Bogota Bag and Negative-pressure wound therapy (NPWT) Experience in Children

Introduction: as the war that took place in Syria caused many tragedies, it also brought children with open abdominal wounds which are not very common in pediatric surgery practice. In this study, we present the results of ten children treated with BB and NPWT for open-abdomen. Material and methodsMaterials and Methods: we retrospectively reviewed the hospital records of ten children who were treated with BB and NPWT in our clinic between February 2016 and June 2018.Results: Ten of the patients had sustained firearm injuries during the war in Syria. There were four girls and six boys. The average age was 8.1 years (2-14 years). Five patients received BB in emergency conditions followed by NPWT. Five patients received NPWT only. Abdomen could be closed in all 10 patients who treated with combined BB and/or NWPT. Enteroatmospheric fistula developed in one patient and ventral hernia developed in one patient. No mortality occurred in our patients.Conclusion: BB and NPWT techniques can be applied fast and easy and have a high success rate in children with an open abdomen

Administration of a second dose antivenom in the early period: Is it effective in scorpion stings?

Aim: It has been known for years that the toxic effects of scorpion envenomation can be fatal. Scorpion antivenom administration reduces the severity of systemic toxicity and fatal complications resulting from envenomation. In cases where clinical progression is poor, a second dose of antivenom can be applied. We aimed to investigate the effectiveness of a second dose of antivenom in this study. Materials and Methods: One hundred patients between 0-17 years who were followed up due to scorpion stings or poisonings in Hatay Mustafa Kemal University, Faculty of Medicine, Department of Pediatrics between October 2016 and March 2018 were analyzed for age, gender, season, site of scorpion stings, clinical findings, treatment, follow-up steps and the effects of a second dose of antivenom on clinical progression retrospectively. Results: Of the total 100 patients, 45 were female (45%) and 55 were male (55%). The average age of the patients was 3.5 years. Sting locations in order of frequency were as follows; feet, hands, legs, arms, head-neck, genital area. Single dose antivenom was given to 26 patients and a second dose was given to the remaining 74 patients. All patients recovered except two patients who were referred with cardiopulmonary insufficiency and passed away. Conclusion: We observed that early antivenom therapy reduces the risk of developing systemic toxicity and also an administered second dose of antivenom corrects systemic findings. We think that the second dose of antivenom should be applied at the 8th hour especially in pediatric patients with ongoing serious systemic findings and all patients should be observed for at least 24 hours

Infants with vitamin B12 deficiency-related neurological dysfunction and the effect of maternal nutrition

Aim: Studies linked vitamin B12 deficiency in infancy are most commonly in patients with hematological and dermatological complaints rather than infant with neurodevelopmental retardation. In our study we aimed to evaluate the data of infants who presented with various neurological complaints and determined neurodevelopmental retardation due to vitamin B12 deficiency and also effects of maternal diet on the infants. Material and Methods: Infants who were admitted with various neurological complaints due to vitamin B12 deficiency between the dates of September 2016 and March 2018 were included in this study. Patients were retrospectively analyzed according to age, growth and development, clinical and laboratory findings (neurological, hematologic), continuation of breastfeeding, age at onset of complemantary food. During the pregnancy and lactation, the amount of feeding with animal foods, intake of vitamin supplements, duration of breastfeeding and vitamin B12 levels were examined. Results: The most common complaints were fatigue, pallor, no eye contact, apathy, vomiting, constipation, diarrhea, refusal to feed, retardation to growth and development, undeveloped or lost of ability (ability to tonic neck reflex, ability to sit supported and unsupported ability to sit). In the neurological examination of infants; iIn 13 infants, there was hypotonia, undeveloped ability to tonic neck reflex and ability to sit (supported and unsupported). Fifteen, in 15 infants just undeveloped ability to sit (supported and unsupported) and also in 6 infants had swallowing disorders. Conclusion: Vitamin B12 routinely to all pregnant women like folic acid and iron supplementation. In addition, developmental stages of infants should be evaluated and vitamin supplements should be given to infants when necessary

Clinic entity that should not be forgotten in children with high fever; PFAPA syndrome

Aim: PFAPA syndrome which we thought was not well recognized. The high fever clinic of PFAPA syndrome usually mimics infectious conditions therefore it can lead to unnecessary and costly diagnostic tests and treatments. We evaluated the medical history, clinical findings and outcomes of pediatric patients diagnosed with PFAPA syndrome Material and Methods: In Mustafa Kemal University, Faculty of Medicine, Department of Pediatrics between September of 2016 and 2017, demographics, clinical, laboratory, diagnosis and treatment data of our patients diagnosed with PFAPA syndrome were retrospectively reviewed. Results: 68 patients were studied in our study, of which 27 (39.7%) were females and 41 (6.2%) were males. The mean age at onset of symptoms was 21.7 months. The mean age of diagnosis was 34.9 months. The mean duration between episodes of the disease was 27.05 days and the mean duration of episodes was 4.91 days. Conclusion: PFAPA syndrome which causes unnecessary costly examinations and treatments should be kept in mind in high fever clinic and also medical treatment was found to be effective in patients with PFAPA syndrome

Akut viral gastroenteritlerde oral çinko kullanımının hastalığın semptomları ve süresine etkisinin değerlendirilmesi

Introduction: Acute viral gastroenteritis is the second most common cause of high morbidity and mortality in childhood. Viral gastroenteritis is the most common cause of severe diarrhea and associated hospitalizations especially in toddlers. It has been shown that the administration of 20 mg of zinc daily during acute diarrhea reduces the duration of watery diarrhea by 25% and it has been reported to have protective and therapeutic effects in the acute period. The aim of this study is to retrospectively determine the beneficial effects of oral zinc supplementation on the severity and duration of complaints of toddlers who were treated in our clinic with the diagnosis of acute viral gastroenteritis. Methods: Toddlers who were hospitalized in the Department of Pediatrics for acute viral gastroenteritis between October 2016 and March 2018 were included in the study. The study was retrospective and the data of the patients were obtained from the patient files. The diagnosis of acute viral gastroenteritis was made by detecting the adenovirus-rotavirus antigen in the fresh stool specimens. The patients were divided into two groups. Group 1: patients who received zinc supplementation in addition to support treatment. Group 2: patients who received only supportive therapy. Results: The mean number of vomiting was 3.60 / day and watery diarrhea was 5.20 / day in group-1 while number of vomiting was 6.1 / day and watery diarrhea was 8.9 / day in group-2 in the 36th hour during treatment. The tolerability of oral feeding at 36 th hour was 49.39% ( 41) in group-1 and 45.07% (32) in group-2. The mean number of vomiting and watery diarrhea in group-1 cases at 72th hours was 1.2 / day and 4.30 / day, while in group-2 cases, 3.90 / day and 7.20 / day. Conclusions: Although the physiopathology of the effects of zinc on gastroenteritis is not yet fully understood, diarrhea is seen both as a cause and as a result of zinc deficiency. The fact that patients with gastroenteritis benefit from zinc support suggests that zinc enhances this effect by increasing intestinal immunity.Giriş: Akut viral gastroenteritler çocukluk çağında yüksek morbidite ve mortalitenin en sık ikinci sebebidir. Özellikle oyun çağı ve okul çağı çocukluk döneminde tüm dünyada şiddetli ishallerin ve buna bağlı hastane yatışları ile bebek ölümlerinin en sık nedeni viral gastroenteritlerdir. Akut ishal sırasında günlük 20 mg çinko verilmesinin sulu dışkılama süresini %25 azalttığı gösterilmiştir ve akut dönemde koruyucu ve terapotik etkileri olduğu bildirilmiştir. Bu çalışmanın amacı, çocukluk çağında morbiditesi ve mortalitesi yüksek hastalıkların başında gelen akut viral gastroenterit tanısıyla kliniğimizde tedavi edilen 2-5 yaş arası oyun çağı çocuk hastaların yakınmalarının şiddeti ve süresi üzerinde oral çinko kullanımının etkisini retrospektif olarak belirlemektir. Yöntem: Akut viral gastroenterit tanısıyla Ekim 2016 – Mart 2018 tarihleri arasında yatırılarak tedavi edilen 2-5 yaş arası oyun çağı dönemindeki çocuk hastalar çalışmaya alındı.Çalışma retrospektif olup hastaların verileri hasta dosyalarından elde edildi.Akut viral gastroenteri tanısı taze dışkı örneğinde adenovirüs-rotavirüs antijeni saptanması ile konuldu.Hastaların verileri Çinko tedavisi alanlar (Grup-1) ile çinko tedavisi almayanlar (Grup-2) arasında karşılaştırıldı. Bulgular: Çinko tedavisi verilen grup-1’deki olguların 36.saatteki ortalama kusma ve dışkılama sayısı 3,6/gün ve 5,2/gün iken çinko almayan grup-2 olgularınki 6,10/gün ve 8,90/gün idi.36. Saatte oral beslenmeyi tolere etme grup-1 de % 49.39 (41) iken grup-2 de % 45.07 (32) idi.72.saatte grup-1 olguların ortalama kusma ve dışkılama sayısı 1,20/gün ve 4,30/gün iken grup-2 olgularda 3,90/gün ve 7.20/gün idi. Sonuç: Çinkonun gastroenteritler üzerindeki etkilerinin fizyopatolojisi henüz tam olarak anlaşılamamış olmakla birlikte ishaller, hem çinko eksikliğinin bir nedeni, hem de bir sonucu olarak görülmektedir. Gastrenteritli olguların çinko desteğinden fayda görmesi, çinkonun intestinal immuniteyi arttırarak bu etkiyi sağladığını düşündürmektedir

Is there a predictive association between vitamin D concentrations and lower respiratory tract infections in infants?

Aim: Vitamin D deficiency have been estimated to be endemic in the worldwide and in each age group and also it is reported that vitamin D has important effects on both natural and acquired immunity and there may be a relationship between deficiency and predisposition to infections The aim of this study is to investigate whether serum vitamin D level are effective in infant lower respiratory tract infection which is one of the most mortal infectious diseases in worldwide. Material and Methods: In our study, between October 2016 and January 2018 in Department of Pediatrics, the data of 418 infants with LRTI and their ages ranging from 5 to 24 months and were examined retrospectively. Vitamin D levels were studied in 106 of this patients. Results: In group-1, the mean duration of vitamin D supplementation was 4.9 months, while the mean in group-2 was 8.6 months. Breastfeeding time was 3.27 months in group 1 while it was 5.71 months in group 2. Both the duration of breastfeeding and the duration of vitamin D supplementation were shorter in group 1 than in group 2.Those difference between the groups was in terms of statistically significant (p< 0.05) Conclusion: Vitamin D deficiency in infants may be associated with LRTI, and even vitamin D deficiency may be a predisposing factor for severe LRTIs and also the frequency and severity of LRTIs can be reduced with optimal serum levels of vitamin D

A cause of fever that should be kept in mind in family medicine in settlements where livestock farming is widespread: Brucellosis

Aim: In our country, where animal husbandry is widespread, we aimed to examine retrospectively data concerning childhood Brucellosis cases, which are not very high in the literature, which may occur with many variable clinical findings and may cause misdiagnosis and serious complications. Materials and Methods: The data of these patients with the diagnosis of Brucellosis who were treated between October 2016 and October 2018 in a Pediatric Clinic were retrospectively analyzed. For the diagnosis of Brucellosis in patients, the Wright agglutination test with complaints and clinical findings set at the titer being 1/160 or above was used. Results: In our study, the mean age of the patients was 7.4 years (3-15). 52.12% (n=37) were male and 47.88% (n=34) were female. All patients had a risk factor for Brucellosis infection. In 88.7% (n=63) of these patients, consumption of milk and dairy products (precipitates, fresh cheese was not cooked), and 11.3% (n=8) of raw meat (raw meatball) consumption and animal contact history were determined. Conclusion: Although early diagnosis and response to treatment with Brucellosis are very good, late diagnosis and inadequate treatment may cause mortality and morbidity with serious complications. Complaints of fatigue, weight loss and especially joint pain with long term fever should be evaluated by family physicians and pediatricians. The diagnosis of these patients should be kept in mind in the diagnosis of Brucellosis, an endemic disease common in our country

A significant danger to children : foreign body ingestion

Aim: The most important way for children to communicate with their surroundings is to take every substance that they keep in hand to their mouths. Foreign bodies that are ingested can be found anywhere in the gastrointestinal tract. Especially foreign bodies in esophagus may be the cause of morbidity and mortality. For this reason, the ingestion of foreign bodies in children is one of the most important health problems. Material and Methods: Between January 2014 and June 2017, 119 patients, admitted to Mustafa Kemal University [MKÜ] Faculty of Medicine, Department of Pediatric Surgery with foreign body ingestion diagnosis, were retrospectively studied. Patients were evaluated in terms of age, gender, complaints of arrival, ingested foreign body quality, location in the gastrointestinal tract and treatment approaches. Results: Of the patients, 74 were males [62%] and 45 were females [38%]. The mean age of the patients was 4.3 years [6 months-15 years]. Foreign bodies most commonly seen in the esophagus first stenosis in 73 patients [61%].Most commonly complaint at presentation was parental recognition of the ingested object and hypersalivation. The most commonly ingested foreign bodies included coins. Conclusion: Esophagoscopy must be performed foreign bodies in the esophagus should be treated conservatively, in case of clinical suspicion, the possibility of foreign body ingestion must be kept in mind. Education of the parents and taking some precautions where the children play are the most important protective factors

Effects of olive oil applied to the nonfunctional distal colon on atrophic changes in patients undergoing ostomy

Aim: Temporary colostomy is commonly performed for diseases requiring multi-stage surgery in pediatric surgical practice such as for anal atresia and Hirschsprung’s disease. Through this study, we aimed to decrease the diameter difference between the proximal and distal colon and subsequently provide surgical ease and to investigate the effect of 1-month application of pure olive oil, which is considered a trophic factor, to prevent distal colonic atrophy. Materials and Methods: In total, 24 pediatric patients who were treated at our clinic between June 2017 and November 2018 and who were scheduled to undergo colostomy closure were prospectively followed up. The patients were grouped into the following two groups: control group (n = 10), patients who were administered 5 cc 0.9% physiological saline solution twice a day for a month and olive oil group (n = 9), patients who were administered 5 cc pure olive oil as a trophic agent twice a day for a month. Results: There were significant differences in terms of mucosal thickness, muscular thickness, wall thickness, and colonic lumen diameter between the proximal and distal colon in the control group. On the other hand, in the olive oil group, there was no significant difference between the proximal and distal colon. However, there was a significant difference between the two groups in terms of first bowel movement and discharge times. Conclusion: Administration of olive oil from the distal colon opening prior to performing colostomy closure can decrease the diameter difference between the proximal and distal colons and provide easier surgical performance

A significant danger to children : foreign body ingestion

Aim: The most important way for children to communicate with their surroundings is to take every substance that they keep in hand to their mouths. Foreign bodies that are ingested can be found anywhere in the gastrointestinal tract. Especially foreign bodies in esophagus may be the cause of morbidity and mortality. For this reason, the ingestion of foreign bodies in children is one of the most important health problems. Material and Methods: Between January 2014 and June 2017, 119 patients, admitted to Mustafa Kemal University [MKÜ] Faculty of Medicine, Department of Pediatric Surgery with foreign body ingestion diagnosis, were retrospectively studied. Patients were evaluated in terms of age, gender, complaints of arrival, ingested foreign body quality, location in the gastrointestinal tract and treatment approaches. Results: Of the patients, 74 were males [62%] and 45 were females [38%]. The mean age of the patients was 4.3 years [6 months-15 years]. Foreign bodies most commonly seen in the esophagus first stenosis in 73 patients [61%].Most commonly complaint at presentation was parental recognition of the ingested object and hypersalivation. The most commonly ingested foreign bodies included coins. Conclusion: Esophagoscopy must be performed foreign bodies in the esophagus should be treated conservatively, in case of clinical suspicion, the possibility of foreign body ingestion must be kept in mind. Education of the parents and taking some precautions where the children play are the most important protective factors