Abdullah Yazar

Mehmet Berat Taş, Semih Erden, İbrahim Kılınç, Abdullah Yazar. Clin Psychopharmacol Neurosci -0001;0:. https://doi.org/10.9758/cpn.26.1489

As participation of children in exercise and organized sports increases worldwide, the health care needs of young athletes differ substantially from those of adults due to age-specific physiological, biomechanical, and psychosocial characteristics related to growth and development. Pediatric Sports Medicine (PSM) is a pediatric-based, multidisciplinary subspecialty that encompasses preparticipation physical evaluation (PPE), exercise prescription, management of sports injuries and overuse syndromes, sport-related concussion, heat-related illnesses, assessment of sudden cardiac event risk, relative energy deficiency in sport (RED-S), planning safe sports participation for children with chronic medical conditions, and safeguarding in sport. In the United States, PSM is formally structured through pediatric-based fellowship training and board certification, whereas Europe lacks a standardized model and relies on heterogeneous approaches integrating pediatrics, sports medicine, and rehabilitation. In Türkiye, sports medicine training remains largely adult-oriented. Given that pediatric subspecialty training is strictly based on prior pediatric specialization and that pediatricians are routinely consulted for comprehensive medical evaluations, the absence of a pediatric-based PSM structure has resulted in notable gaps in pediatric-specific PPE standardization, early sport specialization and load management, RED-S screening, integration of school–club–health care systems, and the health care component of safeguarding policies. This narrative review presents a literature-based synthesis of the conceptual foundations and clinical and public health rationale of PSM, summarizes relevant international guidelines and consensus statements, and proposes a feasible framework for its implementation in Türkiye, where this subspecialty has not yet been established.

Aims: Bronchiolitis is a leading cause of pediatric emergency visits and hospitalization in infants, with a broad spectrum of clinical severity. This prospective study aimed to evaluate demographic, clinical, laboratory, radiological, and microbiological characteristics of children with bronchiolitis and to analyze their association with disease severity according to Wang’s criteria. Methods: A total of 305 children aged 0–24 months who presented to the pediatric emergency department of our institution and were diagnosed with bronchiolitis were prospectively enrolled. Patients were classified as having mild, moderate, or severe bronchiolitis. Demographic features, clinical findings, laboratory parameters, imaging results, respiratory support requirements, length of hospital stay, and viral and bacterial etiologies were recorded and analyzed.Results: The median age was 7 months, and 61.6% of patients were male. Mild, moderate, and severe bronchiolitis were observed in 49.8%, 31.5%, and 18.7% of patients, respectively. Recurrent respiratory tract infections were more frequent in moderate and severe disease (29.2% and 22.8%) compared with mild cases (11.2%; p=0.001). Chronic comorbidities were also associated with higher severity (p=0.007). Hospitalization rates increased significantly with severity (14.5% in mild vs 80.2% in moderate and 57.9% in severe cases; p

Introduction: Familial Mediterranean Fever (FMF) is an autoinflammatory disease which exhibits an autosomal recessive inheritance manner and is characterized by inflammation of serosal membranes including pleurae, synovia, and peritoneum, usually with accompanying fever and pain, and presents with symptomatic episodes. Kidney Injury Molecule-1 (KIM-1) is a novel biomarker of acute renal injury (ARI) which is secreted by the proximal tubule cells after occurrence of kidney damage, which shows tubule damage sensitively and is easily detectable by urinary biochemistry analysis. Neutrophil Gelatinase Associated Lipocalin (NGAL) is a novel biomarker that can be identified in the distal tubules and collecting ducts after development of ARI. Besides some traditional parameters like glomerular filtration rate, there is no specific biomarker to predict kidney injury or failure in FMF. There is very scant data regarding role of NGAL and KIM-1 in predicting FMF-related nephropathy and kidney failure. Our objective was to shed some light on whether urinary KIM-1 and/or NGAL levels can be used as biomarkers of renal injury in FMF patients.Methods: This prospective study included patients with clinical diagnosis of FMF who were admitted to our Pediatric Emergency Clinic between January 2018 and January 2019, and healthy children of similar gender and age as controls. Urine samples were collected for urinary KIM-1 and NGAL analyses. When a sufficient number of patients were reached, KIM-1 and NGAL levels were measured from the samples. Urinary KIM-1 levels were determined using an ELISA kit. Urinary KIM-1 levels were standardized for urine creatinine (ng/mg). NGAL enzyme activities were measured spectrophotometrically using commercial kits.Results: A total of 56 children, 51.8% (n=29) Familial Mediterranean Fever patients and 48.2% (n=27) controls, were recruited. Kidney injury molecule-1 levels in pediatric FMF patients were elevated than those noted in the controls (p=0.003), while KIM-1/creatinine ratios were similar (p=0.500). Pediatric FMF patients had elevated NGAL levels than those of the controls (p<0.001). Mean NGAL/creatinine ratio of FMF patients (5.24±4.19) were also higher than that of the control group (0.03±0.03) (p<0.001).Conclusion: While findings indicating acute tubular damage such as proteinuria and hematuria have not developed, high KIM-1 and NGAL levels may indicate that these biomarkers are likely to be used as reliable, non-invasive, and early predictors of renal injury. Larger multicenter clinical studies are necessary for urinary levels of these molecules to be routinely used for earlier recognition of FMF-related renal injury.

Introduction: Therapeutic plasmapheresis (TP) is an extracorporeal treatment method used for a variety of patients with various diseases. Methods: For this retrospective study, patients who were admitted to the pediatric intensive care unit (PICU) and received TP therapy between 2013 and 2023, and whose medical records were reached, were included. Results: A total of 72 children were included in the study. The most common indication for TP was septic shock, followed by multisystem inflammatory syndrome in children (MIS‐C). The median number of TP sessions was 2, and the median PRISM III score was 14.5. Of the patients, 56.9% had ASFA class 3 diagnoses, and 5.6% developed thrombosis as a complication. The mortality rate was 44.4%, most of whom had an underlying disease. Conclusion: TP is an important supportive therapy in critically ill patients admitted to PICUs. We believe that early initiation of TP may be life‐saving with proper indications.

In our country, a considerable number of athletes are under the age of 18, and concerns regarding their physical, psychosocial, and athletic development are increasingly prominent. In the US, Pediatric Sports Medicine (PSM) , which has yet to be established in Turkey and many European countries, deals with the care and monitoring of young athletes. This study aimed to explore the challenges pediatricians face during preparticipation evaluation (PPE) of young athletes, the difficulties encountered in managing this specific population, and their perspectives on how the establishment of a PSM division could contribute, particularly in addressing legal responsibilities. An online questionnaire was comprised of 12 questions, which addressed participants' personal and professional features, as well as which specialties pediatric athletes were mostly referred, types of sports of pediatric athletes, challenges experienced with the athlete and his/her parents during PPE, their awareness on PSM fellowship abroad, and their opinions on interests of PSM and establishment of PSM in our country. A total of 360 pediatricians were recruited. Of the participants, 89.7% reported challenges with parents due to requesting immediate issuance of reports and 52.2% due to requesting reports without the child being present. Of the participants, 69.2% had never heard about PSM. Of the participants, 83.3% stated that establishment of PSM in Turkey would definitely make contribution, and 73.9% stated that PSM should definitely be established. Awareness of PSM is low among pediatricians. The establishment of PSM in Turkey is widely supported and considered to be beneficial.

Objective: There are numerous athletes under 18 years of age in our country, whose physical, psychosocial and athletic developments have become more of an issue. The aim was to determine challenges confronted by coaches of pediatric athletes in the referral of pediatric athletes for preparticipation medical clearance, management of injuries, pre- and postparticipation follow-up, and opinions of coaches about whether establishment of Pediatric Sports Medicine (PSM) would be warranted. Materials and Methods: This questionnaire addressed coaches’ age, sex, the sport branch they were dealing with, physicians to whom they refer pediatric athletes, challenges experienced with the athlete and his/her parents during preparticipation evaluation (PPE), challenges experienced by parents during PPE, suggested branch for referral, awareness of coaches on PSM abroad, and their opinions on interests of PSM and establishment of PSM in our country. Results: A total of 352 coaches were included. The most common branch of coaching was football (21.4%). The most common physicians they were referring to were sports medicine specialists (52.0%), family medicine specialists (44.9%), general pediatricians (33.8%), and pediatric cardiologists (29.3%). Of the participants, 69.0% had never heard about PSM. Regarding areas of interest of PSM, 55.1% stated they had no idea, 37.5% routine follow-up and 25.0% physical examination of pediatric athletes. Of the participants, 90.1% stated that establishment of PSM in our country would definitely contribute to PPE, and 94.9% stated that it should definitely be established. Conclusion: It was concluded that awareness on PSM is low among coaches and that the establishment of PSM would definitely make contribution in Türkiye. Cite this article as: Akkuş A, Aslan H, Özkaymakoğlu C, et al. Challenges confronted by coaches in evaluation of pediatric athletes: Awareness on pediatric sports medicine. Turk Arch Pediatr. 2025;60(3):314-318.

Orbital cellulitis is a serious infection of the fat and muscle tissue outside the eyeball. Preseptal cellulitis is a generally mild infection of the tissues in the front of the eyelid. Although both conditions can cause eye pain, eyelid swelling and erythema, they can be confused with each other, but their clinical effects are very different. Preseptal cellulitis is a mild condition that rarely leads to serious complications, whereas orbital cellulitis can cause vision loss and even death. The most common underlying cause of both conditions is the spread of infection from nearby tissues (acute sinusitis, etc.) to the orbit through the surrounding tissues. One of the most important and serious complications of orbital cellulitis is orbital abscess. When orbital abscess is detected by clinical findings and radiologic examinations, intravenous broad-spectrum antibiotic treatment and emergency surgical intervention are required immediately. In this article, we will present a case that progressed from preseptal cellulitis to orbital cellulitis and orbital abscess and required surgical treatment. In conclusion, if there is no response to treatment in orbital infections, serious complications (orbital abscess, etc.) should be considered. Differential diagnosis should be made quickly with radiologic imaging. If necessary, surgery should be performed. Management of the disease should be planned and followed in a multidisciplinary manner with joint opinions from pediatrics, ophthalmology and otolaryngology branches.

Coronavirus disease 2019 (COVID-19) and COVID-19-related multisystem inflammatory syndrome in children (MIS-C) is known to be a life-threatening health problem worldwide. The study investigates the potential relationship between asymmetric dimethylarginine (ADMA) levels and disease severity in such conditions. We conducted an observational, prospective study between July 2021 and January 2022. The study enrolled 98 patients diagnosed with COVID-19, 21 patients diagnosed with MIS-C, and 42 healthy individuals who served as a control group. The COVID-19 patients were further categorized into three subgroups based on their level of care: outpatients, those requiring hospitalization, and those requiring intensive care. The MIS-C patients formed a distinct fourth group. COVID-19 outpatients had a median ADMA level of 8097.0 ng/L (interquartile range: 6436.06–10840.0 ng/L), while those requiring hospitalization had a higher level of 13,195.60 ng/L (11,472.4–15,862.2 ng/L). Patients in intensive care exhibited the highest median ADMA level at 19,361.4 ng/L (15,596.65–23,367.9 ng/L). MIS-C patients also had elevated ADMA levels, with a median of 15,735.50 ng/L (13,486.6–20,532.5 ng/L). Receiver operating characteristic (ROC) curve analysis revealed that an ADMA level of 6135.15 ng/L could distinguish between patients and controls with 95% sensitivity, 100% specificity, 100% positive predictive value, and 87.5% negative predictive value. Conclusions: In conclusion, our study is the first to investigate ADMA levels in children with COVID-19 and MIS-C. We found that ADMA levels were significantly elevated in children with COVID-19 requiring intensive care and those with MIS-C, suggesting a potential role for ADMA as a biomarker of endothelial dysfunction in these populations. What Is Known: • Endothelial dysfunction is a determinant of poor prognosis in various cardiovascular diseases and plays a critical role in the pathogenesis of COVID-19 and MIS-C. • Asymmetric dimethylarginine (ADMA) is a well-known biomarker of endothelial dysfunction. Elevated levels of ADMA adversely affect vascular endothelial function by reducing nitric oxide production. What Is New: • It is the first to show that elevated ADMA levels in children with COVID-19 and MIS-C are associated with disease severity. • ADMA has been identified as a potential biomarker that can be used to assess the prognosis of COVID-19 and MIS-C in children and to predict the severity of the disease.