The Effect of Play Activities for COVID-19 Positive and MIS-C Pediatric Patients on the Anxiety and Fear of Children and Their Parents

Cilj: Ova studija imala je za cilj utvrditi učinke igre na anksioznost i strah pedijatrijskih pacijenata pozitivnih na COVID-19 i pacijena- ta s MIS-C-om te njihovih roditelja Metode: Ovo je eksperimentalna studija koja je pripremljena putem STROBE smjernica. Ispitanu populaciju činilo je 38 djece koja su liječena u odjelu sveučilišne COVID-19 bolnice. Dječji mjerač anksioznosti Rezultati: Utvrđene su značajne razlike dječje anksioznosti i straha u eksperimentalnoj skupini prije i nakon igre te značajne razlike između rezultata anksioznosti roditelja i djece (<0,05). Međutim, nije pronađena značajna razlika između rezultata anksioznosti i straha nakon igre djece u eksperimentalnoj skupini i rezultata kontrolne skupine. Diskusija: Eksperimentalna skupina imala je niske prosječne rezultate anksioznosti i straha nakon igre.Aim: This study aims to determine the effects of play activities for COVID-19 positive and MIS-C pediatric patients on the anxiety and fear of children and their parents. Methods: This is an experimental study that was prepared through STROBE. The study population consisted of 38 children treated in a university hospital COVID-19 unit. The Children’s Anxiety Meter-State and the Children’s Fear Scale were administered before and after the play activities. The parents’ fear and anxiety were assessed using the COVID-19 Phobia Scale and the Beck Anxiety Inven- tory. The book and coloring set was prepared in advance and delivered to the experimental group in a package. After the sets were given to the parents, the parents read the book to their children the same day. Afterward, they were asked to color pictures of coro- navirus precautions together with the children. SPSS 22.00 package program was used to analyze the study data. The Mann-Whit- ney U test was used to compare independent groups, and Wilcoxon analysis was used to analyze dependent variables before and after the play activities. Results: Based on the children’s anxiety and fear scores in the experimental group, significant differences were found before and after the play activities and significant differences between the anxiety scores (<0.05) of parents and children. However, no significant difference was found between post-play anxiety and fear scores of children in the experimental group and the scores of the control group. Discussion: The experimental group had low mean anxiety and fear scores after the play activities. Play activities should be used to reduce the anxiety and fear of children who are treated in isolation in hospitals during the COVID-19 pandemic. Even if children are restricted to isolation rooms, their daily routines should be maintained, and their parents should be supported

Impaired IL-23-dependent induction of IFN-gamma underlies mycobacterial disease in patients with inherited TYK2 deficiency

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-alpha/beta (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23-dependent induction of IFN-gamma is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.ANRS Nord-Sud ; CIBSS ; CODI ; Comité para el Desarrollo de la Investigación ; Fulbright Future Scholarshi

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

Bloodstream infections due to Trichosporon species in paediatric patients: Results from the first national study from Turkey

Background: Invasive Trichosporon infections are rarely seen opportunistic fungal infections in children and mainly affect immunocompromised patients. This multicenter retrospective study has rewieved the characteristics, risk factors, treatment modalities and outcomes of bloodstream infections caused by Trichosporon species in children diagnosed over the past ten years in Turkey. Methods: The study was performed with the participation of 12 of 55 hospitals invited from Turkey. In each center, the patients with bloodstream infections caused by Trichosporon spp. between January 2010 and December 2020 were retrospectively ascertained and the results were reported to the study coordinator by means of a simple case report. Data were collected on patient demographics, underlying condition(s), treatment of.infections caused by Trichosporon spp, and 7 and 30- day mortality rates. Results: A total of 28 cases with fungemia caused by Trichosporon spp. were included in the study. The most common underlying disease was paediatric cancers (39.3%). T. asahii infections were detected in 78.5 % (n=22) of patients. A various spectrum of antifungal treatment regimens were used including intravenous amphotericin B monotherapy in 35.7%, intravenous amphotericin B and voriconazole combination in 32.1% and intravenous voriconazole monotherapy in 28.6% of the patients. The overall mortality rate was 28.5 %. The mortality rates were 12.5% in the voricanozole, 30% in the amphotericin B and 33.3% in combined voriconazole -amphotericin B arms Conclusions: Invasive Trichosporon infections with an important impact of patients quality of life are almost related to underlying diseases with an overall mortality rate of 28.5%. Voriconazole was found to be associated with lower mortality rates when compared with other treatment regimens. (c) 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved

Evaluation of possible COVID-19 reinfection in children: A multicenter clinical study

Background: Although it was originally unknown whether there would be cases of reinfection of coronavirus disease 2019 (COVID-19) as seen with other coronaviruses, cases of reinfection were reported from various regions recently. However, there is little information about reinfection in children. Methods: In this study, we aimed to investigate the incidence and clinical findings of reinfection in pediatric patients who had recovered from COVID-19. We retrospectively evaluated all patients under 18 years of age with COVID-19 infection from a total of eight healthcare facilities in Turkey, between March 2020 and July 2021. Possible reinfection was defined as a record of confirmed COVID-19 infection based on positive reverse transcription-polymerase chain reaction (RT-PCR) test results at least 3 months apart. Results: A possible reinfection was detected in 11 out of 8840 children, which yielded an incidence of 0.12%. The median duration between two episodes of COVID-19 was 196 (92–483) days. When initial and second episodes were compared, the rates of symptomatic and asymptomatic disease were similar for both, as was the severity of the disease (p = 1.000). Also, there was no significant difference in duration of symptoms (p = 0.498) or in hospitalization rates (p = 1.000). Only one patient died 15 days after PCR positivity, which resulted in a 9.1% mortality rate for cases of reinfection in pediatric patients. Conclusion: We observed that children with COVID-19 were less likely to be exposed to reinfection when compared with adults. Although the clinical spectrum of reinfection was mostly similar to the first episode, we reported death of a healthy child during the reinfection

Türkiye’ de Pediatrik Nötropenik Hasta İzlemi

Objective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. the aim of this questionnaire study was to determine these differences in Turkey. Material and Methods: A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center. Results: Thirty-six centers including 20 (55.5%) University Hospitals, 12 (%33.3) Research Hospitals, three (8.3%) State Hospital and one Private University Hospital participated in this survey. 94.3% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6% (24/36) of the centers had toilet in all patients’ room. the door features of patients’ room included mostly (94.1%, 32/34) manually opened door. Ten (27.7%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2%, 13/34) centers prefered hickmann catheter for accessing a patient’s central line. Training was given for catheteter care in all centers. Sixteen (44.4%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75%). Conclusion: the prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.Giriş: Maligniteli hastaların tedavi sürecindeki en önemli komplikasyonlardan biri enfeksiyonlardır. Nötropenik hastalarda enfeksiyon kontrolü ve izolasyon önlemleri için merkezden merkeze değişen farklı uygulamalar mevcuttur. Anket çalışmasının amacı Türkiye’deki bu farklılıkları ve ihtiyaçları belirlemektir. Gereç ve Yöntemler: Çok merkezli tanımlayıcı çalışmaya Türkiye’nin farklı coğrafik bölgelerinden pediatrik nötropenik hasta takip eden 36 merkez dahil edildi. Kemik iliği transplantasyon üniteleri çalışmaya alınmadı. Her merkezle en az üç kez iletişime geçildi. Anketi her merkezden iki doktor yanıtladı. Anket kişisel, genel hasta bakımı ve nötropenik hasta bakımını içeren 64 sorudan oluşmaktaydı. Bulgular: Çalışmaya katılan merkezlerin 20 (%55.5)’si üniversite hastanesi, 12 (%33.3)’si eğitim araştırma hastanesi, 3 (%8.3)’ ü devlet hastanesi ve bir tanesi de özel üniversite hastanesi idi. Merkezlerin %94.3’ünün yatak kapasitesi 50 yatak ve üzerinde idi. Yirmi bir (%58) merkezin çocuk enfeksiyon hastalıkları servisi mevcuttu. Tüm merkezlerin enfeksiyon kontrol komitesi vardı. Merkezlerin %25 (n= 9)‘inde nötropenik ateş (NPA) tanısı alan çocuk hastalar tek kişilik odalarda izleniyordu. Tüm odalarda tuvalet bulunan merkez sayısı 24 (%66.6) idi. Hasta odalarının büyük çoğunluğunda elle açılıp kapanır kapı (%94.1) ve musluk (%97.1) mevcuttu. on (%27.7) merkezin oda havalandırması için hepa-filtreli sistemi vardı. Beşinde negatif basınçlı oda mevcuttu. on üç merkezde kateter olarak hickman kateter tercih edilmişti. Tüm merkezlerde kateter bakımı için eğitim verilmekte idi. Hiçbir merkezde hasta ziyaretine ve hastane odasında bitki veya çiçek bulundurmaya izin verilmemekteydi. Merkezlerin %45.7’sinde hastanede oyuncak bulundurma ile ilgili hastane politikası vardı. Sonuç: Sonuç olarak, nötropenik hastaları enfeksiyondan korumak için hastanelerde çeşitli yaklaşımlar uygulanmaktadır. Rehberler belirlenip bu rehberler ışığında hastane koşulları düzenlenmeli ve nötropenik hasta izlemi yapılmalıdır

Pediatric Neutropenic Patients Care In Turkey

Objective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. The aim of this questionnaire study was to determine these differences in Turkey. Material and Methods: A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center. Results: Thirty-six centers including 20 (55.5%) University Hospitals, 12 (%33.3) Research Hospitals, three (8.3%) State Hospital and one Private University Hospital participated in this survey. 94.3% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6% (24/36) of the centers had toilet in all patients' room. The door features of patients' room included mostly (94.1%, 32/34) manually opened door. Ten (27.7%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2%, 13/34) centers prefered hickmann catheter for accessing a patient's central line. Training was given for catheteter care in all centers. Sixteen (44.4%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75%). Conclusion: The prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.WoSScopu