The Earthquake Disaster in Türkiye: A Review from Child and Adolescent Psychiatry Perspective

The earthquake has long-lasting various mental and behavioral effects on children and adolescents. The aim of this review was to discuss the nature and extent of psychiatric problems, management options, and the process of organizing psychological interventions for affected children. Individuals show a range of physically, emotionally, and cognitively healthy responses that can help them cope with the aftermath of a disaster. Psychiatric symptoms such as acute stress reactions, post-traumatic stress disorder, depression, anxiety disorder, increased risk of suicide, sleep disorders, substance use disorders, and psychotic disorders may develop in some children. Comorbidities and sub-clinical syndromes are also common. There are many risk factors and protective factors in the development of mental disorders. Close follow-up of children at high risk and interventions for psychosocial support may prevent the development of mental disorders. It is very important to start the intervention at the earliest period. The psychological impacts of young disaster victims can be addressed by skilled local volunteers, medical professionals, and educators in primary health care programs. With the nation's overall social and economic recovery, children can recover more quickly from traumatic experiences

Evaluation of the relationship between vitamin D level and adropin, IL-1β, IL-6, and oxidative status in women

Background/aim: Vitamin D, adropin, proinflammatory cytokines, and oxidative stress closely related with metabolic homeostasis and endothelial dysfunction. The aim of the present study is to investigate how vitamin D levels affect serum adropin, IL-1ß, IL-6, and oxidative stress. Materials and methods: A total of 77 female subjects were divided into 3 groups according to vitamin D levels. Biochemical parameters, adropin, IL-1ß, IL-6, oxidative stress markers were studied in these groups, and the results were compared statistically. Results: Serum adropin, IL-1ß, IL-6, total oxidant status (TOS) and total antioxidant status (TAS) and oxidative stress index (OSI) levels differed significantly between the vitamin D groups (p < 0.05). A significant positive correlation was detected between vitamin D, and adropin and TAS (r = 0.807; p < 0.001, r = 0.814; p < 0.001, respectively). A significant negative correlation was detected between vitamin D, and IL-1ß, IL-6, TOS, OSI (r = –0.725; p < 0.001, r = –0.720; p < 0.001, r = –0.238; p = 0.037, r = –0.705; p < 0.001, respectively). Conclusions: Vitamin D could show its effects through vitamin D receptors on tissues or on the ENHO gene in adropin secreting tissues via direct or indirect mechanisms. Proinflammatory cytokines, oxidative stress, and adropin targeted studies could contribute to the prevention and treatment of diseases associated with vitamin D deficiency in future

Ekstrakraniyal malign germ hücreli tümör tanılı hastaların klinik özellikleri ve tedavi sonuçları; 20 yıllık tek merkez deneyimi

Introduction: Germ cell tumors account for 2–3% of all pediatric tumors. The aim of this study was to evaluate the clinical features and treatment outcomes of pediatric patients treated and followed up for extragonadal MGCTs in our center. Materials and Methods: A total of 41 patients diagnosed with MGCTs in the pediatric oncology department of Akdeniz University between June 1999 and June 2019 were evaluated retrospectively. Results: Twenty-nine (71%) of the patients were girls and female dominance (p<0.001). The median age was 3.22 (0–18) years. The most patients in the ≤ 5year age group (p<0.001). Nineteen (44%) of the tumors were gonadal and 22 (54%) were extragonadal. The most common histolology of MGCTs were yolk sac tumor (36%), mixed GCTs (29%), immature teratoma (20%), and dysgerminoma (15%). Twenty-five (61%) patients presented with advanced stage disease and 37 patients (90%) were treated with chemotherapy. The patients with stage I testicular and stage I ovarian germ cell tumors underwent complete tumor resection followed by a watch-and-wait approach with alpha fetoprotein monitoring without chemotherapy. Of six patients with relapse/refractory disease, two patients survived. Two patients who underwent autologous stem cell transplantation showed complete response but later died due to infection. The median follow-up period of the patients was 34.9 (4–190.6) months and the 10-year overall and disease-free survival rates were 77.1±6.8% 77.1±6.8%. Two relapsed refractory patients who underwent autologous transplantation survived at a mean of 33.21 months. Conclusions: The clinical features and treatment outcomes of the patients in our study were consistent with the literature. The fact that most of our patients were symptomatic at presentation and had advanced stage disease when diagnosed highlights the importance of detailed evaluation and examination. Although good outcomes are achieved in patients with early stage disease, new treatment approaches are needed for patients with advanced and relapsing diseaseGiriş: Germ hücreli tümör tüm pediatrik tümörlerin %2-3’ünü oluşturur. Özellikle platin bazlı kemoterapi rejimlerinin uygulanmasından sonra sağ kalım oranları %85’lerden fazladır. Malign germ hücreli tümörler (MGHT) çocuklarda oldukça heterojen bir gruptur. Bu çalışma ile ekstrakraniyal MGHT tanılı hastalarımızın klinik özellikleri ve tedavi sonuçlarının değerlendirilmesi amaçlandı. Gereç ve Yöntem: Akdeniz Üniversitesi Çocuk Onkoloji Kliniği’nde 1999 –2019 Haziran tarihleri arasında ekstrakraniyal MGHT tanısı alan 41 hasta geriye dönük olarak değerlendirildi. Bulgular: Hastaların 29 (%71) `i kız olup K/E cinsiyet oranı: 1,75 olup anlamlı olarak kız cinsiyet hakimdi (p<0.001). Ortanca tanı yaşı 3,22 yıl (0-18 yaş) olup hastalar ağırlıklı olarak (%56 hasta) ≤ 5 yaş idi (p<0.001). Tümörlerin 19 (%44) `ü gonadal, 22 (%54) `ü ekstragonadal olup en sık ekstagonadal yerleşim yeri sakrokoksigeal bölge (%22) idi. Histolojik değerlendirmede sırasıyla yolk sak tümörü (%36), mikst GHT (%29), immatür teratom (%20) ve disgerminom (%15) saptandı. Hastaların 25 (%61)`i ileri evre hastalık ile başvurmuştu. Hastaların 37 (%90)’ına kemoterapi verildi. Evre I testis ve evre I over GHT hastalarında tümörün cerrahi olarak tam çıkartılmasının ardından αFP değerleri takip edilerek “bekle ve izle” yaklaşımı ile kemoterapi verilmedi. Tanı sonrası relaps refrakter hastalık ile seyreden 6 hastanın ikisi progresif hastalıktan kaybedildi. Otolog kök hücre nakli yapılan iki hastada nakil sonrası kür sağlanmasına rağmen enfeksiyon nedeni ile kaybedildi. Hastaların ortanca izlem süresi 34.9 ay (4-190,6 ay), 5 ve 10 yıllık genel ve hastalıksız yaşam oranları 81.9±6.3%, 81.9±6.3% ve 77.1±6.8% 77.1±6.8 ve %77,1±6,8 olarak bulundu. Nakil yapılan iki hastanın sağkalım süresi ortalama 33.21 ay olarak hesaplandı. Sonuç: Ekstrakraniyal MGHT`lerin tedavisinde, konservatif cerrahi, evre I hastalar için “bekle ve gör” yaklaşımı ve platin bazlı kemoterapi rejimleri ile başarılı sonuçlar alınmaktadır. İlk başvuruda hastaların yakınmalarının olmasına rağmen çoğu hastanın ileri evre hastalık ile başvurduğunun saptanması hekimlerin ayrıntılı değerlendirme ve muayenelerinin önemine dikkat çekmektedir. Erken evre hastalarda sonuçlar başarılı iken ileri evre ve relaps hastalarda yeni tedavi yaklaşımlarına ihtiyaç vardır

Evaluation of the Indicators of Inflammation in Children and Adolescents with Attention Deficit and Hyperactivity Disorder: Effect of Sex and Subtype

Aim: It was aimed to evaluate the hematological inflammatory markers in treatment-naive andcomorbidity-free children and adolescents with attention deficit and hyperactivity disorder(ADHD) in this study.Material and Methods: One hundred sixty-nine children aged 6-18, who were diagnosed withADHD according to DSM-5 criteria were included in the study. Age and sex-matched 59healthy children without any psychiatric and/or medical disorder were included as a controlgroup. The children who had an intellectual disability and/or autism spectrum disorder, acute,chronic or inflammatory diseases were excluded from the study. Smoking, obesity and usingpsychotropic medications and lack of data in records were other exclusion criteria. ADHD andcontrol groups were compared in terms of sociodemographic characteristics, inflammatorymarkers and hematological parameters.Results: Mean platelet volume (MPV) and Basophil (BASO) levels were significantly higherin the ADHD group compared to the control group and this statistical difference was onlyobserved for boys. In hyperactivity subtype, red cell distribution width (RDW), lymphocyte(LYMPH) and monocytes (MONO) were higher; in attention deficit subtype mean plateletvolume-to-lymphocyte ratio (MPVLR) was higher than all other subtypes and control group.MPV was similar in three subtypes, and were higher in all of them than the control group.Conclusion: This study revealed that MPV and BASO tend to be higher in the ADHD groupespecially in boys. Hematological biomarkers may be useful for diagnosis of ADHD anddetermination of ADHD subtypes but data on this subject are insufficient and morecomprehensive studies are needed

Evaluation of the Indicators of Inflammation in Children and Adolescents with Attention Deficit and Hyperactivity Disorder: Effect of Sex and Subtype

Aim: It was aimed to evaluate the hematological inflammatory markers in treatment-naive andcomorbidity-free children and adolescents with attention deficit and hyperactivity disorder(ADHD) in this study.Material and Methods: One hundred sixty-nine children aged 6-18, who were diagnosed withADHD according to DSM-5 criteria were included in the study. Age and sex-matched 59healthy children without any psychiatric and/or medical disorder were included as a controlgroup. The children who had an intellectual disability and/or autism spectrum disorder, acute,chronic or inflammatory diseases were excluded from the study. Smoking, obesity and usingpsychotropic medications and lack of data in records were other exclusion criteria. ADHD andcontrol groups were compared in terms of sociodemographic characteristics, inflammatorymarkers and hematological parameters.Results: Mean platelet volume (MPV) and Basophil (BASO) levels were significantly higherin the ADHD group compared to the control group and this statistical difference was onlyobserved for boys. In hyperactivity subtype, red cell distribution width (RDW), lymphocyte(LYMPH) and monocytes (MONO) were higher; in attention deficit subtype mean plateletvolume-to-lymphocyte ratio (MPVLR) was higher than all other subtypes and control group.MPV was similar in three subtypes, and were higher in all of them than the control group.Conclusion: This study revealed that MPV and BASO tend to be higher in the ADHD groupespecially in boys. Hematological biomarkers may be useful for diagnosis of ADHD anddetermination of ADHD subtypes but data on this subject are insufficient and morecomprehensive studies are needed

Cinsel İstismarda Uyurgezerlik Olgu Sunumu

Çocukluk çağında maruz kalınan fiziksel, cinsel ve duygusal ihmal ve/veya istismar birçok ruhsal bozukluğa yol açabilmektedir. Cinsel istismar sonrası en sık karşılaşılan ruhsal bozukluklar; anksiyete bozuklukları, depresyon, posttravmatik stres bozukluğu, yeme bozukluğu ve uyku bozukluklarıdır. Hemen hemen her ruhsal bozukluk uyku düzenini etkilemesine rağmen cinsel istismarın uyurgezerliği tetiklemesi nadir görülmektedir. Bu olgu sunumunda, cinsel istismar ile tetiklenen uyurgezerlik olgusu tartışılacaktır. Anahtar kelimeler: Cinsel istismar; uyurgezerlik; posttravmatik stres bozukluğ