Şule Selin Akyan Soydaş

Objective: Chronic cough is a common and challenging cause of pediatric respiratory visits. Differentiating underlying causes, ranging from infection to airway inflammation and aspiration, requires detailed clinical evaluation. Flexible bronchoscopy (FB) can provide additional information regarding lower airway pathology. This study aimed to investigate cough phenotype, radiological and bronchoscopic findings, bronchoalveolar lavage fluid (BALF) cytology, and treatment response in children undergoing FB for chronic cough. Methods: This retrospective study included 30 children who underwent FB at a tertiary pediatric center between January 2020 and September 2025. Demographic, clinical, radiological, bronchoscopic, and BALF cytology data were analyzed. Bronchoalveolar lavage samples were classified according to predominant inflammatory cell type. Results: The median age was 10.2 years (Q1-Q3: 5.7-15.0), and 20/30 (66.7%) patients had wet/ productive cough. Chest computed tomography was available in 27 patients, with abnormalities detected in 20 (74.1%); atelectasis was the most common finding (11/27, 40.7%). Bronchoalveolar lavage fluid cytology was macrophage-dominant in 21/30 (70.0%) and neutrophil-dominant in 9/30 (30.0%). Lipid-laden macrophages (LLMs) were identified in 7/30 (23.3%). Neutrophilpredominant BALF was more common in patients with bronchoscopic findings suggestive of infection (P = .013). Patients with LLM positivity showed symptomatic improvement following antireflux therapy. Conclusion: Bronchoalveolar lavage fluid cytology may provide supportive information regarding airway inflammatory patterns in selected children with chronic cough. Interpretation should remain cautious because of the small sample size and retrospective single-center design. Integrating cytologic findings with clinical and bronchoscopic data may support clinical evaluation in children with chronic cough.

Objective: Obstructive sleep apnea (OSA) in children with morbid obesity is an important health problem requiring early diagnosis and intervention due to its high prevalence and multidimensional clinical effects. This study aimed to assess the Pediatric Sleep Questionnaire (PSQ)-based OSA risk in children with morbid obesity and to evaluate associated clinical and laboratory findings. Materials and Methods: This retrospective cross-sectional study included children with morbid obesity who were admitted to a tertiary pediatric pulmonology outpatient clinic between 2021 and 2023 and followed up for at least one year. Morbid obesity was defined as a body mass index (BMI) ≥99th percentile. Patient clinical characteristics were obtained from the electronic medical record system. OSA was evaluated using the PSQ. Patients were divided into two groups according to the PSQ cut-off value: Group 1 included children with PSQ scores 5, and a these three patients were in Group 2 based on their PSQ scores. Conclusion: In this study, the risk of OSA in children with morbid obesity, as assessed by the PSQ, was found to be high. Our findings highlight the importance of clinical awareness of OSA in children with morbid obesity. Further PSG-based studies with larger sample sizes are needed to better establish the potential role of the PSQ as a feasible alternative screening tool for early diagnosis.

B: Pectus excavatum (PE) is associated with a significant psychosocial burden during adolescence. Vacuum bell therapy(VBT) is a non-surgical treatment option;however, its relationship with body image outcomes remains incompletely understood. M: This prospective cohort study was conducted in a paediatric pulmonology outpatient clinic in Türkiye as part of a MECOR project. Adolescents aged 10–18 years with PE undergoing VBT were consecutively enrolled. Chest depth was measured using standardized manual external caliper methods. Body image perception was assessed using the Body Image Questionnaire (BIQ), and also included the Pectus Excavatum Evaluation Questionnaire (PEEQ) and the Pediatric Quality of Life Inventory (PedsQL). Assessments were performed at treatment initiation and after 6 months. R: Of 42 eligible patients who initiated VBT,35 completed the 6-month follow-up. Chest depth significantly improved during follow-up, accompanied by a significant reduction in BIQ scores, indicating improved body image perception. Improvement in BIQ was moderately correlated with changes in chest depth measurements(r=0.47, p=0.04). No correlation was observed between BIQ change and baseline pulmonary function parameters(r=−0.03, p=0.98). A strong negative correlation was found between baseline deformity severity and body image improvement(r=−0.61, p<0.001). In multivariable regression models adjusted for deformity severity was not independently associated with changes in BIQ. C: VBT was associated with significant improvement in chest morphology and body image perception in adolescents with pectus excavatum. However, after adjustment for baseline severity, changes in chest depth alone did not independently predict body image improvement, highlighting the multifactorial nature of psychosocial outcomes in PE.

Data on occupational exposure–related lung diseases in children/adolescents are limited, and diagnostic approaches are not well defined. This study aimed to describe the clinical features with a spesific diagnostic evaluation of occupational exposure–related lung diseases in children and adolescents. This descriptive, case-based study included patients evaluated for work-related dyspnoea, cough, and wheezing. A standardized diagnostic protocol was applied, including baseline spirometry and PEF monitoring performed four times daily for 10 days during active occupational exposure, followed by a 10-day work cessation period with continued PEF monitoring and repeat spirometry. Five patients aged 13–17 years (four males) were included. Occupational exposures comprised hairdressing chemicals, cooling gases, welding fumes, cement dust, and automotive paint chemicals, with exposure durations ranging from 6 months to 2 years. At presentation, all patients demonstrated significant bronchodilator reversibility in FEV₁(22–28%). During active work exposure, mean PEF values ranged between 300–350 L/min, increasing to 450–500 L/min during work cessation. Control spirometry showed a reduction in FEV₁ reversibility to 8–12%. ICS/LABA therapy was initiated in all patients after diagnostic evaluation;however, symptoms persisted/worsened during ongoing exposure. Following occupational modification, all patients showed marked clinical improvement. Early diagnosis using a structured diagnostic algorithm is particularly crucial in childhood, a period during which occupational roles are more easily modifiable and the development of occupational lung disease can still be prevented. This standardized follow-up protocol combining spirometry and home-based PEF monitoring provides a feasible and objective approach in children.

Bu çalışmada, PFAPA sendromlu çocuklarda profilaktik tedavide kullanılan kolşisin ile Streptococcus salivarius K12'nin kısa dönem klinik etkinliğinin karşılaştırılması amaçlandı. Sincan Eğitim ve Araştırma Hastanesi Çocuk Romatolojisi Kliniği'nde yürütülen bu tek merkezli retrospektif çalışmaya, Eurofever/PRINTO kriterlerine göre PFAPA tanısı alan ve profilaktik tedavi sonrası yaklaşık 3 aylık takip verileri bulunan 64 çocuk dahil edildi. Hastaların 33'ü kolşisin, 31'i Streptococcus salivarius K12 tedavisi aldı. Demografik özellikler ile tedavi öncesi ve sonrası atak sırasında ölçülen en yüksek vücut sıcaklığı, atak süresi ve son üç aydaki atak sıklığı değerlendirildi. Gruplar arasında cinsiyet dağılımı, hastalık başlangıç yaşı, tedavi başlangıç yaşı ve tedavi öncesi klinik özellikler açısından anlamlı fark saptanmadı. Kolşisin grubunda tedavi sonrası en yüksek ateş ve atak süresi anlamlı olarak azalırken (her ikisi için p≤0,003), atak sıklığında sınırda anlamlı değişiklik gözlendi (p=0,035). Benzer şekilde Streptococcus salivarius K12 grubunda da en yüksek ateş ve atak süresi anlamlı düzeyde azalırken (her ikisi için p≤0,003), atak sıklığında anlamlı iyileşme izlenmedi (p=0,121). Kolşisin ve Streptococcus salivarius K12, PFAPA'da kısa dönemde benzer klinik etkinlik göstermiştir. Her iki tedavi de özellikle atak şiddetini yansıtan ateş yüksekliği ve atak süresini azaltırken, atak sıklığı üzerinde anlamlı etki göstermemiştir. Bulgular, Streptococcus salivarius K12'nin seçilmiş hastalarda alternatif bir profilaktik seçenek olabileceğini düşündürmektedir. Daha büyük örneklemli, çok merkezli ve randomize kontrollü çalışmalara ihtiyaç vardır

Background: Advances in genetic analysis techniques and strategies have enabled the identification of rare novel genetic entities in children's interstitial lung disease (chILD). Aims: To describe an extensive array of demographic, clinical, radiological, and laboratory data from a national registry of children with diffuse lung disease caused by rare and novel genetic variants. Study Design: Retrospective cohort study. Methods: This study used data from the chILD Türkiye (chILD‐TR) registry to analyze rare genetic chILD subtypes, excluding surfactant protein gene variants, ABCA3 , and NKX2‐1 , between November 2021 and January 2024. Of 671 patients in chILD‐TR, 182 underwent genetic analysis excluding surfactant protein‐related variants, resulting in 37 patients identified with rare genetic variants included in the study. Results: Among the 37 patients with rare genetic variants, 19 (51.4%) were male, and the median age at diagnosis was 40.5 months (IQR 15.5–115.5). Genetic analysis conducted on 15 patients identified COPA , STAT3 , STING1 , ADA , ZNFX1 , PIK3CD , PLCG2 , OAS1, CCR2, RNF168 and ATM gene variants, which are associated with immunodeficiency/dysregulation and autoinflammation; 15 NPC1 , SMPD1 , GBA1 , SLC7A7 , MARS1 , FARSB , and PEPD genes, variants linked to inherent metabolic errors. Seven patients were found with TBX4 , SLC34A2 , PLG , and SMAD4 gene variants. All patients were born at term, and five (13.5%) of them were small for gestational age. Two patients (5.4%) had previously been on a mechanical ventilator in the neonatal intensive care unit, 25(67.6%) had familial consanguinity, and 23 (62.1%) had comorbid systemic disease. Thirteen patients (35.1%) required oxygen support. All patients underwent chest computed tomography scans at initial assessment, showing ground‐glass opacities in 29 (78.3%), infiltrations in 27 (72.9%), and interlobular septal thickening in 20 (54%). Eight patients (21.6%) received oral steroids, and six (16.2%) received pulse steroids in addition to their primary treatments for systemic diseases. Conclusions: Interstitial lung disease rarely occurs in children, but increased awareness and genetic testing may enable earlier diagnosis. Recognizing that diffuse parenchymal lung disease can occur in rare systemic diseases may improve diagnoses and treatment.

Introduction‐Aim: The study evaluates the long‐term effect of COVID‐19 on lung function in children, considering symptoms, physical examination findings, radiologic and laboratory evaluations during the acute infection period (AIP). Material and Methods: This prospective, longitudinal, multicenter study involved 270 patients with confirmed SARS‐CoV‐2 infection. Patients underwent pulmonary function tests (PFTs) (spirometry, diffusion capacity of the lung for carbon monoxide (DLCO), and plethysmography) at the 3rd and 6th months of follow‐up. Clinical characteristics, radiological, and laboratory findings during AIP were analyzed to establish the relationship with PFT parameters on long‐term follow‐up. Results: The mean age was 12.97 ± 3.43 years (6–18 years), and 141(52.2%) were girls. Most patients had mild disease, while 193 patients were classified as having pneumonia. Overall mean PFT parameters were normal at the 3rd and 6th months, and FEV ₁ %, FVC%, and DLCOadj% showed statistically significant longitudinal changes. Abnormal DLCOadj was observed in patients with COVID‐19 pneumonia at the 6th month when compared with the non‐pneumonia group ( p = 0.046). At the 3rd month follow‐up, comorbidities were independently associated with abnormal FEV ₁ (OR 6.30, 95% CI 2.61–15.17, p < 0.001) and abnormal FVC (OR 3.47, 95% CI 1.72–7.00, p < 0.001). Respiratory system related abnormal physical examination findings were also independently associated with abnormal FEV ₁ (OR 3.04, 95% CI 1.13–8.21, p = 0.028). Dyspnea showed a borderline association with abnormal FVC (OR 2.11, 95% CI 0.98–4.54, p = 0.057). Pathologic chest radiography, interlobular septal thickening on thorax CT, ground‐glass opacity, fever, dyspnea, and respiratory system related abnormal physical examination findings during the AIP were associated with abnormal PFT parameters during follow‐up. Disease severity scores did not differ significantly between children with normal and abnormal. Conclusions: Most children had preserved mean pulmonary function during follow‐up after SARS‐CoV‐2 infection. However, children with COVID‐19 pneumonia, comorbidities, and respiratory system related abnormal physical examination findings during the AIP may be at increased risk for persistent functional abnormalities. Follow‐up assessment in higher‐risk children should include spirometry, and DLCO measurement should be considered when feasible.

Cystic fibrosis (CF) results from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, causing multisystem disease and impaired quality of life. CFTR modulators have improved pulmonary and nutritional outcomes, yet potential metabolic effects such as dyslipidemia remain a concern, particularly in adults. Pediatric data are limited. This study evaluated the effects of CFTR modulators on lipid and lipoprotein profiles in children with CF. This retrospective study was conducted at a tertiary pediatric pulmonology center. Body mass index (BMI) Z-scores, lung function tests, and serum lipid profiles were compared between baseline and six months after initiation of CFTR modulator therapy. Twenty-six patients were included finally. The median age was 11 (5.9-15.6) years; 53.8% were female, and 80.8% received elexacaftor/tezacaftor/ivacaftor. After six-month therapy, significant improvements were observed in BMI (p = 0.047), FEV₁ (p = 0.005), and FVC Z-scores (p = 0.001). Although HDL, LDL, VLDL, triglycerides, and total cholesterol increased numerically, none reached statistical significance. No difference was found between BMI changes and lipid alterations. Over six months of continuous CFTR modulator therapy, we observed improvements in pulmonary and nutritional outcomes without evidence of clinically meaningful lipid deterioration. This study adds real-world pediatric data regarding lipid profile changes during CFTR modulator therapy. While these therapies significantly improve pulmonary and nutritional outcomes, we observed no evidence of lipid deterioration over six months of treatment. These findings contribute to the evolving understanding of the systemic effects of CFTR modulators in childhood and underscore the importance of ongoing cardiometabolic evaluation as survival improves.

Introduction: Respiratory illnesses are a major cause of mortality and morbidity in pediatric and neonatal intensive care units (ICUs). This study aimed to determine the impact of pediatric pulmonologist (PP) consultation on children in ICUs and assess differences in clinical outcomes. Methods: This single-center, retrospective, cross-sectional cohort study included children aged 0–18 years for whom PP consultations were requested between June 2022 and June 2023. Children were divided into two groups based on the median time from ICU admission to the consultation request. Group 1 (n = 221) received consultations within 14 days, defined as early consultation, while group 2 (n = 66) received consultations after 14 days, defined as late consultation. We compared demographic, clinical, and radiologic characteristics and the length of stay (LOS) in the hospital, ICU, and mechanical ventilator (MV). Results: Two hundred eighty-seven children were consulted by PPs. The most common reasons for the PP consultation were respiratory failure (39.4%), preoperative evaluation (14.6%), pneumonia (8.7%), atelectasis (5.9%), and suspicion of foreign body aspiration (5.6%). The median LOS in the hospital was 33 (IQR = 61) days, in the ICU was 13 (IQR = 33) days, and on the MV was 10.50 (IQR = 30.50) days. Group 1 had significantly lower LOS in the hospital, ICU, and MV than group 2 (p < 0.001 for all). We found that being monitored on an MV (p < 0.001), being consulted for prolonged intubation or respiratory failure (p < 0.001), and being consulted by a PP after a median of 14 days are the main contributors to prolonged ICU LOS. Conclusions: Early PP consultation for children treated in the PICU and NICU may be associated with better outcomes. Nevertheless, the retrospective nature of our study, the lack of risk scoring data for patients, and the numerous factors that can influence the LOS in the ICU and hospital for pediatric patients necessitate further comprehensive research to substantiate our findings.