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Objective: Epilepsy is a chronic disease with high morbidity. Our study aims to investigate the scores of anxiety and depression in children with epilepsy and their mothers and the role of parental attitudes in these children. Material and Methods: The study included 35 children with epilepsy and their mothers. Control group consisted of 35 healthy children of similar age and sex to the study group and their mothers. Parenting Style Inventory (PSI), Parental Attitude Research Instrument (PARI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), Revised Children's Anxiety and Depression Scale - Parent version (RCADS-P) scales were used in the patient and control groups. Results: There was no statistically significant difference between mother anxiety and depression scores in terms of BDI and BAI scales. There were no significant differences between the total and subscale scores of the anxiety and depression in the children of study and control groups in terms of RCADS-P. Strictness/supervision subscale of PSI average was statistically significantly higher in the patient group but the Psychological Autonomy subscale average was found lower. The mean scores of Excessive Maternity and Obsession and Discipline subscale of PARI were significantly higher in the patient group. Conclusion: Mothers of children with epilepsy may be overprotective or authoritarian. Overprotective or authoritative parental attitudes in children can lead to loss of self-esteem. Therefore, besides the treatment of children with epilepsy, attention should be paid to improving the wrong attitudes of their parents. [ABSTRACT FROM AUTHOR]

Objectives: There is no consensus on the lower and upper limits of 25-hydroxyvitamin D (25-OHD) deficiency and insufficiency. We determined the (25-OHD) deficiency and insufficiency cut-off values in children. Methods: The study examined 422 children aged 0-18 years old whose simultaneous parathormone (PTH) and (25-OHD) levels were measured at the paediatric outpatient clinics of our tertiary research hospital in Istanbul from January 1, 2014 to December 31, 2017. Those without chronic diseases were included in this cross-sectional retrospective study. Results: We found that the average serum (25-OHD) level was lower in girls. There were negative correlations between (25-OHD) and PTH and age. The level that decreased PTH below the upper level was 14.42 ng/mL and the 25(OH) D level that decreased it to the lowest limit was 26.61 ng/mL. The (25-OHD) level that caused maximum suppression of PTH was 22.5 ng/mL. Conclusions: The vitamin (25-OHD) deficiency (lowest value) and insufficiency (range) cut-off should be 14-23 ng/mL for children living in Istanbul. By age subgroup, the vitamin (25-OHD) deficiency and insufficiency cut-off values are 21-31, 15-21 and 13-18 ng/mL for those 0-2, 3-6 and 7-18 years, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Radial artery occlusions (RAOs) impose an important problem that limit transradial interventions. In this study, we represent that it is possible to perform interventions through occluded radial arteries.Method: Twenty-five patients with RAO who had retrograde flow shown by doppler ultrasonography were enrolled into our study. After preparing the radial region, the radial artery was accessed with a puncture needle. A 0.014″ guidewire was introduced into the brachial artery via the radial artery with the aid of balloon back up. Lesion was predilated with a drug coated peripheral balloon, and a sheath was placed at the end.Results: Radial artery recanalization could be established in 22 of 25 cases and coronary angiography could be performed from those occluded radial arteries. Neither the occlusion duration nor the caliber of the radial artery had any effect on the success rate of recanalization attempts. Two patients had a hematoma because of the intervention and there were no other complications.The patency rates at 1 month follow up have been only 33.4%, too much lower than we expected.Discussion and Conclusion: In patients with RAO because of a previous angiographic intervention via their radial arteries may be reintervened from their occluded radial artery safely and effectively. So, our procedure is not intended for neither the recanalization nor keeping the patency of the radial artery, but suitable for those patients in whom other routes of intervention are not wanted. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to investigate the impact of serum zinc, and vitamin D levels on the development of asthma, and its clinical characteristics. Methods: In our cross-sectional study; 50 patients who were diagnosed as atopic asthma and 70 healthy children consisted the control group. In both groups levels of vitamin D, and zinc were analyzed. Results: A statistically significant intergroup difference was not detected as for age, gender, body height (percentile), and weight (percentile) of the patients (p>0.05). Mean vitamin D levels in the asthmatic patient, and control groups were 32.61±9.48 nmol/L, and 42.55±15.42 nmol/L, respectively. Between two groups a statistically significant difference was found (p=0.001). Zinc levels were higher in the control group without any statistically significant difference between groups (p=0.25). A statistically significant negative correlation (−0.635) was found between vitamin D levels, and severity of asthma in the patient group. As the level of vitamin D increased, a decrease in severity of asthma was seen (p=0.04). Conclusion: Though larger series are needed to arrive at definitive conclusions, we think that vitamin D deficiency rather than zinc deficiency, might convey importance in the emergence, and exacerbation of asthma. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to evaluate morbidity and mortality rates, and relevant effective factors among babies delivered in our hospital between January 2009 and December 2011. Methods: We evaluated the neonatal care unit data on mortality and morbidity among babies delivered between January 1st 2009 and December 31st 2011, and analyzed epidemiological data of these babies born at gestational age of >22 weeks with a birth weight above 500 gr. Results: One thousand nine hundred five live babies and 32 stillbirths were delivered in the year 2011. Twelve babies died during early neonatal period. The rates of perinatal and early neonatal mortality, and stillbirth were found to be 2.27%, 0.61%, and 1.65%, respectively. The causes of perinatal death were stillbirths (68.1%), congenital malformations (11.3%), prematurity-related factors (9%), and other etiologies (11.6%) in order of decreasing frequency. The most frequent indications for hospitalizations were neonatal hyperbilirubinemia (35.3%), and suspected sepsis (13.4%), and other etiologies. Our median mortality rate among babies delivered before the 32nd weeks of gestation within three years was 14.5%. Conclusion: Providing adequate antenatal care for pregnants, realization of deliveries under optimal conditions, and delivery of sufficient postnatal care will dramatically decrease neonatal mortality rates. [ABSTRACT FROM AUTHOR]

Acquired immune deficiency syndrome is a clinical condition caused by human immunodeficiency virus (HIV) which can be transmitted either vertically or horizontally. More than 90% of children living with HIV in developing countries have been infected through mother to child transmission during pregnancy, around the time of birth, or through breastfeeding. In order to reduce the number of infected children, increasing emphasis should be placed on preventing mother to child transmission programs with the use of antiretroviral medications in the pregnant woman during pregnancy and at delivery and, starting immediately after birth for the exposed infant. Here, we present the case of a 60-day-old infant heavily immunocompromised due to an extremely high viral burden of HIV, which was acquired perinatally from an undiagnosed and untreated mother, leading to severe bronchopneumonia, sepsis, septic shock and death. [ABSTRACT FROM AUTHOR]

Methemoglobinemia is a disease developing as a result of oxidation of iron in hemoglobin from Fe+2 to Fe+3 and causing cyanosis due to inadequate oxygen transport to tissues. We present a 36-day-old patient who developed cyanosis after receiving local anesthesia, with the intention to draw attention to the risk of secondary methemoglobinemia caused by local anesthetics in small children. A 36-day-old male patient developed cyanosis following achillotomy operation. The level of methemoglobinemia was 27.2% (N: 0-2%). The patient received oxygen therapy by a face mask and intravenous ascorbic acid. Cyanosis regressed and the methemoglobin level dropped to 1.5% at the 12th hour of treatment, thus, he was discharged. In patients with a blood methemoglobin level above 20%, oxygen therapy by a face mask and ascorbic acid and methylene blue therapies are used. Infants and prematures are more sensitive to oxidizing agents since erythrocyte NADH-cytochrome b5 reductase levels are nearly half of those in advanced ages. The risk of methemoglobinemia increases among infants younger than one year of age. Local anesthetic agents should be used in the lowest effective dose in infants younger than one year of age, and risk of methemoglobinemia should be kept in mind. [ABSTRACT FROM AUTHOR]

The prevalence of primary cardiac tumors has been reported to be between 0.19% and 0.0017%. Cardiac tumors are usually intracavitary lesions and more than 75% of them are benign. Myxomas are rare in childhood and constitute 10% of all pediatric cardiac tumors. Myxomas localized in the right ventricle are very rare in children. In this paper, we describe a 14-year-old boy with right ventricular myxoma. [ABSTRACT FROM AUTHOR]

When branchial clefts and pouches do not atrophy between 4 and 7 weeks of fetal life or when an anomalous or incomplete fusion occurs, congenital neck anomalies may develop. We present a rare case of a mass resembling a branchial sinus on the right side of the neck of a 2-month-old baby, which originated from the fourth branchial arch-derived structures and varies in size with weeping. A 2-month-old boy was brought with a complaint of a congenital swelling on his neck. His physical examination revealed a cyst on the right lower region of the neck, which swelled when he wept, and prolonged neonatal jaundice. On computed tomography of the neck, a formation consistent with a branchial cleft cyst originating from the right jugulodigastric region extending up to the right infraclavicular region and to the pyriform sinus was observed. The child was maintained under surveillance. Branchial cysts account for 30% of congenital neck cysts in children. Masses derived from the fourth branchial arch are more frequently seen on the left side. In our patient, this rare mass was localized on the right side of the neck and was diagnosed when the baby was 2 months old. During the Valsalva maneuver, pyriform sinuses fill with air passing through their orifices and consequently the size of the mass varies in size. Third and fourth branchial sinus anomalies should be considered in neck masses whose size changes with Valsalva maneuver. [ABSTRACT FROM AUTHOR]

Aim: Transcutaneous bilirubin (TCB) measurement methods cause false results during and after phototherapy (PT), so bilirubin levels are followed by total serum bilirubin (TSB) measurement, which causes taking blood samples and increases the risk of infection. We compared the TCB measurements made with Bilicare™ and TSB measurements by preventing PT exposure of a part of the skin in newborns receiving PT and evaluating the reliability of the measurements made with Bilicare™ after PT. Methods: This study was conducted between 01 February-30 June 2020 as a single-center cross-sectional study. The study included newborns aged 35 weeks and up who were admitted to a neonatal intensive care unit for PT. TSB measurements were reviewed by the hospital automation system. Bilicare™ bilirubin meter was used for TCB measurements. Simultaneous TSB and TCB measurements were made before PT. The skin area to be measured was covered with a radio-opaque patch. After PT, simultaneous TSB, exposed skin area TCB, and patched skin area TCB were measured. Simultaneous TSB and TCB measurements were repeated 24 h after the end of PT. The relationship between these data was evaluated statistically. Results: This study was conducted with 171 late preterm and term newborns with a gestational age of ≥35 weeks. 79 (46.1%) were female and 92 (53.9%) were male newborns. The mean gestational age was 38.3±1.15 weeks. When maternal and newborn blood groups were evaluated, 107 (62.5%) had no blood incompatibility, 53 (30.9%) had ABO incompatibility incompatibility, 9 (5.2%) had Rh incompatibility, 1 (0.6%) had subgroup incompatibility, and 1 (0.6%) had ABO incompatibility and Rh incompatibility. The correlation coefficient (r) of TSB and TCB measurements made before PT was 0.97 and a strong correlation was found. A correlation coefficient (r) of 0.98 and a strong correlation between closed skin area TCB measurement and TSB measurement immediately after PT were detected. The correlation coefficient (r) was 0.96 and a strong correlation was found between the TCB and TSB measurements performed 24 h after the PT was terminated. Conclusion: This study shows that TCB measurements made from unexposed areas can be safely measured in patients with PT. [ABSTRACT FROM AUTHOR]

Aim: Neonatal sepsis is a disease with multisystemic involvement accompanied by bacteremia in the first 28 days of life and in which the pathogen micro-organism spreads to different systems via the blood. Laboratory tests with high sensitivity and specificity are needed for the early diagnosis of neonatal sepsis. The purpose of this study was to investigate the effectiveness of pentraxin 3 in neonatal sepsis. Methods: This prospective clinical study was performed between November, 2015, and March, 2016, with 49 newborns diagnosed with sepsis and under monitoring at the neonatal intensive care unit and with Tollner sepsis scores of 5 or above and with 35 healthy neonates. Blood was collected from every patient diagnosed with sepsis for complete blood count, C-reactive protein, blood culture and pentraxin 3 measurements. Results: No significant difference was determined between the patient and control groups in terms of birth weight or gender. C-reactive protein, leukocyte, and pentraxin 3 levels were found to differ significantly between the healthy newborns in the control group and the septic patients. A significant correlation was observed between pentraxin 3 levels and serum C-reactive protein levels (r=0.44, p<0.05). The area under the curve was statistically significant at logistic regression analysis (area: 0.782). Conclusions: The data from our study show that pentraxin 3 may represent a valuable marker in the differential diagnosis of neonatal sepsis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the characteristics of children who are diagnosed with brain death (BD) in a tertiary care pediatric intensive care unit (PICU) and highlight the organ donation rates. Methods: A retrospective observational study was conducted among pediatric patients who met the criteria of BD based on the medical records in all deaths that occurred between January 2018 and May 2021. The demographic data, main BD cause, duration between admission to PICU and BD decision, length of stay, time between BD decision and cardiac arrest, presence of apnea and ancillary tests, and organ donation status were recorded. Results: This study analyzed 642 patients who are admitted to the PICU, wherein 1.9% was diagnosed as BD. Asphyxia was the most frequent cause of BD (33.3%). The mean interval between the suspected of BD diagnosis and median of duration between BD decision and cardiac arrest were 18.58±13.77 (min: 3, max: 48) h and 36 (minimum (min): 1, maxsimum (max): 192) h, respectively. The mean length of stay in the PICU was 16.75±11.36 days (min: 3, max: 42). The disorders related to BD include diabetes insipidus (58.3%) and hypothermia (33.3%). Apnea test was positive in 6 (50%) of 12 children. At least one ancillary test was used in all patients. Five of 12 (41.7%) patients were not eligible for organ donation because they were refugee, and the families of the remaining 7 patients did not give permission for organ donation. Conclusion: Organ donation can be increased if frequent family meetings are held by an experienced and trained team coordinator, including psychologists and religious authorities. This issue can be organized as a certified and standardized program throughout the country. [ABSTRACT FROM AUTHOR]

We are representing a case of successful retrograde recanalization of a chronic ostial occlusive lesion of the left main coronary artery (LMCA) via a saphenous vein graft. A 70-year-old male patient, with a history of previous (3 years ago) coronary artery bypass surgery, was evaluated with coronary angiography because of his recent anginal symptoms. Left main coronary artery could not be visualized from the aortic root. It could be visualized with drilled balloon technique which was introduced retrogradely from a saphenous vein graft, and the chronic ostial lesion of the LMCA could be treated with balloon dilatation and stenting. Coronary occlusions can be treated retrogradely via the native collaterals and grafts. The coronaries that are not visualized with an antegrade fashion can be visualized with a retrograde way with the drilled balloon introduced through a patent graft. We could not find any publication about this technique on the web-based research. When encountered with a totally occluded ostial lesion of the LMCA, that cannot be visualized even from the aortic root, it may be tried to be visualized through a patent graft retrogradely. This is a safe and reliable method in patients with a total occlusion of the LMCA who also have a patent saphenous vein graft. [ABSTRACT FROM AUTHOR]

We are representing a case of successful retrograde recanalization of a chronic ostial occlusive lesion of the left main coronary artery (LMCA) via a saphenous vein graft. A 70-year-old male patient, with a history of previous (3 years ago) coronary artery bypass surgery, was evaluated with coronary angiography because of his recent anginal symptoms. Left main coronary artery could not be visualized from the aortic root. It could be visualized with drilled balloon technique which was introduced retrogradely from a saphenous vein graft, and the chronic ostial lesion of the LMCA could be treated with balloon dilatation and stenting. Coronary occlusions can be treated retrogradely via the native collaterals and grafts. The coronaries that are not visualized with an antegrade fashion can be visualized with a retrograde way with the drilled balloon introduced through a patent graft. We could not find any publication about this technique on the web-based research. When encountered with a totally occluded ostial lesion of the LMCA, that cannot be visualized even from the aortic root, it may be tried to be visualized through a patent graft retrogradely. This is a safe and reliable method in patients with a total occlusion of the LMCA who also have a patent saphenous vein graft. [ABSTRACT FROM AUTHOR]

Aim: B12 vitamin deficiency may cause cardiac autonomic dysfunction, heart rate variability, endothelial dysfunction and subclinical atherosclerosis, a significant degree of reduction in heart ejection fraction and deformation of the left ventricular myocardium. We aimed to investigate the effect of B12 deficiency in children on cardiac electrical activity by comparing the Tp-e and QT dispersion values between healthy children and children with B12 deficiency. Methods: The demographic data, laboratory results electrocardiography and echocardiography results of isolated B12 patients (n=64) with vitamin B12 deficiency and control group (n=64) included in the study between 15.3.2020 and 15.06.2020 were prospectively recorded and comparatively analyzed. Results: A total of 128 patients included in the study. Corrected QT (QTc) value and Tp-e interval, were statistically significantly higher in the patient group (p<0.05). Tp-e/QT and Tp-e/QTc ratios in the patient groups were statistically significantly higher than the ones in the control group (p<0.05). Conclusion: Repolarization differences in B12 deficient children when compared to those of healthy children, might reflect subclinical symptoms. [ABSTRACT FROM AUTHOR]

Objective: Inhaled bronchodilators are commonly used in the treatment of patients hospitalized with the diagnosis of acute bronchiolitis. The mesh nebulizer, developed in recent years, allows to deliver the smaller particles of drugs to the distal airways. The aim of this retrospective study is to compare the effectiveness of mesh nebulizers with jet nebulizers in terms of clinical improvement, length of hospital stay and intensive care requirement. Method: The study was conducted in Haseki Research and Training Hospital. Seventy-five pediatric patients between 1-24 months of age who were hospitalized with the diagnosis of acute bronchiolitis were included in the study. Forty patients were treated with jet nebulizer and 35 patients were treated with mesh nebulizer. The responses to the treatment were evaluated with duration of hospitalization, changes in heart rates, respiratory rates and Wang respiratory scores at 24th and 48th hours of therapy and requirement of intensive care. Results: Respiratory syncytial virus was the most commonly isolated viral pathogen (37.3%), followed by rhinovirus. Wang respiratory scores were significantly decreased in patients using mesh nebulizers at the 24th (p<0.001) and 48th hours (p<0.001) of treatment. Respiratory and heart rates were significantly improved at the 48th hours of therapy (p=0.026, p=0.023, respectively). The patients who were treated with jet nebulizer had longer hospital stay than those treated with mesh nebulizer (p=0.006). Conclusion: It was concluded that mesh nebulizer contribute to rapid improvement in acute respiratory failure, shortened the duration of hospitalization and may decrease the requirement of intensive care in patients with acute bronchiolitis. [ABSTRACT FROM AUTHOR]

Amaç: Tip-1 diyabetli çocuklarda anemi parametrelerinin metabolik kontrolle ilişkisi literatürde az yer almaktadır. Tip- 1 diabetes mellitus (DM) tanılı çocuklarda anemi insidansı, anemi parametreleri ve bu parametrelerin metabolik kontrolle ilişkisinin araştırılması planlanmıştır. Yöntemler: Benzer yaş ve cinsiyette olan 33 tip-1 diyabetli ve 33 sağlıklı çocuğun tıbbi kayıtlarından retrospektif olgu kontrol çalışması yapılmıştır. Her iki grupta hemogram parametreleri ve demir, total demir bağlama kapasitesi (TDBK), ferritin, vitamin B12, folat anemi parametreleri olarak kayıt edildi. Ayrıca olgu grubunda HbA1c seviyeleri, diyabet süresi ve insülin tedavi dozu not edildi. Bulgular: Tip-1 DM'li çocuklarda diyabet süresi 8,4±11,4 ay, HbA1c seviyesi 10,6±2,9 ve insülin tedavi dozu 0,7±0,2 u/kg/ gündü. Olgu ve kontrol grubunda hemogram parametrelerinin karşılaştırılmasında anlamlı fark saptanmadı. TDBK kontrol grubuna göre daha düşük saptandı (p=0,02). Folat ve ferritin seviyesi hastalarda kontrol grubuna göre daha yüksek saptandı (p=0,001). Sonuç: Bu çalışmaya göre tip-1 DM çocuklarda anemi riskini artırmamaktadır. Hastalarda ferritin seviyesi kontrole göre daha yüksek saptanmıştır, bu durum tip-1 DM'de enflamasyonun varlığını desteklemektedir. [ABSTRACT FROM AUTHOR]

Background: Migraine is the most common primary headache in children. Neuromediators and deterioration in circadian rhythm and sleep disorders can play a role in the etiology of migraines. Aim: To determine the serum melatonin levels of children with migraine and the relationship between melatonin and childhood migraine. Materials and Methods: Thirty-five children aged between 10 and 18 years with migraine as the case group and 35 healthy children of similar age and sex as the control group were included in the study. Venous blood samples were taken at 09.00 AM and melatonin analysis was performed using enzyme-linked immunosorbent assay (ELISA). Results: The mean serum melatonin levels of the case group and control group were found to be 300.1 ± 67.3 pg/mL and 314.9 ± 64.0 pg/mL, respectively. There was no statistically significant difference between the groups (P = 0.351). Comparison of the melatonin levels in the case group according to the clinical characteristics was not significantly different. Conclusion: An association between sleep and migraine is predictable, but its pathophysiology is not yet known. Etiological studies continue and the relationship between melatonin and migraine remains unclear. [ABSTRACT FROM AUTHOR]

The article presents a case study of a five-month-old girl with fever, febrile and pale, splenomegaly with no hepatomegaly. Topics discussed include body temperature of the patient which was high in spite of drugs ampicillin/sulbactam and netilmicin therapy, diagnosis of hemophagocytic lymphohistiocytosis (HLH) due to hemophagocytosis on bone marrow aspiration in the patient, and treatment given to the patient for HLH with drugs dexamethasone and etoposide.

Aim: Acute rheumatic fever (ARF) is an inflammatory disease developing as a response to group A streptococcal infection. Platelet parameters and neutrophil/lymphocyte ratios (NLRs) have been used as markers of inflammation severity in various inflammatory diseases in recent years. The purpose of this study was to evaluate platelet parameters and NLRs of patients with a diagnosis of ARF under monitoring by our clinic, and to compare these with a healthy control group. Materials and Methods: Fifty patients diagnosed with ARF (37 with carditis and 13 without carditis) and 50 age- and sex-matched healthy children were included in the study. The subjects' demographic characteristics, complete blood count values, acute phase reactants, and transthoracic echocardiography findings were recorded. Results: NLR, leukocyte, neutrophil, and platelet numbers were statistically significantly higher in the ARF group than in the control group (p<0.001), while hemoglobin, lymphocyte, and mean platelet volume (MPV) values were significantly lower (p<0.001). No statistically significant difference in MPV, plateletcrit (PCT) or NLR values was observed between the ARF subgroups with or without carditis. Platelet distribution width (PDW) was significantly higher in those ARF patients with carditis (p=0.003). Correlation analysis revealed that platelet count was positively correlated with leukocyte and neutrophil numbers, MPV was negatively correlated with leukocyte numbers, and PCT was significantly positively correlated with leukocyte and neutrophil numbers. PDW exhibited negative correlation with lymphocyte count and positive correlation with NLR. Conclusion: MPV values were significantly lower and NLR values significantly higher in patients with ARF. Thus, it is thought that these parameters can be used as markers in patients diagnosed with ARF. [ABSTRACT FROM AUTHOR]

Aim: Especially in the developed countries; there has been an increase in the prevalence of atopic diseases over the past 40 years. This is explained by the improved living conditions and reduced exposure to infections. In this study, effects of some infections on atopic diseases were investigated. Methods: Fifty atopic patients and 46 age-and sex-matched healthy children were included in the study. Skin prick test was performed and serum immunoglobulin (Ig) E levels were determined in all subjects. Serum-specific IgG was investigated to detect seropositivity of hepatitis A virus (HAV), Toxoplasma gondii, Epstein-Barr virus (EBV) and cytomegalovirus (CMV). In addition, Helicobacter pylori feacal antigen test was done. Results: Anti-HAV IgG seropositivity (30.0%) and H. pylori antigen positivity (22.0%) were significantly lower in atopic children than in controls (52.1%, 47.8%, respectively). There was no statistically significant difference between the two groups in seropositivities of T. gondii, EBV viral capsid antigen and CMV IgG. Conclusion: HAV and H. pylori may be protective infections in atopic patients. However, there is a need for larger scale studies to achieve generalizable results. [ABSTRACT FROM AUTHOR]

Pediatric aortic dissection is an emergency condition that is difficult to diagnose and is associated with high morbidity and mortality. To draw attention to this issue, we present two male cases diagnosed with aortic dissection because of an autopsy. A 16-year-old man with severe new-onset chest pain had an unremarkable physical examination, electrocardiography, and laboratory values. Aortic dissection was not detected on non-contrast computed tomography or echocardiography. Type A aortic dissection was discovered during the patient's autopsy. In the second case, a 10-year-old male patient complained of fever, vomiting, and abdominal pain. The physical examination and biochemical tests were unremarkable. Type B aortic dissection was discovered during the autopsy. Genetic and congenital causes predisposing to aortic dissection and hypertension or a history of trauma were not detected in either patient. Aortic dissection, which is very rare in children, should be considered in cases of persistent chest pain, and rapid diagnosis with contrast-enhanced tomography is vital. [ABSTRACT FROM AUTHOR]

Aim: Familial Mediterranean Fever (FMF) is an auto inflammatory disease characterized by recurrent attacks of fever and inflammation of serosal tissues. In this study, we aimed to investigate the relationship of clinical and laboratory findings with genetic mutations and disease severity scores in children diagnosed with FMF. Methods: Fifty-four patients (27 girls and 27 boys) were enrolled in this study. The subjects were divided into groups according to disease severity score and gene mutations. Regional distributions, clinical and laboratory findings and MEFV mutations were evaluated. Clinical and laboratory findings were compared between the groups. Results: The mean age of the patients was 10.50±3.66 years. The most frequent complaints were fever, abdominal pain and arthralgia. The most frequent mutation was M694V (54.6%), followed by E148Q mutation (11.1%). The disease severity score in patients with M694V homozygous was higher than in other patients. Arthritis, erythema and myalgia were found to be higher in moderate-severe disease group than in mild disease group. Erythrocyte sedimentation rate during attacks were found to be higher in moderate-severe disease group.The patients were mostly from Eastern Anatolia region. Conclusion: Homozygous M694V mutation is associated with a more severe clinical course. The disease may be severe in patients with high sedimentation rate during attacks. [ABSTRACT FROM AUTHOR]

Abstract: Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral disease that occurs in approximately 30 countries. It has the most extensive geographic range among the tick-borne viruses that affect human health. Recently, a 6-year-old boy presented with complaints of fever, fatigue, and loss of appetite. He revealed a history of tick bite in rural Istanbul three days prior to presentation. A hyperemia was detected at the site of the tick bite. Laboratory tests showed that alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine phosphokinase levels were elevated and that the prothrombin time and activated partial thromboplastin time were prolonged. Anti-CCHF virus IgM ELISA and a reverse transcriptase-PCR assay for CCHF RNA were both positive. Phylogenetic studies revealed that the virus was a new AP92-like CCHF strain, which was named KMAG-Hu-07-01 (accession number EU057975 ). This patient could provide important information on the transmission dynamics of CCHF infection. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the relationship of plasma D-dimer levels with duration of hospitalization and radiological and laboratory findings in patients with pneumonia. Methods: Forty-seven patients with pneumonia (31 boys and 16 girls, mean age: 4.2±4.7 years) were included in the study. The patients were divided into two groups according to duration of hospitalization and three groups according to radiological findings. D-dimer and other laboratory findings were compared between the groups. Results: The mean serum D-dimer level was 1333.5±1364.4 ng/L. There was no statistically significant difference in D-dimer, leukocyte, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) between the groups divided according to duration of hospitalization. In addition, there was no statistically difference in D-dimer levels between the groups divided according to radiological findings. Age, percentage of neutrophils, ESR and fibrinogen levels were higher in patients with lobar pneumonia when compared with the other groups and CRP level was higher in lobar pneumonia group when compared to interstitial pneumonia group. D-dimer levels were negatively correlated with age and positively correlated with ESR, CRP, and fibrinogen. Conclusion: In our study, D-dimer levels were high in patient with pneumonia. Further studies with a larger number of patients are necessary to determine the role of D-dimer levels as an acute-phase reactant in patients with pneumonia. [ABSTRACT FROM AUTHOR]

The prevalence of childhood urinary stone disease has increased significantly in recent years. Risk factors for urinary stones include metabolic disturbances, genetic and anatomical abnormalities. A comprehensive metabolic evaluation is essential in all children with urolithiasis. This review describes the pathophysiology, causes, clinical findings, evaluation, and management of childhood urolithiasis. [ABSTRACT FROM AUTHOR]

The presence of a foreign body in the heart have been reported, mostly in adults. Deaths and injuries can result from the breakage or rupture of angiography catheters. We present a case in which an angiocath tip was identified in the right ventricle of a pediatric patient, and the patient died as a result thereof. As no similar cases have been reported, we would like to draw attention to this subject. A 4.5-month-old female patient who was hospitalized 3 times during her life had a history of peripheral venous access establishment in the extremities with angiocatheters. During these hospital admissions, a central catheter was not inserted, and no additional problems were identified. Emergency personnel responded and found the patient at home, experiencing bradycardia and arrhythmia. She was resuscitated and taken to the hospital, where she died. The autopsy revealed, the tip of a 1.5 cm long, 1 mm wide lumen catheter had penetrated the right ventricular wall (Fig. 1) (Fig. 2), thus her death was attributed to complications that developed as a result of the peripheral vascular access catheter tip breaking and migrating to the right ventricle. Although the patient did not have an ECG, physical examination by the emergency ambulance personnel revealed an irregular and bradycardic heartbeat, suggesting that the child may have developed arrhythmia and atrioventricular conduction block. Health care professionals must check upon removal of peripheral intravenous access, and record whether the integrity of the peripheral catheter tip was compromised to prevent similar events in future.Fig. 1Angiocath tip piercing the right ventricular wall and exiting the heartFig. 2a A 1.5 cm long, b 1 mm wide lumen catheter tip penetrating the right ventricular wallAngiocath tip piercing the right ventricular wall and exiting the hearta A 1.5 cm long, b 1 mm wide lumen catheter tip penetrating the right ventricular wall [ABSTRACT FROM AUTHOR]

Objective: The kidney is the second most commonly affected organ by severe acute respiratory syndrome coronavirus-2, characterized by hematuria, proteinuria, and acute kidney injury. There are few studies describing renal involvement in pediatric cases. Materials and Methods: This retrospective study evaluated the prevalence of hematuria, proteinuria, and acute kidney injury in severe acute respiratory syndrome coronavirus-2-positive pediatric cases (1-18 years old) who visited emergency department between March and November 2020. Patients with urinary tract infections were excluded. An age-specific upper limit of reference interval was used to define "elevated serum creatinine" (greater than upper limit of reference interval) and acute kidney injury (>1.5 times upper limit of reference interval). Results: A total of 228 patients were evaluated, median age was 12.7 years (interquartile range: 7.5; 16.1), and 51.3% were male. The prevalence of asymptomatic, mild, and moderate-to-severe disease was 12.7% (29/228), 77.2% (176/228), and 10.1% (23/228), respectively. The prevalence of hematuria, proteinuria, and elevated serum creatinine was 15.8% (36/228), 6% (14/228), and 3% (7/228), respectively. Kidney involvement (i.e., at least 1 of these findings) was 23.2% (53/228) and significantly higher in the moderate-to-severe disease (43.5%). None of the patients met the acute kidney injury criterion. In logistic regression analysis, female sex (odds ratio: 1.97, 95 CI%: 1.03; 3.70, P = .040) and fever (odds ratio: 2.28, 95% CI: 1.19; 4.36, P = .012) were independent predictors of kidney involvement. Three patients demonstrated a kidney presentation (macroscopic hematuria) on admission, and another patient was diagnosed with C3 glomerulonephritis during hospitalization. Conclusion: Kidney involvement was found about in 1 quarter of children with coronavirus disease 2019. Awareness and recognition of kidney involvement and follow-up are important in the management. [ABSTRACT FROM AUTHOR]

Aim: Breastfeeding ensures ideal physical, intellectual and behavioral development of infants, and also protects them against infections and chronic diseases. In this study, we aimed to evaluate the impact of feeding patterns on physical growth and mental development of infants in the first 6 months of life. Methods: In this study, we retrospectively analyzed medical files of infants aged between 0 and 6 months who were referred to a provincial family health center. According to their feeding patterns, they were divided into 3 groups as only breastfed group (group AS, n=63), only formula-fed group (group FM, n=30), and the group of infants fed with both breast milk, and baby formulas (group AF, n=63). Weight, height and head circumferences of the infants were measured at birth, and at postnatal months 1., 2., 3., 4., and 6. and were evaluated for each group. Results: Normal birth rate was higher in the breastfed group (41.3%) when compared with the formula-fed babies (31.6%). During 6 weeks of the follow-up period, statistically significant increases were detected in body weights of the infants fed only with breast milk at months 1., 2. and 3., in body heights at month 2, and in head circumferences at months 1., 2. and 3. (p<0.05). The increase in body height in the infants fed both with breast milk and baby formulas was higher at months 4, and 6 than those in the other groups. Conclusion: Breast-fed babies grow faster than formula-fed babies within the first months of life, but later on, their growth rates slow down. However, they grow up with a healthier life and mental capabilities as well as being protected from deleterious effects of obesity. [ABSTRACT FROM AUTHOR]

Aim: To investigate the frequency of atopic disease, a prototype Th2 disease in patients with familial Mediterranean fever (FMF). Materials and Methods: This study included 49 children with FMF and 30 age-and gender-matched healthy children. All participants were questioned about allergic diseases using the modified questions from ISAAC Study questionnaire. Total immunoglobulin (Ig) E levels and eosinophil counts were determined, and skin-prick test was performed. Results: The skin-prick test showed no significant difference in the rate of positive response to at least one allergen in the children with FMF (10.2%) and the control group (10.0%). The rate of physician-diagnosed asthma, allergic rhinitis and eczema were similar in both groups. The answers given to the questions about allergic diseases were similar and there was no difference in the measurements of IgE levels and eosinophil counts of the two groups. Conclusion: We determined that atopy frequencies were similar in children with and without FMF. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus type 1 is the most common endocrine metabolic disorder occurring in childhood and adolescence due to the autoimmune destruction of pancreatic beta cells as a result of various environmental factors interacting with an underlying genetic predisposition. Diabetes is a risk factor for early onset atherosclerosis, and the high mortality rate seen in these patients is partially related to cardiovascular diseases. Objectives: This study was conducted to compare mean platelet volume as a marker of early atherosclerosis with aortic intima-media thickness in children with type 1 diabetes and to identify its correlation with known cardiovascular risk factors. Patients and Methods: The study included 27 patients between age range of 6 and 17 years that were diagnosed with type 1 diabetes and 30 healthy children of the same age range who did not have any chronic disease. In both groups, we used the color Doppler ultrasound to measure children’s aortic intima-media thickness and identify their mean platelet volumes. Results: There was no significant difference between the groups regarding gender distribution, age, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL) cholesterol levels (P > 0.05). Also no significant difference could be documented between the patient and control groups regarding the aortic intima-media thickness and mean platelet volume (P > 0.05). However, there was a significant correlation between aortic intima-media thickness and mean platelet volume (r = 0.351; P < 0.05). Conclusions: In the present study, there was no evidence of early atherosclerosis in children with type 1 diabetes. However, mean platelet volume having a significant correlation with aortic intima-media thickness may be useful as an early marker of atherosclerosis. [ABSTRACT FROM AUTHOR]

Background/aim: The mechanism of edema formation in nephrotic syndrome is still poorly understood. We aimed to evaluate the volume status in children with steroid-sensitive nephrotic syndrome (SSNS) and to emphasize the importance of echocardiography in demonstrating of volume changes. Materials and methods: Thirty-two SSNS patients and 30 healthy children were enrolled in this study. The volume statuses of patients were evaluated by clinical and laboratory features, including fractional sodium excretion (FENa) and distal sodium/potassium exchange (UK/UNa+K ratio). Inferior vena cava collapsibility index (IVCCI), left atrial diameter (LAD), aortic diameter (AD), and left ventricular mass index (LVMI) were measured using conventional echocardiographic methods. Results: FENa was lower in children with NS; however, the distal K/Na ratio of the patient and control groups did not differ. In addition, IVCCI, LAD, AD, and LVMI were not different among groups. When evaluating the volume status of patients, 8 patients (25%) were hypovolemic while 24 patients (75%) were nonhypovolemic (normovolemic or hypervolemic). LAD was significantly lower in hypovolemic patients. Conclusion: The majority of children with SSNS are normovolemic or hypervolemic and echocardiography is an easy and valuable method for the evaluation of volume status in these patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate serum zinc levels in children with neurogenic bladder. Materials and Methods: The study involves 47 patients with neurogenic bladder who applied to the Pediatric Nephrology Outpatient Clinic of our hospital between January 1, 2015 and December 31, 2018 as well as 35 healthy children with no acute or chronic disease. The blood count, biochemical parameters, and serum zinc levels of all children included in the study were taken from the hospital information system. Results: In our study, serum zinc levels were lower in children with neurogenic bladder compared to the control group (71.6±16.5 µg/dl vs. 82.5±12.0 µg/dl, respectively; p=0.001), and zinc deficiency was higher in the patient group (51% vs. 14.3%, respectively; p=0.001). A significant positive correlation was found in the study group between serum zinc levels and their hemoglobin, hematocrit, serum calcium, and alkaline phosphatase levels. Conclusion: We determined the serum zinc levels in children with neurogenic bladder to be lower than those in healthy children. Therefore, children with neurogenic bladder need to be monitored more closely during their follow-up in terms of anemia, vitamin and mineral deficiencies, and nutrition regulation, and be provided with vitamin and mineral supplements if necessary. [ABSTRACT FROM AUTHOR]

Background: Prolonged cardiac repolarization may increase cardiovascular susceptibility to ventricular arrhythmias, leading to sudden cardiac death. This condition in obese children is not clearly demonstrated in childhood. Objectives: This study aimed to investigate the effect of obesity on cardiac electrical activity in children by comparing Tp-e intervals between obese and healthy children and evaluating the correlation between Tp-e intervals and insulin resistance in obese children. Methods: The study enrolled 50 obese and 50 healthy children. A pediatric cardiologist assessed electrocardiograms and echocardiographs. Electrocardiographic, demographic, and laboratory parameters were analyzed statistically. Results: There was no statistically significant difference between the two groups in age and gender (P > 0.05). The Tp-e intervals were statistically higher in the obese group than in the control group (P = 0.001). A statistically significant difference was found between the obese group with or without insulin resistance and the control group in Tp-e intervals (P = 0.001 for all). All other ECG parameters were similar in the patient and control groups. Conclusions: It is essential to recognize the early symptoms of future cardiovascular events in childhood obesity cases. Repolarization differences in obese children, when compared with the normal population, may reflect obesity-related early-stage subclinical findings. Prospective broad-based studies are needed to recognize these early changes. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome (MS) has reached epidemic proportions worldwide. This syndrome is associated with cardiovascular risk factors, including functional and structural cardiac and vascular changes. The aim of our study was to evaluate subclinical atherosclerosis and its associated risk factors in children with MS. Methods: The study cohort comprised 52 children with MS and 38 age- and sex-matched healthy children. The diagnosis of MS was made according to criteria adopted by the World Health Organization. Blood pressure based on 24-h ambulatory blood pressure monitoring (ABPM), carotid intima-media thickness (cIMT), carotid distensibility coefficient (DC) and flow-mediated endothelium-dependent dilation (EDD) were assessed in all children. Results: We found a significantly higher cIMT in children with MS than in healthy children, but carotid DC and flow-mediated EDD were lower in the former. Multivariate analysis revealed that a higher cIMT was independently associated with a higher nighttime systolic blood pressure (SBP) and lower high-density lipoprotein-cholesterol (β = 0.386, p = 0.011 and β = 0.248, p = 0.042, respectively). Also, higher nighttime SBP remained an independent predictor of lower DC (β = 0.495, p = 0.009), and higher 24-h SBP was the only independent predictor for a lower EDD (β = 0.532, p = 0.004). Conclusions: Atherosclerotic vascular changes were common among our pediatric patients with MS and easily determined by high-resolution ultrasound imaging. In particular, subclinical atherosclerosis was clearly associated with nocturnal or 24-h systolic hypertension as measured by ABPM. We therefore recommend that subclinical vascular changes and AMBP measurements should be used as diagnostic markers to predict atherosclerotic risks in this pediatric patient group. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to investigate the demographic characteristics, role of family factors, etiology and the factors affecting the prognosis in children who had been admitted to our hospital between 04 August 2007 and 24 January 2009 due to intoxication and, based on these data, to determine the preventive measures that can be taken. Methods: One hundred and one children (61 girls and 33 boys) were included in the study. Patient age and sex, manner of poisoning, time between ingestion of poison and hospital admission, and attitudes and behaviors of families were recorded. Results: The poisoned patients represented 1.23%of all pediatric emergency admissions. The mean age of the patients was 6.75±5.30 years (range: 2-16). Self-poisoning was detected in 49 cases and 52 cases were accidental poisoning. It was seen that adolescent over 12 years of age were more prone to suicidal poisoning and children aged 2-6 years were more susceptible to accidental poisoning. Paracetamol (13.8%) and amitriptyline (10.7%) were the most common drugs. Conclusion: Although there are important improvements in the management of intoxication,family education and preventive measurements are of great importance. [ABSTRACT FROM AUTHOR]

Objective: Adolescents with COVID-19 are usually asymptomatic or they have milder symptoms, but the psychological effects of the disease on adolescents is unknown. In our knowledge, to date no published studies have evaluated the anxiety status of adolescents with COVID-19 infection. In this study, we aimed to investigate the anxiety status of adolescents with COVID-19. Material and Methods: Eighteen adolescents hospitalized with moderate symptoms of COVID-19 and seventeen adolescents non hospitalized with mild symptoms of COVID-19 and 29 healthy adolescents were enrolled in the study. The State and Trait Anxiety Inventory (STAI) questionnaire was performed to both groups and scores were compared. Results: The adolescents with COVID-19 had significantly higher anxiety scores in the State Anxiety Inventory (SAI) (p:0.019) and the Trait Anxiety Inventory (TAI) (p:0.048) than healthy adolescents. Comparison of adolescents with mild and moderate symptoms showed no significant difference both in SAI (p:1.0) and TAI (p:0.98) scores. Conclusion: COVID-19 has a psychological impact on adolescents causing higher anxiety scores independent from the disease severity. [ABSTRACT FROM AUTHOR]

Predictors of early diagnosis and severe infection in children with coronavirus disease 2019 (COVID-19), which has killed more than 4 million people worldwide, have not been identified. However, some biomarkers, including cytokines and chemokines, are associated with the diagnosis, pathogenesis and severity of COVID-19 in adults. We examined whether such biomarkers can be used to predict the diagnosis and prognosis of COVID-19 in pediatric patients. Eighty-nine children were included in the study, comprising three patient groups of 69 patients (6 severe, 36 moderate and 27 mild) diagnosed with COVID-19 by real-time polymerase chain reaction observed for 2–216 months and clinical findings and 20 healthy children in the same age group. Hemogram, coagulation, inflammatory parameters and serum levels of 16 cytokines and chemokines were measured in blood samples and were analyzed and compared with clinical data. Interleukin 1-beta (IL-1β), interleukin-12 (IL-12) and interferon gamma-induced protein 10 (IP-10) levels were significantly higher in the COVID-19 patients (p = 0.035, p = 0.006 and p < 0.001). Additionally, D-dimer and IP-10 levels were higher in the severe group (p = 0.043 for D-dimer, area under the curve = 0.743, p = 0.027 for IP-10). Lymphocytes, C-reactive protein and procalcitonin levels were not diagnostic or prognostic factors in pediatric patients (p = 0.304, p = 0.144 and p = 0.67). Increased IL-1β, IL-12 and IP-10 levels in children with COVID-19 are indicators for early diagnosis, and D-dimer and IP-10 levels are predictive of disease severity. In children with COVID-19, these biomarkers can provide information on prognosis and enable early treatment. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome (MS), a cluster of potent risk factors for cardiovascular disease, is composed of insulin resistance, obesity, hypertension and hyperlipidemia. The aim of our study was to investigated the relationships between MS and left ventricular mass index (LVMI) in childhood MS. This study included 50 children and adolescents with MS aged between 7-18 years. Methods: Thirty age- and sex-matched healthy children served as a control group. The diagnosis of MS was made according to the criteria adapted from the World Health Organization. They underwent clinical examination with causal blood pressure (BP) measurements, 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiogram. Patients underwent echocardiography to detect left ventricular hypertrophy (LVH). LVMI was calculated as left ventricular mass/height. Results: The mean age of MS group was 12.0 ± 3.1 years. The mean value of LVMI was 46.5 ± 11.5 g/m in the MS group and it was significantly higher than those in the healthy children. The prevalence of severe LVH was 12 % using adult criteria (LVM > 51 g/m) and 44 % using pediatric criteria (LVM > 95th percentile). The mean daytime systolic BP load ( β = 0.315, p = 0.003) and HOMA-IR ( β = 0.368, p = 0.006) were found as the independent predictors of LVMI. Conclusions: In conclusion, LVH occurs commonly in pediatric MS and is associated with systolic hypertension and insulin resistance. LVMI should be measured routinely for the predicting of cardiovascular risks in these patients. [ABSTRACT FROM AUTHOR]

Introduction: To determine the seroprevalence of autoimmune thyroiditis and gluten-sensitive enteropathy (GSE) in patients with type 1 diabetes mellitus (T1DM) and to emphasize the importance of early diagnosis. Patients and Methods: Fifty-five children and adolescents (age ranged 3-18 years) with T1DM were included in the study. Hemoglobin A1c (HbA1c), free T3 (fT3), free T4 (fT4), thyroid stimulating hormone (TSH), anti-tiroglobulin (anti-TG), anti-thyroid peroxidase (anti-TPO), anti-gliadin IgA and IgG, and anti-endomisyum IgA antibody (anti-EMA) were investigated. Results: Eight of our cases (14.5%) were positive for anti-TPO, 9/55 (16.3%) for anti-TG, 8/55 (14.5%) for anti-EMA, 8/55 (14.5%) for anti-gliadin IgA, and 5/55 (9.0%) for anti-gliadin IgG. None of these antibodies were detected in healthy controls. In eight patients, who had positive anti-TPO and anti-TG, thyroid ultrasound results confirmed thyroiditis. Anti-EMA and anti-gliadin IgA were positive in five patients. Four of them were diagnosed with GSE. Conclusion: In patients with T1DM, the seroprevalences of autoimmune thyroiditis and GSE were higher than that in healthy controls. Therefore, regardless of the symptoms of patients, autoimmune thyroiditis and GSE should be investigated in all patients with T1DM. Thus, the most rapid and meaningful method is to investigate the presence of autoantibodies using serological tests. [ABSTRACT FROM AUTHOR]

Introduction: To determine the seroprevalence of autoimmune thyroiditis and gluten-sensitive enteropathy (GSE) in patients with type 1 diabetes mellitus (T1DM) and to emphasize the importance of early diagnosis. Patients and Methods: Fifty-five children and adolescents (age ranged 3-18 years) with T1DM were included in the study. Hemoglobin A1c (HbA1c), free T3 (fT3), free T4 (fT4), thyroid stimulating hormone (TSH), anti-tiroglobulin (anti-TG), anti-thyroid peroxidase (anti-TPO), anti-gliadin IgA and IgG, and anti-endomisyum IgA antibody (anti- EMA) were investigated. Results: Eight of our cases (14.5%) were positive for anti-TPO, 9/55 (16.3%) for anti-TG, 8/55 (14.5%) for anti-EMA, 8/55 (14.5%) for anti-gliadin IgA, and 5/55 (9.0%) for anti-gliadin IgG. None of these antibodies were detected in healthy controls. In eight patients, who had positive anti-TPO and anti-TG, thyroid ultrasound results confirmed thyroiditis. Anti-EMA and anti-gliadin IgA were positive in five patients. Four of them were diagnosed with GSE. Conclusion: In patients with T1DM, the seroprevalences of autoimmune thyroiditis and GSE were higher than that in healthy controls. Therefore, regardless of the symptoms of patients, autoimmune thyroiditis and GSE should be investigated in all patients with T1DM. Thus, the most rapid and meaningful method is to investigate the presence of autoantibodies using serological tests. (The Me di cal Bul le tin of Ha se ki 2012; 50: 39-42) [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to determine the relationship between mean platelet volume (MPV) and duration of response to treatment in children with steroid-sensitive nephrotic syndrome (SSNS). Patients and Methods: This is a retrospective study which included 32 children with SSNS. The control group consisted of 32 age- and gender-matched healthy children. Results: The mean age of the children with SDNS (21 males) was 6.45±3.71 years and that of controls (20 males) 6.81±1.97 years. The duration of response to steroid therapy of the patients was 14.7±6.8 days. While there were no relationship between duration of treatment and the MPV, duration of treatment was inversely correlated with red blood cell count (r=-0.484, p=0.005). Conclusion: There was not an association between the MPV and the duration of response to treatment. However, the response time to treatment was increased with a decrease in number of erythrocytes. We may interpret this situation as follows: a decrease in red blood cell count may result in reduced delivery of oxygen to tissues. [ABSTRACT FROM AUTHOR]

Introduction: The aim of our study was to determine the relationship between mean platelet volume (MPV) and duration of response to treatment in children with steroid-sensitive nephrotic syndrome (SSNS). Patients and Methods: This is a retrospective study which included 32 children with SSNS. The control group consisted of 32 age- and gender-matched healthy children. Results: The mean age of the children with SDNS (21 males) was 6.45±3.71 years and that of controls (20 males) 6.81±1.97 years. The duration of response to steroid therapy of the patients was 14.7±6.8 days. While there were no relationship between duration of treatment and the MPV, duration of treatment was inversely correlated with red blood cell count (r=-0.484, p=0.005). Conclusion: There was not an association between the MPV and the duration of response to treatment. However, the response time to treatment was increased with a decrease in number of erythrocytes. We may interpret this situation as follows: a decrease in red blood cell count may result in reduced delivery of oxygen to tissues. [ABSTRACT FROM AUTHOR]

Subacute sclerosing panencephalitis (SSPE) is a progressive inflammatory disorder of the central nervous system with high mortality rate. The disease has been associated with a persistent infection with an aberrant measles virus and no effective treatment has been available. Herein, we describe the case of a nine-year-old female who presented with neurological findings, i.e. myoclonic jerks of the head and upper extremities and abnormalities in the executive function, and was diagnosed with SSPE. Her family reported that these complaints and findings have been present for three weeks. Past medical history revealed that the girl was not immunized according to the immunization calendar and had a febrile rash illness at the age of six years old. Ophthalmic examination showed bilateral papilledema. Cranial computed tomography (CT), magnetic resonance (MR) imaging and MR venography findings were not remarkable. The measles immunoglobulin G titers in the cerebrospinal fluid (CSF) and serum were 347 IU/mL and 265 IU/mL, respectively. Lumbar CSF opening pressure was elevated (270 mm water); intracranial hypertension secondary to SSPE was the remarkable feature of the present case. [ABSTRACT FROM AUTHOR]

Subacute sclerosing panencephalitis (SSPE) is a progressive inflammatory disorder of the central nervous system with high mortality rate. The disease has been associated with a persistent infection with an aberrant measles virus and no effective treatment has been available. Herein, we describe the case of a nine-year-old female who presented with neurological findings, i.e. myoclonic jerks of the head and upper extremities and abnormalities in the executive function, and was diagnosed with SSPE. Her family reported that these complaints and findings have been present for three weeks. Past medical history revealed that the girl was not immunized according to the immunization calendar and had a febrile rash illness at the age of six years old. Ophthalmic examination showed bilateral papilledema. Cranial computed tomography (CT), magnetic resonance (MR) imaging and MR venography findings were not remarkable. The measles immunoglobulin G titers in the cerebrospinal fluid (CSF) and serum were 347 IU/mL and 265 IU/mL, respectively. Lumbar CSF opening pressure was elevated (270 mm water); intracranial hypertension secondary to SSPE was the remarkable feature of the present case. [ABSTRACT FROM AUTHOR]

Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by involvement of skin, joints, gastrointestinal tract (GIT), and kidney; its pathogenesis is still controversial. The aim of our study was to investigate the role of oxidative stress in the pathogenesis of HSP. Plasma advanced oxidation protein products (AOPP) level was measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at the active stage had significantly higher AOPP levels than those at the remission stage of HSP and the controls (42.9 ± 25.7, 30.6 ± 11.8, 27.9 ± 11.2 mmol/l; P = 0.027 and P = 0.023 respectively). The mean AOPP levels of the patients with arthritis and/or arthralgia were significantly higher those than without joint involvement (48.3 ± 26.0 and 22.3 ± 9.3, P = 0.036 respectively). However, AOPP levels were similar in patients with and without gastrointestinal involvement. Plasma AOPP levels were positively correlated with leukocyte and thrombocyte count at disease onset, whereas they were found to be negatively correlated with serum glucose and sodium levels. The mean thrombocyte count was the only independent predictor of increased level of AOPP in regression analysis (β = 0.407; P = 0.029). In conclusion, this study showed that increased oxidative stress may play an important role in the pathogenesis of HSP. Also, we suggest that higher platelet count might be an indirect indicator of oxidative stress in these patients. Further research is required to identify the potential association between oxidative stress and increased thrombocyte count in children with HSP. [ABSTRACT FROM AUTHOR]

Background: Malpractice in medicine refers to the failure of a physician to meet a standard of diagnosis and treatment, damages/injuries caused by reprehensible ignorance, or negligence of a doctor. Methods: Allegedly malpractice cases of pediatricians and the cases in which causal link between malpractice and death was confirmed by the decision of the First Board of Specialization of the Council of Forensic Medicine between the dates of Januray 1, 2012 and December 31, 2014 were analyzed retrospectively. Results: The study revealed that in the majority of 286 cases, the infants were 0-28 days old (n = 115; 40.2%) and were hospitalized due to respiratory problems (n = 111; 38.8%). The allegations of malpractice cases were most frequently seen in private hospitals (n = 120; 42%). Malpractice was found in 17.5% of the cases (n = 50), in which the majority of cased were proved to be diagnostic errors (n = 24; 48%). The most common diagnostic error was the misdiagnosis of "healthy child" in medical malpractice cases (n = 11, 22%). Conclusions: In conclusion, it is considered to be important for the pediatricians to maintain proper communication with the relatives of the patients while monitoring their health condition, and pediatricians are expected to be more careful--especially in the diagnostic phase--in the cases involving 0-1 age group as children are most likely to be diagnosed as healthy in this age group. [ABSTRACT FROM AUTHOR]

Objective: Environmental tobacco smoke (ETS) exposure is associated with many diseases, including lower respiratory tract infections, in pediatric age groups. In this study, we aimed to assess the effect of household ETS exposure on symptom frequency and clinical severity in children and adolescents with COVID-19. Materials and Methods: This retrospective study included pediatric cases (<18 years old) with a positive SARS-CoV-2 test, who were admitted to our hospital between 20.03.2020 and 01.05.2020. Patients with respiratory diseases and active smokers were excluded. Demographic characteristics, symptoms, and clinical severity of COVID-19 were obtained from parents and children using a questionnaire and from patients' files. Household ETS exposure was assessed by questionnaire. Results: A total of 167 patients (median age 145 months, 50.7 % male) were included in the study. The frequency of household ETS exposure was 50.9%, and the frequency of cough was significantly higher in exposed children than non-exposed children (71.4% vs 50.8% respectively, p=0.02). The frequency of both fever and cough was significantly higher ETS-exposed in the subgroup of cases with a mild clinical course (69.5% vs 48.1% respectively, p= 0.02 for fever and 67.8% vs 44.4% respectively, p=0.01 for cough). There was no relationship between clinical severity and household ETS exposure. Conclusion: Household ETS exposure may impact COVID-19 pediatric cases as demonstrated by the increased frequency of cough and fever in ETS-exposed children. As new lockdown measures are implemented, increasing public awareness about the effect of household ETS exposure on COVID-19as well as encouraging a decrease in ETS exposure are essential. [ABSTRACT FROM AUTHOR]

Infantile Pompe disease (glycogen storage disease type 2) is a fatal disease with autosomal recessive inheritance, leading to hypertrophic cardiomyopathy, hypotonia and respiratory failure. It is a progressive condition due to accumulation of glycogen in the muscles. We aimed to present a case of infantile Pompe disease in a patient who had giant QRS complexes in electrocardiographic monitoring and hypertrophic cardiomyopathy involving the interventricular septum and the left ventricle on echocardiography. [ABSTRACT FROM AUTHOR]

Bite is a type of wound received from the teeth of an animal, including humans. Human bites are third leading cause of all bites after dog and cat bites. Human bites are severe wounds due to the risk of contamination with mix oral flora and rapid tissue destruction. Bite wounds created by humans are seen in variety of circumstances including aggression, rape, murder, and child abuse. Oral cavity contains beta-hemolytic streptococci, anaerobes and other microorganisms. There have been reported cases of septicemia, severe necrotizing fasciitis, HIV infection, and death caused by human bites. Early reporting and treatment of bite wounds decrease the number and severity of wound infection. Here, we present the case of human bite in a nine-day-old girl and discuss the treatment approaches in the light of the relevant literature. [ABSTRACT FROM AUTHOR]