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Activated carbon from agro-industrial waste, namely tea twigs derived from the processing of Camellia Sinensis branches, using a potassium hydroxide activator for CO2 adsorption has been conducted in this study. Various carbonization temperatures (4000C and 5000C) and heating times of 1 h and 3 h were used in this study. The concentration of potassium hydroxide (40 % and 60 %) and the ratios of activator solutions to carbon precursor made from pyrolysis of tea twigs (2:1 and 4:1) were varied for the chemical activation process. The effectiveness results of the obtained activated carbon were characterized through using Brunauer-Emmett-Teller analyzer and Temperature Programme Desorption-CO2 to determine the surface area and capacity maximum of CO2 adsorption. The optimum condition for the synthesis of activated carbon that produces high surface area was obtained at sample CCS 400/1 A2B1 where biochar carbonized at temperature of 400 °C kept for 1 h with a ratio of activator solution and precursor 4:1 using KOH concentration of 40 %. The highest surface area was obtained 1403 m2 g−1 with pore volume 0.9 m2 g−1 and pore size 1.11 nm and proved the presence of microporous areas in produced activated carbon. The maximum CO2 adsorption capacity obtained in this study was 5.1573 mmol g−1. This result could be related to the higher amount of microporous present in the activated carbon that facilitates the access of CO2 to the active sites at the pores of activated carbon.

Improving the quality of syngas from fine coal waste using the sorption-enhanced gasification process is a novel technology in the production of H2. The effect of CaO on CO2 absorption and H2 increase in the steam fine coal gasification process was determined in a fixed bed gasifier. The steam gasification process took place at 650 °C using bentonite and CaO as catalysts and absorbents. Steam increased the H2 concentration in the syngas to 58 vol%. In-situ CO2 absorption is more effective with the addition of CaO. The maximum percentage of CO2 was absorbed when the Ca/C ratio 2 was 78.33 %. The H2 content in the syngas after the CO2 was absorbed increased rapidly to 75.80 vol% at a Ca-to-carbon-mole ratio (Ca/C) of 1.5 and a steam-to-feedstock ratio (S/F) of 1.5. CaO did not produce significant results for low heating value (LHV) or cold gas efficiency (CGE), with results of 12 MJ/Nm3 and 44.53 %. The dominant water gas shift reaction due to the influence of steam and CaO increased H2/CO up to 9.11, which made the syngas from this work suitable for Fischer–Tropsch synthesis.

Introduction: Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children. Patients and methods: We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. Results: The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8% vs 26.4%; P = .85). We also did not find a significant difference between the groups in the incidence of ventilator-associated pneumonia (VAP) (9.6% vs 8.3%; P = .77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs 12.5%; P = .014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR, 6.4; 95%CI, 2.73–14.9). Conclusion: In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children. Resumen: Introducción: La profilaxis de las úlceras por estrés (PUE) se utiliza comúnmente en las Unidades de Cuidados Intensivos Pediátricos (PICU). Sin embargo, no hay pruebas sólidas que apoyen esta práctica y se necesitan urgentemente ensayos clínicos controlados aleatorios (ECCA) pediátricos. Nuestro objetivo era evaluar el valor de la PUE con omeprazol en pacientes críticos pediátricos. Pacientes y métodos: Ensayo controlado aleatorio abierto, con inclusión de 144 niños ingresados en la UCI con una puntuación en la escala pediátrica de evaluación del fallo multiorgánico secuencial (pSOFA) inferior a 16. Los pacientes fueron asignados al azar a recibir omeprazol para el PUE o a no recibir profilaxis. La variable de resultado principal fue el desarrollo de hemorragia digestiva alta o infecciones nosocomiales. Resultados: La frecuencia de hemorragia gastrointestinal fue del 27.1%, aunque solo desarrollaron hemorragia clínicamente significativa el 5,6% de los pacientes. No se observaron diferencias significativas en la incidencia de hemorragia entre los grupos de profilaxis y de control (27,8% vs. 26,4%; P = ,85). Tampoco surgieron diferencias significativas en la incidencia de la neumonía asociada al ventilador (NAV) entre ambos grupos (9,6% vs. 8,3%; P = ,77). La incidencia de bacteriemia asociada a catéter venoso central (BACVC) fue mayor en el grupo de profilaxis en comparación con el grupo de control (30,6% vs. 12,5%; P = ,014). Ningún paciente desarrolló diarrea por Clostridium difficile. No se encontraron diferencias significativas en la tasa de mortalidad, la duración de la estancia en la UCIP o la duración de la ventilación mecánica. La ventilación mecánica fue un predictor independiente de hemorragia (OR, 6,4; IC 95%: 2,73–14,9). Conclusión: En pacientes ingresados en la UCIP con disfunción orgánica de leve a moderada, el uso de omeprazol parece ineficaz para la prevención del sangrado gastrointestinal a la vez que aumenta el riesgo de BACVC. Se recomienda restringir el PUE a niños sometidos a ventilación mecánica.

Resumen: Introducción: La profilaxis de las úlceras por estrés (PUE) se utiliza comúnmente en las Unidades de Cuidados Intensivos Pediátricos (PICU). Sin embargo, no hay pruebas sólidas que apoyen esta práctica y se necesitan urgentemente ensayos clínicos controlados aleatorios (ECCA) pediátricos. Nuestro objetivo fue evaluar el valor de la PUE con omeprazol en pacientes críticos pediátricos. Pacientes y métodos: Ensayo controlado aleatorizado abierto, con inclusión de 144 niños ingresados en la UCI con una puntuación en la escala pediátrica de evaluación del fallo multiorgánico secuencial (pSOFA) inferior a 16. Los pacientes fueron asignados al azar a recibir omeprazol para el PUE o a no recibir profilaxis. La variable de resultado principal fue el desarrollo de hemorragia digestiva alta o infecciones nosocomiales. Resultados: La frecuencia de hemorragia gastrointestinal fue del 27,1%, aunque solo desarrollaron hemorragia clínicamente significativa el 5,6% de los pacientes. No se observaron diferencias significativas en la incidencia de hemorragia entre los grupos de profilaxis y de control (27,8 vs. 26,4%; p = 0,85). Tampoco surgieron diferencias significativas en la incidencia de la neumonía asociada al ventilador (NAV) entre ambos grupos (9,6 vs. 8,3%; p = 0,77). La incidencia de bacteriemia asociada a catéter venoso central (BACVC) fue mayor en el grupo de profilaxis en comparación con el grupo de control (30,6 vs. 12,5%; p = 0,014). Ningún paciente desarrolló diarrea por Clostridium difficile. No se encontraron diferencias significativas en la tasa de mortalidad, la duración de la estancia en la UCIP o la duración de la ventilación mecánica. La ventilación mecánica fue un predictor independiente de hemorragia (OR 6,4; IC 95%: 2,73-14,9). Conclusión: En pacientes ingresados en la UCIP con disfunción orgánica de leve a moderada, el uso de omeprazol parece ineficaz para la prevención del sangrado gastrointestinal a la vez que aumenta el riesgo de BACVC. Se recomienda restringir el PUE a niños sometidos a ventilación mecánica. Abstract: Introduction: Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children. Patients and methods: We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection. Results: The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8 vs. 26.4%; p = 0.85). We also did not find a significant difference between the group in the incidence of ventilator-associated pneumonia (VAP) (9.6 vs. 8.3%; p = 0.77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs. 12.5%; p = 0.014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR 6.4; 95% CI, 2.73-14.9). Conclusion: In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children.

The high cost of commercial membranes has boosted the search for alternative materials to be used as a substitute to facilitate the practical application of this technology. One of the most promising alternatives to commercial membranes is ceramic clay-based materials. Their low cost, natural availability, and long-term functional robustness make these cost-effective materials feasible for scaled-up systems. In this work, ceramic membranes containing different amounts of activated carbon were made from oil palm empty-fruit bunch (AC-OPEFB) (20, 15, and 10 wt%) and iron oxide powder (2.5 wt%). These membranes were utilised to remove contaminants of Fe, Mn, Zn, NH3–N, and PO4. The most favourable rejection percentages for each contaminant in this work are 92.03, 97.08, 99.67, 84.56, and 87.10%. The Brunauer-Emmet-Teller (BET) analysis results show that the membrane surface area has an inverse relationship with AC-OPEFB composition (wt.%) contained in the membrane.

Resumen: Objetivos: Analizar el rendimiento de la escala Sequential Organ Failure Assessme (SOFA) adaptada por edad en niños ingresados en la unidad de cuidados intensivos pediátricos (UCIP) y establecer si la escala SOFA puede competir con el síndrome de respuesta inflamatoria sistémica (SRIS) para el diagnóstico de sepsis, de acuerdo con las recomendaciones del consenso Sepsis-3. Métodos: Estudio prospectivo observacional en 2 centros con 281 niños ingresados en la UCIP. Se calcularon las puntuaciones de las escalas SOFA, Pediatric Risk of Mortality (PRISM) y Pediatric Index of Mortality-2 (PIM2) y se evaluó la presencia de SRIS al ingreso. La variable primaria fue la mortalidad a los 30 días. Resultados: La puntuación SOFA fue más alta en los no supervivientes (p

Objectives: To assess performance of the age-adapted SOFA score in children admitted into Paediatric Intensive Care Units (PICUs) and whether the SOFA score can compete with the systemic inflammatory response syndrome (SIRS) in diagnosing sepsis, as recommended in the Sepsis-3 consensus definitions. Methods: Two-centre prospective observational study in 281 children admitted to the PICU. We calculated the SOFA, Pediatric Risk of Mortality (PRISM), and Pediatric Index of Mortality-2 (PIM2) scores and assessed for the presence of SIRS at admission. The primary outcome was 30-day mortality. Results: The SOFA score was higher in nonsurvivors (P

Synthesis of SnO2–Fe3O4 nanocomposites was conducted. The purpose of this study was to obtain the SnO2–Fe3O4 nanocomposites, the effectiveness of photodegradation Congo red by SnO2–Fe3O4 nanocomposites and determine the kinetics of photodegradation. The XRD analysis showed that the SnO2–Fe3O4 nanocomposite best mass ratio was 1:1 based on the highest intensity of characteristic angle (2θ), which is 26.54° and had the smallest crystal size, which is 9.662 nm. Based on the UV-Vis DRS result, the SnO2–Fe3O4 nanocomposites bandgap value was 2.3 eV. The magnetization saturation value of SnO2–Fe3O4 nanocomposites was 64.96 emu/g. The morphology of SnO2–Fe3O4 nanocomposites showed by the TEM image, where the dark spots spread in the lighter areas. The surface of SnO2–Fe3O4 nanocomposites characterized by SEM with the result was bumpy surface and many pores. The EDS result of SnO2–Fe3O4 nanocomposites confirmed the presence of Fe, Sn, and O elements. The functional group of SnO2–Fe3O4 nanocomposites showed by FTIR data, the stretch band of Sn–O characteristics showed at wavenumber 590 cm−1, and the stretch band of Fe–O showed at wavenumber 563 cm−1. The optimum condition of nanocomposites at a contact time of 90 min and the optimum concentration of 18 mg/L showed that the percent of photodegradation was 50.76%. The photodegradation rate of SnO2–Fe3O4 was fitted to Pseudo-second-order.

Resumen: Introducción: Se ha sugerido que las alteraciones en las hormonas tiroideas ocurridas en pacientes con enfermedad crítica, fenómeno conocido como síndrome del enfermo eutiroideo (SEE), pueden tener valor pronóstico. No obstante, los datos en población pediátrica son escasos. El objetivo del estudio fue evaluar la prevalencia y el valor pronóstico del SEE en niños críticos. Materiales y métodos: Estudio prospectivo observacional en 70 niños críticos ingresados en la unidad de cuidados intensivos pediátricos (UCIP). Se determinaron los niveles de triyodotironina libre (T3L), tiroxina libre (T4L) y tirotropina (TSH) en las primeras 24 horas de ingreso. La variable de resultado principal fue la mortalidad a los 30 días. Resultados: Se observó SEE en el 62,9% de los pacientes, aunque adoptó formas diversas. El patrón más frecuente fue un nivel bajo de T3L con niveles normales de T4L y TSH (25,7% de los pacientes). La combinación de valores bajos de T3L, T4L, y TSH ocurrió en el 7,1% de los pacientes. Hubo un hallazgo inusual de TSH elevada en 3 pacientes que podría estar asociado a la gravedad de la enfermedad. Los valores bajos de T4L se observaron con una frecuencia significativamente mayor en pacientes fallecidos en comparación con supervivientes (50% versus 19,2%, p = 0,028). El SEE predijo la mortalidad de manera independiente (OR = 3,91; IC 95% = 1,006-15,19; p = 0,0491). La combinación de niveles bajos de T3L, T4L, y TSH fue el mejor factor pronóstico independiente de mortalidad (OR = 16,9; IC 95% = 1,40-203,04; p = 0,026). Se observó una correlación negativa entre la TSH y la duración de la estancia en la UCIP (rs = —0,35; p = 0,011). El valor de T3L fue significativamente menor en pacientes tratados con perfusión de dopamina, comparados con pacientes que no la recibieron (2,1 ± 0,66 versus 2,76 ± 0,91 pg/ml, p = 0,011). Conclusión: El SEE es común en niños críticos y parece estar asociado a la mortalidad y la gravedad de la enfermedad. Abstract: Introduction: Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children. Materials and methods: A prospective observational study conducted on 70 critically ill children admitted into pediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24 hours of PICU admission. Primary outcome was 30-day mortality. Results: NTIS occurred in 62.9% of patients but it took several forms. The most common pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P = .028). NTIS independently predicted mortality (OR = 3.91; 95% CI = 1.006-15.19; P = .0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR = 16.9; 95% CI = 1.40-203.04; P = .026). TSH was negatively correlated with length of PICU stay (rs = —0.35, P = .011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1 ± 0.66 versus 2.76 ± 0.91 pg/mL, P = .011). Conclusion: NTIS is common among critically ill children and appears to be associated with mortality and illness severity.

Introduction: Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, paediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children. Materials and methods: A prospective observational study conducted on 70 critically ill children admitted into paediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24 h of PICU admission. Primary outcome was 30-day mortality. Results: NTIS occurred in 62.9% of patients but it took several forms. The commonest pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P = .028). NTIS independently predicted mortality (OR = 3.91; 95% CI = 1.006–15.19; P = .0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR = 16.9; 95% CI = 1.40–203.04; P = .026). TSH was negatively correlated with length of PICU stay (rs = —0.35, P = .011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1 ± 0.66 versus 2.76 ± 0.91 pg/mL, P = .011). Conclusion: NTIS is common among critically ill children and appears to be associated with mortality and illness severity. Resumen: Introducción: Se ha sugerido que las alteraciones en las hormonas tiroideas ocurridas en pacientes con enfermedad crítica, fenómeno conocido como síndrome del enfermo eutiroideo (SEE), pueden tener valor pronóstico. No obstante, los datos en población pediátrica son escasos. El objetivo del estudio fue evaluar la prevalencia y el valor pronóstico del SEE en niños críticos. Materiales y métodos: Estudio prospectivo observacional en 70 niños críticos ingresados en la unidad de cuidados intensivos pediátricos (UCIP). Se determinaron los niveles de triyodotironina libre (T3L), tiroxina libre (T4L) y tirotropina (TSH) en las primeras 24 horas de ingreso. La variable de resultado principal fue la mortalidad a los 30 días. Resultados: Se observó SEE en el 62,9% de los pacientes, aunque adoptó formas diversas. El patrón más frecuente fue un nivel bajo de T3L con niveles normales de T4L y TSH (25,7% de los pacientes). La combinación de valores bajos de T3L, T4L, y TSH ocurrió en el 7,1% de los pacientes. Hubo un hallazgo inusual de TSH elevada en 3 pacientes que podría estar asociado a la gravedad de la enfermedad. Los valores bajos de T4L se observaron con una frecuencia significativamente mayor en pacientes fallecidos en comparación con supervivientes (50% versus 19,2%, p = 0,028). El SEE predijo la mortalidad de manera independiente (OR = 3,91; IC 95% = 10,06–15,19; p = 0,0491). La combinación de niveles bajos de T3L, T4L, y TSH fue el mejor factor pronóstico independiente de mortalidad (OR = 16,9; IC 95% = 1,40–203,04; p = 0,026). Se observó una correlación negativa entre la TSH y la duración de la estancia en la UCIP (rs = —0,35; p = 0,011). El valor de T3L fue significativamente menor en pacientes tratados con perfusión de dopamina, comparados con pacientes que no la recibieron (2,1 ± 0,66 versus 2,76 ± 0,91 pg/ml, p = 0,011). Conclusión: El SEE es común en niños críticos y parece estar asociado a la mortalidad y la gravedad de la enfermedad.

This study examines the levels and patterns of potentially toxic elements (PTEs) in surface sediment of Almus Dam Lake (ADL), a key fish breeding site in Türkiye. PTE concentrations in sediment were ranked: Hg (0.05 ± 0.01) < Cd (0.16 ± 0.01) < Pb (9.34 ± 1.42) < As (18.75 ± 15.65) < Cu (63.30 ± 15.17) < Ni (72.64 ± 20.54) < Zn (86.66 ± 11.95) < Cr (108.35 ± 36.40) < Mn (1008 ± 151) < Fe (53,998 ± 6468), with no significant seasonal or spatial differences. Ecological risk indices (mHQ, EF, I geo , CF, PLI, E r i , mCd, NPI, PERI, MPI, and TRI) showed low contamination levels. Health risk assessments, including LCR, HQ, and THI, indicated minimal risks to humans from sediment PTEs. Statistical analyses (PCA, HCA, SCC) identified natural, transportation, and anthropogenic PTE sources, with slight impacts from agriculture and fish farming. This research underlines contamination status of ADL and emphasizes the need for targeted management strategies, offering critical insights for environmental safeguarding., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study was carried out to determine the spatial-temporal distributions of limnological parameters of Çanakkale Strait (ÇS) and İstanbul Strait (İS), Turkiye. Fluvial (n = 11) and lacustrine (n = 4) habitats water samples were collected in the dry and rainy seasons of 2022-2023. Among limnological parameters, the highest mean electrical conductivity values of 6063 μS/cm were noted in the İS basin during the rainy season and the lowest was 0.04 mg/L for nitrite in the ÇS basin. Generally, the levels of organic contaminants and ecological risk indices were as follows: rivers of İS > rivers of ÇS > Alibey Dam Lake (İS) > Atikhisar Dam Lake (ÇS). The highest non-carcinogenic health risks of 0.88 were noted for children in the ÇS basin during the dry season and the lowest of <0.01 in Atikhisar Dam Lake during the rainy season. Multivariate statistical techniques were applied to data to categorize investigated ecosystems and sources apportionment of contaminants and geospatial distribution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). Our aim was to assess the usefulness of SUP with omeprazole in critically ill children., Patients and Methods: We conducted a randomized, controlled open-label trial, including 144 children admitted into a PICU with a paediatric Sequential Organ Failure Assessment (pSOFA) score of less than 16. We randomly allocated patients to SUP with omeprazole or no SUP. The primary outcome was development of upper gastrointestinal bleeding or nosocomial infection., Results: The incidence of gastrointestinal bleeding was 27.1%, but clinically significant bleeding developed in only 5.6% of patients. We did not find a significant difference in the incidence of bleeding between the prophylaxis and control groups (27.8% vs 26.4%; P = .85). We also did not find a significant difference between the groups in the incidence of ventilator-associated pneumonia (VAP) (9.6% vs 8.3%; P = .77). The incidence of central line-associated bloodstream infection (CLABSI) was higher in the prophylaxis group compared to the control group (30.6% vs 12.5%; P = .014). None of the patients developed Clostridium difficile-associated diarrhoea. We did not find significant differences in mortality, length of PICU stay or duration of mechanical ventilation. Mechanical ventilation was an independent predictor of bleeding (OR, 6.4; 95%CI, 2.73-14.9)., Conclusion: In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Introduction: Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children., Materials and Methods: A prospective observational study conducted on 70 critically ill children admitted into pediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24hours of PICU admission. Primary outcome was 30-day mortality., Results: NTIS occurred in 62.9% of patients but it took several forms. The most common pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P=.028). NTIS independently predicted mortality (OR=3.91; 95% CI=1.006-15.19; P=.0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR=16.9; 95% CI=1.40-203.04; P=.026). TSH was negatively correlated with length of PICU stay (r s =-0.35, P=.011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1±0.66 versus 2.76±0.91pg/mL, P=.011)., Conclusion: NTIS is common among critically ill children and appears to be associated with mortality and illness severity., (Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)