Invasive fungal infections in children with hematologic and malignant diseases.

BACKGROUND: To evaluate the clinical feature and outcome of invasive fungal infections (IFI) in children with hematologic and malign diseases. PATIENTS AND METHODS: The medical records of children with hematologic and malignant diseases, who were hospitalized at our hospital between January 2010 and December 2011, were reviewed. Proven, probable, and possible IFIs were diagnosed according to the revised definitions of the European Organization for Research and Treatment of Cancer/Mycosis Study Group. The demographic, clinical, and laboratory characteristics of the patients who met the study criteria were evaluated. RESULTS: IFI was diagnosed in 67 (7.2%) febrile episodes of 56 patients, of which 10 (1.2%) were proven, 20 (2%) probable, and 37 (4%) possible IFI. Blood culture of 10 cases with proven IFI yielded yeast and the most common isolated agent was Candida parapsilosis. Seventy percent of cases with fungemia had central venous catheter (CVC). Twenty cases with probable IFI had invasive mold infection. The cases with mold infection had higher median C-reactive protein values, lower neutrophil counts, and longer duration of neutropenia compared with the cases with yeast infection. A total of 14 patients (20.9%) died. Presence of CVC, bone marrow transplantation, total parenteral nutrition, prolonged fever, and proven/probable IFI were detected more often in patients who died, compared with patients who survived. CONCLUSIONS: IFIs are important causes of death in children with hematologic and malignant diseases. Mold infections are seen more frequently in cases with prolonged and profound neutropenia, and invasive yeast infections, especially with non-albicans Candida species, in cases with CVC. Early and effective treatment considering these findings will help to decrease the mortality.

Comparison of HbA1c levels in obese and non-obese polycystic ovarian patients.

AIM: To compare obese and non-obese polycystic ovary syndrome (PCOS) patients with respect to lipid profile, hormone profiles, and hemoglobin A1c (HbA1c) values indicating chronic hyperglicemia. MATERIALS AND METHODS: Thirty PCOS patients with a body mass index (BMI) > 25 and 35 non-obese PCOS patients with BMI < 25 were compared with regard to basal luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol (E2), fasting blood sugar (FBS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TCOL), triglyceride (TG), and HbA1c values. RESULTS: HDL value (p = 0.005) was significantly higher in non-obese group while TG (p = 0.001) was higher in the obese group. No significant difference was found between other values. CONCLUSION: Lipid metabolism impairment seems to be more marked in obese PCOS patients. Moreover, it is obvious that insulin resistance is higher in obese group. The absent difference between obese and non-obese groups in terms of HbA1c values suggests that insulin resistance occurring in the obese group may also be important in the non-obese group. In this context, cardiovascular risks may increase in non-obese PCOS patients.

Serum vitamin A and beta-carotene concentrations and renal scarring in urinary tract infections.

OBJECTIVE: To evaluate the role of vitamin A on renal scarring in recurrent urinary tract infections (UTIs). DESIGN: Twenty three children with UTIs and renal scarring (mean (SD) age 7.3 (3.9) years) and 91 children without renal scarring (6.4 (3.4) years) were studied. All the children had serum vitamin A and beta-carotene measurements and nutritional evaluation. Renal scarring was assessed by technetium-99m dimercaptosuccinic acid (99mTc DMSA) scanning. Nutritional status of all the patients was within normal limits and not different between the groups. RESULTS: Mean (SD) serum vitamin A and beta-carotene concentrations were not significantly different between the patients with and without renal scarring (vitamin A 53.2 (22.6)/46.8 (17.0) micrograms/dl and beta-carotene 232.3 (201.3)/272.4 (86.0) micrograms/dl respectively). However, when the patients with renal scarring and with greater than 10% difference among the DMSA uptakes of their kidneys (11 cases) were evaluated, a significant negative correlation was determined between the serum vitamin A concentrations and the magnitude of the difference in uptakes of each kidney. The same relation was not true for serum beta-carotene concentrations. CONCLUSION: This study demonstrated a relation between serum vitamin A concentrations and magnitude of hypoactivity in 99mTc DMSA scanning in kidneys with advanced scarring.

Topical anaesthesia in haemodialysis: evaluation of topical anaesthesia with lidocaine during vascular access in children undergoing long-term haemodialysis for chronic renal failure.

Children with chronic renal failure are frequently exposed to painful invasive procedures. Ointments containing lignocaine-prilocaine, when used before intravenous punctures, have been reported to lessen the pain sensation. The aim of this study was to interpret the effectiveness of lidocaine 2.5% ointment in preventing pain when used before venous and arterial punctures in children undergoing a haemodialysis programme for chronic renal failure. Eight children were included in this study. The pain level was identified by the patients using a linear analogue scale. When topical anaesthetic and placebo were compared, there was no statistical difference in interpretation of pain during arterial (P > 0.4), venous (P > 0.375) or both (P > 0.4) procedures. We conclude that lidocaine 2.5% ointment is not effective in preventing pain in children undergoing long-term haemodialysis. In these patients some other factors, like psychological factors, puncture technique and needle size must be taken into consideration for the prevention of pain.