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A letter to the editor is presented which discusses a medical case of a 9.5-year-old girl with swollen feet for eight days after her hospitalization for diagnosed diabetes mellitus (DM) type 1 and ketoacidosis (DKA), diagnosed with insulin edema.

A letter to the editor is presented on chickenpox-associated immune thrombocytopenic purpura.

Animal bites are among the top causes of preventable traumatic injuries. We describe the case of an 8-month-old female infant who was brought to the emergency department by her grandfather with serious rodent bites on her eyes, nose, right cheek, upper right extremity, and other smaller bites all over her body. This case is another proof of child neglect, or a possible infanticide attempt, as the motives of leaving the child in a hut without proper care, are not cleared up to this date. Rodent bites could be associated with Streptobacillus moniliformis infection and rat-bite fever. If the bites are left untreated for hours, the infant may suffer from hypovolemic shock due to bleeding, a possible fatal situation. The emergency surgical treatment of wounds is of vital importance., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Skarentzos et al.)

Mantadakis E, Zikidou P, Tsouvala E, Thomaidis S, Chatzimichael A. Severe iron deficiency anemia and anasarca edema due to excessive cow`s milk intake. Turk J Pediatr 2019; 61: 102-106. The authors describe a 13-month-old girl who presented with progressively worsening anasarca edema that developed over the last three weeks along with increasing fatigue. Over the last several months she was consuming progressively increasing amounts of fresh cow`s milk. Laboratory examinations on admission showed severe microcytic and hypochromic anemia (hemoglobin 3.8 g/dl) and hypoferritenemia indicative of iron deficiency, while urinalyses showed no proteinuria. The child was transfused with 13ml/kg packed red blood cells and approximately 2g/kg intravenous albumin. On the second and fourth hospital days, she received 100 mg of iron sucrose intravenously that she tolerated well. Eight months after the described events, she is healthy with normal hemoglobin for age, while she has no laboratory evidence of cow`s milk protein allergy. Pediatricians should be aware of the association of severe iron deficiency anemia (IDA) and anasarca edema, and should screen infants in their practice for anemia at the age of 12 months or sooner, if risk factors are present.

Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This article has been retracted by the authors under the agreement between the Editor-in-Chief, Masayuki Saijo and authors.

The study examined the changes of training load and physiological parameters in relation to competitive performance during a period leading to a national championship. The training content of twelve swimmers (age: 14.2±1.3 yrs) was recorded four weeks before the national championship (two weeks of normal training and two weeks of the taper). The training load was calculated: i) by the swimmer's session-RPE score (RPE-Load), ii) by the training intensity levels adjusted after a 7×200-m progressively increasing intensity test (LA-Load). Swimmers completed a 400-m submaximal intensity test, a 15 s tethered swimming and hand-grip strength measurements 34-35 (baseline: Test 1), 20-21 (before taper: Test 2) and 6-7 (Test 3) days before the national championship. Performance during the national championship was not significantly changed compared to season best (0.1±1.6%; 95% confidence limits: -0.9, 1.1%; Effect Size: 0.02, p=0.72) and compared to performance before the start of the two-week taper period (0.9±1.7%; 95% confidence limits: 0.3, 2.1%; Effect size: 0.12, p=0.09). No significant changes were observed in all measured physiological and performance related variables between Test 1, Test 2, and Test 3. Changes in RPE-Load (week-4 vs. week-1) were correlated with changes in performance (r=0.63, p=0.03) and the RPE-Load was correlated with the LA-Load (r=0.80, p=0.01). The estimation of the session-RPE training load may be helpful for taper planning of young swimmers. Increasing the difference between the normal and last week of taper training load may facilitate performance improvements.

Objective: To characterize a spectrum of mechanical properties of four representative types of modern dental resin composites and to investigate possible interrelations., Methods: Four composite resins were used, a microhybrid (Filtek Z-250), a nanofill (Filtek Ultimate), a nanohybrid (Majesty Posterior) and an ormocer (Admira). The mechanical properties investigated were Flexural Modulus and Flexural Strength (three point bending), Brinell Hardness, Impact Strength, mode I and mode II fracture toughness employing SENB and Brazilian tests and Work of Fracture. Fractographic analysis was carried out in an SEM to determine the origin of fracture for specimens subjected to SENB, Brazilian and Impact Strength testing. The results were statistically analyzed employing ANOVA and Tukey post hoc test (a=0.05) while Pearson correlation was applied among the mechanical properties., Results: Significant differences were found between the mechanical properties of materials tested apart from mode I fracture toughness measured by Brazilian test. The latter significantly underestimated the mode I fracture toughness due to analytical limitations and thus its validity is questionable. Fractography revealed that the origin of fracture is located at notches for fracture toughness tests and contact surface with pendulum for Impact Strength testing. Pearson analysis illustrated a strong correlation between modulus of elasticity and hardness (r=0.87) and a weak negative correlation between Work of Fracture and Flexural Modulus (r=-0.46) and Work of Fracture and Hardness (r=-0.44). Weak correlations were also allocated between Flexural Modulus and Flexural Strength (r=0.40), Flexural Strength and Hardness (r=0.39), and Impact Strength and Hardness (r=0.40)., Significance: Since the four types of dental resin composite tested exhibited large differences among their mechanical properties differences in their clinical performance is also anticipated., (Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.)

Despite the fact that sunlight-dependent skin synthesis is the major mechanism for vitamin D synthesis in vivo, vitamin D-deficiency rickets continues to occur in exclusively breastfed infants in Greece. We present such a case in a 5-month-old infant who presented with afebrile seizures and whose mother was underexposed to sunlight due to veiling for religious reasons. Additionally, we briefly but thoroughly review the relevant medical literature. A high index of suspicion is required for nutritional rickets, when seizures occur in exclusively breastfed infants whose mothers have inadequate exposure to sunlight., (Copyright © 2012. Published by Elsevier B.V.)

The authors describe the case of a 70-day-old boy who was mistakenly diagnosed as suffering from acute hepatitis B, when he presented with persistent unconjugated hyperbilirubinemia and transaminasemia and was found to be seropositive for the hepatitis B surface antigen. The antigenemia was transient and related to his recent immunization with Infanrix-Hexa. Caution is required during interpretation of a positive HBsAg test that is obtained within 28 days after vaccination against hepatitis B.

Summary: The researchers describe the case of a earlier healthy 3-year-old boy, who developed immune thrombocytopenic purpura (ITP) 26 days after immunization with the second dose of seasonal influenza vaccine. He recovered quickly and uneventfully within 2 days after receiving a single dose of intravenous immunoglobulin. Review of the medical literature showed that symptomatic thrombocytopenia occurs in a substantial number of children and adults who require hospitalization for complicated natural influenza infection, particularly avian influenza. In contrast, it is exceptionally rare after influenza immunization, as only few case reports describe such an association in adults but not in children. As the risk of thrombocytopenia after natural influenza seems to be much higher than after immunization, annual influenza vaccination is advised for patients with personal history of ITP who at risk of influenza-related complications owing to underlying medical problems.

Background: Erythema nodosum (EN) is the most frequent type of panniculitis in childhood. Although frequently idiopathic, it may be associated with a wide variety of conditions ranging from infections, to sarcoidosis, to collagen vascular diseases to drugs., Case Report: We present an 8-year-old boy who developed EN during the course of febrile gastroenteritis due to salmonella enteritidis. He received intravenous ampicillin 150 mg/kg/day divided in equal doses every six hours for 10 days. The skin lesions gradually disappeared, and he recovered fully without sequelae., Conclusions: Salmonellosis should be considered in the differential diagnosis of EN in children with gastrointestinal symptoms, and stool cultures should be performed when indicated.

Aim: The aim of this study was to examine the changes of maximal inspiratory mouth pressure (PImax) during a 400-m front crawl swimming trial., Methods: Eleven well-trained competitive swimmers (age: 17.6+/-0.8 years, mean+/-SE) performed a 400-m front-crawl trial with maximum effort (296.2+/-4.76 s). Then, on different days they swam a 300-m, 200-m and 100-m trials at a velocity corresponding to the 400-m trial. Measurements of PImax from residual volume at upright body position before and immediately after each trial were conducted using a portable mouth pressure meter., Results: Maximal inspiratory mouth pressure did not change significantly after the 100-m and 200-m trial compared to baseline (131.8+/-9.7 and 123.7+/-10.3 vs. 140.9+/-8.9 cmH(2)O, P>0.05). However, PImax was significantly lower after the 300-m (118.8+/-7 cmH(2)O, P=0.02) and 400-m trials (118.1+/-9.9 cmH(2)O, P=0.01)., Conclusions: These results indicate that during a maximum effort of 400-m front crawl, the reduction of inspiratory muscle strength occurs after 300-m. This should be considered for competitive swimming training by implementing swim race distance-specific respiratory muscle training.

Purpose: To investigate the desensitizing ability of a one-bottle bonding agent and a glutaraldehyde-based HEMA formulation on sensitive tooth cervical areas for a period up to 9 months., Methods: The sample consisted of 40 patients with cervical hypersensitivity. Three sensitive teeth per patient were treated; one received One-Step (one-bottle bonding agent), the other Gluma Desensitizer (glutaraldehyde-based agent) and the third distilled water (control group). The hypersensitivity level was determined before, immediately after the desensitizing session, at 8 weeks, and 9 months post-treatment. Measurements of sensitivity were determined by the patient's response to tactile and air-blast stimuli. A verbal rating scale was used and scored as follows: 0, no discomfort; 1, discomfort but no severe pain; 2, severe pain during simulation; 3, severe pain after simulation. The results were subjected to statistical analysis by Kruskal-Wallis test (a=0.05)., Results: Both treatment procedures resulted in reduction of hypersensitivity to both stimuli, for up to 9 months. No significant differences were recorded between One-Step and Gluma Desensitizer at immediate and 8-week examinations, whereas Gluma Desensitizer produced lower hypersensitivity than One-Step at the 9-month assessment. In general, a lower level of reduction was found for the 9-month interval compared to the 8-week hypersensitivity score for both agents tested. A placebo effect was observed with water treatment, ranging from 4.7 to 27.5% reduction of hypersensitivity.