Showing papers in "Turkish Journal of Pediatrics in 2014"

Safety assessment of essential and toxic metals in infant formulas

Abstract: The aim of this study was to assess toxic metal (Cd, Pb and Al) contamination and levels of three essential trace elements (Mn, Cr and Co) in 63 infant formulas. In addition, the levels of these metals in the study samples were compared with the acceptable limits of toxic heavy metals and the recommended daily allowances (RDAs) of essential trace elements. According to our results, the toxic metal levels measured in the formulas were within the acceptable limits, with the exception of Al levels in 8 of the 63 samples. In 16 samples, Mn levels exceeded 600 μg/day, and the Cr content in 7 samples was higher than 5.5 μg/day, these amounts being the adequate intake levels for infants. Cobalt levels in 10 formulas were higher than the RDA. In view of these findings, which indicate that metal levels in infant formulas are generally much higher than those found in breast milk, breast milk should be preferred for infant feeding. Moreover, since infants are potentially more susceptible to metals, infant foods should be monitored regularly and checked for contamination by toxic metals as well as for levels of essential trace elements.

Association between vitamin D deficiency and disease activity in juvenile idiopathic arthritis.

Abstract: Vitamin D has been shown to have immunomodulatory and anti-inflammatory properties in addition to its well-established role in the maintenance of mineral homeostasis and bone health. The aims of this study were to evaluate vitamin D status in patients with juvenile idiopathic arthritis (JIA), and also to examine whether there is an association between serum levels of 25-hydroxyvitamin D [25(OH)D] and disease activity in JIA. Children with JIA who had an outpatient visit between March and April 2011 were evaluated retrospectively. Clinical and laboratory findings and vitamin D levels were evaluated. Disease activity was calculated using JADAS-27. Serum vitamin D levels were measured using high-performance liquid chromatography (HPLC). A total of 47 patients, 29 (61.7%) of them girls, with a mean age of 9.3±3.9 years and a median follow-up period of 28 months, were included in the study. The mean serum vitamin D level of all patients was 17.7±11.6 ng/ml. Vitamin D insufficiency (serum vitamin D: 15-20 ng/ml) and deficiency (serum vitamin D level 20 ng/ml). There was a significant negative correlation between vitamin D levels and disease activity (p=0.01, r=-0,37). The mean JADAS-27 score was significantly higher in patients with 25(OH)D levels 15 ng/ml (p = 0.003). We suggest that vitamin D deficiency may be a possible modifiable risk factor affecting disease activity in JIA.

Both parents of neonatal intensive care unit patients are at risk of depression

Abstract: Postpartum depression is a serious disorder that can be seen not only in mothers but also in fathers; therefore, it negatively affects the whole family. Hospitalization in the neonatal intensive care unit (NICU) is a stress factor for the parents and contributes to depression. We aimed to detect the frequency of postpartum depression and the contributing risk factors in parents of NICU patients. The Edinburgh Postnatal Depression Scale was used for mothers and the Beck Depression Inventory was performed for fathers in the 2nd and 6th weeks after delivery. At the 2nd week, maternal depression frequency was found as 38.3%, with a mean score [ms] of 10.97±6.93. At the 6th week, maternal depression frequency was 33.3% (ms: 9.57±5.78). Paternal depression was 11.7% (ms= 7.13±7.35) at the 2nd week and 10.0% (ms: 6.50±5.79) at the 6th week. The frequency of maternal depression remained stable, but mean maternal depression scores were decreased at the 6th week compared to the 2nd week (p=0.023). However, paternal depression scores were similar in both periods (p=0.428). The infants' disease severity at admission to the NICU, as shown by SNAPPE-II risk scores, was positively correlated with Edinburgh depression scores of the mothers at the postnatal 2nd week, but not at the 6th week. In conclusion, NICU stay of high-risk infants may cause depression in their mothers and fathers, even in the absence of any previous risk factor. Although at a lower rate than in mothers, fathers may also suffer from depression. Parental depression screening and whole family support during NICU hospitalization are strongly recommended.

Prevalence of allergic rhinitis and risk factors in 6- to 7-yearold children in İstanbul, Turkey.

Abstract: The aim of this study was to evaluate the prevalence of allergic rhinitis and its relationship with various risk factors in 6-7-year-old children living in Istanbul. A total of 11,483 children aged 6-7 years in 75 primary schools from all districts of Istanbul were surveyed. Prevalence of symptoms of allergic rhinitis was assessed using a translated version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Of them, 9,875 (50.7% M, 49.3% F) questionnaires were appropriately completed by the parents. The prevalence rates of lifetime, current and physician-diagnosed allergic rhinitis were 44.3%, 29.2% and 8.1%, respectively. There was nearly a two-fold variation in the prevalence rates of rhinitis between the districts of Istanbul. Frequent paracetamol and antibiotic use in the first year of life, history of frequent upper respiratory tract infections, adenotonsillectomy, breastfeeding less than six months, dog at home or perianal redness in the first year of life, and frequent trucks passing near the home were independent risk factors.

Can biochemical markers predict the severity of hypoxic- ischemic encephalopathy?

Abstract: Hypoxic-ischemic encephalopathy (HIE) due to perinatal asphyxia remains an important cause of neonatal morbidity and mortality. The aim of this study was to investigate the predictive values of biochemical parameters, including serum creatine kinase (CK), lactate dehydrogenase (LDH), uric acid (UA), and lactate, in newborns with HIE. A total of 94 patients who were diagnosed with HIE were prospectively enrolled into the study. According to the Sarnat and Sarnat classification, 29 (30.9%) patients had Stage I, 36 (38.3%) Stage II, and 29 (30.9%) Stage III HIE. When CK, LDH, UA, and lactate were used together in order to determine the stage of HIE, specificity and sensitivity were calculated to be 87% and 94%, respectively. Measurement of serum CK, LDH, lactate, and UA levels together is a promising method in determining the stage of hypoxia in the laboratory before clinical manifestations occur so that hypothermia treatment can be initiated earlier.

Association of respiratory distress syndrome and perinatal hypoxia with histologic chorioamnionitis in preterm infants.

Abstract: The aim of this study was to evaluate the relationship between neonatal mortality-morbidity and pregnancies with preterm premature rupture of membranes (PPROM), particularly those complicated by histologic chorioamnionitis (HCA), in preterm infants. A retrospective study was conducted on 58 preterm neonates born to 46 pregnant women with PPROM. Maternal characteristics, placental examination, and neonatal morbidity and mortality were analyzed. Of 1,392 deliveries, 46 (3.3%) pregnancies and 58 newborn infants were complicated with PPROM. HCA was present in 21 (1.5%) cases, and 15 of them were <28 weeks of gestational age. In the HCA (+) group, 8/21(38%) neonates had 5-minute Apgar scores of <5, 12/21 (57.1%) infants had patent ductus arteriosus (PDA), and 16/21 (76.1%) infants had respiratory distress syndrome (RDS). The latency period was significantly longer and the rate of chorioamnionitis and percentage of major neonatal morbidity and mortality were significantly higher in preterm infants with gestational age <28 weeks. Respiratory distress syndrome, perinatal hypoxia and PDA were significantly associated with HCA in preterm infants.

Allergic diseases in children with primary immunodeficiencies.

Abstract: The aim of this study was to evaluate and compare the frequency of atopy and allergic disease in all groups of primary immunodeficiency (PID) patients. The study was done on 318 patients with PID between the ages of 6 months and 18 years. The patients and their parents were questioned regarding their histories of asthma and allergic disease. Within the study group, 82.4% of the patients had antibody deficiency, 10.4% combined immunodeficiency, 6.6% phagocyte number or function defect, and 0.6% complement deficiency. Patients with selective immunoglobulin (Ig)A deficiency had a more significant history of ever wheezing compared to those with IgG subclass deficiency (p=0.022). The frequency of current wheezing was higher in patients with antibody deficiency than in patients with combined immunodeficiency (p=0.049). In conclusion, patients with antibody deficiency, especially those with selective IgA deficiency, should be evaluated regarding asthma and allergic diseases if recurring respiratory symptoms are present.

Erythema nodosum in children: evaluation of 39 patients

Abstract: Erythema nodosum (EN) has been associated with various infectious and noninfectious diseases. A total of 39 EN patients seen between May 2005 and February 2012 were evaluated retrospectively in this study. The etiology of EN was established in 22 of the 39 children (56.4%). Streptococcal infection was the most common cause (23%), followed by tularemia (10.2%) and tuberculosis (latent tuberculosis infection (LTBI) 5%, pulmonary tuberculosis 2.5%). Miscellaneous conditions were as follows: Behcet disease (2.5%), cytomegalovirus (CMV) (2.5%), Giardia lamblia infection (2.5%), and sarcoidosis (2.5%). Four cases had double diagnoses as follows: streptococcal infection plus Mycoplasma pneumoniae, streptococcal infection plus LTBI, streptococcal infection plus Chlamydophila pneumoniae, and tularemia plus LTBI. Streptococcal infections are the most common causative factors of EN among children in our setting. In some cases, either of two diagnoses may induce EN. Etiologic factors should be investigated for the diagnosis and specific treatment of the underlying diseases.

Viral etiology of acute lower respiratory tract infections in hospitalized young children in a children's referral hospital in Iran

Abstract: Viruses are considered major causes of acute respiratory tract infections among children under 5 years old. In this study we investigated the prevalence of three respiratory viruses--respiratory syncytial virus (RSV), influenza virus (INF) and adenovirus (ADV)--among hospitalized children with acute viral lower respiratory tract infections (LRTIs). Nasopharyngeal aspirates were collected from children under five who had been hospitalized for LRTIs. The clinical data, including demographic data (age and sex), vital symptoms and signs at admission, duration of fever, duration of hospitalization, chest X-ray findings and outcome were considered. All inpatient specimens were tested by reverse transcriptase-polymerase chain reaction (RT-PCR) for RSV and the INF-A, INF-B and parainfluenza viruses and by polymerase chain reaction (PCR) for ADV. Out of those from 232 patients, 58 (25%) specimens were positive for either RSV, INF or ADV. The most predominant pathogens were RSV (40 cases, 17.2%), followed by INF (10 cases, 4%; including 8 type A and 2 type B) and ADV (8 cases, 3.4%). A total of 32 (55.1%) viral cases were identified in the spring, followed by 19 (32.7%) in the autumn and 7 (12%) in the winter. There was no significant correlation between clinical symptoms and the individual virus detected. In our study, RSV and INF were the two most common causes of LRTIs. These data are helpful for guiding the development of further vaccines as well as the use of antiviral drugs. Further studies will be needed to investigate other respiratory viruses such as parainfluenza, human metapneumovirus and rhinovirus.

Determinants of continued breastfeeding beyond 12 months in Turkey: secondary data analysis of the Demographic and Health Survey.

Abstract: Continued breastfeeding at year 1 is one of the core indicators for assessing global infant and young child feeding practices. The study aims to determine the frequency of breastfeeding after 12 months (long-term breastfeeding) according to a number of infant and maternal characteristics and to investigate the effects of long-term breastfeeding on the nutritional habits and growth status of children as seen in the national data. The sample included 1666 children aged 12 to 35 months from the 2003 Turkey Demographic and Health Survey. Only 55.9% of children were breastfed beyond 12 months. The rates of long-term breastfeeding were higher in the presence of the following characteristics: high birth order, long preceding birth interval, religious marriage ceremony, usage of traditional contraceptive methods, mothers aged 30-34 years and overweight mothers. Rates were lower for mothers with tobacco exposure and for bottle-fed infants. Long-term breastfeeding did not affect the consumption of plain yogurt, solid foods and semi-solid foods; however, it was associated with a decreased intake of bottled milk and fruit juice. The rates of long-term breastfeeding were similar in the case of undernourished children and of those with normal growth status. Long-term breastfeeding was related to certain maternal and infant characteristics; however, it did not affect the consumption of complementary food. Breastfeeding promotion programs should include targeted interventions for younger, primiparous and smoking mothers.

Unilateral multicystic dysplastic kidney in children.

Abstract: This study was performed to evaluate the clinical course and renal outcome of patients with unilateral multicystic dysplastic kidney (MCDK). We retrospectively reviewed the medical records of 59 cases with MCDK followed at Sanliurfa Children's Hospital between January 2009 and February 2013. The median age of the patients (boys 52.5%) was 31 months (range: 6-197) and the median follow-up period was 23 months (range: 6-111). Forty-two (71.2%) patients were diagnosed antenatally. The MCDKs were found more often on the right side (55.9%). The most frequently associated urological abnormality was contralateral vesicoureteral reflux (VUR) (26.6%). A total of 3 (5%) patients developed chronic renal insufficiency (CRI), 2 of whom had grade IV and V VUR; the other patient with CRI had a small and hyperechogenic contralateral kidney, suggesting dysplasia-hypoplasia, without any urological anomalies on imaging studies. The size of MCDK was unchanged in 20 (34%), had regressed in 26 (44%), and had increased in 9 (15.3%) patients. Total involution was documented in 4 (6.7%) patients. Compensatory hypertrophy occurred in 36/45 (80%) patients, with a mean age of 19.2±8.3 months. Proteinuria and hypertension were detected in 1 (1.7 %) patient each. In conclusion, abnormalities in the contralateral kidney in patients with MCDK increase the risk of renal failure. An initial investigation for associated urinary tract malformations should be done and the growth and function of the contralateral kidney, hypertension, and proteinuria should be monitored in all children with MCDK.

Leptin-to-adiponectin ratio in obese adolescents with nonalcoholic fatty liver disease

Abstract: The leptin-to-adiponectin (L/A) ratio has been used to show insulin resistance (IR) in recent years. The aim of this study was to investigate the L/A ratio in obese adolescents and compare this ratio in patients with and without nonalcoholic fatty liver disease (NAFLD) and also with healthy controls. The second aim was to search the possible correlations between the L/A ratio with the markers of IR and inflammation. A total of 47 obese (mean age: 13.1±2.1 years) and 19 healthy children (mean age: 13.8±0.3 years) were included in the study. The presence of fatty liver was identified by ultrasonography. Cases were divided into three groups as NAFLD (+) and NAFLD (-) obese patients and controls. Liver biochemistries, insulin and serum lipids, C-reactive protein, tumor necrosis factor-alpha (TNF-alpha), interleukin-6, adiponectin, and leptin were determined. The L/A ratio was calculated. IR was estimated according to the homeostasis model assessment of insulin resistance (HOMA-IR). The L/A ratio was significantly higher in NAFLD (+) patients than in the other two groups, and in NAFLD (-) patients than the healthy peers. Moreover, L/A ratio correlated more strongly with weight for height (r: 0.528, p<0.0001), alanine aminotransferase (ALT) (r: 0.499, p<0.0001), triglyceride (r: 0.591, p<0.0001), and HOMA-IR (r: 0.574, p<0.0001) than did either leptin and adiponectin alone. This study shows that the L/A ratio is a noninvasive predictor of NAFLD in obese children and correlates with weight for height, ALT, triglyceride, and HOMA-IR better than each single adipokine.

Deep neck infections in children: experience in a tertiary care center in Turkey

Abstract: The aim of this study was to elucidate the clinical presentations, diagnostic clues and management of deep neck infections (DNI) in pediatric patients. Demographic characteristics, clinical manifestations, predisposing factors, duration of symptoms before presentation, history of previous antibiotic use, duration of hospitalization, laboratory and radiographic evaluations, management, complications, and outcomes of 25 patients (19 male/6 female; mean age: 47.9±39.0 months) diagnosed with DNI were analyzed retrospectively. Retropharyngeal abscesses occurred especially in preschool children, whereas peritonsillar abscesses occurred especially in school children. Nine of 25 (36%) patients underwent surgical intervention in addition to medical therapy. Contrast-enhanced computed tomography provided additional information in half of the patients. DNIs should be considered in the differential diagnosis of children who present with fever and neck mass even in the absence of more specific findings. Medical treatment can be considered an option to surgical treatment by utilizing the advantages of imaging techniques and empirical antibiotics.

Viral etiology in infants hospitalized for acute bronchiolitis.

Abstract: Acute bronchiolitis is predominantly a viral disease. Respiratory syncytial virus is the most common agent, but other newly identified viruses have also been considered as causes. The aim of the present study is to determine the respiratory viruses causing acute bronchiolitis in hospitalized infants. Infants younger than 2 years of age who were hospitalized for acute viral bronchiolitis in a children's hospital between November 2011 and May 2012 were evaluated for the presence of viruses as etiologic agents using a realtime polymerase chain reaction method.A total of 55 infants were included in this study. The mean age of the children was 6.98±5.53 months, and 63.6% were male. In the 55 children, 63 viruses were detected. A single viral pathogen was detected in 47 (85.5%) patients, and two viruses were co-detected in 8 (14.6%) patients. Respiratory syncytial virus was the most common virus identified, accounting for 25 (45.5%) cases, followed by rhinovirus (n=9, 16.4%), and human metapneumovirus (n = 8, 14.5%).Although respiratory syncytial virus remains the major viral pathogen in infants hospitalized for acute broncholitis, more than half of bronchiolitis cases are associated with other respiratory viruses.

Effects of seasonal variation and maternal clothing style on vitamin D levels of mothers and their infants.

Abstract: In Turkey, vitamin D deficiency has been seen in children as well as in their mothers. We assessed the vitamin D status of 83 infants and their mothers, categorized into four groups according to season and mothers' clothing style. We measured serum levels of 25-hydroxy vitamin D, calcium, inorganic phosphorus and alkaline phosphatase in each mother-infant pair. In the summer, the rate of vitamin D deficiency was higher in mothers who wore clothing that covered nearly all of the body (55%) than in mothers whose clothing covered less of the body (13.6%) (p=0.016). In the winter, nearly half of both groups of mothers had vitamin D deficiency or insufficiency, and there were no significant differences based on their clothing style (p>0.05). In all groups of infants, vitamin D deficiency and insufficiency rates were found to be very low. It seems that 400 IU/daily vitamin D intake is adequate for infants in Turkey; for mothers, we propose vitamin D supplementation during the pregnancy and lactation period.

Prevalence and molecular characterization of rotaviruses as causes of nosocomial diarrhea in children.

Abstract: Rotaviruses have been confirmed as causative agents of nosocomial gastroenteritis in children, but limited data exist concerning the epidemiology of nosocomial rotavirus gastroenteroentritis in Iran. The aim of this study was to determine the prevalence and molecular characteristics of rotavirus in children less than five years old with nosocomial diarrhea in Shahrekord (southwest of Iran). This cross-sectional study was conducted between December 2010 and October 2011. The study population consisted of children aged 6 to 60 months who were hospitalized in the pediatric ward of Hajar Hospital in Shahrekord, Iran, due to diseases other than diarrhea. Nosocomial diarrhea was defined as that occurring more than 48 hours after admission to the hospital for non-diarrheal causes. Rotavirus and G genotypes were determined by seminested reverse transcriptase polymerase chain reaction in 100 stool samples. In these 100 samples, the prevalence of rotavirus infection was 30%; the most common genotyes were G1 (20%) and G9 (20%). According to the findings of the study, genotyping of rotavirus is necessary to monitor changes in strain prevalence. Identifying strains over time could affect future vaccine strategies and detect any regional differences of genotype prevalence.

Alpha-fetoprotein-producing hepatoid gastric adenocarcinoma in a child presenting with spontaneous gastric perforation.

Abstract: Gastric adenocarcinoma is a rare entity in the pediatric population. Gastric hepatoid adenocarcinoma with elevated serum alpha-fetoprotein (AFP) is seen extremely rarely in children. A 12-year-old boy was admitted to the hospital with complaint of abdominal pain. X-ray revealed free air density below the diaphragm. Emergent laparotomy showed perforated stomach. Four weeks after the operation, he was readmitted with severe gastrointestinal obstruction symptoms. He underwent an explorative laparotomy, which revealed intestinal edema and diffuse small solid nodules covering the peritoneum. Serum AFP level was mildly elevated. Endoscopic evaluation of the upper gastrointestinal tract was performed, and a gastric mass was detected. All pathological findings were compatible with gastric carcinoma showing hepatoid differentiation. We report an unusual case of AFP-producing hepatoid gastric adenocarcinoma presenting with gastric perforation. This is, to the best of our knowledge, the first reported case of AFP- producing hepatoid gastric adenocarcinoma presenting with gastric perforation in a child.

Acute tubulointerstitial nephritis-uveitis (TINU) syndrome developed secondary to paracetamol and codeine phosphate use: two case reports.

Abstract: Tubulointerstitial nephritis (TIN) refers to a group of heterogeneous diseases affecting the interstitial compartment of the kidney. It might be primary or can develop secondary to many urinary systemic diseases. Primary TIN develops mainly following drug usage, exposure to toxins, and also infections and humoral and cell-mediated immune reactions. In some patients, signs of systemic inflammatory reactions can be the first presenting symptoms. Histopathological evaluation reveals mononuclear cells and lymphocytes in the interstitium and tubuli. Acute and chronic TIN can resolve after elimination of the culprit destructive factors, as drugs, toxins and immune reaction. Combination of tubulointerstitial inflammation and uveitis is termed as tubulointerstitial nephritis-uveitis (TINU) syndrome. Uveitis might occur before, after, and also concomitantly with TIN. Herein, two adolescent cases of TIN and TINU, seemingly developed secondary to paracetamol and codeine phosphate use, are presented.

Frequency of red cell allo- and autoimmunization in patients with transfusion-dependent beta thalassemia and affecting factors

Abstract: In this study, we aimed to determine the frequency of red cell allo- and autoimmunization and analyze the factors responsible for the development of antibodies in patients with transfusion-dependent thalassemia. This crosssectional study was conducted on 139 patients with thalassemia major and intermedia who received leukodepleted RBC transfusions on a regular basis. Patients with a positive antibody screen were further tested for antibody identification by a gel method. Red cell alloantibodies were found in 9 (6.4%) patients, and autoantibodies were found in 17 (12.2%) patients. The most common alloantibodies detected were those against Rh and Kell antigen systems. The alloantibody development rate was higher in thalassemia intermedia patients, in Rh(-) patients, in patients with an initial transfusion age >2 years and in patients with a transfusion interval >3 weeks (p<0.05). The autoantibody development rate was found to be higher in adult and splenectomized patients (p<0.05). Data from this study demonstrate that the RBC antibody development rate is high in our region. RBC antigen phenotyping and crossmatching with Kell and Rh subgroups may reduce alloimmunization in chronically transfused beta-thalassemia patients.

Predictive value of biochemical, echocardiographic and electrocardiographic markers in non-surviving and surviving asphyxiated full-term newborns.

Abstract: Severe perinatal asphyxia can cause multiple organ dysfunction and early neonatal mortality. This prospective study was conducted at the Regional University Hospital Neonatology Center in Serbia. The aim of this study was to compare fullterm asphyxiated newborn infants (n=55) with (n=13) and without (n=42) mortality outcome and healthy full-term newborns (n=36) regarding biochemical (cardiac troponin I, creatine kinase (total and MB fraction) and C-reactive protein), echocardiographic (ejection fraction, fractional shortening, mitral regurgitation, significant tricuspid regurgitation, and patent ductus arteriosus) and electrocardiographic (ST segment elevation/depression, T wave inversion and corrected QT interval) markers of myocardial damage in order to assess their predictive value in the clinical outcome. Statistically significant differences in the majority of the tested markers of ischemic myocardial lesion were found between perinatal asphyxia survivors and the control group. However, among the biochemical indicators, only the level of cardiac troponin I was significantly higher in the group of neonates who died compared to the group of asphyxiated neonates who survived (p: 0.000), with an area under the receiver operating characteristic curve of 0.821 and cutoff value for lethal outcome of 0.135 μg/L (sensitivity 0.85; specificity 0.69). In addition, differences in ejection fraction, fractional shortening and significant tricuspid regurgitation (≥2+) were also found between the two subgroups of asphyxiated newborns. Cardiac troponin I is the most sensitive ischemic myocardial lesion biochemical marker in the prediction of early mortality in perinatal asphyxia patients.

Risk factors of severe atopic dermatitis in childhood: single-center experience.

Abstract: The aim of this study was to evaluate the risk factors of disease severity to facilitate better management of children with severe atopic dermatitis (AD). All the patients were diagnosed using Hanifin-Rajka criteria. After medical and family histories were obtained and a detailed physical examination was performed, disease severity was determined with the objective SCORing Atopic Dermatitis (SCORAD) index. Skin prick tests were performed, and percent of peripheral blood eosinophils, total serum IgE and specific IgE were measured. The median age of the 501 patients was 15 months (interquartile range [IQR]: 6-40 months), and 62.9% (315) were male. Sensitization to at least one allergen and foods was observed in 40.3% (202) and 30.9% (155) of all patients, respectively. Of the study group, 17.6% (88) had severe disease. When logistic regression analyses were performed, with adjustments, the risk factors for severe AD were determined to be eosinophilia (odds ratio [OR] 1.137, 95% confidence interval [CI] 1.062-1.217; p=0.003) and food allergen sensitization (OR: 1.937, 95%CI: 1.217-3.084; p=0.005). The patients with severe AD had sensitization to common allergens, food allergens and eosinophilia more frequently than those with mild-moderate disease (p=0.001, p=0.001 and p=0.005, respectively). Eosinophilia may predict severe disease and allergic sensitization. Further large-scale follow-up studies are needed to improve the reliability and relevance of this relation.

INSURE method (INtubation-SURfactant-Extubation) in early and late premature neonates with respiratory distress: factors affecting the outcome and survival rate.

Abstract: We studied the effects of administering exogenous surfactant for the treatment of respiratory distress in premature neonates (born before 37 weeks of gestational age [GA]) and compared the role of different risk factors on the outcome as well as survival rate. All the neonates (242) suffered from moderate to severe respiratory distress, identified by clinical signs, chest X-ray, respiratory distress syndrome (RDS) score >6, and blood gas measurements. All the neonates included were treated by administering surfactant (Beractant or Poractant alfa, dosage 100 mg/kg). The INSURE method was "successful" in 74% of patients, meaning there was no need for a second dose of surfactant or mechanical ventilation repetition. The factors that determined the "success" (Table II) were as follows: type of delivery, weight, GA, and number of fetuses. The factors affecting survival were: number of fetuses, mechanical ventilation dependency, pregnancy complications, and type of surfactant. The INSURE method reduced mortality (91.3% survived).

Mycosis fungoides mimicking nevoid hyperkeratosis of the nipple and areola in an adolescent.

Abstract: Mycosis fungoides is one of the great imitators in dermatology; it can mimic many dermatoses. Nevoid hyperkeratosis of the nipple and areola is a rare idiopathic disease with typical clinical features of verrucous thickening and brownish discoloration of the nipple, areola or both. Here, a 16-year-old male patient with mycosis fungoides mimicking nevoid hyperkeratosis of the nipple and areola has been reported. To our knowledge, this is the first atypical MF patient to have presented with a NHNA-like lesion. Although the clinical appearance of nevoid hyperkeratosis of the nipple and areola is highly characteristic for diagnosis, histopathological examination is recommended, especially in cases with atypical features such as unexpected age, male gender and unilateral location.

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome.

Abstract: Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare autosomal recessive congenital disorder that includes childhood-onset camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and noninflammatory pericarditis. A seven-year-old male patient had a diagnosis of CACP. He had pericardial effusion and underwent surgical tube drainage. CACP syndrome is seen very rarely, and differential diagnosis is very important. CACP is usually treated medically, but surgery may sometimes be preferred, as in our patient.

Effect of supplementary zinc on body mass index, pulmonary function and hospitalization in children with cystic fibrosis.

Abstract: Zinc deficiency, which is common in patients with cystic fibrosis (CF), can lead to several complications that may increase the number of hospital admissions in this group of patients. As supplementary zinc can prevent such complications, this study was performed to evaluate the effect of supplementary zinc on body mass index (BMI), forced expiratory volume in one second (FEV1) and number of hospitalizations in CF patients. In this study, 30 children with CF, who were referred to the Digestive Diseases Clinic of the Children's Medical Center in Tehran, were enrolled. Supplementary zinc of 2 mg/kg per day was administered to all patients. Serum level of zinc, alkaline phosphatase, and albumin as well as BMI, FEV1, and number of hospitalizations were compared before and after zinc administration. Height (p<0.001), weight (p<0.001) and BMI (p=0.001) were significantly increased after zinc, while the number of hospitalizations was significantly decreased (p=0.023). In contrast to patients with normal pulmonary function tests who received supplement therapy, BMI was not increased in those with abnormal pulmonary function after supplementary zinc. Supplementary zinc can increase BMI in CF patients, mostly in those with normal pulmonary function. While supplementary zinc may decrease the number of hospitalizations, other factors can also influence the hospitalization number.

Secular trend of menarche age in an immigrant urban city in Turkey: Izmir.

Abstract: SUMMARY: Tekgul N, Saltik D, Vatansever K. Secular trend of menarche age in an immigrant urban city in Turkey: Izmir. Turk J Pediatr 2014; 56: 138-143. The purpose of this study was to investigate the secular trend of menarche age within the last 35 years in an immigrant urban city in Turkey-Izmir. We found the mean age at menarche as 13.10±1.18 years for 121,257 women. The reported mean age at menarche showed a decreasing trend over time. For women born before 1963 (≥40 years of age), the mean age at menarche was 13.08±1.21 years. For women born from 1964-1973 (30-39 years of age), the mean age at menarche was 13.12±1.19 years. For women born from 1974-1983 (20-29 years of age), the mean age at menarche was 13.11±1.18 years, and for those born after 1984 (15-19 years of age), the mean age at menarche was 13.06±1.16 years (p=0.000). When divided according to socioeconomic status, the mean age at menarche was 13.11±1.11 in the high socioeconomic group, 13.22±1.25 in the middle socioeconomic group, and 12.75±1.02 in the low socioeconomic group (p=0.000). In conclusion, in the Turkish population, the mean age at menarche has decreased from 13.12 to 13.06 over the past 30 years, and the mean age at menarche was lower in the low socioeconomic group.

Comparison of transcutaneous and total serum bilirubin measurement in Turkish newborns.

Abstract: Severe neonatal hyperbilirubinemia can be prevented by screening for neonatal jaundice. Transcutaneous bilirubin (TcB) measurement is a noninvasive method for screening neonates. The aim of this study was to examine the correlation between TcB measurement (using the JM-103 bilirubinometer) and total serum bilirubin (TSB) measurement. To our knowledge, this is the first study evaluating the usefulness of the JM-103 bilirubinometer in Turkish neonates. Two hundred and fifty healthy infants in our well-baby nurseries and follow-up clinic with a gestational age of ≥36 weeks who were ≤15 days old were enrolled in this study. TcB measurements were taken usinng the JM-103; almost simultaneously, TSB was checked using a spectrophotometric method. The mean±SD TSB level was 11.2±4.6 mg/dl (range, 0.9-27.0 mg/dl); 17.2% of cases had TSB>15 mg/dl. There was good correlation between transcutaneous bilirubin and total serum bilirubin measurements (Pearson's correlation coefficient 0.87 for TcB from the forehead, 0.88 for TcB from the sternum; p<0.001). The transcutaneous bilirubin measurement tended to underestimate the value with increasing discrepancy at higher TSB values. The mean difference between serum bilirubin and transcutaneous (from the sternum and forehead) bilirubin values was significantly lower in cases not requiring phototherapy than in those requiring phototherapy [2.6 mg/dl (sternum) vs 4.8 mg/dl, 2.9 mg/dl (forehead) vs. 5.2 mg/dl, respectively; p<0.001] Although the JM-103 bilirubinometer tends to underestimate serum bilirubin, especially in patients with high bilirubin levels, it is a suitable screening tool to identify jaundiced infants that require a serum bilirubin check and may reduce the need for TSB measurements.

Myopia, visual acuity and strabismus in the long term following treatment of retinopathy of prematurity.

Abstract: The purpose of this retrospective study is to evaluate the long-term ophthalmological outcome in children with retinopathy of prematurity (ROP) who were treated for threshold disease with indirect laser photocoagulation. 107 eyes of 56 patients with threshold ROP treated with indirect laser photocoagulation and 202 eyes of 101 control patients with spontaneously regressed ROP were included. Fixation pattern, ocular motility findings, visual acuity, anterior segment examination, cycloplegic refraction and indirect ophthalmoscopic dilated fundus examination findings of all the included subjects were recorded. The incidence of unfavorable visual outcome defined as Snellen acuity of < 0.2, esotropia, strabismus surgery, nystagmus, myopia (≥ -0.50 D) and astigmatism (≥ 1.50 D) was significantly higher in the treated group than in the control group. These results indicate that premature babies with threshold ROP treated with indirect laser photocoagulation require frequent and long-term follow-up in order to determine refractive status and the presence of ocular motility disorders over time.

A case of pediatric age anticholinergic intoxication due to accidental Datura stramonium ingestion admitting with visual hallucination.

Abstract: Datura stramonium (DS) is a hallucinogenic plant that can produce anticholinergic toxicity because of its significant concentrations of toxic alkaloids, such as atropine, hyoscyamine, and scopolamine. DS grows in both rural and urban areas in Turkey. Clinical findings of toxicity are similar to those of atropine toxicity. DS abuse is common among adolescents because of its hallucinatory effects. However, accidental DS poisoning from contaminated food is very rare. Accidental poisonings are commonly seen among children. Children are more prone to the toxic effects of atropine; ingestion of even a small amount can cause serious central nervous system symptoms. Treatment is supportive; antidote treatment is given rarely. An eight-year-old male with accidental DS poisoning who presented to the Pediatric Emergency Department with aggression, agitation, delirium, and visual hallucinations is reported. Language: en

Approach to thyroid nodules in children and adolescents.

Abstract: Thyroid nodule prevalence is about 1.8% in healthy children; however, malignancy frequency is higher than in adults. Approximately 26.4% of thyroid nodules generate thyroid cancer in childhood. Coexisting thyroid disease, history of irradiation of the neck, post-pubertal age, female sex, and thyroid malignancy in the family are risk factors for developing nodules. After evaluation of the medical history and detailed physical examination, the second step is assessment of thyroid function and measurement of calcitonin level. Thyroid stimulating hormone (TSH) value in the upper range seems to be correlated with cancer. Calcitonin levels must be evaluated, especially if medullary cancer is suspected. Ultrasonography (USG) is the first-line imaging tool in the diagnosis of thyroid nodules. It gives information about the nodule size, echogenicity and location. Hypoechogenicity, microcalcifications, undefined margins, high internodular vascular flow, and subcapsular localization are clues of malignant lesions. Scintigraphy is only recommended in a solid nodule with the presence of suppressed TSH. Fine-needle aspiration biopsy (FNAB) has 90% accuracy and is very useful in the selection of patients for surgery. It must be applied to all nodules ≥1 cm and nodules ≤1 cm suspicious for malignancy. The other diagnostic tools are elastography, immunocytochemical markers and genetic evaluation. In the management of thyroid nodules, surgery is advised, especially if there is difficulty in distinguishing benign lesions from carcinoma.