Selvi Kelekçi

Prolonged cough in children is one of the major complaints seen in hospitals. It is difficult to make a proper diagnosis and start the appropriate treatment. Fraction of exhaled nitric oxide (FeNO) measurement is a valuable non-invasive diagnostic tool in determining the cause of prolonged cough in children. Although there are several studies on asthma and COPD, there is a lack of them on other lung diseases such as tuberculosis, bronchiectasia, bronchiolitis obliterans (BO), and pneumonia. In this study, pre-treatment FeNO levels of patients with various lung diseases were measured and results from the sick patient groups were compared with the results from the control group. Pre-treatment FeNO levels in BO, asthma, and tuberculosis patient groups were higher than in the control group (p < 0.001). There was no significant difference between the acute bacterial pneumonia and bronchiectasia groups, and the control group (p > 0.05). FeNO measurement is a highly important guiding tool in diagnosis and treatment of various lung diseases.

Urinary tract infections (UTIs) are common infections affecting children. The aim of our study is to determine microorganisms that cause community-acquired urinary tract infections and their antibiotic susceptibility in children. Our investigation includes 150 cases which has positive urine culture. The cases are detected at Pediatric Polyclinics of Dicle University between June 2010 and June 2011. The study included 118 (78.7%) female and 32 (21.3%) male children. Urinary tract infections were seen in autumn 10.7% (n = 16), summer 35.3% (n = 53), winter 30.7% (n = 46) and spring 23.3% (n = 35). The culture results indicated 75.3% (n = 113) Escherichia coli; 20.7% (n = 31) Klebsiella; 2.7% (n = 4) Proteus and % 1.3 (n = 2) Pseudomonas. The antibiotic resistance against Escherichia coli was found out is amikacin (3%), ertapenem (7%), imipenem (0%), meropenem (0%), nitrofurantoin (9%), trimethoprim/sulfamethoxazole (58%), piperacillin (83%), amoxicillin/clavulanate (50%), ampicillin/sulbactam (65%), cefazolin (54%), cefotaxime (51%), cefuroxime sodium (51% ) and tetracycline (68%). The resistance ratios of Klebsiella are amikacin (0%), imipenem (0%), levofloxacin (0%), meropenem (0%), amoxicillin/clavulanate (57%), ampicillin/sulbactam (79%), ceftriaxone (68%), cefuroxime sodium (74%) and trimethoprim/sulfamethoxazole (61%). The results represent the increasing antibiotic resistance against microorganisms among the community-acquired UTI patients in a developing country such as Turkey. So, the physicians should consider resistance status of the infectious agent and choose effective antibiotics which are nitrofurantoin and cefoxitin for their empirical antibiotic treatment. Furthermore, they should be trained about selection of more effective antibiotics and check the regional studies regularly.

Hydrocarbon pneumonia is distinct among the types of childhood pneumonia in that it has a different pathogenesis and treatment and is preventable. In this study, the cases of 54 children with hydrocarbon pneumonia admitted to the Dicle University Medical Faculty Pediatric Chest Diseases Unit between the years 2006 and 2010 were analyzed retrospectively. The medical records of 54 patients diagnosed with pneumonia after ingesting/inhaling hydrocarbons were analyzed retrospectively. Age, sex, presenting symptoms, clinical status, radiological and laboratory findings and response to treatment and prognosis were noted. 35 (64.8%) of the patients were male, 19 (35.2%) were female and the ages of the patients ranged from 1 to 5 with an average of 2.49 ± 0.80. The etiologies of the pneumonia were thinner (33%), naphta (3.7%) and kerosene. In 49 of the patients (90.7%), the symptoms started to occur the day the patient was exposed to hydrocarbons. The average length of hospital stay was 4.0 ± 2.3 days. Six patients were treated in the intensive care unit (ICU), and one patient with hydrocarbon pneumonia due to kerosene ingestion died. Inhaled corticosteroids were administered to 18 patients who were progressively deteriorating and inhaled salbutamol was given to 16 patients with bronchospasm. Patients with radiological findings on their chest X-rays and auscultatory findings were found to have longer hospital stays (p < 0.05). To prevent chemical pneumonia, precautions must be taken to stop children under 5 years of age from using/abusing chemical substances. Although some cases of chemical pneumonia lead to death, with diligent care and treatment, the outcomes are promising. The patients in this study group responded well to treatment with inhaled corticosteroids and salbutamol.

Cystic fibrosis (CF) is a genetic disease with autosomal recessive inheritance and is common in Caucasian people. The prevalence of this disease is between 1/2,000 and 1/3,500 live births, and the incidence varies between populations. Although the CF transmembrane conductance regulator gene is expressed in the kidneys, renal involvement is rare. With advances in the treatment of CF, life expectancy has increased, and some previously unobserved disease associations are now seen in patients with CF. It is important to follow patients with CF for possible abnormalities that may accompany CF. In this paper, we present two rare cases of CF accompanied by nephrotic syndrome.

This study was planned to evaluate the relationships between the levels of total antioxidant capacity (TAC) and Coenzyme Q (CoQ10) and clinical outcome in hospitalized children with pandemic influenza (H1N1). Serum copper (Cu) and zinc (Zn) levels were also determined to evaluate the changings of oxidative stress's enzyme activities depending on their cofactor concentrations. Children with suspected H1N1 virus infection were hospitalized and nasal swabs were sent to laboratory for confirmation of H1N1 by rRT-PCR assay. Age and sex matched 31 healthy children were included as Control Group. Total antioxidant capacity and CoQ10 were determined by spectrophotometry and HPLC, respectively, and Cu and Zn were determined using atomic absorption spectrometer. Totally 28 children had H1N1 and 37 children had seasonal influenza (SI). TAC, CoQ10 and Zn levels were found to be significantly decreased in H1N1 patients (1.01 +/- 0.19, 752.2 +/- 163, 69 +/- 27, respectively) compared to Control Group (1.64 +/- 0.36, 934 +/- 21, 92 +/- 4, respectively). Seasonal Influenza group had significantly decreased TAC and Zn levels (1.31 +/- 0.27, 78 +/- 34 respectively) compared with control group (1.64 +/- 0.36, 92 +/-41, respectively). CoQ10 levels were also found as decreased in H1N1 compared to seasonal influenza (752.2 +/- 163 vs 1022 +/- 199, p = 0.003). There was a significant correlation between CoQ10 levels of sera and chest radiographic findings of patients with H1N1 pneumonia. No significant differences were found in serum Cu levels between patients with H1N1 and SI or control group (150 +/- 45 vs 127 +/- 37, p = 0.215). CONCLUSIONS, Pandemic influenza infection had increased oxidative stress compared to the seasonal influenza.

Familial mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent and self-limiting fever, peritonitis, arthritis, synovitis, pleuritis, carditis, and erysipelas-like lesions. The aim of this study was to investigate the frequency of the MEFV gene mutation in patients who admitted to hospital with preliminary diagnosis FMF and who had undergone a prior appendectomy. We retrospectively reviewed the files of 52 patients between the ages of 7-18 who admitted to hospital with preliminary diagnosis of FMF and who had undergone a prior appendectomy. Age, gender and the MEFV gene mutations were included in the data. The 12 known, common MEFV gene mutations [E148Q, P369S, F479L, M6801 (G/C), M6801 (G/A), 1692del, M694V, M6941, K695R, V726A, A744S, R761H] were investigated in the patients. Of these 52 cases, 29 (55.8%) were female and 23 (44.2%) were male. Their mean age was 12.1 +/- 3.1 years (range 7-18 yr). MEFV gene mutation was detected in 31/52 cases (59.6%). In this study was found an high frequency of the MEFV gene mutation in patients admitted to hospital with a preliminary diagnosis FMF who had undergone a prior appendectomy. MEFV gene mutations were M694V 16/41 (39%), E148Q 13/41 (31%), M6801 6/41 (15%), V726A 4/41 (10%) and R761H 2/41 (5%). Other genes mutations were F479L, M6801 (G/A), 1692del, M6941, K695R and A744S. There are too much indications of unnecessary appendectomy in MEFV gene mutation carriers. In MEFV gene mutation carriers the frequency of appendicitis can be higher than the normal population. A more detailed and extensive study should be done about it.