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BACKGROUND: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population. METHODS: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded. RESULTS: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU. CONCLUSION: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.
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COVID-19 , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Serviço Hospitalar de Emergência , Feminino , Febre/etiologia , Humanos , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Síndrome de Resposta Inflamatória SistêmicaRESUMO
BACKGROUND: Anaphylaxis is a potentially life-threatening condition caused by a variety of triggers. However, anaphylaxis following an abdominal trauma is an exceptionally rare condition and could be the first and only sign of hepatic hydatid cyst, especially when no obvious etiology is present. Here, we present such a rare case and discuss relevant diagnostic and management strategy in light of the literature. CASE REPORT: This case report refers to a 17 year-old previously healthy girl admitted in our pediatric emergency department (ED) for syncope after a minor blunt abdominal trauma. She was hypotensive on admission and shortly after she developed urticaria and angioedema. She was diagnosed with anaphylaxis and treated immediately. Possible etiologies including drug or food ingestion, insect bite, and previous allergy/anaphylaxis history were excluded. After stabilization abdominal imaging was performed, which revealed a ruptured large hepatic hydatid cyst in the vicinity of biliary tree. Albendazole treatment was started and surgical resection was performed after clinical stabilization, which confirmed the cyst rupture into the biliary ducts. Patient recovered without complications after surgery and was discharged uneventfully. CONCLUSION: This case report highlights that hydatid cyst rupture should be included in the differential diagnosis of anaphylaxis without obvious etiology, particularly in regions where hydatid disease is endemic. Ruptured hydatid cyst leading to anaphylaxis requires timely diagnosis, management and emergent intervention.
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Anafilaxia , Cistos , Equinococose Hepática , Equinococose , Echinococcus , Adolescente , Anafilaxia/diagnóstico , Anafilaxia/etiologia , Animais , Criança , Cistos/complicações , Equinococose/complicações , Equinococose/diagnóstico , Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico , Equinococose Hepática/cirurgia , Feminino , Humanos , Ruptura/complicaçõesRESUMO
OBJECTIVE: Unscheduled return visits to the emergency department (unscheduled RTED) increase both the workload and overcrowding in the emergency department. The aim in the present study is to identify the patient groups that require more careful and closer follow-up to reduce the rates of unscheduled RTED and hospital admissions after a return visit. METHODS: Among the patients admitted to the emergency department of our hospital between 2016 and 2017, those who made an unscheduled RTED within 72 hours after their first visit to the emergency department were evaluated retrospectively. RESULTS: Of the 137,787 eligible children, 3294 (2.8%) made unscheduled RTEDs within 72 hours. The median age was 28 months, and 1848 (57.6%) were male patients. The admission rate at the return visit was significantly higher among children younger than 2 years, in the patients presenting with respiratory complaints and severe acute conditions, and in those who presented to the emergency department for the first time during the department's busiest hours. The risk of admission upon a return visit to the emergency department was 2.7 times higher in the male sex, 5.4 times higher in children younger than 2 years, 5.9 times higher in patients with respiratory complaints, 4.9 times higher in patients with gastrointestinal tract complaints, and 27,000 times higher in patients with severe acute conditions. CONCLUSIONS: Unscheduled RTED and hospitalization rates can be reduced with more careful evaluation of young children, patients with respiratory and gastrointestinal complaints and those who apply during emergency department busiest hours.
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Serviço Hospitalar de Emergência , Readmissão do Paciente , Criança , Pré-Escolar , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIM OF THE STUDY: Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. METHODS: This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. RESULTS: A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). CONCLUSIONS: The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.
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Reanimação Cardiopulmonar , Cardioversão Elétrica , Adulto , Criança , Estudos Transversais , Pessoal de Saúde , Humanos , TurquiaRESUMO
OBJECTIVE: The objective of this study was to detect variables associated with burnout syndrome (BS) in pediatric intensive care units (PICUs) and pediatric emergency medicine departments (PEDs) in high-volume centers from different parts of Turkey. METHODS: An observational, cross-sectional multicenter study was performed. The Maslach Burnout Inventory scale was administered to all of health care providers working in PICUs and PEDs. In this study, health care providers were defined as physicians, nurses, and other staff (secretaries, cleaning and patient care staff) working in PICU and PEDs. RESULTS: A total of 570 participants completed the survey. The major finding of this study was that 76.1% (n = 434) of PICU and PED health care professionals had BS. The most prominent subscale of BS was emotional exhaustion (62.5%). The rate of BS was higher among health care providers working in PEDs compared with PICUs (79.1% vs 73.7%, P = 0.04). The frequency of BS according to emotional exhaustion and depersonalization subscales was higher in health care providers of PEDs. The rate of BS was also significantly higher in younger employees, females, those working 51 or more hours totally in a week, those having a low monthly salary, those single or divorced, those without children, those with no childcare at home, those not owning a home, those not doing regular exercise and not having regular breakfast, those with total employment time of less than 1 year, and those not having a car or not having a hobby. In PEDs, when the daily evaluated number of patients was equal to or more than 44 (sensitivity, 88%; specificity, 66%), it predicted the occurrence of BS. In PICUs, when the number of patients cared for by 1 nurse was equal to or more than 3, it predicted the occurrence of BS (sensitivity, 78%; specificity, 62%). CONCLUSIONS: By creating early intervention programs to prevent BS, shortages of health care professionals can be avoided and the costs of health care expenditures related to infections can be decreased.
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Esgotamento Profissional , Médicos , Esgotamento Profissional/epidemiologia , Criança , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Unidades de Terapia Intensiva PediátricaRESUMO
OBJECTIVE: The aims of the present study were to investigate the reasons parents prefer the pediatric emergency department for nonurgent admissions and to evaluate the effect of parental age and educational level on nonurgent admissions and the relationship between the reasons for nonurgent admissions and child age. METHODS: We conducted a cross-sectional survey at an emergency department of a tertiary care pediatric referral center. A questionnaire that was prepared to understand the reasons underlying nonurgent admissions was administered to the parents of 1033 children who were classified as nonurgent cases using the Pediatric Canadian Triage and Acuity Scale (4-5). RESULTS: The most common reasons for nonurgent admissions were the concern for progression in child's complaints, the complaints with an onset outside working hours, and the parental perception that more cautious and better care is provided in the emergency department. The most urgent complaints from the parental perspective included fever (23.1%), vomiting (11.0%), and diarrhea (10.5%), respectively. The mean age of the mothers was 31.1 ± 5.9 years (17-51 years), and the mean age of the fathers was 34.94 ± 6.1 years (20-60 years). Parents younger than 30 years were more likely to prefer the emergency department due to convenience and economic reasons. Nonurgent admissions due to confidence in the emergency department were more frequent among parents who were primary school graduate. CONCLUSIONS: It is critically important to examine why parents prefer the emergency department for nonurgent conditions of their children and to develop solution offers in this regard. The improvements to be made in the emergency department would both prioritize patients requiring urgent care and increase the productivity of emergency department staff.
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Fatores Etários , Escolaridade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Pais/psicologia , Adulto , Criança , Estudos Transversais , Feminino , Mau Uso de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , TurquiaRESUMO
This study aimed to describe the clinical characteristics and serious medical and psychosocial complications of pregnant and postpartum adolescent patients at a pediatric emergency department (PED). Demographic and clinical data of all pregnant and postpartum adolescents who presented to the PED of a single tertiary referral hospital between January 2020 and January 2023 were collected and documented retrospectively. Twenty-seven patients with a mean age of 16.7 ± 0.8 years were included in the study. The main presenting complaints were abdominal pain (n = 9), suspicion of pregnancy (n = 5), cough, seizure, and vomiting (3 patients each). Potentially life-threatening medical complications included stroke (n = 3), placental abruption (n = 1), and carbon monoxide intoxication (n = 1). Sexual assault (n = 4), physical assault (n = 2), recurrent pregnancies (n = 5), and suicide attempts (n = 4) were serious psychological and social complications in our patient group. Pregnant and post-partum adolescents may present to PED with serious lifethreatening complications, and permanent sequelae may occur. In addition to sexual and physical violence, various psychological problems are comorbid conditions. These patients should be managed with a multidisciplinary biopsychosocial approach, and these issues considered in their acute treatment and follow-up at emergency departments.
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OBJECTIVES: Over-testing and over-treatment are common in children with croup at pediatric emergency departments (PED). The objective of the study was to improve care for children with croup. METHODS: In this quality improvement (QI) initiative, all pediatric residents starting their rotation in the PED attended an informative presentation about croup and were provided reminders throughout their rotation. The primary outcome of this QI initiative was to reduce nebulized epinephrine (NE) use among children with mild croup by 50% over 7 months. The secondary outcome was to reduce X-rays by 50% over 7 months. Other outcomes included the administration of dexamethasone to all children with croup, reduction of antibiotics, laboratory tests, and revisits, and shortening the duration between physical examination to dexamethasone and NE treatments, and the length of stay (LOS) at the PED. RESULTS: NE administration to patients with mild croup decreased from 80.2% to 36.3% (p < 0.001). The proportion of children with X-rays decreased from 37.4% to 17.1% (p < 0.001). There was a significant increase in dexamethasone administration, and significant decreases in laboratory blood tests, expanded viral PCR panel tests, and antibiotic prescription among all croup cases (p < 0.001). Revisit rates were not significantly different (p > 0.05). Time to dexamethasone and LOS shortened significantly (p < 0.001). CONCLUSION: With this QI intervention, decreases in the rate of administration of NE to mild croup cases, antibiotic prescription, X-ray, laboratory blood and respiratory PCR panel tests in all croup cases were achieved without an increase in revisits. However, unnecessary NE, antibiotic, and X-ray rates are still high.
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Crupe , Dexametasona , Serviço Hospitalar de Emergência , Epinefrina , Melhoria de Qualidade , Humanos , Crupe/tratamento farmacológico , Crupe/diagnóstico , Crupe/terapia , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Feminino , Masculino , Lactente , Pré-Escolar , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Criança , Tempo de Internação/estatística & dados numéricos , Broncodilatadores/uso terapêutico , Broncodilatadores/administração & dosagem , Nebulizadores e VaporizadoresRESUMO
OBJECTIVE: Previous studies have reported on a link between carboxyhemoglobin (COHb) levels and the severity of presenting findings. However, studies on pediatric populations evaluating the effect of age on presenting symptoms are severely lacking. The aim of this study was to investigate the presence of any link between age and presenting symptoms in children with carbon monoxide (CO) poisoning. METHODS: This retrospective study was undertaken in Ankara Children's Hematology and Oncology Hospital, a tertiary care center, between January 2007 and March 2010. The medical records of patients aged between 0 and 16 years with a confirmed diagnosis of CO poisoning, defined as the presence of a COHb level of more than 5%, were evaluated. Relevant information such as age, sex, source of CO, coaffected family members, month of presentation, time of presentation and presenting symptoms, duration of oxygen treatment in the emergency department, need for admission to an inpatient ward or intensive care unit, Glasgow Coma Scale scores, and administered treatments during follow-up was recorded for each patient on preprepared forms. For the purpose of comparison, patients were divided into 2 groups based on COHb levels (group 1, 5%-25%; group 2, >25%). Comparisons were also made after dividing patients into 3 age groups: infants (0-3 years), preschool and early-school children (4-8 years), and adolescents (9-16 years). RESULTS: The records of 261 patients were deemed sufficient for inclusion in the final analysis, 149 (57.1%) of which were female, and 112 (42.9%) were male, with a median age of 7.0 years (range, 1 month to 16 years) and a mean COHb level 16.9% (SD, 7.8%). Two hundred eighteen patients (83.5%) had a COHb between 5% and 25% on presentation, whereas the remaining 43 patients (16.5%) had a presenting COHb of greater than 25%. Neurologic symptoms such as headache, syncope, seizures, and confusion were encountered more frequently in the COHb greater than 25% group compared with the group with 5% to 25% COHb levels, with adolescents having more severe symptoms than do younger patients. CONCLUSIONS: In this study, we managed to demonstrate the presence of more severe symptoms in patients with a COHb level of 25% or greater. Further analysis revealed that severe symptoms were more pronounced in adolescents and that the severity of symptoms increased with age.
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Intoxicação por Monóxido de Carbono/complicações , Carboxihemoglobina/análise , Adolescente , Fatores Etários , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/diagnóstico , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Cefaleia/etiologia , Humanos , Lactente , Masculino , Náusea/etiologia , Convulsões/etiologia , Índice de Gravidade de Doença , Síncope/etiologiaRESUMO
Hydrogen peroxide solutions are often used in daily life as a household disinfectant and in cosmetic products and are therefore a common source of intentional poisonings, especially for children. When ingested in small amounts, it may cause severe central nervous system damage as a result of arterial emboli like our case. The benefit of hyperbaric oxygen treatment in this situation is known, but the neurologic deficits of our case did not improve with this method and finally brain death occurred. This is may be related by the timing of treatment after the event. We would like to emphasize that every clinician must be aware of the dangers of hydrogen peroxide ingestion and hyperbaric oxygen treatment may be of benefit if it is performed immediately.
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Morte Encefálica/diagnóstico , Peróxido de Hidrogênio/intoxicação , Pré-Escolar , Ingestão de Alimentos , Evolução Fatal , Feminino , HumanosRESUMO
Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia. Neuroradiological imaging showed left caudate, putaminal and posterior insular ischaemic infarct secondary to complete occlusion of the left ICA and accompanying partial left middle cerebral artery occlusion. He was treated with anticoagulant and anti-aggregant agents. Rarely, minor head trauma can result in internal carotid artery dissection, thrombus formation and arterial occlusion, leading to arterial ischaemic stroke. Prompt diagnosis and management are crucial to achieve a good neurological outcome.Abbreviations: AIS: arterial ischaemic stroke; ANA: anti-nuclear antibody; APA: anti-phospholipid antibody; APTT: activated partial thromboplastin time; CAD: carotid artery dissection; CCAD: cranio-cervical artery dissection; CRP: C-reactive protein; CT: computed tomography; CTA: computed tomography angiography; dsDNA: double-stranded DNA; ESR: erythrocyte sedimentation rate; ICA: internal carotid artery; LA: lupus anticoagulant; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; MTHFR: methylenetetrahydrofolate reductase; PT INR: prothrombin time international normalised ratio.
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Isquemia Encefálica , Traumatismos Craniocerebrais , AVC Isquêmico , Acidente Vascular Cerebral , Trombofilia , Masculino , Criança , Humanos , Adolescente , Isquemia Encefálica/complicações , Acidente Vascular Cerebral/etiologia , Artéria Carótida Interna , Angiografia por Ressonância Magnética , Traumatismos Craniocerebrais/complicações , AVC Isquêmico/complicações , Trombofilia/complicaçõesRESUMO
OBJECTIVE: This study was conducted to reveal the characteristics of pediatric emergency revisits of children with COVID-19 and the factors associated with clinical worsening and hospitalization at the revisit. MATERIALS AND METHODS: In pediatric emergency visits of children between July 2020 and March 2021 with COVID-19, the patients who had a revisit within 7 days were included in the study. Demographic and clinical characteristics, test results, and the relationship of these variables with clinical worsening and hospitalization at the revisit were investigated. RESULTS: In 6779 children with COVID-19, 284 (4.1%) patients included in the study. 51.8% of the patients were male, the median age was 11.1 years, and median time to revisit time was 2.0 days. The rates of clinical worsening and hospitalization were 9.1% and 14.7%, respectively. Children younger than 24 months and those with chronic diseases were more commonly hospitalized at the revisit. Though the frequency of laboratory and radiologic testing at the revisit was significantly increased compared to the first presentation, tests did not play an important role in the decision-making processes. More than 85% of patients were clinically mild at the first presentation and revisit. CONCLUSIONS: Children with a diagnosis of COVID-19 can revisit the emergency without evident clinical worsening. Since revisits cause increase in frequency of laboratory and radiological testing, preventing unnecessary revisits of children with COVID-19 can reduce the workload and cost of health care services. We may consider changing our perspective on revisit patients to make decisions based on clinical findings instead of obtaining for more laboratory tests.
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COVID-19 , Readmissão do Paciente , Criança , Humanos , Masculino , Feminino , Serviço Hospitalar de Emergência , Hospitalização , Estudos RetrospectivosRESUMO
BACKGROUND: The data on the indirect protection of children via the coronavirus disease 2019 (COVID-19) vaccination of household members are insufficient, and analyses to evaluate the efficacy of COVID-19 vaccines are limited. METHODS: We gathered data on 12,442 patients under the age of 18 regarding the vaccination status of their household members, their vaccine preferences and doses, and their previous history of COVID-19 infection immediately before the patients were administered a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between September 1, 2021 and December 5, 2021. RESULTS: A total of 18.4% (2289) were vaccinated, 91.4% with BNT162b2mRNA vaccine, 8.6% with inactivated COVID-19 vaccine; 48.7% received a single dose, and 51.3% had 2 doses. Real-time RT-PCR positivity proportions were much higher in older children ( P < 0.001) and were higher in children 12 years of age and older [odds ratio (OR), 1.34; 95% confidence interval (CI): 1.21-1.47] compared with others. SARS-CoV-2 infection was significantly lower in the vaccinated group (fully and incompletely) ( P < 0.001). Unvaccinated (OR, 4.88; 95% CI: 3.77-6.13) and incompletely vaccinated children (OR, 1.83; 95% CI: 1.52-2.12) had a higher risk of COVID-19 infection compared with fully vaccinated patients No significant association was found between the COVID-19 real-time RT-PCR positivity rates of patients and the vaccination status or vaccine preferences of household members ( P > 0.05 each). CONCLUSIONS: SARS-CoV-2 infection rates were significantly lower in vaccinated children, especially with mRNA vaccines. The indirect protection of unvaccinated children via the vaccination of household members against COVID-19 seems inadequate. The individual vaccination of children remains crucial.
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Vacinas contra COVID-19 , COVID-19 , Pais , Vacinação , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Criança , Humanos , SARS-CoV-2 , Vacinação/estatística & dados numéricosRESUMO
[This corrects the article DOI: 10.1055/s-0041-1735493.].
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Coronavirus disease 2019 (COVID-19) is now a global pandemic. The aim of this study was to investigate the prevalence of COVID-19 in pediatric patients and to compare the characteristics of positive and negative patients. This study conducted from March to May 2020 in a tertiary children's hospital. Patients were included if they were under 18 years old and a SARS-CoV-2 polymerase chain reaction test had been performed. Of the 1,812 patients included in the study, 365 (20.1%) were positive for COVID-19. The median age was 102 months in the positive group, 70 months in the negative group ( p < 0.001). The sex distribution was almost equal. Nearly all positive patients had been in close contact with a COVID-19 infected family household member ( p < 0.001). The most common symptoms were fever (54.4%) and cough (38.6%). The asymptomatic patient rate was higher in the positive group ( p < 0.001). Lymphopenia (<1500/mm 3 ) was found in 29.9% of the positive children ( p = 0.005). When the groups were compared, white blood cell, neutrophil, lymphocyte, and platelet counts; neutrophil-to-lymphocyte ratio; and C-reactive protein level were lower in the positive group. Chest radiography was performed in 95.3% of the positive patients, and the results of 29.7% of them were interpreted as pathological ( p < 0.001). Most of the pediatric patients had a history of contact with COVID-19 positive individuals, and therefore, the diagnosis is generally suspected from a history of household exposure to COVID-19. Lymphopenia can help predict positivity. Awareness, reinforcing infection control measures, and performing health management within families are important steps to manage these patients.
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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.
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Epistaxe , Lágrimas , Adolescente , Criança , Feminino , HumanosRESUMO
Positive parent-child interaction, in particular bond between mother and child, is important for the mental and behavioral development of children. The aim of this study was to evaluate both mother-child interactions as well as the developmental status of children admitted to the pediatric emergency department with accidental poisoning using Parenting Interactions with Children: Checklist of Observations Linked to Outcomes tool (PICCOLO) and Denver Developmental Screening Test-II (DDST-II). Children between ages 1 to 5 years who were admitted to the emergency department with accidental poisoning were included in the study alongside a control group selected from healthy volunteers. A ten-minute video recording was obtained both for the case and control groups, while the mother and her child played together in a separate room. The interaction of mother-infant pair was assessed using the PICCOLO tool. The children`s development was examined using the DDST-II. The video recordings of 115 children (n=65 in the case group and n=50 in the control group) were evaluated. A high score of PICCOLO-teaching domain (≥9 points) was associated with a 3.3-fold increase in terms of risk of poisoning [p < 0.05, at 95% confidence interval (CI) of 1.34-8.37]. Multivariable analysis revealed that the PICCOLO-teaching domain was a significant factor. A high proportion of cases had either abnormal or questionable DDST-II scores (p < 0.05). In order to improve the bond between mother and child, drug poisoning prevention training must be meticulously provided to both mothers and children alike. Developmental assessments of these children as a holistic approach also should not be forgotten.
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Venenos , Desenvolvimento Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Relações Mãe-Filho , Mães , Relações Pais-FilhoRESUMO
Background: Acute bronchiolitis is one of the most common diseases of early childhood. There are many recent changes in the treatment of acute bronchiolitis. The aim of this study is to evaluate treatment approaches to acute bronchiolitis among clinicians and to observe compliance with clinical guidelines. Materials and Methods: Our study was designed as a multicenter cross-sectional descriptive study. A cohort of pediatric residents, fellows, and attendants were surveyed with a questionnaire including general and occupational characteristics of pediatricians and treatment choices in acute bronchiolitis. Results: A total of 713 questionnaires were collected. Most commonly applied treatment among pediatricians was inhaled salbutamol, followed by intravenous hydration, hypertonic saline, and inhaled steroid. Most commonly preferred treatment in the management of mild bronchiolitis was oral hydration and inhaled salbutamol in severe bronchiolitis. Conclusion: Although recent guidelines for the treatment of acute bronchiolitis does not support the use of many different therapies, pediatricians still tend to use them, especially bronchodilators, corticosteroids, and antibiotics.
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The relationship between the possible factors affecting pubertal onset and pubertal timing was investigated in the Denizli province in Turkey. A total number of 3311 subjects (1562 girls, 1749 boys) aged 6-16.5 years participated in this study. Body mass index (BMI) was calculated. Pubertal stages were assessed according to methods of Marshall and Tanner. Testicular volume was determined using Prader orchidometer. Menarcheal age was recorded. All parents and students completed different questionnaires on demographic variables affecting pubertal timing such as socioeconomic conditions, psychosocial factors, exercise, nutritional status, chronic diseases, migration and birth weight. Using distribution percentiles of pubertal stages according to age, the relation between pubertal timing and factors affecting puberty was investigated. There was no significant association between exercise, birth weight, migration, chronic disease, and socioeconomic status and age of puberty onset. Menarcheal age of overweight and obese girls was significantly lower than that of girls with normal weight. In-family stress was the cause of early puberty in girls and of delayed puberty in boys.
Assuntos
Puberdade , Adolescente , Índice de Massa Corporal , Criança , Doença Crônica , Estudos Transversais , Exercício Físico , Feminino , Humanos , Masculino , Estado Nutricional , Puberdade/fisiologia , Classe Social , TurquiaRESUMO
AIM: To investigate the pubertal development of Turkish school children, to look for possible secular trends in pubertal development. METHODS: 1,562 girls and 1,749 boys (aged 6-16.5 years) from urban and rural schools were studied. Weight and height were measured and body mass index was calculated. Pubertal stages were assessed according to Tanner. Testicular volume was determined using an orchidometer. Menarcheal age was recorded. RESULTS: In girls, mean ages at breast stage (B) were 7.74 +/- 1.08 years for B1, 10.16 +/- 0.97 for B2, 11.72 +/- 1.29 for B3, 12.97 +/- 1.17 for B4, and 13.66 +/- 0.89 for B5. Mean ages at pubic hair stage (PH) were 8.72 +/- 1.50 years for PH1, 10.57 +/- 1.39 for PH2, 12.12 +/- 1.10 for PH3, 13.10 +/- 1.04 for PH4, and 13.87 +/- 0.83 for PH5. Mean age at menarche was 12.41 years. Menarcheal age was earlier in overweight and obese children compared with that in normal children. In boys, mean ages at each maturity stage according to testis volume (G) were 8.70 +/- 1.38 years for G1, 11.76 +/- 1.28 for G2, 12.81 +/- 1.0 for G3, 13.17 +/- 0.87 for G4, and 13.87 +/- 0.98 for G5. Mean ages at PH in boys were 9.39 +/- 1.81 years for PH1, 12.02 +/- 1.33 for PH2, 13.05 +/- 0.88 for PH3, 13.42 +/- 0.87 for PH4, and 14.02 +/- 0.92 for PH5. CONCLUSIONS: The current study provides an up-to-date reference of normal sexual maturation of Turkish children. While the mean age at onset of puberty in boys was comparable to that of other populations in the world, girls were found to start pubertal development earlier than in other populations.