The Association of Angiotension Converting Enzyme Gene Polimorphism with Prognosis of Henoch-Schönlein Purpura with Renal Involvement in the Children

Aim:Henoch-Schönlein purpura (HSP) is a vasculitis rarely progresses to renal failure. The mechanism of renal failure in HSP has been associated with increased angiotensin converting enzyme (ACE) activity and increased local angiotension-II concentration as a result of deletion in ACE gene. Here relation between ACE gene polymorphism and prognosis of HSP nephritis was investigated.Materials and Methods:Forty-two children with HSP nephritis and ACE gene polymorphism studied were included in the study. Those who have deletion (DD) allele (Group-1) and heterozygous deletion (ID) or insertion (II) allele (Group-2)) compared according to their demographic characteristic, severity of renal involvement.Results:Between two groups, there was no statically difference in the terms of age, gender distribution and duration of follow-up (p=0,347, p=422, p=0,267). In group-1, 11 cases had mild, 14 had moderate, 4 had severe renal involvement. In group-2 4 cases had mild, 8 had moderate and 1 had severe renal involvement. There was no statistically significant difference in severity of renal involvement between two groups (p=0,375). Although there was a difference in proteinuria recovery rates between the two groups, the number of cases was not enough for statistical analysis (p=0,127) [ID or II / ID (OR): 3,667, (95% Cl 0.619-21.739).Conclusion:There was no significant association between the severity of renal involvement of HSP with DD genotype or D allele, however, this needs to be supported by studies with larger series

Successful Treatment of Acanthamoeba Meningoencephalitis in an Immunocompetent Child

Acanthamoeba meningoencephalitis is a very rare entity with high mortality rate. Its diagnosis is usually delated, and the optimal approach for its treatment is uncertain. In presented case, early diagnosis was made with direct examination of cerebral spinal fluid, and immediate initiation of accurate treatment with amphotericin B and fluconazole survived patient

Recurrent Candida albicans Ventriculitis Treated with Intraventricular Liposomal Amphotericin B

Central nervous system (CNS) infection with Candida is rare but significant because of its high morbidity and mortality. When present, it is commonly seen among immunocompromised and hospitalized patients. Herein, we describe a case of a four-year-old boy with acute lymphoblastic leukemia (ALL) who experienced recurrent Candida albicans meningitis. The patient was treated successfully with intravenous liposomal amphotericin B at first attack, but 25 days after discharge he was readmitted to hospital with symptoms of meningitis. Candida albicans was grown in CFS culture again and cranial magnetic resonance imaging (MRI) showed ventriculitis. We administered liposomal amphotericin B both intravenously and intraventricularly and favorable result was achieved without any adverse effects. Intraventricular amphotericin B may be considered for the treatment of recurrent CNS Candida infections in addition to intravenous administration

Recurrent Candida albicans Ventriculitis Treated with Intraventricular Liposomal Amphotericin B

Central nervous system (CNS) infection with Candida is rare but significant because of its high morbidity and mortality. When present, it is commonly seen among immunocompromised and hospitalized patients. Herein, we describe a case of a four-year-old boy with acute lymphoblastic leukemia (ALL) who experienced recurrent Candida albicans meningitis. The patient was treated successfully with intravenous liposomal amphotericin B at first attack, but 25 days after discharge he was readmitted to hospital with symptoms of meningitis. Candida albicans was grown in CFS culture again and cranial magnetic resonance imaging (MRI) showed ventriculitis. We administered liposomal amphotericin B both intravenously and intraventricularly and favorable result was achieved without any adverse effects. Intraventricular amphotericin B may be considered for the treatment of recurrent CNS Candida infections in addition to intravenous administration

The Clinical Efficacy and Safety of Ertapenem for the Treatment of Complicated Urinary Tract Infections Caused by ESBL-Producing Bacteria in Children

Background. Urinary tract infections (UTIs) are common and important clinical problem in childhood, and extended-spectrum-beta-lactamase- (ESBL-) producing organisms are the leading cause of healthcare-related UTIs. In this study, we aimed to evaluate the clinical efficacy and safety of ertapenem therapy in children with complicated UTIs caused by ESBL-producing organisms. Methods. Seventy-seven children with complicated UTIs caused by ESBL-producing organisms were included in this retrospective study, and all had been treated with ertapenem between January 2013 and June 2014. Results. Sixty-one (79%) females and sixteen (21%) males with a mean ± standard deviation (SD) age of 76.6±52 months (range 3–204, median 72 months) were enrolled in this study. Escherichia coli (E. coli) (n=67; 87%) was the most common bacterial cause of the UTIs followed by Klebsiella pneumoniae (K. pneumoniae) (n=9; 11.7%) and Enterobacter cloacae (E. cloacae) (n=1; 1.3%). The mean duration of the ertapenem therapy was 8.9±1.6 days (range 4–11). No serious drug-related clinical or laboratory adverse effects were observed, and the ertapenem therapy was found to be safe and well tolerated in the children in our study. Conclusion. Ertapenem is a newer carbapenem with the advantage of once-daily dosing and is highly effective for treating UTIs caused by ESBL-producing microorganisms

Neurologic Adverse Events Associated with Voriconazole Therapy: Report of Two Pediatric Cases

Although voriconazole, a triazole antifungal, is a safe drug, treatment with this agent is associated with certain adverse events such as hepatic, neurologic, and visual disturbances. The current report presents two cases, one a 9-year-old boy and the other a 17-year-old girl, who experienced neurologic side effects associated with voriconazole therapy. Our aim is to remind readers of the side effects of voriconazole therapy in order to prevent unnecessary investigations especially for psychological and ophthalmologic problems. The first case was a 9-year-old boy with cystic fibrosis and invasive aspergillosis that developed photophobia, altered color sensation, and fearful visual hallucination. The second case was a 17-year-old girl with cystic fibrosis and allergic bronchopulmonary aspergillosis, and she experienced photophobia, fatigue, impaired concentration, and insomnia, when the dose of voriconazole therapy was increased from 12 mg/kg/day to 16 mg/kg/day. The complaints of the two patients disappeared after discontinuation of voriconazole therapy. Our experience in these patients reminded us of the importance of being aware of the neurologic adverse events associated with voriconazole therapy in establishing early diagnosis and initiating prompt treatment. In addition, although serum voriconazole concentration was not measured in the present cases, therapeutic drug monitoring for voriconazole seems to be critically important in preventing neurologic side effects in pediatric patients