Protracted Febrile Myalgia in a Child as the Presenting Sign of Familial Mediterranean Fever: Case Report and Review of the Literature

Protracted febrile myalgia (PFM) is a rare form of vasculitic disease which is an uncommon dramatic manifestation of familial Mediterranean fever (FMF), characterized by severe crippling myalgia and high fever. We describe a 14-year-old boy who presented with fever, abdominal pain and severe myalgia in all his muscles for 5 days. The diagnosis of PFM was considered based on the presence of fever, paralyzing myalgia with normal CPK, elevated CRP and ESR. Thus, we started prednisolone treatment and his symptoms disappeared and acute-phase reactants declined rapidly. Mutational analysis of the MEFV gene demonstrated homozygote M694V mutation. Thus, he was diagnosed as PFM and FMF. In this report, we present a child with PFM as the sole feature preceding the diagnosis of FMF, and draw attention to the PFM for the diagnosis of FMF even the patient does not fulfi ll the criteria for the clinical diagnosis. © Trakya University Faculty of Medicine

QT and JT dispersion in children with familial mediterranean fever

Objectives: This study aims to determine QT dispersion and JT dispersion, and their relationship with conventional echocardiography values in a group of children with familial Mediterranean fever (FMF). Patients and methods: The study included 48 FMF patients (26 males, 22 females, mean age 11.10±3.42 years; range 5 to 18 years) as the FMF patients and 31 healthy children (17 males, 14 females, mean age 9.61±2.83 years; range 5 to 17 years) as the healthy controls. Electrocardiography and conventional echocardiography were performed on the FMF patients and healthy controls. Both groups were evaluated with a standard 12-lead electrocardiography. QT, JT and RR distances were measured in both groups. The corrected QT (QTc) and corrected JT (JTc) were calculated. QTcd and corrected JT dispersion (JTcd) were detected. Results: There was no statistically significant difference between the FMF patients and healthy controls in terms of RR, QT, QTd, QTcd, JT, JTc, JTd, and JTcd measurements and echocardiography parameters. QTc value was higher in the FMF patients than the healthy controls. Conclusion: QTc value indicates increased ventricular sensitivity and is an important marker of cardiovascular mortality. It has an important effect on sudden cardiac death and arrhythmia. Our study results suggest that electrocardiographic monitoring may be useful in patients with FMF

Split-bolus MR urography: synchronous visualization of obstructing vessels and collecting system in children

Several vascular abnormalities related with urinary system such as crossing accessory renal vessels, retroiliac ureters, retrocaval ureters, posterior nutcracker syndrome, and ovarian vein syndrome may be responsible for urinary collecting system obstruction. Split-bolus magnetic resonance urography (MRU) using contrast material as two separate bolus injections provides superior demonstration of the collecting system and obstructing vascular anomalies simultaneously and enables accurate preoperative radiologic diagnosis. In this pictorial review we aimed to outline the split-bolus MRU technique in children, list the coexisting congenital collecting system and vascular abnormalities, and exhibit the split-bolus MRU appearances of concurrent urinary collecting system and vascular abnormalities

Protracted Febrile Myalgia in a Child as the Presenting Sign of Familial Mediterranean Fever: Case Report and Review of the Literature

Protracted febrile myalgia (PFM) is a rare form of vasculitic disease which is an uncommon dramatic manifestation of familial Mediterranean fever (FMF), characterized by severe crippling myalgia and high fever. We describe a 14-year-old boy who presented with fever, abdominal pain and severe myalgia in all his muscles for 5 days. The diagnosis of PFM was considered based on the presence of fever, paralyzing myalgia with normal CPK, elevated CRP and ESR. Thus, we started prednisolone treatment and his symptoms disappeared and acute-phase reactants declined rapidly. Mutational analysis of the MEFV gene demonstrated homozygote M694V mutation. Thus, he was diagnosed as PFM and FMF. In this report, we present a child with PFM as the sole feature preceding the diagnosis of FMF, and draw attention to the PFM for the diagnosis of FMF even the patient does not fulfill the criteria for the clinical diagnosis

Epileptik kadınlarda karbamazepinin neden olduğu DNA hasarının değerlendirilmesi

Pregnancy is one of the most difficult problems to be solved in epileptic female patients. The main concern with antiepileptic drugs (AEDs) during pregnancy is the Teratogenicity. Carbamazepine (CBZ) is one of the most frequently prescribed AEDs. Its potential toxic effects on DNA have been investigated by various tests, but the results were contradictory. To clarify this toxicity, comet assay was performed in peripheral lymphocytes of 32 epileptic women treated with CBZ monotherapy for at least one year. This was performed with a control group that included 16 and non-drug using healthy females. The damaged (limited and extensive, migrated) cells in patients’ group were significantly higher than that of the control group (p 8 mcg/ml were higher than those of the patients who have less than 0,05). No significant correlation was noted between the duration of the therapy and the comet scores either (p > 0,05). We suggest that CBZ have mutagenic, carcinogenic and teratogenic effect and this effect may increase with high therapeutic levels and begins within the first year of the treatment.Epileptik kadın hastalarda gebelik, çözülmesi en zor problemlerden biridir. Gebelik sırasındaki antiepileptik ilaçlar (AED'ler) ile ilgili ana endişe Teratojenite'dir. Karbamazepin (CBZ) en sık reçete edilen AED'lerden biridir. DNA üzerindeki potansiyel toksik etkileri çeşitli testlerle araştırılmıştır, ancak sonuçlar çelişkilidir. Bu toksisiteyi açıklığa kavuşturmak için, CBZ monoterapisi ile tedavi edilen 32 epileptik kadının periferal lenfositlerinde en az bir yıl boyunca kuyruklu yıldız analizi yapıldı. Bu, sağlıklı dişi kullanan 16 ve uyuşturucu olmayan kontrol grubu ile yapıldı. Hasta grubundaki hasarlı (sınırlı ve geniş, göç eden) hücreler, CBZ monoterapisinin insan lenfositleri üzerindeki tespit edilebilir bir DNA hasar etkisine işaret eden kontrol grubundan (p 8 mcg / ml olan hastalarda kuyruklu yıldız skorları 0,05). Terapi süresi ile kuyruklu yıldız puanları arasında da anlamlı bir ilişki bulunmadı (p> 0,05). CBZ'nin mutajenik, kanserojen ve teratojenik etkiye sahip olduğunu ve bu etkinin yüksek terapötik düzeylerde artabileceğini ve tedavinin ilk yılında başladığını öne sürüyoruz

Epileptik kadınlarda karbamazepinin neden olduğu DNA hasarının değerlendirilmesi

Pregnancy is one of the most difficult problems to be solved in epileptic female patients. The main concern with antiepileptic drugs (AEDs) during pregnancy is the Teratogenicity. Carbamazepine (CBZ) is one of the most frequently prescribed AEDs. Its potential toxic effects on DNA have been investigated by various tests, but the results were contradictory. To clarify this toxicity, comet assay was performed in peripheral lymphocytes of 32 epileptic women treated with CBZ monotherapy for at least one year. This was performed with a control group that included 16 and non-drug using healthy females. The damaged (limited and extensive, migrated) cells in patients’ group were significantly higher than that of the control group (p 8 mcg/ml were higher than those of the patients who have less than 0,05). No significant correlation was noted between the duration of the therapy and the comet scores either (p > 0,05). We suggest that CBZ have mutagenic, carcinogenic and teratogenic effect and this effect may increase with high therapeutic levels and begins within the first year of the treatment.Epileptik kadın hastalarda gebelik, çözülmesi en zor problemlerden biridir. Gebelik sırasındaki antiepileptik ilaçlar (AED'ler) ile ilgili ana endişe Teratojenite'dir. Karbamazepin (CBZ) en sık reçete edilen AED'lerden biridir. DNA üzerindeki potansiyel toksik etkileri çeşitli testlerle araştırılmıştır, ancak sonuçlar çelişkilidir. Bu toksisiteyi açıklığa kavuşturmak için, CBZ monoterapisi ile tedavi edilen 32 epileptik kadının periferal lenfositlerinde en az bir yıl boyunca kuyruklu yıldız analizi yapıldı. Bu, sağlıklı dişi kullanan 16 ve uyuşturucu olmayan kontrol grubu ile yapıldı. Hasta grubundaki hasarlı (sınırlı ve geniş, göç eden) hücreler, CBZ monoterapisinin insan lenfositleri üzerindeki tespit edilebilir bir DNA hasar etkisine işaret eden kontrol grubundan (p 8 mcg / ml olan hastalarda kuyruklu yıldız skorları 0,05). Terapi süresi ile kuyruklu yıldız puanları arasında da anlamlı bir ilişki bulunmadı (p> 0,05). CBZ'nin mutajenik, kanserojen ve teratojenik etkiye sahip olduğunu ve bu etkinin yüksek terapötik düzeylerde artabileceğini ve tedavinin ilk yılında başladığını öne sürüyoruz

The comparison of FOLFOX regimens with different doses of 5-FU for the adjuvant treatment of colorectal cancer: A multicenter study

Purpose We aim to compare the efficiency and toxicity of three different 5-fluorouracil (5-FU) administration types in 5-FU, leucovorin, and oxaliplatin (FOLFOX) combination treatment for adjuvant therapy in colorectal cancer (CRC). Methods Five hundred and seventy patients with stage III colorectal carcinoma who received different FOLFOX regimens after curative resection were included. Patients were divided into three groups as FOLFOX-4, modified FOLFOX-6 (mFOLFOX-6), and mFOLFOX-4 for comparison of toxicity and disease-free survival (DFS) and overall survival (OS) times. Results Three-year DFS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 65%, 72%, and 72%, respectively. Five-year OS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 69%, 75%, and 67%, respectively. There was no statistically significant difference between the three treatment groups in terms of DFS and OS (p = 0.079, and p = 0.147, respectively). Among grade 1-2 adverse events (AE), thrombocytopenia, neuropathy, and stomatitis were more common in the mFOLFOX-6-treated group. The frequency of grade 1-2 nausea and vomiting were similar in mFOLFOX-6 (36.3% and 24%, respectively) and mFOLFOX-4 (32.4% and 24.7%, respectively) groups but were higher than that in the FOLFOX-4 (19.5% and 11.3%, respectively) group. Among the most common grade 3-4 AE, neutropenia (53.4%, 9%, and 13.5%, respectively) and diarrhea (10.5%, 2.2%, and 2.4, respectively) were more common in FOLFOX-4. The rate of anemia and febrile neutropenia was similar in treatment groups (p = 0.063, and p = 0.210, respectively). Conclusion In the adjuvant treatment of stage III CRC patients, three different 5-FU administration types in FOLFOX combination treatment can be used with similar efficiency and manageable toxicity