Turkish archives of pediatrics最新文献

Introduction: Giant cell tumor of bone (GCTB) is a rare, typically benign neoplasm that primarily affects long bones in adults, with clival involvement being extremely rare, particularly in pediatric cases: a mini-review shows a total of 28 described cases, of which only 5 were truly pediatric (within 14 years of age). Surgery is the treatment of choice, and Denosumab is reported to be the most effective drug therapy. To date, the GCTB's molecular hallmark is the somatic mutation p.Gly34Trp, at the H3F3A gene (H3.3 p.Gly34Trp mutation), but in this case, the mutation H3.3 p.Gly35Trp was identified. Case Presentation: A 9-year-old female presented with progressive ocular pain, ptosis, and diplopia. MRI revealed a 42 × 32 × 30 mm mass in the clivus and sphenoid body. The patient underwent partial resection, and histology confirmed GCTB. Molecular testing revealed the presence of the H3.3 p.Gly35Trp mutation, and we demonstrate that this is the true mutation associated with GCTB, not the previously described (H3.3 p.Gly34Trp). Due to residual tumor tissue, the patient was treated with Denosumab, a RANKL inhibitor. During a 2-year follow-up, the tumor size stabilized, and no significant adverse effects were observed. Conclusion: This case represents the first pediatric clival GCTB harboring the H3.3 p.Gly35Trp mutation. Molecular diagnostics played a crucial role in confirming the diagnosis and demonstrating that the true mutation harbored by GCTB is H3.3 p.Gly35Trp and not the formerly described (H3.3 p.Gly34Trp). Denosumab therapy effectively controlled the tumor without major side effects, although long-term treatment duration and safety require further study.

Objective: Growth curves are important tools for assessing the growth and development of children in the target population by age. Measuring head circumference (HC) in infants is an important tool in monitoring infant health and brain development. The aims of this study are to construct current 0-2-year-old HC growth curves and percentiles and compare the methods used in the construction of growth curves for HC measurements by gender. Materials and Methods: The study is a retrospective research that includes the HC measurements of a total of 2832 (n = 1438 girls, n = 1394 boys) children examined between 2018 and 2021 in Başkent University hospital, Ankara. Lambda-Mu-Sigma, LMSP, and LMST methods based on Box-Cox Cole and Green (BCCG), Box-Cox power exponential (BCPE), and Box-Cox t (BCT) distributions respectively, and quantile regression (QR) method were used to construct the fitted growth curves. Model performances were evaluated using the generalized Akaike information criterion. The analyses were conducted using R 4.1.2 version. Results: According to the LMS and QR methods, percentile values of HC measurements by gender were calculated and the results were compared. Smoothed HC growth curves were constructed and compared for both methods by gender. The present study, Neyzi et al study, and World Health Organization (WHO) standards were compared for the third, 50th and 97th percentiles of HC. Conclusion: This study showed that the third-97th HC percentiles calculated by LMS and QR methods are very close to each other. Additionally, this study showed that the HC percentiles of Turkish children were slightly different compared to WHO standards.

Objective: There is no widely accepted method that can reflect the core temperature exactly. The aim of this study is to investigate the accuracy of frequently used body temperature measurement methods. Materials and Methods: A total of 104 patients aged 3-9 years were included in this cross-sectional study. The body temperature was measured using a non-contact cutaneous thermometer (NCCT), tympanic thermometer (TT), temporal artery thermometer (TAT), and electronic oral thermometer. Four consecutive measurements each with a different technique were taken from each patient. The oral thermometer was accepted as the reference body temperature measurement method and an oral body temperature measurement of ≥37.8°C was accepted as fever. Results: The NCCT and TT provided lower body temperature results than the oral measurement, while the TAT measured body temperatures higher than the oral thermometer. In patients whose temperature was measured as <37.8°C orally, the oral and TT measurements showed a strong positive association, while the other methods showed a weak positive association with the oral thermometer. In patients with fever, the oral and TT, and the oral and NCCT had a strong positive association while the oral thermometer and TAT had a moderate positive association. The result provided by the ROC analysis that was performed to determine the fever cut-off value for NCCT was 37.4°C, 37.7°C for TT, and 38°C for TAT. Conclusion: None of the peripheral measurement methods can accurately measure the core temperature. However, the results can be interpreted more accurately if the characteristics of the thermometers are well known.

Objective: This study aimed to investigate the epidemiological, clinical, laboratory, and radiological characteristics of children diagnosed with Hashimoto's thyroiditis and to present the experiences of a referral center.

Materials and methods: This study included 200 pediatric patients diagnosed with Hashimoto's thyroiditis between January 2020 and May 2024 at a single center. The data were extracted and compiled from the participants' medical records, including clinical information, physical examination findings, laboratory test results, and radiological imaging.

Results: Mean age of the study population was 11.3 ± 3.2 years at diagnosis, with a female predominance. At the time of clinical presentation, 8.5% of the study participants were 6 years of age or younger. The majority of patients, comprising 39.5% of the cohort, exhibited euthyroid thyroid function. Additionally, 33.5% of the patients were classified as having subclinical hypothyroidism, 22% demonstrated overt hypothyroidism, and 5% presented with hyperthyroidism. Approximately one-third of the study participants were referred for further evaluation due to the identification of abnormal thyroid function test results during routine screening examinations. 48% of the patients had a documented family history of thyroid disease. At diagnosis, 39.5% were prepubertal. The rate of overt hypothyroidism was higher in prepubertal patients compared to pubertal patients (41.8% vs. 9.1%, P < .005). Mean gland volume SDS was 2.61 ± 3.69, and 45.5% had goiter. Thyroid nodular lesions were identified in 5.5% of the study participants. Fine-needle aspiration biopsy was performed on five patients, revealing benign findings in three cases and atypia of undetermined significance in the remaining two cases.

Conclusion: Patints with subclinical hypothyroidism who have a baseline TSH level exceeding 8.5 mIU/L at initial presentation and do not receive treatment are likely to progress to overt hypothyroidism during subsequent follow-up. Prepubertal cases were more frequently observed compared to previous reports, and the course of hypothyroidism was more severe in prepubertal patients. These findings suggest a potential shift towards earlier onset of autoimmunity in children. Further studies are warranted to substantiate this observation.

Objective: Atropa belladonna, known as the deadly nightshade, is one of the most poisonous plants in the world. Deadly nightshade poisoning in both children and adults has been rarely reported and is mostly in the form of case reports. The aim of this study was to illuminate the findings of weed poisoning in childhood.

Materials and methods: Clinical and laboratory findings of 54 children with acute deadly nightshade and other weed poisoning followed in our center between January 2010 and January 2022, were retrospectively reviewed.

Results: In the study analyzing 54 children admitted to the pediatric intensive care unit for poisoning, 24 cases (44.4%) were attributed to deadly nightshade, with the remaining cases involving other weed poisonings. The most common symptoms were flushing, vomiting, mydriasis, gibberish, dry mouth, and tachycardia. Three patients required mechanical ventilation. No patient was dead. Patients were categorized into 2 groups: mild/moderate (no encephalopathy, n : 46) and severe poisoning (with encephalopathy, n : 8). The severe poisoning group had a higher incidence of urinary retention, incoherent speech, dry mouth, agitation, lethargy, convulsions, and coma, which led to longer intensive care unit (ICU) stays and an increased need for respiratory support (P < .05). Furthermore, a statistically significant difference was observed between deadly nightshade poisoning and other weed poisonings, particularly in the presence of symptoms such as headache, flushing, mydriasis, incoherent speech, encephalopathy, convulsions, and coma, all of which contributed to extended ICU stays and elevated respiratory support requirements (P < .05). Notably, neostigmine was administered in all cases of deadly nightshade poisoning due to the unavailability of physostigmine. Our findings showed that the first signs and symptoms of acute deadly nightshade and other weed poisoning may be severe in some children, but no death was observed. Meaningless speech, mydriasis, coma, and lachrymation were negative prognostic signs in childhood weed poisoning. We believe that neostigmine may be an alternative for deadly nightshade poisoning in cases when physostigmine is unavailable.

Conclusions: Our study highlights the severity of poisonings involving deadly nightshade and other weeds in pediatric patients. Despite the significant clinical manifestations observed, no fatalities were recorded. The findings underscore the importance of early recognition and appropriate management, emphasizing the need for heightened awareness among healthcare professionals and caregivers.

Objective: The objective is to study to what extent the development of retinopathy of prematurity (ROP) is associated with assisted conception (AC) and in vitro fertilization (IVF) in a tertiary referral hospital.

Materials and methods: This study is a retrospective observational cohort study. Very-low-birth weight (VLBW) infants with gestational age (GA) <32 weeks or birth weight <1500 g were admitted to the neonatal unit of a tertiary care hospital between January 1, 2011, and December 31, 2021. The study determined the degree of ROP developed according to the type of fertilization used for conception. Main outcome measures were ROP prevalence in pregnancies obtained after IVF/intracytoplasmic sperm injection (ICSI) in the period from January 1, 2011, to December 31, 2021, in a tertiary hospital.

Results: Of the 408 infants included in the study sample, 105 (25.7%) were born following AC and 12.4% of these developed ROP. In our sample, the practice of IVF was not associated with an increase in the incidence of VLBW infants (R2 = 0.12; P = .29).

Conclusion: Conception achieved via AC or IVF is not significantly associated with ROP in any degree of severity.

Vasculitis in children represents a diverse group of diseases characterized by inflammation of blood vessels, which can lead to significant morbidity if not promptly recognized and managed. This review explores the epidemiology, pathophysiology, classification, and management of key pediatric vasculitides. Classification based on vessel size aids in diagnosis and treatment. Understanding these conditions" clinical features and therapeutic options is critical for improving pediatric patient outcomes and preventing long-term complications. Continued research is essential for refining treatment strategies and enhancing patient care.