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Aim: Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome with a high mortality rate and has been labeled a global pandemic in March 2020. Gaucher Disease (GD) is one of the rare inherited lysosomal storage diseases (LSDs). We aimed to call attention to the frequency, susceptibility of COVID-19 infection, and the factors that prevent this infection in patients with GD as compared to other LSDs. Material and Methods: The study was conducted retrospectively between September and December 2020. Participants were divided into two groups: GD group (19 patients) and the control group (19 patients, those with other LSDs). All patients were contacted by phone to collect data about their health status, and any possible contact with Covid-19 patients. Results: Six of the GD patients (36.8%) had contacted a confirmed COVID-19 infected person but only three (15.8%) had developed a mild COVID-19 with fever and fatigue that did not require hospital admission. Four of the control group patients (21.1%) had experienced contact with a person with a confirmed COVID-19 infection. Three of the control group patients, that comprised of patients with various LSDs other than GD (15.8%) were positive on COVID-19 PCR tests and two of them had developed a mild COVID-19 infection. One of these (with Mucopolysaccharidosis type 1) had severe symptoms and required hospitalization. Conclusion: There is no consensus on the management of rare diseases such as lysosomal storage diseases during the COVID-19 pandemic. Developing plans regarding the management of COVID-19 infections in LSDs will be useful when drawing up consensus guidelines.

There is limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination associated myocarditis.We aimed to define the myocardial damage occurring after BNT162b2 vaccination, raise awareness about adverse reactions developing after vaccination, and determine the patterns and scope of Cardiac magnetic resonance imaging (MRI) findings.A total of 9 patients diagnosed with vaccine-associated myopericarditis were followed up.The mean age of the patient at diagnosis was 15.3 ± 1.0 (range: 14-17) years, and all patients were male. Seven patients presented with myocarditis symptoms after their second vaccine dose, one patient presented with pericarditis symptoms after his first dose, and the other patient presented with myocarditis symptoms after his booster dose. The median time at presenting to the hospital was 3 (range: 2-22) days. Seven (77.7%) patients had abnormal electrocardiography (ECG) findings, and the most prevalent finding was diffuse ST-segment elevation. Initial cardiac MRI results were abnormal in all patients, where 8 (88.8%) patients had late gadolinium enhancement, and 5 (55.5%) had myocardial edoema. Three patients showed local left ventricular wall-motion abnormalities. In their follow-up MRIs 3-6 months later, myocardial edoema was present in 2 (28.5%) patients, while late gadolinium enhancement was present in all patients (7/7, 100%, 2 patients did not have control MRI time). Hypokinetic segments were still present in one of the 3 patients. No negative cardiac events were observed in the short-term follow-up of any patient.Further follow-up evaluation and larger multicenter studies are needed to determine the clinical significance of persistent cardiac MRI abnormalities.

Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers. Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study. Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it. Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.

Objective Encouraged by reports of favorable outcomes following the use of corticosteroids in patients with moderate-to-severe coronavirus 2019 (COVID-19) pneumonia, we aimed to present our experience with early short-term corticosteroid use at our center in pediatric patients with COVID-19 pneumonia. Methods One hundred and twenty-nine pediatric patients were included in the study. Patients were divided into four groups according to the type and dose of corticosteroids given: Group 1 (those receiving dexamethasone 0.15 mg/kg/d); Group 2 (those receiving methylprednisolone 1 mg/kg/d); Group 3 (those receiving methylprednisolone 2 mg/kg/d); and Group 4 (those receiving pulse methylprednisolone 10–30 mg/kg/d). Results Of 129 patients, 19 (14.7%) patients were assigned to Group 1, 30 (23.3%) patients to Group 2, 30 (23.3%) patients to Group 3, and 50 (38.8%) patients to Group 4. Thirty-two (24.8%) patients were followed in the pediatric intensive care unit (PICU), of whom 13 (10%) required mechanical ventilation, and 7 (%5.4) died. In Group 4, the hospitalization length was significantly longer than in other groups (p Conclusion Although children usually have a milder course of COVID-19 than adults, underlying diseases and obesity increase the severity of disease manifestations also in children. Further studies are needed to define the exact role of corticosteroids in COVID-19 patients.

İmmün trombositopenik purpura (İTP), izole trombositopeni ile kendini gösteren hematolojik bir hastalıktır. Etiyolojisinde son bir aydaki viral enfeksiyonlar sıklıkla bulunur. COVİD-19 enfeksiyonu sonrası çeşitli hematolojik komplikasyonların yanı sıra ITP gelişimi de görülebilmektedir. Bu yazıda COVİD-19 enfeksiyonu sırasında teşhis edilen ve kanama bulgusu olmayan bir çocuk akut ITP olgusu sunulmaktadır.

In this study, it was aimed to evaluate the demographic, clinical and laboratory characteristics of MIS-C patients in our hospital, to share our treatment approach, and to assess the outcomes of short- and long-term follow-up.MIS-C patients who were admitted and treated in our hospital between July 2020 and July 2021 were evaluated. Demographic, clinical, laboratory, and follow-up data were collected from patient records retrospectively.A total of 123 patients with MIS-C (median age, 9.6 years) were included the study. Nineteen (15.4%) were mild, 56 (45.6%) were moderate, and 48 (39%) were severe MIS-C. High CRP, ferritin, pro-BNP, troponin, IL-6, and D-dimer values were found in proportion to the severity of the disease (p 0.001, p 0.001, p 0.001, p 0.001, p = 0.005, p 0.001), respectively. Two (1.6%) patients died. The mean follow-up period was 7.8 months. Valve failure, left ventricular dysfunction/hypertrophy, coronary involvement, and pericardial effusion were the most common cardiac pathologies in the short- and long-term follow-up of the patients. In the long-term follow-up, the most common reasons for admission to the hospital were recurrent abdominal pain (14.2%), cardiac findings (14.2%), pulmonary symptoms (8%), fever (7.1%), neuropsychiatric findings (6.2%) and hypertension (3.5%). Neuropsychiatric abnormalities were observed significantly more common in severe MIS-C patients at follow-up (p = 0.016). In the follow-up, 6.2% of the patients required recurrent hospitalization.MIS-C is a serious and life-threatening disease, according to short-term outcomes. In addition to the cardiac findings of patients with MIS-C, long-term outcomes such as neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms should be monitored. Key Points • In MIS-C patients, attention should be paid not only to cardiac findings, but also to symptoms related to other systems. • Patients should be followed up in terms of neuropsychiatric findings, persistent gastrointestinal symptoms, fever and pulmonary symptoms that may occur during follow-up.

Background: This study investigated whether SARS-CoV-2 infection, depression, anxiety, sleep problems, cigarette, alcohol, drug usage contribute to psychotic-like experiences (PLEs) among adolescents during the pandemic. We also aimed to explore whether baseline inflammatory markers or the number of SARS-CoV-2-related symptoms are associated with PLEs, and the latter is mediated by internalizing symptoms. Methods: Altogether, 684 adolescents aged 12–18 (SARS-CoV-2 group n = 361, control group (CG) n = 323) were recruited. The Community Assessment of Psychic Experiences-42-Positive Dimension (CAPE-Pos), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Pittsburg Sleep Quality Index (PSQI) questionnaires were completed by all volunteers using an online survey. C-reactive Protein and hemogram values, and SARS-CoV-2-related symptoms during the acute infection period were recorded in the SARS-CoV-2 group. Group comparisons, correlations, logistic regression, and bootstrapped mediation analyses were performed. Results: CAPE-Pos-Frequency/Stress scores were significantly higher, whereas GAD-7-Total and PSQI-Total scores were significantly lower in SARS-CoV-2 than CG. Among the SARS-CoV-2 group, monocyte count and the number of SARS-CoV-2-symptoms were positively correlated with CAPE-Pos-Frequency/Stress scores. Besides SARS-CoV-2, cigarette use, GAD-7, and PHQ-9 scores significantly contributed to the presence of at least one CAPE-Pos “often” or “almost always”. PHQ-9 and GAD-7 fully mediated the relationship between the number of SARS-CoV-2 symptoms and CAPE-Pos-Frequency. Conclusions: This study is the first to show a possible relationship between SARS-CoV-2 infection and PLEs among adolescents. Depression, anxiety, and cigarette use also contributed to PLEs. The number of SARS-Cov-2-symptoms and PLEs association was fully mediated by internalizing symptoms, but prospective studies will need to confirm this result. © 2021

Bruselloz pastörize edilmemiş süt ve süt ürünlerinin ağız yoluyla alınmasıyla veya enfekte hayvan salgılarıyla yakın temas yoluyla bulaşan, gram negatif bir kokobasil olan Brucella türlerinin neden olduğu ülkemizde de yaygın olarak görülen zoonotik bir hastalıktır. Bruselloz özgül olmayan semptom ve bulgulara sahip olması nedeniyle diğer birçok hastalığı taklit edebilir. Kırım Kongo Kanamalı Ateşi (KKKA) brusellozun ayırıcı tanısında yer alan zoonotik bir hastalıktır. Bu yazıda KKKA ön tanısı ile hastanemize sevk edilen ve bruselloz tanısı konulan iki pediatrik olgu sunulmuştur., Brucellosis is a common zoonotic disease in our country caused by Brucella species, a gram negative coccobacillus that is transmitted by oral ingestion of unpasteurized milk and dairy products or by close contact with infected animal secretions. Because brucellosis has nonspecific symptoms and findings, it can mimic many other diseases. Crimean-Congo Hemorrhagic Fever (CCHF) is a zoonotic disease included in the differential diagnosis of brucellosis. In this article, two pediatric cases referred with a pre-diagnosis of CCHF and diagnosed with brucellosis were presented.

Introduction The aim of this study was to make the differential diagnosis between acute appendicitis and multisystem inflammatory syndrome in children (MIS-C) for patients presenting with the complaint of acute abdominal pain (AAP) and to identify the determining factors for the diagnosis of MIS-C. Materials and Methods Eighty-one children presenting with AAP/suspected AAP were evaluated. Of these, 24 (29.6%) were included in the MIS-C group (MIS-C/g) and 57 were included in the suspected appendicitis group (S-A/g), which consisted of two subgroups: appendicitis group (A/g) and control observation group (CO/g). Results Comparing MIS-C/g, A/g, and CO/g, duration of abdominal pain (2.4, 1.5, 1.8 days), high-grade fever (38.8, 36.7, 37°C), severe vomiting, and severe diarrhea were higher in MIS-C/g. Lymphocytes count (LC) was lower, while values of C-reactive protein (CRP), ferritin, and coagulopathy were higher in MIS-C/g (p Conclusion The duration of abdominal pain, presence of high-grade and prolonged fever, and evaluation of hemogram in terms of high neutrophil count and low LC exhibit high sensitivity and negative predictive value for MIS-C presenting with AAP. In case of doubt, inflammatory markers such as CRP, ferritin, D-dimer, and serology for SARS-CoV-2 should be studied to confirm the diagnosis.

Community-acquired pneumonia (CAP) in children continues to be one of the prominent causes of pediatric morbidity and mortality worldwide. By determining the risk factors associated with the development of complicated CAP (CCAP), new approaches for early diagnosis and effective treatment can be identified.This retrospective cohort study enrolled patients with CAP and CCAP who visited the pediatric ward of the study hospital between January 1, 2017 and December 31, 2017. For patients with CCAP, data regarding medical procedures performed, surgical intervention, and hospitalization duration were collected.A total of 111 patients, 93 (83.7%) with CAP and 18 (16.3%) with CCAP, aged between 3 months and 18 years were hospitalized because of severe pneumonia. The mean age of the patients was 3.6 ± 1.2 years and 60 (54%) of them were female. The mean age of patients with CCAP was higher than that of patients with CAP (4.2 ± 3.3 vs. 2.8 ± 2.1 years respectively); however, the difference was not significant (p = 0.012). Patients with CCAP exhibited a significantly higher C-reactive protein level than those with CAP (10.06 ± 7.55 vs. 4.43 ± 3.37 g/L respectively; p = 0.007). Hypoxia upon admission was noted more commonly in the CCAP group than in the CAP group (p 0.001).Findings related to hypoxia, respiratory distress, and pleural effusion on imaging are important distinguishing factors associated with the development of complications in patients hospitalized with CAP. Therefore, CCAP etiology, diagnosis, and treatment approaches should be established and protective measures adopted.

Tetanus is an acute-onset disease that results from exposure to the exotoxins produced by Clostridium tetani. It is characterized by tonic muscle spasms and has high morbidity and mortality. Respiratory failure is the most severe problem related to generalized tetanus. Mechanical ventilation is almost always mandatory for the therapy of respiratory insufficiency in patients with tetanus-developed airway obstruction. The patient presented herein was 15 years old and unvaccinated, and had generalized tetanus and respiratory failure. He was transported to pediatric intensive care unit following intubation. In this report, we aimed to present the follow-up and treatment of a patient with severe tetanus in pediatric intensive care unit.

Concerns about the psychiatric sequelae after COVID-19 infection have increased as the pandemic spreads worldwide. The increase in self-isolation during this pandemic period has also revealed the importance of feelings of loneliness. This study aimed to examine the relationship between baseline inflammation levels, internalizing symptoms, and feelings of loneliness in adolescent COVID-19 survivors in the long term.A total of 74 adolescents (41 girls, 55.4%, mean age 14.88) and their parents were included in the study. This cross-sectional study assessed internalizing symptoms via Revised Children's Anxiety and Depression Scale (RCADS) and feelings of loneliness using the UCLA-loneliness scale. Baseline inflammatory markers at COVID-19 diagnosis were collected. Logistic regression analysis was used to determine predictors for depression in adolescents.The most common disorder was Major Depressive Disorder (MDD) (25.7%), and 33.8% of the adolescents were in the clinical range in at least one internalizing domain. Baseline C-Reactive Protein (CRP) levels correlated weakly with MDD scores. Loneliness scores correlated with all internalizing symptoms, strong association with MDD scores. Loneliness, anxiety, and parental anxiety were associated with an increased likelihood of MDD. Baseline CRP positivity did not predict MDD in adolescent COVID-19 survivors.This study indicates that anxiety, loneliness, and parental anxiety play an important role in adolescents' experience of depressive symptoms after COVID-19 infection. Thus, screening parental psychopathology and loneliness in COVID-19 survivors seems to be preventive for adolescent mental health problems.

Currently, there is not any specific effective treatment for COVID-19. There are many studies published and ongoing especially on adult patients. Treatment options in pediatric patients are determined according to the agents used in adult patients. Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Supportive therapy forms the basis of the treatment as the symptoms and disease course in children are mild. There are currently no randomized controlled trials of drugs that can be used to treat COVID-19 in children. However, in severe clinical cases, the drugs used in adults are evaluated and used on a case-by-case basis. There is a growing need for well-designed controlled clinical trials to better define the safety and efficacy of potential treatments for COVID-19 in children.

Background Burkholderia cepacia complex is an aerobic, non-spore-forming, catalase-positive, nonfermentative, Gram-negative bacterium common in environment. It is a serious pathogen especially for patients with cystic fibrosis (CF). But pathogenicity of Burkholderia is not limited to patients with CF. Herein, we aimed to reveal clinical patterns and outcomes of Burkholderia infections in pediatric patients in our hospital and also antimicrobial susceptibility of the isolated strain. Methods This retrospective study was conducted in Ankara Hematology Oncology Children's Training and Research Hospital. Patients with isolates of Burkholderia spp. between January 6, 2013, and January 12, 2018, were included in the study. Results Burkholderia spp. was isolated from 55 patients. 94.6% of these patients had underlying diseases and had prior hospitalization within a year. Burkholderia gladioli grew in 15 patients' samples (27.3%); 38 patients grew B. cepacia (69.1%). None of the patients that B. gladioli was isolated was diagnosed as CF;. all had nosocomial infections. B. gladioli seemed to be more susceptible to aminoglycosides, piperacillin-tazobactam, carbapenems and ciprofloxacin than B. cepacia (P = 0.00), whereas B. cepacia seemed to be more susceptible to ceftazidime than B. gladioli (P = 0.032). In addition, B. cepacia was more susceptible to trimethoprim-sulfamethoxazole and levofloxacin than B. gladioli, but this difference was not statistically significant (P = 0.76). Conclusions The incidence of nosocomial infections caused by Burkholderia spp. is rare especially in pediatric literature. In our study, nosocomial Burkholderia infections occurred mostly in intensive care unit patients. The surveillance of Burkholderia infections is still very important, and the clinicians should be aware of changing epidemiology and increasing resistance of the microorganism. Besides, there are no internationally agreed minimal inhibitory concentration breakpoints and disk-diffusion test thresholds for susceptibility testing for Burkholderia. Thus, the methods which were used for antibiotic susceptibility testing in our center might cause uncertainty about the results and internationally agreed minimal inhibitory concentration breakpoints and disk-diffusion test thresholds for susceptibility testing for Burkholderia is still a gap to fill for the current literature.

Background: Infectious complications are one of the most life-threatening complications and result in substantial mortality and morbidity in children who have been burned. The goal of the study is to assess the risk factors for sepsis in pediatric burn patients in a referral hospital. Methods: This study was performed at the Pediatric Burn Unit of Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital during the period between January 2014 and June 2017. The patients were evaluated for age, sex, burn etiology, burned body surface area (BSA), the presence of inhalation injury, sepsis, positive cultures, the micro-organisms cultured samples, and septic focus. Results: A total of 181 patients were included in the study. The most common cause of burns was scalds in 120 patients (66.3%). Forty-one patients (22.7%) developed health-care-associated infection and sepsis. Gram-negative micro-organisms were isolated in 40 (97.6%) patients (Acinetobacter spp., Pseudomonas aeruginosa, Klebsiella pneumonia) with sepsis. Carbapenem resistance was detected in 31 (93.8%) of 40 patients. Mortality was observed in 11 patients (6.1%) in the group with sepsis. Burn surface area, burn depth, C-reactive protein (CRP) values, mortality, Garces index, and Baux index were higher in the group with sepsis (p < 0.05). Multiple regression analysis revealed that mechanism of injury (flame), burned BSA >= 25%, C-reactive protein >= 6 mg/dL (area under the curve [AUC]: 0.76 p < 0.001 and AUC: 0.90, p < 0.001, respectively) at admission were independent parameters for development of sepsis in pediatric burn patients. Conclusion: Multi-drug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were important agents of blood stream infection in burned children. Burned BSA >= 25% and CRP >= 6 mg/dL were risk factors for developing sepsis in pediatric burn patients.

This study aimed to compare the effectiveness of 2% chlorhexidine gluconate in 70% alcohol with that of 10% povidone-iodine, for dressing changes in pediatric hematology-oncology patients with port catheters, in preventing catheter-related bloodstream infection (CRBSI).In this prospective, multicenter, observational, and cross-sectional study, 45 patients (25 patients for chlorhexidine, 20 patients for povidone-iodine) with port catheters were evaluated from January 2018 to May 2019. The sociodemographic, clinical, and port catheter-related variables were evaluated. The mean age of the patients was 6.28 ± 4.58 years, and 60% of patients were female.Among the patients whose dressings were changed using 2% chlorhexidine gluconate in 70% alcohol, the mean number of dressing changes was 39.52 ± 29.7 and the rates of exit-site infection and CRBSI were 20% (2.37/1000 catheter-days) and 16% (1.90/1000 catheter-days), respectively. Among the patients whose dressings were changed using 10% povidone-iodine, the mean number of dressing changes was 48.0 ± 31.48 and the rates of exit-site infection and CRBSI were 15% (1.59/1000 catheter-days) and 10% (1.06/1000 catheter-days), respectively. None of the patients developed pocket infections. The rates of CRBSI and exit-site infections were not different between the 2 antiseptic solutions.This study found no differences between the effectiveness of 2% chlorhexidine in 70% alcohol and that of 10% povidone-iodine solution in preventing CRBSI. Therefore, both solutions can be used in dressing changes.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a pandemic in mid-March of 2020.

Çocuklarda Multisistem İnflamatuar Sendrom (MIS-C), artmış inflamatuar yanıtla karakterize, SARS-CoV-2 enfeksiyonu ile ilişkili ciddi bir klinik durumdur. MIS-C, bakteriyel enfeksiyonlar dahil olmak üzere diğer pediatrik inflamatuar ve enfeksiyöz durumlarla ortak özellikler taşır. Yanlış tanıdan kaçınmak için MIS-C şüphesi olan hastalarda ayırıcı tanıda bakteriyel gastroenterit etkeni olarak Salmonella enfeksiyonları akılda tutulmalıdır. Bu raporda, SARS-CoV-2 enfeksiyonu için güçlü laboratuvar veya epidemiyolojik kanıtlarla birlikte semptomları ve bulguları nedeniyle başvuru sırasında öncelikle MIS-C tanısı düşünülmesine rağmen, kesin salmonelloz teşhisi konan pediatrik hastalardan oluşan bir vaka serisi sunulmuştur., Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe clinical condition associated with the SARS-CoV-2 infection characterized by an increased inflammatory response. MIS-C shares common features with other pediatric inflammatory and infectious conditions including bacterial infections. Salmonella infections should be kept in mind as a causative agent of bacterial gastroenteritis in the differential diagnosis of patients with suspected MIS-C to avoid misdiagnosis. In this report, a case series of pediatric patients with a final diagnosis of salmonellosis were presented, although a primarily diagnosis of MIS-C at admission was considered due to symptoms and findings together with strong laboratory or epidemiological evidence for SARS-CoV-2 infection.

OBJECTIVE: Although the initial reports of coronavirus disease (COVID-19) cases in children described that children were largely protected from severe manifestations, clusters of pediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease (KD), toxic shock syndrome (TSS), and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome (MAS). Our objective was to develop a protocol for the evaluation, treatment, and follow-up of patients with MIS-C. METHODS: The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of pediatric critical care, cardiology, rheumatology, surgery, gastroenterology, hematology, immunology, infectious disease, and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. CONCLUSION: Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a pediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C.

Healthcare-acquired infections (HAIs) have become a major concern and a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). The purpose of this study was to evaluate HAI rates as well as the rates of invasive device utilization at a PICU at a large tertiary care pediatric teaching hospital from a developing country over a 4-year period, and to compare findings with those of the National Health Safety Network United States, the International Nosocomial Infection Control Consortium, and Turkey's national HAI rates. An active prospective surveillance was performed at a tertiary care PICU from January 2014 to December 2017. It was especially analyzed for nosocomial infections, related to invasive devices: the central line catheter (CL), mechanical ventilator (MV), and the urinary catheter (UC). During the 4-year period, a total of 2,855 patient admissions and 30,499 patient-days were evaluated. The device-associated (DA)-HAI incidence density was 17.57 per 1,000 patient-days, and the incidence rate was 18.8 per 100 admissions. The most common site of the DA-HAIs was ventilator-associated pneumonia (VAP) with the highest rate (60.9%). The second was the central line-associated bloodstream infection (CLA-BSI) rate (24.8%). Catheter-associated urinary tract infections (CA-UTI) rank third (14.3%). The HAI location was VAP in 187 patients (11.31/1,000 MV-days), CLA-BSI in 76 patients (4.39/1,000 CL-days), and CA-UTI in 44 patients (3.35/1,000 UC-days). The most frequent pathogens, isolated from the overall DA-HAIs as being causative microorganisms were Acinetobacter baumannii (23%), followed by Pseudomonas aeruginosa (14%). Resistance of Acinetobacter baumannii to Carbapenem was 76.47%, and methicillin-resistance Staphylococcus aureus was 50% at the pediatric ICU. This study reported data on incidence rates as well as pathogens of HAIs from a developing country's PICU, which may later supply useful data about other pediatric hospitals.

Introduction:Community-acquired pneumonia(CAP) in children has tended to decrease in recent years with effective vaccination and treatments.However,the frequency of complicated community-acquired pneumonia (CCAP) is gradually increasing.By determining risk factors for the development of CCAP,new approaches for early diagnosis and effective treatment can be determined. Method: Records of 113 patients who were hospitalized due to CAP and CCAP between January 2017 and December 2017 were examined.Demographic characteristics of the patients,comorbid diseases,admission symptoms,physical examination findings,laboratory and imaging results, treatments, hospital stay and treatment response were recorded. Pleural effusion,if empyema developed in patients with CCAP,thoracentesis and/or chest tube insertion,fibrinolytic therapy,and the need for additional surgical intervention were investigated. Results:Our patients had a mean age of 3.6 ± 2.2, 60(53%) were female and 53(47%) were male.93 (82.3%) of the patients were diagnosed with CAP and 18(15.9%) were diagnosed with CCAP.Detection of pleural effusion at the admission of patients in multivariate logistic regression[(OR (95% CI),4.24 (1.77-10.16), p

The hepatosplenic (HS) form of cat scratch disease (CSD) is rarely seen; however, management of the treatment is challenging for clinicians. Monotherapy or combination regimens may be preferred based on severity of cases. Along with that, there are uncertainties as to the combination and duration of antibiotics effective against the microorganisms. In this report, a 12-year-old girl diagnosed with HS-CSD and unresponsive to primary treatment with macrolide group antibiotic was presented. The patient had liver findings compatible with CSD, confirmed radiologically and pathologically, and Bartonella henselae indirect immunofluorescence assay IgG was positive at 1/2048 titre. A combination therapy for six months with doxycycline and rifampicin was initiated, and the patient was successfully treated. The preference for monotherapy or combination regimen in HS-CSD is predominantly determined by the clinician according to the severity of the patient’s clinical findings. The effectivity of antimicrobial regimen in HS-CSD requires further investigation.

Severe acute respiratory syndrome causing coronavirus (SARS-CoV-2) is a new corona virus responsible for the pandemic named Coronavirus Disease 2019(COVID-19). Although the pathogenesis of the disease has not been completely understood yet, it may cause clinical pictures with various degrees of multisystem involvement(1,2).

AIMS: Recently, multisystem inflammatory syndrome in children (MIS-C) has been recognized in association with coronavirus disease 2019 as a cytokine storm syndrome. MIS-C presents with symptoms similar to Kawasaki disease and macrophage activation syndrome (MAS). We aimed to better understand this cytokine storm syndrome by comparing the initial laboratory findings of MIS-C and MAS. METHODS: Patients who were diagnosed with MAS due to systemic juvenile idiopathic arthritis in our clinic between March 2002 and November 2020 and with MIS-C between 20 September and 20 October 2020 were enrolled into the study. The medical files of all patients were reviewed retrospectively. RESULTS: A total of 13 MAS (9 boys, 4 girls) and 26 MIS-C (16 boys,10 girls) patients were included in the study. Hemoglobin, absolute neutrophil and lymphocyte counts, C-reactive protein (CRP), ferritin, fibrinogen and lactate dehydrogenase (LDH) levels showed significant differences between the two groups (P

Background: The role of combination regimens in the treatment of invasive fungal infections (IFI) in patients with hematologic malignancies remains unclear. This study was aimed to demonstrate experience data about combined antifungal therapy (CAT) in pediatric IFI patients with haematological malignancies. Methods: Between January 2014 and December 2017, a total of 33 IFI episodes in 28 patients with hematological malignancies were analyzed retrospectively. Results: Of the patients (19 with acute lymphoblastic leukemia, and 9 with acute myeloblastic leukemia), 21 (75%) had leukemia relapse and 7 (25%) had remission. IFI was classified as possible in 26 (78.8%) episodes, probable in 5 (15.1%) episodes, and proven in 2 (6.1%) episodes. LamB (%50) was the most preferred agent in monotherapy. Mean duration of monotherapy was 12.84 ± 4.28 (5-24) days. LamB plus voriconazole (54.5%) were the most common combination preference in CAT. Mean duration of CAT was 42.36 ± 36.4 days, and unchanged according to combination regimen type (p = 0.571). Total mortality rate and IFI attributable mortality rate were 60.7% vs 76.5%. Mortality rate was significantly higher in patients with relapse (p = 0.006). Complete response was obtained in 81.8% of surviving patients. Duration of neutropenia and CAT, and recovery time were not found statistically different in the episodes with/without death and according to relapse or remission status. Side effects due to CAT use were observed quite low level. Conclusion: CAT has been found to be safe in IFI episodes of pediatric leukemia. The result will contribute to the data about combined antifungal use in daily clinical practice in pediatric haematological patients with IFI.

Development of pneumothorax during the course of COVID-19 is very rare, and may occur secondary to severe pulmonary involvement causing alveolar damage in the parenchyma, or is seen as a complication of respiratory support. Until now, quite a few cases have been reported. Herein, we shared a case of spontaneous pneumothorax with persistent air leakage without any parenchymal or pleural involvement.

Erken çocukluk döneminde komplikasyonlarının ağır seyretmesi ve uzun dönem morbiditesinin yüksek olması nedeniyle akut bakteriyel menenjit bu yaş grubunda en önemli enfeksiyonlar arasında yer alır. Menenjit etkenleri yaşa, konak faktörlerine, yaşanılan bölgelere göre farklılık gösterir. Menenjitin semptom ve bulguları sistemik enfeksiyonla ilişkili ateş, iştahsızlık, zayıf beslenme, baş ağrısı, üst solunum yolu enfeksiyon semptomları gibi nonspesifik bulgulardan, meningeal iritasyon bulguları, kafa içi basınç artışı sendromu ve nöbetlere kadar değişiklik gösterir. Akut bakteriyel menenjitin erken tanısı ve tedavisine hızla başlanması hastalığın prognozu açısından çok önemlidir. Tanıda altın standart yöntem, etkenin beyin omurilik sıvısında gösterilmesidir. Tedavi protokolü enfeksiyonun eradikasyonu için en kısa zamanda uygun antibiyotik tedavisinin başlanması, enfeksiyona bağlı sekellerin en aza indirilmesi ve eğer kardiyopulmoner bozukluk varsa destek sağlanmasıdır. Aşılama ve kemoprofilaksi bakteriyel menenjit gelişimini azaltan iki önemli antitedir. Türkiye’de pnömokok ve Hib aşılarının ulusal aşı programına dahil edilmesiyle meningokok menenjitinin görülme sıklığı artmıştır. Meningokok aşısı risk grubundakilere kuvvetle önerilirken, yaygınlığı dünyada bölgesel olarak değişiklik gösterdiğinden aşı tercihi, lokal epidemiyolojik ve ekonomik değerlendirmelere göre ülke bazında yapılmalıdır., In early chilhood, due to severe course of complications and long term morbidity, acute bacterial meningitis is one of the most important infection diseases. Causative agents are different according to age, host factors and living areas. Meningeal symptoms and findings vary from non-spesific findings such as fever, poor feeding, head ache, upper airway infection sypmtoms to meningial irritation findings,increased intracranial pressure syndrome and seizures. Early diagnosis and rapid treatment of acute bacterial meningitis is very important for the prognosis of the disease. The gold standart of the diagnosis is showing the agent in cerebrospinal fluid. The treatment protocol includes starting appropriate antibiotics rapidly, minimizing sequelaes due to infection and providing supportive treatment if there is a cardiopulmonary disorder. Vaccination and chemoprophylaxis are two important entities that reduce the development of bacterial meningitis. In Turkey since the addition of Hib and pneumococcal vaccines to national vaccine programme, the incidence of meningococcus meningitis has increased. While the meningococcal vaccine is strongly recommended for risk groups, since its prevalence varies regionally in the world, the choice of vaccine should be made on country basis according to local epidemiological and economic evaluations.

Infective endocarditis (IE) is an infection of the endocardium and/or heart valves that involves thrombus formation (vegetation). This condition might damage the endocardial tissue and/or valves. An indwelling central venous catheter is a major risk factor for bacteremia at-risked pediatric populations such as premature infants; children with cancer and/or connective tissue disorders. Herbaspirillum huttiense is a Gram-negative opportunistic bacillus that may cause bacteremia and pneumonia rarely in this fragile population. Herein we report the very first case of bacteremia and IE in a pediatric oncology patient caused by H. huttiense.

BackgroundCOVID-19 has a milder clinical course in childhood with significantly lower mortality than in adulthood. The presence of comorbid conditions such as cardiovascular disease and respiratory disease is thought to be associated with increased mortality in adults. There is very little information on the clinical course of COVID-19 in children with pre-existing comorbid conditions. MethodsWe retrospectively evaluated laboratory-confirmed pediatric COVID-19 at the Children’s Hospital of Ankara City Hospital. The patients were classified as those with and without pre-existing comorbid conditions and the two groups were compared for age, gender, clinical picture at presentation, the presence of severe disease, and pediatric intensive care unit (PICU) requirement. ResultsA total of 317 children were confirmed to have COVID-19 infection. A pre-existing comorbid condition was present in 59 (18.6%) and absent in 258 (81.4%). The rate of lower respiratory tract infection was significantly higher in the patients with comorbidities (p=0.012). None of our patients had severe disease on admission and severe disease did not develop during follow-up. ConclusionsOur results indicate that the clinical course of COVID-19 in children with pre-existing comorbid conditions may not be as severe as in adults, and lower respiratory infection may be more common in children with pre-existing comorbidities.

Since the outbreak of 2019 novel coronavirus infection (COVID-19) 5,698,246 cases were infected with COVID-19, there were 352,461 deaths. Various characteristics of COVID-19 were presented but to our knowledge this is the first pediatric case, an eight year old boy, presenting like Steven Johnson Syndrome. In patients with atypical presentations and pulmonary findings COVID-19 should be kept in mind.

Meningococcal conjugate vaccine was administered for the first time to pilgrims in 2018 in Turkey prior to their departure to the Hajj. This study aimed to determine the effect of vaccination on the prevalence of Neisseria meningitidis carriage among the pilgrims returning to Turkey. This prospective paired (departing and arriving) cohort study included pilgrims aged 10–80 years and compared N.meningitidis carriage before and after pilgrimage. Oropharyngeal samples were collected from 229 pilgrims before departing for Mecca, Kingdom of Saudi Arabia (KSA) and after their return to Turkey. Meningococcal carriage was detected in 3.9% (n = 9) at the time of departure; all positive samples were serogroup B. Upon returning to Turkey,1 (0.4%) pilgrim, who was not a carrier before pilgrimage, was positive for serogroup B. This study is the first to examine meningococcal carriage following the administration of conjugate vaccine to Hajj pilgrims from Turkey.

The routine use of pneumococcal conjugated vaccines (PCVs) in childhood has significantly reduced the frequency of invasive pneumococcal diseases (IPDs). Serotype replacement has occurred, resulting in an increase in nonvaccine serotypes. Despite this changing profile, both invasive and noninvasive cases continue to be seen with strains within the scope of PCV coverage. Although older children with comorbid disease are described as a risky group for vaccine insufficiency, vaccine failure patterns should be described in detail.

Kanik Yuksek S, Tezer H, Ozkaya Parlakay A, Gulhan B, Kara A, Ciftci E, Tapisiz A, Celik M, Ozdemir H, Aykac K, Demirdag TB, Tural Kara T, Hayran G, Ince E. Impact of the mandatory Hepatitis A immunization program: before and after the vaccine in Ankara, Central of Turkey. Turk J Pediatr 2019; 61: 677-685. In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vaccine was included in the mandatory vaccination schedule of Turkey on November 2012. We aimed to evaluate the cases of HAV infection followed in Ankara, which is located in the center of Central Anatolia, retrospectively according to the date of the administration of the mandatory hepatitis A vaccine. A total of 272 children followed-up between January 2008 and December 2015 for HAV infection in five separate hospitals were enrolled to the study. There were 200 (68.2%) cases in the pre-vaccination group, 72 (31.74%) cases in the post-vaccination group, and 55.1% were male in total. The immunization status were as follow; 89.7% (n = 244) unvaccinated, 0.4% (n = 1) vaccinated and 9.9% (n = 27) with unknown immune status. There was a statistically significant difference between the groups in hospitalization rates, but no statistically significant differences in hospitalization indications, length of hospital stay, complication types and proportions, and normalization period of transaminases. The national hepatitis A immunization program in Turkey has had a significant impact when the targeted population is considered, with suggestive herd protection effects.