The prevalence of atopic dermatitis in adolescents living in Denizli, Turkey (ISAAC Phase III): Is a parent working in textile industry a risk factor?

Objective: To evaluate trends in the prevalence of symptoms and risk factors of atopic eczema in 13-14 years old school children in Denizli. Material and Methods: This survey was first conducted in 2002 and repeated in 2008 using the same ISAAC questionnaire in the same age group. Possible risk factors were also asked. Results: A total of 3004 children (response rate, 93.8%) in 2002 and 4078 children (response rate, 75%) in 2008 were included into the studies. Doctor diagnosed eczema ever increased from 2.1% to 3% (POR =0.7, 95% CI = 0.52-0.95, p= 0.015). The prevalence of itch rash ever and itch rash in last 12 month decreased respectively from 20.8% to 14.7% (POR =1.52, 95% CI =1.39-1.72, p<0.001) and from 15.4% to 9.5% (POR=1.72, 95% CI=1.49-1.99, p<0.001). The prevalence of itch rash with typical distribution, itch rash cleared completely in last 12 month and kept awake at night by this itchy rash in last 12 month were significantly decreased in 2008. Atopic family history, tumble drying at home, working father or mother in textile industry were found as significant risk factors for atopic eczema in 2008. Conclusion: Although the prevalence of doctor diagnosed atopic eczema in 13-14 years age group was found to be increasing in Denizli, this study showed a decrease in the prevalence of typical clinical symptoms and signs of atopic eczema. Atopic family history, tumble drying at home, a working parent in textile industry were important risk factors for doctor diagnosed atopic eczema in 2008. Copyright © 2016 by Türkiye Klinikleri

Urine Pentraxin 3 Levels as A Marker for the Presence of Renal Parenchymal Scar

[No Abstract Available

First-line, early and long-term eculizumab therapy in atypical hemolytic uremic syndrome: a case series in pediatric patients

Introduction: Studies relating to first-line, early, and long-term eculizumab treatment and outcomes in children with atypical hemolytic uremic syndrome (aHUS) are scarce and unclear. The aim of this case-series study was to evaluate the outcomes of first-line, early, and long-term eculizumab treatment in our aHUS patients. Materials and Methods: We reviewed the data from four pediatric patients with aHUS who were treated with eculizumab. In three of them, eculizumab was used as a first-line therapy, and the follow-up period was ≥2 years in three patients. Results: Plasma exchange could not be performed in any patient. Plasma infusions were used only in Patient 1 (a 14-month-old boy) for 8 days without any response. Therefore, eculizumab was started on day 11 after admission. Patient 2 (a 16-month-old boy), Patient 3 (an 11-year-old girl), and Patient 4 (a 32-month-old girl) were treated with eculizumab as a first-line therapy, which was started 2–4 days after admission. The dosage of eculizumab was adjusted according to body weight. The hematologic parameters (the time frames were 3–17 days) and C3 (the time frames were 10–17 days) returned to normal in all patients after receipt of eculizumab. Although Patient 1 developed stage III chronic kidney disease, complete renal recovery occurred in Patients 2 and 4. Patient 3 also had reflux nephropathy with bilateral grade III vesicoureteral reflux and renal scars. Her creatinine clearance returned to the baseline value after receiving eculizumab. No complications related to eculizumab were observed in any patient during the follow-up period. Conclusion: Eculizumab can be successfully used as a first-line therapy in pediatric aHUS patients. We observed that the early initiation of eculizumab was associated with the complete recovery of renal function. © 2016, Springer International Publishing Switzerland

Comparison of Antibiotic Resistance Patterns of Microorganisms Causing Acute Pyelonephritis in Children at 5-year Interval

Objective: Urinary tract infections (UTIs) are among the most common bacterial infections in children. Selection of empirical antibiotic therapy is based on patient characteristics and regional antibiotic resistance patterns. Antibiotic resistance driven by inappropriate antibiotic use remains currently one of the major public health concerns. The aim of this study was to compare the microbiological spectrum of pediatric acute pyelonephritis and antimicrobial resistance patterns in two time periods 5 years apart.Method: Clinical characteristics, treatment modalities, causative uropathogens in urine cultures, antibiotic susceptibility and resistance patterns of the patients with acute acute pyelonephritis were compared between the two time periods.Results: Group 1 consisted of 86 children (mean age 3.52 +/- 0.4 years, 32 boys) hospitalized, and treated for acute pyelonephritis between 2012-2013; Group 2 included 72 children (mean age 3.78 +/- 0.7 years, 25 boys) between 2017-2018. Escherichia coli was the most common microorganism in both groups. The most frequently used antibiotics for pyelonephritis treatment in both groups were amikacin (55% vs 51%) and ceftriaxone (33% vs 37%), gentamicin (5% vs 22%) While 77% of the children in Group 1 used prophylactic antibiotics, this rate was significantly lower with 23% in Group 2. Resistance to ampicillin, cefepime and ceftriaxone were significantly lower in Group 2. Ceftriaxone resistance which created concerns in recent years regressed from 60% to 37%.Conclusion: Our study revealed significant reductions in rates of resistance to several antibiotics, particularly ceftriaxone within 5 year-period. Possible explanations for these results may be that aminoglycosides are preferred more frequently than ceftriaxone therapy, prophylactic treatment is limited in selected cases, and cephalosporins are not used for prophylaxis. We believe that rational empirical antibiotic selection will prevent the development of resistance in urinary tract infections

Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review

Cardiac involvement is very rare in patients with Henoch-Schönlein purpura (HSP). In this case study, we present an 8-year-old girl presenting with HSP-induced myocarditis and thrombus in the right atrium and HSP nephritis. To date, 15 cases of HSP-related cardiac involvement have been reported in the PubMed/MEDLINE, Scopus, and Google Scholar databases. These cases, together with our case, are included in this review. We excluded those patients with other rheumatologic diseases (acute rheumatic fever, acute post-streptococcal glomerulonephritis, Kawasaki disease) accompanied by HSP. Three were children and 13 were adults and all were male except our case. This review revealed tachyarrhythmia, chest pain, dyspnea, murmur, and heart failure as the major signs. Cardiac tests, electrocardiogram (ECG), and imaging methods (echocardiography in all patients, cardiac magnetic resonance imaging (MRI) in three, cardiac biopsy in one, and post-mortem necropsy in three) showed that the cardiac involvements were pericardial effusion, intra-atrial thrombus, myocarditis, coronary artery changes, myocardial ischemia, infarction and necrosis, subendocardial hemorrhage, and left ventricular dilatation. Kidney involvement was not observed in three patients. As the treatment, high-dose prednisolone and cyclophosphamide, oral corticosteroid, azathioprine, nadroparin calcium, ACE inhibitors, calcium antagonists, beta-blockers, and diuretics were used. Eleven patients (all three children and eight of the adults) had a complete cardiac recovery. Cardiac involvement in adults was more likely to be fatal. Death (three patients), ischemia, and infarct have been reported only in adults. We suggested that early and aggressive treatment can be life-saving. MRI examination is effective at identifying cardiac involvement. © 2020, International League of Associations for Rheumatology (ILAR)

Could serum pentraxin 3 levels and IgM deposition in skin biopsies predict subsequent renal involvement in children with Henoch–Schönlein purpura?

Background: The aim of this study was to evaluate the potential of serum pentraxin 3 (PTX3) values as an early predictor of subsequent renal involvement in patients with Henoch–Schönlein purpura (HSP) with no abnormalities on urinary examination and in renal function tests at disease onset. Methods: This was a prospective cohort study which included 60 pediatric patients with HSP (age range 3–15 years) who were diagnosed between February 2011 and October 2012 and 60 age- and sex-matched healthy controls. The patients were followed up for at least 18 months. Clinical findings were recorded for all patients at first examination, and blood samples for routine laboratory parameters and PTX3 value as well as skin biopsy specimens were obtained from each subject. Results: Of the 60 patients with HSP, 29 (48.3 %) developed subsequent renal involvement, of whom four underwent kidney biopsy. The mean serum PTX3 level of patients with subsequent renal involvement was significantly higher than those of patients without renal involvement and of the controls (2.20 ± 1.30 vs. 1.36 ± 0.85 and 1.03 ± 0.7 ng/ml, respectively; p = 0.004). Immunofluorescence evaluation of skin biopsy revealed that in addition to immunoglobulin A (IgA) deposition, the IgM deposition was significantly associated with subsequent renal involvement (p = 0.008). Conclusions: A high PTX3 level and IgM staining in skin biopsies from HSP patients may be harbingers of subsequent renal involvement. © 2014, IPNA