INTRODUCTION: Healthcare-associated infections (HAIs) represent a significant source of morbidity and mortality in neonatal intensive care units (NICUs). During the neonatal period, risk factors include prematurity, an immature immune system, invasive procedures, and prolonged hospitalization. This study aimed to identify the causative agents and risk factors associated with HAIs.
METHODS: This study encompassed 297 patients who were hospitalized in the NICU and diagnosed with HAIs between January 1, 2020, and December 30, 2023. Demographic, clinical, and laboratory data were retrospectively analyzed.
RESULTS: According to the type of HAIs, bloodstream infection (BSI) accounted for 53% (n=158), central line-associated BSI (CLABSI) for 4.3% (n=13), urinary tract infection for 8.7% (n=26), ventilator-associated pneumonia (VAP) for 0.3% (n=1), bone and joint infection for 1% (n=3), and skin and soft tissue infection for 1.3% (n=4). The CLABSI and VAP rates were 5.45 and 1.67, respectively. The overall mortality rate was 3% (n=9). The most commonly isolated agents were Gram-positive bacteria (79.8%), Gram-negative bacteria (17.8%), and Candida spp. (2.4%). Statistically significant differences were observed in prematurity (p=0.010), birth weight (p<0.001), mode of delivery (p=0.010), postnatal days (p=0.012), duration of hospitalization (p=0.004), mechanical ventilation (p=0.009), operation (p=0.031), presence of total parenteral nutrition (p<0.001), and central venous catheter use (p<0.001) between the groups.
DISCUSSION AND CONCLUSION: Consistent with the existing literature, Gram-positive microorganisms were identified as the predominant causative agents of HAIs. However, the incidence of Gram-negative bacteria and Candida spp. increased in the presence of specific risk factors. Identifying causative agents and associated risk factors is crucial for mitigating HAIs in the NICU.

INTRODUCTION: Cesarean scar pregnancy (CSP) is a rare ectopic pregnancy implanted in a previous cesarean scar and is associated with risks of hemorrhage, uterine rupture, and infertility. Rising cesarean rates have increased its incidence, accounting for up to 6% of ectopic pregnancies. Diagnosis is made by transvaginal ultrasound, which typically shows an empty uterine cavity and a gestational sac at the anterior isthmus with thin myometrium. Treatment options include methotrexate, uterine artery embolization, hysteroscopic or laparoscopic excision, and curettage. No consensus standard exists; management should be individualized.
METHODS: We retrospectively analyzed 129 CSP patients treated between 2015 and 2025 at Zeynep Kamil Hospital, Istanbul. Inclusion required an ultrasound-confirmed diagnosis and complete hematologic data. Patients managed conservatively or with incomplete records were excluded. Treatment included primary curettage, methotrexate plus curettage, or laparoscopic repair. Curettage was ultrasound-guided using a Karman cannula. Hemoglobin and hematocrit levels were compared pre- and postoperatively, and transfusion needs were documented.
RESULTS: Of the 129 patients, 123 (95.4%) underwent curettage, 3 underwent methotrexate plus curettage, and 3 underwent laparoscopic repair. The mean hemoglobin drop was 0.8 g/dL (p<0.001), and the mean hematocrit decrease was 2.2% (p<0.001). Only 3 patients (2.3%) required transfusion. Subgroup analysis showed greater hemoglobin decline in patients with a gestational age ≥8 weeks and fetal cardiac activity. Compared with the literature reporting larger declines and higher transfusion rates, our outcomes were favorable.
DISCUSSION AND CONCLUSION: Ultrasound-guided therapeutic curettage is a safe, effective, and fertility-preserving first-line treatment for CSP. It achieved low blood loss and minimal transfusion requirements compared with prior reports. Despite the retrospective design and lack of long-term follow-up, our results support curettage as a reliable option in appropriately selected patients.

INTRODUCTION: To determine pain characteristics, pain intensity, and symptom changes during migraine attacks in premenstrual and menstrual women.
METHODS: This qualitative phenomenological study was conducted from April 1 to April 30, 2024, involving 21 women aged between 18 and 52 years who had been diagnosed with migraine. The participants presented to the neurology outpatient clinic of a training and research hospital with complaints of pain during their menstrual periods. Data were collected through individual in-depth interviews, which were audio recorded.
RESULTS: A total of 21 female patients with migraine participated in the study. The mean age of the participants was 30.90±7.1 years, the mean age at migraine onset was 19.19±3.49 years, and the mean duration of migraine pain was 11.95±7.16 hours. Migraine pain was described as unilateral or bilateral in 12 cases (57.14%). Pain frequency was 1–4 times per month in 12 participants (57.14%), pain duration was 1–4 hours in 9 participants (42.86%), 12 participants (57.14%) took medication within 30 minutes to 4 hours after pain onset, and 18 participants (85.71%) reported difficulty concentrating due to pain. Five main themes were identified: “characteristics of migraine pain,” “symptoms initiating a migraine attack,” “physical findings accompanying migraine,” “psychosocial findings accompanying migraine,” and “coping with migraine.”
DISCUSSION AND CONCLUSION: The findings emphasize the need for better management of perimenstrual migraine attacks in all menstruating women. Patients’ knowledge about the disease and its characteristics should be improved, and they should be informed that migraine is an incurable but controllable chronic disease and that its attacks can be prevented.

INTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly recognized in children with a normal body mass index (BMI), and its etiology is generally associated with metabolic, genetic, and environmental factors. Although childhood obesity is a well-known cause of MAFLD, the condition can also develop in non-obese children, often due to underlying metabolic disorders.
METHODS: This retrospective, cross-sectional study was conducted over a three-year period at a Pediatric Gastroenterology Clinic. Initially, 253 pediatric patients diagnosed with hepatic steatosis by abdominal ultrasound were screened. After excluding overweight children and children with obesity, 20 non-obese patients with hepatic steatosis were included in the final analysis. The study focused on identifying secondary causes of hepatic steatosis in this cohort by collecting demographic, clinical, biochemical, and metabolic data.
RESULTS: Of the 20 non-obese children evaluated by a pediatric metabolic specialist, two were diagnosed with a metabolic disease. Significant biochemical markers, such as elevated serum triglyceride, ALT, and AST levels, prompted further metabolic investigations, enabling early diagnosis and treatment.
DISCUSSION AND CONCLUSION: This study highlights the critical role of metabolic and genetic screening in the evaluation of hepatic steatosis in non-obese children, particularly during infancy and early childhood. Early identification of underlying metabolic disorders may enable appropriate intervention and help prevent long-term complications. Non-obese pediatric MAFLD requires careful evaluation and targeted metabolic testing to achieve timely treatment and improved outcomes.

INTRODUCTION: This study aimed to determine the prevalence of postpartum depression (PPD) in mothers after normal vaginal delivery (NVD) and to identify associated risk factors.
METHODS: Two hundred post-NVD mothers participated in this cross-sectional study. The Edinburgh Postnatal Depression Scale (EPDS; cutoff ≥13) and sociodemographic information were used. The chi-square test or Fisher’s exact test was applied to assess categorical variables, while the Mann–Whitney U test and independent samples t-test were used to compare continuous variables. Logistic regression was performed to identify predictors of postpartum depression; p<0.05 was considered statistically significant.
RESULTS: The prevalence of PPD was 15% (n=30). Logistic regression revealed a significantly higher risk of PPD among mothers with comorbidities (OR=21.0), unplanned pregnancies (OR=83.5), smoking (OR=27.6), lack of a companion (OR=35.8), obstetric complications (OR=31.7), and formula use (OR=17.8) (all p<0.001).
DISCUSSION AND CONCLUSION: PPD is a significant public health concern among mothers after NVD and is strongly associated with specific risk factors. Routine PPD screening and targeted support are crucial for mothers with these risk factors.

INTRODUCTION: Congenital lung malformations (CLM)—including congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (PS), congenital lobar overinflation (CLO), bronchogenic cyst (BC), and isolated congenital bronchial atresia (BA)—have shown increased prenatal diagnosis rates with the more effective use of antenatal imaging methods such as ultrasound (US) and magnetic resonance imaging (MRI). However, the optimal management of these lesions remains unclear. We aimed to investigate the diagnostic processes and management approaches in patients with CLM diagnosed at our clinic.
METHODS: This retrospective, cross-sectional study included 46 patients aged 0–18 years who were diagnosed with CLM between April 2018 and March 2025. Data on the time and method of diagnosis, presenting complaints, whether surgery was performed, and imaging modalities were recorded.
RESULTS: The median age of the patients was 60 months (IQR 62). In the prenatal diagnosis group, the median age at first presentation was 38 months (min–max=1–156) for asymptomatic patients and 6 months (min–max=0.2–132) for symptomatic patients. Sixty-three percent of cases were diagnosed prenatally, and 37% were diagnosed postnatally. Sixty-nine percent (20/29) of prenatally diagnosed cases were asymptomatic at birth. Most radiological lesions were unilobar and unilateral and did not show mediastinal shift. The most commonly affected lobe was the right lower lobe. CPAM (43.5%) was the most common diagnosis, followed by PS (17.8%). Advanced imaging, in addition to ultrasound and chest X-ray, was performed in 20% of the CPAM group and 37.5% of the PS group.
DISCUSSION AND CONCLUSION: The majority of our CLM cases were diagnosed prenatally. In prenatally diagnosed cases that are asymptomatic postnatally, the types and timing of diagnostic tests vary on a case-by-case basis, and the timing of surgical treatment remains uncertain. We believe that further prospective studies and stronger scientific evidence are needed in this field and that management decisions should be based on an individualized benefit–risk assessment.

INTRODUCTION: Marfan syndrome is more than a genetic diagnosis; it poses a significant cardiovascular risk, with critical structures such as the aortic root potentially affected before clinical symptoms appear. This study evaluated the echocardiographic profiles and characteristic clinical features of genetically confirmed pediatric Marfan syndrome patients in a tertiary center.
METHODS: Pediatric patients with confirmed Marfan syndrome who underwent transthoracic echocardiography between October 2018 and May 2025 were retrospectively reviewed. Aortic dimensions and valvular pathologies were assessed according to American Society of Echocardiography criteria. Clinical data, family history, and anthropometric features were also documented.
RESULTS: Ten patients (8 females, 2 males; mean age 12.4±5.6 years) were included. Aortic root dilatation was observed in two patients, mitral valve prolapse in nine patients, and mitral regurgitation in six patients based on their most recent outpatient follow-up evaluations. Four patients received medical therapy; however, treatment adherence was inconsistent and outcomes varied. Most patients exhibited tall stature and had a positive family history. No cardiovascular surgeries were performed during the follow-up period.
DISCUSSION AND CONCLUSION: In pediatric Marfan syndrome, severe cardiovascular complications may remain clinically silent until advanced stages. Our findings indicate that even in genetically confirmed cases, early echocardiographic evaluation frequently detects valvular abnormalities and aortic involvement before clinical deterioration. These results underscore the critical importance of early diagnosis and regular echocardiographic surveillance to optimize follow-up and prevent delayed recognition of potentially fatal complications.

INTRODUCTION: Azoospermia, the most severe form of male infertility, is characterized by the absence of sperm in the ejaculate as a result of spermatogenesis failure. The aim of this study was to identify genetic anomalies associated with Y chromosome microdeletions and sex chromosomal aneuploidy.
METHODS: A total of 134 azoospermic patients were included in the study. Following a general clinical evaluation and laboratory testing, karyotype analysis and Y chromosome microdeletion screening were performed.
RESULTS: The study included 134 infertile males with azoospermia. The overall rate of cytogenetic anomalies was 9.7%. Chromosomal abnormalities were detected in 7 of 134 cases (5.2%). The most common genetic abnormality was 47,XXY (Klinefelter syndrome), with a prevalence of 3.7%. Y chromosome microdeletions were identified in 5 patients (3.7%).
DISCUSSION AND CONCLUSION: This study highlights the significant role of genetic factors, particularly chromosomal abnormalities and Y chromosome microdeletions, in the etiology of azoospermia. In addition, Y chromosome microdeletions were identified in a notable subset of cases. These findings emphasize the importance of comprehensive genetic screening, including both karyotype analysis and Y chromosome microdeletion testing, in the diagnostic evaluation of azoospermic men to guide clinical management and genetic counseling.

Gilbert’s syndrome (GS) is a benign disorder that causes chronic jaundice and unconjugated hyperbilirubinemia. When it occurs in conjunction with hereditary spherocytosis (HS), it can lead to an elevated risk of severe hyperbilirubinemia and associated complications. However, acute pancreatitis is a rare complication in this setting. This study explores complex etiologies in severe hyperbilirubinemia and pancreatitis through two acute pancreatitis cases. One case involves a patient with HS and hepatitis B, and the other is of GS with HS contributing to the condition. Two pediatric patients with severe hyperbilirubinemia and acute pancreatitis, managed at different time points in our pediatric gastroenterology clinic, were presented. GS in one case and hepatitis B infection in the other were considered contributing factors but did not fully explain the disease’s severity. A systematic review of clinical, laboratory, and imaging findings identified hereditary spherocytosis as the common underlying condition. A 16-year-old boy with consanguineous parents presented with recurrent abdominal pain and jaundice. Laboratory and imaging findings indicated acute pancreatitis due to gallstones, extreme hyperbilirubinemia, and HS with GS. Genetic testing confirmed GS (UGT1A polymorphism). ERCP relieved the obstruction, and the patient was referred for cholecystectomy and splenectomy. The other boy, a 14-year-old with chronic hepatitis B, presented with acute abdominal pain. Imaging revealed gallstones, splenomegaly, and acute pancreatitis. Laboratory findings suggested HS, confirmed by osmotic fragility testing. MRCP excluded bile duct obstruction. Following stabilization, laparotomic cholecystectomy and splenectomy were performed without complications. We present two pediatric cases with distinct etiologies who developed severe hyperbilirubinemia and acute pancreatitis in the presence of hereditary spherocytosis. These cases highlight the complex interplay of underlying conditions contributing to disease severity. By adding to the limited literature on this association, we aim to enhance understanding of the diverse etiologies of severe hyperbilirubinemia and acute pancreatitis.

Tracheoesophageal fistula (TEF) is an extremely rare congenital anomaly in newborns. In this case, we emphasize the role of contrast tube esophagography in diagnosing TEF and highlight how intraoperative guidewire placement facilitated fistula localization during surgical exploration. A female newborn was admitted to the neonatal intensive care unit due to respiratory distress and wheezing. Her condition deteriorated on day 4, necessitating endotracheal intubation and mechanical ventilation. Despite treatment for congenital pneumonia, intermittent respiratory distress persisted. On day 23, TEF was confirmed via contrast esophagography. At 25 days of age, the patient underwent rigid esophagoscopy, which confirmed the presence of TEF. A guidewire was advanced through the fistula to aid in its localization, allowing for precise surgical repair. This case underscores the challenges associated with diagnosing H-type TEF in neonates and highlights the crucial role of contrast esophagography and intraoperative guidewire placement in optimizing surgical management.