Sami Ulus Children Research Articles

Hematological parameters in pediatric patients with primary headache

Aim: The present study aimed to evaluate the pain parameters in children with primary headache according to the International Classification of Headache Disorders, 3rd edition, diagnostic criteria and to investigate the role of hematological parameters in diagnosis in case the distinguish is difficult especially in children with migraine and tension headache. Materials and Methods: Medical data belonging age, gender, headache characteristics, hematological parameters of the outpatients with headache consulted in Beþtepe Child Neurology Outpatient Clinic of Dr. Sami Ulus Children's Hospital between July 2017 and August 2019 were examined retrospectively. SPSS statistical software was used to perform statistical data analysis. Results: A total of 243 patients (151 female, 92 male) were included in the study. The mean age was 13.68 ± 2.25 years. One hundred and one (58 female, 43 male) patients were diagnosed with migraine and 142 (93 female, 49 male) with tension type headache. Migraine presented the characteristics of unilateral (61.2%), pulsatile (88.5%) headache of moderate to severe intensity that worsens with physical activity, occurs usually in mornings (%46,5) and is accompanied by nausea or by photophobia and phonophobia (%34,3). Tension-type headache presented the characteristics of circumferential (53,2%), pressing (87.7%) headache of mild severe intensity that is triggered by school stress and accompanied phonophobia (65.2%), and occurs usually in evenings (55.3%). White blood cells, neutrophil, monocyte, monocyte-lymphocyte ratio and neutrophil-lymphocyte ratio were significantly higher in patients with migraine and lymphocyte and platelet counts were significantly higher in patients with tension type headache. Conclusion: In terms of shining a light on the future, consideration of the contribution of hematological parameters to differential diagnosis as a diagnostic support, due to the difficulties associated in particular with the presence of overlapping symptoms in the differential diagnosis of migraine and tension headache in childhood could make a significant difference.

Serum IgG, and IgM Levels in Children with Febrile Convulsions

At the Dr. Sami Ulus Children's Hospital Ankara, Turkiye, 20 patients, twelve being between 6 months-2 year old and eight being between 2-4 years, with their first febrile convulsions (FC) were examined for serum IgG, IgA, IgM levels during the period of March 1989-]uly 1989. Twenty healthy children were used as controls, seven being between 6 months-2 years old and thirteen being between 2-6 years. The serum IgG, IgA and IgM levels of the patients between 6 months-2 years were 805.000 + 307.8984 mg/ dl, 49.7167 + 27.9807 mg/dl and i55.1833 + 62.9696 mg/dl respecttvelly.
 The serum IgG, IgA and IgM levels of the patients between 2-4 years were : 989.1250 ± 314.5359 mg/dl, 92.6125 ± 34.5663 mg/dl and 159.8750 ± 45.6647 mg.ldl respectivelly. The mean IgA levels of the 12 FC patients between 6 months-2years were 49.7167 ± 27.9807 mg/dl and the mean level of IgA in the age matched control group was 81.0427± 31.3551 mg/dl and the difference between them was statistically significant (p <0. 005).
 We conclude that FC under 2 years of age is associated with low serum IgA levels.

The socioeconomic and biological risk factors for developmental delay in early childhood

To investigate the biological and socioeconomic factors associated with developmental attainment in socioeconomically disadvantaged children. This study was performed at the Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, between January and December 2010. The effects of biological, socioeconomic risk factors on developmental delay were investigated in 692 children (3 months-5 years) using the Denver II. Low-level maternal education (odds ratio [OR], 11.118; 95 % CI, 4.211-29.351), low-level paternal education (OR, 2.107; 95 % CI, 1.333-3.331), low-level household income (OR, 2.673; 95 % CI, 1.098-2.549), and ≥ 3 children in the family (OR, 1.871; 95 % CI, 1.206-2.903) were strongly associated with abnormal on Denver II; biological risk factors, including birth weight, gestational age at birth, and maternal age at birth <20 years, were correlated with suspect on Denver II results based on univariate analysis. Low-level maternal education (OR, 6.281; 95 % CI, 2.193-17.989), premature birth (32-36 weeks of gestation; OR, 0.535; 95 % CI, 0.290-0.989) were strongly associated with abnormal on Denver II results, and low-level paternal education (OR, 3.088; 95 % CI, 1.521-6.268), low-level household income (OR, 1.813; 95 % CI, 1.069-3.077), low birth weight (<1,500 g; OR, 3.003; 95 % CI, 1.316-6.854), premature birth (27-31 weeks of gestation; OR, 2.612; 95 % CI, 1.086-6.286), and maternal age at birth <20 years (OR, 3.518; 95 % CI, 1.173-10.547) were strongly associated with suspect on Denver II results based on multivariate analysis. Socioeconomic risk factors were observed to be as important as biological risk factors in the development of children aged 3 months-5 years.

Acute rheumatic fever in the Central Anatolia Region of Turkey: a 30-year experience in a single center

The study was carried out in Dr. Sami Ulus Children's Hospital to investigate and to compare the incidence and findings of acute rheumatic fever patients (ARF) seen in the past 30 years. The medical records of 1,115 patients with ARF admitted to Dr. Sami Ulus Children's Hospital Department of Pediatric Cardiology during 1980-2009 were retrospectively analyzed. Twenty-one percent of those patients were admitted between 1980 and 1989, 44.6% between 1990 and 1999, and 34.2% between 2000 and 2009. The highest incidence was detected in the second decade with a rate of 60.0:100,000. Male/female ratio was 1:18. The age of patients ranged between 2 and 15 years. Carditis was detected in 64.7% of patients, arthritis in 59.1%, and chorea in 14.1%. Mitral regurgitation was the most common echocardiographic finding. Heart failure was detected in 13.8%. Recurrent attacks occurred in 8.1% of patients. The median follow-up was 6.8 years (range, 1.2-10.5 years). The prevalence of chronic rheumatic valvular disease was 58%. Mortality rate was 0.8%. Although the incidence of ARF has decreased in the last decade, it still continues to be an important public health problem in Turkish pediatric population.

External Genital Proportions in Prepubertal Girls: A Morphometric Reference for Female Genitoplasty

An understanding of normal genital anatomy is essential for a successful surgical approach and outcome in feminizing genitoplasty. We sought to establish genital standards in female children through external genital measurements taken from the end of the neonatal period until the beginning of adolescence. This prospective study included 205 females who were anesthetized for surgery for various diagnoses between January 2007 and March 2008. Patient age ranged from 1 month to 10 years. Patients were divided into 4 age groups-1 to 12, 13 to 24, 25 to 60 and 61 to 120 months. Information on patient age, height, weight and, for patients younger than 1 year, head circumference was retrieved from patient charts. Measurements of clitoris length, clitoris width, labia majora length, left and right labia minora length and width, and perineal distance were recorded. Specific equations were generated using these values to estimate the expected external genital structure dimensions in girls. Length of labia majora vs age, length of labia majora vs body weight, perineal distance vs body weight, clitoral width vs body weight and clitoral length vs age reference percentile curves were prepared. The equations and percentile curves generated can be used as a guide in prospective feminizing genitoplasty. Furthermore, patients and their families can be informed regarding the variability of external genitalia dimensions. This information should ensure a healthier appreciation of the postoperative genitalia by patients and their families.

Evaluation of Urine Collection Methods for the Diagnosis of Urinary Tract Infection in Children

Objective: To evaluate the accuracy of urine sample collection methods among children suspected of having urinary tract infections. Subjects and Methods: Four methods for urine sample collection were evaluated in 1,067 children aged 0–16 years with suspected urinary tract infections over 2 months at Dr. Sami Ulus Children’s Hospital. Within 30 min of collection, all specimens were sent to the laboratory, refrigerated and processed according to standard hospital microbiological procedures. Urine samples were analyzed using routine culture techniques. Results: At initial sending of the urine culture, 617 (57.8%) had negative culture results, 145 (13.6%) had positive culture results, and 305 (28.6%) had evidence of bacterial contamination. Clean catch specimens showed a contamination rate of 14.3% and urethral catheterization specimens showed a similar contamination rate (14.3%). However, urethral catheterization was preferred in only a small number of cases (n = 7). Suprapubic aspiration was also used in a small number of cases (n: 11) and the contamination rate for suprapubic aspiration was 9.1% (n: 1/11). The contamination rate for sterile urine bag was 43.9%, significantly higher than the other methods (p < 0.001). Conclusion: Suprapubic aspiration showed the lowest contamination rate and sterile urine bag showed the highest contamination rate among 4 methods of urine sample collection. Contaminated specimens, needed to be repeated and this procedure increased the cost of urine culture. In conclusion, measures should be taken to reduce the contamination rate in our center. This is an area where further investigation is required.

Underlying diseases of recurrent pneumonia in Turkish children*

The aim of the present study was to determine the relative frequency of recurrent pneumonia in children and to describe its underlying illnesses. Materials and methods: Children between 3 months and 16 years old who had a history of 2 or more episodes of pneumonia per year, or 3 or more episodes in a lifetime were investigated retrospectively at Doctor Sami Ulus Children's Training and Research Hospital between January 2002 and December 2004. Results: Out of 595 children admitted for pneumonia, 62 (10.42%) met the criteria for recurrent pneumonia. An underlying illness was demonstrated in 56 patients (90.32%). In this study, the underlying illness was diagnosed during recurrence in all patients. The patients with persistent pneumonia were excluded from the study. Underlying diseases were bronchial asthma (30.64%), immune deficiency disorders (17.75%), aspiration syndromes (17.75%), and congenital anomalies (16.12%). No predisposing illness could be demonstrated in 6 patients (9.68%). Conclusion: Approximately 1 in 10 children with pneumonia in our hospital had recurrent pneumonia. Most of these children had an underlying illness, which was demonstrated. Bronchial asthma was the most common underlying illnesses for undiagnosed recurrent pneumonia in children.

Bismuth Salts in the Treatment of Helicobacter pylori Infection in Children

Delghani et al. [1] evaluated the efficacy of three different regimens for eradication of Helicobacter pylori (H. pylori) infection in children. The authors concluded that quadruple therapy containing bismuth yields better results and can be used as first-line of therapy. The study is both well designed and well managed, and highlights the need for novel therapies in children with H. pylori infection. Here are some important points of the study that should be discussed. The study group was composed of 120 children with a mean age of 12 ± 4 years (range 2–18 years). H. pylori eradication was assessed with urea breath test (UBT). The utility of UBT in children over 6 years of age was confirmed by numerous studies. The sensitivity and specificity for children in this group were found to be 100 and 98% respectively, with positive predictive value (PPV) and negative predictive values (NPV) of 98 and 100% respectively. In young children, however, false-positive results compromise the accuracy of the test. For children under the age of 6 years, specificity was determined to be 88% and PPV 69% [2]. The accuracy of UBT can be improved by increasing delta over baseline (DOB) cut-off values; however, the false-positive rate remains high [2, 3]. It would be better to provide brief methodologic data regarding UBT including information at least about cut-off values and whether values are adjusted for age. The authors reported the eradication rate with quadruple therapy with bismuth 91.8% compared to 82.1 and 80.5% with current triple therapies containing clarithromycin in the second group and metronidazole in third group, respectively. The authors suggested quadruple therapy as the first-line of therapy for the eradication of H. pylori infection in children in their geographic area. Treatment of H. pylori infection in children with protocols containing bismuth compounds have been reported with variable success [4–7]. In a recent report of pooled data [8], bismuth triple therapies were found to be more efficacious than proton pump inhibitor triple therapies (77 vs. 64%) as a first-line treatment. Indeed, the eradication rate is better with quadruple therapy in the present study, but not sufficiently high to suggest it as a first-line therapy (p = 0.33). Secondly, bismuth compounds are major drugs of rescue regimens after H. pylori treatment failure. The most important cause of treatment failure is drug resistance. In this case, it is fairly logical to reserve bismuth compounds as a second-line option to decrease the risk of drug resistance. Although the use of bismuth compounds has been reported in children [8], they still require approval to use. Therefore, the use of bismuth compounds in children may be of ethical concern. In adults, it has recently been suggested that fluoroquinolone-based rescue therapies constitute an encouraging second-line strategy, representing an alternative to quadruple therapy with efficacy, simplicity, and safety [9–11]. Although pediatric data is limited, fluoroquinolone-based therapies can be tried as rescue therapy in children over the age of 8 [12]. Lastly, compliance is an important determinant of treatment success. Multiple drug use is an important risk factor and therefore compliance is expected to be low with quadruple therapy. In conclusion, it is still too early to suggest quadruple therapy containing bismuth compounds as a first-line option in children with H. pylori infection. Moreover, we need further comparable studies in order to determine the case for quadruple therapies containing bismuth compounds as a second-line option. S. Gokce (&) Pediatric Gastroenterology, Hepatology and Nutrition, Dr. Sami Ulus Children’s Hospital, Ankara, Turkey e-mail: drgokce0007@yahoo.com

Bronchopulmonary dysplasia in very low birth weight infants

The developments in newborn care have enabled many more very low birth weight premature infants to live. The aim of our study was to determine the risk factors for bronchopulmonary dysplasia (BPD) development by evaluating mild and moderate/severe BPD in extramural neonates with a birth weight <1501 g. A case-control study was conducted between January 1, 2004- December 31, 2006 at the Dr. Sami Ulus Children's Hospital Neonatal Intensive Care Unit. Patients with BPD and without BPD were compared. Bronchopulmonary dysplasia was diagnosed and classified according to the Bancalari criteria. One-hundred and six (106) extramural premature infants with a birth weight <1501 g and admitted to the Neonatal Unit in the first three days of life and survived for more than 28 postnatal days were included. Patients with multiple congenital anomalies and complex cardiac pathologies were excluded. The maternal and neonatal risk factors, clinical features, mechanical ventilation treatment were compared. The principal risk factors for BPD development were analyzed and followed by logistic regression test. The diagnosis was mild BPD in 27 of the 106 patients and moderate/severe BPD in 29. The incidence of BPD was 52.8%. Fifty of 106 patients had no BPD. Analysis of risk factors revealed that gestational age < or =28 weeks (p=0.019), birth weight < or =1000 g (p=0.007), hypothermia (p=0.003), acidosis (p=0.003) and hypotension (p=0.005) at admission, respiratory distress syndrome (RDS) ( p<0.001), mechanical ventilation therapy (p<0.001), surfactant therapy (p=0.005), higher amount of mean fluid therapy on 7(th) days (p=0.008), nosocomial infection (p<0.001), higher amount of mean packed red cell transfusions (p<0.001) and more than two packed red cell transfusions (p=0.033) were risk factors associated with the development of BPD. Multivariant logistic regression analysis showed acidosis at admission (OR 5.12, 95%CI 1.17-22.27, p=0.029), surfactant treatment (OR 7.53, 95%CI 2.14-26.45, p=0.002), nosocomial infections (OR 4.66, 95%CI 1.27-17.12, p=0.02) and PDA (OR 9.60, 95%CI 2.23-41.22, p=0.002) were risk factors increasing the severity of BPD. The most important risk factors for BPD development in our study were RDS and nosocomial infections while the presence of acidosis at admission, surfactant administration, nosocomial infections and the presence of PDA were the most important risk factors regarding BPD severity. Presence of acidosis at admission as a risk factor emphasized the importance of suitable transport conditions for premature infants.

Hemostatic Side Effects of High-Dose Methotrexate in Childhood Acute Lymphoblastic Leukemia

The purpose of this study is to investigate the hemostatic side effects of HDMTX. Between 2001 and 2002, 20 children with acute lymphoblastic leukemia at the Dr. Sami Ulus Children's Hospital, Department of Pediatric Hematology and Oncology, treated according to the St. Jude ALL XIII protocol were eligible to this study. Methotrexate at a dose of 2 g/m2was infused over 24 hours. Coagulation screening studies included prothrombin time (PT), APTT, fibrinogen, fibrin degradation product (D-Dimer), factor II, factor V, factor VII, factor VIII, factor IX, factor X, PC, PS, AT-III determinations before HDMTX therapy (PreT), 1 day after (PostT1D), and 1 week after (PostT1W) the end of the HDMTX infusion. We found that PT and APTT were prolonged, PC, PS, and AT-III levels were decreased with a slight increase in D-Dimer 1 day after the administration of HDMTX and all of them returned to the normal levels by 7 days. In addition we found that FVII, FIX, FX were significantly decreased 1 day after therapy and normalised by 7 days.

Çocukluk Çağı Akut Lenfoblastik Lösemili Olgularda Yüksek Doz Methotreksat Uygulamasının Oral Glukoz Tolerans Testi Üzerine Etkileri

Effects of High-Dose Methotrexate Therapy on Glucose Metabolism in Childhood Acute Lymphoblastic Leukemia Methotrexate (MTX) has been used in the treatment of childhood acute lymphoblastic leukemia (ALL) for over 40 years. A number of the acute toxicities are common with high dose methotrexate (HDMTX) infusion, including myelosuppression, vomiting, orointestinal mucositis, hepatic and renal toxicities, neurological disturbances. On the other hand, effect of HDMTX therapy on glucose metabolism was not known. Between 2001 and 2002, twenty children with acute lymphoblastic leukemia at the Dr. Sami Ulus Children's Hospital, Department of Pediatric Hematology and Oncology were treated according to the St. Jude ALL XIII protocol were eligible to this study. Dose of MTX (2 gr/m2) was infused over 24 hours. Orally glucose tolerance test was performed at before HDMTX therapy, 1 day and 1 week after the therapy. We found that HDMTX infusion did not significantly effect on orally glucose tolerance test during the first week. Methotreksat (MTX), akut lenfoblastik losemi (ALL) tedavisinde 40 yildan fazla suredir kullanilmaktadir. Yuksek doz MTX (YDMTX) tedavisine bagli myelosupresyon, kusma, mukozit, norolojik bozukluklar, hepatik ve renal toksisite bildirilmistir. Ancak, YDMTX tedavisinin oral glukoz tolerans testi uzerine etkileri bilinmemektedir. Dr. Sami Ulus Cocuk Sagligi ve Hastaliktan Merkezi Pediatrik Hematoloji ve Onkoloji bolumlerinde 2001 - 2002 tarihleri arasi ALL tanisi ile, St. Jude Total XIII ALL protokolunde bulunan ve YDMTX tedavisi almakta olan 20 hasta calismaya alindi. Yuksek DMTX tedavisi 2gr/m2 dozunda, 24 saatlik infizyon seklinde verildi. Tedavi oncesi (TO), tedavi sonrasi 1. gun (TS1G) ve tedavi sonrasi 7. gun (TS7G) oral glukoz tolerans testi (OGTT) uygulandi. Yuksek DMTX tedavisi sonrasindaki 1 hafta suresince glukoz metabolizmasinda belirgin bir degisiklik saptamadik.

Folic acid supplementation and neural tube defects

American Journal of Medical GeneticsVolume 109, Issue 1 p. 67-69 Research Letter De novo translocation t(5;6)(q35;q21) in an infant with Walker-Warburg syndrome Nilüfer Karadeniz, Corresponding Author trkaradeniz@hotmail.com Dr. Zekai Tahir Burak Woman's Hospital, Department of Medical Genetics, Ankara, TurkeySevil sokak 16/3, 06590 Cebeci-Ankara, Turkey.Search for more papers by this authorAyşegül Zenciroğlu, Dr. Sami Ulus Children's Hospital, Department of Neonatology, Ankara, TurkeySearch for more papers by this authorY.K. Yavuz Gürer, Dr. Sami Ulus Children's Hospital, Department of Child Neurology, Ankara, TurkeySearch for more papers by this authorNesrin Şenbil, Dr. Sami Ulus Children's Hospital, Department of Child Neurology, Ankara, TurkeySearch for more papers by this authorYasemin Karadeniz, Kırıkkale University, Medical Faculty, Department of Radiology, Ankara, TurkeySearch for more papers by this authorHaluk Topalŏlu, Hacettepe Children's Hospital, Department of Child Neurology, Ankara, TurkeySearch for more papers by this author Nilüfer Karadeniz, Corresponding Author trkaradeniz@hotmail.com Dr. Zekai Tahir Burak Woman's Hospital, Department of Medical Genetics, Ankara, TurkeySevil sokak 16/3, 06590 Cebeci-Ankara, Turkey.Search for more papers by this authorAyşegül Zenciroğlu, Dr. Sami Ulus Children's Hospital, Department of Neonatology, Ankara, TurkeySearch for more papers by this authorY.K. Yavuz Gürer, Dr. Sami Ulus Children's Hospital, Department of Child Neurology, Ankara, TurkeySearch for more papers by this authorNesrin Şenbil, Dr. Sami Ulus Children's Hospital, Department of Child Neurology, Ankara, TurkeySearch for more papers by this authorYasemin Karadeniz, Kırıkkale University, Medical Faculty, Department of Radiology, Ankara, TurkeySearch for more papers by this authorHaluk Topalŏlu, Hacettepe Children's Hospital, Department of Child Neurology, Ankara, TurkeySearch for more papers by this author First published: 22 March 2002 https://doi.org/10.1002/ajmg.10286Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Citing Literature Volume109, Issue115 April 2002Pages 67-69 RelatedInformation

Etiology of chronic diarrhea.

With worldwide use of oral rehydration solutions, the treatment of acute diarrhea does not pose much of a problem. However, chronic diarrhea is still harmful, especially for the growth and development status of the children. Between January 1993 to December 1996, patients who suffered from chronic diarrhea for more than one month duration and admitted to Dr. Sami Ulus Children's Hospital were evaluated for epidemiological and etiologic factors. Seventy consecutive patients were evaluated. The mean age was 40.8 months and 52% were males. Malnutrition was detected in 80% of cases. Etiologic factors included celiac disease 30%, cow milk allergy 17%, bacterial and parasitic factors 26%, cystic fibrosis 10% and postinfectious gastroenteritis 10%. Eosinophilic gastroenteritis, chronic nonspecific diarrhea, pseudo-obstruction, neurofibromatosis and inflammatory bowel disease were rarely detected. Celiac disease and cow milk allergy were implicated as the most common causes of chronic diarrhea. The vicious cycle of faulty nutrition, malnutrition and infection and postinfectious enteropathy were also significant factors in the etiology of chronic diarrhea. It may be considered that cow milk protein prick test, sweat test, immunologic tests and mucosal biopsies should be performed for the definite diagnosis of chronic diarrhea.