Mesut Garipardic

Enuresis Prevalence and Accompanying Factors in Schoolchildren: A Questionnaire Study from Southeast Anatolia

Introduction: The aims of this study were to establish the prevalence of enuresis, to determine accompanying factors, and to identify common methods in the management of enuresis in Turkish children aged between 6 and 11 years living in eastern Anatolia. Methods: The parents of 3,527 schoolchildren aged between 6 and 11 years completed a self-administered questionnaire. The questionnaire asked about sociodemographic data, enuresis data, physical or psychological disorders, and family stressors. Descriptive statistics and χ2 test were used for data analysis. Results: The response rate was 88%. The overall prevalence of reported enuresis was 12.96%, and the prevalence of marked enuresis (at least weekly) was 9.8%. Enuresis was notably more common in boys (male:female ratio 1.6), and the prevalence rates decreased by age without gender bias. Of all enuretic children, 21% had also daytime bed-wetting. The rate of a positive family history was 42% for siblings only and 66% for the other family members. Significantly more of the dry children woke up spontaneously at night to void as compared with the enuretic children (p < 0.001). The parental concern level was not high, and only 15% of the children visited a physician for the management of enuresis. Low socioeconomic status, unfavorable perinatal or postnatal history, and unsatisfactory familial characteristics were significantly more frequent in the enuretic group (p < 0.05). The enuretic children had also higher rates of poor school performance and poor social adaptation as compared with nonenuretic children (p < 0.001). Conclusions: These results suggest that the prevalence of enuresis in eastern Anatolia is similar to that reported from western Anatolia and from most other countries. Turkish families did not report a high-level concern about enuresis, and the problem was managed primarily within the family.

PREMARITAL SCREENING TEST RESULTS FOR β-THALASSEMIA AND SICKLE CELL ANEMIA TRAIT IN EAST MEDITERRANEAN REGION OF TURKEY

Hemoglobinopathies are common diseases in Mediterranean region of Turkey. In this study, the results of a 3-year premarital screening program are reported in Kahramanmaras province, which is located in East Mediterranean region. A total of 48,126 persons were screened in this program. Hematological analyses and electrophoresis were done to identify carriers. The prevalence of β-thalassemia trait and of sickle cell anemia trait, which were 2.1% and 0.5% in Turkey, were found to be 2.8% and 0.4%, respectively, in our study. Of the carriers of the β-thalassemia trait, 82% had high hemoglobin A2, 34% had high hemoglobin F, and 18% had both high hemoglobin F and hemoglobin A2. β-Thalassemia trait in Kahramanmaras is slightly higher than the average rate in Turkey. However, sickle cell anemia trait is similar to Turkeys averages.

Pityriasis rosea-like eruption due to pneumococcal vaccine in a child with nephrotic syndrome.

A pityriasis rosea‐like eruption can occur as a consequence of treatments with gold compounds and captopril. It has rarely been reported to have an association with vaccinations such as smallpox, BCG, hepatitis B, and diphtheria toxoid. It has not previously been documented to develop after pneumococcal vaccination. We report a case of pityriasis rosea‐like eruption that developed following pneumococcal vaccination in a child with nephrotic syndrome.

Prevalence and Associated Factors of Day Wetting and Combined Day and Night Wetting

Background: This study was conducted to determine the prevalence of diurnal enuresis (DE) and its association with background variables among children aged 5–15 years living in Sivas and Kahramanmaraş, Turkey. Methods: The parents of 1,760 children voluntarily completed a questionnaire consisting of 42 items under supervision of a researcher. Results: Overall, the reported prevalence of DE was 4.2%, with a tendency to decrease with increasing age and with no difference between genders. Smoking during pregnancy, delayed initiation and dealing with the child by punishment in toilet training, urination frequency, urgency, soiling, arousal difficulty, urinary infection history, lower school performance, poor social adaptation, wetting history in the family, were all significantly prevalent among diurnal enuretics (p < 0.05). Socioeconomic or sociodemographic factors based on families and stressful life events were not associated with DE (p > 0.05). 63.9% of all parents reported some level of concern about the wetting problem and 51.7% of the diurnal enuretics had previously visited a physician. Conclusions: The prevalence of DE in our sample is not too different from the prevalence rates reported previously from Turkey and other countries. This type of enuresis seems to be more associated with an organic neurological or urological disorder than is nocturnal enuresis.

Tuberculosis of the Knee in a Child

The diagnosis for skeletal tuberculosis is often overlooked. We report a 9-year-old patient with a history of 2 years of swollen joint, with a diagnosis of tuberculosis of the knee with involvement of the proximal tibial epiphysis, and treated surgically and with anti-tuberculosis drug therapy.

An overlooked association of brachial plexus palsy: diaphragmatic paralysis.

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isnt done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.

Anesthesia for a patient with Fanconi anemia for developmental dislocation of the hip: a case report

Fanconi anemia is a rare autosomal recessive inherited bone marrow failure syndrome with congenital and hematological abnormalities. Literature regarding the anesthetic management in these patients is limited. A management of a developmental dislocation of the hip was described in a patient with fanconi anemia. Because of the heterogeneous nature, a patient with fanconi anemia should be established thorough preoperative evaluation in order to diagnose on clinical features. In conclusion, we preferred caudal anesthesia in this patient with fanconi anemia without thrombocytopenia, because of avoiding from N2O, reducing amount of anesthetic, existing microcephaly, hypothyroidism and elevated liver enzymes, providing postoperative analgesia, and reducing amount of analgesic used postoperatively.

Hand grip and pinch strength in patients with nocturnal enuresis: is there a role of muscle strength in pathogenesis of enuresis?

To examine the association of muscle strength with nocturnal enuresis.

Papulopustular eruption following diphtheria–tetanus–pertussis vaccine

Dear Editor, Immunization has successfully reduced the incidence of vaccine-preventable diseases, but vaccination can cause both minor and, infrequently, serious sideeffects. Cutaneous reactions are rarely seen after administration of vaccines and commonly seen following hepatitis B and bacillus Calmette–Guérin (BCG) vaccines. Diphtheria–tetanus–pertussis vaccine (DTP) is a less frequently incriminated product. We report a childwith recurrentpapulopustular lesionshealingwith scars after her first, second and third DTPvaccines. A 6-month-old girl presented with a papulopustular lesiononher left forearm2 daysaftertheadministration ofDTPvaccine.Dermatologicalexaminationshoweda papulopustular 5-mm lesion on an erythematous base on the same extremity far from the vaccination area (Fig. 1). There were no other abnormal findings on physical examination. Routine hematological and biochemical parameters were within normal limits. Bacteriology culture and Gram stain of the lesion yielded negativeresults.Shehadahistoryofdevelopingpapulopustular lesionson thescalp after thefirstandsecond dose of DTP vaccines. All of the lesions healed with scars within 1 month. When she was 18 months old, the father refused the rappeldoseof thevaccine.When she began primary school, the diphtheria and tetanus (DT) vaccine was administrated and cutaneous lesions didnotdevelop inanypartof thebody. The cutaneous adverse effects of anti-infective vaccines include local and generalized reactions. BCG vaccine induces specific and non-specific dermatological complications at the inoculation site or out of vaccination. Hepatitis B vaccine can cause urticaria and angioedema, erythema nodosum, systemic lupus erythematosus, lichen planus and thrombocytopenic purpura. Gianoti–Crosti syndrome can develop after measles–mumps–rubella (MMR) vaccine and influenza vaccine. Pneumococcal vaccination can induce Sweet’s syndrome and acute exanthematous pustular dermatitis. Herpes zoster was reported after chicken pox vaccination. Although widely administrated, DTP vaccine is responsible for moderate-to-severe systemic events infrequently such as high fever; persistent, inconsolable crying lasting 3 h or more; collapse; or short-lived convulsions (usually febrile). Prolonged convulsion or encephalopathy are rarely reported severe neurological events. Cutaneous adverse effects such as transient tenderness, pain, swelling and locoregional adenopathy have been reported as local reactions independently of serum DTP immunoglobulin (Ig)G levels and aluminum hydroxide concentrations. Urticaria, erythema multiforme, granuloma formation are rarely reported. These reactions are substantially more common following the administration of DTP than of DT, but they are self-limited and can be safely managed with symptomatic treatment. Sakaguchi and Inouye reported a strong relationship between anaphylaxis to DTP vaccines and the presence of specific IgE to gelatin. However, in our country, DTP vaccines with gelatin are not available. In our patient, the papulopustular eruptions following three DTP vaccinations were probably due to the