Objective: Hypertension (HT) can cause vascular and microvascular changes.There is no barrier between systemic blood and ocular region.Changes in choroidal perfusion pressure due to HT may impair retinal function and oxygenation, and subfoveal choroidal thickness (SCT) may be affected by these changes.The aim of this study was to evaluate the effect of arterial HT on SCT in children. Method:The study was performed on 102 cases (51 patients and 51 controls), prospectively.Optical coherence tomography was used for the measurement of SCT and mean values of 3 consecutive measurements were evaluated.All cases had blood pressure measurements during all day via ambulatory blood pressure monitoring.Also, both groups were evaluated for the target organ damage.Results: There were 51 cases in patient group with the average age of 14.4±2.8years, and the rest of 51 control cases were meanly 14.5±2.8years in age (p=0.980).SCT was measured thinner in patients with target organ damage than the cases without target organ damage (p=0.027).SCT measurements of patients and control cases were not statistically significant different (p=0.569).Especially SCT was statistically significantly thinner in cases with increased left ventricular mass, left ventricular mass index and hypertensive nephropathy (p=0.02,p=0.00, p=0.039, respectively). Conclusion:Choroidal thickness decreases in patients with HT who develop target organ damage.Therefore, close follow-up of hypertensive patients with appropriate life changes and medical treatments is important before target organ damage develops.
A 5-month-old boy with progressive respiratory distress was admitted to our hospital. Physical examination revealed mild tachypnea and retraction. The left main bronchus was found as severely collapsed between the right pulmonary artery and the descending aorta, on the bronchoscopic evaluation. Further evaluation revealed persistent ductus venosus (PDV). As in the fetal period the ductus venosus arises from the posterior aspect of the left portal vein, a PDV is considered another type of intrahepatic portosystemic shunt. Therefore, he was diagnosed with congenital portosystemic venous shunt, leading to persistent respiratory distress. The PDV was closed with Amplatzer vascular plug II, and then he had immediate clinical improvement. Congenital portosystemic venous shunts (CPSS) are rare vascular malformations associated with severe complications. Here we presented a case with progressive respiratory distress as a result of CPSS and rapid improvement after embolization.
Amaç: Perimiyokardit miyokardın, miyoperikardit ise perikardın daha baskın olarak etkilendiği ancak hem miyokardın hem de perikardın da kısmen tutulumu ile karakterize inflamatuar sendromlardır. Bu çalışmada, kliniğimizde akut perimiyokardit ve miyoperikardit tanısı alan hastaların başvuru klinik prezentasyonu, laboratuvar ayırıcı tanı, görüntüleme teknikleri ve klinik deneyimlerimizle beraber tedavi yönetimimizin mortaliteye etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çocuk kardiyoloji birimine 01.01.2015- 01.08.2017 tarihleri arasında başvuran perimiyokardit/miyoperikardit tanısı almış hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, laboratuvar ve ileri görüntüleme sonuçları kaydedildi. Bulgular: Hastaların yaş aralığı 1-17 yıl (13±5,47) idi. Başvuru yakınması 16 (%88,9) hastada göğüs ağrısı, bir hastada ateş, bir hastada enterit idi. Kardiyak enzimler tüm hastalarda yüksek bulundu. Beş hastanın (%27,7) ejeksiyon fraksiyonu (EF) %55'in altında izlendi. Mortalite bir hastada izlendi. İntravenöz immünglobulin (IVIG) alan ve almayan hastalarla sol ventrikül diyastolik ve sistolik çapları, EF, fraksiyonel kısalma, göğüs ağrısı arasında fark saptanmadı (p=0,566, 1,000, 0,095, 0,208). Sonuç: Göğüs ağrısı, çarpıntı gibi şikâyetlerle başvuran ve öyküsünde üst solunum yolu enfeksiyonu olan hastalarda ön planda perimiyokardit/miyoperikardit akla gelmelidir. Sıklıkla tedavisiz de kendini sınırlayan bir hastalık olmasına rağmen bu hastaların yatarak yakın izlemi seçili hastalarda nonsteroidal antiinflamatuar ilaçlar ile beraber IVIG uygulanması da göz önünde bulundurulmalıdır.
Abstract Objective The aim of the study is to evaluate vitamin D (vit D) levels in children with and without development of multisystem inflammatory syndrome in children (MIS-C) after coronavirus disease 2019 (COVID-19) and also between those with severe and moderate MIS-C. Methods This comprises retrospective data of 68 patients including 34 patients with MIS-C and admitted into the pediatric intensive care unit (MIS-C group) and 34 patients without MIS-C (non-MIS-C group) were analyzed for their presenting characteristics, serum vit D levels, ventilatory needs, and prognostic scores. Results Vit D levels were significantly lower in patients with versus without MIS-C [9 (2–18) vs. 19 (10–43) ng/mL, p <0.001], and also in patients with severe versus moderate MIS-C [7.5 (2–17) vs. 9 (5–18) ng/mL, p = 0.024]. Vit D deficiency (levels <12 ng/mL) was more common in the MIS-C versus non-MIS-C group (79.4 vs. 11.8%, p <0.001) and in severe versus moderate MIS-C (92.9 vs. 70.0%, p <0.001). The severe versus moderate MIS-C was associated with significantly higher levels of procalcitonin [7.6 (0.9–82) vs. 1.7 (0.2–42) ng/mL, p = 0.030] and troponin [211 (4.8–4,545) vs. 14.2 (2.4–3,065) ng/L, p = 0.008] and higher likelihood of reduced ejection fraction (75.0 vs. 15.4%, p = 0.004). Conclusion Our findings indicate the higher prevalence of vit D deficiency in pediatric COVID-19 patients with versus without MIS-C, as well as in those with severe versus moderate MIS-C. Higher troponin and procalcitonin levels and dyspnea at presentation seem also to be risk factors for severe MIS-C, more pronounced cardiac dysfunction, and poorer prognosis.
Abstract Introduction Multisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. In this study, the clinical findings, organ involvements, similarities, and differences in laboratory and imaging of the children with MIS-C and KD at the time of admission will be revealed in detail, and the treatment methods and follow-up results will be revealed. Material and method Our study was a single-center study and included pediatric patients who were treated with a diagnosis of MIS-C between March 2020 and July 2023 in the pediatric cardiology, pediatric emergency, pediatric infection, and pediatric intensive care clinics at Celal Bayar University and who were treated with a diagnosis of KD (complete/incomplete) between January 2015 and July 2023. MIS-C diagnosis was made according to the Turkish Ministry of Health COVID-19 guidelines. Sociodemographic characteristics, clinical, laboratory, and echocardiography findings, treatments given, and clinical course of all patients included in the study were evaluated. Results The median age was 30 months (7–84) in KD and 96 months (6-204) in MIS-C, and it was significantly higher in the MIS-C group ( p = 0.000). Symptom duration was significantly longer in the MIS-C group ( p = 0.000). In terms of clinical features, gastrointestinal syndrome findings (nausea, vomiting, abdominal pain) and respiratory findings (dyspnea) were significantly higher in the MIS-C group ( p = 0.007, p = 0.000, p = 0.002, respectively). Regarding cardiovascular system involvement, coronary involvement was significantly higher in the KD group. However, valvular involvement, left ventricular systolic dysfunction, and pericardial effusion were significantly higher in the MIS-C group ( p = 0.000, p = 0.001, p = 0.003, p = 0.023, respectively). In terms of laboratory findings, white blood cell count was higher in KD ( p = 0.000), absolute lymphocyte count, platelet level, blood sodium, and albumin levels were lower in MIS-C group ( p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.003, respectively), ferritin and troponin levels were significantly higher in MIS-C group. These results were statistically significant ( p = 0.000, p = 0.000, respectively). D-dimer and fibrinogen levels were high in both groups, and no significant statistical difference was detected between the two groups. There was no significant difference between the two groups regarding the length of hospitalization and mortality, but steroid use was significantly higher in the MIS-C group ( p = 0.000). Conclusion In conclusion, this study has demonstrated the similarities and differences between MIS-C and KD regarding clinical findings, organ involvement, and laboratory and imaging results. The results of our study have important implications in terms of contributing to the data in the existing literature on these two diseases and for the correct diagnosis and better management of pediatric patients presenting with these disorders. What is known Multisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. What is new Although MIS-C and KD have many similarities, their symptoms, disease processes, possible complications, and treatment regimens may differ.
Iatrogenic arteriovenous fistulas (AVF), which are increasing in the literature with the increase of surgical closed vascular interventions in diagnosis and treatment, are rare but have fatal complications. AVF may present with congestive heart failure symptoms, cardio-pulmonary symptoms, and leg edema immediately after the operation or over the years, depending on the size of the fistula. Diagnosis can be made by imaging examinations such as Doppler ultrasonography, computed tomography, or magnetic resonance angiography in patients with suspected AVF. The endovascular stentgrafting approach seems to be more popular in eligible patients due to surgical treatment's high morbidity and mortality rates. We aimed to report a rare case of iliac arteriovenous fistula that developed after a laparoscopic intervention due to ovarian cyst rupture and successfully grafted with an endovascular covered stent.
Acute rheumatic fever (ARF) is an inflammatory disease that occurs following an infection with certain strains of group A beta-hemolytic streptococci. Despite dramatic falls in the incidence, Acute Rheumatic Fever remains a major cause of morbidity and mortality associated with acquired heart disease in developing countries. Infective endocarditis (IE) is defined as a microbial infection of the endothelial surface of the heart. IE occurs most frequently in patients with chronic rheumatic heart disease. As far as we know, the simultaneous occurrence of both conditions has not been previously reported. References to our outpatient clinic with complaints of fever and joint pain, clinical and laboratory findings suggestive of infective endocarditis fits both with both the ARF and remitted entirely with appropriate treatment, as far as we know, we think that this is not a case of our similar event in the literature. Here we present a case of a fifteen-year-old girl with concurrent acute rheumatic fever and infective endocarditis.
The present study aimed to investigate the outcomes of psychiatric symptoms and family functions on treatment adherence in children, in addition to sociodemographic characteristics and clinical factors related to the disease.The research sample consisted of 43 children who were followed up with rheumatic heart disease diagnosis during the study. Clinical features were obtained from the patient files. The family assessment device evaluating family functioning and the strengths and difficulties questionnaire scale to screen emotional and behavioural problems in children were used.Considering the regularity of treatment in our patients, there were 31 (72%) patients adherent to secondary prophylaxis regularly, 7 (6.9%) patients were partially adherent, and 5 (11.6%) patients non-adherent. Patients were divided into treatment adherent (Group 1) and non-adherent (Group 2). There was no statistically significant impact on treatment adherence whether the patients receive enough information, lifestyle, fear of developing adverse effects, fear of addiction, lack of health insurance, difficulties in reaching the drug or hospital. However, the fear of syringes on treatment adherence had an effect statistically significantly (p = 0.047). Forgetting to get a prescription and/or take the drug when the time comes was statistically higher in the non-adherent group (p = 0.009). There was no statistically significant effect of psychosocial factors on treatment adherence between groups.Providing an effective active recall system, involving primary care workers, providing training on the disease and its management, and a comprehensive pain management programme can improve the process, especially for cases where secondary prophylaxis is missed.
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