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BACKGROUND Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosuppressed children. Early detection of the infection can improve prognosis in this patient population. OBJECTIVES To investigate the utility of Aspergillus galactomannan antigen assay (GM-EIA) as a diagnostic tool for IA in at-risk paediatric patients. PATIENTS/METHODS For the study, 659 GM-EIA results from 59 patients diagnosed with IA and 3368 GM-EIA results from 351 subjects without evidence for IA (controls) were reviewed retrospectively. Three cut-off values (i.e. ≥0.5, ≥1, ≥1.5) were specified to determine GM-EIA positivity. RESULTS The median age was 6.3 years for boys and 14.5 years for girls. There was a significant difference between the girls and boys in terms of age (p

Objective: Peripheral neuropathy is an important potential side effect of statin use. This study was an investigation of the incidence of peripheral neuropathy in patients taking atorvastatin or rosuvastatin for hypercholesterolemia and the relationship to the dose and duration of the treatment. Methods: In all, 50 patients using a statin treatment and 50 healthy controls matched for age and gender who had never taken a statin were included in the study. Polyneuropathy was assessed with a neurological examination and electroneuromyography (ENMG). Results: While no polyneuropathy was detected in the control group, polyneuropathy was seen in 33 (66%) of the patients in the statin group (p1 year). Electrodiagnostic changes have been detected in motor and sensory nerves in nerve conduction studies of patients on long-term statin treatment. The assessment of neurological symptoms, like tingling, numbness, pain and tremor in the hands and feet, and unsteadiness during walking associated with peripheral neuropathy may be useful in the follow-up of the patients on long-term statin treatment. Early detection of peripheral neuropathy and changing hypercholesterolemia treatment may prevent permanent nerve damage.

Objectives:Acute bacterial sinusitis (ABS) is among frequent infections in children. Its diagnosis is clinical unless a suspicion of complication exists. This study aimed to evaluate pediatricians’ clinical approaches to ABS.Materials and Methods:This retrospective study analyzed diagnosis, treatment and complication data of patients diagnosed with ABS between June 2015 and June 2018 in our pediatric primary care unit.Results:The study group consisted of 536 patients [female/male 235/301 (43.8%/56.2%)]. The median age was 6.6 (7 months-17.9 years) years. Median duration of symptoms was 7 (1-46) days. Major complaints were cough (n=379, 70.7%), nasal discharge (n=234, 43.7%) and fever (n=168, 31.3%). Among 468 patients with available data, persistent (>10 days) upper respiratory tract infection (URTI) was present in 198 (42.3%) while 8 (1.7%) had severe URTI. Worsening URTI data could not be defined because of inadequate records. Duration of symptoms was

Objective There are lack of studies considering the suboptimal management of dyslipidemia especially in cardiology outpatient clinics. This study was conducted to assess the patient adherence to cholesterol treatment recommendations and attainment of low-density-lipoprotein cholesterol (LDL-C) goals. Methods EPHESUS (NCT02608645) is a national, observational and multicenter registry which has been designed as a cross-sectional study to allow inclusion of all consecutive patients with hypercholesterolemia in cardiology outpatient clinics. The present subgroup analyses of the EPHESUS trial included patients with known peripheral artery disease or atherosclerotic cerebrovascular disease, and coronary heart disease namely secondary prevention. Results The present analysis of the EPHESUS study included 1482 patients (62.79 +/- 10.4 years, 38.2% female) with secondary prevention from 40 sites in Turkey. Regarding recommended lipid targets for LDL-C, only 267 patients (18%) were below the target of 70 mg/dL. Females were significantly more off-target when compared with male patients (396, 85.5% vs 67, 14.5%; P = 0.017). Moreover, the achievement of LDL-C goal was significantly decreased with illiteracy (233, 19.2% vs 35, 13.1%; P = 0.02). Patients who think that the cholesterol treatment should be terminated when the cholesterol level of a patient has normalised were higher in the off-target group (34.0% vs 24.7%, P < 0.001). Besides, physician perceptions about LDL-C goal for secondary prevention were significantly related with LDL-C target attainment. Conclusions EPHESUS is an important study with large population in terms of representing real-life practice of the adherence to dyslipidemia guidelines in secondary prevention patients in Turkey. Perceptions, knowledge, and compliance with the guidelines for secondary prevention have increased, but it is far below from the desired levels even in cardiology outpatient clinics. There is a need for patients' and physicians' education regarding the treatment of hyperlipidemia. WOS:000483810100004 2-s2.0-85066839340 PubMed: 31038781

Broad and deep perianal wounds are challenging in both adult and pediatric ICUs. These wounds, if contaminated with gastrointestinal flora, can cause invasive sepsis and death, and recovery can be prolonged. Controlling the source of infection without diverting stool from the perianal region is complicated. The option of protective colostomy is not well-known among pediatric critical care specialists, but it can help patients survive extremely complicated critical care management. These authors present three critically ill children who required temporary protective colostomy for perianal wounds because of various clinical conditions. Two patients were treated for meningococcemia, and the other had a total artificial heart implantation for dilated cardiomyopathy. There was extensive and profound tissue loss in the perianal region in the patients with meningococcemia, and the patient with cardiomyopathy had a large pressure injury. Timely, transient, protective colostomy was beneficial in these cases and facilitated the recovery of the perianal wounds. Temporary diverting colostomy should be considered as early as possible to prevent fecal transmission and accelerate perianal wound healing in children unresponsive to local debridement and critical care.

Objectives: the aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: a retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined. Results: there were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5-14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1-3 years of age (9.3%), 148 were 3-6 years of age (12.8%), 298 were 6-12 years of age (25.8%), 233 were 12-15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1-3 days). Fever was median at 38.4 degrees C (38.0-38.7 degrees C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma). Conclusions: to the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution., NA

Yabancı ülkelere ait edebiyat eserlerinde ötekine veya kendi öz kimliğine dönük alışılmadık ve olumsuz peşin yargıları inceleyen imgebilim araştırmaları disiplinlerarası bir çalışma gerektirmektedir. İngiliz romantik dönem şairi Lord Byron’ın Türk Hikâyesinden Bir Kesit- Gâvur eseri, şiir görünümünde ideolojik olmakla birlikte, sosyal psikoloji çerçevesinde kalıp yargılar içermekte ve imgebilim açısından oldukça zengin öğeler barındırmaktadır. Söz konusu eserde Türk, yabancı (Gâvur), Müslüman ve Hristiyan bağlamında “öteki” kavramını oluşturan unsurların bir araya getiren kültür ve mantalitenin incelenmesi gerekmektedir. Bu bağlamda Türk imgesinin esere ne şekilde yansıdığı, olumlu veya olumsuz açıdan ne gibi peşin hükümler içerdiği imgebilim açısından irdelenecektir. Lord Byron’un kendi bakış açısıyla özgün bir şekilde kurguladığı şiirde Türk/Osmanlı imajına dönük dizeler ele alınacak; esere ismini veren yabancının ya da Türk gözüyle “Gâvur” olarak adlandırılan karakterin algısında oluşmuş ve dizelere dökülmüş Türk imgesinin tespiti, yorumlanması ve değerlendirilmesi yapılacaktır.

Objective: In this study, we aimed to investigate the effect of hypertension (HT) and antihypertensive treatment on prognosis, which is one of the cardiovascular risk factors affecting the prognosis of COVID-19. Methods: We included 117 patients diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction (PCR). The patients were divided into a hypertensive group and a control group. Biochemical, complete blood count and imaging data of the patients were recorded. Mortality of patients with and without HT was evaluated. The effect of antihypertensive therapy on mortality was evaluated. Results: In thorax CT, ground glass opacity and pneumonic consolidation were found statistically significantly higher in the hypertensive group (p

Background and aims Effective treatment of high low-density lipoprotein cholesterol (LDL-C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real-life management of patients with DM in terms of LDL-C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL-C goal attainment by assessing the perceptions of both physicians and patients. Methods We compared the diabetic and non-diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL-C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia. Results Of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL-C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off-target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL-C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low-dose, non-adherent) statin (28.3%) dosages. Conclusions In real-life clinical cardiology practice, diabetic patients are far below the recommended LDL-C treatment goals. High-intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages. WOS:000627464100001 2-s2.0-85102297383 PubMed: 33630348

Background Vaccination is the most important way out of the novel coronavirus disease 2019 (COVID-19) pandemic. Vaccination practices have started in different countries for community immunity. In this process, health authorities in different countries have preferred different type of COVID-19 vaccines. Inactivated COVID-19 vac- cine is one of these options and has been administered to more than 7 million people in Turkey. Inactivated vaccines are generally considered safe. Kounis syndrome (KS) is a rare clinical condition defined as the co-existence of acute coronary syndromes and allergic reactions. Case Report We present the case of a 41-year-old woman with no cardio- vascular risk factors who was admitted at our emergency department with flushing, palpitation, dyspnea, and chest pain 15 min after the first dose of inactivated CoronaVac (Sinovac Life Sciences, Beijing, China). Electrocardiogram (ECG) showed V4-6 T wave inversion, and echocardiog- raphy revealed left ventricular wall motion abnormalities. Troponin-I level on arrival was elevated. Coronary angiog- raphy showed no sign of coronary atherosclerosis. She was diagnosed with type 1 KS. The patient’s symptoms resolved and she was discharged from hospital in a good condition. Why Should an Emergency Physician Be Aware of This? To the best of our knowledge, this is the first case of allergic myocardial infarction secondary to inactivated coronavirus vaccine. This case demonstrates that KS can occur after in- activated virus vaccine against COVID-19. Although the risk of severe allergic reaction after administration of CoronaVac The patient has given informed consent to the publication of this case report. seems to be very low, people who developed chest pain af- ter vaccine administration should be followed by ECG and troponin measurements.

Background Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off‐label treatment of novel coronavirus disease (COVID‐19). However, cardiac safety of these drugs is still controversial in COVID‐19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. Methods This is a single‐center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post‐treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in‐hospital mortality because of ventricular arrhythmias were evaluated. Results Our cohort comprised 101 hospitalized COVID‐19 patients (mean age of 49.60 ± 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5‐days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P

BACKGROUND: Pertussis is a disease leading to high morbidity and mortality in neonates and infants. Bronchiolitis is the most common cause of hospitalization especially in children < 2 year-old. Although the clinical findings are different in these two diseases, it is sometimes difficult to make this distinction in partially or fully vaccinated children. This study aimed to identify the incidence, clinical and laboratory effects of B. pertussis as a causative agent in hospitalized children with acute bronchiolitis. METHODS: The study included patients diagnosed with acute bronchiolitis and admitted to the Division of Pediatric Infectious Diseases from January 2012 to December 2015, aged 24 months or younger, evaluated for viruses and bacteria with polymerase chain reaction in respiratory tract secretions. RESULTS: The study included 380 patients hospitalized with acute bronchiolitis. Of these patients, 85.8% were identified to be positive for at least one respiratory pathogen. The most commonly identified pathogens were respiratory syncytial virus (RSV) A/B, rhinovirus, parainfluenza virus, adenovirus, bocavirus and metapneumovirus A/B. B. pertussis was only detected in 5 patients (1.5%). In the patients with B. pertussis identified, coinfection with another virus was observed including rhinovirus (n= 2), influenza A virus (n= 1), coronavirus OC43 (n= 1) and RSV A/B (n= 1). The presence of B. pertussis did not appear to cause any significant clinical or laboratory differences in patients. CONCLUSIONS: B. pertussis is a rare pathogen in patients admitted to hospital for acute bronchiolitis. However, in patients who do not respond to standard bronchiolitis treatment, B. pertussis should be considered as a causative agent. Early identification of this pathogen is important in terms of quarantining the patient, administering appropriate antimicrobial treatment, and prophylactic treatment to household and other close contacts.

AIM Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard. METHODS We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019. RESULTS Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 ± 11 years vs 69 ± 12 years, P

Objective Respiratory syncytial virus (RSV) is one of the most prevalent causes of lower respiratory tract infection (LRTI). The primary objective of this study is to provide the risk modelling of confirmed RSV infection in children who were born preterm at 29 to 35 weeks of gestational age and presented with LRTI. Study Design This prospective, multicenter study was performed between October 2015 and March 2017. Premature infants born with gestational age between 29 and 35 weeks that were ≤2 years of age at the beginning of the RSV season and admitted to the hospital with clinical findings of LRTI during the season were included. RSV-positive and -negative infants were compared in terms of demographic features, risk factors, and requirement of hospitalization. Results RSV positive group was lower than RSV negative group and ratio of ≤3 months age at admission was significant higher in RSV (+) group. RSV-positive infants were found to be significantly born during or 3 months prior to RSV season. The rate and duration of hospitalization and need for mechanical ventilation were significantly higher in RSV positive infants. The rate and duration of hospitalization in RSV positive patients was related to the chronological age. Conclusion This study showed that preterm infants with RSV-associated LRTI significantly needed more hospitalization, intensive care admission, and mechanical ventilation. In addition need of hospitalization and duration of hospitalization were significant higher in ≤3 months of age. Therefore, we suggest the importance of palivizumab prophylaxis in infants ≤ 3 months chronological age, especially during the RSV season.

Influenza is an important cause of respiratory illness in children and is still an important cause of morbidity and mortality in children. The influenza virus subtypes determine the prevalence of the epidemic and pandemic influenza, the hospitalization and mortality rates in children each year. Surveillance of the circulation of different influenza virus strains is important in ensuring a good strain con-cordance for the composition of the annual influenza vaccine. The Global Influenza Hospital Surveillance Network® (GIHSN) is an international institution in which tertiary hospitals from many countries participate and where epidemiological surveillance of influenza disease is conducted. Six centers from Turkey participated in the study organized by GIHSN during the influenza season 2016 2017. The aim of this study was to demonstrate the frequency of influenza, virus types, clinical characteristics and vaccination rates in children admitted to our hospital with influenza-like symptoms in the influenza season 2016-2017. Informed consents were obtained from patients. 217 pediatric patients were screened with in the 24th and 48th hours of the hospitalization. Then a nasal/nasopharyngeal swab were collected from 184 patients who met the inclusion criteria. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) was used to obtain laboratory results. Influenza virus, influenza virus subtypes were studied by rRT-PCR. The 83.3% of the patients with positive influenza was under 5 years of age. The rate of influenza positivity was 16.3% (n= 30 patients). Influenza A (H3N2) was the predominant strain in children. The 70% of isolates were influenza A (H3N2) and the 30% were influenza B (Yamagata). There were no case of influenza A (H1N1) or influenza B (Victoria). In 30% of cases with influenza positivity, there was an underlying disease. The most prevalent of them were neuromuscular disease followed by cardiovascular disease and asthma. Tobacco exposure was 86.6% in influenza positive cases. The empirical oseltamivir prescription rate was 28.2%. The vaccination rate of the influenza vaccine was very low (1.6%). The out of 3 patients with influenza positivity were admitted to pediatric intensive care unit, and 2 of them required mechanical ventilation. None of these patients required extracorpereal membrane oxygenation and did not die. Our results highlight the importance of surveillance for influenza and in particular, influenza vaccination rates of groups with risk for morbidity and mortality, such as children, need to be increased.

Tural Kara T, Ozdemir H, Erat T, Yahsi A, Aysev AD, Tacyildiz N, Unal E, Ileri T, Ince E, Haskologlu S, Ciftci E, Ince E. Is antibiotic lock therapy effective for the implantable long-term catheter-related bloodstream infections in children? Turk J Pediatr 2019; 61: 895-904. Catheter-related bloodstream infections (CRBSIs) are an important problem in pediatric patients with central venous catheters. This study aimed to determine the incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in pediatric patients. Between January 2010 and November 2015 all hospitalized pediatric hematology, oncology and immunology patients diagnosed with CRBSIs were retrospectively analyzed. Seventy-eight CRBSI episodes were detected in 60 pediatric patients. The incidence of CRBSIs was 4.20/1000 catheter days. The most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Pseudomonas aeruginosa, Klebsiella spp., and Escherichia coli were other commonly isolated microorganisms. ALT was administered in 42 patients. The success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. CRBSIs are an important cause of morbidity and mortality in pediatric patients. ALT is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs, though in some cases catheter removal is necessary. ALT helps to prevent unnecessary catheter removal in pediatric patients.

Kanik Yuksek S, Tezer H, Ozkaya Parlakay A, Gulhan B, Kara A, Ciftci E, Tapisiz A, Celik M, Ozdemir H, Aykac K, Demirdag TB, Tural Kara T, Hayran G, Ince E. Impact of the mandatory Hepatitis A immunization program: before and after the vaccine in Ankara, Central of Turkey. Turk J Pediatr 2019; 61: 677-685. In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vaccine was included in the mandatory vaccination schedule of Turkey on November 2012. We aimed to evaluate the cases of HAV infection followed in Ankara, which is located in the center of Central Anatolia, retrospectively according to the date of the administration of the mandatory hepatitis A vaccine. A total of 272 children followed-up between January 2008 and December 2015 for HAV infection in five separate hospitals were enrolled to the study. There were 200 (68.2%) cases in the pre-vaccination group, 72 (31.74%) cases in the post-vaccination group, and 55.1% were male in total. The immunization status were as follow; 89.7% (n = 244) unvaccinated, 0.4% (n = 1) vaccinated and 9.9% (n = 27) with unknown immune status. There was a statistically significant difference between the groups in hospitalization rates, but no statistically significant differences in hospitalization indications, length of hospital stay, complication types and proportions, and normalization period of transaminases. The national hepatitis A immunization program in Turkey has had a significant impact when the targeted population is considered, with suggestive herd protection effects.

Bu calismada puntalanmis ipliklerin punta sayilarindaki degisimin, bu ipliklerden uretilen orme kumaslarin aciklik-koyuluk (L*), yansima (R), Absorpsiyon katsayisi / Sacilma katsayisi (K/S) ve renk farkliligi (ΔE*) degerleri uzerinde etkililerinin arastirilmasi amaclanmistir. Bu amacla 283 dtex lineer yogunluga sahip ve kesitinde 100 filament bulunan, farkli punta sayisina sahip ipliklerden duz orgu kumaslar uretilmistir. Uretilen kumaslar boyanmis ve renk parametreleri olculmustur. Elde edilen sonuclar Realcolor 1.3 paket programi kullanilarak analiz edilmistir. Calisma sonucunda punta sayisi ve kumas konstruksiyonundaki degisimin R ve L* degerleri uzerinde etkili oldugu tespit edilmistir.

Introduction: Respiratory syncytial virus (RSV) is among the major causes of severe mortality and morbidity in both children and adults worldwide. This study aimed at demonstrating the course of RSV in our country. Materials and Methods: Simultaneous RSV surveillance was implemented within the scope of Global Influenza Hospital Surveillance Network in Ankara in the season of 2016-2017. Results: A total of 917 cases were included into the study, and RSV polymerase chain reaction was positive in 145 patients (15.8%). Among the RSV positive cases, 132 were under five years old and 13 were over five. There was no underlying disease in 86.3% of the cases under five years of age, and the most common underlying disease was chronic obstructive pulmonary disease in the five years and older group. While 9.8% of the cases under the age of five was admitted to the intensive care unit, only one case out of 13 patients over the age of five was admitted to the intensive care unit. Although the rate of infection was higher among children under five years of age, there was one mortal case in this group, while one of two patients older than 65 years died in the group over the age of five. Conclusion: In our country, clinical and epidemiological data have great importance for the prevention of mortality and morbidity associated with RSV infections, and extensive surveillance studies are needed.

Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient’s clinical condition and the laboratory and radiological data.

In recent years, the use of synthetic dyes and pigments in textile finishing companies has been discussed for their harmful effects on human health and environment. For this reason, the use of natural dyestuffs from plants in the nature has begun to increase because of the biodegradability, toxicity, human health and waste water contamination. In this study, wool yarns were dyed using different mordant materials and natural dyes which is extracted from parts such as berry, leaf and branch of Sambucus ebulus L. (Dwarf Elder). As a result of the color measurements and color comparisons measured in the spectrophotometer, it was determined that the darker colors can be reached by mordanting with Iron Sulphate (FeSO4) according to K / S values. As a result, it is stated that Sambucus ebulus L. plant, which is used in many fields such as medicine, pharmacy, food and chemistry, can be used in natural dyeing due to its brown and tones and may be an alternative to plants used in natural dyeing such as safflower, quince and walnut., Son yıllarda tekstil terbiye işletmelerinde kullanılan sentetik boyarmaddelerin ve pigmentlerin kullanımı insan sağlığı ve çevreye verdiği zararlardan ötürü tartışılmaktadır. Bu sebeple, biyolojik olarak parçalanabilirliği, toksik (zehirli) olmaması, insan sağlığı ve atık su kontaminantı için herhangi bir sorun oluşturmaması nedeniyle doğadaki bitkilerden elde dilen doğal boyarmaddelerin kullanımı artmaya başlamıştır. Bu çalışma kapsamında Sambucus ebulus L. (Bodur mürver) bitkisinin meyve, yaprak ve gövde gibi kısımlarından elde edilen doğal boyarmaddeyle yün iplikleri farklı mordan maddeleri kullanılarak boyanmıştır. Spektrofotometre cihazında yapılan renk ölçümleri ve renk karşılaştırmaları sonucunda, Demir Sülfat (FeSO4) ile yapılan mordanlama sonucunda elde edilen K/S değerleri ile daha koyu renklere ulaşılabildiği tespit edilmiştir. Sonuç olarak, tıp, eczacılık, gıda ve kimya gibi birçok alanda kullanılan Sambucus ebulus L. bitkisinin özellikle doğal boyamacılık alanında da kullanılabileceği, elde edilen kahverengi ve tonları açısından aspir, ayva, ceviz gibi doğal boyacılıkta kullanılan bitkilere alternatif olabileceği belirtilmiştir.

Objective: In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19). Methods: This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed. Results: A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16-4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads ≥2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021-1.192, p=0.040) were independently associated with in-hospital death. Conclusion: This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients.

Bu calismada, ring, kompakt, rotor ve hava jetli (vortex) egirme sistemleriyle uretilmis ipliklerin farkli yapi ve ozelliklerinin bobin boyamada renk verimliligi uzerine etkileri arastirilmistir. Bu amacla, ayni harman kullanilarak, farkli iplik numaralarinda %100 penye ring, kompakt, rotor ve vortex iplikler uretilmis ve 370 gr/dm3 bobin yogunlugunda, yumusak sarim prensibine gore delikli plastik boyama patronlarina sarilmistir. Bobinler bobin boyama makinesinde uc farkli konsantrasyonda reaktif boyarmadde ile boyanmistir. Boyama sonrasi renk degerleri (L*, a*, b*, c* ve h), renk farkliliklari (ΔE) ve boyama kuvveti (K/S) degerleri spektrofotometre kullanilarak olculmustur. Sonuc olarak, ayni sartlar altinda vortex ve rotor ipliklerinin ring ve kompakt ipliklere gore daha koyu renkte boyanabilecegi belirlenmistir.

Introduction: The aim of this study was to determine the frequency of central line-associated bloodstream infections, risk factors, their relationship with catheter insertion location, and the effect of central line-associated bloodstream infections on mortality and pediatric intensive care unit (PICU) length of stay. Methods: This was a prospective, observational and cohort study, carried out between November 2009 and February 2011. During this period, all the patients who had central-line were monitored for central line-associated bloodstream infection. Results: In the study period, 275 patients were admitted to our PICU. The frequency of invasive device usage was 38.9% (107) for central venous catheter, 38.2% (105) for mechanical ventilation, 53.3% (147) for urinary catheter, and 11.3% (32) for artery line. Central line-associated bloodstream infection was detected in 16 (14.8%) of the patients and 23 central line-associated bloodstream infection attacks were observed. There were 14 central line-associated bloodstream infection attacks in 1.000 central venous catheter usage days. There were 168 patients without central venous catheter and 4 (2.4%) of them had blood stream infection. Thirty-six patients died and the mortality rate was 13%. Five of these patients (13.8%) died due to central line-associated bloodstream infection, 27 (25%) of them had central venous catheter and 9 (6%) of them did not (p=0.001). Conclusion: In conclusion, central line-associated bloodstream infection is one of the serious healthcare-associated infections, and it is an important cause of morbidity and mortality in PICUs.

In recent years, the use of synthetic dyes and pigments in textile finishing companies has been discussed for their harmful effects on human health and environment. For this reason, the use of plant–based dyestuffs from the nature has begun to increase because of the biodegradability, non–toxicity, human health and waste water contamination. Natural dyes are substances synthesized by some plants, animals, lichens and fungi in nature. Fungal species, including lichenized fungi have been used as natural colorants in different parts of the world throughout the history. In this study, natural dyes were extracted from Lactarius deliciosus and Lactarius sanguifluus collected from Osmaniye province (East Mediterranean region) of Turkey. Wool yarn (for carpet) was dyed with these natural dyes by using different mordants. CIELab (L*, a*, b*, c* and h), color differences (ΔE) and color strength (K/S) values of dyed wool yarns were determined. According to the dyeing results, cream and brown colors were obtained from L. deliciosus and L. sanguifluus respectively; the use of mordant (ferrous sulfate) increased the color strength of dye goods. This is the first study on dyeing of wool yarns with natural dyes obtained from L. deliciosus and L. sanguifluus collected from East Mediterranean (Osmaniye province) of Turkey.

Background Ulcus vulvae acutum (UVA) is a disease characterized by primary aphthous ulcer or reactive nonsexually related acute genital ulcer. The etiology is unknown. The diagnosis is made by excluding other infectious and noninfectious causes which can be responsible for vulvar ulcer. Case report A 12-year-old girl had a pustule-like lesion which appeared on her genital region 4 days ago and grew rapidly with a swelling and tenderness. Before the admission, she did not take any medication except the analgesics. On the physical examination, no pathological findings were observed other than a very painful ulcero-necrotic lesion with purulent discharge which was on the entrance of the vagina, at 6 o’clock position. The whole blood count showeda hemoglobin level of 12.6 g/dL, a white blood count of 4210/mm3, and a platelet count of 187000/mm3. ESH was 14 mm/h and CRP was 26 mg/L. The serum biochemistry analysis and complete urinalysis were normal. Discharge culture was performed and intravenous piperacillin-tazobactam and fluconazole were administered empirically. Beside the antimicrobial agents oral paracetamol, ibuprofen and topical lidocainewere added to the treatment.Uveitis was not observed andPathergy test and HLA B51 were negative. The vaginal and urine cultures were negative. The serological tests for EBV, CMV, herpes simplex virus (HSV) type 1 and 2, Toxoplasma gondii, parvovirus B19, hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis A virus (HAV), human immunodeficiency virus (HIV), and VDRL were found to be negative. The patient was started on intravenous methylprednisolone(2 mg/kg/day) with the preliminary diagnosis of UVA. Application of topical steroid and anesthetic on the lesions was continued. After the methylprednisolone treatment, the ulcer rapidly shrank and the pain markedly relieved. On the 6thday of hospitalization, the dosage of methylprednisolone was reduced to 1 mg/kg/day and she was discharged. No new lesions were evident in the follow-up and the methylprednisolone was stopped gradually within 3 weeks. During the 9-month follow-up, there were no new lesions and complaints. Conclusion The most prevalent cause of genital ulcers is HSV and it is related to sexual activity. When vulvar ulcer is observed in children, the history of sexual activity and sexual abuse should be carefully questioned. If there is no history of sexual activity, after excluding all the other possible causes, UVA should be considered first for the differential diagnosis.

Background: Bacille Calmette-Guerin (BCG) vaccine may cause some cutaneous complications at the injection site. Although some of these are normal reactions, unexpected complications may be seen. Clinical features, treatment modalities and outcomes of these complications have not been clearly defined in literature. We aimed to determine the local cutaneous complications after BCG vaccine and clinical experiences in our hospital. Methods: Between May 2013 and December 2016, previously healthy children aged older than 2 months, without underlying disease or drug use history, who were admitted with localized cutaneous complications after BCG vaccine, were retrospectively analyzed. Demographic and clinical features, laboratory findings, treatments and outcomes were collected from database. Results: Twenty patients were diagnosed as having local cutaneous complications. Abscess formation (30%), localized inflammation signs (45%), purulent discharge (10%), crust (10%) and eczematous lesion (5%) were found as local cutaneous complications. Drainage was performed in 14 (70%) patients. Oral amoxicillin clavunate therapy was given to four (20%) patients due to isolating Staphylococcus aureus (2/4), Staphylococcus hominis (1/4), and Exiguobacterium aurantiacum (1/4) from the drainage or purulent discharge culture. Anti-tuberculosis drugs (isoniazid and rifampicin) were used in six (30%) patients. Five of them had positive acid-resistant bacilli, tuberculosis polymerase chain reaction or tuberculosis culture results and one (5%) patient was diagnosed as having a lupus vulgaris because histopathological examination of his lesion showed granulomatous dermatitis. In addition, there was no lesion to drain in four (20%) patients and they were followed without treatment. On follow-up, all lesions completely recovered. Conclusions: There is no still consensus about treatment of the local complication after BCG vaccine. In our study, some complications improved with conservative treatment. However, drainage, anti-tuberculosis drugs and antibiotic treatments were needed in some cases. As a result, treatment should be decided to each patien t’s clinical symptoms and underlying disease. Int J Clin Pediatr. 2017;6(3-4):37-41 doi: https://doi.org/10.14740/ijcp279w

ABCTRACTIn this paper, two natural dyes were extracted from Junipers leaves (Juniperus oxycedrus L. and Juniperus excelsa Bieb.). Wool yarn (for carpet) was dyed with the extract using ferrous (II) sulfate, potassium dichromate and sodium sulfate as mordant. Then, CIELab (L*, a*, b*, c,* and h) values, color differences (ΔE) and color strength (K/S) values of dyed wool yarns were examined and the fastness properties of dyed wool against dry and wet rubbing were evaluated. According to the experimental results, the use of mordant increased the color strength of dye goods. All mordant increased the rub fastness of dyed samples such as similar scientific studies previously. Compared to two junipers, dyeing samples of J. excelsa are dyed darker than that of J. oxycedrus.

Objective Peripheral neuropathy is an important potential side effect of statin use. This study was an investigation of the incidence of peripheral neuropathy in patients taking atorvastatin or rosuvastatin for hypercholesterolemia and the relationship to the dose and duration of the treatment. Methods In all, 50 patients using a statin treatment and 50 healthy controls matched for age and gender who had never taken a statin were included in the study. Polyneuropathy was assessed with a neurological examination and electroneuromyography (ENMG). Results While no polyneuropathy was detected in the control group, polyneuropathy was seen in 33 (66%) of the patients in the statin group (p Conclusion This study revealed an increased risk of peripheral neuropathy with long-term statin use (>1 year). Electrodiagnostic changes have been detected in motor and sensory nerves in nerve conduction studies of patients on long-term statin treatment. The assessment of neurological symptoms, like tingling, numbness, pain and tremor in the hands and feet, and unsteadiness during walking associated with peripheral neuropathy may be useful in the follow-up of the patients on long-term statin treatment. Early detection of peripheral neuropathy and changing hypercholesterolemia treatment may prevent permanent nerve damage.

Objective: Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients’ understanding and perceptions of high cholesterol as well as physicians’ knowledge and awareness of lipid management strategies. Methods: This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. the study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of the PP group patients received statin therapy (p, Amaç: Türkiye’de dislipideminin suboptimal yönetimini az sayıda çalışma doğrudan değerlendirmiştir. Bu çalışma, hastaların yüksek kolesterol algısını ve lipit yönetim stratejileri ile ilgili olarak hekimlerin kolesterol hakkındaki bilgi ve farkındalığını değerlendirmek amacıyla yapıldı. Yöntemler: Çalışma gözlemsel ve çok merkezli bir çalışmadır (ClinicalTrials.gov identifier: NCT02608645). En az 18 yaşında olan, kardiyoloji kliniklerine başvuran ikincil korunma (SK) grubunda ve çok yüksek, yüksek riskli birincil korunma (PK) grubundaki ardışık hastalar çalışmaya alındı. Çalışma popülasyonu, Türkiye’de 40 bölgeden 1868 hasta içermektedir. SK grubunda hastaların üçte ikisine (%67.5) statin verildi, PK hastalarının sadece %30.1’ine statin tedavisi verildi (p

Introduction: Whooping cough-like respiratory tract infections (WCLRTI) caused by factors other than the Bordetella pertussis are available. Clinical picture is difficult to differentiate between the B. pertussis and viral respiratory infections. Methodology: Eighty-five patients with the diagnosis of WCLRTI were divided into 3 groups. Group 1 involved patients with pertussis shown by nasopharyngeal aspirate culture (NAC) and/or PCR. Group 2 consisted of patients who B. pertussis was not detected by NAC however, clinicians still evaluated them as potential patients of pertussis. Group 3 involved patients with the diagnosis of WCLRTI and those with VRTI detected by antigen detection/PCR. Results: Patients with pertussis had longer duration of the symptoms prior to admission. Paroxysmal cough, whooping, vomiting after coughing, cyanosis, apnea, seizures and abdominal hernias were more common in patients with pertussis. Fever, wheezing, tachypnea, retraction, fine crackles and rhonchi were more common in Group 3. Chest radiographs of patients in Group 3 revealed more bronchopneumonic infiltration, increased aeration, and atelectasis. CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) were significantly higher in Group 3. Of the patients 43.6% had no pertussis vaccination due to being < 2 months in age and 29.4% had 1 dose. Conclusions: Pertussis should be thought in differential diagnosis of children with complaints of episodes of paroxysmal cough, cough accompanied by gasping, vomiting after coughing; with leukocytosis, lymphocytosis and a normal chest X-ray. The majority of children with pertussis infection are those who have not had the opportunity for vaccination.

Karbuz A, Karahan ZC, Aldemir-Kocabas B, Tekeli A, Ozdemir H, Guriz H, Gokdemir R, Ince E, Ciftci E. Evaluation of antimicrobial susceptibilities and virulence factors of Staphylococcus aureus strains isolated from community-acquired and health-care associated pediatric infections. Turk J Pediatr 2017; 59: 395-403. The aim of this study was to investigate the enterotoxins and Panton-Valentine leukocidin (PVL) gene as virulence factor, identification if antimicrobial sensitivity patterns, agr (accessory gene regulator) types and sequence types and in resistant cases to obtain SCCmec (staphylococcal cassette chromosome mec) gene types which will be helpful to decide empirical therapy and future health politics for S. aureus species. Total of 150 isolates of S. aureus were isolated from the cultures of the child patients in January 2011 and December 2012. In this study, the penicillin resistance was observed as 93.8%. PVL and mecA was detected positive in 8.7% and in 6% of all S. aureus strains, respectively. Two MRSA (methicillin resistant S.aureus) strains were detected as SCCmec type III and SCCmec type V and five MRSA strains were detected as SCCmec type IV. SET-I and SET-G were the most common detected enterotoxins. In both community-associated and healthcare-associated MRSA strains, agr type 1 was detected most commonly. The most common sequence types were ST737 in 13 patients than ST22 in eight patients and ST121 in six patients. This study highlights a necessity to review the cause of small changes in the structural genes in order to determine whether it is a cause or outcome; community-acquired and healthcare associated strains overlap.

Congenital lobar emphysema is a rare disease, which is characterized by pulmoner hyperinflation. Depending on the degree of bronchial obstruction, the clinical presentation may be variable. We report a rare case with congenital lobar emphysema in a 38-days-old male infant who presented with severe respiratory distress and hypertension. Air trapping in the left upper lung and significant mediastinal shift to the right were observed on the chest x-ray. Emphysematous changes were detected on the thorax computed tomography and considered as congenital lobar emphysema. The upper left lobectomy was successfully performed by pediatric surgeons. On postoperative follow up, no sign of respiratory distress occurred and the patient was normotensive. In this report, a case with congenital lobar emphysema, which is a rare cause of respiratory distress and hypertension is discussed. Saudi Med J 2016; Vol. 37 (7): 796-798 doi: 10.15537/smj.2016.7.13407 How to cite this article: Tural-Kara T, Ozdemir H, Ciftci E, Ince E. Congenital lobar emphysema. A rare cause of hypertension. Saudi Med J . 2016 Jul;37(7):796-8. doi: 10.15537/smj.2016.7.13407.

WOS: 000433285000010, PubMed ID: 28968197, Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.