Oxidative stress parameters in children with acute rheumatic fever.

BACKGROUND: The aim of this study was to investigate of the role of oxidative stress (OS) in acute rheumatic fever (ARF) and its relationship with the progress of the disease. METHODS: Thirty patients with ARF and 31 age-sex-matched healthy children were enrolled in this study. Serum malondialdehyde (MDA), protein carbonyl (PCO), high-sensitivity C-reactive protein (hs-CRP), cytokines (tumor necrosis factor-α and interleukin-6) and total antioxidant capacity (TAC) were measured. The diagnosis of ARF was based on the Jones criteria. RESULTS: Patients with ARF had significantly higher serum MDA, PCO, hs-CRP and cytokine levels and lower TAC than healthy controls. On Pearson's correlation analysis we found that oxidative stress markers were positively correlated with hs-CRP and cytokines, while TAC was negatively correlated with MDA, PCO, hs-CRP and cytokines. The number of valves involved as well as the level of mitral valve involvement was also significantly related to the oxidative stress parameters and TAC. All oxidative stress parameters decreased significantly with anti-inflammatory therapy while TAC increased. CONCLUSION: Malondialdehyde and PCO, as biomarkers, as well as hs-CRP together with the other available diagnostic tools, can be used in the evaluation of patients with ARF.

Seropositivity of Hepatitis A in Children Aged 7-14 Years in Diyarbakir Province Center.

BACKGROUND Hepatitis A virus (HAV) is a common morbidity in society, and mortality is more common in older ages. It is important to identify the prevalence in the population, the development of primary protection methods, and vaccination policies. This study aimed to identify anti-HAV seropositivity in children in 3 different schools in Diyarbakir, Turkey, to evaluate the risk factors influencing prevalence, and thus to develop strategies to prevent infection. MATERIAL AND METHODS The study was a prospective investigation of 600 children with a mean age of 10.5 years (range, 7-14), including 291 males and 309 females. RESULTS The seropositivity was 45.7% (41.2% in males and 49.8% females) with a statistically significant difference by sex (p=0.042). It was also significantly correlated with age. Factors significantly associated with seropositivity were educational level and income of parents, number of rooms in the house, type of toilet, number of siblings, and source of drinking water. Hence, older age, more siblings, crowded household, and low socioeconomic level are risk factors for seropositivity. CONCLUSIONS Protection strategies for the disease include improving socioeconomic level, increasing the level of education, disseminating appropriate drinking water, improving infrastructure and sewage disposal, and public health education on hygiene and the importance of vaccination. We also believe that active immunization against HAV in Turkey in general and in our province in particular can prevent infection in children and related complications in older people.

Evaluation of Heavy Metal (Lead, Mercury, Cadmium, and Manganese) Levels in Blood, Plasma, and Urine of Adolescents With Aggressive Behavior.

Background Heavy metals can cause health problems by affecting the biological structure even at very low concentrations. Asymptomatic heavy metal poisoning causes non-specific symptoms such as behavioral disorders, difficulty in learning, and aggressive behaviors. There is also a great concern about the incidence of aggressive behavior among adolescents. A few research studies have concluded that a complex interaction or combination of factors leads to an increased risk of aggressive behavior in adolescents. This study aims to determine the correlation between the heavy metal levels in blood, plasma, and urine and the aggression level in adolescents. Materials and methods Two hundred twenty-eight adolescents between the ages of 13 and 19 were enrolled in the study. Blood, plasma, and urine heavy metal levels of the participants were measured by an inductively coupled plasma mass spectrometer (ICP-MS) device (Model 7700x; Agilent, Santa Clara, CA, USA). Buss and Perry's aggression questionnaire was used to investigate the correlation between heavy metals and aggressive behaviors in adolescents. Results Lead blood (r=0.34, p<.01), lead plasma (r=0.22, p<0.01), lead urine (r=0.31, p<.01), mercury blood (r=0.35, p<0.01), mercury urine (r=0.21, p<0.01), manganese blood (r=0.34, p<0.01), manganese plasma (r=0.33, p<0.01) and manganese urine (r=0.39, p<0.01) were positively correlated with tendency to aggression whereas no significant relationship was found between cadmium in blood, plasma, urine and mercury in plasma with aggression. Conclusion The study showed valuable data to associate a significant relationship between adolescents' aggression levels and heavy metals. There is an undeniable relationship between the health of adolescents and environmental pollution caused by heavy metals. Therefore, taking the necessary measures to prevent environmental heavy metal pollution is crucial for adolescent health.

[A retrospective investigation of clinical and laboratory findings in children with acute rheumatic fever, reactivation and compliance with prophylaxis]. / Akut romatizmal atesli çocuklarda klinik ve laboratuvar bulgularin geriye dönük olarak incelenmesi: Reaktivasyon ve koruyucu tedaviye uyumunun arastirilmasi

OBJECTIVES: We aimed to retrospectively investigate the patients with acute rheumatic fever (ARF) by evaluating their clinic and laboratory properties, echocardiographic findings as well as the reactivation and the compliance to penicillin prophylaxis. STUDY DESIGN: The study involved 255 patients (143 boys, 112 girls; mean age 10.1±2.7 years) with ARF. Their sex, age, clinic and laboratory properties, echocardiographic findings, the reactivation and the compliance to penicillin prophylaxis were recorded. RESULTS: Patients spent 13.3±4.3 days in the hospital, and 94 had a history of ARF. Arthritis was found in 233 patients, carditis in 166, Sydenham's chorea in 14, subcutaneous nodule in 2, and arthritis-carditis in 151 patients. Erythema marjinatum was not found in any patient. Arthralgia (n=15) and fever (n=246) were found in patients. Throat culture was positive in 94 patients and anti-streptolysin-O titers were high in 124 patients. Mitral involvement was found in 205 patients while the combination of mitral and aortic valve involvement were observed in 118 patients. CONCLUSION: ARF still continues to be a major public health problem in our country. A bad prognosis may be prevented by early diagnosis and treatment. The importance of appropriate prophylaxis should also be emphasized.

Antibiotic Susceptibility of Microorganisms Grown in Tracheal Aspirate Cultures of Pediatric Intensive Care Patients.

Background Microorganisms proliferating in the hospital setting cause infections with high morbidity and mortality rates. In intensive care units (ICUs), the rates of antibiotic resistance and microorganisms grown in cultures may vary by time period. Antibiotic sensitivity must be known for a correct empirical treatment approach. This study aimed to investigate the distribution and antibiotic resistance profiles of pathogenic microorganisms isolated from tracheal aspirate samples in the ICU. Methodology This study enrolled 100 tracheostomized patients aged one month to 18 years, regardless of gender, who were followed in the ICU of Dicle University for more than 72 hours. Medical data were retrospectively evaluated from the medical records. Care was taken to collect samples before changing antibiotics. Antibiotherapy was continued until after culture antibiogram results were obtained, or empirical antibiotic therapy was started by giving consideration to the potential source in patients with a suspected infection. Results An analysis of the tracheal aspirate culture samples of the patients showed that Pseudomonas aeruginosa (54%), Acinetobacter baumannii (16%), and Staphylococcus aureus (8%) were the most common pathogens. An analysis of the culture antibiogram results of the tracheal aspirate samples obtained from the entire study population showed that P. aeruginosa was 100% resistant against vancomycin, clindamycin, and teicoplanin, but highly sensitive to colistin and amikacin. A. baumannii was highly resistant to almost all antibiotics but showed no resistance against colistin. Carbapenems being frequently preferred for cases where empirical therapy should be initiated for ICU infections can be one of the reasons for a high carbapenem resistance rate in our hospital. Conclusions We believe that starting empirical therapy with colistin when infections caused by Pseudomonas and Acinetobacter are suspected may be an appropriate initial therapy until culture antibiogram results become available. Microbiological data are crucial for a correct empirical treatment approach. In this way, intensive antibiotic usage and subsequent high antibiotic resistance can be adequately controlled.

Evaluation of Hematological Parameters of Children Diagnosed with COVID-19: Single-Center Experience.

OBJECTIVE: Although many pediatric studies on children infected with coronavirus disease 2019 (COVID-19) have been published, the diagnosis, clinical symptoms, laboratory findings, and treatment of COVID-19 in children are still unclear. MATERIALS AND METHODS: This study was conducted with an aim to examine the hematological findings of symptomatic pediatric patients diagnosed with COVID-19 in May 2020 at the Pandemic Hospital in Dicle University. Patient records were evaluated retrospectively. This study involved 59 symptomatic pediatric patients with a definite diagnosis of COVID-19 who had positive SARS-CoV-2 RT-PCR test results on nasopharyngeal swab between March 15, 2020 and May 31, 2020. RESULTS: The records of a total of 10 (16.9%) patients under the age of 1; 21 (35.6%) patients aged 1-10 years, and, 28 (47.5%) patients aged 10-18 years, who had been diagnosed with COVID-19 were evaluated. Based on severity, 35 (59.3%) patients were in the mild group (group 1) and 24 (40.7%) patients were in the moderate-severe group (group 2). The blood parameters of WBC, neutrophil, lymphocyte, monocyte, and thrombocyte counts, the hemoglobin (Hgb) level, and NLR, PLR, MPV, fibrinogen, ferritin, and D-dimer levels were compared between groups, the difference was not statistically significant (P > .05). LDH was higher in group 2 (P = .014). CONCLUSION: Since children infected with COVID-19 show mild clinical symptoms or are asymptomatic, fewer pediatric patients may be detected than adults. Therefore, it should be known that the laboratory findings typical for adults may not accompany the disease in pediatric cases. More studies are needed to determine the most appropriate COVID-19 treatment approach for children, as hospitalization history and testing rates are less reported among children.

Cardiac thrombus developing after an accidental high-voltage electric shock in a child.

Electric shock is a condition that may affect various organ systems and potentially cause death. Cardiac findings vary from asymptomatic mild injury to fatal myocardial involvement. Herein we present a five-year-old boy with a cardiac thrombus developing after an accidental electrical shock. Cardiac arrhythmias and evidence of ischemia have been reported after electric shock; we were, however, unable to identify an earlier case report of intracardiac thrombosis related to electric shock. Findings such as elevated cardiac enzymes and systolic dysfunction, which indicate myocardial damage following electric shock, were present in our patient. We think that the cardiac thrombus might have resulted from the myocardial damage and the slowed intracardiac blood flow related to systolic dysfunction. As the thrombus was thought to have been formed through known mechanisms, it was treated traditionally. However, further data regarding the etiology and management of such thrombi is needed.

ST-segment elevation following lightning strike: case report and review of the literature.

Lightning strikes may cause injury to the heart, ranging from slight electrocardiographic changes to fatal damage. As heart injury is the most important cause of mortality in these patients, cardiac monitoring is crucial. Even though various ECG changes have been reported, published data on pathologic ST-segment changes is scarce. Herein, we present a seven-year old patient with ST-segment elevation following a lightning strike. There is not sufficient data regarding lightning-related myocardial ischemia. However, because of the similar effects of lightning strikes and high-voltage electric shocks, we believe myocardial injury related to lightning may be managed in the same manner as is cardiac involvement associated with electric shock.