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.
ORIGINAL ARTICLE PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODSFifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTSMedian follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function. Iatrogenic renal arterial lesions including pseudoaneurysm (PA), arteriovenous fistula (AVF), and arteriocaliceal fistula (ACF) are rare, but life-threatening conditions (1). The chief symptom usually includes macroscopic hematuria (2, 3). Catheter angiography is the gold standard for both diagnosis and treatment (1).Previous studies have evaluated the iatrogenic renal arterial lesions following partial nephrectomy (1, 3-7), but there were only a few studies on iatrogenic renal arterial lesions following any iatrogenic renal interventions (2). In the present study, to the best of our knowledge, we report the largest series of iatrogenic renal arterial lesions following various renal interventions such as biopsy, percutaneous nephrolithotomy (PCNL), percutaneous nephrostomy, and partial nephrectomy. We focused on clinical presentations, imaging findings, management, and outcomes. Methods PatientsData regarding iatrogenic renal arterial lesions treated by endovascular embolization performed at our institution between March 2003 and December 2013 were evaluated retrospectively. A total of 55 patients with iatrogenic renal arterial lesions, who underwent endovascular embolization were included in the study. There were 40 males and 15 females with a median age of 40 years (range, 8-85 years). Patients with traumatic renal arterial lesions treated with endovascular embolization were excluded from the study. Informed con...
Genetic predisposition and placental insufficiency in early gestation might play a role in the etiology of hypospadias.
IntroductionMagnetic resonance imaging (MRI) as a method for breast exams has been used increasingly frequently during the last decade. In particular, it is preferred for selected cases as a diagnostic and problem-solving method for its high contrast resolution, multiplanar capability of examination, lack of ionizing radiation, and capacity to obtain dynamic contrast images (1, 2). Conventional MRI has disadvantages such as time-consuming screening and requirement of high-value contrast agents (3). Despite the fact that dynamic contrast-enhanced MRI is an efficient diagnostic exam with high sensitivity, but its limited specificity creates a need for new techniques (1-7). Therefore, additional sequences are sought that would increase image quality, reduce imaging time and enable differential diagnosis for lesions (4). Diffusionweighted imaging (DWI) is one of these fast MRI sequences. By recording the free movement of water molecules in the extracellular space, DWI creates different signals in images as a result of the inhibition of this movement and therefore diffusion restriction, which occurs due to an increase in cell frequency in the presence of a malignant mass. The apparent diffusion coefficient (ADC) is a quantitative measure of the diffusion of water molecules within tissue. Using the data in various b-values obtained from DWI in MRI, ADC maps are created and ADC values of lesions can be calculated (8,9). Recent studies showed that DWI and ADC measurements had high rates of accuracy and specificity in the differential diagnosis of malignant and benign breast lesions (10-13).Breast cancer is a heterogeneous disease, and its natural course after diagnosis varies among patients. In the follow-up of patients with tumors of the same diameter, some experience tumor recurrence after a very short time, whereas others continue living a healthy life. Therefore, prognostic factors and molecular subgroups are used in order to determine differences between clinical and biologic behaviors of patients with breast cancer and establish the high-risk group, which demonstrates a quick disease progression (14-17). Although some of these factors (tumor diameter, axillary involvement, histologic characteristics of tumor, hormone receptors) have a well-known role in determining prognosis, there is ongoing intensive research regarding hormone receptors, tumor proliferation rate, and molecular prog- Breast Health 2016; 12: 123-132 DOI: 10.5152/tjbh.2016 12: 123-132 DOI: 10.5152/tjbh. .2897 123 ABSTRACT Objective: The aim of this study was to evaluate the effect of the apparent diffusion coefficient (ADC) and diffusion-weighted imaging in differentiating benign from malignant breast lesions, histopathologic subtypes of breast tumors, and to find a correlation with prognostic factors using 3T MR. Materials and Methods:A total of 165 patients aged between 16 and 78 years with 181 histopathologically-verifed breast lesions were enrolled in this study. A 3T MR system and bilateral phased array breast coil was used. Diffusion-weigh...
Although the prevalence of urolithiasis is nearly 2-3% in childhood, the risk of recurrence may range from 6.5-54%. There has been an increase in urinary stone disease among pediatric age groups, and stone disease has a multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to comorbidities such as loss of kidney function. Following diagnosis, the requirement for surgery, such as stone extraction and correction of anatomical anomalies, is determined. Medical and supportive treatments are also needed to prevent recurrence and urinary tract infections and to preserve renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment is dependent on the cause of the urinary stone disease. The morbidities associated with pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow-up and medical treatment protocols.
Introduction: The aim of this study is to determine the coinfections with other respiratory pathogens in SARS-CoV-2 infected children patients in a pediatric unit in Istanbul. Methodology: This retrospective descriptive study was conducted in a 1000-bedded tertiary education and research hospital in Istanbul. All children hospitalized with the diagnosis of SARS-CoV-2 infection had been investigated for respiratory agents in nasopharyngeal secretions. Laboratory confirmation of SARS-CoV-2 and the other respiratory pathogens were performed using reverse transcriptase-polymerase chain reaction (RT-PCR). Results: A total of 209 hospitalized children with suspected SARS-CoV-2 infection between March 2020-May 2020 were enrolled in this study. Among 209 children, 93 (44.5%) were RT-PCR positive for SARS-CoV-2 infection, and 116 (55.5%) were RT-PCR negative. The most common clinical symptoms in all children with SARS-CoV-2 infection were fever (68.8%) and cough (57.0%). The other clinical symptoms in decreasing rates were headache (10.8%), myalgia (5.4%), sore throat (3.2%), shortness of breath (3.2%), diarrhea (2.2%) and abdominal pain in one child. In 7 (7.5%) patients with SARS-CoV-2 infection, coinfection was detected. Two were with rhinovirus/enterovirus, two were with Coronavirus NL63, one was with adenovirus, and one was with Mycoplasma pneumoniae. In one patient, two additional respiratory agents (rhinovirus/enterovirus and adenovirus) were detected. There was a significantly longer hospital stay in patients with coinfection (p = 0.028). Conclusions: Although the coinfection rate was low in SARS-CoV-2 infected patients in our study, we found coinfection as a risk factor for length of hospital stay in the coinfected patient group.
Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis of childhood and young adolescence due to persistent measles virus infection of the central nervous system. In majority of cases onset occurs from 5-15 years of age. In a nonimmunized population the average onset is 8 years. Children with SSPE had experienced natural infection with the rubeola virus at an early age, half before age 2 years. SSPE generally occurs 5-10 years after measles infection. In the early stages of the disease behavioral and personality changes is followed by myoclonic jerks and convulsions. In late stages dementia, stupor and coma develops. Diagnosis is achieved by typical clinical findings, measles antibody titer increase in cerebrospinal fluid (CSF) and serum, high amplitude, slow, sharp waves in EEG. Prognosis is poor and death ensues in about 3 yr after the diagnosis. Here it is presented a 7-years-old boy with involuntary movements in both hands, drop attacks while walking, ataxia and stupor. Due to suggestive radiological and clinical findings and a history of recent mumps infection he was thought to have acute disseminated encephalomyelitis initially and given treatment. But due to clinical deterioration and detection of anti measles IgG in serum and CSF, SSPE diagnosis was confirmed. With this SSPE case presenting initially as ADEM, the authors tried to emphasize that presentation of SSPE may clinically and radiologically be diverse and a thorough differential diagnosis is mandatory for a definite diagnosis.
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