Brescia-COVID Respiratory Severity Scale (BRCSS) and Quick SOFA (qSOFA) score are most useful in showing severity in COVID-19 patients.

In this study, we compare the predictive value of clinical scoring systems that are already in use in patients with Coronavirus disease 2019 (COVID-19), including the Brescia-COVID Respiratory Severity Scale (BCRSS), Quick SOFA (qSOFA), Sequential Organ Failure Assessment (SOFA), Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age (MuLBSTA) and scoring system for reactive hemophagocytic syndrome (HScore), for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians. We classified the patients into two groups according to the stage of the disease (severe and non-severe) and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 h. Of the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR 6.1, 95% CI 2.105-17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR 4.757, 95% CI 1.438-15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively. Calculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. Our prediction is that early interventions for high-risk patients, with early identification of high-risk group using BRCSS and qSOFA, may improve clinical outcomes in COVID-19.

Which hematological markers have predictive value as early indicators of severe COVID-19 cases in the emergency department?

Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and nonsevere cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters. Materials and methods: In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio, neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (nonsevere or severe). Results: The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters. Conclusion: Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups.

Are type 1 interferons treatment in Multiple Sclerosis as a potential therapy against COVID-19?

BACKGROUND: The Coronavirus (COVID-19), (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)) has been spreading worldwide since its first identification in China. It has been speculated that patients with comorbidities and elderly patients could be at high risk for the pandemic reasoned respiratory insufficiency and death. At first, it was thought that the patients who use immunmodulator therapy could be even at higher risks of disease complications. However, it has been also speculated about that using immunmodulators could be an advantage for the clinical prognosis. Therefore, several immunmodulators are currently being tested as potential treatment for COVID-19. METHODS: In this paper we report on a patient that has been treated with type 1 interferon for multiple sclerosis who developed COVID-19. RESULTS: Despite using immunmodulator, the symptoms of the patient at hospitalization were mild and he did not show elevated D-dimer, and there was no lymphopenia. He was discharged to home-quarantine with no symptoms. DISCUSSION: This report supports the idea of using type 1 interferon in the treatment could be effective in COVID-19 affected patients.

Daily Practice of Mechanical Ventilation and Weaning in Turkish PICUs: A Multicenter Prospective Survey.

OBJECTIVES: To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. DESIGN: The prospective observational multicenter cohort study was conducted at 15 hospitals. Data were being collected from November 2013 to June 2014, with two designated researchers from each center responsible for follow-up and data entry. SETTING: Fifteen tertiary PICUs in Turkey. PATIENTS: Patients between 1 month and 18 years old requiring conventional mechanical ventilation for greater than 48 hours were included. A single-center was not permitted to surpass 20% of the total sample size. Patients with no plans for conventional mechanical ventilation weaning were excluded. INTERVENTIONS: Conventional mechanical ventilation MEASUREMENTS AND MAIN RESULTS:: Pertinent variables included PICU and patient demographics, including clinical data, chronic diseases, comorbid conditions, and reasons for intubation. Conventional mechanical ventilation mode and weaning data were characterized by daily ventilator parameters and blood gases. Patients were monitored until hospital discharge. Of the 410 recruited patients, 320 were included for analyses. A diagnosis of sepsis requiring intubation and high initial peak inspiratory pressures correlated with a longer weaning period (mean, 3.65 vs 1.05-2.17 d; p < 0.001). Conversely, age, admission Pediatric Risk of Mortality III scores, days of conventional mechanical ventilation before weaning, ventilator mode, and chronic disease were not related to weaning duration. CONCLUSIONS: Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration.

Acute Mercury Poisoning in a Group of School Children.

OBJECTIVE: Elemental mercury is a toxic liquid element that is used widely in the home, medicine, agriculture, and industry. It is readily vaporized and inhaled at room temperature. Thereby, inhalation can cause acute or chronic poisoning. Mercury can be found in environmental naturally find but some dangers sources give rise to contaminations. It can be very dangerous to all living organisms, especially children. METHODS: This study presents the features of mercury poisoning in a group of pediatric cases. Data were obtained for 29 pediatric cases exposed to elemental mercury in a high school chemistry laboratory in Turkey. Patients with a blood mercury level exceeding 10 µg/L or a urine mercury level exceeding 15 µg/L were considered to have mercury poisoning. The patients were treated with 2,3-dimercaptopropane sulfonic acid or D-penicillamine. RESULTS: Twenty-nine children with mercury poisoning were admitted to the hospital. The median duration of exposure was 58 (range, 15-120) minutes. Ten (29%) children were asymptomatic. Physical and neurological examinations were normal in 19 (65.5%) children. The most common presenting complaint was headache. The most common neurological abnormality, partly dilated/dilated pupils, was present in 9 (31%) children. Mercury levels were measured in blood samples every 5 days, and the median blood mercury level was 51.98 (range, 24.9-86.4) µg/L. There was a positive correlation between the duration of exposure and maximum blood/urine mercury levels (P = 0.001). CONCLUSIONS: Elemental mercury exposure is potentially toxic; its symptomatology varies, especially in children. Secure storage of mercury and other toxic substances and provision of information about this subject to individuals who might be exposed to mercury and their families might help to prevent mercury poisoning.

Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study).

PURPOSE: Although influenza primarily affects the respiratory system, in some cases, it can cause severe neurological complications. Younger children are especially at risk. Pediatric literature is limited on the diagnosis, treatment, and prognosis of influenza-related neurological complications. The aim of the study was to evaluate children who suffered severe neurological manifestation as a result of seasonal influenza infection. METHODS: The medical records of 14 patients from six hospitals in different regions of the country were evaluated. All of the children had a severe neurological manifestations related to laboratory-confirmed influenza infection. RESULTS: Median age of the patients was 59 months (6 months-15.5 years) and nine (64.3%) were male. Only 4 (28.6%) of the 14 patients had a comorbid disease. Two patients were admitted to hospital with influenza-related late complications, and the remainder had acute complication. The most frequent complaints at admission were fever, altered mental status, vomiting, and seizure, respectively. Cerebrospinal fluid (CSF) analysis was performed in 11 cases, and pleocytosis was found in only two cases. Neuroradiological imaging was performed in 13 patients. The most frequent affected regions of nervous system were as follows: cerebellum, brainstem, thalamus, basal ganglions, periventricular white matter, and spinal cords. Nine (64.3%) patients suffered epileptic seizures. Two patients had focal seizure, and the rest had generalized seizures. Two patients developed status epilepticus. Most frequent diagnoses of patients were encephalopathy (n = 4), encephalitis (n = 3), and meningitis (n = 3), respectively. The rate of recovery without sequelae from was found to be 50%. At discharge, three (21.4%) patients had mild symptoms, another three (21.4%) had severe neurological sequelae. One (7.1%) patient died. The clinical findings were more severe and outcome was worse in patients <5 years old than patients >5 years old and in patients with comorbid disease than previously healthy group. CONCLUSION: Seasonal influenza infection may cause severe neurological complications, especially in children. Healthy children are also at risk such as patients with comorbid conditions. All children who are admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications even if their respiratory complaints are mild or nonexistent.

Henoch-Schönlein purpura complicated by acalculous cholecystitis and intussusception, and following recurrence with appendicitis.

Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. Gastro-intestinal involvement occurs in two-thirds of patients. The characteristic skin lesions generally precede abdominal symptoms or present concurrently. A 7-year-old boy presented with intussusception and acalculous cholecystitis and had a cholecystectomy. Two weeks later he was re-admitted with features typical of HSP which responded to corticosteroids. Eleven months later he presented with abdominal pain and recurrence of HSP and, at laparotomy, there was acute appendicitis. This is the first case of a child presenting with HSP complicated by acalculous cholecystitis.

The report of sequence analysis on familial Mediterranean fever gene (MEFV) in South-eastern Mediterranean region (Kahramanmaras) of Turkey.

Familial Mediterranean fever (FMF) is defined as an inherited and autosomal recessive disease. Many researches have been done about this subject, and we believe that it should be necessary to focus on phenotype-genotype correlation, especially novel mutation types. We aim to announce the results of FMF sequence analysis in Kahramanmaras/Turkey. The number of participants is 380 males and 451 females who clinically diagnosed as FMF subjects of different age groups. Genomic sequences of exons 2 and 10 and in some cases exon 3 of the MEFV gene were scanned for mutations by sequence analyzer. The most common mutation identified in 230 (57.07 %) patients is heterozygous. The frequencies of mutation types in heterozygous subjects are R202Q (39.13 %), E148Q (18.70 %), M680I (16.52 %), M694V (13.91 %), and V726A (4.78 %), respectively. The most striking point among the compound heterozygous subjects is R202Q/M694V mutation type found at the highest rate (32 subjects). Fever and peritonitis are the most frequent signs of homozygous M694V and combine heterozygous mutations. Interestingly, the rate of homozygous mutation types (M694V/M694V+ R202Q/R202Q) is 96.70 % among all compound homozygous mutation types. The most frequent rate of homozygous patients is M680I mutation types (68.42 % in all homozygous mutation types). Two novel mutations were found in this study: N206K (p.Asn206Lys) and S208T (p.Ser208Tyr). Our findings in this study on the FMF sequence analysis are different from the results obtained from the other regions of Turkey.

Decreased vitamin b(12) levels in children with nocturnal enuresis.

Objectives. Nocturnal enuresis is a common pediatric problem, the etiology of which is unclear. In the present study, vitamin B(12) and folate levels were measured in children with nocturnal enuresis and compared with those in healthy control group children to investigate whether there was any relation with enuresis and neurogenic maturation as a first time in the literature. Methods. In this cross-sectional study, we included thirty children (16 girls, 14 boys) who had presented with primary nocturnal enuresis (PNE) complaints in the study group and 31 children (13 girls, 18 boys) in the control group. Body weight and height measurements were obtained and complete blood counts and vitamin B(12) and folate levels were measured in all children. Results. No difference was found in age, height, and weight between study and control groups. Also the mean levels of the hemoglobin, hematocrit, and mean corpuscular volume (MCV) were not different between the two groups. Significantly lower mean vitamin B(12) and folate levels were found in the enuresis group compared with the control group. Conclusions. Further studies are needed to clarify B(12) and folate deficiency in larger series so that these tests can be included in routine investigations of enuretic children.

Diabetic ketoasidosis is associated with prothrombotic tendency in children.

Children and adolescents with type I diabetes mellitus (DM) may present with diabetic ketoacidosis (DKA), which is associated with significant morbidity and mortality. This study aimed to evaluate the hematological parameters at diagnosis (0th hour) and 96th hour after the initiation of treatment in children with DKA. Twenty-six children with DKA treated in Dicle University Faculty of Medicine between September 2002 and August 2003 were included in this study. General characteristics of the patients and hematological parameters (platelet count, white blood cell count, prothrombin time, partial thromboplastin time (PTT), bleeding time, coagulation time, protein C, protein S, antithrombin III, fibrinogen, D-dimer, factor VIII, factor IX, and factor X levels) at diagnosis (0th hour) and 96th hour after the initiation of treatment were determined. The mean age of the children (10 girls and 16 boys) was 9.15 ± 3.85 years (range: 4-15 years). DKA developed for the first time in 58.3% of these children and they had recently been diagnosed as DM. After hematological parameters at 0th hour were evaluated, increased platelet count, decreased PTT, low protein C, and high factor VIII levels were determined at diagnosis, indicating prothrombotic tendency. If the hematological parameters at 0th hour were compared with those at 96th hour; platelet count decreased, PTT increased, protein C and factor VIII levels turned to be normal at 96th hour. When all the results are considered together, children with DKA appeared to have a prothrombotic tendency. Although this tendency was not reflected in clinical findings in this study, it should be kept in mind that children with DKA are prone to the development of thrombosis and they need to be investigated for the possibility of thrombosis.

Hand grip and pinch strength in patients with nocturnal enuresis: is there a role of muscle strength in pathogenesis of enuresis?

AIMS: To examine the association of muscle strength with nocturnal enuresis. SUBJECTS AND METHODS: One hundred sixty-three patients with monosymptomatic nocturnal enuresis (8-14 years old) were recruited from outpatient clinics. Two hundred eight healthy students served as the control group (8-14 years old) from two primary schools. Physical examinations and the age, gender, height, weight, dominant hand, and body mass of these children index were recorded. A calibrated, Jamar dynamometer was used to assess grip strength at the first two settings. A pinch gauge was used to assess the key pinch of the right and left hands of these children. Two measurements of each grip and pinch were obtained at 15 sec intervals and mean values were analyzed. RESULTS: The hand grip strength test and pinch was significantly lower in the enuretic group compared with the control group. These low results of the muscle strength in the enuretic group showed that whole body muscle weakness may contribute to the pathogenesis of enuresis as a possible etiological factor. CONCLUSIONS: In this first study on the association of muscle strength with nocturnal enuresis, it was found that neuromuscular function is abnormal in enuretic patients. In this neuromuscular abnormality, the motor activity is affected.

Intracranial hemorrhage: clinical and demographic features of patients with late hemorrhagic disease.

BACKGROUND: This retrospective study presents clinical, demographical features and radiological findings as well as outcomes of 31 infants with intracranial hemorrhage (ICH) due to vitamin K deficiency and hence evaluates the risk factors involved. METHODS: Thirty-one cases (17 males and 14 females) having a mean age of 52.52 ± 20.80 days with intracranial hemorrhage due to late hemorrhagic disease of the newborn (LHDN), hospitalized in our clinics were included in the study. Cranial computerized tomography (CT) was performed in all patients for the diagnosis and evaluation of ICH. RESULTS: It was found that the most frequent presenting symptoms were pallor (77.4%), seizures (58%), altered consciousness (58%), vomiting (44%) and poor feeding (35%). Pulsatile fontanel was found in 61% and bulging in 26%. Seven (22.5%) patients had prior history of antibiotic usage. All patients (93.5%) except two were breast fed. Sixteen (51.6%) were delivered at home. Eighteen (58%) had a history of single-dose vitamin K prophylaxis on the first day of delivery. Parenchymal (44%), subdural (39%) or subarachnoidal (22.5%) bleeding was observed. Seven (22.6%) were exitus. During the follow-up period (ranging from 3 months to 18 months) neurological examination findings were recorded. CONCLUSION: Our results indicate that it may be questionable whether single-dose vitamin K prophylaxis at birth is adequate for the prevention of LHDN and if a different timing of this prophylaxis should be made for the exclusively breast fed infants.

Premarital screening test results for ß-thalassemia and sickle cell anemia trait in east Mediterranean region of Turkey.

Hemoglobinopathies are common diseases in Mediterranean region of Turkey. In this study, the results of a 3-year premarital screening program are reported in Kahramanmaras province, which is located in East Mediterranean region. A total of 48,126 persons were screened in this program. Hematological analyses and electrophoresis were done to identify carriers. The prevalence of ß-thalassemia trait and of sickle cell anemia trait, which were 2.1% and 0.5% in Turkey, were found to be 2.8% and 0.4%, respectively, in our study. Of the carriers of the ß-thalassemia trait, 82% had high hemoglobin A2, 34% had high hemoglobin F, and 18% had both high hemoglobin F and hemoglobin A2. ß-Thalassemia trait in Kahramanmaras is slightly higher than the average rate in Turkey. However, sickle cell anemia trait is similar to Turkey's averages.

The etiology of severe neonatal hyperbilirubinemia and complications of exchange transfusion.

Exchange transfusion (ECT) has an important role in preventing kernicterus in the treatment of indirect hyperbilirubinemia of the newborn. In present study, the etiology of hyperbilirubinemia and complications of ECT were studied over a five-year period in the Eastern Mediterranean region of Turkey. We describe our experience of 89 ECTs performed from 2003-2008 in 79 newborns with hyperbilirubinemia. The mean gestational age was 37 +/- 2.1 weeks and the mean of peak total bilirubin levels was 28.1 +/- 6.4 mg/dl. The most common cause of hyperbilirubinemia was ABO isoimmunization (38%). Complications of ECT developed in 17 neonates (21.5%), the most common being thrombocytopenia and seizure. None of newborns died secondary to ECT. Our data showed higher morbidity rates associated with ECT in the treatment of hyperbilirubinemia in our region. In order to prevent adverse effects of ECT, serum bilirubin levels should be closely monitored in newborns with ABO immunization.

Oxidative stress and protective effect of erythropoietin on methotrexate-induced esophageal damage.

INTRODUCTION: An experimental study was conducted to investigate the role of oxidative stress and effects of erythropoietin (EPO) on methotrexate-induced esophageal damage. MATERIALS AND METHODS: Twenty-four female Sprague-Dawley rats were equally divided into 3 groups: Sham operation animals (group S) were administered subcutaneous injections of 0.2 mL of 0.9% NaCl; control animals (group MTX) were administered subcutaneous injections of methotrexate (5 mg/kg) and EPO-treated animals (group EPO) were administered subcutaneous injections of methotrexate (5 mg/kg) and EPO (2000 IU/kg) once daily for 4 consecutive days. At the fifth day, the distal 1.5-cm esophageal segments were harvested for biochemical and histologic investigations. Oxidative damage was assessed by measuring the levels of malondialdehyde and nitric oxide, and activities of superoxide dismutase and catalase in homogenized samples of esophageal tissue. Histologic damage to esophageal tissue was scored and total tissue damage scores were calculated. RESULTS: Malondialdehyde levels in the S and EPO groups were significantly lower than those in the MTX group (P<0.05). Catalase and superoxide dismutase activities, and nitric oxide levels in the S and EPO groups were significantly higher than those in the MTX group (P<0.05). Esophageal tissue damage was significantly less in the EPO group than that in the MTX group (P<0.05). CONCLUSIONS: Free radicals elevate in methotrexate given rats' esophagus and EPO has significant preventive effects on methotrexate-induced oxidative damage of esophagus in a rat model.

Plasma visfatin concentrations in childhood obesity: relationships with insulin resistance and anthropometric indices.

BACKGROUND: The aim of this study was to investigate the relationships between plasma visfatin, insulin resistance, lipid profile and anthropometric measurements in obese children. SUBJECTS AND METHODS: Plasma levels of visfatin, insulin, glucose, lipid profile and anthropometric indices were determined in 30 obese children and compared with those in 30 age- and gender-matched non-obese children. Visfatin was measured with enzyme-linked immunosorbent assay and logarithmically transformed to log visfatin for parametric comparisons. RESULTS: The obese group had significantly elevated plasma visfatin, fasting glucose and insulin and homeostasis model assessment (HOMA) values, as well as elevated lipid concentrations, compared with non-obese children. In the obese group log visfatin correlated positively with weight (p = 0.007), waist circumference (p = 0.007), hip circumference (p = 0.034), BMI (p = 0.005), insulin (p = 0.041) and HOMA (p = 0.044). No correlation was found between visfatin and lipid profile in obese children (p >0.05). Linear regression analysis revealed significant positive relationships between log visfatin and BMI (p = 0.005), insulin and BMI (p <0.001), and between HOMA and BMI (p <0.001) in the obese group but not in the control group. Multivariate regression analysis with log visfatin as a dependent variable showed that only BMI (p = 0.005) and bodyweight (p = 0.014) correlated positively with log visfatin in obese children. CONCLUSIONS: An increased visfatin concentration may be associated with BMI and insulin resistance in obese children. Although these findings may lay a foundation for further hypotheses, the limited sample size in the present study means that longitudinal studies with more patients are needed.