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Öğe A Case with Mega Cisterna Magna Renal and Ear Anomalies: Is This a New Syndrome?(Hindawi Ltd, 2013) Konca, Capan; Caliskan, Bahar; Tas, Mehmet AliBackground. Extrarenal pathologies may be associated with renal position and fusion anomalies. According to the literature, our patient is the first horseshoe kidney case that had mega cisterna magna, arachnodactyly, and mild mental retardation. Case Report. A 9-year-old boy admitted because of the myoclonic jerks. He had a dysmorphic face, low-set and cup-shaped ears, arachnodactyly, and mild mental retardation. The patient's laboratory findings were normal except for a mild leucocytosis and hypochromic microcytic anemia. His cerebrospinal fluid was cytologically and biochemically normal. Cranial MRI revealed 1.5 cm diametered mega cisterna magna in the retrocerebellar region. Although there were no significant epileptical discharges in the electroencephalography, there were slow wave discharges arising from the anterior regions of both hemispheres. Because he had stomachache, abdominal ultrasonography was performed, and horseshoe kidney was determined. Abdominal CT did not reveal any abnormalities except the horseshoe kidney. There were not any cardiac pathologies in echocardiography. He had normal 46XY karyotype and there were no repeated chromosomal derangements, but we could not evaluate for molecular and submicroscopic somatic changes. He was treated with valproic acid and myoclonic jerks did not repeat. Conclusion. We suggest that the presence of these novel findings may represent a newly recognized, separate syndrome.Öğe Childhood Brucellosis in Southeastern Region of Turkey: A retrospective analysis(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2013) Konca, Capan; Tutanc, Murat; Gunes, Ali; Tas, Mehmet AliObjective: To evaluate the clinical and laboratory findings, treatment modalities and outcomes of children with brucellosis in a four-year period Methods: This retrospective study included 34 children who were admitted to Dicle University Pediatric Infectious Diseases Service with brucellosis between 2003-2007. Demographic features, clinical symptoms, physical examination and laboratory findings of patients were evaluated. The standard tube agglutination test, Rose Bengal test and clinical findings were used as diagnostic criteria for brucellosis. Results: In the study, twelve patients (35%) were female and 22 (65%) were male. The mean age was 9.2+/-3.4 years. Twenty-one patients (61.7%) were from rural areas of Turkey. All of the children except two patients have reported to consume unprocessed milk and dairy products. The most frequent complaints and clinical findings were fever (88.2%) and musculo-skeletal system symptoms (76.4%). Hematological involvement was significantly apparent in laboratory results. Trimethoprimsulfamethoxazole+ rifampicin were administered to children smaller than 8 years and doxycycline+ rifampicin to children older than 8 years during 6 weeks for treatment. Four patients were relapsed. Conclusion: Musculoskeletal system complaints and fever are the most common symptoms in brucellosis. Brucellosis should be considered in the differential diagnosis of patients with hematological signs. Combined treatments should be administered within a sufficient period to provide successful treatment and prevent relapse.Öğe Clinical and Demographic Features of Children Diagnosed with Cystic Fibrosis after Sweat Test Screening for Failure to Thrive, Chronic Diarrhea or Recurrent Pulmonary Infections(Galenos Yayincilik, 2013) Konca, Capan; Gunes, Ali; Sen, Velat; Yel, Servet; Yolbas, Ilyas; Ece, Aydin; Gurkan, Mehmet FuatIntroduction: The aim of this study was to investigate the incidence of cystic fibrosis (CF) in patients with recurrent pulmonary infection, chronic diarrhea and failure to thrive having no specific diagnosis and also to investigate the demographic features, and clinic and laboratory findings of such patients. Materials and Methods: The diagnosis of CF has been established through measuring the sweat conductivity in children presenting with one or more characteristic phenotypic features of CF. A chloride concentration lower than 59 mmol/l was interpreted as negative; 60-79 as borderline and over 80 as positive. A borderline sweat test result supported with genetic mutation, nasal potential difference or elastase activity was diagnosed as atypical CF. Results: A total of 356 patients fulfilled the study criteria. Twenty (5.6%) patients were diagnosed as CF. The mean age of the patients was 19.3 +/- 18.1 months and 234 (65.7%) of them were boys. Of the patients suffered from recurrent pulmonary infection, chronic diarrhea and failure to thrive; 15.5%, 10.1%, and 7% were diagnosed as CF, respectively. Major presenting complaints were fever, respiratory tract diseases, failure to thrive, and chronic diarrhea in patients with CF. A total of 430 sweat tests were applied to 356 patients and 20 of the 33 patients with a test resulting over 60 mmol/L were diagnosed as CF. Conclusions: CF should be considered for the differential diagnosis of the patients presented with chronic diarrhea, recurrent pulmonary infection, and failure to thrive. While the incidence of CF in white people is approximately 1 in 3000 individuals, we found a higher rate of 5.6% in our study group.Öğe Clinical, radiological and laboratory findings in 185 children with tuberculous meningitis at a single centre and relationship with the stage of the disease(Biomed Central Ltd, 2015) Gunes, Ali; Uluca, Unal; Aktar, Fesih; Konca, Capan; Sen, Velat; Ece, Aydin; Hosoglu, SalihBackground: A delay in the diagnosis and treatment of tuberculosis meningitis (TBM) may lead to increased mortality and morbidity. The aim of this study was to describe the clinical, radiological and laboratory findings of TBM on a cohort of 185 pediatric patients at a single centre over a 10 year period and to investigate relationship between the stage of the disease. Methods: The hospital records of 185 TBM children that presented to the Pediatric Clinics of Dicle University Hospital were retrospectively evaluated. The age, gender, family history of tuberculosis, result of Mantoux skin test, status of BCG vaccination, stage of TBM at hospitalization, and clinical, laboratory and radiological features were recorded. Clinical staging of TBM was defined as follows: Stage I, no focal neurological findings and Glasgow Coma Scale (GCS) score 15; Stage II, GCS 15 presenting with focal neurological deficit or all the patients with GCS 10-14; Stage III, all the patients with GCS < 10. Relationships between results and stages of TBM were investigated. Results: The mean age of the patients was 53.5 +/- 44.9 months (4 months-18 years). 121 (65.4 %) of the patients were male and 64 (34.6 %) female. Family history of tuberculosis was defined in 62 (33.5 %) patients. Forty five (24.3 %) children had BCG vaccination scar. Mantoux skin test was interpreted as positive in 35 (18.9 %) patients. Sixty-eight (36.8 %) children were at stage I TBM, 57 (30.8 %) at stage II and 60 (32.4 %) were at stage III on admission. Mean duration of hospitalization was 23.9 +/- 14.1 days. Totally, 90 patients (48.6 %) had abnormal chest X-ray findings (parenchymal infiltration in 46 (24.9 %), mediastinal lymphadenopathy in 36 (19.5 %), miliary opacities in 25 (13.5 %), pleural effusion in 2 (1.1 %), and atelectasis in 2 (1.1 %) patients). One hundred sixty seven (90.3 %) patients had hydrocephalus in cranial computerized tomography. There were 24 (13.0 %) patients with positive culture for Mycobacterium tuberculosis and 3 (1.6 %) patients with positive acid-fast bacilli in cerebrospinal fluid. Overall mortality rate was 24 (13.0 %). Among the findings; patients at Stage III had less frequent positive chest X-ray abnormality, miliary opacities and BCG vaccination scar when compared with patients at Stage I and II (p = 0,005; p = 0,007, p = 0.020, respectively). Conclusions: Children with TBM and positive chest X-ray findings at hospital admission were more frequently diagnosed at Stage I, and BCG vaccination might be protective from the Stage III of the disease.Öğe Evaluation of cases with diabetic ketoacidosis monitorized in intensive care units(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2011) Tutanc, Murat; Celik, Tanju; Basarslan, Fatmagul; Gunes, Ali; Konca, Capan; Yel, Servet; Boşnak, MehmetObjective: In this study, we have investigated the demographic and clinical characteristics of pediatric cases with diabetic - ketoacidosis (DKA) followed-up in intensive care units. Methods: This is a retrospective analysis of all patients' files with respect to their demographic factors as gender, complaints, age and clinical features. Mann Whitney U and chi-square statistical tests were performed. Results: The study group consists 16 female and 9 male children with a mean age of 9.9 +/- 3.7 years. The most frequent complaints of the cases were dyspnea, polydipsia, weight loss and polyuria in decreasing order of frequency. They admitted to the hospital because of respiratory distress, tachypnea tachycardia and acidosis. They treated by DKA protocol in the intensive care unit. We normalized Glasgow Coma Scores (GKS) in 12 +/- 5, blood sugar levels in 14 +/- 7, and blood gas levels in 14 +/- 7 hours. Any complication had not developed and the patients under glycemic control were discharged from the hospital with recommendations for outpatient follow-up. Conclusion: DKA cases could be treated rapidly and successfully thanks to accurate and rapid diagnosis followed by strict monitorization protocol. In conclusion we wanted to emphasize that monitorization of patients with DKA should be performed in pediatric intensive care units.Öğe Hereditary Spherocytosis: Evaluation of 68 Children(Springer India, 2015) Konca, Capan; Soker, Murat; Tas, Mehmet Ali; Yildirim, RukenTo determine the clinical and hematologic features of 68 children with hereditary spherocytosis (HS). In this retrospective study, we analyzed recorded information of 68 HS patients diagnosed between March 1997 and March 2007, including clinical manifestations at admission, gender, median age at diagnosis, family history, hematologic and biochemical data, patient management, complications, median age of splenectomy, and median follow-up time. Sixty-eight patients with HS (36 male and female) were investigated. The median age at diagnosis was 5.6 years (range 3 months to 18 years). Twenty-seven (39.7 %) had parents with consanguineous marriages, and 20 (29.4 %) had parents with first-degree consanguinity. Predominant clinical manifestations at admission were anemia in 59 patients (86.76 %), splenomegaly in 49 (72.05 %), and jaundice in 33 (48.52 %). Patients were classified as mild, moderate, or severe in 29.4, 61.7, and 8.8 % of patients, respectively. Five patients (7.3 %) underwent splenectomy. Major complications of HS were hemolytic, aplastic, and megaloblastic crises and cholelithiasis in 7 (10.2 %), 1 (1.4 %), 7 (10.2 %), and 6 (8.8 %) of patients, respectively. There were no deaths during follow-up. HS should be considered in evaluating possible diagnoses in patients with hemolytic anemia. In this study, the clinical course of patients with HS was relatively benign, with low proportions of patients having splenectomized and aplastic crises.Öğe Meningitis in Children: Evaluation of 197 Patients(Derman Medical Publ, 2015) Gunes, Ali; Konca, Capan; Aktar, Fesih; Sen, Velat; Uluca, Unal; Yel, Servet; Tas, M. AliAim: The aim of our study was to evaluate the epidemiologic, clinic and laboratory results and the answers to treatment of meningitis cases. Material and Method: In this study, the epidemiologic, clinic and laboratory results of 197 patients hospitalized with central nervous system infection diagnosis in the Department of Pediatric Health and Diseases of the Faculty of Medicine of Dicle University between 1st of January 2003 and 1st of January 2006 have been studied retrospectively. The files have been studied in details for age, sex, complaints, and results of physical examination, laboratory results, radiological results and treatments applied. Results: 118 of the patients were male, 79 were women and the mean age calculated was 62,2 +/- 47,3 months. 137, 27 and 33 patients have been respectively considered as ABM, AM and TM. The most frequent complaints of application to hospital were fever (95,4%), vomiting (82,7%), headache (45,6%) and change of consciousness (21,3%). The presence of many risks about meningitis has been observed. The most frequent risk factors were head trauma history, parenchymal lung tuberculosis, military tuberculosis, presence of V-P shunt, meningocele, varicella history, having mumps, and the presence of purulent ear discharge. BOS has developed in 7 patients and for five patients, reproduction occurred in blood culture. The most important central nervous system sequels or complications were in order of frequency hydrocephalies requiring the installation of V-P shunt, brain edema, epilepsies, subdural effusions, tuberculoma, retention of head pair, and brain apses. The rate of mortality was (% 13.1). Discussion: During the period of execution of the study, the mortality and morbidity of central nervous system diseases were still at high risk. But this may be associated to the absence of vaccination programs for frequent meningitis factors such as pneumococcus and H. influenza were not in routine vaccination program in our country; thus we consider that further studies about this issue after vaccination are required.Öğe Neonatal tetanus in Turkey; what has changed in the last decade?(Biomed Central Ltd, 2008) Dikici, Bünyamin; Uzun, Hakan; Yilmaz-Keskin, Ebru; Tas, Taskin; Gunes, Ali; Kocamaz, Halil; Konca, CapanBackground: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.Öğe Refractory Status Epilepticus After Ingestion of Amanita Virosa in an Epileptic Child(Aves, 2014) Konca, Capan; Guenes, Ali; Kocamaz, Halil; Yel, Servet; Boşnak, MehmetIntroduction: Status epilepticus is considered refractory when seizure activity continues after receiving treatment with a benzodiazepine followed by infusion of traditional antiepileptic drugs. Mushroom poisoning may lead to variable clinical pictures. Although it is known that mushroom poisoning may develop epileptic seizures, there are no data about status epilepticus associated with amanita virosa mushroom poisoning in the literature. Case Report: A 6-year-old epileptic patient who regularly used antiepileptic drugs and had no seizures for 2 years was admitted to the emergency department due to refractory status epilepticus after ingestion of mushroom. Seizures that were refractory to antiepileptic therapy was controlled with intubation and mechanical ventilation after general anesthesia. Laboratory tests were normal, except elevated PTZ and aPTT. The patient, who had no additional problems and stabilized, was discharged on the fifth day of admission. Conclusion: We suggested that mushroom poisoning may reduce the threshold for seizures in our patient. In this study, it is emphasized that different clinical features may be found in a patient at the same time.Öğe Seropositivity for Chlamydia Pneumoniae and Mycoplasma Pneumoniae in Asthmatic Children(Derman Medical Publ, 2015) Tutanc, Murat; Gurkan, M. Fuat; Yel, Servet; Gunes, Ali; Konca, Capan; Bilen, GulserenAcute respiratory tract infections may trigger acute asthma attacks and may be held responsible for etiopathogenesis in children with asthma. Although bacterial infections attract a limited amount of attention, recently Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP), in particular, are reported to be the possible factors. IgM and IgG seroprevalence was investigated in 66 children patients with bronchial asthma (between the ages of 3 and 14) for CP and Mycoplasma pneumoniae. In a total of 66 cases, 18 (27.2%) patients were detected with IgG positivity for CP whereas 27 of them (40.9%) were detected with IgG positivity for MP. IgG positivity was determined in 6 patients (13.0%) in the control group for CP, and in 6 patients (10.8%) in the control group for MP. The rate of the asthma patients with IgG seropositivity for MP was 4 times higher than that of the control group. It was seen that IgG antibody seropositivity for CP was higher in those with more frequent attacks. No such difference was observed in terms of IgG antibody seropositivity for M. pneumoniae. There are many studies indicating that CP and MP infections take an importance place in the etiology of bronchial asthma and asthma attacks in children. The results obtained reveal the effect of both microorganisms on the etiopathogenesis of the bronchial asthma and the increased number of asthma attacks.Öğe Splenectomy in patients with thalassemia major: Evaluation of 35 cases(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2013) Konca, Capan; Yildirim, Ruken; Dikici, Bünyamin; Tas, Mehmet AliObjective: Beta-thalassemia is common, worldwide, autosomal recessive and inherited type of anemia which results from absent or reduced synthesis of beta globin. Splenectomy may be performed for the treatment of many hematologic diseases. The aim of this study is to discuss recorded data of thalassemia major patients who underwent splenectomy. Methods: The records of 782 patients with thalassemia major were reviewed retrospectively. Of these patients, 35 splenectomized patients with available data were included in the study. Recorded data of patients were evaluated as for age at diagnosis, gender, age at splenectomy, surgical indications, chelation therapy, annual transfusion requirements, and postoperative clinical response. Statistical analyses were performed with statistical package of SPSS version 13.0. Results: Twenty-two (63%) male and 13 (37%) female patients were included in the study. Mean age at diagnosis was 8 +/- 2 months and splenectomy was 8.5 years. The main indication for splenectomy was increased transfusion requirement (57.14%). The annual transfusion requirement reduced from preoperative 235 +/- 30 mL/kg to 115 +/- 15 mL/kg postoperatively. Mean serum ferritin levels were 1745 +/- 761 ng/mL, and 1985 +/- 570 ng/mL before, and after splenectomy. None of the patients developed any complications such as sepsis or coagulation disorder. Conclusion: These results suggest that splenectomy is beneficial to improve the quality of the lives of patients and significantly reducing blood consumption. Inadequate iron chelation therapy may be associated with progression to splenectomy.
