Predictive Parameters of Steroid Dependency in Minimal Change Disease

The most common type of nephrotic syndrome in children is minimal change disease (MCD), which is usually responsive to steroid therapy. Steroid dependency is one of the handicaps in the management of these children. Thus, the early prediction of the disease course may improve treatment strategy. Demographic characteristics and laboratory parameters of 35 patients at the time of MCD diagnosis were retrospectively obtained from the hospital records. There were 23 (65%) patients with steroid sensitive (SSNS) and 12 (35%) with steroid dependent nephrotic syndrome (SDNS). There was a significant difference between the patients with SSNS and SDNS in terms of age at diagnosis, remission time, and mean values of platelet volume, low density lipoprotein cholesterol, uric acid, urine protein-to-creatinine ratio, total cholesterol and creatinine (p = 0.003, p < 0.001, p = 0.013, p = 0.006, p = 0.036, p = 0.02, p = 0.003, and p = 0.034, respectively). The prediction of early markers of steroid dependency can reduce the side effects of steroids and facilitate the use of appropriate drugs

The 6th of february earthquake and the Turkish society of pediatric nephrology-organizational aspects of pediatric kidney care

The 6 February 2023 earthquake that struck southern and central Turkey and northern and western Syria had unique drawbacks, such as the occurrence of two strong, destructive earthquakes nine hours apart in multiple and densely populated geographical areas, exposure to unforgiving winter conditions, and increased anxiety and fear due to multiple aftershocks [1, 2]. As of 26 March 2023, >50 000 people have been killed and many more have been injured in Turkey [3]. One recent editorial and a letter emphasized the vital importance of increased awareness of disaster preparedness and rapid action on organizational issues [4, 5]. Nongovernmental organizations including academic medical societies should take responsibility during disasters [6] and work together with other stakeholders. Since an earthquake should be considered a “kidney disaster” because of crush injuries and resultant acute kidney injury [7], the Turkish Society of Pediatric Nephrology (TSPN) took primary responsibility during the immediate and early phases of earthquake

Evaluation of musroom intoxications presenting at the emercency department of dr. behçet uz children's hospital

Mantar zehirlenmeleri tüm dünyada sıkça görülen önemli bir sorundur. Eriskinlerde mantar zehirlenmeleri tüm akut zehirlenme vakalarının yaklasık %7'sini olusturmaktadır. Klinik, mantarın cinsine göre hafif bir bulantı kusmadan, karaciger yetmezligine kadar degismektedir. Bu çalısmada, Ocak-Aralık 2002 tarihleri arasında Dr. Behçet Uz Çocuk Hastanesi Acil Servisi'ne mantar zehirlenmesi nedeni ile basvuran 21 olgu retrospektif olarak degerlendirildi. Olguların 11'i (%52) kız, 10'u (%48) erkekti. 21 olgunun 9'unun (%43) 10 yas ve üzerinde oldugu ve 17'sinin (%81) sonbahar aylarında basvurdugu belirlendi. En sık gelis sikayeti; 17 olguda (%81) bulantı ve kusma, 5 olguda (%24) buna ek olarak ishal idi. 7 olguda (%33) kolinerjik semptomlar, 3 olguda karaciger yetmezlik bulguları ve 6 olguda (%28) nörolojik bulgular vardı. Ölüm 3 olguda (%14) karaciger yetmezligi nedeni ile olurken 18 olgu (%85) sekelsiz iyilesti. Sonuç olarak, Izmir ili ve çevresindeki mantar zehirlenmelerinin genellikle 10 yasın üzerinde ve sonbahar aylarında gerçeklestigi ve karaciger yetmezligi gelisenlerin dısında çogunlukla sekelsiz iyilestigi saptanmıstır.Mushroom toxicity is a worldwide concern. In the adult population, mushroom toxicity constitutes seven percent of all acute intoxications. The clinical feature may vary from mild nausea and vomiting to hepatic insufficiency according to the type of mushroom. In this study, we analyzed 21 patients who were seen at the Emercency Department of Dr. Behçet Uz Chıldren's Hospıtal from January 2002 to December 2002. 11 of the 21 patients (52%) were female and 10 of them (48%) were male. 9 of the 21 patients (43%) were older than 10 years and 17 of the 21 patients (81%) were hospitalized in spring. The most common symptoms were vomiting in 17 patients (81%) and diarrhea in 5 patients (24%).We observed cholinergic symptoms in 7 patients (33%), hepatic insufficiency in 3 patients (14%) and neurologic symptoms in 6 patients (28%). Death occured in 3 patients as a result of hepatic insufficiency and the rest of the patients recovered without any sequelae. Mushroom intoxications in Izmir and envira were mostly diagnosed in children older than 10 years and in spring. Most of the patients recovered without any problems, except patients who developed hepatic insufficiency

Development, characterization, and in vivo assessment of mucoadhesive nanoparticles containing fluconazole for the local treatment of oral candidiasis

This study aimed to develop a suitable buccal mucoadhesive nanoparticle (NP) formulation containing fluconazole for the local treatment of oral candidiasis. The suitability of the prepared formulations was assessed by means of particle size (PS), polydispersity index, and zeta potential measurements, morphology analysis, mucoadhesion studies, drug entrapment efficiency (EE), in vitro drug release, and stability studies. Based on the optimum NP formulation, ex vivo drug diffusion and in vitro cytotoxicity studies were performed. Besides, evaluation of the antifungal effect of the optimum formulation was evaluated using agar diffusion method, fungicidal activity-related in vitro release study, and time-dependent fungicidal activity. The effect of the optimum NP formulation on the healing of oral candidiasis was investigated in an animal model, which was employed for the first time in this study. The zeta potential, mucoadhesion, and in vitro drug release studies of various NP formulations revealed that chitosan-coated NP formulation containing EUDRAGIT(®) RS 2.5% had superior properties than other formulations. Concerning the stability study of the selected formulation, the formulation was found to be stable for 6 months. During the ex vivo drug diffusion study, no drug was found in receptor phase, and this is an indication of local effect. The in vitro antifungal activity studies showed the in vitro efficacy of the NP against Candida albicans for an extended period. Also, the formulation had no cytotoxic effect at the tested concentration. For the in vivo experiments, infected rabbits were successfully treated with local administration of the optimum NP formulation once a day. This study has shown that the mucoadhesive NP formulation containing fluconazole is a promising candidate with once-a-day application for the local treatment of oral candidiasis

Rapidly progressive glomerulonephritis in a child with Henoch-Schönlein Vasculitis and familial Mediterranean fever

Henoch-Schonlein Vasculitis (HSV) is systemic small vessel vasculitis involving the skin, kidney, joints, and gastrointestinal tract. The proportion of patients reported to have renal involvement varies between 20% and 80%. Rapidly progressive glomerulonephritis (RPGN)is rare syndrome in children, characterized by clinical features of glomerulonephritis (GN) and rapid loss of renal function. We present a severe kidney involvement in a 14 year old boy with HSV in who is carring MEFV mutation. A 14 year old boy had developed sudden onset of palpable purpuric rash on his extensor surfaces of lower extremities. He had elevated an erythrocyte sedimentation rate (ESR) (45 mm/h), C-reactive protein (3.74 mg/dl), serum urea 66 mg/dl, serum creatinine 1.8 mg/dl. Also, he had hypocomplementemia. Antinuclear antibody, anti ds DNA, antineutrophil cytoplasmic antibody, anticardiolipine antibodies were negative. Urinalysis revealed macroscopic hematuria and proteinuria with a 24-h urinary protein excretion of 55 mg/m2/h. The renal biopsy specimen showed crescentic and necrotizing glomerulonephritis. He had also M694V/E148Q compound heterozygote mutation. Clinical symptoms and renal failure resolved with intermittant hemodialysis and medical therapy

COVID-19 in pediatric nephrology centers in Turkey

Background/aim: There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. Materials and methods: This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. Results: Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10–15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. Conclusion: COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients’ susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage

Attention deficit and hyperactivity symptoms in children with monosymptomatic nocturnal enuresis

Amaç: Çocuklarda monosemptomatik nokturnal enürezis psikolojik ve davranışsal sorunlara neden olabilir. Bu çalışmanın amacı monosemptomatik nokturnal enürezisi olan çocuklarda dikkat eksikliği ve hiperaktivite bulgularının değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya altı ile 12 yaşları arasında monosemptomatik enürezisi olan 57 çocuk (23 erkek, 34 kız) ve 57 sağlıklı kontrol (25 erkek, 32 kız) katıldı. Çocuklarda dikkat eksikliği ve hiperaktivite bulgularını tanımak için anneler tarafından 48 soruluk çoktan seçmeli bir anket olan Conners Ebeveyn Değerlendirme Ölçeği yanıtlandı. Bulgular: Enürezisli çocukların yaş ortalaması 8,54±2,18 iken, kontrol grubundakilerin yaş ortalaması 9,12±2,13 idi. Enürezis grubunda dikkat eksikliği puanı kontrol grubundan anlamlı olarak yüksekti (p=0,02). Hiperkativite puanı açısından ise iki grup arasında anlamlı fark bulunmadı (p=0,36). Alt ıslatma sıklığı, dikkat eksikliği ya da hiperaktivite bulguları olan ve olmayan enüretik çocuklar arasında farklı değildi (p=0,06). Çıkarımlar: Bu çalışmanın sonuçları artmış dikkat eksikliği bulgularına işaret ettiğinden, monosemptomatik nokturnal enürezisi olan çocuklarda psikolojik ve davranışsal değerlendirme gerekebilirAim: Monosymptomatic nocturnal enuresis in children may cause psychological and behavioral problems. The aim of this study was to assess symptoms of attention deficit and hyperactivity in children with monosymptomatic nocturnal enuresis. Material and Method: Fifty-seven children (23 male, 34 female) with monosymptomatic nocturnal enuresis and 57 healthy controls (25 male, 32 female) aged 6 to 12 years participated in the study. Conners&amp;#8217; Parent Rating Scale-48 (CPRS), a 48-item multiple-choice questionnaire, was completed by the mothers to identify the attention deficit and hyperactivity symptoms in children. Results: Mean age of the children with enuresis was 8.54&plusmn;2.18 years and that of the control group 9.12&plusmn;2.13 years. Attention deficit score in the enuretic group was significantly higher than that in the control group (p=0.02). Hyperactivity scores were not significantly different between the groups (p=0.36). Bedwetting frequencies were not different between enuretic children with and without attention deficit or hyperactivity symptoms (p=0.06). Conclusions: Psychological and behavioral assessment may be indicated in children with monosymptomatic nocturnal enuresis since the results of this study demonstrate increased attention deficit symptomatology

Actigraphy applications in children

Uyku çocuğun sağlıklı büyümesinde önemli yer tutar. Bu nedenle uyku bozukluğu hem çocuk hem aile için büyük sorun yaratır. Son yıllarda geliştirilen aktigrafi çocuk ve adolesanlarda uyku ve uyanıklık siklusunu ölçen motor aktiviteleri hassas bir şekilde algılayan, el veya ayak bileklerine takılarak kullanılan, istirahat ve aktivite paternlerinin dijital ortamda kaydedilmesine ve depolanmasına olanak sağlayan; küçük, hafif, saat şeklinde taşınabilir cihazdır. İçerdiği mikrosensorların kapasitelerine bağlı olarak değişen sürelerle aktivite kaydı yapabilen ve non-dominant ele takılarak kullanılan bu cihazlar uyku günlükleri ile birlikte, uyku yakınması olan kişilerde uzun süreli uyku takibi amacı ile kullanılmaktadırlar. Çocukluk çağında uykuyu etkileyecek patolojiler aktigrafi ile tespit edilebilmektedir. Polisomnografiye alternatif olarak geliştirilen ve kullanımı kolay olan bu cihaz ile çocukluk çağı uyku bozuklukları kolayca tanınıp takip edilebilir.Sleeping is an important factor for the growth of children in a healthy way. Therefore, sleeping disturbances may cause serious problems both for children and their families. Recently developed actigraphy is a small and light device, portable like a watch to perceive motor activities which measures sleep and wakefulness cycles sensitively in children and adolescents, worn on hand and foot ankles, enables resting and activity patterns to be recorded and stored in a digital media. These devices, that can record activities in variable periods depending on capacities of microsensors that they include and worn on non-dominant hand are being used for long term follow-up of sleeping with sleeping diaries of people who complain about sleeping disturbances. The pathologies that will affect sleeping during childhood can be detected by actigraphy. Sleeping disturbances of childhood can easily be identified and followed with this device which can easily be used and was developed as an alternative to polysomnography

Çocuklarda giardiasis ile serum IGA, IGE, IGG, IGM ve CRP düzeyleri arasındaki ilişkinin incelenmesi

Giardiasis, Giardia lamblia'nin neden olduğu Türkiye'de çocuklar arasında yaygın olan intestinal protozoal bir enfeksiyondur. Bu çalışmada çocuklarda immunoglobulin A, E, G, M ve C-reaktif protein (CRP) ile giardiasis arasındaki ilişkiyi belirleme amaçlanmış. Bu nedenle native-lugol, formol etil asetat ve trikrom çoklaştırma yöntemlerinden en az biriyle dışkılarında Giardia Lamblia kist ve/veya trofozoiti saptanan 2-15 yaşları arasında 31 çocuk hasta grubu olarak kabul edilmiştir (HG). Aynı yaş grubundan sağlıklı 50 çocuk kontrol grubu (KG) kabul edilmişlerdir. Kan immunoglobulin ve CRP düzeyleri sırası ile ELISA ve agglütinasyon yöntemleri ile ölçülmüştür.Her iki grupta IgA düzeyleri normal sınırlar içinde bulunmuştur. HG'da (%38.7) ve KG'da (%16) olgunun IgE düzeylerinin normalin üzerinde olduğu saptanmıştır (p<0.05). Buna karşın HG'da (%38.7) ve HG'da (%2) IgG düzeyinin normalin altında olduğu saptanmıştır (p<0.05). HG'da %32.25 ve KG'da (%6)'sının IgM düzeyinin yüksek olduğu görülmüştür (p<0.05). CRP düzeyinin HG'da (%25.8) ve KG'da ise (%4)'ünde normalin üstünde olduğu gözlenmiştir. (p<0.05).Sonuç olarak; giardiasis ile serum IgE, Ig M ve CRP artışının yanısıra IgG azalışının ilişkili olabileceği düşünülürken, herhangi bir artış gözlenmeyen serum total IgA 'nın yerine spesifik komponentlerinin araştırılması uygun olacaktır.Giardiasis, an intestinal protozoan infection caused by Giardia lamblia, is common in Turkey, especially in children. This study was designed to determine the link between blood levels of immunoglobulins (Ig) of A, E, G, M and C-Reactive Protein (CRP) and giardiasis in children. A total of 31 children, aged between 2 and 15 years-old, whose stool samples were found to be positive for Giardia lamblia cysts and/or trophozoites by at least one method of saline-Lugol, formalin-ethyl acetate and trichrome staining, were enrolled in the study group (SG). The control group (CG) consisted of 50 age-matched healthy children. Blood levels of immunoglobulins and CRP were measured by ELISA and agglutination methods, respectively. IgA levels were found to be within normal range in all cases of both groups, the IgE levels were found over normal range in (38.7%) of SG and in (16%) of CG (p&lt;0.05). However in (38.7%) of SG and in (2%) of CG IgG levels were found under normal range (p&lt;0.05). In (32.25%) of SG and in (6%) of CG, the IgM levels were found higher than normal range (p&lt;0.05). CRP levels were found over normal range in (25.8%) of SG and (4%) of CG (p&lt;0.05). These results revealed a correlation between giardiasis and both increase in serum IgE, IgM and CRP levels and decrease in serum IgG levels. Specific components of IgA should be assessed instead of total serum IgA

Evaluation of the Student’s Parents about the School Milk Programme: The Case of Isparta

In this study, it was aimed to determine the approaches of primary school students’ parents participating in the school milk programme in the Isparta province. The data obtained by the questionnaire method were used from 359 students’ parents who were included in the school milk programme. The families were divided into four groups according to the household income. It was determined that the families consumed more pasteurized milk. The average age of the interviewed individuals was 37.14 years. About 36.21% of the parents were high school graduates. 53.48% of them spend money on milk less than 50 TL. Household size was 4.05 persons. 21.84% of them consume milk hot. The attitude of the parents to the school milk programme was generally positive (82.17%). The school milk programme was believed to be a habit of consuming milk. It was found that 33.33% of the surveyed parents were negative about the school milk programme because they did not trust the content of the milk distributed. In the study, 49.30% of the parents thought that the school milk programme increased the milk consumption habits of the children and 67.97% thought that there was not more supply of milk distributed. For the purpose of implementing the school milk programme, 48.75% of the families had a judge to love the milk and make milk drinking habit. The majority of the families (62.40%) were preferred daily milk in the products distributed and 44% believed that drinking milk was subjected to nutritional analysis. It is suggested that the Ministry of National Education and the Ministry of Health should inform families about the benefits of milk and school milk programme