Turkish Journal of Pediatrics 

About: Turkish Journal of Pediatrics is an academic journal published by Turkish National Pediatric Society. The journal publishes majorly in the area(s): Medicine & Population. It has an ISSN identifier of 0041-4301. It is also open access. Over the lifetime, 3414 publications have been published receiving 26313 citations.

Pattern of acute poisonings in childhood in Ankara: what has changed in twenty years?

Abstract: Poisoning represents one of the most common medical emergencies in childhood, and epidemiological properties differ from country to country. Thus, special epidemiological surveillance for each country is necessary to determine the problem according to which preventive measures can be taken. The purpose of this study was to clarify the characteristics of acute poisoning cases admitted to a pediatric referral hospital. All poisoned patients under 17 years of age, except for cases food poisoning, presenting to the Emergency Department (ED) from January 1995 to December 2000 were determined. The information about each case was recorded on standardized forms and a retrospective chart review survey was done. Complete epidemiological and clinical data were obtained for 489 patients. The mean age of all poisoned patients (mean +/- standard deviation) was 5.96 +/- 4.87 years, and the age range was 0.01 to 17 years. Three hundred and thirty-one children, forming 63.6% of all patients, were under five years of age. Slightly more boys (52.3%) than girls were intoxicated at ages less than 10 years, after which more girls (79%) than boys were involved. The majority of all cases were due to accidental poisoning (78.1% of all poisonings) which occurred mostly in children under five years of age (73.3%). While accidental poisonings (97.1%) were the most common mode of poisoning between 1-5 years, self-poisonings (67.3%) had the highest ratio in cases over 10 years of age. In patients younger than one year of age, 74.2% of all poisonings were due to therapeutical error. Drugs were the most frequent offending agent (57.7%), followed by ingestion of a caustic/corrosive substance (16.8%) and carbon monoxide (CO) intoxication (9.4%). Analgesics were the most common agents, forming 23.7% of all poisonings due to drugs, followed by ingestion of multiple drugs and tricyclic antidepressants at ratios of 21.6% and 9.6%, respectively. The most common route of poisoning was ingestion of the poison (437/489 patients, 89.4%) and most were ingested inside the house (93.3%). About half of all poisoned patients (50.9%) were admitted to the ED within the first two hours of ingestion, and gastric lavage was performed on about half of the poisoned children (48.7%). In most of the cases, hospital treatment was non-specific, including general measures of decontamination and supportive-symptomatic therapy. During the six-year study period, two patients were lost due to acute poisoning, yielding an overall mortality rate of 0.4%. While most of the poisonings were due to accidental ingestions in infancy and primary school ages without sex predilection, the incidence of self-poisonings, especially in girls, was found to be increased. Analgesics, tricyclic antidepressant drugs (which seemed to form a new and dangerous group) and caustic/corrosive substances were the most commonly ingested agents. The early awareness of poisoning and appropriate therapeutic measures taken seemed to be efficacious with a very low mortality rate. The epidemiological and preventive properties of childhood poisonings should be further searched by prospectively designed multicentered studies throughout our country.

Serum immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations in healthy children: a study using nephelometric technique.

Abstract: Immunoglobulin (Ig) G, IgM, IgA and IgG subclass (IgG1, IgG2, IgG3, IgG4) concentrations were determined in more than 500 healthy Turkish children using nephelometric technique. These parameters were thought to be highly varied for different ethnic groups because of environmental and genetic factors. Methodology used in previous studies has been reported to affect age-related normal values. Serum IgG, IgM, IgA and IgG1, IgG2, IgG3, IgG4 levels were measured in 510, 491, 486, 542, 511, 515, and 545 healthy children, respectively. According to their age, the patients were divided into 14 groups. In contrast to most of the previous studies, age-related normal values for IgG4 levels were also obtained. In conclusion, it has been suggested that our study as an example for Caucasians using nephelometric technique will supply useful information about age-related normal serum immunoglobulin and IgG subclass concentrations.

Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis.

Abstract: Diagnosis of neonatal sepsis may be difficult because clinical presentations are often nonspecific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. In this study, we aimed to investigate the role of procalcitonin (PCT), C-reactive protein (CRP), interleukin (IL)-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. Twenty-six neonates with blood-culture positivity and clinical sepsis, hospitalized for clinical suspicion of neonatal sepsis in neonatal intensive care units of Balcali Hospital, Cukurova University and Adana State Hospital between May 2000 and January 2001 (Group I) and 29 healthy neonates followed at the neonatal units and outpatient clinics of these hospitals (Group II) in the same period were studied. Among the septic neonates, 13 had early-onset (Group Ia) and 13 had late-onset (Group Ib) neonatal sepsis, while 14 of the healthy neonates had perinatal risk factors (Group IIa) and 15 of them had no risk factors (Group IIb). The demographic and clinical characteristics of the septic and healthy neonates were recorded, blood samples for determining serum PCT, CRP, IL-6, IL-8 and TNF-alpha were collected from the healthy and the septic neonates before starting treatment, and these investigations were repeated on the 3rd and 7th days of treatment. In this study, it was found that: (a) pre-treatment mean serum PCT, CRP, IL-6, IL-8 and TNF-alpha levels were significantly higher in the septic neonates than in the healthy ones, (b) compared with the pre-treatment values, serum PCT, IL-6 and TNF-alpha had progressively decreased on the 3rd and 7th days of the treatment in the 17 recovered patients, though they progressively increased in nine patients who died during treatment, (c) the area under the receiver operating characteristic (ROC) curve (AUC) for PCT, TNF-alpha, IL-6, CRP, and IL-8 were 1.00, 1.00, 0.97, 0.90 and 0.68, respectively. For the cut-off value of PCT > or = 0.34 ng/ml, the test was found to have a sensitivity of 100%, specificity of 96.5%, positive predictive value of 96.2%, negative predictive value of 100% and diagnostic efficacy of 98.3% for bacterial sepsis in neonates. For the cut-off value of TNF-alpha > or = 7.5 pg/ml, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic efficacy were found to be 100%, 96.6%, 96.2%, 96.5% and 98.3%, respectively. It was detected that sensitivity, specificity and diagnostic efficacy values were lower for IL-6, CRP and IL-8. We conclude that PCT and TNF-alpha are the best markers in the diagnosis of neonatal sepsis, and these markers are also valuable in following the effectiveness of treatment and determining the prognosis of the disease.

Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency with the G1528C mutation: Clinical presentation of thirteen patients

Abstract: Long-chain 3-hydroxyacyl-coenzyme A (CoA) dehydrogenase is one of three enzyme activities of the mitochondrial trifunctional protein. We report the clinical findings of 13 patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. At presentation the patients had had hypoglycemia, cardiomyopathy, muscle hypotonia, and hepatomegaly during the first 2 years of life. Seven patients had recurrent metabolic crises, and six patients had a steadily progressive course. Two patients had cholestatic liver disease, which is uncommon in beta-oxidation defects. One patient had peripheral neuropathy, and six patients had retinopathy with focal pigmentary aggregations or retinal hypopigmentation. All patients were homozygous for the common mutation G1528C. However, the enoyl-CoA hydratase and 3-ketoacyl-CoA thiolase activities of the mitochondrial trifunctional protein were variably decreased in skin fibroblasts. Dicarboxylic aciduria was detected in 9 of 10 patients, and most patients had lactic acidosis, increased serum creatine kinase activities, and low serum carnitine concentration. Neuroradiologically there was bilateral periventricular or focal cortical lesions in three patients, and brain atrophy in one. Only one patient, who has had dietary treatment for 9 years, is alive at the age of 14 years; all others died before they were 2 years of age. Recognition of the clinical features of long-chain 3-hydroxyacyl-CoA deficiency is important for the early institution of dietary management, which may alter the otherwise invariably poor prognosis.

The world's children.

Abstract: World leaders from 159 countries agreed at the 1990 World Summit for Children to specific goals which would reduce levels of child and maternal mortality, and give every child access to basic education, clean water, and proper sanitation by 2000. Major progress has since been achieved in most countries, with more than 80% of the world's children now immunized against diphtheria, tetanus, and pertussis. Moreover, the deaths of over 1 million children annually are being averted through the increased use of oral rehydration therapy against diarrheal dehydration, poliomyelitis and guinea worm have almost been eradicated, the consumption of iodized salt is protecting approximately 12 million infants annually from iodine deficiency, and access to safe drinking water is on the rise. Scientific developments in pediatrics, the strengthening of national health services, and the use of cost-effective primary health care approaches such as immunization, oral rehydration therapy, the promotion of breast feeding, and growth monitoring have helped reduce the national rate of infant mortality (IMR) in Turkey to 42 per 1000 live births compared to the urban IMR in Turkey during the 1940s of 300-350/1000. Developments in public health, the Convention on the Rights of the Child (CRC), education and child development, and child protection and the CRC are discussed.