LEİSHMANİA HEPATİTLİ BİR OLGU VAROL, Fatma İlknur; AKYAY, Arzu; SELİMOĞLU, Ayşe ...
Çağdaş tıp dergisi,
09/2020, Letnik:
10, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Sayın editör,
Hatice Köse ve ark.nın1 Cağdaş Tıp Dergisi’nin 2018 yılı ikinci sayısında (Cağdaş Tıp Dergisi 2018;8(2);165-167) yayımlanan“Erişkin bir visseral leishmaniazis olgusu:Tanı ve tedavi ...seçeneklerinin irdelenmesi: Olgu Sunumu” başlıklı olgu sunumunu ilgi ile okudum. Bu olgu sunumu ülkemizde ateş, pansitopeni ve hepatosplenomegalisi olan hastalarda mutlaka vissera leishmaniazisin hatırlanmanmasını vurgulaması yönüyle değerli bir calışmadır.
Bizim de İnönü Universitesi Tıp Fakultesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çocuk Gastroenteroloji, Hepatoloji ve Beslenme Birimi’nde daha önce izlediğimiz lieshmania hepatitli olgumuzu, çocuk hastalarda da uzamış ateş, karın şişliği, halsizlik, iştahsızlık, hepatosplenomegali, lökopeni, trombositopeni ve hepatit gibi bulgularla karşımıza çıkabileceği konusunda dikkatli olunması gereğini vurgulama amacıyla özetlemek istiyorum.
Üç yaşında erkek hasta yaklaşık beş aydır devam eden halsizlik, iştahsızlık, ateş ve karın şişliği şikâyetleri ile kliniğimize başvurdu. Özgeçmiş ve soy geçmişinde özellik olmayan hastanın fizik muayenesinde genel durumu orta, düşkün, cilt rengi soluk, kalp ritmik, solunum sesleri doğal, karaciğer kot altında 8 cm ve sert, dalak kot altında 10 cm ele geliyordu ve nörolojik muayenesi normaldi. Tam kan sayımında WBC:3,5 (103/M), HGB:9,3 g/dL, PLT:129 (103/M), INR:1, biyokimyasında total protein: 7,9 g/dL, albümin:3,2 g/dL, total bilirun: 0,7 mg/dL AST: 127 U/L, ALT 94 U/L olarak geldi. Abdominal USG’de karaciğer kraniokaudal 9 cm boyutta, homojen parankim ekosunda olup konturlar düzenli izlendi. İntrahepatik safra yolları normal izlendi. Ana portal ven ve hepatik venler ve dalları normaldi. Dalak kraniokaudal 10 cm boyutta, homojen parankim yapısında olup konturları düzenli idi. Dinamik BT’de karaciğer kraniokaudal 2 cm boyutta, homojen parankim yapısında konturları düzenli izlendi. Hepatik ve portal ven normal izlendi. Portal ven ve splenik ven ektaziktir. Pankreas izlenen kesitlerde homojen parankim yapısında ve normal boyutta izlendi. Dalak 14,5 cm (SM) boyutta, homojen parankim yapısındadır olarak rapor edildi. Pansitopenisi olan hastaya kemik iliği yapıldı ve kemik iliğinde leishmania görüldü (Resim 1).
Hastaya antimon içeren 10-20 mg/kg/g glucantim başlandı. Üç hafta sonunda halen klinik düzelme olmaması üzerine 3 mg/kg lipozomal amfoterisin B 0. 1. 2. 3. 4. ve 10. günlerde günde tek doz olmak üzere, toplam 18 mg/kg dozunda uygulandı 2. Herhangi bir yan etki ile karşılaşılmadı. Klinik ve laboratuvar değerleri düzelen hasta ayaktan takip edilmek üzere taburcu edildi. İzleminde hastanın splenomegalisi 6 ay sonra düzeldi.
Zoonotik bir enfeksiyon olan visseral leishmaniasisin ana rezervuarı köpekler ve kemiricilerdir. Akut başlangıçlı hastalıkta ateş yüksekliği, iştahsızlık, halsizlik, solukluk ve karın şişliği en sık başvuru nedenlerindendir. Fizik muayenede en belirgin bulgu ileri boyutlara ulaşabilen dalak büyüklüğüdür. Yurdumuzda, çocukluk çağında yapılan leishmaniasis araştırmalarında hepatosplenomegali %97,7-99 oranında, solukluk ise %50-99 oranında saptanmıştır 3. Bu nedenle özellikle splenomegalisi ön planda hepatitik tabloda gelen hastalarda ateş de varsa VL düşünülmelidir. Bazı olgularda splenomegalinin tedavi sonrası uzun sürede düzeleceği de unutulmamalıdır.
Chanarin-Dorfman syndrome (CDS) is a rare autosomal recessive
inherited neutral lipid metabolism disorder (NLSD) characterized
by lipid vacuoles in leukocytes (Jordans’ anomaly) on a
peripheral blood ...smear and ichthyosiform erythroderma with
involvement of multiple tissues in the body including the liver,
skin, muscle, eyes, ears, and central nervous system. More than
100 cases have been documented worldwide, mostly from the
Mediterranean region and the Middle East
Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in ...highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.
In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.
Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.
Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.
Thromboembolism in Children Öncül, Yurday; Akyay, Arzu; Özgen, Ünsal
Indian journal of pediatrics,
05/2023, Letnik:
91, Številka:
7
Journal Article
Recenzirano
Objective
To study pediatric patients who were diagnosed with thrombosis between January 2009 and March 2020.
Methods
Patients were evaluated with respect to thrombophilic risk factors, localization ...of the thrombus, response to treatment, and recurrence rates during the last 11 y.
Results
Among 84 patients, 59 (70%) had venous thrombosis and 20 (24%) had arterial thrombosis. The number of documented thrombosis amongst hospitalized children in authors’ hospital has increased over the years. It has been observed that the annual incidence of thromboembolism has increased after 2014. Thirteen patients were recorded between 2009 and 2014 and 71 patients between 2015 and 2020 (until March 2020). Exact thrombosis localization could not be detected in 5 patients. The median age of patients was 8 ± 5.95 (range 0–18). Fourteen children (16.9%) had a history of familial thrombosis. Genetic and/or acquired risk factors were detected in 81 (96.4%) of the patients. Overall, 64 patients (76.1%) had acquired risk factors such as infection (20.2%), catheterization (13.1%), liver disease (11.9%), mastoiditis (8.3%), liver transplantation (6%), hypoxic-ischemic encephalopathy (4.8%), dehydration (3.6%), trauma (3.6%) and cancer (2.4%). As genetic risk factors, the most common genetic mutations were PAI-1 4G>5G, MTHFR C677T, and MTHFR A1298C mutations. Twenty-eight (41.2%) patients had at least one genetic thrombophilic mutation. At least one homozygous mutation in 37 patients (44%) and at least one heterozygous mutation in 55 patients (65.4%) were detected.
Conclusions
The annual incidence of thrombosis has increased over the years. Genetic predisposition and acquired risk factors play an important role in etiology, treatment, and follow-up in children with thromboembolism. Especially, genetic predisposition is common. Thrombophilic risk factors should be investigated and optimal therapeutic and prophylactic measures should be promptly taken in children with thrombosis.
In children, cancer chemotherapy may impair the functioning of the cardiac autonomic nervous system. Moreover, it is not known whether there are any differences between intensive and maintenance ...phases of chemotherapy. Therefore, the aim of the current study was to assess autonomic nervous system activity using heart rate variability, in children receiving intensive or maintenance cancer chemotherapy.
For that purpose, children who were healthy (healthy control, n = 30), receiving intensive chemotherapy (chemotherapy, n = 30), and receiving maintenance chemotherapy (maintenance, n = 25) were included in the study. Autonomic nervous system activity was measured by means of heart rate variability. Electrocardiogram recordings were used to calculate time- and frequency-domain heart rate variability parameters.
Time-domain parameters such as standard deviation of NN intervals and frequency-domain parameters such as total power were lower during the intensive chemotherapy but not during maintenance phase (standard deviation of NN intervals: 50±5, 33±3, and 48±3 ms, and total power: 2613±504, 1379±296 and 2295±264 ms2, respectively for healthy control, chemotherapy and maintenance groups, P<0.001 for both standard deviation of NN intervals and total power).
The present results indicate that intensive chemotherapy perturbs the function of heart rate variability in children, with recovery during the maintenance phase. This suggests that intensive chemotherapy is likely to affect the autonomic nervous system but this effect does not appear to be permanent.
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