Evaluation of pediatric trauma score and pediatric age-adjusted shock index in pediatric patients admitted to the hospital after an earthquake.

BACKGROUND: In our earthquake-prone country, it is crucial to gather data from regional hospitals following earthquakes. This information is essential for preparing for future disasters and enhancing healthcare services for those affected by earthquakes. This study aimed to evaluate the Pediatric Trauma Score (PTS) and the Shock Index, Pediatric Age-Adjusted (SIPA), in children affected by earthquakes, to provide clinicians with insights into the severity of trauma and hemodynamic stability. METHODS: The study included patients admitted to our hospital's pediatric emergency service within the three weeks following the earthquake. We evaluated their age, sex, admission vital signs, mechanical ventilation requirements, development of crush syndrome, length of hospital stay, PTS, and SIPA. RESULTS: Our study included 176 children (89 females and 87 males) with trauma. Fifty-eight (32.95%) children had crush syndrome, and 87 (49.43%) were hospitalized. The median PTS was 10 (ranging from -3 to 12), and the median SIPA was 1.00 (ranging from 0.57 to 2.10). We observed a negative correlation between the time spent under debris and PTS (r=-0.228, p=0.002) and a positive correlation with the SIPA score (r=0.268, p<0.001). The time spent under debris (p<0.001) and SIPA score (p<0.001) were significantly higher in hospitalized children. PTS was significantly lower in hospitalized children than in others. A PTS cutoff point of 7.5, and a SIPA cutoff point of 1.05, predicted hospitalization in all children. Time spent under debris and SIPA were significantly higher in children with crush syndrome than in others (p<0.001). PTS at a cutoff point of 8.5 and SIPA at a cutoff point of 1.05 predicted crush syndrome in all children. CONCLUSION: PTS and SIPA are important practical scoring systems that can be used to predict the severity of trauma, hospitalization, crush syndrome, and the clinical course in pediatric patients admitted to the hospital due to earthquake trauma.

Clinical characteristics of firearm-related injuries in children in Turkey.

BACKGROUND: A significant number of children are injured by or die from firearm-related incidents every year, although there is a lack of global data on the number of children admitted to pediatric emergency departments (PEDs) and pediatric intensive care units (PICU) with firearm injuries. This study is the most comprehensive analysis of firearm injuries sustained by children in Turkey to date. METHODS: This multicenter, retrospective, cohort study was conducted between 2010 and 2020 with the contributions of the PEDs, PICUs, intensive care units, and surgery departments of university hospitals and research hospitals. RESULTS: A total of 508 children were admitted to hospital with firearm-related injuries in the research period, although the medical records of only 489 could be obtained. Of the total admissions to hospitals, 55.0% were identified as unintentional, 8.2% as homicide, 4.5% as self-harm, and 32.3% as undetermined. The Glasgow Coma Scale (GCS) and ventilation support were found to be the most significant predictors of mortality, while head/neck injury, length of stay (LOS) in the hospital and surgical interventions were found to be the most significant predictors of disability. The overall mortality of firearm-related injuries was 6.3%, and the mortality for children admitted to the PICU was 19.8%. The probability of disability was calculated as 96.0% for children hospitalized with firearm injuries for longer than 75 days. CONCLUSIONS: Head/neck injury, LOS in the hospital, and surgical interventions were found to be the most significant parameters for the prediction of disability. Hospitalization exceeding 6 days was found to be related to disability.

A Case of Astasia-Abasia as Early Onset Conversion Disorder Triggered by Psychosocial Stress Factors. / Psikososyal Stres Faktörleriyle Tetiklenen Erken Baslangiçli Konversiyon Bozuklugu Olarak Astazi-Abazi Olgusu.

Conversion disorder is defined as the loss or change of motor, sensory, and autonomic nervous system-related functions that cannot be explained completely with organic causes. The etiology of the disease may be explained by psychoanalytic theory, learning theory, sociocultural factors, and some traumatic life events besides genetic and neurobiological factors. The onset is usually between late childhood and early adulthood. The disorder occurs after a high rate of psychosocial stressors and the symptoms can vary. While astasia, as one of the possible complaints in conversion disorder, is defined as not being able to stand due to loss of motor power or sensory loss; abasia is identified as patients having no apparent motor problem but not being able to walk properly. Both conditions can be of organic as well as the psychogenic origin. In this paper, the clinical signs of a seven-year-old boy who was admitted to emergency service of Mersin University Faculty of Medicine with the complaints of astasia and abasia but was found to have conversion disorder is presented. The results of the medical examinations and the possible psychosocial stress factors behind these symptoms, as well as the treatment process of the case, were shared. With this report, we is aimed to draw attention to the importance of early diagnosis of the disorder, the necessity of an interdisciplinary approach in the treatment process, and the handling of psychosocial factors leading to somatic symptoms.

The role of immature granulocyte percentage in predicting acute chest syndrome and the severity of the vaso-occlusive crisis in sickle cell disease.

BACKGROUND: Sickle cell disease (SCD) is an inflammatory disease that can result in both chronic and acute inflammation. Immature granulocytes (IG) are not-yet-mature white blood cells that can be easily detected in complete blood count (CBC) tests. In recent studies it has been suggested that IG may play a role in determining the prognosis of inflammatory diseases. The aim of our study was to investigate the role of IG percentage on predicting acute chest syndrome (ACS) and the severity of vaso-occlusive crisis (VOC) in patients with SCD. METHODS: The study cohort consisted of 49 SCD patients admitted to the emergency department for VOC. If symptoms did not regress despite appropriate treatment including hydration and analgesia, they were hospitalized. Patients whose symptoms regressed were discharged from the emergency department within 24 hours. Blood samples, including CBC and C-reactive protein (CRP), a marker of inflammation, were taken within the first hour of admission. Steady state laboratory parameters from the previous visit in the last three months were collected from patient files. RESULTS: The mean age was 18±4 (range 8-25) years. Most were hospitalized (41/49; 83.7%) and 8 of 49 were discharged from the emergency department after their treatment for VOC. ACS developed in 13 of 49 (26.5%). White blood cell, neutrophil and nucleated red blood cell counts, percentage of IG (IG%) and CRP levels were significantly increased in patients with VOC. IG% of patients with ACS was significantly higher than patients without ACS. However, ROC analysis showed that IG% was not associated with the development of ACS or hospitalization for VOC. CONCLUSIONS: Despite a small SCD cohort, the significant increase in the IG% in patients with VOC compared to their baseline values has suggested a role for IG% in predicting VOC. Although IG% was higher in ACS, its utility in predicting ACS was poor.

Posterior reversible encephalopathy syndrome (PRES) due to acute hypertension in children: 12 years single-center experience.

The objective of the study is to evaluate the clinical and neuroradiological findings, the risk factors for recurrence and the prognosis in patients with posterior reversible encephalopathy syndrome developed secondary to acute hypertension in children. The study was conducted between 2008 and 2019 at Mersin University Faculty of Medicine. A total of 49 episodes were evaluated retrospectively in 38 patients with PRES secondary to acute hypertension. The demographic data, etiology, and clinical and neuroradiological findings were recorded. Twenty-one (55.3%) patients were female; the mean age was 11.8 years. The etiology of acute hypertension in 29 (76.3%) patients was end-stage renal disease (ESRD). The most common clinical findings were seizure (81.6%) and altered consciousness (79.6%). Status epilepticus developed in eight (16.3%) episodes. MRI lesions were atypical in 33 episodes (67.3%). In eight (21%) patients, PRES recurred. Irreversible brain damage was detected after PRES in three (7.8%) patients. C-reactive protein and erythrocyte sedimentation rate were elevated in 82.2% and 71.4% of the episodes, respectively. A statistically significant relationship was found between the recurrence, the duration of hospitalization at the PICU, SE and the occurrence of irreversible lesion (p = 0.013, p = 0.015, p = 0.001 respectively). Also, there were statistically significant relationships between recurrence and ESRD; epilepsy and recurrences; SE and irreversible brain damage (p = 0.02, p = 0.012, p = 0.025 respectively). Although PRES is usually known to have a good prognosis, the mortality and morbidity rates may increase in the long-term follow-up as in our study. In this study, the etiology, the presence of status epilepticus, PICU history, atypical MRI lesions and increased inflammatory markers were found to be important for the prognosis in PRES.

Función del índice de volumen plaquetario medio/linfocitos en el diagnóstico de la apendicitis durante la niñez / Role of mean platelet volume-to-lymphocyte ratio in the diagnosis of childhood appendicitis

Introducción. El índice de volumen plaquetario medio/linfocitos (IVPML) es un parámetro novedoso de inflamación y trombosis. El objetivo fue evaluar si cumple una función en el diagnóstico de la apendicitis pediátrica.Población y métodos. Se revisaron retrospectivamente historias clínicas de pacientes de hasta 18 años con sospecha de apendicitis aguda (AA) sometidos a apendicectomía entre enero de 2016 y diciembre de 2017. Según la evaluación histopatológica, se clasificó a los pacientes en apéndice normal y apendicitis simple y perforante. Se midieron volumen plaquetario medio (VPM), amplitud de distribución plaquetaria (ADP), IVPML, índice de plaquetas/linfocitos (IPL), recuentos de plaquetas y leucocitos, y concentración de proteína C-reactiva (PCR).Resultados. Se revisaron los registros de 219 niños con sospecha de AA sometidos a tratamiento quirúrgico por apendicitis, y se incluyó a 100 niños sanos de la misma edad y sexo. Comparados con los controles, los valores medios de IVPML, IPL, leucocitos y PCR fueron más elevados en los niños con apendicectomía (p < 0,001). Estos valores fueron más elevados en los casos de apendicitis simple que de apéndices normales (p< 0,01). Comparados con la apendicitis simple, estos valores fueron más elevados en los niños con apendicitis perforante (p< 0,001). Las áreas bajo la curva del IVPML e IPL fueron 0,771 y 0,726 en la predicción de apendicitis y 0,693 y 0,722 en la predicción de perforación, respectivamente.Conclusiones. Una concentración elevada de IVPML podría contribuir a diagnosticar la AA pediátrica. Además, puede ayudar a diferenciar la apendicitis simple de la perforante.

Introduction. Mean platelet volume-to-lymphocyte ratio (MPVLR) has emergedas a novel parameter of inflammation andthrombosis. The aim was to evaluate whether MPVLR has a role in the diagnosis ofchildhood appendicitis. Population and methods. Retrospectively reviewed the medical records up to 18 year with suspected acute appendicitis (AA) who underwent appendectomy between January 2016 and December 2017. Based on histopathological evaluation, the patients were classified into normal appendix, and simple and perforated appendicitis. Preoperative mean platelet volume (MPV), platelet distributionwidth (PDW), MPVLR, platelet-to-lymphocyteratio (PLR), counts of platelets and white bloodcells (WBC), and C-reactive protein (CRP) levels were measured. Results. A total of 219 children with clinically suspected AA who underwent surgical treatmentfor appendicitis were reviewed, and 100 gender-age matched healthy subjects were included. Compared with the controls, the mean levels of MPVLR, PLR, WBC and CRP were significantly higher in the children underwent appendectomy (p <0.001). These values were significantly higherin simple appendicitis than in normal appendices (p<0.01). Compared with simple appendicitis,these levels were significantly higher in thechildren with perforated appendicitis (p <0.001). The area under curves for MPVLR and PLR were0.771 and 0.726 in the prediction of appendicitisand 0.693 and 0.722 in the prediction of perforation, respectively. Conclusions. Increased level of MPVLR may bevaluable for aiding the diagnosis of pediatric AA. In addition, it can help discriminate simple and perforated appendicitis in children.

Role of mean platelet volume-to-lymphocyte ratio in the diagnosis of childhood appendicitis. / Función del índice de volumen plaquetario medio/linfocitos en el diagnóstico de la apendicitis durante la niñez.

INTRODUCTION: Mean platelet volume - to -lymphocyte ratio (MPVLR) has emerged as a novel parameter of inflammation and thrombosis. The aim was to evaluate whether MPVLR has a role in the diagnosis of childhood appendicitis. POPULATION AND METHODS: Retrospectively reviewed the medical records up to 18 year with suspected acute appendicitis (AA) who underwent appendectomy between January 2016 and December 2017. Based on histopathological evaluation, the patients were classified into normal appendix, and simple and perforated appendicitis. Preoperative mean platelet volume (MPV), platelet distribution width (PDW), MPVLR, platelet-to-lymphocyte ratio (PLR), counts of platelets and white blood cells (WBC), and C-reactive protein (CRP) levels were measured. RESULTS: A total of 219 children with clinically suspected AA who underwent surgical treatment for appendicitis were reviewed, and 100 genderage matched healthy subjects were included. Compared with the controls, the mean levels of MPVLR, PLR, WBC and CRP were significantly higher in the children underwent appendectomy (p <0.001). These values were significantly higher in simple appendicitis than in normal appendices (p<0.01). Compared with simple appendicitis, these levels were significantly higher in the children with perforated appendicitis (p <0.001). The area under curves for MPVLR and PLR were 0.771 and 0.726 in the prediction of appendicitis and 0.693 and 0.722 in the prediction of perforation, respectively. CONCLUSIONS: Increased level of MPVLR may be valuable for aiding the diagnosis of pediatric AA. In addition , it can help discriminate simple and perforated appendicitis in children.

Introducción. El índice de volumen plaquetario medio/linfocitos (IVPML) es un parámetro novedoso de inflamación y trombosis. El objetivo fue evaluar si cumple una función en el diagnóstico de la apendicitis pediátrica. Población y métodos. Se revisaron retrospectivamente historias clínicas de pacientes de hasta 18 años con sospecha de apendicitis aguda (AA) sometidos a apendicectomía entre enero de 2016 y diciembre de 2017. Según la evaluación histopatológica, se clasificó a los pacientes en apéndice normal y apendicitis simple y perforante. Se midieron volumen plaquetario medio (VPM), amplitud de distribución plaquetaria (ADP), IVPML, índice de plaquetas/linfocitos (IPL), recuentos de plaquetas y leucocitos, y concentración de proteína C-reactiva (PCR). Resultados. Se revisaron los registros de 219 niños con sospecha de AA sometidos a tratamiento quirúrgico por apendicitis, y se incluyó a 100 niños sanos de la misma edad y sexo. Comparados con los controles, los valores medios de IVPML, IPL, leucocitos y PCR fueron más elevados en los niños con apendicectomía (p < 0,001). Estos valores fueron más elevados en los casos de apendicitis simple que de apéndices normales (p < 0,01). Comparados con la apendicitis simple, estos valores fueron más elevados en los niños con apendicitis perforante (p < 0,001). Las áreas bajo la curva del IVPML e IPL fueron 0,771 y 0,726 en la predicción de apendicitis y 0,693 y 0,722 en la predicción de perforación, respectivamente. Conclusiones. Una concentración elevada de IVPML podría contribuir a diagnosticar la AA pediátrica. Además, puede ayudar a diferenciar la apendicitis simple de la perforante.

Evaluation of T-wave alternans in pediatric patients with chronic renal failure.

INTRODUCTION: Microvolt T-wave alternans (TWA) is known to be useful in prediction of ischemia and sudden death in high-risk populations and there are no studies in children with chronic renal failure (CRF). Cardiac problems seem to be responsible for an important part of death in children and young adults with CRF. The aim of this study is to evaluate Holter microvolts TWA measurements in children with CRF comparing to the control group. METHODS: This prospective study included 40 patients with CRF and 48 healthy controls. The history, echocardiography and microvolt TWA values based on 24-hour ECG recordings of the patients were evaluated. Analysis of microvolt TWA was considered on the basis of three leads (V5, V1 and AVF). RESULTS: Compared with the controls, the mean systolic and diastolic blood pressure values and average heart rates were significantly higher in the children with CRF (p = 0.001 and p = 0.026, respectively). Also, the values of left ventricular internal dimensions at end diastole and end-diastolic volume were significantly higher in CRF group (p = 0.01 and p = 0.049, respectively) and couplet ventricular extrasystole was detected in 2 patients with CRF. Consequently, all TWA values in three leads were increased in CRF group than the control group but the only increase in V5 lead was statistically significant (p = 0.028). CONCLUSIONS: This study has demonstrated that microvolt TWA values increased in pediatric patients with CRF. TWA might be used for early risk assessment in pediatric patients with CRF in the future.

Evaluation of renal tumors in children.

OBJECTIVE: Renal tumors are not uncommon in children. In this study, we aimed to evaluate the clinical and pathological features of renal tumors in children. MATERIAL AND METHODS: Between January 2008 and December 2017, the records of children with renal tumors in our institution were retrospectively analyzed. Data collected were composed of demographic and clinical characteristics including gender, age at time of diagnosis, symptoms, laterality of the tumor and pathological evaluation. RESULTS: A total of 48 children with renal tumor (28 males and 20 females) were included in the study. They were diagnosed at mean age of 53.26±46.64 months (range: 1-192) and the mean follow-up period was 73.45±48.92 months (range: 6-120). The most common symptom was a lump or mass in the area of the kidneys (45.8%), abdominal pain and hematuria (14.6%). Four patients (8.3%) were diagnosed at antenatal period. 68.8% of the children had Wilms tumor and the major histological groups of non-Wilms renal tumors were renal cell carcinoma (12.5%), congenital mesoblastic nephroma (10.4%) and angiomyolipoma (4.2%). 10.4% of the children had bilateral tumors and one patients had Wilms tumor with horseshoe kidney. 87.5% of the children were treated with surgery and of those 7 (14.5%) underwent nephron-sparing surgery. The patients had chemotherapy and radiotherapy (83.3% and 41.7%, respectively). Seven patients (14.6%) died during follow-up. CONCLUSION: Wilms tumor is the most common pediatric renal neoplasm. On the other hand, we showed that considerable number of children with renal tumors had non-Wilms tumors including renal cell carcinoma, congenital mesoblastic nephroma and angiomyolipoma.

Relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease.

OBJECTIVES: Recently, mean platelet volume-to-lymphocyte ratio has emerged as a novel parameter of inflammation. No study has investigated the role of mean platelet volume-to-lymphocyte ratio in children with Kawasaki disease. We aimed to evaluate the relationship between mean platelet volume-to-lymphocyte ratio and coronary artery abnormalities in Kawasaki disease. METHODS: Between January 2008 and January 2017, a total of 58 children with Kawasaki disease and 42 healthy subjects matched for sex and age were enrolled. Before the treatment, transthoracic echocardiography for all children was performed. Clinical and laboratory results including mean platelet volume, platelet distribution width, red blood cell distribution width, and counts of platelets, neutrophils, lymphocytes, and white blood cells, erythrocyte sedimentation rate, and C-reactive protein levels were measured. Mean platelet volume-to-lymphocyte ratio was calculated as mean platelet volume divided by lymphocyte count. RESULTS: Compared with healthy controls, mean platelet volume-to-lymphocyte ratio was significantly lower in the children with Kawasaki disease (p<0.01). A total of 14 patients (24.1%) had incomplete Kawasaki disease and 15 (25.8%) children with Kawasaki disease had coronary involvement. Mean platelet volume-to-lymphocyte ratio was significantly lower in patients with coronary artery abnormalities (p<0.01). According to receiver operating characteristic curve analysis performed for the prediction of coronary artery abnormalities, the best cut-off point for mean platelet volume-to-lymphocyte ratio was 2.5 (area under curve=0.593, sensitivity 53.3%, specificity 51.1%). CONCLUSION: It was first shown that the children with Kawasaki disease have lower mean platelet volume-to-lymphocyte ratio compared with control subjects. Mean platelet volume-to-lymphocyte ratio may be helpful in predicting coronary artery lesions in patients with Kawasaki disease.

El valor de proteínas de fase aguda y la prueba LightCycler® SeptiFast en el diagnóstico de infecciones bacterianas y virales en niños / The value of acute phase reactants and LightCycler® SeptiFast test in the diagnosis of bacterial and viral infections in pediatric patients

Introducción. Evaluamos el nivel de reactantes de fase aguda y la prueba LightCycler® SeptiFast para diferenciar infecciones bacterianas vs.virales. Métodos. Estudio prospectivo en niños febriles. Se analizaron recuento de leucocitos, proteína C-reactiva y procalcitonina en días 1, 3 y 7 de hospitalización. El día 1 se realizaron hemocultivo y radiografía de tórax. Se evaluaron dos grupos de niños que presentaron infecciones bacterianas o virales. Resultados. Se incluyeron 94 niños febriles. La temperatura media de la fiebre fue significativamente más alta en niños con infecciones bacterianas que con infecciones virales (p < 0,001). En 34 (72,3%) niños con infecciones bacterianas, el hemocultivo fue negativo. De ellos, 12 (35,2%) presentaron prueba SeptiFast positiva. No hubo resultados positivos en hemocultivos de niños con infecciones virales y todos tuvieron resultado negativo para la prueba SeptiFast. La media de proteína C-reactiva el primer día de hospitalización fue significativamente más alta en el grupo con infecciones bacterianas (p < 0,001) y en los días 3 y 7 junto con la procalcitonina fueron significativamente más altas en niños con infecciones bacterianas (p <0,001). La sensibilidad y especificidad de los leucocitos, la proteína C-reactiva y la procalcitonina fueron 63,8%, 44,7%, 74,5% y 78,7%, 68,1% y 100%, respectivamente. Las áreas bajo la curva de los leucocitos, la proteína C-reactiva y la procalcitonina fueron 0,519, 0,764 y 0,835, respectivamente. Conclusiones. Los reactantes de fase aguda, en especial procalcitonina, y la prueba LightCycler® SeptiFast podrían ayudar a diferenciar infecciones bacterianas de virales.

Introduction: This study was performed to investigate the value of acute phase reactants and LightCycler® SeptiFast test to differentiate bacterial and viral infections. Population and methods: Children with fever were enrolled to this prospective study. Peripheral white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were studied from all patients on day 1, 3 and 7. Blood culture and chest X-ray were also obtained on day 1. Blood samples for LightCycler® SeptiFast test were obtained in all patients to use them if there was uncertain diagnosis between bacterial or viral infection. The patients were divided into two groups as bacterial and viral infection. Results: A total of 94 children with fever were enrolled. The mean value of fever was significantly higher in bacterial group than viral group (p <0.001). In bacterial infection group, 34 (72.3%) patients had negative blood culture. Of those, 12 (35.2%) had positive SeptiFast test. There were no positive blood culture in patients with viral infection group and all of them had negative SeptiFast test. The mean levels of CRP on the first day of admission were significantly higher in bacterial group than viral group (p <0.001). CRP and PCT levels of day 3 and 7 were significantly higher in bacterial group (p <0.001). The sensitivity and specificity levels of WBC, CRP and PCT were 63.8%, 44.7%, 74.5% and 78.7% ,68.1% and 100%, respectively. Conclusions: We found that acute phase reactants, especially PCT, and LightCycler® SeptiFast test may help to differentiate bacterial and viral infections.

The value of acute phase reactants and LightCycler® SeptiFast test in the diagnosis of bacterial and viral infections in pediatric patients. / El valor de proteínas de fase aguda y la prueba LightCycler® SeptiFast en el diagnóstico de infecciones bacterianas y virales en niños.

INTRODUCTION: This study was performed to investigate the value of acute phase reactants and LightCycler® SeptiFast test to differentiate bacterial and viral infections. POPULATION AND METHODS: Children with fever were enrolled to this prospective study. Peripheral white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT) were studied from all patients on day 1, 3 and 7. Blood culture and chest X-ray were also obtained on day 1. Blood samples for LightCycler® SeptiFast test were obtained in all patients to use them if there was uncertain diagnosis between bacterial or viral infection. The patients were divided into two groups as bacterial and viral infection. RESULTS: A total of 94 children with fever were enrolled. The mean value of fever was significantly higher in bacterial group than viral group (p <0.001). In bacterial infection group, 34 (72.3%) patients had negative blood culture. Of those, 12 (35.2%) had positive SeptiFast test. There were no positive blood culture in patients with viral infection group and all of them had negative SeptiFast test. The mean levels of CRP on the first day of admission were significantly higher in bacterial group than viral group (p <0.001). CRP and PCT levels of day 3 and 7 were significantly higher in bacterial group (p <0.001). The sensitivity and specificity levels of WBC, CRP and PCT were 63.8%, 44.7%, 74.5% and 78.7% ,68.1% and 100%, respectively. CONCLUSIONS: We found that acute phase reactants, especially PCT, and LightCycler® SeptiFast test may help to differentiate bacterial and viral infections.

INTRODUCCIÓN: Evaluamos el nivel de reactantes de fase aguda y la prueba LightCycler® SeptiFast para diferenciar infecciones bacterianas vs. irales. MÉTODOS: Estudio prospectivo en niños febriles. Se analizaron recuento de leucocitos, proteína C-reactiva y procalcitonina en días 1, 3 y 7 de hospitalización. El día 1 se realizaron hemocultivo y radiografía de tórax. Se evaluaron dos grupos de niños que presentaron infecciones bacterianas o virales. RESULTADOS: Se incluyeron 94 niños febriles. La temperatura media de la fiebre fue significativamente más alta en niños con infecciones bacterianas que con infecciones virales (p < 0,001). En 34 (72,3%) niños con infecciones bacterianas, el hemocultivo fue negativo. De ellos, 12 (35,2%) presentaron prueba SeptiFast positiva. No hubo resultados positivos en hemocultivos de niños con infecciones virales y todos tuvieron resultado negativo para la prueba SeptiFast. La media de proteína C-reactiva el primer día de hospitalización fue significativamente más alta en el grupo con infecciones bacterianas (p < 0,001) y en los días 3 y 7 junto con la procalcitonina fueron significativamente más altas en niños con infecciones bacterianas (p <0,001). La sensibilidad y especificidad de los leucocitos, la proteína C-reactiva y la procalcitonina fueron 63,8%, 44,7%, 74,5% y 78,7%, 68,1% y 100%, respectivamente. Las áreas bajo la curva de los leucocitos, la proteína C-reactiva y la procalcitonina fueron 0,519, 0,764 y 0,835, respectivamente. CONCLUSIONES: Los reactantes de fase aguda, en especial procalcitonina, y la prueba LightCycler® SeptiFast podrían ayudar a diferenciar infecciones bacterianas de virales.

Can whole-blood parameters be used in follow-up of children with rheumatic valvular heart disease?

OBJECTIVES: The aim of the present study was to investigate the relationships between red blood cell distribution width, platelet distribution width, and mean platelet volume and the presence and severity of valvular involvement in patients with rheumatic heart disease. METHODS: Between April, 2012 and December, 2015, 151 patients who were admitted to the Pediatric Cardiology Unit with diagnosis of rheumatic heart disease and 148 healthy children were included to our study. Transthoracic echocardiography for all children was performed, and the values of red blood cell distribution width, platelet distribution width, and mean platelet volume, besides other blood count parameters, erythrocyte sedimentation rate, and C-reactive protein levels were recorded. RESULTS: Red blood cell distribution width, platelet distribution width, mean platelet volume, and C-reactive protein levels were significantly higher in patients with rheumatic heart disease when compared with healthy controls (p0.05). CONCLUSION: This is the first study in children with rheumatic heart disease that demonstrated significantly increased red blood cell distribution width, platelet distribution width, and mean platelet volume levels, as well as evaluated all three parameters together. Furthermore, red blood cell distribution width values in the chronical period of acute rheumatic fever, due to the positive correlation with the other chronic inflammatory markers, may help make the diagnosis in children.

The prevalence, serogroup distribution and risk factors of meningococcal carriage in adolescents and young adults in Turkey.

The serogroup epidemiology of invasive meningococcal disease (IMD), which varies considerably by geographic region and immunization schedule, changes continuously. Meningococcal carriage data are crucial for assessing IMD epidemiology and designing f potential vaccination strategies. Meningococcal seroepidemiology in Turkey differs from that in other countries: serogroups W and B are the predominant strains for IMD during childhood, whereas no serogroup C cases were identified over the last 10 y and no adolescent peak for IMD was found. There is a lack of data on meningococcal carriage that represents the whole population. The aims of this multicenter study (12 cities in Turkey) were to evaluate the prevalence of Neisseria meningitidis carriage, the serogroup distribution and the related risk factors (educational status, living in a dormitory or student house, being a household contact with Hajj pilgrims, smoking, completion of military service, attending bars/clubs) in 1518 adolescents and young adults aged 10-24 y. The presence of N. meningitidis DNA was tested, and a serogroup analysis was performed using polymerase chain reaction. The overall meningococcal carriage rate was 6.3% (n = 96) in the study population. A serogroup distribution of the 96 N. meningitidis strains isolated from the nasopharyngeal specimens revealed serogroup A in 5 specimens (5.2%), serogroup B in 9 specimens (9.4%), serogroup W in 64 specimens (66.6%), and serogroup Y in 4 specimens (4.2%); 14 were classified as non-grouped (14.4%). No serogroup C cases were detected. The nasopharyngeal meningococcal carriage rate was 5% in the 10-14 age group, 6.4% in the 15-17 age-group, and 4.7% in the 18-20 age group; the highest carriage rate was found in the 21-24 age group (9.1%), which was significantly higher than those of the other age groups (p < 0.05). The highest carriage rate was found in 17-year-old adolescents (11%). The carriage rate was higher among the participants who had had close contact with Hajj/Umrah pilgrims (p < 0.01) or a history of upper respiratory tract infections over the past 3 months (p < 0.05). The nasopharyngeal carriage rate was 6.3% among adolescents and young adults in Turkey and was similar to the recent rates observed in the same age groups in other countries. The most prevalent serogroup was W, and no serogroup C cases were found. In conclusion, the present study found that meningococcal carriage reaches its peak level by age 17, the highest carriage rate was found in 21 - to 24 - year-olds and the majority of the carriage cases were due to serogroup W. Adolescents and young adult carriers seem to be a potential reservoir for the disease, and further immunization strategies, including adolescent immunization, may play a role in the control of IMD.

Serotonin Syndrome after Clomipramine Overdose in a Child.

Serotonin syndrome (SS) is a potentially life-threatening condition associated with increased serotonergic activity in central nervous system and may occur during the use of serotonergic drugs. Although increasing frequency of serotonergic drug use in children, pediatricians, emergency medicine and pediatric intensive care specialists have not enough knowledge and experience about SS that is a potentially life-threatening condition. A 12-year-old girl patient was admitted to our emergency room with the history of involuntary contractions on her extremities and alteration of consciousness. Her physical examination showed agitation, hyperthermia, dilated pupils, tremor, increased deep tendon reflexes, positive spontaneous clonus, agitation, flushed skin and diaphoresis, excessive perspiration, and continuous horizontal ocular movements. The patient diagnosed as SS by clinical history, physical and laboratory findings. In this paper, we will discuss SS occurred in a 12-year-old girl after concurrent clomipramine and risperidone use.

Diagnostic value of red blood cell distribution width in pediatric acute appendicitis.

BACKGROUND: The aim of this study was to evaluate the diagnostic value of red blood cell distribution width (RDW) in children with acute appendicitis. METHODS: In this retrospective study, a total of 344 children aged ≤18 years with clinically suspected acute appendicitis who underwent appendectomy between January 2007 and January 2014 were reviewed, and 200 healthy controls of the same age group were included. Based on histopathology, the patients were classified as having normal appendix, simple or perforated appendicitis, and preoperative white blood cell count (WBC), C-reactive protein (CRP) and RDW were compared. RESULTS: Compared with the controls, mean WBC, CRP and RDW were significantly higher in the appendectomy group (P <0.001). The children with simple or perforated appendicitis had significantly higher WBC, CRP and RDW than did those with normal appendix (P <0.001). Mean WBC and CRP were significantly higher in the children with perforated appendicitis (P <0.001), but no statistically significant difference was found in RDW between the simple and perforated appendicitis groups (P = 0.081). CONCLUSIONS: Children with histologically proven acute appendicitis have higher RDW than children without appendicitis, but the diagnostic value of RDW was not superior to WBC or CRP in children with acute appendicitis. Although higher RDW may be valuable for aiding the diagnosis of acute appendicitis in children, it is not a useful marker for predicting perforated appendicitis.

Evaluation of Neurodevelopment Using Bayley-III in Children with Cyanotic or Hemodynamically Impaired Congenital Heart Disease.

OBJECTIVE: The purpose of this study was to compare neurological development of children with cyanotic or hemodynamically impaired congenital heart disease (CHD) and healthy controls by using "Bayley Scales of Infant and Toddler Development Screening Test, Third Edition" (Bayley-III). PATIENTS: Children with CHD (n = 37) and healthy controls (n = 24) aged between 1 and 41 months who were admitted to the Department of Pediatric Cardiology at our university hospital were included. The participants were assessed using Bayley-III test. All patients had cyanotic or hemodynamically impaired CHD. Weight, height, body mass index (BMI), mid-arm circumference (MAC), triceps skinfold thickness (TSF), and head circumference (HC) were measured and standard deviation scores (SDSs) were determined. RESULTS: SDS values of weight, height, BMI, MAC, and TSF of the patients as well as HC values were significantly lower than the control group (P < .001). Compared with controls, the patients had significantly lower mean scores in all Bayley-III subscales (P < .001). We observed similar results in Bayley-III scores including the mean values of cognitive, language, and global motor scores for the CHD patients with and without cardiac surgery (P > .05). CONCLUSION: This study demonstrated that children with cyanotic or hemodynamically impaired CHD have delayed neurodevelopmental outcomes compared with healthy children as assessed using Bayley-III.

Subacute sclerosing panencephalitis with parkinsonian features in a child: A case report.

BACKGROUND: Subacute sclerosing panencephalitis (SSPE) can present with atypical clinical signs which may result in delayed diagnosis and treatment. We present a child with SSPE whose initial manifestation was parkinsonism. PATIENT: This 12-year-old boy presented with the complaint of difficulty in standing up and walking for 2 months. Neurological examination revealed generalized rigidity, bradykinesia, impaired postural reflexes, and a mask-like facies. The initial diagnosis of Juvenile Parkinson Disease was made. He had no improvement with levodopa, trihexyphenidyl, tetrabenazine and clonazepam. The EEG showed irregular background activity with generalized slow waves which were not suppressed with diazepam injection. SSPE was considered and the diagnosis was confirmed with the identification of measles antibodies in cerebrospinal fluid. CONCLUSION: SSPE should be considered in children and adolescents with parkinsonian symptoms, particularly in the absence of a history of vaccination against measles.

The role of trapidil on neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury.

BACKGROUND: Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. Trapidil is an antiplatelet agent and several studies demonstrate the beneficial effect of trapidil in various forms of tissue injury. The effects of trapidil on neuronal apoptosis in HIBI have not been reported previously. AIMS: The aim of this study is to evaluate the effect of trapidil on neuronal apoptosis in neonatal rat model of HIBI. STUDY DESIGN: Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2h. They were treated with trapidil or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia were performed. Neuronal apoptosis was evaluated by the terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) and caspase-3 staining methods. RESULTS: Trapidil treatment either before or after hypoxia results in significant reduction of the numbers of apoptotic cells in both hemispheres, when it is compared with saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups are significantly higher than that in the left hemispheres. CONCLUSIONS: These results show that trapidil administration either before or after hypoxia reduces neuronal apoptosis and we propose that trapidil may be a novel approach for the therapy of HIBI.

Platelet-activating factor antagonist (ABT-491) decreases neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury.

Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. To date, no study has investigated the role of platelet-activating factor (PAF) antagonists on neuronal apoptosis in neonatal rat model of HIBI. In the present study, we evaluated the effect of a highly potent and selective PAF antagonist (ABT-491) on neuronal apoptosis in neonatal rat model of HIBI. Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2 h. They were treated with ABT-491 or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia was performed. Neuronal apoptosis was evaluated by the terminal-transferase mediated dUTP biotin nick-end-labeling (TUNEL) and caspase-3 staining methods. Administration of ABT-491 either before or after hypoxia resulted in significant reduction of the numbers of apoptotic cells in both hemispheres, when compared to saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups were significantly higher than that in the left hemispheres. These results suggested that ABT-491, a highly potent and selective PAF antagonist, administration either before or after hypoxia reduces apoptosis and we propose that ABT-491 may be a novel approach in the treatment of HIBI.