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    Are thyroid functions affected in multisystem inflammatory syndrome in children?
    (Galenos Publication System, 2022) Elvan-Tuz, Ayşegül; Ayrancı, İlkay; Ekemen-Keleş, Yıldız; Karakoyun, İnanç; Çatlı, Gönül; Kara-Aksay, Ahu; Karadağ-Öncel, Eda; Dündar, Bumin Nuri; Yilmaz, Dilek
    Introduction: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 is defined as the presence of documented fever, inflammation, and at least two signs of multisystem involvement and lack of an alternative microbial diagnosis in children who have recent or current SARS-CoV-2 infection or exposure. In this study, we evaluated thyroid function tests in pediatric cases with MIS-C in order to understand how the hypothalamus-pituitary-thyroid axis is affected and to examine the relationship between disease severity and thyroid functions. Material and methods: This case-control study was conducted in our clinic between January 2021 and September 2021. The patient group consisted of 36 MIS-C cases, the control group included 72 healthy children. Demographic features, clinical findings, inflammatory markers, thyroid function tests, and thyroid antibody levels of MIS-C cases were recorded. Thyroid function tests were recorded in the healthy control group. Results: When MIS-C and healthy control groups were compared in terms of thyroid hormones, free triiodothyronine (FT3) level was lower in MIS-C cases, while free thyroxine (FT4) level was found to be lower in the healthy group (p=<0.001, p=0.001, respectively). Although the FT4 level was statistically significantly lower in the healthy group, no significant difference was found compared with the reference intervals according to age (p=0.318). When compared to the MIS-C cases without intensive care requirement, FT3 levels were also lower in MIS-C cases admitted to the intensive care unit and received steroid treatment (p=0.043, p=<0.001, respectively). Discussion: In conclusion, since the endocrinological system critically coordinates and regulates important metabolic and biochemical pathways, examination of this system may be beneficial for MIS-C. In our study, low FT3 levels were associated with both the diagnosis of MIS-C and severe clinical presentation. Further studies are needed to predict the prognosis and develop a long-term follow-up management plan.
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    Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study)
    (Springer, 2023) Yilmaz, Dilek; Keles, Yildiz Ekemen; Emiroglu, Melike; Duramaz, Burcu Bursal; Ugur, Cuneyt; Kocabas, Bilge Aldemir; Celik, Talyan
    Purpose Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU).Methods This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented.Results A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells x mu L, platelet count 153 vs. 212 cells x 10(3)/ mu L, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 mu g/L, ferritin 644 vs. 334 mu g/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log d-dimer (mu g/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care.
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    A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey
    (Springer, 2023) Yilmaz, Dilek; Ustundag, Gulnihan; Buyukcam, Ayse; Sali, Enes; Celik, Umit; Avcu, Gulhadiye; Belet, Nursen
    This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027). Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs.