Childhood Poisoning During the COVID-19 Pandemic.

OBJECTIVE: To determine changes caused by the effect of the COVID-19 pandemic by examining the children admitted to our hospital because of poisoning during the pandemic and comparing these with data from a study conducted in the pre-pandemic period. MATERIALS AND METHODS: A retrospective examination was made of children who were admitted to our pediatric emergency department with poisoning between March 2020 and March 2022. RESULTS: Of the 82 (0.7%) patients admitted to the emergency department, 42 (51.2%) were girls, the mean age was 6.43 ± 5.62 years, and the majority of children (59.8%) were under 5 years of age. The poisonings were determined to be accidental in 85.4% of cases, 13.4% were suicide attempts, and 1.2% were iatrogenic. Poisonings occurred most frequently (97.6%) at home and most frequently (85.4%) by digestive tract. The most common causative agent (68%) was non-pharmacological agents. Caustic-corrosive substances were determined in 39% of cases, medical drugs in 32%, toxic gases in 11%, alcohol (hand sanitizers) in 8.5%, insecticide-pesticide in 6.1%, food in 1.2%, and animal bites in 1.2%. Compared to the study conducted in our hospital in 2013-2014, the difference in terms of factors causing poisoning was statistically significant (P < .001). Of the current study cases, 14 (17.1%) were followed up in the intensive care unit, and no mortality developed. CONCLUSIONS: The period of the COVID-19 pandemic was seen to cause an increase in poisoning rates with caustic-corrosive substances, alcohol (hand disinfectants), and toxic gases. Families should be made aware of this issue and take special precautions.

The COVID-19 Pandemic and the Prevalence of Childhood Obesity in Turkiye.

OBJECTIVES: To examine the prevalence of overweight and obesity in school-age children in Isparta Province, Turkiye, during the coronavirus disease 2019 (COVID-19) pandemic, and to compare the results with those of previous studies conducted in Isparta in 2005, 2009, and 2014. METHODS: The study was carried out in schools in the city center of Isparta in March 2022, during which the weight and height of students were measured using a scale and stadiometer, and the body mass indices (BMI), BMI percentiles, and z scores were calculated. RESULTS: Of the 8871 students assessed, 4547 (51.3%) were female and the mean age of the sample was 11.92 ± 3.42 (6-18.93) years. The prevalence of overweight was 12%, the prevalence of obesity was 14.5%, and the prevalence of overweight + obesity was 26.5%. A comparison of the figures since 2005 revealed the prevalence of overweight to be stable, while the prevalence of obesity and the prevalence of overweight + obesity were found to have witnessed a increase (χ 2 : 57.01, P < 0.001). The prevalence of obesity was 13% among girls under 11 years of age and 14.3% among girls over 11 years of age; and 18.2% and 12.8% among boys under and over 11 years of age, respectively (χ 2 : 23.26, P < 0.001). The prevalence of obesity was significantly higher in boys under 11 years of age. CONCLUSIONS: The prevalence of overweight + obesity was nearly stable in the 3 studies conducted over the 17-year period, but we witnessed an increase in our most recent study conducted during the pandemic. The prevalence of obesity is significantly higher in boys under 11 years of age.

Foreign Body Ingestion and Management in Children.

OBJECTIVE: The aim of the study is to evaluate of the children who came to our hospital with the complaint of foreign body (FB) ingestion and were treated. METHODS: A retrospective evaluation was made of the records of children who presented at our institution between January 2014 and August 2021 with the complaint of FB ingestion. RESULTS: Evaluation was made of 297 children, comprising 121 female children (40.7%) with a mean age of 61.1 ± 50.3 months (range, 4-202 months). The ingested FB most frequently was coins (n = 88, 29.6%). The most common complaint on presentation was vomiting in 47 cases (15.8%). Endoscopy was applied to 75 cases (25.3%), and most common FB was removed from the upper esophagus in 31 cases (41.3%). The most frequently removed FB was coins at the rate of 40%. Of the 211 cases left to a spontaneous course, 117 were in the intestines, 22 in the stomach, and in 72 cases localization could not be determined on conventional radiography as the FB was not opaque. In 7 cases with a bolus of food caught in the esophagus, 3 had corrosive esophagus stricture (1 case with colon transposition), 2 had operated esophagus atresia, 1 had eosinophilic esophagitis, and 1 had congenital esophagus stricture. CONCLUSIONS: Although there can be serious outcomes, there is spontaneous expulsion in most cases. However, a significant proportion requires a timely endoscopic procedure. Attention must be paid to underlying diseases when FBs, such as a food bolus, are in the esophagus.

Comparison of Body Composition and Body Mass Index in the Determination of Obesity in Schoolchildren.

OBJECTIVE: The determination of obesity that develops with an increase in the percentage of fat in the body may not always be possible in the real sense with body mass index, which is frequently used in practice. This study aimed to compare the results obtained from body mass index and bioelectrical impedance analysis measurements in evaluating obesity in Turkish school-aged children using age-related percentile curves. MATERIALS AND METHODS: The study included 1127 children (604 boys and 523 girls) recruited from a screening of the schools in the city center of Isparta between May 20 and June 20, 2014. Body mass index was calculated, and the variables of fat mass, body fat percentage, fat-free body mass, and total body water were measured with a Tanita BC-418 MA device. RESULTS: According to the body mass index values, 23.8% of the study sample was overweight/ obese, and according to bioelectrical impedance analysis, this rate was 14.7%. When examined by gender, males' overweight/obese ratio was 19.9% (overweight 11.3% and obese 8.6%) according to body mass index and 12.9% (overweight 7.1% and obese 5.8%) using the bioelectrical impedance analysis method. In females, the overweight/obese ratio was 19% (overweight 9.4%, obese 9.6%) according to body mass index and 16.7% (overweight 9.6% and obese 7.1%) using the bioelectrical impedance analysis method. CONCLUSION: The results obtained from the weight-based body mass index method were not consistent with the body fat percentage results obtained with the bioelectrical impedance analysis method. Since the fat ratio is also crucial in evaluating obesity, care should be taken when diagnosing obesity using body mass index only.

COVID-19-associated multisystem inflammatory syndrome in children: Experiences of three centres in Turkey.

BACKGROUND: The pathogenesis and clinical manifestations of the multisystem inflammatory syndrome in children (MIS-C) has not yet been fully elucidated and there is no clear consensus on its treatment yet. OBJECTIVES: To evaluate our patients diagnosed with MIS-C and present them to the literature in order to contribute to the better understanding of this new disease, which entered paediatric practice with the SARS-CoV-2 peak. METHODS: In this study, 17 MIS-C cases diagnosed according to the Centers for Disease Control and Prevention criteria were included. RESULTS: Of the patients, 7 (41.2%) had a comorbidity. Gastrointestinal system involvement was the most prominent in the patients (70.6%). Laparotomy was performed in 3 patients due to acute abdomen. Two patients had neurological involvement. Of the patients, 15 (88.2%) received intravenous immunoglobulin and 13 (76.5%) received both intravenous immunoglobulin and methylprednisolone. Two patients received invasive mechanical ventilation and 4 patients received high flow rate nasal cannula oxygen therapy. One of our patients who needed invasive mechanical ventilation and high vasoactive-inotrope support died despite all supportive treatments including plasmapheresis and extracorporeal membrane oxygenation. CONCLUSIONS: MIS-C picture can have a fatal course and may present with severe gastrointestinal and neurological signs. Unnecessary laparotomy should be avoided.

Brucellosis with splenic abscess in a child initially suspected to have covid-19.

COVID-19 can manifest with signs and symptoms related to many different systems. Therefore, in the examination of almost every patient, COVID-19 infection is excluded first This may cause other diseases to be missed, as almost occurred in the case of a 15-year old boy with brucellosis and a splenic abscess. Public and health care personnel fear of COVID-19 may cause more harm than the virus itself.

Familial Mediterranean Fever Mutation Analysis in Pediatric Patients With Inflammatory Bowel Disease: A Multicenter Study.

BACKGROUND: The aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases has been reported previously. METHODS: Children with IBD (334 ulcerative colitis (UC), 224 Crohn's disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. RESULTS: A total of 597 children (mean age: 10.8 ± 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/ heterozygous) in patients with UC (P < .05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P = .031, P = .045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P = .007). CONCLUSION: Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not have a high impact on inflammatory response and clinical outcome of the disease.

Amino acids and fatty acids in patients with beta thalassemia major.

BACKGROUND: Oxidative damage and increasing of lipid peroxidation are caused by chronic iron overload in patients with beta thalassemia major. Fatty acids are important structural elements for palmitoylation of membrane proteins which constitute a great part of natural membranes. Oxidative damages caused by reactive oxygen derives in thalassemic erythrocytes can be determined with lipid peroxidation, protein oxidation, and antioxidant system elements. The aim of study was to evaluate the relationship between amino acid and fatty acid levels with iron overload and antioxidant enzymes in beta thalassemia major. METHODS: A total 40 patients with beta thalassemia major with regular blood transfusion and chelating agents were included in the study. The levels of serum amino acid, fatty acid, ferritin, antioxidant enzymes and malondialdehyde were measured. RESULTS: Only C16- palmitoyl level was found significantly low in patients, other fatty acids and amino acids were in normal range. There were lower malondialdehyde and ferritin levels in patients with low C-16 palmitoyl level (p<0.05).  Conclusions: The high levels of ferritin and malondialdehyde in the patients with low C16-palmitoyl levels might be caused by this fatty acid's preventative effect on oxidative stress.

Evaluation of the Change in the Prevalence of Overweight and Obesity in Schoolchildren in South-west Turkey from 2005 to 2014.

BACKGROUND: To examine the prevalence of overweight and obesity among schoolchildren in our region and to compare the results with previous studies conducted in the same region in 2005 and 2009. METHODS: This study was conducted at seven primary and three high schools in the center of the province of Isparta, Turkey in 2014, randomly selected for two studies of obesity five and nine years previously. Students were weighed and measured, and BMI was calculated. The results were then compared with those from 2005 and 2009. RESULTS: The study consisted of 7116 students, 3445 (48.4%) females, and with a mean age of 11.7±2.7 yr (range 5.8-18.9 yr). The prevalence of overweight was 13.6% and that of obesity 9.9%. When the data were compared with the 2005 and 2009 studies, a statistically significant increase was determined in the prevalence of overweight (X2 = 4.826, P=0.0280 and X2 =19.012, P<0.0001). The prevalence of obesity in the 2005 and 2009 studies was 11.6% and 12.5%, compared to 9.9% this study. The decrease observed in this study was statistically significant (X2=8.720, P=0.0031 and X2=20.708, P<0.0001). The total prevalence's of overweight and obesity combined were 23.8%, 23.5% and 23.5% for 2005, 2009 and 2014, respectively. CONCLUSION: The prevalence of combined overweight and obesity was stable over the nine years, but there was significant increase in the prevalence of overweight. Population-based preventive strategies, therefore, need to be maintained and intensified.

Kawasaki disease in a 9-year old girl presenting with febrile cholestasis: case report and review of literature.

Kawasaki disease is a systemic vasculitis that develops during childhood, especially in those younger than 5 years. Gastrointestinal involvement does not belong to the classic diagnostic criteria. We reported here, a 9-year old girl who presented with febrile cholestasis, and developed a medium right coronary artery aneurysm despite intravenous immunoglobulin administration on the 9th day of fever. Hepatobiliary ultrasonographic evaluation revealed normal findings. Seroimmunologic markers of cholestasis were negative. Her clinical feature was ameliorated shortly after a second dose of intravenous immunoglobulin administration. We consider that a high index of suspicion of Kawasaki disease could prevent delayed diagnosis and complications.

Breakfast habits, dairy product consumption, physical activity, and their associations with body mass index in children aged 6-18.

The purpose of this study was to determine breakfast habits, dairy product consumption, and physical activity and their relations with body mass index (BMI) in schoolchildren and adolescents. This cross-sectional, school-based study was performed with children aged 6-18 years. Height and weight were measured, and a BMI z-score was calculated for each child. Breakfast consumption frequency, intake of milk and other dairy products, physical activity habits, and mothers' employment status were assessed via a self-report questionnaire. Multiple linear regression analysis was used to estimate the association between these habits and BMI z-scores. Seven thousand one hundred sixteen children were included, 3445 (48.4%) female, with a mean age of 11.7 ± 2.7 years (5.8-18.9). Of these, 62.6% had breakfast every day. Boys ate breakfast daily significantly more often than girls (64.5 and 60.7%, respectively; p < 0.001). The percentage of children eating breakfast daily decreased with age (79.1% at 6-11 vs. 52.1% at 12-18 years, p < 0.001). Sixty-four (0.9%) children consumed no dairy products. Milk intake was negatively and significantly associated with BMI z-score (ß = - 0.103, p < 0.001). Cheese consumption and the mother being employed were positively and significantly associated with BMI z-score (ß = 0.517, p < 0.001, and ß = 0.172, p < 0.001, respectively). Children engaging in physical activity had higher BMI z-score values than others (0.22 ± 0.01 vs. 0.12 ± 0.02, p < 0.001). Prevalence of overweight/obese was higher among children of working mothers compared to those of unemployed mothers (respectively, 29.3, 23.3%, p < 0.001). CONCLUSIONS: Skipping breakfast was associated with overweight/obesity in schoolchildren and adolescents, while milk consumption exhibited a protective effect. What is known? • Dietary interventions should be incorporated into a multidisciplinary strategy for obesity prevention. • Most studies of habitual physical activity in children suggest that the overweight and obese children are less active. What is new? • Milk consumption seems to have a protective effect against overweight/obesity, irrespective of yogurt or cheese consumption. • Children engaging in greater physical activity had higher body mass index values than others.

Child with Pancreatic Hydatid Cyst Presenting with Cholestasis.

Although hydatid cysts are often seen in the liver and lungs, they may be present in many organs. Even in countries where hydatid cyst disease is endemic, the occurrence of pancreatic hydatid cysts is rare. Pancreatic hydatid cysts are important for the differential diagnosis of patients with pancreatic pseudocysts and cystic carcinomas. We could not find cystic echinococcosis cases which are kept together pancreas and liver in PubMed. In this article, we highlight the fact that pancreatic cystic echinococcosis may play a role in the etiology of cholestasis and that cysts may not be isolated in the pancreas in a pediatric population.

A rare complication of esophageal dilatation: Brain abscess.

Brain abscess is an uncommon serious disease, which has been reported as a rare complication of repeated esophageal dilations; however, routine periprocedural antibiotic prophylaxis is not currently recommended. Herein, we present a brain abscess that developed after esophageal dilatation for the treatment of induced caustic esophageal strictures. The clinical presentation is non-specific, the most reported signs are high fever and neurologic findings. Cases have been reported in the literature in adult and pediatric patients. Cranial imaging is essential for diagnosis, drainage and antibiotics are essential in its treatment. Clinical improvement was achieved with antibiotic therapy and surgical drainage. This serious complication should be kept in mind when treatment of corrosive strictures though repeated esophageal dilatation is planned and prophylaxis should be considered in selected patients.

The protective effect of pomegranate juice in paracetamol-induced acute hepatotoxicity in rats.

AIM: Being the most commonly used antipyretic and analgesic, paracetamol is one of the most common causes of childhood poisoning in the world and maintains its importance also in our country. Paracetamol poisoning is one of the most common causes of liver failure. This study aimed to investigate if pomegranate juice had protective effect in acute liver toxicity related with paracetamol. MATERIAL AND METHODS: A total of 36 Wistar-Albino rats were divided into four groups as the paracetamol group (3 000 mg/kg paracetamol), the pomegranate juice + paracetamol group (1.5 mL pomegranate juice plus 3 000 mg/kg paracetamol), the pomegranate juice group (1.5 mL pomegranate juice) and the control group (1.5 mL distilled water). Pomegranate juice and distilled water were administered for eight days. Paracetamol was administered on day 8. The level of thiobarbituric acid reactive substances, as an oxidative marker, was measured in the blood and liver tissue on day 9. In addition, liver tissues were evaluated histologically (in terms of increased connective tissue, granular degeneration, mononuclear cell infiltration, necrotic cells and vascular congestion). RESULTS: The liver tissue and blood thiobarbituric acid reactive substances levels were found to be significantly lower in the pomegranate juice + paracetamol group compared to the paracetamol group (p<0.05). Histologically, structural changes related with damage were observed in both the paracetamol group and pomegranate juice + paracetamol group. The extent of damage was statistically significantly lower in the pomegranate juice + paracetamol group (p<0.001). CONCLUSIONS: Our results related with oxidative and histologic evaluation showed that pomegranate juice might have a preventive effect in paracetamol-induced acute liver damage.

Gallstones in childhood: etiology, clinical features, and prognosis.

AIM: The aim of this study was to determine demographic and clinical features in children diagnosed with gallstones, risk factors for gallstone formation, the effectiveness of ursodeoxycholic acid therapy, and the course of the disease. MATERIALS AND METHODS: Patients aged 0-18 years were followed up for at least 6 months after the diagnosis of gallstones with ultrasonography and were evaluated retrospectively. Patients were evaluated with respect to age, sex, presenting symptoms, BMI, facilitating factors, accompanying diseases, family history of gallstones, history of ceftriaxone use, laboratory tests, ultrasonography findings and follow-up, and therapeutic approaches and results. RESULTS: The study was completed with 70 patients. Thirty-nine (55.7%) patients were females. The mean age of the patients was 9.3±5.29 (0.3-18) years. The mean age among females was statistically significantly higher than that among males (P=0.007).No risk factor for stone formation was encountered in 50% of cases, whereas a family history of gallstones was present in 17.1%. Use of ceftriaxone was present in 8.6% of cases, total parenteral nutrition in 10%, obesity in 5.7%, hereditary spherocytosis in 4.3%, and Down's syndrome in 4.3%. The probability of dissolution of stones was 3.6 times higher in patients with stone sizes up to 5 mm [odds ratio (OR): 3.65, P=0.020], 3.9 times higher in those aged younger than 2 years (OR: 3.92, P=0.021), and 13.9 times higher in those with a single stone (OR: 13.97, P=0.003). CONCLUSION: Our findings show that unknown causes are still prevalent in stone formation and that ursodeoxycholic acid exerts no effect on stone dissolution; however, diagnosis at younger than 2 years of age, a single stone, and small size of stone are factors affecting dissolution.

The protective effect of Capparis ovata in acute hepatotoxicity induced by paracetamol.

BACKGROUND/AIM: To investigate the efficiency of Capparis ovata as a protective agent against acute paracetamol toxicity of the liver. MATERIALS AND METHODS: A total of 36 Wistar albino rats were divided into 4 groups: 1) paracetamol, 2) Capparis ovata + paracetamol, 3) Capparis ovata, and 4) control. Groups 2 and 3 were given Capparis ovata and Groups 1 and 4 distilled water for 8 days. On day 8, 3000 mg kg-1 paracetamol was administered orally to Groups 1 and 2. Samples were taken on day 9. AST, ALT, total bilirubin, direct bilirubin, GGT, and ALP levels were assessed. Lipid peroxidation markers and thiobarbituric acid-reactive substance (TBARS) levels were measured in the blood and liver. Liver tissues were evaluated histologically. RESULTS: AST, ALT, and total bilirubin levels were lower in Group 2 than in Group 1 (P < 0.05). TBARS levels were lower in Groups 2 (P = 0.000), 3 (P = 0.001), and 4 (P = 0.001) than in Group 1. Degenerative findings were lower in the Capparis ovata + paracetamol group than in the paracetamol group (P < 0.05). CONCLUSION: It can be concluded that Capparis ovata has a protective effect on the liver, both histopathologically and biochemically, against paracetamol-induced liver injury.

Peptic Ulcers and Erosions in Children at a Pediatric Unit in Turkey.

OBJECTIVE: To study the characteristics of peptic ulcer and erosion in pediatric patients. METHODS: Over a period of seven years, 1,026 children underwent upper gastrointestinal endoscopy in our pediatric gastroenterology unit. RESULTS: Peptic ulcers and erosions were found in 59 (7.2%) patients [ulcers in 42 (5.1%)and erosions in 17 (2.1%)]. Thirty (50.9%) children presented with acute upper gastrointestinal bleeding. Helicobacter pylori positivity was found in 27 patients (45.8%), and ulcerogenic medication use was found in 13 (22%) patients. CONCLUSION: The main risk factors for childhood peptic ulcer and erosions were H. pylori infection and non-steroidal anti-inflammatory drug use.

Cystic Eechinococcosis in Childhood: Five-Years of Experience From a Single-Center.

OBJECTIVE: To evaluate the clinical data and prognosis of cystic echinococcosis during a 5-year period who were followed by the pediatric clinics. METHODS: Demographic, clinical, laboratory, and prognosis data of 34 patients with cystic echinococcosis obtained between 2009 to 2014 were retrospectively evaluated. Of these, 10 patients were excluded because of incomplete data or failure to follow up. RESULTS: A total of 24 (12 males and 12 females) children were included the study. The mean ages of patients were 11.17 ± 3.71 (range, 5-17) years. The most common symptoms were abdominal pain (41.7%), cough (16.7%), and fatigue (12.5%). Localization of the parasite in the patients was determined to be as follows: liver (54.2%), lung (33.3%), and intraabdominal (4.2%). Multiorgan involvement was observed in 8.3% of the cases. Indirect hemagglutination test was positive in 13 (54.2%) patients at admission. All patients received treatment with albendazole. Seven patients were treated with puncture-aspiration-injection-re-aspiration (PAIR) (29.2%). Open surgery was performed in six patients (24.2%). One patient was treated with both PAIR and open surgery. CONCLUSIONS: Cystic echinococcosis is a serious public health problem in developing countries. Hydatid cyst should be considered in the presence of suspicious radiological and clinical findings in endemic areas.