Rotavirus and adenovirus gastroenteritis: time series analysis.

BACKGROUND: This study investigated the effects of changes in weather conditions (monthly average temperature, monthly minimum temperature, monthly average humidity) on rotavirus and adenovirus gastroenteritis frequency and whether there was a seasonal correlation. METHODS: Between 2006 and 2012, 4702 fecal samples were taken from patients ≤ 5 years of age with acute gastroenteritis; these samples were analyzed in terms of rotavirus group A and adenovirus serotype 40-41 antigens using time-series and negative binomial regression analysis. RESULTS: Rotavirus antigens were found in 797 samples (17.0%), adenovirus antigens in 113 samples (2.4%), and rotavirus and adenovirus antigens together in 16 samples (0.3%). There was a seasonal change in rotavirus gastroenteritis (P < 0.001), and a 1°C decrease in average temperature increased the ratio of rotavirus cases in those with diarrhea by 0.523%. In addition, compared with data from other years, the number of patients was lower in the first month of 2008 and in the second month of 2012, when the temperature was below -20°C (monthly minimum temperature). There was no statistically significant relationship between adenovirus infection and change in weather conditions. CONCLUSION: Various factors such as change in weather conditions, as well as the population's sensitivity and associated changes in activity, play a role in the spread of rotavirus infection.

Effect of antiepilepsy drug therapy on ventricular function in children with epilepsy: a tissue Doppler imaging study.

Impaired cardiac myocardial function may contribute to the risk for sudden unexpected death of a patient with epilepsy. This study aimed to investigate the effect of antiepilepsy drugs (AEDs) on cardiac function in pediatric epileptic patients using standard and tissue Doppler imaging (TDI) echocardiography. This hospital-based, prospective cross-sectional study investigated 52 epileptic children (mean age 9.3 ± 3.1 years) treated with AEDs (duration 2.4-10.0 years) and 36 healthy children (mean age 9.5 ± 4.0 years). In the epilepsy group, standard echocardiography showed increased left ventricular (LV) end-diastolic and end-systolic diameters, an increased LV mass index, and preserved ejection fraction. The patients also exhibited increased mitral peak A-wave velocity and mitral E-wave deceleration time as well as a decreased mitral E/A ratio. The E/Em ratio was significantly higher in the epilepsy group (5.6 ± 1.2) than in the control group (5.2 ± 1.1) (p = 0.016). In the epilepsy group, TDI showed an increased isovolumetric relaxation time and myocardial performance index (MPI). It also exhibited decreased early diastolic velocity (Em) and a decreased mitral annular displacement index in these patients. There were positive correlations between the LV lateral wall MPI (r = 0.231), septal MPI (r = 0.223), and LV mass index (p < 0.05) but no correlation with the duration of AED treatment. The authors detected subclinical ventricular dysfunction associated with AEDs at a preclinical stage. They suggest that TDI can be useful for determining the short- and long-term cardiac effects of AEDs.

Is atrial electromechanical coupling delayed in patients with secundum atrial septal defect?

BACKGROUND: There is no available published information about the atrial electromechanical coupling time (AEMCT) in patients with atrial septal defect (ASD). The aim of this study was to investigate the relationship between ASD and AEMCT obtained by tissue Doppler imaging (TDI). METHODS: A total of 35 patients with ASD and 22 healthy controls were included in the study. The time intervals from the onset of the P-wave on the surface electrocardiogram to the beginning of the late diastolic A-wave (PA) representing AEMCT were obtained from the lateral mitral annulus, septal mitral annulus, and right ventricular (RV) tricuspid annulus, and named PA-lateral, PA-septal, and PA-tricuspid, respectively. The difference between PA-septal and PA-tricuspid, PA-lateral and PA-septal, and PA-lateral and PA-tricuspid were defined as intra-right AEMCT, intra-left AEMCT, and inter- AEMCT, respectively. RESULTS: PA-tricuspid, PA-septal, and PA-lateral values were longer in patients with ASD when compared with the controls, but did not reach statistical significance (39.9 ± 19.1 vs. 37.2 ± 15.5, P = 0.952; 49.6 ± 14.0 vs. 45.4 ± 11.1, P = 0.826 and 60.3 ± 16.3 vs. 59.7 ± 12.5, P = 0.437, respectively). There were no significant differences between the ASD and control groups in terms of inter-atrial, intra-right atrial, and intra-left AEMCT (21.3 ± 2.3 vs. 20.8 ± 4.6, P = 0.957; 9.7 ± 3.3 vs. 6.9 ± 1.3, P = 0.723 and 13.6 ± 4.7 vs. 10.9 ± 4.5, P = 0.518, respectively). Furthermore, ASD diameter and total septum length did not correlate with AEMCT. CONCLUSION: Both intra- and inter-AEMCT were not increased in patients with ASD than control subjects. In addition, we found no association between the ASD diameter and indices of AEMCT in patients with ASD.

What is the safe approach for neonatal hypernatremic dehydration? A retrospective study from a neonatal intensive care unit.

OBJECTIVES: The aims of this study were to evaluate the prevalence, complications, and mortality of hypernatremic dehydration in neonates and to compare the effect of correction rate at 48 hours on mortality and on neurological outcome in the short term. METHODS: This retrospective study was conducted between January 2007 and 2011 in the neonatal intensive care unit. Term neonates were included. The patients were grouped as follows: group 1 = 150 to 160 mmol/L, group 2 = 161 to 170 mmol/L and group 3 = 171 to 189 mmol/L. RESULTS: Among 4280 neonates, 81 cases (1.8%) had hypernatremic dehydration. Groups 1, 2, and 3 consisted of 55, 23, and 3 patients, respectively. Mortality rates were as follows: 3.6%, 17.3%, and 66.6%. Mean serum sodium (Na) correction rates at 0 to 24 hours and 24 to 48 hours were 0.48 ± 0.2 versus 0.38 ± 0.31 mmol/L per hour (group 1) and 0.49 ± 0.21 versus 0.52 ± 0.28 mmol/L per hour (group 2), respectively. In 32 patients (58.1%) from group 1 and in 13 patients (56.5%) from group 2, correction rate of 0.5 mmol/L per hour or less was achieved. Twenty-two patients developed convulsions, which was the most common complication during therapy. Serum Na greater than 160 mmol/L at admission (odds ratio, 1.9; 95% confidence interval, 1.3-3.7) and serum Na correction rate of greater than 0.5 mmol/L per hour (odds ratio, 4.3; 95% confidence interval, 1.2-6.5) were independent risk factors for death or convulsion. There was a significant difference between groups 1 and 2 in Denver Developmental Screening Test II results (64.1% vs 30.7 %, P = 0.001). CONCLUSION: Hypernatremic dehydration is an important problem that should be managed properly to avoid adverse outcomes.

The prevalence and outcomes of thrombocytopenia in a neonatal intensive care unit: a three-year report.

Neonatal thrombocytopenia is one of the most common hematologic disorders in neonatal intensive care units (NICUs). The purpose of this study was to determine the prevalence of thrombocytopenia and whether thrombocytopenia has an effect on the occurrence of intraventricular hemorrhage (IVH) ≥ grade 2 and on mortality rate. This study was carried out retrospectively in neonates admitted to NICU of Cumhuriyet University in Sivas, Turkey, between 2009 and 2012. Among 2218 neonates evaluated, 208 (9.4%) developed thrombocytopenia. The prevalence of IVH ≥ grade 2 was more in infants with thrombocytopenia (7.2%) than in those without thrombocytopenia (4.4%), although this was not statistically significant (P = .08). In univariate analysis, IVH ≥ grade 2 was higher in cases with very severe thrombocytopenia (35.7%, n = 5) than in those with mild (2.1%, n = 2), moderate (4.7%, n = 3), and severe thrombocytopenia (15.2%, n = 5) (P = .04). Multivariate logistic regression analysis showed that birth weight <1500 g (OR 6.2, 95% CI 3.4-9.8; P = .0001), gram-negative sepsis (OR 2.5, 95% CI 1.8-4.2; P = .01), very severe thrombocytopenia (OR 1.3, 95% CI 1.1-2.1; P = .03), and platelet transfusion ≥2 (OR 7.3, 95% CI 4.1-12.1; P = .001) were significant risk factors for mortality. The results of our study suggest that outcomes of neonates with thrombocytopenia depend not only on platelet count but also on decreased gestational age or birth weight, prenatal factors, and sepsis.

Tularemia in children: evaluation of clinical, laboratory and therapeutic features of 27 tularemia cases.

Tularemia is a zoonotic disease caused by Francisella tularensis. We aimed to explicate the clinical and laboratory findings of 27 consecutive tularemia patients who were included into the study. The average duration between onset of symptoms and diagnosis was 19.1 +/- 7.3 days. Sore throat (100%), fever (93%) and myalgia (100%) were the most frequently observed symptoms, while lymphadenopathy (100%), pharyngeal hyperemia (85%), tonsillitis (74%), and rash (7%) were the most frequently observed physical findings. Treatment failed in 6 patients: 1/13 streptomycin- (changed to doxycycline + streptomycin), 1/7 ciprofloxacin- (changed to streptomycin), and 4/7 gentamicin- (changed to streptomycin) receiving patients who had longer duration to treatment (26.5 +/- 2.9 days) than the 21 successfully treated cases (17.0 +/- 6.8 days). Tularemia should to be taken into account in the differential diagnosis in cases having tonsillopharyngitis and cervical lymphadenopathy without response to beta lactam/macrolide-group antibiotics in rural areas. We believe that streptomycin should be the first-line antibiotic in the treatment of pediatric tularemia cases, but it should be supported by comprehensive studies with larger patient series.

A Case Study on EEG Analysis: Embedding Entropy Estimations Indicate the Decreased Neuro-Cortical Complexity Levels Mediated by Methylphenidate Treatment in Children with ADHD.

Objective: Complexity analysis is a method employed to understand the activity of the brain. The effect of methylphenidate (MPH) treatment on neuro-cortical complexity changes is still unknown. This study aimed to reveal how MPH treatment affects the brain complexity of children with attention deficit hyperactivity disorder (ADHD) using entropy-based quantitative EEG analysis. Three embedding entropy approaches were applied to short segments of both pre- and post- medication EEG series. EEG signals were recorded for 25 boys with combined type ADHD prior to the administration of MPH and at the end of the first month of the treatment. Results: In comparison to Approximate Entropy (ApEn) and Sample Entropy (SampEn), Permutation Entropy (PermEn) provided the most sensitive estimations in investigating the impact of MPH treatment. In detail, the considerable decrease in EEG complexity levels were observed at six cortical regions (F3, F4, P4, T3, T6, O2) with statistically significant level (p < .05). As well, PermEn provided the most meaningful associations at central lobes as follows: 1) The largeness of EEG complexity levels was moderately related to the severity of ADHD symptom detected at pre-treatment stage. 2) The percentage change in the severity of opposition as the symptom cluster was moderately reduced by the change in entropy. Conclusion: A significant decrease in entropy levels in the frontal region was detected in boys with combined type ADHD undergoing MPH treatment at resting-state mode. The changes in entropy correlated with pre-treatment general symptom severity of ADHD and conduct disorder symptom cluster severity.

Treatment failure of gentamicin in pediatric patients with oropharyngeal tularemia.

BACKGROUND: Tularemia is a zoonotic infection, and the causative agent is Francisella tularensis. A first-line therapy for treating tularemia is aminoglycosides (streptomycin or, more commonly, gentamicin), and treatment duration is typically 7 to 10 days, with longer courses for more severe cases. MATERIAL/METHODS: We evaluated 11 patients retrospectively. Failure of the therapy was defined by persistent or recurrent fever, increased size or appearance of new lymphadenopathies and persistence of the constitutional syndrome with elevation of the levels of the proteins associated with the acute phase of infection. RESULTS: We observed fluctuating size of lymph nodes of 4 patients who were on the 7th day of empirical therapy. The therapy was switched to streptomycin alone and continued for 14 days. The other 7 patients, who had no complications, were on cefazolin and gentamycin therapy until the serologic diagnosis. Then we evaluated them again and observed that none of their lymph nodes regressed. We also switched their therapy to 14 days of streptomycin. After the 14 days on streptomycin therapy, we observed all the lymph nodes had recovered or regressed. During a follow-up 3 weeks later, we observed that all their lymph nodes had regressed to the clinically non-significant dimensions (<1 cm). CONCLUSIONS: All patients were first treated with gentamicin, but were than given streptomycin after failure of gentamicin. This treatment was successful in all patients. The results of our study suggest that streptomycin is an effective choice of first-line treatment for pediatric oropharyngeal tularemia patients.

Cardiac findings in children with Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. MATERIAL/METHODS: Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. RESULTS: Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12±2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (<1 cm) pericardial effusion. Fifteen (65%) patients had segmental wall motion abnormalities (hypokinesia). A second echocardiography revealed that all wall motion abnormalities had disappeared; the pericardial effusion persisted in only 2 of 7 patients (28%). CONCLUSIONS: Cardiac involvement appears to be more frequent in children with CCHF disease than in adults, but it is slighter and almost totally reversible; however, the course of the disease in children is milder than it is in adults.

Risk and Prognostic Factors in Perinatal Hemorrhagic Stroke.

BACKGROUND: Perinatal stroke encompasses a heterogeneous group of focal neurological injuries early in brain development. In this study, we aimed to compare risk and prognostic factors in preterm and term infants with perinatal hemorrhagic stroke (PHS). PATIENTS AND METHODS: The study includes 66 infants with PHS. The infants were evaluated for demographic characteristics, fetal and maternal risk factors, perinatal events, clinical and neuroimaging findings, complications, and sequales. RESULTS: Of 66 infants with PHS, 44 (66.70%) were preterm and 22 (33.30%) were term infants. Primiparity, mucosal bleeding, and multiple lobes involvement were more common in term infants than preterm infants (P < 0.05); however, respiratory insufficiency, neonatal sepsis, perinatal asphyxia, respiratory distress syndrome, use of invasive mechanical ventilation, use of noninvasive mechanical ventilation, and prolonged hospitalization were more common in preterm infants than term infants (P < 0.05). Eight (12.12%) infants died during infancy period. Small for gestational age and mucosal bleeding were more common in infants who are dead than those alive (P < 0.05). Forty-two (63.63%) infants were followed. Cerebral palsy and/or epilepsy and/or hydrocephalus were diagnosed in 36 (85.72%) infants during follow-up. CONCLUSION: Our findings showed that PHS was much more common in preterm infants. Mucosal bleeding and multiple lobes involvement were more common in term infants. PHS has high morbidity and mortality rates. Small for gestational age and mucosal bleeding were more common in infants who are dead.

Anti-MOG Antibody Seropositive Neuromyelitis Optica: A Rare Pediatric Case.

Neuromyelitis Optica spectrum disorder (NMO-SD) is a rare demyelinating disease detected in pediatric patients affecting the primary optic nerve and spinal cord. Clinical findings might overlap with other demyelinating diseases and compare to particularly multiple sclerosis the treatment regimens significantly differ. Therefore, to establish an immediate and definite diagnosis of NMO-SD is crucial. In the majority of patients, the aquaporin-4 antibody is detected in the serum as one of the supporting diagnostic criteria. The antibody against myelin oligodendrocyte glycoprotein (MOG) is recently reported to be associated with serum aquaporin-4 antibody seronegative NMO-SD. Although not included in the diagnostic criteria, we believe that anti-MOG antibody may facilitate the diagnosis of NMO-SD. We herein report a pediatric case of NMO-SD with the anti-MOG antibody seropositivity.

Evaluation of auditory brainstem potentials in children with acute Herpes simplex encephalitis.

OBJECTIVE: In this study, auditory brainstem potentials (ABPs) were studied in children with Herpes simplex encephalitis (HSE) to determine the ABP abnormalities in HSE during childhood. We also wished to determine whether or not to use ABP in early diagnosis of HSE. METHOD: The study includes 28 children; eight children with acute HSE, nine with nonspecific encephalitis, and 11 healthy age-matched control subjects. The diagnosis of HSE was confirmed by the demonstration of Herpes simplex virus type 1 in CSF by polymerase chain reaction. Recordings of ABPs were performed by using Nihon Kohden Neuropack 2 device. RESULTS: The study includes eight children (four females and four males) with acute HSE, nine children (five males and four females) with nonspecific encephalitis, and 11 healthy age-matched control subjects (six males and five females). Age ranges of the patients and controls were between six months and 12 years. There was not statistically significant difference between the groups for age and gender (p > .05). There were significant differences in the mean latencies of the wave IV on the right ear and in the mean interpeak latencies (IPLs) of the waves III-V on the right and left ears between the nonspecific encephalitis group and the control group (p < .05). However, there were no statistically significant differences between the HSV and control groups (p > .05). In addition, there was no significant difference between HSV and nonspecific groups (p > .05). CONCLUSIONS: Our findings revealed that there were mild ABP abnormalities in children with nonspecific encephalitis, but no ABP abnormality in patients with HSV encephalitis. However, we think that more extensive and detailed studies should be performed to determine whether or not there were ABP abnormalities in childhood HSV encephalitis.

Left ventricular myocardial deformation abnormalities in seizure-free children with epilepsy.

PURPOSE: Although there is a higher risk of structural cardiac disease in people with epilepsy, there is no detailed advanced analysis of cardiac functions in patients with epilepsy. This study aimed to determine early echocardiographic findings of Left Ventricular (LV) dysfunction using cardiac strain technique in seizure-free children with epilepsy. METHOD: The study investigated 60 children with epilepsy who had no seizures in the preceding 6 months, without any known cardiovascular disease and treated with one antiepileptic drug and 60 healthy subjects who underwent clinical evaluation including electrocardiography (ECG), standard echocardiography, tissue Doppler imaging (TDI) and two-dimensional Speckle Tracking Echocardiography (2DSTE). RESULTS: Despite the normal M-mode values, global longitudinal strain of the epilepsy of the control group was as follows: -16.86 ± 3.71, -18.95 ± 3.75, respectively (p = 0.001); global strain rates were determined as follows: -0.99 ± 0.23, -1.14 ± 0.31, respectively (p = 0003). The patients also had increased A-wave velocity, and decreased E/A ratio (p < 0.01). TDI results showed diastolic dysfunction as mirrored by significantly increased isovolemic relaxation time (IVRT), Early mitral inflow (E)/ Early diastolic velocity (E'), and Tei index (p < 0.01). There was no significant difference in LV torsion, Peak LV twist, and ECG parameters between the patients and the controls. CONCLUSIONS: In seizure-free patients, cardiac systolic and diastolic functions were impaired when compared to healthy children. There was no difference in the patient group to explain the decline in cardiac functions and there may be unknown different factors besides the known risk factors.

Acute necrotizing encephalopathy causing human bocavirus.

Acute necrotizing encephalopathy is characterized by multiple, symmetrical lesions involving the thalamus, brainstem, cerebellum, and white matter and develops secondarily to viral infections. Influenza viruses are the most common etiological agents. Here, we present the first case of acute necrotizing encephalopathy to develop secondarily to human bocavirus. A 3-year-old girl presented with fever and altered mental status. She had had a fever, cough, and rhinorrhea for five days. The patient was admitted to the intensive care unit with an initial diagnosis of encephalitis when vomiting, convulsions, and loss of consciousness developed. Signs of meningeal irritation were detected upon physical examination. There was a mild increase in proteins, but no cells, in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging showed symmetrical, heterogeneous hyperintensities bilaterally in the caudate nuclei and putamen. Ammonium, lactate, tandem mass spectroscopy, and urine organic acid were normal. No bacteria were detected in the CSF cultures. Human bocavirus was detected in a nasopharyngeal aspirate using real-time PCR, while no influenza was detected. Oseltamivir, acyclovir, 3% hypertonic saline solution, and supportive care were used to treat the patient, who was discharged after two weeks. She began to walk and talk after one month of physical therapy and complete recovery was observed after six months. Human bocavirus is a recently identified virus that is mainly reported as a causative agent in respiratory tract infections. Here, we present a case of influenza-like acute necrotizing encephalopathy secondary to human bocavirus infection.

Bilateral brachial plexopathy complicating Henoch-Schönlein purpura.

An 11-year-old boy presented with convulsion, fever, rash, abdominal pain, swelling on the eyelids, elbow and wrists, oliguria and hematuria. Based on the abnormal findings the patient was diagnosed with Henoch-Schönlein purpura. On the 3rd day of admission, neurological examination showed ataxic gait, loss of deep tendon reflexes, and decreased (4/5) of muscle strength on all extremities. Additionally, bilateral loss of touch, pain and temperature sensation in a glove, from the elbows to distal region (on C5-T1 level) was diagnosed. Cerebrospinal fluid examination and cranial magnetic resonance imaging (MRI) were normal. The patient was discharged with oral prednisolone on the 7th day of admission. One week after discharging from the hospital, he was re-admitted with vertigo and seizures. He was in coma. MRI of cranial, cervical and cervical plexus were normal. Electromyography showed severe bilateral brachial plexopathy. Prednisolone and intravenous immunglobulin (IVIG) therapy were given without significant improvement. He was discharged from the hospital on the 17th day of admission. On the second month of follow-up, a second cure of IVIG was given because of no clinical improvement. Now, he is on the 4th month of follow-up, unfortunately, no improvement was noted on his muscle strength and sensorial abnormalities on the upper extremities.