Murat Söker

Central Nervous System Tuberculosis in Children: A Review of 214 Cases

Objective. To study the clinical, laboratory, and treatment features observed in pediatric patients with tuberculous meningitis in Turkey. Study Design. Retrospective case review study. Methods. Review of medical records for demographic data, medical history, clinical manifestations, auxiliary test results, complications, and treatment of 214 children with central nervous system tuberculosis (TB) admitted to Dicle Universitys hospital between August 1988 and February 1996. Results. Of the 214 patients with tuberculous meningitis, 112 (52%) were male. The mean age at presentation was 4.1 years, with 165 patients (77%) younger than 5 years. Twenty-two patients (10%) were in the first stage of the disease, 120 (56%) in the second, and 72 (34%) in the third. Our epidemiologic data showed that 141 (66%) of the patients had a family history of TB, and 64 (30%) had a Mantoux skin test result of >10 mm of induration. Radiographic studies demonstrated abnormal chest findings in 187 patients (87%) (hilar adenopathy, 33%; infiltrates, 33%; miliary pattern, 20%; and pleural effusions, 1%, and 172 (80%) cases with hydrocephalus, 26% with parenchymal disease, 15% with basilar meningitis, and 2% with tuberculomas. Only 22 (13%) of 164 children had a positive acid-fast bacilli smear in cerebrospinal fluid, andMycobacterium tuberculosis was isolated in 49 patients (30%). All the patients were treated with Isoniazid, rifampin, and streptomycin or pyrazinamide for 2 months, followed by 10 months of Isoniazid and rifampin alone. Also, all the patients received adjuvant treatment with steroids early in the course of treatment, and 140 of 172 cases with hydrocephalus had surgical intervention. The overall mortality rate was 23%. Conclusion. One or more of these findings: a family history of TB, positive tuberculin skin test results, abnormal cranial computed tomography, and/or cerebrospinal fluid analysis compatible with TBM were found in all but 3 children in our study. central nervous system, tuberculous meningitis, diagnosis, hydrocephalus, children.

Serum Levels of IL-1 beta, sIL-2R, IL-6, IL-8, and TNF-alpha in Febrile Children with Cancer and Neutropenia

Serum levels of interleukin-1 beta (IL-1β), soluble interleukin 2 receptors (sIL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) were measured to predict some characteristics of febrile episodes in children with cancer and neutropenia. Forty-eight episodes of febrile neutropenia were determined in 23 pediatric cancer patients, including 35 febrile episodes without identifiable source, 7 episodes of bacteremia due to Gram-negative organisms and 4 due to Gram-positive organisms, and 2 fungal infections. Interleukin-6, sIL-2R, and IL-8 levels were significantly higher at the beginning of the febrile episodes than those of controls (p<0.001, p<0.001, and p<0.001). Interleukin-6, sIL-2R, and IL-8 levels were higher in patients with bacteremia due to Gram-negative organisms than in those with Gram-positive ones (p=0.042, p=0.006, and p=0.023, respectively). TNF-α and IL-1β levels were similar in febrile episodes and controls (p>0.05). In conclusion, sIL-2R, IL-6, and IL-8 levels may be helpful in the prediction of infection in febrile cancer patients with neutropenia and measurements of IL-1β and TNF-α were not useful for identifying the presence and the type of infection in febrile neutropenic episodes in children.

Bone mineral density in children with beta-thalassemia major in Diyarbakir.

Bone mineral status has extensively been investigated in adult thalassemics but less in thalassemic children. This study involves measurements of the bone mineral density (BMD), various demographic and biochemical parameters in 47 thalassemic children and 50 healthy controls with comparable age, sex, socioeconomic and regional distribution. Patients have significantly higher aspartate aminotransferase, alanine aminotransferase, phosphorous, osteocalcin, serum carboxy terminal teleopeptide fragment of type I collagen, intact parathyroid hormone (iPTH) and ferritin levels while they have significantly lower 25-hydroxy vitamin D (25OH-D), alkaline phosphatase and z-scores both at lumbar and femur compared to controls. Patients with high iPTH (30%) had significantly lower z-scores and 25OH-D while larger osteocalcin. We conclude that a significantly lower BMD in beta-thalassemic children compared with their healthy counterparts is a complex process and may partially attributed to their slower physical development, caused by iron overload and chelation therapy which may influence the liver as well as the endocrine tissues.

Prolidase activity and oxidative status in patients with thalassemia major.

Aim: Prolidase is a specific imidodipeptidase involved in collagen degradation. The increase in the enzyme activity is believed to be correlated with the increased intensity of collagen degradation. The study aimed to evaluate the relationship between prolidase activity and oxidative status in patients with thalassemia major. Methods: Comparison was made between 87 patients diagnosed with thalassemia major and 33 healthy children of similar age and gender. Mean age of the subjects was 7.5±4.3 years in the group of patients with thalassemia major and 8.9±3.1 years in the control group. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) measurement. Results: Prolidase activity was significantly increased in patients with thalassemia major (53.7±8.7u2009U/l) compared to the control group (49.2±7.2u2009U/l, P<0.001). TOS was significantly increased in the patient group (5.31±3.14u2009mmol H2O2 equiv./l) compared to the control group (3.49±2.98u2009μmol H2O2 equiv./l) and the OSI was also significantly increased in the patient group (3.86±3.28 arbitrary unit) compared to the control group (2.53±2.70 arbitrary unit) (P<0.0001 and P<0.001, respectively), while there were no significant differences between the patient (1.61±0.30u2009μmol Trolox equiv./l) and control (1.64±0.33u2009μmol Trolox equiv./l) groups with respect to TAC. Conclusion: Significant increases in prolidase activity in patients with thalassemia major may constitute a key parameter in demonstrating a disorder of the collagen metabolism. J. Clin. Lab. Anal. 24:6–11, 2010.

Paraoxonase and arylesterase activity with oxidative status in children with thalassemia major.

Purpose The aim of this study was to study paraoxonase and arylesterase activities along with oxidative status parameters, and to find out whether there is any increased susceptibility to atherogenesis, which might be reflected with increased oxidative stress and decreased serum paraoxonase/arylesterase activity in β-thalassemia major (BTM) patients. Patients and Methods Eighty-seven patients with BTM and 33 healthy individuals were enrolled in the study. Results Paraoxonase and arylesterase activities were significantly lower in BTM patients than controls (for all P<0.0001), whereas total oxidant status, total peroxide concentration levels, and oxidative stress index were significantly higher (P<0.0001, <0.0001, and <0.001, respectively). Correlations were found between serum iron and ferritin and levels of total oxidant status in BTM patients. Significant correlation was found with serum total peroxide concentration levels and paraoxonase and arylesterase activities in patients with BTM. Conclusions It was seen that oxidative stress increases, while serum paraoxonase activity is decreased in BTM patients. Decrease in paraoxonase activity seems to be associated with both the degree of oxidative stress and anemia. BTM patients may be more prone to development of atherogenesis because of low serum paraoxonase/arylesterase activity.

Severe microangiopathic hemolytic anemia and thrombocytopenia in a child with Brucella infection

Abstract We present a case of severe microangiopathic hemolytic anemia and thrombocytopenia with epistaxis, gross hematuria, hemoglobinuria, and skin purpura in a child with Brucella septicemia proven by culture. The patient showed the features of this illness: leukopenia, severe hemolytic anemia, thrombocytopenia, fragmentation of erythrocytes in the peripheral blood smear, increased erythropoiesis, megakaryopoiesis, and granulomata cell invasion in the bone marrow. The patient was treated with rifampin and doxycycline. Platelets and leukocyte numbers rose to normal values by the 6thxa0day. She was discharged on the 14thxa0day. Follow-up of the patient 1xa0year later showed normal bone marrow morphology. Differential diagnosis, pathogenesis, and therapy of Brucella infection are discussed.

Prothrombin G20210A gene mutation with LightCycler polymerase chain reaction in venous thrombosis and healthy population in the southeast of Turkey

Venous thrombosis (VT) is a common disease, with an annual incidence in the general population of approximately 1 per 1000. The prevalence of genetic risk factors for thrombosis varies greatly in different parts of the world. Prothrombin G20210A (PT G20210A) gene mutation has been recently identified as a common risk factor in venous thrombosis. Sixty-one patients with VT, differing in age and sex, and 340 healthy subjects were consecutively enrolled into our study to determine the prevalence of PT G20210A in VT and in the healthy population of the southeast of Turkey. The mutation was identified with fluorescence resonance energy transfer (FRET) with the LightCycler polymerase chain reaction. The PT G20210A mutation was found to be 6.5% (4/61) in the VT group and 1.2% (4/340) in the healthy group (P = 0.021). Three patients with VT had a heterozygous PT G20210A mutation, and the other patient with VT had both Factor V Leiden and PT G20210A mutations. We showed that this method may be used safely for detection of the PT G20210A gene mutation, and the prevalence of PT G20210A mutation is significantly higher in patients with VT than in the healthy population in the southeast of Turkey.

Primary gastric adenocarcinoma in a 2.5-year-old girl

Abstract.Primary gastric adenocarcinoma is extremely rare in children. Here, we report an additional case of primary adenocarcinoma, located at the lesser curvature in a girl at the age of 2.5 years. She had no family history and no apparent underlying cause for the tumor. She died 4 months after admission despite complete resection of the mass and chemotherapy.

Electrocardiologic and echocardiographic features of patients exposed to scorpion bite

The purpose of this study is to examine clinical progress and hemodynamic and electrocardi ologic features (QT depression and heart rate variability [HRV]) of patients exposed to a scorpion bite. Seventeen patients bitten by scorpions, and, as a control group, 15 healthy subjects were included in the study. Standard electrocardiograph (ECG) records, 24-hour Holter-ECG, and Doppler echocardiographic examinations were performed. Holter ECG indicated sinus tachycardia, sinus bradycardia, paroxysmal supraventricular tachycardia, atrial fibrillation, first-degree and second-degree atrioventricular block not requiring treatment, early atrial beats, and early ventricular beats in the patients at frequen cies of 82%, 12%, 35%, 12%, 8%, 70%, and 47%, respectively. HRV parameters that reflected parasympathetic activity (SD 35 ±13-43 ±16, RMS-SD: 20 ±9-30 ± 12, high frequency: 7.8 ±2-4.3 ±3, p<0.05) were significantly lower (p<0.05). Low frequency, which especially showed sympathetic activity (LF: 11 ± 13-11 ±23, p>0.05), was similar in both groups. In addition, the LF/HF ratio, which reflected sympathovagal balance, was significantly increased in the patient group (1.5 ±1-3.0 ±2, p = 0.005). Corrected QT and QT dispersion values were not significantly different with respect to the control (p>0.05). In the patient group compared to the control, a significant decrease was determined in the proportion of mitral E velocity to mitral A velocity (mEv/mAv), diastolic filling period (DFP), and left ventricular ejection fraction (LVEF), while a significant increase was noticed in pulmonary artery pressure (PAP) (mEv/mAv: 0.9 ±0.4-1.7 ±0.6, DFP: 362 ±8.5-425 ±89, LVEF: 53.1 ±6.7-68.6 ±5.8, PAP: 38.1 ±13-27.2 ±6, p<0.05). Scorpion bite leads to serious cardiovascular disorders, associated with decreased HRV, decreased systolic and diastolic functions, increased arrhythmic events, and hemodynamic disturbance with sympathetic and parasympathetic balance disturbance.

Urinary Kidney Injury Molecules in Children with Iron-Deficiency Anemia

Background The aim of this study was to investigate the urine levels of human kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-β-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with iron-deficiency anemia (IDA). Material/Methods Thirty-five children with IDA and 32 matched healthy controls were recruited. We assessed complete blood count, serum iron, iron-binding capacity, ferritin, serum levels of urea, creatinine (Cr), sodium (Na), potassium (K), calcium (Ca), and glucose levels. Estimated glomerular filtration rate (eGFR) was calculated. Urinary NAG, NGAL, KIM-1, and L-FABP were measured and divided by urine creatinine for comparisons. Results There were no significant differences in serum urea, Cr, or eGFR between the IDA group and the control group (p>0.05, for all). IDA patients had significantly higher urine NGAL/Cr, L-FABP/Cr, KIM-1/Cr, and NAG/Cr compared with the control group (p<0.05). There were significant negative correlations between hemoglobin, hematocrit, red blood cell count, and urine NGAL/Cr, NAG/Cr, L-FABP/Cr, KIM-1/Cr levels (p<0.05). Conclusions Higher urinary kidney injury molecule levels in IDA patients suggest a possible subclinical renal injury in pediatric IDA patients whose renal functions and serum electrolytes were normal.