Sukru Arslan

Childhood brucellosis is still a severe problem in the eastern region of Turkey.

Of the 103 patients, 52 (50.4%) were girls, 51 (49.6%) were boys, and ages ranged from 20 months to 16 years (8.31± 3.58 years). The mean period between onset of symptoms and admission to hospital ranged from 2 days to 3 years (68.0± 192.8 days). A positive family history for brucellosis was noted in 14 (13.5%) patients. The most frequently observed symptoms and signs are summarized in Table 1. The most commonly observed symptoms and signs were fever, arthralgia, malaise, hepatosplenomegaly, hepatomegaly and arthritis. Neurobrucellosis was diagnosed in one (0.9%) patient. Anaemia was observed in 18 (17.4%) patients; leukocytosis in 15 (14.5%); and leukopenia in eight (7.7%) patients. Erythrocyte sedimentation rate was studied in 84 (81.5%) patients; it was found to be high in 61.9%. Brucella agglutination test was 1/160 or higher in all patients; it was 1/160 in 17 (16.5%) patients, 1/320 in 28 (27.0%) patients, 1/640 in 41 (39.8%) patients, and 1/1280 in 17 (16.5%) patients. Brucella was cultured in only three patients. It was isolated from both blood and bone marrow in two patients and from blood in one patient and also from cerebrospinal fluid in one of two patients who had positive blood and bone marrow cultures for Brucella.

Urinary tract infection and antibiotic susceptibility in malnourished children.

In this study, 31 (30%) cases of urinary tract infection(UTI) of 103 patients with malnutrition, who were admitted to ourhospital, were investigated prospectively. Our purpose was to determinethe frequency of UTI, species of bacteria caused toinfection and their antibiotic susceptibility in infants withmalnutrition. The mean age of the patients with UTI was 11.5 ±7.6 months (ranging 50 days-30 months). The main symptoms were fever,vomiting, diarrhea, cough, and seizures. The mean body weight was 5.8± 1.9 kg (2–10 kg), and height was 67.5 ± 7.8 cm(58–85 cm). Seven of them had mild, 11 had moderate, and 13 hadsevere malnutrition. The most common isolated microorganism from urinecultures was Escherichia coli (54.8%). Most strains ofEscherichia coli were resistant to co-trimoxazole(82.3%), ceftriaxone (17.6%), cefotaxime (17.6%),and ciprofloxacine (17.6%), but none of them were resistant togentamicin. In conclusion, we would like to emphasize that UTIpredominantly by gram negative microorganisms are frequent in theinfants with malnutrition, and these microorganisms are mostly resistantto co-trimoxazole which is used commonly in practical medicine andprophylaxis.

Cranial computed tomography in purulent meningitis of childhood.

The cranial computed tomography (CT) findings of 48 children with purulent meningitis were examined, prospectively, to determine the importance of cranial CT findings on the prognosis of childhood meningitis, in a developing country. The age of children ranged from 2 months to 13 years. Of 48 patients, 29 (60.5%) survived without sequelae, 13 (27%) survived with sequelae, and six (12.5%) died. Cranial CT was normal in 21 (43%) patients of 48 children with meningitis at admission. Abnormal CT findings were detected in 10, 11, and 6 children in the groups of survived without sequelae, survived with sequelae, and deaths, respectively, at admission (p < .05) We found that CT scan results were correlated with neurological signs (p < .05). At least one or more cranial CTs were was re-taken in children in whom the first CT revealed abnormal findings; we did not find a statistically significant difference for the follow-up CT findings between the groups (p > .05). Hydrocephalus and subdural effusion were the commonest abnormal CT findings. In conclusion, our findings showed that cranial CT may safely be used to detect intracranial complications of meningitis in childhood and the ratio of sequelae and death were more common in children with abnormal cranial CT than those of normal cranial CT findings. Additionally, there was a positive correlation between CT scan results and neurological signs

Report of eight children with amitraz intoxication

Many pesticides are formulated in organic solvents. An example is amitraz, one of the formamidine groups of pesticidal chemicals. It is commonly used for the treatment of generalized demodicosis in dogs and for the control of ticks and mites in cattle and sheep. In this article, the clinical and laboratory findings of eight children with amitraz intoxication are reviewed. The purpose was to enlighten the findings of amitraz intoxication in children. Of the eight patients, five (62.5%) were boys, three (37.5%) were girls, and the ages ranged from 1 to 4 years. All children accidentally ingested amitraz orally, with no dermal exposure. The most common observed signs were decreased consciousness and bradycardia. Leukocytosis, hyperglycemia, hypernatremia, increased serum aspartate transaminase level, and prolonged partial prothrombin time were diagnosed in children. None of the children had hypothermia, hypotension, or convulsion and none of the patients died. The findings show that the initial signs and symptoms of acute amitraz intoxication appeared severe but they disappeared, with only supportive care needed in most cases within a few days.

Effects of High-Dose Methylprednisolone Therapy on Coagulation Factors in Patients with Acute Immune Thrombocytopenic Purpura:

Autoimmune thrombocytopenic purpura (ITP) is a disease that presents with skin and mucous membrane bleeding due to thrombocytopenia. In the literature, there are a few studies about the effect of high-dose steroid therapy on coagulation tests in different diseases, but their results are still controversial. In this study, coagulation parameters were investigated that might have a role in hemostatic compensation in childhood acute ITP before and after high-dose methylprednisolone (HDMP) treatment. The study includes 21 children age 1.5 to 14 years with acute ITP and 21 healthy age-matched control subjects. All patients with acute ITP received HDMP for 7 days. Before and after HDMP treatment (0 and 8 days) prothrombin time, partial thromboplastin time, fibrinogen, Protein C, Protein S, antithrombin III, and the levels of factor II (FII), FV, FVII, FVIII, FIX, FX, FXI, and FXII were studied in all subjects. The results were compared with those of the control group. Pre-treatment Protein C and Protein S levels in the patient group were significantly lower than those in the control groups (p<0.05). Protein S and Protein C levels were significantly improved after HDMP treatment in patient group. There were lower FV, FVII, FX values in the patient group compared to the control groups on admission. There was no difference in AT III and fibrinogen levels before and after treatment. As a result, some changes in the coagulation system associated with thrombocytopenia were observed in patients with acute ITP. These changes may be accepted as compensatory mechanisms to maintain hemostasis.

Immunoglobulin subgroups in children with febrile seizures

Background : The aim of the present study was to determine whether or not there was a role for immunoglobulin (Ig) or IgG subgroups in the pathogenesis of febrile seizures (FS).

Multiple metastatic tuberculous abscesses in a severely malnourished infant.

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Serum immunoglobulins and immunoglobulin G subclasses with recurrent wheezing

In this study serum immunoglobulins (Ig) and IgG subclasses were measured in 42 patients (ranging 9 month-6 year) with recurrent wheezing and in 37 healthy children determined the relationship between serum Igs and recurrent wheezing. Patients were divided into two groups according to the age [9 month-2 year (n: 15), and 2–6 year (n: 27)]. In the patients placed in 9–24 month age group, serum lgG4 level was found to be lower than controls (p<0.05). But there was not a significant difference in mean serum concentrations of total IgG, IgA, IgM, IgE, IgG1 lgG2 and lgG3 subclasses between the groups (P>0.05). In the 25 month-6 year age group the mean IgE level was increased compared to the control while lgG3and lgG4 levels were decreased (p<0.05). On the other hand, in the 9–24 month age group there was no significant difference between the patients and controls for IgG subclasses deficiency (P>0.05). However, significant difference in IgG subclasses deficiency was present between the patients and controls in the 25 month-6 year group (P<0.001). In conclusion, our findings suggest that wheezing in childhood may be associated with low lgG3and /or lgG4, and in older children high IgE level may be a part of pathogenetic mechanism in patients with recurrent wheezing.

Doppler Echocardiographic Evaluation of Pulmonary Artery Pressure in Children with Acute Pneumonia

In this prospective study 37 children (ranging 2 months-15 years) with acute pneumonia were evaluated by Doppler echocardiography for the presence of pulmonary hypertension (PH). The goal of this study was to determine the frequency of PH in children with acute pneumonia because the diagnosis of PH influenced the treatment of pneumonia in these patients. The patients who had more than 35 mmHg of systolic pulmonary arterial pressure were considered to have PH. In our study PH was found in 15 (40.5%) of 37 patients. We did not find any significant difference for the parameters including the age, weight, height, clinical symptoms and signs (fever, cough, dyspnea, tachycardia and tachypnea etc.), and laboratory findings such as hemoglobin, PCO2, HCO3 and PO2 between the patients with and without PH (p>0.05). However, there was a significant difference in cyanosis, cardiac failure, blood pH level and O2 saturation measured by pulse oximetry between the patients with and without PH (p<0.05).

Modified Primary Closure Method for the Treatment of Pilonidal Sinus.

OBJECTIVE Pilonidal sinus (PS) is considered to be the acquired disease of especially in the sacrococcygeal region. Various primary or secondary or flap methods, accompanied by one of local curettage, phenol application, electro-cauterization and total sinus excision methods, are used for the treatment of pilonidal sinus. However, currently there is not a single widely accepted treatment method. MATERIALS AND METHODS Ninety-eight patients who had operation for PS in Atatürk University, Department of General Surgery between January 2012 and August 2014 were included in this study. The patients were categorized into two groups: first, the patients undergone total sinus excision with primary closure (Group 1), and second, patients undergone total sinus excision with modified primary closure (MPC) (Group 2). Among all 98 patients participated in this study, age, sex, type of operation, duration of operation, amount of excised skin, duration of postoperative stay at hospital and complications were evaluated. RESULTS Forty-four patients (44.9%) underwent primary closure method, while 54 patients (55.1%) underwent MPC method. Mean duration of operation was 39.1 (30-60) minutes, mean diameter of excised material was 9.3 (8-11) cm(2) and mean duration of stay at hospital was 1.4 (1-3) days for the patients in the first group. Meanwhile, duration of operation was 52.2 (35-70) minutes, mean diameter of excised material was 2.6 (2-4) cm(2) and mean duration of stay at hospital was 1.6 (1-3) days for the patients in the second group. There was statistically significant difference between the two groups by means of duration of operation, dehiscence of surgical wound, recurrence and development of general complications (p<0.001, p<0.05, p<0.05 and p<0.005, respectively). According to the multivariate analysis, during surgical treatment of pilonidal sinus, primary closure method increases the rate of complication 6.65 times and MPC method increases the duration of operation 1.2 times. CONCLUSION We hereby suggest that MPC method could be a good alternative for surgical treatment of PS, because it causes fewer complications and recurrence.