Associated factors of legal child marriage in Turkey: pregnancy and below-average intelligence.

Turkish civil code permits child marriages at 16-17 years of age, but if a child is 16 years old judicial consent is needed. Before making a final decision on marriage consent, the judges refer these children to the doctor, and ask whether they are psychologically and physically ready for marriage. While the literature on child marriage in Turkey is rich, little is known about the underlying factors leading 16-year-old girls to request legal child marriage. This study examined the socio-demographic and clinical characteristics of girls applying to the courts for judicial marriage consent. Hospital records of girls admitted to a hospital in the Istanbul province of Turkey between January 2015 and December 2018 for the assessment of their physical and mental readiness for marriage were scanned. Of the 122 girls admitted to hospital for this purpose, eight were excluded as they had incomplete data, leaving 114 participating girls. All girls were Turkish citizens and had been referred from the law courts. Being pregnant/having a child (54.4%), having had a religious (non-legal) marriage (49.1%) and having an intelligence score of less than 90 (91.2%) were common among the participants. Among those who had a religious marriage, 78.6% were pregnant/had a child at the time of evaluation and 32.1% reported that they were pregnant before their religious marriage took place. None of the participants reported being forced to marry, but many had run away from home to marry (33.3%). Among those running away to marry, the major reason for deciding to do this was being pregnant (63.2%). Running away from home to marry was found to be related to lower parental educational levels (p<0.05). Contrary to the literature, the findings indicate that girls who request judicial consent for legal child marriage in Turkey are not being forced to marry. However, lower educational level seems to be an important factor. Below-average intelligence of the girl and her parents, running away from home to marry and early unsafe sexual intercourse, leading to child pregnancy, were found to be closely associated with legal child marriage in Turkey.

Neurological Manifestations of Pediatric Acute COVID Infections: A Single Center Experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases. MATERIALS AND METHODS: The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD). RESULTS: Of the 2530 children who underwent RT-PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0-17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%). CONCLUSION: The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children.

Emotional and behavioral problems in children and adolescents with hearing loss and their effects on quality of life.

PURPOSE: Determination of mental functions in children with hearing loss is important in improving the quality of life of the child. Many scales have been developed for this purpose. In this study, it was aimed to determine the emotional and behavioral effects of both the child with hearing loss and the parent in the hearing loss and device process, and to investigate the effect of this situation on the quality of life. METHODS: Forty-five children aged 7-17 years with sensorineural hearing loss with audiometric methods and 32 healthy controls without hearing problem were included in the study. All children received a Powers-Weakness Questionnaire-Self-Reporting Scale, Strengths and Difficulties Questionnaire, Child Anxiety and Depression Scale, and Kid-KINDL Quality of Life Scale. In all parents, the Parental Statement of Powers-Weaknesses Questionnaire and the Kid-KINDL Quality of Life Scale parental form questionnaires were applied. RESULTS: In the patient group, both mother (p = 0.001) and father (p = 0.027) education levels were significantly lower than the control group. The success rate of the sick children was lower than that of healthy children (p = 0.013). According to the surveys, the quality of life scale and all subscales were significantly lower in the patient group than in the control group (p < 0.05 for each). Child depression inventory score was also significantly higher in the patient group (p = 0.005). CONCLUSIONS: Data obtained in the study indicate that children with hearing disabilities should be closely monitored and undergo a better rehabilitation process in terms of both anxiety and depression and their quality of life. According to our findings, since the parents of hearing-impaired children are observed to have a low level of education, it is seen that these families should be educated more closely in approaching children and improving their quality of life.

Foveal avascular zone and vessel density in children with attention deficit hyperactivity disorder.

PURPOSE: To compare the retinal and choroidal microvasculature quantitatively via optical coherence angiography (OCTA) in children with attention deficit hyperactivity disorder (ADHD) who were under methylphenidate (MFD) treatment or newly diagnosed as ADHD and were not taking any medication. METHODS: This was a cross-sectional, comparative, and observational study. The children who were between 6 and 17 years old and previously diagnosed as ADHD and were under MFD treatment or who were newly diagnosed as ADHD were included in the study. Optical coherence tomography angiography imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The main outcome measure of the study was OCTA parameters of the children with ADHD. RESULTS: A total of 186 eyes of 186 patients were included in the study. There were 80 eyes in the control group (newly diagnosed) and 106 eyes in the treatment group (under MFD treatment). The mean duration of methylphenidate use in the treatment group was 33.9 ± 20.1 months (between 6 and 84 months). The choriocapillary flow area (p = 0.03), superficial parafoveal thickness (p = 0.01), and deep parafoveal thickness (p = 0.01) were statistically greater in the treatment group than the control group. CONCLUSION: Most of the important OCTA parameters especially foveal avascular zone (FAZ) area and FAZ perimeter were similar in the two groups. There was a significant difference between the two groups in parafoveal thickness values which might point to a slight effect of MFD on retinal circulation.

The role of psychiatric status on pediatric extremity fractures: a prospective analysis.

PURPOSE: The aim of the study was to investigate the relationship between attention deficit and hyperactivity disorder (ADHD), anxiety, and depression with pediatric extremity fractures. METHODS: Between November 2014 and November 2016, consecutive 138 patients with pediatric extremity fractures were prospectively investigated in terms of the tendency to anxiety, depression, or ADHD in the study group. Consecutive 168 non-trauma patients who were admitted to general pediatrics outpatient clinic were included the control group. Patients were performed with Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV S), The Screen for Child Anxiety-Related Emotional Disorders (SCARED), and The Children's Depression Inventory (CDI). RESULTS: There were not any significant differences between study and control groups regarding the age, gender distribution, economical level, or previous psychiatric admission rates (p > 0.05). In the study group, the previous ADHD history and previous fracture history were significantly higher than the control group (p < 0.05). In the study group, the severity of depressive signs and anxiety were significantly higher than the control group (p = 0.000 and p = 0.019; respectively). Regarding the previous fracture history, conduct disorder and tendency to depression were significantly higher in the study group (p = 0.001 and p = 0.011; respectively). CONCLUSIONS: The signs of ADHD, anxiety, and depression were determined to be higher in children with extremity fractures compared with the non-traumatic population. In patients with especially behavioral problems and depressive signs, directing to the child and adolescent psychiatrists will be protective to prevent re-fractures and high-energy traumas.

Pediatric patients with psoriasis and psychiatric disorders: premorbidity and comorbidity in a case-control study.

BACKGROUND: Psychiatric disorders are thought to play an important role in the onset, exacerbation and course of several chronic dermatological diseases. We aimed to investigate psychiatric diagnoses in children with psoriasis before and during the disease and to examine potentially related factors. METHODS: A total of 108 children aged 8-16 years, 54 with a diagnosis of psoriasis and 54 healthy individuals, were included in the study. Participants were evaluated using The Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version (K-SADS PL), Children's Dermatology Life Quality Index (CDLQI), Screen for Child Anxiety Related Emotional Disorders (SCARED) and Children's Depression Inventory (CDI), and the results were compared using statistical techniques. RESULTS: At least one psychiatric diagnosis was present in 70.3% of children with psoriasis and in 27.7% of the control group, the difference being significant (p = .0001). It was seen that 73.6% of children with a psychiatric diagnosis were psychiatric diagnoses in the premorbid period. Children with psoriasis were determined to have 9.21-fold greater risk of anxiety (p = .0001) and a 6.65-fold greater risk of depression (p = .0019) compared with the control group. CONCLUSIONS: A statistically significant increase in psychiatric disorders occurs in disease periods in cases of pediatric psoriasis. Moreover, a high prevalence of psychiatric disorders was detected in the premorbid process. We think that it is important for these to be considered in the management of the disease and in controlling exacerbation, and for the mechanisms involved to be elucidated.

Effects of Long-Term Use of Prescription Methylphenidate on Myocardial Performance in Children with Attention-Deficit/Hyperactivity Disorder: A Tissue Doppler Imaging Study.

OBJECTIVE: Many children diagnosed with attention-deficit/hyperactivity disorder are treated with methylphenidate (MPH). The purpose of this study was to evaluate the relationship between long-term use of osmotic-release oral system methylphenidate (OROS MPH) and cardiac functions. METHODS: The study involved 116 subjects 6-18 years of age. Fifty-eight of these were in the case group and were using OROS MPH (extended-release capsules). Fifty-eight children not receiving treatment were included in the control group. Participants were also assessed using 12-channel electrocardiography (ECG), transthoracic 2D echocardiography, Doppler echocardiography, and tissue Doppler imaging (TDI). The findings obtained were compared using statistical methods. RESULTS: No significant differences were determined between the case and control groups in terms of systolic blood pressure and diastolic blood pressure or 12-channel ECG findings. There was also no difference in 2D and M-mode measurements among the echocardiography findings. Of the TDI parameters obtained, only E' septal values differed significantly between the case and control groups. However, this was not at such a level as to indicate cardiac function impairment. CONCLUSIONS: The study data showed that the echocardiographic parameters we measured resulted in no clinical difference between the children using MPH and the healthy controls. We conclude that MPH use in children does not impair cardiovascular functions at short-term follow-up.

The effect of deformity correction on psychiatric condition of the adolescent with adolescent idiopathic scoliosis.

PURPOSE: The purpose of this prospective study was to evaluate the effects of deformity correction on body image, quality of life, self-esteem, depression and anxiety in patients with adolescent idiopathic scoliosis (AIS) who underwent surgery. METHODS: Between June 2014 and July 2015, 41 consecutive patients who underwent surgery for AIS were compared with the control group of 52 healthy patients regarding the changes in the pre- and postoperative quality of life and psychiatric status of patients with deformity correction. Body Cathexis Scale (BCS), Pediatric Quality of Life Inventory (PedsQL), Children's Depression Inventory (CDI), Piers-Harris self-esteem questionnaire (PH-SEQ) and state-trait Anxiety Inventory for Children were used to evaluate the patients. RESULTS: There was a significant decrease in postoperative first-year Cobb angle and trunkal shift imbalance compared with the preoperative values (p = 0.0001 and p = 0.0001). Postoperative first-year thoracic kyphosis angle and body height showed a significant increase according to preoperative values (p = 0.0001 and p = 0.0001). Postoperative PH-SEQ score and PedsQL total score showed a significant increase in the study group compared to the preoperative level, but no significant difference was found between the control group. Postoperative CDI score, BCS score, STAI-state and STAI-trait scores decreased significantly in the study group compared with preoperative scores. CONCLUSIONS: Surgical correction of deformity in AIS provided significant improvements regarding quality of life and psychiatric condition. Spinal surgeons should be aware of the possible psychological problems of AIS patients and should keep in mind that deformity correction not only improves physical health but also improves mental health. These slides can be retrieved under Electronic Supplementary Material.

Pericallosal Lipomas: A Series of 10 Cases with Clinical and Radiological Features.

AIM: A pericallosal lipoma is a fat-containing lesion occurring in the interhemispheric fissure closely related to the corpus callosum, which is often abnormal. This is the most common location for an intracranial lipoma. In this study, we aim to report on the clinical and radiographic aspects of ten patients diagnosed with pericallosal lipomas. MATERIAL AND METHODS: A retrospective analysis of patients who presented to the neurology and neurosurgery outpatient clinics of Kayseri Training and Research Hospital between 2010 and 2014 revealed that 10 patients had the diagnosis of pericallosal lipoma. The clinical and magnetic resonance imaging data were obtained by reviewing their files. RESULTS: Ten patients with an average age of 35.8 years (11-80 years) were included in the study. The mean follow-up was 17 months (8-31 months). No neurological deficits related to the lesions were found during neurological examination in any of the patients. Four patients had tubulonodular lipomas while the other 6 presented with curvilinear lipomas. Four patients (40%) displayed a coexistent corpus callosum hypoplasia. In contrast to previous reports, 3 of these patients had a curvilinear lipoma while the remaining one had tubulonodular lipoma. Also, one of the patients displayed plaque lesions attributable to multiple sclerosis. During the follow-up period, no growth in the lipomas was recorded in any of the patients. No surgical intervention was performed as none of the patients displayed symptoms caused by the lipoma. CONCLUSION: In this study, we found a stronger association of corpus callosum hypoplasia with posteriorly situated curvilinear lipomas. Our results are in disagreement with previous studies, which suggested corpus callosum anomalies were more often associated with anteriorly situated tubulonodular lipomas. Pericallosal lipomas are benign, self-limiting or slow-growing lesions that generally remain asymptomatic. These lesions occur in the midline and surround critical neurovascular structures. Therefore, surgical intervention should be avoided in asymptomatic cases.