Objective: This study examined patients referred to the pediatric and pediatric allergy departments of Şırnak State Hospital with preliminary diagnoses of scabies and atopic dermatitis, who were diagnosed with scabies and underwent treatment, as well as the applied treatment and treatment responses. The aim of this study was to contribute to the literature. Materials and Methods: Data from 77 pediatric patients aged 0–18 years who were referred to the Pediatric Allergy and Immunology and Pediatric Health and Diseases outpatient clinics of Şırnak State Hospital with a preliminary diagnosis of scabies or atopic dermatitis between May 2025 and November 2025 were retrospectively reviewed. Demographic characteristics, household size, bed sharing, nocturnal itching, family history of similar complaints, treatment adherence, treatment use by all individuals in the household, hygiene practices, and clinical treatment response were evaluated. Results: The study included a total of 77 child patients, 29 of whom were girls (37.7%) and 48 were boys (62.3%). The youngest patient was 1 year old and the oldest was 17 years old. A total of 35.1 of the cases were treated with a diagnosis of atopic dermatitis at the initial presentation. Itching that woke the patient from sleep at night was observed in 77.9%, and a family history of similar complaints was observed in 67.5%. Bed sharing was observed in 28.6%, and dormitory living in 9.1%. The rate of patients who achieved clinical benefit from Scabies treatment was 59.7%. While no treatment success was achieved in patients who shared a bed, clinical improvement was observed in 83.6% of those who did not share a bed (p<0.001). Failure to use the treatment together among all individuals in the household and failure to comply with hygiene measures were significantly associated with treatment failure (p<0.001). In the logistic regression analysis, household size and a diagnosis of AD at the initial presentation were significantly associated with treatment failure (B = 3.763, p < 0.001 and B = 8.477, p = 0.022, respectively). Conclusion: The most important determinants of treatment failure in children with scabies are crowded household structure, bed sharing, failure to treat all individuals in the household simultaneously, and inadequate hygiene practices. Cases confused with atopic dermatitis lead to delays in diagnosis. Early diagnosis, correct treatment, and simultaneous treatment of all contacts are critically important in controlling the disease.
We read with genuine interest the article by Toksöz and Teber recently published in the Turkish Journal of Pediatric Disease, which presents long-term efficacy and safety data on levetiracetam (LEV) monotherapy in 101 children managed at a tertiary pediatric neurology centre (1). The reported seizure-response rate of 72.3%, with complete seizure freedom in 38.0% of patients, positions this study squarely within the broader real-world evidence base and confirms LEV’s standing as a first-line antiseizure medication (ASM) in childhood epilepsy. Particularly clinically useful is the identification of age over four years and low pre-treatment seizure frequency as independent predictors of a favourable response—two stratification criteria that translate directly into day-to-day prescribing decisions. Yet, precisely because this paper contributes to a growing corpus of retrospective evidence on LEV, it also highlights several dimensions that deserve more rigorous prospective investigation. To begin with, situating the results of Toksöz and Teber within the comparative effectiveness literature raises questions that a single-arm retrospective design cannot resolve. A systematic review and meta-analysis of four randomised controlled trials including 381 children demonstrated that LEV monotherapy was associated with a significantly lower frequency of at least one seizure and a 76% reduction in dermatological adverse events relative to carbamazepine (CBZ), while seizure-freedom rates did not differ significantly between the two agents (2). This context matters: an overall response rate of 72.3% is meaningful, but without a comparator arm—whether historical or concurrent—it remains difficult to determine whether this figure reflects a drug effect, a patient-selection effect, or an institutional effect. A large Turkish tertiary centre cohort of 281 children treated with LEV monotherapy across a decade found seizure reduction rates that, while broadly consistent with the current paper, varied substantially by epilepsy aetiology—ranging from idiopathic to symptomatic and cryptogenic forms (3). Heterogeneity in patient mix is therefore a critical variable, and its underreporting limits how far the findings of Toksöz and Teber can be generalised to other settings, Table I summarises the efficacy and adverse-event profiles across the major cohorts and meta-analyses cited in this commentary, placing the index study in comparative perspective. A closely related limitation concerns the absence of structured epilepsy syndrome classification in the cohort. The International League Against Epilepsy (ILAE) 2017 framework —distinguishing focal, generalised, combined generalised-and-focal, and unknown epilepsies—is not a bureaucratic formality; it carries direct and differential therapeutic implications (4). LEV holds regulatory approval as adjunctive therapy for focal-onset seizures and juvenile myoclonic epilepsy, but its behaviour across syndrome subtypes diverges in ways that aggregate response rates flatten into invisibility. A head-to-head systematic review and meta-analysis comparing LEV versus oxcarbazepine in children found that focal epilepsy subgroups drove most of the seizure-free advantage observed with LEV, while outcomes in other syndromic categories were considerably narrower (5). The clinical decision that a practitioner makes when initiating LEV in a child with Rolandic epilepsy—a syndrome with a favourable natural history regardless of treatment—should not be conflated with the decision made for a child with drug-resistant generalised epilepsy. Disaggregating outcomes by ILAE-classified syndrome type is not merely a methodological nicety; it is the minimum granularity needed to transform observational data into actionable prescribing evidence. Future work from this group should prioritise syndrome classification at enrolment. The adverse-event profile documented by Toksöz and Teber —45.5% of patients affected, with drowsiness, irritability, and fatigue predominating—is numerically consistent with prior series (6). The published literature, however, draws attention to a dimension of LEV toxicity that chart-based retrospective ascertainment systematically underestimates: the neuropsychiatric spectrum. Behavioural dysregulation under LEV, encompassing irritability, emotional lability, hyperactivity, and, in a minority of cases, frank psychotic symptoms, has been documented in up to 37.6% of pediatric patients in series that used structured ascertainment methods (7). A systematic review specifically examining behavioural side effects in children on LEV confirmed a statistically significant relative risk of 2.18 for total behavioural adverse events compared to placebo—hostility, nervousness, and aggression being the most frequently reported domains (8). These reactions are not trivial. A child whose seizures are controlled but who becomes aggressive, oppositional, or emotionally dysregulated has not simply ‘tolerated’ the drug; the family’s quality of life has been exchanged for seizure freedom, which is a different clinical outcome entirely. Neurodevelopmental comorbidities magnify this risk: children with pre-existing cognitive or psychiatric vulnerabilities are disproportionately susceptible to LEV-related behavioural deterioration, a factor impossible to fully control for in retrospective designs (9). Integrating standardised tools—the Child Behavior Checklist (CBCL) or the Strengths and Difficulties Questionnaire (SDQ)—at baseline and at each scheduled visit would allow future studies to detect these effects early and systematically, before they become reasons for treatment discontinuation rather than data points in the record. A dimension not discussed by Toksöz and Teber, yet central to understanding long-term LEV performance in children, is the concept of treatment retention as an integrated measure of efficacy and tolerability. In a real-world European pediatric cohort, the one-year LEV continuation rate was estimated at 72%, with insufficient efficacy—rather than adverse events— accounting for the majority of discontinuations. This architecture of drug attrition carries a practical message: achieving initial seizure control is necessary but not sufficient; sustaining it without accumulated tolerability burden is the harder clinical problem. Age-specific pharmacokinetic variability compounds this challenge. LEV clearance in young children is substantially faster than in adults, resulting in lower plasma concentrations at standard weight-based doses and potentially explaining some of the apparent efficacy ceiling observed in younger age groups —a finding that aligns with the age-related predictor identified by Toksöz and Teber (10). Prospective designs incorporating therapeutic drug monitoring would allow disentanglement of pharmacokinetic from pharmacodynamic sources of treatment failure, a distinction with direct therapeutic implications for dose adjustment strategies in the under-four age group. A final perspective, critical from a global pediatric neurology standpoint, concerns the generalisability of these findings beyond well-resourced tertiary settings. A systematic review and meta-analysis estimated the prevalence of childhood epilepsy in sub-Saharan Africa at 7.8 per 1000 population, with treatment gaps exceeding 80% in several regions (11). The recent inclusion of LEV on the WHO Essential Medicines List was a meaningful step, yet access remains constrained in low-and middle-income countries (LMICs) by drug cost, cold-chain logistics, and the scarcity of trained pediatric neurologists (12). A scoping review of epilepsy care outcomes in LMICs underscored that real-world effectiveness data generated in Turkish or European tertiary centres cannot be uncritically transposed to contexts where EEG is unavailable, neuroimaging is sporadic, and the interval between seizure onset and specialist consultation may span years (13). The cohort of Toksöz and Teber does not report on diagnostic delays, socioeconomic stratification, or access-related variables—all of which shape LEV outcomes in resource-limited settings in ways that standard efficacy metrics do not capture. Collaborative networks linking high-income and LMIC centres could help establish globally representative benchmarks and identify which elements of current management protocols are feasibly exportable, Figure 1 proposes a syndrome-stratified, neurobehaviourally monitored prospective framework that could serve as a blueprint for such collaborative efforts. In summary, the study by Toksöz and Teber makes a genuine and valuable contribution: it provides real-world evidence of LEV’s efficacy in a sizeable pediatric cohort, documents the adverse-event landscape with clinical honesty, and offers two stratification criteria with immediate utility at the point of prescribing. The path to a more complete understanding of LEV in childhood epilepsy runs through syndrome-specific prospective designs, standardised neurobehavioural monitoring incorporated from enrolment, retention and therapeutic drug monitoring analyses, and deliberate cross-centre collaboration that places these findings within a global epidemiological frame. Levetiracetam has more than justified its first-line status; the question of for whom, at what dose, and at what neuropsychiatric cost remains, in meaningful ways, open.
This clinical case report describes a 1.5-month-old infant with ductal origin of the right pulmonary artery. The surgical management included reconstruction of the right ventricular outflow tract and reimplantation of the right pulmonary artery using a 6‑mm ringed expanded polytetrafluoroethylene (ePTFE) graft.
Biliary atresia is a rare and fatal cholestatic disorder characterized by progressive obliteration of the extrahepatic and intrahepatic bile ducts, typically presenting during the neonatal period. Ethology remains uncertain, although immune-mediated injury, viral triggers, and developmental anomalies have been implicated. Kasai portoenterostomy is the primary treatment for biliary atresia, with optimal outcomes achieved when performed within the first 60 days of life. Despite early intervention, many patients experience progressive cirrhosis and portal hypertension. Liver transplantation remains the definitive therapeutic option. The timing of liver transplantation in early infancy remains controversial. A primary concern is increased mortality associated with the inability to administer live childhood vaccines to infants transplanted before six months of age, thereby elevating the risk of subsequent life-threatening infections. A 6-kg infant was diagnosed with biliary atresia and underwent surgery 84 days of age. Robotic-assisted Kasai portoenterostomy was performed to maintain bile flow until transplantation and to minimize adhesion formation, both of which are beneficial for subsequent transplantation. This report presents the technical aspects of the procedure.
Objective: We aimed to assess the diagnostic performance of renal ultrasonography (USG) compared with technetium-99m dimercaptosuccinic acid renal cortical scintigraphy (DMSA scintigraphy) in detecting renal parenchymal damage in paediatric patients with vesicoureteral reflux (VUR) and/or recurrent urinary tract infection (rUTI). Materials and Methods: We retrospectively analysed 181 paediatric patients who underwent both renal USG and DMSA scintigraphy. Kidneys coded as absent were excluded. Diagnostic accuracy indices (sensitivity, specificity, PPV, NPV, accuracy, and AUC with 95% confidence intervals) were calculated at kidney and patient levels. Logistic regression was performed to evaluate the impact of age, gender, and renal uptake. Results: In comparison to DMSA scintigraphy as the reference standard, USG identified parenchymal damage with a sensitivity of 50.9% for the left kidney and 44.7% for the right kidney, while demonstrating exceptional specificity (>99%). At the patient level (n=162), USG achieved a sensitivity of 49.4%, specificity of 100%, accuracy of 76%, and AUC of 0.75. DMSA scintigraphy identified significantly more kidneys with parenchymal injury than USG in all age cohorts. Logistic regression further indicated that advancing age and diminished renal uptake on DMSA scintigraphy were independent predictors of parenchymal damage, while sex was not significant. Conclusion: Ultrasonography demonstrated excellent specificity but limited sensitivity compared with DMSA scintigraphy. These findings indicate that USG alone is inadequate for the early detection of renal parenchymal damage in children with VUR and/or rUTI. DMSA scintigraphy remains essential in this high-risk population.
Objective: Acute rheumatic fever remains a significant cause of morbidity and mortality, particularly in developing countries. According to the Modified Jones Criteria updated by the American Heart Association in 2015, populations with an annual incidence of fewer than 2 new cases per 100,000 individuals are considered low-risk. A nationwide multicenter study conducted in Türkiye reported an annual incidence of 8.8 per 100,000, classifying the country as being within the moderate–to–high–risk category. In this study, we aimed to evaluate the clinical, demographic, and echocardiographic characteristics of patients diagnosed with acute rheumatic fever at a secondary healthcare center. Material and Methods: The clinical and demographic data of patients diagnosed with acute rheumatic fever at Denizli State Hospital between March 2015 and December 2024 were retrospectively evaluated. Patient records were accessed through the hospital’s electronic database. Results: A total of 60 patients were diagnosed with acute rheumatic fever during the study period. The most common presenting complaint was joint pain. Carditis and joint involvement (91.6% and 92.8%, respectively) were the most frequently observed major manifestations, while Sydenham chorea was diagnosed in 30% of the patients. According to the most recently modified criteria, the frequencies of polyarthritis, monoarthritis, and polyarthralgia as major manifestations were similar (30.1%, 28.6%, and 33.3%, respectively). Treatment-related complications included hepatotoxicity in four patients, and epistaxis, peptic ulcer, steroid-induced myopathy, esophageal candidiasis, and hyponatremia in one patient each. Conclusion: Acute rheumatic fever remains a commonly encountered disease in Türkiye. With the recent updates to the Jones Criteria, the proportion of missed acute rheumatic fever cases in moderate-to-high–risk populations is expected to decline substantially. The high frequency and clinical significance of both the disease itself and its treatment-related complications underscore the importance of effective streptococcal eradication and early diagnosis.
Objective: Noonan syndrome (NS) and related RASopathies are genetically heterogeneous disorders caused by dysregulation of the RAS/MAPK signaling pathway and are characterized by overlapping clinical features, including distinctive craniofacial appearance, growth impairment, congenital heart defects (CHD), and variable neurodevelopmental involvement. Comprehensive molecular characterization is essential for accurate diagnosis and genotype–phenotype correlation. Evaluation of well-characterized single-center pediatric cohorts may provide clinically relevant real-world insight into genotype–phenotype relationships within routine practice. The aim of this study is to delineate genotype–phenotype correlations in a well-characterized pediatric cohort. Materials and Methods: This retrospective single-center study included pediatric patients between January 2022 and September 2025 with molecularly confirmed diagnosis of NS and related RASopathies. Clinical, laboratory, and imaging findings were reviewed. Targeted next-generation sequencing of RASopathy-associated genes was performed. Detected variants were interpreted according to American College of Medical Genetics and Genomics guidelines, and segregation analysis was conducted when available. Results: The cohort comprised 20 pediatric patients from 19 unrelated families, with a mean age of 6.1 years. CHD was identified in 80% of patients, most commonly pulmonary valve stenosis (65%), while cardiac involvement was not universal. Short stature was observed in 65% of cases and represented the most frequent reason for referral. Disease-associated variants were identified in nine different genes, with PTPN11 being the most frequently affected (40%), followed by LZTR1 (15%), NF1 (10%), and RAF1(10%). Most variants were classified as pathogenic or likely pathogenic, whereas a limited number were categorized as variants of uncertain significance. Integrated interpretation incorporating phenotype–genotype concordance and segregation data supported the potential clinical relevance of selected uncertain variants. Conclusion: This pediatric cohort highlights the marked clinical and genetic heterogeneity of NS and related RASopathies. The absence of cardiac involvement in some patients underscores the limitations of phenotype-based assessment alone. Comprehensive molecular testing remains critical for accurate diagnosis, refinement of genotype–phenotype correlations, and appropriate long-term management.
Objective: Late-onset neonatal sepsis (LOS) is frequently complicated with thrombocytopenia. The aim of this study was determine the prevalence of LOS, and whether platelet indices affect LOS and mortality in neonates with thrombocytopenia in the neonatal intensive care unit (NICU) population. Materials and Methods: This retrospective observational cohort study included neonates admitted to a level 4 NICU between 2018 and 2022 who developed thrombocytopenia (platelet count <150×10⁹/L). Platelet indices were recorded during thrombocytopenic episodes preceding or coinciding with late-onset sepsis (LOS). Multivariable logistic regression and Cox proportional hazards models were used. Results: A total of 223 (13.3%) thrombocytopenic neonates were included in the study. According to multivariable logistic regression analysis, multiparity (OR: 3.32 95% CI 1.40-7.89, p=0.006), caesarean section (OR: 5.81, 95% CI 1.99-16.89, p<0.001), invasive ventilation (OR: 8.43 95% CI 3.60-19.75, p<0.001, high MPV levels (OR: 1.62 95% CI 1.24-2.12, p<0.001) and duration of thrombocytopenia (OR: 1.13 95% CI 1.06-1.20, p=0.001), duration of hospitalization (OR: 1.03 95% CI 1.01-1.05, p=0.004) were independently associated with the development of LOS. Multivariable Cox hazard modelling demonstrated that invasive ventilation (HR: 9.459, 95% CI 3.38-26.45, p<0.001), platelet transfusion (HR: 2.833 95% CI 1.54-5.20, p=0.001), lymphopenia (HR: 0.766, 95% CI 0.64-0.92, p=0.003), grade 2≥ of NEC (HR: 7.274, 95% CI 1.68-31.52, p=0.008), any type of haemorrhage (HR: 2.728, 95% CI 1.69-9.10, p=0.001), platelet nadir (HR: 0.972, 95% CI 0.96-0.98, p<0.001), MPV (HR: 0.805, 95% CI 0.66-0.98, p=0.032), and lymphopenia (HR: 0.745, 95% CI 0.63-0.89, p=0.001) independently predicted overall mortality. Conclusion: Key findings indicate that larger platelet sizes, prolonged thrombocytopenia, and extended hospitalization are linked to late neonatal sepsis. Furthermore, lower platelet levels characterized by smaller platelet sizes and the necessity for platelet transfusions may also contribute to these adverse outcomes.
Objective: The purpose of our study was to examine the association between endoscopically diagnosed Helicobacter pylori (HP) gastritis and hepatosteatosis, and to investigate the correlation between the presence of HP and biochemical and anthropometric measurements in children. Materials and Methods: Patients who were followed up in the Pediatric Gastroenterology outpatient clinic of Kayseri City Training and Research Hospital and underwent esophagogastroduodenoscopy performed by the attending gastroenterologist were evaluated. Patients aged between 2 and 18 years, with a histopathological diagnosis of gastritis, both HP positive and negative, were enrolled in the study. Results: In patients with HP-positive gastritis, the incidence of hepatosteatosis was found to be statistically significantly higher compared to those with HP-negative gastritis (χ² = 22.704; p <0.001). A statistically significant weak positive correlation was found between the density of HP and the grade of hepatosteatosis (rho = 0.344; p <0.001). Conclusion: The HP-positive gastritis in children is associated with the development of hepatosteatosis, and the higher grade of hepatosteatosis in patients with HP-positive gastritis suggests that HP gastritis may impact the development of fatty liver.
Objective: The aim of this study was to examine the relationship between motor performance and sensory processing skills and quality of life in preschool children with type 1 diabetes (T1DM). Materials and Methods: The study included children with T1DM aged between 60 and 78 months. Sociodemographic information of the children was recorded. Motor performance were assessed using the “Bruininks-Oseretsky Motor Competency Test 2 (BOT 2),” sensory processing skills using the “Sensory Processing Scale (SPM) House Form,” and quality of life using the “Children’s Quality of Life Scale (CQL). Results: A total of 20 children with T1DM were included in the study. In the relationship between BOT 2 and CQL, the following BOT 2 parameters were found to be associated with CQL; fine motor sensitivity [physical functioning (r=-0.510, p=0.020), school functioning (r=-0.580, p=0.010), and total CQL score (r=-0.550, p=0.010)], fine motor integration [emotional functioning (r=-0.450, p=0.040), psychosocial health (r=-0.570, p=0.010), and total CQL score (r=-0.520, p=0.010)], hand dexterity [school functioning (r=-0.480, p=0.020)], and bidirectional coordination [physical functioning (r=-0.450, p=0.040)]. A moderately positive correlation was found between physical functionality and the SPM parameters body awareness (r=0.049, p=0.020), planning and ideation (r=0.047, p=0.030), and total SPM score (r=0.450, p=0.040). A moderately positive correlation was found between planning and ideation and the total CQL score (r= 0.440, p= 0.040). Conclusion: In preschool children with T1DM, impairments in motor skills and sensory processing abilities are associated with quality of life. It is recommended to assess motor performance and sensory processing skills in early childhood.
Objective: Maternal nutrition is increasingly recognized as a modifiable determinant of fetal cardiovascular development. Experimental and epidemiological studies suggest that iron deficiency may contribute to congenital heart disease, but data focusing on ventricular septal defect (VSD) remain limited. This study aimed to evaluate the association between maternal iron status and isolated perimembranous VSD in offspring. Materials and Methods: This single-center retrospective case–control study included mothers of 41 infants younger than one year with isolated perimembranous VSD and 38 control mothers whose infants had no structural heart disease after echocardiographic evaluation. Maternal laboratory parameters were retrieved from electronic medical records, and the earliest available results were used for analysis. Evaluated parameters included hemoglobin, ferritin, vitamin B12, folate, and 25-hydroxyvitamin D. Group comparisons were performed using the Mann–Whitney U test or chi-square test, as appropriate. Binary logistic regression was used to assess independent associations with VSD, and receiver operating characteristic analysis was performed for ferritin. Results: Maternal ferritin levels were significantly lower in the VSD group than in controls (median 25.8 [IQR 15.5–52.0] vs 57.9 [IQR 21.3–79.3] ng/mL, p=0.012), whereas maternal hemoglobin, vitamin B12, folate, and vitamin D levels did not differ significantly. In multivariable logistic regression adjusted for maternal age, hemoglobin, vitamin B12, and folate, ferritin remained independently associated with VSD (OR 0.83 per 10-ng/mL increase, 95% CI 0.72–0.96, p=0.012). Ferritin showed moderate discriminative ability for VSD (AUC 0.665, 95% CI 0.537–0.781). Conclusion: Lower maternal ferritin levels were associated with isolated perimembranous VSD in offspring, independent of hemoglobin levels. These findings suggest that reduced maternal iron stores may be relevant to fetal septal development and warrant confirmation in prospective studies with measurements obtained during early pregnancy.
Objective: Cytomegalovirus (CMV) pneumonia in immunocompetent children remains underrecognized, and standardized diagnostic criteria are lacking. We aimed to describe the clinical characteristics of immunocompetent children with CMV pneumonia and to evaluate the relationship between bronchoalveolar lavage (BAL) fluid and serum CMV DNA loads and laboratory results. Materials and Methods: In this retrospective cohort study, medical records of 62 immunocompetent children who underwent flexible bronchoscopy for recurrent pneumonia or persistent wheezing between November 2023 and January 2025 were reviewed. CMV pneumonia was defined by detection of CMV DNA in BAL using real-time polymerase chain reaction (PCR). Quantitative CMV DNA load in BAL and serum were expressed as international units per milliliter (IU/mL). Demographic, clinical, laboratory, and radiological findings were recorded. Correlations between CMV DNA load in BAL and serum and blood indices were analyzed. Results: Twenty patients (32.2%) were diagnosed with CMV pneumonia. The median age was six years (1.5-9.7), and 55% were male. The most common presenting symptom was chronic cough (85%). Patchy consolidation was the most frequent radiographic finding (45%), while chest computed tomography most commonly demonstrated consolidation (55%), often with bilateral (70%) and multilobar involvement (70%). Serum CMV PCR was positive in six patients (30%). No significant correlation was observed between BAL CMV DNA load (median; 2650 IU/mL; IQR; 311-16874) and serum CMV DNA load (median; 700 IU/mL; IQR; 443-2650) (p > 0.963). BAL CMV DNA load showed a strong positive correlation with serum monocyte count (r = 0.861, p<0.001) and mean platelet volume (MPV) (r = 0.759, p < 0.001). Eleven patients (55%) received intravenous ganciclovir at 5 mg/kg/per dose twice daily for 21 days, and demonstrated clinical and radiological improvement without documented significant adverse effects. Conclusion: BAL CMV PCR demonstrated a higher detection rate than serum CMV PCR in immunocompetent children with recurrent pneumonia or persistent wheezing. Elevated monocyte count and MPV may reflect CMV-related pulmonary inflammation.
Objective: The aim of this study was delineate the burden of low lumbar bone mineral density (BMD) in children with CD (celiac disease) and evaluate differences in BMD according to assessment timing and gluten-free diet (GFD) adherence, using concurrent tissue transglutaminase IgA (c-tTG-IgA), and describe accompanying anthropometric and biochemical profiles. Materials and Methods: This retrospective cohort included CD patients (n=123) aged 5–18 years who underwent dual-energy X-ray absorptiometry (DEXA) between January 1, 2022, and December 31, 2024. Age-adjusted and height-adjusted BMD z-scores (BMD-AAz and BMD-HAz) were calculated. Patients were grouped as diagnosis or follow-up (≥12 months), and follow-up was subdivided into GFD-non-adherent follow-up group (FU-NonAdh) and GFD-adherent follow-up group (FU-Adh). Results: Low BMD based on BMD-HAz (≤−1) was present in 37.4% (osteopenia 24.4%; osteoporosis 13.0%). Compared with diagnosis group, follow-up group had higher BMD-AAz and BMD-HAz (p=0.022 and p=0.011). BMD-HAz was higher in FU-Adh group than in diagnosis and FU-NonAdh group (p<0.001 and p=0.005), whereas FU-NonAdh group did not differ from diagnosis group. The low BMD group had a lower body mass index (BMI) z-score and shorter GFD duration (p<0.001 and p=0.010). Serum calcium levels were lower in the osteoporosis group than in the normal BMD group (p=0.003). Conclusion: Lumbar BMD impairment is frequent in pediatric CD, with the most evident improvement in the GFD-adherent follow-up group. In secondary analyses, lower BMI z-scores and shorter GFD duration were observed in children with low BMD, which may help inform risk stratification.
Hodgkin lymphoma (HL) in pediatric patients typically presents with mediastinal and supradiaphragmatic lymphadenopathy. Predominant skeletal involvement at diagnosis is exceptionally rare and represents a significant diagnostic challenge. We present the case of a 10-year-old child with a 6-month history of progressive weight loss, right hip pain, and gait disturbance. Initial imaging suggested non-malignant orthopedic conditions, but further studies revealed multifocal osteolytic bone lesions. A bone biopsy ultimately confirmed classical Hodgkin lymphoma. A Positron Emission Tomography/Computed Tomography (PET/CT) scan demonstrated intensely hypermetabolic osseous lesions with only minimal, disproportionately mild, nodal disease. Based on the Lugano classification, the patient was classified as Ann Arbor stage IV. The patient exhibited rapid clinical improvement following the initiation of OEPA (Vincristine, Doxorubicin, Etoposide, Prednisone) induction chemotherapy. This case underscores the importance of including lymphoproliferative disorders in the differential diagnosis of unexplained multifocal osteolytic lesions in children and highlights the critical role of timely tissue biopsy.
Objective: Childhood obesity is a growing global health problem linked to chronic inflammation and metabolic complications, including dyslipidemia, insulin resistance, type 2 diabetes mellitus, nonalcoholic fatty liver disease, and hypertension. Fetuin-A, a hepatokine involved in insulin signaling and inflammation, has been studied in adults, but its role in pediatric obesity is unclear. This study evaluated fetuin-A levels in obese adolescents and their association with anthropometric and metabolic parameters. Materials and Methods: This cross-sectional study included 40 obese adolescents (BMI > 95th percentile) and 30 healthy controls (BMI between the 15th and 85th percentiles) who had no additional systemic diseases and were not receiving any medication. Anthropometric measurements and fasting glucose, insulin, high-sensitivity C-reactive protein, and fetuin-A were assessed. The presence of dyslipidemia, hepatic steatosis, and hypertension was evaluated. Results: Hs-CRP levels were significantly higher in obese patients than in controls (p=0.015) However, fetuin-A levels did not differ significantly between the groups. Fetuin-A showed no correlation with insulin resistance, lipid parameters, hepatic steatosis, or hypertension. Conclusion: Obesity-related complications (insulin resistance, dyslipidemia, fatty liver, and hypertension) were observed in more than half of our group. Although hs-CRP levels of obese cases were high, fetuin-A concentrations were observed to be similar in all cases and in subgroup analyzes. It may be due to factors affecting fetuin-A levels or its posttranslational modification. Further large-scale longitudinal studies are required to elucidate its contribution to metabolic inflammation in children.
Objective: The aim of this study was to evaluate potential neuroinflammatory processes in pediatric migraine using hematological inflammatory indices and to examine their associations with age and gender. Materials and Methods: This retrospective cross-sectional study included 90 children diagnosed with migraine and healthy control group, conducted between August 1, 2019, and August 1, 2025. Complete blood count parameters were analyzed for all participants. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and other hematological inflammatory markers were calculated. Comparisons were made between the migraine and control groups. Additionally, the migraine group was subdivided according to age, gender, and treatment status, and subgroup analyses were performed. Results: Platelet-to-lymphocyte ratio values were significantly higher in the migraine group than in the control group. In gender-based comparisons, a statistically significant difference was observed only in red blood cell (RBC) counts, whereas no gender-related differences were detected in other inflammatory parameters. Within the migraine group, lymphocyte counts decreased in the older age subgroup, while platelet counts and NLR values showed a significant increase. Among patients receiving flunarizine treatment, no significant differences were observed in inflammatory markers, except for mean corpuscular volume (MCV). Conclusion: Platelet-to-lymphocyte ratio may serve as a marker of increased inflammatory burden in pediatric patients with migraine. The age-related increase in inflammatory indices may reflect neuroinflammatory processes involved in migraine pathophysiology. These findings highlight the importance of considering age in the clinical evaluation of pediatric migraine patients.
Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems and is characterized by periods of flare-ups and remission. In approximately 15-20% of SLE patients, clinical symptoms onset during childhood or adolescence and are defined as juvenile SLE (jSLE). Age at disease onset has been suggested to influence the clinical phenotype, severity of inflammatory activity, and overall disease course in jSLE. The aim of this study was to compare clinical features and disease course between prepubertal (<10 years) and pubertal (≥10 years) jSLE patients. Materials and Methods: This retrospective, single-center, cross-sectional study was conducted on patients diagnosed with jSLE who were followed up at the pediatric rheumatology clinic between January 2015 and September 2025. Patients included in the study had been diagnosed with jSLE according to the 2012 Systemic Lupus International Collaborating Clinics classification criteria. Results: A total of 54 patients with juvenile-onset SLE were included, of whom 88.9% were female. Patients were grouped according to age at diagnosis: prepubertal-onset jSLE (<10 years) included 9 patients (16.7%), and pubertal-onset jSLE (≥10 years) included 45 patients (83.3%). Fever and elevated C-reactive protein levels were significantly more common in jSLE with pre-pubertal onset, whereas mucocutaneous involvement was more prevalent in jSLE with pubertal onset. Renal, hematological, and neurological involvement, autoantibody profiles, and disease activity and damage index at diagnosis were similar across groups. At the last visit, disease activity was significantly lower in jSLE with pre-pubertal onset. No differences in treatment were observed between age groups. Conclusion: In this cohort, prepubertal-onset jSLE tended to present with more prominent inflammatory features, whereas pubertal-onset jSLE more often showed mucocutaneous involvement. Despite these observed phenotypic differences, cumulative organ damage appeared similar between groups.
Objective: Thrombocytosis, particularly in children, can lead to spurious biochemical findings such as pseudohyperkalemia, which may result in unnecessary interventions if unrecognized. This study aimed to evaluate the effect of platelet count on serum potassium levels in children with thrombocytosis and to analyze the association between potassium levels and the etiological factors of thrombocytosis. Materials and Methods: In this retrospective study, 1899 pediatric patients with platelet counts >600×10⁹/L were analyzed over one year. After excluding conditions that could affect serum potassium (e.g., essential thrombocytosis, anemia, polycythemia/leukocytosis, renal or hepatic disease, and hyperbilirubinemia), 1210 cases of reactive thrombocytosis were included. Patients with available serum potassium measurements and follow-up data at 3 and 6 months were assessed. Results: The mean age of the 1210 patients was 2.7±3.4 years, and 54.8% were male. Thrombocytosis was primarily due to infections (71.8%) and surgery, burns, or trauma (28.2%). Platelet counts ranged from 600×10⁹/L to 2.193×10⁹/L, and serum potassium levels from 2.47 to 9.3 mEq/L. Hyperkalemia occurred in 20.4% of patients, increasing with higher platelet counts (16.7% for 600–900×10⁹/L, 29.1% for 900–1000×10⁹/L, and 33.5% for >1000×10⁹/L). Significant decreases in platelet and potassium levels were observed at 3- and 6-month follow-ups (p<0.001). A weak positive correlation was observed between platelet and potassium levels (r=0.187), more pronounced in infection-related cases (r=0.218). Potassium increased by 0.06 mEq/L for every 100×10⁹/L rise in platelet count, with a significant correlation only above 1000×10⁹/L (r=0.196, p=0.038). Conclusion: Pseudohyperkalemia is a common yet overlooked phenomenon in pediatric thrombocytosis. Recognizing the quantitative platelet–potassium relationship can prevent diagnostic confusion and unnecessary treatment.
Objective: Bronchoalveolar lavage (BAL) is a widely used diagnostic tool for evaluating lower respiratory tract infections and pulmonary pathologies in children. BAL provides valuable diagnostic information and can significantly influence management strategies, particularly in patients with malignancy, immunodeficiency (ID), or critical illness. This study aimed to assess the diagnostic and therapeutic value of BAL in pulmonary fungal infections. Material and Methods: This retrospective study analyzed BAL samples obtained by flexible fiberoptic bronchoscopy (FFB) between 2019 and 2024 in the Pediatric Pulmonology Department of a tertiary referral center. Among 668 patients who underwent FFB, those with BAL fungal culture, BAL Aspergillus DNA PCR, and BAL galactomannan antigen (GM) testing were included. Demographic, clinical, radiological, and bronchoscopic findings, as well as antifungal treatment modifications based on BAL results, were evaluated. Results: BAL results from 668 patients were reviewed. Fungal culture was performed in 236 (35.3%), Aspergillus DNA PCR in 127 (19%), and GM in 121 (18.1%) patients. Among those tested for fungal culture, 58.9% were male, with a mean age of 7.0 years (±5.7). Fungal culture positivity was found in 26 (11%) patients: Candidaalbicans (n=14), Aspergillus spp. (n=5), Candidadubliniensis (n=3), Aspergillus fumigatus (n=3), and Penicillium spp. (n=1). Culture positivity was significantly higher in patients with malignancy (p=0.011). BAL Aspergillus DNA PCR was positive in two patients, and BAL GM in five. Based on BAL results, antifungal therapy was modified in seven patients. Conclusion: BAL fungal culture, BAL GM, and Aspergillus PCR testing are valuable diagnostic tools for pulmonary fungal infections in children, especially those with malignancy or immunodeficiency (ID). The observed treatment modifications following BAL results emphasize their clinical importance not only in establishing diagnosis but also in guiding and optimizing antifungal therapy.
Objective: Vascular access is a critical factor in the monitoring and treatment of neonates requiring intensive care. In this context, peripherally inserted central catheters (PICCs) are one of the primary methods for safely and for extended periods in neonates, compared to traditional central vascular access routes. This study aimed to evaluate the indications and complications of PICC placement and to raise awareness of the development and implementation of protocols to prevent complications. Materials and Methods: In this study, after obtaining approval from the Ethics Committee, the indications, compositions, and clinical outcomes of patients born at Mersin City and Education Hospital between 01.01.2024-01.10.2025, weighing ≤1500 g and those who had peripheral central catheters left in place, were evaluated retrospectively. Results: A total of 89 patients were included in the study. Forty-nine cases were male (44.9 %). Forty-nine of the cases were 28 weeks of gestation or less. Thirty-three cases were inserted due to prematurity, forty-two due to feeding difficulties, and three due to pre/post-operative complications. The median PICC placement day was 5 d (4-12.5), and the median weight was 1020 g (780-1310). Nineteen cases developed complications related to PICCs. Among the complications, phlebitis was the most common (47.4%). Four patients required catheter removal due to infection. Nine patients (10.1%) died. Eighty patients (89.9%) were discharged after recovery. Conclusion: Peripherally inserted central catheters play a crucial role in neonatal intensive care by providing reliable, long-term venous access in neonates. When used with appropriate indications, strict aseptic technique, and standardized care protocols, they provide a healthy and safe vascular pathway for newborns with low complication and infection rates. A specialized team approach, guided by protocols, can enhance the quality of care in the neonatal intensive care unit.
