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The diagnosis and treatment of vulvovaginitis in children is poorly managed because it is difficult to determine whether the agent causing vulvovaginal inflammation is a single bacterial species.This study retrospectively evaluated genital microbiological findings in prepubescent girls with vulvovaginitis and then compared the findings to healthy controls without discharge.This was a retrospective case-control study of 483 prepubescent girls aged 2-10 years with vulvovaginitis and 50 age-matched healthy asymptomatic controls. Data were collected at the Pediatric General Outpatient Unit of the Hospital of the Bezmialem Vakıf University from December 2015 to March 2021.Of the 483 positive vaginal cultures in the study group, 248 (51.3%) exhibited potential causative agents. Conversely, 8 of 50 (16%) of the vaginal cultures in the control group (P.001) exhibited potential causative agents. Streptococcus pyogenes was the most frequently detected causative agent of vulvovaginitis in the study group. S. pyogenes was present in specimens from 74 girls (15.8%) with symptoms of vulvovaginitis vs 1 (4.1%) specimen in the control group. Other specific organisms identified in the study group were Escherichia coli (12%), Haemophilus influenzae (5%), Staphylococcus aureus (4.3%), Candida albicans (4.3%), and Streptococcus agalactia (3.3%).Among prepubescent girls with vulvovaginitis, 51.3% of vaginal cultures exhibited potential causative agents in the study group. Our microbiological data indicated that the most common pathogens were S. pyogenes and E. coli.

Objective: Luckenschadel skull is a skull that is radiologically characterized by lacunae in the cranial vault. To date, although the association between neurological abnormalities and scoliosis is well recognized, no relationship between idiopathic scoliosis and a lacunar skull has been defined. We explored the incidence and time courses of lacunar skulls in patients with idiopathic scoliosis. Materials and Methods: Spinal X-rays of 3,170 children aged 6–16 years with idiopathic scoliosis evaluated from October 2010 to August 2020 were examined for the presence of an irregular inner calvarial table indicative of a Luckenschadel skull. A total of 1,760 (55.5%) of the 3,170 images included the skull. We also explored the frequency of intraspinal abnormalities in children with lacunar skull images who underwent spinal magnetic resonance imaging. Results: The study population consisted of 1,760 children, 1,203 girls (68.4%) and 557 (31.6%) boys. A total of 268 (15.2%) clearly evidenced lacunar skulls in their radiographs; 186 (69.4%) girls (11.3 ± 4.3 years) and 82 (30.6%) boys (12.6 ± 3.3 years). Two of the 56 patients (3.6%) who underwent spinal MRI had intraspinal abnormalities (isolated Chiari malformation-I). No additional neurological problems were detected in children with lacunar skulls. Conclusion: We conclude that the lacunar skull is very common in children with idiopathic scoliosis who lack any other neurological pathology. The lacunar skull does not disappear even in adolescence. Although previous publications have stated that lacunar skull disappears over time in radiographic images, we observed that it became more noticeable over time in children with scoliosis.

Molluscum contagiosum (MC) is viral skin infection that is most commonly observed in children. Zinc homeostasis is essential for proper immune function, especially in host-virus interactions. This study aimed to investigate the effectiveness of oral zinc sulfate treatment in children with MC.The subjects included 23 children with MC and 30 age/sex-matched healthy children as controls. Children with MC received oral zinc sulfate for 2 mo, and serum zinc levels were measured before and after the treatment period. Patients were examined every 4 wk for evidence of partial or complete lesion regression. Lesion numbers were recorded before treatment and during follow up.The mean serum zinc levels in children with MC did not differ from those in controls (80.57 ± 10.14 vs 81.90 ± 8.47 μg/dL, respectively, P = 0.370). After zinc sulfate supplementation, the mean serum zinc levels increased from 80.57 ± 10.14 to 100.5 ± 9.95 μg/dL (P0.001) in subjects with MC. After a 2-mo treatment period, six subjects exhibited resolution of lesions at the 1-mo follow up, 10 subjects at the 2-mo follow-up, and three subjects at the 3-mo follow up. Disease recurrence was not observed. A 6-y-old boy and two 4-y-old girls without other systemic symptoms had MC lesions that persisted after zinc sulfate therapy and throughout the 1-y follow up. One female subject experienced complete recovery in after treatment month 4, but recurrence was observed in month 7 and persisted for 18 mo.Our findings support the use of oral zinc sulfate as a therapy for children with MC.

Background Free radicals found in cigarette smoke can harm all tissues and cellular structures in the human body. Passive smoking increases free radical production, leads to the depletion of antioxidants and increases oxidative stress which causes lipid peroxidation. Many studies have been conducted to determine the effects of passive smoking on antioxidant enzymes and lipid levels in adults, but pediatric studies on this topic are few. In our study, we compared the levels of antioxidants, oxidants, total and LDL cholesterol in children exposed to passive cigarette smoking with a healthy control group that was not exposed to passive smoking. Methods A total of 41 children (4–17 years of age, 24 girls and 17 boys) exposed to passive smoking and 18 healthy girls and 12 healthy boys were included in this study. Secondhand smoking was confirmed via measurement of the cotinine/creatinine ratio. Various sociodemographic characteristics of patients were recorded. The levels of catalase, thiol, myeloperoxidase were measured to determine the antioxidant and oxidant levels in children, while the levels of total cholesterol and LDL cholesterol were measured to determine the alterations in lipid profile. Results The groups were similar in regard to demographic characteristics. Myeloperoxidase levels were significantly higher in the passive cigarette smoking group compared to the non-exposure group; however, catalase and thiol levels were similar. In regard to lipid profile, the levels of total cholesterol and LDL cholesterol were also similar in those with and without exposure to passive smoking. Conclusions Our findings suggest that the effects of passive smoking initially influence oxidants (MPO), but not antioxidants (thiol and catalase). However, it is apparent that passive smoking adversely affects oxidative balance in children and this may lead to the development of various diseases which could cause significant morbidity and mortality.

Congenital nephrotic syndrome is a term used to describe a condition in babies who develop severe proteinuria and hypoalbuminaemia within their first three months of life. They generally have oedema and ascites from birth which, because of increased intra-abdominal pressure, can result in an umbilical hernia. The report presents a five-month old infant with congenital nephrotic syndrome who had spontaneous umbilical hernia rupture with evisceration. The approach to umbilical hernias is usually conservative, but in selected cases elective surgery may be indicated.

The aim of the following study is to evaluate the risk of obstructive sleep apnea syndrome (OSAS) in subjects with vitamin D deficiency.Prospective and comparative study.We enrolled 240 subjects into the study. The participants were divided into 2 groups based on 25-hydroxyvitamin D (25[OH]D) levels: low level of 25(OH)D ( 20 ng/mL) group (n = 120). Subjects were classified as being at a high or low risk of developing OSAS by using the Berlin Questionnaire. Risk of developing OSAS, gender, age, and body mass index (BMI) z-score were assessed by comparing the low level of 25(OH)D group and control group.No statistically significant difference was observed between the low level of 25(OH)D group and control group in terms of gender, age, and BMI z-score distributions; P = 0.323, P = 0.387, and P = 0.093, respectively. There were 24 subjects with high risk of developing OSAS in 2 groups (17 subjects in the low level of 25[OH]D group and 7 subjects in the control group). In the low level of 25(OH)D group, the risk of developing OSAS was found to be significantly higher than the control group (P = 0.030). BMI z-score was found significantly higher in high-risk groups than low-risk groups (P = 0.034 for low-level 25[OH]D group and P = 0.023 for control group).The findings revealed that low level of 25(OH)D increases the risk of developing OSAS.

Drug-induced hemolytic anemia is an immune-mediated phenomenon that leads to the destruction of red blood cells. Here, we present a case of life-threatening ceftriaxone-induced hemolytic anemia (CIHA) in a previously healthy 3-year-old girl. We also reviewed the literature to summarize the clinical features and treatment of hemolytic anemia. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with high mortality. Our patient had a sudden loss of consciousness with macroscopic hematuria and her hemoglobin dropped from 10.2 to 2.2 g/dl over 4 hours, indicating that the patient had life-threatening hemolysis after an intravascular dose of ceftriaxone who had previously been treated with ceftriaxone in intramuscular form for six days. CIHA is associated with a positive direct antiglobulin test, revealing the presence of IgG in all cases and C3d in most cases. Our patient's direct antiglobulin test was positive for IgG (3+) and for C3d (4+). The case was managed successfully with supportive measures and intravenous immunoglobulin therapy. Ceftriaxone is used very frequently in children; an early diagnosis and proper treatment of hemolytic anemia are essential to improve the patient outcome. The pathophysiological mechanism is the same as for non-drug autoimmune hemolytic anemia. However, there is still no consensus treatment for CIHA. Intravenous immunoglobulin can be used in clinical emergencies, such as our case, or in refractory cases.

Objective: The hypothalamus plays a crucial role in the regulation of feeding behavior. The anorexigenic neuropeptide alpha-melanocyte-stimulating hormone (α-MSH) and the orexigenic neuropeptide agouti-related protein (AgRP) are among the major peptides produced in the hypothalamus. This study investigated the plasma concentrations of α-MSH and AgRP in underweight and obese children and their healthy peers. The associations between α-MSH and AgRP levels and anthropometric and nutritional markers of malnutrition and obesity were also assessed. Methods: Healthy sex-matched subjects aged 2 to 12 years were divided into 3 groups, as underweight (n=57), obese (n=61), and of normal weight (n=57). Plasma fasting concentrations of α-MSH and AgRP were measured by enzyme-linked immunosorbent assay. The differences between the three groups as to the relationships between plasma concentrations of α-MSH and AgRP and anthropometric data, serum biochemical parameters and homeostatic model assessment of insulin resistance were evaluated. Results: Obese children had significantly lower α-MSH levels than underweight (1194±865 vs. 1904±1312 ng/mL, p=0.006) and normal weight (1194±865 vs. 1762±1463 ng/mL, p=0.036) children; there were no significant differences in the α-MSH levels between the underweight and normal weight children (p=0.811). Also, no significant differences were observed between the underweight and obese children regarding the AgRP levels (742±352 vs. 828±417 ng/mL, p=0.125). We found a significant positive correlation between plasma α-MSH and AgRP levels across the entire sample. Conclusion: This study is the first to demonstrate body weight-related differences in α-MSH and AgRP levels in children. Circulating plasma α-MSH levels in obese children were markedly lower than those of underweight and normal-weight children. This suggests that α-MSH could play a role in appetite regulation. Bezmiâlem Vakıf Üniversitesi Bezmiâlem Vakıf Üniversitesi

Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies) and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination.

Amaç: Yeme sorunları ve iştahsızlık çocukluk çağında sık görülen durumlardır. Ancak çocukların az bir kısmında yeme bozukluğu saptanır. Yeme bozukluğu saptanan çocukların erken tanınması ve tedavilerinin düzenlenmesi önemlidir. Bu çalışmada çocukluk çağı yeme bozukluğu tanısı ile takip edilen hastaların klinik ve demografik özelliklerinin değerlendirilmesini amaçlanmıştır.Metod: Bezmialem Vakıf Üniversitesi, Çocuk Gastroenteroloji Polikliniğine Ocak 2013 ve Aralık 2014 tarihleri arasında başvuran, çocukluk çağı yeme bozukluğu tanısı almış 18 yaş altı yüz çocuğun demografik özellikleri, klinik özellikleri, tanıları dosya taraması yöntemi ile önceden hazırlanmış araştırma formuna işlendi. Çocukluk çağı yeme bozuklukları uygun kriterler ışığında sınıflandırıldı. Yeme bozukluklarının yukarda tanımlanan özelliklerinin hem grupların kendi içinde hem de gruplar arasında tanımlayıcı istatistikleri yapıldı. Bulgular: Olgular, 64 (%64) duyusal besin reddi, 4 (%4) infantile anoreksi, 4 (%4) posttravmatik yeme bozukluğu, 17 (%17) komorbid durum ve 11 (%11) kompleks yeme bozukluğu şeklindeydi. Olguların boy z skorları -0,81±1,75 ve kilo z skorları ise -0,92±1,55 şeklinde ve yaş ortalaması 36,57±32,21 ay (Min:3 maks:184 median:27) olarak bulundu.Sonuç: Elde edilen veriler ışığında yeme bozukluklarının genel özellikleri tartışıldı. Bu çalışma yeme bozuklukları klinisyen, diyetisyen, psikolog/psikiyatrist, fizyoterapist ve/veya konuşma terapistinin de içinde bulunduğu bir ekip tarafından değerlendirilmesi ve yönetilmesi gerektiğini göstermektedir.Anahtar Kelimeler: duyusal besin reddi, infantil anoreksi, oral motor disfonksyon, posttravmatik yeme bozukluğu, yeme bozukluğu, Objective: Eating problems and anorexia are frequent conditions in childhood. However, a small proportion of children are diagnosed with feeding disorder. It is important the early recognition and treatment of these children. This study aimed the evaluation of clinical and demographic characteristics of patients being followed with feeding disorder.Methods: This study was carried out among one hundred feeding disorder diagnosed children under 18 years old who attended the Gastroenterology outpatient clinic in the Bezmialem University's Hospital between January2013–December 2007. Clinical and demographic characteristics of patients were commited to the prepared research form by file scanning method. Feeding disorders are classified in the light of appropriate feeding disorder's criterias. Descriptive statistics were performed in individual and in between groups.Results: One hundred cases were described as 64 (%64) sensory food aversions, 4 (%4) infantile anorexias, 4 (%4) posttraumatic feeding disorders, 17 (%17) comorbidities and 11 (%11) complex feeding disorders. Height z scores were -0,81±1,75 and weight z scores were -0,92±1,55 and the average age of cases were 36,57±32,21 months (Min:3 max:184 median:27).Discussion: The general features of eating disorders are discussed in the light of the obtained data. This work indicates that these feeding disorders should be assessed and managed by a team which includes physician, dietician, psychologist / psychiatrist, physical therapist and / or speech therapists.Key words: feeding disorder, oral motor dysfunction, sensory food aversion, infantil anorexia, post traumatic feeding disorder 77

Although rotavirus gastroenteritis is quite common in the pediatric population, secondary bacterial sepsis following rotavirus infection is a rare clinical entity. Gram-negative bacilli are the fifth most common cause of meningitis in infants but this infection rarely occurs after gastroenteritis. Here, we report a 2.5-month-old infant who developedEscherichia coli(E. coli) meningitis after acute rotavirus gastroenteritis. The 2.5-month-old male infant with fever, vomiting, and watery diarrhea that started 1 day earlier was admitted to the hospital. Rotavirus antigen in stool sample was positive. He was hospitalized, and fever was measured at 39.5°C on the second day. Lumbar puncture was done for suspicion of meningitis, and cerebrospinal fluid (CSF) findings suggested meningitis. Intravenous vancomycin and cefotaxime were started empirically. SinceE. colireproduction was seen in blood culture and CSF culture, treatment was continued with cefotaxime. The patient was discharged with minimal midlevel hydrocephalus findings in cranial ultrasonography and magnetic resonance imaging following 21 days of antibiotics treatment. Septicemia development following rotavirus gastroenteritis is an extremely rare clinical condition. It is vital to start prompt antibiotic treatment as soon as the diagnosis of secondary bacterial infection is made because of high mortality and morbidity rates.

Objectives: The aim of this study was to investigate the 25-hydroxyvitamin D [25(OH)D] status of children with growing pains and to evaluate the efficacy of vitamin D treatment on the resolution of pain symptoms. Subjects and Methods: One hundred and twenty children with growing pains were included in a prospective cohort study. Serum 25(OH)D and bone mineral levels were measured in all subjects at the time of enrollment. The pain intensity of those with vitamin D deficiency was measured using a pain visual analog scale (VAS). After a single oral dose of vitamin D, the pain intensity was remeasured by means of the VAS at 3 months. The 25(OH)D levels and VAS scores before and after oral vitamin D administration were compared by means of a paired Student's t test. Results: In the 120 children with growing pains, vitamin D insufficiency was noted in 104 (86.6%). Following vitamin D supplementation, the mean 25(OH)D levels increased from 13.4 ± 7.2 to 44.5 ± 16.4 ng/ml, the mean pain VAS score decreased from 6.8 ± 1.9 to 2.9 ± 2.5 cm (a mean reduction of -3.8 ± 2.1, p < 0.001) and the difference was statistically significant. Conclusion: Supplementation with oral vitamin D resulted in a significant reduction in pain intensity among these children with growing pains who had hypovitaminosis D.

To investigate serum concentrations of vaspin, apelin, and visfatin in underweight children and their association with anthropometric and nutritional markers of malnutrition.We recruited 44 underweight prepubertal children (youngest age=2 years) with thinness grades of 1, 2, and 3, and body weights Mean vaspin and apelin levels were significantly lower in underweight children compared to controls (vaspin: 0.44±0.18 vs. 0.58±0.35 pg/mL, p=0.024; apelin: 483.37±333.26 vs. 711.71±616.50 pg/mL, p=0.041). Visfatin levels were lower in underweight children compared to controls, but the values were not statistically significant (177.81±158.01 vs. 221.15±212.94 pg/mL, p=0.119).: In underweight children, decreased vaspin and apelin levels should be considered in the etiology of anorexia.

OBJECTIVE We assessed the association of breast-feeding and timing of solid food introduction with childhood obesity. METHODS The children were grouped according to the duration of breast-feeding (0-1, 2-6, 7-12, 13-18, and 19-24 months) and the age at which solid foods were introduced (

Hidrosefali degisik hastalik durumlarinda ortaya cikan ventrikullerde genisleme ve beyin omurilik sivisi basincinin artmasi ile belirgin bir bulgudur Beyin omurilik sivisi akimini duzeltmek icin en sik uygulanan yontem ventrikulo peritoneal sant vasitasiyla beyin omurilik sivisinin periton icine bosaltilmasidir Sant kullaniminda en sik karsilasilan komplikasyon enfeksiyon veya tikanmaya bagli olarak santin islev bozuklugudur Kendiliginden kolon perforasyonu nadir gorulen bir komplikasyondur Bu yazida yenidogan doneminde hidrosefali saptandiktan sonra ventrikulo peritoneal sant uygulamasi yapilan ve sant kateterinin anusten ciktigi gorulen iki olguyu sunduk ve iki olgu nedeni ile hidrosefalik cocuklarda ventrikulo peritoneal sant komplikasyonlarini ve bunlarin icerisinde kolon delinmesinin onemini tartismayi amacladik Turk Ped Arfl 2013; 48: 255 8