bluuebunny/crossref_metadata_2025 huggingface dataset:
Çocuk İstismarı Açısından Risk Grubunda Olan Psikiyatrik Engelli Çocukların Engelli Sağlık Kurulu Raporlarına Göre Engel Durumları ve Özel Eğitim Hakkı
Authors: Kaya Ahsen , Meral Orhan , Güler Hülya , Aktaş Ekin Özgür
Published: May 2015

Aim: Disabled children are a risky group for child abuse, while they mostly cannot predict the outcomes of the results of their behaviors and also they are insufficient in directing their behaviors, and cannot sift and know right from wrong. In this study, it was aimed to draw attention to the causes of disability and the disability ratios of the children with psychiatric disabilities who are at risk for child abuse.
Materials and methods: With this regard, 2839 reports belong to children under 18, those were prepared between 01 January, 2011 and 30 June, 2013 by Disabilities Health Board of the Hospital, were examined and 2103 of them included children with psychiatric disabilities were analyzed retrospectively. Data were evaluated with SPSS (version 18.0) statistical program.
Results: 1432 (68.1%) of the subjects were male, 671 (31.9%) were female, and the mean age was 6.7±4.3. The most common diagnosis for the subjects (n=911) was mild mental retardation. The first mostly stated cause of application in the reports was to have special education (95.3%).
Conclusion: Special education right, which is one of the most important social rights for children with psychiatric disabilities, is offered free of charge with his/her disability report. The state providing this right free of charge is an important step towards the protection of the children from abuse. Moreover, special education right being ranked as the first among the reasons for application to Disability Report shows that families are contributing to the protect their children from abuse -intentionally or unintentionally.
Enjeksiyon Nöropatisi Olgularına Adli Tıbbi Yaklaşım
Authors: Ünal Volkan , Ünal Esra özgün , Emir Abdurrahman , Özer Yusuf , Çağdır Sadi
Published: May 2015

Objective: Redundant injections, false administration techniques and the injections applied by unqualified personnel can cause injection neuropathy. The purpose of this study is to characterize the post-injection neuropathy cases, to identify the active ingredients used for injection and, knowing the fact that the a number of sciatic nerve injuries are secondary to medical intervention, to discuss if post-injection neuropathy can be considered as malpractice.Materials and methods: A retrospective study was conducted based on the analysis of 121 cases which were sent to the Council of Forensic Medicine from the courts with a post-injection neuropathy claim in 2008-2010. All patients were evaluated for the agent injected, indication for injection and person who injected the drug and the severity of neurodeficit.Results: It was found that 107 (88.4 %) of 121 cases sent to Council of Forensic medicine were male, 14 (11.6%) of them were female. Majority (n=93, %76.8) of the injections were applied by a nurse or health officer. Diclofenac sodium is the major injection agent. While 47 (38.8%) of the cases had only diclofenac sodium injection, with combined treatments 58 of the cases had diclofenac sodium injected. On the other hand, 10 (8.3%) of the cases were injected with analgesics, whose active ingredients couldn’t be determined from the medical records. In one case the doctor and the nurse was found responsible for the post-injection neuropathy.Conclusions: Animal testing shows that the injection neuropathy can happen because of the toxic effects of the injection agent. Even if the injection done properly, there may happen various neurological sequels, but being careful while choosing injection agent and educating medical staff should lower the rates of unwanted complications.Keywords: Injection Neuropathy, Intramuscular Injection, Malpractice
Antalya İlinde Denetimli Serbestlik Karan Alınan Kişilerde Uyuşturucu Madde Kullanımının Araştınlması
Authors: Kulaksızoğlu Burak , Kulaksızoğlu Sibel , Ellidağ Hamit Yaşar , Yılmaz Necat , Bozkurt Selen
Published: May 2015

Objective: The aim of this study is to retrospectively analyze the substance use specifications and sociodemographic data of individuals who were brought to the Clinic of Psychiatry of the Antalya Education and Research Hospital.Methods: The recorded files of the individuals in the archives of the probation unit who were referred to our hospital by the Branch Office of the Probation and Help Center (BOPHC) were retrospectively analyzed and the data obtained were recorded in the data form.Results: When the substance use among the individuals presenting to the Antalya Education and Research Hospital in between 2012 and 2014 were analyzed, substance use had increased 82% and 76% between the years 2013 and 2014, respectively. Ninety-seven percent of substance users were male with a 118% and 102% increase in marijuana use in 2013 and 2014, respectively. Morphine use increased by 43% and 42%, respectively. The frequency of substance use in females increased by 52% and 131%, respectively. The mean age of the substance users has decreased in the last three years. Fifty eight percent of the substance users in the year 2014 were single, 74% of them graduated from the secondary school, and 65% were self-employed.Conclusion: Narcotic substance use increased markedly in the last three years in the Antalya region, according to the data obtained in this study. The rate of substance use was higher when compared to the other cities. The most commonly used substance was marijuana. Substance use increased among women. The mean age of the substance users decrease. Only 14% of the substance users desired to be treated.Key Words: drug addiction, probation, Antalya, cannabis
Cinsel İstismara Uğrayan Çocuk ve Ergenlerin Sosyodemografik Özellikleri ve Ruhsal Değerlendirmesi
Authors: Koçak Uğur , Alpaslan Ahmet Hamdi
Published: May 2015

Aim: In this study, it was aimed to determine socio-demographic characteristics and psychiatric diagnoses of sexually abused children and adolescents.
Materials and Methods: The data of the sexually abused children and adolescents (n=158) who were referred to the Department of Child and Adolescent Psychiatry for a forensic report between October 2012 and May 2014 were examined retrospectively. The socio-demographic characteristics, psychiatric diagnoses, mental statuses, juridical requests, and abuser-victim relationships of the forensic cases were collected from the outpatient medical records. The cases were diagnosed using DSM-IV TR criteria.
Results: Of the 158 cases included in the study, 17.7% (n=28) was male and 82.3% (n=130) was female. Their age varied between 6 and 18 years, with a mean of 13.94 (sd±2.56) years. Vaginal penetration was the most reported type of abuse with a rate of 32.5%, followed by sexual touching (29.9%), anal penetration (22.3%) and the others. When the psychiatric diagnoses of the cases were analyzed, post traumatic stress disorder (PTSD) was the most common diagnosis with a rate of 24.1%, followed by depressive disorder (20.9%), and acute stress disorder (19.0%) respectively, 36.1% of the cases had no psychiatric diagnosis.
Conclusion: The incidence rate of child sexual abuse is increasing alarmingly in our country such as in the world. Our findings suggest that broader interdisciplinary research is needed to reveal child and adolescent sexual abuse.
Keywords: child, adolescent, sexual abuse, sociodemographic characteristics.
Tıbbi Uygulama Hatası Riski Yüksek Olan Uzmanlık Dallarının Tıpta Uzmanlık Sınavında Tercih Edilme Önceliklerinin Yıllara Göre Değişimi
Authors: Kasap Hüseyin , Akar Taner , Demirel Birol , Dursun Ahmet Zahit , Sarı Serhat , Özkök Alper , Aydemir Önder
Published: May 2015

Objective: Malpractice is defined as the illness going out of its normal course, delayed healing, death of a patient because of physicians unlawful and/or defective medical practice and treatment. The increase in the both criminal and compensation cases claiming malpractice have led the physicians to practice defensive medicine. Defensive medicine’s reflection to the "Examination for Specialty in Medicine" is that specialties withlower risk are preferred priorly.Materials and Methods: In this research it is aimed to demonstrate the change of preference priorities of specialties by physicians after the risk groups were determined relying on the ’Compulsory Liability Insurance Related to Medical Malpractice’, entered into force in 2010. According to this insurance, the group with the highest risk is 4th and the group with the lowest risk is the 1st. The base points of specialties according to 2009-2013 Examination for Specialty in Medicine (TUS) placement results were included to the research.Results: From 2009 to 2013 it was determined that second group’s base points increased gradually, third group remained stable and the fourth group decreased significantly.Conclusion: We believe that, the reason of the change of the priority of physicians is not only the rise of the violence of which the physicians are subjected to, but also, in spite of the increased number of claims braught and the amount of indemnity due to the higher risk of the medical application faults compared to other groups, the almost steady income of the physicians compared with that risks that take. While it is being discussed that defensive medicine is practiced more often each day, we demonstrated in this research that this situation is even reflected to the preferences of specialist candidates.Keywords: Medical malpractice, Defensive medicine, Examination for specialty in medicine.
Cinsel İstismara Uğrayan İşitme Engelli Çocukların Adli Süreçte Yaşadığı Zorluklar Bir Olgu Serisi
Authors: Ünver Hatice , Olgun Nesligül Nihal , Şişmanlar Şahika Gülen , Coşkun Ayşen , Biçer Ümit
Published: May 2015

Introduction: Sexual abuse means to meet sexual needs and desires of an adult with using children or adolescent. Sexual abuse was not detected in any sociodemographic groups and can be seen in every socioeconomic level. Diagnosis of sexual abuse is usually made with a history which taken from the child. Because of verbal communication is very important of evaluation in the diagnosis of sexual abuse; hearing impaired children are more abuse than other children and their inability to express themselves fell them in more risky situations.Method: In this case series; it is considering that sociodemographic characteristics and difficulties in the diagnosis and assessment process of 3 hearing impaired children who sexually abused and evaluation process will be discussed of these children.Results: Sexual abuse of children is an important public health problem that leads to long-term negative results. Therefore the training and raising awareness of professionals in the judicial process will help to evaluate more comfortable and accurate in the system of these children.Key words: Sexual abuse, Hearing impaired, Child and adolescent
Toplumsal Olaylarda Güvenlik Güçlerinin Müdahalelerine Bağlı Yaralanmaların Adli Raporlama Süreçleri Olgu Serisi
Authors: Koçar İlker , Koçyatağı Ökkeş , Kar Hakan , Bilgin Nursel Gamsız , Dokgöz Halis
Published: May 2015

Many injuries, even deaths can be seen as a result of the intervention of the security forces to protest demonstration or social events in our country.  The right of individual application to medical facilities for their health status and treatment is ensured by constitutional law and international legal regulations. Despite this assurance many problems can occur during forensic reporting process concerned with both medical facilities and judicial authorities.Key words: Social event; Protest demonstration; Injury; Individual application Forensic report.
Eskişehirde Evsiz Ölümleri 10 Yıllık Deneyim
Authors: Çelikel Adnan , Karbeyaz Kenan , Düzer Selma , Akkaya Harun , Ortanca İbrahim , Balcı Yasemin
Published: May 2015

Objective: Homelessness is a major social problem that can be seen in all societies. The causes of homelessness indicate changes according to the society. Eskişehir is in the western region of the Anatolia, where is known as high socioeconomic level and a student city. The aim of this study is to present the homeless deaths data by analyzing and comparing with the literature in Eskişehir.Materials and Methods: We retrospectively analyzed 3108 autopsy between 2004 and 2013 in Eskişehir. Considering autopsy reports and judicial investigation identified 34 homeless deaths and included in the study.Results: Ten years period covered and it was found that 1.1% of the forensic deaths were homeless death. The cases were mostly 40-50 age group (38.2 %) and 91.2% were male. It was determined that 61.8% died of the natural reasons.Conclusion: Consequently, this study demonstrated that homelessness is a problem in our city. A significant portion of the homeless people is passed away from curable and preventable reasons. To prevent homeless deaths, homeless people should be recorded and be supported health and social lives. Investigations must be carefully analyzed in homeless deaths. Autopsy and necessary tests should be performed.Keywords: Homeless, Forensic medicine, Autopsy.
Başkent Üniversitesi Ankara Hastanesi Acil Servisine Başvuran Adli Nitelikteki Çocuk Olguların Değerlendirilmesi
Authors: Büken Erhan , Yaşar Zehtiye Füsun
Published: May 2015

Objective: This study has been carried out in order to determine the demographic properties, application reasons and qualifications of the legal reports prepared of the forensic cases in the group of 0-18 ages that applies to the Emergency Service of Başkent University Ankara Hospital and to compare the data obtained with similar studies.Materials and Methods: Sample of this study which has a descriptive characteristic is compose of 2397 forensic notification reports prepared between the dates of 01/01/2013-31/12/2013 in the Emergency Service of Başkent University Ankara Hospital. The study includes the evaluation of664 reports of the children.Results: The cases of children between 0-18 years who applied to Children Emergency Service constitute 27,70% of all forensic reports. 316 (45,0%) of the children are girls and 348 (49,5%) are boys. The highest rate of the cases is seen in 0-6 year group with 402 (50,54%) children. When we look at the distribution of the ty pe of the case regardless the gender, it is observed that the emergency services are applied for bum cases at most (n:218,32,83%) and this is respectively followed by the poisoning (n: 119, 17,92%), falling down (n: 77, 11,60%), traffic accidents (n: 70.10,54%) and swallowing foreign object (n: 63, 9,49%) cases. When the type of the cases are assessed considering the gender, it is seen that burn comes first in the girls with 39,55% and in boys with 27,87%.Conclusion: Accidents constitute a major part of the preventable health problems in childhood. The injuries that occur as a result of such accidents and have a forensic characteristic happen generally in consequence of home accidents. In order to prevent the children accidents, taking necessary security measures in the living spaces is seen as an effective method to decrease the risks of accident.Keywords: Forensic case, Child, Accident, Precaution.
1306 Nazal Kırıklı Olgunun Adli Rapor Sürecinin Değerlendirilmesi
Authors: Karbeyaz Kenan , Düzer Selma , Düzer Sertaç , Balcı Yasemin
Published: May 2015

Objective: Nasal fracture is frequently seen in facial region traumas due to its anatomical properties and location. Some problems are encountered during report process of nasal fracture patients in Judicial Medicine Director Office. In this study, we have aimed to emphasize the evaluation of nasal fractures for judicial traumatology and the any problem during judicial reportprocess.Materials and methods: Between 01 June 2011 and 31 May 2014, 24306 judicial report which ordered by Eskişehir Judicial Medicine Director Office were investigated and then, 1306 patients with nasal fracture were evaluated retrospectively and included to the study.Results: Totally 2104 correspondences were performed for report preparation according to trauma’s degree in 1306 patients. Additional document, graphy and consultation were requested once in 764 patients and twice in 17 patients. The ages and sex of the patients were found similar with the literature.Conclusion: We concluded that the employment of Judicial Medicine Specialists should be increased in health institutions in long term and judicial medicine director offices should be integrated to the databases of health institutions in cities in short-term.Keywords: Nasal fracture. Judicial report. Trauma.
Considerations on Liver Injuries Caused by CPR Case Presentation
Authors: Ioan Beatrice , Hanganu Bianca , Neagu Marius
Published: May 2015

Cardiac arrest is a life-threatening condition which requires fast maneuvers for saving the victim’s life. Cardio-pulmonary resuscitation (CPR) is one of the easiest and handiest maneuver which proved many times to be savior even though sometimes it could worsen the victim’s prognosis. In this paper the authors present the case of a 75-year old male, with a significant medical history and long term thrombolytic treatment who suffered a witnessed cardiac arrest. The emergency team who arrived at the victim’s home initiated the CPR and transported him to the hospital. The electrocardiogram showed inferior-lateral acute myocardial infarction and the cardiologist in the emergency room decided to transfer him to another hospital for specialized treatment. Despite the fact that the CPR was continued in the ambulance in order to maintain the cardiac activity, the blood pressure decreased gradually and he died couple of hours later. Internal examination at the autospy revealed multiple injuries caused by the cardiac massage: rib and sternum fractures, massive intraperitoneal bleeding, liver laceration and contusion. This paper brings to the attention of the physicians the issue of the iatrogenic injuries following the CPR and the possibility for these injuries to contribute to thanatogenesis. The authors also analyze the factors influencing the quality of the life-saving procedures and the role of the pathologist in establishing the correct cause of death taking into the gravity of the CPR related injuries.Keywords: CPR, liver injury, death
Geç Dönemde Gebeliğin Sonlandırılmasının Bir Nedeni Olarak Dev Antenatal Hidronefroz Fetal Otopsi Olgusu
Authors: Hasanov Adalat , Musayev Jamal , Karimova Ilaha , Zeynalov Hikmat
Published: May 2015

The late termination of pregnancy constitutes the important medical and ethic problems around the world. There should be serious medical and social indications for termination of pregnancy in this period. Here, a case of late termination of pregnancy with the request of the parents due to antenatal hydronephrosis was presented. Antenatal hydronephrosis does not constitute a serious indication for late pregnancy termination because of its spontaneous regression and the availability of treatment options postnatally. The termination of pregnancy due to such reasons is risky, especially in late period of pregnancy, which abortion complications are frequent. In this regard, giving sufficient information about presented disease, its course and treatment to future mother and her family by healthcare workers is important.Key words: Antenatal hydronephrosis, fetus, autopsy, ultrasonography.
Fat Embolism After Surgery for Gynecomastia
Authors: Grozeva Maria , Gornev Radoswet , Mitova Vania , Hadjiev Rossen , Zashev Miroslav , Penchev Dimitur
Published: May 2015

Gynecomastia is a benign enlargement of the male breast, secondary to gland proliferation and is a common problem among the male population. Treatment is primarily surgical. The most common intra- and postoperative complication is bleeding, followed by seroma, infection, insufficient results, inverted nipple and nipple necrosis. The embolism is one of the non-specific complications. A 24-year-old male was presented to the Surgery Department with a diagnosis unilateral gynecomastia. The operation proceeded without complication and around 10 hours later, the patient complained of weakness in all four limbs, later nausea, and vomiting and after full cardiopulmonary resuscitation, the patient died. The main reason for the patient’s death was concluded to be a postoperative pulmonary thromboembolism and fat embolism was discovered. In addition, there was a papillary carcinoma of the thyroid, which was missed before. We reported that unilateral gynecomastia associated with papillary carcinoma of the thyroid detected rarely at autopsy and fat embolism after surgery for gynecomastia is a rare complication.Key words: Gynecomastia, fat embolism, autopsy
Hatay’da Seri Cinayetler Olgu Serisi
Authors: Ortanca İbrahim , Demirkıran Dua Sumeyra , Çelikel Adnan , Arslan Muhammet Mustafa
Published: May 2015

There is not any case report in Turkey on serial murders. In this paper, we aim to present a serial murder case in which five people were killed in a row of three different incidents, and discuss it comparing with literature.In the first incident, a man making love with a woman in his car was shot dead by two men one with mask, while the woman was released. The second and third events occurred also in the same manner however both men and women were killed. All five victims were killed in their cars at a desolate area and they were fired from outside the car. All were making love witli their partners in the car atthat momentTherefore these five murders are included in the definition of serial murder “unlawful killing of two or more victims by the same of fender (s) in separate events”. According to characteristics of suspects and common features of victims, murders can be classified as “mission” or “visionary” type.Keywords: Serial murders, Hatay, Turkey, Forensic medicine.
According to plan? disaster risk knowledge and organizational responses to heat wave risk in london, uk
Authors: Abeling Thomas
Published: May 2015

This paper explores how disaster risk knowledge shapes local heat wave risk management in London, UK. Its focus is on the implementation of the UK National Heatwave Plan through public sector organizations in London. Empirical evidence stems from 49 semi‐structured, expert interviews with risk managers from local authorities, and health and social care organizations in London. Findings suggest that the National Heatwave Plan is an important source of disaster risk knowledge, but that it has not been successful in steering sustainable change in the way that heat risk is planned for at the local level. The plan is perceived locally as a public health strategy focused on emergency response. This reinforces local heat wave planning approaches that are enacted through public health and that prioritize short‐term response actions, rather than long‐term preventive strategies. This paper argues that the provision of disaster risk knowledge can undermine paradigm shifts in local risk planning if it constrains consideration of alternatives to existing risk management approaches.
Viscoelastic Creep of Eagle Ford Shale: Investigating Fluid/Shale Interaction
Authors: Miller Guindon Leah
Published: May 2015

In this viscoelastic model, shale creep deformation was characterized and rheological models were developed. It not only addressed instantaneous, transient, and long-term sample deformations, but also enabled the estimation of proppant-embedment depth during production. Creep deformation was most pronounced when water impregnated the shale; decaneimpregnated samples produced less creep deformation; and the least creep was measured when shale was dry. The theory of linear viscoelasticity was used to model the samples’ time-dependent deformation.
Treatment of cyanotic heart diseases in children
Authors: Jovanovic Ida , Parezanovic Vojislav , Ilic Slobodan , Hercog Djordje , Vucicevic Milan , Djukic Milan , Vulicevic Irena , Brajkovic Zoran , Vukomanovic Goran , Ilisic Tamara , Mimic Branko , Milincic Zeljka , Simeunovic Slavko
Published: May 2015

Cyanotic heart diseases are relatively rare, but they are severe and
heterogeneous congenital heart diseases, which require complex surgery.
Development of different advanced surgical procedures, such as arterial
switch operation (ASO), Fontan and its modifications, Norwood etc.
operations, as well as better perioperative care significantly improved
survival rate and quality of life of these children. The study group included
308 children treated for cyanotic heart disease in Yugoslavia, in the period
January 2000 to July 2004. Some of them (239, 77.6%) were treated at the
University Children?s Hospital in Belgrade, and others (69, 22.4%) in
different institutions abroad. The age of the operated patients varied
between 1 day and 19 years (median 12 months). The patients (pts) were
divided into four groups, according to the disease and type of the operation.
In the whole group of 308 patients treated due to cyanotic heart disease,
there were 232 (75.3%) cases with open heart surgery and 76 (24.7%) with
closed procedures. The mortality rate was significantly different between
disease/operation groups, and age groups. Average mortality rates differed
from 11.8% for palliative procedures to 12.5% for complete corrections.
Mortality rate and achieved surgical results in treatment of chil?dren with
cyanotic heart diseases were significantly worse than those published by
leading cardiac surgery centers in the world. However, there is a clear
tendency in introducing new surgical procedures, lowering the age at which
the operation is done and decreasing the mortality rates.
Surgical management of developmental disorder of the hipin older children by double osteotomy of the pelvis
Authors: Brdar Radivoj
Published: May 2015

Our results of surgery of developmental disorder of the hip (DDH) in older
children and adolescents by using the combination of Selter?s innominate
osteotomy and osteotomy of the superior pubis ramus were presented in this
paper, enclosing the period from 1993 to 1995. The study included 11 hips,
i.e. 9 patients, aged 8 to 23 years, mean age 13 years at the time of
surgery. The mean follow-up period was 8 years. Combined osteotomy was very
efficient, what was verified by X-ray findings, confirming the Wieberg?s
and acetabular angles, as well as by clinical range of hip motion and gait.
In comparison to other similar osteotomies, this method is simpler, less
traumatic and carries lower risk.
Value of rapid test for identification of beta hemolytic Streptococcus antigens in children with Streptococcal pharyngitis
Authors: Nestorovic Branimir , Laban-Nestorovic Suzana , Paripovic Veselinka , Milosevic Katarina
Published: May 2015

Beta-hemolytic group A streptococcus (Streptococcus pyogenes) is the most
common bacterial agent associated with the upper respiratory tract infections
in humans. The most frequently group A streptococcus-associated disease is
pharyngitis. Males and females are equally affected by group A streptococcus.
There is seasonal increase in the prevalence of group A
streptococcus-associated pharyngitis. Streptococcal pharyngitis is most
prevalent in winter and early spring with higher incidence of disease
observed in crowded population such as school children. Early diagnosis and
treatment of group A streptococcal pharyngitis has been shown to reduce the
severity of symptoms and further complications such as rheumatic fever and
glomerulonephritis. The conventional methods used for identification of group
A streptococci depend on isolation and identification of the organism on
blood agar plates. These methods usually require 18-24 hours of incubation at
37?C. Such delay in identifying the group A streptococcus has often made
physicians to administer therapy without first disclosing the etiological
agent. Development of immunologic tests, capable of detecting the group A
streptococcal antigen directly from the throat swabs, produced rapid test
results employed for better treatment of patients. STREP A test is a rapid
immunochromatographic test for the detection of group A streptococci from
throat swabs or culture. The accuracy of the test does not depend on the
organism viability. Instead, group A strep antigen is extracted directly from
the swab and identified using antibodies specific for the group A
carbohydrates. We compared rapid test with conventional throat swab in 40
children, who met Centor criteria for streptococcal pharyngitis (absence of
cough, high fever, purulent pharyngitis, enlarged and painful cervical lymph
nodes). Overall congruence of rapid test and culture was 94%. Test is easy to
perform and it is recommended as the first diagnostic test for management of
children with streptococcal pharyngitis. In children with negative test, but
with characteristics highly suggestive of streptococcal infection, throat
culture should be performed.
Erythromycin-resistant Streptococcus pyogenes
Authors: Lazarevic Gordana , Laban Suzana , Jovanovic Milica , Potkonjak Biljana
Published: May 2015

Streptococcus pyogenes is the most prevalent cause of tonsillopharyngitis in
children. The drug of choice for infections caused by this microorganism is
penicillin. The problem of treating such infections arises when
erythromycin-resistant strains occur. The aim of the study was to determine
the prevalence of Streptococcus pyogenes resistant to erythromycin. The
organism was recovered from the pharynx of children hospitalized or treated
on outpatient basis at the University Children?s Hospital in Belgrade.
Streptococcus pyogenes was identified on blood agar, using bacitracin disc,
and confirmed by latex agglutination test (Slidex bioMerieux). Disc diffusion
test was carried out to estimate the penicillin resistance. Erythromycin disc
was used as screening method to detect erythromycin-resistant Streptococcus
pyogenes. MIC for erythromycin was performed by broth dilution method. In the
study period from January 2001 to December 2003, all 1100 isolates of
Streptococcus pyogenes had usual level of penicillin sensitivity. In 2001,
only 0.45% of isolates were erythromycin-resistant. In 2002, erythromycin
resistance was 0.63%, while in 2003, it was 1.09%. MIC for erythromycin was
from 1 to 128 mg/l. Three strains had constitutive and one strain had
inducible resistance to clindamycin. According to the results, our conclusion
is that, despite sensitivity to penicillin, resistance to macrolides is the
emerging phenomenon. Reasonable use of macrolide antibiotics is necessary to
maintain the resistance at the lowest level.
Congenital hiatus hernia associated with reflux esophageal stenosis
Authors: Sindjic Sanja , Lukac Marija , Lukac Radoslav , Radlovic Nedeljko , Lekovic Zoran , Jesic Milos , Maglajlic Svjetlana , Mandic Marija
Published: May 2015

A small group of three patients presented in our study represents
extraordinary and very complicated problem of congenital hiatus hernia in
infant period from 6th to 9th month of life, associated with gastroesophageal
reflux and consecutive esophageal stenosis. There are two very rare and
delicate entities within differential diagnosis, in the domain of the same
pathology: congenitally short esophagus and congenital esophageal stenosis;
with completely different surgical options for their treatment. That is why
an optimal diagnostics and an adequate operative technique are extremely
important for the treatment of hiatus hernia. The upper gastrointestinal
barium radiography is definitely the method of diagnosing hiatus hernia,
which provides typical, almost pathognomonic image of hiatus hernia
accompanied by the esophageal stenosis. Nissen fundoplication is the
technique of choice for its surgical treatment, with gastrostomy for probable
postoperative esophageal dilatation. The results are more than satisfying:
early peroral feeding, with spontaneous resolving of esophageal stenosis,
which significantly diminishes the need for esophageal bougienage.
Paralysis plexus brachialis - diagnostics and prognostics protocol
Authors: Petronic Ivana , Markovic Milena , Cirovic Dragana , Dzamic Dragana , Marsavelski Ana , Nikolic Gordana
Published: May 2015

Traction injuries of the brachial plexus, if obstetrical, are diagnosed
immediately upon birth based on clinical features, while the type and the
degree of injury are confirmed by neurophysiological examination. In such
cases, physical therapy is promptly applied and followed up until the age of
three months, when, after consultation with neurosurgeon, either physical
therapy is continued or surgery is performed. In traumatic injuries, based on
clinical, neurological and neurophysiological findings, necessary surgical or
pre- and postoperative physiatric interventions are performed. Timely
diagnostics and therapy of brachial plexus injuries, followed by recovery of
paralytic muscle motor function, enable motion coordination and prevention of
contractures. From 2000-2004, 181 cases of brachial plexus birth trauma and
26 cases of brachial plexus traumatic lesions were diagnosed and treated in
our institution. Among patients, there were 107 boys and 74 girls with birth
injury of the brachial plexus, and 16 boys and 8 girls with traction injury
of the brachial plexus sustained in traffic accident. Physical treatment
involved combined thermo-, electro-, and kinesitherapy, with alignment of
extremities. Upon completion of any treatment session and clinical and
neurophysiological examinations, doctors? consultation determined whether to
continue with physical therapy or to perform surgery followed by physical
therapy with rehabilitation until achieving the maximal motor recovery. The
analysis of results showed that functional and motor recovery was best if
therapy was initiated immediately after the obstetrical injury or following
the surgery. Therapeutic approach was individualized and depended on the
level and degree of lesions. Thus, maximal motor and functional recovery of
the injured extremity was achieved, with work therapy and professional
orientation of such patients.
Cystic neck growth in children
Authors: Trifunovic Branislav , Zamaklar Dragan , Parabucki Dragoslav , Rakic Ivan , Milosavljevic Marko
Published: May 2015

The treatment of cystic neck lesions in 105 patients hospitalized in our
institution over last 5 years was analyzed retrospectively in this study. The
most frequent lesion was medial cyst of the neck, manifesting in almost 50%
of patients. Lateral cysts, dermoid cysts and cystic hygroma were found in
25%, 10% and 8%, respectively. Although congenital in origin, clinical
manifestation of medial cervical cyst occurs usually in preschool and
particularly in school period (average 6 year). Cysts of the neck were
present in male and female equally. The most frequent complication in early
postoperative period was hematoma. During three-year follow-up there was
neither recurrence nor malignant alteration.
Impact of lower urinary tract dysfunction treatment on frequency of urinary tract infection in children with vesicourinary reflux
Authors: Radojicic Zoran , Vukadinovic Vojkan , Djordjevic Miroslav , Scepanovic Dusan , Cirovic Dragana , Krstic Zoran , Perovic Sava
Published: May 2015

Correlation between lower urinary tract dysfunction, urinary tract infection
(UTI) and vesicoureteral reflux (VUR) is complex and well known. The impact
of lower urinary tract dysfunction treatment on frequency of UTI in
children with VUR was assessed in our study. Lower urinary tract dysfunction
was diagnosed in 32 girls and 4 boys; 19 (53%) of them had VUR in 24 kidney
units. All patients were on chemo-prophylaxis and were advised how to
restore regular voiding and assume normal posture, in order to reach an
optimal relaxation of the pelvic floor during voiding. Eight patients (42%)
with signs of hyperactive bladder and/or small bladder capacity were
administered anticholinergic-oxybutynin (0.2 mg/kg of body weight). Eleven
patients (58%) with sign of bladder-sphincter dysfunction and/or residual
urine volume over 20% were treated by alfa-blocker-alfuzosin (0.1 mg/kg of
body weight). Four children with constipation were advised to use fiber-rich
diet. During 12-mount follow-up, none had febrile UTI, and 7 (37%) had 1 to
3 UTI without temperature. In conclusion, conservative treatment of VUR
should include chemo-prophylaxes, lower urinary tract dysfunction treatment,
and treatment of constipation, what was confirmed by our study as well.
Refractory convulsive status epilepticus in childhood
Authors: Dimitrijevic Nikola , Bogicevic Dragana , Nikolic Dimitrije , Mitic Vesna , Vunjak Nevenka , Rsovac Snezana
Published: May 2015

Refractory convulsive status epilepticus (RCSE) is life-threatening
condition, with seizures lasting over one hour and not responding to first
and second-line anticonvulsant drug therapy. Any mistreatment or delayed
proper treatment significantly increase mortality and neurologic sequelae.
First line drugs for convulsion ceasing are benzodiazepines, phenobarbital
and phenytoin. In case of refractory status, infusion of midazolam and
general anesthesia should be administered. The most important measures of the
intensive care are control of vital functions, homeostasis, prevention and
therapy for possible brain and systemic complications. Discovery of etiology
of status epilepticus is highly important because symptomatic therapy should
be administered. Overall mortality rate during RCSE is 13.5%, and is much
higher in acute symptomatic group - 28.6%. Early sequelae rate is 40.6%,
27.3% and 70% in idiopathic and acute symptomatic groups, respectively.
Laparoscopic appendectomy in children - new fashion or privilege
Authors: Golubovic Zoran , Janic Nenad , Jovanovic Branislav
Published: May 2015

Whether laparoscopic appendectomy is superior to open appendectomy for simple
and perforated appendicitis in children is still debatable. To answer this
question, surgical experience of three experienced pediatric surgeons in a
single institution was studied during one year in all cases of laparoscopic
appendectomy. From January 2003 to January 2004, all laparoscopic
appendectomies were reviewed for operative technique, advantages,
disadvantages, operative time and length of stay. There were 44 laparoscopic
appendectomies in children aged 4 to 19 years. Operating time dropped from 52
minutes at the beginning to less than 25 minutes at the end of year.
Operating time in perforated appendicitis was slightly longer, from 58-65
minutes. Length of stay was 1-2 days for simple cases, and maximum 5 days for
perforated ones. There were no postoperative complications such as abscess,
bowel obstruction, bleeding, wound infection or mortality. Laparoscopic
appendectomy is at least as safe and effective, if not superior to, as open
appendectomy for both, simple and perforated appendicitis. Postoperative pain
is less, and recovery is faster. Laparoscopic appendectomy is our procedure
of choice in pediatric surgery.
Persistent hyperinsulinemic hypoglicemia of the neonate
Authors: Maglajlic Svjetlana , Jesic Milos , Necic Svetislav , Lukac Marija , Sindjic Sanja , Jesic Maja , Vujovic Dragana
Published: May 2015

Persistent hyperinsulinemic hypoglicemia of the neonate is a rare
heterogenous disease (clinically, histologically, metabolically and
genetically), which is characterized by inadequatly high insuline rates in
the presence of severe hypoglicemia. Hyperinsulinism, rather a syndrome than
a disease, of which the main metabolic feature is hypoglicemia and decreased
concentration of free fatty acids and ketones in serum (insulin inhibits
lypolisis and sinthetizes ketonic bodies), presents a major diagnostic and
therapeutic chalenge. The disease is often followed by brain atrophy
contributed by the attacks of hypoglicemia. It is inherited as an autosomally
recessive and autosomally dominant disease. The genetic defects is located on
the short arm of the chromosome 11. The authors report a successfully applied
conservative treatment in a neonate with persistent hyperinsulinemic
hypoglicemia.
The benefit of plasma exchange in anuric patient with steroid-resistant nephrotic syndrome - long-term follow-up
Authors: Peco-Antic Amira , Marsenic Olivera , Kruscic Divna , Kostic Mirjana , Golubovic Ema
Published: May 2015

Recently, plasma exchange (PE) has been added to the treatment regimen for
patients with steroid-, cyclophosphamide-, and cyclosporine-resistant
nephrotic syndrome. This is a case report of a female patient with severe
acute renal failure (ARF) during the relapse of steroid-resistant nephrotic
syndrome (SRNS) who recovered completely after PE and became
steroid-sensitive in further follow-up of 48 months. An 8-year-old girl was
referred to Nephrology Department of the University Children?s Hospital due
to relapse of SRNS complicated with ARF. Her nephrotic syndrome
(mesangioproliferative glomerulonephritis) was diagnosed at the age of 17
months. During the following 6 years, she was given several therapeutic
regimens including pulse prednisolone, cyclophosphamide, Cyclosporine (CyA),
but she continued to have frequent relapses and during the last six months
she was steroid- and cyclosporine-resistant. Three days before admission, she
was febrile, had cellulites of the lower abdominal wall, diarrhea, vomiting,
hypovolemic shock with generalized edema, severe hypoproteinemia and
hypoalbuminemia. In a local hospital, she was treated with fresh frozen
plasma, albumin, methylprednisolone, furosemide and antibiotics, but she
became anuric and was referred to our hospital. There were no signs of
hemolysis. Anuria lasted for 12 days. She was discharged after 42 days in
remission with normal GFR. Principal treatment included: 13 sequential
hemodialysis sessions (30% of body weight was removed as excess volume), 6
PE, corticosteroids, CyA, ACE inhibitor, antibiotics, antimycotics, and
cimetidine. Six PE sessions were performed every other day. In further
48-month follow-up, while under the treatment of CyA the patient had a few
steroid-sensitive relapses, the first being 6 months after PE. The second
kidney biopsy showed focal segmental glomerulosclerosis with no signs of
apparent CyA nephrotoxicity. ?Malignant? course of disease in our patient was
a good reason to introduce PE into the treatment. Since PE was the only
additional mode of treatment, it is believed that its effect was crucial for
milder activity of the disease.
Nonclassic congenital adrenal hyperplasia resulting from 21-hydroxylase deficiency
Authors: Jesic Maja , Jesic Milos , Sajic Silvija , Maglajlic Svjetlana , Necic Svetislav , Bojic Vladislav
Published: May 2015

Nonclassic CAH, also termed as late onset of CAH, is a very mild form of
21-hydroxylase deficiency. The incidence of disease is estimated at 0.1% of
population. Nonclassic CAH is usually diagnosed in the childhood before the
age of 6 to 8 years as premature pubarche. The disease is not common in the
infants and usually not before 6 to 8 months. This is a case report of
7-month female infant who was suspected of mild hyperandrogenism because of
premature pubarche. The diagnosis was confirmed by mild basal elevation of
17-OHP (5.55 ng/ml) and characteristic hyper-response to ACTH, reaching
values of 21 ng/ml, as well as accelerated bone maturation. The conventional
treatment of NCAH was initiated, with glucocorticoid therapy (hydrocortisone)
for one year and a half. After that period, our decision was to discontinue
the hormonal therapy because of the impression that hyperandrogenism was mild
(mild deficiency of the enzymes for steroid hormone synthesis). Child?s
growth, development and maturation are under constant control.
Rubinstein-Taybi syndrome
Authors: Grkovic Slobodanka , Jesic Milos , Jesic Maja , Maglajlic Svjetlana
Published: May 2015

Rubinstein-Taybi syndrome is a malformation occurring with approximate
incidence of 1 per 10.000 live-born children. The diagnosis is usually based
on specific facial dysmorphism in neonatal period, as well as on
characteristic deformities of the hands and feet. Our study presents a male
child who was diagnosed to have Rubinstein-Taybi syndrome when he was one
month old. The child had all characteristic clinical features. In further
follow-up period, corrective surgery and control of his psychomotor
development are being planned.
Occult spinal dysraphia - a case report
Authors: Raicevic Mirjana , Abramovic Dusan , Mihajlovic Miljan , Petronic Ivana , Vidosavljevic Marko
Published: May 2015

One of the most complex and most difficult congenital anomalies is spina
bifida. Peter Van Forest was the first one who noticed this anomaly in 1587,
and Recklinghausen, in 1886, classified spina bifida to types and suggested
surgical procedures for its management. Earlier name, spina bifida, is
currently more and more replacing with a term ?defect of neural tube? (NTDs),
or even more, ?spinal dysraphia?. Anomaly can appear at any level of spinal
cord (cervical, thoracal, lumbar and sacral) and posterior localization is
more often than the anterior one. Contrary to the open spinal dysraphism that
can be perceived immediately, closed spinal dysraphism is very deceiving
anomaly, and therefore, it must be treated properly as soon as it is
diagnosed. Because of its seclusion, the term usually used is ?occult spinal
dysraphism (OSD)?. The incidence of this anomaly is unknown, but it has been
reported that it is more common among female children. Etiology of OSD is
also unknown, but some of its risk factors are as follows: previous pregnancy
with NTD, partner with NTD, type 1 diabetes mellitus, usage of
anticonvulsives, a lack of folates in mother?s nutrition. Prenatal diagnose
of OSD is practically impossible. Skin changes, orthopedic, urological and
neurological problems, suggest considering this complex anomaly. X-ray, ECHO,
MRI, as well as neuropsychological examination corroborate diagnosis. At the
same time, the diagnosis (once it is confirmed) represents the indication for
neurosurgical treatment.
Topical events in physical treatment of pediatric neuromuscular disorders
Authors: Nikolic Gordana , Marsavelski Ana , Petronic Ivana , Dimitrijevic Nikola , Bogicevic Dragana , Nikolic Dimitrije
Published: May 2015

Physical treatment plays very important role in treatment of children with
neuromuscular disorders. It is usually symptomatic and preventive, not being
usual, except in children with cerebral palsy. Physical treatment of children
with neuromuscular disorders is specific because good clinical knowledge as
well as additional education for application of procedures is required during
treatment with final evaluation of the achieved results. In fact, whole
scientific philosophy is needed since natural development of child with
neuromuscular disorders is in close correlation with the degree of
retardation that may vary from one disease to another in relation to child?s
age as well as to clinical presentation of the disease. Upon neurological
diagnose and medicamentous treatment, different physical procedures are
applied in order to achieve the best possible results in motor development
and in psychic and social reeducation as well.
The criteria for verifying brain death in children
Authors: Simic Dusica , Petkovic Milos , Kovacevic Irina , Budic Ivana
Published: May 2015

The American Committee, followed by the British, consisting of experts in
various fields, in 1968 and 1976, respectively, reached the following
consensus: ?If a brain stem is dead, a brain is dead, if a brain is dead, a
person is dead...? In the last few years, definition of brain death was
necessary due to organ transplantation. Most of criteria verifying brain
death do not include the specific determinants of brain death in children.
This paper specifies the most up-to-date guidelines for diagnosis of brain
death in children of various ages.