Ayşegül Bükülmez

Nasal carriage of Staphylococcus aureus in 4–6 age groups in healthy children in Afyonkarahisar, Turkey

Aim: Staphylococcus aureus is a common cause of disease, particularly for colonized persons. Although methicillin‐resistant S. aureus (MRSA) infection has frequently reported, population‐based S. aureus and MRSA colonisation estimates are lacking. Our objective in this report is to present the prevalance of S. aureus carriage among 4–6 age groups healthy children in our region.

Molecular characterization of rotaviruses in mid-western Turkey, 2006–2007

Vaccines against rotaviruses are now available in numerous countries, including Turkey. As the vaccines may show various efficiencies against different type specificities and routine vaccination in infants might result in selection and immune escape of wild-type rotavirus strains, strain surveillance has been initiated before and during the vaccine introduction. We aimed to provide corresponding information on local strain prevalence in Anatolia, mid-western Turkey during the introduction of rotavirus vaccines. Stool samples positive for group A rotavirus by commercial enzyme immunoassay were subjected to reverse transcription-polymerase chain reaction based genotyping of the outer capsid antigens, VP7 and VP4, determining G and P type specificities respectively. Among 36 fully and 5 partially typeable strains we detected genotype G1, G2, and G9 VP7 specificities and genotype P[4], P[6] and P[8] VP4 specificities in 5 individual and 4 mixed combinations. The most common strain was G2P[4] (n=17), followed by G9P[8] (n=9). Other strains were G1P[8] (n=2), G2P[8] (n=2), G1+2P[8] (n=2), G9P[4] (n=1), G2+9P[8] (n=1), G4+9P[6] (n=1), and G2P[4+8] (n=1). Partially typed strains included 2 G1P[NT] and 3 G2P[NT] strains. Our data may help determine a baseline of the rotavirus genotype prevalence in Turkey and see if changes in the incidence of individual strains will be observed after routine use of vaccine.

Lacrimo-auriculo-dento-digital syndrome with QT proglongation

We have read the article by E. Onrat et al. entitled “Lacrimo-auriculo-dento-digital syndrome with QT prolongation1. It was amazing to realize that the same boy presented to the paediatric emergency department with seizures 4∞∞months earlier. The patient had been diagnosed with epilepsy before and had been treated with phenobarbital, without any benefit. Thereafter during a screening programme he was diagnosed as having long QT syndrome, in addition to the LevyHollister syndrome, upon which beta-blockers were started. During follow-up, the prolongation of QT did not change and the dose of the beta-blockers was doubled again without any improvement. On admission to the emergency department, the boy was found to be severely hypocalcaemic (serum calcium level 4.3∞∞mg/dl). It is stated in the above article that his serum levels of sodium potassium and calcium were normal, but no quantitative values were given. The QTc on admission was 500∞∞∞msec. Emergency treatment of hypocalcaemia was achieved by bolus administration of i.v. calcium gluconate, followed by continuous infusion. Serum phosphorus was 11.66∞∞mg/dl during the hypocalcaemic period. The serum magnesium level was 1.40∞∞mg/dl, within the normal range. The serum parathormone level was 3.00∞∞pg/ml, far below the normal range of 10-65∞∞mg/ml. Computed tomography of the skull yielded calcifications of the basal ganglia. This work-up for hypocalcaemia revealed that the patient had had hypoparathyroidism which was the main cause of the hypocalcaemia and the resultant QT prolongation. Upon the diagnosis of hypoparathyroidism the patient was given i.v. calcium first, followed by oral calcium after determining that serum calcium levels reached normal levels. After correction of hypocalcaemia QTc was found to be 340∞∞msec. The patient was also given calcitriol, first at 0.25∞∞mcg/24h followed by 0.75∞∞mcg/24h when it was impossible to maintain normal serum calcium only with calcium administration. The beta-blocker therapy used for the last 2∞∞years was stopped. The patient is still receiving treatment with oral calcium and alcitriol and is without symptoms. His QTc is 320∞∞msec. We have to emphasize that what is new in this particular patient is not the QT prolongation but rather the hypoparathyroidism. This may be part of the LADD syndrome or a coincidence which will become clearer after further research and case reports. Hypoparathyroidism has not been reported before in the LADD syndrome but it is well known that it can occur in several dysmorphic syndromes and even a specific syndrome has been reported in Middle Eastern children2. In hypoparathyroidism, enamel hypoplasia may occur, with dry and scaly skin and horizontal lining of the nails, and keratoconjunctivitis, which were prominent features in our patient also. These overlaps strongly suggest that LADD syndrome and hypoparathyroidism may have a common aetiology, or both may be a part of a sequence. Therefore, we believe that what is new in this specific patient with LADD syndrome is not the QT prolongation but rather the hypoparathyroidism and for the time being, hypoparathyroidism should be kept in mind when evaluating LADD patients.

Complex regional pain syndrome type 1 in a pediatric patient: Case report

Complex regional pain syndrome type 1 is one of the causes of morbidity of childhood which is also named reflex symphathetic dystrophia. The syndrome is characterized with regional pain and vasomotor, sudomotor and sensory changes in the distal parts of the extremities involved. Complex regional pain syndrome type 1 shows difference in children in terms of clinical picture and imaging methods compared to adults. The most important point is that the prognosis is generally better in children if early diagnosis and treatment is provided. On the other hand, causes including presence of psychological factors or less contribution of imaging methods in children lead to delayed diagnosis or erroneous diagnosis. In this article, a 10 year-old male patient who was diagnosed with complex regional pain syndrome type 1 was described. Thus, we aimed to remind clinicians that this syndrome should also be kept in mind in the differential diagnosis of pain in children.

Çocuklarda tüberkülin cilt testi

Tuberkuloz dunyada ve ulkemizde onemini koruyan ve dikkatli sekilde takibi gereken en oldurucu enfeksiyon hastaliklarindan birisidir. Hastalik gelisme riski yasin azalmasi ile beraber artmakta ve 2 yasin altinda artis belirginlesmektedir. Cocukluk cagi tuberkulozu tanisinda altin standart eriskin yasta da oldugu gibi basilin gosterilmesi ya da kulturde uretilmesidir. Ancak cocuklarda, bakteriyolojik tani orani eriskinlerden daha dusuk oranlarda bildirilmistir (% 30-50). Bu nedenle tuberkuloz enfeksiyonu suphesi bulunan cocuklara tani amacli olarak, ilk etapta deri testi yapilmalidir. Tuberkuloz basili ile temasin belirlenmesinde kullanilan en basit test tuberkulin cilt testidir. Tuberkulin cilt testinin esasi, basilin belirli antijenik bilesenlerinin, tuberkuloz basili ile enfekte kisilerde gecikmis tipte asiri duyarlilik reaksiyonu olusturmasidir. Test saflastirilmis protein turevi (Purified Protein Derivative: PPD) ile yapilir. PPD testi, sol onkolun 2/3 ust kisminda ic yada dis yuzune, cilt icine yapilir. Gec tipte hucresel asiriduyarlilik reaksiyonu sonucu endurasyon (kabarti-sertlik) olusumu gorulur. Bu yazida, standart tuberkulin cilt testinin cocuklarda uygulanmasi ve yorumlanmasi ele alindi.