The Characteristics of Patients With COVID-19-Associated Pediatric Vasculitis: An International, Multicenter Study.

OBJECTIVE: COVID-19-associated pediatric vasculitis, other than Kawasaki disease (KD)-like vasculitis in multisystem inflammatory syndrome in children (MIS-C), is very rare. This study sought to analyze the characteristics, treatment, and outcomes in patients with COVID-19-associated pediatric vasculitis (excluding KD-like vasculitis in MIS-C). METHODS: The inclusion criteria were as follows: 1) age <18 years at vasculitis onset; 2) evidence of vasculitis; 3) evidence of SARS-CoV-2 exposure; and 4) ≤3 months between SARS-CoV-2 exposure and vasculitis onset. Patients with MIS-C were excluded. The features of the subset of patients in our cohort who had COVID-19-associated pediatric IgA vasculitis/Henoch Schönlein purpura (IgAV/HSP) were compared against a pre-pandemic cohort of pediatric IgAV/HSP patients. RESULTS: Forty-one patients (median age 8.3 years; male to female ratio 1.3) were included from 14 centers and 6 countries. The most frequent vasculitis subtype was IgAV/HSP (n = 30). The median duration between SARS-CoV-2 exposure and vasculitis onset was 13 days. Involvement of the skin (92.7%) and of the gastrointestinal system (61%) were the most common manifestations of vasculitis. Most patients (68.3%) received glucocorticoids, and 14.6% also received additional immunosuppressive drugs. Remission was achieved in all patients. All of the patients with IgAV/HSP in our cohort had skin manifestations, while 18 (60%) had gastrointestinal involvement and 13 (43.3%) had renal involvement. When we compared the features of this subset of 30 patients to those of a pre-pandemic pediatric IgAV/HSP cohort (n = 159), the clinical characteristics of fever and renal involvement were more common in our COVID-19-associated pediatric IgAV/HSP cohort (fever, 30% versus 5%, respectively [P < 0.001]; renal involvement, 43.3% versus 17.6%, respectively [P = 0.002]). Recovery without treatment and complete recovery were each less frequent among our COVID-19-associated pediatric IgAV/HSP patients compared to the pre-pandemic pediatric IgAV/HSP cohort (recovery without treatment, 10% versus 39%, respectively [P = 0.002]; complete recovery, 86.7% versus 99.4%, respectively [P = 0.002]). CONCLUSION: This is the largest cohort of children with COVID-19-associated vasculitis (excluding MIS-C) studied to date. Our findings suggest that children with COVID-19-associated IgAV/HSP experience a more severe disease course compared to pediatric IgAV/HSP patients before the pandemic.

Evaluation of Choroidal Thickness, Choroidal Vascularity Index and Peripapillary Retinal Nerve Fiber Layer in Patients with Juvenile Systemic Lupus Erythematosus.

OBJECTIVE: The aim of this study was to conduct a detailed ophthalmological examination in children with systemic lupus erythematosus (jSLE), including choroidal thickness (ChT), choroidal vascularity index (CVI) and peripapillary retinal nerve fiber layer (RNFL). METHODS: The study included all jSLE patients ( n = 21) diagnosed according to the Systemic Lupus International Collaborating Clinics classification criteria between January 2017 and April 2017, and an age- and gender-matched control group ( n = 21). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used to assess disease activity. After routine eye examinations, ChT at five points (750 µ and 1500 µ from the center of the fovea both in the temporal and nasal quadrants and under the fovea), total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA), CVI and RNFL thickness at the optic disc were evaluated. RESULTS: One patient had active ocular involvement in the form of episcleritis. Another patient had corticosteroid-induced cataract. The median age of the patients was 16 years (6-19 years). ChT at five points, TCA, LA and SA were found to be higher in patients with jSLE, whereas RNFL thickness and CVI were similar to those of the healthy control individuals. No correlation was determined between optical coherence tomography findings, SLEDAI and the immunological parameters (antinuclear antibodies, anti-double-stranded DNA, complements 3 and 4, extracted nuclear antigen antibody, antiphospholipid antibody). Intraretinal and subretinal fluid was not present in any of the patients. CONCLUSION: The choroid was thicker in patients with jSLE than in the control group. The study results suggest that jSLE may affect the choroid. Ophthalmological evaluation is important in SLE patients, even in the absence of relevant complaints.

Comparing immunoglobulin A vasculitis (Henoch-Schönlein purpura) in children and adults: a single-centre study from Turkey.

OBJECTIVE: Immunoglobulin A vasculitis/Henoch-Schönlein purpura (IgAV/HSP) is a systemic vasculitis involving small vessels with the deposition of immune complexes containing IgA. It is the most common primary systemic vasculitis of childhood and is much less common in adults. Our aim was to investigate the differences and similarities between adult and paediatric patients with IgAV/HSP. METHOD: We retrospectively evaluated the medical records of 35 adult and 159 paediatric (˂ 18 years old) patients with a clinical diagnosis of IgAV/HSP who were seen at the Departments of Rheumatology and Pediatric Rheumatology, Hacettepe University, Ankara, Turkey. The paediatric and adult patients were classified with IgAV/HSP according to the Ankara 2008 and American College of Rheumatology 1990 criteria, respectively. RESULTS: Upper respiratory tract infection was a common predisposing factor for both adults (34.3%) and children (21.4%). Creatinine and C-reactive protein were higher; and skin biopsy, hypertension, renal involvement, haematuria, proteinuria, and renal insufficiency at diagnosis were more frequent in adults than in children. Thrombocyte count was higher in children than in adults. Follow-up without treatment and complete recovery were more frequent in children, while persistent haematuria, chronic renal failure, relapse, and the use of corticosteroids/azathioprine were more frequent in adults. The only independent predictive factor for relapse was persistent haematuria. CONCLUSION: Various clinical and laboratory characteristics differ between children and adults with IgAV/HSP. Overall, IgAV/HSP has a self-limiting course in children but represents a more severe form of disease in adults, with more severe renal involvement. Persistent haematuria is a predictive factor for relapse.

Assessing the effectiveness of sustainable land management policies for combating desertification: A data mining approach.

This study investigates the relationship between fine resolution, local-scale biophysical and socioeconomic contexts within which land degradation occurs, and the human responses to it. The research draws on experimental data collected under different territorial and socioeconomic conditions at 586 field sites in five Mediterranean countries (Spain, Greece, Turkey, Tunisia and Morocco). We assess the level of desertification risk under various land management practices (terracing, grazing control, prevention of wildland fires, soil erosion control measures, soil water conservation measures, sustainable farming practices, land protection measures and financial subsidies) taken as possible responses to land degradation. A data mining approach, incorporating principal component analysis, non-parametric correlations, multiple regression and canonical analysis, was developed to identify the spatial relationship between land management conditions, the socioeconomic and environmental context (described using 40 biophysical and socioeconomic indicators) and desertification risk. Our analysis identified a number of distinct relationships between the level of desertification experienced and the underlying socioeconomic context, suggesting that the effectiveness of responses to land degradation is strictly dependent on the local biophysical and socioeconomic context. Assessing the latent relationship between land management practices and the biophysical/socioeconomic attributes characterizing areas exposed to different levels of desertification risk proved to be an indirect measure of the effectiveness of field actions contrasting land degradation.

Unilateral Congenital Lacrimal Fistula with Renal Agenesis and Pelvic Kidney: A Case Report and Review of the Literature.

A 12-year-old boy presented to the clinic of ophthalmology because of watering and discharge from his left lower eyelid. The inspection examination revealed an orifice that was associated with congenital lacrimal fistula (CLF). He underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings. Systemic evaluation revealed multiple renal anomalies: right renal agenesis and left ectopic pelvic kidney. This case is unique because this is the first reported case of CLF accompanied with ectopic pelvic kidney in the literature.

Concentrated platelet-rich plasma used in root canal revascularization: 2 case reports.

AIM: To present two case reports describing the treatment of immature teeth with necrotic pulps using concentrated platelet-rich plasma (cPRP) with 12-month clinical and radiographic follow-up. SUMMARY: Root canal revascularization was performed on immature permanent teeth clinically and radiographically diagnosed as requiring root canal treatment. Following disinfection of the canal space with triple antibiotic paste (1 : 1 : 1: ciprofloxacin, metronidazole and cefaclor), a tissue scaffold was created with cPRP prepared using 2-step centrifugation. The final restoration was completed with white mineral trioxide aggregate and composite resin. The patients were recalled for clinical and radiographic evaluations every 3 months. At the 12-month follow-up apical closure by narrowing of the apical foramen and convergence of the apical walls in the treated teeth was observed.

Putative factors associated with molar incisor hypomineralisation: an epidemiological study.

AIM: The aim of the study was to examine the aetiological factors involved in the development of molar incisor hypomineralisation (MIH). METHODS: The study population comprised 4,049 children (2,029 girls, 2020 boys) aged 7-12 years. Children were examined for MIH in the school environment. Putative aetiological factors were evaluated using a questionnaire sent to children's families. The questionnaire included questions on prenatal, perinatal, and postnatal systemic conditions. Multivariate analysis was performed using multiple logistic regression, and Pearson's Chi-square test was used to evaluate nominal or ordinal variables with Fisher's exact test used in cases of small sample sizes. A level of p < 0.05 was considered statistically significant. RESULTS: MIH was observed in 7.7 % of the study population. A total of 3,827 completed questionnaires were returned, yielding a response rate of 95.3 %. MIH was found to be associated with prematurity (7 %), gastrointestinal problems (3.9 %), pneumonia (6.3 %), frequent fever (26.1 %), measles (14.7 %), and chickenpox (29.3 %) before age 4 years. STATISTICS: Prevalence did not vary significantly between girls and boys (p > 0.05). Prematurity, gastrointestinal problems, pneumonia, frequent high fever, measles, and chickenpox before age 4 years were found to be significantly related with MIH (p < 0.05). CONCLUSIONS: The aetiology of MIH is not clear yet, and the results of this study support the results of previous studies regarding the putative causal effect of several factors.

Significance of vitronectin and PAI-1 activity levels in carotid artery disease: comparison of symptomatic and asymptomatic patients.

AIM: Carotid atherosclerosis one of the main risk factors for ischemic stroke. Acute thrombosis after atherosclerotic plaque disruption is a major complication of primary atherosclerosis, leading to acute ischemic syndromes and atherosclerotic progression. PAI-1 is the most important and most rapidly acting physiological inhibitor of tissue-type (t-PA) and urokinase type (u-PA) plasminogen activators. Active PAI-1 form spontaneously converts to the latent with a half-life of ~1 h. Complex formation with vitronectin increases half life of PAI-1 by two- to four-folds. Thus, this inhibitor function of PAI-1 facilitated by Vn that binds the inhibitor and may regulate its activity by the stabilizing the active PAI-1 conformation. In addition, PAI-1/VN complexes may effect vascular structure and function. However, the exact role of these complexes in vascular remodelling are not completely clear. The aim of the present study was determining, correlating and comparing the plasma vitronectin, t-PA and PAI-1 activity levels in asymptomatic and symptomatic patients with carotid artery plaque. METHODS: A total of 37 carotid artery disease patients were included in this study. Blood samples were obtained from Cerrahpasa Medical School, Department of Heart and Vessel Surgery, University of Istanbul. Plasma vitronectin, tPA and PAI-1 activity levels were determined by ELISA. RESULTS: We found plasma PAI-1 activity levels were elevated in the asymptomatic group as compared with symptomatic group (P=0.038). We have also found a positive correlation between PAI-1 activity and vitronectin levels in symptomatic group (r=0.399, P=0.039). CONCLUSION: Decreased PAI-1 activity levels correlate with vitronectin in the symptomatic group; a) may be the consequence a compensatory mechanisms (due to possibilty in increased fibrinolytic activity and decreased vascular remodelling) against disease progression. b) or may be also cause progression of disease by increase of vascular remodelling.

The effects of different doses of melatonin on lipid peroxidation in diet-induced hypercholesterolemic rats.

This study aims to see in an animal experiment how differently the low and high doses of melatonin affect the antioxidant status and peroxidation of lipids. Forty-two male Wistar-Albino rats weighing about 200 gr (180-220) aged 6-7 months were used. Of these rats, 12 were fed with normal rat chow for 12 weeks. The latter ones were divided into two groups, each containing 6 rats. Group 1 (control group) received daily intraperitoneal injections of NaCl (0.9%; w/v). Group 2 was injected ethanol daily (4%; v/v; i.p.) to see the effects of ethanol in which we dissolved melatonin. Thirty rats were fed with a diet enriched with cholesterol (2%; w/w), cholic acid (0.5%; w/w) and propilthyouracil (0.5%; w/w) for 12 weeks. These rats were divided into three groups each containing 10 rats. The low-dose group received melatonin 1 mg/kg/d; i.p. (group 3), the high-dose group received melatonin in a dose of 10 mg/kg/d; i.p. (group 4), and only the cholesterol group did not get any vehicle (group 5). Total cholesterol (TC), LDL cholesterol (LDL-C), total antioxidant capacity (TAC), oxidized LDL (oLDL) and TBARS lelvels were measured in all groups. The produced high-cholesterol diet increased LDL cholesterol. Melatonin decreased the extent of this plasma lipoprotein increase and also prevented the oxidation of it. This effect was clearer when the dose was higher. Antioxidant status seems to be also dose-dependent (Tab. 2, Ref. 33).

Long-term follow-up of a complicated crown fracture treated by partial pulpotomy.

AIM: To present the 7-year follow-up of a permanent incisor with complicated crown fracture, treated by partial pulpotomy. SUMMARY: A healthy permanent right central maxillary incisor with complicated crown fracture was treated by partial pulpotomy and reviewed clinically and radiographically for 7 years. At each recall, there was no spontaneous pain; the pulp showed signs of vitality and no periapical radiolucency developed. KEY LEARNING POINTS: Partial pulpotomy may be a successful permanent treatment in cases of complicated crown fracture.

TBARS, carnitine, and reduced glutathione levels in human bladder carcinoma.

In this study, we investigated tissue levels of reduced glutathione (GSH) and carnitine as well as thiobarbituric acid reactive substances (TBARS, as a marker of lipid peroxidation) levels in bladder carcinoma and control group of patients. The average GSH, carnitine and TBARS levels for tumor group were respectively 7.11 +/- 3.3 micro g/mg protein, 1.81 +/- 0.39 nmol/mg protein, and 4.29 +/- 3.2 micro mol/mg protein, versus 14.45 +/- 4.11 micro g/mg protein, 2.14 +/- 0.66 nmol/mg protein, and 2.3 +/- 0.6 micro mol/mg protein for normal bladder tissues. Thus, tissue reduced glutathione levels (GSH) were significantly lower in patients as compared with the control group (p < 0.001) whereas average TBARS levels in the tumor group were found to be higher than those in control group. The average tissue carnitine levels in the patient group were found to be lower compared with the control group but the difference was not statistically significant (p > 0.05).

Investigation of the relationship between oral parafunctions and temporomandibular joint dysfunction in Turkish children with mixed and permanent dentition.

The purpose of this study was to investigate the relationship between temporomandibular joint (TMJ) dysfunction, bruxism and oral parafunctions in the permanent and mixed dentition of Turkish children. Examinations were performed on 59 children (26 girls and 33 boys) without TMJ dysfunction and 123 children (54 boys and 69 girls) with TMJ dysfunction in the mixed dentition. In the permanent dentition 89 children without TMJ dysfunction (45 girls and 44 boys) and 123 children with TMJ dysfunction (69 girls and 54 boys) were inducted into this study. The children with oral parafunctions (bruxism, nail biting and thumb/finger sucking) were determined through questionnaires. The Z-test was used for the analyses of the correlation between variables and differences between the groups. Generally a significant correlation was found between finger/thumb sucking and nail biting and TMJ dysfunction in the mixed dentition and bruxism was observed significantly to be associated with TMJ dysfunction in the permanent dentition (P < 0.05). The evaluation of the results showed that in the mixed dentition groups nail biting was significantly higher in the girls with TMJ dysfunction and finger or thumb sucking was significantly higher in the boys with TMJ dysfunction compared with those without TMJ dysfunction (P < 0.01). In the permanent dentition; bruxism and thumb/finger sucking were significantly higher in girls with TMJ dysfunction higher than those without TMJ dysfunction (P < 0.05). However, thumb/finger sucking was significantly higher in boys without TMJ dysfunction than with TMJ dysfunction (P < 0.05). The results of this study showed that the association of parafunctions and TMJ dysfunction is present in the mixed (thumb/finger sucking and nail biting) and the permanent dentitions (bruxism).

Does von Willebrand Factor Have an Effect on the Occurrence of the Diabetic Complications?

It has been reported that von Willebrand factor (vWf) plays a role in the development of complications of diabetes mellitus. The relationships between vWf and polyneuropathy, nephropathy, and retinopathy were investigated in the patients with type 2 diabetes mellitus. 58 patients with type 2 diabetes mellitus (22 men and 36 women, mean age 54 ± 9 ) and 30 healthy nondiabetic controls (12 men and 18 women, mean age 40 ± 11) were admitted to this study. They were examined by an internist, a neurologist and an ophtalmologist for complications of diabetes mellitus. Electromyography was performed to all the patients. The mean vWf levels of the patients and control group were 1.48 ± 0.55 and 1.25 ± 0.32 IU/mL respectively. There was no significant difference between the two groups (p= 0.146). Diabetic retinopathy in 18 patients (31%), polyneuropathy in 20 patients (34.5%), trap neuropathy in 5 patients (8.6%), microalbuminuria in 9 patients (15.5%), macroalbuminuria in 2 patients (3.5%) and normoalbuminuria in 47 patients (81%) were detected. The difference between vWf levels of the patients with retinopathy and without retinopathy were not statistically significant (p= 0.913). There was no significant difference between patients with polyneuropathy and without polyneuropathy group (p= 0.737). There was also no difference between trap neuropathy and without trap neuropathy (p= 0.431), and between polyneuropathy and trap neuropathy (p= 0.246) patient subgroups. The vWf levels in normoalbuminuric, microalbuminuric and macroalbuminuric patient groups were not different (p values: 0.526, 0.392 and 0.759 respectively). vWf levels between patients with complications of diabetes mellitus and control group were not different (p> 0.05). There was not a significant correlation between the vWf level and body mass index, serum glucose, triglycerides, total cholesterol, HDL-C, LDL-C, VLDL-C, platelet counts, fibrinogen levels, prothrombin and activated thromboplastin times in 33 patients with any complication of diabetes mellitus (p> 0.05). We conclude that, vWf has not an effect in the development of complications in patients with diabetes mellitus.

Relationships between the children and the parents for coronary risk factors.

BACKGROUND: We aimed to investigate the relation of coronary risk factors in children to coronary heart disease (CHD) or coronary risk factors in their parents. METHODS: A sample of 252 parents of 164 children with two or more coronary risk factors were included in this study. The control group consisted of 175 parents of 114 children with no risk factors. Both groups were evaluated for coronary risk factors and CHD. The children in the groups were separated into sex and age groups consisting of 7 to 11-years-olds, 12 to 15-years-old and 16 to 18-years-old. RESULTS: Many lipid parameters related with coronary risk factors in the mothers of 7 to 11-year-old girls, in the fathers of 7 to 11-year-old girls and 16 to 18-year-old boys were at higher levels than in the control group. Anthropometric parameters, especially those of reflecting body fatness such as skinfold thickness measurements and total bodyfat percentage values were at higher levels in the fathers of 12-15- and 16 to 18-year-old girls. The higher levels of most of the anthropometric and biochemical parameters in the fathers of 16 to 18-year-old boys were striking. Hyperlipidemia prevalences in the fathers of 7 to 11-year-old girls and boys were higher than the control parents. In the study group, the girls positively correlated with both their parents for total cholesterol levels and positively correlated with only their mothers for height, bodyfat percentage, triglycerides and low-density lipoprotein- cholesterol (LDL-C) levels. However, the boys positively correlated with their mothers for weight and with their fathers for bodyfat percentage, diastolic blood pressure (BP) values and serum LDL-C levels. The proportion of individuals who had ischemic findings on treadmill exercise testing was significantly greater than control group in only the fathers of 12 to 15-year-old boys (P<0.05). CONCLUSIONS: The parents, especially the fathers of children with coronary risk factors have higher levels of coronary risk factors than those in the control group. There is a familial aggregation of body fatness and adverse lipid levels in the families of the children with coronary risk factors. The parents of children recognized as having coronary risk factors should be evaluated for these risk factors too.

Prevalence of temporomandibular dysfunction in Turkish children with mixed and permanent dentition.

This study was carried out to determine the prevalence of temporomandibular joint (TMJ) dysfunction in mixed and permanent dentition and to evaluate the sex distribution in Turkish children. One hundred and eighty-two children with mixed dentition and 212 with permanent dentition were selected for the study, which used a questionnaire and clinical examination. Children with one or more signs (TMJ sounds, TMJ tenderness, muscle tenderness, restricted mouth opening) and/or symptoms (TMJ pain during mastication and mouth opening, restriction of the jaw opening and TMJ sounds) met the criterion of TMJ dysfunction. The total prevalence of signs and symptoms of TMJ dysfunction in the studied population was 68% (68% in girls and 68% in boys) in mixed dentition and 58% (61% in girls and 56% in boys) in permanent dentition. The Z-test and analysis of variance (ANOVA) were used for statistical analysis of the difference between the results. The total prevalence of signs and symptoms of TMJ dysfunction in mixed dentition was found to be higher than in permanent dentition (P < 0.05). No statistically significant difference was found in the total prevalence of TMJ dysfunction between girls and boys.

The relationship between occlusal factors and bruxism in permanent and mixed dentition in Turkish children.

The aim of this study was to investigate the relationship between occlusal factors (overjet, overbite, Angle's Classification of molars and cuspids, the relationship of the primary molars, openbite, lateral openbite, scissorbite and crossbite) and bruxism in permanent and mixed dentition in Turkish children. For this reason 182 children with mixed dentition and 212 children with permanent dentition were included in this study. Occlusal conditions were examined clinically and bruxism was assessed by using interview and questionnaires. Z Test was used to compare the results. It was found that in both dentitions some occlusal factors related with bruxism (overjet > 6 mm, overbite > 5 mm, negative overjet, openbite in permanent dentition; overjet > 6 mm, overbite > 5 mm, scissorbite, anterior-posterior multiple teeth crossbite, Angle Class I occlusion in mixed dentition.

Carbohydrate-deficient transferrin and sialidase levels in coronary heart disease.

Transferrin is a N-glycosylated glycoprotein and plays an important role in iron transport from sites of absorption and storage to sites of utilization. The main component of normal serum transferrin contains two biantennary glycans, each consisting of 2 mol of sialic acid (Tetrasialo transferrin). Normal serum also contains small amounts of tri- and disialotransferrin. We have undertaken this study to investigate the levels of serum carbohydrate-deficient transferrin (Desialotransferrin) and sialidase levels in patients with coronary heart disease. In patient group, serum desialotransferrin and sialidase levels were found to be significantly higher than control group (p < 0.01 and p < 0.001, respectively). We conclude that increased activity of sialidase may be responsible for increased desialotransferrin in patients with coronary heart disease. Serum desialotransferrin levels may be useful critaria to diagnosis and pathogenesis of coronary heart disease.