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This study compared egg quality parameters in layers under free-range system with prefabricated pens and backyard while emphasizing hen age. A total of 300 eggs collected from prefabricated pens and backyard farming families in the Çamardı District of Niğde Province were used as study materials. The assessed external and internal egg quality characteristics included egg weight, shape index, shell thickness, shell breaking strength, albumen index, Haugh unit, yolk index, and yolk colour. The effect of production system on albumen index, Haugh unit, and yolk colour score was found statistically significant. There was a significant effect of age on shape index, shell thickness, shell breaking strength, albumen index, Haugh Unit, yolk index, and yolk colour score. The effect of interaction between age and production system was statistically significant for shape index, shell thickness, yolk index, Haugh Unit, and yolk colour score. It was determined that the egg`s meat and blood spots percentages from the free-range and backyard systems were 10.6% and 15.3%, respectively. It was concluded that while eggs produced from free-range system are superior in terms of egg weight, shape index, and Haugh unit those obtained from backyard hens are higher in eggshell thickness, eggshell breaking strength, and egg yolk colour.

Objective: Acute lower respiratory tract infection (ALRTI) is the most frequent cause of hospitalization in infantsyounger than 5 years. In the main, alveolar and bronchial infections are responsible for 90% of deaths from respiratory disease.The aim of this study was to investigate the epidemiology, clinical findings, and treatment modalities of respiratory viruses detected with real-time polymerase chain reaction (PCR).Material and Methods: A total of 235 children between the age of 1 and 24 months who were hospitalized due to ALRTI between January 2014 and December 2018 and who had positive PCR results for respiratory viruses were included in the study. Demographics, clinical findings, laboratory tests, treatment modalities, need for the high-frequency nasal cannula (HFNC) or mechanical ventilation, length of hospital stay, and the requirement for treatment within a pediatric intensive care unit (PICU) were recorded. Results: In total, 55.5% of the children were male with a mean age of 6.1±6 months. Respiratory syncytial virus (RSV) was present in 106, rhinovirus in 35, influenza in 23, and other viruses in the remaining 71. There was a significant seasonal difference among the various etiologies. Fever was present in patients with influenza, multiple viral infections, adenovirus, and human metapneumovirus (HMPV). There was no significant difference in the physical examination among patients presenting with a pertussis-like cough, feeding difficulty, or lethargy. The white blood cell (WBC) count increased due to adenovirus and HMPV infection; however, differences in C-reaktif protein(CRP), mean platelet volume (MPV), and eosinophilia were not significant. There was no significant difference between the chest X-ray findings and medical treatment based on the viral etiology. Fifty-four patients were followed up in the PICU. Although influenza was only the third most common etiology, it was the most common cause of PICU admission. Conclusion: RSV continues to be an important viral etiology for hospitalization in children below 2 years old. Influenza was the most frequent virus requiring admission to the PICU. Widespread immunization against influenza has been related to the decline of the LRTI in children., Amaç: Akut alt solunum yolu enfeksiyonu (ALRTI), 5 yaşından küçük bebeklerde en sık hastaneye yatış nedenidir. Çoğunlukla, alveolar ve bronşiyal enfeksiyonlar, solunum hastalıklarından kaynaklanan ölümlerin %90'ından sorumludur. Bu çalışmanın amacı, real-time PCR ile saptanan solunum yolu virüslerinin epidemiyolojisini, klinik bulgularını ve tedavi yöntemlerini incelemektir.Gereç ve Yöntemler: Ocak 2014 - Aralık 2018 tarihleri arasında ALRTI nedeniyle hastaneye yatırılan ve solunum yolu virüsleri için pozitif PCR sonuçları olan 1-24 aylık toplam 235 çocuk çalışmaya dahil edildi. Demografik veriler, klinik bulgular, laboratuvar testleri, tedavi modaliteleri, yüksek frekanslı nazal kanül (HFNC) veya mekanik ventilasyon ihtiyacı, hastanede kalış süresi ve çocuk yoğun bakım ünitesinde (ÇYBB) tedavi gereksinimi kaydedildi.Bulgular: Toplamda çocukların% 55.5'i erkekti ve yaş ortalaması 6.1±6 aydı. Respiratuvar sinsityal virüs (RSV) 106'da, rinovirüs 35'te, influenza 23'te ve diğer virüsler kalan 71'de mevcuttu. Çeşitli etiyolojiler arasında önemli bir mevsimsel farklılık vardı. Ateş influenza, çoklu viral enfeksiyonlar, adenovirüs ve human metapnömovirüs (HMPV) hastalarında vardı. Boğmaca benzeri öksürük, beslenme güçlüğü veya letarji ile başvuran hastalar arasında fizik muayenede anlamlı fark yoktu. Adenovirüs ve HMPV enfeksiyonu nedeniyle WBC sayısı arttı; ancak CRP, MPV ve eozinofilideki farklılıklar anlamlı değildi. Viral etiyolojiye göre akciğer grafisi bulguları ile medikal tedavi arasında anlamlı bir fark yoktu. ÇYBB'de elli dört hasta izlendi. İnfluenza sadece üçüncü en yaygın etiyoloji olmasına rağmen, ÇYBB'ye kabulün en yaygın nedeniydi.Sonuç: RSV iki yaşın altındaki çocuklarda hastaneye yatış için önemli bir viral etiyoloji olmaya devam etmektedir. İnfluenza, ÇYBB'de izlenmeyi gerektiren en sık görülen virüstür. İnfluenzaya karşı yaygın aşılama, çocuklarda ASYE'nin azalmasıyla ilişkilidir.

Büyüme ve gelişmenin en hızlı olduğu 0–5 yaş arası dönem, sağlıklı gelişimi olumsuz etkileyen çok sayıda etmene karşı oldukça duyarlı bir dönemdir. Bu çalışmada 5 yaş altındaki hastaların beslenme öyküleri, büyüme parametrelerini belirlemek ve bu parametreleri etkileyebilecek faktörlerin tespiti amaçlandı.Gereç-yöntem: Çalışmaya 6 aylık dönemde hastanede yatırılarak tedavi edilen 5 yaş altındaki çocuklar dahil edildi. Yaş, cinsiyet, boy ve vücut ağırlıkları (persantilleri), yatış tanıları, kronik hastalık ve hastanede yatış öyküsü, aşılanma durumu, ebeveyn yaşları, ebeveynlerin eğitim durumu ve ortalama gelirleri ile anne sütü alım süreleri ve ek gıdaya geçiş zamanları ile ilgili verileri geriye dönük olarak kaydedildi.Bulgular: Çalışmaya ortanca yaşları 8 ay (1-59 ay) olan 344 hasta (%54,7erkek) dahil edildi. Doğum sonrası hastaların %97,1’i anne sütü ile beslenmeye başlanmışken, çalışma sırasında bir yaştan büyük olanların %18’i 1 yıldan kısa süre emzirilmişti. Hastaların 6. ayda tek başına anne sütü ile beslenme oranı %30,8’di. Hastaların annelerinin eğitim durumu ve ailelerin aylık gelir düzeyleri Türkiye ortalamasından düşük bulundu. Anne-baba yaşı, ebeveyn eğitim düzeyi ve ailenin aylık geliri ile kilo ve boy persantilleri arasında ilişki saptanmadı. Anne yaşı ve annenin eğitim düzeyi ile tek başına anne sütü ile beslenme süresi arasında ilişki bulunmazken, ailenin aylık geliri arttıkça tek başına anne sütü alım süresini uzadığı tespit edildi (p

BACKGROUND Iron intoxication can occur accidentally in children or intentionally by adolescents as a suicide attempt. They usually present with various symptoms including vomiting and diarrhea. Clinical studies in this field has been reported different doses of ingested elemental iron that caused serious toxicity, but none of these studies determined the minimum cut-off of ingested iron that triggered the risk of severe toxicity. The aim of this study was therefore to investigate the demographic features of iron intoxication in Turkish children and to determine the lowest cut-off of ingested elemental iron triggering serious intoxication and the need for prompt management. METHODS This retrospective study investigated 83 Turkish patients with accidental and intentional iron poisoning. RESULTS Of the 83 cases of acute iron intoxication, accidental iron consumption was more common than intentional use. Fifty-three patients ingested a median toxic dose of elemental iron of 40.0 mg/kg (IQR, 33.5 mg/kg). The median serum iron concentration in the first 6 h of ingestion was 150 μg/dL (IQR, 282 μg/dL). Twenty patients were given deferoxamine, whereas 63 patients were given supportive treatment. CONCLUSION The cut-off of ingested elemental iron that triggered serious toxicity and the need for deferoxamine in children

An overdose of isoniazid (INH) is potentially fatal and attempts at suicide are very rare in children. Three patients aged 14-17 years who were receiving INH for tuberculosis prophylaxis were admitted to the emergency department with generalised tonic-clonic seizures. There was metabolic acidosis and elevated levels of blood creatine kinase, aminotransferases and lactate dehydrogenase following ingestion of excess INH in attempts at suicide. The presumed total amounts of INH ingested were 3 g (40 mg/kg), 9 g (160 mg/kg) and 6 g (100 mg/kg), respectively. They all improved with general supportive measures including airway protection, gastric lavage, activated charcoal administration, sodium bicarbonate infusion, fluid replacement, seizure control and pyridoxine administration. They were discharged without complications. Attempts to commit suicide by excess intake of INH is rare in children but should be considered in the differential diagnosis of acute intractable seizures and metabolic acidosis refractory to conventional anticonvulsant therapy in adolescents.

Refugee children are defined as an at-risk population as they have a high risk of physical and mental health conditions. While data exist regarding the mental health of refugee children, there are limited data about their medical health issues and mortality. Therefore, this study aimed to analyze the demographic data, clinical results, treatment/management data, and mortality data of hospitalized refugee children. This is a descriptive study that analyzed the demographic data, clinical findings, treatment/management data, and mortality data of 728 refugee children aged between 1 month and 18 years who were hospitalized in a tertiary pediatric hospital between 2013 and 2018. During the 5 year duration of this study (2013-2018), there were 12,031 patients hospitalized in the department of general pediatrics. Of these patients, 728 (6%) were refugee children [median age 1.2 (IQR 4.4) years]. The most frequent ethnic origin was Syrian, followed by Iraqi and Afghan [465 (63.87%); 174 (23.9%), and 39 (5.3%), respectively]. The median duration of hospitalization was 6 (IQR 6) days. Those refugee patients who were hospitalized in the pediatric intensive care unit were significantly younger [median age 3.7 (IQR 9.4) years]. The mortality rate in the department of general pediatrics was 16.4% for refugee patients and 8.6% for non-refugee patients (p = 0.001). A logistic regression model revealed that factors associated with mortality included younger age (OR 1.6; CI 1.2-2.1) and being a refugee (OR 2.1; CI 1.3-3.2). Our study revealed detailed knowledge about demographic, clinical, and mortality data, with the largest known series about refugee children in the literature. The results show that mortality rates are significantly higher in refugee pediatric patients who are hospitalized in Turkey than in non-refugee patients.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome of excessive immune activation. Secondary HLH syndrome develops as a complication of infection, drugs, rheumatologic conditions, or malignancy. The main objectives of this work were to identify the etiology of secondary HLH and prognostic factors associated with mortality. Patients diagnosed with secondary HLH, between January 2011 and December 2016, were retrospectively included in this study. We analyzed clinical and laboratory findings as well as prognostic factors from 24 pediatric patients diagnosed with secondary HLH. The mean age of patients at the time of diagnosis was 79.9 ± 68.7 months (range: 2-202) and 54.2% of the patients were male. The most frequent HLH-2004 criterion was fever (100%). Underlying triggers of HLH were as follows: 13 (54.1%) infections, juvenile idiopathic arthritis in 5 patients (20.8%), drugs in 3 patients (12.5%), malignancies in 2 (0.8%), Kawasaki disease in 1 (0.4%) patient, and 1 (0.4%) with unknown triggers. The median time of diagnosis was 3 days (1-67 days). Overall, the mortality rate was 20.8%. In our logistic regression model, factors associated with mortality were decreased albumin levels (OR1 = 2.3[1.48-3.43]) and etoposide usage (OR2 = 1.22 [1.14-1.89]). The patient's 30-day survival was inferior among patients whose albumin level was 2 g/dL or less compared to those over 2 g/dL. Increased awareness of the underlying condition is critical in HLH patients. Our study emphasizes the prognostic significance of albumin level.

Colchicine poisoning is an uncommon but serious form of drug intoxication. It may produce life-threatening systemic effects. In toxic doses it produces nausea and vomiting and bone marrow suppression, often leading to sepsis, hypocalcemia, adult respiratory distress syndrome, and direct cardiotoxic effects.The aim of this study was to describe demographic features and the outcome of patients poisoned with colchicine.A retrospective study of the pediatric intensive care unit database was performed for patients ≤18 years of age who had colchicine poisoning between July 2008 and July 2013.The total number of patients with drug poisoning in the study period was 144. Nine of 144 were related to colchicine poisoning. The median age was 4 years (range 20 months to 16 years) and the number of females was five. Six of the nine cases presented after ingesting0.5 mg/kg, whereas two patients had consumed 0.5 to 0.8 mg/kg. One patient had received colchicine0.8 mg/kg. Three patients died.Among drug intoxications, colchicines can lead to severe clinical conditions. All patients suspected of having colchicine intoxication should be managed in the pediatric intensive care unit regardless of the actual degree of poisoning.

We investigated the presence of nutritional rickets in Syrian and Iraqi refugee infants who presented to hospital in Turkey in 2017. 25(OH)D levels were examined in 77 refugee children. Nutritional rickets was diagnosed in 22 (28.5%) children; 11 patients with rickets did not follow up.

Three infants aged between 38 days and 43 days all presented with poor weight gain, hyponatremia, hyperkalemia, and were diagnosed as having urinary tract infections, which were accompanied by urinary tract malformations in our cases. Hydration and infection treatments were given. A few days after admission, hormonal studies revealed normal cortisol and 17-hydroxy progesterone levels and markedly high aldosterone levels, thus the patients were diagnosed as having transient pseudohypoaldosteronism. After the proper treatment was given, the transient pseudohypoaldosteronism resolved. In conclusion, when an infant with urinary tract infection or malformation has electrolyte abnormalities, pediatricians should consider the diagnosis of transient pseudohypoaldosteronism.

Aim: Pulmonary hypertension is a major cause of morbidity and mortality among Down syndrome patients with congenital heart disease. Asymmethric dimethyl arginine (ADMA) is an endogenous inhibitor of nitric oxide synthesis. Increased plasma levels of ADMA may be related with pulmonary hypertension. The aim of this study was to evaluate the relationship between ADMA and pulmonary hypertension in Down syndrome patients with congenital heart disease.Material and Method: The study group consisted of 21 children with Down syndrome with congenital heart disease. Plasma ADMA concentrations were analyzed according to the presence or absence of pulmonary hypertension.Results: The mean age of the 21 patients was 29.7±23.5 months (range: 3-88 months). Six patients with congenital heart disease had accompanied with pulmonary hypertension. Fifteen patients had no pulmonary hypertension. The levels of ADMA showed no statistically significant difference between the groups (p >0.05).Conclusion: No correlation was shown between ADMA levels and pulmonary hypertension in children with Down syndrome with congenital heart disease. However, multicenter prospective studies with enlarged sample sized are needed to provide more realistic results about the connection between ADMA and pulmonary hypertension in Down syndrome children., Amaç: Konjenital kalp hastalığı bulunan Down sendromlu hastalarda pulmoner hipertansiyon önemli bir morbidite ve mortalite nedenidir. Asimetrik dimetil arjinin (ADMA) nitrik oksit sentezinin endojen inhibitörüdür. Artmış plazma ADMA seviyeleri pulmoner hipertansiyonla ilişkili olabilir. Bu çalışmanın amacı konjenital kalp hastalığı bulunan Down sendromlu hastalarda pulmoner hipertansiyon ve ADMA arasındaki ilişkinin değerlendirilmesidir.Gereç ve Yöntem: Çalışma grubunu konjenital kalp hastalığı bulunan 21 Down sendromlu çocuk oluşturmaktadır. Plazma ADMA konsantrasyonları pulmoner hipertansiyon olup olmamasına göre analiz edildi.Bulgular: 21 hastanın ortalama yaşı 29,7±23,5 ay (3-88 ay) idi. Konjenital kalp hastalıklı altı hastaya pulmoner hipertansiyon eşlik etmekte idi. On beş hastada pulmoner hipertansiyon yoktu. ADMA seviyeleri açısından gruplar arasında istatistiksel olarak fark saptanmadı (p >0,05).Sonuçlar: Konjenital kalp hastalığı bulunan Down sendromlu çocuklarda pulmoner hipertansiyon ile ADMA seviyeleri arasında ilişki görülmedi. Bununla birlikte, Down sendromlu çocuklarda ADMA ve pulmoner hipertansiyon arasındaki ilişkinin saptanmasında daha gerçekçi sonuçlar elde etmek için geniş örneklem içeren prospektif, çok merkezli çalışmalara ihtiyaç vardır.

The present study was conducted to determine young children's (aged 1-60 months) exposure to and use of mobile devices. The study included 422 parents of children aged 1-60 months admitted to pediatric outpatient clinics. A questionnaire was administered to the parents via face-to-face interview. Children's overall exposure to mobile devices was 75.6% (n = 319). Of the children, 24.4% (n = 103) had never used a mobile device. Among the children that had used a mobile device, 20.6% (n = 66) were aged between 1 and 12 months; 24.5% (n = 78) were aged between 13 and 24 months. The median age at the first time use of a mobile device was 12 months. The youngest child that used a mobile device was 6 months old. Tablets had a significant difference in the age at first use compared with other mobile media types (P 0.01). Children's overall mobile device ownership was 30.7% (98/319) in frequency. There was a positive relationship between mobile device ownership and age (p 0.001). The most commonly owned mobile device was a "tablet" at a frequency of 68.4% (67/98). The frequency of tablet ownership was inversely associated with household income (P 0.01). Of the children that used mobile devices, 25.7% (82/319) used multiple mobile devices simultaneously. Among 422 children, 15.9% (n = 67) had a tablet in their room. The frequency of tablet use and ownership was inversely related to the mother's educational level (P 0.01). The parents reported that 22.3% (n = 71) never received help while navigating the mobile device. The most frequent activity with mobile devices was watching videos (70.8%, n = 226). Of the parents, 59.6% (190/319) let their children use mobile devices while they are doing daily tasks or domestic chores. Of the parents, 91.5% (n = 386) reported not having been informed by a doctor about the effects of mobile devices on their children.Conclusion: This study demonstrates a high prevalence of exposure to mobile devices in young children. The frequency of tablet use and ownership of offspring was inversely related with maternal educational level and household income. What is Known: • Mobile phones and other similar mobile devices are now embedded in the daily lives of children. • There are limited data about mobile media use in early childhood, and few guidelines on which clinicians can base their recommendations. What is New: • The exposure to mobile devices is high in young children aged 1-60 months. • The frequency of tablet use and ownership of offspring was inversely related to household income and maternal educational level.

Acute respiratory tract infection remains a major cause of childhood hospitalization and mortality in young children. Human bocavirus (HBoV) is a virus belonging to the Parvoviridae family, which has been newly discovered to be associated with respiratory tract infection in children. Human bocavirus infection is usually seen as form of co-infection. The frequent associations of HBoV with other respiratory viruses might be explained by the persistence of HBoV in the respiratory tract. HBoV primary events generally associated with mild respiratory illness. Here, we reported three patients who developed an extremely severe acute life-threatening respiratory failure due to HBoV infection. J Microbiol Infect Dis 2016; 6(3): 145-147

Epinephrine plays an integral role in the treatment of several life treating diseases. It can be administered at different doses and through different routes of administration. Nebulized L-epinephrine has been described as a safe treatment method. There is a significant difference in doses between nebulization and parenteral administration of epinephrine. Medication errors can result in death due to the use of high-dose epinephrine with parenteral administration. Here we report a child patient who was accidentally exposed to an approximately 30-fold higher dose of intravenous epinephrine. However, the patient did not develop permanent damage. Medication errors are common in pediatric inpatients, and efforts to reduce them are needed.

Kurt F, Kendirli T, Gunduz RC, Kesici S, Akca H, Sahin S, Kalkan G, Derbent M, Tuygun N, Odek C, Gultekin-Keser A, Oguz S, Polat E, Derinoz O, Tekin D, Teksam O, Bayrakci B, Suskan E. Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2018; 60: 488-496. The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% of the patients were males, and 44% were younger than one year of age. The witnessed arrest rate was 75.8% (138/182) and the rate of bystander CPR was 13.9% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1- 15) min, while it was 15 (5-40) min for the remaining patients (p < 0.001). The ROSC rate was 94.9% in patients who underwent CPR for less than 20 min and 22% in patients requiring CPR longer than 20 min (p < 0.001). Survival to hospital discharge was 14.3%. Of these patients, 57.7% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results.

Health care-associated infections (HCAIs) cause considerable morbidity and mortality in pediatric intensive care units (PICUs). The objective of this point prevalence study was to assess the burden of HCAIs in PICUs in Turkey. Fifty PICUs participated in this study. Data regarding demographics, microbiological findings, therapeutic interventions, and outcomes were collected for all PICU inpatients. A total of 327 patients participated in the study: 122 (37%) experienced 1 or more HCAI. The most frequently reported site of infection was lower respiratory tract (n=77, 63%). The most frequently isolated pathogens were Pseudomonas aeruginosa, Acinetobacter species, and Candida species. Two hundred and forty-seven patients (75%) were receiving antimicrobial therapy at the time of the survey, and the most frequently administered antimicrobials were third generation cephalosporins. Hospital type, male, PICU stay >7 days, and mechanical ventilation were found to be independent risk factors for HCAIs. At the 4-week follow up, 43 (13%) patients had died, 28 (65%) of whom died of HCAIs. Endotracheal intubation, urinary catheter, male, and HCAIs were independent risk factors for mortality. This national, multicenter study documented a high prevalence of HCAIs in Turkey. In light of the 'primum non nocere' principle, the prevention of these infections should be a priority of public health policy.

Aim: This study aims to evaluate the general characteristics of patients with acute carbon monoxide poisoning in childhood. Materials and Methods: Medical reports of 240 patients with carbon monoxide poisoning who were admitted to the Pediatric Emergency Department between January 2005 and 2013 (mean age, 82.5±56 months; 115 boys, 125 girls) were retrospectively analyzed. Demographic features of patients, sources of exposure, clinical signs, blood carboxyhemoglobin levels, laboratory findings, and treatment methods were evaluated. Results: Approximately half of the poisonings were observed in winter (December and January). Among the sources of exposure to carbon monoxide gas, the stove was found to be the most common source. Majority of patients suffered from fainting and headaches, whereas 16% of patients had no active complaints. The average of the initial blood carboxyhemoglobin level was 14.9±10%, and 14.2% of patients had a level of >25%. All patients underwent normobaric oxygen therapy, and 21.7% of them underwent hyperbaric oxygen treatment. Conclusion: Unexpected deaths because of carbon monoxide poisoning gradually increase, particularly in winter. Carbon monoxide poisoning should be considered in the patients presenting with suspicious findings, particularly in winter. Blood carboxyhemoglobin levels are useful for diagnosis. (Eurasian J Emerg Med 2015; 14: 189-91)

Synthetic cannabinoid receptor agonists are becoming increasingly popular in adolescent age group as an abused substance. Therefore, pediatric emergency physicians should be prepared for Bonzai utilizations which are being more common day by day. The aim of the study is to investigate cases who admitted to a pediatric emergency service with use of Bonzai.

Kasapkara CS, Yilmaz-Keskin E, Ozbay-Hosnut F, Akcaboy M, Polat E, Olgac A, Zorlu P. An infant with an extremely rare cobalamin disorder: Methionine synthase deficiency and importance of early diagnosis and treatment. Turk J Pediatr 2019; 61: 282-285. Functional methionine synthase deficiency can be separated into two classes, cobalamin (Cbl) deficiency type E (CblE) and type G (CblG), which are the result of mutations that affect methionine synthase reductase or methionine synthase, respectively. Deficiency of methionine synthase activity may result in megaloblastic anemia without methylmalonic aciduria and neuromuscular abnormality of varying severity. Delayed milestones, ataxia, cerebral atrophy, muscular hypotonia, neonatal seizures, and blindness have been reported as the associated clinical findings. Early diagnosis and treatment are crucial for a more favorable diagnosis of the affected cases. Herein we report a three-month-old boy with CblG disease who presented with failure to thrive, chronic diarrhea, feeding intolerance, oral ulcers, microcephaly and hypotonia, and showed a dramatic response to treatment. In the first few months of life, megaloblastic anemia accompanied by apparent neurological involvement should direct physicians to order examinations like measurement of total homocysteine and methylmalonic acid levels to detect possible forms of inherited Cbl intracellular metabolism disorders.

Colchicine is frequently used in the treatment of familial Mediterranean fever (FMF). First symptoms of colchicine intoxication are gastrointestinal disturbances, such as abdominal cramps, diarrhea, pancytopenia and so on. Herein, we report a female FMF patient with pancytopenia and hemophagocytic lymphohitiocytosis (HLH), following colchicine intoxication for committing suicide. To our knowledge, this is the first reported case of a patient with HLH associated with colchicine intoxication.

Introduction: Childhood poisoning is commonly encountered in pediatric emergency medicine departments. As a result of a violation of the dieffenbachia plant body or parts of the leaves, effects can be seen in a spectrum from mild local irritation to death. Case Report: Here, we report a 1-year, 11-month-old child patient, presenting with local irritation symptoms after violation of dieffenbachia plant leaves, who required supported treatment. Conclusion: Ornamental plants in our homes should be considered a risk factor for toxicity., Introduction: Childhood poisoning is commonly encountered in pediatric emergency medicine departments. As a result of a violation of the dieffenbachia plant body or parts of the leaves, effects can be seen in a spectrum from mild local irritation to death. Case Report: Here, we report a 1-year, 11-month-old child patient, presenting with local irritation symptoms after violation of dieffenbachia plant leaves, who required supported treatment. Conclusion: Ornamental plants in our homes should be considered a risk factor for toxicity

Neonatal cholestasis is a rare presenting feature of cystic fibrosis which usually cannot be differentiated from other types of cholestasis. Herein, the authors report a 63 d-old boy with cystic fibrosis presenting with neonatal cholestasis mimicking biliary atresia. A new mutation in CFTR gene resulting in severe phenotype has been described. The cystic fibrosis patients with c.3871 G > T mutation may have acholic gaita mimicking biliary atresia in the absence of insipissated bile with minimal histologic findings in the liver.

A 6-week-old girl, the first child of non-consanguineous parents, was admitted to the hospital for evaluation of vomiting. She was small for gestational age (1500 g). On admission, she weighed 1830 g, and appeared dehydrated. The blood glucose was 880 mg/dL. Insulin and C-peptide levels were