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Cardiac involvement is a common and serious problem in multisystem inflammatory syndrome in children (MIS-C). Echocardiographic evaluation of systolic and diastolic function by traditional, tissue Doppler and three-dimensional (3D) echocardiography was performed in consecutive 50 MIS-C patients during hospitalization and age-matched 40 healthy controls. On the day of worst left ventricular (LV) systolic function (echo-1), all left and right ventricular systolic function parameters were significantly lower (p

Amaç: Bu çalışmada pandemi döneminde; sosyal izolasyon, alınan önlemler ve hastane protokollerinin üçüncü basamak pediatrik yoğun bakım pratiğine etkisini araştırmak amaçlanmıştır. Gereç ve Yöntem: Çalışmamıza; 15 Mart 2020-1 Haziran 2020 tarihleri arasında çocuk yoğun bakım ünitemize kabul edilen çocuk hastalar dahil edildi. Hastaların demografik özellikleri, yatış tanıları, mekanik ventilatöre bağlanma oranları, mekanik ventilatörde kalış süreleri, ÇYBÜ ve hastane yatış süreleri, PRİSM III skorları ve mortalite durumları medikal dosya verilerinden retrospektif olarak kaydedildi. Elde edilen veriler pandemiden önceki yılın aynı dönemiyle (15 Mart 2019 – 1 Haziran 2019) karşılaştırıldı. Bulgular: Pandemi döneminde ÇYBÜ’ne kabül edilen hasta sayısı 200’dü. Pandemi öncesi (2019) dönemde 379 hasta yatışı olmuştu. ÇYBÜ’ne kabül edilen hasta sayısında pandemi döneminde bir önceki yıla göre %47 oranında bir düşüş saptadık. Pandemi öncesi dönem ile pandemi dönemi; hastaların yoğun bakıma yatış tanıları açısından karşılaştırıldığında, solunum yolu hastalıkları (pnömoni, bronşiolit, astım vb.) ve post-op hasta yatışlarında azalma, diabetik ketoasidoz nedeni ile yatışlarda artış saptandı ve istatistiksel olarak anlamlı farklılık vardı. Ayrıca hastaların pandemi döneminde mekanik ventilatörde kalış süreleri, hastanede kalış süreleri ve yoğun bakımda kalış sürelerinde azalma saptadık ve bu durum istatistiksel olarak da anlamlıydı. Sonuç: Sosyal mesafenin, maske kullanmanın ve hijyen kurallarına uyumun enfeksiyon bulaş riskini azalttığını ve bu durumun yoğun bakım yatış sayısında azalmaya neden olduğu tahmin etmekteyiz. Buradan yola çıkarak; sosyal mesafeye ve el hijyenine uyumu belki de hayatımızın bir parçası olarak kabul edip, bulaş riskinin yüksek olduğu kreş ve okullarda ileriki dönemlerde buna yönelik düzenlemelerin yapılması gerektiğini vurgulamak istiyoruz.

Tetanus is an acute-onset disease that results from exposure to the exotoxins produced by Clostridium tetani. It is characterized by tonic muscle spasms and has high morbidity and mortality. Respiratory failure is the most severe problem related to generalized tetanus. Mechanical ventilation is almost always mandatory for the therapy of respiratory insufficiency in patients with tetanus-developed airway obstruction. The patient presented herein was 15 years old and unvaccinated, and had generalized tetanus and respiratory failure. He was transported to pediatric intensive care unit following intubation. In this report, we aimed to present the follow-up and treatment of a patient with severe tetanus in pediatric intensive care unit.

Background: Water-pipe smokers are exposed to several toxicants, including carbon monoxide (CO), causing potential health effects. Objectives: The aim of the study was to investigate demographic features and exhaled CO levels of water pipe smoking (WPS) young. Methods: The study was implemented at the outdoor areas of WPS cafes, in Ankara, in August. Demographic characteristics and exhaled CO levels of young were detected before and after one hour of WPS. Findings:. Mean exhaled CO levels before and after WPS were 1.4±1.2 ppm (min 0.1-max 5.6) and 9.4±5.3 ppm (min 3-max 25), respectively (p=0.001). Males and cigarette smokers had higher mean exhaled CO levels, before WPS (p=0.033 and p=0.001, respectively). A significant correlation was detected between duration of WPS and with exhaled CO levels before (p=0.005, r=0.363) and after WPS (p=0.039, r=0.270). In association with the rise in daily number of cigarettes, a rise in exhaled CO levels was detected after WPS (p=0.044, r=0.383). Conclusions: In Ankara, nearly half of WPS young are also cigarette smokers, are mostly students or unemployed, and WPS is perceived as a social event. Mean post-WPS levels were lower compared to previous studies, because study was conducted in the open and non-polluted air. Males, cigarette smokers and longer years of WPS practice are associated with higher mean exhaled CO levels, suggesting that these groups are subject to more health detriment risks caused by CO exposure. Large cohort studies, especially targeting high-risk groups are needed in understanding how to curb WPS and take environmental and policy controls.

Monosymptomatic nocturnal enuresis (MNE) is defined as involuntary nighttime urination of children over five years of age without any congenital or acquired defect in the central nervous system. Many factors, mainly nocturnal polyuria, sleep disorders, decreased bladder capacity, and bladder dysfunctions play a role in the etiology of MNE.Eighty-three children diagnosed with MNE were included in the study. Complete blood cell count, blood biochemistry, renin, and aldosterone levels of all children were obtained. Twenty-four-hour urine samples were collected separately daytime and nighttime and urinary electrolytes were evaluated. Also, 24-hour ambulatory blood pressure monitoring (ABPM) was performed for each patient. The results were evaluated by comparing both enuretic children vs. control group and enuretic children with polyuria vs. without polyuria.When we compared the enuretic children and the control group in terms of urinary electrolytes, the fractional excretion of sodium (FENa) and fractional excretion of potassium (FEK) values of the enuretic group were higher than the control. The evaluation of the 24-hour ABPM findings revealed no significant difference in terms of the mean arterial pressure (MAP) and diastolic blood pressure (DBP) during the daytime and nighttime measurements. The daytime systolic blood pressure (SBP), however, was significantly lower in the enuretic group. When enuretic children with and without polyuria and the control group were compared, the nighttime, FENa, FEK, as well as nighttime urinary excretion of calcium and protein were significantly higher in enuretic children with polyuria. No difference was detected on the MAP, SBP, or DBP values.In conclusion, the nighttime urinary solute excretion of enuretic children was found to be higher and this condition may especially be associated with pathogenesis of nighttime polyuria. In enuretic children, nighttime blood pressure changes were not influential in the etiopathogenesis in all patient groups and multiple mechanisms may play a role in the pathogenesis of enuresis.

Amaç: Çocuklarda SARS-Cov-2 enfeksiyonu sonrasında ateş, kardiyojenik şok ve hiperinflamasyon bulguları ile gelişen multisistem inflamatuar sendrom tablosu yaşamı tehdit edici olabilmektedir. Bu çalışma ile multisistem inflamatuar sendrom tanısı alan hastaların başvuru şikayet ve sürenin hastalık şiddetine etkisini araştırmak amaçlandı.Gereç ve yöntem: Eylül 2020-Ağustos 2021 tarihleri arasında merkezimizde Hastalık Kontrol ve Önleme Merkezleri (CDC) vaka tanımı ile multisistem inflamatuar sendrom tanısı alan 99 çocuk hasta tıbbi kayıtları geriye dönük olarak değerlendirildi. Demografik özellikleri, başlangıç klinik bulguları, başvuru süreleri not edildi. Hastalar yoğun bakım ihtiyacına göre sınıflandırıldı.Bulgular: Hastaların medyan yaşı 10 (6-14) ve %62,6’sı erkekti. Tanıdan önceki medyan semptom süresi 4 (3-5) gündü. Başvuru sırasında hastaların tümünde ateş, %81,8’inde gastrointestinal ve %75,8’inde kardiyovasküler tutulum mevcuttu. Ağır ve orta şiddette MİS-C olarak değerlendirilen %56,6 hastanın yoğun bakım gereksinimi oldu. Ateş süresinin uzun olması, sağlık kuruluşuna gecikmiş başvuru, hastanın kardiyovasküler etkileniminin ön planda olması, yüksek inflamatuvar belirteçler, lenfopeni ve trombositopeni varlığı yoğun bakım gereksinimini etkileyen önemli parametreler olarak bulundu.Sonuç: Çocuklarda multisistem inflamatuar sendrom, SARS-CoV-2 enfeksiyonu ile ilişkili ateş, inflamasyon belirtileri ve organ disfonksiyonu ile karakterize yeni bir hastalıktır. Gecikmiş başvuru ile uzamış ateş, ilk başvuru anında kardiyak ve inflamatuar belirteçlerin yüksek olması yoğun bakım gereksinimini artırmaktadır., Purpose: Multisystem inflammatory syndrome that occurs after SARS-Cov-2 infection with fever, cardiogenic shock and hyperinflammation in children, can be life threatening. In this study, it was aimed to investigate the effects of the complaint and duration at diagnosis on the severity of multisystem inflammatory syndrome in children.Materials and methods: The medical records of 99 pediatric patients, who were diagnosed multisystem inflammatory syndrome between September 2020 and August 2021 according to Centers for Disease Control and Prevention, were evaluated retrospectively. Demographic features, initial findings, and admission time of patients were noted. Patients were categorized according to intensive care necessity.Results: The median age of the patients was 10 (2-18) and 62 (62.6%) of patients were male. The median duration before admission was 4 (1-10) days. All patients has fever, 81.8% had gastrointestinal and 75.8% had cardiovascular involvement at admission. The patients (56.6%) who were accepted as severe and moderate MIS-C required intensive care. Prolonged fever, delayed admission, cardiovascular involvement, high inflammatory markers, lymphopenia and thrombocytopenia were found to key parameters determining the need for intensive care.Conclusion: Multisystem inflammatory syndrome in children is a new disease characterized by fever, signs of inflammation and organ dysfunction associated with SARS-CoV-2 infection. Delayed admission, high cardiac and inflammatory markers at diagnosis increase the need for intensive care.

Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.

The aim of this study was to compare the clinical and laboratory findings in SARS-CoV-2 (COVID-19) with those of other respiratory viruses in critically ill children.It is a single center retrospective descriptive study conducted in a 32-bed pediatric intensive care unit (PICU). Our study was performed in Ankara City Hospital, Ankara, Turkey, between 1 March 2020, and 1 March 2021. Demographic and clinical characteristics of the patients were collected and we recorded the antibiotic use, antiviral treatments, respiratory and extracorporeal supports, PICU stay and survival rates.A total of 202 pediatric patients who tested positive for either COVID-19 or for another respiratory virus panel (RVP) were included in the study. Seventy-two patients were COVID-19 positive. The median age of COVID-19 positive patients and RVP positive patients was 97 and 17 months, respectively. Hypoxia was much more common in patients with RVP than in COVID-19 patients. Low oxygen saturation in arterial blood (SaO2), increased oxygen saturation index (OSI) and fraction of inspired oxygen (FiO2) needs were more significant in RVP patients than in COVID-19 patients. Respiratory support therapies, such as high-flow nasal cannula and non-invasive ventilation (NIV), were used more frequently in RVP patients than in COVID-19 patients.It is important to distinguish between COVID-19 and RVP cases in order to prioritize intensive care needs in these patients. In addition, non-Covid diseases should not be left aside in the pandemic and appropriate care should be provided to them.COVID-19 originated in Wuhan, China, at the end of 2019 and has since spread around the world. During the key period of the pandemic from 1 March 2020, to 1 March 2021, the pediatric intensive care unit registered a total of 72 patients testing positive for SARS-CoV-2 and 130 patients positive for RVP on the respiratory virus panel. In this single-center study, we compared the clinical differences and course of the disease in pediatric intensive care patients infected with SARS-CoV-2 with patients diagnosed with respiratory tract viruses during the COVID-19 outbreak. Unlike previous studies, this is the first to compare the clinical manifestations of COVID-19 with other respiratory pathogens requiring intensive care. Respiratory support therapy, such as high-flow nasal cannula (HFNC) and NIV, was prescribed more frequently in RVP patients than in COVID-19 patients. In our study, low oxygen saturation in the arterial blood (SaO2), increased OSI and increased fraction of inspired oxygen (FiO2) requirements were more significant in RVP patients than in COVID-19 patients. In parallel, the need for mechanical ventilation was higher in RVP patients than in COVID-19 patients. Therefore, we believe that RVP patients should be followed more carefully during this pandemic period.

Amac: Bu calismada iki yillik sure icinde hastanemiz yogun bakimimiza kabul edilen zehirlenme olgularinin demografik ozelliklerini, zehirlenme nedenlerini, yogun bakimdaki prognozlarini ve kalis surelerini, mekanik ventilator ve ekstrakorporeal destek tedavisi gereksinimlerini degerlendirmeyi amacladik. Gerec ve Yontemler: Yogun bakim unitemize 1 Ocak 2017- 31 Aralik 2018 tarihleri arasinda kabul edilen 138 hastanin yas ve cinsiyet dagilimlari, zehirlenme nedenleri, acil servise basvuru sureleri ve acil servisten yogun bakima alinma sureleri, yogun bakimda ve hastanede kalis sureleri geriye donuk arastirildi. Bulgular: Zehirlenme nedeni ile yogun bakima kabul edilen 138 hastanin 74'u (%53,6) kiz, 64'u (46,4) erkekti. Yas ortalamasi 118,4 (8-218 ay) aydi. Olgularin %34,8', kaza, %50,8'i ozkiyim amacli ve %14,4'u keyif verici madde sonucu zehirlenmeydi. Hastalarin 106‘i (%76,8) ilaclarla, 32’si (%23,2) ilac disi maddeler ile zehirlenmisti. Ilac iliskili zehirlenmelerde santral sinir sistemi ilaclari en sik rastlanan ajan iken, ilac disi etkenlerden en sik sentetik kanabinoidler gozlendi.Antidepresan ilaclar en sik neden olarak saptandi. Yogun bakimda ortalama kalis suresi 2,2 gun (1-24 gun)'du. Mortalite orani %2,1'di. Tartisma: Cocukluk cagi zehirlenmeleri hastaneye basvurularin en sik nedenlerinden biridir.. Zehirlenmenin erken farkedilmesi ve uygun tedavi yaklasimlari hayat kurtaricidir. Aile egitimi, ilaclarin cocuklarin ulasamayacagi yerlerde saklanmasi, recetesiz ilac satilmamasi gibi koruyucu onlemler onemlidir. Calismamizda keyif verici maddeler ile zehirlenme orani yuksek bulunmustur. Bu artisin azaltilmasi icin cevre bilinci ve devlet denetimlerin arttirilmasi gerekmektedir.

Amaç: Bu çalışmanın amacı, pediatrik yoğun bakım takibi gereken travma hastalarında, travma nedenlerini ve klinik seyrini incelemek ve mülteci çocuklar özelinde demografik özellikler, travma oluşum mekanizması, travma şiddeti ve prognoz açısından olası farklılıkları değerlendirmektir.Gereç ve Yöntemler: 1 Mayıs 2020-30 Nisan 2021 tarihleri arasında çocuk yoğun bakım ünitemize travma ön tanısı ile başvuran 175 hastanın kayıtları geriye dönük olarak incelendi. Hastalar Türk vatandaşları ve Suriye vatandaşları (mülteci hastalar) olarak iki gruba ayrıldı. Elde edilen veriler bu iki grup arasında karşılaştırıldı.Bulgular: Hastaların 119’u (%68) T.C. vatandaşı ve 56’sı (%32) mülteci hastaydı. T.C. vatandaşı hastaların ortanca yaşı 6 (3-12; IQR) ve mülteci hastaların ortanca yaşı 4 (2-10; IQR) olarak saptandı (p=0.092). T.C. vatandaşlarının 70’i (%58.8), mülteci hastaların 43’ü (%76.8) erkekti (p=0.027). Araç içi trafik kazası T.C. vatandaşların 27’sinde (%22.7), mülteci hastaların 4’ünde (%7.2) görüldü ve farklılık istatistiksel olarak anlamlı bulundu (p=0.011). Mülteci hastalardaki araç dışı trafik kazası oranı T.C. vatandaşlarına göre daha fazlaydı (%23.2 ve %10; sırasıyla) (p=0.035). Travma nedeni ile 10 hasta hayatını kaybetmişti. Ölen hastaların yedisi (%5.8) T.C. vatandaşı, üçü (%5.3) göçmendi.Sonuç: Çalışmamızda mülteci çocuklarda araç dışı trafik kazasının daha fazla görüldüğünü ancak her iki grupta klinik olarak bir fark olmadığını saptadık. Göçmen sorunlarının daha dikkatli değerlendirilmesi, çocuk nüfusuna odaklı projeler ve çalışmalar, sosyo-ekonomik koşullarının iyileştirilmesi, eğitim sistemine düzenli katılımın sağlanması yaralanma oranlarını azaltabileceğini düşünmekteyiz., Objective: This study aimed to examine the causes and clinical course of trauma in trauma patients requiring pediatric intensive care unit (PICU) follow-up and evaluate possible differences related to demographic characteristics, trauma mechanism, trauma severity, and prognosis in refugee children.Material and Methods: The records of 175 patients admitted to our PICU between May 1, 2020 and April 30, 2021 with a preliminary diagnosis of trauma were retrospectively reviewed. The patients were divided into two groups as Turkish citizens and Syrian citizens (refugee children). The obtained data were compared between these two groups.Results: 119 (68%) were Turkish citizens and 56 (32%) were refugees. The median age of the Turkish citizens was 6 (3–12; IQR) years and the median age of the refugee patients was 4 (2–10; IQR) years (p = 0.092). Further, 70 (58.8%) of the Turkish citizens and 43 (76.8%) of the refugee patients were males (p = 0.027). In-vehicle traffic accidents were observed in 27 (22.7%) of the Turkish citizens and 4 (7.2%) of the refugee patients, with the difference being statistically significant (p = 0.011). The rate of non-vehicle traffic accident in the refugee patients was higher than that in the Turkish citizens (23.2% and 10%, respectively) (p = 0.035). Ten patients died due to trauma, of which 7 (5.8%) patients were Turkish citizens and 3 (5.3%) were refugee patients.Conclusion: In our study, we found that non-vehicle traffic accidents were more common in refugee patients, but there was no clinical difference between Turkish citizens and refugee patients. We think that more careful evaluation of immigrant problems, projects, and studies focused on the child population, improvement of socioeconomic conditions, and regular participation in the education system can reduce injury rates.

OBJECTIVE: Although the initial reports of coronavirus disease (COVID-19) cases in children described that children were largely protected from severe manifestations, clusters of pediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease (KD), toxic shock syndrome (TSS), and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome (MAS). Our objective was to develop a protocol for the evaluation, treatment, and follow-up of patients with MIS-C. METHODS: The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of pediatric critical care, cardiology, rheumatology, surgery, gastroenterology, hematology, immunology, infectious disease, and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. CONCLUSION: Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a pediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C.

We aimed to evaluate the characteristics and outcomes of critically ill children managed in an intensive care unit because of coronavirus disease (COVID-19) pneumonia with respiratory support requirements.We performed a single-center retrospective observational study in a pediatric intensive care unit (PICU) with 32 beds in Ankara City Hospital, Ankara, Turkey, from 13 March 2020 to 31 December 2020. Patients who needed positive-pressure ventilation (PPV) therapy for COVID-19 pneumonia were included in the study. Demographic, clinical and laboratory data were extracted from the patients' electronic medical records. As outcomes, the hospitalization rate of all pediatric patients diagnosed as having with COVID-19 by Polymerase Chaın Reactıon(PCR), PICU admission rate for COVID-19 pneumonia among all hospitalized patients, PPV support rate, intensive care hospitalization duration (days), total hospitalization duration (days), survival rate and tracheotomy requirement were evaluated.During the study period, 7033 children tested positive for COVID-19 in PCR tests. Of these patients, 1219 were hospitalized for COVID-19. Seventeen patients needed PPV support because of COVID-19 pneumonia. High proportion (65%) of patients admitted to the PICU had comorbid diseases. Noninvasive ventilation was applied in 15 patients (88%). The hospitalization rate among the children with COVID-19 was 17%, of whom 1.6% were admitted to the PICU. Mortality rates were 0.056% of all the cases and 0.32% of the hospitalized patients in our hospital.The presence of a comorbid disease could be a sign of severe disease in children with higher lethality. Very few children required PPV support because of severe COVID-19 pneumonia.Coronavirus disease (COVID-19) spread from Wuhan, China, and caused an outbreak that threatened human health globally. Reports worldwide have shown that the outbreak mainly affected the adult population. Data about severe COVID-19 pneumonia in children are limited. Treatment interventions for the adult population have been adapted for children. Our article was aimed at building an opinion about this patient group. We found that severe COVID-19 pneumonia occurred in only a small population. Cardiac and neurological comorbidities are associated with higher mortality rates. Only a few patients with COVID-19 required mechanical ventilation support.

Purpose: Successful resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. This study aimed to determine the knowledge, skills, and attitudes of the pediatric healthcare professionals about the defibrillator use and to offer solutions if there was room for improvement. Procedures: This was a multicenter survey study. Findings: The study included 716 healthcare professionals with an average age of 30.1 ± 5.8 years; 50% (n=358) were pediatric residents and 41.3% (n=296) had less than three years of professional experience. Self-declared level of knowledge about defibrillation/cardioversion was low-to-medium for 66.5% (n=476); 60.8% (n=435) had never practiced these procedures and 22.2% (n=159) had never received any training about defibrillator use. There was a significant relationship between professional experience and the proportion of participants who correctly responded to the first-shock dose for defibrillation but not for cardioversion. Conclusion: Professional experience is crucial in the correct defibrillator use. However, the defibrillation/cardioversion procedures are prone to errors since they are not commonly applied in day to day practice. An ideal approach to improve the experience of personnel could be to use practical training with case-based simulations and to educate the personnel about the features of the defibrillators available in their clinics.

We aim to evaluate urinary total BPA (tBPA) levels and association with medical devices used on patients in pediatric intensive care units. This cross-sectional descriptive study included 117 critically ill children. Urinary tBPA levels were determined using high-performance liquid chromatography. General estimating equations with repeated measures analyzed the effect of interventions and devices on urinary BPA levels. A total of 292 urine samples taken from 117 child intensive care patients were studied. When age, sex, and body mass index-for age z-scores were controlled, cases having endotracheal intubation showed higher urinary tBPA levels (p = 0.003) and hemodialyzed patients had considerably higher urinary tBPA levels (p = 0.004). When confounding factors were controlled, cases using both multiple iv treatment and more than four medical devices showed higher urinary tBPA levels than their counterparts (p = 0.007 and p = 0.028, respectively). The use of certain medical devices and interventions could increase BPA exposure in pediatric intensive care patients.

Konjenital muskuler distrofiler (KMD) nadir görülen, infant döneminde kas güçsüzlüğü ve motor gelişimde gecikme ile kendini gösteren bir grup hastalıktır. Bunların en ağır formlarından biri Walker Warburg Sendromu (WWS)' dur. WWS otozomal resesif geçişli, beyin ve göz anomalilerinin eşlik ettiği bir hastalıktır. Beyinde tip 2 lizensefali, beyaz cevherde hipomyelinizasyon, hidrosefali, korpus kallosum agenezisi, gözde katarakt, optik sinir displazisi, retinal displazi, lens defektleri görülür. Destek tedavisi verilse de oldukça mortal seyreder, ortalama yaşam ömrü dört ay civarındadır. Burada, klinik ve görüntüleme yöntemleriyle WWS düşünülen, kas biyopsisinde alfa distroglikan eksikliği görülerek tanısı desteklenen bir olgu sunulmuştur.

OTO, ARZU/0000-0003-0229-2759; Sevketoglu, Esra/0000-0002-8330-2877, WOS: 000496521400006, PubMed: 31435144, Objectives:To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p = 60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.

Emeksiz S, Kutlu NO, Alacakir N, Caksen H. A case of steroid-resistance Hashimoto's encephalopathy presenting with sensorimotor polyneuropathy. Turk J Pediatr 2018; 60: 310-314. Hashimoto`s encephalopathy (HE) is a rare, auto-immune disease characterized by symptoms of acute or subacute encephalopathy associated with increased anti-thyroid antibody levels. The course of most HE cases is relapsing and remitting, which is similar to that of vasculitis and stroke. Steroids are the first line treatment in HE. In steroid non-responders other immunomodulatory therapies or plasmapheresis could be applied. We report a case of steroid-resistance HE with sensorimotor polyneuropathy, as a rare presentation of this disorder. Our case showed that HE may present with sensorimotor polyneuropathy; therefore HE should be considered in the differential diagnoses of polyneuropathy.

Objective: The use of therapeutic plasma exchange (TPE) in pediatric intensive care units (PICUs) has increased in recent years. In this study, we retrospectively report and discuss therapeutic plasmapheresis management in the intensive care unit of a children’s hospital. Material and Methods: Demographic, clinical and laboratory data of the patients who were subjected to TPE between 1 January 2016 and 1 June 2018 were obtained from the hospital information system and medical records. Results: A total of 190 sessions of therapeutic plasma exchange was performed on 43 patients (Male:Female ratio of 1:1.26). The median age of the patients was 99 months (range 6-214 months). The most common indication was sepsis-related multiple organ failure (n:23, 53.5%). All procedures were conducted using the cell-separator centrifugal method. The ratio of complications during manipulations was 5.7%. No life-threatening complication associated with the therapeutic plasma exchange procedure was observed. The outcome of treatment was complete recovery in 38 (88.4%) patients. Conclusion: Therapeutic plasma exchange can be used as an important treatment method in critically ill patients in pediatric intensive care units. The procedure can be safely performed in children., Amaç: Pediatrik yoğun bakım ünitelerinde terapötik plazma değişimi (TPD) uygulamaları son yıllarda artmıştır. Çalışmada, bir çocuk hastanesi yoğun bakım ünitesinde terapötik plazma değişimi uygulamalarımızı geriye dönük olarak araştırmayı ve literatür bilgisi ile tartışmayı amaçladık. Gereç ve Yöntemler: 1 Ocak 2016 - 1 Haziran 2018 tarihleri arası terapötik plazma değişimi uygulanan hastalara ait demografik, klinik ve laboratuvar verileri hasta dosyaları ve hastane otomasyon sistemi kayıtlarından elde edildi. Bulgular: 43 hastaya toplam 190 seans terapötik plazma değişimi uygulandı. Erkek:Kız oranı 1:1.26, ortanca yaş 99 ay (6-214 ay )’dı. En sık endikasyon sepsis ilişkili çoklu organ yetmezliği (23 hasta, %53.5) olarak bulundu. Tüm işlemler hücre ayırıcı santrifüj yöntemi kullanılarak yapıldı. İşlemler sırasında %5.7 işlemde komplikasyon görüldü. Hiçbir hastada plazmaferez işlemi ile ilişkili yaşamı tehdit edici bir komplikasyon gelişmedi. Terapötik plazma değişimiyle 38 (%88.4) hastada tam iyileşme görüldü. Sonuç: Çocuk yoğun bakımda yatan kritik hastaların tedavisinde terapötik plazma değişimi kullanımı önemli bir destek tedavidir ve klinik iyileşmede önemli rol oynar. Ayrıca çocuk hastalarda güvenle uygulanabilmektedir.

Spontaneous pneumomediastinum (SPM), is a rare and benign entity in the pediatric population. Alveolar rupture as a result of increased intrathoracic pressure due to an asthma attack, vomiting or Valsalva maneuvers (e.g., forceful cough, shouting), is the most frequent reason. Here, we report a 14-year-old male patient who presented to the pediatric emergency department with chest pain and was diagnosed with SPM, and discuss the clinical and radiological characteristics as well as the management of SPM., Spontan pnömomediastinum (SPM), çocukluk çağında nadir görülen genellikle iyi seyirli bir durumdur. İntratorasik basıncın artmasına neden olan astım atağı, kusma veya valsalva manevraları (öksürük, bağırma) sonucunda gerilen alveollerin rüptürü en sık nedenidir. Burada, şiddetli göğüs ağrısı nedeniyle çocuk acil servise başvuran ve akciğer grafisinde pnömomediastinum saptanan 14 yaşında bir erkek hasta sunulmuş, bu olgudan yola çıkılarak klinik ve radyolojik özellikleri ile birlikte SPM olgu yönetimi tartışılmıştır.

Posterior reversible encephalopathy syndrome is characterized by hypertension, seizure, headache, clouding of consciousness, and visual disturbance, and is diagnosed in the presence of typical lesions on magnetic resonance imaging. We retrospectively evaluated five patients who were diagnosed as having posterior reversible encephalopathy syndrome and followed up in Meram Medical Faculty, Pediatric Intensive Care and Hematology wards, between January 2010 and January 2014. We reviewed the demographic and clinical data, and neuroimaging findings. The primary diseases of the subjects included acute lymphocytic leukemia (n=2), Henoch-Scholein purpura (n=1), systemic lupus erythematous (n=1), and acute poststreptococcal glomerulonephritis (n=1). The mean age was 10 +/- 4.58 years (range, 5-14 years). Acute elevation of blood pressure was found in all patients (n=5). Initial neurologic manifestations included seizure, clouding of consciousness, headache, and visual disturbance. After the diagnosis was made through clinical evaluations and magnetic resonance imaging, complete clinical recovery was obtained in all patients with the appropriate therapeutic approach. In conclusion, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with encephalopathy and underlying diseases such as nephritis, vasculitis, malignancy accompanied by hypertension, and a history of use of medication.

A ve B ureten Stafilakokus Aureus tarafindan olusur, cogunlukla yenidogan ve cocuklarda gorulur. Komplikasyonlar zamaninda tedavi edilmediginde ortaya cikabilir. Cocuklarda mortalite orani yaklasik %4’tur. Bu yazida aldigi kemoterapi tedavisinin yedinci gununde cildinde soyulma gorulen fibrosarkom tanili 42 gunluk erkek bebek sunuldu. Nikolsy belirtisi muspet olan olguya, deri biyopsisi yapilarak SHDS tanisi konuldu. Uygun sistemik antibiyotik tedavisi ve lokal deri bakimi ile SHDS yaklasik 21 gunde tamamen iyilesti. Anahtar Kelimeler: Stafilokokal haslanmis deri sendromu, cocuk yogun bakim unitesi, eksfoliatif toksin Staphylococcal scalded skin syndrome (SSSS) is caused by Stafilakokus Aureus producing exfoliative toxins A and B, and mostly seen in neonates and children. Complications may occur if not treated timely and properly. The mortality rate from SSSS in children is approximately 4%. This report presents a 42-day-old infant who developed exfoliation and peeling of the skin on the seventh day of chemotherapy that given for fibrosarcoma. Since the Nikolsky’s sign was positive, we performed skin biopsy to confirm the diagnosis of SSSS. In approximately 21 days, complete recovery was achieved with appropriate systemic antibiotic therapy and topical dermatologic treatment.

Sismanlar-Eyuboglu T, Aslan AT, Gezgin-Yildirim D, Buyan N, Emeksiz S, Kalkan G. What triggered massive hemoptysis in Goodpasture syndrome with isolated pulmonary involvement in a 14-year-old boy? Turk J Pediatr 2019; 61: 611-614. Goodpasture syndrome is a rare, autoimmune disease associated with the development of antibodies against a specific antigen both in glomerular basement membrane and alveolar basement membrane. It is very rare in childhood and its incidence is not known. Although the mechanism of the disease is the same in lung as in the kidney, sometimes it presents with involvement of only one organ. Pulmonary involvement may be lifethreatening in patients with massive hemoptysis. Herein we report a 14-yearold boy with isolated lung involvement. He had massive hemoptysis following bronchoscopy and recovered succesfully with treatment.

Pamuk U, Gursu HA, Emeksiz S, Ozdemir-Sahan Y, Cetin I. A rare cause of fatal cardiac arrhythmia: Inhalation of butane gas. Turk J Pediatr 2018; 60: 755-756. Butane gas, especially available in lighters, is commonly misused among adolescents and its side effects are rarely observed but serious. A 14-yearold male was brought to our emergency department. The electrocardiographic (ECG) examination showed biphasic T waves in leads V4-V6, and long QTc at 481ms. Echocardiographic study showed left ventricular systolic dysfunction. Troponin I level was found to be high at 9.1 ng/ml. Taking into consideration the patient`s history, clinical and laboratory findings, ventricular fibrillation and myocardial injury resulting from butane gas inhalation was diagnosed.

Posterior reversibl ansefalopati sendromu hipertansiyon, nöbet (konvulsiyon), baş ağrısı, bilinç bulanıklığı ve görme bozukluğu ile giden ve manyetik rezonans görüntülemede belirgin lezyonlarla tanısı konulan bir durumdur. Ocak 2010 ve Ocak 2014 tarihleri arasında Meram Tıp Fakültesi çocuk yoğun bakım ve hematoloji servislerinde izlenen beş posterior reversibl ansefalopati sendromu olgusu geriye dönük olarak değerlendirildi. Demografik ve klinik özellikleri ve görüntüleme bulguları gözden geçirildi. Olguların birincil hastalıkları; akut lenfositik lösemi (iki hasta), Henoch-Schönlein purpurası (bir hasta), sistemik lupus eritematozus (bir hasta) ve poststreptokoksik akut glomerülonefritti (bir hasta). Ortalama yaş 104,58 yıldı (5-14 yıl). Kan basıncının yüksekliği tüm hastalarda vardı. Başlangıç nörolojik belirtiler; nöbet, bilinç bulanıklığı, baş ağrısı ve görme bozukluğuydu. Klinik değerlendirme ve manyetik rezonans görüntüleme ile tanı konulduktan sonra uygun tedavi yaklaşımı ile tüm hastalarda klinik iyileşme sağlandı. Sonuç olarak, ansefalopati tablosu ile gelen ve zemininde nefrit, vaskülit ve malinite; kliniğinde kan basıncı yüksekliği ve ilaç kullanımı olan olgularda ayırıcı tanıda posterior reversibl ansefalopati sendromu düşünülmelidir., Posterior reversible encephalopathy syndrome is characterized by hypertension, seizure, headache, clouding of consciousness, and visual disturbance, and is diagnosed in the presence of typical lesions on magnetic resonance imaging. We retrospectively evaluated five patients who were diagnosed as having posterior reversible encephalopathy syndrome and followed up in Meram Medical Faculty, Pediatric Intensive Care and Hematology wards, between January 2010 and January 2014. We reviewed the demographic and clinical data, and neuroimaging findings. The primary diseases of the subjects included acute lymphocytic leukemia (n2), Henoch-Schönlein purpura (n1), systemic lupus erythematous (n1), and acute poststreptococcal glomerulonephritis (n1). The mean age was 10±4.58 years (range, 5-14 years). Acute elevation of blood pressure was found in all patients (n5). Initial neurologic manifestations included seizure, clouding of consciousness, headache, and visual disturbance. After the diagnosis was made through clinical evaluations and magnetic resonance imaging, complete clinical recovery was obtained in all patients with the appropriate therapeutic approach. In conclusion, posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients who present with encephalopathy and underlying diseases such as nephritis, vasculitis, malignancy accompanied by hypertension, and a history of use of medication.