OBJECTIVE: The aim of the study was to investigate the relationship between the severity of allergic rhinitis (AR) and neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in pediatric patients. METHODS: This study is a retrospective, cross-sectional, and observational study including 200 AR patients and 160 healthy controls. Of the patients, 39% were boys with a mean age of 10.5 years. The study included children with persistent and intermittent AR. Of the controls, 50.6% were boys with a mean age of 10.3 years. We compared NLR and PLR from blood test between study and control groups. They were also compared according to AR severity within the patient group. RESULTS: The NLR was 1.64 +/- 1.29 in the study group whereas 1.18 +/- 0.31 in the control group. The PLR was 102.72 +/- 31.20 in the study group whereas 79.36 +/- 11.72 in the control group. When NLR and PLR were compared between groups, we found statistically significant differences in both NLR and PLR (p=0.003, p=0.001, respectively). We found a statistically significant difference when comparing both NLR and PLR in patients with intermittent and persistent AR. These rates increased with disease severity (p=0.000, p=0.000, respectively). CONCLUSION: Both NLR and PLR are useful markers for the diagnosis and severity of AR. Clinicians can use these markers to assess disease severity in pediatric patients at the beginning of the diagnostic process.

Determining the characteristics and risk factors of severe disease is extremely important to combat atopic dermatitis (AD), which has an increasing prevalence recently. In this study, we aimed at investigating the clinical characteristics of pediatric patients with AD and identifying the factors associated with the severity of the disease. A total of 304 pediatric patients diagnosed with atopic dermatitis were included. The patients' age at admission, age at onset of symptoms, the presence of atopy history in their family, eosinophil levels obtained from blood counts were recorded, together with the data of cigarette exposure, area of residence. Disease severity was determined according to the SCORAD index. Epidermal prick tests (EPT) were applied to all patients. There was a negative correlation between the SCORAD score and both age at admission (r=0.277, p<0.001) and age at onset of the symptoms (r=-0.474, p<0.001). Food sensitization rates were higher in individuals with moderate-severe disease (90.7% vs. 23.1%; p<0.001) and patients with food allergy (FA) had significantly higher SCORAD scores [33 (IQR: 22-44) vs 14 (IQR: 12-16); p<0.001]. SCORAD scores of the individuals living in rural areas were higher than the ones living in urban [22 (IQR: 15-39.5) vs 15(IQR:12-22); p<0.001]. Familial atopy history was more common in patients with moderate-severe disease (66.5%vs 17.5%; p<0.001). The SCORAD scores were higher in patients exposed to passive smoking [21(IQR:14.75-38) vs. 13(IQR:12-16); p<0.001]. The eosinophil count found to be positively correlated with SCORAD scores (r=0.531, p<0.001). Our findings show that early-onset, food sensitivity, living in rural areas, having familial atopy history and passive cigarette smoke exposure play a role in severe AD. Since it is remarkably correlated with SCORAD scores, eosinophil count can be used as a marker to assess the severity of AD in children.

Objective: The aims of this study were (1) to compare 25-OH vitamin D levels between children with upper and those with lower extremity fractures and (2) to determine whether 25-OH D insufficiency prevalence is increased compared to healthy controls. Methods: This is a prospective case–control study for 12 months. The study was conducted with children aged 5-18 years, including 60 children with non-displaced, impaction type upper extremity and lower extremity fractures resulted from low-energy trauma. In addition, 60 healthy children were included as controls. In all participants, risk factors for low bone mineral density were assessed and serum 25(OH)D levels were measured. Vitamin D levels were compared among groups. Results: Vitamin D deficiency (25-OH D <20) was 14.8 times (OR= 95% CI= 5.61 - 39.8) and 2.9 times (OR= 95% CI= 1.46-5.75) higher in patients with upper and lower extremity fractures, respectively. In the upper extremity fracture group, serum 25-OH D level was considered deficient (25-OH D level=<20 ng/mL) in 91.6% (55/60). In comparison, it was considered as insufficient (serum 25-OH D level=20-30 ng/mL in 8.3% (5/60) of the patients. In the lower extremity fracture group, serum 25(OH)D level was considered as deficient in 75.0% (45/60), while it was considered as insufficient in 25.0% (15/60) of the patients. In the control group, serum 25-OH D level was considered deficient in 10.0% (6/60), while it was considered insufficient in 61.6% (37/60) of subjects. The 25-OH D deficiency and insufficiency were more common in the whole fracture group (upper plus lower extremity fracture groups) when compared to healthy controls. Conclusion: This study has shown that hypovitaminosis D is associated with an increased risk for fracture in the pediatric population, and the fracture risk is higher in upper extremity fractures than in lower extremity fractures. In children with fractures, routine vitamin D evaluation should be considered. Level of Evidence: Level III, Diagnostic Study Cite this article as: Ergün T, Cansever M. Comparison of 25-OH vitamin D levels between children with upper and those with lower extremity fractures: A prospective case–control study. Acta Orthop Traumatol Turc. 2022;56(2):76-80.

Objective T-cell receptor excision circles are expensive for neonatal severe combined immunodeficiency screening in developing countries. We aimed to detect immunodeficiencies presenting with lymphopenia to enable screening in the general population and to improve awareness regarding lymphopenia among clinicians. Study Design This study was conducted prospectively. In all newborns included, complete blood count from umbilical cord blood samples was recorded. Absolute lymphopenia was defined as absolute lymphocyte count <3,000/mm³ in umbilical cord blood sample. Complete blood count was repeated at month 1 in cases found to have lymphopenia. Results Overall, 2,000 newborns were included in the study. Absolute lymphopenia was detected in 42 newborns (2.1%), while lymphocyte count was >3,000/mm³ in 1,958 newborns (97.9%). Two infants with persisted lymphopenia at the end of the first month; therefore, further evaluations such as lymphocyte subsets for severe combined immunodeficiency (SCID) were done. In the first infant, the lymphocyte subgroups were detected as compatible with T (−), B (−), natural killer cells (NK) (+) SCID phenotype RAG defect. Sanger sequencing revealed that NM_000448 c.2209C > T (p.R737C) homozygous mutation of RAG1 gene. In the other infant, the lymphocyte subgroups were found as considered with T (−), B (+) NK (−) SCID phenotype JAK3 defect. Both patients underwent hematopoietic stem cell transplantation from human leukocyte antigen-matched family member. Conclusion Absolute lymphopenia by complete blood count is a more simpler, relatively noninvasive and inexpensive screening methodfor detection of SCID in newborns compared with T-cell receptor excision circles technique. Key Points Received: 04 March 2021 Accepted: 30 April 2021 Article published online: 11 June 2021 © 2021. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Down syndrome is the most common chromosomal aberration. Patients with Down syndrome suffer more infections than those without the disease. Underlying immunological disorders are considered to be the reason for the increasing frequency of infections in patients with Down syndrome. In addition, some anatomical abnormalities in the respiratory tract accompanying Down syndrome can disturb the innate immunity and contribute to the increase in infection rate. Respiratory tract infections are one of the most common causes of mortality in patients with Down syndrome. Awareness of the underlying reason for frequent respiratory tract infections should result in a decrease in mortality among these patients and contribute to an improvement in their quality of life.