Zahide Yalaki

Anne ve ergenlerdeki depresif belirtilerin ergen intiharları ile ilişkisi

Objectives: The aim of this study was to investigate the existence of depression symptoms, an important risk fac- tor in suicide attempts, in adolescents who attempted sui- cide and also in their mothers. OZET Amac: Bu calismanin amaci intihar girisiminde bulunan ergenlerde ve annelerinde, intihar girisiminde onemli bir risk faktoru olan depresif belirtilerin varligini arastirmaktir. Gerec ve yontem: Calismaya intihar girisimi ile basvuran 141 ergen ve anneleri alinmistir. Olgularin sosyodemog- rafik ozellikleri kaydedilmis, hastalara ve annelerine Beck Depresyon Olcegi ve Beck Umutsuzluk Olcegi uygulan- mistir.

An infant with hypercalcemia and hyperammonia: inborn error of metabolism or not? Answers

Pathological findings of this patient were mild dehydration, oral intolerance, andmetabolic acidosiswith alkaline urine and normal anion gap, hyperammonia, hypercalcemia, hypokalemia, positive urine anion gap, nephrolithiasis, and hypercalciuria. These findings were consistent with a diagnosis of distal renal tubular acidosis (dRTA). Intravenous fluid supply and oral sodium bicarbonate replacement therapy at 2 mEq/kg/day improved the metabolic acidosis, hyperammonemia, and dehydration in a few days. Potassium citrate was added for hypokalemia and prevention of urinary calculi. The serum ammonia level reduced to 97 mg/dL on the seventh day of treatment and the patient was discharged after an 18-day hospitalization. Ultimately, whole exome sequencing demonstrated a novel homozygote mutation in ATP6VOA4 gene, c.474delGinsTC (p.E158Dfs*29) (p.Glu158Asp*29). Our patient had weight gain with medication. Plasma ammonia level should be obtained for any child with unexplained vomiting, lethargy, or other evidence of an encephalopathy. Significant hyperammonia is observed in a limited number of conditions. Inborn errors of metabolism like urea cycle defect and many of the organic acidemia are at the top of list. Newborn transient hyperammonemia in differential diagnosis of newborn, and fatty acid oxidation defects may be considered in older infants. Urine organic acid analysis should be done for organic acidemia. Metabolic acidosis is not a typical feature of the urea cycle defect. Plasma amino acid analysis is helpful in the differentiation of the specific defects in this group [1]. Differential diagnosis of hyperammonia with less significant elevation in infants other than inborn errors of metabolism is transient hyperammonia of newborn, severe infection, liver failure, and urinary tract infection associated with congenital ureteral obstruction [2]. In our patient, we detected slight hyperammonia and analyzed plasma amino acid and urine organic acid tests which were found normal. Hypercalcemia is rarely seen in children and is a much less common problem than hypocalcemia. The cause of hypercalcemia is age-related with many cases underlying genetic origin. In order to provide the most appropriate treatment, the most important point is to establish the correct diagnosis promptly [3]. Causes of hypercalcemia in infants with elevated parathyroid hormone (PTH) levels include neonatal hyperparathyroidism, mucolipidosis type II, parathyroid-related pathologies, and phosphate depletion in prematurity. Causes of hypercalcemia in infants with low or suppressed PTH levels are malignancy, drug-induced, acute immobilization, genetic diseases likeWilliams and Down syndrome, idiopathic hypercalcemia of infancy, granulomatous disease like subcutaneous fat necrosis, sarcoidosis, tuberculosis, and endocrine causes like hyperthyroidism, Addison’s disease, pheochromocytoma, congenital hypothyroidism, diabetic ketoacidosis; inborn errors of metabolism like congenital lactase deficiency, Bartter syndrome, blue diaper syndrome, disaccharidase intolerance; renal causes like distal renal tubular acidosis, multicystic dysplasia, ketotic diet. Conditions with normal PTH levels are familial hypocalciuric hypercalcemia and types I, II, and III and early-onset primary hyperparathyroidism [4]. Ammonia (NH3 and NH4) is vital in maintaining the acid base status. Most NH4 is synthesized in proximal tubules. In the loop of Henle, NH4 goes into the interstitium, gets converted into NH3, and is accumulated in the medullary interstitium. Finally, NH3 diffuses into acidified urine as a buffer in the distal tubule. Both chronic metabolic acidosis and hypokalemia act as stimuli for renal ammoniagenesis and ammonia reabsorption. Because dRTA manifests as both hypokalemia and acidosis, it is reasonable that the abovementioned mechanism leads to high medullary ammonia concentration and subsequent serum hyperammonemia. This association was This article refers to the article that can be found at (https://doi.org/10. 1007/s00467-018-4018-z).

The Role of Acyclovir in the Treatment of Herpes zoster Virus Infections in Immunocompromised Children

We would like to thank you the interest of Dr. Sinan Oğuz and Dr. Nilden Tuygun in our study and your invaluable contributions. Viral antibody (19.6%) was found in the stool of 638 out of the total of 3258 patients. It was found that rotavirus was positive in 590 (18.1%) and enteric adenovirus in 48 (1.5%) of these cases (1). Positive monthly and seasonal the number (n) and percentage (%) values of enteric infections are highlighted. Many ways (fecal-oral, aerosol, etc.) of transmission of enteric diseases (2, 3), it is thought that the cause of their abundance in the region in the August may be associated with seasonal parameters. Specifying the source of rotavirus and taking the necessary measures against the ways of transmission proves to be significant. As a result of the availability of coastline appropriate for swimming and increased heat and humidity levels in the region in the summer months, people have greater chance of having contact with the sea in August. Parallel to this, it was thought that the level of marine pollution (the granting of waste water to the sea, etc.) changes might have triggered the rotavirus infections. In our study, the frequency (17.24%) of cases with rotavirus antibody positivity in the summer months (27.43%), especially in August was established (1). These results make us think that the ways of transmission of rotavirus positivity may be different. The facts that seasonal parameters might be related with enteric infections were reported in many studies such as Çelik et al. and Barril et al. studies (4, 5). It is thought that the necessity of considering many parameters in a complex way in specifying the source of many enteric infections will be beneficial in the prevention of these infections. In conclusion, specifying sources of contamination and taking the necessary measures can enable protection against the enteric infections most common in childhood.

Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children.

AIM The aim of our study was to investigate the relation of blood carboxyhemoglobin level with presentation finding and clinical properties and to demonstrate neurological and cardiological findings which are indicators of tissue hypoxia in patients followed up because of carbonmonoxide (CO) poisoning. MATERIAL AND METHODS Three hundred and twenty-five patients who were followed up because of carbonmonoxide poisoning between 2011 and 2013 in our pediatric emergency department were evaluated prospectively. Ethics committee approval was obtained for the study on 10.19.2011 (number: 0437). The carbonmonoxide levels, source of intoxication, neurological and cardiological findings and treatment methods were recorded. Blood gases and cardiac enzymes were studied and electrocardiography (ECG) was performed. The data were analysed using SPSS for windows 16.0 package program. RESULTS One hundred and sixty-eight (51.7%) of the patients were female and the median age was 9 years (11 days-17 years). Two hundred and twenty-eight (70.2%) of the patients were poisoned while using heater and 78.1% presented during winter months. The median carbonmonoxide level of the patients was found to be 24.8%. Cardiac enzymes were found to be increased in 10.5% of the patients, first degree A-V block was found in 0.6% and negative T wave was found in 0.3%. Glasgow coma score was found to be below 14 in 4.6% of the patients. A significant correlation was found between the carboxyhemoglobin levels and neurological findings, cardiological findings and lactate (p<0.05). Normobaric oxygen treatment was given to 76.3% of the patients and hyperbaric oxygen treatment was given to 23.7%. CONCLUSIONS We think that neurological disorders and cardiac findings may be closely related, since systemic involvement may be easier in carbonmonoxide poisoning in children, Glasgow coma score should be assessed in the follow-up of the patients and cardiac enzymes and serum lactate levels should be monitored closely from the time of presentation.

844 Reye’s Syndrome and Disseminated Intravascular Coagulation Presented by Rotavirus Infection

Rotavirus is one of the leading causes of severe gastroenteritis in childhood, which is an infection known to be limited to the gastrointestinal system. However, a case of extra-intestinal complication developed during rotavirus gastroenteritis is presented here. Case A five years old patient with febrile convulsion, also having complaints of vomiting, diarrhea, and fever was brought to our hospital. General condition of the patient was bad; she was unconscious and severely dehydrated. Her laboratory findings showed acidosis and renal failure; coagulation tests showed impairment. During her monitoring, gastrointestinal bleeding, increase in liver function test values, hyperammonemia, neutropenia, and hypoglycemia were developed. Rotavirus antigen was found to be positive in the gaita test. Patient’s general condition was improved by giving antibiotics, liquids, fresh frozen plasma, and thrombocites in the early stages after which she was discharged. Close monitoring of patients with rotavirus gastroenteritis in terms of extra-intestinal complications and applying appropriate treatment in the early stages may save lives.

369 Evaluation of Carbon Monoxide Poisoning in Children

Carbon monoxide poisoning is an important health problem that may lead to deaths during winters. The purpose of this study was to patients who were diagnosed with carbon monoxide poisoning. Methods 196 patients between 0–17 years of age, who were treated at the Ankara Education and Research Hospital Child Emergency Service for the carbon monoxide poisoning diagnosis between November 2011 and April 2012 were evaluated. Patients’ complaints, socio-demographic data, biochemical parameters were recorded. Findings The age median of the patients was 10.0 while 51.5% were female. The most frequent complaint was: nausea, vomiting (27.6%). Carboxyhemoglobin (COHb) level average was 25.5±10.3 (5.1–61). Serum lactate median was 2.1 (0.1–11.2). Neurological findings were determined in 22.4% of the patients. Normobaric oxygen treatment was given to 75.5% of the patients, while 24.5% were given hyperbaric oxygen treatment. A positive correlation was determined between Lactate and COHb levels (P= 0.01, r= 0.228). A negative correlation was determined between Glaskow Coma Scale and COHb levels (p=0.01, r= –0.383). Patients with neurological findings had an average COHb level at 35.7% ±16, patients without neurological findings had an average COHb level at 22.5% ±7.7 (p=0.001). Blood lactate level was higher in patients with neurological findings than patients without neurological findings (p= 0.01). Results COHb level in carbon monoxide poisoning cases is an important indicator for the existence of neurological findings. Since increase in lactate is correlated with the poisoning level and neurological findings, high lactate levels should be taken into consideration.

Yenidoğan döneminde preseptal selülit Olgu Sunumu

Ozet Yenidogan doneminde preseptal selulit nadirdir Burada dogustan dakriyostenoz zemininde gelisen hemofilus influenzaya bagli preseptal selulit tanisi alan bir yenidogan olgusu sunulmustur Ondokuz gunluk erkek hasta sol gozde akinti sislik ve kizariklik nedeni ile hastanemize basvurdu Fizik muayenesinde sol goz cevresi odemli hiperemikti akintisi mevcuttu Kraniyoorbital tomografisinde dogustan dakriyostenoz saptandi Hastaya damardan ampisilin ve seftriyakson baslandi Goz kulturunde beta laktamaz negatif hemofilus influenza uredi Izlemde ldquo;probing rdquo; yapilmasi planlandi Hemofilus influenza yenidoganda preseptal selulitin nadir etkenlerindendir Hastalik zemininde dogustan dakriyostenoz gibi anomaliler olabileceginden cocuk goz doktorlari ile birlikte calismak yararli olacaktir Boyle olgularda genel anestezi altinda uygulanan ldquo;probing rdquo; ameliyatlarindan basarili sonuclar alinmaktadir Turk Ped Ars 2010; 45: 295 8 Anahtar sozcukler: Dakriyostenoz hemofilus influenza preseptal selulit yenidogan