ABSTRACT Aim Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially life‐threatening hyperinflammatory complication of Crimean‐Congo hemorrhagic fever (CCHF), yet pediatric data remain limited. This study aimed to characterize the clinical phenotype of pediatric CCHF‐associated sHLH and to identify early clinical features associated with sHLH development. Methods PCR‐confirmed pediatric CCHF cases from four tertiary centers in Türkiye (2018–2025) were retrospectively analyzed, and clinical characteristics, laboratory findings, treatment, and outcomes were compared between children with and without sHLH. Results Of 79 patients, 27 (34.2%) fulfilled the diagnostic criteria for sHLH. Compared with children without sHLH, these patients more frequently presented with hemorrhagic findings (44.4% vs. 11.5%, p = 0.002), diarrhea (37.0% vs. 7.7%, p = 0.004), and bradycardia (25.9% vs. 1.9%, p = 0.002), and had lower platelet and fibrinogen and higher ferritin, AST, ALT, and LDH concentrations at diagnosis. On multivariable analysis, bradycardia (OR 11.1, 95% CI 1.7–126.3), hemorrhagic findings (OR 7.1, 95% CI 2.1–26.5), and diarrhea (OR 6.4, 95% CI 1.6–29.0) remained independent predictors; hemorrhagic findings and diarrhea preceded the sHLH diagnosis, whereas bradycardia was identified concurrently. Ferritin and aPTT worsened progressively only in children with sHLH, whereas platelet count declined in both groups. Despite more frequent immunomodulatory therapy and transfusion, no deaths occurred. Conclusions Secondary HLH should be actively considered in pediatric CCHF, particularly with hemorrhagic findings, diarrhea, or bradycardia preceding full laboratory evolution to facilitate earlier diagnosis and timely therapy.
ABSTRACT Background Medication adherence is essential for the effective management of Type 1 diabetes in adolescents. This study investigated the associations between medication adherence and diabetes management self‐efficacy, anxiety, depression, psychological resilience, perceived helicopter parenting, and glycosylated hemoglobin (HbA1c) levels. Methods In the study, Morisky Medication Adherence Scale, Diabetes Management Self‐Efficacy Scale in Adolescents with Type 1 Diabetes Mellitus, The Hospital Anxiety and Depression Scale, Child and Youth Resilience Measure and Helicopter Parent Attitude/s Scale were administered to 142 adolescent participants aged 12–18 years with Type 1 diabetes mellitus. Results Medication adherence was positively correlated with psychological resilience ( r = 0.488; p < 0.001) and negatively correlated with diabetes management self‐efficacy total score and anxiety level ( r = −0.501; p < 0.001 and r = −0.242; p = 0.004, respectively). In group analysis, it was found that self‐efficacy and psychological resilience levels were higher and anxiety and depression levels were significantly lower in the group with high medication adherence. In regression analysis, psychological resilience ( B = 0.046; p = 0.007), diabetes management self‐efficacy ( B = −0.035; p = 0.002) and anxiety ( B = −0.085; p = 0.015) were independently associated with medication adherence. Significant negative relationships were found between medication adherence and perceived helicopter parenting sub‐dimensions, between medication adherence scores and mother basic trust ( r = −0.167; p = 0.048), mother ethics ( r = −0.181; p = 0.032), father basic trust ( r = −0.194; p = 0.022) and father ethics ( r = −0.186; p = 0.028) sub‐dimensions. Conclusions These findings indicate that diabetes management self‐efficacy, psychological resilience, anxiety, depression, and helicopter parenting attitude are associated with adherence to medication. Given the cross‐sectional design, longitudinal, multicentre, and multi‐informant studies are needed to clarify the temporal direction of these relationships.
ABSTRACT Background To evaluate temporal changes in serum interleukin‐40 (IL‐40), hypoxia‐inducible factor‐1 alpha (HIF‐1α), and procalcitonin (PCT) levels between early and post‐rewarming measurements in neonates with moderate‐to‐severe hypoxic–ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH), and to determine the prognostic value of these biomarkers together with the Hammersmith Neonatal Neurological Examination (HNNE), amplitude‐integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI) for predicting cerebral palsy (CP). Methods Thirty‐five neonates with HIE treated with TH and 20 healthy term neonates were prospectively enrolled. Serum IL‐40, HIF‐1α, and PCT levels were measured before and after TH. Associations between biomarkers, HNNE, aEEG, MRI findings, and CP at follow‐up were evaluated. Results Serum IL‐40, HIF‐1α, and PCT levels decreased significantly between the early and post‐rewarming measurements (all p < 0.001). Although biomarker levels differed from controls, they were not associated with subsequent CP. In contrast, HNNE, aEEG, and MRI showed strong prognostic performance for subsequent CP among surviving infants. Conclusion Serum IL‐40, HIF‐1α, and PCT levels showed significant temporal decreases between the early and post‐rewarming measurements in neonates with HIE undergoing TH; however, these biomarkers did not predict subsequent CP among surviving infants. HNNE, aEEG, and MRI each demonstrated strong prognostic performance for subsequent CP when evaluated individually in this cohort.
