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Brucellosis is one of the most common zoonosis worldwide. It is still endemic in many regions of the world. A 6-year-old female was admitted to the emergency department (ED) due to a sudden change in consciousness, urinary incontinence, vomiting, and difficulty in walking. Neurological examination demonstrated abducens nerve paralysis, mild-to-moderate motor deficit in hemiparesis in the left arm. Brain magnetic resonance imaging showed a hemorrhagic focus at the right frontal lobe and thrombosis in the superior sagittal sinus of the brain. The diagnosis of neurobrucellosis was confirmed by identifying Brucella spp. in the blood culture on the day 6 of pediatric intensive care unit admission; thus, trimethoprim-sulfamethoxazole and rifampicin, and ceftriaxone were promptly initiated. Despite neuroprotective management and acetazolamide, the patient's neurological problems and high intracranial pressure (ICP) persisted. An external ventricular drainage tube and a Codman ICP monitor were placed to be on the consent vigilance of the patient's neurological condition. The patient's ICP continued to increase despite the current treatment regimen; therefore, a decompressive bitemporal craniectomy was performed. The ICP level of the patient returned to its normal range immediately after the craniectomy. The patient did not have any notable neurologic sequelae at the first-year follow-up. Neurobrucellosis is a rare complication of systemic brucellosis and may present as meningitis, encephalitis, myelitis, radiculitis, and/or neuritis. Herein, we describe a six-year-old girl with brucellosis complicated with cerebral vein thrombosis. This case illustrates the need for close monitoring of patients with unexplained neurological signs or symptoms for brucellosis in endemic areas.

Background: Autoimmune hepatitis (AIH) is characterized by increased immunoglobulin G (IgG) levels, the presence of autoantibodies, and various degrees of lymphocyte predominant inflammation and fibrosis histologically. Immunosuppressive therapy induces remission in approximately 80% of those affected. However, liver transplantation is indicated in patients with acute liver failure with encephalopathy at presentation. Liver supporting systems, including plasma exchange (PE) allow bridging patients to transplantation or spontaneous recovery in the setting of liver failure. The role of these systems has not been assessed in children with liver failure of autoimmune etiology. Case: Herein, we report three cases of AIH with fulminant presentation, with marked symptom resolution with PE as an adjunct therapeutic option to immunosuppressive treatment. Conclusion: In the setting of AIH, PE may have a special therapeutic role by removing autoantibodies and cytokines, therefore preventing further liver damage and decompensation, and allowing time for recovery.

Aim: Although there are some treatment options for glucocorticoid induced osteoporosis (GIO), new drug alternatives are still needed. In this study, we aimed to determine the protective effects of misoprostol and melatonin in an experimental GIO model.Methods: The rats were grouped into four, with 10 rats in each group. The 1st group was chosen as the control group, which were not intervened with. Group 2 was the steroid group, group 3 the misoprostol group and group 4, the melatonin group. To the rats in groups 2, 3 and 4, 10 mg/kg subcutaneous methylprednisolone was administered for 28 days. To the rats of the 3rd group, 200 mg/day misoprostol was given per day by a cannula to the stomach. The rats in the 4th group received 5mg/kg intraperitoneal melatonin during this 28-days period. Lumbar vertebrae and femur bone mineral density (BMD) of all rats were measured by Dual-energy X-ray absorptiometry (DEXA) and assessed in pre- and post-treatment periods.Results: In the steroid group, when the pre- and post-treatment-BMD values of the rats were compared, statistically significant decreases were found in vertebrae, whole femur, femur proximal, femur diaphysis and distal femur bone regions (P=0.011, P=0.005, P=0.007, P=0.005 and P=0.013; respectively). In the misoprostol group, a statistically significant decrease was observed only in the whole femur region (P=0.012) when the pre- and post-treatment BMD values of the rats were compared, while no significant changes were observed in vertebrae, femur proximal, femur diaphysis and distal femur bone regions (P=0.093, P=0.401, P=0.161 and P=0.123; respectively). In the melatonin group, when the pre- and post-treatment BMD values of the rats were compared, a statistically significant decrease was observed only in the vertebrae region (P=0.009), no significant changes were observed in whole femur, femur proximal, femur diaphysis and distal femur bone regions (P=0.386, P=0.445, P=1.000 and P=0.483; respectively). Conclusion: Positive effects of misoprostol and melatonin on bone metabolism were determined in this experimental study. Misoprostol and melatonin seem to be potential agents that can be used in the prevention of GIO., Amaç: Glukokortikoid kaynaklı osteoporoz için kullanılan bazı tedavi seçenekleri olsa da, yeni ilaç alternatiflerine hâlâ ihtiyaç duyulmaktadır. Çalışmamızda ratlarda glukokortikoid kaynaklı osteoporoz modelinde misoprostol ve melatoninin koruyucu etkilerini belirlemeyi amaçladık.Yöntemler: Ratlar her grupta 10'ar adet olacak şekilde dört gruba ayrıldı: Grup1 kontrol, grup 2 steroid, grup 3 misoprostol, grup 4 melatonin grubu olarak belirlendi. Grup 2, 3, 4’teki ratlara 28 gün boyunca 10 mg/kg/gün subkutan metilprednizolon uygulandı. Grup 3’teki ratlara ilave olarak 200 mg/gün orogastrik misoprostol, grup 4’teki ratlara ilave olarak 5 mg/kg/intraperitoneal melatonin uygulandı. Tüm ratların lomber vertebra ve femur kemik mineral yoğunluğu DEXA yöntemi ile ölçülerek tedavi öncesi ve sonrası değerler karşılaştırıldı.Bulgular: Steroid grubunda, çalışma sonrası vertebra, tüm femur, femur proximal, femur diaphysis ve distal femur kemik mineral yoğunluğu değerleri istatistiksel olarak anlamlı derecede düşük bulundu (sırasıyla; P=0,011, P=0,005, P=0,007, P=0,005 ve P=0,013). Misoprostol grubunda sadece tüm femur bölgesinde çalışma sonrası kemik mineral yoğunluğu düşük (P=0,012) olup vertebra, femur proximal, femur diaphysis ve distal femur bölgeleri osteoporozdan korunmuştu (sırasıyla; P=0,093, P=0,401, P=0,161 ve P=0,123). Melatonin grubunda sadece vertebra bölgesinde çalışma sonrası kemik mineral yoğunluğu düşük (P=0,009) olup tüm femur, femur proximal, femur diaphysis ve distal femur bölgelerinde osteoporozdan korunmuştu (sırasıyla; P=0,386, P=0,445, P=1,000 ve P=0,483).Sonuç: Bu deneysel çalışmada misoprostol ve melatoninin kemik metabolizması üzerindeki olumlu etkileri belirlenmiştir. Misoprostol ve melatonin GIO’nun önlenmesinde kullanılabilecek potansiyel ajanlar gibi görünmektedir.

Southern Europe has seen remarkable turnarounds in female labour force participation (FLFP) over the past four decades. In Turkey, however, scores of women have yet to join the labour force. To address this ‘Turkish puzzle’, we present comparative data on women’s work in Portugal, Spain, Italy and Greece (SE-4) and Turkey. Through Qualitative Comparative Analysis, we identify the factors behind rising FLFP in Southern Europe to explore the prospects for a steeper rise of FLFP in Turkey. We reveal two causal pathways to rising FLFP: (i) left party rule, or (ii) combinations of higher levels of take-up of early education and care, higher levels of tertiary education among women and larger size of service sector employment.

OTO, ARZU/0000-0003-0229-2759; Sevketoglu, Esra/0000-0002-8330-2877, WOS: 000496521400006, PubMed: 31435144, Objectives:To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p = 60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.

Emeksiz S, Kutlu NO, Alacakir N, Caksen H. A case of steroid-resistance Hashimoto's encephalopathy presenting with sensorimotor polyneuropathy. Turk J Pediatr 2018; 60: 310-314. Hashimoto`s encephalopathy (HE) is a rare, auto-immune disease characterized by symptoms of acute or subacute encephalopathy associated with increased anti-thyroid antibody levels. The course of most HE cases is relapsing and remitting, which is similar to that of vasculitis and stroke. Steroids are the first line treatment in HE. In steroid non-responders other immunomodulatory therapies or plasmapheresis could be applied. We report a case of steroid-resistance HE with sensorimotor polyneuropathy, as a rare presentation of this disorder. Our case showed that HE may present with sensorimotor polyneuropathy; therefore HE should be considered in the differential diagnoses of polyneuropathy.

Encephalitis is a complex neurological disease that is associated with significant morbidity and mortality, and the etiology of the disease is often not identified. Human metapneumovirus (hMPV) is a common cause of upper and lower respiratory tract infections in children. Few reports are available showing possible involvement of hMPV in development of neurologic complications. Here, we describe an infant, the youngest case in literature, with refractory status epilepticus and severe encephalitis in whom hMPV was detected in respiratory samples and review diagnostic workup of patient with encephalitis.

Posterior reversible encephalopathy syndrome is characterized by hypertension, seizure, headache, clouding of consciousness, and visual disturbance, and is diagnosed in the presence of typical lesions on magnetic resonance imaging. We retrospectively evaluated five patients who were diagnosed as having posterior reversible encephalopathy syndrome and followed up in Meram Medical Faculty, Pediatric Intensive Care and Hematology wards, between January 2010 and January 2014. We reviewed the demographic and clinical data, and neuroimaging findings. The primary diseases of the subjects included acute lymphocytic leukemia (n=2), Henoch-Scholein purpura (n=1), systemic lupus erythematous (n=1), and acute poststreptococcal glomerulonephritis (n=1). The mean age was 10 +/- 4.58 years (range, 5-14 years). Acute elevation of blood pressure was found in all patients (n=5). Initial neurologic manifestations included seizure, clouding of consciousness, headache, and visual disturbance. After the diagnosis was made through clinical evaluations and magnetic resonance imaging, complete clinical recovery was obtained in all patients with the appropriate therapeutic approach. In conclusion, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with encephalopathy and underlying diseases such as nephritis, vasculitis, malignancy accompanied by hypertension, and a history of use of medication.

OBJECTIVES The objectives of this study were to determine the causes, location of cardiopulmonary arrest (CPA) in children, and demographics of cardiopulmonary resuscitation (CPR) in Turkish pediatric emergency departments and pediatric intensive care units (PICUs) and to determine survival rates and morbidities for both in-hospital and out-of-hospital CPA. METHODS This multicenter descriptive study was conducted prospectively between January 15 and July 15, 2011, at 18 centers (15 PICUs, 3 pediatric emergency departments) in Turkey. RESULTS During the study period, 239 children had received CPR. Patients' average age was 42.4 (SD, 58.1) months. The most common cause of CPA was respiratory failure (119 patients [49.8%]). The location of CPA was the PICU in 168 (68.6%), hospital wards in 43 (18%), out-of-hospital in 24 (10%), and pediatric emergency department in 8 patients (3.3%). The CPR duration was 30.7 (SD, 23.6) minutes (range, 1-175 minutes) and return of spontaneous circulation was achieved in 107 patients (44.8%) after the first CPR. Finally, 58 patients (24.2%) were discharged from hospital; survival rates were 26% and 8% for in-hospital and out-of-hospital CPA, respectively (P = 0.001). Surviving patients' average length of hospital stay was 27.4 (SD, 39.2) days. In surviving patients, 19 (32.1%) had neurologic disability. CONCLUSION Pediatric CPA in both the in-hospital and out-of-hospital setting has a poor outcome.

WOS: 000188698800013, PubMed ID: 14726226, Mycobacterium tuberculosis (H37Rv)-infected guinea-pig model was used to investigate the effect of water extract of propolis (WEP). After subcutaneous inoculation of tubercle bacilli, each animal received oral WEP (n = 9), isoniazid (n = 5) or saline (n = 6) as placebo and were sacrificed 30 days later. Formation of necrosis was less prominent in the group treated with WEP, but was not statistically significant (P > 0.05). The granuloma formation in the same group was more prominent than the placebo and isoniazid groups; however, this finding failed to reach statistical significance by the Kruskal-Wallis test (P > 0.05). These findings suggest that Turkish WEP may have a limited effect on the development of tuberculosis infection in this guinea-pig model

Calciphylaxis is a poorly understood and highly morbid syndrome of vascular calcification and skin necrosis. Hypercalcemia, hyperphosphatemia, and secondary hyperparathyroidism are the factors implicated in the pathogenesis of calciphylaxis, which is generally identified in patients with hyperparathyroidism secondary to end-stage renal disease. It has also been observed in primary hyperparathyroidism, end-stage liver disease, and rheumatoid arthritis, in the absence of renal disease. There are few case reports of calciphylaxis occurring in hypercalcemia of malignancy. An unusual case is reported of calciphylaxis associated with malignant melanoma of the soft parts in the absence of renal or parathyroid disease. This is the first reported case of this soft tissue sarcoma showing calciphylactic changes.

Head circumference (HC) is one of the most significant findings in physical examination, especially in the evaluation of the development and early diagnosis of neurological disorders in children. In the standard charts for developmental evaluation of Turkish children, there is no HC reference values for children over 6 years of age. Since the HC standards show differences among races and generations, many researchers have obtained normal values for their own populations, and recommend periodic reevaluation of these standards. In this study, the HC of 1826 healthy children (945 male, 881 female) aged between 6 and 12 years was measured in order to establish the Turkish standards. The sample represented various socioeconomic levels in the city of Malatya, Turkey. The study was conducted in ten schools and measurements were done twice by a pediatrician and the mean was recorded. Charts and graphs for boys and girls were prepared separately. Results were compared to the values of other populations. HC values of Turkish children were similar to that of Irish children. The data obtained in this study may replace the Nelhaus criteria to be used in clinics. However, a more widespread study should be carried out by including children from different regions of Turkey.

Bu tez çalışmasında günümüzde de bir mezhep olarak varlığını sürdüren Nizârî İsmâilîliğinin Ortaçağda sahip olduğu fedâîlik kurumu incelenecektir. Orta Çağ'ın, siyasal, sosyal, dini yönelim ve gelişimini kökünden etkileyecek eylemlerin sahibi olan fedâîlik kurumu, örgütsel ve bireysel bazda tarihsel ve kuramsal bir özgünlük taşımaktadır. İnsanın siyasi otorite ve iktidar ile tanıştığı andan beri kullandığı silahlı mücadele, öldürme, ölme kavramları pek çok açıdan fedâîlik kurumu içerisinde klasik tanım ve yönelimlerinden ayrılmakta, ön değişkenlere bağlı yeni tanımlamalara kavuşmaktadır. Bu bağlamda klasik bir silahlı mücadele unsurundan, teorik, yapısal, eylemsel bazda ayrışan fedâîlik, insanlık tarihinde ender görülen ontolojik bir anlam kazanmaktadır. Diğer taraftan Nizârî İsmâilîliği'nin örgütlenme biçimi, organize siyasal yapılara ve devletlere karşı uyguladığı özgün mücadele metodlarının içerisinde yer alan ?fedâîler? ve ?fedâîliği? gerekli kılan ideolojik nedenler ile bu kurumun oluşum safhaları, teorik-kuramsal temelleri, çeşitli fenomenler üzerinden gelişen telkin safhası, eylem sahası ve amacı, Orta Çağ tarihinde var olan devletlere etkisi incelenmeye anlınacaktır. Zira fedâî denilince Orta Çağ devletleri içerisinde önemli ve kilit yerlerde bulunan askeri, siyasi ve dini önder ve figürleri suikast ile yok eden, eylemini gerçekleştirdikten sonra da kendi hayatını hiçe sayarak genellikle kendi ölümüyle buluşan kimseler akla gelmektedir. Tarihsel fedâîlik incelemesi yalnızca eylemler üzerinden yapılamayacağından fedâîlerin, bu konuma nasıl geldikleri, örgütlenmelerinin hangi siyasi, dini, sosyolojik geleneklerden temel aldığı, nasıl, nerede oluşturulduğu ayrıca fedâîlere atfedilen bir takım iddialar ve bu iddiaların kökenleri tarafımızdan incelenecektir. Dolayısı ile tezimiz fedâîlik kurumunun temelinde yer alan çeşitli yapısal özellikleri ontolojik bir sorgulamadan geçirmeyi amaçlamaktadır.Anahtar kelimeler: Fedâî, Hasan b. Sabbah, Haşaşi, İsmâilî, Ölüm, Suikast, Şehâdet In this study, we examine the order of assassins in Medieval Age which was a part of Nizari Ismailis creed which continues their existence today as a sect. The order of assassins has a historical and organizational peculiarity deserving to be examined on organizational and individual basis. Within the order of assassins, concepts of armed struggle, killing and dying which humanity have used since acquiring political authority and power diverge form their classical definitions and tendencies in many aspects, and by standing out of its structural meanings to some extent, it adopts new definitions based on many predetermined variable and gained an ontological meaning. Organizational form of Nizari Ismailism, organizations which it formed within its body, individual struggle methods, ?assassins? which is the most efficient weapon among these methods and ideological grounds which required ?the concept of assassination?, the foundation stages of this creed, its theoretical basis, its indoctrination stage, the stage of action and its goal among these constitute a quite scientific value in terms of their affects on states. The term assassin recalls persons who have the purpose of killing military, political, religious leaders and figures by assassination and who, after achieving his goal, faces their own deaths by disregarding their own lives. We examine how there persons came to those positions, on what political, religious, sociological traditions this organization stemmed from, how and where it came/brought into existence. Therefore our dissertation aims to put organizational characteristics which lays the foundations of the order of assassins and which are in its theoretical basis to an ontological examination.Key words: Assassin, Hasan b. Sabbah, Hashishin, Ismailis, Death, Assassination, Martyrdom 509

Brucellosis can present initially with its haematological findings including anaemia, leukopenia, and thrombocytopenia and may mimic primary haematological diseases. We present two patients with complaints of severe epistaxis and isolated thrombocytopenia which was initially diagnosed as idiopathic thrombocytopenic purpura but which was finally attributed to brucellosis. Their platelet count reverted to normal within 2-3 weeks of initiating antibrucellosis treatment with recovery from the disease.

In order to determine the efficiency of intranasal midazolam in prolonged convulsive episodes, we conducted a prospective study in children with various types of seizures. Nine patients (six boys, three girls; age range 6 months to 9 years) with prolonged convulsions lasting more than 10 min were treated with intranasal midazolam, 0.3 mg/kg. The success rate was 100% with only one case requiring a second dose. Estimated duration of seizures was 12-30 min (mean 18.6) while mean time elapsed until cessation of seizures was 139.6 s (range 60-480). No significant adverse effects were noted except for one patient who had seizures secondary to serious CNS infection and respiratory depression after intranasal midazolam.

Ectopic thymic tissue can present a diagnostic dilemma when it is located in the posterior mediastinum. The diagnosis can be made by awareness of it and by use of computed tomography (CT) and magnetic resonance imaging (MRI). Rarely, ectopic thymus are reported to cause airway obstruction. In infants ectopic thymic tissue should also be considered in the differential diagnosis of secondary pneumonias and emphysema especially located in the upper lung zones.

Seckel syndrome is a rare genetic disorder with a typical "bird-headed" appearance. It could affect many organ systems but renal involvement is uncommon. Polyarteritis nodosa is systemic vasculitic disorder which also involves kidneys. We report a case of Seckel syndrome in a 9 year-old boy with renal involvement due to polyarteritis nodosa. According to the literature, this is the first report of polyarteritis nodosa in Seckel syndrome.

Coagulase-negative staphylococci (CNS) have emerged as an important pathogen in nosocomial infections. About 80% to 90% of CNS isolates associated with nosocomial infections are methicillin resistant. 1 Hospital-acquired infections caused by these bacteria are generally associated with the use of medical devices in seriously ill or immunocompromised patients. 2 CNS are the most common isolated organisms in infectious peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD), causing approximately half of the episodes of CAPDassociated peritonitis. 3 The present study reports the epidemiologic and clinical features of a sepsis and peritonitis caused by methicillin-resistant S epidermidis

WOS: 000188214900004, PubMed: 14687891, Background: The aim of this study was to determine the acute effects of antioxidant caffeic acid phenethyl ester (CAPE) and alpha-tocopherol (vitamin E) on nitric oxide (NO) production, neutrophil infiltration, and antioxidant enzyme activities on an in vivo model of renal ischemia-reperfusion injury. Methods: Rats were divided into five equal groups each consisting six rats: sham operation, ischemia, ischemia-reperfusion (I/R), I/R plus CAPE, and I/R plus vitamin E groups. CAPE or vitamin E was administered intraperitoneally before reperfusion. After experimental procedure, rats were sacrificed and both ipsilateral and contralateral kidneys were removed and prepared for NO concentrations, myeloperoxidase (MPO), catalase (CAT) and superoxide dismutase (SOD) activities. Results: Acute administration of vitamin E decreased NO concentrations in both ipsilateral and contralateral renal tissues compared to I/R group. SOD activity was increased in I/R and I/R + CAPE groups compared to sham operation group. The most prominent results were encountered in MPO activities, which did not change in contralateral kidneys in both ischemia and I/R groups. There was a significant decrease in ipsilateral MPO activity in ischemia group and a significant increase in I/R group compared to sham operation group. Pretreatment with intraperitoneal CAPE significantly diminished the tissue MPO activity indicating the prevention of the neutrophil sequestration into the kidney. Conclusion: There is a role for CAPE in attenuation in renal damage after I/R injury of the kidney, in part at least by inhibition of neutrophil sequestration. (C) 2003 Elsevier B.V. All rights reserved.

In order to assess the effects of age-related changes of serum dehydroepiandrosterone sulphate (DHEAS) and androstenediol (AED) concentrations on BCG vaccination throughout the puberty period, we matched 41 prepubertal (mean age 8.63 +/- 1.36 years, range 8-14 years) and 43 pubertal (mean age 13.8 +/- 1.31 years, range 10-16 years) schoolchildren who were PPD negative and free of disease or medication known to affect immune function. The tuberculin test was performed 8 weeks after vaccination and tuberculin response and hormone levels were compared between prepubertal and pubertal subjects. We found a higher tuberculin response in the pubertal group when compared with the prepubertal ones. The pubertal children had 79.1 per cent tuberculin positivity compared with 46.4 per cent of prepubertal children (p0.05). Diameters of induration of the tuberculin test among prepubertal students vs. pubertal students were 9.5 +/- 3.8 mm and 11.9 +/- 3.7 mm, respectively (p0.005). Pubertal stage, testis volume, and pubic stage were also found to have significant effects on tuberculin test results. No difference was observed between both sexes with regard to responses of the tuberculin test in either the prepubertal or the pubertal group (p0.05). DHEAS and AED levels in the tuberculin-positive subjects were found to be significantly higher than tuberculin-negative ones (p = 0.040 and p = 0.046, respectively). Among both these hormones, only AED levels were correlated with tuberculin test responses. These results suggest that AED may play a role in the immunity to BCG vaccination and further immunological investigations are warranted to provide support for this idea.

Midazolam is a relatively new anticonvulsive agent in the benzodiazepine group. It has a short onset of duration and is practical for use, providing several alternatives such as intravenous, intramuscular, and intranasal routes. The buccal route could be an alternative choice for seizure control in an emergency setting. However, no sufficient reports are available on buccal midazolam administration. The present study was designated to examine the efficacy of buccal midazolam in children at different ages with seizures of more than 5 min duration. Nineteen previously unreported children, aged from 1 month to 15 years, were treated with a 0.3 mg/kg dose of buccal midazolam; 13 had prolonged seizures, and six had status epilepticus, with a duration of 5-45 min (mean 22 min). Sixteen of 19 seizures (84.2%) stopped within 10 min of buccal midazolam being given. The drug efficacy in patients with status epilepticus was 50%. However, all patients with convulsions shorter than 30 min showed a perfect response (100%). Convulsion episodes stopped within 3.89+/-2.22 min (median time 3 min). Seizure duration was correlated with cessation of seizure (r=0.76, P

The term hypomelanosis of Ito (HI) has been used as a diagnosis for individuals with swirly hypopigmentation or depigmentation distributed along the lines of Blaschko. HI should be appropriately evaluated for a possible association with chromosomal or genetic mosaicism or chimerism. We report a six-month-old severely motor and mental retarded boy with these typical cutaneous lesions associated with extracutaneous features, including facial dysmorphism, polydactyly, and inguinal hernia. The cytogenetic examination of lymphocytes demonstrated a mosaicism of 46, XY, der (13;13) (q10;q10), +13/46, XY. This is the first case reported in the literature showing an association between phylloid pigmentary pattern of hypomelanosis of Ito and trisomy 13 mosaicism.

Oxygen-derived free radicals have been implicated in the pathogenesis of renal injury after ischemia-reperfusion. Caffeic acid phenethyl ester (CAPE), an active component of propolis extract, exhibits antioxidant and anti-inflammatory properties. To determine whether CAPE offers any advantage over alpha-tocopherol, we compared their effects on an in vivo model of renal ischemia-reperfusion injury in rats. CAPE at 10 micromol/kg or alpha-tocopherol at 10 mg/kg was administered intraperitoneally before reperfusion. Acute administration of CAPE suppressed ischemia-reperfusion induced renal lipid peroxidation and tissue injury more than alpha-tocopherol. CAPE may therefore offer a therapeutic advantage in acute injury settings.

Morgagni hernia (MH) is the least common type of congenital diaphragmatic hernias. Although its course is often asymptomatic, it may be associated with various respiratory and gastrointestinal symptoms. We describe 7 children with MH during a 5-year period in three pediatric centers in Turkey. All children had acute or chronic respiratory symptoms; cough was the most frequent. The diagnosis was made by posterior-anterior (PA) and lateral chest X-rays. The PA chest X-rays showed a homogenous mass in 2 and a gas-filled cystic image in 3 children in the right cardiophrenic angle. A retrocardiac homogeneous density in one child, and bilateral consolidation in lower lung areas in another child were also seen. All lateral chest X-rays showed gas-filled bowel loops above the diaphragm. The diagnosis was confirmed by barium-contrast radiograph. Four patients had five additional anomalies, i.e., ventricular septal defect, right inguinal hernia, congenital hip dislocation, pectus carinatum, and obstruction of the uretero-pelvic junction. All of the hernias were repaired by an abdominal approach. There were no complications or recurrences during follow-up. In conclusion, MH should be considered in the differential diagnosis of cases of long-standing respiratory symptoms and/or when an unexplained radiological image, especially on the right cardiophrenic area, is present.

Collagen cross-links are formed during the maturation process of bone matrix. They have been considered as valuable markers in some metabolic, endocrinologic, and neoplastic bone disorders. As an advantage, it can be measured in urine as well as in serum samples. However, the excretion characteristics remains controversial.We investigated urinary free deoxypyridinoline (f-Dpd) excretion in first-void urine samples and in 24-hour collections in healthy Turkish children. We also evaluated the possible correlations and gender-related differences in Dpd excretion between these sampling methods. Both urine samples of 62 subjects (aged from 31 to 120 months) were analyzed by Immulite chemiluminescent technique.There were no remarkable differences in f-Dpd excretion between first-void and 24-hour urine samples, although f-Dpd values of the first-void samples were slightly higher (Dpd: creatinine, mean +/- SD, 20.5 +/- 5.8 nmol/mmol vs. 19.6 +/- 5.6 nmol/mmol, respectively, p0.05). A strong linear correlation was found between 24-hour and first-void urine f-Dpd excretions (r = 0.77, p0.05). In addition, f-Dpd showed no gender-related differences between boys and girls in either 24-hour or first-void urine samples (p0.05).Because of difficulties in long-time urine collection in infants and young children, f-Dpd assessment in first-void single urine samples is an easy, safe, and non-invasive method.

Infantile-onset leukoencephalopathy of van der Knaap type is manifested by initially normal or near normal neurological findings despite infantile-onset megalencephaly and magnetic resonance imaging evidence of severe white matter affection. Until this entity was recently described, these cases were usually presented under the heading of atypical variants of Alexander disease. To date 63 individuals have been reported in English literature. We report a four-year-old boy presented in the first months of life with progressive megalencephaly, delay in walking, clumsiness, convulsions and magnetic resonance imaging evidence of diffuse swelling of white matter, cystic cavitations in frontal, temporal and parietal lobes.

Neutrophil chemotaxis and random migration were evaluated in 21 patients with thalassemia major and 21 healthy controls by a filter technique (Boyden chamber). Chemotactic and random migrations in patient group were found to be defective, which may partially account for the increased susceptibility to infection occasionally observed in these patients. The effects of serum ferritin levels, transferrin saturations that show iron overload, total count of blood transfusions for chronic immunostimulation, desferrioxamine therapy, and splenectomy on these neutrophil functions were examined in thalassemic patients in order to determine whether they are responsible for these defective functions because the mechanism of abnormal neutrophil chemotaxis and random mobility in thalassemic patients is not still clear.

Nitric oxide (NO) serves many functions within the kidney, and recent evidence suggests that NO contributes to glomerular injury. Adrenomedullin (AM) is a novel hypotensive peptide originally isolated from human pheochromocytoma. Recent studies showed that plasma AM concentrations correlated with the extent of proteinuria. We have examined the possible role of these two agents by studying plasma and urinary total nitrite (NO-2 + NO-3) and AM levels in children with minimal change nephrotic syndrome (MCNS). In comparison with healthy controls, children with MCNS had increased urinary nitrite excretion (micromol/mg urinary creatinine), irrespective of whether the disease was in relapse or remission (3.2+/-0.2 in relapse, n=13; 1.9+/-0.3 in remission, n=12; 1.0+/-0.2 in controls, n=10, P0.05). Plasma nitrite levels (micromol/l) were high in relapse compared with controls (53.2+/-8.7 vs. 32+/-4.0, P0.05). Plasma AM levels (pmol/ml) were decreased in relapse (27.6+/-1.4 in relapse, 43.3+/-1.2 in remission, 41.5+/-1.6 in controls, P0.05). Urinary AM levels (pmol/mg urinary creatinine) were significantly higher in relapse than in remission and in controls (156+/-43 in relapse, 56+/-18 in remission, 36+/-16 in controls, P0.05). Our data indicate that NO may play a role in mediating the clinical manifestations of MCNS in children. However, changes in AM levels may be the result of heavy proteinuria.

Posterior reversibl ansefalopati sendromu hipertansiyon, nöbet (konvulsiyon), baş ağrısı, bilinç bulanıklığı ve görme bozukluğu ile giden ve manyetik rezonans görüntülemede belirgin lezyonlarla tanısı konulan bir durumdur. Ocak 2010 ve Ocak 2014 tarihleri arasında Meram Tıp Fakültesi çocuk yoğun bakım ve hematoloji servislerinde izlenen beş posterior reversibl ansefalopati sendromu olgusu geriye dönük olarak değerlendirildi. Demografik ve klinik özellikleri ve görüntüleme bulguları gözden geçirildi. Olguların birincil hastalıkları; akut lenfositik lösemi (iki hasta), Henoch-Schönlein purpurası (bir hasta), sistemik lupus eritematozus (bir hasta) ve poststreptokoksik akut glomerülonefritti (bir hasta). Ortalama yaş 104,58 yıldı (5-14 yıl). Kan basıncının yüksekliği tüm hastalarda vardı. Başlangıç nörolojik belirtiler; nöbet, bilinç bulanıklığı, baş ağrısı ve görme bozukluğuydu. Klinik değerlendirme ve manyetik rezonans görüntüleme ile tanı konulduktan sonra uygun tedavi yaklaşımı ile tüm hastalarda klinik iyileşme sağlandı. Sonuç olarak, ansefalopati tablosu ile gelen ve zemininde nefrit, vaskülit ve malinite; kliniğinde kan basıncı yüksekliği ve ilaç kullanımı olan olgularda ayırıcı tanıda posterior reversibl ansefalopati sendromu düşünülmelidir., Posterior reversible encephalopathy syndrome is characterized by hypertension, seizure, headache, clouding of consciousness, and visual disturbance, and is diagnosed in the presence of typical lesions on magnetic resonance imaging. We retrospectively evaluated five patients who were diagnosed as having posterior reversible encephalopathy syndrome and followed up in Meram Medical Faculty, Pediatric Intensive Care and Hematology wards, between January 2010 and January 2014. We reviewed the demographic and clinical data, and neuroimaging findings. The primary diseases of the subjects included acute lymphocytic leukemia (n2), Henoch-Schönlein purpura (n1), systemic lupus erythematous (n1), and acute poststreptococcal glomerulonephritis (n1). The mean age was 10±4.58 years (range, 5-14 years). Acute elevation of blood pressure was found in all patients (n5). Initial neurologic manifestations included seizure, clouding of consciousness, headache, and visual disturbance. After the diagnosis was made through clinical evaluations and magnetic resonance imaging, complete clinical recovery was obtained in all patients with the appropriate therapeutic approach. In conclusion, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with encephalopathy and underlying diseases such as nephritis, vasculitis, malignancy accompanied by hypertension, and a history of use of medication.