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Umbilical vein catheterization (UVC) is commonly used in neonatal intensive care units (NICUs). However, it poses a significant risk for portal venous thrombosis (PVT). The aim of this study was to evaluate the patients with PVT due to UVC in a NICU in terms of the development of chronic thrombus, portal hypertension (PHT), and possible additional complications in the long-term outcome. Demographic, clinical characteristics, laboratory findings, ultrasonography imaging, and treatment of patients aged three years and younger who were diagnosed with PVT after UVC in the NICU and followed up by the pediatric gastroenterology outpatient clinic of our hospital were evaluated retrospectively.  Results: A total of 29 pediatric patients were analyzed. Isolated left PVT was seen in 25 (86.2%) patients and two-sided/bilateral PVT in four (13.8%) patients during hospitalization in the NICU. In the follow-up of four patients with combined right and left PVT who received anticoagulant therapy, the thrombus disappeared completely in three patients, whereas it persisted in one patient with partial recanalized flow in the left portal vein. Long-term follow-up of these patients is important for the management of PHT. Since UVC is commonly used in NICU, routine ultrasound evaluation of these patients for thrombosis can enable the diagnosis of PVT in the asymptomatic period.

Recent guidelines suggest non-biopsy serology–based approach for the diagnosis of celiac disease; however, there is no evidence-based data regarding noninvasive follow-up of mucosal healing. The aim of this study is to investigate the efficacy of serology in reflecting mucosal status in the follow-up of pediatric patients with celiac disease. This is a validation study conducted at a university hospital. Patients who had biopsy proven celiac disease (Marsh III) at diagnosis, and had been followed-up for at least 12 months, were prospectively evaluated with duodenal biopsies. tTG-IgA and EMA tests were performed on the day of endoscopy. One hundred four patients with a mean age of 7.4 ± 4.02 years were included in the study. The sensitivity and specificity of tTG-IgA were 85.2% and 61% respectively, with a high negative predictive value (NPV) of 92.2% but a very low positive predictive value (PPV) of 43.4%. We found that a cutoff value of 68.5 U/mL for tTG-IgA had a sensitivity, specificity of 85.2% and 85.7% respectively. The AUC was 0.891. The sensitivity and specificity of EMA was 77.8% and 87% respectively, with a high NPV of 91.8% but low PPV of 67.7%.Conclusion: This study suggests that negative tTG-IgA and/or EMA can be used as an indicator of mucosal improvement in the follow-up of pediatric patients with celiac disease. However, positive serology (i.e., < 10 × ULN) may be misleading in reflecting mucosal status in the follow-up of pediatric patients with celiac disease. What is Known:• The tissue transglutaminase IgA (tTG-IgA) and endomysium IgA (EMA) tests are widely used, sensitive and reliable diagnostic tests, but their role in monitoring adherence to dietary treatment in celiac patients has not yet been demonstrated.• There is still no reliable and non-invasive marker of persistent villous atrophy or mucosal recovery.What is New:• Negative celiac serology detected in the follow-up of pediatric patients with celiac disease was successful in demonstrating histopathological mucosal healing.• Positive celiac serology, which is highly reliable in the diagnosis of celiac disease, has not been successful in reflecting mucosal status when used in the follow-up of pediatric patients with celiac disease.

Brucellosis remains as an endemic infection of humans in many parts of the world; Latin America, Asia including Middle East and Mediterranean region including Turkey. Neonatal brucellosis is very rare and clinical manifestations as well as transmission route are not well-defined. The neonate can be either infected transplacentally, or by ingestion of mother's secretions and blood during delivery, or by ingestion of breast milk. Here, we present two cases with two different transmission route and clinical findings. First case is a premature infant born after 31 weeks of gestation and hospitalized for respiratory distress in addition to hepatosplenomegaly and leukocytosis. Brucella species were isolated from the initial blood culture obtained just after birth. Clinical and laboratory findings improved with decreased ventilatory support after replacement of antibiotherapy with trimethoprim-sulfamethoxazole (TMP-SMX) and rifampicin. Second case was a 28 days old, term infant. Her sibling was diagnosed as brucellosis and during evaluation of the family members, her mother was found to have brucellosis just before delivery. Initial evaluation of the baby after birth was totally normal. Beside medical advice, she was breastfed and in the 4th week of life she was found to have leucopenia and neutropenia, and brucella tube agglutination test turned to be positive. After antibiotherapy, laboratory findings were normalized. Breastfeeding was ceased during the treatment periods of both mothers. Both families were from rural regions of Turkey, who were using unpasteurized dairy products. Both patients were treated with TMP-SMX and rifampicin for 6 weeks without any complication. Brucella spp must be sought as a causative agent in the differential diagnosis of intrauterine and neonatal infections in endemic countries. Family members of patients from rural areas of the country must be questioned about traditional food consumption, as findings of neonatal brucellosis are various and vague.

Metoclopramide is a dopamine antagonist in the central nervous system and an antiemetic agent. It can cause extrapyramidal symptoms side effects such as dystonic reactions characterized by involuntary, sustained or spasmodic contractions of muscle groups, resulting in twisting, repetitive or abnormal postures. In this study, we aimed to report a pediatric patient who presented with acute dystonia due to metoclopramide use and was finally diagnosed with MIS-C.

Epiploic appendicitis is an uncommon and self-limiting disease. Clinically, it can often mimic acute appendicitis or acute diverticulitis, which are more common causes of acute lower abdominal pain. A 16-year-old male patient was admitted to our pediatric gastroenterology outpatient clinic with complaints of diarrhea (4 times a day) and severe abdominal pain in the epigastric region for three days. Abdominal computed tomography showed normal pancreas, hepatosteatosis, thickening of the cecum wall, multiple mesenteric lymphadenopathy in the right lower quadrant, areas similar to fat necrosis and 25x20 mm lesions compatible with EA. The patient, whose clinical and laboratory findings improved completely with antibiotic therapy, was discharged. In this study, we aimed to draw attention to epiploic appendicitis, which is one of the causes of acute lower abdominal pain in children and should be kept in mind in order to prevent unnecessary operations.

Brucellosis remains as an endemic infection of humans in many parts of the world; Latin America, Asia including Middle East and Mediterranean region including Turkey. Neonatal brucellosis is very rare and clinical manifestations as well as transmission route are not well-defined. The neonate can be either infected transplacentally, or by ingestion of mother's secretions and blood during delivery, or by ingestion of breast milk. Here, we present two cases with two different transmission route and clinical findings. First case is a premature infant born after 31 weeks of gestation and hospitalized for respiratory distress in addition to hepatosplenomegaly and leukocytosis. Brucella species were isolated from the initial blood culture obtained just after birth. Clinical and laboratory findings improved with decreased ventilatory support after replacement of antibiotherapy with trimethoprim-sulfamethoxazole (TMP-SMX) and rifampicin. Second case was a 28 days old, term infant. Her sibling was diagnosed as brucellosis and during evaluation of the family members, her mother was found to have brucellosis just before delivery. Initial evaluation of the baby after birth was totally normal. Beside medical advice, she was breastfed and in the 4th week of life she was found to have leucopenia and neutropenia, and brucella tube agglutination test turned to be positive. After antibiotherapy, laboratory findings were normalized. Breastfeeding was ceased during the treatment periods of both mothers. Both families were from rural regions of Turkey, who were using unpasteurized dairy products. Both patients were treated with TMP-SMX and rifampicin for 6 weeks without any complication. Brucella spp must be sought as a causative agent in the differential diagnosis of intrauterine and neonatal infections in endemic countries. Family members of patients from rural areas of the country must be questioned about traditional food consumption, as findings of neonatal brucellosis are various and vague. Keywords Brucellosis, neonate, breast milk Bruselloz, Orta Dogu, Asya, Dogu Avrupa, Orta ve Guney Amerika ulkeleri ile ulkemizin de dahil oldugu Akdeniz havzasinda halen endemik olan sistemik bir enfeksiyon hastaligidir. Neonatal bruselloz oldukca nadir gorulur ve bebege bulas yollari ile ilgili net bilgiler bulunmamaktadir. Bebege bulasin, anne karninda plasentadan direkt olarak, dogum sirasinda annenin genital sistemindeki sekresyonlarin ve kanin yutulmasi ya da enfekte anne sutunun icilmesi ile olabilecegi dusunulmektedir. Bu raporda iki yenidogan bebekte iki farkli bulas yolu ve klinikleri sunulmaktadir.ilk olgu, 31. gebelik haftasinda dogan solunum sikintisi, hepatosplenomegalisi, lokositozu olan premature bebekti. Hastadan dogar dogmaz alinan kan kulturunde brusella uremesinin ogrenilmesiyle degistirilen antibiyotik tedavisi sonrasinda mekanik ventilasyon destegi kesilebildi, hepatosplenomegalisi ve lokositozu duzeldi. Ikinci olgu ise kardesine bruselloz tanisi konuldugu icin ailesi arastirilirken annesine dogumdan hemen once bruselloz tanisi konan 28 gunluk miadinda dogan bebekti. Bebegin dogumdaki ilk degerlendirmesi tamamen normalken, tibbi oneriye ragmen emzirilmisti. Yasamin 4. haftasinda gelisen lokopeni ve notropeni nedeniyle tekrar degerlendirildi ve brusella tup aglutinasyon testinin pozitiflestigi saptandi. Hastaya verilen antibiyotik tedavisinden sonra hastanin degerleri normale donmustur. Her iki hastada da anne sutu annelerin tedavisi tamamlanincaya kadar kesildi, bebekler mama ile beslendi. Her iki ailenin de kirsal kesimde yasayan ve pastorize edilmemis sut urunlerini kullanan aileler oldugu goruldu. Her iki hastaya da trimetoprim sulfametoksazol ve rifampisin tedavisi 6 hafta sureyle herhangi bir komplikasyon gozlenmeksizin kullanildi. Sonuc olarak; bruselloz ulkemiz gibi endemik ulkelerde, intrauterin ve neonatal enfeksiyonlarin ayirici tanisinda mutlaka dusunulmeli ve arastirilmalidir. Neonatal donemdeki klinik bulgular farkli ve muphem olabilecegi icin ailenin geleneksel aliskanliklari, ozellikle kirsal kesimden gelen hastalarda sorgulanmalidir. Anahtar kelimeler Bruselloz, yenidogan, anne sutu

[LANGUAGE=”English”]Epiploic appendicitis is an uncommon and self-limiting disease. Clinically, it can often mimic acute appendicitis or acute diverticulitis, which are more common causes of acute lower abdominal pain. A 16-year-old male patient was admitted to our pediatric gastroenterology outpatient clinic with complaints of diarrhea (4 times a day) and severe abdominal pain in the epigastric region for three days. Abdominal computed tomography showed normal pancreas, hepatosteatosis, thickening of the cecum wall, multiple mesenteric lymphadenopathy in the right lower quadrant, areas similar to fat necrosis and 25x20 mm lesions compatible with EA. The patient, whose clinical and laboratory findings improved completely with antibiotic therapy, was discharged. In this study, we aimed to draw attention to epiploic appendicitis, which is one of the causes of acute lower abdominal pain in children and should be kept in mind in order to prevent unnecessary operations.[LANGUAGE=”Turkish”]ÖZETEpiploik apandisit nadir görülen ve kendi kendini sınırlayan bir hastalıktır. Klinik olarak, sıklıkla akut alt karın ağrısının daha yaygın nedenlerinden olan akut apandisiti veya akut divertiküliti taklit edebilmektedir. On altı yaşında erkek hasta üç gündür ishal (günde 4 kez), epigastrik bölgede ve sağ alt kadranda şiddetli karın ağrısı şikayetleri ile çocuk gastroenteroloji polikliniğimize başvurdu. Karın bilgisayarlı tomografisinde pankreas normal, hepatosteatoz, çekum duvarında kalınlaşma, sağ alt kadranda çok sayıda mezenterik lenfadenopati, yağ nekrozuna benzer alanlar ve epiploik apandisit ile uyumlu 25x20 mm lezyonlar görüldü. Antibiyotik tedavisi ile klinik ve laboratuvar bulguları tamamen düzelen hasta taburcu edildi. Bu çalışmada, çocuklarda akut alt karın ağrısı nedenlerinden olan ve gereksiz operasyonların önlenmesi amacıyla akılda tutulması gereken epiploik apendisite dikkat çekmeyi amaçladık.