Mental and Psychosomatic Effects of the Coronavirus Disease 2019 Pandemic on Adolescents: A Validation Study.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has had detrimental impacts on both physical and mental health worldwide. In addition to the behavioral effects, it has caused a range of psychological problems such as depression, anxiety, sleep disorders, and anger. Fear and stress have been particularly prevalent in individuals. This study aims to assess the psychometric properties of the Scale for the Evaluation of Mental and Psychosomatic Effects of the COVID-19 Pandemic (COVID-19 PRPEDS) on adolescents and explore the pandemic's psychosomatic effects. MATERIALS AND METHODS: A total of 503 adolescents between the ages of 14 and 18 years who continue their high school education constituted the study population. The COVID-19 PRPEDS comprising 18 items and 2 subscales (Mental Effects, Psychosomatic Effects), was used in adolescents. The forms were delivered to the students via the Internet, and in addition to the scale, the age and sex of the adolescents were recorded. RESULTS: A majority of the participants (96.6%, n = 486) had knowledge about COVID-19, 93.8% (n = 472) could differentiate COVID-19 from other diseases, 96.6% (n = 486) were able to explain the transmission ways of COVID-19 and 96% (n = 483) took the necessary precautions to protect themselves from COVID-19. The COVID-19 PRPEDS scores of males were higher than females. The study validation index was above 0.9, which is considered to be acceptable for adolescents. CONCLUSIONS: Like in the other pandemics, adolescents experienced serious mental health problems during the COVID-19 pandemic. In addition to its psychosomatic effects, the mental issues related to the pandemic were more common in male adolescents. Cite this article as: Ince G, Üzüm Ö, Eliaçik K, Kanik A, Emir B, Helvaci M. Mental and psychosomatic effects of the coronavirus disease 2019 pandemic on adolescents: A validation study. Turk Arch Pediatr. 2024;59(1):60-69.

Postnatal surgery for myelomeningocele in neonates: neurodevelopmental outcomes.

BACKGROUND: The study aims to evaluate the neurodevelopmental outcomes of neonates with myelomeningocele (MMC) operated in the postnatal period. METHODS: This is a prospective follow-up study in a tertiary neonatal intensive care unit. Neurodevelopmental outcomes of term neonates operated for MMC and healthy term newborns were compared with the Bayley Scales of Infant and Toddler Development -Third Edition (BSID III) at 12-18 months. RESULTS: A total of 57 cases were included in the study (patient group = 27; control group = 30). Demographic data between the groups were similar. Cognitive, linguistic, and motor composite scores of the patient group were lower than those of the control group (p < 0.001). In the patient group, those who underwent ventriculoperitoneal shunt had lower cognitive, language and motor scores than those without shunt (p < 0.05). The cognitive, linguistic, and motor composite scores in the patient group who underwent surgery before 72 h were better than those who underwent surgery after 72 h. DISCUSSION: In our study, it was found that the neurodevelopmental prognosis of MMC cases requiring ventriculoperitoneal shunt in the postnatal period was significantly worse than those without shunt. It is the first study in which the neurodevelopment of patients with MMC who were operated in the postnatal period was evaluated with BSID III evaluated and delays in all areas were shown in cases with MMC compared to normal cases. Better neurodevelopmental outcomes in patients operated in the first 72 h suggest that early surgery will improve neurodevelopmental outcomes in patients with MMC.

Investigating the Potential Connection Between Cyberchondria and Vaccine Hesitancy in High School Students.

BACKGROUND: Internet use, which provides the opportunity to access information from anywhere, and anytime, is increasing among adolescents and young adults. In studies examining the effect of technology use in adults, it has been observed that there is a relationship between cyberchondria and vaccine hesitancy. This study aimed to uncover the potential relationship between cyberchondria and vaccine hesitancy in adolescents and to obtain data for combating anti-vaccination in this age group. MATERIALS AND METHODS: A total of 2.353 high school students were enrolled within the scope of this research. The forms were delivered to the students online and 531 volunteers participated in the survey. The Cyberchondria Severity Scale and Vaccine Hesitancy Scale were used to evaluate the details of the relationship between cyberchondria and vaccine hesitancy levels in adolescents. RESULTS: The compulsion subscales of the Cyberchondria Severity Scale in males and vaccine repugnance subscales of the Vaccine Hesitancy Scale in females were statistically significantly higher. Cyberchondria and vaccine hesitancy have a strong relationship with each other except benefits and protective value of vaccines subscale of vaccine hesitancy. CONCLUSION: Health policymakers should be aware of this relationship and there is a need to develop novel online intervention programs for combating anti-vaccination, particularly among cyberchondriac adolescents who have relatively high vaccination hesitancy, particularly during the pandemic.

Understanding Vaccine Hesitancy: Social Isolation in Relation to Social Media Addiction and COVID-19 Anxiety.

BACKGROUND: Despite significant advancements in immunization over the last century, vaccine hesitancy is a major threat to world health. Health-related information available from a variety of sources, including new media such as social media platforms, can encourage vaccine hesitancy. The aim of this study is to determine the level of vaccine hesitation among adults, specifically their belief in the advantages of vaccination and their perceptions of vaccine-related dangers in relation to social media addiction and coronavirus disease 2019 (COVID-19) anxiety. MATERIALS AND METHODS: Between December 2021 and January 2022, 454 adults participated in an online cross-sectional survey consisting of the social media use disorder scale, the vaccine hesitancy scale, and the coronavirus anxiety scale. RESULTS: The results of the study revealed a strong correlation between social media addiction, vaccine hesitation, and COVID-19 anxiety. CONCLUSION: Given the potential for misinformation to spread through social media, especially in a situation like a pandemic, the conscious use of social media should be emphasized and anti-addiction measures are required. Novel programs including online interventions should be developed to promote vaccination among social media addicts who have relatively high vaccination hesitancy.

Characteristics and Results of Hospital Admission Caused by Influenza Virus Infections in Children under 5 Years Old.

AIMS: The influenza virus is an infectious disease with acute respiratory tract infections, caused secondary bacterial infections and death. In this study, we aimed to determine which predictors were associated with the need for high-flow nasal cannula oxygen therapy (HFNC) and transition to intensive care for influenza virus and also to compare single viral pathogens with multiple ones. METHODS: Inpatients under the age of 5 with influenza virus-related respiratory tract infections between November 2015 and March 2019 were included in the study. Demographic features, comorbidities, symptoms, secondary bacterial infection, need for HFNC and pediatric intensive care unit and respiratory support system, length of hospital stay, polymerase chain reaction tests were recorded. RESULTS: A total of 93 patients were included in the study. It was determined that 53.8% of the cases were male and 84.9% were under the age of 2. Comorbidities were present in 50.5% of the cases. Secondary bacterial pneumonia developed in 56.9% of the cases. Patients with secondary bacterial pneumonia had higher PICU need, HFNC need and hospital stay (p = 0.014, p ≤ 0.001 and p ≤ 0.001, respectively). Patients with comorbidity had longer hospital stays and a higher need for HFNC (p ≤ 0.001 and p = 0.001, respectively). CONCLUSIONS: In this study, it was determined that especially comorbidity and secondary bacterial infection aggravated the clinical treatment of hospitalized patients. Therefore, it was concluded that patients with comorbidity should be followed closely and secondary bacterial pneumonia should be recognized and treated early.

Comparison of clinically related factors and treatment approaches in patients with acute bronchiolitis.

AIM: Acute bronchiolitis is a lower respiratory tract infection caused by viral agents in children aged under two years. Treatment includes hydration, oxygen, nebulized salbutamol, and intravenous steroids. This study aimed to determine the clinically related factors, the effect of viral agents on the clinical picture, and the efficacy of treatment methods in patients admitted with acute bronchiolitis. MATERIAL AND METHODS: Patients aged under two years of age who were hospitalized with a diagnosis of moderate/severe acute bronchiolitis between March 2015 and March 2019 were included in the study. Demographic data, hospitalization time, body temperature, presence of congenital heart disease, history of atopy, acute-phase reactants, mean platelet volume values, and respiratory virus panel results were recorded. The treatment modalities, length of hospitalization, intensive care hospitalization, and high-flow nasal cannula oxygen therapy (HFNC) were recorded. RESULTS: Four hundred twenty-two patients were included in the study. The duration of hospitalization was found to be significantly longer in patients aged under one year and in patients with acyanotic congenital heart disease. A single viral agent was detected in 69 (51.9%) patients. Rhinovirus was detected in 70 patients and RSV was detected in 37. The duration of hospitalization was found to be significantly shorter in patients who received only oxygen and/or intravenous fluid treatment compared with those who received nebulized salbutamol and/or intravenous steroids. In addition, and there was no significant difference between the groups in terms of HFNC and hospitalization in the intensive care unit. CONCLUSION: Rhinovirus was the most common cause of acute bronchiolitis in our study. It was observed that congenital heart disease prolonged the length of hospitalization. In the treatment approaches, it was observed that hydration and oxygen therapy were sufficient treatment methods for the patients, in accordance with the recommendations of the American Academy of Pediatrics, and giving nebulized therapy prolonged the hospitalization period due to the treatment discontinuation steps.

The evaluation of burnout and job satisfaction levels in residents of pediatrics.

AIM: The aim of the study was to examine the level of job-related burnout and the level of job satisfaction among residents of pediatrics. MATERIAL AND METHODS: A total of 102 residents of pediatrics who were trained in two Ministry of Health teaching and research hospitals and in two university hospitals in Izmir were included in the study. Demographic data (age, sex), lifestyle (living with parents or not, marital status, number of children) and professional characteristics (total time spent in profession, time spent in residency, number of night shifts per month, institution type: teaching hospital/university) were collected. Maslach Burnout Inventory (subscales: emotional exhaustion, desensitization, personal accomplishment) and Minnesota Satisfaction Questionnaire were used. RESULTS: High levels of emotional exhaustion and desensitization, and low levels of personal accomplishment and job satisfaction were found in residents of pediatrics. Low levels of emotional exhaustion in teaching and research hospitals and low levels of desensitization in university hospitals were determined (p<0.05). We found a positive correlation between age and job satisfaction levels and a negative correlation between age and emotional exhaustion levels (p<0.05). There were negative correlations between the length of time in education and desensitization and between the number of night shifts per month and desensitization (p<0.05). CONCLUSIONS: In residents of pediatrics, there is a high-level burnout and low-level of job satisfaction. Emotional exhaustion is more common in teaching and research hospitals and desensitization is more common in universities. Younger age, lower seniority, and the higher number of work-shift increases the burnout.

Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease.

OBJECTIVE: To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. METHODS: The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age- and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). RESULTS: Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289 , P = 0.025 ). Low levels of Hb seem to affect the femoral cartilage thickness. CONCLUSION: These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

Toilet training age and influencing factors: a multicenter study.

To determine toilet training age and the factors influencing this in our country, 1500 children who had completed toilet training were evaluated in a multicenter study. The mean age of toilet training was 22.32 ± 6.57 months. The duration it took to complete toilet training was 6.60 ± 2.20 months on the average. In univariant analysis, toilet training age increased as the parental education level, specifically that of the mother, increased. The training age of children whose mothers had over 12 years of education differed significantly from that of children of mothers with less education. There was no significant difference in toilet training age with regard to the education level of the father, or the employment status of the mother. We also found significant differences with respect to family income level, toilet type and training method. In multivariant analysis, family income >5000 TL and use of a potty chair were determined to be factors affecting toilet training age. In conclusion, toilet training age in Turkey, a developing country, was found to be lower than that in developed countries.

Mortal quintet of sickle cell diseases.

BACKGROUND: Sickle cell diseases (SCDs) are chronic inflammatory processes on capillary level. We tried to understand some possible correlations between stroke and severity of SCDs. METHODS: All patients with SCDs were taken into the study. RESULTS: The study included 343 patients (174 males and 169 females). There were 30 cases (8.7%) with stroke. The mean ages were similar in both groups (32.5 versus 29.1 years in the stroke group and other, respectively, P>0.05). The female ratios were similar in both groups, too (43.3% versus 49.8%, respectively, P>0.05). Prevalences of associated thalassemia minors were also similar in them (73.3% versus 65.1%, respectively, P>0.05). Smoking was higher among the stroke cases, significantly (26.6% versus 13.0%, P<0.05). Mean white blood cell count, hematocrit value, and mean platelet count of the peripheric blood were similar in both groups (P>0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, chronic renal disease, rheumatic heart disease, avascular necrosis of bones, cirrhosis, and mortality were all higher in the stroke group, the differences were only significant for acute chest syndrome (ACS), digital clubbing, and leg ulcers (P<0.05 for all), probably due to the small sample size of the stroke group. CONCLUSION: SCDs and smoking are chronic destructive processes on endothelium, and both terminate with early organ failures in life. Probably smoking, digital clubbing, leg ulcers, ACS, and stroke are mortal quintet of the SCDs that may indicate shortened survival in such patients.

Tonsilectomy in sickle cell diseases.

BACKGROUND: We tried to understand whether or not there are lowered prevalences of terminal consequences of sickle cell diseases (SCDs) with tonsilectomy. METHODS: All cases with SCDs were taken into the study. RESULTS: The study included 334 patients (164 females). There were 27 cases with tonsilectomy and 307 cases without. The mean ages, female ratios, and prevalences of associated thalassemia minors and smoking were similar in both groups (P>0.05 for all). Although the white blood cell and platelet counts of peripheric blood were higher in patients without tonsilectomy, the mean hematocrit value was lower in them, but the differences were nonsignificant probably due to the small sample size of the tonsilectomy group (P>0.05 for all). Similarly, although the painful crises per year, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, rheumatic heart disease, avascular necrosis of bone, cirrhosis, stroke, and mortality were higher in cases without tonsilectomy, the differences were nonsignificant probably due to the same reason again (P>0.05 for all). CONCLUSION: There may be an inverse relationship between prevalence of tonsilectomy and severity of SCDs, and the tonsils may act as chronic inflammatory foci accelerating the chronic endothelial damage all over the body in such patients.

Changes in the cornea related to sickle cell disease: a pilot investigation.

PURPOSE: To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). METHODS: This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. RESULTS: The mean CCT value was 509.6 ± 20.7 µm in the study group and 520.8 ± 23.6 µm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm², 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm², 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. CONCLUSIONS: The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.

Clinical and economic results of ventriculoperitoneal shunt infections in children.

AIM: This study evaluated the clinical and economic outcomes of ventriculoperitoneal shunt infections. MATERIAL AND METHODS: Patients diagnosed with ventriculoperitoneal shunt infections for the first time between 1 January 2007 and 31 December 2011 were included in this study. Demographic, clinical, and economic data were analyzed retrospectively. A cost coefficient (total cost/follow-up period) and hospitalization coefficient (duration of hospitalization/follow-up period) were calculated for each patient. RESULTS: In total, 132 shunt infections (mean follow-up, 734 ± 367 days) were evaluated in 51 patients (mean age, 16.6 ± 9.22 months; median age, 3 months; range, 1-88 months; 28 females, 21 males). In 23 patients (45%), shunt infections were seen in the first 2 months following shunt placement. Seven patients died during the follow-up. There was a negative correlation between the age at diagnosis and the hospitalization duration (p = 0.005, r = -0.381). The average cost of hospitalization per patient was 6397 ± 4338 TL. There was a negative correlation between the cost index and the age at diagnosis (p = 0.04, r = -0.292). CONCLUSION: Ventriculoperitoneal shunt infections have significant medical and economic impacts. Younger the diagnosis of patients, the hospitalization duration and treatment cost were higher.

Faecal calprotectin levels in children with Henoch-Schönlein purpura: is this a new marker for gastrointestinal involvement?

AIM: We aimed to investigate the significance of faecal calprotectin (FC) levels in children diagnosed with Henoch-Schönlein purpura (HSP) and examine its relationships with gastrointestinal system (GIS), renal involvement and with clinical findings. PATIENTS AND METHODS: In total, 66 children diagnosed with HSP for the first time and a control group of 25 healthy children were included. The cases were divided into mild and severe groups on the basis of GIS findings. FC was measured twice in all patients with HSP: within 3 days of onset of disease (FC1) and on day 15 (FC2). These results were compared with those of the control group. Faecal occult blood, gastric wall thickness and duodenal wall thickness were measured at the same time as FC1 in all patients, and the presence of renal involvement was recorded. RESULTS: Of the 66 patients, 37 (56%) were females (mean age, 7.5±2.9 years; range, 2.5-14.5 years) and were diagnosed with HSP. Renal involvement was detected in 19 (28%) cases and GIS involvement was found in 28 (43%) cases. GIS involvement was mild in 16 (53%) cases and severe in 12 (43%). A significant difference was detected in FC1 levels between the groups with and without GIS involvement (P=0.01). A marked difference was observed in FC1 levels between the groups with and without renal involvement (P=0.017). CONCLUSION: FC may be a reliable marker for HSP, particularly for identifying GIS and renal involvement as well as disease severity.

Sickle cell diseases and ileus.

BACKGROUND: We tried to understand whether or not there is an increased incidence of ileus in patients with sickle cell diseases (SCDs). METHODS: All cases with SCDs were taken into the study. RESULTS: The study included 325 patients (160 females). The mean ages were similar in both sexes (29.3 versus 29.8 years in females and males, respectively, p > 0.05). Incidence of ileus was higher in males, significantly (3.6% versus 1.2%, p < 0.01). All of the ileus cases were able to be treated with simple and repeated red blood cell (RBC) transfusions without any surgical procedure. Smoking was higher in males, too (21.8% versus 6.2%, p < 0.001). The mean hematocrit value was also higher in males, significantly (24.4% versus 23.0%, p = 0.016). RBC units transfused, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, and chronic renal disease were all higher in males, too (p < 0.05 for all). On the other hand, although the general mortality, white blood cell and platelet counts of peripheric blood, painful crises per year, rheumatic heart disease, avascular necrosis of bone, cirrhosis, and stroke were all higher in males, the differences were nonsignificant probably due to the small sample sizes of the groups (p > 0.05 for all). CONCLUSION: Although the relatively young mean ages of the patients with SCDs, the very high incidences of ileus are probably due to the strong atherosclerotic and obstructive natures of the two pathologies, and ileus should be treated with simple and repeated RBC transfusions to restore bowel perfusion in such patients.

Left renal atrophy.

BACKGROUND: We tried to understand whether or not there is a higher risk of left renal atrophy in human being. METHODS: All patients applying to the Hematology Service with any underlying complaint were studied. RESULTS: The study included 2,417 cases (1,248 females). The mean ages were 47.3 versus 50.7 years in females and males, respectively (p<0.000). There were 33 cases (1.3%) with the left renal atrophy against five cases (0.2%) with the right (p<0.001). The left renal atrophy cases have splenomegaly (SM) in 51.5%, thalassemia minors (TMs) in 30.3%, sickle cell diseases (SCDs) in 27.2%, myeloproliferative disorders in 18.1%, chronic lymphocytic leukemia in 6.0%, cirrhosis in 6.0%, solid organ malignancies in 6.0%, chronic obstructive pulmonary disease in 3.0%, multiple myeloma in 3.0%, and Waldenström's macroglobulinemia in 3.0%. Similarly, the right renal atrophy cases have SM in 20.0%, TMs in 40.0%, and SCDs in 20.0%. CONCLUSION: Left renal atrophy may be significantly higher than the right side in human being. Aortic pressure induced flow disorders in the left renal vein, structural anomalies of the left renal vein, and possibly the higher arterial pressure of the left kidney due to the shorter distance to the heart as an underlying cause of atherosclerosis may be some of the possible causes. Due to the stronger arterial wall protecting itself from compression and high prevalences of SM and left varicocele in population, SM induced flow disorders of the left renal vein may be the most common cause.

Autosplenectomy in severity of sickle cell diseases.

BACKGROUND: We tried to understand whether or not there is an association between prevalence of autosplenectomy and severity of sickle cell diseases (SCDs). METHODS: All SCDs patients with red blood cell (RBC) transfusions of less than 50 units in their lives were put into the first group and 50 units or higher were put into the second group. RESULTS: The study included 316 patients (155 females). There were 224 cases (70.8%) in the first group and 92 cases (29.1%) in the second group (p<0.001). The male ratio was significantly higher in the second group (64.1% versus 45.5%, p<0.001). Although both the white blood cell and platelet counts were higher in the second group, there was a significant difference in platelet counts (p=0.005), and this was probably due to the small sample sizes. Although the prevalence of autosplenectomy was significantly higher in the first group (56.2% versus 45.6%, p<0.05), the mean number of painful crises per year, digital clubbing, chronic obstructive pulmonary disease (COPD), leg ulcers, stroke, chronic renal disease (CRD) and coronary heart disease (CHD) were significantly higher in the second groups (p<0.05 for all). CONCLUSION: In contrast to the lower prevalence of autosplenectomy, the mean number of painful crises per year, digital clubbing, COPD, leg ulcers, stroke, CRD, and CHD were significantly higher in the second group. So there may be an inverse relationship between prevalence of autosplenectomy and severity of SCDs, and spleen may act as a chronic inflammatory focus as a filter of blood for these abnormally hard RBCs.

The importance of microalbuminuria in predicting patient outcome in a PICU.

OBJECTIVE: To evaluate the prognostic significance of microalbuminuria in critically ill children. DESIGN: Prospective study. SETTING: PICU of a teaching hospital. PATIENTS: Admitted critically ill children. INTERVENTIONS: The urine albumin-creatinine ratio was measured at admission and at 24 hours. Pediatric Risk of Mortality, Pediatric Index of Mortality II, Pediatric Logistic Organ Dysfunction, and Inotrope Score were calculated. MEASUREMENTS AND MAIN RESULTS: In total, 102 patients (median age, 19 mo) were included in the study, among whom were 30 mortalities. Microalbuminuria was identified in 62 patients (64%). The patients were classified into three groups: patients with sepsis, patients with noninfectious systemic inflammatory response syndrome, and patients without systemic inflammatory response syndrome. The highest clinical scores, albumin-creatinine ratio levels, mortality rate, and duration of mechanical ventilation were found in the sepsis group, and the lowest values were seen in patients without systemic inflammatory response syndrome (p < 0.05). Significant correlations were observed between the albumin-creatinine ratio levels and the clinical scores (p < 0.05). The receiver operating characteristics curve analysis showed that the areas under the curves were 0.818 and 0.781, respectively, for albumin-creatinine ratio measured at admission and at 24 hours to identify PICU mortality. At a cutoff value of 34.2 mg/g, albumin-creatinine ratio measured at admission may be able to discriminate between patients a with sensitivity of 63.3%, specificity of 93.3%, positive predictive value of 95%, and negative predictive value of 56%. CONCLUSIONS: Microalbuminuria is a simple, inexpensive, and useful tool for predicting mortality and morbidity in critically ill children in the PICU.

Severe acute disseminated encephalomyelitis with clinical findings of transverse myelitis after herpes simplex virus infection.

BACKGROUND: ADEM is a central nervous disease that leads to myelin damage as a result of autoimmune response that develops after infections or vaccination. Herpes Simplex Virus (HSV) infection rarely leads to ADEM. PATIENT: 25-month-old male due to urinary retention, paradoxical respiration and muscle weakness after herpetic gingivostomatitis diagnosed as transverse myelitis. In follow-up with cranial and spinal magnetic resonance imaging multiple lesions were demonstrated. Electroneuromyography findings were compatible with acute sensorimotor neuropathy, serum anti-GM2 antibodies and Herpes Simplex Virus (HSV) Type 1/2 IgM / IgG detected negative and positivite, respectively. With these findings he was diagnosed acute disseminated encephalomyelitis (ADEM) following HSV infection. Although acyclovir, intravenous immunoglobulin, methylprednisolone and plasmapheresis therapies, he is still in intensive physical therapy program with heavy sequel. RESULTS: In our case, ADEM demonstrated transverse myelitis clinic after HSV infection which is rarely seen in literature. As well as clinic and spinal imaging findings, cranial imaging findings helped establishment of ADEM diagnosis. CONCLUSION: To our best knowledge, HSV is a rare etiological and probably the poor prognostic factor of ADEM.