The relationship between gastric ultrasound findings and endoscopically aspirated volume in infants and determining the antral cutoff value for empty stomach diagnosis.

BACKGROUND/AIMS: Pulmonary aspiration of gastric content is a serious perioperative complication. The objective of this prospective study was to assess the relationship between the gastric volumes suctioned endoscopically and quantitative (antral cross-section area) and qualitative (empty vs. nonempty) examination of the gastric antrum. Furthermore, the study aimed to determine the best antral cross-section area cutoff value for a truly empty antrum in infants. METHODS: This study was performed in a pediatric gastrointestinal endoscopy unit. Antral sonography was performed in supine and right lateral decubitus positions in 46 fasted infants prior to upper gastrointestinal endoscopic evaluation. Antral cross-sectional area measurements in both positions and qualitative evaluation of the antrum (according to a three-point grading system) were recorded. Gastric contents were endoscopically suctioned and measured. RESULTS: Forty-six patients (aged under 24 months) were included. According to the three-point qualitative grading system, 76.1% of patients were classified as grade 0. The best cutoff value for the antral cross-section area in the right lateral decubitus position, indicating an empty antrum, was determined to be 2.40 cm2 . At this specific cutoff value, the sensitivity was 100%, the specificity was 68.6%, and the negative predictive value was 100%. CONCLUSIONS: Gastric ultrasonography can confirm an empty or nearly empty stomach in healthy infants.

Evaluation of vascular and perfusional changes in the retina and choroid of children with multisystem inflammatory syndrome.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is hyperinflammation following coronavirus disease 2019 (COVID-19), which affects many organs. The retina and choroid are affected by COVID-19 through microangiopathy and thrombosis but the literature on MISC-C is limited. METHODS: Thirty children (60 eyes) with MIS-C (the study group, or SG) and 32 age-and gender-matched healthy children (64 eyes) (the control group, or CG) were included in the prospective case-control study. Complete ophthalmological examinations, measurements of the vessel densities of the retinal layers, and flow area of the outer retina and choriocapillaris in both groups were conducted with optical coherence tomography angiography (OCT-A). RESULTS: The mean age of the SG was 11.9 ± 3.9 and that of the CG was 12.5 ± 4.6 years (p = 0.197). In this study we found that the vessel density of the deep layer of the inner retina was decreased significantly and was reduced in the outer retina of flow area in the SG in comparison with the CG (p < 0.05, for all). However, there was no significant difference between the groups regarding other measurements. CONCLUSIONS: In MIS-C patients, vessel densities in the deep layer of the inner retina and in the flow area of the outer retina decreased significantly. This OCTA-A finding suggests that MIS-C is related to endothelial thrombotic condition problems in small branches of the retinal artery. The results of this study support the idea that there is a need for screening of MIS-C patients for the presence of these microangiopathic and perfusional complications.

Clues for inflammatory diseases in the differential diagnosis of a child with sacroiliitis.

BACKGROUND: The purpose of this study was to compare the demographic, clinical and laboratory characteristics of patients with enthesitis-related arthritis (ERA), familial Mediterranean fever (FMF) and inflammatory bowel disease (IBD), which are inflammatory diseases that may develop sacroiliitis. Thus, it was aimed to reveal various findings that may indicate primary disease in patients with sacroiliitis. METHODS: Pediatric patients aged 6-18 years, who were being followed with a diagnosis of ERA (n = 62), FMF (n = 590), and IBD (n = 56) over the period 2013-2021 were included in the study. Sacroiliitis (n = 55) was diagnosed by magnetic resonance imaging of the sacroiliac joint, obtained from clinically suspected patients. RESULTS: Sacroiliitis was detected in 54.8% of ERA patients, 2.3% of FMF patients, and 12.5% of IBD patients. The mean follow-up period was 4.1 ± 2.8 years (10 months-8 years) for the entire study group. The most common MRI finding for sacroiliitis was bone marrow edema. Peripheral joint involvement (73.5%) and HLA B27 positivity (64.7%) was significantly higher in ERA patients, and ERA was diagnosed more frequently in patients presenting with sacroiliitis. Non-steroidal anti-inflammatory drugs (NSAIDs) were the first choice of treatment agent when sacroiliitis developed in all three patient groups. CONCLUSIONS: The clinical and laboratory findings of ERA, FMF and IBD can sometimes be intertwined or can even coexist. Treatment may differ depending on the disease associated with sacroiliitis, although NSAIDs may be used in the first-line treatment of all three diseases. Sacroiliitis patients with HLA B27 positivity and peripheral arthritis may need to be addressed as ERA.

Celiac crisis with thrombocytopenia and coagulopathy in a child.

BACKGROUND: Celiac disease rarely presents with edema, hypoalbuminemia, acute metabolic deterioration, and electrolyte imbalances. This life-threatening condition is defined as a celiac crisis and may mimic disorders with metabolic derangement and sepsis. The crisis may present at onset or develop in celiac disease patients with poor compliance to a gluten-free diet. The fluid resuscitation and replacement of electrolyte deficits are life-saving modalities. CASE: A 14-month-old girl was admitted with fever, lethargy, severe dehydration, edema, hypotension, and commenced sepsis therapy. However, the patient had a growth delay and loss of weight with diarrhea and delayed motor skills. On admission, laboratory evaluation showed anemia, coagulopathy, hypoalbuminemia, electrolyte disturbances, and metabolic acidosis and developed thrombocytopenia during follow-up. The celiac serological tests and upper gastrointestinal endoscopic duodenal mucosa appearance, and duodenum histopathology findings suggested celiac disease. CONCLUSIONS: This case highlights that a celiac patient may present with a severe illness like sepsis and may be associated with cytopenia and coagulopathy in the celiac crisis.

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.

Evaluation of eye involvement in paediatric celiac disease patients.

BACKGROUND: The non-classic presentation of paediatric celiac disease (CeD) becomes increasingly common in daily practice, which requires an awareness of eye findings. The purpose of this study was to evaluate eye involvement and effect of gluten-free diet on ocular involvement in paediatric CeD patients by measuring the thicknesses of choroid and ganglion cell complex (GCC) composed of retinal nerve fibre layer, ganglion cell layer and inner plexiform layer using enhanced depth imaging optical coherence tomography. METHODS: Forty-three CeD patients aged between four and 16 years (mean age: 9.9 ± 4.1, 12 boys and 31 girls) and 48 healthy children (mean age: 11.3 ± 4.1,17 boys and 31 girls) were compared. Following comprehensive eye examinations, thicknesses of choroid at three points and GCC layers (retinal nerve fibre layer at five points, ganglion cell layer and inner plexiform layer) were obtained using enhanced depth imaging optical coherence tomography. Measurement of thicknesses of choroid and GCC layers by a trained optical coherence tomography technician and an ophthalmologist who were not aware about group of children in paediatric CeD patients with 1 year gluten-free diet was carried out. RESULTS: All layers of subfoveal, nasal and temporal choroid were significantly thinner in CeD than in the control group (P < .001, all, respectively). No significant difference was observed between the CeD and control groups in terms of GCC thicknesses (P > .05, all, respectively). CONCLUSION: Paediatric CeD caused thinning of subfoveal, nasal and temporal areas of choroid, and this change is apparent even after 1 year gluten-free diet. This eye involvement should be more closely screened at diagnosis, and long-term clinical results of thin choroid should be determined. Thicknesses of GCC layers were not different in CeD group and may reveal the effect of diet or not involvement.

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.

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.

Is kiwifruit allergy a matter in kiwifruit-cultivating regions? A population-based study.

BACKGROUND: Although kiwifruit is known as a common cause of food allergy, population-based studies concerning the prevalence of kiwifruit allergy do not exist. We aimed to determine the prevalence and clinical characteristics of IgE-mediated kiwifruit allergy in 6-18-year-old urban schoolchildren in a region where kiwifruit is widely cultivated. METHODS: This cross-sectional study recruited 20,800 of the randomly selected 6-18-year-old urban schoolchildren from the Rize city in the eastern Black Sea region of Turkey during 2013. Following a self-administered questionnaire completed by the parents and the child, consenting children were invited for skin prick tests (SPTs) and oral food challenges (OFCs). Children with suspected IgE-mediated kiwifruit were skin prick tested with kiwifruit (commercial allergen and prick-to-prick test with fresh kiwifruit) and a pre-defined panel of allergens (banana, avocado, latex, sesame seed, birch, timothy, hazel, cat, Dermatophagoides pteronyssinus, and Dermatophagoides farinae). All children with a positive SPT to kiwifruit were invited for an open OFC. The prevalence of IgE-mediated kiwifruit allergy was established using open OFCs. RESULTS: The response rate to the questionnaire was 75.9% (15783/20800). The estimated prevalence of parental-perceived IgE-mediated kiwifruit allergy was 0.5% (72/15783) (95% CI, 0.39-0.61%). Of the 72 children, 52 (72.2%) were skin tested, and 17 (32.7%) were found to be positive to kiwifruit with both commercial extract and kiwifruit. The most frequently reported symptoms in kiwifruit SPT-positive children were cutaneous (n = 10, 58.8%) followed by gastrointestinal (n = 6, 35.3%) and bronchial (n = 4, 23.5%). Oral symptoms were reported in six (35.3%) children. All children who were kiwifruit positive by SPT were found positive during the oral challenge. The confirmed prevalence of IgE-mediated kiwifruit allergy by means of open OFC in 6-18-year-old urban schoolchildren living in Rize city was 0.10% (95% CI, 0.06-0.16). CONCLUSION: Prevalence of parental-perceived and clinically confirmed kiwifruit allergy is not consistent. In contrast to expectations, kiwifruit allergy prevalence was low in a city where it is cultivated and highly consumed.

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.

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.

Gastrointestinal Neuroendocrine Tumors in Two Children.

BACKGROUND: Enterochromaffin-like cell hyperplasia and neuroendocrine tumors are relatively rare in childhood. CASE CHARACTERISTICS: A 15-year-old girl who presented with epigastric pain and a 6-year-old boy who was admitted with hematochezia. Endoscopy revealed nodules in the stomach in Case 1, and polyploidy lesion in the rectum in Case 2. OUTCOME: Enterochromaffin-like cell hyperplasia in Case 1 and neuroendocrine tumor in Case 2. MESSAGE: A low index of suspicion for neuroendocrine tumors in children can result in delay in the detection of these rare but potentially malignant diseases.

The etiology of hypertransaminasemia in Turkish children.

The aim of this study was to investigate the causes of elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in children. We analyzed the medical records for children aged 3 months to 18 years who presented to the hospital with ALT >45 IU/L and/or AST >50 IU/L, between 2012 and 2014, for various reasons, including those not related to liver disease. In total, 281 children met the study criteria. This group comprised of 125 (44.5%) females and 156 (55.5%) males. At the presentation, the most common patient complaint was fatigue (53.4%), while 15.7% of the patients reported no symptoms. The most common findings on the physical examination were jaundice and hepatomegaly. In 15% of the cases, the findings were normal. According to the diagnosis, the most common cause of the elevated transaminases were infections (34%), with hepatitis A virus (HAV) infection as the leading cause (18.9%). Drug-induced liver injury (DILI) was the cause in 18.1% of the cases and non-alcoholic fatty liver disease (NAFLD) in 11.1%. The highest transaminase levels were associated with HAV infection, while DILI and NAFLD caused only slightly elevated transaminases. Overall, our results show that the elevated transaminases in children are most often caused by infections, DILI, and NAFLD. In a majority of cases, elevated ALT and AST indicate liver disease, however, they could also be associated with conditions other than liver damage. Additionally, the elevated enzymes can be detected in completely healthy individuals.

Status of vitamin D, antioxidant enzymes, and antioxidant substances in neonates with neonatal hypoxic-ischemic encephalopathy.

OBJECTIVE: To investigate the concentration of vitamin D (VD), glutathione peroxidase (GP), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) in neonates with hypoxic-ischemic encephalopathy (HIE). MATERIAL AND METHODS: This study was performed prospectively in term neonates treated for HIE. Samples were collected from the neonates in study and control groups at 6-14 h and on day 5 of their lives for 25-OH vitamin D3, antioxidant enzymes including GP and SOD and oxidants substances including MDA and AOPP. RESULTS: This study was performed with 31 term neonates with HIE and 30 healthy term neonates. Maternal VD level was statistically lower in the study group (9.8 ± 6.8 ng/mL) than the control (16.4 ± 8.7 ng/mL) (p = 0.002). SOD and MDA levels were significantly high, and VD level was significantly low in the study group on the first day of life (p = 0.001 and p = 0.028, respectively). SOD and GP levels were significantly high in the study group on day 5 (p < 0.05). VD was significantly low in the study group on day 5 and the proportion of subjects with VD below 5 ng/ml was significantly lower in the control group (p= <0.05). CONCLUSION: VD has neuroprotective and antioxidant properties. We detected VD levels were low in infants with HIE and their mothers. This finding may be useful for decreasing of brain damage.