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

Comparison of the efficacy of once- and twice-daily colchicine dosage in pediatric patients with familial Mediterranean fever - a randomized controlled noninferiority trial

Background: In this study, we examined the efficacy and safety of a once-daily dosage schema of colchicine compared with a twice-daily dosage schema in pediatric patients with familial Mediterranean fever (FMF). Methods: In this 24-week, multicenter, randomized controlled noninferiority trial, pediatric patients newly diagnosed with FMF carrying a homozygous or compound heterozygous mutation and not receiving any treatment were included. Patients were randomly assigned using a block randomization method to receive treatment with a once- or twice-daily dosage. Clinical and laboratory characteristics and medication side effects were recorded and compared between groups. The study was carried out in compliance with Good Clinical Practice and the Consolidated Standards for Reporting of Trials (CONSORT) statement. Results: A total of 92 patients were selected, and 79 patients completed the study. There were 42 patients in the once-daily dosage group and 37 in the twice-daily dosage group. The results indicated that the once-daily dosage was not inferior to the twice-daily dosage regarding decrease in attack frequency and duration as well as improvement in clinical findings and Mor severity scores. Alterations in laboratory findings indicating inflammation, such as erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A, were similar in both groups. The rates of drug side effects were similar between the once- and twice-daily dosage groups, implying comparable safety of colchicine, with the exception of diarrhea, which was slightly higher in the once-daily dosage group. Conclusions: Using colchicine with either a once- or twice-daily dosage provides similar clinical and laboratory improvements. Considering both efficacy and safety, colchicine can be prescribed with a once-daily dosage. Trial Registration ID: ClinicalTrials.gov identifier NCT02602028. Registered 5 November 2015

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

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

COL12A1 Gene Variant and a Review of the Literature: A Case Report of Ullrich Congenital Muscular Dystrophy

Introduction: Mutations in collagen type IV-associated genes lead to Ullrich congenital muscular dystrophy (UCMD) and Bethlem myopathy (BM). COL12A1 gene mutations have rarely been reported in patients with UCMD- and BM-like disorders not involving COL6 mutations. UCMD-2 results from homozygous mutations in the COL12A1 gene on the long arm of chromosome 6. Pathogenic variants in COL12A1 result in a rare congenital connective tissue/myopathy overlap syndrome under the heading of myopathic Ehlers-Danlos syndrome. COL12A1 dominant pathogenic variants have been rarely reported, and the phenotypic spectrum has not yet been identified. Case Presentation: We describe a female patient aged 2 years and 10 months exhibiting a milder phenotype who presented due to pronounced joint hyperlaxity, frequent falls, and skin lesions. Genetic analysis revealed a homozygous c.8903C>T (p.Pro2968Leu) missense variant that had previously been described but concerning which there had been no clinical report, in the COL12A1 gene. Discussion/Conclusion: This report is presented in order to raise awareness of rare mutations in the COL12A1 gene that affect muscle and connective tissue and to add to the literature in defining the phenotypic spectrum