Peritoneal dialysis in children: Infectious and mechanical complications: Experience of a tertiary hospital in Elazig, Turkey.

Background: Peritoneal dialysis (PD) is frequently used in pediatric patients with renal failure. Aim: In the present study, we evaluated the indications and complications of PD and patients' outcomes in pediatric patients. Patients and Methods: Medical records of patients who underwent PD between 2012 and 2019 were analyzed retrospectively. The patients were divided into two groups as acute PD (APD) (Group 1) and chronic PD (CPD) (Group 2). If the patient was diagnosed with acute kidney injury (AKI), an APD catheter was inserted, while a CPD catheter was inserted for patients with stage 5 chronic renal failure or those in which AKI persisted for more than 6 weeks. Results: Group 1 and Group 2 consisted of 62 and 64 patients, respectively. The most common indications for PD were AKI (64.5%) in Group 1, and obstructive uropathy and reflux nephropathy (45.3%) in Group 2. The overall complication rate was 30%. These were leakage at the catheter insertion site (11.2%), catheter occlusion (4.8%), and peritonitis (4.8%) in Group 1; and peritonitis (14.1%), catheter occlusion (6.2%), and inguinal hernia (4.6%) in Group 2. The mortality rate was 72.5% and 23.4% in Group 1 and Group 2, respectively. The most common causes of mortality were multisystem organ failure (40%) and sepsis (33.5%) in both groups. A total of 83 patients (32 in Group 1 and 51 in Group 2) had omentectomy. Catheter revision and/or removal were performed in 11.9% of all patients. Omentectomy had no effect on the prevention of catheter occlusion (p > 0.05). Conclusion: The mortality rate is lower in CPD patients than in APD patients. Although PD in pediatric patients is associated with potential complications, its actual rate is relatively low. The primary catheter dysfunction rate is low, and omentectomy has no significant effect on preventing catheter occlusion.

The use of nitrofurantoin for children with acute cystitis caused by extended-spectrum Β-lactamase-producing Escherichia coli.

BACKGROUND: Acute cystitis in children caused by extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli) is on the rise. Treatment of these is usually parenteral treatment. The aim of this study was to investigate the clinical and microbiological efficacy of oral nitrofurantoin treatment in children with lower urinary tract infection (UTI) caused by ESBL-producing E. coli. METHODS: Fifty children with lower UTI due to ESBL-producing E. coli were prospectively studied. Demographic data, clinical condition, laboratory values, treatment regimens, and complications of the patients were recorded. Urine samples were obtained by transurethral catheterization or clean catch; urine bags were not used for specimen collection for culture. Patients with lower UTI due to ESBL-producing E. coli and found to be susceptible to nitrofurantoin were given oral nitrofurantoin. Patients were re-evaluated 3-4 days after the end of treatment. Renal scintigraphy was performed 1-3 months after the end of treatment. RESULTS: A total of 50 pediatric patients (48 females and 2 males) were enrolled into study. The mean age was 7.5 ± 3.96 years (range, 1-17 years). The duration of nitrofurantoin treatment was 10 days. Bacteriological response was observed in 49 of 50 patients (98%). No patient had symptoms after treatment. No significant side-effect was observed in any of the patients. All patients had normal serum creatinine values. Renal scintigraphic study, which was performed in all patients 1-3 months after completion of treatment, demonstrated the non-scarring in 48 of 50 patients (96%). CONCLUSIONS: UTIs due to ESBL-producing E. coli are a serious problem because of the bacteria's multidrug antibiotic resistance pattern. This study suggests that oral nitrofurantoin treatment could be a good alternative for lower UTI caused by ESBL-producing E. coli in pediatric patients.

Cerebral arterial thrombosis in a child with nephrotic syndrome.

Nephrotic syndrome (NS) in childhood may be associated with thromboembolic complications, mainly in venous origin. However, arterial thrombosis may also be seen as a very rare and life-threatening complication. Herein, we described a case of steroid-resistant NS who did not respond to full-dose steroid treatment for 8 weeks and was complicated by neurological findings. The renal biopsy was consistent with focal segmental glomerulosclerosis. His cerebral magnetic resonance angiography showed the sudden termination of M3 branch of the left middle cerebral artery which corresponded with subacute infarction in the left frontoparietotemporal area. Thrombosis panel yielded the results of hyperhomocysteinemia (46.1 µmol/L, range: 5-15 µmol/L) and heterozygous methylene tetrahydrofolate reductase mutation (C677T, A1298C). After that, the patient was given medical therapy including anticoagulant treatment. Improvement in the neurological outcome was determined on the 1st month of follow-up examinations.

Seroprevalence of Helicobacter pylori infection among children and their parents in eastern Turkey.

OBJECTIVES: To determine the seroprevalence of Helicobacter pylori infection among healthy children in eastern Turkey, to assess risk factors for seroconversion, and to assess the role of parental infection status in the transmission of H. pylori. METHODS: A commercial enzyme immunoassay test for IgG to H. pylori was used. Demographic information obtained included age, gender, socio-economic status and living conditions. RESULTS: One hundred and fifty-two (43.9%) of 346 children were seropositive. There was no significant difference in rates of seroprevalence between boys and girls (P > 0.05), but a significant rise was noted with increasing age (P < 0.001). We found a strong inverse correlation between family income and seropositivity (P < 0.001). Seroprevalence also varied significantly with the educational level of the mother (P < 0.001). There were no significant differences in seroprevalence associated with place of residence, water supply and the number of persons per room (P > 0.05). The prevalence of infection in the corresponding parents was 85.4% for mothers and 76.3% for fathers. Seroprevalence was higher in children whose mother was infected (P < 0.001). CONCLUSIONS: In eastern Turkey, as in other developing countries, H. pylori infection occurs early and increases with age. Infected parents, especially infected mothers, may have a important role in the transmission of H. pylori within families.

Serum lipid changes during anticonvulsive treatment serum lipids in epileptic children.

Serum lipid profile changes were investigated in 53 children receiving phenobarbital (n = 14), carbamazepine (n = 21), and valproic acid (n = 18) for their newly diagnosed seizure disorder. The patients were followed prospectively. Serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations increased after 3 months of treatment with carbamazepine and remained high after one year. Serum total cholesterol levels increased after 3 months of treatment with phenobarbital and remained high after one year. Serum lipid concentrations did not change during valproic acid therapy. Serum lipid profiles should be carefully monitored in children receiving enzyme inducing antiepileptic drugs.