Turkish archives of pediatrics最新文献

Beta-thalassemia major (B-TM) is an inherited hematological disease that affects nearly 300 million people worldwide. This study aimed to evaluate the effects of group-based mobile learning on stress, anxiety, depression, and pain among beta-thalassemia major patients. This randomized clinical study was conducted on 48 patients with beta-thalassemia major in Jahrom, Iran. Participants were randomly assigned to the control and intervention groups. Their partners in the intervention group were trained in self-care through mobile learning. The 21-item Depression, Anxiety, and Stress Scale and a visual analog scale for pain assessment were used to collect the data. Data were analyzed using the Statistical package for the Social Sciences version 23.0. Although there was no significant difference between the control and intervention groups in the mean pre-test scores of depression (P = .21), anxiety (P = .05), stress (P = .48), and pain (P = .46), the mean post-test scores of depression, anxiety, and stress in the intervention group were significantly lower than the control group (P = .0001). The mean scores of depression (P = .33), anxiety (P = .74), stress (P = .83), and pain (P = .6) did not change significantly in the control group, while all these mean scores decreased significantly in the intervention group for DASS (P = .001) and pain (P = .002). Group-based mobile learning is effective in reducing depression, anxiety, stress, and pain in B-TM.

The imposter phenomenon (IP) may have a negative impact on the ability of healthcare providers to make difficult and accurate decisions. This study presents an empirical approach, segregating the real imposters based on a simulation, and aims to investigate the prevalence and severity of IP and evaluate the attitude in the decision-making process of pediatric residents with impostorism. A simulation-based case study with the 113 pediatric residents was performed with the Clance Imposter Phenomenon Scale to identify IP scores and appropriate management skills for the case. The collected data were divided and combined into different categories based on the IP scale scores and the success of case management to further detect how real imposters were affected. Our study revealed that 24 (21.2%) of residents have moderate, 33 (25.7%) of residents have frequent, and 29 (29.2%) of residents have intense impostorism feelings. The imposter scores were found to be higher among female participants (P = .006). However, when considering the prevalence of significant impostorism (defined as both frequent and intense), there was no statistically significant difference between females and males (P = .088). The data indicated that an increase in IP scores was associated with a higher likelihood of delayed pressing the help button for both the overall and post-exclusion groups (P < .001). The analysis also revealed a significant correlation and a monotonic-linear trend between IP scores and the decision-making process, even after excluding the unsuccessful participants (P < .001). This is the first study to demonstrate the prevalence of IP among pediatric residents, potentially leading to challenges in patient care and resulting in delayed decisionmaking and self-doubt with feelings of inadequacy. The findings support the claim that higher imposter scores are associated with a greater tendency to seek help from more experienced individuals, even when fully capable of managing cases independently. This emphasizes the importance of awareness about the IP, as these factors can directly impact both the well-being of trainees and patient care outcomes.

Helicobacter pylori (HP) is the most common bacterial infection in humans. Helicobacter pylori infection, which frequently increases with age, is seen in 30%-56.6% of children in Turkey, although it varies by region. In this study, we aimed to determine the frequency of HP in children and adolescents who underwent upper gastrointestinal endoscopy and gastric biopsy in our region and to compare the changes over the years. Cases who underwent upper gastrointestinal endoscopy for various indications between 2007 and 2022 in our pediatric gastroenterology unit were included in the study. The clinical and endoscopic characteristics of 1737 cases whose histopathologic specimens were obtained, have been retrospectively analyzed from their records. The diagnosis of HP infection was based on the presence of HP on histopathologic examination of gastric biopsy specimens. Of 1737 cases, 504 (29%) were HP positive. The HP positive case rates were 14.5%, 26.9%, and 33.6% in the 0-6, 7-12, and 13-18 age groups, respectively. H. pylori positivity was detected in 65.7% of patients with duodenal ulcers, and the relationship between duodenal ulcers and HP positivity was significant (P < .001). The average HP positivity rates were 44%, 28.6%, and 24.2% in 2007-2012 (group 1), 2013-2017 (group 2), and 2018-2022 (group 3). H. pylori positivity rates significantly decreased in years (P = .001/P = .056/P < .001). We found that the frequency of HP infection in children decreased in our region over the years. Helicobacter pylori positivity was higher in older than younger children. A decrease in HP frequency prevalence may be possible in parallel with awareness and socioeconomic development.

The management of Gram-negative bacterial infections poses a significant challenge due to the emergence of highly effective antibiotic-resistant mechanisms, leading to treatment failures, particularly among hospitalized children. This patient population experiences elevated rates of both mortality and morbidity, and the available antibiotic options against these bacteria are limited. Carbapenems, such as meropenem, represent one of the choices for treatment. While meropenem is highly effective against Gram-negative bacteria, the prevalence of multidrug-resistant infections in hospitals has become a growing concern. In response to this challenge, exploring innovative strategies is crucial. One such strategy is the implementation of high-dose extended meropenem infusion treatment. Researchers propose that extended meropenem treatment may offer a viable solution to combat resistant bacteria. Despite a limited number of studies focusing on the effectiveness of this strategy in children, our comprehensive review of the literature revealed promising findings. Our examination specifically compared extended infusion with standard infusion approaches. The evidence suggests that extended infusion of meropenem provides more benefits compared to standard infusion methods. Researchers consistently reported positive results in their observations, with the exception noted in very low birth weight neonates and children with infections caused by carbapenem-resistant Enterobacteria and Acinetobacter baumannii spp. In conclusion, extended meropenem infusion treatment emerges as a promising option for managing resistant infections. However, it is essential to underscore the need for further studies to robustly support the observed benefits of this treatment regimen.

Objective: This study aimed to compare high-flow nasal cannula oxygen therapy (nc-HFOT) and non-invasive nasal cannula ventilation (nc-NIV) in terms of intubation requirements.

Materials and methods: The study was conducted retrospectively on cases followed up in the pediatric intensive care unit (PICU) between October 2019 and December 2021.

Results: Of all cases, 43 (55.8%) were male, and the median age was 16 months. The median PRISM-3 score for all cases was 2.5 (range: 0-3). Among the cases 45 cases (58.4%) received nc-HFOT treatment, and 32 cases (41.6%) received nc-NIV treatment. The median duration of respiratory support for all cases was 2 days, and 14 cases (18.2%) needed intubation. The median PICU stay day for all cases was 7 days, and the median hospital stay day was 11 days. The median age, PICU, and hospital stay days of the nc-NIV group were significantly higher (P < .05). In the logistic regression analysis, the probability of requiring intubation in cases initially nc-NIV was performed was found to be 4.95 times higher than those using nc-HFOT (OR: 4.95, 95% CI: 1.3-18.8, P = 0.01). Additionally, cases with underlying chronic diseases were found to have a 5.9 times increased likelihood of requiring intubation compared to those without (OR: 5.9, 95% CI: 1.41-24.5, P = .01). Five cases (6.5%) were lost during intensive care stay.

Conclusion: The application of nc-NIV increases intubation by 4.95 times compared to the application of nc-HFOT. The intubation rate in cases with underlying chronic diseases is also 5.9 times higher than those without.

In emergencies, infants and young children are at risk of morbidity and mortality, which is increased by malnutrition. Environmental factors, food insecurity, household needs, misconceptions regarding breastfeeding, uncontrolled distribution of breast-milk substitutes, and psychological trauma make it difficult to implement proper feeding practices during disasters. Breastfeeding reduces the risk of infectious diseases and mortality in emergencies and is the safest way of feeding. Therefore, breastfeeding should be supported and promoted under all circumstances. When breastfeeding is not possible, relactation, wet nursing, or donor human milk should be considered as alternatives. If these options are not feasible, infant formula should be used. Formula should be provided only for infants in need, based on individual assessment. Donations of breast-milk substitutes should not be accepted; when needed, the procurement and distribution should be conducted by a single center under strict control, adhering to the requirements of the Code and Codex Alimentarius. Education and support should be provided to the family for the safe use of formulas. For infants older than 6 months, appropriate complementary feeding should be started. Complementary foods should contain nutrients that support the growth and development of infants, and they should be stored, prepared, and served safely. In conclusion, nutrition of infants and young children should be given priority in disasters as part of all emergency interventions. Determining the infants needs and ensuring proper nutrition, overcoming environmental challenges, and supporting parents will reduce nutrition-related risks and protect the health and well-being of infants and young children in emergencies.

Objective: We aimed to analyze the clinical presentation, imaging, histopathology, and surgical management of pediatric intraabdominal cysts, which are relatively common but diverse lesions that pose diagnostic challenges.

Materials and methods: We conducted a retrospective analysis of pediatric intraabdominal cysts from 2010 to 2021 in a single tertiary center. We collected data on demographics, symptoms, radiological findings, surgical approaches, and histopathological diagnoses and compared them with the current literature.

Results: A total of 36 cases were included. There were 30 females and 6 males, aged 1 to 16 years. Abdominal pain was the most common symptom, followed by tenderness and distention. Diarrhea and vomiting were also reported in some cases. The cysts varied in size, location, and origin and were diagnosed as lymphangioma, mucinous cystadenoma, paratubal cyst, lowgrade mucinous neoplasm, mature cystic teratoma, duplication cyst, mesothelial cyst, pseudocyst, serous cystadenoma, and simple hepatic cyst. The surgical management depended on the type and location of the cysts and involved excision, oophorectomy, appendectomy, or resection.

Conclusion: Pediatric intraabdominal cysts are heterogeneous lesions that require timely diagnosis and surgical resection. They may present with various symptoms and complications, depending on their size and location. Radiological and histopathological evaluation is essential for accurate diagnosis and optimal treatment.

Objective: Natural disasters cause enormous environmental, economic, and human losses. Children are the most vulnerable group and face severe consequences. While the primary cause of post-traumatic death is direct injury, the secondary cause is crush syndrome (CS). In this study, we aimed to share our experience in the management of children with CS during disasters by evaluating the clinical and laboratory outcomes of a group of 26 paediatric patients.

Materials and methods: Age, weight, length of time under rubble, laboratory results, and characteristics of crush injuries were assessed in 26 paediatric patients admitted to the emergency department after the earthquake. Diagnostic criteria for CS were established and the need for dialysis, hyperbaric oxygen or amputation and its determinants were assessed.

Results: Crush syndrome was observed in 10 of the 26 patients. Significant differences in creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase, hematocrit, pH, HCO3, and myoglobin levels were observed between patients with and without CS. None of the individuals rescued from the rubble within the first 6 hours had symptoms associated with CS. These 10 patients who developed CS were rescued within the first 48 hours of the earthquake, while 2 siblings were rescued after 81 hours and did not develop CS.

Conclusion: The fact that the children were rescued from the rubble after 81 hours without developing CS shows the importance of patience in rescue operations. In addition, the very cold weather conditions during this earthquake may have prevented the development of dehydration and acute kidney injury and reduced the possibility of CS.