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Aim It is a known fact that pubertal development is negatively affected in patients with chronic diseases. In this study, we aimed to investigate the effects of juvenile idiopathic arthritis (JIA), the most common chronic rheumatic disease of childhood, on pubertal development.Materials and MethodsA total of 72 children (42 girls, 30 boys) diagnosed with JIA according to the International League of Associations for Rheumatology diagnostic criteria were included. Pubertal development was assessed by the Tanner–Marshall method. Breast development in girls (thelarche stage 1–5) and testis volume in boys (genital stage 1–5) were assessed. The Tanner stages of the patients were compared with the pubertal development averages of healthy Turkish children reported previously.ResultsThe mean patient age was 13.8±3.3 years. The girls’ mean age at puberty onset and menarcheal age were found to be 10.87±1.22 and 12.83±1.05 years, respectively. They did not differ from healthy Turkish girls in terms of puberty onset age and menarcheal age (p=0.07) and from their own mothers in terms of menarcheal age (p=0.66); however, their completion of puberty was delayed (p=0.001). The boys’ mean age at puberty onset was 13.8±2.2 years, and we found that both onset and completion of puberty were delayed (p=0.001; p=0.003, respectively). The rate of delayed puberty in all patients was found to be 4.1%.Discussion and Conclusion: We found that completion of puberty was delayed in girls with JIA, although puberty onset age and menarcheal age were not affected, and that both onset and completion of puberty were delayed in boys with JIA., Amaç: Kronik hastalıklarda puberte gelişiminin olumsuz etkilendiği bilinmektedir. Bu çalışmada çocukluk çağının en yaygın kronik romatolojik hastalığı olan jüvenil idiyopatik artritin (JİA) puberte gelişimine olan etkilerini araştırmak amaçlanmıştır.Gereç ve Yöntemler: Çalışmamıza International League of Associations for Rheumatology tanı kriterlerine göre JİA tanısı almış 72 (42 kız, 30 erkek) çocuk dahil edildi. Pubertal gelişim Tanner–Marshall metoduyla değerlendirildi. Kızlarda göğüs gelişimi (telarş evre 1–5), erkeklerde testis hacmi (genital evre 1–5) değerlendirildi. Hastaların Tanner evreleri sağlıklı Türk çocuklarının önceden bildirilmiş pubertal gelişim ortalamaları ile karşılaştırıldı.Bulgular: Hastaların yaş ortalaması 13,8±3,3 yıl idi. JİA’lı kızlarda puberte başlangıç yaşı 10,87±1,22, menarş yaşı ise 12,83±1,05 yıl olarak saptandı. Kızların puberte başlangıç ve menarş yaşı sağlıklı Türk kızlarınınkinden (p=0,07) ve menarş yaşı kendi annelerinin menarş yaşından (p=0,66) farklı değildi; fakat pubertenin tamamlanmasının geciktiği saptandı (p=0,001). Erkek çocuklarda ise puberte başlangıç yaşı 13,8±2,2 yıl idi ve pubertenin başlamasının ve tamamlanmasının geciktiği tespit edildi (sırasıyla p=0,001; p=0,003). Tüm hastalarda geç puberte oranı %4,1 olarak saptandı.Tartışma ve Sonuç: JİA’lı kızlarda puberte başlangıç yaşı ve menarş yaşı etkilenmemekle birlikte pubertenin tamamlanmasının geciktiği, JİA’lı erkek çocuklarda ise hem puberte başlangıcının geciktiği hem de pubertenin tamamlanma süresinin uzadığı saptanmıştır.

Chronic functional constipation is a common gastrointestinal disorder in children with no underlying organic cause. Although reasons such as bad eating habits and early transition to solid food are blamed for constipation, the etiology of the disease has not been fully elucidated. Our study aims to determine the differences in stool microbiota between children with chronic functional constipation and healthy children. Feces samples of 49 patients and 40 healthy children who meet Rome IV criteria were analyzed by 16s rRNA /PCR (Polymerase Chain Reaction) method. Within the sample microbial diversity, the Shannon diversity index was calculated based on the profiles obtained using the R 2.15.2 software package programe. In our study, no statistically significant difference was found between the study group and the control group in terms of the Shannon Diversity Index (p 0.005). Although there is no significant difference between microbiota subtypes, the fact that Lactobacillus kefiri and Bifidobacterium infantis were detected only in healthy children may guide the supportive treatments to be given to constipated children. The results of our study also show that there is a need for more comprehensive studies in large populations, supporting other literature studies showing that the gastrointestinal microbiota is different in constipated and normal children.

Today, obesity in childhood is considered as an important health problem, especially in developed countries. This study aims to determine the prevalence of obesity in children and to reveal the relationship between television watching habit, computer use and socioeconomic status in children.A cross-sectional study was performed in 11 public schools selected with random sampling in Istanbul. A total of 1479 children (767 males (51.9%)) were included in the study. Their ages ranged from 10-15, and the mean age was 11.95±1.36 years for girls and 12.06±1.39 years for boys. Demographic characteristics and factors affecting obesity were inquired with the structured questionnaire form.The height, and body weights of the students were measured, and their body mass ındexes were calculated. Those with a BMI above the 95th percentile were considered obese, and those between the 85In the study group, the obesity rate was calculated as 5.3%, and the mild obesity rate as 14.9 percent. The total prevalence of overweight and obese children was 20.2%. The frequency of obesity in the high socioeconomic level group was significantly higher than low one (p0.01). The average daily screen time was 3.74±1.58 hours. The obesity risk was found to increase three times when this period exceeded five hours. In the logistic regression analysis, while high socioeconomic level was found as the main determinant among the risk factors for obesity, the effects of daily screen time were found to be marginally significant (p0.045).The lifestyle of the families with high socioeconomic status is the main determinant of obesity in adolescents. Nutrition with higher calorie foods, more frequent media use and a more sedentary life brought about is an obesogenic environment created by a high socioeconomic status. Environmental risk factors for obesity should be assessed.Günümüzde özellikle gelişmiş ülkelerde çocuk yaşlardaki şişmanlık önemli bir sağlık problemi olarak ele alınmaktadır. Bu çalışma, çocuklarda obezite sıklığını belirleyebilmeyi ve çocuklarda televizyon izleme alışkanlığının, bilgisayar kullanımının ve sosyoekonomik durumun obezite ile ilişkisini ortaya koymayı amaçlamaktadır.İstanbul’da tesadüfi örnekleme ile seçilen 11 tane devlete ait ilköğretim okulunda kesitsel bir araştırma yapıldı. Araştırmaya 767 erkek (%51,9), 712 kız (%48,1) olmak üzere toplam1479 öğrenci katıldı. Yaşları 10-15 arasında değişmekte olup, ortalama yaş kızlarda 11,95±1,36 yıl, erkeklerde 12,06±1,39 yıldı. Yapılandırılmış anket formu ile demografik özellikler ve obezitede etkili olan faktörler sorgulandı. Öğrencilerin boy ve kiloları ölçüldü ve beden kitle indeksi (BMI) hesaplandı. BMI 95. persantilin üzerinde olanlar şişman olarak, 85-95 persantilleri arası hafif şişman (overweight) olarak kabul edildi.Araştırma grubunda obezite oranı %5.3, hafif şişman oranı %14,9 olarak saptandı. Obez ve hafif şişman toplam sıklığı %20,2 bulundu. Sosyoekonomik düzeyin yüksek olduğu grupta obezite sıklığı kız ve erkek cinste de anlamlı yüksek olarak belirlendi (p0,01). Obezite risk faktörlerinde ana belirleyici olarak sosyoekonomik durum saptandı.Ortalama televizyon izleme ve bilgisayar kullanma süresi 3,74±1,58 saatti. Bu sürenin 5 saatin üzerinde olduğunda obezite riskinin 3 kat arttığı saptandı. Lojistik regresyon analizinde sosyoekonomik düzey ana belirleyici olarak saptanırken, televizyon izleme ve bilgisayar kullanım süresinin obeziteye etkisi sınırda anlamlı olarak bulundu. (p0,045).Yüksek sosyoekonomik duruma sahip ailelerin yaşam tarzı adölesanlarda obezite için ana belirleyicidir. Daha yüksek kalorili gıdalar ile beslenme, daha çok media kullanımı ve bunun getirdiği daha sedanter yaşam yüksek sosyoekonomik durumun oluşturduğu obesojenik bir çevredir. Obezite için çevresel risk faktörleri belirlenmelidir.

Candida enfeksiyonu myokardit, endokardit ve dilate kardiyomyopatinin nadir bir sebebidir. Antifungal tedavinin baslanma zamanin bu hastalarda mortalite oranlarini etkiledigi iyi bilinmektedir. Kardiyak Candida enfeksiyonlarindaki optimal antifungal secenegi ve tedavi suresi ise henuz kesin olarak tanimlanmamistir. Bu calismada akut lenfoblastik losemi tanili dort yasindaki bir cocukta Candida albicansa bagli nadir bir dilate kardiyomiyopati ve endokardit vakasi paylasilarak tedavisi tartisildi. (J Pediatr Inf 2014; 8: 82-5) Anahtar kelimeler: Dilate kardiyomiyopati, candida, akut losemi Abstract

Amac: Bu calismanin amaci cocuk Hodgkin hastaliginda hastalarin yasam suresi ve tedaviye yanitini inceleyerek sagkalimi etkileyen degiskenleri arastirmaktir Gerec ve Yontem: Hastanemiz Cocuk Hematoloji Onkoloji Klinigi rsquo;nde 1996 2011 yillari arasinda izlenen ve tedavi edilen 43 Hodgkin lenfoma hastasi geriye donuk olarak incelendi On sekiz yas altinda yeni tani almis 23 erkek ve 20 kiz hasta calismaya dahil edildi Bulgular: Ortanca yas dokuz yil bes ay olup bir hasta evre I 21 hasta evre II 12 hasta evre III ve dokuz hasta evre IV idi Hastalar erken evre ve ileri evre olarak siniflandirildi Evre I evre IIA ve dusuk riskli evre IIB hastalar erken evre evre III evre IV ve yuksek riskli evre IIB hastalar ileri evre olarak degerlendirildi On dokuz hasta erken evre 24 hasta ileri evre idi En sik histolojik alt tip 22 hasta ile noduler sklerozan tipti On sekiz hastada B bulgulari vardi Calismada hemoglobin duzeyi lokosit sayisi eritrosit cokme hizi bakir fibrinojen laktik dehidrojenaz ferritin ve haptoglobin duzeylerinin tedaviye yaniti uzerine etkisi arastirildi Otuz sekiz hasta yasamakta olup yedi hastada hastalik yineledi ve bes hasta oldu Ortanca izlem suresi yedi yil dort aydi Ortalama sagkalim suresi 12 66 plusmn;0 70 yildir En son olum besinci yilda gorulmus olup; bu aydaki kumulatif sagkalim orani 85 9 standart hata 6 1 rsquo;dir Erken evrelerde ortalama sagkalim suresi 13 10 plusmn;0 81 yil ileri evreler icin 12 56 plusmn;0 96 yildi Cikarimlar: Bulky hastalik ortalama sagkalim suresi icin kotu seyir degiskeniydi Kadin cinsiyet bulky hastalik ve noduler sklerozan alt tipi hastaliksiz yasam icin kotu seyir etmeniydi Turk Ped Arfl 2013; 48: 310 4

In this study, we aimed to determine the frequency of pericardial effusion (PE) in children diagnosed with acute lymphoblastic leukemia (ALL). Clinical features of patients with effusion were evaluated. For this purpose, we reviewed the medical records of ALL patients who had pretherapy echocardiograms. A total of 90 patients aged between 1.8 and 16.3 years were analyzed retrospectively. In 23 of 90 (25.6%) patients, PE was detected at initial diagnosis. The age of patients with PE ranged between 1.8 and 14.8 years (mean 5.05 ± 3.77 years). The female/male ratio was 9/14. Six (26.1%) patients were T-lineage and 17 (73.9%) were B-lineage ALL. Nine (39%) patients were in standard risk group, 13 (57%) were in median risk group, 1 (4%) patient was in high-risk group. Mean initial white blood cell count was 40.756 ± 38.653/mm(3) (range 23.000-130.000/mm(3)). Mean initial hemoglobin count was 7.3 ± 1.39 gr/dL (range 5.5-10.1 gr/dL), mean initial platelet count was 35.200 ± 26.300/mm(3) (range 4.000-118.000 mm(3)). Size of effusions was between 2 and 6 mm (mean size 3.3 ± 1.8 mm). All patients had normal left ventricular systolic function. In 87% of patients, effusions disappeared in the first 7 days and, in 13%, disappeared between 8th and 15th days of chemotherapy. None of the patients required pericardiocentesis. Cardiac dysfunction did not occur among any of these patients during chemotherapy. In conclusion, PE is not frequent in childhood ALL. It usually does not cause cardiac impairment. It responds to treatment of leukemia.

Cardiac involvement, such as pericarditis, myocarditis, and endocarditis, is seen in juvenile idiopathic arthritis. Although there have been some reports about right-ventricular systolic and diastolic functions of adults with rheumatoid arthritis and left-ventricular systolic and diastolic functions of children with JIA, there have been no studies about RV functions of children with JIA. The aim of this study was to determine RV functions in children with JIA. We performed conventional echocardiography and tissue Doppler imaging measurements of the right ventricle of patients with JIA. All patients were in sinus rhythm at the time of examination without overt LV heart failure and with normal LV ejection fraction. Fifty-five children with the diagnosis of JIA and 33 healthy control subjects were included in the study. Peak systolic, early, and late diastolic tricuspid annular velocities were significantly decreased in JIA patients compared with healthy controls (p < 0.05). Isovolumic accelaration (IVA), as a measure of myocardial acceleration during isovolumic contraction of the right ventricle, was also significantly lower in JIA patients than in healthy controls (p < 0.05). RV systolic and diastolic functions, in addition to the previously shown LV functions, are affected in JIA patients. IVA decreases in JIA patients and may be used as an alternative, noninvasive parameter for the assessment of RV systolic function in children with JIA.

Background: Autoimmune mechanisms and drugs used in treatment increase the risk of liver disease in patients with juvenile idiopathic arthritis (JIA) and hepatitis A virus (HAV) vaccination is important, especially in intermediate-endemicity areas like Turkey. In our study, we aimed to evaluate the immune response to hepatitis A vaccine and vaccine safety in children with JIA. Methods: This study was carried out in our hospital’s Pediatric Rheumatology outpatient clinic and Healthy Child clinic between the years 2003 and 2008. The study group consisted of 47 children with JIA (23 male and 24 female) diagnosed according to International League of Associations for Rheumatology diagnostic criteria. The control group consisted of 67 healthy children (31 female, 36 male) who did not have a history of hepatitis A infection or vaccination. Both groups were vaccinated with two doses of hepatitis A vaccine at 6-month intervals. Anti-HAV IgG >80 MIU was accepted as positive response. Results: There was no significant difference between the groups in terms of age and sex. None of the patients with JIA had fever, clinical worsening, or disease activation after vaccination. Anti-HAV IgG positivity rate was significantly higher in the control group (p

BackgroundIron deficiency and iron-deficiency anemia are the most common nutritional deficiencies in children, especially in developing countries. Iron-deficiency anemia in infancy is associated with impaired neurodevelopment. Studies have shown an association between iron deficiency without anemia and adverse effects on psychomotor development.ObjectiveTo determine the effects of iron deficiency and iron-deficiency anemia on psychomotor development in childhood.MethodsWe evaluated psychomotor development in healthy children with iron deficiency and iron-deficiency anemia with the use of the Denver II Developmental Screening Test (DDST-II). If the child score was more than 90th percentile compared to children in the same age group, the test was scored as “delay”; it was scored as a “caution” if the child score was between the 75th and 90th percentiles. The test result was interpreted as “normal,” if there was no delay and only one “caution” for any item. If the child had one or more “delays” or more than two “cautions,” the result was classified as “abnormal.”ResultsDDST-II scores were abnormal in 67.3% of subjects with iron-deficiency anemia, 21.6% of those with iron deficiency, and 15.0% of control subjects. The difference from the control group in the percentage of abnormal scores was significant for subjects with iron-deficiency anemia ( p < .01) but not for those with iron deficiency (p = 0.203); p > .05. (p-value, post-hoc comparison of 2 groups.)ConclusionsIron-deficiency anemia impaired psychomotor development during childhood. However, the evidence on the adverse effects of iron deficiency remains controversial. The Denver II Developmental Screening Test is a valuable test to detect early developmental delays, especially in infants with risk factors.

Background: We aimed to evaluate the cause, clinical profile, and short-term outcome of status epilepticus cases that were admitted to our pediatric emergency unit between 1 January and 31 December 2008. Methods: We studied the clinical features of 59 seizures that occurred in 56 patients aged between 3 months and 15 years with the diagnosis of status epilepticus. We observed the clinical course and outcome of 53 cases for 6 to 18 months. The correlation between the cause of the seizure and the patient's age at the time of status epilepticus was evaluated as well as the correlation between the risk of seizure recurrence and family history of seizure, the neurological status of the patient prior to seizure and the presence of epilepsy. Results: The most common cause of status epilepticus is febrile illness in children younger than 2 years and idiopathic/cryptogenic and remote symptomatic causes in children older than 2 years. The rate of recurrence of seizure was significantly higher in cases with existing neurological abnormalities, prior epilepsy and seizures with remote symptomatic causes. The most common triggering factors of status epilepticus development in cases with epilepsy were noncompliance for anti-epileptic drugs and infectious fever. Conclusions: In our study, the risk factors for seizure recurrence were the presence of prior epilepsy, existence of neurological abnormalities and remote symptomatic causes. We argue that improving the compliance of patients and their families to take medicine appropriately and training them in how to cope with febrile illnesses may decrease the recurrence of seizures.

Hepatitis B vaccination can prevent hepatitis B virus infection and its serious consequences, including liver cancer and cirrhosis. Serious side effects reported after receiving hepatitis B vaccination are very uncommon. A majority of the ophthalmological complications seen following hepatitis B vaccination consist of vision loss, optic neuritis, papillary edema, uveitis, acute placoid pigment epitheliopathy and central vein occlusion. We present a 9-year-old girl who was referred to our hospital with decrease in vision and pain in the left eye a week after hepatitis B vaccination. A diagnosis of vaccine- induced optic neuritis was made. The clinical picture improved after systemic corticosteroid treatment. Acute optic neuritis might be a rare complication of hepatitis B vaccination. Parents should be aware of the potential serious side effects of the vaccine.

Aim: The purpose of this study was to evaluate prospectively the age-related incidence and severity of primary vesicoureteral reflux (VUR) in siblings of children with reflux and to conclude whether screening of this group is required or not. Methods: A total of 71 siblings (32 boys, 39 girls) of reflux patients, aged less than 15 years (mean age, 8.4 years) were included in the study. Examination methods including urinalysis, urine culture, renal ultrasonography, and voiding cystourethrography were performed in all of the siblings. Additionally, 99m technetium (Tc)-dimercaptosuccinic acid (DMSA) renal cortical scintigraphy was performed in siblings with VUR. Results: Primary VUR was found in 10 (14%) of the siblings, and the incidence for girls and boys were 41.7% and 9.3%, respectively. The reflux incidence in siblings aged less than 6 years was 40%, whereas in siblings older than 6 years it was found 60%. DMSA scintigraphy was performed on all the siblings with VUR, of whom 5 had normal and 5 had abnormal findings. Conclusion: The incidence of primary VUR in siblings of affected children was found higher compared to the siblings of children without the disease, supporting the necessity to screen this population.

Aim To investigate probable aetiological risk factors and to identify whether there are any differences in bone age between normal children and children with primary nocturnal enuresis (PNE). Methods Ninety children with primary nocturnal enuresis and 40 healthy children were included in the study. Enrolment began in January 2001, and continued through July 2002. Data were obtained via consultation with children and their families, physical examination and laboratory findings. Left hand and wrist graphs of each patient were acquired, and, using Tanner Whitehouse charts (TW-2), bone ages were determined via comparison of 20 hand and wrist bones. Results Of the total of 90 children with primary nocturnal enuresis participating in the study, 52 (57.8%) were male and 38 (42.2%) were female. Of the control group, 24 (60%) were male and 16 (40%) were female. Differences between chronological ages and bone ages of the PNE and control groups were 0.57+/-0.59 and 0.54+/-0.67 y, respectively, and no significant difference was seen (p = 0.484). In 90% of the children in the PNE group there was found to be a primary nocturnal enuresis history in the family, whereas in the control group this rate was only 7.5%. Of the children with PNE, 62.2% had very deep sleeping habits, while 7.5% of the control group had this problem. Conclusion Our study provides no evidence that bone ages of children suffering from PNE are lower than normal children. We found that a family history of enuresis, male sex and difficulty in waking were risk factors in primary nocturnal enuresis.

Introduction: Carnitine deficiency is an autosomal recessively inherited disease characterized by a low carnitine concentration in plasma and tissues. Primary carnitine deficiency (PCD) is caused by a deficiency in the plasma membrane carnitine transporter, with urinary carnitine wasting causing systemic carnitine depletion. The most common presentation of PCD is hypoketotic hypoglycemic encephalopathy. Cardiomyopathy can also be seen. Case Report: A 9-month-old girl was admitted to our clinic with wheezing, respiratory distress and nighttime cough. She was pale, expirium was prolonged, breath sounds were coarse bilaterally and were increased in the right hemithorax. Results: She had hypochromic microcytic anemia and the serum CPK level was elevated. Cardiothoracic index was increased (0.62). In the chest X-ray there was hyperaeration especially in the upper regions of the left lung, and paracardiac infiltration in the right lung. The echocardiogram showed dilated cardiomyopathy. In pulmonary perfusion scintigraphy, perfusion of the right lung was 26% and of the left lung 74%. Cardiomegaly and dilatation in main the pulmonary artery was detected in the MR angiogram. Plasma carnitine and acylcarnitine levels were found to be significantly low. Fat accumulation in myocytes and rare atrophic fibers were detected in a muscle biopsy. Oral carnitine supplementation was started at a dose of 100 mg/kg. All the symptoms and findings regressed within a short period of time. Discussion: This case was presented to emphasize that carnitine deficiency can present with respiratory tract symptoms like wheezing and recurrent respiratory tract infections. Although PCD usually presents with hypoketotic hypoglycemia in infants, it also has to be suspected in the etiology of dilated cardiomyopathy. Treatment is very easy and lifesaving once the correct diagnosis is made, and the prognosis is excellent with lifelong carnitine supplementation.

Familial Mediterranean Fever (FMF) is generally defined with short endurance, suddenly observed fever (39-40 °C) and painful abdomen, joints, chest. The aim is to measure the impact of pharmacist-led education on the quality of life (QoL) of children with FMF. This study was carried out in the Pediatric Rheumatology out-patient clinic of Istanbul Medeniyet University Ministry of Health Goztepe Research and Teaching Hospital, Istanbul. The QoL of 59 children was measured using the PedsQL 4.0 Generic Core Scale. Oral and written education about the disease and its treatment was provided and after a lag period QoL was reevaluated. Significant improvements in QoL were recorded in the domains of physical, psychosocial and school functioning (p

Canakinumab (CAN), a selective, human anti-IL-1β monoclonal antibody is approved for SJIA in over 30 countries. Efficacy and safety of CAN over 12 weeks have been demonstrated in 2 phase III trials [1]. Out of these trials >60% of the pts received a previous biologic and were switched to CAN due to lack of efficacy or for safety reasons, and may be more refractory to another biologic therapy.

Volume guaranteed (VG) synchronized intermittent mandatory ventilation (SIMV) is a novel mode of SIMV that provides automatic adjustment of the peak inspiratory pressure for ensuring a minimum set tidal volume and there are limited data about the effects of VG ventilation on short term neonatal outcomes in preterm infants with respiratory distress syndrome (RDS).The main objective of this study was to evaluate the effect of VG ventilation on duration of ventilation and total supplemental oxygen. We also aimed to compare the early neonatal outcomes of VG ventilation versus conventional SIMV on short-term outcomes in preterm babies with RDS who were given surfactant.In this randomized controlled study, preterm infants who were admitted with RDS and given surfactant were divided into 2 groups: group 1 included infants ventilated on conventional SIMV (n = 30) and group 2 included infants ventilated on VG ventilation (n = 42). Neonatal morbidities such as air leak, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and duration of mechanical ventilation and total oxygen supplementation were all recorded.There were no significant differences between two groups in terms of demographic features. Infants ventilated with VG mode had significantly shorter duration of ventilation and need of total supplemental oxygen. The incidences of oxygen related short term complications including BPD, ROP, and IVH were also significantly lower in these infants compared with those ventilated with conventional SIMV. No significant differences were found between two groups with respect to NEC and air leak.In conclusion, VG ventilation in combination with surfactant treatment significantly reduced both duration of mechanical ventilation and early neonatal oxygen related morbidities including BPD, ROP and IVH in preterm infants with RDS. This data favors the use of VG ventilation in respiratory support of premature infants.

Dinleyici, Ener Cagri/0000-0002-0339-0134; Carman, Kursat Bora/0000-0002-4629-1873; Akarsu, Saadet/0000-0002-2673-8842; Kondolot, Meda/0000-0002-1168-3228; Ozdemir, Halil/0000-0002-7318-1688; ONCEL, Selim/0000-0002-5493-1818; Velipasaoglu, Sevtap/0000-0002-0200-8079; Ciftci, Ergin/0000-0002-4955-160X; NUHOGLU, CAGATAY/0000-0003-2187-4121; Aykan, Hayrettin Hakan/0000-0001-5136-3977; Emiroglu, Melike/0000-0003-1307-0246; Yasa, Olcay/0000-0002-1347-5019 WOS: 000303054700011 PubMed: 22170238 Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (< 0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children < 1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.

Juvenile idiopathic arthritis (JIA) is the most common inflammatory disease of childhood characterized by chronic synovitis and associated with a number of extra-articular manifestations. The course of JIA is highly variable, ranging from a mild, self-limiting form to a very aggressive disease. Disease subtypes are significant predictors for persistent disease activity. Children with oligoarthritis have a better outcome than those with either systemic or polyarticular disease in relation to the main outcomes such as remission, functional limitation, and radiological damage. Disturbance of growth and bone metabolism is a serious complication of JIA. Growth disturbances vary from general growth retardation to local acceleration of growth in the affected joint. Short stature is an important complication in children with JIA. Patients with a history of systemic JIA treated with glucocorticoids for at least 2 years during childhood have a final height standard deviation score (SDS) under –2 SD and a final height below their target height. Decreased bone mineral density (BMD) and osteopenia with possible bone fractures are other complications of JIA. The precise etiology of growth retardation is unknown. Multiple factors such as decreased physical activity, nutritional insufficiency, increased proinflammatory cytokines, and medications may play a role in skeletal maturation. Several hormones are important for normal postnatal longitudinal bone growth, but it is generally accepted that growth hormone (GH) is the most important hormone in bone growth. Children with JIA and severe growth retardation may have normal pulsatile GH secretion and are reported to have reduced insulin-like growth factor-1 (IGF-1) levels and IGF-binding protein-3 (IGFBP-3). Growth retardation in these children may be due to direct effects of proinflammatory cytokines on the growth plate, or increased levels of inflammatory cytokines may inhibit the effects of GH on the growth plate. Inflammation and corticosteroid therapy are major determinants of linear growth impairment. Effective control of the inflammation with earlier use of disease-modifying anti-rheumatic drugs and modulators of cytokines improves growth velocity in patients with JIA. Treatment with GH earlier after the onset of the disease may prevent growth and metabolic complications induced by chronic inflammation and long-term steroid therapy. Care of children with JIA requires a multidisciplinary team consisting of a pediatric rheumatologist, a physiotherapist, a pediatric endocrinologist, a nutritionist, a psychotherapist, and a social worker.

Hypereosinophilic syndrome (HES) and the association of hypereosinophilia with acute lymphoblastic leukaemia (ALL) are both rare in children. Some acute myelogenous leukaemias can present with eosinophilia, but the relationship between HES and ALL is not well known and is rarer than the relationship between HES and acute myelogenous leukaemia. Patients are diagnosed with HES when no cause is found to explain the eosinophilia leading to end organ damage. For this reason, it is recommended that patients presenting with hypereosinophilia be carefully assessed to exclude any malignant clonal proliferation. HES may present with severe clinical manifestations such as high leucocyte count, anaemia, thrombocytopaenia, hepatosplenomegaly or cardiac and neurological involvement, all of which are primarily features of myeloproliferative disorders. Some patients with HES can develop chronic eosinophilic leukaemia. Successful treatment of HES with agents used in chronic myeloid leukaemia supports the idea that HES can be a chronic myeloid disorder. There are few cases reporting an association between ALL and hypereosinophilia that precedes or is concomitant with ALL. Here we report the case of a 14-year-old girl who developed common B ALL 7 months after diagnosis and treatment of HES. Interestingly, eosinophilia was not concomitant with the diagnosis of ALL.

We aimed to evaluate the cause, clinical profile, and short-term outcome of status epilepticus cases that were admitted to our pediatric emergency unit between 1 January and 31 December 2008.We studied the clinical features of 59 seizures that occurred in 56 patients aged between 3 months and 15 years with the diagnosis of status epilepticus. We observed the clinical course and outcome of 53 cases for 6 to 18 months. The correlation between the cause of the seizure and the patient's age at the time of status epilepticus was evaluated as well as the correlation between the risk of seizure recurrence and family history of seizure, the neurological status of the patient prior to seizure and the presence of epilepsy.The most common cause of status epilepticus is febrile illness in children younger than 2 years and idiopathic/cryptogenic and remote symptomatic causes in children older than 2 years. The rate of recurrence of seizure was significantly higher in cases with existing neurological abnormalities, prior epilepsy and seizures with remote symptomatic causes. The most common triggering factors of status epilepticus development in cases with epilepsy were noncompliance for anti-epileptic drugs and infectious fever.In our study, the risk factors for seizure recurrence were the presence of prior epilepsy, existence of neurological abnormalities and remote symptomatic causes. We argue that improving the compliance of patients and their families to take medicine appropriately and training them in how to cope with febrile illnesses may decrease the recurrence of seizures.

Spontaneous remission/regression of cancer is defined as partial or complete disappearance of malignant disease temporarily or permanently in the absence of medical treatment. This event is named as spontaneous regression for solid tumors and spontaneous remission for leukemia. The authors report the case of a girl aged 4 years and 3 months, who presented with mediastinal mass and leukemic findings in the bone marrow both of which reappeared after spontaneous regression and remission, respectively.

To investigate growth, development and bone mineralization of children with juvenile idiopathic arthritis (JIA).Thirty patients between 4-17 years of age (mean 11.34 +/- 3.88) resistant to therapy were studied. Enrollment began in November 1999 and continued through November 2004 and children with chronic disease were excluded. Data like height, weight, medications and acute phase reactants were obtained from medical records. On study-visit, puberty was assessed by physical examination and bone mineral density (BMD) was measured. Serum Ca, P, ALP, insulin-like growth factor-1 (IGF-1) and urinary Ca/Cr and hydroxyproline /Cr levels were measured. Results were compared with the control group that consisted of 30 cases of similar age and gender.Patients with JIA had decreased height standard deviation score (SDS) and growth retardation. BMD of the cases in the study group was lower than the control group (p0.05). Patients who were at younger age at the onset of the disease had lower BMD. Among the drugs, only steroids had a negative effect on growth. Serum IGF-1 levels of the study group were significantly lower than the control group (p0.0001).Early diagnosis and suppression of disease activity is important in prevention of osteoporosis and growth retardation in children with JIA. BMD has to be measured yearly in patients for accurate diagnosis of osteoporosis. Vitamin D and Ca-rich nutrition with promotion of physical activity and controlled use of steroids may protect the children against bone loss.

We aimed to review characteristics of mushrooms and mushroom poisoning and compare clinical picture, laboratory data, treatment modalities and prognostic factors in children with amanita intoxication and non-amanita mushroom poisoning.We analyzed 39 pediatric patients through 1994-2004, retrospectively from the patient files and evaluated the patients in two groups as patients with amanita intoxication and patients with non-amanita mushroom poisoning. All of the cases were admitted to the hospital in autumn. Twenty three (59%) of the patients were female and 16 (41%) were male. Mean age of the patients was 8.05 +/- 2.10 years.Amanita phalloides toxin was detected in the serum in 8 patients. Eleven (28%) of the cases were strongly suggestive of amanita poisoning but alpha amanitin level could not be studied. The average time of appearance of symptoms after mushroom consumption, duration of symptoms, hospital stay, serum AST, ALT, PT and creatinine levels were significantly higher in patients with amanita poisoning (p0.01). Conventional therapy, antidote therapy together with hemoperfusion were carried out in 16 (41%) of the patients. Four of the patients in whose blood amatoxin was detected (50%) and 3 of the patients highly suggestive of amanita poisoning (30%), totally 7 patients died of hepatic coma. The average time of admission to hospital, mean AST, ALT, creatinine and PT values at 3rd day were significantly higher in patients who died of hepatic coma. Prognosis was better in case of early admittance to hospital in patients with amanita poisoning.Early diagnosis and treatment in mushroom poisoning can be life saving. Public awareness is very important in prevention of intoxication as well as encouraging early admission to hospitals.

Interleukin (IL)-18 has been identified as a mediator inducing interferon gamma release from type 1 helper (Th1) cells, CD8+ T cells, and natural killer cells, synergizing with IL-12. Several studies report differential roles of IL-18; but little is known about the role of IL-18 in Th1/Th2 balance in children. The aim of this study was to evaluate the role of IL-18 in Th1- and Th2-mediated diseases of children. Serum IL-18 levels were measured in a group of patients with acute asthma exacerbation (n = 24), in a group of patients who had recently been diagnosed as type I insulin-dependent diabetes mellitus (n = 18), and in a group of healthy subjects (n = 20). The groups were compared with respect to IL-18 levels. Significantly lower serum IL-18 levels were found in patients with acute asthma (median, 8.55 pg/mL) and insulin-dependent diabetes mellitus (median, 7.20 pg/mL) than in control subjects (median, 140.10 pg/mL; p < 0.05 and p < 0.001, respectively). We suggest that IL-18 may play an immunoregulatory role in allergic and autoimmune diseases and decreased expression of IL-18 can shift the immune responses to both Th1- and Th2-mediated ways.

Background Canakinumab (CAN), a selective, fully-human anti-IL-1β monoclonal antibody is approved for SJIA in over 30 countries. Efficacy and safety of CAN over 12 weeks have been demonstrated in 2 phase III trials. 1 In these trials, >60% of the pts received a previous biologic and were switched to CAN due to lack of efficacy or for safety reasons, and may be more refractory to another biologic therapy. Objectives To present a post-hoc evaluation of CAN efficacy in biologic-naive (BN) pts and those previously exposed to biologics (BE) during the first 12-weeks. Methods Pooled data from CAN naive pts, enrolled in two phase III trials 1 and an extension phase (up to interim data lock 10 August 2012) were considered. Pts (2–19 yrs) with active SJIA were enrolled and received CAN 4 mg/kg or placebo sc every 4 weeks for 12 weeks. CAN naive pts who entered the trials and received at least one dose of CAN were included in this analysis (N=178 CAN naive pts). Descriptive efficacy analyses of adapted ACR-JIA responses at Week 12 are provided for the BN and BE pts groups. Results At baseline, there were 66 (37%) BN pts whereas anakinra (ANA), tocilizumab (TCZ), etanercept (ETN) and adalimumab (ADA), were the biologics received by 78 (44%), 10 (6%), 58 (33%) and 9 (5%) pts, respectively. The main reasons for discontinuation of biologics in BE group (n=112) was lack of efficacy (ANA, n=32; TCZ, n=7; ETN, n=56; ADA, n=9) or safety/tolerability (ANA, n=20; TCZ, n=4, ETN, n=0). At Week 12, the BN and BE groups were similar in aACR-JIA 30 and 50 response rates. Numerically higher aACR-JIA 70 and 90 response rates were achieved in BN vs. BE pts (Table). aACR-JIA 70 and 90 response rates were similar in pts previously exposed to ANA vs those not exposed to ANA at 12 weeks (aACR-JIA70: 58% vs.63% and aACR-JIA 90:47% vs 50%). Compared to pts who discontinued ANA due to lack of efficacy, there was a trend towards higher aACR-JIA 70 and 90 response rates at Week 12 in pts who stopped ANA for other reasons (aACR-JIA70: 34% vs.74%; aACR-JIA90: 25% vs. 63%). A higher aACR-JIA 30, 50, 70 and 90 response rates were observed in TCZ naive pts vs. those pts exposed to TCZ (n=10) [aACR-JIA30: 71% vs.50%; aACR-JIA50: 70% vs. 50%; aACR-JIA70: 61% vs.50%; aACR-JIA90: 49% vs. 40%]. Higher aACR-JIA 70 and 90 responses were observed for ETN naive pts vs. those exposed to ETN [aACR-JIA70: 67% vs. 48%; aACR-JIA90: 58% vs. 31%]; while ADA- naive pts had similar responses to CAN as ADA-exposed pt (aACR-JIA 70: 61% vs 56%) and they had higher aACR-JIA 90 response (aACR-JIA90: 50% vs. 22%). Conclusions In general, BE pts achieved aACR-JIA 50,70 and 90 responses to CAN quickly in the first 2 weeks, and maintained their response up to Week 12; albeit at a numerically lower level than BN pts. These data support the consistent efficacy of CAN across different subgroups of pts. References Ruperto N, et al. N Engl J Med 2012;367(25). Disclosure of Interest P. Quartier Grant/research support: Abbvie, BMS, Chugai-Roche, Novartis, Pfizer and SOBI, Consultant for: Abbvie, Chugai-Roche, Novartis, Pfizer, Servier and SOBI, Speakers bureau: Chugai-Roche, MEDIMMUNE, Novartis, Pfizer, A. Grom Consultant for: Novartis, Roche, NovImmune, N. Ruperto Grant/research support: To Gaslini Hospital: Abbott, Astrazeneca, BMS, Centocor Research & Development, Eli Lilly and Company, “Francesco Angelini”, Glaxo Smith & Kline, Italfarmaco, Novartis, Pfizer Inc., Roche, Sanofi Aventis, Schwarz Biosciences GmbH, Xoma, Wyeth Pharmaceuticals Inc., Speakers bureau: Astrazeneca, Bristol Myers and Squibb, Janssen Biologics B.V., Roche, Wyeth/Pfizer, H. Brunner Consultant for: Novarits, Roche, Astrazeneca, Celgene, Pfizer, Janssen, UCB, GSK, BMS, Speakers bureau: Novartis, K. Schikler Grant/research support: Pfizer, Novartis, Abbvie, Roche, Genentech, Speakers bureau: Abbvie, Novartis, M. Erguven: None declared, L. Goffin Consultant for: Novartis, Pfizer, M. Hofer Grant/research support: Novartis, Pfizer, Abbvie, T. Kallinich Grant/research support: Novartis, Speakers bureau: Roche, Novartis, ALK, K. Marzan Grant/research support: Novartis, C. Gaillez Employee of: Novartis, K. Lheritier Shareholder of: Novartis, Employee of: Novartis, K. Abrams Shareholder of: Novartis, Employee of: Novartis, A. Martini Grant/research support: The Gaslini Hospital, which is the public Hospital where I work as full time employee, has received contributions to support the PRINTO research activities from the following companies: Bristol Myers and Squibb, Centocor Research & Development, Glaxo Smith & Kline,Novartis,Pfizer Inc, Roche, Sanofi Aventis, Schwarz Biosciences GmbH., Speakers bureau: Abbott, Bristol MyersSquibb, Astellas, Behringer, Italfarmaco, MedImmune, Novartis, NovoNordisk, Pfizer,Sanofi, Roche, Servier, D. Lovell Grant/research support: National Institutes of Health- NIAMS, Consultant for: Astra-Zeneca, Centocor, Amgen, Bristol Meyers Squibb, Abbott, Pfizer, Regeneron, Roche, Novartis, UBC, Forest Research Institute, Horizon, Johnson & Johnson, Speakers bureau: Novartis, Roche DOI 10.1136/annrheumdis-2014-eular.1099

Interleukin-1β (IL-1β) plays a key role in the pathogenesis of systemic juvenile idiopathic arthritis (SJIA). Efficacy and safety of canakinumab (CAN), a selective, fully human, anti- IL-1β monoclonal antibody, have been demonstrated in 2 phase III trials. Here we present 12-week results of a post-hoc pooled analysis.

Background IL-1β, a key inflammatory cytokine, appears to play a prominent role in systemic juvenile idiopathic arthritis (SJIA). Canakinumab (CAN), a fully human, anti-IL-1β monoclonal antibody selectively binds to IL-1β and inactivates its signaling, thus suppressing inflammation and associated pain. Objectives To assess the efficacy and safety of CAN in SJIA patients (pts) with active systemic features at enrollment. Methods In this 4-week randomized, controlled, double-blind study (β-SPECIFIC 1), pts with active signs and symptoms of SJIA were randomized (1:1) to receive a single dose of CAN (4mg/kg) or placebo sc at Day 1. The primary endpoint, proportion of pts achieving an adapted ACRpedi30 criteria (plus absence of fever) at Day 15, has been reported earlier 1 . Secondary endpoints included higher adapted ACRpedi response both at Day 15 and 29, Physician global assessment (PGA) of disease activity (0-100 mm VAS), number of joints with active arthritis, C-reactive protein (CRP), pain intensity (0-100 mm VAS) and overall safety. Results A total of 84 pts (CAN, n=43; placebo, n=41) were randomized. High discontinuation rate in the placebo group (90.2%) was due to unsatisfactory therapeutic response vs CAN group (14%). CAN provided statistically significant superior response rates vs placebo at all visits for all ACR response levels: at Day 15, ACRpedi 30, 83.7% vs 9.8%; ACRpedi 50, 67.4% vs 4.9%; ACRpedi 70, 60.5% vs 2.4%; ACRpedi 100, 32.6% vs 0, respectively (all p≤0.0001). Furthermore, CAN provided clinically meaningful improvement vs placebo for, PGA of disease activity; number of active joints and CRP as early as Day 3 (Table). Least square means in overall pain intensity were significantly lower in the CAN vs placebo group at Days 15 and 29 (both, p Conclusions A single dose of CAN has superior efficacy to placebo in SJIA pts, providing rapid onset of action and robust initial response in majority of pts, while demonstrating an acceptable safety and tolerability profile. References Ruperto N et al, [abstract] Arthritis Rheum 2011;63 S1030 Disclosure of Interest P. Quartier Grant/Research support from: Novartis, Consultant for: Novartis, M. Erguven Grant/Research support from: Novartis, G. Horneff Grant/Research support from: Abbott, Pfizer, Consultant for: Abbott, Pfizer, Novartis, Roche, Y. Berkun: None Declared, K. Lheritier Shareholder of: Novartis, Employee of: Novartis, D. Kim Shareholder of: Novartis, Employee of: Novartis, K. Abrams Shareholder of: Novartis, Employee of: Novartis, T. Constantin: None Declared

Background Systemic juvenile idiopathic arthritis (SJIA) is an IL1β-mediated autoinflammatory disease, characterized by spiking intermittent fever, rash, and arthritis. Canakinumab (CAN), a selective, fully human, anti-IL1β monoclonal antibody has shown promising efficacy and safety data in SJIA patients (pts). Objectives To demonstrate CAN allows tapering of corticosteroids (CS) and to evaluate time to flare in CAN vs placebo (PCB) pts with SJIA and active systemic features. Methods This Phase 3 trial had two parts. In Part 1 (P1), all patients (2-20 yrs) received open label CAN to identify responders and to taper CS. In Part 2 (P2), pts who successfully tapered their CS were randomized to receive CAN or PCB. In P1, pts received CAN (4mg/kg; max 300 mg) sc injection every 4 wks. Primary objectives were to determine if ≥25% of pts on CS at study entry could successfully taper the CS dose (P1); if time to flare was longer for CAN vs PCB (P2), and safety. Results 177 pts (128 on CS; 49 steroid-free) entered P1, of which 100 pts (CAN, n=50; PCB, n=50) entered P2; most of the remaining 77 pts were eligible (>ACR30 at Day 15) to directly enter an open-label extension study following P1. In P1, 92 pts attempted CS tapering and 57 (62%) were successful, representing 44.5% (57/128; p Conclusions For SJIA patients with active features, canakinumab sc injection every 4 weeks allowed successful steroid tapering, with one third being able to discontinue their CS. Canakinumab significantly decreased the risk of SJIA flare, while demonstrating an acceptable safety and tolerability profile. Disclosure of Interest N. Ruperto Grant/Research support from: Abbott, Astrazeneca, Bristol Myers and Squibb, Centocor Research & Development, Eli Lilly and Company, “Francesco Angelini” s.p.a, Glaxo Smith & Kline, Italfarmaco, Merck Serono, Novartis, Pfizer Inc., Regeneron, Roche, Sanofi Aventis, Schwarz Biosciences GmbH, Xoma, Wyeth Pharmaceuticals Inc., Speakers Bureau: Astrazeneca, Novartis, Bristol Myers and Squibb, Roche, Janssen Bilogics B.V., H. Brunner Consultant for: Novartis, UCB, Genentech, Jansen, GSK and Medimmune, Paid Instructor for: Participant in Scientific Advisory Committee for Canakinumab program in SJIA, P. Quartier Speakers Bureau: Novartis, T. Constantin: None Declared, N. Wulffraat: None Declared, G. Horneff Grant/Research support from: Abbott, Pfizer, Consultant for: Abbott, Pfizer, Novartis, Roche, R. Brik: None Declared, L. McCann: None Declared, O. Kasapcopur: None Declared, L. Rutkowska-Sak: None Declared, R. Schneider Consultant for: Hoffman-La-Roche, Speakers Bureau: Hoffman-La-Roche, Y. Berkun: None Declared, I. Calvo: None Declared, M. Erguven Grant/Research support from: Novartis, L. Goffin: None Declared, M. Hofer Consultant for: Novartis, T. Kallinich Speakers Bureau: Novartis, S. Knupp: None Declared, Y. Uziel Consultant for: Novartis, S. Viola: None Declared, K. Nistala Grant/Research support from: Arthritis Research UK Career Progression Fellow, C. Wouters: None Declared, R. Cimaz: None Declared, M. Ferrandiz Grant/Research support from: Novartis, B. Flato: None Declared, M. Luz Gamir: None Declared, I. Kone-Paut: None Declared, A. Grom Consultant for: Novartis, J&J, B. Magnusson Grant/Research support from: Swedish Association of local Authorities and Regions, Consultant for: Roche AB, S. Ozen Consultant for: Novartis, F. Sztajnbok: None Declared, K. Lheritier Shareholder of: Novartis, Employee of: Novartis, D. Kim Shareholder of: Novartis, Employee of: Novartis, K. Abrams Shareholder of: Novartis, Employee of: Novartis, A. Martini Grant/Research support from: Abbott, Astrazeneca, Bristol Myers and Squibb, Centocor Research & Development, Eli Lilly and Company, “Francesco Angelini” s.p.a, Glaxo Smith & Kline, Italfarmaco, Merck Serono, Novartis, Pfizer Inc., Regeneron, Roche, Sanofi Aventis, Schwarz Biosciences GmbH, Xoma, Wyeth Pharmaceuticals Inc., Speakers Bureau: Astrazeneca, Novartis, Bristol Myers and Squibb, Glaxo Smith & Kline, D. Lovell Consultant for: Abbott Laboratories, Centocor Inc, Amgen, Astra Zeneca Pharmaceutical, Bristol-Myers Squibb, Hoffmann-La Roche, Inc., Novartis Pharmaceutical Corporation, Pfizer Inc, Regeneron, UBC, Wyeth Pharmaceuticals, Xoma Corporation, Speakers Bureau: Wyeth Pharmaceuticals

Background: Colchicine used in the treatment of FMF inhibits absorption of Vitamin B12. Objective: To evaluate serum vitamin B12 levels in cases with Familial Mediterranean Fever (FMF) receiving long term colchicine therapy. Method: Serum vitamin B12 and folic acid levels, and full blood count of 70 patients with FMF that received more than 5 years of colchicine therapy were evaluated. The results were compared with 80 patients that received less than 5 years of colchicine therapy and 70 healthy children. Results: Mean age of the patient group was 15.5±2.45 years; and the mean age of the patients that received less than 5 years of colchicine therapy was 10.24±4.02 years. Mean vitamin B12 level of the patients that received more than 5 years of colchicine therapy (208.37±40.57 pg/ml) was significantly lower than the patients that received less than 5 years of colchicine therapy (390.77±124.19) and the control group (478.31±135.76) (p=0.0001, p

Methods In this cross-sectional study, patients who had been followed up for at least a 6 month-period were recruited from different centers and registered thorough a webbased registry. Patients were grouped according to their ANA positivity. Clinical and demographic features were compared between ANA positive and negative groups. The results were explored by univariate and multivariate regression analysis (OR, %95 CI).

In this study, we aimed to investigate epidemiologic factors in children with Acute Lymphoblastic leukemia (ALL). The parents of 105 children diagnosed and treated as ALL between the years 1997 –2007 in our Clinic of Pediatric Hematology-Oncology were questioned and results were compared with control group that consisted of 102 healthy children with similar age and gender. The mean age of the patients was 8.57 ± 3.95 years. The mean age at diagnosis was 5.87 ± 3.73 years. There was no significant difference between the groups in terms of type of delivery, birth weight, asphyxia at birth, resuscitation with high-concentration oxygen and ventilatory support (p>0.05). There was also no significant difference between the groups in terms of duration of breast feeding. The rate of exposure to infections prior to diagnosis was higher in control group (p:0.003). Besides that, the rate of going to nursery was also significantly higher in control group (p:0.014). There was no difference between the groups in terms of X-ray exposure (p>0.05). In conclusion over-protection from infectious agents in and delay in meeting with some specific agents seems to increase ALL risk. Infections in early infantile period can be protective against leukemia. There has to be more extended studies on this subject.