Return visit characteristics of SARS-CoV-2 PCR-positive cases in a pediatric emergency department.

BACKGROUND: The aim of this study was to evaluate return visits to the pediatric emergency department (ED) for children who were detected to be positive for SARS-CoV-2 by polymerase chain reaction (PCR). METHODS: Between April 2, 2020, and January 20, 2021, children aged 0 to 18 years who were detected to be SARS-CoV-2 PCR-positive and discharged from the ED were evaluated. Among them, patients who returned to the ED within 14 days of quarantine were included in the study. For the first presentation and return visit, demographics, clinical findings, laboratory and radiologic investigations, and ward/pediatric intensive care unit (PICU) admissions were recorded. Patients were divided into 5 groups according to clinical severity. RESULTS: Among 575 children who were confirmed to be SARS-CoV-2 PCR-positive, 50 (8.6%) of them [median age: 10.4 years (IQR: 4.8-15.2); 26 females] had returned. There was no difference for age, sex, underlying diseases, or symptoms for patients who returned or did not for the first presentation, but the percentage of those from whom laboratory tests were obtained was higher in cases of return visits. For symptomatic cases on the first presentation, the most common reason for return was having additional symptoms. The most common symptoms at the return visit were fever, cough, and sore throat. There was no severe/critical case in terms of clinical severity. Among all cases, 36 (72.0%) patients were discharged from the ED, 13 (26.0%) were observed for 6-8 h and then discharged, and 1 (2.0%) was admitted to the ward; there was no PICU admission or death, respectively.

Effects of administration of subtoxic doses of acetaminophen on liver and blood levels of insulin-like growth factor-1 in rats.

Acetaminophen (APAP) is widely used in the treatment of pain. Toxic doses of APAP cause acute liver failure, but therapeutic doses are believed to be safe. The purpose of this study is to investigate the effects of administration of subtoxic doses of APAP on liver and blood levels of insulin-like growth factor-1 (IGF-1) in rats. Low dose (100 mg/kg) and high dose (250 mg/kg) of APAP were intraperitoneally injected into Wistar albino rats. Following administration of therapeutic doses of APAP, there were no significant changes in serum transaminases and liver glutathione levels. Both doses of APAP induced a decrease in liver and blood levels of IGF-1 when compared with the controls. There was no significant difference in liver IGF-1 levels between the high-dose and low-dose APAP groups; however, there was a significant difference in blood IGF-1 levels between both the groups. The histological examination showed that low dose of APAP induced mild degree of structural change, while high dose of APAP induced severe structural damage. In conclusion, these results suggest that blood IGF-1 levels may have a value in predicting hepatic damage resulting from therapeutic doses of APAP.

Value of rapid antigen test for pandemic influenza A (H1N1) 2009 in the pediatric emergency department.

OBJECTIVE: Pandemic H1N1 influenza is the predominant influenza virus circulating in Turkey in 2009. Because of the clinical manifestations of influenza overlap with those attributable to other common respiratory illnesses of childhood, establishing a diagnosis of influenza requires confirmatory testing. The aim of our study was to define the predictive value of rapid influenza antigen detection test in children presenting to a pediatric emergency care department with influenza-like illness and to compare with clinical signs and symptoms. METHODS: From October to November 2009, 3646 patients presented with influenza-like illness to the pediatric emergency department. Influenza-like illness is defined as fever with cough or sore throat in the absence of a known cause other than influenza. Enrollment criteria included fever and at least one of the following symptoms: coryza, cough, headache, sore throat, or myalgia. All 322 enrolled patients received a nasal wash for rapid influenza diagnostic tests, and the results were compared with clinical signs. RESULTS: Rapid influenza detection test result was found positive in 167 (51.9%) of 322 patients. Clinical findings included fever as the presenting complaint (100%), fever (≥38 °C) (93.4%), cough (91.3%), rhinorrhea (66.1%), sore throat (35.1%), vomiting-diarrhea (22.4%), myalgia (20.2%), headache (18%) and shortness of breath (12.1%). There were 211 patients (65.5%) at high risk for the development of complications of pandemic H1N1 influenza A such as chronic lung disease (asthma) (n = 103, 48.8%), age younger than 2 years (n = 78, 37%), and neurologic disease (n = 10, 4.7%). The positivity rate and sensitivity of the test increase up to 70% in patients, who had the high body temperature (≥39 °C). The rapid test achieved the highest sensitivity in patients, who have high fever (≥39 °C), myalgia, vomiting, and diarrhea. CONCLUSIONS: We found that if the patients have high fever (≥39 °C), myalgia, and vomiting-diarrhea together, the likelihood of rapid antigen test positivity rate increases in patients, who presented with influenza-like illness.

Combined treatment with progesterone and magnesium sulfate positively affects traumatic brain injury in immature rats.

AIM: It is well known that head trauma results in damage in hippocampal and cortical areas of the brain and impairs cognitive functions. The aim of this study is to explore the neuroprotective effect of combination therapy with magnesium sulphate (MgSO4) and progesterone in the 7-days-old rat pups subjected to contusion injury. MATERIAL AND METHODS: Progesterone (8 mg/kg) and MgSO4 (150 mg/kg) were injected intraperitoneally immediately after induction of traumatic brain injury. Half of groups were evaluated 24 hours later, the remaining animals 3 weeks after trauma or sham surgery. Anxiety levels were assessed with open field activity and elevated plus maze; learning and memory performance were evaluated with Morris Water maze in postnatal 27 days. RESULTS: Combined therapy with progesterone and magnesium sulfate significantly attenuated trauma-induced neuronal death, increased brain VEGF levels and improved spatial memory deficits that appear later in life. Brain VEGF levels were higher in rats that received combined therapy compared to rats that received either medication alone. Moreover, rats that received combined therapy had reduced hipocampus and prefrontal cortex apoptosis in the acute period. CONCLUSION: These results demonstrate that combination of drugs with different mechanisms of action may be preferred in the treatment of head trauma.

Anxiety caused by traumatic brain injury correlates to decreased prefrontal cortex VEGF immunoreactivity and neuron density in immature rats.

AIM: Traumatic brain injury (TBI) may cause neuropsychiatric disorders such as anxiety disorder which has negative effects on cognitive functions and behavior. The aim of this study is to investigate the effects of TBI on anxiety and vascular endothelial growth factor (VEGF) immunoreactivity on the prefrontal cortex of immature rats, which is one of the anxiety-related regions of the brain in 7-day-old immature rats subjected to contusion injury. MATERIAL and METHODS: Rats were divided into three groups: Control (n=7), Sham (n=7) and TBI (n=7). Anxiety levels were assessed with open field activity and elevated plus maze in postnatal 27 days. Prefrontal cortex damage related to TBI was examined by cresyl violet staining and VEGF immunostaining. Prefrontal cortex neuronal density was calculated. Serum corticosterone levels were determined. RESULTS: The anxiety level in the TBI group was significantly greater than the control and sham groups. The prefrontal cortex VEGF immunostaining score and neuron density were decreased in the TBI group compared to control and sham group. Serum corticosterone levels were significantly increased in the TBI group. CONCLUSION: These results indicate that TBI decreases VEGF immunoreactivity in prefrontal cortex neurons and increases the anxiety levels of immature rats.

Relationship between circulating IGF-1 levels and traumatic brain injury-induced hippocampal damage and cognitive dysfunction in immature rats.

It is well known that traumatic brain injury (TBI) induces the cognitive dysfunction resulting from hippocampal damage. In the present study, we aimed to assess whether the circulating IGF-I levels are associated with cognition and hippocampal damage in 7-day-old rat pups subjected to contusion injury. Hippocampal damage was examined by cresyl violet staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Spatial memory performance was assessed in the Morris water maze. Serum IGF-1 levels decreased in both early and late period of TBI. Decreased levels of serum IGF-1 were correlated with hippocampal neuron loss and spatial memory deficits. Circulating IGF-1 levels may be predictive of cognitive dysfunction resulted from hippocampal damage following traumatic injury in developing brain. Therapy strategies that increase circulating IGF-1 may be highly promising for preventing the unfavorable outcomes of traumatic damage in young children.

The effect of Rho kinase inhibitor Y-27632 on endotoxemia-induced intestinal apoptosis in infant rats.

The aim of this study was to evaluate the effect of Rho kinase inhibitor, Y-27632 on the intestinal apoptosis in endotoxemic infant rats. Wistar albino 15-17-day-old rat pups (n = 21) were randomized to three experimental groups: (1) controls; (2) endotoxemia (LPS); and (3) endotoxemia treated with Y-27632 (LPS + Y-27632). Endotoxemia was induced in rats by intraperitoneal (i.p) injection of lipopolysaccharide (Escherichia coli serotype 0111:B4; 10 mg/kg). Y-27632 was administered 5 mg/kg i.p at three times, just, 8 and 16 h after LPS injection. Twenty-four hours after LPS injection, intestinal apoptosis was assessed by hematoxylin and eosin staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay and immunohistochemistry for active caspase-3. Endotoxemia induced extensive apoptotic injury in the intestinal tissues. The administration of Y-27632 to endotoxemic infant rats caused a marked decrease in the number of apoptotic cells in both intestinal epithelium and lamina propria. In conclusion, the inhibition of Rho kinase with Y-27632 diminished the intestinal apoptotic damage induced by endotoxemia in infant rats.

Protective effect of an adenosine A1 receptor agonist against metamidophos-induced toxicity and brain oxidative stress.

The aim of this study was to evaluate the effects of different doses of an adenosine A(1) selective agonist, phenylisopropyl adenosine (PIA), on metamidophos-induced cholinergic symptoms, mortality, diaphragm muscle necrosis, and brain oxidative stress. A LD(50) dose of metamidophos (20 mg/kg body weight, p.o.) was followed by 1 mL/kg body weight of 0.9% NaCl or 1 mg/kg, 2 mg/kg, 3 mg/kg, or 5 mg/kg body weight PIA ip. Incidence of clinical signs including chewing, salivation, convulsion, and respiratory distress did not show any significant difference among all treatment groups (p > 0.05). PIA was found to be effective to reverse the necrotic changes in diaphragm muscle induced by metamidophos significantly in all groups. Brain Thiobarbituric Acid Reactive Substance (TBARS) levels were significantly increased after the metamidophos poisoning. Administration of 2 to 5 mg/kg body weight PIA decreased brain TBARS levels compared to 0.9% NaCl treated rats. The results indicate that, although different doses of PIA reduced the OP-induced oxidative stress and diaphragm necrosis, a single dose of PIA was not able to recover cholinergic signs and symptoms of metamidophos poisoning.

Chemical burn in domestic setting with an uncommon agent: hydrofluoric acid.

Chemical burns, in particular because of hydrofluoric acid, are not common in the pediatric emergency department. Here, we describe an infant presenting with digital ischemic findings owing to late diagnosis of hydrofluoric acid splash in domestic setting.

The effect of melatonin on endotoxemia-induced intestinal apoptosis and oxidative stress in infant rats.

OBJECTIVE: To evaluate the effect of melatonin on the intestinal apoptosis along with oxidative damage in endotoxemic infant rats. DESIGN AND SETTING: Prospective animal study in a university-based experimental research laboratory. SUBJECTS AND INTERVENTIONS: Wistar albino 7-day-old rat pups (n=21). The animals were randomized into three experimental groups: (1) controls; (2) endotoxemia; (3) endotoxemia treated with melatonin (10mg/kg). Endotoxemia was induced in rats by intraperitoneal injection of lipopolysaccharide (Escherichia coli serotype 0111:B4; 3 mg/kg). MEASUREMENTS AND RESULTS: Four hours after LPS injection, the antioxidant enzyme activities, including superoxide dismutase (SOD), glutathione peroxidase (GPx), and thiobarbituric acid reactive substance (TBARS) levels as an indicator of lipid peroxidation, were determined. Intestinal apoptosis was assessed by hematoxylin-eosin staining and terminal deoxynucleotide transferase-mediated fluorescein-dUTP nick end labeling. The administration of melatonin into endotoxemic rats prevented the increase in the TBARS levels, and increased the activities of antioxidant enzymes and attenuated apoptotic cell death in both intestinal epithelium and lamina propria. CONCLUSIONS: Melatonin diminished the intestinal oxidative stress and apoptotic damage induced by endotoxemia in infant rats.

Multiple erythematous nodules and ecthyma gangrenosum as a manifestation of Pseudomonas aeruginosa sepsis in a previously healthy infant.

Pseudomonas aeruginosa septicemia is rare in healthy infants and children. Also not common, dermatologic manifestations such as ecthyma gangrenosum and indurated erythematous nodular lesions may be the first signs of pseudomonas infection, or may appear later in the course of the disease. Peripheral facial paralysis and mastoiditis are also rare and serious complications of acute otitis media caused by P. aeruginosa. We report a previously healthy 6-month-old boy who had an uncommon presentation and rare complications during the course of P. aeruginosa sepsis.

Protective effect of melatonin against maternal deprivation-induced acute hippocampal damage in infant rats.

It is known that maternal deprivation induces hippocampal damage in the developing brains. In the present study, we examined the effects of melatonin on maternal deprivation-induced hippocampal damage both during and after stress-hyporesponsive period (SHRP). Hippocampal damage was examined by cresyl violet staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. The results showed that a single episode of maternal deprivation for 24 h at post-SHRP induced neuronal loss in hippocampus regions of the brain in the infant rats, while it did not influence hippocampal neurons in SHRP. Melatonin prevented maternal deprivation-induced hippocampal damage in the infant rats at post-SHRP. These results suggest that melatonin is a potentially beneficial agent to improve the neurobehavioral outcomes of maternal deprivation in later developmental period.

Effects of maternal deprivation on melatonin production and cognition in adolescent male and female rats.

OBJECTIVES: It is known that maternal deprivation (MD) may alter cognitive functions such as learning and memory in adult life by effecting normal growth and development. However, the mechanisms of these cognitive alterations are unknown. The aim of this study is to investigate the effects of maternal deprivation on cognition and melatonin production in adolescent male and female rats. METHODS: The litters were separated daily from their mothers for 6 hours on postnatal days 2 to 20. The spatial memory performance was evaluated using a Morris water maze between the postnatal 26th and 32nd days. Plasma melatonin levels were determined on postnatal days 42. RESULTS: MD-rats had longer escape latencies at the second, third and fifth days of training days and spend significantly less time in probe trial, compared to control animals. MAIN FINDINGS: The repeated maternal deprivation caused low blood melatonin levels and there was a significant negative correlation between blood melatonin levels and spatial memory performance in both of male and female adolescent rats. CONCLUSION: These results suggest an association between melatonin production and neurodevelopment. Further studies are needed to determine the interaction between maternal deprivation and pineal gland maturation/function.

QTc dispersion in children with severe head trauma.

OBJECTIVE: Corrected QT (QTc) interval prolongation has been described after subarachnoid hemorrhage and head injury in adults. Abnormal QTc prolongation is associated with a higher risk of ventricular arrhythmias. The aim of this study was to analyze QTc interval and QTc dispersion in children with severe head trauma. METHODS: Forty-three patients with severe head trauma and 49 children with no or only mild head injury as controls were enrolled in the study. QT interval from standard 12-lead electrocardiogram immediately after admission was calculated. QT interval was corrected by heart rate according to Bazett formula, and then QTc dispersion was calculated. At the same time, levels of serum electrolytes were measured. RESULTS: Although no significant difference in terms of age, sex, and R-R interval was found, QTc interval and QTc dispersion values were significantly increased in the patients with severe head trauma compared with those with no or only mild head injury (QTc, 447 +/- 31 vs. 409 +/- 27 milliseconds; QTc dispersion, 77 +/- 22 vs. 52 +/- 16 milliseconds, respectively). When the patients with severe head trauma were categorized as those with or without intracranial hemorrhage, both QTc interval and QTc dispersion were significantly greater in those with intracranial hemorrhage. These electrocardiographic parameters were inversely associated with Glasgow Coma Scale score, serum calcium levels, and, at a lesser degree, potassium levels. CONCLUSIONS: Children with severe head trauma, especially those with intracranial hemorrhage have longer QTc interval and greater QTc dispersion.

Acute trichinellosis in children compared with adults.

OBJECTIVES: Trichinellosis is a cosmopolitan parasite infection caused by Trichinella nematodes that is acquired from consumption of raw meat from several animal species. Knowledge of the clinical pattern and laboratory features of the disease in childhood is limited. The purpose is to study the clinical pattern of trichinellosis caused by Trichinella britovi in children and to compare it in household adults. METHODS: We evaluated all children up to 17 years of age and their adult householders exposed to the consumption of infected meat during an outbreak of trichinellosis. A questionnaire was developed to record clinical data. The blood sample was collected for blood count, muscle enzymes, serum electrolytes, albumin and serology. All exposed children were treated with mebendazole, and severe symptomatic patients received prednisolone. Clinical and laboratory presentations and outcome were recorded. To evaluate the clinical picture of trichinellosis in childhood, clinical and laboratory findings were compared between children and household adults with a confirmed diagnosis who consumed the same amount of infected meat. RESULTS: In 47 (62%) of 76 children with suspected trichinellosis, the diagnosis was serologically confirmed. The main clinical and laboratory findings in children were fever, abdominal pain, myalgia, facial and/or eyelid edema, rash, eosinophilia and increased muscular enzymes. The incubation period was similar in children and adults, but myalgia (66% versus 96%, P < 0.01), facial and/or eyelid edema (57% versus 86%, P < 0.05), eosinophilia (52% versus 96%, P < 0.01) and increased serum creatine kinase (38% versus 79%, P < 0.01) were less common in children than in adults. Seroconversion occurred in fewer children than adults, but the difference was not statistically significant. CONCLUSIONS: T. britovi infection shows a benign course and a milder clinical picture in children than in adults who consumed the same amount of infected meat.

Sigmoid sinus thrombosis following mastoiditis: early diagnosis enhances good prognosis.

Sigmoid sinus thrombosis following mastoiditis is a rare, but potentially life-threatening, condition. Its treatment usually consists of systemic antibiotics and mastoidectomy. In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging. The patient responded very well to intravenous antibiotics with a rapid clinical improvement and complete recanalization of the thrombosed sigmoid sinus. In conclusion, mastoiditis may present few clinical symptoms. In case of treatment failure or new-onset neurologic deficit in children with acute otitis media, life-threatening complications associated with mastoiditis should be considered. Early diagnosis is important, as favorable prognosis can be achieved with conservative management without performing any surgical intervention.

Protective effect of melatonin against head trauma-induced hippocampal damage and spatial memory deficits in immature rats.

It is well known that head trauma induces the cognitive dysfunction resulted from hippocampal damage. In the present study, we aimed to demonstrate the effect of melatonin on hippocampal damage and spatial memory deficits in 7-day-old rat pups subjected to contusion injury. Melatonin was injected intraperitoneally at the doses of 5 or 20 mg/kg of body weight immediately after induction of traumatic injury. Hippocampal damage was examined by cresyl violet staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Spatial memory performance was assessed in the Morris water maze. Melatonin significantly attenuated trauma-induced neuronal death in hippocampal CA1, CA3 regions and dentate gyrus, and improved spatial memory deficits, which was equally effective at doses of 5-20 mg/kg. The present results suggest that melatonin is a highly promising agent for preventing the unfavorable outcomes of traumatic brain injury in young children.

The ill child in the emergency department and the accompanying people: a cross-sectional analysis.

OBJECTIVE: The objective of this study is to investigate relationship between the number of the family members visiting the emergency department with pediatric patients and patient characteristics such as age, insurance status, traumatic complaint, whether event was acute or not, and to estimate number of family members who had any time off from their work among this group. METHOD: A prospective cross-sectional study was performed using a questionnaire which included demographic characteristics, number of family members, number of family members who were taking hours off from work. In the 15-day period (1-15 August 2003), all persons who accompanied the children to the university-based PED (annual volume: 18,000) were asked to participate in the study. RESULTS: A total of 575 persons accompanied the 300 children seen in PED (1.92 persons per child). Number of persons accompanying the children was found to be inversely related to age (Pearson correlation, P = 0.000). Seventy-nine children (32.1%) of those with acute complaints had family members who took time off from their work, whereas 29 (53.70%) of those with chronic illnesses had such family members (P = 0.003). The mean number of family members of children who had been referred from another healthcare institution was 2.06 +/- 0.77, whereas the mean number of family members of patients who presented directly to the PED was 1.85 +/- 0.63 (P = 0.013). The mean number of family members of patients who had insurance for their child and those who do not have were 1.84 +/- 0.66 and 2.06 +/- 0.71, respectively, (P = 0.001). CONCLUSIONS: Numbers of family members were positively associated with a history of referral to another institution for the same reason, and inversely related to the parents' age and insurance status.

The effects of regular aerobic exercise in adolescent period on hippocampal neuron density, apoptosis and spatial memory.

It is known that positive effects of regular aerobic exercise on cognitive functions in humans and also animals; but how to the effects of aerobic exercise in adolescent period is unknown. The present study examined the effects of regular aerobic exercise on spatial memory using the Morris water maze, cell density and apoptosis of hippocampus in adolescent rats. Twenty-two days of age male rats were run on a treadmill for 30 min/session at a speed of 8m/min and 0 degrees slope, five times a week for 8 weeks. The present study showed that exercise induced significant cognitive improvement throughout brain maturation in rats. The number of hippocampal CA1 and CA3 neurons, and gyrus dentatus neurons were significantly increased in the exercised rats. There was no significant difference of CA2 neuron density between exercise and control groups. There was no significantly differences in any groups according to the results of apoptosis that account of TUNEL positive cells. The present results suggest that regular moderate aerobic treadmill exercise benefit in cognitive functions. This result may derive from treadmill exercise-induced increase cell density without altering of apoptosis in the hippocampus and dentate gyrus of adolescent rats.