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Recently published experimental and clinical studies indicate that oxidative stress leads to the pathogenesis and progression of alcohol-induced tissue injuries. Quercetin is a type of flavonoid compound that influences antioxidant and anti-inflammatory activities have protective and therapeutic effects for treating various diseases including diabetes mellitus and neuro-degenerative diseases. In this study, fetal alcohol syndrome was tested in rat models, with the aim of verifying the protective effect of quercetin in preventing alcohol-induced liver and lymphoid tissue (thymus, spleen, and lymph nodes) injuries on the 21st day for the offspring of alcohol treated mother rats. The pregnant rats were randomly assigned into four groups. The control group (C) (n = 3) of pregnant rats received only physiological saline intraperitoneally (i.p.) throughout the pregnancy (1 to 21 days gestation) and during lactation until postnatal day 21. The quercetin positive control group (QT) of pregnant rats (n = 3) received quercetin at 50 mg/kg/days i.p. for the same period. The ethanol treatment group (E) (n = 3) of pregnant rats received 1 ml/day of 40% v/v ethanol (4 g/kg) intragastrically (i.g) for the same period. The model group of pregnant rats (EQ) received ethanol + quercetin (n = 3) with a dose of 1 ml/day of v/v ethanol (4 g/kg i.g.) and quercetin at 50 mg/kg body weight per day i.p. for the same period. Ten offspring were used in each of the C, QT, E and EQ groups. Malondialdehyde (MDA), protein carbonyl content (PC) and chemiluminescence levels (CL) in liver and lymphoid tissues significantly increased in group E versus the C group (P < 0.05–P < 0.001) whereas glutathione levels (GSH), glutathione reductase (GR), glutathione peroxidase (GP), superoxide dismutase (SOD), and catalase (CAT) activities significantly decreased in group E compared to the C group (P < 0.05–< 0.001). However, tissue MDA, PC, and CL levels decreased in the EQ group compared to group E. GSH level, GP, GR, SOD, and CAT activity were significantly increased by quercetin (P < 0.05–P < 0.001). The plasma TNFα, IL-1β, and IL-6 levels and NF-κB activation significantly increased in group E compared to the C and QT groups, but IL-10 significantly decreased in group E compared to the C and QT groups. The TNFα, IL-1β, and IL-6 levels and NF-κB activation significantly decreased in group EQ compared to group E. In conclusion, quercetin has a protective effect against maternal alcohol-induced oxidative and inflammatory damage in the liver and lymphoid tissues of newborn rats. [ABSTRACT FROM AUTHOR]

Subaponeurotic (subgaleal) fluid collection (DSFC) is a rare clinical entity of unknown etiology. We aimed to present our series of infants who were diagnosed with DSCF at Ankara University Children's Hospital. We retrospectively reviewed clinical findings, imaging studies, laboratory tests, management, and clinical courses of infants diagnosed with DSCF between June 2014 and June 2018. Five infants (4 males, 1 female), aged 5–14 weeks, were identified during the study period. All deliveries were non-progressive (3 normal deliveries, 2 cesarean sections) while instrumentation (vacuum extraction or forceps) was used in 2. History of recent trauma, concern for child abuse, and family or personal history of coagulopathy were negative for all patients. Conservative management with the spontaneous resolution was observed in 2 to 12 weeks in all infants. Although rare, DSFC should always be kept in mind in the differential diagnosis of scalp swelling in young infants. The diagnosis is primarily clinical, and current treatment is conservative. [ABSTRACT FROM AUTHOR]

This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (<24 h after cardiac surgery) in a cohort of children undergoing cardiac surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1-480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age ( p = .009), greater body weight ( p = .009), absence of preoperative pulmonary hypertension ( p = .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35-10.7; p < .05), shorter cardiopulmonary bypass ( p = .008) and cross-clamp ( p = .022) times, lower PRISM III-24 ( p < .05) and PELOD ( p < .05) scores, lower inotropic score ( p < .05) and vasoactive-inotropic score ( p < .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30-3.92; p < .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the clinical characteristics of children demonstrating neurological complications with pandemic influenza (H1N1). We reviewed the medical and laboratory records of all children who were hospitalized with neurological symptoms and who had proven influenza virus infection by reverse transcriptase-polymerase chain reaction on nasal and throat swabs. Eight children aged between 10 months and 7 years had neurological complications due to pandemic influenza (H1N1) and five of them were female. Four of them were previously healthy; there was chronic renal failure (CRF) in one and neurologic disease in three patients. Seven of them had seizure and altered consciousness. Seven of them were followed in pediatric intensive care units. We performed lumbar puncture in four patients and their cerebrospinal fluid examinations showed pleocytosis in one and no cell in three specimens. Neuroimaging was performed in four patients and three of them had abnormalities. We diagnosed aseptic meningitis in one, acute disseminated encephalomyelitis (ADEM) in one, acute necrotizing encephalopathy (ANE) in one, meningoencephalitis in one, and status epilepticus in four patients. All patients were treated with oseltamivir and antiepileptic drugs. One patient with CRF died; four previously healthy patients recovered fully, and three patients who had neurologic disorder returned to their previous neurological status. In conclusion, during pandemic influenza (H1N1) infection, neurological complications may be seen in addition to the respiratory infection. The type of neurological involvement may be variable such as triggering seizure, aseptic meningitis, encephalitis, ADEM, and ANE. Neurological complications frequently recover fully especially in previously healthy children, but sometimes a severe clinical course occurs. [ABSTRACT FROM AUTHOR]

Purposes: The aims of this study were to review the frequency, characteristics, and the clinical course of primary immunodeficiency (PID) patients admitted to pediatric intensive care unit (PICU) and attempt to identify factors related with mortality that might predict a poor outcome. Methods: We performed a retrospective review of children with PID aged 1 month to 18 years and admitted to PICU from January 2002 to January 2012 in our tertiary teaching children's hospital. Results: There were a total of 51 patients accounting for 71 admissions to the PICU. The most common diagnosis was severe combined immunodeficiency. Respiratory problems were the leading cause for admission. A total of 20 patients received hematopoietic stem cell transplantation. Immune reconstitution was achieved in 9 (45 %) patients and eight of them did survive. In all 56 % of all admission episodes resulted in survival. Risk factors for mortality included requirement of mechanical ventilation ( P < .001), number of organ system failure ( P = .013), need for renal replacement therapy ( P < .001), use of inotropes ( P < .001), higher Pediatric Logistic Organ Dysfunction (PELOD) score ( P = .005), and length of PICU stay ( P < .001). Conclusions: This is the first study regarding the outcome and mortality-related risk factors for PID patients requiring PICU admission. We suggest that PICU management is as important as early diagnosis and treatment for these patients. Prediction of those at risk for poorer outcome might be beneficial for accurate intensive care management and survival. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine serotype distribution and investigate antimicrobial resistance patterns of Streptococcus pneumoniae in healthy Turkish children in the era of community-wide pneumococcal conjugate vaccine (PCV7). The study was conducted on 1,101 healthy children less than 18 years of age. Specimens were collected with nasopharyngeal swabs between April 2011 and June 2011. Penicillin and ceftriaxone susceptibilities were determined by E-test according to the 2008 Clinical Laboratory Standards Institute, and serotypes of the isolates were determined by Quellung reaction. The nasopharyngeal pneumococcal carriage rate was 21.9 % (241/1,101). Using the meningitis criteria of minimum inhibitory concentration values, 73 % of the isolates were resistant to penicillin and 47.7 % of them were resistant to ceftriaxone. Half of all pneumococcal isolates were serotyped as 19F (15.2 %), 6A (15.2 %), 23F (10.3 %), and 6B (9.3 %) and surprisingly, no serotype 19A was isolated. Serotype coverage rates of PCV7 and non-PCV7 were 46.2 and 53.8 %, respectively. The most common penicillin- and ceftriaxone-resistant serotypes were 6A, 6B, 14, 19F, and 23F. Penicillin- and ceftriaxone-resistant isolates were more prevalent in serotypes covered by PCV7 than the non-PCV7 serotypes. Conclusion: After the community-wide PCV7 vaccination, more non-PCV7 serotypes were isolated from the carriers compared to the time before PCV7 was used especially the serotype 6A, and the antimicrobial resistance of pneumococci was significantly increased. [ABSTRACT FROM AUTHOR]

To describe the circulation dynamics of human rotavirus genotypes and to understand the epidemiological changes of rotavirus infection in Turkey, one of the countries where the highest mortality rates are seen due to rotavirus in Europe. Stool samples of children under 5 years of age which gave positive results for rotavirus antigen were stored at −20°C and then genotyped using multiplex reverse transcription polymerase-chain reaction. Of the 494 stool samples, 137 (28.1%) were positive for rotavirus antigen and 100 (73%) samples which could be genotyped successfully were included in the study. 42 (42%) samples were from inpatients, and 58 (58%) were from outpatients. The median age of the children was 16 months (5 days-59 months). G9 and P[8] were the most frequent G and P genotypes, and were detected in 30 (30%) and 55 patients (55%), respectively. In 90 samples for which both G and P genotypes could be determined, 34 different combinations were found. G9P[8] was the most frequent genotype detected in 19 patients (19%), followed by G1P[8] and G4P[6] each in 7 (7%) patients. The incidence of mixed infection was found to be 26%. Novel strains like P2A[6] and P[5] and unusual reassortant strains were detected. Distribution of rotavirus genotypes exhibited distinctive changes in this study. When the everchanging epidemiology of rotaviruses is taken into account, ongoing surveillance studies are important before the inclusion of rotavirus vaccines in national immunization program of Turkey. [ABSTRACT FROM AUTHOR]

Childhood community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but studies on the treatment of children hospitalized with CAP are limited. Although ampicillin/sulbactam is frequently used to treat the pediatric population there are very limited data about the effect of the parenteral form for childhood CAP. Hence, a retrospective study was conducted to assess clinical response to empirical parenteral ampicillin/sulbactam among children hospitalized with CAP. A total of 501 children with presumed bacterial etiology and treated with intravenous ampicillin/sulbactam were included in the study. Treatment was defined as failure if the initial ampicillin/sulbactam therapy was changed because of no clinical improvement 72 h or more after its use or clinical worsening at any time. Thirty-one (6.2%) children needed treatment change whereas 470 (93.8%) were treated successfully with ampicillin/sulbactam. In multivariate analysis, male gender [OR (95%CI): 3.32 (1.37-8.04), p = 0.008], CRP levels [OR (95%CI) 1.04 (1.01-1.08), p = 0.024], and existence of pleural effusion [OR (95%CI) 5.74 (2.17-15.15), p = 0.0001] were found to be significantly associated with treatment failure for the whole study group. For the subgroup of children between 3 and 60 months of age; respiratory rate [OR (95%CI) 1.06 (1.02-1.10), p = 0.0006] was also found to be an additional risk factor. In conclusion, this is the largest study showing that empiric parenteral ampicillin/sulbactam is effective, safe, and well tolerated for treatment of children hospitalized with CAP. However, pleural effusion was found to be the main factor associated with treatment failure. [ABSTRACT FROM AUTHOR]

Unlabelled: Ligneous conjunctivitis is a rare and unusual form of chronic pseudomembranous conjunctivitis which usually starts in early infancy. Plasminogen deficiency has recently been associated with ligneous conjunctivitis. The disease may be associated with pseudomembranous lesions of other mucous membranes in the mouth, nasopharynx, trachea, and female genital tract and also with congenital hydrocephalus. In this report, a 1-month-old Turkish boy who had pseudomembranous conjunctivitis, occlusive hydrocephalus, and hydrocele is presented. After surgery for ventriculo-peritoneal shunt establishment, he developed inspiratory stridor, respiratory distress, and pulmonary atelectasis. Tracheal pseudomembranes were also demonstrated by bronchoscopy. Plasminogen antigen level and plasminogen activity were very low. Genomic DNA from the patient was screened for mutations in the plasminogen gene and a homozygous L650fsX652 mutation (deletion of 2081C) was detected. Both of his parents were heterozygous for this mutation. He died due to respiratory failure during follow-up.Conclusion: Ligneous conjunctivitis related to type I plasminogen deficiency is relatively common in the Turkish population, however, mutations are heterogeneous and a common founder is unlikely. [ABSTRACT FROM AUTHOR]

The clinical spectrum of arthritis in 124 children with well-documented familial Mediterranean fever (FMF) was investigated in a retrospective study. Seven mutations in the FMF gene (MEFV) were also screened using restriction enzyme digestion and amplification refractory mutation system techniques in 110 patients. Mean age at the onset of FMF arthritis was 5.93±3.50 years, 75% of the patients being under 10 years of age. Arthritis in the lower extremities, upper extremities, and small joints of the hands and feet was noted in 122 (98%), 17 (14%), and 15 (12%) patients, respectively. Three patients had atypical arthritis involving temporomandibular, sacroiliac, and sternoclavicular joints. Although most of the arthritic attacks resolved within a few weeks, 12 (10%) patients developed protracted arthritis persisting for months. Amyloidosis was demonstrated in 17 (14%) patients who had not received colchicine treatment. Mutation analysis confirmed the diagnosis of FMF in 77 (62%) children. The clinical presentations of arthritis in FMF may be an important source of diagnostic confusion in FMF. Mutation analysis is of value in situations of diagnostic uncertainty. [ABSTRACT FROM AUTHOR]