Enes Coskun

Plasma microRNA profiling of pediatric patients with immune thrombocytopenic purpura.

Immune thrombocytopenic purpura (ITP) is a commonly acquired autoimmune bleeding disorder in children. MicroRNAs (miRNAs) are small RNAs which are found in cells and circulation, and play a role in protein synthesis and regulation. In this study, we aimed to determine a biomarker for childhood ITP comparing the plasma miRNA levels of children having ITP with healthy children. A total of 86 patients with ITP and 56 healthy children followed up by the Department of Pediatric Hematology and Oncology in University of Gaziantep since July 2011 were enrolled in the study. The 86 patients with ITP were evaluated in two groups as 43 acute ITP (aITP) and 43 chronic ITP (cITP) patients. Plasma expression levels of 379 miRNAs were investigated by RT-PCR (quantitative RT-PCR) technique and they were compared between aITP, cITP, and control groups. For all miRNAs, the average of raw quantification cycle values of three groups separately in the analysis chip was accepted as the reference gene value, and normalization was done according to this value. Statistically significant differences were detected in seven miRNAs (miR-302c-3p, miR-483-5p, miR-410, miR-544a, miR-302a-3p, miR-223-3p, and miR-597) investigated between the groups with respect to the expression levels. The expression rates were found to be over 95% in miR-302c-3p and miR-483-5p, over 75% in miR-410, and over 40% in miR-544, miR-302a-3p, and miR-223-3p in all three groups. The detection of significant differences between plasma miRNA levels of aITP and cITP patients and healthy children may provide useful information in the prediction of the course of disease, determination of disease etiopathogenesis, and the development of new therapeutic modalities.

Unusual presentation: Pulmonary hemosiderosis with celiac disease and retinitis pigmentosa in a child†

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease characterized by anemia, hemoptysis and recurrent alveolar hemorrhage. The combination of IPH and celiac disease (CD) is extremely rare. We report a 9‐year‐old boy with Lane‐Hamilton syndrome, co‐occurrence of pulmonary hemosiderosis with CD. This presentation is unique presentation because he has also retinal pigmentation. Pediatr. Pulmonol. 2011; 46:820–823.

Bacterial agents causing meningitis during 2013–2014 in Turkey: A multi-center hospital-based prospective surveillance study

ABSTRACT This is an observational epidemiological study to describe causes of bacterial meningitis among persons between 1 month and 18 y of age who are hospitalized with suspected bacterial meningitis in 7 Turkish regions. covering 32% of the entire population of Turkey. We present here the results from 2013 and 2014. A clinical case with meningitis was defined according to followings: any sign of meningitis including fever, vomiting, headache, and meningeal irritation in children above one year of age and fever without any documented source, impaired consciousness, prostration and seizures in those < 1 y of age. Single tube multiplex PCR assay was performed for the simultaneous identification of bacterial agents. The specific gene targets were ctrA, bex, and ply for N. meningitidis, Hib, and S. pneumoniae, respectively. PCR positive samples were recorded as laboratory-confirmed acute bacterial meningitis. A total of 665 children were hospitalized for suspected acute meningitis. The annual incidences of acute laboratory-confirmed bacterial meningitis were 0.3 cases / 100,000 population in 2013 and 0.9 cases/100,000 in 2014. Of the 94 diagnosed cases of bacterial meningitis by PCR, 85 (90.4%) were meningococcal and 9 (9.6%) were pneumococcal. Hib was not detected in any of the patients. Among meningococcal meningitis, cases of serogroup Y, A, B and W-135 were 2.4% (n = 2), 3.5% (n = 3), 32.9% (n = 28), and 42.4% (n = 36). No serogroup C was detected among meningococcal cases. Successful vaccination policies for protection from bacterial meningitis are dependent on accurate determination of the etiology of bacterial meningitis. Additionally, the epidemiology of meningococcal disease is dynamic and close monitoring of serogroup distribution is comprehensively needed to assess the benefit of adding meningococcal vaccines to the routine immunization program.

Prevalence and Clinical Significance of Antithyroid Antibodies in Children with Immune Thrombocytopenic Purpura

Background and objective: To determine the prevalence and the clinical significance of thyroid autoantibodies and their influence on treatment response in children with idiopathic thrombocytopenic purpura (ITP). Patient and Method: We retrospectively analyzed the antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies from the records of 151 ITP patients who were admitted to the Pediatric Hematology Department of Gaziantep University between 2009 and 2012. Results: Anti-TPO and/or anti-TG was found positive in 38 (36.8%) of 103 patients whose thyroid autoantibody levels were measured. The comparison of positivity ratios of autoantibodies between acute and chronic ITP patients showed no significant difference. However, the separate comparison of each group of ITP patients with control group showed significantly high positivity ratios of autoantibodies in ITP patients. The initial mean platelet count of anti-TPO positive patients at diagnosis was significantly less than that of the negative patients (P = .008). One month after treatment, platelet count of anti-TPO positive patients was significantly less than that of the negative patients (P = .01). Moreover, the mean platelet counts of anti-TPO positive patients were significantly less than those of the negative patients after intravenous immunoglobulin treatment (P < .001). Conclusion: We demonstrated that the thyroid-autoimmune-diseases-related autoantibodies are frequently found in childhood ITP. Although no recommendation is found in international guidelines regarding screening for thyroid autoantibodies in patients with ITP, in view of the high incidence of antithyroid antibodies and their potential negative effect on treatment response, screening these patients for such antibodies would be recommended.

Epidural hematoma and cephalohematoma with congenital hypofibrinogenemia.

Cerebral hematoma described as the bleeding into the cerebrum leads to an expanding mass of blood that damages surrounding neural tissues. It is a very rare clinical finding of congenital hypofibrinogenemia. In this case study we are reporting a 5-year old boy with massive epidural hematoma and recurrent cephalohematoma as a result of minor trauma.

Severe Rotavirus gastroenteritis in a patient with infant leukemia

Hemangiomas are the most common tumors of infancy. Most of them require no treatment, but treatment is needed if dramatic aesthetic, and/or functional impairment as visual or airway obstruction or ulceration arises. We reported a 6-month-old infant presented with a 6-week history of a rapidly growing cutaneus hemangioma on the right eyelid and caused visual impairment. The patient was successfully treated with the use of oral propranolol therapy. We suggest that propranolol can be considered as a first line treatment in a patient with infantil hemangioma.Objectives: The aim of this study was to examine levator palpebralis superior muscle histologically in patients with congenital blepharoptosis and to investigate the relationship between these findings and age, sex and degree of blefaroptosis in this patient group. Materials and methods: Levator muscle of 13 patients with congenital ptosis, who had applied to Dicle University Medical Faculty Ophthalmology Clinic and had undergone levator palpebralis superior muscle resection between january 2009-january 2010, has been examined histopathologically in Histology and Embriology Deparment. During preoperative period, ptosis amount, levator function (LF), tear functions, Bell\s phenomenon and jaw-winking phenomenon were evaluated. All patients underwent resection of levator palpebralis superior muscle. Received postoperative levator muscle was examined by light microscopy. Results: The average age of 9 (69.2%) male and 4 (30.8%) female cases were 10.61 p 4.77 (4- 19) years. In histological examination, the quality and quantity of the levator muscle fibrils have been assessed. There was no relationship detected between histological features of levator palpebralis superior muscle and patient\s age and gender (p>0.05). Patients with weak levator palpebralis superior muscle were detected to have fatty degeneration histologically. The higher the levator palpebralis superior muscle function revealed decreased fatty degeneration and increased skeletal muscle fibrils. Conclusion: More ultrastructural studies in larger populations are needed to support the relationship between structure and function of levator palpebralis superior muscle in patients with congenital blepharoptosis.Amac: Lateral epikondilit (tenisci dirsegi) en fazla tani konulan dirsek yan agri nedenidir. Bu calismanin amaci tenisci dirsegi tedavisinde tek doz kortikosteroid enjeksiyonu ile otolog trombositten zengin plazma (TZP) enjeksiyonunun etkilerini karsilastirmaktir. Gerec ve yontem: Dirsek yan kisminda agri sikâyeti sonucu klinigimize muracaat edip, lateral epikondilit tanisi konan 15 hastanin (6 erkek ve 9 kadin) 15 dirsegi calisma kapsamina alindi. Olgularin 1. grubuna tek doz 0,5 ml Bethametasone ve 0.5 ml Prilokain karisimi, 2. grup olgulara 1ml otolog TZP lokal olarak uygulandi. Bulgular: Verhaar skorlama sistemine gore alinan sonuclara gore ilk takiplerde lokal steroid enjeksiyonu yapilan hasta grubunda sonuclarin daha iyi oldugu fakat sonraki takiplerde iyi sonuclarin goruldugu vaka sayisinda azalma oldugu goruldu. TZP grubunda ise ilk takiplerde sonuclarin kotu oldugu fakat sonraki takiplerde daha iyi sonuclarin alindigi goruldu. Sonuc: Otolog TZP enjeksiyonun lateral epikondilitte iyi yonde etkinliginin zamanla artigi soylenebilir, fakat bunun daha iyi anlasilmasi icin olgu sayisi ve takip suresi artirilmis yeni calismalarin yapilmasi gereklidir.

Helicobacter Pylori Infection-Related Pancytopenia in a Young Boy

Deficiency of vitamin B12 (VitB12), also known as cobalamin, and Helicobacter pylori infection are commonly seen in our region. Inadequate dietary intake of VitB12, lack of intrinsic factor (IF) secretion by the stomach, impaired intestinal absorption of IF-cobalamin complex, or absence of VitB12 transport protein are the common causes of cobalamin deficiency [1]. Dietary cobalamin is strictly protein bound and requires the action of gastric acid to release it. When the gastric acid secretion is impaired due to H. pylori infection, cobalamin absorption is decreased and that may cause VitB12 deficiency. The association between VitB12 and H. pylori infection have been demonstrated in children and adults [2, 3]. We herein present a patient with VitB12 deficiency who has pancytopenia accepted to be related with H. pylori infection. A 13-year-old-boy was referred to our pediatric hematology outpatient clinic because of very low serum hemoglobin level. His dietary history revealed that he was consuming meat products up to 2 times weekly and consuming eggs up to 4 times weekly. His medical history did not reveal any significant health problem. He complained of weakness, dizziness, and dull abdominal pain in the last 4 weeks. He had pallor on physical examination and his blood test showed the following: hemoglobin (Hb): 5.3 g/dL; mean corpuscular volume (MCV): 106 fL; red cell distribution width (RDW): 20; reticulocyte count: 0.56%; white blood cell count (WBC): 2230/mm3; platelet count: 56000/mm3; total bilirubin: 1.39 mg/dL; and direct bilirubin: 0.2 mg/dL. Additionally at peripheral blood smear, neutrophil hypersegmentation was detected. Megaloblastic changes in normoblasts, giant metamyelocytes, and heterogeneity were seen in bone marrow aspiration. Serum ferritin and folate levels were normal. However, his VitB12 level was 50 pg/mL (180–300 pg/mL) and antiparietal cell antibody was negative. His urea breath test was positive for H. pylori infection. In order to prove etiologic relationship with H. pylori infection and pancytopenia, we need to treat the patient’s H. pylori first before VitB12 treatment. Due to the reduced hemoglobin level of the patient, we held concomitant treatment of both conditions together. We started treatment against H. pylori (amoxicillin and clarithromycin for 15

Varicella zoster enfeksiyonunu takiben gelişen immun trombositopenik purpura

Although thrombocytopenia is a rarely observed complication following chickenpox, it can lead to serious bleeding problems. In order to underline rare hematologic complications of varicella infection and the importance of vaccination, here we reported a seven year old boy who developed severe thrombocytopenia during varicella infection and gave good response to intravenous immunoglobulin therapy.