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At the present study, study we aimed to analyze the risk factors for cardiac arrhythmias related disease factors by evaluating some ventricular repolarization parameters in the electrocardiographic (ECG) evaluation of CD. The study was conducted retrospectively from the files of the patients. The ECG evaluation of 63 patients aged 5-18 years diagnosis with CD and 63 healthy control group in Adana City Training and Research Hospital, between 01.2018-11.2022. Patients who were taking any drugs, who had a chronic disease and/or abnormal tests (vitamin B12, folate, tissue transglutaminase, anti-endomysium antibody titers) were excluded from the study. The ventricular repolarization parameters (QT interval, QTc interval, QT dispersion, QTc dispersion, Tp-e interval, Tp-e/QT, Tp-e/QTc) analyzed on ECG and compared both groups. The measured ventricular repolarization parameters of the patients and control groups were not statistically different. From the ECG data, it was found that the QTc min value was higher in patients diagnosed before 5 years old than the patients diagnosed after 8 years old. While the QTc dispersion was higher in patients diagnosed after 8 years old than the patients with an age at diagnosed before 5 years old. It was found that the values of QT min, QT max, and QT in the ECG were influenced by the duration of the disease and significantly high related with the disease duration (more than 5 years). We found that QTc dispersion was higher in patients with a later diagnosis. This suggests that cardiac involvement is also increased in patients with a late diagnosis.

Objective Aim of the study is to assess the clinical characteristics and treatment outcomes of multisystem ınflammatory syndrome in children (MIS-C) associated with COVID-19. Study design The study comprised 52 children with MIS-C admitted to University of Health Sciences Adana City Training and Research Hospital pediatric wards from September 2020 to April 2021. Demographic characteristics and clinical data were retrospectively collected from patient files. Results Median age of patients was 9 (5–13) years. Fever (92.3%), abdominal pain (76.9%), rash (48.1%) and vomiting (48.1%) were the most common presenting symptoms. Fever duration was 8 (4.25–10) days in overall. Depressed left ventricular ejection fraction was found in 17.3% of patients. At admission, elevated levels of C-reactive protein, procalcitonine, erythrocyte sedimentation rate, D-dimer and ferritin were found in 98.1%, 96.2%, 75%, 84.6% and 69.2% of the patients, respectively. Lymphopenia, hyponatremia and hypoalbuminemia were found in 76.9%, 59.6% and 42.3% of the patients. Intravenous immunoglobulin was used in 96.2%, corticosteroids in 71.2% and anakinra in 3.8% of the patients. In total, 28.8% of the patients were admitted to pediatric intensive care unit and 17.3% received vasopressor support. Median duration of hospital length of stay was 12.5 days. Comorbidities were present in 19.2% of the patients. No mortality was recorded. Conclusions While being rare and treatable, MIS-C is the ugly and mysterious face of the COVID-19 pandemic for children. The increasing number of MIS-C cases shows that this phenomenon is more common than thought. Comprehensive studies are required to understand the pathogenesis of the disease and determine the treatment regimens clearly. Lay summary While being rare and treatable, multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is the ugly and mysterious face of the COVID-19 pandemic for children. MIS-C is now thought to be a post-infectious (SARS-CoV2) hyperinflammatory disease secondary to an abnormal immune response, rather than a complete obscurity. The increasing number of MIS-C cases and new case series reports from all over the world show that MIS-C is more common than thought. Despite our increasing experience, we may encounter a new finding every day in MIS-C patients. Therefore, we want to contribute to literature by presenting the MIS-C cases we treated in our clinic in detail. We have experienced that MIS-C patients can apply with similar but also different and unique characteristics. In case of delayed diagnosis or treatment, morbidity and mortality rates may increase. Therefore, the level of awareness and knowledge of all physicians, especially those dealing with pediatric patients, about MIS-C should be increased. Although the early effects of MIS-C are known, we don’t have enough information about the long-term consequences yet. Comprehensive studies are required to understand the pathogenesis of the disease and determine the treatment regimens clearly.

Neurologic complications that can lead to serious mortality and morbidity in pediatric heart transplant recipients have been reported to range from 23.6% to 45%. In this study, the frequency, time, cause, and characteristics of neurologic complications in pediatric heart transplant recipients were evaluated.We retrospectively reviewed data of 37 pediatric heart transplant recipients aged18 years who were seen at our hospital between 2007 and 2017. Medical records were reviewed to identify neurologic complications. Clinical features were compared between pediatric heart transplant patients with and without neurologic complications.The rate of posttransplant neurologic complications in pediatric heart transplant was 27% (10/37). Median age of patients with neurologic complications was 12 years (range, 11-18 years). Median time for neurologic complications was 3 days (range, 2-46 days). Primary diagnoses of these 10 recipients were dilated cardiomyopathy (n = 7) and restrictive cardiomyopathy (n = 3). There were no significant differences between recipients with and without neurologic complications (P.05).The etiologies of neurologic complications were posterior reversible encephalopathy syndrome in 3 patients (8.1%), stroke in 2 patients (5.4%), peripheral neuropathy in 2 patients (5.4%), hypertensive encephalopathy in 1 patient (2.7%), and drug encephalopathy in 1 patient (2.7%).Neurologic complications may lead to serious mortality and morbidity in pediatric heart transplant patients. Seizures, posterior reversible encephalopathy syndrome, stroke, peripheral neuropathy, transient ischemic attack, and cerebral infections are the most common neurologic complications, which are seen in the perioperative period in particular. Careful follow-up of pediatric heart transplant patients, with detection and early treatment of neurologic findings, will contribute to lower rates of sequelae. To our knowledge, this is the largest study to show a detailed experience of neurologic complications in pediatric heart transplant patients from a single center in Turkey.

Özet: Konjenital lober amfizem, alt solunum yollarında hiperinflasyon ile karakterize nadir rastlanan akciğerin doğumsal bir anomalisidir. Konjenital lober amfizemli hastalarda klinik seyir, hastalığın ortaya çıktığı yaşa, etkilenen loba veya normal lobların baskılanmasına bağlı olarak değişebilir. Tanısı klinik ve görüntüleme yöntemleri ile birlikte konulur. Semptomları hafif olan olgular konservatif tedavi ile izlenirken, ağır solunum semptomu olan olguların lobektomi ile tedavisi iyi sonuçlar vermektedir. Konjenital lober amfizem, nadir görülen bir akciğer anomalisi olmasına rağmen, nedeni bilinmeyen solunum sıkıntısı olan hastalarda ayırıcı tanıda göz önünde bulundurulması gereken bir hastalıktır. Bu yazıda erken dönemde konjenial lober amfizem tanısı konulan, hafif semptomları olması nedeniyle de konservatif tedavi yöntemleri ile izlenilen 4 aylık kız hasta sunulmaktadır., Congenital lobar emphysema is a rare congenital anomaly of the lung characterized by hyperinflation of the lower respiratory tract. In patients with congenital lobar emphysema, the clinical course may vary depending on the age at which the disease occurs, suppression of the affected lobe or normal lobes. Diagnosis is made together with clinical and imaging methods. While the patients with mild symptoms are followed with conservative treatment, the treatment of patients with severe respiratory symptoms with lobectomy gives good results. Although congenital lobar emphysema is a rare lung anomaly, it should be considered in the differential diagnosis in patients with unresolved respiratory distress. In this article, we present a 4-month-old girl who was diagnosed with congenial lobar emphysema in the early period and who was followed with conservative treatment because of mild symptoms.

The aim was to assess the utility and feasibility of a comprehensive cardiac screening protocol in young athletes before participation in sports. A total of 380 athletes referring before participation in sports, between April, 2014 and April, 2015, were included in this study. The mean age was 12.4 years. A screening protocol has been applied to all, including personal and family history, physical examination, 12-lead electrocardiography, transthoracic echocardiography, 24-hour rhythm Holter analysis, and treadmill exercise test. The most frequent complaints were chest pain in 19 (5%), dyspnoea in 13 (3.4%), and dizziness and fainting in five patients (1.3%) on exercise. There was sudden death and arrhythmia in 41 patients (10.7%) owing to family history. Heart murmur was present in 20 (5.2%) and hypertension in 10 patients (2.6%) on physical examination. The 12-lead electrocardiography was abnormal in 9 patients (2.4%). The findings of transthoracic echocardiography were insignificant in 47 patients (12.3%) and in five patients (1.3%) a haemodynamically important condition was detected. The 24-hour rhythm Holter analysis was abnormal in six patients (1.5%). There were significant ST changes in two patients (0.5%) on treadmill exercise test with normal findings on myocardial perfusion scans. No significant relation was present between findings of screening protocol and transthoracic echocardiography, 24-hour rhythm Holter analysis, or treadmill exercise test results.Pre-participation screening in young athletes should consist of a targeted personal history, family history, physical examination, and 12-lead electrocardiography. Other tests should be applied only if the screening indicates the presence of a cardiovascular disease.

Steroids are used in the treatment of acute rheumatic fever with moderate-to-severe carditis. Corticosteroids have several cardiovascular side affects that are more common in adults than in children. Corticosteroid-related bradycardia is a rarely seen side effect. Children with bradycardia following oral corticosteroid use are rarely reported previously. We present a child who developed bradycardia after oral corticosteroid treatment and concurrent Wolff–Parkinson–White pattern.

Objectives The aim was to evaluate the role of tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), to identify myocardial dysfunction, and to evaluate myocardial segmental deformation in acute viral myocarditis. Methods Twenty-one patients and twelve healthy children were studied prospectively. The TDI and STE were performed before and after treatment. The myocardial velocities (Sm , Em , and Am ) and time intervals (isovolumic contraction, isovolumic relaxation, and ejection times [ET]) at interventricular septum (IVS), left, and right ventricular basal segments were examined by TDI. The left ventricular global longitudinal strain (LVGLS) and strain rate (LVGLSR), left ventricular global circumferential strain (LVGCS) and strain rate (LVGCSR), and right ventricular global longitudinal strain (RVGLS) and strain rate (RVGLSR) were examined by STE. Results Sm and Em at IVS and at LV, ET at IVS, ET at RV, ET at LV were significantly lower in patients before treatment than controls. LVGLS, LVGLSR, LVGCS, LVGCSR, RVGLS, RVGLSR were significantly decreased in patients before treatment than controls. There was significant improvement for LVGLS, LVGLSR, LVGCS, LVGCSR, and RVGLS in patients after treatment. Sm , Em , and Am at LV were significantly lower in patients before treatment than in patients after treatment. In spite of improvements, Sm , Em , and ET at IVS, LVGLS, LVGLSR, LVGCS, LVGCSR were significantly lower in patients after treatment than controls. Conclusions The TDI and STE were useful methods for detection of early myocardial dysfunction and evaluation of treatment outcomes in acute viral myocarditis.

Objectives: Breast-feeding with high sodium content milk may cause hypernatremic dehydration in neonates (NHD). The number of cases with NHD tends to increase particularly in the higher temperature seasons. In this prospective case-control study, the relationship between NHD and breast milk sodium (Na) levels and demographic features of NHD were investigated during the summer season. Methods: The study included term newborns admitted to the neonatal intensive care unit of our hospital with the diagnosis of hypernatremic dehydration between June 2009 and October 2009. Serum sodium level ≥ 150mEq/L was accepted as hypernatremia. Among 109 NHD patients, breast milk sodium level was evaluated in 50 cases. Term infants without hypernatremic dehydration were taken as the control group (50 cases). Results: Postnatal age at admission ranged between 2 and 12 days and mean serum Na concentration was 152 mEq/L (150-173 mEq/L). A significant weight loss of >10% was determined in 85% of cases. Breast milk Na was significantly higher in the hypernatremic group (24.3 ± 20.3 mEq/L) compared to the control group (12.6 ± 6.79 mEq/L) (p < 0.001). In primiparous mothers, the mean breast milk Na level was statistically higher than that of multipara mothers (21.16 ± 19.9 mEq/L vs 15.48 ± 9.96 mEq/L, p < 0.016). Conclusions: In this study, we demonstrated that high breast milk sodium level was closely related with NHD and being a primiparous mother appeared as a significant factor for high breast milk sodium content. In this respect, all pregnant women especially primiparous should be educated about infant nutrition and neonatal dehydration. Health care providers should emphasize importance of frequent milking and more fluid intake, especially in summer.

AIM To investigate myocardial deformation and function during treatment for Kawasaki disease (KD) in children. METHODS We performed speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) in 15 children with KD and 15 healthy children during treatment for KD. STE was performed for longitudinal and circumferential strain (S) and strain rate (SR) at the left ventricle (LV) and for longitudinal S and SR at the right ventricle (RV). TDI was performed at the base of interventricular septum (IVS), LV, and RV. RESULTS Among TDI parameters, Em and ejection time (ET) at IVS, ET at LV and ET at RV obtained obtained before treatment were significantly lower in patients with KD compared to controls. After treatment, in spite of improvements, ET at IVS and ET at RV remained significantly lower in patients with KD compared to controls. Left ventricular global longitudinal and circumferential S and SR values obtained before treatment were significantly lower in patients with KD compared to controls. Left ventricular S and SR values were found to be increased after treatment. However, left ventricular global circumferential S value remained significantly lower in patients with KD compared to controls. There were no significant differences in right ventricular global longitudinal S and SR values between patients and controls before treatment. CONCLUSION During acute phase, patients with KD have reduced global left ventricular S and SR which may be more sensitive indicators of myocardial inflammation. This study showed gradual improvements in left ventricular myocardial function during treatment for KD.

The objective was to compare the efficacy and safety of naproxen (NXN) to acetylsalicylic acid (ASA) in the treatment of acute rheumatic fever (ARF). The data of 338 children were retrospectively analyzed. The patients were grouped according to joint and valve involvement and also drug chosen [methyl prednisolone (mPSL), ASA or NXN]. The treatment results and adverse events in each group were compared. The mean age was 10.3 years and the median follow-up was 62 months. Median time for normalization of acute phase reactants was 1 week in patients given steroids and 2 weeks in patients given ASA or NXN. ASA was replaced with NXN in 18 patients (10.2%) due to hepatic toxicity. The rate of rebound, recurrence and the prevalence of rheumatic valve disease were not different in patients given NXN, ASA or mPSL. In conclusion, NXN is a safe and effective alternative to ASA in the treatment of ARF in children.

Orgun A, Karagöl C, Pamuk U, Gürsu HA, Çetin İ. A rare cause of facial nerve palsy in a young infant: Kawasaki disease. Turk J Pediatr 2018; 60: 433-435. Kawasaki disease (KD) is a vasculitis in which the most common complication is development of coronary aneurysms. Neurological complications rarely occur in KD patients such as facial nerve palsy (FNP). FNP associated with KD may indicate increased risk of coronary artery aneurysm. Infants with facial nerve paralysis and unexplained-prolonged febrile period should be evaluated with echocardiography. Here in, we present a 4-month-old female with FNP and unexplained fever who was diagnosed KD due to echocardiographic findings.

Amaç: Yenidoğan indirekt hiperbilirübinemisi nedenlerinden kan grubu uygunsuzlukları sık görülür Minör kan grubu uyuşmazlığı çok ender olup kan değişimine gereksinim gösteren ciddi hemolitik reaksiyonlara yol açabilir Minör kan grupları arasında en sık görülenler; non D Rh antijenleri c C e E Kell Duffy Kidd ve MNS rsquo;dir Bu çalışmada Yenidoğan Kliniği rsquo;ne indirekt hiperbilirübinemi tanısıyla yatırılan bilinen veya saptanabilen hiperbilirubinemi nedenleri dışındaki olgularda minör kan gruplarının saptanması ve bunların olası etkilerinin araştırılması planlandı Gereç ve Yöntem: 01 07 31 09 2009 tarihleri arasında 107 yenidoğanda sarılık nedeninin minör eritrosit antijenleriyle ilişkisi araştırıldı ABO Rh uygunsuzluğu hipotiroidi glükoz 6 fosfat dehidrogenaz eksikliği doğuştan metabolik hastalık sepsis gibi bilinen diğer hiperbilirübinemi nedenli hastalar çalışmaya alınmadı Çalışma için etik kurul onayı alınmıştır 25 06 2006 35 2009 Minör eritrosit antijenleri insan kökenli monoklonal antiserumlar kullanılarak jel santrifügasyon yöntemiyle çalışıldı Antikor tarama testi pozitif bulunan annelerde antikor belirlemesi yapıldı Annede mevcut antikorlara karşılık gelen ve bebekte pozitif bulunan antijenler uygunsuzluk sebebi kabul edildi Antikor tarama sonucuna bakılmaksızın Kell C E c e antijenlerinin varlığı araştırıldı. Bulgular: Yüz yedi yenidoğanın yedisinde 6 5 minör eritrosit uyuşmazlığı saptandı Kliniğe yatırılan toplam 230 indirekt hiperbilirubinemili hasta değerlendirildiğinde ise pozitiflik 3 rsquo;dü En sık uyuşmazlık dört olgu ile MNS grubundan ldquo;s rdquo; antijenine bağlıydı Diğer antijenler ise; C Jka S Lub ve N rsquo;di Kell antijeni pozitif bulunan bir olgunun annesinde antikor tarama testi negatifti Uygunsuzluk saptanan olguların hiç birisinde direkt coombs testi pozitifliği ya da ciddi hemoliz bulgusuna rastlanmadı Diğer olgularla karşılaştırıldığında bu olgularda sarılık daha geç fark edilmiş ancak seyri benzer olmuştur. Çıkarımlar: Sarılıkla gelen yenidoğanlarda minör eritrosit antijenleri düzenli çalışılmamaktadır Ancak minör kan gruplarının da yenidoğan sarılığına yol açabileceği ciddi hemolitik hastalık oluşturabileceği ve patolojik sarılıklarda araştırılması gerektiği akılda tutulmalıdır., Aim: ABO Rh incompatibilities are common causes of blood group incompatibility in newborns On rare occasions alloimmunization due to minor erythrocyte antigens may cause severe hemolytic disease requiring exchange transfusion Most common minor erythrocyte antigens include non D Rh antigens c C e E Kell Duffy Kidd and MNS In this study we aimed to investigate minor erythrocyte antigens and their possible effects in newborns who were hospitalized for indirect hyperbilirubinemia and did not have any other detectable cause for neonatal jaundice Material and Method: Between July 1st 2009 and September 31st 2009 107 newborns were enrolled to investigate the relationship between minor erythrocyte antigens and neonatal jaundice Patients with common causes of hyperbilirubinemia such as ABO Rh incompatibility hypothyroidism glucose 6 phosphate dehydrogenase deficiency inborn errors of metabolism and sepsis were excluded The study was approved by the ethics commite 25 06 2006 35 2009 Minor erythrocyte antigens were studied by performing gel centrifugation method using human monoclonal antibodies Antibodies were detected in mothers with positive antibody screening Antigens which countered the antibodies present in the mother and which were found to be positive in the infant were considered as a cause of incompatibility Kell C E c e antigens were investigated in all newborns regardless of their antibody screening results Results: Minor erythrocyte incompatibility was detected in 7 out of 107 newborns 6 5 Assessment among 230 newborns hospitalized for indirect hyperbilirubinemia revealed a rate of 3 for minor erythrocyte antigen positivity The most common incompatibility was related to ldquo;s rdquo; antigen which was detected in 4 patients Other antigens detected included C Jka S Lub and N Only 1 patient was found to carry Kell antigen However his mother displayed negative antibody screening Direct coombs positivity or severe hemolysis could not be detected in any of the patients with minor erythrocyte antigen incompatibility Although the clinical course was similar jaundice was realized much later in these infants when compared to other infants with indirect hyperbilirubinemia Conclusions: Currently minor erythrocyte antigens are not being investigated routinely in neonatal jaundice However clinicians should keep in mind that minor erythrocyte antigens can cause indirect hyperbilirubinemia and sometimes severe hemolytic disease Therefore they should remember to study these antigens in newborns with pathologic jaundice Turk Arch Ped 2013; 48: 23 9

Newborns (n=72) were randomized into two groups, despite of the dose of lipid infusion. Group I (n=37) received 0.5 g/kg on the 1st day, 1.0 g/kg on the 2nd day, 1.5 g/kg on the 3rd day, 2.0 g/kg on the 4th day and 3.0 g/kg on the 5th day of life. Group II (n=35) received 1.5, 1.5, 2.0, 2.5 and 3.0 g/kg of lipids respectively. Serum levels of triglycerides (TG) were measured at 24, 48 h and on the 5th day of life. Additionally we calculated the amount of parenteral calories obtained in both groups.