Objective: We determined the diagnostic role of nucleated red blood cell (NRBC) count in neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE).
Methods: Newborns treated for moderate-to-severe HIE in a neonatal intensive care unit between January 2020 and January 2021 were included in the study. The study was designed as a retrospective cohort. NRBC counts, blood gas, and demographic and clinical characteristics were recorded before and after treatment in newborns with HIE who received therapeutic hypothermia treatment and in healthy newborns as a control group. The results of the healthy control and moderate-severe HIE groups were compared.
Results: A total of 90 infants, 45 in the control group and 45 in the HIE group, were included in the study. The groups were similar in terms of gestational week, birth weight, type of delivery and gender (p>0.05). The NRBC count before hypothermia was significantly higher in the HIE group than in the control group (p=0.001). After hypothermia treatment, NRBC count decreased significantly in the HIE group (p=0.001), and the results were similar in the control group. According to the results of the ROC analysis, the area under the curve was determined as 0.983. Maximum sensitivity and specificity and the threshold value for NRBC (x103/mm3) in predicting HIE was found to be 0.63 with 95% confidence intervals.
Conclusion: NRBC count, which is an easy and a fast test, can be used in clinical practice to support the diagnosis of moderate-severe HIE.

Objective: The aim of the study was to examine the Inflammatory Arthritis Facilitators and Barriers to Physical activity (IFAB) questionnaire’s validity and reliability in Turkish-speaking patients with inflammatory arthritis.
Methods: One hundred-thirty one patients aged between 20 and 65 years, diagnosed with inflammatory arthritis were included in the study. To test validity, patients were asked to fill out the patient evaluation form, Health Assessment Questionnaire, Fear-Avoidance Beliefs Questionnaire, Tampa Scale of Kinesiophobia and Short Form-36 (SF-36) at the same time as the IFAB questionnaire, which is adapted to Turkish via Google Forms. 35 were randomly selected out of 131 participants who participated in the study refilled IFAB questionnaire for test-retest reliability two weeks after the first application.
Results: The internal consistency coefficient of the scale was found to be 0.804. Scale items total correlations are ranged from 0.407 to 0.620. Test-retest reliability correlation coefficient was 0.703. Kaiser-Meyer-Olkin value is 0.729. The Bartlett test of sphericity was found to be statistically significant (p<0.001). A confirmatory factor analysis model showed an acceptable fit (CMIN/DF: 2.095; IFI: 0.925; CFI: 0.921; RMSEA: 0.092). A negative correlation was found between the IFAB questionnaire total score and the Health Assessment Questionnaire score, a positive correlation was found between all SF-36 dimensions dimension scale except for emotional role difficulty (p<0.05).
Conclusion: The IFAB questionnaire is a self-administered, practical, cost-free, valid, and reliable scale for Turkish-speaking inflammatory arthritis patient. We believe that questionnaire will guide health professionals in planning and maintenance of holistic physical activity programs that support factors that facilitate physical activity and improve factors that hinder physical activity in patients with inflammatory arthritis.

Objective: The current study analyses the patients who underwent surgical resection with intracranial meningiomas.
Methods: This study reviewed the data of eighty-four patients diagnosed and operated with intracranial meningioma. The study was conducted retrospectively by analyzing the clinical characteristics and the histopathological results of the patients. Age at surgery, gender, and tumor location according to World Health Organization (WHO) 2021 tumor classification criteria were determined. Brain computed tomography and cranial magnetic resonance imaging was used to assess the tumor before operation and presence of recurrence/residual lesion at follow-up. Surgical management was evaluated according to Simpson resection grade.
Results: Fifty-nine were women (70%) and 25 were men (30%). Female/male ratio was 2.36/1. The average age was 55.58 years (range: 28-79 years). The most common locations of surgical intracranial meningiomas were convexity, and parasagittal/falcine. Fifty-four (64.3%) patients with Simpson grade I and II, 26 (30.9%) with grade III, and 4 (4.8%) patients with grade IV resection were carried out. The most common histopathological results were transitional meningioma 28 (33.3%) patients, atypical 22 (26.2%) patients, meningothelial meningioma 21 (25.0%) patients. Sixty (71.4%) patients had WHO grade I tumor, 22 (26.2%) patients grade II tumor, and 2 (2.4%) patients grade III tumor.
Conclusion: Although meningiomas are more common in female patients, grade II and III meningiomas show gender equality. The main goal of surgery is to remove the meningioma completely, including dura and bone if needed. Maximal safe surgical resection should be performed in surgery and preserve the patient’s neurological functions.

Objective: This study was conducted to determine the drug/non-drug product use status of parents for their children before admission to the hospital.
Methods: The universe and sample of this descriptive and cross-sectional study consisted of 91 parents who applied to the pediatric emergency service of a training and research hospital for treating their children, were admitted to the infant service and agreed to participate in the study between June and December 2017. Data were collected using Information Form created by the researchers.
Results: A statistically significant difference was found between the drug administration status of children before admission to the hospital according to age group (p<0.05). The rate of giving medication to children aged over 6 months (73.3%) before admission to the hospital was found to be higher than children aged 6 months and younger (50%). Simultaneously, a significant difference was found between the use of non-drug products according to age groups (p<0.01). The rate of giving non-drug products to children aged over 6 months (33.3%) was found to be higher than children aged 6 months and younger (8.7%).
Conclusion: The rate of drug use by families without the recommendation of a physician was high. Education is given to families on rational drug use could reduce the frequency of individual drug use.

Objective: We evaluated the knowledge and opinions of the parents of children who were followed up with chronic kidney disease (CKD) in our pediatric nephrology clinic.
Methods: A seasonal influenza vaccine questionnaire was administered to a voluntary parents of patients with CKD between the ages of 6 months and 18 who applied to the Pediatric Nephrology Department of Health Sciences University Ýzmir Tepecik Training and Research Hospital between November 2019 and February 2020, and those who completed the questionnaire were included in the study.
Results: Parents of 64 patients diagnosed with CKD completed the questionnaire. It was learned that only 44 (68.8%) participants were informed about the vaccine. It was seen that 10 patients (15.6%) had seasonal flu vaccine. Fifty-four participants who had not yet had their child vaccinated were asked about their reasons for not getting vaccine. The most frequent answer was that families did not have sufficient information about the vaccine requirement. There was no significant difference in the rate of vaccination between the two groups of patients who were administered and did not use immunosuppressive drugs. A statistically significant difference was found between accessing the information about the participants who had knowledge about vaccine. The children diagnosed with CKD were classified into two groups as having kidney transplantation and other patients. The knowledge about influenza vaccine and the awareness of the high risk of their children of influenza infection to parents of children with kidney transplantation was significantly higher.
Conclusion: The rate of vaccination against influenza is very low in pediatric patients with CKD. Therefore, it is thought that this ratio can be increased by increasing the giving of information about influenza infection and vaccination to parents by physicians in pediatric nephrology clinics.

Objective: In this study, was aimed to examine the burden perception between patients with chronic diseases and their caregivers.
Methods: This descriptive and correlational study was conducted with 400 patients and caregivers who applied to state hospital between January and June 2019 and agreed to participate in the study. Data were collected through face-to-face interviews with the Zarit Caregiving Burden Scale and the Self-Perceived Burden Scale.
Results: The mean total score of the Zarit Caregiver Burden Scale obtained from the study was 23.91±17.24, and the burden of caregivers was found to be light. The mean score of the patients from the self-perceived burden scale was 23.06±10.29, and it was found that the patients perceived themselves as a burden to their caregivers. It was determined that there was a compelling and significant positive correlation between the patients’ self-Perceived Burden Scale and the Zarit Caregiving Burden Scale mean scores of caregivers (r=0.850 p=0.000).
Conclusion: As a result, the research emphasizes that it is necessary to plan and develop initiatives to measure the burden perception between patients with chronic diseases and their caregivers, to raise awareness about the concepts of caregiving and caregiving, and to reduce the burden that may develop in the caregiving and caregiving process.

Objective: This study investigated relationship between early respiratory support and neurodevelopmental outcomes in extremely low birth weight infants.
Methods: Our study included infants born before 32 weeks’ gestation at a birth weight of 750-1000 g that were admitted to the neonatal intensive care unit and underwent a neurodevelopmental evaluation at the corrected age of 24 months. Two hundred-twelve infants were divided into 3 groups by determining the predominant type of respiratory support required in the first 3 days of life. Infants who received supplemental oxygen therapy group 1, those who received nasal continuous positive airway pressure and/or nasal intermittent mandatory ventilation were in group 2, and intubated infants were included in group 3. Differences between the groups and relationships between neurodevelopment scores [mental development index (MDI); psychomotor development index (PDI)] were examined.
Results: The patients mean birth weight was 887±73 g and mean gestational age was 27±1.9 weeks. MDI and PDI values were below 70 in the intubated patient group (68 and 66, respectively). Patients who received noninvasive ventilation or supplemental oxygen therapy for the first 3 days of life had significantly higher MDI and PDI values. In terms of morbidities of prematurity, intubated infants had higher rates of bronchopulmonary dysplasia, patent ductus arteriosus, intraventricular hemorrhage, and retinopathy of prematurity.
Conclusion: Restrictive invasive ventilation policies can be applied to preterm infants and may improve neurodevelopmental outcomes. The results of this study suggest that every additional day of invasive mechanical ventilation should be avoided if possible.

Objective: Cardiovascular diseases are one of the prevalent death causes in patients with type 1 diabetes mellitus (DM), and atherosclerosis can begin in childhood. This study analyzed aortic elasticity of children with type 1 DM diagnosis and compare them with healthy children.
Methods: Thirty-one patients DM diagnosis for at least 4 years and 19 healthy children participated in the study. Anthropometric measurements and demographic characteristics of all individuals were obtained. The parameters related to aortic diameter by Doppler and M-mode monitoring were determined and used in aortic strain, elastic modulus, aortic stiffness index β and aortic distensibility calculations.
Results: The myocardial performance index, systolic and diastolic function, elastic modulus, aortic distensibility values of two groups with similar anthropometric measurements and demographic features were similar. In the patient group, decrease in aortic strain value and an increase in aortic stiffness index were found statistically significant (p<0.05). The difference in aortic stiffness index and elastic modulus values of the group with poor glycemic control was statistically significant (p<0.05).
Conclusion: This study indicates that cardiovascular involvement starts in childhood with findings such as decreased aortic strain and increased aortic stiffness before deteriorate systolic and diastolic functions of patients with type 1 DM. Strict glucose control should be maintained to preserve arterial elasticity and prevent atherosclerosis.

Objective: Metoclopramide is a dopamine receptor antagonist. It is not routinely recommended in children, particularly because of its extrapyramidal side effects. In this study, it was aimed to examine the reasons for the use of metoclopramide and their response to emergency treatment in children who developed acute extrapyramidal symptoms due to metoclopramide use.
Methods: Patients who applied to the pediatric emergency service between 01.06.2019 and 31.05.2020 because of side effects related to the use of metoclopramide were included in the study. All the patients were treated with biperidene lactate.
Results: Twenty patients without chronic disease, who were not taking any medication other than metoclopramide, and had an acute dystonic reaction due to metoclopramide for the first time were evaluated (median: 33.5 months, 55% male). Seventeen of the patients had taken the medication for acute gastroenteritis, two for motion sickness and one for a suicide attempt. In 16 patients, the drug was given by their mothers without a doctor’s recommendation. Side effects in the normal dose range occurred in 16 of the patients. Findings occurred within a median of 4 h after metoclopramide ingestion. The median response to biperiden lactate treatment was 15 min. A positive and significant correlation was found between the metoclopramide dose taken and the clinical response time to biperiden lactate administered in the emergency department (r: 0.514; p=0.018).
Conclusion: Metoclopramide causes an acute dystonic reaction in children, even in the normal dose range. Biperiden lactate is an effective and rapid treatment option. As the metoclopramide dose increases, clinical improvement occurs later.

Objective: Depression is common in the emergency service due to a higher number of patients, urgency status in the patients, and dense night shifts in emergency physicians compared to other units. In this study, depression levels were compared between emergency service and other internal medicine physicians.
Methods: The research was conducted on 70 emergency service assistants and 70 other internal branch assistants working in training and research hospitals. Survey questions consisting of three parts were asked the participants. In the first part, questions about their sociodemographic characteristics were asked. In the second part, their perspectives according to their profession were asked. In the third part, Beck Depression Inventory (BDI) was applied. Pearson chi-square and Fisher’s exact test were used in the analysis of categorical variables.
Results: Although the emergency department assistants had higher BDI scores for “mild mood disorder” and “borderline clinical depression” than other internal medicine assistants, no significant difference was found in the total score. When the subparameters of the scale were examined, a difference was found between emergency and internal medicine physicians in terms of fatigue and appetite. The thought of resigning, exposure to psychological/physical violence, dissatisfaction with living in the city, smoking, and antidepressant use was statistically higher in emergency medicine residents.
Conclusion: Among our emergency physicians, the BDI subgroup scores that questioned fatigue and appetite are higher. Thoughts of resignation, exposure to psychological/physical violence, smoking, and antidepressant use are more common. Emergency service physicians are a more fragile group and need to be supported.

Objective: The aim of this study was to investigate the clinical outcomes of newborns brought to the pediatric emergency room and determine the factors affecting hospitalization from the emergency room.
Methods: The hospital records of all newborns admitted to the pediatric emergency department of our hospital between September 1, 2020 and September 1, 2021, outside working hours, were retrospectively reviewed. The season of admission, postnatal age, sex, immigration status, complaints of admission and clinical outcomes of the infants were analyzed. Infants hospitalized and not hospitalized from the emergency department were compared in terms of these parameters.
Results: One thousand eighty two newborns were included in the study (median age: 5 days; 570 males). The most frequent admissions were in summer (259, 23.6%) and autumn (462, 42.7%). Hundred and forty infants (12.9%) were Syrians. The most common presenting complaint was jaundice (913, 84.3%). Forty-two (3.8%) infants were hospitalized. There was no significant difference between the infants discharged from the pediatric emergency service and those hospitalized with respect of postnatal age, gender, immigration status and application season. Those who were admitted with complaints of high fever (p<0.001) and with complaints suggesting dehydration (p=0.001) were hospitalized at a higher rate. The median length of hospital stay of the inpatients was 2 days (interquartile range: 1-5). No mortality was seen.
Conclusion: The rate of hospitalization was found to be very low in newborns who were admitted to the pediatric emergency room. However, the risk of hospitalization was higher in newborns who presented with complaints of high fever and dehydration.

Objective: Today, the survival rate of low-birth-weight infants has increased thanks to supportive care. However, various permanent health problems, especially neurodevelopmental retardation, can be seen in these infants. This study investigates the risk factors associated with neurodevelopmental retardation, especially hypocarbia, in this patient group.
Methods: All patients who were hospitalized in our neonatal ýntensive care unit between January 1 and December 31, 2016, with a gestational age of less than 32 weeks, without congenital anomalies, and who came for regular follow-up were included in this study. Demographic, clinical and laboratory data were obtained retrospectively from file records. The neurodevelopment of the patients was evaluated between 18 and 24 months with the Bayley Scales of Infants and Toddler Development, Second Edition (Bayley-II).The demographic, clinical and laboratory parameters of the patients with and without neurodevelopmental retardation were compared.
Results: Neurodevelopmental retardation was observed in 9 (16.1%) of the 56 patients included in the study. No neurodevelopmental retardation was detected due to cerebral palsy, hearing impairment or visual impairment. When the patient groups with and without neurodevelopmental retardation were compared in terms of demographic, clinical and laboratory parameters, birth weight and first and fifth-minute Apgar scores were lower in patients with neurodevelopmental retardation, while mechanical ventilation requirement, reintubation, convulsion, patent ductus arteriosus treatment, hypotension, bronchopulmonary dysplasia, asphyxia, hyperglycemia and hypocarbia rate were higher (p<0.05).
Conclusion: While providing mechanical ventilation support, in addition to the negative effects of hypercarbia on neurodevelopment, the negative effects of hypocarbia on neurodevelopment should also be kept in mind.

Objective: Vasovagal syncope (VVS) is the most common type of syncope in pediatric patients. One potential pathophysiological mechanism for developing VVS involves autonomic dysfunction. In this study, we evaluated autonomic functions during the asymptomatic period in patients with VVS.
Methods: Patients attending to a pediatric cardiology outpatient clinic and diagnosed with VVS and control subjects consisting of healthy children were included. All subjects underwent electrocardiography, echocardiography, and Holter ECG monitoring. Then time domain index parameters in Holter ECG: SDNN, SDNNIndx, SDANN, pNN50, rMMSD and minimum, mean, and maximum heart rate were evaluated.
Results: Twenty-four children (15 female, 9 male) with recurrent VVS and 27 healthy children (19 female, 8 male) were enrolled. While mean and maximum heart rates did not differ significantly between patients with syncope and healthy children, minimum heart rate was lower in syncope patients (49.3±5.41; 44.4±5.6 p=0.007). Statistical analysis of the results showed a significant increase in SDNN, SDNNIndx, SDANN, pNN50 and r MMSD in VVS patients compared to controls (p<0.01).
Conclusion: As indicated by parameters of heart rate variability, pediatric patients with VVS exhibit chronic autonomic differences in the form of increased sympathetic and parasympathetic impulses during the asymptomatic period of their condition compared to healthy children. Although clinical history remains the most important diagnostic tool in patients with VVS, Holter ECG monitoring may provide useful diagnostic information in patients with difficult differential diagnosis.

Objective: Currently there are conflicting data about the incidence of community-acquired infections of common respiratory viruses during the pandemic caused by the novel Severe acute respiratory syndrome-Coronavirus-2.
Methods: The data of the patients, who were admitted to the neonatal intensive care unit for suspected community-acquired neonatal pneumonia during the respiratory syncytial virus (RSV) season in the pre-Coronavirus disease-2019 (COVID-19) pandemic era (October 2019-March 2020) and post-COVID-19 pandemic era (October 2020-March 2021) were retrospectively analyzed.
Results: A total of 869 patient records were screened. Seventy patients (22%) in the pre-COVID-19 pandemic era and 15 patients (6.8%) in the post- COVID-19 pandemic era met the selection criteria and were included in the analysis. In the pre- and post- COVID-19 pandemic era respectively, males accounted for 57.1% and 73.3% of patients (p=0.245), the mean gestational age at birth was 37±2 and 35±3 weeks (p=0.007), the mean birth weight was 3045±601 and 2386±840 g (p=0.001), the mean postnatal age at admission was 9±3 and 7±1 days (p=0.177), and the mean length of hospital stay was 10±3 and 8±2 days (p=0.023). RSV was detected in 42 (60%) patients in the pre- COVID-19 pandemic era compared to 2 (13.3%) patients in the post-COVID-19 pandemic era (p=0.001).
Conclusion: A 3-fold decrease in hospitalizations due to community acquired pneumonia was observed in the post COVID-19 era. Strict compliance with the rules such as mask use, hand washing, and social distancing and lockdown during the COVID-19 pandemic could explain the decrease in neonatal pneumonia.

Objective: Risk scoring is the key point of the upper gastrointestinal bleeding (GIB) which determines the management of the patient. In this study our aim is to measure the success of Rockall score (RS) and Blatchford score that are frequently used in upper GIB.
Methods: In this retrospective descriptive type of study, the patients over 18 years of age who referred to emergency department with upper GIB between the years 2010-2012 were included. A total of 423 patients were included in study. Pre-endoscopic Rockall (PRS), complete RS and Blatchford scores are calculated. High-risk patient, transfusion and mortality predictions of these three scoring and shock index (SI) were calculated statistically.
Results: Of the 423 patients 293 (69.3%) were males and mean age was 63.7±15.7 years. The frequency of melena was 78% (n=330), hematemesis 49.6% (n=210), and syncope 12.1% (n=51) in the patients’ complaints at admission. Mean PRS was 3.15±1.61, RS was 5.05±2.13, Blatchford score was 10.19±3.78, and SI was 0.82±0.25. Blatchford score was found to be the most successful in predicting transfusion. RS and Blatchford score were the most successful scores in predicting the high-risk patient. In our study, the mortality rate was 5.7% (n=24), and the RS was the most valuable score in estimation.
Conclusion: By identifying low and high risk patients for transfusion, need for hospitalization, and mortality, risk scores can be used safely by the clinician to guide the treatment of patients.

Hematuria is a warning and serious symptom of the disease with a broad spectrum. Although it first brings to mind diseases related to benign pathologies at young ages, it is one of the clinical markers for cancer, especially in the elderly and requires further investigation. There are some risk factors for cancer-induced hematuria such as male gender, age >35, analgesic abuse, chronic hemodialysis, radiation exposure or carcinogens. Additionally, rare diseases should not be ignored in the differential diagnosis of hematuria. Here, we present an extremely rare case of renal rhabdomyosarcoma of kidney in an elderly female patient who was admitted to the emergency department with hematuria.