Prevalence of scalp disorders and hair loss in children.

Hair loss in children can have psychologic effects that interfere with a child's growth and development. In our case series, we evaluated 1003 children aged 0 months to 17 years who presented to the pediatric and dermatology outpatient clinics at Fatih University, Ankara, Turkey, from December 2009 through October 2010. The patients were routinely examined for scalp disorders and hair loss. We documented 69 patients with scalp disorders and hair loss, most commonly seborrheic dermatitis (SD), transient neonatal hair loss (TNHL), alopecia areata (AA), temporal triangular alopecia (TTA), and pityriasis amiantacea (PA); The clinical presentation of scalp disorders and hair loss in children varies widely and may be attributed to congenital or acquired causes. Hair loss in children can be associated with serious illness. Therefore, hair examination by a pediatrician or dermatologist is an important part of the physical examination.

Preauricular sinus, nephrolithiasis, infantine eczema and natal tooth: a new association.

Preauricular sinuses (ear pits) are common congenital abnormalities. The incidence of preauricular sinus is widely varied. Usually asymptomatic, they manifest as small hollows adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. They may be bilateral, increasing the likelihood of being inherited, in 25-50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3-10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. A girl, who was three months and 20 days old, was presented because of the co-existence of a right infected preauricular sinus, nephrolithiasis, infantile eczema and a natal tooth.

The relationship between serum magnesium levels with childhood obesity and insulin resistance: a review of the literature.

BACKGROUND: Magnesium, the second most abundant intracellular cation, plays a major role in regulating insulin effect and insulin mediated glucose uptake. It has been shown that serum magnesium levels were negatively correlated with HOMA-IR (homeostasis model of insulin resistance) index. AIM: To investigate the relationship between serum magnesium levels with obesity and insulin resistance in childhood. METHODS: Two hundred and three children and adolescents (117 obese children and 86 controls) were included. Obese cases were also subgrouped according to the presence or absence of insulin resistance (IR) as "IR (+) obese" and "IR (-) obese", respectively. Serum glucose, insulin and magnesium levels were measured after a 12-h fasting at 8-8.30 a.m. We assessed insulin sensitivity by using HOMA-IR index as a surrogate marker of insulin resistance. RESULTS: Serum levels of magnesium were significantly lower in the IR (+) obese group than controls (p = 0.014). At the same time, there was a positive correlation between serum magnesium levels and body mass index-standard deviation score (BMI-SDS) (r = -0.28, p = 0.03) in the IR (-) obese group. CONCLUSIONS: Low serum magnesium levels may contribute to the development of insulin resistance in obese children.

Baby walkers: a perspective from Turkey.

AIM: To determine in an urban population in Turkey, the frequency of baby walker (BW) use, beliefs and attitudes of mothers regarding BWs, frequency of BW-related injuries and whether families receive counselling from their paediatricians about BWs or not. METHODS: Children aged 2 months to 5 years who attended the well-child care clinics of Fatih University Hospital in Ankara comprised the sample. A semi-structured questionnaire was verbally administered. RESULTS: Of 495 children, 75.4% was found to use BW. Female gender [odds ratio (OR) = 1.82, 95% confidence interval (CI) =1.19-2.78) and lower maternal education (OR = 0.37, 95% CI = 1.18-0.74) were found to be associated with BW use. Frequencies of injuries associated with BWs were low (7.8%). Only 92 (18.6%) families received appropriate counselling by their paediatricians. CONCLUSION: The results of our study show that BW use is common in urban Turkey. Families are not informed about the lack of benefits and potential hazards of BWs and base reasons of using and not using on unique cultural beliefs rather than informed, evidence-based decisions. Paediatricians in Turkey and potentially other countries require information about the need for counselling families about the hazards associated with BW use.

Doppler sonography of the superior mesenteric artery in children with recurrent abdominal pain.

PURPOSE: Abdominal pain is one of the most common conditions in childhood and adolescence. The aim of this study was to evaluate the superior mesenteric artery (SMA) Doppler findings in children with recurrent abdominal pain. METHOD: Duplex Doppler sonographic measurements were performed in 20 patients with recurrent abdominal pain and in 34 controls. RESULTS: The mean blood flow velocities, blood flow volume, and diameter of the SMA were significantly lower in patients with recurrent abdominal pain than in controls. CONCLUSION: Insufficient development and/or vasoconstriction of the SMA vascular bed may be involved in recurrent abdominal pain, but further studies on larger groups are needed to test this hypothesis.

Methylphenidate-induced acute orofacial and extremity dyskinesia.

Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. Orofacial dyskinesia appeared 5 hours after methylphenidate administration, persisted for 10 hours, and had completely resolved within 2 days. Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors' knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug-receptor interactions via different mechanisms.

[Newborn with genital interlabial mass with spontaneous resolution: case report]. / Recién nacida con tumoración genital interlabial de resolución espontánea. Caso clínico.

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartner's duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.

Pediatricians' attitude about the use of infant walkers.

UNLABELLED: Infant walkers are still very popular even though their use might cause injuries. A survey was carried out to obtain information about attitudes and pediatricians' approach regarding the use of infant walkers. Two hundred and forty seven pediatricians who attended the 44th Turkish Congress of Pediatrics and Europediatrics (2008) were invited to reply to a questionnaire prepared by the authors. Two hundred and twenty six questionnaires replied in full were included. The median age of participants (119 women) was 39 years old (range: 29-58 years old). Out of the total, 4% recommended the use of a walker; 32.2% left the decision to parents' judgment, and 63.7% did not recommend its use. A hundred and five had previously treated an infant who had an injury associated to the use of the walker; out of them, 73.3% did not recommend its use and 57.1% stated that there should be a ban on the sale and manufacture of walkers. CONCLUSIONS: Out of the total number of surveyed pediatricians, 4% recommend the use of infant walkers and over 30% leave this decision to parents. Those pediatricians who took care of babies who had an injury associated to the use of a walker were less prone to recommending it.

Is routine abdominal ultrasonography necessary in macrosomic newborns with difficult delivery?

Adrenal hemorrhage is a relatively uncommon clinical problem of the newborn period. Clinical features of adrenal hemorrhage are variable. An abdominal mass, anemia, unexplained/persistent jaundice, bluish discoloration of the scrotum may be the presenting sign. Here, we presented a macrosomic infant (4150 gr) whose left side adrenal hematoma associated with asphyxia and early onset of hyperbilirubinemia. We concluded that the pediatricians should be considered abdominal US screening regard as internal hemorrhage in macrosomic newborns who delivered with difficult labor and then seen pathologic jaundice.

[An uncommon cause of hypocalcemic convulsion: congenital rickets. Case report]. / Una causa infrecuente de convulsión hipocalcémica: raquitismo congénito. Caso clínico.

Vitamin D deficiency and rickets are major health problems in developing countries. Congenital rickets is a rare form of rickets. Maternal vitamin D deficiency is the most important risk factor for vitamin D deficiency and rickets in newborns and early infancy. In this report, we presented a two-month old infant with seizures while hospitalized for pulmonary infection. Finally, congenital rickets due to maternal vitamin D deficiency was diagnosed.

Children with food refusal: an assessment of parental eating attitudes and their styles of coping with stress.

BACKGROUND: In this study, we aimed to assess the eating attitudes and stress coping styles of parents whose children presented to the clinic complaining of food refusal. METHODS: The parents of 31 children aged ≥3 years, presented to the clinic with the complaint of food refusal. The control group consisted of 30 healthy children with no prior history of food refusal, and their parents. In both groups, birth features, body mass indexes (BMIs), eating attitudes and stress coping styles of the parents were assessed. The parents of both groups were studied, in part utilizing the eating attitudes test (EAT), and the coping styles of stress scale (CSSS). RESULTS: Our study found that body weights and BMI values of the fathers in the study group were significantly lower than fathers in the control group. There was no significant difference in EAT scores between the two groups; however, where the children's body weight and height for age percentile was under 25%, the parents had significantly lower EAT scores. When CSSS scores were assessed, the optimistic approach score of the mother and the self-confident score of the father were found to be significantly high in both groups. CONCLUSION: The parental perception and definition of eating problems does not necessarily indicate the presence of an eating disorder in a child. In fact, the eating attitudes of the fathers were related to the low percentile weight and height values of the children, and a child's food refusal was not dependent on the stress coping style used by the parent.

Separation anxiety disorder increases among neonatal intensive care unit graduates.

AIM: To evaluate whether separation anxiety disorder (SAD) develops in the later life of the infants, who were separated from their mothers in relation to being in neonatal intensive care unit (NICU). METHODS: A group of 57 children, ages over 6 years old who were cared in NICU has been evaluated retrospectively by using the SAD diagnostic scale which is adapted according to DSM-IV. Another age and sex matched 50 children who admitted to the outpatient unit were selected as control group. RESULTS: We found that the scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU. CONCLUSION: The NICU should be arranged to support the development of the baby. Families should be informed about the necessity of sustaining an early mother-infant interaction. By supporting mother-infant interaction, it will be provided that the baby will establish a more secure relation with his/her mother, develop more healthy and have less behavior problems in the future life.

Paediatric Halitosis and Helicobacter pylori Infection.

OBJECTIVE: To compare the presence of Helicobacter pylori (H. pylori) infection by stool antigen test in children with and without halitosis. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Fatih University Hospital, Ankara, Turkey, between December 2008 and June 2009. METHODOLOGY: Fifty-three patients aged between 3-15 years who presented to paediatrics outpatient clinic with halitosis and 55 healthy children aged between 4-15 years without halitosis were included in the study. Halitosis was confirmed with organoleptic test. Stool antigen test was performed in both groups. Intergroup proportions were compared using chisquare and Fisher exact tests with significance at p < 0.05. RESULTS: The H. pylori stool antigen test was positive in 11 out of 53 patients (20.8%) with halitosis and 12 of 55 healthy controls (21.8%). The rate of positive H. pylori stool antigen test results were similar between two groups (p > 0.05). Twoweeks eradication treatment was administered to 11 patients with H. pylori infection and halitosis. After treatment, the symptoms of 8 patients with halitosis (72.7%) completely resolved and persisted in 3 patients (27.3%). Seven of the 11 patients who were administered eradication treatment also had abdominal pain along with halitosis. Both symptoms completely resolved in all those patients after treatment. CONCLUSION: Although no statistically significant difference existed between the rate of H. pylori infections among those with and without halitosis. Eradication treatment was found beneficial in the treatment of children with halitosis and positive H. pylori stool antigen test.

Knee joint pain may be an indicator for a hip joint problem in children: a case report.

Knee joint pain is one of the most common complaints related to the skeletal system encountered by paediatricians. Knee joint pain generally occurs as the result of hypermobility and growing pains, though disorders manifesting as arthritis/arthralgia and orthopaedic problems should be considered in the differential diagnosis. A thorough and careful physical examination and laboratory and radiological findings are of importance for an accurate diagnosis. Although treatment should be based on the aetiology of the knee pain, non-steroid anti-inflammatory drugs can be used to alleviate the pain. A 7-year-old male patient presented with recurring pain in the left knee. Physical examination of the patient, laboratory tests, and radiological examination of the knee joint were normal; roentgenograms performed for a presumed hip joint problem revealed a focal cortical defect on the left femoral head and an increased effusion in the left hip joint space compared with the right counterpart. With this case report, we would like to highlight that paediatric health and diseases specialists (paediatricians) should consider hip joint pathologies when patients present with knee pain, particularly knee pain with an unidentified aetiology.

Effect of pseudoephedrine on cardiac rhythm of children with rhinitis.

OBJECTIVE: To investigate the effect of pseudoephedrine on heart rhythm of children with rhinitis. METHODS: The study included 25 children diagnosed with rhinitis from March 2009 through February 2010 in the Department of Pediatrics. Holter records were obtained for 24 h before and at the fourth day of pseudoephedrine treatments. RESULTS: Study group consisted of 18 girls (72%) and 7 boys (28%) with a mean age of 8.7 ± 3.4 (4-17.9 years). Common complaints of the patients were rhinorrhea (100%), cough (68%) fatigue (48%), sore throat (36%), and headache (28%). Of the 25 patients whose Holter recordings were evaluated, rare supraventricular extrasystoles were observed in one prior to the administration of pseudoephedrine, which were not repeated on this patient's follow-up recording on day four. There were two ventricular extrasystoles in the day four Holter recording of another patient. None of the patients complained of chest pain or palpitation. There were no observations of supraventricular tachycardia, ventricular tachycardia or ventricular fibrillation. No statistical differences could be found (p > 0.05) in the values before treatment and those on day four of treatment of either the time-dependent Heart rate variability (HRV) parameters SDNN, SDNN index, SDANN and RMSSD, or the frequency-dependent parameters (TP, HF, LF). No statistical difference could be determined between heart rate values of the patients before treatment and those on day four of treatment (p > 0.05). CONCLUSIONS: This study has established that therapeutic doses of pseudoephedrine do not cause an additional dysrhythmia risk for children with no health problem except rhinitis.

Recién nacida con tumoración genital interlabial de resolución espontánea: Caso clínico / Newborn with genital interlabial mass with spontaneous resolution: Case report

Las tumoraciones interlabiales en las recién nacidas son temas infrecuentes, de interés para pediatras, cirujanos, urólogos, dermatólogos y ginecólogos infantiles. Los quistes interlabiales neonatales más frecuentes son los quistes himeneales y los quistes glandulares parauretrales. Varias tumoraciones interlabiales, incluyendo las de origen embrionario, tejido ectópico, prolapso, anomalías urinarias o neoplasias, pueden aparentar ser simples quistes. Entre estos están el prolapso de uretra, vagina o útero, el ureterocele ectópico, el quiste del conducto de Gartner, el hidrometrocolpos asociado a himen imperforado y el rabdomiosarcoma botroide. El diagnóstico diferencial es importante tanto para el enfoque terapéutico como por el seguimiento. Se presenta el caso de una niña de 3 días de edad con diagnóstico de quiste himeneal y sus posibles diagnósticos diferenciales.

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartner's duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.