The Effect of Graston Technique on Pain, Proprioception, Flexibility, and Disability in Patients with Chronic Non-specific Low Back Pain.

Background: Chronic non-specific low back pain (CNLBP) causes significant dysfunction in patients. The Graston Technique (GT) is a new intervention in pain management but there is a lack of evidence in the literature regarding its effectiveness in low back pain. Study Objective: This study aims to investigate the effect of GT added to exercise on pain, proprioception, disability, flexibility, and quality of life in individuals with CNLBP. Methods: This was a randomized controlled trial with a total of 30 CNLBP patients. Setting: Karabük University Training and Research Hospital, Turkey. Participants: Thirty patients (mean age = 38.46 ± 9.03 years) with CNLBP for at least 12 weeks were included in the study. The patients were randomly divided into two groups intervention and control. Intervention: Graston was applied three times a week for four weeks in addition to the exercise program in the intervention group, while only the exercise program was applied to the control group. Outcome measures: Pain intensity, pressure pain threshold, proprioception, flexibility, disability, and quality of life were evaluated at the beginning and end of the study. Results: Significant improvements in pain, disability, and quality of life were found in both the control and intervention groups (P < .05). There was an increase in flexibility and a decrease in proprioception deviation angles of 15° and 30° in the GT group (P < .05). The improvement in pain and disability in the intervention group was significant compared to the control group (P < .05). However, there was no significant difference between the groups regarding pressure pain threshold, flexibility, proprioception, and quality of life (P > .05). Conclusion: GT added to exercise in patients with CNLBP better reduces pain and disability, improves proprioceptive sense, and increases mobility and quality of life. GT may be used as a supportive treatment during the rehabilitation of CNLBP patients.

Could the 14q23.2 microdeletion or AKAP5 haploinsufficiency be a potential cause of intellectual disability?

Intellectual disability is characterized by impairment in at least two of the following areas: social skills, communication skills, self-care tasks, and academic skills. These impairments are evaluated in relation to the expected standards based on the individual's age and cultural levels. Additionally, intellectual disability is typically defined by a measurable level of intellectual functioning, represented by an intelligence quotients core of 70 or below. Autism spectrum disorder is a developmental disability resulting from differences in the brain, often characterized by problems in social communication and interaction, and limited or repetitive behaviors or interests. Hereditary spherocytosis is a disease characterized by anemia, jaundice, and splenomegaly as a result of increased tendency to hemolysis with morphological transformation of erythrocytes from biconcave disc-shaped cells with central pallor to spherocytes lacking central pallor due to hereditary injury of cellular membrane proteins. An 11-year-old female patient was referred to Pediatric Genetics Subdivision due to the presence of growth retardation and a diagnosis of hereditary spherocytosis. Since she also had dysmorphic facial features, such as frontal bossing, broad and prominent forehead, tubular nasal structure, and thin vermillion, genetic tests were performed. Chromosomal microarray analysis revealed a 2.5 Mb deletion in the 14q23.2q23.3 region. Deletion was also identified in the same region in her father, who had the same phenotypic characteristics, including hereditary spherocytosis and learning difficulties. We propose that the PLEKHG3 and AKAP5 genes, which are located in this region, may contribute to the development of intellectual disability.

Central nervous system thrombosis in pediatric acute lymphoblastic leukemia in Turkey: A multicenter study.

BACKGROUND: In patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increases due to hemostatic changes secondary to the primary disease and due to treatment-related factors. In this multicenter study, we aimed to research the frequency of central nervous system (CNS) thrombosis occurring during treatment, hereditary and acquired risk factors, clinical and laboratory features of patients with thrombosis, treatment approaches, and thrombosis-related mortality and morbidity rates in pediatric ALL patients. PROCEDURE: Pediatric patients who developed CNS thrombosis during ALL treatment from 2010 to 2021 were analyzed retrospectively in 25 different Pediatric Hematology Oncology centers in Türkiye. The demographic characteristics of the patients, symptoms associated with thrombosis, the stage of the leukemia treatment during thrombosis, the anticoagulant therapy applied for thrombosis, and the final status of the patients recorded through electronic medical records were determined. RESULTS: Data from 70 patients with CNS thrombosis during treatment, out of 3968 pediatric patients with ALL, were reviewed. The incidence of CNS thrombosis was 1.8% (venous: 1.5 %; arterial: 0.03%). Among patients with CNS thrombosis, 47 had the event in the first 2 months. Low molecular weight heparin (LMWH) was the most commonly used treatment with a median of 6 months (min-max: 3-28 months). No treatment-related complications occurred. Chronic thrombosis findings occurred in four patients (6%). In five (7%) patients who developed cerebral vein thrombosis, neurological sequelae (epilepsy and neurological deficit) remained. One patient died related to thrombosis, and the mortality rate was 1.4%. CONCLUSION: Cerebral venous thrombosis and, less frequently, cerebral arterial thrombosis may develop in patients with ALL. The incidence of CNS thrombosis is higher during induction therapy than during other courses of treatment. Therefore, patients receiving induction therapy should be monitored carefully for clinical findings suggestive of CNS thrombosis.

Modified Myocardial Performance Index in Fetal Growth Disturbances as Diagnostic and Prognostic Adjunct.

BACKGROUND: Fetal growth disturbance can be associated with cardiac dysfunction. This study aimed to assess the modified myocardial performance index in growth-restricted and appropriate for gestational age fetuses and evaluate both its prognostic value in perinatal period and also its association with adverse perinatal outcomes. METHODS: Totally 131 pregnant women were included in this prospective study. Of these, 56 cases were in study group with a diagnosis of small fetus and 75 cases were in control group with a diagnosis appropriately grown fetus. Fetal echocardiography was performed in all pregnant women to measure modified myocardial performance index. Umbilical, middle cerebral and uterine artery Doppler ultrasound parameters were measured in the study group. Small fetuses were categorized into 2 subgroups of late-onset fetal growth restriction and small for gestational age. RESULTS: Modified myocardial performance index was significantly higher in small fetuses compared to controls (0.45 vs. 0.37, P <.001). Newborn intensive care unit admission rates were significantly higher in small fetuses than in controls (chi-square test, P <.001). The highest mean modified myocardial performance index was recorded in the late-onset fetal growth restriction subgroup (0.45 vs. 0.41 vs. 0.37). The sensitivity and specificity of modified myocardial performance index in predicting adverse outcomes at a cut-off value of 0.41 were 63% and 75%, respectively. There was a significant negative correlation between modified myocardial performance index values and birth weights. CONCLUSIONS: We found higher left fetal heart modified myocardial performance index values in small fetuses indicating the presence of prenatal cardiac dysfunction. Fetal myocardial performance deteriorates in concordance with severity of growth restriction. Modified myocardial performance index can also be used to predict adverse perinatal outcomes among growth-restricted fetuses.

Reliability of the Modified Star Excursion Balance Test in individuals with Down Syndrome.

Neuromotor problems such as hypotonia, incoordination, impaired sensory-motor integration lead to significant delays in motor skills and balance development in individuals with Down Syndrome (DS). Balance control is essential for performing many motor skills independently and safely. Standardised testing of balance control can contribute significantly to the rehabilitation of individuals with DS. The purpose of this study was to determine intrarater and interrater reliability of the Modified Star Excursion Balance Test (SEBT) for individuals with DS. Thirteen individuals with DS were recruited in this study. Intraclass correlation coefficients (ICC [3,1]) with 95% confidence intervals, standard error of measurement (SEM), the smallest detectable difference (SDD) and the Spearman rank correlation coefficient were calculated. In all directions of the Modified SEBT, no statistically significant difference was found between two raters' first and second measurements (p > 0.05). Interrater reliability for all reach directions of the Modified SEBT was high, with ICC ranging from 0.990 to 0.998.95% confidence intervals, SEM and SDD ranged from 0.924 to 0.999, 0.180-2.434 and 3.270-6.747, respectively. The Modified SEBT are reliable for evaluating dynamic balance in individuals with DS aged between 6 and 24 years.

Utility of the Platelet-to-Lymphocyte Ratio in Diagnosing and Predicting Treatment Success in Preterm Neonates with Patent Ductus Arteriosus.

BACKGROUND: We investigated the predictive ability of the platelet-to-lymphocyte ratio (PLR) in preterm infants to discriminate those with and without hemodynamically significant PDA (hsPDA and non-hsPDA), hsPDA defined by those requiring medical intervention. METHODS: This observational retrospective cohort study included premature neonates (<34 weeks gestational age) with routine complete blood counts in a neonatal intensive care unit. RESULTS: PLR values on the 1st, 2nd, 3rd, and 7th days of birth were higher and lymphocyte counts were lower in the hsPDA than in the non-hsPDA group. Plateletcrit (PCT) values on the 2nd and 3rd days of birth were lower in the hsPDA group. All hsPDAs closed with medical therapy. CONCLUSIONS: PLR may be a supportive tool for predicting those preterm infants with PDAs requiring medical intervention. This may serve as a guide for future studies investigating the predictive value of PCT and PLR for hsPDA in preterm infants.

Effect of core strength training on balance, vertical jump height and throwing velocity in adolescent male handball players.

BACKGROUND: The aim of this study was to examine the effects of core strength training (CST) on dynamic balance and vertical jump height, and throwing velocity in handball players. METHODS: Twenty male handball players (mean age 14.90±0.44 years) participated in this study. The players randomly divided into two groups as CST and control (CON) groups. Dynamic balance, vertical jump, and throwing velocity were measured before and after a six-week CST. RESULTS: Significant differences were found at anterior (P=0.009) and posteromedial (P=0.017) directions of the Star Excursion Balance Test (SEBT) in only CST group. There were significant improvement in vertical jump height of participants compared to pre-test scores in both CST (P=0.047) and CON group (P=0.013). No significant difference was found for throwing velocity compared with pre-test in both groups. There were no significant differences in all parameters when CST and CON groups were compared (P>0.05). CONCLUSIONS: The results of the present study indicated that a 6-week CST did not improve dynamic balance, vertical jump height and throwing velocity in adolescent male handball players. We believe that longer CST programs may provide significant benefits.

The role of perspective in event segmentation.

People divide their ongoing experience into meaningful events. This process, event segmentation, is strongly associated with visual input: when visual features change, people are more likely to segment. However, the nature of this relationship is unclear. Segmentation could be bound to specific visual features, such as actor posture. Or, it could be based on changes in the activity that are correlated with visual features. This study distinguished between these two possibilities by examining whether segmentation varies across first- and third-person perspectives. In two experiments, observers identified meaningful events in videos of actors performing everyday activities, such as eating breakfast or doing laundry. Each activity was simultaneously recorded from a first-person perspective and a third-person perspective. These videos presented identical activities but differed in their visual features. If segmentation is tightly bound to visual features then observers should identify different events in first- and third-person videos. In addition, the relationship between segmentation and visual features should remain unchanged. Neither prediction was supported. Though participants sometimes identified more events in first-person videos, the events they identified were mostly indistinguishable from those identified for third-person videos. In addition, the relationship between the video's visual features and segmentation changed across perspectives, further demonstrating a partial dissociation between segmentation and visual input. Event segmentation appears to be robust to large variations in sensory information as long as the content remains the same. Segmentation mechanisms appear to flexibly use sensory information to identify the structure of the underlying activity.

Evaluation of left ventricular functions with two-dimensional speckle-tracking echocardiography (2D-STE) and N-terminal ProBNP in diabetic children.

Simsek A, Turan Ö, Çiftel M, Kardelen F, Durmaz E, Özdem S, Akçurin G, Ertug H. Evaluation of left ventricular functions with twodimensional speckle-tracking echocardiography (2D-STE) and N-terminal ProBNP in diabetic children. Turk J Pediatr 2018; 60: 633-641. The purpose of this study was to examine the existence of subclinical left ventricular dysfunction by using 2D-STE and NT-ProBNP levels in children and adolescent patients with type 1 diabetes mellitus. Furthermore, it was also aimed to investigate the effects of the diabetes duration and the metabolic control of the disease on cardiac functions. The patient group was composed of 63 children who were being followed up for the type 1 diabetes mellitus. The control group was composed of 36 healthy children who were of the similar age. Patients with type 1 diabetes mellitus were divided into groups; according to the duration of the disease; group 1: 3-5 years, group 2: 6-10 years of follow-up. The conventional echocardiography and 2D-STE were applied to all of the patients and control individuals. NT-Pro BNP level was measured in the diabetes group. In the conventional echocardiographic examination; there was no difference between the patient and control groups in terms of left ventricular systolic functions, left ventricular diastolic functions; late-diastolic flow velocity in mitral valve (A) values increased and E-wave/A-wave ratio (E/A ) values decreased in diabetes mellitus patients. According to the 2D-STE results; global longitudinal strain, (-17.28±2.24 vs. -19.49±2.22; p < 0.05) and circumferential strain (-12.86±3.19 vs. -17.71±4.62; p < 0.05) were lower in diabetic patients compared to the parameters of control group individuals. There was no difference between levels of NT-ProBNP of the group 1 and group 2 diabetes mellitus patients. Our study showed that there was a dysfunction on the left ventricular systolic functions of the patients with type 1 diabetes mellitus. NT-Pro BNP levels were not considered as a distinguishing factor for the early stages of diabetes mellitus.

Pesticide residues in muscles of some marine fish species and seaweeds of Iskenderun Bay (Northeastern Mediterranean), Turkey.

Pesticide residues in muscles of nine marine fish and four seaweed species of Iskenderun Bay (Northeastern Mediterranean) have been investigated. In sampled fish species, two herbicides, three insecticides, two fungicides, and one synergist were identified and quantified. Metribuzin DADK, propamocarb HCl, and piperonyl butoxide (PBO) were detected in all the muscles of sampled fish species. Metribuzin DADK was the most abundant pesticide residue in fish muscles and the highest metribuzin DADK concentration was found in sardine (311.20 µg/kg). Propamocarb HCl concentrations varied greatly among species; from 0.530 ± 0.020 µg/kg in striped sea bream to 34.170 µg/kg in sea bass. The level of PBO ranged from 0.001 µg/kg for fourlined terapon to 0.013 µg/kg for sardine. No measurable oxamyl residue was found in any of the muscles of sampled fish species (except sardine). In seaweeds, two herbicides and two insecticides were identified and quantified. Metribuzin DADK was the most abundant and found in Cystoseira corniculata (5.01 mg/kg), Corallina elongata (0.703 mg/kg), and Jania rubens (3.85 mg/kg). Molinate was a minor contaminant and only found in Corallina elongata (0.002 mg/kg). Pyrethrin I was determined only in Padina pavonia to be 0.567 mg/kg. Pyrethrine II was found in Padina pavonia and Corallina elongate to be 1.214 and 0.229 mg/kg, respectively. The most hazardous pesticide residues of organochlorines and organophosphorus were not detected in both sampled fish muscles and seaweeds. There are no clear maximum residue limits for the detected eight pesticide residues declared for fish muscle by European Union MRL (2017). In conclusion, it can be considered that observed concentrations of pesticides in sampled nine marine fish species do not have a potential health risk for consumers. Some of the detected pesticide residues can be toxic for algae and aquatic life and regular monitoring studies are therefore essential to control the pesticide concentrations of aquatic biota in the region.

Fatty acid composition and biogenic amines in acidified and fermented fish silage: a comparison study.

In the presented study, ensiling of discard fish by acidification or fermentation was evaluated. Klunzinger's ponyfish which is a discard fish was used for the production of fish silage by acidification (3% formic acid for Method FA; 1.5% formic and 1.5% sulphuric acid for Method FASA) and fermentation (Lactobacillus plantarum for Method LP and Streptococcus thermophilus for Method ST). The chemical, microbiological and nutritional properties of the differently preserved fish silages were estimated during a storage period of 60 d at ambient temperature. Compared to the raw material, a slight increase in saturated fatty acids and a slight decrease in polyunsaturated fatty acids were observed in all silages. At the end of the storage period, the aerobic bacteria counts after applying Methods FA, FASA, LP and ST amounted to 2.35, 2.39, 5.77 and 5.43 log cfu/g, respectively. The analysis of thiobarbituric acid revealed that acidification of silages accelerated the lipid oxidation. Nine biogenic amines were found in raw fish and different silages. The initial histamine concentration in raw fish was 0.17 mg/100 g and in all silages it remained at low levels during the storage period. The initial tyramine content was found to be 1.56 mg/100 g in raw fish and increased significantly in all silages. The increase of the tyramine content in fermented silages was considerably higher than in acidified silages (23-48 mg/100 g and 5-10 mg/100 g, respectively). It can be concluded that acidified or fermented fish silage should be considered as potential feed component for animals because of its high nutritional value and appropriate microbiological and chemical quality.

Assessment of left ventricular function by tissue Doppler echocardiography in pediatric chronic kidney disease.

BACKGROUND: Cardiovascular (CV) disease remains the most common cause of mortality in chronic kidney disease (CKD). METHODS: In this cross-sectional study, 43 pediatric patients with CKD were divided into two groups according to their estimated glomerular filtration rate (eGFR): groups 1 and 2 (eGR; 29-75 and 15-29 mL/min/1.73 m(2), respectively). M - mode, conventional pulsed wave Doppler (cPWD) echocardiography and tissue Doppler imaging (TDI) were performed in all patients and 16 healthy controls. Maximal early (E wave) and late (A wave) diastolic flow velocities were assessed by cPWD. Using TDI, the early (E') and late (A') diastolic filling velocities were recorded. Early and late diastoles were evaluated using E' values and E/E' ratios, respectively. RESULTS: Left ventricular hypertrophy (LVH) was determined in 19/43 (44.2%) patients. The E/E' ratio was significantly higher in group 2 than in group 1 and controls. E/E' was found to be positively correlated with left ventricular mass (LVM) index, and negatively with hemoglobin (Hb) levels. Low Hb levels were only independent predictor of E/E' (p = 0.001, ß: -0.470, 95% CI: -0.764; -0.196). E' ratio was significantly lower in both patient groups compared to the controls. CONCLUSIONS: LVH and diastolic dysfunction are already present in early stages of CKD. Treatment of risk factors, such as anemia, is important to improve the clinical outcome.

Musculoskeletal injuries in Homer's Iliad: the War of Troy revisited.

Homer's Iliad--the most famous and influential epic poem--has been previously reviewed with respect to head, craniomaxillofacial, neck, thoracic, and hand injuries in the literature. However, to the best of the authors' knowledge, there are no data regarding musculoskeletal injuries. This article describes the musculoskeletal injuries that had ensued during the war of Troy. The Turkish translation of the original epic poem Iliad was reviewed for musculoskeletal injuries, that is, their descriptions, outcome, the weapons used, and the engaged warriors. Extremity injuries were evaluated as regards the affected bones. The pertinent treatment methods were also recorded. In total, 103 musculoskeletal injuries were detected during 81 combats. The most commonly involved areas were the shoulder (15.5%), the head (14.5%), the cervical vertebrae (14.5%), and the thoracic vertebrae (8.7%). The weapons used were spear (n = 52); sword (n = 9); arrow (n = 9); stone (n = 8); and cane, animal, the hand, Chariot race, and broken yoke (n = 1 for each). Fifty-four combats (66.6%) resulted in death. Therapeutic herbs, compound of milk, and essence of fig were used as treatment alternatives. While providing a historic snapshot on the war of Troy, in this article, the authors have reviewed the musculoskeletal injuries and their management in those ancient times. Despite the long period in between, unfortunately, physicians/surgeons are still faced with war injuries in current medical practice. The authors strongly hope that, at least in the near future, physicians will be left with only natural health problems and without those artificially generated by human beings.

Assessment of atrial electromechanical delay in children with acute rheumatic fever.

PURPOSE: There may be an increase in the risk of atrial arrhythmia due to left atrial enlargement and the influence on conduction system in acute rheumatic fever. The aim of this study is to investigate atrial electromechanical delay and P-wave dispersion in patients with acute rheumatic fever. PATIENTS: A total of 48 patients diagnosed with acute rheumatic fever and 40 volunteers of similar age, sex, and body mass index were included in the study. The study groups were compared for M-mode echocardiographic parameters, interatrial electromechanical delay, intra-atrial electromechanical delay, and P-wave dispersion. RESULTS: Maximum P-wave duration, P-wave dispersion, and interatrial electromechanical delay were significantly higher in patients with acute rheumatic fever compared with the control group (p < 0.001). However, there was no difference in terms of intra-atrial electromechanical delay (p > 0.05). For patients with acute rheumatic fever, a positive correlation was identified between the left atrium diameter and the P-wave dispersion and interatrial electromechanical delay (r = 0.524 and p < 0.001, and r = 0.351 and p = 0.014, respectively). Furthermore, an important correlation was also identified between the P-wave dispersion and the interatrial electromechanical delay (r = 0.494 and p < 0.001). CONCLUSION: This study shows the prolongation of P-wave dispersion and interatrial electromechanical delay in acute rheumatic fever. Left atrial enlargement can be one of the underlying reasons for the increase in P-wave dispersion and interatrial electromechanical delay.

Prediction of neurodevelopmental outcome in term neonates with hypoxic-ischemic encephalopathy.

BACKGROUND: Hypoxic ischemic encephalopathy may result in many neurological deficits. It is crucial to make early diagnosis and assess the prognosis correctly. AIMS: We aimed to determine the factors to evaluate the prognosis of hypoxic ischemic encephalopathy. METHODS: Electroencephalography, neuroimaging, periodic neurological exams and a developmental test at 44-48 months after discharge from the hospital were performed on twenty five term newborn infants with clinical evidence of hypoxic ischemic encephalopathy. RESULTS: Normal/mildly abnormal neonatal electroencephalography correlated with favorable outcome, particularly if neuroimaging was normal. The cranial MRI sensitivity was 83.3%, while the specificity was 57.9%, the positive predictive value was 38.5%, and the negative predictive value was 91.6%. Moderate/severely abnormal electroencephalography and multifocal/diffuse cortical or deep gray matter lesions correlated with poor outcome. CONCLUSIONS: Newborn infants with hypoxic ischemic encephalopathy should be treated in neonatal intensive care units, assessed with periodic neurological examination, electroencephalogram and brain imaging. This would help to initiate early intervention and improve the outcome of patients.

Endothelial dysfunction and atherosclerosis in children with irreversible pulmonary hypertension due to congenital heart disease.

OBJECTIVE: To assess endothelial dysfunction and the risk for coronary atherosclerosis in children with irreversible pulmonary hypertension due to congenital heart disease (CHD). METHODS: The study included 18 cyanotic patients (the mean age was 12.28 ± 3.26 years) who developed irreversible pulmonary hypertension due to cyanotic and acyanotic CHDs, and 18 control patients (the mean age was 11.78 ± 3.00 years). Study groups were compared for flow-mediated dilatation (FMD), carotid intima media thickness (CIMT) and atherosclerotic risk factors. RESULTS: Compared to the control group, the mean FMD was significantly reduced in the cyanotic group (5.26 ± 2.42% and 9.48 ± 2.60%, respectively; P-value < 0.001). No significant difference was observed between the groups in CIMT (0.41 ± 0.08 mm and 0.39 ± 0.06 mm, respectively; P-value = 0.299). The levels of total cholesterol, low-density lipoprotein-cholesterol and very low-density lipoprotein-cholesterol were statistically significantly lower compared tothe control group (P-value = 0.001, 0.006 and 0.014, respectively), whereas no statistically significant difference was found in the levels of high-density lipoprotein-cholesterol and triglycerides (P-value = 0.113 and 0.975, respectively). CONCLUSIONS: Systemic endothelial dysfunction in children with irreversible pulmonary hypertension due to CHD was noted but there was no increased risk for atherosclerosis.

The effects of extraction methods on the contents of fatty acids, especially EPA and DHA in marine lipids.

This study aims to evaluate the efficiency of trans-methylation methods in fish oil obtained using Soxhlet extraction method and Bligh and Dyer method and also to observe the effects of extraction methods on the contents of polyunsaturated fatty acids [PUFAs, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] in five marine species: sardine (Sardinella aurita), anchovy (Engraulis encrasicolus), sea bream (Sparus aurata), brushtooth lizardfish (Saurida undosquamis) and chub mackerel (Scomber japonicus). The results showed that Bligh and Dyer extraction method was more efficient in extracting polar and non-polar lipids than Soxhlet method and also prevented losses of PUFAs by a reduction in the oxidation. The level of EPA showed fluctuations for the two extraction methods. However, Soxhlet method showed significant decrease (p < 0.05) in the level of DHA for all fish species. The use of n-heptane proves to be superior for the recovery of unsaturated fatty acids, especially EPA and DHA.

Coexistence of symptomatic iron-deficiency anemia and duodenal nodular lymphoid hyperplasia due to giardiasis: case report.

Iron-deficiency anemia due to iron malabsorption and duodenal nodular lymphoid hyperplasia (NLH) has been described in children with Giardia intestinalis infection. Also, symptomatic iron-deficiency anemia is rarely encountered in male adolescents. A 14-year-old boy underwent esophagogastroduodenoscopy for investigation of symptomatic iron-deficiency anemia (hemoglobin 5.8 g/dL, mean corpuscular volume 65.3 fL, serum ferritin < 1.5 ng/mL). He had a sufficient diet for iron and recurrent bouts of diarrhea without melena. At upper endoscopy, duodenal mucosa was diffusely nodular. Histopathologic evaluation of biopsy samples from the duodenum revealed infection with Giardia intestinalis. His anemia improved with metronidazole and iron treatment.