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Background The diagnosis of brain death is primarily clinical. Sometimes ancillary tests are needed. Objective This study compared sensitivity and interobserver agreement of the 10-, 7- and 4-point CT angiography scoring systems for the diagnosis of brain death in children. Materials and methods CT angiography examinations of 50 pediatric patients with a clinical diagnosis of brain death were evaluated according to 10-, 7- and 4-point scoring systems. Images were evaluated by two radiologists who considered the vessel opacification first in the arterial phase (A 0 –V 50 ) and then in the venous phase (A 0 –V 50 ). We evaluated interobserver agreement for the assessment of vessel opacification and diagnosis of brain death. We compared the differences among brain death diagnoses between children with craniotomy–craniectomy defects, open fontanelles and preserved bone integrity. We subdivided children into two groups according to age: ≤ 2 years and > 2 years. We calculated sensitivities according to age groups. Results Using the clinical exam as the reference standard, we found sensitivities for 10-, 7- and 4-point scoring systems to be 70%, 88% and 92% in the A 0 –V 50 method and 40%, 82% and 82% in the A 50 –V 50 method, respectively. Percentage agreement between readers was 78% for the 7-point scale using the A 0 –V 50 method and more than 90% for other scoring systems for both the A 0 –V 50 method and the A 50 –V 50 method. The sensitivity was much lower in children with open anterior fontanelles compared to the groups with preserved bone integrity and with a craniotomy–craniectomy defect. Conclusion Just as in adult age groups, in children the 4-point scale appears to be more sensitive than the 10- and 7-point scales for CT angiography-based assessment of brain death. Because the scoring systems have similar sensitivities, they could be used as ancillary tests in pediatric cases.

Fasciola hepatica is a zoonotic liver trematode that usually causes infection in cattle and sheep, and is transmitted to humans by consuming water and aquatic plants contaminated with metacercaria. The detection of Fasciola eggs in stools, serological evaluation and radiological evaluation are essential for diagnosis. Triclabendazole is the first-line therapy for fascioliasis. However, as triclabendazole is not an easily accessible drug in countries such as Turkey, it reveals a quest for alternative therapies. In this report, we present a 10-year-old boy with fascioliasis successfully treated with a course of metronidazole 1.5 g/ day for 3 weeks in 2020. During the follow-up, eosinophilia and radiological findings completely recovered. Here we report a case of pediatric fascioliasis that was cured with metronidazole successfully.

BackgroundThe first afebrile seizures in children are an important and common reason for emergency department admissions. We aim to examine the presentation, laboratory/neurodiagnostic investigation, and emergency management of children with first afebrile seizures.MethodsThe retrospective study included 333 patients aged 1 month to 18 years admitted with a first afebrile seizure to the pediatric emergency department of Prof. Dr. Cemil Taşcıoğlu City Hospital between January 2017 and January 2020. Age, gender, seizure duration and type, treatments for seizures, laboratory, neurophysiological, and radiological investigations, ward or intensive care unit hospitalizations, and antiepileptic drugs on discharge were recorded.ResultsThe average age of the patients was 81.6 ± 62.9 months; 187 (56.2%) were male and 146 (43.8%) were female. Two hundred and sixty-one (78.4%) patients had only one seizure. In 45 (13.5%) of the patients, the seizure recurred in the emergency department. Hypoglycemia, hyponatremia, and hypocalcemia were detected in 13 (3.9%) patients. Patients with clinically significant cranial computed tomography results were at an increased risk for seizures lasting longer than 5 min. Patients with focal seizures had more recurrences, were given more antiepileptic drugs during the emergency, had better known etiology, more intensive care unit hospitalization, and greater post-discharge antiepileptic drug prescription.ConclusionsBiochemical abnormalities remain in the background in the etiology of afebrile seizures. Patients with abnormal neuroimaging on cranial tomography tended to have longer seizures. Patients with focal seizures followed a more complicated course as they had more recurrences and more hospitalization in the intensive care unit.

Objective: To evaluate the role of magnetic resonance (MR) diffusion tensor imaging (DTI) in the assessment of liver fibrosis and inflammation in chronic viral hepatitis by measuring apparent diffusion coefficient (ADC) and fractional anisotropy (Fa) values. Material and Methods: Twenty-seven patients (5 women and 22 men;mean age39.8±11.3) with hepatic fibrosis were included in our study. The relationship between ADC, Fa values and histological activity index (HAI) score were evaluated using Spearman’s correlation coefficient. Patients were subgrouped as group A (fibrosis score 1) and group B (fibrosis score 3). The mean ADC and Fa values of groups A and B were compared using Student’s t-test. To evaluate the use of ADC and Fa values in distinguishing group A from group B, ROC analysis was applied; sensitivities and specificities were calculated. Results: Fa values correlated with HAI scores significantly (r=0.397, p<0.05) The difference was significant between the mean ADC values (group A:1.46± 0.191x103mm2/s; group B:1.105± 0.141x10-3 mm2/s; p<0.001) and Fa values (group A: 0.473±0.091; group B: 0.643± 0.007; p<0.001) between the groups. For distinguishing group A from group B, ADC had a sensitivity of 81.8% and a specificity of 93.8%. The sensitivity and specificity of Fa were 90.9% and 100%, respectively. Conclusion: Diffusion tensor imaging may play a role in the evaluation of fibrosis and HAI scores in patients with liver fibrosis.

Aim: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. Materials and methods: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. Results: A total of 45 children with a median age was 8 (2–17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. Conclusion: RDUS parameters didn’t show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.

Cat scratch disease (CSD) is an infection caused by Bartonella henselae, presents with non-specific symptoms like lymphadenopathy, fever, and fatigue. It can progress to disseminated disease, leading to complications such as liver and splenic micro abscesses, osteomyelitis, encephalitis, and uveitis. Diagnosis is challenging due to varied presentations and limited tests. Treatment involves supportive care, with severe cases requiring antimicrobial therapy. In this report, we present a case of Cat scratch disease characterized by an atypical clinical manifestation, hepatosplenic and paravertebral involvement.

Amaç: Fokal böbrek lezyonlarının benign, malign ayırımındagörünüşteki difüzyon katsayısı (apparent diffusion coefficient- ADC) ve fraksiyonel anizotropi (Fa) ölçümlerinin diagnostikperformanslarının belirlenmesi. Gereç ve Yöntem: Çalışmamıza, bilgisayarlı tomografi (BT) ve ultrason (US) gibi değişik görüntüleme modaliteleri ile tanıkonulan ve manyetik rezonans diffüzyon tensör görüntülemesi(DTI) yapılmış 21 hastada (9 kadın and 12 erkek ; ortalama yaş 54,1 ), 25 fokal renal lezyon dahil edildi. Lezyonlar 6 solid renalhücreli karsinom (RCC), 1 kistik RCC, 1 anjiomyolipom (AML) ve 17 kistik lezyondan ( 16 Bosniak tip I kist, 1 Bosniak tip IIkist) oluşmaktaydı. ADC ve Fa ölçümleri iki radyolog tarafından, konsensusa varılarak yapıldı. Malign ve benign lezyonlara aitADC ve Fa değerleri ANOVA ve Tukey testleri kullanılarakkarşılaştırıldı. ROC analizi kullanıldı; sensitivite ve spesifitehesaplandı. Bulgular: Malign lezyonların ortalama ADC ve Fa değerlerisırasıyla 1.29±0.4 mm2/sn ve 0.34±0.1 ölçüldü. Benign lezyonlarınortalama ADC ve Fa değerleri sırasıyla 2.6±0.7 mm2/sn ve0.19±0.12 ölçüldü. Aralarındaki fark istatistiksel olarak anlamlı idi(P<0.05). Malign lezyonları, benign lezyonlardan ayırmada ADCve Fa ölçümlerinin, Az değerleri sırasıyla 0.95 ve 0.83 bulundu. ADC ve Fa ölçümlerinin sensitivite ve spesifite değerleri sırasıyla100%-83.3% ve 100%-77.8% bulundu. Sonuç: Malign ve benign fokal renal lezyonların ADC ve Faölçümleri değerleri arasında istatistiksel anlamlı farklar mevcuttur. Malign renal lezyonlarda düşük ADC ve yüksek Fa değerleriizlenirken, benign renal lezyonlarda yüksek ADC ve düşük Fadeğerleri izlenir.

OBJECTIVE: The aim of this study was to investigate cranial magnetic resonance imaging (MRI) findings in different age groups and genders in pediatric epilepsy, to determine the percentages of etiologic factors, and to evaluate the association between MRI positivity and treatment resistance. METHODS: Cranial MRIs of 359 patients with epilepsy aged 1 month to 18 years were retrospectively evaluated. Etiologic factors as an underlying cause of epilepsy were classified as previous parenchymal damage, hippocampal sclerosis, malformations of cortical development, tumor, neurocutaneous syndrome, myelination disorder, vascular anomaly, metabolic/genetic/neurodegenerative diseases, encephalitis, and an uncategorized \"other\" group. Data were transferred to IBM SPSS Statistics 25.0 (SPSS Inc., Chicago, IL, USA), and descriptive statistics, correlation analyses, chi- square, and t-tests were performed. RESULTS: Among the patients included in the study, 141 (39.3%) had pathological findings on MRI related to the etiology. Previous parenchymal damage (39.7%) was the most common etiologic cause in all age groups. Regarding the relationship between drug resistance and MRI positivity, MRI positivity was observed in 72% of drug-resistant cases, while a complete response to therapy was found in 67.6% of MRI-negative cases. CONCLUSION: MRI guides clinicians to determine the presence of an etiologic factor as the underlying cause of childhood epilepsy before treatment planning. MRI positivity is a remarkable indicator of response to antiseizure drug treatment and drug resistance. Keywords: Drug resistance; epilepsy; etiology; magnetic resonance imaging; polytherapy.

[LANGUAGE= \"English\"] Heparin-induced thrombocytopenia syndrome (HITS) is a rare complication of low-molecular-weight heparin (LMWH). It is an autoimmune-mediated side effect of LMWH which is caused by platelet-activating antibodies that recognize platelet factor-4/heparin complexes. Although HITS often leads to thrombosis in large veins and arteries, it can be presented as microvascular thrombosis. In this article, we report a case of HITS complicated with multiple digital necrosis after administration of LMWH.[LANGUAGE= \"Turkish\"] Heparin kaynaklı trombositopeni sendromu (HKTS) düşük moleküler ağırlıklı heparinin (DMAH) nadir bir komplikasyonudur. DMAH’nin trombosit faktör-4 / heparin komplekslerini tanıyan trombosit aktive edici antikorların neden olduğu otoimmün aracılı bir yan etkisidir. Her ne kadar HKTS büyük venlerde ve arterlerde tromboza yol açsa da, mikrovasküler tromboza da neden olabilmektedir. Bu yazıda, DMAH uygulanmasından sonra çoklu parmak nekrozu ile komplike olmuş bir HKTS vakasını sunmaktayız.