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Amac: Akut alt solunum yolu enfeksiyonlari (ASE) 5 yas alti cocuklardaki olumlerinin en sik nedenini olusturur. Bu calismada akut ASE tanisi alan hastalarda serum 25 (OH) vitamin D duzeylerinin yas gruplarina gore ince lenmesi planlanmistir. Metod: Calismaya Saglik Bilimleri Universitesi Ankara Kecioren Egitim ve Arastirma Hastanesi’nde Temmuz 2018-Temmuz 2019 tarihleri arasinda ASE tanisi ile izlenen 1 ay-18 yas araliginda cocuk hastalar dahil edildi. Hastalarin hastaneye basvuru sikayeti, sosyodemografik ozellikleri, serum 25 (OH) vitamin D duzeyi, hastaneye yatis oykusu ve yatis suresi kaydedildi. Bulgular: Calismaya ortanca yasi 4 yas (1 ay-17 yas) olan 65’i (%61,9) erkek (E/K:1,6) toplam 105 hasta dahil edildi. Yirmi dokuz (%27,6) hasta yatirila rak, 76 (%72,6) hasta ayaktan takip edildi. Hastalarin 44’u viral akut alt solunum yolu enfeksiyonu, 61’i bakteriyel akut alt solunum yolu enfeksiyo nu tanisi ile izlenmistir. Serum 25 (OH) vitamin D duzeyi hastalarin 63’unde dusuk ( 20 ng/mL olarak saptandi. Calismaya dahil edilen 1 yas altindaki 32 hastanin kis mevsiminde dogan larinda tani aninda ortanca serum 25 (OH) vitamin D duzeyleri, diger mevsimlerde dogan 1 yas altindaki hastalara gore daha dusuk saptandi. Bir yasindan kucuk ve akut ASE nedeni ile yatirilarak tedavi edilen hastalarin serum ortanca 25 (OH) vitamin D duzeyi [25,9 ng/mL (1,7-87,7)], ayaktan tedavi edilen 1 yasindan kucuk hastalarinkine [42,1 ng/mL (16,6-62,6)] gore daha dusuk bulundu (p=0,035). Sonuc: Calismamizda akut ASE tanisi ile izlenen hastalarda serum vitamin D eksikligi/yetersizliginin sik olarak saptanmasi, vitamin D dusuklugunun cocuklarda akut ASE’nin gelisiminde ve ilerlemesinde onemli bir risk fakto ru oldugunu dusundurmustur.

ÖZET Amaç: Kawasaki hastalığı çocukluk çağının en yaygın vaskülitlerinden biridir. Bu çalışmada son 10 yılda pediatri kliniğinde Kawasaki hastalığı tanısı alan hastaların geriye dönük olarak değerlendirilmesi amaçlanmıştır. Materyal-Metod: Bu çalışmada, 2007-2017 yılları arasında tanı kriterlerine göre Kawasaki hastalığı tanısı almış olan 44 olgunun demografik ve klinik özellikleri, ekokardiyografi bulguları ve laboratuvar bulguları, tedavi ve izlem sonuçları dosya kayıtlarından geriye dönük olarak incelendi. Sonuçlar: Çalışmaya 24 (54%) erkek, 20 (%46) kız olmak üzere toplam 44 olgu dâhil edildi. Tanı esnasında hastaların ortalama yaşı 49,2±31,4 (7-160) aydı. Ortalama ateş süresi 8,1±2,1gün iken ortalama hastane yatış süresi 8,4gün ±2,9 gün olarak tespit edildi. Tanı alan olguların 36 (%81) komplet Kawasaki hastalığı, 8 (%19) hasta inkomplet Kawasaki hastalığı olarak değerlendirildi. Bazı olgularda serum sodyum, albümin ve/veya D vitamini düzeyi düşüklüğü ve/veya sterilpiyüri saptandı. Olguların hepsine yüksek doz intravenöz immünoglobulin (2 g/kg) ve antienflamatuvar dozda aspirin (80-100 mg/kg/gün) başlandı. İki olguya IVIG sonrası ateşin devam etmesi üzerine tekrarlayan intravenöz immünoglobulin infüzyonu verildi. Olguların tamamında klinik ve laboratuar bulguları tedavi ile düzelirken yalnızca bir olguda rekurrens gelişti. Tartışma: Kawasaki hastalığının erken dönemde tanı alması, bu hastalığa bağlı gelişebilecek ciddi komplikasyonları önleme açısından oldukça önemlidir. Hiponatremi, hipoalbüminemi, artmış serum transaminaz düzeyleri ve/veya steril piyüri varlığının Kawasaki hastalığıtanısını destekleyen laboratuvar bulguları olduğu düşünüldü.

Urolithiasis (UL) is a common health problem in the world and the observed incidence of this disease is increasing in the infantile period. The study included cases of UL diagnosed before the age of two who had a comprehensive analysis for possible etiologic variables and were followed for a minimum of 6 months. Of the 60 patients included in the study, 37 were male, and the male/female ratio was 1.6. The average age at diagnosis is 8.5 +/- 4.5 months. Of the cases diagnosed 41 (68.3%) were before than 1 year of age. The average time for follow-up is 28.9 +/- 22.6 months. There was a family history of stone disease in 41 (68.3%) cases. Twenty-four (40%) patients were treated for dehydration at least once before stone disease was identified. The number of patients presenting with symptoms is 43 (71.7%). Restlessness was noted as the main symptom. In 17 (28.3%) patients, stone disease was found incidentally. Metabolic causes (n: 19, 31.6%) were determined to be the most common underlying cause, followed by UTI-related causes (n: 12, 20%). During the follow-up, 57 (64%) of the stones spontaneously disappeared. The size of 16 (18%) stones reduced, while the size of eleven remained same (13%). Following their absence, nine (15%) of the stones reappeared. The essential strategy is to identify high-risk groups, to closely monitor them, and to take preventative interventions against modifiable conditions such as dehydration if possible.

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.

Purpose: To measure and compare posterior ocular layers in remission period in children with familial Mediterranean fever (FMF).Methods: A randomly selected eye and fellow eye of 20 FMF patients an...

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.

Background Urinary tract infections (UTI) are one of the most common bacterial infections in children and a major cause of hospitalization. In this study we investigated the clinical characteristics, causative uropathogens; their antibiotic susceptibility and resistance patterns, treatment modalities and efficacy in children hospitalized for UTI in a tertiary care setting. Methods Patients hospitalized for an upper UTI between March 2009 and July 2014 were enrolled. The urine culture-antibiogram results and accompanying urinary tract abnormalities were recorded retrospectively. Results A total of 142 patients (104 girls, 73.2%; 38 boys, 26.8%) were enrolled. Mean patient age was 32.6 ± 4.1 months. History of recurrent UTI was present in 45.8% (n = 65), with prior hospitalization in 12.0% (n = 17). Frequency of vesicoureteral reflux was 18.3% (n = 26). Gram-negative enteric microorganisms yielded growth in all culture-positive UTI and the most common microorganism was Escherichia coli (n = 114, 80.3%). Extended spectrum beta-lactamase-producing (ESBL (+)) bacterial strains were detected in 49.3% (n = 70), with third-generation cephalosporin resistance in all and increased duration of hospitalization. Conclusions The prevalence of UTI with ESBL (+) bacterial strains with multi-drug resistance is increasing in the hospitalized pediatric population, therefore rational use of antibiotics is essential.

Objective Congenital nephrogenic diabetes insipidus (CNDI) is a rare inherited disorder characterized by a renal insensitivity to arginine vasopressin (AVP). In the majority of the cases, CNDI is caused by mutations in the arginine vasopressin receptor 2 (AVPR2) gene. Our objective is to report a novel mutation in the AVPR2 gene causing CNDI in a 6-year-old boy, presenting with growth failure and dull normal cognitive functions. Methods The proband was the third off-spring of non-consanguineous parents and had polyuria (4.3 L/day), polydipsia (5 L/day). The diagnosis of CNDI was established by a water-deprivation test and a desmopressin challenge test. Genetic studies were also carried out in the mother, siblings and affected family members, since excessive fluid intake and diuresis were also reported in these individuals. All exons of the AVPR2 gene for all participants were amplified and sequenced. Bioinformatics analysis for wild-type and mutant AVPR2 were obtained with Swiss-Model and UCSF Chimera 1.10.2. Results A novel, hemizygous, missense mutation was identified at the position 80th in exon 2 (p.H80Y) of AVPR2 in the proband. The proband’s mother, maternal aunt and grandmother were heterozygous and his maternal uncle was hemizygous for this mutation. Bioinformatic analysis indicates this mutation would cause significant conformational changes in protein structure. Conclusion p.H80Y mutation will cause inappropriate folding of the protein compromising water homeostasis via AVPR2 and AVP and leading to diabetes insipidus. We suggest that future functional investigations of the H80Y mutation may provide a basis for understanding the pathophysiology of the NDI in patients with this variant.

OBJECTIVE: Henoch-Schönlein purpura HSP is the most common childhood vasculitis, characterized by purpuric rash, arthritis, gastrointestinal system and renal involvement. In this study, our aim is to analyze the epidemiological, clinical and laboratory data of the children with HSP being followed-up at the Department of Pediatrics, Keçiören Training and Research Hospital.METHODS: HSP patients who were hospitalized between November 2006 and November 2011 and followed-up for at least six months were enrolled in the study. The patient records were analyzed retrospectively. RESULTS: Ninety-one cases aged 2-17 years 48 girls, 43 boys were enrolled in the study. Purpuric rash was present in all of the patients. Gastrointestinal involvement was detected in 69.2% n=63 of the cases as the second common finding. However, invagination developed in only two cases 2.2% . Joint and renal involvement was present in 64.8% n=59 and 16.4% n=15 of the cases, respectively. Only 2.2% of the patients with renal involvement had nephrotic level of proteinuria n=2 . Rarer findings including testicular involvement and peripheric neuropathy were detected in 8.8% n=8 and %1.1 n=1 of the cases. Disease recurrence rate was low in our patient group 6.6%, n=6 .CONCLUSION: It is remarkable that gastrointestinal involvement was the second most common finding in our study. Serious complications emerged in the early term, mainly due to gastrointestinal involvement. Meanwhile disease recurrence and surgical complication rates were relatively low and the course of HSP was benign in most of the cases. Nevertheless, it should be remembered that long-term follow-up patients especially with renal involvement is of great importance., AMAÇ: Henoch-Schönlein Purpurası HSP purpurik döküntü, artrit, gastrointestinal ve renal tutulum ile karakterize, çocukluk çağının en sık görülen vaskülitidir. Bu çalışmada beş yıllık bir süreç içerisinde Keçiören Eğitim ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniği’nde HSP tanısı ile izleme alınan çocukların epidemiyolojik, klinik ve laboratuvar verilerinin değerlendirilmesi amaçlandı.YÖNTEMLER: Kasım 2006-Kasım 2011 tarihleri arasında HSP tanısı ile en az altı ay izlenmiş olan hastalar çalışmaya alındı. Hastaların dosya kayıtları retrospektif olarak değerlendirildi.BULGULAR: Yaş aralığı 2-17 yıl olan toplam 91 olgu 48 kız, 43 erkek değerlendirildi. Purpurik döküntü tüm olgularda ortak görülen tek bulguydu. Hastalarda ikinci sıklıkta gastrointestinal tutulumun ortaya çıktığı %69,2, n=63 , bununla beraber sadece iki olguda invajinasyon geliştiği görüldü %2,2 . Eklem tutulumu sıklığı %64,8 n=59 iken, olguların %16,4’ünde n=15 renal tutulum ve bu olguların yalnızca %2,2’sinde n=2 nefrotik düzeyde proteinüri saptandı. Olguların %8,8’inde n=8 testiküler tutulum ve %1,1’inde n=1 periferik sinir tutulumu gibi daha nadir bulgular geliştiği gözlendi. Çalışmamızda hastalığa bağlı nüks oranları düşük bulundu %6,6, n=6 .SONUÇ: Çalışmamızda purpuradan sonraki en sık bulgunun gastrointestinal sistem tutulumu olması dikkat çekiciydi. Ciddi komplikasyonlar erken dönemde yine gastrointestinal tutuluma bağlı olarak görüldü. Bununla beraber hastalığa bağlı cerrahi komplikasyon ve nüks oranları düşüktü. Ortalama on aylık izlem sonunda prognozun iyi olduğu ve tüm olguların herhangi bir sekel bırakmadan iyileştiği gözlendi. Yine de HSP’li hastalarda özellikle renal tutulum varlığında uzun süreli izlemin önem taşıdığı sonucuna varıldı.

Objective: Headache is a common complaint in both adults and children. Although the majority of headaches in children are benign, they are still frightening for the parents. The aim of this study was to determine headache types, etiology, triggering factors, associated symptoms, and the necessity of brain imaging techniques in this patient group. Material and Methods: This study was conducted on children with headaches who presented to the pediatric neurology clinic of Kecioren Training Hospital from November 2014 to January 2015. The criteria defined by the International Headache Society were used to classify the headache types. results: One hundred patients consisting of 59 girls and 41 boys, with an age range of 3-17 years, were enrolled in this prospective study. The mean age on admission was 12.8±3.2 years. The duration of headache was more than 2 years in 31% of the patients. The leading cause of headache was migraine in 58 patients (58%), followed by tension type headache in 26 patients (26%). A relevant family history was present in 37 patients (44%) with primary headache. Six patients had cerebral magnetic resonance abnormalities. conclusion: The evaluation of headache should include not only a detailed history of the child but also detailed general and neurological examinations. Neuroimaging should not be part of a routine initial examiation of children with headache.

1. The X-ray diffraction analysis demonstrated pure ammonium acid urate (AAU) calculus. 2. A pure AAU stone is a rather rare diagnosis in childhood; the actual etiology and pathophysiology of AAU stones are still not completely defined. We believe that a combination of dehydration episodes, presence of a chronic acidotic state, and intake of a low-protein diet due to propionic acidemia contributed to the development of AAU nephrolithiasis in our patient. 3. We think that these two entities are most probably related to each other rather than occurring coincidentally.

Background The importance of exercise is remarkable in children with Juvenile Idiopathic Arthritis (JIA). ClinicalPilatesTherapy don’t generatefatigue,help inhibition of pain with respiratorycontrol and muscle spasm.This exercise model is entertainingand can be appliedas a group. Even though clinical pilates therapy is used on adult rheumatic patients, there is no study in JIA. Objectives To investigate the effects of Clinical Pilates Therapy on daily living activities and motor function in patients with JIA. Methods The study included 9 children (8F;1M) with JIA.After obtaining demographics, Childhood Health Assessment Questionnaire (CHAQ) was performed to evaluate daily living activities of children. Sedimentation rate (ESR) and C-reactive protein(CRP) were recorded. Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was applied to assessment the motor function. The same assessments were repeated after treatment.Therapy sessions were done three times a week. A session was included warm-ups,the main workout and cool down.Therapy sessions were done three times a week, two times a day, two weeks, each session lasting one hour. The warm up exercises included the warm up exercises of clinical pilates exercises and light – intensity dance. The main exercises consisted of clinical pilates exercises and the cool down exercises consisted of the cool down exercises of clinical pilates and body image affirmation exercises with dance figures (this method is named as Clinical Pilates Therapy by Edibe Unal). Results The mean age was 11,11±2,47 years. The mean duration of disease was 5,22±2,72 years. 5 oligoarticuler and 4 polyarticular type JIA were included. After the treatment,there were significant improvements in BOTMP scores(P 0,05). Conclusions It was concluded that clinical pilates therapy was shown positive effects on motor function in patients with JIA. But we considered that the application of this method in two weekly is not sufficient to show an effect on daily living. We assured that this method should be investigated on a larger patient group and in a longer period to obtain further effects. As a result, Clinical Pilates Therapy can be considered as reliable and safety exercise model in children with JIA to improve motor function in a short period. References Boros, C. and B. Whitehead, Juvenile idiopathic arthritis. Australian family physician, 2010; 39(9): p. 630-6. Oliveira, S., et al., Proxy-reported health-related quality of life of patients with juvenile idiopathic arthritis: the Pediatric Rheumatology International Trials Organization multinational quality of life cohort study. Arthritis and rheumatism, 2007; 57(1): p. 35-43. Emery, H.M., S.L. Bowyer, and C.E. Sisung, Rehabilitation of the child with a rheumatic disease. Pediatric Clinics of North America, 1995; 42(5): p. 1263-83. Klepper, S.E., Effects of an eight-week physical conditioning program on disease signs and symptoms in children with chronic arthritis. Arthritis care and research: the official journal of the Arthritis Health Professions Association, 1999; 12(1): p. 52-60. Disclosure of Interest None Declared