Emine Kocabas

Cerebral salt wasting in tuberculous meningitis: treatment with fludrocortisone.

Abstract Three cases of cerebral salt wasting complicating tuberculous meningitis are described. Diagnosis was based on hyponatraemia associated with high urinary sodium excretion and inappropriately high urine output in the presence of dehydration. Treatment with fludrocortisone resulted in sodium and fluid homeostasis.

Hepatitis B and C virus infections in Turkish children with cancer

In this study, we tested 137 Turkish children with cancer (51 with acute leukemia, 48 with lymphoma, 38 with solid tumors) while they were undergoing chemotherapy, and a control group of 45 for evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections using the enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). The control group included children with other disease who had applied to the outpatient clinic during the study period and had no history of jaundice or transfusion. Sixty-five (47.4%) patients with cancer and 7 (20%) children in the control group were positive for hepatitis B surface antigen (HBsAg) (p < 0.01). HBV DNA was detected in 59 (43.1%) patients and in 9 (20%) controls (p < 0.01). HCV specific antibody (anti-HCV) was detected in 8 (5.8%) patients and in 1 (2.2%) control (p > 0.05). Eight patients (5.8%) had circulating HCV RNA, but none had in the control group (p = 0.09). Ten (13.9%) of the 72 patients who were negative for HBsAg had circulating HBV DNA, and 7 (5.4%) of the 129 patients who were negative for anti-HCV had circulating HCV RNA. We concluded that HBV and HCV infections are common among Turkish children with cancer. In countries where HBV infection is widespread among the general population as in Turkey, children with cancer are under greater risk for HBV infection.

Clinical and epidemiological features of Turkish children with 2009 pandemic influenza A (H1N1) infection: Experience from multiple tertiary paediatric centres in Turkey

Abstract Background: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey. Methods: We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals. Results: A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis. Conclusions: In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.

Crystalline-Like Keratopathy after Intravenous Immunoglobulin Therapy with Incomplete Kawasaki Disease: Case Report and Literature Review

A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment.

Helicobacter pylori Antibodies in Patients on Chronic Hemodialysis

Prof. Yahya Sagliker, Department of Internal Medicine, Cukurova University, Faculty of Medicine, TR-01330 Adana (Turkey) Table 1. Characteristics of hemodialysis patients Hp(-) Dear Sir, A variety of gastrointestinal tract disorders are seen in uremic patients and gastritis, gastroduodenal ulceration, and bleeding are frequent complications of uremia [1]. Reduced gastric motility, changes in gastric morphology and histology, and increased gastrin levels may induce gastroduodenal lesions [2]. Helicobacter pylori (HP), a gram-negative spiral bacterium, has been shown to be strongly associated with gastritis, peptic ulcer disease and nonulcer dyspepsia, to be increased with gastritis, peptic ulcer disease and nonulcer dyspepsia [3]. Increased urea content of the gastric mucus could be a risk factor for HP in patients with chronic renal failure [4]. We measured the prevalence of HP in 91 hemodialysis (HD) patients and the results were correlated with dialysis duration, blood urea levels, receiving antacids or not. Ninety-one HD patients, 55 males and 36 females, aged between 16 and 70 years (mean age 41.4 ± 1.4 years) were studied. The mean duration of HD was 22.9 ± 2.2 months (range: 6-120 months). Sixty-eight HD patients (74.7%) were receiving aluminium antacids and calcium carbonate as phosphate binders. Serum samples for blood urea and Hp were taken before dialysis. Thirty-five age-matched healthy subjects with normal renal function were used as controls. Patients who had received antibiotics and colloidal bismuth preparations prior to blood sampling were excluded. IgG antibodies against HP were measured by using the IgG ELISA test where the sensitivity and specificity of this technique was near 95%. The χ2 test and the t test were used for statistical analysis. NS = Not significant. HP was detected in 13 (14.3%) of 91 patients undergoing regular HD. The mean predialysis serum urea in HP positive (+) and HP negative (-) patients was 127.3 ± 16.1 and 108.6 ± 19.8mg/dl, respectively, the difference being significant at p < 0.001. There were no difference between HP (+) and HP (-) patients with respect to sex, age, and HD duration. The receiving

Epidemiology of meningococcal infections in children in mid-southern part of Turkey

Abstract59 patients were treated for meningococcal infections in Çukurova University Faculty of Medicine, Division of Pediatric Infectious Diseases. 50.8% of patients were male, 33.9% were under two years of age and 61% were under five. 78% of patients were admitted to hospital in winter and spring time. Meningococcal meningitis (MM) was present in 39% of patients on admission, however, meningococcemia in 27.1% and meningococcemia and meningococcic meningitis (Meningococcemia + MM) in 33.9%. Fatality rate was 18.6% and no association was found between mortality and clinical type of disease (p>0.05), but mortality ratio decreased with an increasing age (p<0.01). No deaths occurred among the 12 patients who received IV penicillin treatment shortly before admitting to hospital, on the other hand 11 of 47 patients (23.4%) without such a previous treatment died.

Antifungal consumption, indications and selection of antifungal drugs in pediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey

OBJECTIVES The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey. METHODS A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed. RESULTS A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies. CONCLUSION The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital.

Recurrent epididymo-orchitis in an 8-year-old child with Kostmann syndrome (severe congenital neutropenia).

Abstract Underlying congenital genito-urinary tract anomalies are the most common cause of recurrent epididymo-orchitis in prepubertal boys. An 8-year-old boy was admitted with recurrent pulmonary and skin infections, was diagnosed as Kostmann syndrome and developed epididymo-orchitis. This appears to be the first case of Kostmann syndrome associated with epididymo-orchitis.

Detection of Hepatitis B and C Infection by Polymerase Chain Reaction among Hemodialysis Patients

Accessible online at: www.karger.com/journals/nef Dear Sir, Patients undergoing hemodialysis (HD) potentially have an increased risk of exposure to viral hepatitis. As anemia is an unavoidable complication of chronic renal failure, HD patients often require frequent blood transfusions with consequent high risk of posttransfusion hepatitis. Additionally, they may be exposed to viruses from other patients by being crowded and common use of equipment. Firstly, the risk of hepatitis B virus (HBV) infection has been determined and problems due to HBV have been reduced by use of immunization, periodic testing, isolation of infected patients and by improved disinfectant procedures. Despite these control measures, elevated serum alanine aminotransferase (ALT) levels have been found in some HD patients. Currently, because of the detection of a high rate of antibody to hepatitis C virus (HCV) in these patients, HCV is thought to be the major cause of hepatitis in HD units. The detection of viral hepatitis is still a difficult problem because of the use of less sensitive and specific serological assays. Seropositivity may indicate infection or immune response. The polymerase chain reaction (PCR) method that amplifies viral genome is a highly specific and more sensitive technique. The aim of our study was to determine the prevalence of HBV DNA and HCV RNA by the PCR method in HD patients. In this study, the association of HBsAg and anti-HCV positivity with blood transfusion and duration of HD were also investigated.