Ankara Bilkent City Hospital, Children’s Hospital
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Pediatric syncope: Clinical and demographic findings from a neurological outpatient cohort
Objective: Syncope, a temporary loss of consciousness caused by cerebral hypoperfusion, is often benign but can signal serious neurological or cardiac issues. We retrospectively analyzed pediatric syncope cases in this study. Material and Methods: We analyzed 514 patients aged 6–18 years who presented with syncope to a pediatric neurology outpatient clinic. Results: Most patients (36.7%) had a single episode, though recurrent cases were also common. The primary triggers were prolonged standing (17.2%) and sudden postural changes (14.4%). Prodromal symptoms such as dizziness, visual disturbances, and nausea were reported in 69.5% of cases. Electroencephalography (EEG) was performed in 72.2% of patients, revealing epileptiform activity in 27 individuals. EEG requests increased significantly in patients with recurrent syncope episodes (p<0.010). Cranial MRI was performed in 37.5% of the patients, and abnormalities were detected in 16.6%, most commonly arachnoid cysts. However, no statistically significant correlation was found between MRI utilization and the frequency of syncope episodes. Final diagnoses were predominantly vasovagal syncope (75.6%), followed by psychogenic syncope (10.3%), seizures (8.75%), cardiogenic syncope (4.5%), and hypoglycemia (0.85%). Conclusion: These results highlight the mostly benign nature of pediatric syncope, with vasovagal syncope as the most frequent diagnosis. EEG is useful for identifying underlying epilepsy, while neuroimaging should be reserved for selected cases.
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Retrospective cross-sectional analysis of Vitamin D deficiency in pediatric patients: Clinical findings from a tertiary care center
Objective: The 25-Hydroxyvitamin D (25(OH)D) deficiency is a prevalent global health concern, particularly among children, leading to conditions such as rickets and increasing the risk of respiratory infections and chronic diseases. Contributing factors include limited sun exposure, poor dietary intake, and growth demands. This study aimed to assess the clinical and laboratory characteristics of pediatric paients with 25-Hydroxyvitamin D (25(OH)D) deficiency at our clinic. Material and Methods: This retrospective study was conducted at a tertiary care center in İstanbul, Türkiye, including pediatric patients diagnosed with 25-Hydroxyvitamin D (25(OH)D) deficiency between January 2020 and December 2023. Data on sociodemographic, medical history, symptoms, physical examinations, and laboratory results were extracted from electronic medical records. Patients with 25-Hydroxyvitamin D levels below 20 ng/mL were classified as deficient. Correlation analyses were employed to assess the associations between 25-Hydroxyvitamin D (25(OH)D) levels and clinical factors. The study was approved by the Istanbul Medipol University Ethical Review Board. Results: A total of 5229 pediatric patients with 25-Hydroxyvitamin D (25(OH)D) deficiency or insufficiency were included in the study, with a slight female predominance (51%). The highest frequency of deficiency was observed among children aged 2 to 3 years. Symptom-onset complaint records were retrospectively reviewed. The most commonly documented complaints at presentation were fatigue (30.75%), followed by non-specific or asymptomatic presentations (28.95%). Given the retrospective design of the study, these symptoms may not be specific to 25-Hydroxyvitamin D (25(OH)D) deficiency and could be attributable to other concurrent conditions. Notably, in several cases, 25-Hydroxyvitamin D (25(OH)D) deficiency was detected incidentally during medical evaluations performed for unrelated reasons. Conclusion: The 25-Hydroxyvitamin D (25(OH)D) deficiency is a common condition in childhood and may present with a wide range of symptoms or remain asymptomatic. Early detection is crucial, particularly in at-risk groups such as toddlers and children with limited sun exposure. Clinicians should be aware of the non-specific nature of symptoms and consider 25-Hydroxyvitamin D (25(OH)D) status in routine pediatric evaluations. Broader awareness and preventive strategies are needed to reduce the clinical burden of this silent but prevalent deficiency.
Self-esteem and depressive symptom levels in adolescents with Type 1 Diabetes
Objective: This study aimed to examine self-esteem and depressive symptom levels in adolescents with type 1 diabetes, shedding light on the impact of living with a chronic illness on adolescent mental health. Material and Methods: The study population consisted of patients followed in the Pediatric Endocrinology Outpatient Clinics of three Educational and Research Hospitals located on the Anatolian side of Istanbul between September 2023 and November 2023. The sample consisted of 202 adolescents aged 13-18 who met the inclusion criteria and agreed to participate in the study. Data were collected using the “Personal Information Form,” “Coopersmith Self-Esteem Inventory (CSEI),” and the “Adolescent Quick Depressive Symptom Inventory (AQ-DSI-17-SF).” Data were analyzed using the SPSS for Windows 26.0 software package. Results: The results of this study revealed that the self-esteem levels of adolescents with Type 1 diabetes were moderate (26.06±7.9), while their depressive symptom levels were mild (10.73±3.5). There was a negative correlation between HbA1c levels and CSEI scores (r = -0.228; p=0.001), and a statistically significant positive correlation between HbA1c levels and AQ-DSI-17-SF scores (r = 0.401; p=0.001). Conclusion: The findings indicate that the HbA1c levels of the adolescents who participated in the study were generally within the target range, reflecting a successful approach to disease management. In this context, it can be suggested that adolescents who manage their disease effectively are also able to maintain their psychological well-being in a healthier manner.
The relationship between body image, self-esteem, and body mass index in primary school children
Objective: With the increasing prevalence of childhood obesity, there is a growing interest in understanding how the ideal body image influence children’s self-perception and whether this may potentially lead to various psychological problems. Therefore, this study aimed to examine the relationship between body image, self-esteem, and Body Mass Index (BMI) in primary school children, to identify individuals at risk at an early stage. Material and Methods: The study sample consisted of 342 primary school children aged 6-12 years. The Sociodemographic Information, Children’s Body Image Scale (CBIS) and Children’s Rosenberg Self-Esteem Scale (CRSS) were used to gather data. Body weight and height were measured, and BMI was calculated. Data were analyzed using Chi-square, Mann–Whitney U, Kruskal–Wallis, Spearman correlation, and multiple linear regression tests. Results: BMI was moderately associated with perceived body image (r = 0.428; p < 0.001) and body dissatisfaction (r = 0.422; p < 0.001) but showed minimal correlation with self-esteem and age (CRSS: r = 0.011, p > 0.05; NSE: r = 0.002, p > 0.05; PSE: r = 0.014, p > 0.05; Age: r = 0.032, p > 0.05), while self-esteem measures did not significantly differ by body satisfaction status (CRSS: H = 0.599, p = 0.741; NSE: H = 0.293, p = 0.864; PSE: H = 0.950, p = 0.622). Regression analysis identified BMI (B = 0.094; 95% CI: 0.071–0.116; β = 0.411; p < 0.001) as the strongest predictor of body dissatisfaction, followed by age (B = 0.078; 95% CI: 0.006–0.150; β = 0.106; p = 0.035), whereas other sociodemographic and psychological variables, including gender (B = 0.199; p = 0.122) and self-esteem (NSE: B = −0.022, p = 0.368; PSE: B = 0.023, p = 0.469), did not significantly predict dissatisfaction levels. Conclusion: BMI has a significant influence on body image perception in primary school-aged children, whereas self-esteem appears to be less affected by body satisfaction at this developmental stage. These results highlight the need for early, gender-sensitive, and family-centered interventions to promote healthy body image.
A 11-year retrospective analysis of intussusception cases in children
Objective: Intussusception is a prevalent etiology of emesis and abdominal discomfort in pediatric patients. This investigation sought to elucidate the correlation between epidemiological factors, clinical progression, diagnostic procedures, therapeutic interventions, and patient outcomes, with particular emphasis on the safety profile of hydrostatic reduction in subjects presenting with intussusception. Material and Methods: In this retrospective study, we analyzed the data of children who were diagnosed and treated for intussusception in the hospital database and the Picture Archiving and Communication Systems (PACS) from January 2013 to December 2023. Demographic data, symptoms at presentation, mode of diagnosis, treatment modality, and associated complications were also recorded. Results: Of the 165 patients, 60% were boys and 40% were girls, with a mean age of 35.5 years (1-193 months). Of the patients, 44.2% (n= 73) were presented within 24 hours of symptom onset. All patients had abdominal pain, and 24 (14.5%) had the classic triad of abdominal pain, vomiting, and red stools. Ultrasonography-guided hydrostatic reduction (USHR) and surgery resulted in a cure in 134 (93.3%) and 31 (6.7%) patients, respectively. The overall recurrence rate was 16.3%, with no mortality. There was a statistically significant difference between the length of the invaginated segment (4 cm or more) and USHR (p=0.004). Conclusion: The USHR of invagination is effective regardless of the duration of symptoms and number of recurrences.
Health literacy levels of adolescents and their parents visiting a pediatric outpatient clinic
Objective: This study aimed to assess the health literacy (HL) levels of adolescents and their parents attending the pediatric outpatient clinic of a training and research hospital and to evaluate the hypothesis that HL correlates with serum 25-hydroxyvitamin D3 levels, serum vitamin B12 (cobalamin) levels and sociodemographic characteristics. Material and Methods: This descriptive cross-sectional study included 302 adolescents aged 14 years and older, along with their parents, who attended the general pediatrics outpatient clinic of Haydarpaşa Numune Training and Research Hospital from November to December 2022. Data were collected using a sociodemographic information form, serum 25-hydroxyvitamin D3 levels, serum vitamin B12 levels of adolescents according to hospital records, the Hacettepe University Health Literacy Scale-Long Form (HU-HL) for parents, and the Adolescent e-Health Literacy Scale (eHEALS) for adolescents. Non-parametric statistical tests were used due to the non-normal distribution of the data. Results: The mean age of adolescents was 15.47±1.09 years, with 56% identified as female. The mean age of the parents was 44.49±5.02 years, with 84.8% being mothers. Among parents, 21.2% exhibited low HL levels, 57.3% shown moderate levels, and 21.5% displayed high levels. The average total score of eHEALS was 27.78±5.40. Female parents exhibited markedly superior HL scores compared to male parents (p=0.003). Serum 25-hydroxyvitamin D3 (25(OH)D3) levels, serum vitamin B12 (cobalamin) levels, as well as body mass index (BMI), exhibited no significant correlation with HL scores. Nonetheless, parents of female adolescents had markedly higher HL scores compared to those of male adolescents (p=0.013). Conclusion: Parents of female adolescents demonstrated significantly higher HL levels than those of male adolescents. These findings underscore the need for targeted interventions to address HL disparities among caregivers and adolescents. Future research should explore longitudinal and causal relationships between HL and biological as well as sociodemographic determinants.
Do hematologic parameters predict coronary artery involvement in children with Kawasaki disease? A retrospective study
Objective: Kawasaki disease (KD) is an acute systemic vasculitis of childhood that may lead to coronary artery involvement (CAI) if not promptly treated. Early identification of laboratory predictors for coronary complications is essential. This study aimed to identify early laboratory predictors of coronary complications in KD, to help clinicians assess risk during the acute phase. Material and Methods: We retrospectively analyzed 38 pediatric KD patients. Clinical and laboratory data—including hemoglobin (Hb), hematocrit (Htc), white blood cell count (WBC), platelet counts (PLT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), liver enzymes, and Harada scores—were collected and compared between patients with and without CAI. Receiver operating characteristic (ROC) and logistic regression analyses were performed. Results: The mean age was 35.0±32.6 months, with 65.8% male. CAI was observed in 16 of 38 patients (42.1%). No statistically significant differences were found in the laboratory values at diagnosis between patients with and without CAI. Conclusion: Routine hematological and inflammatory markers at admission were not predictive of CAI in KD. These findings highlight the need for high clinical suspicion in incomplete cases and suggest that incorporating clinical features and risk scores may improve early risk stratification.
Assessment of enteral nutrition in preterm infants with patent ductus arteriosus undergoing medical treatment
Objective: The aim of this study was evaluate the effect of enteral nutrition during treatment in preterms under 32 weeks of gestation with patent ductus arteriosus receiving medical treatment. Material and Methods: Preterm newborns born before 32 weeks of gestation who received medical treatment for patent ductus arteriosus were categorized into three groups based on their enteral feeding status during treatment: Group A (not fed), Group B (fed <60 ml/kg/day), and Group C (fed ≥60 ml/kg/day). Gastrointestinal system problems and neonatal morbidities were compared with nutritional status. In this retrospective study, 105 patients were included. Results: Gastrointestinal intolerance was more common in group A, which was never fed (p=0.017) and the time to full enteral nutrition was the longest in this group (p=0.024). In the most fed group C, the time to regain birth weight was the longest (p=0.002). Daily weight gain was the lowest in patients in group A (p=0.022) and mortality was the most common in this group (p=0.003). There was no statistically significant difference in the incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage and sepsis between fed and unfed infants. Conclusion: No statistically significant adverse effects of enteral feeding were observed in preterms treated medically for patent ductus arteriosus. This study shows that enteral feeding does not increase gastrointestinal or neonatal morbidities, and that feeding during treatment appears to be safe
Evaluation of basic life support training provided to mothers of preterm infants
Objective: Preterm infants admitted to neonatal intensive care units (NICUs) are at an increased risk of requiring basic life support (BLS). This study aimed to evaluate the impact of BLS training on the knowledge and anxiety levels of mothers of preterm infants. Material and Methods: This prospective descriptive study included mothers of preterm infants born at less than 37 weeks of gestation who were either discharged from the NICU or being treated in the mother-infant adaptation unit. Participants were provided with BLS training using visual materials. A questionnaire assessing knowledge levels and the State-Trait Anxiety Inventory (STAI Form TX-1 and TX-2) were administered before and after the training. Pre- and post-training questionnaire responses and anxiety scores were analyzed. Results: A total of 100 mothers participated in the study. Post-training knowledge levels regarding BLS significantly improved (p<0.001). State and trait anxiety scores significantly decreased after the training (p<0.001). Mothers with a university education had higher pre-training knowledge scores compared to those with primary or secondary education (p<0.001); however, post-training knowledge levels were similar across all educational groups (p = 0.600). Conclusion: BLS training increased knowledge levels and reduced anxiety among mothers of preterm infants. Therefore, developing and disseminating appropriate BLS training programs for parents may play a crucial role in improving public health. Moreover, reducing parental anxiety through such training could contribute to enhancing the quality of neonatal care.
Efficacy and safety of levetiracetam treatment in childhood epilepsy
Objective: Levetiracetam (LEV) is a second-generation antiepileptic drug widely used in pediatric epilepsy due to its favorable pharmacokinetics, efficacy, and tolerability. This study aimed to evaluate the long-term efficacy and safety of LEV treatment in children with epilepsy. Material and Methods: A retrospective review was conducted on pediatric patients diagnosed with epilepsy and treated with LEV at a tertiary pediatric neurology center. Treatment efficacy was assessed based on seizure frequency reduction of more than 50% or complete seizure freedom. The occurrence and types of adverse effects were also analyzed. Statistical analyses included chi-square tests, independent t-tests, and logistic regression models. Results: A total of 101 patients were included in the study. LEV was initiated as the first antiepileptic drug in 9.9% of patients. By the end of the follow-up, 34.7% remained on LEV treatment, and 11.9% discontinued LEV. LEV was effective in 72.3% of patients, with 38.0% achieving complete seizure freedom. The drug was significantly more effective in patients older than four years and those with a lower pre-treatment seizure frequency. The mean LEV dose was 24.8 mg/kg/day in the effective group and 33.8 mg/kg/day in the ineffective group. Adverse effects were observed in 45.5% of patients, with the most common being drowsiness, irritability, and fatigue. Patients with a prior history of adverse reactions to other antiepileptic drugs had a significantly higher likelihood of developing side effects with LEV. Conclusion: Levetiracetam (LEV) is an effective and well-tolerated treatment option for childhood epilepsy, with high efficacy rates and a manageable safety profile. Older children, those receiving lower doses, and those with a lower pre-treatment seizure burden demonstrated better treatment outcomes. Careful monitoring is necessary for patients with a history of adverse reactions to other anti-epileptic drugs.
Diabetes-specific eating disorder and psychological flexibility in adolescents with type 1 diabetes: Impact on metabolic control and anthropometric measurements
Objective: This study aimed to evaluate the risk of diabetes-specific eating disorders (EDs) and disease acceptance in adolescents with type 1 diabetes mellitus (T1DM) and to examine their associations with metabolic control and anthropometric measurements. Material and Methods: A total of 73 adolescent with T1DM (11-19 years) participated. Data were collected face to face using questionnaires on sociodemographic and clinical characteristics, the Diabetes Eating Problem Survey-Revised (DEPS-R), and Acceptance and Action Diabetes Questionnaire (AADQ). Biochemical results and anthropometric measurements were obtained from medical records and direct assessment. Data were analyzed via SPSS and JASP. Results: Nearly half of the participants (45.2%) were at high risk for diabetes-specific EDs. The mean DEPS-R score was 21.3±12.0, and the mean AADQ score was 47.6±9.7. Skipping main meals was associated with higher DEPS-R scores (p=0.025) and lower AADQ scores (p=0.009). A weak negative correlation was found between HbA1c and AADQ score (r=-0.280, p=0.018). Conclusion: A considerable proportion of adolescents with T1DM are at high risk for EDs, and poor disease acceptance is linked to worse metabolic control. These findings underscore the importance of routine screening for disordered eating in clinical practice and the potential value of incorporating psychological flexibility-based interventions to improve outcomes.
From bedside to revisit: identifying risk factors for outpatient revisits following pediatric viral lower respiratory tract infections – insights from hospitalized cases of RSV, HBoV and influenza
Objective: Acute lower respiratory tract infections (ALRTIs) are among the leading causes of hospitalization, particularly in children under five years of age. A substantial proportion of children discharged after hospitalization for viral ALRTIs experience recurrent respiratory tract infections; however, the clinical predictors of these recurrences have not yet been fully defined. This study aimed to investigate the relationship between recurrent hospital visits due to respiratory tract infections within one year post-discharge and various clinical and demographic factors in pediatric patients hospitalized with ALRTIs caused by respiratory syncytial virus (RSV), human bocavirus (HBoV), or influenza viruses (IFV). Material andMethods: This retrospective observational study included pediatric patients hospitalized due to RSV, HBoV, or IFV infections between January and December 2023. Demographic characteristics, clinical presentation, hospitalization details, and post-discharge follow-up data were evaluated. Recurrent hospital visits related to respiratory tract infections within one year of discharge were analyzed. Results:A total of 519 patients were evaluated. Recurrent hospital visits due to respiratory tract infections were identified in 216 patients (41.6%) during the follow-up period. Younger age (p = 0.028) and the presence of chronic illness (p = 0.011) were found to be significant risk factors for these repeat visits. No significant association was observed between recurrent visit frequency and variables such as sex, identified viral pathogen, laboratory parameters, or radiological findings. Conclusion: Younger age and comorbid chronic illnesses were identified as important risk factors for recurrent hospital visits following viral ALRTIs. These findings highlight the need for more structured and targeted follow-up strategies in pediatric patients at higher risk after hospital discharge.
Enhancing the Capacity of Health Systems to Overcome Challenges and Strengthening Nurses and other Healthcare Professionals in COVID-19 Process
Nowadays, leaders and executives are faced with a complex set of problems that do not have a complete solution, threaten their career and the future of their institutions, and that the parties are harmed. When evaluating ambiguous information that contradicts each other, the priority of the manager and leader should be to implement the solution that gives the least harm to the majority. When a process such as COVID-19, which caused a pandemic and left our lives under uncertainty, more than one crisis situation emerged, which we had to manage both personally and as healthcare professionals. The important point here is related to how we manage and lead these extraordinary situations we encountered in the Quantum era. How we keep pace with change and how we can lead this planning process is an important issue. Because people faced a risk in the context of the most important human right and constitutional right “right to live”. Therefore, how to protect ourselves and stay healthy during this process have been our top priorities. The first thing that comes to mind when it comes to protecting and strengthening health is undoubtedly the health professionals who have adopted this issue as a professional principle. Health professionals have important responsibilities in planning this crisis in terms of planning, speed, compliance and trust. This article, prepared in a compilation style, discusses what can be done within the scope of the COVID-19 process, by improving the capacity of managers and leaders to overcome difficulties in the health system they are in and strengthening nurses and health professionals.
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Management of Trauma And Surgical Procedures in Children During The COVID-19 Pandemic
Coronavirus 2019 (COVID-19) infection was first identified in China and spread to the whole world in a very short time. The COVID-19 pandemic was declared by the World Health Organization (WHO) in March 2020 due to the rapid inc rease in the number of cases and deaths. Studies show that the virus is primarily transmitted by respiratory droplets and close contact. Although 90% of children are asymptomatic or have mild symptoms, they should be accepted as positive until they are proven negative regardless of any complaints. Despite the process, trauma, burn and surgical emergencies continue to concern pediatric surgeons. The basic principles those generally accepted during Covid-19 pandemic are to perform emergency and urgent surgical procedures and to reschedule elective surgeries. However, the most important issue in the process is to take precautions for protecting the healthcare team and to plan keeping hospital reserves. We aimed to adapt general principles of trauma and surgery to the COVID-19 pandemic in children and to discuss the specific conditions in our review.
Adverse Drug Reactions During COVID-19 Treatment
Adverse drug reactions are unintented and harmful reactions to drugs. Coronavirus disease 2019 (Covid-19) has been widely spread. Although many drugs are used in the treatment of COVID-19, there is still no specific treatment with proven reliability and effectiveness and there are many studies to find effective treatment. Attention should be taken regarding the properties, interactions and undesired drug reactions of drugs used in the treatment of COVID-19. The aim of this review is to draw attention to adverse drug reactions of the drugs that are being used in COVID-19 treatment.
COVID-19 Management in Children: Approach in Pediatric Cardiology
In children, cardiac involvement can be observed during the course of COVID-19, which is mostly mild, and COVID-19 may develop in children who have previously been known to have congenital or acquired heart disease. The subject of this article is how these children should be evaluated cardiacly, and how the follow-up and treatment of children with heart disease will be managed during the pandemic. Considering the articles and guides published in the literature, some determinations were made and the suggestions developed were presented in this article.
Cytokine Release Syndrome and Treatment in COVID-19
The emergent outbreak of coronavirus disease 2019 (COVID-19) is a global health problem and has been recognized as a pandemic. Although COVID-19 leads to mild flu-like symptoms in most patients, the disease may cause frequently fatal, severe complications, such as acute respiratory distress syndrome and cytokine release syndrome. In these pati ents, defects in lymphocytic cytolytic activity trigger the proinflammatory cytokine cascade, and then “cytokine storm” begins. As a result, it leads to uncontrolled active macrophage entry into the tissues and hemophagocytosis. Here, the responses of host cells, cytokine release syndrome and the therapeutic approaches to alleviate the cytokine storm in COVID-19 will be reviewed.
Use of Convalesant Plasma in CoOVID-19 Infection
Coronavirus 2 (SARS-CoV-2), which started in December 2019 in Wuhan province in China and caused serious respiratory infections in humans, was accepted as a pandemic on March 11, 2020. The disease from SARS-CoV-2 is called COVID-19. In a short period of five months, approximately 4 million people were infected and 300 thousand people died from this disease. To date, no specific therapeutic agents or prophylaxis for COVID-19 are available, so it is among the passive immunization treatment options with the plasma of patients who recover from the disease. Convalescent plasma therapy has been used in epidemic periods in the past and has been shown to be effective. Neutralizing antibodies in plasma contributes to recovery by inactivating the virus. In the literature, there are 4 publications presenting a total of 21 patients receiving convalescent plasma. They reported that the patients benefited from the treatment of convalescent plasma and that there were no complications. Studies have been initiated about convalescent plasma all over the world and their results are interestedly awaited.
Hematologic Parameters of Patients with COVID-19 Infection
SARS-CoV-2 causes primarily respiratory tract infection, but can also affect hematopoietic and immune systems. Quantitative and qualitative changes in lymphocytes, neutrophils, monocytes and platelets, are reported in infected patients. These changes are related to the severity of the disease. Lymphopenia is the most common finding in adult patients infected with SARS-CoV-2, while it is much less common in children. Leukocytosis can be detected in patients with severe infection, but rare in patients with mild to moderate infection. Thrombocytopenia or thrombocytosis can also be seen in accordance with the clinic. Dysplastic morphological changes in neutrophils and platelets can be detected in peripheral smear of patients.
SARS COV-2 Infection in Children with Leukemia
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directed great attention and anxiety all over the world. Epidemiologic models predict that the current COVID-19 pandemic will last several months or even several years, until the development of a vaccine and/or herd immunity. Although the course of the infection is often not severe in children, it can be life threatening especially in immunocompromised children with leukemia. Hematopoietic and lymphoid cancers are accounting for approximately 40% of all childhood cancers. The five-year survival rate for childhood cancer has approached to 70% and more than 80% for leukemia in our country. During COVID pandemic, children with leukemia may also have COVID-19 infection, especially when their bone marrow is depressed due to chemotherapy. It is observed that factors such as the underlying type of cancer, status of remission, or having stem cell transplantation may affect the prognosis. As well as standard and proven treatments for febrile neutropenia, all tests and treatments should be applied very quickly and properly for COVID 19 as is all suspected patients. These efforts may contribute to increase the survival of our children with cancer. Given the absence of data to address concerns related to SARS-CoV-2 infection while on chemotherapy, questions are increasing about the approach for management of systemic immunosuppressive therapies, i.e. ceasing or reducing the immunosuppressive medications in children with leukemia. The current rapid worldwide spread of COVID-19 necessitates identifying optimal preventive strategies and effective medical management. In this report, we tried to review appropriate literature-based approaches for prevention, diagnosis and management of treatment protocols for children with cancer during the pandemic period.
Coagulation System Abnormalities in Patients With COVID-19 Infection
COVID-19 infection caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) in China led to a pandemic all over the world. Although mortality rate between 4.3% to 14.6%, studies have shown that coagulation dysfunction is a major cause of death in patients with severe COVID-19 infection. The majority of the severely ill patients have underlying disease (i.e. diabetes, cardiovascular disease, hypertension) and initially present with respiratory insufficiency but some of them progress to systemic disease causing multiple organ dysfunction. This manuscript reviews coagulation system abnormalities in patients with COVID-19 infection.
COVID-19 Management in Pediatric Emergency Medicine
Emergency departments are on the front line in the management of Covid-19 cases. Emergency department personal need to be equipped with appropriate personal protective equipment and trained in its use. Pre-triage screening is necessary to prevent nosocomial infection. The clinical presentation of Covid-19 ranges from non-specific symptoms to acute respiratory distress syndrome. Personal in triage must maintain a high index of suspicion when evaluating all patients, but especially those with fever, cough, dyspnea, or signs of a respiratory illness. Healthcare workers who perform aerosol processing should be carefully. Even though morbidity and mortality are rare in pediatric population, clinicians should be aware that they may infect more vulnerable populations and social distance should be encouraged.
The coronavirus disease 2019 (COVID-19), which has been accepted as a pandemic since March 2020, has caused millions of patients and hundreds of thousands of deaths all over the world. The diagnosis of which is important due to its high contagiousness, there are many publications evaluating the radiological approach of this disease in adults, however there are very few reports of pediatric patients worldwide. The aim of this study is to evaluate the radiological approach in pediatric COVID-19 patients by literature review and to guide diagnosis and treatment follow-up with radiological findings.
SARS-CoV-2 in Terms of Medical Microbiology Laboratory
Coronaviruses (CoV), which are in the Coronaviridae family, cause different severity of gastrointestinal, respiratory and systemic diseases in wild and domestic animals, and can lead to different clinical manifestations, ranging from colds to pneumonia, depending on immunity. To date, seven types of coronavirus have been identified as infectious agents in humans; of these, HCoV 229E, HCoV NL63, HCoV HKU1 and HCoV OC43 typically cause cold symptoms in immunocompetent individuals, while SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) and MERS-CoV (Middle East Respiratory Syndrome Coronavirus) is zoonotic and cause severe respiratory diseases and deaths. SARS CoV-2, the causative agent of COVID-19, is the seventh coronavirus identified as an infection agent in humans, which started in December 2019 in Wuhan, Hubei Province of China and was identified as a pandemic in a short time. Since the World Health Organization (WHO) defines SARS-CoV-2-sourced COVID-19 as a pandemic, and because of the increasing number of cases and deaths worldwide, structure of the novel virus and viral diagnosis methods gained importance respectively for vaccine studies and for controlling the outbreak caused by the virus.
Personnel Protective Equipment for Healthcare Professionals During COVID-19 Pandemic
COVID-19 is highly contagious and transmission dynamics of COVID-19 are not yet fully elucidated. It is known that the ill person begins to become contagious before the symptoms of the disease begin. Also asymptomatic person who are infected but does not have symptoms and signs, can infect other individuals. The only way for health workers to protect themselves from COVID-19 is proper use of personal protective equipment and to ensure hand hygiene. COVID-19 is transmitted through close contact and large respiratory droplets and not transmitted by airborne. The surgical mask prevents the passage of respiratory droplets. However, during the aerosol producing procedures performed on the patient, small particles containing infectious particles are scattered to air in high amounts. Healthcare workers are more likely become infected during these procedures. It is recommended to wear respirator during these procedures. Use of masks or respirators must be in conjunction with other recommended PPE and appropriate hand hygiene.
Currently, there is not any specific effective treatment for COVID-19. There are many studies published and ongoing especially on adult patients. Treatment options in pediatric patients are determined according to the agents used in adult patients. Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Supportive therapy forms the basis of the treatment as the symptoms and disease course in children are mild. There are currently no randomized controlled trials of drugs that can be used to treat COVID-19 in children. However, in severe clinical cases, the drugs used in adults are evaluated and used on a case-by-case basis. There is a growing need for well-designed controlled clinical trials to better define the safety and efficacy of potential treatments for COVID-19 in children.
COVID-19 and Children: From an Epidemiological Perspective
COVID-19, caused by SARS-CoV-2, has rapidly progressed globally started from early days of 2020 and was disseminated to 187 countries and territories by April. As of May 3, 2020, COVID-19 has led to a total of 3,507,442 cases and 245,241 related deaths, globally. Turkey, was successful to delay the first COVID-19 case until March 10, yet, case numbers increased fast, reaching to the top 7th rank in the list of countries with the highest case numbers. It is fortunate that the case-fatality ratio was relatively low, with a somewhat stable course around 2.5%. Somewhat stable course of new case numbers, with an apparent decrease through the end of April led to onset of normalization attempts in the country. The future course of the pandemic will be mainly determined by compliance of the general public with personal hygiene, mask use and social distancing. Globally, COVID-19-related morbidity and mortality rates are lower among children than in adults. Underlying mechanisms for this difference has not been clarified, yet, may be linked to lower exposure rates among children, their immune response may be different and/or higher rates of asymptomatic cases may have lower admissions/testing among children. However, it is important to emphasize that children are prone to SARS-CoV-2, too and all relevant preventions should be ensured. This issue should also be considered in evaluating potential risk of infection transfer from asymptomatic youngsters to the elderly and/or to those with chronic diseases. Data on COVID-19-related case numbers and deaths in Turkey have not been published so far for children. This requires urgent consideration for related reporting and novel research activities on health burden of COVID-19 on Turkish children. Success in combating the COVID-19 pandemic requires concurrent efforts for clinical management of patients together with epidemiological studies of available national data and establishment of specific research to provide evidence for national and international preventive interventions. Learnings from this pandemic will provide direct evidence for management of future pandemics, and all related parties should be motivated to prepare detailed reporting of ongoing efforts and their outputs.
Psychomotor Retardation and Agenesis of Vena Cava Inferior and Sacrum Associated with Unusual Features of Vacterl Anomalies
We report a 3-year-old female. Her malformations included facial and limb abnormalities, sacral agenesis, ASD, VUR and the absence of inferior vena cava. Vena cava inferior agenesis association with VACTERL has not been reported in the literature before. Newborn or infants with limb anomalies should be better evaluated for the other anomalies
Copyright © 2013 The Author(s) https://creativecommons.org/licenses/by/4.0
Late Diagnosis of a Patient with Morquio Syndrome
Morquio Type A Syndrome (Mucopolysaccharidosis IVA) is an autosomal recessive disorder characterized by the lysosomal accumulation of keratan sulfate and chondroitin-6 sulfate particularly in the bone and cornea due to the deficiency of N-acetylgalactosamine-6-sulfate sulfatase. The major clinical signs are short stature, skeletal dysplasia, dental anomalies, and corneal clouding. Sensorineural hearing loss, valvular heart diseases, joint laxity, and cervical myelopathy can also accompany the disease. As the affected patients do not have central nervous system involvement, the Morquio A syndrome is accepted to be a good candidate for enzyme replacement and gene therapies. Preclinical studies have shown that enzyme replacement treatment enables a significant decrease in tissue and blood keratan sulfate levels, and treatment should be performed as early as possible in lysosomal storage diseases in order to achieve successful curative therapy. In this case report, we present a patient aged 11 years and 2 months who had systemic skeletal dysplasia and was admitted to our hospital with terminal respiratory failure. Unfortunately, the patient was diagnosed as MPS IVA at the late stage of the disease and did not receive any enzyme replacement treatment.
Moyamoya Disease in a Child with Germ Cell Tumor
Moyamoya disease (MMD) is a cerebrovascular condition that predisposes affected patients to stroke in association with progressive stenosis of the intracranial internal carotid arteries and their proximal branches. Moyamoya disease has been described in association with a variety of congenital and acquired diseases. Some congenital hematological diseases (Fanconi anemia, sickle cell anemia), genetic syndromes (Apert’s syndrome, Seckel syndrome, Robinow syndrome, Down syndrome, neurofibromatosis type I), metabolic diseases (homocystinuria) are known to associated with Moyamoya syndrome. It is also known that MMD may develop after cranial radiotherapy in children with sella/ chiasma region tumors or after prophylactic cranial irradiation for leukemia. However, there is no data regarding the presence of an association between ovarian tumor and MMD. Here, we report a case of an 8-year-old girl with recurrent ovarian tumor developed MMD after salvage chemotherapy.