Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening–Flanders (VIS–Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS–Flanders project aims to set an example for other regions worldwide.

A 45-year-old woman with chronic hepatitis C was treated with peginterferon alpha-2b in combination with ribavirin, which activated psoriasis. In the patient, psoriasis reoccurred after being inactive for 10 years. One week after institution of therapy, she presented with plaques of psoriasis at her injection site having been administered a first dose of peginterferon alpha-2b. Psoriatic lesions of the patient worsened dramatically during therapy. Cutaneous lesions appeared at the injection sites, in the face, the scalp hair, at the back of the ears, under the breasts and armpits, and in the regions of the anus and elbows. In the second week of treatment, transaminase levels of the patient regressed to normal. Detectable hepatitis C virus RNA in the serum was eliminated at week 14 of treatment. Because of the severity of psoriatic disease activity, therapy was discontinued at the end of 14 weeks after treatment onset. This side effect of peginterferon alpha-2b plus ribavirin treatment should be kept in mind in the treatment of patients with a history of psoriasis combined with active hepatitis C.

OBJECTIVES: Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results. METHODS: Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included. RESULTS: Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26). CONCLUSIONS: The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Its prevalence approaches 10% in hyper endemic areas. The aim of treating chronic HBV infection is to halt progression of liver injury by suppressing viral replication or eliminating infection. This study was planned to evaluate the advantages of combination therapy with interferon-alpha plus second-generation nucleoside analogues (lamivudine or famciclovir), or vaccination with a pre-S2 and S proteins containing vaccine in chronic HBV infection. 29 patients were divided into three groups and were treated with the following combinations: (1) IFN-alpha2a 9 million units 3x week for 6 months with HBV vaccine 20 microg given on 0, 1 and 2 months; (2) IFN-alpha2a 6 million units 3x week plus famciclovir 250 mg 3x day for 6 months; (3) IFN-alpha2a 6 million units 3x week plus lamivudine 100 mg/day for 6 months. Complete response was suspected in 3 patients in group 1, in 4 patients in group 2, and in 7 patients in group 3. Partial response was suspected in 4, 1 and 2 patients in groups 1, 2 and 3, respectively. The results of the present study suggest that the combination of IFN-alpha with lamivudine is more effective than the combination of IFN-alpha with HBV vaccination or famciclovir.

Methods:- Results:was 8.8% (n = 48). Key words:J Pediatr Emerg Intens Care Med 2015; 2: 65-70 BULGULARÜnitemizde 2007 -2013 tarihleri arasında takip ve tedavi edilen toplam 546 hastanın 283'ü erkek (%52), 263'ü kız (%48) idi. Hastalarımızda ortanca yaş 24 ay; yaş dağılım aralığı 1 -240 ay, yatış günü ortanca değeri 3 gün; yatış günü dağılım aralığı 1 -430 gün olarak tespit edildi.Çalışma süresince ünitemize yatırılan hasta sayısının aynı dönemde hastanemizde yatan hasta sayısının %1.4'ü olduğu görüldü. Hastalarımızın %78'i çocuk acilden, %17'si çocuk kliniği servislerinden, %5'i ise dış merkezlerden ünitemize kabul edilmişti.Hastaların yatış tanıları incelendiğinde ilk üç sırada solunum sistemi hastalıkları (n=314, %57,5), nörolojik hastalıklar (n=225,%41,2) ve zehirlenmeler (n=96,%17,6) yer alıyordu. 442 (%80,9) hastanın yatış nedeni olan birden fazla tanısı vardı. Yatış nedenleri ve görülme sıklık-ları Tablo 1'de verilmiştir. Diğer hastalıklar başlığı içinde travma, romatolojik hastalıklar, gastrointestinal sistem hastalıkları, onkolojik hastalıklar, allerjik hastalıklar, dermatolojik hastalıklar, göz hastalıkları, çocuk cerrahisinin postoperatif hastaları yer alıyordu.Çalışmaya aldığımız hastaların %41,1'inde (n=226) yoğun bakım yatışları esnasında eşlik eden kronik hastalık tespit edildi. Mevcut kronik hastalıklar sıklık sırasına göre nörolojik sistem hastalıkları (n=124, %22,7), kardiyovasküler sistem hastalıkları (n=39, %7,1) ve metabolik sistem hastalıkları (n=30, %5.3) şeklindeydi (Tablo 2).Hastaların 133'ünde (%24,4) MV gereksinimi oldu. Hastaların MV'de kalış süresi ortanca değeri 120 saat (1 saat-2160 saat) olarak saptandı. Mekanik ventilatör desteği alan hastaların 46'sı (%34,6) kaybedildi. Hastaların 19'u (%3,5) trakeostomili idi. Trakeostomili hastalarımızın 13'üne ünitemizde yatarken trakeostomi açılmış, 6'sının ise yatışlarında trakeostomileri vardı.Kan ve kan ürünleri transfüzyonu yapılan hasta sayısı 117 (%21,4) olarak tespit edildi. Hastaların 57'sine (%10,4) eritrosit süspansiyonu (ES) ve taze donmuş plazma (TDP), 38'ine (%7) ES, 18'ine (%3,3) TDP, 4'üne (%0,7) ES-TDP-trombosit süspansiyonu (TS), 2'sine (%0,4) intravenöz immünglobulin transfüzyonu yapıldı. Kan ve kan ürünleri transfüzyonu yapılan hastaların 35'i (%29,9) eks oldu.Çocuk yoğun bakım gereksinimi ortadan kalkan 316 (%57,9) hastanın takip ve tedavilerinin devamı için diğer bir servise yatışı yapıldı. Hastaların 84'ü (%15,4) ise kardiyak cerrahi, renal replasman tedavisi, plazma değişimi, bronkoskopi ihtiyacı nedeni ile düzey 3 hizmet veren ço-cuk yoğun bakım ünitelerine sevk edildi. Hastaların 98'i (%17,9) direkt çocuk yoğun bakımımızdan taburcu edildi. Yoğun bakımda takip ettiğimiz hastalarda kaba mortalite