A major health problem facing immigrant children: nutritional rickets.

OBJECTIVES: Nutritional rickets (NR) is still an important problem and one which increasing influxes of immigrants are further exacerbating. This study evaluated cases of mostly immigrant children followed up with diagnoses of NR in our pediatric endocrinology clinic. METHODS: Details of 20 cases diagnosed with NR between 2017 and 2020 were retrieved from file records. RESULTS: Twenty (11 male) cases were included in the study. Three (15%) were Turkish nationals and the others (85%) were immigrants. Hypocalcemia and hypophosphatemia were detected in 17 and 13, respectively. Alkaline phosphatase (ALP) values were normal in two cases, while ALP and parathyroid hormone (PTH) values were elevated in all other cases, and PTH levels were very high (473.64 ± 197.05 pg/mL). 25-hydroxyvitamin D levels were below 20 ng/mL in all cases. Patients with NR received high-dose long-term vitamin D or stoss therapy. Six patients failed to attend long-term follow-up, while PTH and ALP levels and clinical findings improved at long-term follow-up in the other 14 cases. CONCLUSIONS: The elevated PTH levels suggest only the most severe cases of NR presented to our clinic. Clinically evident NR is therefore only the tip of the iceberg, and the true burden of subclinical rickets and osteomalacia remains unidentified. Public health policies should therefore focus on universal vitamin D supplementation and adequate dietary calcium provision, their integration into child surveillance programs, adequate advice and support to ensure normal nutrition, exposure to sunlight, and informing families of the increased risk not only for resident populations but also for refugee and immigrant children.

Evaluation of Growth Hormone Results in Different Diagnosis and Trend Over 10 Year of Follow-up: A Single Center Experience

Objective: The aim was to evaluate the results of diagnosis, follow-up and treatment of the patients who recieved growth hormone (GH) treatment for the last 10 years and to determine the differences in the process and results over the years. Methods: Anthropometric, clinical, laboratory data, treatment adherence and side effects were evaluated retrospectively in 767 patients who recieved GH treatment between 2009-2018. Patients were grouped as isolated GH deficiency (IGHD), multiple pituitary hormone deficiency (MPHD), small for gestational age (SGA), and Turner syndrome (TS) depending on diagnosis. Results: GH treatment was started in 689 cases (89.8%) with IGHD, 24 (3.1%) with MPHD, 26 (3.4%) with SGA and 28 (3.7%) with TS. Median age of GH treatment onset was the earliest in SGA (8.4 years) and the latest in the IGHD group (12.0 years). At the time of treatment cessation, height standard deviation score (SDS) in IGHD and MPHD was significantly higher than treatment initiation time, whereas there was no significant difference in TS and SGA. One hundred eighty-nine cases reached the final height. Final heights for girls/boys were: IGHD 154/164.9 cm; MPHD 156.2/163.5 cm; TS 146.7 cm; and SGA 145.7/-cm, respectively. Target height SDS-final height SDS median values were IGHD: 0.1, MPHD: 0.6, SGA: 0.5, TS: 2.4 respectively. The patients' treatment compliance was high (92%) and the incidence of side effects was low (2.7%). Conclusion: In our cohort, GH treatment start age was late and no difference in this was observed in the last 10 years. The improvement in the height SDS was most marked in the IGHD and MPHD groups, the least in the TS and SGA groups.

Cigarette smoking in adolescents with type 1 diabetes mellitus and congenital adrenal hyperplasia.

Asfuroglu P, Arasli-Yilmaz A, Aycan Z. Cigarette smoking in adolescents with type 1 diabetes mellitus and congenital adrenal hyperplasia. Turk J Pediatr 2019; 61: 236-243. Adolescence is a long period involving many physical and psycho-social changes experienced during transition from childhood to adulthood. In this period, behaviors such as curiosity and risk-taking are common, and cigarette smoking initiation is one of those behaviors. In this study, it was aimed to find out whether chronic diseases are an effective factor or not in the cigarette smoking initiation of adolescents. One-hundred adolescents with Type 1 Diabetes Mellitus (T1DM) and 50 adolescents with Congenital Adrenal Hyperplasia (CAH) aged 12 and above under follow-up at the Pediatric Endocrinology Clinic and 100 healthy adolescents within the same age group who applied to the Adolescent Outpatient Clinic were included in the study. A survey was applied to all of these adolescents, which had been developed by researchers and contained questions about their socio-demographic features and cigarette smoking. Fourteen (5.6%) of the 250 adolescents were smokers. The rate of those who tried, but quitted cigarette smoking was found as approximately 20%. Cigarette smoking rate of those with T1DM was 1%, of those with CAH was 4%, and of the healthy adolescents was 11%. Cigarette smoking was significantly lower in those with a chronic disease (2%) than those who were healthy (11%). Adolescents` parents and friends had an effect on the cigarette smoking initiation, and adolescents smoked their first cigarette generally because of curiosity. It was seen in this study that the adolescents with a chronic disease less frequently smoked cigarettes than the healthy adolescents, the rate of cigarette smoking in parents of cigarette smoking adolescents was very high, and their parents and friends had an effect on cigarette smoking initiation of adolescents.

Evaluation of children presenting to the emergency room after electrical injury.

BACKGROUND/AIM: To evaluate children who presented to the Pediatric Emergency Department with electrical injury and to discuss the follow-up of these cases and potential precautions that can be taken. MATERIALS AND METHODS: A total of 36 patients presented to the Pediatric Emergency Department with electrical injury between May 2010 and May 2013, and these cases were investigated retrospectively. The patients' age and sex, location and form of exposure to electric current, seasonal distribution, length of hospital stay, musculoskeletal and cardiovascular system complications, renal damage, and treatments were recorded. RESULTS: The majority of the patients were exposed to low-voltage electrical current at home. When the patients were evaluated based on the type of electric current, alanine transaminase, aspartate transaminase, creatine kinase, and creatine kinase-myocardial isoenzyme levels were found to be significantly higher among patients who were exposed to high-voltage electric current. None of the patients died, and the mean length of hospital stay was 2.50 ± 1.06 days. CONCLUSION: Electrical injuries can present with a wide variety of problems, ranging from a simple injury to life-threatening severe multiple organ injury. Even simple precautions can prevent possible morbidity and mortality. We think that the public level of knowledge and awareness should be increased.