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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]

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]

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]

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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]

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]

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]

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]