Evaluation of Clinical and Radiological Indicators of Childhood Head Trauma

Objective: The aim of this study is to determine the clinical signs of traumatic brain injury and its long-term effects on prognosis by evaluating the clinical and radiological findings of the patients admitted to the pediatric emergency department due to blunt head trauma. Method: The cases who applied to the pediatric emergency department due to head trauma were examined prospectively. Glaskow Coma (GCS) and Pediatric Trauma Scores (PTS) were calculated. The patients were evaluated neurologically 6 months after they were discharged. Results: A total of 707 pediatric patients [mean age: 59.8 +- 42.6 months; range: 1 month to 13 years; 263 (37.2%) girls] were evaluated prospectively. Pathology was detected in 101 cases (45.9%) [(epidural hematoma, 14; subdural hematoma, 11; brain edema, 36; intracerebral hematoma, 6; subarachnoid hemorrhage, 8; cerebral contusion, 22. Seventy-two (10.1%) patients had skull fractures.] Seventeen cases (2.4%) were operated, and 7 (1.4%) cases were lost. In children aged < 2 years vomiting, tachypnea, focal neurological findings, multitrauma, GCS <15 and low PTS were more common with traumatic brain injury (p <0.05). Vomiting, GCS <15 and low PTS were more common in children >2 years old and with traumatic brain injury (p <0.05). Neurological sequelae were not detected in patients aged <2 years with mild trauma. Loss of consciousness, pulse rate, respiratory and blood pressure abnormalities, focal neurological findings, low GCS and PTS were more common in children aged >2 years and with neurological sequelae (p <0.05). Conclusion: Physical examination findings, GCS, and PTS levels are useful tools in predicting the short- and long-term consequences of the injury

COMPARTMENT SYNDROME IN A CHILD FOLLOWING SNAKEBITE

Compartment syndrome is a rare complication of snakebite In this article we report a seven year old girl with compartment syndrome resulting from a viper envenomation Only ten vials of antivenin were used due to inavailability Despite aggressive medical treatment except for insufficient dose of antivenom administration her clinical situation continued to worsen and she required a fasciotomy In conclusion prompt institution of adequate antivenin treatment is imperative in snakebite cases However fasciotomy should be kept in mind in compartment syndrome related with snakebite which does not respond to medical therap

The Effect of M694V Mutation on Clinical Presentation and Acute Phase Response in Children with Familial Mediterranean Fever: Single Center Experience in Western Turkey

Objective: The aim of this study was to investigate the phenotype-genotype correlation and the relationship between clinical severity score and acute phase response in children with familial Mediterranean fever (FMF) in Western Turkey. Material and Methods: The medical records of 87 FMF children (mean age: 11.1 +/- 3.6 years; range: 3-20 years; mean age at diagnosis: 8.3 +/- 3.5 years; mean follow up: 31.2 +/- 27.7 months; female: 55.2%) mutations on MEFV gene were retrospectively reviewed. We used Tel Hashomer diagnostic criteria and severity score. Correlations between white blood cell (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) during attack-period as well as clinical severity scores were investigated. The patients were grouped according to one or two alleled mutations and the presence of the M694V mutation. Clinical parameters and WBC, CRP and ESR levels were compared among the groups. Results: M694V homozygosity was found in 22 patients (25.3%). Amyloidosis was seen in six patients (6.9%). All of them had M694V homozygote mutation. The measured WBC (r=0.294; p: 0.006), CRP (r=0.720; p<0.001) and ESR (r=0.716; p<0.001) values were correlated with clinical severity score. The presence of two mutated alleles or M694V homozygosity was associated with a higher clinical severity score, higher levels of WBC, CRP and ESR as well as higher risk of amyloidosis compared to the others (p<0.05). Conclusion: M694V homozygote genotype shows higher acute phase response during attack-period and severe clinical course in children with FMF in Western region of Turkey

A Rare Cause of Metabolic Acidosis Fatal Transdermal Methanol Intoxication in an Infant

WOS: 000380870300009PubMed ID: 26196361Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonicclonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, <3 meq/L) and exposure to spirit-soaked bandages (%96 methanol) for 24 hours and 3 days. The patient's serum methanol level was 20.4 mg/dL. She was treated with fomepizole and continuous venovenous hemodialysis (CVVHD) in the pediatric intensive care unit, and methanol levels decreased to 0 mg/dL after 12 hours. During follow-up, massive edema and subarachnoid hemorrhage in the occipital lobe were detected by computed tomography of the brain. The patient died after 7 days. Although methanol intoxication occurs predominantly in adults, it must be considered in children with high-anion gap metabolic acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant

Pediatric risk and index of mortality in an intensive care unit

Aim: The purpose of the study is to determine the discriminative ability and calibration of Pediatric Risk of Mortality (PRISM I) I and Pediatric Index of Mortality (PIM) II in predicting the mortality in children admitted to a medical-surgical pediatric intensive care unit (PICU) in Turkey

Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey

WOS: 000496521400006PubMed ID: 31435144Objectives: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

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

Background/aim: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure. Material and methods: This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis. Results: Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p 0.001), ARDS (p = 0.001), lower respiratory tract infections (p 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026). The failure rate was 13.4%. sepsis, ARDS, prolonged intubation, and use of nasal masks were associated with NIV failure (p = 0.001, p 0.001, p 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in 5 (10.6%), neurological deterioration in 4 (8.5%) and developing ARDS in 3 (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR: 9.841, 95% CI: 2.0021-48.3742). FiO(2) > 55% at 6th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on 16 children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC) Conclusion: Absence of reduction in the respiration rate within an hour, FiO(2) requirement >55% at 6th hours and PRISM-3 score >8 predict NIV failure

The Effect of Aminoglycosides on Colistin-Containing Regimens in the Treatment of Carbapenem-Resistant Gram-Negative Infections in Pediatric Intensive Care Units: A Two-Center Experience

WOS: 000485683800010Objective: This study aimed to assess the outcomes including morbidity and mortality of carbapenem-resistant gram-negative (CRGN) infections in pediatric critical care setting. The second aim was to investigate the impact of aminoglycosides on colistin-containing regimen in CRGN-infected pediatric critical care patients. Materials and Methods: We retrospectively evaluated medical records of 82 patients who had received colistin in combination with an aminoglycoside (CA group) or another antibiotic (CO group) at two reference pediatric intensive care units (PICUs) between February 2011 and February 2016. Results: We enrolled 82 CRGN-infected patients who were admitted to PICUs of two hospitals. The median age of the patients was 24 (25th-75th percentile; 8-78.75) months, and the median duration of hospital stay was 30 days (25th-75th percentile; 16.7-57.7). No statistical difference was observed in the variables, including microbiological response, attributable mortality, crude mortality, and the duration of achieving first negative culture (p>0.05). Clinical response was significantly more observed in the CA group (85.5% vs. 63.2; p=0.048), and attributable mortality was higher in the CO group (12.7% vs. 31.6%; p=0.055). Nephrotoxicity did not show statistical difference between groups (p=0.357), and neurotoxicity was not observed. Conclusion: Colistin-containing regimen in combination with an aminoglycoside may be an effective and safe antimicrobial agent without a significant increase in side effects