Short-term azithromycin use is associated with QTc interval prolongation in children with cystic fibrosis

BACKGROUND

Azithromycin is used for children with cystic fibrosis (CF) for its immunomodulatory and anti-inflammatory action. This study investigated the short-term alterations in QTc interval associated with azithromycin prophylaxis in pediatric patients with CF.

METHODS

This study included 121 patients with mild CF, of whom 76 received azithromycin (patient group) and 45 did not receive azithromycin (control group). The patient and control groups were categorized according to age as under 12 years of age and over 12 years of age. The first presentation measured all the patient and control groups at basic QTc time intervals. The QTc intervals of all patients were then remeasured systemically at 1, 3, and 6 months. Age categories and QTc intervals that were calculated at each month in the patient and control groups were compared statistically.

RESULTS

A statistically significant difference was detected in the patient group between the initial QTc interval time and the electrocardiogram (ECG) findings in the first and third months after prophylaxis treatment (p < 0.001; p = 0.01). However, no statistically significant difference was detected in the sixth month (p > 0.05) in all groups. Almost all of the children's QTc intervals were within normal range and within the safety zone (under 0.44 s). No statistically significant difference was detected in the control group between the initial ECG and the QTc intervals measured at 1, 3, and 6 months.

CONCLUSION

Short-term use of azithromycin prophylaxis in pediatric patients with mild CF slightly increased the QTc interval in the first and third months of follow-up. Nevertheless, all QTc interval changes fell within the safety zone. Notably, 1 month of follow-up treatment should be performed to check for any alteration in the QTc interval. If increased QTc interval duration is not detected in the first month, azithromycin prophylaxis can be safely prescribed.

The success of the Cystic Fibrosis Registry of Turkey for improvement of patient care

BACKGROUND

Cystic fibrosis (CF) registries play an essential role in improving disease outcomes of people with CF. This study aimed to evaluate the association of newly established CF registry system in Turkey on follow-up, clinical, growth, treatment, and complications of people with this disease.

METHODS

Age at diagnosis, current age, sex, z-scores of weight, height and body mass index (BMI), neonatal screening results, pulmonary function tests, history of meconium ileus, medications, presence of microorganisms, and follow-up were evaluated and compared to data of people with CF represented in both 2017 and 2019 registry data.

RESULTS

There were 1170 people with CF in 2017 and 1637 in 2019 CF registry. Eight hundred and fourteen people were registered in both 2017 and 2019 of whom z-scores of heights and BMI were significantly higher in 2019 (p = 0.002, p =0.039, respectively). Inhaled hypertonic saline, bronchodilator, and azithromycin usages were significantly higher in 2019 (p =0.001, p = 0.001, p = 0.003, respectively). The percent predicted of forced expiratory volume in  1 sec and forced vital capacity were similar in 2017 and 2019 (88% and 89.5%, p = 0.248 and 84.5% and 87%, p =0.332, respectively). Liver diseases and osteoporosis were significantly higher, and pseudo-Bartter syndrome (PBS) was significantly lower in 2019 (p = 0.011, p = 0.001, p = 0.001, respectively).

CONCLUSIONS

The z-scores of height and BMI were higher, the use of medications that protect and improve lung functions was higher and incidence of PBS was lower in 2019. It was predicted that registry system increased the care of people with CF regarding their follow-up. The widespread use of national CF registry system across the country may be beneficial for the follow-up of people with CF.

Evaluation of diagnostic components and management of childhood pulmonary tuberculosis: a prospective study from Istanbul, Turkey

INTRODUCTION

The diagnosis of childhood tuberculosis is difficult and most of the patients are diagnosed clinically. The objective of this study is to reveal the diagnostic and therapeutic components of childhood pulmonary tuberculosis and to analyze the changes that occurred in our country over the years.

METHODOLOGY

All patients diagnosed with tuberculosis between 2006 and 2016 were included. Demographic characteristics, diagnostic and treatment outcomes were recorded and patients were followed up prospectively.

RESULTS

A total of 492 patients were included in the study. 97% had Bacillus Calmette-Guerin vaccine, 36% were diagnosed with microbiologically-confirmed tuberculosis and 64% were diagnosed with clinically-proven tuberculosis. 94% of the patients had symptoms consistent with tuberculosis, all patients had radiologic findings, 74% had a history of tuberculosis contact and 63% had tuberculin skin test positivity. The diagnoses included primary tuberculosis in 62%, secondary tuberculosis in 21%, progressive primary tuberculosis in 13% and miliary tuberculosis in 4%. 48% of the patients received a treatment regimen containing three drugs as the initial treatment, and drug-related side effects developed in 12%. Isoniazid resistance was detected in 13% of the patients and rifampicin resistance was detected in 8%. None of the patients died due to tuberculosis. In the last 50 years in Turkey, the rates of Bacillus Calmette-Guerin vaccination and diagnosis of tuberculosis cases have increased and the mortality rates have decreased over the years.

CONCLUSIONS

Our study is one of the few prospective studies and revealed the differences between the recent data and the past 50 years in childhood tuberculosis in Turkey.

Evaluation of cardiac arrhythmias by electrocardiographic markers in pediatric patients who have tuberous sclerosis without cardiac rhabdomyoma

BACKGROUND

Tuberous sclerosis (TS) is an autosomal dominant and hereditary disorder. Cardiac rhabdomyoma and arrhythmias are the most deleterious risk factors linked to TS. Although arrhythmias in pediatric patients with TS who have cardiac rhabdomyoma have been frequently reported, arrhythmia in patients who have TS without rhabdomyoma is rarely reported in the literature. The study aimed to assess the susceptibility of pediatric patients who have TS without cardiac rhabdomyoma to cardiac arrhythmia using electrocardiographic (ECG) markers.

METHODS

This prospective study included 10 patients who had TS without cardiac rhabdomyoma. The control group was made up of 30 healthy children of the same age and sex as the patient group. P wave, P wave dispersion, QT dispersion, QTc dispersion, TP-e interval, and TP-e interval dispersion were calculated on 12-lead surface ECGs for each patient in both groups and compared.

RESULTS

P wave, P wave dispersion, QT dispersion, and QTc dispersion were found to be significantly higher in the patient group (P<0.001). Furthermore, patients had a greater Tp-e interval and Tp-e interval dispersion than healthy children (P<0.001).

CONCLUSION

Pediatric patients with TS without cardiac rhabdomyoma might be prone to atrial and ventricular arrhythmias according to their prolonged ECG markers. Our findings suggest that patients with TS without cardiac rhabdomyoma need close monitoring for atrial and ventricular arrhythmias.

Assessment of Right Heart Functions in Children with Mild Cystic Fibrosis

BACKGROUND

Cystic fibrosis (CF) is a multisystemic disease that prevalently involves the lungs. Hypoxemia occurs due to the existing of progressive damage to the pulmonary parenchyma and pulmonary vessels. The condition may cause systolic and diastolic dysfunction to the right ventricle due to the effects of high pulmonary artery systolic pressure (PASP). The study aimed to determine echocardiographic alterations in PASP, right ventricle (RV) anatomy, and functions in mild CF children.

MATERIALS AND METHODS

RV anatomy, systolic, and diastolic functions were evaluated with conventional echocardiographic measurements. Estimated PASP was used measured with new echocardiographic modalities, including pulmonary artery acceleration time (PAAT), right ventricular ejection time (RVET), and their ratio (PAAT/RVET). The obtained echocardiographic data were statistically compared between the patient group and the control group.

RESULTS

The study consisted of 30 pediatric patients with mild CF and 30 healthy children with similar demographics. In patient group, conventional parameters disclosed differences in RV anatomy, both systolic and diastolic functions of RV compared with the healthy group. We did not compare the patient group with published standard data because of the wide range variability. However, new echocardiographic parameters showed notable increase in pulmonary artery pressure compared with values of control group and published standard data (p<0.001).

CONCLUSION

Elevated PASP, RV failure, and Cor pulmonale usually begin early in children with mild CF. In addition to routine echocardiographic measurements to evaluate RV, we recommend the use of new echocardiographic modalities for routine examinations and in the follow up of children with mild CF.

A Snapshot of Pediatric Patients with COVID-19 in a Pandemic Hospital

AIM

Reports describing coronavirus disease 2019 (Covid-19) in children are fewer than adult studies due to milder clinical picture. We aimed to share our experience at a single center with an emphasis on collective decision making.

MATERIALS AND METHODS

A suspected case was defined as the presence of symptoms suggestive of COVID-19 and/or positive contact history. SARS-CoV-2 PCR positive patients were defined as confirmed COVID-19. Between March 12, 2020, and May 15, 2020, all children presenting with fever, cough, or respiratory difficulty were investigated for COVID-19. A total of 719 children were examined at outpatient clinics, and 495 were tested with polymerase chain reaction (PCR) for suspicion of COVID-19. A team was organized for monitoring and treating patients either as outpatients or hospitalization. Patients were evaluated in terms of age, gender, travel history, epidemiological history, clinical symptoms and signs, laboratory and radiological findings, treatment, and outcome.

RESULTS

Sixty patients were hospitalized for suspicion of COVID-19. Forty-three patients were diagnosed as probable or confirmed COVID-19. 21 of 43 patients (48.8%) were PCR confirmed. The remaining 22 were diagnosed by epidemiologic history, clinical assessment, and computerized thorax tomography (CT) findings. The median age was 126 and 78.5 months in PCR positives and PCR negatives, respectively and the youngest patient was a 28 days old baby. Nineteen of the patients had an upper respiratory infection (44.1%). Although five patients had no clinical signs, chest X-ray, or CT revealed pneumonia.

CONCLUSIONS

As previously reported, the clinical manifestations of COVID-19 in children are mostly mild. Even very young kids can become infected following exposure to sick family members. International and local guidelines are valuable for decision making since it is a new disease. A combination of chest disease, infectious diseases, and emergency care physicians approach will aid the appropriate management of cases.

Short-term efficacy of ORS formulation and propranolol regimen in children with POTS

BACKGROUND

To evaluate the short-term effectiveness of reduced-osmolarity oral rehydration salt formulation (ORS) and propranolol in children diagnosed with postural orthostatic tachycardia syndrome (POTS) in head-up tilt testing (HUTT).

METHODS

Children were admitted with symptoms of orthostatic intolerance (OI) occurring in a standing position and disappearing in the supine position. Patients with heart rate increments of ≥40bpm and symptoms of OI constituted the pediatric POTS group in HUTT. A total of 70 pediatric patients with POTS were included in the study. POTS patients were divided into two groups based on whether they were prescribed reduced-osmolarity ORS and propranolol or not. The study group comprised patients on a regimen of reduced-osmolarity ORS and propranolol (n=34), while the control group comprised patients who were not prescribed any medication (n=36). The frequency of symptoms and standardized symptom scores were analyzed before and after 3 months of treatment in both groups.

RESULTS

The post-treatment frequency of syncopal attacks was significantly reduced in both groups (P<0.01 for both groups), but the post-treatment standardized symptom scores were significantly reduced in the pediatric study group compared with the control group (P<0.01).

CONCLUSION

The frequency of syncopal attacks was significantly reduced and the symptom scores for OI were improved in the study group. The improvement in OI symptom scores was better in the treatment group than in the control group. The control group symptoms persisted and caused extreme difficulty in their daily activities. In view of its clinical efficacy, we strongly advocate the use of combined treatment of reduced-osmolarity ORS and low-dose propranolol in pediatric patients with POTS.

Evaluation of autonomic nervous system function in children with overactive bladder syndrome

PURPOSE

We aimed to evaluate the autonomic nervous system activity in children with overactive bladder (OAB) syndrome.

METHODS

Included in the study were 40 children with overactive bladder and 28 healthy controls. Autonomic tests were performed on all participants, including heart rate interval variation (RRIV), heart rate response to valsalva maneuver, and sympathetic skin response (SSR).

RESULTS

Mean valsalva rates in the overactive bladder and control groups were 1.53 ± 0.29 and 1.30 ± 0.18, respectively, a statistically significant difference (P < 0.001). Also significantly different were deep breathing RRIV values of the study and control groups: 56.65 ± 14.66 and 47.92 ± 10.15, respectively (P = 0.008). No statistical differences were found in SSR when OAB patients were compared with controls (P > 0.05).

CONCLUSIONS

This study demonstrated a parasympathetic hyperactivity in children with OAB, results suggesting a dysfunction in their autonomic nervous systems. Neurourol. Urodynam. 36:673-676, 2017. © 2016 Wiley Periodicals, Inc.

SIRT1 gene variants are related to risk of childhood obesity

Obesity is a multifactorial disorder resulting from the interaction between genetic, psychological, physical, environmental, and socioeconomic factors. SIRT1 gene has important effects on the regulation of adiponectin, caloric restriction, insulin sensitivity, coronary atherosclerosis, and cardiovascular diseases. The aim of this study was to investigate the association between childhood obesity and SIRT1 gene polymorphisms regarding rs7895833 A > G in the promoter region, rs7069102 C > G in intron 4, and rs2273773 C > T in exon 5 using PCR-CTPP method in 120 obese and 120 normal weight children. In this study, BMI, systolic and diastolic blood pressure, LDL cholesterol, triglyceride, and insulin levels were significantly higher and HDL-cholesterol levels were significantly lower in obese children compared to normal weight children. For rs7895833 A > G, the rate of having AG genotype and G allele was significantly higher in obese children compared to non-obese group (p < 0.001). The risk for obesity was increased by 1.9 times in G allele carriers; therefore, A allele may be protective against obesity. Both study groups had CT heterozygote genotype for rs2273773 C > T. There was no significant difference for rs7069102 C > G gene polymorphism between groups.

CONCLUSION

This is the first study reporting an association between SIRT1 gene polymorphisms and obesity in children.

A remarkable age-related increase in SIRT1 protein expression against oxidative stress in elderly: SIRT1 gene variants and longevity in human

Aging is defined as the accumulation of progressive organ dysfunction. Controlling the rate of aging by clarifying the complex pathways has a significant clinical importance. Nowadays, sirtuins have become famous molecules for slowing aging and decreasing age-related disorders. In the present study, we analyzed the SIRT1 gene polymorphisms (rs7895833 A>G, rs7069102 C>G and rs2273773 C>T) and its relation with levels of SIRT1, eNOS, PON-1, cholesterol, TAS, TOS, and OSI to demonstrate the association between genetic variation in SIRT1 and phenotype at different ages in humans. We observed a significant increase in the SIRT1 level in older people and found a significant positive correlation between SIRT1 level and age in the overall studied population. The oldest people carrying AG genotypes for rs7895833 have the highest SIRT1 level suggesting an association between rs7895833 SNP and lifespan longevity. Older people have lower PON-1 levels than those of adults and children which may explain the high levels of SIRT1 protein as a compensatory mechanism for oxidative stress in the elderly. The eNOS protein level was significantly decreased in older people as compared to adults. There was no significant difference in the eNOS level between older people and children. The current study is the first to demonstrate age-related changes in SIRT1 levels in humans and it is important for a much better molecular understanding of the role of the longevity gene SIRT1 and its protein product in aging. It is also the first study presenting the association between SIRT1 expression in older people and rs7895833 in SIRT1 gene.

Extraordinary cause of complete colonic obstruction in children: urinary retention

Complete colonic obstruction in children may occur secondary to congenital, and acquired factors related to the gastrointestinal system. Herein, we report an extraordinary presentation of complete colonic obstruction due to extensive urinary retention in a 3-year-old boy. The possible underlying mechanism was detected as urinary infection in a child with horseshoe kidney. The treatment of the bladder symptoms and urinary infection relieved the obstruction of the colon. To our knowledge, especially in children, colonic obstruction due to urinary retention has not been reported in the literature.

Skin temperature measurement using an infrared thermometer on patients who have been exposed to cold

BACKGROUND

The aim of this study was to determine if the skin temperature of febrile children is affected by the child's exposure to cold outdoor temperatures immediately prior to the taking of that temperature.

METHODS

A total of 150 febrile and non-febrile children (aged 3-10 years) who had walked to the hospital's pediatric emergency department and were thus exposed to outside cold weather were enrolled in the study. Using infrared thermometry, forehead and chest skin temperatures were simultaneously measured every 2 min during the first 14 min after presentation. Temperatures were recorded and differences between the two measurements were calculated.

RESULTS

By the fifth evaluation (10 min from the first reading), skin temperatures from forehead and chest had equalized.

CONCLUSION

Determination of fever from the body parts that had been exposed to cold environmental conditions may cause contradictory results if taken while the child is still chilled from exposure to the cold. For accuracy, children should be acclimated to the indoor temperature before taking body temperature readings. Acclimation takes at least 10 min after coming in from cold weather outside.

A pediatric case of factitious disorder with unexplained bleeding symptoms

Factitious disorder is characterized by deliberate production or imitation of physical or psychological symptoms in order to adopt the sick role. The disorder can be seen as factitious bleeding. Factitious bleeding is a rare disorder in pediatric population. The concomitant appearance of hemoptysis and hematuria in the same patient has not been previously reported. In this case report, we present a pediatric case of factitious disorder with both hemoptysis and hematuria.

Plasma paraoxonase activity and oxidative stress and their relationship to disease severity in children with allergic rhinitis

BACKGROUND

Oxidative stress may play a role in the pathophysiology of several diseases including allergic rhinitis (AR). In children with AR an antioxidant enzyme paraoxonase (PON1) has not been previously investigated. The aim of this study was to investigate plasma PON1 activity and plasma total oxidant status (TOS), which are in the form of plasma reactive oxidants, and their association with severity of disease in house-mite-sensitive children with AR.

METHODS

This study included 66 children with persistent AR and 40 healthy controls aged between 7 and 12 years old. Plasma PON1, TOS, and total serum immunoglobulin E (IgE) were measured. The nasal symptom scores and body mass index were evaluated at the time of blood collection.

RESULTS

Mean serum PON1 levels were significantly lower and, TOS levels were higher in the patient group than in the control group (p ≤ 0.001 and p ≤ 0.002, respectively). A significant negative correlation was observed between serum levels of PON1 and nasal symptom scores. However, serum levels of TOS were correlated with nasal symptom scores positively. There were no correlations between levels of total IgE and levels of PON1 and TOS levels.

CONCLUSION

Plasma PON1 and TOS levels may serve as predictors of disease severity in children with AR and both of them appear to be attractive candidates for modulating inflammation in AR.

Oxidative and antioxidative status of children with acute bronchiolitis

OBJECTIVE

Oxidative stress has been shown to contribute to the pathogenesis of acute and chronic lung inflammatory diseases. This article aimed to evaluate the oxidant/antioxidant status of children with acute bronchiolitis through the measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index.

METHODS

Children with acute bronchiolitis admitted to the pediatric emergency department of a university hospital between January and April of 2012 were compared with age-matched healthy controls. Patients with acute bronchiolitis were classified as mild and moderate bronchiolitis. Oxidative and antioxidative status were assessed by measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index.

RESULTS

Thirty-one children with acute bronchiolitis aged between 3 months and 2 years, and 39 healthy children were included. Total oxidative status (TOS) was higher in patients with acute bronchiolitis than the control group (5.16±1.99 μmol H2O2 versus 3.78±1.78 μmol H2O2 [p=0.004]). Total antioxidant capacity (TAC) was lower in children with bronchiolitis than the control group (2.51±0.37 μmol Trolox eqv/L versus 2.75±0.39 μmol Trolox eqv/L [p=0.013]). Patients with moderate bronchiolitis presented higher TOS levels than those with mild bronchiolitis and the control group (p=0.03, p<0.001, respectively). Patients with moderate bronchiolitis had higher oxidative stress index levels than the control group (p=0.015). Oxygen saturation level of bronchiolitis patients was inversely correlated with TOS (r=-0.476, p<0.05).

CONCLUSION

The balance between oxidant and antioxidant systems is disrupted in children with moderate bronchiolitis, which indicates that this stress factor may have a role in the pathogenesis of the disease.

Osteocalcin, cortisol levels, and bone mineral density in prepubertal children with asthma treated with long-term fluticasone propionate

AIMS

The objective of this study is to determine the effects of the long-term treatment with inhaled fluticasone propionate on osteocalcin, cortisol levels, and bone mineral status in children with asthma.

METHODS

This cross-sectional study examined 230 prepubertal children with asthma (aged 6–11) who had intermittently used inhaled fluticasone propionate for at least 5 years at a mean daily dose of 200 μg (range: 200-350 μg). Serum osteocalcin, cortisol, and bone mineral density (BMD) of the lumbar spine were obtained from each participant. The control group consisted of gender- and age-matched children (n = 170) who were newly diagnosed with asthma and who were not being treated with corticosteroid.

RESULTS

The average age (± SEM) was 8.9 ± 0.7 years, their mean (± SEM) daily steroid dose was 180.3 ± 55.0 μg, with 236.5 ± 17.2 g total steroid use during treatment. Between the study and the control groups, no significant differences were observed in cortisol, osteocalcin levels, and BMD (p > 0.05).

CONCLUSION

Long-term treatment with inhaled fluticasone propionate (100 μg twice daily) revealed no negative effects on serum osteocalcin, cortisol levels, and BMD in children with asthma.

Pupillometric assessment of autonomic nervous system in children with allergic rhinitis

OBJECTIVE

The purpose of this study was to investigate autonomic nervous system dysfunction by measuring pupil sizes in pediatric patients with allergic rhinitis.

SUBJECTS AND METHODS

The study group consisted of 60 children (28 girls and 32 boys) who were age and gender matched with the control group, which also consisted of 60 children (26 girls and 34 boys). The diagnosis of allergic rhinitis was based on the history, physical examination and skin prick test performed by an allergologist. Pupil diameter measurements were performed using the pupillometer incorporated in the NİDEK OPD-Scan.

RESULTS

In the allergic rhinitis group, mean photopic and mesopic pupil diameters were 3.52 ± 0.07 and 5.98 ± 0.21, respectively, while in the control group, corresponding measurements were 4.03 ± 0.18 and 6.55 ± 0.16. There was a significant difference for photopic and mesopic pupil diameter between the groups (p < 0.001).

CONCLUSION

This study showed that the pupil size in response to a light stimulus in children with allergic rhinitis was smaller than that of the control group and may indicate parasympathetic hyperactivity and sympathetic hypoactivity.