Pathogens in Pediatric Septic Arthritis: A Multi-Center Study in Turkiye (PEDSART Study).

OBJECTIVES: Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. METHODS: In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. RESULTS: Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. CONCLUSIONS: Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.

An evaluation of childhood carbon monoxide intoxications in a rural area using the Beaufort wind scale.

Climatic changes are known to affect CO intoxications. The purpose of this study was to examine childhood CO intoxications with the Beaufort wind scale (BWS) classification of wind speeds. The demographic data (age and sex) and information concerning the hour, day, and month of presentation to the emergency department for cases diagnosed with CO intoxication over a 7-year period between 2015 and 2021 in the pediatric emergency department of a tertiary training and research hospital in a rural area were examined. Wind speeds (m/s) measured on the days of presentation to the emergency department were recorded. The wind category on the BWS on the day of intoxication was then determined. Four hundred twenty-two patients, with a mean age of 95.12 ± 59.4 (1-215) months, 218 (51.7%) girls and 204 (48.3%) boys were diagnosed with CO intoxication over the 7-year study period. A comparison of wind speeds on the days of presentation to hospital revealed a significantly higher wind speed in 2020 than in the other years (p<0.001). A comparison of the groups in terms of the BWS revealed a significant difference between the years of presentation to hospital (p:0.001). This is the first study to investigate CO intoxications in the pediatric emergency department with the BWS. A significant association was observed between wind speed based on the BWS and childhood CO intoxications. Further studies evaluating wind in the rural setting and CO intoxications are now needed for protection against such intoxications.

The effect of the lunar cycle on migraine: preliminary findings from a retrospective study.

AIM: The purpose of this study was to evaluate the relationship between the lunar cycle and attacks observed in patients diagnosed with migraine and under follow-up in our pediatric neurology clinic. METHODS: Cases diagnosed with migraine and under follow-up at the Balikesir University Medical Faculty Pediatric Neurology Clinic, Turkey, undergoing attacks between 01.09.2019 and 01.09.2021, and whose attacks were recorded were included in the study. Patients' migraine attacks were investigated retrospectively, and the stage of the lunar cycle at which they occurred, based on the lunar calendar, was determined. RESULTS: The mean age of the patients in the study was 13.39 ± 2.64 (8-17) years. Female gender was observed in the majority of attacks in all lunar cycles, and was most common in the first quarter. Headache was most common in the frontal region during the first quarter and full moon, and auras were also most frequent in the first quarter. Stress and exercise were the most frequent migraine-triggering factors in the first and third quarters, and in the full moon. Migraine attacks were shortest in duration in the full moon, and longest in the first quarter. The frequency of attacks (per week) was highest in the new moon and third quarter, and lowest in the full moon. CONCLUSIONS: This study investigated the relationship between migraine attack characteristics in children and the lunar cycle. It represents the first such investigation of the association between the lunar cycle and pediatric migraine attacks.

Kleefstra Syndrome.

Kleefstra syndrome (KS), previously referred to as 9q subtelomeric deletion syndrome (9qSTDS), is characterised by moderate to severe developmental delay/mental retardation, childhood hypotonia, and brachy-microcephaly (main clinical phenotype), midface hypoplasia, prognathism, lip and eyebrow shape anomalies. The true prevalence of KS is unknown, but it is estimated that it occurs with a frequency of 1/200.000 in cases with mental retardation. On literature search, approximately 110 patients have been reported so far. Genetic analysis should be planned and interdisciplinary monitoring should be provided in cases suspected to have KS.   Key Words: Child, Genetic disorder, Kleefstra Syndrome, Dysmorphism.

Mental health of children of health workers during the COVID-19 pandemic: A cross-sectional study.

Children are exposed to large amounts of information and high levels of stress and anxiety from adults around them, the media, and social communication networks during the Covid-19 period. The purpose of this study was to compare the anxiety and depression levels of the children of health workers following the declaration by the World Health Organization (WHO) of Covid-19 as a global pandemic with those of age-matched children of non-health worker parents. This prospective, case-controlled, cross-sectional study was performed between July and September 2020. One hundred forty-six participants were enrolled, 71 children of health worker parents in the study group, and 75 age- and sex-matched children of non-health worker parents in the control group. While no significant difference was determined between the children of health workers and non-health workers in terms of CDI scores, total STAI-C scores were higher among children of health workers (70.36 ± 12.43) than in children of non-health worker parents (65.62 ± 11.83) (p = .02). This study shows that since their parents work in intensive and high-risk environments during the Covid-19 pandemic, the children of health workers may be at greater psychological risk than other children.

Evaluation of Burden and Anxiety in Caregivers of Patients with Pediatric Celiac Disease in the COVID-19 Pandemic.

Background Anxiety and caregiver burden increase among caregivers for individuals with chronic disease. The purpose of this study was to compare the anxiety levels and caregiver burden among caregivers for cases with pediatric celiac disease (CD) before and during the COVID-19 pandemic. Materials The Zarit Burden Interview (ZBI) and the Beck Anxiety Inventory (BAI) were applied to 29 parents caring for pediatric CD patients in January 2020, when COVID-19 cases had not yet been seen in Turkey. The study was designed prospectively. The scales were also reapplied to the same study group online during the COVID-19 pandemic (May 2020). The results were then compared. Results Parents caring for 29 cases of pediatric CD; 21 mothers (72.4%), six fathers (20.7%), and two aunts (6.9%) took part in the study. Mean ZBI scores before and during the COVID-19 pandemic were 27.51 ± 14.12 (8-73) and 38.68 ± 10.95 (21-57), respectively ( p < 0.01). Mean BAI scores before and during the COVID-19 pandemic were 13.27 ± 7.65 (1-27) and 23.48 ± 12.40 (2-48), respectively ( p < 0.01). Conclusion Increased anxiety and caregiver burden among caregivers of pediatric CD cases during the COVID-19 pandemic were identified for the first time in the literature in this study.

Have the sleep habits in children of health workers been more affected during the COVID-19 pandemic?

BACKGROUND: Changes have occurred in children's sleep habits during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to compare the sleep patterns during the COVID-19 pandemic of school age children of health worker parents (Group 1) and non-health worker parents (Group 2). METHOD: One hundred twenty-two participants were included in Group 1 and 250 in Group 2. The families' sociodemographic characteristics (education levels and occupations of mothers and fathers, parental shift-working status, monthly family income, number of children in the family, and place of residence), general information for the children taking part (diagnosis of COVID-19 or COVID-19 related isolation, distance education, participation in sporting activities, time spent watching TV, time devoted to reading, time spent on telephones/tablets/computers, and time spent on indoor activities), and the responses given to the Children's Sleep Habits Questionnaire (CSQH)-abbreviated form were all examined. RESULTS: Group 1 consisted of 122 individuals, 66 (54.1%) female and 56 (45.9%) male, and Group 2 of 250 individuals, 129 (51.6%) female and 121 (48.4%) male. Statistically significant differences were determined between the groups in terms of parental education levels and occupations, family monthly income, number of children in the family, place of residence, parental shift-working status, and length of time spent on indoor activities. Total CSHQ scores were 41.57 ± 7.57 (20-60) in Group 1 and 39.6 ± 8.47 (17-68) in Group 2 (p:0.03). CONCLUSION: Greater impairment of sleep habits of school age children of health workers compared to those of non-health workers in the COVID-19 pandemic is proved for the first time in this study. Further assessment of the effects of the COVID-19 pandemic on children's sleep habits is now required, and appropriate measures must be taken in the light of the results obtained.

Neurofibromatosis Type 1 and Vitamin B12.

The aim of this study was to evaluate vitamin B12 levels in the patients diagnosed with neurofibromatosis type 1 (NF1) and to compare them with a healthy group. In this study, the files of the patients, who were admitted to the pediatric neurology outpatient clinic of a tertiary university hospital and were followed up after being diagnosed with neurofibromatosis type 1 during the 15-month period, were evaluated retrospectively (Study group). Demographic data, and laboratory test results (complete blood count, iron, iron-binding capacity, ferritin, vitamin B12 and folate) were recorded from the patient files. The cases admitted to the hospital for routine child health examination in the same period were taken as the control group. Vitamin B12 levels were statistically significantly lower in the study group compared to the control group (p=0.012). This study is the first study evaluating vitamin B12 levels in NF1 patients. Key Words: Neurofibromatosis type 1, Neurofibromin, Nutrition, Vitamin B12.

Vitamin B12 and folic acid levels in pediatric migraine patients.

Migraine is a recurrent, primary cause of headache. Although prophylactic vitamin B12 therapy is used on migraine patients, there is a limited number of studies examining the levels of B12 vitamin and folic acid in pediatric patients diagnosed with migraine. The study group (Group 1) included 65 pediatric patients diagnosed with migraine in the Pediatric neurology outpatient clinic, and 87 healthy cases admitted to the general pediatric clinic were included in the control group (Group 2). Complete blood count parameters, vitamin B12, folic acid, ferritin, and 25 OH D vitamin levels of the study and control groups were compared. The mean vitamin B12 level was 196.42 ± 95.54 pg/mL (59-499) in Group 1 and 240 ± 105.24 pg/mL (74-619) in Group 2. The mean folic acid level was 8.85 ± 3.49 pg/mL (3.68-23.70) in Group 1 and 7.24 ± 7.17 pg/mL (1.11-35.50) in Group 2. There was a statistically significant difference between Group 1 and 2 in terms of vitamin B12 and folic acid levels (p = 0.008, p = 0.00). The results of this study indicate the requirement for routine evaluation of vitamin B12 and folic acid levels in pediatric patients diagnosed with migraine.

A novel de novo mutation at the ABCC8 gene in a newborn with transient diabetes mellitus.

Neonatal diabetes mellitus is a monogenic disease that can present with hyperglycemia, dehydration, failure to thrive, and ketoacidosis within the first six months of life. Neonatal diabetes mellitus can be transient or permanent. Here, we describe a 10-week-old infant with transient neonatal diabetes mellitus who presented with diabetic ketoacidosis and was found to have heterozygous a de novo mutation, p.Thr1381Asn in the ABCC8 gene, which encodes the SUR1 protein. There was no family history of diabetes mellitus and the parents were negative for the mutation at ABCC8. The patient started on insulin therapy and remission of diabetes occurred at 4 months of age. The patient remained euglycemic over a 2-year follow-up period without necessitating any medicine.

Childhood horse and donkey bites; a single tertiary health center experience in a rural area.

BACKGROUND: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas. MATERIALS AND METHODS: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files. RESULTS: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48-190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin-clavulanic acid was prescribed in 28 (77.8%) cases. CONCLUSION: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.

The status of drug wastage in the pediatric emergency department of a tertiary hospital.

BACKGROUND: The aim of this study was to evaluate surplus drugs left over from medications used via the intravenous and intramuscular routes in a pediatric emergency unit of a tertiary hospital in Turkey and to determine the financial burden imposed by drug wastage. MATERIALS AND METHODS: The study was planned prospectively on patients presenting to the pediatric emergency department of a tertiary university hospital between January 1 and April 30, 2017, on weekdays and between 08:00 and 16:00, for any reason, and receiving intravenous and/or intramuscular drug administration resulting in drug wastage after treatment. RESULTS: The number of patients enrolled in the clinical trial was 1620 (35.9%). Twenty-one different medications were administered via the intravenous or intramuscular (IM) routes during the study. The proportion of total medication wastage at the end of trial was estimated to be 0.425. The drug with the highest proportion of mean wastage to drug form was paracetamol (1000mg vial) at 0.79. The total cost of the drugs used for the patients in the study was US$580.98, and the overall burden of drug wastage was US$288.09. The three medications involving the highest wastage costs were methylprednisolone, ondansetron, and dexamethasone. The total wastage cost/total drug cost ratio was 0.495. CONCLUSION: If commercial drugs with intravenous and IM formulations are used by the pediatric age group, then dosage formulations appropriate for pediatric age group use also need to be produced. The development by manufacturers of ampoules and similar products suitable for multiple use will also reduce drug wastage. Reducing levels of drug wastage will inevitably reduce the drug expenditure.

A Retrospective Analysis of Central Physician Appointment System Data in a Tertiary Health Center in Turkey.

INTRODUCTION: Considerable advances have been made in hospital appointment systems in the past 60 years. In Turkey, the Central Physician Appointment System (CPAS) is used together with appointments made through direct presentations to the hospital. This study evaluated CPAS data. MATERIALS AND METHODS: CPAS data for the previous 2 years (2015, Group 1; 2016, Group 2) were evaluated retrospectively. Department-based analysis was also performed. Total number of clinics, CPAS capacity, number of appointments through CPAS, and numbers of patients keeping appointments and "no shows" and ratios calculated from these were investigated. RESULTS: Overall, 1,704,594 patients were examined in 20 departments during the 2-year period (January 1, 2015-December 31, 2016). Mean CPAS capacity per department was 12,831 ± 7,691 in Group 1 and 11,573 ± 6,849 in Group 2 (p = 0.588). Ratios of appointments made through CPAS to CPAS capacity were 0.7 in Group 1 and 0.84 in Group 2 (p = 0.009). The ratio of patients keeping appointments made through CPAS to the number of appointments made through CPAS was 0.772 in Group 1 and 0.775 in Group 2 (p = 0.831). The departments with the highest number of appointments made through CPAS to CPAS capacity were Neurosurgery in Group 1 (0.99) and Ophthalmology in Group 2 (0.99). The department with the lowest ratio was Infectious Disease and Clinical Microbiology in Group 1 (0.28) and Group 2 (0.45). CONCLUSIONS: The use of CPAS has increased. However, some CPAS vacancies remain unfilled, and some appointments are not kept. CPAS capacities must be adjusted in line with take-up rates through regular department-based analysis.

An overview of the health status of Syrian refugee children in a tertiary hospital in Turkey.

OBJECTIVE: Migration is a problem affecting all family members, but particularly children. Child refugees are the highest risk group for the health systems of receiving countries. We investigated the health of 104 Syrian child refugees presenting to a tertiary hospital in Turkey. SETTINGS AND DESIGN: A retrospective study was conducted in the pediatric clinic. MATERIALS AND METHODS: The medical files of Syrian refugee children (0-18 years) presenting to Adiyaman University Hospital, Pediatric Clinic between 01 and 30 November 2015, were investigated. Demographic data, body measurements, and laboratory results obtained from patients' medical records were evaluated. RESULTS: Mean age of patients was 53.5 ± 49.6 (2-198) months; 63 were male and 41 were female. Seventy-two patients (69.2%) were under 5 years of age. Weight in 20 patients (19.2%), height in 33 (31.7%), head circumference in 2 (1.9%), and body mass index in 7 (6.7%) were below the third percentile. All patients with body weight below the third percentile had chronic malnutrition. Anemia was present in 35 (50%) of the 70 patients for whom complete blood count data were available. CONCLUSION: Health workers involved with Syrian refugee children must consider the two preventable conditions; malnutrition and anemia.

Rare Giant Angiokeratoma of the Vulva: A Case Report.

BACKGROUND: Angiokeratoma of fordyce occurring over on the vulva is a rare condition. Fordyce angiokeratoma is observed more frequently among men than women. In women, it is generally observed in later life, and appears as multiple dark purple papules, measuring 2-4 mm, on the vulva. CASE REPORT: We present the case of a 17-year-old white teenage girl with giant Fordyce angiokeratoma on the right vulva. The angiokeratoma was removed and a V-Y advancement flap was made. CONCLUSION: In the literature, this is the first childhood case reported in which a reconstruction of the vulva was performed.

[Possible Relation Between Antenatal Venlafaxine Use and VACTERL Association in a Newborn: A Case Report]. / Antenatal Venlafaksin Kullanimi ve VACTERL Asosiasyonunun Olasi Iliskisi: Bir Olgu Sunumu.

Major depressive disorder is common during antenatal period and many women are prescribed antidepressant drugs despite no antidepressant can be regarded as definitely safe in pregnancy. Previous studies have suggested links between gestational use of selective serotonin reuptake inhibitors (SSRI) or serotonin and norepinephrine reuptake inhibitors (SNRI) and certain birth defects. VACTERL association is a rare group of congenital malformations which were observed to occur together more often than would be expected by chance. Diagnosis requires coexistence of at least three congenital malformations from vertebral (V), anal (A), cardiac (C), tracheoesophageal (TE), renal (R), and limb (L) regions. Here, a case of a newborn female whose mother's gestational history revealed venlafaxine use before and during her pregnancy is reported. This newborn had anal atresia, patent ductus arteriosus, tracheoesophageal fistula, and upper limb anomalies. To the best of authors' knowledge this is the first report of VACTERL association possibly related to gestational use of SSRI or SNRI.

The First Infant Death Associated With Human Coronavirus NL63 Infection.

Human coronavirus NL63 (HCoV-NL63) primarily infects the upper respiratory tract. However, it may cause severe lower respiratory tract infection, and the clinical course may be severe in immunocompromised patients. To our knowledge, child death due to HCoV-NL63 has not been reported. We present a fatal lower respiratory tract disease associated with HCoV-NL63 in a 7-month-old malnourished infant.

Antibacterial resistance patterns of pediatric community-acquired urinary infection: Overview.

BACKGROUND: Urinary tract infection (UTI) is common in children. The aim of this study was therefor to construct a guide for the empirical antibiotic treatment of community-acquired UTI by investigating the etiology and antimicrobial resistance patterns of uropathogens and analyzing the epidemiological and clinical patient characteristics. METHODS: A total of 158 children with positive urine culture were included in the study. Antibiotic susceptibility testing was performed with Vitek 2 Compact for 28 commonly used antimicrobials. RESULTS: Mean age was 3.36 ± 3.38 years (range, 45 days-15 years). Escherichia coli (60.1%), and Klebsiella spp. (16.5%) were the most common uropathogens. For all Gram-negative isolates, a high level of resistance was found against ampicillin/sulbactam (60.1%), trimethoprim/sulfamethoxazole (44.2%), cefazolin (36.2%), cefuroxime sodium (33.5%), and amoxicillin/clavulanate (31.5%). A low level of resistance was noted against cefepime (8.7%), ertapenem (4.6%), norfloxacin (1.3%), and meropenem (0.7%). There was no resistance against amikacin. CONCLUSIONS: There is high antibiotic resistance in children with UTI. The patterns of uropathogen antimicrobial resistance vary in susceptibility to antimicrobials depending on region and time. Thus, the trends of antibiotic susceptibility patterns should be analyzed periodically to select the appropriate regimen for UTI treatment.

Risk Factors Related to Caregivers in Hospitalized Children's Falls.

PURPOSE: This study aimed to evaluate the risk factors for falls in hospitalized children in relation to their caregivers. METHODS: This was a case control study to evaluate the risk factors for falls in hospitalized children in relation to their caregivers. The children included in our study were at the hospital between June 2014 and June 2015. Demographic data of patients, caregivers, some habits; education level; and number of siblings were recorded. RESULTS: The data of 117 patients were evaluated, and there were 39 patients with a fall event and 78 patients who did not experience a fall. The mean age for the fall group and the non-fall group were 14.71±9.36 and 15.62±10.65months, respectively. The mean age for the caregivers of the fall group and the non-fall group were 29.33±5.89 and 29.53±5.56years, respectively. There was a statistically significant difference in fall risk related to the caregivers' education level (p<0.01) and caregivers' habit of smoking (p<0.01). The analysis of risk factors related to caregivers for pediatric inpatient falls, by multivariate logistic regression, showed that low educational level of caregivers (OR=0.361; CI=0.196-0.665; p<0.01), caregivers' smoking (OR=4.863; CI=1.058-22.358; p<0.05) and increased length of stay for the children (OR=1.994; CI=1.475-2.696; p<0.01) carried a higher risk for pediatric inpatient falls. CONCLUSIONS AND PRACTICE IMPLICATIONS: The data obtained in our study have shown that caregivers play a key role in fall events in hospitalized children. Nurses and other health workers should consider children's caregivers educational level and habits for prevention of hospitalized children falls.