Mahmut Abuhandan

Childhood brucellosis is still a severe problem in the eastern region of Turkey.

Of the 103 patients, 52 (50.4%) were girls, 51 (49.6%) were boys, and ages ranged from 20 months to 16 years (8.31± 3.58 years). The mean period between onset of symptoms and admission to hospital ranged from 2 days to 3 years (68.0± 192.8 days). A positive family history for brucellosis was noted in 14 (13.5%) patients. The most frequently observed symptoms and signs are summarized in Table 1. The most commonly observed symptoms and signs were fever, arthralgia, malaise, hepatosplenomegaly, hepatomegaly and arthritis. Neurobrucellosis was diagnosed in one (0.9%) patient. Anaemia was observed in 18 (17.4%) patients; leukocytosis in 15 (14.5%); and leukopenia in eight (7.7%) patients. Erythrocyte sedimentation rate was studied in 84 (81.5%) patients; it was found to be high in 61.9%. Brucella agglutination test was 1/160 or higher in all patients; it was 1/160 in 17 (16.5%) patients, 1/320 in 28 (27.0%) patients, 1/640 in 41 (39.8%) patients, and 1/1280 in 17 (16.5%) patients. Brucella was cultured in only three patients. It was isolated from both blood and bone marrow in two patients and from blood in one patient and also from cerebrospinal fluid in one of two patients who had positive blood and bone marrow cultures for Brucella.

Hyponatremic dehydration: an analysis of 78 cases.

Our purpose was to determine thefrequency of convulsion in children withhyponatremic dehydration (HD). We alsoinvestigated whether or not there was arelationship between the severity ofhyponatremia and the degrees of malnutrition inour region (Eastern Anatolia of Turkey) inwhere malnutrition is frequently observed.In this study, the clinical and laboratoryfindings of 78 patients with diarrhoea (acute,persistent or chronic diarrhoea) and HD werestudied. When diarrhoea lasts longer than 2 and4 weeks they were accepted as persistent andchronic diarrhoea, respectively. Patients weresaid to have HD if they had the clinicalfindings of dehydration associated withhyponatremia [Serum sodium (SNa)<130 mmol/L)]. Nutritional status of thechildren was assessed by the Gomezclassification using weight for age; it wasaccepted as normal those were between90%–110%, mild malnutrition 75%–89%,moderate malnutrition 60%–74% and severemalnutrition <60%. Of 78 patients, 40 wereboys, 38 were girls. The age and weight of thepatients ranged from 40 days to 36 months(8.94 ± 5.49 months) and from 2000 to 10300 g(5535.25 ± 1702.10 g) respectively. Allpatients except four had malnutrition; 15(20.3%) had mild malnutrition, 30 (40.5%) hadmoderate malnutrition and 29 (39.2%) hadsevere malnutrition. Forty-seven patients hadacute, 16 patients had persistent, and 15patients had chronic diarrhoea. SNa levels werebetween 104 and 129 mmol/L(121.21 ± 6.12 mmol/L). There was notstatistically a significant difference betweenSNa level and the degree of malnutrition, andSNa level and the types (acute, persistent orchronic) of diarrhoea (p > 0.05). Of 78patients, 12 (15.3%) patients had convulsion,of whom eight had convulsion associated withfever. Convulsion was noted in nine (19.1%)and three (18.7%) patients with acute andpersistent diarrhoea, respectively (p > 0.05).Also, we observed that when hyponatremia wasseverer, convulsions tended to be more occuring(p < 0.05). Five (6.4%) children died and allof them had severe malnutrition and septicemia.We determined that the frequency of convulsionin HD was 15.3% (12/78), and there was not adifference between the cases of acute,persistent and chronic diarrhoea for thefrequency of convulsion. We also found asignificant difference was not present betweenSNa level and the degree of malnutrition, andbetween SNa level and the types (acute,persistent or chronic) diarrhoea. However, weobserved that when hyponatremia was severer,convulsions tended to be more occuring.

Antibiotic sensitivity and resistance in children with urinary tract infection in Sanliurfa

OBJECTIVE This study aimed to evaluate antibiotic resistance in the province of Şanliurfa and to observe any difference between antibiotic resistance rates. MATERIAL AND METHODS The study comprised 107 children who presented at the pediatric polyclinic with complaints of urinary tract infection with the diagnosis of urinary tract infection and whose urine cultures exhibited bacterial growth. The patients were analyzed with respect to the frequency of proliferating pathogens, sensitivity to the antibiotics used and the rates of developed resistance to the antibiotics. RESULTS A total of 107 patients aged between 1 year and 15 years were included in the study, encompassing 14 (13.1%) males and 93 (86.9%) females. According to the urine culture results, proliferation of Escherichia coli (E. coli) was observed in 69 (64.5%), Klebsiella spp. in 13 (12.1%), Proteus mirabilis in 9 (8.4%), Staphylococcus aureus in 5 (4.7%), Pseudomonas aeruginosa in 5 (4.7%), Acinetobacter spp. in 3 (2.8%) and Enterococcus spp. in 3 (2.8%) patients. For proliferating E. coli, high resistance rates to ceftriaxone (39.5%), nitrofurantoin (19.7%), ampicillin-sulbactam (64.1%), co-trimoxazole (41.5%), amoxicillinclavulanate (51.7%) and cefuroxime (38.1%) were observed. All of isolated microorganisms were resistant to ampicillin-sulbactam, amoxicillin-clavulanate, co-trimoxazole, ceftriaxone, cefuroxime and cefoxitin in decreasing frequencies. The most effective antimicrobial agents were determined to be imipenem, sulpera-zone, quinolone and aminoglycosides. CONCLUSION In our region, parenteral antibiotics that should be selected for the empirical treatment of UTIs in all age groups are the aminoglycosides and 3(rd) generation cephalosporines. In contrast to other studies, these results suggest that co-trimoxazole should be used for children aged 0-1, and 2(nd) generation cephalosporins should be used for the oral treatment of children aged 1-5 due to the low rate of resistance to nitrofurantoin in patients aged over 5 years.

Doppler Echocardiographic Evaluation of Pulmonary Artery Pressure in Children with Acute Pneumonia

In this prospective study 37 children (ranging 2 months-15 years) with acute pneumonia were evaluated by Doppler echocardiography for the presence of pulmonary hypertension (PH). The goal of this study was to determine the frequency of PH in children with acute pneumonia because the diagnosis of PH influenced the treatment of pneumonia in these patients. The patients who had more than 35 mmHg of systolic pulmonary arterial pressure were considered to have PH. In our study PH was found in 15 (40.5%) of 37 patients. We did not find any significant difference for the parameters including the age, weight, height, clinical symptoms and signs (fever, cough, dyspnea, tachycardia and tachypnea etc.), and laboratory findings such as hemoglobin, PCO2, HCO3 and PO2 between the patients with and without PH (p>0.05). However, there was a significant difference in cyanosis, cardiac failure, blood pH level and O2 saturation measured by pulse oximetry between the patients with and without PH (p<0.05).

Asymptomatic bacteriuria in infants in eastern Turkey.

In this study, the prevalence of asymptomatic bacteriuria (ABU) was investigated in the 146 infants without symptoms suggesting urinary tract infection, age ranged from 29 days to 15 months (mean 4.56 +/- 3.30 months). Our purpose was to determine the prevalence ofABU in infants living in Eastern Turkey and to define the relationship between pyuria and ABU in infants. Of 146 infants, 77 (52.7%) were males, and 69 (47.3%) were females. Although we would like to select randomized healthy infants for the study, 47 (32.1%) infants had a mild to severe malnutrition. While various microorganisms were cultured in 41 (28%) infants in the first urinary culture, only 18 (12.3%) infants had a positive culture in the second urinary culture. The prevalence of ABU was 12.3%. Although ABU prevalence was higher in the infants with malnutrition than those without malnutrition (14.8% 1 vs. 11.1%), there was not a difference between the groups (p>0.05). There was a positive relation between urinary culture positiveness and pyuria (p < 0.001). The prevalence of ABU was much higher (12.3%) than the literature data, which was probably related to very low socioeconomic status of our region where malnutrition and its related disorders are commonly seen. The high ratio might also be related to the method of urine collection, because we used sterile collecting bag, but not suprapubic aspiration method.

An Evaluation of Oxidative Status in Serum and Breast Milk of Mothers Giving Birth Prematurely and at Full-Term

Background: Burning fat and carbohydrates to provide energy in biological systems causes the formation of free oxygen species. Objectives: This study aimed to evaluate the oxidative status of serum and breast milk of mothers giving birth prematurely and at full-term. Materials and Methods: The study comprised 50 mothers who gave birth at full-term at more than 38 weeks and 43 mothers who gave birth pre-term at below 32 weeks. On the postnatal 5th day, samples of the mother’s milk and serum were taken and stored at -80°C until the study day. On the study day, the total oxidant and total antioxidant levels were measured using the Erel method and the oxidative stress index (OSI) was calculated. Results: While the total oxidant level and total antioxidant level values of the milk of the premature birth mothers were found to be significantly high compared to those of the full-term birth mothers (P = 0.001), no statistically significant difference was found in the oxidative stress index values (P > 0.05). No statistically significant difference was found in the total oxidant level and oxidative stress index values of the serum of the premature birth mothers compared to those of the full-term birth mothers, while the total antioxidant level was found to be significantly low (P = 0.04). Conclusions: The oxidants and antioxidants in the milk of mothers giving birth prematurely were found to be significantly higher than those of full-term birth mothers. This can be evaluated as the milk of the premature birth mothers providing increased antioxidant defense to protect the infant.

Ampisilin-Sulbaktam Kullanımı Sonrası Akut Gastroenterit Gelişen Hastalarda Probiyotik ve Sinbiyotiklerin Kullanımı

Aim: This study aimed to evaluate of the effectiveness of probiotic and synbiotic in patients with acute gastroenteritis developing after ampicillin-sulbactam use. Material & Method: Eighty patients who developing gastroenteritis after antibiotics use were studied. We were followed by giving synbiotic to 27 and probiotics to 27 placebos to 26 of these patients. Results: We were observed that early in the first 24 hours and longest 96 hours the remission of clinical symptoms for all groups who get to study. While clinical improvement and earlier remission of the synbiotic group compared with both the probiotic group and the placebo group were found to be significantly lower (p = 0.04), however, between the probiotic and the placebo-treated groups was not statistically significant (p> 0.05). Conclusions: We observed that it is more appropriate to use synbiotic containing preparations to prevent and providing early clinical remission of diarrhea-associated antibiotic