Thinning of the retinal nerve fiber and choroidal layers in adolescents with anorexia nervosa: A controlled study.

PURPOSE: We aimed to evaluate retinal nerve fiber and choroidal layer alterations in adolescents with anorexia nervosa using spectral-domain optical coherence tomography. METHODS: Thirty patients with anorexia nervosa and 30 healthy adolescents aged 12-18 years were included in this study. Their age, sex, body mass index, anorexia nervosa type, disease duration, and spectral-domain optical coherence tomography data were recorded. RESULTS: Central macular thickness and retinal nerve fiber layer thickness in the temporal and inferior regions were significantly lesser in patients with anorexia than in healthy controls (p<0.05). Moreover, significant choroidal thinning around the foveal and subfoveal regions in patients with anorexia was observed (p<0.05). In addition, a statistically significant relation between the increase in disease duration and the thinning of the inferior retinal nerve fiber layer was detected (p<0.05). CONCLUSION: The retinal nerve fiber layer and choroidal layer thicknesses were lesser in patients with anorexia than in healthy controls. Screening for retinal indices might prevent the development of irreversible retinal pathologies in adolescents with anorexia nervosa. In addition, thinning of the retinal nerve fiber and choroidal layers could reflect structural or functional changes in the brain of adolescents with anorexia nervosa.

Menstrual Cycle Pain Is Independent of Ovulation in Adolescents With Primary Dysmenorrhea.

STUDY OBJECTIVE: This study aimed to evaluate the presence of anovulation in adolescents with primary dysmenorrhea (PD). DESIGN: Prospective cohort study. SETTING: Hacettepe University Children's Hospital, Adolescent Medicine outpatient clinic between September 2018 and September 2019. PARTICIPANTS: Healthy female adolescents (between 11 and 18 years of age), with regular menstruation with a score of 1-3 according to the Numerical Rating Scale (NRS) and grade 0 (no limitation for daily activities, no analgesic need and systemic symptoms) according to the Verbal Multidimensional Scoring System (VBSS) were recruited as a control group. The participants who met the diagnostic criteria for PD with an NRS score ≥4, had analgesic need in at least the last 3 menstrual cycles, had defined moderate-to-severe PD according to VMSS (Grade 2-3), and had analgesic need every time were accepted as the PD group. INTERVENTION AND MAIN OUTCOME MEASURES: For the determination of ovulation, suprapubic pelvic ultrasound and luteal SP levels were used. The first day of menstruation (DOM) was accepted as the first day of the menstrual cycle. The participants were called to the outpatient clinic for a total of 3 visits during 1 cycle; the first visit was for the suprapubic pelvic ultrasound imaging on the 12th-18th DOM, the second visit was for the first SP level measurement on the 21st-24th DOM, and the third visit was for the second SP level measurement on the 28th-31st DOM, if the next expected menstruation has not started yet. Participants' anthropometric measurements, menstrual history, family history of dysmenorrhea, and additional symptoms accompanying pain were recorded. RESULTS: Anovulatory cycle rates according to 2 different references for SP threshold values (3 and 5 ng/mL) were 31.7% and 36.6% in the PD group, and 44.4% and 55.6% in the control group, respectively (P = .250, P = .095). In the PD group, NRS scores were similar for the ovulatory and anovulatory cycles for both SP threshold values (P = .320, P = .205). When the reference value for SP threshold was accepted as ≥5 ng/mL, the NRS score was significantly higher in the ovulatory group (P = .0017). When the distribution percentages of SP levels were evaluated among all participants, the median value was 5.5 ng/mL. CONCLUSION: Contrary to classical information, anovulatory cycles are not rare in PD patients, and pain severity is at the same level in these cycles. The pathogenesis of PD in adolescents requires further study.

Hepatitis A virus age-specific seroprevalence after the implementation of a Toddlers' Vaccination in Turkey: Shifting susceptibility to adolescents.

AIM: In Turkey, improvements in sanitation and the implementation of a vaccination program resulted in reduced rates of childhood exposure to hepatitis A virus. The incidence of symptoms and the complications of the disease are known to be increased in later ages. We aimed to describe changes in the seroprevalence of hepatitis A virus from the pre-vaccine era (2012) to the post-vaccine era (2018) in different age groups. MATERIAL AND METHODS: Levels of anti-hepatitis A virus immunoglobulin (Ig)-G of patients with no chronic disease and who were admitted to our hospital between 2013-2018 were obtained retrospectively from a single children's hospital database system. RESULTS: A total of 3238 subjects were enrolled in the study (2820 children, 418 adults). The overall percentage of seropositivity was 60.5% in group 1 (age ≤2 years), 57.9% in group 2 (age 2-6 years), 31.2% in group 3 (age 7-11 years), 32.7% in group 4 (age 12-18 years), 44.6% in group 5 (age 19-24 years), and 73.9% in group 6 (age >25 years). Between 2013-2018, the increase in the number of seropositive individuals in group 2 (p<0.01), and the decrease in groups 3 and 4 were statistically significant from 2013 to 2018 (p=0.028, p<0.01). CONCLUSION: According to the data of this single-center children's hospital in Turkey, hepatitis A virus seropositivity increases significantly in the preschool age group, but decreases in school-age children and adolescents after vaccination.

Knowledge and awareness of optimal use of reporting guidelines in paediatricians: A cross-sectional study.

Aim: The aim of this study was to investigate pediatricians' ideas and awareness of reporting guidelines of scientific researches, as well as the use of these guidelines in routine practice. Material and Methods: This cross-sectional survey was conducted among pediatricians working at two of the largest pediatric hospitals in Ankara. The pediatricians were asked to complete a 13-item questionnaire in Turkish about reporting guidelines and the Enhancing the Quality and Transparency of Health Research internet network, and their level of knowledge, awareness, and use of these guidelines were investigated. Results: A total of 224 physicians from both centers agreed to participate in the study (56.4% of the target population). The average age of the participants was 34±9.24 years, their median age was 31 (min-max: 24-63) years, and 71.4% were female physicians. The participants' median duration in their careers was 6 (min-max: 1-39) years and 63.8% had participated in a scientific study as a researcher. Forty-five (20%) of the participants had known about the reporting guidelines before and reported that they had most frequently heard about them via journals, congresses, and seminars. Twenty (26.6%) of these physicians had used the guidelines. Sixty-five (29%) of the participants had served as a reviewer for a scientific article, but only three (4.6%) stated that they had made use of the guidelines while reviewing the articles. Some 83.5% of the participants reported that they would like to be informed about reporting guidelines. Both centers had similar knowledge levels about the use of the guidelines. Conclusion: The awareness and use of reporting guidelines of scientific researches by pediatricians is insufficient.

Association of hemolysis with high dose intravenous immunoglobulin therapy in pediatric patients: An open-label prospective trial.

Immunoglobulin therapy can be used to treat a wide variety of diseases. However, intravenous immunoglobin products can cause several adverse reactions, including hemolysis. The objective of this study was to determine the extent of anemia and hemolysis after high dose intravenous immunoglobin (2g/kg) and its relationship to the ABO blood type system and hemolytic anemia blood parameters in pediatric patients. Incidence of 'Intravenous immunoglobulin related hemolysis' was %19 (6/31) after high dose intravenous immunoglobulin therapy. The blood parameters were measured before IVIG infusion (1-24h before infusion) and 3-10 days after the first day of infusion. In terms of decrease in Hb levels; decline of <1g/dL was detected in 25 patients (80.6%), ≥1g/dL in 2 patients (6.5%) and >2g/dL (severe hemolysis) in 4 patients (12.9%) after infusion. The decrease in hemoglobin, haptoglobin levels, the increase of reticulocyte count or direct bilirubin were statistically significant after infusion. Five of 6 hemolysis patients had non-O blood group, however statistically significant difference was not noted between these two groups. Also, intravenous immunoglobulin-related hemolysis was determined significantly higher in female than male patients. CONCLUSION: Mild to moderate hemolysis may be undetected after infusion and the true incidence of such reactions is difficult to document without careful clinical and laboratory follow-up. A careful risk assessment analysis should be performed before intravenous immunoglobulin infusion.

Atypical presentation of multicentric Castleman disease in a pediatric patient: pleural and pericardial effusion.

UNLABELLED: Castleman disease (CD) is a rare poorly understood lymphoproliferative disorder. Pediatric onset CD has been reported before. However, most of them have benign unicentric pattern. Multicentric CD (MCD) is quite rare in children. Herein, we report a 13-year-old adolescent boy with MCD of the hyaline vascular variant presenting with pleural and pericardial effusion, which is an uncommon presentation. CONCLUSION: MCD should be considered in the differential diagnosis of pleural and/or pericardial effusion with unexplained lymph nodes in children. What is Known •Pediatric Castleman disease (CD) most commonly occurs in the unicentric form, which typically is asymptomatic and cured by lymph node excision. •The diagnosis of MCD can be difficult owing to the heterogeneity of presentation and potential for nonspecific multisystem involvement. What is New •A 13-year-old adolescent boy was diagnosed with MCD of the hyaline vascular variant presenting with pleural and pericardial effusion, which is an uncommon presentation. •In a pediatric patient with fever, pleural-pericardial effusion and multiple lymph nodes, MCD should be considered in differantial diagnosis.

Brain death and organ donation of children.

We aimed to define the demographic characteristics, clinical features and outcome of patients with brain death, and to emphasize the importance of organ donation from children. Data for the period from September 2009 to October 2012 were collected retrospectively. Twenty children who were diagnosed as brain death were included. Data including demographics, major cause leading to brain death, duration of brain death evaluation, ancillary tests used to confirm brain death, complications and outcome, duration of hospitalization and organ donation were collected for statistical evaluation. The mean age was 6.2 years, and the male/female ratio 1.85. The major cause leading to brain death was most often traumatic brain injury, seen in 11 patients (55%). The mean duration of brain death evaluation was 6.7 and 1.7 days in Centers I and II respectively. The mean duration of hospitalization was 12.5 days. Electroencephalography (EEG) was used in 18 patients (90%). Complications included hyperglycemia in 13 cases and diabetes incipitus in 7 cases (65% and 35%, respectively). Mean duration of survival was 9.8 days. In Center I, one of the patients' parents gave consent to organ donation, while four parents in Center II agreed to organ donation. The study demonstrated that the duration of brain death evaluation was longer in Center I than in Center II (p<0.05). When both centers were compared, there was no significant difference in regard to obtaining consent for organ donation, survival after diagnosis of brain death and length of stay in the PICU (p>0.05). Early diagnosis of brain death and prompt evaluation of patients by ICU physicians once the diagnosis is taken into consideration will probably yield better organs and reduce costs. Training PICU physicians, nurses and organ donation coordinators, and increasing children's awareness of the need for organ donation via means of public communication may increase families' rate of agreement to organ donation in the future.

An unusual localization of the umbilicus in a neonate.

We report the case of a male neonate with a low-set umbilicus. Physical examination revealed an appropriately grown term infant with no unusual findings, except ectopically placed umbilical cord at the level of the bladder in the hypogastric zone. The infant underwent detailed investigations that revealed no associated malformation. To the best of our knowledge, this is the first case with very distinct localization of the umbilicus without any congenital abnormalities.

Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey.

BACKGROUND: The aim of this study was to establish the frequencies of vitamin D deficiency and insufficiency among healthy children aged 1-16 years and also to determine the factors affecting the levels of vitamin D in Turkey. METHODS: A total of 849 healthy individuals whose ages ranged from 1 to 16 years were included in the study. Serum 25(OH)D, calcium, phosphorous and alkaline phosphatase l levels were measured at the end of the winter period. The approximate daily calcium intake was calculated by using a 1-week diet history. RESULTS: We determined that the prevalence of vitamin D deficiency (<20 ng/mL) was 8% and that of vitamin D insufficiency (20-29 ng/mL) was 25.5% in the population investigated. The average daily intake of calcium was especially low in the >8-year-old age group (<1300 mg/day). CONCLUSION: Vitamin D insufficiency was found to be very common in the population investigated. The daily calcium intake was below the adequate levels especially in school children. Vitamin D supplementation after the first year of life could be beneficial especially for school children and adolescents. The government must develop public policies for the fortification of milk, milk products, and fruit juices with vitamin D.