Can Ischemia-Modified Albumin Be a Helpful Marker in the Diagnosis and Follow-Up of Childhood Intussusception?

OBJECTIVES: Intussusception is the invagination of a proximal segment of the intestine into a more distal segment. The present study aimed to determine the sensitivity of the ischemia-modified albumin (IMA) and the correlation between IMA and the severity of intestinal ischemia in intussusception cases. METHODS: Thirty-six consecutive children aged between 0 and 16 years presenting with the clinical and radiological features of intestinal obstruction caused by intussusception were enrolled in the study. The age- and sex-matched control group was composed of patients undergoing outpatient surgery. The patients were categorized as cases of type I (ileoileal), type II (ileocecal), and type III (colocolic) based on the ultrasonography findings. RESULTS: The mean IMA level of the intussusception group was 179.13 ± 220.33 ng/mL, whereas the mean level was found as 89 ± 70.9 ng/mL in the control group. When the patients were categorized as ileoileal, ileocecal, and colocolic, the mean IMA levels were detected as 235.65 ± 268.14 ng/mL, 174.46 ± 212.8 ng/mL, and 46.95 ± 19.56 ng/mL, respectively. There was a moderate correlation between the invaginated segment lengths measured by the surgeon during the operation and IMA levels. CONCLUSIONS: Our study findings reveal that IMA can be used as an auxiliary diagnostic marker in patients presenting with symptoms and signs suggestive of intussusception. Thus, patients can be screened for mechanical bowel obstruction due to intussusception and may be referred to pediatric surgery centers earlier for further examination.

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study.

BACKGROUND: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. METHODS: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. RESULTS: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. CONCLUSIONS: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. IMPACT: MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

Analysis of patients presenting with serum electrolyte imbalance in terms of the differential diagnosis of pseudohypoaldosteronism.

OBJECTIVE: The aim of this study was to contribute to the differential diagnosis of transient pseudohypoaldosteronism (t-PHA). METHODS: Twenty-nine infants, younger than 24 weeks, and with high aldosterone levels were included in the study. The patients were divided into two groups as t-PHA and other diagnoses group. Of 29 patients, 18 were in the t-PHA group and 11 were in other diagnoses group. RESULTS: The means aldosterone, plasma renin activities (PRA), adrenocorticotropic hormone (ACTH), cortisol, and 17-hydroxyprogesterone (17-OHP) of those with t-PHA were 138±92.8 ng/dL, 8.39±10.57 ng/mL/h, 26.86±19.56 ng/L, 19.44±21.84 µg/dL, and 7.66±10.71 ng/mL, respectively. In other diagnoses group, the mean level of aldosterone, PRA, ACTH, cortisol, and 17-OHP levels was 100.9±70 ng/dL, 5.49±8.41 ng/mL/h, 408.28±491.9 ng/L, 19.99±14.43 µg/dL, and 11.99±12.21 ng/mL, respectively. In the t-PHA group, the number of patients with high PRA was eight (50%), while the number of patients with high levels was two (18.1%) in other diagnoses group. In the t-PHA group, although the average serum K levels were the same in both groups, serum aldosterone/K ratios were higher. CONCLUSION: When an infant younger than 24 weeks, with urinary tract infection and/or urinary tract malformation has electrolyte abnormalities, pediatricians should primarily consider the diagnosis of t-PHA. Thus, many unnecessary investigations and inappropriate treatments can be avoided.

Just a vitamin? Should cobalamin (Vitamin B12) levels be checked in children with neurological disadvantages?

OBJECTIVE: The assay of serum cobalamin (Cbl) level is commonly used to diagnose Cbl deficiency. Unexpectedly, the elevated Cbl levels may be determined in some of the patients and its interpretation is difficult. We investigated the association between elevated Cbl levels and a variety of clinical entities in patients presenting with various neurological symptoms. METHODS: The data were obtained from the patients' electronic medical records in a tertiary hospital affiliated with a university. The pediatric patients with serum Cbl levels above 1000 pg/mL were included in the study. The patients with serum Cbl levels below 900 pg/mL and above 200 pg/mL constituted the control group. RESULTS: The mean Cbl level of the patients with neurological problems was 1424.2±354.2 pg/mL, whereas the average Cbl level of neurologically healthy was 1316±317.8 pg/mL, and the difference was statistically significant. While the rate of having neurological deficits or symptoms in the study group was found to be 24%, this rate was only 18% in the control group. Unexpectedly, despite elevated Cbl level, the high mean corpuscular volume rate was higher in the study group compared to the control group. CONCLUSION: This study highlights the importance of the disorders of Cbl metabolism in patients presenting with various neurological symptoms. In children with neurological deficits, serum Cbl levels should be checked. In case of high Cbl level is determined, patients should be followed up closely, and further investigations should be performed in terms of Cbl metabolism disorders.

The Utility of Neutrophil Gelatinase-Associated Lipocalin in the Detection of Emerging Lung Injury due to Mechanical Ventilation in Children: A Preliminary Study.

OBJECTIVE: Lung injuries are mostly ignored in patients supported by mechanical ventilation. Neutrophil gelatinase-associated lipocalin has come into prominence as an early sensitive and highly predictive biomarker of inflammation. The purpose of the study was to assess the capability of neutrophil gelatinase-associated lipocalin in recognizing lung injuries in children requiring mechanical ventilation. MATERIALS AND METHODS: This prospective case-controlled study was carried out in a tertiary pediatric intensive care unit. The entire study group consisted of a total of 45 patients, 15 in the patient group (supported by invasive mechanical ventilation) and 30 in the control group (self-breathing). Whether lung injuries developed or not was investigated by measuring serumneutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin levels in the course of ventilation support. RESULTS: In the patient group supported by mechanical ventilation, mean levels of serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin were measured as 192 ± 136.7 ng/mL and 43.7 ± 57.5 ng/mL, respectively. In the control group (self-breathing patients), mean levels of serum-neutrophil gelatinase-associated lipocalin and urine-neutrophil gelatinase-associated lipocalin were found as 144.8 ± 95 ng/mL and 39.3 ± 85 ng/mL, respectively. The levels of serum-neutrophil gelatinase-associated lipocalin were higher in those ventilated mechanically, compared to self-breathing patients. Although urineneutrophil gelatinase-associated lipocalin levels were higher among mechanically ventilated patients than the controls, the difference was not statistically significant. CONCLUSION: Based on our study findings, we consider that neutrophil gelatinase-associated lipocalin may be a useful biomarker for emerging lung injuries due to mechanical ventilation in critically ill children and deserves to be investigated.

Unusual localization and coexistence of primary hydatid cyst: a case report.

Hydatid cysts are zoonotic parasitic infections caused by Echinococcus granulosus. Although witnessed in all body parts, the first and most important locations for this parasite are the liver and lungs. Unusually, hydatid cysts are rarely located in the pelvic region. The majority of such cysts generally develop secondary to spontaneous rupture of an hepatic hydatic cyst or due to surgical inoculation. Incidentally diagnosed in a patient admitted with the picture of acute abdomen, a case of primary hydatid cyst located in retrovesical region, an uncommon localization for hydatid cysts, is presented in this report. In patients admitted with symptoms of abdominal pain in endemic regions, and in those suspected of having unidentified cystic lesions, the unusual localization of a primary hydatid cyst should be considered.

The Collocation of Ischemia-Modified Albumin and Blood Gas Parameters in the PICU Setting.

Ischemia modified albumin (IMA) is a marker that has been determined to be elevated in hypoxic conditions. This study aimed to investigate the relationships between serum IMA and blood gas parameters (BGPs) and evaluate whether IMA can be used as a parameter clinically in terms of reflecting tissue hypoxia in ventilator management. BGPs and serum IMA level were measured in blood samples drawn simultaneously from patients. Mean serum IMA levels, mean pCO2, mean pO2, and lactate levels were 82.56 ± 25.47 ng/mL, 47.99 ± 22.81 mm Hg, 53.62 ± 30.43 mm Hg, and 2.13 ± 3.22 mmol/L, respectively. No correlation was found between serum IMA level and BGPs. Our findings showed that serum IMA level can be concluded not to be a suitable parameter in ventilator management. However, IMA can be a reliable guide if used together with venous BGPs in terms of the estimating of tissue oxygenation, especially within the last few hours.

Two Sisters with Angelman Syndrome: A Case Series Report.

Angelman syndrome (AS) is known as an intellectual disability related to speech impairment, ataxia and behavioral uniqueness, including a combination of frequent laughter and smiling, apparent happy demeanor, excitable personality and hypermotor behavior. In this report, we present a 5-year-old girl with AS associated with atypical clinical manifestations, including developmental dysplasia of the hip and simian line in the right hand, and her elder sister with AS. Even if any gene mutation cannot be demonstrated, it should be kept in mind that different mutations may exist in the cases that are the suggestive of clinical AS. Therefore, AS patients can be exposed to special education, and their quality of life can be elevated.

A case report with sacral appendage: Is it accessory penis or human tail?

Kocaoglu C, Kocaoglu Ç, Akkoyun I, Karanis IE. A case report with sacral appendage: Is it accessory penis or human tail? Turk J Pediatr 2017; 59: 335-337. Lumbo-sacro-coccygeal appendages are very rare congenital anomalies. It is difficult to say that they are a evolutionary inheritance (tail) from our ancestors or an anomaly (pseudotail) occuring during embrional development. If it is a true tail, this lesion contains adipose and connective tissue, striated muscle, blood vessel and nerves, and is covered by skin. However, if this lesion is a pseudotail, it may be an anomalous prolongation of the coccygeal vertebra, lipoma, teratoma, condrodystrophy or parasitic fetus. We present an infant with a sacral appendage resembling a penis, and its clinical and pathologic differential diagnosis and management are discussed based on literature. Sacral appendages, such as asaccessory penis or human tail, are treated through simple surgical excision. However, patients must be carefully evaluated regarding teratoma and spinal cord pathology.

Is Level of Serum Ischemia-Modified Albumin A Useful Biomarker in Carbon Monoxide Poisoning Cases?

OBJECTIVES: Ischemia-modified albumin (IMA) is an emerging diagnostic biomarker for many ischemic conditions. The study was conducted to investigate whether there is a change in IMA levels in carbon monoxide poisoning and, if so, the clinical relevance of IMA levels. METHODS: This study was performed between October 2013 and April 2014 to compare levels of serum IMA drawn at the time of admission to the emergency department in 49 patients poisoned with carbon monoxide and 37 healthy controls. Serum IMA, blood carboxyhemoglobin, and lactate levels were analyzed. RESULTS: Ischemia-modified albumin levels of patients with carbon monoxide poisoning were higher than those of controls. In patient group, however, there was no correlation between serum IMA and carboxyhemoglobin levels (r = -0.244, P > 0.05), whereas a negative correlation was detected between serum IMA and lactate levels (r = -0.334, P < 0.05). After all, a positive correlation was present between carboxyhemoglobin and lactate levels (r = 0.399, P < 0.05). CONCLUSIONS: Results from this preliminary study suggest that IMA might have diagnostic value in carbon monoxide poisoning and may be a parameter to be used clinically together with carboxyhemoglobin levels in terms of reflecting tissue hypoxia. In addition, IMA may be a criterion, especially in delayed cases where carboxyhemoglobin level may be normal in deciding hyperbaric oxygen treatment. To clarify this issue, further studies with larger population are needed.

Effect of long-term Helicobacter pylori infection on growth of children: a cohort study.

BACKGROUND: The effects of Helicobacter pylori (H. pylori) infection on growth are a controversial issue. We investigated the effects of long-term H. pylori infection on height and weight in children. METHODS: A total of 200 children of 7-18 years old suffering from dyspeptic complaints were classified into two groups: H. pylori positive and negative groups, respectively. Whether the infection was impoved was followed up while performing urea breath test, and according to exposure time to the infection, the children were further divided into group 1 (≤1.5 months), group 2 (>1.5-≤6 months) and group 3 (>6 months). Antropometric measurements were obtained and repeated every six months. RESULTS: Mean growth velocity scores in the H. pylori positive and negative groups were 0.49±3.85 [95% confidence interval (CI): -0.21-1.18] and 1.98±4.42 (95% CI: 1-2.96), respectively. The difference between both groups was statistically significant (P=0.012). Mean growth velocity scores in groups 1, 2 and 3 were 0.96±3.84, 0.16±4.51 and -0.85±3.09, respectively. Mean growth velocity scores of group 3 were significantly lower than those of groups 0 and 1 (P=0.005 and P=0.041). The mean weight scores in group 3 were similar to those in group 2, but the scores in group 3 were significantly lower than those in group 1 (-1.75±1.05, -1.21±1.37 and -0.88±1.49, respectively). CONCLUSION: As the duration of exposure is prolonged in children with H. pylori infection, the negative effect of the infection on both height and weight is evident.

Are obesity and metabolic syndrome associated with plasma adropin levels in children?

Studies performed on mice suggest that adropin is a peptide hormone playing a role in metabolic homeostasis and prevention of obesity-associated insulin resistance. Our study was conducted to investigate the role of adropin in children with obesity or metabolic syndrome. The study group consisted of 70 patients, including 42 obese and 28 with metabolic syndrome, and 26 healthy volunteers. After anthropometric variables and blood pressure of all participants were measured, serum lipids were analyzed, liver USG and oral glucose tolerance test were performed, and HOMA-IR values were calculated. Plasma adropin levels were collectively analyzed from collected plasma samples. In patient and control groups, no difference was observed in the levels of adropin (327.7±124.7 vs. 344.6±208.5 ng/L, respectively). The adropin levels of metabolic syndrome, obesity, and control groups also showed no difference (316±142.3, 335.8±112.5, and 344.6±208.5 ng/L, respectively). While the adropin levels of patients with and without hepatic steatosis were 319.6±123.7 and 347.8±128.7 ng/L, respectively, patients with HOMA-IR values of <3.16 and ≥3.16 had levels 342.3±124.8 and 296.5±136.7 ng/L, respectively. Although statistically insignificant, our findings are considered to support the hypothesis suggesting a nexus between adropin and obesity and metabolic syndrome. Small sample size in our study may have prevented our results to reach a more significant level. So, long-term follow-up studies with large population are needed to enlighten the role of adropin in metabolic homeostasis.

Cerebral atrophy in a vitamin B12-deficient infant of a vegetarian mother.

In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, simulating aplastic anaemia or leukaemia. In addition to haematological symptoms, infants may experience weakness, fatigue, failure to thrive, and irritability. Other common findings include pallor, glossitis, vomiting, diarrhoea, and icterus. Neurological symptoms may affect the central nervous system and, in severe cases, rarely cause brain atrophy. Here, we report an interesting case, a 12-month old infant, who was admitted with neurological symptoms and diagnosed with vitamin B12 deficiency.

Serum ischemia-modified albumin levels in children with epileptic seizures.

OBJECTIVES: The aim of the present study was to determine the level of ischemia-modified albumin (IMA) in children with epileptic seizures (ESs) and its relation with the seizure duration. METHODS: The study was performed with 88 children as a prospective case-control study. Blood samples for IMA were obtained from 57 patients (mean age [SD], 50.86 [51.15] months) within 3 hours after ES and 31 healthy control subjects (mean age [SD], 53.13 [40.87] months). Ischemia-modified albumin was measured by the albumin cobalt binding test. RESULTS: Although the mean (SD) of serum IMA level of the patients with seizure was 13.66 (13.16) U/mL, the mean (SD) of serum IMA level for the control group was 3.73 (1.93) U/mL. Ischemia-modified albumin levels were significantly higher in patients with seizure, compared with that in the control group (P < 0.01). When patients were grouped in itself according to the duration of ESs, the levels of IMA were detected to be increased in patients as the duration of seizures was lengthened. CONCLUSIONS: Increased IMA levels after seizures suggest that IMA assay during seizure may be useful for predicting the diagnosis and severity of convulsion.

Fluid management in children with diarrhea-related hyponatremic-hypernatremic dehydration: a retrospective study of 83 children.

AIM: To investigate serum creatinine and electrolyte status of children with diarrhea-related hyponatremic or hypernatremic dehydration. METHODS: Medical history of 83 patients admitted to the Pediatric Intensive Care Unit of the Konya Education and Research Hospital, Konya, Turkey with diarrhea, dehydration and electrolyte imbalance was retrospectively evaluated according to the degree of dehydration, serum creatinine, electrolytes, blood gas, approaches to the treatment such as content of given fluid, HCO3- and acute periotenal dialysis. Of 65 patients with hyponatremia, 44 (67.7%) were given fluids at appropriate concentration according to their age, and 21 (32.3%) were given fluids at higher concentration. Of 18 hypernatremic patients, 11 (61.1%) were given fluids at appropriate concentration for age, and seven (38.9%) were given fluids at higher concentration. RESULTS: Mean duration of amelioration of serum sodium levels for those admitted with hyponatremia and given fluids at appropriate concentration for age and at higher concentration were 33.9 ± 28.3 h and 53.7 ± 31.6 h, respectively. Mean duration of amelioration of serum sodium levels for hypernatremics and given fluids at appropriate concentration for age and at higher concentration were 34.7 ± 22.1 h and 46.3 ± 32 h, respectively. Four (4.8%) hyponatremic patients and three (3.6%) with hypernatremia were treated with acute peritoneal dialysis. Mortality rate was 6% (five of all patients). CONCLUSION: The children with severe diarrhea should be closely followed-up as to clinical examination, serum electrolytes, creatinine and blood gases, and because no single intravenous fluid management is optimal for all children, intravenous fluid therapy should be individualized for each patient.

Persistent metabolic acidosis and severe diarrhoea due to Artemisia absinthium poisoning.

Herbs have long been used in the treatment of various disorders in traditional medicine since ancient age. Artemisia absinthium, one of these herbs, has traditionally been used in different societies for antibiotic, antiparasitic, antifungal and antipyretic purposes. Here, we report a poisoning case of a 10-month-old male infant progressing with severe diarrhoea and persistent metabolic acidosis after ingesting home-prepared Artemisia absinthium extract which was given for the treatment of common cold.

Successful treatment of hemorrhagic bullous henoch-schönlein purpura with oral corticosteroid: a case report.

Henoch-Schönlein purpura (HSP) is a vasculitis of small-sized blood vessels, resulting from immunoglobulin-A-mediated inflammation. It is the most common acute systemic vasculitis in childhood and mainly affects skin, gastrointestinal tract, joints, and kidneys. The characteristic rash of HSP consists of palpable purpuric lesions 2 to 10 mm in diameter concentrating in the buttocks and lower extremities. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. This report describes a 4.5-year-old female patient with HSP associated with hemorrhagic bullous lesions.