Multicentric analysis of childhood tuberculosis in Turkey.

Only a few series of pediatric tuberculosis (TB) have been reported in the last 20 years. The purpose of this study was to evaluate the clinical, radiological, microbiological, and treatment characteristics of childhood TB. A total of 539 children with childhood TB diagnosed over a 12-year period (1994-2005) in 16 different centers in Turkey participated in the study. The medical records of all childhood TB patients were investigated. A total of 539 children (274 males, 265 females) with childhood TB aged 10 days-17 years participated in the study. Age distribution was nearly equal among all age groups. We detected the index case in 39.8% of the patients. More than one index case was detected in 17.3% of the patients. A minimum 15-mm induration is accepted on tuberculin skin test (TST) following Bacillus Calmette-Guérin (BCG) vaccination. The TST was positive in 55.3% of the patients. Acid-fast bacillus smear was positive in 133, and polymerase chain reaction for Mycobacterium tuberculosis was positive in 45 patients. In 75 patients (13.9%), cultures yielded M. tuberculosis. One hundred fifty-one patients (28%) did not present for followup, and families of 5 patients (0.9%) discontinued the treatment. Pulmonary TB (n=285) and meningeal TB (n=85) were the most frequent diseases. In 29% of the patients, there was poor adherence to treatment or patients were lost to follow-up. We have demonstrated that household contact screening procedures play a major and important role, especially considering the high ratio of cases with contact index cases. We also recommend that the positive TST values should be reviewed according to the local cut-off data and should be specified in as many countries as possible. In view of the considerably high percentages of patients lost to follow-up and treatment discontinuation observed in our study, we suggest that application of directly observed treatment short-course (DOTS) is preferable.

[Different clinical form of tuberculosis in childhood: three cases]. / Cocukluk çaginda tüberkülozun farkli klinik formlari: Uç olgu.

Childhood tuberculosis (Tbc) is an important cause of morbidity and mortality and the highest case burden, an estimated 95% of all Tbc cases is found in developing countries. Although childhood Tbc contributes to only 3-6% of the total caseload in industrialized countries, it makes up a large proportion (15-20%) of all Tbc cases in developing countries. The diagnosis of tuberculosis in children is quite difficult and seldom confirmed and is based mainly on clinical signs, symptoms, history of contact with adult and special investigations. Tbc in children, which is paucibacillary in nature, is usually smear-negative. Bacteriological confirmation by culture of Mycobacterium tuberculosis the gold standard of diagnosis, but rarely exceeds 30-40%. In this writing, we report three different cases those are diagnosed as a Tbc and treated.

Nasal carriage of Staphylococcus aureus in children with allergic rhinitis and the effect of intranasal fluticasone propionate treatment on carriage status.

OBJECTIVE: The aim of this study is to determine the rate of nasal carriage of Staphylococcus aureus (NCSA) in children with allergic rhinitis (AR) and to determine the effect of intranasal fluticasone propionate spray on the NCSA. PATIENTS AND METHODS: Nasal swabs were taken from the children admitted to general pediatrics and pediatric pulmonology clinics. Patients were divided into two groups according to the presence or absence of AR. Diagnosis of AR was based on the patient's symptoms. Nasal swabs were taken from AR patients before and after the treatment with intranasal fluticasone propionate, and from the control group at the beginning and after 2 months. RESULTS: Whole NCSA rate was 17.9%; it was 21.4% for AR patients and 15.9% for control group, respectively (p>0.05). Treatment with intranasal fluticasone propionate spray did not influence NCSA in AR patients. CONCLUSION: It seemed that NCSA was not increased in children with AR and treatment with intranasal fluticasone propionate spray did not change NCSA in AR patients. It is obvious that better understanding of the factors affecting the acquisition and loss of NCSA might increase our knowledge about the relationship between NCSA, allergic airway diseases and their treatments.

Concurrent septic arthritis and urinary tract infection in a patient with nephrocalcinosis and vesicoureteral reflux.

An eight-month-old boy who presented with a 15-day history of vomiting was revealed to be suffering from urinary tract infection and nephrocalcinosis caused by vitamin D intoxication. During the treatment of vitamin D intoxication (alendronate, 5 mg/day), he developed urinary tract infection and septic arthritis of the left hip joint. Escherchia coli was isolated from his blood, urine, and joint fluid culture. He was operated, joint drainage was performed and appropriate intravenous antibiotic treatment was given for four weeks. After discharge, a voiding cystoureterogram revealed grade 4 vesicoureteral reflux in the right ureter. Combination of complex urinary anomalies associated with stagnation of urine flow and altered urinary dynamics, and metabolic urinary anomalies, such as hypercalciuria/nephrocalcinosis, may facilitate the occurrence of rare systemic complications of urinary tract infection.

Sinus of Valsalva aneurysm as a cause of right proximal coronary artery spasm.

Sinus of Valsalva aneurysm (SVA) is an infrequent cardiac anomaly. Variations in the origin and course or distribution of the epicardial coronary arteries are rarely found in the population. SVA can be acquired, secondary to infectious, degenerative or traumatic processes. This paper describes congenital right SVA and abnormal origin of conus branch of right coronary artery as a cause of acute coronary syndrome. After surgical repair of the SVA, the prognosis is usually good, and the risk of recurrence is rare.

Aberrant origin of the right ventricular coronary artery: A case report.

This case describes a 45-year-old man with an abnormal origin of the right ventricular branch of the right coronary artery originating from a separate ostium in the right coronary sinus. Coronary arteries with abnormal origin constitute roughly 0.64% to 1.2% of all the representations encountered during coronary angiography. We suggest that the presence of such a vessel must be shown in patients undergoing coronary angiography and/or cardiac surgery.

[Using of fibrinolytics in the treatment of complicated parapneumonic effusion and empyema in children]. / Cocuklarda komplike parapnömonik efüzyon ve ampiyem tedavisinde fibrinolitiklerin kullanimi.

Bacterial pneumonia is associated with a high incidence of pleural effusions in children. These parapneumonic effusions usually resolve spontaneously if patients are treated with appropriate antibiotics. However, a small percentage of parapneumonic effusions will become complicated, either loculated non-purulent fluid or an empyema. The traditional therapeutic approaches for complicated parapneumonic effusions includes catheter drainage and systemic antibiotics. Tube drainage often fails if the fluid is loculated by fibrinous adhesions and surgical operation require. Intrapleural administration of fibrinolytics is an effective treatment for complicated parapneumonic effusions and pleural empyemas, improving the drainage without causing systemic fibrinolysis or local hemorrhage. The global success rate were between 44% and 100%, in most cases more than 80%. Both streptokinase and urokinase have been used for this purpose but there are few reports of their use in the children. Intrapleural streptokinase and urokinase are equally efficacious in treating complicated parapneumonic effusions and empyemas. Intrapleural instillation of fibrinolytics is an effective and safe mode of treatment for complicated parapneumonic effusions and pleural empyemas, and may reduce the need for more invasive surgical procedures.

Prevalence of irritable bowel syndrome in adolescents in Turkey: effects of gender, lifestyle and psychological factors.

Scarce data exist concerning the prevalence of irritable bowel syndrome in adolescence. Changes in lifestyle, presence of stressors and psychological vulnerability during this stage of life place adolescents in the risk group for irritable bowel syndrome. The aim of this study is to determine the prevalence of irritable bowel syndrome in adolescents who are about to begin their university studies and to identify lifestyle and psychological factors related to irritable bowel syndrome. All students newly enrolled at Abant Izzet Baysal University during the 2005-2006 academic year were recruited. Questionnaires including the Rome II questionnaire, the Beck Depression Inventory and the State-Trait Anxiety Inventory were sent to the addresses of the eligible students before matriculation to the university. A total of 2217 students completed the questionnaires, of which 2038 (91.9%) were regarded as valid. Irritable bowel syndrome prevalence was 10.8% and was significantly higher in females than in males (14.0% vs. 7.1%, p<0.001). In logistic regression analyses, gender (OR=2.48, 95% CI=1.68-3.66) and depression (OR=1.08, 95% CI=1.04-1.12) were significantly linked to irritable bowel syndrome. The prevalence of irritable bowel syndrome in this adolescent population is similar to that reported in other studies. The association of irritable bowel syndrome with depression should guide preventive and therapeutic efforts for this specific age group.

Assessment of right ventricular diastolic filling parameters by Doppler echocardiography.

BACKGROUND: Right ventricular diastolic function has been evaluated in various diseases by the pulsed Doppler technique. Right ventricular diastolic filling parameters show changes with age, heart rate and respiration. Evidences of diastolic left and right ventricular dysfunctions have been reported by echocardiographic studies in asthmatic patients. In the present study, before and after treatment of asthma the right ventricular diastolic filling parameters were compared in children with moderate asthma by Doppler echocardiography (a non-invasive technique). METHODS: The study group consisted of 20 children (eight girls, 12 boys) with asthma. During the present study these patients were treated with inhaled steroid and beta-2 agonist daily. Before treatment all patients were evaluated by Doppler echocardiography. At 4-6 weeks after treatment 15 patients that had shown improvement in their symptoms according to the symptom score were also evaluated by Doppler echocardiography. RESULTS: The mean age was 8.6 +/- 2.69 years and mean period of symptoms were 56.4 +/- 35.8 months. When compared with results of echocardiography before and after treatment, the right ventricular diastolic filling parameters (acceleration time: P < 0.01, deceleration time: P < 0.01 and isovolumetric relaxation time: P < 0.05) were found to be significantly different. CONCLUSIONS: We observed significant improvement of right ventricular diastolic filling parameters by Doppler echocardiography after treatment in children with asthma.

Ebstein's anomaly in siblings: an original observation.

Siblings, a 26-year old male and a 31-year old female, were found do have Ebstein's anomaly. Ebstein's anomaly is characterized by a downward displacement of the tricuspid valve into the right ventricle due to anomalous attachment of the tricuspid leaflets. Echocardiography is the method of choice to diagnose Ebstein's anomaly on its own or in association with other heart defects. Complications such as right ventricular failure, infective endocarditis, and paradoxical embolism can occur. Ebstein's anomaly diagnosed in adult life is a benign and stable disease, particularly if the patient is asymptomatic. These cases may represent a familial form of Ebstein's anomaly.