Aim: This study aimed to evaluate the knowledge and attitudes of family physicians and family health personnel who are responsible for childhood vaccination services in primary care regarding meningococcal, rotavirus, and human papillomavirus vaccines. Methods: This cross-sectional study was conducted between October 2021 and January 2022. A total of 700 healthcare professionals from all geographical regions in Turkey were included in the study. The participants filled out an online questionnaire consisting of 39 questions created with Google Forms. Results: Of the participants, 340 (48.6%) are family physicians, and 360 (51.4%) are family health personnel. Most participants are from the Marmara region, Turkey’s most densely populated region. The most recommended vaccine among the participants was rotavirus (84.3%), while the least recommended vaccine was human papilloma virus (47.6%). The number of family physicians recommending meningococcal and human papilloma virus vaccines was significantly higher than that of family health personnel (p < 0.001). Furthermore, there was a statistically significant correlation between seeing a patient with these viruses in one’s professional life or considering the severity of these three diseases to be severe and recommending these vaccines (p < 0.001 for both). However, lack of knowledge about vaccines and doses, the high cost of vaccines, and concerns about side effects were among the reasons for not recommending vaccines. Conclusions: Healthcare professionals involved in childhood immunization should be trained to increase their knowledge and awareness on this issue. The training plan and curriculum should take into account the issues raised in our research, such as age, occupation, region of residence, and professional experience. In general, knowledge about the efficacy and safety of vaccines will help healthcare professionals develop their confidence in vaccines and willingness to recommend childhood vaccines to others.

Sleep terror (ST) is a common NREM parasomnia in early childhood and may be associated with broader emotional and behavioral dysregulation. However, its links with psychopathological symptoms and nutritional biomarkers remain unclear. This study compared children with ST and healthy controls (HC) in terms of psychopathology, sleep features, and biochemical markers, and explored short-term changes in a subgroup of children with ST receiving supplementation for documented micronutrient deficiencies. Forty-eight children aged 24-60 months with ST and 48 HC were evaluated for sociodemographic, sleep, biochemical, anthropometric, and standardized scale data obtained from electronic medical records. A subset of 25 children with ST with documented micronutrient deficiencies received guideline-based supplementation and had biochemical and scale reassessments after a mean interval of 90.6 days, as part of routine clinical follow-up. Children with ST showed shorter sleep duration and higher rates of bedtime resistance at the nominal level, but these differences did not survive FDR correction (FDR p = .092 and 0.069, respectively). Only nocturnal awakenings remained significant after FDR correction (FDR p = .028). In contrast, total anxiety, behavioral dysregulation, and sleep disturbance scores were markedly higher in the ST group and remained significant after FDR correction (all FDR p < .001). Vitamin D (20.4 vs. 25.8 ng/mL; p = .015, FDR p = .026), vitamin B12 (231.7 vs. 309.4 pg/mL; p = .002, FDR p = .003), and folate (11.3 vs. 13.1 ng/mL; p = .016, FDR p = .028) levels were lower in the ST group. At follow-up, vitamin B12 increased significantly (201.8→281.1 pg/mL; p = .006, FDR p = .009; r = .631, 95% CI [0.237, 0.926]), whereas other biomarkers did not change significantly after FDR correction. Anxiety, behavioral dysregulation, and sleep disturbance scores decreased substantially; however, change-score analyses did not show statistically robust associations between vitamin B12 change and symptom change after FDR correction. ST in early childhood was associated with a multidimensional profile of anxiety, behavioral dysregulation, parent-rated sleep disturbance, and lower vitamin D, vitamin B12, and folate levels. Clinical symptom differences remained robust after FDR correction. During naturalistic follow-up, vitamin B12 increased and symptom scores decreased, but change-score analyses did not support a direct biomarker-symptom association. These findings should be interpreted as hypothesis-generating. Larger prospective, controlled studies are needed to clarify the role of micronutrient status in early childhood ST.

In the present study, cardiovascular risk indices (Atherogenic Index of Plasma [AIP], Atherogenic Coefficient [AC], Castelli Risk Index-1 [CRI-1], and Castelli Risk Index-2 [CRI-2]) and bone mineral density (BMD SDS) were evaluated in patients with Familial Mediterranean Fever (FMF), and the association of these parameters with disease severity and MEFV gene mutations was investigated. A total of 126 participants (96 FMF patients and 30 healthy controls) were included in the study. FMF patients were classified as mild, moderate, or severe according to the PRAS severity score. Cardiovascular risk indices, biochemical parameters of bone metabolism, and BMD SDS values were compared among the groups. The relationship between BMD SDS and atherogenic indices was assessed by Spearman correlation analysis. The results were also analyzed according to MEFV gene mutations. No significant difference was detected among the groups in terms of sex or age (p > 0.05). FMF patients were found to have substantially higher cardiovascular risk indices than the control group, and these indices increased in parallel with disease severity (p < 0.05). The BMD SDS value of the severe FMF group was significantly lower than that of the other groups (p = 0.025). No difference was detected among the groups with respect to bone metabolism parameters (p > 0.05). No significant correlation was observed between BMD SDS and cardiovascular risk indices (p > 0.05). M694V was the most frequently detected mutation, and the BMD SDS value was lower in patients carrying mutations other than M694V (p = 0.011). The increased cardiovascular risk in FMF patients is associated with disease severity. Severe disease is accompanied by a reduction in bone mineral density. The lack of an association between cardiovascular risk and bone mineral density suggests that these systems may be affected through different mechanisms. It is important that FMF patients are monitored with respect to cardiovascular and bone health.

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is getting more prevalent in children with obesity, and simple and non-invasive biomarkers are needed for early detection. In this study, the discriminative performance of the ALT/AST ratio (AT index) for MASLD was evaluated in comparison with metabolic indices such as HOMA-IR and TyG derivatives. Methods: A total of 410 children with obesity aged 5–18 years were included in this prospective, multicenter cross-sectional study. Anthropometric measurements, laboratory data, and abdominal ultrasonography findings of the participants were evaluated. MASLD was diagnosed based on ultrasonographic findings. The discriminative performance of the indices was evaluated using ROC analysis, and factors independently associated with MASLD were assessed using multivariate logistic regression analysis. Results: BMI SDS, ALT, AT index, insulin, HOMA-IR, and TyG/ALT values were found to be significantly higher in the MASLD (+) group (p < 0.05). The AT index demonstrated statistically significant but modest discriminative ability for MASLD (AUC = 0.621; p < 0.001) and showed 70.5% sensitivity and 50.7% specificity at a cutoff value of >0.88. In the multivariate analysis, the AT index (OR: 3.401; 95% CI: 1.717–6.735; p < 0.001) and BMI SDS were identified as factors independently associated with MASLD.HOMA-IR and prolactin-related indices were not found to be significant as independent predictors. Conclusions: The ALT/AST ratio is a simple and accessible biomarker associated with MASLD in children with obesity. Although its discriminative performance is modest, its association with hepatic involvement and metabolic dysfunction suggests that it may provide supportive exploratory information in the evaluation of MASLD. However, further validation studies are required before broader clinical application.

Kalsiyum (Ca) minerali, nöromüsküler ve sinyal yolaklarının düzenlenmesi, kemik gelişimi, büyümesi ve bakımı ile hücre iskeletinin stabilitesi için gereklidir. Birçok önemli işlevi olan kalsiyumun plazma düzeyini normal aralıklarda tutmak önemlidir. Plazma kalsiyum düzeylerinin kontrolü, bağırsaktan emilim, renal tübüllerden emilim ve gerektiğinde kemik depolarından dengelemenin birleşimiyle sağlanır. Bazı hastalıklar durumunda bu denge bozulur ve hipokalsemi veya hiperkalsemi meydana gelebilir. Hipokalseminin başlıca semptomları arasında kas seyirmeleri ve spazmları, karpopedal spazm, huzursuzluk, fokal veya jeneralize nöbetler, kişilik bozuklukları, ekstrapiramidal bulgular, apne, stridor, bronkospazm, laringospazm, kilo alamama, beslenme güçlüğü, kuru cilt, kırılgan tırnaklar, atopik egzema, diş çürüğü, karın ağrısı, kusma, kabızlık ve biliyer kolik alır. Hiperkalsemisi olan hastalarda böbrek tutulumuna bağlı poliüri, polidipsi, nefrolitiyazis, nefrokalsinoz, distal renal tübüler asidoz, nefrojenik diyabetes insipidus, akut ve kronik böbrek yetmezliği görülebilir. Gastrointestinal sistemde anoreksi, bulantı, kusma, kabızlık, pankreatit ve peptik ülser görülürken, kas iskelet sisteminde kas güçsüzlüğü, kemik ağrısı, osteopeni/osteoporoz görülebilir. Depresyon, tükenmişlik sendromu, konsantrasyon bozukluğu, bilinç bulanıklığı, konfüzyon ve koma gibi nörokognitif değişiklikler izlenebilir. Hiperkalseminin en ciddi bulgusu ise bradikardi ve QT aralığının kısalması sonucu meydana gelen kardiyak arresttir. Bu bölümde kalsiyumun, profilaksi gerektiren durumları, diyetteki kalsiyum içeren ürünleri, hipokalsemi/hiperkalsemi etiyolojisi, klinik durumu ve tedavisi anlatılacaktır. Calcium (Ca) mineral is necessary for the regulation of neuromuscular and signaling pathways, bone development, growth and maintenance, and stability of the cytoskeleton. It is important to keep the plasma levels of calcium, which has many important functions, within normal ranges. Control of plasma calcium levels is achieved by a combination of absorption from the intestine, absorption from the renal tubules, and, when necessary, balancing from bone stores. In some diseases, this balance is disrupted and hypocalcemia or hypercalcemia may occur. The main symptoms of hypocalcemia include muscle twitching and spasms, carpopedal spasm, restlessness, focal or generalized seizures, personality disorders, extrapyramidal findings, apnea, stridor, bronchospasm, laryngospasm, failure to gain weight, feeding difficulties, dry skin, brittle nails, atopic eczema, tooth decay, abdominal pain, vomiting, constipation, and biliary colic. In patients with hypercalcemia, polyuria, polydipsia, nephrolithiasis, nephrocalcinosis, distal renal tubular acidosis, nephrogenic diabetes insipidus, acute and chronic renal failure due to renal involvement may be observed. Anorexia, nausea, vomiting, constipation, pancreatitis and peptic ulcer are observed in the gastrointestinal system, while muscle weakness, bone pain, osteopenia/osteoporosis may be observed in the musculoskeletal system. Neurocognitive changes such as depression, burnout syndrome, impaired concentration, clouding of consciousness, confusion and coma may be observed. The most serious finding of hypercalcemia is cardiac arrest resulting from bradycardia and shortening of the QT interval. This section will discuss calcium, conditions requiring prophylaxis, calcium-containing products in the diet, etiology, clinical status and treatment of hypocalcemia/hypercalcemia.

Major depressive disorder (MDD) in adolescence is influenced by genetic, psychosocial, and biological factors. Nutritional deficits—particularly vita