In COVID-19-induced acute respiratory distress syndrome, the lungs are incapable of filling with sufficient air, leading to hypoxemia that results in high mortality among hospitalized patients. In clinical trials, low-molecular-weight heparin was administered via a specially designed soft-mist inhaler device in an investigator initiated, single-center, open-label, phase-IIb clinical trial. Patients with evidently worse clinical presentations were classed as the “Device Group”; 40 patients were given low-molecular-weight heparin via a soft mist inhaler at a dose of 4000 IU per administration, twice a day. The Control Group, also made up of 40 patients, received the standard therapy. The predetermined severity of hypoxemia and the peripheral oxygen saturation of patients were measured on the 1st and 10th days of treatment. The improvement was particularly striking in cases of severe hypoxemia. In the 10-day treatment, low-molecular-weight heparin was shown to significantly improve breathing capability when delivered via a soft-mist inhaler.

The known about this topic In the literature, studies directed to violence in the sector of healthcare have mostly been conducted in adult emergency clinics. There are two studies related to exposure to violence in pediatric clinics in our coutry. In a study conducted in the province of Konya with 95 pediatric nurses, exposure to violence was found as 77.9%. In a childrens' hospital, it was reported that 17% of 253 healthcare workers were exposed to physical violence in the last 6 months. Contribution of the study The aim of this study was to determine the status of violence in health in pediatric clinics and to draw attention to necessary precautions required to reduce violence against healthcare workers.

Objectives: This study aims to investigate serum pentraxin 3 (PTX3) levels during acute episode of acute rheumatic fever (ARF) and their relationship with disease severity. Patients and methods: The prospective study was conducted between January 2015 and December 2018 and included 52 ARF patients (22 girls, 30 boys, mean age 10.7±2.1 years; range, 5 to 16 years) experiencing an acute episode and 22 healthy children (13 girls, 9 boys, mean age 10.3±3.8 years; range, 5 to 16 years). ARF patients were classified into three groups based on the clinical course: isolated arthritis (n=17), mild carditis (n=19), and moderate/severe carditis (n=16). Blood samples were collected from all patients before treatment and from the healthy children in the control group to measure PTX3 levels. PTX3 was measured using sandwich enzyme-linked immunosorbent assay method. Results: Plasma PTX3 levels were significantly higher in ARF group compared to the control group (4.7±5.2 and 1.2±1.7 ng/mL, p<0.001). Subgroup analysis of serum PTX3 levels in ARF patients with isolated arthritis, mild carditis, and moderate/severe carditis (3.2±3.1 ng/mL, 4.3±5 ng/mL, and 6.7±6.6 ng/mL, respectively) showed that serum PTX3 was significantly higher in the moderate/severe carditis group compared to the other groups (p<0.05). Analysis of echocardiographic data showed that serum PTX3 was positively correlated with left ventricular end-diastolic diameter, left atrial diameters, and mitral A velocity and negatively correlated with E/A ratio (p<0.05; r=0.231, 0.402, 0.562, -0.586, respectively). Conclusion: High PTX3 level during an acute episode of ARF may help predict the clinical course and the severity of accompanying carditis. However, prospective studies with larger sample sizes are needed.

Background Duchenne muscular dystrophy (DMD) is an X-linked muscular disease which is caused by the absence of dystrophin. Troponin elevation with acute chest pain may indicate acute myocardial injury in these patients. We report a case of DMD that presented with ACP and troponin elevation, who was diagnosed with acute myocardial injury, and successfully treated with corticosteroids. Case presentation A 9-year-old with DMD was admitted to the emergency department with the complaint of acute chest pain. His electrocardiogram (ECG) revealed inferior ST elevation and serum troponin T was elevated. The transthoracic echocardiography (TTE) demonstrated inferolateral and anterolateral hypokinesia with depressed left ventricular function. An ECG-gated coronary computed tomography angiography ruled out acute coronary syndrome. Cardiac magnetic resonance imaging revealed mid-wall to sub-epicardial late gadolinium enhancement at the basal to the mid inferior lateral wall of the left ventricle and corresponding hyperintensity on T2-weighted imaging, consistent with acute myocarditis. A diagnosis of acute myocardial injury associated with DMD was made. He was treated with anticongestive therapy and 2 mg/kg/day of oral methylprednisolone. Chest pain resolved the next day, and ST-segment elevation returned to normal on the third day. Troponin T decreased in the sixth hour of oral methylprednisolone treatment. TTE on the fifth day revealed improved left ventricular function. Conclusion Despite advances in contemporary cardiopulmonary therapies, cardiomyopathy remains the leading cause of death in patients with DMD. Acute chest pain attacks with elevated troponin in patients with DMD without coronary artery disease may indicate acute myocardial injury. Recognition and appropriate treatment of acute myocardial injury episodes in DMD patients may delay the development of cardiomyopathy.

ÖzSolunum hastalığına neden olan koronavirüs COVID-19 (SARS-CoV-2) ilk olarak 12 Aralık 2019'da Çin'in Wuhan şehrinde neden olduğu salgın hastalık sırasında tespit edilmiştir ve dünyaya yayılmıştır. Sağlık uzmanları tarafından COVID-19 üzerine yapılan araştırmalar, virüsün doğrudan yayılmasını önlemeye ve enfekte hastaları tedavi etmeye odaklanmıştır. Fakat, bazı çalışmalarda insanların dışkısında, atıksu örneklerinde virüs tespit edilmiş ve atıksu yoluyla olası bulaşma vakaları bildirilmiştir. Bu bağlamda, virüs içeren arıtılmış veya ham atıksular, arıtma çamurları, suyun tekrar kullanımı ve alıcı su ortamlarına deşarj edilmesi ikincil bulaşmaya neden olabileceği göz ardı edilmemelidir. Atıksu arıtma tesislerinin deşarj suları ve geri kazanılmış atıksular yoluyla virüsün yayılmasını engellemek için etkili bir dezenfeksiyon uygulanması bu nedenle önem arz etmektedir. Virüsün çevreye yayılmasını önlemek için atıksudan virüs giderme yöntemleri uygulanmalıdır. Bu nedenle bu çalışmada, virüsün atıksularda bulunabilirliği ve arıtımına yönelik yöntemler ele alınarak mevcut durumu hakkında bilgi verilmiştir.