Effects of carvedilol therapy on cardiac autonomic control, QT dispersion, and ventricular arrhythmias in children with dilated cardiomyopathy

The purpose of this study was to examine the effects of carvedilol therapy on autonomic control of the heart and QT-interval dispersion (QTd) among children with idiopathic dilated cardiomyopathy (DCM) whose symptoms were not adequately controlled with standard congestive heart failure therapy. Material/Methods: Patients with DCM who were treated with carvedilol were enrolled in the study. All patients had undergone carvedilol therapy in addition to standard therapy for at least 6 months. Clinical, echocardiographic, and electrocardiographic parameters, and 24-h Holter records of patients were retrospectively evaluated before and after carvedilol treatment. Results: A total 34 patients (mean age: 7.4±4.3 years) with DCM were analyzed in the study. The median follow-up period was 9.5 months. After the 6 months of carvedilol therapy the clinical score significantly improved, left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) significantly increased, and left ventricle enddiastolic dimensions and end-systolic dimensions significantly decreased. There were statistically significant increases in mean SDNN, SDANN, rMSSD, and pNN50 (p=0.002, p=0.001, p=0.008, and p=0.026, respectively). After the carvedilol therapy, SDNN was correlated with the clinical score, heart rate, LVEF, LVFS, and total premature ventricular contractions (PVCs). In addition, rMSSD and pNN50 were correlated with heart rate, LVEF and LVFS. A significant reduction was observed in QTc-minimum, QTc-maximum, and QTd values (434.9±40.7 vs. 416.1±36.5, 497.8±43.6 vs. 456.3±41.7, 58.6±17.1 vs. 49.3±15.6; p<0.001, p=0.001, and p=0.008, respectively). QTd was significantly related to PVCs (r=0.62, p=0.02). Conclusions: We conclude that the addition of carvedilol to standard therapy can improve clinical symptoms and heart rate variability, and reduce in arrhythmia markers in children with DCM

The association between febrile seizures and iron deficiency anemia in childhood

Amaç: Çocukluk çağında en sık görülen konvülziyon tipi olan febril konvülziyonun etiyolojisi ve risk faktörleri içinde son yıllarda demir eksikliği anemisi üzerinde durulmaktadır. Çalışmamızda demir eksikliği ve demir eksikliği anemisiyle febril konvülziyon arasındaki ilişkinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Kasım 2003- Ağustos 2004 tarihleri arasında hastanemiz Çocuk Hastalıkları polikliniği ve acil servise başvuran yaşları 6 ay ile 5 yaş arasında 139 çocuk çalışmaya dahil edildi. Hastalarda demir eksikliği anemisi ve febril konvülziyon tanıları Amerikan Pediatri Akademisi kriterlerine göre belirlendi. Çalışma grubu, bir veya birden fazla febril konvülziyon geçirmiş, antiepileptik tedavi almayan 93 çocuktan oluştu. Kontrol grubu ateşli hastalığı olan konvülziyon geçirmemiş (n=21) ve sağlıklı çocuklardan (n=25) oluşturuldu. Bulgular: Çalışma grubu ve kontrol grupları arasında Hb, MCV ve ferritin düzeylerinde istatistiksel olarak anlamlı bir fark saptanmadı (p>0,05). Febril konvülziyon grubunda sağlıklı çocuk ve ateşli kontrol grubuna göre serum demir düzeyi anlamlı düşük bulundu. Tartışma: Çalışmamızda febril konvülziyonlu çocuklarda demir eksikliği anemisi oluşmadan serum demir düzeyinde düşüklük saptanması, febril konvülziyonda demir eksikliğinin kolaylaştırıcı belki de tetikleyici faktör olabileceğini düşündürmektedir. Ancak bu bulguyu aydınlatmak için daha fazla standardize edilmiş kontrollü çalışmaya ihtiyaç vardır.Aim: Febrile seizures are the most common seizure type in childhood. In recent years febrile seizures are linked with iron deficiency anemia. The aim of this study is to evaluate the association between febrile seizures and iron deficiency and iron deficiency anemia. Material and Method: 139 children, aged 6 months to 5 years, admitted to our pediatric outpatient and emergency clinic between November 2003 and August 2004 were enrolled in the study. The diagnosis of iron deficiency anemia and febrile seizures were made according to the criteria of American Academy of Pediatrics. The study group consisted of 93 children with one or more febrile convulsions. None of them was on antiepileptic therapy. The control groups consisted of children with a febrile illness in the absence of convulsions (n=21) and healthy children (n=25). Results: There was no statistically significant difference in Hb, MCV and ferritin levels between the study and control groups (p&gt;0,05). The serum iron levels were lower in the children with febrile seizures compared to the children with a febrile illness in the absence of febrile seizures and healthy children. The result is statistically significant (p&lt;0,05). Discussion: The present study showed that the percentage of iron deficiency is higher in the children with febrile seizures compared to the control groups even before the anemia develops. The results of this study suggest that iron deficiency may play a role in the etiopathogenesis of febrile seizures. However, further standardized and controlled studies are required to evaluate this finding