Çapan Konca

The Association between Vitamin D Levels and Urinary Tract Infection in Children

Aim: We aimed to examine whether there is any association between serum levels of 25-hydroxyvitamin D [25(OH)D3] and urinary tract infection (UTI) among children. Methods: White blood cell count, serum C-reactive protein, calcium, phosphorus, alkaline phosphatase, parathormone, and serum 25(OH)D3 levels were measured in 82 children experiencing a first episode of UTI, with no risk factors for UTI, and 64 healthy control children. Results: The mean serum levels of 25(OH)D3 among children with UTI were significantly lower than those of controls (11.7 ± 3.3 vs. 27.6 ± 4.7 ng/ml; p < 0.001). The serum levels of 25(OH)D3 were significantly lower in patients with acute pyelonephritis compared to patients with lower UTI (8.6 ± 2.8 vs. 14.2 ± 3.0 ng/ml; p < 0.001). Within the study group, mean serum levels of 25(OH)D3 among girls were lower than those of boys (10.9 ± 3.4 ng/ml vs. 13.2 ± 4.4 ng/ml; p < 0.001). Multivariate analysis showed that a serum 25(OH)D3 level of <20 ng/ml (odds ratio 3.503, 95% confidence interval 1.621-7.571; p = 0.001) was associated with UTI in children. Conclusions: Our results suggest that vitamin D deficiency may be a risk factor for UTI in children.

Gynecologic age is an important risk factor for obstetric and perinatal outcomes in adolescent pregnancies.

BACKGROUND Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity. AIM To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA. METHODS In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA≤3 years (101 women) and GA>3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period. FINDINGS Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA>3 years, adolescent pregnancies with GA≤3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU. CONCLUSION Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications.

Is there a relationship between low vitamin D and rotaviral diarrhea

For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection.

The mean platelet volume levels in children with PFAPA syndrome.

OBJECTIVES To assess whether mean platelet volume (MPV) can be used as a marker in the differential diagnosis of periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome. METHODS The leucocyte counts, thrombocyte counts, and MPV values of 57 children with PFAPA syndrome were recorded during an attack and an attack free period. These values were compared with a healthy control group of 55 individuals. Demographic features of the PFAPA patients group including age, gender and age of first attack, age at diagnosis, frequency of attacks, serum reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also recorded. RESULTS The MPV values of the children with PFAPA both during an attack and attack free period were found significantly lower than the MPV values of healthy control group (p<0.001). Also, the MPV values of the children with PFAPA during an attack were significantly lower than in attack free periods (p<0.001). The MPV values showed no correlation with leucocytes counts, CRP, and ESR during attacks. A 8.30fl [area under the curve (AUC: 0.965)] optimal cutoff value of MPV with a sensitivity of 89.5% and specificity of 92.8% was determined during an attack in children with PFAPA. CONCLUSIONS The MPV values during an attack and attack free period of patients with PFAPA is lower than in controls. The MPV values may be used as a marker in the differential diagnosis of PFAPA syndrome but more studies are needed and they should be prospective in order to validate this data.

Choroidal Thickness in Children with Beta Thalassemia Major.

Purpose The purpose of this study was to determine whether there are differences in choroidal thickness in children with beta thalassemia major (&bgr;-TM). Methods Thirty-five patients with &bgr;-TM and 38 healthy children aged between 3 and 16 years participated in the study. After complete eye examinations were conducted on the participants, choroidal thickness measurements were performed using optical coherence tomography. Correlations between choroidal thickness and laboratory and clinical parameters, such as age, sex, hemoglobin and ferritin levels, duration of disease, type and duration of chelating therapy, visual acuity, intraocular pressure, central corneal thickness, and axial length were also evaluated. Results The mean ages for the study group and for the control group were 8.2 ± 2.7 and 7.9 ± 2.4 years, respectively. There were no statistical differences between groups in terms of visual acuity, intraocular pressure, central corneal thickness, or axial length (p > 0.05). Choroidal thicknesses at the foveal center were 286 ± 33 &mgr;m in &bgr;-TM patients and 335 ± 423 &mgr;m in the healthy control children. Choroidal thicknesses at each point within the horizontal nasal and temporal quadrants were thinner in the &bgr;-TM group. There was a positive correlation between choroidal thickness and hemoglobin levels and a negative correlation between choroidal thickness and ferritin levels (r = 0.924, p < 0.001 and r = -0.947, p < 0.001, respectively). There was no correlation between clinical or ocular characteristics and choroidal thickness. Conclusions Choroidal thickness was significantly thinner in all quadrants in children with &bgr;-TM. This thinning of the choroid may be the reason for the development of eye disorders in older patients with &bgr;-TM.

Epidemiological and Clinical Characteristics and Outcomes of Scorpion Envenomation in Hospitalized Children in Adiyaman, Turkey

Scorpion envenomation is a public health problem in tropical and subtropical countries. The majority of scorpion sting cases present with local pain at the site of sting and follow a benign clinical course. Severe intoxication may include cardiac and respiratory dysfunction, leading to multi-system organ failure and death (1, 2). The deaths in scorpion sting envenomation (SE) are attributed to cardiopulmonary complications, such as myocarditis and acute pulmonary edema (3). Cases of SE are common in Turkey, especially in Southeast Anatolia, owing to its geographical location, climate and socioeconomic structure (4). However, there is a scarcity of epidemiologic data on SE in Turkey because of the underdeclaration of scorpion sting cases and paucity of studies on the subject. Therefore, this study aims to evaluate the children hospitalized owing to scorpion stings and their epidemiological and clinical characteristics in Adiyaman province. Medical records of 80 patients were retrospectively reviewed to collect the following data: age, gender, clinical symptoms (localized and systemic), vital signs, information about the date and place of the sting occurrence, anatomical sting site, time elapsed between the sting and arrival at the hospital, type of scorpion, severity of the patients’ symptoms, treatment modalities and outcomes. The diagnosis of SE was based on the history of scorpion sting. The scorpion type was identified based on the colour of the scorpion defined by the patient or bystander. A. crassicauda and M. eupeus are more commonly known as the black and yellow scorpions, respectively (4). Patients were classified into three classes according to clinical severity as follows: class I: local manifestations; class II: systemic involvement; and class III: cardiovascular, respiratory or neurological symptoms (such as cardiogenic shock, pulmonary edema, altered consciousness and convulsive crisis) (5). A total of 80 subjects were recruited for this study. Of these, 42 (52.5%) were male and 38 (47.5%) female, with a mean age of 6.5 ± 4.1 years (range: 6 months to 17 years). Moreover, 51 (63.7%) and 29 (36.3%) of these subjects were from rural and urban areas, respectively. In terms of the type of scorpion, 32 (40%) subjects were stung by black scorpions and 27 (33.7%) by yellow scorpions. In 13 (16.3%) cases, the patients could not identify the colour of the scorpions. The most common sting sites were lower extremity (n = 53, 66.2%), upper extremity (n = 17, 21.2%) and body (n = 7, 8.8%). The patients were mostly stung during the day (57.5%). The average time elapsed between being stung and admitted in the hospital was 100.3 ± 106.5 minutes (range: 20 to 490 minutes). Based on clinical severity, 34 (42.5%), 44 (55%) and 2 (2.5%) patients were classified into classes I, II, and III, respectively. Table 1 presents the demographic and epidemiological characteristics of the subjects. Table 1. Demographic and Epidemiological Characteristics of Patients a The majority of the cases (63.7%) were reported during summer. The monthly distribution of scorpion sting cases was as follows: 11.2% in May, 13.7% in June, 27.5% in July, 22.5% in August and 10% in September; this indicates that the number of scorpion sting cases peaked in July. Patients exhibited both local and systemic effects. The most common local symptoms were pain (n = 71, 88.7%), hyperemia (n = 43, 53.7%) and swelling (n = 23, 28.7%). The most common systemic symptoms included cold extremities (50%), pallor (16.2%), hypotension (7.5%), hypertension (7.5%), sweating (6.2%) and dry mouth (6.2%). The most common laboratory findings were high the most common laboratory findings were high lactate dehydrogenase (LDH) (n = 10), creatine phosphokinase (CPK) (n = 9), Aspartat aminotransferase (AST) (n = 2) and Alanine aminotransferase (ALT) (n = 2) levels. Leucocytosis was present in 9 (11.2%) cases and hypoglycaemia was observed in 1 (1.2%) case. An electrocardiogram (ECG) was conducted for all the patients. The most common electrocardiography sign was tachycardia (30%). Other ECG abnormalities were ST alterations (n = 5, 6.2%) and prolonged QT (n = 6, 7.5%). Table 2 presents the patients’ clinical and laboratory features. Table 2. Clinical and Laboratory Features of Patients a,b One 5 mL dose of scorpion polyvalent antivenom ampoule, steroid and antihistaminic, was administered to all the patients in emergency services before they were admitted to the hospital. The second antivenom application and a five-step treatment plan, which was suggested by Bawaskar (6), were administered based on the clinical findings in PICU. Before discharge, all the participants were immunized for tetanus. The mean hospitalization time was 2.1 ± 1.4 days (range: 6 hours to 6 days). Except for the one case, all other patients (n = 79) were discharged after recovery. The one patient (1.2%) who had died of cardiac and respiratory arrest manifested evidence of severe envenomation. In conclusion, this study reported on the epidemiological and clinical characteristics of scorpion poisoning in Adiyaman, Turkey during a one-year period. Although males were found to be more susceptible to scorpion stings than females, the difference was not statistically significant. The age of the majority of the scorpion sting victims was less than 10 years. The majority of scorpion stings occurred during daytime. The most common sting sites were the distal part of the extremities. The results of this study showed that intoxications caused by scorpions in Southeast Anatolia region mostly occurred in the summer months, especially July and August. Scorpionism in Adiyaman is essentially caused by two species of scorpions: A. crassicauda and M. eupeus. Both local and systemic effects were observed in clinical evaluations. The results of our study supported that although systemic toxicity signs due to scorpion stings appear frequently, life-threatening signs are rare. To decrease morbidity and mortality rates, patients should be monitored in PICU with an early and appropriate treatment approach.

Acute irritant bullous contact dermatitis caused by Euphorbia helioscopia

E. helioscopia (sun spurge) is used in traditional medicine in Turkey to treat warts, rheumatic pains, and superficial tissue swelling (2). 12-Deoxyphorbol13-phenylacetal-20-acetate is considered to be the most irritant component in the sap (3, 4). The bullous lesions that developed on our patients’ skin occurred after only brief exposure to the sap of the plants. Only a few cases of contact dermatitis associated with E. helioscopia have been reported previously in the literature (1, 5). The plants constitute a risk to children, who may be exposed to the sap during play, and to those who may be exposed when the plants are used in traditional medicine.

Association between serum 25-hydroxyvitamin D levels and TTN.

Aim: To investigate the association between serum 25-hydroxyvitamin D (25(OH)D3) levels and transient tachypnea of the newborn (TTN). Methods: Calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathormone (PTH) and serum 25(OH)D3 levels were measured in 51 infants diagnosed with TTN and 59 healthy control infants for comparison. Demographic factors including gestational age, birth weight, gender, delivery mode, parity, vitamin D supplementation during pregnancy and severity of TTN were recorded. Results: The serum levels of 25(OH)D3 were significantly lower in infants with TTN compared to infants with no respiratory distress (p < 0.01). There was no statistically significant difference in serum Ca, P and ALP levels between the groups while the serum levels of PTH were significantly higher in the study group (p < 0.01). No correlation was found between the serum 25(OH)D3 levels and severity of TTN. Vitamin D supplementation (400 IU/day) during pregnancy did not affect the serum levels of newborns. Conclusion: Our data suggests that lower 25(OH)D3 serum levels are associated with an increased risk of TTN and vitamin D may have a role in the pathogenesis of TTN.

An Overview of Antibacterial Resistance Patterns of Pediatric Community-Acquired Urinary Infections.

Urinary tract infection (UTI) is common in children. The aim of this study was therefor to construct a guide for the empirical antibiotic treatment of community‐acquired UTI by investigating the etiology and antimicrobial resistance patterns of uropathogens and analyzing the epidemiological and clinical patient characteristics.

The First Infant Death Associated With Human Coronavirus NL63 Infection.

Human coronavirus NL63 (HCoV-NL63) primarily infects the upper respiratory tract. However, it may cause severe lower respiratory tract infection, and the clinical course may be severe in immunocompromised patients. To our knowledge, child death due to HCoV-NL63 has not been reported. We present a fatal lower respiratory tract disease associated with HCoV-NL63 in a 7-month-old malnourished infant.