Suna Özdem

Objective: The purpose of this study was to evaluate the factors, particularly post-vaccination C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR), associated with the clinical decision to initiate antibiotic treatment following the 2-month diphtheria–acellular pertussis–tetanus–Haemophilus influenzae Type B–inactivated poliovirus (DaBT-Hib-IPV) vaccine in hospitalized infants. Methods: A retrospective review was conducted on the medical records of 46 infants. The study included infants hospitalized between 2022 and 2024 at Mersin City Training and Research Hospital who received the 2-month vaccine and subsequently underwent post-vaccination laboratory testing. Infants were categorized based on whether they received antibiotic treatment. Results: Antibiotics were administered to 20 infants, and 26 were observed without any treatment. Despite having a significantly higher gestational age (p = 0.027), the hospital stays of the antibiotic group were significantly longer (median 99 vs. 78 days, p < 0.001). C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were elevated in the antibiotic group (CRP = 2.82 vs. 1.63 mg/dL, p < 0.001; NLR= 0.90 vs. 0.72, p = 0.041). Culture positivity was low in antibiotic recipients (3/20, 15%). CRP was the only independent predictor of antibiotic administration when adjusted for gestational age and weight at vaccination (Exp(B) = 3.997, p = 0.003). Conclusions: In this cohort of NICU-hospitalized, predominantly preterm infants, a population that does not represent the general population of vaccinated 2-month-old infants, post-vaccination elevations in CRP and NLRs were associated with the clinical decision to initiate antibiotic treatment; however, in the absence of a validated infection reference standard, these markers cannot be assumed to reliably differentiate true infection from vaccine-induced inflammation. To prevent unnecessary antibiotic use and optimize patient management, these markers must be evaluated in conjunction with clinical findings, culture results, and supplementary biomarkers.

This study aimed to evaluate the determinants of postoperative complications in pediatric surgical patients and investigate whether the Systemic Immune-Inflammation Index (SII) independently predicts complication type in a predominantly acute abdominal pediatric surgical population. This retrospective study included patients aged 0 to 18 years who underwent surgical procedures between 2017 and 2024. Demographic characteristics, preoperative laboratory parameters, culture results, postoperative complications, and clinical outcomes were recorded. The primary outcome was postoperative complication class (local vs systemic). Secondary outcomes included in-hospital mortality, length of hospital stay, and readmission. Multivariable regression analyses were performed. A total of 307 pediatric patients were included; 64.17% were male. The majority underwent acute abdominal emergency surgery (89.54%). The most frequent culture growth site was the peritoneum (65.47%). Gram-negative microorganisms accounted for 94.46% of isolates, whereas Gram-positive organisms constituted 5.21%; fungal growth was observed in 1.30% of patients. Local complications were observed in 96.42% of patients, whereas systemic complications occurred in 3.58%. Overall mortality was 2.93%. Fever was significantly more common among non-survivors compared to survivors (77.78% vs 12.75%, P < .001), and systemic complications were associated with mortality ( P = .040). Although SII values were higher in Gram-negative infections, SII did not independently predict complication type or mortality in this heterogeneous cohort. Gram-negative pathogens predominate in pediatric surgical infections. However, laboratory inflammatory indices, including SII, did not independently predict postoperative complication type or mortality. These findings suggest that clinical and perioperative factors play a more important role in determining outcomes in this predominantly acute abdominal pediatric surgical population.

Objective: The clinical profiles of child victims admitted to hospitals following earthquakes, as well as the characteristics associated with hospital stay, are important. This study aimed to analyze the clinical outcomes of pediatric victims admitted following a sudden earthquake to enhance preparedness for accessing essential health services to reduce losses in future disasters. Methods: Among 2158 patients referred to the pediatric emergency department (PED), 356 children followed at our tertiary inpatient clinic were included. Demographics, surgical interventions, and the presence of life‐threatening conditions like crush syndrome and fasciotomy/amputation were investigated. Crush syndrome was defined as clinical and laboratory evidence of muscle injury accompanied by systemic complications odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: Among the patients, 56.5% were male. The median length of hospital stay was 4 days (range: 1–120). The most common injury mechanism was entrapment under rubble, and the lower extremities were the most frequently affected injury site. Compartment syndrome developed in 31.7% of patients, and 2.8% underwent amputation. Crush syndrome was identified in 75.3% of hospitalized patients and was significantly more common among children admitted on the second day or later after the earthquake. Elevated creatine phosphokinase (CPK) levels significantly increased the likelihood of developing crush syndrome (OR: 61.7, 95% CI) and the need for fasciotomy (OR: 16.9, 95% CI). Fasciotomy was required in 28.9% of patients. Dehydration was associated with an increased risk of fasciotomy (OR: 7.2) and amputation (OR: 5.4). Elevated levels of myoglobin, uric acid, blood urea nitrogen/creatinine, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly associated with crush syndrome and fasciotomy ( p < 0.001). Conclusion: The high burden of crush‐related complications in pediatric earthquake victims underscores the need for pediatric‐specific trauma protocols in disaster settings. Early identification of risk factors and rapid intervention may reduce severe outcomes such as fasciotomy, renal failure, and amputation.

Bruselloz, çocukluk çağında endemik bölgelerde sık görülen önemli bir zoonotik enfeksiyondur. Bu çalışmada, bakteriyemik ve bakteriyemik olmayan çocukluk çağı bruselloz olgularının klinik, laboratuvar ve serolojik özelliklerinin karşılaştırılması amaçlanmıştır.Bu retrospektif çalışmada, Şubat 2017 - Temmuz 2024 tarihleri arasında bruselloz tanısı almış 117 çocuk hasta değerlendirildi. Hastalar, kan kültürü sonucuna göre bakteriyemik (n=38) ve bakteriyemik olmayan (n=79) olarak iki gruba ayrıldı. Verilerin analizinde R versiyon 4.5.0 yazılımı kullanıldı. Sürekli değişkenlerde normallik dağılımı Shapiro–Wilk testi ile değerlendirildi. İkili karşılaştırmalarda parametrik veriler için bağımsız gruplar t-testi, parametrik olmayanlar için Wilcoxon testi kullanıldı. Kategorik değişkenlerde Pearson ki-kare veya Fisher exact testleri uygulandı. p<0,05 anlamlı kabul edildi.Bakteriyemik hastalarda hastaneye yatış oranı (%39,5), bakteriyemik olmayanlara göre (%11,4) anlamlı olarak yüksekti (p=0,001). Yatış süresi dağılımı da gruplar arasında farklıydı (p=0,035). Splenomegali (p=0,004) ve artrit (p=0,001), bakteriyemik olmayan grupta daha sık görüldü. Laboratuvar bulgularında, bakteriyemik grupta hemoglobin düzeyi (p=0,037) ve MPV (ortalama trombosit hacmi) (p=0,048) anlamlı olarak daha düşüktü. CRP, ESR, WBC ve serolojik test sonuçlarında gruplar arasında anlamlı fark saptanmadı.Bakteriyemik çocukluk çağı bruselloz olgularında lokal bulgular daha az izlenmekte ancak hastaneye yatış ihtiyacı daha fazla olmaktadır. Düşük hemoglobin ve MPV değerleri, bakteriyeminin olası göstergeleri olarak düşünülebilir. Elde edilen bulgular, çocukluk çağı brusellozunun klinik çeşitliliğine ışık tutmakta ve erken risk sınıflaması açısından katkı sağlamaktadır.

The Systemic Immune-Inflammation Index is a measurement of the systemic immune-inflammatory response (SII), which is used as both a diagnostic and predictive index for many diseases. Burns are a major public health problem among children. Infection caused by burns is the most important cause of mortality in children. In this study aims to investigate the predictive and diagnostic performance of SII for infection for pediatrics at the burn center and the causes of burns and responsible microorganisms and possible risk factors on infection. Data were collected retrospectively from 42 pediatric patients between 2013 and 2023 and analyzed in the burn center. Infected and uninfected burn patients were compared. Scalds were the most common cause of burns in both groups, (91.3%; 87%, respectively). The most frequently isolated microorganism was Pseudomonas aeruginosa (52,6%). Central venous catheter use was the biggest risk factor for infection (OR = 8,077; 95% CI 1,523 to 42,834). The AUC value demonstrated an acceptable diagnostic performance (AUC = 0,605; 95% CI 0,450 to 0,746) Similarly, the odds ratio suggested a potential relationship between SII and infection (OR = 2,057; 95% CI 0,489 to 8,657), but both failed to reach statistical significance. The results of this investigation indicate limited predictive and diagnostic utility for SII. CRP performed better diagnostically than SII (AUC = 0,877; 95% CI 0,747 to 0,955), suggesting that traditional inflammatory markers may still be a better way to predict infection in pediatric burns. Moreover, substantial disparities in hemoglobin levels, lymphocyte counts, CRP, and procalcitonin between infected and uninfected groups indicate that a multi marker strategy may prove more efficacious than dependence on a solitary index. While the SII showed a tendency to predict infection in pediatric burn patients, it did not achieve statistical significance in our research. These findings highlight the need for larger-scale studies to clarify the role of SII in infection prediction among pediatric burn patients. Further research with larger cohorts or multicenter studies could help determine whether SII has clinical utility in this population. Also, accurate identification of infectious agents, development of effective treatment strategies, avoidance of prophylactic antibiotic use, and strict adherence to isolation precautions will significantly reduce the risk of infection in centers where burn patients are followed up.

Purpose COVID-19 and influenza infections have similar modes of transmission and clinical symptoms but have different prognoses and treatment methods; therefore, it is important to make a final diagnosis. Herein, we aimed to compare the demographic, clinical, and laboratory differences in hospitalized pediatric patients with COVID-19 and influenza. Methods This retrospective study comprised patients with COVID-19 managed between March 2020 to February 2022, and patients with influenza managed between December 2017 to February 2022, at a tertiary care hospital. The clinical data and laboratory parameters were obtained from the medical records of the hospital. Pediatric intensive care unit (PICU) admission, need for oxygen support, and the mortality rates of the patients were recorded and compared statistically. Results Overall, 107 patients with COVID-19 and 250 patients with influenza were included. Underlying chronic disease (UCD) rates were statistically higher in patients with COVID-19 (p < 0.001). When the symptoms were compared, fever, cough, and runny nose were more common in patients with influenza, and abdominal pain and rash were more common in patients with COVID-19 (p < 0.05). In patients with influenza, white blood cell count and absolute neutrophil count values were lower (p = 0.021 and p = 0.037, respectively), and aspartate aminotransferase and creatinine kinase values were higher (p = 0.007 and p < 0.001, respectively). PICU admission rates and oxygen support needs were similar in both groups (p > 0.05). When the virus was COVID-19, it had 7.8 times higher risk of mortality compared to influenza (p = 0.002). There were statistically significant risk for mortality when the virus was COVID-19, the risk of mortality was 6.9 times higher in those with UCD, 8.5 times higher in those with admission to PICU and 3.8 times higher in those with needing mechanical ventilation (MV) compared to when the virus was influenza (p = 0.004, p = 0.006 and p = 0.049, respectively). The mortality rate was higher in patients with COVID-19 (p = 0.007). Conclusion This study showed that COVID-19 might negatively affect the survival times and increase mortality rates, especially in children with an UCD, admitted to the PICU and in need of MV.

Objective Crimean–Congo hemorrhagic fever (CCHF) is a zoonotic disease that is mainly transmitted by tick bites. During the COVID-19 pandemic, a change of notifications has been reported for most infectious diseases. We aimed to compare CCHF in pediatric patients during the COVID-19 pandemic and before the pandemic period with demographic, clinical, and laboratory features.Methods Overall, 18 CCHF patients were evaluated and divided into two groups: those admitted from May 2014 to February 2020 were placed in the “prepandemic” group and those admitted from March 2020 to August 2021 were placed in the “pandemic” group. Patients were diagnosed as CCHF with polymerase chain reaction (PCR) and immunoglobulin M (IgM) antibody positivity in the blood samples.Results Pediatric CCHF cases were more frequent during the 2 years of the COVID-19 pandemic period compared with the 6 years before the pandemic (10 cases and 8 cases, respectively). There were no demographic and clinically significant differences between the two groups. Prepandemic patients had lower platelet (PLT) levels than pandemic patients (p = 0.021). Two CCHF patients in the pandemic group were hospitalized with a preliminary diagnosis of multisystem inflammatory syndrome in children (MIS-C). Seventeen patients (94.4%) were treated with ribavirin. All the patients recovered.Conclusion The frequency of CCHF appeared to have been increased during the COVID-19 pandemic. But there was no difference between the prepandemic and pandemic groups from a demographic and clinical finding point of view of patients diagnosed with CCHF.

Introduction: Human brucellosis is one of the most common zoonotic infections in the world. The definitive diagnosis of brucellosis is based on cultured Brucella organisms from blood or other tissue samples. We aimed to compare bacteremic and nonbacteremic brucellosis patients with demographical, epidemiological, clinical and laboratory features and determine the predictive factors affecting blood culture positivity. Materials and Methods: Children aged 1 month to 18 years who were followed up with the diagnosis of brucellosis between January 2005 and March 2021 were included in this retrospective study. According to the isolation of Brucella melitensis in blood culture, the patients were divided into two groups as bacteremic and nonbacteremic and compared in terms of demographic, clinical and laboratory characteristics. Results: One hundred eighty-nine (116 male, 61.4%) patients diagnosed with brucellosis were included in the study. There were 76 (40.2%) bacteremic and 113 (59.8%) nonbacteremic patients. Bacteremic patients were younger than nonbacteremic patients. Fever, arthralgia, hepatomegaly and splenomegaly were significantly higher in the culture positive group. High levels of C-reactive protein (CRP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were found to be significant in the bacteremic group. Conclusion: In our study, history of fever and arthralgia, hepatomegaly and splenomegaly in physical examination and high CRP, ALT and AST levels in the biochemical analysis were important factors determining blood culture positivity.

Purpose: To report bilateral anterior uveitis and corneal punctate epitheliopathy in children with multisystem inflammatory syndrome (MIS-C) secondary to coronavirus disease (COVID-19). Participants and methods: Five patients who were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies and diagnosed with MIS-C were evaluated. Ophthalmologic examinations were performed in order to reveal ocular findings in MIS-C disease. Results: Slit lamp examinations showed bilateral non-granulomatous acute anterior uveitis in all patients and severe corneal punctuate epitheliopathy in three of the patients. These ocular findings mostly disappeared with treatment in about one week. Conclusion: Bilateral non-granulomatous acute anterior uveitis and dry eye can be detected in patients diagnosed with MIS-C secondary to COVID-19. Even if generally, COVID-19 is not a life threatening disease in children by itself, inflammatory ocular manifestations can be detected in MIS-C secondary to COVID-19.