Awareness of Covid-19 and attitudes toward vaccination in parents of children between 0 and 18 years: A cross-sectional study.

PURPOSE: Many countries are struggling with the covid-19 pandemic. Although many measures have been adopted to reduce the transmission of the virus, vaccination is the only solution for controlling and ending the pandemic. The purpose of this study is to evaluate the awareness of covid-19 and attitudes toward covid-19 vaccination in parents. DESIGN AND STUDY: The research is a descriptive and cross-sectional study. The online survey was conducted. The population of the study consisted of parents of children aged 0-18 who agreed to participate through the social media (Facebook and Instagram) between May 26 and July 7, 2021. With the community research model, the minimum sample size was determined as 384. A parent description form and the Coronavirus (Covid-19) Awareness Scale (CAS) were used for data collection. RESULTS: The mean Contagion Precaution Awareness sub-factor score of the CAS was 28.84 ± 10.55, the mean Awareness of Following Current Developments sub-factor score was 10.27 ± 4.63, and the Hygiene Precaution Awareness sub-factor score was 9.54 ± 3.55. Thirty-seven percent of the parents wanted their child/children to be vaccinated against Covid-19. A statistically significant association was determined between wished to have their child/children vaccinated against covid-19 and the mean CAS sub-factors scores (p < 0.05). CONCLUSIONS/PRACTICE IMPLICATIONS: Parents' awareness of covid-19 in this study was moderate. The willingness of parents to have their children vaccinated against covid-19 was also low. In order to increase Covid-19 vaccination rates, doubts and lack of information concerning the vaccine need to be overcome by identifying reasons for vaccine hesitancy.

Dose-dependent effects of adalimumab in neonatal rats with hypoxia/reoxygenation-induced intestinal damage.

Tumor necrosis factor-alpha (TNF-α) has an important role in hypoxia/reoxygenation (H/R)-induced intestinal damage. It was shown that blocking TNF-α with infliximab has beneficial effects on experimental necrotizing enterocolitis and hypoxic intestinal injury. However, there is no data about the effect of adalimumab on H/R-induced intestinal damage. Therefore, we aimed to determine potential dose-dependent benefits of adalimumab in such damage in neonatal rats. Wistar albino rat pups were assigned to one of the four groups: control group, hypoxia group, low-dose adalimumab (5 mg/kg/day) treated group (LDAT), and high-dose adalimumab (50 mg/kg/day) treated group (HDAT). On the fourth day of the experiment, all rats except for the control group were exposed to H/R followed by euthanasia. Malondialdehyde (MDA), myeloperoxidase (MPO), TNF-α, total antioxidant capacity (TAC), and total oxidant capacity (TOC) were measured in intestinal tissue. TAC and TOC values were used to calculate the oxidative stress index (OSI). Histopathological injury scores (HIS) were also evaluated in the tissue samples. MDA levels were significantly lower in the LDAT and HDAT groups (p < 0.001). TNF-α levels were significantly lower in the LDAT group (p < 0.001). OSI was significantly higher in the H/R group than in the control and LDAT groups (p < 0.001). Mean HIS values in the LDAT group were significantly lower than those in the H/R and HDAT groups (p < 0.001). This experimental study showed that low-dose adalimumab appears to have a beneficial effect on intestinal injury induced with H/R in neonatal rats.

Restless leg syndrome in children with celiac disease.

Isikay S, Isikay N, Per H, Çarman KB, Kocamaz H. Restless leg syndrome in children with celiac disease. Turk J Pediatr 2018; 60: 70-75. Celiac disease (CD) is an immune-mediated enteropathy triggered by ingestion of dietary gluten in genetically predisposed individuals. The aim of the study was to determine the prevalence of restless leg syndrome (RLS) in children with CD and to investigate the associated factors for RLS. Totally 494 children with the ages ranging between 11-18 years were included. Among those, 226 were under follow-up with CD and constituted the study group while other 268 children did not have any symptoms or signs associated with CD and established the control group. The demographic data, educational status and routine laboratory data of children including complete blood count, ferritin, vitamin B12, foliate and 25 (OH) vitamin D levels were recorded. The RLS prevalence and associated symptoms of children were defined with a questionnaire. There was no statistically significant difference between the 2 groups regarding the age and gender. Moreover, RLS prevalence was also similar in both groups (3.5% vs 3.0% in CD and control groups, respectively, p=0.98). However, interestingly, in CD group, the mean age of the patients at the onset of RLS symptoms was statistically significantly younger (p=0.02) and the disease was more severe (p=0.026) than the control group. In correlation analysis in CD group, the RLS severity significantly negatively correlated with serum ferritin, folic acid or 25 (OH) vitamin D levels in Celiac disease group. In this study we did not determine an increased prevalence of RLS in children with CD. However, in CD group, the age at the onset of RLS symptoms was significantly younger and the disease was more severe in CD group compared with the control cases.

Investigation of celiac disease followed by immune thrombocytopenic purpura diagnosis in patients and comparison with literature.

OBJECTIVE: Celiac disease (CD) and Immune thrombocytopenic purpura (ITP) may occur together as a result of similar autoimmune mechanisms. The aim of this study was to assess the frequency of CD in a group of ITP patients and in the literature. METHODS: A total of 29 patients in Pamukkale University Faculty of Medicine Hospital Pediatric Hematology and Oncology Department with ITP were included in the study. Test was performed for the antibodies related to CD. Positive result for celiac antibodies was confirmed with biopsy. The results were compared with the literature. RESULTS: Of the study group, 13 patients (44.8%) were female and 16 (55.2%) were male. The mean age was 7.2±4.7 years and mean platelet count at the time of admission was 13,440±11,110/mm3 (range: 2000-41,000/mm3). Twelve patients (41.4%) were diagnosed as acute ITP, 6 patients (20.7%) as persistent ITP, and 11 patients (37.9%) as chronic ITP, according to the duration of thrombocytopenia. Antibody positivity was detected in 1 patient. Histological evaluation was compatible with CD. Results were compared with studies regarding the prevalence of CD in the population. No significant difference was found. CONCLUSION: Although it is not necessary to perform CD test in every case of ITP, the presence of differential diagnosis of CD is important to prevent unnecessary treatment, especially in ITP patients with growth retardation or malabsorption findings.

Celiac Disease Presenting with Immune Thrombocytopenic Purpura.

Celiac disease (CD) is an immunological disorder. Clinical manifestations occur as a result of intestinal mucosa damage and malabsorption. CD is also associated with extraintestinal manifestations and autoimmune disorders. The coexistence of CD and autoimmune diseases has been described before. In this article, a patient with CD presenting with thrombocytopenia is discussed.

Respiratuvar depression after accidental nasal ingestion of brimonidine eye drops in infant.

OBJECTIVES: Brimonidine tartrate is an alpha-2 agonist used for glaucoma treatment. It can lead to serious poisoning symptoms when misused by children. CASE REPORT: In this case report, 3 months-old male patient with severe central nervous system depression and respiratory arrest as a result of accidentally nasal instillation of 1 cc brimonidine tartrate that benefited from mechanic ventilation and naloxone treatment was presented. CONCLUSION: This case report suggested, that misuse of nasal brimonidine eye drop could result in serious respiratory distress and central nervous system depression. Mechanical ventilation and naloxone administration can be useful for these patients.

THE NEUROLOGICAL FACE OF CELIAC DISEASE.

BACKGROUND: Several neurological disorders have also been widely described in celiac disease patients. OBJECTIVE: The aim of this study was to determine the incidence of accompanying different neurologic manifestations in children with celiac disease at the time of diagnosis and to discuss these manifestations in the light of the recent literature. METHODS: This prospective cross sectional study included 297 children diagnosed with celiac disease. The medical records of all patients were reviewed. RESULTS: In neurological evaluation, totally 40 (13. 5%) of the 297 celiac patients had a neurological finding including headache, epilepsy, migraine, mental retardation, breath holding spells, ataxia, cerebral palsy, attention deficit hyperactivity disorder, Down syndrome and Turner syndrome in order of frequency. There was not any significant difference between the laboratory data of the patients with and without neurological manifestations. However; type 3a biopsy was statistically significantly more common among patients without neurological manifestations, while type 3b biopsy was statistically significantly more common among patients with neurological manifestations. CONCLUSION: It is important to keep in mind that in clinical course of celiac disease different neurological manifestations may be reported.

THE NEUROLOGICAL FACE OF CELIAC DISEASE / A face neurológica da doença celíaca

BackgroundSeveral neurological disorders have also been widely described in celiac disease patients.ObjectiveThe aim of this study was to determine the incidence of accompanying different neurologic manifestations in children with celiac disease at the time of diagnosis and to discuss these manifestations in the light of the recent literature.MethodsThis prospective cross sectional study included 297 children diagnosed with celiac disease. The medical records of all patients were reviewed.ResultsIn neurological evaluation, totally 40 (13. 5%) of the 297 celiac patients had a neurological finding including headache, epilepsy, migraine, mental retardation, breath holding spells, ataxia, cerebral palsy, attention deficit hyperactivity disorder, Down syndrome and Turner syndrome in order of frequency. There was not any significant difference between the laboratory data of the patients with and without neurological manifestations. However; type 3a biopsy was statistically significantly more common among patients without neurological manifestations, while type 3b biopsy was statistically significantly more common among patients with neurological manifestations.ConclusionIt is important to keep in mind that in clinical course of celiac disease different neurological manifestations may be reported.

ContextoVárias doenças neurológicas têm sido amplamente descritas em pacientes com doença celíaca.ObjetivoO objetivo deste estudo foi determinar a incidência de diferentes manifestações neurológicas em crianças com doença celíaca em acompanhamento no momento do diagnóstico e discutir essas manifestações à luz da literatura recente.MétodosEste estudo seccional transversal prospectivo incluiu 297 crianças diagnosticadas com a doença celíaca. Os registros médicos de todos os pacientes foram revistos.ResultadosNa avaliação, 40 (13,5%) dos 297 pacientes celíacos havia algum achado neurológico, incluindo dor de cabeça, epilepsia, enxaqueca, retardo mental, crises de perda de choro, ataxia, paralisia cerebral, síndrome de déficit de atenção e hiperatividade, e síndrome de Turner, em ordem de frequência. Não houve qualquer diferença significativa entre os dados laboratoriais de pacientes com e sem manifestações neurológicas. No entanto, biópsia tipo 3a foi, estatisticamente, significativamente mais comum entre os pacientes sem manifestações neurológicas, enquanto o tipo 3b foi mais comum e estatisticamente significante entre os pacientes com manifestações neurológicas.ConclusãoÉ importante manter em mente que, no curso clínico da doença celíaca, diferentes manifestações neurológicas podem ser relatadas.

Peripheral neuropathy electrophysiological screening in children with celiac disease.

BACKGROUND: The involvement of the peripheral nervous system in children with celiac disease is particularly rare. OBJECTIVE: The aim of this study was to assess the need for neurophysiological testing in celiac disease patients without neurological symptoms in order to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. METHODS: Two hundred and twenty consecutive children with celiac disease were screened for neurological symptoms and signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 167 asymptomatic patients as well as 100 control cases were tested electro-physiologically for peripheral nervous system diseases. Motor nerve conduction studies, including F-waves, were performed for the median, ulnar, peroneal, and tibial nerves, and sensory nerve conduction studies were performed for the median, ulnar, and sural nerves with H reflex of the soleus muscle unilaterally. All studies were carried out using surface recording electrodes. Normative values established in our laboratory were used. RESULTS: Evidence for subclinical neuropathy was not determined with electrophysiological studies in any of the participants. CONCLUSION: In this highly selective celiac disease group without any signs, symptoms as well as the predisposing factors for polyneuropathy, we did not determine any cases with neuropathy. With these results we can conclude that in asymptomatic cases with celiac disease electrophysiological studies are not necessary. However, larger studies with the electrophysiological studies performed at different stages of disease at follow-ups are warranted.

The Frequency of Epileptiform Discharges in Celiac Disease.

BACKGROUND: We studied patients with celiac disease to define the frequency of epileptiform discharges on electroencephalography. METHODS: A total of 307 children with a diagnosis of celiac disease (study group) and 197 age- and sex-matched healthy children as controls (control group) were included in this study. The study group was further divided into newly diagnosed celiac disease patients (n = 216) and patients who were on a gluten-free diet (n = 91) for at least 6 months. Medical histories of all children including age, sex, symptoms, weight, height, physical examination findings, and laboratory data were recorded. All patients underwent an electroencephalograph in a pediatric neurology electroencephalograph laboratory with a 32-channel electroencephalograph for 30 minutes. RESULTS: Twenty-five patients were defined to have epileptiform discharges (spike/sharp-wave discharges); 24 (7.8%) of those patients were in the celiac disease group and 1 (0.5%) was in the control group (P = 0.001). Among those 24 patients, 21 (9.7%) were in newly diagnosed celiac disease group and 3 (3.3%) were in the gluten-free diet group (P = 0.03). CONCLUSIONS: Patients diagnosed with celiac disease are prone to epileptiform activities on electroencephalography and should be evaluated carefully. Moreover, strict adherence to a gluten-free diet early should be advised in those patients with epileptiform activities because it may effectively decrease the occurrence of epileptiform activities.

Peripheral neurppathy electrophysiological screening in children with celiac disease / Triagem eletrofisiológica de neuropatia periférica em crianças com doença celíaca

Background The involvement of the peripheral nervous system in children with celiac disease is particularly rare. Objective The aim of this study was to assess the need for neurophysiological testing in celiac disease patients without neurological symptoms in order to detect early subclinical neuropathy and its possible correlations with clinical and demographic characteristics. Methods Two hundred and twenty consecutive children with celiac disease were screened for neurological symptoms and signs, and those without symptoms or signs were included. Also, patients with comorbidities associated with peripheral neuropathy or a history of neurological disease were excluded. The remaining 167 asymptomatic patients as well as 100 control cases were tested electro-physiologically for peripheral nervous system diseases. Motor nerve conduction studies, including F-waves, were performed for the median, ulnar, peroneal, and tibial nerves, and sensory nerve conduction studies were performed for the median, ulnar, and sural nerves with H reflex of the soleus muscle unilaterally. All studies were carried out using surface recording electrodes. Normative values established in our laboratory were used. Results Evidence for subclinical neuropathy was not determined with electrophysiological studies in any of the participants. Conclusion In this highly selective celiac disease group without any signs, symptoms as well as the predisposing factors for polyneuropathy, we did not determine any cases with neuropathy. With these results we can conclude that in asymptomatic cases with celiac disease electrophysiological studies are not necessary. However, larger studies with the electrophysiological studies performed at different stages of disease at follow-ups are warranted. .

Contexto O envolvimento do sistema nervoso periférico em crianças com doença celíaca é particularmente raro. Objetivo O objetivo do presente estudo foi avaliar a necessidade de testes neurofisiológicos em pacientes com doença celíaca sem sintomas neurológicos, a fim de detectar neuropatia subclínica precoce e suas possíveis correlações com características clínicas e demográficas. Métodos Duzentos e vinte crianças consecutivas com doença celíaca foram pesquisadas para os sinais e sintomas neurológicos, e foram incluídos somente aqueles sem sintomas ou sinais. Além disso, os portadores de comorbidades associadas à neuropatia periférica ou história de doença neurológica também foram excluídos. Os 167 pacientes assintomáticos, bem como 100 casos controles foram testados electrofisiologicamente para doenças do sistema nervoso periférico. Estudos de condução nervosa motora, incluindo ondas F foram realizados para os nervos medianos, ulnar, fibular e tibiais; realizaram-se estudos de condução sensorial para o nervo mediano, ulnar, e nervos surais com reflexo H do músculo sóleo unilateralmente. Todos os estudos foram realizados utilizando gravação por eletrodos de superfície. Foram usados valores normativos estabelecidos em nosso laboratório. Resultados Não foi determinada evidência de neuropatia subclínica com estudos eletrofisiológicos em qualquer um dos participantes. Conclusão Neste grupo altamente seletivo de pacientes com doença celíaca sem quaisquer sinais, sintomas, bem como os fatores predisponentes para a polineuropatia, não se determinou qualquer caso com neuropatia. Com estes resultados, pode-se concluir que, em casos assintomáticos com doença celíaca os estudos eletrofisiológicos não são necessários. No entanto, são necessários maiores estudos eletrofisiológicos realizados em diferentes fases da doença. .

The prevalence of celiac disease among patients with familial mediterranean Fever.

BACKGROUND: Familial Mediterranean Fever and celiac disease are both related to auto-inflammation and/or auto-immunity and they share some common clinical features such as abdominal pain, diarrhea, bloating and flatulence. Objectives We aimed to determine the association of these two diseases, if present. METHODS: Totally 112 patients diagnosed with Familial Mediterranean Fever and 32 cases as healthy control were included in the study. All participants were examined for the evidence of celiac disease, with serum tissue transglutaminase IgA levels (tTG IgA). RESULTS: Totally 144 cases, 112 with Familial Mediterranean Fever and 32 healthy control cases were included in the study. tTG IgA positivity was determined in three cases with Familial Mediterranean Fever and in one case in control group. In that aspect there was no significant difference regarding the tTG IgA positivity between groups (P=0.81). Duodenum biopsy was performed to the tTG IgA positive cases and revealed Marsh Type 3b in two Familial Mediterranean Fever cases and Marsh Type 3c in the other one while the biopsy results were of the only tTG IgA positive case in control group was Marsh Type 3b. In HLA evaluation of the celiac cases; HLA DQ2 was present in two celiac cases of the Familial Mediterranean Fever group and in the only celiac case of the control group while HLA DQ8 was present in one celiac case of the Familial Mediterranean Fever group. CONCLUSIONS: We did not determine an association of Familial Mediterranean Fever with celiac disease. Larger studies with subgroup analysis are warranted to determine the relationship of these two diseases.

Gastrointestinal system lesions in children due to the ingestion of alkali and acid corrosive substances.

BACKGROUND/AIM: TO examine esophageal and gastric lesions in children due to the ingestion of alkali and acid corrosive substances and to emphasize all related complications. MATERIALS AND METHODS: The reports of 103 children who ingested or were suspected to have ingested corrosive substances and who then underwent upper gastrointestinal endoscopic inspections were evaluated retrospectively. RESULTS: Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently contained sodium hydroxide, followed by hydrochloric acid, sodium hypochlorite, and sulfuric acid. Endoscopic inspections were abnormal in 68% of the cases. Esophageal lesions were observed in 56.3% of the patients, while gastric lesions were observed in 35%. During the follow-up period, esophageal strictures developed in 4.9% of patients, while gastric outlet obstructions developed in 1%. CONCLUSION: Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently contained sodium hydroxide, followed by hydrochloric acid, sodium hypochlorite, and sulfuric acid. Endoscopic inspections were abnormal in 68% of the cases. Esophageal lesions were observed in 56.3% of the patients, while gastric lesions were observed in 35%. During the follow-up period, esophageal strictures developed in 4.9% of patients, while gastric outlet obstructions developed in 1%.

The prevalence ff celiac disease among patients with familial mediterranean fever / Prevalência da doença celíaca entre pacientes com Febre Familiar do Mediterrâneo

Background Familial Mediterranean Fever and celiac disease are both related to auto-inflammation and/or auto-immunity and they share some common clinical features such as abdominal pain, diarrhea, bloating and flatulence. Objectives We aimed to determine the association of these two diseases, if present. Methods Totally 112 patients diagnosed with Familial Mediterranean Fever and 32 cases as healthy control were included in the study. All participants were examined for the evidence of celiac disease, with serum tissue transglutaminase IgA levels (tTG IgA). Results Totally 144 cases, 112 with Familial Mediterranean Fever and 32 healthy control cases were included in the study. tTG IgA positivity was determined in three cases with Familial Mediterranean Fever and in one case in control group. In that aspect there was no significant difference regarding the tTG IgA positivity between groups (P=0.81). Duodenum biopsy was performed to the tTG IgA positive cases and revealed Marsh Type 3b in two Familial Mediterranean Fever cases and Marsh Type 3c in the other one while the biopsy results were of the only tTG IgA positive case in control group was Marsh Type 3b. In HLA evaluation of the celiac cases; HLA DQ2 was present in two celiac cases of the Familial Mediterranean Fever group and in the only celiac case of the control group while HLA DQ8 was present in one celiac case of the Familial Mediterranean Fever group. Conclusions We did not determine an association of Familial Mediterranean Fever with celiac disease. Larger studies with subgroup analysis are warranted to determine the relationship of these two diseases. .

Contexto A Febre Familiar do Mediterrâneo e a doença celíaca são ambas relacionadas com auto-inflamação e/ou auto-imunidade e partilham algumas características clínicas comuns tais como dor abdominal, diarréia, distensão abdominal e flatulência. Objetivo Determinar a associação destas duas doenças, se presente. Métodos Um total de 112 pacientes diagnosticados com Febre Familiar do Mediterrâneo e 32 casos como controle saudável foram incluídos no estudo. Todos os participantes foram examinados para a evidência da doença celíaca, com níveis de IgA séricos transglutaminase (tTG IgA). Resultados Um total de 144 casos, 112 com Febre Familiar do Mediterrâneo e 32 casos controle saudável foram incluídos no estudo. A positividade tTG IgA foi determinada em três casos com Febre Familiar do Mediterrâneo e em um caso no grupo controle. Neste aspecto não há nenhuma diferença significativa em relação a positividade tTG IgA entre os grupos (P= 0,81). Biópsia de duodeno realizado para os casos positivos de tTG IgA e revelou Marsh tipo 3b em dois casos de Febre Familiar e Marsh tipo 3C no outro, enquanto o resultado da biópsia do único caso positivo tTG IgA no grupo controle foi Marsh tipo 3b. Na avaliação de HLA dos casos de doença celíaca, HLA DQ2 esteve presente em dois casos de doença celíacas do grupo Febre Familiar do Mediterrâneo e no caso celíaco do grupo controle, enquanto HLA-DQ8 estava presente em um caso de doença celíaca do grupo Febre Familiar do Mediterrâneo. Conclusão Não se determinou uma associação de Febre Familiar do Mediterrâneo com doença celíaca. Maiores estudos com análise de subgrupo são necessários para determinar a relação entre estas duas doenças. .

The importance of the serum quantitative levels of hepatitis B surface antigen and hepatitis B e antigen in children with chronic hepatitis B.

BACKGROUND/AIMS: We aimed to investigate the clinical importance of quantitative levels of serum hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg), and to detect their correlation with hepatitis B virus (HBV) DNA load, alanine aminotransferase (ALT) levels, hepatic activity index (HAI) and fibrosis scores. MATERIALS AND METHODS: A total of 56 HBeAg-positive children with chronic hepatitis B (CHB) were included in the study. Quantification of HBsAg and HBeAg was performed using an automated chemiluminescent microparticle immunoassay. Comparisons were performed using the paired t-test, Mann-Whitney U test or t-test for independent samples. Correlations were tested using the Pearson correlation analysis. RESULTS: Significant differences were found between groups of pre- and post treatment quantitative levels of HBsAg, HBeAg, HBV DNA, and ALT. Comparison of HBsAg, HBeAg, HBV DNA, and ALT levels before the treatment and decrease ratios of these levels after treatment according to HAI and fibrosis scores did not show any statistically significant differences. There was a positive correlation between pretreatment HBV DNA load and HBeAg levels, and a negative correlation between pretreatment HBV DNA and ALT levels. There was a negative correlation between decrease ratios of HBsAg and ALT levels after treatment. Patients with post treatment HBeAg seroconversion had a lower post treatment HBV DNA load and a higher decrease ratio of HBsAg than patients who did not have HBeAg seroconversion. CONCLUSION: The present study indicated that HBsAg and HBeAg levels significantly decreased during treatment and that HBeAg correlated with HBV DNA load. Quantitative HBeAg and HBsAg assays could therefore have an important role in treatment of CHB.

Prevalence of celiac disease in children with idiopathic epilepsy in southeast Turkey.

BACKGROUND: We examined the prevalence of celiac disease in children with idiopathic epilepsy. METHODS: Patients were screened for celiac disease using the immunoglobulin A anti-tissue transglutaminase antibody. Upper gastrointestinal endoscopy and small intestinal biopsy were offered to all antibody-positive patients. The control group consisted of 400 healthy children. RESULTS: A total of 600 patients (332 boys, 268 girls; 8 months-15 years; 9.40 ± 4.09 years) were studied. In 38 patients, the diagnosis was childhood partial epilepsy with occipital paroxysms. Six of the 38 patients with childhood partial epilepsy with occipital paroxysms (15.7%) had positive immunoglobulin A anti-tissue transglutaminase antibody. The frequency of biopsy-proven celiac disease was 15.7% (6/38) among children with childhood partial epilepsy with occipital paroxysms. None of the control patients had positive immunoglobulin A anti-tissue transglutaminase antibody results. CONCLUSIONS: These findings suggest that the prevalence of celiac disease in children with partial epilepsy with occipital paroxysms may be higher than with other types of epilepsies. It may be reasonable to screen individuals with this type of epilepsy for celiac disease.

Protective effects of L-carnitine, N-acetylcysteine and genistein in an experimental model of liver fibrosis.

AIM: Liver fibrosis is a reversible wound-healing response that occurs following liver injury. In this study, we aimed to investigate the possible protective effects of L-carnitine, N-acetylcysteine and genistein in liver fibrosis induced by carbon tetrachloride (CCl4). In addition, the effects of these agents were compared in the same study. METHODS: In this study, rats were randomly allocated into 8 groups, consisting of 10 rats each, as follows: a control group, CCl4, L-carnitine, N-acetylcysteine, genistein, CCl4 and L-carnitine, CCl4 and N-acetylcysteine, and CCl4 and genistein. At the end of 6 weeks, blood and liver tissue specimens were collected. Alanine aminotransferase (ALT); aspartate aminotransferase (AST); complete blood count, tumor necrosis factor-α (TNF-α); platelet-derived growth factor-BB (PDGF-BB); interleukin-6 (IL-6); liver glutathione level; oxidant/antioxidant status; scores of hepatic steatosis, necrosis, inflammation, and fibrosis; and the expression of α-smooth muscle actin were studied. RESULTS: Although the ALT and AST values in the group administered CCl4 were significantly higher than in all the other groups (P<0.05), there was no significant difference between the control group and the groups administered CCl4 combined with L-carnitine, N-acetylcysteine and genistein (P>0.05). There were significant differences in the levels of TNF-α, PDGF-BB and IL-6 (P<0.05) between the CCl4 group and the groups with L-carnitine, N-acetylcysteine and genistein added to CCl4. N-acetylcysteine and genistein had positive effects on the oxidant/antioxidant status and on liver necrosis and fibrosis scores. CONCLUSIONS: In our study, L-carnitine, N-acetylcysteine and genistein showed significant protective effects in liver fibrosis induced by CCl4.

Hemlock (Conium Maculatum) Poisoning In A Child.

Poison hemlock (Conium maculatum) is a plant that is poisonous for humans and animals. Accidental ingestion of the plant may result in central nervous system depression, respiratory failure, acute rhabdomyolysis, acute renal failure and even death. The main treatment of hemlock poisoning is supportive care. The case of a 6-year-old girl who was admitted to the emergency department with complaints of burning sensation in mouth, hypersalivation, tremor in hands and ataxia after ingestion of poison hemlock is presented here with clinical and laboratory features. In this case, we aim to report that accidental ingestion of plants resembling vegetables that are consumed daily can lead to serious complications and even death.

Severe scorpion envenomation in children: Management in pediatric intensive care unit.

BACKGROUND: Scorpion envenomation is a common public health problem worldwide and children are at greater risk of developing severe cardiac, respiratory and neurological complications. The aim of this study was to evaluate the effects of antivenin and/or prazosin use on prognosis of scorpion-envenomed children admitted to pediatric intensive care unit (PICU). METHODS: The standardized medical records of 45 children hospitalized with severe scorpion sting in PICU were retrospectively evaluated. General characteristics of the children, clinical and laboratory findings, treatment approaches and prognosis were evaluated. RESULTS: The mean age of the patients were 6.1 +/- 4.1 years ranging between 4 month and 15 years. Male to female ratio was 1.8. Thirty-three (71.1%) cases of scorpion stings came from rural areas. Twenty-six (57.8%) of the patients were stung by Androctonus crassicauda. The most common sting localization was the foot-leg (55.6%). The mean duration from the scorpion sting to hospital admission was 4.5 +/- 2.6 hours. The most common findings at presentation were cold extremities (95.5%), excessive sweating (91.1%) and tachycardia (77.7%). The mean leukocyte count, and serum levels of glucose, lactate dehydrogenase, creatine phosphokinase and international normalized ratio were found above the normal ranges. Prazosin was used in all patients, dopamine in 11 (24.4%) and Na-nitroprusside in 4 (8.8%) patients. Two children died (4.4%) due to pulmonary oedema. These children, in poor clinical status at hospital admission, needed mechanical ventilation, and death occurred despite use of antivenin and prazosin in both of them. CONCLUSION: The current management of children with severe scorpion envenomation consists of administration of specific antivenom and close surveillance in a PICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The aggressive medical management directed at the organ system specifically can be effective. Our data indicated that when admission to hospital is late, the beneficial effect of antivenom and/or prazosin is questionable in severe scorpion stings.