INTRODUCTION: Congenital hypothyroidism is defined as the deficiency of thyroid hormones in newborn babies, with the incidence of 1 in 1400 to 2800. The aim of this study is to evaluate cases referred from the congenital hypothyroidism (CH) newborn screening program.
METHODS: 135 cases with high capillary TSH who were referred from the national screening program between January 2017–July 2019 were included in the study.
RESULTS: 48 of 135 cases (35.6%) were diagnosed as CH. The mean onset of treatment was 17.31 ± 9.92 days. Clinical findings suggesting hypothyroidism were detected in 27 patients (56.2%) and goiter was detected in 2 patients (4.1%). According to imaging findings 16 (35.5%) patients were diagnosed as dysgenesis [1 (2.2%) agenesia, 3 (6.7%) ectopia, 12 (26.6%) hypoplasia), 11 were as dyshormonogenesis (24.5%), 18 were as eutopic thyroid (40%). Mean levothyroxine dose was 12.7±2.5 mcg/kg/day and the mean onset of treatment in 30.4% of diagnosed patients were in first 14 days and 93.3% were in first 30 days.
DISCUSSION AND CONCLUSION: Dysgenesis and dyshormonogenesis are the most common detectable causes of congenital hypothyroidism. The normal localization of the thyroid gland in about half of the patients suggests that transient causes of CH may be more common than expected. Considering that only 1/3 of the patients were treated in the first 2 weeks, it was thought that referral of patients is still an important problem and should be faster.

INTRODUCTION: Cardiac abnormalities associated with celiac disease (CD) have been reported. However, changes in electrocardiographic (ECG) parameters in children with CD have not been previously evaluated in the literature. In this study, we aimed to evaluate these parameters that may be determinative in the development of atrial and ventricular arrhythmia with CD.
METHODS: Patients diagnosed as CD in the gastroenterology clinic were included in the study. ECG measurements of QT, Tp-e and P intervals were performed. TheTp-e/QT ratio was calculated from these measurements. Echocardiographic and ECG parameters of patients and controls were compared. Patients with elevated anti-tissue transglutaminase Ig A (IgA-tTG) levels were considered positive serology. Patients were divided in three group and compared with each other according to ECG parameters; as new diagnosis, patients with seropositive and patients with seronegative under gluten free diet at least 6 months.
RESULTS: Fifty-two patients with CD and 59 healthy volunteers were included. P-wave dispersion, QTd, corrected QT dispersion (QTcd), Tp-e dispersion and TP-e/QT ratio were higher in children with CD compared to controls. We did not find any correlation between IgA-tTG levels and P-wave, QT andTp-e dispersions. There were not any difference between three groups of CD patients for ECG and echocardiographic parameters.
DISCUSSION AND CONCLUSION: CD is associated with changes in some ECG parameters, which areconsidered as predict atrial and ventricular arrhythmias in special populations. Therefore, children with CD should be evaluated for these parameters and more electrophysiological studies are needed to demonstrate clinical and prognostic implications of these parameters for CD.

INTRODUCTION: Evaluate neonatal outcomes of immigrant preterm babies and compare them with Turkish preterm babies in neonatal intensive care unit (NICU).
METHODS: A retrospective study was conducted in the NICU of Necmettin Erbakan University between October 2015 and October 2019. Antenatal, natal and postnatal outcomes of prematurity infants were evaluated and compared.
RESULTS: Maternal age (p<0.001), antenatal follow-up (p<0.001), antenatal steroid use (p<0.001), patent ductus arteriosus (PDA) (p=0.03) and bronchopulmonary dysplasia (BPD) (p=0.05) were statistically higher in the Turkish patients. The rates of breast-feeding (p<0.01) and kangaroo mother care (p<0.01) were found higher among Turkish mothers. On the other hand, necrotizing enterocolitis (NEC) rate (p=0.002) was found higher among immigrant babies. Duration of mechanical ventilation and oxygen supply were similar for both groups; however, the duration of nazal-continue positive air way pressure use was longer in the Turkish patients (p=0.01).
DISCUSSION AND CONCLUSION: In this study, immigrant mothers were young and their antenatal follow-ups were insufficient. While rate of hospitalization in neonatal intensive care unit and, following this, NEC rate were higher in immigrant preterm infants, respiratory distres syndrome (RDS), PDA and BPD were more commonly encountered in Turkish preterm infants.

INTRODUCTION: To make a retrospective descriptive analysis of children with acute carbon monoxide intoxication and to present two patients with rare neuroradiological findings.
METHODS: We identified and reviewed the medical records of pediatric patients diagnosed with acute carbon monoxide (CO) intoxication and hospitalized in our department during a 10-year period. Epidemiologic and clinical data were collected and analyzed.
RESULTS: A total of 326 children (166 girls, 160 boys; age range 1 to 17.8 years) ) with CO poisoning were identified. Their ages ranged from 1 to 17.8 years, with a mean of 8.3± 4.8years. Improperly vented coalor wood stoves was the most common (80.7%) cause of intoxication. The most common presenting symptom was nausea/vomiting and headache. Seizure was in 32 patients (9.8%). Two patients died and the mortality was 0.6%. All patients received normobaric oxygen therapy until their carboxyhemoglobin (COHb) levels were decreased below 2% and their symptoms resolved. One hundred of 326 patients ( 30.7%) also were treated with hyperbaric oxygen therapy (HBOT) as indicated by signs and symptoms or COHb levels. Brain imaging was performed in 19 patients (thirteen magnetic resonance imaging and six CT), and was normal in 15. Acute brain stem demyelination related to water pipe smoking developed in one patient. All patients showed complete recovery without neurological sequelae except one who had mild right hemiparesis at discharge.
DISCUSSION AND CONCLUSION: Acute CO intoxication is an important health problem in our country, especially in winter, because of poorly functioning heating systems. The clinical spectrum including neurological findings varies during childhood. We suggest that HBO therapy could beused safely in children.In adition, we believe that a combined treatment regime consisting of pulse methylprednisolone and HBO treatment might have should be tested as a more therapeutic potential for preventing neuronal damage in selected pediatric patients with CO poisoning.

INTRODUCTION: To evaluate the clinical characteristics, predisposing factors and surgical outcomes of rhegmatogenous retinal detachment (RRD) in pediatric patients
METHODS: This retrospective consecutive case series included 79 pediatric patients diagnosed with RRD and were treated by surgical intervention. Demographic data, predisposing factors, the status of macular involvement, presence of proliferative vitreoretinopathy (PVR), the type of initial surgery, and the surgical anatomical and visual outcomes of patients were recorded.
RESULTS: The study included 79 eyes of 79 children with a mean age of 11.63±4.36 years. There were 59 (74.7%) male and 20 (25.3%) female patients in the study group. The mean follow-up period was 18.65±6.04 months. Trauma (45%) was found to be the most common predisposing factor associated with RRD. Other common predisposing factors were myopia (42%), congenital/developmental anomaly (9%), and history of ocular surgery (4%). Macular detachment was present in 56 eyes (70.8%). At the initial examination, the mean visual acuity (VA) was 1.72±1.01 logMAR (n=60). As a primary surgical treatment, 48 eyes (60.7%) had undergone pars plana vitrectomy (PPV), 11 eyes (13.9%) had scleral buckle (SB), and 20 (25.3%) eyes had PPV combined with SB procedures. Reattachment was achieved in 50 (%63.2) eyes after the first surgery. The final mean VA was improved to 1.58±0.87 logMAR, and the anatomical success rate was 74.6%.
DISCUSSION AND CONCLUSION: This study demonstrated that pediatric RRD is commonly associated with trauma and myopia. Successful outcomes were obtained in both groups after RRD surgery. Although associated with poor visual outcomes, careful ophthalmologic assessment and surgical management can preserve visual functions in children with RRD.

INTRODUCTION: Henoch-Schönlein purpura (HSP) is a common systemic vasculitis of the childhood. The aim of this study was to evaluate the clinical, epidemiological and laboratory findings of 117 children with HSP.
METHODS: The medical records of 117 children with HSP were reviewed retrospectively. Clinical findings were purpura, abdominal pain, and arthralgia; laboratory findings were increased erythrocyte sedimentation rate, decreased serum C3 levels, leukocytosis, blood in the stool, hematuria, and proteinuria.
RESULTS: Among the 117 patients enrolled in the study, 68 were males (58.1%) and 49 were females (41.9 %). The median age was 85 [49] months. Ninety-eight (97.9%) patients had purpuric skin lesions,71 (60.6%) had arthritis/arthralgia, 52 (44,4%) had gastrointestinal involvement and 27 (23%) had renal involvement. The median duration of hospitalization day was 6 [10] days. The most common localization of skin lesions was lower extremities and particularly ankles.
DISCUSSION AND CONCLUSION: Purpuric skin lesions were the most common symptoms, followed by arthritis/arthralgia, gastrointestinal involvement and renal involvement in our patients. Seasonal distributions, genders and ages of the patients were consistent with the literature. Although clinical findings showed a variation among the patients, almost all patients presented the cardinal features of HSP.

INTRODUCTION: As obesity rates in children and adolescents increased, nonalcoholic fatty liver disease has become the most common liver disease affecting this organ. The study aimed at the evaluation of the effectiveness of lifestyle modifications as a method of improving the liver function indexes of children with nonalcoholic fatty liver disease.
METHODS: The study group consisted of 49 patients with nonalcoholic fatty liver disease (35 boys and 14 girls), age range 3-16 years (mean 10,51±3,18 years). The anthropometric measurements and laboratory tests were performed. Features of steatosis of the liver were evaluated by ultrasound. The mean follow-up period was 2,45±1,45 years. APRI (AST to Platelet Ratio) and PNFS (Pediatric NAFLD Fibrosis Score) were calculated. The Mediterranean diet and physical exercises have been recommended. End-point parameters were a decrease in aminotransferase level and body weight.
RESULTS: In the study group, 35 children (71.43%) were obese, and 7 (14.29%) were overweight. In 22/49 cases (44.9%) BMI loss was achieved, in the other patients BMI gain was noted. Abnormal ALT level was observed in 25/49 children. In the group of children with increased ALT level significant reduction of ALT, AST and GGT levels were found concerning baseline values (Table 2). There was also a significant decline in mean APRI level and PLT count. Moreover, a decrease in ALT level was negatively related to PNFS, APRI and GGT.
DISCUSSION AND CONCLUSION: Lifestyle modification has a significant effect on the decrease in aminotransferase levels, even in children who fail to achieve BMI reduction.

INTRODUCTION: The aim of this study was to evaluate the place of clinical symptoms and findings, and radiological imaging in the diagnosis of foreign body aspiration in children, and to investigate the validity of existing diagnostic algorithms.
METHODS: Medical records of 120 children who underwent rigid bronchoscopy with the diagnosis of FBA were examined. The sensitivity and specificity of the parameters used in the diagnosis of FBA and their predictive values were calculated.
RESULTS: 78.9% of the patients were younger than 3 years and 63.8% were male. The peak incidence was 18 months. The rate of negative bronchoscopy was 30.8% and 87.3% of these patients were younger than 3 years. It was observed that the value with the highest diagnostical sensitivity and diagnostic accuracy rate (sensitivity; 92.54% and diagnostic accuracy; 85.7%) had positivity of the any of the radiological findings, and among these, there was detection of one-sided excessive ventilation on chest X-ray (sensitivity; 70.0% and diagnostic accuracy; 70.01%) Patients with positivity of any of the radiological findings who additionally had wheezing together with cyanosis or dyspnea had 100% specificity.
DISCUSSION AND CONCLUSION: Particularly, male children under age of 3 years have an increased risk of FBA. Neither clinical symptoms nor radiological findings alone are sufficiently specific and sensitive in the diagnosis of FBA. The most important factor in the decision to perform bronchoscopy is the evaluation of radiological findings together with physical examination and history.

INTRODUCTION: The study was carried out as a cross-sectional study to evaluate the relationship among obesity awareness, emotional eating and obesity on middle school children.
METHODS: The sample of the study comprised a total of 421 children who are 10-14 years of age and attend the fifth, sixth, seventh and eighth grades. The data were collected using a socio-demographic data collection form, the Obesity Awareness Scale and the Emotional Eating Scale. The heights and weights of the children were measured by the researchers and their body mass index (BMI) percentile were calculated. The data were analyzed using Pearson’s correlation analyses.
RESULTS: Of the children, 14.7% were obese, 13.8% were overweight according to the BMI percentile. There was no relationship between obesity, obesity awaraness and emotional eating (p>.05).
DISCUSSION AND CONCLUSION: The study found that emotional eating and obesity awareness were not affected the middle school children’s obesity.

INTRODUCTION: Dentoalveolar injuries are complex conditions affecting teeth and surrounding tissues and frequently seen in children or adolescents. The purpose of this study was to investigate levels of knowledge of traumatic dental injury among trauma emergency physicians (EPs).
METHODS: A questionnaire was used to investigate EPs’ levels of knowledge of and therapeutic approaches to avulsion. One hundred EPs were included in the study. The questionnaire was mailed to participants, and the data obtained were evaluated. Descriptive statistics and chi square tests were used for statistical analysis.
RESULTS: Our results showed that although EPs frequently encountered dental traumas, they stated that the dental emergencies had not been included in their medical education. And the knowledge level of dental avulsion of all EPs included in the study was following; 24% low, 56% moderate and only 18% high.
DISCUSSION AND CONCLUSION: EPs possessed inadequate knowledge concerning the immediate treatment of dental avulsion. The treatment of avulsion should be included in the medical curriculum. This will result in appropriate emergency treatments in dental avulsion being provided in emergency settings.

INTRODUCTION: The incidence and spectrum of nail abnormalities in children differ from adults. The aim of this study is to investigate the frequency and spectrum of the nail abnormalities in children and adolescents admitted to a dermatology outpatient clinic.
METHODS: This cross-sectional study included 600 patients under the age of 18 who admitted to a dermatology outpatient clinic with any dermatological complaint between March and May 2018.
RESULTS: In the study, among 600 patients; 325 (54.16%) were female and 275 (45.84%) were male. The mean age was 9.18 ± 5.12 years (1 month to 17 years). Nail abnormalities were present in 226 patients of whom 131 (58%) were female and 95 (42%) were male. The rate of nail abnormalities was 37.66% (226/600) among the study group. The number of nail abnormalities detected was 288 and the number of abnormality types was 23. The most common group of nail abnormalities were surface (18.16%) and color (16.50%) changes. The most common nail abnormalities were leukonychia (16.50%), onychoschizia (6.5%), and onychophagia / onychotillomania (6.5%). The fingernail abnormalities were significantly higher in males than females. Leukonychia and onychophagia / onychotillomania were significantly higher in males than females. The rate of patients admitted with ungual complaints among the patients with nail abnormalities was 10.61% (24/226).
DISCUSSION AND CONCLUSION: Nail abnormalities are very common in childhood. Although patients do not have a primary complaint, evaluation of the nails during physical examination may prevent the occurence of permanent damage to the nails and spread of the infectious diseases of the nails.

INTRODUCTION: The aim of the study is to review the clinical features and treatment of the tuberous sclerosis complex patients followed up in our hospital and to discuss the findings with the literature.
METHODS: Clinical-laboratory findings and treatment of 15 tuberous sclerosis patients who applied to the child neurology policlinic between 2007-2017 were retrospectively reviewed.
RESULTS: 15 patients aged between 8 months–17 years were included in the study. Female/male ratio was 47/53. Thirteen patients (86%) referred with convulsions, 7% with skin hypo-pigmented macule and 7% with detection of a renal cyst in the ultrasonography. At the time of the diagnosis, skin findings were present in 93% of the patients. There were infantile spasms in 23%, focal seizures in 54%, generalized tonic-clonic in 15% and atonic seizures in 8% of the patients who referred with seizures. In addition to the known antiepileptics in treatment, m TOR inhibitors were used in two patients. Forty percent was diagnosed with resistant epilepsy. Seven of the patients (46%) had various levels of mental retardation. There were cardiac findings in 33the %, ocular findings in 33%, renal involvement in 27% of the patients. The most common (87%) neuroradiologic finding was subepandymal nodule.
DISCUSSION AND CONCLUSION: It was observed that the signs and symptoms of our patients were compatible with the literature. In childhood, refractory epilepsy and mental retardation were the most important clinical findings. The age of onset of seizures in patients with resistant epilepsy was under one year of age. These patients had infantile spasms and larger number of cortical tubers in cranial MRI findings. It was observed that evorolimus treatment had no marked effect on the seizure frequency. However, patients with tuberous sclerosis should be closely monitored for the development of malignancies in the long term and the monitoring should be to continue in adulthood.

INTRODUCTION: This study was designed to determine the psychometric properties of the scale developed to evaluate the pediatric pain management knowledge (PPMK) and skills of nursing students.
METHODS: It is a methodological study conducted to develop the PPMK Scale for nursing students. A 29-item scale was administered to a total of 343 nursing students, were 3rdyear -taking the pediatric nursing course and 4thyear -carrying out their internship training at a state university. The scale items were selected through item-total score correlation analysis, and the sensitivity and specificity of the scale was evaluated using ROC analysis.
RESULTS: The students’ mean age was 21.92±1.150 and 76.2% were female. As a result of explanatory factor analysis, the scale consisting of six subscales was found to explain 50.30% of the total variance. The fit indexes of confirmatory factor analysis were calculated as RMSEA 0.063, GFI 0.85, CFI 0.93, IFI 0.93, RFI 0.86, NFI 0.88 and TLI 0.92. The Cronbach alpha coefficient of the entire scale was determined as 0.864. The correlations of the scale items with the scale total score ranged between 0.285 and 0.625.
DISCUSSION AND CONCLUSION: In this study, it was determined that the PPMK Scale was a valid and reliable tool for nursing students. It is recommended that after the students’ knowledge level is determined using the current measurement tool for PPMK, nursing curriculum should be revised and enriched, and further studies should be conducted on this topic.

Narcolepsy is a childhood and adolescence disorder, that until recently remained unidentified until adulthood, with a reported time from onset to diagnosis of around a decade. This disorder affects approximately 0.05% of the population and starts in childhood and adolescence about half of the time. The main symptom of hypersomnia is excessive daytime sleepiness or prolonged night-time sleep that has occurred for at least 3 months prior to diagnosis. Patients with narcolepsy also exhibit hallucinations and delusions, however the differential diagnosis between the disorders is often unclear.Case presented in our study is an example of atypical narcolepsy with coexistence of psychotic symptoms.

In our case upon the set-off of the second attack of excessive daytime sleepiness, the differential diagnosis of recurrent hypersomnia was not considered. This is due to the fact that the first attack of narcolepsy with hallucinatory component of the patient could have been misdiagnosed as acute transient psychotic attack.
Hallucinations and delusions sometimes appear in patients with narcolepsy. The differential diagnosis between the disorders is not always simple. In ou study we present teh case which illustrate this overlap.

Child and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be concidered in case of evaluation for a diagnosis of primary hypersomnia following a multidisciplinary cooperation of neurologists, paediatricians and psychiatrists.

Cardiomyopathy is a major factor contributing to mortality and morbidity in patients with Duchenne and Becker muscular dystrophies (DMD/BMD), and is therefore among the increasingly important findings. These X-linked recessive disorders involve the deficiency or absence of dystrophin in the skeletal muscle as well as the myocardium. This defect brings about changes in the cardiac muscle in three phases: an initial hypertrophic stage, followed by an arrhythmogenic stage, and finally end-stage dilated cardiomyopathy due to increased loss of myocytes. While cardiac involvement can be observed in carriers of BMD and DMD, the incidence of dilated cardiomyopathy is reported to be higher in BMD patients than DMD patients. The only curative treatment option for medically refractory dystrophinopathic end-stage heart failure is heart transplantation (1).
In this report, we present two patients 14 and 15 years of age who presented with dilated cardiomyopathy and were diagnosed with muscular dystrophy. One of the patients remains under follow-up with a left ventricular assist device (LVAD) as a bridge-to-transplantation, while the other underwent successful orthotopic heart transplantation.