Pediatric cancer patients have an increased risk of potentially life-threatening fungal infections such as Candida parapsilosis, associated with long-term CVADs. The Infectious Diseases Society of America (IDSA) guidelines on Candida catheter-related bloodstream infections recommend systemic antifungal therapy and catheter removal. In this study, we focused on our experience with antifungal failure due to totally implanted catheter-associated C. parapsilosis bloodstream infections. We investigated cases leading to port removal in pediatric malignancy patients and the associated patient outcomes. In the first phase of the study, a retrospective chart review was performed to collect patient information, including primary disease; time from hospitalization to port-related candidemia; antifungal drug choice; and the time at which port removal occurred. During the second phase, antifungal susceptibility tests for C. parapsilosis were performed in our microbiology laboratory. All patients had fevers and were neutropenic at the time of candidemia diagnosis. The mean duration between the first isolation of Candida parapsilosis from the port samples to the port removal was 9.75 ± 5.29 days for 11 patients. Patient fevers lasted for a mean time of 16.22 ± 6.51 days. The median recovery duration from fever after CVC removal was four days (range 2-12 days). The median duration for achieving negative blood cultures, following antifungal treatment was 18 days (range 10-27 days). Our data favored the removal of catheters in the presence of ongoing fever, as suggested by the guidelines, independent of the chosen antifungal treatment. Future studies with large samples are needed to evaluate the effects of catheter removal on mortality rates and patient outcomes.
Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent attacks of fever and polyserositis. It is the most frequent periodic fever syndrome. In FMF, sterile peritonitis, pleuritis and arthritis are frequently seen in addition to recurrent febrile attacks. Skin and muscle involvement is less common. Here, we report four patients presented with skin lesions or myalgia. Most striking findings in those patients are the absence of other major criteria for FMF and dominancy of skin lesions or myalgia. All four patients had MEFV gene mutations on both alleles. In patients with erysipelas-like lesions or erythema nodosum along with arthritis/arthralgia or recurrent myalgia, FMF should be kept in mind.
A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : It has be en shown that many chil dren who ex pe ri en ce res pi ra tory syncyti al vi rus (RSV) in fec ti on in in fancy de ve lop re cur rent whe e zing epi so des and ast hma la ter. Viral ro le in pat ho ge ne sis of ast hma is still a de ba te. We ai med to in ves ti ga te the re cur ren ce of whe e zing epi so des, atopy and se rum cyto ki ne le vels in chil dren en co un te red with RSV in fec tion. Ad di ti o nally, we ai med to com pa re the se pa ra me ters in chil dren with non-RSV bronc hi o litis. M Ma at te er ri ia al l a an nd d M Me et t h ho od ds s: : The study was con duc ted bet we en Ja nu ary 2006 and No vem ber 2008 in Do kuz Ey lul Uni ver sity hos pi tal. Se venty chil dren aged bet we en 0-36 months who we re diag no sed with acu te bronc hi o li tis for the first ti me we re rec ru i ted for the study. Na sop hary ngeal la va ge flu id was analy zed with poly me ra se cha in re ac ti on (PCR) for RSV an ti gen in all pa ti ents. Se rum im mu nog lo bu lin E, to tal eo si nop hil co unt, in ter le u kin (IL)-4, IL-13 and γ-in terfe ron (IFN-γ) le vels we re ob ta i ned at the last exa mi na ti on of the pa ti ents af ter a fol low up pe riod of 1-3 ye ars. R Re e s su ul lt ts s: : Re cur ren ce of a whe e zing epi so de was ob ser ved in 35% and 53.3% of the pa ti ents in RSV gro up and non-RSV gro up, res pec ti vely (p= 0.064). Me an se rum IFN-γ and IL-4 le vels we re de tec ted to be sig ni fi cantly hig her in non-RSV gro up. No sig ni fi cant re la ti on was de tec ted bet we en re cur ren ce of whe e zing epi so des and to tal eo si nop hil co unt, se rum IgE, IL-4, IL-13, and IFN-γ le vels. C Co on nc c l lu u s si i o on n: : No dif fe ren ce co uld be de tec ted bet we en RSV and non-RSV bronc hi o li tis re gar ding sub se qu ent whe e zing epi so des. Alt ho ugh se rum IL-4 and IFN-γ levels we re hig her in non-RSV bronc hi o li tis gro up, no sig ni fi cant cor re la ti on was ob ser ved bet we en the se pa ra me ters and re cur ren ce of whe e zing epi so des. K Ke ey y W Wo or rd ds s: : Asthma; bronchiolitis Ö ÖZ ZE ET T A Am ma aç ç: : Süt çocukluğu döneminde respiratuvar sinsityal virus (RSV) infeksiyonu geçiren çocukların daha sonra hışıltı atakları ve astım geçirdikleri gösterilmiştir. Astımın patogenezinde virüslerin rolü halen tartışmalıdır. RSV infeksiyonu ile karşılaşan çocuklarda hışıltı ataklarının tekrarlamasını, atopi ve serum sitokin düzeylerini araştırmayı ,ayrıca bu parametreleri RSV-dışı bronşioliti olan çocukların sonuçları ile karşılaştırmayı amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışma Ocak 2006 ile Kasım 2008 arasında Dokuz Eylül Üniversitesi Hastanesinde gerçekleştirildi. İlk kez akut bronşiolit tanısı koyulan 0-36 ay yaş aralığında 70 çocuk çalışmaya alındı. Tüm hastalarda nazofarenjiyal lavaj sıvısı RSV antijeni bakımından polimeraz zincir reaksiyonu (PCR) ile incelendi. Bir ila üç yıllık takip süresinden sonra hastaların son muayenelerinde serum immunoglobuli...
Iron overload is associated with an increased risk of atrial and ventricular arrhythmias. Data regarding the relationship between electrocardiographic parameters of atrial depolarisation and ventricular repolarisation with cardiac T2* MRI are scarce. Therefore, we aimed to investigate these electrocardiographic parameters and their relationship with cardiac T2* value in patients with β-thalassemia major. In this prospective study, 52 patients with β-thalassemia major and 52 age- and gender-matched healthy patients were included. Electrocardiographic measurements of QT, T peak to end interval, and P wave intervals were performed by one cardiologist who was blind to patients’ data. All patients underwent MRI for cardiac T2* evaluation. Cardiac T2* scores less than 20 ms were considered as iron overload. P wave dispersion, QTc interval, and the dispersions of QT and QTc were significantly prolonged in β-thalassemia major patients compared to controls. Interestingly, we found prolonged P waves, QT and T peak to end dispersions, T peak to end intervals, and increased T peak to end/QT ratios in patients with T2* greater than 20 ms. No significant correlation was observed between electrocardiographic parameters and cardiac T2* values and plasma ferritin levels. In conclusion, our study demonstrated that atrial depolarisation and ventricular repolarisation parameters are affected in β-thalassemia major patients and that these parameters are not correlated with cardiac iron load.
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