Objective: The aim of the study was to define predictors of syncope recurrence in children and adolescents with vasovagal syncope and to determine the value of tilt test. Methods: A retrospective observational study performed of prospective cohort of 150 patients aged between 8-18 years who were referred to our clinic because of fainting or who underwent tilt test with the pre-diagnosis of vasovagal syncope. The progress updated by telephone or face-to-face interview. Unpaired t-test, Mann-Whitney U test used for normal and non-normal distributed variables. Logistic regression analysis was used to determine the predictors of recurrence. Results: Tilt test was positive in 97 and negative in 53 patients. Forty-eight patients had mixed, 34 had vasodepressor and 15 had cardioinhibitory type syncope. Recurrence found significantly higher in patients who had syncope in the first 20 minutes of the test (p=0.012). The number of the episodes decreased after the test; 3.86±4.75 vs 0.73±0.44, p<0.001). The recurrence was higher in patients who had more than 4 episodes. The recurrence was similar between positive and negative tilt groups. Age of syncope (OR 1.01, 95% CI 1.002, p=0.027) positive family history (OR 4.47, 95% CI 1.071-1.389, p=0.001) and the number of previous syncopal episodes (OR 1.22, 95% CI 1.882-10.623, p=0.003) were identified as risk factors for recurrence of vasovagal syncope. Original Investigation Özgün Araşt›rma 688ÖZET Amaç: Bu çalışmada vazovagal senkoplu çocuk ve adölesanlarda senkop yinelemesinin öngördürücülerini saptamak ve tilt testinin bu süreçte-ki değerini belirlemek amaçlanmıştır. Yöntemler: Kliniğimize daha önce bayılma nedeniyle başvuran ve senkop nedeni açıklanamayan veya vazovagal senkop düşünülerek tilt testi yapılmış, 8-18 yaş arası 150 hastanın kayıtları ileriye dönük retrospektif gözlemsel olarak değerlendirilerek, son durumları telefon veya yüz yüze görüşülerek güncellendi. Normal ve normal olmayan değişkenler için t-testi ile Mann-Whitney U testi, vazovagal senkop rekürrens öngördürü-cülerinin saptanması için lojistik regresyon kullanıldı. Bulgular: Tilt testi yapılan 150 hastanın 97'sinde tilt testi pozitif, 53'ünde negatif bulunmuştur. Tilt testi 48 hastada mikst, 34 hastada vazodepresör ve 15 hastada kardiyo-inhibitör şeklindeydi. Tilt testi 65 hastada pasif, 32 hastada provokatif fazda pozitifleşti. Testin ilk 20 dakikası içinde senkop görülenlerde anlamlı olarak senkop yinelemesinin daha fazla olduğu gözlendi (p=0,012). Tilt testi yapılana kadar tüm hastalarda senkop sayısı ortalama 3,86±4,75 iken test yapıldıktan sonra senkop sayısı ortalama 0,73±0,44 olarak bulundu (p<0,001). Daha önce dörtten fazla senkop geçi-renlerde yineleme oranı daha yüksek bulundu. Tilt testi pozitif ve negatif olanlarda yineleme oranları arasında istatistiksel olarak fark saptanmadı. Senkop yaşı (OR 1,01, %95 CI 1,002, p=0,027), pozitif aile öyküsü (OR 4,47, %95 CI 1,071-1,389, p=0,001), daha önceden geçirilmiş senkop atak sayısı (OR 1,22, %95 CI 1,623, p=0,003), senkop yinelemesinin bağı...

Introduction: Diabetic ketoacidosis (DKA) is the most common cause of acute morbidity and mortality in children and adolescents with type 1 diabetes mellitus (T1DM). Because DKA management is associated with complications, endocrine communities have published guidelines and attempted to set standards for DKA diagnosis and management worldwide. In this study, for the patients followed up in the intensive care unit who have been treated according to DKA protocols, clinical and laboratory characteristics, differences between new and old diagnosed patients, and results of treatment were evaluated. Methods: The records of 67 patients hospitalized in the pediatric intensive care unit for the past two years were reviewed retrospectively. Patients were grouped as newly diagnosed and old diagnosed diabetics. Results: The mean age of the patients was 8.66 ± 5.0 years (3 months to 17.9 years) and 39 (58.2%) were male. Forty-five patients (67.1%) presented with mild DKA and 22 (33.9%) with severe DKA. Fourteen (63.6%) of the severe DKA cases were newly diagnosed with T1DM. Six patients had hyponatremia (corrected serum Na level <135 mmol/L) and five had hypernatremia (serum Na level >145 mmol/L). Only one of the hyponatremic patients had severe acidosis, while four of the hypernatremic patients had severe acidosis. At the 14th hour, blood glucose levels were below 200 mg/dl, blood ketones became negative in 5.8 hours, and at 9.1 hours, blood pH and/or HCO 3 levels were normalized, recovery criteria were completed, and subcutaneous (SC) insulin injection was started. Of the patients, 38 (56.7) were newly diagnosed with T1DM. The mean age of newly diagnosed T1DM patients was smaller (7.40 ± 4.96) than those with old diagnosis, respiratory rates (RRs) were higher and pCO 2 levels were lower on admission. Blood glucose, blood ketone negativity, acidosis, and Glasgow coma score (GCS) scores of the newly diagnosed T1DM patients improved later than the previous diagnoses. Only one patient under two years of age with a pH of 6.89 was given HCO 3. None of the patients had symptomatic brain edema and death. Conclusions: As a result, DKA is an acute and serious complication of diabetes, whose results are promising when managed only with minimal individual changes according to guidelines. Bicarbonate administration is not needed except in patients with very severe acidosis. Bedside blood ketone monitoring seems to be important because it allows for early enteral feeding.

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The contribution of postnatal steroid administration to early brain damage in preterm babies with bronchopulmonary dysplasia ABSTRACT Background/aim: Postnatal corticosteroids are commonly used to treat bronchopulmonary dysplasia (BPD). We aimed to show whether S100 calcium-binding B (S100B), neuron-specific enolase (NSE), Tau protein or microtubule-associated protein tau (MAPT), and glial fibrillary acid protein (GFAP) levels would provide any evidence of early neurological damage in premature infants receiving postnatal low dose dexamethasone therapy for BPD treatment. Materials and methods:In this cohort study, 136 preterm infants diagnosed with BPD at ≤32 weeks of gestation formed the study group and 64 preterm infants formed the control group. NSE, S100B, GFAP, and MAPT levels were first measured before the postnatal corticosteroid treatment in both the patient and the control group on the 28th day and, for a second time, after treatment termination in the patient group.Results: There were significant differences between the measured GFAP, MAPT, and NSE values of the BPD and control groups on the 28th day, whereas there was no significant difference between the measured S100B values of the two groups. There were a statistically significant difference between the NSE values measured on the 28th day and after the treatment within the BPD group, whereas no significant difference existed between the GFAP, MAPT, and S100B values. Conclusion:NSE levels, which indicate brain damage in the early period, increased in preterm babies with BPD who had been administered postnatal dexamethasone.

Objectives Amniotic band syndrome and osteogenesis imperfecta are two distinct diseases that develop due to structural defects of the collagen protein. In our paper, we report the concurrence of these two diseases rarely seen in the newborn period. Case presentation A female infant born at 33rd gestational week was found to have constrictive bands in her right lower extremity and flexion contractures in distal joints of lower and upper extremities due to amniotic bands in postnatal physical examination. While being treated for respiratory difficulty, she was diagnosed with osteogenesis imperfecta and treated with bisphosphonates upon being found to suffer bilateral humeral fractures on the sixth day of life. She received respiratory support with mechanical ventilation due to respiratory tract complications related to osteogenesis imperfecta and died on the 384th day of life. Conclusions One should bear in mind that other collagen tissue diseases may accompany the amniotic band syndrome; this possibility should be definitely pursued if clinical suspicion exists.