Objective Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome associated with multiorgan damage that occurs following coronavirus disease 2019 (COVID-19). Research on clinical and laboratory findings, and imaging studies, aiming to predict the progression to severe disease state is limited. This study recruited patients with MIS-C who presented with mild or severe symptoms from a single center in Turkey and evaluated factors related to their symptoms. Methods This retrospective study included 25 pediatric patients with mild and severe presentations of MIS-C. We explored the differences in demographic and clinical data on clinical severity to understand their possible diagnostic and prognostic values. Results Patients with MIS-C had cardiovascular symptoms (68%), gastrointestinal symptoms (64%), dermatologic/mucocutaneous findings (64%), lung involvement (36%), and neurological symptoms (16.0%). About 45.1% of patients with MIS-C had manifestations that overlapped with Kawasaki disease. Eleven patients (44%) were admitted to the intensive care unit, and one (4%) patient died. Grouping based on clinical severity did not differ statistically in terms of gender, age, height, weight, body mass index, and duration of hospital stay. Procalcitonin and ferritin levels correlated with disease severity. The receiver operating characteristic curve for D-dimer gave the highest value of area under the curve, among other biomarkers. The cutoff value for D-dimer was determined as more than 6780. Conclusions Although COVID-19 is usually mild in children, some can be severely affected, and clinical severity in MIS-C can differ from mild to severe multisystem involvement. This study shows that procalcitonin, ferritin, and D-dimer levels may give us information about disease severity.

Background: The suicide rate among adolescents around the world has increased rapidly. There are many risk factors for attempting suicide, but not all have been clarified yet. Therefore, it is very important to identify risk factors. This study evaluated adolescents with a history of suicide attempts and their association with chronic diseases. Besides, to check whether they attempted suicide multiple times. Other clinical features related to multiple suicide attempts were investigated. Method: This study used a multicentre, retrospective cross-sectional design; 253 adolescents admitted to emergency departments in 2019 for suicide attempts were evaluated. Results: Adolescents with chronic disease were at greater risk for both single and multiple suicide attempts and patients had a 6.14 times higher risk of multiple attempts ( p = .013). The likelihood of multiple attempts did not differ according to the presence of somatic or psychiatric disease. Multiple attempters were more likely to poison themselves with their therapeutic drugs ( p = .002). Conclusion: When adolescents with a chronic disease present to the emergency services after a single suicide attempt using their therapeutic drugs, families should be informed regarding the potential for further attempts.

Objective The most common childhood convulsive disorder happens to be febrile seizure (FS), which is an important health problem leading to economic burden and parental anxiety. Further investigation into the etiological causes of FS will guide us for appropriate measures during the follow-up period. The aim of study is to identify the percentage of viral and bacterial pathogens in the etiological causes of children with FS, and also if there is any difference between simple and complex FSs. Methods This prospective study randomly enrolled 100 pediatric patients with FS between January 2017 and July 2017. Nasopharyngeal swabs were obtained from all children at presentation. The respiratory panel was performed with a multiplex real-time polymerase chain reaction method to detect the 21 most common viruses. A complete blood count, absolute neutrophil count, absolute lymphocyte count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, blood culture, throat culture, urine analyses, urinary culture, and stool tests analysis were performed in all the patients. Results During the study period, at least one virus was detected in 87% of patients. Bacterial agents were detected in only 13% of patients. Coinfections of the viruses and bacterial pathogens were found in 24% of patients. The most frequently detected virus was influenza A (Inf A) (18%), followed by rhinovirus (12%). Coinfections of the viruses and bacterial pathogens, mixed viral infections, and Inf A were common in children who experienced complex FS. Inf A was detected in 16% of patients with simple FSs and 30% of patients with complex FSs and a significant difference between them (p < 0.01). Conclusion The results of this study showed that respiratory viral and bacterial pathogens are important in the etiology of FS in children. It is considered that complex FSs may be triggered by Inf A. The fact is viral pathogens are very common; therefore, antibiotics must be carefully prescribed. These results also draw attention to the use of the quadrivalent influenza vaccine in the prevention of FS related to the flu.

Objective: Emergency departments are becoming increasingly crowded. Analyzing patients who refuse treatment in the emergency department is crucial to improve the quality of care and reduce overcrowding. This study determined why some parents who presented to the pediatric emergency department during the coronavirus disease-2019 (COVID-19) pandemic refused treatment for their children. Materials and Methods: The study was conducted at the Kartal Dr. Lütfi Kırdar City Hospital, Pediatric Emergency Clinic. Patients who presented to the pediatric emergency department between November 1, 2021 and December 31, 2021 and whose parents refused treatment were analyzed retrospectively via telephone interviews. Demographic characteristics, diagnosis, and reasons for refusal to treatment were analyzed. Results: Over the 2-month period, parents of 154 (0.3%) of 51.111 patients who presented to the pediatric emergency department refused treatment. Parents refused treatment for the following reasons: 68 (44%) parents refused treatment because the patient felt well, 36 (23%) wanted to continue treatment at home, and 18 (11%) wanted to avoid hospitalization. Of the patients who refused treatment, 16 (10%) returned to the pediatric emergency department within 72 h with the same symptoms, and 5 of them were hospitalized. Conclusion: The COVID-19 pandemic has increased patients’ refusal to treatment because of the fear of infection. The inappropriate use of emergency services, which leaves physicians with insufficient time to explain medical examinations and treatments to the family members of patients in a clear and understandable language, as well as the patients’ right to re-present to hospitals after refusing treatment, are the main reasons. Actions should be taken to improve working conditions, increase satisfaction of healthcare professionals, raise awareness among patients and their family members and reduce overcrowding at emergency departments. These actions can prevent treatment refusal, even during the COVID-19 pandemic.

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Objective: Poisoning is a substantial public health problem preventable with basic precautions. This study aims to contribute to the literature by analyzing the demographic variables, epidemiological characteristics, and prognosis of children brought to the pediatric emergency department of our center due to poisoning in the last five years. Methods:We retrospectively evaluated the medical records of 1928 patients who were under-18 years old and admitted with acute intoxication diagnosis to our tertiary hospital's pediatric emergency department in Istanbul between 2016 and 2021. Patients were divided into two groups by poisoning factors: drug and non-drug substances. Results:We included all 1928 patients (55.1% male, 44.9% female). The median age was 30 (20-49) months, and 85.5% (n=1650) of patients were under 72 months old. There was a male gender dominance (62.4%) among patients aged 3-6, all of whom had accidental poisoning (100%). Poisonings among patients older than 12years of age were more common in girls (59.8%) and were mainly suicidal attempts (65.2%). We detected drug exposure in 58.9% (n=1047) of patients; the most common drugs were analgesics (13.5%, n=269), psychotropics (6.2%, n=102), and hormone preparations (4.5%, n=86). We also detected non-drug exposure in 41.1% (n=792) of patients; the most common non-drug substances were corrosive-caustic substances (14.6%, n=284), and detergent poisonings (5.5%, n=106). None of the patients died. Conclusion:Patients in the under 6 years old group admitted due to poisoning were predominantly male, and all cases were accidental. Whereas poisonings above the age of 12 were more common in girls and were usually due to suicide. Our study also showed that poisonings in children passed with milder symptoms, and we discharged most of the children after a short observation without the need for hospitalization. Well-balanced clinical management may prevent unnecessary hospitalization and unnecessary medical interventions.

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