The impact of the COVID-19 pandemic on accidental and suicidal drug intake rates, what has the pandemic changed?

OBJECTIVE: The primary aim of this study was to review the patients admitted to pediatric emergency service with a history of accidental and suicidal drug intake within the first nine months of the pandemic period and the same period a year ago. PATIENTS AND METHODS: The study is done retrospectively on patients with a history of accidental and suicidal drug intakes between March-December 2019 and March-December 2020. RESULTS: The study included 360 patients. Of 250 (69.4%) patients admitted in 2019, 163 (65.2%) of them were accidental drug intakes, while 87 (34.8%) were suicidal drug intakes. In 2020, of the 110 (30.6%) patients admitted, 73 (66.4%) of them were accidental drug intakes, while 37 (33.6%) were suicidal drug intakes. The ratio of accidental drug intakes to total patient admissions in 2019 and 2020 was 0.23% and 0.33%, respectively (z=-0.44; p=0.65).  The ratio of suicidal drug intakes to total patient admissions in 2019 and 2020 was 0.12% and 0.16%, respectively (z=-0.1956; p=0.84), and an increase in the ratio of suicidal drug intakes was observed during the pandemic. CONCLUSIONS: With the pandemic, increased cases of neglect because of accidental drug intake and the increase in suicidal drug intake are worrisome. Protecting and improving the mental health of the society, especially of parents and adolescents, is very important in preventing suicide and child neglect and abuse from reaching dangerous levels in pandemics.

A CHILD WITH LARON SYNDROME ASSOCIATED WITH VASCULITIS.

BACKGROUND AND OBJECTIVES: Levels of insulin-like growth factor-I are characteristically low in Laron syndrome which is a factor that has important roles on vascular health and development. Congenital insulin-like growth factor-I deficiency was reported to be associated with some vascular disorders. However, vasculitis diseases and Laron Syndrome association has not been reported in English literature up to date. PATIENT: We report the case of a two and a half years old Turkish girl, who was diagnosed as Laron syndrome when she was 12 months old. She presented with acute vasculitis lesions. Her physical examination and laboratory studies did not reveal a specific infectious agent or also an autoimmune disease was not detected. Her lesions disappeared during hospitalization without a complication. CONCLUSION: Since insulin-like growth factor-I reduces endothelial cell oxidative stress and maintains the structural integrity of vessels, some common mechanisms might be responsible for the occurrence of vasculitis in this patient with Laron syndome. The role of insulin-like growth factor-I and recombinant human insulin-like growth factor-I treatment choice in vasculitis diseases is a matter of investigation.

Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography.

The purpose of our investigation was to determine the anatomical variations in the coeliac trunk-hepatic arterial system and the renal arteries in patients who underwent multidetector CT (MDCT) angiography of the abdominal aorta for various reasons. A total of 100 patients were analysed retrospectively. The coeliac trunk, hepatic arterial system and renal arteries were analysed individually and anatomical variations were recorded. Statistical analysis of the relationship between hepatocoeliac variations and renal artery variations was performed using a chi(2) test. There was a coeliac trunk trifurcation in 89% and bifurcation in 8% of the cases. Coeliac trunk was absent in 1%, a hepatosplenomesenteric trunk was seen in 1% and a splenomesenteric trunk was present in 1%. Hepatic artery variation was present in 48% of patients. Coeliac trunk and/or hepatic arterial variation was present in 23 (39.7%) of the 58 patients with normal renal arteries, and in 27 (64.3%) of the 42 patients with accessory renal arteries. There was a statistically significant correlation between renal artery variations and coeliac trunk-hepatic arterial system variations (p = 0.015). MDCT angiography permits a correct and detailed evaluation of hepatic and renal vascular anatomy. The prevalence of variations in the coeliac trunk and/or hepatic arteries is increased in people with accessory renal arteries. For that reason, when undertaking angiographic examinations directed towards any single organ, the possibility of variations in the vascular structure of other organs should be kept in mind.

Case report. Isolated complete congenital sternal cleft in an adult: MDCT imaging findings.

Sternal cleft is a very rare midline defect. Incomplete forms are more common than complete ones. In this challenging anomaly, the underlying mediastinal structures (especially the heart and great vessels) can easily be injured by external trauma. In addition, the deformity is cosmetically unpleasant and quite alarming to the young patient and the patient's family. In this report, we describe the multidetector CT (MDCT) images that demonstrate the complete sternal cleft.

Bilateral maxillary sinus hypoplasia and aplasia: radiological and clinical findings.

Maxillary sinus hypoplasia (MSH) is classified into three types depending upon embryological development of the sinus and uncinate process. Type III MSH is characterized by a near-absence of the uncinate process and an almost absent cleft-like sinus. Bilateral maxillary sinus aplasia or severe hypoplasia with associated paranasal sinus abnormalities is extremely rare. Two cases with severe maxillary sinus hypoplasia/aplasia (one of them with other associated paranasal sinus abnormalities) are presented in this article. This extremely rare abnormality should be kept in mind to prevent misdiagnosis and possible complications during endoscopic sinus surgery.

Preoperative evaluation of the congenital aural atresia on computed tomography; an analysis of the severity of the deformity of the middle ear and mastoid.

OBJECTIVE: To compare the development of temporal bone in normal and atretic ears and to assess some radiological landmarks that could be important in the hearing restoration interventions in such patients. MATERIAL AND METHODS: Thirty-five patients with 40 atretic external ears were evaluated with temporal bone CT and compared to a control group of 40 normal ears retrospectively. Using comparable slice levels in all patients, the course and the caliper of the facial canal, the surface area of the incus and malleus, the level of mastoid aeration, the location and anteroposterior diameters of the jugular bulb and sigmoid sinus, the direction and the caliber of the tympanic bony part of the Eustachian tube, area of the middle ear cavity, distance from facial nerve to incudomalleolar joint, to the vestibule and to the jugular bulb were included in the assessment. Non-parametric and parametric statistical tests were used for comparison. RESULTS: In atretic ears middle ear sectional area was found to be smaller at the equivalent plane as compared to control subjects (mean area index: 19.3mm(2) versus 47.4mm(2)). Mastoid aeration was low in general and the ossicles in the atretic ears were hypoplastic (mean ossicular sectional area: 8.3mm(2) versus 11 mm(2)). The distance from the jugular bulb to the facial nerve was significantly lower (mean: 6.2mm versus 6.8mm) (p<0.05) in the atretic ears. Facial canal caliber, distance from the facial canal to the incudomalleolar joint and distance from the facial canal to the vestibule in the atretic ears (means: 1.49, 2.93 and 1.82, respectively) did not show statistically significant difference from the control subjects (means: 1.44, 2.91 and 1.83, respectively) (p>0.05 for all). CONCLUSION: External ear atresia is significantly associated with middle ear and mastoid abnormalities. The ossicles were underdeveloped which always have to be considered during reconstructive surgery. Radiologically, in the atretic ears anterior-posterior length of the temporal bone was more influenced as compared to superior-inferior portion, which justifies abnormal route of the facial nerve canal. However, there is no abnormality in the development of the facial nerve as the caliper is similar to the control subjects.

Persistent mediastinal and axillary lymph node tuberculosis in a renal transplant patient with successful outcome.

Tuberculosis is an opportunistic infection that carries substantial morbidity and mortality in renal transplant recipients. We report here about a 21 year-old man with a living related renal transplant from his mother who developed persistent extra-pulmonary tuberculosis. The disease showed aggressive invasion to the axillary and mediastinal regions with abscess formations, despite standard antituberculosis treatment. During the course of the disease, immunosuppressive therapy was stopped, and the patient received extraordinary doses of multiple antituberculosis drugs. The patient then showed an uneventful course with good clinical and radiological responses.

A rare extrahepatic syndrome related to acute hepatitis type B: epididymitis in an adolescent.

Hepatitis B is a common, vaccine-preventable infection with high mortality and morbidity rates worldwide. Numerous extrahepatic syndromes have been described in patients with either acute or chronic viral hepatitis B. But there is no previous report of co-existence of HBV infection and epididymitis in the English literature. We would like to present and discuss a 12-year-old male patient with epididymitis that might be relation exist with an underlying acute hepatitis B infection.

Craniocerebral gunshot wounds: results of less aggressive surgery and complications.

Four hundreds patients who suffered from cranial gunshot wounds injuries were analyzed. Surgical therapy, primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments were applied. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. In 130 of 400 patients, bone and metal fragments were determined on control CT scans. Most of the deaths in this group of patients were attributed to the influence of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scans. Surgery was not performed until the infection developed. Retained fragments did not increase the infection risk but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome. The prognostic importance of complications such as intracranial haemorrhage, epileptic seizures, hydrocephalus, was also investigated.

Idiopathic hypogonadotrophic hypogonadism associated with arachnoid cyst of the middle fossa and forebrain anomalies: presentation of an unusual case.

We report a 22-yr-old male patient with hypogonadotrophic hypogonadism (HH) associated with a giant middle fossa arachnoid cyst (AC) diagnosed by magnetic resonance imaging (MRI). He presented with pubertal and growth delay. He also had learning disabilities and anosmia. Laboratory investigation revealed pre-pubertal levels of testosterone and normal results of the combined test of anterior pituitary function, except for in GnRH acute and prolonged test. Cranial MRI showed an AC in left middle fossa with expansion to suprasellar cisterna and several abnormalities like left temporal lobe hypoplasia, left optic tract and bilateral olfactory bulb hypoplasia and left hypothalamic hypoplasia.

Effect of short-acting inhaler beta2-agonists on serum cardiac troponin in wheezy infant.

Cardiac troponin (cTn) is highly specific for myocardial injury. However, effect of beta2-agonist therapy on cTn in wheezy infants is unknown. We aimed to assess serum troponin in children with wheezy infant treated by short-acting inhaler beta2-agonists. Twenty-four children, under 5 years old, with the diagnosis of wheezy infant with acute exacerbation were enrolled in the study. Subjects were treated three times by a standard dose of nebulized salbutamol (0.15 mg/kg per dose; maximum, 3 mg; Ventolin Nebules Ampule) therapy. The heart rate, respiratory rate, cTnI, creatine kinase (CK), CK-MB levels, and electrocardiogram were measured in wheezy infant before and after 60-minute nebulized salbutamol. In the control group the heart rate, respiratory rate, cardiac troponin I (cTnI), CK, CK-MB levels, and electrocardiogram were recorded at admission. For Seventeen boys (70.8%) and seven girls (29.2%) with wheezy infant, the mean age of the patients was 21.4 +/- 18.13 months and for control groups the mean age was 17.28 +/- 16.09 months (p = 0.419). There was no significant difference in serum troponin in patients before treatment, after treatment period, and in controls (mean +/- SD, 0.049 +/- 0.03, 0.043 +/- 0.048, and 0.044 +/- 0.034, respectively; p = 0.14, p = 0.72, and p = 0.35, respectively). Short-acting inhaler 32-agonists do not influence circulating troponin levels in wheezy infant with acute attack.

Recurrent pneumothorax at an infant with miliary tuberculosis.

A seven-month-old girl with miliary tuberculosis (Tbc) admitted to hospital due to development of acute dyspnoea and cyanosis at the end of third month of anti-Tbc therapy. Pneumothorax was evident at right lung with the chest radiography. A chest tube placed under water seal was applied. The patient healed up and then discharged. One week later, the patient admitted to hospital again, with same complaints due to pneumothorax at the same hemithorax. Same treatment was applied to the patient. Anti-Tbc therapy was stopped at the end of 12th month. Although, pneumothorax is a rare life-threatening complication of miliary Tbc, it's not seen only on admission or soon after beginning of the therapy, but it can be seen several months later during treatment. We want to report this case. That is the first case in which pneumothorax developed during therapy of an infant with miliary Tbc.

Increased abnormal pituitary findings on magnetic resonance in patients with male idiopathic hypogonadotrophic hypogonadism.

Idiopathic hypogonadotropic hypogonadism (IHH) is a well-known disorder apart from its pathogenesis, which is still mostly unclear, even though a diverse subgroup of patients with hypogonadotropic hypogonadism and hyposmia/anosmia--the Kallman syndrome--have been partly linked to a mutated gene, known as kal-1 gene. In this study, we aimed to evaluate the sellar region of patients with IHH on magnetic resonance (MR). Pituitary MR of 120 male patients with IHH, diagnosed by a thorough endocrinologic assessment, were compared with pituitary MR of 49 healthy cases selected randomly who underwent detailed endocrinologic and neurologic evaluation and were assessed as healthy. Patients with IHH were diagnosed with microadenomas and irregularly contrasting pituitary (ICP), 18.2 and 10.7%, respectively. Although some anatomic variations were seen in healthy controls, microadenomas and ICP had solely been observed in patients with IHH and none in controls. Intact appearence of hypophysis in patients with IHH was significantly lower than in randomly selected healthy male subjects (p = 0.021). Mean infundibulum width of hypophysis and transverse diameter of posterior hypophysis were significantly broader in patients with IHH than in controls (both having p < 0.001), while mean hypophysis height and volume did not differ between groups. Results showed unusual incidence of pituitary abnormalities on pituitary MR in male patients with IHH. In conclusion, MR imaging is particularly useful in defining the morphological aspects of the hypothalamo - pituitary region in some endocrine disorders and other researchers might want to bear our findings in mind when performing MR evaluation of similar patient subgroups.

TRUS, CT and MRI findings of hydatid disease of seminal vesicles.

Hydatid disease of the urogenital system, especially seminal vesicles and prostate, or retroperitoneum is a very rare condition. Secondary dissemination of seminal vesicles has not been described before. We describe the transrectal ultrasonography (TRUS), CT and MRI findings of a secondary solitary hydatid cyst of the left seminal vesicle, in a patient with disseminated hydatid disease involving all abdominal organs except for right kidney. We obtained typical findings of hydatid cyst at all modalities.

Effects of octreotide treatment on Graves' ophthalmopathy and circulating sICAM-1 levels.

Efficacy of octreotide treatment for Graves' ophthalmopathy (GO) and the effects of this treatment on the serum levels of the circulating intercellular adhesion molecule-1 (sICAM-1) were evaluated. Ten patients with GO were treated with octreotide three daily SC injections of 100 micrograms, for 3 months. Octreotide treatment was initiated after restoration of euthyroidism with antithyroid drugs. All patients were treated with methimazole to maintain euthyroidism during the study. Sera were collected from all patients before and 3 months after initiation of the study, and from 20 age- and sex-matched healthy subjects for sICAM-1 measurement. sICAM-1 was measured by a sandwich ELISA method. Proptosis in all patients was evaluated by orbital CT scan before and 3 months after initiation of the study. Two of 10 patients did not respond to octreotide therapy, while the remaining eight patients showed regression or improvement after therapy. Octreotide therapy was particularly successful in patients with soft tissue involvement of GO (class II or III disease). Mean proptosis and ophthalmopathy index scores were significantly decreased after 3 months of octreotide therapy. Mean sICAM-1 levels were significantly higher in patients before octreotide therapy (470.5 +/- 52.6 ng/mL, p < 0.0001) when compared to normal subjects (186.5 +/- 53.3 ng/mL). Mean sICAM-1 levels were significantly decreased 3 months after octreotide therapy (from 478.7 +/- 52.6 to 415 +/- 42.8 ng/mL, p = 0.012) in the 8 patients who responded to therapy. In contrast, sICAM-1 levels remained unchanged or increased in two patients with poor response to octreotide therapy. Our results suggest that octreotide therapy could be a treatment modality in patients with GO. The mechanism by which octreotide acts on GO is not clear. The observed decrease in sICAM-1 levels during octreotide therapy suggests that octreotide may have immunomodulatory properties. Further investigation is needed to determine the optimal dose and duration of octreotide therapy.

Diagnostic value of MRI in tuberculous meningitis.

In this study 15 patients with clinical findings and positive cerebrospinal fluid analyses for tuberculous meningitis were evaluated with magnetic resonance imaging (MRI). Tuberculous meningitis was diagnosed in 11 cases when thick meningeal enhancement was present after intravenous injection of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) in T1-weighted images. Intra-axial tuberculomas were present in 8 patients, 2 of whom had intra-axial tuberculomas without MRI evidence of meningitis. Tuberculomas showed ring or nodular enhancement in postcontrast T1-weighted images, but the most significant MR feature of intraparenchymal tuberculomas was the hypointense appearance of the lesions on T2-weighted images.