Ankara Bilkent City Hospital, Children’s Hospital
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A comprehensive clinical and microbiological profile of culture-positive urinary episodes in children with Acute Lymphoblastic 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.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
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.
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.
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.
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 > 0.05; NSE: r = 0.002, p > 0.05; PSE: r = 0.014, p > 0.05; Age: r = 0.032, p > 0.05), 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 self-esteem (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, gender-sensitive, 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.
A 11-year retrospective analysis of intussusception cases in children
Objective: Intussusception is a prevalent etiology of emesis and abdominal discomfort in pediatric patients. This investigation sought to elucidate the correlation between epidemiological factors, clinical progression, diagnostic procedures, therapeutic interventions, and patient outcomes, with particular emphasis on the safety profile of hydrostatic reduction in subjects presenting with intussusception. Material and Methods: In this retrospective study, we analyzed the data of children who were diagnosed and treated for intussusception in the hospital database and the Picture Archiving and Communication Systems (PACS) from January 2013 to December 2023. Demographic data, symptoms at presentation, mode of diagnosis, treatment modality, and associated complications were also recorded. Results: Of the 165 patients, 60% were boys and 40% were girls, with a mean age of 35.5 years (1-193 months). Of the patients, 44.2% (n= 73) were presented within 24 hours of symptom onset. All patients had abdominal pain, and 24 (14.5%) had the classic triad of abdominal pain, vomiting, and red stools. Ultrasonography-guided hydrostatic reduction (USHR) and surgery resulted in a cure in 134 (93.3%) and 31 (6.7%) patients, respectively. The overall recurrence rate was 16.3%, with no mortality. There was a statistically significant difference between the length of the invaginated segment (4 cm or more) and USHR (p=0.004). Conclusion: The USHR of invagination is effective regardless of the duration of symptoms and number of recurrences.
Health literacy levels of adolescents and their parents visiting a pediatric outpatient clinic
Objective: This study aimed to assess the health literacy (HL) levels of adolescents and their parents attending the pediatric outpatient clinic of a training and research hospital and to evaluate the hypothesis that HL correlates with serum 25-hydroxyvitamin D3 levels, serum vitamin B12 (cobalamin) levels and sociodemographic characteristics. Material and Methods: This descriptive cross-sectional study included 302 adolescents aged 14 years and older, along with their parents, who attended the general pediatrics outpatient clinic of Haydarpaşa Numune Training and Research Hospital from November to December 2022. Data were collected using a sociodemographic information form, serum 25-hydroxyvitamin D3 levels, serum vitamin B12 levels of adolescents according to hospital records, the Hacettepe University Health Literacy Scale-Long Form (HU-HL) for parents, and the Adolescent e-Health Literacy Scale (eHEALS) for adolescents. Non-parametric statistical tests were used due to the non-normal distribution of the data. Results: The mean age of adolescents was 15.47±1.09 years, with 56% identified as female. The mean age of the parents was 44.49±5.02 years, with 84.8% being mothers. Among parents, 21.2% exhibited low HL levels, 57.3% shown moderate levels, and 21.5% displayed high levels. The average total score of eHEALS was 27.78±5.40. Female parents exhibited markedly superior HL scores compared to male parents (p=0.003). Serum 25-hydroxyvitamin D3 (25(OH)D3) levels, serum vitamin B12 (cobalamin) levels, as well as body mass index (BMI), exhibited no significant correlation with HL scores. Nonetheless, parents of female adolescents had markedly higher HL scores compared to those of male adolescents (p=0.013). Conclusion: Parents of female adolescents demonstrated significantly higher HL levels than those of male adolescents. These findings underscore the need for targeted interventions to address HL disparities among caregivers and adolescents. Future research should explore longitudinal and causal relationships between HL and biological as well as sociodemographic determinants.
Do hematologic parameters predict coronary artery involvement in children with Kawasaki disease? A retrospective study
Objective: Kawasaki disease (KD) is an acute systemic vasculitis of childhood that may lead to coronary artery involvement (CAI) if not promptly treated. Early identification of laboratory predictors for coronary complications is essential. This study aimed to identify early laboratory predictors of coronary complications in KD, to help clinicians assess risk during the acute phase. Material and Methods: We retrospectively analyzed 38 pediatric KD patients. Clinical and laboratory data—including hemoglobin (Hb), hematocrit (Htc), white blood cell count (WBC), platelet counts (PLT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), liver enzymes, and Harada scores—were collected and compared between patients with and without CAI. Receiver operating characteristic (ROC) and logistic regression analyses were performed. Results: The mean age was 35.0±32.6 months, with 65.8% male. CAI was observed in 16 of 38 patients (42.1%). No statistically significant differences were found in the laboratory values at diagnosis between patients with and without CAI. Conclusion: Routine hematological and inflammatory markers at admission were not predictive of CAI in KD. These findings highlight the need for high clinical suspicion in incomplete cases and suggest that incorporating clinical features and risk scores may improve early risk stratification.
C-reactive protein as a predictor of complication and hospital stay in pediatric appendicitis: Role of inflammatory biomarkers
Objective: Acute appendicitis (AA) is a leading cause of pediatric abdominal pain requiring surgical intervention. Differentiating simple appendicitis (SA) from complicated appendicitis (CA) preoperatively remains a clinical challenge. This study aimed to evaluate the diagnostic and prognostic utility of routinely available inflammatory markers—including C-reactive protein (CRP), fibrinogen, immature granulocyte (IG) count and percentage, neutrophil-to-lymphocyte ratio (NLR), and mean platelet volume (MPV)—in children with AA. Material and Methods: This retrospective study included pediatric patients (<18 years) who underwent appendectomy for AA between January 2020 and December 2022. Patients were categorized as having SA or CA based on intraoperative and histopathological findings. Preoperative laboratory parameters were compared between groups. Spearman correlation and regression analyses were performed to assess associations with complication status and hospitalization duration. Results: A total of 94 patients were included (mean age: 12.1±3.6 years; 63.8% male). CA was identified in 9 patients (9.6%). CRP levels were significantly higher in the CA group (p = 0.043) and independently predicted complications (OR: 1.018, 95% CI: 1.005–1.032, p =0.009). CRP was moderately correlated with both hospital stay (r =0.369, p <0.001) and fibrinogen levels (r =0.525, p <0.001). In multivariate linear regression, CRP remained a significant predictor of prolonged hospitalization (β =0.365, p =0.002), while fibrinogen did not. IG count, IG percentage, NLR, and MPV were not significantly associated with complication status or hospital stay. Conclusion: CRP is a practical and reliable marker for predicting both complicated appendicitis and prolonged hospitalization in children. Fibrinogen is associated with disease burden but lacks independent predictive value. IG%, NLR, and MPV did not demonstrate clinical utility in this cohort. CRP may aid in preoperative risk stratification and postoperative care planning in pediatric AA.
Assessment of enteral nutrition in preterm infants with patent ductus arteriosus undergoing medical treatment
Objective: The aim of this study was evaluate the effect of enteral nutrition during treatment in preterms under 32 weeks of gestation with patent ductus arteriosus receiving medical treatment. Material and Methods: Preterm newborns born before 32 weeks of gestation who received medical treatment for patent ductus arteriosus were categorized into three groups based on their enteral feeding status during treatment: Group A (not fed), Group B (fed <60 ml/kg/day), and Group C (fed ≥60 ml/kg/day). Gastrointestinal system problems and neonatal morbidities were compared with nutritional status. In this retrospective study, 105 patients were included. Results: Gastrointestinal intolerance was more common in group A, which was never fed (p=0.017) and the time to full enteral nutrition was the longest in this group (p=0.024). In the most fed group C, the time to regain birth weight was the longest (p=0.002). Daily weight gain was the lowest in patients in group A (p=0.022) and mortality was the most common in this group (p=0.003). There was no statistically significant difference in the incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage and sepsis between fed and unfed infants. Conclusion: No statistically significant adverse effects of enteral feeding were observed in preterms treated medically for patent ductus arteriosus. This study shows that enteral feeding does not increase gastrointestinal or neonatal morbidities, and that feeding during treatment appears to be safe
Evaluation of basic life support training provided to mothers of preterm infants
Objective: Preterm infants admitted to neonatal intensive care units (NICUs) are at an increased risk of requiring basic life support (BLS). This study aimed to evaluate the impact of BLS training on the knowledge and anxiety levels of mothers of preterm infants. Material and Methods: This prospective descriptive study included mothers of preterm infants born at less than 37 weeks of gestation who were either discharged from the NICU or being treated in the mother-infant adaptation unit. Participants were provided with BLS training using visual materials. A questionnaire assessing knowledge levels and the State-Trait Anxiety Inventory (STAI Form TX-1 and TX-2) were administered before and after the training. Pre- and post-training questionnaire responses and anxiety scores were analyzed. Results: A total of 100 mothers participated in the study. Post-training knowledge levels regarding BLS significantly improved (p<0.001). State and trait anxiety scores significantly decreased after the training (p<0.001). Mothers with a university education had higher pre-training knowledge scores compared to those with primary or secondary education (p<0.001); however, post-training knowledge levels were similar across all educational groups (p = 0.600). Conclusion: BLS training increased knowledge levels and reduced anxiety among mothers of preterm infants. Therefore, developing and disseminating appropriate BLS training programs for parents may play a crucial role in improving public health. Moreover, reducing parental anxiety through such training could contribute to enhancing the quality of neonatal care.
Efficacy and safety of levetiracetam treatment in childhood epilepsy
Objective: Levetiracetam (LEV) is a second-generation antiepileptic drug widely used in pediatric epilepsy due to its favorable pharmacokinetics, efficacy, and tolerability. This study aimed to evaluate the long-term efficacy and safety of LEV treatment in children with epilepsy. Material and Methods: A retrospective review was conducted on pediatric patients diagnosed with epilepsy and treated with LEV at a tertiary pediatric neurology center. Treatment efficacy was assessed based on seizure frequency reduction of more than 50% or complete seizure freedom. The occurrence and types of adverse effects were also analyzed. Statistical analyses included chi-square tests, independent t-tests, and logistic regression models. Results: A total of 101 patients were included in the study. LEV was initiated as the first antiepileptic drug in 9.9% of patients. By the end of the follow-up, 34.7% remained on LEV treatment, and 11.9% discontinued LEV. LEV was effective in 72.3% of patients, with 38.0% achieving complete seizure freedom. The drug was significantly more effective in patients older than four years and those with a lower pre-treatment seizure frequency. The mean LEV dose was 24.8 mg/kg/day in the effective group and 33.8 mg/kg/day in the ineffective group. Adverse effects were observed in 45.5% of patients, with the most common being drowsiness, irritability, and fatigue. Patients with a prior history of adverse reactions to other antiepileptic drugs had a significantly higher likelihood of developing side effects with LEV. Conclusion: Levetiracetam (LEV) is an effective and well-tolerated treatment option for childhood epilepsy, with high efficacy rates and a manageable safety profile. Older children, those receiving lower doses, and those with a lower pre-treatment seizure burden demonstrated better treatment outcomes. Careful monitoring is necessary for patients with a history of adverse reactions to other anti-epileptic drugs.
Diabetes-specific eating disorder, psychological flexibility and metabolic control in adolescents with Type 1 Diabetesmetabolic Diabetes
Objective: This study aimed to evaluate the risk of diabetes-specific eating disorders (EDs) and disease acceptance in adolescents with type 1 diabetes mellitus (T1DM) and to examine their associations with metabolic control and anthropometric measurements. Material and Methods: A total of 73 adolescent with T1DM (11-19 years) participated. Data were collected face to face using questionnaires on sociodemographic and clinical characteristics, the Diabetes Eating Problem Survey-Revised (DEPS-R), and Acceptance and Action Diabetes Questionnaire (AADQ). Biochemical results and anthropometric measurements were obtained from medical records and direct assessment. Data were analyzed via SPSS and JASP. Results: Nearly half of the participants (45.2%) were at high risk for diabetes-specific EDs. The mean DEPS-R score was 21.3±12.0, and the mean AADQ score was 47.6±9.7. Skipping main meals was associated with higher DEPS-R scores (p=0.025) and lower AADQ scores (p=0.009). A weak negative correlation was found between HbA1c and AADQ score (r=-0.280, p=0.018). Conclusion: A considerable proportion of adolescents with T1DM are at high risk for EDs, and poor disease acceptance is linked to worse metabolic control. These findings underscore the importance of routine screening for disordered eating in clinical practice and the potential value of incorporating psychological flexibility-based interventions to improve outcomes.
From bedside to revisit: identifying risk factors for outpatient revisits following pediatric viral lower respiratory tract infections – insights from hospitalized cases of RSV, HBoV and influenza
Objective: Acute lower respiratory tract infections (ALRTIs) are among the leading causes of hospitalization, particularly in children under five years of age. A substantial proportion of children discharged after hospitalization for viral ALRTIs experience recurrent respiratory tract infections; however, the clinical predictors of these recurrences have not yet been fully defined. This study aimed to investigate the relationship between recurrent hospital visits due to respiratory tract infections within one year post-discharge and various clinical and demographic factors in pediatric patients hospitalized with ALRTIs caused by respiratory syncytial virus (RSV), human bocavirus (HBoV), or influenza viruses (IFV). Material andMethods: This retrospective observational study included pediatric patients hospitalized due to RSV, HBoV, or IFV infections between January and December 2023. Demographic characteristics, clinical presentation, hospitalization details, and post-discharge follow-up data were evaluated. Recurrent hospital visits related to respiratory tract infections within one year of discharge were analyzed. Results:A total of 519 patients were evaluated. Recurrent hospital visits due to respiratory tract infections were identified in 216 patients (41.6%) during the follow-up period. Younger age (p = 0.028) and the presence of chronic illness (p = 0.011) were found to be significant risk factors for these repeat visits. No significant association was observed between recurrent visit frequency and variables such as sex, identified viral pathogen, laboratory parameters, or radiological findings. Conclusion: Younger age and comorbid chronic illnesses were identified as important risk factors for recurrent hospital visits following viral ALRTIs. These findings highlight the need for more structured and targeted follow-up strategies in pediatric patients at higher risk after hospital discharge.
Enhancing the Capacity of Health Systems to Overcome Challenges and Strengthening Nurses and other Healthcare Professionals in COVID-19 Process
Nowadays, leaders and executives are faced with a complex set of problems that do not have a complete solution, threaten their career and the future of their institutions, and that the parties are harmed. When evaluating ambiguous information that contradicts each other, the priority of the manager and leader should be to implement the solution that gives the least harm to the majority. When a process such as COVID-19, which caused a pandemic and left our lives under uncertainty, more than one crisis situation emerged, which we had to manage both personally and as healthcare professionals. The important point here is related to how we manage and lead these extraordinary situations we encountered in the Quantum era. How we keep pace with change and how we can lead this planning process is an important issue. Because people faced a risk in the context of the most important human right and constitutional right “right to live”. Therefore, how to protect ourselves and stay healthy during this process have been our top priorities. The first thing that comes to mind when it comes to protecting and strengthening health is undoubtedly the health professionals who have adopted this issue as a professional principle. Health professionals have important responsibilities in planning this crisis in terms of planning, speed, compliance and trust. This article, prepared in a compilation style, discusses what can be done within the scope of the COVID-19 process, by improving the capacity of managers and leaders to overcome difficulties in the health system they are in and strengthening nurses and health professionals.
Copyright © 2020 The Author(s) https://creativecommons.org/licenses/by/4.0
Management of Trauma And Surgical Procedures in Children During The COVID-19 Pandemic
Coronavirus 2019 (COVID-19) infection was first identified in China and spread to the whole world in a very short time. The COVID-19 pandemic was declared by the World Health Organization (WHO) in March 2020 due to the rapid inc rease in the number of cases and deaths. Studies show that the virus is primarily transmitted by respiratory droplets and close contact. Although 90% of children are asymptomatic or have mild symptoms, they should be accepted as positive until they are proven negative regardless of any complaints. Despite the process, trauma, burn and surgical emergencies continue to concern pediatric surgeons. The basic principles those generally accepted during Covid-19 pandemic are to perform emergency and urgent surgical procedures and to reschedule elective surgeries. However, the most important issue in the process is to take precautions for protecting the healthcare team and to plan keeping hospital reserves. We aimed to adapt general principles of trauma and surgery to the COVID-19 pandemic in children and to discuss the specific conditions in our review.
Adverse Drug Reactions During COVID-19 Treatment
Adverse drug reactions are unintented and harmful reactions to drugs. Coronavirus disease 2019 (Covid-19) has been widely spread. Although many drugs are used in the treatment of COVID-19, there is still no specific treatment with proven reliability and effectiveness and there are many studies to find effective treatment. Attention should be taken regarding the properties, interactions and undesired drug reactions of drugs used in the treatment of COVID-19. The aim of this review is to draw attention to adverse drug reactions of the drugs that are being used in COVID-19 treatment.