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Purpose: Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). Methods: This study is a retrospective case–control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren–Lawrence classification. Demographic characteristics were noted. Results: There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). Conclusion: The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. Level of evidence: III. WOS:000858649600002 Q1

Purpose: To obtain information on characteristics, management, current objective nutritional status and perception of nutritional status of children with cerebral palsy (CP) from healthcare professionals (HCPs) and caregivers. Materials and methods: A detailed survey of several items on eight main topics (general characteristics, motor function, comorbidities, therapies, anthropometry, feeding mode and problems and perceived nutritional status) was developed and tested for the study. Correlation between nutritional status and Gross Motor Function Classification System (GMFCS) levels was assessed using continuous variables (Z-scores for weight-for-age, height-for-age, weight-for-height, and body mass index-for-age), and categorical variables (being malnourished, stunted, or wasted). HCP and caregiver perceptions of the child's nutritional status as well as agreement between perceived and objective nutritional status and agreement between perceived nutritional status and concerns about the nutritional status were analyzed. Results: Data were available for 497 participants from eight European countries. Poorer nutritional status was associated with higher (more severe) GMFCS levels. There was minimal agreement between perceived and objective nutritional status, both for HCPs and caregivers. Agreement between HCP and caregiver perceptions of the child's nutritional status was weak (weighted kappa 0.56). However, the concerns about the nutritional status of the child were in line with the perceived nutritional status. Conclusions: The risk of poor nutritional status is associated with more severe disability in children and adolescents with CP. There is a mismatch between HCP and caregiver perceptions of participants' nutritional status as well as between subjective and objective nutritional status. Our data warrant the use of a simple and objective screening tool in daily practice to determine nutritional status in children and adolescents with CP., Danone Nutricia Research, Utrecht, the Netherlands; Nutricia Advanced Medical Nutrition in Czech Republic; Nutricia Advanced Medical Nutrition in Greece; Nutricia Advanced Medical Nutrition in Hungary; Nutricia Advanced Medical Nutrition in Italy; Nutricia Advanced Medical Nutrition in Poland; Nutricia Advanced Medical Nutrition in Slovakia; Nutricia Advanced Medical Nutrition in The Netherlands; Nutricia Advanced Medical Nutrition in Turkey; Danone Nutricia Research, This study was sponsored by Danone Nutricia Research, Utrecht, the Netherlands. Local financial support was provided by the local business units of Nutricia Advanced Medical Nutrition in Czech Republic, Greece, Hungary, Italy, Poland, Slovakia, The Netherlands, and Turkey. Medical writing support was provided by Tim Kelly, Medi-Kelsey Limited, funded by Danone Nutricia Research.

Objective. Homozygous OCLN variants have been reported in patients with band-like calcification with simplified gyration and polymicrogyria (BLC-PMG) which is characterized by microcephaly, intracranial calcification and severe developmental delay. The OCLN gene encodes the integral membrane protein, occludin. Methods. Herein, we report three additional cases with homozygous OCLN variants that were identified via Trio-WES in two consanguineous unrelated families. Results. We detected a previously reported frameshift variant in two cases in Family 1 and a novel missense variant in a case in Family 2. The potential pathogenicity of both variants in the index cases was investigated using in silico tools, and both variants were determined to be rare and predicted to be pathogenic. All of the presented cases exhibited clinical features in common with earlier reported patients, such as severe intellectual disability, microcepha-ly, polymicrogyria, epilepsy, hypotonia and severe developmental delay. On the other hand, in addition to the common phenotypic features, our two cases in Family 1 showed features similar to those previously reported in cases from two Turkish families carrying the same frameshift variant, such as renal failure. Significance. We herein expand the spectrum of OCLN gene variants with a description of an additional novel homozygous missense variant. The frameshift variant in Turkish cases may thus be a phenotype associated with renal failure in addition to the core phenotype associated with other OCLN gene variants, and such variants could be important for rapid molecular diagnosis and treatment. The frameshift variant in Turkish cases might also be investigated for both a potential founder effect and mutational hot spot.

Cystic fibrosis is one of the most common inherited diseases. It presents with recurrent respiratory infections, pancreatic insufficiency, and growth retardation. Neurological involvement becomes more common as life expectancy increases. Chronic hypoxia, impaired glucose intolerance, autoimmune mechanisms, vasculitis changes, and micronutrient deficiencies seem to cause neuropathy in cystic fibrosis. This study was aimed to investigate peripheral neuropathy in pediatric cystic fibrosis patients. Twenty-one cystic fibrosis patients and 19 healthy control subjects between the ages of 7 and 17 years were included. Their nerve conduction study results and laboratory investigations were analyzed. Participants were classified into four groups; 1. Cystic fibrosis with vitamin D deficiency, 2. Cystic fibrosis with normal vitamin D levels, 3. Healthy subjects with vitamin D deficiency, 4. Healthy subjects with normal vitamin D levels. We found statistically significantly lower sensory median nerve sensorial nerve action potential, sensorial sural nerve conduction velocity, and motor peroneal nerve compound motor action potential in cystic fibrosis patients with vitamin D deficiency than in other cases. We also found that the main difference between cystic fibrosis and control groups was especially in patients with low vitamin D levels. Nerve damage starts at an early age, especially in cystic fibrosis patients especially those with vitamin D deficiency. Electrophysiological evaluation to assess neuropathy is important even in asymptomatic patients. Prevention of hypovitaminosis D is important to prevent neuropathy in cystic fibrosis patients.

Chronic cough is the most common complaint during childhood. Various pathophysiologic mechanisms may cause cough. Knowledge of the mechanisms underlying chronic cough plays an important role in the choice of treatment to evaluate the role of leukotrienes in children with nonspecific isolated chronic dry cough. The patient group consisted of children with isolated chronic dry cough persisting for > 4 weeks and the control group included healthy children. Medical histories were elicited and physical examinations were performed, then respiratory function testing was done and chest X-rays were obtained. Patients were given inhaled corticosteroid. The urine leukotriene E4 (uLTE4) levels in the patient and control groups was measured by enzyme immunoassay. The patient group included 55 patients, 25 of them were males between 6 and 12 years old. The control group included 25 healthy children between 6 and 12 years old, 12 of them were males. There were no pathologic findings on physical examinations, pulmonary function testing, and chest X-rays. The complaints of cough in 50 patients were resolved after treatment. The median level of uLTE4 was 73.1 ng/mmol creatinine (range, 15.59-787.55 ng/mmol creatinine) in the patient group, and 64.2 ng/mmol creatinine (range, 12-282 ng/mmol creatinine) in the control group. No significant difference was detected between the 2 groups with respect to age, gender, and uLTE4 levels. Different pathophysiologic mechanisms are known to influence nonspecific isolated chronic dry cough. Various mechanisms, other than leukotrienes, may also give rise to dry cough.

Aim:Most of the childhood elbow area fractures constitute supracondylar humerus fractures. The treatment approach in Gartland type II fractures is controversial. The purpose of our study was to compare the effectiveness of cast and splint in conservative treatment of type II supracondylar humerus fractures.Methods:Sixty-nine pediatric patients admitted to our clinic due to gartland type II supracondylar humerus fractures between 2015 and 2020 were retrospectively evaluated. Closed reduction upper-elbow cast was applied to 26 patients, and closed reduction upperelbow splint treatment was applied to 43 patients. Radiological results of the patients were compared.Results:The mean age of the patients participating in the study was 4.86±2.61. Forty-two of 69 patients were male and 27 were female. Neurovascular deficit and compartment syndrome were not observed in any of the patients. When compared radiologically, no significant difference was found between the two groups.Conclusion:Type II supracondylar humerus fractures, where conservative treatment is planned, the upper elbow casting or splint selected for immobilization shows similar effectiveness in protecting reduction.

Objective: To evaluate the risk factors of subclinical neuropathy, and the nerve conduction study (NCS) results in children, and adolescents with type 1 diabetes mellitus (T1DM). Methods: A total of 81 patients without neuropathy symptoms were studied. Demographical features, pubertal stage, disease duration, NCS results, lipid profile results in the last 2 years, HbA1c results in the last 5 years, and the types of treatments (multiple-dose and insulin pump therapy) were recorded. Results: The median age was 14 (5) years, 49.3 % (n=40) of the study group was female and 81.5 % (n=66) of the patients were pubertal. Of the patients, 16.04% had abnormal NCS results. There were no significant differences between patients with normal and abnormal NCS results in terms of demographical features, pubertal stage, disease duration, lipid profiles, and dysglycemia. No significant differences were found between the types of treatment in terms of NCS results. The proximal and distal compound muscle action potential (CMAP) amplitudes of the median nerve were significantly lower in patients with poor glycemic control than in those with well-glycemic control. Sensory nerve action potential (SNAP) amplitudes of sural nerve were significantly lower in patients whose disease durations were ≥60 months than in those

Aim We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis. Methods The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed. Results Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5–6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3–7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis. Conclusion The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition.

Background Because of the broad anatomical variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures.Methods The present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range = 19 to 76) with displaced proximal humerus fractures who were treated by open reduction and internal fixation. After anatomic reduction and fixation was achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index.Results The mean AAND was 6 ± 0.36 cm (range = 5.5–6.6), and the mean arm length was 32.91 ± 2.9 cm (range = 24–38). The mean axillary nerve ratio was 0.18 ± 0.02 (range = 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients.Conclusion During the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered as a safe zone for the prevention of possible axillary nerve injury.

Aim:Septic arthritis may represent a direct invasion of joint space by various microorganisms. The aim of this study was to determine the epidemiological characteristics of patients with septic arthritis in our clinic and to discuss the diagnosis, treatment and management.Methods:Thirty-four patients diagnosed with septic arthritis between June 2008 and December 2014 were retrospectively evaluated. Clinical and epidemiological characteristics of the patients, microorganisms causing infection and treatment choice were analyzed.Results:Most patients were male (55.9%) and the mean age of the patients was 42.8 (1-87) years. The knee was the most often affected joint (91.6%). Fever was present in only 17.6% of the cases. Gram staining was positive in only 17.6% of the synovial fluid samples analyzed. Among the 34 patients studied, 10 had positive synovial fluid culture (29.4%). Staphylococcus aureus was the most common pathogen.Conclusion:Gram negative staining, absence of fever and normal leukocyte count do not rule out septic arthritis but only reduce the possibility. Samples should be taken prior to antibiotic treatment to avoid false negative detection of positive samples. Serial needle aspiration, drainage and empirical antibiotherapy should be kept in mind in the treatment of septic arthritis.

Intellectual developmental disorder with dysmorphicfacies, seizures, and distallimb anomalies(IDDFSDA) is anautosomal recessivemultisystem disorder caused by compound heterozygous or homozygous variants in the geneOTUD6B.Herein, we describe novel pathogenic compound heterozygous variants inOTUD6Bidentified via whole-exome sequencing in an index case exhibited the severe IDDFSDA phenotype. The potentialpathogenicityof the novel frameshift and missense variants in the index case was investigated usingin silicotools. The truncating frameshift variant in one allele was predicted to undergo degradation via nonsense-mediated decay of the mRNA molecule. To predict the severity of the damage to the protein caused by the missense variant in the other allele and its effects on phenotypic severity was further investigated together with a previously reported first homozygous missense variant in the same domain in another patient with a less severe IDDFSDA phenotype using structural modeling and molecular dynamics (MD) simulations for the first time. Based on these analyzes, it is anticipated that Tyr216Cys in the earlier reported case with less severe IDDFSDA will lead to localized destabilization, whereas Ile274Arg in the presented index case with the severe IDDFSDA phenotype will lead to significant distortion in the overall fold of OTUD6B. Our findings suggest that compound LOF and ultrarare missense variants may be contribute to the underlying variability expressivity associated with this disorder. In conclusion, our findings support that the clinical severity could be related with the predicted functional severity of the variations in OTUD6B. However, additional functional studies are required.

Objectives Acute seizures and post-stroke epilepsy have been reported more frequently in patients with pediatric stroke than adults. Acute seizures in the first days of a stroke may deteriorate stroke and ischemia-related neurodegeneration and contribute to the development of post-stroke epilepsy. In this study, we aimed to investigate risk factors for the development of post-stroke epilepsy in children with arterial ischemic stroke. Materials and Methods We recruited 86 children with arterial ischemic stroke. We analyzed variables, including age at admission, gender, complaints at presentation, focal or diffuse neurologic signs, neurologic examination findings, laboratory investigations that were conducted at admission with stroke (complete blood cell count, biochemical-infectious-metabolic-immunological investigations, vitamin B12 levels, vitamin D levels), neuroimaging results, etiologies, time of the first seizure, time of remote seizures, and development of neurologic deficit retrospectively. Seizures during the first six hours after stroke onset were defined as ‘very early seizures’. ‘Early seizures’ were referred to seizures during the first 48 h. Patients who experienced two or more seizures that occurred after the acute phase of seizures were classified as ‘epileptic.’ A binary logistic regression analysis was used to estimate risk factors. Results An acute seizure was detected in 59% and post-stroke epilepsy developed in 41% of our cohort. Binary logistic regression analysis demonstrated that ‘very early seizures’ increased epilepsy risk six-fold. Epilepsy was 16 times higher in patients with ‘early seizures’. Low vitamin D levels were defined as a risk factor for post-stroke epilepsy. Conclusion Seizures in the very early period (within the first six hours) are the most significant risk factors for the development of post-stroke epilepsy Further studies regarding seizure prevention and neuroprotective therapies are needed because post-stroke epilepsy will affect long term prognosis in patients with pediatric stroke.

Background. - Hereditary polyneuropathies are heterogeneous group of diseases of the peripheral nervous system. In this study, we investigated the demographic, clinical, electrophysiological, and genetic characteristics of hereditary polyneuropathy patients diagnosed and followed up in our tertiary center clinic in Izmir, Turkey. Methods. - Patients who were diagnosed with hereditary polyneuropathies during nerve conduction studies in our center were evaluated retrospectively. Results. - In a total of 1484 nerve conduction studies, 207 patients were diagnosed with polyneuropathy. Ninety-nine of those patients were determined to have hereditary polyneuropathy, 52 of which were male and 47 were female. Sixty-nine patients with hereditary polyneuropathy were compatible with axonal and 30 were compatible with demyelinating polyneuropathy. Genetic analysis was performed in 69 patients, and 49 of those patients were genetically diagnosed, leading to a diagnosis rate of 71%. Conclusions. - Advances in genetics have led to an increase in the heterogeneity of hereditary polyneuropathies, causing difficulties in the use of existing classifications. Although typical mutations expected in childhood-onset polyneuropathies are seen less frequently, polyneuropathies are frequently encountered as findings of complex, multisystemic diseases. (C) 2020 Elsevier Masson SAS. All rights reserved.

Aim: In this study, we aimed to discuss the result of arthroscopic surgery for shoulder instability and we planned to show the value of instability tests for determining success of surgery. Methods: Patients, who were operated for shoulder instability between 2008 and 2013, were included in this study. Visual analogue scale, Rowe and Oxford shoulder scores of the patients were recorded preoperatively and at the final follow-up visit. Physical examination finding were noted at the final follow-up visit. Results were analyzed using SPSS. Results: Twenty one patients were included in this study. Re-dislocation was detected in two patients. There was no re-dislocation in patients with an osseous Bankart lesion. All clinical scores improved in all patients, however those with a negative apprehension test had better clinical scores. Conclusion: Arthroscopic Bankart repair is an effective procedure for the treatment of shoulder instability. Presence of osseous Bankart lesion plays an important role in the prognosis. Apprehension test is useful for assessing shoulder stability in the postoperative follow-up.

WOS: 000404044200010, PubMed ID: 28464723, Congenital myasthenic syndromes are clinically and genetically heterogeneous disorders of neuromuscular transmission. Most are treatable, but certain subtypes worsen with cholinesterase inhibitors. This underlines the importance of genetic diagnosis. Here, the authors report on cases with genetically proven congenital myasthenic syndromes from Turkey. The authors retrospectively reviewed their experience of all patients with congenital myasthenic syndromes, referred over a 5-year period (2011-2016) to the Child Neurology Department of Dokuz Eylul University, Izmir, Turkey. In addition, PubMed was searched for published cases of genetically proven congenital myasthenic syndromes originating from Turkey. In total, the authors identified 43 (8 new patients, 35 recently published patients) cases. Defects in the acetylcholine receptor (n = 15; 35%) were the most common type, followed by synaptic basal-lamina associated (n = 14; 33%) and presynaptic syndromes (n = 10; 23%). The authors had only 3 cases (7%) who had defects in endplate development. One patient had mutation GFPT1 gene (n = 1; 2%). Knowledge on congenital myasthenic syndromes and related genes in Turkey will lead to prompt diagnosis and treatment of these rare neuromuscular disorders., NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [NS6277]; German Research Foundation (DFG) (Emmy Noether Arbeitsgruppe), The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Genetic studies performed in AGE's laboratory were supported by NIH Grant NS6277. SC is funded by the German Research Foundation (DFG) (Emmy Noether Arbeitsgruppe).

In neonates supraphysiological oxygen therapy has been demonstrated to cause neuronal death in hippocampus, prefrontal cortex, parietal cortex, and retrosplenial cortex. There is a need for the detection of novel neuroprotective drugs. Neuroprotective effects of lacosamide or memantine have been demonstrated in adult patients with ischemia, trauma and status epilepticus. The effects in immature brains may be different. This study aimed to evaluate neuroprotective effects of lacosamide and memantine treatment in a hyperoxia-induced brain injury model in immature rats. This study was performed in the Animal Experiments Laboratory of Dokuz Eylul University Faculty of Medicine. Neonatal Wistar strain rat pups were exposed to hyperoxia (80% oxygen + 20% nitrogen) for five days postnatally. They were divided into five groups; hyperoxia + lacosamide, hyperoxia + memantine, hyperoxia + lacosamide and memantine, hyperoxia + saline, control groups. After termination of the experiment, brain tissues were examined. Neuron counting in examined regions were found to be higher in hyperoxia + memantine and hyperoxia + lacosamide and memantine groups than hyperoxia + saline group. The presence of apoptotic cells evaluated with TUNEL and active Caspase-3 in hyperoxia + memantine and hyperoxia + lacosamide and memantine groups were found to be lower compared to hyperoxia + saline group. This study demonstrates that neuron death and apoptosis in newborn rat brains after hyperoxia is reduced upon memantine treatment. This is the first study to show the effects of memantine and lacosamide on hyperoxia-induced damage in neonatal rat brains.

Acute cerebellitis is one of the most common cerebellar disorders and occurs due to para-infectious, post-infectious, or post-vaccination cerebellar inflammation. Herpes simplex virus-1 (HSV-1) is known as a common infectious cause of sporadic encephalitis. Cerebellar involvement of HSV-1 is rare and almost always associated with meningoencephalitis. To date, HSV-1 has been identified as the cause of acute isolated cerebellitis in only two patients. Here we report another case of isolated acute cerebellitis caused by HSV-1 in a 20-month-old boy.

Aim: This is a unique study that aimed to determine anemia and inflammatory status in simple febrile seizure vs complex febrileseizure patients. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are positively correlated with inflammatory markersincluding TNF alpha and IL-6. They are practical, inexpensive, and valuable tools for evaluating inflammation.Materials and Methods: Patients presenting with first febrile seizures were enrolled retrospectively. We investigated hemoglobin,hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and red blood cell distribution width valuesand white blood cell count, neutrophil, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean plateletvolume, C - reactive protein.Results: Our study showed that higher neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and lower mean platelet volumevalues in complex febrile seizure cases than simple febrile seizure cases. We determined cut-off values for neutrophil/lymphocyteratio, platelet/lymphocyte ratio, and mean platelet volume of 2.5, 10523.3, and 7.3 respectively.Conclusion: High neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and low mean platelet volume values can help distinguishsimple febrile seizure and complex febrile seizure patients and predict the clinic. The optimal cut-off values that we determined mayguide clinicians.

Bayram E, Yis U, Paketci C, Okur D, Polat I, Cakmakci H, Hiz S, Anlar B. Changes of primary headache related white matter lesions in pediatric patients. Turk J Pediatr 2018; 60: 380-384. We aimed to describe the long-term prognosis of white matter lesions detected on magnetic resonance imaging in children with primary headache. Children who were admitted with the complaint of headache and had nonspecific white matter lesions on magnetic resonance imaging were included in the study. The clinical findings of the patients were reinvestigated using the same magnetic resonance imaging scanner and acquisition protocol after at least a two year period. Magnetic resonance imaging results of the patients were documented in detail. Findings of the baseline and follow-up studies were compared with each other by the same radiologist. Among the 11 patients, 8 ( 72.7%) were male and 3 (27.3%) were female. Mean age of patients at the time of second imaging was 12.9±2.3 years. Eight (72.7%) had migraine without aura, 1 (9.1%) had tension-type headache and 2 (18.2%) had migraine with aura. The mean clinical follow-up period of the patients was 4.31±1.31 years. All patients had low headache frequency on the last control visit when compared to the first clinical findings. The follow-up magnetic resonance imaging studies showed two newly developed white matter lesions in two patients who had migraine without aura and the white matter lesions disappeared in the patient who had tension-type headache, compared to the baseline neuroimaging. Findings of the baseline and long-term follow-up magnetic resonance imaging studies of the patients with primary headache showed no significant changes in terms of the location, size and laterality. Repeated neuro-imaging studies are not warranted in the absence of the progression in clinical findings.

Objective: Duchenne Muscular Dystrophy (DMD) is the most severe form among a variety of muscular dystrophies. While studies into the etiology and pathophysiology of DMD have progressed fast, there still is no therapy for the disease. The presence of a severe chronic disease such as DMD can seriously affect patients as well as caregivers. In this study, we planned to compare quality of life and sleep between cases diagnosed as DMD and healthy controls while at the same time assessing the levels of anxiety in the patients' mothers. Method: In this study, 17 cases with a diagnosis of DMD and 20 healthy controls were enrolled. All the patients and controls were male. The social status of patients and controls was assessed with a sociodemographic data form. To evaluate the children's quality of life, the Pediatric Quality of Life Inventory (PedsQL) was completed by children and parents. The Pittsburgh Sleep Quality Index (PSQI) is a selfreported questionnaire used to evaluate the quality of sleep in children. We measured the mothers' anxiety with the State-Trait Anxiety Inventory (STAI) - state anxiety and trait anxiety forms. Mann-Whitney U test and chi square test were used for statistical analysis. Results: A statistically significant difference was found in comparing both parents' and children's PedsQL forms between patients and controls. The quality of sleep also differed significantly between cases and controls. In the STAI state and trait anxiety forms, no significant difference was found between the anxiety levels of patients' mothers and the control persons' mothers. Conclusion: As key result of our study, we found that there are more problems in the DMD patients' sleep, and the quality of life is lower than in the healthy controls. Problems in motor functionality may affect emotional and social functionality and possibly the quality of children's sleep. Amaç: Duchenne Musküler Distrofi (DMD) birçok musküler distrofi arasında en ciddi olanıdır. DMD'nin etyolojisi ve patofizyolojisi üzerine yapılan araştırmalardaki hızlı ilerleyişe rağmen, tedavisi henüz mümkün değildir. DMD gibi ciddi kronik bir hastalığın varlığı hem hastalar hem de bakımverenler üzerinde büyük etkilere sebep olabilir. Biz bu çalışmada DMD tanılı olgular ile sağlıklı kontrollerin yaşam ve uyku kalitesini karşılaştırmayı aynı zamanda olgu ve kontrollerin annelerinin de anksiyete düzeyini değerlendirmeyi planladık.Yöntem: Çalışmaya 17 DMD tanılı olgu ile 20 sağlıklı kontrol dahil edilmiştir. Olgu ve kontrollerin hepsi erkektir. Olgu ve kontrollerin sosyal durumu sosyodemografik veri formu ile değerlendirilmiştir. Çocukların yaşam kalitelerini değerlendirmek için çocuklar ve ebeveynleri tarafından doldurulan Çocuklar için Yaşam Kalitesi Ölçeği (ÇİYKÖ) kullanılmıştır. Pittsburg Uyku Kalitesi İndeksi (PUKİ) çocukların uyku kalitesini değerlendirmek için kullanılan bir özbildirim ölçeğidir. Annelerin anksiyetesi Durumluk- Süreklilik Anksiyete Ölçeği (STAI)-durumluk ve süreklilik formları ile değerlendirilmiştir. Mann Whitney U ve kikare istatistiksel analiz olarak kullanılmıştır. Bulgular: Olgu ve kontrollerin hem ÇİYKÖ ebeveyn hem ÇİYKÖ çocuk formları kıyaslandığında istatistiksel anlamlı fark bulunmuştur. Olgu ve kontrollerin uyku kalitesi arasındaki fark da istatistiksel olarak anlamlı çıkmıştır. STAI durumluk ve süreklilik ölçeklerinde olgu ve kontrollerin annelerinin anksiyete düzeyleri arasında anlamlı fark bulunmamıştır. Sonuç: Bizim çalışmamızın temel bulgusu DMD’li olguların uykuda daha fazla zorlukları olduğu ve yaşam kalitelerinin sağlıklı kontrollere göre daha düşük olduğudur. Motor işlevsellikteki zorlukların duygusal, sosyal işlevselliğe ve belki de çocukların uyku kalitesine etkileri olabilir

Despite the significant advancements in perinatal care, it is not clear whether or not the neurodevelopmental outcome in children with intraventricular hemorrhage (IVH) has improved in parallel with the declining incidence of periventricular- IVH. In this study, we aimed to assess the periventricular-IVH-induced mortality and morbidity rates, as well as the short-term neurodevelopmental outcomes in premature infants. Two hundred and sixty five patients who were admitted between September 2005 and May 2006 were investigated for periventricular-IVH. Sixty-six patients with periventricular-IVH were compared with 66 premature infants who were not associated with hemorrhage. Of the periventricular-IVH diagnosed premature infants, 59% were born at or before week 32, 61% had a body weight below 1500 g, and 24.9% had hemorrhage. In cases with periventricular-IVH, the rates of premature retinopathy and periventricular leukomalacia were significantly high ( P 0.05) while the relation between periventricular-IVH and neuromotor developmental retardation was significant ( P< 0.05). The outcome was poorer as the grade of bleeding increased ( P< 0.05). As a conclusion, regardless of risk factors, periventricular-IVH is an important early indicator of neurodevelopmental retardation, and those cases having such condition should be always assessed with a neurodevelopmental evaluation. The detection of neurodevelopmental retardation in short term with appropriate educational strategy could be beneficial for long-term outcome.

Purpose: Children's low interest in food and 'lack of appetite' are of serious concern for parents and in consequently for the professionals. This study aimed to examine parental feeding strategies, effects of meal time environment, describe family functioning, and clarify general parental attitudes of the children with poor appetite from a developing country without any physical health problem that might affect growth, cause pain or discomfort during feeding.

Rotavirus is a leading cause of gastroenteritis in children under 5 years of age. It is known that neurological manifestations like seizures, encephalopathy and encephalitis can rarely be seen due to rotavirus infections. Cerebellar involvement is extremely rare. We present an uncommon neurological manifestation of rotavirus infection in a 4-year-old Turkish child who presented with hypotonia, reduced consciousness and mutism. Magnetic resonance imaging revealed diffusion abnormalities in the splenium of corpus callosum and nucleus dentatus bilaterally. She was diagnosed with rotavirus cerebellitis. She improved well with dexamethasone and intravenous immunoglobulin but still has dysarthria and poor fine motor coordination.

Ya­z›fl­ma­Ad­re­si/Ad­dress­for­Cor­res­pon­den­ce:­Samed Ordu Haseki Egitim ve Arastirma Hastanesi, Ortopedi Klinigi, Istanbul, Turkiye GSM.: +90 505 629 12 49 E-pos ta: s_ordu@hotmail.com Gelifl­Tarihi/Received:­30 Eylul 2013­Ka­bul­Ta­ri­hi/Ac­cep­ted:­4 Ocak 2014 Haseki T›p Bulteni, Galenos Yay›nevi taraf›ndan bas›lm›flt›r. The Medical Bulletin of Haseki Training and Research Hospital, published by Galenos Publishing. Dizin Medial Kompartman Osteoartritinde Unikondiler Diz Artroplastisi Uygulanan Hastalarin Kisa Donem Sonuclari Short-Term Results of Medial Unicondylar Knee Arthroplasty

Oxygen therapy used in the treatment of perinatal hypoxia induces neurodegeneration in babies with immature antioxidant mechanisms. Zonisamide is a new antiepileptic drug used in childhood intractable seizures. Many studies demonstrated its neuroprotective effects. There is no study evaluating its effect on hyperoxic brain injury. The aim of this study was to investigate the neuroprotective effect of zonisamide on hyperoxia-induced neonatal brain injury. A total of 21 Wistar rat pups were used. The animals were divided into three groups: control group, hyperoxia group, and zonisamide-treated group. The zonisamide-treated group received an intraperitoneal injection of zonisamide. Zonisamide significantly preserved the number of neurons in CA1 and dentate gyrus parts of hippocampus, prefrontal, and parietal cortex. Zonisamide treatment also decreased the number of apoptotic neurons in all examined parts of hippocampus, prefrontal, and parietal cortex. We suggest that zonisamide treatment may be used as a neuroprotective agent in hyperoxic brain injury.

Subacute sclerosing panencephalitis is caused by persistent brain infection of mutated virus, showing inflammation, neurodegeneration, and demyelination. Although many factors are emphasized in the pathogenesis of subacute sclerosing panencephalitis, the exact mechanism of neurodegeneration remains unknown. Micro-RNAs are small, noncoding RNAs that regulate gene expression at the posttranscriptional levels. Micro-RNAs are essential for normal immune system development; besides they are also implicated in the pathogenesis of many chronic inflammatory disorders. The aim of this study is to investigate the expression patterns of micro-RNAs 146a, 181a, and 155 in peripheral blood mononuclear cells of patients with subacute sclerosing panencephalitis. We enrolled 39 patients with subacute sclerosing panencephalitis and 41 healthy controls. Quantitative analysis of micro-RNAs 146a, 181a, and 155 were performed using specific stem-loop primers followed by real-time polymerase chain reaction. All of 3 micro-RNAs were upregulated in subacute sclerosing panencephalitis patients. In addition, the level of micro-RNA 155 expression was higher in stage 3 patients. But, micro-RNA 146a and 181a expression levels showed no association or correlation with clinically relevant data. Alteration of peripheral blood mononuclear cell micro-RNAs in subacute sclerosing panencephalitis may shed new light on the pathogenesis of disease and may contribute to the aberrant systemic rise in mRNA levels in subacute sclerosing panencephalitis.

Aim We aimed to describe the efficacy and safety of levetiracetam in paediatric patients receiving chemotherapy for haematologic disorders. Methods Children with haematologic disorders who were receiving chemotherapy agents and developed seizure during treatment and treated with levetiracetam were included in the study. The clinical data of the patients were retrospectively evaluated. Primary haematologic diagnosis, chemotherapeutic agents, age at first seizure, seizure type, interictal electroencephalography findings, magnetic resonance imaging findings, response to the levetiracetam treatment, dose of levetiracetam, levetiracetam side effects and treatment period were recorded. Results Ten patients with a mean age 12.4 ± 2.96 years were included in the study. Possible triggering factors for seizures were chemotherapeutic agents in 60% (n = 6), posterior reversible encephalopathy syndrome in 20% (n = 2) and central nervous system involvement of the primary disease in 20% (n = 2). Nine patients received levetiracetam monotherapy, and one patient received levetiracetam that was added on oxcarbazepine due to the intractable seizures. The mean duration of antiepileptic treatment that overlapped with chemotherapy was 7.3 ± 3.5 months. Nine patients (90%) were seizure free after levetiracetam monotherapy, and one patient (10%) had ≥50% seizure reduction after levetiracetam who was previously treated with oxcarbazepine. No side effects were observed for levetiracetam during treatment. Conclusion Levetiracetam treatment is safe and effective to prevent seizures in children receiving chemotherapy for haematologic disorders.