Arzu Gebeşçe

C-reactive protein and procalcitonin during febril attacks in PFAPA syndrome

OBJECTIVES To assess the levels of procalcitonin (PCT) and C-reactive protein (CRP) in children diagnosed with PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) during their febrile attacks. METHODS 23 patients with diagnosis of PFAPA included into the study prospectively during a three years period. In these patients, CRP and PCT values were recorded during 78 febrile episodes. Furthermore, 20 patients with diagnosis of pneumonia were chosen as a control group and their CRP and PCT values were measured. Normal reference values for CRP and PCT were 0-10 mg/L and 0-0.5 ng/mL, respectively. RESULTS Mean CRP and PCT values of patients with PFAPA were 94.8±71.6 mg/L and 0.29±0.14 ng/mL, respectively. In control group, mean CRP value was 153.2±26 mg/L and PCT was 1.59±0.53 ng/mL. CRP and PCT were high in control group. CRP was detected high and PCT was normal in PFAPA. Compared to control group, in PFAPA group, CRP values were not significantly (p>0.05) and PCT values were significantly lower (p<0.001). CONCLUSION During febrile episodes in the patients with diagnosis of PFAPA, CRP values were substantially elevated, whereas PCT values were within normal levels. Concomitant assessment of CRP and PCT in addition to clinical diagnostic criteria may be of help in making diagnosis and distinguishing febrile attacks from infections. However, studies in larger groups are required.

Importance of the Ultrasonography in Diagnosis of Ileal Duplication Cyst

Gastrointestinal duplication cysts are rare congenital anomalies that can be seen in anywhere of the gastrointestinal system from the mouth to the anus. These are prenatally diagnosed through antenatal ultrasonography. However, attention must be paid since these formations might be confused with ovarian or mesenteric cysts. Our patient, who had been diagnosed with ovarian cyst on the ultrasonography performed in another center and with mesenteric cyst based on the abdominal MRI carried out at fifth month of life, presented to our clinic with the only complaint of constipation at 9th month of life. The diagnosis was set through double wall appearance of duplication cyst on the abdominal ultrasonography. The patients cyst was resected.

Smith-Lemli-Opitz Syndrome: A Case with Annular Pancreas

Smith-Lemli-Opitz syndrome is an autosomal recessive disease of cholesterol metabolism. It is a multiple malformation syndrome with typical dysmorphic features such as bitemporal narrowing, ptosis, epicanthus, microcephaly, micrognathia, and cardiovascular, skeletal, urogenital, and gastrointestinal anomalies. This report presents a typical case of Smith-Lemli-Opitz syndrome with annular pancreas which is an unreported gastrointestinal abnormality.

The Type of Anesthesia Used during Cesarean Section Is Related to the Transient Tachypnea of the Newborn

Aim. To demonstrate whether transient tachypnea of the newborn (TTN) is found more frequently in women undergoing general or combined epidural-spinal (CES) anesthesia during Cesarean section. Methods. This study was done retrospectively. A total of 1447 Cesarean sections (C/S) were performed in our clinic between January 2008 and December 2011. General anesthesia was performed in 1078 (74.5%) of the Cesarean cases. CES anesthesia was performed in 369 cases (25.5%). The International Classification of Diseases,Tenth Revision code of P22.1, was used to identify the infants with TTN. Stratified multivariate analysis was undertaken on subgroups to assess the effect modification by factors known to influence the incidence of TTN: maternal age, maternal systolic-diastolic artery pressure, heart rate, Apgar score at 1 and 5 minutes, sex, time interval from spinal block to skin incision, and time interval from skin incision to umbilical cord clamping. Results. The rate of TTN diagnosis was found to be higher in parturients who had a cesarean section with combined epidural-spinal anesthesia, but no statistical differences were found. (P < 0.05) (odds ratio = 1.471 and 95%CI: 0.92–2.35). Conclusions. The incidence of TTN was found related to C/S but independent from the type of anesthesia. However, studies with a wider spectrum of patients and a lower quantitative difference between the groups are needed in order to draw firm this conclusions.

The effect of family members on breastfeeding practices among Turkish mothers.

In spite of the overwhelming evidence that the single most important nutrient for infants is breastmilk, children all over the world, and especially in developing countries, die within the first year of life because of illnesses related to insufficient and imbalanced nutrition. Most of these illnesses can be avoided with early and consistent breastfeeding. The World Health Organization recommends that every baby be fed exclusively on breastmilk for the first 6 months of life, and the UNICEF Innocenti Declaration states that children should continue to be breastfed while receiving appropriate and adequate complementary foods for up to 2 years of age or beyond. The statistics founds indicate that in Turkey, like in many regions of the world, low rates of breastfeeding are a problem. We would like to share the results of our survey. There are many factors such as poverty, education, tradition, and physical limitations that can affect a woman’s success with breastfeeding. Our self-administered survey was conducted to look at the factors most relevant to Turkish mothers. We surveyed 1,750 breastfeeding mothers, and 96.5% of them reported breastfeeding postpartum. Unfortunately, only 32.3% were able to practice exclusive breastfeeding for the first 3 months of life, and only 19% practiced exclusive breastfeeding for the first 6 months of life. In the first 3 months of life, 64.6% of mothers reported providing breastmilk and formula to their infants; this rate increased to 73.9% for the first 6 months of life. Among other questions, participating mothers were asked if family members had any influence on their breastfeeding practice in the first 6 months. Of the participating mothers, 63% reported that the influence of family members led them to give their babies formula and food in addition to breastmilk in the first 6 months. When the mothers were asked to elaborate on how their families had influenced their decisions, they commonly described their family members as being critical of their ability to care for the infant, particularly when the infant cried, and suggesting that the infant was dehydrated, underweight, or badly cared for in general. In conclusion, although breastfeeding newborns is common in Turkey, the percentage of mothers who continue to breastfeed exclusively as recommended by the World Health Organization is falling. A major factor in a mother’s breastfeeding practice is the influence of family members. To achieve the breastfeeding standards set out by the World Health Organization, mothers and their family members must be educated through antenatal breastfeeding education programs that teach the importance of maintaining successful breastfeeding practices, and the drawbacks of early supplementation. In addition, programs that encourage breastfeeding must be developed for working mothers. Most important is that breastfeeding mothers must be evaluated in terms of their social environment, so as to protect them from negative influences. Psychological support to mothers is crucial to ensuring the sustainability of breastfeeding and achieving breastfeeding goals.

The Effects of Inhaled β-Adrenergic Agonists in Transient Tachypnea of the Newborn

Aim. To investigate the efficacy of an inhaled β-adrenergic agonists in transient tachypnea of the newborn (TTN). Method. We retrospectively analyzed a cohort of 51 term infants (Group 1) and 37 term infants (Group 2) monitored in the newborn intensive care unit diagnosed with TTN. Infants in Group 1 received humidified oxygen alone, and infants in Group 2 were administered the inhaled β-2 agonist plus humidified oxygen. Results. TTN clinical respiratory assessment, respiratory rate, oxygen saturation values, need for supplemental oxygen therapy, blood gas PH, PO2, and duration of hospitalization were significantly improved in infants in Group 2 as compared with infants in Group 1 (P < .05). No statistically significant difference was observed with regard to blood glucose, potassium, heart rate, and PCO2 (P > .05). Conclusion. Inhaled β-adrenergic agonist added to humidified oxygen was found to improve clinical and laboratory parameters. We believe that further studies should be conducted with larger groups to demonstrate the efficacy of β-2 agonists in TTN patients.

To Evaluate Serum Eosinophil Cationic Protein and Total IgE Concomitantly May Predict the Persistence of Wheezing in Young Children

Background. We investigated the predictive value and the relative risk of the evaluation of serum eosinophilic cationic protein (sECP) and total IgE levels concomitantly in relation to the persistence of wheezing in young children. Methods. The study was conducted prospectively between January 2007 and December 2010. A hundred and eight children, aged between three months and four years, with three or more episodes of wheezing, were studied to evaluate the role of eosinophil inflammation and its relation to persistence of wheezing two years later. Results. A statistically significant difference in terms of total IgE and sECP values was observed between the groups (P < 0.05). When measurement of IgE and sECP was assessed concomitantly, the sensitivity was found to be 92.68%, the negative predictive value was found to be 71.43%, accuracy rate was found to be 84.26%, and the relative risk was found to be 3.06 in group 1. Conclusions. In this study, we aimed to emphasize the importance of the assessment of sECP and total IgE concomitantly, as being two noninvasive and easily applicable tests, useful in predicting persistent wheezing in early childhood.

Levetirasetam for the Treatment of Refractor Neonatal Seizures

Konvülsiyonlar yenidoğan döneminde, özellikle prematürelerde sık görülür. Konvansiyonel antiepileptiklerin güvenirliliği ve etkinliği ayrıntılı olarak araştırılmıştır. Buna rağmen, en sık kullanılan fenobarbitalin bile daha önce bilinmeyen apopitoz gibi uzun dönem yan etkileri yeni fark edilmektedir. Oysa yeni antiepileptiklerden levetirasetamın çocuk ve erişkinlerin parsiyel başlangıçlı, idiyopatik ya da jeneralize nöbetlerindeki etkinliği ve güvenirliği ile ilgili birçok çalışma yapılmıştır. Ancak yenidoğanlarda özellikle prematürelerdeki çalışmalar sınırlıdır. Bu yazıda klasik antiepileptiklerere cevap vermeyen, ancak levetirasetamla nöbetleri kontrol altına alınan yedi günlük ikiz prematüre olgular sunuldu. Her iki hastanın uzun süreli takiplerinde nöbet ve ilaca bağlı her hangi bir yan etki gözlenmedi.

Pneumatic reduction in the treatment of childhood intussusception cases

Intussusception that is defined as insertion of proximal intestine into distal segment is the second most common acute abdomen pathology after appendicitis. In this retrospective study, we evaluated the patients presented with intussusception and the results of pneumatic reduction. A retrospective analysis of files and operation logs of patients with intussusception from 2007 to 2011 were done. In this study, 13 male (72,2%) and 5 female (27,8%), totally 18 patients were analyzed. Mean age was 20,36 months (6,5-95 months). The most common clinical presentations were abdominal pain, vomiting, bloody stool and irritability and duration of complains were 6-52 hours. Although in all patients signs of intussusception were found on abdominal ultrasound examination, in 8 (44%) patients abdominal mass was detected on physical examination. In 15 (83,3%) patients pneumatic reduction was successfully performed and manual reduction was done in 3 (16,7%) patients. In conclusion, abdominal ultrasound that was performed in patients presented with abdominal pain and vomiting may affect the rate of early diagnosis of intussusception. In these patients, pneumatic reduction, as a first choice of treatment, can be carried out easily and successfully.