Clinical and Cytokine Profile of Children With COVID-19: A Report From Turkey

Background We aimed to analyze the expression of infection-related biomarkers and inflammatory cytokines in laboratory-confirmed cases and compare the differences between clinically severe and non-severe ones. Method We randomly selected 35 patients who were hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). Blood serum was obtained at the time of admission to the hospital, on the third to the fifth day, and at the time of discharge. Result The median age of our patients was 56.5±69.7 months (range: 1-205 months). The mean pro-B-type natriuretic peptide (pro-BNP) was significantly higher at the time of admission than on the third to the fifth day of illness. The mean pro-B-type natriuretic peptide levels at three time points were significantly higher in patients with severe cases than in mild-moderate cases. However, there was no significant difference between the clinical severity with regard to the cytokine levels at disease onset and recovery. Conclusion In the study, it was shown that cytokines play an important role in the pathogenesis of COVID-19. Therefore, it may be beneficial to use agents such as tocilizumab in the treatment

Evaluation of thymic dimensions in patients with multisystem inflammatory syndrome

Background. Multisystem inflammatory syndrome (MIS-C) is the most important complication of COVID-19 in the pediatric population. Unfortunately, this problem is an unpredictable situation in patients with COVID-19. We aimed to evaluate the effects of MIS-C on thymus dimensions in pediatric patients. Methods. We retrospectively analyzed the files of 368 pediatric patients aged 2-18 years, who were diagnosed with COVID-19. Computer Tomography (CT) images of 22 patients diagnosed with COVID-19 and 10 patients diagnosed with MIS-C were evaluated in detail by two board-certified radiologists. Eighteen age and sexmatched patients who applied to the emergency department of our hospital for any reason and had a CT scan for any reason were selected as the control group. The data of both groups were statistically compared. Results. Considering the differences between the groups in terms of laboratory data, monocytes, hemoglobin, and platelet were significantly lower in the MIS-C group than the other groups. Procalcitonin, C- reactive protein, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proBNP levels were statistically significantly higher in the MIS-C group compared to the other groups Regarding the differences in thymus dimensions, thymus AP diameter, transverse diameter, length, thickness, and volume were significantly higher in the MIS-C group than in the other groups There was a significant positive correlation between the transverse diameter of the thymus and CRP, procalcitonin, pro-brain natriuretic peptide (proBNP), and NLR levels. Conclusions. Our study shows that thymus dimensions and acute phase reactants are higher in pediatric patients in the MIS-C group. Also, thymus transverse diameter, thymus thickness, and PLR values pose a risk for the development of MIS-C. More research is needed on the role of the thymus gland in the pathogenesis and diagnosis of MIS-C

Diverse phenotypic expression of NPHP4 mutations in four siblings

Nephronophthisis (NPHP) is an autosomal recessive disease characterized by renal tubular basement membrane disruption, interstitial fibrosis and tubular cysts that progresses to end-stage kidney disease (ESKD). There are also characteristic extrarenal manifestations. Mutations of more than thirteen genes that can cause NPHP have been identified. We herein report four siblings from a consanguineous family, who carried the same NPHP4 mutations but presented with different disease phenotypes ranging from enuresis nocturna to ESKD. Diluted urine and echogenic kidneys in ultrasound examination were consistent, which is typical for 100% of the NPHP cases that have been described. Chronic kidney disease developed in the older two brothers. The observed phenotypic differences are likely to be related to environmental and epigenetic factors, oligogenic inheritance and modifier genes affecting the age of presentation of signs and symptoms. NPHP should be considered as an important cause of CKD in children, which insidiously progresses to ESKD, with no specific therapy available

Pharmacogenetic Testing for Predicting Methylphenidate Treatment Outcomes in Childhood Attention Deficit Hyperactivity Disorder in Turkey:Focus on Carboxylesterase 1, Latrophilin-3, and Catechol-O-Methyltransferase

Pharmacogenetic studies involving Carboxylesterase 1 (CES1), Latrophilin-3 (LPHN3), and Catechol-O-methyltransferase (COMT) revealed individual differences regarding therapeutic response in children with attention deficit hyperactivity disorder (ADHD) under methylphenidate (MPH) treatment. This study aimed to evaluate MPH's association with the adverse effect status in children and its relationship with CES1, LPHN3, and COMT in the Turkish population. The study included 102 children and adolescents with ADHD, who were categorized as responders, or the adverse effect group based on their treatment response. The Naranjo Adverse Drug Reaction Probability Scale evaluated the presence and severity of adverse effects. Saliva sample was taken from the patients and genotype distribution of CES1 rs3815583, CES1 rs2307227, LPHN3 rs6551665, LPHN3 rs1947274, LPHN3 rs6858066, LPHN3 rs2345039, and COMT rs4680 were examined. In the adverse effect group, instances of carrying the GG genotype in CES1 rs2307227, having G vs. T genotype and GG vs. GT were significantly higher. In LPHN3 rs2345039, carrying the C genotype vs. G was associated with a serious adverse effect. In COMT rs4680, individuals with the AA or GG genotype were significantly higher in the adverse effect group. Our study suggests a relationship between genetic polymorphisms and the side effect status in children receiving MPH.</p

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Are student knowledge levels and attitudes about avulsion dental trauma adequate in the faculty of medicine?

Aim: The aim of this study was to measure the knowledge levels and attitudes of medical students in Kahramanmaraş city on traumatic dental injuries, particularly dental avulsion.&#x0D; Methodology: A total of 224 students studying at the medical school in Kahramanmaraş province were included in this research. The students filled out two-part questionnaire forms containing 17 items in total. We used descriptive frequency analysis, crosstabs, and the chi-square test.&#x0D; Results: Only 7.6% of the students had received relevant training on dental injuries; however, 70.6% did not find the training sufficient. In the case report on replanting a primary tooth, 70.1% of the participants agreed that the primary tooth should not be replanted. In the case report on replanting a permanent tooth, 70.5% of them stated that, although they knew the fallen tooth to be a permanent tooth, they would refer the patient to a dentist immediately because they did not have relevant knowledge for the case. Additionally, 7.6% of the participants stated that if a permanent tooth was avulsed, they would keep the tooth in milk.&#x0D; Conclusion: We concluded that students majoring in medicine had insufficient knowledge levels and attitudes regarding dental injuries leading to avulsion, and we believe this subject needs to be covered by the relevant curriculum.&#x0D;  &#x0D; How to cite this article: İpek S, Soğukpınar Önsüren A. Are student knowledge levels and attitudes about avulsion dental trauma adequate in the faculty of medicine? Int Dent Res 2021;11(Suppl.1):143-51. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.22&#x0D;  &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.&#x0D;  </jats:p

Environment policies in the scope of government programs and development plans

Çevre, yaşanan çevre sorunları ve ekonomik krizlerle ilişkili olarak 1970'li yıllardan itibaren devlet ve hükümetlerin gündemlerinde yer edinmeye başlamıştır. Bu çerçevede hem ulusal hem de uluslararası düzeyde pek çok girişimde bulunulmuş ve "çevre" bir politika nesnesi haline gelmiştir. Çevre politikası, hava, toprak, su, gürültü ve görüntü kirliliği, iklim değişikliği, ozon tabakasının incelmesi, biyolojik çeşitliliğin azalması, doğal kaynakların tükenmesi, katı ve sıvı atıklar, erozyon, enerji kaynakları, nüfus artışı, yoksulluk gibi kesin sınırları çizilmesi çok zor olan birçok çevre sorununu ve çözümünü kapsamaktadır. Çevre sorunlarının çok boyutluluğuna ve sınır tanımaz özelliğine rağmen, ekonomik gelişmişlik ve büyümenin gerisinde yer almasına bağlı olarak, bu geniş boyutlu politika alanı gündemin arka sıralarında kalmıştır.1923'ten itibaren Türkiye'de tüm politikaların hem yapılması hem uygulanmasında temel belirleyici faktör hükümetler olmuştur. Bu çerçevede politika analizi çalışmalarında kamu politikasının oluşturulması ve uygulanması sürecinde baş aktör hükümetlerdir. Hükümetler temel kamu politikalarını belirlemekten, kamu kurumları da hükümetin belirlediği bu politikaları uygulamaktan sorumludur. Hükümet programındaki hedefler hükümetlerin iktidar sürelerinde kamu politikasına dönüşmektedir. Bu nedenle hükümet programları üst politika belgelerinden biri olarak kabul edilebilir. Türkiye, Cumhuriyet tarihinde çok farklı dönemlerden geçmiş ve Türkiye'de altmış beş hükümet kurulmuştur. Sosyo-kültürel, ideolojik ve ekonomik farklılıklar bu dönemlere damgasını vurmuş, tüm politikalarda olduğu gibi çevre politikaları da bu süreçte değişmiştir. Dönemin siyasal sistemine ve ekonomik programlarına bağlı olarak çevre politikası aktif ya da pasif hale getirilmiş, öncelikler değiştirilmiştir. Bu çalışmada üst politika belgelerinden olan hükümet programları ve kalkınma planları üzerinden bu tarihsel süreçteki Türk çevre politikası analiz edilecektirEnvironment had been placed at state and government agendas since 1970's regarding to exposed environment problems and economical crisis. In this frame, many attempts in both national and international level had been done and it became a policy object. Environment policy covers many environment problems of which certain borders cannot be drawn and resolutions likes air, soil, water, noise and visual pollution, climate change, thinning of ozone layer, decreasing of biological variety, depletion of natural resources, solid and liquid waste, erosion, energy resources, population increase, poverty, etc. Despite of multi dimension and unlimited feature of environment problems, this wide dimensioned policy field became behind of agenda depending on its being at the behind of economical development and progressing.Since 1923, both maker and applicator of the all policies in Turkey has been government. The head actor is government at composing and applying public policies at the policy analysis studies in this frame. The governments are responsible to determine basic Public Policies; public organizations are responsible to apply those determined policies by the governments. The objectives in government program turn into public policy after governments coming into power. Therefore government programs can be accepted one of higher policy documents. Turkish Republic had very different periods in its history and sixty five governments have been established in Turkey. Socio-cultural, ideological and economic differences leaved mark on those periods; environment policies have been changed in this period as it is same in all policies. Depending on political system and economical program of the period, environment policy became active or passive; priorities have been changed. Turkish Environment Policies will be analyzed over Government programs and development plans that are included in higher policy documents within this historical perio