Aim: COVID-19 is a pandemic that causes high morbidity and mortality, especially in severe patients. In this study, we aimed to search and explain the relationship between biochemical markers, which are more common, easily available and applicable to diagnose and to stage the disease. Materials & methods: In this study, 609 patients were evaluated retrospectively. 11 biochemical parameters were included in analysis to explain the relationship with severity of disease. Results: Nearly, all the parameters that have been evaluated in this study were statistically valuable as a predictive parameter for severe disease. Areas under the curve of blood urea nitrogen (BUN)/albumin ratio (BAR), CALL score and lymphocyte/C-reactive protein ratio were 0.795, 0.778 and 0.770. The BUN/BAR and neutrophil/albumin ratios provide important prognostic information for decision-making in severe patients with COVID-19. Conclusion: High BUN/BAR and neutrophil/albumin ratios may be a better predictor of severity COVID-19 than other routinely used parameters in admission.

Abstract IntroductionIn this study, we compare the predictive value of clinical scoring systems that are already in use in patients with COVID-19, including the BCRSS, qSOFA, SOFA, MuLBSTA and HScore, for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians.Materials and MethodsWe classified the patients into two groups according to the stage of the disease (severe and non-severe) by using the slightly modified and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 hours.ResultsOf the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR: 6.1, 95% CI: 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR: 4.757, 95% CI: 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively.ConclusionCalculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. With early identification of the high-risk group using BRCSS and qSOFA, early interventions for high-risk patients can improve clinical outcomes in COVID-19.

Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and nonsevere cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters. Materials and methods: In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio, neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (nonsevere or severe). Results: The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters. Conclusion: Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups.

In this study, we compare the predictive value of clinical scoring systems that are already in use in patients with Coronavirus disease 2019 (COVID-19), including the Brescia-COVID Respiratory Severity Scale (BCRSS), Quick SOFA (qSOFA), Sequential Organ Failure Assessment (SOFA), Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age (MuLBSTA) and scoring system for reactive hemophagocytic syndrome (HScore), for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians. We classified the patients into two groups according to the stage of the disease (severe and non-severe) and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 h. Of the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR 6.1, 95% CI 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR 4.757, 95% CI 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively. Calculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. Our prediction is that early interventions for high-risk patients, with early identification of high-risk group using BRCSS and qSOFA, may improve clinical outcomes in COVID-19.

Background: The Coronavirus (COVID-19), (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)) has been spreading worldwide since its first identi- fication in China. It has been speculated that patients with comorbidities and elderly patients could be at high risk for the pandemic reasoned respiratory insufficiency and death. At first, it was thought that the patients who use immunmodulator therapy could be even at higher risks of disease complications. However, it has been also speculated about that using immunmodulators could be an advantage for the clinical prognosis. Therefore, several immunmodulators are currently being tested as potential treatment for COVID-19. Methods: In this paper we report on a patient that has been treated with type 1 interferon for multiple sclerosis who developed COVID-19. Results: Despite using immunmodulator, the symptoms of the patient at hospitalization were mild and he did not show elevated D-dimer, and there was no lymphopenia. He was discharged to home-quarantine with no symptoms. Discussion: This report supports the idea of using type 1 interferon in the treatment could be effective in COVID-19 affected patients.

Objectives: To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. Design: The prospective observational multicenter cohort study was conducted at 15 hospitals. Data were being collected from November 2013 to June 2014, with two designated researchers from each center responsible for follow-up and data entry. Setting: Fifteen tertiary PICUs in Turkey. Patients: Patients between 1 month and 18 years old requiring conventional mechanical ventilation for greater than 48 hours were included. A single-center was not permitted to surpass 20% of the total sample size. Patients with no plans for conventional mechanical ventilation weaning were excluded. Interventions: Conventional mechanical ventilation Measurements and Main Results: Pertinent variables included PICU and patient demographics, including clinical data, chronic diseases, comorbid conditions, and reasons for intubation. Conventional mechanical ventilation mode and weaning data were characterized by daily ventilator parameters and blood gases. Patients were monitored until hospital discharge. Of the 410 recruited patients, 320 were included for analyses. A diagnosis of sepsis requiring intubation and high initial peak inspiratory pressures correlated with a longer weaning period (mean, 3.65 vs 1.05-2.17 d; p < 0.001). Conversely, age, admission Pediatric Risk of Mortality III scores, days of conventional mechanical ventilation before weaning, ventilator mode, and chronic disease were not related to weaning duration. Conclusions: Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration.

Gemcioglu, Emin MD; Erden, Abdulsamet MD; Davutoglu, Mehmet MD; Karabuga, Berkan MD; Kucuksahin, Orhan MD Author Information

Dear Editor At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, China, and it spread quickly to other countries. This has led to a pandemic that has spread throughout most countries of the world in 2020. A wide variety of symptoms and signs can be seen in coronavirus disease 2019 (COVID-19) infection, such as fever, coughing, shortness of breath, arthralgia, muscle pain and diarrhea. COVID-19 infection may show clinical or laboratory features that are similar to those of a variety of diseases. For example, it is difficult to distinguish dengue and COVID-19 because they have shared clinical and laboratory features.1,2 In a case report from Singapore, two patients with false-positive results from rapid serological testing for dengue, who were later confirmed to have severe acute respiratory syndrome COVID-19 infection, were reported.3 Brucellosis is the most common zoonosis worldwide and is a significant public health problem in many developing countries such as our country, Turkey.4 Brucellosis typically presents with fever, malaise and arthralgia.5 Common symptoms of COVID-19, such as fever, myalgia or arthralgia, can also be seen in brucellosis. The laboratory findings of these infections may be similar. Thrombocytopenia and leukopenia are common in COVID-19 and can also be seen in brucellosis. When there is a suspicion of brucellosis, the Rose Bengal test is recommended as the first test. This is a plaque agglutination test with high sensitivity that is easy to apply, has low cost and provides qualitative results. Therefore, it is frequently used as a screening test in human brucellosis cases. For this reason, we performed the Rose Bengal test on patients with COVID-19 presenting fever and arthralgia, because our country is within the endemic region for brucellosis. In our tertiary-level medical facility, the patients received their diagnoses either through a positive polymerase chain reaction (PCR) for SARS-CoV-2 or through fulfilling three clinical criteria, including having fever and/or respiratory symptoms, compatible chest imaging findings and decreased lymphocyte count.6 We questioned the patients in our case series to ascertain any history of brucellosis, but found that none of them had any history relating to brucellosis or other zoonotic diseases. In eight of these patients, Rose Bengal tests were positive. These results are provided in Table 1. The median age of these eight patients was 58.5 years, and five of them were female. Arthralgia and fatigue were present in all eight patients; fever and cough were present in seven (87.5%). No patient had anosmia, ageusia, abdominal pain or diarrhea. Fourteen days after treatment for COVID-19, we performed the Rose Bengal test on all patients again, and its positivity became negative. The Rose Bengal test may sometimes give a false-positive result. Various antigens obtained from Brucella melitensis and Brucella abortus are generally used in serological tests. Among these, the most widely used antigen is smooth lipopolysaccharide (S-LPS). The Rose Bengal test detects S-LPS-specific immunoglobulin M (IgM), immunoglobulin G (IgG) and immunoglobulin A (IgA) antibodies. However, this test lacks specificity to discriminate the false-positive serological reactions caused by bacteria (especially Gram-negative bacteria) sharing S-LPS epitopes with Brucella.7, 8 It has been shown that the Rose Bengal test might have cross-reactivity with certain bacteria, including are Francisella tularensis, Afipia, Escherichia hermannii, Stenotrophomonas maltophilia, Yersinia enterocolitica, Escherichia coli, Salmonella urbana, Vibrio cholerae and others.9-11 Other IMD. Physician, Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey. orcid.org/0000-0001-9751-8452

OBJECTIVE:Elemental mercury is a toxic liquid element that is used widely in the home, medicine, agriculture, and industry. It is readily vaporized and inhaled at room temperature. Thereby, inhalation can cause acute or chronic poisoning. Mercury can be found in environmental naturally find but some dangers sources give rise to contaminations. It can be very dangerous to all living organisms, especially children.METHODS:This study presents the features of mercury poisoning in a group of pediatric cases. Data were obtained for 29 pediatric cases exposed to elemental mercury in a high school chemistry laboratory in Turkey. Patients with a blood mercury level exceeding 10 μg/L or a urine mercury level exceeding 15 μg/L were considered to have mercury poisoning. The patients were treated with 2,3-dimercaptopropane sulfonic acid or D-penicillamine.RESULTS:Twenty-nine children with mercury poisoning were admitted to the hospital. The median duration of exposure was 58 (range, 15-120) minutes. Ten (29%) children were asymptomatic. Physical and neurological examinations were normal in 19 (65.5%) children. The most common presenting complaint was headache. The most common neurological abnormality, partly dilated/dilated pupils, was present in 9 (31%) children. Mercury levels were measured in blood samples every 5 days, and the median blood mercury level was 51.98 (range, 24.9-86.4) μg/L. There was a positive correlation between the duration of exposure and maximum blood/urine mercury levels (P = 0.001).CONCLUSIONS:Elemental mercury exposure is potentially toxic; its symptomatology varies, especially in children. Secure storage of mercury and other toxic substances and provision of information about this subject to individuals who might be exposed to mercury and their families might help to prevent mercury poisoning.

Purpose Although influenza primarily affects the respiratory system, in some cases, it can cause severe neurological complications. Younger children are especially at risk. Pediatric literature is limited on the diagnosis, treatment, and prognosis of influenza-related neurological complications. The aim of the study was to evaluate children who suffered severe neurological manifestation as a result of seasonal influenza infection. Methods The medical records of 14 patients from six hospitals in different regions of the country were evaluated. All of the children had a severe neurological manifestations related to laboratory-confirmed influenza infection. Results Median age of the patients was 59 months (6 months—15.5 years) and nine (64.3%) were male. Only 4 (28.6%) of the 14 patients had a comorbid disease. Two patients were admitted to hospital with influenza-related late complications, and the remainder had acute complication. The most frequent complaints at admission were fever, altered mental status, vomiting, and seizure, respectively. Cerebrospinal fluid (CSF) analysis was performed in 11 cases, and pleocytosis was found in only two cases. Neuroradiological imaging was performed in 13 patients. The most frequent affected regions of nervous system were as follows: cerebellum, brainstem, thalamus, basal ganglions, periventricular white matter, and spinal cords. Nine (64.3%) patients suffered epileptic seizures. Two patients had focal seizure, and the rest had generalized seizures. Two patients developed status epilepticus. Most frequent diagnoses of patients were encephalopathy ( n = 4), encephalitis ( n = 3), and meningitis ( n = 3), respectively. The rate of recovery without sequelae from was found to be 50%. At discharge, three (21.4%) patients had mild symptoms, another three (21.4%) had severe neurological sequelae. One (7.1%) patient died. The clinical findings were more severe and outcome was worse in patients <5 years old than patients >5 years old and in patients with comorbid disease than previously healthy group. Conclusion Seasonal influenza infection may cause severe neurological complications, especially in children. Healthy children are also at risk such as patients with comorbid conditions. All children who are admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications even if their respiratory complaints are mild or nonexistent.

Drowning is defined as a situation which results in the death of the patient within the first 24 hours, while “near-drowning” refers to all conditions of submersion which does not cause death but brings about morbidity and damaging effects. A twenty-five-month-old boy was found immobile in a bathtub filled with water. The patient was transported to the intensive care unit from the emergency department where he vas ventilated with a bag-mask, then intubated, and diagnosed with respiratory insufficiency, and his respiration was supported by mechanical ventilator. Physical examination of the patient showed that he was hypothermic, not breathing spontaneously, his heart rate was 120/min., blood pressure 100/80 mmHg, he was unconscious, and Glasgow Coma scale was 5. The first blood analysis results were mmol/L. The pulmonary edema regressed, cardiopulmonary hemodynamic returned to normal. Then, at the 48th hour he was weaned from mechanical ventilator support. The patient was discharged from the hospital in good health, without negative cognitive and motor symptoms on the 10th day. The present case report aimed to highlight the importance of basic and advanced life support in cases of near-drowning which happens frequently among children, and to discuss the management of pulmonary edema and other complications.

Olgu Sunumu / Case Report Non-ketotik hiperglisinemi (NKH) otozomal resesif geçiş gösteren serumda ve özellikle beyin omurilik sıvısında glisinin aşırı birikimi ile karakterize nadir görülen, yaşamı tehdit eden doğuştan bir metabolik hastalıktır.Üç aylık kız çocuğu emmeme, solunum yetmezliği ve sık tekrarlayan nöbet geçirme yakınmalarıyla yoğun bakım ünitesine

Introduction: The purpose of this study was to retrospectively evaluate patients admitted to the pediatric intensive care unit in order to determine the mortality data of our clinic and to identify the risk factors that affect mortality. Methods: The data of 454 patients aged 1 month-18 months hospitalized for more than 24 hours at the pediatric intensive care unit between December 1, 2013, and June 30, 2015 were retrospectively evaluated by using the hospital records. Results: Of the 454 patients included in the study, 220 patients (48.5%) were female and 234 were male (51.5%). The most common reason for admission to the pediatric intensive care unit was respiratory system diseases (110 patients, 24.2%). A total of 213 (46.9%) patients had also a concurrent chronic disease during their stay at the pediatric intensive care unit. One hundred thirty four (29.5%) of the patients required mechanical ventilation, and the average duration of mechanical ventilation was 13 days (1-114). Thirty (22.3%) of these patients were identified as having developed complications related to mechanical ventilation. The mortality rate was found to be higher in patients requiring vasoactive drug support (p<0.05). However, the presence of chronic disease was found to have higher effect on mortality than the need for vasoactive drug support (p<0.05). According to the evaluation of the mortality scoring, the Pediatric Risk of Mortality (PRISM) score of patients who died was statistically higher (9.1±7.6) than that of other patients (p<0.001). It was determined that mortality rate was significantly increased in patients requiring blood and blood products (p<0.01). The mortality rate at our pediatric intensive care unit was determined as 15.6%. Conclusion: Logistic regression analysis of the factors that affect mortality indicated that the need for mechanical ventilation support, higher PRISM scores, and the need for blood/blood product transfusions statistically significantly increased the mortality rate.

Chylothorax is caused by the distruption or obstruction of the thoracic duct or its tributaries that result in leakage of chyle into the pleural space. A 3.5-year-old male patient without significant past medical history was admitted to the outpatient clinic of our hospital with persistent coughing. The initial chest radiograph demonstrated consolidation and effusion in the left lung upon which we performed thoracentesis. The pleural fluid had milk-white color. The biochemical analysis showed that its density was 1015 with pH: 7, glucose: 168 mg/dl, triglyceride: 2101 mg/dl, and WBC: 590/mm3. We started the treatment by offering a low-fat diet and somatostatin 3 μgr/kg/h. The chest tube was removed on the 25th day after the cessation of chylous pleural fluid from the tube in addition to the improvement that was visible on the chest radiograph; the patient was discharged. We would like to emphasize that chylothorax may occur very rarely but spontaneously and the use of somatostatin therapy may reduce the need for surgical intervention

Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. Gastro-intestinal involvement occurs in two-thirds of patients. The characteristic skin lesions generally precede abdominal symptoms or present concurrently. A 7-year-old boy presented with intussusception and acalculous cholecystitis and had a cholecystectomy. Two weeks later he was re-admitted with features typical of HSP which responded to corticosteroids. Eleven months later he presented with abdominal pain and recurrence of HSP and, at laparotomy, there was acute appendicitis. This is the first case of a child presenting with HSP complicated by acalculous cholecystitis.

Familial Mediterranean fever (FMF) is defined as an inherited and autosomal recessive disease. Many researches have been done about this subject, and we believe that it should be necessary to focus on phenotype-genotype correlation, especially novel mutation types. We aim to announce the results of FMF sequence analysis in Kahramanmaras/Turkey. The number of participants is 380 males and 451 females who clinically diagnosed as FMF subjects of different age groups. Genomic sequences of exons 2 and 10 and in some cases exon 3 of the MEFV gene were scanned for mutations by sequence analyzer. The most common mutation identified in 230 (57.07 %) patients is heterozygous. The frequencies of mutation types in heterozygous subjects are R202Q (39.13 %), E148Q (18.70 %), M680I (16.52 %), M694V (13.91 %), and V726A (4.78 %), respectively. The most striking point among the compound heterozygous subjects is R202Q/M694V mutation type found at the highest rate (32 subjects). Fever and peritonitis are the most frequent signs of homozygous M694V and combine heterozygous mutations. Interestingly, the rate of homozygous mutation types (M694V/M694V+ R202Q/R202Q) is 96.70 % among all compound homozygous mutation types. The most frequent rate of homozygous patients is M680I mutation types (68.42 % in all homozygous mutation types). Two novel mutations were found in this study: N206K (p.Asn206Lys) and S208T (p.Ser208Tyr). Our findings in this study on the FMF sequence analysis are different from the results obtained from the other regions of Turkey.

Şilotoraks, duktus torasikus ya da dallarinin bozulmasi ya da tikanikligina bagli olarak plevral araliga siloz sivinin sizmasidir. Oncesinde herhangi bir yakinmasi bulunmayan 3,5 yasinda erkek hasta, oksuruk ve hiriltili solunum sikayetleriyle basvurdu. Akciger grafisinde sol akcigerde konsolidasyon ile birlikte plevral efuzyon saptandi. Kapali sualti drenaja alinan hastanin efuzyon sivisinin gorunumu sut beyaz renkte, pH 7, dansite 1015, trigliserit 2101 mg/dl, glikoz 168 mg/dl, lokosit 590 mm3 bulundu. Plevral efuzyon sivisi kulturunde ureme olmadi. Bu bulgularla hastaya silotoraks tanisi konuldu. Yagdan fakir diyetle birlikte somatostatin 3 μgr/kg/saat baslandi. Somatostatin tedavisine 2 hafta devam edilen hasta 25. gunde toraks tupu cikarilarak taburcu edildi. Şilotoraksin cok nadiren de olsa spontan gerceklesebilecegi, tedavide somatostatin kullaniminin cerrahi mudahale ihtiyacini azaltabilecegi vurgulandi.

Background and aims: Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity characterized by headache, visual disturbances, seizures, and the presence of edema on MRI scan, predominantly in the posterior white matter. We wanted to refer to a patient diagnosed PRES. Aims: We wanted to refer to a patient diagnosed PRES. Methods: 15 years old female patient. FMF, FMF depending on the amyloidosis and amyloidosis patients with renal failure receiving hemodialysis was started three months ago. Admitted to hospital before nausea, vomiting, headache going on 6–8 hours after the onset of complaints in the eyes blinking, twitching at the corners of the mouth in the form of 1–2 minutes duration was admitted to our emergency department patients with seizures. GCS: 12 that fluctuations in consciousness, arterial pressure 177/150 mmHg in patients as measured by cranial CT scans were obtained. Right parieto, parietosuperi and parietoposteri observed hypodense areas in the region to press the patients with a diagnosis of acute encephalopathy was admitted to the intensive care pediatrics. Emergency and after hemodialysis patients held antihypertensive therapy, cranial MR were taken. Results: As a result of the etiological processes that many PRESS heterogeneous disease. Conclusions: In this report: We wanted to emphasize in a patient with amyloidosis associated kidney failure PRES development.