Detection and molecular characterisation of adenovirus in children under 5 years old with diarrhoea

Background/aim: To determine the frequency, genotype distribution, and genetic relatedness of adenoviruses in children under 5 years old with diarrhoea and to investigate their distribution according to clinical findings, age, months, and seasons. Materials and methods: Stool samples were collected from 180 children with acute gastroenteritis who presented from July 2007 through June 2011 at the Ankara Training and Education Hospital. Stool samples were analysed by immune chromatographic test (ICT), enzyme immunoassay (EIA), and polymerase chain reaction (PCR). All adenovirus types were determined by nucleotide sequence analysis. A phylogenetic tree was constructed by Mega 6.0 using the neighbour-joining method. Results: Five percent of the samples were positive for adenovirus (9/180) by ICT, 6.1% (11/180) by EIA, and 13.9% (25/180) by PCR. Adenovirus gastroenteritis did not show any differences in age group, sex, month, or season. In this study, 16 (64%) of the PCR positive samples were AdV41, 6 (24%) were AdV40, 2 (8%) were AdV31, and 1 (4%) was AdV7, as determined by nucleotide sequencing. Conclusion: AdV31 and AdV7 were associated with gastroenteritis. Adenovirus serotypes showed a similarity of 80% (20/25) and 20% (5/25) with Asian and American serotypes, respectively.

Primary cavitary tuberculosis in an infant.

In infants, tuberculosis usually progresses as hilar lymphadenopathy and parenchyma changes in lungs; associating cavitary lesions are rare. A six-month-old infant was admitted to our hospital with fever. Physical examination revealed decreased breathe sounds in the right lung. Chest radiograph showed pneumonic infiltration in the right middle lobe. The patient was hospitalized with a diagnosis of lobar pneumonia and antibiotic treatment was started. On the sixth day, because no clinical improvement was observed in the patient, computerized thorax tomography was performed. Tomography revealed multiple lymphadenopathies in the right hilar pretracheal and subcarinal region. The patient's tuberculin and acid-resistant bacteria tests were negative; however, the quantiferon test was positive. Family screening revealed active tuberculosis in the mother. Tuberculosis in infants may present with unusual clinical and radiologic findings, and primary cavitary tuberculosis can also be seen in this age group.

Mechanical ventilation in children.

Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.

The Serum Concentrations of Trace Elements and Vitamin A in Turkish Six-Month-Old Infants with Different Feeding Practices.

Breast feeding is the first and most important step of a healthy diet. Breast milk contains important vitamins and trace elements such as iron, zinc, copper, and vitamin A. The aim of our study was to evaluate the levels of hemoglobin, hematocrit, mean corpuscular volume, serum iron, iron binding capacity, ferritin, serum zinc, copper and vitamin A in three groups of infants, which were determined based on feeding practices. The infants in all groups were not given prophylactic iron in the first 6 mo. Two hundred fifty-nine infants were included in the study. One hundred fifty-one (58.3%) were fed with breast milk, 91 (35.1%) were fed with breast milk+formula, and 17 (6.6%) were fed with formula only. Serum copper and vitamin A levels were found to be low in formula-only fed infants compared to other groups with a statistically significant difference (p=0.017, p=0.022 respectively). The serum zinc level was found to be low in 15.9% of the breast fed infants, 17.6% of the breast milk+formula fed infants, and 23.5% of the formula-only fed infants. Although the formula-only fed infants had lower values, the difference was not statistically significant among groups (p=0.716). We think that formula fed infants potentially have low levels of copper and vitamin A in the first 6 mo and may be offered supplements. Alternatively, formula mineral and vitamin contents could be enriched. We think that further studies on this subject are needed.

Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children.

AIM: The aim of our study was to investigate the relation of blood carboxyhemoglobin level with presentation finding and clinical properties and to demonstrate neurological and cardiological findings which are indicators of tissue hypoxia in patients followed up because of carbonmonoxide (CO) poisoning. MATERIAL AND METHODS: Three hundred and twenty-five patients who were followed up because of carbonmonoxide poisoning between 2011 and 2013 in our pediatric emergency department were evaluated prospectively. Ethics committee approval was obtained for the study on 10.19.2011 (number: 0437). The carbonmonoxide levels, source of intoxication, neurological and cardiological findings and treatment methods were recorded. Blood gases and cardiac enzymes were studied and electrocardiography (ECG) was performed. The data were analysed using SPSS for windows 16.0 package program. RESULTS: One hundred and sixty-eight (51.7%) of the patients were female and the median age was 9 years (11 days-17 years). Two hundred and twenty-eight (70.2%) of the patients were poisoned while using heater and 78.1% presented during winter months. The median carbonmonoxide level of the patients was found to be 24.8%. Cardiac enzymes were found to be increased in 10.5% of the patients, first degree A-V block was found in 0.6% and negative T wave was found in 0.3%. Glasgow coma score was found to be below 14 in 4.6% of the patients. A significant correlation was found between the carboxyhemoglobin levels and neurological findings, cardiological findings and lactate (p<0.05). Normobaric oxygen treatment was given to 76.3% of the patients and hyperbaric oxygen treatment was given to 23.7%. CONCLUSIONS: We think that neurological disorders and cardiac findings may be closely related, since systemic involvement may be easier in carbonmonoxide poisoning in children, Glasgow coma score should be assessed in the follow-up of the patients and cardiac enzymes and serum lactate levels should be monitored closely from the time of presentation.

Renal replacement therapies in pediatric intensive care patients: experiences of one center in Turkey.

BACKGROUND: Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children. METHODS: The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005. RESULTS: Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient. CONCLUSION: In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.