Kazım Küçüktaşçı

Serum Vitamin B12 and Folate Concentrations and the Effect of the Mediterranean Diet on Vulnerable Populations

Low vitamin B12 and folate levels in expectant mothers may lead to low stores in babies. The aim of this study was to determine the frequencies of vitamin B12 and folate deficiencies in pregnant women and neonates, and to assess the effect of maternal vitamin status on babies’ vitamin levels in the Aegean region of Turkey, where the Mediterranean diet (mainly fresh fruits and vegetables) is adopted. We studied 72 pregnant women and their singleton-term babies. Venous blood samples of expectant mothers were collected 1 h before delivery and cord blood of babies were obtained at birth. The mean vitamin B12 in maternal and cord blood serum was 163.1 ± 72.0 pg/mL and 146.2 ± 102.5 pg/mL, and the mean folate, 9.8 ± 4.8 ng/mL and 15.8 ± 3.8 ng/mL, respectively. There were statistically significant correlation between maternal and cord blood serum vitamin B12 (r = 0.61, P = .04) and folate levels (r = 0.65, P < .001). 70.8% of the mothers and 83.9% of the babies were vitamin B12 deficient (<200 pg/mL). Neither group showed folate deficiency. The mean level of vitamin B12 in mothers significantly varied by the type of diet (241.6 (72.1) pg/mL versus 155.9 (68.2) pg/mL; P = .012). Vitamin B12 deficiency in pregnant women and neonates may be a public health problem in our community. The Mediterranean diet in these vulnerable groups may be an aggravating factor for vitamin B12 deficiency. Prenatal screening of all expectant mothers, prenatal supplementation of vitamin B12, and an increase in animal-source food intake may improve expectant mothers vitamin B12 level.

Dandy-Walker's Variant and Tetralogy of Fallot with Atrial Septal Defect and Patent Ductus Arteriosus and Primary Hypothyroidy - A New Association

An 11-month-old girl who has Dandy-Walker’s variant (DWV) associated with tetralogy of Fallot (TOF), atrial septal defect (ASD), patent ductus arteriosus (PDA), and primary hypothyroidy is presented. There has been no report describing a case of DWV associated with TOF, ASD and PDA and primary hypothyroidy. The first case of Dandy-Walker malformation associated with TOF was reported by Kohyama et al in 1988, since then, a few cases were reported in the literature. Our patient is the first reported case.

Fatal Pulmonary Embolism Due to Inherited Thrombophilia Factors in a Child With Wolfram Syndrome.

Wolfram syndrome-1 is a rare and severe autosomal recessive neurodegenerative disease characterized by diabetes mellitus (DM), optic atrophy, diabetes insipidus, and deafness. Poorly controlled type 1 DM increases the risk for thrombosis. However, coexistence of DM and hereditary thrombosis factors is rarely observed. Here we present the case of a 13.5-year-old, nonfollowed girl newly diagnosed with poorly controlled Wolfram syndrome on the basis of the results of clinical and laboratory examinations. On the eighth day after diabetic ketoacidosis treatment, pulmonary embolism developed in the subject. Thrombus identified in the right atrium using echocardiography was treated by emergency thrombectomy. Homozygous mutation in the methylenetetrahydrofolate reductase gene C677T, heterozygous factor-V Leiden mutation, and active protein C resistance were identified in the patient. The patient was lost because of a recurring episode of pulmonary embolism on the 86th day of hospitalization. We present this case to highlight the need for investigating hereditary thrombosis risk factors in diabetic patients in whom thromboembolism develops.

Patent duktus arteriyozuslu erken doğan bir bebekte parasetamol tedavisi

Sayin Editor Patent duktus arteriyozus PDA ozellikle asiri dusuk dogum agirlikli erken dogan yenidoganlarda sik gorulen bir sorundur Patent duktus arteriyozus kapatilmasinda tibbi tedavi olarak indometazin ve ibuprofen kullanilmaktadir Bununla birlikte bu ilaclar bazi yan etkilere neden olabilmektedir Cerrahi kapatma tibbi tedavinin uygulanmasina bir engel oldugu veya basarisiz oldugu yenidoganlarda uygulanmaktadir Ancak cerrahi kapatma sirasinda veya daha sonra bazi komplikasyonlar gorulebilmektedir 1 2 Bu yazida agizdan uc kez ibuprofen verilmesine ragmen PDA rsquo;si kapanmayan ve cerrahi kapatma oncesi parasetamol tedavisi ile hemodinamik olarak duktusu belirgin kuculen ve cerrahi islemden kurtulan bir erken dogmus erkek bebek olgusu sunuldu Yirmi alti yasindaki annenin ilk gebeliginden erken dogum ve oligohidramniyos nedeniyle bir kez betametazon uygulandiktan 48 saat sonra hastanemizde 24 hafta bes gunluk olarak sezaryen ile 820 g dogan erkek olgunun birinci ve besinci dakika Apgar skoru sirasiyla 5 ve 7 idi Entube halde mekanik ventilatorde izlenen olgunun dogum sonrasi altinci saatinde bakilan hemograminda beyaz kure 74 600 micro;L hemoglobin 15 2 g dL trombosit 417 000 micro;L periferik yaymada 44 polimorfonukleer lokosit 18 lenfosit 12 bant olgunlasmamis olgun hucre orani 0 27 10 monosit 16 promiyelosit toksik granulasyon 30 normoblast saptanirken blastik hucre yoktu Lokomoid reaksiyon toksik granulasyon olgunlasmamis olgun hucre orani polimorfonukleer lokosit orani 0 27 saptanan olguda erken yenidogan sepsis dusunulerek duzenli kulturleri alinip ampisilin ve netilmisin damardan uygun dozda baslandi Radyolojik ve klinik olarak sikintili solunum sendromu dusunulmedi Kan biyokimyasal degiskenleri normal degerlendirilen olgunun izleminde kulturlerde ureme olmamasi ve enfeksiyon belirteclerinin negatif saptanmasi nedeniyle antibiyoterapi kesildi Dogum sonrasi dorduncu gunde ufurumu olmayan ancak femoral arter nabizlari sicrayici ve FiO2 gt; 40 seyreden hastada yapilan ekokardiyografi rsquo;de EKO kucuk sekundum atriyal septal defekt saptanirken duktus kapaliydi ve izlem onerildi Dogum sonrasi sekizinci gunde tum odaklarda 1 6 sistolik ufurum duyulan olgunun tekrarlanan EKO rsquo;sunda PDA 2 mm sol atriyum LA aort anulusu Ao orani 1 5 saptandi ve agizdan ibuprofen tedavisi baslandi Tedavinin ikinci gununde trombositopeni 28 000 micro;L gelismesi nedeniyle ibuprofen verilemedi Dogum sonrasi 11 gunde ufurumu devam eden trombosit 119 000 micro;L kreatinin 0 8 mg dL olan hastaya agizdan 10 5 5 mg kg gun dozda 24 saatlik araliklarla ilk ibuprofen tedavisi uygulandi Birinci tedaviden sonra yapilan EKO rsquo;da duktus capi 2 mm LA Ao orani 1 4 saptanan ve hemodinamik acidan anlamli olan olguya ayni dozda iki tedavi daha agizdan ibuprofen verildi Buna ragmen hemodinamik olarak anlamli PDA rsquo;si devam eden hastaya aileden yazili onam alinarak cerrahi girisimden once dogum sonrasi 20 gununde agizdan parasetamol tedavisi 15 mg kg doz alti sa araliklarla 72 sa verildi Parasetamol tedavisinden once ve sonra hemogram periferik yayma ve karaciger islev testleri normaldi Tedaviden sonra yapilan EKO rsquo;da duktus capinin 1 mm rsquo;ye LA Ao oraninin 1 1 rsquo;e geriledigi goruldu ve izlem onerildi Dogum sonrasi 47 gununde ufurum saptanmayan olguda 75 gunde duktus tamamiyle kapandi Tablo 1 Kafa ici kanamasi olmayan olgunun izleminde agir bronko pulmoner displazi ve evre 1 premature retinopatisi gelisti Olgu dogum sonrasi 108 gunde oksijensiz olarak oksijen doygunlugu gt; 90 taburcu edilip yenidogan poliklinik izlemine alindi Hemodinamik acidan anlamli EKO bulgusu LA Ao gt;1 4 duktus capi gt;1 4 mm saptanan bulgu veren PDA hastalarina tibbi tedavi baslanmaktadir 1 Indometazin gecici veya kalici bobrek islev bozuklugu nekrotizan enterokolit beyin oksijenlenmesinde azalma gibi komplikasyonlara yol acabildigi icin arastirmacilar daha guvenilir bir farmakolojik ajana yonelmislerdir 3 4 Diger bir siklooksijenaz inhibitoru olan ibuprofenin daha az beyin bobrek ve mezenterik yan etkilerinin oldugu; beyin kan akiminin otoregulasyonunu arttirdigi; hayvan deneylerinde oksidatif stresi takiben norolojik islevleri korudugu gosterilmistir 5 7 Ulkemizden yapilan bir calismada PDA rsquo;nin kapatilmasinda agizdan ibuprofen tedavisinin damardan indometazin tedavisi kadar hatta daha etkili oldugu bildirilmistir 8 Patent duktus arteriyozus kapatilmasinda tibbi tedavinin kontrendike oldugu veya tedavinin basarisiz oldugu durumlarda cerrahi yolla kapatma uygulanmaktadir Cerrahi kapatmaya bagli yineleyen laringeal sinir hasari silotoraks pnomotoraks sol ventrikul islev bozuklugu ve skolyoz gibi komplikasyonlar gorulebilmektedir 1 Tibbi ve cerrahi kapatma tedavilerinin olasi komplikasyonlari nedeniyle arastirmacilar PDA tedavisinde yeni arayislara yonelmislerdir Bu maksatla PDA tedavisinde yeni bir ajan olan parasetamol kullanilmaya baslanmistir 9 10 Parasetamol prostaglandin sentetazin peroksidaz bilesenini engelleyerek etkili olur Ilk kez Hammerman ve ark 9 iki kez ibuprofen ile PDA rsquo;si kapanmayan veya ibuprofenin verilmesine engel oldugu bes olguya alti saat araliklarla 15 mg kg doz rsquo;dan verilen agizdan parasetamol tedavisiyle ilk uc gunde olgularin tamaminda duktusun kapandigini veya kuculdugunu hicbir yan etkinin gorulmedigini bildirmislerdir Ikinci calisma ulkemizden yapilmis olup ayni gerekcelerle sekiz olguya uygulanan parasetamol tedavisiyle 87 5 oraninda basari saglandigi belirtilmistir 10 Biz de bu iki calismadan yola cikarak uc kez agizdan ibuprofen tedavisiyle PDA rsquo;si kapanmayan olgumuza cerrahi girisimden once parasetamol tedavisini ayni dozda 72 saat sureyle uyguladik Tedaviden sonra yapilan EKO rsquo;da duktusun hemodinamik olarak belirgin geriledigi ve kuculdugu goruldu Tedavi sirasinda herhangi bir yan etki saptanmadi Izlemde EKO kontrollerinde duktus acikligi kuculen ve hemodinamik acidan anlamli olmayan olguda duktusun dogum sonrasi 75 gunde tam olarak kapandigi saptandi Bu olgu sunumuyla tekrarlayan ibuprofen teavilerine ragmen PDA rsquo;si kapanmayan cok dusuk dogum agirlikli erken dogan yenidogan olgularina cerrahi girisimden once parasetamol tedavi sansinin verilmesi gerektigini dusunmekteyiz Yazisma Adresi Address for Correspondence: Dr Kazim Kucuktasci Pamukkale Universitesi Tip Fakultesi Cocuk Sagligi ve Hastaliklari Neonatoloji Bilim Dali Denizli Turkiye E posta: drkkucuktasci@gmail com Gelis Tarihi Received: 07 08 2012 Ka shy;bul Ta shy;ri shy;hi Ac shy;cep shy;ted: 17 09 2012 Kaynaklar 1 Hamrick SE Hansmann G Patent ductus arteriosus of the preterm infant Pediatrics 2010; 125 5 : 1020 30 2 Chiruvolu A Jaleel MA Therapeutic management of patent ductus arteriosus Early Hum Dev 2009; 85 3 : 151 5 3 Betkerur MV Yeh TF Miller K Glasser RJ Pildes RS Indomethacin and its effect on renal function and urinary kallikrein excretion in premature infants with patent ductus arteriosus Pediatrics 1981; 68 1 : 99 102 4 Edwards AD Wyatt JS Richardson C et al Effects of indomethacin on cerebral haemodynamics in very preterm infants Lancet 1990; 335 8704 : 1491 5 5 Kushnir A Pinheiro JM Comparison of renal effects of ibuprofen versus indomethacin during treatment of patent ductus arteriosus in contiguous historical cohorts BMC Clin Pharmacol 2011; 11: 8 6 Patel J Roberts I Azzopardi D Hamilton P Edwards AD Randomized double blind controlled trial comparing the effects of ibuprofen with indomethacin on cerebral hemodynamics in preterm infants with patent ductus arteriosus Pediatr Res 2000; 47 1 : 36 42 7 Su PH Chen JY Su CM Huang TC Lee HS Comparison of ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants Pediatr Intern 2003; 45 6 : 665 70 8 Teksam O Yigit Ş Karagoz T Korkmaz A Yurdakok M Tekinalp G Yenidogan bebeklerde patent duktus arteriyozusun tedavisinde oral ibuprofen ve intravenoz indometazin: bir retrospektif calisma Cocuk Sagligi ve Hastaliklari Dergisi 2004; 47: 96 102 9 Hammerman C Bin Nun A Markovitch E Schimmel MS Kaplan M Fink D Ductal closure with paracetamol: a surprising new approach to patent ductus arteriosus treatment Pediatrics 2011; 128 6 : e1618 21 10 Oncel MY Yurttutan S Degirmencioglu H et al Intravenous paracetamol treatment in the management of patent ductus arteriosus in extremely low birth weight infants Neonatology 2012; 103 3 : 165 8

Evaluation of visceral leishmaniasis diagnosis using indirect fluorescent antibody tests in 4 pediatric patients

Visceral Leishmaniasis (VL) in infancy is mostly seen between the ages of 2-4,and visceral infection causes long standing fever, weakness, weight loss, hepatosplenomegaly and pancytopenia. Leishmania infantum is responsible for VL in Turkey. In this study, 4 pediatric cases of VL were analysed retrospectively. Bone marrow aspirate was obtained in two cases and Leishmania amastigotes were not obtained in these cases. Leishmania antibodies by the indirect immun fluorescent antibody test (IFAT) were positive in all cases. We consider that IFAT was a suitable alternative to parasite detection in the conclusive diagnosis of visceral leishmaniasis in pediatric patients when strong clinical suspicion is present.