Low HDL-C and the Risk of Hospitalisation in Children with COVID-19.

OBJECTIVE: To investigate high-density lipoprotein cholesterol (HDL-C) levels in children with COVID-19. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Goztepe Professor Suleyman Yalcin City Hospital, Istanbul, Turkiye, between 2020 and 2022. METHODOLOGY: The hospital data were examined to find children (<18 years) who presented with COVID-19. The associations between HDL-C, inflammatory biomarkers, hospital admission requirements, and prolonged hospital stays in children with COVID-19 were analysed. RESULTS: During the study period, 1,056 children were diagnosed with COVID-19. Lipid levels were measured in 193 patients during outpatient clinic visits from the same hospital records. One hundred and twenty-seven (65.5%) patients displayed low HDL-C levels. One hundred and nine (86.5%) of the patients with low HDL-C and 33 (50.0%) of the patients with normal HDL-C were hospitalised (p=0.012). Patients with lower HDL-C exhibited higher triglyceride (median 124 vs. 81 mg/dl, p<0.001), glucose (median 116 vs. 101 mg/dl, p=0.001), lactate dehydrogenase (LDH) (median 343 vs. 251 mg/dl, p<0.001), C-reactive protein (CRP) (median 0.6 vs. 0.5 mg/L, p=0.009), D-dimer (median 1.3 vs. 0.3 mcg/mL, p<0.001), ferritin (median 127 vs. 40 µg/L, p<0.001), and uric acid (median 5.5 vs. 4.5 mg/dL, p=0.002) levels compared to children with normal HDL-C. Logistic regression (LR) analysis showed that age (OR = 0.87, CI for OR 0.80-0.94, p < 0.001), ferritin (OR = 1.004, CI for OR 1.001-1.006, p = 0.003), and D-dimer (OR = 2.171, CI for OR 1.183-3.984, p = 0.012) were associated with lower HDL-C level in children with COVID-19. CONCLUSION: Low HDL-C levels were common in children with COVID-19. Children with COVID-19 and low HDL-C were more frequently hospitalised and had higher inflammatory biomarkers of COVID-19 than children with COVID-19 and normal HDL-C levels. KEY WORDS: HDL-C, HDL-C levels in children, COVID-19, Children with COVID-19.

Dual effect of methylene-tetrahydrofolate reductase and angiotensinconverting enzyme gene polymorphisms on the risk of acute ischemic stroke.

Ischemic stroke, a prevalent neurological disease, is the major reason of serious disability and death worldwide. Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms increase homocysteine levels which also raise the risk of vascular diseases. Angiotensin-converting enzyme (ACE) gene polymorphisms can cause vascular reorganization and disrupt arterial wall stability. The aim of this study was to explore how the MTHFR and ACE gene polymorphisms are related to acute ischemic stroke. A total of 200 individuals (102 acute ischemic stroke patients and 98 healthy controls) were included in this case-control research. MTHFR gene C677T (rs1801133) and A1298C (rs1801131) polymorphisms were studied through polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays, ACE gene I/D polymorphism (rs1799752) was studied by PCR. The MTHFR C667T and ACE I/D polymorphisms did not show any statistically meaningful differences between healthy controls and acute ischemic stroke patients (P>0.05). However, compared to healthy controls, acute ischemic stroke patients had almost nine-fold higher prevalence of the CC genotype based on the MTHFR A1298C polymorphism (P=0.024, OR=8.8, 95%Cl=1.27-208.2). Additionally, individuals with acute ischemic stroke had greater frequencies of the combined genotypes of MTHFR and ACE gene polymorphisms in the forms of CC/CC (C667T/A1298C), CC/ DD (A1298C/ACE I/D) and CC/CC/DD (C677T/A1298C/ACE I/D) (P = 0.027, P = 0.015 and P = 0.037, respectively). A statistically significant correlation was assessed between MTHFR gene A1298C polymorphism and acute ischemic stroke. Additionally, it was discovered that the genotype combinations of CC/CC (C667T/A1298C), CC/DD (A1298C/ACE I/D) and CC/CC/DD (C677T/A1298C/ ACE I/D) have risk-increasing effects on acute ischemic stroke. To employ these genetic variations as alternative treatments for ischemic stroke, these findings should be validated by more research.

Evaluation of electrocardiography, echocardiography and cardiac T2* for cardiac complications in beta thalassemia major.

Cardiac complications such as heart failure and arrhythmias caused by "iron-induced" cardiomyopathy are considered as the primary cause of death in the patients with ß-thalassemia major. The aim of this study was to evaluate electrocardiography, echocardiography according cardiac T2* and ferritin findings of patients followed-up for ß-thalassemia major, and to investigate the importance of these findings for early detection of cardiac complications. The study included 41 patients and 25 healthy individuals with matched age and gender. The cardiac T2* results revealed a cardiac iron load below 20 ms in 12 (29.27%) patients, and above 20 ms in 29 (70.73%) patients. All electrocardiography parameters significantly increased in the patient group when compared to the control group (p < 0.05). All parameters except P wave segment in electrocardiography and T peak-end/QT ratio were significantly higher in the group with cardiac T2* < 20 ms than the group with cardiac T2* > 20 ms (p < 0.05). Intraventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass and left ventricular mass index detected by echocardiography were significantly higher in the group with T2* < 20 ms (p < 0.05). Electrocardiography, echocardiography, cardiac T2* and ferritin findings should be carefully evaluated in these patients in order to detect early signs of cardiac complications.

Clinical presentations of pain in patients with COVID-19 infection.

BACKGROUND: Pain can be considered an early sign of COVID-19 infection. There are no studies that specifically investigate the frequency, characteristics, and presentation patterns of pain in COVID-19 infection. AIMS: Our aim is to evaluate the frequency, localization, and severity of pain among the presenting signs and symptoms in patients with COVID-19. METHODS: Patients with the diagnosis of COVID-19 who were admitted to our hospital between March and June 2020 were retrospectively analyzed. Patients' general symptoms at the first admission to the hospital, presence of pain at admission, localization, severity, and persistence of pain were queried by phone call. RESULTS: A total of 210 inpatients diagnosed with COVID-19 were recruited from the hospitals database. Complaints of the patients were 76.6% fatigue, 69.3% pain, 62% fever, 45.3% cough, 43.5% loss of taste and/or smell, 25% diarrhea, and 0.5% skin lesions respectively. Pain was the chief complaint in of 46.61% of the patients. Pain complaints had started on average 2.2 (± 2.8) days before admission. Among 133 patients reporting pain, the distribution of site was 92 (69.2%) myalgia/arthralgia; 67 (50.4%) headache; 58 (43.6%) back pain; 44 (33.1%) low back pain; 33 (25.0%) chest pain; 28 (21.1%) sore throat; and 18 (13.6%) abdominal pain. CONCLUSIONS: The most common pain symptoms were myalgia/arthralgia and headache (69.17% and 50.37%) and found to be much higher than previously reported. Pain is one of the most common complaints of admission to the hospital in patients with COVID-19. Patients who apply to health institutions with pain complaints should be evaluated and questioned in suspicion of COVID-19 infection.

A case of acute hepatitis following mad honey ingestion.

Acute hepatitis is characterized by liver inflammation and liver cell necrosis. The most frequently observed underlying cause thereof is viruses, but various other causes, such as alcohol, medication, or toxins may also lead thereto. In this paper, a case of acute hepatitis presenting with bradycardia, hypotension, and a prominent increase in liver enzymes following mad honey ingestion is discussed. Since there are only few cases of acute hepatitis following mad honey ingestion in the literature, we want to present this subject matter.

The Analysis of Poisoning Cases Presented to the Emergency Department within a One-Year Period.

OBJECTIVES: Intoxication is the emergence of unwanted signs and symptoms in an organism after exposure to potentially harmful chemical, physical or organic materials. In our study, we evaluated demographic and etiological factors of adult patients admitted to the emergency department with suicidal or accidental poisoning. METHODS: This study was conducted retrospectively by using data from the forensics books, protocol notebooks and patient files. Patients over the age of 14 years that were admitted to the Goztepe Training and Research Hospital during a 1-year period (September 2011-September 2012) with poisoning were included in the study. RESULTS: A total of 430 patients were included in the study and 278 of those patients were females (64.7%). The male/female (F/M) ratio was 1.82/1 and the mean age of the patients was 27.4±11.75 years. The analyses showed that in 348 patients (80.93%) the cause of poisoning was medicine, in 39 patients (9.06%) alcohol and drugs, in 37 patients (8.6%) rat poison, in 4 patients (0.93%) a caustic substance and organophosphates in 2 patients (0.46%). The highest rate of admittance due to poisoning was seen in July, followed by August and September. When the frequency of admittance was evaluated in terms of seasons: summer had the highest frequency with 35.6%, then autumn with 29.1%, spring with 19.8% and winter with 15.6%. CONCLUSIONS: The results of our studies are similar to previously reported studies in Turkey. Poisoning cases are more common in women and the most common way of poisoning is by medication. Unlike previous reports from the literature, we found that poisoning was most frequent in the summer.

Retrospective evaluation of emergency service patients with poisoning: a 3-year study.

The purpose of this retrospective study was to evaluate the characteristics of cases of acute poisoning in adults who were admitted to emergency service over a 3-year period. Clinical charts were analyzed retrospectively for etiologic and demographic patient characteristics. A total of 810 adults were admitted to the emergency center with acute poisoning. The female-to-male ratio was 2:1. Mean ages of female and male patients were 28.8+/-12.9 years and 35.1+/-15.4 years, respectively, and many patients (46.9%) were between the ages of 16 and 25 years. Medicinal drugs were found to be the primary cause (60.5%) of poisoning, and tricyclic antidepressants were the most frequent causative agents (36.3%). Seasonal distribution of poisoning cases suggested a peak in the summer months (35.4%). Overall, 68.6% of acute poisonings were suicide attempts, and of these patients, 84.9%, 14%, and 1.1% were attempting suicide for the first, second, and third times, respectively. Among 810 cases of acute poisoning, 15 were fatal. The following conclusions were reached by investigators: (1) in the test region, younger females, especially single females, were at greater risk for poisoning than other patient groups, (2) self-poisoning cases constituted the majority of all poisonings, and (3) the main agents of self-poisoning were medicinal drugs, with antidepressants used most frequently. It was also found that unintentional poisoning commonly resulted from intake of foods, especially mushrooms.