Search

Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system, that predominantly affects the spinal cord and the optic nerve. Its key features include transverse myelitis, commonly associated with extensive inflammation spanning three or more consecutive vertebral segments. Longitudinal extensive spinal cord lesions can also occur in systemic autoimmune diseases, infections, vascular and metabolic disorders, subsequent to irradiation, intramedullary tumors and paraneoplastic myelopathies. We present a case study of an 8-year-old girl seropositive for antibodies against the aquaporin 4 who displayed longitudinal extensive spinal cord lesions, that was initially misdiagnosed as an intramedullary tumor.

The aim of this study is to investigate the associations between febrile seizure and serum levels of vitamin B12, folic acid, and homocysteine. One hundred and four children who presented with febrile seizure and 75 controls who presented with febrile illness unaccompanied by seizure were enrolled into the study. Mean levels of vitamin B12, folic acid and homocysteine were compared between two groups. Mean vitamin B12 level in the febrile seizure group was significantly lower than the control group. The febrile seizure patients with 3 or more had significantly lower serum folic acid than the subgroups with two or one episode only. Serum concentrations of folic acid were significantly lower in the febrile seizure subgroup with body temperature 37.5-39.0-C at time of convulsion. Low serum vitamin B12 may reduce a child's threshold for seizure and may be a risk factor for febrile seizure. Low serum folic acid level may be predisposed to recurrent febrile seizure.

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.

Purpose: Febrile seizures (FS) are the most common type of seizures in children.The aim of this study was to evaluate the relationship between platelet indices and FS in children. Materials and Methods: This prospective study included 40 children who presented with FS and 30 controls who presented with febrile illnesses without seizures. Complete blood counts, including platelet count (PC), mean platelet volume (MPV), and platelet distribution width (PDW) from both groups within 1 hour of FS and 1 month later were obtained. Results: We found that the MPV and PDW within 1 hour of seizure in children with complex FS group was higher than simple FS group while there was no significant difference in MPV and PDW between patients in the simple and complex FS groups at 1 month. The mean PC was not significantly different between simple and complex FS groups; but, we found that the mean PC in the complex FS group was slightly lower than simple FS group.There was a moderate significant positive correlation between MPV and PDW in children with FS while there was a moderate significant negative correlation between PC and MPV, PDW for FS . Conclusion: Our findings suggest that the increasing platelet turnover in complex FS group causes a slightly decrease in the PC, an significantly increase of MPV and PDW values indicating that these parameters may play an important role in predicting the severity of FS in children at diagnosis. [Cukurova Med J 2016; 41(4.000): 695-701]

Purpose: To define the clinical and laboratory findings of lymphadenopathy (LAP) resulting from benign and malignant causes during childhood. Material and Methods: 224 patients who were admitted to the clinic with peripheral lymphadenopathy were evaluated. Patient age, gender, laboratory and radiologic results, final diagnoses, and duration, localization, size, consistency, spread, and accompanying local and systemic symptoms of lymphadenopathy were determined. Lymphadenopathy in patients with benign and malignant causes were compared. Results: One hundred twenty-six of 224 patients (56.0%) were male and 98 (44.0%) were female. The analysis comprised 224 patients divided into 2 groups. The first group included 186 patients with benign causes and the second group included 38 patients with malignant causes. The most frequent cause of local lymphadenopathy in the benign group was acute lymphadenitis (34.8%), the most common cause in the malignant group was Hodgkin's lymphoma (4.3%). The most significant cause of general lymphadenopathy in the benign group was EBV (10.0%), whereas Hodgkin's lymphoma (23.3%) was most influential in malignant cases The results revealed that findings, such as chronic course, general lymphadenopathy, supraclavicular and cervical location, organomegaly, abdominal lymphadenopathy, weight loss, constitutional symptoms (night sweats or fatigue, anemia, thrombocytopenia, and leucopenia) were associated with malignant diseases. Conclusion: Infections are the most common cause of lymphadenopathy among benign diseases. Malignant causes and tuberculosis should be considered in older patients, chronic lymphadenopathy, general lymphadenopathy, associated organomegaly, abnormal laboratory findings, and the presence of constitutional symptoms. Cervical lymphadenopathy was most frequent in patients with local and general lymph node enlargement. [Cukurova Med J 2015; 40(3.000): 418-429]

Cytomegalovirus (CMV) infection is a common viral infection worldwide, with a frequency as high as 90% in developing countries. Only 10% of primary CMV infection is symptomatic in immunocompetent patients, and it rarely causes specific complications. We report CMV colitis in an immunocompetent adolescent with hereditary spherocytosis and spontaneous rupture of the spleen, who was critically ill with septicemia and significant non-bloody diarrhoea that responded to specific CMV treatment. [Cukurova Med J 2015; 40(3.000): 609-613]

Meningococcal infections that have high mortality and morbidity in childhood and progress rapidly are an important health problem. It is one of the most important emergent diseases of the infectious diseases. Neisseria meningitidis has 13 serogroups. A, B, C, Y and W135 are the most common cause of invasive diseases among these serogroups. The outcome of meningococcal disease is dependent on the immediate recognition of two major complications: Shock and increased intracranial pressure syndrome. Rapid recognition of the disease and these complications are very important for the outcome of affected patients with appropriate treatment. Our case is a 6-month-old girl who presented with fever, malaise and a rapidly spreading rash all over the body. Septic shock due to meningocoxemia was considered because of the typical rash, weakness, susceptibility to sleep and low blood pressure. This case report includes a review of septic shock therapy due to meningococemia in a patient who was diagnosed with invasive meningococcal disease and died despite rapid and appropriate treatment methods.

Amaç: Bu çalışma, çocuk yoğun bakım ünitemizde yatarak tedavi gören zehirlenme olgularının demografik, epidemiyolojik ve klinik özelliklerini geriye dönük olarak gözden geçirmek ve literatür ile karşılaştırmak amacıyla planlanmıştır. Gereç ve Yöntem: 2015-2019 yılları arasında akut zehirlenme nedeniyle çocuk yoğun bakım ünitesine kabul edilen 581 hastanın kayıtları geriye dönük olarak incelendi.Bulgular: Çalışmaya 581 hasta dahil edildi. Hastaların yaş aralığı 3 ay-18 yaş arasında değişmekteydi ve kız/erkek oranı 1.6 idi. Zehirlenmelerin çoğunluğunun oral yolla (%97.8) gerçekleştiği, %57.1’inin kaza ile, %39.1’inin özkıyım amaçlı ve %3.8’nin ise terapötik nedenlerle zehirlendiği gözlendi. Hastaların % 80.9’u ilaç ilişkili iken, %19.1’i ilaç dışı maddelerle gerçekleşmişti. İlaç ilişkili zehirlenmelerde santral sinir sistemi ilaçları (%40.6) en sık rastlanan ajan olup ilaç dışı nedenlerden en çok fare zehiri ile zehirlenme tespit edildi. Bu çalışmamızda mortalite oranı %0.1 olarak saptandı. Sonuç: Bölgemizde çocuk yoğun bakım ünitesine yatış gerektiren en sık zehirlenme nedenin ilaç zehirlenmeleri olması, öncelikle bu konuda toplumun daha fazla bilinçlendirilmesi gerektiğini göstermektedir. Ayrıca çalışmamızın ilimiz ve çevresinde görülen çocuk yoğun bakım ünitesine yatış gerektiren çocukluk çağı zehirlenme hastalarının epidemiyolojik ve klinik özelliklerini yansıtması nedeniyle görev yapan hekimlere yol göstereceğini ve sonuçlarımızın bölgesel zehirlenme verilerinin güncellenmesine katkıda bulunacağı görüşündeyiz.

Sarcina ventriculi gram pozitif, oblik, anaerobik bir bakteri olup insanlarda ilk kez 1842 yılında gastrointestinal sistemde tanımlanmıştır. Sarcina ventriculi gecikmiş mide boşalması ve mide çıkış tıkanıklığı ile ilişkili bulunmuştur. Bugüne kadar veterinerlik literatüründe bu mikroorganizmaya bağlı sayısız ölümcül hastalık bildirilmiş ancak insanlarla ilişkili birkaç vaka bildirilmiştir. Bu yazıda Çölyak hastalığı, selektif IgA eksikliği ve Sarcina ventriculi duodeniti tanısı alan 10 yaşında bir kız hastayı sunduk. Bilgilerimize göre Çölyak hastalığı ve Sarcina ventriculi duodeniti birlikteliği daha önce tanımlanmamıştır. Bu nedenle bu yazıda nadir olan Çölyak hastalığı ve Sarcina ventriculi duodeniti birlikteliğine dikkat çekmek istedik.

Sitomegalovirüs (CMV) infeksiyonu tüm dünyada sıkça görülen bir viral infeksiyon olup, gelişmekte olan ülkelerde infeksiyonu geçirme oranı %90'lara çıkmaktadır. İmmünkompetan kişilerde primer CMV infeksiyonu %10 semptomatik olup, nadiren organ spesifik komplikasyonlara neden olur. Biz herditer sferositozlu ve spontan dalak rüptürü olan immünkompetan kritik sepsisli ve kansız ishali olan hastada CMV tedavisine yanıt veren CMV kolitli hastayı bildirdik.

Amaç: Lenfadenopati, lenf nodunun boyut ve/veya karakterindeki anormallik olarak tanımlanır. Bu çalışmada amacımız çocukluk çağında selim ve malign nedenlere bağlı periferik lenfadenopatilerin klinik ve laboratuvar bulgularını belirlemek. Materyal ve Metod: Çalışmaya periferik lenfadenopati nedeni ile hastanemize başvuran 224 hasta alındı. Hastaların; yaşı, cinsiyeti, laboratuvar ve radyolojik bulguları, tanıları, lenfadenopatinin; süresi, lokalizasyonu, boyutu, kıvamı, yayılımı, eşlik eden lokal ve sistemik semptomları kaydedildi. Malign ve selim hastalıklara bağlı lenfadenopatilerin klinik ve laboratuvar özellikleri karşılaştırıldı. Bulgular: İki yüz yirmi dört hastanın 126’sı (%56.0) erkek, 98’i (%44.0) kız idi. Hastalar 2 gruba ayrıldı. Birinci grupta selim nedenlere bağlı lenfadenopatisi olan 186 hasta, ikinci grupta ise malign nedenlere bağlı lenfadenopatisi olan 38 hasta mevcuttu. Yüz altmış hastada(%73.2) localize lenfadenopati vardı. Selim hasta grubunda lokalize lenfadenopatinin en sık nedeni akut lenfadenitler (%34.8) iken, malign hasta grubunda en sık nedenin Hodgkin lenfoma (%4.3) olduğu tespit edildi. İki yüz yirmi dört hastanın 60’ında (%26.8) jeneralize lenfadenopati vardı. Jeneralize lenfadenopatinin selim hasta grubunda başlıca nedeni Epstein–Barr virus enfeksiyonu (%10.0) iken, malign hasta grubunda Hodgkin lenfoma (%23.3) olduğu tespit edildi. Servikal bölge lokalize ve jeneralize lenfadenopatilerde en sık tutulan bölgedir. Malign ve selim nedenlere bağlı lenfadenopailer en sık servikal bölgede görüldü. Elde ettiğimiz sonuçlara göre kronik seyirli, jeneralize lenfadenopati, supraklavikular, servikal ve inguinal yerleşimli lenfadenopati, organomegali, abdomanial lenfadenopati, hilier lenfadenopati ve anormal laboratuvar bulgularının (trombositopeni, periferik yaymada blast ) varlığında öncelikle malign nedenler düşünülmelidir. Sonuç: Enfeksiyonlar çocukluk çağında periferik lenfadenopatinin en sık nedenidir. Malignite riski yaş ve lenfadenopatinin süresi ile artmaktadır. İleri yaş, kronik lenfadenopati, jeneralize lenfadenopati, eşlik eden organomegali, anormal laboratuvar bulguların varlığında öncelikle malignite düşünülmelidir.