Explore the vast range of titles available.

We review oxidative stress-related newborn disease and the mechanism of oxidative damage. In addition, we outline diagnostic and therapeutic strategies and future directions. Many reports have defined oxidative stress as an imbalance between an enhanced reactive oxygen/nitrogen species and the lack of protective ability of antioxidants. From that point of view, free radical-induced damage caused by oxidative stress seems to be a probable contributing factor to the pathogenesis of many newborn diseases, such as respiratory distress syndrome, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, and retinopathy of prematurity. We share the hope that the new understanding of the concept of oxidative stress and its relation to newborn diseases that has been made possible by new diagnostic techniques will throw light on the treatment of those diseases.

Pediatric pneumonia (PP) remains an important topic in undergraduate medical education and offers a suitable framework for evaluating large language models (LLMs) in AI-assisted learning. We developed a 27 open-ended survey including five core domains of PP, such as diagnosis, etiology, diagnostics, treatment, and prevention. DeepSeek V3, Gemini 2.0, and ChatGPT-3.5, were each provided with identical reference materials. Two pediatric infectious disease specialists independently assessed responses using a structured 10-point rubric through Licert, which presents a custom evaluation tool. DeepSeek V3 achieved the highest mean score (9.9), outperforming ChatGPT-3.5 (7.7), and Gemini 2.0 (7.5) through all domains ( p  < 0.001). Moreover, it received a full score in 26 out of 27 questions (96.3%) and achieved an accuracy score of  ≥ 5. In addition, the highest performance appeared in higher-order reasoning areas, including age-specific etiology and imaging interpretation, with DeepSeek V3 outperforming others by up to 3.2 points. While all models demonstrated almost safety, the variability in content quality however highlights the necessity for careful platform selection. Therefore, future research should explore educational outcomes comparing AI-assisted and conventional learning approaches to better define the role of LLMs in medical education.

Summary Background Clinical characteristics, microbiology, treatment and outcomes of Gram-negative bacterial (GNB) meningitis with/without ventriculitis in children are limited. Methods All hospitalized patients with GNB meningitis in a tertiary care university hospital between January 2012 and December 2022 were retrospectively recorded. Results During the 10-year study period, 55 GNB meningitis were identified. The median age was 28 months. The majority were male (65.5%), while 29.1% had a history of prematurity, and 25.5% were primarily diagnosed with malignancy. Acinetobacter spp. (22%) and Pseudomonas spp. (20%) were the leading causative agents of meningitis, followed by Klebsiella spp. (18%) and Escherichia coli . (16%). Neurosurgical operation history in the last month (71%) appears to be one of the most common contributing factors and time from previous neurosurgery to meningitis episode was median 12 days. Both ventriculoperitoneal shunt or external ventricular drainage were present in 45 (82%) cases. While the combination of meropenem and ciprofloxacin was the most commonly used intravenous treatment, colistin was mostly used in five episodes (4/5 survived) intraventricular/intrathecal way. Infection-related mortality was 13% and deaths were commonly seen in cases infected with Acinetobacter spp. , Klebsiella spp. and Escherichia coli. Conclusion Managing GNB meningitis is challenging due to poor CSF penetration of many antibiotics and rising multidrug resistance. Given the evolving resistance patterns, particularly the persistence of penicillin resistance and the emergence of carbapenem resistance, continuous surveillance of antimicrobial susceptibility profiles is essential. This allows for timely adaptation of empiric therapy protocols and supports effective infection control strategies. Although surgical procedures and catheter use were not significantly associated with mortality in our cohort, these remain key risk factors for the development of Gram-negative meningitis and ventriculitis. Therefore, strict adherence to aseptic technique is essential for prevention.

ObjectiveWe aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with multisystem inflammatory syndrome in children (MIS-C) and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country.MethodsChildren (aged <18 years) who diagnosed with MIS-C and severe/critical pediatric cases with COVID-19 and were admitted to hospital between March 26 and November 3, 2020 were enrolled in the study.ResultsA total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C, were included in the study. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only three deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral.ConclusionDifferences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count are reliable diagnostic parameters for MIS-C cases.Key Points• MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe/critical pediatric cases with COVID-19.• Higher CRP and low total WBC count are the independent predictors for the diagnosis of MIS-C.• MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19.

Mechanical ventilation is a lifesaving treatment and has complications such as ventilator associated pneumonia (VAP) that lead to high morbidity and mortality. Moreover VAP is the second most common hospital-acquired infection in pediatric intensive care units. Although it is still not well understood, understanding molecular pathogenesis is essential for preventing and treating pneumonia. A lot of microbes are detected as a causative agent of VAP. The most common isolated VAP pathogens in pediatric patients are Staphylococcus aureus, Pseudomonas aeruginosa, and other gram negative bacteria. All of the bacteria have different pathogenesis due to their different virulence factors and host reactions. This review article focused on mechanisms of VAP with molecular pathogenesis of the causative bacteria one by one from the literature. We hope that we know more about molecular pathogenesis of VAP and we can investigate and focus on the management of the disease in near future.

A Correction to this paper has been published: https://doi.org/10.1007/s10067-021-05692-w

Background Rapid development and global spread of multidrug resistant Klebsiella pneumonia ( K. pneumoniae ) as a major cause of nosocomial infections is really remarkable. The aim of this study was to explore risk factors for health care associated blood stream infections (BSI) caused by ESBL-producing K. pneumoniae in children and analyze clinical outcomes. Methods A retrospective review of patients younger than 18 years-old with blood stream infection caused by K. pneumoniae was performed. Patients with ESBL-producing K. pneumoniae isolates were compared with ESBL-non-producing isolates in terms of risk factors, outcome and mortality. Results Among 111  K. pneumoniae isolates 62% ( n  = 69) were ESBL –producing K. pneumoniae . The median total length of hospitalization and median length of stay in hospital before infection was significantly higher in patients with ESBL-producing isolates than ESBL-non-producing. Use of combined antimicrobial treatment was significantly different between ESBL-producing and ESBL-non-producing groups, 75.4% and 24.6%, respectively ( p  = 0.001). Previous aminoglycoside use was higher in cases with ESBL –producing isolates ( p  = 0.001). Logistic regression analysis showed a significant correlation between mortality and use of combined antibiotics (OR 4.22; p  = 0.01). Conclusion ESBL production in K. pneumoniae isolates has a significant impact on clinical course of BSIs. Total length of hospitalization, length of hospital stay before infection, prior combined antibiotic use and use of aminoglycosides were significant risk factors for development of ESBL-producing K. pneumoniae related BSI.

The coronavirus disease pandemic is a major problem that the world has been facing since December 2019. It mainly affects the respiratory system; however, the disease can affect the kidneys to different degrees. This study aimed to determine the changes in tubular dysfunction and inflammation parameters in children with coronavirus disease using urine biomarkers. We included 36 children who tested positive for severe acute respiratory syndrome coronavirus 2 on real-time reverse transcriptase-polymerase chain reaction using respiratory specimens. Coronavirus disease-positive and -negative period parameters were evaluated. For measurement of interleukin-1β, interleukin-6, and urine β2 microglobulin levels, patients' urine samples were collected at diagnosis and 1 month after discharge. Additionally, routine urine and hematological parameters were evaluated concurrently. For all patients, the median urine β2 microglobulin, serum urea, and lactate dehydrogenase levels were significantly higher in the coronavirus disease-positive period than in the coronavirus disease-negative period (P < .05). Further, serum platelet count was significantly lower in the coronavirus disease-positive period than in the coronavirus disease-negative period (P < .05). However, there was no difference in serum creatinine, interleukin-6, or interleukin-1β levels between the 2 periods (P > .05). Our results suggest kidney involvement and tubular dysfunction in patients with asymptomatic, mild, and moderate infections. Furthermore, interleukin-1β and interleukin-6 levels were high in the urine, even in non-critically ill patients. We believe that these findings contribute to the accumulation of evidence on continued inflammation in the kidney.

Objective: Seasonal influenza is an acute viral respiratory tract infection which exhibits annual epidemics worldwide and effects all age groups. Surveillance studies provide monitoring annually circulating viruses. In addition, virus types can be determined in such period targeting patient-based diagnosis. The present study aims to evaluate the effect of duration of the viral classification studies in the laboratory on treatment planning in cases hospitalized due to influenza- like symptoms.Material and Methods: Children younger than 18 years of age, hospitalized due to symptoms that might be associated with influenza infection between the December 2015 and April 2016 influenza season were tested for Influenza A and Influenza B viruses in nasopharyngeal swab sampling. Demographic characteristics, duration of symptoms, duration to get the viral detection results (polymerase chain reaction: PCR) in the laboratory, and duration of hospitalization were evaluated.Results: A total of 132 pediatric patients were included in the study and the median age was 27.1 months (IQR (interquartile range): 4-99.7). Fifteen patients (11.3%) were influenza positive by PCR. Empirical oseltamivir treatment was given to 22% of the patients. Among the fifteen patients (11.3%) who were positive for influenza virus, six were administered empirical oseltamivir within the first 48 hours of admission, before the laboratory results were obtained and no antiviral was administered to the others found influenza positive. At the admission, the median symptom duration was 2 days (IQR: 1-4) whereas median hospitalization duration was 7 days (IQR: 4-11). The median duration to get the laboratory results was 8 days (IQR: 6.2-10).Conclusion: Waiting for the laboratory results may take time In the seasonal Influenza Infection period for patients with Influenza symptoms and findings requiring hospitalization and this is not an effective method in influenza control. Thus, starting the treatment should be preferred at admission, and in the first 48 hours in indicated cases.