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BACKGROUND/AIMS: We aimed to perform the validity and reliability analysis of the Turkish version of the Pediatric Nutritional Risk Score (PNRS). MATERIALS AND METHODS: The study group consisted of 149 patients aged between 1 month and 18 years who were admitted to the hospital for at least 48 h. The patients' age, gender, anthropometric measurements, length of stay, admission diagnosis, daily body weights, food consumption, and pain status were recorded. Backward and forward translations into Turkish were done. PNRS was performed by two different physicians. The consistency of the PNRS results was evaluated to determine the validity of PNRS. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Of all patients, 69 (46.3%) were female and 80 (53.7%) were male. The mean length of the stay was 7.3±4.0 days. The mean age of the patients was 51.9±63.6 months. The Kappa coefficient between the two physicians was 0.66. Weight loss was observed in 65.2% of the patients in the high-risk group and 25.4% in the low-risk group. The hospital malnutrition rate was 31.5%. A higher risk was identified in those with

Aim:The purpose of this study was to elicit data concerning the clinical and laboratory features of children with growth hormone deficiency monitored by the Pediatric Endocrinology and Metabolism Polyclinic in order to produce useful information for future cases. Methods: The medical records of 185 patients diagnosed with growth hormone deficiency at the Dr. Behçet Uz Pediatrics and Pediatric Surgery Research Hospital Pediatric Endocrinology and Metabolism Polyclinic were examined retrospectively. The subjects were allocated into 4 groups according to the cause of growth hormone deficiency. Demographic and clinical characteristics of the patients were assessed and compared across these groups. Results: One hundred and fifty-four patients were diagnosed with idiopathic growth hormone deficiency, 16 (8.6%) with combined growth hormone deficiency, 13 (7%) with Turner’s Syndrome, and 2 (1.1%) with chronic renal failure. On the other hand, the most common accompanying hormone deficiency was TSH deficiency, determined in 21 (11.4%) patients. Two or more hormone deficiencies were present in 10 (5.4%) patients. Intracranial pathologies were present in 15.6% of the idiopathic growth hormone deficiency group and 81.2% of the combined growth hormone deficiency group. Bone age, height SDS, and stimulation test peak responses were significantly lower in the combined growth hormone deficiency group than in the other groups. Conclusion: The principal risk factors determining prognosis in cases of growth hormone deficiency are etiology, accompanying hormonal or chromosomal disorders, and early treatment.

Background Functional gastrointestinal disorders (FGID) may affect or may be affected by postpartum depression (PPD), mode of feeding and postpartum life quality. We aimed to evaluate the interaction between FGID and these parameters in infants. Methods The study group consisted of babies attending our outpatient clinics. There were three age groups: 4-6 weeks, 3-4 months and 6-7 months. Demographic data of the babies and mothers, and data of feeding were collected. For the diagnosis of FGID, Rome III criteria were used. Mothers were screened with the Edinburgh Depression Scale. Quality of life (QoL) scores were obtained by using the `Maternal Postpartum Quality of Life Questionnaire`. Factors affecting the presence of FGID, PPD and quality of life were analyzed. Results Two hundred thirteen infants were enrolled during the study period. FGID was present with similar rates in both genders and was lower (31.5%) in the 6-7 month-old group (p=0.001). Infantile colic was higher in girls (68.6% vs. 31.4%, p=0.016). In 4-6 week-old infants with infantile dyschesia, the delivery route was mostly cesarean (83.3% vs. 16.7%, p=0.006). Similarly, regurgitation was more frequent in 6-7 month-old infants born by cesarean (88.9% vs. 11.1%, p=0.035), and was more frequent in infants being exclusively breastfed (60.9%, p=0.037). QoL scores were lower in mothers with depression (20.9±3.4 vs. 23.9±3.6, p=0.003). Infantile colic was higher in mothers with depression, but not significantly (29.3% vs. 11.4%, p=0.057). Conclusions Caesarian section delivery and breastfeeding were influential on infantile dyschesia and regurgitation subgroups. No other studied factor seemed to affect FGID.

Objective: To evaluate the prevalence and the risk factors of allergic rhinitis in a particular area. Methods: The main study group consisted of all school children in Kemalpasa district aged 13-14 years. Children with current rhinitis based on responses given in ISAAC questionnaire survey were further evaluated for confirmation. Parents responded to a more detailed questionnaire about allergic diseases and risk factors. Then peak nasal inspiratory flow (PNIF) was evaluated to objectively assess nasal patency. Skin-prick test was performed for ten common allergens. Results: The questionnaire was answered by 90.8% (1373) of children. The prevalence of physician-diagnosed AR was 11.1%. Current rhinitis was found to be 31.3%. Of this group, 55.0% were admitted for the parent questionnaire and tests. Precisely, 90.3% of children accepted PNIF evaluation, and %10.1 of them had a nasal obstruction. Skin-prick tests revealed allergy for at least 1 allergen in 16.6% of children. The present study showed that the children with maternal allergic rhinitis history had 2,18 fold, and the children with seasonal allergic rhinitis had 2,11 fold higher possibility of sensitization to an allergen. The probability of perennial allergic rhinitis was 3,1 fold higher in the children who had siblings with allergic rhinitis. Conclusion: We included all children in a specific age group living in an area in our survey. As well as we found the prevalence of current rhinitis with the ISAAC questionnaire; we also evaluated peak nasal inspiratory flow and used skin-prick tests that yielded objective results.

Karın ağrısı çocuk acil servise en sık başvuru nedenlerinden biridir. Acil koşullarında uygun öykü ve fizik muayene ile birleştirilmiş hasta başı ultrasonografi karın ağrısına hızlı ve doğru şekilde yaklaşılmasını sağlar. Burada karın ağrısı olan ve hasta başı ultrasonografi bulguları ile Nutcracker sendromu tanısı alan 15 yaşında kız hasta bildirilmiştir. Abdominal pain is one of the most common causes of admission to pediatric emergency department. Point-of care ultrasonography combined with appropriate history and physical examination provides rapid and accurate management of abdominal pain in emergency setting. Here, we report a 15-year-old girl with abdominal pain who was diagnosed with Nutcracker syndrome by the guidance of point of care ultrasound findings.

Introduction: Environmental tobacco smoke (ETS) is thought to increase the severity and number of attacks in wheezy children. Objective assessments are needed to change the behavior of families to reduce the exposure of wheezy children to ETS. Aim: To determine whether informing families about their children’s urinary cotinine levels curtailed the exposure of children to ETS. Material and methods: A survey was used to determine the ETS exposure level, and the urinary cotinine level of each patient was tested. Children with positive urinary cotinine levels were included in the second part of the study. The families were randomly divided into two groups: an intervention group that was advised about urinary cotinine levels by telephone and a non-intervention group that was not so advised. The groups were followed-up 2 months later, and urinary cotinine levels were measured once again. Results: The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037). Conclusions: Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

Objectives Even though allergen immunotherapy is an effective treatment method that has been used on rhinitis, asthma and venom anaphylaxis for over 100 years, systemic reactions (SRs) limit the use of this treatment method. We classified SRs associated with subcutaneous immunotherapy (SCIT) according to the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Risk factors for the SRs were assessed. Methods In this study 67,758 injections to 1350 children with allergic rhinitis and/or asthma were analyzed throughout January 1999–December 2014. Results A total of 51 systemic reactions were observed in 39 patients (0.075% per injection, %3 per patient). Mean age of SRs observed patients was 13 ± 2.6 years (range 9.5–16 years) and 64.1% were male, 35.9% were female. 51.3% of SRs were grade 1, 38.5% grade 2, 7.7% grade 3 and 2.6% grade 4. SRs were early onset in 41% of the patients and delayed onset in 59%. 76.9% of SRs were seen during maintenance therapy and 56.4% during peak pollen season. In 28.2% of cases previous local reactions and in 30.8% previous grade 1 reactions were determined. There was no fatal outcome from any of the SRs. Conclusion SCIT related SRs are generally of mild severity. Although only 10% of the SRs were grade 3 or 4, there is a still a small risk of severe reactions. 76.9% of SRs were observed during maintenance therapy. Delayed-onset SRs rate in our study is 59%. So both clinicians and parents should be alert about the delayed reactions after SCIT.

Background Local and especially systemic reactions are important problems in subcutaneous immunotherapy (SCIT). Local and systemic reactions develop in 0.7% to 4% and 0.2% of all injections, respectively. Objective To evaluate the frequency of and risk factors for reactions developing in pediatric patients undergoing SCIT. Methods Local and systemic reactions developing after 14,308 injections between 2003 and 2013 were retrospectively evaluated in the current study using the Subcutaneous Immunotherapy Systemic Reaction Grading System, as recommended by the World Allergy Organization. The type of allergic disease, allergens producing a sensitivity, allergen immunotherapy content, adjuvant content, and the effects of treatment phase on the frequency of adverse effects were investigated. Results Of 319 patients, local reactions occurred in 11.9%, wide local reactions occurred in 5%, and systemic reactions occurred in 4.7%. A local reaction was observed in 0.38% of all injections, whereas a systemic reaction was observed in 0.1% of all injections. Local reactions were most frequent in the build-up phase, and systemic reactions were most frequent in the maintenance phase ( P = .01). Side reactions were more common in patients undergoing SCIT with multiple allergens ( P = .002) and house dust mite ( P = .001). No statistically significant difference was found between adjuvant content and adverse effect frequency ( P = .32). Conclusions The frequencies of local and wide local reactions during SCIT were lower than expected. Although systemic reactions were frequently seen, no fatal reaction was observed in the current study. House dust mite SCIT and multiple allergen use increased the risk of reaction.

Sipahi S, Nacaroglu HT, Can D, Gunay I, Unsal-Karkiner CS, Kamali H, Ozdemir A, Gunay T. Effect of socioeconomic status on allergic diseases and atopy in school children. Turk J Pediatr 2017; 59: 670-677. Higher family socioeconomic status (SES) has been suggested as a risk factor for allergic diseases. We investigated the effect of SES on the prevalence of allergic diseases and atopy. The study included 13-14-year-old primary school students in Kemalpasa, Turkey. The International Study of Asthma and Allergies in Childhood phase 1 questionnaire was administered to all students to identify allergic diseases. Those identified as having allergic diseases underwent a skin prick test (SPT). Group I included students with allergic diseases and a positive SPT. Group II comprised students with allergic disease who were SPT negative. The control group was randomly selected from the students with no allergic diseases. Three weighted SES scores were calculated for each student (equally weighted, education-weighted, and social class-weighted). SES was classified as lower, middle, or upper according to the weighted SES scores. Allergic diseases were detected in 657 of the 1,373 children who participated in the study. A higher percentage of children with allergic diseases and atopy were in the lower SES group in all weighted SES analyses compared with controls (Group I: 59%, 83.1%, 67.5%; Group II: 62.9%, 80%, 63.5%; control group: 12.4%, 12.9%, 21.2%). Significantly more children with allergic and atopic diseases (Groups I and II) were in the lower SES group compared with the control group (p < 0.001). In contrast to the hygiene hypothesis, we found the incidence of atopic disease was higher in families with lower SES.

To determine the risk factors for developing candida infections in pediatric intensive care unit (PICU). The present study was conducted as a case–control study and included the population of patients who were admitted to PICU during the period of March 2010–March 2011. During the study period, a total of 57 patients in PICU had candidemia, 4 cases were excluded due to their PICU stay less than 48 h and one due to the insufficient data. The most commonly isolated Candida species was C. albicans, followed by C. parapsilosis. The median duration of hospitalization in PICU was higher (22.0 d) in candidemia patients compared to control group (13.5 d) (p = 0.037). The patients with candidemia had higher rates of presence of mechanical ventilation, presence of central venous catheter, and being under total parenteral nutrition; compared to the control group. The longer PICU durations, mechanical ventilation, central venous catheter, total parenteral nutrition were the associated factors. Although trials for predicitive models or scoring systems for development of candidemia have been performed; more future studies were required for practical usage in clinics settings in order to prevent candidemia.

Ozet Yenidogan bakteriyel menenjitleri ozellikle intrakranial apselerle komplike olabileceginde dolayi yuksek mortalite ve morbiditeye sahiptir. Proteus mirabilis yenidoganlarda nadir gorulen menenjit etkenidir. Biz beyin apseleri ile komplike olan P. mirabilis menenjitli bir yenidogan olgusunu sunduk. Buradan etkili antibiyoterapi almasina ragmen klinik durumu kotulesen menenjitli tum yenidoganlara hizli ve kolayca uygulanabilen kranial ultrasonografinin onemli goruntuleme yontemi oldugu belirtmek istedik. (J Pediatr Inf 2013; 7: 162-5) Anahtar kelimeler: Proteus mirabilis, beyin apsesi, ultrasonografi Abstract Neonatal bacterial meningitis is associated with high morbidity and mortality, especially when complicated with intracranial abscesses. Proteus mirabilis is a rare microorganism as an etiologic agent for meningitis in the noenatal period. In this case report we presented a case of P. mirabilis menigitis complicated with multiple cranial abscesses. In conclusion, we recommend cranial ultrasonography which can be easily and rapidly performed in neonates, especially with the progressive clinical course despite the appropriate therapy. (J Pediatr Inf 2013; 7: 162-5)

Background Prospective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors. Objective The aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey. Methods Fifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated. Results A total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p > 0.05). Conclusion Childhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma.

Objective We aimed to establish the characteristics of anaphylaxis in childhood. Methods Forty-four patients who had experienced anaphylaxis in a period of 10 years (from 1999 to 2009), were included in the study. Parameters analysed were age, gender, concomitant allergic disease, trigger, setting, clinical symptoms, treatment, prognosis and prophylaxis. Results The total numbers of anaphylaxis cases were 44 in a ten-year period. The ages of patients ranged from 3 to 14 years (11.50 ± 3.87 years) and the majority were male. 33 of the patients (75%) had a concomitant allergic disease. The trigger was determined in 93.2% of the cases, being most frequent: food (27.3%), and SIT (25%), followed by bee sting, medications and others. Respiratory (95.5%), dermatological (90.9%), cardiovascular (20.5%), neuropsychiatric (25%), and gastrointestinal (11.4%) symptoms were seen most frequently. For anaphylaxis triggered by food, the duration of anaphylactic episode was significantly longer (p < 0.05). No biphasic reaction was observed during these attacks. Of our patients, only one developed respiratory failure and cardiac arrest due to SIT, and intensive care support was required. Discussion As a trigger for anaphylaxis, the frequency of SIT is so high that it cannot be described by the study group including patients who were followed up in an outpatient allergy clinic.

Background The Neonatal Resuscitation Program (NRP) is an effective tool in decreasing mortality and morbidity due to birth asphyxia. The aim of the study was to assess the skill and knowledge level of pediatric residents in a teaching hospital and the effects of NRP training. Methods Subjects consisted of pediatric residents of Dr Behcet Uz Hospital, Izmir, Turkey. They were assessed on practice exam scenarios and NRP provider course flow charts. Teams with two members were formed randomly. Each resident was evaluated on a 100 point scale covering all resuscitation steps and interventions. Exam scores were analyzed for two major parameters: resident participation in NRP training (never, within the last 6 months, and ≥6 months previously) and being a senior (>18 months residency). Results A total of 49 residents enrolled in the study (94.2% of the target group). Twenty-one residents had NRP training (42.9%). Junior residents comprised 46.9% of the study group. The mean skill score was 72.1, and it was significantly higher for senior residents and residents who attended the NRP course (P < 0.05). Although there was no difference between the members within a team, residents who had not attended the NRP course performed better when paired with a resident with NRP certification. Conclusions NRP training significantly increases the resuscitation knowledge and skill of pediatric residents, although this can be achieved by being a senior. Residents should undergo training as soon as possible to achieve a higher level of quality in resuscitating babies.

Ozet Amac: Akilci antibiyotik kullaniminin yayginlastirilmasi icin hekimlerin yaninda ailelerin de bilgilendirilmesi onemlidir. Bu nedenle oncelikle ailelerin antibiyotikler dahil ilac kullanimi ile ilgili bilgi duzeyi ve tutumlarinin belirlenmesi onemlidir. Bu calismada, hastanemiz cocuk sagligi ve hastaliklari poliklinigine basvuran hastalarin ebeveynlerinin ilac kullanimina iliskin tutumlarini belirlemeyi amacladik. Gerec ve Yontemler: Calisma 86 cocugun ebeveynleri ile yuz yuze goruserek gerceklestirildi. Veri toplamada kullanilan ankette sosyodemografik degiskenlerin yaninda antibiyotik kullanimi ile ilgili tutumu anlamaya yonelik bolumler bulunmaktaydi. Ebeveynlerin antibiyotik kullanimina iliskin tutumlari ile ilgili olarak dokuz baslik altinda soru soruldu. Ilac kullanimina iliskin tutum belirlenirken sorular, dogru tutumlar ve yanlis tutumlar olarak ikiye ayrildi. Her iki grup soruda calisma grubunun ortalamasi alinarak ortalama alti ve ustu ebeveynler, bagimsiz degiskenler yonunden karsilastirildi. Bulgular: Ebeveynlerin ogrenim durumlari ve ailenin gelir duzeyi ile dogru antibiyotik kullanimi arasinda iliski olmadigi saptandi. Hekimin antibiyotik secimine guvenin, ogrenim durumu yukseldikce azaldigi goruldu. Hekime danisma, hekimin onerilerine uyma ve ilac prospektusu okuma tutumlari %85 uzerinde saptandi. Sonuc: Ailelerin akilci antibiyotik kullanimi konusunda tutumlarinin genelde olumlu oldugu goruldu. Benzer calismalarin yalnizca tutum degil, davranislari da olcecek bicimde yapilmasi ile daha aydinlatici sonuclar alinmasi olasi olacaktir. (J Pediatr Inf 2013; 7: 57-60) Anahtar kelimeler: Uygun antibiyotik kullanimi, cocuk, ebeveyn Abstract Objective: To ensure the appropriate use of antibiotics, it is imperative to raise consciousness among families as well as pyhsicians. Therefore it is crucial to determine the knowledge and attitudes of parents towards the use of medicines. In this study we assessed the attitudes of parents of children towards the use of antibiotics following admission to our hospital's paediatric internal diseases clinic. Material and Methods: The study comprised faceto-face interviews with parents of 86 children. A data collection survey contained sections to define the habits of antibiotic usage as well as sociodemographic variables. Parents' attitudes towards drug usage were assessed within nine basic topics in which the questions were divided into ”correct” and ”incorrect” attitudes. The average of both groups was calculated and aboveand below-average parents were compared in terms of independent variables. Results: Level of education and income showed no meaningful association with correct usage. However a higher level of education increased confidence in the physician. Attitudes of consulting the physician, following advice and reading instructions were over 85%. Conclusion: The attitudes of parents towards the appropriate use of medicines were generally positive. Similar studies based on not only attitudes but also behaviour are required. (J Pediatr Inf 2013; 7: 57-60)

Ozet Psoas apsesi ender rastlanilan, genellikle tanisi zor ve gec konulan bir durumdur. PA cocuklarda ve genclerde daha sik, yaslilarda daha seyrek gorulmektedir. Klasik bulgulari ates, karin agrisi, bel agrisi ve topallayarak yurumedir. Istahsizlik, titreme, kilo kaybi ve kitle eslik edebilir. Psoas apsesi primer ve sekonder olarak siniflandirilir. Idrar yolu enfeksiyonu klinigi ile gelen izlemde psoas apsesi tanisi alan ve sadece antibiyotik tedavisi ile duzelen, nadir gorulen olgu sunuldu. (J Pediatr Inf 2013; 7: 31-4) Anahtar kelimeler: Psoas apsesi, idrar yolu enfeksiyonu, antibiyotik tedavisi Abstract Psoas abscess is a rare clinical situation in which the diagnosis is very difficult and late. Classical symptoms include fever, abdominal and lumbar pain, limping, anorexia, shivering, weight loss and mass at palpation. Psoas abscesses are divided into two groups; primary and secondary. Here we present a rare pediatric case with psoas abscess secondary to urinary tract infection and full recovery was achieced with antimicrobial therapy without requirement for surgical intervention. (J Pediatr Inf 2013; 7: 31-4)

Eosinophilic cellulitis (Wells’ syndrome) is an uncommon condition of unknown etiology. Wells’ syndrome is usually seen in adulthood but very rare in childhood. Although pathogenesis of the disease is not very clear, it is a hypersensitivity reaction developing against a variety of exogenous and endogenous antigenic stimuli. Paraphenylenediamine is a strong allergen frequently used as a temporary henna tattoo, which makes the color darker. Here, a 9-year-old male patient with Wells’ syndrome is presented, which developed following a temporary henna tattoo and shown by the patch test sensitivity to paraphenylenediamine.

Background: Leukotriene receptor antagonists (LTRAs) are drugs which have been widely used more than ten years. As the use of LTRAs increases, our knowledge with respect to their side effects increases as well. Objectives: The objective of our study was to evaluat the observed side effects of LTRAs used in patients with astma. Patients and Methods: 1024 patients treated only with LTRAs owing to asthma or early wheezing were included in the study for a five-year period. The observed side effects of LTRAs in these patients were retrospectively investigated. The side effects were divided into two parts as psychiatric and non-psychiatric. Results: Among the 1024 cases included in the study, 67.5% of the patients out of 41 with side effects were male, 32.5% were female and the average age was 6.5 years. The rate of patients with asthma was 63.41% and 36.58% of the patients had early wheezing. It was determined that sex, age and diagnosis (early wheezing or asthma) of the patients were ineffective in the emergence of side effects. The average period for the emergence of side effects was the first month. It was observed that hyperactivity was the most frequently observed psychiatric side effect and that abdominal pain was the non-psychiatric side effect. Conclusions: The side effects of LTRAs were common in children. Therefore, patients must be informed at the beginning of the treatment and they must be evaluated at certain intervals.

Objective: We aimed to reveal the factors effecting the success rates of participants and change in their levels of knowledge following Neonatal Resuscitation Program (NRP) courses in our country.

Studies of the prevalence of asthma should be supported by objective markers. We aimed to measure the prevalence of childhood asthma in a particular area and age group using a questionnaire, and to compare the results with the rates of asthma diagnosed by objective measures. All students aged 13-14 (n=1511) in Kemalpasa, Izmir, were included in the study. Children whose responses on the ISAAC Phase-I Questionnaire revealed current wheezing were invited to the district health center. The prevalence of clinically proven asthma (current wheezing supported by objective markers) was investigated. The questionnaire was answered by 1373 (90.87%) students. Current wheezing was indicated in 428 children (31.0%), significantly more in girls than in boys (p0.05). However, the prevalence of clinically proven asthma decreased by 42.5% when using objective markers. This study provided important epidemiologic information about the prevalence of asthma as indicated by questionnaires as opposed to that indicated by objective measures, especially in countries where the language lacks a word for "wheezing."

Aim: The lifestyle and environmental changes associated with industrialization and urbanization are crucial factors in determining the prevalence of allergic diseases. Material and Methods: The aim of this study was to determine the prevalence of asthma and other allergic disorders in an industrial town.Study Design: Prospective, Cross-sectional study. This cross-sectional population-based study was conducted in Kemalpasa, Ýzmir, Turkey, which is an industrial town. Using the International Study of Asthma and Allergies in Childhood (ISAAC), the questionnaire was carried out on 1511 school-children aged between 13-14 years living in the district center. Results: The ISAAC Phase One questionnaire was answered by 1373 (90.87%) students. Six hundred ninety two (50.5%) of the children were girls and 681 (49.5%) were boys. The frequency of ever wheezing was 34%,that of current wheezing was 31.1% and that of physician-diagnosed asthma was 4.1%. The frequency of ever rhinitis was 36.6%, current rhinitis was 31.3%, current allergic rhino-conjunctivitis was 22.1% and physician-diagnosed allergic rhinitis was 11.1%. The frequency of ever eczema was 11.3% and that of physician-diagnosed eczema was 3.6%. Conclusion: The prevalence of asthma was found to be significantly higher, although there was no significant difference in allergic rhinitis and eczema compared with non-industrial neighboring states. The incidence of asthma was higher than other provinces which may be explained by the risk factors associated with this industrialized area. The fact that only children of the same age group and residence were evaluated contributed to the epidemiological value of our study.

Introduction The aim of this study was to compare the body temperature measurements of infrared tympanic and forehead noncontact thermometers with the axillary digital thermometer. Methods Randomly selected 50 pediatric patients who were hospitalized in Dr Behcet Uz Children's Training and Research Hospital, Pediatric Infectious Disease Unit, between March 2012 and September 2012 were included in the study. Body temperature measurements were performed using an axillary thermometer (Microlife MT 3001), a tympanic thermometer (Microlife Ear Thermometer IR 100), and a noncontact thermometer (ThermoFlash LX-26). Results Fifty patients participated in this study. We performed 1639 temperature readings for every method. The average difference between the mean (SD) of both axillary and tympanic temperatures was -0.20°C (0.61°C) (95% confidence interval, -1.41°C to 1.00°C). The average difference between the mean (SD) of both axillary and forehead temperatures was -0.38 (0.55°C) (95% confidence interval, -1.47°C to 0.70°C). The Bland-Altman plot showed that most of the data points were tightly clustered around the zero line of the difference between the 2 temperature readings. With the use of the axillary method as the criterion standard, positive likelihood ratios were 17.9 and 16.5 and negative likelihood ratios were 0.2 and 0.4 for tympanic and forehead measurements, respectively. Discussion The results demonstrated that the infrared tympanic thermometer could be a good option in the measurement of fever in the pediatric population. The noncontact infrared thermometer is very useful for the screening of fever in the pediatric population, but it must be used with caution because it has a high value of bias.

Brucella infections have a wide spectrum of symptoms especially in children, making the diagnosis a complicated process. The gold standard for the final diagnosis for brucellosis is to identify the Brucella spp. isolated from blood or bone marrow cultures. The main purpose of this work was to evaluate the factors affecting the isolation of Brucella spp. from blood cultures. In our study, the ratio of fever, presence of hepatomegaly, and splenomegaly were found to be higher in the bacteremic group. In addition, C-reactive protein levels and liver function enzymes were found to be higher in the bacteremic group. In our opinion, while evaluating the febrile child with suspected Brucella infection, we highly recommend sampling blood cultures regardless of the history of previous antimicrobial therapy and duration of the symptoms.

Amaç: İnek sütü alerjisi çocukluk çağında en sık görülen gıda alerjisidir. Tanıda gecikme olduğunda sistemik reaksiyonlar ortaya çıkarken, yanlış tanı konulduğunda annenin ve çocuğun yetersiz beslenmesine neden olmaktadır. Diğer alerjik hastalıklar gibi besin aler- jileri de son yıllarda giderek büyüyen bir sorundur. Amacımız, inek sütü alerjisi vakala- rının özelliklerini saptamak ve sıklığının artıp artmadığını belirlemektir. Gereç ve Yöntemler: Çalışmamız retrospektif ve kesitsel olarak planlandı. Hasta verileri Pediatrik Allerji Bölümü hasta dosyalarından toplandı. Gıda alerjisi tanısı konulan has- talar arasından inek sütü alerjisi saptanan hastalar çalışmaya alındı. Bulgular: 2003-2011 yılları arasında gıda alerjisi tanısı ile takip edilen 264 olgu arasından inek sütü alerjisi tanısı alan 105 olgu çalışmaya alındı. Hastaların çoğu 2 yaşından küçük (%78,1), erkek cinsiyette (%62,9) idi ve anamnezinde süt alımını takiben kesin öykü vardı (%79,1). Olguların %75,2’sini IgE aracılı inek sütü alerjileri oluşturmaktaydı. Hastaların yarısından fazlası 2010 ve 2011 yıllarında başvuran hastalardı. Bu artışdan daha çok 1 yaş altındaki hastaların fazla olması sorumluydu (p=0.015). En sık tutulan sistem, deri (%67,5) ve multisistem (%15,7) olarak bulundu. Sonuç: Detaylı bir öykü inek sütü alerjisi tanısında önemli bir rol oynar. Yaşamın ilk yılı içinde çok sayıda hasta çeşitli semptom ve bulgularla karşımıza çıkar. Genellikle hayatı tehdit eden bir durum olmamakla birlikte beslenme, çocuğun gelişimi ve büyümesinde rol oynadığı için doğru tanı çok önemlidir., Objective: Cow’s milk allergy is the most frequent food allergy in childhood. Delayed diagnosis may cause a number of systemic dysfunctions, while incorrect diagnosis may result in deficient nutrition of the mother and the child. As in other types of allergies, food allergy is also a growing problem in recent years. Our aim was to determine the characte- ristics of our patients allergic to cow’s milk, and see if there was an increasing trend. Material and Methods: The study was of retrospective and cross-sectional design. Patient data were collected from Pediatric Allergy Department patient files. Cases of food allergy were reviewed and patients fulfilling the criteria of cow’s milk allergy were included in the study. Results: A total of 105 cases with cow’s milk allergy out of 264 food allergies who were followed up between 2003-2011 were investigated. Most of the patients were under 2 years of age (78.1%), were males (62.9%) and presented with a history of allergy (79.1%). IgE mediated cases constituted the majority (75.2%). More than half of the patients admitted in 2010 and 2011. This was mostly due to the increased number of patients less than twel- ve months of age (p=0.015). Most frequently involved system was skin (67.5%) and mul- tisystem involvement was 15.7% Conclusion: A detailed history is the key element of diagnosing cow’s milk allergy. There is a considerable number of cases within the first year of life which may present with dif- ferent signs and symptoms. Although not a life threatening situation, correct diagnosis is vital as nutrition is a key component in the development and growth of child.

Dinleyici, Ener Cagri/0000-0002-0339-0134; Carman, Kursat Bora/0000-0002-4629-1873; Akarsu, Saadet/0000-0002-2673-8842; Kondolot, Meda/0000-0002-1168-3228; Ozdemir, Halil/0000-0002-7318-1688; ONCEL, Selim/0000-0002-5493-1818; Velipasaoglu, Sevtap/0000-0002-0200-8079; Ciftci, Ergin/0000-0002-4955-160X; NUHOGLU, CAGATAY/0000-0003-2187-4121; Aykan, Hayrettin Hakan/0000-0001-5136-3977; Emiroglu, Melike/0000-0003-1307-0246; Yasa, Olcay/0000-0002-1347-5019 WOS: 000303054700011 PubMed: 22170238 Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (< 0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children < 1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.

The purpose of this study was to evaluate the susceptibility of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae clinical isolates to ertapenem in a tertiary pediatric care center in Turkey.All isolates of ESBL-producing Enterobacteriaceae were collected from clinical specimens from children, and susceptibility tests were done using the Vitek 2 compact system.Ninety-nine per cent of the ESBL-producing Escherichia coli isolates were found to be susceptible to ertapenem, 99.5% to imipenem and 100% to meropenem. In the Klebsiella species, 91.5% of the isolates were susceptible to ertapenem, 99.3% to imipenem and 100% to meropenem.The results of our data, including isolates from children, showed that ertapenem had high in vitro activity against the majority of the ESBL-producing E. coli and Klebsiella species, as reported in previously published studies. However, additional clinical studies are required to assess the clinical activity of ertapenem and the clinical importance of the resistant isolates.

Objectives: The objective of our study was to evaluat the observed side effects of LTRAs used in patients with astma. Patients and Methods: 1024 patients treated only with LTRAs owing to asthma or early wheezing were included in the study for a five-year period. The observed side effects of LTRAs in these patients were retrospectively investigated. The side effects were divided into two parts as psychiatric and non-psychiatric. Results: Among the 1024 cases included in the study, 67.5% of the patients out of 41 with side effects were male, 32.5% were female and the average age was 6.5 years. The rate of patients with asthma was 63.41% and 36.58% of the patients had early wheezing. It was determined that sex, age and diagnosis (early wheezing or asthma) of the patients were ineffective in the emergence of side effects. The average period for the emergence of side effects was the first month. It was observed that hyperactivity was the most frequently observed psychiatric side effect and that abdominal pain was the non-psychiatric side effect. Conclusions: The side effects of LTRAs were common in children. Therefore, patients must be informed at the beginning of the treatment and they must be evaluated at certain intervals.

Sphingomonas paucimobilis, which was previously named as Pseudomonas paucimobilis in 1977 as an etiologic agent of human infection, is a nonfermenting gram-negative bacillus found in soil and water. Limited reports of S paucimobilis infection have been documented to date. Especially, nosocom

Background: The role of bronchodilators in the treatment of bronchiolitis remains controversial. Methods: A double-blind, placebo controlled trial was performed to evaluate the clinical response to nebulized salbutamol. One hundred and fifty-six infants aged between 7 weeks and 24 months who had had an episode of wheezing and other signs and symptoms of bronchiolitis were randomized to three groups as follows: (i) nebulized salbutamol was administered to 52 patients in group I at a dose of 0.15 mg/kg in 2 mL saline; (ii) saline was nebulized to 52 patients in group II and (iii) in group III 52 patients received mist in a tent. All three groups were administered oxygen during the procedures. Treatment was repeated with the same agent after 30 min if the respiratory score was 5 or more. Respiratory rate, heart rate, oxygen saturation and presence of cyanosis, wheezing, retractions were recorded before and after each treatment. Results: The decrease in the respiratory score was 5.2 ± 1.8, 0.82 ± 2.4 and 1.7 ± 1.3 in group I, II and III, respectively. The decrease in group I was significantly higher than in the other groups. Heart rate was similar between groups. Oxygen saturation decreased in group I without reaching statistical significance. Conclusions: Salbutamol was shown to be effective and safe in the treatment of acute bronchiolitis.