Nagehan Aslan

The Role of Urbanization in Childhood Obesity.

Obesity is becoming the most frequently diagnosed chronic disease in many countries affecting all age groups and specifically the pediatric population. To date, most approaches have focused on changing the behavior of individuals with respect to diet and exercise. Almost all researchers agree that prevention could be the key strategy for controlling the current epidemic of obesity. Prevention may be achieved by changes in lifestyle through a variety of interventions targeting the urban environment, physical activity, time spent watching television and playing computer games and consumption of carbonated drinks. However, as yet, these strategies seem to have had little impact on the growing increase of the obesity epidemic. In this article, we aimed to discuss the effect of rapid urbanization on childhood obesity and to suggest solutions to this problem.

Increased oxidative stress parameters in children with moderate iodine deficiency.

Abstract Background: Iodine is a part of thyroid hormones and has been reported to act directly as an antioxidant or induce indirectly antioxidant enzymes. This study aimed to assess the urinary iodine concentration and its relationship between the antioxidant and oxidative stress capacity in healthy school-aged children. Methods: In total, 196 students from five primary schools, randomly selected between 9 and 12 years (mean age: 10.2±1.2 years), were enrolled in the study. Urinary iodine levels were measured by spectrophotometry with the Sandell-Kolthoff reaction. Total antioxidant status (TAS) and total oxidant status (TOS) were analysed from urine samples. The ratio of TOS to TAS was regarded as an oxidative stress index (OSI), an indicator of the degree of oxidative status. Results: Fifty-four percentage (107) of the children had iodine deficiency (ID) and the majority of them (30%) had mild ID. There was no severe-ID child in the population (<20 μg/L). Urine TAS levels were significantly lower in the moderate-ID group than in the mild-ID group (6.5±4.1 vs. 11.3±4.1 mmol, p<0.001) and the iodine-sufficient group (11.0±5.3 μmol, p<0.001). TOS levels and OSI were found higher in the moderate-ID group than in the mild-ID group (4.8±2.1 vs. 3.7±2.1 μmol, p<0.001) and the iodine-sufficient group (4.8±2.1 vs. 3.4±2.5 mmol, p<0.001). In the moderate-ID group, low urine iodine levels exhibited significant negative correlations with OSI (r=−0.660) and TOS (r=−0.248) and a positive correlation with TAS (r=0.475). Conclusions: We found that children with moderate ID were exposed to more oxidative burden than children with mild ID or iodine sufficiency. Increased systemic oxidative stress induced by moderate ID could cause development of ID-related complications and diseases. Iodine supplementation could have a beneficial role in the prevention of oxidative stress.

A rare complication of esophageal dilatation: Brain abscess

Brain abscess is an uncommon serious disease, which has been reported as a rare complication of repeated esophageal dilations; however, routine periprocedural antibiotic prophylaxis is not currently recommended. Herein, we present a brain abscess that developed after esophageal dilatation for the treatment of induced caustic esophageal strictures. The clinical presentation is non-specific, the most reported signs are high fever and neurologic findings. Cases have been reported in the literature in adult and pediatric patients. Cranial imaging is essential for diagnosis, drainage and antibiotics are essential in its treatment. Clinical improvement was achieved with antibiotic therapy and surgical drainage. This serious complication should be kept in mind when treatment of corrosive strictures though repeated esophageal dilatation is planned and prophylaxis should be considered in selected patients.

Burkitt lymphoma with unusual presentation: Acute pancreatitis.

Pancreatitis due to malignant infiltration is an uncommon condition in childhood. Pancreatic lymphomas constitute <2% of all non‐Hodgkin lymphomas. Only six reported cases with various clinical presentation have been documented in the literature. Described herein is the case of a nine‐year‐old boy with abdominal pain, jaundice, emesis, weight loss, diarrhea, who developed hyperlipidemia and cholestasis. Pancreatitis was suspected due to high amylase and lipase. Computed tomography and magnetic resonance cholangiopancreatography showed diffuse enlargement of the pancreas. This sausage pancreas imaging was suggestive of autoimmune pancreatitis, but the patient was diagnosed with Burkitt lymphoma on bone marrow aspiration, and rapidly improved with chemotherapy. Burkitt lymphoma should be kept in mind when patients present with pancreatitis, especially with diffuse enlarged pancreas.

A case of brainstem encephalitis treated with plasmapheresis

DOI: 10.4328/JCAM.5390 Received: 26.09.2017 Accepted: 27.11.2017 Publihed Online: 27.11.2017 Printed: 01.05.2018 J Clin Anal Med 2018;9(3): 235-8 Corresponding Author: Nagehan Aslan, Çocuk Yoğun Bakım Bilim Dalı, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Adana, Türkiye. GSM: +905055499986 E-Mail: nagehan_aslan@hotmail.com Abstract Brain stem encephalitis is a rare disease, which can be triggered by infection, with an unclear etiology, in which infectious and autoimmune mechanisms are thought to play a role in the pathogenesis [1]. Major clinical symptoms are ataxia, muscle weakness and ocular and bulbar dysfunction [2]. Its etiology can vary from infection to autoimmune reasons. Listeria, enterovirus type 71 and Herpes simplex virus are the most common infectious causes. It may also be caused by neurobehcets, Bickerstaff’s encephalitis, autoimmune diseases such as multiple sclerosis and paraneoplastic reasons [3-5]. With those in mind, the underlying etiology is unclear in most cases [2]. Treatment is based on etiology. Immunosuppressive treatment can be tried in brain stem encephalitis patients whose etiology can not be made clear [6]. In this case report, we present a case of brainstem encephalitis which did not respond to the present treatment and was treated with plasmapheresis.

Child with Pancreatic Hydatid Cyst Presenting with Cholestasis

Although hydatid cysts are often seen in the liver and lungs, they may be present in many organs. Even in countries where hydatid cyst disease is endemic, the occurrence of pancreatic hydatid cysts is rare. Pancreatic hydatid cysts are important for the differential diagnosis of patients with pancreatic pseudocysts and cystic carcinomas. We could not find cystic echinococcosis cases which are kept together pancreas and liver in PubMed. In this article, we highlight the fact that pancreatic cystic echinococcosis may play a role in the etiology of cholestasis and that cysts may not be isolated in the pancreas in a pediatric population.

Evaluation of Our Food Protein Induced Proctocolitis Cases: A Single CenterExperience

Aim: The purpose of this study was to determine clinical characteristics, laboratory findings and course in infants diagnosed with allergic proctocolitis. Materials and methods: Thirty-four patients diagnosed with food protein-induced proctocolitis in our clinic between 2013 and 2016 were evaluated retrospectively. Files were reviewed in terms of symptoms, clinical features, laboratory findings and responses to treatment. Results and discussion: Sixteen (47%) patients were female. Mean age was 3.3 ± 2.3 months (1-10 months). Eleven (32.3%) cases presented with pronounced rectal bleeding and 23 (67.6%) with bloody spots or streaks in stool. In terms of nutrition, 76.4% of babies were receiving breast milk alone, and the remainder received breast milk with supplementary formula. Mean peripheral eosinophil rate was 8.6 ± 6.3%. Response was achieved solely by removal of milk and dairy products from the mother’s diet in 25 (73.5%) cases, while multiple allergen food (eggs, nuts, fish etc.) elimination was applied to mothers in 8 (23.5%) and breast milk was discontinued for 3 months in one case. Symptoms resolved in a mean 6.4 ± 5.9 days (1-25) following of elimination diet. Conclusion: Our study shows that allergic proctocolitis in infancy frequently appears in exclusively breastfed babies, that the condition has a benign course and that cow’s milk protein plays an important role in the etiopathogenesis.

Kawasaki disease in a 9-year old girl presenting with febrile cholestasis: case report and review of literature

Kawasaki disease is a systemic vasculitis that develops during childhood, especially in those younger than 5 years. Gastrointestinal involvement does not belong to the classic diagnostic criteria. We reported here, a 9‐year old girl who presented with febrile cholestasis, and developed a medium right coronary artery aneurysm despite intravenous immunoglobulin administration on the 9th day of fever. Hepatobiliary ultrasonographic evaluation revealed normal findings. Seroimmunologic markers of cholestasis were negative. Her clinical feature was ameliorated shortly after a second dose of intravenous immunoglobulin administration. We consider that a high index of suspicion of Kawasaki disease could prevent delayed diagnosis and complications.