The Importance of Neutrophil/Lymphocyte and Lymphocyte/Monocyte Ratios in The Diagnosis of Influenza in Children.

BACKGROUND: We aimed to analyze the neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR) to investigate their value in supporting the diagnosis of influenza in cases with influenza-like symptoms. METHODS: A total of 5,693 pediatric patients who applied to the Pediatric Clinic between January 2015 and December 2018 were included in the study. Complete blood count and influenza rapid antigen tests were evaluated at the time of admission. RESULTS: The mean LMR was significantly lower in patients with influenza A than non-influenza A patients (p < 0.001). LMR was also significantly lower in those with influenza A or B compared to those in the influenza-negative group (p < 0.001). There was no significant difference (p = 0.83) in terms of the mean LMR between influenza B positive and negative patients. The mean NLR was significantly higher in influenza A positive patients in comparison with influenza A negative patients (p < 0.001), and it was significantly lower in influenza B positive patients than in influenza B negative patients (p < 0.001). CONCLUSIONS: We concluded that LMR and NLR, which had been rarely examined in the literature, had important value in the diagnosis of influenza. However, these values alone were far from being sufficient for the definitive diagnosis of influenza.

Clinical and Laboratory Comparison of Covid-19 and Influenza A/B in Children.

BACKGROUND: The clinical picture of COVID-19 shows significant similarity with influenza. In this study, it was aimed to compare the clinical and laboratory findings between pediatric patients diagnosed with COVID-19 and those with influenza A or B, and to obtain data on the differential diagnosis of COVID-19 from influenza in children. METHODS: The study included 104 patients with COVID-19, 140 patients with influenza A and 135 patients with in-fluenza B (379 patients in total) who were admitted to our tertiary hospital with symptoms of acute respiratory tract infection. RESULTS: Fever, cough, runny nose, and pharyngeal hyperemia rates were significantly lower in patients with COVID-19 than in those with influenza A/B. The highest leukocytosis and lymphocytosis rates were seen in influenza A patients. Eosinophil levels were found significantly lower in the influenza A/B patients compared to the COVID-19 group. C-reactive protein levels were significantly higher in the influenza A/B group when compared with the COVID-19 group. The mean PDW value was significantly higher in the COVID-19 patients compared to influenza A/B. CONCLUSIONS: Our study data show that low body temperature and loss of taste and smell support the diagnosis of COVID-19, and fever, cough, pharyngeal hyperemia, and runny nose support the diagnosis of influenza. While leukocytosis and increased C-reactive protein suggest influenza, high PDW and eosinophil levels support COVID-19.

The relationship of argyrophilic proteins of the nuclear-organized regions and atopic dermatitis in children.

BACKGROUND: The argyrophilic proteins of nuclear-organized regions (AgNOR), visualised with colloidal silver methods as black dots are known as AgNOR. To date, the relationship between AgNOR and cancer and inflammatory conditions has been investigated. However, there has been no report investigating the relationship between AgNOR and atopic dermatitis. The aim of this study was to investigate the relationship between atopic dermatitis and AgNOR in paediatric patients. METHODS: Twenty-nine children with atopic dermatitis and 23 healthy children were included in the study. AgNOR test results were analysed prospectively. RESULTS: The mean AgNOR number (40.19 ± 21.06) in the patient group was significantly higher than the control group (12.83 ± 10.40) (P < .001). CONCLUSIONS: This study investigated the association between AgNOR and atopic dermatitis for the first time in the literature. In the study, atopic dermatitis and AgNOR were found to be related. In the study, for the first time with the ROC analysis, AgNOR limit values with high sensitivity and specificity levels were determined in the diagnosis of atopic dermatitis.

Late presenting Bochdalek hernia with gastric perforation.

Late-onset congenital diaphragmatic hernias that give symptoms beyond the neonatal period are rare and are difficult to diagnose. The diagnosis is usually made in case of complications such as intestinal obstruction, strangulation, and perforation, which further necessitate immediate surgical repair. The case of a 5-year-old child presenting with acute respiratory distress with gastric strangulation and perforation secondary to Bochdalek hernia is reported here. Although presentation in the latter ages is less common, congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in children. Symptoms and diagnostic tools should truly be interpreted. Gastrointestinal complications must urgently be recognized, and early surgical intervention must be performed.

The prevalence of goiter and hypothyroidism among school children 6 years after introduction of a mandatory salt iodination program in a severely iodine-deficient area of the West Black Sea region of Turkey.

The objective of the current study was to determine the prevalence and the degree of iodine deficiency after mandatory salt iodization in Yigilca's school-aged children. A total of 806 school children aged 6-19 years were evaluated. The prevalence of goiter in children aged 6-12 and 13-19 years was 20.3 and 23.8%, respectively. The prevalence of hypothyroidism in children aged 6-12 and 13-19 years was 10.4 and 18.9%, respectively. The median serum free tetraiodothyronine (fT4) levels in children aged 6-12 and 13-19-years were 1.16 ng/dL and 0.91 ng/dL, respectively. The median urinary iodine concentration levels in children aged 6-12 and 13-19 years were 83 µg/l and 78 µg/l, respectively. The frequency of autoimmune thyroid disease was 2.1% in Yigilca's SAC. Goiter and iodine deficiency problems remain in rural areas of the West Black Sea Region of Turkey.

A case of bronchogenic cyst mimicking foreign body aspiration.

Bronchogenic cysts (BCs) can be life threatening if they compress vital structures in infants and small children. In particular, subcarinal cysts can be life-threatening and compromise the airways. In infants, the initial presentation may be respiratory distress. We report a case of mediastinal cystic mass compressing the main left bronchus. The case was an 18-month-old boy who had been admitted with acute respiratory distress. Chest x-ray showed overdistension of the left lung and a mediastinal shift. Foreign body aspiration was diagnosed. Magnetic resonance imaging was performed, which has shown a mediastinal cystic mass; therefore, the patient underwent thoracotomy. Surgical intervention revealed a subcarinal extrapulmonary BC that compresses the left main bronchus. The diagnosis of BC was confirmed with pathological investigation. In this report, we present a case of BC with the emphasis on the differential diagnosis with foreign body aspiration.

Allergic contact dermatitis to para-phenylenediamine in a tattoo: a case report.

It is highly popular among children and young adults to have temporary henna tattoos on their bodies in different colors and figures. Henna is a greenish natural powder obtained from the flowers and dry leaves of Lawsonia alba plant and its allergenicity is very low. Henna is also used in combination with other coloring substances such as para-phenylenediamine in order to darken the color and create a permanent tattoo effect. Para-phenylenediamine is a substance with high allergenicity potential and may cause serious allergic reactions. Here, we aimed to draw attention to the potential harms of para-phenylenediamine containing temporary tattoos by presenting a child patient who developed allergic contact dermatitis after having a scorpion-shaped temporary tattoo on his forearm.

Do gastrointestinal and respiratory signs and symptoms correlate with the severity of gastroesophageal reflux?

BACKGROUND: Gastroesophageal reflux (GER) is a disorder that is common by seen in childhood and may lead to severe complications. In this study, we ascertained the incidence of GER among the children who had typical and atypical complaints of GER and whether there was a difference between two groups comparing the findings of 24-hour pH-meter. METHODS: 39 out of 70 patients with typical and atypical GER symptoms were diagnosed as GER by 24-hour pH-meter monitoring. The patients were divided into three groups, those having gastrointestinal complaints, those having respiratory complaints and those having both gastrointestinal and respiratory symptoms. RESULTS: Evaluated the GER prevalence in these groups, it was found to be 60% in the gastrointestinal group, 48.6% in the respiratory group and 75% in the mixed group. When pH-meter measurements of GER positive patients were compared within the clinical groups, the fraction of time that pH was lower than 4 was found to be significantly higher in the mixed group (p = 0.004). CONCLUSIONS: The coexistence of gastrointestinal and respiratory symptoms in the patients with GER may be related to the severe reflux.

Retrospective clinical and laboratory evaluation of children with brucellosis.

BACKGROUND: Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented. METHODS: Data for 147 patients, aged 2-16 years, were evaluated retrospectively. RESULTS: The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia. CONCLUSION: Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.

Low-grade osteomyelitis of the fifth metatarsal with possible concomitant Freiberg's disease of the metatarsal head.

Freiberg's disease, metatarsal avascular necrosis, is most often seen in healthy athletic adolescent girls. Presenting symptoms include vague pain, swelling, and loss of motion in the involved metatarsophalangeal joints. Low-grade osteomyelitis often is difficult to identify. In this case report, we present a 14-year-old girl with low-grade osteomyelitis of the fifth metatarsal accompanied by possible Freiberg's disease in the same metatarsal.

The evaluation of children with monosymptomatic nocturnal enuresis for attention deficit and hyperactivity disorder.

OBJECTIVE: Monosymptomatic nocturnal enuresis (MNE) and attention deficit and hyperactivity disorder (ADHD) are multifactorial disorders and biological, social, and psychological factors may play significant roles in the development of both. Children with enuresis display a higher prevalence of ADHD compared to the normal population. This study aimed to evaluate the relationship between MNE and ADHD. METHODS: A total of 64 children between the ages of 6 and 13 years who were referred due to primary MNE, their parents, and 42 healthy control cases, were evaluated in terms of attention deficit and hyperactivity by a child psychiatrist using the DSM-IV-2000-TR diagnosic scale. RESULTS: Of the children with enuresis, 17 had predominantly inattentive type (26.6%), nine had predominantly hyperactive-impulsive type (14.1%), and eight had combined type (12.5%). In the control group, two cases had predominantly inattentive type (4.8%), two cases had predominantly hyperactive-impulsive type (4.8%), and one had combined type (2.4%). CONCLUSIONS: The prevalence of ADHD is higher in children with MNE compared to the normal population. As attention deficit may also negatively effect the treatment of enuresis, children with MNE should be evaluated in terms of attention deficit and those with positive symptoms should be provided with psychosocial support.

Does maternal diet affect infantile colic?

OBJECTIVE: The aim of this study was to investigate the effect of maternal diet on infantile colic without any interventions or food restrictions. METHODS: Thirty colicky and 29 non-colicky infants were included in this prospective study. Mother's diet and baby crying time were recorded for 1 week by mothers; nutritionist classified contents of mother's diet and compared the diet of mother in colicky and non-colicky infants. RESULTS: It was found that mothers of non-colicky infants consumed significantly more grapes and lemons than mothers of colicky infants (p = 0.044). The crying time was moderately negatively correlated with the percentage of protein in the maternal diet (R = -0.45, p = 0.01) and the presence of potatoes in the maternal diet (R = -0.38, p = 0.034) and positively correlated with the maternal consumption of walnut (R = 0.38, p = 0.034), banana (R = 0.44, p = 0.01). CONCLUSIONS: Removing bananas from the maternal diet may reduce colic. The consumption of a protein-rich maternal diet, grapes, lemons and potatoes by breastfeeding mothers may protect infants from colic.

An easy technique for removal of knotted catheter in the bladder: percutaneous suprapubic cystoscopic intervention.

Uncontaminated urine samples are indispensable to precisely diagnose urinary tract infections in new-borns or infants. Among many clinical interventions for urine collection are described, the most common noninvasive practice is using sterile bags, associated with significant contamination of samples. In children, however, invasive methods i.e. catheterization, are generally needed for reliable urine specimens. Almost always all the inserted catheters are easily drawn back, nevertheless, might not work as expected, and lead to considerable problems that cannot be overcome. Herein, a case of a female newborn treated with a successful percutaneous suprapubic cystoscopic procedure for extracting knotted urinary catheter in the bladder is presented. The least invasive and easiest technic is suggested to be used when catheter is knotted in the bladder, as elaborately stated.

Determination of underlying causes in asymptomatic, early-stage renal diseases by dipstick test.

AIM: To prevent possible chronic kidney diseases in healthy school- age children by screening for hematuria and proteinuria using a urine strip. METHODS: The incidence of hematuria and proteinuria was determined in 1848 healthy school-age children aged 7 to 14 years by urine screening in the eastern region of Turkey in 2008. Cases with persistent hematuria and/or proteinuria were referred to a pediatric nephrologist, and further examinations were carried out. RESULTS: Isolated hematuria, isolated proteinuria, and combined hematuria-proteinuria were found in 92 (4.9%), 16 (0.8%) and 10 (0.5%) patients, respectively. In addition, 11.9% (11/92) of cases of isolated hematuria and 40% (4/10) of cases of combined hematuria- proteinuria were observed to have persisted. Persistent hematuria and persistent hematuria-proteinuria were found in 11 (0.5%) and 4 (0.2%) patients, respectively. In these cases, underlying causes were found: renal stone disease, hypercalciuria, urinary tract infection, vesicoureteral reflux, atrophic kidney, and IgA nephropathy. CONCLUSION: According to this study, cases with persistent hematuria should be examined especially in terms of renal stones, hypercalciuria, and urinary tract infection.

Sedoanalgesia in pediatric daily surgery.

PURPOSE: The present report was focused on clinical advantages of sedoanalgesia in the pediatric outpatient surgical cases. METHOD: Sedoanalgesia has been used to sedate patients for a variety of pediatric procedures in our department between 2007 and 2010. This is a retrospective review of 2720 pediatric patients given ketamine for sedation with midazolam premedication. Ketamine was given intravenously (1-2 mg/kg) together with atropine (0.02 mg/kg) and midazolam (0.1 mg/kg) + a local infiltration anesthetic 2 mg/kg 0.5% bupivacaine hydrochloride. RESULT: Median age of the patients included in the study was 5.76 ± 2.12 (0-16 years). The main indications for ketamine include circumcision (69%), inguinal pathologies (inguinal hernia (17%), orchidopexy (2.68%), hydrocele (3.38%), hypospadias (1.94%), urethral fistula repair (0.33%), urethral dilatation (0.25%), and other conditions. All of our patients were discharged home well. In this regard, we have the largest group of patients ever given ketamine. CONCLUSION: Sedoanalgesia might be used as a quite effective method for daily surgical procedures in children.

H1N1 influenza A virus Related Pneumonia and Respiratory Failure.

Influenza viruses are common respiratory pathogens in humans and can cause serious infection that leads to the development of pneumonia. In this study, the clinical and laboratory features of 36 patients from Turkey who are hospitalized in intensive care unit due to pandemic influenza A (H1N1) associated pneumonia and respiratory failure were retrospectively evaluated. The most common symptoms were cough and fever. Consolidation (36.1 %) and interstitial changes (30.6 %) were the most frequently identified findings on chest radiographs at the time of admission. Six of the patients (16.7 %) died. Mortality occurred in 3 of 13 patients (23.1 %) with underlying disease, whilst it occurred in only 3 of 23 patients (13 %) who were previously healthy. Mortality was found to be significantly associated only with an elevated lactate dehydrogenase level. A significant relationship was determined only between the presence of lymphopenia and acute respiratory distress syndrome and the need for intensive care treatment. The average time elapsed from the onset of the symptoms until admission was 8.67 ± 2.87 days for the patients died, and 6.0 ± 3.8 days for the patients survived.