Comparison of acute bloody and watery diarrhea: a case control study.

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Speech Delay In Toddlers: Are They Only "Late Talkers"?

Speech delay is prevalent in toddlers. Although some children with speech delay are able to catch up with their peers with time, the delay might be part of a broader condition such as global developmental delay, which requires specific diagnostic work-up. The current study aimed to present the demographic features, developmental profiles of the first 100 preschool-aged children who were seen at Hacettepe University Ihsan Dogramaci Children's Hospital-Developmental Pediatrics Unit with parental concern of speech delay. Moreover, risk factors associated with speech delay, possible diagnosis and intervention strategies are documented. Thirty-one of 100 children were diagnosed with autism spectrum disorder (ASD) and global developmental delay (GDD). The current study presented that 4 out of 5 toddlers exceeded the recommended TV watching time. Moreover, almost one third of children had a poor linguistic home environment. Three parents whose children were diagnosed with ASD or GDD, refused to be reported as 'autism spectrum disorder' or 'intellectual disability' with the anxiety of labeling their child. As a result, these children were unable to receive special education paid for by the government. This study presented 31 of 100 children needed further diagnostic work up and early intervention. Therefore, pediatricians should not underestimate speech delay. On the other hand, due to the fact that, the regulations to receive special education and therapy often create anxiety for the parents, we think that this system needs to be updated and special education support should be determined by the special needs of each child.WoSScopu

Mental Health Of Syrian Refugee Adolescents: How Far Have We Come?

Among the consequences of war, its impact on the mental health of children and adolescents is one of the most significant. A previous study from our team evaluated the psychiatric symptoms of Syrian refugee adolescents living in one of Turkey's Temporary Accommodation Centers (TACs) in 2016. Findings suggested that mental health had been compromised in these teens. Since then many measures have been taken to address this problem. The aim of the current study was to re-assess the mental health status of adolescents living in the same center. A total of 76 adolescents (35 female, 41 male) aged between 12-18 years (14.2 +/- 0.83 years) received the Brief Symptom Inventory (BSI) which assessed their anxiety, depression, negative self-concept, somatization and hostility levels in addition to a Global Severity Index (GSI). Results > 1.0 indicated psychopathological symptoms. All BSI sub-scores decreased from 2016 to 2019 showing significant improvement in psychopathological symptoms. The most significant change was in the GSI score which decreased from 2.15 to 0.8. For the 2019 participants a significant correlation was found between years of stay at the camp and the depression subscale. Evaluation to assess gender differences found that adolescent girls reported significantly higher scores than males in anxiety, depression, somatization and the global severity index. This study has shown that interventions designed to tackle post-traumatic stress symptomology may have been effective in improving the mental health status of these teens and can provide a roadmap for tackling existing issues in vulnerable conditions. Additionally, females are under higher risk for psychopathology so gender targeted interventions may specifically be necessary to deal with such issues.WoSScopu

Home Accident Or Physical Abuse: Evaluation Of Younger Children Presenting With Trauma, Burn And Poisoning In The Pediatric Emergency Department

Most cases of physical abuse and neglect refer to pediatric emergency clinics, and these patients are diagnosed as only home accidents. Cases that cannot be diagnosed and managed correctly are again exposed to severe trauma and consequently, they may die. The aim of this study is to evaluate the physical abuse and neglect in children younger than three years of age, admitted to the pediatric emergency department with the complaints of trauma, burn, drug poisoning and/or caustic ingestion. This prospective study included 132 patients who were admitted to the pediatric emergency department. Children were classified into three groups as "no abuse", "suspected abuse" and "abused" after being evaluated with a standard form. Additionally, suspected abuse and abused cases were evaluated once again by "The Team of Child Abuse and Neglect Evaluation, Research and Treatment" in Hacettepe University, Ihsan Dogramaci Children's Hospital. The frequency of the suspected abuse or abused cases in all burn, trauma and poisoning cases was found to be 7.5%. It was noticed that 65 of the patients (49.2%) were physically neglected considering the mechanism of occurrence of events. Unplanned pregnancy, absence of prenatal follow-up, high number of siblings, previous physical abuse in the family, absence of witness during the event, and hospitalization were statistically significant differences between no abuse and suspected abuse or abused cases (p<0.05). Moreover, age group and income were significant risk factors in the logistic regression model for the patients who were thought to be suspected abuse/abused in univariate analyses (age group: Odds ratio (OR) 0.279, 95% confidence interval (CI) 0.085-0.723, p=0.0049; income: OR 2.323, 95% CI 1.052-6.198, p=0.0345). In conclusion, most cases of physical abuse and neglect are referred to the pediatric emergency clinics, and these patients are misdiagnosed as home accidents. The physicians working in the emergency department should be informed and trained in recognizing the cases of abuse and neglect, making the differential diagnosis, identifying the high-risk families and appropriate physical and psychological treatment for the abused and neglected children.WoSScopu

Plasma Phthalate Levels in Pubertal Gynecomastia

OBJECTIVE: Several untoward health effects of phthalates, which are a group of industrial chemicals with many commercial uses including personal-care products and plastic materials, have been defined. The most commonly used, di-(2-ethylhexyl)-phthalate (DEHP), is known to have antiandrogenic or estrogenic effects or both. Mono-(2-ethylhexyl)-phthalate (MEHP) is the main metabolite of DEHP. In this study, we aimed to determine the plasma DEHP and MEHP levels in pubertal gynecomastia cases. PATIENTS AND METHODS: The study group comprised 40 newly diagnosed pubertal gynecomastia cases who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital. The control group comprised 21 age-matched children without gynecomastia or other endocrinologic disorder. Plasma DEHP and MEHP levels were measured by using high-performance liquid chromatography. Serum hormone levels were determined in some pubertal gynecomastia cases according to the physician's evaluation. RESULTS: Plasma DEHP and MEHP levels were found to be statistically significantly higher in the pubertal gynecomastia group compared with the control group (P<.001) (DEHP, 4.66 +/- 1.58 and 3.09 +/- 0.90 mu g/mL, respectively [odds ratio: 2.77 (95% confidence interval: 1.48-5.21)]; MEHP, 3.19 +/- 1.41 and 1.37 +/- 0.36 mu g/mL [odds ratio: 24.76 (95% confidence interval: 3.5-172.6)]). There was a statistically significant correlation between plasma DEHP and MEHP levels (r: 0.58; P < .001). In the pubertal gynecomastia group, no correlation could be determined between plasma DEHP and MEHP levels and any of the hormone levels. CONCLUSIONS: DEHP, which has antiandrogenic or estrogenic effects, may be an etiologic factor in pubertal gynecomastia. These results may pioneer larger-scale studies on the etiologic role of DEHP in pubertal gynecomastia. Pediatrics 2010; 125: e122-e129WoSScopu

Poor Appetite in School Children: Is It a False Perception of Parents?

Aim: Poor appetite is a common symptom in childhood that can either be organic or nonorganic. Prolonged poor appetite may affect children's growth negatively. However picking at food or refusing to eat stresses parents out. In this study, we aimed to investigate the relationship between parental perception of the child's body measurements and appetite in school children who were admitted to the outpatient clinic with the complaint of sustained poor appetite. Materials and Methods: A total of 105 school children (6-15 years old) with the complaint of poor appetite who were investigated several times previously with no organic reason were included in the study. The study was conducted with a questionnaire that was filled out by parents recording demographics. Anthropometric measurements including body weight and height were measured by the same researcher. Body mass index was calculated and BMI for-age was determined. Patients with normal BMI percentile values and patients with low BMI percentile values were compared. Results: 105 children (M/F: 51/54) with a mean age of 8.2 +/- 1.9 years were studied. Mean body weight and height of children were 23.8 +/- 5.7 kg and 124.1 +/- 11.6 cm, respectively. Mean BMI of children was 15.2 +/- 1.5. According to BMI percentiles 65.7% (n=69) of children were normal weight, 30.5% (n=32) were underweight, and 3.8% (n=4) were overweight. When compared in terms of BMI percentiles no difference was found between the groups. Conclusion: Perception of the parents of their children's growth is influenced by many factors and usually does not reflect the facts. In our study, we found that the majority of the children with poor appetite were in normal weight range according to BMI percentile. Nevertheless, nearly one third of the children were underweight, a fact that should not be ignored

Munchausen by Proxy Syndrome: A Case Series Study from Turkey

Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a caregiver deliberately exaggerates, fabricates, and/or induces health problems in those in their care. The condition is extremely difficult to characterize and diagnose, as it manifests in many forms, often confusing the medical team. Insufficient knowledge regarding the syndrome and rare consideration of the differential diagnosis results in failure to recognize the problem. Literature suggests that an increase in physician awareness of the disorder can prevent or reduce its morbidity and mortality. For this reason, we believe that case series can help increase current knowledge on epidemiology, aetiology, diagnostic criteria, advised management of MSBP, and the psychological portrait of the perpetrator. Additionally, no data from Turkey has previously been presented on this issue. This study aimed to report characteristics of MSPB victims and alleged perpetrator, which were diagnosed and managed by a multidisciplinary team

Vaccination Practices in Pediatric Dialysis Patients Across Europe. A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group Study

Background: Data on the immunization practices in pediatric chronic kidney disease (CKD) patients are scarce. The purpose of this study was to evaluate current vaccination practices for children on dialysis across European pediatric nephrology centers. Methods: A total of 18 tertiary pediatric nephrology centers from 12 European countries were included in the study. The data on universal national immunization programs and immunization practices for children with chronic disease or risk were recorded from European Center for Disease Prevention and Control and the World Health Organization. The immunization practices and center protocols for monitoring antibody titers after vaccination in dialysis patients were obtained through a questionnaire. Results: All centers included in the study recommended immunization against hepatitis B virus (HBV), diphtheria, tetanus, pertussis, Hemophilus influenzae type b (Hib), poliomyelitis, measles, mumps, rubella (MMR), and streptococcus pneumonia in dialysis patients. In 16 centers, dialysis patients were vaccinated against influenza virus annually. HBV protective antibody titers were measured in 17 centers (during dialysis period in 14 centers, during pre-renal transplantation preparations in 14 centers or in both times in 11 centers). Hepatitis A virus (HAV) was reported to be followed in 13 centers, in 8 centers during dialysis period, and in 11 centers during pre-RTx preparations. MMR and varicella-zoster virus (VZV) protective antibody titers were measured during the dialysis period or before renal transplantation (RTx) in 12 and 15 centers, respectively, and in 6 centers both titers were checked both times. Conclusion: There are variations in vaccination practice across Europe. Children with CKD, those undergoing dialysis, and transplant candidates should receive age-appropriate vaccinations before RTx as well as before the transition to adult nephrology clinics and antibody levels should be monitored to evaluate the immunization status before and after RTx. (C) 2017 S. Karger AG, Basel