INTRODUCTION: Dental anxiety is described as state anxiety as it occurs due to the dental treatment procedure. The present study aimed to evaluate the etiological factors of dental anxiety in children aged 7-8 and 11-12 years old.
METHODS: A total of 370 children of both genders were enrolled in the study. The socioeconomic status, education levels and family income of the parents, oral hygiene habits, and caries status of the children were recorded on a structured questionnaire. The dental anxiety of both children and their mothers were evaluated by the administration of a questionnaire based on Corah’s Dental Anxiety Scale(DAS). The Children’s Fear Survey Schedule-Dental Subscale(CFSS-DS) was also used to assess the dental anxiety levels of the children. Data were analyzed using SPSS 19.0 software program. Descriptive statistics were used for sociodemographic data. Parametric and non-parametric tests were used for comparing means/medians, whereas chi-square tests were used for comparing proportions. Student t-test and analysis of variance (ANOVA) with Bonferroni correction were employed to compare the anxiety scale results. All significance levels were set at 0.05.
RESULTS: A negative correlation was found between the age groups and dental anxiety levels in children(p=0.02). The difference between gender and dental anxiety was statistically significant(p=0.01). Boys were found more anxious than girls. The differences between the dental anxiety and the education level of the mothers, and the family income of the parents were not statistically significant(p>0.05). It was detected that the maternal dental anxiety level strongly affected the anxiety level of the children in a group of 7-8 years (p=0.01), while no significant difference was found in a group of 11-12 years(p>0.05). A positive correlation was found between the dental caries scores of the children and dental anxiety level(p=0.01).
DISCUSSION AND CONCLUSION: Dental anxiety is multifactorial, and is far more complex than can be explained by a single contributing factor.

INTRODUCTION: Asthma is the most common chronic disease in children and imposes a huge burden on the health system of countries. The aim of the present study is to investigate the burden of asthma disease in children in Asia during 1990-2019.
METHODS: All data sources from the Global Burden of Disease study (2019) were used to estimate the breast cancer prevalence, mortality, disability-adjusted life years and asthma in children aged 0-14 years in Asia from 1990 to 2019. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and attributable risks.
RESULTS: There is a positive and significant correlation between human development index (HDI) and disease incidence in both sexes (r = 0.417, P<0.05), and this correlation is positive and significant in both females (r = 0.401, P <0.05) and males (r = 0.420, P <0.05). There is also a significant negative correlation between HDI and disease mortality in both sexes (r = -0.475, P <0.05) and this negative correlation is significant in females (r = -0.459, P <0.05) and males (r = - 0.483, P <0.05). The study of YLDs showed that there is a significant negative correlation HDI and YLL in both sexes (r = -0.474, P<0.05), and in women (r= -0.456) and men (r=-0.483, P<0.05).
DISCUSSION AND CONCLUSION: Given that YLL is higher in countries with low HDI, greater attention must be paid to reduce incidence and premature death attributable to the asthma in these countries.

INTRODUCTION: Oral diseases can affect various aspects of life in children with attention deficit hyperactivity disorder (ADHD). The aim of this study is to evaluate the oral health conditions, oral health behaviors, and the oral health–related quality of life (OHRQoL) of children with ADHD.
METHODS: A sample of 76 children with ADHD who were treatment naive was compared to 71 healthy children, with ages ranging from 6 to 13 years. Through an intraoral clinical examination, the numbers of decayed, missing, and filled teeth (DMFT, dmft index), the plaque index (PI), the gingival index (GI), occlusion status, overjet, overbite and parafunctional oral habits were determined. The children’s parents completed the Turkish version of Early Childhood Oral Health Impact Scale (T ECOHIS) and questionnaires regarding oral health behaviors and dental care.
RESULTS: The child impact score (CIS) of T-ECOHIS were significantly higher among children with ADHD compared to control group patients (16 versus 12) consistent with poorer OHRQoL. They also had more dental trauma in both dentitions and more frequent nail-biting habits compared to the participants in the control group.
DISCUSSION AND CONCLUSION: In our study, T ECOHIS-CIS scores showed that the children with ADHD had been affected more when compared to the children without ADHD in the presence of oral health problems.

INTRODUCTION: Discrimination of inflammatory bowel diseases (IBD) from other gastrointestinal diseases in pediatric patients is highly important and the definitive diagnosis of IBD is established by endoscopic examination. The use of noninvasive methods (clinical symptoms and laboratory tests) allows an early and accurate referral of patients from first step health centers to advanced health centers. We aimed to investigate the effectiveness of fecal calprotectin (FC) in the discrimination of IBD from other gastrointestinal diseases in children.
METHODS: The retrospective study included the patients that underwent FC testing and colonoscopy. Demographic characteristics, alarm symptoms (AS), and abnormal laboratory findings (ALF) were recorded for each patient. A negative calprotectin result was considered to be less than 50 μg/g, and a second cutoff value for FC was accepted as 150 µg/g. Definitive diagnosis was established by colonoscopy in each patient.
RESULTS: The study included 88 consecutive patients (mean age, 10.2 ± 6.1 years; 51.1% female). Of these, 20 (22.7%) patients were diagnosed with IBD. No significant difference was found between IBD and non-IBD patients with regard to presence of AS except for involuntary weight loss (p=<0.001). The prevalence of increased CRP and hypoalbuminemia was significantly higher in IBD patients (p=0.002 and p=0.026, respectively). FC >50 µg/g (80.0 vs 39.7 %, p=0.044, OR: 6.07, 95% CI 1.83 to 23.42) and >150 µg/g (60.0 vs 16.2 %, p=0.002, OR: 7.78, 95%, CI 1.83 to 20.14) was significantly higher in IBD patients compared to non-IBD patients.AS combined with ALF and FC >150 µg/g had the highest specificity (95.12%).
DISCUSSION AND CONCLUSION: Although primary care clinicians often use AS and laboratory parameters in the discrimination of IBD from non-IBD diseases, FC was found to have a relatively higher diagnostic value.

INTRODUCTION: Atopy is associated with a genetic predisposition to develop allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis. In this study, we aimed to compare the prevalence of familial Mediterranean fever mutations in asthma and allergic rhinitis patients with controls in pediatric population and to analyse the positive or negative effect of MEFV mutations in the development of atopy.
METHODS: For the detection of FMF mutations, 88 pediatric patients (51 allergic asthma, 17 allergic rhinitis and 20 both asthma and allergic rhinitis cases) and 92 controls were included in our study. Total genomic DNA was extracted from peripheral blood samples using DNA isolation kit and patients and control group were screened for MEFV gene mutations using Reverse Hybridization procedure (Strip Assay).
RESULTS: There were 9 carriers (heterozygous mutation) in patient group. Control group had 21 carriers and 1 individual with compound heterozygous mutation. It was not detected any homozygous mutation in both two groups. The number of individuals with mutation were statistically higher in the control group than in the patients of asthma and allergic rhinitis (p=0.015) and the mutation number (allelic frequency) in the control group was also higher than in patients (p=0.014).
DISCUSSION AND CONCLUSION: We can suggest that FMF mutations are lesser in allergic rhinitis and asthma cases than in normal population. Asthma and allergic rhinitis may be more common in individuals without FMF mutation. It can be thought that MEFV gene mutations are effective to prevent allergic reactions on the basis of Th2 suppression.

INTRODUCTION: Nowadays, insufficiency and deficiency of vitamin B12 and folate have been an important health problem. The purpose of the present study was to determine the frequency of vitamin B12 and folate deficiencies in pregnant women and their babies at birth.
METHODS: The study group consisted of 117 pregnant women and their single and term babies in Izmir Ege Maternity Hospital. Analysis of vitamin B12, folate and homocysteine levels were performed from venous blood samples that were obtained from mother and cord blood at birth and questionnaire using face-to-face interview method was applied to included pregnant women. The mean duration of pregnancy was 39.1±0.89 weeks and mean age of pregnant was 28.2±6.2 years.
RESULTS: Vitamin B12 deficiency (<130 pg/ml) was in 88.9% of mothers and 56% of babies. Folate deficiency (<4 ng/ml) was found in 6.8% of mothers, but not found in any babies. The homocysteine levels were high (>8 µmol/l) in 58.1% of mothers and 63.2% of babies. There was a significant correlation between maternal and cord blood vitamin B12, folate and homocysteine levels (p<0.01). However, there was no correlation between maternal vitamin B12 and homocysteine levels (ρ=-0.016, p=0.354).
DISCUSSION AND CONCLUSION: Low maternal vitamin B12 levels are strongly associated with low cord blood vitamin B12 levels. This data reveals that vitamin B12 deficiency is a preventable public health problem that can occur from the neonatal period.

INTRODUCTION: This study was conducted to examine the effect of three different methods for reducing pain and stress among term neonates undergoing venipuncture.
METHODS: The research sample comprised 80 term neonates with hyperbilirubinemia who were being treated at the Neonatal Intensive Care Unit. The term neonates were allocated, according to the randomization method, into a smelling breast milk group (n = 20), a pacifier/dummy group (n = 20), a prone position group (n = 20), and a control group (n = 20).
RESULTS: It was determined that there was a statistically significant correlation between the pain and stress score averages of the breast milk, prone position, and pacifier/dummy groups according to all measurements taken before, during, and after the procedure (p < 0.001). It was discovered that there was a difference between the Premature Infant Pain Profile-Revised form (PIPP-R) and the mean stress scores of the control group and the breast milk, prone position, and pacifier/dummy groups after the procedure (p < 0.001).
DISCUSSION AND CONCLUSION: In study, it was concluded that the breast milk smell, prone position, and giving a pacifier made of sterile gloves are effective in reducing the pain and stress of newborns during the venipuncture procedure. Non-pharmacological methods such as smelling breast milk, prone position, and giving a pacifier/dummy are recommended to reduce pain and stress among term neonates during interventional procedures.

INTRODUCTION: Kawasaki disease (KD) is difficult to diagnose in infants, since the disease course is subtle. We aimed to identify whether infants with KD demonstrate significant alterations in laboratory parameters that can be used to distinguish them from other febrile infants.
METHODS: In this retrospective case-control study, infants diagnosed with KD between January 2010 and December 2019 were evaluated and compared to a cohort of febrile infants admitted with prolonged fever during the same period. Demographic, clinical, and laboratory features were recorded and compared between those two groups.
RESULTS: A total of 42 infants (27 male) with KD (32 incomplete KD) and age-matched 84 febrile infants (57 male) were evaluated. Coronary artery involvement was identified in 20 (47.6%) infants of whom 5 (25%) had coronary aneurysms. All infants with KD were treated with IVIG and high dose acetylsalicylic acid, and 38 (90.5%) responded to treatment. Duration of fever and hospitalization was longer in infants with KD compared to controls (p˂0.001). White blood cell (WBC), eosinophil, platelet counts, platelet distribution width (PDW), acute phase reactants, alanine aminotransferase, and gamma glutamyl transferase were significantly higher; whereas, mean platelet volume (MPV), hemoglobin, and albumin levels were lower in the KD group compared to controls. Lower MPV and albumin values were found to be independently associated with higher likelihood of having KD diagnosis.
DISCUSSION AND CONCLUSION: It may be difficult to diagnose KD in infants. Our data shows that MPV and albumin may be used as supportive parameters to discriminate KD from other febrile conditions in infants.

INTRODUCTION: During the COVID-19 pandemic, pediatric emergency department visits and pediatric intensive care unit (PICU) admissions were significantly decreased. This study aimed to evaluate the impact of prevention strategies on the PICU admissions during COVID-19 outbreak.
METHODS: We included all patients admitted to PICU from March 15th to September 15th, 2020, and those admitted in the same period in 2019. Incidence rates ratios (IRR) between 2019 and 2020 cohorts (IRR-1) and restriction (March 2020-June 2020) and post-restriction (July 2020-September 2020) (IRR-2) were computed using Poisson modelling according to the data distribution. We analyzed the number of PICU admission and patient characteristics.
RESULTS: A total of 437 patients of 465 admissions were included. In 2020, the number of PICU admission significantly decreased by 65% compared to 2019 (0.355[0.287-0.440]). During restriction period, the number of PICU admission significantly decreased by 40.3% compared to post-restriction period (0.597[0.493-0.722]). Lower respiratory tract infections (LRTIs) significantly decreased by 19% in post-restriction period compared to restriction period (0.811[0.684-0.960]). Cardiopulmonary arrest before PICU admission significantly increased during restriction period compared to post-restriction period (15.5% vs 4.8%, p<0.015).
DISCUSSION AND CONCLUSION: It was shown that there was a significant decrease in all PICU admissions especially due to LRTIs during the COVID period. During restriction period cardiopulmonary arrest prior PICU admission increased compared to post restriction period and 2019. Our study doesn't demonstrate an increase in illnesses severity scores but the significant increase in cardiopulmonary arrest may be explain with delay in health care access and fear of COVİD-19 transmission.

INTRODUCTION: As application of flexible bronchoscopy (FB) has a high risk for infection transmission, it is recommended to postpone elective FB procedures during COVID-19 pandemic. We aimed to determine how COVID-19 pandemic affected pediatric FB implementation.
METHODS: Medical records of patients who underwent FB from March 11, 2015 to September 11, 2020 were examined retrospectively. Records of post-COVID-19 period (March 11, 2020 to September 11, 2020) were compared with records of pre-COVID-19 (consists of each six-month time window from March 11 to September 11 of each year from 2015 to 2019) period in terms of hospitalization status of the patients, with numbers and indications of FB. Some additional measures were taken during FB procedure in post-COVID-19 period. Number of health workers infected during FB procedures in post-COVID-19 period was reviewed.
RESULTS: Of total 182 procedures, the least FB was performed in post-COVID-19 period (34, 30, 36, 36, 25 and 21 procedures respectively from 2015 to 2020). While microbiological sampling with bronchoalveolar lavage was the most common indication in post-COVID-19 period, atelectasis was leading in pre-COVID-19 period (p<0.001). In post-COVID-19 period most of the patients were inpatients while outpatient predominance was determined in pre-COVID-19 period (p<0.001). None of the health workers was infected during FB procedure.
DISCUSSION AND CONCLUSION: Postponing elective FB procedures decreased the numbers and affected the indications of procedures during COVID-19 era. Taking additional measures are of great importance and effective to prevent transmission of infection during FB.

INTRODUCTION: Aim: This study aims to determine the effect of breastfeeding education given to parents in the early postpartum period on the duration of exclusive breastfeeding for the first six months, breastfeeding success and breastfeeding self-efficacy levels of mothers.

METHODS: Materals and Methods: Study has three groups including control (n = 49), Intervention I (n = 48) and Intervention II groups (n = 48). As a nursing intervention, breastfeeding training using pre-structured training modules was given to the mothers only in Intervention Group 1 and to the mothers and fathers in Intervention Group 2. Routine nursing services were provided to the families in the control group. The infant feeding behaviors of the mothers in all three groups were monitored until the end of the sixth month. The parental introductory information form, infant follow-up form, LATCH Diagnosis and Evaluation Scale and Breastfeeding Self-Efficacy Scale were used to collect the data.
RESULTS: Results: It was determined that breastfeeding training given to mothers increased breastfeeding self-efficacy levels and breastfeeding success and this increase was statistically significant (p <0.05). It was determined that the difference between the SNS feeding rates between the three groups at the 1st, 2nd, 4th and 6th months was significantly higher than the control group (p <0.05).
DISCUSSION AND CONCLUSION: Conclusions: Breastfeeding training increased the mothers’ breastfeeding self-efficacy and duration of exclusive breastfeeding, but fathers’ support made no significant difference.

Actinomyces rarely cause infections in nasal sinuses with local symptoms and its identification is difficult so initiation of treatment might be delayed. A 7-year-old boy with recurrent nasal bleeding was found to be infected in paranasal sinuses with actinomyces which was confirmed by histopathological studies. The case was initially managed with surgical resection and systemic antibiotics and later discharged and referred to out patient clinic.

Wilms' tumor is one of the most common childhood solid malignancies, which accounts for almost 95% of renal malignancies in pediatrics, and classically arises from primitive metanephric cells. Exceptionally it may occur at places other than kidneys. The estimated rate of nephroblastoma outside the kidneys is almost 0.5 to 1% of Wilms' tumor cases. Extrarenal Wilms' tumor occurs mostly in childhood.
In this article, we report a 3-year-old girl who first presented with spinal dysraphism and a mass in the lumbar spinal cord with a histopathological diagnosis of nephrogenic rest, and after one year, a Wilms tumor arose in this location. When extrarenal wilms tumor located in the spine is unlikely to be suspected preoperatively because it is embryologically less intuitive. Thus, we report this case of a congenital Wilms tumor associated with spinal dysraphism to increase awareness and describe this malignant tumor's clinical outcome.

Childhood hypophosphatasia (HPP) presents with bowing of the limbs, poor mobility, chronic pain, short stature, fractures, motor impairment. Enzyme replacement therapy (ERT) provides improved pulmonary and physical function in life-threatening perinatal and infantile forms of HPP. However, treatment of the patients without life-threatening HPP is limited. This report describes the results of asfotase alfa (Strensiq®, Alexion Pharmaceuticals, Inc.) treatment in a 6-year-old girl with childhood HPP, who presented with premature loss of primary teeth, low mobility, and chronic pain in the legs. Sequence analysis of the TNSALP gene revealed three heterozygous variants; c.526G>A (reported previously), c.1051G>C (novel), c.787T>C (reported previously). After a four-year follow-up under ERT, a marked reduction in leg pain and restlessness was observed and physical therapy assessments showed remarkable improvements in motor function, pain score, and quality of life. Treatment decision in childhood HPP is not as clear as in infantile and perinatal forms and it is mostly based on the clinical and radiological condition of the patient. In patients with childhood HPP without severe skeletal involvement but accompanying motor retardation, ERT may improve quality of life, motor functions, and daily activities.

Introduction: Autologous hematopoietic stem cell transplantation(AHSCT) is an increasingly used curative treatment for some solid tumors in children. Instead of allogeneic transplantation, the risk of developing graft versus host disease (GvHD) is much lower after AHSCT. Although the clinical findings of auto-GVHD are mild and self-limited in most cases, rare cases may be severe and need intensive immunosuppressive treatment. Here, we present a case who underwent autologous HSCT due to relapsed neuroblastoma, developed steroid-refractory GvHD after AHSCT, and achieved remission using ruxolitinib.
A 12 years old female patient was diagnosed with relapsed neuroblastoma. After metaiodobenzylguanidine treatment, AHSCT was performed, and the status of the disease was a very good partial response at the time of transplantation. Our patient was diagnosed with severe and steroid-refractory GvHD with skin involvement after AHSCT. We used ruxolitinib with extracorporeal photopheresis because of the essential side effects of the other drugs and got a very good response. Over the following five months, there was no recurrence of GvHD. She was in complete remission of neuroblastoma after two years of AHSCT.
It is crucial to keep in mind that GvHD may develop after AHSCT. Ruxolitinib is an effective treatment for GvHD also after AHSCT. Further studies and case reports are needed to understand the disease's pathogenesis and regulate appropriate treatment.