Begum Baris Cetinkaya

Background: Familial Mediterranean Fever (FMF) is a chronic autoinflammatory disease that may adversely affect sleep quality, emotional well-being, and other patient-reported outcomes during childhood and adolescence. However, previous pediatric studies have frequently included heterogeneous patient populations with varying disease activity, limiting understanding of the relationship between disease severity and psychosocial functioning. Objective: To evaluate sleep quality and depressive symptoms in clinically stable children and adolescents with FMF during attack-free periods and to investigate their relationships with disease severity assessed using the International Severity Scoring System for Familial Mediterranean Fever (ISSF) and developmental factors. Methods: This cross-sectional case–control study included 72 children and adolescents with FMF and 88 age- and sex-comparable healthy controls. All patients with FMF were evaluated during clinically stable attack-free periods while receiving maintenance colchicine therapy. Depressive symptoms and sleep quality were assessed using the Children’s Depression Inventory (CDI) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Disease severity was evaluated using the ISSF. Multivariable logistic regression analysis was performed to identify factors independently associated with poor sleep quality. Results: Healthy controls demonstrated significantly higher mean CDI and PSQI scores than patients with FMF (CDI: 10.3 ± 6.8 vs. 8.2 ± 5.3, p = 0.048; PSQI: 4.7 ± 2.7 vs. 3.0 ± 2.3, p < 0.001). Poor sleep quality (PSQI ≥ 5) was more frequent among controls (46.6% vs. 25.0%, p = 0.006). Within the FMF cohort, adolescents (13–18 years) had significantly poorer sleep quality than younger children (p = 0.005). Increasing age was independently associated with poor sleep quality (OR 1.24, 95% CI 1.07–1.43; p = 0.003), whereas FMF diagnosis was not independently associated with poor sleep quality after adjustment for age and sex. No significant association was identified between ISSF-defined disease severity and psychosocial outcomes. Sleep quality showed a modest positive correlation with depressive symptom severity (Spearman’s ρ = 0.313, p = 0.007). Conclusions: Children and adolescents with FMF receiving maintenance colchicine therapy during clinically stable attack-free periods did not demonstrate poorer sleep quality or greater depressive symptom severity than age- and sex-comparable healthy controls. Increasing age appeared to be more closely associated with poor sleep quality than clinically assessed disease severity, whereas sleep quality showed a modest association with depressive symptom severity. These findings suggest that incorporating routine assessment of sleep quality and psychological well-being into multidisciplinary follow-up may facilitate a more comprehensive evaluation of children and adolescents with FMF.

Background/Objectives: Asthma, one of the most common chronic diseases in childhood, and acute bronchiolitis, a leading cause of hospitalization in early childhood, remain significant contributors to morbidity and mortality. Methods: This retrospective cohort study evaluated the efficacy and safety of intravenous magnesium sulfate (IV MgSO₄) as a secondary treatment in pediatric patients with acute asthma exacerbation unresponsive to first-line therapy and in patients with acute bronchiolitis unresponsive to supportive care. A total of 450 patients aged 6 months to 18 years, including 252 with acute asthma exacerbation and 198 with acute bronchiolitis, were included. Results: Significant improvements in peripheral capillary oxygen saturation were observed after IV MgSO₄ administration in both groups (p < 0.001). In the acute asthma exacerbation group, IV MgSO₄ also significantly reduced tachypnea compared to the acute bronchiolitis group (p < 0.001). No adverse effects related to IV MgSO₄ were observed. Conclusions: These findings suggest that IV MgSO₄ may be both beneficial and safe as an early secondary treatment in acute asthma exacerbations.

Introduction: Atypical antipsychotics are widely prescribed in child and adolescent psychiatry and are known to affect cardiac repolarization, most commonly reflected by QTc prolongation. However, QTc alone may not fully capture repolarization heterogeneity. The frontal QRS–T angle f(QRS–T) is an electrocardiographic marker reflecting ventricular depolarization–repolarization mismatch. This study aimed to evaluate and compare f(QRS–T) alongside other repolarization parameters in children and adolescents receiving atypical antipsychotics versus healthy controls. Methods: This retrospective observational study included 45 children and adolescents (6–17 years) receiving atypical antipsychotics for at least six months and 45 age‐ and sex‐matched healthy controls. Standard 12‐lead ECG recordings were obtained to measure f(QRS–T), QTc, Tp‐e interval, and Tp‐e–based ratios. Correlation analyses assessed associations between f(QRS–T), QTc, and duration of antipsychotic use. Hierarchical multiple linear regression was performed to identify independent predictors of f(QRS–T) in the patient group. Receiver operating characteristic (ROC) analysis evaluated the discriminative ability of f(QRS–T) for QTc prolongation (QTc ≥ 440 ms). Results: Children receiving atypical antipsychotics exhibited significantly higher f(QRS–T), QTc interval, Tp‐e interval, Tp‐e(c), Tp‐e(c)/QT, and iCEBc ratios compared with healthy controls ( p < 0.05). Frontal QRS–T angle was positively correlated with QTc ( r = 0.406, p < 0.001) but not with the duration of antipsychotic treatment. In hierarchical regression analysis, age, sex, QTc and duration of antipsychotic use were not independent predictors of f(QRS–T). ROC analysis demonstrated that f(QRS–T) moderately discriminated patients with QTc prolongation (AUC = 0.735); a cut‐off value of 26.5° yielded a sensitivity of 72% and a specificity of 60%. Conclusion: f(QRS–T) is significantly increased in children and adolescents receiving atypical antipsychotics and is associated with QTc prolongation, although it is not independently predicted by treatment duration or conventional QT‐based indices. These findings suggest that f(QRS–T) may serve as a complementary electrocardiographic marker of repolarization heterogeneity alongside QTc in the cardiac safety monitoring of pediatric patients treated with atypical antipsychotics.

Amaç: Antenatal dönemde yenidoğanda ortaya çıkan fiziksel yaralanmalar “doğum travması” olarak belirtilmektedir. Klavikula kırıkları yenidoğanlarda kemiğe bağlı en sık görülen doğum travmasıdır. Çalışmamızda yenidoğan muayenesinde klavikula kırığı saptanan olguların değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Hastanemizde 1 Ocak 2022 ile 1 Ağustos 2024 tarihleri arasında doğan bebeklerin dosyaları retrospektif olarak incelendi. Çalışmamızda belirtilen 2,5 yıllık zaman aralığında hastanemizde doğum sayısının 2756 olduğu (2022:1185,2023:1044,2024:527) tespit edildi. Bu doğumların içerisinde klavikula kırığı tespit edilen 31 yenidoğan hasta çalışmaya dahil edildi. Bulgular: Toplam doğumların %42,6’sı normal spontan vajinal yol ile olurken %57,4’ünün sezaryen yöntemi ile olduğu tespit edildi. Çalışmamızda olguların kız/erkek oranı 13/18 idi. Olguların anne yaşı ortalaması 26,64 ± 4,61 gebelik haftası ortalaması 39,08 ± 1,04 idi. Doğum şekli değerlendirildiğinde normal vajinal doğum ile doğan 29 (%93,5), sezaryen ile doğan 2 (%6,5) olgu saptandı. Çalışmamızda doğum tartısı en az olan olgu 2770 gr iken en fazla doğum tartısına sahip olgu 4640 gr’dı. Olguların doğum ağırlığı ortalaması 3462,25 ± 453,11 gr saptandı. Klavikula kırığı saptanan olgularımızın %93,5’i (n:29) vajinal yol ile dünyaya gelirken, %6,5 ‘inin (n:2) ise sezaryen ile doğduğu saptandı. Sonuç: Çalışmamızda tüm doğumların %1,1’inde klavikula kırığı saptandı. Ayrıntılı yenidoğan muayenesinde klavikula kırığı şüphesi olan hastalarda direk grafi ile tanı konmaktadır. Genellikle konservatif yaklaşım ile sekelsiz iyileşme olmaktadır. Doğum travmasının şiddetine bağlı gelişen sinir hasarı varlığında uzun dönem takip ve komplikasyonlar görülebilmektedir.