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Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

Objective: Due to the hot climate of the Southeastern Anatolia Region, snake poisoning is common, which causes serious mortality and morbidity. We aimed to present the clinical course, complications and treatment approaches of patients hospitalized with snakebites. Methods: One-hundred and eight pediatric patients treated in the hospital for snakebites, excluding dry bite, were included in the study during a 5-year period. Gender, age, bite site, month, time, type of intervention in the field, symptoms, laboratory findings, complications, tetanus vaccination and antivenom administration were recorded by reviewing patient files. Results: The patients were aged between 10.2+3 (2-15) years and 72 (66.7%) were males. Seventy-three (67.6%) of patients were from rural areas. The bites were mostly from the lower extremity, at between 12-18 o’clock. Grade 1 patients were excluded from the study. At the time of admission, there were 47 (43%) grade 2 and 31 (28%) grade 3 patients. It was observed that with increased grade, higher levels of white blood cell count, glucose level and hospital stay were seen (p

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.

Objective: This study aims to investigate modes of transmission and clinical features of coronavirus disease 2019 in healthcare workers in pediatric intensive care units. Materials and Methods: This multicenter descriptive study was conducted between March and November 2020. Patient demographics, clinical characteristics, origin of coronavirus disease 2019, treatment modalities, and loss of workdays were recorded. Results: Seven hundred and sixty-eight healthcare workers from 16 pediatric intensive care units were enrolled and 114 (14.8%) healthcare workers with a mean age of 29.7 +/- 6.7 years became coronavirus disease 2019 patients. Seventy-six (66.7%) patients were female. Approximately half (54.3%) of the patients were physicians, 34.2% were nurses, and 11.4% were ancillary staff. Transmission was deemed to occur through patient contact in 54.3% of the patients. Comorbid illness was present 10.5% of the patients. Transmission occurred during endotracheal intubation in 21%, cardiopulmonary resuscitation in 9.6%, and non-invasive ventilation in 12.2% of patients, while transmission was a result of multiple possible procedures in 43.8%. Intensive care admission was needed for 13.1% of the patients. Five patients needed oxygen by cannula, 7 needed oxygen with a non-rebreathing mask, 5 needed high-flow nasal cannula support, 5 needed non-invasive ventilation, and 3 needed invasive mechanical ventilation. Fortunately, no infected healthcare workers died. Conclusion: Coronavirus disease 2019 in healthcare workers is a significant problem in pediatric intensive care units. Transmission seems to occur particularly frequently during patient care procedures such as intubation, ventilation and aerosol therapy, which highlights the importance of proper use of full sets of personal protective equipment during all procedures during care of coronavirus disease 2019 patients. WOS:000744060100015

Yılan zehirlenmeleri tropikal iklimin görüldüğü bölgelerde ciddi mortalite ve morbidite nedenidir. Güneydoğu Anadolu Bölgesi de sıcak iklimi nedeniyle yılan zehirlenmelerinin sık görüldüğü bir bölgedir. Bu tez çalışmamızda Dicle Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çocuk Acil Polikliniğine başvuran Çocuk Acil Kliniği, Büyük Çocuk ve Çocuk Yoğun Bakım Ünitelerine Ekim 2006- Mayıs 2011 tarihleri arasında yatırılarak tedavi edilen zehirli yılan ısırığı tanılı 108 çocuk olgu çalışma kapsamına alındı. Çalışmaya alınan hastalarda yılan ısırmasının meydana geldiği olay yeri, zamanı, mevsimi, semptomlar, gelişen klinik tablolar, laboratuar bulguları, ilk müdahale süresi ve şekli, toksik etkiler ve komplikasyonlar, spesifik tedavi yaklaşımları (antivenom), semptom ve komplikasyonların tedavi yaklaşımları, tetanoz immünizasyonu yönünden olgular değerlendirildi. Dicle Üniversitesi Tıp Fakültesi Pediatri acil bölümüne başvuran ve yaşları 10,21+3,08 ( 2-15) yıl arasında değişen 72 ’si erkek (%66,7), 36’si kız (%33,3) toplam 108 yılan ısırması vakamızın dosyaları retrospektif olarak incelendi. Vakalarımızın 60’ı (%55,6) Diyarbakır, 17’si (%15.7) Mardin, 13’ü (%12) Şırnak’tan başvurmuş olup 73’ü (%67,6) bu illerin kırsal kesimindendi. Isırılmaların çoğu Mayıs-Haziran ayları arasında görüldü. Olgularımızın 27’si (%25) mayıs ayında, 20’si (%18,5) haziran ayında, 19’u (%17,6) temmuz ayında ısırılmıştır. Olgularımızda ısırılmadan sonra en yakın sağlık kuruluşuna ulaşma süresi bilinmezken hastanemize başvurma süresi ortalama 5,1 8,06 saat idi. Özellikle alt extremiteden ısırılmanın sık (%69,4) olduğu görülmüştür. Isırılma en çok 57 (%52,8) vaka sayısı ile 12:00-18:00 saatleri arasında olmuştur. Ünitemize başvuran olguların 10’una (% 9,3) ısırılan bölgenin proksimaline turnike uygulandığı, 9’ una (% 8,4) jiletleme-kanatma yapıldığı, 3 (% 2,8) olgumuza emme işlemi yapıldığı, buz uygulanmasının hiçbir olgumuzda yapılmadığı gözlendi. Olgularımızda sıklıkla başvuru anında görülen lokal bulgular ısırılan bölgede daha belirgin olmak üzere, aynı ekstremitede değişik derecelerde ağrı, kızarıklık ve ödem idi. Olguların 47 (%43,5)’si grade 2, 31 (%28,7)’ i grade 3 ile başvurdu. Tedavi sırasında en çok gelişen komplikasyon %9,2 sıklıkta kompartman sendromu oldu. Olgularımızın 3’ü dış merkezden kompartman sendromuna bağlı fasiyotomi açılmış olarak geldi, 7’sine kompartman sendromu nedeniyle kliniğimizde ortopedi ile konsülte edilerek fasiyotomi açıldı. Olgularımızın tümü ağızdan veya intravenöz sıvı tedavisi aldı. Bölgemizde tetanoz aşısı kırsal bölgelerde düzenli uygulanamadığından aşı takvimi getiremeyen 84 olgumuza tetanoz toksoidi yapıldı. Antibiotik 89 olgu (%82,4), analjezi 93 olgu (%86,1), kortikosteroid 63 olgu (%58.3), antihistaminik 62 olgu (%57,4), antivenom 80 olguya (%74,07) uygulandı. Ünitemizde antivenom serum uygulananların hiçbirinde minör advers reaksiyon gelişmedi. Bir olgumuz kaybedildi; derin anemi, DIC, ciddi solunum sıkıntısı ile yoğun bakıma alınıp entübe edilerek mekanik ventitatöre bağlanarak 7 gün takip edilen 4 yaşında kız hasta idi. Sağ el ikinci parmağında nekroz gelişen 1 olgumuza amputasyon uygulandı. Snake envenomation is a reason of serious mortality and morbidity in trophical zones. Because of the hot climate of Southeastern Anatolia region, snake envenomation is seen oftenly. This study include 108 child were bitten by poissonous snake that admitted and hospitalized Resarch Hospital of Dicle University pediatric department between october 2006 and may 2011 retrospectively. Patients in the study are evaluated to localization of bite, time and season bite, symptoms, clinical signs, laboratory findings, first treatment time and option, toxic effects and complications, spesific treatment options and tetanus immunization. The patients ages who admitted to research hospital of Dicle University pediatric department ranges between 2-15 years and average age was 10,21+3,08 years. 72 of patients were male (%66,7), 36 of patients were female (%33,3). These 108 case were investigated retrospectively. 60 of our cases (55.6%) in Diyarbakir, 17 (15.7%) of Mardin, 13 (12%) were admitted to Şırnak and 73 (67.6%) lived in rural areas of these provinces. Most of bites were seen between the months of May-June. 27 cases (25%)were bited in May, 20 (18.5%) were bited in June and 19 (17.6%) were bited in July. The time to reach the nearest health institution in our cases was unknown after the bittting and the average time for admission to hospital was 5.1  8.06 hours. Especially the lower extremities (69.4%) were frequently bitten. Most poisonings in 57 (52.8%) with the number of cases has been between the hours of 12:00 to 18:00. 10 (9.3%) of our cases which admitted to our unit (9.3%) tourniquet was applied proximal to the bite area. Bleeding was applied to 9 (%8,4) cases. Suction was applied to 3(%2,8) cases. İce was not applied any of our cases. In our patients, local signs which often seen at presentation were varying degree of pain, erythema and edema at same extremity. 47 patients (43.5%) were admitted with grade 2, 31 (28.7%) were admitted with grade 3. Most frequent complication developed during treatment was the compartment syndrome (%9,2). In 3 cases came from other center, fasciotomy was opened due to compartment syndrome. 7 of our cases were consulting with orthopedics and fasciotomy was opened because of compartment syndrome. All subjects received oral or intravenous fluid therapy. Because of tetanus vaccination in rural areas in our region not apply regularly, 84 of our cases who cauld not get vaccination Schedule were received to tetanous toksoid. Antibiotics were used in 89 cases (%82,4), analgesia were used in 93 cases (%86,1), corticosteroids were used in 63 cases (%58,3), antihistaminic were used in 62 cases (%57,4) and antivenom were used in 86 cases (%74,07). Any minor adverse reactions to antivenom serum occurred in our unit. One of our patient died. She was 4 years old and she has got severe anemia, DIC and respiratory failure. In ıntensive care unit, she was entubated and followed 7 days with mechanical ventilation support. In one case whom developed necrosis of the second finger of right hand was performed amputation.”

Güncel anlamda görsel sanatlarda doğa ve ruhsallık kavramlarını ele almak sanat tarihsel bir perspektifi gereksinir. Tarihsel olarak bakıldığında bu kavramlar bizi sembolizm ve onun muştuladığı romantizm akımlarına ulaştırır. Bu doğrultuda bir çalışma günümüze kadar uzanan bir izlek oluşturmayı mümkün kılar.Sembolizm düşe ve imgeleme yaklaşımıyla gerçeğin görünümlerini sorgulayan bir iç dil geliştirmiştir. Rüyalar, fanteziler ve bilinç dışı bu ifade için ona kaynaklık ederken, doğayı derinlemesine ruhsal bir kavrayışla ifade etmede esin vermiştir. Mistisizm, ölüm, erotizm, öte dünya, mistik varlıklar ve gizemli olan, ifade edilemeyen her şey sembolizmin ilgi alanına girmektedir. Uzamla bağını koparmış, fantastik ve düşsel dışavurumu ifade etmede imge bilinçdışı yeni bir boyut kazanmıştır. Bu içeriğin ve dilin romantizmi şekillediğini ve öncülü bir doğaya sahip olduğunu söylemek mümkündür.Romantizmle birlikte özellikle doğa, metafizik anlamlar kazanarak, manevi arayışlara eşlik eden, ruhsal özgürlüğün sembolü haline gelmiştir. Duygularla, düş gücüyle, melankoli ve nostalji ile özdeşleşmiştir. Aşkınlık ve sınırsızlığı ifade etmek için yeni bir ruhsal bütünlüğün temsilcisi olarak gündeme gelir. Panteizme yaklaşan bir tavırla doğa tanrısal varoluşa ulaşmanın yüce duyguların sembolüdür. Günümüzde hala pastorallik benzer duygusal çağrışımları akla getirir.Günümüz sanatında birbirine girift ele alınan doğa ve ruhsallık kavramları tarihsel bağlamı içerisinde ele almak ilişkisel anlamda önem taşır. Farklı medyalarla iş üreten birçok güncel sanatçıda, üretimin şekillenmesinde bu birikimin ve esinin izlerine rastlıyoruz. Considered historically, After the Industrial Revolution, the urban life, financial and technological changes have brought with them suspicions concerning that human being will not able to have connections with nature and his own presence again.In this sense, for human being, it is possible to mention a new life model which requires adoptation process.The new life model is described as different mentality and perception that change culture, human relations and iner life. The distinctive feature of this mentality is the great significance for reason and reasonable approches that keep the iner life in the second place. This situation has brought with it the fall of religious morals, the weakness of humanistic relationship and a standart lifeformulation.Historically, since the apperance of Romanticism, a lot of artists working witj different techniques deal with the nature almost as the worship of the nature to describe its spiritual theme. The new meanings are referred to the nature as the need to revive the connection with the nature, the universe, the instinct and the power of spirit.The nature has also become a bsis for nostalgic longings with utopian approach. The most significant feature of the theme of the nature is described as an attempt to have spiritual themes. 84

Aim: The purpose of this research was to determine depression levels in parents of children hospitalized in the intensive care unit and to identify any variation between maternal and paternal depression levels. Method: The study was performed with 25 mothers and fathers of patients hospitalized between February and April 2015 in the Gaziantep University Faculty of Medicine Hospital, Pediatric Intensive Care Unit. The Beck Depression Inventory was used to evaluate the parents’ depression levels. Results: The mothers and fathers of 25 patients were included in the study. The mean age of the patients was 61.2 ± 53.8 months range, 3-172 months . Nineteen 76% of patients had poor socioeconomic status, 4 16% had average socioeconomic status, and 2 8% had good status. The mean Beck Depression Inventory score was 17.9 ± 11.1 among mothers and 17.1±9.95 among fathers. No correlation was determined between socioeconomic status and maternal or paternal depression level p= 0.64 and p= 0.77, respectively . Similarly, there was no correlation between education level and maternal or paternal levels of depression p= 0.37 and p= 0.77 . Conclusion: Depression levels in both mothers and fathers of children hospitalized in the pediatric intensive care unit are significantly higher than those of the normal population. This study might now be repeated with wider patient groups. This study reveals the need for mothers and fathers of patients to be given psychological counseling and psychiatric support., Amaç: Bu araştırma; çocuk yoğun bakım ünitesine çocuğu yatırılan ebeveynlerin depresyon düzeyini, anne ve babaların depresyon düzeyleri arasında farklılık olup olmadığını belirlemek amacıyla yapılmıştır. Yöntem: Bu çalışma; Gaziantep Üniversitesi Tıp Fakültesi Hastanesi Çocuk Yoğun Bakım Ünitesi’ne Şubat –Nisan 2015 tarihleri arasında yatan 25 hastanın anne ve babaları ile yapıldı. Değerlendirme için Beck depresyon ölçeği kullanıldı. Bulgular: Hastaların yaş ortalaması 61.2±53.8 ay min.3 max.172 idi.,. Hastaların 19’unun %76 sosyoekonomik düzeyi kötü, 4’ünün %16 sosyoekonomik düzeyi orta, 2’sinin %8 sosyoekonomik düzeyi iyiydi. Hastaların anne ve babalarına yapılan Beck depresyon ölçeği skorlamasında annelerin depresyon skoru ortalaması 17.9 ± 11.1, babaların depresyon skoru ortalaması 17.1±9.95 saptandı. Sosyoekonomik düzey ile anne ve baba depresyon düzeyi arasında korelasyon saptanmadı p:0.64 ve p:0.77 . Benzer şekilde eğitim düzeyi ile anne ve baba depresyon düzeyi arasında da korelasyon yoktu p:0.37 ve p:0.77 . Sonuç: Çocuk Yoğun Bakım Ünitesi’nde yatan çocukların hem anne hem de babalarında depresyon oranları normal populasyona göre belirgin derecede yüksektir. Daha geniş hasta gruplarıyla bu çalışmalar tekrarlanabilir. Bu çalışma, hastaların anne ve babalarına psikolojik danışmanlık ve psikiyatrik destek verilmesi gerekliliğini ortaya koymaktadır.