Loneliness, Social Support, Social Trust, and Subjective Wellness in Low-Income Children: A Longitudinal Approach.

The progress and development of society in every sense is possible by raising healthy individuals. To do so, it is necessary to ensure the physical and mental development of children in a healthy way. There are many variables that affect the physical and mental development of children. These variables are affected by individual factors, social structure, social interactions and cultural values. In addition, when these factors interact with each other, their effect on behavior and well-being may increase. Undoubtedly, one of the primary factors negatively affecting a child's physical and psychological development is the adverse economic conditions and hardships experienced by his/her family and consequently, by the child. Increasing poverty hinders children's access to resources, and thus negatively affects their mental health as well as their physical development. Furthermore, positive economic conditions pave the way for an improved environment, better nutrition, higher-quality education, elevated social status, more friends, reduced feelings of loneliness, and increased social support and trust and all of these positively contribute to psychological well-being. Therefore, based on the conviction that early interventions can be protective and screening is needed to determine the proper intervention, this study aims to investigate the relationship between psychological well-being, loneliness, social support and social trust, all of which affect the psychological health of children living in economically disadvantaged families. To this end, answers to the following questions were sought. Is there a significant relationship between the loneliness, social support, social trust and psychological well-being of the children from low-income families? Do the feelings of loneliness, social support and social trust of the children from low-income families significantly predict their psychological well-being?

The relationship between the use of digital display devices and headphones and primary headaches in children.

BACKGROUND: Headache represents the most common neurologic symptom in children. In this study, we investigated the relationship between watching television, listening to music with headphones, smartphone, tablet, and computer use, and primary headaches in children. We aimed to determine whether primary headache in children is associated with excessive use of digital display devices and headphones and whether reducing the use of digital display devices and headphones affects primary headache. METHODS: The study included 69 children with primary headaches and 64 with no headaches as a control group. All subjects were evaluated for demographic and headache characteristics and the use of digital display devices and headphones. Our recommendation for patients and families was to decrease the use of digital display devices and headphones, and the headache burden was re-evaluated after one month. RESULTS: Headache frequency was more common in patients who watched television and used smartphones or tablets for more than 6 hours per day. Using a smartphone or tablet for more than 3 hours daily was more common in the study group than the control group. Headache frequency decreased in all patients one month after the digital imaging device and headphones were restricted. CONCLUSIONS: Watching television and using a smartphone or tablet strongly associates with primary headaches during childhood.

INTRODUCCIÓN: La cefalea representa el síntoma neurológico más común en los niños. En este estudio se investigó la relación entre ver televisión, escuchar música con auriculares, el uso del teléfono inteligente o tableta y computadora y el dolor de cabeza primario en niños. Nuestro objetivo fue determinar la asociación entre la cefalea primaria en niños y el uso excesivo de dispositivos de visualización digital y auriculares, y el efecto de la disminución del uso de dispositivos de visualización digital y auriculares sobre la cefalea primaria. MÉTODOS: El estudio incluyó a 69 niños con cefaleas primarias y 64 niños sin cefaleas como grupo control. Se evaluaron las características demográficas y de dolor de cabeza y uso de dispositivos de visualización digital y auriculares de los participantes. Se aconsejó a los pacientes y familiares que disminuyeran el uso del dispositivo de pantalla digital y los auriculares y se volvió a evaluar la carga de dolor de cabeza después de 1 mes. RESULTADOS: La frecuencia de la cefalea fue más frecuente en los pacientes que veían televisión y utilizaban un teléfono inteligente o una tableta más de 6 horas al día. El uso de más de 3 horas al día fue más común en el grupo de estudio que en el grupo control. La frecuencia del dolor de cabeza disminuyó en todos los pacientes 1 mes después de la restricción del dispositivo de imagen digital y los auriculares. CONCLUSIONES: Ver la televisión y el uso de un teléfono inteligente o tableta se asocian estrechamente con el dolor de cabeza primario en la infancia.

The relationship between the use of digital display devices and headphones and primary headaches in children / La relación entre el uso de dispositivos de visualización digital y auriculares y el dolor de cabeza primario en niños

Abstract Background: Headache represents the most common neurologic symptom in children. In this study, we investigated the relationship between watching television, listening to music with headphones, smartphone, tablet, and computer use, and primary headaches in children. We aimed to determine whether primary headache in children is associated with excessive use of digital display devices and headphones and whether reducing the use of digital display devices and headphones affects primary headache. Methods: The study included 69 children with primary headaches and 64 with no headaches as a control group. All subjects were evaluated for demographic and headache characteristics and the use of digital display devices and headphones. Our recommendation for patients and families was to decrease the use of digital display devices and headphones, and the headache burden was re-evaluated after one month. Results: Headache frequency was more common in patients who watched television and used smartphones or tablets for more than 6 hours per day. Using a smartphone or tablet for more than 3 hours daily was more common in the study group than the control group. Headache frequency decreased in all patients one month after the digital imaging device and headphones were restricted. Conclusions: Watching television and using a smartphone or tablet strongly associates with primary headaches during childhood.

Resumen Introducción: La cefalea representa el síntoma neurológico más común en los niños. En este estudio se investigó la relación entre ver televisión, escuchar música con auriculares, el uso del teléfono inteligente o tableta y computadora y el dolor de cabeza primario en niños. Nuestro objetivo fue determinar la asociación entre la cefalea primaria en niños y el uso excesivo de dispositivos de visualización digital y auriculares, y el efecto de la disminución del uso de dispositivos de visualización digital y auriculares sobre la cefalea primaria. Métodos: El estudio incluyó a 69 niños con cefaleas primarias y 64 niños sin cefaleas como grupo control. Se evaluaron las características demográficas y de dolor de cabeza y uso de dispositivos de visualización digital y auriculares de los participantes. Se aconsejó a los pacientes y familiares que disminuyeran el uso del dispositivo de pantalla digital y los auriculares y se volvió a evaluar la carga de dolor de cabeza después de 1 mes. Resultados: La frecuencia de la cefalea fue más frecuente en los pacientes que veían televisión y utilizaban un teléfono inteligente o una tableta más de 6 horas al día. El uso de más de 3 horas al día fue más común en el grupo de estudio que en el grupo control. La frecuencia del dolor de cabeza disminuyó en todos los pacientes 1 mes después de la restricción del dispositivo de imagen digital y los auriculares. Conclusiones: Ver la televisión y el uso de un teléfono inteligente o tableta se asocian estrechamente con el dolor de cabeza primario en la infancia.

A Case Study on EEG Analysis: Embedding Entropy Estimations Indicate the Decreased Neuro-Cortical Complexity Levels Mediated by Methylphenidate Treatment in Children with ADHD.

Objective: Complexity analysis is a method employed to understand the activity of the brain. The effect of methylphenidate (MPH) treatment on neuro-cortical complexity changes is still unknown. This study aimed to reveal how MPH treatment affects the brain complexity of children with attention deficit hyperactivity disorder (ADHD) using entropy-based quantitative EEG analysis. Three embedding entropy approaches were applied to short segments of both pre- and post- medication EEG series. EEG signals were recorded for 25 boys with combined type ADHD prior to the administration of MPH and at the end of the first month of the treatment. Results: In comparison to Approximate Entropy (ApEn) and Sample Entropy (SampEn), Permutation Entropy (PermEn) provided the most sensitive estimations in investigating the impact of MPH treatment. In detail, the considerable decrease in EEG complexity levels were observed at six cortical regions (F3, F4, P4, T3, T6, O2) with statistically significant level (p < .05). As well, PermEn provided the most meaningful associations at central lobes as follows: 1) The largeness of EEG complexity levels was moderately related to the severity of ADHD symptom detected at pre-treatment stage. 2) The percentage change in the severity of opposition as the symptom cluster was moderately reduced by the change in entropy. Conclusion: A significant decrease in entropy levels in the frontal region was detected in boys with combined type ADHD undergoing MPH treatment at resting-state mode. The changes in entropy correlated with pre-treatment general symptom severity of ADHD and conduct disorder symptom cluster severity.

Suffering and happiness in Turkish folk poetry in the context of positive psychology: The examples of Asik Mahzuni Serif and Neset Ertas.

The widespread adoption of positive psychology at the beginning of the century has fortified the scholarly foundations of "happiness." Thus, researchers have focused on "happiness" rather than "suffering" in boosting the joy of life within positive psychology, aiming for individuals to achieve peace with themselves and society. With the developments in positive psychology, over recent years, the idea of integrating both positive and negative aspects of human nature to build a better life for oneself and others has contributed to the rise of second-wave positive psychology (PP 2.0). The present study aimed to explore suffering and happiness in Turkish folk culture through a sample of poems by Asik Mahzuni Serif and Neset Ertas. The study results indicated that suffering-themed concepts were mentioned more than happiness-themed concepts. Within the theme of suffering, the world was the most frequently mentioned concept in Mahzuni's works. He emphasizes in his works that the world is the source of many sufferings. In Ertas's poems, moreover, love was found to be the most frequently mentioned suffering-themed concept. Ertas considers love to be the most significant source of suffering. It was also determined that while separation is the least used concept in the theme of suffering in Mahzuni's verses, it is never mentioned in Ertas's poems. Other concepts pointing to the theme of suffering are poverty, ignorance, longing, death, and slavery. We found that the theme of happiness is mentioned much less frequently than the theme of suffering. While the most used happiness-themed concept is misery/remedy, in Mahzuni's words, love is cited in Ertas's poems. Expressing the view that suffering can be an opportunity for people, Mahzuni emphasizes in his poems that people can grow by learning lessons from their suffering. Ertas, moreover, sees love as the most important source of happiness. The other concepts referencing happiness in the poems were friend, mother, soft answer, and spring. Overall, the results suggest that suffering is an important source of building resilience, which, in turn, can produce happiness. People can grow with the help of the experience of suffering so that this experience can contribute to their flourishing.

Risk and Prognostic Factors in Perinatal Hemorrhagic Stroke.

BACKGROUND: Perinatal stroke encompasses a heterogeneous group of focal neurological injuries early in brain development. In this study, we aimed to compare risk and prognostic factors in preterm and term infants with perinatal hemorrhagic stroke (PHS). PATIENTS AND METHODS: The study includes 66 infants with PHS. The infants were evaluated for demographic characteristics, fetal and maternal risk factors, perinatal events, clinical and neuroimaging findings, complications, and sequales. RESULTS: Of 66 infants with PHS, 44 (66.70%) were preterm and 22 (33.30%) were term infants. Primiparity, mucosal bleeding, and multiple lobes involvement were more common in term infants than preterm infants (P < 0.05); however, respiratory insufficiency, neonatal sepsis, perinatal asphyxia, respiratory distress syndrome, use of invasive mechanical ventilation, use of noninvasive mechanical ventilation, and prolonged hospitalization were more common in preterm infants than term infants (P < 0.05). Eight (12.12%) infants died during infancy period. Small for gestational age and mucosal bleeding were more common in infants who are dead than those alive (P < 0.05). Forty-two (63.63%) infants were followed. Cerebral palsy and/or epilepsy and/or hydrocephalus were diagnosed in 36 (85.72%) infants during follow-up. CONCLUSION: Our findings showed that PHS was much more common in preterm infants. Mucosal bleeding and multiple lobes involvement were more common in term infants. PHS has high morbidity and mortality rates. Small for gestational age and mucosal bleeding were more common in infants who are dead.

Red cell distribution width and neutrophil-to-lymphocyte ratio as a predictive factor in treatment of pediatric patients with burns.

BACKGROUND: Red cell distribution width (RDW) is associated with mortality in certain diseases. Neutrophil-to-lymphocyte ratio [NLR] is being used as a decisive parameter in inflammatory diseases. The association between morbidity and RDW-NLR in children with burns is unclear. We aimed to evaluate effectivity of these markers in children with burn. METHODS: Retrospectively the treatment records of 39 children with second-degree superfisial, second-degree deep, and third-degree burns were evaluated. First group included patients those treated with grafts and second group included those treated with topical agents. Total body surface area [TBSA], age, RDW, NLR, sex, and albumin values were evaluated. The association of RDW and NLR with both groups were analysed. RESULTS: Patients in group 2 had mild increase in RDW and NLR values but it was not more statistically significant than in group 1. A positive relationship between NLR and length of hospital stay, TBSA and length of hospital stay, and RDW and lymphocyte values was found. A negative correlation between albumin values and length of hospital stay was found. CONCLUSION: NLR is associated with morbidity in patients with burns; although RDW has not any relationship with morbidity in pediatric scald burns.

Anti-MOG Antibody Seropositive Neuromyelitis Optica: A Rare Pediatric Case.

Neuromyelitis Optica spectrum disorder (NMO-SD) is a rare demyelinating disease detected in pediatric patients affecting the primary optic nerve and spinal cord. Clinical findings might overlap with other demyelinating diseases and compare to particularly multiple sclerosis the treatment regimens significantly differ. Therefore, to establish an immediate and definite diagnosis of NMO-SD is crucial. In the majority of patients, the aquaporin-4 antibody is detected in the serum as one of the supporting diagnostic criteria. The antibody against myelin oligodendrocyte glycoprotein (MOG) is recently reported to be associated with serum aquaporin-4 antibody seronegative NMO-SD. Although not included in the diagnostic criteria, we believe that anti-MOG antibody may facilitate the diagnosis of NMO-SD. We herein report a pediatric case of NMO-SD with the anti-MOG antibody seropositivity.

Genotype-Phenotype Correlations in Charcot-Marie-Tooth Disease Due to MTMR2 Mutations and Implications in Membrane Trafficking.

Charcot-Marie-Tooth type 4 (CMT4) is an autosomal recessive severe form of neuropathy with genetic heterogeneity. CMT4B1 is caused by mutations in the myotubularin-related 2 (MTMR2) gene and as a member of the myotubularin family, the MTMR2 protein is crucial for the modulation of membrane trafficking. To enable future clinical trials, we performed a detailed review of the published cases with MTMR2 mutations and describe four novel cases identified through whole-exome sequencing (WES). The four unrelated families harbor novel homozygous mutations in MTMR2 (NM_016156, Family 1: c.1490dupC; p.Phe498IlefsTer2; Family 2: c.1479+1G>A; Family 3: c.1090C>T; p.Arg364Ter; Family 4: c.883C>T; p.Arg295Ter) and present with CMT4B1-related severe early-onset motor and sensory neuropathy, generalized muscle atrophy, facial and bulbar weakness, and pes cavus deformity. The clinical description of the new mutations reported here overlap with previously reported CMT4B1 phenotypes caused by mutations in the phosphatase domain of MTMR2, suggesting that nonsense MTMR2 mutations, which are predicted to result in loss or disruption of the phosphatase domain, are associated with a severe phenotype and loss of independent ambulation by the early twenties. Whereas the few reported missense mutations and also those truncating mutations occurring at the C-terminus after the phosphatase domain cause a rather mild phenotype and patients were still ambulatory above the age 30 years. Charcot-Marie-Tooth neuropathy and Centronuclear Myopathy causing mutations have been shown to occur in proteins involved in membrane remodeling and trafficking pathway mediated by phosphoinositides. Earlier studies have showing the rescue of MTM1 myopathy by MTMR2 overexpression, emphasize the importance of maintaining the phosphoinositides equilibrium and highlight a potential compensatory mechanism amongst members of this pathway. This proved that the regulation of expression of these proteins involved in the membrane remodeling pathway may compensate each other's loss- or gain-of-function mutations by restoring the phosphoinositides equilibrium. This provides a potential therapeutic strategy for neuromuscular diseases resulting from mutations in the membrane remodeling pathway.

Attitudes of physicians concerning vaccines not included in the national immunization schedule.

Çatakli T, Duyan-Çamurdan A, Aksakal-Baran FN, Güven AE, Beyazova U. Attitudes of physicians concerning vaccines not included in the national immunization schedule. Turk J Pediatr 2018; 60: 290-297. The aim of this study was to identify attitudes of family physicians and pediatricians working in sub-provinces of central Ankara concerning rotavirus (RV), human papilloma virus (HPV), meningococcal conjugate vaccine (MenACWY-MCV4) and adolescent and adult pertussis (Tdap) vaccines which are not included in the National Immunization Schedule (NIS). Questionnaires were conducted with 300 family physicians and 230 pediatricians who were selected by random sampling. RV vaccine is the most commonly recommended vaccine by physicians (60.5%). It is the vaccine they want to be added to the NIS the most (48.5%). Tdap vaccine is the least recommended vaccine (24.1%) and the least preferred for inclusion in the NIS (19.6%). Of the physicians recommending the RV vaccine 94.0% believe that `RV-related diarrhea cases exhibit a severe course of illness in children younger than two years old.` Pediatricians recommend RV, meningoccocal and Tdap vaccines more than family physicians (p < 0.05). Of the physicians who do not recommend RV, HPV, and conjugated meningococcal vaccine 87.5%, 96.7% and 27.6% found the vaccines expenive, respectively. Of the physicians who do not recommend Tdap vaccine 90.4% think that `Tdap vaccination is not a health problem of priority for their country.` In conclusion physicians are recommending vaccines which are not included in the NIS. Their common concern for not recommending these vaccines is expensive price.

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy.

PURPOSE: Although there is a higher risk of structural cardiac disease in people with epilepsy, there is no detailed advanced analysis of cardiac functions in patients with epilepsy. This study aimed to determine early echocardiographic findings of Left Ventricular (LV) dysfunction using cardiac strain technique in seizure-free children with epilepsy. METHOD: The study investigated 60 children with epilepsy who had no seizures in the preceding 6 months, without any known cardiovascular disease and treated with one antiepileptic drug and 60 healthy subjects who underwent clinical evaluation including electrocardiography (ECG), standard echocardiography, tissue Doppler imaging (TDI) and two-dimensional Speckle Tracking Echocardiography (2DSTE). RESULTS: Despite the normal M-mode values, global longitudinal strain of the epilepsy of the control group was as follows: -16.86 ± 3.71, -18.95 ± 3.75, respectively (p = 0.001); global strain rates were determined as follows: -0.99 ± 0.23, -1.14 ± 0.31, respectively (p = 0003). The patients also had increased A-wave velocity, and decreased E/A ratio (p < 0.01). TDI results showed diastolic dysfunction as mirrored by significantly increased isovolemic relaxation time (IVRT), Early mitral inflow (E)/ Early diastolic velocity (E'), and Tei index (p < 0.01). There was no significant difference in LV torsion, Peak LV twist, and ECG parameters between the patients and the controls. CONCLUSIONS: In seizure-free patients, cardiac systolic and diastolic functions were impaired when compared to healthy children. There was no difference in the patient group to explain the decline in cardiac functions and there may be unknown different factors besides the known risk factors.

Congenital Hemophilia A Presenting With Hashimoto's Encephalopathy and Myocarditis: The First Reported Case.

Here, we report a case of hemophilia A with myocarditis, encephalopathy, and spontaneous intramedullary hemorrhage. A 14-month-old male infant presented with loss of consciousness, generalized tonic-clonic convulsions, and cardiac failure. The neurological examination was normal. Myocarditis was diagnosed. After administration of fresh frozen plasma, the aPTT did not return to normal. The factor VIII (FVIII) level was 10.2% the normal level, and the patient was diagnosed with hemophilia A. The cerebrospinal fluid (CSF) evaluation was unremarkable, with the exception of elevated CSF protein levels. An electroencephalogram revealed diffuse slowing of background activity. The spinal MRI revealed chronic bleeding in areas of the medulla spinalis. Tests for the antibodies associated with autoimmune encephalitis were negative. Anti-thyroglobulin (THG) (11.8 U/mL [normal, 0 to 4 U/mL]) and anti-thyroid peroxidase (TPO) (53.9 U/mL [normal, 0 to 9 U/mL]) antibodies were present in the serum. The patient received 1 g/kg intravenous immunoglobulin G (IVIG) for 2 days based on a diagnosis of myocarditis and Hashimoto's encephalopathy. After the first month of treatment his clinical findings were negative. He developed an inhibitor to FVIII 1 month after initiation of FVIII replacement therapy. Hemophilia A has various clinical presentations. Autoimmunity may lead to early inhibitor development in patients with hemophilia.

Use of a fibrovascular tube in creation of neo-urethra during penile reconstruction.

INTRODUCTION: There are several techniques employed in the surgical treatment of total or partial penile reconstruction, hypospadias surgery, and urethral stricture. Urethral reconstruction is performed in different ways applying these techniques. OBJECTIVE: We evaluated use of a fibrovascular sheath to create a neo-urethra formed around a silicon tube. MATERIAL AND METHODS: We used nine male New Zealand rabbits for this study. In the first step, we placed a silicone tube under the skin in the lower abdomen of the rabbits and waited for the formation of a fibrovascular sheath to totally surround the tube. In the second step, the silicone tube was removed and the formed fibrovascular sheath was anastomosed with penile urethra over a silicone 8F Foley catheter. Ten days after the second step, the silicone Foley catheter was removed. Twenty days after the second step, we evaluated the newly created neo-urethra with a retrograde urethrogram. Thirty days after the second step, the rabbits were sacrificed and the bladder, urethra, and neo-urethra were removed for histopathological examination. RESULTS: Six of the rabbits completed the study. After the first operation, in the third month, formation of the fibrovascular sheath was observed around the silicon tube. After anastomosis and removal of the silicon Foley catheter, urine was seen to pass through the neo-urethral meatus. Urethrocystography showed that the neo-urethra and penile urethra were aligned and urine flow was regular. Histopathological evaluation showed that the structural integrity of the newly formed urethra was comparable with the structure of the regular urethra (Table) and the calibration did not change over time, although the newly formed urethra was not covered with uroepithelium. CONCLUSIONS: In this study, we achieved promising results with use of a newly formed fibrovascular sheath as a neo-urethra.

Acute necrotizing encephalopathy causing human bocavirus.

Acute necrotizing encephalopathy is characterized by multiple, symmetrical lesions involving the thalamus, brainstem, cerebellum, and white matter and develops secondarily to viral infections. Influenza viruses are the most common etiological agents. Here, we present the first case of acute necrotizing encephalopathy to develop secondarily to human bocavirus. A 3-year-old girl presented with fever and altered mental status. She had had a fever, cough, and rhinorrhea for five days. The patient was admitted to the intensive care unit with an initial diagnosis of encephalitis when vomiting, convulsions, and loss of consciousness developed. Signs of meningeal irritation were detected upon physical examination. There was a mild increase in proteins, but no cells, in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging showed symmetrical, heterogeneous hyperintensities bilaterally in the caudate nuclei and putamen. Ammonium, lactate, tandem mass spectroscopy, and urine organic acid were normal. No bacteria were detected in the CSF cultures. Human bocavirus was detected in a nasopharyngeal aspirate using real-time PCR, while no influenza was detected. Oseltamivir, acyclovir, 3% hypertonic saline solution, and supportive care were used to treat the patient, who was discharged after two weeks. She began to walk and talk after one month of physical therapy and complete recovery was observed after six months. Human bocavirus is a recently identified virus that is mainly reported as a causative agent in respiratory tract infections. Here, we present a case of influenza-like acute necrotizing encephalopathy secondary to human bocavirus infection.

Medical ozone therapy reduces shock wave therapy-induced renal injury.

OBJECTIVES: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. METHODS: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. RESULTS: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). CONCLUSION: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Important of Angiopoietic System in Evaluation of Endothelial Damage in Children with Crimean-Congo Hemorrhagic Fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) causes endothelial activation and dysfunction by affecting the endothelium directly or indirectly. In maintaining the vascular integrity, vascular endothelial growth factor (VEGF-A) and its receptor (VEGFR1) and angiopoietin-2 (Ang-2) and its receptor (Tie-2) are very important mediators. For this reason, we aimed at studying the association of Ang-2 and VEGF and their receptors Tie-2 and VEGFR1 with CCHF infection. METHODS: Thirty one CCHF patients and 31 healthy controls (HC) were included in the study. CCHF patients were classified into 2 groups in terms of disease severity (severe and nonsevere). VEGF-A, VEGFR1, Ang-2 and Tie-2 levels were measured in all groups. RESULT: Serum levels of Tie-2, Ang-2, VEGF-A and VEGFR1 were significantly increased in CCHF patients compared with the HC. Furthermore, serum Tie-2, Ang-2, VEGF and VEGFR1 levels were found to be significantly higher in the severe group than in the nonsevere and HC groups (P < 0.05 and P < 0.001, respectively). Also, Tie-2, Ang-2, VEGF-A and VEGFR1 levels were significantly higher in the nonsevere group than in the HC group (P < 0.05). CONCLUSION: Having statistically significant higher Ang-2, Tie-2, VEGF-A and VEGFR1 levels in the severe group when compared with the other groups suggested that VEGF-related Ang-2/Tie-2 system played a critical role in the pathogenesis of the disease, and these markers could be used as the severity criteria.