Introduction: Beta-thalassemia major is a chronic hematologic condition that requires lifelong medical care and imposes substantial psychosocial demands on families. Primary caregivers, particularly parents, face ongoing emotional, financial, and practical stressors that may place them at increased risk for depressive symptoms. Despite this burden, routine screening for caregiver mental health remains limited in many pediatric settings. This study aimed to assess depressive symptoms among primary caregivers of children with beta-thalassemia major using the Patient Health Questionnaire-2 (PHQ-2) and to explore potential associations with sociodemographic and clinical characteristics. Materials and Methods: This cross-sectional descriptive study included 49 primary caregivers of children with beta-thalassemia major followed at a tertiary pediatric hematology center in Türkiye. Data were collected using a structured sociodemographic questionnaire and the PHQ-2. Relationships between depressive symptoms and caregiver- and child-related variables were examined Results: Sixteen percent of caregivers scored above the PHQ-2 cutoff, indicating increased risk for depression. PHQ-2 scores did not differ significantly according to the child’s gender, transfusion frequency, medication use, or presence of medical complications. Similarly, no significant associations were found with parental age, education level, chronic illness, household income, household size, or immigration status. Although not statistically significant, higher depressive symptom scores were observed among caregivers with first-degree relatives affected by chronic illness and among those whose children did not receive formal social support services. Conclusion: A meaningful proportion of caregivers of children with beta-thalassemia major exhibited elevated depressive symptoms, even in the absence of clear sociodemographic or clinical predictors. These findings highlight the importance of incorporating brief mental health screening tools into routine pediatric hematology follow-up and emphasize the need for multidisciplinary approaches that address both medical and psychosocial aspects of chronic childhood illness. Further studies with larger samples are warranted to better identify risk factors and to inform targeted support strategies for caregivers.
Introduction: The relationship between vitamin D supplementation and urinary stone formation in infancy remains controversial, leading to variability in clinical practice regarding continuation or discontinuation of vitamin D in infants diagnosed with urolithiasis. This study aimed to evaluate whether serum 25-hydroxyvitamin D levels are associated with the presence of urolithiasis in infants. Materials and Methods: This retrospective study included 77 infants who underwent renal ultrasonography for suspected urinary stone disease. Patients were classified according to the presence or absence of ultrasonographically detected urolithiasis. Clinical and laboratory parameters, including serum 25-hydroxyvitamin D levels and urinary calcium-to-creatinine ratios, were recorded. Hypercalciuria was defined using age-specific reference values. Factors associated with urolithiasis were evaluated using univariate and multivariate logistic regression analyses. Results: Of the 77 infants, 54 had ultrasonographically detected urolithiasis. Mean serum 25-hydroxyvitamin D levels were similar between infants with and without urolithiasis (34.44±13.63 vs 34.81±15.68 ng/mL, p=0.917). None of the infants exhibited vitamin D excess or intoxication. Infants with stones had higher median urinary calcium-to-creatinine ratios compared with those without urolithiasis median (min-max) [0.58 (0.02–1.98) ve 0.34 (0.08–1.8) mg/mg; p=0.031], and hypercalciuria was more frequent in this group (37% vs 13%, p=0.030). Although younger age and hypercalciuria were associated with urolithiasis in univariate analyses, these associations did not remain statistically significant in multivariable models. Serum vitamin D levels were not associated with stone presence in either univariate or multivariate analyses. Conclusion: In this study, serum 25-hydroxyvitamin D levels were not found to be associated with urolithiasis in infants. These findings suggest that vitamin D status alone may not fully explain stone formation during early infancy. Decisions regarding continuation or discontinuation of vitamin D supplementation should therefore consider the overall metabolic and clinical context, including urinary calcium excretion, rather than relying solely on serum vitamin D levels.
Introduction: Adverse Childhood Experiences (ACEs) refer to potentially traumatic experiences such as abuse, neglect, and household dysfunction that an individual experiences before the age of 18. This study aims to examine the frequency and temporal trends of Adverse Childhood Experiences (ACEs) among first-year late adolescents starting university for the first time between 2023 and 2026. Materials and Methods: This research was conducted as a repeated cross-sectional study. Data were collected through an anonymous online questionnaire distributed via social media and student networks. Participants voluntarily joined from various regions of Türkiye. At the end of the study, the numbers of participants in 2023, 2024, 2025, and 2026 were 138, 137, 136, and 139, respectively, for a total of 550 students. The ACE-Q 10 scale was used to assess the frequency of adverse childhood experiences (ACEs). Changes over the years were analyzed using the Pearson Chi-square test, the Linear-by-Linear Association test, and multivariable logistic regression analyses. Results: Fifty-three percent of participants reported experiencing at least one ACE, while 9.6% reported exposure to four or more ACEs. Emotional neglect was the most common type of child abuse across all years, followed by emotional abuse, with physical or medical neglect being the least frequent. Childhood sexual abuse increased significantly from 5.8% in 2023 to 17.4% in 2026 (p-trend=0.001). The prevalence of alcohol or substance abuse problems in the family also increased from 3.6% to 10.1% (p-trend=0.033). The percentage of students with four or more ACE scores increased significantly from 5.8% to 16.5% (p-trend = 0.004). Conclusion: Among late adolescent students starting university, an increased trend was observed, particularly in cases of sexual abuse and high ACE burden. Although the findings are not nationally representative, they suggest a need for continued monitoring of ACEs and strengthening child protection and trauma-focused preventive programs.
Introduction: Neural tube defects (NTDs) are major congenital malformations that require multidisciplinary management during the neonatal period and are associated with additional congenital anomalies and adverse neurodevelopmental outcomes. This study aimed to evaluate the perinatal characteristics and thyroid function tests (TFTs) of newborns with NTDs admitted to our neonatal intensive care unit (NICU) and to determine the frequency of hypothyroidism in this population. Materials and Methods: This single-center retrospective study included neonates diagnosed with NTDs and admitted to a tertiary NICU between January 2019 and June 2024. TFT results obtained during the first year of life were evaluated. Demographic, clinical, and laboratory data were retrieved from the medical records. Results: After exclusion of patients with missing data, 49 neonates were included. Of these, 30 (61.2%) were female and 19 (38.8%) were male. The mean gestational age was 37±3 weeks, mean birth weight was 2887±670 g, and mean maternal age was 27.5±6 years. Forty-three infants (87.8%) were delivered by cesarean section. Thirty (61.2%) were born at term and 19 (38.8%) were preterm. The most common NTD locations were the lumbar and lumbosacral regions. Hydrocephalus was the most frequent associated anomaly, affecting 27 infants (55.1%), and 20 underwent ventriculoperitoneal shunt placement. TFTs were performed within the first postnatal week in 25 infants. Among the infants evaluated during the first postnatal week, 5 (20.0%) had thyroid function test abnormalities consistent with hypothyroidism, corresponding to 10.2% of the entire cohort. All infants with hypothyroidism underwent surgery within the first week of life, and TFTs were obtained postoperatively. Levothyroxine treatment was initiated in three infants. None of the infants with normal initial TFTs developed hypothyroidism during follow-up. Conclusion: In this study, TFT abnormalities consistent with hypothyroidism were more frequently observed in newborns with NTD than the reported population-based prevalence of congenital hypothyroidism. Because TFTs were obtained after surgery, postoperative factors, including povidone-iodine exposure, may have contributed to thyroid dysfunction. However, persistent hypothyroidism during follow-up in some patients suggests that additional etiological factors should also be considered.
Introduction: Nephrotic syndrome is associated with immüne inflammatory activation and alterations in platelet-related parameters. This study aimed to compare complete blood count parameters, platelet/mean platelet volüme related indicators, and hematological inflammatory indices between children with nephrotic syndrome and healthy controls, and to evaluate their relationship with steroid response and relapse frequency. Materials and Methods: This retrospective case-control study included 72 children with nephrotic syndrome and 40 healthy controls. Laboratory data obtained at the time of diagnosis, before steroid treatment, were analyzed. Complete blood count parameters, platelet/mean platelet volüme related indicators, and hematological inflammatory indices, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immüne inflammation index, and systemic inflammatory response index, were evaluated. Patients with nephrotic syndrome were further classified as steroid sensitive or steroid resistant. Steroid sensitive patients were also compared according to relapse frequency. Results: Hemoglobin, white blood cell count, absolute neutrophil count, red cell distribution width, and platelet count were significantly higher in the nephrotic syndrome group than in the control group, whereas mean platelet volume was significantly lower. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immüne inflammation index were also significantly higher in the nephrotic syndrome group. No significant differences were found between steroidsensitive and steroid resistant nephrotic syndrome groups in complete blood count parameters, platelet/mean platelet volüme related indicators, hematological inflammatory indices, or biochemical parameters. Among steroid sensitive patients, platelet count, platelet-to-lymphocyte ratio, and systemic immüne inflammation index were significantly higher in the frequent relapse group than in the infrequent relapse group. Correlation analyses showed limited associations, mainly between platelet count and albumin or total cholesterol levels. Conclusion: Complete blood count derived indices may provide practical supportive information regarding inflammatory and platelet related alterations in children with nephrotic syndrome. Platelet count, mean platelet volume, platelet-to-lymphocyte ratio, and systemic immüne inflammation index differed particularly in patient control comparisons. At the same time, platelet related indices were also higher among steroid sensitive patients with frequent relapses. These parameters should be interpreted as complementary indicators rather than standalone diagnostic or prognostic markers.
Introduction: As the menstrual cycle is considered a vital sign of adolescent health, understanding normal menstrual characteristics is crucial. This study aimed to evaluate menstrual knowledge among adolescent and young adult females across different developmental stages and to examine the association between receiving menstrual information and menstrual knowledge. Materials and Methods: A total of 257 adolescent and young adult females aged 10-24 years were included in the study and completed an online, self-administered questionnaire. Participants were categorized into early (10-14 years), middle (15-18 years), and late adolescence/young adulthood (19-24 years). Sociodemographic characteristics, menstrual information sources, and menstrual knowledge were assessed using multiple-choice questions. Each correct response to menstrual knowledge questions in accordance with the American College of Obstetricians and Gynecologists 2015 Committee opinion, was scored as 1 point (total score: 0-4), with higher scores indicating greater menstrual knowledge. Participants who correctly answered all items were classified as having complete menstrual knowledge. Results: Overall, 91.4% of participants reported receiving menstrual information, most commonly from parents (70.8%), followed by the internet/media (58.8%) and school/teachers (58.4%). Complete menstrual knowledge rates (64.3% vs 31.8%, p=0.003) and menstrual knowledge scores (3.66±0.59 vs. 3.00±1.12, p=0.002) were significantly higher among those who had received menstrual information compared with those who had not. Both complete menstrual knowledge rates and knowledge scores increased across developmental stages (p=0.029 and p=0.003, respectively), with the highest levels observed in late adolescence/young adulthood. Conclusion: Although most adolescents and young adults reported having received menstrual information, correct menstrual knowledge remained suboptimal, particularly during early and middle adolescence. These findings underscore the importance of structured, developmentally adapted menstrual health education programs that extend beyond simple information dissemination. Integrating age-appropriate menstrual education into school curricula and routine adolescent healthcare may facilitate earlier recognition of abnormal menstrual patterns and support informed health-seeking behaviors.
Introduction: Esophageal atresia (EA) is a disease that is accompanied by other concomitant systemic anomalies in 30-70% of cases. In this study, we aimed to evaluate the antenatal and postnatal factors that influence mortality in patients with EA, examine the relationship between these factors and mortality and compare the effectiveness of mortality classification defined in the literature in assessing mortality. Materials and Methods: This retrospective study examined records of patients diagnosed with EA who were hospitalized between 2010 and 2020 in the NICU. Patient demographics, additional congenital anomalies, and Montreal, Bremen, and Spitz mortality classifications were evaluated. Results: A total of 71 patients were included in the study. The mean gestational week of the patients was 35.7 ± 2.5, and the mean birth weight was 2382 ± 715 g. The mortality rate was 29.5% (21/71).All patients with three or more concomitant anomalies had died. All mortality classifications were significant in predicting mortality. Low birth weight, prematurity, low APGAR score, presence of preoperative pneumonia, and presence of preoperative intubation were concluded to be significant in predicting mortality. The highest correlation between mortality and classification systems was found for the Montreal classification. Conclusion: The identification of risk factors determining mortality remains controversial. Prematurity, a low APGAR score, the presence of more than three anomalies, preoperative pneumonia, and the need for invasive mechanical ventilation have been found to increase mortality in EA. In conclusion, there is a need for new classification systems that evaluate various parameters that affect mortality, including multiple congenital anomalies.
Introduction: Early childhood development is critical for lifelong health and well-being, influenced by parenting practices and socioeconomic conditions, particularly in low- and middle-income countries like Vietnam. This study examines how positive discipline and socioeconomic factors shape developmental outcomes in young children. Materials and Methods: Data from 2,705 children aged 24–59 months were analyzed from a national survey conducted in Vietnam from 2020 to 2021. A 20-item index assessed health, learning, and psychosocial outcomes. Multivariable logistic regression, adjusted for maternal education, residence, ethnicity, and wealth, evaluated associations with discipline practices. Results: Positive discipline, such as explaining behavior or offering alternatives, was associated with better developmental outcomes (odds ratio= 2.37 and 2.10, respectively). Higher maternal education (odds ratio= 1.84, p<0.001), urban residence (odds ratio= 1.48, p=0.013), pre-primary education attendance (odds ratio= 1.74, p<0.001), and majority ethnicity (odds ratio= 2.37, p<0.001) also associated with improved outcomes. Violent discipline showed no significant effect (p=0.82). Rural and ethnic minority children faced developmental disparities. Conclusion: Positive discipline and favorable socioeconomic conditions enhance early childhood development in Vietnam. Interventions like parenting training and expanded early education access can reduce disparities, particularly for rural and ethnic minority families, improving pediatric outcomes.
Introduction: The development of bronchopulmonary dysplasia (BPD) is multifactorial, and the extent to which individual risk factors influence its development may vary. The aim of this study is to analyse the risk factors for BPD and to determine preventive future approaches for them. Materials and Methods: This study was conducted on newborns with a gestational age ≤32 weeks. admitted to the neonatal intensive care unit, Antenatal, natal, and postnatal risk factors for premature infants were evaluated by collecting data from patient files using a retrospective cross-sectional descriptive study method. Results: According to the inclusion criteria, 539 patients were included in the study. BPD was detected in 172 patients (31.9%) at any stage (mild-moderate-severe). Low gestational age, low birth weight, delayed transition to enteral feeding, low free thyroxine levels, delayed initiation of vitamin D supplementation, erythrocyte transfusion and counts, and prolonged respiratory support durationwere found to be risk factors for BPD development (p<0.05). According to the results of the multivariate logistic regression analysis, the day of oxygen restriction [odds ratio (OR), 1.332; 95% confidence interval (CI) 1.064–1.667, p=0.012] and red blood cell transfusion (OR 41.865, 95% CI 1.337–1310.596, p=0.034) were found to be independent risk factors for BPD. Conclusion: In our study, oxygen support period and erythrocyte transfusion may independent risk factors for BPD development. Additionally, as a significant new finding, we determined that low free thyroxine levels and delayed initiation of vitamin D supplementation may be related to the severity of BPD.
Introduction: Tooth discoloration is a common side effect of liquid iron supplements used in pediatric patients. This in vitro study aimed to evaluate the effects of ferric polymaltose, ferrous sulfate, and Lipofer® iron supplements, when mixed with orange juice, on the color change and enamel surface roughness of primary teeth. Materials and Methods: Sixty primary canine teeth were embedded in acrylic resin and randomly divided into six groups. Each supplement was diluted with either orange juice or distilled water. Samples were immersed in the solutions for 5 minutes daily over 28 days. Color change (ΔE00) was measured with a spectrophotometer, and surface roughness was assessed using a profilometer on days 0, 7, 14, 21, and 28. Results: Among the iron supplement groups, the Lipofer® group showed significantly less discoloration effect (p<0.05). Mixing iron supplements with orange juice had no statistically significant effect on primary teeth discoloration and enamel surface roughness (p>0.05). Conclusions: Lipofer® supplementation caused less discoloration compared to other iron preparations. Based on the findings of our study, the administration of iron supplements mixed with orange juice may be recommended to enhance taste tolerance in pediatric patients.
Introduction: Since heart failure is among the most important mortality reasons among Thalassemia Major patients, these patients must be regularly checked for heart problems. Our study was planned to compare pulse wave doppler images and segmental tissue doppler images from 8 different areas and their copeptin, NT-pro ANP, NT-proBNP, CK-MB, and ultra-sensitive troponin I value with those of healthy individuals. Materials and Methods: Fifty-nine Thalassemia Major patients over the age of 10, who were asymptomatic concerning cardiac symptoms, were divided into two groups (Group 1T2*<20 msn and Group 2: >20 msn). Echocardiography data and biochemical parameters of patient groups were compared with the control group. Results: In both patientgroups, NT-proBNPvalueswerefoundto besignificantlyhigher compared to the control group (p<0.001), and no correlation was found between NTproBNP and cardiac MRI. In tissue doppler imaging of lateral and medial sections of the mitral annulus, it was seen that IVCT and IVRT measurements of both patient groups were extended and Myocardial Performance Index (MPI) measurements were increased. E, A, and S measurements of Group 1 were found to be lower compared to the control group. There were no significant differences between the groups in terms of copeptin, NT-proANP, CK-MB, and US-Troponin I values. Conclusion: Investigated biochemical indicators could not bestronglycorrelated with iron accumulation. By calculating MPI values with tissue doppler echocardiography, global cardiac dysfunction may be identified earlier and chelation therapy may be revised.
Introduction: Childhood obesity is associated with systemic inflammation and metabolic disturbances. This study aimed to investigate the relationships between obesity, systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) in children and adolescents. Materials and Methods: A total of 217 children (126 controls, 91 obese; mean age 12.2 +/- 3.4 years) were included. Anthropometric measurements, laboratory parameters, and inflammatory indices (SII, SIRI) were assessed. Multiple linear regression analyses were performed to examine associations between BMI SD, age, gender, pubertal status, and inflammatory indices. Results: Obese children had significantly higher weight SD, height SD, BMI SD, NEU, MPV, glucose, total cholesterol, LDL-C, TG, ALT, GGT, SII, and SIRI compared to controls (p<0.05), while HDL-C was lower (p=0.041). Regression analyses showed that BMI SD was a significant positive predictor of both SII and SIRI (p<0.001), whereas age, gender, and pubertal status were not significant. The models explained 8.6% and 7.2% of the variance in SII and SIRI, respectively. Conclusion: Our findings indicate that childhood obesity is associated with elevated systemic inflammatory markers and that BMI SD is a strong predictor of systemic inflammation. These results highlight the importance of early weight management to reduce inflammatory risk in children and adolescents.
Although Imerslund-Gr & auml;sbeck syndrome (IGS) is a rare disease, it can also cause rare comorbid clinical conditions. IGS or selective vitamin B12 (cobalamin) malabsorption with proteinuria is a rare autosomal recessive disorder characterized by vitamin B12 deficiency. IGS is caused by mutations in the gene CUBN encoding cubilin or AMN encoding amnionless. Homozygous or compound heterozygous mutations in either CUBN or AMN lead to IGS. Vitamin D deficiency is considered a major public health concern. Inadequate sun exposure, limited oral intake, and impaired intestinal absorption are common risk factors for vitamin D deficiency. Moreover, vitamin D binding receptor protein and 25-OHD urinary extraction are associated with profound vitamin D deficiency, in IGS. Constitutional symptoms, such as weakness and fatigue, are the conditions that may occur in the deficiency of both vitamin B12 and vitamin D. For this reason, we would like to emphasize the importance of monitoring vitamin D levels periodically in patients diagnosed with IGS, as clinical findings may be similar.
Introduction: Anorexia nervosa (AN) is the psychiatric disorder with the highest mortality rate. Although suicide is the most common cause of death in patients with AN, sudden cardiac death, arrhythmias, and electrolyte imbalances are among the other causes. This study aimed to determine the mortality rate and causes of death in patients followed for AN and atypical AN (AAN). Materials and Methods: Patients who presented to the Adolescent Health Department of our hospital between February 2014 and February 2025, were diagnosed with AN or AAN, and were followed in our department, were included in the study. Sex, age at presentation, body weight, height, and body mass index (BMI) data were obtained from medical records. Patients were contacted by phone to determine their current status, and for those who had died, the cause of death was recorded. Results: Of the 391 patients followed with AN or AAN, 322 were included in the study. Among them, 110 had AN (106 female, 4 male) and 212 had AAN (188 female, 24 male). The mean age at presentation was 15.1 +/- 1.6 years in the AN group and 15.0 +/- 1.6 years in the AAN group (p = 0.545). The median duration since diagnosis for all patients was 3.9 years (IQR 2.7-6.3). No deaths occurred during medical follow-up in our clinic; however, one patient with AN who was not under regular follow-up was reported to have died by suicide. For all patients with AN and AAN whose data were available, the mortality rate was 0.7 per 1000 person-years, whereas for patients with AN it was 1.9 per 1000 person-years. Conclusion: Consistent with the literature, suicide was identified as the most common cause of death, and no patient was lost due to medical complications. The mortality rate in our study was lower than previously reported for AN. Our findings suggest that regular follow-up with a multidisciplinary team may reduce mortality due to medical complications, whereas lack of consistent follow-up increases the risk of death.
Introduction: The World Health Organization has recognized vaccine hesitancy as one of the top ten threats to global health. Consequently, it is imperative to investigate vaccine hesitancy both between and within countries. The aim of this study was to determine the prevalence of vaccine hesitancy among mothers of children aged five years and under in northeastern Turkey and to identify the factors associated with vaccine hesitancy. Materials and Methods: This cross-sectional study was conducted with mothers presenting to the pediatric outpatient clinic of a public hospital. Maternal reluctance toward vaccination was evaluated using the Parents’ Attitudes about Childhood Vaccines (PACV) scale. Data were analyzed by chi-square and logistic regression analysis. Results: Of the participating mothers, 27.4% exhibited vaccine hesitancy. Independent predictors of vaccine hesitancy were having a male child, active use of social media, and the father’s attainment of a university degree. Conclusion: In this study, vaccine hesitancy was found to be considerably higher compared to other studies conducted in Turkey. Therefore, further research on vaccine hesitancy should be conducted at the national level, considering different communities and cultures, and local health policies should be developed to address the identified risk factors.
Introduction: Pediatric pneumonia can result from bacterial or viral pathogens, presenting with overlapping clinical features, which makes accurate differentiation challenging. In developing countries, where access to microbiological diagnostics is limited, timely identification of the etiology is crucial to guide treatment. Basic inflammatory markers such as absolute neutrophil count (ANC), neutrophilto-lymphocyte ratio (NLR) and C-reactive protein (CRP) may help distinguish bacterial from viral infections. This study evaluates the diagnostic value of routine inflammatory markers in severe pneumonia. Materials and Methods: This cross-sectional study included 61 children aged 2 months to 5 years with severe pneumonia at Children's Hospital 1, Vietnam. Bacterial etiology was confirmed using real-time polymerase chain reaction from tracheal aspirates; viral pneumonia was identified by detecting respiratory viruses in the absence of bacteria. Clinical characteristics and inflammatory markers were collected. Comparative and receiver operating characteristic (ROC) curve analyses were performed to assess diagnostic performance. Results: 51 children (83.6%) had bacterial pneumonia, and 10 (16.4%) had viral pneumonia. Bacterial pneumonia was more common with recurrent pneumonia and high fever (p < 0.05). ANC (p < 0.005), NLR (p = 0.0002), and CRP (p = 0.01) were significantly elevated in bacterial cases. Area Under the ROC Curve (AUROC) showed NLR had the highest discriminatory value (AUROC = 0.87). The optimal NLR cutoff value (>= 0.8) yielded 78.4% sensitivity and 90% specificity. Combining NLR and CRP with clinical symptoms increased specificity but reduced sensitivity. A moderate positive correlation was observed between NLR and CRP (Spearman's rho = 0.514, p < 0.0001). Conclusion: NLR and other inflammatory markers offer practical value in distinguishing severe bacterial pneumonia, particularly in resource-limited settings. Nevertheless, interpretation should always be guided by clinical context.
