Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9–12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × μL, p = 0.028; platelet count 166 vs. 216 cells × 10 3 /μL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% ( p < 0.001, 95% CI 0.217–0.550), lethargy increased the risk of overlap with KD by 2.6-fold ( p = 0.011, 95% CI 1.244–5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% ( p < 0.001, 95% CI 0.298–0.559). Conclusion : Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD. What is Known: • In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C. What is New: • Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C pa...

Objective:Murmurs are abnormal audible heart sounds produced by turbulent blood flow. Therefore, murmurs in a child may be a source of anxiety for family members. Families often use online materials to explore possible reasons for these murmurs, given the accessibility of information on the Internet. In this study, we evaluated the quality, understandability, readability, and popularity of online materials about heart murmur.Methods:An Internet search was performed for “heart murmur” using the Google search engine. The global quality score (on a scale of 1 to 5, corresponding to poor to excellent quality) and Health on the Net code were used to measure the quality of information presented. The understandability of the web pages identified was measured using the Patient Education Materials Assessment Tool (score range from 0 to 100%, scores below 70% reflect poor performance). The readability of each web pages was assessed using four validated indices: the Flesch Reading Ease Score, the Flesch–Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook. The ALEXA traffic tool was used to reference domains’ popularity and visibility.Results:We identified 230 English-language patient educational materials that discussed heart murmur. After exclusion, a total of 86 web pages were evaluated for this study. The average global quality score was 4.34 (SD = 0.71; range from 3 to 5) indicating that the quality of information of most websites was good. Only 14 (16.3%) websites had Health on the Net certification. The mean understandability score for all Internet-based patient educational materials was 74.6% (SD = 12.8%; range from 31.2 to 93.7%). A score suggesting these Internet-based patient educational materials were “easy to understand”. The mean readability levels of all patient educational materials were higher than the recommended sixth-grade reading level, according to all indices applied. This means that the level of readability is difficult. The average grade level for all web pages was 10.4 ± 1.65 (range from 7.53 to 14.13). The Flesch–Kincaid Grade level was 10 ± 1.81, the Gunning Frequency of Gobbledygook level was 12.1 ± 1.85, and the Simple Measure of Gobbledygook level was 9.1 ± 1.38. The average Flesch Reading Ease Score was 55 ± 9.1 (range from 32.4 to 72.9).Conclusion:We demonstrated that web pages describing heart murmurs were understandable and high quality. However, the readability level of the websites was above the recommended sixth-grade reading level. Readability of written materials from online sources need to be improved. However, care must be taken to ensure that the information of web pages is of a high quality and understandable.

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Introduction Localized tetanus is a rare form of tetanus that can progress to generalized tetanus. Case In this report, we present a case of localized tetanus in a 9-year-old boy who had never been vaccinated against tetanus. He had an interesting clinical presentation and was successfully treated. Discussion This case is the first case reported in the literature that is characterized by tetanus localized in the chest, abdomen and back muscles. This clinical condition of tetanus being localized only in the trunk without the involvement of the head and extremities is so characteristic that it can be described as ‘truncal tetanus’. Conclusion Localized tetanus can be found in many different parts of the body, depending on location of the injury. Owing to the risk of progression to generalized tetanus, it is important to obtain a full history and perform careful physical examination for an early and accurate diagnosis.

Aim This study aimed to compare chest computed tomography (CT) findings with reverse‐transcription polymerase chain reaction (RT‐PCR) test results in children with probable or definitive diagnosis of coronavirus disease 2019 (COVID‐19). Methods In this retrospective archive study, pediatric patients who were followed up in the hospital with a possible or definitive diagnosis of COVID‐19 and who had chest CT at presentation were included. CT scan images of the patients were reinterpreted by a pediatric radiologist and compared with their RT‐PCR test results. Results Of the total of 89 patients, 33 had negative and 56 had positive RT‐PCR tests. The presence of pulmonary lesions and consolidation was statistically significantly higher in the RT‐PCR negative group than in the RT‐PCR positive group ( p = 0.037 and 0.001, respectively). Lobe involvement of 0%–25% was higher in the RT‐PCR positive group ( p = 0.001), and lobe involvements of 25%–50% and 50%–75% were significantly higher in the RT‐PCR negative group ( p = 0.001 and 0.005, respectively). Central and perihilar involvement was found to be statistically significant in the RT‐PCR negative group ( p = 0.008 and 0.005, respectively). Conclusion Chest CT findings may provide some clues in predicting RT‐PCR positivity in children with a probable diagnosis of COVID‐19. Lobe involvement percentage of up to 25% is a finding in favor of patients with positive RT‐PCR test, whereas 25%–75% lobe involvement, central and perihilar involvement, and consolidation can be interpreted in favor of patients with negative RT‐PCR test.

Introduction Tetanus is a preventable infectious disease with vaccination. Cephalic tetanus is the rarest form in which local tetanus can involve the cranial nerves. Case Herein, we report a case of cephalic tetanus in a 16-month-old girl who had never been vaccinated. The patient, who had a complaint of a wound on the cheek mucosa for 2 weeks, was seen playing with the soil in the garden 1 week ago and was found to have abundant soil removed by her mother. The patient was diagnosed as cephalic tetanus according to her complaints and clinical findings. Discussion We believe that, this is the first case reported in the literature of cephalic tetanus in such a young child wherein the disease focus of infection from a wound on the cheek mucosa. The symptom we defined as ‘a child who cries when she smiles’ presented in this case could only be associated with this disease. Conclusion In addition to detailed anamnesis and meticulous physical examination, the clinical symptoms that we have described for the first time in a child with cephalic tetanus should also be considered for early and accurate diagnosis.

Objective This study aimed to compare the readability and the contents of the patient information texts regarding vaccination on Turkish Internet sites. Material and Methods Websites were searched in the Google search engine using the keywords “what is vaccination?” “benefits of vaccination,” “harms of vaccination,” and “side effects of vaccination” in May 2018. Readability was determined using Ateşman and Bezirci–Yilmaz formulas. According to Ateşman readability formula, the higher the readability of a text, the easier it can be read. Readability of “health-care professional” websites was compared with that of “non–health-care professional” websites. The content of the websites was analyzed by two pediatricians. Results After the exclusion of the website not fulfilling the criteria, 44 websites, of which 20 were created by health-care professionals and 24 by non–health-care professionals, were evaluated. Ateşman readability scores were 53.62 ± 14.27 and 54.30 ± 8.60 for websites created by health-care professionals and non–health-care professionals, respectively. Mean readability level was “moderately difficult” for both groups according to Ateşman formula, and there was no significant difference between the two groups (p = 0.83). Mean readability level was categorized as at “secondary-high school” with Bezirci–Yilmaz readability formula, and there was no significant difference between the two groups (p = 0.68). The percentage of the contents of websites prepared by health-care professionals was found to be significantly higher when compared with non–health-care professionals (p = 0.04). Conclusion It was found that the readability of the patient information texts in the web pages related to vaccination was moderately difficult and that the text content was insufficient. To improve the readability, short sentences should be prepared by health-care professionals with few words and syllables. Existing texts should be revised in the light of current information.

Purpose: The aim of this study was to compare the effects of hyperbaric oxygen therapy (HBOT) induced hyper-oxygenation and normobaric oxygen therapy (NBOT) on myocardial repolarisation parameters in children with carbon monoxide (CO) poisoning. Materials and Methods: This prospective study included 77 girls and boys aged 0–18 years who were diagnosed and treated for CO poisoning. There were no changes in the routine clinical evaluation and treatment practices of patients. Patients who received NBOT (n=40) and HBOT (n=37) were divided into two groups. These groups were compared in terms of their demographic characteristics, carboxyhaemoglobin, lactate, troponin levels and myocardial repolarisation parameters of electrocardiography (ECG) (Tp-e interval, Tp-e dispersion, QTc and Tp-e/QTc ratio). Results: There were no significant intergroup differences in terms of carboxyhaemoglobin, lactate and troponin levels at the time of admission; admission and post-treatment Tp-e, Tp-e dispersion, corrected QTc and TPe/QTc ratio and post-treatment change rates of each ECG parameter. Conclusion: There was no intergroup difference in terms of repolarisation parameters of ECG in children with CO poisoning. The possible reason for this may be myocardial reperfusion damage due to hyper-oxygenation associated with HBOT therapy.