Erdal Taskin

Serum procalcitonin and cerebrospinal fluid cytokines level in children with meningitis.

AIMS: To determine the level of serum procalcitonin and cerebrospinal fluid cytokines in children with bacterial or viral meningitis and to document the use of these parameters in differential diagnosis. RESULTS: Before the start of antibiotic treatment, serum procalcitonin and tumor necrosis factor alpha levels were found to be higher in acute bacterial meningitis compared with viral meningitis and with the control group. Similarly, cerebrospinal fluid interleukin-6 levels were found to be significantly higher in children with acute bacterial meningitis compared with viral meningitis. However, no significant difference was determined between groups in respect to the cerebrospinal fluid interleukin-8 level. CONCLUSION: Serum procalcitonin and cerebrospinal fluid tumor necrosis factor alpha levels can be used in the early diagnosis of bacterial meningitis. Similarly, they may be useful adjuncts in differential diagnosis of bacterial and viral meningitis.

Serum and Hair Levels of Zinc, Selenium, Iron, and Copper in Children with Iron-Deficiency Anemia

In the present study, the serum and hair levels of zinc, selenium, and copper were determined in children with iron-deficiency anemia (IDA). A total of 52 anemic children aged 1–4 yr constituted the study group. Fortysix healthy children acted as controls. The copper and zinc levels were measured with an atomic absorption spectrophometer. Serum and hair selenium was determined by a spectroflourometric method. The serum zinc and selenium concentrations in the IDA group were found to be significantly lower and serum copper significantly higher than those in the controls (p<0.05). Lower iron, zinc, and selenium concentrations (p<0.001) but not copper were found in hair (p>0.05).

Treatment of Iron Deficiency Anemia with Intravenous Iron Preparations

Objective: We aimed to determine the effects of intravenous iron therapy on blood parameters in pediatric patients who do not tolerate oral iron therapy for any reason. Patients and Methods: The patient group consisted of candidates for elective operations requiring blood transfusions in order to raise hemoglobin (Hb) concentrations rapidly and for whom oral iron administration is useless and compliance with long-term treatment is definitely impossible due to sociocultural factors. Sixty-two children were included in the study. Venous blood samples were taken at diagnosis, and after 1 week and 1, 2 and 3 months. Hb, hematocrit, erythrocyte indices (mean erythrocyte volume, mean erythrocyte Hb and mean erythrocyte Hb concentration), serum iron (SI) levels, iron binding capacity, transferrin receptor (CD71) and serum ferritin levels were measured. Iron sucrose was used as an intravenous iron preparation. Results: All children showed improvements in iron deficiency anemia. A statistically significant elevation occurred between the time of diagnosis and week 1 (p<0.05) in nearly all parameters. SI was raised until at least 1 month of therapy. There was no significant difference between transferrin receptors measured before and after the intravenous iron therapy. Ferritin did not exceed the values achieved in the 1st month. Mild side effects were encountered in only 8 (12.9%) patients. Treatment was not discontinued because of side effects in any case. The patients in the control group were given an oral form containing ferroglycine sulfate. Conclusion: Intravenous iron therapy can replace oral therapy in patients whose blood parameters must be raised rapidly and in situations where oral iron administration would not be appropriate for any reason. However, reinforcement with oral iron therapy or additional intravenous doses would be appropriate.

Frequency of hypoferritinemia, iron deficiency and iron deficiency anemia in outpatients.

The prevalence rates of hypoferritinemia (IDec/one abnormal indicator), iron deficiency (IDef/two abnormal indicators) and iron deficiency anemia (IDA) in children who were referred to the outpatient clinics of the Department of Pediatrics for the first time within 1 month were investigated. Exclusion criteria were iron therapy before and during the study period and a history of chronic illness. Acute-phase reactants, such as erythrocyte sedimentation rate and C-reactive protein levels, were measured in all cases indicative of infectious diseases. Blood samples were obtained from each study patient admitted to the outpatient clinics during the study period. The hospital charts were later further evaluated, and samples of patients with any current illness known to interact with the iron status of the patient were discarded, and patients were contacted to supply new samples about 1 month after treatment of the infection. Thus, in patients with indications of an infection, samples obtained 1 month after treatment were assessed.The children (n = 557) were divided into four age groups: those aged 4 months to 2 years (group I), 2–6 years (group II), 7–12 years (group III) and 12–18 years (group IV). Children with a decrease in serum ferritin levels without anemia (IDec), and those with lower ferritin, transferrin saturation (TS) and serum iron (SI) concentration (IDef) were evaluated. IDA was diagnosed if hemoglobin (Hb) concentrations were lower than those adjusted for age, ferritin <12 ng/ml and TS ≤16% and if SI was decreased. IDec, IDef and IDA were detected in 26, 11.1 and 12.7% of the patients, respectively. Only 50.1% of the patients visiting the outpatient clinics were found to be normal. The rates of IDec (28.9%), IDef (21.9%) and IDA (26.2%) were highest in group I. IDec had the highest percentages in all groups. In group I, the rates of IDec, IDef, and IDA were 37.2, 66.1 and 69%, respectively. SI concentration was abnormal in 77.1% of the cases in group I (4 months to 2 years of age). Half of the patients referred to the outpatient clinics were suffering from abnormalities related to lower SI concentrations. Close monitoring and treatment of iron deficiency is advised especially in early childhood.

Serum, urine, and saliva levels of ghrelin and obestatin pre- and post-treatment in pediatric epilepsy.

INTRODUCTION In this study, we aimed to determine the serum, urine, and saliva levels of acyl ghrelin, des-acyl ghrelin, and obestatin in the newly diagnosed idiopathic generalized pediatric epilepsy patients in the pretreatment period and in the third month of valproic acid. MATERIAL AND METHODS Thirty pre- and post-treatment cases of patients who were diagnosed with idiopathic generalized epilepsy and 30 control patients were included in this study. Serum, saliva, and urine levels of ghrelin were measured in epileptic group and in the control group in the pretreatment period and in the third month of the treatment. RESULTS There were 14 females and 16 males. Mean age was 8.9 ± 2.5 years. Mean body mass index was 17.2 ± 2.3 in the patients and 16.6 ± 2.0 in the control group, whereas it was 16.8 ± 2.1 in the third month of the therapy (P > 0.05). Pretherapy serum, urine, and saliva levels of acyl ghrelin were 36.45 ± 9.93, 31.78 ± 12.87, and 34.23 ± 11.49 pg/mL, respectively in the patient group. Post-treatment serum, urine, and saliva levels of acyl ghrelin were 51.34 ± 12.01, 48.24 ± 16.76, and 44.90 ± 14.99 pg/mL in the patient group. Pretherapy serum, urine, and saliva levels of des-acyl ghrelin were 419.62 ± 75.63, 370.59 ± 60.11, and 396.28 ± 60.76 pg/mL, respectively in the patient group. Post-therapy serum, urine, and saliva levels of des-acyl ghrelin were 458.61 ± 87.10, 429.92 ± 55.81, and 449.48 ± 74.32 pg/mL, respectively in the patient group. Pretherapy serum, urine, and saliva levels of obestatin were 23.02 ± 3.15, 14.27 ± 4.22, and 29.52 ± 5.39 ng/mL, respectively. Post-therapy serum, urine, and saliva levels of obestatin were 24.30 ± 4.18, 15.27 ± 6.43, and 30.94 ± 7.42 ng/mL, respectively. CONCLUSION There was a significant increase in the serum, urine, and saliva levels of acyl ghrelin and des-acyl ghrelin without an increase in post-therapy body mass index in idiopathic generalized epilepsy patients.

Is the Antiglobulin Test a Good Marker for Predicting the Development of Hemolytic Disease of the Newborn in ABO Incompatibility

We read with great interest the article by Valsami et al 1 that reported the importance of the direct antiglobulin test (DAT) in cord blood for predicting the development of hemolytic disease of the newborn (HDN). They concluded that, although ABO incompatibility remains the main cause of a positive DAT, other causes, such as alloimmunization and drug interactions should also be investigated. In addition, they suggested that the relevant impact of DAT positivity on the development of HDN should be considered. Although we agree with their conclusion, we think that the study has many limitations and therefore, we would like to make some constructive comments on their article. Firstly, although they mentioned that a positive DAT in ABO incompatibility is considered a major risk factor for the development of severe HDN, they didnot presentdata for a control group who had negativeDATs.Bycontrast,thepositivepredictivevalueofapositive DAT for the development of HDN is as low as 23%. 2 This is due to

Audit of Pediatric Transfusion Practices in a Tertiary Care Hospital: Correspondence

To the Editor: We read with great interest the article by Bahadur et al. [1] who performed a retrospective audit related to transfusion practices in a tertiary care hospital, in order to determine the propriety of usage of different blood components in a pediatric population. They reported a low (59.65 %) appropriate blood components usage in their study, and therefore, advised regular auditing of transfusion practices from time to time. They also reported a high (82.9 %) appropriate whole blood transfusions, which was most appropriately (100%) used for double venous exchange transfusion (ET). In their report, authors also support the use of fresh whole blood for massive transfusion in cases of acute bleeding and for ET in cases of hemolytic disease of newborn (HDN). But, today, whole blood is not an appropriate choice for transfusion generally, for avoiding undesirable adverse effects, especially in pediatrics-neonatology; and also, patients should be given the blood components which they needed. In modern medical practice, only blood components like red blood cells, white blood cells, plasma, clotting factors and platelets; instead of the whole blood; are commonly used. In Turkey, Ministry of Health does not allow the preparation and usage of whole blood in routine; expect for a few special conditions like massive hemorrhage and ET for severe neonatal hyperbilirubinemia [2]. Severe hyperbilirubinemia caused by HDN is the most common indication of ET in newborn infants in order to prevent development of kernicterus [3]. Exchange transfusion can be performed using many different combinations of blood components, including both fresh whole blood and packed red blood cells reconstituted with fresh frozen plasma [4]. The classical approach in ABO hemolytic disease is ETwith group O whole blood of infant’s Rh type with low titer plasma anti-A and antiB antibodies [5]. However, the type O Rh-specific red blood cells, which are reconstituted with type AB plasma, are recommended in case of ABO incompatibility. When ET is planned with group O Rh-negative blood, one should ask for O Rhnegative packed red blood cells suspended in AB plasma to minimize the anti-A and anti-B titres [6]. Yigit et al. demonstrated that use of type O red cells suspended in A or B plasma for the ET decreased the re-ET risk significantly, compared with group O whole blood in the ABO hemolytic disease [7]. Transfusion of the blood products is used for manymedical conditions to replace lost components of the blood. However, blood transfusions may be related to some severe adverse reactions like post transfusion hemolysis, graft vs. host disease etc., which require close attention. Therefore, use of appropriate blood component that is required by the patient is crucial for better clinical outcome and avoiding unnecessary adverse events. Moreover, use of appropriate packed red blood cells reconstituted with fresh frozen plasma for ET in ABO hemolytic disease is important for avoiding re-ET. In conclusion, instead of whole blood, specific blood components which are mainly required by patients should be preferred in the pediatric transfusion practice. The response of the original authors was not received on this correspondence and thus, expert opinion was sought.

Allopürinolün hipoksik iskemik beyin hasarı oluşturulan yenidoğan sıçanlarda kaspaz 3 ve kaspaz 8 aktivitesi üzerine etkisi

Sum mary Aim: During reperfusion period of hypoxia-ischemia, cyclooxygenase and xanthine oxidase pathways are induced. A xanthine oxidase inhibitor, allopurinol has been shown to be neuroprotective in hypoxicischemic encephalopathy. Caspase-8 and caspase-3 have a key role in neuronal apoptosis. We aimed to test repeated doses of allopurinol’s effect on caspase-3 and caspase-8 activities in newborn rats with hypoxic-ischemic encephalopathy. Material and Method: Seven days old newborn rats were taken and there were 10 rats in each group. After Ethical Committee was approved (TIBDAM-25), rats were subjected to left carotid artery ligation and hypoxia (8% oxygen and 92% nitrogen) for two and half hours. Hypoxic ischemic rats treated with 24 mg/kg allopurinol 30 minutes and 12 hours (AL48 group), and 30 minutes, 12 and 24 hours (AL72 group) after hypoxicischemic insult. Twenty four hours after last dose, rats were decapitated. The others groups were sham and salinetreated hypoxicischemic (H-I) group. Caspase3 and caspase8 activities were measured in both hemispheres. Results: There was no difference in caspase-3 and caspase-8 activities between right and left brain hemispheres in each group (p>0.05). Caspase-3 and caspase-8 activities were significantly lower in sham group when compared to H-I group, AL48 and AL72 groups (all of it, p=0.0001). Even though there were no difference activities of caspase3 and caspase8 between H-I group and AL48 group (p>0.05), activities of caspase3 and caspase8 in AL72 group were significantly lower than H-I group and AL48 group (respectively p= 0.0001, p=0.001). Conclusions: Decreased activities of caspase3 and caspase8 in AL72 group may suggest that totally dosage of 72 mg/kg allopurinol may be effective for reducing neuronal apoptosis in newborn rats with hypoxicischemic insult. (Turk Arch Ped 2013; 48: 48-52)

Yenidoğan Yoğun Bakım Ünitesindeki Prematür Bebeklerin Arter, Ven ve Kapiller Kan Gazı Değerlerinin Karşılaştırılması

Amac: Bu calismada kan gazi olcumleri arasinda bir iliski olup olmadigi ve kapiller kan gazi ornekleri ile arter(A) ve venoz(V) degerler arasinda bir iliski kurulup kurulamayacagi arastirildi. Materyal ve Metod: Yenidogan yogun bakim unitesi(YYBU)nde yatmakta olan gobek arter ve venoz kateter takilan hastalar calismaya alindi. Gobek arter ve ven, kapiller kan gazlari alinarak pH, pCO2, BE, HCO3 ve oksijen saturasyonlari arasindaki korelasyon arastirildi. Bulgular:Ortalama gestasyon haftasi 29.0 ± 2.5 (24-35) hafta ve ortalama dogum agirligi 1173 ± 421 (500-2200) g olan 111 prematur bebekten 114 es zamanli kan gazi ornegi alindi. olgular uc gruba ayrildi;

Malnütrisyonlu çocuklarda serum leptin lipid ve protein düzeyleri ve antropometrik ölçümlerin değerlendirilmesi Orijinal Araştırma

Agir derecede protein enerji malnutrisyonu tanisi alan cocuklarda serum leptin duzeyi ile antropometrik olcumler serum lipidleri lipoproteinleri total protein albumin arasindaki iliskinin arastirilmasi ve leptinin tanisal degerinin saptanmasi amaclandi Malnutrisyon tanisi ile izlenen 36 cocuk calisma grubunu olusturdu Otuz cocuk ise kontrol grubu olarak calismaya alindi Malnutrisyonlu cocuklarin 21’i marasmus 15’i kwashiorkor olarak siniflandirildi Serum leptin duzeyleri kontrol grubuna gore marasmuslu ve kwashiorkorlu cocuklarda belirgin olarak dusuk idi p lt;0 001 sirasiyla 6 82±2 28 2 09±0 93 2 27±1 01 ng ml Ancak marasmus ile kwashiorkor gruplari arasinda anlamli bir fark yoktu p gt;0 05 Serum trigliserid ve cok dusuk dansiteli lipoprotein Very low density lipoprotein = VLDL duzeyleri kontrol grubuna gore malnutrisyonlu cocuklarda dusuk idi ve en dusuk trigliserid ve VLDL duzeylerinin marasmuslu cocuklarda oldugu goruldu sirasiyla 133 66±24 20 26 48±8 21 mg dl Ayrica marasmuslu ve kwashiorkorlu cocuklardaki serum kolesterol duzeylerinin kontrol grubuna gore dusuk oldugu saptandi sirasiyla 131 25±25 97 122 20±22 99 144 76±26 20 mg dl Malnutrisyonlu cocuklardaki serum leptin duzeyinin metabolik dengeyi gostermede onemli bir sinyal oldugu ayrica bircok antropometrik ve biyokimyasal parametre ile pozitif korelasyon gostermesi nedeni ile beslenme durumunu degerlendirmede kullanilabilecegi sonucuna varildi Anahtar Kelimeler: cocukluk cagi leptin protein enerji malnutrisyonu