ISSN 1302-9940

Hzl Arama




J Child: 19 (2)

Cilt: 19  Say: 2 - 2019

1.
indekiler
Contents

Sayfalar I - IV

2.
Yazarlara Bilgi
Author Information

Sayfalar V - VI

DERLEME
3.
Meningokok alar
Meningococcal vaccines
Manolya Kara, Ayper Somer
doi: 10.5222/j.child.2019.40427  Sayfalar 51 - 59
Neisseria meningitidis, asemptomatik tayclktan hayat tehdit eden invazif meningokok hastalna kadar geni bir yelpazede karmza kmaktadr. Hastala kar; dnyada yaygn olarak kullanmda olan iki eit (polisakkarit ve konjge) meningokok as mevcuttur. Polisakkarit meningokok alar 2 yandan sonra, zellikle invazif meningokok hastal riskinin artt adolesan ve gen erikinlerde, konjge alarn bulunmad lkelerde tercih edilmektedir. Konjge meningokok alarndan MenACWY-CRM, 2 aylktan itibaren kullanlabilmesi sebebi ile nem tamaktadr. Yaplan almalar sonucu MenACWY-CRM as stocuu, ocuk, adolesan ve erikinlerde etkin ve dk yan etki profiline sahip bulunmutur.
Neisseria meningitidis, is confronted in a wide spectrum of disease ranging from asymptomatic carriers to life-threatening invasive meningococcal disease. Worldwide, two types of meningococcal vaccines (polysaccharide and conjugated) are in clinical use against disease. Polysaccharide meningococcal vaccines are preferred in countries where there is no access of conjugate vaccine in adolescents and young adults (after the age of 2), who are particularly at risk for invasive meningococcal disease. MenACWY-CRM, one of the conjugated meningococcal vaccines, is important since it can be used from 2 months of age. The results of the studies have shown that the MenACWY-CRM vaccine has an effective and low side-effect profile in infants, children, adolescents and adults.

4.
Salam ocuk zleminde Hipertansiyon Taramas
Screening for Hypertension in Well-Child Follow-up
Bahar Kural
doi: 10.5222/j.child.2019.45403  Sayfalar 60 - 62
Taramalar, bir salk sorununun belirti vermeden nce saptanmasna ynelik salk hizmetleridir. Sorunun kalc bozukluklara yol amadan tannp, dzeltilmesini amalar. Hipertansiyon 18 yan altndakilerde daha az sklkta grlmesine ramen, sklk artmaktadr. Kantlar, yaamn erken dnemlerinde yksek kan basncnn zararl, yaam boyu kardiyovaskler etkilere sahip olduunu, hipertansiyon taramasnn potansiyel yararlar ve ocukluktan balayarak nlenmesi ile ilgili sorular gndeme getirdiini gstermektedir. Bu makalede Trkiyede uygulanan ocukluk anda hipertansiyon taramas ve dier lkelerin uygulamalarnn incelenmesi amalanmtr.
Screenings are the health services for the detection of a health problem before any symptoms observed. They aim to identify and treat the problem without causing permanent disturbances. Although hypertension is found less frequently among those aged under 18 years, the prevalance is growing. Evidence indicates that elevated blood pressure early in life has detrimental lifelong cardiovascular effects, raising questions about the potential benefits of hypertension screening and prevention starting in childhood. The aim of this article is to investigate the screening for hypertension in childhood in Turkey and in other countries.

ARATIRMA
5.
nc basamak bir pediatrik endokrinoloji merkezinde izlenen ar boy ksal olgularnn etiyolojik deerlendirmesi
Evaluation of the etiology of severe short stature in children at a tertiary pediatric endocrinology centre
Utkucan Ukun, Firdevs Bas, Sukran Poyrazoglu, Mine kr, Feyza Darendeliler, Ruveyde Bundak
doi: 10.5222/j.child.2019.18942  Sayfalar 63 - 76
GR ve AMA: Aratrmamzn amac stanbul'da nc basamak bir Pediatrik Endokrinoloji merkezinde izlenen ar boy ksal olgularnn etiyolojik profilini ve karakteristiklerini incelemektir.
YNTEM ve GERELER: Rastgele seilen 500 ar boy ksal (boy SDS <-3SD) olgusundan izlem sresi 12 ay ve zeri olan 320 hasta almaya alnmtr
BULGULAR: Olgularn %94.1'inde patolojik boy ksal saptanmtr. Patolojik boy ksalklarnda en sk etiyolojik neden endokrin bozukluklar (%50,9) olarak saptanmtr. Bunu srasyla spesifik sendromlar ve kromozom anomalileri (%13,2), orantsz boy ksalklar (%12,8), kronik hastalklar ve malntrisyon (%12,8), catch-up bymeyi yakalayamayan gebelik yana gre kk (SGA) olgular (%3,8) ve psikososyal boy ksal (%0,6) izlemektedir. Endokrin bozukluklar iinde en sk etiyolojik neden byme hormonu eksikliidir. (%95,2)
TARTIMA ve SONU: Ar boy ksal olan ocuklarda patolojik boy ksal nedenleri dlanmaldr. Aratrmamz ar boy ksal olgularnda en sk etiyolojik nedenin endokrin bozukluklar olduunu gstermitir. Gerek tm olgularda gerek de endokrin bozukluklar iinde en sk etiyolojik neden byme hormonu eksiklii olarak saptanmtr.
INTRODUCTION: The aim of this study was to describe the characteristics and the etiological profile of children with severe short stature evaluated at a tertiary Pediatric Endocrinology centre in Istanbul
METHODS: Randomly selected 500 patients with the diagnosis of severe short stature (height SDS<-3SD) were selected for this study. Among those, 320 patients with at least 12 months of follow-up were included
RESULTS: Among these patients pathological short stature was diagnosed in 94.1%. Endocrine disorders (50.9%) was found to be the leading cause among pathological short stature; followed by specific syndromes and chromosomal abnormalities (13.2%), disproportionate short stature (12.8%), chronic diseases and malnutrition (12.8%), small for gestational age (SGA) with failure of catch-up growth (3.8%) and psychosocial short stature (0.6%). Of those with endocrine disorders; the most common etiology was growth hormone deficiency (GHD) (95.2%)
DISCUSSION AND CONCLUSION: Pathological causes should be ruled out in children with severe short stature. Our results showed that the most common cause was GHD among all subjects.

6.
Serebral parezili ocua sahip anne-babalarn tutumlar
Nilin Doyran Bengisu, Nur Aydnl, Mine alkan
doi: 10.5222/j.child.2019.39327  Sayfalar 77 - 83
GR ve AMA: Bu almann amac serebral palsili (SP) ocuklarn ve SP'li ocua sahip anne-babalannn sosyodemografik zelliklerinin anne-baba tutum ve davranlarna olan etkilerini incelemektir.


YNTEM ve GERELER: almaya yalar 1-6 arasnda deien, tedavisi sren, tedaviye yeni balanacak olan 50'er SP'li olgunun annesi ile epilepsisi, nrolojik zr, kronik hastal olmayan 50 salam ocuun annesi alnd. Her grubun nitel sosyodemografik zellikleri "ki-kare" testi ile karlatrld. Anne - baba tutumlarna ait verilerin karlatrlmasnda "Mann- Whitney U Testi" kullanld. statistikler SPSS 10.0 ile Windows ortamnda yapld.
BULGULAR: almamzda elde edilen bulgulara gre; her iki SP grubunda da "ar koruyuculuk" boyutunun annelerde farkl olmad grld. "Ar koruyuculuk" boyutunun dnda "eitlik-paylama", "ev kadnln reddetme", "e geimsizlii" ve "bask-disiplin" boyutlar iki grupta karlatrldnda ayn ekilde anlaml bir fark bulunmad. SP gruplarnda alan anne dzeyinin dk olma sebebinin eitim dzeyleri ile paralel olarak, annelerin ocuklar ile daha fazla ilgilenebilmek amacyla almadklarn dndrmektedir. Annelerin evde olmaktan ve ev ilerinden mutlu olmamas ve ocuklarna zarar vermekten korkmas ile ocuktaki kronik hastalk ile koruyuculuk arasnda doru orantl bir iliki olduu dnlmektedir.

TARTIMA ve SONU: almamzn sonucu olarak tan ve tedavide SP'li ocuklarn motor faaliyetlerine younlarken, elik eden duygusal ve davransal sorunlarn ounlukla ikinci planda kaldn dndrmekte, ailenin ve ocuklarn hastala birlikte uyumlarnn salanmasnda ve anne-babalarn ocuklarna kar tutum ve davranlarnn ynlendirilmesinde psikolojik danmanlk hizmetinin gerekliliini ve nemini vurgulamaktadr.

7.
Ulusal Baklama Programna Girmeden nce Farkl Sosyoekonomik Dzeyleri Bulunan ki Okulda Hepatit A ve Hepatit B Alarnn Uygulanma Sklklar
Administration Frequencies of Hepatitis A and Hepatitis B Vaccines at Two Schools with Different Socioeconomic Status Before Admission to National Immunization Program
Bahar Kural
doi: 10.5222/j.child.2019.78095  Sayfalar 84 - 88
GR ve AMA: Hepatit A ve hepatit B alarnn lkemiz Geniletilmi Baklama Programna girmeden nce, sosyoekonomik dzeyleri farkl iki okulda, 7-15 ya aras ocuklarda her iki etkene ynelik alama oranlarnn ve seroprevelanslarn karlatrlmas amalanmtr.
YNTEM ve GERELER: almamz 2003 ylnda, stanbul Bakrky ilesinde, sosyoekonomik dzeyi farkl iki okulda renim gren 546 ocuk arasnda yaplmtr. Ebeveynlere alma ncesi bilgilendirme toplants yaplm, almaya gnll ebeveynlerin ocuklar almaya dahil edilmitir. ocuklarn hepatit A ve hepatit B alar uygulanma durumu, ocukta sarlk geirme yks sorguland. ocuklardan alnan venz kanlardan Anti HAV IgG, HbsAg, Anti Hbs belirteleri allmtr.
BULGULAR: Sosyoekonomik dzeyin daha yksek olduu okulda hepatit A ve hepatit B as ile alanma oranlar ve bu etkenlerin seroprevalanslar istatistiksel anlaml olarak yksek saptanmtr.
TARTIMA ve SONU: Ulusal Alama Programnda yer almayan alarn uygulanmas, sosyoekonomik dzeye gre farkllk gsterebilmektedir. Gnmzde hepatit A ve hepatit B alarnn Ulusal Baklama Programnda yer almas, ocuk salnda var olan bir sosyal eitsizliin kaldrlmas asndan nemli bir halk sal giriimidir.
INTRODUCTION: The aim of this study was to compare the vaccination rates and seroprevalences against hepatitis A and hepatitis B in children between 7-15 years of age, in two schools from different socioeconomic status, before being included The Expanded Programme on Immunization in Turkey.
METHODS: Our study was performed in 2003 in 546 children in two schools from different socioeconomic status in Istanbul Bakrky district. Parents were informed before the study with a meeting and children of those parents who were willing to participate in the study were included. Administration of hepatitis A and B vaccines and history of jaundice in children were questioned. Anti HAV IgG, HbsAg and Anti Hbs markers were studied from venous blood samples taken from children
RESULTS: Vaccination rates with hepatitis A and hepatitis B vaccines and seroprevalence of these agents were found to be significantly higher in the school where the socioeconomic level was higher.
DISCUSSION AND CONCLUSION: The administration of vaccines not included in National Immunization Program may vary depending on socioeconomic status. Today, the implementation of hepatitis A and hepatitis B vaccines into The National Immunization Program is an important public health initiative in terms of removing the existing social inequality in child health.

8.
Kronik Nrolojik Hastalk Tanl ocuklarn Ebeveynlerinde Grlen Depresyon ve Anksiyete
Depression and Anxiety Observed In Parents of Children Diagnosed with Chronic Neurological Diseases
Ayen Yenici, Nur Aydnl, Mine alkan
doi: 10.5222/j.child.2019.87094  Sayfalar 89 - 95
GR ve AMA: Kronik hastalk tanm geriye dn olmayan, kalc yetersizlie neden olabilen patolojik deiiklikler ile oluan ve hastann rehabilitasyonu iin zel eitim, uzun sre bakm, gzetim ve denetim gerektirebilecek durum olarak yaplmaktadr. Hasta olan ailenin en deerli varl ocuk ise bu durum tm aile iin gerek travma kayna olmaktadr. Dolaysyla bu almann amac; hasta ocuklarn ebeveynlerinde depresyon ve anksiyete orannn iinde bulunulan duruma bal olarak yksek olduunu gstermek ve psikolojik destek ihtiyacnn gerekliliine dikkat ekmektir.
YNTEM ve GERELER: Bu aratrma stanbul niversitesi Tp Fakltesi ocuk Sal ve Hastalklar Anabilim Dal ocuk Nrolojisi bilim dalna bavuran hasta ocuklarn anne, baba ve yaknlar ile stanbul ili ili ilesi merkez ASMye bavuran salkl ocuk/ocuklara sahip olan ebeveynlerden katlmay kabul edenler ile yaplmtr. Beck Depresyon lei (BD), Beck Anksiyete lei (BA) ve aratrmac tarafndan hazrlanan aile grme formu kullanlmtr. Katlm kabul eden bireylerden onam alnarak yz yze grme teknii uyguland. Katlmclarn cevaplar; katlmc ya da aratrmac tarafndan forma kaydedilerek, BD ve BA kapsamndaki sorularn seeneklerinden kendileri iin uygun olanlar iaretlemeleri istenmitir.
BULGULAR: Aratrmaya katlanlardan ocukta kronik nrolojik hastalk olan vaka grubu (n=60) ile ocukta kronik nrolojik hastalk olmayan ebeveynlerin oluturduu kontrol grubu (n=60) depresyon ve anksiyete dzeyleri asndan karlatrldnda anlaml bir farkllk olmad grlmtr (t= 1,273 p>0.05).
TARTIMA ve SONU: Hem anksiyete hem depresyon dzeylerinin arasnda anlaml bir farkllk olmamas, ancak her iki grupta da hem anksiyete hem depresyonun yksek oranda varl, daha ileri dzeyde yaplabilecek aratrmalara gerek duyulduunu gstermektedir.
INTRODUCTION: The definition of chronic disease is defined as durum a condition (situation) which is caused by irreversible pathological changes that may cause permanent disability and may require special education, long-term care, supervision and control for the rehabilitation of the patient. If the patient is the child who is the most valuable asset for the entire family, this situation is a source of real trauma. Hence; this study aimed to show the parents of children with chronic neurological disease have higher depression and anxiety depending on the circumstances and the need for psychological support and to draw attention to the necessity.
METHODS: This study was conducted with the parents and relatives of the sick chil/children who applied to the Department of Pediatric Neurology of Istanbul Medical Faculty and the parents and relatives of healthy child/children who applied to the central family health center ili in Istanbul. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and family interview form prepared by the researcher were used in this study. Informed consent was obtained from the participants and face to face interview technique was applied. The answers of the participants; were recorded by the participant or researcher on the form and asked to mark the options of the questions within the scope of BDI and BAI.
RESULTS: In this research it is observed that there is no significant difference between the case group(parents of children with chronic neurological disease n=60) and the control group (parents of children without chronic neurological disease n= 60). (t = 1.273 p> 0.05).
DISCUSSION AND CONCLUSION: While there is no significant differencebetweenanxiety and depression levels of the case and control groups, still anxiety and depression levels have high rate of presence. Therefore it can be necessary to make some further researches.

OLGU SUNUMU
9.
Akut Ebstein-Barr Virs Enfeksiyonu Srasnda Saptanan Hiperamilazemi
Hyperamilasemia Determined in the Course of Ebstein-Barr Virus Infection
Ferhan Ta, mer Suat Fitz, Ergin ifti
doi: 10.5222/j.child.2019.50470  Sayfalar 96 - 99
Makroenzimler, fizyolojik ya da patolojik durumlarda serumda bulunan yksek molekler arlkl enzimlerdir. Makroamilaz, ilk tanmlanm olan ve en sk grlen makroenzimdir. Burada makroamilazemi bir ocuk hasta sunulmutur. yanda erkek hasta ate ve boyunda ilik nedeniyle getirildi. Muayenesinde servikalde ok sayda lenfadenopatisi, hepatomegali ve splenomegali saptand. Atei, servikal lenfadenopati, hepatomegali, splenomegalisi olan ve periferik yaymasnda atipik lenfositleri saptanan hastada akut Ebstein-Barr virs enfeksiyonu dnld. Laboratuar tetkiklerinde amilaz dzeyi yksek saptand ve EBV enfeksiyonuna sekonder parotit gibi bir komplikasyon olabilecei dnld. Tedavisiz izlenen hastann takiplerinde ikayetleri ve muayene bulgular gerilemesine ramen amilaz dzeyinin yksek seyrettii grld. Amilaz ykseklii nedeniyle yaplan tkrk bezi ultrasonografisinde (USG) viral enfeksiyona sekonder olabilecek bulgular olduu grld. Yaplan abdominal USGde pankreas normal ve minimal splenomegali saptand. Baklan fraksiyone amilaz klirensi <%1 saptanan hastada amilaz yksekliinin geirilen enfeksiyon ile ilikili olmaktan ok makroamilazemiye bal olduu kansna varld. Amilaz ykseklii tesadfen bulunmu bir laboratuar bozukluk olarak karmza kabilir. Makroamilazeminin tannmas hastalara gereksiz inceleme ve giriim yaplmasn nleyebilir.
Macroenzymes are the high molecular weight enzymes which could be in the serum in physiologic or pathologic situations. The first described macroenzyme is macroamylase and it is seen most frequently as macroenzyme. Here we present a child with macroamylasemia. A 3-year-old boy admitted to the hospital with fever and cervical swelling. On the examination, there were several cervical lymphadenopathies, hepatomegaly and splenomegaly. Patient had been thought to have acute Ebstein-Barr virus (EBV) infection because of having fever, cervical lymphadenopathies, hepatomegaly, splenomegaly and atypical lymphocytes on the peripheral smear also. On laboratory findings, amylase levels were elevated. It was thought to be a secondary complication, like parotitis, due to EBV infection. After following patient without any treatments, complaints and all findings are regressed except amylase levels. Salivary gland and abdominal ultrasonography (USG) were performed to find the cause of elevated amylase levels. On the salivary gland USG, there were findings secondary to viral infections and on the abdominal USG, pancreas was normal but there was minimal splenomegaly. Fractional excretion of amylase level is determined <%1 on the patient. After all findings, as a conclusion, elevated amylase levels on our patient is thought to result from macroamylasemia rather than EBV infection. High amylase level could be determined incidentally. Recognizing macroamylasemia could prevent unnecessary examinations and interventions to patients.

10.
Mikoplazma Pnmonisine bal souk agltinin hastal; sk grlen hastaln az grlen komplikasyonu.
Cold agglutinin disease due to Mycoplasma pneumonia; uncommon complication of common disease.
Erdem Gnll, Ahmet Soysal, Atila Tanyeli, Blent Karada, Metin Karabcolu
doi: 10.5222/j.child.2019.67044  Sayfalar 100 - 104
14 yanda kz hasta 3 gndr sren yksek ate ve ksrk ikayeti ile bavurdu. Yaknmalar baladktan sonra oseltamivir kullanmaya balad renildi. Fizik incelemesinde sol akcier alt ve orta zonlarda solunum seslerinde azalma ve sa akcierde krepitan ralleri mevcut idi. Laboratuar incelemesinde Hemoglobin 10,6 g/dL, Hematokrit %33.5, MCV 76,5 fL, beyaz kre says 5,97 bin /uL, trombosit says 180 bin/uL, CRP 205,6 mg/L, prokalsitonin 1,28 ing/mL idi. PA akcier grafisinde sol akcier orta ve alt zonlarnda lober konsolidasyon, sa akcier alt zonda infiltrasyon ile uyumlu grnt mevcut idi. Hastaya seftriakson, klaritromisin ve teikoplanin tedavileri baland. Tedavinin 3. gnnde atei dt. Genel durumu dzeldi. Tedavinin 10. gn ekilen PA akcier grafi bulgular belirgin dzeldi ancak alnan kontrol tetkiklerinde Hemoglobini 10,8 g/dL, Hematokrit %20,6, trombosit says 519 bin/uL olarak bulundu. Hastann retiklositi % 2,14 Direkt ve indirekt Coombs testi pozitif bulundu. Souk Agglutinin titrasyon testi 1/2016, Kriyoglobulin negatif, Kriyofibrinojen negatif bulundu. Mycoplasma pneumoniae (M. pneumoniae) IgM 1,33 (pozitif), M. pneumoniae IgG 0,38 (negatif), EBV - VCA IgM: 0,62 (negatif), EBV - VCA IgG: 196 (pozitif) bulundu. Hasta klinik olarak izlendi. Ek bir tedavi verilmeden hasta levofloksasin tedavisi ile taburcu edildi. zleminde hemoliz krizi tekrar gzlenmedi.

Sonu: Akcier enfeksiyonu geiren hastalarda hemoglobin hematokrit uyumazl saptandnda souk agglutinasyon hastal akla getirilmelidir.
A 14-year-old female patient presented with a 3-day history of high fever and cough. She had oseltamivir after her complaints started. Physical examination revealed decreased breath sounds in the lower and middle zones of the left lung and crepitant rales in the right lung. In the laboratory examination, hemoglobin 10.6 g / dL, hematocrit 33.5%, MCV 76.5 fL, white blood cell count 5.97 thousand / uL, platelet count 180 thousand / uL, CRP 205.6 mg / L, procalcitonin 1.28 ing / mL found. PA chest X-ray showed consolidation in the middle and lower zones of the left lung and infiltration in the lower zone of the right lung. Ceftriaxone, clarithromycin and teicoplanin were started. On the third day of treatment, fever was decreased and her general condition improved. On the 10th day of clinical follow-up, the chest X-ray findings improved significantly, but hemoglobin level was decreased to 10.8 g / dL and hematocrit 20.6%, platelet count 519 thousand / uL, and reticulocyte count found 2.14%, respectively. Direct and indirect Coomb were positive. Cold Agglutinin titration test found 1/2016, Cryoglobulin negative, Cryofibrinogen negative. Mycoplasma pneumoniae (M. pneumoniae) IgM 1.33 (positive), M. pneumoniae IgG 0.38 (negative), EBV - VCA IgM: 0.62 (negative), EBV - VCA IgG: 196 (positive). She was discharged with levofloxacin treatment without any additional treatment. No hemolysis crisis was observed during the follow-up.

Conclusion: Cold agglutination disease should be considered when hemoglobin - hematocrit incompatibility is detected in patients with lung infection

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