INTRODUCTION: Obesity is a systemic inflammatory state affecting various organs including lungs. The rising prevalence of asthma and obesity among children has led to hypothesis of causality of obesity in development of asthma.
METHODS: 150 asthmatic children meeting the diagnostic criteria were enrolled for this study. Thorough clinical and anthropometric examination was done. The children were then categorized into two groups based on BMI as those with normal BMI and overweight/obesity. They were then followed up over 12 months and information collected was analyzed.
RESULTS: Of the 150 children, 72% were male and 45.3% belonged to the age group of 6-11 years. In 46.7%, asthma was diagnosed <5 years. 50% of the children missed school for 1-5 days in a year. Majority(63.3%) of the asthmatic children were able to perform the same level of physical activity as their peers. 54% of the asthmatic children had mild persistent asthma. Overweight/obesity was present in 19.3% of participants. Majority(72.4%) of the obese asthmatic children were diagnosed <12 years and had moderate-severe persistent asthma. Asthmatic children with overweight/obesity had higher night awakenings and missed school days at enrolment and follow up. Overweight/obese asthmatic children visited the emergency, required rescue medications and received steroids more often than children with normal BMI.
DISCUSSION AND CONCLUSION: Obese asthma is a well defined phenotype of childhood asthma characterized by higher disease burden and poor response to treatment. Hence a bipronged strategy to tackle overweight/obesity and control asthma in this group is warranted. Children with overweight/obesity and asthma have higher number of emergency visits, hospitalizations and use of rescue medications. Hence strategies directed towards reduction of obesity at an early age may help reduce the severity of asthma.

INTRODUCTION: Lower respiratory tract infections are one of the leading causes of mortality and morbidity in children. Chest X-Rays, which are frequently used in the diagnosis, cause ionizing radiation exposure and loss of time. We aimed to compare the diagnostic accuracy of chest radiography (CR) and lung ultrasonography (US) in patients with lower respiratory tract infections (LRTI).
METHODS: The study was designed as methodological research. Of the 62 patients evaluated in our study, four refused to participate, and eight were excluded from the study due to their underlying chronic diseases. All 50 patients (between the ages of 0-18 years)were evaluated with a preliminary lower respiratory tract infection diagnosis. Lung US was performed by a 3rd-year pediatric resident who had six hours of online ultrasonography training. CR was taken after Lung US.
RESULTS: The mean age of the 50 cases included in this study was five years and three months; 35 of 50 patients (70%) had a clinical diagnosis of pneumonia, 15 (30%) of them had a clinical diagnosis of bronchiolitis. Statistically significant interobserver agreement was found between US and CR (Kappa value 0.772, 95% Confidence Interval (0.590-0.925) (p=0.000). The sensitivity of lung US was 95%, the specificity was 85.7% when the CR was accepted as the gold standard.

DISCUSSION AND CONCLUSION: Our study demonstrates that lung US could be used instead of CR to diagnose and follow-up pediatric cases with LRTI.

INTRODUCTION: Testicular tumors are rare in children and have a bimodal distribution. The first peak is in two years of age and comprising mainly non-germ cell neoplasia in situ derived tumors. Here is presented clinical features and treatment of testicular tumors in prepubertal children in our center.
METHODS: The clinical records of patients treated testicular tumours younger than 18 years in our institution from January 2006 to June 2022 were reviewed retrospectively.
RESULTS: A total of 12 patients were included in this study. All patients were younger than 3 years, except one patient, who was 8 years old. The median age at primer diagnosis was 17 months (1–107 months). The most common clinical presentation was testicular swelling (n=9). Three patients were diagnosed incidentally.
Serum α-fetoprotein (AFP) was increased in 3 patients with yolk sac tumor (>1000 ng/dL) and in one patient with mature cystic teratoma (1 month-old infant with an AFP concentration of 629 ng/dL). Preoperative β-hCG level was normal in all patients.
Of 11 patients whose preoperative scrotal ultrasound could be reached, 5 solid-cystic lesions, 3 cystic lesions, and 2 solid lesions were reported. Calcification was detected in 4 patients.
All 4 patients with malignant tumors and 3 patients with benign tumors underwent radical inguinal orchidectomy. Of the 5 tumors removed by testis preserving surgery 2 were mature teratomas, 2 were epidermoid cyst and 1 was benign multicystic lesion.
There was a patient with yolk sac tumor who died in the fifth month postoperatively while receiving chemotherapy, and the remaining patients had no metastatic or local primary testicular tumor recurrence during a mean follow-up of 92 months (2-198 months).

DISCUSSION AND CONCLUSION: Most prepubertal tumors are benign and testicular sparing surgery can be performed in patients with negative serum tumor markers. Inguinal radical orchidectomy is sufficient in the treatment of yolk sac tumor.

INTRODUCTION: A variety of developmental abnormalities of the tracheobronchial tree and pulmonary parenchyma are found in the newborn. There is limited data available on their presentation and clinical course from third world countries.
METHODS: A retrospective review of medical records of children with congenital lung malformations was conducted at our tertiary care hospital from June 2014 to June 2018.
RESULTS: The study included 30 patients with 12 males and 18 females. Mean age at diagnosis was 13months (range 1month to 4 years). Congenital pulmonary airway malformation was the most common malformation present in 18(60%) patients followed by congenital lobar emphysema in 4(13.3%), bronchogenic cyst in 3(10%), bronchopulmonary sequestration in 2(6.7%), bronchial atresia in 2(6.7%) and pleuropulmonary blastoma in 1(3.3%) patient. Most common presentation was recurrent upper respiratory tract infection (53.3%). Lobectomy was the most common surgical procedure performed in 86.6% of the patients followed by excision of cyst in 10% of the patients. Post operative complication rate was 30% with an overall survival of 93.3%. Average follow up duration was 9 months.
DISCUSSION AND CONCLUSION: The predominant lung malformation in this study was Congenital pulmonary airway malformation. Recurrent respiratory tract infection with or without respiratory distress was the most common mode of presentation. Health education to raise the awareness and emphasis on antenatal ultrasonography can avoid the inordinate delays in diagnosis and treatment. Surgery is curative with good long-term outcome.

INTRODUCTION: Nephrotic Syndrome (NS) is the most common childhood glomerular disease manifested by proteinuria, edema and hypoalbuminemia. The aim of this study is to examine children with primary NS in terms of clinical laboratory and histopathological features, to evaluate treatment responses.
METHODS: Thirty-eight (21 boys/ 17 girls) patients followed up with primary NS included in the study.
RESULTS: The mean age at diagnosis was 6.4 years. Histopathological diagnoses were focal segmental glomerulosclerosis (FSGS) in 17 patients, minimal change disease (MCD) in 8, membranoproliferative glomerulonephritis (MPGN) in 3, and membranous glomerulonephritis (MN) in 1 patient. Patients with MPGN was older than MCD and FSGS (p = 0.035). Twenty-four patients were steroid sensitive. Steroid response rates were 88% in patients with MCD, 41% in patients with FSGS and 33% in those with MPGN. At last visit, three (7.9%) were diagnosed as chronic kidney disease (CKD).
DISCUSSION AND CONCLUSION: NS is the most common glomerular disease of childhood. Early diagnosis and histopathological features of the disease have an important place in prognosis. Knowing the demographic, clinical and pathological features of the disease is helpful in monitoring and prognostic prediction.

INTRODUCTION: The skin prick test (SPT) is the standard tool for determining respiratory allergen sensitizations. Different allergen sensitization patterns have been observed within countries and regions according to geographical and seasonal variations. This study aims to identify the sensitization pattern of children in different age groups and to define the minimum number and type of allergen extracts in an SPT to detect a sensitized child.
METHODS: This retrospective study was conducted in the outpatient clinic of the Pediatric Allergy, Immunology, and Pulmonology Unit of a tertiary Children's Hospital from October 2019 to December 2020. Children aged between 2 and 18 years suspected of inhalant allergy with the presence of clinically relevant symptoms were included. The results of SPT were collected from medical records to determine the optimal panel to cover 95% of the sensitized children.
RESULTS: A total of 1821 patients with SPT results were evaluated. Forty-three patients (2.4%) were excluded from the study because some allergen extracts did not apply. Consequently, 1778 children (male/female ratio of 1.33) were included in the study. The median age (interquartile range) was 8 years (2-18). The most common sensitizations were to grasses (Lolium perenne and Poa pratensis), trees (Olea europaea and Fraxinus excelsior), cereals (Avena sativa and Hordeum vulgare), animal dander (cat and dog), and weeds (Plantago lanceolata and Ambrosia artemisiifolia). The rate of sensitization tended to increase with age. Applying an SPT that included six allergen extracts for 2-5 years, five for 6-11 years, and four for 12-18 years was sufficient to identify 95% of sensitized children.
DISCUSSION AND CONCLUSION: A test panel with six allergen extracts was sufficient to identify most of the sensitized children and adolescents suspected of allergy and had clinically relevant symptoms. An SPT with fewer allergen sources was required to detect older sensitized children than younger children.

INTRODUCTION: With the spread of technological possibilities, the idea that humanoid robots can accompany medical interventions has gained momentum. The objective of this two-armed randomized controlled study is (i) to assess the effect of a human-like robot in behavior guidance during children’s dental treatment, by comparing dental anxiety scale, behavioral scale, pulse rate and amylase levels in the saliva and (ii) to determine whether the children would like to have treatment with a humanoid robot.
METHODS: 102 children (52 girls, 50 boys; mean age: 6.71±1.43 years) were included. Exclusion criteria were children showing definitely negative behaviour (Frankl 1) during dental prophylaxis at the first visit and children who had dental treatment before. 50 children were participated in robot group (RG) and 52 children were participated in control (CG). Facial Image Scale (FIS), Frankl Behaviour Rating Scale (FBRS), physiological pulse rate and salivary alpha amylase (sAA) level were used to assess the stress related changes. Mann-Whitney U-test and Student t-test were used to compare groups. In-group comparisons were tested with Wilcoxon signed rank test. Chi square test, Continuity (Yates) correction, and Fisher Freeman Halton test were used to compare qualitative data. Statistical tests were used with p value fixed at 0.05.
RESULTS: The post-treatment FIS score of RG in the 6-10 year-olds was significantly lower then CG (p<0.05). Post-treatment FBRS score was statistically significantly higher in the RG than in the CG in younger and older children (p<0.05). In children aged between 6-10 years, pulse rates during and after treatment in RG were significantly lower than those in CG (p<0.05). No correlation was found between children’s anxiety and behavior and sAA levels.
DISCUSSION AND CONCLUSION: The robot was found to be more effective in reducing dental anxiety and pulse rate in children aged 6-10 years, and it was more preferred by children of this age.

INTRODUCTION: This study aimed to compare the dental fear and anxiety of dental patients aged 6-12 years before and during the COVID-19 pandemic.
METHODS: The first phase of the study was conducted on Group 1 (n=350) before the pandemic and the second phase was conducted on Group 2 (n=350) during the COVID-19 pandemic. Dental anxiety and fear were assessed using 4 scales: the Modified Dental Anxiety Scale (MDAS), the Modified Child Dental Anxiety Scale (MCDAS), the Dental Subscale of the Children’s Fear Survey Schedule Dental (CFSS-DS), the Dental Fear Scale (DFS). In the second phase, participants also filled out a questionnaire related to the COVID-19 pandemic. Data were analyzed using SPSS Statistics 25 (IBM, Armonk, New York).
RESULTS: There was no significant difference between the two groups based on socio-demographic variables (p>0.05). Scores during the pandemic decreased significantly for the MDAS, CFFS-DS and DFS (p=0.002, p=0.002, p=0.010, respectively). In Group 2, 2% of them reported that their anxiety increased because of the change in the dentists’ personal protective equipment and 30.9% reported they were anxious about COVID-19 transmission.
DISCUSSION AND CONCLUSION: In this study, dental fear and anxiety decreased during the COVID-19 pandemic. Personal protective equipment was not effective on dental fear and anxiety.

Garre's osteomyelitis is a rare chronic inflammatory disease with reactive peripheral bone formation due to low-grade local infection.
Here we present a 12-year-old female with chronic osteomyelitis and proliferative periostitis with no definite source of infection, such as caries and periodontitis. The patient had a history of hospitalization 4-5 times with the same symptoms intermittently in the last two years at the referred hospital. The patient had undergone a biopsy at the referred hospital, and she was referred to our hospital with a histopathological diagnosis of osteoid osteoma. Physical examination showed a unilateral swelling in the right mandible at our hospital admission. Since we could not exclude the diagnosis of bacterial osteomyelitis, antibiotics were continued. Periapical radiography, magnetic resonance, computed tomography, and clinical features supported the diagnosis of Garre's osteomyelitis, so antimicrobial therapy was discontinued. Biopsy materials were reexamined by the pathologist at our hospital, and Garre's osteomyelitis was considered. Nonsteroidal anti-inflammatory drugs were started. We added colchicine treatment because she failed to achieve remission, and normal facial symmetrical morphology was not achieved in the two-month follow-up period. However, the symptoms regressed within one year, and the swelling disappeared.

Chickenpox, the primer infection of varicella-zoster virus (VZV), is usually benign, self-limiting disease and rarely causes severe complications. Encephalitis is a rare neurological complication of VZV in previously healthy children. We report an immunocompetent child without vaccination diagnosed with VZV encephalitis who was treated with acyclovir, and methylprednisone and recovered completely.