared on her trunk during phototherapy in the neonatal period. The skin biopsy findings were consistent with epidermolysis bullosa. Due to persistent hepatosplenomegaly and cholestasis, metabolic tests and liver biopsy were performed. During the follow-up, hemolytic anemia and red urine were detected. The levels of porphyrin metabolites were determined at high concentrations in plasma, stool and urine analysis, which were suggestive of congenital erythropoietic porphyria.

Anomalous origin of the left coronary artery from the pulmonary artery presenting as dilated cardiomyopathy.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly and one of the causes of myocardial ischemia. It often presents with atypical signs and symptoms, especially in childhood. In this case report, an 11-year-old girl presented with dilated cardiomyopathy in our clinic and was followed for five years. Echocardiography showed multiple left-to-right shunts on the interventricular septum, the confirmation of which was done by multi-slice computed tomography and coronary angiography. Therefore, we suggest that ALCAPA should be suspected in young patients diagnosed with dilated cardiomyopathy.

The assessment of thoracal approaches in the treatment of aortic coarctation.

OBJECTIVES: The optimal choice of surgery in coarctation of the aorta (CoA) remains controversial but it needs to be individualised. However, in most conditions, a surgical approach through thoracotomy maintains adequate exposure to create aortic patency. This study aimed to assess the efficiency and reliability of thoracal approaches in the treatment of CoA by examining the mid- and late-term outcomes, and determining the predictive factors for re-intervention. METHODS: Patients who underwent CoA repair through thoracotomy between September 2015 and February 2023 were included in the study, except for those with complex cardiac diseases. Medical records were retrospectively analysed and peri-operative course, follow-up findings on echocardiogram and physical examinations were obtained. The complication rate, postoperative arch gradient, need for antihypertensive medication use, and freedom from re-intervention were evaluated and then compared in terms of age at surgery. RESULTS: Overall, 98 patients including 50 neonates were reviewed. The most common surgical method was extended end-to-end anastomosis, performed in 53 patients. The median follow-up time was 4.6 years. There was one death in hospital and one late mortality in the cohort. Eight complications were observed in the cohort but all recovered well. Overall, 13 re-interventions, six redo surgeries and seven balloon angioplasties were carried out in 12 patients. Ten of the re-interventions were carried out within the first year of the initial surgery. One- and three-year freedom from re-intervention rates were 89.5 and 86.4%, respectively. However, there was no significant predictive factor for re-intervention. Comparisons according to the age at surgery did not differ, except for intensive care unit stay. The need for hypertensive medication was initially in 14 (14.2%) patients and then reduced to eight (8%) patients. The mean peak residual gradient on postoperative examination was 9 mmHg. CONCLUSION: Thoracotomy provided feasible surgical access that led to satisfactory results with a low complication rate, negligible residual gradient, low incidence of hypertension and excellent rate for freedom from re-intervention in the treatment of CoA.

A case of mitral papillary muscle rupture due to blunt chest trauma.

Mitral regurgitation due to papillary muscle rupture after blunt chest trauma is uncommon. Sudden onset severe mitral regurgitation may lead to death due to heart failure if surgical repair is delayed. A previously healthy 12-year-old girl underwent splenectomy and chest tube insertion for pneumothorax after a traffic accident in a vehicle 15 days before. She was discharged from the hospital after a nine-day follow-up. She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized. Transthoracic echocardiogram showed severe mitral regurgitation with freely moving posterior mitral chordae and prolapse of the posterior mitral valve leaflet. She received reimplantation of the complete ruptured posteromedial papillary muscle of the mitral valve. Her medical condition improved after the operation. On the postoperative echocardiogram, the left ventricular systolic function was normal with no mitral regurgitation.

[Different surgical approaches to Scimitar syndrome]. / Scimitar sendromuna farkli cerrahi yaklasimlar.

Scimitar syndrome is a rare congenital heart defect characterized by the combination of vascular, bronchial, and parenchymal malformations. This syndrome includes anomalous right pulmonary venous drainage to the inferior caval vein, hypoplastic right pulmonary artery, right lung hypoplasia and the presence of aortopulmonary collaterals to the right lung. In this study, we evaluate the different surgical approaches of 3 cases with Scimitar syndrome who was corrected successfully.

An unusual case of acute rheumatic fever presenting with unilateral pulmonary edema.

The differential diagnosis of acute rheumatic fever (ARF) in children, especially those younger than five years, may be difficult, even with strict application of the updated Jones criteria. They are likely to present with atypical symptoms that can mimic various conditions. Herein we report a 27-month-old girl with ARF presenting unilateral pulmonary edema secondary to severe mitral regurgitation. Taking into account atypical clinical presentations in these younger ARF patients will prevent the delay in the diagnosis and will have an impact on treatment to reduce morbidity and mortality of the disease.

Accuracy of prenatal diagnosis of congenital heart disease with fetal echocardiography.

OBJECTIVE: To study the diagnostic value of fetal echocardiography in detecting congenital heart disease (CHD) during the prenatal period. METHODS: One hundred and ninety-seven pregnant women with a high risk of prenatal CHD of their fetuses were included in this study. The fetal heart was scanned with echocardiography, performing complete evaluation of the cardiac system. The prenatal echocardiographic findings were correlated with postnatal echocardiography results or autopsy findings, if the pregnancy was terminated or the fetus died in utero. RESULTS: 10 of the 197 fetuses showed CHD by fetal echocardiography, whereas postnatal echocardiography and postmortem examination revealed cardiac abnormalities in 21 patients. Of those, 7 (41.1%) had the most common referral indication, i.e., cardiac abnormality, found on routine ultrasound examination. Specificity and sensitivity of fetal echocardiography for cardiac abnormalities were found to be 98 and 42%, respectively. The positive predictive value of echocardiography was 90% and the negative predictive value 93%. CONCLUSIONS: We conclude that fetal echocardiography is a reliable tool for prenatal diagnosis in experienced hands. Pediatric cardiologists should be more aware while performing fetal echocardiography in patients referred by obstetricians for CHD.

Pretransplant Stable Systolic Cardiac Functions Play an Important Role in Short-term Systolic Cardiac Functions After Kidney Transplant in Children.

OBJECTIVES: In this study, our aim was to evaluate the systolic cardiac parameters and related risk factors in children within 6 months after kidney transplant. MATERIALS AND METHODS: We retrospectively evaluated 24 children who received kidney transplants. Clinical and laboratory parameters before and after transplant were recorded. Results were evaluated statistically, with a P value less than .05 considered significant. RESULTS: Before transplant, systolic cardiac functions were within normal limits. After transplant, ejection fraction (63.35% ± 5.38% vs 66.95% ± 4.62%; P = .01) was significantly increased and left ventricular mass index (32.63 ± 17.21 g/m2.7 vs 31.29 ± 15.65 g/m2.7; P = .78) was not significantly decreased, whereas fractional shortening (52.16% ± 15.32% vs 59.8% ± 12.94%; P = .54) did not change. Systolic blood pressure, systolic blood pressure index, diastolic blood pressure, and diastolic blood pressure index values were not statistically different before and after transplant (P > .05). The number of antihypertensive agents was significantly decreased (P = .001). Before and after transplant, cardiac geometry was normal in 15 patients (62.5%) and 17 patients (70.8%). CONCLUSIONS: Our patients, who had stable systolic cardiac function before transplant, showed further improvements in systolic cardiac function even within 6 months after transplant. Therefore, strictly monitored and controlled blood pressure, volume, anemia, and nutrition in children before transplant may play important roles in achieving better cardiac systolic function after kidney transplant.

[Preliminary results of interferon alpha-2a and lamivudine combination therapy regimen in children with chronic hepatitis B]. / Kronik hepatit B tanisi alan çocuklarda interferon-alfa 2a ve lamivudin kombinasyonu tedavisinin erken dönem sonuçlari.

The combination therapy regimen of interferon (IFN)-alpha and lamivudine (LAM), a nucleoside analogue, is lately in use in chronic hepatitis B (CHB) infections. The aim of this study was the evaluation of the efficacy of IFN-alpha 2a and LAM combination therapy in children with CHB infection. Twenty-seven cases (mean age 10.4 +/- 3.7 years, 20 males) who were followed up between 2002 and 2005 in Pediatric Gastroenterology Department, were included in the study. IFN-alpha 2a (5 MU/m2 SC, three times a week for 6 months) and LAM (4 mg/kg/d PO, maximum 100 mg/d for one year) were given simultaneously. LAM medication was extended to two years in non-responders. Alanine aminotransferase (ALT) levels, hepatitis markers and HBV-DNA were monitored once in three months. "Partial" response was defined as normal levels of ALT and negative HBV-DNA, and "complete" response was defined as seroconversion of HBeAg/anti-HBe. The cases whose HBV-DNA not getting negative and whose ALT levels did not decrease to the normal values were defined as "non-responders". In our study, one case (4.3%) was found non-respondant, "partial" response was seen in 13 (56.5%) cases, whereas "complete" response was seen in 9 cases (39.1%) out of 23 cases who have got the medications as long as a year. There was no significant difference between the response to the therapy regimen and the age, sex, ALT levels, hepatic activity indices (HAI) and HBV-DNA levels (p>0.05). As a result, IFN-alpha 2a and LAM combination therapy regimen is an effective alternative therapy in childhood, and the efficacy of the therapy was not influenced by age, sex, initial ALT levels, HBV-DNA and HAI in our study group.

A Comparison of Bladder Catheterization and Suprapubic Aspiration Methods for Urine Sample Collection From Infants With a Suspected Urinary Tract Infection.

This study compares 2 sampling methods for urine cultures in young infants. We analyzed data on urine samples obtained from 83 infants using 2 sources of urine: suprapubic bladder aspiration (SPA) and bladder catheterization. All specimens were subjected to both urinalysis and culture, and the results compared. Eighty-three infants with positive urine culture results obtained by bladder catheterization were subjected to SPA. Of these, only 24 (28.9%) and 20 (24%) yielded positive urine culture and abnormal urinalysis data, respectively. Samples obtained via catheterization had a high false-positive rate (71.1%). The sensitivity and specificity of urinalysis were 66.7% (95% CI, 44.68% to 84.33%) and 93.22% (95% CI, 83.53% to 98.08%), respectively. In infants younger than 12 months, SPA is the best method to avoid bacterial contamination, showing better results than transurethral catheterization.

The subclinical effect of celiac disease on the heart and the effect of gluten-free diet on cardiac functions.

This study aimed to investigate the effects of celiac disease (CD) on cardiac function in children by using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Forty-nine patients diagnosed with CD were enrolled into the study. Group 1 consisted of 26 (53%) patients who had recently been diagnosed and had not been on gluten-free diet whereas Group 2 consisted of 23 (47%) patients who had been on regular gluten-free diet for at least 10 months. 20 healthy children were enrolled into the study as the control group. The deceleration time (DT) and the left ventricle (LV) isovolumetric relaxation time (IVRT) were significantly shorter in Group 1 compared to Group 2 and the control group (p=0.002, p=0.015). Mitral valve E/E' ratio was significantly lower in Group 1 and 2 when compared to the control group (p < 0.001). The study demonstrated that evaluation of these parameters by using TDE could be beneficial in the early diagnosis of cardiac involvement in children with CD.

Abusive head trauma: two case reports.

Abusive head trauma is a serious form of child abuse and mostly seen in infants below the age of two years as a result of a strong shaking by the caregiver who aims to stop the infant's crying. Characteristic symptoms include subdural hematomas, encephalopathy, retinal hemorrhages and fractures of the long bones. When physically examined, there are generally no externally visible signs. For this reason, it can be underdiagnosed, if it is not considered in the differential diagnosis. When the information provided from the parents is inconsistent and contradictory with the clinical picture of the patient, this form of abuse must be suspected and retinal hemorrhages should be searched. In this article, two patients who were admitted to our emergency department and diagnosed with physical child abuse are reported. One of these patients had a history of minor head trauma after falling down from the sofa and the other one had a history of breathlessness and loss of consciousness as a result of excessive crying.

The mechanical properties and stiffness of aorta in obese children.

Obesity in children has also been associated with the development of early cardiovascular abnormalities. The aim of this study was to investigate the relationship between aortic stiffness and some risk factors in obese children. Sixty obese children and 60 age- and sex-matched healthy controls were assessed. The mechanical property parameters were measured or computed: lumen diastolic and systolic diameters, aortic strain and elastic modules. Compared to controls, obese children had altered stiffness values of the aorta, whereas strain was not different. Compared to controls, obese children had higher systolic and diastolic blood pressure values. Insulin level, homeostasis model assessment (HOMA) score, and total cholesterol, triglycerides, lowdensity lipoprotein (LDL), and leptin levels were significantly higher, while adiponectin, high-density lipoprotein (HDL) levels and quantitative insulin sensitivity check index (QUICKI) scores were significantly lower in obese children than in controls. Obesity in children increases aortic stiffness, which suggests that the joint effect of insulin resistance, serum leptin and adipokine levels and obesity can have a considerable impact on preclinical arterial changes and could play an important role in the early pathophysiology of macrovascular disease.