Evalution of C-reactive protein, procalcionin and serum amyloid A levels in the diagnosis of bacterial infection disease in children

Prospektif olarak yapılan bu çalışmaya Haziran 2009-Haziran 2011 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Kliniğine bakteriyel enfeksiyon tanısı ile yatırılarak tedavi edilen 120 hasta alınmıştır. Hastalar sepsis, pnömoni, menenjit, piyelonefrit, diğer enfeksiyon olmak üzere 5 grupta incelenmiştir. Hastalardan başlangıçta, 48.saatte, 7 ve 10. günlerde tam kan sayımı, C-Reaktif Protein (CRP), Prokalsitonin (PCT) ve Serum Amiloid A (SAA) çalışılmıştır. CRP, PCT ve SAA gruplar arasında karşılaştırıldığında, CRP değerlerinin gruplar arasında fark göstermediği bulunmuştur. PCT sepsis grubunda pnömoni grubuna ve diğer enfeksiyonlar grubuna göre anlamlı oranda yüksek saptanmıştır. SAA ise sadece menenjit grubunda pnömoni grubuna göre daha yüksek saptanmıştır, diğer gruplar arasında fark saptanmamıştır. CRP, PCT ve SAA'nın tedavi sürecindeki değişimi değerlendirildiğinde, CRP ve SAA'da 48. saatte başlangıca göre anlamlı düşme görülmezken, PCT tüm hasta gruplarında başlangıca göre 48. saatte anlamlı düşme göstermiştir. Tüm hastalarda başlangıçta, 48.saatte, 7 ve 10. günlerde CRP-PCT ve CRP-SAA arasında pozitif korelasyon saptanmıştır. Hastalar invaziv bakteriyel enfeksiyon ve lokalize bakteriyel enfeksiyon olarak 2 grupta incelendiğinde PCT invaziv enfeksiyon grubunda tüm çalışma günlerinde istatistiksel olarak anlamlı oranda yüksek saptanırken, CRP ve SAA değerleri her iki grup arasında fark göstermemiştir. Sonuç olarak PCT, invaziv bakteriyel enfeksiyonların tanısında, hastalığın ciddiyetinin belirlenmesinde ve tedaviye yanıtın izlenmesinde daha değerli bir parametre olarak karşımıza çıkmaktadır. Hastaların klinik durumlarının, semptom sürelerinin, CRP, PCT ve SAA kinetiklerinin de dikkate alınarak birlikte değerlendirilmesi, hastaların tanısında ve izleminde yararlı olacaktır.In this prospective study 120 pediatric patients who were hospitalized with bacterial infection in Uludag University Medical Faculty Pediatric Clinic between June 2009 and June 2011 are included. Patients are evaluated in 5 groups as sepsis, pneumonia, meningitis, pyelonephritis and other infection groups. Total blood count, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) levels of patients are evaluated at admission, at 48th hour of hospitalization and on days 7 and 10.The comparison of levels of CRP did not differ between all groups, while PCT levels of sepsis group was significantly higher than both the pneumonia and other infection groups. SAA levels were only higher in meningitis group than pneumonia group. No other group showed difference between the levels of CRP, PCT and SAA in this study. The levels of PCT decreased at the 48th. hour of hospitalization according to the admission levels in all groups, while CRP and SAA levels did not decrease. The levels of CRP positively correlated with both the levels of PCT and SAA at admission, at the 48th. hour and on days 7 and 10. When patients were divided into two groups as invasive bacterial infection group and localised bacterial infection group; PCT levels were found significantly higher in invasive bacterial infection group than localised bacterial infection group on all studying days while CRP levels and SAA levels showed no significant difference between two groups on all studying days.PCT seems to be a more valuable parameter in diagnosing invasive bacterial infections. In conclusion, evaluating clinical findings and duration of symptoms of patients together with CRP, PCT and SAA levels will be more helpful in diagnosis and treatment

Comparison of C-Reactive protein, procalcitonin and serum amyloid A levels in diagnosis of bacterial infection in children Çocuklarda bakteri enfeksiyonlari{dotless}ni{dotless}n tani{dotless}si{dotless}nda C-Reaktif protein, prokalsitonin ve serum Amiloid-A düzeylerinin karşi{dotless}laşti{dotless}ri{dotless}lmasi{dotless}

Objective: The aim of the study was to compare C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) levels in children with bacterial infection. Material and Methods: In this prospective study, 120 pediatric patients who were hospitalized with bacterial infection in the Uludag University Medical Faculty Pediatric Clinic between June 2009 and June 2011 were included. Patients were evaluated in 5 groups as sepsis, pneumonia, meningitis, pyelonephritis and other infection groups. Before initiating the antimicrobial therapy, blood samples for whole blood count, blood culture, CRP, PCT and SAA were obtained from children with bacterial infection. This procedure was repeated three times at 48 h, 7 and 10 days. Whole blood count was performed using an automated counter, Cell Dyn 3700 (Abbott Diagnostics Division, Santa Clara, CA, USA). CRP and SAA were determined by an immunonephelometric method using BN II device (Dade Behring Marburg GMBH, Marburg, Germany). PCT was measured by Enzyme- Linked Fluorescent Assay (VIDAS PCT; Brahm Diagnostica GMBH, Lyon, France). Results: Of the patients, 66 (55%) were male and 54 (45%) were female. The median age was 37.5 months (1-209). PCT levels of the sepsis group was significantly higher than those of the pneumonia and other infection groups (respectively, p=0.001, p=0.003). SAA levels were higher in the meningitis group than those of the pneumonia group (p=0.007). When patients were divided into two groups as invasive bacterial infection group and localised bacterial infection group; PCT levels were found significantly higher in the invasive bacterial infection group than those of the localised bacterial infection group. Also, percentage change of PCT at the 48th hour, 7 and 10 days was determined as significantly higher in the invasive bacterial infection group than that of the localised bacterial infection group. Conclusion: In this study, PCT seems to be a more valuable parameter in diagnosing invasive bacterial infections. © 2013 by Pediatric Infectious Diseases Society

Poor Appetite in School Children: Is It a False Perception of Parents?

Aim: Poor appetite is a common symptom in childhood that can either be organic or nonorganic. Prolonged poor appetite may affect children's growth negatively. However picking at food or refusing to eat stresses parents out. In this study, we aimed to investigate the relationship between parental perception of the child's body measurements and appetite in school children who were admitted to the outpatient clinic with the complaint of sustained poor appetite. Materials and Methods: A total of 105 school children (6-15 years old) with the complaint of poor appetite who were investigated several times previously with no organic reason were included in the study. The study was conducted with a questionnaire that was filled out by parents recording demographics. Anthropometric measurements including body weight and height were measured by the same researcher. Body mass index was calculated and BMI for-age was determined. Patients with normal BMI percentile values and patients with low BMI percentile values were compared. Results: 105 children (M/F: 51/54) with a mean age of 8.2 +/- 1.9 years were studied. Mean body weight and height of children were 23.8 +/- 5.7 kg and 124.1 +/- 11.6 cm, respectively. Mean BMI of children was 15.2 +/- 1.5. According to BMI percentiles 65.7% (n=69) of children were normal weight, 30.5% (n=32) were underweight, and 3.8% (n=4) were overweight. When compared in terms of BMI percentiles no difference was found between the groups. Conclusion: Perception of the parents of their children's growth is influenced by many factors and usually does not reflect the facts. In our study, we found that the majority of the children with poor appetite were in normal weight range according to BMI percentile. Nevertheless, nearly one third of the children were underweight, a fact that should not be ignored

The Characteristics of Non-Diabetic Mothers with Macrosomic Newborns

Introduction: Fetal macrosomia is a condition with heterogeneous etiologic factors and its' frequency is increasing in recent years. Many macrosomic infants are born without any risk factors and accurate prediction of macrosomia is not possible with only single risk factor. The aim of this study was to research the characteristics of healthy mothers without diabetes who gave birth to macrosomic infants. Materials and Methods: This case-control study comprised 291 healthy pregnant women who were monitored and delivered at Mardin Women and Children's Hospital. Inclusion criteria were (a) no disease or conditions that may affect birth weight, (b) normal healthy pregnancy and (c) singleton live infants born between 37-42 weeks with no structural defects. A birth weight above 4.000 g was defined as macrosomic neonate. The study group was divided in two; group 1 had a birth weight less than 4.000 g and group 2 had a birth weight above 4.000 g. Characteristics of mother and newborn were analyzed to determine any association with macrosomia. Results: The logistic regression analysis results indicated that the risk of macrosomic infant were male gender of the infant [odds ratio (OR): 3.39; 95% confidence interval (CI): 2.010-5.211; p<0.001], maternal age being above 35 years (OR: 2.25; 95% CI: 1.919-4.005; p=0.026) and duration of gestation being above 40 weeks (OR: 1.72; 95% CI: 1.103-2.949; p=0.009). Conclusions: There are various factors behind having a macrosomic infant in the absence of glucose intolerance. These risk factors should be taken into consideration for possible complication of macrosomia and mothers with the risk factors should be informed