Mother's psychopathological conditions and parenting characteristics according to smoke exposure.

The study aims to investigate the relationship between maternal smoking and smoke exposure with the mother's parenting attitude and psychopathological conditions in the absence of any health problems in the mother-child pairs. A descriptive form consisting of 27 questions, a "Parental Attitude Scale", and a "Depression, Anxiety, and Stress Scale" was applied by mothers with children aged 2 to 6 years. Of the 450 voluntary mothers included in the study, 107 (23.8%) had environmental smoke exposure and 69 (15.0%) were smokers. The highest quartile of democratic subscores was associated with maternal smoking and smoke exposure when confounding factors were controlled. Compared to non-smokers and unexposed, the adjusted odds ratio of having abnormal anxiety scale subscores was 3.90 [95% CI: 1.69-8.97] for smokers. When parenting types were included, mothers' smoking status and overprotective subscores were found to be associated with anxiety. There is an interaction among mothers' smoking, parenting types, and anxiety scores.

Evaluation of the Signs and Symptoms of Children for Whom a Vitamin D Test Is Requested: In Which Cases Do Pediatricians Want a Vitamin D Test?

OBJECTIVE: In this study, we aimed to assess the frequency of vitamin D deficiency according to age and sex in children and to investigate their relationship with demographic characteristics, presentation complaints, and accompanying clinical findings. MATERIALS AND METHODS: Vitamin D levels and demographic and clinical characteristics of 1505 children aged 2-18 years who applied to the hospital between January 01, 2017, and December 31, 2017, were analyzed. Patients who had a disease that could negatively affect vitamin D absorption and metabolism, who were diagnosed with rickets, or who took vitamin D supplements were excluded from the study. RESULTS: The median vitamin D level of children was 17.7 ng/mL, and the prevalence of vitamin D deficiency and insufficiency was 26.4% and 33.4%, respectively. Females were the group most at risk for vitamin D deficiency. Another group at risk for vitamin D deficiency was adolescents. Vitamin D deficiency or insufficiency was detected in approximately half of the school-age and preschool children. Of the patients, 18% were admitted to the hospital by their parents to have their vitamin D levels checked. No health problems were detected in 47.7% of the patients whose vitamin D level was checked. Neurological complaints were more common in patients with vitamin D deficiency or insufficiency when compared to the group with normal vitamin D levels (P < .001). CONCLUSIONS: The risk of vitamin D deficiency in children is highest in the female sex and adolescent age group. Neurological complaints are more likely to be associated with vitamin D deficiency or insufficiency.

Parental Attitudes and Knowledge About Lumbar Puncture in Children.

OBJECTIVES: Lumbar puncture (LP) is fundamental for diagnosis and treatment; however, some parents do not provide consent for their children to undergo the procedure, which can make diagnosis and determination of the optimal treatment difficult. The present study aimed to describe the level of knowledge and attitudes toward LP of parents whose children were scheduled to undergo the procedure. METHODS: A prospective cross-sectional descriptive study of a convenience sample of parents of 84 children aged 2 months to 17 years scheduled for LP at a single academic children's hospital between 2015 and 2017. Parents were administered a written survey and interviewed by a physician other than the person who did the LP. Data on parental level of knowledge and attitudes regarding LP, in addition to reasons for refusal, were collected.The parents of 84 patients scheduled for LP due to various indications were administered a face-to-face survey interview. The survey was used to collect parental demographic data, as well as opinions and knowledge about LP and postinterventional complications. RESULTS: The mean age of the 84 patients (57% male and 43% female) was 6.4 ± 5.17 years. Lumbar puncture was planned for the presumptive diagnosis of neurological disease in 45.25% of the patients, central nervous system infection in 45.25%, and acute encephalopathy in 9.5%. Among the parents, 65% (n = 55) had no knowledge or attitude about LP prior to the survey interview. The most common parental concern related to LP was paralysis (25%), followed by infertility (2%), mental retardation (1%), and disease progression (1%). Only 4.7% of the parents did not provide consent for their child to undergo LP. CONCLUSIONS: We found that most parents had little knowledge about LP, and the most common parental concern was paralysis. Despite this, in our study, only 5% of parents did not consent to LP.

Analysis of Refugee Children Hospitalized in a Tertiary Pediatric Hospital.

Refugee children are defined as an at-risk population as they have a high risk of physical and mental health conditions. While data exist regarding the mental health of refugee children, there are limited data about their medical health issues and mortality. Therefore, this study aimed to analyze the demographic data, clinical results, treatment/management data, and mortality data of hospitalized refugee children. This is a descriptive study that analyzed the demographic data, clinical findings, treatment/management data, and mortality data of 728 refugee children aged between 1 month and 18 years who were hospitalized in a tertiary pediatric hospital between 2013 and 2018. During the 5 year duration of this study (2013-2018), there were 12,031 patients hospitalized in the department of general pediatrics. Of these patients, 728 (6%) were refugee children [median age 1.2 (IQR 4.4) years]. The most frequent ethnic origin was Syrian, followed by Iraqi and Afghan [465 (63.87%); 174 (23.9%), and 39 (5.3%), respectively]. The median duration of hospitalization was 6 (IQR 6) days. Those refugee patients who were hospitalized in the pediatric intensive care unit were significantly younger [median age 3.7 (IQR 9.4) years]. The mortality rate in the department of general pediatrics was 16.4% for refugee patients and 8.6% for non-refugee patients (p = 0.001). A logistic regression model revealed that factors associated with mortality included younger age (OR 1.6; CI 1.2-2.1) and being a refugee (OR 2.1; CI 1.3-3.2). Our study revealed detailed knowledge about demographic, clinical, and mortality data, with the largest known series about refugee children in the literature. The results show that mortality rates are significantly higher in refugee pediatric patients who are hospitalized in Turkey than in non-refugee patients.

Nutritional Rickets with Severe Complications in Syrian and Iraqi Refugee Children.

We investigated the presence of nutritional rickets in Syrian and Iraqi refugee infants who presented to hospital in Turkey in 2017. 25(OH)D levels were examined in 77 refugee children. Nutritional rickets was diagnosed in 22 (28.5%) children; 11 patients with rickets did not follow up.

Eosinophilic Granulomatosis with Polyangiitis in a 4-Year-Old Child: Is Montelukast and/or Clarithromycin a Trigger?

The aim of the presentation of this case is to discuss whether there is an association with eosinophilic granulomatosis with polyangiitis (EGPA) and the use of montelukast, and clarithromycin and to discuss a successful treatment course. A 4-year-old girl with a preceding history of asthma attacks and increased eosinophil counts was admitted. She had been using clarithromycin for five days and montelucast for a month. She was eventually diagnosed with EGPA with detailed examination. Clinicians should remember EGPA in children with asthma and hypereosinophilia. Patients receiving leukotriene receptor antagonists and/or macrolides should be monitored for developing a multisystem disease. Treatment with immunosuppressive agents may be required to ensure a good prognosis.

Secondary hemophagocytic lymphohistiocytosis in pediatric patients: a single center experience and factors that influenced patient prognosis.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome of excessive immune activation. Secondary HLH syndrome develops as a complication of infection, drugs, rheumatologic conditions, or malignancy. The main objectives of this work were to identify the etiology of secondary HLH and prognostic factors associated with mortality. Patients diagnosed with secondary HLH, between January 2011 and December 2016, were retrospectively included in this study. We analyzed clinical and laboratory findings as well as prognostic factors from 24 pediatric patients diagnosed with secondary HLH. The mean age of patients at the time of diagnosis was 79.9 ± 68.7 months (range: 2-202) and 54.2% of the patients were male. The most frequent HLH-2004 criterion was fever (100%). Underlying triggers of HLH were as follows: 13 (54.1%) infections, juvenile idiopathic arthritis in 5 patients (20.8%), drugs in 3 patients (12.5%), malignancies in 2 (0.8%), Kawasaki disease in 1 (0.4%) patient, and 1 (0.4%) with unknown triggers. The median time of diagnosis was 3 days (1-67 days). Overall, the mortality rate was 20.8%. In our logistic regression model, factors associated with mortality were decreased albumin levels (OR1 = 2.3[1.48-3.43]) and etoposide usage (OR2 = 1.22 [1.14-1.89]). The patient's 30-day survival was inferior among patients whose albumin level was 2 g/dL or less compared to those over 2 g/dL. Increased awareness of the underlying condition is critical in HLH patients. Our study emphasizes the prognostic significance of albumin level.

Chronic recurrent multifocal osteomyelitis: a case report.

Chronic recurrent multifocal osteomyelitis is a rare autoinflammatory, immunologic disorder. It may involve recurrent inflammatory bone pain associated with aseptic osteomyelitis. If the diagnosis is delayed, it negatively influences quality of life by leading to persistent symptoms or joint damage. Herein, we report a 16-year-old male patient who presented with left hip and right knee pain lasting for the last two months and was diagnosed as having chronic recurrent multifocal osteomyelitis as a result of further evaluation. Improvement was achieved with prednisolone and methotrexate treatment that was initiated when no response to ibuprofen treatment could be obtained. Chronic recurrent multifocal osteomyelitis must be considered in the differential diagnosis in patients presenting with joint symptoms when clinical and radiologic bone lesions are found, no microorganism growth is observed, and no response to antibiotic treatment is obtained.

Exposure to and use of mobile devices in children aged 1-60 months.

The present study was conducted to determine young children's (aged 1-60 months) exposure to and use of mobile devices. The study included 422 parents of children aged 1-60 months admitted to pediatric outpatient clinics. A questionnaire was administered to the parents via face-to-face interview. Children's overall exposure to mobile devices was 75.6% (n = 319). Of the children, 24.4% (n = 103) had never used a mobile device. Among the children that had used a mobile device, 20.6% (n = 66) were aged between 1 and 12 months; 24.5% (n = 78) were aged between 13 and 24 months. The median age at the first time use of a mobile device was 12 months. The youngest child that used a mobile device was 6 months old. Tablets had a significant difference in the age at first use compared with other mobile media types (P < 0.01). Children's overall mobile device ownership was 30.7% (98/319) in frequency. There was a positive relationship between mobile device ownership and age (p < 0.001). The most commonly owned mobile device was a "tablet" at a frequency of 68.4% (67/98). The frequency of tablet ownership was inversely associated with household income (P < 0.01). Of the children that used mobile devices, 25.7% (82/319) used multiple mobile devices simultaneously. Among 422 children, 15.9% (n = 67) had a tablet in their room. The frequency of tablet use and ownership was inversely related to the mother's educational level (P < 0.01). The parents reported that 22.3% (n = 71) never received help while navigating the mobile device. The most frequent activity with mobile devices was watching videos (70.8%, n = 226). Of the parents, 59.6% (190/319) let their children use mobile devices while they are doing daily tasks or domestic chores. Of the parents, 91.5% (n = 386) reported not having been informed by a doctor about the effects of mobile devices on their children.Conclusion: This study demonstrates a high prevalence of exposure to mobile devices in young children. The frequency of tablet use and ownership of offspring was inversely related with maternal educational level and household income. What is Known: • Mobile phones and other similar mobile devices are now embedded in the daily lives of children. • There are limited data about mobile media use in early childhood, and few guidelines on which clinicians can base their recommendations. What is New: • The exposure to mobile devices is high in young children aged 1-60 months. • The frequency of tablet use and ownership of offspring was inversely related to household income and maternal educational level.

Changes in thiol/disulfide homeostasis in juvenile idiopathic arthritis.

BACKGROUND: The pathogenesis of juvenile idiopathic arthritis (JIA) remains unknown, but imbalance between the oxidant and antioxidant defense systems may play a role. Measuring thiols in plasma provides an indirect indication of antioxidative defense. The aim of the present study was to investigate the association between JIA and dynamic thiol/disulfide homeostatic status. METHODS: This case-control study involved 34 JIA patients and 30 age- and gender-matched healthy controls. The patients were divided into subgroups according to Simplified Disease Activity Index (SDAI) score: active, SDAI > 3.3; remission, SDAI ≤ 3.3. RESULTS: Native thiol and total thiol were significantly lower in the JIA group than in the control group (P = 0.001). There was no significant difference in the disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios between the JIA and control groups (P > 0.05). Based on SDAI score, 22 JIA patients were in the remission subgroup, and 12 JIA patients were in the active subgroup. Native thiol and total thiol were significantly lower in the active JIA subgroup than in the remission subgroup (P = 0.001), but there were no significant differences in the other parameters. There was no significant difference in thiol and disulfide levels between systemic-onset JIA and other JIA (P > 0.05). CONCLUSIONS: Plasma thiol is lower in JIA patients, especially during periods of active disease, than in healthy controls, indicating that low thiol might be an important factor in the etiology of JIA and that antioxidant systems are negatively affected by inflammatory diseases, especially during periods of active disease.

Kikuchi-Fujimoto disease triggered by Salmonella enteritidis in a child with concurrent auto-immune thyroiditis and papilloedema.

Kikuchi-Fujimoto disease (KFD) is a histiocytic necrotising lymphadenitis characterised by painful cervical lymphadenopathy, fever, malaise and weight loss. Infections, auto-immune pathogenesis and a genetic association have been implicated. A 12-year-old boy presented with a 1-month history of fever, abdominal pain, constipation and weight loss, and a painful lymph node was detected in the right axilla. Chest CT demonstrated multiple lymph nodes, especially in the left mediastinum. Salmonella enteritidis group D was detected in a blood culture and he was treated with ceftriaxone, followed by meropenem. An axillary lymph node biopsy demonstrated necrotising histiocytic lymphadenitis and KFD was diagnosed. He was discharged 35 days after admission. He was re-admitted 3 weeks later with recurrence of symptoms and headache and was found to have papilloedema of the left eye and auto-immune thyroiditis. Intravenous immunoglobulin (IVIG) 400 mg/kg/day was administered for 5 days. The fever and papilloedema slowly resolved and, subsequently, the thyroiditis, and he has remained well on follow-up. This is the first report of an association of S. enteritidis infection and papilloedema with KFD. IVIG may be required in prolonged or recurrent cases and in those with an auto-immune association.

The variable clinical phenotype of three patients with hepatic glycogen synthase deficiency.

BACKGROUND: Glycogen synthase deficiency, also known as glycogenosis (GSD) type 0 is an inborn error of glycogen metabolism caused by mutations in the GYS2 gene, which is transmitted in an autosomal recessive trait. It is a rare form of hepatic glycogen storage disease with less than 30 cases reported in the literature so far. The disorder is characterized by fasting hyperketotic hypoglycemia without hyperalaninemia or hyperlactacidemia. It is a glycogenosis with lack of liver glycogen synthesis, therefore hepatomegaly is not observed in patients with glycogen synthase deficiency. Symptoms of fasting hypoglycemia in patients with glycogen storage disease type 0 (GSD0) usually appear for the first time in late infancy when weaning from overnight feeds. Seizures associated with low blood glucose may also occur, but they are rare. Clinical management is therefore based on frequent meals composed of high protein intake during the day and addition of uncooked cornstarch in the evening. CASE PRESENTATION: Herein we report three new cases of liver glycogen synthase deficiency (GSD0). The first patient presented at the 4 years of age with recurrent hypoglycemic seizures. The second patient who is the brother of the first patient presented at 15 months with asymptomatic incidental hypoglycemia. Glucose monitoring in both patients revealed daily fluctuations from fasting hypoglycemia to postprandial hyperglycemia and lactic acidemia. A third patient was consulted for ketotic hypoglycemia and postprandial hyperglycemia at the 5 years of age. CONCLUSIONS: Genetic analyses of the siblings revealed homozygosity for mutation c.736C>T on the GYS2 gene confirming the diagnosis. The third patient was found to be homozygous for c.1145G>A. GSD0 is more common than previously assumed. Recognition of the variable phenotypic spectrum of GSD0 and routine analysis of GYS2 are essential for the correct diagnosis.

First manifestation of citrullinemia type I as Sandifer syndrome.

Kiliç M, Altinel-Açoglu E, Zorlu P, Yüksel D, Bülbül S, Haeberle J. First manifestation of citrullinemia type I as Sandifer syndrome. Turk J Pediatr 2017; 59: 696-698. We report an eleven-month-old infant girl who presented as Sandifer syndrome clinically but was later diagnosed with citrullinemia type I. Metabolic evaluation and molecular analysis confirmed the correct diagnosis. Despite the fact that many patients are already known in the literature, this is the first report of a Sandifer syndrome-like presentation of citrullinemia type I. This paper suggests that suspicion of Sandifer syndrome should also lead to inclusion of urea cycle disorders in the list of differential diagnoses.

Systemic Manifestation of Rotavirus Infection in Children: A Report of Three Cases.

INTRODUCTION: Rotavirus is a leading cause of acute gastroenteritis in children. Although the clinical complaints associated with rotavirus are generally gastrointestinal, including vomiting and diarrhea, data suggest that it can also cause symptoms that extend beyond the gastrointestinal tract. CASE PRESENTATIONS: We report three pediatric cases of rotavirus infection: one accompanied by encephalopathy and two with elevated hepatic transaminase activity. The patients were admitted to Dr. Sami Ulus maternity and children's health and diseases training and research hospital, Ankara, Turkey, from 2012 - 2014. The presented patients' aspartate aminotransferase (AST) (1765-2614 IU L-1) and alanine aminotransferase (ALT) (1448-3558 IU L-1) levels are, to date, the highest reported levels associated with rotavirus infections, and suggest that the rotavirus can cause severe hepatic transaminase elevation. CONCLUSIONS: This report aimed to increase awareness of the occurrence of extra-intestinal systemic manifestations of rotavirus infection. Although such cases may be rare, they still suggest that that rotavirus is a systemic viral infection.

Hypoalbuminemia and Malnutrition Associated With Cow's Milk Allergy: A Case Report.

INTRODUCTION: Cow's milk allergy is the most common food allergy in children. Symptoms usually involve the skin and the gastrointestinal and respiratory tracts. Gastrointestinal tract manifestations of cow's milk allergy are nonspecific, and are the only type that can be diagnosed in all age groups. Here, we report a rare case of cow's milk allergy in an infant with hypoalbuminemia and malnutrition. CASE PRESENTATION: A nine-month-old girl was admitted to Dr. Sami Ulus maternity and children's health and diseases training and research hospital, Ankara, Turkey, in September 2013, for weakness and swelling of the legs that had endured for two days. She had bilateral pretibial pitting (+2) edema. Laboratory data revealed albumin at 1.7 g/dL; serum Na, K, urea, creatinin, and alanine-aspartate aminotransferase levels were normal. Her urinary analysis did not reveal proteinuria. Stool samples were normal, and stool steatocrite was negative. Anti-gliadin, anti-endomysium, and anti-tissue transglutaminase antibodies were negative. Cow's milk allergy was diagnosed due to cow's milk-specific IgE and skin prick test results. CONCLUSIONS: On rare occasions, cow's milk allergy presents with hypoalbuminemia. When diagnosis is delayed, this allergy may impair the growth and quality of life and may even be life-threatening.