Coşkun Çeltik

Neuron-specific enolase as a marker of the severity and outcome of hypoxic ischemic encephalopathy

The aim of this study was to evaluate serum concentrations of neuron-specific enolase (NSE) as a marker of the severity of hypoxic ischemic encephalopathy (HIE) and to elucidate the relation among the concentrations of NSE, grade of HIE and short-term outcome. Forty-three asphyxiated full-term newborn infants who developed symptoms and signs of HIE (Group 1) and 29 full-term newborn infants with meconium-stained amniotic fluid but with normal physical examination (Group 2) were studied with serial neurological examination, Denver developmental screening test (DDST), electroencephalogram and computerized cerebral tomography (CT) for neurological follow-up. Thirty healthy infants were selected as the control group. In the patient groups, two blood samples were taken to measure NSE levels, one between 4 and 48 h and the other 5-7 days after birth. Serum NSE levels were significantly higher in infants with HIE compared to those infants in Group 2 and control group. The mean serum concentrations of the second samples decreased in all groups studied but they were significantly higher in Group 1 compared to those in Group 2. Serum NSE concentrations of initial samples were significantly higher in patients with stage III HIE than in those with stages II and I. The sensitivity and specificity values of serum NSE as a predictor of HIE of moderate or severe degree (cut-off value 40.0 microg/l) were 79 and 70%, respectively, and as a predictor of poor outcome (cut-off value 45.4 microg/l) were calculated as 84 and 70%, respectively. The predictive capacity of serum NSE concentrations for poor outcome seems to be better than predicting HIE of moderate or severe degree. However, earlier and/or CSF samples may be required to establish serum NSE as an early marker for the application of neuroprotective strategies.

Factor V Leiden Mutation and Other Thrombophilia Markers in Childhood Ischemic Stroke

The aim of this study was to evaluate the association between ischemic childhood stroke and thrombophilia. The prevalence of thrombophilia risk factors in 30 unrelated children with ischemic stroke were compared with 33 age-matched control subjects. Patients and control group were tested for the presence of activated protein C (APC) resistance, antiphospholipid antibodies (APLA), increased factor VIII levels, and for the deficiency of protein C (PC), protein S (PS), and antithrombin. When APCR was detected in patients or in controls, factor V Leiden (FVL) mutation was also tested. Seventeen of 30 patients (56.6%) had at least one thrombophilia marker compared with only 5 of 33 control subjects (15.1%). Three children with ischemic stroke (10%) were affected with a combination of two or more thrombophilia markers whereas none of the children in the control group had a combination of risk factors. Seven of 30 children with ischemic stroke (23.3%) and one of 33 control subjects (3.03%) had APC resistance and in all of them FVL mutation were found. The prevalence of FVL mutation was higher among pediatric stroke patients than among control subjects (p < 0.05). None of the patients but one child from the control group (3.03%) had PS deficiency. Antithrombin and PC deficiencies and the presence of APLA and increased factor VIII levels were more frequent in the pediatric stroke patients than in controls but the difference was not statistically significant (p > 0.05). These data confirm that stroke in children is commonly associated with a combination of multiple risk factors and especially the prevalence of FVL mutation is increased in children with ischemic stroke compared with control subjects.

Risk factors of status epilepticus in children.

Abstract Background : Although there is abundant literature about the morbidity and mortality rates of status epilepticus (SE), little is known about the risk factors of this medical emergency. The aim of the present study is to assess the risk factors of SE in children.

Thrombocytopenia: an important indicator for the application of partial exchange transfusion in polycythemic newborn infants?

Abstract Background: The conventional therapeutic approach in polycythemic newborn infants is to apply partial exchange transfusion (PET) when hematocrit value exceeds 70% or when the infant develops symptoms with the exception of plethora.

Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension.

Background: Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT). Methods: This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50). Fifty healthy children were also selected for the control group. Electrocardiography and echocardiography were used to evaluate cardiac functions. Corrected QT (QTc) ≥ 0.45 was accepted as prolonged on electrocardiography. The study group was divided into 3 groups: cirrhotic, noncirrhotic, and control. Then, the CCMP group was created according to the diagnostic criteria. Latent CCMP was diagnosed in the presence of prolonged-QTc along with a minor criterion (tachycardia). Manifest CCMP was diagnosed in the presence of at least 2 major criteria (prolonged-QTc along with abnormal echocardiographic findings). Moreover, in this study, the risk factors for CCMP were investigated. Results: The CCMP group included 10 cases (20%). Nine of these cases had latent CCMP (18%), and the remaining one (2%) had manifest CCMP. All of the cases with CCMP had cirrhosis and ascites. None of the patients with CCMP had severe cardiac symptoms, but they were already using some cardioprotective drugs such as propanolol and spironolactone. As risk factors for CCMP, pediatric end-stage liver disease scores, Child-Pugh scores, and ascites grades were found to be significant for the determination of CCMP. The most important risk factor was ascites severity (P = 0.001, odds ratio 9.4). Conclusions: Approximately 20% of children with PHT have CCMP. A detailed cardiac examination should be carried out periodically in children with cirrhotic PHT, especially in the presence of ascites and high Child-Pugh score.

Segmental intestinal dilatation associated with omphalocele

A 2850 g, 1-day-old girl baby, was born after 38 weeks’ gestation via cesarean section. A small omphalocele was detected with ultrasound when her mother was examined at 38 weeks of her gestation, in a local obstetric clinic (Fig. 1a). Therefore, the mother was referred to our obstetric unit. In the ultrasound examination, there was a small omphalocele with a 3 cm diameter and 10 cm × 6 cm cystic mass in the fetal abdomen (Fig. 1b). The cyst was filled with thick fluid. Physical examination showed a healthy vigorous newborn with abdominal distention and a small omphalocele. A huge mobile mass was confirmed in the abdomen by palpation. A plain radiography of abdomen showed a gasless area in the lower quadrants. Laboratory findings were within normal limits. A gastrointestinal duplication was suspected and she was fed with mother’s milk because there were no gastrointestinal obstruction signs or symptoms and discharged meconium before the operation. Laparotomy was carried out on fourth day after birth. The omphalocele sac was resected and abdominal defect was enlarged. There was a huge dilatation of 10 cm × 6 cm × 6 cm in the ileal segment. Midgut rotation was normal but cecum was mobile (Fig. 2a). The ileal segment was resected, an ileoileostomy was performed and the abdominal defect was closed. The small bowel loops were 51 cm and the distance between the anastomosis and the cecum was 15 cm. The postoperative course was uneventful. The baby was discharged after her 17th day, and she is presently 17 months old and healthy. Microscopic examination of the resected ileal segment showed normal ganglion cells but there were edema, inflammatory cells, and large-caliber blood vessels, focal necrotic and bleeding areas. Muscular layer of some dilated segment became thick due to hypertrophy, whereas some of them became thin.

Food allergy in children with refractory gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) and food allergy are frequent disorders of childhood. The purpose of this study was to determine the frequency of food allergy in children with refractory GERD.

Intraerythrocytic potassium levels and early insulin release in children with moderate malnutrition.

Potassium deficiency and insulin releasing defect in severe protein-energy malnutrition (PEM) have been reported previously. The aim of this study was to investigate the existence of potassium deficiency and early insulin releasing defect in moderate PEM, which is more common in children. This study was carried out prospectively in the Pediatrics Department at Trakya University. The study group comprised 30 children with moderate PEM who were also classified as stunted, wasted, and stunting-wasting. Thirty healthy children were selected as controls. Although there was no statistical difference between the study and control groups in terms of serum potassium and initial insulin levels, intraerythrocytic potassium and early insulin release in patients were significantly lower than in controls. The stunting-wasting cases had the lowest intraerythrocytic potassium and early insulin response to intravenous glucose administration. This study suggests that it is appropriate to evaluate moderate PEM cases for intraerythrocytic potassium deficiency and early insulin releasing defect. Potassium supplements should be given if necessary.

Listeria Monositogenez Menenjitli Bir Olgu Sunumu

Yuksek ates kusma uykuya egilim yakinmasiyla getirilen stupor halindeki 3 yasindaki erkek hastada beyin omurilik sivisi incelemesinde ksantokromi protein yuksekligi lenfosit hakimiyeti saptanmasi uzerine antituberkuloz tedavi baslandi ikinci gunu kaybedilen postmortem BOS kulturunde Listeria Monositogenez ureyen olgu bu yas grubunda Listeriozisin nadir olmasi ve olgunun belirgin bir risk faktoru tasimamasi nedeniyle sunulmustur Anahtar kelimeler: Listeria Monositogenez Menenjit Tuberkuloz