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BACKGROUND: In previous studies, it has been demonstrated that Neonatal Resuscitation Program (NRP) courses improve the early outcomes of infants with perinatal asphyxia, but there has been no evidence to demonstrate the effect of NRP on long-term outcomes of perinatal asphyxia. The goal of the present study was to determine the effect of NRP courses on the long-term neurodevelopmental outcome of perinatal asphyxia. METHODS: This prospective study included infants referred to the Neonatal Unit during the years 2003-2005. Those patients who were referred before NRP courses (pretraining period) were designated as group 1, those who were referred after the first NRP course (transition period) as group 2, and those who were referred after the second NRP course (post-training period) as group 3. Neurodevelopmental outcomes were assessed and compared at 4-6 years of age. RESULTS: The study involved 40 patients: 23 in group 1, nine in group 2 and eight in group 3. The number of patients who had been diagnosed with cerebral palsy was 13 in group 1, two in group 2, and one in group 3, which was a significant decrease. The number of patients with seizures and electroencephalography abnormality was 12 and 14 in group 1, three and two in group 2, and one and one in group 3, respectively, which was also a significant decrease. CONCLUSIONS: NRP courses have positive effects on short-term as well as long-term neurodevelopmental outcomes of infants with perinatal asphyxia. Further studies are required to determine the effects of NRP courses on minor deficits, such as cognitive and behavioral disturbances.

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AIM: To define clinical features of patients with alternating hemiplegia of childhood. METHODS: We retrospectively reviewed the clinical presentation and course of the disease in patients diagnosed between January 2003 and December 2008 at the Pediatric Neurology Department of the Istanbul Medical Faculty. RESULTS: The nine patients had a mean age of 6.6 months (2-15 months) at the onset of symptoms. Paroxysmal eye movements were the early symptom of five patients. All patients had recurrent alternating hemiplegic episodes and relief of symptoms while sleeping. Duration of events varied widely from few minutes to several days and was associated with slowly progressive neurological deterioration. Flunarizine might decrease frequency of events but is not effective to neurological deterioration. Amantadine as an alternative agent is used in add-on therapy, but epileptogenic side effect prevented the evaluation of long-term efficacy. CONCLUSION: Trials on new agents like amantadine are necessary for more effective control of the disease.

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OBJECTIVE: To assess the dietary intakes of the adolescents in the area of Edirne, Turkey. DESIGN: Cross-sectional, prospective, epidemiological study. SETTINGS AND SUBJECTS: Our study group consists of 1944 adolescents aged between 12 to 17 years; 940 females and 1004 males. INTERVENTIONS: Three-day self-reported food records were collected from the subjects and evaluated by a nutrient database program. Reported nutrient intake data were analyzed for gender differences. Minitab statistical program was used to compare nutritional data of subjects. RESULTS: Energy, calcium, magnesium, folic acid, vitamins A, E, thiamine, and fiber intakes of whole adolescents, and also iron intakes of female adolescents were most likely to be inadequate compared with the recommendations. Iron, calcium, folic acid, thiamine, and fiber intakes were below two thirds of RDA/DRI in a large proportion of the adolescents. The intakes of protein, riboflavin, vitamin C, phosphorus and zinc were found to be adequate in a large percentage of the subjects. Forty eight percent of females and 60.1 % of males were below 2/3 of the RDA for energy. CONCLUSION: Pediatricians and dietitians should train the adolescents living in our region and our country on practical strategies for making healthy food choices rich in nutrient content relative to energy value to ensure intakes that approach the recommendations.

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BACKGROUND: In previous studies the efficacy of the Neonatal Resuscitation Program (NRP) was evaluated, demonstrating good retention of knowledge in the participants. The aim of the present study was to evaluate the knowledge and proficiency that pediatric residents gained and retained following NRP and to determine the necessity and timing of the refresher courses. METHODS: The study consisted of 42 pediatric residents who were divided into three groups. Group 1 included pediatric residents who attended the course 1 year previously (n = 18); group 2, 6 months previously (n = 12); and group 3 included those residents who had not attended the NRP previously (n = 12). A written test consisting of 100 questions was applied, and endotracheal intubation skill on a neonatal manikin was evaluated. RESULTS: The percentage of correct answers of participants in groups 1 and 2 decreased similarly during the 6 month and 1 year time period following previous courses. After the new NRP the correct answers increased significantly in groups 1 and 2. The duration of intubation attempt was 17.8 +/- 6.0 s in group 1, 17.5 +/- 1.5 s in group 2, and 22.3 +/- 2.6 s in group 3 before the course and decreased after the course to 10.9 +/- 2.0 s in group 1, 10.3 +/- 1.5 s in group 2, and 11.7 +/- 1.6 s in group 3. The knowledge missing after 6 months and 1 year were similar, while intubation skill decreased after 1 year following the course. CONCLUSIONS: Due to worsening of test findings at 6 months after NRP, and deterioration of performance of intubation 1 year after NRP, it is suggested that a refresher course may be required every year.

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BACKGROUND: The aim of this study was to evaluate the fall-related trauma cases who were admitted to our pediatric emergency unit. METHODS: We retrospectively evaluated the files of 161 cases (100 males [62.1%], 61 females [37.9%]) who had sustained falls and were admitted to our pediatric emergency unit. Data on the patients' age, sex, arrival type, type of fall, height fallen, type of injuries, radiological findings and hospitalization rates were investigated. RESULTS: Of 161 cases mean age was 4.29+/-3.33 years and height fallen was 135+/-95 centimeters. The common types of fall were from furniture (35.4%), stairs (17.4%) and balconies and windows (11.2%). Major injuries included head trauma (84.4%), soft tissue (72.7%) and extremity (37.9%). Thirty cases (18.6%) were hospitalized, while 112 cases (69.6%) were treated as outpatient and 11.8% of them were discharged due to their own demand. CONCLUSION: The majority of fall-related injuries in childhood mostly occurs in private houses and head trauma is the most frequent injury. To decrease the frequency of the fall injuries, strategies should include parents' education about the mechanism of falls and increase prevention strategies.

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The aim of the study was to evaluate the efficacy of short-course antimicrobial therapies [single intramuscular dose of ceftriaxone (50 mg/kg, not exceeding 1 g), 5 days of azithromycin (10 mg/kg on day 1, then 5 mg/kg daily on days 2-5) and the traditional 10-day course of amoxicillin/clavulanate (90/6.4 mg/kg/day in 2 doses)] in children with acute otitis media (AOM). The study was conducted as a prospective, comparative, open randomized trial between February 2001 and April 2003, and 104 children were enrolled, with a mean age of 3.8 (2.3) years. The clinical and otoscopic assessments of the children were made on days 0, 3, 11 and 30 after admission, and tympanometry was performed on day 30. The patients were diagnosed and followed with a scoring system. Clinical success was achieved in 29/34 patients (85.3%) in the ceftriaxone group, 27/31 patients (87.1%) in the azithromycin group and 34/39 children (87.2%) in the amoxicillin/clavulanate group. The rate of persistence of middle-ear fluid did not differ between the three groups (p>0.05). During the one-month period, no recurrent case was observed. The most common drug-related adverse effects were associated with the gastrointestinal system. In conclusion, for the treatment of children with AOM, the clinical success of single-dose intramuscular ceftriaxone and of five-day azithromycin treatments was comparable to that of the traditional 10-day therapy with high-dose amoxicillin/clavulanate.

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BACKGROUND: We planned this study to evaluate trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers, and the importance of helmet usage. METHODS: Data in this study were obtained by retrospective review of the files of trauma cases admitted to the Pediatric Emergency Unit of Trakya University Medical Faculty between January 2003 and August 2005. Patients' age, gender, clinical signs, type of injury, season of the event and percentage of hospitalization were obtained from hospital records. RESULTS: Fifteen (24.6%) of 61 cases who were admitted to our emergency unit were females and 46 (75.4%) were males. The types of trauma of all patients who suffered from bicycle accidents were as following: 42 (68.9%) head trauma, 29 (47.5%) extremity trauma, 49 (80.3%) soft tissue trauma, 2 (3.3%) abdominal trauma, and one case of urogenital trauma. Also multiple traumas were present in most of these cases. Thirteen patients had extremity fractures and three had cranial fractures. None of the bicycle drivers were using helmets at the time of the trauma. CONCLUSION: Bicycle drivers should have specific education, helmet use must become widespread and special traffic regulations have to be settled.

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This study was designed to estimate the rubella seroprevalence in unvaccinated Turkish adolescent girls in urban and rural areas of Edirne, and to create preventive strategies for congenital rubella syndrome (CRS). The sample, representing 12- to 17-year-old adolescent girls, consisted of 1,600 subjects selected from school lists by systematic and random sampling, which was matched by age and urban-rural residency strata proportional to the corresponding distributions in the Edirne population. For each participant, a questionnaire was completed and rubella-specific IgG antibodies were measured. After analysis of samples, seropositivity prevalence, equivocal and seronegative samples of adolescent girls in Edirne were determined as 93.1%, 0.6% and 6.3%, respectively. Data from the present study may indicate that 6.9% of adolescent girls have considerable risk for rubella infection during pregnancy. Eliminating rubella and CRS in Turkey will require national health service efforts, including vaccination of all adolescents and all susceptible women of childbearing age.

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OBJECTIVE: Monitoring of the dorsal sural sensory nerve action potential (SNAP) is a sensitive method for detection of peripheral neuropathies. We tried to determine the normal dorsal sural nerve conduction values of the childhood population and assessed the clinical utility of this method in diabetic children who have no clinical sign of peripheral neuropathy. METHODS: In the study, 36 healthy and 27 diabetic children were included. In all subjects peripheral motor and sensory nerve studies were performed on the upper and lower limbs including dorsal sural nerve conduction studies. RESULTS: The dorsal sural SNAP mean amplitude was 8.24+/-3.08 microV, mean latency was 2.47+/-0.48 ms, mean sensory conduction velocity was 41.63+/-5.43 m/s in healthy children. Dorsal sural SNAPs were absent bilaterally in one diabetic patient. In the other 26 diabetic patients, the mean dorsal sural nerve distal latency was longer (2.93+/-0.63 ms, P = 0.004), mean SCV was slower than in healthy subjects (36.68+/-7.66 m/s, P = 0.005). However, dorsal sural nerve amplitude was not different between the groups. A dorsal sural nerve latency of more than 2.9 ms had a sensitivity of 50% and a specificity of 75%. A dorsal sural nerve velocity of less than 36 m/s had a sensitivity of 54% and a specificity of 92%. CONCLUSIONS: We designated the reference values of the dorsal sural nerve in healthy children. In addition, our findings suggest that dorsal sural nerve conduction studies may have value to determine neuropathy in the early stages in children with diabetes. SIGNIFICANCE: The dorsal sural nerve conduction studies in diabetic children may have value to determine the neuropathy in its early stages.

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