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In this study, full widths at half maximum (FWHM), asymmetry indexes, chemical shifts (ΔE) and Kβ-to-Kα X-ray intensity ratios of some pure metals (Mn, Fe, Cu and Zn) and some of their oxidized compounds (Mn 2 O 3 , Fe 2 O 3 , Fe 3 O 4 , Cu 2 O 3 and ZnO) were investigated. The samples were excited by 59.54 keV photons emitted from a 241 Am radioisotopes source and characteristic K X-rays emitted from the samples were counted by a Si(Li) detector. The results have shown that the Kβ-to-Kα X-ray intensity ratios, asymmetry indexes, chemical shifts and full widths at half maximum (FWHM) values can change with sample sizes., 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.)

Bovine tuberculosis might be seen in low-income countries, especially in children fed with raw milk. The most common transmission route is fecal-oral way, and it is most likely through unpasteurized dairy products. Although clinical and radiological findings are like non-zoonotic tuberculosis, treatment approaches may differ in individuals with zoonotic tuberculosis. Prevention of zoonotic diseases requires multidisciplinary approaches. These approaches include the development of veterinary and surveillance studies for the detection of communicable diseases in farm animals, as well as informing the public about raw milk consumption. In this case report, a patient with zoonotic pulmonary tuberculosis related to Mycobacterium bovis because of consumption of raw milk was presented. A five-month-old male was admitted to the hospital due to a persistent, feverless, non-productive cough since birth. Empirical antibiotic treatment was started with a preliminary diagnosis of pneumonia because of left upper lobe and right pericardial infiltration on chest X-ray. However, after two weeks of antimicrobial therapy, the patient's clinical and laboratory findings did not improve. This led to the referral for a computed tomography imaging, which revealed tracheomalacia, consolidation on the right upper lobe, an indistinguishable mass or consolidation on the left middle lobe of the lung, peribronchial thickening on the basal segment of the lower lobe, and mediastinal lymphadenopathy. Three consecutive days of fasting gastric lavage fluid was sent to the reference laboratory for acid-resistant bacillus examination, polymerase chain reaction (PCR) and culture studies. As the clinical findings were compatible and PCR was positive, the patient was started on quadruple antituberculous therapy. After initiation of anti-tuberculosis drugs, the patient's findings radiologically and clinically were improved. Mycobacterium bovis was grown in the culture. In the meantime, it was discovered that the patient was fed with raw milk. Due to the patient's clinical symptoms and the growth of Mycobacterium bovis in the gastric lavage fluid culture, the diagnosis of bovine tuberculosis was made. The culprit was that the milk of the cow belonging to the patient's family, which was later found to be infected with M.bovis, was milked and given to the patient without boiling. Today, unpasteurized dairy products continue to be consumed, especially in rural areas. One of the most important steps to prevent zoonotic diseases is to raise awareness about not consuming raw milk and undercooked meat. To elucidate the epidemiological link in childhood, taking a good anamnesis, including questioning raw milk consumption, is essential in the diagnosis of tuberculosis.

This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027).  Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: This study was conducted with the aim of examining the effect on pain intensity of the vibration technique applied at the injection site and squeezing a stress ball during the administration of Pfizer-BioNTech COVID-19 vaccination., Methods: This was a randomized controlled single-blind experimental study. The study included 120 adults who were randomly selected between July and November 2022. One experimental group (n = 40) received local vibration by means of a Buzzy® device, and the other (n = 40) were given a stress ball to squeeze. Routine vaccination procedure was performed with the control group (n = 40). The level of pain felt during the vaccination procedure was assessed on a visual analog scale., Results: The pain score of individuals during the vaccination procedure was found to be significantly lower in the vibration group than in the control group (P = .005) and the stress ball group (P = .036), but there was no significant difference between the control and stress ball groups (P = .851). Also, it was found that the variables of gender, age and body mass index did not affect the average pain intensity of individuals during the vaccination procedure., Conclusions: It was found that local vibration applied by means of the Buzzy® device was effective in reducing the levels of pain relating to administration of the Pfizer-BioNTech COVID-19 vaccination. Nurses should think of the application of vibration as a choice in the management of pain relating to Pfizer-BioNTech COVID-19 vaccination., (© 2023 Japan Academy of Nursing Science.)

Objective: The aim of this study is to investigate the temporal relationship between the first occurrence of thromboembolic events (TEE) and the timing of myeloproliferative neoplasm (MPN) diagnosis and to determine risk factors for TEE-related mortality in MPN., Patients and Methods: A total of 138 BCR-ABL-negative MPN patients with TEE, diagnosed from January 2010 to December 2019, were included in this retrospective cohort. Patients were compared according to mortality and subjects were classified into three groups with respect to having suffered index TEE before, during, or after MPN diagnosis., Results: The mean age of surviving patients was 57.5±13.8, while those who had died had a mean age of 72.0±9.0 (p<0.001). Males represented 56.5% of patients with mortality and 60.9% of those without mortality (p=0.876). TEE was detected in 26.0% of MPN patients, and TEE-related mortality rate was 16.7%. There was no relationship between mortality and the classification of patients according to index TEE (p =0.884). High age (p<0.001) and danazol use (p=0.014) were independently associated with TEE-related mortality., Conclusions: The temporal relationship between TEE and MPN diagnosis was not found to influence mortality. Older patients and danazol recipients should be considered to have a higher risk of TEE-related mortality.

Robust and reusable magnetic chitosan/calcium alginate double-network hydrogel beads (CSMAB) with an environmentally benign biocomposite material synthesis approach were used adsorption of surfactant and removal of methylene blue dye sequentially for the first time. Double network hydrogel structure with sodium alginate and chitosan and acidification of the surface with HCl provided the reusability of the beads at the pollutant removal in water. The CSMAB beads were characterized for structural analysis by FESEM, EDX, BET, VSM, and FTIR techniques. They were used for the adsorption of cationic hexadecylpyridinium chloride (HDPCl) and anionic sodium dodecyl sulfate (SDS) surfactants and reused in the removal of cationic methylene blue dye without any pretreatment. The effect of pH, adsorbent dose, and temperature on surfactant removal efficiency was analyzed and pH was found the statistical significance. The adsorption capacity of CSMAB beads with a surface area of 0.65 m 2  g -1 was calculated as 1.9 mg g -1 for HDPCl, and 1.2 mg g -1 for SDS, respectively. The SDS and HDPCl adsorption followed the pseudo-second-order kinetic and Freundlich isotherm model. The thermodynamic results showed that the surfactant adsorption process is an exothermic and spontaneous process. SDS-reacted CSMAB beads showed higher efficiency with 61 % in the removal of methylene blue dye., 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 B.V. All rights reserved.)

Objective: To determine the clinical significance of serum 25-hydroxy (OH) vitamin D levels in pediatric patients with multisystem inflammatory syndrome in children (MIS-C) and compare the vitamin D levels of these patients with those patients with Coronavirus disease-2019 (COVID-19) and healthy controls., Methods: This study was designed for pediatric patients aged 1 month to 18 years and conducted between July 14 and December 25, 2021. Fifty-one patients with MIS-C, 57 who were hospitalized with COVID-19, and 60 controls were enrolled in the study. Vitamin D insufficiency was defined as a serum 25 (OH) vitamin D level of less than 20 ng/mL. Severe MIS-C was classified as necessitating intensive care due to cardiovascular instability, the necessity for non-invasive or invasive mechanical ventilation, and/or a diminishing Glasgow coma scale. World Health Organization definition criteria were used to describe the clinical stages of COVID-19 in children and patients were divided into four groups according to the clinical severity of COVID-19: asymptomatic, mild, moderate, and severe/critical., Results: The median serum 25 (OH) vitamin D was 14.6 ng/mL in patients with MIS-C, 16 ng/mL in patients with COVID-19, and 21.1 ng/mL in the control group (p<0.001). Vitamin D insufficiency was present in 74.5% (n=38) of patients with MIS-C, 66.7% (n=38) of patients with COVID-19, and 41.7% (n=25) of the controls (p=0.001). The percentage of four or more affected organ systems was 39.2% in patients with MIS-C. The correlation between the number of affected organ systems and serum 25 (OH) vitamin D levels was evaluated in patients with MIS-C and there was a moderate negative correlation (r=-0.310; p=0.027). A weak negative correlation was found between the severity of COVID-19 and serum 25 (OH) vitamin D (r=-0.320, p=0.015)., Conclusion: Vitamin D levels were insufficient in both the MIS-C and COVID groups. Furthermore, vitamin D levels correlated with the number of affected organ systems in MIS-C and the severity of COVID-19., (©Copyright 2023 by Turkish Society for Pediatric Endocrinology and Diabetes | The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

Objective: To compare volume and surface area measurements of the lateral pterygoid (LPM), medial pterygoid (MPM), and masseter muscles (MM) as calculated on magnetic resonance imaging (MRI) based on the position of the temporomandibular joint disk, mouth position, and patient sex, and to calculate the correlations of the measurements among the muscles., Study Design: Measurements of muscle volume and area were performed on the MRIs of 51 patients. Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests were used to calculate the significance of differences in measurements. The Spearman correlation coefficient calculated the correlation of measurements among the muscles. The significance of difference was established at P < .05., Results: Volume and area of the left MPM in patients with disk displacement without reduction (DDWOR) were larger than in patients with normal disk position (P ≤ .040). MM volumes were smaller with DDWOR than with DD with reduction bilaterally (P ≤ .031). The volume and area of LPM and MM were significantly different between closed and open mouth positions (P < .001). Differences in volume and area between females and males were significant for all muscles in volume (P ≤ .021) and for MPM and MM in area (P ≤ .021). Significant positive correlations were found among all muscles for volume and area., Conclusion: Volume and area measurements of the masticatory muscles varied according to disk and mouth position and patient sex and exhibited significant positive correlations., Competing Interests: Declaration of interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Afebrile seizures are the common causes of emergency department (ED) admissions in childhood, and there is limited data on the observation period in emergency service follow-up of these patients in terms of seizure recurrence in the literature. This study aims to determine the seizure recurrence time in afebrile seizures and the risk factors that determine it., Methods: Patients aged between 1 month and 18 years with afebrile seizures were included in the study. Seizure recurrence times, demographic data, diagnosis of epilepsy, use of antiseizure medications, Electroencephalography (EEG) and imaging results, structural abnormalities, hospitalizations, and treatments were recorded., Results: The median age of 623 patients included in the study was 42 months (16.0-94.0 months) and 59.9% were male. Epilepsy was diagnosed in 372 (59.7%) of the patients. Short-acting benzodiazepine was administered in 249 of the cases. The mean observation time of the patients was 36 hours (24-98 hours). Electroencephalography (EEG) was applied in 437 (70.1%) of the patients and abnormality was detected in 53.5%. Seizure recurrence was observed in 149 patients (23.9%). The median time of seizure recurrence was 1.0 hour (0.5-4.0 hours). Eighty-six percent of the seizure recurrences (n = 129) occurred within the first six hours and 95.3% (n = 142) within the first 12 hours. Risk factors included a history of febrile seizures (p = 0.001, OR = 2.7), not receiving short-acting benzodiazepine therapy (p = 0.026, OR 1.7), previous structural abnormalities (p = 0.018, OR 1.8), and cluster seizures (p = 0.001, OR 6.7) for all patients and also EEG abnormalities in pediatric ED for first seizure (p = 0.012, OR 2.4)., Conclusion: Patients with a history of febrile seizure, previous structural abnormalities, cluster seizures, EEG abnormalities in pediatric ED, and patients who didn't receive BZD treatment were at risk for seizure recurrence in the early period. Since most seizure recurrences occur within the first 6 hours, this period is the most critical time for recurrence risk., 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 © 2022 Elsevier Inc. All rights reserved.)

Background: The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma., Methods: Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images., Results: There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs., Conclusions: When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To investigate the existence of a possible linkage between the thickness of corpus callosum (CC) regions and the first antiepileptic drug response in patients with Selects., Materials and Methods: CC thickness of 68 patients with Selects and 42 healthy controls between 4 and 12 years of age were measured using brain magnetic resonance imaging (MRI). Clinical and EEG features of newly diagnosed Selects patients were recorded. Patients were divided into two groups: good-response (patients without seizures within 24 weeks) and poor-response (patients with ≥ 1 seizure within 24 weeks). Thickness of CC was compared between patients (good-response and poor-response groups).and healthy controls., Results: The thicknesses of genu and isthmus were significantly reduced in the Selects group than healthy controls. Isthmus and splenium were significantly thinner in poor responders than those in the good-response group (p = 0.005 and p < 0.001, respectively). The total number of seizures was negatively correlated with the thickness of the body, isthmus, and splenium (p < 0.001). There was no significant difference in CC thickness of the children with and without electrical status epilepticus in sleep (ESES). The thickness of the isthmus and splenium were significantly thinner in patients receiving ≥ 2 antiepileptic drugs (p = 0.002 and p = 0.001, respectively)., Conclusions: Our study highlights the notable differences in areas of CC in Selects patients. These changes may help uncover the underlying cause of seizure recurrence and antiepileptic drug (AED) response. Different thinner parts of CC may be a protective mechanism to prevent seizure spread to other brain regions. CC thickness can be used as a new radiologic biomarker for predicting first AED response and seizure recurrence in Selects patients., Competing Interests: Conflicts of interest Not applicable., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The incidence of vaccine hesitancy is increasing in many countries. This study aims to determine parents` attitudes and related factors regarding COVID-19 vaccine acceptance for themselves and their children aged 12-18., Methods: A cross-sectional survey was conducted on parents between 16th November and 31st December 2021, after COVID-19 vaccines were initiated for children in Türkiye. In the survey, the sociodemographic characteristics of the parents, whether they and their children were vaccinated against COVID-19, and if not, the reasons for this were asked. Multivariate binary logistic regression analysis was used to evaluate the factors affecting parents` refusal to vaccinate their children for COVID-19., Results: Three hundred and ninety-six mothers and fathers were included in the final analysis. Overall, 41.7% of parents reported vaccine refusal for their children. COVID-19 vaccine refusal was higher in mothers younger than 35 (β = 6.5, p = 0.002, 95% CI: 2.0-23.1), children aged 15 and younger (β = 2.3, p = 0.001, 95% CI: 1.4-3.7). Concerns about the side effects of the COVID-19 vaccine (29.7%) and their children not wanting to be vaccinated (29.0%) were the most common causes of COVID-19 vaccine refusal., Conclusions: In the present study, the rate of children not vaccinated due to COVID-19 vaccine refusal was relatively high. Parents` concerns about vaccine side effects, as well as their children`s unwillingness to be vaccinated, suggest that both parents and adolescents should be informed about the importance of COVID-19 vaccines.

Background: There is no specific biomarker used in the diagnosis of COVID-19 and predicting its clinical severity. This study aimed to investigate the utility of ischemia-modified albumin (IMA) in diagnosing and predicting clinical severity in children with COVID-19., Methods: Between October 2020 and March 2021, 41 cases constituted the COVID-19 group and 41 cases constituted the healthy control group. IMA levels were measured at admission (IMA-1) and 48-72 hours (IMA- 2) in the COVID-19 group. In the control group, it was measured at admission. COVID-19 clinical severity was classified as asymptomatic infection, mild, moderate, severe, or critical disease. Patients were divided into two groups (asymptomatic/mild and moderate/severe) to evaluate IMA levels in terms of clinical severity., Results: In the COVID-19 group, the mean IMA-1 level was 0.901±0.099, and the mean IMA-2 level was 0.866±0.090. The mean level of IMA-1 in the control group was 0.787±0.051. When IMA-1 levels of COVID-19 and control cases were compared, the difference was statistically significant (p < 0.001). When clinical severity and laboratory data are compared, C-reactive protein, ferritin and ischemia-modified albumin ratio (IMAR) were statistically significantly higher in moderate-severe clinical cases (p=0.034, p=0.034, p=0.037 respectively). However, IMA-1 and IMA-2 levels were similar between the groups (p=0.134, p=0.922, respectively)., Conclusions: To date, no study has been conducted on IMA levels in children with COVID-19. The IMA level may be a new marker for the diagnosis of COVID-19 in children. Studies with a larger number of cases are needed to predict clinical severity.

Background: The aim of this study was to evaluate the experiences of patients aged 18-24 years who were diagnosed with multiple sclerosis before the age of eighteen, during the transition from pediatric care to adult care., Methods: This research was in the type of phenomenological qualitative research. Focus group interviews were conducted between December 2020 and October 2021 with seventeen participants who had been diagnosed with multiple before the age of eighteen, aged 18-24, voluntarily having agreed to participate in the study. The views of the participants were analyzed with Maxqda Plus v10 data analysis software, and thematic coding was created by the researchers., Results: Of the participants, 58.9% were female, 76.5% had their first attack after the age of 13, and it was determined that 64.7% of them took oral tablets for therapeutic purposes. As a result of the content analysis; four thematic codes emerged: (a) Perceptions of the Illness and Pediatric Clinic Before Transition, (b) Perceptions of the Disease and Adult Clinic After Transition to the Adult Clinic, (c) Expectations from the Clinic They Received Service from During Their Childhood, (d) Expectations from the Clinic They Used in Adulthood., Conclusion: This study revealed that individuals with multiple sclerosis did not receive any medical care regarding the transition from pediatric clinics to adult clinics. Describing the experiences of young adult patients with multiple sclerosis in pediatric clinics and their experiences in the transition to adult clinics allows for the definition of comprehensive, individualized and transitional nursing interventions., Competing Interests: Declaration of Competing Interest The authors declare that there are no conflict of interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Multisystem inflammatory syndrome in children (MIS-C), associated with Coronavirus disease-2019, is defined as the presence of documented fever, inflammation, and at least two signs of multisystem involvement and lack of an alternative microbial diagnosis in children who have recent or current Severe acute respiratory syndrome-Coronavirus-2 infection or exposure. In this study, we evaluated thyroid function tests in pediatric cases with MIS-C in order to understand how the hypothalamus-pituitary-thyroid axis was affected and to examine the relationship between disease severity and thyroid function., Methods: This case-control study was conducted between January 2021 and September 2021. The patient group consisted of 36 MIS-C cases, the control group included 72 healthy children. Demographic features, clinical findings, inflammatory markers, thyroid function tests, and thyroid antibody levels in cases of MIS-C were recorded. Thyroid function tests were recorded in the healthy control group., Results: When MIS-C and healthy control groups were compared, free triiodothyronine (fT3) level was lower in MIS-C cases, while free thyroxine (fT4) level was found to be lower in the healthy group (p<0.001, p=0.001, respectively). Although the fT4 level was significantly lower in controls, no significant difference was found compared with the age-appropriate reference intervals (p=0.318). When MIS-C cases were stratified by intensive care requirement, fT3 levels were also lower in those admitted to intensive care and also in those who received steroid treatment (p=0.043, p<0.001, respectively)., Conclusion: Since the endocrine system critically coordinates and regulates important metabolic and biochemical pathways, investigation of endocrine function in MIS-C may be beneficial. These results show an association between low fT3 levels and both diagnosis of MIS-C and requirement for intensive care. Further studies are needed to predict the prognosis and develop a long-term follow-up management plan.

Purpose: To determine the accuracy of bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse (ETD) diameter ratios to predict space-occupying lesions (SOLs) or elevated intracranial pressure (ICP) in pediatric head trauma., Methods: Children who presented to the emergency department with head trauma and underwent cranial computed tomography (CT) were enrolled and examined by ocular ultrasonography (US), and the ONSD was measured at 3 mm posterior to the globe and ETD were measured. Ratios of ONSD at 3 mm/ETD were calculated. All ONSD measurements and ratios were calculated from cranial CT images., Results: Subjects with elevated ICP had increased ONSD measurements and ratios. To predict elevated ICP, the AUC for ONSD at 3 mm was 0.956 (95% CI 0.896-1). At a cut-off level of 5.1 mm, the sensitivity and specificity of ONSD 3 mm values for elevated ICP were 92.9% and 94.0%. For the ONSD 3 mm/ETD ratio, it was 0.980 (95% CI 0.959-1). At a cut-off level of 0.22, the sensitivity and specificity were 100% sensitivity and 88.0%. All sonographic ONSD measurements and ratios were significantly correlated with readings calculated from cranial CT images., Conclusion: Sonographic ONSD measurements and ratios were found to be quite sensitive to detect elevated ICP on cranial CT images. Additionally, there was a significant correlation between measurements calculated by ocular US and cranial CT scans. Bedside ocular US seems to be a promising and useful tool to determine ICP in children with head trauma., (© 2022. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Today, as the elderly population in the world increases, the increase in those living in nursing homes causes their problems to be even more important. Spatial hazards cause injury and death most of the time, therefore should be evaluated risks then corrective and preventive actions should be implemented. Fine-Kinney is one of the most widely used risk assessment methods, but it has some shortcomings. One of them is that risk factors such as probability, frequency, and severity are accepted as equally important, but they can have different importance weights in real-life applications. Another is that experts assess the risk magnitudes using their opinions, who usually tend to use linguistic expressions instead of crisp numbers, in incomplete information and uncertain situations. The last is that the experts' experiences are not effectively incorporated into the automation of the risk assessment. The adaptive neuro-fuzzy inference system (ANFIS) method, which is a machine learning method, can overcome all these shortcomings. In this study, a novel hybrid risk assessment method based on Fine-Kinney and ANFIS is developed to predict the class of a new occurring risk. The hybrid method was applied to nursing homes located in Turkey. The risk classes predicted with the hybrid method were compared to ones found in the traditional Fine-Kinney method. It was determined that the prediction accuracy and Fleiss kappa value of the new hybrid method were 95.745% and 0.929 respectively. Thus, the hybrid method can be used instead of the traditional Fine-Kinney method to determine the class of a new risk, because it does not require a large number of experts and provides a faster assessment., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Introduction: This study aimed to evaluate the preliminary diagnosis, demographic characteristics, and outcomes of patients whose serum total tryptase levels were measured while in a tertiary pediatric hospital and to ascertain the role of serum tryptase levels in the etiology, diagnosis, severity, and course of systemic anaphylaxis. Methods: Patients ages between 1 month and 17 years who were followed up in the pediatric emergency department or as inpatients and with a diagnosis of immediate-type reactions between September 1, 2019, and August 31, 2021, were included in the study. Patient data were obtained retrospectively by examination of medical records and patient observation forms. Results: It was determined that serum tryptase levels were measured in a total of 310 patients during the study period. One hundred and fifty-five patients who met the defined diagnostic criteria were named as the anaphylaxis group and their data were detailed. The serum tryptase elevation was detected in 15.5% of the patients among the samples that met the anaphylaxis diagnostic criteria. No relationship was found between the serum total tryptase levels, the triggering factor, and the severity of anaphylaxis. Discussion: Anaphylaxis is a complex syndrome that involves different phenotypes that develop with various triggers in which different immunologic pathways, cell types, and mediators play a role. Serial measurements, including the basal value measured at least 24 hours after the symptoms disappear, are useful to confirm the diagnosis and guide the diagnostic tests during the follow-up, especially allergy evaluation.

Background: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population., Methods: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded., Results: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU., Conclusion: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Nucleic acid aptamers are target-specific oligonucleotides selected from combinatorial libraries through an iterative in vitro screening process known as Systemic Evolution of Ligands by Exponential Enrichment (SELEX). In this report, the selection of bacteria differentiating ssDNA aptamer candidates from a combinatorial library through the whole-cell SELEX method was performed. The enriched SELEX pool was sequenced using Illumina Next-Generation Sequencing (NGS) technology and analyzed for the most abundant sequences using CLC Genomics Workbench. The sequencing data resulted in several oligonucleotide families from which three individual sequences were chosen per SELEX based on the copy numbers. The binding performance of the selected aptamers was assessed by flow cytometry and fluorescence spectroscopy, and the binding constants were estimated using binding saturation curves. Varying results were obtained from two independent SELEX procedures where the SELEX against the model gram-negative bacterium Escherichia coli provided more selective sequences while the SELEX library used against gram-positive bacterium Listeria monocytogenes did not evolve as expected. The sequences that emerged from E. coli SELEX were shown to bind Lipopolysaccharide residues (LPS) and inhibit LPS-induced macrophage polarization. Thus, it can be said that, performed whole-cell SELEX could be resulted as the selection of aptamers which can bind LPS and inhibit LPS induced inflammation response and thus can be candidates for the inhibition of bacterial infections. In future studies, the selected aptamer sequences could be structurally and chemically modified and exploited as potential diagnostic tools and therapeutic agents as LPS antagonists., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI., Methods: The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded., Results: The median age of the 136 children was 9 (IQR: 5-14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2-8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively)., Conclusion: Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.

A 3-arm, parallel group, randomized clinical trial examines the effect of aromatherapy through inhalation and foot massage on blood pressure and stress response in patients with essential hypertension. Lavender oil reduced blood pressure, heart rate, serum cortisol, and subjective anxiety in hypertensive patients., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Cellular energy required for the maintenance of cellular life is stored in the form of adenosine triphosphate (ATP). Understanding cellular mechanisms, including ATP-dependent metabolisms, is crucial for disease diagnosis and treatment, including drug development and investigation of new therapeutic systems. As an ATP-dependent metabolism, endocytosis plays a key role not only in the internalization of molecules but also in processes including cell growth, differentiation, and signaling. To understand cellular mechanisms including endocytosis, many techniques ranging from molecular approaches to spectroscopy are used. Surface-enhanced Raman scattering (SERS) is shown to provide valuable label-free molecular information from living cells. In this study, receptor-mediated endocytosis was investigated with SERS by inhibiting endocytosis with ATP depletion agents: sodium azide (NaN 3 ) and 2-deoxy-d-glucose (dG). Human lung bronchial epithelium (Beas-2b) cells, normal prostate epithelium (PNT1A) cells, and cervical cancer epithelium (HeLa) cells were used as models. First, the effect of NaN 3 and dG on the cells were examined through cytotoxicity, apoptosis-necrosis, ATP assay, and uptake inhibition analysis. An attempt to relate the spectral changes in the cellular spectra to the studied cellular events, receptor-mediated endocytosis inhibition, was made. It was found that the effect of two different ATP depletion agents can be discriminated by SERS, and hence receptor-mediated endocytosis can be tracked from single living cells with the technique without using a label and with limited sample preparation.

Objective: To evaluate the distribution and characteristics of respiratory viral pathogens and to assess the epidemiological data, clinical features, and prognoses of infected children in a pediatric emergency department during the COVID-19 pandemic., Materials and Methods: Between September 1, 2020, and April 30, 2021, patients aged between 0 and 18 years arrived at the pediatric emergency department and were tested by nasopharyngeal/tracheal specimen polymerase chain reaction for both SARS-CoV-2 and other viral respiratory pathogens. Demographics, symptoms, laboratory and radiologic investigations, respiratory viruses detected by PCR, presence of co-infection and co-infecting viruses, need for respiratory support, hospitalization, length of hospital stay, and prognosis were recorded., Results: There were 327 patients for whom PCR tests were performed and 118 (36.0%) of them had positive results for SARS-CoV-2 and/or other respiratory viruses. Rhinovirus was the most commonly detected pathogen with 74 (62.7%) cases, followed by enterovirus with 38 (32.2%) and adenovirus with 20 (16.9%) cases. There was no detection of influenza virus or respiratory syncytial. SARS-CoV-2 PCR results were positive in 14 (11.9%) cases and there was only 1 coinfection of SARS-CoV-2 occurring together with rhinovirus. For 43 (36.4%) patients, there was co-infection, and among co-infections, the most common was that of rhinovirus and enterovirus, seen in 37 (86.0%) cases., Conclusion: A decrease was observed in the positivity rate of respiratory viral pathogens, while no cases of influenza virus or respiratory syncytial virus were observed in our study. Circulating viruses may change due to multifactorial approaches during the COVID-19 pandemic.

Aim: Tremor is an involuntary, rhythmic, oscillatory movement of body parts around a central point or plane which arises from contraction of antagonist muscles. Evaluation of pediatric patients with tremor can be challenging due to limited population-based studies in children. The aim of this study is to evaluate the demographic, clinical and laboratory features of childhood tremor, retrospectively., Materials and Methods: Patients under the age of 18 years presenting with tremor (n = 111) to the Pediatric Neurology Unit of Kecioren Research and Training Hospital between January 2014 and December 2019 were included in the study. Patients with neuromuscular disease, vertebral pathology or incomplete data in hospital records were not included. Also, benign tremor causes (jitteriness, shuddering attack, etc.) seen in the neonatal and infancy period were excluded from the study as the number of patients was insufficient. Demographic data, type and duration of tremor, accompanying symptoms, chronic diseases and medications, family history, physical and neurological examination, laboratory findings, neuroimaging findings were retrospectively analyzed and recorded., Results: A total of 111 children (59 girls and 52 boys) were included in our study and the female to male ratio was 1.1. The mean age at tremor onset and age at admission to hospital were 13.2 ± 2.8 years (range 4-17 years), and 14.8 ± 2.0 years (range 6-17 years), respectively. The most common type of tremor was essential tremor (62.2%), followed by enhanced physiologic (18.9%). None of the patients had acute metabolic disorder. Diagnostic tests revealed the etiology in 12 patients. These were vitamin B12 deficiency in 11 patients and multiple sclerosis in one patient. Drug-induced and task-specific tremors were determined in 4 patients each. It was determined that in patients with a positive family history, tremor appeared or was noticed at a younger age., Conclusions: Most of the cases with tremor can be diagnosed accurately by a detailed medical history, physical and neurological examination. Essential tremor is the most common type of tremor in children. Laboratory tests and imaging methods have limited additional yield in elucidating the etiology. Early recognition of tremor and related signs and symptoms in childhood is important for the detection and treatment of the possible underlying cause., (© 2021. Belgian Neurological Society.)

Aim: To investigate clinical and laboratory data, management and outcomes of pediatric trauma patients who initially received blood product transfusions., Methods: Between January 2011-January 2021, traumatic children who underwent blood product transfusions within 24 h of arrival at the emergency department were included. Demographics, clinical and laboratory data, Injury Severity Score (ISS), volume of transfused blood products and crystalloid boluses in 24 h were recorded. Massive transfusion (MT) was defined as transfusion of ≥40 mL/kg of all blood products in 24 h., Results: Among 32 cases, 8 (25.0 %) patients met the MT threshold criterion. Length of pediatric intensive care unit (PICU) stay and mechanical ventilation (MV) were longer for patients who received MT although there was no difference for age, ISS, volume of crystalloid boluses, length of hospital stay, and 30-day mortality between those who received MT or not. Volume of crystalloid boluses was higher in patients who died than those who survived but the volume of blood products was similar for two groups. An APTT value of >37.5 s was identified as a predictor of 30-day mortality (OR = 48.000, 95 % CI: 3.704-621.998, p: 0.003)., Conclusion: Children who received MT had longer durations of MV and PICU stay than those who did not receive, but there was no significance for ISS, volume of crystalloid boluses, hospital stay, or mortality between two groups. Volume of crystalloid boluses was higher in patients who died than those who survived. An APTT value of >37.5 s can be used to predict 30-day mortality., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: This pilot randomized controlled experimental study was conducted to investigate effects of music on sleep quality and comfort levels of pregnant women., Methods: The sample of the study consisted of 70 pregnant women who met the inclusion criteria and agreed to participate in the study. The pregnant women were assigned to the music (n=35) and control groups (n=35). In the study, the musical pieces composed in Uşşak mode were played for the participants in the music group. The pregnant women in the music group were first asked to empty their bladder and then listen to music for 30 min in a semi-Fowler's position with their head and shoulders raised 30°, in a quiet and dim environment, every other day for two weeks before going to sleep. The Pregnant Information Form, Prenatal Comfort Scale (PCS) and Pittsburgh Sleep Quality Index - 1 week (PSQI-1 week) were used to collect the study data., Results: The analysis of the mean scores obtained from the overall PSQI-1 week by the pregnant women in the music and control groups by weeks demonstrated that there was a statistically significant difference between the music and control groups in the second week (p<0.05). There was no statistically significant difference between the two groups in terms of the mean scores they obtained from the overall PCS (p>0.05)., Conclusions: Music increased the sleep quality of the pregnant women in the music group, but had no effect on their comfort levels., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Background An important aspect of developing and maintaining a high-quality standardized patient (SP) program is incorporating quality assurance processes. Trainer and instructor feedbacks are considered critical in achieving these goals. The aim of this study is to determine programmatic and systematic issues in the scope of quality assurance and improvement through trainer and instructor feedback on SP performance. We also presented a logic model based on a synthesis of the current literature to ensure the development and maintenance of a quality management culture in the SP program. Methods A retrospective analysis of SP scoring was conducted, and written feedback forms completed by trainers and instructors in a large Canadian university's SP program were collected. The previous six years (2014-2020) of SP feedback forms in the scope of quality assurance were reviewed and analyzed. Descriptive statistics were utilized to analyze the ratings. Thematic analysis was conducted on the data gathered from the written feedback. Results A total of 138 feedback forms were reviewed and analyzed in the study. The mean ratings given by the trainers for feedback and professionalism were 4.27 ± 1.29 and 4.77 ± 0.8, respectively. The mean ratings given by the instructors for knowledge of case information, appropriate responses, and affect were 4.84 ± 0.64, 4.86 ± 0.35, and 4.71 ± 0.76, respectively (from a range of 1 to 5). Four key themes emerged from the written feedback: nonverbal behaviors in simulation activity or feedback sessions, providing feedback from the patient perspective, consistency between role portrayal and scenario, and adapting easily to changing situations. Conclusions Component scoring on SP performance did not discriminate individual issues, but the qualitative comments identified certain specific issues. Further research is needed to establish standards of continuous quality improvement (CQI) within an SP program., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Uzelli Yılmaz et al.)

Background: Infantile Spasms Syndrome (ISS) encompasses both West syndrome (WS), comprising epileptic spasms, psychomotor stagnation or regression and hypsarrhythmia, and also infants presenting with epileptic spasms who do not fulfill the triad of WS., Objective: To investigate the knowledge, attitude, and practice regarding ISS among Turkish pediatricians and pediatric residents., Methods: A cross-sectional study was conducted among pediatricians and pediatric residents from all regions of Turkey. Knowledge, attitude, and practice (KAP) about ISS were assessed using a questionnaire including 45 questions., Results: Out of 174 participants, 91.4% of respondents thought that ISS was a type of epilepsy. The two most recognized etiologic causes were structural abnormalities (90.8%) and genetic disorders (90.2%). Infantile colic (78.7%) and gastroesophageal reflux (75.9%) were reported to be the most common confusing diagnoses in this study. Almost all the respondents agreed that EEG recordings should be obtained for a patient with suspected ISS. Half of the participants stated that steroids were the first choice for treatment. Nearly all participants agreed on referring a pediatric patient with suspected ISS to a pediatric neurologist., Conclusion: Our findings highlight the importance of medical education as awareness is critical for diagnosing ISS. To facilitate rapid diagnosis, it is also important to combine medical education with public action. To ensure a sufficient level of knowledge about epileptic spasms and ISS, a strategy based on the socio-cultural characteristics of each population should be developed., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Agricultural pollutants are harmful components threatening human health, wildlife, the environment, and the ecosystem. To avoid their exposure, developing prevention and detection systems with high sensitivity and selectivity is required. Most conventional methods, including molecular and chromatographic techniques, cannot be adopted for outdoor on-site detection even though they can provide sensitive and selective detection. Thus, detection platforms that can provide on-site detection via miniaturized and high throughput systems should be developed. As an alternative method, surface-enhanced Raman scattering (SERS) provides unique information about the substances in the presence of plasmonic nanostructures, and it can be portable with the use of portable detection systems and spectrometers. In this study, on-site detection of agricultural pollutants through SERS is reviewed. Three different types of agricultural pollutants were pointed out. On-site detection of biological pollutants, including bacteria and viruses, is reviewed as the first type of pollutant. As a second type, the detection of pesticides, antibiotics, and additives are focused on as chemical pollutants. The third group includes the detection of microplastics and also nanoparticles from the environment., Competing Interests: Conflict of interestThe authors declare no competing interests., (© Qatar University and Springer Nature Switzerland AG 2022.)

Background: The present study aimed to assess the efficacy of non-invasive ventilation (NIV) on the clinical course, oxygenation, need for invasive mechanical ventilation (IMV), and outcomes for children with pulmonary edema after drowning., Methods: We conducted a retrospective chart review. Children who were referred to the pediatric emergency department due to drowning-related pulmonary edema and underwent NIV between May 2014 and October 2020 were included. Demographics, vital signs, clinical findings, and results of laboratory and radiologic investigations were recorded. Patients were divided into six groups using the Szpilman classification system. The need for IMV, the need for pediatric intensive care unit admission, and the length of NIV treatment and stay in the pediatric intensive care unit were recorded for each patient., Results: Twenty-five patients were enrolled. According to the Szpilman classification, 13 (52.0%) patients were evaluated as grade 3 and 12 (48.0%) as grade 4. All patients were treated with bi-level positive airway pressure in the spontaneous / timed mode. A significant increase in oxygen saturation (SpO₂) and SpO₂/fraction of inspired oxygen ratios was observed from the beginning of NIV treatment and this increase was also observed for the second and fourth hours. There was a decrease in respiratory rate at the fourth hour of NIV treatment. No patient subsequently deteriorated to require IMV., Conclusions: We have reported a favorable clinical course of drowning patients who underwent early use of NIV in the pediatric emergency department. Management of drowning patients with pulmonary edema by NIV with close follow-up can be successfully applied in selected cases., (© 2021 Japan Pediatric Society.)

Objective: The objective of this study was to evaluate physical examinations, imaging, and laboratory analyses individually and combined using innovative statistical analysis methods for the accurate diagnosis of pediatric appendicitis., Methods: Patients admitted to hospital with symptoms of abdominal pain whose pediatric appendicitis scores greater than 3 were included in the study. Clinical, radiologic, and laboratory findings and as a new biomarker calprotectin (CPT) concentrations were evaluated individually and combined using artificial neural networks (ANNs), which revealed latent relationships for a definitive diagnosis., Results: Three hundred twenty patients were evaluated (190 appendicitis [43 perforated] vs 130 no appendicitis). The mean ± SD age was 11.3 ± 3.6 years and 63% were male. Pediatric appendicitis scores, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin (PCT) and CPT concentrations were higher in the appendicitis group; however, only WBC and ANC were higher in first 24 hours of pain. White blood cells and CRP were diagnostic markers in patients whose appendix could not be visualized using ultrasonography (US). On classic receiver operating characteristic (ROC) analysis, the areas under the curve (AUCs) were not strong enough for differential diagnosis (WBC, 0.73; ANC, 0.72; CRP, 0.65; PCT and CPT, 0.61). However, when the physical examination, US, and laboratory findings were analyzed in a multivariate model and the ROC analysis obtained from the variables with ANN, an ROC curve could be obtained with 0.91 AUC, 89.8% sensitivity, and 81.2% specificity. C-reactive protein and PCT were diagnostic for perforated appendicitis with 0.83 and 0.75 AUC on ROC., Conclusions: Although none of the biomarkers were sufficient for an accurate diagnosis of appendicitis individually, a combination of physical examination and laboratory and US was a good diagnostic tool for pediatric appendicitis., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: In this study, it was aimed to determine the relationship between quality of life and the fear experienced due to the COVID-19 pandemic., Method: This cross-sectional descriptive study was conducted with a total of 1060 participants from Turkey's 65 provinces. The research data were collected through an online questionnaire consisting of three parts: "Personal Information Form", "The Fear of COVID-19 Scale (FCS)" and "World Health Organization Life Quality Scale-Short Form (WHOQOL-BREF)". Independent two-group t-test (Student's t-test), and one-way ANOVA test were used to compare the means of groups. The Pearson Correlation Coefficient was calculated to determine the level of correlation between two independent continuous variables. A value of p < .05 was accepted as the threshold for statistical significance., Results: The fear levels of women, married individuals and primary school graduates were found to be high, while quality of life was low among participants with poor economic status, those with COVID-19 symptoms and subjects who had been in close contact with a COVID-19-positive patient. In addition, there was an inverse relationship between the level of fear related to COVID-19 and quality of life (physical and psychological health)., Practice Implications: Nurses are recommended to develop new care and evaluation strategies that will cover psychosocial and economic areas, as well as physical health, in order to protect and maintain the well-being of individuals during the COVID-19 pandemic., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The objective of the present study was to the determine the accuracy of point-of-care ultrasound (POCUS) in assessing closed reduction (CR) of pediatric forearm fractures in a pediatric emergency setting., Methods: After determination of the need for CR using X-ray images by an orthopedic consultant, POCUS examinations were performed just before and after the reduction attempt. The transducer was positioned longitudinally over the dorsal, volar, and lateral surfaces of the radius and ulna to view the fracture site. The presence of angulation, displacement, or bayonetting of the fracture fragments was recorded. The adequacy of realignment according to the POCUS and the orthopedic consultant's final determination were recorded., Results: Sixty-two patients were enrolled in the study and 96 bones were evaluated. The sensitivity and specificity of POCUS for adequacy of CR were 95.8% [95% confidence interval (CI): 88.3-99.1)] and 95.8% (95% CI: 78.8-99.8), the positive predictive value was 98.5% (95% CI: 91.0-99.7), and the negative predictive value was 88.4% (95% CI: 71.6-95.8). The corresponding positive and negative likelihood ratios were 23 (3.37-156.77) and 0.04 (0.01-0.12). There was high agreement between POCUS and X-ray images for predicting adequacy of CR [κ: 0.892 (±0.053)]. There was also a significant correlation between POCUS and X-ray measurements of angulation and displacement performed before and after CR, respectively (p < 0.001)., Conclusion: Our study has reported the successful use of POCUS for the management of pediatric forearm fractures in a pediatric emergency department. Point-of-care ultrasound can minimize radiation exposure and appears to be an alternative and accurate tool for reduction attempts., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Wound healing is an essential physiological process involving many cell types and their products acting in a marvellous harmony to repair damaged tissues. During the healing process, cellular proliferation and extracellular matrix remodelling stages could be interrupted by undesired factors including microorganisms and altered metabolic activities. In such a case, the process requires some external stimulants to accelerate or remediate the healing stages., Methods: In this study, we report a multifunctional wound healing stimulating agent. In this context, hexagonal boron nitride (hBN) nanoparticles, silver nanoparticles (AgNPs) and polydopamine(pdopa) were used through mussel-inspired chemistry of dopamine to obtain pdopa coated hBN (hBN@pdopa) and AgNPs decorated hBN@pdopa (hBN@pdopa-AgNPs). These two nanostructures were investigated to observe stages of healing., Results: AgNPs were chosen for inflammation reduction and hBN for induced cell proliferation and migration. In in vitro experiments, firstly, high cellular uptake capacity and biocompatibility of hBN@pdopa and hBN@pdopa-AgNPs were evaluated. They were also tested for their reaction against increased concentration of reactive oxygen species (ROS) in injured cells. Finally, their effect on cellular migration, intracellular tube formation and F-actin organization were monitored by light and confocal microscopy, respectively., Conclusion: The results clearly indicate that the hBN@pdopa-AgNPs significantly decrease ROS production, promote wound closure, and reorganize tube formation in cells., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background/aim: This study aimed to analyze the serum melatonin levels and changes in sleep patterns in pediatric patients with coronavirus disease 2019 (COVID-19)., Materials and Methods: This study was designed as a descriptive, cross-sectional study. Serum melatonin levels and sleep parameters of children with the diagnosis of COVID-19 who had mild and moderate disease (i.e., COVID-19 group) were compared with those of children admitted with non-COVID-19 nonspecific upper respiratory tract infection (i.e., control group). The sleep disturbance scale for children (SDSC) questionnaire was applied to the participants› primary caregivers to analyze their sleep patterns at present and six months before symptom onset and to investigate the impact of COVID-19 on sleep patterns., Results: The entire study cohort consisted of 106 patients. The COVID-19 group included 80 patients, while the control group consisted of 26 patients. The mean serum melatonin levels were 136.72 pg/mL and 172.63 pg/mL in the COVID-19 and control groups, respectively (p = 0.16). There was no significant difference between the groups in terms of 6 subcategories of the SDSC questionnaire regarding the present time and 6 months before symptom onset. The total SDSC scores were also similar in two different evaluation time points described above (p = 0.99), Conclusions: We conclude that COVID-19 did not impact the sleep parameters of children. Serum melatonin levels of all patients were higher than the reference range; however, they were higher in the non-COVID-19 patient group than the COVID-19 group. Since serum melatonin levels were higher than the reference values in children with COVID-19, and this disease is significantly less morbid in children, melatonin may have protective effects against COVID-19., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

In this study, the albedo factors (number, energy, and dose) of some boron compounds were investigated at a scattering angle of 180°. Eight boron compounds were tested in the mean atomic number range of 4.571 ≤ Z‾ ≤ 19.00. The samples were irradiated by gamma rays emitted at 59.54 keV from an Am-241-point source with an activity of 0.43 MBq. The scattered gamma rays were counted by an ultra-low energy germanium detector with a resolution of 140 eV at 5.9 keV. The results showed that the albedo factors decreased as the mean atomic number increased. The correlations between the albedo factors and mean atomic numbers were also high., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

In addition to tetrahydrobiopterin deficiencies and phenylalanine hydroxylase deficiency (phenylketonuria) due to PAH variants, the deficiency of the co-chaperone protein DNAJC12 was identified in 2017 as a novel cause of inherited hyperphenylalaninemia, revealing the genetic etiology in previously unresolved cases. In this study, we aimed to investigate DNAJC12 deficiency in non-tetrahydrobiopterin-deficient persistent hyperphenylalaninemia cases without biallelic PAH variants in a single pediatric metabolic center. It was determined retrospectively that 471 patients with non-tetrahydrobiopterin deficiency-hyperphenylalaninemia had undergone PAH gene sequencing and 451 patients had biallelic variants in PAH. DNAJC12 sequencing was performed in the remaining 20 patients, identifying a previously reported homozygous splice-site variant (c.158-2A > T) in one patient with axial hypotonia and developmental delay, and a novel, homozygous c.404del (p.Arg135Lysfs*21) frameshift variant in an asymptomatic patient. In segregation analysis, the asymptomatic patient's both parents were also found to be homozygous for this variant and hyperphenylalaninemic. The parents may have had academic difficulties but intellectual disability could not be confirmed due to lack of cooperation. The symptomatic patient significantly benefited from treatment with sapropterin dihydrochloride and neurotransmitter precursors. DNAJC12 deficiency might be responsible for approximately 10% or more of cases with unexplained hyperphenylalaninemia. The phenotypic spectrum is broad, ranging from early infantile hypotonia to incidental diagnosis in adulthood. Similar to tetrahydrobiopterin deficiencies, early diagnosis and treatment with sapropterin dihydrochloride and neurotransmitter precursors can be beneficial, supporting the analysis of DNACJ12 gene in patients with unexplained hyperphenylalaninemia., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In this study, we measured the effective atomic numbers of some boron compounds (H 4 BNa, H 3 BO 3 , Na 2 B 4 O 17 H 20 , B 4 C, BN, NaCaB 5 O 17 H 16 , B 2 O 3 , Ca 2 B 6 O 16 H 10 , Zn 2 B 6 O 14 H 6 , TiB 2 , Fe 2 B, Ni 3 B, ZrB 2 , and LaBO 3 ) by using 59.54 keV energy gamma rays emitted from an Am-241 radioactive source. Rayleigh and Compton scattering peaks were detected using a high purity germanium detector with a resolution of 182 eV at 5.9 keV. In addition, the effective atomic numbers of the boron compounds were theoretically calculated by using WinXCOM code. We concluded that the calibration curve obtained can be used for the qualitative analysis of compounds with effective atomic numbers in the range of 3.95 ≤ Z ≤ 54.15 because the experimental and theoretical effective atomic numbers were in very good agreement., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: COVID-19 is an emerging disease of global public health concern., Aims: To evaluate the epidemiological, clinical, laboratory, and radiologic findings and the clinical outcomes of children who were diagnosed with SARS-CoV-2 by polymerase chain reaction (PCR), and to evaluate the effect of the trends in intervention measures., Study Design: Between April 2, 2020 and January 16, 2021, children aged 0-18 years who had presented at the pediatric emergency department and were diagnosed with confirmed SARS-CoV-2 by PCR were enrolled., Methods: Details on demographics, epidemiologic characteristics, clinical findings, laboratory data, and radiologic investigations, hospital admissions, and prognosis were recorded. According to clinical severity, patients were divided into 5 groups as asymptomatic, mild, moderate, severe, or critical. We classified the outbreak into 3 periods. The first was between April 2, 2020, the date when the first pediatric case of our hospital was detected, and June 1, 2020, when restrictive measures were relaxed. The second period was between June 1, 2020 and November 15, 2020, when restrictive measures were reimplemented. The third period was between November 15, 2020 and January 16, 2021., Results: A total of 600 patients [median age: 10.3 years (IQR: 4.4-15.1); 304 females] were enrolled. Among them, 25.0% were asymptomatic, while the 3 most common symptoms among symptomatic cases were fever, cough, and fatigue. There was contact with a COVID-19 PCRpositive individual in 73.5% of the cases, with 76.6% of those being a household contact. There were 23 (3.9%) moderate, severe, or critical cases in terms of clinical severity. The presence of chronic disease, a pathological physical chest examination, and procalcitonin levels of >0.05 ng/mL were identified as predictors of being moderate, severe, or critical. Twenty-four (4.0%) patients were admitted to the hospital; 14 (2.3%) to the ward and 10 (1.6%) to the pediatric intensive care unit. In the second intervention period, we observed a rapidly increasing number of new cases daily, especially in August. From September, an increase was observed, being particularly marked from October to November 18. Since then, there was a decrease in the daily number of cases., Conclusion: The majority of the cases were asymptomatic or had a mild clinical presentation. The presence of chronic disease, a pathological physical chest examination, and procalcitonin levels of >0.05 ng/mL were identified as predictors of being moderate, severe, or critical in terms of clinical severity. Strict intervention measures seem to be effective in containing the spread of COVID-19.

Background: Bedside sonographic assessment of the optic nerve sheath has gained popularity for evaluating intracranial pressure in recent years., Objective: To investigate the bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball diameter ratios, which are related with cerebral edema (CE), in children with diabetic ketoacidosis (DKA) before and after treatment., Methods: Children aged 12 months to 18 years, who were diagnosed with DKA were included. The ONSD was measured at 3 mm posterior to the globe in the anterior axial transbulbar view. The eyeball transverse diameter (ETD) and eyeball vertical diameter (EVD) were measured and ratios of ONSD/ETD and ONSD/EVD were calculated. Bedside ultrasound (US) examinations were performed at the beginning and at the end of fluid therapy., Results: About 43 patients were enrolled. About 12 (27.9%) patients had mild, 14 (32.6%) moderate, and 17 (39.5%) severe DKA. At baseline, the ONSD measurements and ratios were significantly higher in severe DKA group than in those with mild or moderate DKA group. All ONSD measurements, ONSD/ETD, and ONSD/EVD ratios at the end of therapy were significantly lower compared with baseline measurements. At the end of therapy, ONSD measurements and ratios were similar among DKA severity groups., Conclusion: The ONSD measurements and ratios decreased from the beginning of DKA treatment, which could be considered as an indicator of an increase in intracranial pressure at the time of admission. Ocular US may serve as a promising tool to perform further risk stratification of children with DKA and to identify DKA-related CE., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia., Methods: Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated., Results: There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values., Conclusion: DUS can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes., (© 2021 Wiley Periodicals LLC.)