Objective: Bronchiectasis is a condition characterized by irreversible abnormal dilation and anatomic breakdown of the bronchial tree. In our study we aimed to understand the causes of osteoporosis at molecular levels and to investigatethe usefulness of RANKL and OPG levels as markers in early diagnosis and follow-up of osteoporosis, RANKL inhibitors in the treatment of osteoporosis. Materials and Methods: 30 noncystic fibrosis bronchiectasis patients were diagnosed as osteoporosis with DEXA and applied to the Pediatrics Chest Diseases Department of Meram Medical Faculty of Necmettin Erbakan University between June 2015 and June 2016 were included in our study. BMD values were determined by DEXA and QUS in the patient group and only QUS in the control group. Results: In the patient group 56.6% (n: 17) were male, 43.4% (n: 13) were. There was no statistically significant difference between RANKL, OPG, RANKL / OPG ratios, BALP, OST, NTX values between the patient and control group (p> 0.05). The median serum Ca level was 9.51 (IQC: 0.74) in the patient group and 9.75 (IQC: 0.47) in the control group, there was a statistically significant difference between them (p = 0.003). There was a strong positive correlation between QUS z scores and DEXA z scores in the patient group (p = 0.008). Conclusion: In conclusion, we could not pinpoint the role of RANK / RANKL / OPG in the pathogenesis of osteoporosis in patients with noncystic fibrosis bronchiectasis. However, we think it is appropriate to conduct studies on a wider series in this topic.

Objective: The COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. We aimed to contribute to the medical literature by sharing the knowledge and experience of pediatric patients who were diagnosed as having COVID-19 in a one-year period. Method: Patients aged 1 month to 18 years who were diagnosed as having COVID-19 in our clinic, between March 2020 and April 2020, from when COVID-19 was declared as a pandemic, were included in the study. Results: Four hundred sixty-seven children were included in the study. There were 34 (7.3%) patients under one year of age, 111 (23.8%) between 1-5 years, 98 (30.4%) between 5-10 years, 142 (30.4%) between 11-15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and dyspnea (17.1%) in those aged over 15 years of age were found significantly more common compared with the other age groups. Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Four patients died during the study period (0.8%, 4/494). Conclusion: Although COVID-19 has an asymptomatic and mild course in children, it should be kept in mind that it may have a severe course.

Chronic cough is one of the most common complaints of childhood to consult a doctor. There are many causes such as respiratory tract infections, gastroesophageal reflux, persistent bacterial bronchitis, asthma, cystic fibrosis, congenital malformations, and foreign body aspiration in children under the age of five. However, neither transient hypogammaglobulinemia of infancy (THI) among the causes of chronic cough, nor chronic cough among the application complaints of THI are not questioned. In this study, we aimed to draw attention to the role of THI in the etiology of chronic cough under the age of five. Our study included 55 pediatric patients under the age of five who applied to the pediatric pulmonary diseases outpatient clinic in between January 2015 and December 2020 with the complaint of chronic cough, who were excluded from other causes of chronic cough in etiology, and who met the criteria for THI according to the European Society for Immunodeficiencies (ESID). Demographic, clinical and laboratory characteristics and follow-ups of these patients were reviewed retrospectively. In our study, the mean age of 55 patients at admission was 21.73 ± 11.50 months (median age: 18 months), and the mean age of IgG recovery was 38.65 ± 16.81 months. The mean recovery time was 16.93 ± 12.85 months. Of the patients, 22.4% had a history of consanguinity, 23.4% had prematurity, and 18.2% had a frequent sickness in siblings. The most common complaint accompanying chronic cough in patients was frequent respiratory tract infection, 16.3%. Along with IgG, 26.4% of the patients had low IgA and 31.5% had low IgM in laboratory testing. In antibody responses, isohemagglutinin, anti-tetanus, anti-pneumococcal, anti-HBs vaccine responses were found to be positive in 90.6%, 63.9%, 66.7% and 97.7% of the cases, respectively. 72.7% of the patients received inhaler treatment, 45.5% received antibiotic prophylaxis, and 2.2% received intravenous immunoglobulin (IVIg) treatment. After the IgG value of the patients returned to normal, it was observed that 86.3% of the patients’ cough complaint have disappeared. Transient hypogammaglobulinemia of infancy mostly presents with recurrent lower and upper respiratory tract infections. The most common complaint is cough. It is not questioned whether the cough is chronic or not. In this study, we aimed to investigate the follow-up and prognosis of patients under the age of five who had a chronic cough complaint, when other causes of cough were ruled out and THI was detected. In the study, when the IgG levels of the patients return to normal, the cough complaints disappear to a large extent, showing that THI may also be among the causes of chronic cough.

Objective: The COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. Our aim was to describe clinical findings and outcomes of SARS-CoV-2 viral infection and Covid-19 disease cared for at a large pediatric tertiary care hospital during the first year of the pandemic. Methods: Patients aged 1 month to 18 years who were diagnosed as having COVID-19 between March 2020 and April 2021 were included. The files of patients diagnosed with covid-19 were reviewed retrospectively. Results: 467 children were included in the study. There were 34 (7.3%) patients under one year of age, 111 (23.8%) between 1-5 years, 98 (30.4%) between 5-10 years, 142 (30.4%) between 11-15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and dyspnea (17.1%) in those aged over 15 years of age were found significantly more common compared with the other age groups (p<0.05). Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Four patients died during the study period (0.8%, 4/467). Conclusion: While SARS-CoV-2 infection may be asymptomatic and Covid-19 disease usually has a mild clinical course, some children have severe disease or mortality.

Objectives: We aimed to investigate depression, burnout, attitude, and burden of caregivers of children with cystic fibrosis (CF), and especially caregivers of children with primary ciliary dyskinesia (PCD) due to limited number of studies on this topic, and to compare them according to their children’s clinical status. Methods: Clinical features and demographic data of children and their families were asked to caregivers in four pediatric pulmonology centers. Beck Depression Inventory (BDI), Maslach Burnout Inventory (MBI), Zarit Caregiver Burden Scale (ZCBS), and Parental Attitude Research Instrument (PARI) were administered to caregivers in both groups. Results were compared between the two groups. Results: In total, 131 children with CF and 39 with PCD and their caregivers were involved in study. All primary caregivers were mothers in both groups. Depression, burnout, and burden scores of mothers of children with CF were significantly higher than mothers of children with PCD (p=0.017, p=0.024, p=0.038, respectively). Burnout was higher in both CF and PCD groups with low family income (p=0.022, p=0.034). Number of hospital visits in the previous six months was correlated with burnout in both CF and PCD groups (r=0.207, p=0.034; r=0.352, p=0.044). Conclusions: Although mothers of children with CF have higher depression, burnout, burden, and negative attitudes towards children than mothers of children with PCD, it is disregarded in mothers of children with PCD. Psychological problems of mothers of children with CF and PCD may increase with frequent hospital visits, hospitalizations, low family income, number of children, and chronic disease in another child.

Coronavirus disease 2019 (COVID-19) is a viral disease caused by a novel coronavirus that can lead to severe acute respiratory failure. Recent studies have shown that aggravating factors in the etiology of COVID-19 disease include genetic defects and autoantibodies against type 1 interferon. Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis disease. SARS-CoV-2 infection and immunosuppressive drugs may temporarily inhibit immunologic system, then may lead to active tuberculosis by reactivation or infection of M. tuberculosis. We aimed to show that there is a relationship between covid-19 infection and an increase in the number of tuberculosis patients. Eight patients diagnosed with tuberculosis in the Pediatric Pulmonology and Pediatric Infectious Diseases Clinics of Necmettin Erbakan University, Meram Medical Faculty between March 2020 and May 2021 were enrolled in this study. The presence of COVID-19 infection was confirmed by COVID-19 antibody test and patient’s detailed medical history. The patient with negative antibody test was also included in the study if other family members confirmed for COVID-19 infection by RT-PCR. We evaluated demographic data, laboratory findings, imaging tests and pathology results of all patients. The remarkable increase in the number of tuberculosis activation in the recent year suggests the role of COVID-19 infection. The pathologic structure of the virus may be responsible of the increase, although the mechanism is not fully understood. Further research should be done on this topic.

Isoniazid for 6-9 months is the most widely used form of tuberculosis (TB) preventive treatment. We aimed to assess the side effects of isoniazid by using the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), and uric acid (SUA) in children and adolescents receiving long term isoniazid for latent tuberculosis infection. The study included children ≤18 yrs of age who underwent TB preventive treatment with isoniazid (IPT) between 2015 and 2019 at an university hospital. Serum transaminase, SUA, urea, and creatinine levels of patients were measured before the initiation of IPT, 15th day, and once a month during treatment. Patients with either ALT, AST, or SUA results above cut-off levels during treatment were evaluated. The final values in follow up were included in the analysis of the data. A total of 141 children who underwent IPT were included. Seventy children had family members with confirmed tuberculosis disease and 71 children had TST positivity. SUA increased above cut-off values in 16 children (11.3%) and half of them had uric acid levels over 7 mg/dL. The median duration of the development of hyperuricemia was 4.0 months. ALT or AST increased above cut-off values in 23 children (16.3%). ALT was above cut-off values in 7 patients, AST was high in 20 patients. The median duration to the development of AST and/or ALT levels above cut-off was 4.0 months. Two patients had hepatotoxic transaminase levels. Three patients had both elevated transaminases and SUA levels. İsoniazid may also cause hyperuricemia beside elevation in transaminases in children.

Objectives: To evaluate the risk factors of recurrent pulmonary exacerbation and poor prognosis in children with idiopathic pulmonary hemosiderosis (IPH).  Methods: In this multicenter study, 54 patinets with diagnosis of IPH included. Medical records were retrospectively reviewed from three tertiary care hospitals between 1979 and 2019. Also, current information and the long-term progress of patients was determined by contacting the families by telephone. Results: A total of 54 children were included. The median age of onset of symptoms was 4.5 ± 3.8 years. The median time from onset to diagnosis was 0.9 years ± 2.2. The mean number of recurrent episodes per child in the recurrence-positive group was 3.55 (1-15). Univariate analysis demonstrated that patients presenting with hypoxia or requiring transfusion at the time of presentation had significantly more recurrence episodes (P=0.002). Multivariate analysis showed that the presence of hypoxia at the time of initial presentation was a significant independent predictor of recurrent episodes (P=0.027). The median follow-up was 3.3 ± 4.8 years (0.75 months-27 years). There was a significant relationship between the presence of hypoxia, transfusion history, ANA positivity, and elevated transaminases at the time of initial evaluation and treatment response. Conclusions: The present study provides important information on the clinical course and outcome of pediatric IPH, and substantial information regarding factors that affect recurrent exacerbations and prognosis. Demonstrating of hypoxia as an independent risk factor in recurrence episodes could be guide physicians in the planning of treatment strategies.