Evaluation of epicardial adipose tissue in children with type 1 diabetes.

INTRODUCTION: Epicardial adipose tissue (EAT), the visceral fat surrounding the heart between the myocardium and visceral pericardium, intersects with Type 1 diabetes (T1D). This review aims to elucidate the intricate association between EAT and childhood T1D. MATERIALS AND METHODS: In this retrospective study, two pediatric groups were involved children with type 1 diabetes, and healthy children. Epicardial fat thickness was measured appropriately, and the study documented HbA1c levels and time to diabetes diagnosis for comprehensive analysis. RESULTS: Encompassing 51 children with T1D and 69 healthy controls, revealed that children with type 1 diabetes had a mean HbA1c level of 9.4 ± 0.2, and a mean insulin dose of 0.94 units/kg/day. Epicardial adipose tissue (EAT) values were significantly higher in the Type 1 DM group. It has been shown that epicardial fat thickness may have a specific and sensitive value in type 1 diabetics. DISCUSSION: The increased presence of epicardial fat tissue in children with type 1 diabetes is highlighted, prompting the consideration of various mechanisms. However, the complexity of this relationship underscores the need for further studies to provide a more comprehensive understanding of the underlying factors. Ongoing research in this area is crucial for advancing our knowledge and potential therapeutic interventions. IMPACTS: Cardiac complications are one of the most important causes of morbidity and mortality in people with type 1 diabetes. Being able to detect cardiological complications of diabetes at an early stage contributes to morbidity. We found that epicardial fat tissue thickness was thicker in children with type 1 diabetes than in healthy children. Epicardial fat tissue thickness may be associated with poor control in children with type 1 diabetes and maybe a guide in terms of cardiac risks.

A Comparative Analysis of Pediatric Emergency Department Admissions Before and During the COVID-19 Pandemic.

Objectives This study aims to evaluate the outbreak's impact on emergency services, with findings obtained from patients who applied to our pediatric emergency service before and during the pandemic period. Methods In this study, the Pediatric Emergency Polyclinic of Hatay Mustafa Kemal University (MKU) Department of Pediatrics was evaluated during the COVID-19 pre-pandemic period and the COVID-19 pandemic period. Demographic features, complaints, discharge situations, diagnostic groups, and diagnoses of 16,730 non-traumatic patients one month to 18 years old were compared retrospectively. Results Comparing the pre-pandemic period and the pandemic period, it was determined that there was a statistically significant difference in the average age of patients, age groups, admission hours, triage classification, complaints, and diagnoses seen. Conclusion According to the findings obtained in the study, pediatric emergency department admissions decreased significantly during the pandemic period. As a result of the pandemic measures taken, the incidence of diseases caused by infectious agents, such as respiratory tract infections, decreased. The change in pediatric emergency service habits with the pandemic highlights the importance of conducting more comprehensive epidemiological studies in terms of more efficient and effective use of pediatric emergency health services in Turkey.

The effect of full blood count and cardiac biomarkers on prognosis in carbon monoxide poisoning in children.

AIMS: In this study, cardiac biomarkers, blood parameters, electrocardiography (ECG), and echocardiography were investigated in children with carbon monoxide (CO) poisoning, and the diagnostic value of these parameters was investigated. METHODS: The demographical, clinical, and laboratory data of children aged 0-18 years who were admitted to the pediatric emergency department due to CO poisoning between January 2019 and January 2022 were retrospectively scanned from medical records. The patients were divided into two groups as troponin-I positive and troponin-I negative. RESULTS: There were 107 children aged 0-18 years (average age, 10.46 ± 5.77 years; 51% female) with CO poisoning. There were 13 patients with troponin-I positive myocardial injury. Troponin-I was positive in 3 patients whose carboxyhemoglobin (COHb) level was below 2% at the time of admission. In one patient, troponin-I, which was normal at admission, increased by the 24th hour of hospitalization. Hyperbaric oxygen therapy was given due to headache in one patient, although the COHb level of that patient was below 25%. An NT-proBNP level of ≥ 219.5 ng/L predicted the development of troponin-I positivity with a sensitivity of 70% and a specificity of 86.7% (AUC, 0.967 (0.58-0.994); p = 0.017). White blood cell (WBC), neutrophil, neutrophil-to-lymphocyte ratio (NLR), immature granulocyte (IG), and IG% levels were found to be significantly higher in the troponin-positive patient group. DISCUSSION AND CONCLUSION: NT-proBNP has been shown to be an early diagnostic marker for myocardial dysfunction. Additionally, when cardiac markers are not available, full blood parameters may assist clinicians for patient treatment and referral.

Evaluation of thymic dimensions in patients with multisystem inflammatory syndrome.

BACKGROUND: Multisystem inflammatory syndrome (MIS-C) is the most important complication of COVID-19 in the pediatric population. Unfortunately, this problem is an unpredictable situation in patients with COVID-19. We aimed to evaluate the effects of MIS-C on thymus dimensions in pediatric patients. METHODS: We retrospectively analyzed the files of 368 pediatric patients aged 2-18 years, who were diagnosed with COVID-19. Computer Tomography (CT) images of 22 patients diagnosed with COVID-19 and 10 patients diagnosed with MIS-C were evaluated in detail by two board-certified radiologists. Eighteen age and sexmatched patients who applied to the emergency department of our hospital for any reason and had a CT scan for any reason were selected as the control group. The data of both groups were statistically compared. RESULTS: Considering the differences between the groups in terms of laboratory data, monocytes, hemoglobin, and platelet were significantly lower in the MIS-C group than the other groups. Procalcitonin, C- reactive protein, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proBNP levels were statistically significantly higher in the MIS-C group compared to the other groups Regarding the differences in thymus dimensions, thymus AP diameter, transverse diameter, length, thickness, and volume were significantly higher in the MIS-C group than in the other groups There was a significant positive correlation between the transverse diameter of the thymus and CRP, procalcitonin, pro-brain natriuretic peptide (proBNP), and NLR levels. CONCLUSIONS: Our study shows that thymus dimensions and acute phase reactants are higher in pediatric patients in the MIS-C group. Also, thymus transverse diameter, thymus thickness, and PLR values pose a risk for the development of MIS-C. More research is needed on the role of the thymus gland in the pathogenesis and diagnosis of MIS-C.

Evaluation of Pulmonary Functions After Discharge in Pediatric Patients with COVID-19: A Prospective Study.

Objectives: The aim of this study was to investigate the pulmonary function of pediatric patients with COVID-19 after recovery. Methods: Pediatric patients aged 5-18 years hospitalized with diagnoses of COVID-19 and discharged with recovery were included in this prospective study. Pulmonary function tests (PFTs) were performed through spirometry. Results: The patient group consisted of 34 children and the control group of 33. The forced vital capacity (FVC%) values of the control and patient groups were 110.62±11.71 and 94.21±13.68 (p<0.001), forced expiratory volume in the first second (FEV1%) values were 104.91±6.26 and 98.67±14.93 (p=0.032), FEV1/FVC% values were 108.50±8.81 and 101.06±24.89 (p=0.034), and forced expiratory flow (FEF) 25-75% values were 106.71±6.68 and 101.85±24.89, respectively (p=0.286). However, Spearman correlation analysis revealed moderate negative correlation between length of hospital stay and FEF 25-75% (r=-0.364, p=0.35). Conclusion: PFTs in pediatric patients after recovery from COVID-19 were abnormal in the present study. The results were significant in terms of the development of mixed-type lung disease. Further long- and short-term studies are now needed for a better understanding of the prognosis in these patients.

Evaluation of cases with infantile hemangioma requiring treatment.

AIM: Infantile hemangiomas are the most common benign vascular tumours in infants. In this study, we aimed to evaluate the effectiveness of propranolol therapy in patients with infantile hemangioma.

Oral health experiences of Turkish children with acute rheumatic fever or rheumatic heart disease.

Purpose: Children with acute rheumatic fever (ARF) or using depot-penicillin because of rheumatic heart disease (RHD) are prone to the risk of infective endocarditis (IE) and poor oral hygiene. This cross-sectional study aimed to investigate oral health experiences of a group of healthy children and a group of children with ARF or who were using depot-penicillin because of RHD (study group). Materials and methods: Medical and dental data of 86 children aged between 5-12 years were investigated in this study. Medical histories, decayed, missing, and filled teeth, plaque index, gingival index, toothbrushing frequencies, and the study and healthy groups' socioeconomic levels were recruited and examined. Results: The 'dmft' of the study and healthy groups were found to be 5.51±3.81 and 2.37±2.31, respectively, while the 'DMFT' of the study and healthy groups were 1.71±2.28 and 1.06±1.59, respectively. There was no significant difference between the gingival indexes of the study group 0.89±0.39 and the healthy group 0.62± 1.03 (p=0.112). Nevertheless, the groups significantly differed regarding the plaque index, which were 0.87±0.40 and 0.45±0.41, respectively (p<0.001). The tooth brushing frequencies in the study and healthy groups being twice a day or more were 23.3% and 46.5%, respectively. Conclusion: The children with ARF or using depot-penicillin because of RHD had more permanent and primary tooth caries and poorer oral health than the healthy group in this study.

Clinical, biochemical, and echocardiographic evaluation of neonates with vitamin D deficiency due to maternal vitamin D deficiency.

OBJECTIVE: There are a few number of case reports and small-scale case series reporting dilated cardiomyopathy due to vitamin D-deficient rickets. The present study evaluates the clinical, biochemical, and echocardiographic features of neonates with vitamin D deficiency. PATIENTS AND METHODS: In this prospective single-arm observational study, echocardiographic evaluation was performed on all patients before vitamin D3 and calcium replacement. Following remission of biochemical features of vitamin D deficiency, control echocardiography was performed. Biochemical and echocardiographic characteristics of the present cohort were compared with those of 27 previously published cases with dilated cardiomyopathy due to vitamin D deficiency. RESULTS: The study included 148 cases (95 males). In the echocardiographic evaluation, none of the patients had dilated cardiomyopathy. All of the mothers were also vitamin D deficient and treated accordingly. Comparison of patients with normocalcaemia and hypocalcaemia at presentation revealed no statistically significant difference between the ejection fraction and shortening fraction, while left ventricle end-diastolic diameter and left ventricle end-systolic diameter were higher in patients with hypocalcaemia. Previously published historical cases were older and had more severe biochemical features of vitamin D deficiency. CONCLUSION: To the best of our knowledge, in this first and largest cohort of neonates with vitamin D deficiency, we did not detect dilated cardiomyopathy. Early recognition and detection before developing actual rickets and preventing prolonged hypocalcaemia are critically important to alleviate cardiac complications.

MIS-C with diarrhea complaint and acute kidney injury: A pediatric COVID-19 patient.

We present the case of a 3-month-old male infant patient who initially presented with severe dehydration with acute kidney injury secondary to COVID-19. Regarding the individual's previous history, the patient had congenital heart disease and was taking furosemide and captopril. The patient improved after initial hydration therapy. However, on the fourth day of hospitalization, the patient suddenly deteriorated and was found to have MIS-C. The patient's clinical course progressively worsened despite maximum support, and he died from severe MIS-C. We conclude that during the COVID-19 period, MIS-C is a serious health problem that should be considered in the differential diagnosis of patients with acute kidney injury.

Predictive value of cardiac markers in the prognosis of COVID-19 in children.

BACKGROUND AND AIM: Occasionally, children with COVID-19 may develop arrhythmia, myocarditis, and cardiogenic shock involving multisystemic inflammatory syndrome in children (MIS-C). This study aimed to identify the laboratory parameters that may predict early cardiovascular involvement in these patients. MATERIALS AND METHODS: Data of 320 pediatric patients, aged 0-18 years (average age, 10.46 ± 5.77 years; 156 female), with positive COVID-19 reverse transcription-polymerase chain reaction test and with cardiac biomarkers at the time of admission to the pediatric emergency department were retrospectively scanned. The age, sex, COVID-19-associated symptoms, pro-brain natriuretic peptide (proBNP), CK-MB, and troponin I levels of the patients were recorded. RESULTS: Fever was noted in 58.1% of the patients, cough in 29.7%, diarrhea in 7.8%, headache in 14.7%, sore throat in 17.8%, weakness in 17.8%, abdominal pain in 5%, loss of taste in 4.1%, loss of smell in 5.3%, nausea in 3.4%, vomiting in 3.8%, nasal discharge in 4.4%, muscle pain in 5%, and loss of appetite in 3.1%. The proBNP value ≥282 ng/L predicted the development of MIS-C with 100% sensitivity and 93% specificity [AUC: 0.985 (0.959-1), P < 0.001]; CK-MB value ≥2.95 with 80% sensitivity and 77.6% specificity [AUC: 0.792 (0.581-1), P = 0.026]; and troponin I value ≥0.03 with 60% sensitivity and 99.2% specificity [AUC: 0.794 (0.524-1)]. CONCLUSIONS: Cardiac markers (proBNP and troponin I), especially proBNP, could be used to detect early diagnosis of cardiac involvement and/or MIS-C in pediatric patients with COVID-19 and to predict related morbidity and mortality.

The Role of ProBNP on Prognosis in Scorpion Stings.

INTRODUCTION: Scorpion stings are a major health problem with potentially fatal consequences. Children under the age of 10 y especially face a great risk. Predicting the prognosis is important in reducing mortality and morbidity because it enables the use of early treatment options. In this study, we examine the relationship between proBNP and prognosis in scorpion stings. METHODS: This is a retrospective analysis of patients aged ≤18 y who were admitted to the child emergency service with a scorpion sting. We examined the demographical data, clinical findings, laboratory records, treatments, and results of the patients. We classified stage 1 and stage 2 scorpion envenomation as group 1 (mild-moderate) and stage 3 and 4 as group 2 (severe). A t test was used for normally distributed data, and the Mann-Whitney U test was used for nonnormally distributed data. The correlation analysis was done using the Spearman test. RESULTS: There were 32 (74%) patients in the mild-moderate group and 11 (26%) in the severe group. ProBNP 1 was significantly higher in the severe group at admission (P=0.016). There was no difference between the troponin I values (P=0.051). ProBNP 2 (12th hour) and proBNP 3 (24th hour) were higher in the severe group (P=0.001 and P=0.032, respectively). There was a negative correlation between proBNP and echocardiographic findings involving ejection fraction and shortening fraction (r=-0.703, P=0.002). CONCLUSIONS: In our study, the first proBNP values were significantly higher in the severe group. This suggests that proBNP may be beneficial in predicting prognosis.

Is N95 face mask linked to dizziness and headache?

OBJECTIVES: During the COVID-19 pandemic, healthcare professionals are recommended to use PPE to prevent the transmission of disease. Healthcare workers who use N95 FFR, which has an important place, experience complaints such as headache and dizziness. In this study, we plan to find the cause of these complaints and aim to clarify whether they are associated with the use of N95 mask. METHOD: Healthcare workers first put on a surgical mask for at least 1 h and a maximum of 4 h, this process was then repeated on another day with the same workers wearing N95 masks. After removing the mask, capillary blood gases were taken and a questionnaire was given. RESULTS: Thirty-four participants over the age of 18 were included in the study; 19 participants were female (56%) and 15 male (44%). The results of the capillary blood gas analysis after the use of surgical mask and N95 mask, respectively: pH: 7.43 ± 0.03; 7.48 ± 0.04 (p < 0.001); pCO2: 37.33 ± 8.81; 28.46 ± 7.77 mmHg (p < 0.001); HCO3: 24.92 ± 2.86; 23.73 ± 3.29 mmol/L (p = 0.131); Base excess (BE): 1.40 (- 3.90-3.10); - 2.68 (- 4.50-1.20) [median (Q1-Q3)] (p = 0.039); lactate: 1.74 ± 0.68; 1.91 ± 0.61 (p = 0314). Headache, attention deficit and difficulty in concentrating were significantly higher after using N95 mask. CONCLUSION: Respiratory alkalosis and hypocarbia were detected after the use of N95. Acute respiratory alkalosis can cause headache, anxiety, tremor, muscle cramps. In this study, it was quantitatively shown that the participants' symptoms were due to respiratory alkalosis and hypocarbia.

A case of intracardiac echinococcosis.

We describe a case of multisystemic cystic echinococcosis exhibiting intracardiac involvement. A lesion inside the lateral wall of the left ventricle induced negative T waves on leads V5 and V6.