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Ashman phenomenon is an aberrant ventricular conduction seen in atrial fibrillation. It is due to a change in the length of QRS complex. It is most often mistaken for a premature ventricular contraction (PVC) or ventricular tachycardia. A 15-year-old male patient was admitted to the emergency department with the complaint of palpitation. He had a 3-year history of type 1 diabetes mellitus and he was using isotretinoin for nodular acne for 1 month. His heart rate was 195 beats/min and his electrocardiographic findings were compatible with supraventricular tachycardia (PVC). Adenosine was administered as an intravenous push twice, however, since atrial fibrillation did not return to normal sinus rhythm , he was transferred to our pediatric intensive care unit. After a transesophageal echocardiography showing no thrombus or structural defect, synchronized cardioversion was attempted at escalating doses of 0.5 J/kg, 1 j/kg and 1.5 j/kg dose, but the patient was unresponsive. After the cardioversion, the patient did not return to normal sinus rhythm hence re-evaluated with ECG again. Persisted tachycardia, absence of p waves, similar extra-ventricular beats and unequal R-R distances were observed. This rhythm was found to be compatible with atrial fibrillation and that the supraventricular pulses delivered with the accompanying aberration were Ashman’s phenomena. After infusion of 3 mg/kg, amiodarone was continued 6 mcg/kg/min as maintenance infusion. His rhythm went back to normal. Amiodarone infusion was discontinued at the 48th hour and the patient was transferred to pediatric cardiology service with oral propranolol treatment. The Ashman phenomenon is a very rare condition in childhood and should be distinguished from the series of PVC and sequentially identified supraventricular complexes, due to completely different treatment options.

Septic arthritis is an inflammation of the synovial membrane and synovial fluid in the joints caused by bacterial, viral or fungal agents. Since it has high morbidity rate, requires urgent intervention. The synovial membrane is a highly vascular structure, but because it is not a protective basement membrane, the microorganisms that come through the bloodstream can easily settle here. For this reason, it should be kept in mind that an infection such as septic arthritis may develop in a hematogenous way in patients exposed to many invasive procedures, and having long-term catheter in pediatric intensive care unit. Serratia species are a gram-negative facultative anaerobic population of the Enterobacteriaceae group and have become more common in recent years as a cause of hospital-acquired bacteremia, pneumonia and urinary tract infections in intensive care units. However, primary joint infections secondary to infection with Serratia marcescens are extremely rare. Almost all cases were seen in trauma patients, immunocompromised patients, in those with central catheters and intensive care patients. When septic arthritis due to Serratia marcescens is not treated urgently, septicemia and mortality risk is high and may cause permanent destruction of the joint. Here, we present a rare case of septic arthritis caused by Serratia marrascens after a bacteremia in a patient with Escobar variant of Multiple Pterygium syndrome who had a central vascular access device and was hospitalized in the pediatric intensive care unit.

Introduction: To evaluate the etiology and characteristics of children admitted to the emergency department with an acute convulsive epileptic seizure. Methods: Data of patients who were admitted to the emergency department with a convulsive epileptic seizure were reviewed. The patients were divided into febrile seizure, first idiopathic non-febrile seizure, idiopathic epilepsy, symptomatic epilepsy, and symptomatic seizure groups. Results: A total of 335 children were included in the study. Febrile seizures were the most common cause of convulsive seizure (38.5% of all visits), followed by idiopathic epilepsy-related seizures (35.8%), symptomatic epilepsy-related seizures (8.1%), first non-febrile seizures (17.6%), and symptomatic seizures (1.5%). The mean age of the patients was 4.73 years, and it was significantly lower in patients with febrile seizures when compared to the other groups (p

Antifungal-lock therapy (AfLT) has arrived as an investigational approach for preventing catheter removal with limited clinical evidence of its efficiency. The principle of AfLT consists of catheter lumen replenishment by a selected antimicrobial agent and then locking it for an alternative treatment to eradicate the microbes embedded in endoluminal biofilms. Herein, we report a pediatric hematology-oncology patient with Candida parapsilosis-related central venous access device infection in which catheter removal was performed despite the systemic and intraluminal caspofungin treatment. For now, we recommend higher doses of caspofungin for AfLT especially in Candida parapsilosis-related catheter infections.