Ankara Bilkent City Hospital

OBJECTIVE:Behavioral problems in children may be associated with developmental characteristics and parental stress levels. This study aimed to identify potential early risk indicators and focal points for preventive intervention related to behavioral problems among preschool children suspected of developmental delay before diagnosis or formal intervention. MATERIALS AND METHODS:This cross-sectional study included 89 children aged 24-60 months referred for their first evaluation for suspected delays and 37 typically developing (TD) peers. Development was assessed with the Ages and Stages Questionnaire-Turkish version (ASQ-TR). Mothers completed the ASQ: Social-Emotional, Child Behavior Checklist (CBCL/1.5-5), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Parenting Stress Index-Short Form (PSI-SF). Groups were compared, and regression analyses identified child and parent factors associated with behavioral problems. Concurrently, the study examined the developmental, psychological, and familial factors associated with behavioral problems among children at developmental risk. In this subgroup, regression analyses assessed the associations between predefined child variables (age, sex, ASQ-TR domain scores) and maternal measures (BDI, STAI, PSI-SF, parental education, socioeconomic status) with CBCL outcomes. RESULTS:Children with developmental risk had significantly higher CBCL total, internalizing, and externalizing scores than TD peers. Maternal depression symptom and anxiety scores did not differ between groups, but parenting stress was higher among mothers of children with risk. Within the developmental risk group, parenting stress was consistently associated with total, internalizing, and externalizing problems. Delays in personal-social and social-emotional domains were linked to total and externalizing difficulties, while gross motor delays were related to internalizing problems. The number of delayed developmental domains correlated with both behavioral problems and parenting stress. CONCLUSION:Behavior problems are higher among children identified as being at developmental risk through screening, and parenting stress is closely associated across behavioral domains even before formal diagnosis or intervention. Multiple delays appear to exacerbate both child and parent outcomes. These findings highlight the need for early, family-centered interventions addressing children's developmental and behavioral needs alongside parental well-being.

Family-centered care, including open visitation and effective communication, is increasingly recognized as essential in pediatric intensive care. Despite growing international evidence supporting open visitation policies and family involvement, significant variation exists in implementation across different healthcare systems and cultural contexts. This study aimed to evaluate the current visitation policies and family information practices in pediatric intensive care units (PICUs) in Turkey. A web-based survey was conducted among 59 PICUs across Turkey, focusing on ICU characteristics, visitation policies, and the provision of family information. The survey was distributed through the Turkish Pediatric Intensive Care Society network, and responses were obtained from one designated representative per unit. The majority of the units (78

Introduction: Candida (Candidozyma) auris is a fungal pathogen that has drawn attention due to its high antifungal resistance rates, ability to persist on abiotic surfaces, and potential to cause healthcare-associated outbreaks. In addition to clade I, II, III, and IV reported from South Asia, East Asia, Africa, and South America, respectively, clade V has been confirmed in patients in Iran and clade VI in Singapore. The variabilities in antifungal efficacy and clinical presentation across different clades of C. auris underscore the importance of clade identification. Whole genome sequencing (WGS) is the gold standard for determining which clade C. auris isolates belong to. However, WGS is expensive and requires bioinformatics expertise. Cost-effective clade identification may be performed using the polymerase chain reaction (PCR)-based clade identification (ClaID) method. The aim of this study is to determine the clade of the clinical C. auris strains isolated at our center using the ClaID method and to determine the in vitro antifungal susceptibility profiles of the isolates. Materials and Methods: In this study, the ClaID method was applied to detect the clades of 28 C. auris isolates which were collected at Ankara Bilkent City Hospital between October 2021 and March 2023. The minimum inhibitory concentration (MIC, mg/L) values of the isolates for fluconazole, amphotericin B, anidulafungin, micafungin, itraconazole, voriconazole, posaconazole, and flucytosine were determined using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) microdilution method. The MIC values obtained were interpreted according to the breakpoints and epidemiological cut off values documented by EUCAST or the Centers for Disease Control and Prevention tentative breakpoints. Results: The ClaID method identified all isolates as belonging to clade I. All isolates were resistant to fluconazole and susceptible-increased exposure to amphotericin B. One isolate was assessed as resistant to echinocandins (anidulafungin and micafungin). Conclusion: The C. auris isolates in this study were determined to belong to Clade I and our susceptibility results were consistent with the expected high fluconazole resistance for this clade. In one C. auris isolate, echinocandin resistance confirmed with a reference method was detected for the first time in our country. The results obtained in this study regarding clade analysis and in vitro antifungal susceptibility profiles are of particular significance as a remarkable contribution to the limited reported data in T & uuml;rkiye.

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that may result in progressive lung damage. The Specific PCD Evaluation by CT (SPEC) scoring system has been specifically used in PCD patients since 2024. This study aimed to evaluate the SPEC score in children with PCD. This retrospective, cross-sectional, single-center study included 47 children with confirmed or highly likely PCD who underwent thin-section thoracic computed tomography (CT). Pediatric radiologists evaluated CT scans using SPEC, Bhalla, and modified Brody scoring systems. We analyzed pulmonary function tests performed within 3 months of CT. We compared its performance with established scoring systems. The median age at CT was 8 years (Q1–Q3: 5.5–13.0). SPEC scores ranged from 0 to 51 (median 29). All three CT scoring systems showed strong intercorrelations; the SPEC-modified Brody correlation was ρ = 0.894 (p < 0.001), and the SPEC-Bhalla correlation was ρ = − 0.838 (p < 0.001). SPEC scores showed strong negative correlations with FEV₁ z-score (ρ = − 0.748, p < 0.001) and FVC z-score (ρ = − 0.722, p < 0.001) and positively correlated with age (ρ = 0.425, p = 0.003). SPEC scoring showed bronchiectasis predominantly in the lower and middle lobes, with the left lower lobe most frequently affected (68.1

Objective: Hereditary angioedema (HAE) is a rare disease associated with significant morbidity and mortality, particularly due to laryngeal attacks. This study aimed to describe the demographic and clinical characteristics of adults with HAE followed at a single center, with a focus on triggers, diagnostic delay, and treatment approaches. Materials and Methods: This retrospective cohort study included 15 patients aged >= 18 years who were followed at our center between 2019 and 2024. Clinical and laboratory data were obtained through retrospective review of medical records. Results: Fifteen HAE patients were included; 73.3% were female (median age: 34 years, range: 21-73). The diagnostic delay was 8 years (range: 0-49), and patient age was positively correlated with diagnostic delay (r=0.706, p=0.003). Thirteen patients had HAE-1 and two HAE-2; attacks most commonly involved the face/extremities (46.7%) and gastrointestinal tract (33.3%). Laryngeal attacks occurred in 60% of patients, with 13.3% requiring intensive care unit (ICU) follow-up but no intubation. Attacks were most frequently reported by patients in association with stress or fatigue (86.7%), followed by trauma. Among female patients, 27.3% reported a temporal association between menstrual cycles and attack occurrence. Prodromal symptoms occurred in 66.7%, most commonly skin tightness and tingling. Icatibant was used on demand (median response: 60 min); short-term prophylaxis during procedures (46.7%) prevented attacks. Three patients receiving long-term prophylaxis (LTP) with danazol reported a reduction in attack frequency. Patients with prior ICU admission were more likely to receive LTP (p = 0.029), likely reflecting greater disease severity and reverse causality rather than a causal effect of LTP on ICU admission. Conclusion: This study provides descriptive real-world data on adults with HAE in a setting with limited access to first-line prophylactic therapies. Stress-related factors were frequently reported in association with attacks, and diagnostic delay appeared to be shorter among younger patients. Restricted access to first-line LTP remains a relevant clinical challenge.