[Pneumomediastinum and subcutaneous emphysema during asthmatic attacks in three patients]. / Uç olguda astim atagi sirasinda görülen subkütan amfizem ve pnömomediastinum.

Pneumomediastinum is defined as free air or other gases contained within the mediastinum. In children it is an uncommon clinical condition with good prognosis. It most frequently occurs with exacerbations of asthma but also may occur after cough, vomiting, excessive valsalva maneuver and after the first wheezing attack as well. The first-line treatment for pneumomediastinum is to relieve the inciting factor. Otherwise, no specific therapy is recommended for uncomplicated cases, three boys, with the ages of 4, 8 and 13, presented in the emergency department, each after a few days of shortness of breath and respiratory distress. Chest radiography revealed pneumomediastinum and subcutaneous emphysema which had occured after severe asthmatic attacks. All of these patients have improved spontaneously with conservative treatment.

Efficacy of continuous midazolam infusion and mortality in childhood refractory generalized convulsive status epilepticus.

PURPOSE: Continuous midazolam infusion is commonly used for the management of status epilepticus (SE). The purpose of this study was to assess the efficacy of midazolam and mortality in childhood refractory generalized convulsive SE. METHODS: We included 27 children with refractory generalized convulsive SE. Midazolam was given 0.2 mg/kg as bolus, followed by 1-5 microg/kg/min as continuous infusion. Clinical data and response to treatment were recorded for each patient. RESULTS: Acute symptomatic SE accounted for 52%, and central nervous system (CNS) infections were the most frequently associated etiologic condition (44%). Complete control of seizures was achieved with midazolam infusion in the 26 (96%) children within 65 min; at a mean midazolam infusion rate of 3.1 microg/kg/min. Adverse effects such as hypotension, bradycardia or respiratory depression did not occur during midazolam infusion. In one (4%) patient with acute meningoencephalitis, SE could not be controlled. Five (19%) patients died; four had acute symptomatic aetiology and one had progressive encephalopathy. CONCLUSION: Midazolam is effective and safe in the control of refractory generalized convulsive SE. The response to treatment and mortality were related to the underlying aetiology.

Factors Influencing Serum Vitamin D Concentration in Turkish Children Residing in Izmir: A Single-Center Experience.

OBJECTIVE: The aim of this study was to examine the vitamin D status of children and to determine the factors influencing serum 25-hydroxyvitamin D [25(OH)D] concentration in Turkish infants living in Izmir. METHODS: In this study, we examined the serum 25(OH)D levels of 100 infants aged 1 to 24 months and of 22 mothers from Izmir, Turkey. The study also included a questionnaire given to the mothers to acquire data on the demographic characteristics of the infants and their mothers as well as information on vitamin D supplementation, clothing habits, and sunlight exposure. RESULTS: Vitamin D deficiency was present in 31% of infants and 81.8% of mothers. Twenty-four male (42.9%) and 7 female (15.9%) infants were found to be vitamin D deficient (<20 mg/dL); 9 male (16.1%) and 17 female (38.6%) infants to be vitamin D insufficient (20-30 mg/dL); and 23 male (41.1%) and 20 female (45.5%) infants were vitamin D sufficient (>30 mg/dL). Only 63% of the infants were receiving vitamin D supplementation and 52% were said to be having regular exposure to sunlight. Mean serum vitamin D levels were lower in infants whose mothers were dressed according to the culture of traditional covered clothing (44%) compared to those infants whose mothers' dressing style provided more exposure to sunlight. CONCLUSION: We conclude that low exposure to sunlight, inadequate use of vitamin D supplementation, and large family size are factors influencing the vitamin D status of Turkish children living in the inner city of Izmir.

A case of hypomagnesemia with secondary hypocalcemia caused by Trpm6 gene mutation.

An offspring of marriage between two first cousins presented with atonic seizures developed on the 20(th) day of life. The physical examination of the case was normal. In laboratory results, Ca(+2) level was 5.7 mg/dl, Mg(+2): 0.4 mg/dl (1,3-2,1), PTH: 28.4 pg/ml (12-92), and P-: 4.5 mg/dl. The case was diagnosed as hypomagnesemia with secondary hypocalcemia (HSH) and TRPM6 gene mutation analysis revealed a homozygote mutation of E157X.

[Co-existence of Kala-azar and salmonellosis in a 16 month-old baby? Or a false positive widal reaction in Kala-azar?]. / 16 aylik bir bebekte Kala-azar ve salmonellozis birlikteligi mi? Kala-azar'da yanlis pozitif Widal reaksiyonu mu?

A 16 month-old boy was referred to our hospital with a prolonged fever, hepatosplenomegaly, anemia and leucopenia. Visceral leishmaniasis was the first suspected diagnosis but the bone-marrow aspiration material revealed no Leishmania amastigotes. As the group agglutination test for Salmonella typhi-O was positive at 1/320 dilution, a diagnosis of salmonellosis was made and meropenem therapy was started. Although the fever decreased on the fourth day of therapy, the expected clinical improvement did not occur and there was a recurrence of the fever. At that point even though his parents were told about the seriousness of his condition, they had the patient charged from the hospital. About one week later, the patient was hospitalized again with the same complaints. His organomegaly had increased and his pancytopenia was more severe at this time. The re-assessment of the patient raised again the suspicion of kala azar. IFAT for Leishmania infection demonstrated a high level of positivity (1/1024) and a second bone-marrow aspiration material revealed Leishmania amastigotes. After the patient was started on meglumine antimonate therapy, his clinical and laboratory findings improved. The case has been evaluated according to two different points of view based on the co-existence of salmonellosis and kala azar or a possible false positive Widal reaction in kala-azar.

Ketamine and midazolam for invasive procedures in children with malignancy: a comparison of routes of intravenous, oral, and rectal administration.

We investigated the efficacy of a combination of ketamine and midazolam, comparing intravenous, oral, and rectal administrations for invasive procedures in children with malignancy. Seventy-three children under 5 years of age, who were scheduled for invasive procedure, were assigned to one of three groups: IV group (n = 25), ketamine 1 mg/kg and midazolam 0.05-0.1 mg/kg were given intravenously; PO group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg were given orally; and PR group (n = 24), ketamine 3 mg/kg and midazolam 0.5 mg/kg given rectally. Vital signs including blood pressure, pulse rate, respiratory rate, and oxygen saturation were monitored, and patients were observed for side-effects. Optimal sedation (drowsy and asleep) was provided in 78 per cent of all patients and no statistical difference was observed among the three groups. No severe complications were observed in all groups. Recovery time from sedation was significantly longer in the intravenous group (>120 min in two patients). Hallucination was noted in three (12 per cent) patients given intravenous medication, but not in those given oral or rectal medications. It is concluded that intravenous, oral, and rectal midazolam/ketamine are equally effective for invasive procedures in children with malignancy. The use of intravenous ketamine/midazolam may produce prolonged sedation and psychedelic effects in children. These adverse effects may alter the child's comfort and parental satisfaction.