INTRODUCTION: This study was conducted to examine the electrocardiographic markers used in the risk assessment of cardiac arrhythmia in children with obesity.
METHODS: In this prospective study, 60 childrenaged 3-17 years with exogenous obesity and 60 age and sex-matched healthy controls were included. Demographic data, assessment of atrial and ventricular arrhythmia risk markers in electrocardiography, and standard echocardiography measurements were performed. P-values of <0.05 were considered significant.
RESULTS: The mean ages of the study and control groups were 11.51±3.48 years and 10.74±3.72 years, respectively. Both groups had 30 males and 30 females. Study group had significantly higher mean body mass index (BMI) compared with the control group. In electrocardiographic examinations, P dispersion (Pd), QT dispersion (QTd), corrected QTd (QTcd), Tpeak-Tend (Tp-e), Tp-e/QT, and Tp-e/QTc values were significantly higher in the obese group compared with the control group. In echocardiographic examinations, dimensions of the heart chambers and vascular structure and wall thicknesses were found to be significantly higher in children with obesity.
DISCUSSION AND CONCLUSION: The electrocardiographic risk markers used to predict cardiac arrhythmias are found to be increased in children with obesity. This may suggest that increased body weight and adiposity may have unfavorable effect oncardiac conduction system.

INTRODUCTION: Celiac disease is associated with an increased risk of cardiovascular disease due to inflammation and autoimmunity involved in its pathophysiology. We aimed to evaluate vascular involvement in children with celiac disease based on augmentation index, carotid pulse wave velocity, carotid intima-media thickness, echocardiographic findings, and blood pressure.


METHODS: This cross-sectional and controlled study was performed at a single center between 2018 and 2019. The study population consisted of 44 patients with celiac disease who had been on a gluten-free diet for at least one year.

RESULTS: We compared the celiac patients and the healthy group. While the celiac patients had significantly higher carotid intima media thickness and carotid pulse wave velocity values, there was no difference in the augmentation index values. There was no significant difference in cIMT, AIx and carotid PWV values between the diet-compliant and non-compliant groups.
DISCUSSION AND CONCLUSION: Although hypertension was not detected, arterial stiffness and carotid intima media thickness measurements were higher in the celiac disease patients compared to healthy controls. This showed that these parameters can be used in early vascular damage assessment. These measurements, which are non-invasive and repeatable methods, can be a guide for the monitoring of the development of preclinical atherosclerosis in the follow-up of the pediatric patients diagnosed with celiac disease.

INTRODUCTION: The purpose of this study is to assess the prognostic power of preoperative laboratory biomarkers in the pediatric age group diagnosed with appendicitis in the emergency department in distinguishing complicated appendicitis from non-complicated appendicitis and predicting postoperative outcomes.
METHODS: The population of this descriptive, cross-sectional, retrospective study consisted of children (younger than 18 years of age) who applied to our hospital’s emergency department between January 2020 and October 2021 and underwent surgical intervention with the diagnosis of acute appendicitis. Preoperative laboratory test results, intraoperative surgical outcomes, length of hospital stay and postoperative complications data were recorded in the patient follow-up forms and analyzed.

RESULTS: The intraoperative and pathological data revealed that 179 (37.8%) and 294 (62.1%) patients had complicated and non-complicated appendicitis, respectively. The analysis of the complete blood count results indicated that the C-reactive protein (CRP) level, and CRP-to-albumin ratio (CAR), neutrophil count, leukocyte count, monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR) were significantly higher, whereas the sodium and albumin levels were significantly lower in patients with complicated appendicitis than in patients with non-complicated appendicitis. Among the parameters investigated, the NLR, CAR values, and presence of hyponatremia were found to be significantly associated with the length of hospital stay and postoperative complication rates in patients with complicated appendicitis.

DISCUSSION AND CONCLUSION: The findings of our study show that leukocyte counts, neutrophil counts, NLR values, CRP, sodium, and direct bilirubin levels measured preoperatively in the emergency department can be used to identify pediatric patients with complicated appendicitis. In addition, MLR and CAR values, as new biomarkers, can provide guidance in emergency interventions and also predict postoperative outcomes.

INTRODUCTION: Urea cycle disorders (UCD) still have poor neurological outcome despite early diagnosis and treatment. We aimed to present the neurological outcome of UCD patients and to determine the simple and accessible main factors affecting the neurological outcome.
METHODS: This is a descriptive cross-sectional study conducted in two pediatric metabolism centers in 29 patients from 25 unrelated families who were followed and diagnosed with UCD based on clinical presentation, neurological parameters, biochemical measurements, and molecular analysis.
RESULTS: Within the study population, the most common diagnosis was ASSD in 13 (44.82%) patients, followed by NAGSD in five patients (17.24%), OTCD in four patients (13.79%), ARG1D in three patients (10.34%), CPS1D in three patients (10.34%), and ASLD in one patient (3.44%). Peak ammonia levels were observed to be significantly higher in patients with delayed milestones and patients who had Denver II <-2SDS results (p=0.032, p=0.026). Effect sizes were large in both groups. Delayed milestones were noted in 17 (94.4%) of the cases with peak ammonia >500μmol/L (n=18). Patients with abnormal neurological parameters had a significantly higher mean hyperammonemic episodes per year. Extracorporeal detoxification was received to eight patients, combination with therapeutic hypothermia in two patients. However, rapid regression was observed in brain edema in those who underwent therapeutic hypothermia.
DISCUSSION AND CONCLUSION: Our study emphasizes the effect of peak ammonia levels and the frequency of hyperammonemic episodes on the neurological outcome. There were still poor neurocognitive outcomes despite extracorporeal detoxification. This highlights the need to reassess current treatment strategies, including the threshold for starting extracorporeal detoxification if ammonia levels exceed 500 µmol/L. The use of therapeutic hypothermia by experienced teams may be promising due to its brain edema-reducing effects.

INTRODUCTION: The aim of the study is to evaluate the dietary macronutrient distribution effect on serum lipid profile in Type 1 Diabetes Mellitus (T1D).
METHODS: This cross-sectional study included 82 children and adolescents between the ages of 2 and 18 with diabetes age ≥1 year. Dietary intake was evaluated by 3-days food diaries, including three consecutive days (two weekdays and one weekend day).
RESULTS: The mean age of 82 patients with diabetes (PwD) was 11.6±4.3 years (min 2-18 years) (45.1 % female), the median diabetes duration was 3.4 (2.9) years, the mean HbA1c level was 7.0 (1.4)%, and mean BMI standard deviation score (SDS) was 0.2±1.1. The median distribution of energy from carbohydrates, protein and fat in total energy intake was 50.0 (6.2)%, 17.4 (2.7)% and 32.5 (5.1)%, respectively. Dietary fiber intake was inadequate in 77.9%, while 93.9% SFA intake was above the above the recommendation. For children and adolescents with T1D, mean serum cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein level were 162.9±33.4 mg/dl, 86.2±49 mg/dl, 87.9±29.2 mg/dl, and 60.7±17.9 mg/dl, respectively.
DISCUSSION AND CONCLUSION: To maintain healthy eating, consuming foods high in saturated fat should be limited, and children and adolescents with T1D should be supported for consuming diets high in fiber by their family and healthcare professionals.

INTRODUCTION: Urinary tract infection (UTI) is one of the most common bacterial infections in children. Empirical treatment is commenced according to the patient's characteristics and the antimicrobial susceptibility patterns in the region. Therefore, determination of antimicrobial resistance patterns has a great importance for effective treatment. The aim of this study is to determine the pathogens that cause urinary tract infections in patients admitted to a university hospital in Izmir and to determine their antimicrobial susceptibility pattern.
METHODS: The files of patients aged between 0-18 years, followed up with diagnosis of urinary tract infection, vesicoureteral reflux and neurogenic bladder in Ege University Pediatric Nephrology Unit between February 2013 and November 2018 were retrospectively reviewed.
RESULTS: A total of 1126 positive urine cultures from 279 patients (65%female) were included into the study. Gram-negative pathogens constituted 88.2% of the cultures. Escherichia coli (E. coli) was the most common isolated bacteria with a prevalence of 59.1% followed by Klebsiella pneumonia with 17.9 %, Enterococcus faecalis 8.3 % (n= 93). Ampicillin, cefuroxime and trimethoprim-sulfamethoxazole with susceptibility rates of 18.6%, 39.6%, 49.0% respectively, constitute of the highest resistant antimicrobials to Enterobacteriaceae. Enterococcus spp. showed the highest resistance to gentamycin with 50% resistance to tested cases. Pseudomonas spp. with 64.3% susceptibility, showed the highest resistance to piperacillin-tazobactam
DISCUSSION AND CONCLUSION: This study reveals that bacterial resistance to commonly used antimicrobials in UTI is an important and challenging problem that requires planning.

INTRODUCTION: Tooth discoloration is a common clinical finding, which is considered primarily as an aesthetic problem. Black stain (BS) is a specific type of extrinsic tooth discoloration mostly seen in children but also in adults and it is not relevant with gender. The present study was aimed to investigate the relationship between the presence of BS and dental caries incidence, dental plaque scores and to examine the colonization of Streptococcus mutans, Lactobacillus spp., Actinomyces spp. and Capnocytophaga spp. in dental plaque samples with or without BS. The socioeconomic status of the family, the oral hygiene and dietary habits of the children, medical and dental history of the children were also compared between two groups.
METHODS: A total of 1000 children aged 3-12 years were examined to take part in the study. From these group, children with BS (n=44) were selected as the study group. With the same number of the study group, with the same age and same sex, children without BS (n=44) were categorized as the control group. Dental examinations including the presence of BS, dental caries incidence and dental plaque scores were performed by a same investigator. A structured questionnaires were completed by the parents. The levels of S. mutans, Lactobacillus spp., Actinomyces spp. and Capnocytophaga spp. were determined from dental plaque samples. All data were analyzed by SPPS 25.0 using student t, Mann Whitney-U, Fisher’s Exact and chi square tests.
RESULTS: BS was detected in 4.4% of the patients in the present study. DMFT and DMFS scores were significantly lower in children with BS than without BS. (p=0.001 and p=0.010). However, no statistically significant difference was found between dmft and dmfs scores and the presence of BS (p>0.05). The less number of S. mutans and Lactobacillus spp. and a greater number of Actinomyces spp. and Capnocytophaga spp. were found in children with BS. There was no statistically significant relationship between S. mutans and Actinomyces spp. and the presence of BS (p>0.05). The colonization of Lactobacillus spp. were statistically significantly lower while the colonization of Capnocytophaga spp. were significanty higher in BS group than control group (p<0.05).
DISCUSSION AND CONCLUSION: Results suggest that the different microbial composition of BS might be associated with the lower caries experience in affected subjects.

INTRODUCTION: Gonadotropin-releasing hormone analogs (GnRHa) are standard medical treatments for precocious puberty. Studies on their side effects in adults have shown that these drugs can cause changes in electrocardiography (ECG), along with some cardiovascular effects; however, the number of studies on children is limited. This study investigated the effects of these drugs on ECG parameters in children diagnosed with central precocious puberty(CPP).

METHODS: This prospective study included 44 girls who were initiated on GnRHa treatment and diagnosed with CPP. ECG was performed before treatment and repeated after 6 months of treatment.
RESULTS: The mean age of the children was 9.13±1.55 years. Leuprolide acetate (3.75 mg IM) was administered to all the patients following the standard protocol. The comparison of the pretreatment and 6-month ECG parameters revealed a prolonged QT interval after treatment, with a statistically significant difference(p<0.001). There were no significant differences in the pre- and post-treatment values of PR, QRS, QT interval, QTc interval, QT dispersion, and QTc dispersion (p>0.05).
DISCUSSION AND CONCLUSION: Despite a significant increase in QT interval on ECG with GnRHa compared to pretreatment ECGs, this increase was attributed to variability in heart rate. Even if regular ECG monitoring is considered after GnRHa treatment initiation, they are believed to be safe drugs in children.

INTRODUCTION: Traumas are the most common cause of mortality and morbidity in children.COVID-19 was shown to affect pediatric mental health, child neglect, and the occurrence of traumatic injuries. This study aimed to characterize pediatric trauma cases presented in our institution before and after the pandemic.
METHODS: Patients with trauma who were admitted to our emergency department between March-2019 and March-2021 were included. Patients were classified into two groups as before and after the pandemic (March-2020). Trauma characteristics, the severity of the injury, and the prognosis were assessed. Patients’ injury severity score (ISS) and pediatric trauma score (PTS) were noted.
RESULTS: A total of 1718 patients were included in the study. The number of pediatric trauma admissions dropped from 1039 to 679 after the pandemic started. There was no difference between these groups in terms of age (p=0.874) or gender (p=0.106). There was a significant decrease in the number of traumatic injuries (p<0.001) especially during the first shutdown period (April, May, and June 2020. On the contrary, there was a significant increase in terms of foreign body aspiration (p=0.001) and pedestrian injury (p=0.016). Although a significant increase was noted in the ISS of the patients(p<0.001), no difference was found between the PTSs (p=0.075) and multi-organ injuries(p=1.000). Also, no significant difference was observed regarding mortality(p=0.650), household accidents(p=0.600), trauma type(p=0.533), need for transfusion(p=0.166), surgery(p=0.077) or mechanical ventilation(p=0.464) between both groups.
DISCUSSION AND CONCLUSION: COVID-19 pandemic altered social patterns, leading to a decrease in pediatric traumas. This decrease was most prominent during the shutdown period. The variables showing severe trauma such as the need for surgery did not change, despite a significant increase in ISS. This was attributed to a decrease in admissions for minor trauma.