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Lead (Pb), mercury (Hg), and cadmium (Cd) have known harmful effects on children's well-being. The object of this study was to measure the levels of heavy metals (Pb, Hg, and Cd) in breast milk and infant hair, connected environmental factors, and the impact on infant growth and development at 8 months. Seventy-four breast milk samples and 46 infant hair samples were analyzed. Cd, Pb, and Hg were detected in 99%, 91%, and 87% of breast milk samples, respectively. Cd levels were higher in the hair of infants in extended families, living in older houses and when there was a maternal history of anemia and postpartum anemia. Hg levels in breast milk were higher in Denver II suspicious/abnormal infants than in Denver II normal infants. Further biomonitoring studies and preventive measures should be conducted to minimize exposure to toxic metals in early childhood period.

Objectives: The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002. Methods: A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics. Results: The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p < 0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p < 0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively). Conclusions: There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Ağır metaller yaygın kullanımları nedeniyle en zararlı çevresel kirleticilerdendir. Kurşun, civa ve kadmiyum çevresel kaynakları, vücuda alınış yolları, toksik etkileri ve vücutta saptanma yöntemleri iyi bilinen metallerdir. Çocukluk döneminde ağır metal temasının saptanmasında saç materyalinin kullanılması, toplanması, saklanması ve taşınması kolay ve düşük maliyetlidir. Bununla birlikte saçın alınacağı yer ve miktarının net olmaması, kontaminasyon riski, güvenilir referans aralıklarının olmayışı dezavantajlarıdır. Günümüzde kan ve saç düzeyleri ile büyüyen fetusta etkileri arasında ilişki için yeterli verisi olan tek element metil civadır. Bununla birlikte kurşun ve kadmiyum temasının ve toksik etkilerinin değerlendirmesinde saç örneklerinin kullanılması sınırlıdır. Çevresel teması göstermede saç analizinin iyi bir yöntem haline gelmesi için birçok bilimsel konunun aydınlatılmaya ihtiyacı vardır, Heavy metals are the most harmful environmental pollutants, due to widespread use. Lead, mercury, and cadmium are well-known regard as environmental resources, ways of receiving the body, the toxic effects, detection methods in biological markers. Using hair sample have many advantages such as easily and noninvasively collected with minimal cost collection, and it is easily stored and transported to the laboratory for analysis. However, it have disadvantages risk of contamination, lack of reliable reference values, and no consensus exists on the length of the hair specimen to be collected, or the amount, or the position on scalp. Nowadays, methylmercury is the only element for which sufficient data exist to define the relationship between concentrations in blood, concentrations in hair, and effects on the target (the developing fetus). But, analysis of lead and cadmium in hair samples is limited to use for the exposure to lead and cadmium and their toxic effects. Many scientiŞc issues need to be highlighted before hair analysis can become a useful tool in understanding environmental exposures

We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3-72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Dogramaci Children's Hospital at 30-45 days post partum. At 40-55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non-colic. When the infants were 7-8 months old, another interview was done. The colic group had higher proportions of less-educated (≤ 8 years) and smoking mothers, extended family and families with domestic violence than the non-colic group. The colic group of mothers had significantly higher rates of 'impaired bonding' in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non-colic group. No differences were revealed for faecal enzyme activities. At 7-8 months, the colic group was shorter than the non-colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant.

The compliance of parents with child passenger safety (CPS) has been mainly explained by their level of knowledge. Social, ethnic and cultural factors have not been investigated in detail. This study investigated the rate of compliance of parents with CPS guidelines, as well as the factors hindering it. Parents of infants aged 2-10 days were enrolled. The proportions of families obtaining a car safety seat (CSS; 57%) and complying with CPS recommendations (2%) were very low. Most of the parents thought CSS were harmful for infants (mother, 57%; father, 63%), despite having already purchased one. Parents believed their children to be too small to use CSS and cannot sit in CSS because they should lie flat on their backs at all times. These prejudices may be due to the social and cultural circumstances specific to Turkey, or corresponding findings may be found in countries with similar socioeconomic status. Language: en

Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. Orofacial dyskinesia appeared 5 hours after methylphenidate administration, persisted for 10 hours, and had completely resolved within 2 days. Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors’ knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug–receptor interactions via different mechanisms.

We aimed to investigate zinc and copper concentrations in breast milk at two months postpartum and the relationship between these concentrations and the characteristics of mother infant dyads. A total of 142 mothers were enrolled. The median concentrations of breast milk Zinc and Copper were 625 mu g/L and 239 mu g/L, respectively. These concentrations were not related to maternal age, parity, smoking habits, iron and vitamin/mineral supplementation, birthweight, gestational age, or feeding type. The concentrations had no effect on anthropometric measurements of infants at two months of age.

The mental health of the mother influences early mother-infant relationship. This study aimed to explore the relations between maternal psychopathologies, particularly postpartum depression, social-obstetrical factors and mother-infant bonding. One hundred and eighty-nine mother-infant pairs who participated in the longitudinal study entitled “Mother-Infant Care Study” were evaluated at the second month postpartum. The Brief Symptom Inventory (BSI) had been applied to all mothers in the first 3 days postpartum. At the second month postpartum, mothers were assessed with the Edinburgh Postpartum Depression Scale (EPDS), Postpartum Bonding Questionnaire (PBQ), and Mother-Infant Bonding Scale (MIBS). The mean maternal age was 25.1 (±5.2) years. The EPDS scores were higher in the mothers who had been supported lifelong by a psychologist due to psychological problems, had a birth interval of ≤2 years, and had smoking habits at the second month postpartum. Mothers with a female infant had higher PBQ score than those with a male infant. The EPDS score was correlated positively with the PBQ and MIBS scores. There were positive correlations between the EDS scores and all subscales of PBQ and MIBS scores. Some subscales and indexes of the BSI were correlated with the PBQ, MIBS and EPDS scores. Identifying postpartum depression and other psychopathologies in mothers is critical for prevention of mother-infant bonding impairment in the early postpartum period.

Objective: The aim of this study was to determine prevalence of problematic eating behaviour (PEG), associated risk factors, feeding practices including place of meal, variety of diet, and habits of consuming junk food, the mothers' perception of the child growth status in comparison to his/her peers, and the effects on anthropometric measurements. Methods: This study was carried out among children aged 12-72 months who attended the outpatient clinic in the Ihsan Dogramaci Children's Hospital between February-June 2007. Three hundred and thirty-one mothers of children were asked to complete an extensive questionnaire covering socio-demographic characteristics and their child's general eating behaviour and feeding practices at mealtimes. Children with PEB were identified based on their mothers' statements. Results: Three hundred and thirty-one cases were 3.32 +/- 1.39 years old. One hundred thirty-five mothers reported having a child with PEB. The mothers described the children's problematic behaviour as: need to walk around with the child during mealtime (45.6%), watching TV during meals (41.9%), picky or fussy eating (39%), vomiting and/or retching (25.7%), retaining food in the mouth for a long time (20.6%), and not eating solid foods (11.8%). In children who had ate neither meat nor vegetables and fruits, took cod-liver oil-containing supplement during the course of the study, and had taken iron supplements in the first year of life, PEB was more frequent than in others. The mean z scores of weight for age (WAZ) were significantly lower in cases with PEB than without PEB. Discussion: Counselling and supporting of the mother/caregiver could alleviate the effect of inappropriate solutions taken by families. Insistence on composing of the diet variety including especially vegetables, fruits and meat may be promoted by provision of alternative cooking/presentation samples to mothers of children who refuse some foods. Pediatricians should be alerted that lower WAZ values may be a warning indicating a problem which may cause stagnated growth in children with PEB.

The objectives of this study were (1) to evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk at 2 months postpartum, (2) to investigate the relationship between Pb and Cd levels in breast milk and some sociodemographic parameters and (3) to detect whether these levels have any influence on the infant's physical status or on postpartum depression in the mothers. Pb and Cd levels in breast milk were determined by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The median breast milk concentrations of Pb and Cd were 20.59 and 0.67 mu g/l, respectively. In 125 (87%) of 144 samples, Pb levels were higher than the limit in breast milk reported by the World Health Organization (WHO) (>5 mu g/l). Breast milk Cd levels were >1 mu g/l in 52 (36%) mothers. The mothers with a history of anemia at any time had higher breast milk Pb levels than those without a history of anemia (21.1 versus 17.9 mu g/l; p=0.0052). The median breast milk Cd levels in active and passive smokers during pregnancy were significantly higher than in non-smokers (0.89, 0.00 mu g/l, respectively; p=0.023). The breast milk Cd levels of the mothers who did not use iron and vitamin supplements for 2 months postpartum were found to be higher than in those who did use the supplements (iron: 0.73, 0.00 mu g/l, p=0.023; vitamin: 0.78, 0.00 mu g/l, p=0.004, respectively). Breast milk Cd levels at the 2nd month were correlated negatively with the z scores of head circumference and the weight for age at birth (r=-0.257, p=0.041 and r=-0.251, p=0.026, respectively) in girls. We found no correlation between the breast milk Pb and Cd levels and the Edinburgh Postpartum Depression Scale scores. Breast milk monitoring programs should be conducted that have tested considerable numbers of women over time in view of the high levels of Pb in breast milk in this study. (C) 2011 Elsevier B.V. All rights reserved.

Preauricular sinuses (ear pits) are common congenital abnormalities. The incidence of preauricular sinus is widely varied. Usually asymptomatic, they manifest as small hollows adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. They may be bilateral, increasing the likelihood of being inherited, in 25-50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3-10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. A girl, who was three months and 20 days old, was presented because of the co-existence of a right infected preauricular sinus, nephrolithiasis, infantile eczema and a natal tooth.

Adrenal hemorrhage is a relatively uncommon clinical problem of the newborn period. Clinical features of adrenal hemorrhage are variable. An abdominal mass, anemia, unexplained/persistent jaundice, bluish discoloration of the scrotum may be the presenting sign. Here, we presented a macrosomic infant (4150 gr) whose left side adrenal hematoma associated with asphyxia and early onset of hyperbilirubinemia. We concluded that the pediatricians should be considered abdominal US screening regard as internal hemorrhage in macrosomic newborns who delivered with difficult labor and then seen pathologic jaundice.

Backgroud and aims: To analyse infantile (birth characteristics, feeding type) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support to mother, familial atopy) risk factors for infantile colic and to follow up infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. Methods: 660 mothers who delivered at Dr. Zekai Tahir Burak Maternity Hospital, were enrolled within postpartum 3-72 hours. Infants with insolablepersistant crying and subsequent four infants with no crying episodes were invited to Hacettepe University Ihsan Dogramaci Children's Hospital at postpartum 30-45 days by phone. At postpartum 40-55 days, infants were examined; 47 infants were diagnosed as colic cases and 142 as noncolic. When the infants were 7-8 month old, another interview was done. Results: Colic group had higher percentages of less educated (≤8 years) and smoking mothers, extended family, families with domestic violence than noncolic group. Colic group had significantly higher rates of “impaired bonding” in Postpartum Bonding Questionaire, higher scores of Edinburg Postpartum Depression Scale, higher scores for hostility subscales of Brief Symptom Inventory and more irregular sleep pattern than noncolic group. At 7-8 months, colic group was shorter than noncolic group. Conclusion: Colic was associated with some perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having infantile colic had negatively affected sleeping pattern and height of infant.

The effect of maternal mood on breastfeeding initiation and exclusivity is not clear. Gagliardi et al 1 showed that even low levels of depressive symptoms detected by the Edinburgh Postnatal Depression Scale are negatively associated with breastfeeding. This prompted us to look at our data in Mother–Infant Care Study.2 3 In this comprehensive study, mothers voluntarily enrolled within 3 days post partum between July and October 2006 and followed. In the first interview, 577 mothers completed a questionnaire including maternal, gestational and neonatal characteristics, breastfeeding initiation time and the Brief Symptom Inventory (BSI). Of these women, 298 mothers were available at 4–6 weeks post partum for a telephone interview and were questioned about the feeding …

Pneumococcal meningitis does continue to be an important cause of mortality and morbidity in childhood despite widespread vaccination. It develops thorough invasion of the meninges by the agent via bloodstream. It may manifest typical signs of meningeal irritation and even the symptoms not belonging to the central nervous system, such as diarrhea. The diagnosis is made by microscopic evaluation and culture of cerebrospinal fluid (CSF) obtained by lumbar puncture. Despite the treatment, the risk of occurrence of cerebral and neurologic complications is high. A two-month old baby girl was presented to our outpatients' clinic because of fever and diarrhea; she was diagnosed with pneumococcal meningitis and developed cerebral infarct during surveillance. The reason why we presented this patient is to highlight that meningitis due to pneumococ, one of the most common causing agents in childhood meningitis, may have clinical presentations other than expected. Key words: Pneumococcal meningitis; cerebral infarct; infant. DOI: 10.3329/bjms.v10i1.7320 Bangladesh Journal of Medical Science Vol.10 No.1 Jan 2010 pp.52-56