Gulcin Bozlu

Platelet-activating factor antagonist (ABT-491) decreases neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury

Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. To date, no study has investigated the role of platelet-activating factor (PAF) antagonists on neuronal apoptosis in neonatal rat model of HIBI. In the present study, we evaluated the effect of a highly potent and selective PAF antagonist (ABT-491) on neuronal apoptosis in neonatal rat model of HIBI. Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2 h. They were treated with ABT-491 or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia was performed. Neuronal apoptosis was evaluated by the terminal-transferase mediated dUTP biotin nick-end-labeling (TUNEL) and caspase-3 staining methods. Administration of ABT-491 either before or after hypoxia resulted in significant reduction of the numbers of apoptotic cells in both hemispheres, when compared to saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups were significantly higher than that in the left hemispheres. These results suggested that ABT-491, a highly potent and selective PAF antagonist, administration either before or after hypoxia reduces apoptosis and we propose that ABT-491 may be a novel approach in the treatment of HIBI.

Diagnostic value of red blood cell distribution width in pediatric acute appendicitis.

The aim of this study was to evaluate the diagnostic value of red blood cell distribution width (RDW) in children with acute appendicitis.

The diagnostic value of red blood cell distribution width in children with acute appendicitis

The aim of this study was to evaluate the diagnostic value of red blood cell distribution width (RDW) in children with acute appendicitis.

The prevalence, serogroup distribution and risk factors of meningococcal carriage in adolescents and young adults in Turkey

ABSTRACT The serogroup epidemiology of invasive meningococcal disease (IMD), which varies considerably by geographic region and immunization schedule, changes continuously. Meningococcal carriage data are crucial for assessing IMD epidemiology and designing f potential vaccination strategies. Meningococcal seroepidemiology in Turkey differs from that in other countries: serogroups W and B are the predominant strains for IMD during childhood, whereas no serogroup C cases were identified over the last 10 y and no adolescent peak for IMD was found. There is a lack of data on meningococcal carriage that represents the whole population. The aims of this multicenter study (12 cities in Turkey) were to evaluate the prevalence of Neisseria meningitidis carriage, the serogroup distribution and the related risk factors (educational status, living in a dormitory or student house, being a household contact with Hajj pilgrims, smoking, completion of military service, attending bars/clubs) in 1518 adolescents and young adults aged 10–24 y. The presence of N. meningitidis DNA was tested, and a serogroup analysis was performed using polymerase chain reaction. The overall meningococcal carriage rate was 6.3% (n = 96) in the study population. A serogroup distribution of the 96 N. meningitidis strains isolated from the nasopharyngeal specimens revealed serogroup A in 5 specimens (5.2%), serogroup B in 9 specimens (9.4%), serogroup W in 64 specimens (66.6%), and serogroup Y in 4 specimens (4.2%); 14 were classified as non-grouped (14.4%). No serogroup C cases were detected. The nasopharyngeal meningococcal carriage rate was 5% in the 10–14 age group, 6.4% in the 15–17 age-group, and 4.7% in the 18–20 age group; the highest carriage rate was found in the 21–24 age group (9.1%), which was significantly higher than those of the other age groups (p < 0.05). The highest carriage rate was found in 17-year-old adolescents (11%). The carriage rate was higher among the participants who had had close contact with Hajj/Umrah pilgrims (p < 0.01) or a history of upper respiratory tract infections over the past 3 months (p < 0.05). The nasopharyngeal carriage rate was 6.3% among adolescents and young adults in Turkey and was similar to the recent rates observed in the same age groups in other countries. The most prevalent serogroup was W, and no serogroup C cases were found. In conclusion, the present study found that meningococcal carriage reaches its peak level by age 17, the highest carriage rate was found in 21 - to 24 - year-olds and the majority of the carriage cases were due to serogroup W. Adolescents and young adult carriers seem to be a potential reservoir for the disease, and further immunization strategies, including adolescent immunization, may play a role in the control of IMD.

Serotonin Syndrome after Clomipramine Overdose in a Child

Serotonin syndrome (SS) is a potentially life-threatening condition associated with increased serotonergic activity in central nervous system and may occur during the use of serotonergic drugs. Although increasing frequency of serotonergic drug use in children, pediatricians, emergency medicine and pediatric intensive care specialists have not enough knowledge and experience about SS that is a potentially life-threatening condition. A 12-year-old girl patient was admitted to our emergency room with the history of involuntary contractions on her extremities and alteration of consciousness. Her physical examination showed agitation, hyperthermia, dilated pupils, tremor, increased deep tendon reflexes, positive spontaneous clonus, agitation, flushed skin and diaphoresis, excessive perspiration, and continuous horizontal ocular movements. The patient diagnosed as SS by clinical history, physical and laboratory findings. In this paper, we will discuss SS occurred in a 12-year-old girl after concurrent clomipramine and risperidone use.

Subacute sclerosing panencephalitis with parkinsonian features in a child: A case report

BACKGROUND Subacute sclerosing panencephalitis (SSPE) can present with atypical clinical signs which may result in delayed diagnosis and treatment. We present a child with SSPE whose initial manifestation was parkinsonism. PATIENT This 12-year-old boy presented with the complaint of difficulty in standing up and walking for 2 months. Neurological examination revealed generalized rigidity, bradykinesia, impaired postural reflexes, and a mask-like facies. The initial diagnosis of Juvenile Parkinson Disease was made. He had no improvement with levodopa, trihexyphenidyl, tetrabenazine and clonazepam. The EEG showed irregular background activity with generalized slow waves which were not suppressed with diazepam injection. SSPE was considered and the diagnosis was confirmed with the identification of measles antibodies in cerebrospinal fluid. CONCLUSION SSPE should be considered in children and adolescents with parkinsonian symptoms, particularly in the absence of a history of vaccination against measles.

Evaluation of T-wave alternans in pediatric patients with chronic renal failure

INTRODUCTION Microvolt T-wave alternans (TWA) is known to be useful in prediction of ischemia and sudden death in high-risk populations and there are no studies in children with chronic renal failure (CRF). Cardiac problems seem to be responsible for an important part of death in children and young adults with CRF. The aim of this study is to evaluate Holter microvolts TWA measurements in children with CRF comparing to the control group. METHODS This prospective study included 40 patients with CRF and 48 healthy controls. The history, echocardiography and microvolt TWA values based on 24-hour ECG recordings of the patients were evaluated. Analysis of microvolt TWA was considered on the basis of three leads (V5, V1 and AVF). RESULTS Compared with the controls, the mean systolic and diastolic blood pressure values and average heart rates were significantly higher in the children with CRF (p = 0.001 and p = 0.026, respectively). Also, the values of left ventricular internal dimensions at end diastole and end-diastolic volume were significantly higher in CRF group (p = 0.01 and p = 0.049, respectively) and couplet ventricular extrasystole was detected in 2 patients with CRF. Consequently, all TWA values in three leads were increased in CRF group than the control group but the only increase in V5 lead was statistically significant (p = 0.028). CONCLUSIONS This study has demonstrated that microvolt TWA values increased in pediatric patients with CRF. TWA might be used for early risk assessment in pediatric patients with CRF in the future.

Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers

BACKGROUND The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing. METHODS Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS. RESULTS 115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p=0.022 and aOR: 1.02, p=0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p=0.003). CONCLUSION IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma.

Relationship of Hemoglobin Concentration at Admission and Need for Erythroyte Transfusion During Hospitalization with Mortality in Pediatric Critical Care Patients

©Telif Hakkı 2017 Çocuk Acil Tıp ve Yoğun Bakım Derneği Çocuk Acil ve Yoğun Bakım Dergisi, Galenos Yayınevi tarafından basılmıştır. Yazışma Adresi/Address for Correspondence: Dr. Ali Ertuğ Arslanköylü, Mersin Üniversitesi Tıp Fakültesi, Çocuk Yoğun Bakım Bilim Dalı, Mersin, Türkiye E-posta: aliertug@gmail.com Geliş Tarihi/Received: 25.02.2017 Kabul Tarihi/Accepted: 10.03.2017 Amaç: Bu çalışmanın amacı çocuk yoğun bakım ünitesine yatış sırasındaki hemoglobin düzeyi ve izlem sırasında eritrosit transfüzyonu gereksinimi ile mortalite arasındaki ilişkinin araştırılmasıdır. Yöntemler: Bu ileriye yönelik çalışmaya on iki yataklı çocuk yoğun bakım ünitesine bir yıl süreyle kabul edilen toplam 260 hasta dahil edilmiştir. Hastaların demografik özellikleri, yatış nedenleri, yatış süreleri, mekanik ventilatör gereksinimi ve mekanik ventilatörde kalma süreleri, pediyatrik mortalite riski III ve pediyatrik lojistik organ disfonksiyon skorları, yatış anındaki tam kan sayımı değerleri ile transfüze edilme durumları kayıt edildi. Bulgular: Çalışmaya alınan hastalardan 34 olgu eksitus oldu. Çalışmamızda kaba mortalite oranı %13 idi. Eksitus olan hastaların ortalama hemoglobin düzeyleri (10,55±2,45 g/dL) sağ kalan hastaların değerlerine (11,58±2,15 g/dL) göre daha düşük bulundu (p=0,011). Transfüzyon uygulanan hastaların mortalite oranı transfüze edilmeyen hastalara göre anlamlı olarak yüksek bulundu (%40,2 vs. %1,6; p<0,001). Sonuç: Çalışmamızda kritik çocuk hastalarda çocuk yoğun bakım ünitesine başvuru sırasında anemi varlığı ve/veya takip sırasında transfüzyon gereksinimi artmış mortalite riski ile ilişkili bulunmuştur. Anahtar Kelimeler: Çocuk yoğun bakım, anemi, transfüzyon, mortalite Introductıon: This study aimed to investigate the relationship of hemoglobin concentration at admission to pediatric intensive care unit and erythrocyte transfusion during hospitalization with mortality. Methods: In this prospective study, we included 260 patients who were admitted to a 12-bed pediatric intensive care unit in a one-year period. Demographic characteristics, admission etiologies, length of stay in the pediatric intensive care unit, mechanical ventilation rates, pediatric risk of mortality III and pediatric logistic organ dysfunction scores, complete blood count on admission and erythrocyte transfusion during hospitalization were recorded prospectively. Results: Of the 260 cases, 34 were exitus. The mortality rate was 13%. The mean hemoglobin concentration of patients who were exitus was lower than that of patients who survived (10.55±2.45 g/dL vs. 10.55±2.45 g/dL, p=0.011). Although platelet levels were lower in patients who were exitus than in survivors, the difference was not statistically significant (320.352±181.731/mm3 vs. 352.231±174,129/mm3 p=0.325). The mortality rate in transfused patients was higher than in patients who were not transfused. (40.2% vs. 1.6%, p<0.001). Conclusion: Hemoglobin concentration at admission in patients who die in pediatric intensive care unit is significantly lower than in those who survive. In this study, increased mortality risk in patients admitted to pediatric intensive care unit was found to be associated with the presence of anemia and need for erythrocyte transfusion.

Can whole-blood parameters be used in follow-up of children with rheumatic valvular heart disease?

OBJECTIVES The aim of the present study was to investigate the relationships between red blood cell distribution width, platelet distribution width, and mean platelet volume and the presence and severity of valvular involvement in patients with rheumatic heart disease. METHODS Between April, 2012 and December, 2015, 151 patients who were admitted to the Pediatric Cardiology Unit with diagnosis of rheumatic heart disease and 148 healthy children were included to our study. Transthoracic echocardiography for all children was performed, and the values of red blood cell distribution width, platelet distribution width, and mean platelet volume, besides other blood count parameters, erythrocyte sedimentation rate, and C-reactive protein levels were recorded. RESULTS Red blood cell distribution width, platelet distribution width, mean platelet volume, and C-reactive protein levels were significantly higher in patients with rheumatic heart disease when compared with healthy controls (p0.05). CONCLUSION This is the first study in children with rheumatic heart disease that demonstrated significantly increased red blood cell distribution width, platelet distribution width, and mean platelet volume levels, as well as evaluated all three parameters together. Furthermore, red blood cell distribution width values in the chronical period of acute rheumatic fever, due to the positive correlation with the other chronic inflammatory markers, may help make the diagnosis in children.