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Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.

Objective: Few cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in children compared with the total number of cases in the general population. No pediatric studies (or cases) have evaluated extracorporeal techniques in severe coronavirus disease 2019 (COVID-19) patients. In this article, we aimed to describe the clinical features, treatments, and outcomes of four children with COVID‐19 who were treated with therapeutic plasma exchange (TPE) and continuous renal replacement therapy (CRRT) in our pediatric intensive care unit (PICU).Materials and Methods: The children with COVID 19 pneumonia admitted to the PICUs from March 23, and May 6, 2020 were collected. Demographic data and reason for hospitalization were recorded. Vital and laboratory findings were examined in children with extracorporeal treatments. Results: Noninvasive mechanical ventilation, antiviral and antibacterial therapy, supportive antioxidant treatments were administered for 11 children. Respiratory failure and vital signs were more serious in four patients than in other patients. Therefore, we performed extracorporeal support treatments, TPE and CRRT. The patients showed a rapid clinical response to these treatments.Conclusion: TPE and CRRT can use for severe COVID-19 infection receiving other supportive and medical treatments in children., Amaç: Genel popülasyondaki toplam vaka sayısı ile karşılaştırıldığında, çocuklarda az sayıda ağır akut solunum sendromu koronavirüs 2 (SARS-CoV-2) enfeksiyonu bildirilmiştir. Hiçbir çocuk çalışması (veya vaka) ağır koronavirüs hastalığı (COVID-19) hastalarında ekstrakorporeal teknikleri değerlendirmemiştir. Bu yazıda, çocuk yoğun bakım ünitemizde (ÇYBÜ) terapötik plazma değişimi (TPD) ve sürekli renal replasman tedavisi (SRRT) ile tedavi edilen dört COVID‐19 çocuğun klinik özelliklerini, tedavilerini ve sonuçlarını tanımlamayı amaçladık.Materyal ve Methot: 23 Mart ve 6 Mayıs 2020 itibaren ÇYBÜ’ne kabul edilen COVID-19 pnömonisi olan çocuklar toplandı. Demografik veriler ve hastaneye yatış nedeni kaydedildi. Ekstrakorporeal tedavi uygulanan çocuklarda yaşamsal ve laboratuvar bulguları incelendi.Bulgular: Noninvaziv mekanik ventilasyon, antiviral ve antibakteriyel tedavi, destekleyici antioksidan tedaviler 11 çocuğa uygulandı. Diğer hastalara göre dört hastada solunum yetmezliği ve vital bulguları daha ciddiydi. Bu nedenle ekstrakorporeal destek tedavileri, TPD ve SRRT uyguladık. Hastalar bu tedavilere hızlı bir klinik yanıt gösterdi.Sonuç : TPD ve SRRT, çocuklarda diğer destekleyici ve tıbbi tedaviler alan ağır COVID-19 enfeksiyonu için kullanılabilir.

IntroductionThrombocytopenia is acommon haematological finding in critically ill patients. Studies have shownthat decreased platelet counts are associated with prolonged hospitalisation,increased costs, and mortality in adult populations. However,not enough studies have investigated the incidence of thrombocytopenia and therelationship between thrombocytopenia and the prognoses of paediatric patientswho require treatment in the intensive care unit. We evaluated theeffects of initial platelet counts on the outcomes of.pediatric intensive careunit patients.Material and MethodsWe performed a retrospective analysisof the records of all patients admitted to the pediatric intensive care unitbetween October 2016 and December 2017. The relationship between the initialthrombocyte counts and the need of invasive mechanical ventilation andnon-invasive mechanical ventilation,inotropic drug use, continuous renalreplacement need, duration of hospitalization and mortality rate wereinvestigated. ResultsTotally 387 patients were included inthe study. Age distributions ranged from 1 month to 17 years, and the meanpatient age was 3.95±4.80 years. The most frequent diagnoses of patients wererespiratory disorders (144 patients; 37.2%). There was a statisticallysignificant relationship between thrombocyte levels of the first complete bloodcount performed during admission and invasive mechanical ventilation, non-invasive mechanical ventilation, inotropic druguse, mortality, acute kidney injury, and continuous renal replacement therapy.Analyses of receiver-operator characteristic (ROC) curves for the thrombocytecounts showed that with a cutoff value of 102,000, mortality had 92.7%sensitivity and 53.1% specificity. The odds ratios (ORs) and relationshipbetween prognostic factors and thrombocytopenia were calculated using logisticregression models. ORs were 4.616 for continuous renal replasman therapy, 6.682for inotropic drug use, and 3.649 for mortality. ConclusionA low platelet count at the time ofadmission to the pediatric intensive care unit should be considered an independent risk factor thatincreases mortality and morbidity and prolongs hospitalisation. Extensive careshould be provided to this group of patients., GirişTrombositopeni,kritik hastalardaki ortak bir hematolojik bulgudur. Araştırmalar, trombositsayısındaki azalmanın, hastanede yatış süresinin uzaması, artan maliyetler veyetişkin popülasyonunda mortalite ile ilişkili olduğunu göstermiştir. Ancak,trombositopeninin görülme sıklığını ve trombositopeni ile yoğun bakımünitesinde tedavi gerektiren pediatrik hastaların prognozları arasındakiilişkiyi araştıran yeterli çalışma yoktur. Başvuru trombosit sayısının çocukyoğun bakım ünitesi hastalarındaki sonuçlarını değerlendirdik.Gereç ve yöntemlerÇocukyoğun bakım ünitesine Ekim 2016 - Aralık 2017 tarihleri ​​arasında başvuran tümhastaların kayıtlarının geriye dönük olarak inceledik. Başvuru trombositsayıları ile invaziv mekanik ventilasyon ihtiyacı ve non-invaziv mekanikventilasyon ihtiyacı, inotropik ilaç kullanımı arasındaki ilişki, sürekli renalreplasman ihtiyacı, hastanede yatış süresi ve mortalite oranları araştırıldı.SonuçlarÇalışmayatoplam 387 hasta dahil edildi. Yaş dağılımları 1 ay ile 17 yıl arasındadeğişmekte olup, ortalama hasta yaşı 3,95 ± 4,80 idi. Hastaların en sık başvurutanısı solunum sıkıntısı idi (144 hasta;% 37.2). Başvuru sırasındaki ilk tamkan sayımı trombosit seviyeleri ile invaziv mekanik ventilasyon, invaziv olmayanmekanik ventilasyon, inotropik ilaç kullanımı, mortalite, akut böbrek hasarı vesürekli böbrek replasman tedavisi arasında istatistiksel olarak anlamlı birilişki vardı. Trombosit sayısı için receiver-operator characteristic (ROC)eğrilerinin analizi, 102.000'lik bir kesim değerinde ölüm oranının% 92.7duyarlılığa ve% 53.1 özgüllüğe sahip olduğunu göstermiştir. Odds oranları(OR'ler), prognostik faktörler ve trombositopeni ile arasındaki ilişki lojistikregresyon modelleri kullanılarak hesaplandı. ORs sürekli renal replasmantedavisi için 4.616, inotropik ilaç kullanımı için 6.682 ve mortalite için3.649 idi.SonuçÇocukyoğun bakıma yatış sırasındaki düşük trombosit sayısı, mortalite ve morbiditeyiartıran ve hastanede yatış süresini uzatan bağımsız bir risk faktörü olarakdüşünülmelidir. Bu hasta grubuna daha yakın izlem yapılmalıdır.

OBJECTIVE: Sepsis is an important cause of mortality and morbidity in critically ill patients. Early diagnosis of sepsis is important for treatment and prognosis. C-reactive protein (CRP) and procalcitonin (PCT) are the most commonly used biomarkers for diagnosis of sepsis. However, PCT can lead to significant increase of hospital costs and cannot be routinely performed in every center. With this point of view, we aimed to investigate the importance of the routine hemogram parameters like red cell distribution width (RDW) and mean platelet volume (MPV) in the diagnosis of sepsis.MATERIAL AND METHODS: The medical records of 173 patients over 2 years of age who were admitted to Okmeydanı Training and Research Hospital, Pediatric Intensive Care Unit, between October 2016 and March 2018 were reviewed retrospectively. Demographic data of patients and the initial laboratory values were recorded. Patients were divided into two groups according to development of sepsis or not. The prognostic and laboratory differences between the groups were compared. Receiver operating characteristic (ROC) curves were used for sepsis biomarkers.RESULTS: Thirty-eight (16.8%) of the patients were admitted with either sepsis and septic shock. A statistically significant relationship was determined between sepsis and CRP (p %16 can be considered as a marker that increase mechanical ventilation and red blood cell transfusion beside prolonging duration of hospitalization in intensive care unit., AMAÇ: Sepsis, yoğun bakım hastalarında önemli mortalite ve morbidite nedenidir. Sepsisin erken tanısı, tedavi ve prognoz için önemlidir. Sepsis için en yaygın kullanılan biyobelirteçler C-reaktif protein (CRP) ve prokalsitonindir (PKT). Bununla birlikte, rutin olarak istendiğinde özellikle PKT belirgin hastane maliyeti oluşturmaktadır ve her merkezde bakılamamaktadır. Bu düşünce ile rutin hemogram parametrelerinden olan eritrosit dağılım genişliği (RDW) ve ortalama trombosit volümünün (OTH) sepsis tanısındaki değerliliğini incelemeyi amaçladık.GEREÇ VE YÖNTEM: Ekim 2016 ile Mart 2018 tarihleri arasında Okmeydanı Eğitim ve Araştırma Hastanesine yatırılan 2 yaş üstü 173 hastanın tıbbi kayıtları geriye dönük olarak incelendi. Çalışmaya alınan tüm hastaların demografik bilgileri ve yatışı sonrası ilk laboratuvar değerleri kaydedildi. Hastalar başvuru tanısına göre sepsisi olanlar ve olmayanlar olarak iki gruba ayrıldı. Gruplar arasındaki prognostik ve laboratuvar farklılıklar karşılaştırıldı. Sepsis biyobelirteçleri için receiver operating characteristic (ROC) eğrileri kullanıldı.BULGULAR: Hastaların 38’i (% 16.8) sepsis ve septik şok ile başvurdu. Sepsis ile CRP (p%16 ile mekanik ventilatör (p=0.014)ve eritrosit transfüzyonu (p=0.009) gereksiniminin arttığı, yoğun bakım yatış süresinin uzadığı gösterilmiştir (p=0.044).SONUÇ: Bu çalışma ile RDW ve OTH’nin sadece anemi ve trombositopeni ayrımında kullanılmayacağını, aslında bir akut faz reaktanı gibi, sepsis ve inflamasyon ile ilişkili birer belirteç olduğu gösterilmiştir. Ayrıca RDW>%16 olması mekanik ventilatör ve eritrosit transfüzyonu gereksinimini artıran, yoğun bakım yatış süresini uzatan bir belirteç olarak gösterilmiştir.

Summary Aim In this study, mycophenolate mofetil (MMF) and methylprednisolone (MP) were compared in terms of rejection and duration of activity of the transplant in New Zealand rabbits that underwent retroperitoneal heart transplantation. Methods Retroperitoneal heart transplantation was performed in New Zealand white rabbits. The animals were divided into two groups. MMF group (group 1) (10 donors, 10 recipients): 12.5 mg/kg MMF was administered orally for two days prior to the surgery; MP group (group 2) (nine donors, nine recipients): 2 mg/kg MP was administered intramuscularly for two days prior to the surgery. After the operation, we waited until all motor activity in the transplanted heart had stopped. The transplant was then removed and the recipient was sacrificed. A donor in the MP group was excluded since it died before the motor activity had stopped. Results No statistically significant difference was found between the groups in terms of rejection score (p = 0.865). However, duration of motor activity was found to be statistically significantly longer in the MMF group, compared to the MP group (p = 0.013). Conclusion In this experimental study, MMF was similar to MP in terms of rejection but had better efficacy in terms of duration of motor activity of the transplant.

Giriş: Koroner arter baypas greftleme operasyonu (KABGO) öncesitedavi almış kronik obstrüktif akciğer hastalığı (KOAH) olan bireylerle, KOAHolmayan bireyler, cerrahi sonrası uzamış mekanik solunum desteği (UMSD) ve altsolunum yolu infeksiyonu (ASYİ) açısından karşılaştırılmıştır.Hastalarve Yöntemler: Kalp ve Damar Cerrahisikliniğinde, valvüler patolojisi ve konnektif doku hastalığı (Marfan sendromuvb.) bulunmayan, izole on-pump KABGO yapılmış, 233 hasta çalışmaya alındı.Veriler retrospektif olarak toplandı. Operasyon öncesi dönemde kliniğimizdestandart preoperatif laboratuvar tetkikleri, solunum sistemi sorgusunda veyamuayenesinde patoloji saptanan kişilere solunum fonksiyon testi (SpirobankSpirometry, MIR Medical International Research Product) yapılmıştır. KOAH olanhastalarda, KOAH şiddetini belirlemek için GOLD kılavuzu kullanılmıştır. Bütünhastalar iki gruba ayrılmıştır. KOAH hastalarını içeren grup; grup 1, KOAHolmayan hastaları içeren grup; grup 2 olarak adlandırılmıştır.Bulgular: UMSD görülme hızı grup 1’de %4.8, grup 2’de %1.8 olduğugörülürken; ASYİ oranı grup 1’de %6.3, grup 2’de %1.7 olduğu tespit edildi.Sonuç: Çalışmamıza göre; operasyon öncesitedavi görmüş KOAH hastalarının, KOAH olmayan hastalara göre on-pump KABGOsonrası, UMSD ve ASYİ açısından hızları yüksek olmakla birlikte istatistikselolarak anlamsız olduğunu söyleyebiliriz. (UMSD açısından p= 0.348; ASYİaçısından p= 0.088)., Introduction: In our study COPD and non-COPD patients who underwentCABG were compared in terms of prolonged mechanical ventilation and lowerrespiratory tract infektion.Patientsand Methods: A total of 233 patientswithout valvular pathology and connective tissue disorders, such as Marfansyndrome, who underwent isolated on-pump CABG in the Department ofCardiovascular Surgery were retrospectively studied. Preoperative laboratorytests and respiratory system test (Spirobank Spirometry, Medical InternationalResearch Product) were applied in patients who had pathology in respiratorysystem query or examination were performed at our clinic during thepreoperative period. The severity of COPD in COPD patients was evaluatedaccording to the COLD guideline. All patients were divided in two groups. Thegroup including COPD patients was named group 1 and the other group including non-COPDpatients was named gruop 2. Results: UMSD rates in groups 1 and 2 were 4.8% and 1.8%,respectively. Lower respiratory tract infection rates in groups 1 and 2 were6.3% and 1.7%, respectively.Conclusion: According to our study, we can saythat the rate of UMSB and lower respiratory tract infection occuring in treatedCOPD patients after CABG is statiscally indifferent according to non-COPDpatient. (p= 0.348 for UMSD, p= 0.088 for lower respiratory tract infection).

1970'li yıllardan sonra finansal sistemde meydana gelen değişimler sonucu Bretton Woods Uluslararası Ödemeler Sistemi'nin sona ermesiyle birlikte fiyat dalgalanmaları yaşanmaya başlamıştır. Finansal piyasalarda meydana gelen belirsizlik ve dalgalanmalar, yatırımcıları söz konusu kur ve faiz riskinden koruyabilmek için yeni finansal ürünlerin ortaya çıkmasına neden olmuştur. Yatırımcıları kur veya faiz riskinden korumayı amaçlayan finansal araçlar, türev ürün veya türev araç olarak isimlendirilmektedir. Türev ürünler yatırımcıları risklerden koruma veya risklerini yönetme açısından günümüzde büyük öneme sahiptir. Forward sözleşmelerle başlayan türev ürünler organize piyasaların oluşturulması ile futures, opsiyon ve swap sözleşmeler gibi türlerinin de ortaya çıkmasıyla çeşitlilik kazanmıştır. Finansal piyasalarda gelecek ile ilgili belirsizlik olması türev ürünlere olan talebi artırmaktadır. Türev ürünlerin en büyük avantajı ve riski, bu ürünler spekülasyon amacı ile kullanıldığında, kaldıraç etkisi ile, yatırımcıların büyük kazanç ya da kayıplarla karşılaşmalarına neden olmaktadır.Gelişmekte olan ülkelerde oluşan risklere karşı türev ürün sözleşmeleri önem kazanmaktadır. Türkiye'yi incelediğimizde türev ürünlerin artarak gelişme gösterdiği görülmektedir. Bu çalışmanın amacı vadeli işlem piyasaları ve bu piyasalarda işlem gören türev araçları tanıtmak; Türkiye'de kullanımı, Türkiye'deki gelişimi, işleyiş esasları, vergilendirilmesi ve muhasebeleştirilmesi ile ilgili örneklerle uygulamalarını göstermektir.Anahtar Kelimeler: Türev Finansal Araçlar, Türev Piyasalar, Türkiye'de Türev Piyasaların Gelişimi, Türev Finansal Araçların Vergilendirilmesi, Türev Ürünlerin Muhasebeleştirilmesi After 1970's, price fluctuations are experienced in the market. The main reason was; Bretton Woods system of monetary manegement came to the end due to the changes in financial system. New financial tools are developed in order to minimize currency risk and interest rate of the investors in the uncertain and fluctuating market coditions. The new tools are named as derivative products or derivative tools. Derivative products are very important to minimize the risks of investors. The derivative products, starting with forward contracts has been developed with with the organized markets and the product variety is increased by development of future, option and swap contracts. The demand of financial product is increasing with the uncertainty for the future in the market. The de-mand of financial products is increasing with the uncertainty for the future in the market. The utmost advantage and the biggest risk at the derivative product. If the derivative product is used for speculations, effect of the financial leverage can cause very serious amount of profit or financial losses.Derivative product are becoming more and more important especiallyin the developing countries, which have higher risks in the financial market. If we focus to Turkey, same developing picture of derivative product is also valid. The aim of this study is introduce the derivate tools in the futures market; to show the use cases in Turkish market. With the focus of development, taxation and accounties.Keywords: Derivative Financial Instruments, Derivatives Markets, The development of derivatives markets in Turkey, Taxation For Derivative Instruments, Accounting For Derivative Instruments 191

Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden) heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump) as compared to Group 2 (off-pump). But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893), P>0.05 for bilateral pleural effusion (P=0.780)]. Left pleural effusion was encountered to be lower in Group 2 (off-pump). The difference was found to be statistically significant (P0,05 para derrame pleural à direita (P=0,893), P>0,05 para derrame pleural bilateral (P=0,780)]. O derrame pleural esquerdo encontrado foi menor no Grupo 2 (CEC). A diferença foi estatisticamente significativa (P