The association of serological tests and anemia in celiac disease

Aim: Celiac disease (CD) is a common immune-mediated enteropathy caused by gluten. These patients may apply with many different clinical forms. The aim of this study is to determine the association of serological tests and type of anemia in CD. Methods: Totally117 biopsy proven CD patients aged between 1-17 years were included. Serological and hematological parameters of all patients were studied. Results: Anemia was identified in 71 (60.7%) cases. Patients with anemia were diagnosed earlier than other patients (5.2±4.5 vs. 15.3±33.8 years, p=0.012). Among CD patients with anemia 39 (54.9%) were having iron deficiency, 22 (30.9%) were having folate deficiency and 10 (14%) were having vitamin B 12 deficiency. In patients with tissue transglutaminase (tTG) seropositivity serum iron levels and ferritin levels were significantly lower compared to anti-gliadin antibody (AGA) or anti-endomysium antibody (EMA) seropositivity  (35±23.5 vs. 57.5±33.3, p=0.007 and 12.4±21.9 vs. 24.2±18.5, p=0.026, respectively). Low serum folate levels were more frequent in the presence of tTG seropositivity compared with AGA+EMA seropositivity (81.8% vs. 25%, p=0.015).  Conclusions: Anemia is an important cause of admission in CD. These patients are diagnosed earlier as a result of anemia. Alone tTG seropositivity is more valuable to demonstrate anemia associated with iron or folate deficiencies

The predictive role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in children with simple febrile seizures

Aim: To evaluate the predictive roles of biochemical and complete blood count parameters in the diagnosis of febrile seizures by comparing these between patients with simple febrile seizures and febrile patients without seizures. Methods: One hundred fifty-two children (66 girls and 86 boys), aged 6-60 months presenting with fever symptoms presenting to our hospital’s pediatric emergency department between January 2015 and January 2020 were included in the study. Demographic data, complete blood count parameters and biochemical parameter levels were compared between the two groups. These were divided into a patient group with simple febrile seizures (n = 74) and a febrile control group without seizures (n = 78). Results: Comparison of biochemical parameters revealed significantly higher glucose, CRP, and ALT levels in the febrile seizure group, while Ca and Na were significantly lower. Comparison of complete blood count parameters revealed significantly higher white blood cell (WBC), neutrophil, red cell distribution width, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values in the febrile seizure group, while hemoglobin, hematocrit, mean corpuscular volume, lymphocytes, and mean platelet volume were significantly lower. Conclusions: We think that in addition to markers such as WBC, leukocytes, and CRP for evaluating inflammation in patients with febrile seizures, simple, easily available, and inexpensive tests such as NLR and PLR can also be useful for assessing inflammation

The neuro-inflammation and excitotoxicity in perinatal brain injury: The emerging role of brain mast cells

Perinatal brain injury is a serious neurodevelopmental problem that can be occurred in preterm and term newborn infants. It is well established that neuro-inflammation is implicated in the pathophysiology of perinatal brain injury. The excitotoxicity is considered as a common molecular mechanism of perinatal brain injury. These insults are capable of leading to neuro-inflammation, but however neuro-inflammation is also able to induce the excitotoxicity in the developing brain. Thus, neuro-inflammation is both a cause and a consequence of excitotoxicity resulting in the brain damages during perinatal period. Excessive glutamate accumulation in the synaptic cleft in the brain is a prominent mechanism in the excitotoxicity while vasoactive and pro-inflammatory mediators such as histamine, prostaglandins, interleukin 1 (IL-1) β and tumor necrosis factor (TNF)-α released from brain-resident immune cells play a major role in neuro-inflammation that lead to the brain damages. Although the role of brain-resident microglial cells has been well documented in these neuro-inflammation processes, evidence for the role of brain mast cells (BMCs) has recently begun to emerge. Growing evidence indicates that brain mast cells are first responders of inflammatory insults in the developing brain and their activation is involved in induced brain injury. We have recently demonstrated that ibotenate-induced excitotoxicity leads to the activation of brain mast cells in a model of ibotenate-induced brain injury in newborn rats. Thus, in this review we point out the current knowledge on the bidirectional role of brain mast cells in neuro-inflammation and excitotoxicity underlying perinatal brain injury

Migralepsy; clinical and electroencephalography findings in children

Aim: Migralepsy is a clinical entity that occasionally represents a diagnostic problem. An apparent history and clinical manifestation of migraine may mask the epileptic attack accompanying migralepsy. The aim of this study is to present our experience with clinical and electroencephalography (EEG) findings and treatment of our patients diagnosed with childhood migralepsy disease.Methods: We documented six patients who were initially followed-up with a diagnosis of migraine, subsequently observed to have epileptic seizures, and then diagnosed with migralepsy.Result: Our patients became asymptomatic by giving good responses to antiepileptic therapy based on clinical and electroencephalography (EEG) findings.Conclusions: This case series shows that EEG recording can be useful in all stages of migraine for long-term, safe monitoring. Identifying patients with possible migralepsy will enable them to receive antiepileptic treatment

The Obstetrics Gynecology and Children’s Hospital Emergency Room waiting time before hospitalization

Background: One of the most substantial factors affecting patient satisfaction in the Obstetrics–Gynecology and Children’s Hospital is the wait time in the emergency room.Objective: We retrospectively studied the waiting periods of patients visiting the emergency room patients in Bolu Izzet Baysal Obstetrics-Gynecology and Children’s hospital.Method: Using an automated documentation system for each patient that recorded the season in which the patients consulted the emergency room, the month, day, time, examination time, hospitalization decision time, the hospitalization clinic following the decision to hospitalize, and the time to hospitalization, we retrospectively studied the waiting periods of emergency room patients in Bolu Ýzzet Baysal Obstetrics–Gynecology and Children’s Hospital.Results: A total of 15,004 patients who consulted the hospital emergency room between November 24, 2009, and August 25, 2011, and who were hospitalized in a clinic were included in this study. The highest frequency of emergency room patient visits occurred during the summer season (28.1%), in the month of July (10.2%), on Mondays (16.1%), and between 8 and 11 AM (22.1%; p < 0.05). The emergency room wait time of patients consulting the pediatric clinic was (55 ± 67 min), which was significantly shorter than the wait time of patients consulting other clinics (p < 0.05).Conclusion: The majority of patients who were hospitalized in any clinic through the emergency room consulted the hospital during the daytime hours. The time to hospitalization for the admitted patients was within an acceptable time frame. We believe that conducting comprehensive research to determine whether it is possible to reduce wait times even further to increase patient satisfaction will be instructive.Keywords: Emergency Room, acceptance-waiting time, emergency-waiting time, hospitalization-waiting timeAfrican Health Sciences 2013; 13(4): 1162 - 116

Effect of COVID-19 pandemic on children undergone percutaneous endoscopic gastrostomy due to neurologic diseases

Aim: To investigate the effects of SAR-CoV-2 infection on nutritional status in patients who underwent percutaneous endoscopic gastrostomy (PEG) for neurological disorders. Methods: The clinical and laboratory follow-up data of the patients who underwent PEG in our clinic between 2002 and 2018 were evaluated before and during the pandemic. The results were analyzed statistically. Results: Twenty patients were included. They were 70.9±64.4 months old at the time of PEG, 97.9±67.8 months before the pandemic, and 105.5±60.8 months during the pandemic (p=0.048). Weight for age at the time of PEG increased from 10.7±4.6 kg to 15.6±7.2 kg before the pandemic. Hemoglobin was 12.3±1.4 g/dl at the time of PEG, 13.5±1.6 g/dl before the pandemic (p=0.045). Vitamin D was 24.1±8.9 ng/ml at the time of PEG and increased to 45.7±9.7 ng/ml during the pandemic (p=0.018). The annual number of visits before the pandemic was 9.8±5.7 and decreased to 2±1.7 during the pandemic (p=0.003). Twelve (%60) of the patients developed PEG complications, 6(30%) had their PEG replaced. Those who had developed PEG complications had low levels of albumin (3.3±0.4 vs 4±0.4 g/dl, p=0.022) and vitamin B12 (578±199 vs 1299±533 pg/ml, p=0.007). Conclusions: Even if PEG is applied late, it provides a partial improvement in patients, but the COVID-19 pandemic reversed these benefits and caused an increase in PEG complications. In order for the patient to get the maximum benefit from PEG, close follow-up is essential

Use of salidroside in a lipopolysaccharide-induced periventricular leukomalacia model

Aim: Research into the different treatment methods based on the intrauterine lipopolysaccharide (LPS)-induced Periventricular leukomalacia (PVL) model, as one of the main causes of morbidity in preterm infants still continues to be relevant. The present study investigates the effect on PVL of salidroside obtained from Rhodiola Rosea (golden root, orpin rose), which is a plant with known for its medicinal qualities. Method: To develop an induced PVL model, a 500 microgram/kg dose of LPS (Escherichia coli, serotype 055:B5, Sigma) was applied to two pregnant rats intraperitoneally on day 18, day 19 and day 20 of gestation. One of the LP applied rats was given 25 mg/kg Salidroside (250 mg Rhodiola root extract capsules, which include 3 mg Salidroside) by oral gavage (LPS+Salidroside), and a physiological saline solution was given to the control group. After delivery, 10 offspring of the LPS-applied mother, nine offspring of the LPS+Salidrosideapplied mother and seven offspring of the control mother were sacrificed on postnatal Day 7 with ether anesthesia. The caspase enzyme located in apoptosis pathways of 10 percent neutral-buffered formalin fixed brain tissue was stained immunohistochemically, and apoptotic cells were counted. Results: No statistically significant difference was noted between the LPS+Salidroside group and the control group, while a statistically significant difference was noted between the LPS and LPS+Salidroside groups. It was observed that Salidroside reduced LPS induced apoptosis. Conclusion: The intended experimental neuroprotective effect of Salidroside usage was provided through the inhibition of apoptosis in a PVL-damaged brain

Subclinical immune reactions to viral infections may correlate with child and adolescent diagnosis of attention-deficit/hyperactivity disorder: A preliminary study from Turkey

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders of childhood and  adolescence. Studies focusing on the relationship of infectious agents and ADHD are scarce. It is also known that cerebellar injury may lead to  hyperactive behavior. This study aimed to evaluate the relationship  between viral agents of cerebellitis and the diagnosis of ADHD.Methods: The study group was formed of 60 consecutive ADHD patients and 30 healthy children. IgG levels for VZV; HSV-1, CMV, Measles, Mumps, Rubella and EBV were evaluated.Results: Males were significantly higher among patients with ADHD (65% vs. 40%, p=0.025). Patients with ADHD displayed significantly higher positivity for measles IgG (80% vs. 60%, p=0.044). When patients with ADHD were classified according to their pubertal status, adolescents with ADHD displayed higher positivity for mumps (100% vs. 74.4%, p=0.043). Most of the patients were diagnosed with ADHD-Combined or  Hyperactive/Impulsive Subtypes (56.6%) while 43.3% were diagnosed with ADHD-predominantly inattentive type. When patients with subtypes of ADHD were compared in terms of seropositivity, it was found that patients with ADHD-Combined/ Hyperactive-Impulsive subtypes had significantly elevated reactions for Rubella (100% vs. 88.5%, p=0.044).Conclusion: Although limited to a single center and may be prone to sampling biases, our results may support the notion that immune reactions may be related with ADHD among children and adolescents. Further,  prospective studies from multiple centers are needed to support our  findings and establish causality.Key words: ADHD, infection, immunology, measles, rubella, mumps, Ig

Effects of gestational exercise on hyperoxia-induced brain damage in the newborn

Aim: Preterm infants encounter hyperoxia relatively early on as they leave the intrauterine environment earlier than expected, while also being exposed to a higher level of hyperoxic stress due to insufficiencies in their antioxidant defense mechanisms. With that in mind, we investigate whether running exercises performed during pregnancy can contribute to the development of tolerance to neonatal hyperoxic brain damage. Method: While two female rats maintained a sedentary pregnancy, one female rat performed the mandatory running exercise for 30 minutes for five days a week throughout the pregnancy. Following delivery, the sedentary rats and the exercised rat were kept together with their offspring for five days at oxygen concentrations above 80 percent in order to induce brain damage. The offspring were sacrificed on postnatal Day 7 and brain/body ratio measurements were obtained. Results: The brain/body ratios in the control, hyperoxia and exercise-hyperoxia groups were found to be median (IQR) 0.074(0.68-0.77), 0.065(0.06-0.067) and 0.064(0.060-0.068), respectively. The brain/body ratios of the offspring of the mothers in the hyperoxia group were found to be significantly lower than the control group (p=0.002), irrespective of exercise (p=0.007). No statistically significant difference was noted between the offspring of the sedentary and the exercised mothers in the hyperoxia group (p=0.94). Conclusion: Hyperoxia was found to result in lower brain mass relative to total body mass. This finding, which indicates the presence of microcephaly, reflects the negative effects of hyperoxia on brain development. Contrary to expectations, exercises performed during pregnancy had no significant effect on the brain/body weight ratio of the offspring

Zanimljiv slučaj bruceloze neobičnih obilježja u djeteta

Brucellosis is a zoonotic infection, which is still a major public health concern worldwide. Common clinical findings are usually nonspecific involving fever, arthralgia, myalgia, weakness and malaise. Since none of the symptoms of brucellosis is pathognomonic, it may have a similar course with various multisystemic diseases. In terms of focal involvement, sacroiliitis is the most common musculoskeletal manifestation in adult patients, while it is quite rare in pediatric patients. Blood culture is the gold standard in the diagnosis of brucellosis. In the absence of culture facilities, the diagnosis traditionally relies on serologic testing with a variety of agglutination tests such as the Rose Bengal test and the serum agglutination test. However, these agglutination tests are accompanied by frequent false negative results such as seen in prozone phenomenon, which maylead to diagnostic delays. In this article we present a rarely encountered pediatric brucellosis patient who had sacroiliitis-spondylitis, which are rarely reported in children, and exhibited prozone phenomenon in agglutination tests.Bruceloza je zoonotična infekcija koja još uvijek predstavlja znatan javnozdravstveni problem širom svijeta. Najčešći klinički nalazi obično su nespecifični, a uključuju groznicu, artralgiju, mialgiju, slabost i klonulost. Kako nijedan od simptoma bruceloze nije patognomoničan, tijek ove infekcije može biti sličan raznim multisistemskim bolestima. Prema učestalosti, sakroiliitis je najčešća koštano-mišićna manifestacija u odraslih bolesnika, ali je rijetka u pedijatrijskih bolesnika. Krvna kultura je zlatni standard u dijagnostici bruceloze. Kad oprema za kulturu nije dostupna dijagnostika se tradicionalno oslanja na serološko testiranje pomoću raznih aglutinacijskih testova, kao što su Rose Bengal test i test serumske aglutinacije. Međutim, ovi aglutinacijski testovi praćeni su čestim lažno negativnim rezultatima, primjerice u fenomenu prozone, što pak može odgoditi postavljanje dijagnoze. U ovom članku prikazujemo rijedak slučaj pedijatrijskog bolesnika s brucelozom koji je imao sakroiliitis-spondilitis, što se rijetko nalazi u djece, dok su aglutinacijski testovi pokazali fenomen prozone