Background: With the increase in pediatric obesity, the prevalence of metabolic syndrome (MetS) is rising worldwide. Early identification of children with obesity who are prone to developing MetS is important. Objectives: This study aimed to evaluate the value of the Systemic Immune–Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI) in predicting MetS in obese children and adolescents. Methods: This prospective single-center cross-sectional study involved 99 children and adolescents with obesity. The patients were assigned to two groups, MetS+ (n = 42) and MetS- (n = 57), based on the presence of MetS. Complete blood count results from the first visit were evaluated. Results: The white blood cell (WBC), platelet, and neutrophil counts were higher in the MetS+ group (P = 0.003, P = 0.022, and P < 0.001, respectively), while no significant difference was observed in lymphocyte (P = 0.865) and monocyte counts (P = 0.488) between the two groups. When inflammatory parameters were compared, SII (P < 0.001), platelet-to-lymphocyte ratio (PLR) (P = 0.024), neutrophil-to-lymphocyte ratio (NLR) (P = 0.002), and SIRI (P = 0.012) were significantly elevated in the MetS+ group compared to the MetS- group. Binary logistic regression analysis revealed that SII and homeostasis model assessment of insulin resistance (HOMA-IR) were statistically significant risk factors for the presence of MetS (P = 0.003, P = 0.012, respectively). Additionally, a significant positive correlation was found between SII and diastolic blood pressure (DBP) (P = 0.024), high-density lipoprotein cholesterol (HDL-C) (P = 0.019), and fasting plasma glucose (FPG) (P = 0.048), as well as between SIRI and HDL-C (P = 0.044) and FPG (P < 0.001). Receiver operating characteristic analysis of the SII and SIRI ability to predict MetS in adolescents and children with obesity showed that the SII was more discriminative than the SIRI, with a specificity of 0.82, sensitivity of 0.57, and an area under the curve of 0.708. Conclusions: The SII and SIRI can be used for the early diagnosis of MetS in pediatric obesity patients.

Objective: Postpartum mental health, significantly influences breastfeeding. Dysphoric milk ejection reflex (D-MER) is defined as negative emotional reaction to milk ejection, such as unpleasant feelings, anger-irritability or a strange feeling in the stomach. This study investigates the impacts of D-MER on mothers experiencing negative emotions during breastfeeding. Method: This cross-sectional, descriptive study was conducted between July 1 and September 30, 2023 among surveyed mothers with babies of ages 0–2 experiencing discomfort while breastfeeding. Mothers reached out through Instagram and Facebook and completed a semi-structured 45-question survey using a Google form. Results: Out of 141 mothers, 27.7% ( n : 39) had D-MER findings. Common emotions included tension (48%), exhaustion (43%), intolerance (41%), hypersensitivity (35%), and restlessness (33%). Symptoms reported to begin within the first month of breastfeeding in 59% of D-MER cases. Nausea was reported in 30% of mothers. The most common conditions that increased the severity of D-MER symptoms were insomnia, stress and breast fullness. Sleeping or resting, being alone, doing something else, drinking cold water, listening to music and talking to mothers who had similar experiences helped the mothers relax. In cases with D-MER findings, about 17.9% considered stopping breastfeeding, with 7.7% stopping. The postpartum depression score was ≥13 in 59% of D-MER cases. Conclusion: D-MER, which can cause early cessation of breastfeeding, may also be associated with the mother’s mental health problems. Raising awareness about D-MER and equipping health professionals on this subject are important in the continuity of breastfeeding.

It is thought that airway inflammation is more common in obese asthmatic patients because inflammation is harder to control and does not respond well to glucocorticoid treatment. This study's aim was to investigate the effect of obesity on airway and systemic inflammation in children with asthma and to identify the biomarkers that play a role in this inflammation. The study included patients aged 6-16 years who were diagnosed with asthma in the paediatric allergy outpatient clinic of Bagcilar Training and Research Hospital in Turkey. Complete blood count parameters were compared between three groups: obese asthmatic (n=43), obese non-asthmatic (n=45), and non-obese non-asthmatic (control group, n=30). Levels of high-sensitive CRP (hs-CRP), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and matrix metalloproteinase-9 (MMP-9), and 25(OH)-vitamin D were compared between the groups. No statistically significant differences were observed in 25(OH)-vitamin D, NGAL, OPN, hs-CRP, and MMP-9 levels between groups. There was a statistically significant negative correlation between FEV1/FVC and NGAL and MMP-9. This is the first study to investigate levels of hs-CRP, NGAL, OPN, MMP-9, and 25(OH)-vitamin D in obese asthmatic children. Larger studies with sputum and BAL examinations are required to determine the potential of biomarkers for identifying inflammation in obese asthmatic children.

Background: Matrix metalloproteinase-9 (MMP-9) is an enzyme implicated in the pathogenesis of renal diseases. Renal involvement is the principal cause of morbidity and mortality in children with Henoch-Schönlein purpura (HSP). Objectives: The aim of this study was to evaluate whether serum and urinary MMP-9 levels are associated with renal involvement in HSP Patients and Methods: We evaluated 40 children with HSP (patient group) and 27 healthy volunteer children (control group). The patient group was divided into two subgroups based on the presence or absence of nephritis. Nephritis was defined as the existence of hematuria and/or proteinuria. All anthropometric data, physical examination findings, blood pressure, and laboratory parameters were recorded. The serum and urine samples were analyzed to determine the MMP-9 levels three days after the initial phase of the disease. Results: The mean age was 7.65 ± 3.41 (range 2 - 16) years in the patient group and 9.52 ± 3.91 (range 2 - 16) years in the control group. Henoch-Schonlein purpura nephritis (HSPN) was identified in eight patients. There was no significant difference in the serum MMP-9 levels between the HSPN subgroup and the controls (P > 0.05). However, there were significant differences in the urinary MMP-9 levels between the HSP subgroup and the control group (P < 0.05), with the urinary MMP-9 levels being significantly higher in patients in the HSP subgroup (P = 0.001). Further, the urinary MMP-9 levels were significantly higher in the patients with nephritis than in the patients without nephritis (P = 0.001) and the controls (P = 0.001). The optimal cut-off point (sensitivity; specificity) of the urinary MMP-9 level for the diagnosis of HSPN was 94.7 pg/mL. Conclusions: The levels of MMP-9 in the urine were remarkably high in patients with HSPN. This non-invasive marker may therefore be an important indicator for the early diagnosis of nephritis in children with HSP. Keywords: Henoch-Schönlein Purpura; Henoch-Schönlein Purpura Nephritis; Matrix Metalloproteinase-9

Natural disasters present a significant and growing threat to the well-being of children. Every year 175 million children globally are expected to be affected by natural disasters, including floods, cyclones, droughts, heatwaves, severe storms, and earthquakes. In emergencies, children of all age groups, especially those under 5, are the most affected part of the community, with child mortality rates 2-70 times higher than average. Clean water, sanitation and hygiene measures, vaccination to prevent infectious diseases, providing psychological support to vulnerable children in an age-appropriate approach, and paying particular attention to children with special needs are extremely important. Healthcare personnel and families should have adequate information and preparation to do what is necessary before, during, and after emergencies to minimize the negative effects on children. In this review, we aim to discuss the effects of emergencies on children and the prevention methods. Cite this article as: Büke Ö, Karabayır N. Protection of child health in emergencies. Turk Arch Pediatr. 2024;59(3):243-249.

Objective The objective of this study was to assess the result of intravenous pentoxifylline as an adjunct to antibiotic therapy on mortality and morbidity in very low birth weight (VLBW) preterm neonates with nosocomial sepsis. Methods For the 18 VLBW preterm neonates, as an adjunct therapy to antibiotics regimens, pentoxifylline (5 mg/kg/h for 6 hours) was administered to premature infants with sepsis on 3 successive days. Clinical and laboratory parameters were recorded before and after treatment. Results Following pentoxifylline therapy, the immature-to-total neutrophil ratio and C-reactive protein (CRP) levels were significantly decreased, while the blood pH and base excess were significantly increased (p < 0.05). The axillary temperature, noninvasive blood pressure, hemoglobin, leukocyte, and thrombocyte values did not significantly differ after treatment (p > 0.05). Coagulase-negative staphylococci (CoNS) (32%), Streptococcus hominis (7.3%), Pseudomonas aeruginosa (5.3%), and Candida parapsilosis (3.1%) were identified in the blood cultures. There were no short-term morbidities (intraventricular hemorrhages, necrotizing enterocolitis, periventricular leukomalacia, and patent ductus arteriosus), no adverse effects, and no mortalities during or after the pentoxifylline therapy in the preterm neonate participants. Conclusion The CRP levels and heart rate both decreased, while the pH and base excess parameters of the blood gas analysis changed positively after pentoxifylline treatment in VLBW preterm neonates with nosocomial sepsis.