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Amaç: Migren çocuk ve ergen yaş grubunda değişen yaşam tarzları ve psikososyal faktörler ile birlikte görülme sıklığı giderek artan önemli bir klinik problemdir. Birincil baş ağrıları arasında yer alan migrenin biyokimyasal, genetik ve çevresel faktörlerle ilişkili nörovasküler bir hastalık olduğu bilinmektedir. Son yıllarda yapılan birçok çalışmada migren patogenezinde oksidatif stres sorumlu tutulmuştur. Oksidatif stres varlığında tiyol/disülfit homeostazisinin disülfit yönünde bozulması beklenmektedir. Tiyol/disülfit homeostazisinin çocuklarda migren ile olan ilişkisini araştıran geniş çaplı araştırmalar mevcut değildir. Çalışmamızda migren tanılı çocuklarda dinamik tiyol/disülfit homeostazisi ilişkisini belirlemeyi ve bu dengede disülfit yönünde bozulma görülürse migren proflaksisi ve/veya tedavisinde oksidatif stresten korunma ve/veya antioksidan tedavi kullanımı ile ilgili literatüre katkı sağlanmasını amaçladık.Gereç ve Yöntemler: Çalışmaya Sağlık Bilimleri Üniversitesi, Ankara Keçiören Eğitim ve Araştırma Hastanesi’nde Çocuk Nöroloji Polikliniği’nde değerlendirilerek migren tanısı alan 8-18 yaş arasındaki 71 hasta ve Genel Çocuk Polikliniği’ne başvuran 70 sağlıklı çocuk dahil edilmiştir. Toplanan örneklerde serum doğal tiyol, total tiyol, disülfit, disülfit/doğal tiyol yüzdesi, disülfit/total tiyol yüzdesi ve doğal tiyol/total tiyol yüzdesi ölçümleri yapılarak migren hastaları ve sağlam çocuklar karşılaştırılmıştır.Bulgular: Migren sıklığı yaşla birlikte artmış; 8-12 yaş %18.3, 13-15 yaş %36.6, 16-18 yaş %45.1 olarak tespit edilmiştir. Ağrı şekli %85.9 ile en sık zonklayıcı olup ağrıların %59.2’si bilateral bulunmuştur. Hastaların %11.3’ü atak ağrısının 30 dakikadan kısa sürdüğünü belirtmiştir. Gruplar karşılaştırıldığında doğal tiyol, doğal tiyol/total tiyol değerleri kontrol grubunda anlamlı olarak yüksek saptanmıştır (sırasıyla p=0.022, p=0.005). Disülfit, disülfit/doğal tiyol, disülfit/total tiyol değerleri ise hasta grubunda anlamlı olarak yüksek bulunmuştur (sırasıyla p=0.039, p=0.005, p=0.005). İstatistiksel olarak anlamlı olmasa da kontrol grubunda total tiyol değerleri hasta grubundan yüksek bulunmuştur (p=0.115).Sonuç: Migren hastalığı sık görülmesine rağmen çocuklarda bu konuda yapılmış prospektif çalışma oldukça az sayıdadır. Çalışmamızda migren tanılı çocuklarda migren hastalığı ile tiyol/disülfit homeostazisi arasındaki ilişki incelenmiş olup oksidatif strese yönelik parametreler yüksek bulunmuştur. Migren hastalarındaki yüksek oksidatif stres değerleri antioksidan etkili maddelerin hastalığın tedavisinde rol oynayabileceğini düşündürmektedir. Bu konuyla ilgili destekleyici çalışmalara ihtiyaç vardır., Objective: Migraine is a common disease in childhood. Oxidative stress has been implicated in the pathogenesis of migraine. Dynamic thiol/disulfide homeostasis is proven to be a marker of oxidative stress. We aimed to investigate the correlation between migraine and dynamic thiol/disulfide homeostasis. Material and Methods: A total of 141 children (71 migrain and 70 controls) were included. The serum total thiol, native thiol, and disulfide levels were measured and the ratios of disulfide/native thiol, disulfide/total thiol and native thiol/total thiol were compared between migraine patients and healthy children during attack-free period.Results: Native thiol levels and native thiol/total thiol ratio were significantly lower in the migraine group than the control group (p=0.022, p=0.005, respectively); whereas disulfide levels, disulfide/native thiol and disulfide/total thiol ratios were significantly higher in the migraine group than the control group (p=0.039, p=0.022, p=0.005 respectively).Conclusion: Our results demonstrate that there is an ongoing oxidative process in pediatric migraineurs even during attack-free period. This result may shed light on further studies analyzing dynamic changes in the oxidant-antioxidant balance during the attack and the aura phase to support the presence and importance of oxidative stress in pediatric migraine.

Background Nocturnal enuresis (NE) may negatively affect social and emotional life as well as mood in both children and their mothers. The aim of this study is to evaluate severity of self-reported depressive symptomatology and determine the relevant factors in children with primary monosymptomatic nocturnal enuresis (MNE) and their mothers by using depression inventories. Methods Children Depression Inventory (CDI) for children and Beck Depression Inventory (BDI) for mothers were administered to the study group. The children and mothers in the patient and control groups were compared according to the depression inventory scores. The relationship of various sociodemographic factors with those scores was also investigated. Results BDI scores of the mothers of children with primary MNE demonstrated minor depressive symptomatology and were significantly higher than the mothers in the control group (p = 0.002). Moreover, although within the normal range, CDI scores of the children with primary MNE were also significantly higher than the controls (p = 0.031). Main factors associated with BDI scores were the presence of primary MNE, maternal educational level, and CDI scores. School achievement of the children, monthly income of the family, and BDI scores were found to be correlated to the CDI scores. Conclusions Primary MNE was found to be associated with negative mood of the mothers in the present study. As misinformed parental attitudes adversely affect family dynamics, improved awareness of, and maternal education regarding primary MNE is vital in improving the holistic outcome of families affected by MNE.

Celebi-Tayfur A, Yaradilmis RM, Ulus F, Caltik-Yilmaz A, Ozayar E, Kosar B, Buyukkaragoz B, Horasanli E. Bismuth intoxication resulting in acute kidney injury in a pregnant adolescent girl. Turk J Pediatr 2019; 61: 292-296. Bismuth intoxication is a rare cause of acute kidney injury (AKI) and is usually reversible by appropriate therapeutic measures. We present here a case of an adolescent pregnant girl who developed AKI due to an overdose of colloidal bismuth subcitrate (CBS, total amount of 6 g). She received parenteral chelating agent dimercaprol for 14 days. Continuous venovenous hemodiafiltration (CVVHD) with high-flux membrane was carried out in the first 3 days of chelating therapy and intermittent hemodialysis for 11 days, thereafter. The patient recovered clinically and was discharged after 21 days. She gave birth to a healthy term boy. At the last visit, the baby was 6 months old with normal growth and development as well as normal kidney functions. Neither deterioration in renal functions nor emergence of proteinuria was recorded in the patient during follow-up care after hospital discharge. In cases of AKI due to an overdose of CBS, treatment with dimercaprol combined with high flux hemodiafiltration and subsequently hemodialysis appears to be both useful and safe for bismuth elimination.

Giriş: Ebeveyn anketleri, çocukların gelişimini değerlendirmek amacıyla çocuk sağlığı ve hastalıkları polikliniklerinde sıkça kullanılmaktadır. Bu çalışmada annenin, yaşı ve eğitim durumunagöre çocuğunun gelişimi hakkında bilgi düzeyi ile standart gelişimsel tarama testi sonuçları karşılaştırılmış ve toplumumuzda çocukların gelişiminin değerlendirilmesinde ebeveyn anketlerinin doğruluğu değerlendirilmiştir.Materyal ve Metod: Annelere Türk çocuklarına uyarlanan ve standardize edilen Denver II gelişimsel tarama testindeki çocuğun kronolojik yaşına uygun maddeler soruldu ve cevapları kaydedildi. Daha sonra çocuklara Denver II gelişimsel tarama testi, sertifikalı çocuk gelişim uzmanı veya çocuk sağlığı ve hastalıkları uzmanı tarafından uygulandı. Annelerin ankete verdiği cevaplar ile Denver II gelişimsel tarama testi sonuçları karşılaştırıldı, birbiriyle uyumlu ve uyumsuz maddeler kaydedildi.Bulgular: Çalışmaya 178 anne ve çocuk dahil edildi. Anne raporu ve test sonuçları olguların %55’inde uyumluydu. Anne yaşı ve eğitim düzeyine göre belirlenmiş gruplarda bu uyum benzer oranlardaydı. Uyumsuz maddelerin dağılımı her gelişim alanında benzer orandaydı.Tartışma:Bu çalışmada anne raporu ile standart gelişimsel tarama testi sonucu arasındaki uyum yetersiz bulunmuştur. Diğer gelişim testleri ve okul performansı ile korelasyon gösterdiği saptanan Denver II gelişimsel tarama testinin anne raporlarına göre daha güvenilir olduğu düşünülmüştür. Gelişimselgecikmelerin belirlenmesi için anne raporları ve Denver II testi sonuçlarının, Türk toplumuna uyarlanmış ve standardize edilmiş diğer testlerle doğrulanması gerekmektedir., Background: Parental questionnaires are extensively used in pediatric outpatient clinics for developmental evaluation. Our purpose was to examine the accuracy of questionnaires in our population by comparing developmental screening test results with mother's report in relation with her age and education.Methods: Mothers were interviewed using the items corresponding to their child's chronological age on the Denver II developmental screening test adapted for Turkish children. Then the Denver II test was administered to the child by a certified child development specialist or pediatrician. Mothers' answers to the questionnaire and the child's Denver II test results were compared and discrepancies were recorded.Results: The sample consisted of 178 mother-child dyads. Mothers' reports and test scores were concordant in 55% of cases, with similar rates in all maternal age and educational groups. Items subject to disagreement were distributed equally over all developmental domains.Conclusion: The rate of agreement between mother's reports and screening test results was unsatisfactory. While the Denver II, previously shown to correlate with other tests and school performance, is more likely to be accurate than mother's report, both data need to be confirmed by other tests standardized and adapted to the population in order to detect developmental delays.

Aim: Thelaboratory and imaging methods are not sufficiently sensitive to determine precisely the neurotoxic effects of bilirubin in neonates. The neuron-specific enolase and calcium binding protein B, which are sensitive biomarkers of cellular damage in the central nerve system, were used in the present study to demonstrate possible neurotoxic effects of bilirubin below 20 mg/dL. We hypothesized that neuron-specific enolase and calcium binding protein B might be helpful for our purposes. Material and Methods: The present study included 33 full-term infants hospitalized for phototherapy treatment (patient group) along with 29 healthy full-term infants (control group). The serum bilirubin levels of the patient group were all below 20 mg/dl. Two serum samples were obtained from all 62 infants at an interval of at least 48hrs which were used for the measurement of bilirubin, calcium binding protein B, and neuron-specific enolase levels. Results: There was no significant difference in terms of the serum levels of calcium binding protein B between the patient and control groups but there was a significant difference of the serum levels of neuron-specific enolase between the groups. In addition, there were no significant changes in the levels of calcium binding protein B and neuron-specific enolase among the patient group before and after the phototherapy. Conclusion: We conclude that, considering the serum levels of calcium binding protein B and neuron-specific enolase, a serum bilirubin level of, Aim: The laboratory and imaging methods are not sufficiently sensitive to determine precisely the neurotoxic effects of bilirubin in neonates. The neuron-specific enolase and calcium binding protein B, which are sensitive biomarkers of cellular damage in the central nerve system, were used in the present study to demonstrate possible neurotoxic effects of bilirubin below 20 mg/dL. We hypothesized that neuron-specific enolase and calcium binding protein B might be helpful for our purposes.Material and Methods: The present study included 33 full-term infants hospitalized for phototherapy treatment (patient group) along with 29 healthy full-term infants (control group). The serum bilirubin levels of the patient group were all below 20 mg/dl. Two serum samples were obtained from all 62 infants at an interval of at least 48hrs which were used for the measurement of bilirubin, calcium binding protein B, and neuron-specific enolase levels.Results: There was no significant difference in terms of the serum levels of calcium binding protein B between the patient and control groups but there was a significant difference of the serum levels of neuron-specific enolase between the groups. In addition, there were no significant changes in the levels of calcium binding protein B and neuron-specific enolase among the patient group before and after the phototherapy.Conclusion: We conclude that, considering the serum levels of calcium binding protein B and neuron-specific enolase, a serum bilirubin level of

In childhood acute lymphoblastic leukemia (ALL), non-hematological manifestations involving the musculoskeletal system can also be encountered. These manifestations may cause a delay in the diagnosis of leukemia. The presented case in this report is a six-year-old boy who developed bone pain and long bone fracture and was diagnosed as ALL after a considerable delay. This case is presented to draw attention to the fact that leukemia must be considered in pediatric patients who present with bone manifestations.