Müjgan Sıdal

Corticosteroid treatment of childhood Bell’s palsy

The therapeutic effect of corticosteroids in acute idiopathic peripheral nerve paralysis (Bells palsy) in children is controversial. The authors evaluated the effect of steroids on the early and late outcome of children with Bells palsy in a prospective randomized controlled setting. Forty-two patients (21 females, 21 males) with complete paralysis were enrolled in the study. Group 1 (n = 21) received methylprednisolone (1 mg/kg daily for 10 days orally); Group 2 (n = 21) did not. All patients were observed in the first 3 days of the disease and at 4, 6, and 12 months of follow-up. The mean age of Group 1 was 52.4 +/- 4.3 months, not significantly different from that of Group 2. In Group 1, 86% and 100% exhibited normal nerve function at 4 and 6 months of follow-up, respectively; in Group 2, 72% and 86% demonstrated complete recovery at 4 and 6 months, respectively, with improvement in all patients by 12 months. The improvement rates between the treated and untreated groups did not differ significantly. No side effects necessitated steroid withdrawal. The results of this study indicate that steroid therapy initiated at an early stage of childhood Bells palsy does not significantly improve the outcome.

Airway foreign bodies in childhood

OBJECTIVE To define clinical spectrum of airway foreign body aspiration in children and to evaluate the outcome and complications. METHODS A total of 53 patients (27 girls, 26 boys) with a mean age of 30.0+/-32.7 months, who aspirated foreign bodies were treated with bronchoscopy were divided into two groups with respect to the time they were diagnosed as early (Group 1, n=22, </=24 h after aspiration) and late diagnosed group (Group 2, n24 h after aspiration). The two groups were followed up prospectively for complications. RESULTS A total of 72% of patients were under a 3-year age group. Choking episode history was reported in 32% of patients but when families were questioned about it more in detail the rate increased to 51%. Acute episode of choking seemed trivial most of the families. Cough (69.8%), decreased breath sounds (52.8%) and wheezing (45.1%) were predominant symptoms. Sunflower seed (32. 1%) and peanuts (15.1%) were noted as common aspirated materials. Air trapping (59%) and consolidation (47%) were the most frequent radiological findings especially in the late diagnosed group (P<0. 01). Patients who aspirated organic materials frequently developed pneumonia diagnosed in late period after aspiration. CONCLUSION Pediatricians must be conscious to check for foreign body aspiration who have sudden onset of cough and wheezing episode. In any suspicion, a bronchoscopy should be considered even if there is not any positive history for aspiration. Children should be followed up after bronchoscopy for complications.

Acute hepatitis A virus infection in Turkey.

Anti‐HAV IgM positive serum samples from acute phase hepatitis A patients from various areas in Turkey were tested for viral RNA by RT‐PCR (reverse transcriptase polymerase chain reaction), using primer pairs from two different regions of the HAV genome. The PCR products amplified from both genomic regions underwent phylogenetic analyses. A comparison of the regions showed the same genotyping results, and the RT‐PCR‐2 in the 5′NCR demonstrated greater sensitivity compared to RT‐PCR‐1 in the VP1‐P2A region. The majority of the isolates belonged to genotype IB and are related closely to each other; however, two isolates related even more strongly to the HAV HM175 strain. Two (n = 37) RT‐PCR positive sera were classified under genotype IA. A surprising finding emerged for the mean levels of serum transaminases AST and ALT: higher levels were found in patients under 10 years of age compared to older patients. Anti‐HAV IgM levels were determined quantitatively and, in addition, the HAV‐RNA genome equivalents were ascertained by real time RT‐PCR. No evidence was found for an association between viral load and the higher transaminase levels in the younger group. J. Med. Virol. 80:785–790, 2008.

Etiology of acute otitis media in childhood and evaluation of two different protocols of antibiotic therapy: 10 days cefaclor vs. 3 days azitromycin

BACKGROUND Acute otitis media (AOM) is a common childhood infection that is frequently treated by antibiotics. There are no prospective and comprehensive trials evaluating childhood AOM for etiologic pathogens and resistance pattern in Turkey. The aims of the study were to determine the bacterial etiologies and resistance patterns, and identify the efficacy and the relapse rates of 3 days of azitromycin and 10 days of cefaclor therapy in AOM. METHODS This prospective, randomized, single-blind, open study was carried out in 78 cases of AOM. Mean age was 30.7+/-27 months. Tympanocentesis and aspiration of middle ear fluid (MEF) were used to obtain purulent material from the middle ear. Group 1 consisted of the cases (n=41) on azitromycin therapy and Group 2 (n=37) on cefaclor. Dosage of azitromycin was 10 mg/kg per day for 3 days and cefaclor 40 mg/kg per day for 10 days. The patients were evaluated on days 3-5 (second visit), day 10 (third visit), and day 30 (fourth visit) during follow-up. RESULTS A total of 50 species were isolated from 44 of 78 cases from which materials were obtained (44/78; 56.4%). Most frequently isolated microorganism was Streptococcus pneumoniae (n=18; 36%), followed by Haemophilus influenzae (n=11; 22%), S. aureus (n=9; 18%), Moraxella catarrhalis (n=4; 8%), and group A beta-hemolytic streptococcus (GAS, n=4; 8%). Enterococcus faecalis was isolated from three cases and H. parainfluenzae from one. Penicillin and amoxicillin resistances of bacteria were found to be 40 and 36%, respectively. The frequency of penicillin and amoxicillin resistance in </=24-month age group was 59 and 66.6%, respectively. The patients did not demonstrate significant differences in terms of cure rate on the third to fifth day (Group 1: 32.5%; Group 2: 36.4%), 10th day (Group 1: 76.9%; Group 2: 84.8%), and on 30th day (Group 1: 91.3%; Group 2: 81.8%). There were no significant differences with respect to side effects, relapse, and re-infection rate between the two groups. CONCLUSION In more than half of the AOM cases, bacteria were isolated from MEF and most frequently isolated organisms were S. pneumoniae, H. influenzae, and S. aureus. Three-day azitromycin therapy was as effective as 10-day cefaclor therapy.

Trial of Co-trimoxazole Versus Procaine Penicillin G and Benzathin Penicillin + Procaine Penicillin G in the Treatment of Childhood Pneumonia

This study, which aimed to assess the results of three different regimens in the treatment of pneumonia, was carried out at the Pediatric Outpatient Department of Capa Childrens Hospital in Istanbul on 151 patients aged between 4 months and 14 years. The first group (n = 46) received co-trimoxazole orally for 10 days and the second group (n = 63) procaine penicillin G in intramuscularly for 10 days. Benzathin penicillin G combined with procaine penicillin G was given to the third group (n = 42) as a single dose intramuscularly. While the best results were obtained with penicillin procaine G, no statistically significant difference was found between this regimen and co-trimoxazole therapy (chi 2 = 0.305023 P = 0.5). We suggest that co-trimoxazole is easy to administer and cost effective in the ambulatory treatment of pneumonia in children.

Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study

Aim:  To evaluate whether mucolytic agents have an adjuvant role with antibiotics in the treatment of children with rhinosinusitis.

Group A beta hemolytic streptococcal infections and obsessive‐compulsive symptoms in a Turkish pediatric population

Abstract  The purpose of the present study was to evaluate obsessive‐compulsive disease (OCD) in Turkish Children who had group A beta hemolytic streptococcal (GABHS) infections and those who had not. Thirty‐one children and adolescents (the study group) were compared with 28 children and adolescents. The Childrens Yale‐Brown Obsessive‐Compulsive Scale (CY‐BOCS) scores were rated between study group and control group. The mean score, obsession and compulsion scores of CY‐BOCS in the study group were significantly higher than they were in the control group (P < 0.05). The GABHS infections should be assessed in the etiology of OCD in children. Considering GABHS infections may help the treatment of OCD.

Acute obstructive respiratory tract diseases in a pediatric emergency unit: evidence-based evaluation.

Objectives The objective of this study was to determine the evidence-based performance of the pediatric emergency unit in the diagnosis of and treatment approach to the patients with asthma, bronchiolitis, and croup. Methods In this study conducted in a retrospective cross-sectional way, emergency cards and computer data have been used. In the performance evaluation, the National Hospital Ambulatory Medical Care Survey criteria were considered. In the evaluation of performance in diagnosis, the rates of chest x-ray studies and use of corticosteroids and antibiotics were examined. Use of antibiotics in the cases not having a fever or any symptoms of bacterial infection and failure in prescribing steroids to the cases with moderate-to-severe symptoms were considered as bad performance criteria. &khgr;2 test was used for the data, which can be classified; Mann-Whitney U and Student t tests were used for the data with normal distribution and for the continuous variables. Results Study groups were composed of 2795 patients (1742 cases with asthma, 115 cases with croup, 938 cases with bronchiolitis) aged between 3 and 140 months (mean [SD], 41.2 [31] months). Chest x-ray study was requested significantly more often in the cases of bronchiolitis and croup with severe symptoms. In asthma cases, chest x-ray study was requested in those with severe clinical symptoms. In all 3 groups, a significant difference between the severity levels of the cases, from whom hemogram was requested, was determined. Biochemical tests were requested more often in those with severe bronchiolitis or asthma. Antibiotics were prescribed to none of the mild bronchiolitis cases. However, steroids were recommended more often to patients with moderate and severe bronchiolitis. They were administered to all patients with croup. Systemic steroids were prescribed more often to those with moderate or severe asthma. Conclusions In our unit, both antibiotics administration and chest x-ray studies requested in patients with bronchiolitis, croup, and asthma were in low rates. Steroids in asthma attacks were found to be high in severe cases and in croup cases as well.

The impact of systematic use of oral rehydration therapy on outcome in acute diarrheal disease in children.

A review of our experience with diarrheal disease (DD) at the University of Istanbul Childrens Hospital in Çapa, covering the years 1987 to 1989, is presented in this paper. DD is one of the most common conditions encountered among patients presenting to the outpatient clinic (5.9% of all cases). The majority of DD cases were in the four-to 12-month age group. During the surveillance period, summertime peaks in DD were observed, suggesting an increase in bacterial infection. Out of 8749 cases of DD, 5.2% showed severe dehydration. Rates of hospitalization for DD did not show any differences over the three years. However, mortality from DD significantly decreased from 1.15 to 0.57% during this three-year period. This was attributed to more rational use of oral rehydration solutions, as a result of the close monitoring and recording of findings introduced by the protocol of this study. Malnutrition, sepsis, pneumonia, and other severe systemic diseases were found to be the most important risk factors affecting hospitalization and mortality rates. Infants, especially those under three months, had the highest risk for hospitalization and mortality.

Çocukluk çağında nadir görülen kosta kaynaklı Ewing sarkomu Ayın Olgusu

Olgu: Sekiz yasinda kiz hasta iki aydir devam eden oksuruk sol gogus agrisi ve sol gogsunde sislik sikayeti ile poliklinigimize getirildi Fizik muayenesinde: Buyume ve gelismesi yasina uygun olan hastanin sol gogus duvarinda orta klavikuler hatta 5 kosta hizasinda 4x2 cm boyutlarinda ele gelen sert bir kitle saptandi Diger sistem muayeneleri normal idi Laboratuvar bulgulari: Htc: 40 Hb : 13 1 gr dl lokosit: 5500 mm3 trombosit 367000 mm3 idi ve periferik kan yaymasinda 66 PNL 30 lenfosit 4 monosit goruldu Sedimentasyon hizi saatte 24 mm idi Akciger PA grafisinde sol 5 kosto kondral bileskede mevcut kemik yapisinda destruksiyon yapan radyoopasite artisi gosteren supheli alan goruldu Resim 1 Toraks bilgisayarli tomografisinde BT sol 5 kosta anterolateralinde kemik yapida destruksiyon ve akciger parankimi icine protruzyon gosteren 3 5 x 2 cm boyutlarinda 2 cm kalinliginda kalsifiye komponenti bulunan kitle saptandi Karin ultrasonografisi ekokardiyografi ve kemik iligi aspirasyonu normaldi LDH alfa feto protein ve beta “human corionic gonadotropin” degerleri de normal sinirlardaydi Klinik seyir ve tedavi: Sol gogus duvarinda tumoral kitle on tanisi ile ameliyat edildi Patoloji degerlendirmesi yuvarlak hucreli habis tumor Ewing tumoru “Askin tumoru” primitif noroektodermal tumor PNET Tumoru saptandi Resim 2 Tedavisi duzenlenmek uzere Pediatrik Hematoloji Onkoloji biriminden izleme alindi nbsp;TartismaResim 1: Akciger grafisi sol 5 kosto kondral bileskede kemik yapisinda destruksiyon yapan radyoopasite artisi Resim 2: Kitle patolojisi H E x 310 MIC 2 Difuz membranoz MIC 2 pozitifligi Cocukluk caginda nadir gorulen kosta kaynakli Ewing sarkomu Cocukluk cagi malignitelerinin 2’sini primer kemik kaynakli tumorler olusturur Bunlar arasinda Ewing sarkomu osteosarkomdan sonra ikinci sikliktadir [1 2] Cocukluk yas grubu icerisinde gogus duvarindan kaynaklanan tumorlerde selim tumorler kondroblastom enkondrom osteoblastom vb ilk siralarda yer alirken malign tumorlerde ise birinci siklikta Ewing sarkomu daha az siklikta osteosarkom ve kondrosarkom gorulur [1 3] Ilk kez 1921’de James Ewing [2] tarafindan tarif edilmistir Ewing sarkomu 3 25 yaslari arasinda siklikla da 10 15 yaslari arasinda gorulur [3 5] Cinsiyet orani K E :2 1’ dir En sik uzun kemiklerin diyafizinden kaynaklanir Sirasiyla alt ekstremite femur en sik pelvis iliyak kemik en sik ust ekstremite humerus en sik ve govde govdeden kaynaklananlarin 10’u kostalardan olusur kemikleri ile cok daha nadir de genitouriner traktus ve meninks gibi bolgelerden kaynaklanabilir [3 4 7] En sik lokal agri olmak uzere lokal sislik ve ates sikayetleri ile hastalar doktora basvurur Ates bulundugunda radyolojik bulgulari osteomiyelit ile karisabilir Teshis aninda 20 30 oraninda metastaz vardir Genellikle de hematojen yolla akciger ve beyine metastaz yapar Direkt invazyon yolu ile mediyasten diyafram ve perikardi arka mediyasten yerlesimli olanlar intervertebral foraminalar yolu ile spinal kanalina yayilabilirler Ewing sarkomunun parasempatik sinir orijinli oldugu bilinmektedir Primitif noroektodermal tumorlerden ozellikle lenfoma rabdomiyosarkom noroblastom ve ‘‘out cell’’ karsinomu ayirici tanidaki diger hastaliklardir C myc onkojenin ve t [11;22] q24:q12 translokasyonunun varligi ve yuvarlak hucreli tumorler arasinda 75 oraninda PAS glikojen granullerini depolayan tek tumor olmasi ozelligi ile digerlerinden ayrilir [1 3] Makroskopik olarak periost reaksiyonu yaptigi icin sogan zari gorunumune neden olur Radyolojik teshiste direkt kemik grafileri BT ve manyetik rezonans kullanilabilir Gunumuzde cerrahi kemoterapi ve radyoterapi tedavide birlikte uygulanmaktadir Tam rezeksiyon oncelikle uygulanmaya calisilmakla beraber femur tibiya ve cikarilamayacak bolgede olan tumorlerde baslangicta 9 haftalik bir kemoterapi sonrasi tumorun cerrahi rezeksiyonu uygulanmaktadir [6] Kemoterapide Ifosfamid etoposid vinkristin adriyamisin sitoksan ve aktinomisin D kullanilmaktadir [6 7] Ewing sarkomu radyoterapiye yanitli tumorler arasinda yer almaktadir Primer tumor alanina 5500 6000 cGy dozunda radyoterapi uygulanmasi onerilmektedir [6] Uzun sureli yasamda radyoterapiye bagi gelisen sekonder kemik tumoru riski nedeniyle tam rezeke edilemeyen tumorlerde ve lokal nuks durumlarinda kullanilmalidir Tani aninda metastaz ve yumusak doku yayiliminin bulunmasi yuksek LDH duzeyi saptanmasi ve erkek cinsiyet olmasi kotu prognostik faktorlerdir [2 6] Hastamizda kiz cinsiyet LDH duzeyinin normal olmasi tumorun yumusak dokuya yayilmis olmamasi ve metastaz saptanmamasi nedeniyle iyi prognoza sahip oldugu soylenebilir Bes yillik sag kalim 55 60 oraninda iken lokalize tumorlerde 75’lere kadar cikabilir Metastaz var ise 5 yillik survi 20 30’larda seyretmektedir [1 4 6 7] Yaygin metastaz ve cikarilamayacak lokalizasyonda olan tumorlerde yogun kemoterapi uygulandiktan sonra kemik iligi transplantasyonu uygulanmaktadir [6] Gogus kafesinde ozellikle kostalarda lokalize sisliklerde oncelikle iskelet sisteminin selim tumorleri akla gelmekle birlikte ozellikle Ewing sarkomu ve osteosarkom unutulmamalidir