Turkish archives of pediatrics最新文献

Objective: The aim of this study is to evaluate how the frequent sugar and protein intake is associated with the severity of plaque-induced gingivitis in children. Materials and Methods: A cross-sectional study was conducted, involving 38 subjects (4-14 years) at a mean age of 8.5 ± 2.32 years with diagnosed plaque-induced gingivitis based on the Löe-Silness Gingival Index (GI) (0 < GI ≤ 3). The gingival status was assessed by the Silness-Lőe Plaque Index (PLI), GI, and Papillary Bleeding Index by Saxer and Muhlemann. The nutritional status was established through an in-depth questionnaire on protein and sugar intake. Results: The increased frequency of sugar consumption in children with plaque-induced gingivitis is related to enhanced gingival inflammation. Higher values of PLI among the rep- resentatives were established with frequent sugar intake (P = .04). Frequent dairy protein con- sumption was associated with lower levels of PLI (P = .04). This index is indicative of the amount of accumulated dental plaque, which is the main etiological factor involved in plaque-induced gingivitis. Conclusion: It can be concluded that uncontrolled sugar consumption in children was asso- ciated with enhancement of the severity of plaque-induced gingivitis. Frequent dairy protein intake has the potential to serve as an essential prevention strategy regarding the onset and aggravation of plaque-induced gingival inflammation in childhood. A well-balanced diet, rich in proteins and with restricted sugar intake, is considered a possible tool in the prevention and control of plaque-induced gingivitis in childhood.

Objective: With the World Health Organization's (WHO) implementation of the "test and treat all" policy in 2016, there should have been a great change in mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and its determinants. This study aimed to assess MTCT of HIV after the adoption of the universal "test and treat" policy. Materials and Methods: A retrospective cohort study of HIV-exposed infants (HEIs) between the ages of 6 weeks to 18 months enrolled from 1 January 1, 2017 to December 31, 2021. The study was carried out at the "Prevention of Mother to Child Transmission" center (PMTCT) of the HIV unit, Regional Hospital Bamenda (RHB) of the Northwest region of Cameroon. Data was col- lected from files with the aid of predesigned data collection forms. Results: During the study, out of the 294 HEIs included, 13 were positive, giving a frequency of 4.4%. Not taking antiretrovirals by the mother, or taking them 4 weeks prior to delivery, or after delivery, mixed feeding, and breastfeeding duration greater than 12 months were determinants of MTCT of HIV. Also, 4 out of the 294 exposed infants died, giving a death rate of 1.4%. No fac- tor analyzed was found to be significantly associated with the death rate of HEIs at 18 months. Conclusion: This study showed a reduction in the frequency of MTCT of HIV due to the imple- mentation and adoption of the universal "test and treat" policy. Also, starting maternal anti- retroviral treatment after delivery and a breastfeeding duration greater than 12 months were associated with MTCT of HIV.

Objective: Investigating the validity and reliability of the Turkish versions of the obesity-specific health-related quality of life perception scales for children and parents , Sizing Me Up/Sizing Them Up (SMU/STU), was the aim of this study. Materials and Methods: Sizing me up/sizing them up were translated into Turkish following a standardized translation procedure. Test-retest reliability, internal consistency, discriminant and convergent validity, as well as confirmatory factor analysis (CFA) were all assessed. Results: Sizing me up /sizing them up had a total scale Cronbach's alpha of 0.873, 0.872. In the test-retest evaluations, significant correlation was found in the SMU (except the Teasing/ Marginalization subscale), while no correlation was found in the Physical Functioning, Teasing/ Marginalization, School and Mealtime Difficulties subscales in the STU. The Pediatric Quality of Life Generic Core Scales (PedsQL) total mean score and the SMU/STU total mean scores exhibited a significant correlation (r=0.671, P < .0001/r=0.663, P < .001). Regarding the SMU total scale score and other subscale scores, excluding the Social Avoidance subscale, and the STU total scale score and other subscale scores, excluding Mealtime and School Functioning, a significant difference was found between the OB and non-OB samples. In CFA, the com- parative fit index (CFI) and root mean square error of approximation (RMSEA) values were not compatible with the expected values. Conclusion: The results demonstrated that both scales are suitable for use in the Turkish context and showed the validity and reliability of the Turkish versions of the SMU/STU; however, some inconsistencies were found in the items related to social avoidance in the SMU scale and posi- tive social attributes, mealtime challenges, and school functioning in the STU, so it is recom- mended that these items should be interpreted separately and carefully when evaluating scale scores by researchers or clinicians.

Objective: Enthesitis is rare in chronic nonbacterial osteomyelitis (CNO) compared to enthesi- tis-related arthritis. It may be asymptomatic in CNO patients. This study aimed to evaluate the presence of subclinical enthesitis in patients with CNO using ultrasonography (US). Materials and Methods: Patients with CNO were included in this study and evaluated with US by an expert pediatric radiologist. The entheses of 7 tendons were assessed bilaterally, includ- ing the common extensor and flexor tendons, the quadriceps tendon, the proximal and distal patellar tendons, the Achilles tendon, and the plantar fascia. Results: Fifty CNO patients were included. The median age of the patients was 12.4 years, and 58% were female. Subclinical enthesitis was identified in 3 patients (6%). These 3 patients were male, older than 6 years at diagnosis, had bilateral sacroiliitis, and were positive for human leukocyte antigen-B27. The enthesitis was located in the right quadriceps, right plantar fascia, and bilateral Achilles. One of these patients also had a clinical history of enthesitis at diagnosis. Treatment modification was not done when subclinical enthesitis was detected since they were in clinical remission and acute phase reactants were within normal limits. However, the patient with bilateral subclinical Achilles enthesitis had a disease flare afterward, and methotrexate was switched to etanercept. Conclusion: Subclinical enthesitis can be observed especially in CNO patients with overlappin- genthesitis-related arthritis features. The use of US may prove beneficial in detecting subclini- cal enthesitis and predicting disease flare.

Objective: Pediatric patients with histopathologically confirmed granulomatous lymphade- nopathy were evaluated etiologically. Materials and Methods: In this study, patients who presented to the tertiary pediatric infec- tious disease clinic with histopathologically confirmed granulomatous lymphadenopathy were retrospectively reviewed, and the etiological evaluation of granulomatous inflammation based on patient history, clinical findings, and additional tests were presented. Results: The study included 91 patients. In the study, 48 (52.7%) patients underwent biopsy from the cervical region, 21 (23.1%) patients underwent biopsy from the axillary region, 13 (14.3%) patients underwent biopsy from the submandibular and 9 (9.9%) patients underwent biopsy from lymph node sites other than these regions. Cervical lymphadenopathy was more common in patients over the age of 10, while axillary lymphadenopathy was more common in patients under the age of 5. A statistically significant difference was found between the age groups in the biopsy sites (P=.007). When the etiology of the patients was examined, it was found that 78 (85.7%) patients had infectious and 3 (3.3%) patients had non-infectious causes. The cause could not be determined for 10 (11%). There was a difference in etiology frequency according to the lymphadenopathy locations (P=.001). Conclusion: In this study, the most common etiology of granulomatous lymphadenopathy was shown to be infections, especially mycobacteria. Less common were toxoplasmosis, aspergil- lus, and cat scratches. Among non-infectious causes, chronic granulomatous disease should be kept in mind.

Objective: The aim was to investigate the rates, duration, and possible influencing factors of breast milk feeding (BMF) in preterm infants in the neonatal intensive care unit (NICU) at discharge and in the first year of life. Materials and Methods: In a retrospective cohort study, 173 preterm infants <37 weeks who were hospitalized in the NICU were evaluated. Information was obtained from hospital records and mothers via telephone. Results: The BMF rate was 90.7% with 62.4% exclusively breastfeeding (EBF) and 28.3% partially breastfeeding at discharge. The exclusive, partial, and formula feeding rates were 53.7%, 27.7%, 18.5% and 43.9%, 37%, 19.1% at 4 and 6 months, respectively. The median EBF and total BMF durations were 4 (1-6) and 12 (4.5-24) months, respectively. Very preterms were weaned at a higher rate in the first 6 months compared to moderate and late preterms (50%, 26.3%, 33.3%, P=.046, respectively). EBF at discharge was significantly associated with EBF at 4 and 6 months by chronological and corrected age. The BMF rate for >12 months was higher for multiparous mothers (56.40%, 36.10%, P=.02). Total BMF duration was shorter in preterms with sepsis compared to those without sepsis (median 5 (1-12) and 12.5 (5-24) months, P=.02). It was positively correlated with gestational age (P=.046, r = 0.13), birthweight (P=.012, r=0.17), APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores 1-minute (P=.002, r = 0.22) and 5-minutes (P=.016, r = 0.16), and maternal age (P < .001, r = 0.25) and negatively correlated with the length of stay in the NICU (P=.031, r=-0.14) and the intubation time (P=.006,r= -0.41). Conclusion: To improve breastfeeding, EBF should be aimed at discharge in all preterms. After discharge, breastfeeding support and close follow-up should be continued for all preterms, especially very preterms.

Adrenal insufficiency presents a significant clinical challenge due to its diverse etiologies and potentially life-threatening consequences. This review highlights the spectrum of adrenal insuf- ficiency, focusing on primary adrenal insufficiency (PAI). Childhood PAI, predominantly con- genital, presents unique diagnostic and management considerations. An aspect of this review is the discussion of PAI related to non-congenital adrenal hyperpla- sia, particularly adrenocorticotropic hormone (ACTH) resistance syndromes and autoimmune adrenal insufficiency. The clinical presentation, diagnosis, and treatment management of these rare childhood PAI types are assessed through 5 case studies. Despite advancements in genetic understanding, some cases are unsolved and remain diag- nostic mysteries. There is a need for further research and elucidation of molecular etiopatho- genesis in adrenal insufficiency. Clinicians are pivotal in identifying these rare diseases and providing lifesaving outcomes.

Objective: Growth hormone neurosecretory dysfunction (GH-NSD) is a rare cause of short stat- ure. Diagnosis is established by evaluating nocturnal growth hormone secretion in patients with normal growth hormone stimulation tests. The aim of this study was to evaluate the first- and second-year treatment responses and final height in patients diagnosed with GH-NSD and treated with recombinant human growth hormone (rhGH). Materials and Methods: This retrospective study examined 500 patients treated with rhGH for short stature at a pediatric endocrinology clinic at Akdeniz University. Among them, 18 patients diagnosed with GH-NSD were included in the study. At the time of treatment initiation, param- eters such as insulin-like growth factor 1 (IGF-1), growth hormone (GH) stimulation test results, mean GH level during sleep, height standard deviation score (SDS), mid-parental height (MPH), and predicted adult height (PAH) were assessed. Treatment responses during the first and second years, as well as final height data, were analyzed. Results: GH therapy improved height velocity (HV) and overall height. The mean baseline height SDS of the patients was -3.13 ± 0.36. In the first year, Δheight SDS was 0.72 ± 0.44, and in the second year, Δheight SDS was 1.00 ± 0.70. Patients who reached their final height had a mean height SDS of -1.72 ± 0.83 and Δheight SDS of 1.46 ± 0.62. A correlation was found between the baseline height SDS, PAH SDS, MPH SDS, and first-year HV. Conclusion: Patients with GH-NSD treated with rhGH respond well to treatment, achieving genetic height potential.

The transition of the cardiovascular system from fetal life to extrauterine life occurs through different physiological mechanisms. The development of the lungs are parallel to the devel- opment of the cardiovascular system. Cardiac and vascular tone are affected by genetic and environmental factors, including hormonal influences and autonomic reflexes. During the tran- sition period, significant changes occur in preload, myocardial contractility, and afterload. The timing of cord clamping has a profound effect on these changes. Cerebral autoregulation is severely impaired in preterm infants, and cerebral blood flow is almost completely pressure- passive, especially in extremely preterm infants. Disrupted autoregulation is also more frequent in sick infants. Knowledge of transitional factors in different periods is essential for proper man- agement of newborn infants.

Objective: The aim of this study was to assess active standing test responses in ovewrweight or obese children and to determine the factors that contribute to orthostatic abnormalities. Materials and Methods: Orthostatic responses were investigated in bothobese and overweight children. To provide an overview of the autonomic nervous system (ANS), blood pressure and heart rate measurements, laboratory parameters, and anthropometric measures were analyzed. Results: A total of 123 overweight or obese children, with a median age of 15.03 (range from 6.9 to 17.9), were included in this study. Seventy-seven patients (63%) were obese, whereas 46 (37%) were overweight. Orthostatic disturbances were observed in 78 patients (63%). In the standing test, 73 patients (59%) exhibited an abnormal response. Orthostatic hypotension (33%), ortho- static hypertension (30%), and postural orthostatic tachycardia syndrome (18%), were detected in the patients. The group that had orthostatic hypotension had a lower systolic pressure in the standing test after 10 min. The group with orthostatic hypertension had higher body mass index. Furthermore, the orthostatic group displayed significantly higher levels of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), insulin, and HbA1c. Conclusion: The results of this study signifies a connection between obesity or being overweight and ANS, . highlighting the need for evaluation of the ANS in obese or overweight children to predict the adverse consequences and to prevent occuring during childhood.