A Case of Spontaneous Pneumothorax with Persistent Air Leakage During the Course of COVID-19

Development of pneumothorax during the course of COVID-19 is very rare, and may occur secondary to severe pulmonary involvement causing alveolar damage in the parenchyma, or is seen as a complication of respiratory support. Until now, quite a few cases have been reported. Herein, we shared a case of spontaneous pneumothorax with persistent air leakage without any parenchymal or pleural involvement.

Cranial MRI Findings in Predicting the Severity of Hypoxic-Ischemic Encephalopathy in Term Neonates

Objective: The aim of this study is to compare magnetic resonance imaging (MRI) findings with severity of hypoxic-ischemic encephalopathy (HIE) in term neonates. Methods: Sixty-three newborns with HIE in whom cranial MRIs were performed within the first 3 weeks of life between 2016 and 2020 were included in the study. Severity of HIE was graded using Sarnat & Sarnat staging. In statistical analysis, Stage 1 was considered as mild, Stage 2 or 3 as severe HIE. The signal intensities of perirolandic cortex, posterior limb of internal capsule (PLIC), globus pallidus, and cerebrospinal tract on T1- weighted imaging (T1WI), and of perirolandic cortex, PLIC, ventrolateral thalamus, lateral edge of putamen and tegmentum on T2WI, and brain diffusion weighted imaging (DWI) findings were evaluated with consensus by two radiologists blinded to clinical findings. Gestational age, birth weight and MRI signal intensities were compared with HIE groups using t test, and Fisher-Exact test. Results: There were 31 and 32 infants with mild and severe HIE, respectively. Gestational age and birth weight were not different between mild and severe HIE groups. The number of cases with abnormal signals in PLIC and globus pallidus on T1WI, and PLIC on T2WI were significantly higher in severe HIE (p=0.022, p=0.008, and p=0.032, respectively). The presence of signal abnormality in other regions and DWI were not significantly different between HIE groups. Conclusion: Cranial MRI may play a remarkable role in determining pattern and severity of HIE. Signal abnormality in PLIC and globus pallidus may suggest severe HIE in term neonates.

Y Shaped Colonic Duplication Mimicking Intestinal Volvulus: A Case Report and Review of Literature

Enteric duplications are rare congenital anomalies found anywhere from mouth to anus. Colonic duplications constitute about 13% of all enteric duplications. In this report a 6-year-old boy with chronic abdominal pain for a duration of last 2 years requiring intermittent hospital admissions was diagnosed as colonic duplication mimicking intestinal volvulus. Clinical findings are nonspecific and definitive diagnosis can only be made during surgical intervention and surgical treatment is advocated for all duplications. The topic is discussed under the light of relevant literature with a brief a brief literature review.

Relationship Between Intraoperative Cerebral Desaturation and Postoperative Complications In Pediatric Patients Undergoing Congenital Heart Surgery: Prospective Cohort Study

Objective: In this study, we aimed to investigate the incidence of cerebral desaturation and the possible relationship between intraoperative cerebral desaturation and postoperative complications. Methods: A prospective, observational study was performed 115 patients under 18 years of age who required open heart surgery in a university hospital. Cerebral desaturation was defined as a 25% decrease in cerebral saturation (low alarm limit) when compared with the basal value. Duration (second) was referred to the amount of time the patient stays below low alarm limit. Depth (%) was referred to gap between the patient’s cerebral regional oxygen saturation (rSO2) level and the rSO2 low alarm limit. The cerebral desaturation score was calculated using the %*seconds. The patients were divided into two groups: group 1 (desaturation score >3000 %sec) and group 2 (desaturation score ≤ 3000 %sec). The groups were compared in terms of demographic data, intraoperative and postoperative variables, postoperative complications, and duration of intensive care and hospital stays. Results: In the study, 59 patients (51.3%) were male and 28 patients (24.3%) had cyanotic heart disease. A total of 55 patients (47.8%) experienced over 3000 %sec desaturation. Postoperative complications were found to be increased in group 1 (71% vs 3.3%; χ²=57.119, p<0.001). In the multiple logistic regression analysis, desaturation score>3000 %sec (p<0.001), low body surface area (p=0.001) and prolonged cardiopulmonary bypass (p=0.006) were found to be associated with postoperative complications. Conclusion: In patients undergoing congenital heart surgery, cerebral desaturation score >3000 %sec is associated with a negative effect on patient prognosis.

Dynamic Renal Scintigraphy Results of Pediatric Patients Operated Due to Unilateral Ureteropelvic Junction Obstruction: A Novel Approach to Overestimated Ipsilateral Differentiated Renal Function

Objective: The aim of this study was to scintigraphically investigate the preoperative and postoperative renal functions of patients operated due to ureteropelvic junction obstruction, discuss the factors affecting the indication of surgery and emphasize the important points to consider during scintigraphic examination. Method: We retrospectively analyzed pediatric cases who underwent pyeloplasty due to ureteropelvic junction obstruction. Patients operated for primary ureteropelvic junction obstruction whose preoperative and postoperative dynamic scintigraphy results could be obtained were included in the study. The patients were divided into two groups as those with <50% and ≥50% ipsilateral differentiated renal function. The difference between the groups was considered statistically significant when p<0.05. Results: The median ages of 36 cases in <50% DRF group and 24 cases in ≥50% DRF group were 7.7 months and 8.5 months, respectively. The mean ipsilateral differentiated renal function values of the main groups were significantly different from each other both in the preoperative and postoperative periods. The changes within the two main groups were also analyzed, yielding significant differences. Ipsilateral differentiated renal function changes on a general, group and subgroup basis, and preoperative ultrasound findings of the ipsilateral kidney in subgroups were revealed. Conclusion: Increased hydronephrosis degree and renal pelvis anterior-posterior diameter are closely related to overestimated ipsilateral kidney function. For deciding on surgery in patients with ureteral obstruction, scintigraphic examinations make sense with the help of US and the clinical condition of the patient.

Neuroblastoma-targeted Anticancer Drug Delivery

Neuroblastoma (NB) is the most common solid tumor in pediatric cases. NB accounts for about 8% of malignancies in patients younger than 15 years, and since 50% of newly diagnosed cases metastasize to regional lymph nodes, bone marrow, bone, liver, and skin, the disease is usually diagnosed in its late stages. Overexpression of N-MYC, which is characterized by poor prognosis in NB, changes the progression of the disease and the course of the treatment. Targeting these pathways may be a treatment option in NB, since the mTOR and AURKA pathways interact with N-MYC and directly cause protein stabilization. The widespread use of conventional chemotherapeutics has some limitations associated with their common side effects and the bioavailability of the drugs. New therapeutic approaches have focused on nanoparticle (NP) -based therapies, and chemoimmunoagents in the form of many NPs are being tried in NB. Here, we review new therapeutic approaches that would help to treat NB.

Molecular Epidemiology and Clinical Risk Factors of Rotavirus Diarrhea: Single Center 5-Year Experience

Objective: Acute gastroenteritis due to the rotavirus is one of the common causes of morbidity and mortality in children under five years of age. The objective of this study was to evaluate the epidemiological, clinical, and laboratory data of rotavirus diarrhea in hospitalized children under five years of age. Methods: All children between one month and 60 months old ages who were hospitalized in Health Sciences University Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital during September 2013 to August 2017 and diagnosed as acute gastroenteritis with rotavirus antigen test positive in feces were included in the current study. Data of the patients were collected retrospectively from medical records. Results: A total of 100 patients were evaluated.The median age of the patients was 13 months (IQR 5-45 months) and 54 patients were male and 46 were female.The highest hospitalization rate was in December, followed by November, and in October. The most common type of G9P (8) serotype was detected in rotavirus serotype analysis by PCR. Breastfeeding infants had milder clinic findings in comparison to the older ones. It was found that clinical findings were milder and Vesicari score was lower in infants who had breast milk. Vesikari score was found to be high in children with severe clinical findings. Conclusion: Rotavirus infection is important for all ages.In case of fever, increased numbers of vomiting and diarrhea, and higher Vesikari system scores may be associated with the severe clinical forms. Determination of rotavirus serotypes and clinical monitoring of genotypic changes are required.

The Role of the Fetal MRI to Predict the Postnatal Survival in Fetuses with Congenital Diaphragmatic Hernia

Objective: To assess the role of the magnetic resonance imaging (MRI) to predict the postnatal survival in patients with congenital diaphragmatic hernia (CDH). Method: 25 patients with CDH who had fetal MRI between 2015 and 2020 were enrolled in this retrospective study. Patients were divided into two groups according to the postnatal survival at 30 days of age: alive and dead. The fetal MRI images were assessed to calculate the lung-to-liver signal intensity ratio (LLSIR), and the total lung volume (TLV). In addition, the site of the defect (right or left), accompanying liver herniation (present or absent), detectable-ipsilateral lung parenchyma at the apex (present or absent) were also recorded. MRI images were evaluated by two pediatric radiologists. A p value lesser than 0.05 was considered statistically significant. Results: Among 25 fetuses, 6 were alive and 19 were dead within 30 days after birth. The detectable lung parenchyma had a relationship with the alive group (p = 0.023). Observed-to-expected TLV (p = 0.001) and LLSIR (p = 0.023) were significantly lower in the dead group. Using the cutoff values for the observed-to-expected TLV as 0.27 (a sensitivity of 84%, a specificity of 84%) and for the LLSIR as 2.02 (a sensitivity of 89%, a specificity of 67%) were found as predictors for death. Conclusion: The postnatal survival in CDH may be predicted using the observed-to-expected TLV and LLSIR on the fetal MRI. The presence of the detectable-ipsilateral lung parenchyma at the apex may also be associated with the postnatal survival.

Evaluation of the Cases who Applied to University Hospital Child and Adolescent Mental Health Committee Because of Sexual Abuse

Objective: The aim of this study was to examine the sociodemographic characteristics, psychiatric diagnoses and factors associated with psychiatric diagnoses of children and adolescents who are victims of sexual abuse. Method: The files of 92 children and adolescents aged between 0-18 who were referred to University Hospital Child and Adolescent Psychiatry Forensic Policlinic between January 2017 and December 2019 due to sexual abuse were evaluated retrospectively. Psychiatric diagnoses of the cases were made according to DSM 5 diagnostic criteria. Intellectual capacity of the cases was evaluated according to the latest verison of Wechsler Intelligence Scale for Children. Results: In our study, 78 (84.8%) cases were female and 14 (15.2%) were male. Mean age of the cases was 14.1±3.88 years. The most common type of sexual abuse was touching (52.2%, n=48). There was a psychiatric diagnose in 50 (54.3%) of them. The most common psychiatric diagnoses were posttraumatic stress disorder (n=29, 31.5%) and major depressive disorder (n=25, 27.2%). The rate of psychiatric diagnosis was significantly higher in cases exposed to coercion and violence (p=0.032). In 32 cases (34.8%), it was determined that the abuser was within the family. Conclusion: Sexual abuse has an effect on child’s development throughout life.In our study, the rate of psychiatric diagnosis was high. It is very important to provide the necessary psychiatric support to the victims of sexual abuse. With the studies to be done in this area, awareness can be increased and necessary precautions can be taken.

Congenital Neutropenia in Children: Evaluation of Infectious Complications, Treatment Results and Long-Term Outcome

Objective: Infections are an important cause of morbidity and mortality for patients with congenital neutropenia. In the present study, we report on the incidence, type, localization of documented infections, as well as the clinical features and long-term outcome in patients with congenital neutropenia in our clinic. Method: We performed a retrospective chart review of children with neutropenia seen at our hospital from 2000-2018. The data of 15 patients with congenital neutropenia were included in this study. Clinical and laboratory data were analyzed retrospectively using patients’ files and an electronic data system. Results: The median age at diagnosis was 34 months (range, four months- 150 months) and the median follow-up time was 48 months (range, 13-179 months). The leading causes of hospital admission before the establishment of the diagnosis were upper respiratory tract infection in six, pneumonia in four, gingival stomatitis in three and soft tissue infection in two patients. We reached the documented 74 hospitalization episodes and the most common reasons for hospitalization were pneumonia (35%), fever (21%), stomatitis (16%), cutaneous and deep soft tissue infections (12%). Conclusion: The management of infectious complications in children with congenital neutropenia is crucial. Early diagnosis is essential to prevent infections and permanent organ damage. Congenital neutropenia should be suspected in patients with a history of frequent upper respiratory tract infection, and necessary investigations should be performed accordingly. However, it should be kept in mind that the clinical findings of the patients may vary despite having the same mutation.