Neurological Manifestations of Pediatric Acute COVID Infections: A Single Center Experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases. MATERIALS AND METHODS: The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD). RESULTS: Of the 2530 children who underwent RT-PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0-17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%). CONCLUSION: The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children.

Evaluation of biochemical parameters in Rubus tereticaulis treated rats and its implications in wound healing.

We evaluated the effects of Rubus tereticaulis in healing process by determining the total carbonyl content, collagen synthesis, and total protein level on rat wounded tissues. Wounds were performed in the back of 54 Wistar rats, using a biopsy punch instrument with 0.6 mm in diameter. Rats were randomly divided into three groups: (i) un-treatment wounds group served as "controls", (ii) Madecassol® used as "positive control" group, and (iii) the application of topical cream of R. tereticaulis served as "treatment" group of wound healing. The animals were killed at the end of experiment under anesthesia with ketamine, and tissue samples were collected for the evaluation at three times intervals (3rd, 7th, and 14th day). The wounded areas were analyzed for total carbonyl content, collagen, and total protein levels by HPLC, ELISA, and spectrophotometric methods, respectively. Total carbonyl content in the treatment group was significantly lower in comparison with control group on 3rd day (2.839 ± 0.438 vs. 3.216 ± 0.216 nmol carbonyl/mol protein; p < 0.5) and 14th days (4.222 ± 0.128 vs. 4.784 ± 0.077 nmol carbonyl/mol protein; p < 0.05), respectively. New collagen formation on the wound sites after the initial injury was noted in the treated and positive control groups (5.310 ± 0.331 vs. 5.164 ± 0.377 mg collagen/g wet tissue) at the 3rd day than control group (2.180 ± 0.718 mg collagen/g wet tissue, p < 0.01), and in treated and positive control groups at 7th day (9.654 ± 0.201, 9.053 ± 1.062 mg collagen/g wet tissue, p < 0.01); and in treated and positive control groups at 14th day (8.469 ± 0.236, 5.631 ± 0.531 mg collagen/g wet tissue, respectively; p < 0.05) in comparison with the control group. Total protein level of samples did not change significantly between the groups. Thus, application of R. tereticaulis ameliorated the wound healing process in rats as it facilitated collagen formation through healing of the wound. Evaluating total carbonyl content by HPLC could be useful as an advance procedure for quantification of healing.

Effect of Horse-chestnut seed extract on matrix metalloproteinase-1 and -9 during diabetic wound healing.

The effects of aqueous-ethanol extract of Horse chestnut (HCE) on MMP-1 and MMP-9 expressions during cutaneous wound healing in diabetic rats were investigated in this study. The expressions of MMP-1 and MMP-9, wound closure, myeloperoxidase (MPO) activity, hydroxyproline, and malondialdehyde (MDA) levels in wound tissue were measured. Quercetin glucuronide in HCE was identified as main compound using a LC-MS/MS. The hydroxyproline level was significantly increased in the treated group versus control after the 3rd and 7th days (p < 0.05). The MDA level and MPO activity were significantly lower in the treatment group (p < 0.05). MMP-1 gene expression level in treated rats was increased in the 7th day while it was reduced in 14th day. MMP-9 gene expression level in treated rats was decreased in 7th, and 14th days compared to control (p < 0.05). These results show that HCE accelerated the cutaneous wound-healing process in diabetic rats via MMP-1 and MMP-9 regulation. PRACTICAL APPLICATIONS: The main function of MMPs is to degrade and deposite the various components of the extracellular matrix. Also, they participate physiological processes such as inflammation, angiogenesis, and tissue remodeling. Horse chestnut seeds (HC) are known to be rich in saponins and flavonoids. HC are used for the treatment of abdominal pain, stomach ache, cold, hemorrhoids, arterial stiffness, rheumatism, oedema, diarrhea, chronic venous insufficiency and also as an antihemorrhagic and antipyretic in traditional medicine. It has been shown that HC has anti-inflammatory, antioedema, vessel protective, and free radical scavenging properties. This study indicates that HCE could be an effective agent for wound healing in diabetic wound model via its ability to suppress the MMP-9 gene expression and regulates MMP-1 gene expression besides its antioxidative, anti-inflammatory effects.

Levels of Melatonin in Continuous Spikes and Waves During Sleep.

Levels of melatonin have been reported before in children with epilepsy, but such has not been reported to date in those with continuous spikes and waves during sleep. The aim of the present study was to assess serum melatonin levels and melatonin circadian rhythm in patients with continuous spikes and waves during sleep and epilepsy. Serum melatonin was measured in 39 children stratified into 3 groups. Group 1 included 15 patients with continuous spikes and waves during sleep, group 2 included 12 epilepsy patients, and group 3 included 12 controls, respectively. Blood samples were taken from all participants at 1:00 am and 9:00 am and melatonin levels were measured using a quantitative enzyme-linked immunosorbent assay test. The 9:00 am melatonin levels of group 1 were significantly decreased and pair groups were compared. The Pa value (representing a comparison between groups 1 and 2) was .002, the Pb value (representing a comparison between groups 1 and 3) was .001, and the Pc value (representing a comparison between groups 2 and 3) was .86. These findings suggest that the 9:00 am melatonin levels were significantly decreased in the comparison of groups 2 and 3. Further detailed research is necessary to determine the factors leading to the rapid decline of morning melatonin levels of children with continuous spikes and waves during sleep.

Ethanol extract of Cotinus coggygria leaves accelerates wound healing process in diabetic rats.

CONTEXT: Cotinus coggygria Scop. (Anacardiaceae) leaves that were used as wound healing in traditional Balkan and Anatolian folk medicine, could be potentially effective in treating diabetic wounds. OBJECTIVE: This study investigates biochemical and histological effects of ethanol extract of C. coggygria (CCE) on excision wound model in diabetic rats. MATERIALS AND METHODS: This study was conducted on diabetic Wistar albino rats, which were injected by a single dose (50 mg/kg i.p.) streptozotocin. Afterward an excision wound model was created in all animals; diabetic control rats were applied topically simple ointment and diabetic treatment rats were applied topically 5% (w/w) ointment with CC, once a day during the experimental period. Malondialdehyde, glutathione and hydroxyproline levels in wound tissues were investigated at the end of 3rd, 7th, and 14th days. Histopathological examination was also performed. RESULTS: Hydroxyproline content was significantly increased in the CCE treated group versus control after the 3rd and 7th days (15.33 versus 11.83; 19.67 versus 15.67 mg/g, p < 0.05; respectively). A statistically significant elevation in glutathione at the end of 3rd, 7th, and 14th days (5.13 versus 1.58, p < 0.05; 4.72 versus 1.88, p < 0.05; 3.83 versus 1.88 µmol/g, p < 0.05, respectively) and a statistically significant decrease in malondialdehyde level at the end of 7th day (4.49 versus 1.48 nmol/g, p < 0.05) were determined in the treated group versus control group. These results were also supported by histological analyses. DISCUSSION AND CONCLUSION: These findings indicate that CCE accelerated the cutaneous wound healing process in diabetic wounds, in confirmation of its traditional use.

The effect of topical ethanol extract of Cotinus coggygria Scop. on cutaneous wound healing in rats.

The aim of this study is to determine the cutaneous wound healing effects of the ethanol extract of Cotinus coggygria leaves in rats by excision wound model to provide scientific evidence for the traditional use of C. coggygria Scop. The levels of malondialdehyde, catalase, superoxide dismutase, glutathione and hydroxyproline were investigated in wound tissues. Histopathological examination was also performed. The hydroxyproline content of the granulation tissue and the glutathione levels were both significantly higher in the treatment group than in the control group (p < 0.05 for both); while the malondialdehyde levels were significantly lower in the treatment group (p < 0.05). These results were supported with histological results. The ethanol extract of C. coggygria Scop could be considered as an effective agent in wound healing in accordance with its traditional use.

Oxidative stress causes plasma protein modification.

We investigated the effect of oxidative systems on plasma proteins using Chloramine-T, a source of free radicals. Plasma specimens from 10 healthy volunteers were treated with 40 mmol/L Chloramine-T (1:1 v/v). Total protein and plasma carbonyl levels were evaluated spectrophotometrically. Identification of plasma proteins modifications was performed by SDS-PAGE, protein and lipid electrophoresis. Protein fragmentation was evaluated by HPLC. Total protein levels of oxidised plasmas were significantly lower (4.08 ± 0.12 g/dL) than control (7.86 ± 0.03 g/dL) (P < 0.01). Plasma carbonyl levels were higher (1.94 ± 0.38 nmol/mg protein) in oxidised plasma than that of control (0.03 ± 0.01 nmol/mg protein) (P < 0.01). Plasma oxidation had no significant effect on the levels of proteins and lipids. Protein fragmentations were detected in oxidised groups compared to those of the control. We conclude that protein modifications have direct effect on the protein functions, which are related to stress agent, its treatment period(s), and the methodology used for evaluating such experimental results.

Evaluation of clinical course and neurocognition in children with self-limited infantile epilepsy in a Turkish cohort study.

The outcome of children with self-limited infantile epilepsy was reported to be normal psychosocial and cognitive development as a characteristic criterion. We aimed to investigate the clinical course and neurocognitive outcome in children with self-limited infantile epilepsy in a Turkish cohort. The clinical course, electroencephalographic (EEG) characteristics, neuroimaging, treatment, and outcome of children with self-limited infantile epilepsy were retrospectively analyzed. All infants were reevaluated with the Denver Developmental Screening Test in addition to neurologic examination. Of 44 patients, self-limited familial infantile epilepsy was diagnosed in 8 infants (18.2%) and self-limited nonfamilial infantile epilepsy in 28 (63.6%). Interictal EEGs and neurologic examinations were normal in all cases. Fine motor and gross motor skills, language, adaptive personal/social skills were near-normal in all patients with self-limited familial infantile epilepsy. Delay in language parameters was observed in 2 infants with self-limited nonfamilial infantile epilepsy. Language skills should be thoroughly evaluated with detailed neurocognitive screening tests in patients with self-limited infantile epilepsy.

Determination of oxidant stress in plasma of rheumatoid arthritis and primary osteoarthritis patients.

Determination of oxidant stress in plasma of rheumatoid arthritis (RA) and primary osteoarthritis (POA) patients is important in understanding the pathogenesis of these diseases. In this study, we examined the relationship between oxidant stress and inflammation by measuring protein carbonyl content, thiol levels and plasma protein fractions as the oxidation markers and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) tests as inflammation markers. Protein carbonyls content was higher in RA and POA patients, as compared to controls (p<0.0001), while the plasma thiol levels in both groups of patients were significantly lower than controls (p<0.0001). Increased levels of proteins under 40 kDa molecular mass were detected in the RA and POA patients compared to that of controls (p<0.0001) both in HPLC and SDS-PAGE analysis. Total protein concentration in plasma of RA patients was higher than the controls (p<0.001), while in POA patients was lower than that of controls (p<0.001). ESR and CRP levels were higher in both the patient groups than the normal group (p<0.001). These results suggested that alterations in the oxidant stress markers could be the cause of inflammation in these diseases. Thus, while working for RA/POA treatment strategies, consideration of the relationship between oxidant stress and inflammation would be worth evaluating.

Erdosteine prevents colonic inflammation through its antioxidant and free radical scavenging activities.

After intracolonic administration of trinitrobenzene sulphonic acid (TNBS), Sprague-Dawley rats were treated orally either with saline or erdosteine (100 mg/kg per day), a sulfhydryl-containing antioxidant, for 3 days. On the 4th day, rats were decapitated and distal colon was removed for the macroscopic and microscopic damage scoring, for the measurement of malondialdehyde (MDA), glutathione (GSH) and collagen levels, myeloperoxidase (MPO) activity, luminol and lucigenin chemiluminescence (CL) and DNA fragmentation. Lactate dehydrogenase (LDH) activity, tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, and antioxidant capacity were assayed in blood samples. Colitis caused significant increases in the colonic CL values, macroscopic and microscopic damage scores, MDA and collagen levels, MPO activity and DNA fragmentation, along with a significant decrease in tissue GSH level. Similarly, serum cytokines and LDH were elevated in the saline-treated colitis group as compared with the control group. On the other hand, erdosteine treatment reversed all these biochemical indices, and histopathologic alterations induced by TNBS, suggesting that erdosteine protects the colonic tissue via its radical scavenging and antioxidant activities.

Chemometric determination of naproxen sodium and pseudoephedrine hydrochloride in tablets by HPLC.

A new chemometric determination by high-performance liquid chromatography (HPLC) with photodiode array (PDA) detection was implemented for the simultaneous determination of naproxen sodium and pseudoephedrine hydrochloride in tablets. Three chemometric calibration techniques, classical least squares (CLS), principle component regression (PCR) and partial least squares (PLS) were applied to the peak area at multiwavelength PDA detector responses. The combinations of HPLC with chemometric calibration techniques were called HPLC-CLS, HPLC-PCR and HPLC-PLS. For comparison purposes the HPLC method called the classic HPLC method was used to confirm the results obtained from combined HPLC-chemometric calibration techniques. A good chromatographic separation between two drugs with losartan potassium as an internal standard was achieved using a Waters Symmetry C18 Column 5 microm 4.6+/-250 mm and a mobile phase containing 0.2 M acetate buffer and acetonitrile (v/v, 40:60). The multiwavelength PDA detection was measured at five different wavelengths. The chromatograms were recorded as a training set in the mobile phase. Three HPLC-chemometric calibrations and the classic-HPLC method were used to test the synthetic mixtures of naproxen sodium and pseudoephedrine hydrochloride in the presence of the internal standard. The HPLC-chemometric approaches were applied to real samples containing drugs of interest. The experimental results obtained from HPLC-chemometric calibrations were compared with those obtained by a classic HPLC method.