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Background: Fulminant myocarditis is a rare, life-threatening condition. Decompensated heart failure caused by fulminant myocarditis is managed with inotropic agents, mechanical ventilation, and mechanical circulatory support. Levosimendan is a novel inotropic agent that also has vasodilatory and cardioprotective properties. However, information about levosimendan use in children is limited in the literature. Case Report: We report the full recovery of a 3.5-year-old male patient with an inotrope-resistant heart failure treated with levosimendan therapy who was diagnosed as having fulminant myocarditis after presenting with acute decompensated heart failure and low cardiac output. Conclusion: Levosimendan therapy may offer an effective treatment for children with acute decompensated heart failure secondary to fulminant myocarditis resistant to standard therapy. [ABSTRACT FROM AUTHOR]

Objective Sepsis and septic shock are leading causes of mortality and morbidity in intensive care units. Our study aimed to compare the pediatric risk of mortality (PRISM-3) score, which is used for predicting mortality risk among critically ill patients in pediatric intensive care units, with laboratory parameters, particularly lactate parameters. Methods This study included 38 patients aged 1 month to 18 years who were managed for sepsis and septic shock in a pediatric intensive care unit. Lactate, D-dimer, troponin T, and N-terminal prohormone of brain natriuretic peptide levels were measured at the 0th and 24th hours. The patients were divided into survivors and nonsurvivors and those with septic shock and those without. Results There were a total of 38 patients with a median age of 12 months, of whom 17 (44.7%) were males and 21 (55.3%) were females. Six (15.8%) patients died within 7 days after the diagnosis. Nonsurvivors had significantly higher median values of PRISM-3 (p = 0.002), C-reactive protein (p = 0.046), and partial arterial carbon dioxide pressure (p = 0.041). PRISM-3 showed a good discriminatory power (area under the curve [AUROC] = 0.878; p < 0.0001) and baseline lactate level showed a moderate level of discriminatory power (AUROC = 0.734 p = 0.0254) for early mortality within 7 days. Conclusion PRISM-3 and baseline lactate predict early mortality in children with sepsis and septic shock. We suggest that adding lactate, which is not included in the PRISM-3 score, to the score may increase the score's predictive ability for mortality. We believe, however, that randomized, controlled, multicenter studies with larger sample sizes should be conducted to test this hypothesis. [ABSTRACT FROM AUTHOR]

Background: To determine the level of knowledge on human papillomavirus (HPV) infection and vaccination, and the attitude towards HPV vaccination in pediatricians, obstetricians and gynecologists (OBG)., Materials and Methods: Participants were administered a 40-question survey, investigating the demographic properties, the knowledge on the HPV infection-vaccination and attitudes towards vaccination., Results: The study enrolled a total of 228 participants (131 pediatricians and 97 OBGs). At a rate of 99.6%, the participants agreed with the fact that the HPV infection was the most common sexually transmitted disease and 33.8% of the participants had the opinion that the HPV vaccination should be administered only in women. The lowest level of HPV vaccine recommendation was among the pediatrics specialists (59.4%, p=0.012). When asked whether they would have their daughters receive HPV vaccination, 79.5% of the participants answered favorably; this rate was 36.7% for the sons. At a rate of 59.5% of the participants thought that the HPV vaccine needed to be included in the national vaccine schedule. Most of the participants (91.6%) had the idea that reduction of the vaccine costs would increase the vaccination frequency., Conclusions: We observed that the consideration of the costs and the prejudices relating to the inefficacy of vaccination as well as the inadequate level of knowledge were involved in the physicians' resistance to HPV vaccination. We believe that the healthcare professionals should be informed adequately to overcome false beliefs, thereby ensuring success of the HPV vaccine upon inclusion in the national vaccine schedule in the future.