Başak Nur Akyıldız

Cyanide poisoning caused by ingestion of apricot seeds

Abstract Aim: To report diagnostic, clinical and therapeutic aspects of cyanide intoxication resulting from ingestion of cyanogenic glucoside-containing apricot seeds. Methods: Thirteen patients admitted to the Pediatric Intensive Care Unit (PICU) of Erciyes University between 2005 and 2009 with cyanide intoxication associated with ingestion of apricot seeds were reviewed retrospectively. Results: Of the 13 patients, four were male. The mean time of onset of symptoms was 60 minutes (range 20 minutes to 3 hours). On admission, all patients underwent gastric lavage and received activated charcoal. In addition to signs of mild poisoning related to cyanide intoxication, there was severe intoxication requiring mechanical ventilation (in four cases), hypotension (in two), coma (in two) and convulsions (in one). Metabolic acidosis (lactic acidosis) was detected in nine patients and these were treated with sodium bicarbonate. Hyperglycaemia occurred in nine patients and blood glucose levels normalised spontaneously in six but three required insulin therapy for 3–6 hours. Six patients received antidote treatment: high-dose hydroxocobalamin in four and two were treated with a cyanide antidote kit in addition to high-dose hydroxocobalamin. One patient required anticonvulsive therapy. All patients recovered and were discharged from the PICU within a mean (SD, range) 3.1 (1.7, 2–6) days. Conclusion: Cyanide poisoning associated with ingestion of apricot seeds is an important poison in children, many of whom require intensive care.

A comparative study: The efficacy of liquid paraffin and lactulose in management of chronic functional constipation

Abstract Objectives : To determine and compare efficacy, safety and optimal dose of two laxatives, liquid paraffin and lactulose, in 40 children with chronic functional constipation.

Old agent, new experience: colistin use in the paediatric Intensive Care Unit—a multicentre study

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.

Correlation of abdominal fat accumulation and stiffness of the abdominal aorta in obese children.

AIM To evaluate abdominal adipose tissue accumulation in obese children by ultrasound measurement and compare with the elastic properties of the abdominal aorta. CHILDREN AND METHODS A total of 56 obese children and a control group of 30 non-obese children had an ultrasound examination for measurements of thickness of visceral, preperitoneal, and subcutaneous fat as well as abdominal aorta stiffness parameters. Anthropometric measurements and metabolic risk profile were assessed by physical examination and blood tests. RESULTS Abdominal aorta stiffness parameters were all significantly higher in the obese children than in the controls. Among the adipose tissue compartments, visceral fat thickness was the strongest correlate of abdominal aorta stiffness parameters. Similarly, the correlation between visceral abdominal adipose tissue and fasting insulin levels, HOMA score, and pulse pressure also approached significance. CONCLUSIONS This study suggests that abdominal adipose tissue accumulation is closely associated with cardiovascular risk factors in obese children, and among abdominal adipose tissue compartments, visceral fat thickness was strongly correlated with the elastic properties of the abdominal aorta.

Recurrent Pulmonary Alveolar Proteinosis Secondary to Agammaglobulinemia

Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant derived material in the lung of patients. PAP is rare in children. The patient presented with respiratory failure. In the history she was diagnosed with agammaglobulinemia at 8 months of age and has been treated by IVIG once in a month. She had two pulmonary alveolary proteinosis attacks before. Chest X‐ray showed bilateral diffuse infiltrates. Initial diagnosis were pneumonia, ARDS, and lung edema. Whole‐lung lavage revealed lipoproteinaceous material similar to surfactant. This findings and high level of LDH was as evaluated pulmonary alveolary proteinosis. She discharged from the hospital without any respiratory complication on the ninth day. This is the first case report recurrent PAP associated with agammaglobulinemia. Pediatr Pulmonol. 2008; 43:710–713.

Childhood Stroke: Results of 130 Children From a Reference Center in Central Anatolia, Turkey

BACKGROUND Although stroke among children is rare, it can cause significant morbidity and mortality. We aim to share our experience of children with arterial ischemic stroke. METHODS The initial symptoms, demographical features, risk factors, neurological examination, neuroradiological findings, and clinical follow-up data of 130 Turkish children seen between 2002 and 2013 were retrospectively analyzed. RESULTS Sixty-eight patients were male. Thirty of the children were aged from 1 to 12 months (seven of them died in this period). Focal neurological signs were the most common presentation, and hemiplegia or hemiparesis were the most common focal signs. Underlying risk factors were detected in 103 patients. Infections and congenital heart disease were the most common risk factors. Seven of the nine children with recurrent arterial ischemic strokes had one or more underlying diseases (moyamoya disease in two children along with factor V Leiden mutation, tuberculous meningitis, congenital heart disease, homocystinuria, and hemiconvulsion-hemiplegia-epilepsy syndrome). The arterial ischemic stroke was located in the middle cerebral circulation in 68 (36 left and 32 right) and in the posterior cerebral artery in 41. Eighteen children died. The neurological outcome was assessed in 98 children. Of these children, 66 children have neurological deficits and 52 children have seizures. Stroke in the first year of life is more often fatal. Recurrent stroke is associated with poor prognosis. CONCLUSION Tuberculous meningitis is still a risk factor for arterial ischemic stroke in Turkey. Arterial ischemic stroke in the first year of life and recurrent arterial ischemic stroke represent poor prognostic features.

Case series of mercury toxicity among children in a hot, closed environment.

Abstract Mercury poisoning is much more prevalent in the general population than possibly many physicians realize. We present data on 26 pediatric cases with mercury intoxication from exposure to mercury by inhalation or skin contact as a result of a broken thermometer in a school laboratory. This is the largest pediatric series in Turkey. During a 3-month period, the study team observed the children for clinical symptoms, physical findings, and blood and mercury levels. Of all patients, 21 inhaled, 3 inhaled and touched the element, and 2 took the mercury home. Sixteen children were symptomatic at admission, although blood mercury levels in the symptomatic children were higher than those in asymptomatic children (P = 0.003). The urine mercury levels were not statistically different between the groups at the admission (P > 0.05). The exposure times were 3.5 and 2 hours for symptomatic and asymptomatic children, respectively (P = 0.003). The 2 children who took the mercury home had the highest blood mercury levels and the most prolonged exposure time. N-acetylcysteine and chelation treatments were started in 21 children who had symptoms of mercury intoxication and high mercury levels in their blood or urine. No adverse effects were observed during chelation therapy. Prompt removal of children from contaminated environments and proper decontamination or elimination of devices containing large amounts of mercury from schools are necessary to prevent serious complications caused by exposure to mercury.

Is plasma exchange effective in prevention of hepatic transplantation in fulminant Wilson disease with hepatic failure

778 W ilson disease (WD) is an autosomal recessive disorder characterized by the accumulation of copper in the body, especially in the liver, brain, kidney, and cornea (1,2). Liver involvement can manifest itself as cirrhosis, chronic active hepatitis, or fulminant hepatic failure (2). Mortality is particularly high in patients in whom fulminant hepatic failure is accompanied by hemolytic crisis (3). Hepatic transplantation is the only treatment for these individuals when copper-chelating agents are insufficient (3,4). Chelating agents such as D-penicillamine and trientine are the primary medications used for treatment (3). Moreover, methods such as plasma exchange (PE) can be lifesaving in the early periods of fulminant hepatic failure when copper should be immediately eliminated from the circulation (3,5). PE is a procedure that involves the removal of patient’s plasma from the blood, substituting a plasma-replacement solution of fresh frozen plasma (FFP) and returning ‘‘treated’’ plasma to the blood circulation. By this procedure, unwanted plasma components are removed and the remaining plasma is returned to the body (6). This procedure can be performed on patients with WD and copper can be removed quickly from the blood. In this way, hemolysis that is caused by the oxidative effects of copper can be eliminated and hepatic functions can be stabilized (4,7,8). PE is effective in treating hepatic encephalopathy and clinical homeostasis in fulminant hepatic failure; it can also eliminate the need for urgent liver transplantation in some cases (5,7–9). We present data on a 9-year-old girl who presented with hemolytic crisis and jaundice. She was diagnosed with fulminant WD in the early phases and avoided having a liver transplant after the successful implementation of PE in our intensive care unit.

Silent brain infarcts in two patients with zeta chain-associated protein 70 kDa (ZAP70) deficiency

Zeta-chain associated protein 70 kDa deficiency (ZAP70) is a form of severe combined immunodeficiency (SCID). It is caused by defects in the signaling pathways associated with T-lymphocyte activation. ZAP70 deficiency is characterized by a marked reduction in peripheral CD8+ T-cells. In this report, we described two patients with ZAP70 deficiency who presented with recurrent infections, lung tuberculosis (TBC), congenital nephrotic syndrome (CNS), and silent brain infarcts (SBIs) as a common feature. The first patient initially presented with recurrent infections and TBC as in a classic SCID patient. At the age of 4, he was interned with febrile seizure. Cranial magnetic resonance imaging (MRI) showed SBIs. The second patient, an 8-month-old boy, presented with congenital nephrotic syndrome caused by cytomegalovirus (CMV) and he had also SBIs.

Organophosphate intoxication presenting as diabetic keto-acidosis

Abstract Organophosphate (OP) poisoning is common in developing countries. The presenting symptoms and signs of OP intoxication are multiple and may cause diffuculty in differential diagnosis, especially in children. A case of OP intoxication is reported who presented as diabetic keto-acidosis.