Immature event-related alpha dynamics in children compared with the young adults during inhibition shown by day-night stroop task.

Introduction: Inhibitory control develops gradually from infancy to childhood and improves further during adolescence as the brain matures. Related previous studies showed the indispensable role of task-related alpha power during inhibition both in children and young adults. Nonetheless, none of the studies have been able to investigate the direct differences in brain responses between children and young adults when confronted with a stimulus that should be inhibited. Because, unlike event-related designs, task-related designs involve continuous tasks over a certain period, which precludes the possibility of making such a comparison. Accordingly, by employing event-related design, the present study first time in the literature, aimed to analyze the event-related alpha phase locking and event-related alpha synchronization/ desynchronization to differentiate the inhibitory processes in children compared to young adults. Methods: Twenty children between the ages of 6 to 7 years and 20 healthy young adult subjects between the ages of 18 to 30 years were included in the study. Day-night Stroop task was applied to all subjects during 18-channel EEG recordings. Event-related time-frequency analysis was performed with the complex Morlet Wavelet Transform for the alpha frequency band (8-13 Hz). Event related spectral perturbation (ERSP) in three different time windows (0-200 ms, 200-400 ms, 400-600 ms) and Event-related phase locking in the early time window (0-400 ms) was calculated. Results: The children had increased alpha power in early and late time windows but decreased alpha phase locking in the early time windows compared to young adults. There were also topological differences between groups; while young adults had increased alpha phase-locking in frontal and parietal electrode sites, children had increased occipital alpha power and phase locking. Discussion: The shift in event-related alpha power observed from posterior to anterior regions with age may suggest a progressive maturation of the frontal areas involved in inhibitory processes from childhood to adulthood. The results of the present study showed that children and young adults had different EEG oscillatory dynamics during inhibitory processes at alpha frequency range.

Clinical and laboratory evaluation of children with congenital hyperinsulinism: a single center experience.

OBJECTIVES: To evaluate and present the data regarding clinical, laboratory, radiological and the results of molecular genetic analysis of patients with hyperinsulinemic hypoglycemia in our clinics. METHODS: A total of 9 patients with CHI followed at Istanbul Medipol University. Data related to gender, age at presentation, birth weight, gestational age, consanguinity, glucose and insulin levels at diagnosis, treatment modalities, response to treatment, the results of genetic analysis and radiological evaluation were gathered from the files. RESULTS: The oldest age at presentation was 6 months. KATP channel mutation was detected in 55% (n: 5). Diazoxide unresponsiveness was seen in 55% (n: 5). Octreotide was effective in 3 of them. 18F-DOPA PET performed in 4 diazoxide unresponsive patients revealed focal lesion in 3 of them. Spontaneous remission rate was 66% (n:6). All the patients with normal genetic result achieved spontaneous remission. Spontaneous remission was even noted in diazoxide unresponsive patients and in patients with focal lesion on 18F-DOPA PET. CONCLUSIONS: Clinical presentation of patients with congenital hypereinsulinism is heterogeneous. Spontaneous remission rate is quite high even in patients with severe clinical presentation. It is important to develop methods that can predict which patients will have spontaneous remission. Reporting the clinical and laboratory data of each patient is important and will help to guide the management of patients with hyperinsulinemic hypoglycemia.

The role of makorin ring finger protein-3, kisspeptin, and neurokinin B in the physiology of minipuberty.

BACKGROUND: There is no data regarding the interrelationships of circulating Makorin Ring Finger Protein-3 (MKRN3), Kisspeptin (KISS1), and Neurokinin B (NKB) concentrations during minipuberty in humans. OBJECTIVE: To determine temporal changes in circulating concentrations of MKRN3, KISS1, NKB, and gonadotropins and investigate interrelationships between them in healthy full-term (FT) and preterm (PT) infants during minipuberty period. METHODS: A prospective study of 6-month follow-up performed. Eighty-seven healthy newborns, 48 FT (19 boys/29 girls), and 39 PT (21 boys/18 girls) (gestational age 31-37 weeks), were included. Blood samples were taken at 7 days (D7), 2 months (M2), and 6 months (M6) of age. Serum MKRN3, KISS1, NKB, LH, FSH, total testosterone (TT), and estradiol (E2) concentrations were measured. RESULTS: Seventy infants completed the study. MKRN3, KISS1, and NKB concentrations were similar in FT girls and boys. PT boys and girls also had similar concentrations of MKRN3, KISS1, and NKB. FT babies had significantly higher NKB concentrations than PT babies at D7, M2, and M6. MKRN3 and KISS1 concentrations do not differ between FT and PT babies. A strong positive correlation was found between MKRN3 and KISS1 at each time point and in all groups. FSH, LH, TT/E2 concentrations decrease while those of MKRN3 and KISS1 have a trend to increase toward the end of minipuberty. No correlation was detected between gonadotropins and MKRN3, KISS1, NKB concentrations. CONCLUSION: Strong positive correlation demonstrated between KISS1 and MKRN3 suggests that interrelationship between molecules controlling minipuberty is not similar to those at puberty.

Theta and alpha oscillatory responses differentiate between six-to seven-year-old children and adults during successful visual and auditory memory encoding.

The healthy maturation of the brain is one of the intriguing topics that need to be investigated to understand human brain and child development. The present study aimed to investigate the development of memory processes both for auditory and visual memory using electroencephalography (EEG)-Brain Dynamics methodologies. Sixteen healthy children between the ages of 6 and 7 years and eighteen healthy young adults (age: 21.32 ± 3.28 years) were included in the study. EEG was recorded from 18 channels during the visual and auditory memory paradigms. Two different subtests of the WISC-IV IQ test were applied to all children. Event-related theta (4-7 Hz), alpha (8-13 Hz) power and phase-locking were analyzed. The young adults had higher memory performance than the children for both auditory and visual paradigms. The children had increased theta phase-locking and left alpha power in response to the remembered objects in comparison to the forgotten objects. The young adults had higher theta and alpha phase-locking than the children over the frontal and central locations (p < 0.05), and the children had higher parietal-occipital alpha phase-locking than the young adults. There was an increase in alpha power in children, whereas young adults had decreased post-stimulus alpha power in response to memory paradigms. The present study showed that frontocentral theta and alpha phase-locking had an essential role in brain maturation and successful memory performance. Event-related theta and alpha responses could be one of the important indicators of the mature and healthy brain, and these responses could change depending on the maturation state and age.

Elevated 1-h post-load plasma glucose levels in normal glucose tolerance children with obesity is associated with early carotid atherosclerosis.

CONTEXT: Evidence suggests that the 1-h post-load plasma glucose (1-h PG) ≥155mg/dL during an oral glucose tolerance test (OGTT) predicts development of type 2 diabetes (T2DM) and associated complications, among adults with normal glucose tolerance (NGT), but relevant data on children is scarce. OBJECTIVES: To investigate whether NGT children with obesity whose 1-h PG is ≥155mg/dL have an increased carotid intima-media thickness (IMT) and exhibit non-alcoholic fatty liver disease (NAFLD) diagnosed by ultrasonography, as compared with NGT subjects with 1-h PG <155mg/dL and impaired glucose tolerance (IGT). METHODS: Cardio-metabolic profile, OGTT, measurements of carotid IMT and liver ultrasonography were analyzed in 171 non-diabetic children with obesity. Subjects were divided into 3 groups: NGT subjects with a 1-h PG <155mg/dL, NGT subjects with a 1-h PG ≥155mg/dL, and IGT subjects. RESULTS: As compared with NGT individuals with a 1-h PG <155mg/dL, NGT individuals with a 1-h PG ≥155mg/dL exhibited higher carotid IMT (0.75±0.15mm vs. 0.68±0.15mm; p<0.05). No significant differences were observed in carotid IMT between IGT and NGT subjects with a 1-h PG ≥155mg/dL (0.75±0.18mm vs 0.75±0.15mm; p>0.05). Of the three glycemic parameters, 1-h and 2-h PG, but not fasting glucose, were significantly correlated with carotid IMT. There were no significant differences for increased risk of having NAFLD between the three groups. CONCLUSIONS: These data suggest that a value of 1-h PG ≥155mg/dL in children and adolescents with obesity is as important as IGT with respect to cardiovascular risks.

Evaluation of vitamin D status and its correlation with gonadal function in children at mini-puberty.

CONTEXT: The effects of Vitamin D on reproductive function in adults have gained interest. Studies have demonstrated some associations. Hypothalamic-pituitary-gonadal axis is activated during the first 6 months of life, called as mini-puberty. This HPG activation is important for future gonadal function. There are no data regarding the association of gonadal hormones and 25(OH)D levels at mini-puberty. Demonstration of any association would form the basis for studies that will search for the effects of 25(OH)D on gonadal hormones at mini-puberty. OBJECTIVE: To characterize the associations between 25(OH)D levels and gonadal hormones at mini-puberty. DESIGN: Cross-sectional cohort analysis. PATIENT(S) OR OTHER PARTICIPANT(S): A total of 180 (94 boys and 86 girls) healthy appropriate-for-gestational-age neonates were included. MAIN OUTCOME MEASURE(S): 25(OH)D, LH, FSH, total testosterone, oestradiol, AMH and inhibin B levels were measured at postnatal 30-45 days. All infants were divided into three groups including vitamin D deficiency (<10 ng/mL), vitamin D insufficiency (10-20 ng/mL) and vitamin D sufficiency (>20 ng/mL). Correlations between vitamin D status and reproductive hormones were analysed. RESULT(S): Total testosterone level was higher (mean: 0.52 ± 0.32 vs 0.26 ± 0.2 ng/mL; P: 0.008) and inhibin B was lower in 25(OH)D deficient than sufficient girls (mean: 21.2 ± 15.71 vs 53.25 ± 47.25 pg/mL; P: 0.021). CONCLUSION(S): A modest effect of 25(OH)D was identified on total testosterone and inhibin B in girls at mini-puberty. The 25(OH)D may have an effect on gonadal function during early life. Randomized controlled trials could clarify the importance of vitamin D on gonadal hormones at mini-puberty.

Immunomodulator effect of topical zinc oxide application in tuberculin skin test.

OBJECTIVE: We aimed to evaluate the sensitivity of tuberculin skintest (purified protein derivative-PPD) by topical zinc application on test site to improve diagnostic reliability. METHODS: We performed this study in 100 children aged 6-14 years, and plasma zinc levels were analyzed after 10-12 hours fasting. After PPD, we applied 40% zinc oxide cream on one forearm and placebo on the other forearm. PPD indurations were measured 72 hours later. RESULTS: In this study, 26% of the children showed increases in PPD induration following local zinc applications. There was no correlation between indurations size and serum zinc levels. CONCLUSION: We concluded that topical zinc cream application can enhance sensitivity of tuberculin reactivityin the diagnosis of tuberculosis.

Is children's Body Mass Index associated with their parents' personality? A prospective controlled trial.

BACKGROUND: The aim of this study was to elucidate the effect of the personal characteristics and psychological status of parents on their children's Body Mass Index (BMI) by using validated questionnaires. METHODS: Obese and healthy control group was assessed with The Parental Attitude Research Instrument (PARI) for the evaluation of parental attitudes towards their children. Additionally, Depression Anxiety and Stress Scale (DASS) were used to assess the relationships between parental depression, anxiety, stress and childhood obesity. RESULTS: A total of 105 children and their parents were divided into two groups. The study group consisted of 58 children with a BMI of higher than 85th percentile whereas 47 children with normal BMI (<85th percentile) were included as the control group. In both groups, the BMI of mothers which is between 25-and 30 kg/m2 and >30 kg/m2 had significant impact on the risk of children's obesity status 1.12-fold and 3.68-fold respectively. The PARI results provided that the children who had disciplined, over-protective parents and those in the parental incompatibility group had higher risk of being obese. Analysis of the DASS Test results showed that children having depressed parents had significantly higher risk of obesity than children whose parents were not depressed (P<0.05). CONCLUSIONS: Our results provided that, the parent's status such as obesity, depression and strict personal behaviors have negative impact on their children's weight which is resulting with obesity.

Surgery vs medical treatment in the management of PFAPA syndrome: a comparative trial.

BACKGROUND: Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a common disorder in children but there is little or no consensus on its optimal diagnosis and management. OBJECTIVES: To compare the outcome of different management approaches - medical therapy or tonsillectomy. METHODS: The medical records of children diagnosed with PFAPA between 2008 and 2013 were retrospectively reviewed according to the modified Thomas test criteria. Patients were divided into two groups: group 1 for medical treatment - corticosteroids, a single intramuscular injection of methylprednisolone, and group 2 for surgery - tonsillectomy alone or tonsillectomy plus adenoidectomy .The course of the disease including the number and duration of episodes and the presence of remission, was documented. RESULTS: 105 patients (30 in group 1, 75 in group 2) met the study's inclusion criteria. Groups 1 and 2 were followed up for a mean (SD) of 23.6 (11.0) and 24 (10.3) months, respectively. At the end of the follow-up period, the number of episodes was 5.8 (6.3) vs 1.8 (1.9) (P<0.01) and their duration was 2.2 (1.3) vs 1.1 (0.8) days (P=0.03), both of which were significantly lower in group 2.The need for hospitalization during this period was significantly lower for group 2 at 1.1 (2.0) vs 0.1 (0.3) (P<0.01) and the remission rate in group 2 was significantly higher than in group 1 (98.6% vs 56.6%, P<0.01). CONCLUSION: This study demonstrated that surgery is superior to medical treatment for PFAPA in terms of increased remission rates and a decrease in the number and duration of episodes.

Evaluation of in utero sensitization by screening antigen-specific immunoglobulin E levels in umbilical cord blood.

INTRODUCTION: The incidence of asthma and atopic reactions is increasing worldwide. Previous reports have suggested that maternal exposure to allergens during pregnancy may have potential effects on allergic sensitization in infants. AIM: To evaluate the effects of maternal exposure to environmental allergens during pregnancy on in-utero sensitization. MATERIAL AND METHODS: Two hundred mothers and their infants were analyzed in this cross-sectional study. Mothers were given a questionnaire that had a series of questions to evaluate the maternal allergic status and environmental exposures during pregnancy. Plasma specific immunoglobulin E (IgE) levels to pets, grass, food (nuts) of all mothers and their infants were analyzed by an immune-enzymatic assay. RESULTS: There was no significant correlation between plasma specific IgE positivity in mothers, with regard to keeping indoor domestic pets, living in grass habitat, eating nuts in diet. A significant correlation was found between specific IgE presence in mothers and allergic reactions; however, there was no correlation between plasma specific IgE positivity of mothers and infants. CONCLUSIONS: We concluded that prenatal maternal sensitivity to environmental allergens could not be evaluated as a predictive factor for in-utero sensitization.

The GABAA receptor γ2 subunit (R43Q) mutation in febrile seizures.

BACKGROUND: Febrile seizure is the most common form of childhood seizure. Although its exact cause is unclear, many researchers emphasize the importance of its genetic predisposition. Recent genetic studies revealed the importance of the mutations of the gamma-aminobutyric acid A receptor as the etiology of the febrile seizures. R43Q mutation affecting the γ2-subunit N-terminal domain has been related to childhood absence epilepsy and febrile seizure. METHODS: We investigated R43Q mutations of the GABRG2 gene, located on the long arm of chromosome 5 encoding the γ2-subunit of the gamma-aminobutyric acid A receptor. We studied 44 patients with febrile seizure and 49 children without any febrile seizure who were admitted to our clinic. RESULTS: We found that 36% of our patient group, the children who experienced febrile convulsions, had heterozygous R43Q mutation. Statistical studies revealed that heterozygous R43Q mutation of gamma-aminobutyric acid A receptor γ2 subunit was higher in the study group than in the control group (P < 0.01). CONCLUSIONS: Heterozygous gamma-aminobutyric acid A receptor γ2 subunit (R43Q) mutation may have an effect in the development of febrile seizures.

A retrospective analysis of adenoidal size in children with allergic rhinitis and nonallergic idiopathic rhinitis.

BACKGROUND: Increased incidence of adenoidal tissue enlargement in children with allergic rhinitis (AR) when compared to non-atopic children had been reported. However, data with respect to the comparison of adenoidal size in children with AR and non-allergic idiopathic rhinitis (IR) is still lacking in the literature. OBJECTIVE: We aimed to compare the size of the adenoid in children with AR and with nonallergic IR. METHODS: Adenoid/nasopharynx ratios (ANR) of all children were calculated in both AR and IR patients and the mean ratios were compared. RESULTS: There were 52 patients in the AR group and 56 patients in the nonallergic IR group. Demographic data were similar within the two groups. The mean ANR was 0.59 +/- 0.08 in AR group, whereas it was 0.77 +/- 0.12 in nonallergic IR group. The ANR was very significantly high in the nonallergic IR patients (p = 0.0001). CONCLUSION: Our results suggest that there could be a cellular immune deficiency in allergic children which effects the enlargement of the pharyngeal tonsils. This might be explained with the hypothesis that allergic patients have a deficiency in T-helper 1 cell activity and interferon-gamma production. Larger studies which compare the cytokine profiles of children with AR and with nonallergic IR, will clarify the role of recurrent respiratory infection which is a real problem in clinical practice with allergy.

Assessment of DNA damage in children exposed to indoor tobacco smoke.

The present study is aimed to evaluate the possible DNA damage in children who are living with smoker parents. The tests were conducted by using alkaline comet assay, measured as a percentage of DNA damage in tail (%DNA(T)). The children that participated in the study were selected from the pediatric unit of a hospital in Istanbul, Turkey. %DNA(T) was significantly higher (p<0.01) in children who were exposed to indoor tobacco smoke (10.73+/-1.38) compared to the children in the control group (8.16+/-1.29). The number of cigarettes consumed by household members did not seem to affect the severity of the DNA damage. Since children spend most of their time at home and cannot remove themselves from harmful living conditions this important genotoxic finding should be considered by smoker parents for the future health consequences of their children.

Hemoglobin a1c levels in children with asthma using low dose inhaled corticosteroids.

OBJECTIVES: Steroids may raise the blood glucose levels as a systemic effect. Due to this, the potential effect of prophylactic use of inhaled steroids (ICS) on HbA1c levels in children with asthma was investigated. STUDY DESIGN: Case control study. ? SETTING: Outpatient department. PARTICIPANTS: 141 children with asthma but without diabetes (study group) and 52 children without diabetes or asthma (control group). MAIN OUTCOME MEASURE: HbA1c levels. RESULTS: The mean age of the study group (n=141) was 6.6?3.0 years and comprised 70 females (50% of the group) and 71 males. The mean age of the control group (n=52) was 7.1?3.0 years, and comprised 24 females (46%) and 28 males (54%). Age and sex differences between the groups were not significant. The mean HbA1c value was 5.44?0.75% among the children with asthma and 5.14?0.41% in the control group. HbA1c levels in children with asthma was significantly higher than the control group (P=0.006). No significant correlation was found between cumulative dose of ICS and HbA1c levels. Similarly, levels of HbA1c did not change with increased time of usage of ICS (P=0.96). CONCLUSION: Asthmatic children who are taking low doses of ICS have higher HbA1c values than healthy children.

Nocturnal enuresis in Turkey: prevalence and accompanying factors in different socioeconomic environments.

AIM: To study the prevalence of nocturnal enuresis and the impact of associated familial factors in Turkish children with a different socioeconomic status. METHODS: A specific questionnaire was distributed to 3,000 parents of primary school children (6-12 years old). Of these children, 1,500 attended primary schools in Umraniye, a suburban region of Istanbul (group 1), and the other 1,500 children visited schools in Suadiye, a well-developed part of Istanbul (group 2). The first part of the survey investigated the familial conditions of the children (financial status, family history of enuresis, and family size). The second part of the questionnaire surveyed the demographic and physical characteristics of the children. The last part was designed to investigate the opinions and beliefs of the parents about nocturnal enuresis and treatment modalities. The prevalence rates of nocturnal enuresis and associated familial factors of these children from two different regions of Istanbul were compared. RESULTS: Of the 3,000 questionnaires distributed, 2,589 (86.3%) were returned and included in the final analysis. The mean age of group 1 and 2 children was 8.88 +/- 1.4 and 8.9 +/- 1.5 years, respectively (p > 0.05). The gender of the subjects was equally distributed (48.6% males and 51.4% females). Enuresis was present in 334 children (25.5%) of group 1 and in 205 children (16%) of group 2. Enuresis was significantly more common in group 1 (p < 0.01). The families consisted of 4.69 +/- 1.4 and 4.1 +/- 1.1 persons, respectively (p < 0.01). A yearly income of USD 7,000 was achieved in group 2 by 54%, in group 1 by only 0.7% (p < 0.01). Only 26 children of group 1 (7.8%) and 22 children of group 2 (10.8%) were noted to receive medical enuresis treatments, with no statistically significant difference between the groups (p > 0.01). The parents of the enuretic children from the suburban region of Istanbul were found to consider the condition a normal developmental entity. They believed that enuresis will resolve spontaneously and that no treatment is necessary. On the contrary, the parents of the enuretic children in the well-developed region of the city believed that enuresis is a psychological problem and that intensive psychological assistance is essential for the management. CONCLUSIONS: Our study indicates that the prevalence of nocturnal enuresis in Turkey is comparable to that reported in the literature. The parents consider that enuresis nocturna is not a fatal disorder, that the drugs used in the treatment may be harmful, and that no medical assistance is required. Trained health personnel and physicians should inform the parents about enuresis in order to prevent possible behavioral and self-esteem problems.

Efficacy of salbutamol and ipratropium bromide in the management of acute bronchiolitis--a clinical trial.

BACKGROUND: A wide range of drugs are commonly used to treat bronchiolitis, but evidence of their effectiveness is limited. OBJECTIVES: To investigate the efficacy of ipratropium bromide and salbutamol in the treatment of patients with moderate-severe bronchiolitis. METHODS: Sixty-nine infants with moderate-severe bronchiolitis hospitalized at their first episode of wheezing or crepitations in the chest were enrolled in a prospective, double-blind, placebo-controlled trial. Patients were randomly assigned to receive nebulized salbutamol, ipratropium bromide or placebo. Main outcome measures were changes in oxygen saturation rates and clinical scores and duration of hospitalization. RESULTS: In the bronchodilator groups, clinical scores were better compared to the placebo group at 30 min (8.4 +/- 1.3 vs. 7.5 +/- 0.8, p < 0.05). Bronchodilator groups had also significantly lower clinical scores (7.3 +/- 1.2 vs. 5.9 +/- 1.1, p < 0.0001, and 5.3 +/- 1.4 vs. 4.5 +/- 1.6, p = 0.006, respectively) and higher oxygen saturation rates compared to the placebo group at 8 and 24 h (89.6 +/- 2.4 vs. 94.3 +/- 4.4, and 92.2 +/- 2.6 vs. 95.9 +/-4.4, respectively, p < 0.0001). Improvement rates and duration of hospitalization were not statistically different among groups. CONCLUSIONS: Clinical scores and oxygen saturation levels improved more rapidly in the bronchodilator groups than in the placebo group up to 24 h, but these drugs did not have a sufficient effect to change the natural course of the disease.

Effectiveness of nebulized furosemide added to nebulized salbutamol in children with acute asthma.

BACKGROUND: Nebulized furosemide has been shown to be protective against bronchoconstricting stimuli. METHODS: To investigate whether inhaled furosemide would exhibit an additional therapeutic effect in children with acute asthma we performed a double-blind, placebo-controlled study in which patients with acute asthma attack were randomized to receive either nebulized salbutamol (0.15 mg/kg) plus nebulized furosemide (10 mg/m(2)) or nebulized salbutamol (0.15 mg/kg) plus nebulized saline as placebo. In all patients, clinical asthma scores (CAS) were determined before and after drug administration. Peak expiratory flow rates (PEFR) were measured by a peak flow meter. RESULTS: CAS and PEFR improved in both groups with nebulized salbutamol treatment. The CAS changed from 3.56 +/- 2.13 to 2.06 +/- 1.84 (p = 0.0001) in the study group and from 4.44 +/- 2.63 to 2.56 +/- 1.86 (p = 0.0003) in the control group. PEFR increased from 177.50 +/- 65.88 to 221.88 +/- 66.05 L/min in the first group (p = 0.0001) and from 183.13 +/- 51.73 to 218.13 +/- 60.25 in the second group (p = 0.0001). CONCLUSION: Adding nebulized furosemide to nebulized salbutamol in pediatric patients experiencing an acute asthma attack did not produce greater improvement in clinical (p = 0.3829) or spirometric (p = 0.3839) parameters than nebulized salbutamol alone.

Actinomycotic suppurative thyroiditis in a child.

AIM: To present a rare case of actinomycotic suppurative thyroiditis in an infant with provision of the etiology, pathogenesis, clinical findings and treatment of this rare disease. DESIGN: A report of an 18-month-old female infant who presented with fever, erythema, induration and tenderness of the neck. The patient had the diagnosis of acute suppurative thyroiditis after a series of laboratory evaluation. RESULT: She was treated successfully with surgical debridement and intravenous penicillin G. CONCLUSION: Although rare, Actinomyces spp. should be considered in the etiology of acute suppurative thyroiditis. Because of its fastidious nature the probability of positive culture is low, thus, the microbiology laboratory should be called in advance to make preparations before culture and transport.

Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure.

BACKGROUND: The present study investigates the role of early use of EEG in children with no known neuropathology prior to the first CFS, and the contribution made by computed tomography (CT) and magnetic resonance imaging (MRI) to treatment and prognosis. METHODS: Over a period of 7 years, the authors evaluated 159 children (age range: 2 months-5 years) who were being treated for CFS at Haydarpasa Numune Training and Research Hospital, Pediatrics Clinic, Istanbul, Turkey, and who had no previously known neurological disorder. Patients who presented with febrile seizure were determined to have CFS if they fulfilled the following criteria: <3 months of age when seizure occurred, duration of seizure >/=15 min, more than one seizure occurred during a single episode of illness, or focal seizures and postictal neurological deficit was found. EEG was performed on all patients. CT was performed on the patients who had postictal neurologic deficit or focal seizures. Cranial MRI was performed on patients who had focal findings in their EEGs. RESULTS: Electroencephalogram abnormality was found in 71 cases; 51 of these were diagnosed with epilepsy during follow up. Six of the 16 cases whose EEGs were abnormal between days 2 and 6 were diagnosed with epilepsy. Twenty of the 30 cases whose EEGs were abnormal between days 7 and 10 were diagnosed with epilepsy. All 25 cases who had abnormal EEGs after day 11 were diagnosed with epilepsy. CT was performed for 36 patients, of which five were found to have pathological changes. Pathological changes were detected in two of the nine patients who had cranial MRI. Patients who received CT or MRI were all diagnosed with epilepsy during follow up. CONCLUSION: The results suggest that if neurological examination of CFS patients are normal after their clinical status has stabilised, EEG should be performed after 7 days at the earliest, however for the most accurate diagnosis EEG should be performed 10 days after CFS. The most important predictor for neuroimaging was found to be detection of postictal neurologic deficit. MRI had no advantages over CT in first treating CFS in the emergency unit.