[Show abstract][Hide abstract] ABSTRACT: Introduction: Mushroom poisoning is a medical emergency, diagnostic and treatment dilemma for physicians. Most cases present with self-limiting gastrointestinal symptoms. The regional profile of poisoning epidemiology in Turkey has previously been reported. However, information about mushrooms is still limited. The aim of this study was to identify the epidemiology of wild mushroom poisonings in the Trakya region in a 7-year period. Materials and methods: The study was designed retrospectively by examining the files of the patients who presented to the emergency department of Trakya University Faculty of Medicine from January 2002 to July 2008. Results: The overall male to female ratio was 0.88:1. All patients were intoxicated due to accidental pick up and consumption of wild mushrooms from open fields, woodlands and meadows. The most common findings on physical examination were epigastric pain. Fifty-six patients (74.7%) were discharged from the emergency department, 18 patients (24.0%) were hospitalized (one died on the 5th day), and one patient died in the emergency department. Conclusions: Care should be taken especially for patients presenting late. Patients may have hepatic dysfunction that needs haemodialysis or even liver transplantation.
Full-text · Article · Sep 2010 · Hong Kong Journal of Emergency Medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine the cost of radiologic imaging in pediatric trauma patients admitted to the pediatric emergency department.
All patients were retrospectively evaluated according to age, gender, details of injury, radiological investigations ordered and their results, cost of radiologic imaging, length of stay, outcome of the injury, and hospitalization rates.
The cost of radiologic imaging was retrospectively analyzed in 1231 trauma patients aged between one month and 15 years (mean 5.91 +/- 3.82 years). For the 996 patients who had radiological imaging, 3382 images were taken in total. Of these, only 300 (8.8%) were abnormal. The mean (and SD) total cost of radiologic imaging was US$ 40.42 ($34.38) (range $4.67 to $139.26). Total cost correlated inversely with Glasgow Coma Scale (GCS) (r = -0.37, p < 0.001), directly with Injury Severity Score (ISS) (r = -0.27, p < 0.001) and was not correlated with the Pediatric Trauma Score (PTS) (r = -0.16, p > 0.05). The mean (and SD) duration of hospital stays was 8.54 (10.91) hours.
Advanced radiological images may help in early diagnosis of trauma cases. However, periodic education programs to prevent unnecessary radiological imaging in emergency departments are also necessary to decrease the cost of these imaging modalities.
Preview · Article · Jul 2010 · Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the relationship between intracranial injury and serum tau protein levels in pediatric patients with minor head trauma (MHT).
We included 60 pediatric patients with MHT (Glasgow Coma Scale [GCS], 14-15) and 28 control patients. The patients were divided into 3 groups as follows: those without (group 1) and with (group 2) intracranial lesions shown on cranial computed tomography (CCT) and the control group (group 3).
The mean serum tau protein level was 96.06 +/- 70.36 pg/mL in group 1, whereas it was 112.04 +/- 52.66 pg/mL in group 2, with no statistically significant difference between the groups (p = .160). The mean serum tau protein levels between the study groups (group 1 and group 2) and control (38.52 +/- 29.01) were statistically significant (P < .001 and P < .001, respectively). The GCS score and pathologic condition in CCT were only influential variables on tau protein levels.
We found that serum tau protein increased after MHT but did not distinguish between those with and those without intracranial lesions demonstrable on CCT.
Full-text · Article · May 2010 · The American journal of emergency medicine
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe the characteristics of patients with a minor head injury (MHI) who were admitted to a pediatric emergency unit and to identify the clinical signs and symptoms that most reliably predict the need for cranial computed tomography (CCT) and hospital admission following MHI.
All patients were retrospectively evaluated according to age, gender, details of injury, presenting symptoms, physical examination findings, radiological investigations ordered and results, length of stay, outcome of the injury and hospitalization rates.
The factors affecting indications for computed tomography and hospitalization were retrospectively analyzed in 916 patients--585 males and 331 females, aged between 1 month and 15 years (mean: 5.01 +/- 3.58 years), with MHI. A multivariate analysis revealed significant correlations between CCT abnormalities and Glasgow Coma Scale scores of 13 or 14, headache, posttraumatic amnesia, blurred vision, cephalohematomas, periorbital ecchymoses, otorrhea and abnormal neurological findings. CCT abnormalities were identified in 67 (19.8%) of the 338 CCT scans. Twenty of the 67 patients (29.9%) with CCT scan abnormality had no clinical signs. Of all cases, 125 (13.6%) were hospitalized, 617 (67.4%) were treated as outpatients, and 174 (19.0%) left the emergency department based on a personal decision.
Some clinical risk factors can be used as predictors of abnormalities in CCT scans following MHI, but the absence of such clinical findings does not exclude the possibility of intracranial injuries.
Full-text · Article · Aug 2009 · Pediatric Neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Scald injuries are the most common type of burn in childhood. The authors' aim in this study was to determine the characteristics of scald burns and to identify clinical signs and symptoms which help to predict the indications for hospitalization after scalding burn injury. All patients were retrospectively evaluated according to gender, ages, cause of burn, burn size and depth, distribution of burn area, first aid given, management, and patient's outcomes. The factors affecting indication for hospitalization were retrospectively analyzed in 165 patients, 95 males and 70 females aged 1 month to 13 years (mean 2.74 +/- 2.44 years), with scalding burn injury. The most common cause of scald injuries were hot water (106 patients) or hot tea and coffee (39 patients). The mean percent of TBSA burned was 10.26 +/- 7.26%. Sixty-nine patients had required hospitalization. In the multivariate logistic regression analyses, among study subjects, only age and TBSA were risk factors significantly correlated to hospitalization (P < .001, P < .01, respectively). Prevention of scald injuries will require a two-prolonged approach: educating families and changing the traditional methods of preparing soup, milk, and tea in Turkey and elsewhere. To create effective programs for preventing scald injuries, it is essential to consider ethnic, cultural, socioeconomic, and environmental factors based on these characteristics.
Full-text · Article · Apr 2009 · Journal of burn care & research: official publication of the American Burn Association
[Show abstract][Hide abstract] ABSTRACT: Diclofenac, a widely used nonsteroidal anti-inflammatory drug, has been reported to cause fatal drug-induced rhabdomyolysis very rarely. We report a case of a 13-month-old girl who developed fatal rhabdomyolysis after administration of intramuscular diclofenac for relief of pain caused by a scalding burn injury. Rhabdomyolysis due to diclofenac has not been reported in children. Here, we present the first case report to demonstrate rhabdomylysis secondary to diclofenac administration.
Full-text · Article · Jan 2009 · Medical Journal of Trakya University / Trakya Universitesi Tip Fakultesi Dergisi
[Show abstract][Hide abstract] ABSTRACT: We have studied whether curcumin protects different pulmonary aspiration material-induced lung injury in rats.
The experiments were designed in 60 Sprague-Dawley rats, randomly allotted into one of six groups (n=10): normal saline (NS, control), enteral formula (Biosorb Energy Plus, BIO), hydrochloric acid (HCl), NS+curcumin-treated, BIO+curcumin-treated, and HCl+curcumin-treated. NS, BIO, HCl were injected in to the lungs. The rats received curcumin twice daily only for 7 days. Seven days later, both lungs in all groups were examined histopathologically, immunohistochemically, and biochemically. Histopathologic examination was performed according to the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. Immunohistochemical assessments were examined for the activity of inducible nitric oxide synthase (iNOS) and the expression of surfactant protein D (SP-D). Malondialdehyde (MDA), hydroxyproline (HP), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activity were measured in the lung tissue.
Our findings show that curcumin inhibits the inflammatory response reducing significantly (P<0.05) all histopathological parameters in different pulmonary aspiration models. Pulmonary aspiration significantly increased the tissue HP content, MDA levels and decreased the antioxidant enzyme (SOD, GSH-Px) activities. Curcumin treatment significantly decreased the elevated tissue HP content, and MDA levels and prevented inhibition of SOD, and GSH-Px enzymes in the tissues. Furthermore, our data suggest that there is a significant reduction in the activity of iNOS and a rise in the expression of SP-D in lung tissue of different pulmonary aspiration models with curcumin therapy.
Our findings support the use of curcumin as a potential therapeutic agent in acute lung injury.
Full-text · Article · Nov 2008 · Pediatric Surgery International
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the efficiency of inducible nitric oxide synthase (iNOS) specific inhibitor, S-methylisothiourea sulfate (SMT) in preventing lung injury after different pulmonary aspiration materials in rats.
The experiments were performed in 80 Sprague-Dawley rats, ranging in weight from 220 to 250 g, randomly allotted into one of the eight groups (n=10): normal saline (NS, control), Biosorb Energy Plus (BIO), sucralfate (SUC), hydrochloric acid (HCl), NS+SMT treated, BIO+SMT treated, SUC+SMT treated, and HCl+SMT treated. NS, BIO, SUC, HCl were injected in to the lungs in a volume of 2 ml/kg. The rats received twice daily intraperitoneal injections of 20 mg(kg day) SMT (Sigma Chemical Co.) for 7 days. Seven days later, rats were killed, and both lungs in all groups were examined immunohistochemically and histopathologically.
Our data show that SMT inhibits the inflammatory response significantly reducing (p<0.05) peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation in different pulmonary aspiration models. Furthermore, our data suggest that there is a significant reduction in the activity of iNOS and arise in the expression of surfactant protein D in lung tissue of different pulmonary aspiration models with SMT therapy.
It was concluded that SMT treatment might be beneficial in lung injury, therefore shows potential for clinical use.
No preview · Article · Sep 2008 · International Journal of Pediatric Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the fall-related trauma cases who were admitted to our pediatric emergency unit.
We retrospectively evaluated the files of 161 cases (100 males [62.1%], 61 females [37.9%]) who had sustained falls and were admitted to our pediatric emergency unit. Data on the patients' age, sex, arrival type, type of fall, height fallen, type of injuries, radiological findings and hospitalization rates were investigated.
Of 161 cases mean age was 4.29+/-3.33 years and height fallen was 135+/-95 centimeters. The common types of fall were from furniture (35.4%), stairs (17.4%) and balconies and windows (11.2%). Major injuries included head trauma (84.4%), soft tissue (72.7%) and extremity (37.9%). Thirty cases (18.6%) were hospitalized, while 112 cases (69.6%) were treated as outpatient and 11.8% of them were discharged due to their own demand.
The majority of fall-related injuries in childhood mostly occurs in private houses and head trauma is the most frequent injury. To decrease the frequency of the fall injuries, strategies should include parents' education about the mechanism of falls and increase prevention strategies.
No preview · Article · Aug 2007 · Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
[Show abstract][Hide abstract] ABSTRACT: We planned this study to evaluate trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers, and the importance of helmet usage.
Data in this study were obtained by retrospective review of the files of trauma cases admitted to the Pediatric Emergency Unit of Trakya University Medical Faculty between January 2003 and August 2005. Patients' age, gender, clinical signs, type of injury, season of the event and percentage of hospitalization were obtained from hospital records.
Fifteen (24.6%) of 61 cases who were admitted to our emergency unit were females and 46 (75.4%) were males. The types of trauma of all patients who suffered from bicycle accidents were as following: 42 (68.9%) head trauma, 29 (47.5%) extremity trauma, 49 (80.3%) soft tissue trauma, 2 (3.3%) abdominal trauma, and one case of urogenital trauma. Also multiple traumas were present in most of these cases. Thirteen patients had extremity fractures and three had cranial fractures. None of the bicycle drivers were using helmets at the time of the trauma.
Bicycle drivers should have specific education, helmet use must become widespread and special traffic regulations have to be settled.
No preview · Article · Nov 2006 · Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
[Show abstract][Hide abstract] ABSTRACT: A 4-year-old boy was admitted with left hemiplegia. Thrombophilia marker examination resulted with factor V Leiden mutation heterozygosity, a deficiency of antithrombin III and a high level of factor VIII. Cranial computed tomography scan revealed an ischemic infarct in the region of right anterior cerebral artery. In the literature, combinations of multiple thrombophilia risk factors that trigger cerebral ischemic stroke in children have been emphasized. To our knowledge, this is the first child with these combinations of thrombophilia risk factors and ischemic stroke to be reported in the literature.
No preview · Article · Nov 2006 · Brain and Development
[Show abstract][Hide abstract] ABSTRACT: This study was designed to estimate the rubella seroprevalence in unvaccinated Turkish adolescent girls in urban and rural areas of Edirne, and to create preventive strategies for congenital rubella syndrome (CRS). The sample, representing 12- to 17-year-old adolescent girls, consisted of 1,600 subjects selected from school lists by systematic and random sampling, which was matched by age and urban-rural residency strata proportional to the corresponding distributions in the Edirne population. For each participant, a questionnaire was completed and rubella-specific IgG antibodies were measured. After analysis of samples, seropositivity prevalence, equivocal and seronegative samples of adolescent girls in Edirne were determined as 93.1%, 0.6% and 6.3%, respectively. Data from the present study may indicate that 6.9% of adolescent girls have considerable risk for rubella infection during pregnancy. Eliminating rubella and CRS in Turkey will require national health service efforts, including vaccination of all adolescents and all susceptible women of childbearing age.
Full-text · Article · Oct 2006 · The Turkish journal of pediatrics
[Show abstract][Hide abstract] ABSTRACT: In recent years, it has been possible for patients with Down syndrome to live longer with advanced medical treatment and social support. As a result, the problems of these patients, such as thyroid diseases, leukemia, and Alzheimer disease, would be encountered more frequently. In this study, we aimed to perform the brain perfusion of children with Down syndrome by technetium 99m hexamethylpropylene amine oxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) and to determine the relationship between brain perfusion and epilepsy, thyroid function tests, congenital heart disease, and level of mental and motor development. Thirty patients with Down syndrome, aged between 1 and 15 years, were included in our study. Demographic data, the existence of epilepsy and congenital heart defects, the level of mental and motor development, serum levels of thyroid hormones, and autoantibodies were determined. All patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI). Cerebral SPECT was performed in all cases to evaluate the brain perfusion pattern. According to the visual evaluation of cerebral SPECT results, hypoperfusion was detected in 11 cases (37%). Patients with cerebral hypoperfusion (group 1) and patients with normal cerebral perfusion (group 2) were compared. There was no difference between group 1 and group 2 in terms of demographic data, congenital heart defects, IQ levels, thyroid hormones, and autoantibodies, but the incidence of epilepsy was significantly higher in group 1 (P<.001). When motor and mental development levels were compared, it was found that cases in group 1 were significantly more retarded in personal-social and fine motor skills (P<.05). The present study showed that cerebral hypoperfusion in children with Down syndrome is mostly related to epilepsy and the other coexisting conditions, congenital heart disease and hypothyroidism. Patients with cerebral hypoperfusion also have more retarded developmental levels, especially in personal-social and fine motor skills.
No preview · Article · Aug 2006 · Journal of Child Neurology
[Show abstract][Hide abstract] ABSTRACT: Ceftriaxone is known to induce reversible precipitations, known as pseudolithiasis, in the gallbladder and urinary tract. The aim of this study was to investigate the incidence and predisposing factors that contribute to this side effect.
A prospective study was conducted in 156 children admitted for the treatment of various infections with different daily ceftriaxone doses (50 mg/kg, 75 mg/kg, and 100 mg/kg). Sonographic examinations of the gallbladder and urinary tract were performed before treatment on the third and seventh day of therapy, and at the first and second month after the end of treatment. Patients with positive findings were followed with weekly sonographic examinations until the abnormality resolved.
Abnormal gallbladder sonograms were demonstrated in 27 children (17%); 16 of them (10%) had gallbladder lithiasis, 11 had gallbladder sludge (7%) (n = 4 on the third day, n = 23 on the seventh day), and 1 developed urolithiasis (0.6%). Five children (19%) were symptomatic. The abnormalities resolved after a mean of 16 days (range 10-30 days). Patients with pseudolithiasis were older and treated with higher drug doses than those with normal sonographic findings (P < 0.01 and P < 0.05, respectively).
Biliary pseudolithiasis (and infrequently nephrolithiasis) usually occurs in children receiving high doses of ceftriaxone. It is generally asymptomatic. When this reversible complication becomes symptomatic, unnecessary cholecystectomy should be avoided.
No preview · Article · Jun 2006 · Journal of Clinical Ultrasound
[Show abstract][Hide abstract] ABSTRACT: A high incidence of iron-deficiency is a common observation among adolescent girls, whereas only limited data are available regarding the folic acid status of this group. This study was designed to determine the prevalence of biochemical folic acid deficiency in a group of Turkish adolescent girls.
We surveyed the serum folic acid, complete blood count, and dietary folic acid intake of Turkish adolescent girls after using three-day self-reported food intakes in urban and rural areas of Edirne, Turkey.
A sample population was composed of 704 adolescent girls; their serum folic acid levels were found to be adequate for 37.6% (> or = 6 ng/mL), marginal for 46% (3 to 5.9 ng/mL), and at deficient levels for 16.3% (< 3 ng/mL). Folic acid deficiencies were found in 20.1% (36 of 179) and 14.7 % (61 of 416) of adolescent girls from rural and urban areas, respectively. Self-reported three-day folic acid intakes were correlated with the corresponding blood values for this nutrient. In the logistic regression analysis, three factors emerged as significant independent predictors of folic acid deficiency: low income (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.3-4.2, p < .001), low vitamin C (OR: 1.9, 95% CI: 1.1-3.5, p < .05), and folic acid intake (OR: 4.8, 95% CI: 2.8-8.1, p < .001).
Data from the present study may indicate that serum folic acid is low in a group of Turkish adolescent girls. These low values appear to be associated with low income, and low dietary intakes of folic acid and vitamin C.
Full-text · Article · May 2006 · Journal of Adolescent Health
[Show abstract][Hide abstract] ABSTRACT: Immune response against pertussis can be induced by infection and/or vaccination and vaccine induced immunity is known to wane within the decade following vaccination. Our aim was to assess the pertussis immune response among adolescent girls in the province of Edirne in Turkey. In addition we determined the relationship between the immune response and age, residence, and vaccination status.
Serum samples were collected from 359 adolescent girls, 12 to 17 years old. The subjects were selected by systematic randomisation from school rosters and sampled by age and urban-rural residence strata proportional to the corresponding distributions in the Edirne population. Pertussis immunity was determined by an in-house quantitative ELISA method for anti-PT and anti-FHA antibodies.
Protective levels of antibody (>10 EU/ml) for anti-pertussis toxin and anti-filamentous heamagglutinin were found in 95.3% and 97.2% of the overall study group respectively. In 12- to 14-year-olds protective levels were shown in 94.1% and 97.0%, in 15- to 17-year-olds in 97.5% and 97.5%, in rural areas in 96.7% and 97.5%, and in urban areas in 94.5% and 97.5%, respectively (p >0.05).
The high percentages of protective levels of antibodies in our study population might be an indicator of previous infections, which are a threat to infants who have not completed primary immunisation. In this respect, adult immunisation should be considered.
Full-text · Article · Sep 2005 · Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
[Show abstract][Hide abstract] ABSTRACT: In this study, technetium 99m hexamethylpropyleneamine oxime (99mTc-HMPAO) single photon emission computed tomography (SPECT) was performed on 18 asphyxiated and epileptic children who also had a status epilepticus episode, and the results were compared with those for 21 children without a status epilepticus episode. All patients underwent a detailed neurologic history, interictal electroencephalography, computed tomography, and/or magnetic resonance imaging. Visual evaluation of the SPECT study showed that 16 patients of group 1 had 56 hypoperfused regions in cerebral blood flow. However, in group 2, visual evaluation showed only six detectable hypoperfusion areas in five patients. When an asymmetric index value of 3 was considered as a cutoff point, 82 regions in group 1 and 57 regions in group 2 were above this value after the quantitative SPECT evaluation. The mean number of pathologic brain regions was found to be higher in group 1 (5.1 +/- 4.3) than in group 2 (2.7 +/- 2.4) (P = .014). The localization of hypoperfused regions that were observed in temporal and frontal regions was generally similar in both groups. In conclusion, the functional activities of the brain vary in both asphyctic and epileptic children, with and without status epilepticus. These children might be candidates for refractory convulsive disease, and interictal SPECT can be a reliable method for the detection of brain lesions in these patients.
No preview · Article · Aug 2005 · Journal of Child Neurology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to obtain data about the nutritional intake of adolescent girls from Edirne, Turkey. In a sample of 940 healthy adolescent girls aged between 12 and 17 years, intake of macronutrients and micronutrients was assessed from 3-day self-reported food records. In general, macronutrient intake was found to be adequate whereas micronutrient intake was lower than the recommended dietary allowance (RDA). The percentage of energy distribution of the subjects derived from carbohydrates, proteins, and fats was 53.6%, 10.9%, and 35.5%, respectively. Compared with the RDA, reported intakes of thiamin, riboflavin, niacin, calcium, phosphorus, iron, zinc, and fiber were most likely to be inadequate; those of folic acid and potassium were adequate; and those of vitamins A and C were well above. Adolescent girls living in the rural area consumed lower amounts of energy, carbohydrate, protein, niacin, folic acid, vitamin C, and sodium and higher amounts of thiamin compared with those living in the urban area. Based on the findings of this study, a preventive nutritional concept for Turkish adolescent girls was proposed.
No preview · Article · Apr 2005 · Nutrition Research