The effect of the COVID-19 pandemic on pediatric emergency admissions and tendency towards prescribing antibiotics

Aim: To determine the changes in the diagnoses of patients admitted to pediatric emergency department due to infection and the change in the tendency towards prescribing antibiotics during the COVID-19 pandemic. Methods: Age, gender and the diagnoses of and the antibiotics prescribed for patients under the age of 18 who admitted to the pediatric emergency department on two separate days before and during the pandemic period were compared retrospectively. Results: It was found that the admissions to the pediatric emergency department decreased by 83% during the pandemic period compared to the pre-pandemic period. Upper respiratory tract infection (URTI) was diagnosed in 61.6% of the patients during the pre-pandemic period compared to 32.6% of the patients during the pandemic periods, indicating a statistically significant difference between the groups (p<0.001). The percentage of patients diagnosed with paranasal infection in the pandemic period was also significantly lower than in the pre-pandemic period. On the other hand, the percentages of patients diagnosed with urinary infection and diagnoses other than infection in the pandemic period were significantly higher than in the pre-pandemic period. Additionally, the percentage of patients who were prescribed amoxicillin-clavulanic acid (CAM) was significantly higher, whereas the percentage of patients who were prescribed Clarithromycin was significantly lower in the pandemic period than in the pre-pandemic period. Furthermore, it was determined that Oseltamivir was not prescribed during the pandemic period. Conclusions: Quarantines imposed due to the COVID-19 pandemic and the use of masks have reduced the incidence of upper and lower respiratory tract infections. In parallel, it was determined that the percentage of patients presented to the pediatric emergency department with the diagnosis of non-infectious diagnoses has increased. This result has been attributed to the use of masks and the attention paid to the hygiene, which caused a decrease in the incidence of infectious diseases, influenza in particular

Von Hippel Lindau disease with metastatic pancreatic neuroendocrine tumor causing ectopic Cushing's syndrome

We present a 39-year-old woman who was previously diagnosed with Von Hippel Lindau Disease (VHLD). She had surgery and radiotherapy for cranial hemangioblastoma (HA) 11 years ago and had unilateral adrenalectomy for pheochromocytoma in another hospital 6 month prior to her admission to our center. Moon face, buffalo hump, central obesity, progressive weight gain and menstrual irregularities persisted after adrenalectomy. Her laboratory results were consistent with ectopic Cushing's syndrome (ECS). A pancreatic solid mass with a nodule on the left lung were revealed upon computed tomography. In addition, Gallium-68 Somatostatin Receptor PET confirmed the pancreatic involvement and demonstrated additional lesions on the left lung and in the aortocaval lymphatic system on the right side, suggesting metastatic pancreatic neuroendocrine tumor (PNET). Peptide receptor radionuclide therapy (PRRT) with [(177)Lutetium-DOTA(0), Tyr(3)] octreotate was performed on the patient, with no side effects observed. She was discharged from the hospital 10 days after the first cycle

HELLP syndrome

HELLP syndrome is characterized by hemolysis, elevated liver enzymes and thrombocytopenia. With a incidence of 0.1%-0.8% it is known to be effected by genetic predisposition. Unlike preeclempsia multiparity increases the risk of HELLP syndrome. Diagnosis is made by the classic clinical triad. Thrombocyte counts are especially important for classification of the disease. When making a diagnosis, severe preeclempsia, acute fatty liver of pregnancy, hemolytic ureamic syndrome and thrombocytopenic thrombotic purpura should be always be kept in mind for differential diagnosis. HELLP syndrome has several complications , including but not limited to; disseminated intravascular coagulopathy, acute renal failure, pulmonary edema, liver rupture and hematoma and retinal detachment. Suggested treatment modality consists, stabilization of blood pressure and magnesium sulfate infusion. Then evaluation of fetal status and planning delivery method and time if maternal status remains unstable. If prognosis seems favorable without urgent delivery and fetus can benefit from it, a course of betamethasone can be given to fetuses between 24 and 34 weeks of gestational age. The only and definite treatment of HELLP syndrome is delivering the baby. Suggested benefits of steroid therapy and other experimental treatments are still to be proven effective by large randomized controlled trials. [Archives Medical Review Journal 2014; 23(4.000): 735-760

Active Surveillance of Influenza A and Other Respiratory Viruses in Children with Influenza-like-illness in Two Seasons

Introduction: The aim of this study was to asses the surveillance of influenza A/other respiratory viruses and risk factors in hospitalized children with the symptoms of influenza-like illness during two consecutive influenza seasons