Ankara Bilkent City Hospital, Children’s Hospital
This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
Maternal versus paternal rejection in adolescent suicidality: A study in a socioeconomically disadvantaged cohort
Objective: Parental acceptance–rejection is linked to adolescent mental health, yet its distinct maternal versus paternal associations with suicidality in disadvantaged youth remain underexplored. This exploratory study aimed to delineate these specific relationships, examining perceived parental rejection as a predictor for suicidal ideation (SI) intensity, non-suicidal self-injury (NSSI), and psychopathology in a high-risk cohort. Materials and Methods: Forty-six adolescents (82.6% girls; M age = 15.7±1.1 ) hospitalized in an ICU following a serious suicide attempt completed the Parental Acceptance-Rejection/Control Questionnaire and Youth Self-Report. A clinician assessed suicidality using the Columbia-Suicide Severity Rating Scale. Bivariate and multivariate regression analyses were performed to identify key predictors. Results: A clear dissociation emerged between maternal and paternal roles. Greater perceived maternal rejection—particularly indifference and neglect—was significantly associated with higher SI intensity (B = 0.128, p < 0.001), and a perceived lack of maternal warmth correlated with depressive symptoms (r = 0.454, p = 0.002). In contrast, paternal acceptance was unrelated to SI or internalizing problems; however, paternal hostility was significantly associated with externalizing behaviors (r = 0.381, p = 0.013). Additionally, conduct problems were the only significant predictor of lifetime NSSI (OR = 1.125, p = 0.040), and SI intensity predicted a history of multiple suicide attempts (OR = 1.559, p = 0.016). Conclusion: In this high-risk cohort, maternal rejection appeared to be more closely linked to suicidal ideation and internalizing distress, whereas paternal hostility showed a stronger association with externalizing behaviors. These exploratory findings point to the potential value of family-centered prevention approaches that enhance maternal responsiveness and address behavioral dysregulation to help mitigate suicide risk.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
Evaluation of awareness and knowledge levels of pediatric residents on tuberculosis
Objective: Data on pediatric residents’ awareness and knowledge of childhood tuberculosis in Türkiye are limited. This study aimed to evaluate the awareness and knowledge levels of pediatric residents regarding childhood tuberculosis at Ankara City Hospital. Materials and Methods: This cross-sectional study was conducted between August and September 2023 among pediatric residents at Ankara Bilkent City Hospital. A 15-item online multiple-choice questionnaire assessed knowledge related to epidemiology and prevention, clinical–laboratory–imaging evaluation, treatment, and prophylaxis of childhood tuberculosis. Incomplete or unsubmitted questionnaires were excluded from the analysis. Results: A total of 172 pediatric residents participated in the study, of whom 72.7% were female. Eighty-six residents (50.0%) were classified as junior and 86 (50.0%) as senior. Senior residents demonstrated significantly higher correct response rates than junior residents regarding incorrect statements about BCG vaccination (53.5% vs. 38.4%, p=0.047), definition of close contact in tuberculosis (91.9% vs. 79.1% p=0.017), interpretation of abnormal PPD values (93.0% vs. 76.7%, p=0.003), microbiological diagnostic methods (80.2% vs. 58.1%, p=0.002), and typical radiographic findings in childhood pulmonary tuberculosis (89.5% vs. 74.4%, p=0.010) (p<0.050 for all). Correct response rates increased progressively with advancing residency year (X2 : 37.295, df:1, p<0.001). Conclusion: Senior pediatric residents demonstrated significantly higher knowledge levels regarding childhood tuberculosis compared with junior residents. These findings highlight the importance of structured and continuous educational programs beginning early in residency and reinforced throughout training. Given the endemic nature of tuberculosis in Türkiye, targeted and regularly updated educational interventions may improve early recognition, diagnostic accuracy, appropriate treatment, and overall clinical outcomes. Future multicenter studies incorporating key domains of tuberculosis knowledge—epidemiology and prevention, clinical–laboratory–imaging evaluation, and treatment and prophylaxis—may help identify regional gaps and guide standardized educational strategies.
Evaluation of clinical, demographic, and echocardiographic characteristics of patients with acute rheumatic fever diagnosed in the secondary care hospital
Objective: Acute rheumatic fever remains a significant cause of morbidity and mortality, particularly in developing countries. According to the Modified Jones Criteria updated by the American Heart Association in 2015, populations with an annual incidence of fewer than 2 new cases per 100,000 individuals are considered low-risk. A nationwide multicenter study conducted in Türkiye reported an annual incidence of 8.8 per 100,000, classifying the country as being within the moderate–to–high–risk category. In this study, we aimed to evaluate the clinical, demographic, and echocardiographic characteristics of patients diagnosed with acute rheumatic fever at a secondary healthcare center. Material and Methods: The clinical and demographic data of patients diagnosed with acute rheumatic fever at Denizli State Hospital between March 2015 and December 2024 were retrospectively evaluated. Patient records were accessed through the hospital’s electronic database. Results: A total of 60 patients were diagnosed with acute rheumatic fever during the study period. The most common presenting complaint was joint pain. Carditis and joint involvement (91.6% and 92.8%, respectively) were the most frequently observed major manifestations, while Sydenham chorea was diagnosed in 30% of the patients. According to the most recently modified criteria, the frequencies of polyarthritis, monoarthritis, and polyarthralgia as major manifestations were similar (30.1%, 28.6%, and 33.3%, respectively). Treatment-related complications included hepatotoxicity in four patients, and epistaxis, peptic ulcer, steroid-induced myopathy, esophageal candidiasis, and hyponatremia in one patient each. Conclusion: Acute rheumatic fever remains a commonly encountered disease in Türkiye. With the recent updates to the Jones Criteria, the proportion of missed acute rheumatic fever cases in moderate-to-high–risk populations is expected to decline substantially. The high frequency and clinical significance of both the disease itself and its treatment-related complications underscore the importance of effective streptococcal eradication and early diagnosis.
Bone mineral density in pediatric celiac disease: Clinical, biochemical, and serologic profiles—a retrospective cohort study
Objective: The aim of this study was delineate the burden of low lumbar bone mineral density (BMD) in children with CD (celiac disease) and evaluate differences in BMD according to assessment timing and gluten-free diet (GFD) adherence, using concurrent tissue transglutaminase IgA (c-tTG-IgA), and describe accompanying anthropometric and biochemical profiles. Materials and Methods: This retrospective cohort included CD patients (n=123) aged 5–18 years who underwent dual-energy X-ray absorptiometry (DEXA) between January 1, 2022, and December 31, 2024. Age-adjusted and height-adjusted BMD z-scores (BMD-AAz and BMD-HAz) were calculated. Patients were grouped as diagnosis or follow-up (≥12 months), and follow-up was subdivided into GFD-non-adherent follow-up group (FU-NonAdh) and GFD-adherent follow-up group (FU-Adh). Results: Low BMD based on BMD-HAz (≤−1) was present in 37.4% (osteopenia 24.4%; osteoporosis 13.0%). Compared with diagnosis group, follow-up group had higher BMD-AAz and BMD-HAz (p=0.022 and p=0.011). BMD-HAz was higher in FU-Adh group than in diagnosis and FU-NonAdh group (p<0.001 and p=0.005), whereas FU-NonAdh group did not differ from diagnosis group. The low BMD group had a lower body mass index (BMI) z-score and shorter GFD duration (p<0.001 and p=0.010). Serum calcium levels were lower in the osteoporosis group than in the normal BMD group (p=0.003). Conclusion: Lumbar BMD impairment is frequent in pediatric CD, with the most evident improvement in the GFD-adherent follow-up group. In secondary analyses, lower BMI z-scores and shorter GFD duration were observed in children with low BMD, which may help inform risk stratification.
Hypertension in children with congenital adrenal hyperplasia: Prevalence and associated factors
Objective: Congenital adrenal hyperplasia (CAH) is a group of inherited disorders of adrenal steroidogenesis that may predispose affected patients to hypertension through both disease- and treatment-related mechanisms. Although hypertension represents an important comorbidity in CAH, its prevalence and contributing factors in the pediatric population, particularly across different CAH subtypes, remain incompletely defined. The aim of this study was to evaluate the prevalence and determinants of hypertension in patients with CAH. Material and Methods: This retrospective, single-center study included 143 children and adolescents aged 1–21 years with a confirmed diagnosis of CAH who were followed at a tertiary pediatric center. Blood pressure measurements obtained during routine outpatient visits were evaluated according to age-, gender-, and height-specific pediatric reference values. Patients were classified by CAH subtype, and demographic, clinical, and treatment-related characteristics were compared between patients with and without hypertension. Correlations between blood pressure levels and clinical parameters were analyzed. Results: A total of 143 patients with CAH (female-to-male ratio, 1.38) were included, with a median follow-up duration of 111.33 months (IQR; 144.70). Hypertension was diagnosed in 15 patients (10.5%). The prevalence of hypertension differed significantly according to CAH subtype (p<0.001), with the highest rate observed in patients with 11β-hydroxylase deficiency (88.8%), followed by those with 21-hydroxylase deficiency (8.4%). No cases of hypertension were observed in other CAH subtypes. Patients with hypertension received significantly higher hydrocortisone doses compared with normotensive patients (p=0.012), while fludrocortisone dose did not differ between groups. Blood pressure levels showed strong correlations with age at last visit and moderate correlations with follow-up duration and body mass index. Hypertensive cardiomyopathy was detected in 40% of hypertensive patients and was more frequent in those with 11β-hydroxylase deficiency. Conclusion: Hypertension is a relevant clinical finding in children with CAH and is closely associated with disease subtype, particularly 11β-hydroxylase deficiency. Long-term follow-up, regular blood pressure monitoring and careful evaluation of glucocorticoid exposure may be important for cardiovascular risk assessment in this population.
The changing etiology of NICU-Admitted neonatal viral pneumonia: A multiplex RT-PCR era snapshot
Objective: Viral pathogens are an important cause of lower respiratory tract infection (LRTI) leading to hospitalization in neonates and young infants. This study evaluated the etiologic distribution, clinical course, and management of multiplex RT-PCR–confirmed LRTI among neonatal intensive care unit (NICU) admissions. Materials and Methods: Between September 2022 and November 2023, neonates admitted to the NICU with LRTI and a positive respiratory viral panel (multiplex RT-PCR) were retrospectively analyzed (n=44). Disease severity at admission was assessed using the Downes score. Demographics, seasonality, respiratory support, treatments, and outcomes were recorded. Correlations between Downes score, oxygen requirement (FiO₂), and length of stay were examined. Results: Median age at admission was 17 days (range: 1–45). Admissions peaked in January (29.5%) and November (18.1%). The most common presenting findings were respiratory distress/tachypnea, cough, and feeding difficulties. Median Downes score was 2 (range: 1–8) and median FiO₂ requirement was 31% (range: 25–45%). Respiratory support was required in 32 infants: mechanical ventilation in 11.4% (n=5), non-invasive ventilation in 22.7% (n=10), and supplemental oxygen in 38.6% (n=17). The most common agents were SARS-CoV-2 (n=22; 50%) and respiratory syncytial virus (RSV) ( n=14; 31.8%). Downes score correlated positively with FiO₂ (r=0.39, p=0.008) and length of hospital stay (r=0.42, p=0.004). Oseltamivir was administered to three infants with influenza. Median length of stay was 6 days (range: 2–56) and no mortality occurred. Conclusion: In this multiplex RT-PCR era snapshot, SARS-CoV-2 and RSV predominated among NICU-admitted neonates and young infants with viral LRTI. Management was primarily supportive, and admission Downes score may help anticipate oxygen requirement and hospitalization duration.
Transcatheter atrial septal defect closure in children weighing ≤15 kg: A single-center experience
Objective: The aim of this study was to assess the feasibility, safety, and outcomes of transcatheter atrial septal defect (ASD) closure in children weighing ≤15 kg, a group in whom transcatheter intervention is often deferred due to limited evidence and perceived procedural risks. Materials and Methods: This retrospective single-center study included 34 children weighing ≤15 kg who underwent transcatheter ASD closure. Demographic, echocardiographic, procedural, and post-procedural follow-up data were analyzed. Results: The mean age was 4.14±1.16 years, and the mean ASD diameter on transthoracic echocardiography was 10.41± 2.96 mm. The median balloon-sized ASD diameter was 14.30 mm (IQR: 12–17). All procedures were performed using Amplatzer Septal Occluder devices, with a 100% procedural success rate. The mean pulmonary artery pressure was 19.50±5.01 mmHg, and median pulmonary vascular resistance was 0.97 Wood units (0.44-1.20). A transient episode of supraventricular tachycardia occurred in one patient (2.94%), with no device embolization or other major complications observed. In most patients, right ventricular dimensions normalized and no residual shunt was observed by the first postoperative day. Conclusion: Transcatheter ASD closure in carefully selected children weighing ≤15 kg appears to be a safe and effective procedure, achieving high procedural success and low complication rates comparable to those observed in heavier patients. Early right ventricular remodeling and the absence of major adverse events further support the feasibility of this approach in appropriately selected cases.
A comprehensive clinical and microbiological profile of culture-positive urinary episodes in children with acute lymphoblastic leukemiaurinary leukemia
Objective: This study aimed to assess the frequency, causative microorganisms, antimicrobial resistance patterns, and unusual clinical and laboratory findings of culture-positive urinary episodes throughout the entire chemotherapy course in pediatric patients with Acute Lymphoblastic Leukemia (ALL). Material and Methods: We reviewed the medical records of 93 pediatric ALL patients who completed BFM-based chemotherapy protocols between 2019 and 2025. A total of 1265 urine cultures were analyzed. Culture positivity was defined as ≥105 colony-forming units per milliliter (CFU/mL) of a single or two different pathogens. For retrospective analysis, contamination was defined by a negative control culture within 48–72 hours or clinical resolution without antibiotic treatment. Data on urinalysis, neutropenia status, and antibiotic resistance were collected. Results: Forty-eight patients (51.6%) experienced a median of two culture-positive episodes. Incidence was highest during intensive treatment phases (induction, reinduction). Escherichia coli was the most common agent (39.8%), followed closely by Klebsiella pneumoniae (36.7%). Overall ESBL positivity was 26.6%. A concerning 30.6% of K. pneumoniae isolates showed carbapenem resistance. Standard urinalysis was found to be unreliable, with 71.4% of positive cultures lacking typical findings; leukocyturia was only present when the absolute neutrophil count was relatively preserved. Three cases of urosepsis (3%) were identified, all involving highly resistant organisms. Conclusion: Pediatric ALL patients, particularly during intense chemotherapy, face a high burden of culture-positive urinary episodes and a notable shift towards multidrug-resistant non-E. coli pathogens like K. pneumoniae. The unreliability of standard urinalysis in this immunocompromised population necessitates the routine collection of urine cultures during febrile neutropenia workups, irrespective of symptoms, to ensure timely, targeted therapy guided by local resistance data. The observed extreme resistance profile appears to be a transient reflection of the intensive chemotherapy environment.
Bronchoalveolar lavage: A key tool in pulmonary fungal infection management
Objective: Bronchoalveolar lavage (BAL) is a widely used diagnostic tool for evaluating lower respiratory tract infections and pulmonary pathologies in children. BAL provides valuable diagnostic information and can significantly influence management strategies, particularly in patients with malignancy, immunodeficiency (ID), or critical illness. This study aimed to assess the diagnostic and therapeutic value of BAL in pulmonary fungal infections. Material and Methods: This retrospective study analyzed BAL samples obtained by flexible fiberoptic bronchoscopy (FFB) between 2019 and 2024 in the Pediatric Pulmonology Department of a tertiary referral center. Among 668 patients who underwent FFB, those with BAL fungal culture, BAL Aspergillus DNA PCR, and BAL galactomannan antigen (GM) testing were included. Demographic, clinical, radiological, and bronchoscopic findings, as well as antifungal treatment modifications based on BAL results, were evaluated. Results: BAL results from 668 patients were reviewed. Fungal culture was performed in 236 (35.3%), Aspergillus DNA PCR in 127 (19%), and GM in 121 (18.1%) patients. Among those tested for fungal culture, 58.9% were male, with a mean age of 7.0 years (±5.7). Fungal culture positivity was found in 26 (11%) patients: Candida albicans (n=14), Aspergillus spp. (n=5), Candida dubliniensis (n=3), Aspergillus fumigatus (n=3), and Penicillium spp. (n=1). Culture positivity was significantly higher in patients with malignancy (p=0.011). BAL Aspergillus DNA PCR was positive in two patients, and BAL GM in five. Based on BAL results, antifungal therapy was modified in seven patients. Conclusion: BAL fungal culture, BAL GM, and Aspergillus PCR testing are valuable diagnostic tools for pulmonary fungal infections in children, especially those with malignancy or immunodeficiency (ID). The observed treatment modifications following BAL results emphasize their clinical importance not only in establishing diagnosis but also in guiding and optimizing antifungal therapy.
Radiological evaluation of Chiari 1 malformation: Diagnostic findings and postsurgical imaging
Objective: Chiari 1 malformation is a congenital anomaly characterized by downward displacement of the cerebellar tonsils through the foramen magnum. Surgical decision-making in Chiari 1 largely depends on clinical symptoms and imaging findings, particularly the presence of headache and syringohydromyelia. This study aimed to evaluate the radiological characteristics and postoperative imaging changes in pediatric patients with Chiari 1 and Chiari 1.5 malformations. Material and Methods: This retrospective study included 101 pediatric patients (age range; 1–18 years) diagnosed with Chiari 1 or Chiari 1.5 based on brain and cervical spine MRI findings between November 2022 and April 2025. Clinical and radiological data, including tonsillar descent, syringomyelia, craniovertebral junction anomalies, and basal angle measurements were analyzed. Twenty-one patients underwent posterior fossa decompression and postoperative MRIs were evaluated at 3 and 6 months. Statistical analyses were performed using chi-square, Mann–Whitney U, Wilcoxon signed-rank, and McNemar tests, with p <0.050 considered significant. Results: Among the 101 patients, 52 (51%) were female, and 49 (49%) were male (mean age; 11.1±4.9 years). Headache was significantly more frequent in operated patients (66.7% vs. 32.5%, p=0.014). Syringomyelia was also more common in the surgical group (33.3% vs. 3.8%, p <0.001), and tonsillar descent was greater (14.3±5.3 mm vs. 9.5±3.6 mm, p<0.001). No significant differences were found between the groups regarding age, sex, basal angle, or foramen magnum diameter. Postoperative follow-up revealed regression of syrinx dimensions and clinical improvement in all operated patients. Conclusion: Headache, syrinx formation, and greater tonsillar descent are key radiological and clinical predictors of surgical intervention in pediatric Chiari 1. While craniovertebral junction anomalies and hydrocephalus may coexist, they appear less predictive of surgical necessity. Posterior fossa decompression remains a safe and effective treatment in symptomatic pediatric patients, leading to both clinical and radiological improvement.
Anxiety disorder of hypertensive children and burnout levels of their families
Objective: Our study focused on assessing the anxiety levels of children and adolescents being monitored for hypertension (HTN), as well as the burnout levels experienced by their caregivers. Material and Methods: The study included 67 patients, aged 12 and older, who were monitored for HTN as the study group, and 60 children and adolescents, matched for gender and age, without chronic illnesses, were selected from the pediatric outpatient clinic for routine check-ups to serve as the control group. The State Anxiety Inventory (STAI-1), Trait Anxiety Inventory (STAI-2), and Beck Anxiety Inventory (BAI) were applied to the children, while the Maslach Burnout Inventory (MBI) was applied to their parents. Results: We found the mean STAI-1 scores of the study group lower than the control group (43.6±6.4 vs. 51.6±15.4; p <0.001). However, no difference was detected between these groups in terms of the STAI-2 scores (p= 0.140). The median BAI scores were higher in study group than control group (10.0 vs.6.5; p=0.010) but no significant difference have been found in terms of severity of anxiety (p=0.170). There was no difference in caregivers between the emotional exhaustion (MBI-EE) and personal accomplishment (MBI-PA) subscale scores of the MBI of the caregivers (p=0.280, p=0.340 respectively). Conclusion: Our study revealed low anxiety levels among HTN patients and low burnout scores in their families. However, we believe that continuous psychiatric support for both patients and their families may be essential for managing chronic conditions, indicating the need for further research in this area regard.
Recurrent isolated torsion of fallopian tube in premenarcheal 12-year-old girl
Isolated torsion of the fallopian tube is an uncommon event. It is a difficult condition to evaluate clinically and surgery is often necessary to establish the diagnosis. In this case report, a 12 year old female isolated fallopian tube torsion (ITT) -a rare condition in the pediatric age group requiring laparoscopic surgery due to recurrance- is presented with acute pelvic pain, nausea, and vomiting. A diagnostic laparoscopy was performed which confirmed the diagnosis of isolated tubal torsion. Based on this experience as well as other similar reported cases, isolated torsion of the fallopian tube should beconsidered in the differential diagnosis of acute lower abdominal/pelvic pain in the female patient. Prompt surgical intervention may allow for preservation of the tube.
Prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis
Objective: Seasonal allergic rhinitis (SAR) is one of the most common allergic diseases in childhood and is characterized by nasal congestion, rhinorrhea, sneezing, and itching. Beyond these classical nasal symptoms, SAR may also be associated with sleep disturbances. The present study aimed to determine the prevalence of sleep disturbances in children with SAR and to evaluate potential clinical predictors, including symptom severity, symptom timing, and comorbid allergic diseases. Material and Methods: Children aged 6–16 years with seasonal allergic rhinitis (SAR) who were followed at the Pediatric Allergy and Immunology Department of Ankara City Hospital were enrolled in the study. An age- and demographically matched control group was also recruited. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC). SAR severity was classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines, and symptom intensity was further evaluated using a visual analog scale (VAS). Logistic regression analysis was performed to identify independent predictors of SDSC-defined sleep disturbances. Results: A total of 115 children with SAR (mean age: 11.6±3.2 years; 61.7% male) and 115 healthy controls were included. According to SDSC, 43.3% of children with SAR had clinically significant sleep disturbances. Compared with controls, children with SAR had significantly higher SDSC total scores (63.4±15.5 vs. 53.9±12.2; p < 0.001) and higher scores across all subscales. In multivariate logistic regression, an elevated nasal VAS score remained an independent predictor of sleep disturbances (OR: 1.86; 95% CI: 1.06-2.41; p=0.020). Conclusion: Sleep disturbances were more prevalent in children with SAR than in healthy controls, and greater nasal symptom severity was independently associated with impaired sleep quality. Incorporating routine sleep quality assessment into the clinical evaluation of children with SAR may improve disease management and contribute to better overall quality of life.
Feeding problems in preterm infants: Associations with perinatal risks and development
Objective: This study aimed to examine behavioral feeding difficulties in preterm infants compared with term infants and to explore how perinatal risk factors, birth weight, and developmental outcomes are associated with feeding problems in preterm infants. Material and Methods: A total of 107 infants aged 18–24 months were included, comprising 60 preterm and 47 term infants. Feeding behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and developmental status was evaluated with the Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III). Preterm infants were further classified as small (SGA), appropriate (AGA), or large (LGA) for gestational age and perinatal risk levels were based on National Neonatology Association guidelines. Results: Sociodemographic characteristics were comparable between groups. No significant differences were observed between preterm and term infants across any BPFAS domains, although preterm infants tended to show slightly higher scores. Within the preterm group, Bayley-III composite and subscale scores were not correlated with BPFAS outcomes. However, SGA infants demonstrated significantly higher total frequency, total problem, and poor strategies scores than their AGA and LGA peers (p = 0.021, p=0.023, p=0.032, respectively). BPFAS scores did not differ significantly by perinatal risk classification, though higher values were consistently observed in the high-risk group. Conclusion: Feeding difficulties in preterm infants likely result from the interplay of biological, developmental, and environmental factors. Within this context, SGA infants may be particularly susceptible, with potential implications for later growth and metabolic health. Early identification and holistic, multidisciplinary follow-up that integrates nutritional, developmental, and family-centered care are essential to support healthy feeding patterns and prevent long-term complications.
Social pediatrics internship students’ perspectives on the Covid-19 pandemic’s effects on children
Objective: Social pediatrics evaluates children’s health within the context of society, environment, education, and family, employing a global, holistic, and multidisciplinary approach to child health. Our study aimed to explore the viewpoints and attitudes of fifth-year medical students who completed the Social Pediatrics Internship Education Program regarding the effects of the COVID-19 pandemic on children. Material and Methods: We asked medical students to write about the most common effects of the COVID-19 pandemic on children from their perspective using a Google Form. Subsequently, we employed both quantitative and qualitative methodologies to analyze the responses provided by the medical students. Results: Overall, 246 students voluntarily participated in the study and wrote a total of 1722 items. The medical students predominantly addressed the impact of the COVID-19 pandemic on various facets of children’s well-being, including development, physical activity, community/social dynamics, physical health, mental health, safety, healthcare access and provision, and infectious diseases. Conclusion: This study highlights the ability of medical students who undertook the Social Pediatrics programme to demonstrate empathy and adopt a social pediatrics perspective when examining the impact of COVID-19 on children.
Pediatric unintentional injuries in emergency care: A three-year retrospective study from a tertiary care center
Objective: Pediatric unintentional injuries are a major public health concern, as most are preventable. This study aimed to assess emergency department cases by etiology, demographics, seasonal distribution, and outcomes, to define the regional profile and guide prevention. Material and Methods: This retrospective study included 2524 children aged 0–18 years admitted with unintentional injuries between January 2021 and June 2024. Cases were classified as trauma, poisoning/aspiration, environmental injuries, or other causes. Results: Of the cases, 1454 (57.6%) were male, median age 47 months. Poisoning/aspiration was most common (n=1153; 45.6%), followed by trauma (n=840; 33.2%), environmental injuries (n=473; 18.7%), and others (n=62; 2.4%). Poisonings predominated in 0–5 years, while trauma was more frequent in adolescents. Leading poisoning causes were drugs (n=516; 20.4%) and corrosives (n=441; 17.5%). Carbon monoxide poisoning was notable among environmental injuries (n=267; 10.6%). Most patients were discharged (80.6%), while 14.5% were hospitalized, 3.7% required intensive care, and 5.5% underwent surgery. Mortality and sequelae were each 0.3%. Seasonal variation was evident: poisonings in spring–summer, trauma in summer–autumn, and carbon monoxide in winter. Conclusion: Poisonings were the leading cause in early childhood, while trauma predominated in adolescents. Preventive strategies, including parental education, household safety, and region-specific policies, are essential to reduce morbidity and mortality.
Bowel habit changes in children with PFAPA Syndrome: Before and after treatment evaluation with the Bristol Stool Scale
Objective: Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome is one of the most common autoinflammatory diseases of childhood. Although gastrointestinal system (GIS) complaints are reported, bowel habits have not been objectively evaluated in these patients. This study investigated changes in bowel habits before and after treatment in children with PFAPA using the Bristol Stool Scale and daily stool frequency. Materials and Methods: We included 101 children diagnosed with PFAPA according to the EUROFEVER/PRINTO criteria. Clinical, laboratory, daily stool frequency, and stool form were evaluated during febrile attacks before and after treatment. Stool form was evaluated using the Bristol Stool Scale and classified as hard (types 1–3), normal (type 4), and loose (types 5–7). Results: Following treatment, median daily stool frequency during attacks decreased (2 [0.25–10] vs. 1 [0.25–6]; p=0.008), while stool form assessed by the Bristol Stool Scale remained unchanged (4 [1–7] vs. 4 [1–7]; p=0.943). No significant difference was observed in stool consistency categories (p=0.174). In the probiotic group, patients with normal stool form increased from 53.6% (n=15) pre-treatment to 57.1% (n=16) post-treatment. Conclusion: To our knowledge, this study is the first to objectively evaluate bowel habits in children with PFAPA syndrome. Following treatment, stool frequency during episodes decreased significantly, while stool form remained unchanged. These results indicate that post-treatment alterations in bowel habits are primarily related to stool frequency. Future studies incorporating fecal biomarkers may provide further insights into gastrointestinal involvement and potential subclinical intestinal inflammation in PFAPA.
Clinical and laboratory characteristics of nephropathic cystinosis in a resource-limited region
Objective: Cystinosis remains a significant cause of morbidity in developing countries. Key challenges include limited access to specialized clinics, availability of cysteamine treatment, and difficulties in monitoring treatment efficacy, such as measuring leukocyte cystine levels. The aim of this study was to describe the clinical characteristics, growth patterns, and renal outcomes of pediatric patients with nephropathic cystinosis in a resource-limited region Material and Methods: This retrospective study included 17 patients diagnosed with cystinosis who were followed in the Pediatric Nephrology Clinic of a tertiary care center between June 2016 and April 2023. Clinical and laboratory characteristics were evaluated, and statistical analyses were performed using IBM SPSS Statistics. Results: After a median follow-up period of 69.24 months, no significant change was observed in weight SDS ((median [IQR]; baseline vs. follow-up; -3.6 [1.35] vs. -2.8 [1.55], p=0.255). However, height SDS significantly decreased (median [IQR]; baseline vs. follow-up; -2.8 [2.44] vs. -3.9 [2.35], p=0.034). Ocular involvement was present in all patients, and six were diagnosed with hypothyroidism. The majority of patients (n=9) exhibited biochemical features consistent with renal Fanconi syndrome. One patient initially presented with persistent hypochloremic hypokalemic metabolic alkalosis and subsequently developed Fanconi syndrome during follow-up, while another showed transient metabolic alkalosis at presentation. The median estimated glomerular filtration rate (eGFR) significantly declined from diagnosis (116.66 [62.69] mL/min/1.73 m²) to the last follow-up (77.40 [95.18] mL/min/1.73 m², p=0.007). Twelve patients had an eGFR <90 mL/min/1.73 m²; three progressed to stage 3 chronic kidney disease, and three required renal replacement therapy. Conclusion: Growth retardation and progression to chronic kidney disease are significant challenges for cystinosis patients in resource-limited settings. Improving access to specialized care and monitoring is essential to enhance patient outcomes.
Pediatric syncope: Clinical and demographic findings from a neurological outpatient cohortneurological cohort
Objective: Syncope, a temporary loss of consciousness caused by cerebral hypoperfusion, is often benign but can signal serious neurological or cardiac issues. We retrospectively analyzed pediatric syncope cases in this study. Material and Methods: We analyzed 514 patients aged 6–18 years who presented with syncope to a pediatric neurology outpatient clinic. Results: Most patients (36.7%) had a single episode, though recurrent cases were also common. The primary triggers were prolonged standing (17.2%) and sudden postural changes (14.4%). Prodromal symptoms such as dizziness, visual disturbances, and nausea were reported in 69.5% of cases. Electroencephalography (EEG) was performed in 72.2% of patients, revealing epileptiform activity in 27 individuals. EEG requests increased significantly in patients with recurrent syncope episodes (p<0.010). Cranial MRI was performed in 37.5% of the patients, and abnormalities were detected in 16.6%, most commonly arachnoid cysts. However, no statistically significant correlation was found between MRI utilization and the frequency of syncope episodes. Final diagnoses were predominantly vasovagal syncope (75.6%), followed by psychogenic syncope (10.3%), seizures (8.75%), cardiogenic syncope (4.5%), and hypoglycemia (0.85%). Conclusion: These results highlight the mostly benign nature of pediatric syncope, with vasovagal syncope as the most frequent diagnosis. EEG is useful for identifying underlying epilepsy, while neuroimaging should be reserved for selected cases.
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Retrospective cross-sectional analysis of Vitamin D deficiency in pediatric patients: Clinical findings from a tertiary care centerpediatric center
Objective: The 25-Hydroxyvitamin D (25(OH)D) deficiency is a prevalent global health concern, particularly among children, leading to conditions such as rickets and increasing the risk of respiratory infections and chronic diseases. Contributing factors include limited sun exposure, poor dietary intake, and growth demands. This study aimed to assess the clinical and laboratory characteristics of pediatric paients with 25-Hydroxyvitamin D (25(OH)D) deficiency at our clinic. Material and Methods: This retrospective study was conducted at a tertiary care center in İstanbul, Türkiye, including pediatric patients diagnosed with 25-Hydroxyvitamin D (25(OH)D) deficiency between January 2020 and December 2023. Data on sociodemographic, medical history, symptoms, physical examinations, and laboratory results were extracted from electronic medical records. Patients with 25-Hydroxyvitamin D levels below 20 ng/mL were classified as deficient. Correlation analyses were employed to assess the associations between 25-Hydroxyvitamin D (25(OH)D) levels and clinical factors. The study was approved by the Istanbul Medipol University Ethical Review Board. Results: A total of 5229 pediatric patients with 25-Hydroxyvitamin D (25(OH)D) deficiency or insufficiency were included in the study, with a slight female predominance (51%). The highest frequency of deficiency was observed among children aged 2 to 3 years. Symptom-onset complaint records were retrospectively reviewed. The most commonly documented complaints at presentation were fatigue (30.75%), followed by non-specific or asymptomatic presentations (28.95%). Given the retrospective design of the study, these symptoms may not be specific to 25-Hydroxyvitamin D (25(OH)D) deficiency and could be attributable to other concurrent conditions. Notably, in several cases, 25-Hydroxyvitamin D (25(OH)D) deficiency was detected incidentally during medical evaluations performed for unrelated reasons. Conclusion: 25-Hydroxyvitamin D (25(OH)D) deficiency is a common condition in childhood and may present with a wide range of symptoms or remain asymptomatic. Early detection is crucial, particularly in at-risk groups such as toddlers and children with limited sun exposure. Clinicians should be aware of the non-specific nature of symptoms and consider 25-Hydroxyvitamin D (25(OH)D) status in routine pediatric evaluations. Broader awareness and preventive strategies are needed to reduce the clinical burden of this silent but prevalent deficiency.
First aid knowledge among caregivers of children receiving home health care
Objective: Parents of children receiving home health care must possess adequate first aid knowledge to manage emergencies effectively. This study aimed to assess the level of first aid knowledge among caregivers of pediatric patients receiving home health care and to identify factors associated with knowledge gaps. Materials and Methods: This cross-sectional study was conducted with 66 caregivers of children aged 1 month-18 years registered at the Home Health Services Unit of Prof. Dr. Cemil Tascioglu City Hospital between November 2024 and February 2025. Data were collected through face-to-face interviews using a 20-item first aid knowledge questionnaire developed from a literature review. Demographic and clinical characteristics were recorded. Results: The average first aid knowledge score was 8.18±4.88 (range: -4 to 18), indicating a 39.0% success rate. Most participants were mothers (86.4%) with elementary or middle school education (65.2%). Significant positive correlations existed between first aid knowledge and both education level (rho=0.290, p=0.019) and age group (p=0.030), with caregivers aged 35-45 showing higher knowledge scores than those aged 18-25 (p=0.015). Critical gaps in knowledge were seen in poison control hotline awareness (4.5%), fall-from-height intervention (16.7%), and unconscious child assessment (27.3%). Despite low knowledge levels, 87.9% of participants were willing to receive first aid training. Conclusion: Caregivers of children receiving home health care show inadequate first aid knowledge, especially in critical emergencies. Lower education levels and younger age are linked to reduced knowledge. The strong motivation for training among caregivers offers a chance for targeted educational efforts. Urgent, comprehensive, and customized first aid training programs are necessary, particularly for caregivers of medically complex children using specialized medical devices.
The hidden costs of seizure control: Metabolic and hormonal effects of anti-seizure medications in children
Objective: This study aimed to evaluate the metabolic and hormonal effects of anti-seizure medications (ASMs) in children with epilepsy by comparing serum levels of vitamin D, calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), vitamin B12, folate, thyroid-stimulating hormone (TSH), and free thyroxine (fT4) between ASM-treated patients and healthy controls. A secondary aim was to investigate differences between patients treated with valproate (VPA) and those treated with levetiracetam (LEV). Materials and Methods: A total of 106 pediatric epilepsy patients undergoing ASM therapy were included in the study, with 93 on monotherapy and 13 on polytherapy for at least six months. Additionally, 80 age- and sex-matched healthy controls were included. Serum biochemical parameters were analyzed retrospectively. Subgroup analyses compared patients on VPA and LEV monotherapy. Statistical comparisons and correlation analyses assessed relationships between drug exposure and biochemical values. Results: Vitamin D levels were significantly lower in ASM-treated patients compared to controls (p<0.001). TSH levels were higher in the VPA group than in the LEV group (p<0.001), although there were no significant differences in thyroid hormone levels between ASM-treated patients and the healthy control group overall. No significant differences were observed in calcium, phosphorus, ALP, vitamin B12, or folate levels between the groups. The duration of ASM use was not correlated with any of the biochemical parameters. Conclusion: Vitamin D deficiency and changes in thyroid function may occur in children treated with ASMs, especially VPA. However, vitamin B12 and folate levels tend to stay stable. Given the ongoing fluctuations in vitamin D and thyroid hormone levels, more frequent monitoring of these parameters may be warranted in pediatric epilepsy patients on ASM therapy. In contrast, less frequent assessment of vitamin B12 and folate may be enough unless there are clinical reasons to test further. More prospective studies are needed to determine the best monitoring approaches.
Risk factors and outcomes of neonatal progressive hydrocephalus: A retrospective analysis
Objective: Hydrocephalus is a complex neurological disorder affecting the central nervous system, which can lead to severe neurodevelopmental complications despite early diagnosis and treatment. Although advances in diagnostic and therapeutic methods have been achieved, managing hydrocephalus remains challenging. Neural tube defects are among the most common causes of hydrocephalus, highlighting the importance of prenatal diagnosis. Treatment often involves surgical intervention, making imaging techniques and timely surgical management critical. This study aimed to investigate the risk factors, etiologies, and treatment outcomes of neonates diagnosed with hydrocephalus. Material and Methods: A retrospective study was conducted on neonates diagnosed with hydrocephalus and followed at Ankara Bilkent City Hospital Neonatal Intensive Care Unit between September 2019 and January 2023. Neonates who died in the delivery room or during transfer, whose records were incomplete, or whose families were unreachable were excluded. Clinical, demographic, and treatment data were obtained from hospital records and analyzed. Results: Out of 115 patients screened, 104 met the inclusion criteria. Of these, 42% were born prematurely. The prevalence of congenital hydrocephalus was 74%, post-hemorrhagic hydrocephalus 24.1%, and post-infectious hydrocephalus 1.9%. Female infants comprised 58.7% of cases, and 87.5% were delivered via cesarean section. Among mothers, 42.5% reported regular folic acid intake during pregnancy. Parental consanguinity was noted in 24.5% of cases. Additional anomalies were present in 74% of patients, with 67.3% receiving an antenatal diagnosis. Epilepsy was observed in 36.5% of patients, and 39.9% of these were treated with antiepileptic drugs. Ventriculoperitoneal shunts were placed in many patients, with 44.7% requiring shunt revision, predominantly due to infection (33.7%). Referral cases accounted for 17.3%, mostly post-hemorrhagic hydrocephalus, with a 72% epilepsy rate and 25.3% antiepileptic treatment initiation in this subgroup. Conclusion: This study provides comprehensive insights into the epidemiology, familial risk factors, etiological profiles, and treatment outcomes of progressive hydrocephalus diagnosed antenatally or postnatally. The findings offer valuable data to inform improved diagnostic and therapeutic strategies for neonates affected by hydrocephalus.
Evaluation of awareness and knowledge levels of pediatric residents on brucellosis
Objective: Brucellosis, endemic in Türkiye, requires physicians’ awareness for early recognition, diagnosis, and treatment. This study aimed to assess pediatric residents’ knowledge and awareness of brucellosis. Material and Methods: Between August and September 2023, pediatric residents with 0–48 months of training at Ankara Bilkent City Hospital were surveyed using an online 15-item, cross-sectional, multiple-choice questionnaire covering demographics, clinical findings, diagnosis, treatment, and prophylaxis. Each item included four response options reflecting different diagnostic or therapeutic approaches. Incomplete or unsubmitted forms were excluded. Results: A total of 174 residents participated (73% female). Of these, 84 (48.3%) were senior and 90 (51.7%) junior. Senior residents had significantly higher correct response rates than juniors regarding complications (88.1% vs. 83.3%), clinical symptoms (91.1% vs. 70.2%), laboratory findings (77.8% vs. 58.3%), diagnostic serology (52.2% vs. 28.6%), magnetic resonance imaging (MRI) for sacroiliitis (83.3% vs. 65.5%), antibiotic combinations (72.2% vs. 50.0%), and treatment of spondylitis (47.8% vs. 23.8%) (p<0.050 for all). Knowledge improved progressively with residency year (linear-by-linear association, p<0.001). Conclusion: Senior residents demonstrated significantly greater knowledge of brucellosis compared to juniors. These results emphasize the importance of structured, continuous education that begins early in residency and is reinforced periodically. Given the endemic nature of brucellosis in Türkiye, targeted and regularly updated training programs for pediatric residents may improve recognition, diagnostic accuracy, appropriate treatment, and clinical outcomes. Future multi-center studies may better reflect regional differences in awareness and training.
Clinical characteristics and outcomes of invasive pneumococcal disease in neonates: A retrospective study
Objective: Invasive pneumococcal disease (IPD) is a rare but serious cause of neonatal sepsis associated with significant morbidity and mortality. Despite widespread pneumococcal conjugate vaccine (PCV) use in infants, neonates remain vulnerable due to lack of direct vaccination and potential vertical or horizontal transmission. This study aimed to characterize the clinical, laboratory, and microbiological features of neonatal IPD and to evaluate associated outcomes in this high-risk population. Material and Methods: We conducted a retrospective cross-sectional study of neonates (0–30 days old) diagnosed with IPD between September 2019 and April 2025. Diagnosis was confirmed by isolation of Streptococcus pneumoniae from sterile body fluids or PCR detection. Demographic, clinical, microbiological, and outcome data were analyzed. Results: Among 68 IPD cases, 12 neonates with pneumococcal bacteremia were identified; no meningitis or focal infections were observed. The cohort had equal sex distribution, mean gestational age of 35±3.8 weeks, and 33.3% had comorbidities. Early-onset sepsis (≤72 hours) accounted for 25% of cases, with the remainder presenting as late-onset sepsis (>72 hours). One neonate had concurrent SARS-CoV-2 infection. All patients survived; one preterm infant developed neurological sequelae attributable to pre-existing conditions. Antibiotic susceptibility testing showed reduced sensitivity to penicillin (20%) and ceftriaxone (16.7%), while vancomycin and linezolid remained highly effective. Conclusion: Neonatal invasive pneumococcal bacteremia, although uncommon, continues to pose clinical challenges, particularly due to evolving antimicrobial resistance. Our findings emphasize the importance of vigilant clinical monitoring and tailored antimicrobial therapy in this vulnerable population. Continued surveillance and prospective studies are warranted to assess the impact of maternal and early infant vaccination strategies on neonatal IPD prevention.
Recurrent pericarditis in children: Clinical findings and outcomes
Objective: In this study, we aimed to evaluate the clinical findings and follow-up data of children with recurrent pericarditis (RP). Material and Methods: This study had a retrospective design and included pediatric patients with recurrent pericarditis evaluated between January 2017 to January 2023. The initial diagnosis of pericarditis was made according to the criteria determined in the European Society of Cardiology guideline. Results: We enrolled 16 children (14 males) with recurrent pericarditis with median age 12.8 (8 – 17) years. Eight patients (50%) presented with fever, pericardial effusion in 11 patients (68.7%). Pericardiocentesis was performed in 9 (56.2%) patients. The median erythrocyte sedimentation rate (ESR); C-reactive protein (CRP) levels at the time of diagnosis were 43 (25-70) mm/h and 107 (61-190) mg/dl, respectively. In total, 16 patients had 36 recurrences during follow-up. The main symptom during the relapses was chest pain, similar to that of the first attack. Four patients (25%) had a history of previous cardiac surgery. Three patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) only. NSAID and colchicine were administered to 13 patients. One patient received corticosteroid and one patient received anakinra treatment. Conclusion: Patients with recurrent pericarditis in childhood have an autoinflammatory phenotype. Furthermore, successful management of patients with recurrent pericarditis requires a teamwork approach involving cardiologists, rheumatologists and clinical immunologists.
Self-esteem and depressive symptom levels in adolescents with Type 1 Diabetes
Objective: This study aimed to examine self-esteem and depressive symptom levels in adolescents with Type 1 Diabetes, shedding light on the impact of living with a chronic illness on adolescent mental health. Material and Methods: The study population consisted of patients followed in the Pediatric Endocrinology Outpatient Clinics of three Educational and Research Hospitals located on the Anatolian side of Istanbul between September 2023 and November 2023. The sample consisted of 202 adolescents aged 13-18 who met the inclusion criteria and agreed to participate in the study. Data were collected using the “Personal Information Form,” “Coopersmith Self-Esteem Inventory (CSEI),” and the “Adolescent Quick Depressive Symptom Inventory (AQ-DSI-17-SF).” Data were analyzed using the SPSS for Windows 26.0 software package. Results: The results of this study revealed that the self-esteem levels of adolescents with Type 1 Diabetes were moderate (26.06±7.9), while their depressive symptom levels were mild (10.73±3.5). There was a negative correlation between HbA1c levels and CSEI scores (r = -0.228; p=0.001), and a statistically significant positive correlation between HbA1c levels and AQ-DSI-17-SF scores (r = 0.401; p=0.001). Conclusion: The findings indicate that the HbA1c levels of the adolescents who participated in the study were generally within the target range, reflecting a successful approach to disease management. In this context, it can be suggested that adolescents who manage their disease effectively are also able to maintain their psychological well-being in a healthier manner.
The relationship between body image, self-esteem, and body mass index in primary school children
Objective: With the increasing prevalence of childhood obesity, there is a growing interest in understanding how the ideal body image influence children’s self-perception and whether this may potentially lead to various psychological problems. Therefore, this study aimed to examine the relationship between body image, self-esteem, and Body Mass Index (BMI) in primary school children, to identify individuals at risk at an early stage. Material and Methods: The study sample consisted of 342 primary school children aged 6-12 years. The Sociodemographic Information, Children’s Body Image Scale (CBIS) and Children’s Rosenberg Self-Esteem Scale (CRSS) were used to gather data. Body weight and height were measured, and BMI was calculated. Data were analyzed using Chi-square, Mann–Whitney U, Kruskal–Wallis, Spearman correlation, and multiple linear regression tests. Results: BMI was moderately associated with perceived body image (r = 0.428; p < 0.001) and body dissatisfaction (r = 0.422; p < 0.001) but showed minimal correlation with self-esteem and age (CRSS: r = 0.011, p > 0.050; NSE: r = 0.002, p > 0.050; PSE: r = 0.014, p > 0.050; Age: r = 0.032, p > 0.050), while self-esteem measures did not significantly differ by body satisfaction status (CRSS: H = 0.599, p = 0.741; NSE: H = 0.293, p = 0.864; PSE: H = 0.950, p = 0.622). Regression analysis identified BMI (B = 0.094; 95% CI: 0.071–0.116; β = 0.411; p < 0.001) as the strongest predictor of body dissatisfaction, followed by age (B = 0.078; 95% CI: 0.006–0.150; β = 0.106; p = 0.035), whereas other sociodemographic and psychological variables, including gender (B = 0.199; p = 0.122) and selfesteem (NSE: B = −0.022, p = 0.368; PSE: B = 0.023, p = 0.469), did not significantly predict dissatisfaction levels. Conclusion: BMI has a significant influence on body image perception in primary school-aged children, whereas self-esteem appears to be less affected by body satisfaction at this developmental stage. These results highlight the need for early, gendersensitive, and family-centered interventions to promote healthy body image.
Gender effect on dextranomer hyaluronic acid injection material durability: A rat bladder model
Objective: In failed cases treated with the endoscopic sub-ureteric injection method, no residue from the previous injection material was found during cystoscopy at the second injection. The clinical observation of an increased incidence of recurrent reflux in girls than in boys reminds us that bladder gender may influence the stability of the injection material. The aim of the study was to determine whether there is a gender-related difference in the durability of the subureteric injection material. Material and Methods: Twenty male and female Wistar-Albino rats were evenly divided into four groups. The experimental group received a submucosal injection of 0.1cc dextranomer hyaluronic acid copolymer (Dexell®) into the bladder. In addition, the control group received 0.1cc of 0.9% NaCl. Tissue hyaluronidase activity was measured biochemically using the ELISA method. The injection sites were assessed histopathologically and immunohistochemically with CD31 and CD34 Rabbit Monoclonal Antibodies. Results: Biochemically, tissue hyaluronidase activity in female groups was statistically significantly higher than in males. Histopathologically, there were no significant differences between the genders or between the experimental and control groups in relation to fibrosis formation. Regarding immunohistochemistry, angiogenesis was statistically significantly higher in all females, regardless of whether they were in the study or control group, compared to males. Concerning progenitor cell activity, there is no difference between the genders, whereas the difference between the study and control groups was significant. Conclusion: Biochemically, higher hyaluronidase activity in the female rat bladder may cause a faster breakdown of the hyaluronic acid compound in the injection material. The high permeability of inflammatory cells in the female rat bladder, as detected histochemically, may accelerate the destruction process with the aid of lytic enzymes in these cells.
Etiology and clinical features of hypertransaminasemia in children: A retrospective study from a tertiary care center in Türkiye
Objective: This study aimed to investigate the etiology of hypertransaminasemia in children and to evaluate the clinical characteristics of patients based on age and underlying causes. Material and Methods: A total of 210 pediatric patients aged between 1 month and 18 years who presented to the Pediatric Gastroenterology Outpatient Clinic with hypertransaminasemia were retrospectively analyzed. Hypertransaminasemia was defined as AST >50 IU/L and ALT >45 IU/L on at least two separate occasions within two months. Results: The mean age of the patients was 5.36±5.30 years and 50.5% were female. At presentation, 30.5% were asymptomatic, with fever being the most common symptom (23.4%). Physical examination findings were normal in 53.8% of cases. Mean AST and ALT values were significantly higher in symptomatic patients compared to asymptomatic ones (p<0.001). No significant difference were observed between age groups in terms of mean ALT and AST values (p=0.290, p=0.190). Hypertransaminasemia was mild in 55.7% of patients, moderate in 20.5%, and severe in 23.8%. An underlying etiology was identified in 61% of cases. The most common cause was infectious diseases, followed by metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic/genetic disorders. Severe hypertransaminasemia was significantly more frequent in infectious diseases than in idiopathic cases or MASLD, whereas mild hypertransaminasemia was more common in MASLD and idiopathic cases compared to infections (p<0.001). Conclusion: Infectious diseases and MASLD remain the leading causes of hypertransaminasemia in children. Infectious etiologies contribute across all age groups, MASLD is strongly linked to obesity and adolescence. As elevated transaminase levels may be the only clinical clue, especially in asymptomatic patients with normal physical examinations, careful follow-up and comprehensive evaluation are essential to avoid potential complications.