Meltem Ugras

Varicella gastritis in an immunocompetent child

The varicella zoster virus (VZV) is a very rare cause of gastritis. Gastritis caused by VZV can be presented as abdominal pain, vomiting. Most of the cases reported with varicella gastritis in the literature are immunocompromised patients with various kinds of malignancy, and most of these patients are adults. Here we report an adolescent girl with acute abdominal pain. The girl was immunocompetent. Her endoscopically taken biopsy material revealed varicella, and her gastritis was healed with acyclovir therapy. This is a very rare condition and not frequently reported in the literature. The authors want to drive attention to the fact that varicella gastritis can be seen in immunocompetent children, the presentation can be nausea, vomiting and/or (severe) abdominal pain. Serological studies may be less helpful than tissue studies, so interventional procedures should be done.

Comparison of FISH, RFLP and agar dilution methods for testing clarithromycin resistance of Helicobacter pylori

BACKGROUND/AIMS Clarithromycin resistance is an important factor of Helicobacter pylori (H. pylori) eradication failure in adults and children. There are some tests to determine resistance such as restriction fragment length polimorphism (RFLP), fluorescence in situ hibridisation (FISH), PCR and (culture) agar dilution. Clarithromycin resistance is reported between 16.8%-48.2% in Turkey using PCR, 18% in Japan using RFLP. The aim of the study is to compare the efficacy of FISH, RFLP and culture. MATERIALS AND METHODS Patients with gastric complaint underwent endoscopic examination. H. pylori status of all patients was tested with urea breath test. Gastric biopsy samples obtained from adult patients and children were studied. Each tissue was analised with FISH, PCR-RFLP anda gar dilution. RESULTS A total 100 patients were positive by UBT and histology for H. pylori. Tissues from 89 adults and 11 children were evaluated. According to FISH and RFLP clarithromycin resistance was 26% and 16% respectively. Among 100 patients H. pylori was cultured in 52 tissue samples, among these samples 7 were resistant to clarithromycin. There was strong correlation between the results of FISH and RFLP; RFLP and culture; and FISH and culture. CONCLUSION There is a high ratio of clarithromycin resistance in the studied population. All 3 tests are valuable, but FISH seems to be more sensitive among these tests. We suggest FISH should be used for detecting clarithromycin resistance among H. pylori infected patients before eradication therapy.

Comparison of the therapeutic effects of sildenafil citrate, heparin and neuropeptides in a rat model of acetic acid-induced gastric ulcer

Aims: The purpose of our investigative work has been to determine whether there can be therapeutic roles in the administration of sildenafil citrate, heparin and several neuropeptides on an animal model where gastric ulcers were induced with acetic acid, and to compare their efficacy. Materials and methods: The animals were divided into 13 groups, with 4 animals in each. Gastric ulcers was induced in the animals of 12 groups with one untreated group being left as the control (Group I ‐ control; given normal saline (NS)). The other groups were: Group II (ulcer + NS); Group III (5 mg/kg sildenafil citrate, low dose); Group IV (10 mg/kg sildenafil citrate, high dose); Group V (0.6 mg/kg heparin, low dose); Group VI (6 mg/kg heparin, high dose); Group VII (20 nmol/kg des‐acyl ghrelin); Group VIII (40 nmol/kg des‐acyl ghrelin); Group IX (4 nmol/kg acyl ghrelin); Group X (8 nmol/kg acly ghrelin); Group XI (20 pmol/kg Nesfatin‐1); Group XII (15 nmol/kg Obestatin) and Group XIII (5 nmol/kg Neuropeptide Y). Gastric neuropeptide expression was measured using an immunohistochemical method, and the amount in circulation was detected using ELISA. To compare with no treatment, the controls and other treatment groups, we recorded loss of the surface epithelium of the stomach, erosion, bleeding and inflammatory cell infiltration in the upper halves of the gastric glands. Key findings: The muscularis and the layers beneath it were, however, apparently normal. The gastric mucosa healed with little or no inflammation when sildenafil citrate, low dose heparin, ghrelin, NUCB2/Nesfatin‐1, obestatin, Neuropeptide Y were administered. Significance: Overall the data indicate that low dose heparin, and especially sildenafil citrate and neuropeptides, can be used clinically as an alternative approach in the treatment of the gastric ulcer. HIGHLIGHTSSildenafil citrate is the most promising agent in the treatment of gastric (peptic) ulcer.Neuropeptides can be important among the options for the treatment of gastric ulcers.Although heparin has the potential to treat the gastric ulcer, it is the weakest option.Nesfatin‐1, Obestatin and Neuropeptide Y decrease in the circulation and the gastric tissue when ulcers are present.

Superior mesenteric artery syndrome: A rare but life threatening disease

Superior mesenteric artery syndrome was observed in an adolescent patient. He had a 1-day history of nausea, vomiting, and abdominal pain, without chronic or recurrent symptoms. Diagnosis was established by abdominal plain x-ray, contrast enhanced abdominal computed tomography, and endoscopic examination. The patient was hospitalized, monitorized, and decompressed by nasogastric tube without oral feeding. The symptoms of the patient were gradually relieved by conservative treatment and he was discharged after one week. Clinicians should be careful when facing upper gastrointestinal symptoms that are resistant and non-responsive to treatment, and this syndrome should be kept in mind. This case is presented to draw attention to this disease because of its rare incidence.

New born children with Encephalocele

Background: Encephaloceles result from failure of the surface ectoderm to separate from the neuroectoderm. We aimed to review the data of cases with occipital encephalocele. Case report: Patient records were reviewed retrospectively for encephalocele. The clinical, radiological and surgical data were evaluated. Five female newborns with occipital encephaloceles were included. All but one mother was over-aged; none consumed folic acid regularly during pregnancy. All were within normal ranges for weight and height, only two had microcephaly The size of occipital encephalocele varied between 7cmx6cm and 28cmx20cm. The encephaloceles were resected surgically and ventriculoperitoneal shunt was placed to all cases. One patient died early after surgery due to respiratory problems. Other cases were followedup regularly; all have motor retardation and feeding difficulty are attending to physical rehabilitation programmes. Conclusion: Prenatally diagnosed occipital encephaloceles resulted in severe morbidity. Close multidisciplinary follow-up is necessary. Folic acid consumption should be encouraged.

Esophageal squamous papilloma in a child.

7-year-old boy experienced nausea, abdominal pain, and vomiting for 3 years. He was hospitalized several times due to respiratory tract infections. His weight and height were in the 25-50th percentile. The results of physical and laboratory evaluations were normal. Upper gastrointestinal system endoscopy (UGE) indicated the presence of a 1×2 cm polypoid mass with a rough surface adjacent to the lower esophageal sphincter, and a linear ulcer (>5 mm) on the upper tip of the lesion (Figure 1). He had gastric hyperemia and normal bulbus and duodenum. A pathological evaluation indicated the presence of a papillomatous proliferation in the squamous epithelium (Figure 2), severe esophagitis, and gastritis without Helicobacter pylori infection. Multiplex polymerase chain reaction could not detect any HPV DNA. Esomeprazole therapy was initiated, and the family was informed about the recommended diet. The boy underwent monthly evaluations and his gastrointestinal symptoms had resolved on the second visit. Repeat endoscopy, which was performed after 4 months, indicated normal histological findings, with no esophageal mass.

A Survey Study on Families Child Car Safety Seats Usage and Awareness

ÖZET Amaç: Bu çalışmada, ebeveynlerin çocuk oto güvenlik koltuğu (ÇOGK) kullanım oranları ve bu konu hakkındaki bilgi düzeyleri değerlendirildi. Gereç ve Yöntemler: Bu çalışmaya, çocuk polikliniğine başvuran 250 ebeveyn alındı. “Sosyodemografik özellikler”, “çocuk oto güvenlik koltuğu (ÇOGK) kullanımını etkileyen faktörler”, “ÇOGK kullanımı” ve “ÇOGK kullanımı ile ilgili bilgiler” hakkındaki 22 soruluk anket, yüz yüze görüşme yöntemiyle uygulandı. Varyans analizine yönelik olarak t-test, sürekli değişkenler için iki ortalama arasındaki farkın önemlilik testi kullanıldı. Kesikli ve kategorik değişkenlere yönelik olarak ki-kare testi uygulandı. Bulgular: Ebeveynlerin %93.6’sı ÇOGK hakkında bilgi sahibi olup, %80.8’i ÇOGK kullanıyor, %12.8’i ise kullanmıyordu. Gelir düzeyi yüksek olan ebeveynlerin ÇOGK kullanım oranı yüksekti (p < 0,05). Ebeveynlerin eğitim durumu da ÇOGK kullanımı ile doğru orantılıydı (p < 0,05). ÇOGK’nin doğru yerleşimini ailelerin %98’i biliyordu. ÇOGK’nu çocuğun yaşına uygun olarak değiştiren ebeveynlerin oranı %53.5 idi. Yaşa uygun olarak değiştirilmesi gereksinimi hakkındaki bilgi düzeyi geliri orta ve iyi düzeyde olanlarda ve babanın eğitimi yükseköğrenim düzeyinde olanlarda daha yüksekti (p < 0,05). ÇOGK kullanmanın kanuni zorunluluk olduğunu bilenlerin oranı %88.6 idi. ÇOGK hakkındaki bilgiyi ebeveynlerin %37’si internetten, %33’ü medya yoluyla, %27’si ise çevresindeki kişilerden edinmişti. Hekim tavsiyesiyle bilgi sahibi olanların oranı oldukça düşüktü (%3). Sonuç: Ebeveynlerin eğitim ve gelir düzeylerindeki artış ÇOGK kullanımını artırarak çocuk yaralanma ve ölümlerini azaltabilir. Tıp öğrencilerine tıp eğitiminde ve ebeveynlere rutin çocuk vizitlerinde çocuk güvenliği ve ÇOGK kullanımı hakkında bilgi verilmelidir CAYD 2014;1(2):87-95. Anahtar Kelimeler: Aile, bilgi düzeyi, çocuk oto güvenlik koltuğu, trafik kazaları

2009-2011 Yılları Arasında Afyon Kocatepe Üniversitesi Tıp Fakültesi Yenidoğan Servisinde Takip Edilen Konjenital Anomalili Bebeklerin Değerlendirilmesi

2009-2011 Yillari Arasinda Afyon Kocatepe Universitesi Tip Fakultesi Yenidogan Servisinde Takip Edilen Konjenital Anomalili Bebeklerin Degerlendirilmesi

871 Frequency of Norovirus Infection in Children with Acute Gastroenteritis

Background and Aims Noroviruses are one of the common causes of acute gastroenteritis and have a great impact on child health. The aim of this study was to determine the prevalence of Norovirus in children with acute gastroenteritis in 2009 and 2010. Methods Fecal samples were collected from children under 16 years of age who were suffering from acute gastroenteritis. All the children were referred to Yeditepe University Hospital, located in Istanbul. Norovirus was detected using immunochromatography. Results Norovirus infection was detected in 112 of the 1027 collected samples (10.9%). Most of the positive cases were between 1 and 24 months of age (n=75, 67%). The rate of norovirus infection peaked in winter in 2010 (in winter and spring: n=57, 92%), however, the rates were not significantly different between seasons in 2009 (in winter and spring: n=26, 52%, in summer: n=23, 46%). We did not detect any positive cases in late summer and autumn in 2010. Conclusions This study improves our epidemiological knowledge of the prevalence of Norovirus in Istanbul. Immunochromatography is preferable, that provides rapid diagnosis. The prevalence of Norovirus is similar but seasonal distribution is different between two years. Most of the cases were < 24 months of age. Because this virus is transmitted by contaminated food or water, and transmitted by personal contact, we recommend improved training in hygiene to reduce the incidence of Norovirus infection in children. Like Rotavirus, Norovirus vaccine can be developed to prevent infection.

542 A Rare Cause of Swallowing Difficulty that should be always in Mind

Aim Swallowing difficulty among children is not a frequent complaint. Generally this problem is associated with gastroesophageal reflux, esophagitis, and rarely is seen as an outcome of esophageal strictures. We report here a boy who was admitted to our clinic with swallowing difficulty but finally had a different diagnose. Material and method A 6-year-old boy was admitted due to swallowing difficulty. The family was in France and the child had this complaint almost for 4 months. The boy had lost 5kg but still was in the 50th centile both for weight and height. His physical, neurological and fundoscopic examinations were normal. But he was in a bad mood and seemed exhausted. He told that he could not swallow large particles and his portions became smaller gradually. Esophageal narrowing/stricture was thought thus Barium enema was performed and showed a normal esophagus. Then upper gastrointestinal endoscopy was performed, Endoscopical esophagitis and gastritis was confirmed by pathology with H. pylori gastritis. Although the boy was put on PPI and antibiotics his complaints did not improve, and he was still in a depressed mood. Finally a cranial MR was taken and showed a 4×3cm diameter mass located in the inferior vermis and 4th ventricle advancing to foramen magnum. Conclusion Swallowing difficulties in children is generally due to mild problems such as gastroesophageal reflux, esophagitis or food allergies. If swallowing difficulty is together with weight loss and is persistant for months intracranial pathologies, as in our case, should be searched.