Dr. Behçet Uz Çocuk Hastalıkları Hastanesi

Patient-ventilator asynchrony (PVA) is common during invasive mechanical ventilation in children and may increase respiratory workload and discomfort. The IntelliSync+ (IS+) algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms to optimize inspiratory and expiratory cycling in real time. This study evaluated the efficacy and safety of IS+ compared with conventional physician-tailored synchronization in spontaneously breathing pediatric patients. Multicenter, prospective, randomized controlled, single-blind crossover trial conducted in four pediatric intensive care units between March 2024 and May 2025. Patients aged 1 month to 18 years undergoing invasive mechanical ventilation were randomized to begin with either IS+ or conventional synchronization. Each mode was applied for 90 min (30-min run-in and 60-min measurement), separated by a 30-min washout period. The primary outcome was the Asynchrony Index (AI). Secondary outcomes included major and minor asynchrony indices, Comfort-B scores, end-tidal carbon dioxide (EtCO2), oxygen saturation (SpO2), and leak percentage. Twenty-five patients completed both study phases. Compared with conventional synchronization, IS+ significantly reduced the overall AI (median 5.1% [IQR 4.2-6.4] vs. 12.4% [IQR 9.9-15.6]; P < 0.001), as well as both major and minor asynchrony indices (P < 0.001 for both). The frequencies of double triggering, auto-triggering, trigger delay, and early cycling decreased significantly, while ineffective efforts were unchanged and late cycling slightly increased. Comfort-B scores improved modestly (P = 0.02) and EtCO2 decreased (P < 0.001), whereas SpO2 and leak remained stable. Closed-loop synchronization with IS+ significantly improved patient-ventilator interaction without compromising comfort, oxygenation, or safety. These results support closed-loop synchronization as a feasible and physiologically sound strategy for improving ventilatory support quality in pediatric invasive mechanical ventilation. [ClinicalTrials.gov], identifier [NCT05731024].

This study investigates the psychological challenges, stressors, and coping strategies of disaster rescue workers involved in the February 6, 2023, earthquakes in Kahramanmaraş Turkey. Using a qualitative phenomenological design, data were gathered through semi-structured interviews with 21 volunteers. Themes explored include trauma exposure, coping strategies, psychosocial support, and burnout. Thematic analysis identified three core themes: (1) Psychosocial Effects of Disaster Response, such as mental health impacts and social disruption; (2) Psychological Resilience and Coping Mechanisms, including resilience development and specific coping behaviors; and (3) Traumatic Experiences, involving direct trauma exposure and psychological intrusions. Participants, averaging 36.4 years in age and 9.2 years of experience, displayed notable resilience despite severe trauma. The findings highlight the critical role of individual coping skills and collective supports such as team cohesion and empathy. The study concludes that promoting disaster workers' mental health requires integrated emotional, social, and organizational support to enhance resilience and recovery.

WHAT IS KNOWN : •Anti-dopaminergic agents (metoclopramide (MCP), trimethobenzamide (TMB), and domperidone (DOM)) are used for diabetic gastroparesis, but their effects on diabetic eye are not well studied. • These drugs do not affect intraocular pressure or tear production in diabetic rats. • They increase retinal prolactin receptor expression and reduce VEGF and CD31 immunoreactivity, indicating modulation of angiogenesis-related markers in the diabetic retina. •These findings may encourage future research to explore the potential role of prolactin-elevating antidopaminergic agents in diabetic retinopathy.

Background: Oral food challenges (OFCs) are the gold standard for diagnosing IgE-mediated food allergies in children, although they carry an inherent risk of inducing allergic reactions, including anaphylaxis. This study examined clinical outcomes and predictors of positive OFC results in a pediatric cohort from a region with high exposure to sesame and tree nuts. Methods: We retrospectively analyzed 310 OFCs in 211 children (median age: 21 months [IQR: 14–37.3]) at a tertiary pediatric allergy center from January 1 to December 31, 2023. Reaction patterns and predictors of OFC positivity, including age, sex, initial reaction type, skin prick test (SPT) wheal size, and serum-specific IgE (sIgE) levels, were evaluated. Results: OFC positivity occurred in 12.3% (38/310) of the challenges, and was most commonly triggered by milk or dairy products (44.7%), tree nuts (23.6%), and eggs (18.4%). Cutaneous symptoms predominated (94.7%), followed by gastrointestinal (10.6%) and respiratory (7.9%) manifestations. Anaphylaxis occurred in 13.2% (5/38) of the positive OFCs. Positive OFC patients were older (P = 0.009), had longer follow-up (P = 0.046), and were more likely to have presented with urticaria (P &lt; 0.001) or anaphylaxis (P &lt; 0.001). Multivariate logistic regres-sion identified milk or dairy products (OR: 3.326, 95% CI: 1.437–7.702, P = 0.005), sesame (OR: 7.022, 95% CI: 1.194–41.311, P = 0.031), and hazelnut (OR: 11.286, 95% CI: 3.858–33.017, P &lt; 0.001) as independent predictors of OFC positivity. Conclusion: OFC positivity was 12.3%, and was predominantly triggered by milk, tree nuts, and eggs. Severe reactions, including anaphylaxis, occurred despite low sIgE and SPT values, confirming the limited utility of sensitization markers in predicting clinical reactivity. Older age, longer follow-up, history of urticaria or anaphylaxis, and challenges with milk, sesame, or hazelnut were independently associated with positive OFCs. These results underscore the critical role of risk-stratified, closely monitored OFCs in ensuring diagnostic accuracy and guiding safe, personalized management in pediatric IgE-mediated food allergy.

Cognitive Disengagement Syndrome (CDS) is increasingly viewed as a distinct childhood condition. Although it overlaps with ADHD in some features, emerging evidence suggests a unique behavioral and cognitive profile. However, research examining social functioning and emotion recognition in children with pure CDS remains limited. This study compared social competence and facial emotion recognition abilities among children aged 8 to 12 years across three groups: those with elevated CDS symptoms (n = 43), those with ADHD (n = 40), and healthy controls (n = 43). Social functioning and peer relationships were evaluated using parent- and child-report social skills scales and peer interaction questionnaires. Emotion recognition was measured with the Reading the Mind in the Eyes Test (RMET). Children with CDS showed significantly lower social skills and RMET scores than both ADHD and control groups (p < .001). Teachers reported fewer school friendships for the CDS group compared to ADHD and controls (p < .001), and CDS children also reported fewer out-of-school friendships than peers in the other groups (p = .035). Both child and teacher reports noted greater peer relationship difficulties in the CDS group compared to the other groups (p < .001). Teachers also observed more solitary behavior and lower group participation among CDS children (p < .001). Within the CDS group, social skills were negatively associated with oppositionality (r = -.347) and positively associated with inattention severity (r = .346). Regression analysis identified social skills scores as independent predictors of peer relationships across the full sample (p < .001). These findings suggest that children with elevated CDS symptoms experience greater social difficulties and more pronounced emotion recognition impairments than both ADHD and typically developing peers, reflecting a distinct social-cognitive profile that extends beyond overlapping ADHD symptoms. The results underscore the importance of early recognition and targeted interventions.

(Abstracted from Reprod Biomed Online 2025;51(2):104697, doi:10.1016/j.rbmo.2024.104697) Receptivity modulators control and facilitate cell differentiation and embryo development as well as inflammatory pathways and suppression of paternal alloantigens. Molecular changes driven by the microenvironment of the endometrium drive endometrial thickening that prepares the uterus for implantation.

IntroductionJuvenile Systemic Lupus Erythematosus (jSLE) is a rare pediatric rheumatic disease characterized by systemic inflammation that can lead to organ damage. Compared to adults, it often has a more severe course in children. Both disease activity and treatments may result in temporary or permanent damage.ObjectivesTo evaluate risk factors associated with damage occurrence in patients with jSLE.MethodsThis multicenter, retrospective study included patients with jSLE followed for at least 12 months. Low-dose corticosteroid therapy was defined as prednisolone 0.01-0.03mg/kg/day (max 7.5mg/day). The annual cumulative steroid dose was calculated by dividing the total steroid intake by 365.25 times the number of follow-up years. Collected data included SLEDAI and SDI scores at initial and final visits, laboratory parameters, and flare characteristics.ResultsA total of 158 patients (86.7% female) from 17 centers were included. Median age at diagnosis was 13.8years, with a median follow-up of 35months. Organ damage was present in 14 patients at diagnosis and in 23 at final visit. Damage types included proteinuria, cognitive dysfunction (each 3.2%), and others such as cataracts, erosive arthritis, avascular necrosis, optic atrophy, and vertebral collapse. Patients with damage had significantly higher SLEDAI scores at both time points, delayed transition to low-dose steroids, and a lower rate of achieving Lupus Low Disease Activity State (LLDAS) (p = .006).ConclusionPersistent disease activity and delayed control are major contributors to organ damage in jSLE. Early and sustained disease suppression is critical to prevent long-term complications.