Children with critical illnesses are at increased risk for intestinal injury, gastrointestinal dysfunction, and feeding intolerance, which are associated with delayed recovery and increased morbidity and mortality during their course in the pediatric intensive care unit (PICU). Optimizing energy and protein delivery significantly reduces the incidence of infectious complications and multiorgan failure in critical illness. Enteral nutrition (EN) is the preferred mode of nutrient intake in patients with critical illnesses. Despite the growing awareness of the benefits of EN in patients with critical illnesses, subsequent maintenance of EN delivery in PICUs remains suboptimal. In children with critical illnesses, little data are reported on the factors that influenced EN. Feeding intolerance in children with critical illnesses may be due to alterations in gastrointestinal motility secondary to underlying disease or medication administration. This study aimed to summarize recent insights into the role of hyperglycemia, EN caloric density, and gastrointestinal feedback mechanism, and routine intensive care management, such as sedation, analgesia, and catecholamine on feeding intolerance in children with critical illnesses.

Objective: Cardiac catheterization and angiography can be performed for diagnostic or interventional purposes in patients with congenital heart diseases. This study aimed to evaluate the outcomes of cardiac catheterization in neonates as a newly established unit. Material and Methods: Records of neonates (under 28 days), who underwent cardiac catheterization and angiography procedures in our clinic between October 2020 and July 2021, were retrospectively reviewed. The demographic data of patients, echocardiographic diagnosis, cardiac catheterization, and angiography indications, and their outcomes were evaluated.
Results: A total of 76 cardiac catheterization and angiography sessions were performed in 66 neonates (34 males and 32 females), and this number constituted 22% of all angiography procedures performed in our hospital during childhood. Patients’ median age and weight were 9 days (range, 1-28) and 3.1 kg (range, 1.7-4.3), respectively. Of the sessions, 88% (67/76) were performed for interventional purposes and 12% (9/76) for diagnostic. In 67 interventional angiography sessions, 74 interventional procedures were performed. The most common interventional procedures were patent ductus arteriosus stenting (n=47/74, 64%); balloon atrial septostomy (n=16/74, 22%); and pulmonary balloon valvuloplasty (n=5/74, 7%). Among the diagnostic procedures, 5 were for postoperative patient evaluation, wherein 3 patients were on extracorporeal membrane oxygenation (ECMO) support. The median procedure and fluoroscopy time were 37 min (range, 9-137) and 468 s (range, 66-2490), respectively. No complications were observed in 64/76 procedures (84%). Hence, complications were observed in 12/76 (16%) procedures, whereas major complications were observed in 8 and minor in 4 procedures. Two patients needed ECMO support in the catheterization laboratory during the procedure. No case died within the first 24 h. One of the two patients, under ECMO, was successfully discharged.
Conclusion: With the advancement in technological amenities, cardiac catheterization procedures, especially interventional procedures, could be performed with low mortality and high success rates in newborns. Diagnostic catheterizations should be performed for highlighting the underlying problems after cardiac surgery, where other diagnostic tools are insufficient.

Objective: Prolonged coagulation test is a common finding before surgery. This study determined the prolonged prothrombin time (PT) and/or activated partial thromboplastin time (aPTT) during the surgical preparation of pediatric patients.
Material and Methods: As a cross-sectional study, 74 children aged 0.25-17 years, who had prolonged preoperative coagulation tests, were included in the Eskiþehir State Hospital Pediatric Hematology and Oncology Clinic between September 3, 2013, and September 16, 2014.
Results: The mean age of the children was 5.6±3.4 years, wherein 60 (81%) cases were male. Adenoid-tonsillar operations were planned in 46%, circumcision in 43%, abdominal operations in 5%, and other operations in 6%. A history of bleeding was found in 7 (10%) of the families and 3 (4%) of the cases. Previous surgery or injury was found in 24 (32%) of the children and did not develop more bleeding than expected. The coagulation tests revealed 22 (30%) patients with prolonged PT (value range: 14-35.1 s), 47 (63%) with prolonged aPTT (value range: 37.1-129.6 s), and 5 (7%) with both prolonged PT and aPTT. A necessary operation was performed in 47 patients who did not have a history of bleeding diathesis in the patient or family, with a normal mixed test and factor levels, and PT of <20 s and aPTT of <63.3 s. No bleeding complications were observed during or after the operation in any of these cases.
Conclusion: Our results revealed that in case of prolonged PT or aPTT values before surgery, no risk of bleeding is encountered during the surgery if a history of bleeding diathesis is not present in the patient or family and factor levels are normal.

Objective: This study aimed to evaluate and compare the risk in detecting cervical intraepithelial neoplasia (CIN) 2+ or higher lesions by performing immediate colposcopy in patients with positive high-risk non-human papillomavirus (HPV) 16/18 subtypes, regardless of their cytology results.
Material and Methods: A total of 264 patients with HPV-positive subtypes, aged 20-65 years, with any type of cervical cytology results were included in the study. A liquid-based cytologic cervical cancer screening with HPV testing was carried out between November 2020 and May 2021. Cytological specimens were classified according to the Bethesda system (2014), and HPV identification was analyzed with Cobas 4800 system. Colposcopy-guided endocervical curettage and endometrial biopsy were performed.
Results: A total of 123 patients had HPV non-16/18 oncogenic types, wherein 34 (69.3%) had no dysplasia, 9 (18.3%) had CIN 1, and 2 (4.08%) had CIN 2-3.
Conclusion: Colposcopic evaluation may be considered in cases of non-16/18 high-risk HPV subtypes with abnormal cytologic results. Among the patients who had negative cervical cytology and positive non-HPV-16/18, 4.08% were women with CIN 2-3. Following the algorithm according to the guidelines, there will be a risk of 4.08% of misdiagnosing CIN 2+ lesions by gynecologists. Organizing large-scale randomized controlled studies will help in understanding the meaning or importance of this topic.

Objective: This study aimed to investigate the relationship between the aortic arch structure classification and the success of endovascular reperfusion therapy in acute ischemic stroke (AIS). Material and Methods: Between January 2018 and December 2018, 207 patients, who were brought to the Stroke Center of Gaziantep University, Þahinbey Research and Practice Hospital due to AIS and who underwent endovascular therapy, were analyzed retrospectively. The demographic features of patients, aortic arch classification, and modified-thrombolysis-in-cerebral-infarction (mTICI) scores used for reperfusion in endovascular therapy were evaluated. Findings were statistically analyzed (p<0.05).
Results: A total of 207 patients underwent endovascular procedures with the mean age was 64.4±13 years, wherein 69 (33.3%) had type 1 aortic arch, 99 (47.8%) had type 2 aortic arch, and 39 (18.8%) patients had type 3 aortic arch, whereas 47 (22.7%) patients had a bovine arch. TICI 2b and above recanalization were achieved in 188 (90.8%) patients after endovascular therapy. At the end of the third month, good clinical outcomes were observed as modified Rankin scale of 0-2 in 78 (37.7%) patients, whereas 61 (29.5%) patients had mortality. The prognosis was worse in patients with type 3 aortic arch structure (p=0.016). Conclusion: Our study revealed that complex aortic arch structure had no negative effect on the success of endovascular therapy. However, the prognosis was poor at the end of the third month in patients with complex aortic arch structures.

This study aimed to focus on using high quality personal protective equipment (PPE). Low quality PPE usage can cause life-threatening problems for health care workers and public health. The coronavirus disease-2019 pandemic has led to a substantial increase in the usage of face mask wordwide. Fabric, surgical, N95, filtration face mask 2 (FFP2), and FFP3 masks are used to avoid the increased risk of transmission. These masks directly contact the skin; therefore, they may cause the inhalation of the filtration fibers on the mask. Thus, the materials and methods used in mask production are an important public health concern. A 37-year-old healthcare worker was admitted to the emergency department with shortness of breath and cough after wearing an FFP3 mask for an hour. The patient presented with following vital signs: Oxygen saturation (SpO2) of 89%, heart rate of 120 beats/min, blood pressure of 89/60 mmHg, and respiratory rate of 25 breaths/min. Stridor and bilateral wheezing were noted on physical examination. Considering that the patient developed an anaphylactic reaction due to the fiber material on the inner surface of the mask worn by the patient, anaphylaxis treatment was administered. Following the treatment, patient’s clinical status had improved and SpO2 reached up to 98%. The patient had a history of atopy; therefore, antihistamines were prescribed and dietary modifications were recommended. We report the first case of anaphylactic reaction in a healthcare worker, resulting from the fiber part of a face mask. When foreign body aspiration is suspected, the possibility of anaphylactic reaction to the aspirated material should also be considered. Our case emphasizes that before using face masks, the inner surface should be checked and it must be intact. Additionally, people with the history of atopy should be more careful in selecting the materials used in masks; they should carefully examine the product they bought. Being competent and careful in the controls during the production phase has a great importance in protecting the lives of healthcare workers.