Clinical utility of serum tryptase levels in pediatric anaphylaxis.

Introduction: This study aimed to evaluate the preliminary diagnosis, demographic characteristics, and outcomes of patients whose serum total tryptase levels were measured while in a tertiary pediatric hospital and to ascertain the role of serum tryptase levels in the etiology, diagnosis, severity, and course of systemic anaphylaxis. Methods: Patients ages between 1 month and 17 years who were followed up in the pediatric emergency department or as inpatients and with a diagnosis of immediate-type reactions between September 1, 2019, and August 31, 2021, were included in the study. Patient data were obtained retrospectively by examination of medical records and patient observation forms. Results: It was determined that serum tryptase levels were measured in a total of 310 patients during the study period. One hundred and fifty-five patients who met the defined diagnostic criteria were named as the anaphylaxis group and their data were detailed. The serum tryptase elevation was detected in 15.5% of the patients among the samples that met the anaphylaxis diagnostic criteria. No relationship was found between the serum total tryptase levels, the triggering factor, and the severity of anaphylaxis. Discussion: Anaphylaxis is a complex syndrome that involves different phenotypes that develop with various triggers in which different immunologic pathways, cell types, and mediators play a role. Serial measurements, including the basal value measured at least 24 hours after the symptoms disappear, are useful to confirm the diagnosis and guide the diagnostic tests during the follow-up, especially allergy evaluation.

Parvovirus B19 infection mimicking systemic lupus erythematosus, successfully treated with intravenous immune globulin.

INTRODUCTION: Parvovirus B19 infection generally presents as a transient viral illness in children but rarely shows systemic lupus erythematosus-like symptoms. CASE REPORT: Here we present a 7-year-old girl with parvovirus B19 infection who had prolonged fever, rash, pancytopenia and hypocomplementemia making it difficult do differentiate from the first episode of systemic lupus erythematosus. Because she had severe progressive pancytopenia she was administered intravenous immune globulin treatment and her clinical course was dramatically improved. DISCUSSION: Parvovirus B19 infection can mimic systemic lupus erythematosus and it may be difficult to differentiate a recent parvovirus B19 infection and the first presentation of systemic lupus erythematosus. Absence of discoid lesions, alopecia, Raynaud phenomenon and autoimmune hemolytic anemia may help to distinguish parvovirus B19 infection from systemic lupus erythematosus. CONCLUSIONS: Parvovirus B19 infection may cause a severe clinical picture resembling systemic lupus erythematosus even in otherwise healthy children. Intravenous immune globulin treatment might be considered in cases resistant to supportive management.

Influence of Rosa damascena hydrosol on skin flora (contact culture) after hand-rubbing.

Aim and Introduction: Rosa damascena is one of the most well-known species of the Rosaceae family and is widely used in the food and perfume industry. Rose hydrosol is a product which is produced by distillation of rose petals. There is very little research about the antimicrobial effect of rose hydrosol. In this study, we aimed to investigate the antibacterial effect of Rosa damascena hydrosol in vivo. Method: 45 adult volunteers who were not healthcare workers were included in this study. Exclusion criteria included existing skin disorders or lacerations, pregnancy, presence of nail polish, recent handwashing or use of antiseptic lotion/soap in the last week, and antibiotic use in the last 3 months. At baseline, each subject was asked to rub the fingertips of the dominant hand on a sheep-blood agar plate. The subjects were randomly divided into two groups: one group rubbed their hands with 3 mL of alcohol-based hand antiseptic and the other group with 3 mL of rose hydrosol. Following sample collection, the subjects were asked to rub their hands according to the World Health Organization's (WHO) "How to Hand Rub" technique. After the hand-rubbing sequence, the hands were allowed to air-dry and fingertip sampling was performed. Culture plates were evaluated by a microbiologist blinded to group assignment. Rose hydrosol was analysed by gas chromatography/mass spectrometry. Results: The main components of rose hydrosol are phenyl ethyl alcohol, beta-citronellol and geraniol. Of the total of 45 participants, 23 were included in rose hydrosol group and 22 in the alcohol-based hand-rub group. The colony counts decreased significantly in the alcohol-based solution group after hand-rubbing, whereas there was no significant reduction in the rose hydrosol group. Conclusion: A number of studies have shown good antimicrobial activity in rose products, especially in rose oil, but we found no antibacterial effect of rose hydrosol after hand-rubbing. However, it must be borne in mind that the amount and types of rose hydrosol components are highly influenced by the given agro-meteorological conditions and technological production methods.

Bulging fontanel during a measles infection.

INTRODUCTION: Introduction Causes of a bulging fontanel in children include viral/bacterial meningitis, encephalitis, hydrocephaly, intracranial bleeding, psedotumor cerebri and central nervous system tumors. A less well-known cause of acutely-developing fontanel bulging is transient intracranial hypertension. CASE REPORT: A 7-month-old female was brought to our hospital with fever, cough, watery nasal secretion and bulging fontanel for the last 3 days. The cranial ultrasound examination and cerebrospinal fluid examinations were normal. The patient's irritability and fontanel bulging improved the day after admission but a maculopapular rash developed. The measles Ig M was positive. Measles PCR was positive from urine and nasopharyngeal swab samples. The signs of intracranial hypertension of the patient recovered completely the day after admission and did not recur during the follow-up. The patient was discharged on the 5th day of admission. DISCUSSION: Transient intracranial hypertension is thought to result from a transient increase in the quantity of the circulating cerebrospinal fluid but the pathogenesis is not clear. CONCLUSIONS: Based on this case, we report that transient intracranial hypertension could develop during a measles infection.

Midstream Clean-Catch Urine Culture Obtained by Stimulation Technique versus Catheter Specimen Urine Culture for Urinary Tract Infections in Newborns: A Paired Comparison of Urine Collection Methods.

OBJECTIVE: The group of Herreros Fernández developed a new, safe, quick, and successful technique for collecting midstream clean-catch urine(MS-CCU) in newborns based on bladder stimulation and lumbar paravertebral massage maneuvers. The purpose of this study was to compare the contamination rates of catheter specimen urine (CSU) and MS-CCU by a lumbar/sacral stimulation technique in newborns. MATERIALS AND METHODS: Full-term newborns ranging in age from 2 to 28 days who needed an investigation for a presumed urinary tract infection (UTI) were included in the study. Two samples, MS-CCU by lumbar/sacral stimulation technique and CSU, were collected consecutively for each patient. Suitable samples were obtained from 90 patients. RESULTS: The contamination rate in MS-CCU cultures (n = 24/90, 26.66%) was higher than in CSU cultures (n = 9/90, 10%), and the difference was statistically significant (p = 0.039). Thirteen patients had UTI according to both samples (14.14%). In urine analysis, while there was no statistically significant difference in bacteriuria (p = 0.61) and nitrite positivity (p = 0.14) between patients with and without UTI, pyuria (p = 0.01) and leukocyte esterase positivity (p = 0.01) were higher in patients with UTI, and the difference was statistically significant. CONCLUSION: The contamination rate in MS-CCU cultures was two and a half times greater than in the CSU culture samples. Thus, MS-CCU cannot replace the catheter for the diagnosis of UTI.

Mild hypotonia and recurrent seizures in an 8-month-old boy: Questions.

Hypomagnesemia with secondary hypocalcemia is a rare autosomal recessive disorder which manifests in early infancy with generalized seizures, other symptoms of neuromuscular irritability, and growth disturbances. Homozygous mutations in the magnesium transporter gene, transient receptor potential melastatin 6 (TRPM6), cause the disease. Here, we present an 8-month-old Turkish boy with a novel mutation of TRPM6. The patient, son of first-degree cousins, was hospitalized because of recurrent seizures and mild hypotonia. He had seizures since the newborn period and he had been treated with phenobarbital but there was no favorable response to therapy. His past history also revealed hypocalcemia detected on the newborn period but serum magnesium levels were not studied at that time. During hospitalization, we detected hypocalcemia, hypomagnesemia, and normal parathormone levels. Abdominal ultrasound was normal. Magnesium excretion was slightly increased. Considering the consanguinity of the parents and clinical features of the patients, genetic testing of the TRPM6 gene was performed and a novel homozygous mutation was detected as c.3178A>T. He was started on magnesium and calcium supplementation and he is symptom-free for 1 year. We would like to call attention to the measurement of serum magnesium levels in children with hypocalcemic convulsions. Early and appropriate treatment with magnesium supplementation is crucial.