Eylem Ulas Saz

The relation of vitamin D deficiency with puberty and insulin resistance in obese children and adolescents.

Abstract The prevalence of obesity among children and adolescents has been rapidly increasing in recent years. Obese individuals are at risk for vitamin D deficiency. The aim of this study was to investigate the relation of vitamin D deficiency with puberty and insulin resistance in obese children and adolescents. A total of 106 children and adolescents (48 prepubertal and 58 pubertal) between 8 and 16 years of age were included in the study. Fasting blood glucose, insulin, lipid profile, calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D [25(OH)D] levels, as well as blood glucose and insulin concentrations at 120 min of oral glucose tolerance test were measured. Insulin resistance was calculated using the homeostasis model assessment. Daily vitamin D intake was questioned. Serum 25(OH)D level was normal in only 3.8%, insufficient in 34.0%, and deficient in 62.2% of the subjects. There was a statistically significant rate of 25(OH)D deficiency in the pubertal group compared with that in the prepubertal group. Those subjects with 25(OH)D deficiency were found to have greater insulin resistance. Vitamin D deficiency is common among obese children and adolescents. Low vitamin D levels in obese individuals may accelerate the development of metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease by further increasing insulin resistance.

Convulsive status epilepticus in children: Etiology, treatment protocol and outcome

This study aimed to determine the etiology, treatment protocol and outcome of convulsive status epilepticus (SE) in children. An institutional treatment protocol using benzodiazepines (diazepam and midazolam) was assessed in a retrospective case study. The treatment protocol (Ege Pediatric Status Epilepticus Protocol or EPSEP) was developed based on an operational definition of pediatric SE according to the duration of seizure activity. Pediatric SE is divided into three categories: initial SE (20-30 min), established SE (30-60 min) and refractory SE (>60 min). Eight (30%) of the studied episodes were initial SE, 10 (37%) were established SE, and 9 (33%) were refractory SE. With respect to the etiological spectrum of SE, 11 (40%) children had meningitis or encephalitis. Febrile SE was identified in 7 (26%) patients. Only 2 episodes of initial SE (7.5%) were controlled with first step of the protocol (two concomitant-doses of rectal diazepam). Midazolam bolus and infusions (up to 1.2 μg/kg/min) were used to treat 22 episodes of SE (9 refractory SE, 10 established SE and 3 initial SE). Complete arrest of convulsive SE was achieved in 21 of 22 (95%) episodes with midazolam infusion. We concluded that the combined use of benzodiazepines (diazepam+midazolam) was safe and effective in the treatment of convulsive SE in children.

Hypogammaglobulinemia: Incidence, risk factors, and outcomes following pediatric lung transplantation

Abstract:  Infection is the leading cause of morbidity and mortality in the first year following lung transplantation. HG after adult lung transplantation has been associated with increased infections and hospitalization as well as decreased survival. The purpose of this study is to define the incidence, risk factors, and outcomes of HG in the first year following pediatric lung transplantation. A retrospective review of all lung transplant recipients at a single pediatric center over a four‐yr period was performed. All serum Ig levels drawn within one yr of transplantation were recorded. An association between HG during the first year after transplantation and age, race, gender, diagnosis leading to transplantation and clinical outcomes including hospitalization, infections requiring hospitalization, viremia, fungal recovery from BAL lavage, and mortality was sought. HG was defined using age‐based norms. Fifty‐one charts were reviewed. Mean (±s.d.) post‐transplantation levels for IgG, IgA, and IgM were 439.9 ± 201.3, 82.3 ± 50.2, and 75.2 ± 41.4 mg/dL, respectively. HG was present in 48.8%, 12.2%, and 17.1% of patients for IgG, IgA, and IgM, respectively. Patients with HG for IgG were older (14.3 ± 3.8 vs. 9.2 ± 5.4 yr; p < 0.01). IgA and IgM HG were associated with invasive aspergillosis (p < 0.01 and p = 0.05, respectively). IgG and IgM levels inversely correlated with bacterial infections and hospital days, respectively (p < 0.01, p < 0.05). HG is a frequent complication following pediatric lung transplantation. Low Ig levels are associated with increased infections and hospital stay.

Effectiveness of a new bioequivalent formulation of oseltamivir (Enfluvir®) on 2010-2011 seasonal influenza viruses: an open phase IV study.

OBJECTIVE The aim of this multicenter prospective study was to evaluate the efficacy of a new bioequivalent formulation of oseltamivir for the treatment of influenza A, influenza B, and H1N1 during the 2010-2011 influenza season. METHODS We compared the symptoms and signs of 300 pediatric patients presenting to three university hospitals with an influenza-like illness between January and March 2011. Nasal swab specimens were collected from all children and tested by reverse-transcription polymerase chain reaction (RT-PCR) for influenza viruses. After randomization, half of the participants were prescribed oseltamivir, while the other half were observed conservatively. Forty patients who were followed-up for influenza prior to the study were also included in the evaluation. RESULTS Influenza was confirmed by RT-PCR in 129 children, 71 of whom were prescribed oseltamivir. The durations of the symptoms fever, cough, nasal congestion, and rhinorrhea were significantly shorter for patients who were treated with oseltamivir compared with untreated patients (p<0.002 for all symptoms). Early initiation of oseltamivir therapy (within 48 h of the onset of symptoms) was associated with more favorable outcomes and an earlier recovery than in patients for whom treatment was delayed (beyond 48 h). Thirty-seven patients (28.7%) had H1N1, 44 (34.1%) had influenza A, 46 (35.7%) had influenza B, one (0.8%) had H1N1 plus influenza A, and one (0.8%) had influenza A plus influenza B viruses. In the comparison of the duration of symptoms according to the different virus types, a statistically significant difference was only observed in patients with influenza B who had a longer duration of cough (p<0.001), nasal congestion (p<0.001), and rhinorrhea (p<0.001). CONCLUSIONS Oseltamivir is an effective treatment for the management of seasonal influenza and H1N1, and should be initiated immediately without waiting for laboratory confirmation of diagnosis.

Pseudomonas necrotizing fasciitis following an intramuscular injection in an immunocompetent child

Necrotizing fasciitis (NF) is a deep-seated infection of the subcutaneous tissue that results in progressive destruction of fascia and fat, but may spare the skin. It is classified into two types: Type 1 is polymicrobial, and is caused by aerobic and anaerobic bacteria. Type 2 is monomicrobial, and is most often caused by Group A Streptococci. Monomicrobial NF caused by Pseudomonas aeruginosa is extremely rare. Only five such cases have been reported in children: three of whom had acute leukemia and presented with NF involving the vulva; one who developed NF following penetrating trauma; and the last who was an immunocompetent infant. We report the second case of a Type 2 NF caused by P. aeruginosa in a 3-year-old boy without any known immunodeficiency or complicated medical illnesses. To our knowledge, the present case is also the first case in the literature that developed Type 2 NF caused by P. aeruginosa following an i.m. injection.

Effects of Air Quality and Climate Change on Airway Hyperreactivity in Children (A Multi-Centered Study)

The clinical effects of environmental pollution and climate change on respiratory health is a contemporary debate issue. In this study, the sulfur dioxide (SO 2 ), particulate matter (PM 10 ) levels, and climate conditions in the city of Izmir, have been taken together with the patients with asthma or acute bronchiolitis, who admitted to the children’s emergency departments of the four university/education-research hospitals in Izmir. From September 1, 2007 until August 31, 2008, the 22,467 patients who admitted to these centers because of airway hyperreactivity, were of age 3.05±1.57 on the average, and the male/female ratio was 1.7. Among the patients, 79.3% were having acute bronchiolitis, and 20.7% an asthma attack. As SO 2 and PM 10 levels increase, the daily asthma attacks, patients with acute bronchiolitis, and total of patients with hyperactivity, were observed to increase (p<0.001). In addition, the numbers in the following five days after the increase of air pollution rate, were observed to increase statistically significantly (p<0.001). The number of asthma and acute bronchiolitis patients applying to emergency, was negatively correlated with daily average temperature, but positively correlated with relative humidity, actual air pressure, and sea- level pressure levels (p<0.001). Reflecting on the increase of asthma and acute bronchiolitis in developed societies, there is a necessity of effective reliefs such as effectively monitoring the within-city air quality, taking the industrial centers out of the city, promoting public transportation, and preserving the natural life.

Invisible Ingested Foreign Body: Aluminum Can Top

We report a patient who ingested a ring pull from a coke can in which could not be seen on radiography. We also want to emphasize the ability of this tool in detecting thin metallic and aluminium objects that are invisible on standard radiograms. Saz et al. found the sensitivity, specifity, positive and negative predictive values (PPV, NPV) of handheld metal detectors to be 88.6%, 100%, 100% and 55.5% respectively (95% confidence intervals) in patients who ingested a metallic foreign body [1].

A `glue sniffer` teenager with anuric renal failure and hepatitis

Yurtseven A, Türksoylu M, Yazıcı P, Karapınar B, Saz EU. A `glue sniffer` teenager with anuric renal failure and hepatitis. Turk J Pediatr 2018; 60: 206-209. `Inhalant abuse` is a common form of volatile drug abuse throughout the world especially in developing countries. This substance mainly contains toluene. Acute toluene inhalation produces a biphasic response with an initial central nervous system (CNS) excitation followed by CNS depression as well as various metabolic alterations. Chronic inhalational abuse is associated with muscular weakness, gastrointestinal symptoms, renal and hepatic injury. In this report, a 16-year-old boy presented with jaundice, nausea, vomiting and reduced urine output. He developed severe acute renal/hepatic damage due to abuse of gas products. Since toluene is the main toxic agent involved in glue sniffing which is metabolized to hippuric acid, the present case was treated with continuous hemodiafiltration, plasma exchange and conservative therapy to eliminate hippuric acid. The jaundice gradually disappeared, he had complete recovery of renal/hepatic functions in ten days. We aimed to increase the awareness among emergency physicians that ``glue sniffing` should be considered in the differential diagnosis of unexplained reversible acute renal/hepatic damage.

Integration of radiology and clinical score in pediatric appendicitis

The efficacy of ultrasonography (US) and abdominal X‐ray in combination with Pediatric Appendicitis Score (PAS) is complicated in the diagnosis of acute appendicitis. Abdominal X‐ray is as useful as US with clinical assessment when evaluated by experienced pediatric radiologist in acute appendicitis. The aim of this study was to determine the value of US and abdominal X‐ray for appendicitis in children when combined with clinical assessment based on PAS, and to establish a practical pathway for acute appendicitis in childhood.

Infantil delirium induced by cycloplegic eye drops

Cyclopentolate 1% and tropicamide 1% eye drops are considered to be safe in the pediatric population for the fundus examination and treatment of ocular diseases. Although adverse reactions rarely occur, some of them can be life-threatening such as seizure, delirium, coma, arrhythmia, acute life-threatening event, and death. Here we report 15 months old boy who developed delirium after administration of ocular cyclopentolate 1% drops in both eyes during a routine examination for retinopathy of prematurity. Cyclopentolate is a parasympatholytic drug with actions similar to atropine. With ophthalmic administration of cyclopentolate, severe central nervous system effects and systemic reactions may occur. In order to minimize absorption following instill one or two drops of 1% solution, applying pressure to nasolacrimal sac for 2 to 3 min should be considered. In mild to moderate toxicity, benzodiazepines may be used to control central nervous system findings secondary to anticholinergic effects.