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AMAÇ: Bu çalışma mantar tüketimi ile ilgili çocuk acil başvurularının klinik özellikleri ve sonlanımlarını değerlendirerek merkezimize ait tabloyu resmetmek, hasta yönetimi ve eğitim planlamasına yol gösterici veri üretmek amacıyla gerçekleştirildi. GEREÇ VE YÖNTEM: Geriye dönük 10 yıllık sürede mantar zehirlenmesi tanısı ile acil servise başvurmuş 18 yaş altı hastaların dosyaları incelendi ve oluşturulan bir form üzerinden hastaların demografik ve klinik özellikleri kaydedilerek değerlendirildi. BULGULAR: Değerlendirilen süre kapsamında çocuk acil servise başvurmuş toplam 689.000 hastadan 65 çocuk (%0,009) mantar zehirlenmesi tanısı almıştı. Mantar yedikten sonra semptomların başlama süresi ortalama 5,2±10,3 saatti ve hastaların %71’inde semptomlar ilk 6 saat içinde başlamıştı. Büyük çoğunluğunda gastrointestinal yakınmalar ön planda olup, kusma (%78) en sık görülen semptomdu. Hastaların tamamı hastaneye yatırıldı. Hastanede izlem süresi ortalama 3±1,5 gündü. Hasta yaşının küçük olması, başvuru fizik muayenesinde patolojik bulgu saptanması ve spesifik hepatoprotektif ve antidot tedavileri verilmiş olması hastanede yatış süresinin daha uzun olması ile ilişkili bulundu(p

We aimed to evaluate patients with acute ataxia and to determine the warning clinical factors in the early prediction of neurological emergencies.Patients with a history of balance and gait coordination disorder and clinically diagnosed as acute ataxia in pediatric emergency department were included in the study. As a result of final diagnosis, the characteristics of patients with and without clinically urgent neurological pathology (CUNP) were compared. CUNP was defined as any nervous system disorder requiring early diagnosis and prompt medical or surgical treatment and/or intensive care unit admission to prevent disabling or life-threatening evolution.Eighty-eight patients with a median age of 5 years were included in the study (37 [42%] patients with CUNP and 51 [58%] without CUNP). In the CUNP group, the median age of patients and symptom duration were significantly higher (P 0.001 and P = 0.011, respectively). The most common etiologies were acute post/parainfectious cerebellar ataxias (n = 40 [45.4%]), acute cerebellitis (n = 9 [10.2%]), and Guillain-Barré syndrome (n = 8 [9%]). Hyporeflexia/areflexia and dysmetria were associated with a higher risk of CUNP. Headache, loss of consciousness, and visual dysfunction were the findings appearing exclusively in patients with CUNP.The most common etiologies in acute ataxia are benign and transient, whereas life-threatening conditions may occur rarely and may require urgent intervention. Older age; prolonged symptom duration; focal neurological deficits such as hemiparesis, hyporeflexia, and visual impairment; and nonspecific findings such as loss of consciousness and headache are the most striking "red flags" of a potential neurological emergency and should alert clinicians to CUNP.

Objective Closing of schools within the scope of the pandemic measures and switching to online education have negatively affected the mental and physical health of children as well as their education. The effect of complete reopening of schools on the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not fully known. In the 2021–2022 academic year, the Ministry of National Education of Türkiye has decided to continue face-to-face education at all levels and in all private and public schools, by following a series of measures. There are no studies on school transmission reported from Türkiye since then. This study aimed to assess the dynamics of coronavirus diseases 2019 (COVID-19) transmission in schools by evaluating the data of the school contact screening outpatient clinic of a tertiary children's hospital. Methods According to the Ministry of National Education guidelines in Türkiye, all students in a class with two polymerase chain reaction (PCR)–confirmed COVID-19 cases are sent to their homes and have a SARS-CoV-2 PCR test on the fifth day. While the students with negative test results return to school, students who test positive continue to stay at home until the 10th day. The current study retrospectively analyzed the screening results of primary, middle, and high school students who presented at the school contact screening polyclinic during the first semester of the 2021–2022 academic season. Results There were a total of 11,608 presentations to the school contact screening polyclinic, and 1,107 children tested positive with SARS-CoV-2 PCR (9.5%). The median weekly positivity rate was 9.7% in primary school, 9.4% in middle school, and 5.6% in high school. The weekly positivity rate increased from the 16th week at all school levels; the positivity rates ran in parallel before this time but significantly increased from the 16th week to the half-term break. Conclusion The curve of the positivity rates in schools was similar to Türkiye's pandemic curve. In this respect, the low SARS-CoV-2 transmission in schools correlated with the low number of cases in the community.

This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS).Infants (aged 1-4 months) evaluated in the pediatric emergency department for FWS were divided into two groups:The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI): 0.85-0.94] for C-reactive protein (CRP), 0.86 (95% CI: 0.81-0.91) for absolute neutrophil count (ANC), 0.84 (95% CI: 0.78-0.89) for the SII, and 0.81 (95% CI: 0.74-0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p 0.001 and p = 0.008, respectively).We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection.

Pediatric stroke is a neurological emergency. Knowing the predictive clinical markers for childhood stroke will help in early diagnosis and patient management. This study aims to (1) evaluate patients admitted to the pediatric emergency department (PED) with acute neurological signs and/or symptoms who underwent neuroimaging and (2) determine the clinical warning signs for the early recognition of stroke.One hundred one patients aged 1 month to 18 years who were admitted with stroke-related neurological signs and symptoms and underwent neuroimaging in the PED were retrospectively analyzed using the file record system. As a result of these imaging tests, the characteristics of patients with stroke and nonstroke were compared.The mean age of the 92 included patients was 10.7 (SD, 4.5) years. Among the admission symptoms of the patients, a significant difference was observed only in terms of speech disorder, whereas a significant difference was found in the examination results for altered consciousness and dysarthria. The incidences of hemiplegia and hemiparesis were higher in the stroke group, but they were not statistically significant. The median duration of time from symptom onset to PED admission was 240 minutes (interquartile range, 30-1440 minutes). The mean time from PED admission to magnetic resonance imaging in the stroke group was 2.3 (SD, 0.7) hours, which was significantly shorter than for the nonstroke group (4.9 [SD, 1.2] hours, P = 0.002).Childhood stroke is a neurological emergency that requires a multidisciplinary approach. Early stroke diagnosis is vital for treatment and prognosis. With respect to sudden neurological deficits, particularly dysarthria, altered consciousness, hemiplegia, and hemiparesis, should alert clinicians to stroke. In addition, interdepartmental cooperation is essential both in the rapid recognition of stroke and the treatment and follow-up processes.

Cefdinir is a third-generation oral cephalosporin used frequently in the pediatric population. The most common side effects of cefdinir are diarrhea, nausea and dyspepsia. The side effect of turning the stool color to red and giving a bloody appearance, which is alarming for both families and physicians, is very rare. In this case report, we discussed 4 cases who referred to the emergency department with bloody stool due to the use of cefdinir. The important conclusion to be drawn from this case report is to know the rare side effects of commonly used drugs such as cefdinir. This will save time and resources and prevent unnecessary interventions on the patient.

Introduction:This study aimed to evaluate the neuroimaging results and associated characteristics of patients admitted to a pediatric emergency department for their first afebrile seizures.Methods:Patients admitted to the Emergency Room of University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Hospital between January 1, 2016 and December 31, 2019, with a diagnosis of first afebrile seizure were included in this study. Patients in this study included children without prior neurological or chronic disease and no history of drug use. The medical files of the patients were examined retrospectively.Results:In our study group, 55% were male (n=22) and 45% were female (n=18). The median age was 4.50 (0.25-17.00) years. The median seizure duration was 5.0 (0.03-30.0) minutes. Physical examinations performed in the emergency department yielded unremarkable findings in 80% (n=32) of the patients. A computed tomography scan detected a specific pathology in 10% (n=4) of the patients and magnetic resonance imaging was used in 12.5% (n=5) of the patients. There was no significant difference in terms of gender, age, and seizure duration between patients with and without pathology detected in neuroimaging (p>0.05).Conclusion:On evaluating patients admitted to the emergency department with their first afebrile seizures, 85% had normal neuroimaging findings. Variables such as gender, age, and seizure duration were not associated with the presence or absence of pathology in neuroimaging.

Tedavi reddi çocuk acil servislerinde hekim ve hasta için önemli bir sağlık sorunudur. Hastalar acil tıbbi tedaviyi herhangi bir zamanda reddedebilir. Bu çalışmada çocuk acil servise başvuran ebeveynlerin çocuklarının tedavisini reddetme nedenlerinin belirlenmesi amaçlanmıştır. Sağlık Bilimleri Üniversitesi Dr Sami Ulus Kadın Doğum Çocuk Sağlığı ve Hastalıkları Eğitim Araştırma Hastanesi Çocuk Acil Kliniği’ne 2016 - 2018 yılları arasında başvuran ve ebeveynlerinin tedaviyi reddettiği hastaların verileri red formları ve elektronik kayıtları incelenerek geriye dönük incelendi.İki yıllık dönemde çocuk acil kliğine 207.494 hasta başvurusundan 118 (%0,05) hastanın ebeveyni tedaviyi reddetmiştir. Hastaların tanıları sıklık sırasıyla; alt solunum yolu enfeksiyonu 46 (%39), akut odağı olmayan ateş 14 (%11.9), beşer hasta ilaç zehirlenmesi ve akut gastroenterit idi. Hastaların 71’i (%60.2) tedaviye evde devam etmek için, 24’ü (%20.3) takip ve tedaviyi başka merkezde yaptırmak istediği için tedaviyi reddetmiştir. 16 (%13.5) hasta lomber ponksiyon girişimini kabul etmeyerek tedaviyi reddetti. Çocuk acil servise 2 yıllık sürede başvuran hastaların %0,05 tedaviyi reddetmiştir. En sık tedavi reddi nedenleri; ailelerin tedaviyi evde veya başka merkezlerde devam etmek istemesi ve girişimsel işlemler ile ilgili olası yan etkilerin ailelerde korkulara neden olup, hastada ağrı olasılığı nedeniyle tedaviyi reddetme karar vermesi olarak görülmektedir.

BACKGROUND Acute appendicitis is the most common reason for abdominal surgery in children. The aim of this study was to evaluate the utility of biomarkers in predicting complicated appendicitis (CA). METHODS Patients having a diagnosis of acute appendicitis who underwent operations were retrospectively determined, and the utility of biomarkers in predicting CA was evaluated. RESULTS A total of 251 patients were included in the study. The mean age was 130.9 ± 48.8 months, 148 of the cases (59%) were simple appendicitis, and 103 (41%) were CA. The C-reactive protein (CRP) levels, immature granulocyte (IG) percentage, white blood cell counts, and absolute neutrophil counts were significantly higher in the CA patients. The bilirubin levels and neutrophil to lymphocyte ratios were not useful for predicting CA. The best area under the curve (AUC) values to predict CA were with the IG percentage and CRP level (0.82), the IG percentage [odds ratio (OR) 9.36, 95% CI (4.94-17.75), p

Background: COVID-19 Pandemic greatly affected our lives in all areas. Due to the social isolation policies implemented during this period, the majority of parents and all school-age children spent their lives at home. This study aims to investigate the effects of pandemic and isolation on home accidents treated in our center.Methods: Foreign body ingestion (G.FB), foreign body aspiration (R.FB), and corrosive substance ingestion (CS) cases admitted to our hospital between March 11, 2019 and March 10, 2021 were retrospectively analyzed. Demographic data, type and cause of home accidents, the time of the accident and the admission to the hospital, the location of the foreign body, the time of exit were recorded and collected. The patients were divided into two groups pre-pandemic period (11 March 2019-10 March 2020) and the COVID pandemic period (11 March 2020-10 March 2021), and the data were evaluated in two groups as Results: During the two years, a total of 982 patients were admitted to our hospital for G.FB, R.FB, or CS. Four hundred and eighty-three of them (49.2%) were in the pre-pandemic period and 499 (50.8%) were in the pandemic period (p=0.206). The mean age of the patients was 3.63±3.32 years; 82.4% of the patients in the pre-pandemic group and 85.4% of the patients in the pandemic group were children Conclusions: It can be thought that the main reason why home accidents are common in the 0-6 age group is due to the developmental characteristics of the child rather than the longer time spent at home. Pandemic and isolation increase the frequency of foreign body aspirations and home accidents in girls.

Aim: Patient selection and management of rapid sequence intubation (RSI) application in the emergency department can be challenging for clinicians. In this study, we aimed to describe the demographic information, clinical characteristics, and medical conditions of the patients who underwent RSI in our hospital’s pediatric emergency department and to present patient management strategies.Methods: Cases between 1 month to 18 years old who underwent RSI in the emergency department between January 2021 and January 2022 were analyzed retrospectively.Results: Eleven patients; 7 girls (63,6%) and 4 boys (36,4%) were included in the study. The median age of the patients was 6(2-15) [minimum (min)-maximum (max)]. The median time from symptom onset to presentation was 120 minutes (min-max 15 minutes-2 weeks). RSI indications were trauma (n=5), intracranial mass (n=4), ventriculoperitoneal shunt dysfunction (n=1), and refractory status epilepticus (n=1). All patients had focal neurological deficits on examination. Glasgow Coma Scale median score was 8 (min-max 4-15). The first neuroimaging method was cranial tomography in ten (90.9%) patients. Intracranial hemorrhage was present in 45.4% (5 patients) of the patients. No complications were observed in any of the patients during the RSI application. One patient died due to intracranial hemorrhage and shunt dysfunction. Neurological deficits (dysarthria, gait disturbance, hemiparesis, and visual impairment) were detected in five patients during their first-month follow-up.Conclusion: This retrospective study identified critically ill children who were admitted to the emergency department with acute neurological symptoms and underwent RSI to prevent increased intracranial pressure and further brain damage., Amaç: Acil serviste hasta seçimi ve hızlı seri entübasyon (HSE) uygulamasının yönetimi klinisyenler için zor olabilir. Bu çalışmada hastanemiz çocuk acil servisinde HSE yapılan hastaların demografik ve klinik özelliklerini ile hasta yönetim stratejilerinin değerlendirilmesi amaçlandı.Yöntemler: 1 Ocak 2021 ile 1 Ocak 2022 tarihleri arasında çocuk acil servisinde HSE uygulanan 18 yaşından küçük hastalar çalışmaya dâhil edildi.Bulgular: Çalışmaya 11 hasta dâhil edildi. Hastaların medyan yaşı 6 (2-15) idi [minimum (min)-maksimum (maks)], 7’si kızdı (%63,6). Semptom başlangıcından başvuruya kadar geçen süre medyan değeri 120 dakikaydı (min-maks 15 dakika-2 hafta). HSE endikasyonları travma (n=5), kafa içi kitle (n=4), ventriküloperitoneal şant disfonksiyonu (n=1), dirençli status epileptikus (n=1) idi. Hastaların Glasgow Koma skala skorları ortanca değeri 8 (min-maks 4-15) idi. Hastaların tamamında fokal nörolojik defisit mevcuttu. İlk nörogörüntüleme yöntemi 10 (%90.9) hastada kraniyal tomografiydi ve beş hastada (%45,4) intrakraniyal kanama mevcuttu. HSE’ye bağlı hiçbir hastada komplikasyon izlenmedi. Hastalardan ikisi exitus oldu (intrakraniyal kanama ve şant disfonksiyonu nedeniyle). Birinci ay kontrollerinde beş hastada dizartri, yürüme bozukluğu, hemiparezi, görme bozukluğu gibi nörolojik defisitler tespit edildi.Sonuç: Bu retrospektif çalışma, akut nörolojik semptomlarla acil servise başvuran ve kafa içi basıncının artmasını ve daha fazla beyin hasarını önlemek için HSE uygulanan kritik hasta çocukları tanımladı.

Fever without a source (FWS) is common clinical status in the young infants. The aim of this study was to evaluate the clinical and laboratory findings of coronavirus disease (COVID-19) infection in well-appearing infants with FWS. Well-appearing febrile infants between 30 and 90 days who were evaluated as FWS in the pediatric emergency department and tested for COVID-19 were divided into two groups: COVID-19 (+) and (−). The clinical and laboratory findings of the patients were compared. The study included 95 febrile infants with FWS, and the mean age was 59.62 ± 16.82 days. The nasopharyngeal COVID-19 polymerase chain reaction test results of 29/95 (30.5%) patients were positive, while 66/95 (69.5%) were negative. The complaints of irritability and nasal congestion were found to be significantly more common in COVID-19-positive patients (p = 0.04 and p = 0.041, respectively). The hospitalization rate (p = 0.009), length of hospital stay (p = 0.026), initiation of antibiotic treatment (p COVID-19 infection may present as an FWS. During the pandemic period, testing for COVID-19 among infants who were evaluated as FWS may reduce unnecessary hospitalizations and antibiotic treatments, and shorten hospital stays and duration of antibiotics.

It is mentioned that the acute renal angina index (aRAI), a new concept, can be used in emergency departments to calculate and accurately predict the risk of developing acute kidney injury (AKI). The aims of the study included: to evaluate the predictive performance of the aRAI (AKI risk classification tool) in predicting AKI in the pediatric emergency department.Patients who met the criteria for systemic inflammatory response syndrome were examined. AKI was defined with creatinine N1.5× baseline 24-72 hours after hospitalization. aRAI and original RAI scores were calculated for patients and were shown as renal angina positive (RA+) above a population-derived threshold. The performance of aRAI in predicting AKI compared to changes in creatinine and original RAI was evaluated.In total, 241 eligible subjects were enrolled. The median age of the patients was 17 months (min-max 1-192). AKI developed in 60 (24.8%) of the patients. According to the aRAI, 76 (31.5%) of 241 patients were RA(+). The aRAI had an NPV of 1.00 and an AUC of 0.948 (0.914-0.983) for the prediction of AKI. Sensitivity was 95% for the aRAI as compared to 48% for an elevation in SCr noted to be at least two times greater than the baseline while in the PED and 61% for original RAI.The aRAI is easily computable, does not depend on complex computational or derivation methods, and is universally accessible. We confirm and extend the findings of previous study reporting the performance of RAI for early prediction of AKI.

Benign acute childhood myositis (BACM) is associated with several viral infections. The aim of this study was to evaluate the progression of myositis symptoms, laboratory findings and oseltamivir treatment in children with influenza- and non-influenza-associated BACM.Patients aged 0-18 years old, admitted to the pediatric emergency department in the seasonal influenza period between 2018 and 2020 were retrospectively analyzed. Patients with acute onset calf tenderness, pain, difficulty in walking and elevated serum creatine phosphokinase were included and were grouped according to influenza rapid test kit results as influenza (A and B) positive, and influenza negative. The time to symptom resolution, laboratory data and the oseltamivir treatment were compared between the groups.There were 94 patients (67 male, 27 female) with a mean age of 77 ± 22 months. Influenza A was detected in 21, influenza B in 27, and neither were detected in 46 patients. Time to symptom resolution of BACM was shorter in the influenza-positive patients than in influenza-negative patients (2.9 ± 1.4 days and 3.5 ± 1.5 days, respectively, P = 0.027). Oseltamivir did not reduce the symptom resolution time in influenza patients. All children had normal hemoglobin and platelet counts, elevated creatine phosphokinase and 76% of them had leukopenia. Neither clinical recurrence nor metabolic disease were reported.Symptoms of BACM tended to resolve slightly earlier in influenza-positive patients and the duration of symptoms was not affected by oseltamivir treatment.

BACKGROUND The aims of this study were to describe the etiologies of acute headache presenting to the pediatric emergency department, determine their clinical characteristics, the prevalence of red flag findings and neuroimaging and identify predictors of headaches because of serious intracranial diseases. MATERIALS AND METHODS Patients from 2 to 18 years of age who visited pediatric emergency department with a chief complaint of headache between January 1, 2016 and August 31, 2020 were retrospectively evaluated. RESULTS The mean age of the 558 patients included in the study was 11.17±3.78 years, and 290 (52%) were female. The most common cause of acute headache was head and neck area infections (except central nervous system infections) in 355 (63.6%) patients. Forty patients (7.2%) had a headache because of serious intracranial diseases. According to binary logistic regression analysis, the findings that predicted a serious intracranial diseases were abnormal neurological physical examination [odds ratio (OR): 187.57; 95% confidence interval (CI): 32.67-1076.64], recent onset or suddenly severe headache (OR: 14.41; 95% CI: 3.14-65.91), and vomiting (OR: 9.42; 95% CI: 1.90-46.63). Neuroimaging was performed in 63 (11.3%) patients, and 7 (1.25%) had a pathology requiring emergency treatment. CONCLUSIONS The majority of acute headaches were evaluated as secondary headache. The most common cause of acute headache was head and neck area infections. Abnormal neurological physical examination, recent onset or suddenly severe headache, and vomiting were the most useful red flags for predicting serious intracranial diseases. The requirement for neuroimaging should be evaluated individually for each patient.

Amaç: Ebeveynlerin kronik hastalığı olan çocuğa sahip olması yaşam kalitelerini ve ruhsal durumlarını olumsuz etkilemektedir. Çalışmamızda, kronik hastalığı olan ve önceden sağlıklı akut hastalık ile acil servise başvuran çocukların annelerinde sürekli ve durumluk kaygı düzeyleri ile depresyon düzeylerinin belirlenmesi ve bunu etkileyen faktörlerin değerlendirmesi amaçlanmıştır. Gereç-Yöntem: Çalışmamız prospektif kesitsel bir çalışmadır. Çocuk Acil Kliniğine önceden sağlıklı ve akut hastalık ile başvuran çocukların anneleri ile kronik hastalığı olan çocukların anneleri çalışmaya dahil edildi. Beck Depresyon Ölçeği (BDÖ) ve Durumluk-Sürekli Kaygı Envanteri (State Trait Anxiety Inventory-STAI) çalışmaya katılan tüm annelere uygulandı. Olguların sosyodemografik verileri sosyodemografik veri toplama formu ile elde edildi. Mann-Whitney-U, Ki-kare ve tek yönlü Anova testleri ile post-hoc analizlerde Tukey HSD istatiksel analizler için kullanıldı. Bulgular: Çalışmaya 101 (%49) kronik ve 105 (%51) akut hastalığı olan çocukların anneleri dahil edildi. Akut ve kronik hasta grupları arasında sürekli kaygı düzeyi ve BDÖ puanları arasında ise anlamlı farklılık saptanmıştır (sırasıyla p=0,004 ve p=0,001). Durumluk kaygı düzeyi puanlarında anlamlı farklılık saptanmamıştır (p=0,778). Hastalar BDÖ’nin kesme puanı (17 puan) dikkate alınarak muhtemel depresyon açısından ikiye ayrıldığında kronik hastalığı olan çocukların annelerinde akut hastalığı olan çocukların annelerine göre yüksek risk altında oldukları saptanmıştır (χ 2=8,641; p=0,004). Sonuç: Çalışmamızın sonuçlarında kronik hastalığı olan çocukların annelerinde sürekli kaygı düzeyleri ve depresif belirti oranları önceden sağlıklı ve akut nedenle acil servise başvuran çocuk annelerine göre anlamlı yüksek tespit edilmiştir. Kronik grup ebeveynlerin eğitim ve sosyoekonomik düzeylerinin daha düşük olduğu saptanmıştır. Kronik hastalığı olan çocukların ebeveynleri ruhsal etkilenim açısından değerlendirilmeli, depresyon ve anksiyete gibi bozukluklar tespit edildiğinde psikolojik yardım almaları sağlanmalıdır.

Büyüme ve gelişmenin en hızlı olduğu 0–5 yaş arası dönem, sağlıklı gelişimi olumsuz etkileyen çok sayıda etmene karşı oldukça duyarlı bir dönemdir. Bu çalışmada 5 yaş altındaki hastaların beslenme öyküleri, büyüme parametrelerini belirlemek ve bu parametreleri etkileyebilecek faktörlerin tespiti amaçlandı.Gereç-yöntem: Çalışmaya 6 aylık dönemde hastanede yatırılarak tedavi edilen 5 yaş altındaki çocuklar dahil edildi. Yaş, cinsiyet, boy ve vücut ağırlıkları (persantilleri), yatış tanıları, kronik hastalık ve hastanede yatış öyküsü, aşılanma durumu, ebeveyn yaşları, ebeveynlerin eğitim durumu ve ortalama gelirleri ile anne sütü alım süreleri ve ek gıdaya geçiş zamanları ile ilgili verileri geriye dönük olarak kaydedildi.Bulgular: Çalışmaya ortanca yaşları 8 ay (1-59 ay) olan 344 hasta (%54,7erkek) dahil edildi. Doğum sonrası hastaların %97,1’i anne sütü ile beslenmeye başlanmışken, çalışma sırasında bir yaştan büyük olanların %18’i 1 yıldan kısa süre emzirilmişti. Hastaların 6. ayda tek başına anne sütü ile beslenme oranı %30,8’di. Hastaların annelerinin eğitim durumu ve ailelerin aylık gelir düzeyleri Türkiye ortalamasından düşük bulundu. Anne-baba yaşı, ebeveyn eğitim düzeyi ve ailenin aylık geliri ile kilo ve boy persantilleri arasında ilişki saptanmadı. Anne yaşı ve annenin eğitim düzeyi ile tek başına anne sütü ile beslenme süresi arasında ilişki bulunmazken, ailenin aylık geliri arttıkça tek başına anne sütü alım süresini uzadığı tespit edildi (p

Introduction:Adrenaline is an important medication used in the treatment of various diseases. The nebulized form of adrenaline is used in respiratory diseases. The aim of this study was to evaluate the effects of nebulized adrenaline treatment on cardiac rhythm.Methods:Children, who were admitted to the hospital and received nebulized adrenaline treatment, were included in the study. The patients were followed up in terms of development of new findings and monitored in terms of the presence of new symptoms. Vital findings were recorded before nebulized adrenaline treatment and at 15, 60 and 120 minutes of treatment.Results:In this study, 48 patients were evaluated. There was no significant difference between the pre- and post-treatment levels in terms of vital signs (p>0.05). When electrocardiography were compared before and after treatment, there was no statistically significant difference in p averaging, QRS duration, QTc interval, p wave dispersion, QT and QTc dispersion.Conclusion:Nebulized adrenaline therapy is an effective, cheap, well tolerated and safe medication for respiratory diseases. Nebulized adrenaline treatment can be used safely at the recommended doses.

BACKGROUND Iron intoxication can occur accidentally in children or intentionally by adolescents as a suicide attempt. They usually present with various symptoms including vomiting and diarrhea. Clinical studies in this field has been reported different doses of ingested elemental iron that caused serious toxicity, but none of these studies determined the minimum cut-off of ingested iron that triggered the risk of severe toxicity. The aim of this study was therefore to investigate the demographic features of iron intoxication in Turkish children and to determine the lowest cut-off of ingested elemental iron triggering serious intoxication and the need for prompt management. METHODS This retrospective study investigated 83 Turkish patients with accidental and intentional iron poisoning. RESULTS Of the 83 cases of acute iron intoxication, accidental iron consumption was more common than intentional use. Fifty-three patients ingested a median toxic dose of elemental iron of 40.0 mg/kg (IQR, 33.5 mg/kg). The median serum iron concentration in the first 6 h of ingestion was 150 μg/dL (IQR, 282 μg/dL). Twenty patients were given deferoxamine, whereas 63 patients were given supportive treatment. CONCLUSION The cut-off of ingested elemental iron that triggered serious toxicity and the need for deferoxamine in children

Background The aim of this study was to evaluate the epidemiological, demographic, clinical characteristics and laboratory findings of pediatric COVID-19 patients. Methods Patients with a positive COVID-19 nasopharyngeal polymerase chain reaction (PCR) test between 11 March 2020 and 31 December 2020 were evaluated. Results During the study period, 3118 patients underwent PCR tests, and 621 of them (19.9%) were positive. Of the patients with a positive test result, 335 were male (53.9%), the median age was 11 years. There were 308 (49.6%) patients that had a history of household exposure. The mean time between the onset of the patients complaints and the diagnosis was 1.88 ± 1.16 days. The most common symptoms were: fever (n = 424), cough (n = 419) and nasal symptoms (n = 157); loss of smell (3.5%) and taste (4.3%) were other symptoms observed in only patients aged 10 years or older. The most common abnormal laboratory finding was lymphopenia (n = 29, 36.7%). Of the 621 patients, the vast majority (n = 546, 87.9%) were classified as mild COVID-19 disease. There was a significant relationship between disease severity and age and comorbidity (p = 0.01 and p < 0.001, respectively). Only 34 patients (5.5%) were admitted to hospital, and two patients were followed-up with a diagnosis of multisystem inflammatory syndrome in children. The mortality rate was 0.32%. Conclusion COVID-19 can cause different symptoms in children. Although the disease generally causes a mild clinic presentation, it should be kept in mind that it may be more severe especially in children with comorbidities.

Objectives It can be difficult to obtain urine samples, especially in children aged 0 to 24 months who have not yet completed toilet training. Bladder catheterization is a common method for urine sampling in this age group. However, if the bladder is not adequately filled, this process fails and repeat catheterization is necessary. Point-of-care ultrasonography (POCUS) is often used to assist invasive procedures in the pediatric emergency department. This study aimed to compare success rates of bladder catheterization in patients with and without POCUS to guide the timing of the procedure. Methods This was a prospective cohort study of children 0 to 24 months presenting to a pediatric emergency department in a tertiary center hospital. Patients were divided into 2 groups; the one group received conventional catheterization (CC group) without POCUS and the other group had catheterization after POCUS (POCUS group). The transverse and anterior-posterior diameter measurements of the bladder were obtained from one view in the transverse orientation using the (6-3 MHz) convex probe. Successful catheterization was defined by obtaining 3 mL or more of urine. Results A total of 110 patients were included in the study, with 56 in the POCUS group and 54 in the CC group. There was no difference between the mean age and sex of the groups. The success rates of obtaining urine samples were 93% and 78% in the POCUS group and CC group, respectively. This difference was statistically significant (P = 0.03). No significant difference was found between measurements of bladder catheterizations with and without obtaining 3 mL or greater urine volumes in the ultrasound group (P > 0.05). Conclusions The use of POCUS during bladder catheterization in children was found to be effective and successful. In addition, the detection of any amount of urine in the bladder using POCUS increases the success rate of bladder catheterization.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder and pediatricians play a critical role in early diagnosis. This study was conducted to evaluate the knowledge, beliefs, and experiences of pediatric residents and pediatricians about ASD. A 35-item questionnaire consisting of two sections was administered. The diagnostic features section consisted of questions measuring the level of knowledge about diagnostic criteria of ASD. The general knowledge and beliefs section consisted of questions about beliefs and experiences regarding ASD. The study consisted of 101 participants. Mean score obtained by all participants from the diagnostic features section was 5.78 ± 1.65. The mean scores obtained by residents and pediatricians from the diagnostic features section were 5.35 ± 1.5 and 6.31 ± 1.68. Pediatricians obtained higher scores significantly than residents from diagnostic features section (t = -2.99, p = 0.004). The mean scores obtained by residents and pediatricians from section of general knowledge and beliefs were 13.69 ± 3 and 14.48 ± 3.15. This difference was not significant (t = -1.27, p = 0.225). This study suggests that participants' knowledge and awareness about ASD was insufficient and while pediatricians knew more about the diagnostic criteria, their awareness and approach regarding ASD were no different from pediatric residents in general practice.

PURPOSE Although sonoelastography has found itself application in assessment of many organs, studies for evaluation of muscles are very few in number and are mostly limited to adults. With this prospective study we aimed to evaluate the value of sonoelastography in assessment of influenza related benign acute myositis in children. METHODS This study enrolled 25 patients with a clinical diagnosis of benign acute childhood myositis (BACM) and 25 age and sex-matched healthy controls. All patients presented to our Emergency Department with the complaint of inability to walk and had increased serum creatine kinase (CK) levels. All patients underwent strain elastography of the gastrocnemius muscle and an elastography score was assigned to each patient by using a previously published 5 point-color scoring system. The findings were compared with those of the control group. RESULTS No statistically significant difference was detected regarding age, weight, height, or body mass index (BMI) between patient and control groups. A statistically significant difference was found between the final elastography scores of the patient and control groups, mean values being 4,16 ± 0,75 versus 3,08 ±0,40 respectively (p

Objectives: The aim of our study is to examine the efficacy and safety of intravenous magnesium sulfate in moderate-severe acute bronchiolitis. Working hypothesis: Intravenous magnesium sulfate treatment may be effective in the treatment of patients with bronchiolitis . Study design: Retrospective, single-center cohort study Methodology: We conducted a study in 150 infants presenting with moderate to severe acute bronchiolitis. A total of 150 infants aged 1 month to 2 years who presented with acute bronchiolitis to our pediatric emergency department between January 2018 and March 2019 were admitted into the study. The demographic characteristics, clinical score, and management of the patients were examined. Results: A total of 150 infants were analyzed: 62 in the magnesium sulfate group (Group I) and 88 in the supportive care group (Group II). Baseline clinical characteristics were similar in both groups. Length of hospitalization was significantly shorter in Group II. Clinical severity scores were also lower significantly earlier in Group I (p=0.031, p=0.008, respectively at first and fourth hour). Conclusions: Intravenous magnesium treatment in moderateto severe acute bronchiolitis does not appear to conferany significant decrease in clinical severity scores when compared to only supportive care

Introduction Serious bacterial infections (SBI) are major causes of mortality and morbidity in children. The aim of this study was to determine the accuracy of the immature granulocyte (IG) percentage in predicting SBI. Methods Patients admitted to the pediatric emergency department with fever were divided into two groups: with SBI and with non-SBI. White blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and the percentage of IG value were recorded, and their accuracy in predicting SBI was evaluated. Results Sixty-one (14.3%) patients fell into the SBI group and 367 (85.7%) were with non-SBI. Mean IG percentage among SBI patients was 0.84 ± 1.21 and 0.27 ± 0.20 for with non-SBI patients (P = .001). Based on disease, the highest IG percentage was found in patients diagnosed with sepsis (IG 3.7 ± 3.5%) and with bacterial meningitis (IG 1.6 ± 1.3%). The area under the curve (AUC) of IG percentage to predict SBI was 0.83 with 95% confidence interval (CI) [0.78-0.88]; WBC was 0.76 (95% CI 0.70-0.83); ANC was 0.73 (95% CI 0.67-0.80), and CRP was 0.79 (95% CI 0.73-0.85). When infection markers were compared to the most appropriate cut-off values in predicting SBI, IG percentage showed the highest sensitivity and specificity. When the cut-off value was determined as >0.35 for IG percentage, sensitivity was 75.4% and specificity was 76.6% in predicting SBI. Conclusion Patients with SBI had a higher IG percentage. Compared to other biomarkers, IG percentage had higher sensitivity and specificity in predicting SBI.

Background : During the coronavirus disease 2019 (COVID-19) pandemic period, the use of emergency services with pediatric non-COVID patients has decreased considerably. We aimed to examine whether there was a change in the demographic data, triage profile, causes, management, and cost of pediatric emergency department (PED) visits of non-COVID patients during the pandemic period. Methods : This study was a retrospective, single-center, observational comparative study that was conducted at the PED. Patient records were examined during “the pandemic spring” and the same period of the previous year. Patient demographics, waiting time, and outcome of the PED visit were analyzed in the entire population of children admitted to the PED during the study period, whereas more precise data such as the reason for PED use, duration of symptoms, urgency levels according to the Emergency Severity Index (ESI), final diagnosis, management, and cost of patient care were analyzed in a sample of admitted patients. We used the chi-square test, Fisher's exact test, and Mann–Whitney U test for statistical analyses. Results : A total of 62,593 PED visits occurred. During the pandemic period, PED visits showed a decrease of 55.8% compared to the previous year. Patients included in the sampling study group were selected using a systematic random sampling method. The median waiting time during the pandemic period was significantly shorter than the previous year (median 14 min [IQR: 5–32] vs. median 5 min [IQR: 2–16]; p

Background: The aim of this study was to evaluate the application of the rapid influenza antigen test and the contribution of the test result to patient management in febrile infants aged 29‒90 days. Methods: The medical records of febrile infants without a focus who presented during influenza seasons from 2017‒2019 were analyzed retrospectively. The study was carried out in the Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital. The demographic characteristics, clinical and laboratory findings, and management of the patients were examined. The patients were divided into two groups as ‘with’ and ‘without’ testing based on whether a rapid influenza antigen test was performed or not. Test results were categorized as positive or negative. Serious bacterial infection (SBI) risk and patient management were evaluated according to test results. Results: A total of 173 patients (110 males/63 females) were evaluated. The influenza test was performed in 94 (54.3%) patients, and 31.9% were positive. SBI was present in 8.7% of all patients. The mean values of white blood cell (WBC), absolute neutrophil, platelet count, C-reactive protein (CRP) and, lumbar puncture, hospitalization, and initiation of antibiotic therapy were significantly lower in the positive group compared to the negative and without testing groups (P

Amac: Oksidatif stres; hucresel metabolizma sirasinda olusan reaktif oksijen turlerinin artisi ile onlari detoksifiye eden, antioksidanlarin yetersizligi sonucu olusan oksidatif dengenin bozulmasi olarak tanimlanir. Reaktif oksijen turleri hucre ici lipit, protein ve DNA gibi makromolekullere hasar vererek hucre olumune neden olur. Oksidatif stres, bircok kronik hastaligin patogenezinden sorumludur. Calismamizin amaci kisa sure uykusuz birakilan cocuk hastalarin oksidatif stres parametrelerinden biri olan serum tiyol-disulfid duzeyini belirleyerek, uykusuzluk sureleri ile oksidatif stres arasindaki iliskiyi arastirmaktir. Gerec veYontem: Yaslari alti ay ile 6 yas arasinda degisen, manyetik rezonans goruntuleme oncesi klinigimize basvuran cocuk hastalar calismaya dahil edildi. Yuksek ates, akut solunum yolu enfeksiyonu, ishal, kusma sikayetleri olan veya major konjenital anomalisi olan veya kronik hastaligi nedeniyle surekli ilac kullanan hastalar calismaya alinmadi. Cekim oncesi en az 4 saat uykusuz birakilan hastalar calisma grubu, uykusunu tam alan hastalar kontrol grubu olarak belirlendi. Serum t iyol ve disulfid duzeyleri Erel ve ark.’nin gelistirdigi yeni kolorimetrik metot ile bakildi. Bulgular: Toplam 95 hasta calismaya dahil edildi. Hastalarin 56’si (%58,9) erkek, 39’u (41,1) ise kiz cocuklardi. Hastalarin ortanca (IQR) yasi 2,0 (2,0) yil, ortanca (IQR) vucut agirligi 13,0 (7,0) kg idi. Manyetik rezonans goruntuleme’den once ortanca (IQR) uykusuzluk suresi 8,0 (4,0) saat idi. Nativ tiyol, total tiyol ve disulfid serum duzeyleri uykusuz ve kontrol hastalarin arasinda anlamli istatistiksel farklilik saptanmadi. Disulfid/nativ tiyol, disulfid/total tiyol ve nativ tiyol/total tiyol gruplar arasinda anlamli bir istatistiksel farklilik saptanmadi. En az dort saat uykusuz olanlarda uykusuzluk suresi ile disulfid duzeyi arasinda orta derecede korelasyon saptandi. Uykusuzluk suresi ile total tiyol arasinda istatistiksel olarak anlamli korelasyon saptanmadi. Sonuc: Kisa sure uykusuz birakilan cocuklarda oksidatif stress dengesinin bozulmadigi kanaatindeyiz.

Colchicine poisoning is an uncommon but serious form of drug intoxication. It may produce life-threatening systemic effects. In toxic doses it produces nausea and vomiting and bone marrow suppression, often leading to sepsis, hypocalcemia, adult respiratory distress syndrome, and direct cardiotoxic effects.The aim of this study was to describe demographic features and the outcome of patients poisoned with colchicine.A retrospective study of the pediatric intensive care unit database was performed for patients ≤18 years of age who had colchicine poisoning between July 2008 and July 2013.The total number of patients with drug poisoning in the study period was 144. Nine of 144 were related to colchicine poisoning. The median age was 4 years (range 20 months to 16 years) and the number of females was five. Six of the nine cases presented after ingesting0.5 mg/kg, whereas two patients had consumed 0.5 to 0.8 mg/kg. One patient had received colchicine0.8 mg/kg. Three patients died.Among drug intoxications, colchicines can lead to severe clinical conditions. All patients suspected of having colchicine intoxication should be managed in the pediatric intensive care unit regardless of the actual degree of poisoning.

Objective: Defibrillation is part of the life-saving chain. Our aim in this study was to evaluate the level of knowledge of pediatricians on defibrillation procedures. Material and Methods: The questionnaire was administered to 308 pediatricians. The specialists were grouped according to their experience as under 5 years, 5-10 years and over 10 years while the research assistants were classified as 1st year, 2nd year, 3rd year and 4th year. Subjects with 0-2 correct answers were classified as less knowledgeable, 3-5 as moderately knowledgeable and 6-8 as knowledgeable. Results: A small percentage of the physicians had received training on the defibrillation procedure. The self-sufficiency rate for the use of the defibrillator device was around 50% in those who received training and around 20% among all physicians. The mean number of correct answers given to the 8 questions used to evaluate the level of knowledge was 4.36±1.77. Approximately half of the subjects (51%) had a moderate level of knowledge. The level of knowledge of the pediatricians who examined patients, had been trained on defibrillator use and used one themselves was significantly higher. The number of correct answers increased as the subject's self-assessment of his/her adequacy increased. There was a significant difference between the level of knowledge of specialists with less than and over 10 years of experience. Conclusion: We found that pediatricians participating in our study did not have adequate defibrillation knowledge. We believe that updating defibrillator device training and increasing the relevant self-confidence before the level of knowledge decreases is very important.

Rabdomiyoliz, kas nekrozu sonucu kas içi içeriğin kan dolaşımına çıkması ile gelişen klinik bir sendromdur. En önemli komplikasyonu akut böbrek hasarıdır. Rabdomiyoliz çok değişik etiyolojik faktörlere bağlı olarak ortaya çıkabilir. En sık nedenler ise travma, aşırı egzersiz, inflamatuar kas hastalıkları, uzun süren hareketsizlik, elektrolit dengesizlikleri ve ilaç toksisitesidir. İlaç zehirlenmelerinde rabdomiyoliz ve olası komplikasyonları açısından dikkatli olunmalıdır. Enalapril elektrolit dengesizliğine neden olarak, essitalopram ise serotonin sendromuna yol açarak olarak rabdomiyolize neden olabilir. Bu yazıda elektrolit bozukluğu veya nöroleptik sendrom gelişmeden, özkıyım amacı ile enalapril ve essitalopram alımı sonrası ılımlı rabdomiyoliz gelişen, öncesinde sağlıklı on beş yaşındaki bir kız çocuğu sunulmuştur. İlaçlar farklı mekanizmalar ile rabdomiyolize neden olabilir. Bazı ilaçların önemli klinik değişliklere yol açmadan da rabdomiyolize neden olabileceği akılda tutulmalıdır.