Introduction:Idiopathic Pulmonary Hemosiderosis (IPH) is a rare cause of alveolar hemorrhage, which is seen primarily in childhood. Celiac disease is defined as a chronic, immune-mediated enteropathy of the small intestine, caused by exposure to dietary gluten in genetically pre-disposed individuals. Association of IPH and celiac disease is known as Lane Hamilton syndrome. There are limited number of case reports of this syndrome in literature.Case Presentation:Although there were no growth and developmental delay and gastrointestinal symptoms like chronic diarrhea, chronic constipation, vomiting, abdominal bloating and pain in the two patients with IPH, they were diagnosed with Lane Hamilton Syndrome. After initiation of gluten-free diet, their IPH symptoms disappeared and hemoglobin levels were observed to return to normal.Conclusions:Even if there were no gastrointestinal symptoms in a patient with IPH, celiac disease should be investigated. These patients may benefit from gluten free diet and IPH symptoms may disappear.

Objectives This descriptive study aimed to compare the clinical and laboratory features of the children with the multisystem inflammatory syndrome in children (MIS-C), requiring pediatric intensive care unit (PICU), admission with the MIS-C patients who did not require PICU admission. Patients and methods This study was conducted between March 2020 and February 2021 at the University of Health Sciences Dr. Behçet Uz Children’s Hospital, a referral center for pediatric infectious diseases in the Aegean Region of Turkey. All hospitalized patients aged 18 years old or less with MIS-C according to the definition of the universal guidelines were included in the study. Data of the patients with the diagnosis of MIS-C were recorded and collected from the electronic medical records of the hospital. The data included demographic characteristics, presenting signs and symptoms, laboratory findings and clinical data. Results A total of 58 patients with MIS-C were included in this study. Thirty-eight (65.5%) patients were male. The median age was 6 years (2 months–16 years). The patients admitted to PICU were 15 (25.9%). The rate of pulmonary involvement was 81.3% (n = 13) in the PICU group. The median procalcitonin, C-reactive protein, erythrocyte sedimentation rate, D-Dimer and ferritin values were significantly higher in the PICU group compared to non-PICU group (p < 0.001, p = 0.02, p < 0.001, p = 0.006 and p = 0.031). Conclusions Besides the depressing cardiac functions reported before, the pulmonary involvement and signs of shock are important factors for PICU admission in children with MIS-C.

IntroductionWe aimed to compare automated ventilation with closed–loop control of the fraction of inspired oxygen (FiO2) to automated ventilation with manual titrations of the FiO2 with respect to time spent in predefined pulse oximetry (SpO2) zones in pediatric critically ill patients.MethodsThis was a randomized crossover clinical trial comparing Adaptive Support Ventilation (ASV) 1.1 with use of a closed–loop FiO2 system vs. ASV 1.1 with manual FiO2 titrations. The primary endpoint was the percentage of time spent in optimal SpO2 zones. Secondary endpoints included the percentage of time spent in acceptable, suboptimal and unacceptable SpO2 zones, and the total number of FiO2 changes per patient.ResultsWe included 30 children with a median age of 21 (11–48) months; 12 (40%) children had pediatric ARDS. The percentage of time spent in optimal SpO2 zones increased with use of the closed–loop FiO2 controller vs. manual oxygen control [96.1 (93.7–98.6) vs. 78.4 (51.3–94.8); P < 0.001]. The percentage of time spent in acceptable, suboptimal and unacceptable zones decreased. Findings were similar with the use of closed-loop FiO2 controller compared to manual titration in patients with ARDS [95.9 (81.6–98.8) vs. 78 (49.5–94.8) %; P = 0.027]. The total number of closed-loop FiO2 changes per patient was 52 (11.8–67), vs. the number of manual changes 1 (0–2), (P < 0.001).ConclusionIn this randomized crossover trial in pediatric critically ill patients under invasive ventilation with ASV, use of a closed–loop control of FiO2 titration increased the percentage of time spent within in optimal SpO2 zones, and increased the total number of FiO2 changes per patient.Clinical trial registrationClinicalTrials.gov, identifier: NCT04568642.

Akrep sokmaları, ısırılma yerine ait lokal reaksiyonlardan, ölüme yol açacak çoklu organ tutulumlarına kadar geniş bir yelpazede klinik bulgulara neden olur. Isırılma sonucu yaşamı tehdit eden en önemli organ tutulumu kalp ve akciğerlerde görülür. Pulmoner ödem ve miyokardit gibi ölümcül komplikasyonlar nedeni ile her akrep sokması ile karşılaşan çocuk hasta gözlem altında tutulmalı, komplikasyonlara karşı yakın takip edilmelidir. Bu makalede akrep sokmasının ender fakat ciddi komplikasyonlarından olan miyokardit ve pulmoner ödemin geliştiği 4 yaşındaki olgunun takip ve tedavi aşamaları sunulmuştur.

INTRODUCTION: Although it has different mortality and morbidity rates all over the world, childhood poisoning has an important place among childhood health problems. The increase in health expenditures, retention time and loss of labor caused by poisonings cause the problem not only to be medical but also social aspects. METHODS: In addition to demographic data of 1043 pediatric patients admitted to our hospital with poisoning complaints, pre-admission intervention, place of poisoning, admission time, agent and time of poisoning, time elapsed after poisoning, admission findings, hospitalization period, diagnostic tests applied and treatment modalities were evaluated retrospectively with their prognosis. RESULTS: Of the 1043 cases, 54.5% were female. Female ratio increased to 82% in 139 suicides. When the causes of poisoning is examined, 47.2% were related to drugs, 41.5% were industrial and 5.4% were agricultural products, 2.7% due to CO, 2.6% were depending on the food,0.5% due to unknown factors and 0.2% occured with animal bites. Gastric-lavage, activated-charcoal, intravenous-fluid regimen (33%) was the most common treatment. Two of the three mortal cases were due to colchicine. DISCUSSION AND CONCLUSION: Although the development in the diagnosis and treatment of poisonings is pleasing, the most accurate approach to this issue will be to increase the protective measures. In addition to these standard measures, each country should set priorities in line with its own epidemiological study. Regarding the higher mortality rate (22%) we may suggest that clinicians should be more careful and aggressive in the diagnosis and treatment of colchicine intoxications, which can be associated with mortality even at low doses.

BackgroundWe aimed to evaluate the correlation of caspofungin E-tests with the prognosis and response to caspofungin therapy of Candida parapsilosis complex bloodstream infections in children hospitalized in a pediatric intensive care unit.MethodsAll children who had C. parapsilosis complex bloodstream infections and who were treated with caspofungin were included in this retrospective study. For each patient, the following parameters, including all consecutive blood and central venous catheter (CVC) cultures, the duration between diagnosis and CVC removal, mortality rate, relapses of the C. parapsilosis complex infections as well as the demographic features, were recorded.ResultsThe central venous catheter survival rate was 33.3% under caspofungin treatment. In 92.4 % of the patients, the negative culture was achieved within a median duration of 12.5 days. The rate of relapses was 18.9%. The overall mortality rate was 37.7% (20 of 53 patients), and the 30-days mortality rate was 7.5% (4 of 53 patients). There was no statistically significant difference between the groups with MIC<2 mg/l and MIC =2 mg/l using CVC survival rate; rate and duration of achieving negative blood culture for C. parapsilosis complex; duration of hospital stay; rate and duration of relapses; overall mortality and 30-days mortality.ConclusionsThe beneficial effects of Caspofungin on biofilms has been shown in vivo, while its impact in children for maintenance of CVC was limited in our study but should not be underestimated in children who strongly need the presence of CVCs. The clinicians should weigh their priority for their patients and choose the optimal antifungal therapy for C. parapsilosis complex infections in children.

Acute infantile hemorrhagic edema (AIHE) is a benign form of cutaneous leukocytoclastic vasculitis that usually occurs in children younger than 2 years of age. Although the etiology is unknown, AIHE often follows infections, drug treatment, or vaccination. The onset of AIHE is often dramatic with petechiae, ecchymoses, and annular, nummular or targetoid purpuric lesions usually appearing on the extremities, face, or ears. In this report we aimed to present a case with AIHE in whomvaccination was considered the etiologic cause.

Antifungal-lock therapy (AfLT) has arrived as an investigational approach for preventing catheter removal with limited clinical evidence of its efficiency. The principle of AfLT consists of catheter lumen replenishment by a selected antimicrobial agent and then locking it for an alternative treatment to eradicate the microbes embedded in endoluminal biofilms. Herein, we report a pediatric hematology-oncology patient with Candida parapsilosis-related central venous access device infection in which catheter removal was performed despite the systemic and intraluminal caspofungin treatment. For now, we recommend higher doses of caspofungin for AfLT especially in Candida parapsilosis-related catheter infections. Keywords: Antifungal-lock technique, Candida species, caspofungin, catheter Antifungal kilit tekniği (AfKT) kateter çıkarılmasını engellemek amacı ile etkinliği hakkında kısıtlı verinin olduğu bir deneysel yaklaşım olarak karşımıza çıkmaktadır. Bu teknikte endoluminal biyofilmler içine gömülü olan etkenlerin eradike edilmesi için katater lümeni, seçilen antimikrobiyal ajanla doldurularak kapatılır. Burada yoğun bakım servisimizde yatan ve Candida parapsilosis ilişkili santral venöz kateter enfeksiyonu olan bir hematoloji-onkoloji hastasından gerek intraluminal gerekse sistemik kaspofungin tedavisine rağmen kateteri çıkartmak zorunda kalışımızı raporladık. Özellikle Candida parapsilosis ilişkili kateter enfeksiyonlarının AfKT ile tedavi edilebilmesi için daha yüksek dozda kaspofungin kullanılmasını önermekteyiz. Anahtar Kelimeler: Antifungal kilit tekniği, Candida türleri, kaspofungin, kateter AbstractÖz