Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (... more Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Case Report: Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes.
Acute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of c... more Acute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of children with severe acute myocarditis who are resist to medical treatment is not well known. We studied the clinical courses of patients with acute fulminant myocarditis supported by extracorporeal membrane oxygenation (ECMO). We performed a retrospective chart review of six children with acute fulminant myocarditis who were treated with ECMO. Demographic information, clinical and vital signs, as well as laboratory results were investigated. The median age of 63 months (13-140 months), the mean ECMO duration was 164 hours (79-402 hours), and median intensive care unit stay was 24 days. The most common symptoms were chest pain (66%) and fever (66%). Severe arrhythmia were seen in two patients. One patient received extracorporeal cardiopulmonary resuscitation. In two patients, right femoral arteries and right femoral veins were used, in others, right common carotid artery and right internal jugular veins were used. Five patients (83.3 %) survived to discharge. ECMO can be used effectively in pediatric patients with acute fulminant myocarditis to support the circulation while awaiting myocardial recovery. Timely use of ECMO can improve the survival rate and may be associated with better outcomes.
Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediat... more Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediatric patients hospitalized in pediatric intensive care units. In this study, we aimed to evaluate demographic and epidemiologic features, interventions, treatments, clinical course, and prognosis of patients hospitalized in pediatric intensive care unit for poisoning retrospectively. The recordings of 172 patients admitted to the pediatric intensive care unit with acute poisoning between 2015 and 2019 were evaluated retrospectively. Results: A total of 172 patients were admitted to our pediatric intensive care unit with the diagnosis of poisoning. Eighty-eight of them (51.2%) were girl. The average age was 5.8±5.6 years, and mean length of stay was 2.9 days. It was noted that 72.1% of patients with poisoning were accidental, whereas 27.9% of them were suicidal. Majority of suicidal patients were girls (89.5%), and the mean age was 13.1±4.9 years. However, only 36.2% of patients with accidental poisoning were girls and the mean age was 3.1±2.6 years. Patients with poisoning were most commonly seen during spring. The most common cause of poisoning was drugs (76.7%). Poisoning with multiple drugs were seen in 36 patients (20.9%). Central nervous system drugs were the most common cause (32.7%). Nausea-vomiting (17.4%), altered mental status (12.7%), Amaç: Zehirlenmeler çocuk yoğun bakım ünitelerine yatan hastalarda önlenebilir morbidite ve mortalitenin önemli bir kısmını oluşturmaktadır. Bu çalışmada, çocuk yoğun bakım ünitemizde zehirlenme nedeniyle tedavi edilen hastaların demografik ve epidemiyolojik özelliklerini, uygulanan tedavileri, klinik seyir ve prognozu geriye dönük olarak değerlendirmeyi amaçladık. Yöntemler: Zehirlenme nedeniyle 2015-2019 tarihleri arasında çocuk yoğun bakım ünitemize yatırılan hastaların dosyaları geriye dönük olarak incelendi. Hastaların demografik özellikleri, uygulanan tedavi ve klinik bulgular kaydedildi. Bulgular: Çocuk yoğun bakım ünitemize zehirlenme tanısıyla 172 hasta yatırıldı. Zehirlenmeler tüm hastaların %8,7'sini oluşturdu. Hastaların %51,2'si kız, %48,8'i erkekti. Ortalama yaş 5,8±5,6 yıl, ortalama yatış süresi 2,9 gündü. Olguların %27,9'u özkıyım amaçlı, %72,1'si kaza sonucu meydana gelmişti. Özkıyım amacı ile zehirlenmelerde yaş ortalaması 13,1±4,9 yıldı ve hastaların %89,6'sı kızdı. Kaza ile zehirlenmelerde ise yaş ortalaması 3,1±2,6 yıl iken, hastaların %36,29'u kızdı. En sık başvuru ilkbahar mevsiminde ve nisan ayında oldu. Hastaların 132'sinde (%76,7) zehirlenme nedeni ilaçlar iken, 40 (%23,2) hastada ilaç dışı maddeler etkendi. Otuz altı hastada (%20,9) çoklu etkenle zehirlenme vardı. En sık zehirlenme nedeni santral sinir sistemi ilaçlarıydı (%32,7). İlaç
Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yata... more Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yatan hastalarda viral patojen sıklığının ve hastaların klinik özelliklerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Kasım 2016-Eylül 2017 tarihleri arasında çocuk YBÜ'ye yatan, viral enfeksiyon şüphesiyle viral solunum paneli gönderilen ve pozitif saptanan 80 hasta çalışmaya dahil edildi. Solunum panelinde adenovirüs (ADV), metapnömovirüs (MPV), parainfluenza virüs (PIV) 1, PIV 2, PIV 3, PIV 4, influenza virüs (IV) A ve IVB, rinovirüs (RV), respiratuvar sinsityal virüs (RSV) A ve RSV B multipleks polimeraz zincir reaksiyonu (PCR) ile çalışıldı. Örnekler entübe olmayan hastalarda nazofarengeal sürüntüden, entübe olan hastalarda trakeal aspirasyon materyalinden alındı. Bulgular: Kasım 2016-Eylül 2017 tarihleri arasında YBÜ'ye toplam 514 hasta yatırıldı. Alt solunum yolu enfeksiyonu tanısıyla yatan 123 hastada nazofarengeal sürüntü veya trakeal aspirasyon materyalinden örnek alınarak Multipleks PCR ile viral enfeksiyon paneli çalışıldı. Ortalama yaş 6.1 ± 3.6 aydı, hastaların %60 (n= 48)'ı erkekti. Seksen hastada 93 pozitiflik saptandı. On üç (%16) hastada çift etken pozitifliği vardı. En sık saptanan viral ajanlar 36 (%45) hastada RSV (A + B), 26 (%27.9) hastada RV, 7 (%7.5) hastada PIV 1, 6 (%6.4) hastada ADV, 5 (%5.3) hastada human MPV, 4 (%4.3) hastada IVA, 4 (%4.3) hastada IVB idi. Çift etken pozitifliğinde en sık RV ve RSV B pozitifliği saptandı. En çok viral etken pozitifliği saptanan aylar aralık (n= 15) ve şubattı (n= 13). Hastaların %57'sine yüksek akımlı oksijen tedavisi, %12'sine noninvaziv mekanik ventilasyon uygulandı.
The aim of our study is to evaluate Code Blue, and its contents applied for pediatric cases in ou... more The aim of our study is to evaluate Code Blue, and its contents applied for pediatric cases in our hospital, draw attention to its implementation and emphasize the importance of its application with respect to patient's safety. Methods: All Code Blue forms applied for pediatric patients at a Acıbadem Mehmet Ali Aydınlar University, Artakent hospital between January 2017 and August 2019, were evaluated retrospectively. Demographic and medical information of cases, reasons for Code Blue alerts, arrival time of the Code Blue Response Team at the scene, all medical interventions and practices performed at the scene were recorded. Results: During the study period 70 pediatric Code Blue calls were made. Among Code Blue patients, 45 cases (64.3%) were male, 25 cases (35.7%) were female. Mean age of the patients was 38.3±14.2 months. Mean arrival time of the code blue team burst on the scene was 2.02±0.91 minutes. The code blue calls were made most commonly from general pediatric wards (n=36; 51.4%) followed by emergency room (ER) (n=23; 32.9%), pediatric polyclinics (n=7; 10%), hospital entrance (n=2; 2.9%), physical therapy and rehabilitation polyclinic, radiology department (n=1; 1.4% for each). Majority of codes (64.3%) were given during work hours. Physicians-in-charge (35.7%), nurses (50%) and other healthcare personnel (14.3%) activated the Code Blue. A total of 35.7% of patients were intubated, and 27.1% of them required cardiopulmonary resuscitation (CPR). The 64.3% of the patients were hospitalized in the pediatric intensive care unit. The rest of the patients continued to receive medical treatment in their respective wards or in the ER. The 68.4% of patients who had received CPR were discharged. The presence of competent, and experienced specialists in the Code Blue team, giving due importance to in-hospital training, and rapid recognition of cases with cardiopulmonary thanks to training offered increase survival rates of patients. In our study where records of pediatric patient were evaluated separately, it is seen that Code Blue system is implemented in compliance with the standards and successfully, particularly in terms of targeted time interval.
Turk Pediatri Arsivi-turkish Archives of Pediatrics, 2020
The clinical characteristics and prognosis of pertussis among unvaccinated infants in pediatric i... more The clinical characteristics and prognosis of pertussis among unvaccinated infants in pediatric intensive care unit Öz Amaç: Çocuk yoğun bakım biriminde boğmaca tanısıyla izlenen hastaların klinik özelliklerini, risk etmenlerini ve seyri etkileyen etmenleri değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çocuk yoğun bakım birimimizde Ocak 2017-Ocak 2019 tarihleri arasında yatan ve boğmaca tanısı alan hastalar geriye dönük olarak değerlendirildi. Örnekler entübe olarak izlenen hastalarda trakeal aspirat materyalinden, diğer hastalarda nazofaringeal sürüntüden alındı. Bordetella pertussis için örnekler multiplex real-time polimeraz zincir reaksiyonu yöntemi ile çalışıldı. Bulgular: On sekiz hasta boğmaca tanısı ile çocuk yoğun bakım birimimize yatırıldı. Hastaların %55,5'i kızdı (n=10), tüm hastalar aşısızdı. Ortanca yaş 40 (38-47,5) gün, ortanca yoğun bakım yatış süresi 9 (5-14) gündü. Başvuru anında hastaların tümünde solunum sıkıntısı, 14 hastada (%77,7) öksürük, 4 hastada (%22.2) ateş, 3 hastada (%16,6) konvülziyon saptandı. Yedi hasta entübe edilerek izlendi. Üç hasta ekstrakorporeal tedavi yöntemleri uygulanmasına rağmen çoklu organ yetersizliği ve kardiyojenik şok nedeniyle kaybedildi. Ölen hastaların ikisinde respiratuar sinsityal virüs, birinde rhinovirüs ko-enfeksiyonu vardı. Toplam lökosit sayıları karşılaştırıldığında ölen hasta grubunda lökosit sayısı
Objective: To expand on the hitherto limited knowledge of the indications and outcomes of pediatr... more Objective: To expand on the hitherto limited knowledge of the indications and outcomes of pediatric liver transplantation (LT) for inherited metabolic diseases (IMDs). Methods: Demographic data, pretransplant clinical and laboratory profiles, post-transplant outcomes and survival rates of twelve patients under 18 years who underwent LT for IMDs between January 2015 and June 2021 were analyzed. Results: Twelve (6 female) of 104 (11.5%) patients had a diagnosis of IMD. Four of the patients were diagnosed with primary hyperoxaluria type 1; two had Crigler-Najjar syndrome; and there was one patient each having maple syrup urine disease, propionic acidemia, tyrosinemia type 1, glycogen storage disease type 1a, Wilson's disease, and homozygous familial hypercholesterolemia, respectively. The mean current ages and ages at transplantation of the patients were 8.7 (1-14.2) and 6.5 (0.3-12.8) years, respectively. Their mean follow-up time was 2.7 (0.5-6.1) years. The distribution of LT indications was poor metabolic control (42%), the need for frequent hospitalization due to an acute life-threatening attack (17%), progressive neuromotor retardation (8%), and target organ failure (33%) respectively. The mean time between diagnosis and LT was 2.7 (0.5-6.1) years. No neurological, hematological, or metabolic complications were observed after LT. The biliary stricture developed in two (16.7%) patients, separation of arterial anastomosis in one (8.3%) and ascites infection in one (8.3%) patient. One-year patient and graft survival rates were both 100%. A significant difference was observed between the patients' pre-operative and current height and weight standard deviation scores, respectively (p=0.001 and p=0.006). LT is a good therapeutic option for improving the metabolic control and quality of life of patients with IMDs. Survival rates are excellent compared with other LT indications when appropriate timing and indication is adhered to.
IntroductionThere have been some significant changes regarding healthcare utilization during the ... more IntroductionThere have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection.MethodsThis is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year.ResultsThe percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabete...
Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediat... more Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediatric patients hospitalized in pediatric intensive care units. In this study, we aimed to evaluate demographic and epidemiologic features, interventions, treatments, clinical course, and prognosis of patients hospitalized in pediatric intensive care unit for poisoning retrospectively. The recordings of 172 patients admitted to the pediatric intensive care unit with acute poisoning between 2015 and 2019 were evaluated retrospectively. Results: A total of 172 patients were admitted to our pediatric intensive care unit with the diagnosis of poisoning. Eighty-eight of them (51.2%) were girl. The average age was 5.8±5.6 years, and mean length of stay was 2.9 days. It was noted that 72.1% of patients with poisoning were accidental, whereas 27.9% of them were suicidal. Majority of suicidal patients were girls (89.5%), and the mean age was 13.1±4.9 years. However, only 36.2% of patients with accidental poisoning were girls and the mean age was 3.1±2.6 years. Patients with poisoning were most commonly seen during spring. The most common cause of poisoning was drugs (76.7%). Poisoning with multiple drugs were seen in 36 patients (20.9%). Central nervous system drugs were the most common cause (32.7%). Nausea-vomiting (17.4%), altered mental status (12.7%), Amaç: Zehirlenmeler çocuk yoğun bakım ünitelerine yatan hastalarda önlenebilir morbidite ve mortalitenin önemli bir kısmını oluşturmaktadır. Bu çalışmada, çocuk yoğun bakım ünitemizde zehirlenme nedeniyle tedavi edilen hastaların demografik ve epidemiyolojik özelliklerini, uygulanan tedavileri, klinik seyir ve prognozu geriye dönük olarak değerlendirmeyi amaçladık. Yöntemler: Zehirlenme nedeniyle 2015-2019 tarihleri arasında çocuk yoğun bakım ünitemize yatırılan hastaların dosyaları geriye dönük olarak incelendi. Hastaların demografik özellikleri, uygulanan tedavi ve klinik bulgular kaydedildi. Bulgular: Çocuk yoğun bakım ünitemize zehirlenme tanısıyla 172 hasta yatırıldı. Zehirlenmeler tüm hastaların %8,7'sini oluşturdu. Hastaların %51,2'si kız, %48,8'i erkekti. Ortalama yaş 5,8±5,6 yıl, ortalama yatış süresi 2,9 gündü. Olguların %27,9'u özkıyım amaçlı, %72,1'si kaza sonucu meydana gelmişti. Özkıyım amacı ile zehirlenmelerde yaş ortalaması 13,1±4,9 yıldı ve hastaların %89,6'sı kızdı. Kaza ile zehirlenmelerde ise yaş ortalaması 3,1±2,6 yıl iken, hastaların %36,29'u kızdı. En sık başvuru ilkbahar mevsiminde ve nisan ayında oldu. Hastaların 132'sinde (%76,7) zehirlenme nedeni ilaçlar iken, 40 (%23,2) hastada ilaç dışı maddeler etkendi. Otuz altı hastada (%20,9) çoklu etkenle zehirlenme vardı. En sık zehirlenme nedeni santral sinir sistemi ilaçlarıydı (%32,7). İlaç
We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis... more We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis and to evaluate the relation of the changes with serum electrolyte levels and ketosis. This study was performed in Istanbul Medical Faculty, Pediatric Emergency and Intensive Care Department between May 2008 and May 2009. The electrocardiographic parameters and QT length of children with diabetic ketoacidosis and ketosis were evaluated at diagnosis and after the treatment. Forty patients were included in the study; 16 (40%) were diagnosed as having diabetic ketosis and 24 (60%) had diabetic ketoacidosis. Twenty-four (60%) patients were male and 16 (40%) were female and the mean age was 9.21±4.71 years (range, 1-16 years). Twelve (30%) cases of diabetic ketoacidosis were mild, three (7.5%) were moderate, and nine (22.5%) were severe. One patient had premature ventricular beats, and four had ST depression. The electrocardiographic parameters were all normal beyond the QTC length prolongat...
Aim: In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infect... more Aim: In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infections the viral agents of which were detected by molecular methods and to compare influenza and other respiratory tract viruses in this context. Material and Methods: The records of 178 patients aged above 2 years who presented to pediatric emergency outpatient clinic with fever and respiratory tract infection findings between December 2013 and April 2014 were examined retrospectively. Results: At least one respiratory tract pathogen was detected by polymerase chain reaction in 78.6% (n=140) of the patients: influenza A 33.5%, influenza B 16.4%, respiratory syncytial virus 9.2%, adenovirus 7.8%, rhinovirus 7.1%, coronavirus 7.1%, human metapneumovirus 5.7%, human bocavirus 5.7%, parainfluenza virus 3.5%, coinfection 2.8%. The mean age of the patients was 6.3±3.6 years. Sixty-nine patients (49.2%) were aged between 2 and 5 years. Seventy-one patients (50.7%) were aged 5 years and above. Upper respiratory tract infection was found with a rate of 65.7% and lower respiratory tract infection was found with a rate of 34.2%. It was observed that the distribution of respiratory tract viruses showed variance by age groups. Influenza A infection was observed with the highest rate in both age groups. Influenza B was the second leading agent (p=0.008) above the age of 5 years and respiratory syncytial virus was the second leading agent in the 2-5 year age group (p=0.003). Influenza viruses were detected in 55.9% of 118 patients who were found to be compatible with the definition of "influenza-like illness" specified in the Center for Disease Control and Prevention guidelines and other viral agenst were detected in 44%. No difference could be found between the clinical pictures and radiological findings caused by influenza and other respiratory tract viruses. Conclusions: In this study, it was concluded that influenza and other respiratory viruses can not be differentiated definitely by clinical and radiological findings, though there are some differences. (
Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has ... more Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has also been associated with encephalitis recently by detection of the virus in cerebrospinal fluid (CSF) of patients presented with encephalitis. This retrospective study aimed to present clinical features of HBOV infections in children with respiratory symptoms and describe unexplained encephalopathy in a subgroup of these patients. Results of 1,143 pediatric nasal samples from mid‐December 2013 to July 2014 were reviewed for detection of HBOV. A multiplex real time polymerase chain reaction assay was used for viral detection. Medical records of the patients were retrospectively analyzed. HBOV was detected in 30 patients (2.6%). Median age was 14 months (5–80). Clinical diagnoses were upper respiratory tract infection (n = 10), bronchopneumonia (n = 9), acute bronchiolitis (n = 5), pneumonia (n = 4), acute bronchitis (n = 1), and asthma execarbation (n = 1). Hospitalization was required i...
Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2015
Varicella infections in infants are commonly self-limited disease but sometimes can cause severe ... more Varicella infections in infants are commonly self-limited disease but sometimes can cause severe complications and also result in death. The varicella vaccine is highly effective in preventing severe varicella and has significantly decreased varicella incidence, hospitalizations, and deaths. The most common complications of Varicella infection that require hospitalization are skin/soft tissue infections, bone/joint infections, sepsis, pneumonia, thrombocytopenia and dehydration. Here we report, a ten-month-old female infant hospitalized for varicella sepsis and purpura fulminans. In the first month of her treatment, osteomyelitis of left elbow has occurred and operated and treated successfully. Osteomyelitis should always be considered in any child who develops pain, swelling and limitation of movement in a limb during or after varicella infection.
Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibo... more Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes.
Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II ce... more Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS.
Our objective was to characterize the etiologic factors and outcome for stroke in children. We re... more Our objective was to characterize the etiologic factors and outcome for stroke in children. We retrospectively reviewed the charts of patients between the ages of 40 days and 94 months (36.5 AE 23.7 months) with stroke seen at Istanbul Medical Faculty, Department of Pediatrics between January 1995 and December 2003. We found 79 cases of stroke: 57 ischemic and 22 hemorrhagic strokes. Seventeen children had vitamin K deficiency dependent hemorrhage. In 14 children stroke occurred as a complication of cardiac disease, 7 had moyamoya disease, 3 had protein C deficiency, 2 had thalassemia, 2 had hyperhomocysteinemia (methylene tetrahydrofolate reductase gene mutation), 2 were heterozygote for factor V Leiden, 3 had Down's syndrome, 1 was diagnosed with antiphospholipid syndrome, 1 had glycogen storage disease, and in 28 children no underlying cause could be found. Multiple risk factors were found in 4 children. The outcome in all 79 stroke patients was as follows: asymptomatic 60%; symptomatic epilepsy or persistent neurologic deficit 37%; death 3%; and recurrent stroke 5%. Thus, an underlying cause for stroke was identified in 65% of the children in the study group; 40% of the children either died or suffered motor and/or cognitive sequelae.
Objectives: Children with peripheral airways obstruction suffer the negative effects of intrinsic... more Objectives: Children with peripheral airways obstruction suffer the negative effects of intrinsic positive end-expiratory pressure: increased work of breathing and difficulty triggering assisted ventilatory support. We examined whether external positive end-expiratory pressure to offset intrinsic positive end-expiratory pressure decreases work of breathing in children with peripheral airways obstruction. The change in work of breathing with incremental pressure support was also tested. Design and setting: Prospective clinical trial in a pediatric intensive care unit. Patients: Eleven mechanically ventilated, spontaneously breathing children with peripheral airways obstruction. Interventions: Work of breathing (using pressure-rate product as a surrogate) was measured in three tiers: (a) Increasing pressure support over zero end-expiratory pressure. (b) Increasing applied positive end-expiratory pressure and fixed pressure support. The level of applied positive end-expiratory pressure at which pressure-rate product was least determined the compensatory positive end-expiratory pressure. (c) Increasing pressure support over compensatory (fixed) positive end-expiratory pressure. Measurements and results: Increases in pressure support alone decreased pressure-rate product from mean 724 ± 311 to 403 ± 192 cmH 2 O/min. Applied positive end-expiratory pressure alone decreased pressurerate product from mean 608 ± 301 to 250 ± 169 cmH 2 O/min. The lowest pressure-rate product (136 ± 128 cmH 2 O/min) was achieved using compensatory positive end-expiratory pressure (12 ± 4 cmH 2 O) with pressure support 16 cmH 2 O. Conclusions: For children with peripheral airways obstruction who require assisted ventilation, work of breathing during spontaneous breaths is decreased by the application of either compensatory positive end-expiratory pressure or pressure support.
Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (... more Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Case Report: Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes.
Acute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of c... more Acute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of children with severe acute myocarditis who are resist to medical treatment is not well known. We studied the clinical courses of patients with acute fulminant myocarditis supported by extracorporeal membrane oxygenation (ECMO). We performed a retrospective chart review of six children with acute fulminant myocarditis who were treated with ECMO. Demographic information, clinical and vital signs, as well as laboratory results were investigated. The median age of 63 months (13-140 months), the mean ECMO duration was 164 hours (79-402 hours), and median intensive care unit stay was 24 days. The most common symptoms were chest pain (66%) and fever (66%). Severe arrhythmia were seen in two patients. One patient received extracorporeal cardiopulmonary resuscitation. In two patients, right femoral arteries and right femoral veins were used, in others, right common carotid artery and right internal jugular veins were used. Five patients (83.3 %) survived to discharge. ECMO can be used effectively in pediatric patients with acute fulminant myocarditis to support the circulation while awaiting myocardial recovery. Timely use of ECMO can improve the survival rate and may be associated with better outcomes.
Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediat... more Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediatric patients hospitalized in pediatric intensive care units. In this study, we aimed to evaluate demographic and epidemiologic features, interventions, treatments, clinical course, and prognosis of patients hospitalized in pediatric intensive care unit for poisoning retrospectively. The recordings of 172 patients admitted to the pediatric intensive care unit with acute poisoning between 2015 and 2019 were evaluated retrospectively. Results: A total of 172 patients were admitted to our pediatric intensive care unit with the diagnosis of poisoning. Eighty-eight of them (51.2%) were girl. The average age was 5.8±5.6 years, and mean length of stay was 2.9 days. It was noted that 72.1% of patients with poisoning were accidental, whereas 27.9% of them were suicidal. Majority of suicidal patients were girls (89.5%), and the mean age was 13.1±4.9 years. However, only 36.2% of patients with accidental poisoning were girls and the mean age was 3.1±2.6 years. Patients with poisoning were most commonly seen during spring. The most common cause of poisoning was drugs (76.7%). Poisoning with multiple drugs were seen in 36 patients (20.9%). Central nervous system drugs were the most common cause (32.7%). Nausea-vomiting (17.4%), altered mental status (12.7%), Amaç: Zehirlenmeler çocuk yoğun bakım ünitelerine yatan hastalarda önlenebilir morbidite ve mortalitenin önemli bir kısmını oluşturmaktadır. Bu çalışmada, çocuk yoğun bakım ünitemizde zehirlenme nedeniyle tedavi edilen hastaların demografik ve epidemiyolojik özelliklerini, uygulanan tedavileri, klinik seyir ve prognozu geriye dönük olarak değerlendirmeyi amaçladık. Yöntemler: Zehirlenme nedeniyle 2015-2019 tarihleri arasında çocuk yoğun bakım ünitemize yatırılan hastaların dosyaları geriye dönük olarak incelendi. Hastaların demografik özellikleri, uygulanan tedavi ve klinik bulgular kaydedildi. Bulgular: Çocuk yoğun bakım ünitemize zehirlenme tanısıyla 172 hasta yatırıldı. Zehirlenmeler tüm hastaların %8,7'sini oluşturdu. Hastaların %51,2'si kız, %48,8'i erkekti. Ortalama yaş 5,8±5,6 yıl, ortalama yatış süresi 2,9 gündü. Olguların %27,9'u özkıyım amaçlı, %72,1'si kaza sonucu meydana gelmişti. Özkıyım amacı ile zehirlenmelerde yaş ortalaması 13,1±4,9 yıldı ve hastaların %89,6'sı kızdı. Kaza ile zehirlenmelerde ise yaş ortalaması 3,1±2,6 yıl iken, hastaların %36,29'u kızdı. En sık başvuru ilkbahar mevsiminde ve nisan ayında oldu. Hastaların 132'sinde (%76,7) zehirlenme nedeni ilaçlar iken, 40 (%23,2) hastada ilaç dışı maddeler etkendi. Otuz altı hastada (%20,9) çoklu etkenle zehirlenme vardı. En sık zehirlenme nedeni santral sinir sistemi ilaçlarıydı (%32,7). İlaç
Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yata... more Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yatan hastalarda viral patojen sıklığının ve hastaların klinik özelliklerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Kasım 2016-Eylül 2017 tarihleri arasında çocuk YBÜ'ye yatan, viral enfeksiyon şüphesiyle viral solunum paneli gönderilen ve pozitif saptanan 80 hasta çalışmaya dahil edildi. Solunum panelinde adenovirüs (ADV), metapnömovirüs (MPV), parainfluenza virüs (PIV) 1, PIV 2, PIV 3, PIV 4, influenza virüs (IV) A ve IVB, rinovirüs (RV), respiratuvar sinsityal virüs (RSV) A ve RSV B multipleks polimeraz zincir reaksiyonu (PCR) ile çalışıldı. Örnekler entübe olmayan hastalarda nazofarengeal sürüntüden, entübe olan hastalarda trakeal aspirasyon materyalinden alındı. Bulgular: Kasım 2016-Eylül 2017 tarihleri arasında YBÜ'ye toplam 514 hasta yatırıldı. Alt solunum yolu enfeksiyonu tanısıyla yatan 123 hastada nazofarengeal sürüntü veya trakeal aspirasyon materyalinden örnek alınarak Multipleks PCR ile viral enfeksiyon paneli çalışıldı. Ortalama yaş 6.1 ± 3.6 aydı, hastaların %60 (n= 48)'ı erkekti. Seksen hastada 93 pozitiflik saptandı. On üç (%16) hastada çift etken pozitifliği vardı. En sık saptanan viral ajanlar 36 (%45) hastada RSV (A + B), 26 (%27.9) hastada RV, 7 (%7.5) hastada PIV 1, 6 (%6.4) hastada ADV, 5 (%5.3) hastada human MPV, 4 (%4.3) hastada IVA, 4 (%4.3) hastada IVB idi. Çift etken pozitifliğinde en sık RV ve RSV B pozitifliği saptandı. En çok viral etken pozitifliği saptanan aylar aralık (n= 15) ve şubattı (n= 13). Hastaların %57'sine yüksek akımlı oksijen tedavisi, %12'sine noninvaziv mekanik ventilasyon uygulandı.
The aim of our study is to evaluate Code Blue, and its contents applied for pediatric cases in ou... more The aim of our study is to evaluate Code Blue, and its contents applied for pediatric cases in our hospital, draw attention to its implementation and emphasize the importance of its application with respect to patient's safety. Methods: All Code Blue forms applied for pediatric patients at a Acıbadem Mehmet Ali Aydınlar University, Artakent hospital between January 2017 and August 2019, were evaluated retrospectively. Demographic and medical information of cases, reasons for Code Blue alerts, arrival time of the Code Blue Response Team at the scene, all medical interventions and practices performed at the scene were recorded. Results: During the study period 70 pediatric Code Blue calls were made. Among Code Blue patients, 45 cases (64.3%) were male, 25 cases (35.7%) were female. Mean age of the patients was 38.3±14.2 months. Mean arrival time of the code blue team burst on the scene was 2.02±0.91 minutes. The code blue calls were made most commonly from general pediatric wards (n=36; 51.4%) followed by emergency room (ER) (n=23; 32.9%), pediatric polyclinics (n=7; 10%), hospital entrance (n=2; 2.9%), physical therapy and rehabilitation polyclinic, radiology department (n=1; 1.4% for each). Majority of codes (64.3%) were given during work hours. Physicians-in-charge (35.7%), nurses (50%) and other healthcare personnel (14.3%) activated the Code Blue. A total of 35.7% of patients were intubated, and 27.1% of them required cardiopulmonary resuscitation (CPR). The 64.3% of the patients were hospitalized in the pediatric intensive care unit. The rest of the patients continued to receive medical treatment in their respective wards or in the ER. The 68.4% of patients who had received CPR were discharged. The presence of competent, and experienced specialists in the Code Blue team, giving due importance to in-hospital training, and rapid recognition of cases with cardiopulmonary thanks to training offered increase survival rates of patients. In our study where records of pediatric patient were evaluated separately, it is seen that Code Blue system is implemented in compliance with the standards and successfully, particularly in terms of targeted time interval.
Turk Pediatri Arsivi-turkish Archives of Pediatrics, 2020
The clinical characteristics and prognosis of pertussis among unvaccinated infants in pediatric i... more The clinical characteristics and prognosis of pertussis among unvaccinated infants in pediatric intensive care unit Öz Amaç: Çocuk yoğun bakım biriminde boğmaca tanısıyla izlenen hastaların klinik özelliklerini, risk etmenlerini ve seyri etkileyen etmenleri değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çocuk yoğun bakım birimimizde Ocak 2017-Ocak 2019 tarihleri arasında yatan ve boğmaca tanısı alan hastalar geriye dönük olarak değerlendirildi. Örnekler entübe olarak izlenen hastalarda trakeal aspirat materyalinden, diğer hastalarda nazofaringeal sürüntüden alındı. Bordetella pertussis için örnekler multiplex real-time polimeraz zincir reaksiyonu yöntemi ile çalışıldı. Bulgular: On sekiz hasta boğmaca tanısı ile çocuk yoğun bakım birimimize yatırıldı. Hastaların %55,5'i kızdı (n=10), tüm hastalar aşısızdı. Ortanca yaş 40 (38-47,5) gün, ortanca yoğun bakım yatış süresi 9 (5-14) gündü. Başvuru anında hastaların tümünde solunum sıkıntısı, 14 hastada (%77,7) öksürük, 4 hastada (%22.2) ateş, 3 hastada (%16,6) konvülziyon saptandı. Yedi hasta entübe edilerek izlendi. Üç hasta ekstrakorporeal tedavi yöntemleri uygulanmasına rağmen çoklu organ yetersizliği ve kardiyojenik şok nedeniyle kaybedildi. Ölen hastaların ikisinde respiratuar sinsityal virüs, birinde rhinovirüs ko-enfeksiyonu vardı. Toplam lökosit sayıları karşılaştırıldığında ölen hasta grubunda lökosit sayısı
Objective: To expand on the hitherto limited knowledge of the indications and outcomes of pediatr... more Objective: To expand on the hitherto limited knowledge of the indications and outcomes of pediatric liver transplantation (LT) for inherited metabolic diseases (IMDs). Methods: Demographic data, pretransplant clinical and laboratory profiles, post-transplant outcomes and survival rates of twelve patients under 18 years who underwent LT for IMDs between January 2015 and June 2021 were analyzed. Results: Twelve (6 female) of 104 (11.5%) patients had a diagnosis of IMD. Four of the patients were diagnosed with primary hyperoxaluria type 1; two had Crigler-Najjar syndrome; and there was one patient each having maple syrup urine disease, propionic acidemia, tyrosinemia type 1, glycogen storage disease type 1a, Wilson's disease, and homozygous familial hypercholesterolemia, respectively. The mean current ages and ages at transplantation of the patients were 8.7 (1-14.2) and 6.5 (0.3-12.8) years, respectively. Their mean follow-up time was 2.7 (0.5-6.1) years. The distribution of LT indications was poor metabolic control (42%), the need for frequent hospitalization due to an acute life-threatening attack (17%), progressive neuromotor retardation (8%), and target organ failure (33%) respectively. The mean time between diagnosis and LT was 2.7 (0.5-6.1) years. No neurological, hematological, or metabolic complications were observed after LT. The biliary stricture developed in two (16.7%) patients, separation of arterial anastomosis in one (8.3%) and ascites infection in one (8.3%) patient. One-year patient and graft survival rates were both 100%. A significant difference was observed between the patients' pre-operative and current height and weight standard deviation scores, respectively (p=0.001 and p=0.006). LT is a good therapeutic option for improving the metabolic control and quality of life of patients with IMDs. Survival rates are excellent compared with other LT indications when appropriate timing and indication is adhered to.
IntroductionThere have been some significant changes regarding healthcare utilization during the ... more IntroductionThere have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection.MethodsThis is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year.ResultsThe percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabete...
Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediat... more Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediatric patients hospitalized in pediatric intensive care units. In this study, we aimed to evaluate demographic and epidemiologic features, interventions, treatments, clinical course, and prognosis of patients hospitalized in pediatric intensive care unit for poisoning retrospectively. The recordings of 172 patients admitted to the pediatric intensive care unit with acute poisoning between 2015 and 2019 were evaluated retrospectively. Results: A total of 172 patients were admitted to our pediatric intensive care unit with the diagnosis of poisoning. Eighty-eight of them (51.2%) were girl. The average age was 5.8±5.6 years, and mean length of stay was 2.9 days. It was noted that 72.1% of patients with poisoning were accidental, whereas 27.9% of them were suicidal. Majority of suicidal patients were girls (89.5%), and the mean age was 13.1±4.9 years. However, only 36.2% of patients with accidental poisoning were girls and the mean age was 3.1±2.6 years. Patients with poisoning were most commonly seen during spring. The most common cause of poisoning was drugs (76.7%). Poisoning with multiple drugs were seen in 36 patients (20.9%). Central nervous system drugs were the most common cause (32.7%). Nausea-vomiting (17.4%), altered mental status (12.7%), Amaç: Zehirlenmeler çocuk yoğun bakım ünitelerine yatan hastalarda önlenebilir morbidite ve mortalitenin önemli bir kısmını oluşturmaktadır. Bu çalışmada, çocuk yoğun bakım ünitemizde zehirlenme nedeniyle tedavi edilen hastaların demografik ve epidemiyolojik özelliklerini, uygulanan tedavileri, klinik seyir ve prognozu geriye dönük olarak değerlendirmeyi amaçladık. Yöntemler: Zehirlenme nedeniyle 2015-2019 tarihleri arasında çocuk yoğun bakım ünitemize yatırılan hastaların dosyaları geriye dönük olarak incelendi. Hastaların demografik özellikleri, uygulanan tedavi ve klinik bulgular kaydedildi. Bulgular: Çocuk yoğun bakım ünitemize zehirlenme tanısıyla 172 hasta yatırıldı. Zehirlenmeler tüm hastaların %8,7'sini oluşturdu. Hastaların %51,2'si kız, %48,8'i erkekti. Ortalama yaş 5,8±5,6 yıl, ortalama yatış süresi 2,9 gündü. Olguların %27,9'u özkıyım amaçlı, %72,1'si kaza sonucu meydana gelmişti. Özkıyım amacı ile zehirlenmelerde yaş ortalaması 13,1±4,9 yıldı ve hastaların %89,6'sı kızdı. Kaza ile zehirlenmelerde ise yaş ortalaması 3,1±2,6 yıl iken, hastaların %36,29'u kızdı. En sık başvuru ilkbahar mevsiminde ve nisan ayında oldu. Hastaların 132'sinde (%76,7) zehirlenme nedeni ilaçlar iken, 40 (%23,2) hastada ilaç dışı maddeler etkendi. Otuz altı hastada (%20,9) çoklu etkenle zehirlenme vardı. En sık zehirlenme nedeni santral sinir sistemi ilaçlarıydı (%32,7). İlaç
We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis... more We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis and to evaluate the relation of the changes with serum electrolyte levels and ketosis. This study was performed in Istanbul Medical Faculty, Pediatric Emergency and Intensive Care Department between May 2008 and May 2009. The electrocardiographic parameters and QT length of children with diabetic ketoacidosis and ketosis were evaluated at diagnosis and after the treatment. Forty patients were included in the study; 16 (40%) were diagnosed as having diabetic ketosis and 24 (60%) had diabetic ketoacidosis. Twenty-four (60%) patients were male and 16 (40%) were female and the mean age was 9.21±4.71 years (range, 1-16 years). Twelve (30%) cases of diabetic ketoacidosis were mild, three (7.5%) were moderate, and nine (22.5%) were severe. One patient had premature ventricular beats, and four had ST depression. The electrocardiographic parameters were all normal beyond the QTC length prolongat...
Aim: In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infect... more Aim: In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infections the viral agents of which were detected by molecular methods and to compare influenza and other respiratory tract viruses in this context. Material and Methods: The records of 178 patients aged above 2 years who presented to pediatric emergency outpatient clinic with fever and respiratory tract infection findings between December 2013 and April 2014 were examined retrospectively. Results: At least one respiratory tract pathogen was detected by polymerase chain reaction in 78.6% (n=140) of the patients: influenza A 33.5%, influenza B 16.4%, respiratory syncytial virus 9.2%, adenovirus 7.8%, rhinovirus 7.1%, coronavirus 7.1%, human metapneumovirus 5.7%, human bocavirus 5.7%, parainfluenza virus 3.5%, coinfection 2.8%. The mean age of the patients was 6.3±3.6 years. Sixty-nine patients (49.2%) were aged between 2 and 5 years. Seventy-one patients (50.7%) were aged 5 years and above. Upper respiratory tract infection was found with a rate of 65.7% and lower respiratory tract infection was found with a rate of 34.2%. It was observed that the distribution of respiratory tract viruses showed variance by age groups. Influenza A infection was observed with the highest rate in both age groups. Influenza B was the second leading agent (p=0.008) above the age of 5 years and respiratory syncytial virus was the second leading agent in the 2-5 year age group (p=0.003). Influenza viruses were detected in 55.9% of 118 patients who were found to be compatible with the definition of "influenza-like illness" specified in the Center for Disease Control and Prevention guidelines and other viral agenst were detected in 44%. No difference could be found between the clinical pictures and radiological findings caused by influenza and other respiratory tract viruses. Conclusions: In this study, it was concluded that influenza and other respiratory viruses can not be differentiated definitely by clinical and radiological findings, though there are some differences. (
Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has ... more Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has also been associated with encephalitis recently by detection of the virus in cerebrospinal fluid (CSF) of patients presented with encephalitis. This retrospective study aimed to present clinical features of HBOV infections in children with respiratory symptoms and describe unexplained encephalopathy in a subgroup of these patients. Results of 1,143 pediatric nasal samples from mid‐December 2013 to July 2014 were reviewed for detection of HBOV. A multiplex real time polymerase chain reaction assay was used for viral detection. Medical records of the patients were retrospectively analyzed. HBOV was detected in 30 patients (2.6%). Median age was 14 months (5–80). Clinical diagnoses were upper respiratory tract infection (n = 10), bronchopneumonia (n = 9), acute bronchiolitis (n = 5), pneumonia (n = 4), acute bronchitis (n = 1), and asthma execarbation (n = 1). Hospitalization was required i...
Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2015
Varicella infections in infants are commonly self-limited disease but sometimes can cause severe ... more Varicella infections in infants are commonly self-limited disease but sometimes can cause severe complications and also result in death. The varicella vaccine is highly effective in preventing severe varicella and has significantly decreased varicella incidence, hospitalizations, and deaths. The most common complications of Varicella infection that require hospitalization are skin/soft tissue infections, bone/joint infections, sepsis, pneumonia, thrombocytopenia and dehydration. Here we report, a ten-month-old female infant hospitalized for varicella sepsis and purpura fulminans. In the first month of her treatment, osteomyelitis of left elbow has occurred and operated and treated successfully. Osteomyelitis should always be considered in any child who develops pain, swelling and limitation of movement in a limb during or after varicella infection.
Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibo... more Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes.
Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II ce... more Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS.
Our objective was to characterize the etiologic factors and outcome for stroke in children. We re... more Our objective was to characterize the etiologic factors and outcome for stroke in children. We retrospectively reviewed the charts of patients between the ages of 40 days and 94 months (36.5 AE 23.7 months) with stroke seen at Istanbul Medical Faculty, Department of Pediatrics between January 1995 and December 2003. We found 79 cases of stroke: 57 ischemic and 22 hemorrhagic strokes. Seventeen children had vitamin K deficiency dependent hemorrhage. In 14 children stroke occurred as a complication of cardiac disease, 7 had moyamoya disease, 3 had protein C deficiency, 2 had thalassemia, 2 had hyperhomocysteinemia (methylene tetrahydrofolate reductase gene mutation), 2 were heterozygote for factor V Leiden, 3 had Down's syndrome, 1 was diagnosed with antiphospholipid syndrome, 1 had glycogen storage disease, and in 28 children no underlying cause could be found. Multiple risk factors were found in 4 children. The outcome in all 79 stroke patients was as follows: asymptomatic 60%; symptomatic epilepsy or persistent neurologic deficit 37%; death 3%; and recurrent stroke 5%. Thus, an underlying cause for stroke was identified in 65% of the children in the study group; 40% of the children either died or suffered motor and/or cognitive sequelae.
Objectives: Children with peripheral airways obstruction suffer the negative effects of intrinsic... more Objectives: Children with peripheral airways obstruction suffer the negative effects of intrinsic positive end-expiratory pressure: increased work of breathing and difficulty triggering assisted ventilatory support. We examined whether external positive end-expiratory pressure to offset intrinsic positive end-expiratory pressure decreases work of breathing in children with peripheral airways obstruction. The change in work of breathing with incremental pressure support was also tested. Design and setting: Prospective clinical trial in a pediatric intensive care unit. Patients: Eleven mechanically ventilated, spontaneously breathing children with peripheral airways obstruction. Interventions: Work of breathing (using pressure-rate product as a surrogate) was measured in three tiers: (a) Increasing pressure support over zero end-expiratory pressure. (b) Increasing applied positive end-expiratory pressure and fixed pressure support. The level of applied positive end-expiratory pressure at which pressure-rate product was least determined the compensatory positive end-expiratory pressure. (c) Increasing pressure support over compensatory (fixed) positive end-expiratory pressure. Measurements and results: Increases in pressure support alone decreased pressure-rate product from mean 724 ± 311 to 403 ± 192 cmH 2 O/min. Applied positive end-expiratory pressure alone decreased pressurerate product from mean 608 ± 301 to 250 ± 169 cmH 2 O/min. The lowest pressure-rate product (136 ± 128 cmH 2 O/min) was achieved using compensatory positive end-expiratory pressure (12 ± 4 cmH 2 O) with pressure support 16 cmH 2 O. Conclusions: For children with peripheral airways obstruction who require assisted ventilation, work of breathing during spontaneous breaths is decreased by the application of either compensatory positive end-expiratory pressure or pressure support.
Uploads
Papers by Agop çıtak