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Background: Side effects of antiepileptic drugs vary depending on the drug itself, drug dose and duration of use. One of these side effects is related to vision., Methods: Patients who had been ordered visual evoked potential (VEP) measurements for various reasons between October 1 st , 2017 and October 1 st , 2019 at a pediatric neurology outpatient clinic and who were on levetiracetam monotherapy for at least six months for the treatment of focal/generalized epilepsy were included in the study and their files were scanned retrospectively (study group: SG). Patient files were evaluated for age, gender, dose and duration of levetiracetam use, presence of a family history of epilepsy, EEG result, cranial magnetic resonance imaging and VEP test results and the parameters were recorded. Twenty-four patients of similar age range without epilepsy were included in the study as the control group (CG)., Results: Eighteen patients 8 boys (44.4%), 10 girls (55.6%) and 24 healthy controls 9 boys (37.5%), 15 girls (62.5%) were included in the study and control groups, respectively. No statistically significant difference was found when the mean VEP latencies were compared between the patient and control groups for the right (P=0.451) and left (P=0.323) eyes. There was a statistically significant difference between the groups, respectively, when VEP amplitudes of the right and left eyes of the SG and CG were compared (P=0.001; P=0.001). There is no correlation between levetiracetam dose and duration of treatment and VEP parameters., Conclusions: The data obtained in this study showed that levetiracetam use affected VEP amplitude outcome but did not affect VEP latency outcome in pediatric patients.

Objectives: Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis., Methods: In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples., Results: Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus , which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin., Conclusions: Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.

Climatic changes are known to affect CO intoxications. The purpose of this study was to examine childhood CO intoxications with the Beaufort wind scale (BWS) classification of wind speeds. The demographic data (age and sex) and information concerning the hour, day, and month of presentation to the emergency department for cases diagnosed with CO intoxication over a 7-year period between 2015 and 2021 in the pediatric emergency department of a tertiary training and research hospital in a rural area were examined. Wind speeds (m/s) measured on the days of presentation to the emergency department were recorded. The wind category on the BWS on the day of intoxication was then determined. Four hundred twenty-two patients, with a mean age of 95.12 ± 59.4 (1-215) months, 218 (51.7%) girls and 204 (48.3%) boys were diagnosed with CO intoxication over the 7-year study period. A comparison of wind speeds on the days of presentation to hospital revealed a significantly higher wind speed in 2020 than in the other years (p<0.001). A comparison of the groups in terms of the BWS revealed a significant difference between the years of presentation to hospital (p:0.001). This is the first study to investigate CO intoxications in the pediatric emergency department with the BWS. A significant association was observed between wind speed based on the BWS and childhood CO intoxications. Further studies evaluating wind in the rural setting and CO intoxications are now needed for protection against such intoxications., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Aim: The purpose of this study was to evaluate the relationship between the lunar cycle and attacks observed in patients diagnosed with migraine and under follow-up in our pediatric neurology clinic., Methods: Cases diagnosed with migraine and under follow-up at the Balıkesir University Medical Faculty Pediatric Neurology Clinic, Turkey, undergoing attacks between 01.09.2019 and 01.09.2021, and whose attacks were recorded were included in the study. Patients' migraine attacks were investigated retrospectively, and the stage of the lunar cycle at which they occurred, based on the lunar calendar, was determined., Results: The mean age of the patients in the study was 13.39 ± 2.64 (8-17) years. Female gender was observed in the majority of attacks in all lunar cycles, and was most common in the first quarter. Headache was most common in the frontal region during the first quarter and full moon, and auras were also most frequent in the first quarter. Stress and exercise were the most frequent migraine-triggering factors in the first and third quarters, and in the full moon. Migraine attacks were shortest in duration in the full moon, and longest in the first quarter. The frequency of attacks (per week) was highest in the new moon and third quarter, and lowest in the full moon., Conclusions: This study investigated the relationship between migraine attack characteristics in children and the lunar cycle. It represents the first such investigation of the association between the lunar cycle and pediatric migraine attacks., (© 2022. The Author(s) under exclusive licence to Belgian Neurological Society.)

Introduction: Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs' hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19., Method: A short survey was carried out in May-June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region., Results: In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines., Conclusion: Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs.

Children are exposed to large amounts of information and high levels of stress and anxiety from adults around them, the media, and social communication networks during the Covid-19 period. The purpose of this study was to compare the anxiety and depression levels of the children of health workers following the declaration by the World Health Organization (WHO) of Covid-19 as a global pandemic with those of age-matched children of non-health worker parents. This prospective, case-controlled, cross-sectional study was performed between July and September 2020. One hundred forty-six participants were enrolled, 71 children of health worker parents in the study group, and 75 age- and sex-matched children of non-health worker parents in the control group. While no significant difference was determined between the children of health workers and non-health workers in terms of CDI scores, total STAI-C scores were higher among children of health workers (70.36 ± 12.43) than in children of non-health worker parents (65.62 ± 11.83) ( p  = .02). This study shows that since their parents work in intensive and high-risk environments during the Covid-19 pandemic, the children of health workers may be at greater psychological risk than other children.

Background: Understanding SARS-CoV-2 seroprevalence among health care personnel is important to explore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future., Methods: We enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed., Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19., Conclusions: Health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission., Competing Interests: Conflict of interest All contributing authors declare no conflict of interest. The study is not funded by any organization. The study is approved by Hacettepe University Ethics Committee (Approval No: 2020/11-57)., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Migraine is a recurrent, primary cause of headache. Although prophylactic vitamin B12 therapy is used on migraine patients, there is a limited number of studies examining the levels of B12 vitamin and folic acid in pediatric patients diagnosed with migraine. The study group (Group 1) included 65 pediatric patients diagnosed with migraine in the Pediatric neurology outpatient clinic, and 87 healthy cases admitted to the general pediatric clinic were included in the control group (Group 2). Complete blood count parameters, vitamin B12, folic acid, ferritin, and 25 OH D vitamin levels of the study and control groups were compared. The mean vitamin B12 level was 196.42 ± 95.54 pg/mL (59-499) in Group 1 and 240 ± 105.24 pg/mL (74-619) in Group 2. The mean folic acid level was 8.85 ± 3.49 pg/mL (3.68-23.70) in Group 1 and 7.24 ± 7.17 pg/mL (1.11-35.50) in Group 2. There was a statistically significant difference between Group 1 and 2 in terms of vitamin B12 and folic acid levels (p = 0.008, p = 0.00). The results of this study indicate the requirement for routine evaluation of vitamin B12 and folic acid levels in pediatric patients diagnosed with migraine., (© 2020. Belgian Neurological Society.)

Background Anxiety and caregiver burden increase among caregivers for individuals with chronic disease. The purpose of this study was to compare the anxiety levels and caregiver burden among caregivers for cases with pediatric celiac disease (CD) before and during the COVID-19 pandemic. Materials The Zarit Burden Interview (ZBI) and the Beck Anxiety Inventory (BAI) were applied to 29 parents caring for pediatric CD patients in January 2020, when COVID-19 cases had not yet been seen in Turkey. The study was designed prospectively. The scales were also reapplied to the same study group online during the COVID-19 pandemic (May 2020). The results were then compared. Results Parents caring for 29 cases of pediatric CD; 21 mothers (72.4%), six fathers (20.7%), and two aunts (6.9%) took part in the study. Mean ZBI scores before and during the COVID-19 pandemic were 27.51 ± 14.12 (8-73) and 38.68 ± 10.95 (21-57), respectively ( p < 0.01). Mean BAI scores before and during the COVID-19 pandemic were 13.27 ± 7.65 (1-27) and 23.48 ± 12.40 (2-48), respectively ( p < 0.01). Conclusion Increased anxiety and caregiver burden among caregivers of pediatric CD cases during the COVID-19 pandemic were identified for the first time in the literature in this study., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest. Note Authors have reviewed the article and approved the final version of article. Authors' Contribution 1. Study concept and design: I.H.B., G.T., and M.T. 2. Acquisition of data: I.H.B., H.A., S.K., and C.N.D. 3. Analysis and interpretation of data: I.H.B., G.T., H.A., S.K., and M.T. 4. Drafting of the manuscript: I.H.B., G.T., C.N.D., and H.A. 5. Critical revision of the manuscript for important intellectual content: G.T. and M.T. 6. Statistical analysis: S.K., C.N.D., and H.A. 7. Administrative, technical, and material support: S.K. and N.D. 8. Study supervision: I.H.B., H.A., and G.T., (Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Changes have occurred in children's sleep habits during the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to compare the sleep patterns during the COVID-19 pandemic of school age children of health worker parents (Group 1) and non-health worker parents (Group 2)., Method: One hundred twenty-two participants were included in Group 1 and 250 in Group 2. The families' sociodemographic characteristics (education levels and occupations of mothers and fathers, parental shift-working status, monthly family income, number of children in the family, and place of residence), general information for the children taking part (diagnosis of COVID-19 or COVID-19 related isolation, distance education, participation in sporting activities, time spent watching TV, time devoted to reading, time spent on telephones/tablets/computers, and time spent on indoor activities), and the responses given to the Children's Sleep Habits Questionnaire (CSQH)-abbreviated form were all examined., Results: Group 1 consisted of 122 individuals, 66 (54.1%) female and 56 (45.9%) male, and Group 2 of 250 individuals, 129 (51.6%) female and 121 (48.4%) male. Statistically significant differences were determined between the groups in terms of parental education levels and occupations, family monthly income, number of children in the family, place of residence, parental shift-working status, and length of time spent on indoor activities. Total CSHQ scores were 41.57 ± 7.57 (20-60) in Group 1 and 39.6 ± 8.47 (17-68) in Group 2 (p:0.03)., Conclusion: Greater impairment of sleep habits of school age children of health workers compared to those of non-health workers in the COVID-19 pandemic is proved for the first time in this study. Further assessment of the effects of the COVID-19 pandemic on children's sleep habits is now required, and appropriate measures must be taken in the light of the results obtained., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The aim of this study was to evaluate vitamin B12 levels in the patients diagnosed with neurofibromatosis type 1 (NF1) and to compare them with a healthy group. In this study, the files of the patients, who were admitted to the pediatric neurology outpatient clinic of a tertiary university hospital and were followed up after being diagnosed with neurofibromatosis type 1 during the 15-month period, were evaluated retrospectively (Study group). Demographic data, and laboratory test results (complete blood count, iron, iron-binding capacity, ferritin, vitamin B12 and folate) were recorded from the patient files. The cases admitted to the hospital for routine child health examination in the same period were taken as the control group. Vitamin B12 levels were statistically significantly lower in the study group compared to the control group (p=0.012). This study is the first study evaluating vitamin B12 levels in NF1 patients. Key Words: Neurofibromatosis type 1, Neurofibromin, Nutrition, Vitamin B12.

Background: The aim of this study was to evaluate surplus drugs left over from medications used via the intravenous and intramuscular routes in a pediatric emergency unit of a tertiary hospital in Turkey and to determine the financial burden imposed by drug wastage., Materials and Methods: The study was planned prospectively on patients presenting to the pediatric emergency department of a tertiary university hospital between January 1 and April 30, 2017, on weekdays and between 08:00 and 16:00, for any reason, and receiving intravenous and/or intramuscular drug administration resulting in drug wastage after treatment., Results: The number of patients enrolled in the clinical trial was 1620 (35.9%). Twenty-one different medications were administered via the intravenous or intramuscular (IM) routes during the study. The proportion of total medication wastage at the end of trial was estimated to be 0.425. The drug with the highest proportion of mean wastage to drug form was paracetamol (1000mg vial) at 0.79. The total cost of the drugs used for the patients in the study was US$580.98, and the overall burden of drug wastage was US$288.09. The three medications involving the highest wastage costs were methylprednisolone, ondansetron, and dexamethasone. The total wastage cost/total drug cost ratio was 0.495., Conclusion: If commercial drugs with intravenous and IM formulations are used by the pediatric age group, then dosage formulations appropriate for pediatric age group use also need to be produced. The development by manufacturers of ampoules and similar products suitable for multiple use will also reduce drug wastage. Reducing levels of drug wastage will inevitably reduce the drug expenditure., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Avicenna Journal of Medicine.)

Background: The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas., Materials and Methods: The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files., Results: The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48-190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin-clavulanic acid was prescribed in 28 (77.8%) cases., Conclusion: Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Avicenna Journal of Medicine.)

Introduction: Considerable advances have been made in hospital appointment systems in the past 60 years. In Turkey, the Central Physician Appointment System (CPAS) is used together with appointments made through direct presentations to the hospital. This study evaluated CPAS data., Materials and Methods: CPAS data for the previous 2 years (2015, Group 1; 2016, Group 2) were evaluated retrospectively. Department-based analysis was also performed. Total number of clinics, CPAS capacity, number of appointments through CPAS, and numbers of patients keeping appointments and "no shows" and ratios calculated from these were investigated., Results: Overall, 1,704,594 patients were examined in 20 departments during the 2-year period (January 1, 2015-December 31, 2016). Mean CPAS capacity per department was 12,831 ± 7,691 in Group 1 and 11,573 ± 6,849 in Group 2 (p = 0.588). Ratios of appointments made through CPAS to CPAS capacity were 0.7 in Group 1 and 0.84 in Group 2 (p = 0.009). The ratio of patients keeping appointments made through CPAS to the number of appointments made through CPAS was 0.772 in Group 1 and 0.775 in Group 2 (p = 0.831). The departments with the highest number of appointments made through CPAS to CPAS capacity were Neurosurgery in Group 1 (0.99) and Ophthalmology in Group 2 (0.99). The department with the lowest ratio was Infectious Disease and Clinical Microbiology in Group 1 (0.28) and Group 2 (0.45)., Conclusions: The use of CPAS has increased. However, some CPAS vacancies remain unfilled, and some appointments are not kept. CPAS capacities must be adjusted in line with take-up rates through regular department-based analysis.

Objective: Migration is a problem affecting all family members, but particularly children. Child refugees are the highest risk group for the health systems of receiving countries. We investigated the health of 104 Syrian child refugees presenting to a tertiary hospital in Turkey., Settings and Design: A retrospective study was conducted in the pediatric clinic., Materials and Methods: The medical files of Syrian refugee children (0-18 years) presenting to Adiyaman University Hospital, Pediatric Clinic between 01 and 30 November 2015, were investigated. Demographic data, body measurements, and laboratory results obtained from patients' medical records were evaluated., Results: Mean age of patients was 53.5 ± 49.6 (2-198) months; 63 were male and 41 were female. Seventy-two patients (69.2%) were under 5 years of age. Weight in 20 patients (19.2%), height in 33 (31.7%), head circumference in 2 (1.9%), and body mass index in 7 (6.7%) were below the third percentile. All patients with body weight below the third percentile had chronic malnutrition. Anemia was present in 35 (50%) of the 70 patients for whom complete blood count data were available., Conclusion: Health workers involved with Syrian refugee children must consider the two preventable conditions; malnutrition and anemia., Competing Interests: There are no conflicts of interest.

Background: A new age in communications began with the entry into use of cell phones and their applications. Cell phones and their various applications must be actively used in patient monitoring in the healthcare system., Introduction: The purpose of this study was to determine the length of stay in the pediatric emergency department observation unit (PEDOU) based upon the notification of abnormal laboratory results (ALRs) via the short message service (SMS)., Materials and Methods: Patients with ALRs notified through the SMS (April-May-June 2015: study period) were evaluated retrospectively, and those admitted to hospital after such notification were enrolled as the study group (SG). Patients presenting to the pediatric emergency department (April-May-June 2014: control period), whose ALRs were not notified through the SMS, and who were hospitalized for treatment, were enrolled as the control group (CG). Age, sex, length of stay in the PEDOU (min), admission diagnosis, and receiving department were recorded for both groups., Results: Number of patients monitored in the PEDOU was 8584 during the study period and 8507 during the control period (p = 0.27). Length of stay of patients monitored in the PEDOU during the control period (n = 8507) and study period (n = 8584) was 136.4 and 133.5 min, respectively (p = 0.92). One hundred forty-seven patients were enrolled as the SG and 154 as the CG. Length of stay in the PEDOU was 221.1 ± 86.9 (65-542) min in the CG and 154.8 ± 76.6 (15-442) min in the SG (p < 0.001, 95% confidence interval: 47.5-84.8)., Conclusions: Notification of ALRs through the SMS does not affect length of stay in the PEDOU. Use of this method reduces length of stay of patients who require more rapid hospitalization.

Background: Angiokeratoma of fordyce occurring over on the vulva is a rare condition. Fordyce angiokeratoma is observed more frequently among men than women. In women, it is generally observed in later life, and appears as multiple dark purple papules, measuring 2-4 mm, on the vulva., Case Report: We present the case of a 17-year-old white teenage girl with giant Fordyce angiokeratoma on the right vulva. The angiokeratoma was removed and a V-Y advancement flap was made., Conclusion: In the literature, this is the first childhood case reported in which a reconstruction of the vulva was performed.

Patients with β-thalassemia major (β-TM), a disease that emerges due to disorder of hemoglobin (Hb) synthesis, require life-long erythrocyte transfusion. The purpose of this study was to evaluate skin color and iron levels of patients with β-TM using a visual skin color chart. Each patient's skin color was matched on a skin color chart under a fluorescent lamp by the same physician on each occasion. Iron, iron binding capacity, ferritin and complete blood count (CBC) were studied for each patient enrolled. Colors marked on the visual skin color chart were compared with the laboratory results. Thirty-five patients being monitored at our hospital were included, 19 (54.3%) males and 16 (45.7%) females. The colors marked on the chart darkened as patients aged (p = 0.002, r = 0.49), the frequency of annual transfusions (p = 0.022, r = 0.385), ferritin levels (p < 0.001, r = 0.72) and iron levels increased (p = 0.001, r = 0.538) and as total iron binding capacity (TIBC) decreased (p < 0.001, r = -0.709). On the basis of this study, iron deposition in patients with β-TM was correlated with the colors on the chart.

Major depressive disorder is common during antenatal period and many women are prescribed antidepressant drugs despite no antidepressant can be regarded as definitely safe in pregnancy. Previous studies have suggested links between gestational use of selective serotonin reuptake inhibitors (SSRI) or serotonin and norepinephrine reuptake inhibitors (SNRI) and certain birth defects. VACTERL association is a rare group of congenital malformations which were observed to occur together more often than would be expected by chance. Diagnosis requires coexistence of at least three congenital malformations from vertebral (V), anal (A), cardiac (C), tracheoesophageal (TE), renal (R), and limb (L) regions. Here, a case of a newborn female whose mother's gestational history revealed venlafaxine use before and during her pregnancy is reported. This newborn had anal atresia, patent ductus arteriosus, tracheoesophageal fistula, and upper limb anomalies. To the best of authors' knowledge this is the first report of VACTERL association possibly related to gestational use of SSRI or SNRI.

Background: Urinary tract infection (UTI) is common in children. The aim of this study was therefor to construct a guide for the empirical antibiotic treatment of community-acquired UTI by investigating the etiology and antimicrobial resistance patterns of uropathogens and analyzing the epidemiological and clinical patient characteristics., Methods: A total of 158 children with positive urine culture were included in the study. Antibiotic susceptibility testing was performed with Vitek 2 Compact for 28 commonly used antimicrobials., Results: Mean age was 3.36 ± 3.38 years (range, 45 days-15 years). Escherichia coli (60.1%), and Klebsiella spp. (16.5%) were the most common uropathogens. For all Gram-negative isolates, a high level of resistance was found against ampicillin/sulbactam (60.1%), trimethoprim/sulfamethoxazole (44.2%), cefazolin (36.2%), cefuroxime sodium (33.5%), and amoxicillin/clavulanate (31.5%). A low level of resistance was noted against cefepime (8.7%), ertapenem (4.6%), norfloxacin (1.3%), and meropenem (0.7%). There was no resistance against amikacin., Conclusions: There is high antibiotic resistance in children with UTI. The patterns of uropathogen antimicrobial resistance vary in susceptibility to antimicrobials depending on region and time. Thus, the trends of antibiotic susceptibility patterns should be analyzed periodically to select the appropriate regimen for UTI treatment., (© 2016 Japan Pediatric Society.)

Human coronavirus NL63 (HCoV-NL63) primarily infects the upper respiratory tract. However, it may cause severe lower respiratory tract infection, and the clinical course may be severe in immunocompromised patients. To our knowledge, child death due to HCoV-NL63 has not been reported. We present a fatal lower respiratory tract disease associated with HCoV-NL63 in a 7-month-old malnourished infant.

Purpose: This study aimed to evaluate the risk factors for falls in hospitalized children in relation to their caregivers., Methods: This was a case control study to evaluate the risk factors for falls in hospitalized children in relation to their caregivers. The children included in our study were at the hospital between June 2014 and June 2015. Demographic data of patients, caregivers, some habits; education level; and number of siblings were recorded., Results: The data of 117 patients were evaluated, and there were 39 patients with a fall event and 78 patients who did not experience a fall. The mean age for the fall group and the non-fall group were 14.71±9.36 and 15.62±10.65months, respectively. The mean age for the caregivers of the fall group and the non-fall group were 29.33±5.89 and 29.53±5.56years, respectively. There was a statistically significant difference in fall risk related to the caregivers' education level (p<0.01) and caregivers' habit of smoking (p<0.01). The analysis of risk factors related to caregivers for pediatric inpatient falls, by multivariate logistic regression, showed that low educational level of caregivers (OR=0.361; CI=0.196-0.665; p<0.01), caregivers' smoking (OR=4.863; CI=1.058-22.358; p<0.05) and increased length of stay for the children (OR=1.994; CI=1.475-2.696; p<0.01) carried a higher risk for pediatric inpatient falls., Conclusions and Practice Implications: The data obtained in our study have shown that caregivers play a key role in fall events in hospitalized children. Nurses and other health workers should consider children's caregivers educational level and habits for prevention of hospitalized children falls., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to determine whether there are differences in choroidal thickness in children with iron deficiency anemia (IDA)., Methods: Fifty-two patients with IDA and 54 healthy children between 3 and 16 years of age were enrolled in this study. After complete eye examinations were conducted for each participant, the choroidal thickness was measured using optical coherence tomography. Correlations between the choroidal thickness and clinical and laboratory parameters were also evaluated., Results: There were no statistically significant differences between the two groups in terms of visual acuity, intraocular pressure, central corneal thickness, or axial length (P > 0.05). The choroidal thicknesses at the foveal center were 303.13 ± 27.14 μm in the IDA patients and 333.67 ± 39.77 μm in the healthy control children (P < 0.001); additionally, the choroidal thicknesses at each point within the horizontal nasal and temporal quadrants were thinner in the IDA group. There were positive correlations between the choroidal thickness and hemoglobin (r = 0.337; P < 0.001), mean corpuscular volume (r = 0.305; P = 0.001), iron (r = 0.264; P = 0.006), and ferritin (r = 0.287; P = 0.003) levels; however, there were no correlations between the clinical or ocular characteristics and the choroidal thickness., Conclusions: The patients with IDA had significantly thinner choroidal thicknesses than those of the healthy children. Choroidal thinning in childhood may be an early sign of deterioration in the ocular blood circulation, without any risk of atherosclerosis in advanced age in the patients with IDA.

Objective: This study aimed to investigate whether there is a relationship between 25-hydroxy vitamin D [25(OH)D 3] values and incidences of primary epistaxis among children., Methods: A total of 42 cases and 55 matched controls were included in our study. The study group and control group were well matched for age and gender. Age, gender, activated partial thromboplastin time (APTT) with reference to the international normalized ratio (INR), prothrombin time (PT), and 25(OH)D 3, parathormone (PTH), alkaline phosphatase (ALP), calcium (Ca), magnesium (Mg), and phosphorus (P) values were recorded for each participant., Results: Serum 25(OH) D values were found to be statistically significantly (P = 0.03) lower in children with primary epistaxis than in the healthy control group. Our study also revealed that 25(OH) D values were considerably (P < 0.001) lower in the group with primary epistaxis and upper respiratory tract infections (RTI) than in the group with primary epistaxis without upper RTI. Univariate logistic regression analyses demonstrated that 25(OH)D 3 < 20 ng/ml [odds ratio (OR) 1.117, 95% confidence interval (CI) (1.019-1.225); P = 0.019] and serum albumin level [OR 3.499, 95% CI (1072-11,426); P = 0.038] ratio were significantly related to primary epistaxis. Furthermore, multivariate logistic regression analyses revealed that 25(OH)D 3 < 20 ng/ml [OR 1.141, 95% CI (1047-1242); P = 0.003] and serum albumin level [OR 3.340, 95% CI (1068-10,446); P = 0.038] ratio were significantly related to primary epistaxis., Conclusions: Many studies have revealed that vitamin D is a preventive and therapeutic agent for inflammation and infection, thereby providing benefits for children with primary epistaxis. In line with this, our study suggested that a patient's vitamin D status could also be important for the prevention of childhood primary epistaxis, although further studies are required to validate our findings., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: Hepatitis A virus (HAV) still continues to be a serious public health problem worldwide. Mean platelet volume (MPV) is a marker of platelet function and activation. This study aimed to evaluate the relationship between MPV in acute hepatitis A patients as compared to the control group and to assess MPV as an acute phase reactant in acute hepatitis A., Patients and Methods: Seventy-six patients were enrolled in this study. The control group consisted of 41 healthy age- and sex-matched individuals. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, prothrombin time (PT), platelet count (PC), serum albumin (ALB), and mean platelet volume (MPV) levels were recorded. The diagnosis of HAV infection was based on anti-HAV Ig M positivity., Results: The mean levels of MPV in the study group were significantly statistically lower than in the control group (p < 0.001). The MPV levels revealed no correlation with the ALT, AST, ALP, and GGT levels (p > 0.05), but the MPV levels correlated with the platelet counts (p < 0.05). A 9.75 fL [area under the curve (AUC: 0.756)] optimal cutoff level of MPV with a sensitivity of 69.7% and specificity of 68.3% was determined in the children with acute hepatitis A., Conclusions: MPV levels were significantly lower in the patients with acute hepatitis A as compared to the healthy control group. This study demonstrated that MPV may be a negative acute phase reactant for acute hepatitis A. Further studies will explain the role that MPV plays in inflammation and other viral infections.

Background: For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection., Methods: Seventy patients with rotaviral diarrhea and 67 healthy patients were enrolled in this study. Serum 25-hydroxy vitamin D(3) (25(OH)D(3)), parathormone, calcium, phosphate, alkaline phosphatase, complete blood count parameters, and C-reactive protein were compared between pre-school children hospitalized due to rotaviral diarrhea and healthy children. Additionally, birthweight, feeding habits in the first 6 months of life, vitamin D and multivitamin supplements, and rotaviral vaccinations were also evaluated in each group., Results: There were no differences between the groups with regard to gender and age, but 25(OH)D(3) was significantly different: 14.6 ± 8.7 ng/mL in the rotaviral diarrhea patients versus 29.06 ± 6.51 ng/mL in the health controls (P < 0.001), and serum 25(OH)D(3) <20 ng/mL (OR, 6.3; 95%CI: 3.638-10.909; P < 0.001) was associated with rotaviral diarrhea., Conclusions: Low vitamin D is associated with rotaviral diarrhea. This is the first study in the literature to show this, and this result needs to be repeated in larger controlled clinical studies., (© 2015 Japan Pediatric Society.)

Epidermoid cysts are rarely detected malformations in the oral cavity. Their development sites are the sublingual, submaxillary, and submandibular spaces. In this paper, we report a three-month-old infant who was admitted to our hospital due upper lip swelling. Magnetic resonance imaging showed that she had a two-centimeter cystic lesion and fusion defects of orbicularis oris muscle. The cyst was surgically removed and histopathological diagnosis was "epidermoid cyst." In recent literature, we could not find reports related to orbicularis oris muscle fusion defects because of epidermoid cyst.

Background: Thanatophoric dysplasia (TD) is the most lethal and most severe type of dysplasia. It has distinct features, the most important of which is short tubular bones and short ribs with platyspondyly, allowing a precise radiologic and prenatal ultrasonographic diagnosis. It has been reported to be caused by mutations in the FGFR3 gene, but exactly how cytogenetic abnormalities might lead to TD is unclear., Case Report: We report a case of TD with different prenatal sonographic features compatible with the classification of type I. In the result of cytogenetic examination, we found de novo CAs in 28% of cells analyzed from the affected infant; 75% of the abnormalities were numerical, and of those, 25% were structural aberrations; 21% of cells revealed predominantly numerical aberrations. Monosomy 18, 21 and 22 was observed in 4% of cells, monosomy 20 in 2%, and monosomy 7, 8, 14, 17 and 19 in 1%. Structural changes were observed in 7% of cells., Conclusions: It appears that these chromosomes may be preferentially involved in and important for TD development.

Background: Ecthyma gangrenosum is an infective lesion of the skin and mucosal membranes. It is most commonly caused by Pseudomonas aeruginosa, and the most important risk factors are malignancy and neutropenia. However, it has rarely been reported in children who were previously healthy. Persistent hyperplastic primary vitreous has been described as the persistence of the fetal hyaloid vascular system. Acute otitis media with facial paralysis is an infrequent association., Case Report: We report the case of a 5-month-old boy hospitalized because of fever, otorrhea and necrosis on his body. He had peripheral facial paralysis on the same side as otorrhea. Leukocoria was determined in the right eye. He had many gangrenous ulcers on the extremities and body., Conclusions: We present a previously healthy pediatric patient diagnosed with persistent hyperplastic primary vitreous, ecthyma gangrenosum (by the septicemia of P. aeruginosa), and peripheric facial paralysis (a complication of acute otitis media), admitted to hospital.

Background: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey., Methods: We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals., Results: A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis., Conclusions: In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.