Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study).

PURPOSE: Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU). METHODS: This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented. RESULTS: A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × µL, platelet count 153 vs. 212 cells × 103/ µL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 µg/L, ferritin 644 vs. 334 µg/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log D-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively.     Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care. WHAT IS KNOWN: • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. WHAT IS NEW: • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay.

Clinical and Cytokine Profile of Children With COVID-19: A Report From Turkey.

Background We aimed to analyze the expression of infection-related biomarkers and inflammatory cytokines in laboratory-confirmed cases and compare the differences between clinically severe and non-severe ones. Method We randomly selected 35 patients who were hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). Blood serum was obtained at the time of admission to the hospital, on the third to the fifth day, and at the time of discharge. Result The median age of our patients was 56.5±69.7 months (range: 1-205 months). The mean pro-B-type natriuretic peptide (pro-BNP) was significantly higher at the time of admission than on the third to the fifth day of illness. The mean pro-B-type natriuretic peptide levels at three time points were significantly higher in patients with severe cases than in mild-moderate cases. However, there was no significant difference between the clinical severity with regard to the cytokine levels at disease onset and recovery. Conclusion In the study, it was shown that cytokines play an important role in the pathogenesis of COVID-19. Therefore, it may be beneficial to use agents such as tocilizumab in the treatment.

Thrombotic Microangiopathy in a Severe Pediatric Case of COVID-19.

In this case report, we report a pediatric patient with COVID-19 and atypical hemolytic uremic syndrome (aHUS). A 3-year-old girl with fever and respiratory distress was admitted to the hospital. The patient tested positive for COVID-19 by a PCR test. As her respiratory distress increased and blood gas indicated deep respiratory acidosis on the third day of the pediatric intensive care unit follow-up, the patient was intubated and ventilated. Thorax computerized tomography (CT) showed bilateral effusion and atelectasis. During her follow-up, the pleural effusion resolved but there were marked consolidation areas and ground glass opacities compatible with COVID-19 on the follow-up CT. On the 10th day, she became anuric and developed progressive thrombocytopenia and persistent microangiopathic hemolytic anemia, which were suggestive of HUS given a high creatinine level (1.9 mg/dl), an undetectable haptoglobin level, reticulocytosis (8%), and an LDH level of 2540 U/l. Direct Coombs test returned negative. Examination of a peripheral blood smear revealed schistocytes. Disseminated intravascular coagulation was ruled out by normal INR and PTT. In the light of the available findings, we considered the patient to have thrombotic microangiopathy (TMA) triggered by COVID-19. It was not a TTP-form of TMA but rather an aHUS type, based on an ADAMTS13 activity level >5%. Hence, plasmapheresis was performed with fresh frozen plasma (FFP). After 4 weeks, she became completely asymptomatic, and her hemodynamic parameters normalized. COVID-19 induced uncontrolled complement activation leading to the development of aHUS. Early diagnosis and treatment may reduce morbidity and mortality since its treatment options.

Ambient Air Quality and General Health Outcomes in Nigde (Turkey) between 2011 and 2017.

BACKGROUND: We aimed to provide information for health practitioners and other related people about the association between ambient air quality and adverse health outcomes in the general population of Nigde, a central Turkish city, within the context of current health data epidemiological evidence. METHODS: The present study highlights the connection between health problems and time series of particulate matter (PM10) and sulphur dioxide (SO2) in Nigde, Turkey between 2011 and 2017. Significant morbidity is linked to ambient air pollution, resulting in a significant economic cost to society. RESULTS: We found that the required funds to treat cancers and chronic obstructive pulmonary disease triggered by ambient air pollution in Nigde, exceed 9 million US dollars per year, even when only the city center is taken into account. CONCLUSION: As Turkish cities grow and urban population density increases, air pollution issues need to be given priority in order to protect the health of the public and support sustainable development for future generations. It is recommended that particulate matter concentration in this urban center should be significantly reduced to minimize health problems.

Evaluation the Effect of Different Antioxidants Applied After Bleaching on Teeth Color Stability / Avaliação do efeito de diferentes antioxidantes aplicados após o clareamento na estabilidade da cor dos dentes

Objective: Vital bleaching is a popular treatment option for discolored teeth; but at post-treatment stage, loss of adhesion is highly reported. Literature focused on antioxidant application for the answer of this issue. The aim of this study was to compare the effects of six different antioxidants on color stability of bleached teeth. Material and Methods: This study included total of 84 extracted intact non-carious lower incisors. 35% hydrogen peroxide was applied on the labial surfaces of specimens in accordance with manufacturer's instructions. The bleached teeth were divided into 7 groups. No antioxidants were applied to the control group. For the experimental groups, the following antioxidants were applied for 10 minutes each: 5% proanthocyanidin, 5% sodium ascorbate, 5% lycopene, %5 green tea, %5 white tea and %5 α-tocopherol. CIE L*, a* and b* values of the teeth were measured by a spectrophotometer. One-way ANOVA was used to determine the differences among the groups. Multiple comparisons were examined with Tukey HSD. Results: The one-way ANOVA test revealed a statistically significant difference between the groups (p < 0.005). Highest color change was observed in lycopene group and the lowest in green tea group. Conclusion: Proanthocyanidin, white tea and green tea could be considered as post-bleaching antioxidant alternatives based on their herbal nature. (AU)

Objetivo: O clareamento vital é uma opção popular de tratamento para dentes descoloridos, mas na fase pós-tratamento, a perda de adesão é altamente relatada. A literatura enfocou a aplicação de antioxidantes para a resposta desta questão. O objetivo deste estudo foi comparar os efeitos de seis diferentes antioxidantes na estabilidade da cor de dentes clareados. Material e Métodos: Este estudo incluiu um total de 84 incisivos inferiores extraídos, intactos e não cariados. Peróxido de hidrogênio a 35% foi aplicado nas superfícies labiais dos espécimes de acordo com as instruções do fabricante. Os dentes clareados foram divididos em 7 grupos. Nenhum antioxidante foi aplicado ao grupo controle. Para os grupos experimentais, os seguintes antioxidantes foram aplicados por 10 minutos cada: proantocianidina a 5%, ascorbato de sódio a 5%, licopeno a 5%, chá verde a 5%, chá branco a 5% e α-tocoferol a 5%. Os valores CIE L *, a * e b * dos dentes foram medidos por um espectrofotômetro. ANOVA um fator foi usada para determinar as diferenças entre os grupos. As comparações múltiplas foram examinadas com Tukey HSD. Resultados: O teste ANOVA revelou uma diferença estatisticamente significativa entre os grupos (p <0,005). A maior mudança de cor foi observada no grupo do licopeno e a menor no grupo do chá verde. Conclusão: Proantocianidina, chá branco e chá verde podem ser considerados como alternativas antioxidantes pós-clareamento com base em sua natureza fitoterápica. (AU)

Ambient air quality and asthma cases in Nigde, Turkey.

Urban air quality is one of the key factors affecting human health. Turkey has transformed itself into an urban society over the last 30 years. At the same time, air pollution has become a serious impairment to health in many urban areas in the country. This is due to many reasons. In this study, a nonparametric evaluation was conducted of health effects that are triggered by urban air pollution. Nigde, the city which is the administrative centre of Nigde province was chosen of the effects of air pollution since, like many central Turkish cities, it is situated on a valley where atmospheric inversion occurs. In this paper, the relationship between ambient urban air quality, namely PM10 and sulphur dioxide (SO2), and human health, specifically asthma, during the winter season is examined. Air pollution data and asthma cases from 2006 to 2010 are covered in this study. The results of our study indicate that total asthma cases reported in Nigde between 2008 and 2010 were highly dependent on ambient SO2 concentration. More asthma cases were recorded when 30 µg m(-3) or higher SO2 was present in the ambient air than those recorded under cleaner ambient air conditions. Moreover, it was determined that in Nigde in 2010, asthma cases reported in males aged between 45 and 64 were closely correlated with ambient SO2 (α=0.05).

An investigation on physical, chemical, and bacteriological quality of municipally supplied and well waters of the towns and city centre in the province of Nigde, Turkey.

Physical, chemical, and bacteriological properties of municipally supplied water and well water in selected towns and the city centre (Nigde, population 76,000) of the province of Nigde, located in central Anatolia, in Turkey, were investigated in this study. A composition of 70 samples were collected, 31 from Nigde city centre; 17 from Bor; 8 from Ulukisla; 6 from Altunhisar; 6 from Ciftlik and 2 from Camardi. Analyses showed that all the samples collected were found to have been chemically safe to consume for domestic purposes. Twenty-three water samples were found potentially unsafe because of the existence of coliform bacteria in them, which was probably caused by the inexistence of sufficient chlorination. Physical tests indicated that 11 water samples were found to have deposit; therefore, the use of such water causes risks where human health is a concern, based upon Turkish national standards (TSE, 1984).