The Role of Mean Platelet Volume in Multisystem Inflammatory Syndrome in Children With Cardiac Manifestations.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a novel pediatric disorder associated with coronavirus disease 2019. However, no laboratory parameters can diagnose MIS-C. This study aimed to determine the changes in mean platelet volume (MPV) and investigate its relationship with cardiac involvement in MIS-C. METHODS: In this single-center retrospective study, 35 children with MIS-C, 35 healthy children and 35 febrile children were enrolled. Patients with MIS-C were further subdivided depending on the presence of cardiac involvement. For all patients, the white blood cell, absolute neutrophil, absolute lymphocyte, platelet counts, MPV and C-reactive protein levels were recorded. Ferritin, D-dimer, troponin and CK-MB levels and the day when IVIG was administered were recorded and compared between groups. RESULTS: Thirteen patients with MIS-C had cardiac involvement. The mean MPV of the MIS-C group was significantly higher than those of the healthy ( P = 0.0001) and febrile ( P = 0.027) groups. Using a cutoff of >7.6 fL, the MPV had a sensitivity of 82.86% and specificity of 82.75%, and the area under the MPV receiver operating characteristics curve was 0.896 (0.799-0.956). The MPV was significantly higher in patients with cardiac involvement than in those without ( P = 0.031). Logistic regression analysis revealed that the association between the MPV and cardiac involvement was significant (odds ratio, 2.28; 95% confidence interval, 1.04-2.95; P = 0 .039). CONCLUSIONS: The MPV may indicate cardiac involvement in patients with MIS-C. Large cohort studies are needed to define an accurate cutoff value for the MPV.

Carfilzomib: A Tale of a Heartbreaking Moment: Case Report and Concise Review of the Literature.

BACKGROUND: Carfilzomib, a proteasome inhibitor, known as a therapeutical option for people who have already received one or more previous treatments for multiple myeloma, has well known cardiac and systemic adverse effects. OBJECTIVE: There is evidence supporting that adverse effects are dose dependent, yet there is no known patient phenotype characterized by worse associated consequences, nor are there widely accepted monitoring protocols. RESULTS: In this article we describe two patients with cardiovascular adverse events related to carfilzomib treatment and their clinical course. Our goal was to present two cases of daily practice, which highlighted the complexity of their management and led to underline how baseline evaluation and close follow-up with echocardiography and cardiac biomarkers, including natriuretic peptides, remain an important tool for the cardiotoxicity surveillance. CONCLUSION: These reflections should lead to further studies in order to identify high risk patients for cardiovascular adverse event and clarify the real incidence of cardiotoxicity of this drug and adequate follow-up timing. Finally further research is needed to evaluate strategies for prevention and attenuation of cardiovascular complications of cancer therapy.

The Efficacy of Oral Vitamin B12 Replacement for Nutritional Vitamin B12 Deficiency.

Standard treatment of vitamin B12 deficiency has not been well established in childhood, the ideal amount of supplemental vitamin B12 is not clear. Vitamin B12 deficiency is classically treated with intramuscular injections. In this study, we aimed to investigate the efficacy of oral therapy in children with vitamin B12 deficiency. Patients with serum cobalamin concentrations <300 pg/mL aged between 6 months to 18 years were included in this prospective study. Children were treated orally either with a combination of multivitamin tablet daily or vitamin B12 ampules. Serum specimens were obtained at the end of first and third months of treatment for vitamin B12 levels. A total of 79 patients were included in the study. The mean pretreatment vitamin B12 level increased from 182±47.6 pg/mL to 482±318 pg/mL after 1 month of treatment in the whole cohort. Comparison of the pretreatment vitamin B12 levels with first and third month posttreatment values showed significant difference (P-value, 0.001 and 0.028, respectively). In this study, oral cyanocobalamin was found effective for the treatment of vitamin B12 deficiency in children.

Prediction of neurodevelopmental outcome in term neonates with hypoxic-ischemic encephalopathy.

BACKGROUND: Hypoxic ischemic encephalopathy may result in many neurological deficits. It is crucial to make early diagnosis and assess the prognosis correctly. AIMS: We aimed to determine the factors to evaluate the prognosis of hypoxic ischemic encephalopathy. METHODS: Electroencephalography, neuroimaging, periodic neurological exams and a developmental test at 44-48 months after discharge from the hospital were performed on twenty five term newborn infants with clinical evidence of hypoxic ischemic encephalopathy. RESULTS: Normal/mildly abnormal neonatal electroencephalography correlated with favorable outcome, particularly if neuroimaging was normal. The cranial MRI sensitivity was 83.3%, while the specificity was 57.9%, the positive predictive value was 38.5%, and the negative predictive value was 91.6%. Moderate/severely abnormal electroencephalography and multifocal/diffuse cortical or deep gray matter lesions correlated with poor outcome. CONCLUSIONS: Newborn infants with hypoxic ischemic encephalopathy should be treated in neonatal intensive care units, assessed with periodic neurological examination, electroencephalogram and brain imaging. This would help to initiate early intervention and improve the outcome of patients.

Comparison of oral alendronate versus prednisolone in treatment of infants with vitamin D intoxication.

AIM: The aim of this report was to compare the efficacy of oral alendronate versus prednisolone treatment in addition to conventional measures in infants with vitamin D intoxication. METHODS: In six infants (aged 8.0 ± 2.1 months) with vitamin D intoxication, time to achieve normocalcemia with prednisolone treatment (Group I, n = 4) or alendronate treatment (Group II, n = 4, two infants started treatment from the baseline and two after unsuccessful prednisolone treatment) in addition to intravenous hydration and diuretic therapy were compared. RESULTS: Baseline serum calcium levels ranged between 3.8 and 4.77 mmol/L. In the prednisolone group, although two patients reached normocalcemia on 7th and 12th days of treatment, other two patients did not despite 23 and 15 days of treatment and therefore switched to alendronate treatment. The mean duration of prednisolone treatment in these four patients was 14.2 ± 6.7 days (range 7-23). In the alendronate group, two patients who started treatment from the baseline achieved normocalcemia on the 5th day. Other two patients achieved normocalcemia 2 days after switching to alendronate. Thus, the mean time to reach normocalcemia after single oral alendronate administration was 3.5 ± 1.7 days (range 2-5) (p < 0.01 versus Group I). CONCLUSION: Alendronate treatment achieves normocalcemia four times earlier than prednisolone treatment and shortens hospital stay in infants with vitamin D intoxication.