The 2023 Türkiye-Syria earthquakes: analysis of pediatric victims with crush syndrome and acute kidney Injury

BACKGROUND

On February 6th, 2023, two consecutive earthquakes struck southeastern Türkiye with magnitudes of 7.7 and 7.6, respectively. This study aimed to analyze the clinical and laboratory findings, as well as management of pediatric victims with Crush Syndrome (CS) and Acute Kidney Injury (AKI).

METHODS

The study included pediatric earthquake victims who were presented to Mersin University Hospital. Clinical and laboratory characteristics of the patients were collected retrospectively.

RESULTS

Among 649 patients, Crush injury (CI), CS and AKI was observed in 157, 59, and 17 patients, respectively. White blood cell count (12,870 [IQR: 9910-18700] vs. 10,545 [IQR: 8355-14057] /µL, P < 0.001), C-reactive protein (51.27 [IQR: 14.80-88.78] vs. 4.59 [1.04-18.25] mg/L, P < 0.001) and myoglobin levels (443.00 [IQR: 198.5-1759.35] vs. 17 [11.8-30.43] ng/ml) were higher in patients with CS, while their sodium (IQR: 134 [131-137] vs. 136 [134-138] mEq/L, P < 0.001) levels were lower compared to non-CS patients. An increase in myoglobin levels was identified as an independent risk factor for developing CS (OR = 1.017 [1.006-1.027]). Intravenous fluid replacement was administered to the patients with CS at a dose of 4000 cc/m2/day. Hypokalemia was observed in 51.9% of the CS patients on the third day. All patients with AKI showed improvement and no deaths were reported.

CONCLUSIONS

Hyponatremia and increase in inflammation markers associated with CS may be observed. An increase in myoglobin levels was identified as a risk factor for CS. Hypokalemia may be seen as a complication of vigorous fluid therapy during hospitalization.

Plasma bisphenol a and phthalate levels in children with cerebral palsy: a case-control study

The case-control study aimed to evaluate potential sources of exposure and the plasma concentrations of bisphenol A (BPA) and phthalates in prepubertal children having cerebral palsy (CP) and healthy control. Blood samples of 68 CP and 70 controls were analyzed for BPA, di-(2-ethylhexyl)-phthalate (DEHP), mono-(2-ethylhexyl)-phthalate (MEHP), and dibutyl phthalate (DBP). BPA and DBP levels were similar in groups. The median DEHP and MEHP levels of the children with CP were significantly lower than those of the controls (p = 0.035, p < 0.001, respectively). Exposure to plastic food containers/bags, personal care hygiene products, household cleaners, wood/coal stove heating, and city water supplies were associated with increased odds of higher BPA and phthalate levels in children with CP. In conclusion, potential exposure sources for BPA and phthalates differ in children with CP and healthy controls, and children with CP are not exposed to higher levels of BPA and phthalates.

Video game playing and oral health in school-age children: A cross-sectional study in Turkey

AIM

The aim of this study is to evaluate the relationship of video game playing with oral/dental health and harmful oral habits in school-age children.

METHODS

The daily video gamer (n = 77) and occasional video gamer (n = 77) children between 6 and 12 years old were included in the study. A questionnaire inquiring socio-demographic characteristics, video gaming and abnormal oral habits of the children was filled by parents. The children were examined intraorally and decayed-missing-filled tooth, the International Caries Detection and the Assessment-II System scores, dental plaque and gingival indices were recorded.

RESULTS

Of the children; 42.9% daily video gamers played video games for between 1 and 2 h and 57.1% played for ≥2 h while all of the occasional video gamers spent for between 1 and 2 h on video game per day. The daily video gamer and occasional video gamer children were not different in terms of socio-demographic characteristics, frequency of having daily tooth brushing habit, using children's toothpaste and having regular dental checkup (P > 0.05). No statistically significant difference was present between the groups in terms of frequencies of abnormal oral habits and having at least one abnormal oral habit (P > 0.05). Severe gingivitis and advanced caries lesions were more common in daily video gamer group (14.2% vs. 3.9%, P = 0.025 and 90.9% vs. 70.9%, P = 0.026, respectively). Daily video gaming time was weakly correlated with plaque index (r = 0.26, n = 77, P = 0.024). Daily video gaming for ≥2 h increased the risk for severe gingivitis (odds (95% confidence interval) = 4.53 (1.07-19.23), P = 0.041) while daily video gaming for between 1 and 2 h decreased the risk for having abnormal oral habit (odds (95% confidence interval) = 0.39 (0.16-0.93), P = 0.034).

CONCLUSION

In school age, daily video gaming may worsen oral and dental health compared with occasional video gaming. Particularly, an excessive video gaming time seems to be associated with poor oral health in school children.

Mother's Nutrition Literacy and Offspring Anemia: A Comparison Study in a Single Center

OBJECTIVE

It is known that mother's knowledge about nutrition is associated with the prevalence of anemia in their children. The aim of this study was to evaluate the frequency of iron deficiency without anemia (ID), iron deficiency anemia (IDA), and anemia in children according to the level of mother's nutrition literacy (NL).

MATERIALS AND METHODS

A cross-sectional study was conducted in a well-child outpatient clinic. The study included healthy children aged between 24 and 59 months and their mothers. Scores of the mothers on the Nutrition Literacy Assessment Tool for Adults and children's anthropometric z-scores, dietary diversity and Mediterranean Diet Quality Index scores, and children's hemoglobin and ferritin levels were collected. Two-group comparison analysis was performed.

RESULTS

Ninety mother-child pairs were included. While 36 mothers (40%) had borderline and 54 (60%) mothers had adequate NL, 15 children (16.7%) had ID, 5 (5.6%) children had IDA, and a total of 18 children (20%) had nutritional anemia. The percentage of wasted children was higher in the group with borderline NL (13.9% vs. 1.9%, P = .036). The percentage of children with ID, IDA, or other nutritional anemia was not different between the borderline and adequate NL groups (30.6% vs. 40.7%, P = .326).

CONCLUSION

The frequency of ID, IDA, or other nutritional anemia in children does not differ significantly between mothers with borderline and adequate NL. Increasing NL of mothers could be a step toward reducing the burden of child undernutrition.

Evaluation of Intestinal Microbiota in Children With Sickle Cell Disease

BACKGROUND AND AIMS

Sickle cell disease (SCD) is a chronic hemolytic anemia that may be life-threatening due to multisystemic effects. Identification of the factors which affect the pathophysiology of the disease is important in reducing mortality and morbidity. This study aimed to determine gut microbial diversity in children and adolescents with SCA compared with healthy volunteers and to evaluate the clinical impact of microbiota.

MATERIALS AND METHODS

The study included 34 children and young adolescents with SCD and 41 healthy volunteer participants. The microbiome was assessed by 16S rRNA sequencing in stool samples. Laboratory parameters of all participants, such as complete blood count and C-reactive protein values and clinical characteristics of SCD patients, were determined and compared, as well as clinical conditions of the patients, such as vascular occlusive crisis and/or acute chest syndrome, frequency of transfusions, intake of penicillin, hydroxyurea, and chelation therapy were recorded.

RESULTS

White blood cell count, hemoglobin, immature granulocyte and C-reactive protein levels were significantly higher in the patient group ( P <0.05). Microbiota analysis revealed 3 different clusters among subjects; controls and 2 clusters in the SCD patients (patient G1 and G2 groups). Bacteroides spp. were more prevalent, while Dialester spp. and Prevotella spp. were less prevalent in SCD compared with controls ( t =2.142, P <0.05). Patient G2 (n=9) had a higher prevalence of Bacteroides and a lower prevalence of Prevotella than patient G1 (n=25).

CONCLUSION

In our study, there was a difference between SCD patients and the control group, while 2 different microbiota profiles were encountered in SCD patients. This difference between the microbiota of the patients was not found to affect the clinical picture (such as vascular occlusive crisis, acute chest syndrome).

Thromboprophylaxis in pediatric patients with earthquake-related crush syndrome: a single centre experience

PURPOSE

Injuries increase the risk of venous thromboembolism (VTE). However, the literature on the management of anticoagulant therapy in pediatric patients with crush injury is limited. In this study, we aimed to share our experience about anticoagulant thromboprophylaxis in pediatric patients with earthquake-related crush syndrome.

METHODS

This study included patients who were evaluated for VTE risk after the Turkey-Syria earthquake in 2023. Since there is no specific pediatric guideline for the prevention of VTE in trauma patients, risk assessment for VTE and decision for thromboprophylaxis was made by adapting the guideline for the prevention of perioperative VTE in adolescent patients.

RESULTS

Forty-nine patients [25 males and 24 females] with earthquake-related crush syndrome had participated in the study. The median age of the patients was 13.5 (8.8-15.5) years. Seven patients (14.6%) who had no risk factors for thrombosis were considered to be at low risk and did not receive thromboprophylaxis. Thirteen patients (27.1%) with one risk factor for thrombosis were considered to be at moderate risk and 28 patients (58.3%) with two or more risk factors for thrombosis were considered to be at high risk. Moderate-risk patients (n = 8) and high-risk patients aged < 13 years (n = 11) received prophylactic enoxaparin if they could not be mobilized early, while all high-risk patients aged ≥ 13 years (n = 13) received prophylactic enoxaparin.

CONCLUSION

With the decision-making algorithm for thyromboprophylaxis we used, we observed a VTE rate of 2.1% in pediatric patients with earthquake-related crush syndrome.

Problematic media use is associated with poor oral health in Turkish school-age children: a pilot cross-sectional study

OBJECTIVES

In the recent years, problematic media use (PMU) has become a serious health concern for children. The precisely defined effects of PMU on children's oral health are unknown. It was aimed to investigate the relationship between the PMU and oral health and oral habits in school-age children.

METHODS

In this cross-sectional study, mothers and their healthy children aged 6-11 years who applied to pediatric dentistry outpatient clinic were enrolled. PMU was assessed using the parent-reported Problematic Media Use Measure Short Form (PMUM-SF). PMUM-SF scores were divided into 3 groups from the lowest to the highest tertile. Multivariable logistic regressions for PMU (moderate-high vs. low) were used to predict the odds of having good and parafunctional oral habits, poor oral hygiene, gingivitis and caries.

RESULTS

Totally 153 mother-child pairs participated in this study. Plaque index, gingival index, ICDAS-II (International Caries Detection and Evaluation System), DMFT and DMFS [decayed (D), missing (M), filled (F) tooth (T) /surfaces (S)] scores were significantly higher in children with moderate-high PMU (P < 0.05). After adjusting for potential confounders, moderate-high PMU decreased the probability of good oral habit of daily toothbrushing [Odds (95% CI) = 0.43 (0.20-0.94)] while it increased the risk of oral parafunctional habit of object sucking/biting [Odds (95% CI) = 3.34 (1.27-8.74)]. Moderate-high PMU increased the risk of moderate-severe gingivitis, moderate-extensive caries and the presence of DMFT [Odds (95% CI) = 2.13 (1.01-4.50); 4.54 (1.11-18.54) and 2.16 (1.07-4.36), respectively].

CONCLUSIONS

Turkish school-age children with a remarkable PMU were significantly more likely to have poor oral health and exhibit oral parafunctional habits Oral health screening seems to be needed for Turkish children experiencing PMU.

Video game playing among preschoolers: prevalence and home environment in three provinces from Turkey

We aimed to investigate the video game habits and their relationship with home environment in children 2-5 years in Turkey. A structured questionnaire about the child's demographic, screen, and video gaming characteristics was completed by parents in five health centers from three provinces. One-quarter of 1245 preschoolers were found to play video games. The prevalence of playing video games was higher in older age, male gender, low parental education, families with 3 or more children, having a game console, computers and tablets at home, child's screen time of more than 2 hours per day, child's non-compliance with the parental screen rules, and presence of someone else playing videogame at home. Of the parents, 54.5% did not know the name of the video game the child was playing. Parents should be counseled about supervising on their children's video game playing habits and selection of well-designed games with the right content.

The Psychosocial Well-Being of Young Video-Gamer Children: A Comparison Study

Objective:

In recent years, young children from all socioeconomic conditions found an opportunity to own or access video game devices. The precisely defined effects of video gaming on young children’s behaviors and mental health are unknown. This study aimed to investigate the relationship between the psychosocial well-being and video gaming in preschool children.

Materials and Methods:

The video gamer (n = 70) and non-gamer (n = 140) children between 2 and 6 years old and their mothers were included in the study. Psychosocial well-being was assessed using the Strengths and Difficulties Questionnaire parent version. Multivariable logistic regressions were used.

Results:

30% of the video gamers played video games for more than 1 hour per day. Factors associated with video gaming included sex, birth order, age of first screen exposure, daily screen time, and parent(s) video gaming. Being a boy, having a daily screen time of more than 1 hour and parent(s) video gaming increased the probability of video gaming [Odds (95% CI) = 3.00 (1.42-6.31), P = .004; 6.28 (2.86-13.80), P < .001; 6.49 (2.77-15.23), P < .001, respectively]. Not being the first child and having an age of first screen exposure older than 12 months old decreased the probability of video gaming [Odds (95% CI) = 0.29 (0.11-0.76), P = .012; 0.34 (0.13-0.89), P = .027, respectively]. Video gamers and non-gamers had statistically similar Strengths and Difficulties Questionnaire scores. There was no association between video gaming and being borderline or abnormal in emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, prosocial behavior, and total difficulties.

Conclusion:

This study investigating the relationship between psychosocial well-being and video gaming revealed that video gaming is not associated with psychosocial well-being in preschool age.

Evaluation of problematic screen exposure in pre-schoolers using a unique tool called "seven-in-seven screen exposure questionnaire": cross-sectional study

Background

Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children’s health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the “Seven-in-Seven Screen Exposure Questionnaire” and to investigate factors associated with problematic screen exposure.

Methods

A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the “Seven-in-Seven Screen Exposure Questionnaire” was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0–13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (< 7) and high (≥ 7). Logistic regression was performed to search for independent parameters associated with problematic screen exposure.

Results

One thousand two hundred forty-five mother-child pairs participated in this study. The median age of the children was 3.9 (IQR: 2.9–4.7) years and 51% were males. Overall, 280 children (22.5%) had a problematic screen exposure score of ≥7 (high). The median problematic screen exposure score was 4 (IQR: 3–6). Maternal age of < 30 years; paternal age of ≥30 years; maternal educational level of ≤12 years; the age of 24–48 months; home-based daycare; postponing eating, toileting, or sleeping while using a screen; and using touchscreen devices were found to be associated with an increased risk of having a high problematic screen exposure score.

Conclusion

Developing national scales to monitor problematic screen use in children would be more effective than monitoring screen time alone. All of the screen use characteristics not recommended in children would be evaluated using problematic screen exposure scales. The “Seven-in-Seven Screen Exposure Questionnaire” may serve as an example for further studies.

Excessive screen time is associated with maternal rejection behaviours in pre-school children

AIM

Early childhood screen exposure leads to multiple adverse health events and parents have a major influence on their children's screen time. Our aim was to determine the association between maternal acceptance-rejection/control behaviours and excessive screen exposure in pre-school children.

METHODS

In this cross-sectional descriptive study, children aged 2-5 years who had daily screen time <1 h (n = 76) and >4 h (n = 62) were enrolled. A structured survey form and Parental Acceptance-Rejection/Control Questionnaire were completed by mothers.

RESULTS

Total rejection scores were found to be lower in those with screen time <1 h than cases with >4 h (82.7 ± 13.2, 89.3 ± 17.2; P = 0.015). In addition, higher hostility, neglect and reverse-affection scores were detected in excessive screen-exposed group (P = 0.033, P = 0.003, P = 0.047, respectively). Multivariate logistic regression analyses revealed that mothers' low acceptance of their children and high neglect score were associated with excessive screen exposure after adjusting possible confounding factors. The undifferentiated rejection and control behaviours of the mothers had no association with excessive screen exposure.

CONCLUSION

Children with excessive screen time may have a problematic relationship with their mothers. The relationship between parent and child should be examined and corrective actions should be taken.

Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy

BACKGROUND AND OBJECTIVES

The comparison of Positron emission tomography- computed tomography (PETCT) and bone marrow biopsy (BMB) modalities in detecting bone marrow disease is an up to date research topic. In this study, we aimed to compare the results of PET-CT and BMB procedures in detecting bone marrow involvement in pediatric malignancies.

METHOD

At the time of diagnosis, PET-CT imaging and BMB performed patients` data were evaluated, retrospectively. Malign diagnoses were Hodgkin's lymphoma in 23 (30.7%), non-Hodgkin's lymphoma in 20 (26.7%), neuroblastoma in 11 (14.7%), Ewing sarcoma in 10 (13.7%), Langerhans cell histiocytosis in 6 (8%), and rhabdomyosarcoma in 5 (6.6%) patients.

RESULTS

Bone marrow involvement was detected in 39 (52%) of 75 patients. Bone marrow involvement was identified by both PET-CT and BMB in 18 (46.1%) patients, by only PET-CT in 12 (30.7%) patients, by only BMB in 9 (23%) patients. The sensitivity of PET-CT was 66%, specificity was 75%, positive predictive value was 60%, and negative predictive value was 80%. Sensitivity, spesificity, positive and negative predictive values of PETCT were different in before mentioned malignancy groups.

CONCLUSION

PET-CT may not have high sensitivity and specificity to identify bone marrow involvement for each type of cancer. The approach of using bone marrow biopsy and PET-CT as complementary modalities seems reliable.

Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers

BACKGROUND

The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing.

METHODS

Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS.

RESULTS

115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p=0.022 and aOR: 1.02, p=0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p=0.003).

CONCLUSION

IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma.