Horner Sendromu Tortikollis İlişkisi; bir Olgu Sunumu

Horner Sendromu, okülosempatik yolaktaki kesinti nedeniyle gözün sempatik innervasyon kaybı sonucu pitozis, miyozis, tek taraflı anhidrozis ve nadiren enoftalmus klinik semptomları ile karakterize nadir görünen bir klinik tablodur. Konjenital musküler tortikollis, sternokleidomastoid kasının fibrozisi ve buna bağlı kısalması ile oluşan bir kas iskelet sistemi malformasyonudur. Bu olgu sunumunda, konjenital musküler tortikollise ikincil gelişen horner sendromu ve bunun rehabilitasyon sürecindeki tanısı ele alınmıştır. Üç aylık bir kız bebek, konjenital musküler tortikollis tanısıyla, çocuk sağlığı ve hastalıkları polikliniği tarafından birimimize yönlendirildi. Öyküsünden, ikiz eşi olarak 34 haftalık gebelik sonrası sezaryen ile doğduğu, doğum sonrası yoğun bakım ihtiyacı olmadığı, ilk kez bir buçuk aylıkken ailesi tarafından boyunda asimetri fark edildiği ve çocuk sağlığı ve hastalıkları polikliniğine başvurduğu öğrenildi. Fizik muayenesinde kraniyofasiyal asimetri, servikal sol lateral fleksiyon, sola rotasyonda kısıtlılık ve olive belirtisi vardı. Rehabilitasyon sırasındaki takiplerinde yüzünün sağ yarısında anhidrozis, daha silik olarak sol tarafta miyozis ve pitozis bulguları da fark edilerek hastaya Horner Sendromu tanısı konuldu. Ayırıcı tanısı yapılarak olası diğer nedenler dışlandı ve etiyoloji hastadaki mevcut tortikollise bağlandı. Sonuç olarak hastalar tortikollis yönünden değerlendirilirken, nadir de olsa, tortikollise Horner Sendromu'nun eşlik edebileceği, klinik bulgular silik seyredebileceğinden tanının kolayca gözden kaçabileceği akılda tutulmalıdırHorner Syndrome is a rare condition characterized with ptosis, miosis, unilateral anhidrosis and rarely enophtalmos resulting from the sympathetic innervation loss by interruption of oculosymathetic pathway. Congenital muscular torticollis is a musculoskeletal system malformation resulting from fibrosis, therefore shortening of sternocleidomastoid muscle. In this report, Horner’s syndrome secondary to congenital muscular torticollis and diagnosis in rehabilitation period are discussed. Three-month-old baby girl was referred to our unit by pediatrics clinic with congenital muscular torticollis diagnosis. Her history comprised of cesarean delivery following a 34-week pregnancy as twin, and no intensive care need; her parents realized asymmetry in neck when she was a-month-anda-half old and they admitted to pediatrics. Craniofacial asymmetry, cervical left lateral flexion, restricted left rotation and olive sign were detected in physical examination. During rehabilitation, anhidrosis in the right side of face, soft left miosis and ptosis were also observed, and patient was diagnosed with Horner’s syndrome. Other possible reasons were ruled out with differential diagnosis and etiology was linked to torticollis. Consequently, while evaluating patients with torticollis, it must be considered that Horner’s syndrome, rarely accompanies, and since clinical findings may be soft, diagnosis may easily be missed ou

C-reactive protein (CRP)/mean platelet volume (MPV) ratio as a new biomarker for community-acquired pneumonia in children

Amaç: Son yıllarda inflamasyon göstergesi olarak değerlendirilen C-reaktif proteinin (CRP)/ortalama trombosit hacmi (OTH) oranı ve beyaz küre sayısı (BKS)/ortalama trombosit hacmi (OTH) oranının toplum kökenli pnömonili (TKP) çocuklarda tanı ve hastalık şiddeti ile ilişkisini araştırmaktır.Gereç ve Yöntem: Çalışma TKP tanısı alan 3 ay ile 18 yaş arasında 60 hasta ve 30 sağlıklı çocuktan oluşturuldu. Hasta ve kontrol grubunda CRP, BKS, OTH, nötrofil/lenfosit oranı (NLO) değerleri ile birlikte CRP/OTH ve BKS/OTH değerleri incelendi.Bulgular: Hasta ve kontrol grubu arasında OTH düzeyleri açısından anlamlı fark saptanmazken, CRP/OTH, BKS/OTH, NLO ve plateletkrit düzeyleri hasta grubunda anlamlı olarak yüksek bulundu. Ciddi pnömonili hasta grubunda (n=27) BKS, NLO, BKS/OTH, CRP/OTH ve CRP düzeyleri hafif-ılımlı pnömonili gruba (n=33) göre anlamlı olarak yüksek saptandı. CRP/OTH ve BKS/OTH oranlarının hastalık belirtilerinin süresiyle arasında pozitif korelasyon gösterildi. Receiver Operating Characteric (ROC) analizinde CRP (Eğri altındaki alan (EAA)=0.801), BKS (EAA=0.761) ve BKS/OTH (EAA=0.731) düzeylerinin TKP’nin tanısında yeterliliği anlamlı bulundu. Ciddi TKP’li hastaların ayrımında ise CRP/OTH (EAA=0.733) ve CRP (EAA=0.708) düzeyleri anlamlı bulundu.Sonuç: CRP/OTH ve BKS/OTH oranları TKP tanısının değerlendirilmesinde ve CRP/OTH oranı hastalık aktivitesinin belirlenmesinde iyi bir belirteç olabileceğini göstermektedir.Purpose: Our aim is to evaluate the relationship between C-reactive protein (CRP)/mean platelet volume (MPV) ratio and white blood cell (WBC)/mean platelet volume (MPV) ratio and diagnosis and disease severity in children with community-acquired pneumonia (CAP). Material and Methods: 60 patients with CAP including 33 mild-moderate (Group 1) and 27 severe pneumonia (Group 2) and 30 healthy children were examined for routine blood test. WBC, MPV, neuotrophile/lymhocyte ratio (NLR), CRP, WBC/MPV, CRP/MPV values were recorded on each patient and healthy groups. Result: CRP/MPV, WBC/MPV, NLR and plateletcrit values were significantly higher in patients group than controls, while MPV value is not correlated between patient and control groups. WBC, NLR, WBC/MPV, CRP/MPV and CRP values were higher in the Group 2 compared to Group 1. CRP/MPV and WBC/MPV were positively correlated with duration of symptoms in the CAP. The area under ROC curve of CRP, WBC and WBC/MPV in diagnosing CAP was significant (0.801, 0.761 and 0.731). Also the area under ROC curve of Group 2 in CRP/MPV and CRP in diagnosing CAP was significant (0.733, 0.708). Conclusion: CRP/MPV and WBC/MPV ratio may be used a marker in the evaluation of CAP diagnosis and CRP/MPV ratio can be good marker prediction of disease activity

Can Neutrophil/Lymphocyte Ratio be Used as a New Biomarker in the Evaluation of Disease Activity in Children with Bronchiolitis?

Aim:Acute bronchiolitis is an inflammatory disease. The aim of this study was to examine the neutrophil / lymphocyte ratio (NLR) in pediatric patients with bronchiolitis and to evaluate their relationship with disease severity.Materials and Methods:The study consisted of 77 patients aged between 3 months and 5 years and 34 healthy children diagnosed as acute bronchiolitis. In the patient and control groups, C-reactive protein (CRP), white blood cell count (WBC), mean platelet volume (MPV), neutrophil and lymphocyte numbers and NLR values were examined.Results:CRP, WBC, NLR and neutrophil counts were significantly higher in patients with bronchiolitis (p<0.01, p<0.001, p<0.001, p<0.001, respectively). MPV levels were significantly lower in the patients (p<0.05). Patients were divided into three groups according to the severity of the disease. In the severe bronchiolitis patient group (n=21), neutrophil and NLR levels were significantly higher than the mild bronchiolitis group (n=25) (respectively p<0.05). In the correlation analysis; There was a positive correlation between NLR and MPV, BKS and CRP (r=0.262–p<0.05; r=0.454–p<0.001; r=0.706–p<0.001 respectively). Among the parameters examined in hospital admissions for bronchiolitis patients, only the field results under the curve in the Receiveroperating characteristic (ROC) analysis for the CRP were found to be diagnostic enough (0.812), but no qualification was found with WBC and NLR (0.692, 0.583, respectively).Conclusions:Increased CRP levels can be used as a good predictor of bronchiolitis in children patients and increased NLR ratio can be used as a good biomarker in determining severity of disease

Akut Bronşiyolit Tanısı Alan Hastalarda Srage-Hmgb1 Aksının Değerlendirilmesi Ve Diğer Inflamatuvar Belirteçler Ile Ilişkisinin Araştırılması

Amaç: Bronşiyolit iki yaşından küçük çocuklarda en sık rastlanan, genellikle viral etkenlerin neden olduğu alt solunum yolu infeksiyonudur. Hastalık küçük havayollarında akut inflamasyon, ödem ve nekroz, artmış mukus ve bronkospazm ile karakterizedir. İleri glikasyon son ürünleri reseptörü (RAGE) inflamasyonu arttıran, devam etmesine neden olan önemli bir medyatör olarak tanımlanmıştır. Ligandları arasında HMGB1 ve S100A12 proteinleri de bulunmaktadır. Bu çalışmada bronşiyolitli hastalarda serum sRAGE, HMGB1, S100A12 düzeylerinin saptanması ve CRP, prokalsitonin, IL-1 ?, TNF alfa gibi inflamatuvar belirteçler ile ilişkisinin değerlendirilmesi, ayrıca akut bronşiyolitli hastalarda hastalık aktivitesini saptamadaki uygunluklarının belirlenmesi amaçlandı. Materyal Metod: Çalışmaya 1-24 ay arasında ilk kez akut bronşiyolit tanısı alan 60 hasta ve 28 sağlıklı kontrol alındı. İlk kez bronşiyolit tanısı alan 1-24 ay arasındaki 60 hasta çalışmaya dahil edildi. Bronşiyolit şiddeti belirlendi ve serum sRAGE, HMGB1, S100A12, procalcitonin, IL-1B, TNF alfa düzeyleri Elisa yöntemi ile ölçüldü. Sonuçlar: Akut bronşiyolitli hastalarda lökosit sayısı, nötrofil-lenfosit oranı, trombosit sayısı, CRP, serum HMGB1, sRAGE, S100A12, prokalsitonin, IL-1 beta ve TNF alfa değerleri yüksek bulundu. Ağır breonşiyolitli hastalarda serum TNF alfa düzeyi artmış bulundu ancak diğer belirteçler ile hastalık şiddeti arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Tartışma: HMGB1-RAGE aksı bronşiyolitli hastalarda inflamasyonun bir göstergesi olarak değerlendirilebilir. Ancak bu belirteçlerin hastalık şiddetini belirlemede kullanımları uygun değildir.Aim: Bronchiolitis is most common lower respiratory tract infection in children under two years of age and usually caused by viral agents. Disease is characterized by acute inflammation, edema and necrosis of small airways, increased mucus and bronchospasm. The receptor for advanced glycation end product (RAGE) That increase the inflammation has been identified as an important proinflamatory mediator. HMGB1 and S100A12 protein are some of RAGE ligands. In this study, it was aimed to determine the levels of serum sRAGE, HMGB1, S100A12 and compare with inflammatory markers such as CRP, procalcitonin, IL-1B and TNF alpha. We also aimed to define the suitability for determination of disease in patients with acute bronchiolitis. Materials and Method: The study included 60 patients who was firstly diagnosed with acute bronchiolitis and 28 healthy controls between 1-24 months. Bronchiolitis severity was determined and measurements were taken of serum sRAGE, HMGB1, S100A12, procalcitonin, IL-1B, TNF alpha with ELISA method. Results: White blood cell count, neutophyl lymphocyte ratio, platelet count, CRP, serum HMGB1, sRAGE, S100A12, procalcitonin, IL-1 beta and TNF alpha levels were increased in patients with acute bronchiolitis. SerumTNF alpha levels were increased in severe bronchiolitis but there were no statistically significant difference between other markers and disease severity. Conclusions: HMGB1-RAGE axis is assessable as an indicator of inflammation in patients with bronchiolitis. Nevertheless using this markers to determine disease severity is not suitable

Periferik Sinir Hastalıkları: Herediter Nöropatiler

Hereditary neuropathies are a heterogeneous group of diseases. The etiologies of childhoodperipheral neuropathies are different from those in adults, and hereditary diseases, especially autosomalrecessive conditions, are common. In most patients, diagnostic studies are limited to clinical evaluation.Although Charcot-Marie-Tooth disease is the most common neuromuscular disease, neuropathies accompanying hereditary metabolic diseases, neurodegenerative and other complex neurological diseasesalso common in childhood neuropathies. Recognizing these also helps in the diagnosis and treatment ofthe underlying disease. Some clinical clues may aid the diagnostic process. In addition to typical findings such as weakness, muscle atrophy, gait disorders, foot deformities, areflexia, findings such as respiratory failure, upper extremity involvement, visual or hearing impairment, pyramidal symptoms andmental retardation may be observed. While advances in genetics have made it easier for patients to bediagnosed, they have also led to increased heterogeneity and difficulties in the use of classifications.Typical mutations expected in childhood-onset neuropathies are less common, and neuropathies oftenpresents as findings of multisystemic diseases. In these patients, it is necessary to insist on further investigations to determine the etiology.&nbsp;</p

The Evaluation of Relationship Between Passive Smoking and Recurrent Episodes of Bronchiolitis in Children Under Two-years Old

Giriş: Tekrarlayan hışıltı atakları özellikle sosyoekonomik düzeyi düşük olan ailelerde, kalabalık ortamda yaşayan, sigara dumanına mâruz kalan ve anne sütü alamayan bebeklerde daha sık olarak görülür Materyal ve Metod: Bu çalışma 2009-2011 tarihleri arasında, Çocuk Sağlığı ve Hastalıkları Kliniği'ne başvurup ilk atak bronşiyolit tanısı alan hastalarda prospektif olarak yapıldı.Sonuçlar: Çalışmaya yaşları 1-24 ay olan toplam 500 infant dahil edildi. Evde sigara kullanımı has-taların %46,6'sında (n=233) mevcuttu. Tekrarlayan bronşiyolit atağı geçiren çocukların, evde sigara mâruziyet oranları istatistiksel olarak anlamlı dere-cede yüksek saptandı (p<0,001).Tartışma: Çalışmamızda, sigara maruziyeti tekrar-layan hışıltı atakları açısından risk faktörü olarak bulundu. Sigara dumanına mâruziyet azaltılarak tekrarlayan akut bronşiyolit ataklarının azaltılabi-leceğini düşünmekteyiz.Objective: Recurrent episodes of wheezing are more common in infants especially with low socioeconomic status who are exposed to smoking, who are not breastfed and lives in crowded families.Material and Methods: This study was performed prospectively with infants diagnosed as first attack bronchiolitis from the outpatient clinics between 2009 to 2011.Results: The study included 500 infants aged between 1-24 months. Cigarette smoking was present in 46.6% (n=233) of the families. There was a significant relationship between recurrent episodes of bronchiolitis and exposure to cigarette smoke (p&lt;0.001). Conclusion: In this study, exposure to cigarette smoke was detected as a risk factor for recurrent episodes of bronchiolitis. The decrease of smoking in the population can prevent recurrence of bronchioliti

Can allergic distant relatives and home environment cause recurrent episodes of wheezing?

Amaç: Akut bronşiyolit, en sık 2 yaşından küçük çocuklarda görülen, daha çok viral etkenlerin neden olduğu bronşiyollerin obstrüksiyonu ile karakterize akut alt solunum yolu hastalığıdır. Atopi ve diğer genetik faktörler de virüsün uyardığı hışıltı gelişiminde hazırlayıcı bir rol oynayabilir. Bu çalışmada, hışıltı atakları ile anne, baba, kardeşler haricindeki uzak akrabalarda atopi ve astım hikayesi, evde toz ve/veya rutubet bulunması arasındaki ilişkiyi araştırdık. Yöntem: Bu çalışma Haziran 2009 ile Haziran 2011 tarihleri arasında, Çocuk Sağlığı ve Hastalıkları Kliniği’ne başvurup ilk atak bronşiyolit tanısı alan hastalarda prospektif olarak yapıldı. Her hastanın yaşı, cinsiyeti, anne, baba, kardeş dışı ailede atopi, astım öyküsü, evde tozlu rutubetli ortam maruzi- yeti sorgulandı. Bulgular: Çalışmaya 1-24 ay arası ilk atak akut bronşiyolit tanısı alan toplam 500 infant dahil edildi. Hastaların %20,2’sinin (n=101) ailesinde (anne, baba, kardeş dışı) atopi, astım mevcuttu. Hane özellik- leri incelendiğinde %27’sinde (n=135) tozlu rutubetli ortam bulundu. İnfantların 3 ve üzeri tekrarlayan hışıltı atağı geçirme oranlarına bakıldığında, tozlu rutubetli ortamda yaşayan hastaların %92.6’sının, tozlu-rutubetli ortamda yaşamayan hastaların %65.2’sinin 3 ve üzeri atak geçirdiği tespit edildi. Anne, baba, kardeş dışı atopi öyküsü olan infantların %91.1’inde tekrarlayan hışıltı atağı görülürken, olmayan infantların %67.9’unda görüldü. Sonuç: Biz çalışmamızda, anne, baba ve kardeş dışı aile bireylerinde astım ve/veya atopi öyküsü bulunması ile tekrarlayan hışıltı atakları arasında anlamlı ilişki saptadık. Tozlu ve/veya rutubetli ortam maruziyeti de tekrarlayan hışıltı atakları için önemli bir risk faktörüdür.Objective: Acute bronchiolitis is a lower respiratory tract infection of children under 2 years of age, characterized by bronchial obstruction. Atopy and genetic factors can play a predisposing role in the development of virus-related wheezing. In this study, we evaluated the relationship between recurrent wheezing attacks and the presence of atopy/asthma in relatives other than father, mother, siblings, and the presence of dust and/or moisture in the house. Methods: This study was performed prospectively with infants diagnosed as first attack bronchiolitis from the outpatient clinics from 2009 to 2011. Each patients&amp;#8217; age, sex, the presence of atopy/asthma in relatives other than father, mother, siblings, and the presence of dust and/or moisture in the house was evaluated. Results: The study included 500 infants aged between 1-24 months. Atopy and/or asthma was present in 20,2% (n=101) of relatives other than father, mother and siblings. Dust and/or moisture was present in 27% (n=135) of houses. When we compared the characteristics of infants, 92.6% of infant living in dust/moisture in the house, 65.2% of infants with no dust/moisture in the house, 91.1% of infants with family history of atopy/asthma in relatives other than mother, father, siblings, 67.9% with no family history had &amp;#8805;3 episodes of wheezing. Conclusion: In this study we found a significant relationship between recurrent episodes of wheezing and the presence of atopy/asthma in relatives other than father, mother, siblings. Presence of dust and/or moisture in the house is also a risk factor for recurrent episodes of wheezing

Serum Endocan Levels in Children with Community-Acquired Pneumonia

In this study, it was aimed to compare the levels of serum endocan with commonly used markers, and also to define the suitability for determination of disease severity in patients with community-acquired pneumonia (CAP). The study included 60 patients and 28 healthy subjects. Pneumonia severity was determined according to British Thoracic Society guidelines for the management of CAP in children. Serum levels of endocan and C-reactive protein (CRP) and white blood cell (WBC), and neutrophil count were measured. Serum endocan levels were increased in patients with CAP. CRP levels, WBC count, neutrophil count and neutrophil lymphocyte ratio were also higher in the CAP group than healthy control group. Endocan was correlated with CRP and WBC count and disease severity. For the identification of CAP, the area under the receiver operating characteristic (ROC) curve of CRP was acceptable for CRP, but not for endocan (0.812 and 0.649, respectively). ROC analysis for endocan to differentiate between severe CAP (n = 29) and mild-moderate CAP (n = 31) gave an area under the curve of 0.769 compared to 0.667 for CRP. Serum endocan levels increase in patients with CAP and can therefore be a useful marker in diagnosis and as a particular indicator of the treatment in the clinical assessment of CAP disease severity. Serum endocan levels of patients with severe CAP were higher compared with patients with mild-moderate CAP. These results revealed that endocan might be a useful indicator of severity of CAP

Serum Endocan Levels in Children with Community-Acquired Pneumonia

In this study, it was aimed to compare the levels of serum endocan with commonly used markers, and also to define the suitability for determination of disease severity in patients with community-acquired pneumonia (CAP). The study included 60 patients and 28 healthy subjects. Pneumonia severity was determined according to British Thoracic Society guidelines for the management of CAP in children. Serum levels of endocan and C-reactive protein (CRP) and white blood cell (WBC), and neutrophil count were measured. Serum endocan levels were increased in patients with CAP. CRP levels, WBC count, neutrophil count and neutrophil lymphocyte ratio were also higher in the CAP group than healthy control group. Endocan was correlated with CRP and WBC count and disease severity. For the identification of CAP, the area under the receiver operating characteristic (ROC) curve of CRP was acceptable for CRP, but not for endocan (0.812 and 0.649, respectively). ROC analysis for endocan to differentiate between severe CAP (n = 29) and mild-moderate CAP (n = 31) gave an area under the curve of 0.769 compared to 0.667 for CRP. Serum endocan levels increase in patients with CAP and can therefore be a useful marker in diagnosis and as a particular indicator of the treatment in the clinical assessment of CAP disease severity. Serum endocan levels of patients with severe CAP were higher compared with patients with mild-moderate CAP. These results revealed that endocan might be a useful indicator of severity of CAP