Tolunay İ, Yıldızdaş RD, Elçi H, Alabaz D. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr 2018; 60: 63-69. In catheter-using units as pediatric intensive care, it is important to know the complications that may occur during the insertion and use of central venous catheterization (CVC), and to take appropriate measures in order to reduce the mortality and morbidity of critical patients. The aim of this study was to evaluate CVC and catheter related complications in our tertiary pediatric intensive care unit. For this prospective study, 155 central venous catheters and/or hemodialysis catheters used with 106 patients, between August 2014 and August 2015 were evaluated. Demographic information about patients, catheter insertion procedure and catheter related complications were recorded. Sixty-two (58.5%) male and forty-four (41.5%) female patients were evaluated in this study. The median age was 67.5 months (1-212). The mean dwell time of catheters was 10.54±8 days. Twenty-two (14.2%) catheters were removed from patients because of catheter related complications. The mean dwell time of complicated catheters was 10.6±8.5 days and there was no statistically significant difference between complicated and non-complicated catheters. Catheter related blood stream infections was diagnosed in 5.1% (8/155) patients and these catheters were removed from patients. Including these patients, positive blood culture was found to be at 14.2% (22/155). The mean dwell time of catheters with positive blood culture was 14.25±7.3 days. The mean dwell time of catheters with positive blood culture was statistically significantly longer than catheters with negative blood culture. In the 3 patients who developed catheter thrombosis, 2 patients were followed up because of infection/sepsis and 1 patient had a neurological disease. Catheter thrombosis developed in 1 femoral vein and 2 internal jugular veins. The development of central venous catheter complications depends on many different factors and it is possible to reduce the complications with precautions taken during replacement and daily use.

Öz Purpose: Vitamin D is a hormone that plays an important role in the regulation of calcium homeostasis and bone health. Vitamin D also has many functions other than skeletal health. The liver is one of the main organs involved in vitamin D metabolism. Recent studies have demonstrated a very high prevalence of vitamin D deficiency and/or insufficiency in patients with chronic liver disease. However, studies in this subject are scarce in children. Materials and Methods: Vitamin D levels and treatment response of children with chronic liver disease diagnosed were evaluated retrospectively. A total of 50 patients, including 17 (34%) female and 33 (66%) male patients, who were being followed for 4 years, were recruited. Results: Vitamin D deficiency or insufficiency was detected in 29 (48%) of 50 patients with a mean age of 7.83 (± 3.70) years at the time of diagnosis. Mean 25-OH vitamin D level was 12.79 (± 4.63) ng/ml). In 24 (82.8%) patients with vitamin D deficiency or insufficiency vitamin D level was recovered after treatment, whereas in 5 patients (17.2%) there was insufficient response. In the presence of cholestasis, the response to treatment was observed to decrease. Conclusion: Since vitamin D levels in patients with chronic liver disease may be low, patients should be examined and treated in this respect. This would also provides support for the current disease.

Leptospirosis is an acute, febrile, systemic, and zoonotic infectious disease characterized by widespread vasculitis caused by Leptospira interrogans from the leptospira family. It can be in the form of asymptomatic infection; it can also progress with severe symptomatic forms characterized by multiorgan involvement such as aseptic meningitis as well as liver and kidney failure. Leptospirosis is transmitted to humans through water, soil, and food contaminated with the urine of infected mice or other mammals.COVID-19 is a newly detected coronavirus that causes pneumonia. The disease has led to a pandemic all over the world. In this case report, we aimed to draw attention to leptospirosis infection in the presence of a case who was followed up with the differential diagnosis of COVID-19 and diagnosed with leptospirosis during the COVID-19 pandemic. Leptospirosis is one of the diagnoses that should be kept in mind in especially developing countries in patients presenting with findings that may be confused with COVID-19 during the pandemic period.

Background;  Protozoa of the genus Leishmania are obligate intracellular parasites and Leishmania species cause a spectrum of species-specific clinical symptoms known as cutaneous, mucocutaneous and visceral leishmaniasis. Leishmania major and Leishmania tropica are known to cause cutaneous leishmaniasis, while Leishmania infantum and Leishmania donovani cause visceral leishmaniasis (VL). However, molecular studies in recent years have shown that Leishmania species cause different clinical symptoms. Objectives; Our aim is to evaluate the relationship between clinical and molecular characterization of leishmania isolates in children with VL defined in Turkey, which is an intercontinental transitional region. Methods; The clinical diagnosis of VL was confirmed by the detection of amastigotes in the bone marrow aspirate and/or the rK39 test and/or molecular methods (genus specific PCR, Real-Time PCR, ITS1 PCR-RFLP, DNA sequencing). Results: Most of the VL patients were referred from the districts of Adana (53.3%) and others from neighboring provinces; Hatay (16.6%), Osmaniye (3%), Gaziantep (3%), Adıyaman (3%) and 20% case were Syrian emigrants. A total of 30 patients with a clinical diagnosis of VL were confirmed by different diagnostic methods. It was found that 93% positive with microscopic examination, 79.1% with rK39 dipstick test, and 60% with genus specific PCR assay in clinical samples. The Leishmania isolates were identified as L. infantum (40%), L. donovani (26.7%) and L. tropica (23.3%) using Real Time PCR, ITS1 PCR-RFLP and DNA sequencing. There was no cutaneous finding in any case in clinical examination. The most common clinical findings were fever (93.3%), splenomegaly (90%), followed by hepatomegaly (76.6%). The most common laboratory finding was thrombocytopenia (86.6%) followed by anemia (70%). Hemophagocytic lympho-histiocytosis was detected in bone marrow aspiration in two of our patients. Since pentavalent antimony salts treatment initially failed in four patients, it was necessary to switch to Liposomal-Amphotericin B treatment and was successfully treated. Conclusions: The presence of L. tropica in VL patients, despite the absence of cutaneous findings in any of the cases, shows that this strain can cause VL, contrary to conventional knowledge. In the Adana province, where this study was carried out, L. infantum from CL cases in previous studies should be taken into account and visceral spread in CL cases and accompanying cutaneous lesions in VL cases should be investigated in detail. Key Words; Visceral leishmaniasis, DNA Sequencing, Leishmania infantum, Leishmania donovani, Leishmania tropica