Ahmet Soysal

Methylergonovine (MEV) is a semi-synthetic ergot alkaloid used in the prevention and control of postpartum hemorrhage. This report describes 12 newborns born on the same day in a local country hospital in Turkey and developed sepsis-like symptoms and encephalopathy within the first 6 h of life due to accidental administration of MEV instead of vitamin K in the delivery room. The major features of MEV poisoning were lethargy (41.7%), seizure (75.0%), feeding intolerance (66.6%), hypoventilation (58.3%), irritability (25%), and peripheral circulatory abnormalities (58.3%). As a conclusion, clinical findings of ergot toxicity in newborns cannot be distinguished from infectious disease or neonatal encephalopathy.

Introduction This randomised, observer-blind clinical trial conducted in Turkey evaluated the immunogenicity, safety and interchangeability of three paediatric inactivated hepatitis A vaccines in 424 seronegative children between 1 and 15 years of age. Methods Potential subjects were screened for anti-hepatitis A virus (HAV) antibodies prior to receiving a first dose of Avaxim 80, Havrix 720 or Vaqta 25, followed by a second dose of either the same vaccine or Avaxim 6 months later. Anti-HAV antibody concentrations were measured 2 weeks after the first injection, at 24 weeks (before the second dose) and at 28 weeks for the evaluation of the immune response. Results Nearly 80% of the children between 1 and 5 years of age and half of those between the ages of 6 and 10 in the population from which the subjects were recruited were seronegative for HAV antibodies. Two weeks after the first dose, 98.2% of all subjects had anti-HAV antibody concentrations equal to or higher than 20 mIU/mL, believed to be seroprotective, and all subjects were seroprotected before and after the second dose. Anti-HAV geometric mean concentrations (GMCs) 2 weeks after the first dose and before the second were similar in children who received Avaxim and Vaqta (P = 0.2), but both were higher than Havrix (P < 0.01). There were no significant differences in the anti-HAV GMCs between the study groups that received two doses of the same vaccine compared with two doses of different vaccines. There were no significant differences in the frequency of any local or systemic adverse events among the study groups following either of the two doses. Conclusion All three vaccines are safe and highly immunogenic in healthy children aged 1 to 15 years. Avaxim 80 may also be given as the second dose when Havrix 720 or Vaqta 25 are given as the first dose. The pattern of seroprevalence seen here is similar to that reported in a number of recent evaluations in Turkey, and are supportive of the routine hepatitis A vaccination of young children.

Hydatid disease caused by Echinococcus granulosus often manifests as a slow growing cystic mass; it mainly affects the liver or lung and rarely other parts of the body such as the brain, heart, spleen, peritoneal cavity, or bone. Hydatid cysts of the musculoskeletal system are rare. Since the intramuscular hydatid cyst closely resembles a soft-tissue tumor on clinical examination, the preoperative radiological diagnosis is very important for the identification of the lesion prior to surgery. We describe a rare case of primary intramuscular hydatidosis in a child, together with its clinical presentation and radiological and histological findings. The treatment principles for hydatid cysts are also discussed.

... Akciğer Hidatik Kist Olgusu Özden TÜREL*, Ahmet SOYSAL*, Bedrettin YILDIZELİ**, Mustafa YÜKSEL**, Mustafa BAKIR* ... Takibinde bronkoplevral fis-tülü düşündüren hava-sıvı seviyesi gözlenen hasta perfore kist hidatik tanısıyla hastanemize sevk edilmiş. ...

The aim of this study was to investigate the association between parasitosis and allergy. We surveyed all children aged 4-12 years living in poor hygienic conditions in a shantytown of Istanbul. After obtaining data from the International Study of Asthma and Allergies in Childhood (ISAAC) and an additional questionnaire, performing a skin-prick test (SPT), and determining total IgE, stool and perianal tape specimens were obtained from 1018 participating children. The prevalence of past episodes of wheezing, current wheezing, asthma, and rhinitis was 31, 14.6, 10.7, and 26.2%, respectively. Parasitosis was present in 49.1%, Enterobius vermicularis (23.3%), being the most common. A history of treatment for enterobiasis was present in 37%. Comparison of children with and without current enterobiasis revealed no significant difference in allergic manifestations and SPT results, except for serum total IgE level (p = 0.018), whereas children with previous enterobiasis were more likely to have current wheezing (p = 0.012). Current wheezers were more likely to have previous enterobiasis (p = 0.01) and a higher maternal employment level (p = 0.036) when compared with those without. According to logistic regression analysis, covariables significantly positively related with current wheezing were previous enterobiasis (p = 0.003) and being &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =5 years of age (p = 0.043), whereas being the first child of the family (p = 0.043) was negatively related. A previous infection with E. vermicularis was found to potentiate current wheezing in a population living in a shantytown in Istanbul.

The association between mycobacterial exposure, vaccination with bacillus Calmette-Guerin (BCG) in early life and atopy remains controversial. Distinguishing between environmental mycobacterial exposure, TB infection and BCG-vaccination is not possible with the tuberculin skin test (TST) but new accurate blood-tests for TB infection present an opportunity to differentiate TB infection from environmental mycobacterial exposure and BCG-vaccination. We used a new blood test in parallel with TST to investigate whether Mycobacterium tuberculosis infection and/or BCG vaccination are associated with development of atopy in children with prior household TB contacts. All children who had contact with adult active pulmonary TB during the last 6 months underwent TST, chest radiography, and RD1–ELISpot assay. The presence of a BCG scar was documented, and assessment of atopy was carried out by International Study of Asthma and Allergies in Childhood questionnaire, allergy skin prick testing (SPT) and evaluation of serum total IgE. Among 361 children enrolled 39 (11%) had a positive SPT, 236 (63%) positive TST, and 189 (52%) positive RD1–ELISpot. The frequency of SPT positivity, ever wheezing, allergic rhinitis, doctor-diagnosed asthma, high serum IgE level, and median total serum IgE levels did not differ significantly different by TST or RD1–ELISpot status. On the other hand, presence of BGC scar was associated with lower median total serum IgE level (p = 0.01) and lower frequency of high IgE (p = 0.003). M. tuberculosis infection whether measured by TST or RD1–ELISpot, was not associated with atopy in children with household TB contact. Presence of a BCG vaccination scar was inversely associated with atopy, as measured by serum IgE.

Aim:  A high rate (48.6%) of extended spectrum beta-lactamase production among Klebsiella pneumoniae (ESBL-KP) clinical isolates in the paediatric wards of our hospital prompted the introduction of enhanced infection control measures, and after the implementation of these measures, we instituted a prospective surveillance programme, with a nested case-control study to determine the risk factors for rectal colonisation by ESBL-KP.Methods:  Over a 1-year period, rectal swabs from patients and samples from the environment and the hands of health-care workers were cultured. Strain typing of ESBL-KP isolates was performed using pulsed-field gel electrophoresis. Characteristics of patients who were colonised with ESBL-KP during hospital stay were compared with those of patients who remained negative for ESBL-KP. Multivariate analysis was performed with model-building using stepwise logistic regression to determine independent risk factors for ESBL-KP acquisition.Results:  Forty (18.5%) of 216 patients became colonised with ESBL-KP. The strongest independent predictors of ESBL-KP colonisation were mechanical ventilation (odds ratio (OR): 4.28) and hospitalisation for longer than 14 days (OR: 6.97). Genotyping of the isolates indicated probable patient-to-patient transmission; however, we could not determine the route of this spread. During the study period, a 1.6% rate of ESBL-KP clinical infection per 500 patient admissions was observed, in contrast to a 7% rate in the previous year.Conclusions:  Prolonged length of stay and mechanical ventilation were independent predictors of ESBL-KP colonisation. Enhanced infection control measures, antimicrobial stewardship and screening for rectal carriage were associated with a substantial decrease in paediatric units.