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Objective: To determine the clinical significance of serum 25-hydroxy (OH) vitamin D levels in pediatric patients with multisystem inflammatory syndrome in children (MIS-C) and compare the vitamin D levels of these patients with those patients with Coronavirus disease-2019 (COVID-19) and healthy controls. Methods: This study was designed for pediatric patients aged 1 month to 18 years and conducted between July 14 and December 25, 2021. Fifty-one patients with MIS-C, 57 who were hospitalized with COVID-19, and 60 controls were enrolled in the study. Vitamin D insufficiency was defined as a serum 25 (OH) vitamin D level of less than 20 ng/mL. Severe MIS-C was classified as necessitating intensive care due to cardiovascular instability, the necessity for non-invasive or invasive mechanical ventilation, and/or a diminishing Glasgow coma scale. World Health Organization definition criteria were used to describe the clinical stages of COVID-19 in children and patients were divided into four groups according to the clinical severity of COVID-19: asymptomatic, mild, moderate, and severe/critical. Results: The median serum 25 (OH) vitamin D was 14.6 ng/mL in patients with MIS-C, 16 ng/mL in patients with COVID-19, and 21.1 ng/mL in the control group (p<0.001). Vitamin D insufficiency was present in 74.5% (n=38) of patients with MIS-C, 66.7% (n=38) of patients with COVID-19, and 41.7% (n=25) of the controls (p=0.001). The percentage of four or more affected organ systems was 39.2% in patients with MIS-C. The correlation between the number of affected organ systems and serum 25 (OH) vitamin D levels was evaluated in patients with MIS-C and there was a moderate negative correlation (r=-0.310; p=0.027). A weak negative correlation was found between the severity of COVID-19 and serum 25 (OH) vitamin D (r=-0.320, p=0.015). Conclusion: Vitamin D levels were insufficient in both the MIS-C and COVID groups. Furthermore, vitamin D levels correlated with the number of affected organ systems in MIS-C and the severity of COVID-19. [ABSTRACT FROM AUTHOR]

Objective: Multisystem inflammatory syndrome in children (MIS-C), associated with Coronavirus disease-2019, is defined as the presence of documented fever, inflammation, and at least two signs of multisystem involvement and lack of an alternative microbial diagnosis in children who have recent or current Severe acute respiratory syndrome-Coronavirus-2 infection or exposure. In this study, we evaluated thyroid function tests in pediatric cases with MIS-C in order to understand how the hypothalamus-pituitary-thyroid axis was affected and to examine the relationship between disease severity and thyroid function. Methods: This case-control study was conducted between January 2021 and September 2021. The patient group consisted of 36 MIS-C cases, the control group included 72 healthy children. Demographic features, clinical findings, inflammatory markers, thyroid function tests, and thyroid antibody levels in cases of MIS-C were recorded. Thyroid function tests were recorded in the healthy control group. Results: When MIS-C and healthy control groups were compared, free triiodothyronine (fT3) level was lower in MIS-C cases, while free thyroxine (fT4) level was found to be lower in the healthy group (p<0.001, p=0.001, respectively). Although the fT4 level was significantly lower in controls, no significant difference was found compared with the age-appropriate reference intervals (p=0.318). When MIS-C cases were stratified by intensive care requirement, fT3 levels were also lower in those admitted to intensive care and also in those who received steroid treatment (p=0.043, p<0.001, respectively). Conclusion: Since the endocrine system critically coordinates and regulates important metabolic and biochemical pathways, investigation of endocrine function in MIS-C may be beneficial. These results show an association between low fT3 levels and both diagnosis of MIS-C and requirement for intensive care. Further studies are needed to predict the prognosis and develop a long-term follow-up management plan. [ABSTRACT FROM AUTHOR]

Copyright of Meandros Medical & Dental Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Coronavirus disease-2019 (COVID-19) is a global pandemic that affects worldwide. Most patients who need intensive care due to COVID-19 develop acute respiratory distress syndrome and patients need long-term mechanical ventilation. This situation increases the risk of dysphagia, aspiration, and aspiration pneumonia in patients. Information about COVID-19-associated dysphagia is still limited. Thus, this study aimed to evaluate the frequency of postextubation dysphagia (PED) and its effect on clinical outcomes. Materials and Methods: Patients with COVID-19 in the adult intensive care unit (ICU) who were left on a mechanical ventilator for at least 24 h and are extubated were retrospectively screened. Gugging swallowing screen (GUSS) test was performed 24 h after extubation to evaluate swallowing function. Patients were examined in two groups as with and without dysphagia. Results: This study included 40 patients who were followed up on a mechanical ventilator and extubated due to COVID-19. According to the bedside GUSS test results, patients were divided into two groups as dysphagia group (n=24) and the non-dysphagia group (n=16). The mean age was higher in the dysphagia group (p<0.001). Re-intubation rate and ICU, and in-hospital mortality were higher in the dysphagia group (p<0.001 for all), whereas the length of stay in the ICU and mechanical ventilation time were longer (p=0.005 and p=0.001). ICU mortality was higher in patients with severe dysphagia (p=0.026). Conclusion: Our study revealed that the risk of PED increased with the age of patients with COVID-19 and PED increased the incidence of re-intubation, which was an important prognostic parameter that indicates mortality. Recognizing dysphagia with the early evaluation of swallowing in extubated patients with COVID-19 diagnosis is important to minimize the risk of aspiration pneumonia with proper nutrition, reduce the increased health cost, and prevent poor clinical outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Turkish Society of Intensive Care / Türk Yogun Bakim Dernegi Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Giriş: Asplenik ve hiposplenik hastalarda bağışıklık sistemi zayıflamakta ve kapsüllü bakteriler ile oluşan pnömoni, menenjit, bakteriyemi ve sepsis gibi enfeksiyonların sıklığında artış izlenmektedir. Antimikrobiyal tedaviye yanıt oranları normal popülasyona göre daha düşük olmaktadır. Morbidite ve mortalite riski artmaktadır. Bu nedenle bu enfeksiyonlara karşı etkin bir aşılama çok önemlidir. Bu hastalarda aşılanma oranı yetersiz kalmaktadır. Hekimler aşılarla ilgili yetersiz ve doğru olmayan bilgilere sahiptir. Bu çalışma ile bu grup hastalarla sık karşılaşan aile hekimi, dahiliye, pediatri, çocuk cerrahisi, enfeksiyon hastalıkları ve klinik mikrobiyoloji (İHKM) ve genel cerrahi branş hekimlerinin bilgi düzeylerinin araştırılması, bu grup hastaların aşılamaları ile ilgili farkındalık oluşturulması amaçlanmıştır. Gereç ve Yöntem: Google formlar aracılığıyla hekimlerin asplenik ve hiposplenik hastalara yapılması gereken aşılarla ilgili bilgi düzeyini, tutum ve davranışlarını ölçen 20 sorudan oluşan anket formu hazırlandı. Verilerin hesaplanmasında Statistical Package for Social Scienses (SPSS) 22 (Inc. Chicago, Illinois, ABD) istatistiksel paket programı kullanıldı. Tanımlayıcı istatistikler kategorik değişkenler için sayı ve yüzde olarak, sürekli değişkenler için ortanca (minimum-maksimum) verilerek yapıldı. Bulgular: Ankete katılan 212 katılımcının %73,1’i kadın olup medyan yaş 33 (min: 24, maks: 90) idi. Katılımcıların tanımlayıcı özellikleri Tablo 1’de sunulmuştur. Katılımcıların %66,5’i aşı ve bağışıklama ile ilgili eğitim almıştı; %99’u asplenik/hiposplenik hastalara aşı öneriyordu. Fonksiyonel aspleni/hipospleni yapan durumlar arasında en çok aşı önerilen ilk üç hastalık; orak hücreli anemi, HIV-AIDS ve siroz-portal hipertansiyon idi (Hekimler bu hastalıklar varlığında sırasıyla; %82,4, %66,2, %54,9 oranında aşı öneriyordu) hekimlerin önerdikleri aşılar Şekil 1’de sunulmuştur. Katılımcıların %61’i elektif splenektomiden en az iki hafta öncesinde aşıların yapılması gerektiği, %57,4’ü ise acil splenektomiden en erken iki hafta sonra aşıların yapılması gerektiği bilgisine sahipti. Katılımcıların %74,9’u hem polisakkarit, hem konjuge pnömokok aşılarını öneriyorken, %79,5’i pnömokok aşısı için rapel doz öneriyordu. Katılımcıların %41,1’i H. influenza tip b aşısının tek doz uygulandığı bilgisine sahipti. Katılımcıların %58,7’si hem konjuge hem protein meningokok aşılarını öneriyorken, %59,1’i meningokok aşısı için rapel doz öneriyordu. Sonuç: Hekimlerin çok önemli bir kısmı asplenik/hiposplenik hastalara aşı önerdiklerini belirtmelerine rağmen fonksiyonel aspleni yapan durumlarda aşılama önerileri düşük saptandı. Aşılama şemasına en uygun önerilerde bulunulan aşı pnömokok aşısı iken meningokok ve Hib aşılarıyla ilgili bilgi düzeyinin daha düşük olduğu görüldü. Risk grubu aşılamalarının daha düzgün yapılabilmesi için eğitimlere ihtiyaç vardır. [ABSTRACT FROM AUTHOR]