Management of pancreatic lithiasis in a 5-year-old girl

Pancreatic lithiasis causing chronic pancreatitis is a very rare entity in childhood. A five-year-old girl presenting with pancreatic lithiasis was treated successfully with a well-organized diagnostic and therapeutic algorithm. The authors emphasize that early diagnosis followed by appropriate therapeutic pancreatographic procedures instead of primary invasive surgical approach can certainly ameliorate progressive and irreversible pancreatic damage. The clinicopathologic features of this rare entity are discussed, with emphasis on diagnosis and treatment.     

Assessment of quality of life in asthmatic Turkish children

Our aim was to assess impairment in quality of life (QOL) in asthmatic children and to determine the influencing factors. The study group consisted of 305 outpatients with asthma, aged 7-17 years, who were undergoing regular checkups in our outpatient clinic. QOL was assessed using the Pediatric Asthma QOL Questionnaire (PAQLQ). Asthma severity, presence of allergic rhinitis, and steroid usage were strongly and negatively associated with the overall PAQLQ score (p = 0.038) in multivariate regression models. Sex, IgE levels, positive skin tests and smoking status demonstrated no statistically significant effects on the overall or three individual domain PAQLQ scores (p = 0.307, 0.137, 0.470, 0.353, respectively). Lung function measures were strongly correlated with each other (Spearman correlation of 0.77), but were not associated with QOL (p = 0.441). Fifty-one percent of the patients reported that asthma affected their lives significantly. This study captured the baseline QOL information about the pediatric asthmatic population and factors influencing QOL and will facilitate longitudinal monitoring.     

Intracerebral hematoma as a complication of intrathecal methotrexate administration

Neurotoxicity of methotrexate is a well-documented issue, but development of an intracerebral hematoma following administration of intrathecal methotrexate is an extremely rare entity. A 6-year-old male with the diagnosis of non-Hodgkin lymphoma was put on a treatment regimen, including intrathecal methotrexate. Six days following the last intrathecal methotrexate administration, the patient developed a deteriorating state of consciousness. There was no history of trauma. Coagulation studies and platelet count were normal. Magnetic resonance imaging of the brain demonstrated a large left frontoparietal hematoma. Intracerebral hematoma may be a very rare, but serious, complication of intrathecal methotrexate administration.     

Molecular strategies for pre-implantation genetic diagnosis of single gene and chromosomal disorders

Pre-implantation genetic diagnosis is used to analyse pre-implantation stage embryos or oocytes for genetic defects, generally for severe Mendelian disorders and chromosome abnormalities. New but controversial indications for pre-implantation genetic diagnosis include identifying human leukocyte antigen compatible embryos suitable as donor, sex selection and adult-onset disorders, particularly cancer. Pre-implantation genetic screening is a variant of pre-implantation genetic diagnosis to improve outcomes of in-vitro fertilisation. Array comparative genomic hybridisation is replacing fluorescence in-situ hybridisation for aneuploidy screening. Besides technical advancement of array platform, the success of pre-implantation genetic screening is strongly related to the embryonic biological nature of chromosomal mosaicism. Having been applied for more than 20 years, pre-implantation genetic diagnosis is recognised as an important alternative to prenatal diagnosis. Diagnosis from a single cell, however, remains a technically challenging procedure, and the risk of misdiagnosis cannot be eliminated.     

Impact of zinc supplementation in children with acute diarrhoea in Turkey

Objective

Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhoea. Our aim was to evaluate the effect of daily zinc supplementation for 14 days on diarrhoea duration, severity, and morbidity in children.

Methods

In a randomised, open label non‐placebo controlled trial, we assessed the efficacy of providing zinc sulfate to 6–60 month old children with acute diarrhoea for 2 weeks followed by 3 months of morbidity surveillance. Children were randomly assigned to zinc (n = 150) and control (n = 130) groups and received 15–30 mg elemental zinc daily.

Results

Supplemented children had significantly improved plasma zinc levels by day 14 of therapy. Zinc deficiency was observed in 2.6% of the treatment and 3.3% of the control group. The mean duration of diarrhoea after starting supplementation was 3.02±2 days in the zinc group and 3.67±3.2 days in the control group. There was no significant difference in diarrhoea duration by treatment group (p>0.05). The number of stools after starting supplementation was 5.8±3.7 and 5.1±3.9 on day 1, 2.9±1.6 and 3.0±2.2 on day 2, and 1.8±1.1 and 1.6±0.9 on day 3 in the zinc and control groups, respectively. There was no significant difference in diarrhoea severity by treatment group (p>0.05). No significant effect was found on the incidence and prevalence of diarrhoea in the zinc compared with the control group.

Conclusion

Our data indicate that supplementing children with acute diarrhoea in Turkey with 3 RDA of elemental zinc for 14 days improved neither diarrhoea duration nor severity despite significant increments in plasma zinc.     

Evaluation of mild head injury in a pediatric population

Approximately 5 million children present to emergency departments, seeking care for head injuries, each year, and 80% of these children are classified as cases of mild head injury. Due to the huge number of patients and low frequency of intracranial lesions in this group, obtaining a computed tomography scan for each and every patient is a significant economic problem. This study was conducted to identify the clinical parameters and the radiographic findings that may be associated with intracranial lesions in children with mild head injury. 421 patients, with a Glasgow Coma Scale score of 15 and without any focal neurological deficit, were studied. Intracranial lesion was noted in 37 cases (8.8%). Sensitivity of a plain radiogram was 43.2%, and specificity was 93%. An intracranial pathology was demonstrated in 28.9% of the patients with a linear skull fracture. The only clinical parameters associated with an increase in the frequency of detection of intracranial lesions were posttraumatic seizures and loss of consciousness. Age, sex, headache, vomiting and scalp lacerations were not associated with a higher frequency. Even when patients with a history of loss of consciousness or posttraumatic seizure were subtracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% neurosurgical intervention was required. Computed tomography is the gold standard in the evaluation of pediatric patients with mild head trauma, and every child who has experienced a head injury should undergo a cranial computed tomography evaluation, even if he or she appears in perfect health.     

Occurrence of anticancer activity of prednisolone via adrenalectomy and inhibition of adrenaline in rats

In this study, the anticancer effect of prednisolone was investigated using rats with normal endogen adrenaline levels (intact), reduced adrenaline levels (metyrosine‐induced) and adrenaline deficiency (adrenalectomized) via gastric adenocarcinoma model. Gastric adenocarcinoma was induced with N‐methyl‐N′‐nitro‐N‐nitrosoguanidine (MNNG). According to our experimental results, prednisolone could not prevent MNNG‐induced adenocarcinoma when used alone in intact rats. There were neither macroscopic nor microscopic signs of cancer in the rat groups that received metyrosine and prednisolone. However, dysplasia occurred in the stomachs of 2 of 10 rats that received metyrosine and prednisolone. There was no adenocarcinoma genesis in the stomachs of adrenalectomized rats that received prednisolone alone. However, yohimbine (a selective blocker of α2‐adrenoreceptors) pretreatment in adrenalectomized rats negated the anticancer effect of prednisolone. In conclusion, prednisolone was shown not to be an anticancer agent in intact rats when used alone; however, it has anticancer effects in rats whose adrenaline levels were reduced via adrenalectomy or metyrosine, which is a catecholamine synthesis inhibitor.     

Panic symptoms in schizophrenia: comorbidity and clinical correlates

The aim of the present study was to investigate the prevalence of panic attack (PA) and panic disorder (PD) in patients with schizophrenia and detect the clinical features. Forty-nine patients with schizophrenia were included in the study. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale (ESRS) and Bandelow Panic and Agoraphobia Rating Scale were administered. Fifteen patients were found to have PA and seven patients had PD. Patients with panic symptoms had higher scores of PANSS, HDRS, CGI and ESRS. Comorbid panic symptoms in schizophrenia may be related to positive symptoms, extrapyramidal side-effects and depression.     

Spontaneous rupture of splenic vein in a pregnant woman during a religious ritual

The treatment of retroperitoneal hemorrhage can be by surgical or a conservative approach but the main problems about these cases are difficulty in diagnosis due to negative results after abdominal lavage and the difficulties in accessing the retroperitoneal area surgically. Retroperitoneal hemorrhage during pregnancy, occurring as a result of spontaneous rupture, is very rare event. Such cases require urgent operation and if not, result in high mortality. A twenty-eight year old pregnant woman was admitted to the hospital dead after collapsing at home during a religious ritual. No systemic or gynecological pathology had been diagnosed. No traumatic injury on her body was found at early postmortem examination. The pathologic findings found at the autopsy are; approximately 2.5 L of coagulated blood in the retroperitoneal region and 10-12 cm of haematoma at the hilum of spleen; dissection revealed a tear of 0.5 cm on lienal vein at a point 3 cm from the hilum. Surgical approach is the most important procedure for diagnosis and therapy of the bleeding. Autopsy may be only diagnostic technique in the case of retroperitoneal hemorrhage death when the death is so rapid that there is no time to intervene surgically.     

Is primiparity a risk factor for advanced maternal age pregnancies?

Objective: Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients.

Methods: The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015.

Results: Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups.

Conclusion: Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor.