Virtual tissue imaging and quantification elastography in determining the effects of chronic kidney disease on tendons in pediatric patients

The aim of this study is to determine the possible elasticity changes of the quadriceps, patellar, and Achilles tendons using the Virtual Touch Tissue Imaging and Quantification (VTIQ) Elastography method in children with chronic kidney disease. VTIQ elastography measurements of the quadriceps, patellar, and Achilles tendons were performed in children with end-stage renal disease and the healthy control group. Tendon stiffness values of the patient and the control group were compared. Twenty children with end-stage renal disease and 13 healthy children were included in the study. The mean age was 13.05 ± 3.3 years,  12.31 ± 3.2 in the patient group and healthy control group, respectively. Age did not show a statistically significant difference between the patient and control group. The median duration of dialysis was 2.0 (1-9) years. Duration of the dialysis showed a positive correlation with shear wave velocity (SWV) of the musculotendinous junction (MTJ) of the right Achilles tendon (r= 0.81 and p=0.001).  Parathormone levels showed a positive correlation with SWV of MTJ of the right Achilles tendon (r=0.62 and p=0.03). There was no statistically significant difference in tendon stiffness values of right quadriceps, patellar tendons, Achilles MTJ, Achilles midtendinous (MIDT) area, left quadriceps, patellar tendons, Achilles MTJ, Achilles MIDT area between the patient and control group (p=0.93, p=0.42, p=0.21, p=0.67, p= 0.55, p= 0.19, p= 0.08, p=0.89, respectively). Tendon stiffness values did not differ in children with CKD compared to healthy children. Nevertheless, further long-time follow-up studies are needed to reveal the relation between tendon stiffness and chronic kidney disease

Elemental mercury intoxication in 7 patients admitted to a pediatric rheumatology clinic

Paç Kısaarslan A, Sözeri B, Baştuğ F, Gündüz Z, Yel S, Nalçacıoğlu H, Şahin N, Özdemir Çiçek S, Poyrazoğlu H, Düşünsel R. Elemental mercury intoxication in 7 patients admitted to a pediatric rheumatology clinic. Turk J Pediatr 2019; 61: 786-790. Mercury (Hg) is a toxic heavy metal that can be classified into three groups; organic (methyl), inorganic (mercuric), and elemental (metallic) mercury(Hg0). Mercury intoxication occurs mostly with the elemental form which can potentially damage the function of any organ, or any subcellular structure. The target organ of mercury is the brain, but peripheral nerve function, renal function, immune function, endocrine and muscle function, and several types of dermatitis have been described. We present 7 patients admitted to a pediatric rheumatology clinic with severe extremity pain. One of the patients had acrodynia, two of them had hypertension, two of them had tubulopathy, and three of them had neuropathy. The treatments were Dimercaptosuccinic acid and metalcaptase. In this report, we emphasize that mercury intoxication should be kept in mind with unexplained extremity pain. Timely diagnosis and treatment may prevent severe morbidity and mortality