İbrahim Hakan Bucak

Clinical and epidemiological features of Turkish children with 2009 pandemic influenza A (H1N1) infection: Experience from multiple tertiary paediatric centres in Turkey

Abstract Background: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey. Methods: We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals. Results: A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis. Conclusions: In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.

Is there a relationship between low vitamin D and rotaviral diarrhea

For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection.

Acute irritant bullous contact dermatitis caused by Euphorbia helioscopia

E. helioscopia (sun spurge) is used in traditional medicine in Turkey to treat warts, rheumatic pains, and superficial tissue swelling (2). 12-Deoxyphorbol13-phenylacetal-20-acetate is considered to be the most irritant component in the sap (3, 4). The bullous lesions that developed on our patients’ skin occurred after only brief exposure to the sap of the plants. Only a few cases of contact dermatitis associated with E. helioscopia have been reported previously in the literature (1, 5). The plants constitute a risk to children, who may be exposed to the sap during play, and to those who may be exposed when the plants are used in traditional medicine.

Ecthyma gangrenosum in a previously healthy pediatric patient and associated facial paralysis and persistent hyperplastic primary vitreous.

Summary Background: Ecthyma gangrenosum is an infective lesion of the skin and mucosal membranes. It is most commonly caused by Pseudomonas aeruginosa, and the most important risk factors are malignancy and neutropenia. However, it has rarely been reported in children who were previously healthy. Persistent hyperplastic primary vitreous has been described as the persistence of the fetal hyaloid vascular system. Acute otitis media with facial paralysis is an infrequent association. Case Report: We report the case of a 5-month-old boy hospitalized because of fever, otorrhea and necrosis on his body. He had peripheral facial paralysis on the same side as otorrhea. Leukocoria was determined in the right eye. He had many gangrenous ulcers on the extremities and body. Conclusions: We present a previously healthy pediatric patient diagnosed with persistent hyperplastic primary vitreous, ecthyma gangrenosum (by the septicemia of P. aeruginosa), and peripheric facial paralysis (a complication of acute otitis media), admitted to hospital.

An Overview of Antibacterial Resistance Patterns of Pediatric Community-Acquired Urinary Infections.

Urinary tract infection (UTI) is common in children. The aim of this study was therefor to construct a guide for the empirical antibiotic treatment of community‐acquired UTI by investigating the etiology and antimicrobial resistance patterns of uropathogens and analyzing the epidemiological and clinical patient characteristics.

The First Infant Death Associated With Human Coronavirus NL63 Infection.

Human coronavirus NL63 (HCoV-NL63) primarily infects the upper respiratory tract. However, it may cause severe lower respiratory tract infection, and the clinical course may be severe in immunocompromised patients. To our knowledge, child death due to HCoV-NL63 has not been reported. We present a fatal lower respiratory tract disease associated with HCoV-NL63 in a 7-month-old malnourished infant.

Evaluation of Choroidal Thickness in Children With Iron Deficiency Anemia

Purpose The purpose of this study was to determine whether there are differences in choroidal thickness in children with iron deficiency anemia (IDA). Methods Fifty-two patients with IDA and 54 healthy children between 3 and 16 years of age were enrolled in this study. After complete eye examinations were conducted for each participant, the choroidal thickness was measured using optical coherence tomography. Correlations between the choroidal thickness and clinical and laboratory parameters were also evaluated. Results There were no statistically significant differences between the two groups in terms of visual acuity, intraocular pressure, central corneal thickness, or axial length (P > 0.05). The choroidal thicknesses at the foveal center were 303.13 ± 27.14 μm in the IDA patients and 333.67 ± 39.77 μm in the healthy control children (P < 0.001); additionally, the choroidal thicknesses at each point within the horizontal nasal and temporal quadrants were thinner in the IDA group. There were positive correlations between the choroidal thickness and hemoglobin (r = 0.337; P < 0.001), mean corpuscular volume (r = 0.305; P = 0.001), iron (r = 0.264; P = 0.006), and ferritin (r = 0.287; P = 0.003) levels; however, there were no correlations between the clinical or ocular characteristics and the choroidal thickness. Conclusions The patients with IDA had significantly thinner choroidal thicknesses than those of the healthy children. Choroidal thinning in childhood may be an early sign of deterioration in the ocular blood circulation, without any risk of atherosclerosis in advanced age in the patients with IDA.

Diagnosis of chromosomal abnormalities in a patient with thanatophoric dysplasia (TD) type I: The first report describing an important association between cytogenetic findings and TD

Summary Background: Thanatophoric dysplasia (TD) is the most lethal and most severe type of dysplasia. It has distinct features, the most important of which is short tubular bones and short ribs with platyspondyly, allowing a precise radiologic and prenatal ultrasonographic diagnosis. It has been reported to be caused by mutations in the FGFR3 gene, but exactly how cytogenetic abnormalities might lead to TD is unclear. Case Report: We report a case of TD with different prenatal sonographic features compatible with the classification of type I. In the result of cytogenetic examination, we found de novo CAs in 28% of cells analyzed from the affected infant; 75% of the abnormalities were numerical, and of those, 25% were structural aberrations; 21% of cells revealed predominantly numerical aberrations. Monosomy 18, 21 and 22 was observed in 4% of cells, monosomy 20 in 2%, and monosomy 7, 8, 14, 17 and 19 in 1%. Structural changes were observed in 7% of cells. Conclusions: It appears that these chromosomes may be preferentially involved in and important for TD development.

Varicella pseudo‐koebner phenomenon associated with vascular access opening

ultraviolet radiation were suggested as possible explanations. Of those recorded cases, seven were localized to the head and neck (H&N) region, four of which involved the ear or surrounding structures. HPV-associated cyst (HPAC) with subsequent malignant change has been reported on only one previous occasion, which involved the perineum. HPV-associated malignancy of the H&N is well recognized, but the literature contains no reports of HPV-associated malignant change of an epidermoid cyst affecting this area. Previous attempts to isolate HPAC in cases of SCC within epidermoid cysts of the H&N have been unsuccessful. Histological features such as papillomatosis and hypergranulosis were identified in our case involving the conchal bowl. HPV is known to infect keratinocytes and follicular epithelium, and to cause a cutaneous cyst known as a verrucous cyst. HPV is known to possess malignant transforming properties in the setting of epidermodysplasia verruciformis. Possible malignant change of an epidermoid cyst should be considered in all cystic lesions with atypical clinical appearance, behaviour or histopathology. Clinical suspicion is essential to allow early diagnosis, imaging and comprehensive surgical excision.

A retrospective evaluation of 44 patients followed-up with a diagnosis of deep neck infection

Aim: he purpose of this study was to evaluate the demographic data and clinical features of patients diagnosed with deep neck infection over a one-year period and hospitalized for treatment in a tertiary training and research hospital. Material and methods: Files for cases treated and followed-up for deep neck infection in ourpediatric department during 2017 were evaluated retrospectively. Age, sex, month of presentation, presentation symptoms, physical examination findings, laboratory results, radiological imaging, consultations requested from other departments, treatments administered, number of days of hospitalization, and complications developing were assessed from these case files. Results: Twenty-eight (63.6%)of the 44 patients hospitalized for treatment for deep neck infection in the pediatricdepartment were boys, and 16 (36.4%) were girls. Patients’ mean age was 57.45 ± 44.35 (5-191) months. Mean duration of hospitalization and treatment was 8.2 ± 2.8 (4-14) days. The most common presentation symptom was swelling in the neck (65.9%), and the most common physical examination finding was cervical lymphadenopathy (81.8%). Tooth decay was present in 27.3% of patients. Consultations were most commonly requested with the ear, nose and throat department, while consultations were requested with the external diseases department for five patients (11.3%). Conclusion: The prevalence of deep neck infection has increased in recent years.Further studies are needed on the subject of deep neck infection, which may involve life-threatening complications. Physicians should pay closeattention to the relation between tooth decay and deep neck infection in all patients followed-up with a diagnosis of such infection.