We examined the foetal cardiac structural and functional characteristics in diabetic pregnancies versus non-diabetic, healthy pregnancies. Between August 2015 and April 2016, 32 pregnant women with pregestational diabetes, 36 pregnant women with gestational diabetes, and 42 healthy pregnant women were scheduled to have foetal echocardiograms to assess cardiac structure and function. In the diabetic groups, the foetal interventricular septum (IVS) thickness was significantly greater than in non-diabetics (p < .05) but none had an IVS >2 SD from normal. The peak velocity of tricuspid E, and the E/A ratio were significantly lower in the diabetic groups (p < .05). Tricuspid valve E values and the E/A ratio were lower in the diabetic group than in the control group (p < .05) but there was no significant difference between the pre-GDM and GDM groups (p > .05). Interventricular septal hypertrophy is the most common structural abnormality in diabetic pregnancies. These changes do not pose a risk to the foetal unless they cause functional impairment. Thus, we believe that it is important for diabetic pregnant women to be monitored for foetal cardiac diastolic dysfunction. Impact statement What is already known on this subject? Pregestational insulin-dependent diabetes mellitus is a relatively common condition in pregnancy, affecting up to 0.5% of the pregnant population. Foetuses of diabetic mothers are at an increased risk of perinatal morbidity and death. Gestational diabetes mellitus is under-recognised and affects up to 4% of pregnancies. Although diabetes mellitus is known to increase the risk of cardiovascular defects and structural changes (myocardial hypertrophy and diastolic dysfunction) due to foetal hyperglycaemia and hyperinsulinism, similar data in women with gestational diabetes is scarce. Moreover, the effect of maternal hyperglycaemia on foetal cardiac structure and function is unclear because of discordant results from previous studies. What do the results of this study add? In this study, we have used foetal echocardiography, two-dimensional US, pulsed wave Doppler and TDI to characterise the foetal cardiac structure and function in normal pregnancies as well as in the pregnancies complicated by GDM, and pregestational DM. Interventricular septum thickness is increased in women with pregestational diabetes mellitus and impaired diastolic function. The dominant right ventricle of the foetal circulation was affected earlier than the left ventricle. What are the implications of these findings for clinical practice and/or further research? Large population-based studies are required to establish the absolute risk of congenital heart defects in patients with pregestational diabetes and pregestational diabetes in the utility of routine screening.

Salusins have emerged as a new biomarker that reflects an increased inflammatory state, which is associated with cardiovascular risk. We investigated the predictive value and usefulness of salusins as an inflammatory biomarker in obese children. This prospective cohort study included 75 obese children and 101 healthy children (as a control group). Salusin-α, Salusin-β, and various cardiovascular parameters were assessed in both groups. Correlation analyses of Salusin-α and Salusin-β with body mass index standard deviation scores and inflammatory and cardiovascular markers were performed. The mean patient age was 11.9±2.4 years for the obese group and 12.5±2.1 years for the control group. The obese children had a significantly higher heart rate, systolic blood pressure, diastolic blood pressure, epicardial adipose tissue thickness, and left ventricular mass than did the children in the control group. There was no significant correlation between Salusin-α and Salusin-β and body mass index; however, there was a negative correlation between Salusin- α and diastolic blood pressure (r = 0.277, p = 0.004). Overall, there was no significant difference in the Salusin-α and Salusin-β levels between obese and healthy children. However, a negative correlation was found between Salusin-α and diastolic blood pressure. Although this result suggests that Salusin-α might be an early marker of cardiovascular involvement in obese children, further studies are needed to demonstrate the predictive value of salusins.

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Introduction Although the childhood clinic of COVID-19 is more innocent than adults, its unknown aspects continue to cause concern among pediatricians. One of these unsettling aspects is the cardiovascular system effects. We investigate the role of ventricular repolarization parameters in predicting arrhythmia risk in pediatric COVID-19. Materials and MethodsTwelve-channel surface electrocardiograms of a total of 166 participants, including children diagnosed with COVID-19 and healthy controls, were analyzed. The QT interval, corrected QT interval, QTc dispersion, Tpeak-Tend, Tp-e dispersion, Tp-e / QT and Tp-e / QTc ratio were calculated. The correlations between ventricular repolarization parameters and laboratory values were examined.Results In our study, the COVID-19 patients had a significantly longer Tpeak-Tend (64.51 ± 8.64 and 57.62 ± 7.96; p < 0.001), Tp-e dispersion (21.77 ± 6.4 and 18.01 ± 6.78; p < 0.001), and corrected QT interval (393.18 ± 20.06 and 380 ± 22.3; p < 0.001) duration than the control group. There was a significantly higher Tp-e / QT ratio (0.17 ± 0.02 and 0.15 ± 0.02; p < 0.001), Tp-e / QTc ratio (0.16 ± 0.02 and 0.15 ± 0.02; p < 0.001) in group with COVID-19 than the controls. In addition a positive correlation was found between Tpeak-Tend interval, Tp-e dispersion and white blood cells in the group with SARS CoV2 infection.Conclusion Evaluating these ventricular repolarization parameters in pediatric SARS CoV2 infection may be useful in predicting the risk of ventricular arrhythmia. Keywords COVID-19; child; ventricular repolarization abnormality ÖzAmaç COVID-19'un çocukluklardaki kliniği, yetişkinlere kıyasla daha masum seyretse de bilinmeyen yönleri pediatristler arasında endişe yaratmaya devam ediyor. Bu tedirgin edici yönlerinden biri de kardiyovasküler sistem etkileridir. Biz de bu çalışmada pediyatrik COVID-19'da aritmi riskini tahmin etmede ventriküler repolarizasyon parametrelerinin rolünü araştırmayı amaçladık. Yöntem ve GereçlerCOVID-19 teşhisi konan çocuklar ve sağlıklı kontroller dahil olmak üzere toplam 166 katılımcının on iki kanallı yüzey elektrokardiyogramı analiz edildi. Tp-e intervali, Tp-e dispersiyonu, Tp-e / QT oranı, Tp-e / QTc oranı, QT intervali, QTc intervali ve QTc dispersiyonu değerleri hesaplandı. Ventriküler repolarizasyon parametreleri ile laboratuvar değerleri arasındaki korelasyonlar incelendi.

ÖzGöğüs ağrısı çocuk acile başvuruların en sık nedenlerinden biridir. Erişkinlerin aksine kardiyak nedenli göğüs ağrıları çocuklarda oldukça nadir olmasına rağmen, çocuk kardiyoloji konsültasyonlarının önemli bir kısmını oluşturur. Ciddi ölüm kaygıları nedeni ile bu hastalara gereksiz, uzun süren ve maliyeti yüksek tetkikler yapılmaktadır. Dikkatle detaylı alınmış bir öykü ile desteklenen fizik muayene ve elektrokardiyografide (EKG) anormal bulgusu olmayan hastalarda kardiyak nedenler büyük olasılıkla dışlanabilmektedir. Akut başlangıçlı ve egzersizle ilişkili olmayan, senkop ya da baş dönmesinin eşlik etmediği, aile öyküsü negatif bulunan, fizik muayene ve EKG' sinde patolojik bulgu saptanmayan hastaların ekokardiyografi ve egzersiz testi gibi daha ileri tetkik amacıyla çocuk kardiyolojiye gönderilmesi hasta ve ailesinde gereksiz endişeye ve aşırı maliyete neden olmaktan öteye geçmeyecektir.

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Çocuklarda santral sinir sistemi tüberkülozu oldukça nadir görülmekle birlikte tüberküloza bağlı ölüm ve uzun dönem sekellerin en sık sebebidir. BCG aşısının hastaları tüberküloz menenjitinden yüksek oranda koruduğu bilinmekle birlikte yaş ile birlikte koruyuculuğu azalmaktadır. Hastalıkta etken her zaman gösterilememekte, tanı ancak hikâye, zik muayene, laboratuvar ve görüntüleme yöntemlerinin birlikte değerlendirilmesi ile konulabilmektedir. Hastalığın prognozu ise erken tanı ve antitüberküloz tedavinin başlanma zamanıyla doğrudan ilişkilidir. Serebral enfarkt ile seyreden santral sinir sistemi tüberkülozu vakası erken tanı ve tedavinin vurgulanması amacıyla sunulmuştur.