Eren Cagan

Nitric oxide, lipid peroxidation, and antioxidant enzyme levels in epileptic children using valproic acid.

In the present study, we investigated the effects of valproic acid (VPA) on nitric oxide (NO) level, lipid peroxidation, and antioxidant enzyme activities in 21 epileptic children and 26 healthy controls. The subjects were selected from those who visited for a checkup or medical treatment at the Mustafa Kemal University Research Hospital. Serum levels of NO(-2), NO(-3), malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) were analyzed by redox or enzymatic reactions and spectrophotometry. Based on the NO(-2) and NO(-3) levels, the NO concentration was about 10% higher in VPA group than in the control group (p<0.001). However, no significant difference was detected for serum MDA, SOD, and CAT levels. It is suggested that NO would play a role in the mechanism of antiepileptic effects by VPA treatment.

Necrotizing fasciitis caused by Staphylococcus epidermidis in a neonate with extremely low birthweight

Necrotizing fasciitis (NF) is a severe life‐threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. The initial skin presentation ranges from minimal rash to cellulites. The lesions subsequently spread rapidly. Even with appropriate medical and surgical therapy, the mortality rate in NF is more than 50%. In cases of neonates, mortality rate is higher than that ratio. High index of suspicion, prompt aggressive surgery, appropriate antibiotics and supportive care are the mainstays of management in the newborn infant with NF. Herein, we report a case of invasive and mortal NF caused by Staphylococcus epidermidis in an infant with extremely low birthweight.

Periorbital cellulitis caused by Bacillus thuringiensis.

Purpose Periorbital cellulitis is an inflammation of the lids and periorbital tissues without signs of true involvement such as proptosis or limitation of eye movement. Methods Bacillus thuringiensis is a Gram-positive, spore-forming soil bacterium with the ability to produce insecticidal crystal proteins. B thuringiensis is an extremely rare causative organism of orbital and periorbital infections. However, it was rarely seen isolated in pediatric cases with preseptal cellulites. Ocular infections of this bacteria quickly progress, within 12–48 hours from inoculation, leading to endophthalmitis or panophthalmitis and irreversible vision loss. Results Periorbital cellulitis should be recognized promptly and treated carefully. Hospitalization, prompt systemic antibiotic therapy, and careful monitoring for signs of sepsis and local invasion are critical. Conclusions We report a rare presentation of periorbital cellulitis caused by B thuringiensis.

Investigation of oxidant and antioxidant pathway changes in acute rheumatic fever

Aim — The purpose of this study was to investigate the role of oxidant stress in the clinical process and pathogenesis of acute rheumatic fever (ARF). Material and methods — The study included 33 children with ARF and 20 healthy control subjects. The diagnosis of ARF was established according to the Jones Criteria. Malondialdehyde (MDA), reduced glutathione (GSH), a-tocopherol, ascorbic acid, retinol and b-carotene levels were measured as markers of oxidative stress together with some antioxidant markers. Results — Our study includes 33 (19 male, 14 female) children with ARF and 20 (11 male, 9 female) healthy control subjects.The mean age ranged between 5–16 years and 5–15 years in the study and control groups, respectively.MDA was measured as 2.1 ± 0.9 nmol/mL in the control group, 3.3 ± 2.7 nmol/mL in the study group before treatment, and 2.1 ± 1.2 nmol/mL after treatment. Blood GSH levels were 48.2 ± 12.7 mg/dL in the control group, 24.7 ± 16 mg/dL in the study group before treatment, and 40.6 ± 21.3 mg/dL in the study group after treatment. MDA and GSH levels prior to the treatment were found to be significantly high and low as compared with the levels of the control group, respectively (P< 0.05, P< 0.001). After treatment, statistically important decrements and increments were determined in the levels of MDA (P< 0.05) and GSH (P< 0.01), respectively. Furthermore, a-tocopherol, retinol and b-carotene levels prior to treatment in the study group, were significantly lower in comparison with control group levels (P= 0.05, P< 0.05, P< 0.01, respectively). Conclusion — We suggested that tissue damage in ARF may not only occur in the presence of increased oxidative stress, but also as a consequence of decreased antioxidant markers.

Bilateral brachial plexus palsy and right Horner syndrome due to congenital cervicothoracal syringomyelia.

Syringomyelia (SM) is a disorder in which a cyst forms within the spinal cord. This cyst, called a syrinx, expands and elongates over time, destroying the center of the cord. Horner syndrome is an infrequent illness caused by a lesion of the cervical sympathetic nerve fiber. Its clinical features are facial anhidrosis, ptosis, miosis, and hypochromia iridis of the affected side. A full-term male newborn infant was admitted with weakness in bilateral upper extremities and narrowing of the palpebral fissure on the right side. Ophthalmologic examination revealed a smaller right pupil. Muscle power in bilateral upper limbs was 1/5. Chest X-ray and cranial magnetic resonance imaging were normal. Magnetic resonance imaging of the cervicothoracic spine showed SM at C4-T2 level. Electromyographic examination revealed bilateral brachial plexus palsy. The diagnosis was of brachial plexus palsy and congenital Horner syndrome due to congenital cervicothoracic SM. According to our best knowledge, this association has not been reported in the literature.

Evaluation of Gelatin Tannate Against Symptoms of Acute Diarrhea in Pediatric Patients

Background Acute diarrhea is the second most common cause of morbidity and mortality worldwide, especially in children aged ≤3 years. Some drugs (e.g., the mucoprotector gelatin tannate) plus a reduced osmolality oral rehydration solution (ORS) may effectively reduce symptom duration and severity. The current trial was therefore designed to assess the efficacy and safety of gelatin tannate in pediatric patients with acute diarrhea. Material/Methods This was a randomized, controlled, double-blind, parallel-group, single-center study comparing gelatin tannate plus ORS (103 patients) with ORS plus placebo (100 patients) in children aged 3 months to 12 years with infectious or noninfectious acute diarrhea. Details about stool consistency and total time to resolution of diarrhea comprised the primary study endpoints. Secondary study endpoints included symptoms of diarrhea at 12, 24, 36, 48, and 72 hours after the first dose of study medication. Results From 12 hours onwards, the incidence of watery stools was significantly lower in the gelatin tannate group than in the ORS group (at 12 hours: 59.2% vs. 77.0%; p=0.01). The same was true for stool frequency (at 12 hours: mean 2 vs. 3 stool productions in the previous 12 hours; p<0.01). At all timepoints during the study, the proportion of patients with Stool Decrease Index improvement was significantly greater (p<0.01) in the gelatin tannate group than in the placebo group (at 12 hours: 66.6% vs. 33.3%; p<0.01). Conclusions Gelatin tannate plus ORS is an effective and safe option for the treatment of acute diarrhea in children. Significant symptom relief is evident 12 hours after starting treatment.

Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study

Abstract Purpose: Ventriculoperitoneal shunt (VPS) is the most common treatment modality for hydrocephalus. However, VPS infection is a common and serious complication with high rates of mortality and morbidity. The objective of this study was to investigate causative agents and the management of VPS infections and to identify risk factors for re-infection in children. Materials and methods: Retrospective, multicentre study on patients with VPS infection at paediatric and neurosurgery departments in four tertiary medical centres in Turkey between January 2011 and September 2014. Results: A total of 290 patients with VPS infections were identified during the study period. The aetiology of hydrocephalus was congenital malformations in 190 patients (65.5%). The most common symptom of shunt infection was fever in 108 (37.2%) cases. At least one pathogen was identified in 148 VPS infections (51%). The most commonly isolated pathogen was coagulase-negative staphylococci, which grew in 63 cases (42.5%), followed by Pseudomonas aeruginosa in 22 cases (14.9%), Klebsiella pneumoniae in 15 cases (10.1%), and Staphylococcus aureus in 15 cases (10.1). The median duration of VPS infection was 2 months (range, 15 days to 60 months) after insertion of the shunt, with half (49.8%) occurring during the first month. VPS infection was treated by antibiotics and shunt removal in 211 cases (76.4%) and antibiotics alone without shunt removal in 65 patients (23.5%). Among the risk factors, CSF protein level greater than 100 mg/dL prior to VPS insertion was associated with a potential risk of re-infection (OR, 1.65; p =.01). Conclusion: High protein levels (>100 mg/dL) before the re-insertion of a VPS may be a risk factor for VPS re-infection.

Çocuklarda Ventriküloperitoneal Şant Enfeksiyonları ve Tedavisi

Amac: VPS cerrahisinin en onemli komplikasyonu cerrahi sonrasi donemde gelisen santral sinir sistemi enfeksiyonudur. VPS enfeksiyonlarinin insidansinin VPS takilan olgularin tumunde %6.5-23.5 oraninda oldugu bildirilmektedir. Bu calismanin amaci hidrosefalili cocuk hastalarda VPS ameliyatlarinin enfeksiyon iliskili komplikasyonlarini ve tedavilerini degerlendirmektir. Materyal ve Metod: Ocak 2011- Ocak 2013 yillari arasinda hidrosefali nedeniyle VPS takilan ve cerrahi girisim sonrasi enfeksiyon iliskili komplikasyon gelisen hastalar calismaya alindi. Hastalarin dosyalari retrospektif olarak incelendi ve analiz edildi. Hastalara ait demografik ozellikler, hidrosefali etyolojisi, sant takilma tarihi, VPS takilmasina ait operasyon notlari, VPS enfeksiyonu tanisi konulduktan sonraki BOS orneklerine ait mikrobiyolojik ve biyokimyasal testlerin sonuclari, tedaviye yonelik olarak yapilan cerrahi mudahele ve verilen antibiyotik turleri, antibiyotiklerin kullanma sureleri degerlendirildi. Bulgular: Yaslari uc gun ile 16 yas arasinda degisen, VPS enfeksiyonu tanisi ile izlenen 35 hasta degerlendirildi. VPS enfeksiyonu tanisi ile izleme alinan 35 hastanin 19’unda BOS kulturunde ureme olurken, 17 hastanin BOS kulturunde ureme olmaksizin inflamasyon bulgulari mevcuttu. En sik izole edilen etken patojen coagulase negative Staphylococci (%78) idi. Hastalarin BOS’larindan izole edilen diger mikroorganizmalar; Staphylococcus aureus, Enterococcus feacalis, Enterococcus gallinarium, Pseudomonas stutzeri, Candida albicans, Streptococcus mitis ve ESBL (-) Klebsiella pneumonia idi. Tedavi sirasinda bir hasta kaybedilirken, 34 hasta sifa ile taburcu edildi. Sonuc: VPS enfeksiyonlarin da erken antibiyotik tedavisi verilmesinin ve enfekte santin cikarilmasinin hayati oneme sahip oldugunu dusunmekteyiz.

TAR syndrome and esophagial atresia: a concomitant or variant condition?

Thrombocytopenia with absent radii (TAR) is rare cause of neonatal thrombocytopenia. TAR syndrome and esophageal atresia with tracheoesophageal fistula has been reported in only two cases in literature. Our case was the first in literature with unilateral TAR syndrome and bilateral absence of thumbs accompanying EA.

Metamizol Sodyum Kullanımına Bağlı Agranülositoz

Metamizol sodyum (Novalgine) ulkemizde ve dunyanin bircok yerinde antipiretik, aneljezik ve spazmolik olarak yaygin olarak kullanilmaktadir. Ancak gelismis ulkelerde siddetli yan etkilerinden dolayi kullanilmamaktadir. Bu yazida ates nedeni ile metamizol sodyum kullanilan ve metamizol sodyum sonrasinda kemik iliginde agranulositoz gelisen ve granulosit koloni-uyarici faktor ile tedavi edilen uc yas dort aylik bir kiz hasta sunulmustur.