Adolesan Yaş Grubunda Jinekomastinin Beden Algısı ve Cinsel Kimlik Üzerine Etkisinin Araştırılması

The aim of our study is to evaluate the effect of gynecomastia on body image perception and sexual identity in the adolescent age group. Fourty seven adolescent boys between 11-18 years who referred to Hacettepe University Ihsan Dogramacı Children?s Hospital Adolescent Unit with gynecomastia determined as study group and sixty three male adolescents within the same age group determined as control group included in our study. We performed Body Image Perception Scale (BIPS) and Bem Gender Role Inventory (BGRI) to study group in the first meeting and at first month control, to the control group only in the first meeting. In the first meeting after scale and inventory filled, we gave detailed information about gynecomastia to the study group. The peak incidence of gynecomastia was seen at Tanner stage III. Gynecomastia was palpated in %74.6 of patients bilaterally. There was no significant difference between study and control groups on chronological and height age, body mass index, average height. Study and control groups were questioned about lipomastia, fast food eating, bicorbonate containing beverage consumption, chronic illness, drug usage and family history about gynecomastia. Chronic illness, drug usage and family history about gynecomastia were significantly more in the study group. Although there was no significant difference between the gynecomastia and control groups in BIPS median points, when the scale items examined in detail, we can say that body image perception is destroyed in the patients with gynecomastia. After detailed information about gynecomastia given in the first meeting, the BIPS points were improved in the first month control that showed us the importance of paying attention to the emotional discomfort of the patient with gynecomastia and giving psychological support to them. According to the BGRI results, we can say that patients with gynecomastia are not affected by the feminine direction. In conclusion, body image perception is destroyed in adolescents with gynecomastia but breast development as a normal finding of pubertal development in girls does not affect adolescent boys in the feminine direction. The degree of emotional discomfort in the adolescent boys with gynecomastia should be assessed by the clinician at clinical mettings and necessary information about gynecomastia should be told and psychological support should be given to them. The psychological support is as much important as the medical therapy.Bu çalışmanın amacı adolesan yaş grubunda jinekomastinin beden algısı ve cinsel kimlik üzerine etkisini değerlendirmektir. Bu çalışmada, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi Adolesan Ünitesi?ne başvuran 11-18 yaş arası 47 jinekomastili olgu hasta grubu, aynı yaşlar arasında olan 63 sağlıklı erkek adolesan ise kontrol grubu olarak belirlenmiştir. Hasta grubuna başvuruda ve 1. ay kontrollerinde Vücut Algısı Ölçeği (VAÖ) ve Bem Cinsiyet Rolü Envanteri (BCRE) uygulanmıştır. Başvuru sırasında anketler uygulandıktan sonra hasta grubuna jinekomasti ile ilgili sözel bilgilendirme yapılmıştır. Kontrol grubuna aynı anketler başvuru sırasında uygulanmıştır. Jinekomasti insidansı Tanner Evre III?te pik yapmıştır. Hastaların %74.6?sında meme diski bilateral palpe edilmiştir. Jinekomastili olguların takvim ve boy yaşları, vücut ağırlığı ve boy ortalamaları kontrol grubu ile karşılaştırıldığında gruplar arasında anlamlı fark saptanmamıştır. Jinekomastili olgular lipomasti varlığı, fastfood ve bikarbonatlandırılmış içecek tüketimi, kronik hastalık varlığı, ilaç kullanım öyküsü ve ailede jinekomasti varlığı açısından kontrol grubu ile karşılaştırıldığında jinekomastili olgularda kronik hastalık, ilaç kullanım ve ailede jinekomasti öyküsü anlamlı olarak fazla bulunmuştur. Jinekomasti ve kontrol gruplarında VAÖ ortanca puanları arasında anlamlı bir fark olmasa da VAÖ madde bazında değerlendirildiğinde beden algısında bozulma olduğu söylenebilir. Jinekomastili olgulara ilk görüşmede yapılan bilgilendirme sonrasında 1. ay kontrolünde tekrarlanan VAÖ ortanca puanlarında artış olması, görüşmeler sırasında hastanın psikolojik açıdan etkilenme derecesine dikkat edilmesi ve bu açıdan da hastaya destek sağlanması gerektiğini göstermektedir. BCRE sonuçlarına göre jinekomastili hastaların cinsel kimlik açısından kadınsı yönde etkilenmediği söylenebilir. Sonuç olarak jinekomastili olgularda beden algısında bozulma mevcuttur fakat kadınlarda pubertenin bir bulgusu olan meme gelişimi, olguların cinsel kimliklerinde kadınsı yönde bir etkilenmeye yol açmamaktadır. Jinekomastili hastaların başvuru sırasında emosyonel rahatsızlık derecelerinin klinik görüşmeler ile değerlendirilmesi ve hastalara jinekomasti ile ilgili bilgilendirme yapılması ve psikolojik açıdan destek sağlanması gerekmektedir. Psikolojik açıdan sağlanacak destek tedavisi en az medikal tedavi kadar önemlidir

Suspected hypersensitivity to beta-lactam antibiotics in children and clinical experiences from pediatric allergy

Giriş: Çocuklarda ilaca bağlı aşırı duyarlılık reaksiyonlarına en sık neden gösterilen ilaçlar beta-laktam antibiyotiklerdir (BLA). Ancak, hastaların %95’inden fazlası uygun bir şekilde değerlendirildiğinde güvenle penisilin grubu ilaçları kullanabilmektedir. Bu çalışmada şüpheli BLA alerjisi nedeniyle başvurmuş hastaların klinik özelliklerini, ilaç alerjisine yönelik yapılan tanısal testleri ve sonuçları incelenerek gerçek BLA alerjisi sıklığını değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmada, üçüncü basamak bir sağlık merkezinde çocuk alerji polikliniğine, bir yıllık sürede, şüpheli BLA alerjisi nedeniyle başvurmuş 44 çocuk retrospektif olarak değerlendirildi. Bulgular: Çalışmaya BLA alerjisi şüphesi ile toplam 44 çocuk (kız/erkek: 24/20) dahil edildi. Hastaların %38,6’sında (n=17) alerjik hastalık öyküsü, %36,4’ünde (n=16) ailede alerjik hastalık öyküsü vardı. En sık bildirilen şüpheli ilaç amoksisilin klavulonat (%75), en sık antibiyotik kullanım nedeni akut tonsillit (%56,8) idi. En yaygın klinik tabloyu cilt bulguları (%97,7) oluşturmaktaydı. Yapılan alerjik değerlendirme sonucunda toplam 5 hastada (%11) BLA alerjisi saptandı. BLA alerjisi saptanan çocuklar ile saptanmayanlar arasında yaş, cinsiyet, atopi öyküsü ya da ailede ilaç alerjisi öyküsü varlığı açısından anlamlı bir farklılık saptanmadı (p>0,05). Sonuç: Tanısal değerlendirme sonrası, sadece öykü ile şüpheli alerjik reaksiyon kabul edilecek olguların gerçekte az bir kısmında BLA aşırı duyarlılığı olduğu gösterilmiştir. BLA’lara karşı alerjik reaksiyon öyküsü olan çocuklarda doğru tanıyı güvenle ortaya koymak ve hastaları gereksiz yere ilaç alerjisi tanısıyla etiketlememek için ayrıntılı bir klinik öykü doğrultusunda uygun ilaç alerjisi değerlendirmesi gerekmektedir.Introduction: Beta-lactam antibiotics (BLA) are the most common drugs that cause drug-related hypersensitivity reactions in children. However, more than 95% of patients can safely use penicillins when properly evaluated. In this study, we aimed to evaluate the actual frequency of BLA allergy by examining the clinical characteristics of the patients, diagnostic evaluation of drug allergy tests and results in patients presenting with suspected BLA allergy. Materials and Methods: In the study, 44 children who admitted to a pediatric allergy outpatient clinic in a tertiary care center with suspected BLA allergy in a one-year period were evaluated retrospectively. Results: A total of 44 children (male/female: 24/20) with suspected BLA allergy were included in the study. 38.6% (n=17) of the patients had a history of allergic disease, 36.4% (n=16) had a family history of allergic disease. The most frequently reported culprit drug was amoxicillin clavulonate (75%) and the most common cause of antibiotic usage was acute tonsillitis (56.8%). Skin findings (97.7%) were the most common clinical presentation. As a result of the allergic evaluation, a total of 5 patients (11%) were found to have BLA allergy. There was no significant difference between children with BLA allergy and those who were not, in terms of age, gender, atopy or family history of drug allergy (p>0.05). Conclusions: After diagnostic evaluation, it has been shown that BLA hypersensitivity is actually present in a small number of cases that are considered to be suspected allergic reactions only with history. In children with a history of allergic reactions to BLAs, an appropriate drug allergy assessment is required in line with a detailed clinical history in order to establish the correct diagnosis confidently and not to label patients with a diagnosis of drug allergy unnecessarily

Frequency of HLA Class I and Class II Alleles in Patients with CVID from Turkey

Background: Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. Certain gene loci are pointed out in several studies in CVID patients. Until now, monogenic defects have been identified in only 2-10% of CVID patients; therefore, association of the disease with HLA alleles may be important for elucidating immunological and genetic mechanisms behind CVID. The aim of this study is to investigate the relationship between CVID and HLA alleles. Methods: HLA class I/II alleles were analyzed in 65 patients with CVID and alleles that may be related to disease susceptibility were determined by comparing with 300 healthy controls. We also evaluated HLA allele frequencies in CVID patients with gastrointestial system (GIS) involvement and autoimmune manifestations. Results: When compared with controls, frequencies of B*27, B*35, C*04, and DRB1*04 alleles were significantly different in patients with CVID (p < .05). Frequencies of C*12, DRB1*13, and DRB1*15 alleles were more frequent in controls, indicating protective alleles (p < .05). There was a statistically significant difference for DQ2 and DQ8 haplotypes between patients with GIS involvement and controls. Conclusion: In comparison with literature, distinctive HLA alleles found in our study may originate from the diversity in gene pool between the populations. These data may provide clues for disease susceptibility

Mutation in BTK Gene Causing an Atypical Presentation of XLA

Patients with X-linked agammaglobulinemia (XLA) are susceptible to bacterial infections particularly due to encapsulated pyogenic bacteria, organisms for which opsonization by antibody is a primary host defense. Additionally, enteroviral encephalitis and chronic diarrhea due to Giardia are seen in XLA. However, fungal infections are rarely present. In this report, we describe the case of a 17 month-old boy with absent BTK protein expression caused by a novel de-novo variant of the BTK gene, who presented with neutropenic fever and sepsis caused by Candida and Pseudomonas aeruginosa

In case of recurrent wheezing and bronchiolitis: Think again, it may be a primary immunodeficiency

Background: Wheezing, starting early in life, is a heterogeneous medical condition caused by airway obstruction due to different underlying mechanisms. Primary immunodeficiencies are also among the risk factors that cause wheezing and recurrent bronchiolitis. ADA deficiency is a primary immunodeficiency, also a rare metabolic disease associated with multisystemic clinical findings. Objective: This report will be helpful for adressing the importance of thinking primary immunodeficiency in case of wheezing and recurret bronchiolitis. Methods: The patient was diagnosed by using a targeted next generation sequencing PID panel. Lymphocyte subsets were measured by flow-cytometry. Results: Here we present an infant with ADA deficiency who admitted with wheezing and recurrent bronchiolitis as the first presentation. He was found to have wheezing, relative CD4+ T cell deficiency, and prolonged neutropenia. Conclusion: Primary immunodeficiencies including ADA deficiency should be considered in infants with wheezing, recurrent bronchiolitis, lymphopenia and neutropenia

Mesh Nebulizer Is As Effective As Jet Nebulizer In Clinical Practice Of Acute Asthma In Children

Background/aim The aim of this study was to compare the effect of salbutamol delivered to children by jet nebulizer (JN) and mesh nebulizer (MN). Materials and methods Children admitted with acute asthma were treated with 3 doses of nebulized salbutamol, 1 given by MN. The patients’ vital signs, lung function measurements, modified pulmonary index score (MPIS), and whole body plethysmography (WBP) measurements were evaluated before and 20 min after each dose of salbutamol. Results Thirty-onechildren [9.5 (6.4–17.2) years, 67.7% male, 32.3% female] with mild (67.7%) and moderate (32.3%) asthma attacks were included in the study. The improvements with MN were comparable with JN in terms of changes in pretreatment and posttreatment forced expiratory volume in the first second (FEV1) (2.57 ± 4.57, 3.65 ± 5.44; P = 0.44), forced vital capacity (FVC) (2.52 ± 5.29, 4.17 ± 7.54; P = 0.28), heart rate (7.33 ± 10.21, 4.14 ± 9.32; P = 0.24), peripheral capillary oxygen saturation (SpO2) (0.38 ± 0.23, 0.43 ± 0.15; P = 0.83), and modified pulmonary index score (MPIS) (−6.30 ± 22.70, −8.77 ± 25.46; P = 0.70). The pre- and posttreatment values of total lung capacity (TLC), residual volume (RV), specific conductance (sGaw), and RV/TLC were similar for the JN and MN groups. Adverse effects were not different: however, complaints of palpitation were significantly higher in the posttreatment MN group than the pretreatment MN group (32.3% vs 9.7%, respectively, P = 0.016). Conclusions These findings support the previous evidence found in studies of adults that MN is as effective as and as safe as JN in the treatment of acute asthma in children.PubMedWoSScopu

Diversity in Serine/Threonine Protein Kinase-4 Deficiency and Review of the Literature

Background: Serine/threonine kinase-4 (STK4) deficiency is an autosomal recessive combined immunodeficiency. Objective: We aimed to define characteristic clinical and laboratory features to aid the differential diagnosis and determine the most suitable therapy. Methods: In addition to nine STK4 deficiency patients, we reviewed 15 patients from the medical literature. We compared B lymphocyte subgroups of the cohort with age-matched healthy controls. Results: In the cohort, median age at symptom onset and age at diagnosis were 6 years 8 months (range, 6-248 months) and 7 years 5 months (range, 6-260 months), respectively. The main clinical findings were infections (in all nine patients [9 of 9]), autoimmune or inflammatory diseases (7 of 9), and atopy (4 of 9). CD4 lymphopenia (9 out 9), lymphopenia (7 out 9), intermittent eosinophilia (4 out 9), transient neutropenia (3 out 9), low IgM (4 out 9), and high IgE (4 out 9) were common. Decreased recent thymic emigrants, naive and central memory T cells, but increased effector memory T cells were present. The increase in plasmablasts (P = .003) and decrease in switched memory B cells (P = .022) were significant. When 24 patients are analyzed, cutaneous viral infections (n = 20), recurrent pneumonia (n = 18), Epstein Barr virus–associated lymphoproliferation (n = 11), atopic dermatitis (n = 10), autoimmune cytopenia (n = 7), and lymphoma (n = 6) were frequent. Lymphopenia, CD4 lymphopenia, high IgG, IgA, and IgE were common laboratory characteristics. Conclusions: The differential diagnosis with autosomal recessive hyper-IgE syndrome is crucial. Because, atopy and CD4 lymphopenia are common in both diseases. Immunoglobulins, antibacterial, and antiviral prophylaxis are the mainstays of treatment. Clinicians may use immunomodulatory therapies during inflammatory or autoimmune complications. However, more data are needed to recommend hematopoietic stem cell transplantation as a safe therapy