Abdullah Yazar

An unusual cause of fever in a neonate: influenza A (H1N1) virus pneumonia.

The 2009 flu outbreak in humans, known as H1N1 influenza A, refers to influenza A due to a new H1N1 strain called swine‐origin influenza virus A. The signs and symptoms of novel influenza A (H1N1) virus infection are similar to those of seasonal influenza, and specific diagnostic testing is required to distinguish novel influenza A (H1N1) virus from seasonal influenza virus. It results in various degrees of infection, ranging from mild to severe to fatal. For the treatment of swine‐origin influenza virus A oseltamivir and zanamivir are effective in most cases. Influenza A (H1N1) pneumonia in the newborn has not been yet reported in the literature. To our knowledge, this is the first report of a neonate of pneumonia in which influenza A (H1N1) virus was isolated. Pediatr Pulmonol. 2010; 45:734–736.

Romatizmal mitral yetmezlikli çocuklarda geleneksel ekokardiyografi ve doku Doppler görüntüleme ile sol ventrikül fonksiyonlarının değerlendirilmesi

Amac: Romatizmal kardit tanisi ile izlenen mitral yetmezlikli cocuklarda sol ventrikul fonksiyonlarini geleneksel ekokardiyografi ve doku Doppler goruntu- leme yontemiyle degerlendirip, sonuclari saglikli kontrol grubu ile karsilastirmayi amacladik. Gerec ve Yontem: Pediatrik kardiyoloji klinigimizde romatizmal kardit sonrasi mitral yetmezlik tanisi ile izlenen 30 hasta ve 5-15 yaslari arasinda 30 saglikli cocuk calismaya dahil edildi. Hasta grubu hafif-orta dereceli mitral yetmezlik ve agir mitral yetmezlik olarak siniflandirildi. Tum ekokardiyografik olcumler ca- lisma grubunun klinik ve laboratuvar sonuclarina kor olan uzman bir pediatrik kardiyolog tarafindan yapildi. Bulgular: Agir mitral yetmezlikli hastalarda sol ventrikul diyastol sonu caplari kontrol grubuna gore anlamli derecede artis gosterdi (4.62±0.82 cm, 3.92±0.39 cm; p=0.008). Yine sol ventrikul sistol sonu caplarinda agir mitral yetmezlikli hastalarda kontrol grubuna gore anlamli olarak artmis bulundu (2.81±0.51, 2.43±0.25, p=0.01). Ejeksiyon fraksiyonu ve fraksiyonel kisalma acisindan gruplar arasinda istatistiksel olarak anlamli fark yoktu (p>0.05). Doku Doppler gorun- tuleme yontemiyle olculen erken diyastolik pik miyokard hizi gruplar arasinda istatistiksel olarak anlamli farklilik gostermedigi halde (p>0.05), atriyal pik sisto- lik hiz, agir mitral yetmezlikli hastalarda, hem kontrol hem de hafif-orta mitral yetmezlikli hastalara gore anlamli derecede yuksek olculdu (sirasiyla p<0.001, p=0.001). Sonuc: Calismamizda, geleneksel ekokardiyografik olcumlerle elde edilen sol ventrikul sistolik ve diyastolik fonksiyonlari acisindan kontrol grubu ile mitral yetmezlikli hasta gruplari arasinda istatistiksel olarak anlamli bir farklilik bulunamamistir. Buna ragmen mitral yetmezlikli hasta grubunda sol ventrikuler fonksiyonlardaki subklinik bozulma doku Doppler goruntuleme yontemiyle saptanmistir.

Response to letter to the editor (10‐0227)

We thank Dr. Kanmaz et al. for their interest in case report. They have pointed out several important issues, although some of them are not directly related to our case report. Influenza A (H1N1) pneumonia in the newborn has not been yet reported in the literature. In the case of human influenza A, oseltamivir can be used for treatment in children aged <1 year and for prevention in children aged 3 months to 1 year. We isolated our case in a separate room after diagnosed as influenza A (H1N1). Our patient, the fifth day of the hospitalization, received treatment with oseltamivir. Even though clinical studies have shown that these medications are the most effective when started within the first 48 h of symptom onset, our patient was treated successfully from the fifth day of the admission. We should emphasize that this is the first report of a neonate of pneumonia in which influenza A (H1N1) virus was isolated. — AHMET SERT, MD* ABDULLAH YAZAR, MD DURSUN ODABAS, MD HUSEYIN BILGIN, MD Department of Pediatrics Konya Training and Research Hospital Konya, Turkey

Efficacy of a diazepam at preventing febrile seizure recurrence after febrile illness

We read with interest the article by Hirabayashi et al., who assessed the efficacy of diazepam suppositories at preventing febrile seizure recurrence during a single febrile illness to determine how to treat patients with a febrile seizure at hospital between December 2004 and March 2006 [1]. In their study, the authors wrote that diazepam was performed during febrile illness in 95 cases, otherwise diazepam was given after a febril seizure by them. So, it is unclear when diazepam were performed. On the other hand, dose intervals of diazepam used to treat seizures in the article were not given. Diazepam suppositories had been given to 95 children on admission, and 108 children had been not treated with diazepam suppositories on admission. The authors divided into two groups as treated and untreated with diazepam suppositories, however, febrile seizures were observed in 2 of the 95 children treated with diazepam versus 16 of the 108 children who were not. But, the authors did not note how to treat cases with a febrile seizure especially in cases with prolonged febrile seizures. Do any interventions have been made? The authors noted that prolonged febrile seizure was defined as one lasting for more than 20 min. However, a febrile seizure lasting for >30 min, particularly in a child younger than 3 yr of age, is the most common cause of status epilepticus [2]. Status epilepticus represents a true neurologic emergency that requires immediate treatment to stop seizure activity and prompt diagnostic evaluation to recognize potentially treatable causes [3]. Treatment must be initiated as early as possible and consists of benzodiazepine administration and supportive measures for the airway and circulation [4]. A continuum exists from a single seizure and escalating seizures to status epilepticus. Seizure treatment is more successful when given earlier [5]. In their study, Hirabayashi et al., found that significant difference was detected in the two groups from the point of view recurrence of a febrile seizure after admission (p = 0.0021). On the other hand, untreated