Evaluation of chilhood ocular trauma: 5-year single-center experience

Amaç: Çocukluk çağı göz travmalarının epidemiyolojisinin ve prognostik faktörlerinin değerlendirilmesi. Gereç ve Yöntem: Bu retrospektif çalışmaya, Kasım 2008 ve Kasım 2013 yılları arasında hastanemiz göz kliniğine göz travması ile başvuran 0-16 yaş arasında 248 hastanın, 258 gözü dahil edildi. Hasta dosyaları taranarak yaş, cinsiyet, travmanın tipi ve oluşum yeri, travmanın oluşumundan hastaneye varışa kadar geçen süre, göz içi basınçları, ilk ve son görme keskinlikleri kayıt altına alındı. McNemar ve Ki-kare testi istatistiksel değerlendirilmede kullanıldı. Bulgular: Çalışmaya dahil edilen 258 gözde erkek/kız oranı 1,3/1 idi. En sık travma uğrama yaşı 7-12 yaş arasında idi. Ön segmentin nonperforan travması (%88,3) en sık rastlanılan tip idi. Tedavi sonrasında en iyi düzeltilmiş görmesi 0,5 ve üzerinde olan göz miktarı %70 (n=182) iken 0,05 ve altında kalan göz oranı %14 (n=36) idi. Takip süresi 1 gün ile 36 ay arasında olduğu tespit edildi. Endoftalmi tespit edilen olgu sayısı 4 (%1,55) iken göz içi yabancı cisim 4 olguda tespit edildi. 6 yaş altında travmaya en sık oyuncaklar neden olur iken 6 yaş sonrasında en sık etken taş ve sopa gibi cisimler idi. Tüm olguların tanıları, uygulanan tedavileri, oküler komplikasyonları ve tedavi sonuçları rapor edildi. Sonuç: Çocukluk çağında oküler travmalar nedeniyle ortaya çıkan tek taraflı körlük engellenebilen ve bu konuda bilgilendirme ve eğitimin önemi vurgulanılarak insidansı azaltabilinecek bir problemdir. Böylelikle daha fazla ebeveyn gözlemi, eğitimsel ve yasal düzenlemelerin oluşturulması, bu tip kazaların morbiditesini ve prevalansını azaltılmasında ciddi öneme haizdir.Aim: To assess the epidemiology and prognostic factors of pediatric ocular traumas. Materials and Methods: This retrospective study included 258 eyes of 248 patients between 0-16 years of age who were presented to ophthalmology clinic of our hospital between November 2008 and November 2013. Age, gender, type and cause of the trauma, time elapsed from the onset of the trauma to admission to the hospital, intraocular pressure, initial and final visual acuities were obtained from the medical records of patients. McNemar and Chi-square tests were used in statistical analyses. Results: In the 258 eyes included in the study, the male to female ratio was approximately 1.3:1, and most were 7 to 12 years old. Non-perforating trauma in the anterior segment was the most common type of injury (88.3%). After the treatment, best corrected visual acuity was 0.5 or better in 70% of the patients, while it was 0.05 or worse in 14%. Follow-up period was ranged from 1 day to 36 months. Endophthalmitis was detected in 4 patients (1.55%) and intraocular foreign body was detected in 4 patients. Toys were the most frequent cause of trauma in children under 6 years of age while it was stone and wood in those over 6 years of age. Diagnoses, therapies implemented, ocular complications, and outcomes were reported. Conclusion: Unilateral blindness in childhood due to ocular traumas is avoidable and its incidence could be markedly reduced by emphasizing an information strategy and education based on prevention of ocular trauma. Thus more adequate adult supervision and educational and legislative measures are necessary and useful in order to reduce prevalence and morbidity of these accidents

Relationship between procalcitonin levels and presence of vesicoureteral reflux during first febrile urinary tract infection in children

WOS: 000302792500042PubMed ID: 22245305OBJECTIVE To investigate the association between the procalcitonin (PCT) level during the first febrile urinary tract infection (UTI) in children and the presence of vesicoureteral reflux (VUR). VUR-associated UTI is among the primary causes of chronic renal failure in Turkey. METHODS From March 2008 to November 2009, patients admitted with their first febrile UTI were included in the present prospective hospital-based study. The serum concentrations of C-reactive protein, complete blood count, and PCT were measured. All patients underwent renal ultrasonography and voiding cystourethrography. RESULTS Of the 66 patients who were diagnosed with UTI, 18 had VUR. The geometric mean of the PCT levels was significantly greater in the children with VUR than in those without (P = .006). After logistic regression adjustment, the association between the PCT levels and the presence of VUR remained significant (odds ratio 5.08, 95% confidence interval [CI] 1.43-18.02). A PCT level >0.56 ng/mL had 66.7% sensitivity (95% CI 41-86.6) and 77.1% specificity (95% CI 62.7-88) for diagnosing VUR. The area under the receiver operating characteristic curve for PCT was 0.715 (95% CI, 0.56-0.86, P = .007), and the area under the curve for C-reactive protein was 0.723 (95% CI 0.58-0.86, P = .006). CONCLUSION A PCT-guided strategy could help in detecting patients with VUR. Large cohort studies are needed to define an accurate cutoff value for children who are at risk of VUR, which increases the risk of renal damage and subsequent scarring

Antimicrobial resistance patterns of uropathogens among children in Istanbul, Turkey

Urinary tract infections are a common cause of end-stage renal disease in Turkey. This prospective study investigated the antibiotic resistance patterns of uropathogens in order to recommend appropriate therapeutic protocols for children with urinary tract infections in Istanbul, Turkey. Between October 2007 and October 2008, children presenting with a first episode of urinary tract infection to a pediatric outpatient clinic were enrolled in the study. Urine samples were cultured, and antimicrobial susceptibility testing was performed. Children with proven urinary tract infections underwent imaging studies where available. A total of 126 children with a first episode of community-acquired urinary tract infection were enrolled in the study. The median age was 60.6 months; 84.1% of the children were female. Of the 126 urine samples, Escherichia coli was the leading uropathogen (81.7%), followed by Proteus spp (7.1%), Klebsiella spp (4.0%), Enterococcus spp (3.2%), Enterobacter spp (2.4%), and Pseudomonas spp (1.6%). Among the isolated uropathogens, resistance to ampicillin (85.0%), amoxicillin-clavulanate (73.8%), cefazolin (37.3%) and trimethoprim-sulfamethoxazole (42.9%) was remarkable. A large number of Enterococcus species were resistant to all antimicrobial agents except vancomycin. A country-based evaluation of antibiotic susceptibility is needed to modify antibiotic treatment. Resistance to antimicrobial agents commonly used to treat urinary tract infections (nitrofurantoin, cefixime) is less a problem than resistance to other antimicrobials (aminopenicillins, cephalosporins, trimethoprim-sulfamethoxazole) frequently prescribed for other indications

Does cord blood bilirubin level help the physician in the decision of early postnatal discharge?

WOS: 000306439600036PubMed ID: 22128898Objective: Early postnatal discharge of newborns leads to the risk of readmission to the hospital, mostly for neonatal hyperbilirubinemia. Increasing the length of hospital stay is not an acceptable solution for medical, social and economic constraints. Hence, predicting the high risk neonates for subsequent hyperbilirubinemia is required. This study was planned to investigate the predictive value of umbilical cord blood bilirubin (CBBil) level for significant neonatal hyperbilirubinemia. Methods: Cord blood bilirubin, serum total/direct bilirubin levels and newborn/mother's blood groups were obtained from 350 term neonates. Total/direct serum bilirubin levels were reevaluated in 95 newborns at 72 hours of age when jaundice appeared according to Kramer's dermal zones. Results: Phototherapy treatment was needed in 14.7% of 95 patients. For recognition the newborns at high risk for developing hyperbilirubinemia, using a CBBil cut-off level of 2.60 mg/dl, we found a positive predictive value of 41.18%, negative predictive value of 97.9% and sensitivity of 50%. Conclusion: Newborns with CBBil values below 2.6 mg/dl are at very low risk of developing hyperbilirubinemia and further need of phototherapy. Knowledge of low risk of hyperbilirubinemia in a newborn could encourage the physicians in the decision of early postnatal discharge

The predictive value of first-day bilirubin levels in the early discharge of newborns

Background: TORCH Early discharge of newborns due to social, economic and medical reasons increases the rate of readmissions, especially for hyperbilirubinemia. Therefore, identification of high-risk neonates for subsequent hyperbilirubinemia is paramount. This study aimed to investigate the level of total serum bilirubin (TSB), which could be used to predict neonatal hyperbilirubinemia at the first day of birth. Methods: Venous blood samples were obtained from 300 newborns during the postpartum period (i.e. 24±6 hours) to determine the blood group, direct Coombs test, TSB and direct bilirubin levels (DBL). Neonates were followed-up for 5 days, and TSB and DBL were recorded in 90 newborns presented with jaundice according to the Kramer's scale within 120±6 hours of birth. Results: In total, 23.3% of the studied newborns (N=90) required phototherapy. The cut-off value of TSB to determine high-risk newborns for subsequent hyperbilirubinemia at the first day of birth was 6.50 mg/dl with positive and negative predictive values of 19.75% and 97.72%, respectively. At this point, the sensitivity and specificity were 76.19% and 76.70%, respectively. Conclusion: According to the results of this study, TSB cut-off point of 6.5 mg/dl at the first day of birth could predict the risk of subsequent hyperbilirubinemia in healthy, term infants with early discharge. Since TSB cut-off point is economic and available, use of this method is recommended in all healthcare centers

The relationship between adiponectin levels and epicardial adipose tissue thickness in non-obese children with asthma

Background: There is an association between adiponectin (APN) and asthma. However, the mechanisms underlying this association is unclear. APN is a predominantly antiinflammatory protein with possible signalling activity in the lung that can be secreted by Epicardial Adipose Tissue (EAT). Our hypothesis is that serum APN levels may be directly and simply related to the amount of EAT accumulation, particularly when it is expressed as thickness in children with asthma. Objective: The aim of this study was to investigate whether serum adiponectin (APN) and epicardial adipose tissue thickness (EATT) have an effect in non-obese children with asthma and in healthy non-asthmatic children, and analyze their relationships with clinical outcomes. Methods: 68 childrens diagnosed with asthma (20 girls/48 boys) who had applied at the pediatric allergy and clinical immunology clinic of the hospital were included in this cross-sectional, observational study. The age-matched control group included 39 healthy children (18 girls/21 boys). EATT was measured by transthoracic echocardiography. The serum APN levels were also checked. Statistical analysis was performed by using independent sample t-test and Spearman correlation analyses. Results: The mean age of the asthma group was 10.2 ± 2.7 years, and the average EATT was found to be 5.7±1.1 mm. The mean age of the control group was 10.5 ± 2.8 years, and the average EATT was found to be 5.1 ± 0.7 mm. The EATT of the asthma group was found to be significantly higher (p < 0.001) in study group. In the asthma group the APN was 10.0 ± 5.3 mg/L, and in the control group the APN was 15.8 ± 10.5 mg/L (p < 0.001). We found that APN was significantly negatively correlated with EATT (r = -0.266, p = 0.006) in asthma and control groups. Conclusion: EATT is associated with non-obese asthmatic childrens. High EATT may be related with high release of pro-inflammatory cytokine and low release of APN. Low levels of APN may be related to low anti-inflammatory effects. Therefore, high EATT and low levels of APN may indicate pro-inflammantory profiles in nonobese asthmatic childrens. © 2009 is a Digital Portal of health science journals in Thailand

Tooth eruption and symptomatology: Are the symptoms assumed to be related to the tooth eruption really associated with teeth?

Despite little evidence, many various complaints might be associated with teething in children. Symptoms related with teething mostly result in delay diagnosis of underlying disease. In this study we explore the relationship between teething and symptoms commonly seen in pediatric clinics. Children less than 36 months of age, who came to Medipol University Faculty of Medicine, between October 2013 and May 2014 for routine well-child visit, were recruited in the study. At visit time 318 infants (60.5%) had one or more visible tooth eruption. Participants were divided in five subgroups according to their age. Parents of infants (mean age 11.5 months) completed questionnaires. The most commonly reported symptom was irritability in 12-18 months (74%), 24-30 months (57%) and 30-36 (44%) months’ periods, drooling in 6-12 months (87%), loss of appetite in 18-24 months (64%). Irritability was statistically significant in all groups except 18-24 month. (p=0.54). Febrile fever was only statistically significant in 6-12 and 12-18 months groups. Increase in biting was become statistically significant after 12 months. Although rates vary according to age group, many mild symptoms previously thought to be associated with teething were found temporally correlated with teething. Before parents/caregivers attribute these symptoms to tooth eruption other possible causes must be ruled out. © 2015, Yuzuncu Yil Universitesi Tip Fakultesi, Universitas Indonesia. All rights reserved

Evaluation of the effects of serum iron levels on lacrimal gland secretion

WOS: 000358741400006PubMed ID: 26228282In our study we aimed to demonstrate the relationship between the serum iron levels, and tears quality and quantity in term newborns. This study was conducted at a single institution between March 2013 and May 2013. A total of 46 newborns were prospectively enrolled. Serum iron levels were measured via the umbilical cord blood. Infants were divided into two groups according to their serum iron levels. Group A, serum iron level 70 mg/dL (n = 19). The evaluation of the osmolarity was tested by using the TearLab Osmolarity System (TearLab Co, San Diego, CA, USA). The assessment of quantity was performed by using Schirmer I test. Osmolarity testing and Schirmer I test (with/without anesthesia) were performed bilaterally on the 1st day of life by an ophthalmologist. The outcomes of Schirmer I and tear osmolarity showed no statistically significant difference between right and left eyes of any infant in the groups. Moreover, there was no statistical difference between sexes in these two groups. Osmolarity was found to have a moderate negative correlation coefficient with serum iron level (r = -0.4, p < 0.01). Furthermore, there was a high positive correlation between Schirmer I with anesthesia and serum iron levels (r = 0.7, p < 0.01). We observed that the quality and quantity of the tears was lower in term newborns with lower serum iron levels than healthy newborns. These results indicate that low serum iron level could affect lacrimal gland functions

Is children's body mass index associated with their parents' personality? A prospective controlled trial

WOS: 000408927800008PubMed ID: 26329657BACKGROUND: The aim of this study was to elucidate the effect of the personal characteristics and psychological status of parents on their children's Body Mass Index (BMI) by using validated questionnaires. METHODS: Obese and healthy control group was assessed with The Parental Attitude Research Instrument (PARI) for the evaluation of parental attitudes towards their children. Additionally, Depression Anxiety and Stress Scale (DASS) were used to assess the relationships between parental depression, anxiety, stress and childhood obesity. RESULTS: A total of 105 children and their parents were divided into two groups. The study group consisted of 58 children with a BMI of higher than 85th percentile whereas 47 children with normal BMI ( 30 kg/m(2) had significant impact on the risk of children's obesity status 1.12-fold and 3.68-fold respectively. The PARI results provided that the children who had disciplined, over-protective parents and those in the parental incompatibility group had higher risk of being obese. Analysis of the DASS Test results showed that children having depressed parents had significantly higher risk of obesity than children whose parents were not depressed (P<0.05). CONCLUSIONS: Our results provided that, the parent's status such as obesity, depression and strict personal behaviors have negative impact on their children's weight which is resulting with obesity