Seda Topçu

Purpose: The study aims to provide reference ranges of complete blood count (CBC) parameters in healthy children in Türkiye. Methods: Children aged 1 month to −18 years who were administered to the Well Child Outpatients Clinics of Department/Unit of Social Pediatrics in 10 centers in different regions of Türkiye were included in the study. Complete blood count measurements were collected from these centers. Results: A total of 24 115 healthy infants and children (12 204 males and 11 911 females) aged 1 month–18 years old were enrolled. Mean and median values of the red blood cell, white blood cell, and platelet parameters according to the age groups are presented in this study. In addition, the nonparametrically determined CBC reference intervals (RIs) corresponding to the 2.5th to 97.5th percentile, stratified by age and sex were provided. Conclusion: This is the first study that established RIs for hematological parameters in Turkish children younger than 18 years old. These data provide a more reliable basis for hematological evaluation across all pediatric healthcare disciplines in Türkiye.

Background. Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants caused by an imbalance between lung injury and lung repair in the developing immature lungs of the newborn. Pulmonary inflammation is an important feature in the pathogenesis of BPD. The aim of this study was to evaluate the relationship between the inflammatory microenvironment and the levels of visfatin and nesfatin-1, which are among the new adipocytokines, in BPD patients. Methods. The groups consisted of 30 patients with BPD and 30 healthy children. Plasma levels of visfatin and nesfatin-1 and inflammation-related markers including interleukin-4 (IL-4), interleukin-10 (IL-10), nuclear factor kappa B (Nf-κB) and matrix metalloproteinase-9 (MMP-9) were determined by enzyme-linked immunosorbent assay (ELISA). RT-PCR was performed to evaluate the change in mRNA expression of visfatin and nesfatin-1 in the groups. Results. Visfatin levels were significantly higher in the BPD group compared to the healthy control (7.05±4.07 ng/ml vs. 2.13±1.66 ng/ml, p<0.0001). There was a 1.36±0.12 fold increase in visfatin mRNA expression (p<0.05) in the BPD group. There was no significant difference in plasma levels of nesfatin-1, IL-4, and IL-10 between the groups. Although MMP-9 and Nf-κB levels were significantly higher in the BPD group (p<0.0001), there was no correlation between visfatin levels and MMP-9 and Nf-κB levels in BPD patients. Conclusions. This study showed that significant changes in visfatin levels in BPD patients might be associated with the risk of developing inflammation in BPD.

The incidence of acute rheumatic fever (ARF), which most commonly affects children aged 5-15 years after group A Streptococcus (GAS) infection, ranges from 8 to 51 per 100 000 people worldwide. Rheumatic heart disease (RHD), which occurs when patients with ARF are inappropriately treated or not given regular prophylaxis, is the most common cause of non-congenital heart disease in children and young adults in low-income countries. Timely treatment of GAS infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is a key aspect of RHD control. The most important factor determining the prognosis of RHD is the severity of cardiac involvement. Although approximately 70% of patients with carditis in the acute phase of the disease recover without sequelae, carditis is important because it is the only complication of ARF that causes sequelae. One-third of patients with ARF are asymptomatic. Patients with mild symptoms of recurrent ARF and silent RHD will develop severe morbidities within 5-10 years if they do not receive secondary preventive treatments. A new screening program should be established to prevent cardiac morbidities of ARF in moderate- and highrisk populations. In the present study, we examined the applicability of echocardiographic screening programs for RHD. Cite this article as: Topçu S, Uçar T. Echocardiographic screening of rheumatic heart disease: Current concepts and challenges. Turk Arch Pediatr. 2024;59(1):3-12.

The coronavirus disease-19 pandemic has adversely affected children’s health since its inception. Apart from the mortality and morbidity due to infection, child health monitoring, vaccination, and nutrition programs, especially in newborns and young children, have been disrupted. Measures such as school closures and curfews to prevent the spread of infection brought along many physical and mental health problems by causing disruption of education, social isolation, and closure of children at home. The possible long-term effects of the delayed implementation of the Sustainable Development Goals in Health have also deeply affected children, who are the most vulnerable victims of the coronavirus disease-19 pandemic. Cite this article as: Topçu S, Gür E. The silent victims of the pandemic: Children during the coronavirus disease 2019 crisis. Turk Arch Pediatr. 2023;58(5):467-472.

Background: The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5–18 by using portable echocardiography in Ankara, Turkey.Methods: The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease.Results: After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools.Conclusions: This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.

Amaç: Hekimlerin human papillomavirus (HPV) ile ilgili farkındalıkları ve HPV aşısının uygulanması konusundaki yaklaşımlarını değerlendirmek amaçlanmıştır.Gereç ve Yöntem: Araştırmaya 147 hekim (98 kadın doğum hekimi, 49 çocuk-aile hekimi dahil edilmiştir. Katılımcılara, araştırmacılar tarafından geliştirilen HPV enfeksiyonu ve HPV aşısı hakkında bilgi ve yaklaşımları değerlendirmek için hazırlanan bir anket formu uygulanmış ve toplanan veriler analiz edilmiştir.Bulgular: Araştırmaya dahil edilen kadın doğum hekimlerinin yaş ortalaması 28.2 yıl, çocuk-aile hekimlerinin 29.2 yıl olup her iki grupta da kadın cinsiyet ağırlıklıdır. Kadın doğum hekimlerinin %74’ü, çocuk hekimlerinin %71’i aşıyı kendilerine yaptırmayı düşündüğünü ifade etmiştir. Kadın doğum hekimlerinin %85’i, çocuk-aile hekimlerinin %78’i aşıyı önerdiklerini ifade etmişlerdir.Sonuç: Toplumda görülen serviks kanserine bağlı ölümler, çocuklara ve ailelere danışmanlık yapacak pozisyonda olan hekimlerin, HPV enfeksiyonu ve HPVaşısı konusunda bilgi düzeylerinin artırılmasıyla, aşının önerilme oranlarını artırarak önlenebilir.

To assess the factors affecting parental childhood vaccine refusal and hesitancy (CVRH) intentions in Turkey.