Intrathecal baclofen use in the management of tetanus related spasm: A case report

Tetanus is an infectious disease of the central nervous system with high mortality rates characterized with respiratory distress and tonic muscle spasms. The most common cause of mortality is cardiovascular complications (40%) and respiratory distress (15%). Despite vaccination programs, tetanus remains to be a significant healthcare issue in developing nations. Prolonged sedation and administration of muscle relaxants prolongs the period on mechanical ventilation and duration of hospitalization in severe tetanus cases. However, intrathecal baclofen (ITB) therapy might shorten the duration of stay at intensive care units, improve patient outcomes, and constitute a treatment option alternative to paralytic agents and sedation. In this manuscript, we present a 12-years-old case diagnosed with tetanus and treated with ITB upon observation of spasms refractory to high dose sedation and muscle relaxants

A Rare Cause of Abdominal Pain in Children: Hereditary Angioedema

Hereditary angioedema (HA) is a rare, autosomal-dominant genetic disorder presenting with recurrent attacks of angioedema. The most commonly involved organs include the extremites, face, neck, upper respiratory tract, genital region and the gastrointestinal tract. Edema of the intestinal mucosa can cause temporary obstruction and severe abdominal pain that can be confused with acute abdomen. Pediatricians and emergency physicians should keep in mind this rare disease in the differential diagnosis of severe abdominal pain

A Rare Cause of Abdominal Pain in Children: Hereditary Angioedema

Hereditary angioedema (HA) is a rare, autosomal-dominant genetic disorder presenting with recurrent attacks of angioedema. The most commonly involved organs include the extremites, face, neck, upper respiratory tract, genital region and the gastrointestinal tract. Edema of the intestinal mucosa can cause temporary obstruction and severe abdominal pain that can be confused with acute abdomen. Pediatricians and emergency physicians should keep in mind this rare disease in the differential diagnosis of severe abdominal pain

Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric Patients

ObjectivesTo identify prognostic factors and indications in patients receiving continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU), and to demonstrate their effect on mortality.MethodsA total of 63 patients admitted between 2011 and 2014 were included in the study. The demographic information, pediatric risk of mortality (PRISM) scores, vasoactive-inotropic score, indication for CRRT, time of starting CRRT, presence of fluid overload, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and non-survivors.ResultsThe overall rate of survival was 69,8%. The most common indication for CRRT was fluid overload (31.7%) followed by acute attacks of metabolic diseases (15.9%), and resistant metabolic acidosis (15.9%). The median duration of CRRT was 58 (IQR 24-96) h. The most common CRRT modality was continuous venovenous hemodiafiltration. The CRRT modality was not different between survivors and nonsurvivors. Sepsis, as the diagnosis for admission to intensive care unit was significantly related to decreased survival when compared to acute kidney injury and acute attacks of metabolic diseases. Patients with fluid overload had significantly increased rate of death, CRRT duration, use of mechanical ventilation, and PICU stay.ConclusionsThe CRRT, can be effectively used for removal of fluid overload, treatment of acute attacks of metabolic diseases, and other indications in critically ill pediatric patients. It has a positive effect on mortality in high-risk PICU patients. This treatment modality can be used more frequently in pediatric intensive care unit with improved patient outcomes, and should be focused on starting therapy in early stages of fluid overload

"Sarsılmış bebek sendromu": Süt çocukluğu döneminde konvulsiyon-çocuk istismarı ilişkisi (Üç adli olgu sunumu)

Süt çocukluğu dönemi fiziksel istismar olgularında, harici travmatik değişimlerin görülme olasılığı oldukça düşüktür. Olgular, daha çok aniden ortaya çıktığı söylenen ve hu yaş grubuna özgü çeşitli hastalık tablolarında gözlenen klinik bulgular sebebiyle özellikle çocuk acil-yoğun bakım ünitelerine getirilmektedir. Bu çalışmada, İstanbul Üniversitesi İstanbul Tıp Fakültesi Çocuk Acil-Yoğun Bakım Ünitesi'ne konvulsiyon klinik bulgusu ile başvuran süt çocukluğu dönemindeki 1 erkek, 2 kız çocuğu fiziksel istismar yönünden kliniğe yansıma şekli ve doğru tanıya yönelme aşamasında adli tıbbi yaklaşımın önemini vurgulamak ve belgelemek amacıyla sunulmuştur. Her üç olguda da, yakın zamanda düşme hikayesi, beyin tomografisinde subdural hematom ve göz dibi incelemesinde yaygın retinal kanama tespit edilmiştir. Öykü derinleştirildiğinde, olguların çocuk istismarı açısından izlenmesinin uygun olacağı sonucuna varılmıştır. Süt çocukluğu dönemi fiziksel istismar olgularında gecikmeden doğru tanı konulmasında, adli olgu olarak değerlendirilip, tespit edilen travmatik değişimlerin adli rapor şeklinde belgelendirilmesinde ve adli makamlara bildirilmesinde Adli Tıp Anabilim Dalları ile birlikte yürütülen koordine çalışmaların ivedilikle yaygınlaştırılması gerektiği düşünülmektedir. Anahtar Kelimeler: Çocuk istismarı, subdural hematom, sarsılmış bebek sendromu

Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care: A Randomized Controlled Trial

PURPOSE: The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group