Increased asymmetric dimethylarginine in vitamin B12 deficient adolescents.

OBJECTIVE: Vitamin B12 deficiency induces hyper-hyperhomocysteinemia by inhibiting intracellular methionine re-methylation. Hyper-hyperhomocysteinemia increases the risk of atherosclerosis. Asymmetric dimethylarginine is an endogenous inhibitor of nitric oxide synthase and its level elevates in cardiovascular diseases. In this study, we aimed to examine the relationship between asymmetric dimethylarginine and arterial stiffness and atherosclerosis in adolescents with vitamin B12 deficiency. METHODS: A total of 88 adolescents with age ranging between 11 and 17 years of age were enrolled for this study. Among them, 50 patients had vitamin B12 deficiency 200 pg/ml. In all cases, the levels of asymmetric dimethylarginine were measured with high performance liquid chromatography method. The carotid artery intima media thickness and left ventricular mass index were measured using echocardiography. All these measurements of the study groups were compared. RESULTS: Both plasma levels of asymmetric dimethylarginine and carotid artery intima media thickness were significantly higher in the vitamin B12 deficiency group than in the control group. Correlation analysis showed significant negative correlation of vitamin B12 with homocysteine, asymmetric dimethylarginine, and carotid artery intima media thickness (p<0.05). CONCLUSION: Our results suggest that endothelial dysfunction starts in the early stage of adolescent vitamin B12 deficiency, and vitamin B12-deficient adolescents have increased circulating asymmetric dimethylarginine, showing that endothelial dysfunction and increased carotid artery intima media thickness be related to atherosclerosis.

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.

Assessment of inappropriate antibiotic use in pediatric patients: Point-prevalence study.

AIM: This study aimed to determine inappropriate antibiotic use in a children's hospital using the point-surveillance method. MATERIAL AND METHODS: One hundred thirteen hospitalized patients were included in the study on the study day. In all patients, data regarding age, sex, antibiotic use, type and dose of antibiotic if used, multiple antibiotic use, presence or absence of consultation with infectious diseases specialist before initiation of antibiotic, form of antibiotic use (empiric, targeted or prophylactic), and reason for antibiotic use were recorded. Inappropriate antibiotic use was determined by an infectious diseases specialist. RESULTS: The rate of antibiotic use was 70.8%. Of the patients receiving antibiotics, 43% were using more than one antibiotic. It was found that 73.7% of antibiotics were prescribed for empiric purposes and 14.3% for targeted therapy, whereas 12% were prescribed for prophylactic purposes. The rate of inappropriate antibiotic use was 33.8% among patients who were given antibiotics. Unnecessary antibiotic prescription was the most common cause for inappropriate antibiotic use (51.9%), followed by unnecessary multiple antibiotic use (29.6%), inaccurate dosing (11.1%), use of broader spectrum than required (7.4%), and use of antibiotics with narrower spectrum than needed (3.7%). The rate of inappropriate antibiotic use was significantly lower in antibiotics that required confirmation by an infectious diseases specialist (6.7%) than those not requiring confirmation (26.3%; p=0.023). The rate of inappropriate antibiotic use was significantly lower in antibiotics prescribed by infectious diseases specialists (8.6%) than those prescribed by other physicians (26.5%, p=0.027). CONCLUSION: Antibiotic use based on consultation with an infectious diseases specialist decreased inappropriate antibiotic use.

Factors that predict disease severity in atopic dermatitis: The role of serum basal tryptase.

BACKGROUND: Increased numbers of mast cells that contain tryptase are found in lesional atopic dermatitis (AD) skin. The association of serum basal tryptase (sBT) with anaphylactic reactions and mast cell diseases has recently been shown in children with venom and food allergy. OBJECTIVE: We aimed to identify the risk factors that predict the severity of AD and the association of sBT levels with AD and disease severity. METHOD: AD diagnosis was made according to Hanifin and Rajka criteria. Disease severity was scored by the objective scoring atopic dermatitis (SCORAD) index. The sBT levels were measured. Skin-prick testing, total immunoglobulin E, eosinophil percentages and counts, and a questionnaire concerning the history of atopic diseases and the risk factors of AD were applied. RESULTS: The children, ages 0.5 to 3.0 years, with AD (n = 85) were analyzed in two groups according to the presence (AD+/atopy+ [n = 55]) or absence (AD+/atopy- [n = 30]) of skin-prick test positivity. The comparisons were made with an age- and sex-matched control group (n = 82). The median (interquartile range) sBT in the AD+/atopy+, AD+/atopy-, and control groups were 5.01 ng/mL (2.75-6.79 ng/mL), 3.02 ng/mL (1.67-4.44 ng/mL), and 2.63 ng/mL (1.31-4.49 ng/mL), respectively (p = 0.003). The median (interquartile range) sBT levels were higher in patients with moderate-severe objective SCORAD index scores compared with the those with mild disease (3.85 ng/mL [2.04-5.91 ng/mL] versus 2.80 ng/mL [1.83-3.48 ng/mL]; p = 0.038). Multivariate logistic regression analysis showed that an sBT level of ≥3.9 ng/mL (odds ratio 8.77 [95% confidence interval, 1.87-41.18]; p = 0.006) was independently associated with an increased risk of moderate-severe AD (objective SCORAD index). CONCLUSION: To our knowledge, this was the first study that indicated that sBT levels may be important in the AD disease process and associated with the disease severity and atopy.

Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study.

The effectiveness of using a face mask with a small diffuser for oxygen delivery (OxyMask) was compared to use of a high-flow nasal cannula (HFNC) in patients with moderate or severe bronchiolitis.The study population in this open, phase 4, randomized controlled trial consisted of 60 patients aged 1-24 months diagnosed with moderate or severe bronchiolitis and admitted to an intensive care unit (ICU) for oxygen therapy. The patients were randomized into two groups according to the method of oxygen delivery: a diffuser mask group and an HFNC group.There were seven failures in the mask group and none in the HFNC group. The survival probability differed significantly between the two treatment methods (p = 0.009).Time to weaning off oxygen therapy was 56 h in the HFNC group and 96 h in the mask group (p < 0.001).Conclusion: HFNC use decreased the treatment failure rate and the duration of both oxygen therapy and ICU treatment compared to the diffuser mask, which implies that an HFNC should be the first choice for treating patients admitted to the ICU with severe bronchiolitis. What is known: • A high-flow nasal cannula (HFNC) does not significantly reduce the time on oxygen compared to standard therapy in children with moderate to severe bronchiolitis. Observational studies show that, since the introduction of HFNC, fewer children with bronchiolitis need intubation. For children with moderate to severe bronchiolitis there is no proof of its benefit. What Is New: • In children with moderate to severe bronchiolitis, HFNC provides faster and more effective improvement than can be achieved with a diffuser mask.

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms.

OBJECTIVE: We compared the protective effects of secure Chlorhexidine Gluconate (CHG)-containing dressings with those of non-antimicrobial transparent dressings. METHODS: This prospective, comparative, single-center clinical study was conducted in a tertiary pediatric intensive care unit from October 2014 to March 2017. The inclusion criterion was catheterization of the jugular vein for ≥48 hour. The study was conducted in two phases. Non-antimicrobial standard dressings were applied both before and after the CHG- dressing phase to negate any coincidental temporal effect. During the standard-dressing phases, the dressings did not include any antimicrobial; transparent CHG-impregnated dressings were applied during the test phase. All patients were divided into two groups by the type of dressing applied (standard and CHG-containing dressings). RESULTS: The standard- and CHG-dressing groups contained 68 and 63 patients, respectively. The median durations of catheterization were 13 (8-22) and 14 (2-28) days, respectively (p>0.05). The Catheter-Related Bloodstream Infection (CRBSI) rate was somewhat lower in the CHG-dressing group (20.6 vs. 26.5%), but the difference was not statistically significant (p>0.05). In the CHG-dressing group, CRBSIs caused by Gram-positive microorganisms totaled 0%, but the figure was 8.8% in the control group (p=0.028). CONCLUSIONS: CHG dressings reduced CRBSIs caused by Gram-positive microorganisms.

Increased Iron Deficiency and Iron Deficiency Anemia in Children with Zinc Deficiency.

OBJECTIVE: The aim of the present study is to determine the presence of iron (Fe) deficiency and Fe deficiency anemia in children with zinc (Zn) deficiency. MATERIALS AND METHODS: This retrospective study comprised 560 patients aged 6 months to 16 years in whom Zn levels in hair samples were measured concurrently with serum levels of ferritin, Fe, Fe-binding capacity, and blood count analysis. For all patients, we retrospectively assessed serum ferritin, serum Fe, Fe-binding capacity, transferrin saturation index, red blood cell count, hemoglobin levels, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width (RDW). Patients were divided into two groups according to the level of the hair Zn level as Zn deficiency (hair Zn level <100 µg/g) and without Zn deficiency (hair Zn level >100 µg/g). Data were analyzed to determine whether there was a significant difference between any of these parameters and the presence of Fe deficiency and Fe deficiency anemia between patients with and without Zn deficiency. RESULTS: A total of 238 patients had Zn levels <100 µg/g, and 322 patients had Zn levels >100 µg/g. The median ferritin level was 16.2 (9.8-24.9) ng/mL in the Zn-deficient group and 18.7 (12-29.3) ng/mL in those without Zn deficiency group. The presence of Fe deficiency was higher in the Zn deficiency group (60.1%) than in the without Zn deficiency group (50%; p<0.05). The presence of Fe deficiency anemia was significantly higher in the Zn deficiency group (20.2%) than in the without Zn deficiency group (12.7%; p<0.05). There were very weak negative significant correlation between hair Zn and RDW level (r=-0.24; p<0.001) and weak positive correlation between hair Zn and MCV (r=0.31; p<0.001). CONCLUSION: Fe deficiency and Fe deficiency anemia increased in patients with zinc deficiency.

High Doses of Boron Have No Protective Effect Against Nephrolithiasis or Oxidative Stress in a Rat Model.

Boron plays roles in the metabolism of calcium, vitamin D, steroid hormones, healthy bone development, and maintenance of cell membranes. The biological effects of boron are dose-dependent but follow a U-shaped pattern, rendering it important to define the active range. The studies of Bahadoran et al. on rats and Naghii et al. on humans showed that low doses of boron (3 and 10 mg/day) prevented kidney stone formation. The aim of this study was to determine whether high doses of boron have an anti-urolithiatic or antioxidant effect on nephrolithiasis in an experimental rat model. The study was conducted on 50 adult male Wistar rats randomized to five groups. Nephrolithiasis was induced with water containing 0.75% ethylene glycol (EG) and 2% ammonium chloride (AC). This treatment was given to animals in all groups for 10 days, except the positive and negative controls. Simultaneously, groups 2, 3, and 4 were given boric acid via gavage at doses of 25, 50, and 100 mg/kg/day (equivalent to 4/8/16 mg boron respectively) as the source of boron. Animals in the negative and positive control groups were given 6 µL/g distilled water without boric acid. At day 10, intra-cardiac blood samples were drawn from all animals. The right and left kidneys were removed for biochemical and histopathological examinations, respectively. The groups were compared with respect to serum urea, creatinine, calcium, phosphorous, total antioxidant status (TAS), total oxidant status (TOS), serum paraoxonase (PON1) activity, tissue calcium and oxalate levels, and stone burden as determined by histopathological examination. Serum urea and creatinine levels were significantly higher (p < 0.001 and p < 0.05, respectively), while serum calcium and phosphorous levels were significantly lower (p < 0.001 and p < 0.001, respectively), in animals given EG/AC compared to negative controls. No significant differences were detected in serum calcium, phosphorous, urea, or creatinine levels between animals treated with boron and positive controls (p > 0.05). Serum PON1 activity was significantly lower in animals given EG/AC than in negative controls (p < 0.001), while no significant difference in serum PON1 level was detected between rats treated with boron and positive controls. No significant differences were detected in vitamin D, TAS, TOS, tissue calcium, or tissue oxalate levels among groups. No stone formation was detected on histopathological examination in negative controls. No significant differences were found in stone formation between rats treated with boron and positive controls. Based on this study, high doses of boron had no protective effect against nephrolithiasis and oxidative stress.

A retrospective evaluation of blood cultures in a pediatric intensive care unit: a three year evaluation.

AIM: In this study, it was aimed to retrospectively assess the frequency and antibiotic resistance of microorganisms isolated from blood cultures of patients in a pediatric intensive care unit. MATERIAL AND METHODS: The study was conducted on blood culture tests obtained from patients in a pediatric intensive care unit and sent to a microbiology laboratory between 2013 and 2016. The species and antibiotic susceptibilities were assessed in microorganisms isolated from the blood cultures. RESULTS: Overall, 4239 blood cultures were obtained. Growth was detected in 324 blood cultures (7.6%). Of the microorganisms isolated, 195 (60.2%) were Gram-positive bacteria, and 107 (33.0%) were Gram-negative bacteria; 22 (6.8%) were fungi. The most commonly isolated microorganisms were Coagulase-negative staphylococci (45.1%), followed by Klebsiella pneumonia (14.5%), and Enterococcus faecalis (6.5%). Among the fungi, the most common was Candida albicans (59.1%), followed by Candida parapsilosis. The resistance rate against methicillin was 89.9% in coagulase-negative staphylococci, and 66% in S. aureus strains. The resistance rate against vancomycin was 3.6% in Enterococci spp. There was no resistance against linezolid in Gram-positive microorganisms. The rate of extended-spectrum beta lactamase positivity was found as 34% in Klebsiella spp. and 100% in Escherichia coli. The resistance rate against carbapenem was 44.9% in Gram-negative bacteriae. The resistance rate against carbapenem was 100% in Acinetobacter baumanii. In Candida albicans, resistance to amphotericine B was 61.5%, and resistance to voriconazole was 7.7%. CONCLUSIONS: To plan effective empiric antibiotic therapy against nosocomial infections in intensive care units, all units should have information about the characteristics of their own flora.

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit.

OBJECTIVE: The aim of this study was to identify microorganisms causing ventilator-associated pneumonia (VAP) and also study the antibiotic resistance/susceptibility. MATERIALS AND METHODS: We retrospectively assessed microorganisms isolated from patients diagnosed with VAP in a pediatric intensive care unit between January 1, 2014, and June 30, 2016. RESULTS: We included 44 patients diagnosed with VAP. The prevalence thereof was 8.6 patients per 1,000 ventilator days. Mechanical ventilation was required for 56.5% of patients. Thirty-three patients (75%) died. An underlying chronic disease was detected in 75% of patients (n=33). Fifty microorganisms were isolated from 44 patients. Single microorganisms were isolated from 86.4% (n=38) and two from 13.6% (n=6) of patients. Of all the isolated bacteria, 96% (n=48) were gram-negative; the most common was Pseudomonas aeruginosa (32%), followed by Klebsiella pneumoniae (24%) and Acinetobacter baumannii (22%). The isolates were most susceptible to colistin (92.6%), followed by piperacillin-tazobactam (71.4%), amikacin (65.2%), and gentamicin (52.2%). No enterobacterium or Acinetobacter strain was resistant to colistin; however, 13% of P. aeruginosa isolates were resistant. CONCLUSION: In VAP, it is essential to catalog antibiotic resistance patterns of bacteria present in the unit to ensure that empirical antibiotic therapy is effective.

The eyes of children with celiac disease.

PURPOSE: To determine possible eye involvement in pediatric patients with celiac disease. METHODS: Children (aged 5-18 years) with classic celiac disease and sex- and age-matched controls were included. In addition to a complete ophthalmologic examination, all patients were scanned by a Scheimpflug camera and spectral domain optical coherence tomography, and Schirmer and break-up time (BUT) tests were performed. Data were evaluated by paired t test, with a P value of <0.05 considered statistically significant. RESULTS: A total of 31 celiac patients (19 females [61%]) and 34 controls (20 females [59%]) were included. Mean age of the celiac patients was 11.0 ± 4.4 years (range, 4-18 years); of the controls, 10.4 ± 2.6 years (range, 5-15 years; P = 0.473). Mean follow-up of patients was 5.4 ± 1.7 years (range, 3-7.2 years). The eyes of children with celiac disease, compared to controls, did show decreased anterior chamber depth (3.5 ± 0.2 vs 3.7 ± 0.2, resp.; P < 0.001), decreased anterior chamber volume (170.8 ± 25.5 vs 190.7 ± 27.4; P < 0.001), lower Schirmer (17.9 ± 9.1 vs 21.6 ± 4.1; P = 0.038), and lower BUT (10.8 ± 3.8 vs 12.1 ± 1.7; P = 0.046), as well as lower retinal nerve fiber layer (general 102.8 ± 8.2 vs 108.9 ± 10.1; P < 0.001). CONCLUSIONS: Decreases in retinal nerve fiber, anterior chamber shallowing, and qualitative and quantitative reduction in tears can occur in celiac patients, even if routine ocular examination reveals no abnormality.

Diagnostic role of mean platelet volume and neutrophil to lymphocyte ratio in childhood brucellosis.

BACKGROUND/AIMS: Brucellosis patients present various non-specific clinical symptoms, such as fever, fatigue, sweating, joint pain, arthritis, myalgia, and headache. Based on the nonspecifity of its clinical signs and symtoms, we decided to evaluate whether mean platelet volume (MPV) , neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) will contribute to the diagnosis. METHODS: In this retrospective study, we reviewed hospital-records of 60 children with a confirmed diagnosis of brucellosis in Kayseri between January 2013 and January 2016, and compared the hematological parameters; white blood cell (WBC) count, hemoglobin (Hb), neutrophil count, lymphocyte count, platelet count, MPV, NLR, and PLR with 55 healthy age and gender matched children. Also, the well known inf lammation markers; erytrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between the patient and control group. RESULTS: We found significant difference among the Hb, platelet count, MPV and NLR values between the patient and control group (p < 0.05). There was no difference between WBC, neutrophil count, lymphocyte count and PLR between the patient and control group (p > 0.05). When the patients were divided into groups as arthritis positive and arthritis negative and compared to the control group; we found that the NLR is more significant in between the arthritis positive and control group (p = 0.013). Also, we found significant difference among the ESR and CRP values between the patient and control group (p < 0.001). CONCLUSIONS: The results of this study indicates that MPV and NLR values can be used as markers of inflammation in childhood brucellosis. Also, NLR is more valuable in children with brucella arthritis.

Dermatological Findings in Turkish Paediatric Haematology-Oncology Patients.

OBJECTIVE: Diagnoses of skin, mucosae, hair and nail manifestations in malignant diseases are often challenging because of life-threatening drug reactions, opportunistic infections or skin involvement of primary processes. Description of morphology, configuration and distribution of lesions is important in order to differentiate the self-healing eruptions from serious side effects of chemotherapy. There are case reports from Turkey including dermatological manifestations of malignancies and case series in adult patients but there are no published large group studies assessing all manifestations in children. The aim of this study was to evaluate the morphological features of dermatological findings in children with haemato-oncological diseases. MATERIALS AND METHODS: The study was performed at the Erciyes University, Faculty of Medicine Pediatric Hematology-Oncology Clinic, Turkey. Three dermatologists daily consulted all patients admitted to the clinic during a one-year period. RESULTS: The study group comprised of 157 children (79 female/78 male) aged 1-16 years (mean 7.19±4.63). Detailed dermatological examinations were performed, including oral-genital mucosae, hair and nails. Thorough skin examination revealed that 70% of the patients exhibited at least one dermatological finding. Generalized xerosis and hyperpigmentation were the most common findings among patients undergoing chemotherapy (24.19%). Multiple nevi on at least 10 covered areas were very frequent among patients undergoing long-term chemotherapy (18.47%). Three were identified as dysplastic nevus, but malignant transformation was not observed during the one-year study period. CONCLUSION: Regular dermatological consultation may help resolve the diagnostic and therapeutic problems in paediatric haemato-oncology clinics.

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants.

BACKGROUND: There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. AIMS: To compare the effect of nebulized 7% HS/salbutamol and 3% HS/salbutamol to 0.9% saline/salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. STUDY DESIGN: Prospective, double-blinded randomized clinical study. METHODS: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A - 0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. RESULTS: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). CONCLUSION: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis.

Reduction in mean platelet volume in children with acute bronchiolitis.

AIM: Platelets which are known to play a role in inflamation change their shapes when they are activated and this change is reflected in mean platelet volume and platelet distribution width values. Therefore, the mean platelet volume and platelet distribution width values are considered to be beneficial parameters for the diagnosis and treatment of many inflammatory diseases. The aim of the study was to evaluate platelet volume indices in children with acute bronchiolitis. MATERIAL AND METHODS: A total of 514 infants who were below the age of 2 years old were evaluated in this study. Three hundred thirteen of these infants were diagnosed with acute bronchiolitis patients and 201 were healthy children. The patients were separated into four groups as mild, moderate, severe bronchiolitis and the control patient group. The groups were evaluated in terms of significant differences in the values of mean platelet volume and platelet distribution width. A p value of <0.05 was considered statistically significant for all results. RESULTS: The mean platelet volume was found to be 6.8±0.6 fL in the patients with mild bronchiolitis attack, 6.7±0.6 fL in the patients with moderate bronchiolitis attack, 6.5±0.5 fL in the patients with severe bronchiolitis attack and 7.3±1.1 fL in the control group. The mean platalet volume was statistically significantly lower in the mild, moderate and severe bronchiolitis attack groups compared to the control group (p=0.000). The platelet distribution width was found to be 17.2%±0.83 in the mild bronchiolitis attack group, 17.1%±0.96 in the moderate bronchiolitis attack group, 17.3%±0.87 in the severe bronchiolitis attack group and 16.9±1.6% in the control patient group. This difference was not statistically significant (p=0.159). The platelet count was statistically significantly higher in the mild, moderate and severe bronchiolitis attack groups compared to the control group (p=0.000). CONCLUSIONS: The mean platalet volume is decreased in patients with acute bronchiolitis. It is not a useful criterion in determining the severity of bronchiolitis attack. It is important that clinicians evaluating hemogram results to also interprete this variable.

Bullous Dermatitis and Skin Necrosis Developing after Adrenalin Extravasation.

Extravasation of vasopressors can have serious complications varying from simple local reactions to skin necrosis and compartment syndrome. Here, we presented bullous dermatitis and skin necrosis which developed due to extravasation of adrenalin infusion in a Hodgkin lymphoma patient with septic shock who was admitted due febrile neutropenia.

Hypopituitarism and Legg-Calve-Perthes disease related to difficult delivery.

Legg-Calve-Perthes (LCP) disease is characterized by idiopathic avascular osteonecrosis of the epiphysis of the femur head. The main factor that plays a role in the etiology of the disease is decreased blood flow to the epiphysis. Many predisposing factors have been suggested in the etiology of LCP disease, and most have varying degrees of effects. Here we present the case of a boy aged 4 years and 10 months with complaints of short stature and a diagnosis of multiple hypophyseal hormone deficiency, in whom LCP disease and difficult birth-related pituitary stalk interruption syndrome were identified by anamnesis. The present case revealed that LCP disease and hypophyseal hormone deficiency could be secondary to difficult birth and that LCP disease could be secondary to insulin-like growth factor 1 deficiency. Additionally, to the best of our knowledge there is no published case on the relation between LCP disease and insulin-like growth factor 1 deficiency. Therefore, we believe that this case is worthy of presentation.

Measurement of hair iron concentration as a marker of body iron content.

The aim of the present study was to define the possible association between blood parameters and hair iron concentration in patient groups showing a difference in body iron content. The study population comprised subjects with iron deficiency anaemia and transfusion-related anaemia with different body iron contents and a healthy control group. All the cases included in the study were examined with respect to hair iron concentration, serum iron, total iron-binding capacity (TIBC), transferrin saturation and erythrocyte markers in the total blood count with ferritin values. Differences in hair iron concentration were evaluated between the groups. Correlation analysis was applied to define the association between the laboratory values used as markers of body iron content and hair iron concentration. A statistically significant difference was determined in hair iron 56Fe and 57Fe concentrations between the group with transfusion-related anaemia, the iron deficiency anaemia group and the healthy control group (P<0.001). In addition, a positive correlation was determined between hair iron 56Fe and 57Fe concentrations and serum iron, ferritin level, transferrin saturation, mean erythrocyte volume and mean erythrocyte haemoglobin values and a negative correlation with TIBC. In conclusion, the results of the present study showed a statistically significant difference in the hair iron concentrations of the patient groups with different body iron content and these values were correlated to the laboratory markers of body iron content.

Diabetic euglycemic ketoacidosis in newly diagnosed type 1 diabetes mellitus during Ramadan fasting.

Real euglycemic diabetic ketoacidosis [DKA; blood glucose <200 mg/dL (11.1 mmol/L)] is rare, and long-lasting starvation conditions due to intervening diseases in type 1 diabetes mellitus patients may also cause it. Euglycemic DKA is also reported in insulin-dependent diabetics with depression, alcoholics, glycogen storage diseases, and chronic liver disease apart from pregnant cases. This case report is presented to emphasize the importance of evaluation of acid-base state, urine glucose, and ketone values at the application in all newly diagnosed type 1 diabetic patients with normal glucose levels by defining euglycemic DKA that resulted from long-lasting starvation during Ramadan fasting in a newly diagnosed 14-year-old male patient.

Compare the effects of intravenous and intraperitoneal mesenchymal stem cell transplantation on ultrafiltration failure in a rat model of chronic peritoneal dialysis.

AIM: The purpose of this study was to compare the possible healing effects of intraperitoneal (IP) and intravenous (IV) mesenchymal stem cell (MSC) transplantation on ultrafiltration failure (UFF) in a chronic rat model of peritoneal dialysis (PD). METHODS: Rats were initially divided into two groups. The UFF-group received once-daily IP injections of 20 mL of 3.86% glucose PD solution for six weeks to stimulate the development of UFF, and a control group received no injections. The UFF group was sub-divided into four groups: an UFF-C group, a MSC-IP group, a MSC-IV group and a placebo (P) group. Peritoneal equilibration tests (PETs) and peritoneal biopsies were performed in the control and UFF-C groups. MSCs were administered by IP injection in the MSC-IP group and by IV injection in the MSC-IV group. The P group received IP injection of placebo. PETs and peritoneal biopsies were performed in the MSC-IP, MSC-IV and P groups at the three weeks after receiving MSCs or placebo. RESULTS: When compared with the control group, ultrafiltration capacity significantly decreased, and the submesothelial thickness increased in the UFF-C and P group, but there were no differences between the control and MSC-IP and MSC-IV groups. The rate of glucose transport was high in the UFF-C and P group compared with the control group, and D/PCr rates in the UFF-C and P group were lower than in the control group. However, D/D0glucose was higher and D/PCr was lower in the MSC-IP group than in the UFF-C and P groups, but D/D0glucose rate of MSC-IV group similar to UFF-C and P groups and there was no difference between MSC-IV group and the other groups in terms of D/PCr rates. The MSC-IP, MSC-IV and P groups had significantly decreased tumor necrosis factor α concentrations compared with the UFF-C group. MSC-IP group had lower levels of TGF-ß1 compared with the P group; MSC-IP group had also lower levels of interleukin-6 compared with UFF-C group. CONCLUSION: The UFF group had a high permeability UFF. These results showed that IV and IP MSC transplantation exerted positive effects on UFF in a chronic rat model of PD. However, healing effect of small solute transport in MSC-IP group was better than MSC-IV group. IP MSC transplantation may be more effective than IV MSC transplantation for the renewal of the peritoneum in chronic PD patients with UFF.