The evaluation of vitamin K status in children with febrile seizure

Background: Febrile seizure is the most common neurological disorder in childhood. The exact pathophysiology of febrile seizures is unknown. Recent studies showed the role of vitamin K in nonhematological and inflammatory disorders. This study aimed to investigate the serum vitamin K levels in children with febrile seizures. Aims: To evaluate vitamin K levels in children with febrile seizures. Study Design: Prospective case-control study. Methods: This multicenter study examined representative populations in 8 different cities in Turkey between April 1, 2018 and April 1, 2019. Blood samples were taken from all children at presentation. Vitamin K1, vitamin K2, tumor necrosis factor-alpha, interleukin 1 beta, and interleukin 6 levels were determined by enzyme-linked immunosorbent assay. Results: A total of 155 children were included in the study—84 children with febrile seizures and 71 children in febrile control group. Serum vitamin K1 and vitamin K2 levels were also higher in children with febrile seizures than in the controls. The results of statistical analysis showed that vitamin K1 and vitamin K2 levels were correlated with tumor necrosis factor-alpha, interleukin 1 beta, and interleukin 6 levels. The median vitamin K1 and vitamin K2 levels of children experiencing their first febrile seizure were higher than those in children with recurrent febrile seizures. Type of febrile seizure has no effect on serum vitamin K1 and vitamin K2 levels. Conclusion: In children with febrile seizures, vitamin K levels are higher than those in the control group. These new findings may contribute to elucidating the etiopathogenesis of febrile seizures

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Health Related Qualıty Of Lıfe Evaluatıon In Sıblıngs Of Chıldren Wıth Chronıc Dısease

Kronik hastalığı olan çocukların, kendileri dışında aile bireylerinin de yaşam kalitesinde değişikliklere neden olabileceği gösterilmiştir. Sağlık ilişkili yaşam kalitesi çalışmaları ülkeler ve hastalık grupları arasında farklılıklar gösterebildiğinden, bu çalışmada Türkiye de kronik hastalığı olan çocukların sağlıklı kardeşlerinde sağlık ilişkili yaşam kalitesinin değerlendirilmesi planlandı. Sağlık ilişkili yaşam kalitesinin değerlendirilmesinde Pediatric Quality of Life Inventory (PedsQL) testi kullanıldı. Ebeveynlerin ve sağlıklı kardeşlerin bireysel yanıtları ile fiziksel sağlık skoru ve psikososyal sağlık skoru (duygusal işlevsellik, toplumsal işlevsellik ve okuldaki işlevsellik) hesaplandı. Çalışmanın primer sonlanım noktası kronik hastalığı olan çocukların kardeşlerinin sağlık ilişkili yaşam kalitesi skorlarının, sağlıklı çocukların kardeşleri ile karşılaştırılması idi. Çalışmaya, kronik hastalığı olan 191 çocuğun (serebral palsi, epilepsi, Tip 1 diyabet, çölyak hastalığı, hematolojik onkolojik malignite, astım) sağlıklı kardeşi ile evde sağlıklı kardeşi olan 100 sağlıklı çocuk dahil edildi. Kronik hastalığı olan çocukların; sağlıklı kardeşlerin bireysel yanıtları ve ebeveyn yanıtları değerlendirmesinde, sağlıklı kardeşlerinde psikososyal sağlık skoru, fiziksel sağlık skoru ve toplam skoru; sağlıklı çocukların sağlıklı kardeşlerine göre belirgin derecede düşük olarak saptandı (p<0.001). Kronik hastalık grubunda, en düşük psikososyal sağlık skoru serebral palsi, hematolojik onkolojik hastalıklar ve astım grubunda saptandı (p<0.001). Fiziksel sağlık skoru değerlendirildiğinde, en düşük skorlar hematolojik onkolojik hastalıklar ve astım grubunda saptandı (p<0.01). Kronik hastalık grubundaki çocukların sağlıklı kardeşlerinin bireysel yanıtlarına göre sağlık yaşam kalitesinde bozulma, kontrol grubuna göre düşük olarak saptandı (%30.4 vs %14.1; p=0.005). Ebeveyn yanıtlarında, sağlıklı çocukların kendi yanıtladıkları ölçeklere göre yaşam kalitesinde bozulmanın daha düşük olduğu görüldü (%30.4 vs %15.1, p<0.05), ebeveynlerin sağlıklı çocuklarda yaşam kalitesindeki bozulmayı daha az farkettikleri görüldü. Kronik hastalığı olan çocukların kardeşlerinin çölyak hastalığı dışında- büyük bölümünün fiziksel ve psikososyal olarak etkilendikleri görülmektedir. Sağlıklı kardeşlerde; psikososyal etkilenme başta olmak üzere global yaşam kalitesinin etkilenmesi ve ebeveyn farkındalığının düşük olması, bu çocuklarda duygusal ihmal ve istismar için riskini arttırmaktadır. Bu nedenle kronik hastalığı olan çocuğu olan ailelerde özel destek programları gerekmektedir.Chronic diseases during childhood can also cause changes in the quality of life of the family members themselves. Because of health related quality of life studies varies between the countries and chronic diseases, the aim of this study was to evaluate the health-related quality of life among healthy siblings of children with chronic diseases. We performed the Pediatric Quality of Life Inventory (PedsQL®) questionnaire for the evaluation of health related quality of life. The physical health score and the psychosocial health score (emotional, social and school functional) were calculated by the individual sibling and parents responses. The primary end point is the comparison of health-related quality of life scores of healthy siblings of children with chronic illness and siblings of healthy children. We enrolled healthy siblings of 191 children with chronic disease (cerebral palsy, epilepsy, diabetes, celiac disease, hematological malignancy, asthma) and 100 healthy children. Physical health score, psychosocial health score and total score in healthy siblings of children with chronic illness; were significantly lower than the healthy children group (p <0.001) regarding to sibling s response and parent s response. In the chronic disease group, the lowest psychosocial health score was found in cerebral palsy, hematological oncological diseases and asthma groups (p <0.001). For physical health score, the lowest scores were found in hematologic oncologic diseases and asthma group (p <0.01). Global impact of the quality of life for healthy siblings of children with chronic disease was significantly higher regarding to individual responses of children comparing the parent s responses (30.4% versus 15.1%, p <0.05). Parental responses were found to be lower in quality of life (30.4% versus 15.1%, p <0.05) than healthy children's self-reported scales, suggesting that parents perceived less deterioration in quality of life in healthy children. It is seen that most of the siblings of children with chronic illness - other than celiac disease - are physically and psychosocially affected. In healthy siblings; impact of global quality of life, especially psychosocial impact, and the low level of parental awareness increase the risk for emotional neglect and abuse in these children. For this reason, special support programs are needed for families with children with chronic illness

Evaluation of quality of life of healthy siblings of children with chronic disease.

The quality of life determination of children with chronic disease is closely related to treatment success. Quality of life assessment studies revealed that it was not limited to the individual, the quality of life of the family members also had to be assessed. Along with the child being diagnosed with chronic illness, some changes occur in the family structure, and in family roles. Quality of life assessment studies in healthy siblings generally indicate a global influence. These children live in different senses such as closure, aggression, depression, anxiety, guilt, and isolation. Psychosocial impact (short or long-term) of healthy siblings have been associated with disease type, severity, disease duration, age, sex, and ability to cope. Further comprehensive studies among healthy siblings of children with chronic disease about quality of life are needed. Building support groups (especially family support groups) to express feelings and thoughts freely for healthy siblings can positively affect the well-being and self-esteem of the child

Functional effects of human milk oligosaccharides (HMOs)

ABSTRACTHuman milk oligosaccharides (HMOs) are the third most important solid component in human milk and act in tandem with other bioactive components. Individual HMO levels and distribution vary greatly between mothers by multiple variables, such as secretor status, race, geographic region, environmental conditions, season, maternal diet, and weight, gestational age and mode of delivery. HMOs improve the gastrointestinal barrier and also promote a bifidobacterium-rich gut microbiome, which protects against infection, strengthens the epithelial barrier, and creates immunomodulatory metabolites. HMOs fulfil a variety of physiologic functions including potential support to the immune system, brain development, and cognitive function. Supplementing infant formula with HMOs is safe and promotes a healthy development of the infant revealing benefits for microbiota composition and infection prevention. Because of limited data comparing the effect of non-human oligosaccharides to HMOs, it is not known if HMOs offer an additional clinical benefit over non-human oligosaccharides. Better knowledge of the factors influencing HMO composition and their functions will help to understand their short- and long-term benefits

Meningitis Due to Streptococcus pneumoniae Serotype 24B in a Patient with Cochlear Implant Previously Vaccinated with the Pneumococcal Vaccine

Streptococcus pneumoniae is a major cause of bacterial meningitis in children. It can progress and carries a serious risk of mortality and morbidity despite effective treatment. Cochlear implantation is a fairly successful procedure for restoring hearing in cases of sensorineural hearing loss. Moreover, patients with cochlear implants are at increased risk of contracting pneumococcal meningitis compared to the general population. The development of meningitis is associated with pathogens in the middle ear that contaminate the cerebrospinal fluid (CSF), as a result of congenital anomalies in the cochlea, and the cochlear implant. A 4-year-old girl presented to our clinic with fever, vomiting, and weakness. A physical examination showed an axillary temperature of 38.3 degrees C, heart rate of 134/min, respiration rate of 50 breaths/minute, and arterial blood pressure of 120/88 mmHg. The patient also had a neck stiffness and her Kernig and Brudzinski signs were positive. It was discovered that the patient had undergone cochlear implantation approximately five months prior due to bilateral congenital sensorineural hearing loss. She had also received the Haemophilus influenzae type b and PCV-13 vaccines in line with the national immunization calendar. Her laboratory findings showed a leukocyte count of 21.900/mm(3) (neutrophils 90% and lymphocytes 10%) and her procalcitonin level was 1.22 ng/ml. An uncountable number of neutrophils was identified in her cerebrospinal fluid, which led to the initial diagnosis of meningitis. There was also 1 mg/dl of glucose (blood glucose, 102 mg/dl) and 706 mg/dl of protein in her cerebrospinal fluid. Empirically, vancomycin (60 mg/kg/day) and ceftriaxone (100 mg/kg/day) were started. Following 5 days of antibiotic treatment, penicillin-susceptible S.pneumoniae was yielded in her CSF culture and identified as serotype 24B. S.pneumoniae with the same antibiotic sensitivity was also identified in her blood culture. Since rhinorrhea was observed on day 16 of hospitalization, she underwent an operation to repair the fistula tract. A computerized tomography cranial scan was performed after the development of acute mental fog at postoperative day 3 and showed brain edema and a thrombus in the right middle cerebral artery. The patient died on day 42 of hospitalization due to multiple organ failure. To our knowledge, this is the first case of meningitis reported in our country associated with S.pneumoniae serotype 24B in a patient with a cochlear implant. While there has been a decrease in the prevalence of invasive pneumococcal disease with routine administration of the pneumococcal conjugate vaccine, a relative increase has been observed in its non-vaccine serotypes. This is relevant not only to patients with more risk factors, such as a cochlear implant, but also those who are at lower risk for pneumococcal infection

The immunization status of children with chronic neurological disease and serological assessment of vaccine-preventable diseases

The aim of this study was to evaluate the age-appropriate immunization coverage in 366 children with chronic neurological disease (CND), to evaluate the use of vaccines not included in routine program, to evaluate serological tests for vaccine-preventable diseases and to describe the related factors in unvaccinated children. 95.6% of all children with had received age-appropriate vaccinations according to the actual National Immunization Program (NIP) during childhood. 12 children (3.6%) had not received vaccines; only two had true contraindications. Because most of the vaccines have been implemented through the NIP for 10 years in Turkey, 88% of children required these new vaccines or booster doses. Moreover, 86.6% of the children and 92.6% of household contacts had no prior history of influenza vaccine. Furthermore, 88% of the patients had not received the varicella vaccine, and the anti-varicella IgG levels were only negative in 27.9%. In addition, 18.6% of the children were negative for anti-mumps IgG, 23.7% for anti-measles IgG, and 6.3% for anti-rubella IgG. Anti-HBs IgG level was 0–10 IU/L in 45.6% of the patients (most of them previously vaccinated) and 79.8% were negative for hepatitis A IgG antibodies. For pertussis infection, the antibody titers of 54.1% of patients were below the protective level, and 10% of patients had a prior acute pertussis infection. Therefore, it is suggested that children with CND should be evaluated for their vaccination status during their first and follow-up visits at certain intervals, and their primary immunization should be completed; moreover, many will need revaccination or booster doses

The attitudes, behaviors, and knowledge of healthcare professionals towards the diagnosis, treatment, and prevention of bacterial meningitis in Turkey

###EgeUn###Introduction: Bacterial meningitis is one of the leading causes of morbidity and mortality among children and adults. Better understanding of the seroepidemiology of meningitis is critical for both the selection and implementation of an effective meningitis vaccine for the national immunization program. Because physicians play a crucial role in the implementation of this vaccine, the aim of this study was to evaluate the attitudes, behaviors, and knowledge of healthcare professionals in Turkey regarding the diagnosis, treatment and prevention of bacterial meningitis, especially pneumococcal and meningococcal meningitis. Methods: This study used a cross-sectional electronic survey with a national convenience sample of 339 physicians (171 pediatric age specialists [PAS] and 168 adult patient specialists [APS]) in Turkey. A web-based questionnaire which consisted 28 questions about the definition, diagnosis, and treatment of bacterial as well as knowledge and/or attitudes about meningococcal vaccines, was designed. Results: Approximately 72.9% (n = 247) of the respondents followed a patient with meningitis in the last year. A 49.5% of participants preferred to perform computerized cranial tomography (CCT) for suspected meningitis cases before lumbar puncture (LP) at 75-100% frequency (27.5% PAS; 72% APS, p ). In addition 27.1% of the respondents reported using a routine steroid as an adjunctive treatment (19% PAS; 35% APS, p ). For meningococcal meningitis, 72.5% of the participants preferred to use third-generation cephalosporins (63.1% PAS; 82.1% APS, p ). For pneumococcal meningitis, approximately 50% of the participants preferred to use a third-generation cephalosporin plus glycopeptide (41.5% PAS; 58.9% APS, p < .05). While 32.7% of the sample preferred to administer a 7-day course of antibiotics for meningococcal meningitis, 40.9% preferred a course of 14 days or more. For pneumococcal meningitis, 88.4% of the sample preferred a 10-14 day course of antibiotics. In addition, 67% of the PAS group and 50% (p < .001) of the APS group thought that a conjugated meningococcal vaccine should be a part of the National Immunization Program. The top five groups recommended for routine immunization included all children, asplenia/splenectomy patients, immunodeficient patients, those who planned to travel to endemic areas, including Hajj, and military personnel. Conclusion: In this large convenient sample of physicians in Turkey, we showed that there are heterogenous approaches to the diagnosis and treatment of bacterial meningitis, also differences between pediatricians and non-pediatricians regarding their beliefs and attitudes, which may be due to differences in the epidemiology and clinical presentation between children and adults. We observed appropriate but unnecessary extended courses of antibiotics for meningitis. Most of the participants thought that children are a vulnerable risk group that should potentially be immunized and that meningococcal vaccines should be included in the National Immunization Program. Our results imply that more awareness is needed regarding diagnosis, treatment, and further recommendations for meningitis at the country level in Turkey

Giant Condyloma Acuminate Due Human Papilloma Virus Type 16 In An Infant Successfully Treated With Topical Imiquimod Therapy

Anogenital warts related to human papillomavirus (HPV) have been observed in children. Definition of the transmission mode, therapy, and follow-up for long term potential complications is important. A 27-month old girl was admitted with multiple pedunculated red-purple colored cauliflower-like lesions of 1.5 years duration. Clinical/histopathological and microbiological diagnosis was condyloma acuminate due to HPV type 16. After 12 weeks of imiquimod 5% cream application (pea-sized) overnight three times per week, the perianal warts had completely disappeared. The mode of transmission of HPV 16 in our case was probably horizontal, related to the sharing of common personal hygiene items in the women’s shelter. We report herein the case of an infant living in a women’s shelter with giant condyloma acuminata due to HPV 16, which was successfully treated with topical imiquimod therapy. This patient should be followed up for recurrence and potential malignant lesions related to HPV type 16.PubMedScopu

Human milk virome analysis: Changing pattern regarding mode of delivery, birth weight, and lactational stage

This article belongs to the Section Prebiotics and Probiotics.The human milk (HM) microbiota is a significant source of microbes that colonize the infant gut early in life. The aim of this study was to compare transient and mature HM virome compositions, and also possible changes related to the mode of delivery, gestational age, and weight for gestational age. Overall, in the 81 samples analyzed in this study, reads matching bacteriophages accounted for 79.5% (mainly Podoviridae, Myoviridae, and Siphoviridae) of the reads, far more abundant than those classified as eukaryotic viruses (20.5%, mainly Herpesviridae). In the whole study group of transient human milk, the most abundant families were Podoviridae and Myoviridae. In mature human milk, Podoviridae decreased, and Siphoviridae became the most abundant family. Bacteriophages were predominant in transient HM samples (98.4% in the normal spontaneous vaginal delivery group, 92.1% in the premature group, 89.9% in the C-section group, and 68.3% in the large for gestational age group), except in the small for gestational age group (only ~45% bacteriophages in transient HM samples). Bacteriophages were also predominant in mature HM; however, they were lower in mature HM than in transient HM (71.7% in the normal spontaneous vaginal delivery group, 60.8% in the C-section group, 56% in the premature group, and 80.6% in the large for gestational age group). Bacteriophages still represented 45% of mature HM in the small for gestational age group. In the transient HM of the normal spontaneous vaginal delivery group, the most abundant family was Podoviridae; however, in mature HM, Podoviridae became less prominent than Siphoviridae. Myoviridae was predominant in both transient and mature HM in the premature group (all C-section), and Podoviridae was predominant in transient HM, while Siphoviridae and Herpesviridae were predominant in mature HM. In the small for gestational age group, the most abundant taxa in transient HM were the family Herpesviridae and a species of the genus Roseolovirus. Bacteriophages constituted the major component of the HM virome, and we showed changes regarding the lactation period, preterm birth, delivery mode, and birth weight. Early in life, the HM virome may influence the composition of an infant’s gut microbiome, which could have short- and long-term health implications. Further longitudinal mother–newborn pair studies are required to understand the effects of these variations on the composition of the HM and the infant gut virome.This study was financially supported by the Eskisehir Osmangazi University Research Grant (2018/2148). This work was also supported by grants to AM from the Spanish Ministry of Science and Innovation (PID2019-105969GB-I00), Generalitat Valenciana (project Prometeo/2018/A/133) and co-financed by the European Regional Development Fund (ERDF).Peer reviewe