Turkish archives of pediatrics最新文献

Objective: Social support is a crucial factor that can offer both preventive and protective benefits against mental problems in mothers. This study investigated the associations between social support and depression, anxiety, and stress disorders in Turkish mothers with young children. Materials and Methods: A cross-sectional survey, comprising 27 questions and the "Depression, Anxiety, and Stress Scale (DASS-21)," was administered to mothers with children between the ages of 2-6 years. Results: Among the 542 participating mothers, 56.5% were employed, 62.2% reported receiving social support, and 53.7% of the children attended nursery or kindergarten. The percentage of participants with high depression scores (>9) was 3.9%, high anxiety scores (>7) was 9.6%, and high stress scores (>14) was 4.1%. Overall, the prevalence of abnormal Depression, Anxiety, and Stress Scale-21 (DASS-21) scores was 11.8%. Multivariate logistic regression analysis revealed that housewives had higher odds of having abnormal DASS-21 scores. Additionally, working mothers without social support and those without access to nursery care had significantly higher rates of abnormal DASS-21 scores. Conclusion: The study emphasizes the importance of social support in improving maternal mental health, particularly for working mothers. Providing adequate social support and access to childcare can enhance maternal well-being, reduce stress, and improve self-efficacy in managing caregiving responsibilities. Future research should focus on developing policies and interventions that strengthen social support networks and improve childcare options to address mental health concerns among mothers.

Objective: To identify the feasibility of achieving the childhood definition of remission, investigate factors affecting achievement and determine the concordance rate with adult definition in children with systemic lupus erythematosus (SLE). Materials and Methods: Medical records of children diagnosed with SLE between 2012 and 2022 were reviewed. The Definitions of Remission in Systemic Lupus Erythematosus (DORIS) definition of remission was used as the adult definition of remission, and a lower glucocorticoid threshold, as proposed, was used for children weighing <50 kg. Cox regression analysis was performed to identify features associated with remission. Results: Among the 50 included patients, 35 (70%) achieved the adult definition of remission in a median of 16 months. While 33 (66%) patients achieved the childhood definition of remission, 25 (76%) achieved both definitions concomitantly. A lower rate of damage (15.2% vs. 52.9%, P= .008) and flare count (median 1 vs. 2, P=.001) were observed in patients with remission despite significantly longer follow-up duration (median 59 months vs. 32 months, P=.007). Survival analysis revealed that the presence of positive anti-dsDNA antibodies (hazard ratio [HR], 0.47; P=.035) and immunosuppressive usage (HR: 0.45, P =.032) were associated with a higher risk of not achieving remission. Conclusion: Childhood definition of remission is achievable in two-thirds of children with SLE and displays substantial concordance with the adult definition. Additionally, the higher risk of failure to achieve remission in children using immunosuppressants reflects a milder course in a subgroup of children who achieved remission and signifies the need for more efficacious treatment modalities for severe manifestations.

Objective: This study aimed to investigate the impact of moderate altitude on neonatal birth weight and growth percentiles at term by controlling for major maternal and fetal risk factors. Materials and Methods: A retrospective, comparative, cross-sectional study was conducted in 2 geographically distinct regions of Türkiye: İstanbul (sea level, 31 m) and Ağrı (moderate altitude, ~1690 m). Pregnant women who delivered at term without comorbidities were included. Maternal demographic and first-trimester hemoglobin and hematocrit levels and neonatal outcomes were collected. Altitude-adjusted hemoglobin values were calculated, and statistical comparisons and multivariate regression analyses were performed. Results: A total of 156 women were included, with 75 in the low-altitude group and 81 in the high-altitude group. Although gestational age did not differ significantly, neonates at high altitude had significantly lower birth weights (3117 ± 424 g vs. 3351 ± 402 g, P < .001) and birth weight percentiles (39.9 ± 27.3 vs. 55.6 ± 26.9, P < .001). In the multivariate linear regression model (F= 6.16, P < .001), male sex and high-altitude residence were independently associated with birth weight percentile (β= +12.88, P =.003, β= -16.05, P = .002). In the high-altitude group, higher maternal hemoglobin levels were independently associated with a lower risk of small-for-gestational-age births (odds ratio [OR] = 0.56, 95% CI: 0.32-0.97, P= .040). Conclusion: Even at moderate altitudes, significant differences in fetal growth outcomes exist, independent of maternal comorbidities. These findings support the need for region-specific growth standards and altitude-aware perinatal surveillance.

Objective: Non-Hodgkin lymphoma (NHL) encompasses a broad range of lymphoid malignancies, among which lymphoblastic lymphoma (LBL) is one of the most prevalent subtypes in pediatric populations. Lymphoblastic lymphoma is further categorized into T-lymphoblastic lymphoma (T-LBL) and precursor B-lymphoblastic lymphoma (B-LBL), collectively representing approximately 20%-25% of all pediatric NHL cases. Advances in treatment strategies adapted from acute lymphoblastic leukemia (ALL) have significantly improved the prognosis of patients diagnosed with LBL. This study aims to review the institutional experience with children diagnosed with LBL and their demographic characteristics, clinical presentation, treatment outcomes, and survival rates over a period of more than 3 decades. Materials and Methods: A retrospective review was performed on children diagnosed with LBL between 1990 and 2022. Information was gathered regarding patient demographics, disease stage at diagnosis, treatment regimens, and clinical outcomes. Results: The cohort included 18 pediatric patients, 13 (72.2%) with T-LBL, and 5 (27.8%) with B-LBL. Most patients with T-LBL presented at advanced stages (III or IV), while patients with B-LBL often presented at earlier stages. T-lymphoblastic lymphoma commonly involved the mediastinum, while B-LBL was associated with skin, lymph node, and skeletal lesions. One patient died from sepsis in the 1990s and 1 from central nervous system relapse, while the rest of the patients survived. Treatment based on ALL regimens resulted in a 5-year event-free and overall survival rate of 88.5%. Conclusion: Modern treatment strategies, including those adapted from ALL regimens, have significantly improved survival outcomes for pediatric LBL patients. This study underscores the effectiveness of these treatments in achieving high survival rates.

Objective: Kawasaki disease (KD) is one of the most common systemic vasculitides and a cause of acquired heart disease in children. The aim was to provide an epidemiological picture of KD with an emphasis on cardiac involvement in Morocco. Materials and Methods: This is a cross-sectional observational study recruiting patients with KD between January 2019 and December 2023. Diagnosis was based on 2017 American Heart Association criteria under the supervision of an expert. Statistical analysis was carried out using the chi-square, Mann-Whitney U, and Fisher's exact tests. Results: Sixty-nine patients were admitted; the mean age was 36 months, the sex ratio was 1.6 (male:female), and the mean days to the first consultation was 10.1. Thirty-nine cases met the criteria for complete forms and 30 for incomplete forms. Coronary dilatations and aneurysms were found in 20 and 7 patients respectively, including 3 giant aneurysms. All patients were treated with intravenous immunoglobulin (IVIG) except 1 and acetylsalicylic acid (ASA), and 23.1% received corticosteroids. Fourteen patients (20.3%) were resistant and 4.3% could benefit from a rescue treatment including second IVIG, Anakinra, and corticosteroids. Six predictive factors of coronary involvement were analyzed and were significant for age ≤ 12 months and ≥ 60 months and delay in IVIG infusion of more than 10 days (P= .045/P = .017). Conclusion: This study demonstrates the importance of raising awareness of KD among primary care physicians, given that a significant proportion of patients were referred from day 10 of fever onward, and paying more attention to extreme ages where coronary involvement is more common.