Tahir Dalkıran

PREMARITAL SCREENING TEST RESULTS FOR β-THALASSEMIA AND SICKLE CELL ANEMIA TRAIT IN EAST MEDITERRANEAN REGION OF TURKEY

Hemoglobinopathies are common diseases in Mediterranean region of Turkey. In this study, the results of a 3-year premarital screening program are reported in Kahramanmaras province, which is located in East Mediterranean region. A total of 48,126 persons were screened in this program. Hematological analyses and electrophoresis were done to identify carriers. The prevalence of β-thalassemia trait and of sickle cell anemia trait, which were 2.1% and 0.5% in Turkey, were found to be 2.8% and 0.4%, respectively, in our study. Of the carriers of the β-thalassemia trait, 82% had high hemoglobin A2, 34% had high hemoglobin F, and 18% had both high hemoglobin F and hemoglobin A2. β-Thalassemia trait in Kahramanmaras is slightly higher than the average rate in Turkey. However, sickle cell anemia trait is similar to Turkeys averages.

A Retrospective Analysis of Patients Monitored in a Pediatric Intensive Care Unit and an Investigation of Factors Affecting Mortality

Introduction: The purpose of this study was to retrospectively evaluate patients admitted to the pediatric intensive care unit in order to determine the mortality data of our clinic and to identify the risk factors that affect mortality. Methods: The data of 454 patients aged 1 month-18 months hospitalized for more than 24 hours at the pediatric intensive care unit between December 1, 2013, and June 30, 2015 were retrospectively evaluated by using the hospital records. Results: Of the 454 patients included in the study, 220 patients (48.5%) were female and 234 were male (51.5%). The most common reason for admission to the pediatric intensive care unit was respiratory system diseases (110 patients, 24.2%). A total of 213 (46.9%) patients had also a concurrent chronic disease during their stay at the pediatric intensive care unit. One hundred thirty four (29.5%) of the patients required mechanical ventilation, and the average duration of mechanical ventilation was 13 days (1-114). Thirty (22.3%) of these patients were identified as having developed complications related to mechanical ventilation. The mortality rate was found to be higher in patients requiring vasoactive drug support (p<0.05). However, the presence of chronic disease was found to have higher effect on mortality than the need for vasoactive drug support (p<0.05). According to the evaluation of the mortality scoring, the Pediatric Risk of Mortality (PRISM) score of patients who died was statistically higher (9.1±7.6) than that of other patients (p<0.001). It was determined that mortality rate was significantly increased in patients requiring blood and blood products (p<0.01). The mortality rate at our pediatric intensive care unit was determined as 15.6%. Conclusion: Logistic regression analysis of the factors that affect mortality indicated that the need for mechanical ventilation support, higher PRISM scores, and the need for blood/blood product transfusions statistically significantly increased the mortality rate.

Acute Mercury Poisoning in a Group of School Children.

Objective Elemental mercury is a toxic liquid element that is used widely in the home, medicine, agriculture, and industry. It is readily vaporized and inhaled at room temperature. Thereby, inhalation can cause acute or chronic poisoning. Mercury can be found in environmental naturally find but some dangers sources give rise to contaminations. It can be very dangerous to all living organisms, especially children. Methods This study presents the features of mercury poisoning in a group of pediatric cases. Data were obtained for 29 pediatric cases exposed to elemental mercury in a high school chemistry laboratory in Turkey. Patients with a blood mercury level exceeding 10 μg/L or a urine mercury level exceeding 15 μg/L were considered to have mercury poisoning. The patients were treated with 2,3-dimercaptopropane sulfonic acid or D-penicillamine. Results Twenty-nine children with mercury poisoning were admitted to the hospital. The median duration of exposure was 58 (range, 15–120) minutes. Ten (29%) children were asymptomatic. Physical and neurological examinations were normal in 19 (65.5%) children. The most common presenting complaint was headache. The most common neurological abnormality, partly dilated/dilated pupils, was present in 9 (31%) children. Mercury levels were measured in blood samples every 5 days, and the median blood mercury level was 51.98 (range, 24.9–86.4) μg/L. There was a positive correlation between the duration of exposure and maximum blood/urine mercury levels (P = 0.001). Conclusions Elemental mercury exposure is potentially toxic; its symptomatology varies, especially in children. Secure storage of mercury and other toxic substances and provision of information about this subject to individuals who might be exposed to mercury and their families might help to prevent mercury poisoning.

Akrep Sokmalarında Doksazosin Etkinliği: Üç Olgu Sunumu

Akrep sokmasi, cocuk yogun bakim unitelerinde takip ve tedavi gerekliligi olan ve zamaninda mudahale edilmedigi takdirde olumcul olabilen cocukluk caginin onemli zehirlenme nedenlerindendir. Cinsine gore farklilik gosteren akrep venomu, isirilan bolgede lokal olarak yada sistemik kardiyovaskuler, norolojik, hematolojik sistem tutulumuna ait belirtilere neden olabilir. Bu bulgular arasinda hipotansiyon/hipertansiyon, solunum yetmezligi, hemoliz, bobrek yetmezligi ve kanama diyatezi sayilabilir. Agir klinik tablo ile gelen akrep sokmasina maruz kalmis kusma, soguk terleme, tasikardi gibi sempatik aktivasyon bulgulari olan cocuklarda vazodilator ilac olarak prozasin onerilmektedir. Literaturde diger bir alfa bloker olan doksazosin kullanimina dair net veri bulunamamistir. Bu yazi ile 14, 18 aylik ve 3 yasinda ekstremite distallerinden (sol el, sol el, sag ayak) akrep sokmasina maruz kalarak basvuran ve sempatik aktivasyon bulgulari olan 3 vakada doksazosin tedavisinin etkinligini vurgulamak istedik. Anahtar Kelimeler: Akrep sokmasi, doksazosin

Spontan Şilotoraks (Bir Olgu Sunumu)

Şilotoraks, duktus torasikus ya da dallarinin bozulmasi ya da tikanikligina bagli olarak plevral araliga siloz sivinin sizmasidir. Oncesinde herhangi bir yakinmasi bulunmayan 3,5 yasinda erkek hasta, oksuruk ve hiriltili solunum sikayetleriyle basvurdu. Akciger grafisinde sol akcigerde konsolidasyon ile birlikte plevral efuzyon saptandi. Kapali sualti drenaja alinan hastanin efuzyon sivisinin gorunumu sut beyaz renkte, pH 7, dansite 1015, trigliserit 2101 mg/dl, glikoz 168 mg/dl, lokosit 590 mm3 bulundu. Plevral efuzyon sivisi kulturunde ureme olmadi. Bu bulgularla hastaya silotoraks tanisi konuldu. Yagdan fakir diyetle birlikte somatostatin 3 μgr/kg/saat baslandi. Somatostatin tedavisine 2 hafta devam edilen hasta 25. gunde toraks tupu cikarilarak taburcu edildi. Şilotoraksin cok nadiren de olsa spontan gerceklesebilecegi, tedavide somatostatin kullaniminin cerrahi mudahale ihtiyacini azaltabilecegi vurgulandi.A-19-year old male patient complained of shortness of breath. Aspiration of the pleural fluid revealed chylothorax. Right chest tube was inserted. His ABG showed hypoxaemia with relative hypercarbia. He underwent right thoracotomy and thoracic duct ligation under general anaesthesia and double lumen endobroncheal intubation. During surgery he lost 1.5 L of blood and 4 L chyle. He was transferred to the SICU intubated and on mechanical ventilation. On the subsequent days chyle leak was reduced to a minimum of 10 ml/hr. On the 9th postoperative day the patient was extubated. He was receiving TPN 2600 kcal/day. He was transferred to the normal floor on the 15th day. After 7 day he was readmitted, his chest showed severe lung fibrosis and consolidation. His ABG showed severe hypercarbia (PaCO2 = 126 mmHg). The patient was intubated. His condition deteriorated and he was considered for lung transplantation. No donor was available. Later he arrested and died. Anaesthesia and surgical management of spontaneous chylothorax is challenging. The mortality rate is high.

A Case of Acute Disseminated Encephalomyelitis Presenting with Decreased Strength in Lower Extremities and Meningitis

Mehmet Davutoglu, Fuat Ozkan, Tahir Dalkiran, Cengiz Dilber, Ekrem Guler, Yalcin Goksugur Kahramanmaras Sutcu Imam Universitesi Tip Fakultesi, Cocuk Yogun Bakim Unitesi, Kahramanmaras, Turkiye Kahramanmaras Sutcu Imam Universitesi Tip Fakultesi, Radyoloji Anabilim Dali, Kahramanmaras, Turkiye Kahramanmaras Sutcu Imam Universitesi Tip Fakultesi, Cocuk Sagligi ve Hastaliklari Anabilim Dali, Kahramanmaras, Turkiye Kahramanmaras Sutcu Imam Universitesi Tip Fakultesi, Cocuk Norolojisi Bilim Dali, Kahramanmaras, Turkiye Kahramanmaras Sutcu Imam Universitesi Tip Fakultesi, Cocuk Acil Unitesi, Kahramanmaras, Turkiye