Evaluation of the functional capacity, respiratory functions and musculoskeletal systems of the children with chest pain for non-cardiac reasons.

Daskapan A, Sanli C, Aydogan-Arslan S, Çiledag-Özdemir F, Korkem D, Kara U. Evaluation of the functional capacity, respiratory functions and musculoskeletal systems of the children with chest pain for non-cardiac reasons. Turk J Pediatr 2017; 59: 295-303. Chronic chest pain in healthy children and adolescents generally arises from non-cardiac factors. The purpose of our study was to compare the evaluation results of effort test, respiratory function and musculoskeletal system in children and adolescents with chest pain for non-cardiac reasons with healthy children and adolescents. Physical activity level was determined by the International Physical Activity Questionnaire. The respiratory function test was performed using a spirometer. The posture analysis was performed to determine the upper body deformities. The effort test was performed on a treadmill. The two groups were similar in terms of the physical activity levels, respiratory function and effort test results (p > 0.05). The rate of the rounded shoulder, kyphosis was significantly higher in the patient group with chest pain (p < 0.005). Consequently, the musculoskeletal system findings including the pectoralis minor shortness, rounded shoulder, and thoracic kyphosis could have a role in non-cardiac chest pain.

Association of MTHFR A1298C polymorphism with conotruncal heart disease.

Congenital heart diseases are common congenital anomalies with 1% prevalence worldwide and are associated with significant childhood morbidity and mortality. Among a wide range of aetiologically heterogeneous conditions, conotruncal anomalies account for approximately one-third of all congenital heart defects. The aetiology of conotruncal heart diseases is complex, with both environmental and genetic causes. Hyperhomocysteinaemia, which is often accompanied by the defects of folic acid metabolism, is known to cause conotruncal heart anomalies. In this study, we have evaluated three polymorphisms in the following two hyperhomocysteinaemia-related genes: methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) and nicotinamide N-methyl transferase (NNMT rs694539) in 79 children with conotruncal heart disease and 99 children without conotruncal heart disease. Genotype distribution of the MTHFR A1298C polymorphism showed a statistically significant difference between the two groups. In the case group, AC and CC genotypes were higher than the control group (p<0.05). We have found that MTHFR A1298C polymorphism is associated with conotruncal heart disease; C allele (p=0.028), AC (OR[95% CI]=2.48[1.24-4.95], p=0.010), CC (OR[95% CI]=3.01[1.16-7.83], p=0.023), and AC+CC (OR[95% CI]=2.60[1.36-4.99], p=0.004) genotypes are more frequent in the patient group. Genotype distributions of the MTHFR C677T and NNMT rs694539 polymorphisms were similar in the two groups when evaluated separately and also according to the dominant genetic model (p>0.05). Our results suggest that MTHFR 1298C allele is a risk factor for conotruncal heart disease.

Serum levels of soluble ICAM-1 in children with pulmonary artery hypertension.

This prospective cross-sectional study attempted to determine both the usefulness of the serum intercellular adhesion molecule-1 (ICAM-1) as a biomarker for pulmonary artery hypertension secondary to congenital heart disease and the nature of this marker's association with catheter angiographic findings. Our study included a total of 70 male and female children, comprising 30 patients with both pulmonary artery hypertension and congenital heart disease, 20 patients with congenital heart disease alone, and 20 healthy control subjects. Levels of ICAM-1 in plasma samples from all groups were measured by the enzyme-linked immunosorbent assay method. Cardiac catheterization was also performed in all patients. The mean serum ICAM-1 levels in pediatric patients who had congenital heart disease with and without pulmonary artery hypertension were 349.6 ± 72.9 ng/mL and 312.3 ± 69.5 ng/mL, respectively (P=0.002). In healthy control subjects, the mean serum ICAM-1 level was 231.4 ± 60.4 ng/mL. According to the results of this study, the ICAM-1 level of the pulmonary artery hypertension group was significantly higher than those of the congenital heart disease group and the healthy control group. Correlation analysis showed that ICAM-1 level was correlated with systolic and mean pulmonary artery pressures (r=0.62, P=0.001; r=0.57, P=0.001)-which are 2 important values used in diagnosis of pulmonary artery hypertension. Moreover, receiver operating characteristic analysis yielded consistent results for the prediction of pulmonary artery hypertension. Therefore, we conclude that ICAM-1 has potential use as a biomarker for the diagnosis and follow-up of pulmonary artery hypertension.

Assessment of pulmonary arterial hypertension and vascular resistance by measurements of the pulmonary arterial flow velocity curve in the absence of a measurable tricuspid regurgitant velocity in childhood congenital heart disease.

This study aimed to determine mean pulmonary arterial pressure (PAPmean) and pulmonary vascular resistance (PVR) using transthoracic echocardiography (TTE) measurements of the pulmonary artery flow velocity curve in children with pulmonary arterial hypertension (PAH) and congenital heart disease when the tricuspid regurgitant velocity (TRV) is not sufficient. This study enrolled 29 congenital heart disease cases with pulmonary arterial hypertension and 40 healthy subjects followed at our center. The mean age was 66.9 ± 77.9 months in the patient group and 76.3 ± 62.1 months in the control group. A positive correlation was found between TRV and systolic pulmonary arterial pressure (r = 0.394, p = 0.035, 95% confidence interval [CI] = 0.032-0.665), whereas a negative correlation was found between corrected acceleration time (AcTc) and PAPmean (r = -0.559, p = 0.002, 95% CI = -0.768 to -0.242). Furthermore, a negative correlation was found between parameters TRV and AcTc (r = -0.383, p = 0.001, 95% CI = -0.657 to -0.019). Based on the cutoff criterion of 124 ms for AcTc, sensitivity was found to be 79.3% and specificity to be 77.5% in distinguishing between the PAH patients and the healthy control patients (receiver operating characteristic [ROC] area under the curve [AUC] = 0.804, 95% CI = 0.691-0.890, p < 0.0001). The sensitivity and specificity of the concomitant use of AcTc and/or TRV were found to be 90 and 73%, respectively, in distinguishing between the PAH patients and the the healthy control patients. The data obtained by TTE also can be appropriate for measuring PAPmean, PVR, and the vasoreactivity test and for determining the priority of implementing cardiac catheterization even if there is no measurable TRV value.

Elevated homocysteine and asymmetric dimethyl arginine levels in pulmonary hypertension associated with congenital heart disease.

Pulmonary arterial hypertension (PAH) is a major cause of morbidity and mortality among patients with congenital heart disease (CHD). This study was designed to determine biomarker levels in patients with PAH associated with CHD (PAH-CHD) and CHD patients without PAH and to investigate the relationship of these potential biomarkers with hemodynamic findings. In this prospective single-center study, patients with CHD were analyzed according to the presence or absence of PAH and compared with healthy control subjects. Cardiac catheterization and echocardiographs were performed. Plasma homocysteine, asymmetric dimethyl arginine (ADMA), and nitric oxide (NO) levels were determined by enzyme-linked immunosorbent assay. Homocysteine and ADMA levels were higher in the PAH-CHD group (n = 30) than among CHD patients with left-to-right shunting but no PAH (n = 20; P < 0.001) and healthy control subjects (n = 20; P < 0.001). There was no difference in NO levels. Cyanotic PAH-CHD patients had significantly higher homocysteine than acyanotic patients in the same group. No correlation was shown between echocardiographic/hemodynamic parameters and homocysteine, ADMA, and NO levels. Homocysteine and ADMA levels are increased in patients with PAH-CHD. These parameters have the potential to be used as biomarkers in the diagnosis and follow-up evaluation of patients with PAH-CHD. However, large, multicentered prospective studies are required to facilitate routine use of these biologic markers in the clinical setting.

Heart rate variability in neonates with hypoxic ischemic encephalopathy.

OBJECTIVE: To evaluate the changes in heart rate variability (HRV) in newborns with hypoxic-ischemic encephalopathy (HIE). METHODS: Twenty-two newborns (14 boys, 8 girls) with moderate or severe HIE and 24 term neonates with similar gestational and postnatal age for control were included in this study. Normalized low and high frequency components of HRV and their ratio were evaluated for 24-h in newborns with HIE and control subjects. RESULTS: The newborns with hypoxic-ischemic encephalopathy had significantly lower normalized low frequency (LFn) and low frequency (LF) / high frequency (HF) values and higher normalized high frequency (HFn) values when compared with the control babies. In addition, when the cases with severe HIE are compared with those of moderate HIE, decreased LFn, LF/HF values and also increased HFn values were present in the severe cases. CONCLUSIONS: HIE is associated with reduced sympathetic nervous system activity, and increased parasympathetic nervous system activity and these activities also correlate with the severity of the disease.

Persistent left superior vena cava: experience of a tertiary health-care center.

BACKGROUND: The aim of this study was to assess the prevalence of persistent left superior vena cava (PLSVC) in patients with all types of congenital heart defects and to determine the congenital heart anomalies accompanying PLSVC. METHODS: The present study is based on a retrospective review of 1205 children who consecutively underwent cardiac catheterization from 2000 to 2007. In order to determine the existence of PLSVC, all the subjects routinely underwent superior vena cava (SVC) injection during angiography at the catheter laboratory of the study center. RESULTS: The prevalence of PLSVC was computed to be 6.1% for the present study population. Transthoracic echocardiography was able to detect PLSVC in 32 children (2.6%) whereas angiography diagnosed PLSVC in 74 children (6.1%). The mean age of the patients with PLSVC was 40.09 ± 50.21 months. A communication between the right and left SVC was determined in 27% of the children who were diagnosed with PLSVC after angiography was performed (20 out of 74). A statistically significant association was present between PLSVC and other congenital cardiac anomalies, including ventricular septal defect (n= 42, 56.8%), atrial septal defect (n= 31, 41.9%), pulmonary stenosis (n= 19, 25.7%), atrioventricular septal defect (n= 10, 13.5%), patent ductus arteriosus (n= 6, 8.1%) and cor triatriatum (n= 3, 4.1%). CONCLUSION: Transthoracic echocardiography usually visualizes dilated coronary sinus in association with PLSVC. However, SVC injection should be performed in patients undergoing angiography so that morbidity and mortality related with persistent left superior vena cava can be avoided during cardiovascular surgery.

Cardiac troponin T in children with acute rheumatic carditis.

The existence of cardiac damage in active rheumatic carditis patients is unknown, especially in those without pericarditis. The aim of this study was to determine cardiac myocyte damage using cardiac troponin T (cTnT) measurements in active rheumatic carditis. The levels of creatine kinase MB isoenzyme (CK-MB), cTnT, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), cardiothoracic ratio (CTR), and fractional shortening (FS) were compared using Mann-Whitney U test between 28 patients with active rheumatic carditis and 32 controls (healthy children). Association of cTnT levels with ESR, CRP, and CTR was evaluated with Spearman correlation analysis. ESR, CRP, cTnT levels, and CTR were statistically higher in the patients than in the controls. There were no differences between the groups for CK-MB levels and FS. No relationships were found between cTnT levels and ESR, CRP, and CTR in the patient group. The results of the study suggest that when cTnT levels are within non-pathological range, there is no serious cardiac damage; however, statistically significant increases in cTnT levels may indicate minor damages in patients with active carditis due to acute rheumatic fever.

Could lower bone turnover be a cause of chest pain during childhood?

Chest pain, a frequent complaint during childhood, rarely originates from a cardiac pathology. Although it usually is idiopathic, it also could be associated with psychogenic, musculoskeletal, respiratory, and digestive disorders. This study aimed to investigate a possible relation between bone mineral density and chest pain in children. Bone mineral density and bone metabolism parameters were measured for 50 children with chest pain, and the findings were compared with those for 40 age- and sex-matched healthy children. Most of the cases (64%) were in the idiopathic group, and musculoskeletal chest pain was the second most frequent complaint (12%). Although bone mineral densities and osteocalcin levels did not differ significantly between the whole chest pain group and the control group, both were found to be lower in the musculoskeletal chest pain group than in other groups and the control group (p < 0.05). Musculoskeletal chest pain may be related to reduced bone mineral metabolism, and monitoring of risk factors is of particular importance.

Effects of GSM-like radiofrequency on distortion product otoacoustic emissions in pregnant adult rabbits.

OBJECTIVES: To determine the effects of 1800 MHz GSM-like Radiofrequency (RFR) on the cochlear functions of pregnant adult rabbits by Distortion Product Otoacoustic Emissions (DPOAEs). METHODS: Eighteen 13-month-old pregnant and eighteen 13-month-old non-pregnant New Zealand White rabbits were studied. They were randomly divided into four groups. Nine pregnant rabbits (Group 2) and nine non-pregnant rabbits (Group 4) were exposed to 1800 MHz GSM-like RFR 15 min daily for 7 days. Nine pregnant (Group 1) and nine non-pregnant rabbits (Group 3) were not exposed to GSM like RFR. Cochlear functions were assessed by DPOAEs at 1.0-8.0 kHz. RESULTS: In all pregnant groups except 2.0 kHz, DPOAE amplitudes were not different in Group 2 and Group1. In Group 4, DPOAE amplitudes at 1.0-4.0 kHz (-1.68 dB SPL at 1.0 kHz, 3.05 dB SPL at 1.5 kHz, 2.96 dB SPL at 2.0 kHz, 1.30 dB SPL at 3.0 kHz and 12.22 dB SPL at 4.0 kHz) were lower than Group 3 (8.67 dB SPL at 1.0 kHz, 17.67 dB SPL at 1.5 kHz, 26.10 dB SPL at 2.0 kHz, 18.10 dB SPL at 3.0 kHz and 35.13 dB SPL at 4.0 kHz) (P < 0.0125). In the pregnant group, harmful effects of GSM-like RFR were less than in the non-pregnant group. CONCLUSION: GSM-like RFR caused decreases in DPOAE amplitudes mainly in non-pregnant adult rabbits. Prolonged exposure may affect the DPOAE amplitude. Recommendations are given to prevent the potential hazardous effects of RF in humans.

Eruptive vellus hair cysts: report of a pediatric case with partial response to calcipotriene therapy.

Eruptive vellus hair cysts (EVHCs) are characterized by asymptomatic, follicular, comedonelike papules usually located on the anterior chest and abdomen. We present a pediatric case of EVHC associated with attention deficit hyperactivity disorder that partially responded to calcipotriene cream within 2 months. Our aim is to refamiliarize clinicians with a common albeit frequently unrecognized disorder of vellus hair follicles.

Topotecan treatment and its toxic effects on hematologic parameters and trace elements.

The aim of this study was to investigate the effects of topotecan, a topoisomerase I-inhibiting anticancer agent, on hematologic parameters and serum levels of trace elements. The study was conducted on three groups consisting of 16 and 18 rabbits in the study groups and 15 rabbits in the control group. Rabbits in group I (n = 16) received high-dose topotecan intravenously (i.v.; 0.5 mg/kg once daily), while rabbits in group II (n = 18) received low-dose topotecan i.v. (0.25 mg/kg once daily) for 3 days. The 15 rabbits comprising the control group did not receive topotecan. Serum samples were collected from each rabbit on the first day, before the treatment, and on the 15th day of treatment. Erythrocytes, hemoglobin, white blood cell count, thrombocyte count, and trace elements such as selenium, copper, lead, zinc, and cobalt were analyzed. Hemoglobin levels and erythrocyte counts were lower in both study groups than in the control group. However, thrombocyte and leukocyte counts were similar in all three groups (p > 0.005). Serum trace element levels (copper, lead, zinc, and cobalt) did not differ significantly between groups. However, serum selenium levels were significantly lower in both study groups than the control group (p < 0.001). The results revealed that topotecan treatment causes a decrease in erythrocyte counts and hemoglobin levels due to bone marrow suppression, and these effects must be taken into account during treatment. In addition, selenium supplementation might be helpful in cancer patients receiving topotecan to increase the effect of the chemotherapeutic agent.

Wolff-Chaikoff effect in a newborn: is it an overlooked problem?

Hypothyroidism is a serious endocrine disorder emerging from deficient production of thyroid hormone (thyroid gland agenesis or dysgenesis, or inborn metabolic defects of thyroid hormone production) or a defect in thyroid hormonal receptor activity. Prevention of iodine organification by means of using iodine-containing drugs or solutions is a protective mechanism for the body and is known as the Wolff-Chaikoff effect. This effect blocks thyroid hormone generation and is often transient, with thyroid hormone synthesis recovering in a few days or weeks. We present a neonate with transient thyroid dysfunction resulting from topical exposure to iodine-containing antiseptic solution. Our aim was to increase awareness that the use of antiseptic iodine solutions in neonates may result in transient hypothyroidism through the Wolff-Chaikoff effect and should be considered after the use of iodine-containing solutions or drugs.

Plasma free carnitine levels in 0-12-month-old infants in relation to feeding styles.

This study was planned to determine the blood carnitine levels of children aged 0-1 year in Kirikkale. Blood samples were taken on Guthrie cards and plasma free carnitine levels were analyzed by tandem mass spectrometry. The mean free carnitine level was 25.12 +/- 10.1 micromol/L (10.1-49.5 micromol/L). To assess the plasma free carnitine levels according to feeding style, babies were grouped as exclusively breastfed (n = 67, 49.3%), artificially fed (n = 24, 17.7%), and mixed fed (n = 45, 33%). The exclusively breastfed infants displayed the lowest free carnitine levels (p < 0.05). However, when this was analyzed in accordance with age, no significant change was observed in plasma free carnitine levels according to feeding style. Results of this study are important as they reveal an indication about the normal values of plasma free carnitine in Turkish infants and their relationship to feeding styles.

Traditional beliefs as forgotten influencing factors on breast-feeding performance in Turkey.

OBJECTIVE: The aim of this cross-sectional study was to identify the infant feeding practices and to evaluate the attitudes and beliefs of mothers on breast-feeding in Turkey. METHODS: This study was established in 10 provinces of Turkey between December 2000 and March 2001 and the study group was comprised of 1,767 women between the ages of 15-49 years (mean 27.6 +/- 6.4 years). Questionnaires were self-filled by mothers in the waiting rooms of the health centers. RESULTS: One hundred seventy-three women (9.9%) were illiterate, 829 (47.7%) had < or =5 years of schooling, and 83.4% were housewives. A significant number of women have traditional beliefs related to breast-feeding practices. According to 23.4% of the women at least 3 calls to prayer (average 12 hours) should be waited before the first breast-feeding postpartum and more than 30% of the mothers believe that colostrum should not be given to the newborn, some mothers breast milk could harm their babies, and an evil eye could harm their breast milk. The traditional belief status and educational status of the women differed significantly between provinces, lower educational status and higher rates of women with traditional beliefs were observed in less developed eastern provinces. Overall, 60.6% of the women were knowledgeable on breast-feeding practices, whereas only 13.5% were scored as good in attitudes. Among all women with breast-feed babies, 35.8% started supplementary feeding in the first 3 months of life. Mother's age, education, occupation and traditional beliefs did not have a significant effect on supplementation time. CONCLUSION: As a result, these findings suggest the importance of taking into account the customs, local beliefs and family influences in planning community health programs.