Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers.

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15-136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202-10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8-15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals.

Cord blood antibody following maternal SARS-CoV-2 inactive vaccine (CoronaVac) administration during the pregnancy.

Maternal vaccination with SARS-CoV-2 vaccines has not been well studied yet in terms of safety and efficacy for protecting the newborn by the placental passage of antibodies. We reported 34 years of old health care worker (HCW) without any known SARS-CoV-2 infection. She had the first dose of SARS-CoV-2 inactivated virus vaccine (CoronaVac, Sinovac Life Science Co, Ltd, Beijing, China) at a gestational age of 28 weeks. The second dose of vaccine was given four weeks later at a gestational age of 32 weeks. HCW did not report any vaccine-related adverse events after either the first or second dose of the vaccine. Three weeks after the second dose of the vaccine, her anti-receptor-binding domain (RBD) of SARS-CoV-2 spike protein antibody was 779 arbitrary units (AU) per ml. She gave a birth of 38 weeks three days gestation age of healthy, full-term girl with a birth weight of 2770 gr. The mother's anti-RBD antibody was 734 AU/ml, the infant's cord blood anti-RBD antibody level was 764 AU/ml, respectively, cord sera/maternal sera transfer ratio was 1,04. This infant is the first identified case of SARS-CoV-2 IgG antibodies detectable in cord blood after maternal vaccination with CoronaVac.

Low levels of urinary epidermal growth factor predict chronic kidney disease progression in children.

Urinary epidermal growth factor (uEGF) has recently been identified as a promising biomarker of chronic kidney disease (CKD) progression in adults with glomerular disease. Low levels of uEGF predict CKD progression and appear to reflect the extent of tubulointerstitial damage. We investigated the relevance of uEGF in pediatric CKD. We performed a post hoc analysis of the Cardiovascular Comorbidity in Children with CKD (4C) study, which prospectively follows children aged 6-17 years with baseline estimated glomerular filtration rate (eGFR) of 10-60 ml/min/1.73 m2. uEGF levels were measured in archived urine collected within 6 months of enrollment. Congenital abnormalities of the kidney and urinary tract were the most common cause of CKD, with glomerular diseases accounting for <10% of cases. Median eGFR at baseline was 28 ml/min/1.73 m2, and 288 of 623 participants (46.3%) reached the composite endpoint of CKD progression (50% eGFR loss, eGFR < 10 ml/min/1.73 m2, or initiation of renal replacement therapy). In a Cox proportional hazards model, higher uEGF/Cr was associated with a decreased risk of CKD progression (HR 0.76; 95% CI 0.69-0.84) independent of age, sex, baseline eGFR, primary kidney disease, proteinuria, and systolic blood pressure. The addition of uEGF/Cr to a model containing these variables resulted in a significant improvement in C-statistics, indicating better prediction of the 1-, 2- and 3-year risk of CKD progression. External validation in a prospective cohort of 222 children with CKD demonstrated comparable results. Thus, uEGF may be a useful biomarker to predict CKD progression in children with CKD.

Aortic Intima-Media Thickness and Mean Platelet Volume in Children With Type 1 Diabetes Mellitus.

BACKGROUND: Diabetes mellitus type 1 is the most common endocrine metabolic disorder occurring in childhood and adolescence due to the autoimmune destruction of pancreatic beta cells as a result of various environmental factors interacting with an underlying genetic predisposition. Diabetes is a risk factor for early onset atherosclerosis, and the high mortality rate seen in these patients is partially related to cardiovascular diseases. OBJECTIVES: This study was conducted to compare mean platelet volume as a marker of early atherosclerosis with aortic intima-media thickness in children with type 1 diabetes and to identify its correlation with known cardiovascular risk factors. PATIENTS AND METHODS: The study included 27 patients between age range of 6 and 17 years that were diagnosed with type 1 diabetes and 30 healthy children of the same age range who did not have any chronic disease. In both groups, we used the color Doppler ultrasound to measure children's aortic intima-media thickness and identify their mean platelet volumes. RESULTS: There was no significant difference between the groups regarding gender distribution, age, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels (P > 0.05). Also no significant difference could be documented between the patient and control groups regarding the aortic intima-media thickness and mean platelet volume (P > 0.05). However, there was a significant correlation between aortic intima-media thickness and mean platelet volume (r = 0.351; P < 0.05). CONCLUSIONS: In the present study, there was no evidence of early atherosclerosis in children with type 1 diabetes. However, mean platelet volume having a significant correlation with aortic intima-media thickness may be useful as an early marker of atherosclerosis.

Hypo- and hypervolemic edema in children with steroid sensitive nephrotic syndrome.

BACKGROUND/AIM: The mechanism of edema formation in nephrotic syndrome is still poorly understood. We aimed to evaluate the volume status in children with steroid-sensitive nephrotic syndrome (SSNS) and to emphasize the importance of echocardiography in demonstrating of volume changes. MATERIALS AND METHODS: Thirty-two SSNS patients and 30 healthy children were enrolled in this study. The volume statuses of patients were evaluated by clinical and laboratory features, including fractional sodium excretion (FENa) and distal sodium/potassium exchange (UK/UNa+K ratio). Inferior vena cava collapsibility index (IVCCI), left atrial diameter (LAD), aortic diameter (AD), and left ventricular mass index (LVMI) were measured using conventional echocardiographic methods. RESULTS: FENa was lower in children with NS; however, the distal K/Na ratio of the patient and control groups did not differ. In addition, IVCCI, LAD, AD, and LVMI were not different among groups. When evaluating the volume status of patients, 8 patients (25%) were hypovolemic while 24 patients (75%) were nonhypovolemic (normovolemic or hypervolemic). LAD was significantly lower in hypovolemic patients. CONCLUSION: The majority of children with SSNS are normovolemic or hypervolemic and echocardiography is an easy and valuable method for the evaluation of volume status in these patients.

Subclinical atherosclerosis and ambulatory blood pressure in children with metabolic syndrome.

BACKGROUND: The metabolic syndrome (MS) has reached epidemic proportions worldwide. This syndrome is associated with cardiovascular risk factors, including functional and structural cardiac and vascular changes. The aim of our study was to evaluate subclinical atherosclerosis and its associated risk factors in children with MS. METHODS: The study cohort comprised 52 children with MS and 38 age- and sex-matched healthy children. The diagnosis of MS was made according to criteria adopted by the World Health Organization. Blood pressure based on 24-h ambulatory blood pressure monitoring (ABPM), carotid intima-media thickness (cIMT), carotid distensibility coefficient (DC) and flow-mediated endothelium-dependent dilation (EDD) were assessed in all children. RESULTS: We found a significantly higher cIMT in children with MS than in healthy children, but carotid DC and flow-mediated EDD were lower in the former. Multivariate analysis revealed that a higher cIMT was independently associated with a higher nighttime systolic blood pressure (SBP) and lower high-density lipoprotein-cholesterol (ß = 0.386, p = 0.011 and ß = 0.248, p = 0.042, respectively). Also, higher nighttime SBP remained an independent predictor of lower DC (ß = 0.495, p = 0.009), and higher 24-h SBP was the only independent predictor for a lower EDD (ß = 0.532, p = 0.004). CONCLUSIONS: Atherosclerotic vascular changes were common among our pediatric patients with MS and easily determined by high-resolution ultrasound imaging. In particular, subclinical atherosclerosis was clearly associated with nocturnal or 24-h systolic hypertension as measured by ABPM. We therefore recommend that subclinical vascular changes and AMBP measurements should be used as diagnostic markers to predict atherosclerotic risks in this pediatric patient group.

Hypercalciuria in children with monosymptomatic nocturnal enuresis.

OBJECTIVE: The aim of this study was to measure the 24 h urinary calcium content in children with monosymptomatic nocturnal enuresis (MNE) and compare with those in healthy children to investigate whether there is any relation with enuresis and hypercalciuria. MATERIAL AND METHODS: This study included 120 children and adolescents with MNE aged between 7 and 14 years. Eighty age- and sex-matched healthy children served as a control group. To determine urinary calcium excretion, 24 h urine samples were collected. The children with enuresis were divided into two sub-groups as hypercalciuric and normocalciuric groups according to the amount of urinary calcium excretion. RESULTS: Hypercalciuria was found in 27 (23%) of the MNE patients compared with two (4%) of continent children (p<0.001). In addition, the mean 24 h urine calcium/body weight ratio was higher in the enuresis group than in the control group, 2.94±2.42 versus 1.59±1.72, respectively (p=0.002). When the children with enuresis were divided into two groups as normokalsiuric and hypercalciuric, the hypercalciuric children were younger and the majority of this group were boys.. CONCLUSIONS: Our study showed that hypercalciuria is common in children with MNE, so we suggested measuring urine calcium levels in NE patients. However, further studies are needed to clarify the relationship between hypercalciuria and NE in larger series..

The quality of life of mothers of children with spina bifida.

Spina bifida (SB) is a common birth defect associated with significant lifelong morbidity. The objective of this study was to assess the quality of life and psychological status of mothers of children with SB. In this study, we included 30 mothers with children with SB and 30 mothers of healthy children. The groups were similar for background variables (child's age, sex, and number of siblings; mother's age, marital status; economic status of the families, and presence of health insurance). The 36-item short-form health survey (SF-36), State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) were administered to all mothers. Except for social functioning and mental health, all SF-36 subscale scores were significantly lower and the mean STAI and BDI scores were higher for mothers of children with SB (P<0.001). SF-36, STAI, and BDI scores were not associated significantly with the child's age, sex, number of siblings, and mother's age. This study shows that the quality of life is affected negatively for mothers of children with SB. The clinician should pay close attention to the psychosocial status of mothers of these children within the scope of disease management.

Paraphenylene diamine hair dye poisoning: an uncommon cause of rhabdomyolysis.

Paraphenylene daimine (PPD) is a kind of aromatic amine that is widely used in several industrial products. Women also use PPD added to henna (Lawasonia alba) as a hair dye. Though rare in Western countries, PPD poisoning is quite common in East Africa, India and Middle Eastern countries because it is a traditional product at these countries. Different pathologies were described as caused by PPD ingestion including angioedema of head and neck, rhabdomyolysis, and acute renal failure. The authors report a case of systemic poisoning with PPD that lead to angioedema resulting in tracheostomy and rhabdomyolysis.

Ambulatory blood pressure monitoring and cardiac hypertrophy in children with metabolic syndrome.

BACKGROUND: The metabolic syndrome (MS), a cluster of potent risk factors for cardiovascular disease, is composed of insulin resistance, obesity, hypertension and hyperlipidemia. The aim of our study was to investigated the relationships between MS and left ventricular mass index (LVMI) in childhood MS. This study included 50 children and adolescents with MS aged between 7-18 years. METHODS: Thirty age- and sex-matched healthy children served as a control group. The diagnosis of MS was made according to the criteria adapted from the World Health Organization. They underwent clinical examination with causal blood pressure (BP) measurements, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiogram. Patients underwent echocardiography to detect left ventricular hypertrophy (LVH). LVMI was calculated as left ventricular mass/height(2.7). RESULTS: The mean age of MS group was 12.0 ± 3.1 years. The mean value of LVMI was 46.5 ± 11.5 g/m(2.7) in the MS group and it was significantly higher than those in the healthy children. The prevalence of severe LVH was 12 % using adult criteria (LVM > 51 g/m(2.7)) and 44 % using pediatric criteria (LVM > 95th percentile). The mean daytime systolic BP load (ß = 0.315, p = 0.003) and HOMA-IR (ß = 0.368, p = 0.006) were found as the independent predictors of LVMI. CONCLUSIONS: In conclusion, LVH occurs commonly in pediatric MS and is associated with systolic hypertension and insulin resistance. LVMI should be measured routinely for the predicting of cardiovascular risks in these patients.

Glucose intolerance: is it a risk factor for cardiovascular disease in children with chronic kidney disease?

A total of 66 children and adolescents with chronic kidney disease (CKD) (20 pre-dialysis patients and 46 chronic dialysis patients) were evaluated to address the prevalence of abnormalities in glucose and insulin metabolism and their association with cardiovascular disease. Glucose intolerance was assessed using an oral glucose tolerance test; insulin resistance was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR). Carotid artery intima-media thickness (IMT) and left ventricular hypertrophy (LVH) were examined as early markers of cardiovascular disease. Thirty-four patients (7 pre-dialysis, 27 dialysis) exhibited an abnormal glucose tolerance; however, ten patients (7 pre-dialysis, 3 dialysis) were insulin-resistant. Height-specific standard deviation scores of carotid artery IMT were above normal in three of the pre-dialysis patients (15%) and in 34 of the dialysis patients (74%). LVH was present in seven pre-dialysis (35%) and 34 dialysis patients (74%). In addition, two of the pre-dialysis patients (10%) and 18 of the dialysis patients (39%) had severe LVH. The prevalence of both increased carotid artery IMT and LVH were similar in patients with or without glucose intolerance in both groups, but severe LVH was more prevalent in pre-dialysis patients with glucose intolerance (p = 0.042). The multivariate analyses showed that neither carotid artery IMT nor LVM index was predicted by serum glucose levels or HOMA-IR. In conclusion, children with CKD are at a high risk of glucose intolerance and also have a greater risk of subclinical cardiovascular disease (CVD). However, the presence of glucose intolerance does not appear to be an independent risk factor for increased carotid artery IMT or LVH.

The quality of life of mothers of children with monosymptomatic enuresis nocturna.

BACKGROUND: The purpose of this study was to assess the effect of monosymptomatic nocturnal enuresis (MNE) on the quality of life of the mothers. METHODS: Mothers who have a child with MNE (n = 60) and mothers who have a child without any health problems (n = 90) were included in the study. Groups were similar for background variables (child's age, gender, and number of siblings; mother's age and marital status; and economic status of families and presence of health insurance). The key question was to determine whether or not the difference between the two groups in terms of the quality of life. All mothers underwent Short-Form Health Survey (SF-36) Questionnaire, Spielberg's State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). RESULTS: All SF-36 subscales except social functioning were significantly lower in mothers of enuretic children. The trait-anxiety score, the subcomponent of the STAI, was higher in mothers who have a child with enuresis nocturna (P < 0.001). The mean BDI score was higher in enuretic group (P < 0.001). There was no significant correlation between SF-36, STAI, and BDI scores and child's age, gender, number of siblings, and mother's age. CONCLUSION: This study shows that the quality of life of the mothers was negatively affected by having a child with MNE.

Elevated plasma advanced oxidation protein products in children with Henoch-Schonlein purpura.

Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by involvement of skin, joints, gastrointestinal tract (GIT), and kidney; its pathogenesis is still controversial. The aim of our study was to investigate the role of oxidative stress in the pathogenesis of HSP. Plasma advanced oxidation protein products (AOPP) level was measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at the active stage had significantly higher AOPP levels than those at the remission stage of HSP and the controls (42.9 ± 25.7, 30.6 ± 11.8, 27.9 ± 11.2 mmol/l; P = 0.027 and P = 0.023 respectively). The mean AOPP levels of the patients with arthritis and/or arthralgia were significantly higher those than without joint involvement (48.3 ± 26.0 and 22.3 ± 9.3, P = 0.036 respectively). However, AOPP levels were similar in patients with and without gastrointestinal involvement. Plasma AOPP levels were positively correlated with leukocyte and thrombocyte count at disease onset, whereas they were found to be negatively correlated with serum glucose and sodium levels. The mean thrombocyte count was the only independent predictor of increased level of AOPP in regression analysis (ß = 0.407; P = 0.029). In conclusion, this study showed that increased oxidative stress may play an important role in the pathogenesis of HSP. Also, we suggest that higher platelet count might be an indirect indicator of oxidative stress in these patients. Further research is required to identify the potential association between oxidative stress and increased thrombocyte count in children with HSP.

Dialysate CA125 levels after 5 years on continuous peritoneal dialysis.

The aim of this study was to evaluate longitudinal changes in dialysate cancer antigen 125 (dCA125) levels over time and to analyze relationships between dCA125 and peritoneal glucose exposure (PGE) in children undergoing long-term peritoneal dialysis (PD). The study group included seven boys and four girls (mean age 13 ± 5.1 years) with a mean PD duration of 84.0 ± 1.1 months. A peritoneal equilibration test (PET) was performed, and dCA125 levels were measured in all patients. Peritoneal appearance rates (AR) of dCA125, the velocity of the decrease in dCA125AR values, and annual PGE levels were also calculated. The final tests were performed at a mean of 63.3 ± 3.5 months after the initial ones. Both dCA125 and dCA125AR levels showed statistically significant decrements during the follow-up period (p = 0.003), with the velocity of decrease in dCA125AR found to be 52.6 ± 19.4%. There were no significant differences in peritoneal transport parameters between the beginning and end of the study period. PGE values were significantly higher in the last year of the study than in the first year (p = 0.014), but the velocity of the decrease in dCA125AR levels was not related to total PGE. In conclusion, a significant decline was found in dCA125 and CA125 AR levels, reflecting mesothelial cell mass, in children undergoing long-term PD (>5 years), but these were not related to PGE.

The Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study: objectives, design, and methodology.

BACKGROUND AND OBJECTIVES: Children and adolescents with chronic kidney disease (CKD) are at high risk for cardiovascular morbidity and mortality. A systemic arteriopathy and cardiomyopathy has been characterized in pediatric dialysis patients by the presence of morphologic and functional abnormalities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Cardiovascular Comorbidity in Children with CKD (4C) Study is a multicenter, prospective, observational study aiming to recruit more than 600 children, aged 6 to 17 years, with initial GFR of 10 to 45 ml/min per 1.73 m(2). The prevalence, degree, and progression of cardiovascular comorbidity as well as its association with CKD progression will be explored through longitudinal follow-up. The morphology and function of the heart and large arteries will be monitored by sensitive noninvasive methods and compared with aged-matched healthy controls. Multiple clinical, anthropometric, biochemical, and pharmacologic risk factors will be monitored prospectively and related to the cardiovascular status. A whole-genome association study will be performed to identify common genetic variants associated with progression of cardiovascular alterations and/or renal failure. Monitoring will be continued as patients reach end-stage renal disease and undergo different renal replacement therapies. RESULTS: While cardiovascular morbidity in adults is related to older age and additional risk factor load (e.g., diabetes), the role of CKD-specific factors in the initiation and progression of cardiac and vascular disease are likely to be characterized with greater sensitivity in the pediatric age group. CONCLUSIONS: The 4C study is expected to provide innovative insight into cardiovascular and renal disease progression in CKD.

Spontaneous intracranial bleeding in a neonate with congenital afibrinogenemia.

Congenital afibrinogenemia, a very rare autosomal recessive coagulation disorder, is characterized by undetectable and extremely low antigen levels of fibrinogen in plasma. We report a male newborn with intracranial bleeding and diagnosed as congenital afibrinogenemia in the neonatal period. All members of the family were asymptomatic. Even though his sister and father showed extremely low fibrinogen levels, they did not have any symptoms. The most important finding of this case was a spontaneous intracranial hemorrhage at a very early stage of life. Another interesting point was the rapid resorption of this hemorrhage.