A.Emin Kürekçi

Plasma Trace Element, Plasma Glutathione Peroxidase, and Superoxide Dismutase Levels in Epileptic Children Receiving Antiepileptic Drug Therapy

Summary: Some antiepileptic drugs (AEDs) may altertrace element metabolism and free radical scavenging enzyme activities in humans and experimental animals. We investigated the effect of longterm AED therapy on copper (Cu), zinc (Zn), manganese (Mn), selenium (Se), magnesium (Mg), glutathione peroxidase (GSH‐PX), and superoxide dismutase (SOD) in the plasma in children with epilepsy. During treatment with valproate (VPA) or carbamazepine (CBZ) monotherapy plasma Cu, Zn, Mn, Se, and Mg concentrations of patients were not statistically different from those of control subjects. The level of seoxidation may be causally involved in some forms of epilepsies, and the decreased free radical scavenging enzyme activity is believed to cause the increased risk of anidiosyncratic drug reaction encountered in the manage‐ment of epilepsy. Because GSH‐PX and SOD are themost important members of antioxidant defense mechanisms, we quantitated the activities of these enzymes inplasma of children with epilepsy receiving VPA or CBZ. Only plasma GSH‐PX activities in VPA group werehigher than those of the control group, and the differencewas statistically significant.

Factor VIII levels in children with thrombosis.

Abstract Background : A number of coagulation defects have been implicated as risk factors in thrombo‐embolic disease. Of these, high levels of clotting factor VIII have been shown to be associated with a five‐ to six‐fold increased risk of thrombosis, compared to levels < 100 IU/dL in adults. The objective of this study was to investigate the prevalence of elevated plasma levels of factor VIII in a pediatric population with thrombo‐embolism (TE).

The normalization period of platelet aggregation in newborns

This study was performed to investigate the normalization period of the transient platelet dysfunction of newborns. A total of 43 healthy newborns of healthy mothers who had received no medication for at least 14 days prior to delivery were included in the study. Venous blood samples of 44 healthy volunteer adults were used as control. Platelet aggregation study was performed in whole blood by impedance aggregometry. Collagen or ADP was used as the aggregating agent. In the platelet aggregation studies using collagen, maximum aggregation values in the first three days of life were lower than those of adults (p < 0.001). These lower values were improved and reached adult values between the 5th and 9th day of life. Lower maximum aggregation values were observed in newborns in comparison with those of adults when ADP was used, but the difference was not significant except for 5 microM concentration of ADP. There was no significant difference between the aggregation time of the collagen and ADP groups (p > 0.05). In conclusion, the platelet responses to ADP and collagen were increased in newborns as the age progressed and reached normal levels between 5th and 9th day of life. If platelet dysfunction does exist after the 10th day of life, this finding may be due to either simple prolongation of the physiological phenomenon or platelet disorders.

Complete platelet recovery after treatment of Helicobacter pylori infection in a child with chronic immune thrombocytopenic purpura: a case report.

Helicobacter pylori gastritis has been associated with autoimmune disease, including immune thrombocytopenic purpura (ITP). The most recent reports also have supported this association in adults. ITP in children differs from that in adults in terms of clinical picture and mechanisms of thrombocytopenia. The authors report a case of a 12-year-old boy with chronic ITP, in whom they detected H. pylori infection and observed a complete platelet recovery after the eradication of H. pylori.

Renal tubular function in children with beta-thalassemia minor.

Background:  β‐thalassemia minor is a common heterozygous haemoglobinopathy that is characterized by both microcytosis and hypochromia. It requires no treatment. It has been postulated that low‐grade haemolysis, tubular iron deposition and toxins derived from erythrocytes might cause renal tubular damage in adult patients with β‐thalassemia minor. Our aim was to investigate the renal tubular functions in children with β‐thalassemia minor and to determine its possible harmful effects.

Recurrent arterial thrombosis in a child: primary antiphospholipid antibody syndrome.

Antiphospholipid antibody syndrome (APS) is characterized by the association of recurrent arterial or veneous thrombosis or recurrent fetal wasteage and the presence of circulating antiphospholipid antibodies, detected as anticardiolipin antibodies or lupus anticoagulant. The authors report an 8-year-old girl, who presented with central retinal artery occlusion and livedo reticularis and was diagnosed as APS. Despite the proper anticoagulant treatment she had several cerebral ischemic events a nd died 29 months after thediagnosis. A larger number of pediatric case investigations will be required for better understanding and treating this rare thrombotic disorder.

The platelet aggregation in children with epilepsy receiving valproic acid.

This study was performed to evaluate the aggregation changes in the whole blood samples of children with epilepsy receiving valproic acid. A total of 25 patients and 15 healthy volunteer adults were included in the study. Platelet aggregation study was performed in whole blood by impedance aggregometry. Platelet counts, the bleeding times, and clotting times of the patients were within normal limits. The aggregation time and maximum aggregation values revealed no significant difference except for those with 2 mu g/ml collagen (p < 0.01) between the two groups. Serum valproic acid levels of the children did not correlate with the maximum aggregation values induced by different concentrations of aggregating agents except for 20 mu M ADP (r = -0.430, p < 0.05). We concluded that the use of valproic acid does not result in thrombocytopenia and platelet dysfunction within therapeutic limits and the drug is reliable in the management of epilepsy.

Platelet aggregation in children with Helicobacter pylori infection.

This study was performed to investigate the platelet aggregation alterations in platelet-rich plasma (PRP) samples of children with Helicobacter pylori (H pylori) infection. Platelet aggregation induced by adenosine diphosphate (ADP), collagen, ristocetin, or epinephrine was studied with photometric aggregometry in 30 patients before and after eradication therapy and in a control group including 15 children. The pretreatment mean maximum aggregation values and slope were significantly lower (P < .0001) in the study group at 10 μmol/L concentrations of ADP (ADP-like defect). The maximum aggregation values and slope revealed no significant differences (P > 0.05) between the study group after therapy and the control group. We concluded that H pylori infection may cause dysfunction of platelets in children and can be reversed by H pylori eradication therapy. Further studies should be carried out to determine the mechanisms of platelet dysfunction in children with H pylori infection.

Familial high factor VIII level in a child with necrotizing fasciitis complicating primary varicella infection

This article describes an unusual association of familial high plasma factor VIII level and necrotizing fasciitis in a 4-year-old girl with primary varicella infection.

Mycoplasma pneumoniae infection in a child after renal transplantation

Abstract:  Although Mycoplasma pneumoniae infections are common among school children and young adults, they have been rarely reported in renal transplant recipients. Herein, we report an 8‐yr‐old boy who had M. pneumoniae infection 1 yr after transplantation and showed liver dysfunction during the course of the disease. In children who underwent renal transplantation and receive immunosuppressive treatment, we suggest that symptoms of a simple upper respiratory tract infection may precede M. pneumoniae disease with potentially serious extrapulmonary complications.