Purpose: Needle procedures are one of the most distressing practices for pediatric oncology patients. Virtual reality (VR) is a distraction method which offers an extremely realistic and interactive virtual environment and helps reduce needle-related pain and distress. The aim of this study was to evaluate the effects of VR method on pain during venous port access in pediatric oncology patients aged 7 to 18 years. Method: Children who had cancer and were between the ages of 7 and 18 years and undergoing a port-a-cath access were randomly assigned through blocked randomization to either the VR intervention group or control group. A commercially available VR headset was fitted to children in the intervention group. Immediately after the port access, pain scores were obtained from children’s self-reports and parents’ proxy reports, using the Wong–Baker FACES Pain Rating Scale. Results: Descriptive characteristics of the children ( n = 71) showed a homogeneous distribution between groups. During the procedure, children in the control group ( n = 36; 5.03 ± 3.35) experienced more pain than the children in VR group ( n = 35; 2.34 ± 2.76; p < .001). Proxy reports of the parents in the experimental group (1.77 ± 2.46) were found to be lower than those in the control group (4.67 ± 2.56; p < .001). Conclusions/Implications for Practice: VR method is effective for reducing pain during venous port access in pediatric oncology patients. VR should be used as a distraction method during venous port access.

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The main purpose of this study is to determine the current status of long-term follow-up (LTFU) for childhood cancer survivors and the challenges of LTFU for pediatric cancer survivors at pediatric oncology institutions in Turkey. Material and methods:A questionnaire was e-mailed to the directors of 33 pediatric oncology centers (POCs) registered in the Turkish Pediatric Oncology Group (TPOG). Of these 33 active TPOG institutions, 21 participated in the study and returned their completed questionnaires.Results: Only 1 of the 21 participating centers had a separate LTFU clinic. The remaining centers provided LTFU care for childhood cancer survivors at the pediatric oncology outpatient clinic. Of these centers, 17 (80.9%) reported difficulty in transition from the pediatric clinic to the adult clinic, 14 (66.6%) reported insufficient care providers, and 12 (57.1%) reported insufficient time and transportation problems. As neglected late effects, 16 (76.1%) centers reported psychosocial and getty job problems and 11 (52.3%) reported sexual and cognitive problems. None of the centers had their own LTFU guidelines for their daily LTFU practice. Conclusion:This study was the first to gain an overview of the needs of POCs and the gaps in survivorship services in Turkey. The results from this study will help to develop a national health care system and national guidelines for pediatric cancer survivors.

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Background: Type 3 von Willebrand disease (VWD) is a severe bleeding disorder with a prevalence of 1:1 million live births. There are several von Willebrand factor (VWF) replacement products used in the treatment of acute bleeding episodes or as prophylaxis. Patients who receive multiple transfusions have an increased risk of developing antibodies against these products. These antibodies can lead to life-threatening anaphylactic reactions. Previous studies have identified immune complex formation and complement activation as the trigger for anaphylaxis, rather than IgE. IgE-mediated anaphylaxis against VWF concentrates has not yet been published. Case: A 4-year-old female patient with type 3 VWD was referred to our hospital because of an anaphylactic reaction during FVIII/VWF concentrate (Immunate Ò) infusion. She had previously received FVIII/VWF concentrate (Haemate P Ò) infusions 8 times without any complications. She did not have antibodies against VWF and FVIII, and serum IgA level was normal. Since she needed factor replacement therapy as a result of a growing hematoma on her scalp, we performed skin prick and intradermal tests 2 days after the reaction. The prick test, with FVIII/VWF (Immunate), was negative, but the intradermal test was positive. We administered a 12-step desensitization protocol with FVIII/VWF concentrate (Immunate) successfully without any reactions. Conclusion: Anaphylactic reaction to factor replacement products is a major problem for patients with VWD, especially type 3 VWD requiring multiple factor infusions. We achieved a successful desensitization with FVIII/VWF concentrate in a patient who had an anaphylactic reaction during the infusion of this product. Our patient is important since she represents the first case of IgE-mediated anaphylaxis against VWF concentrate reported in the literature.

METHODS: Twenty-seven children known to have GSD were included in this study. Fifteen healthy age-and gender-matched children were also included as controls. Routine urine analysis and measurement of urinary ␤ 2 -microglobulin and microalbumin levels were performed for all patients and controls. Renal-function tests, measurement of serum electrolyte, alkaline phosphatase, urinary calcium, blood, and urine pH levels, creation of a urinary and plasma aminogram, calculation of the glomerular filtration rate, bone radiography to detect rachitic manifestations, and abdominal ultrasound to measure renal size were performed for all patients. RESULTS: Twenty-one patients had Ն1 renal abnormality. The most common was increased urinary ␤ 2 -microglobulin level (15 of 21) followed by an abnormal glomerular filtration rate, whether low or high (8 of 21), and microalbuminuria (6 of 21). Sonographically, there was nephrocalcinosis in 1 case and renal stone in another. The area under the receiver operating characteristic curve for ␤ 2 -microglobulin was 0.86 (P ϭ .01) and 0.7 for the urinary microalbumin/creatinine ratio (P ϭ .15). The best cutoff level for predicting renal abnormality for urinary ␤ 2 -microglobulin was 0.22 mg/L with 70% sensitivity and 100% specificity, and the best cutoff value for the urinary microalbumin/creatinine ratio was 4.5 with 86% sensitivity and 50% specificity. CONCLUSIONS: Renal abnormalities are common in patients with GSD. Urinary B 2 -microglobulin level can be considered the gold standard for early detection of renal dysfunction in these patients. LEPTIN AND LEPTIN RECEPTOR IN SERUM INTRODUCTION:Hyperlipidemia may cause glomerulosclerosis in children with nephrotic syndrome (NS). OBJECTIVE: Our goal was to observe the role of soluble leptin receptor (sOBR) and leptin in serum and urine on the mechanism of hyperlipidemia in children with NS. METHODS: Twenty-three children with untreated NS and 15 age-, gender-, and BMI-matched healthy controls were enrolled onto the study. Leptin and sOBR in serum and urine were measured by enzyme-linked immunosorbent assay, and plasma lipid and insulin levels were detected by automatic biochemistry analyzer and radioimmunoassay, respectively. sOBR messenger RNA and membrane protein expression in peripheral blood mononuclear cells were detected by reverse-transcription polymerase chain reaction and immunocytochemistry. RESULTS: Low-density lipoprotein, total cholesterol, triglyceride, and apolipoprotein A levels were increased. sOBR messenger RNA and membrane protein expression by peripheral blood mononuclear cells were significantly lower in the patient group compared with controls. The ratio of serum leptin versus sOBR (free leptin index) was significantly higher in the NS group. Urinary leptin in the patient group was higher than that in the control group. The free leptin index showed no correlation with BMI or total cholesterol, triglyceride, or apolipoprotein B levels in both groups but did show a correlation with plasma albumin, low-density lipoprotein...

Painful torticollis in children requires specific attention. Grisel syndrome is diagnosed on suspicion in patients with recent or history of ongoing upper respiratory tract infections and in patients with restriction of movement or deformity following oto-rhino-laryngologic surgery. Pediatricians should be aware of this condition because early diagnosis and intervention are critical for prognosis in Grisel syndrome.

Growing rates of osteoporosis in the whole world is a serious health problem. As the "expected lifetime" is prolonged, population of elderly women with chronic diseases who require long-term treatment increases. This study aimed to compare antiresorptive treatment-that has become a classic treatment in the light of Canadian Guideline for osteoporosis-with the antiresorptive plus osteoblastic activity inducing treatment modality. The clinical and laboratory results of patients treated with a single dose of 2 mg Strontium ranelate sachet (Protelos ®) or alendronate sodium used weekly 70 mg tablet (Fosamax ® once a week tablet) for 12-months were compared. Treatment compliance has been questioned. A hundred women in post-menopausal period were included in this study. Patient satisfaction survey among the group of strontium ranelate was unsatisfactory. Among patients using alendronate sodium the ease of use in this sense obtained a rate of 91% satisfaction from patients.