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The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non-albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non-albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use (p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non-albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.

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While leukemia is responsible for 25-30% of childhood cancers, acute leukemia accounts for about 97% of leukemia. In children younger than 15 years, Acute lymphoblastic leukemia is about five times more common than acute myeloid leukemia. The annual incidence of acute lymphoblastic leukemia in Turkey is 1.5/100,000. While treatment response and survival rates in acute lymphoblastic leukemia did not reach 10% in 1960s, approximately 80-90% of patients can be remitted with treatment protocols today. In the treatment of high-risk patients, more agents are given at higher doses and for longer periods. In appropriate cases, stem cells are transplanted. Key words: Lymhocytic leukemia, epidemiology, classification, prognosis ÖZ Çocukluk çağı kanserlerinin %25-30'unu lösemiler oluştururken, lösemilerin yaklaşık %97'sinden akut lösemiler sorumludur. On beş yaşından küçük çocuklarda akut lenfoblastik lösemi, akut myeloblastik lösemiye göre yaklaşık beş kat daha sık görülmektedir. Akut lenfoblastik lösemilerin Türkiye'de yıllık insidansı 1.5/100.000'dir. Akut lenfoblastik lösemide tedaviye yanıt ve sağ kalım oranları 1960'lı yıllarda %10 düzeyine ulaşmaz iken, bugün tedavi protokolleri ile hastaların yaklaşık olarak %80-90'ında remisyon sağlanabilmektedir. Yüksek riskli hastaların tedavisinde daha fazla ajan daha yüksek dozlarda ve daha uzun süre verilmektedir. Uygun vakalarda kök hücre nakli yapılmaktadır. Anahtar kelimeler: Lenfositik lösemi, epidemiyoloji, sınıflandırma, prognoz,

Background. Measurement of the optic nerve sheath diameter (ONSD) with point-of-care ultrasound (POCUS) is a non-invasive and radiation-free technique that can be used to assess increased intracranial pressure (ICP). Ophthalmic artery and central retinal artery Doppler indices can be used like transcranial Doppler to evaluate increased ICP. This study aims to examine the diagnostic value of ONSD measurements and central retinal artery Doppler indices in the evaluation of pediatric patients with increased ICP. Methods. This was a prospective, case-controlled single center study. The study group was comprised of a total of 38 pediatric patients with increased ICP and the control group included 19 healthy children. Ophthalmic ultrasound was performed and ONSD and central retinal artery Doppler indices were measured. Results. The mean age of the study group was 80.84 ± 65.12 months. The mean ONSD was 5.9 ± 0.8 (3.6-8.1) mm in the study group and the mean resistive index (RI) was 0.71 ± 0.08 (min:0,55-max:1) and was significantly greater than the control group (p < 0.001 and p < 0.001, respectively). In terms of predicting increased ICP, the ONSD measurement was the strongest parameter, with its area under the curve: 0.767 (95 percent confidence interval: 0.68-0.85). In the study group, the cut-off value for ONSD was 5.8 mm (66 percent sensitivity, 100 percent specificity) and the cut-off value for RI was 0.68 (63 percent sensitivity, 83 percent specificity). Conclusions. Point-of-care ultrasound is a noninvasive and important tool in pediatric intensive care units. Our study is significant as one of the few pediatric studies where central retinal artery Doppler indices are evaluated in addition to OSND, in patients with increased ICP.

This study was aimed to evaluate the success rate of high-flow nasal cannula (HFNC) oxygen therapy and factors causing therapy failure. This prospective observational study included 131 children who received HFNC oxygen and followed-up in the pediatric emergency department, pediatric clinics, and pediatric intensive care unit between March 2018 and December 2019. The median age was 23.0 months (interquartile range [IQR]: 9.0–92.0) and 65 patients were male (49.6%). The most common reason for requiring HFNC oxygen therapy was pneumonia (n = 75, 57.3%). A complex chronic condition was present in 112 (85.5%) patients. Therapy success was achieved in 116 patients (88.5%). The reason for requiring treatment and the patients' complex chronic condition did not affect the success of the therapy (p = 0.294 and 0.091, respectively). In the first 24 hours of treatment, a significant improvement in pulse rate, respiratory rate, pH, and lactate level were observed in successful HFNC oxygen patients (p < 0.05). In addition, these patients showed a significant improvement in SpO2 and SpO2/FiO2 ratio, and a significant decrease in FiO2 and flow rate (p < 0.05). HFNC oxygen success rate was 95.6% in patients with SpO2/FiO2 ≥ 150 at the 24th hour; it was 58.0% in those with SpO2/FiO2 < 150 (p < 0.001). Caution should be exercised in terms of HFNC oxygen failure in patients with no significant improvement in vital signs and with SpO2/FiO2 < 150 during treatment.

Purpose: Incidence of diabetes during pregnancy is increasing worldwide, and intrauterine hyperglycemia exposure may have long-term adverse effects on the cardiovascular health of children. We investigated risk of atherosclerosis and carotid intima-media thickness (CIMT) in infants born macrosomic and in infants of diabetic mothers (IDM) at the age of 8-9 years. Method: 49 infants of diabetic mothers (IDM group) and 13 macrosomic infants (Macrosomic group) were included in the study. They were compared with 26 age-matched healthy children with birth weight appropriate for gestational age born to non-diabetic mothers (Control group). Anthropometric measurements, atherosclerosis risk factors and CIMT measurements were performed.Results: There was no signi cant difference between the groups in terms of age, gender, actual anthropometric measurements, blood pressure measurements, laboratory parameters or atherosclerosis risk factors. Gestational age was lower in the IDM group (p<0.001), while birth weight was higher in the Macrosomic group (p<0.001). High-density lipoprotein cholesterol level was lower in the IDM group than the other groups. Duration of exclusive and total breastfeeding were lower in IDM group than in Control group (p<0.001 for both). Body mass index, skinfold thickness, waist-to-hip ratio and waist-to-height ratio were higher in those breastfed for less than 6 months in the IDM group. The CIMT values were statistically higher in IDM [0.43±.0.047 (0.34-0.60)] and Macrosomic [0.40±0.055 (0.33-0.50)] groups than Control group [0.34±0.047 (0.26-0.45)].Conclusion, CIMT values were higher in IDM and Macrosomic groups. This indicates intrauterine exposure in both groups. Breastfeeding seems very important for IDMs.