Objective: We investigated whether the results of leptin gene (LEP) 2548G/A (rs7799039) and leptin receptor gene (LEPR) 668 A/G (rs1137101) variants, as well as the methylation analysis of CpG regions at nucleotides −31 and −51 of the LEP gene, showed any differences between breastfed and non-breastfed children in this study. Materials and Methods: The cross-sectional study included 100 children aged 2–5 years who were attending nursery and kindergarten and had been accepted to the Department of General Paediatrics. Infants who were exclusively breastfed for the first six months after birth constituted the study group, and those who were not only breastfeed constituted the control group. Methylation percentages at CpG islands of the LEP gene were compared between exclusively breastfed and non-exclusively breastfed infants, and the statistical significance was analyzed by looking for changes in LEP −31 and −51 nt methylation and LEP 2548G/A ve LEPR 668 A/G variants. Results: Both groups were compared by feeding, and the association of LEPR and LEP gene polymorphisms and −51 nt and −31 nt methylations were analyzed. There were no significant differences between the groups regarding genotype and allele frequency for the LEPR 668 A/G, LEP 2548 G/A gene variant, −31 nt methylation, and −51 nt methylation status. Similarly, there was no significant difference in genotype and allele frequency for the LEPR 668 A/G gene variant in terms of duration of exclusive breastfeeding, total breastfeeding, body mass index, family obesity, and satiety status. However, maternal support from family elders and physical activity increased the 51 nt methylation, but this methylation was not significantly affected by BMI, age, or satiety status. Conclusions: Maternal support from family elders and physical activity were associated with increased 51 nt methylation, but this methylation was not significantly affected by BMI, age, or satiety status. However, there are not enough studies in this area to reach a definitive conclusion, and further research is needed.

Objective: Immunization is one of the most important public health interventions. However, vaccine hesitancy has increased in the last few years. The aim of this study was to assess the knowledge, attitudes, and practices of families regarding immunization of 12-60-month-old children. Material and Methods: The data were collected through face-to-face interviews and a questionnaire based on the literature review. A total of 218 families with children aged 12-60 months who visited the general pediatrics outpatient unit for various reasons constituted the study population. Results: Of all the families, 87.6% considered vaccines to be necessary for their children. Among all families, 99.1% reported that their children were vaccinated and 96.3% stated that their children were fully immunized. Most of the parents (%97.7) said that being immunized protects their children's health. Hygiene (39.9%) was reported as the most common way to protect against contagious disease. Of all families, 62.8% knew at least two vaccines in the national program, 3.2% knew the vaccines that are not in the program, and 51.4% knew the vaccine-preventable diseases. Of all families, 29.4% mentioned measles as a vaccine-preventable disease. 74.1% knew at least two vaccine-preventable diseases and vaccines. As maternal education level increased, knowledge about vaccine-preventable diseases also increased. Only 44.5% of families reported the name of the first vaccine applied at birth. 40.8% of families stated that immunization was completed at age 2. 29.8% of families vaccinated their children using vaccines that they had to pay for; 80.3% of families stated that they will vaccinate their children if they were informed about the need. Maternal educational level, maternal employment status, and being informed increased implementation of vaccines not in the national program. 86.7% of families reported that they consider doctors' suggestions about vaccination. Conclusions: Families have a lack of knowledge regarding vaccines; maternal educational level, maternal employment status, and being informed increased vaccination rates of vaccines not in the national program.

The objective of this study was to determine the impacts of preventable causes of fracture, such as vitamin D deficiency, disturbed calcium homeostasis and obesity on fracture occurrence in minor traumas. In this way, the effects of relevant parameters on fracture may be further elucidated. A prospective case-control study in children aged 2–18 years children with and without fractures was performed. Participants with a pediatric trauma score higher than 10 presenting to minor trauma were included to exclude the significant impact of severe trauma on fracture. The effects of obesity, parameters associated with vitamin D and Ca homeostasis on fracture occurrence were evaluated. Univariate and multivariate analyses were used to test for associations between fracture status and the assessed variables. The relationships between the variables and the odds of fracture occurrence were examined using logistic regression models. The sample consisted of 76 patients and 50 controls. There were no significant differences between the patients and controls in terms of age, sex, trauma type and pubertal period. The patients had a significantly higher mean BMI percentile (61.2 ± 30.7, 36.7 ± 30.7; P < 0.001). Likewise, patients were more likely than controls to have a lower mean 25(OH)D level and mean phosphorus level (respectively, 13.4 ± 7.0, 17.3 ± 7.8; P = 0.004, and 4.6 ± 0.7, 5.1 ± 0.8; P < 0.001). Moreover, fractures were substantially more frequent in children with vitamin D deficiency (<20 ng/mL, χ2: 7.781, df: 1, P = 0.005). In the multivariate logistic model, BMI percentile and vitamin D levels remained significantly associated with increased odds of fracture [1.02 (1.01–1.04), P < 0.001 and 0.93 (0.89–0.98), P = 0.01]. The present study supports an association of high BMI and vitamin D deficiency with an increased odds of fracture occurrence in children. The findings may help physicians to reduce the risk factors of fracture by preventive efforts. Thus, unexpected health costs and morbidity may be minimized.

Aim: Vitamin D deficiency is highly prevalent among children worldwide. This study aims to assess the frequency of vitamin D deficiency in children and how it varies according to gender, age, and season in Istanbul. Materials and methods: The study included 3096 children aged 0-18 admitted to the pediatric outpatient clinic in Istanbul. The serum 25 hydroxyvitamin D concentration was categorized into four groups: deficiency (100 ng/mL). Descriptive methods, Chi-square, Independent Samples T-Test, ANOVA, and correlation test were used in the statistical analysis of the data. Results: Of children, 52% were girls and 48% boys. The mean serum 25 hydroxyvitamin D concentration was 21.8 ± 15.8 ng/mL, and the frequency of vitamin D deficiency was 53.1%. There was a different distribution of vitamin D status between age groups. Vitamin D deficiency was more common in older children. There was also a significant difference between girls and boys in the frequency of vitamin D deficiency (57.6% versus 48.3%). The mean serum 25 hydroxyvitamin D concentration was significantly lower in winter and spring. A moderate negative correlation was found between age and serum 25 hydroxyvitamin D concentration (correlation coefficient:-0.36). Conclusion: This study showed that female sex, older children, and the winter/spring seasons were significantly associated with a higher frequency of vitamin D deficiency and a lower mean serum 25 hydroxyvitamin D concentration.

Introduction: Tracheostomy care in children may be challenging, due to lack of knowledge of health care providers. The aim of this study was to determine the level of knowledge of health care providers who follow patients with tracheostomy and to increase this level with theoretical education and training in a simulation laboratory. Materials and Methods: Volunteer participants were subjected to a theoretical pretest which evaluated their knowledge level for the care, follow-up and treatment of patients with tracheostomy. Then, practical testing with three subheadings evaluating the change of the tracheostomy cannula was applied. After theoretical training and one-on-one practical training given to the participants with a simulation model, theoretical and practical posttests were applied. Results: Fifty-one health care providers from six tertiary pediatric clinics in Istanbul were enrolled in the educational course. Only 6 (11.8%) of them received standardised training programme previously. Regarding the theoretical tests, seven of the 33 questions were indicated as crucial. The knowledge level of the participants based on the crucial questions significantly increased after the training (p value <0.05 for all of the crucial questions). Total number of correct answers and correct answers of 3 subheadings also significantly increased after the practical training (p value <0.001 for all). Ninety-five percent of the participants assessed the course as good or excellent. Conclusion: Training in simulation laboratory together with theoratical education can improve the knowledge and skills of the health care providers enabling improved care of children with tracheostomy.

Cetirizine is a selective H1 histamine receptor antagonist derived from piperazine. Piperazine is a cyclic moiety molecule located in the structure of many drugs, including anxiolytics, antidepressants, and antipsychotics. Drug-induced dystonia is reported mostly due to antipsychotic and antiemetic drugs. It occurs due to the disruption of dopamine and acetylcholine balance in favor of acetylcholine. Although cetirizine is a relatively safe drug, it has rarely been reported to cause a dystonic reaction. To the best of our knowledge, there is no reported case of dystonia due to cetirizine in infancy. Here, we present a 7-month-old patient who developed a dystonic reaction after cetirizine administration.

Ayşe Kılıç1, Sevinç Gümüş Pekacar1, Aylin Yetim1, Gonca Keskindemirci1, Mustafa Özçetin2, Muhammet Ali Varkal1, Firdevs Baş3 Şükran Poyrazoğlu3, Feyza Darendeliler3, Dilek Battal4, Ayça Aktaş5, İsmet Çok5 1 Department of Pediatrics, İstanbul University, Medical Faculty, Istanbul 2 Department of Family Health, Istanbul University, Institute of Child Health, Istanbul 3 Department of Pediatric Endocrinology, İstanbul University, Medical Faculty, Istanbul 4 Department of Pharmaceutical Toxicology, Mersin University, Faculty of Pharmacy, Mersin 5 Department of Pharmaceutical Toxicology, Gazi University, Ankara, Turkey Bisphenol A levels and body weight The relationship between urinary bisphenol A levels and body weight in children

Sleep related dissociative disorder is a parasomnia and may be related to childhood adverse events including sexual and/or physical abuse.In this case report, we present a 15-year-old girl with a history of multiple episodes of somnambulism and a family history of multiple relatives with somnambulism, who was admitted to our emergency unit after attempting suicide during sleep.In her 5-year follow-up, parasomnias were replaced by psychogenic non-epileptic seizure attacks.An experience of severe physical abuse in early childhood was uncovered.

Hypomelanosis of Ito (HI) is characterized by unilateral or bilateral hypopigmented skin lesions and usually presents as a multisystemic disorder. Skin lesions may develop in different textures, such as linear, whorled, or patchy, and are often accompanied by abnormalities of the central nervous system, skeletal system, eyes, and teeth. HI is associated with sporadic gene mutations but not gender. Presentation of the current case may be of use in reminding practitioners of the common extracutaneous findings of HI, along with some rare manifestations, such as delayed speech and asymmetric limb growth.

INTRODUCTION:Fibrodysplasia ossificans progressiva previously known as myositis ossificans progressiva is a rare connective tissue disorder with autosomal dominant genetic inheritance. Patients develop heterotrophic ossification starting with the first decade of life. Diagnosis is extremely difficult until ossifications are visible.CASE REPORT:We report a case of fibrodysplasia ossificans progressiva in a 5-year-old boy who has characteristic extracapsular joint movement limitation with bilateral great toe malformation. Before clinical suspicion and genetic confirmation, the patient had undergone various medical tests including biopsy. The patient was diagnosed by the help of characteristic great toe malformations with the help of X-ray taken after ossification signs revealed.CONCLUSION:Fibrodysplasia ossificans progressiva is an unforgiving disease. Late diagnosis can lead the physicians to perform additional invasive test and restrains patients to avoid the exposure of more daily trauma. Although there is no treatment for the disease in current literature, we believe with the characteristic features, it could be diagnosed in short notice and managed properly.

An accurate estimate of body composition is important in the assessment and monitoring of nutrition. Knowing the normal growth rate of children helps early diagnosis of diseases and reduces unnecessary examinations. Different and effective methods for evaluating body compositions have been developed in recent years. Effective measurement of body composition is crucial in taking important health-related decisions in different branches of the clinical sciences. BIA has become a frequently used method in assessing the body composition of patients in clinics as a result of being safe, an indirect method, partly low cost, and an effective evaluation method.

Aim The aim of the study was define the normal values of tympanic and axillary body temperature in healthy children. Methods This observational cross-sectional study was performed in healthy children aged 0 to 17 years who visited the ambulatory general pediatric of Istanbul Medical Faculty. Results Of 1364 children, 651 (47.7%) were girls and 713 were boys, the mean (SD, range) age was 72.5 (53.6, 1–204) months. The mean (SD) axillary body temperature was 36.04°C (0.46°C; minimum, 35.0°C; maximum, 37.6°C). The 95th and 99th percentiles were 36.8°C and 37.0°C, respectively. The mean (SD) tympanic body temperature was 36.91°C (0.46°C; minimum, 35.15°C; maximum, 37.9°C). The 95th and 99th percentiles were 37.6°C and 37.8°C, respectively. There were statistically significant differences between sexes for only tympanic body temperatures. Both axillary and tympanic body temperatures were statistically higher in 0 to 2 months compared with other age groups. For this age group, the 99th percentile was 37.5°C for axillary and 37.85°C for tympanic temperature. Conclusions Axillary and tympanic body temperatures should be considered as fever when they are more than 37.0°C and 37.8°C, respectively. For 0 to 2 months, fever is 37.5°C and 37.85°C in axillary and tympanic temperatures, respectively.

The term adolescence comprises of multiple factors including adolescent’s thoughts,feelings, behavioral characteristics, family structure, health and nutritional conditions, geographical features, climate, culture, and society. Therefore multidisciplinary professional approach is required in this special period. One of these disciplines is the social work discipline. Social work interferes with adolescents, as in the all applicant groups, with the formulation of “psycho-social diagnosis and treatment”. Psychosocial assessment can not be used in place of medical treatment but supports medical treatment. The professional intervention of the social worker with the psychosocial formula in adolescents and families is very meaningful in terms of their continuing quality of life and well-being, and this contribution is also transferred to social refinement. The focus of social work is the “individual in the periphery”. In this review, the aim is to reveal the role of social worker in evaluating adolescent in micro-, and mezzo perspective.

Aim: Cervical lymphadenopathy (LAP) is a common sign and may raise fears about serious illnesses. The aim of our study was to evaluate the patients with cervical LAPs in a general pediatrics clinic setting, and to evaluate follow-up results for potential causes and risk factors for malignancies.Material and methods: Two hundred-eighteen patients aged between 79.4 +/- 46.7 months with LAP were enrolled in this prospective cohort study. The patients were examined in terms of demographics, clinical, radiologic and serologic aspects like Epstein-Barr virus (EBV), cytomegalovirus (CMV), parvovirus B19. A lymph node biopsy was performed in selected patients. The patients were followed-up for 8 weeks and risk factors for malignancy Were evaluated.Results: Seventy patients (41.3%) had specific etiology and 6 (2.7%) had malignant causes. The causes were as follows: 27% (n = 59) infections; 2.7% (n = 6) malignancies; 11.4% (n = 25) other causes. EBV was responsible for 27% of infectious causes. The other common infectious etiologies were CMV 4.3%, parvovirus B-19 2.9%, and group-A beta-hemolytic streptococcus (GAS) 10.8%. Four of the six malignancies were lymphomas. Predictive factors for malignancy were having LAP larger than 30 mm, rubbery lymph node, high serum CRP and LDH values, no hilum in ultrasonography, and enlargement of lymph node in follow-up. High uric acid levels and leucopenia were also common in the malignancy group.Conclusion: Etiology of cervical LAPs was diagnosed in 41.3% patients. Infectious causes were the most common cause with 27%. Malignancy was diagnosed in 2.7% and lymphoma was the most common malignancy. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Symptomatic primary genital herpes infection is very rare in early childhood. Herpes simplex virus 1 type is the infectious agent in 20-50% percent of primery infections. Sexual abuse should be considered when genital herpes is seen in a person before sexual active age. It is mild and self limiting unless the patient is immune compramised. In this paper we discussed a 17 months old patient with genital herpes and approach to genital herpes in children.

Gorham-Stout syndrome is a rare disorder characterized by endothelial proliferation of vascular vessels that results in the development of destruction and resorption of osseous matrix. A 6-year-old girl admitted to hospital with fever and cough. Lytic bone lesions were detected on ribs chest radiograms, and humerus within region of examination. In medical history we learned that right humerus and both of clavicles were broken before when she was 3 years of age at different times from each other with minor traumas. Extensive lytic lesions were observed on radiograms of pelvis, cranium, upper and lower extremities. Magnetic resonance imaging of the patient’s extremities were consistent with Gorham-Stout disease. We presented this case because Gorham-Stout disease is a rare disease and the diagnosis is difficult at its onset, and the disease can easily be confused with other diseases.

Chediak Higashi syndrome is a rare, autosomal recessive disorder that is characterized by variable degrees of oculocutaneous albinism, immune deficiency, recurrent infections and neurological signs. Hemophagocytic lymphohystiocytosis which progresses with acute febrile disease, pancytopenia, hepatosplenomegaly, lymphadenopathy and bleeding disorders, and characterized by massive lymphohystiocytic infiltration and macrophage activation can be lethal. Cytoplasmic giant granules are typically seen in all types of cells. A mutation in the LYST gene has been shown. Nearly 85 % of the cases with CHS are diagnosed as hemophagocytic lymphohistiocytosis within a few years after birth. In the diagnosis and treatment prevalently 2004 Guideline of Diagnosis and Treatment of HLH has been used. Its definitive treatment can only be possible with bone marrow stem cell transplantation. Here, we report a case of a two year- old boy with Chediak Higashi Syndrome who presented with hemophagocytic lymphohystiocytosis.

Objective: Vitamin D is an essential hormone in calcium, phosphor and bone metabolism. Skin synthesizes great amount of vitamin D in sun light, it can also be taken by diet. Vitamin D deficiency may occur in settings with low sunlight exposure. Medical personal are under risk for vitamin D deficiency, especially who works at night shifts and in low sun-exposed buildings. Our aim was to determine vitamin D levels of medical personal and evaluate effect of working time and place on vitamin D levels. Materials and Methods: Ninety-six Medical persons in Istanbul Medical Faculty of Istanbul University, between 1 April to 30 May 2014 were grouped in respect to working shift and place. Mean vitamin D levels are compared between groups. Participants were asked about doing periodical sport activities, sun creme usage and history of bone fractures. According to 25 (OH) Vitamin D levels they were classified as Vitamin D deficiency (<20 ng/ml), insufficiency (21-29 ng/ml) and sufficiency (>30 ng/ml) respectively. Results: Mean 25 (OH) Vitamin D level of all participants was 12.5±0.6 ng/mL. Where 85 (88.5%) of all cases showed deficiency of vitamin D, 10 (10.5%) had insufficient and 1 (1%) sufficient. Mean 25 (OH) Vitamin D level was14.6±7.5 ng/mL (4.1-34.3) in males and 11.8±5.7 ng/mL (2.4-29.3) in females, there was no statistical significance between both sexes. Nurses and other medical stuff had statistical lower vitamin D levels than doctors (p<0.05). There was no difference between vitamin D levels in personal working mainly night or day shift. Medical personal working in emergency-intensive care units showed no difference in vitamin D levels compared to worker in ambulatory settings. Conclusion: Medical personal has low levels of vitamin D and are at risk for vitamin D deficiency.