Müsemma Karabel

Platelet Parameters in Children with Upper Urinary Tract Infection: Is There a Specific Response?

Although complete blood count is routinely ordered in most upper urinary tract infections (UTI), and information regarding the patients platelet indices is made available without added cost, the relationship between platelet count and mean platelet volume (MPV) and specific platelet responses to different infectious agents has not been extensively characterized in UTI. The objectives of this study were to examine platelet counts and platelet indices in children with culture-proven upper UTI to determine if there are organism-specific platelet responses. A retrospective analysis of data from all pediatric urine samples processed at Fatih University Medical School microbiology laboratory was undertaken for a period of two years (January 1, 2005, to December 31, 2006). Of the 200 patients with positive urine cultures, 146 (73%) were infected with gram-negative bacteria and 54 (27%) grew gram-positive bacteria. The platelet count during the episode of upper UTI and the incidence of thrombocytosis was significantly higher with the gram-positive infections than with the gram-negative infections or controls (p < 0.05). A statistically significant higher MPV was detected in the subjects with upper UTI (p < 0.05). Also, our data showed a statistically significant increase in MPV with gram-positive infections compared with the other groups (p < 0.05). In conclusion, based on the importance of the hemostatic component in the pathophysiology of infections, our findings of platelet count and MPV and predictivity of the type of the organism would suggest the usefulness of the routine measurements in children with upper UTI.

High frequency of E148Q sequence variation in children with familial Mediterranean fever in southeast Turkey

OBJECTIVE The aim of this study was to investigate the spectrum of Mediterranean fever (MEFV) gene mutations and genotype-phenotype correlation in children with familial Mediterranean fever (FMF) in southeast Turkey. METHODS A total of 507 children (274 females) with FMF and MEFV gene mutation(s) were included. A 15-year retrospective evaluation was conducted; parameters analyzed were: age, sex, age at symptoms onset, age at FMF diagnosis, delay between symptoms onset and diagnosis, FMF attack symptoms, and response to colchicine. Disease severity scores were calculated and MEFV mutation analysis was performed via real-time PCR for the 6 most frequent mutations. Children with comorbid diseases or tested negative for MEFV gene mutations were excluded to provide homogeneity. RESULTS A family history of FMF was found in 60.2% (n=305) of patients. The most common symptoms reported for FMF attacks were abdominal pain (98.0%), fever (93.9%) and arthralgia (47.3%); 75.0% of patients (n=380) were heterozygous, 14.2% were homozygous (n=72) and 10.8% were compound heterozygous (n=55).The following MEFV gene mutation alleles were identified: E148Q (40.1%), M694V (25.9%), V726A (15.8%), R761H (7.4%), M680I (6.8%), and P369S (4.1%). The M694V subgroup had the lowest mean age of disease onset and the highest mean disease severity score, whereas the E148Q group had later mean disease onset and the lowest mean disease severity score (p<0.05). CONCLUSION The highest E148Q mutation frequency and milder disease in the course of FMF in our study population may be due to geographic and ethnic background dissimilarities of southeast Turkey.

Separation anxiety disorder increases among neonatal intensive care unit graduates.

Aim: To evaluate whether separation anxiety disorder (SAD) develops in the later life of the infants, who were separated from their mothers in relation to being in neonatal intensive care unit (NICU). Methods: A group of 57 children, ages over 6 years old who were cared in NICU has been evaluated retrospectively by using the SAD diagnostic scale which is adapted according to DSM-IV. Another age and sex matched 50 children who admitted to the outpatient unit were selected as control group. Results: We found that the scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU. Conclusion: The NICU should be arranged to support the development of the baby. Families should be informed about the necessity of sustaining an early mother-infant interaction. By supporting mother-infant interaction, it will be provided that the baby will establish a more secure relation with his/her mother, develop more healthy and have less behavior problems in the future life.

Congenital tuberculosis: presentation of a rare case.

Congenital tuberculosis is a rare disease with a high mortality rate. Congenital tuberculosis is considered the result of mother-to-child transmission from the placenta to the fetus, through the ingestion of the amniotic fluid, or via transplacental transmission through the umbilical vein. Given the non-specific clinical signs of tuberculosis, it is usually difficult to diagnose it. The case of a 48-day-old male infant hospitalized due to weight loss, fever, cough, hemoptysis, and respiratory distress for the past 20 days, is presented. In this period, he had received broad spectrum antibiotics but with no improvement. A chest x-ray showed the presence of consolidation and a cavitary lesion in the upper and middle left lung fields. Mycobacterium tuberculosis was detected by polymerase chain reaction in a bronchoalveolar lavage specimen. Congenital tuberculosis was diagnosed based on this finding; hence, a tuberculostatic regimen was started accordingly. The patient died 13 days after treatment initiation. Congenital tuberculosis should be considered in infants with weight loss, fever, cough, hemoptysis and respiratory distress.

Children with food refusal: An assessment of parental eating attitudes and their styles of coping with stress

Background: In this study, we aimed to assess the eating attitudes and stress coping styles of parents whose children presented to the clinic complaining of food refusal. Methods: The parents of 31 children aged ≥3 years, presented to the clinic with the complaint of food refusal. The control group consisted of 30 healthy children with no prior history of food refusal, and their parents. In both groups, birth features, body mass indexes (BMIs), eating attitudes and stress coping styles of the parents were assessed. The parents of both groups were studied, in part utilizing the eating attitudes test (EAT), and the coping styles of stress scale (CSSS). Results: Our study found that body weights and BMI values of the fathers in the study group were significantly lower than fathers in the control group. There was no significant difference in EAT scores between the two groups; however, where the childrens body weight and height for age percentile was under 25%, the parents had significantly lower EAT scores. When CSSS scores were assessed, the optimistic approach score of the mother and the self‐confident score of the father were found to be significantly high in both groups. Conclusion: The parental perception and definition of eating problemsdoes not necessarily indicate the presence of an eating disorder in a child. In fact, the eating attitudes of the fathers were related to the low percentile weight and height values of the children, and a childs food refusal was not dependent on the stress coping style used by the parent.

Puffy Feet in an 11-month-old Infant: A Quiz

An 11-month-old boy with puffy feet had first presented at birth after a normal pregnancy. The boy’s father and 8-year-old sister had the same oedema of the foot unilaterally and the infant’s paternal grandmother was also affected bilaterally. His parents were not related to each other. Physical examination of the patient was normal, apart from the pectus excavatus and pes planus of the feet. Dermatological examination showed a non-inflammatory oedema located on the dorsum of the feet, giving a puffy appearance, and congenital misalignment of the left foot big toe (Fig. 1). Laboratory investigations, including urine analysis, total protein and albumin levels in the blood, abdominal ultrasonography and echocardiography were normal. The patient was started on elastic bandage compression therapy.

Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus

La gastroenteritis por rotavirus es la mas frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los ninos pequenos, ademas de deshidratacion grave y desequilibrios electroliticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatia, deshidratacion, desequilibrio electrolitico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infeccion habitual en nuestro pais (Turquia), con diversas manifestaciones clinicas, entre ellas, las convulsiones, que pueden verse no solo en los ninos con enfermedades neurologicas o sistemicas sino tambien en los ninos sanos. Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.

Supernumerary nipple: Should we be alert?

Supernumerary nipples (SN) are common minor congenital anomalies. SN pose no medical threat, however they can be associated with other medical conditions especially kidney and urinary tract malformations.We present here a female infant with SN with interesting associated malformations. In our patient, umbilical hernia, umbilical granuloma, spina bifida occulta and bilateral ovarian cyst accompanied the accessory nipple, instead of the expected renal or urinary system anomalies. Case Report

Is bicarbonate solution tolerated better than Shohl’s solution in neonatal renal tubular acidosis?

Sirs, Distal renal tubular acidosis (dRTA) was first recognized by Albright et al. as a distinct entity in 1946 [1]. The clinical syndrome described hypokalemia, hyperchloremic metabolic acidosis, inability to lower urine pH below 5.5, nephrocalcinosis, nephrolithiasis and potassium depletion. Additional features included osteomalacia or rickets. The syndrome was designated as “distal renal tubular acidosis” because the establishment of a large pH gradient between urine and blood is the function of the distal nephron. Distal RTA is almost always observed in children as a primary entity inherited in both autosomal dominant and recessive patterns [2]. If detected early in life, therapeutic correction of the acidosis by continuous alkali administration may induce resumption of normal growth, arrest of nephrocalcinosis, and preservation of renal function [2]. We describe the case of a 20-day-old girl with dRTA associated with hypokalemia, metabolic acidosis and dehydration. The girl was born at 40 weeks of gestation, weighing 3,250 g. Her parents described a sister diagnosed with dRTA and treated with Shohl’s (potassium or sodium citrate) solution in the neonatal period. The sister could not tolerate the solution and suffered persistent vomiting and diarrhea, which resulted in death at 4 months. At 20 days of age, the patient was admitted to our outpatient clinic for weight loss (body weight loss 110 g), dehydration, and generalized weakness. Laboratory examination on admission revealed severe acidemia (pH 7.27, PCO2 27 mmHg, plasma bicarbonate 12 mmol/l, base excess −12.4 mmol/l) and a high urine pH (pH=8). Serum analysis revealed sodium 138 mmol/l, chloride 118 mmol/l, total calcium 11.6 mmol/l, ionized calcium 1,26 mmol/l, phosphorus 6.4 mmol/l, urea 58 mg/dl, creatinine 0.6 mg/dl, glucose 83 mg/dl and serum alkaline phosphatase 537 IU/l. Pyuria was noted. However, urine cultures on two occasions showed no growth. No significant protein, glucose, or amino acid was detected in the urine. The urine anion gap (Na + K Cl) was +86 mmol/l [normal range: −10 to +10 mmol/l]. The urinary calcium/creatinine ratio was 0.52 (normal values for infants are below 0.6). Renal ultrasonography was normal. A diagnosis of distal RTA was made, and treatment with sodium bicarbonate infusion was initiated. Two days after admission, infusion was stopped. Shohl’s solution was initiated at a dose of 2 mEq kg day and increased to 16 mEq kg day. Oral potassium citrate, about 2 mEq body weight per day, was added to treat hypokalemia. Vomiting and diarrhea were observed under treatment with Shohl’s solution. Plasma bicarbonate concentrations decreased from 17 to 9 mmol/l and serum pH was 7.1. Metabolic acidosis was treated with bicarbonate infusion and thereafter per oral 2 mmol kg day sodium bicarbonate was initiated. Under sodium bicarbonate and potassium citrate therapies, pH increased to 7.44, PCO2 to 40 mmHg, plasma bicarbonate to 27 mmol/l, base excess to +3.2 mmol/l and potassium to 3.7 mmol/l. No vomiting or diarrhea was observed. In the second month her body weight was 4,450 g, pH 7.42, PCO2 40 mmHg, plasma bicarbonate 28 mmol/l, base excess +3 and potassium 4 mmol/l. Pediatr Nephrol (2007) 22:152–153 DOI 10.1007/s00467-006-0249-5