Ridvan Akin

Plasma Trace Element, Plasma Glutathione Peroxidase, and Superoxide Dismutase Levels in Epileptic Children Receiving Antiepileptic Drug Therapy

Summary: Some antiepileptic drugs (AEDs) may altertrace element metabolism and free radical scavenging enzyme activities in humans and experimental animals. We investigated the effect of longterm AED therapy on copper (Cu), zinc (Zn), manganese (Mn), selenium (Se), magnesium (Mg), glutathione peroxidase (GSH‐PX), and superoxide dismutase (SOD) in the plasma in children with epilepsy. During treatment with valproate (VPA) or carbamazepine (CBZ) monotherapy plasma Cu, Zn, Mn, Se, and Mg concentrations of patients were not statistically different from those of control subjects. The level of seoxidation may be causally involved in some forms of epilepsies, and the decreased free radical scavenging enzyme activity is believed to cause the increased risk of anidiosyncratic drug reaction encountered in the manage‐ment of epilepsy. Because GSH‐PX and SOD are themost important members of antioxidant defense mechanisms, we quantitated the activities of these enzymes inplasma of children with epilepsy receiving VPA or CBZ. Only plasma GSH‐PX activities in VPA group werehigher than those of the control group, and the differencewas statistically significant.

Brainstem auditory-evoked potentials in iron-deficiency anemia

Slight-to-moderate impairments may be observed in mental and motor developments of infants with iron- deficiency anemia. Brainstem auditory-evoked potentials provide a noninvasive means of examining the auditory aspect of the central nervous system functions. In this study the effect of iron-deficiency anemia on auditory functions was investigated by using brainstem auditory-evoked potentials. Brainstem auditory-evoked potentials of the 20 iron-deficient infants were not significantly different from those of the control group that included 20 healthy age-matched infants. Furthermore, there was not a statistically significant difference between the brainstem auditory-evoked potentials of the study group performed before and 3 months after oral iron therapy. Although we could not demonstrate a hearing loss in infants with moderate iron-deficiency anemia in this study, the relationship between severe iron-deficiency anemia and hearing loss or auditory dysfunction remains to be determined.Slight-to-moderate impairments may be observed in mental and motor developments of infants with iron- deficiency anemia. Brainstem auditory-evoked potentials provide a noninvasive means of examining the auditory aspect of the central nervous system functions. In this study the effect of iron-deficiency anemia on auditory functions was investigated by using brainstem auditory-evoked potentials. Brainstem auditory-evoked potentials of the 20 iron-deficient infants were not significantly different from those of the control group that included 20 healthy age-matched infants. Furthermore, there was not a statistically significant difference between the brainstem auditory-evoked potentials of the study group performed before and 3 months after oral iron therapy. Although we could not demonstrate a hearing loss in infants with moderate iron-deficiency anemia in this study, the relationship between severe iron-deficiency anemia and hearing loss or auditory dysfunction remains to be determined.

A Nonsurgical Approach to the Treatment of Phimosis: Local Nonsteroidal Anti-Inflammatory Ointment Application

PURPOSE We evaluated the effectiveness of topical application of nonsteroidal anti-inflammatory ointment for phimosis. MATERIALS AND METHODS A total of 52 children with phimosis was included in this study. Phimosis was graded according to severity. Of the patients 32 were given locally a nonsteroidal anti-inflammatory ointment prepared in ophthalmic usage form from sterile diclofenac sodium ampules (not commercially available). The control group comprised 20 patients given sterile petrolatum ointment. Patients were seen before and after treatment, and graded according to retractibility and appearance of the foreskin. Treatment continued for 4 weeks with 3 applications daily. RESULTS Of the 32 patients 24 responded to therapy and 8 remained unchanged or had insufficient improvement. Three controls responded to therapy and 17 did not. There were no side effects. CONCLUSIONS Nonsteroidal anti-inflammatory ointment application for phimosis may be an alternative to surgery and steroid application.

Intravenous immunoglobulin therapy in acute disseminated encephalomyelitis associated with hepatitis A infection

A 12-year-old girl was admitted to Gülhane Military Medical Academy because of fever, headache, ataxia, and drowsiness which had been present for 3 days. She had been diagnosed with HAV infection 2 weeks before admission. Vital signs were normal on examination, except for a temperature of 38.7 ° C. She was awake, but easily distractible and extremely confused with expressive dysphasia. She had bilaterally increased deep tendon reflexes, and Babinski’s sign was positive. Cranial nerves were intact and cerebellar signs were not observed. There were no signs of meningeal irritation. No motor, sensory or sphincter disturbances were observed. Blood chemistry showed elevated aspartate aminotransferase (AST) (240 U/L) and alanine aminotransferase (ALT) (285 U/L) concentrations. Serum anti-HAV IgM and IgG antibodies were positive, and markers of hepatitis B and C were negative. There was no family history for hepatitis infection and markers of hepatitis A, B and C were negative in all family members. The cerebrospinal fluid (CSF) analysis revealed a protein concentration of 75 mg/dL, with pleocytosis of 70 cells/mm 3 (30% polymorphonuclear cells, 70% lymphocytes) and glucose of 44 mg/dL. There were no oligoclonal bands and the IgG index was normal. Magnetic resonance imaging (MRI) of the brain showed bilateral frontal and insular cortical enlargement with high signal intensity in the cortical and subcortical white matter on T2 weighted images. An additional hyperintense lesion was also noted in the right thalamus (Fig. 1). These lesions were not enhanced after intravenous administration of paramagnetic contrast material. Previous lesions completely resolved on images obtained 15 days after treatment (Fig. 2). There was no serological evidence for any acute or recent infection by measles, rubella, herpes simplex, toxoplasma, cytomegalovirus or mycoplasma. She was treated with a 5-day course of IVIG (400 mg/kg/day), and her signs significantly improved by the third day of therapy. A second lumbar puncture after completion of the treatment revealed normal CSF findings. Neurological examination was normal and MRI scan findings improved 3 weeks later.

The effects of biotin supplementation on serum and liver tissue biotinidase enzyme activity and alopecia in rats which were administrated to valproic acid

Valproic acid (VPA) is a widely used and well-tolerable antiepileptic drug in epileptic patients. However, VPA has many side effects dose-dependent or non-dose-dependent. It is reported that VPA treatment may lead to biotin deficiency and low serum and liver tissue biotinidase enzyme activity (BEA). Major clinical manifestations in biotin deficiency are seborrheic dermatitis, dry skin, fine and brittle hair, and alopecia. We aimed to investigate the effects of biotin supplementation on serum and liver tissue BEA and alopecia during VPA therapy. Rats were randomly divided into 4 groups, each consisted of 15 rats (VPA-B1, VPA-B2, VPA, and control). Except the control group, all groups were administrated VPA dose of 600 mg/kg/d per oral (PO) for 60 days with 12h intervals two divided doses. VPA-B1 was administrated biotin dose of 6 mg/kg/d and VPA-B2 was administrated biotin dose of 0.6 mg/kg/d. In the third week of the study, we determined alopecia in the study groups. Alopecia was seen in the subjects of 13.3% of VPA-B1 (n=2), 13.3% of VPA-B2 (n=2), and 40% of VPA (n=6). But statistical significant effect on alopecia by biotin supplementation was not able to be determined between the study groups. In the control group, alopecia was not observed. The ratios of alopecia in the study groups were statistically higher than the control group (p=0.028). Itchiness was more obvious in the study groups compared with the control group. Serum biotin levels of the biotin supplemented groups (VPA-B1 and VPA-B2) were higher than the other groups (VPA and control group). Serum biotin levels of the VPA group were lower than the control group. There were significant decreases in the levels of serum and liver tissue BEA of the study groups compared with the control group. In conclusion we showed that VPA usage reduced the serum and liver tissue BEA and impaired the biotin utilization by affecting the liver. Partial biotinidase deficiency may lead to alopecia. It might be prevented by biotin supplementation in the patients receiving VPA therapy. We considered that further studies are necessary to find out the effective and safe biotin dose.

The effect of iron supplementation on visual-evoked potentials in infants with iron-deficiency anemia.

Flash visual-evoked potentials were studied in 20 infants with iron-deficiency anemia to determine the effect of iron deficiency on visual function by using visual-evoked potentials in this type of anemia. After iron therapy for 12 weeks, visual-evoked potentials were retested in these otherwise healthy infants. All infants showed an excellent hematological response to iron therapy. Post-treatment visual-evoked potential N2 latencies (negative deflections) decreased significantly compared to the pre-treatment values (p < 0.05). These results suggest that iron-deficiency anemia causes subclinical visual impairment, and visual-evoked potentials may be a useful non-invasive means of detecting subtle effects of nutritional deficiencies and monitoring the nutritional status of infants.

Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect.

Acute bacterial meningitis is a potentially life‐threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors. 1–3 A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered. 1

Evaluation of renal tubular function in children taking anti-epileptic treatment.

Aim:  To assess the effects of anti‐epileptic drugs on renal tubular function.

Vincristine-Induced Unilateral Ptosis in a Child

Vincristine is a vinca alkaloid used in combination with other agents in the treatment of solid tumors, lymphoma, and leukemia, as well as for idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. A dose-limiting complication of vinca alkaloids is neurotoxicity. Vincristine is the oldest and also the most neurotoxic agent in this group. Described here is the case of a 4-year-old girl with unilateral palpebral ptosis. She has been diagnosed with precursor B-cell acute lymphoblastic leukemia. Ptosis was noted on the 45th day of therapy, and the last vincristine was administered on the 28th day of protocol 1. Vincristine-induced unilateral palpebral ptosis is a novel finding. Experience with this case suggests conservative treatment, with periodic examination, especially if ptosis is mild.

Serum and liver tissue biotinidase enzyme activity in rats which were administrated to valproic acid

Valproic acid (VPA) is an antiepileptic drug widely used and well-tolerated by most of patients. Its non-dose-dependent side effects seen mostly are the temporary gastrointestinal disturbances including anorexia and nausea, and hepatoxicity. As to its dose-dependent side effects are the weight loss, tremor, skin eruption and the alopecia. In this study we aimed to put forward the biotinidase deficiency considered as a possible cause of alopecia in the rats administered with valproic acid, and the correlation between liver and serum biotinidase enzyme activities (BEA) and transaminases, albumin and serum valproic acid levels. In our study, 4 groups of which one of them was a control group, each consisting of 15 male Wistar rats was organized. 200, 400, and 600 mg/kg/day of VPA, and distilled water, two divided doses per day, were administered per orally to VPA-1, VPA-2, VPA-3, and control group, respectively, in 60 days. Their serum and liver biotinidase enzyme activities, serum AST, ALT, albumin, and valproic acid levels were measured. Alopecia was seen in the subjects of 6.6% of VPA-1, 13.3% of VPA-2, and 26.6% of VPA-3. Significant difference in the liver tissues BEA was noted only between VPA-3 and the control group. Reductions were observed both in the liver tissues BEA and the serum BEA levels, which are inversely proportional to the VPA doses. A positive correlation between the liver biotinidase enzyme activities and the serum valproic acid levels, and the negative correlation between the liver tissues biotinidase activities and the serum valproic acid levels were noted, respectively. As a conclusion, the partial alopecia which is an initial symptom of reduced biotinidase activity may also be created depending on the reduction of biotinidase activity during valproic acid therapy. The alopecia which may further be observed in the patients receiving valproic acid therapy may be prevented by means of administration of biotin in a dose of 10 mg/day.