Aim: Nutritional B12 deficiency is a treatable cause of neurodevelopmental delay in infants. We report 21 infants with developmental regression and brain atrophy as revealed using cranial magnetic resonance imaging (MRI), secondary to severe vitamin B12 deficiency.Methods: Twenty-one infants aged 4-24 months with B12 deficiencies who were admitted to our clinic between May 2013 and May 2018 were included in the study. MRI, bone marrow aspiration and the Denver-II Developmental Screening Test were performed in all infants. Results: The mean age of the infants was 12.3 months, and the mean B12 level was 70.15 AE 32.15 ng/L. Hypotonia and neurodevelopmental retardation, and anaemia were present in all patients. Their bone marrow examinations were compatible with megaloblastic anaemia. Twelve patients had microcephaly, seven had tremor and one patient died of severe sepsis. Almost all patients were fed with breast milk and their mothers were also malnourished. Nine (42.9%) of the patients were Turkish and 12 (57.1%) were Syrian. All patients had abnormal Denver-II Developmental Screening Test scores. Most patients had severe cortical atrophy, cerebral effusion, thinning of the corpus callosum and delayed myelinisation in cranial MRI. Treatment with B12 resulted in dramatic improvement in general activity and appetite within 72 h. Tremors resolved in all cases. Conclusion: Neurological findings and developmental delay related to nutritional B12 deficiency can be prevented without sequelae if diagnosed early. Screening and treating of mothers for this deficiency will contribute to the health of both the mother and their feeding infant.

Amaç: Maraş otu (MO), tütün türlerinden olan Nicotina Rustica L. yaprakları ile meşe ve asma odunun küllerinden elde edilen, ağızda çiğnenerek kullanılan toz formunda kullanılan dumansız tütün ürünlerindendir. Bölgemizde halk arasında yaygın kullanımından dolayı çocuk vakaların erişimi kolay olmakta ve özellikle küçük yaş gruplarında ciddi intoksikasyon kliniği ile hastalar acilimize başvurmaktadırlar. Çalışmamızın amacı, acil servisimize MO' ya bağlı zehirlenme ile başvuran olguların değerlendirilmesi ve genel hatları ile bu ürünün hastalar üzerindeki etkilerinin araştırılmasıdır. Yöntem: Çalışmaya son 1 yıl içerisinde acil servisimize kazara MO yutmuş, yaşları 10 ay ile 3 yaş arasında değişen, 18 olgu dâhil edilmiştir. Hastalara ait demografik, klinik ve laboratuvar değerleri hasta dosyaları taranarak elde edilmiştir. Ek ilaç alımı olan vakalar dışlanmıştır. Veriler istatistik programına yüklenip değerlendirilmiştir. Bulgular: Çalışmaya alınan hastaların yaşları 20,5 (10-75) ay iken, bunların 10 tanesini erkek bireyler oluşturmaktaydı. Hastaların venöz kan gazı değerlerinde %33,3'ünde metabolik asidoz vardı; bu hastaların pH değerleri (7,26-7,38) iken HCO3 değerleri (16,12-20,90) mmol/L olarak değişmekteydi. Hastaların % 50'sinin laktik asit düzeyleri üst sınırlarda olup 1,9-6,10 mmol/L arasında değişmekteydi. Sonuç: MO, içerdiği yüksek nikotin oranından ve diğer maddelerden dolayı özellikle küçük yaş grubunda ciddi toksisitelere sebep olan maddelerden biri olması nedeniyle vakaların hızlıca değerlendirilip takibe alınması gerekmektedir. Anahtar kelimeler: Çocuk; dumansız tütün; Maraş otu; nikotin; zehirlenme. ABSTRACT Objective: Maras powder (MP) is a smokeless tobacco product obtained from Nicotina Rustica L., which is a type of tobacco, and the ashes of oak and grapevine, used in the form of a powder used in the mouth. Due to the widespread use among the population in our region, access to pediatric cases is easy and patients apply to our emergency department with a serious intoxication clinic especially in young age groups. The purpose of our study is to evaluate the patients who applied to our emergency department with MP-related poisoning and to investigate the general outlines and the effects of this product on patients. Materials and methods: The study included 18 cases, aged between 10 months and 3 years, who had accidentally swallowed MP to our emergency room in the past year. The demographic, clinical, and laboratory values of the patients were obtained by scanning patient files. Cases with additional drug intake are excluded. The data were uploaded to the statistical program and evaluated. Results: While the ages of the patients included in the study were 20.5 (10-75) months, 10 of them were male individuals. Metabolic acidosis was present in 33.3% of patients in venous blood gas values; while the pH values of these patients (7.26-7.38), HCO3 values (16.12-20.90) ranged from mmol / L. Lactic acid levels of 50% of the patients were at the upper limits and ranged between 1.9-6.10 mmol / L. Conclusion:...

Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening multisystem disorder. Reports of the disorder as a side effect of drugs are extremely rare. We report the case of a 3-year-old boy with a history of epileptic seizures in which oxcarbazepine was added to treatment for the last 35 days and dose had been increased. For 10 days he had a fever, hepatosplenomegaly, rash, edema and other systemic symptoms. He was diagnosed with HLH after bone marrow examination. Oxcarbazepine treatment was terminated after the intravenous immunoglobulin treatment. The next day, clinical and laboratory results had improved. This is the first HLH report of an association with oxcarbazepine. Bone marrow aspiration may be indicated to confirm the diagnosis when facing a patient with systemic symptoms after newly added antiepileptic drug treatment.

Gastrointestinal tract is one of the most common extranodal site involved by non-Hodgkin lymphomas. However, Non-Hodgkin lymphomas are seen less in the small intestine. We present here a rare condition inthe literature which is a case of bilateral adrenal masses and Burkitt lymphoma with small intestine origin. Eleven years old male patient was admitted to pediatric emergency service with acute abdomen. Abdominal USG examination revealed intussusception and bilateral adrenal masses. Emergency surgery was planned. In the surgical operation, five lesions were seen in the small intestine. Partial small intestine resection was performed. The patient was diagnosed as Burkitt Lymphoma with small bowel origin due to pathology of resection material. Non-hodgkin lymphomas with small intestine origin usually present with abdominal pain, and their prognosis depends on histological type and grade. NHL-BFM 95 chemotherapy treatment was initiated and a good clinical response was achieved, and the patient remained in complete remission for two months after completion of chemotherapy. In conclusion, Bilateral adrenal masses remain a rare form of Burkitt lymphoma and care must be taken in ruling out other causes of bilateral adrenal masses. Furthermore, with this case, we emphasize that Burkitt lymphoma should be considered in differential diagnosis of bilateral adrenal masses.