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Objective: Membranous nephropathy (MN) is a rare immune complex disease in pediatric population then adults. The prognosis of MN is variable, ranging from spontaneous complete remission to end-stage renal disease (ESRD). The lack of large multicenter studies precludes the possibility of examining in detail the treatment options and clinical outcomes in these patients. The present study aimed to expand the literature on the clinical findings, treatment, and prognosis of MN in pediatric patients. Material and Methods: This single-center retrospective study included 13 patients with a diagnosis of primary and secondary membranous nephropathy. Results: The mean age of the sample was 12.29±3.67 years. Complete remission occurred in 7 (53.8%) patients (of which 1 case was spontaneous remission), and partial remission occurred in 4 (30.8%) patients. In long-term follow-ups; one patient had chronic kidney disease (CKD) and one patient had end-stage renal disease (ESRD). At the last-follow up, proteinuria was noted in 6 (46.2%) patients and microscopic hematuria was noted in 4 (30.8%) and 9 patients were still using low-dose steroids. Conclusion: The current findings have not identified any significant risk factors associated with the prognosis of MN in pediatric patients, but are thought to contribute to the limited data on pediatric MN. Most of the available data on the natural history, treatment options, and long-term outcomes of MN in the pediatric population consists of small, uncontrolled case series. Therefore, we think that larger-scale clinical trials are necessary to clearly elucidate the factors related to the prognosis of pediatric MN.

Amaç: Araştırma, doğum eyleminde olan kadınların yaşadıkları ağrı ile baş edebilmek için bildikleri nonfarmakolojik yöntemleri sorgulamak ve bu yöntemlerden hangilerini tercih ettiklerini belirlemek amacıyla yapılmıştır. Yöntem: Tanımlayıcı olarak tasarlanan araştırmanın evrenini 01.07.2019- 01.03.2020 tarihleri arasında Adıyaman ilindeki bir hastanenin doğumhane servisine yatışı yapılan 250 kadın oluşturmuştur. Örneklem seçiminde gelişigüzel örnekleme yöntemi kullanılmıştır. Araştırmaya, doğum eylemi başlamış, gebelik haftası term olan, vajinal doğum planlanan, kendisinde-bebeğinde herhangi bir sağlık sorunu bulunmayan, tek fetüse sahip, tedavi gebeliği olmayan gebe kadınlar dahil edilmiştir. Veri toplama aracı olarak Katılımcı Bilgi Formu kullanılmıştır. Verilerin analizinde yüzde, ortalama, standart sapma, Kruskal Wallis Testi ve Mann Whitney U Testleri kullanımıştır. Bulgular: Araştırmada kadınların doğum ağrısına yönelik tercih ettikleri nanfarmakolojik yöntemler incelendiğinde; sırasıyla en fazla pozisyon değişikliği (%93.6), bele masaj (%76), sosyal destek (62.8), doğum topu (%47.2), müzik dinleme (%40.4), sacruma masaj (%34.8), aromaterapi (%26), perine masajı (%14.8), yoga/meditasyon (%11.2), sıcak uygulama-perineal sıcak uygulama (%9.6), soğuk uygulama (%8.8), acupres (%6), akupunktur (%4), hipnoz (%2.8), İntradermal Steril Su Enjeksiyonu (%2), Transkütanöz Elektriksel Sinir Stimulasyonu (%0.8) yöntemlerini tercih ettikleri saptanmıştır. Sonuç: Araştırmamızda kadınların tamamının doğum ağrısını azaltmak amacıyla herhangi bir nanfarmakolojik yöntemi tercih ettikleri anlaşılmaktadır. Doğum eyleminde kadını rahatlatan nanfarmakoljik yöntemlerin, doğumhanelerde uygulanması, gebelerin doğum eylemini daha memnun tamamlamalarına olanak sağlayacaktır.

Background Nephrotic syndrome is the most common glomerular disorder of childhood and data on complications are still limited and predisposing risk factors have not been fully defined. The aim of our study is to systematically evaluate treatment and disease-related acute and chronic complications, and to identify the risk factors involved in the development of complications.Methods This single center study was performed at the pediatric nephrology department of a tertiary pediatric hospital in Turkey. A total of 411 patients with a diagnosis of childhood idiopathic nephrotic syndrome, 128 of whom had the disease-releated and treatment-related complications, were included in the study. Patients diagnosed and followed up between January 2010 and January 2022 were evaluated retrospectively.Results Complications occurred in 31.1% of 411 children with childhood idiopathic nephrotic syndrome. The mean age at diagnosis was 7.54 ± 4.37 years, and the male to female ratio was 0.9. Ninety-six pount nine percent of complications were disease-related complications, and 50.8% were drug-related complications. Advanced age at diagnosis, female gender, a high of level of proteinuria, and a low estimated glomerular filtration rate level were determined as significant risk factors for complication development (p = 0.000, p = 0.006, p = 0.04, p = 0.07, respectively). Chronic kidney disease developed in 7% of patients and 2.9% of patients had end-stage renal failure. When the patients who progressed to end-stage renal disease were examined; compared with the control group, patients with complications had a significantly higher ESRD incidence (p Conclusions We hypothesized that closer and careful monitoring of patients at risk for complications and implementation of personalized treatment programs could improve long-term outcomes.

Membranoproliferative glomerulonephritis and renal microangiopathies may manifest similar clinical presentations and histology. Many genetic mutations that cause these diseases have been reported. Studies on mutations in the gene encoding diacylglycerol kinase epsilon identified a novel pathophysiologic mechanism leading to atypical hemolytic uremic syndrome and/or membranoproliferative glomerulonephritis. Here, we present the different clinical presentations and treatments in 4 family members who carried the same homozygous diacylglycerol kinase epsilon mutation. The first patient (age 5 years, 3 months old at diagnosis) had nephrotic syndrome. The kidney biopsy was membranoproliferative glomerulonephritis; partial remission was achieved with cyclophosphamide, cyclosporine, and mycophenolate mofetil treatment. The second patient (age 5 years, 7 months at diagnosis) presented with overlapping atypical hemolytic uremic syndrome and membranoproliferative glomerulonephritis. Remission could not be achieved with cyclophosphamide, cyclosporine, and mycophenolate mofetil, and hemodialysis treatment was started. At 10 years from first admission, the patient had end-stage kidney disease, and kidney transplant was performed successfully. The third patient was admitted with the diagnosis of nephrotic syndrome at 13 months of age, kidney biopsy showed membranoproliferative glomerulonephritis, and spontaneous remission developed during followup. He presented with hemolytic uremic syndrome 15 months after the first admission, and dialysis was started. Remission was achieved with plasma infusion and eculizumab treatment. The fourth patient (a 7-month-old boy and brother of patient 3) had no clinical or laboratory findings. All patients had genetic analysis, and mutation in exon 2:c.473GA(p. W158*) was detected. Our related patients with the same mutation showed different clinical and histological findings. However, we did not observe a clear genotype-phenotype correlation in patients with diacylglycerol kinase epsilon nephropathy, suggesting additional factors mediating phenotypic heterogeneity.

The objective of this study was to determine the common indications of acute intermittent hemodialysis (IHD) treatment in childhood and to assess the characteristics of the procedure, complications, and prognosis.The study included 102 patients aged between 0 and 18 years, who had been acute dialysis indication and treated with IHD.In terms of acute kidney injury (AKI) etiology, glomerular diseases were prominent in 56% of the patients, and 8.6% of surviving patients progressed to end-stage renal disease. Regarding the cause of AKI, having the glomerular disease was determined to be directly associated (p = 0.01) with the risk of progression to chronic kidney disease (CKD) regardless of age, gender, onset time of renal replacement therapy.Glomerular diseases were the most common in AKI etiology and were associated with the progression to CKD, independent of age, gender and the time of IHD onset in our study.

Introduction: Neuropsychiatric (NP) involvement is a restricted area in juvenile-onset systemic lupus erythematosus (jSLE). Aim: To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population. Methods: This study was based upon 24 referral centers' SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collab-orating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses. Results: A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activ-ity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002-7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785-68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049-1.186), P: 0,001 were associated with increased risk for neurologic sequelae. Conclusion: We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed. (c) 2023 Socie ' te ' franc,aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Background: Training received during pregnancy may alter the prenatal stress level. The purpose of this study was to investigate the effects of prenatal education on the stress axis of the body, namely the hypothalamo- pituitary adrenal axis (HPA) and autonomic nervous system (ANS) in different delivery types (vaginal or caesarean section). Materials and Methods: In this prospective study, women who were going to have caesarean or vagi-nal delivery were compared in terms of whether they undertook prenatal education (PNE) in pregnan-cy school or not. Among those of women having PNE, twenty women had caesarean delivery and, therefore, the number of women in other groups was decided accordingly. As a result, a total of 4 groups were formed as follows: women having PNE/caesarean delivery (n=20), having PNE/vaginal delivery (n=20), not having PNE/having caesarean delivery (n=20) and not having PNE/having vaginal delivery (n=20). In these women, the prenatal HPA and ANS activities were measured non-invasively with saliva cortisol and heart rate variability (HRV), respectively. HRV was measured by 5-min electro-cardiogram recording and time- and frequency-domains parameters were calculated.Results: The (PNE) did not affect the prenatal cortisol and HRV parameters in none of the delivery types (vaginal and caesarean) (p>0.05). HRV parameters were higher in women having vaginal delivery than those of caesarean delivery (P0.05).Conclusion: The prenatal education had no effect on HPA and ANS; however, the delivery type altered the HRV parameters. Saliva cortisol and HRV may be useful parameters in terms of examining the phys-iology of the birth processKey Words: Cortisol, Heart rate variability, Prenatal education, Vaginal delivery, Caesarean delivery

Since previous research suggests a role of a circulating factor in the pathogenesis of steroid-sensitive nephrotic syndrome (NS), we speculated that circulating plasma extracellular vesicles (EVs) are a candidate source of such a soluble mediator. Here, we aimed to characterize and try to delineate the effects of these EVs in vitro. Plasma EVs from 20 children with steroid-sensitive NS in relapse and remission, 10 healthy controls, and 6 disease controls were obtained by serial ultracentrifugation. Characterization of these EVs was performed by electron microscopy, flow cytometry, and Western blot analysis. Major proteins from plasma EVs were identified via mass spectrometry. Gene Ontology classification analysis and Ingenuity Pathway Analysis were performed on selectively expressed EV proteins during relapse. Immortalized human podocyte culture was used to detect the effects of EVs on podocytes. The protein content and particle number of plasma EVs were significantly increased during NS relapse. Relapse NS EVs selectively expressed proteins that involved actin cytoskeleton rearrangement. Among these, the level of RAC-GTP was significantly increased in relapse EVs compared with remission and disease control EVs. Relapse EVs were efficiently internalized by podocytes and induced significantly enhanced motility and albumin permeability. Moreover, relapse EVs induced significantly higher levels of RAC-GTP and phospho-p38 and decreased the levels of synaptopodin in podocytes. Circulating relapse EVs are biologically active molecules that carry active RAC1 as cargo and induce recapitulation of the NS phenotype in podocytes in vitro.

We planned this experimental study to investigate the effect of carbamazepine (CMZ) on the endometriotic implants. Rats were randomised into four groups after endometriosis surgery. Drinking water was given to the sham group, 0.2 mg/kg oestradiol valerate (EV) to the EV group, 100 mg/kg/day CMZ to the CMZ group, and 0.2 mg/kg EV and 100 mg/kg/day CMZ to the EV-CMZ group. The endometrium of the rats using CMZ stained more intensely with cytochrome P450-3A4 (CYP3A4) enzyme. No endometrial hyperplasia was found in these rats. Endometriotic implants weight was found to be higher in these rats. There was no difference between the groups in terms of staining of the endometriotic implants with CYP3A4 enzyme. Endometriotic implants were less stained with the CYP3A4 enzyme than the endometrium. According to our results, CMZ does not increase the destruction of oestrogen in the endometriotic implants, unlike the endometrium. It may even cause the lesion to enlarge.Impact statementWhat is already known on this subject? Endometriosis is an oestrogen-dependent, progressive disease. Carbamazepine (CMZ) is known to increase oestrogen degradation by activating the cytochrome P450-3A4 (CYP3A4) enzyme. CMZ can be used in the treatment of endometriosis because it increases oestrogen breakdown in tissues.What do the results of this study add? CMZ can protect the endometrium against hyperplasia by increasing the amount of CYP3A4 enzyme in the endometrium. This effect could not be demonstrated in the endometriotic implants. The presence of CYP3A4 enzyme less in the endometriotic implants than in the endometrium may explain this situation. In addition, the fact that CMZ does not increase the enzyme in the endometriotic implants may contribute to this situation.What are the implications of these findings for clinical practice and/or further research? CMZ may not be a suitable alternative in the treatment of endometriosis. However, it may protect against endometrial hyperplasia. Clinical studies are needed for this effect.

Objective Juvenile idiopathic arthritis (JIA) is the most common autoimmune and familial Mediterranean fever (FMF) the most common autoinflammatory chronic rheumatic disease in childhood. We aimed first to identify developmental and behavioral problems of preschool-age children with common chronic rheumatic diseases, second to compare the diagnostic categories, and third to elucidate the associated factors with these difficulties. Method Of the 91 participants included in this study, 46 were children with rheumatic diseases (27 with JIA and 19 with FMF) and 45 were healthy children. The general developmental and emotional/behavioral problems of each child were evaluated by the Ages and Stages Questionnaire and Child Behavior Checklist-1½-5, respectively. The State-Trait Anxiety Inventory and Beck Depression Inventory were used for maternal well-being. Results Internalizing problem scores were increased, and the percentage of children who failed at least 1 developmental domain and experienced delays in fine motor and problem-solving domains were higher in children with chronic rheumatic diseases when compared with healthy children. Being in the group of rheumatic diseases, fewer maternal education years and higher screen time were found to be independent risk factors significantly associated with any developmental delay in the multivariable model. Maternal trait anxiety scores were positively associated with internalizing and total problems only in FMF. Conclusion Preschool-age children with a diagnosis of chronic rheumatic diseases were more vulnerable for developmental and behavioral problems compared with healthy children. The management of chronic rheumatic diseases in the early years should include the screening of developmental and behavioral problems.

Henoch-Schonlein purpura (HSP) is the most common childhood systemic vasculitis. The present study aims to investigate the effectiveness of the immature granulocyte (IG) percentage as a new marker for predicting internal organ involvement in HSP. This study included 75 patients aged below 18 years who were diagnosed with HSP. The mean age was 7.48±2.77 years. The male/female ratio was 1.14. The findings showed that 35 (46.7%) of the patients had an internal organ involvement. The mean IG percentage was 0.88±0.68 among the patient group with HSP internal organ involvement, while it was 0.31±0.15 in the group without internal organ involvement, and a significant difference was determined between the 2 groups (P=0.000). The findings showed that the patients with renal involvement had the highest mean IG percentage (IG; 1.00±0.21). When the cutoff value for the IG percentage was specified as 0.45 to predict internal organ involvement, the sensitivity was 77.1%, and the specificity was 85%. In this study, the findings showed that IG percentage increased among patients with internal organ involvement in HSP and that its sensitivity, specificity, and predictive values were higher in predicting internal organ involvement compared with other markers.

Carbamazepine (CMZ) increases estrogen metabolism by inducing cytochrome P450 (CYP3A4). We investigated whether CMZ is protective against endometrial hyperplasia (EH). We used 32 female Wistar albino rats divided into four equal groups: the control group received drinking water, the estradiol valerate (EV) group was given EV, the CMZ group was given CMZ, and the EV + CMZ group was given both EV and CMZ. After 30 days the uteri of the rats were removed and serum estrogen and progesterone levels were measured, and endometrial tissue characteristics were evaluated. CYP3A4 expression was assessed using immunohistochemistry. Serum estrogen levels were lowest in the EV group and highest in the CMZ group. Serum progesterone levels were similar among all groups. Glandular density, a proxy measure of EH, was highest in the EV group and lowest in the EV + CMZ group. EH was detected in six of eight rats (75%) in the EV group and two of eight rats (25%) in the EV + CMZ group. Immunohistochemical staining revealed no significant difference in CYP3A4 expression among the four groups. CMZ reduced the negative effect of high dose estrogen that is not balanced by progesterone on the endometrium in rats. The effect likely is probably due to the CYP3A4 enzyme activator effect. CMZ may be protective against EH in high risk women, although confirmation is required.

Experiencing stressful events during early life has been considered as a risk factor for development of functional gastrointestinal disorders in adulthood. This study aimed to investigate the sex-related differences in stress-induced gastrointestinal (GI) dysmotility in rats exposed to neonatal maternal separation (MS). Newborn pups were removed from mothers for 180 min from postnatal day-1 to day-14. Experiments were performed in male and female offsprings at adulthood. Elevated plus maze (EPM) test was used to assess MS-induced anxiety-like behaviors. Ninety minute of restraint stress was applied for once or 5 consecutive days for acute stress (AS) or repeated homotypic stress (RHS), respectively. Measurement of fecal output (FO) and gastric emptying (GE), and hypothalamic microdialysis were performed. Both in males and females, MS produced anxiety-like behaviors. AS delayed GE and increased FO in all groups. In RHS-loaded MS females, AS-induced alterations in GE and FO were restored, however, no adaptation was observed in male counterparts. Regardless of sex and neonatal stress experience, AS significantly increased corticotropin-releasing factor (CRF) release from paraventricular nucleus of hypothalamus, whereas females were found more susceptible than males. Following RHS, AS-induced elevations in CRF release were attenuated only in MS females, but not in males. Both females and males seem to be prone to AS-induced alterations in hypothalamic CRF system and in GI motor functions. Neonatal MS disturbs chronic stress coping mechanisms in males. Conversely, females are likely to circumvent the deleterious effects of neonatal MS on GI functions through developing a habituation to prolonged stressed conditions.

Objective Systemic juvenile idiopathic arthritis is one of the subtypes of juvenile idiopathic arthritis. This type of disease accounts for approximately 10–20% of all cases of juvenile idiopathic arthritis. It typically affects both sexes equally and is usually present in children under 5 years. This study aimed to evaluate the demographic and clinical features of patients who were followed up for the diagnosis of sJIA in a single centre, the treatments they received, the responses to the treatment and the course of the disease. Methods All patients with systemic juvenile idiopathic arthritis who were evaluated at Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, Department of Paediatric Rheumatology, between January 2017 and January 2020 were included in this study. Descriptive features, clinical information, medications, treatment responses and long-term prognosis of patients were evaluated retrospectively. Results The study included 40 patients. 60% (n=24) of the patients were female and 40% (n=16) were male. The diagnosis age of the patients was 7.77±4.82 years and the patients were followed up for an average of 48±41 months. All of the patients had fever at the time of diagnosis. The 3 most common clinical signs after fever were arthralgia, hepatomegaly and lymphadenopathy (65, 55 and 50%, respectively). Ten patients (32.5%) had macrophage activation syndrome at admission. No significant difference was detected between the groups with and without macrophage activation syndrome concerning age, gender and clinical findings. Leukocyte, haemoglobin, platelet and erythrocyte sedimentation rates were significantly lower in the macrophage activation syndrome group compared with the other group, and ferritin was significantly higher. The C-reactive protein value was higher in the group without macrophage activation syndrome, but the difference was not statistically significant. While all patients received corticosteroid therapy as the initial therapy, 87.5% of these patients were administered pulse methylprednisolone therapy. In the follow-up, 21 patients (52.5%) needed biological treatment. Twenty-seven patients (67.5%) had a monocyclic course, 3 patients (7.5%) had a polycyclic course and 10 patients (25%) had a persistent polyarticular course. Conclusion Early diagnosis and treatment of systemic juvenile idiopathic arthritis are important because of the risk of developing macrophage activation syndrome – the most lethal complication. In our evaluation, it was seen that laboratory parameters could provide more guidance than clinical findings. Although steroids are the cornerstone of therapy, biological agents are effective in patients who are not responsive to steroid therapy. Hintergrund Die systemische juvenile idiopathische Arthritis ist ein Subtyp der juvenilen idiopathischen Arthritis. Auf diesen Krankheitstyp entfallen etwa 10 bis 20% aller Falle von juveniler idiopathischer Arthritis. Er betrifft ublicherweise beide Geschlechter gleichermasen und tritt in der Regel bei Kindern unter funf Jahren auf. Ziel dieser Studie war die Bewertung der demografischen und klinischen Merkmale der in einem einzigen klinischen Zentrum mit sJIA diagnostizierten Patienten sowie deren Behandlungen, Reaktionen auf die Behandlung und Krankheitsverlauf. Methoden Alle zwischen Januar 2017 und Januar 2020 in der Abteilung fur padiatrische Rheumatologie des Dr.-Sami-Ulus-Kinderkrankenhauses untersuchten Patienten mit systemischer juveniler idiopathischer Arthritis wurden in diese Studie eingeschlossen. Deskriptive Merkmale, klinische Informationen, Medikamente, Ansprechen auf die Behandlung und die Langzeitprognose der Patienten wurden retrospektiv ausgewertet. Ergebnisse In diese Studie wurden 40 Patienten eingeschlossen. 60% (n=24) der Patienten waren weiblich und 40% (n = 16) waren mannlich. Das Diagnosealter der Patienten lag bei 7,77 ± 4,82 Jahren, und die Patienten wurden durchschnittlich 48 ± 41 Monate nachbeobachtet. Alle Patienten hatten zum Zeitpunkt der Diagnose Fieber. Die drei haufigsten klinischen Symptome nach Fieber waren Arthralgie (65%), Hepatomegalie (55%) und Lymphadenopathie (50%). Zehn der Patienten (32,5%) hatten bei Aufnahme ein Makrophagenaktivierungssyndrom. Es wurde kein signifikanter Unterschied zwischen den Gruppen mit und ohne Makrophagenaktivierungssyndrom in Bezug auf Alter und Geschlecht sowie klinische Befunde festgestellt. Die Erythrozytensedimentationrate von Leukozyten, Hamoglobin, Blutplattchen und Erythrozyten war in der MAS-Gruppe im Vergleich zur anderen Gruppe signifikant niedriger und der Ferritinspiegel war signifikant hoher. Die Konzentration des C-reaktiven Proteins war in der Gruppe ohne Makrophagenaktivierungssyndrom hoher, doch diese Erhohung war statistisch nicht signifikant. Laborparameter scheinen wichtiger zu sein als klinische Befunde. Alle Patienten erhielten als Ersttherapie eine Kortikosteroidtherapie, 87,5% von ihnen wurde eine Methylprednisolon-Stostherapie verabreicht. In der Nachuntersuchung benotigten 21 Patienten (52,5%) eine biologische Behandlung. 27 Patienten (67,5%) zeigten einen monozyklischen, 3 Patienten (7,5%) einen polyzyklischen und 10 Patienten (25%) einen persistierenden polyartikularen Verlauf. Schlussfolgerung Eine fruhzeitige Diagnose und Behandlung der systemischen juvenilen idiopathischen Arthritis ist wichtig, da das Risiko besteht, ein Makrophagenaktivierungssyndrom zu entwickeln – die todlichste Komplikation. In unserer Bewertung wurde festgestellt, dass Laborparameter richtungsweisender sein konnen als klinische Befunde. Obwohl Steroide den Eckpfeiler der Therapie darstellen, sind biologische Wirkstoffe bei Patienten wirksam, die nicht auf eine Steroidtherapie ansprechen.

Background/Aim: Physical activity during pregnancy assumes an important role in the health of both the pregnant and newborn. Our study aims to evaluate the effects of Pilates workouts on labor and newborn outcomes.Methods: This retrospective case control study was conducted with the nulliparous pregnant women admitted to our obstetrics clinic. We evaluated the effects of a Pilates workout program for 70-80 minutes per day, once a week for eight weeks, on the labor and newborn outcomes. We defined the labor outcomes as the type of delivery and the gestational age at delivery and the newborn outcomes as one-minute (APGAR-1) and five-minute Apgar scores (APGAR-5).Results: The incidences of episiotomy, vacuum-assisted vaginal delivery, and cesarean section (CS) were significantly lower in pregnant women who participated in Pilates workouts (P

Children with chronic kidney disease and on kidney replacement therapy may have neurocognitive and psychosocial disorders. Although kidney transplantation improves quality of life, psychological problems may exist in children who undergo kidney transplantation. Herein, we aimed to investigate attention-deficit hyperactivity disorder-like symptoms with MOXO-continuous performance test in children with pre-dialysis chronic kidney disease, dialysis and kidney transplantation.The MOXO-continuous performance test measures four domains of attention-deficit hyperactivity disorder-like symptoms, including attention, timeliness, hyperactivity and impulsivity. Patients with at least three scores - 1.5 standard deviations were considered as positive to MOXO-continuous performance test. Test scores of the pre-dialysis chronic kidney disease, dialysis (divided into peritoneal dialysis and hemodialysis subgroups) and kidney transplantation groups were compared. Correlations of test scores with the patient's clinical and laboratory characteristics and effects of hospitalizations and schooling were assessed.Seventy-two patients aged 13.3 ± 3.4 years (23 with kidney transplantation, 23 on dialysis and 26 with pre-dialysis chronic kidney disease) were evaluated. Overall MOXO-continuous performance test positivity was 29%. No differences were detected between the three groups concerning total or z scores. Attention and timeliness z scores were significantly higher in females (p = 0.004 and p = 0.008, respectively). Age was positively correlated to attention and timeliness total scores (p = 0.000, r = 0.445 and p = 0.004, r = 0.243, respectively), and inversely correlated to hyperactivity total scores (p = 0.000, r = - 0.415).Prevalence of attention-deficit hyperactivity disorder-like symptoms in the study population was much higher than that of pediatric attention-deficit hyperactivity disorder. We believe that the MOXO-continuous performance test is a valid supportive measure for evaluation of attention-deficit hyperactivity disorder diagnosis in children with various stages of chronic kidney disease or on kidney replacement therapy.

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease of childhood. The various subtypes of JIA differ in clinical features and treatments. The aim of this study was to analyze the frequency of JIA subtypes, patient demographic and clinical features, as well as the rates of macrophage activation syndrome, uveitis, and remission in Turkish JIA patients treated at a single center, and to compare the findings to those in the literature. Materials and methods The files of all JIA patients treated at our pediatric rheumatology department between January 2017 and January 2019 were retrospectively reviewed. Patient demographic, clinical, and laboratory data were obtained from the patients' files and hospital database. Results The study included 305 patients (180 females) with a mean age at onset of 7.83 ± 4.62 years. Among all the JIA subtypes, the most frequent was oligoarthritis (41.6%), followed by enthesitis-related arthritis (29.2%), rheumatoid factor (RF)-negative polyarthritis (13.4%) systemic arthritis (9.5%), RF-positive polyarthritis (2.6%), psoriatic arthritis (2.0%), and undifferentiated arthritis (1.6%). At the time of data collection 278 patients (91.0%) were in remission, whereas 27 patients (9.0%) had active disease. Macrophage activation syndrome developed in 12 of the 29 (41.0%) systemic arthritis. Uveitis was noted in 32 (10.0%) patients. Biological agents were administered in 142 of the patients. Conclusion The available data indicate that JIA as a whole is a heterogeneous disease with significant variability in course and long-term outcome. As such, each patient should be evaluated according to his/her disease subtype.

Children born with unilateral renal agenesis (URA) are thought to have a risk of developing hypertension, proteinuria, and progressive chronic kidney disease (CKD). The present study aimed to evaluate the long-term prognosis and clinical characteristics of children with URA. The study included 171 patients aged < 18 years diagnosed as URA who were followed-up for ≥ 1 year and 121 healthy controls matched for age, gender, and BMI. Median age at diagnosis was 2 years (IQR: 1 month–16 years) and the incidence of URA in males (65.4%) was higher than in females. Among the patients, 21 (12.2%) had other urinary system anomalies. It was noted that 2.3% of the patients had proteinuria, 15.2% had hyperfiltration, and 2.9% had CKD. Hypertension based on ambulatory blood pressure monitoring (ABPM) was diagnosed in 18 (10.5%) of the patients, of whom 10 had masked hypertension. Diastolic blood pressure in the URA patients was significantly higher than in the healthy controls. The incidence of hypertension and CKD was significantly higher in the patients with other urinary system anomalies. Patients with a single functional kidney should be periodically evaluated throughout their lifetime for urine protein, blood pressure, and kidney functions. The most remarkable finding of this study is the importance of the use of ABPM for evaluating blood pressure in pediatric URA patients, especially for the detection of masked hypertension and the non-dipper phenomenon, which cannot be achieved with office blood pressure measurement.

6-Hydroxydopamine (6-OHDA) is a widely used chemical to model Parkinson's disease (PD) in rats. Syringic acid (SA) is a polyphenolic compound which has antioxidant and anti-inflammatory properties. The present study aimed to evaluate the neuroprotective role of SA in a rat model of 6-OHDA-induced PD. Parkinson's disease was created by injection of 6-OHDA into the medial forebrain bundle via stereotaxic surgery. Syringic acid was administered daily by oral gavage, before or after surgery. All groups were tested for locomotor activity, rotarod performance and catatony. Dopamine levels in SN were determined by an optimized multiple reaction monitoring method using ultra-fast liquid chromatography coupled with tandem mass spectrometry (MS/MS). The immunoreactivities for tyrosine hydroxylase (TH) and inducible nitric oxide synthase (iNOS) were detected by immunohistochemistry in frozen substantia nigra (SN) sections. Nitrite/nitrate levels, iNOS protein, total oxidant (TOS) and total antioxidant (TAS) status were assayed in SN tissue by standard kits. Motor dysfunction, impaired nigral dopamine release, increased iNOS expression and elevated nitrite/nitrate levels induced by 6-OHDA were significantly restored by SA treatment. Syringic acid significantly improved the loss of nigral TH-positive cells, while increasing TAS capacity and reducing TOS capacity in SN of PD rats. These data conclude that SA is a potential therapeutic agent for the treatment of 6-OHDA-induced rat model of PD. Syringic acid reduced the progression of PD via its neuroprotective, antioxidant and anti-inflammatory effects.

Involuntary movement disorders are rare in childhood. Hyperkinetic movement disorders including chorea stand as the leading cause. Although Sydenham chorea is the major diagnosis in most children and adolescents, appropriate differential diagnosis is fundamental for a final decision. A detailed and careful history as well as physical examination is the principal proceeding for accurate diagnosis. Herein, we report on an adolescent girl who was admitted to our hospital with chorea and subsequently diagnosed with systemic lupus erythematosus (SLE). Accompanying joint complaints in the patient's history, including growth retardation noticed during a physical examination and bicytopenia recognized in laboratory evaluation, increased the suspicion of SLE rather than Sydenham chorea in the patient. Central nervous system involvement defined as neuropsychiatric lupus presents wide clinical findings varying from stroke and seizures to psychosis and cognitive dysfunction. Although disease activity, persistently positive anticardiolipin antibodies, and lupus anticoagulant positivity are reported to be the most important risk factors in neuropsychiatric lupus, they are not always directly correlated. We present this patient in order to draw attention to the importance of physical examination and history in the differential diagnosis of chorea in childhood.Unwillkürliche Bewegungsstörungen im Kindesalter sind selten. Die häufigste Ursache sind hyperkinetische Bewegungsstörungen, einschließlich Chorea. Obwohl die Sydenham-Chorea bei den meisten Kindern und Jugendlichen die Hauptdiagnose darstellt, ist eine angemessene Differenzialdiagnose für eine endgültige Entscheidung von grundlegender Bedeutung. Eine detaillierte und sorgfältige Anamnese sowie eine körperliche Untersuchung sind die wichtigsten Voraussetzungen für eine genaue Diagnose. In diesem Beitrag berichten wir über ein jugendliches Mädchen, das mit Chorea in unser Krankenhaus eingeliefert wurde und bei dem anschließend ein systemischer Lupus erythematodes (SLE) diagnostiziert wurde. Begleitende Gelenkbeschwerden in der Anamnese, eine bei der körperlichen Untersuchung festgestellte Wachstumsverzögerung und eine bei der Laboruntersuchung festgestellte Biztopenie verstärkten den Verdacht auf SLE und nicht auf eine Sydenham-Chorea bei der Patientin. Eine Beteiligung des zentralen Nervensystems, die als neuropsychiatrischer Lupus definiert wird, weist ein breites klinisches Spektrum auf, das von Schlaganfällen und Krampfanfällen bis hin zu Psychosen und kognitiven Funktionsstörungen reicht. Obwohl die Krankheitsaktivität, anhaltend positive Anticardiolipin-Antikörper und eine Positivität auf Lupus-Antikoagulanzien als die wichtigsten Risikofaktoren für neuropsychiatrischen Lupus gelten, besteht nicht immer eine direkte Korrelation. In diesem Artikel wird dieser Patient vorgestellt, um auf die Bedeutung der körperlichen Untersuchung und der Anamnese bei der Differenzialdiagnose von Chorea im Kindesalter aufmerksam zu machen.

To investigate the effect of surgical procedure on the operation's results in patients undergoing emergency peripartum hysterectomy (EPH).The records of patients who underwent EPH due to postpartum hemorrhage between 2010 and 2020 in two tertiary centers with a high crude delivery rate were retrospectively analyzed. Surgical data were compared according to the EPH type.During the study period, 115,709 births occurred in these two centers. EPH was administered for 181 (1.6%) of these patients. Sixty-seven (37%) of the EPH cases involved subtotal EPH (SEPH), and 114 (63%) were total EPH (TEPH). Surgical time (107.3 ± 17.6 vs. 134.2 ± 32.3 min,According to the results, if the bleeding in peripartum hemorrhage requiring EPH can be controlled with SEPH, attempting to remove the cervix completely may be associated with increased surgical time, blood transfusion need, and surgical complications.

Exposure to a high-fat diet (HFD) has been reported to impair central autonomic and enteric neurocircuitries, however, the relevant mechanisms and their time course are inadequately clarified. This study aimed to investigate the effects of HFD consumption through the period of adolescence on gastric motor functions in adulthood. Male Sprague-Dawley rats consumed a regular diet or HFD (60% kcal by fat) from 4 to 12 weeks of age. Body weight and food intake were monitored weekly. In adult rats, gastric emptying (GE) was measured. Additionally, using in-vitro organ bath, contractile and relaxant responses of antral and fundic strips were assessed with bethanechol and sodium nitroprusside (SNP), respectively. The expressions of choline acetyltransferase (ChAT), neuronal nitric oxide synthase (nNOS) and vasoactive intestinal polypeptide (VIP) were detected by immunofluorescence, whereas, the number of myenteric neurons were evaluated by staining with cuprolinic blue and enteric neuronal marker PGP 9.5. In adulthood, the HFD did not alter food intake, while significantly increasing the body weight. In HFD-fed adult rats, increased visceral fat mass was accompanied by delayed GE. Moreover, bethanechol- and SNP-induced responses were attenuated in antral and fundic tissues. HFD remarkably decreased the number of myenteric neurons and NOS immunoreactivity both in fundus and antrum. HFD remarkably decreased ChAT expression, while increasing the immunoreactivity for VIP in antrum. In conclusion, consumption of HFD between early adolescence and adulthood results in obesity and impairment of gastric motor functions. Particularly, HFD-induced gastric dysmotility appears to be predominantly dependent on the modifications in the non-adrenergic non-cholinergic inhibitory neurotransmission.

Çoğunlukla asemptomatik embriyolojik kalıntı olarak karşımıza çıkan paratubal kistler genellikle üreme çağında tanı alırlar. Genellikle küçük boyutlarda olan bu kistler insidental olarak saptanırlar. Çok nadiren komplike olarak cerrahi gerektirebilir. Bu makalede kliniğimizde tedavi ettiğimiz 17 yaşında 30x25x10 cm boyutlarındaki pelvik kitle tanılı vakayı sunmayı amaçladık. Laparatomi ile kist eksizyonu uygulanan hastadan 5 kg ağırlıkta paratubal kist çıkarıldı. Histopatolojik değerlendirmede paratubal seröz kistadenom tanısı konulan hasta şifa ile taburcu edildi. Sonuç olarak nadirde olsa çok büyük boyutlarda basit görünümlü kistik pelvik kitlelerde paratubal seröz kistadenom tanısı akılda tutulmalıdır.

Amaç: Fokal segmental glomerüloskleroz (FSGS), çocuklarda nefrotik sendromun (NS) yaygın nedenlerinden biridir. Bu çalışma, primer FSGS'li çocukların demografik verilerini, klinik seyrini, tedavisini ve böbrek sonuçlarını belirlemeyi ve tek merkez deneyimini raporlamayı amaçlamaktadır. Gereç ve Yöntemler: Üçüncü basamak bir pediatric bakım hastanesinde Temmuz 2005 ile Temmuz 2019 arasında primer FSGS tanısı alan 38 hastanın uzun vadeli sonuçlarına ilişkin retrospektif bir çalışmadır. Bulgular: Fokal segmental glomerüloskleroz tanısı olan 38 çocuk (23 kız ve 15 erkek hasta) dahil edildi ve ortalama tanı yaşı 8.5 ± 4.2 yıldı. Ortalama takip süresi 4.8 ± 4.1 (1-14.6) yıldı. On yedi (%44.7) hasta steroide dirençli NS ve 21 (%55.3) hasta steroide duyarlı NS [12 (%31.6) steroid bağımlı NS ve 9 (%23.7) hasta sık tekrarlayan NS] idi. Başvuru anında bu gruplar arasında yaş, cinsiyet, hematüri, serum albumin ve idrar protein düzeyi açısından anlamlı fark yoktu (p > 0.05). Uzun süreli takipte SRNS’li hastaların %47'sinin tam remisyon, %23.5'inin kısmi remisyon ve %29.4 'ünün de tüm tedavilere dirençli olduğu görüldü. Hastaların %15.8'sinde SDBH gelişmişti. Kötü prognoz için risk faktörleri, başvuruda hipertansiyon (HT) varlığı, kadın cinsiyet ve başlangıç tedavisine yanıtsızlık olarak belirlendi. Sonuç: Çocukluk çağında FSGS, tedaviye yanıt ve prognozda değişkenlik göstermektedir. Bu çalışmada prognozu etkileyen risk faktörleri ile ilgili verilerimizi sunduk.

Immunoglobulin A (IgA) vasculitis (also known as Henoch-Schonlein purpura) is the most common small vessel vasculitis of childhood. The long-term prognosis depends on renal involvement. The aim of this study was to evaluate the risk factors associated with renal involvement in children with IgA vasculitis and to investigate the best timing of urine examination to predict the presence of renal involvement at the sixth month after the diagnosis.In this prospective observational study, medical records, demographic data, clinical findings, laboratory tests, and urine microscopic examinations of pediatric patients diagnosed with IgA vasculitis were evaluated to identify potential risk factors associated with renal involvement.A total of 178 patients with a median age of 6 years were involved in the study. Renal involvement was found in 24 (13.5%) patients. Most of the patients (85.7%), whose urine examination was found to be abnormal at the sixth month after the diagnosis, also had abnormalities in the first month urine examination. Factors significantly associated with renal involvement were as follows: older age, presence of hematuria and or proteinuria in the first month urine examination and patients who presented the disease in the spring season. Multivariate logistic regression analysis showed age ≥8 years (This study has demonstrated that the optimal date to predict the presence of hematuria and/or proteinuria in the sixth month is the urine examination performed in the first month of the disease. Therefore, we think that patients with IgA vasculitis who show a presence of hematuria and/or proteinuria in the first-month urine examination should be followed more closely.

Objective: Leg pain is a common complaint in childhood and is one of the most common causes of admission to pediatric rheumatology outpatient clinics. The aim of this study was to analyze the demographic data and etiology of patients presenting with leg pain and to reveal common causes. Material and Methods: The files of patients who presented to our pediatric rheumatology outpatient department between August 2018 and August 2019 due to leg pain were retrospectively reviewed. Patient demographic, clinical, and laboratory data were obtained from the patients’ files and hospital database. An information form that collected data on patient gender and current age, age at disease onset, age at diagnosis was completed for all patients. Results: The study included 270 patients with a mean age of 10.4 ± 4.8 years, including 170 (63%) females and 100 (37%) males. The mean age of onset of complaints was 9.1 ± 3.2 years. The most common cause of leg pain was hypermobility syndrome with 74 (27.4%) patients. Respectively, 41 (15%) patients were diagnosed with growing pain, 39 (14,4%) patients with Osgood-Schlatter disease, 32 (11,8%) patients with post-infectious arthritis / arthralgia, 28 (10,3%) patients with fibromyalgia, 20 (7,4%) patients with juvenile idiopathic arthritis. Two patients had acute lymphoblastic leukemia and 10 patients had acute rheumatic fever. All patients with fibromyalgia were girls and adolescents. 62.5% of leg pain was bilateral. 44% of patients really had leg pain. Although the complaint of presentation in other patients was leg pain, it was not the legs but the localized knee and ankles. Conclusion: Leg pain is a common complaint both in childhood and adolescence. Hypermobility syndrome was the most common cause in both periods. Osgood-Schlatter disease and fibromyalgia should be considered especially in adolescence and growing pain in childhood. In addition to these benign diseases, diseases such as juvenile idiopathic arthritis and acute rheumatic fever should be considered, especially when the joint is swollen. Leukemia’s, avascular necrosis and meniscopathies may also present with leg pain. As a result, leg pain in children is a complaint that should be considered and patients should be questioned well and differential diagnosis should be made well.

Dent disease is a rare X-linked recessive tubular disorder, characterized by the triad of low molecular-weight proteinuria, hypercalciuria, nephrocalcinosis and/or nephrolithiasis. It is caused by mutations in the CLCN5 gene or OCRL gene. Thirty to 80% of affected males develop end-stage kidney disease between the ages of 30 and 50 years. Some children were reported to present with isolated persistent proteinuria and a part of these patients were diagnosed as having focal segmental glomerulosclerosis with kidney biopsy. Although there is no specific treatment, treatment of proteinuria and hypercalciuria is thought to delay the progression of the disease. For this reason, awareness of the disease findings and early diagnosis are important. In this case report, we present a boy followed-up with isolated persistent proteinuria and then diagnosed as having Dent disease with mutation analysis that showed c.328_330delT (p.Phe110Trpfs27*) in the CLCN5 gene. The importance of researching low-molecular- weight proteinuria and considering Dent disease in the differential diagnosis of children presenting with isolated persistent proteinuria has been emphasized.

Objective: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent, self-limited attacks of fever with serositis. Acute recurrent arthritis is the most commo...

We investigated the protective effect of iloprost against ischemia/reperfusion (I/R) injury in rat ovary. We used 32 female Sprague-Dawley rats randomly allocated to four experimental groups: sham, ischemia, I/R and I/R + iloprost. Ovarian torsion was established in all rats except the sham group. The torsion group was exposed to ischemia for 3 h. The detorsion group was exposed to 3 h ischemia applied + 3 h reperfusion. The detorsion + iloprost group was exposed to ischemia for 3 h + reperfusion for 3 h + intravenous (IV) iloprost infusion for 60 min starting at the beginning of reperfusion. Ovaries were removed and prepared for histopathological evaluation. Reduced glutathione (GSH) and malondialdehyde (MDA) were measured in the blood. The total histopathological injury score and MDA level of the ischemia group were significantly higher than for the sham group. Ovarian injury score and MDA level following I/R increased compared to the ischemia group. Iloprost administration reduced the total injury score and MDA level. The GSH level was higher in the I/R + iloprost group than in the I/R group. We concluded that IV iloprost administration reduces I/R injury in rat ovarian tissue.

Introduction: This study aimed to investigate the complication frequency and the changes in right heart geometry with different access types in the pediatric population. Methods: We included 32 consecutive patients aged between 10 and 19 and who underwent hemodialysis sessions via permanent hemodialysis catheter (nHC = 18) or arterio-venous fistula (nAVF = 14) between January 2013 and March 2018. We recorded and compared the complication frequency and the changes in echocardiography findings with different access types. Findings: Demographic data were similar in both groups. Number of new access creation (nHC = 15 vs nAVF = 1) and all complications (nHC = 19 vs nAVF = 6) were significantly higher in hemodialysis catheter group and the statistical analysis showed the superiority of arterio-venous fistula group in comparison of event-free survival (event-free patients; nAVF = 8 (57%), nHC = 3 (16%); p = 0.02). Control echocardiography showed impressive delta-change in right atrium diameter (p = 0.04), right ventricular end-diastolic volume (p = 0.004), right ventricular end-systolic volume (p Conclusion: Arterio-venous fistula has lower risk of complications, but overloading stress on right heart chambers triggers remodeling process and geometrical changes, which can be early pieces of evidence of delayed right heart dysfunction in pediatric hemodialysis patients.

Objectives: Familial Mediterranean fever (FMF) is a monogenic auto-inflammatory disease which might rarely cause glomerulopathy in patients. The aim of this study was to determine the clinical, demographic, and genetic characteristics and type of glomerular lesions in pediatric FMF patients who underwent kidney biopsy. Methods: The data of 30 pediatric FMF patients with biopsy-proven glomerulopathy were retrospectively reviewed. Patients were grouped into 2 categories as amyloid nephropathy (AN, n = 16) and non-amyloid nephropathy (N-AN, n = 14). Results: The mean age at FMF diagnosis was 7.2 ± 3.0 years. The AN group showed higher rates of hypertension, higher levels of 24-h protein excretion and serum creatinine, and lower estimated glomerular filtration rate at the time of kidney biopsy. The rate of ESRD was found to be higher in the AN group (p = 0.011). Mesangioproliferative glomerulonephritis was the most common pathology in the N-AN group (21.4%). The frequency of amyloidosis was significantly higher in patients with homozygous p.M694V mutations than non-homozygous p.M694V mutations (p = 0.039). Conclusions: In children with FMF, nephropathy is rare. To our knowledge, this is the first study performed in pediatric FMF patients exploring amyloid and non-amyloid glomerulopathies. Patients with AN had higher rates of proteinuria, lower estimated glomerular filtration rate levels, and higher blood pressure than N-AN patients at the time of biopsy.

Introduction Blau syndrome or early-onset sarcoidosis is a rare monogenic autoinflammatory granulomatous disease. It occurs with an autosomal dominant mutation in the nucleotide-binding oligomerization domain containing 2 gene, and the clinical manifestations typically appear in the first 20 years of life. Untreated disease can cause severe disability and blindness. Therefore, early and effective treatment is especially important to prevent eye and joint complications. This study aimed to show that tumor necrosis factor (TNF) inhibitors such as adalimumab are a good treatment option for patients with Blau syndrome or early-onset sarcoidosis. Case report We report the case of a patient with early-onset sarcoidosis who showed the clinical triad of dermatitis, arthritis, and uveitis. The patient had a history of atopic dermatitis-like skin disease at the age of 1 year. At the age of 2.5, she presented with arthritis in bilateral symmetrical wrist and knee joints and with gait disturbance. Bilateral vitritis was detected at the follow-up eye examination performed at the age of 3.5. Treatment was initiated with adalimumab, to which the patient had a very good response, particularly regarding the ocular symptoms. Conclusion Patients with Blau syndrome or early-onset sarcoidosis may be mistakenly diagnosed with juvenile idiopathic arthritis. Eye involvement may be more aggressive in this disease. Treatment with TNF-alpha inhibitors seems to be promising for Blau syndrome patients who do not have a satisfactory response to corticosteroids and conventional disease-modifying antirheumatic drugs.

Objective: A subset of typical Hemolytic-uremic syndrome (HUS) patients requires initiation of renal replacement therapy (RRT) despite aggressive medical intervention. This study aims to evaluate the clinical and laboratory findings of patients diagnosed with typical HUS and efficacy and safety of peritoneal dialysis (PD) and hemodialysis (HD) were compared in managing these cases.Material and Methods: Patients having a diagnosis of typical HUS were retrospectively determined, and assessment the effects of RRT modalities on renal survival.Results: The present study included 49 children with typical HUS, and the mean age was 2.99 ± 1.88 years. Neurological involvement was detected in 15 (30.6%) patients. The neutrophil/lymphocyte ratio (NLR) was significantly higher in the neurological involvement group [odds ratio (OR) 15.42, 95% CI (3.39-70.1), p = 0.005]. In total, 43 (87.7%) patients received RRT and the median time from the first recorded symptom to RRT was six days (range 3-11). While throughout RRT, 10.2% of patients required mechanical ventilation. In this study, 26 (53.1%) patients were managed with PD, and 17 (34.6%) patients were managed with HD. During follow-up, 10.2% of all patients progressed to chronic kidney disease (CKD), proteinuria was detected in 6.1% and hypertension in 4.08%. The risk of CKD was significantly lower in the 3-month period in PD patients than in HD patients (odds ratio (OR) 7.69, 95% CI (0.77-76.07), p = 0.04). Conclusion: We concluded that PD might be as effective and safer as HD concerning kidney recovery. Clinical features and inflammatory markers can predict neurological involvement in typical HUS cases., Amaç: Tipik hemolitik üremik sendrom (HÜS) hastalarının bazılarında, agresif tıbbi müdahaleye rağmen renal replasman tedavisi (RRT) gerekebilir. Bu çalışmanın amacı, tipik HÜS tanısı alan hastaların klinik ve laboratuvar bulgularının değerlendirilmesi, HÜS tanılı hastalarda periton diyalizi (PD) ile hemodiyalizin (HD) etkinlik ve güvenilirliğinin karşılaştırılmasıdır.Gereç ve Yöntemler: Tipik HÜS tanısı olan hastalar retrospektif olarak belirlendi ve RRT modalitelerinin renal sağ kalım üzerindeki etkisi değerlendirildi.Bulgular: Çalışmaya tipik HÜS tanılı 49 hasta dahil edildi ve ortalama yaşları 2.99 ± 1.88 yıldı. Nörolojik tutulum 15 (%30.6) hastada saptandı. Nötrofil/lenfosit oranı nörolojik tutulum olan grupta anlamlı olarak yüksek bulundu [olasılık oranı (OO) 15.42, %95 güven aralığı (GA) (3.39-70.1), p = 0.005]. Toplamda 43 (%87.7) hastaya RRT uygulandı ve ilk kaydedilen semptomdan RRT’ye kadar geçen ortanca süre 6 gündü (aralık 3-11). RRT boyunca hastaların %10.2’sinde mekanik ventilasyon desteği gerekti. Yirmi altı (%53.1) hastada PD, 17 (%34.6) hastada HD yapılmıştı. Takipte tüm hastaların %10.2’si kronik böbrek hastalığına (KBH) ilerledi, %6.1’inde proteinüri ve %4.08’inde hipertansiyon saptandı. PD yapılan hastalarda 3 aylık dönemde KBH riski HD yapılan hastalara göre anlamlı olarak daha düşüktü [ OO 7.69, %95 GA (0.77-76.07), p = 0.04].Sonuç: Böbrek iyileşmesi açısından PD’in HD kadar etkili hatta daha güvenli olabileceği sonucuna vardık. Tipik HÜS vakalarında klinik özellikler ve inflamatuar belirteçler sayesinde nörolojik tutulum tahmin edilebilir.

SUMMARY OBJECTIVE: Adnexal torsion is an important gynecological emergency due to nonfrequent but possible adverse reproductive outcomes. There is no specific laboratory marker to support the preoperative diagnosis or that can be used clinically. The aim of this study was to investigate the diagnostic values of platelet, neutrophil, lymphocyte, and red cell markers as an early indicator of ovarian torsion. METHODS: This retrospective study included 28 female patients who were treated surgically for adnexal torsion between August 2010 and July 2020, and 29 control group women. The demographic data and routine hematological values of patients were compared for adnexal torsion prediction. RESULTS: There were no differences between the groups in terms of the platelet count, platelet distribution width, red cell distribution width, and mean platelet volume values, and there were no differences in the demographic data. Statistical differences were found among white blood cell, hemoglobin, hematocrit, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio, and 81.5% sensitivity and 82.1% specificity were identified for neutrophil/lymphocyte ratio 2.45 (area under the curve AUC 0.892; 95%CI 0.808-0.975; p