INTRODUCTION: Violence is a social problem that is becoming increasingly widespread among school-aged children and adolescents in country. This study was conducted to determine the types, frequencies and the affecting factors of peer bullying among 6th, 7th, and 8th grade students of secondary schools in a city center in Cappadocia.
METHODS: A total of 3059 students attending secondary schools in a city center and this study sample consist of 1288 students. Prior to the study, approvals from the ethical council and institute, as well as written consent from students and their families, were obtained. Data were collected via individual information forms and the Traditional Peer Bullying Scale by the researcher through face-to-face interviews and evaluated by chi-square, single, and multiple logistic regression analysis.
RESULTS: It was defined that 12.0% of the students were bullies, 15.9% were exposed to bullying, 52.1% were exposed to bullying as verbally, and 13.4% were exposed to bullying as physically. Multiple logistic regression revealed that the most important factors affecting the bullying of students were family structure, liking school, and gender; those factors affecting exposure to bullying were liking school, body mass index, and economical status. As the age of the students increased by one year, the likelihood of bullying increased by 1.2 time. Boys were bullied 1.5 times more than girls, and the students of separated parents were bullied 2.7 times more than those whose parents stayed together (p < 0.05).
DISCUSSION AND CONCLUSION: As bullying within schools is an important problem, preventive programs for bullying should be improved and generalized.

INTRODUCTION: Infections and sepsis are the leading causes of death in non-cardiac ICUs and account for 40 percent of all ICU expenditures. Data regarding bloodstream infections (BSIs) due to a carbapenem-resistant gram negative (CRGN) microorganis in pediatric ICUs still remain limited.
METHODS: This study was conducted retrospectively in patients who were admitted to two pediatric critical care units between January 2011 and December 2017. Patients were assigned to two groups. Patients with bloodstream infection (BSI) caused by a carbapenem-resistant gram-negative microorganism and infections were assigned to BSI group other than BSI were assigned to non-BSI group.
RESULTS: This study included 96 critically ill children with a mean age of 48.6 (1-204) months.Requirement of invasive procedures included tracheostomy, foley catheter and central venous catheter were not statistically different among groups, P values were 0.159, 0.291 and 0.803, respectively. The majority of the patients admitted to PICU due to sepsis/septic shock in BSI group (n: 18, 58%) and in non-BSI group (n: 24, 37,9%). Prior third/fourth generation cephalosporin exposure significantly more common in BSI group (51.6% vs.15.5%, P<0.001), carbapenem exposure was not significantly different among groups (35.5% vs 56.9%, P=0.054). Neutropenia (<500/mm3) and thrombocytopenia (150x103/mm3) were more significantly more common in BSI group (P=0.011 and P=0.010) and C-reactive protein (CRP) level was significantly higher (P=0.018). Crude and attributable mortality did not show significance between groups, P values were 0.578 and 0.955, respectively.
DISCUSSION AND CONCLUSION: Carbapenem –resistant gram-negative infections are still major cause of morbiditity, mortality and healthcare associated infections. In this sudy, we evaluated the patients with BSI due to a CRGN microorganism and compared with other infection types. The risk factors and outcomes were similar except prior cephalosporin exposure. As a conclusion, we have to enhance the infection control programs and prevent the patients from redundant antibiotic exposure.

INTRODUCTION: Primary Vesicoureteral reflux (VUR) is defined as retrograde urine flow from the bladder to the upper urinary system according to an insufficient valvular mechanism in the ureterovesical junction. We aimed to clarify factors affecting physical growth in children with primary VUR.
METHODS: The study was performed retrospectively in 260 primary VUR patients without chronic renal disease. Height and weight Z scores were calculated by anthropometric references in Turkish children and compared between patients grouped according to clinical properties.
RESULTS: Mean age of diagnosis was 43±4 months and mean duration of follow-up was 4.2±1.4 years. Mean height and weight Z scores of 260 children were 0,22±0,96 and -0,11±1,0 at diagnosis; 0,14±0,97 and 0,01±1,3 at last visit respectively.
Age at diagnosis, gender, grade, laterality, persistency of VUR had no impact on height and weight parameters. Although initial and final height Z scores were similar, we showed higher height Z score improvement in patients with renal scarring and similarly in patients with surgery performed at least 6 months after the diagnosis. Mean final height and weight Z scores and weight Z score improvement were significantly low in patients with Urinary tract infections (UTIs) than without UTIs at follow-up. Further analysis against UTIs showed that final height Z scores were significantly lower in patients with afebrile UTIs at follow up, while it was similar between patients with and without febrile UTIs.
DISCUSSION AND CONCLUSION: The presence of renal scarring and UTIs at follow-up may lead to growth alterations in patients with primary VUR. Therefore, physicians and parents should be aware of UTI symptoms even in the absence of fever in pediatric VUR, thus prevent renal scarring and alteration in growth.

INTRODUCTION: Recently, it has been reported that the mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) can be used as indicators of inflammation in various inflammatory diseases such as psoriasis, ankylosing spondylitis and ulcerative colitis. In this study, we aimed to assess MPV levels and NLR in children with chronic urticaria (CU) and to compare them with healthy controls.
METHODS: The cases of 46 children with CU [11 with inducible urticaria (IU) and 35 with chronic spontaneous urticaria (CSU)] admitted to our outpatient clinics, and 30 healthy children were evaluated retrospectively.
RESULTS: No statistically significant differences among the CU, CSU, and IU and the control groups were found in terms of NLR and MPV levels (P>0.05). Platelet counts in CU, CSU, and IU and control groups were not statistically significantly different (P>0.05).
DISCUSSION AND CONCLUSION: We found that MPV levels and NLR weren’t different in children with CU, CSU, and IU and in healthy children. It seems that the MPV and NLR could not be used as inflammatory markers of CU in children. We believe that further studies are required in this field.

INTRODUCTION: Despite the dramatic progress on treatment of pediatric solid tumors in the last 3 decades, confronting a relapsed or refractory patient is still challenging. We report our experience of refractory/relapsed pediatric solid tumor patients treated with vincristin + topotecan + cyclophosphamide (VTC) as salvage therapy.
METHODS: Eleven refractory/relapsed patients (5 neuroblastoma, 4 Ewing’s sarcoma, 1 rhabdomyosarcoma and 1 osteosarcoma) who were given VTC as a salvage therapy were evaluated. They, all, were metastatic at diagnosis and received appropriate initial chemotherapy. VTC consisted of vincristin (1.5 mg/m2 on day 1), cyclophosphamide (CYC) (600 mg/m2/day with mesna, on days 1 and 2) and topotecan (TOPO) (1 mg/m2/day on days 1, 2 and 3).
RESULTS: Eleven patients received a total of 53 courses of VTC with a median of 4 (range 2-14). Median age at diagnosis was 12 years. One patient achieved CR, 6 patients had SD, and 4 patients had PD after 2 courses of VTC. Median survival duration is 28 months after diagnosis while it is 16 months after relapse. Median survival duration after first VTC is 5 months (2-21 months). Myelosuppression was the primary dose limiting toxicity.
DISCUSSION AND CONCLUSION: We concluded VTC to have a clinically tolerable but non-satisfactory effect on relapsed/refractory solid tumors in children.

INTRODUCTION: Congenital cardiovascular anomalies and aortic dilatation are common in patients with Turner syndrome. The aim of this study was to compare echocardiography findings with cardiovascular anomalies and aortic dilatation identified using magnetic resonance imaging in children and young adults with Turner syndrome.
METHODS: Twenty-six girls with TS aged 11-20 years were recruited through tertiary centers. Cardiovascular anomalies and aortic diameter were evaluated using cardiovascular magnetic resonance imaging (CVMR). Auxological measurements, karyotype analyses, medical therapies (growth hormone, estrogen, and thyroid replacement therapy) and transthoracic echocardiography findings were recorded for all participants.
RESULTS: Normal cardiac anatomy was identified in 16 (61.5%) of our 26 cases, with no cardiac pathology being identified at either CVMR or echocardiography. Cardiovascular anomalies were identified in 5 of the 26 (19.2%) patients at CVMR. Aortic dilatation was determined in four patients (one with descending and ascending aorta, one with ascending aorta, and two with descending aorta). Aortic size index was < 2 cm/m² in all patients. Echocardiography was normal for the three patients with malformation detected at CVMR.
DISCUSSION AND CONCLUSION: CVMR identifies significant cardiac lesions missed by echocardiography in pediatric patients with Turner syndrome, especially aortic dilatation and other vascular anomalies.

INTRODUCTION: This clinical study examined various dimensions of quality of life in children who underwent liver transplantation.
METHODS: The patient group (n=50) of the study consisted of children and their families where the child had received a liver transplant (possibly from their mother) in Ege University Organ Transplant Research Center. The control group (n=50) consisted of children and their families who did not undergo any organ transplants, did not have any health issues, and were of similar age, gender and socio-economic status with the members of the study group. The children in the study were examined with the quality of life questionnaire named KINDer Lebensqualitätsfragebogen (Children’s Quality of Life Questionnaire, KINDL).
RESULTS: The overall quality of life and the quality of life in the physical, emotional, self-esteem, family, friend, and school sub-categories as reported by the children themselves in the study group, in the 8-12- and 13-16 year age groups were determined to be higher (p<0.05) when compared to the children in the control group. Similarly, the quality of life for the children in the study group, as reported by their families were determined to be higher (p<0.05) when compared to the control group.
DISCUSSION AND CONCLUSION: Liver transplantation haves effects on the quality of life of both the children and their families.

INTRODUCTION: This study aimed to determine the significance of six clinical predictors associated with medically intractable childhood epilepsy.
METHODS: Retrospective cohort study was conducted. A total of 241 children with diagnosed epilepsy were recruited and divided into two groups: 61 patients with intractable epilepsy, and the other 180 patients who responded well to antiepileptic drugs. We investigated seizure semiology, etiology of epileptic encephalopathy, EEG abnormalities and defined the odd ratios of predictor factors for intractable childhood epilepsy; (1) age of seizure onset, (2) asphyxia, (3) NICU history, (4) consanguineous marriage, (5) abnormal neuro-imaging, (6) neuropathologic exam, (7) prematurity, (8) parents seizure history.
RESULTS: According to logistic regression analysis major risk factors for intractable childhood epilepsy are (1) neuropathologic examination P=0.000, odds ratio OR=58.28 95% confidence interval CI=23.95-141.63; (2) abnormal neuro-imaging P=0.000, OR=37.55 CI=16.41-85.94 (3) age of seizure onset P=0.001, OR=9.43 CI=3.66-24.3 (4) asphyxia P=0.001 OR=4.16 CI=1.75-9.87 (5) consanguineous marriage P=0.001 OR=3.02 CI=1.53-5.97 (6) NICU history P=0.003 OR=2.59 CI=1.38-4.87.
DISCUSSION AND CONCLUSION: Presented six predictors can be used to define the medical intractability in children with epilepsy to provide early alternative treatment protocol for better seizure control and quality of life.

INTRODUCTION: Aim: Pediatric nurses play a crucial role in the assessment and management of a child’s pain. The main purpose of nursing care is to eliminate pain and improve the quality of life. The aim of this study was to evaluate the knowledge, practice and beliefs of pediatric nurses about pain.
METHODS: The current study using a descriptive research design included 102 pediatric nurses working at Akdeniz University Hospital, who agreed to participate in the study. Data were collected using a questionnaire developed by the researchers. The data were collected by face to face interview method by the researchers.
RESULTS: Approximately half of the pediatric nurses (40.2%) are in the 20-29 age group, 51% are married and 80.4% are bachelor’s degrees. In this study, 56.9% of the nurses stated that they did not receive any education about pain and 51% stated that they had insufficient knowledge about the evaluation of pain. Although 67.6% of the nurses state that they have a pain scale in their clinics, 65.6% of the nurses do not know the name of the scale. Although the pain was subjective, only 68.6% of the nurses believed that the child/mother had expressed the pain and 22.5% stated that the cause of the pain was always an illness. In the study, 88.2% of nurses stated that analgesia should not be given before the onset of pain.
DISCUSSION AND CONCLUSION: It is very important to make in-service training programs for pain which is considered as a vital finding. It is recommended that nurses increase their level of knowledge of false beliefs/practices about pain. It is considered that the results of this study will be a reference for the development and updating of nursing education, curricula and clinical training.

INTRODUCTION: The mother is an important determinant of the nutrition of her children. The aim of this study is to evaluate the relationship between obese or overweight mothers, their sociodemographic status and appetite on the anthropometric measurements of their children, and evaluate the relationship between breastfeeding duration, initiation time of a complementary diet and children’s BMI classification.
METHODS: Children whose ages were between 2 and 5 years old, with no additional chronic disease, were included. The sociodemographic data anthropometric measurements and appetites of the children and their mothers were determined. Obese or overweight mothers and mothers with normal body mass index (BMI) were studied as two separate groups. The duration of breastfeeding and initiation time of a complementary diet for the children was classified as <4 months, 4–6 months and > 6 months.
RESULTS: A total of 182 children (109 with obese and overweight mothers and 73 with mothers with normal BMI) were included. The distribution of overweight and obese children among the group of obese and overweight mother was higher. When the weight, weight percentile and weight SDS values of the obese or overweight mothers were compared with their children, a moderately statistically significant positive correlation was found. The distribution of overweight and obese children among the group of employed mothers, and the distribution of underweight children among the group of unemployed mothers, was high. A significant relationship was found between maternal appetite and the BMI classification of the children. No statistically significant difference was found between breastfeeding duration, initiation time of a complementary diet and children’s BMI classification.
DISCUSSION AND CONCLUSION: It was determined that mother’s characteristics of having a BMI classification of overweight or obese, excessive appetite and being employed may be risk factors for developing overweight and obese children.

INTRODUCTION: Some evidence exists on the relationship between anthropometric measures and chronic kidney disease. This study aims to investigate the association of neck, wrist and hip circumferences with kidney function in a pediatric population.
METHODS: In this national study, 4200 students aged 7-18 years were selected by random cluster sampling from 30 provinces of Iran. Neck circumference (NC), wrist (WC) and hip (HC) were measured according to standard protocol and were categorized to low and high according to their age-sex specific median values. The estimated glomerular filtration rate (eGFR) was calculated based on the "updated" Schwartz equation.
RESULTS: The response rate was 91.5% (n=3843). The mean (SD) of eGFR was 96.71(19.46), 96.49(21.69), and 96.59 (20.66) ml/min/1.73 m2 for girls, boys and total population, respectively. Compared to other participants, those in the high NC group had significantly higher eGFR [102.12 ±21.31 vs.90.65±18.18, p <0.001] and Cr [high; 0.66± 0.14 vs.0.63 ±0.11mg/dL, p <0.001]. Individuals categorized as high WC had significantly higher eGFR [102.12 ±21.31 vs. 90.83 ±18.16, p <0.001] and Cr [0.66 ±0.15vs. 0.63 ±0.10) mg/dL, p <0.001]. In multivariate model, high NC, WC and HC were associated with higher eGFR (P < 0.001). Moreover, each one unit (cm) increment in NC, WC and HC increased eGFR by 1.42, 3.24 and 0.46 unit, respectively.
DISCUSSION AND CONCLUSION: The findings of this large population-based study suggest that simple anthropometric measures, as wrist and neck circumferences, can be used in epidemiological studies to determine the children and adolescents that might be at risk of kidney dysfunction.

INTRODUCTION: Background: Dengue is becoming endemic in India. Reported case-fatality rate in India is 3-5%.Thrombocytopenia is the most common finding. Platelet indices are gaining importance in the illness.

Aims: To study the platelet indices in children with dengue infection and to note their relationship with the severity of disease.
METHODS: Material and Methods: Observational record based study done over 12 months at a medical college hospital in costal Karnataka. Platelet parameters were noted from hospital based data system and compared with severity of disease (Bleeding score, Severity score, Warning signs and Duration of stay).
RESULTS: Out of 125 dengue positive patients studied, 83% had MPV below 9fl, 68% had PDW below 18, 64% had plateletcrit below 0.1%, 57% had platelet count fall below 1lakh during the illness. Plateletcrit showed significant correlation (p-0.001) with decreasing and increasing trends of platelet count and similar relation to severity of disease. Patients had a longer duration of stay (>4days) when platelet counts decreased to less than 1lakh during the illness compared to those with more than 1lakh (73%vs35%). Platelet counts below 1lakh were noted in 85% (37 of 44) of patients with warning signs as compared to 41% (34 of 81) patients without warning signs.
DISCUSSION AND CONCLUSION: Platelet indices are decreased in dengue infection.Decreased platelet count and plateletcrit correlate with severity of infection.

INTRODUCTION: Cryopyrin-Associated Periodic Syndromes are a subgroup of the Periodic fever syndromes, caused by mutations in the NLRP3 gene. NLRP3 gene mutations can cause 3 clinically different phenotypes. It is known that even the same mutations in the NLRP3 gene can cause different phenotypes. To investigate this situation, we have built a hypothesis that if an individual with IL-1β-511 T/T genotype which is associated with overexpressed IL-1β levels, he/she might have a more severe CAPS phenotype.
METHODS: Thirty-six NLRP3 Exon 3 variant-positive patients with detailed clinical data and 30 healthy controls were selected for the IL-1β genotype investigation. For the analysis of IL-1β -511 allele, the SNP rs1143634 was genotyped using the TaqMan 5'-exonuclease allelic discrimination assay.
RESULTS: Both the Muckle Wells Syndrome patients (severe phenotype) with p.Val198Met mutation and symptomatic patients with p.Gln703Lys variant, did not show an increased IL-1β-511T/T genotype frequency.
DISCUSSION AND CONCLUSION: We suggest that IL-1β-511 T/T polymorphism is not a modifying factor regarding the clinical severity of CAPS patients. However, to expand this theory and in order to find other modifying genetic factors, other polymorphisms of IL-1β or other genes in inflammasome pathway such as Caspase-1 or ASC should be analyzed.

Type 2 Griscelli Syndrome is caused by a mutation in RAB27A gene and usually manifested with silvery-gray hair, immune deficiency and development of hemophagocytic lymphohistiocytosis. Hematopoetic stem cell transplantation is the curative treatment for HLH and reduced-intensity conditioning prevented the morbidity/mortality in the transplantation related to the myeloablative conditioning. We reported a 21 months old boy with cerebral involvement of HLH related to GS.

Giant cell tumors of bone (GCTB) are commonly benign neoplasms and characterized by regional progressive and destructive lesions. They have the malignant potential and capacity to metastasis. Incidents of GCTB are reported in 20% of all benign, 5% of all malignant bone tumors and pediatric cases account for less than 5% of all them. The first line treatment strategy for GCTBs is surgical resection. A male baby presented at our hospital on his 10th day of life suffering from respiratory distress and persistent vomiting. His blood and urine panels were within normal parameters, cranial magnetic resonance imaging (CMRI) was planned to evaluate his condition. The CMRI report noted a ‘suspected 4x3 cm contrasted bone-derived malignant looking mass at the left posterior fossa of the cranium’. The biopsy confirmed: ‘A grade I-II giant cell tumor of bone’. Surgical resection was not possible because of the location of the mass and its proximity to blood vessels but chemotherapy was the one strategy available in this particular case. The chemotherapy regimen consisted of cisplatin 1 mg/kg/day (1-3 days) and doxorubicin 1 mg/kg/day (1,2 days) and was applied four times every month. Using CMRI, we noted a reduction in mass of more than 50% after two sessions and complete regression after four sessions. The patient was given regular follow-ups with no evidence of recurrence and co-morbidity for the next 60 months. We recommend that chemotherapy is a successful alternative strategy when surgical resection, radiotherapy, and other therapies are not indicated for GCTBs.