2023 catastrophic Turkey earthquake: clinical outcomes of pediatric patients rescued under the rubble.

OBJECTIVES: Children are the most vulnerable population affected by the earthquake. We aimed to examine the characteristics, morbidity, mortality, and the factors affecting these pediatric earthquake victims to guide the follow-up of pediatric patients who were rescued under the rubble in possible future disasters. METHODS: This is a retrospective observational study. The files of pediatric earthquake victims aged 0-18 years who were admitted to Adana City Training and Research Hospital between 6 February-30 April 2023 were analyzed. 318 patients were included in the study. RESULTS: Of all patients 48.7% (n = 155) were female and 51.3% (n = 163) were male. The mean age of the patients was 114.8 months. 65.4% (n = 208) of the patients were discharged from our hospital, eighteen patients (5.7%) died. Information on the hour when the patients were rescued under the rubble could be reached in 117 (36.8%) patients. The mean rescue time of these patients was 50.5 hours. 62 (53%) victims were rescued in the first 24 hours after the earthquake. There were 111 patients (34.9%) with fractures. There were 118 patients (37.1%) who underwent fasciotomy surgery. The total number of patients with amputation was 48 (15.1%). There were 36 patients (11.3%) with one limb amputated, 12 patients (%3.7) with more than one limb amputation. Internal organ injury was present in 30.5% (n = 97) of the patients. Of these patients, 85.6% (n = 83) had single organ trauma and 14.4% (n = 14) had multiple organ trauma. There were 58 patients (18.2%) with acute renal failure in follow-up. The mean rescue time for patients with amputation was 83.65 ± 62.9 hours, and for patients without amputation was 36.44 ± 50.6 hours. This difference was statistically significant (p = 0.001). No statistically significant difference was found when the ages of the patients were compared to fasciotomy, amputation, and fracture status. CONCLUSION: While evaluating earthquake-induced trauma, pediatric patients should be approached carefully.

Impacts of intelligent monitoring technology installation and additional modalities on hand hygiene compliance in a burn center: A quasi-experimental longitudinal trial.

BACKGROUND: The increasing development of intelligent technologies for hand hygiene (HH) compliance audit has the potential to create an alternative to direct observation (DO), which is still considered the gold standard but has disadvantages such as lack of standardized monitoring practices, Hawthorne effect, insufficient sample size, and time/resource consumption. We aimed to share our preliminary results on the impacts of intelligent monitoring technology installation (IMTI) and additional modalities on healthcare workers' (HCWs') HH compliance in a Burn Center, according to the "5 Moments of HH" concept defined by the World Health Organization (WHO). METHODS: A quasi-experimental longitudinal trial was conducted over eleven months.The first phase of the three-stage study evaluated basic HH compliances obtained by DO. The system-defined HH performances, which IMTI recorded, were assessed in the second phase. Finally, the effect of IMTI and additional modalities was determined in the third stage. RESULTS: 15202 HH events were performed by 41 HCWs, and a total of 20095 HH opportunities were observed. Four hundred fifty-five opportunities were in the preinstallation phase, and 19640 were during the total post-installation period. IMTIdefined performance rates in both Phase 2 (71.2%) and Phase 3 (80.5%) were generally considerably higher than HH compliances obtained from DO (58.5%). Nurses, physical therapy /anesthesia technicians, and housekeeping personnel showed significant increases, which was insignificant in physicians in phase 2. Meanwhile, a sustained increase was observed regarding IMTI and additional modalities of HH compliance of all HCWs in Phase 3. CONCLUSION: IMTI has significantly increased HH performance rates. Furthermore, combining the IMTI with additional modalities as components of a multimodal strategy recommended by WHO appears to affect the sustainability of the increasing trend of HCWs' HH compliance.

Pathogens in Pediatric Septic Arthritis: A Multi-Center Study in Turkiye (PEDSART Study).

OBJECTIVES: Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. METHODS: In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. RESULTS: Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. CONCLUSIONS: Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.

The effect of dry heat and dry cold application on pain, anxiety and fear levels before blood sample collection in school age children (7-12 years): A randomized controlled study.

BACKGROUND: Blood sampling, which is frequently performed on children admitted to hospital, causes them pain, anxiety and fear. OBJECTIVES: The study was carried out to determine the effects of dry heat and dry cold application before blood sampling on pain, anxiety and fear levels in school age children. METHODS: The study was conducted between June and January 2021 with a parallel-group randomized controlled experimental design. It was carried out with 117 children who applied to the Pediatric Blood Collection Polyclinic of a training and research hospital. The children were assigned to dry heat application, dry cold application and control group by simple randomization. Data were collected using the Child-Family Introductory Information Form, Wong Baker Faces Pain Rating Scale (WBFPS), Child Fear Anxiety Scale (CFAS) and Medical Procedure Fear Scale (MPFS). In the data analysis, descriptive statistics, the Kruskal-Wallis H test, the Dunn test, Yates correction and the Pearson Chi-Square test were used. A level of p < 0.05 was considered statistically significant. RESULTS: It was found that children who were treated with dry heat and dry cold before blood sampling experienced less pain. The anxiety of the children in the dry heat treatment group was lower than the control group. According to the children's MPFS Operational Fear sub-dimension median scores, procedural fear was found to be lower in the dry heat application group. PRACTICE IMPLICATIONS: Pediatric nurses can safely use dry heat and dry cold application in the management of invasive procedure-related pain, and dry heat application in the management of anxiety. TRIAL REGISTRATION: This trial is registered with the US National Institutes of Health (ClinicalTrials.gov) under the number NCT05974319.

A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey.

This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027).  Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children.

MIS-C and Visceral Leishmaniasis Co-occurence: Has the Clinic of Other Diseases Masked in the Pandemia?

At the end of 2019, the newly detected severe acute respiratory syndrome-coronavirus (COVID)-2 in China spread rapidly and caused a global epidemic. It has been observed that the virus, which is the cause of COVID-2019 and can cause severe acute respiratory failure, later causes a hyperinflammatory picture and causes a clinical picture similar to Kawasaki disease. Fever, cardiac involvement and rash are the most common findings in this picture, which is called multisystem inflammatory syndrome (MIS-C). Although its pathophysiology is not fully known yet, the most common cause is thought to be post-infection immune dysregulation. Visceral leishmaniasis (VL) is a zoonosis in which Leishmania infantum and rarely Leishmania donovani are the agents and can cause a similar clinical picture. In this text; we discussed a patient who was followed up with a diagnosis of COVID-associated MIS-C, but without an adequate response in his clinic with MIS-C treatment, and was diagnosed with VL with further examinations. To our knowledge, this is the first MIS-C and VL co-occurence in the literature.

Multi-organ/disseminated echinococcosis in children: Case series and review of the literature.

AIM: Echinococcosis with multi-organ/disseminated involvement is rare in childhood. We aimed to evaluate the clinical and laboratory characteristics and prognosis in paediatric patients with echinococcosis having multiorgan/disseminated involvement. METHOD: We evaluated retrospectively children with echinococcosis with involvement of three or more organs. RESULTS: Thirteen patients were included in the study. The median age was 120 (range 71-189) months. Three (23%) were diagnosed incidentally. Abdominal pain was seen in 5 (38.4%) patients, vomiting in 4 (30.7%), headache in 3 (23%), cough in 2 (15.3%), groin pain in 1 (7.6%), 1 (7.6%) had jaundice and 1 (7.6%) had fever. The median duration of complaints was 48 (0-140) days. The most common tripartite organ was 38.4% (5/13) liver, lung and spleen. Isolated abdominal dissemination was detected in two patients. Two patients had multi-organ involvement and multiple cysts with dissemination. Cyst rupture was observed in three of the patients; recurrent urinary tract infection, hydroureteronephrosis, secondary peritonitis with intra-abdominal abscess, and biliary tract fistula were each observed in one patient. Relapse developed in 3 (23%) patients. CONCLUSION: Echinococcosis is a very slow growing and complex parasitic disease that affects many organs and tissues. In our study, eosinophilia, recurrence, and complications were seen at a higher rate in paediatric patients with multiorgan involvement, who required repetitive surgeries and long-term medical treatment. However, there are scanty data on risk factors, optimum treatment and prognosis.

Deep Vein Thrombosis After a Wild Bee Sting.

Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.

A rare cause of granulomatous hepatitis: Tularemia.

Tularemia is a zoonotic infection caused by Francisella tularensis. Tularemia has several clinical form in humans, including ulceroglandular, pneumonic, oropharyngeal, oculoglandular, and systemic (typhoidal). Tularemia may develop granulomatous and suppurative lesions, especially in the affected regional lymph nodes and various organs. Patients with hepatic involvement typically have elevated transaminase levels, hepatomegaly and rarely jaundice. Histologically, there are typically suppurative microabscesses with occasional surrounding macrophages. Rarely, hepatic granuloma can develop due to tularemia. We present a case of an 8 year-old male residing in a rural village in Turkey, who came to our hospital after having intermittent fever for four months and right upper abdominal pain for two months. Liver had a nodular appearance in liver imaging and liver biopsy were consistent with granulomatous hepatitis. The microagglutination test was positive for tularemia in the patient who was investigated for granulomatous hepatitis etiology. Symptoms and signs improved with tularemia treatment. We present a rare case of hepatic involvement of tularemia in a child. Clinicians should be suspicious of and evaluate for typhoidal tularemia in patients who present with prolonged fever and non-specific systemic symptoms, potentially with associated abdominal pain.

[Rotavirus prevalence and genotype distribution in children with acute gastroenteritis in Adana province]. / Adana ilinde akut gastroenteritli çocuklarda rotavirüs prevalansi ve genotip dagilimi.

Rotavirus is the most common agent of acute gastroenteritis in children under five years of age and still a major cause of mortality and morbidity mainly in devoloping countries. The aim of this study was to determine the circulating rotavirus genotypes in children less than five years of age with acute gastroenteritis in Adana province, before the introduction of the rotavirus vaccine into the national immunization programme. Fecal specimens were collected from children enrolled between December 2012 and November 2016 and rotavirus antigen was searched by a rapid immunochromatographic test method. The antigen positive samples were G and Pgenotyped by hemi-nested type-specific multiplex reverse-transcriptase polymerase chain reaction (RT-PCR). Rotavirus antigen positive fecal specimens from 201 patients of 107 (53.3%) boys and 94 (46.8%) girls were included in this study. Rotavirus infection was most frequently detected in patients with gastroenteritis between the ages of 12 and 23 months. It has been determined that 45% of rotavirus gastroenteritis was determined in children under two years of age. Rotavirus gastroenteritis was more frequent between September and April, but the highest incidence was detected in January. Of 201 rotavirus antigen-positive stool specimens, 167 were PCR positive. Five common G (G1, G2, G3, G4 and G9) and two common P genotypes (P[8] and P[4]) were determined as 91.6% and 96.4% of the isolates, respectively. The most prevalent G and P genotype combination was G1P8 with a frequency of 29.9%, followed by 21% G9P8 About 78% of rotavirus isolates were classified into five common G-P combination genotypes, including G1P8, G9P8 G3P8, G2P4, and G2P8. During the study period, there were significant changes in the distribution of rotavirus genotype. The prevalence of G9P8 genotype sharply decreased from 40% to 8.1% and the prevalence of G1P8 genotype increased from 21.3% to 48.6%. Although no G3P8 isolates were detected in the first two years of the study, this genotype was detected in 18.5% and 13.5% of the samples in 2015 and 2016, respectively. There were no relationship between the age onset of the disease, sex, dehydration development risk and rotavirus genotype. The results from this study indicated that the predominant circulating strains of rotavirus determined in clinical specimens were G1P8 and G9P8. Significant changes were observed in the prevalence of the most common rotavirus isolates over the years. Rotavirus surveillance is important to determine the circulating strains of rotavirus to assess vaccine effectiveness, to monitor vaccine failures, and to detect potential emerging strains.