Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges.

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 Silent Victims of the Pandemic: Children During the Coronavirus Disease 2019 Crisis.

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.

Evaluation of thymopoiesis in healthy Turkish children aged 0-6 years.

BACKGROUND: Early diagnosis and effective treatment serve as life-saving procedures for primary immunodeficiencies (PIDs) which are very common and a major public health problem in Turkey. Severe combined immunodeficiency (SCID) is constitutively a T-cell defect in which naïve T-cell development is defective due to the mutations in genes responsible for the T cell differentiation and insufficient thymopoiesis. So, assessment of thymopoiesis is very important in the diagnosis of SCID and several combined immune deficiencies (CIDs). METHODS: The purpose of this study is to examine thymopoiesis in healthy children via measurement of recent thymic emigrants (RTE); T lymphocytes that express CD4, CD45RA and CD31 to establish the RTE reference values in Turkish children. RTE were measured in the peripheral blood (PB) of 120 healthy infants and children between 0-6 years including cord blood samples, by flow cytometry. RESULTS: The absolute count of RTE cells and their relative ratios were found to be higher during the first year of life, being highest at the 6th month and tending to decrease significantly by age following birth (p=0.001). In the cord blood group, both values were lower than those in the 6-month-old group. The absolute lymphocyte count (ALC) varying by age, was found to reduce to 1850/mm³ in 4-years and after. CONCLUSIONS: Here we evaluated normal thymopoiesis and established the normal reference levels of RTE cells in the peripheral blood of healthy children aged between 0-6 years. We believe that the collected data will contribute to early diagnosis and monitoring of immune reconstitution; serving as an additional fast and reliable marker for many PID patients especially for SCID including many other CIDs, especially in nations where newborn screening (NBS) via T cell receptor excision circles (TREC) has not yet become available.

Evaluation of the effects of the toilet training process on the children's quality of life.

BACKGROUND: Toilet training is a significant developmental milestone for children. During the process of toilet training, voiding and defecation problems may develop, which have a major adverse impact on the child's quality of life (QoL). The aim of this study was to assess voiding and defecation problems in the process of toilet training and evaluate how these issues influenced the children's QoL. METHODS: The children included in the study were followed up at the Department of Social Pediatrics, Ankara University School of Medicine. Participants were surveyed via a questionnaire that included sociodemographic features, the toilet training process, and the Pediatric Quality of Life Inventory. RESULTS: The study included 177 children and their parents. There was no correlation between the parents' age, sociodemographic features, or the timing of the start of toilet training. Voiding problems were found in 55.6% and defecation problems in 23.6% of the children included in the study. Urinary retention during play and nocturnal enuresis were more frequent in the children toilet trained at 25-36 months of age. The self-reported QoL scores in children with voiding problems and with both voiding and defecation problems were lower than those in children did not have any problems. CONCLUSIONS: Even if a child has been toilet trained, it is essential to investigate daily urination and defecation habits at every follow-up visit and to discuss with families when a physician should be consulted.

The role of social support on the relationships between internet use and sleep problems in adolescents during COVID-19 pandemic: a multicentre study.

BACKGROUND: This study examines the frequency of problematic internet use and sleep problems in adolescents aged 14-18 years during the COVID-19 pandemic and identifies the impact of factors such as sociodemographic characteristics, internet habits, changes in daily life, and perceived social support on these problems. METHODS: This multicentre study was a questionnaire-based online survey study. The questionnaire included the Young Internet Addiction Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Scale of Perceived Social Support, as well as questions about demographic information, internet habits, and changes in daily life during pandemic. Several multivariate Backward logistic regression models were run to determine the variables that predicted problematic internet use and poor sleep quality. RESULTS: It was determined that the frequency of problematic internet use was 15.5%, and the frequency of poor sleep quality was 47.8%. Poor sleep quality was found 2.5 times higher in problematic internet users. The perceived social support was found insufficient in adolescents with problematic internet use and poor sleep quality. Various factors such as the excessive use of internet and social media, low school success, lack of physical activity, lack of rules for internet use at home, and worsening of relationships with parents were found to be predictive factors for these problems. CONCLUSIONS: Problematic internet use during the pandemic is associated with worsening sleep quality in adolescents. It is important to create special interventions for problematic internet use and sleep problems that develop in adolescents as a result of restrictions during the pandemic.

Assessment of cows milk-related symptom scoring awareness tool in young Turkish children.

BACKGROUND: The diagnosis of cows milk protein allergy (CMPA) is not always easy. Cow's Milk-related Symptom Score (CoMiSS) has been developed to raise the awareness of CMPA among the primary health-care providers. In this study, we aimed to evaluate the validity of CoMiSS as a diagnostic approach of CMPA in infants in our country. METHODS: Infants with a CoMiSS of more than 12 points were included. An elimination diet was implemented in these infants for 4 weeks, and CoMiSS was reapplied. Infants with a reduction of ≥3 points in CoMiSS were considered responsive to the elimination diet, and an open oral challenge test was performed. Infants with symptom recurrence were diagnosed with CMPA. RESULTS: The study included 168 infants. When they were included in the study, the first CoMiSS score was 13.6 ± 1.9. After the elimination diet, the number of responsive infants was 154 (91.7%). Of the infants, 91 (54.2%) were diagnosed with CMPA with positive challenge. The majority of the patients diagnosed with CMPA presented with gastrointestinal and/or dermatological symptoms (80.3%). Positive family history of allergy was more prevalent in CMPA(+) infants (P < 0.001). The mean atopic dermatitis score was higher in CMPA(+) infants (P = 0.001). Eosinophilia and cows milk-specific IgE (CM-sIgE) positivity were more prevalent in infants with CMPA (P = 0.01 and P < 0.001, respectively). CONCLUSIONS: CoMiSS is a valuable tool to evaluate CMPA in primary care. The presence of multiple symptoms, especially skin involvement, helps to recognise infants with CMPA. Family history and eosinophilia also support the diagnosis of CMPA.

Echocardiographic screening for rheumatic heart disease in Turkish schoolchildren.

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.

Preliminary study on bisphenol A levels and possible exposure history of mother and exclusively breastfed infant pairs.

The aims of this study were to determine bisphenol A (BPA) levels in breast milk and urine specimens of healthy mother and exclusively breastfed infant pairs having no known BPA exposure, and also to examine the relationship between BPA levels and possible BPA exposure history. Forty mothers and their 1-2-month-old exclusively breastfeed infant were included in the study. The questionnaires about sociodemographic characteristics and possible BPA exposure history were filled out. Breast milk and urine samples were taken. BPA analyses of these samples were conducted using high-performance liquid chromatography coupled with mass spectrometry. All mother-infant pairs showed detectable BPA concentrations. The geometric means of BPA levels in breast milk, maternal urine, and infant urine were determined as 0.12 µg/L (0.03-0.59), 0.12 µg/L (0.03-0.73), and 0.13 µg/L (0.02-0.44), respectively. Infants whose mothers were consuming yoghurt in plastic containers had relatively higher urinary BPA levels (p = 0.00). Mothers consuming hot beverages in plastic glass showed higher breast milk BPA levels (p = 0.033). There were no statistical associations between BPA levels and the use of plastic materials and tools (p > 0.05).Conclusion: The measurable BPA concentrations in all breast milk specimens of healthy mothers may reflect possible exposure from dietary or non-dietary sources. Exclusively, breastfed healthy infants without any known BPA exposure may be exposed to BPA from their mothers through breastfeeding. What is Known: • Fetuses, neonates and infants are exposed to BPA from their mothers through placental transfer and breastfeeding. • Breast milk is considered a continuous low-level exposure to BPA. What is New: • BPA was detected in 100% of maternal urine, infant urine, and breast milk in healthy mother-infant pairs having no known BPA exposure. • The measurable amount of BPA in breast milk and infant urine may reflect possible BPA exposure of mother-infant pairs.

Evaluation of Childhood Vaccine Refusal and Hesitancy Intentions in Turkey.

OBJECTIVE: To assess the factors affecting parental childhood vaccine refusal and hesitancy (CVRH) intentions in Turkey. METHODS: A total of 33 children's parents who were referred to two different child health care clinics because of CVRH and 99 controls were enrolled into this study from November through December 2017. The socio-demographic characteristics and perceptions of the parents who refused at least one vaccine for their child/children were compared with controls. RESULTS: The monthly household income was significantly lower in CVRH group than control group. Refusal of the heel stick, refusal of hearing test, not using baby car seat, irregular use of vitamin D and iron prophylaxis, using alterative/complementary medicine, distrust in vaccines were the parameters which were found significantly higher in refused vaccine group than in control group. The beliefs "It may be dangerous for children" and "Distrust to the vaccines" were the most determined factors with a ratio of 51.5% in CVRH group. CONCLUSIONS: This is the first study conducted to investigate the social-demographic characteristics and perception of parental CVRH in Turkey. The beliefs "It may be dangerous for the children" and "Distrust the vaccines" were the most determined factors which may affect CVRH. Some child health protective strategies were less undertaken in CVRH group than in controls; including heel stick test, hearing test, using baby car seat and using of Vitamin D and iron prophylaxis. The parents who have CVRH intentions tend to behave irresponsibly in care of their children.

Evaluation of clinical approaches and physician adherence to guidelines for otitis media with effusion.

OBJECTIVES: Otitis media with effusion (OME) is an important clinical entity because of its high prevalence, difficulties in diagnosis, complications and diversities in management. Herein, we aimed to evaluate current physician approaches on OME and determine clinical adherence to current guidelines. METHODS AND MATERIALS: A total of 370 physicians [Group 1: pediatricians (n = 256, 69.2%), Group 2: otorhinolarynologists (n = 114, 30.8%)] completed a survey instrument addressing demographic data and clinical practice parameters on OME in children. We also compared clinical approaches of Group 1 and Group 2. In addition, multiple logistic regression analysis was performed to evaluate factors which may effect correct approaches. RESULTS: The mean period of clinical experience was 9.30 ±â€¯8.35 [median 6 (1-40)] years. A total of 311 (84%) respondents reported satisfactory level of self-confidence as regards of clinical approaches to OME. Reduced mobility of the tympanic membrane and preference of pneumatic otoscopy was signified by 107 (28.9%) and 64 (17.3%) respondents, respectively. Fifty-six (15.1%) physicians identified "watchful waiting" for 3 months for children who are not at risk while 314 (84.9%) reported preference of medications, with antibiotics the most preferred prescription (n = 223, 63%). Comparison of Group 1 and Group 2 indicated similar results except better, yet insufficient, characterization of physical examination findings of OME by Group 2 (p < 0.001, for each parameter). Group 2 preferred tympanometry more in uncertain cases (p < 0.001) and handled chronic cases better (p < 0.001). Multiple logistic regression analysis revealed lower signification of reduced mobility of the tympanic membrane for respondents who denoted depending on personal experience ([OR] = 3.077 [95% CI 1.042-9.09]) or following clinical guidelines ([OR] = 3.365 [95% CI 1.38-8.20]) rather than combining them both. Rate of antibiotic avoidance was lowest in physicians with a period of clinical experience<5 years ([OR] = 2.14 [95% CI 1.32-3.48]). CONCLUSIONS: Despite notifying high self-confidence and adherence to current guidelines on OME, both pediatricians and otorhinolaryngologists lacked to exhibit proper approaches. Further research is warranted to evaluate the causes of poor adherence to current guidelines and bring suggestions for the maintenance of consistent and correct clinical approaches to OME.

Secular trends in height, weight and body mass index of primary school children in Turkey between 1993 and 2016.

BACKGROUND: The aim of the study was to analyze the secular trends in height, weight and body mass index (BMI) of children in a Turkish primary school in a 23-year time interval. METHODS: The height, weight and BMI of 1099 children between 7 and 15 years old were measured. Data were compared to those of children of the same ages from previous measurements carried out in 1993 (867 children) and in 2003 (1214 children) in the same school. The changes in weight, height and BMI were determined and analyzed statistically. RESULTS: Weight increments between 7.7 and 16.2 kg/23 years and height increments between 1.1 and 8.3 cm/23 years were observed in boys. For girls, weight increments between 6.5 and 13.4 kg/23 years and height increments between 1.3 and 7.2 cm/23 years were indicated. Usually, there were significant height increments between 1993 and 2016 in both genders. However, there were no significant differences in height between 2003 and 2016 for all age groups. Furthermore, there were significant differences in BMI measurements in all age and gender groups between 1993 and 2016. CONCLUSIONS: The secular ascending trend in height seems to stop between 2003 and 2016; however, increments in weight and mean BMI tend to continue in Turkish primary school children and adolescents.

Plasma Amino-Terminal Propeptide of C-Type Natriuretic Peptide Concentration in Normal-Weight and Obese Children.

OBJECTIVE: In studies on the relationship between amino-terminal propeptide of C-type natriuretic peptide (NT-proCNP) concentration and height velocity in children, CNP has been implicated as an emerging new growth marker during childhood. It has been reported that besides its well-studied role in growth, plasma CNP levels are reduced in overweight and/or obese adolescents, suggesting CNP as a potential biomarker in childhood obesity. The primary goal of this study was to test this hypothesis in a Turkish population. METHODS: Consent was taken from 317 children [ages 0-18 (158 girls, 159 boys)] and their parents. All subjects were physically examined; anthropometric measurements were obtained. Body mass index was calculated. During routine blood work, 1 mL extra blood was taken. Plasma NT-proCNP concentration was measured by enzyme-linked immunosorbent assay. RESULTS: Results confirmed the previously described relationship between plasma NT-proCNP concentration and growth velocity. Plasma NT-proCNP concentration showed a negative correlation with age, weight, and height in children. Gender was not a factor that alters the age-dependent plasma NT-proCNP concentration until puberty. CONCLUSION: Unlike previous reports, plasma NT-proCNP concentration of overweight/obese children was not significantly lower than that of children with normal weight in age groups analyzed in a Turkish population. Thus, it is too early to conclude that CNP is a potential biomarker in childhood obesity. Further studies are necessary to address this question.

The relationship between family functioning and the crime types in incarcerated children.

BACKGROUND: We investigated the relationship between the family functioning and crime types in incarcerated children. METHODS: One hundred eighty two incarcerated children aged between 13-18 years who were confined in child-youth prisons and child correctional facilities were enrolled into this descriptive study. Participants completed demographic questions and the McMaster Family Assessment Device (Epstein, Baldwin, & Bishop, 1983) (FAD) with face to face interviews. RESULTS: The crime types were theft, assault (bodily injury), robbery, sexual assault, drug trafficker and murder. The socio-demographic characteristics were compared by using FAD scale, and growing up in a nuclear family had statistically significant better scores for problem solving and communication subscales and the children whose parents had their own house had significantly better problem solving scores When we compared the crime types of children by using problem solving, communication and general functioning subscales of FAD, we found statistical lower scores in assault (bodily injury) group than in theft, sexual assault, murder groups and in drug trafficker group than in murder group, also we found lower scores in drug trafficker group than in theft group for problem solving and general functioning sub-scales, also there were lower scores in bodily injury assault group than in robbery, theft groups and in drug trafficker than in theft group for problem solving subscale. CONCLUSIONS: The communication and problem solving sub-scales of FAD are firstly impaired scales for the incarcerated children. We mention these sub-scales are found with unplanned and less serious crimes and commented those as cry for help of the children.

Anxiety, depression and self-esteem levels in obese children: a case-control study.

BACKGROUND: Obesity is a global health problem affecting all age groups. Childhood obesity, which may cause chronic diseases including diabetes mellitus, cardiovascular disease and cancer, etc., deserves more attention. However, few studies highlight the association between childhood obesity and psychological diseases. In the present study, we aimed to evaluate the psychological condition in obese children. METHODS: One hundred and sixty-seven obese (body mass index (BMI) >95th percentile) and 200 normal weight children (BMI between 5th and 85th percentile) aged 9-16 years were enrolled into this case-control study. In order to assess the self-concept, anxiety and depression levels: the Piers-Harris Children's Self-Concept Scale (PHCSCS), state and trait anxiety inventory for children (STAI-C) and the children depression inventory (CDI) were administered both obese and control groups. RESULTS: There were significant differences among obese and control groups in terms of the total score of PHCSCS [55 (22-69) versus 65 (57-74)], STAI-C [37 (20-55) versus 28 (20-42)], and CDI [12 (4-39)] versus [8 (3-19)]; respectively (p<0.001, p<0.001, p<0.001). We also found statistically significant differences among groups in all of the subscales parameters of PHCSCS (p<0.001). CONCLUSIONS: Our results indicate that obese children may experience psychiatric disorders more than normal-weight peers.

Factors That Affect Perinatal Outcomes of the Second Pregnancy of Adolescents.

STUDY OBJECTIVE: We assessed factors that might affect perinatal outcomes in second pregnancies in adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, MAIN OUTCOME MEASURES: This longitudinal retrospective study was carried out on 66 adolescents who experienced 2 deliveries during their adolescence. Data were collected for the first and second pregnancies. Odds ratios (ORs) and 95% confidence intervals (CIs) for adverse perinatal outcomes in the second pregnancy were calculated using a logistic regression model and SPSS software (version 17.0 for Windows; SPSS Inc, Chicago, IL). A P value < .05 was considered to indicate statistical significance. RESULTS: Body mass index, number of antenatal care visits, weight gain during pregnancy, incidence of anemia, smoking status, gestational week at delivery, cesarean section rate, and birth weight were similar between the first and second pregnancies of these adolescents. Neonatal intensive care unit admission rate, preeclampsia rate, low neonatal birth weight rate, and 5-minute Apgar scores <7 were significantly higher in the first than in the second pregnancy (P < .001). Age of 16 years or younger at the time of first pregnancy (OR = 1.5; 95% CI, 0.9-2.1; P < .01), less than an 18-month interval between births (OR = 1.4; 95% CI, 0.2-1.7; P < .04), presence of gestational complications in the first pregnancy (OR = 1.9; 95% CI, 1.0-3.4; P < .01), and the presence of perinatal complications in the first pregnancy (OR = 1.3; 95% CI, 1.0-1.9; P < .01) were found to be significant indicators for adverse neonatal outcomes in second pregnancies of adolescents. CONCLUSION: We found that the second pregnancies of adolescents were associated with fewer adverse perinatal outcomes than were their first pregnancies. However, some factors regarding the presence of perinatal complications in the first pregnancy, such as maternal age of 16 years or younger at the time of the first pregnancy and interval between first and second pregnancy of less than 18 months, were found to increase the risk of adverse perinatal outcomes for the second births.

Spontaneous Membranous Dysmenorrhea in an Adolescent Girl: A Case Report and Literature Review.

BACKGROUND: Membranous dysmenorrhea is a rare entity. It involves the sloughing of the endometrium in 1 cylindrical or membranous piece, retaining the shape of the uterine cavity. Herein, we report the first case of spontaneous membranous dysmenorrhea in an adolescent girl. CASE: A 17-year-old girl was admitted to the emergency clinic with severe painful menstrual bleeding and passage of tissue via the vagina. Bloody endometrial tissue resembling the endometrial cavity expulsed from the vagina was seen on inspection. The pathologic diagnosis of the mass was membranous dysmenorrhea. SUMMARY AND CONCLUSION: To our knowledge, this is the first case of the spontaneous occurrence of membranous dysmenorrhea. The relationship between membranous dysmenorrhea and endogenous or exogenous progesterone should be investigated further. A review of the literature on membranous dysmenorrhea is presented.

Determining the persistence of maternally acquired antibodies to hepatitis A and varicella zoster during the first 2 years of life in Turkey.

UNLABELLED: Vaccination should be timed to take into account the potential interference of maternal antibodies. The purpose of this study was to determine the persistence of maternally acquired antibodies to hepatitis A and varicella zoster in a group of healthy infants between 6 and 24 months of age. These infants were divided into four groups according to the age at the time of follow-up visits. The study group consisted of infants who were brought to the 6-month follow-up visit (group 1, n=100), 12-month follow-up visit (group 2, n=99), 18-month follow-up visit (group 3, n=59), and 24-month follow-up visit (group 4, n=59). Hepatitis A, varicella IgG, and IgM antibodies were analyzed qualitatively. Hepatitis A IgG seropositivity was determined as 71 % in group 1, 41.4 % in group 2, 0 % in group 3, and 8.5 % in group 4 (p<0.001). Varicella IgG seropositivity was found to be 5 % in group 1, 4 % in group 2, 4 % in group 3, and 1 % in group 4 (p>0.05). CONCLUSION: We found that maternal hepatitis A antibodies in children disappear between 12 and 18 months, whereas maternal varicella antibodies substantially diminish following the sixth month. Therefore, the vaccination timing should be based on factors such as the interference of maternal antibodies, disease susceptibility period, and immune maturation.