How do different types of physical activity affect echocardiography findings and heart rate variability in children?

This study aims to investigate how different types of regular physical activity affect cardiac functions in school children. This is a cross-sectional review of 15 children who are not engaged with any regular physical activity (controls) and 60 athletes who swim (n=15), play basketball (n=15), play volleyball (n=15), and play tennis (n=15) regularly. The children who are not engaged with any sports, the children who swim, and the children who play basketball, volleyball and tennis are statistically similar with respect to age, sex, height, weight and body mass index (p>0.05 for all). When compared to the controls and other athletes, the swimmer children have significantly higher left ventricle diastolic mass, higher left ventricle posterior wall systolic thickness, lower mitral A wave, higher mitral annular plane systolic excursion and higher mitral E/A ratio (p=0.006, p=0.035, p=0.030, p=0.025 and p=0.043 respectively). The swimmer children have significantly lower interventricular septum E and A waves and significantly longer left ventricle IVRT than the controls and other athletes (p=0.001, p=0.040 and p=0.004 respectively). When compared with the controls and other athletes, the swimmer children have significantly lower p-wave dispersion and QT dispersion values (p=0.038 and p=0.035 respectively). The swimmer children have significantly higher total power and SDNN values than the controls and other athletes (p=0.046 and p=0.026 respectively). Swimming might contribute to the growth of cardiac muscles and help to improve the cardiac conduction system and enhance parasympathetic innervation of the heart in children. [Med-Science 2022; 11(4.000): 0-0

The Short-Term Effects of Ketogenic Diet on Cardiac Ventricular Functions in Epileptic Children

OBJECTIVE: Our primary aim was to determine the short-term effects of a ketogenic diet on cardiac ventricular function in patients with refractory epilepsy. METHODS: Thirty-eight drug-resistant epileptic patients who were treated with a ketogenic diet were enrolled in this prospective study. Echocardiography was performed on all patients before beginning the ketogenic diet and after the sixth month of therapy. Two-dimensional, M-mode, color flow, spectral Doppler, and pulsed-wave tissue Doppler imaging measurements were performed on all patients. RESULTS: The median age of the 32 patients was 45.5 months, and 22 (57.8%) of them were male. Body weight, height, and body mass index increased significantly at the sixth month of therapy when compared with baseline values (P 0.05). Doppler flow indices of mitral annulus and tricuspid annulus velocity of patients at baseline and month 6 showed no significant differences (P > 0.05). Tricuspid annular E/A ratio was lower at month 6 (P 0.05), there was a decrease in Ea velocity and Ea/Aa ratio gathered from tricuspid annulus at month 6 compared with baseline (P < 0.05). CONCLUSION: A 6-month duration ketogenic diet does not impair left ventricular functions in children with refractory epilepsy; however, it may be associated with a right ventricular diastolic dysfunction

Childhood headaches and brain magnetic resonance imaging findings

Background: Headaches are common in children and brain magnetic resonance imaging (MRI) studies are widely used in everyday clinical practice because of increasing demands by parents

Are Mean Platelet Volume and Platelet Distribution Width Useful Parameters in Children With Acute Rheumatic Carditis?

Rheumatic fever (RF) is an inflammatory disease caused by autoimmune response to a preceding group A streptococcal infection. Mean platelet volume (MPV) reflects the platelet size and the rate of platelet production in bone marrow, and it may be used as an indicator of platelet activation and severity of inflammation. Fifty-three consecutive patients diagnosed with acute rheumatic carditis and 53 control subjects were enrolled into this study. Leukocyte and platelet counts were significantly higher in patients with acute carditis before treatment compared with controls, whereas MPV and platelet distribution width (PDW) values were not significantly different between groups. Platelet counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values were decreased significantly in patients with RF after treatment. There was not a significant difference in terms of platelet count between the controls and the patient group after treatment. ESR was found to be correlated with CRP in patients before and after treatment. In conclusion, the results of our study showed that MPV and PDW levels do not change during acute rheumatic carditis before and after treatment

Kefir Prevents Adipose Tissue Growth Through the Induction of Apoptotic Elements in High-Fructose Corn Syrup-Fed Rats

Consumption of high-fructose corn syrup (HFCS) in the diet is a causal factor in the development of abdominal obesity; however, the molecular mechanism behind this association is still up for debate. This study evaluated the metabolic disturbances that are caused by HFCS on adipose tissue as well as the possibility of kefir as a therapy to prevent these metabolic disturbances. Male Wistar rats were divided into four groups: control, kefir, HFCS, and HFCS+kefir. HFCS (20%, w/v) was given in drinking water and kefir (1 mL/100 g body weight) by gastric gavage daily for 8 weeks. Levels of insulin signaling, inflammation, and apoptosis-associated proteins of adipose tissues were determined with Western blot and immunohistochemical techniques. Gene expressions were evaluated with semi-quantitative real-time polymerase chain reaction (qRT-PCR). The indirect terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) method was used to assess changes in apoptotic cells, and hematoxylin/eosin staining to determine adipocyte number and diameter. Accordingly, HFCS boosted protein kinase B (Akt) and p-Akt while reducing nuclear factor κB (NF-κB), and tumor necrosis factor alpha (TNFα) levels and kefir treatment restored Akt induction in HFCS-treated rats despite raising NF-κB, and TNFα. Increased expression of Akt and B-cell lymphoma-2 gene (Bcl2) was contrasted with decreased expression of Nfkb, Tnfa, tumor protein 53 gene (p53), and caspase-8 gene (Casp8). Furthermore, while there was a marked reduction in TUNEL-positive cells in the HFCS group, the number of such cells was greater in the HFCS+kefir group. These results show that HFCS intake suppresses apoptosis in adipose tissues, which may be responsible for tissue development and abdominal obesity and may be reversed with kefir administration due to the activation of apoptosis-associated genes and proteins

The evaluation of right and left ventricular functions in children with episodic wheezing exposed to environmental tobacco smoke

The objective of this study is to examine the right and left ventricular functions in children with episodic wheezing at the ages of 1-3 exposed to environmental tobacco smoke (ETS). Thirty-two children monitored at the Pediatric Allergy and Immunology Department of a Research and Training Hospital with the diagnosis of episodic wheezing were included. The prospective assessment of the patients was performed between May 2013 and February 2014. Twenty-five children with episodic wheezing not exposed to ETS formed the control group. The two groups were compared by conducting transthoracic two-dimensional and tissue Doppler echocardiography (TDE) examination in all of the cases. The average age of the study group (24 boys, 8 girls) was 33.1 +/- 8.8 months, the average age of the control group (18 boys, 7 girls) was 31.9 +/- 11.9 months. There was no statistically significant difference between the two groups in terms of age, gender, weight, height, and body mass index values. There was no statistically significant difference between the two groups for the right and left ventricular systolic and diastolic functions in the conventional echocardiographic measurements, and for the measurements of TDE. Limited number of patients is a major limitation of the study. These results should be supported by more comprehensive studies

Factors Affecting Brucella spp. Blood Cultures Positivity in Children

Brucella infections have a wide spectrum of symptoms especially in children, making the diagnosis a complicated process. The gold standard for the final diagnosis for brucellosis is to identify the Brucella spp. isolated from blood or bone marrow cultures. The main purpose of this work was to evaluate the factors affecting the isolation of Brucella spp. from blood cultures. In our study, the ratio of fever, presence of hepatomegaly, and splenomegaly were found to be higher in the bacteremic group. In addition, C-reactive protein levels and liver function enzymes were found to be higher in the bacteremic group. In our opinion, while evaluating the febrile child with suspected Brucella infection, we highly recommend sampling blood cultures regardless of the history of previous antimicrobial therapy and duration of the symptoms

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality

COVID-19 Disease in Presenting to the Pediatric Emergency Department: A Multicenter Study of 8886 Cases.

Background: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical out-comes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.Methods: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific anti-bodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of con-tact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.Results: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.Conclusion: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.(c) 2022 Elsevier Inc. All rights reserved