Sudden-onset haemolacria in an adolescent girl.

Haemolacria, also known as bloody tears, is a physical condition in which a person produces tears partially composed of blood. Multiple disorders can cause haemolacria, including trauma, inflammation, vascular lesions, vicarious menstruation, blood disorders, epistaxis, tumours and psychiatric and systemic disorders. Often, no aetiology is identified. It is usually benign, self-limiting, and the treatment depends on the cause. A 14-year-old girl presented to the paediatric emergency department with sudden onset of bloody tears from both eyes and epistaxis for the first time. A detailed history focusing on aetiological factors was unremarkable. Systemic, ocular, nasal and paranasal examination was also unremarkable. Radiological and laboratory investigations were normal, and the patient was diagnosed with idiopathic haemolacria. High-dose oral vitamin C, prophylactic iron therapy and psychological support were provided as conservative treatment. During regular follow-up, there was a spontaneous reduction in the frequency of symptoms.

Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19.

OBJECTIVE: Although the initial reports of COVID-19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow-up of patients with MIS-C. METHODS: The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. CONCLUSION: Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C.

Evaluation of the Colchicine Poisoning Cases in a Pediatric Intensive Care Unit: Five Year Study.

BACKGROUND: Colchicine poisoning is an uncommon but serious form of drug intoxication. It may produce life-threatening systemic effects. In toxic doses it produces nausea and vomiting and bone marrow suppression, often leading to sepsis, hypocalcemia, adult respiratory distress syndrome, and direct cardiotoxic effects. OBJECTIVE: The aim of this study was to describe demographic features and the outcome of patients poisoned with colchicine. METHODS: A retrospective study of the pediatric intensive care unit database was performed for patients ≤18 years of age who had colchicine poisoning between July 2008 and July 2013. RESULTS: The total number of patients with drug poisoning in the study period was 144. Nine of 144 were related to colchicine poisoning. The median age was 4 years (range 20 months to 16 years) and the number of females was five. Six of the nine cases presented after ingesting <0.5 mg/kg, whereas two patients had consumed 0.5 to 0.8 mg/kg. One patient had received colchicine >0.8 mg/kg. Three patients died. CONCLUSIONS: Among drug intoxications, colchicines can lead to severe clinical conditions. All patients suspected of having colchicine intoxication should be managed in the pediatric intensive care unit regardless of the actual degree of poisoning.

Urinary kidney injury molecules in children with febrile seizures.

OBJECTIVE: Hypoxia occurs following convulsions, and hypoxia is one of the most common causes of acute renal damage. The aim of this study was to investigate urinary levels of kidney injury molecules, including neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-ß-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with febrile seizures (FS) for the first time. METHODS: The study included 28 children with FS and 34 age and gender matched healthy children. Serum biochemistry and blood gases were measured in the serum samples. Estimated glomerular filtration rate (eGFR) was calculated. NGAL, NAG, L-FABP, and creatinine (Cr) were measured in the urine samples. The ratios of kidney injury markers to urinary Cr were used for comparisons. RESULTS: There were no significant differences in eGFR and serum chemistry values between the FS and the control group (p > 0.05). Hypoxia was detected in 67.9% of the FS patients. The FS group had significantly higher urinary kidney injury molecules to Cr ratios compared to the controls, including NGAL/Cr (17.9 ± 9.8; 6.7 ± 4.0, respectively; p < 0.001), NAG/Cr (0.55 ± 0.29; 0.21 ± 0.16, p < 0.001), and L-FABP/Cr (4.85 ± 2.93; 1.74 ± 1.16, p < 0.001). CONCLUSION: Increased urinary NGAL/Cr, NAG/Cr, and L-FABP/Cr values, in patients with FS compared to healthy controls, suggest a possible subclinical renal damage in these patients.

Actitud de los pediatras sobre el uso de andadores para los bebés / Pediatricians' attitude about the use of infant walkers

Los andadores se utilizan frecuentemente a pesar de que su uso puede ocasionar lesiones. Se realizó una encuesta para obtener información sobre las actitudes y el abordaje de los pediatras respecto del uso de andadores. Se invitó a 247 pediatras que asistieron al 44° Congreso Turco de Pediatría y Europediatría (2008) a responder un cuestionario preparado por los autores. Se incluyeron en el análisis 226 cuestionarios respondidos en forma completa. La mediana de edad de los participantes (119 mujeres) fue de 39 años (29 a 58). De ellos, 4% recomendaban el uso de andadores, 32,3% dejaban la decisión a criterio de los padres y 63,7% no lo recomendaban. Ciento cinco habían tratado con anterioridad a un bebé que sufrió una lesión relacionada con el uso del andador; de ellos, 73,3% no recomendaron su uso y 57,1% opinaron que la producción y el uso de andadores deberían prohibirse. Conclusiones. El 4% de los pediatras encuestados recomiendan el uso de andadores para bebés y más del 30% dejan la decisión a los padres. Los pediatras que atendieron a un bebé que sufrió una lesión por el uso del andador fueron menos proclives a recomendarlo.

Infant walkers are still very popular even though their use might cause injuries. A survey was carried out to obtain information about attitudes and pediatricians' approach regarding the use of infant walkers. Two hundred and forty seven pediatricians who attended the 44th Turkish Congress of Pediatrics and Europediatrics (2008) were invited to reply to a questionnaire prepared by the authors. Two hundred and twenty six questionnaires replied in full were included. The median age of participants (119 women) was 39 years old (range: 29-58 years old). Out of the total, 4% recommended the use of a walker; 32.2% left the decision to parents' judgment, and 63.7% did not recommend its use. A hundred and five had previously treated an infant who had an injury associated to the use of the walker; out of them, 73.3% did not recommend its use and 57.1% stated that there should be a ban on the sale and manufacture of walkers. Conclusions. Out of the total number of surveyed pediatricians, 4% recommend the use of infant walkers and over 30% leave this decision to parents. Those pediatricians who took care of babies who had an injury associated to the use of a walker were less prone to recommending it.

Determination of total oxidative stress and total antioxidant capacity before and after the treatment of iron-deficiency anemia.

BACKGROUND: Oxidative stress is an imbalance between the reactive oxygen species and antioxidant system. In this study, total oxidative stress (TOS) and total antioxidant capacity (TAC) were investigated with a new and practical method in childhood iron-deficiency anemia. METHOD: During the study period 80 children between 6 and 60 months were enrolled; 40 children (study group) had iron-deficiency anemia, and 40 children (control group) were healthy. Complete blood count, serum iron, iron-binding capacity, ferritin levels, TOS, and TAC were evaluated. Children diagnosed iron-deficiency anemia were treated with oral ferric iron. After 2 months of the treatment, blood tests of the study groups were repeated to check the challenge. RESULTS: TAC was similar between both groups (1.55 ± 0.26 in control group 1.53 ± 0.19 mmol Trolox Eq./l). Additionally, TOS was significantly higher in iron-deficiency anemia group before treatment with iron (24.3 ± 18.5, in controls groups 14.4 ± 7.1 mmol Trolox Eq./l). We have shown that TAC did not change (before treatment 1.55 ± 0.26, after treatment 1.54 ± 0.26 mmol Trolox Eq./l) although TOS decreased significantly after the treatment of iron-deficiency anemia (before treatment 24.3 ± 18.5, after treatment 12.4 ± 6.9 mmol Trolox Eq./l). We did not find any correlation between hemoglobin, serum iron, iron-binding capacity, ferritin levels, and TOS or TAC among iron-deficiency anemia patients. CONCLUSION: As a result of this study, oxidative stress increases in children with iron-deficiency anemia and this increase can be returned to normal levels by treatment.

Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis.

AIM: To analyze the frequency of pleural effusion and the effect on prognosis in children with acute bronchiolitis. METHODS: A total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients'age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3rd and 7th day of the treatment. RESULTS: Mean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors. CONCLUSIONS: This study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis.