Evaluation of electrocardiographic markers of cardiac arrhythmic events and their correlation with cardiac iron overload in patients with beta-thalassemia major

Iron overload is associated with an increased risk of atrial and ventricular arrhythmias. Data regarding the relationship between electrocardiographic parameters of atrial depolarisation and ventricular repolarisation with cardiac T2* MRI are scarce. Therefore, we aimed to investigate these electrocardiographic parameters and their relationship with cardiac T2* value in patients with beta-thalassemia major. In this prospective study, 52 patients with beta-thalassemia major and 52 age- and gender-matched healthy patients were included. Electrocardiographic measurements of QT, T peak to end interval, and P wave intervals were performed by one cardiologist who was blind to patients' data. All patients underwent MRI for cardiac T2* evaluation. Cardiac T2* scores less than 20 ms were considered as iron overload. P wave dispersion, QTc interval, and the dispersions of QT and QTc were significantly prolonged in beta-thalassemia major patients compared to controls. Interestingly, we found prolonged P waves, QT and T peak to end dispersions, T peak to end intervals, and increased T peak to end/QT ratios in patients with T2* greater than 20 ms. No significant correlation was observed between electrocardiographic parameters and cardiac T2* values and plasma ferritin levels. In conclusion, our study demonstrated that atrial depolarisation and ventricular repolarisation parameters are affected in beta-thalassemia major patients and that these parameters are not correlated with cardiac iron load

Recurrence of Wheezing Episodes in Children with Respiratory Syncytial Virus and Non-Respiratory Syncytial Virus Bronchiolitis

Objective: It has been shown that many children who experience respiratory syncytial virus (RSV) infection in infancy develop recurrent wheezing episodes and asthma later. Viral role in pathogenesis of asthma is still a debate. We aimed to investigate the recurrence of wheezing episodes, atopy and serum cytokine levels in children encountered with RSV infection. Additionally, we aimed to compare these parameters in children with non-RSV bronchiolitis. Material and Methods: The study was conducted between January 2006 and November 2008 in Dokuz Eylul University hospital. Seventy children aged between 0-36 months who were diagnosed with acute bronchiolitis for the first time were recruited for the study. Nasopharyngeal lavage fluid was analyzed with polymerase chain reaction (PCR) for RSV antigen in all patients. Serum immunoglobulin E, total eosinophil count, interleukin (IL)-4, IL-13 and gamma-interferon (IFN-gamma) levels were obtained at the last examination of the patients after a follow up period of 1-3 years. Results: Recurrence of a wheezing episode was observed in 35% and 53.3% of the patients in RSV group and non-RSV group, respectively (p=0.064). Mean serum IFN-gamma and IL-4 levels were detected to be significantly higher in non-RSV group. No significant relation was detected between recurrence of wheezing episodes and total eosinophil count, serum IgE, IL-4, IL-13, and IFN-gamma levels. Conclusion: No difference could be detected between RSV and non-RSV bronchiolitis regarding subsequent wheezing episodes. Although serum IL-4 and IFN-gamma levels were higher in non-RSV bronchiolitis group, no significant correlation was observed between these parameters and recurrence of wheezing episodes

Procoagulant Phospholipid Activity, Whole Blood Thromboelastography and Thrombin Generation Assay to Detect Hypercoagulability in Thalassemic Children

WOS: 00034924270816

Spontaneous epidural and subdural hematoma in a child with afibrinogenemia and postoperative management

Congenital afibrinogenemia is a rare coagulation disorder that exhibits recessive inheritance. The prevalence of this disease is around 1 per 1 000 000, but it is increased in countries where consanguineous marriages are common. Umbilical cord bleeding during the neonatal period is generally the first manifestation of the disease, but a later age of onset is not uncommon. This disease may also be manifested by gastrointestinal, genitourinary, mucosal, muscular, articular, and intracranial bleeding during childhood. Intracranial hemorrhage is a rare condition, but it is the leading cause of death in patients with afibrinogenemia. In this report, we present the case of a 13-year-old female patient with afibrinogenemia who underwent an operation for spontaneous massive extradural and subdural hematoma

Analysis of Fatal Cases of Pandemic Influenza A (H1N1) Virus Infections in Pediatric Patients with Leukemia

Background: Pandemic influenza A/H1N1/2009 virus usually causes mild illness in healthy children. Chronic medical conditions are recognized as increasing the risk for complications of influenza virus infection. Although most studies including children with acute leukemia and H1N1 virus have reported no deaths, some anectodal reports with low patient numbers have reported mortality rates as high as 28.5%. Here, we report patients with leukemia and H1N1 virus and review the literature. Methods: Medical records of all children with leukemia and H1N1 virus in our institution were reviewed for demographic, clinical, and laboratory data. We also carried out a systematic review of the English-language literature. Among the 24 articles found, only patients with leukemia and pandemic H1N1 infections were reviewed by two independent reviewers. Results: Eight of 98 children who received chemotherapy for leukemia were diagnosed with pandemic H1N1 infection. One developed pneumonia and acute respiratory distress syndrome (ARDS) and died. Another one developed hemophagocytic lymphohistiocytosis (HLH) and died due to secondary infection during the 6th week of treatment for HLH. In our study, 2 of 8 patients had a fatal course (25%), compared with an overall mortality of 2.5% in the studies retrieved from PubMed (6/232). Conclusion: Pandemic H1N1 influenza virus caused mortality in patients with ARDS or HLH; an unexpected finding for pandemic H1N1 (2009) influenza virus. Thus, for children with leukemia and infected with H1N1 virus, short-and long-term complications should be kept in mind during evaluation