The analysis of the effects of acute rheumatic fever in childhood on cardiac disease with data mining.

BACKGROUND: Acute rheumatic fever (ARF) is an important disease that is frequently seen in Turkey, it is necessary to develop solutions to cure the disease. It is believed that new data analysis methods may be applied to this disease, and this may be useful to discover previously unrecognized patterns. Data mining of existing records and data repositories may improve knowledge on the diagnosis and management of ARF. In this regard, we planned to make a contribution to the development of new solutions by approaching the problem from a different standpoint. OBJECTIVES: The aim of this study is to analyse the effects of ARF undergone during childhood on the basis of cardiac diseases by using data mining methods. MATERIALS AND METHODS: Classification methods of data mining were used, and experiments were conducted on five algorithms. The records of the patients diagnosed with ARF were analysed by setting models with naive Bayes classifier, decision trees (CART, C4.5, C5.0, C5.0 boosted) and random forest algorithms. The performances of the algorithms that were derived were then compared. Among model performance evaluation techniques, the hold-out, cross-validation and bootstrap methods were tested in diverse ways in an applied manner. Within the scope of the research, the dataset comprising records of 297 patients was utilised in cooperation with Istanbul Medeniyet University Göztepe Training and Research Hospital's Pediatric Cardiology Clinic (Istanbul Medeniyet Üniversitesi Göztepe Egitim ve Arastirma Hastanesi Çocuk Kardiyolojisi Klinigi). Data analysis was carried out with the data of the remaining 201 patients following pre-processing. RESULTS: The results that were obtained from different algorithms were compared based on the model performance evaluation criteria. The best result was shown under the CART model by using the hold-out technique (80% training, 20% testing). According to this model, the importance values of the predictive attributes were listed, and it was found that the "teleNormal" and "cardiomegaly" attributes were not required for ARF diagnosis and treatment. In compliance with this result, it was thought that it should not be necessary for patients have a chest x-ray which is needed for diagnosis of "teleNormal" and "cardiomegaly". This will help reduce costs and thus contribute to the health economy while preventing patients from having unnecessary x-rays. DISCUSSION AND CONCLUSION: The results of this study showed that data mining techniques may be used to analyse diseases such as ARF. The important attributes that affect the disease were obtained in accordance with the results. The results of the best model (CART) may be broadened in numerous ways and provide information for both experienced and inexperienced physicians. This study is considered to be significant as it helps data mining methods become more prevalently used for data analysis in fields of medicine and healthcare.

Fever-induced Brugada syndrome in a 9-year-old boy presenting with acute chest pain.

Besli GE, Yildirim S, Akalin I, Ayhan YI, Kisioglu M, Berdeli A. Fever-induced Brugada syndrome in a 9-year-old boy presenting with acute chest pain. Turk J Pediatr 2018; 60: 571-575. Brugada syndrome, an arrhythmogenic disease, occurs due to mutations involving cardiac sodium channels. It is characterized by persistent or transient ST-segment elevation in the right precordial electrocardiogram leads that could be unmasked by several circumstances, with fever particularly. Molecular and cellular mechanisms leading to Brugada syndrome have not been completely elucidated. Mutations of the SCN5A gene encoding the pore-forming α-subunit of the cardiac sodium channel protein have been attributed in the molecular diagnosis. Although this syndrome is well-known in adults, it is less frequently reported in infants and children. We describe a 9-year-old Turkish boy with a family history of sudden cardiac death, who presented with chest pain and fever-induced expression of the Brugada syndrome phenotype that might be associated with a mutation in SCN5A gene.

Changes in platelet indices in children with bicuspid aortic valve.

Mean platelet volume (MPV) and platelet distribution width (PDW) can help diagnose cardiovascular pathologies. In this study, we aimed to demonstrate the changes in platelet (PLT) indices in children diagnosed with bicuspid aortic valve (BAV) with mild stenosis and without stenosis to compare patients with mild stenosis with those without stenosis. A total of 73 children diagnosed with BAV (30 patients with mild stenosis and 43 without stenosis) with a mean age 9.73 ± 5.01 years and a control group were included in the study. Mean MPV value was significantly lower in the control group compared with patients with BAV with mild stenosis and patients without stenosis (p = 0.001, and p < 0.01, respectively). MPV was significantly greater in patients with mild stenosis than in patients without stenosis (p = 0.049 and p < 0.05, respectively). Patients with mild stenosis had a significantly greater mean PDW value compared with patients without stenosis and the control group (p = 0.024 and p < 0.05, respectively). There was no significant difference between patients without stenosis and the control group with respect to mean PDW value (p > 0.05). In conclusion, the results of this study demonsrate that children with BAV either with or without stenosis have increased MPV; the ones with mild stenosis have even greater values than the ones without stenosis. It emphasizes the risk of thrombosis in children with BAV.

Frequency of pericardial effusion in childhood acute lymphoblastic leukemia and clinical features of these patients.

In this study, we aimed to determine the frequency of pericardial effusion (PE) in children diagnosed with acute lymphoblastic leukemia (ALL). Clinical features of patients with effusion were evaluated. For this purpose, we reviewed the medical records of ALL patients who had pretherapy echocardiograms. A total of 90 patients aged between 1.8 and 16.3 years were analyzed retrospectively. In 23 of 90 (25.6%) patients, PE was detected at initial diagnosis. The age of patients with PE ranged between 1.8 and 14.8 years (mean 5.05 ± 3.77 years). The female/male ratio was 9/14. Six (26.1%) patients were T-lineage and 17 (73.9%) were B-lineage ALL. Nine (39%) patients were in standard risk group, 13 (57%) were in median risk group, 1 (4%) patient was in high-risk group. Mean initial white blood cell count was 40.756 ± 38.653/mm(3) (range 23.000-130.000/mm(3)). Mean initial hemoglobin count was 7.3 ± 1.39 gr/dL (range 5.5-10.1 gr/dL), mean initial platelet count was 35.200 ± 26.300/mm(3) (range 4.000-118.000 mm(3)). Size of effusions was between 2 and 6 mm (mean size 3.3 ± 1.8 mm). All patients had normal left ventricular systolic function. In 87% of patients, effusions disappeared in the first 7 days and, in 13%, disappeared between 8th and 15th days of chemotherapy. None of the patients required pericardiocentesis. Cardiac dysfunction did not occur among any of these patients during chemotherapy. In conclusion, PE is not frequent in childhood ALL. It usually does not cause cardiac impairment. It responds to treatment of leukemia.

The forgotten chamber: right-ventricular functions in juvenile idiopathic arthritis.

Cardiac involvement, such as pericarditis, myocarditis, and endocarditis, is seen in juvenile idiopathic arthritis. Although there have been some reports about right-ventricular systolic and diastolic functions of adults with rheumatoid arthritis and left-ventricular systolic and diastolic functions of children with JIA, there have been no studies about RV functions of children with JIA. The aim of this study was to determine RV functions in children with JIA. We performed conventional echocardiography and tissue Doppler imaging measurements of the right ventricle of patients with JIA. All patients were in sinus rhythm at the time of examination without overt LV heart failure and with normal LV ejection fraction. Fifty-five children with the diagnosis of JIA and 33 healthy control subjects were included in the study. Peak systolic, early, and late diastolic tricuspid annular velocities were significantly decreased in JIA patients compared with healthy controls (p < 0.05). Isovolumic accelaration (IVA), as a measure of myocardial acceleration during isovolumic contraction of the right ventricle, was also significantly lower in JIA patients than in healthy controls (p < 0.05). RV systolic and diastolic functions, in addition to the previously shown LV functions, are affected in JIA patients. IVA decreases in JIA patients and may be used as an alternative, noninvasive parameter for the assessment of RV systolic function in children with JIA.

Kocher-Debré-Sémélaigne syndrome with pericardial effusion.

Kocher-Debré-Sémélaigne syndrome (KDSS) is a rare association of muscular pseudohypertrophy and hypothyroidism in children. We report an 11-year-old female child with hypothyroidism and limb muscle pseudohypertrophy with pericardial effusion. The patient presented with hypertrichosis only. She had dull facies and marked hypertrophy of both calves and cervical muscles. Pericardial effusion was confirmed on investigations. Muscle pseudohypertrophy was a striking feature, and hypothyroidism was confirmed on thyroid studies. Pericardial effusion is known in hypothyroidism but has been very rarely reported with KDSS.