Magnetic resonance imaging findings in COVID-19-related anosmia.

BACKGROUND: The coronavirus disease 2019 (COVID-19) mostly manifests with fever, shortness of breath, and cough, has also been found to cause some neurological symptoms, such as anosmia and ageusia. The aim of the study was to present the magnetic resonance imaging (MRI) findings of patients with anosmia-hyposmia symptoms and to discuss potential mechanisms in light of these findings. METHODS: Of the 2412 patients diagnosed with COVID-19-related pneumonia (RT-PCR at least once + clinically confirmed) between March and December 2020, 15 patients underwent olfactory MRI to investigate the cause of ongoing anosmia/ hyposmia symptoms were included in the study. RESULTS: Eleven (73.3%) patients were female and four (26.7%) were male. A total of eight patients (53.3%) showed thickening in the olfactory cleft region, where the olfactory epithelium is located. In nine patients (60%), enhancement was observed in the olfactory cleft region. Diffusion-weighted imaging showed restricted diffusion in three patients (20%) (corpus callosum splenium in one patient, thalamus mediodorsal nucleus in one patient, and mesencephalon in one patient). DISCUSSION: This study revealed that there is a relationship between anosmia and MRI findings. Larger studies can enlighten the pathophysiological mechanism and shed light on both diagnosis and new treatments.

Rapid Molecular Diagnosis of Group A Streptococcus with a Novel Loop Mediated Isothermal Amplification Method.

BACKGROUND: Group A Streptococcus (GAS) is the most common bacterial cause of acute tonsillopharyngitis. In this study, it was aimed to evaluate the performance of a novel Loop Mediated Isothermal Amplification (LAMP) method in the rapid diagnosis of GAS in samples taken from children with a prediagnosis of acute bacterial tonsillopharyngitis by comparing it with culture and rapid antigen test (RAT) methods. METHODS: A total of 100 throat swab samples taken from children at the pediatrics outpatient clinic with suspected tonsillopharyngitis were included in the study. Throat swab samples were analyzed by RAT, throat culture, and LAMP method. GAS suspected colonies were identified with MALDI-TOF MS system. The isothermal amplification reaction for LAMP was conducted by a novel LAMP instrument. RESULTS: According to the results of throat cultures; 53 of them were positive and 47 were negative in terms of GAS. Six (11.32%) of the culture positive samples were found to be negative by the RAT (sensitivity; 88.68%, specificity 100%). While the antigen test was positive, no culture negative sample was detected. One of the culture positive samples was found negative by LAMP. In two samples, while throat culture was negative, it was observed that LAMP was positive (sensitivity; 98.11%, specificity; 95.74%). In one of these samples, the bacteria grown in the culture were identified as Streptococcus dysgalactiae by mass spectrophotometry. CONCLUSIONS: In this study, it was determined that the LAMP method used in the diagnosis of throat infections caused by GAS has high sensitivity and specificity. We believe that the instrument is easy to use, low cost, portable, and adaptable to point of care tests. There are very few studies in the literature regarding the use of the instrument in this field, and it should be evaluated in terms of its usability in daily practice with new studies.

The Effect of the Covid-19 pandemic on emergency service home service calls due to home accidents in children aged 0-6 in Sakarya, Türkiye?

Background and Aim: The contribution of global pandemics to the emergence of home accidents is unknown. The study aims to retrospectively examine the effect of the Covid-19 Pandemic on Emergency Service Home Service Calls Due to Home Accidents in Children aged 0-6. Methods: Data are reported in two sections. The descriptive part is a retrospective analysis of patients admitted to Sakarya Training and Research Hospital Pediatric Emergency and Adult Emergency Unit between March 16, 2019 and January 31, 2020 (non-COVID-19era) and March 16, 2020 and January 31, 2021 (COVID-19era). The second part of the study, the comparative part, presents mean data for 2019-2020 (non-COVID-19era) and 2020-2021 (COVID-19era) from the same center and the same period. These data will then be compared. Results: A total of 9,110 pediatric patients applied to our center during the study period, of which 7,905 patients were in the non-Covid- 19era period and 1,205 patients were in the Covid-19 era. While the rate of hospital admissions decreased by 85% in the Covid-19era compared to the non Covid-19era, when the periods are evaluated within themselves; the forensic report retention rate in the Covid- 19era increased by 180% and the rate of hospitalization increased by 75%, The rate of drug overdose increased by 280% and chemical substance use increased by 325% compared to the non-Covid-19era. However The Covid-19 era, the fall rate decreased by 31% and the burn rate decreased by 17% compared to the non-Covid-19 era. Conclusions: During the national lockdown period, our pediatric emergency department experienced significantly reduced volumes of children. Despite the decrease in hospital admission rate during the COVID-19 pandemic, there was still a very high increase in poisoning from home accidents. This study can provide a basis for further research on alternative strategies to address the problem of home accidents during the COVID-19 pandemic.

Evaluation of taste and smell disorders in pediatric COVID-19 Cases.

OBJECTIVE: Pediatric coronavirus disease 2019 (COVID-19) cases have a high risk of contagiousness, as they usually progress with asymptomatic or mild respiratory symptoms. Disorder in taste and/or smell has rarely been reported in pediatric cases. In our study, early diagnosis and isolation measures were emphasized by evaluating the clinical, laboratory, and radiological imaging findings of pediatric COVID-19 cases presenting with symptoms of taste and/or smell disorder. METHODS: Seven cases aged 0-18 years were included in the study. The severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test was performed for the seven cases presented with taste and/or smell disorders. Clinical findings, laboratory tests, and radiological imaging of all the cases were evaluated on the day of admission and on the fifth day. RESULTS: Seven (5.7%) of 122 pediatric COVID-19 cases had disorder in taste and/or smell. In two cases, pneumonia findings were detected in thorax computed tomography imaging. It was observed that all the patients fully recovered at the latest on the 21st day. In the cranial diffusion magnetic resonance imaging of a case, diffusion restriction was detected in the corpus callosum splenium. CONCLUSION: Although less common than adults, children with COVID-19 may also have taste and smell disorders, and this may be accompanied by central nervous system imaging findings.

Evaluation of taste and smell disorders in pediatric COVID-19 Cases

SUMMARY OBJECTIVE: Pediatric coronavirus disease 2019 (COVID-19) cases have a high risk of contagiousness, as they usually progress with asymptomatic or mild respiratory symptoms. Disorder in taste and/or smell has rarely been reported in pediatric cases. In our study, early diagnosis and isolation measures were emphasized by evaluating the clinical, laboratory, and radiological imaging findings of pediatric COVID-19 cases presenting with symptoms of taste and/or smell disorder. METHODS: Seven cases aged 0-18 years were included in the study. The severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test was performed for the seven cases presented with taste and/or smell disorders. Clinical findings, laboratory tests, and radiological imaging of all the cases were evaluated on the day of admission and on the fifth day. RESULTS: Seven (5.7%) of 122 pediatric COVID-19 cases had disorder in taste and/or smell. In two cases, pneumonia findings were detected in thorax computed tomography imaging. It was observed that all the patients fully recovered at the latest on the 21st day. In the cranial diffusion magnetic resonance imaging of a case, diffusion restriction was detected in the corpus callosum splenium. CONCLUSION: Although less common than adults, children with COVID-19 may also have taste and smell disorders, and this may be accompanied by central nervous system imaging findings.

Pentraxin 3 as a Marker for Cardiovascular Disease Risk in Overweight and Obese Children.

BACKGROUND: Pentraxin 3 is an inflammatory mediator that may be associated with subclinical inflammation in atherosclerosis and cardiovascular diseases. This study investigated the predictive value of pentraxin 3 as an inflammatory biomarker in overweight and obese children. METHODS: Participants were categorized into three groups: overweight (n = 35), obese (n = 35), and healthy controls (n = 70). Cardiovascular parameters and pentraxin 3 were measured in all participants. RESULTS: The mean pentraxin 3 level was significantly higher in the overweight (10.23 ± 4.42 ng/ml) and obese (11.20 ± 4.12 ng/ml) groups compared to the control (7.93 ± 4.35 ng/ml) group. Pentraxin 3 was significantly correlated with carotid intima media thickness and epicardial adipose tissue thickness in the overweight group. In the linear regression analysis, body mass index and systolic blood pressure were significantly correlated with pentraxin 3 levels in the overweight group, whereas only heart rate was correlated with pentraxin 3 levels in the obese group. In receiver operating characteristic analysis, the optimal cut-off value for pentraxin 3 in the obese group was 9.321 ng/mL, with sensitivity and specificity of 77.1% and 74.3%, respectively [area under the curve (AUC) = 0.764, p < 0.001]. In the overweight group, the optimal cut-off value of pentraxin 3 was 9.263 ng/mL, with sensitivity and specificity of 62.9% and 72.9%, respectively (AUC = 0.687, p = 0.002). CONCLUSIONS: Pentraxin 3 may be an early marker of cardiovascular risk in overweight children. Future longitudinal studies are needed to evaluate the predictive value of pentraxin 3 for cardiovascular disease.

New Oxidative Stress Markers Useful in the Diagnosis of Acute Appendicitis in Children: Thiol/Disulfide Homeostasis and the Asymmetric Dimethylarginine Level.

OBJECTIVES: The aim of this study was to evaluate 2 new oxidative stress markers, thiol/disulfide homeostasis status and the asymmetric dimethylarginine (ADMA) level, in children with acute appendicitis (AA) and to evaluate their diagnostic utility. METHODS: This case-control study included 45 patients with AA and 35 healthy children. Age, sex, white blood cell count, neutrophil-to-lymphocyte ratio, high-sensitivity C-reactive protein (hs-CRP) level, ultrasonographic findings, thiol/disulfide homeostasis parameters (native and total thiol levels, native thiol/total thiol ratios [antioxidant parameters], and disulfide, disulfide/native thiol, and disulfide/total thiol ratios [oxidant parameters]), and the ADMA level were compared between the 2 groups. RESULTS: The native and total thiol levels, and the native thiol/total thiol ratio, were significantly lower, and the disulfide level and disulfide/native thiol and disulfide/total thiol ratios significantly higher, in the AA compared with the control group (all P < 0.001). The ADMA level was significantly higher in a perforated versus nonperforated subgroup of AA patients, but the thiol/disulfide homeostasis parameters did not differ significantly between the two subgroups. In addition, the hs-CRP level and appendiceal wall thickness were higher in the perforated subgroup. The thiol/disulfide antioxidant parameters and ADMA level correlated negatively with the white blood cell count, the neutrophil-to-lymphocyte ratio, and the hs-CRP level, in the AA group, but correlated positively with oxidant parameters. The sensitivity and specificity of the disulfide/native thiol and disulfide/total thiol ratios were high when used to diagnose AA, whereas the sensitivity of the ADMA level was high when used to diagnose perforated appendicitis. CONCLUSIONS: Thiol/disulfide homeostasis and the ADMA level, together with certain other parameters, may be useful biomarkers of AA in children.

Salusin-α levels are negatively correlated with diastolic blood pressure in children with obesity.

Salusins have emerged as a new biomarker that reflects an increased inflammatory state, which is associated with cardiovascular risk. We investigated the predictive value and usefulness of salusins as an inflammatory biomarker in obese children. This prospective cohort study included 75 obese children and 101 healthy children (as a control group). Salusin-α, Salusin-ß, and various cardiovascular parameters were assessed in both groups. Correlation analyses of Salusin-α and Salusin-ß with body mass index standard deviation scores and inflammatory and cardiovascular markers were performed. The mean patient age was 11.9±2.4 years for the obese group and 12.5±2.1 years for the control group. The obese children had a significantly higher heart rate, systolic blood pressure, diastolic blood pressure, epicardial adipose tissue thickness, and left ventricular mass than did the children in the control group. There was no significant correlation between Salusin-α and Salusin-ß and body mass index; however, there was a negative correlation between Salusin- α and diastolic blood pressure (r = 0.277, p = 0.004). Overall, there was no significant difference in the Salusin-α and Salusin-ß levels between obese and healthy children. However, a negative correlation was found between Salusin-α and diastolic blood pressure. Although this result suggests that Salusin-α might be an early marker of cardiovascular involvement in obese children, further studies are needed to demonstrate the predictive value of salusins.

Dynamic thiol/disulphide homeostasis as a novel indicator of oxidative stress in obese children and its relationship with inflammatory-cardiovascular markers.

OBJECTIVE: Childhood obesity is an important cause of cardiovascular risk with chronic inflammation. Oxidative stress may contribute to the pathogenesis of obesity-related cardiovascular pathologies. We aimed to evaluate thiol/disulphide homeostasis as a novel and sensitive marker of oxidative stress and to evaluate its relationship with some inflammatory and cardiovascular markers in obese children. METHODS: In this case-controlled study, 65 children with exogenous obesity and 64 healthy children, as a control group, were included. In both groups, thiol/disulphide homeostasis parameters and inflammatory (white blood cells, platelets, mean corpuscular volume, neutrophil/lymphocyte ratio, and high-sensitivity C-reactive protein) and cardiovascular (epicardial adipose tissue thickness and left ventricular mass index) markers were studied. Correlation analyses of thiol/disulphide homeostasis parameters with body mass index standard deviation scores (BMI SDS) and inflammatory and cardiovascular markers were performed. Receiver-operating characteristic analysis was performed to determine the sensitivity, specificity, and optimal cut-off values of thiol/disulphide homeostasis parameters. RESULTS: Native thiol, total thiol, and native thiol/total thiol ratios (antioxidant parameters) were lower (p<0.05) and disulphide/native thiol and disulphide/total thiol ratios (oxidant parameters) were higher in the obese group than in the control group (p<0.01). A positive correlation of oxidant parameters with BMI SDS and inflammatory markers was found. However, a negative correlation of antioxidant parameters with BMI SDS and inflammatory markers was found. The specificities of disulphide/native thiol and disulphide/total thiol ratios were higher in the obese group. CONCLUSION: The impairment in thiol/disulphide homeostasis, which is indicative of oxidative stress, is associated with inflammation in obesity. In addition, cardiovascular involvement may also contribute to this impairment.

Thiol/disulfide homeostasis as a novel indicator of oxidative stress in children with simple febrile seizures.

Simple febrile seizures are generally benign, but during the seizure, elevated levels of glutamate and high levels of oxygen use due to the high metabolic brain activity result in oxidative stress. However, the relationship between febrile seizures and oxidative stress remains unclear. In this study, we investigated thiol/disulfide homeostasis as a new oxidative stress parameter in patients with simple febrile seizures. This study was performed between February 2016 and May 2016 at the Pediatric Emergency Unit. The study population consisted of 40 patients with a diagnosis of simple febrile seizure and 30 control participants aged 8-59 months. Total thiol, native thiol and disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were used as thiol/disulfide homeostasis parameters and were quantified in patient and control groups. Furthermore, correlations with seizure duration were investigated. In the patient group, native and total thiol levels and native thiol/total thiol ratios were low, and disulfide levels, disulfide/native thiol, and disulfide/total thiol ratios were significantly higher than in the control group. Negative correlations were observed between seizure duration, total and native thiol levels, and native thiol/total thiol ratio, whereas positive correlations were observed between seizure duration and disulfide/native thiol and disulfide/total thiol ratio. The sensitivities of both disulfide/native thiol and disulfide/total thiol ratios were high for simple febrile seizures. Simple febrile seizures may cause impairment in favor of disulfide bonds in thiol/disulfide homeostasis. Overall, these changes may contribute to neuronal cell damage after simple febrile seizures.

Omalizumab's role in the treatment of steroid dependent malignant idiopathic anaphylaxis.

If an anaphylaxis episode is not caused by an identifiable trigger, it is defined as idiopathic anaphylaxis. Although it is rarely observed, idiopathic anaphylaxis is clinically significant because of its morbidity and fatality risk. No effective treatment has been demonstrated to date. We report a girl aged 16 years who had had malignant idiopathic anaphylaxis since the age of 12 years who was treated successfully with omalizumab. Although she avoided allergic trigger foods such as tomato and seafood, she used to have these attacks twice a week. Attacks were averted by taking 60 mg prednisone. When prednisone was tapered down to 5 mg on every alternate day, the episodes recurred. Later, attacks could not be controlled on <30 mg of prednisone daily. After being steroid-dependent for 4 years, subcutaneous omalizumab 225 mg every two weeks was started. Under omalizumab therapy, the attacks disappeared and prednisone was discontinued.

Risk Factors for Pilonidal Sinus Disease in Teenagers.

OBJECTIVE: To investigate the risk factors for pilonidal sinus in teenagers. METHODS: Between January 2013 and September 2015, 55 teenage patients who underwent surgery due to pilonidal sinus disease (PSD) in the Department of Pediatric Surgery, Sakarya University Teaching and Research Hospital were included in this study. Age, gender, body mass index (BMI), number of baths taken per week, time spent sitting per day, family history, and skin color were examined as risk factors. The control group comprised of healthy teenagers without pilonidal sinus disease. RESULTS: Out of the total 42 teenagers, 23 (54.8 %) were girls and 19 (45.2 %) were boys. Patients were classified as obese, overweight, or normal according to their BMI (14.3 %, 31 %, and 54.8 %, respectively). The number of baths taken per week in the PSD group was lower than that in the control group [odds ratio (OR): 3.690; p = 0.004]. The family history of PSD was significantly higher in teenagers with PSD, compared to the control group (OR: 8.652; p = 0.005). No differences were detected between the PSD and control groups with respect to sitting for ≥ 6 h per day (OR: 3.212; p = 0.028). Skin color was not found to be affected by PSD in teenagers (OR: 1.294; p = 0.392). CONCLUSIONS: Heredity and the number of baths taken per week were found to significantly affect the incidence of PSD, whereas other variables (gender, age, BMI, skin color, and time spent sitting per day) did not exhibit any significant influence on the rate of incidence.

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children.

OBJECTIVE: Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS: Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION: Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

[Variable prevalence of allergic rhinitis and risk factors affecting the prevalence]. / Alerjik rinitin degisken prevalansi ve prevalansi etkileyen risk faktörleri.

Allergic rhinitis is described as a chronic inflammation of the nasal mucosa causing rhinorrhea, sneezing, nasal congestion and itching, often characterized with conjunctival injection and ocular itching. The prevalence of pediatric allergic rhinitis has recently shown a sharp increase throughout the world. However, there are significant differences among the regions, thus indicating to the influence of varying genetic and environmental factors upon the development of allergic rhinitis. This regional difference is mainly related to the 'western diet' and 'western lifestyle', with its swift changes in environmental and behavioral factors, besides a genetic predisposition. Some main and potential risk factors contributing to the development of allergic rhinitis are still unclear. In this review, we discuss mostly well known and some emerging new risk factors in the light of recent literature.

Arteriovenous fistula between descending aorta and left inferior pulmonary vein: Closure with vascular plugs.

Echocardiography revealed systemic artery to pulmonary venous fistula, a rare vascular anomaly, in a 20-month-old girl, and multislice computed tomography angiography (CTA) was performed to rule out congenital heart disease. Normal bronchial connection and pulmonary vasculature were observed in the lung. The fistula drained through the left inferior pulmonary vein to the left atrium leading to a left-to-left shunt. Percutaneous intervention was performed in 2 stages using Amplatzer vascular plugs to close successfully.

[Parasites in the Etiology of Pediatric Appendicitis]. / Çocuk Apandisitlerinin Etyolojisinde Parazitler.

OBJECTIVE: Appendicitis is the most common cause of operation in the children. Fekalit, lymphoid hyperplasia, parasites and foreign bodies are accused as the causes of appendicitis. In this study, we wanted to evaluate that the role of parasitic infections in pediatric appendicitis. METHODS: Histopathological results of the patients who underwent operations for acute appendicitis between January 2008 and 2014 were evaluated. The patients who have parasite in appendiceal specimens were detected and parasites were recorded. RESULTS: Fourteen of 846 patients underwent appendectomy, were classified as parasitic appendicitis. Enterobius vermicularis was observed in 12 and Taenia spp. was observed in 2 patients, Three children with appendicitis had parasitic infection in pathological examination. Two of them were Enterobius vermicularis, and one was Taenia spp. CONCLUSION: Enterobius vermicularis is the most common parasites in appendiks. Parasites often cause abdominal pain at right lower quadrant without any inflammation in the appendiks. However, parasites are responsible for some appendicitis as an etiologic factor. In our study, 0.39% of patients with appendicitis, parasites were also detected. As a result, we think that right lower quadrant pain and the incidence of appendicitis will reduce by time with the diagnosis and treatment of parasites.

Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis.

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.