Acute mastoiditis in children: A tertiary care center experience in 2015-2021.

Background: Acute mastoiditis is a suppurative infection of mastoid air cells and is the most common intratemporal complication of otitis media. Aim: This study aimed to evaluate the demographic and clinical characteristics and treatment outcomes of children with acute mastoiditis (AM). Patients and Methods: We retrospectively reviewed the medical records of hospitalized pediatric patients aged between 1 month and 18 years with a diagnosis of AM between May 2015 and December 2021. Results: A total of 28 hospitalized children with AM were enrolled in this study, of whom 22 (78.6%) were males and 6 (21.4%) were females with a mean ± standard deviation age of 93.5 ± 53.2 months (range = 6 months-16.1 years). The most common clinical symptoms were postauricular erythema (n = 17, 60.7%), tenderness (n = 16, 57.1%), swelling (n = 14, 50%), fever (n = 14, 50%), and auricular protrusion (n = 7, 25%). Mastoiditis complications occurred in 10 (35.7%) children. The most common extracranial complication was subperiosteal abscess (n = 8, 28.6%). The erythrocyte sedimentation rate (ESR) and the rate of antibiotic use before hospitalization were higher in patients with complicated mastoiditis (P = 0.006 and P = 0.039, respectively). Surgery was performed in 12 (42.9%) patients. Statistically, more surgical interventions were performed in patients who developed complications (P = 0.003). Conclusion: AM continues as an important disease of childhood. Successful results are obtained with systemic antibiotic therapy and additional surgical intervention as necessary. A careful evaluation of patients with a high ESR and those who received antibiotic therapy before hospitalization is appropriate due to the correlation between these factors and the risk of complication development.

EVALUATION OF FETUIN-A LEVELS IN THE EARLY STAGE OF AUTOIMMUNE THYROIDITIS.

Context: Fetuin-A is a multifunctional protein and is known to be related to metabolic syndrome, vascular calcification, and inflammation. Objective: The purpose of this study was to determine the effects of serum fetuin-A levels on autoimmune thyroiditis without thyroid dysfunction. Subjects and Methods: This prospective case-control study was performed at the pediatric endocrinology outpatient clinic of a tertiary health institution in Istanbul, Turkey between July 2022 and October 2022. Serum fetuin-A levels were assessed using a human fetuin-A enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Houston, TX, USA). Results: The study included 86 participants, of which 42 were patients with Hashimoto's thyroiditis (HT) and 44 were controls. Autoimmune thyroiditis without thyroid dysfunction was found to be related to lower plasma fetuin-A levels. There were no statistically significant differences in the neutrophil-to-lymphocyte ratio, fasting blood glucose level, insulin level, or HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) value between the groups. A fetuin-A level of ≤162.22 µg/mL (80.95% sensitivity and 70.45% specificity) was found to support the identification of autoimmune thyroiditis. Conclusions: The findings of our study suggest that autoimmune thyroiditis without thyroid dysfunction is related to lower fetuin-A levels. Low fetuin-A levels are known to be associated with an increased risk of cardiovascular disease, suggesting that careful monitoring is required in patients with low fetuin-A levels.

Molecular characterization and risk factors for carbapenem-resistant Gram-negative bacilli colonization in children: emergence of NDM-producing Acinetobacter baumannii in a newborn intensive care unit in Turkey.

BACKGROUND: Multidrug-resistant Gram-negative bacilli are responsible for more than 50% of healthcare-associated infections. Colonization dynamics, characteristics, and risk factor data for CR-GNB are scarce in children. AIM: To examine the molecular characteristics of, and risk factors for nosocomial colonization with, carbapenem-resistant Gram-negative bacilli (CR-GNB) in hospitalized paediatric patients in a tertiary university hospital's paediatric units in Turkey. METHODS: A prospective case-control study was performed at a university hospital in Istanbul, Turkey. FINDINGS: A total of 1840 rectal swab specimens were collected from all 762 hospitalized children between March 2013 and October 2013. Among them, 176 (23%) patients were colonized with CR-GNB. Of these, 72 (9%) patients were colonized with carbapenem-resistant Enterobacteriaceae, 138 (18%) with CR-non-fermenter Gram-negative bacilli (CR-NF) and 34 (4%) with both. The median CR-GNB colonization time was 10 days (range: 1-116). The median duration of rectal colonization with CR-GNB was 8 days (range: 1-160). NDM (31%) was the second most frequent carbapenemase identified in Acinetobacter baumannii isolates, and has not previously been detected in Turkey. All of the 17 patients colonized with NDM-producing A. baumannii were newborns in the neonatal intensive care unit. Independent risk factors for CR-GNB colonization were: age <1 year, nasogastric tube placement, presence of underlying chronic diseases, ampicillin usage, surgical intervention, and carbapenem use. CONCLUSION: This is the first description of NDM in A. baumannii in newborn units in Turkey. Carbapenem usage is a common independent risk factor for both CRE and CR-NF colonization, which underscores the importance of antibiotic stewardship programmes.

The effect of octreotid on bacterial translocation from the gut. An experimental study.

Octreotid (OC) is a somatostatin (ST) analog which is being increasingly used during the management of various gastrointestinal disorders. This study was undertaken to assess the probable effects of OC on intraintestinal microflora and bacterial translocation. To our knowledge, no previous work has addressed this issue. Ten rats forming the study group were injected 20 micrograms/kg of OC subcutaneously for seven days. A control group (n = 10) received an equal volume of isotonic saline for seven days. All animals were sacrificed on the eighth day and tissue cultures were obtained from the mesenteric lymph nodes, liver, and spleen. Cultures were also made from the caecal content and a piece of terminal ileum was removed for histopathological examination. For statistical analysis, Mann Whitney-U, and Fisher's exact tests were used. Caecal bacterial content, and bacterial translocation were found to be significantly increased in the study group in comparison to the control group (p < 0.05). Among the study group, there was also a statistically significant increase in the caecal bacterial content in rats with evidence of bacterial translocation (p < 0.05). Histopathological evaluation drew a great deal of attention to submucosal edema present in the study group. OC significantly increases bacterial overgrowth, and translocation in rats. Studies on humans are needed to demonstrate similar clinical effects of OC.

[Klebsiella pneumoniae capsular type 48 isolated for the first time in Turkey]. / Türkiye'de ilk defa izole edilen Klebsiella pneumoniae kapsül tip 48 susu.

Capsule type 48 Klebsiella pneumoniae strains were isolated from cerebrospinal fluid and blood specimens of 4 days old baby. This type of Klebsiella were the first observation in Turkey.

[Klebsiella pneumoniae capsular type 25 and type 16 isolated for the first time in Turkey]. / Türkiye'de ilk defa izole edilen Klebsiella pneumoniae kapsül tip 25 tip 16 suslari.

Klebsiella pneumoniae capsule type 25 and 16 strains were isolated from the urines of two cases having urinary tract infection. These capsule types of Klebsiella were the first observation in Turkey.