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Aim:Acute rheumatic fever (ARF) is an endemic disease especially in developing countries. Due to an autoimmune response to group B streptococcus throat infection, ARF develops in susceptible children. Mean platelet volume (MPV) reflects the platelet size and the rate of platelet production. It is important in cardiovascular events and rheumatic diseases. The MPV/platelet count ratio was determined to be more sensitive than MPV alone in patients with hepatocellular carcinoma, deep vein thrombosis and myocardial infarction. The aim of this study was to investigate changes in MPV and the MPV/platelet count ratio during the active and remission periods of ARF compared with healthy subjects.Materials and Methods:This study population consisted with 70 ARF patients and 70 age and gender matched healthy controls. In all subjects, complete blood count; including haemoglobin, white blood cell count (WBC), platelet count, MPV and C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured during the active stage and during the remission period and compared with healthy individuals.Results:There was no statistically significant difference between the ARF and control groups in terms of the sex and age (p>0.05). Forty-one patients in the ARF group had carditis. The ARF patients in the active stage had significantly higher WBC, CRP and ESR values (p<0.05). Although no significant difference was observed in MPV between the groups (p>0.05); the MPV/platelet count ratio was low during the active stage but increased during the remission period and reached the same values as the healthy controls (p<0.001).Conclusion:We did not find any relationship between MPV and ARF. However, a decreased MPV/platelet count ratio was detected during the active stage of ARF. The present findings emphasize the association between the MPV/platelet count ratio and ARF. The MPV/platelet count ratio may be used to determine the activity of ARF.

Purpose To identify the factors that influence provider’s decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. Methods We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. Results Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians ( p  = 0.334) and between specialists, associate professors and professors ( p  = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. Conclusion Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle.

Acute rheumatic fever (ARF) is a systemic inflammatory connective tissue disease and one of the nonsuppurative, delayed complications of pharyngitis or tonsillitis caused by group A beta-hemolytic streptococci.1 Signs and symptoms affecting the joints, heart, brain, or skin arise due to abnormal immune response about three weeks after a typical throat infection.2 The main cause of morbidity and mortality from the disease is carditis; in the acute period, it can lead to heart failure and death due to pancarditis.3 There are no specific biomarkers for the diagnosis of ARF, and evaluating disease activity at presentation is difficult. M-mode measurements were performed at the level of the tips of the mitral valve leaflets in the parasternal long-axis view of the left ventricle (LV).13 Standard parameters measured in parasternal long-axis by M-mode echocardiography included left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness at end-diastole (IVSTd), and left ventricular posterior wall thickness at end-diastole (LVPWTd). RESULTS There was no statistical difference between ARF and control groups in terms of age, sex, weight, height, body mass index (BMI), heart rate, or blood pressure (p>0.05). At admission, the ARF patients had significantly higher white blood cell (WBC) count, platelet count, CRP, erythrocyte sedimentation rate (ESR), fibrinogen, antistreptolysin O (ASO) levels and significantly lower hemoglobin level (p<0.05).

Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. Central nervous system is the most frequent place of both at the onset and relapse of the disease, but orbital involvement is rarely seen. A seven-year-old girl diagnosed with high risk ALL and Turkish ALL-Berlin Frankfurt Münster (BFM)-2000 high risk group treatment was given. However, after induction and consolidation treatments, before the maintenance treatment she had blindness in her right eye. Ophthalmologic examination her visual acuity was fingers to count in two meters. In her right eye there was exudative retinal detachment and her orbital magnetic resonance imaging (MRI) showed that, there was a mass lesion in the posterior of right orbital globe, on the neighbourhood of optic disc, consistent with metastasis. After ALL-REZ-BFM-2002 relapse protocol treatments and radiotherapy her visual acuity was increased to 6/10. In control orbital MRI regression of mass lesion size was established. Bone marrow transplantation was planned. Orbital involvement is rarely seen in leukemia, but it is responsive to chemotherapy and radiotherapy combination.

Background It is suggested that pregnancy risks may be related to microbial dysbiosis, and it is known that knowledge on this subject is reflected in behaviors. The purpose of this study was to investigate whether microbiota awareness in the first trimester of pregnancy is associated with pregnancy-related risks. Methods Within the scope of the study, the microbiota awareness scale was administered to 426 individuals in the first trimester of pregnancy, and information on any diagnosis related to high-risk pregnancy, gestational age, birth weight, and birth height of the newborn was obtained from their file records. Results The mean total microbiota awareness score of individuals was 61.38 ± 11.00 (26.00–91.00). The microbiota awareness score (56.85 ± 11.65) was found to be lower in individuals diagnosed with high-risk pregnancy ( p  < 0.05) than in healthy subjects (63.64 ± 9.94). Moreover, in individuals with high-risk pregnancies, a positive correlation was found between the microbiota awareness score and newborn birth weight and height ( p  < 0.05). Conclusion The poor microbiota awareness level in pregnant women is associated with high-risk pregnancy and neonatal growth status.

Hemophagocytic lymphohistiocytosis (HLH) represents a severe hyperinflammatory condition with cardinal symptoms of prolonged fever, cytopenias, hepatosplenomegaly, and hemophagocytosis by activated, morphologically benign macrophages with impaired function of natural killer cells and cytotoxic T lymphocytes. A 2-month-old girl, who was admitted with fever, was diagnosed with HLH and her genetic examination revealed a newly defined mutation in the UNC13D (c.175G>C; p.Ala59Pro) gene. She was treated with dexamethasone, etoposide, and intrathecal methotrexate. During the second week of treatment, after three doses of etoposide, it was noticed that there was a necrotic plaque lesion on the soft palate. Pathologic examination of debrided material in PAS and Grocott staining revealed lots of septated hyphae, which was consistent with aspergillosis infection. Etoposide was stopped and amphotericin B treatment was given for six weeks. HLH 2004 protocol was completed to eight weeks with cyclosporine A orally. There was no patient with invasive aspergillosis infection as severe as causing palate and nasal septum perforation during HLH therapy. In immunocompromised patients, fungal infections may cause nasal septum perforation and treatment could be achieved by antifungal therapy and debridement of necrotic tissue.

ObjectivesTo examine the relationship between vaccine hesitancy and children’s developmental diagnosis, medical conditions, and family health characteristics in a developmental-behavioral pediatrics outpatient population.MethodsA retrospective chart review was conducted for 895 children who attended the Developmental Pediatrics Clinic at City Hospital between January 2024 and January 2025. Children with missing vaccination information or medical contraindications were excluded. Sociodemographic data, developmental profiles, parental health status, and vaccination adherence were extracted.ResultsA total of 861 children were included. The rate of parental vaccine hesitancy was 2.3% (n = 20). No significant association was found between vaccine hesitancy and children’s developmental diagnosis (p = 0.62) or socioeconomic status (p = 0.42). However, children with chronic medical conditions associated with developmental risk were significantly more likely to exhibit vaccine hesitancy compared to children without such conditions (p = 0.041). Maternal chronic illness was inversely associated with vaccine hesitancy (p = 0.030), while paternal or broader family health status showed no significant associations.ConclusionsVaccine hesitancy in this developmental-behavioral pediatrics sample was not associated with developmental delays but was linked to parental health conditions. These findings emphasize the need for family-centered counseling approaches when addressing vaccine decisions in developmental pediatric populations.

A 12-month-old boy was admitted to our clinic with a soft mass on his left 10th rib, which was first noticed 20 days prior when he presented with swelling in the anterior chest wall. The patient had no history of chronic disease, contact with sick people, or weight loss, fever, or night sweats. Upon physical examination, his vital signs were normal, but on his left side between his 9th and 10th ribs there was a soft and fixed mass that was 6 x 5 cm in diameter. His abdominal, cardiovascular, and pulmonary examinations were normal and he had a Bacillus Calmette-Guerin vaccine scar on his left shoulder.

Aims: To evaluate the clinical characteristics that distinguish the leiomyoma variants from the ordinary ones, as well as the recurrence risk and patterns of these tumors. Methods: This retrospective, case-control study included women diagnosed with uterine leiomyoma between 2009 and 2019 at a tertiary referral center in Turkey. The clinical characteristics of patients diagnosed with cellular leiomyoma (CL), leiomyoma with bizarre nuclei (LBN), mitotically active leiomyoma (MAL), and ordinary leiomyoma (OL) were examined. Disease recurrence and patterns of variants were evaluated. Results: Among the 1,581 women with uterine leiomyoma, the incidence of CL, LBN, and MAL were 2.9%, 1.2%, and 1.3%, respectively. The occurrence for a single mass (63% in CL, 78.9% in LBN, 61.9% in MAL, 38.8% in OL; p=0.001) was more common, and the diagnosis of intramural leiomyoma (67.4% in CL, 73.7% in LBN, 71.4% in MAL, 90.8% in OL; p=0.002) was less frequent in the leiomyoma variant groups compared with the OL group. Recurrent leiomyosarcoma was observed in one woman with MAL. Conclusions: This study showed that single mass rate was higher and intramural leiomyoma rate was lower in leiomyoma variants than in ordinary variants. Although rare, leiomyoma variants carry a risk of malignant recurrence after hysterectomy, suggesting the need for long-term follow-up. Keywords: Cellular leiomyoma, leiomyoma variant, leiomyoma with bizarre nuclei, mitotically active leiomyoma, recurrence

Background. Intrauterine devices (IUD) are commonly used birth control methods. Colonic perforation is an infrequent but serious complication of IUD. Case. A 34-year-old woman with 2-years history of IUD, inserted at early puerperal period, presented to gynecologist with chronic pelvic pain and dyspareunia. Radiological assessment revealed that there were two copper-T devices: one in uterine cavity and another in the colonic lumen. Attempts of retrieval with colonoscopy and laparoscopy were unsuccessful. Intrauterine device embedded in sigmoid colon wall was removed with resection of the involved segment and primary anastomosis was performed. Conclusion. Although there are cases in literature that are successfully managed with colonoscopy, in chronic cases, formation of granulation tissue complicates retrieval of an IUD by this intervention.