Why do infants pull their ears?

ObjectiveIn this study, we aimed to evaluate the diagnoses of the infants who were admitted to our outpatient clinic with the complaint of pulling on the ear and to identify the related factors which may contribute to the diagnosis.MethodsThis prospective study included a total of 102 infants who were admitted to our hospital with the complaint of tugging and pulling on, touching, and rubbing the ears on the shoulder or pillow and shaking the head between July 2016 and July 2017. The complaints were evaluated throughout the day, and the application seasons, the person referred the patient to the ear, nose, and throat (ENT) specialist, the child development specialist and child psychiatrist, allergy and atopy histories, and the relationship between the results and diagnoses were evaluated.Results46.1% of the patients had normal examination findings, while the second most common finding was cerumen in 37.2%, and the third one was otitis media with effusion (OME) in 16.7%. In infants who were directly referred by the family, normal and serological diagnosis were found to be statistically significantly higher than that of OME diagnosis, whereas in the infants referred by the family physicians and pediatrist, the OME was found to be statistically significantly higher than normal and cerumen levels. The presence of additional complaints in the OME group was found to be higher than normal and cerumen group. In those with complaints during the day, the most common finding was OME, while it was cerumen in those with complaints a few times in a day and normal examination finding in those tugging on their ears only, when they were falling asleep, indicating statistical significance. Of 47 infants with normal physical examination findings, 37 were assessed by the child psychiatrist, and depression was found in six of one of the parents during the family interviews.ConclusionIn this study, the majority of the infants referred to the ENT outpatient clinic had normal examination findings, while the rate of OME diagnosis was high. Considering the negative consequences of EOM in infants, the diagnosis of the EOM becomes extremely important. If there are no otologic pathologies in the majority of infants who were admitted with ear pulling and tugging, the possibility of different factors in etiology gives rise to thought. Therefore, further studies are required to prove this condition.     

Cardiovascular risk assessment in children and adolescents with congenital solitary kidneys

Patients with solitary kidneys (SKs) are at risk of hypertension (HT) and associated end‐organ damage. The authors aimed to evaluate whether children with congenital SKs (CSKs) have higher office, ambulatory, or central blood pressure (BP), increased arterial stiffness or left ventricular mass index, or any risk for arrhythmia. With this purpose, patients with CSK and healthy controls being followed up between January 2018 and June 2019 were enrolled in the study. Demographic, biochemical, and office blood pressure (BP) data were recorded. Then, ambulatory blood pressure monitoring (ABPM) and measurements of central BP (cBP), pulse wave velocity (PWV), and augmentation index (AIx@75) were obtained. Ventricular repolarization parameters were acquired by 12‐lead electrocardiography. Left ventricular mass index (LVMI) and abdominal aortic stiffness parameters including strain, pressure strain elastic modulus (Ep), and normalized Ep (Ep*) were calculated with echocardiographic measurements. Finally, 36 children with CSK and 36 healthy controls were included. Serum creatinine, uric acid, total cholesterol levels, ABPM parameters, cBP levels, and PWV values were significantly higher, and eGFR levels were significantly lower in the CSK group. VR parameters, abdominal aortic stiffness indices, and LVMI were similar between the groups. CSK increased the risk of HT in ABPM (HT_ABPM) by 6 times. PWV was significantly correlated with Ep and Ep* in cases with CSK. Determination of cBP and PWV along with 24‐hour ABPM would be a useful tool in children with CSK.     

Hepatocyte Growth Factor/c-Met Signaling Is Required for β-Cell Regeneration

Hepatocyte growth factor (HGF) is a mitogen required for β-cell replication during pregnancy. To determine whether HGF/c-Met signaling is required for β-cell regeneration, we characterized mice with pancreatic deletion of the HGF receptor, c-Met (PancMet KO mice), in two models of reduced β-cell mass and regeneration: multiple low-dose streptozotocin (MLDS) and partial pancreatectomy (Ppx). We also analyzed whether HGF administration could accelerate β-cell regeneration in wild-type (WT) mice after Ppx. Mouse islets obtained 7 days post-Ppx displayed significantly increased c-Met, suggesting a potential role for HGF/c-Met in β-cell proliferation in situations of reduced β-cell mass. Indeed, adult PancMet KO mice displayed markedly reduced β-cell replication compared with WT mice 7 days post-Ppx. Similarly, β-cell proliferation was decreased in PancMet KO mice in the MLDS mouse model. The decrease in β-cell proliferation post-Ppx correlated with a striking decrease in D-cyclin levels. Importantly, PancMet KO mice showed significantly diminished β-cell mass, decreased glucose tolerance, and impaired insulin secretion compared with WT mice 28 days post-Ppx. Conversely, HGF administration in WT Ppx mice further accelerated β-cell regeneration. These results indicate that HGF/c-Met signaling is critical for β-cell proliferation in situations of diminished β-cell mass and suggest that activation of this pathway can enhance β-cell regeneration.