Medine Ayşin Taşar

Anne ve ergenlerdeki depresif belirtilerin ergen intiharları ile ilişkisi

Objectives: The aim of this study was to investigate the existence of depression symptoms, an important risk fac- tor in suicide attempts, in adolescents who attempted sui- cide and also in their mothers. OZET Amac: Bu calismanin amaci intihar girisiminde bulunan ergenlerde ve annelerinde, intihar girisiminde onemli bir risk faktoru olan depresif belirtilerin varligini arastirmaktir. Gerec ve yontem: Calismaya intihar girisimi ile basvuran 141 ergen ve anneleri alinmistir. Olgularin sosyodemog- rafik ozellikleri kaydedilmis, hastalara ve annelerine Beck Depresyon Olcegi ve Beck Umutsuzluk Olcegi uygulan- mistir.

An infant with hypercalcemia and hyperammonia: inborn error of metabolism or not? Answers

Pathological findings of this patient were mild dehydration, oral intolerance, andmetabolic acidosiswith alkaline urine and normal anion gap, hyperammonia, hypercalcemia, hypokalemia, positive urine anion gap, nephrolithiasis, and hypercalciuria. These findings were consistent with a diagnosis of distal renal tubular acidosis (dRTA). Intravenous fluid supply and oral sodium bicarbonate replacement therapy at 2 mEq/kg/day improved the metabolic acidosis, hyperammonemia, and dehydration in a few days. Potassium citrate was added for hypokalemia and prevention of urinary calculi. The serum ammonia level reduced to 97 mg/dL on the seventh day of treatment and the patient was discharged after an 18-day hospitalization. Ultimately, whole exome sequencing demonstrated a novel homozygote mutation in ATP6VOA4 gene, c.474delGinsTC (p.E158Dfs*29) (p.Glu158Asp*29). Our patient had weight gain with medication. Plasma ammonia level should be obtained for any child with unexplained vomiting, lethargy, or other evidence of an encephalopathy. Significant hyperammonia is observed in a limited number of conditions. Inborn errors of metabolism like urea cycle defect and many of the organic acidemia are at the top of list. Newborn transient hyperammonemia in differential diagnosis of newborn, and fatty acid oxidation defects may be considered in older infants. Urine organic acid analysis should be done for organic acidemia. Metabolic acidosis is not a typical feature of the urea cycle defect. Plasma amino acid analysis is helpful in the differentiation of the specific defects in this group [1]. Differential diagnosis of hyperammonia with less significant elevation in infants other than inborn errors of metabolism is transient hyperammonia of newborn, severe infection, liver failure, and urinary tract infection associated with congenital ureteral obstruction [2]. In our patient, we detected slight hyperammonia and analyzed plasma amino acid and urine organic acid tests which were found normal. Hypercalcemia is rarely seen in children and is a much less common problem than hypocalcemia. The cause of hypercalcemia is age-related with many cases underlying genetic origin. In order to provide the most appropriate treatment, the most important point is to establish the correct diagnosis promptly [3]. Causes of hypercalcemia in infants with elevated parathyroid hormone (PTH) levels include neonatal hyperparathyroidism, mucolipidosis type II, parathyroid-related pathologies, and phosphate depletion in prematurity. Causes of hypercalcemia in infants with low or suppressed PTH levels are malignancy, drug-induced, acute immobilization, genetic diseases likeWilliams and Down syndrome, idiopathic hypercalcemia of infancy, granulomatous disease like subcutaneous fat necrosis, sarcoidosis, tuberculosis, and endocrine causes like hyperthyroidism, Addison’s disease, pheochromocytoma, congenital hypothyroidism, diabetic ketoacidosis; inborn errors of metabolism like congenital lactase deficiency, Bartter syndrome, blue diaper syndrome, disaccharidase intolerance; renal causes like distal renal tubular acidosis, multicystic dysplasia, ketotic diet. Conditions with normal PTH levels are familial hypocalciuric hypercalcemia and types I, II, and III and early-onset primary hyperparathyroidism [4]. Ammonia (NH3 and NH4) is vital in maintaining the acid base status. Most NH4 is synthesized in proximal tubules. In the loop of Henle, NH4 goes into the interstitium, gets converted into NH3, and is accumulated in the medullary interstitium. Finally, NH3 diffuses into acidified urine as a buffer in the distal tubule. Both chronic metabolic acidosis and hypokalemia act as stimuli for renal ammoniagenesis and ammonia reabsorption. Because dRTA manifests as both hypokalemia and acidosis, it is reasonable that the abovementioned mechanism leads to high medullary ammonia concentration and subsequent serum hyperammonemia. This association was This article refers to the article that can be found at (https://doi.org/10. 1007/s00467-018-4018-z).

Characteristics of Children with Acute Carbon Monoxide Poisoning in Ankara: A Single Centre Experience.

The purpose of the study was to define characteristics of children with acute carbon monoxide poisoning. Eighty children hospitalized with acute carbon monoxide poisoning were recruited prospectively over a period of 12 months. Sociodemographic features, complaints and laboratory data were recorded. When the patient was discharged, necessary preventive measures to be taken were explained to parents. One month later, the parents were questioned during a control examination regarding the precautions that they took. The ages of the cases were between one month and 16 yr. Education levels were low in 86.2% of mothers and 52.6% of fathers. All families had low income and 48.8% did not have formal housing. The source of the acute carbon monoxide poisoning was stoves in 71.2% of cases and hot-water heaters in 28.8% of cases. Three or more people were poisoned at home in 85.1% of the cases. The most frequent symptoms of poisoning were headache and vertigo (58.8%). Median carboxyhemoglobin levels at admission to the hospital and discharge were measured as 19.5% and 1.1% (P < 0.001). When families were called for re-evaluation, it was determined that most of them had taken the necessary precautions after the poisoning incident (86.3%). This study determined that children with acute childhood carbon monoxide poisoning are usually from families with low socioeconomic and education levels. Education about prevention should be provided to all people who are at risk of carbon monoxide poisoning before a poisoning incident occurs.

Prevalence of group C and G Streptococcus in pediatric acute tonsilopharyngitis in Turkey

Bu çalışmanın amacı akut tonsillofarenjit tanısı alan çocuklarda C ve G grubu streptokokların sıklığını saptamaktır . Akut tonsillofarenjit tanısı alan 1-15 yaş arası 200 çocuk çalışmaya kabul edildi. Olguların hepsinden alınan boğaz kültür örneği % 5 kanlı agara ekildi. Basitrasin direnci olan beta hemolitik streptokoklar Lancefield lateks aglütinasyona göre gruplandırıldı. Boğaz kültüründe A grubu streptokoklar % 21, C grubu streptokoklar % 3, B grubu streptokoklar % 2, F grubu streptokoklar % 2, G grubu streptokoklar % 1 oranında saptandı. Dört yaşın altındaki olgularda pozitif kültür saptanmadı. Kültürde C ve G grubu streptokok saptananlar ile A grubu streptokok saptananlar arasında yaş, şikayet ve bulgularda fark saptanmadı. Çocukluk çağı akut tonsillofarenjitlerinde C ve G grup streptokoklar, A grubu streptokoklara göre daha az sıklıkla etken olmasına rağmen çocuklarda akut tonsillofarenjitte C ve G grubu streptokoklar endemik ve sporadik enfeksiyonlara neden olabilir.

433 The Knowledge of Sexual Transmitted Diseases Adolescence in Low Economic Level

The purpose of this work is to do a research on the level of awareness about sexually transmitted diseases (STD) of adolescence and the factors effecting it. Method A number of adolescent at the ages of 14–17 (n=527) were asked to complete a survey questioning their level of knowledge of STDs and their sociological and demographical issues. Data were entered into the SPSS 15.0 program and evaluated. A value of p<0.05 was assumed for statistical significance. Findings 78.9% of the adolescent responded positively to the question of whether or not they are aware of the fact that diseases could be transmitted via sexual intercourse. 48.6% of the adolescent responded negatively to whether or not they knew “how the diseases are transmitted”, 59.4% responded negatively to whether or not they know “how to protect themselves from those diseases”, and 67.2% responded negatively to whether or not they know “the symptoms of STDs”. The count of the right answers were in increase in correlation with the education and economic level of the parents (p<0.05). The results showed that 49.3% of them learned information about STDs at school and from medical institutions. 9.3% of them stated that they had intercourse in the last one-year period and 8.0% of them utilized a method of protection. Result Awareness level of adults about STDs is inadequate. For that, schools and medical institutions, where they are inclined most to get education, should organize mass education events for them about these matters.

1816 Sleep Pattern and Sleep Disorders in Preschool-Aged Children

The purpose of this study determine sleep pattern, sleep disorders and factors affecting on preschool-aged children. Material-method The research was conducted on 999 patient 2–6 years presenting patient out-patient clinic. Parents were given a survey containing questions about the sociodemographic and sleep. Results 30.9% of children were entering to bed in the hours 20.00 to 22.00 and 67.0% of children were entering to bed in the hours 22.00 to 00.00. Sleeping and waking hours of children were found to be compatible with their parents (p=0.001). 50.2% of children with bedtime from 20.00 to 22.00 were fall asleep immediately and 22.6% of children with bedtime from 22.00 to 00.00 were fall asleep immediately (p=0.001).We found that 62.9% of children snoring, 72.5% of children with mouth breathing, 38.7% of the children stopped breathing, 79.3% of the children were restless sleep, 80.2% of children saw a nightmare, 43.1% of the children gnashed teeth during the sleep. We found that snoring, mouth breathing were more than and sleeping hours were later for son children and nightmares were more frequent in girls (p<0.05). We found that snoring, mouth breathing, restless sleep and frequent waking findings were more frequent in children with symptoms of attention deficit hyperactivity than in the other group. Conclusions In the preschool-aged children, sleep disorders were common in. Sleep disorders were more frequent in children with hyperactivity symptoms. Primary care assessment of preschool-aged children should be questioned their sleep problems.

1823 The Evaluation of Antibody Responses in Steroid Sensitive Children with Nephrotic Syndrome

Nephrotic syndrome is characterized by massive proteinüria, hypoalbuminemia, and edema. Immunoglobulin changes, T lymphocyte function disorders, and the reduction in complement levels in the nephrotic syndrome cause an increase in the risk of viral and bacterial infections. For this purpose, children with nephrotic syndrome followed in the Pediatric Nephrology Department were screened for antibody levels and seroconversion of hepatitis A, hepatitis B, chicken pox, mumps, measles, rubella, and pneumococcus vaccines. An evaluation of the seroconversion status of study and control groups revealed that all the children had negative anti CMV IgM, anti HCV, anti HIV, anti HAV IgM, HBsAg, antimumps IgM, antimeasles IgM and antirubella IgM. Only two children in the study group had anti-VZV IgM positive. When the study and control groups were evaluated within the groups separately, a statistically significant difference was observed in the positivity of anti HAV IgG, antiHBs, anti pneumococ IgG, anti VZV IgG, antimumps IgG, antimeasles IgG and antirubella IgG before and after vaccination. When the study and control groups were compared to each other in respect to antibody titers before and after vaccination, there was no significant difference in anti HAV IgG, anti HBs, antipneumococcus IgG, antimumps IgG, antimeasles IgG and antirubella IgG. But the study groups were statically different in respect to anti VZV IgG. The evaluation of children with nephrotic syndrome for the seroconversion status and their vaccination against the necessary microorganisms would be a cost effective approach reducing the frequency of relapses and infection related morbidity and mortality.

828 Vitamin D Status is not Associated with the Recurrent Wheezy in Infancy

Low vitamin D status have been found to be associated with the risk of acute upper and lower respiratory tract infections. The deficiency of vitamin D was the significant risk factors contributed to the post-bronchiolitis wheezing in children. We aimed to investigate the association between vitamin D status and occurrence of recurrent acute bronchiolitiThe children with acute bronchiolitis who aged 2 months to 2 years were hospitalized between December 2008 and April 2009 in the Ankara Training and Research Hospital, Ankara, Turkey were included in the analysis. This study was prospective and case-control study. We used a questionnaire addressing demographic factors, exposure to sunlight and vitamin use. We defined children with recurrent wheeze as = 3 wheezing attacks. In total, 56 cases and 30 controls were enrolled. The mean age of all children was 12±7.2 months (2 months- 2 years). The mean of serum 25-OHD3 was 138±56.7 nmol/L in total patients, 134.3±55.6 nmol/L in cases and 145±59.2nmol/L in control group. There was not any significant difference between cases and controls in 25-OHD3 levels (p>0.05). The mean of serum 25-OHD3 was 132.4±58 (10–263) nmol/L in group 1 (n=42) and 140±49 (75–208) nmol/L in group 2 (n=14), the difference was not statistically significant (p>0.05). There was no significant correlation between the number of wheezing attacks (p>0.05). No correlation between vitamin D levels and acute bronchiolitis was found but this may be the result of few numbers of patients that we studied with.

1544 Socioeconomic Status Lower Levels of Parental Knowledge about Child Abuse, Neglect, Experiences and Discipline Methods used

Aim The purpose of this study is families with low socioeconomic status to determine level of knowledge about child abuse and neglect, experiences, disciplinary methods used by children of families and the factors affecting them. Materials and Methods Children’s Clinic admitted that the level of income below the poverty line in 1043 was the child’s parent survey. Sociodemographic characteristics, parents’ level of knowledge about child abuse-neglect, and about their own childhood experiences, their thoughts and behaviors were recorded in the survey. Results 17.7% of the parents’ have received information about child abuse-neglect, 43.2% has suffered neglect, and 37.6% has suffered abuse. We asked “How do you watch on an attitude of an experienced in the case of abuse” 68.6% of parents said ‘ consult official institutions’, 31.4% of parents said ‘family should be deal with a problem or saved within family’. 68.5% of the parents’ said does not threaten, 22.3% of families said threatened emotionally then 2.0% of families said threatened with physical punishment. With the increase of education level of parents an increase in the rate of parents who said ‘I don’t threatened’. We asked to parents ‘How to punish your children?’ 47.0% of families said not to punish. Conclusion The majority of neglect and abuse suffered by the parents and they think that they deserve punishment was the same group of children. Emotional and physical abuse in our society children are still being used as an education and disciplinary methods.

431 The Effect of Sportive Activity on Bone Mineral Density during Adolescence

Aim Hormonal balance, genetic background, calcium/vitamin D metabolism, nutrition, lifestyle and physical activity are principle factors effecting bone health during puberty. The aim of the study is to evaluate the effect of regular sportive activity (SA) on bone mineral density. Materials and methods Adolescents admitted to Department of Pediatrics with licensed regular SA (n: 55) and without regular SA (n: 56) were included in the study. Age, height, body weight, body mass index (BMI), Tanner stages, educational status of parents, mean daily calcium intake, smoking, sun exposure, total of time for watching television and playing computer and type of licensed SA were recorded. Bone mineral density (BMD) was measured with a quantitative ultrasonography device. Results BMI was higher in group without a regular SA (p=0.024). Adolescents with regular SA had higher BMD when compared to group without a regular SA (p=0.011). Vitamin D levels were also higher in group with SA (p<0.001). Daily calcium intake did not show any significant difference between groups (p>0.05). Higher educational status of parents was significantly related with higher prevalence of SA. Vitamin intake was higher in adolescence with SA (p=0.002) and smoking was more common in adolescents without regular SA (p=0.023). Conclusion Quantitative ultrasound can be used to evaluate the BMD in children. Physical activity during adolescence is important for bone growth and SA should be encouraged earlier. Especially, adolescents whose mothers had higher educational status took part in SA more frequently.