GİRİŞZehirlenme vücuda zararlı olabilecek maddelerin ağız, solunum, damar yolu veya cilt gibi yollardan alınmasıdır (1) . Aşılar ve gelişmiş medikal tedavilerle infeksiyonların azalmasından sonra zehirlenmeler çocukluk çağında kazalar ve tümöral hastalıklarla beraber en önemli mortalite nedenlerini oluşturmak-tadır. Acil başvurularda trafik kazaları, düşme ve yanıklardan sonra zehirlenmeler çocukluk çağı kazaları

Objectives: Vaccination of systemic lupus erythematosus patients with non-live vaccines may decrease vaccine-preventable infections and mortalities. In the present study, we aimed to compare the immunogenicity and safety of inactivated hepatitis A vaccination in childhood-onset systemic lupus erythematosus and healthy subjects. Methods: A total of 30 childhood-onset systemic lupus erythematosus and 39 healthy participants who were seronegative for hepatitis A received two doses of the hepatitis A vaccine in a 0- and 6-month schedule. Hepatitis A virus (HAV) IgG antibodies were measured before vaccination and 7 months after the vaccination. Results: Although anti-HAV IgG antibody titers after vaccination were found to be somewhat lower in children with systemic lupus erythematosus than that of the healthy subjects (p < 0.05), the difference in seroconversion rate was insignificant between childhood-onset systemic lupus erythematosus patients (n = 24/30, 80%) and healthy controls (n = 33/39, 84.6%). There was no increase in median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K scores and anti-ds DNA levels after the vaccination procedure. Seroconversion rates in childhood-onset systemic lupus erythematosus patients were not affected by medication, high disease activity (SLEDAI-2K >6) and anti-ds DNA positivity. None of the patients experienced any flare or adverse reaction throughout the study. Conclusions: According to these results, we conclude that inactivated hepatitis A vaccine is safe and well tolerated in childhood-onset systemic lupus erythematosus patients, with no adverse events or increase in activity. Immunogenicity to the hepatitis A vaccine was adequate, with a seropositivity rate of 80%.

Göğüs ağrısı çocuklarda sık görülen bir yakınmadır. Fakat kardiyak kökenli göğüs ağrısı çok az görülmektedir. C alıs mamızın amacı, c ocuk kardiyoloji poliklinig ine go g u s ag rısı nedeniyle bas vuran c ocuklarda tanısal nedenlerin belirlenmesidir. Gereç ve Yöntem: Çalışmaya C ocuk Kardiyoloji poliklinig ine Mart 2017-Ekim 2017 tarihleri arasında go g u s ag rısı yakınmasıyla bas vuran yas ları 3-18 arasında değişen 111'i kız, 99'u erkek olmak üzere 210 vaka alındı. Hastaların dosyalarından öz-soygeçmiş özellikleri, muayenelerindeki patolojik bulguları, ilaç kullanım öyküleri, elektrokardiyografi ve ekokardiyografi sonuçları kaydedildi. Bu veriler istatistiksel olarak değerlendirildi, hastaların dosyalarından etiyolojik nedenler ve tanıların sıklıkları ile cinsiyete ve yaşa göre dağılımları incelendi. Analizlerde SPSS 22.0 programı kullanıldı. Bulgular: Vakalarda göğüs ağrısı en sık istirahat halinde iken (%66.1) ve sternum solunda (%70.7) ortaya çıktığı saptandı. Göğüs ağrısı nedenleri ise en sık sırasıyla kasiskelet sistemi (%43.8), idiyopatik (%28.1) ve psikojenik (%14.7) nedenlere bağlı olduğu görüldü. Bir hastada ise kardiyak nedenli (%0.5) göğüs ağrısı saptandı. Psikojenik nedenli göğüs ağrıları kızlarda daha sık (%54.8) olarak görüldü. Psikojenik nedenlerden depresyon (%68), anksiyete bozukluğu (%25.6) ve panik atak (%6.4) saptandı. Sonuç: Çocukluk c ag ı go g u s ag rılarının c ok az bir kısmı kardiyak nedenlidir. İdiyopatik nedenler, kas-iskelet sistemi kaynaklı nedenlerin yanı sıra psikojenik nedenler de göğüs ağrısı nedeni olarak akılda tutulmalıdır. Tanının kesinleştirilmesi hasta ve ailesinin endişesini gidermek ve doğru tedaviyi uygulamak için çok önemlidir. Ayrıca bu çocukların kardiyolojiye rutin sevkleri ailenin kaygılarını daha çok arttırabileceğinden ve uzun süren pahalı değerlendirmelere neden olacağından her zaman iyi sonuç vermeyebilir.

Objective. To evaluate the effect of maternal smoking during pregnancy on levels of umbilical cord erythropoietin. Methods. Erythropoietin levels were measured in umbilical cord sera of 60 newborns who were delivered vaginally at term. There were 20 (33%) smoking and 40 (67%) nonsmoking mothers. Results. Mean cord serum erythropoietin levels were significantly lower in the nonsmokers (nonsmokers, 24 ± 9 IU/L; smokers, 61 ± 46 IU/L; P < .001). There was a significant positive correlation between the number of cigarettes smoked per day and cord serum erythropoietin levels (r, 0.58; P ≤ .05). Conclusions. Smoking during pregnancy is associated with increased levels of umbilical cord erythropoietin at birth. This may indicate a risk of fetal hypoxia and growth restriction. Education and encouragement of cessation of smoking during pregnancy are important to avoid associated fetal and maternal morbidity and mortality.

Although intussusception and food allergy are common health problems in childhood, the relation between these two diseases remain obscure. The aim of this study is to investigate the relationship between food allergy and intussusception, and the factors associated with both. Patients diagnosed with intussusception by the Brighton Collaboration Intussusception Working Group criteria were prospectively investigated for food allergy per the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Guideline. They were analyzed per demographic features, clinical, physical and laboratory findings. There were eight (38.1%) patients diagnosed with food allergy, while 13 (61.9%) patients were non-allergic. The mean number of days of presenting symptoms was 1.13 days in the allergy group and 7.85 days in the non-allergy group. The mean number of intussusception attacks was 1.63 in the allergy group while 1 in the non-allergy group (p < 0.05, relative risk (RR) = 2.6). In the allergy group, one (13%) patient was followed up, six (75%) patients were reduced with pneumatic and one (13%) patient reduced manually. In the non-allergy group, four (31%) patients were followed up, six (46%) patients were reduced with pneumotic, one (7%) patient was reduced manually, and resection anastomosis was performed in two (15%) patients. Food allergy is an unrecognized associated factor for intussusception patients, which increases the risk for recurrence. Due to the small patient population, these results should be interpreted with caution.

No abstract

Kawasaki disease is common in children and is an acute systemic vasculitis affecting coronary arteries. Kawasaki disease has multisystemic nature with a variety of presenting symptoms. Without treatment 20-25% of Kawasaki disease patients develop coronary artery aneurysms. Our goal is to summarize the clinical data of patients treated with Kawasaki disease at our clinics. Material and Methods: Clinical features, laboratory findings, diagnosis and treatment of 21 patients with Kawasaki disease hospitalized at Turkish Ministry of Health Okmeydanı Training and Research Hospital, Clinic of Pediatrics during January 2009 to January 2015 were retrospectively evaluated.Results: The patients were between 9 and 67 months old (median 27.52± 18.78), 71.4% (n:15) were male. The duration of disease before diagnosis was 7.1±3.48 days, median 6 days. All patients had fever. The most common clinical features were oral cavity changes 95.2% (n:20), rash 85.7% (n:18), conjunctival injection 71.4% (n:15), extremity changes 61,9% (n:13), cervical lymphadenopathy 57.1% (n:12). We also observed sterile pyuria in 33.3%, desquamation of perianal area 28.6 %, aseptic meningitis in 9.5%, hydrops of the gallblader 4.8%. 19.1% patients had incomplete Kawasaki disease. 6 patients, 28.5% had coronary artery abnormalities. Intravenous immunglobulin treatment failure was observed in 9.5% of patients, one of them was diagnosed as macrophage activation syndrome. Conclusion: Kawasaki disease has difficulty in diagnosis because of having broad spectrum of presenting symptoms. Early diagnosis and treatment is very important in preventing coronary artery abnormalities.

Supraventriküler taşikardi (SVT), yenidoğan döneminde en sık karşılaşılan semptomatik taşiaritmidir. Atriyoventriküler re-entry nedeni ile ortaya çıkar ve his demeti ayırım yerinin proksimalinden kaynaklanan anormal bir mekanizma ile oluşur (1). Antenatal dönemde taşikardi hidrops fetalis, postnatal dönemde huzursuzluk, takipne, emme bozukluğu ve kalp yetersizliği kliniği gösterebilir. Acil tedavisi gerekli olup, bazen ilaçlara dirençli ve tekrarlayan ataklar nedeniyle mortaliteye neden olabilir. Burada, iki farklı SVT kliniği olan yenidoğan olguları ve tedavileri sunuldu. Olgu Sunumları Olgu 1 Prenatal izleminde sorunu olmayan 28 yaşındaki annenin 2. gebeliğinden, normal yolla 39 haftalık, 3750 gram ağırlığında doğan erkek bebek postnatal 17. günde emmede azalma, terleme ve hızlı nefes alma yakınması ile çocuk acile getirildi. Vücut ağırlığı 3900 gram, vücut ısısı 36,8 °C, solunum sayısı 82/dk, kalp hızı 276/dk idi. Genel durumu kötü, yenidoğan refleksleri zayıf, kapiller dolum zamanı 5 sn, 3 cm hepatomegali, retraksiyon ve inlemeli solunumu vardı. Tam kan sayımı, kan biyokimyası, kan gazı, akciğer grafisi, C-reaktif protein (CRP), tiroid fonksiyon testleri ve Özet ABS tRACt Supraventriküler taşikardi, yenidoğan döneminde en sık karşılaşılan taşiaritmidir. Yenidoğanlarda klinik bulgular çocukluk çağındaki supraventriküler taşikardiye göre daha ağır seyretmektedir. Burada, iki farklı SVT kliniği olan yenidoğan olguları ve tedavileri sunuldu.