A newborn with diabetic ketoacidosis and thalassemia major: A rare case

Diabetic ketoacidosis is a systemic situation caused byabsolute insulin deficiency and characterized by hyperglycemia,ketonemia, acidemia, glycosuria and ketonuria.Thalassemia Major is a very serious hereditary blooddisorder due to low levels or absence of “beta globulin”chain, characterized by requiring a blood transfusion from3-4. month of life due to the relatively short life of red cells.We, herein presented a rare case of 20 day-old newbornwith anemia, hyperglycemia, vomiting, acidosis being diagnosedas thalassemia major that required blood transfusionin the early period of life and diabetic ketoacidosiswithout ketonuria who born from 24 year old father carrierof thalassemia and 23-year-old mother with carrier of thalassemiaand gestational diabetes.The case was presented in order to emphasize that diabeticketoacidosis can occur in newborns without ketonuriaand thalassemia major may cause anemia in the earlyperiod of life due to hyperglycemia and acidosis

The comparison of early and late effectiveness of systemic and high dose inhaled glucocorticoids in the management of acute asthma attacks in children

Amaç: Bu çalışmada akut astım atağı ile başvuran ço- cuklarda sistemik steroidler ile yüksek doz inhale steroid- lerin etkinliğinin karşılaştırılması amaçlandı. Gereç ve yöntem: Akut astım atağı ile gelen çocuklar randomize olarak iki gruba ayrıldı. Hastalara 1 mg/kg oral yoldan metilprednisolon (Sistemik Steroid Grubu, Grup 1, n=27) veya bir kez 4000 ?g inhale flutikazon (İnhale Steroid Grubu, Grup 2, n=35) verildi. Tedaviyi izleyen birer saat aralıklarla dört saat boyunca astım skoru, birinci saniyede üflenen zorlu ekspiratuar hacim (FEV1) ve zirve ekspiratuar akım (PEF) değerleri ölçüldü. Birincil sonuç hastaneye yatış oranı, ikincil sonuçlar ise astım skoru, FEV1 ve PEF sonuçları ve oksijen saturasyonu ile değerlendirildi. Bulgular: Hastaların geliş anı ile tedavinin dördüncü saati ve hastaların rahat olduğu dönemde PEF değerleri Grup 1’de sırasıyla, 173, 223, 220 L/dk (p0,05).Sonuç: Çocuklarda akut astım atağı tedavisinde, erken ve geç etkinlikleri açısından yüksek doz inhale flutikazon ile sistemik metilprednizolon tedavileri arasında astım skoru, FEV1 ve PEF parametreleri bakımından anlamlı farklılık saptanmadı.Objective: In this study it was aimed to compare effec- tiveness of systemic steroids and inhaled corticosteroids in children who applied with acute asthmatic attack. Materials and methods: Children with acute asthmatic at- tack were randomly allocated to two groups; 1 mg/kg per oral methylprednisolone was given to Group 1 (Systemic steroid group, n=27), and 4000 μg inhaled fluticasone to Group 2 (Inhaled steroid group, n=35). Following treat- ment patients were evaluated for four hours, at one-hour intervals by asthma score, forced expiratory volume in first-second (FEV1) and peak expiratory flow (PEF). Pri- mary outcome of this study was the rate of hospital admis- sions and secondary outcome were asthma score, FEV1, PEF and oxygen saturation. Results: Significant improvements were obtained in mea- sured parameters in both Group 1 and Group 2. Values of measured parameters at hospital admission, 4th hour of treatment and while patients were in comfort were as fol- low: PEF values (Group 1: 173, 223, 220 L/min, p <0.001): Group 2 113, 141 , 192 L/min, p <0.001); FEV 1 (Group 1: 74.9%, 89.5%, 85.6%, p <0.0001; Group 2: 96, 89.8, 93.2 %, p <0.0001); O2 saturation (Group 1:93.2%, 95.6%, 96.8%, p <0.0001, Group 2: 93%, 95.2%, 96.6%, p<0.001); and asthma score (Group 1: 9.4, 6.6, 5.7, p<0.001, Group 2: 9.3, 6.8, 6.5, p<0.001). In all measured parameters significant improvements were observed with treatment modalities within both groups. No significant differences were found in all parameters between Group 1 and Group 2 (p>0.05). Conclusion: No significant differences were found in asth- ma score, FEV 1 and PEF parameters between systemic high-dose methylprednisolone and inhaled fluticasone treatment modalities in acute asthmatic attacks of children

Common pathogens isolated from burn wounds and their antibiotic resistance patterns

Objective: Burn wound infections are the most severe cause of mortality in patients in the burn units. The aim of this study is to determine the bacteriological profile and their antibiotic resistance patterns in burn unit of Dicle University Hospital.Methods: Medical records of 151 burn patients admitted to the burn unit of Dicle University Hospital between June, 2008 and June 2010 were reviewed retrospectively.Results: Our study included 70.2% (n=106) male and 29.8% (n=45) female patients. The mean age of cases was 10.9±14.7 years. The rate of isolated microorganisms were 62.3% (n=94) Acinetobacter baumannii, 25.8% (n=39) Pseudomonas aeruginosa, 7.3% (n=11) Escherichia coli and 4.6% (n=7) Staphylococcus aureus. The most effective antibiotic against A. baumannii was colistin (95%) followed by levofloxacin (84%) and trimethoprimsulfamethoxazole (87%). The most effective antibiotics against P. aeruginosa were amikacin (82%), ciprofloxacin (71%) and levofloxacin (71%). The most effective antibiotics against E. coli were amikacin (91%), meropenem (73%) and imipenem (82%).Conclusion: The prevalence of burn wound infection caused by A. baumannii and multiple drug resistant A. baumannii are increasing worldwide by time. The prevalence of multiple drug resistant P. aeruginosa and E. coliare rising also. So, new strategies of infection prevention should improve as soon as possible.Key words: Burn units, wound infection, multiple drug resistance, antibiotics, Acinetobacter baumannii, Pseudomonas aeruginos

Thrombotic thrombocytopenic purpura concomitant with autoimmune thyroiditis

Thrombotic thrombocytopenic purpura (TTP) is characterized by disseminated thrombotic occlusions located in the microcirculation, microangiopathic hemolytic anemia, thrombocytopenia, fever, and renal and neurologic abnormalities. A 14 year old girl admitted to our hospital complaining bruising on her body and prolonged menstrual bleeding. On her physical examination there were very common bruising on four extremities. On the laboratory studies, Hemoglobin was 9 g/dL; Hematocrit, 24%; white blood count 11600/mm3 and thrombocyte count, 9.000/mm3. According to these findings our first diagnose was idiopatic thrombocytopenic purpura so intravenous immunoglobulin was given to patient for two days. Bone marrow aspiration was performed because of persisting thrombocytopenia despite two days IVIG therapy. Increased number of megakaryocytes was seen in bone marrow. Some accompanying symptoms like headache, numbness in per oral region and extremities, difficulty in speaking, and fluctuation in consciousness for short time occurred. The patient was reevaluated; because thrombocytopenia persisted and some neurological symptoms was observed. Due to these findings we thought that TTP was the diagnosed and plasma exchange was started. Increase was seen in platelet count in the second days of treatment. TTP should be considered in children presenting with atypical thrombocytopenia

The Assessment of Children’s Socio-Demographic Features at the Adolescent Outpatient Clinic

Objective: In this study, we investigated socio-demo­graphic characteristics of adolescents living in our region. Methods: Were analyzed, retrospectively, patients admit­ted Dicle University Faculty of Medicine’ adolescent out­patient clinic. Demographic data, body mass index (BMI), medical history and family background, school status, academic achievement, habits, trauma and psychosocial status were recorded. Results: Of the 244 adolescents, 124/%) were females. The average age of cases was 12.99 ± 1.89 years (10-18 years). 48.3% of adolescents were low BMI. The smoking rate of 32.4% (n=79) and was higher in men. In smok­ers, school performance was lower (p = 0.002), and the rate of suicidal idea was higher (p < 0.001). In those with family history of suicide, the rate of suicidal thoughts or attempted suicide was higher (p = 0.005, p = 0.022, re­spectively). Similarly, in cases exposed to physical vio­lence, the rates of attempted suicide or suicidal thoughts were higher (p=0.011, p=0.001, respectively). In addition, in cases exposed to psychological violence the rates of attempted suicide or suicidal thoughts were higher (p<0.001, p<0.001, respectively). Conclusion: Adolescents, for they can complete this period in a healthy way, health-care services, education units, especially their parents, should be made aware of the adolescence period-specific problems. Additionally, special centers customized adolescents, should be cre­ated and supported by state and private institutions