Mehmet Selçuk Bektaş

The frequency of Hashimoto thyroiditis in children and the relationship between urinary iodine level and Hashimoto thyroiditis.

Abstract The aim of this study was to determine the frequency of thyroid autoimmunity in second grade primary school students and to examine the relationship between iodine and Hashimoto thyroiditis (HT). This was a cohort study performed with 1000 students. Urinary iodine levels, antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies were determined in all children. Children with anti-TPO or anti-Tg antibody positivity or with goiter were summoned for detailed examinations. In total, 36 cases (3.6%) were diagnosed as HT. The goiter frequency was found in 17.5% of the whole cohort. Additionally, iodine deficiency was found in 64.2% of all children. The median urinary iodine excretion was determined as 132 μg/L (range 382 μg/L) in the HT group, whereas it was 73 μg/L (range 390 μg/L) in children with goiter but without HT and 81 μg/L (range 394 μg/L) in normal children. The urinary iodine level of HT cases was significantly higher than the other two groups (p<0.001). HT was also determined in 2% of patients with low urinary iodine levels, in 6.2% of patients with normal urinary iodine levels, and in 7.5% of patients with high urinary iodine levels. Our data demonstrates the close relationship between excessive iodine levels and autoimmunity.

New Coagulant Agent (Ankaferd Blood Stopper) for Open Hemorrhages in Hemophilia With Inhibitor

The treatment of hemophilia A patients with inhibitor could be very expensive. Ankaferd blood stopper (ABS) is a unique folkloric medicinal plant extract, which has historically been used in Turkish traditional medicine as a hemostatic agent. In this article, a 16-year-old boy was presented with uncontrolled bleeding, despite the treatment of factor VIII, rVIIa, factor VIII inhibitor bypass activity (FEIBA), cyclophosphamide, and prednisolone at circumcision site that resolved with ABS in minutes. Our patient with hemophilia A and inhibitor is the first clinical pediatric case.

Evaluation of children with nutritional rickets

Abstract Aim: To evaluate the clinical fi ndings, risk factors, therapy and outcome in 946 children with nutritional rickets. Patients and methods: This retrospective study included a review of medical records of patients with nutritional rickets between March 2004 and 2009. Patients who displayed both the biochemical inclusion criteria and the clinical signs/symptoms or radiological signs of rickets were included in the study. Results: The present study included 946 patients aged between 4 months and 15 years. Distribution of the cases showed a density between December and May. The age at diagnosis, showed two peaks and most of the patients were in the age range 0–23 months and 12.0–15 years. In infants and young children, most of the patients had been admitted to the hospital due to infectious diseases. In older children, short stature and obesity were the most common complaints. Conclusion: Children aged between 0–23 months and 12.0–15 years were under most risk for nutritional rickets, especially in winter and spring and vitamin D should be given to them as supplementation dose.

Cerebral Venous Sinus Thrombosis in 2 Children With Celiac Disease

Cerebral venous sinus thrombosis (CVST) is an uncommon disease in childhood. In the largest study carried out so far, the incidence was 0.67 case per 100 000 children per year. A number of etiologies and risk factors have been so far identified for CVST in childhood, including head trauma, local and systemic infectious diseases, malignancies, and autoimmune diseases. Celiac disease (CD) is a disease of the small intestine caused by an immune response to ingested gluten. Epilepsy, bilateral occipital calcification, cerebellar ataxia, degenerative central nervous system disease, peripheric neuropathy, myopathy, and rarely stroke were defined as neurologic disorders. In this presentation, we report 2 cases (16-year-old boy and 2-year-old boy) with CD and CVST. We emphasized that CD can be investigated in patients with CVST even with the absence of gastrointestinal symptoms. Finally, we suggest that algorithm of CVST can be involved in the investigation of CD.

Retrospective clinical and laboratory evaluation of children with brucellosis

Background:  Acute brucellosis is a zoonotic disease seen in childhood, with non‐specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented.

A case of immune thrombocytopenic purpura presenting with intracranial hemorrhage

Abstract Immune thrombocytopenic purpura is an acute, generally considered a self-limiting benign disorder with a 60%-80% change of spontaneous recovery occurring usually within a few months after onset. Intracranial hemorrhage is a rare but life-threatening complication of childhood immune thrombocytopenic purpura. We report a 4-year-old girl who admitted with headache, vomiting, bleeding from noise and bruises on the extremities. Her neurological examination was normal. Based on laboratory finding she was diagnosed immune thrombocytopenic purpura and intracranial hemorrhage. We suggest that cranial imaging should be perform in patients with immune thrombocytopenic purpura admitted with bleeding symptoms, vomiting and headache even if they had no abnormal neurological signs.

The prevalence of factor V 1691G-A mutation in Van region of Turkey

The prevalence of hereditary thrombotic risk factors shows marked ethnic and geographic variations. Hereditary disorders predisposing for thrombosis are not only antithrombin, protein C and protein S deficiencies, but also hereditary defects such as factor V 1691 G-A (Leiden) (FVL) and prothrombin 20210 G-A mutations [1,2]. FVL causes activated protein C resistance and is the most common thrombophilic mutation worldwide [3]. Guanine to adenine change leads to a replacement of glutamine with arginine at amino acid position 506. It is most prevalent among Caucasians but not found in the Japanese and Africans [1-3]. FVL frequency in the Turkish population has been reported from different parts of Turkey. Overall frequency was reported to be 8% [4]. FVL is believed to have originated somewhere close to Anatolia approximately 20,000 years ago, and the existence of mutation in this geography is expected to be high [5]. Urartu, one of the ancient civilizations in Anatolia, was an Iron Age kingdom, centered on Van Lake in Eastern Turkey. In the study of Dogan Alakoc et al. [5], 60 teeth from the excavations of Van Yoncatepe fortress were subjected to DNA analysis. Of the total 60 samples, one male sample demonstrated a positive amplification result for FV gene and was found to be heterozygous for FVL. As there is no report on the prevalence of FVL in the population in the Van region of Turkey, we aimed to determine the prevalence in that province. A total of 100 healthy children were studied. The mean age of the 100 subjects was 9.08±5.94 years, and 49 (49%) were males and 51 (51%) females. A written consent was obtained from their parents. The frequency of FVL was determined as 9%. FVL frequency is about 3% to 10% in Europeans, but the FVL mutation is rare in East and/or Southeast Asian populations; however, it has been determined at high frequencies in Azerbaijan and Kyrgyzstan populations [6-9]. Wide variations in the frequency of FVL have been reported in different surveys carried out in many countries, depending on the geographical location and the ethnic background of the population. In Caucasian populations, the carrier frequency of FVL was reported to be 2–15% [4]. The highest prevalence rates were obtained in Mediterranean countries [3-7]. The rates from different regions of Turkey and our results showed similar frequencies. The high prevalence of the mutation in the Middle East leads to the possibility that the founders …

Mycoplasma pneumoniae meningoencephalitis: a case report

Abstract Nervous system is the most affected area in mycoplasma pneumoniae infections with exception of respiratory system. It is an important agent of childhood acute encephalitis and respiratory system infections in school-age children and young adults. Routine clinical and laboratory findings to identify spesific diagnosis is limited. Twelve-year-old female patient was admitted with fever, fatigue, sore throat, slipping the right eye, withdrawal of the mouth from the right and right hemiclonic seizures. Test of anti-Mycoplasma pneumoniae (M. pneumoniae) IgM was positive and IgG antibodies were found to be 4-fold increase in the sera of follow-up. This article was presented with the aim of remembering M. pneumoniae to be an differential diagnosis in children with acute encephalitis.

Infantile digital fibromatosis (inclusion body fibromatosis) observed in a baby without finger involvement

A 9-day-old male baby was hospitalized after his birth due to some swells under the skin. The hard consistency nodules observed under the skin all over the body of the patient were of different size, and presented lesions, among which the biggest was 1 × 1 cm. No lesions were observed on the fingers. By superficial ultrasonography, multiple isoechoic hypoechoic lesions were observed among the muscle plan. In thoracolumbar magnetic resonance imaging, multiple massif lesions retaining peripheral contrast (the biggest was 1.7 × 1.4 cm large) had been observed under the skin muscle plans, between the muscles of the extremities. The biopsy was positive for smooth muscle actin, but negative for desmin, S100, and CD34. These findings were diagnosed as infantile digital fibromatosis (IDF) (inclusion body fibromatosis). The case was presented with an objective to illustrate and remind that IDF can be observed in babies without finger involvement.