Salusin-α levels are negatively correlated with diastolic blood pressure in children with obesity.

Salusins have emerged as a new biomarker that reflects an increased inflammatory state, which is associated with cardiovascular risk. We investigated the predictive value and usefulness of salusins as an inflammatory biomarker in obese children. This prospective cohort study included 75 obese children and 101 healthy children (as a control group). Salusin-α, Salusin-ß, and various cardiovascular parameters were assessed in both groups. Correlation analyses of Salusin-α and Salusin-ß with body mass index standard deviation scores and inflammatory and cardiovascular markers were performed. The mean patient age was 11.9±2.4 years for the obese group and 12.5±2.1 years for the control group. The obese children had a significantly higher heart rate, systolic blood pressure, diastolic blood pressure, epicardial adipose tissue thickness, and left ventricular mass than did the children in the control group. There was no significant correlation between Salusin-α and Salusin-ß and body mass index; however, there was a negative correlation between Salusin- α and diastolic blood pressure (r = 0.277, p = 0.004). Overall, there was no significant difference in the Salusin-α and Salusin-ß levels between obese and healthy children. However, a negative correlation was found between Salusin-α and diastolic blood pressure. Although this result suggests that Salusin-α might be an early marker of cardiovascular involvement in obese children, further studies are needed to demonstrate the predictive value of salusins.

Effects of gestational and pregestational diabetes mellitus on the foetal heart: a cross-sectional study.

We examined the foetal cardiac structural and functional characteristics in diabetic pregnancies versus non-diabetic, healthy pregnancies. Between August 2015 and April 2016, 32 pregnant women with pregestational diabetes, 36 pregnant women with gestational diabetes, and 42 healthy pregnant women were scheduled to have foetal echocardiograms to assess cardiac structure and function. In the diabetic groups, the foetal interventricular septum (IVS) thickness was significantly greater than in non-diabetics (p < .05) but none had an IVS >2 SD from normal. The peak velocity of tricuspid E, and the E/A ratio were significantly lower in the diabetic groups (p < .05). Tricuspid valve Ea values and the Ea/Aa ratio were lower in the diabetic group than in the control group (p < .05) but there was no significant difference between the pre-GDM and GDM groups (p > .05). Interventricular septal hypertrophy is the most common structural abnormality in diabetic pregnancies. These changes do not pose a risk to the foetal unless they cause functional impairment. Thus, we believe that it is important for diabetic pregnant women to be monitored for foetal cardiac diastolic dysfunction. Impact statement What is already known on this subject? Pregestational insulin-dependent diabetes mellitus is a relatively common condition in pregnancy, affecting up to 0.5% of the pregnant population. Foetuses of diabetic mothers are at an increased risk of perinatal morbidity and death. Gestational diabetes mellitus is under-recognised and affects up to 4% of pregnancies. Although diabetes mellitus is known to increase the risk of cardiovascular defects and structural changes (myocardial hypertrophy and diastolic dysfunction) due to foetal hyperglycaemia and hyperinsulinism, similar data in women with gestational diabetes is scarce. Moreover, the effect of maternal hyperglycaemia on foetal cardiac structure and function is unclear because of discordant results from previous studies. What do the results of this study add? In this study, we have used foetal echocardiography, two-dimensional US, pulsed wave Doppler and TDI to characterise the foetal cardiac structure and function in normal pregnancies as well as in the pregnancies complicated by GDM, and pregestational DM. Interventricular septum thickness is increased in women with pregestational diabetes mellitus and impaired diastolic function. The dominant right ventricle of the foetal circulation was affected earlier than the left ventricle. What are the implications of these findings for clinical practice and/or further research? Large population-based studies are required to establish the absolute risk of congenital heart defects in patients with pregestational diabetes and pregestational diabetes in the utility of routine screening.

Assessment of paraoxonase and arylesterase activities in patients with iron deficiency anemia.

Paraoxonase-1 (PON1) is a high-density lipoprotein (HDL) associated enzyme with three activities which are paraoxonase, arylesterase and dyazoxonase. We aimed to determine serum (a) paraoxonase and arylesterase activities and, lipid hydroperoxide (LOOH) levels in patients with iron deficiency anemia (IDA) (b) whether there is an association between the development of atherosclerosis and paraoxonase/arylesterase activities in patients with IDA. Twenty-five female with IDA and 22 healthy female as control were enrolled in the study. Serum basal/salt-stimulated paraoxonase and arylesterase activities were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with xylenol orange assay. Basal/salt-stimulated paraoxonase and arylesterase activities were significantly lower in patients with IDA than controls (p<0.001; for all), while LOOH levels were significantly higher (p<0.001). Our results show that paraoxonase and arylesterase activities, which have antiatherogenic capability, are decreased in patients with IDA. Reduced paraoxonase and arylesterase activities may play a role in pathogenesis of atherosclerosis through increased susceptibility to lipid peroxidation in patients with IDA.

Noninvasive assessment of left-to-right shunting in ventricular septal defects by the proximal isovelocity surface area method on Doppler colour flow mapping.

BACKGROUND AND AIM: The proximal isovelocity surface area (PISA), which is the zone of flow convergence appearing on the left ventricular septal surface where flow approaching the defect accelerates, allows quantitative estimation of ventricular septal defect (VSD) flow and defect area on colour Doppler imaging. In the present study, the clinical applicability and reliability of the PISA method in assessing the amount of left-to-right shunting in patients with VSDs were evaluated. PATIENTS AND METHODS: Fifty-eight patients aged 0.25 to 15 years (mean age 4.3+/-4.4 years) with VSDs were prospectively studied. Maximum PISA radius in peak systole (r), peak velocity (V(max)) and velocity time integral (VTI(VSD)) of flow through the VSD were measured. In addition, peak VSD flow (2pir(2) Nyquist limit [NL]), amount of left-to-right shunting (Qp-Qs = heart rate x [2pir(2) x NL x VTI(VSD)]/V(max)) and defect area ([2pir(2) x NL]/V(max)) were calculated. RESULTS: There were significant positive correlations between Qp-Qs values calculated by PISA and other spectral Doppler methods using the cross-sectional area, as well as the VTI of pulmonary-aortic (r=0.73, P<0.001) or mitral-tricuspid (r=0.58, P<0.001) flows and cardiac catheterization (20 patients, r=0.82, P<0.001). PISA-derived left-to-right-shunting discriminated moderate to large defects from small defects, which were classified according to the catheter-derived Qp/Qs ratio (2 or greater versus less than 2; P=0.001) or clinical evaluation (P<0.001). CONCLUSIONS: The present study demonstrated that the PISA method is a reliable semiquantitative method to determine the amount of left-to-right shunting of VSDs and to discriminate moderate to large defects from small defects. Consequently, this method may serve as a simple and useful adjunct to conventional spectral Doppler methods in the noninvasive assessment of patients with VSDs.

Dynamic thiol/disulphide homeostasis as a novel indicator of oxidative stress in obese children and its relationship with inflammatory-cardiovascular markers.

OBJECTIVE: Childhood obesity is an important cause of cardiovascular risk with chronic inflammation. Oxidative stress may contribute to the pathogenesis of obesity-related cardiovascular pathologies. We aimed to evaluate thiol/disulphide homeostasis as a novel and sensitive marker of oxidative stress and to evaluate its relationship with some inflammatory and cardiovascular markers in obese children. METHODS: In this case-controlled study, 65 children with exogenous obesity and 64 healthy children, as a control group, were included. In both groups, thiol/disulphide homeostasis parameters and inflammatory (white blood cells, platelets, mean corpuscular volume, neutrophil/lymphocyte ratio, and high-sensitivity C-reactive protein) and cardiovascular (epicardial adipose tissue thickness and left ventricular mass index) markers were studied. Correlation analyses of thiol/disulphide homeostasis parameters with body mass index standard deviation scores (BMI SDS) and inflammatory and cardiovascular markers were performed. Receiver-operating characteristic analysis was performed to determine the sensitivity, specificity, and optimal cut-off values of thiol/disulphide homeostasis parameters. RESULTS: Native thiol, total thiol, and native thiol/total thiol ratios (antioxidant parameters) were lower (p<0.05) and disulphide/native thiol and disulphide/total thiol ratios (oxidant parameters) were higher in the obese group than in the control group (p<0.01). A positive correlation of oxidant parameters with BMI SDS and inflammatory markers was found. However, a negative correlation of antioxidant parameters with BMI SDS and inflammatory markers was found. The specificities of disulphide/native thiol and disulphide/total thiol ratios were higher in the obese group. CONCLUSION: The impairment in thiol/disulphide homeostasis, which is indicative of oxidative stress, is associated with inflammation in obesity. In addition, cardiovascular involvement may also contribute to this impairment.

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children.

OBJECTIVE: Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS: Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION: Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Pericardial hydatid cyst presenting with cardiac tamponade.

Cases of cardiac hydatid cyst disease are uncommon, occurring in approximately 0.5% to 2% of patients with hydatid disease. Most cardiac hydatid cysts are located in the left ventricle and interventricular septum. Cardiac involvement may have serious consequences. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 10-year-old girl with cardiac tamponade secondary to a pericardial hydatid cyst is described.

Arteriovenous fistula between descending aorta and left inferior pulmonary vein: Closure with vascular plugs.

Echocardiography revealed systemic artery to pulmonary venous fistula, a rare vascular anomaly, in a 20-month-old girl, and multislice computed tomography angiography (CTA) was performed to rule out congenital heart disease. Normal bronchial connection and pulmonary vasculature were observed in the lung. The fistula drained through the left inferior pulmonary vein to the left atrium leading to a left-to-left shunt. Percutaneous intervention was performed in 2 stages using Amplatzer vascular plugs to close successfully.

Increased oxidative stress in children exposed to passive smoking.

BACKGROUND: Atherogenic process is accelerated with cigarette smoke that contains many oxidants and prooxidants, capable of producing free radical and enhancing the oxidative stress. We investigated oxidative and antioxidative status of children who had been exposed to passive smoking and compared with those of not exposed group. METHODS: One hundred forty-three school children aged 9-13 years, 61 of whom had never been exposed to passive smoking, and 82 of whom had been exposed to passive smoking at least 10 cigarette per day for at least last 1 year in their house, were enrolled in this study. Total antioxidative response (TAR) was measured to determine antioxidative status of plasma, and total peroxide concentration was measured to determine oxidative status of plasma. The ratio of TAR to total peroxide was accepted as an indicator of oxidative stress. RESULTS: TAR of plasma was significantly lower in children exposed to passive smoking than in those of not exposed group (p=0.018). Mean (S.D.) values were 1.49 (0.07) and 1.52 (0.08) mmol Trolox Equiv./l, respectively. In contrary, the mean (S.D.) total peroxide level of plasma was significantly higher in children exposed to passive smoking [13.06 (2.34) micromol H2O2/l] than in not exposed group [12.24 (1.74) micromol H2O2/l] (p=0.015). The mean (S.D.) oxidative stress index (OSI) value was significantly higher in the children exposed to passive smoking [0.87 (0.15)] than in not exposed group [0.80 (0.10)] (p=0.001). CONCLUSION: Children who are exposed to passive smoking are exposed to oxidative stress, which has been implicated in the etiopathogenesis of over 100 disorders including atherosclerosis.

Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis.

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.

Treatment of typhoid fever in children with a flexible-duration of ceftriaxone, compared with 14-day treatment with chloramphenicol.

Although the efficacy of ceftriaxone in typhoid fever is well documented, the precise duration of ceftriaxone therapy in children with typhoid fever is not established and varies from 3 to 14 days in the literature. In a prospective, randomized study ceftriaxone was compared with chloramphenicol for treatment of 72 children who had bacteriologically confirmed typhoid fever. Ceftriaxone was given at a dose of 75 mg/kg per day (maximally 2 g/day) intravenously, in two doses until defervescence and continued 5 days after that time. Chloramphenicol was given at a dose of 75 mg/kg per day (maximally 2 g/day) in four doses for 14 days. Mean defervescence time was in 5.4 days in the ceftriaxone group and 4.2 days in the chloramphenicol group (P=0.04). Clinical cure without complications was achieved in all patients in both groups. No patient relapsed in the ceftriaxone group, and four patients relapsed in the chloramphenicol group (P=0.048). The overall results of this study suggest that a flexible-duration of ceftriaxone therapy given until defervescence time, followed by an additional 5 days of therapy is a reasonable alternative to conventional 14-day chloramphenicol treatment in children with typhoid fever.

The oxidative state of children with cyanotic and acyanotic congenital heart disease.

OBJECTIVE: The type of congenital heart disease, early diagnosis, and treatment modality all play an important role in the morbidity and mortality of these diseases. This study examined the relationship between congenital heart disease and oxidative stress in children with cyanotic and acyanotic congenital heart disease. METHODS: In this case-controlled cross-sectional study, the study groups consisted of 29 patients with cyanotic heart disease, 30 patients with acyanotic heart disease, and a control group of 32 healthy individuals. For all groups, the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were calculated. Of the cyanotic group, 12 were diagnosed with tetralogy of Fallot, 7 with transposition of the great arteries, 4 with tricuspid atresia, 4 with double outlet right ventricle and 2 with truncus arteriosus. In the acyanotic group 19 patients had ventricular septal defect (VSD), 5 atrial septal defect (ASD) and 6 patent ductus arteriosus (PDA). Statistical analyses were performed using Chi-square, Mann-Whitney U and Kruskal-Wallis tests. RESULTS: The plasma TAS, TOS, and OSI were significantly higher in the cyanotic group than in the acyanotic group (p<0.0001, p<0.01, and p<0.01, respectively) and controls (p<0.0001, p<0.0001, and p<0.0001, respectively). A comparison between the acyanotic and control groups showed no statistical differences. CONCLUSION: The level of oxidative stress in patients with cyanotic congenital heart disease was significantly higher than in the acyanotic and control groups, which were similar.