INTRODUCTION: Vitamin D in adolescents revealed that subclinical vitamin D deficiency is continuously increasing worldwide. The aim of the study was to investigate the prevalence of vitamin D and subclinical vitamin D deficiency and risk factors among adolescents in summer and winter seasons in Izmir.
METHODS: The medical records of 90 adolescents were reviewed regarding D vitamin status in summer and winter seasons. Blood samples were obtained from 90 adolescents at the end of the summer and end of the winter. Samples assessed for calcium (Ca++), phosphorus (P), magnesium (Mg), parathyriod hormone (PTH), alkaline phosphatase (ALP) and 25 hydroxyvitamin D (25 (OH) D) concentration. The subjects were divided into two groups; first group was the patients who were assessed vitamin D levels and the other laboratory measurements at the end of the winter (n=46), second group was the patients who were assessed same laboratory features at the end of the summer (n=44). The two groups were compared in terms of demographic, clinical and laboratory characteristics.
RESULTS: Among the 90 patients enrolled in the study, 41 (45.5%) were males and 49 (54.5%) were females. The median age was 11±4 years. Vitamin D deficiency percentages of the study group for the end of the winter period were 60.8% and for the end of the summer period was 6.8% but not statistically different. Vitamin D insufficiency percentages of the winter group was higher than the summer group (93.2% vs 39.2%, p>0.05). There were no differences between the groups in terms of laboratory findings including calsium, magnesium and the other bone parameters.
DISCUSSION AND CONCLUSION: Contrary to the expected, we did not detect a seasonal difference in vitamin D levels in adolescents. Although laboratory findings was not found to be statistically significant in vitamin D levels, we can state that the level of vitamin D in winter seaseon might be lower than summer season. Therefore, it should be keep in mind that vitamin D insufficiency is frequent at the enf of winter season and should be considered seasonal differences in adolescent population during the measurement.

INTRODUCTION: The primary purpose of the present study was to investigate the relationship between neonatal kidney dimensions and medullary pyramid thicknesses (MPTs) according to the weight, length and body mass index (BMI) of newborns.
METHODS: A total of 237 (128 [54%] boys and 109 [46%] girls) consecutive term newborns in the first month of life were evaluated. Infants with an underlying renal disease, urinary symptoms, chromosomal abnormalities or low birth weight were excluded from the study. Greyscale ultrasound of neonatal kidneys was performed in standard transverse and longitudinal planes. Renal dimensions, parenchymal thickness and MPT were also evaluated and compared with neonatal age, height, weight, BMI and abdominal and head circumferences. Regression analyses were performed and graphs were plotted to determine the independent factors for renal parameters.
RESULTS: Statistically significant associations were noted in the renal dimensional measurements among neonatal weight (NW), neonatal length (NL), BMI, head circumference (HC) and abdominal circumference (AC) in the infants (p < 0.0001). However, no statistically significant difference was observed between right kidney MPT and NW, HC, AC and BMI. In contrast, a statistically significant association was detected between left kidney MPT and NW, HC, AC and BMI.

DISCUSSION AND CONCLUSION: NKL, NKW and RPT measurements could be a useful method as an indicator of neonatal growth.

INTRODUCTION: Patients with hemophilia need special care and attention in dentistry. Thus we assessed oral and dental Health status in children and adolescents with hemophilia in Rasht, Iran.
METHODS: In this case–control study, 53 hemophiliac patients (A and B), 2‒15 years of age, and 53 healthy children were assessed. A checklist including demographic data was filled out and the subjects were examined by one dentist. The patients were assessed for modified gingival index (MGI), plaque index (PI) and Decayed-missing-filled Teeth (DMFT in permanent teeth and dmft in primary teeth) indices. Data were analyzed with SPSS 19 at a significance level of P<0.05.
RESULTS: The mean age of the subjects was 10.49±4.21 years in the case group and 10.5±4.07 years in the control group. 92.5% of the patients exhibited factor VIII deficiency and the most frequent blood group was A (34%). 63.2% of the subjects in hemophilia group and 13.2% in the control group had a history of bleeding that was significant (P=0.0001). There were significant differences between the two groups in bleeding at tooth eruption and exfoliation sites of deciduous teeth (P=0.0001), flossing (P=0.046), toothpick use (P=0.02) and the history of dental education (P=0.014). No significant difference was found between dmft and DMFT scores between the two groups but DMFS was significantly higher in the hemophilia group (P=0.007). There was also significantly higher plaque index in the hemophilia group (P=0.003).
DISCUSSION AND CONCLUSION: Considering some unsatisfactory oral health conditions in these patients, dental health care and prevention seems necessary and can be effective in the prevention of dental problems and bleedings and complex treatments.

INTRODUCTION: Mothers have different needs, depending on their cultural and religious backgrounds, and these needs to be known and acknowledged by the PICU professional staff. To date, limited studies have been conducted in Turkey, a majority Muslim country, which analyzes the needs of mothers whose children are in PICU. The purpose of this study was to explore parents’ needs in a children hospital’s pediatric intensive care unit (PICU) in Turkey.
METHODS: A descriptive exploratory qualitative study. Individual, semi-structured interviews of a purposive sample of 9 mothers were carried out between December 2013 and May 2014. The mothers were enrolled to participate in the interviews with an average age of 27.4 years in PICU of a major children's hospital in Turkey.
RESULTS: In the content analysis, the main themes "to be sure of receiving the best care, having the needs fulfilled, being able to cope with the emotional feelings" were created.
DISCUSSION AND CONCLUSION: This study presents the disruptions during the PICU process, the fact that it is a difficult process for the mothers and they need too many things during this process and these needs have to be fulfilled.

INTRODUCTION: Simulation training that started with low realistic models in health education has developed in recent years and is now widely used in medicine and nursing education. The purpose of the present research is to compare nursing students’ knowledge, skills, stress and anxiety during the pediatric practices and to determine the students’ satisfaction and confidence levels related to the use of simulation
METHODS: This randomized controlled study was conducted with 57 “third-year” students. The students were assigned to the experimental (n= 23) and control (n=34) groups.
To collect the study data, the Student Information Form, Student’s Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, Educational Practices Questionnaire, Clinical Stress Questionnaire, State-Trait Anxiety Inventory, Nursing Care Knowledge Assessment Form for Children Suffering a Respiratory Disease and Nursing Care Skill Assessment Form for Children Suffering a Respiratory Disease were used. While the students in the experimental group had the simulation training about nursing care of child suffering a respiratory disease, the students in the control group were trained with the traditional education methods. The students in both groups were observed while they gave care in the hospital environment.

RESULTS: Clinical stress, state-trait anxiety and clinical skill scores of the students in the experimental group were higher than the control group. Simulation training contributed to the development of their self-confidence positively.
DISCUSSION AND CONCLUSION: In this study, the simulation training was beneficial, and that student’ clinical application skill achievements improved.

INTRODUCTION: Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of nine in boys, eight in girls. Due to changing socioeconomic conditions, nutritional habit, environmental factors the onset of normal puberty is being seen at younger ages these days. The purpose of this study was to evaluate the dietary habits and environmental factors in cases that presented to or were being followed up by the Child Endocrinology Clinic with symptoms of precocious puberty.
METHODS: The study group included 50 girls aged 2-10 years who presented with symptoms of precocious puberty and whose diagnosis was being monitored. A survey noting food consumption was made recording the girls’ dietary habits, fast-food consumption and frequency, information about their health, physical activity and environmental factors using a 24hoursrecall technique.
RESULTS: The mean age of the girls was 8.6 ± 0.9 years. According to body mass index (BMI) Z-scores, 62.0% of the girls were overweight (≥+1 SD), 34.0% were normal (≥+1 SD - <+1 SD) and 4.0% were underweight. There was a statistically significant difference between the girls’ levels of activity and their mean ages (p < 0.05). The girls’favorite choices of fast food were hamburgers (20.3%),lahmacun[
a thin pizza with spicy meat topping](11.9%), 32% of the girls were using perfumes or skin creams. Plastic culinary utensils were used in 56% of the children's homes. Of those girls who watched more than three or four hours of TV a day 71% were overweight.
DISCUSSION AND CONCLUSION: Increased consumption of fast food containing higher amounts of fat, energy and proteinin conjunction with decreased physical activity, exposure to chemicals that impair the endocrine system, and exposure to stimulating devices (television, computer) may be important factors in the development of precocious puberty. Further research is needed to evaluate the negative effects of these factors.

INTRODUCTION: Febrile seizures are the most common seizures seen in childhood. Although they are usually benign and self-limiting, parents feel great fear and concern about it. The prevalence of febrile seizures varies in different parts of the world. These differences are thought to be due to genetic, geographic and environmental factors. However, there has been no recent study about the prevalence of febrile seizure among Turkish children. This study was designed to find out the prevalence, clinical and some epidemiological features of the febrile seizures among the Turkish school children.
METHODS: A school based, cross-sectional study was conducted in first and second-class children. Stratified cluster sampling technique was used to define the study population, which represents the schools located in the metropolitan area of Izmir. Data were collected through a standard questionnaire from the parents who agreed to be involved in the study. The survey had questions about some demographic features of the children and febrile seizure episodes.
RESULTS: 3806 children and parent pairs accepted to participate in the survey. Febrile seizure prevalence was 4.8% (boys, 5.2%; girls, 4.3%, p>0.05). It was found that 28.5% of the children experienced their first FS between the age of 18 months and three years old and most of them had an upper respiratory tract infection. The most common practice by parents during the seizure was the admission to the nearest emergency room. Recurrence rate for febrile seizure was 33.0%.
DISCUSSION AND CONCLUSION: The febrile seizure prevalence determined in our study is lower than the previous studies in Turkey. It was thought that advancing healthcare systems in our country might be decreased the febrile seizure prevalence within last eight years in Izmir.

Bannayan-Riley-Ruvalcaba Sendromu, makrosefali,glans penis üzerinde maküler hiperpigmente lezyonlar ve benign mezodermal hamartomlar ile karekterizedir. 9,6 yaş erkek olgu; ilk kez yaklaşık 3 aydır farkedilen boyunda şişlik yakınması olması nedeni ile istenen boyun ultrasonografide ciltaltı lipomatöz lezyon ve tiroid bezinde çok sayıda nodül saptanması üzerine Çocuk Cerrahisine yönlendirilmiş. Tiroid ultrasonografisinde tiroid bezinde her iki lobda sınırları net seçilen, bazıları kalsifikasyon, bazıları hipoekoik alan içeren çok sayıda nodül saptanması üzerine malignite şüphesi nedeni ile total tiroidektomi uygulanmış. Hasta operasyonu sonrasında olgu Çocuk Endokrinoloji Departmanına yönledirildi. Fizik muayenede; ağırlık: 30 kg (SDS: -0.38), Boy: 140 cm (SDS: 0.71) Baş çevresi: 59.5 cm (+3.21 SDS) olarak değerlendirildi. Tanner evremesine göre pubik pilosite evre 2 testis boyutları 3+3 ml, peniste hiperpigmente maküler lezyonları saptandı. Özgeçmişinde pubik kıllanmanın 8 yaşında başladığı beliritildi. Laboratuvar incelemelerinde 17-OH Progesteron: 4.8ng/ml(<0.9), kemik yaşı 8 yaş ile uyumlu saptandı. 17-OH Progesteron düzeyi yüksek olan olgudan Nonklasik Konjenital Adrenal Hiperplazi açısından istenen CYP21A2 mutasyon taramasında p.V281L heterozigot mutasyonu saptandı. Makrosefali, lipomatöz lezyonlar ve peniste pigmente maküler lezyonları olan olguda ön planda Bannayan-Riley-Ruvalcaba sendromu düşünüldü. Olgudan istenen PTEN gen mutasyonu taramasında heterozigot p.C136R mutasyonu saptandı

Bannayan-Rıley-Ruvalcaba Syndrome is characterized by macrocephaly, pigmented macules on the glans penis and benign mesodermal hamartomas. 9.6 year old boy was referred to the Pediatric Surgeon following observation of a subcutaneous lipomatous lesion and numerous nodules in the thyroid gland at ultrasonography performed due to swelling in the neck first noticed approximately 3 months before. Thyroid ultrasonography revealed numerous nodules with distinct margins in both lobes of the thyroid gland, some exhibiting calcification and others hypoechoic areas, and total thyroidectomy was performed due to suspicion of malignity. After surgery, the patient was referred to the Pediatric Endocrinology Department. On physical examination, his weight was 30 kg (SDS: -0.38), height 140 cm (SDS: 0.71) and head circumference 59.5 cm (SDS: +3.21). Pubic hair was Tanner stage 2, bilateral testes 3+3 ml palpable. There was multiple hyperpigmented lesions on the penile skin. His past medical history revealed that pubic hair development was reported at the age of 8 years. Laboratory examinations revealed a 17-OH progesterone level of 4.8 ng/ml, bone age compatible with 8 years. P.V281L heterozygous mutation was determined at CYP21A2 mutation screening performed for non-classic congenital adrenal hyperplasia. Bannayan-Riley-Ruvalcaba syndrome was primarily suspected in this case of macrocephaly, lipomatous lesions and pigmented macular lesions on the penis. Heterozygous p.C136R mutation was determined at PTEN mutation scanning.

Feokromasitomalar, sempatik ve parasempatik paraganglionlardan köken alan nöroendokrin tümörlerdir.
Bu yazıda beyin felci nedenli izlenirken feokrositoma tanısı alan, özgeçmişinde hiperinsulinemik hipoglisemi tanısı olan,15 yaşındaki kız olguda laparoskopik korteks koruyucu cerrahi deneyemi paylaşıldı.
Olgu feokromasitoma, hiperinsulinemik hipoglisemi birlikteliğinin ilk defa bildirilmesi ve korteks koruyucu laparoskopik cerrahi deneyiminin paylaşılması amaçlı sunulmuştur.

Pheochromocytomas are neuroendocrine tumors. In this report, we present a 15-year-old girl who had cerebral palsy and pheochromocytoma. She also had a diagnosis of hyperinsulinemic hypoglycemia at past history. She underwent bilateral laparoscopic cortical sparing adrenalectomy.
We report the experience of laparoscopic bilateral cortical sparing adrenalectomy of a pediatric pheochromocytoma.

Vitamin D-Dirençli Rikets (VDDR), X’e bağlı kalıtılan, daimi diş, süt dişi ya da kemik gibi sert dokularda mineralizasyon bozukluklarına sebep olan bir hastalıktır. VDRR’nin dental bulguları genişlemiş pulpa boynuzları ve odası, defektli mine ve dentin, pulpitis, pulpa nekrozu ve travma ya da diş çürüğü olmaksızın tekrarlayan periapikal apseler ve periapikal komplikasyonlardır. Bu durumun tedavisi diş çekimi, pulpa amputasyonu ya da kanal tedavisi gibi endodontic yaklaşımlar, restoratif ve koruyucu yaklaşımlardır. Bu olgu sunumunun amacı 4.5 yaşında VDDR kız hastanın dental klinik, radyografik, histopatolojik bulguları ve tedavi seçeneklerini özetlemektir.

Vitamin D-Resistant Rickets (VDRR) is an X-linked disease, causing mineralization disturbances of hard tissues such as bones and deciduous and permanent dentition. The dental findings of VDRR are enlarged pulp horns and chambers, defective enamel/dentin tissue, pulpitis, pulp necrosis, periapical recurrent abscesses and periapical complications without dental caries or trauma. The treatment options of this condition are extraction, endodontic approaches such as pulpotomy/pulpectomy, restorative and preventive applications. The aim of this case report is to summarize dental clinical, radiographical, histopathological findings and treatment options of VDRR in a 4.5 year-old girl.

Ağır konjenital nötropeni, yaşamın ilk aylarından itibaren ortaya çıkan bakteriyel enfeksiyonlar ve nötrofil sayısının düşüklüğü ile karakterize kalıtsal bir hastalıktır. Nadir görülür ancak ağır enfeksiyonlar nedeniyle hayatı tehdit eder. Bu nedenle erken tanı ve tedavisi önemlidir. Burada kliniğimize ateş ile başvuran ve izleminde ağır nötropeni gelişen iki buçuk aylık bir kız olgu sunulmaktadır.

Severe congenital neutropenia is a hereditary disease characterized by a low number of neutrophils occurring from the first months of life leading to severe infections. It is rare but threatens life because of severe infections. For this reason early diagnosis and treatment of this disease is important. Here we present a case of a two and a half months old girl who admitted to our clinic with fever and absolute neutropenia is determined in her clinical course.

Anafilaksi hızlı başlangıç gösteren ciddi bir alerjik reaksiyondur. Yenidoğan döneminde immünolojik sistemin immaturitesine bağlı nadir görülür. Bu olgu sunumu, üç günlük erkek hastada ampisiline bağlı anafilaksi gelişmesi nedeniyle sunuldu. Yenidoğanlarda ilaç allerjilerinin nadir görülmesi ile birlikte hayatı tehdit edici özellikleri bakımından yakın izlemi önemlidir.

Anaphylaxis is an allergic reaction that is rapid in onset, due to immaturity of the immunological system, is rare in neonatal period. A case of three-day-old male neonate with ampicillin-induced anaphylaxis is being reported. Although drug allergies are rare in newborns, in terms of their life-threaten features, close monitoring is important.

S. maltophilia’nın neden olduğu infeksiyonlar, lösemi gibi immun yetmezlik oluşturan hastalıklarda ölümcül seyredebilir. Burada nadir görülen nötropenik ateş nedeni ile geniş spektrumlu antibiyotik tedavisi altında iken S.Maltophilia bakteriyemisine sekonder perianal selülit ve pnömoni gelişen 8 yaşındaki akut lenfoblastik lösemili çocuk hasta sunuldu.

Infections caused by S. maltophilia may be fatal in diseases such as leukemia which creates immunodeficiency. Herein we report a rare case of 8-year-old girl with acute lymphoblastic leukemia, who developed perianal cellulitis and pneumonia secondary to S.Maltophilia bacteremia while undergoing broad spectrum antimicrobial agents for neutropenic fever.

Renal lenfanjiektazi, böbreği saran lenfatik kanalların kistik malformasyonu ile karakterize selim seyirli, nadir görülen bir hastalıktır. Bu yazıda ağrısız kanlı idrar yapma yakınması ile başvuran, fizik bakı ve tetkiklerinde hipertansiyon ve polisitemi, görüntüleme çalışmalarında sol perirenal lenfanjiektazi ve aynı taraflı böbrek işlevinde azalma saptanan bir ergen olgu sunulmaktadır.

Renal lymphangiectasia (RL) is a rare disorder characterized by cystic malformation of the lymphatic ducts surrounding the kidney. In this article, an adolescent who presented with painless gross hematuria, hypertension, polycythemia and who was detected to have left perirenal lymphangiectasia and ipsilateral decreased renal function on imaging studies was reported.