Ophthalmic Manifestations of Multisystem Inflammatory Syndrome in Children

Objective The aims of this study were to determine the prevalence and clinical features of ophthalmic involvement in multisystem inflammatory syndrome in children (MIS-C) and to evaluate its association with other organ system involvement and the severity of the disease.Methods The demographic data and information on the ophthalmologic and other systemic organ manifestations, laboratory findings, treatment modalities, and clinical outcomes of 97 patients with MIS-C were retrospectively obtained from their hospital records. Sixty-two patients with MIS-C who were examined by ophthalmologists were included in the study. Statistical analysis was performed using R version 3.6.0, and a p- value < 0.05 was accepted as statistically significant.Results The patients' median age was 82 months (range, 11-204 months). Of the patients, 62.9% were male. The most common systemic involvements were mucocutaneous (83.9%) and cardiovascular (82.3%). Kawasaki disease was clinically observed in 71% of the patients (incomplete form, 53.2%). Ophthalmic involvement was observed in 39 patients (62.9%). Thirty-two patients (51.6%) had conjunctival hyperemia;29 (48.4%) lid edema;7 follicular conjunctivitis;3 uveitis;2 subconjunctival hemorrhage;and 1 episcleritis. The patients with ophthalmic involvement were 6.4 times (95% confidence interval [CI], 1.49-27.48;p = 0.013) more likely to exhibit cardiac involvement and 3.53 times (95% CI, 1.35-9.63;p = 0.012) more likely to have severe disease.Conclusion Conjunctival hyperemia, lid edema, and follicular conjunctivitis were observed in at least half of the patients with MIS-C, and those with ophthalmic involvement had a higher risk of cardiac involvement or severe disease.

X-linked agammaglobulinemia presenting with pseudomonas skin abscesses: A case report

Introduction : The skin may be involved in inborn errors of immunity (IEI) and serve as important clues for diagnosis. We report a boy presented with subcutaneous abscesses caused by Pseudomonas aeruginosa and diagnosed as X-linked agammaglobulinemia (XLA). Case Report : A 13-months-old boy patient was referred to our immunology clinic with a history of recurrent fever and skin lesions resistant to conventional therapies on his limbs and cyclic neutropenia. He was the first child of consanguineous parents. His past medical history revealed that he had been suffering from recurrent otitis media, sinopulmonary infections, and conjunctivitis since the age of four months. He was hospitalized with a diagnosis of otitis media, and his fever persisted despite the given antibiotic treatment. Skin abscesses on his extremities occurred and were drained. On physical examination, there were a total of 16 erythematous, hemorrhagic subcutaneous nodules with central black eschar. His tonsils were rudimentary. Peripheral blood sampling showed a white blood cell count 41.3 × 109 /L with 52.3 × 109 /L neutrophils, 33.1 × 109 /L lymphocytes, %2.6 × 109 /L eosinophils, hemoglobin 9.9 g/L, and a platelet count of 397 × 109 /L. Sedimentation 18 mm/h. COVID-19 real-time PCR was negative. His immunological screening revealed that agammaglobulinemia and absence of B cells, consistent with X-linked agammaglobulinemia (Table 1). BTK gene sequence analysis showed the presence of a BTK:c.404-406delACA and BTK:c.407-408insCTTTA hemizygous mutations. To our knowledge, it has never been described before that the compound heterozygosity of these mutations causes X-linked agammaglobulinemia. These variants were classified as likely pathogenic according to the ACMG guidelines and confirmed as XLA. His mother is the carrier. Pseudomonas aeruginosa was isolated in his abscess cultures. Abscess lesions on the right and left leg were drained again, but they repeated. Hereby, the abscess lesions and subcutaneous nodules were evacuated by plastic surgery, and the daily dressing was done with silver material. In the follow-up, the skin lesions improved gradually. The patient was discharged with immunoglobulin replacement therapy and prophylactic antibiotic. Conclusion : Pseudomonas skin infection is common among IEIs, especially patients with neutropenia. XLA should be kept in mind in the evaluation of unexplained cyclic neutropenia and skin abscess resistance to therapy. (Table Presented).

Education of healthcare personnel working with pediatric patients during covid-19 pandemic within the framework of infection control

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

Education of Healthcare Personnel Working with Pediatric Patients During COVID-19 Pandemic within the Framework of Infection Control

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n=4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.