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This study aimed to evaluate and compare changes in the posterior segment of pediatric asthma patients, potentially associated with asthma or inhaled corticosteroids. A retrospective analysis was conducted on children aged 7–17 diagnosed with atopic asthma. The participants were categorized into groups: Group 1 (no inhaled corticosteroids) and Group 2 (inhaled corticosteroid treatment). A control group of healthy children was also included. Demographic data, clinical findings, and laboratory results (e.g., eosinophil count, IgE, CRP levels) were collected. Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to measure posterior segment parameters. Asthma patients demonstrated a statistically significant reduction in subfoveal choroidal thickness, the superficial capillary plexus in the superior and nasal quadrants, the choriocapillaris in the foveal quadrant, and the peripapillary vascular density in the inferior and superior quadrants compared to controls. Inflammation markers such as eosinophil count and CRP showed significant correlations with changes in vascular density. Asthma, as a chronic inflammatory and hypoxic condition, can significantly affect posterior segment parameters, leading to potential visual function impairments in children. Regular monitoring with OCT and OCTA can help detect early microvascular changes, allowing for timely interventions to preserve visual health.

This study aimed to identify the biopsychosocial stressors influencing child and adolescent mental health during periods when facetoface education was suspended and to evaluate the psychological sequelae of school closures and related restrictions. We conducted a retrospective observational study at Kartal Dr. Lütfi Kırdar City Hospital, a tertiary care center in İstanbul, reviewing all patients referred to the child and adolescent consultation-liaison psychiatry (CLP) unit between March 2020 and March 2022. We assessed associations between psychiatric diagnoses and health-related stressors, school closure status, age, and sex using both frequentist and Bayesian methods. During the study period, 264,013 pediatric admissions were recorded, of whom 270 (0.10%) required psychiatric consultation. The proportions of suicide attempts and anxiety diagnoses did not differ between periods of open and closed schools (BF10 = 0.21 and 0.138, respectively; moderate evidence for the null). Multivariate analysis showed that the odds of suicide attempts were higher in patients exposed to family or schoolrelated stressors (OR = 6.63, 95% CI 2.72–16.19), in females (OR = 8.10, 95% CI 4.16–15.77), and with increasing age (OR = 1.32 per year, 95% CI 1.16–1.50). Female sex (OR = 4.17, 95% CI 2.03–8.55) and older age (OR = 1.30 per year, 95% CI 1.12–1.50) were also associated with depression. Anxiety was more likely in those facing isolation or healthrelated stressors (OR = 3.91, 95% CI 1.66–9.22). These findings highlight the differential impact of stressor type on internalizing symptoms and may inform resource allocation and crisisresponse planning in child mental health services.

Background Nonalcoholic fatty liver disease (NAFLD) has become an important health issue in adolescents. Although several parameters and indices have been investigated for the evaluation of NAFLD in adults, these indices are limited in adolescents. In this study, body mass index, waist circumference, triponderal mass index, HbA1c, homeostatic model assessment insulin resistance (HOMA-IR), triglyceride/high-density lipoprotein (Tg/HDL), the lipid accumulation product (LAP) index, the triglyceride-glucose (TyG) index and the aminotransferase (AT) index were examined together, and their diagnostic values in the clinical treatment of NAFLD were compared. Materials and methods Seventynine adolescents (10–19 years old) with obesity who were admitted to a pediatric clinic between January and August 2022 and who were diagnosed with exogenous obesity without any comorbidities were included in the study. The presence of NAFLD was evaluated by liver magnetic resonance imaging. The laboratory findings were obtained retrospectively from system records. Parameters were compared between the NAFLD (+) and NAFLD (-) groups. Logistic regression analysis was used to determine the most effective factors for NAFLD treatment. Receiver operating characteristic (ROC) analysis was performed with significant indices. Sex, HOMA-IR, TyG and AT indices were evaluated together with multivariate analysis to design a diagnostic scale. Results HbA1c, HOMA-IR, AT indices and TyG indices were greater in the NAFLD (+) group ( P  = 0.012; P  = 0.001; P  = 0.012; P  = 0.002, respectively). There was a positive correlation between liver fat percentage and HOMA-IR, the TyG index, the AT index, and Tg/HDL. According to the regression analysis, male sex and elevated HOMA-IR were determined to be significant risk factors for the presence of NAFLD. A probability scale with 4 parameters [sex, HOMA-IR, the TyG index, and alanine aminotransferase (ALT)] was designed with 82.5% specificity and 80% sensitivity. Conclusion Evaluation of the HOMA-IR and TyG indices, especially in high-risk patients, will support the diagnosis of NAFLD via ultrasonography. A probability scale with ALT, HOMA-IR, TyG, and sex data with a diagnostic accuracy of 80% may aid in the diagnosis of NAFLD in adolescents with obesity.

Background. This study aims to compare the posterior ocular structure parameters in children with migraine without aura (MWA), tension-type headache (TTH), and a healthy control group. Methods. The study included 31 patients with MWA, 29 patients with TTH, and 38 healthy controls between 6 and 18 years of age. For all participants, the detailed eye examination and measurements including peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vessel densities and foveal avascular zone (FAZ) parameters measured by optical coherence tomography (OCT) and OCT-angiography (OCTA), were obtained from the patient files. Results. The mean age was 12.1±3.3 years in MWA patients, 12.4±2.8 years in TTH patients, and 11.9±3.8 years in the healthy controls (p=0.844). Among the groups, the mean pRNFL thickness, CMT, and SCT values were lowest in the MWA group. However, this difference was not statistically significant (p=0.621, p=0.854 and p=0.201, respectively). The mean and four-quadrant (superior, inferior, temporal, nasal) pRNFL thicknesses, the CMT, and the SCT were not statistically significant between the groups (p=0.621, p=0.500, p=0.186, p=0.565, p=0.744, p=0.854 and p=0.201, respectively). The macular vascular densities were lower in MWA patients than in the other two groups, and there was a statistically significant difference between the groups only in the nasal quadrant of the deep retinal capillary plexus (p = 0.014). There were also no statistically significant differences between the groups in the superficial and deep FAZ area parameters (p=0.652 and p=0.985). Conclusion. This study suggested that differential diagnosis between MWA and TTH can be difficult in childhood, as these conditions, which can present with ocular symptoms, may also be characterized by changes in posterior segment parameters. Long-term studies incorporating OCT-A in larger patient populations may provide valuable insights into retinal changes associated with these two distinct headache spectrums.

Objective:We aimed to investigate the parameters of complete blood count and the levels of systemic inflammatory biomarkers in children with allergic conjunctivit and to evaluate their role in diagnosis in this study.Method:We included 71 pediatric patients with allergic conjunctivit diagnosis referred from the ophthalmology outpatient clinics who had sensitivity to at least one allergen and 71 age- and sex-matched healthy controls and compared complete blood count results, immunoglobulin E (IgE), neutrophil/lymphocyte, and platelet/lymphocyte ratios and systemic immune-inflammation index results. We built a multivariate model with correlated results.Results:Eosinophil counts and serum total IgE values were significantly higher in the patient group compared to the control group (p<0.001). Other parameters were not statistically different. 70.4% (n=50) of the patients had seasonal allergic conjunctivit, and 29.6% (n=21) had perennial allergic conjunctivit. In the skin prick tests performed in the patient group, 60.6% (n=43) of the patients had pollen, 54.9% (n=39) mite, 12.7% (n=9) dander, 11.3% (n=8) cockroach, and 4.2% (n=3) had alternaria sensitivities. In the multivariate analysis, every 100-cell increase in eosinophil count increased the hazard ratio of allergic conjunctivitis 1.3 times (95% confidence interval: 1.1-1.5), and every 100-units increase in total IgE levels increased 1.2 times (95% confidence interval: 1.1-1.5).Conclusion:We found no significant relationship between neutrophil/lymphocyte and platelet/lymphocyte ratios, and SII with allergic conjunctivit. Increasing eosinophil count and serum total IgE levels increase the hazard ratio for developing allergic conjunctivit. Pollen sensitivity was the most common factor in the skin test in allergic conjunctivit-diagnosed patients.

Objective: Diagnosis of sleep disorders (SD) and restless legs syndrome (RLS) in school-age pediatric population and finding their relevant factors are important to prevent disease dependent complications such as growth-development retardation, loss of neurocognitive function and school failure. The aim of the present study was to determine whether there is a relationship between socio-demographic characteristics, SD and RLS in school children. Materials and Methods: Middle and high school students aged between 13 and 17 were questioned about socio-demographic data, RLS survey and pediatric sleep questionnaire (PSQ). Results: The study included 3.568 appropriately completed surveys. The total PSQ score was 4.3±3.3 for female students and 3.9±3.3 for male students. PSQ score was ≥8 in 326 of 1.992 female students (16.4%), in 215 of 1.576 male students (13.6%) and in 541 of all students (15.2%). The RLS frequency was 4.4% for all students, 4.6% for female students and 4.1% for male students. Total PSQ score, snoring, sleepiness and behavior subscale score had significant correlation with RLS in both genders. A weak but significant correlation was found between PSQ total score and BMI Z score (r=0.256, p<0.001). There was a strong correlation between PSQ score and RLS. The odds ratio of RLS was 2.04 (95% confidence interval: 1.87-2.22) for PSQ score. Conclusion: RLS has close relationships with sleep-related breathing disorders, daytime sleepiness and behavioral problems irrespective of socio-demographic data.

Objective: Investigation of possible prognostic factors affecting survival in the congenital diaphragmatic hernia. Method: We included all congenital diaphragmatic hernia-diagnosed patients treated in neonatal intensive care units of two centers between 2016 and 2020. We recorded antenatal and birth histories, anthropometric measurements, and clinical features of the hernia. We assessed visceral herniation to the hemithorax, pneumothorax, severely decreased fetal lung volume (<15%), the need for emergency intervention due to pneumothorax in the operating/delivery room, and pulmonary hypertension effects on the survival status. We recorded the data retrospectively. Results: We enrolled 31 patients in the study. The clinical conditions associated with high mortality were pulmonary hypertension (p=0.006), pneumothorax (p=0.009), severely decreased fetal lung volume (<15%) (p<0.001), hepatic (p=0.024) and gastric (p=0.029) herniations to the thorax. In a binomial regression model, PTX and hypoplastic lung were the most significant confounders (R2 McF: 0.858, p<0.001). 19.4% of patients needed emergency intervention in the operating/delivery room. There was no statistically significant difference between deceased and alive patients in terms of postnatal day of surgery. Conclusion: Operation time did not statistically affect mortality. Pneumothorax, severely decreased fetal lung volume, hepatic herniation, gastric herniation, and pulmonary hypertension statistically declined survival. PTX and hypoplastic lung were the most significant confounders.

The COVID-19 pandemic profoundly disturbed preschool education in Turkey, necessitating a rapid shift to distance learning for over 1.5 million children. The Ministry of National Education has established programs such as the Educational Content Network in Turkey. Also, the Turkish Radio and Television Association has made the TRT Preschool Application available online to support ongoing distance learning for preschool children. Preschool education in rural parts of Turkey was deeply impacted by the COVID-19 pandemic. While previous research has examined the challenges of distance education broadly, there is a limited exploration of preschool teachers’ experiences during the pandemic lockdown, particularly in rural contexts in Turkey. To ensure sustainability in preschool education during the pandemic lockdown period, this study aimed to examine the experiences of preschool teachers who participated in distance education in rural areas. A qualitative case study was conducted with 10 teachers working in schools located in rural areas with diverse geographical difficulties scattered within the province near the Black Sea to obtain insights into the experiences of preschool teachers during the pandemic. The maximum variation sampling was utilized to select preschool teachers educating children between 45 and 72 months. To promote and facilitate individuals’ participation in the research, the semi-structured interviews were conducted via videoconferencing due to the lockdown. The content analysis was used to discover the meaning of the data. The study revealed that while teachers adapted their teaching methods to prioritize children’s well-being, disparities in digital access and socio-emotional issues within families created significant barriers to learning. The challenges encountered significantly impacted the children’s development in multiple areas. This study emphasized the need for improved infrastructure, providing extensive teacher training, and implementing robust support mechanisms to ensure the comprehensive growth of children in all domains during potential disasters. More research should be conducted to improve teachers’ skills in applying effective teaching strategies in virtual environments.

Background/Objectives: Bronchopulmonary dysplasia (BPD) frequently affects preterm infants and is associated with lasting morbidity. Early prediction remains challenging. The present study investigated whether hematological inflammatory markers—platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and red cell distribution width-to-platelet ratio (RPR)—can predict the development of BPD in preterm neonates. Methods: We performed a retrospective cohort study involving 100 infants born at less than 32 weeks’ gestation. Complete blood count (CBC) parameters were collected at birth, 72 h, 1 week, and 2 weeks of life. Associations between PLR, RDW, RPR, and BPD development were analyzed. Multivariate regression and receiver operating characteristic (ROC) curve analyses were carried out to evaluate the predictive performance of the markers. Results: Forty-nine percent of infants developed BPD. Those with BPD had significantly higher RDW, PLR, and RPR values, and lower lymphocyte and platelet counts at various time points. Gestational age, respiratory distress syndrome, and hematological indices independently predicted BPD. ROC analysis showed that RDW ≥ 67.2 and PLR ≥ 98.13 at 72 h, and RPR ≥ 0.3 at 7 and 14 days had good predictive performance. A combined scoring system, including clinical and hematological markers, achieved high sensitivity and specificity. Conclusions: Hematological inflammatory markers, especially RPR, PLR, and RDW, derived from routine CBC tests may serve as accessible, cost-effective tools for early BPD risk stratification in preterm infants. Additional studies are needed to confirm these results and better define their relevance in clinical practice.

It is known that telomere length (TL) (evaluated with T/S ratio) is shortened in the presence of obesity. In this study, we aimed to investigate how obesity in adolescents and non-alcoholic liver disease (NAFLD) within the obese group affect TL and the clinical significance of the human telomerase reverse transcriptase (hTERT) gene MNS16A VNTR variant in terms of NAFLD. Adolescents with exogenous obesity and healthy controls (aged 10–19 years) who applied to our adolescent outpatient clinic between May-October 2023 were included in this study. We performed upper abdominal ultrasonography to investigate the presence of NAFLD in adolescents with obesity and divided into two groups: those without hepatosteatosis (obese NAFLD (-)) and those with hepatosteatosis (obese NAFLD (+)). We recorded body weight, height, waist circumference, and blood pressure measurements and measured the T/S ratio (telomere sequence copy number/gene single copy number) by the Quantitative Polymerase Chain Reaction method. The groups were compared using frequentist and Bayesian methods. Eighty-three obese adolescents [63 NAFLD(+) 20 NAFLD(-)] and 69 lean controls were included in the study. Pairwise comparisons revealed that T/S ratio was significantly lower in the obese NAFLD (-) group than the obese NAFLD (+) and the control group ( p  = 0.025, p  = 0.007, respectively). T/S ratio was lower in the LL allele group than in the other alleles ( p  = 0.022) and slightly higher in the obese group with metabolic syndrome compared to the obese group without metabolic syndrome ( p  = 0.072). hTERT-MNS16A-VNTR gene variant LL allele had a negative correlation with T/S ratio among the obese adolescent group. Patients with LL alleles had higher ALT, GGT, HOMA-IR, and ALT/AST. Diastolic blood pressure had a significant correlation with the T/S ratio. The T/S ratio was shorter in the obese adolescent group compared to healthy ones but was higher in the NAFLD (+) obese compared to the NAFLD (-) obese. ALT level and ALT/AST ratio were higher, T/S ratio was lower in the hTERT MNS16A VNTR variant LL allele group among obese adolescents. In addition, there was a significant correlation between the T/S ratio and diastolic blood pressure in obese adolescents.