Frequency of SARS-COV-2 infection and COVID-19 vaccine uptake and protection among Syrian refugees : COVID-19 Vaccine among Syrian Refugees.

It is aimed to examine the frequency of COVID-19 disease, the rates of COVID-19 vaccination and the vaccine effectiveness (VE) among Syrian refugees. It is a retrospective cohort study. Syrian refugees aged 18 years and above registered to a family health center in Sultanbeyli district in Istanbul were included. Vaccine effectiveness were calculated for both Pfizer BioN-Tech and CoronaVac (Sinovac) vaccines. The data of 2586 Syrian people was evaluated in the study. The median age of the participants was 34.0 years (min:18.0; max: 90.0). Of the participants 58.4% (n = 1510) were female, 41.6% (n = 1076) were male. In our study of the refugees 15.7% had history of COVID-19 infection. Refugees having full vaccination with Biontech and Sinovac have a significantly lower COVID-19 infection rate than those without vaccination (HR = 8.687; p < 0.001). Adjusted VE for Biontech, Sinovac, and both were 89.2% (95.0% CI:83.3-93.1), 81.2% (95.0% CI:48.72-93.1) and 88.5% (95.0% CI:82.7-92.3), respectively. The results of the study highlight the importance of vaccinations against COVID-19 pandemic, since both vaccines were highly protective in refugees.

Breastfeeding Self-Efficacy, Personal Well-Being and Related Factors in Pregnant Women Living in a District of Istanbul.

In this study, we examined breastfeeding self-efficacy levels, well-being and sociodemographic factors in pregnant women. The population of this descriptive study consisted of women with a pregnancy of 27 weeks or more in the Sultanbeyli district of Istanbul, Türkiye. A questionnaire was administered via telephone calls to pregnant women aged 18 years and older. The first part of the questionnaire included questions regarding breastfeeding history and sociodemographic information. The second part included the Prenatal Breastfeeding Self-Efficacy Scale, and the last part included the Personal Well-Being Scale. Higher scale scores indicate higher levels of self-efficacy and well-being. In total, 385 women participated in the study. The median age of the pregnant women was 28.0 years (18.0-43.0). The median gestational week was 33.0 (27.0-42.0). Among women who had received breastfeeding counseling, those with a higher level of knowledge about breastfeeding had higher breastfeeding self-efficacy (p < 0.05). Women with better economic status also had higher well-being scores (p < 0.05). There was a positive correlation between well-being and breastfeeding self-efficacy approaching the statistical significance level (p = 0.052). It is important to consider factors that may be associated with women's well-being and self-efficacy.

Seasonal pattern of emergency department visits by children with asthma.

Background: It is important to understand the factors associated with seasonal asthma attacks among children so we can evaluate them appropriately. Aim: The study examined the seasonal variation of asthma-related emergency department visits by children in Istanbul. Methods: This descriptive study examined all paediatric patients with asthma who visited the paediatric emergency department of a tertiary hospital in Istanbul, Türkiye, between January 2017 and December 2022. Asthma diagnosis was based on physical examination and clinical history of the patients and asthma-related visits during winter, spring, summer, and autumn were considered repeated measurements. Data analysis was done using SPSS 25.0. Results: Visits by asthmatic children to the emergency department constituted 4.9% of all visits. Some 56.9% of the asthmatic children were male and 43.1% were female. Asthma-related emergency department visits were 10.4% in 2017 and 3.6% in 2022. Visits to paediatric emergency departments due to asthma decreased from 19 685 in 2017 to 7485 in 2022. Between 2017 and 2022, children aged 0-5 years represented the highest proportion of visits (64-72.8%). Asthmatic children aged 0-5 years and 6-11 years were admitted to the hospital mostly in January (13.5%, 13.5%) and December (12.8%, 14.0%). In the age group 12-18 years, the visits occurred mostly in January (11.9%) and March (11.2%). Conclusion: The frequency and number of asthma-related visits to the paediatric emergency department decreased over the 6-year period of this study. There were increases in visits in October, November, December, and January, and decreases in June, July and August.

Evaluation of the predictive value of total IgE and absolute eosinophil levels on allergy test positivity.

OBJECTIVE: Atopic diseases are the most common chronic conditions in childhood. The best treatment for allergic disease is possible with early diagnosis. The purpose of the study was to assess the predictive value of total immunoglobulin E (IgE) and eosinophil levels for allergy test positivity in patients diagnosed with asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). METHODS: Pediatric patients between 0 and 18 years old diagnosed with asthma, AR, AD, and FA were included in the study. Demographic characteristics of the patients, total IgE, eosinophil (absolute and %) values, specific igE (SPIGE), and skin prick test (SPT) results were recorded. RESULTS: The data of 2665 patients were evaluated in the study. Of the patients, 58.6% were male, whereas 41.4% were female. The median age of the children was significantly higher both in SPT-positive and SPIGE-positive patients (p<0.001). If the criteria positivity is accepted as total IgE value is ≥104.5 (for AD: 86.5, asthma: 116.5, AR: 120.5, FA: 42.5) and absolute eosinophil ≥500 and/or eosinophil (%) ≥5%; test positivity was higher for each disease and all patients (p<0.001). CONCLUSION: Total IgE and eosinophil levels can be used to identify atopy in patients with symptoms of AD, asthma, and AR. Total IgE and eosinophil values are suitable and easily obtainable parameters for better evaluation of health-care resources for the diagnosis and follow-up of atopic illnesses.

Retrospective evaluation of adverse reactions after subcutaneous allergen-specific immunotherapy in children with house dust mite allergy.

OBJECTIVE: Although it is accepted as an effective and safe treatment way, side effects can be observed as a result of subcutaneous immunotherapy (SCIT). In our study, it was aimed to evaluate the local and systemic reactions in children after SCIT and the factors that may be associated with these reactions. METHODS: Our study included 138 house dust mite allergic patients with asthma and/or allergic rhinitis who underwent SCIT in the Pediatric Allergy and Immunology Outpatient Clinic between November 2013 and April 2022. Sociodemographic, clinical, laboratory features, and development of adverse reactions after SCIT were analyzed from patient files. RESULTS: The median age of 138 patients was 9.0 years. About 56.5% (n=78) were male, 43.5% (n=60) were female. Of the patients, 55.1% (n=76) had asthma and allergic rhinitis. A total of 7366 SCIT injections were administered to all patients in our clinic. The total number of observed adverse reaction was 118. 50.7% of the patients (n=70) experienced at least one adverse reaction after SCIT. The rate of development of adverse reactions per injection was 1.6% (local: 1.0%, large local: 0.1%, systemic: 0.5%). CONCLUSION: Although serious systemic reactions and death were not observed in our patients; care should be taken in terms of the development of adverse reactions during SCIT in children.

The Effect of House Dust Sensitization on Skin Sebum and Moisture in Children with Allergic Respiratory Diseases.

This study aimed to investigate the levels of skin moisture and sebum in children with a house dust allergy without skin symptoms. This was a case-control study involving children, aged 0-18 years, who were being followed up for an allergic airway disease in a pediatric allergy clinic. Age, gender, hemogram parameters, and IgE values were evaluated. The skin moisture and sebum percentages of the patients and control group were measured by a non-invasive bioimpedance method using a portable digital skin moisture and sebum measurement device on the cubital fossa. The median value of the skin moisture percentage in the house dust mite allergy-positive patient group was significantly lower than that in the house dust mite allergy-negative patients and the control group (p < 0.001). The house dust mite allergy-positive patient group had the lowest skin sebum content. However, there was no statistical significance among the groups in terms of skin sebum percentage (p = 0.102). In the study, children with a house dust allergy were found to have lower levels of skin moisture and sebum. The regular use of moisturizers for children with a house dust allergy should be kept in mind as an effective solution to protect the skin barrier and reduce skin symptoms.

Evaluation of Neuropsychiatric Effects of Montelukast-Levocetirizine Combination Therapy in Children with Asthma and Allergic Rhinitis.

Drug-induced neuropsychiatric effects are important for disease management. We aim to evaluate the neuropsychiatric effects of montelukast-levocetirizine combination therapy in children. This descriptive study was conducted with children aged 2-5 years, diagnosed with asthma and allergic rhinitis, who began to receive montelukast and levocetirizine combination therapy. The respiratory and asthma control test for children (TRACK), Rhino Conjunctivitis Scoring System (RCSS), and common neuropsychiatric effects (irritable behavior, hallucinations, headaches, nightmares, sleep disorders, behavioral and mood disorder, restlessness, depression) were ascertained by the questionnaire applied before and 4 weeks after the treatment. Parents answered on behalf of their children. The most common finding before and after treatment was irritable behavior. While irritable behavior was observed in 82.4% (n = 56) of children before the treatment, this percentage was 63.2% (n = 43) after the treatment (p = 0.004). The percentage of children who developed at least one neuropsychiatric symptom after treatment was 22.1% (n = 15). There was no significant effect of age, gender, RCSS, TRACK, or allergy test positivity on the development of neuropsychiatric symptoms (p > 0.05). According to the results, at least one neuropsychiatric finding developed in approximately one in five children. Identifying risk factors will enable more careful treatment or consideration of alternative treatments for children at higher risk in the clinical follow-up period.

Prevalence and Associated Factors of Dental Caries in Syrian Immigrant Children Aged 6-12 Years.

Immigrant children are among the groups that are sensitive to problems related to dental health. The aim of this study was to examine the dental caries of Syrian immigrant children. The study is a descriptive and retrospective study. Its population consists of Syrian immigrant children aged 6-12 years who were screened for dental health in the year 2022 in Istanbul. DMF-T (permanent teeth) and dmf-t (milk teeth) indices were used, which are the (t-T) criteria obtained by dividing the sum of caries (d-D), caries extracted (m-M) and caries-filled (f-F) teeth by the number of people examined. Higher dmft and DMFT scores indicate worse dental health. Dental screening was performed on 549 Syrian immigrant children. In total, 27.2% (n = 149) were brushing their teeth once a day and 97.3% of the children (n = 534) had at least one decayed tooth. The dmft score for the 6-7 year age (6.45 ± 3.33) group was significantly higher than the 8-9 year (4.98 ± 2.78) and 10-12 year (3.22 ± 2.02) age groups (p < 0.001). In our study, the dental caries were seen at a very-high frequency among immigrant children and the habit of tooth brushing remains at a low level. Lower age was the relevant factor for dental caries in our study.

Evaluation of Physical Activity Level and Related Factors in Pregnancy During the COVID-19 Period.

Objectives: It was aimed to determine the level of physical activity and related factors in pregnant women. Methods: The study is a mixed methods study. The participants are women applied to the pregnancy outpatient clinic of a hospital. The level of physical activity was assessed with the Pregnancy Physical Activity Questionnaire. Sociodemographic questions and seven questions of the International Physical Activity Environment Module were asked. Besides, in-depth interviews were conducted with 14 women. Results: The study was conducted with 304 women. The median age was 29.0 (18.0-40.0) years. The mean total activity and sedentary activity scores were 195.8 ± 107.9 and 37.22 ± 31.08 MET-hours/week, respectively. Pregnant women were mostly involved in light-intensity and housework/caregiving activities. Most of the participants mentioned that they were less active than pre-pregnancy period. The most common reasons for being less active were weakness, fatigue, lack of time and complaints such as low back pain and nausea. Conclusion: More than half of the pregnant women mentioned that they were less active during pregnancy. Thus, interventions should be planned to increase physical activity level of pregnant women.

Adaptation and integration of the thinking healthy programme into pregnancy schools in Istanbul, Turkey.

BACKGROUND: Perinatal mental health is a major public health concern. In Turkey, public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery. METHODS: Following an expert-led adaptation process using the Bernal Framework, field testing was conducted on a group of women and facilitators followed by in-depth interviews (n:8) and group discussions (n = 13). Data were analysed using Thematic Framework Analysis. RESULTS: Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and online group classes. CONCLUSION: THP is transferable to the Turkish cultural and healthcare context. The THP-group version has the potential to add value to Turkey's existing perinatal healthcare programme.

Vaccine Uptake and COVID-19 Frequency in Pregnant Syrian Immigrant Women.

Immigrants have difficulties in the use of essential health services such as vaccinations. Vaccine uptake among pregnant immigrant women is very low. The aim of the study was to examine the vaccination status of pregnant immigrant women who received health services in an immigrant health center (IHC) affiliated to primary health care institutions. The research is a retrospective-designed cross-sectional type of study. The study sample consists of pregnant Syrian women who received health care from the strengthened IHC of a District Health Directorate in Istanbul between August 2020 and 2022. Age, trimesters, number of pregnancies, high-risk pregnancy status, vaccination dates and status against influenza, COVID-19 and tetanus, and vaccine types of COVID-19 were evaluated. The statistical significance level was determined as p < 0.05. None of the pregnant women had received the influenza vaccine. Of the women whose tetanus vaccine data were evaluated, 29.7% had received at least two doses of the tetanus vaccine. Of the pregnant women, 19.4% were vaccinated against COVID-19 with a minimum two doses and 4.2% had a COVID-19 infection during their pregnancy. None of the women with the COVID-19 infection were fully vaccinated against COVID-19. The vaccine uptake of pregnant immigrant women is very low. Public health interventions are needed to improve vaccination coverage among disadvantaged groups.

Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study.

BACKGROUND: Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention. METHODS: This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP - Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks' gestation through pregnancy schools within the University Hospital's catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders. RESULTS: Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. CONCLUSIONS: Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted. TRIAL REGISTRATION: The study was registered at Clinical Trails.gov ( NCT04819711 ) (Registration Date: 29/03/2021).

The changing face of abuse cases in a pediatric intensive care unit: A single-center experience.

BACKGROUND: Due to the increase in abuse and neglect cases in recent years, the purpose of this study was to assess child abuse and neglect of patients who were hospitalized and followed up in our pediatric intensive care unit (PICU). METHODS: A total of 34 abuse and neglect patients who were admitted to the PICU from August 2020 to March 2021 were included retrospectively in the study. Patients' clinical and demographic characteristics were obtained from our hospital's patient record system (HIS). Comorbidities and the mental status of the patients, affected systems, treatments, and outcomes were extracted. RESULTS: In this study, 44.1% (n: 15) of the patients were male and 55.9% (n: 19) were female. Physical neglect such as foreign body aspiration, malnutrition, electrocution, drowning, traffic accident, and body collision was detected in 14 (41.2%) patients. Emotional neglect (taking drugs, alcohol, or suicide) was found in 19 (55.9%) of our patients. Only 1 (2.9%) patient presented with physical abuse. CONCLUSIONS: Perception of neglect varies among different cultures. Any infant or child who is admitted to the PICU with a history that is not consistent, a history of delay in seeking medical attention, a previous history of abuse or suspected abuse, or the absence of the primary caretaker at the appearance of illness should signal possible abuse. Health-care professionals should give more attention to these patients to prevent the overlooking and recurrence of neglect and abuse cases due to the intense work tempo in the PICU.

Can charcoal hemoperfusion treatment be an option for pediatric MIS-C patients? A single-center experience in a tertiary pediatric intensive care unit.

INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a hyper-inflammatory disorder that develops following SARS-CoV-2 infection and has clinical signs that overlap with Kawasaki disease. Immunomodulatory treatments can be used in these patients. One of the alternative treatments reported in the literature is hemoperfusion therapy. In this study, we aim to evaluate our experience of charcoal hemoperfusion therapy in children admitted and followed up with a diagnosis of MIS-C at our Pediatric Intensive Care Unit (PICU). MATERIAL AND METHODS: We performed a retrospective evaluation of children diagnosed with MIS-C and children treated with charcoal hemoperfusion who are admitted to our PICU. RESULTS: Among 49 MIS-C patients, hemoperfusion therapy was performed on 14 patients. Duration of hospitalization, duration of invasive/non-invasive ventilation, VIS, OFI, PRISM 3 scores, and mortality rates were significantly higher in the charcoal hemoperfusion group before treatment. In patients who did not respond to conventional therapies, we observed a statistically significant decrease in the need for inotrope and invasive mechanical ventilation support and statistically significant improvements in clinical indicators after hemoperfusion therapy. DISCUSSION: In our study, we observed a significant clinical and laboratory improvement by charcoal hemoperfusion in our MIS-C patients who had a severe clinical course and multiple organ failure. CONCLUSION: In our opinion, this study is the first report regarding the use of charcoal hemoperfusion therapy in MIS-C patients, and the choice of charcoal hemoperfusion as an initial or rescue therapy is needed to be investigated in large patient groups both in children and adults who are diagnosed with COVID-19 and MIS-C.