Selvi Kelekçi

The evaluation of children with prolonged cough accompanied by American College of Chest Physicians guidelines

In children, coughs lasting longer than 4 weeks are considered to be chronic, with etiological factors varying widely.

Use of complementary and alternative medicine in children who have no chronic disease

AIM In this study, we aimed to evaluate complementary and alternative methods of medicine, determine the frequencies of usage of these methods and investigate the factors which have an impact on their usage. MATERIAL AND METHODS The study was conducted between October, the 15(th) and November, the 15(th) 2012. Approval was obtained from the local ethics committee (08.10.2012/732). The study form prepared was applied to the mothers of the children who presented to our general outpatient clinic and had no chronic disease. The data were recorded in SPSS for Windows v.16 program. Descriptive statistics, chi-square, Mann-Whitney U and logistic regression analyses were applied. A p value of <0.05 was considered significant. RESULTS Two hundred and six children were included in the study. Complementary and alternative medicine was used in 83% of the patients. Wearing an evil eye (45%) bead and prayer (35%) to protect from the evil eye were the most commonly used methods. The most common medical conditions which caused to use of complementary and alternative medicine included anemia, diarrhea, constipation and cough. Belief-based application were being used in 73% of the patients and herbal methods were being used in 57%. In 18% of the patients, interventional methods including cutting had been performed. No difference was found between the patients in whom these methods were used and not used in terms of familial income, education levels of the parents, family type and residence (p>0.05). CONCLUSIONS Complementary and alternative methods of medicine are applied substantially frequently in children. Physicians should have information about these methods in terms of their effects and side effects and warn families and especially mothers about potential risks.

Bacillus Calmette-Guérin is a preventive factor in mortality of childhood tuberculous meningitis.

OBJECTIVES Studies have been done that have focused on the efficacy of bacillus Calmette-Guérin (BCG) vaccination in the prevention of cases of childhood tuberculous meningitis (TBM). However the efficacy of the vaccination in the prevention of mortality has not been sufficiently evaluated. This study aimed to determine the main features of TBM cases in childhood and to evaluate the factors related to mortality, proving the protective effect of BCG vaccination in childhood TBM. METHODS In a retrospective approach, all consecutive cases of TBM in children that occurred between 1997 and 2005, at Dicle University Hospital, were studied. The following data were evaluated: demographic aspects, admission symptoms, radiology and laboratory findings, BCG vaccination status, tuberculin skin test (TST) positivity, and mortality rates. RESULTS In total, 172 cases of childhood TBM were evaluated (mean age 53.3±55.7 months; 109 boys (63.4%)). The majority of these cases (70.4%) had typical TBM symptoms on admission. BCG vaccination data were available for 152 (88.4%) cases and 29 of them (19.1%) were positive. The TST was performed for 143 patients (83.1%) and 28 (19.6%) were found positive. Hydrocephalus was identified in 118 patients (68.6%) on computed tomography examination. A shunt was placed in 79 cases (45.9%). In total, 24 patients (14.0%) died in the hospital. TST negativity was a significant factor for mortality (p=0.012). BCG positivity was found to be a preventive factor from mortality (p=0.05). CONCLUSIONS BCG vaccination is effective in the prevention of TBM-associated mortality in childhood. TST negativity may be a sign of a poor prognosis in TBM cases.

The Clinical Findings and Prophylactic Treatment in Children with Factor X Deficiency

Factor X (FX) is the component of both extrinsic and intrinsic coagulation cascade and is the first enzyme of the common pathway which results in thrombus. Congenital FX deficiency (FXD) is an extremely rare coagulation defect. In this study, we aimed to investigate the clinical and laboratory data of the patients diagnosed with FXD. The files of the 15 patients (7 female, 8 male) diagnosed and followed up for FXD within the last 4 years were evaluated retrospectively. The mean age of the patients was 29 months (min-max:1-144 months). The most presenting complaints were easy bruisability (n = 8; 53%) and epistaxis (n = 8; 53%). FX levels were <1% in six patients, 1–5% in four patients, and >5% in five patients. Heparin added-Protrombin Complex was used for prophlaxy (n = 11; 73%). Any treatment-related complication was not observed. Heparin-added PCC can be used safely for effective prophlaxy. We suggest that family history is important when considering prophlaxy and in patients with life-threatening bleeding or with FXD sibling the prophlaxy should be introduced in the early course.

Diyarbakır yöresi Ailevi Akdeniz Atesli çocuklarda MEFV gen mutasyon sıklıkları

Cocukluk caginda fi zik muayene ve laboratuar yontemleri ile netlestirilmeden yuksek doz D vitamini kullanilmasi onemli yan etkilere yol acabilmektedir. Bu olgu sunumunda dort ay icinde gelisme geriligi nedeni ile bes kez D vitamini ampul (300.000 U) verilen 13 aylik kiz cocugunun klinik ve laboratuar bulgulari degerlendirilmistir. Iatrojenik subklinik D hipervitaminozu tanisi oyku, laboratuar ve radyolojik bulgularla konuldu. Tetkiklerinde hiperkalsemi, parathormon dusuklugu, 25(OH) D vitamin duzeyinin yuksekligi, hiperkalsiuri ve meduller nefrokalsinozis saptandi. Bu olgu sunumunda yanlis ve gereksiz yuksek doz D vitamini kullanimi ve komplikasyonlarinin degerlendirilmesi amaclanmistir.Brucella infection is a systemic disease. It rarely causes local infections like hepatitis in gastrointestinal system. In this article we would like to present an acute hepatitis case related to brucella infection that followed up in our clinic. A male, 30 year-old patient hospitalized due to common muscle pain, high fever and vomiting. During the physical examination the patient\s skin, scleras and mucosal membranes were icteric, the liver was 2-3 cm palpable and tender. Laboratory fi ndings were as follows: AST:1190 U/L; ALT:715 U/L; GGT:961 U/L; ALP:369 U/L; total bilirubin:4.6 mg/dL; direct bilirubin:2.1 mg/dL. Viral markers were found to be negative. We started treatment with streptomicine and doxicycline since, the patient\s standard brucella tube agglutination test was positive (1/60) and brucella spp produced in his blood culture. From the second day of the treatment, we started to get clinical response. On the 17th day of the treatment, he discharged from the hospital because ALT, AST and bilirubine level were found normal and his treatment was completed to the 8 weeks. Brucella is continuing to be an important health problem especially who live in surrounding countryside and have to keep in mind in the differential diagnosis of the acute hepatitis.Adnexal masses have been more frequently detected after common use of ultrasonography (USG). In this study follow-up and management protocol of an adnexal mass during pregnancy was reviewed in the light literature fi ndings. Adnexial masses during pregnancy are managed according to preliminary diagnosis, pregnancy weeks, symptamotology, USG and examination fi ndings and family\s preference. Due to complication risk of surgical operation in pregnancy, appropriate treatment protocols should be prepared in order to fi nd best approaches. In conclusion, adnexes should be carefully examined with obstetrical USG and indication for surgical operation should be made more carefully.

Gene Polymorphisms of Adducin GLY460TRP, ACE I/D, AND AGT M235T in Pediatric Hypertension Patients

Background Hypertension is a major global public health problem that affects both pediatric and adult populations. ACE I/D, AGT M235T, and ADD Gly460Trp polymorphisms are thought to be associated with primary hypertension. In the present study, we examined the frequency of these polymorphisms in a pediatric population with secondary hypertension. Material/Methods Included in the study were 58 hypertensive and 58 normotensive pediatric patients. ACE I/D and AGT M235T polymorphisms are determined by conventional PCR; ADD Gly460Trp polymorphism was investigated using PCR amplification of genomic DNA. Results There were significant differences between the control group and pediatric hypertensive group in terms of ACE I/D (P<0.05) and AGT M235T (P<0.05) polymorphisms, but there were no differences in ADD Gly460Trp (P>0.05) polymorphism. Conclusions We suggest that RAS gene polymorphisms (ACE-I/D, AGT M235T) are significantly associated with susceptibility to diseases that lead to secondary hypertension.

A case of perineal ecthyma gangrenosum.

Ecthyma gangrenosum is a skin lesion associated with Pseudomonas aeruginosa. A previously healthy one-year-old boy who had been diagnosed with varicella 10 days ago was admitted to our hospital with complaints of diarrhea, green ear discharge and new lesions in the diaper area. Intravenous meropenem and amikacin had been previously initiated. Physical examination revealed greenish, well bordered necrotic ulcers on both gluteal areas and the perianal area. Pseudomonas aeruginosa grew in wound culture. A colostomy was opened due to recalcitrant diarrhea and ulcers. The patient remitted in one month and was discharged. T lymphocyte subgroups and immunoglobulins were found to be normal on immunologic evaluation. We presented this case to draw attention to the fact that ecthyma gangrenosum due to Pseudomonas aeruginosa may occur in the diaper area and that sepsis due to Pseudomonas should be investigated.

Cardiac Tamponade may be the First Symptom of Leukemia

Acute myeloblastic leukemia (AML) is originating from hematopoietic precursor cells. CD7 is expressed in 30% of AML cases and is associated with poor prognosis in myeloid malignancies [1,2]. Pericardial effusion complicated by cardiac tamponade is a life-threatening condition is quite rare as the initial symptom in cases with AMLM4 [3,4]. Pericardial effusion can be observed during the course of the leukemiawhile it can also develop secondary to infectious, hemorrhagic causes as well as leukemic infiltration. It is especially associated with chemotherapeutics such as bleomycin, all-trans-retinoic acid, and cyclophosphamide [5]. In this report, it was aimed to increase the awareness of the fact that pericardial tamponade may sometimes be the first sign of leukemia. A 7-year-old boy in toxic appearance presented with fatigue, respiratory difficulty for 1 month. He was hypotensive, tachypneic, and tachycardic. His growth and development were consistent with his age. Respiratory examination revealed fine crackles at the base of the lungs. His heart sounds became muffled and hepatosplenomegaly was detected. Chest X-ray demonstrated increased cardiothoracic index. Transthoracic echocardiography showed pericardial effusion and diastolic right atrial collapse (Figure 1). Pericardiocentesis was performed. Direct examination of the exudative fluid revealed leukemic cells. Complete blood count revealed, hemoglobin level 8 g/dL, platelet count 35 × 106 per mm3, leukocyte count 7,7 × 10 mc/L. Serum lactate dehydrogenase: 1995U/L (normal 125–243U/L), other biochemical tests were normal. According to immunophenotyping study and bone marrow aspiration; the patient was diagnosed with CD7+ AMLM4 (French-American-British classification). Based on AML-BFM-2004 protocol, induction chemotherapy was begun. At the tenth day of the therapy, pericardial fluid was dramatically decreased.The patient now is at thefirst year ofmaintenance therapyof theAML-BFM2004 treatment protocol and healthy. Inchildhood,AMLsexpressionof lymphoid-associated surfaceantigens is amarker of poor prognosis [1]. AML, especially subtypeM4, associatedwith CD7 has a particular worse prognosis with a lower complete remission rate [6]. When complications of leukostasis known as a severemedical emergency necessitating rapid treatment, such

Surgical Outcome of Bronchiectasis in Children: Long Term Results of 60 Cases

BACKGROUND Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis. METHODS We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome. RESULTS There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method. CONCLUSIONS Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

Kan grubu uyuşmazlığı bulunmayan yenidoğanlarda kan değişimi sonuçları

Objective: Hyperbilirubinemia is a common problem of neonatal period that has high morbidity and mortality. Blood exchange is the most effective and urgent treatment modality for very high bilirubin levels that can lead to neurotoxicity called as kernicterus. The aim of this study was to compare 90 minutes exchange transfusion with that of 120 minutes.