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°C (38.0–38.7°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.

Objectives:Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) have been found to be useful indexes for the diagnosis of sepsis in adults. However, the knowledge of their roles and cut-off values in pediatric patients is limited. The primary objective of this study was to assess the ability of NLR and MPV to predict sepsis in children. A secondary aim was to evaluate the comparison of these parameters with C-reactive Protein (CRP).Methods:The study was conducted on pediatric patients, who had two or more of the following criteria were included in the study: tachycardia, tachypnea, temperature change, leukocytosis, or leukopenia for age. Patients were classified into sepsis and non-sepsis groups. The sepsis group was defined as the presence of two or more age specific Systemic Inflammatory Response Syndrome (SIRS) criteria and increased Procalcitonin (PCT) level (>0.5 ng/ml)Result:The median age of the study population was 18 (6-169) months. Two hundred-sixty four episodes of sepsis were recorded in 125 patients. Eighty two were classified as sepsis and 182 as non-sepsis. CRP level and MPV value were significantly higher in the sepsis group compared to non-sepsis group. The median CRP level was 47.8 mg/dl (10.2-119.5) in the sepsis group and 18.6 mg/dl (4.9-66.1) in the non-sepsis group (p=0.006). In the sepsis group, the median MPV value was 8.4 (7.6-9.5) and it was 7.8 (7.1-8.5) in the non-sepsis group (p=0.001). Significant correlations were found between the procalcitonin (PCT) and CRP level (p<0.001; r = 0.279), NLR (p=0.02; r = 0.186) and MPV (p<0.001; r = 0.243). MPV had the highest specificity for predicting sepsis (75.8%). The largest AUC was 0.629 with a cut-off value 8.5 for MPV, while the AUC was 0.557 with a cut-off value 1.97 for NLR and 0.606 with a cut-off value 38.9 for CRP.Conclusions:NLR and MPV values should alert clinicians to the possibility of sepsis and to initiate or change antibiotic treatment.

Restrictive blood transfusion strategy is better than liberal transfusion strategy with regard to the hemodynamic and laboratory values during the early period. PI also provides valuable information regarding the efficacy of PRBC transfusion in clinical practice.

Zehirlenmeler çocuk yoğun bakım üniteleri ve hastane yatışlarında önlenebilir morbidite ve mortalitenin önemli bir kısmını oluşturmakla beraber yoğun bakım gerektiren zehirlenmeler hakkında bilgi sınırlıdır. Bu çalışmada Erciyes Üniversitesi Tıp Fakültesi Çocuk Yoğun Bakım Ünitesi'nde tedavi edilen zehirlenme olgularının değerlendirilmesi amaçlanmıştır. Yöntemler: 2009-2015 yılları arasında akut zehirlenme nedeniyle yoğun bakım ünitesine kabul edilen 186 hastanın kayıtları geriye dönük olarak incelendi. Bulgular: Olguların yaş aralığı 14 ay-17 yaş arasında değişmekteydi ve kız/erkek oranı 1,6:1 idi. Zehirlenmelerin çoğunluğunun evde (%87,6) ve oral yolla (%91,4) gerçekleştiği belirlendi. Olguların %59,1'inin kaza ile, %28,5'inin özkıyım amaçlı, ve %12,4'ünün önerilen tedavinin yanlış uygulanması sonucu zehirlendiği gözlendi. Olguların yaklaşık üçte ikisi (%60,2) ilaç ilişkili iken %39,8'i ilaç dışı maddelerle gerçekleşti. İlaç ilişkili zehirlenmelerde santral sinir sistemi ilaçları (%27,6) en sık rastlanan ajan iken ilaç dışı etkenlerden en çok korozif maddeler gözlendi. Bu çalışmada mortalite oranı %5,4 olarak bulundu. İlaç dışı maddelerle mortalite (%4,3) ilaç ilişkili mortaliteden (%1,1) daha yüksekti. Sonuç: Potansiyel toksinler, bunların saklanma koşulları ve evde güvenliği sağlayacak genel önlemler konusunda toplumun farkındalığının arttırılması ile birlikte sağlık politikalarında, endüstriyel aşamada ve düzenlemeler yapılması gerekmektedir. Anahtar Kelimeler: Zehirlenme, çocuk, yoğun bakım Introduction: Although poisonings represent a significant number of preventable causes of morbidity and mortality admissions to hospital and pediatric intensive care unit, data about poisonings requiring pediatric intensive care unit care level are limited. The aim of this study was to evaluate poisoned patients who were treated in the Pediatric Intensive Care Unit at Erciyes University Faculty of Medicine. Methods: The records of 186 patients admitted to the pediatric intensive care unit due to acute poisoning between 2009 and 2015 were retrospectively evaluated. Results: The poisoned patients were aged between 14 months-17 years and the female to male ratio was 1.6:1. Most poisonings occurred at home (87.6%) via the oral route (91.4%). It was noted that 59.1% of poisoning cases were accidental, whereas 28.5% were suicidal and 12.4% were a result of a therapeutic error. Nearly two-thirds (60.2%) of cases were drug-related, while 39.8% were non-drug-related. Central nervous system drugs (27.6%) were the most common agent in drug-related poisoning, however, corrosive substances were the most common in nondrug-related poisoning. The overall mortality rate in this study was 5.4%. Mortality from non-drug poisoning (4.3%) was higher than from drug-related causes (1.1%). Conclusion: The results of this study emphasize the need for regulations in industrial and health policies related to the aim of increasing awareness of potential toxins, appropriate storage of potential toxins, and general precautions to promote safety at home.

Background and Objectives. The aim of this study was to investigate the factors predicting Pediatric Intensive Care Unit (PICU) mortality and the outcomes in cancer patients admitted to PICU. Methods. We conducted a retrospective study in 48 consecutive cancer patients admitted to the PICU between January 1, 2015 and January 1, 2018. A total of 48 patients (21 males and 27 females) were enrolled in this study. Results. The median age was 77 (33,5-149) months. The median duration of PICU stay was 5 (2-9) days. Patients were classified according to their stage of disease. Ten (20.8%) patients were in the remission group, 9 (18.8%) patients were in the induction period and 29 (60.5%) patients were in the progressive diseasegruops. Thirtynine patients (81.2%) had hematological malignancies, 6 (12.5%) had extracranial solid tumors and 3 (6.3%) had intracranial solid tumors. Thirty-seven patients died and the mortality rate was found to be 77.1%. mortality rates were 11%, 88% and 93% for patients in remission,during induction period and in the progressive disease group, respectively (p &lt; 0.01).The most frequent reasons of PICU admission were respiratory failure in 29 (60.4%), sepsis in 12 (25%), circulatory collaps in 2 (4.2%), and other reasons in 5 patients (10.4%). The median PRISM III among survivors was significantly lower than non-survivors (13.1 &#xb1; 6.4; vs. 20.7 &#xb1; 5.2; p &lt; 0.001). At a cut-off value of 13, the sensitivity of the PRISM III was 94.4% and the specificity was 58.3% (AUC: 0.821). OSDwas present in 41 (85%) patients, 82% of them died (34/41). The presence of MOF, the use of mechanical ventilation and inotrop support were significantly related with mortality. Univariate logistic regression analysis showed that male gender [odds ratio (OR)=5.588, P= 0.041, 95% confidence interval (95%CI) 1.070-29.191], presence of organ system dysfunction[OR=12.143, P= 0.008, 95%CI 1.947- 75.736], need for mechanical ventilation[OR=34.000, P= 0.001, 95%CI 5.272-219.262], IS [OR=8.5, P= 0.001, 95%CI 1.318-54.817]were the predictors ofhigh mortality in pediatric cancer patients. PRISM III score &#x2265; 13 was a predictive criteria of PICU mortality. Conclusion. We conclude that the key to improving survival rates is to pick up on this group of patients as soon as possible.We, believe that cancer patients could be saved by earlier evaluation and intervention by the PICU team when they have a less severe disease.

Objective To examine the efficacy of therapeutic plasma exchange (TPE) in patients critically ill with Crimean‐Congo hemorrhagic fever (CCHF). Methods Patients with CCHF received supportive treatment (ST) or TPE. After laboratory and clinical evaluations, the patients were divided into mild, moderate, and severe CCHF groups according to the severity score index (SSI). To assess the efficacy of TPE, the incubation period, time of admission to hospital, hospitalization duration, mortality rate and times to recovery of the platelet count and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were compared between patients receiving ST and TPE. Result A total of 119 confirmed CCHF cases was analyzed. The median SSIs were 7 in the TPE group and 5 in the ST group. The SSI stages, median incubation times and admission times were similar in the two groups. However, the duration of hospitalization was longer in the TPE group. The overall mortality rates were 9% (3 of 33 patients) in the TPE group and 16% (5 of 31 patients) in the ST group; the difference was significant. The platelet count recovered after a median of 6 (4‐7) days in the ST group. Conclusion The mortality rate was lower in the TPE group than in the ST group, but the duration of hospitalization and the time to platelet recovery were longer in the TPE group than in the ST group. TPE did not contribute significantly to the prognosis of patients with intermediate‐severity CCHF. However, TPE might be efficacious in patients with severe CCHF.

Dursun A, Özsoylu S, Emeklioğlu B, Akyıldız BN. Evaluating the basic life support knowledge among schoolteachers: A cross-sectional survey in Kayseri, Turkey. Turk J Pediatr 2018; 60: 702-708.Children spend a significant proportion of their day in school when they are not with their families.Therefore they might experience medical emergency situations due to injuries, complications of chronic health conditions, or unexpected major illnesses that occur in school. In cases of emergencies, school teachers are expected to play a key role in performing basic life support (BLS) on school children. Very limited data are present in the literature that address the knowledge of the schoolteacher regarding BLS. The primary objective of this study was to asses the BLS knowledge, training status and attitude towards pediatric BLS among schoolteachers.The study had a cross-sectional research design and was conducted between January and March 2017. A self administered questionnaire was used for data collection to assess the knowledge of teachers.The questionnaires were filled in by 541 teachers (243 male and 298 women). The median age of the study population was 39 (34-45) years. One-third of the respondents reported having taken a BLS class in the past (33.1%). The mean for the correct answers for the study population was 5/14 (4/14-7/14). For trained teachers, it was 6/14 (4/14-8/14) and for untrained teachers, it was 5/14 (3/14-7/14)(P < 0.001). There were no differences between teachers who had attended different BLS courses. Significant differences between teachers were observed: 62% of teachers with previous BLS training felt capable of providing cardio pulmonary resusitation (CPR) to their students compared to 48% in the group without previous training (P =0.001). Ninety-five percent of the teachers were eager to attend a BLS course and 92% reported that BLS training should be mandatorily given for teacher certification.Teachers are aware of the importance of BLS and they are willing to attend BLS training programs and improve their knowledge.Despite the fact that the knowledge of trained teachers was found to be better than those of untrained teachers, school teachers in Turkey have a low level of knowledge and skills regarding BLS.

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