Postnatal surgery for myelomeningocele in neonates: neurodevelopmental outcomes.

BACKGROUND: The study aims to evaluate the neurodevelopmental outcomes of neonates with myelomeningocele (MMC) operated in the postnatal period. METHODS: This is a prospective follow-up study in a tertiary neonatal intensive care unit. Neurodevelopmental outcomes of term neonates operated for MMC and healthy term newborns were compared with the Bayley Scales of Infant and Toddler Development -Third Edition (BSID III) at 12-18 months. RESULTS: A total of 57 cases were included in the study (patient group = 27; control group = 30). Demographic data between the groups were similar. Cognitive, linguistic, and motor composite scores of the patient group were lower than those of the control group (p < 0.001). In the patient group, those who underwent ventriculoperitoneal shunt had lower cognitive, language and motor scores than those without shunt (p < 0.05). The cognitive, linguistic, and motor composite scores in the patient group who underwent surgery before 72 h were better than those who underwent surgery after 72 h. DISCUSSION: In our study, it was found that the neurodevelopmental prognosis of MMC cases requiring ventriculoperitoneal shunt in the postnatal period was significantly worse than those without shunt. It is the first study in which the neurodevelopment of patients with MMC who were operated in the postnatal period was evaluated with BSID III evaluated and delays in all areas were shown in cases with MMC compared to normal cases. Better neurodevelopmental outcomes in patients operated in the first 72 h suggest that early surgery will improve neurodevelopmental outcomes in patients with MMC.

Characteristics and Results of Hospital Admission Caused by Influenza Virus Infections in Children under 5 Years Old.

AIMS: The influenza virus is an infectious disease with acute respiratory tract infections, caused secondary bacterial infections and death. In this study, we aimed to determine which predictors were associated with the need for high-flow nasal cannula oxygen therapy (HFNC) and transition to intensive care for influenza virus and also to compare single viral pathogens with multiple ones. METHODS: Inpatients under the age of 5 with influenza virus-related respiratory tract infections between November 2015 and March 2019 were included in the study. Demographic features, comorbidities, symptoms, secondary bacterial infection, need for HFNC and pediatric intensive care unit and respiratory support system, length of hospital stay, polymerase chain reaction tests were recorded. RESULTS: A total of 93 patients were included in the study. It was determined that 53.8% of the cases were male and 84.9% were under the age of 2. Comorbidities were present in 50.5% of the cases. Secondary bacterial pneumonia developed in 56.9% of the cases. Patients with secondary bacterial pneumonia had higher PICU need, HFNC need and hospital stay (p = 0.014, p ≤ 0.001 and p ≤ 0.001, respectively). Patients with comorbidity had longer hospital stays and a higher need for HFNC (p ≤ 0.001 and p = 0.001, respectively). CONCLUSIONS: In this study, it was determined that especially comorbidity and secondary bacterial infection aggravated the clinical treatment of hospitalized patients. Therefore, it was concluded that patients with comorbidity should be followed closely and secondary bacterial pneumonia should be recognized and treated early.

The importance of microalbuminuria in predicting patient outcome in a PICU.

OBJECTIVE: To evaluate the prognostic significance of microalbuminuria in critically ill children. DESIGN: Prospective study. SETTING: PICU of a teaching hospital. PATIENTS: Admitted critically ill children. INTERVENTIONS: The urine albumin-creatinine ratio was measured at admission and at 24 hours. Pediatric Risk of Mortality, Pediatric Index of Mortality II, Pediatric Logistic Organ Dysfunction, and Inotrope Score were calculated. MEASUREMENTS AND MAIN RESULTS: In total, 102 patients (median age, 19 mo) were included in the study, among whom were 30 mortalities. Microalbuminuria was identified in 62 patients (64%). The patients were classified into three groups: patients with sepsis, patients with noninfectious systemic inflammatory response syndrome, and patients without systemic inflammatory response syndrome. The highest clinical scores, albumin-creatinine ratio levels, mortality rate, and duration of mechanical ventilation were found in the sepsis group, and the lowest values were seen in patients without systemic inflammatory response syndrome (p < 0.05). Significant correlations were observed between the albumin-creatinine ratio levels and the clinical scores (p < 0.05). The receiver operating characteristics curve analysis showed that the areas under the curves were 0.818 and 0.781, respectively, for albumin-creatinine ratio measured at admission and at 24 hours to identify PICU mortality. At a cutoff value of 34.2 mg/g, albumin-creatinine ratio measured at admission may be able to discriminate between patients a with sensitivity of 63.3%, specificity of 93.3%, positive predictive value of 95%, and negative predictive value of 56%. CONCLUSIONS: Microalbuminuria is a simple, inexpensive, and useful tool for predicting mortality and morbidity in critically ill children in the PICU.

Mental and Psychosomatic Effects of the Coronavirus Disease 2019 Pandemic on Adolescents: A Validation Study.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has had detrimental impacts on both physical and mental health worldwide. In addition to the behavioral effects, it has caused a range of psychological problems such as depression, anxiety, sleep disorders, and anger. Fear and stress have been particularly prevalent in individuals. This study aims to assess the psychometric properties of the Scale for the Evaluation of Mental and Psychosomatic Effects of the COVID-19 Pandemic (COVID-19 PRPEDS) on adolescents and explore the pandemic's psychosomatic effects. MATERIALS AND METHODS: A total of 503 adolescents between the ages of 14 and 18 years who continue their high school education constituted the study population. The COVID-19 PRPEDS comprising 18 items and 2 subscales (Mental Effects, Psychosomatic Effects), was used in adolescents. The forms were delivered to the students via the Internet, and in addition to the scale, the age and sex of the adolescents were recorded. RESULTS: A majority of the participants (96.6%, n = 486) had knowledge about COVID-19, 93.8% (n = 472) could differentiate COVID-19 from other diseases, 96.6% (n = 486) were able to explain the transmission ways of COVID-19 and 96% (n = 483) took the necessary precautions to protect themselves from COVID-19. The COVID-19 PRPEDS scores of males were higher than females. The study validation index was above 0.9, which is considered to be acceptable for adolescents. CONCLUSIONS: Like in the other pandemics, adolescents experienced serious mental health problems during the COVID-19 pandemic. In addition to its psychosomatic effects, the mental issues related to the pandemic were more common in male adolescents. Cite this article as: Ince G, Üzüm Ö, Eliaçik K, Kanik A, Emir B, Helvaci M. Mental and psychosomatic effects of the coronavirus disease 2019 pandemic on adolescents: A validation study. Turk Arch Pediatr. 2024;59(1):60-69.

Bodily sensations and quality of life in adolescents with non-cardiac chest pain: a comparative study for the undetermined part of a frequent health problem.

BACKGROUND: Chest pain in adolescents represents a considerable burden for health services and is rarely associated with cardiac disease. Since chest pain could be related to psychosocial factors there is a need for exploring the relationships among stressful situations, drug consumption, suicidal behaviors, accompanying bodily symptoms and health-related quality of life in adolescents with non-cardiac chest pain. METHODS: In this study, we assessed these determinants in 108 adolescents with non-cardiac chest pain (NCCP) and a control group of 77 patients using a structured interview applied to the patients presented to the cardiology outpatient clinics of Tepecik Training and Research Hospital, Izmir, Türkiye, between 30 October 2018 and 30 June 2019. After the interview, the adolescents were given a self-administered pediatric quality of life inventory and the body sensations questionnaire for assessing aspects of fear. RESULTS: Adolescents with NCCP expressed more panic associated bodily symptoms and reported worse subjective physical, academic, and emotional functioning in addition to more suicidal ideation. CONCLUSIONS: NCCP could be accepted as a warning sign of an underlying psychosocial problem and requires a more interdisciplinary collaborative care by pediatricians, psychologists, and psychiatrists.

A novel OCRL1 gene mutation in a Turkish child with Lowe syndrome.

Oculocerebrorenal syndrome, also known as Lowe syndrome, is an X-linked recessive disorder that predominantly affects males and is characterized by growth and mental retardation, congenital cataract and renal Fanconi syndrome. OCRL1 is the gene responsible for Lowe syndrome and encodes an inositol polyphosphate-5-phosphatase. We present an 11-year-old boy with Lowe syndrome, who had a de novo frameshift mutation in exon 22 that resulted in amino acid substitution and premature codon termination at position 788. This is a new mutation involving the OCRL1 gene in a patient with Lowe syndrome of Turkish origin and expands the mutation spectrum in this disorder.

Gender differences in severity of sickle cell diseases in non-smokers.

OBJECTIVE: To find out gender differences in severity of sickle cell diseases (SCDs) in non-smokers. METHODS: Three groups of SCDs patients on the basis of red blood cell (RBC) transfusions were included. Less than 10 units in their lives were kept in Group-1, Ten units of higher in Group-2 and 50 units or higher as the Third Group. Patients with a history of using one pack of cigarettes -year or above were excluded. RESULTS: The study included 269 patients. Mean ages of the groups were similar (28.4, 28.5, and 28.9 years, respectively). Prevalences of cases without any RBC transfusion in their lives were 7.2% and 3.7% in females and males, respectively (p<0.05). Prevalences of cases without any painful crisis were 13.8% and 6.0% in females and males, respectively (p<0.001). There was progressive increase according to mean painful crises, clubbing, chronic obstructive pulmonary disease (COPD), leg ulcers, stroke, chronic renal disease (CRD), pulmonary hypertension, and male ratio from the first towards the third groups (p<0.05, nearly for all). Mean ages of mortal cases were 29.1 and 26.2 years in females and males, respectively (p>0.05). CONCLUSION: The higher painful crises per year, digital clubbing, COPD, leg ulcers, stroke, CRD, pulmonary hypertension, and male ratio of the third group, lower male ratio of patients without any RBC transfusion, lower male ratio of patients without any painful crisis, lower mean ages of male SCDs patients with mortality, and longer overall survival of females in the world could not be explained by well known strong atherosclerotic effects of smoking alone, instead it may be explained by the dominant role of male sex in life.

Investigating the Potential Connection Between Cyberchondria and Vaccine Hesitancy in High School Students.

BACKGROUND: Internet use, which provides the opportunity to access information from anywhere, and anytime, is increasing among adolescents and young adults. In studies examining the effect of technology use in adults, it has been observed that there is a relationship between cyberchondria and vaccine hesitancy. This study aimed to uncover the potential relationship between cyberchondria and vaccine hesitancy in adolescents and to obtain data for combating anti-vaccination in this age group. MATERIALS AND METHODS: A total of 2.353 high school students were enrolled within the scope of this research. The forms were delivered to the students online and 531 volunteers participated in the survey. The Cyberchondria Severity Scale and Vaccine Hesitancy Scale were used to evaluate the details of the relationship between cyberchondria and vaccine hesitancy levels in adolescents. RESULTS: The compulsion subscales of the Cyberchondria Severity Scale in males and vaccine repugnance subscales of the Vaccine Hesitancy Scale in females were statistically significantly higher. Cyberchondria and vaccine hesitancy have a strong relationship with each other except benefits and protective value of vaccines subscale of vaccine hesitancy. CONCLUSION: Health policymakers should be aware of this relationship and there is a need to develop novel online intervention programs for combating anti-vaccination, particularly among cyberchondriac adolescents who have relatively high vaccination hesitancy, particularly during the pandemic.

White coat hypertension may be an initial sign of the metabolic syndrome.

AIM: to understand the role and significance of WCH in definition of the metabolic syndrome. METHODS: the study was performed in the Internal Medicine Polyclinic of the Dumlupinar University between August 2005 and March 2007. We took consecutive patients at and above the age of 20 years. Their medical histories including smoking habit, DM, dyslipidemia, and already used medications were learnt, and a routine check up procedure including fasting plasma glucose (FPG), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and an electrocardiography was performed. Comparison of proportions was used as the method of statistical analysis. RESULTS: the study included 1,068 cases. Prevalences of excess weight increased from the third (28.7%) up to the seventh decades (87.0%), gradually (p<0.05 nearly in all steps), and then decreased in the eighth (78.5%, p<0.05) decade of life. The most significant increase was seen during the passage from the third to the fourth decades (28.7% versus 63.6%, p<0.001) with a similar fashion to smoking. Hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired glucose tolerance (IGT), and WCH had a similar fashion with excess weight by increasing until the seventh decade and decreasing afterwards (p<0.05 nearly in all steps). Whereas hypertension (HT), type 2 diabetes mellitus (DM), and coronary heart disease (CHD) always increased without any decrease by decades (p<0.05 nearly in all steps), indicating their irreversible natures. CONCLUSION: WCH may be an initial sign of the systemic atherosclerotic process that can be detected easily and prevented by a trend towards weight loss.

Understanding Vaccine Hesitancy: Social Isolation in Relation to Social Media Addiction and COVID-19 Anxiety.

BACKGROUND: Despite significant advancements in immunization over the last century, vaccine hesitancy is a major threat to world health. Health-related information available from a variety of sources, including new media such as social media platforms, can encourage vaccine hesitancy. The aim of this study is to determine the level of vaccine hesitation among adults, specifically their belief in the advantages of vaccination and their perceptions of vaccine-related dangers in relation to social media addiction and coronavirus disease 2019 (COVID-19) anxiety. MATERIALS AND METHODS: Between December 2021 and January 2022, 454 adults participated in an online cross-sectional survey consisting of the social media use disorder scale, the vaccine hesitancy scale, and the coronavirus anxiety scale. RESULTS: The results of the study revealed a strong correlation between social media addiction, vaccine hesitation, and COVID-19 anxiety. CONCLUSION: Given the potential for misinformation to spread through social media, especially in a situation like a pandemic, the conscious use of social media should be emphasized and anti-addiction measures are required. Novel programs including online interventions should be developed to promote vaccination among social media addicts who have relatively high vaccination hesitancy.

Comparison of clinically related factors and treatment approaches in patients with acute bronchiolitis.

AIM: Acute bronchiolitis is a lower respiratory tract infection caused by viral agents in children aged under two years. Treatment includes hydration, oxygen, nebulized salbutamol, and intravenous steroids. This study aimed to determine the clinically related factors, the effect of viral agents on the clinical picture, and the efficacy of treatment methods in patients admitted with acute bronchiolitis. MATERIAL AND METHODS: Patients aged under two years of age who were hospitalized with a diagnosis of moderate/severe acute bronchiolitis between March 2015 and March 2019 were included in the study. Demographic data, hospitalization time, body temperature, presence of congenital heart disease, history of atopy, acute-phase reactants, mean platelet volume values, and respiratory virus panel results were recorded. The treatment modalities, length of hospitalization, intensive care hospitalization, and high-flow nasal cannula oxygen therapy (HFNC) were recorded. RESULTS: Four hundred twenty-two patients were included in the study. The duration of hospitalization was found to be significantly longer in patients aged under one year and in patients with acyanotic congenital heart disease. A single viral agent was detected in 69 (51.9%) patients. Rhinovirus was detected in 70 patients and RSV was detected in 37. The duration of hospitalization was found to be significantly shorter in patients who received only oxygen and/or intravenous fluid treatment compared with those who received nebulized salbutamol and/or intravenous steroids. In addition, and there was no significant difference between the groups in terms of HFNC and hospitalization in the intensive care unit. CONCLUSION: Rhinovirus was the most common cause of acute bronchiolitis in our study. It was observed that congenital heart disease prolonged the length of hospitalization. In the treatment approaches, it was observed that hydration and oxygen therapy were sufficient treatment methods for the patients, in accordance with the recommendations of the American Academy of Pediatrics, and giving nebulized therapy prolonged the hospitalization period due to the treatment discontinuation steps.

[Hepatitis E virus seropositivity in hemodialysis patients in Hatay province, Turkey]. / Hatay'da hemodiyaliz tedavisi alan hastalarda hepatit e virus seropozitifligi.

Hepatitis E virus (HEV) which is mainly transmitted through faecal-oral route, can also be transmitted via parenteral and vertical route. Recent studies suggest zoonotic nature of the virus. The last studies done in Turkey indicate increasing frequency of HEV infection. This study was conducted to determine the rate of anti-HEV seropositivity among patients with terminal stage renal failure undergoing hemodialysis. A total of 92 patients (54 male, 38 female; age range: 22-71 years, mean age: 55 +/- 11 years) who had undergone hemodialysis for a mean period of 66 +/- 18 months, were included to the study. HEV antibodies were analyzed using anti-HEV IgG enzyme immunoassay (ELISA, Dia.Pro Diagnostic Bioprobes, Italy). In order to study the relationship of anti-HEV positivity between hepatitis C virus and hepatitis B virus infections, anti-HCV antibody and HBsAg were also considered. Mean age, duration of hemodialysis, platelet, serum albumin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, blood transfusion history were the other evaluated parameters. Anti-HEV IgG positivity was detected in 19 (20.6%) patients, while 7 (7.6%) had anti-HCV positivity and 4 (4.3%) had HBsAg positivity. No statistically significant relation was determined between anti-HEV IgG positive and negative patients in terms of hemodialysis duration, blood transfusion, other laboratory findings and anti-HCV and HBsAg positivity (p > 0.05). While the anti-HEV seropositivity rate (20.6%) determined in this study was higher than the rates determined in the same group of patients in the western part of the country (10-16%), the rate was similar to the rates reported from the southeastern part (23%) of Turkey. It can be concluded that screening of patients before or during hemodialysis in terms of anti-HEV antibodies, seems to be of crucial importance in order to establish necessary precautions to prevent parenteral and/or nosocomial transmission of HEV.

Protective effects of N-acetylcysteine on cyclosporine-A-induced nephrotoxicity.

OBJECTIVES: Cyclosporine A (CsA) is used for the treatment of autoimmune and inflammatory disorders. However, CsA-induced nephrotoxicity remains an important clinical problem, and oxidative stress has been implicated as a possible responsible mechanism. We assessed the protective ability of N-acetylcysteine (NAC), an antioxidant, against CsA-induced nephrotoxicity. MATERIALS AND METHODS: Wistar albino rats were randomly assigned into four groups. Group 1 rats were treated with sodium chloride as control, group 2 with CsA, group 3 with CsA and NAC, and group 4 with NAC alone. Animals were sacrificed and blood samples were analyzed for blood urea nitrogen (BUN), serum creatinine (Cr), malondialdehyde (MDA) and nitric oxide (NO) levels, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Kidney sections were analyzed for MDA and NO levels and SOD and GSH-Px activities, as well as histopathological changes. RESULTS: Overall, the treatment of rats with CsA alone produced significant increases in NO and MDA levels and significant decreases in SOD and GSH-Px activities in serum and renal samples. Morphological changes, including tubular epithelial atrophy, vacuolizations, and cellular desquamations, were clearly observed in the rats treated with CsA alone. Concurrent NAC administration with CsA improved renal function, as indicated by lower BUN and Cr values. Moreover, NAC significantly reduced MAD and NO levels and increased SOD and GSH-Px activities in serum and renal tissue, as well as provided a histologically proven protection against CsA-induced nephrotoxicity. CONCLUSION: These results indicate that NAC produces a protective mechanism against CsA-induced nephrotoxicity and suggest a role for oxidative stress in pathogenesis.

Ocular surface disease index for the diagnosis of dry eye syndrome.

PURPOSE: Evaluation of ocular surface disease index (OSDI) questionnaire for the diagnosis of dry eye syndrome. METHODS: Sixty-eight patients admitted to the Ophthalmology Polyclinic of the Dumlupinar University between December 2005 and April 2006 were randomly studied. The OSDI questionnaire was performed before, and the Schirmer and tear film breakup time (TBUT) tests were performed after the routine ophthalmologic examination. RESULTS: There was a significant inverse correlation between the OSDI and TBUT test scores, but no correlation between the Schirmer test scores and OSDI (r = -.296, p = .014, r = -.182, p = .138, respectively). Although there was a significant difference between the low and high OSDI having cases according to the TBUT test scores (p = .043), there was not according to the Schirmer test scores. CONCLUSIONS: The OSDI is a standardized instrument to evaluate symptoms, and can easily be performed and used to support the diagnosis of dry eye syndrome.

Clinical presentation and laboratory findings of organic phosphorus poisoning.

This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5+/-14.1 y (range, 14-80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9+/-16.1 h (range, 1-96 h); mean Glasgow Coma Scale score was 10.2+/-2.9 (range, 3-15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, OPs especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.

The evaluation of burnout and job satisfaction levels in residents of pediatrics.

AIM: The aim of the study was to examine the level of job-related burnout and the level of job satisfaction among residents of pediatrics. MATERIAL AND METHODS: A total of 102 residents of pediatrics who were trained in two Ministry of Health teaching and research hospitals and in two university hospitals in Izmir were included in the study. Demographic data (age, sex), lifestyle (living with parents or not, marital status, number of children) and professional characteristics (total time spent in profession, time spent in residency, number of night shifts per month, institution type: teaching hospital/university) were collected. Maslach Burnout Inventory (subscales: emotional exhaustion, desensitization, personal accomplishment) and Minnesota Satisfaction Questionnaire were used. RESULTS: High levels of emotional exhaustion and desensitization, and low levels of personal accomplishment and job satisfaction were found in residents of pediatrics. Low levels of emotional exhaustion in teaching and research hospitals and low levels of desensitization in university hospitals were determined (p<0.05). We found a positive correlation between age and job satisfaction levels and a negative correlation between age and emotional exhaustion levels (p<0.05). There were negative correlations between the length of time in education and desensitization and between the number of night shifts per month and desensitization (p<0.05). CONCLUSIONS: In residents of pediatrics, there is a high-level burnout and low-level of job satisfaction. Emotional exhaustion is more common in teaching and research hospitals and desensitization is more common in universities. Younger age, lower seniority, and the higher number of work-shift increases the burnout.

Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease.

OBJECTIVE: To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. METHODS: The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age- and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). RESULTS: Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289 , P = 0.025 ). Low levels of Hb seem to affect the femoral cartilage thickness. CONCLUSION: These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

Mortal quintet of sickle cell diseases.

BACKGROUND: Sickle cell diseases (SCDs) are chronic inflammatory processes on capillary level. We tried to understand some possible correlations between stroke and severity of SCDs. METHODS: All patients with SCDs were taken into the study. RESULTS: The study included 343 patients (174 males and 169 females). There were 30 cases (8.7%) with stroke. The mean ages were similar in both groups (32.5 versus 29.1 years in the stroke group and other, respectively, P>0.05). The female ratios were similar in both groups, too (43.3% versus 49.8%, respectively, P>0.05). Prevalences of associated thalassemia minors were also similar in them (73.3% versus 65.1%, respectively, P>0.05). Smoking was higher among the stroke cases, significantly (26.6% versus 13.0%, P<0.05). Mean white blood cell count, hematocrit value, and mean platelet count of the peripheric blood were similar in both groups (P>0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, chronic renal disease, rheumatic heart disease, avascular necrosis of bones, cirrhosis, and mortality were all higher in the stroke group, the differences were only significant for acute chest syndrome (ACS), digital clubbing, and leg ulcers (P<0.05 for all), probably due to the small sample size of the stroke group. CONCLUSION: SCDs and smoking are chronic destructive processes on endothelium, and both terminate with early organ failures in life. Probably smoking, digital clubbing, leg ulcers, ACS, and stroke are mortal quintet of the SCDs that may indicate shortened survival in such patients.