Aydın il merkezi ilköğretim okulu öğrencilerinde anemi ve nütrisyonel anemi prevalansının saptanması

Objective: To determine the prevalence of anemia and nutritional anemia in primary school children in the city of Aydın. Materials and Methods: In Aydın, the central town of Aydın province, a total of 496 students (56% were female) were enrolled into the study by using stratified random sampling method. The students were from the primary schools located in socio-economically low, medium, and high areas of primary health care centers. The avarage age of the students was 10.2±2 years. Statistical analysis was performed using the Kolmogorov-Smirnov test, Student’s t-test, Mann-Whitney U-test and Chi-Square test. Results: The prevalence of anemia, iron-deficiency (ID), iron-deficiency anemia (IDA), vitamin B12 deficiency and vitamin B12 deficiency anemia was 15.7%, 38.7%, 8.3%, 9.1%, 0.8%, respectively. No folic acid deficiency was detected. Among the anemias, 42% of them were microcytic, 58% of them were normocytic and the 45.5% of the microcytic anemias were IDA. Among the females, the rate of ID was 45.1% and the rate of IDA was 11.6%, while in boys the same rates were 30.6% and 4.1%, respectively (p<0.05). Microcytosis was present in 36.5% of subjects with IDA. The Mentzer index was <13 in 13.3% of subjects with microcytic anemia and IDA, and in 77.7% of children with microcytic anemia and no IDA (p<0.001). Regarding socio-demographic characteristics of children; the only statistically significant difference was in the parameters of mother education and anemia. Conclusion: The prevalence of anemia represents a minor public health problem according to the World Health Organization criteria among the primary school students in the central town of Aydın province. Exploration of the reason of anemia among pre-school children, proper treatment of nutritional anemia cases with adequate duration and dose, dietary organizations and proper follow-up will lower the incidence of anemia and nutritional anemia among primary school children. Our study showed that thalassemia trait is defined as a major problem in the differential dignosis of IDA in our region. Diagnosing of these cases with thalassemia will prevent the unnecessary iron therapy and will provide a genetic counseling to the family.Amaç: Aydın ili Merkez İlköğretim Okulu öğrencilerinde anemi ve nütrisyonel anemi sıklığını belirlemektir. Gereç ve Yöntemler: Aydın il merkezinde, 2008-2009 öğretim yılında, sosyoekonomik düzeyi iyi, orta ve düşük sağlık ocağı bölgelerinde bulunan ve tabakalı rastgele örnek seçim yöntemine göre belirlenen ilköğretim okullarında eğitim gören 1-8. sınıf öğrencilerini kapsayan toplam 496 (%56’sı kız) öğrenci çalışmaya alındı. Çocukların yaş ortalamaları 10,2±2 idi. İstatistiksel analizler için Kolmogorov-Smirnov testi, Student t-testi, Mann Whitney U testi ve ki-kare testi uygulandı. Bulgular: Anemi, demir eksikliği (DE), demir eksikliği anemisi (DEA), B12 eksikliği ve B12 eksikliği anemisi prevalansı sırasıyla %15,7, %38,7, %8,3, %9,1, %0,8 saptandı. Folik asit eksikliğine rastlanmadı. Tüm anemilerin %42‘si mikrositer, %58’i normositer; mikrositer anemilerin %45,5’i DEA idi. Kızlarda DE oranı %45,1, DEA oranı %11,6 iken, erkeklerde bu oranlar sırasıyla %30,6 ve %4,1 idi (p<0,05). DEA’sı olanların %36,5‘inde mikrositoz mevcuttu. Mikrositik anemisi ve DEA olan olguların %13,3’ünde, mikrositik anemisi olup DEA olmayan olguların ise %77,7’sinde Mentzer indeksi <13 idi (p<0,001). Daha önce anemi saptanması ve demir ilacı verilmesi oranları anemi saptanan çocuklarda %33,3 ve %29,5, anemi saptanmayan çocuklarda %18,2 ve %15,6 idi. DEA saptanan öğrencilerin %19,8’i, saptanmayan öğrencilerin ise %19,5’i daha önce demir ilacı almıştı. Sosyo-demografik özelliklerden sadece anne eğitim düzeyi ile anemi arasında anlamlı ilişki bulundu. Sonuç: Aydın il merkezi ilköğretim okulu öğrencilerindeki anemi prevalansı Dünya Sağlık Örgütü’ne göre hafif düzeyde sosyal sağlık problemi oluşturmaktadır. Okul öncesi dönemde anemi saptanan çocuklarda nedenin aydınlatılması, tedavi verilen nütrisyonel anemili olguların uygun süre ve dozda tedavi almalarının sağlanması, beslenmelerinin düzenlenmesi ve izlemlerinin yapılması ilköğretim öğrencilerindeki anemi ve nütrisyonel anemi oranlarını düşürecektir. DEA saptanan çocukların yaklaşık 1/5’inin önceden tedavi alması, tedavi ve izlemlerin iyi yapılmadığını düşündürmektedir. Bu nedenle okul çocuklarında tarama programları yapılmalıdır

Bilateral leukocoria in infant with afibrinogenemia

M Necati Demir1, Mehmet Akif Acar1, Yusuf Ziya Aral2, Nurten &amp;Uuml;nl&amp;uuml;11Ankara Education and Research Hospital, Department of Ophthalmology, Ankara, Turkey; 2Aydin Menderes University, Faculty of Medicine, Department of Pediatric Hematology, Aydin, TurkeyPurpose: To report a bilateral leukocoria case in a patient suffering from afibrinogenemia.Methods: An observational case where congenital afibrinogenemia was presented with bilateral retinal and vitreous hemorrhages that proceeded to vitreoretinal surgery was presented. In addition, complete ophthalmic and radiological examinations and vitreoretinal surgery were performed.Results: Right eye had a complete recovery while the left eye showed serious proliferative vitreoretinopathy and shortened retina. Three years after the surgery clinical examination showed that the right eye was aphacic with an attached retina and clear ocular media while the left eye was phtysic.Conclusion: We recommend broad clotting profile for infants suffering from vitreous or retinal hemorrhages with no obvious physical abuse. Our present case furthermore implies that afibrinogenemia can lie beneath the pathogenesis of bilateral leukocoria and should alert physician for the presence of an afibrinogenemia among several types of bleeding predispositions.Keywords: afibrinogenemia, retinal hemorrhage, vitreous hemorrhage, vitrectom

G6PD S218F Mediterranean mutation frequency in children with glucose-6-phosphate dehydrogenase deficiency

AMAÇ: Glukoz-6-fosfat dehidrogenaz (G6PD) enzim eksikliği olan çocuklarda G6PD S218F Akdeniz mutasyonunun görülme sıklığını belirlemek. GEREÇ ve YÖNTEM: Adnan Menderes Üniversitesi Tıp Fakültesi Çocuk Hematolojisi ve Neonatoloji Bilim Dalları'nda 2004-2012 yılları arasında G6PD enzim eksikliği tanısı alan, enzim düzeyi düşük saptanan (<6 U/grHb) ve mutasyon çalışması yapılmış olan hastalar dahil edildi. Enzim düzeyi kantitatif spektrofotometri yöntemi ile, mutasyon analizi lightcycler 1.5 real-time PCR cihazında melting-curve analizi ile yapıldı. BULGULAR: G6PD enzim eksikliği anemisi tanısı konulan 60 hastanın, 29'u yenidoğan sarılığı (YDS), 31'i favizm nedeniyle başvurdu. Hastaların 44'ü erkek (%73,3), 16'sı (%26,7) kız; favizm tanısı konulan olguların 27'si (%87) erkek, 4'ü (%13) kız; yenidoğan sarılığı olgularının 17'si (%58) erkek, 12'si (%41,3) kız idi. Favizm tanısı konulan 31 olgunun 30'unda halsizlik, 28'inde sarılık ve 22'sinde kusma yakınması mevcuttu. Bakla yedikten sonra semptomların görülmesi arasında geçen süre ortalama 6 saat (dağılım, 2-24 saat) idi. Yenidoğan döneminde sarılık ile başvuran olguların üçünde patolojik sarılık, 16'sında uzamış sarılık öyküsü mevcuttu. Dört bebeğe hiperbilirubinemi nedeniyle kan değişimi yapıldı. G6PD eksikliği saptanan 60 olgunun 15'inde (%25) homozigot, 6'sında (%10) heterozigot olmak üzere 21 hastada (%35) G6PD S218F Akdeniz mutasyonu tespit edildi. Mutasyon saptanan olguların 13'ünde (%42) favizm, 8'inde (%27) yenidoğan sarılığı mevcuttu. Homozigot mutasyon saptanan 15 hastanın 1'si (%6,6) kız, 14'ü (%93) erkekti (p<0.001). G6PD S218F heterozigot mutasyonu saptanan 6 hastanın hepsi kızdı. Homozigot mutasyon saptanan olguların 4'ü YDS, 11'i bakla yeme sonrası sarılık; heterozigot mutasyon saptanan olguların ise 4'ü YDS, ikisi bakla yeme sonrası sarılık yakınmasıyla başvurdu.G6PD S218F mutasyon görülme sıklığı açısından favizm ve yenidoğan sarılığı arasında istatistiksel olarak anlamlı fark saptanmadı (P=0.130). SONUÇ: Çalışmamızda G6PD S218F Akdeniz mutasyonu sıklığını %35 olarak saptadık. Bu oran ülkemizdeki diğer çalışmalarda belirtilen oranlardan (%53-80) düşüktü. Bu durum bölgesel farklılıklara bağlı olabileceği gibi çalışmalardaki olgu sayılarının ve olgu özelliklerinin farklılığından da kaynaklanabilir. Akdeniz mutasyonu dışındaki diğer mutasyonların DNA dizi analizi ile saptanması bölgemizin özelliklerini daha iyi yansıtacaktır.OBJECTIVE: To determine the incidence of Mediterranean glucose-6-phosphate dehydrogenase (G6PD) S218F mutation. MATERIALS and METHODS: Were included G6 PD deficiency cases whose enzyme level <6 with mutation analysis, and diagnosed between 2004-2012 at neonatology and pediatric hematology department in Adnan Menderes University Hospital. G6PD activity was determined by quantitative spectrohotometry and mutations were analyzed with LighCycler 5.1 real-time PCR melting-curve analysis. RESULTS: Totaly 60 patients with the diagnosis of G6PD deficiency anemia admitted to hospital; 29 have neonatal jaundice and 31 have favizm. 44 patients (73.3%) were male, 16(26.7%) were female; favizm cases diagnosed 27(87%) patients were male and 4 (13%) were females. 17 cases of neonatal jaundice(58%) were male and 12(41.3%) were female. In 28 of 31 patients diagnosed with favizm have fatigue, 30 patients have jaundice and 22 have vomiting. The average time between the occurance of symptoms after eating fava is 6 hours (range, 2-24 hours). Three patients who presented with jaundice in neonatal period had pathological jaundice, 16 patients had a history of prolonged jaundice. Exchange transfussion was applicated to 4 patients with hyperbilirubinemia. Totaly in 21 patients (35%) G6PD deficiency has been detected; 15 patients (25%) were homozygous, 6(10%) patient were heterozygous of G6PD Mediterranean S218F mutation was detected. Mutations detected in 13(42%) favizm, 8(27%) patients had neonatal jaundice. 1 of 15 patients with homozygous mutation (6.6%) were female and 14(93%) were male (p<0.001). All 6 patients with G6PD mutation S218F heterozygous were female. 4 of homozygous mutation detected patients had neonatal jaundice, 11 had jaundice after eating beans, 4 of patients with heterozygous mutations had neonatal jaundive, and 2 had jaundice after eating bean. There is nostastistically difference between G6PD S218F mutation incidence of favizm and neonatal jaundice in the newborns (p=0.13) CONCLUSION: We determined the incidence of mutations in G6PD Mediterranean S218F as 35%. This ratio is lower than the other investigations in our country with the ratio of 53-80%. This situation may be due to regional differences in the number of cases and case studies, such as caused by differences in characteristics. DNA sequence analysis of mutations other than the detection of mutations in the mediterrannean region determination better reflect the characteristics of our region

Typographical/spelling errors in the references, pictures, tables, figures and graphs in the articles submitted to the journal of Adnan Menderes University School of medicine

AMAÇ: Adnan Menderes Üniversitesi Tıp Fakültesi Dergisi’ne yayımlanmak üzere gönderilen makalelerdeki kaynak, resim, tablo, şekil ve grafiklerdeki yazılım hatalarını belirlemek ve daha özenli hazırlanmış, yayın kurallarına uygun yazılmış makalelerin gelmesini sağlamaktır. GEREÇ VE YÖNTEMLER: Bu çalışmaya Adnan Menderes Üniversitesi Tıp Fakültesi Dergisi’ne yayınlanması için online olarak gönderilen makalelerden 80 tanesi dahil edildi. Makalelerde kaynaklar, resim, tablo ve şekillerdeki yazılım hataları değerlendirildi. Makalelerde “kaynakça” için için önce ilk isim ve yıl girilerek makalenin Pubmed’de olup olmadığına bakıldı: varsa tek tek isimler, makale adı, volüm ve sayfa sayısı kontrol edildi; yoksa makale adı girilerek ya da diğer isimler girilerek tarandı. Pubmed’de yayınlanmayan makaleler, kitap, kitaptan bir bölüm ve internetten erişim için Google arama motoru kullanıldı. Yanlış veya atlanmış yazar isimleri, başlık hatası, yanlış dergi ismi, yanlış volüm, yanlış yıl ve sayfa sayısı gibi doğrudan doğruya bilgiye erişimi engelleyen nitelikteki hatalar majör olarak değerlendirildi. BULGULAR: Makalelerden 43’ü (%53,8) klinik araştırma, 26’sı (%32,5) olgu sunumu, 8’i (%10) derleme, 3’ü(%3,8) deneysel araştırma olup makalelerdeki ortalama kaynak sayısı 18±11,96 (dağılım, 3-61) idi. Altmışsekiz makalede tüm kaynaklarda hata mevcuttu. Oniki makalede hatasız kaynak/kaynaklar vardı. Kaynaklardaki hata oranı %95,9, majör hata oranı %6,14 olarak bulundu. En sık hata yapılan kısımlar sayfa numarası (%52,51), yıl (%13,32) ve yazar ismi (%12,35) idi. Sekiz makalede tablo, şekil, grafik ve resim yoktu; 72 makalede toplam 136 tablo, 133 şekil, grafik, resim sayısı vardı. Yalnızca ondört makaledeki 18 tablo, 28 şekil ve resimde hata olmadığı gözlendi. SONUÇ: Kaynaklar, resim, tablo, şekil ve grafiklerde oldukça yüksek oranda yazılım hatası mevcuttur. Dergilere gönderilen yazılarda, kaynaklar, yazım kuralları dikkatle incelenerek yazılmalı; resim, şekil ve grafik yazıları özenli bir şekilde düzenlenmelidir.OBJECTIVE: Aim of this paper is to determine the spelling errors in text, references, pictures, tables, figures and graphs in articles submitted to the Journal of Adnan Menderes University School of Medicine and to encourage submission of articles written according to the rules of publication. MATERIALS AND METHODS: In this study, Adnan Menderes University School of Medicine, published in the Journal of the online article submitted to one of the 80 included in the study. Eighty articles submitted to be published online in the Journal of Adnan Menderes University Medical Faculty were included in this study. In articles, spelling errors in sections of references, pictures and tables were evaluated. First of all, references of each article were checked to see whether the article was present in PubMed by entering the name of the first author and publication year of the reference. If present in PubMed then the article was scanned by entering the names of each co-author(s), article title, numbers of the volumes and pages. If not present in PubMed the article was also scanned entering the article title or the names of other co-authors. For the articles not published in PubMed, the books, the book chapter(s) and for the URL internet references Google search engine was used. Errors such as incorrect or omitted author names, title errors, incorrect journal names, wrong year, volume and page numbers which prevent the access to correct information directly were accepted as major errors. RESULTS: Forty-three (53.8%) of the articles were clinical trials, 26 (32.5%) were case studies, 8 (10%) of them were review articles and 3(3.8%)of them were experimentalresearch. The average number of references in the articles was 18±11.96 (range,3-61). In 68 articles there were errors in allof the references. Only 12 articles had references with no errors. Error ratio of references was determined as 95.9% while 6.14% of these were major errors. The most common errors were in page numbers (52.51%), years (13.32%) and names of the author’s (12.35%). Eight articles did not include any tables, figures, graphics or pictures. A total of 136 tables, 133 figures, graphics and photos were present in the total of 72 articles. Only 18 tables, 28 drawings and pictures did not have errors in total of 14 articles. CONCLUSION: References, pictures, tables, figures and graphs include high rate of typographical/spelling errors. In articles written to be sent to the journals, references, spelling rules should carefully be examined and pictures, figures and graphics should carefully be corrected prior to the submission

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Evaluation of clinical characteristics, diagnosis and management in childhood immune thrombocytopenic purpura: a single center's experience

purpura (ITP) are controversial. We reviewed the files of 162 children with ITP to evaluate clinical characteristics, response to treatment and outcome. History of antecedent infection, vaccination and serologic evidence for acute viral infection were present in 48%, 5% and 17% of the patients, respectively. At diagnosis, two-thirds of the patients had a platelet count of < 10,000/mu 1 but only 10% had major bleedings. Intracranial hemorrhage was seen in two patients (1.2%) with a mortality rate of 0.6%. Sixteen percent developed chronic ITP. The rate of platelet recovery with mega-dose methylprednisolone (30 mg/kg/d for 3 and 20 mg/kg/d for 4 days) was similar to that obtained with intravenous immunoglobulin or oral prednisolone. Four of seven patients with ITP responded to splenectomy. These data show that mode of treatment has no effect on the clinical course and prognosis of childhood ITP

Involuntary movement in infants during vitamin B12 treatment

Megaloblastic anemia is rare in infants and is generally due to vitamin B12 (cobalamin) deficiency in the mother. Neurologic symptoms of vitamin B12 deficiency include irritability, failure to thrive, hypotonia, and developmental regression/delay. Herein we present 2 infants with vitamin B12 that developed movement disorder 5 d after initiation of vitamin B12 treatment. Symptoms included tremor and myoclonus, involving in particular the face, tongue, and hands. Clinical findings in infants associated with vitamin B12 deficiency vary, and temporary involuntary movement can be observed during vitamin B12 therapy. (Turk J Hematol 2011; 28: 317-22

THE ASSOCIATION BETWEEN HLA CLASS I AND II ALLELES AND THE OCCURRENCE OF INHIBITORS IN TURKISH PATIENTS WITH HEMOPHILIA A: A PILOT STUDY

WOS: 00046451760020