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Rationale: There are many cases of daily reported dog bite injuries around the world. However, craniofacial fractures owing to dog bites are quite rare. They are frequently seen in the pediatric age group. Here, we report the successful management of a pediatric patient with depression skull fracture due to a dog bite injury. Patient’s concerns: A 3-year-old boy was admitted to the emergency department with a complicated skull fracture due to a dog bite injury. In physical examination, the patient was neurologically intact. He had hemorrhagic scalp wounds. Cerebrospinal fluid was leaking on the right temporal and frontal sides. Diagnosis: Cranial computed tomography revealed pneumocephalus, brain edema, and compound fracture associated with right frontal concussion. Intervention: After decompressive craniectomy, duraplasty was performed by placing a galea graft. Depressed fractures were removed and subdural bleeding control was provided. Outcomes: Perioperative and postoperative periods were uneventful. Lessons: Emergency medicine physicians should control possible underlying fracture lines in pediatric head trauma caused by dog bites.

Objective: As a primary immunodeficiency X-linked agammaglobulinemia (XLA) that develops due to Bruton tyrosine kinase signal transduction protein deficiency which progresses with antibody deficiency was firstly described by an American pediatrician Ogden Bruton. In our study, we have aimed to evaluate the demographic, clinical, immunological, genetic characteristics and follow-up findings of patients diagnosed with XLA in our tertiary care Pediatric Immunology Clinic. Method: Twelve patients diagnosed with XLA between 2003-2022 in our pediatric immunology clinic we're included in our study. The patient's age, sex, age at symptom onset and diagnosis, family history, laboratory findings at the time of diagnosis, complications observed during clinical follow-up and treatment modalities used were evaluated retrospectively. Results: The median age of the patients at diagnosis was 36 [interquartile range (IQR) 10.2-69.0] months. While the median age of the patients without a family history at the time of diagnosis was 66 (IQR 41.2-66.0) months which was found to be significantly higher compared to the patients with a family history [11.5 (IQR 2.5-30.0) months] (p=0.004). Recurrent respiratory tract infections were the most common indications for admission. Agammaglobulinemia was detected in all patients except two cases. A significant decrease in B cells was detected by flow cytometry in all patients. The diagnoses were confirmed by genetic analysis for nine patients. Bronchiectasis was observed in four, arthritis in three, and inflammatory bowel disease in one case. In one patient, metaplasia was detected in the cytologic examination of the biopsy specimen obtained during endoscopy performed for the diagnosis of inflammatory bowel disease. Conclusion: Early diagnosis, treatment and regular follow-up convey critical importance in terms of preventing complications in patients with XLA.

Aim:Nowadays, insufficiency and deficiency of vitamin B12 and folate are seen as an important health problem. The purpose of the present study was to determine the frequency of vitamin B12 and folate deficiencies in pregnant women and their babies at birth.Materials and Methods:The study group consisted of 117 pregnant women and their single, term babies in İzmir Ege Maternity Hospital. Analysis of vitamin B12, folate and homocysteine levels were performed from venous blood samples which were obtained from the mother and cord blood at birth. Additionally, a questionnaire using a face-to-face interview method was performed with the pregnant women included in this study. The mean duration of pregnancy was 39.1±0.89 weeks and the mean age of the mothers was 28.2±6.2 years.Results:Vitamin B12 deficiency (8 µmol/L) in 58.1% of mothers and 63.2% of babies. There was a significant correlation between maternal and cord blood vitamin B12, folate and homocysteine levels (p

Objective: Asthma is one of the most common chronic diseases of childhood. Many studies have shown that education positively affects asthma control and patients' quality of life. In this study, it was aimed to measure the awareness levels of children who have been under observation for a long time and who underwent Allergen Specific Immunotherapy (AIT). Methods: Patients with asthma, asthma & allergic rhinitis and/or rhinoconjunctivitis who received subcutaneous AIT between July 2019 and December 2019 were included in our prospective case-control study. A questionnaire was applied to each patient, in which both the levels of awareness related to their disease and AIT, as well as their knowledge of the allergens and prevention measures they were sensitive to were measured. The results were examined. Age, gender, type of allergic diseases, allergen type, AIT time were evaluated statistically. Results: 82 cases (48 boys and 34 girls) were included in the study. The number of patients who know the name of the disease correctly is 68 (82.9%); The number of patients who knew allergens to be sensitive was found to be 47 (57.3%). It was observed that 15%-72% of the cases had information about asthma disease. Age, gender and diseases of the patients were not statistically different. Conclusion: In our study, it was observed that our children were highly aware of especially about sports and environmental protection methods. It is essential to raise awareness of patients and parents for increase treatment success and control the asthma.

Aim:Hyponatremia is a common electrolyte abnormality in hospitalized patients. Administration of isotonic maintenance fluids is recommended to prevent hyponatremia. The present study was conducted to evaluate the frequency and severity of hyponatremia in children with acute lymphoblastic leukemia (ALL).Materials and Methods:The frequency, severity and possible causes of hyponatremia in children with ALL throughout their entire intensive treatment were retrospectively evaluated. All children in this study received isotonic fluids as maintenance IV treatment during the hospitalization period.Results:In a five-year period, 618 hyponatremia episodes seen in 92 children with ALL (median age 59 months), treated with ALLIC 2002 protocol were entered into the study. The median number of hyponatremia episodes per patient was 6. All patients had at least one hyponatremia episode of which 83.2% were classified as mild, 13.2% as moderate, 2.9% as severe and 0.6% as very severe. The median duration of hyponatremia episodes was 5 (range between 1-43) days. The total duration of all hyponatremia episodes of each patient varied from 6 to 138 days with a median of 30 days. In 241 episodes of 68 children, there was inadequate salt intake secondary to oral feeding intolerance, nausea, vomiting and oral aphthous stomatitis. In four patients, seizure was seen during the hyponatremia period and thought to be secondary to hyponatremic encephalopathy. No patient developed central pontine myelinolysis.Conclusion:Hyponatremia is very frequent in ALL patients. Despite the use of isotonic IV fluids, it seems it cannot be completely prevented.