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Kawasaki disease shock syndrome (KDSS) is a rare disease characterized by cardiovascular collapse that requires aggressive supportive and immunomodulatory therapy. The purpose of this report is to highlight our management strategies in KSSS patients. Patients who were followed up with a diagnosis of Kawasaki disease in intensive care unit and those who met the criteria for Kawasaki disease shock syndrome were included in the study. Data were obtained retrospectively from hospital records. Between 2005 and 2020, 5 patients with Kawasaki disease were followed up in the pediatric intensive care unit. Three children in the adolescent age group were diagnosed with Kawasaki disease shock syndrome. Two patients had severe coronary artery dilatation, one patient required therapeutic plasma exchange due to multiple organ failure. Kawasaki disease shock syndrome is a serious, life-threatening form of Kawasaki disease and should be suspected in children with severe inflammation and significant cardiac involvement. Administration of plasmapheresis in addition to steroid therapy appears to be effective in controlling severe disease and should not be delayed.

Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves’ disease but it sometimes occurs in euthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completely understood. Autoimmunity against putative antigens shared by the thyroid and the orbit plays a role in the pathogenesis of disease. There is an increased volume of extraocular muscles, orbital connective and adipose tissues. Clinical findings of thyroid-associated ophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. To assess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflecting inflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemic steroid and/or orbital radiotherapy are the main treatments. In inactive disease with proptosis, orbital decompression can be preferred. Miscellaneous treatments such as immunosuppressive drugs, somatostatin analogs, plasmapheresis, intravenous immunoglobulins and anticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often needed after treatment.

Objective: The data reflecting adverse effects seen during the treatment of nephrotic syndrome (NS) in Turkey are limited. In this study, we aimed to evaluate the side effects of treatment of NS patients observed at our clinic. Material and Method: We retrospectively reviewed the data of 206 patients with NS (126 male; 80 female) followed up at the Pediatric Nephrology outpatient clinic of the Istanbul University Istanbul Medical Faculty between 1986-2010. Results: Mean age of 206 (126 male, 80 female) patients at the time of admission was 3.8±2.8 years (range: 0.2-13.8). During follow-up, 171 patients (83%) experienced at least one side effect due to any of the drugs. The most frequent side effects of steroid treatment in order of decreasing frequency were cushingoid appearance (52%), hypertension (23.4%), growth retardation (17%), cataract (6.8%) and osteoporosis (6.8%). Total duration of steroid use and steriod dose were higher in the patients who suffered from growth retardation, osteoporosis, cataract, hypertension than in those who did not suffer these side effects (p<0.05). Additionally, the patients with growth retardation had a higher relapse rate than in those without growth retardation (p=0.023). Neutropenia was detected in 13 (41.9%) patients who used cyclophosphamide, while in 5 (29.4%) patients who used cyclosporine A hypertension was observed. Conclusion: Adverse effects due to treatment of NS are seen in most of the patients with the diagnosis of nephrotic syndrome. The most serious adverse effects of steroids are growth retardation, osteoporosis, cataract and hypertension. These side effects were found to be related to duration of steroid treatment and total dose of steroids. Patients should be evaluated for these side effects periodically. [ABSTRACT FROM AUTHOR]

Spinal epidural hematoma is a rare clinical disorder that might result in permanent neuro logical deficit and when untreated. We present a 59 year old male admitted to our emergency department with back pain falling to the walnut tree, and paraplegia, and being diagnosed with do not make the intra-channel compression in the T12 vertebral burst fractures and spinal epidural hematoma. [ABSTRACT FROM AUTHOR]

Objectives: In order to maximize the benefits from steroids, patients should understand treatment with this drug. The aim of this study was to investigate inpatients' compliance to steroid treatment. Materials and methods: This study was carried out from April to June 2005 on a total voluntary 118 inpatients in internal medicine clinics of a university hospital. The data were collected using by a questionnaire form and data analysis was performed using frequency tables and chi-square tests. Results: The mean age of the subjects was 48.94±14.72 years and 70.3% of them was female. With regard of educational status, 44.9% of patients were elementary school graduates. A total of 45.8% reported that they had received information about steroids from a health professional. Although 99.2% - 94.6% of subjects knew the correct drug scheduling, only 52.5% knew how to calculate steroid dose. Additionally majority of them (83.1%) did not know side effects of drug and prevention from their side effects. Conclusion: According to our results, patients using steroid did not have sufficient information for adherence to this drug therapy and the patients experienced various problems. In order to relieve these problems, the patients should be better trained about steroid therapy by health professionals. [ABSTRACT FROM AUTHOR]

Background: Corticosteroids have been widely used in attacks of Multiple Sclerosis (MS) and Clinically Isolated Syndromes but may rarely cause psychiatric manifestations, such as depression, mania, psychosis and delirium. Steroid-induced mood disorders have common clinical features, such as subacute onset, manic predominance and having psychotic history. Case Presentation: A 28 year-old housewife who had presented with a sudden blurring of vision had been diagnosed MS and applied 1000 mg/day intravenous methylprednisolone therapy for 10 days as a MS attack therapy in another hospital 20 days ago. One week after the steroid therapy she was taken to our outpatient clinic with paranoia, aggressive behaviors and disorientation. Neurological examination was normal except right optic neuritis. Brain MRI revealed periventricular and cerebellar demyelination. In her medical history she had behavioral pathologies as paranoia, aggression, visual hallucinations 5 years ago and her symptoms recovered without any psychiatric treatment less than one month. She didn't have another attack except optic neuritis, therefore we considered her diagnosis as Clinically Isolated Syndrome. After psychiatry consultation olanzapine at 20 mg/day was initiated and psychiatric excitations were taken under control. Conclusions: Intravenous methylprednisolone is usually administered in 0,5-1 gr/day dosage for 3-10 days in MS. It is considered that there's no significant difference between the administration periods in terms of the efficacy. We consider that it's important to take the psychiatric history before the steroid therapy and to reevaluate the necessity of the high dose steroid therapy and to choose the minimum dosage and period for the patients that have psychotic attack history. [ABSTRACT FROM AUTHOR]

Autoimmune inner ear disease is characterized as a disease with progressive sensorineural hearing loss. The disease can occur primarily or it can accompany other systemic autoimmune diseases. The diagnosis is based on clinical presentation and response to the administration of corticosteroids. The first choice of therapy is the administration of steroids. If the disease is refractory to steroids, immunosuppressants are the second choice. Autoimmune inner ear disease should be kept in mind, when differential diagnosis of any patient with progressive sensorineural hearing loss is made. Here, we present distinguishing characteristics of autoimmune inner ear disease in the lights of literature. [ABSTRACT FROM AUTHOR]