Atropa belladonna (Deadly Nightshade) Poisoning in Childhood

ABSTRACT Objective: A very small amount of Atropa belladonna (AB) can lead to serious symptoms of poisoning and can cause death in children. In this study, demographic, clinic and laboratory results of AB poisoning were evaluated. Methods: A total of 108 cases with belladonna poisoning were retrospectively evaluated. At time of admission, age, age groups, gender, signs and symptoms caused by poisoning, duration of stay in hospital, laboratory data, intensive care needs, and applied treatments were recorded. Results: Approximately 44.4% were females and 55.6% were males. While the most common symptoms were xeroderma and flushing, the most frequent findings were tachycardia and mydriasis. Eight patients complained about astasis and five of them were taken into the intensive care unit. Astasis complaint was relatively higher (p < 0.01) in the patients who needed intensive care than those who did not. Creatine kinase levels were relatively higher (p = 0.06) in the intensive care patients as compared to non-intensive care patients. Neostigmine was given to all patients. Five patients, who failed to respond to therapy, were taken into the intensive care and respond to treatment successfully with physostigmine. Conclusion: Atropa belladonna poisoning may seriously progress in the act of late diagnosis and treatment in childhood. Thus, it is crucial to realize that AB poisoning should be taken into consideration in the patients with flushing, xeroderma with mydriasis, tachycardia, tremor, abdominal pain, and fever symptoms. Patients with astasis complaints should be evaluated carefully in terms of intensive care need. Patients with a Glasgow Coma Scale lower than 12 should be observed in the intensive care.

How Approprıate are the Lengths of Syringe Needles Used for Subcutaneous Injections to the Children at School Age?

ABSTRACT Objectives: To define the normal ranges of the thicknesses of the skin and subcutaneous tissues via ultrasonography, and determine whether the current syringe needle-lengths used for the subcutaneous injections were appropriate. Methods: The thicknesses of the skin and subcutaneous tissues of 2244 students were measured at the left arm using ultrasonography. The patients were divided into three groups based on their age: 6-8, 9-12 and 13-17 years. Results: The thicknesses of the skin, subcutaneous tissue and skin-subcutaneous tissue were found to be positively correlated with their age, body mass index (BMI) and body surface area. All these were observed to be gender related. There was the possibility to make intramuscular injections for 50%, 25% and 25% of boys within the age groups of 6-8, 9-12 and 13-17 years, respectively. For girls, the risk of intramuscular injection was 25% for all the age groups. Conclusion: The study showed that the skin and skin-subcutaneous tissue thicknesses varied as a function of the patients' age, gender, BMIs and body surface areas.

Acute intestinal obstruction due to a non-involuted uterus after cesarean section: case report.

The involution of the uterus is influenced by a number of factors such as advanced childbearing age, electrolyte disturbances, multiparity, repeated cesarean sections, and vaginal infections. The authors report the management of a clinical case of a 41-year-old female who presented with acute intestinal obstruction due to a non-involuted uterus after cesarean section.

Clinical and Haematological Manifestations of Typhoid Fever in Children in Eastern Turkey.

OBJECTIVE: Typhoid fever can involve various organs, leading to a wide range of presentations: from uncomplicated to complicated typhoid fever. The haematological changes are common in typhoid fever and include anaemia, leucopaenia, thrombocytopaenia and bleeding diathesis. This study was undertaken in order to determine the clinical and haematological presentation of typhoid fever in children. METHODS: In this study, records of children and adolescents with typhoid fever aged under or equal to 16 years, admitted to Yuzuncu Yil University Hospital between 2010 and 2014, were analysed retrospectively. RESULTS: The cases (56%) were admitted to our hospital in July and October. Major symptoms of patients were abdominal pain (24%), arthralgia (21%) and fever (11%). In our study, decreased mean platelet volume (31%), eosinopaenia 20%), abnormal platelet count (19%), anaemia (16%), leucocytosis (16%) and eosinophilia (12%) were the most common haematological findings in the children. CONCLUSIONS: Typhoid fever is predominant in children at school age with a slight male predominance. Decreased mean platelet volume and abdominal pain might be useful as early diagnostic clues.

Role of circulating nesfatin-1 in the underweight children with poor appetite.

OBJECTIVE: To investigate serum concentration of nesfatin-1 in underweight children who have poor appetite, and its association with anthropometric markers of malnutrition. PATIENTS AND METHODS: We recruited 50 underweight children and adolescents (aged 2-18 years) who presented with loss of appetite. Thirty age- and sex-matched controls were also included in the study. Fasting serum nesfatin-1 concentrations were measured by using Enzyme-Linked Immunosorbent Assay (ELISA) technique. RESULTS: Mean nesfatin-1 level was significantly higher in underweight children when compared to controls (p<0.001). There was no correlation between serum nesfatin-1 levels and anthropometrics markers. CONCLUSIONS: Our results suggest that nesfatin-1 might have an important role in regulation of food intake and pathogenesis of loss of appetite in children.

Analysis of cerebral toxoplasmosis in a series of 170 allogeneic hematopoietic stem cell transplant patients.

INTRODUCTION: Cerebral toxoplasmosis is a rare but fatal complication in hematopoietic stem cell transplant patients, which mostly is caused by reactivation of latent disease. METHODS: In this study, we report an analysis of cerebral toxoplasmosis in a series of 170 allogeneic stem cell transplant patients during a 30-month period at our institution. RESULTS: Among these allogeneic stem cell transplant patients, 5 were diagnosed with cerebral toxoplasmosis by brain magnetic resonance imaging and polymerase chain reaction of Toxoplasma gondii DNA. The incidence of cerebral toxoplasmosis was found to be 2.94%. CONCLUSION: Mortality rate is known to be very high in cerebral toxoplasmosis; therefore, it is life saving to diagnose the disease in the early stages and start treatment promptly, especially in high-endemic countries like Turkey.

Management of hepatic artery aneurysms.

BACKGROUND: Hepatic artery aneurysm (HAA) is a rare clinical entity that can lead to potentially life threatening complications. We reported our personal experience of 4 cases, in which we used different procedures. METHODS: The first case had a pseudo-aneurysm involving the right hepatic artery. The second case had a pseudo-aneurysm, which was localized distal to the accidentally ligated right hepatic artery from the previous cholecystectomy operation. The third case had multiple aneurysms with accompanying dissecting abdominal aortic aneurysm. The fourth case had a pseudo-aneurysm originating from the proper hepatic artery. A covered stent was successfully placed in the case 1. In the second case, the right hepatic artery was ligated distal to the aneurysm. In the third case, vascular structures were not appropriate for vascular reconstruction, and a covered stent placement and embolization were unsuccessful. In the fourth case, ligation of the proper hepatic artery and cholecystectomy was performed. RESULTS: The third case with multiple aneurysms died from multi-organ failure due to sepsis. The remaining cases (case 1, 2, and 4) are disease free and alive. CONCLUSION: HAAs are more commonly observed clinical entities, and their treatment should be handled for each patient separately. Computerized tomography-Angiography and intraoperative Doppler ultrasound are useful radio-diagnostics for determination of aneurysm and planning the operative procedure (Fig. 5, Ref. 15).

Role of haematological testing: ratio values of circulating platelet aggregates in visual field loss associated with pseudoexfoliation glaucoma.

The aim of the work is to examine the role of circulating platelet aggregates (CPAs) in association with pseudoexfoliation glaucoma (PXG) and searching for visual field (VF) progression. The impact of CPAs in association with PXG and ischaemic events related to optic nerve damage and VF progression has not been so far sufficiently explained. The examination included 80 patients, of whom 35 (44 %) were men with average age of 68.3 +/- 7.0 and 45 (56 %) were women with average age of 65.7 +/- 7.0 (t = 1.66; p = 0.101). Forty of them suffered from primary open-angle glaucoma (POAG) and were included into a control (healthy) group, and 40 patients suffered from pseudoexfoliative glaucoma (PXG) and were included into the experimental group. All the examinees underwent complete ophthalmologic examination of visual acuity, ocular fundus, intraocular pressure and anterior eye segment by biomicroscopy and gonioscopy. In addition, VF examination was performed three times in six-month intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method. The obtained decreased values of CPA proportion were caused by hypercoagulability of blood in PXG group resulting finally in ischaemia and hypoxia helping the progression of visual field. In conclusion, our study shows that CPA examination improves the assessment of the vascular role and PXG prognosis (Tab. 3, Ref. 30).

Anterior ischemic optic neuropathy comorbid with Factor V Leiden and PAI-1 4G/5G mutation.

Acute anterior ischemic optic neuropathy (AION) is a disabling disease which impairs visual functions. AION is characterized by ischemic injury of the optic nerve caused by hypoperfusion in the short posterior ciliary arteries supplying the optic nerve head. AION is a complex multi-factorial disease and is difficult to diagnose based on clinical symptoms and signs alone. We describe the case of a 54-year-old patient affected by AION, with only known risk factors were PAI-1 4G/5G and Factor V Leiden mutation with hyperlipidaemia (Ref. 36). Full Text (Free, PDF) www.bmj.sk.

Diffuse pneumocephalus associated with infratentorial and supratentorial hemorrhages as a complication of spinal surgery.

A 23-year-old woman was transferred to our department with loss of consciousness 6 h after undergoing rod placement for thoracolumbar scoliosis. Both computed tomography and magnetic resonance imaging of the brain revealed diffuse pneumocephalus and infra- and supratentorial hemorrhages. The pedicular screw tracts were analyzed with computed tomography and misplacement of a screw was noticed. It was thought that inadvertent dural injury had occurred at the time of insertion. The patient was re-operated and the dural tear was repaired. To our knowledge, this is the first description of these uncommon complications in one patient after spine surgery.

Myositis ossificans of psoas muscle: magnetic resonance imaging findings.

Myositis ossificans is a benign, localized, self-limiting ossifying soft tissue mass with unknown pathogenesis. It may be confused with a malignant tumor of bone or soft tissues, especially in the early stages of the disease. In this report, we present a case of myositis ossificans affecting unilateral psoas muscle, which to our knowledge is a very uncommon location. There was no history of trauma. We describe the imaging findings and clues to early diagnosis of myositis ossificans.

Monostotic fibrous dysplasia of the clivus: MRI and CT findings.

Fibrous dysplasia is a developmental disorder caused by abnormal proliferation and maturation of fibroblasts resulting in replacement of mature bone by structurally weak, immature woven bone. Clival involvement in monostotic fibrous dysplasia is extremely unusual, and has rarely been reported previously. We report a case of monostotic fibrous dysplasia of the clivus with special emphasis on the imaging findings and differential diagnosis.