Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit

Background Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA. Methods This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis. Results The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, p<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae. Conclusion Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic

Serahsî’nin El-mebsût’unda usûl ve fürû kaideleri

SERAHSÎ’NİN EL-MEBSÛT’UNDA USÛL VE FÜRÛ KAİDELERİ İslâm dini diğer dinlerden farklı olarak bir hukuk anlayışı ortaya koymuş ve zamanla, özellikle de müctehid imamlar döneminde bir hukuk sistemi olarak geliştirilmiş ve zirve noktasına ulaşmıştır. İslâm hukukundaki kavâid anlayışının dayanağı ilk önce Kitâb’ın vazettiği genel nitelikli hükümler ve Sünnet’in cevâmiü’l-kelim özelliğidir. Dolayısıyla bu kültürde yetişen fakihlerin söz konusu kaynaklarda geçen nasların istikrâsı ile, yeni çıkan meseleleri çözüme kavuşturmada sahâbenin tutumu ve onlardan aktarılan veciz ifadeler, müctehid imamların fıkhî düşünceleri, onların ictihâdları, usûl-i fıkıh ilkeleri, mantık kuralları, dil kuralları aracılığıyla ve bunların tümevarım yoluyla tetkik edilmesi sonucunda tespit ettikleri kurallar kavâid ilmi olarak ortaya çıkmıştır. Çalışmamız, üç bölümden oluşmaktadır. “Kavâid Kavramı İle İlgili Genel Bilgiler” olarak isimlendirilen giriş kısmında ilk önce kavâid teriminin kavramsal tahlili yapılarak benzer terimler üzerinde durulmuş, hukuk düşüncesinde genel ilke anlayışı, kavâid ilminin ortaya çıkışı ve tarihsel gelişimi, kavâid’in delil olarak kullanılması, kavâid’in tasnifi ve faydaları hakkında kısa bilgi verilmiştir. Birinci bölümde, fürû‘ ile ilgili kâideler el-Mebsût eserinde sıralanan konular esas alınarak tasnif edilmiştir. Ancak burada sadece ukûbât ile ilgili konular tamamen mustakil bir başlık altında verilmiş ve bu konuyla ilgili temel ilkeler bu başlık altında sıralanmıştır. İkinci bölümde ise, usûl ile ilgili kâideler modern dönemde yazılmış usûl eserlerindeki konuların tasnifi esas alınmış ve var olan kâideye uygun başlıklar atılarak örnekleriyle beraber orada verilmiştir. ABSTRACT THE METHODICAL AND JURISPRUDENTAL MAXIMS IN SARAKHSI’ES AL-MABSUT The Islamic religion has revealed a sense of law is different from other ones and in time, especially in the era of mujtahids developed as a legal system and reached the peak point. The basis of the (legal maxims) concept in Islamic law is firstly the general qualified provisions which preached of the Koran and the feature of the cavâmiu’l-kalim of Sunnah. Therefore the attitudes of the mujtahids who grow up in this culture, with the induction of the holy themes (nas) in the sources, the attitude of companion of prophet (sahaba) in solving the new emerging issues and terse expressions conveyed from them, the mujtahids’ thoughts, methodical maxims, logic rules, through language rules and the rules they have established as a result of their inductive investigation have emerged as legal maxims (kavâid) science. Our research consists of three parts. In the introduction part called “General Knowledge about Kavâid concept”, initially by conceptual analysis of the term legal maxims (kavâid) was analyzed and similar ones have been emphasized and it has been given brief information on the classification and benefits of legal maxims understanding of the general principle in the sense of law, appearance of Legal maxims science, historical development, use of legal maxims as evidence. In the first chapter, the jurisprudential maxims have been classified based on the subjects listed in al-Mebsût’s work. However, only the issues related to Islamic crime law (ukûbât) under completely different headings are given here and the basic principles on this subject are listed under this heading. In the second chapter, The methodical maxims are based on the classification of the subjects in the works written in the modern period and it has been given suitable titles with examples to the existing principles

Hematopoetik Kök Hücre Nakli Yapılan Çocuk Hastalarda Renal Komplikasyonların ve Hipertansiyon Sıklığının Belirlenmesi

The aim of this study is to investigate renal complications, hypertension frequency and risk factors in patients who had hematopoietic stem cell transplantation (HSCT) during their childhood. 167 patients with allogeneic (n=165) and autologous (n=2) transplantation were investigated for renal complications. After transplantation, hemorrhagic cystitis (HC) was developed in 28 patients (%16,8). It was observed that patients who had HSCT at older ages and who had suffered from viral infection developed HC more frequently than others. Besides, patients with underlying malignant diagnosis, patients who had suffered from veno-occlusive disease (VOD) and viral infections after transplantation developed acute kidney injury (AKI-pRIFLE criteria) more frequently than others. At the last visit, 72 patients (41 boys, 31 girls) were evaluated for late-onset renal complications and hypertension. Office blood pressure (BP) measurement and ambulatory blood pressure monitoring (ABPM) were performed in these patients. Ambulatory blood pressure measurements were standardized according to age, gender and height using the least median of squares (LMS) method. According to the American Academy of Pediatrics (AAP) guidelines, among 12 patients (%19,7) with normal office BP, eight of them were diagnosed as prehypertension and four of them were diagnosed as hypertension with ABPM. According to European Society of hypertension (ESH) guidelines, among15 patients (%23,4) with normal office BP, ten of them diagnosed as prehypertension and four of them were diagnosed as hypertension with ABPM. At the last visit, when we have investigated patients with chronic kidney disease (CKD), we observed that patients whose source of hematopoietic stem cell is bone marrow and cord blood, peripheral stem cell, unrelated donor and chronic GVHD developed CKD more frequently than others. Conditioning regimen, acute and chronic GVHD were important factors that have influenced the survival. In conclusion, follow up of patients with HSCT should be done by transplant and pediatric nephrology departments for the risk of renal damage and hypertension.TEŞEKKÜR iii ÖZET iv ABSTRACT v İÇİNDEKİLER vi SİMGELER VE KISALTMALAR viii ŞEKİLLER DİZİNİ x TABLOLAR DİZİNİ xi 1.GİRİŞ VE AMAÇ 1 2.GENEL BİLGİLER 2 2.1. Hematopoetik Kök Hücre Nakli 2 2.2. Hematopoetik Kök Hücre Nakli Sonrası Görülen Komplikasyonlar 4 2.3. Hematopoetik Kök Hücre Nakli Sonrasında Gelişen Renal Komplikasyonlar İçin Risk Faktörleri 5 2.4. Hematopoetik Kök Hücre Nakli Sonrası Görülen Renal Komplikasyonlar 8 2.4.1. Hemorajik Sistit 9 2.4.2.Akut Böbrek Hasarı 11 2.4.3. Proteinüri 15 2.4.4. Nefrotik Sendrom 17 2.4.5. Trombotik Mikroanjiopati 18 2.4.6. Hipertansiyon 20 2.4.7. Kronik Böbrek Hastalığı 23 3. GEREÇ VE YÖNTEM 26 3.1. Çalışma Planı ve Hastalar 26 3.2. Çalışma Kriterleri 26 3.2.1. Çalışmaya Dahil Edilme Kriterleri 26 3.2.2. Çalışma Dışında Bırakılma Kriterleri 26 3.3. Çalışma Verileri 26 3.3.1. Hematolojik Veriler 27 3.3.2. Üriner Sistem Verileri 27 3.4. İstatistiksel Yöntemler 31 3.5. Etik Kurul Onayı 32 4. BULGULAR 33 4.1. Hasta Özellikleri 33 4.2. Hastalarda İzlemde Gelişen Üriner Sistem Komplikasyonlar 36 4.3. Hastaların Son Vizitteki Böbrek Bulguları 45 4.4. Sağ Kalımı Etkileyen Faktörler 56 5. TARTIŞMA 58 6. SONUÇLAR 71 7. KAYNAKLAR 76 8. EKLER 83 Ek 1: Çalışma formuBu çalışmanın amacı çocukluk çağında hematopoetik kök hücre nakli (HKHN) sonrası renal komplikasyonların, hipertansiyonun sıklığını belirlemek ve risk faktörlerini araştırmaktır. Allojenik (n=165) ve otolog (n=2) nakil yapılan 167 hasta incelendi. Nakil sonrası 28 hastada (%16,8) hemorajik sistit (HS) geliştiği görüldü. Büyük yaşta HKHN yapılan ve viral enfeksiyon geçirenlerin daha sık HS geçirdiği gözlendi. Ayrıca malign tanı grubunda olanların, nakil sonrası venookluzif hastalık (VOH) veya viral enfeksiyon geçirenlerin pRIFLE kriterine göre daha sık akut böbrek hasarı (ABH) geçirdiği gözlendi. Son vizitte muayene edilen 72 hasta (41 erkek, 31 kız) geç dönem renal komplikasyon ve hipertansiyon yönünden incelendi. Hastalara ofis kan basıncı (KB) ölçümü ve ambulatuar kan basıncı monitorizasyonu (AKBM) yapıldı. Ambulatuar KB ölçümleri yaş, cinsiyet ve boya göre en küçük medyan kareler (LMS) yöntemi kullanılarak standardize edildi. Amerikan Pediatri Akademisi’nin (APA) rehberine göre ofis KB’si normal olan 12 hastanın (%19,7) sekizinin AKBM’ye göre prehipertansiyon, dördünün hipertansiyon tanısı aldığı görüldü. Avrupa Hipertansiyon Cemiyeti’nin (ESH) rehberine göre ofis KB’si normal olan 15 hastanın (%23,4) onunun AKBM’ye göre prehipertansiyon, beşinin hipertansiyon tanısı aldığı görüldü. Hazırlık rejimi, akut ve kronik GVHH’nin sağ kalımı etkileyen önemli etkenler olduğu görüldü. Son vizitte kronik böbrek hastalığı (KBH) olan hastalar incelendiğinde hematopoetik kök hücre kaynağı kemik iliği ile beraber kordon kanı, periferik kök hücre olan, doku uyumu tam olmayan ve kronik GVHH olanların daha sık KBH geliştirdiği gözlendi. Hazırlık rejimi, akut ve kronik GVHH’nin sağ kalımı etkileyen önemli etkenler olduğu görüldü. Sonuç olarak HKHN yapılan çocuk hastalar renal hasar ve HT gelişimi için riskli bireyler olması nedeni ile nakil ünitesi ile beraber çocuk nefroloji bilim dalı tarafından düzenli olarak takip edilmelidir

Megameatus intact prepuce and associated anomalies

Objective: Megameatus intact prepuce is described as subset of megalourethra or distal hypospadias by several authors. Despite suggested different operative techniques, some authors prefer not to operate this variant of penile anomaly. We aimed to evaluate 31 patients operated due to megameatus intact prepuce and associated anomalies . Material and methods: Thirtyone patients operated between 2008-2018 for MIP were evaluated retrospectively. All data were collected from hospital records. Patient age, application reasons, raphe anomalies, associated genitourinary and extragenitourinary pathologies, operative techniques, and postoperative complications were analyzed. Results: Mean age was 50 months (8-128 months). Ten of the patients had raphe anomalies. Genital raphe hyperpigmentation was seen in 1 patient, raphe deviation and bifurcated raphe was seen in6 and 3 patients respectively. Genitourinary anomalies were detected in 7 patients, bilateral undescended testes in 1 patient, penile chordee in 2 patients, ureteropelvic junction obstruction in 2 patients, penoscrotal web in 1 patient, nocturnal enuresis in one patient. Tubularized incised plate urethroplasty (TIPU) (n=5), tubularized urethral plate urethroplasty (TUPU)(n=16) and meatoplasty (n=10) were the operative techniques. Conclusion: . Co-occuring raphe anomalies should arise awareness of MIP among the clinicians who are engaged with the children’s medical conditions and also the possible anomalies especially in the societies which circumcision is not traditionally required. Further studies with large number series needed for better understanding of this pathology

Multisystem Inflammatory Syndrome in Children Admitted to a Tertiary Pediatric Intensive Care Unit

Background Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU)

Influenza Virus Associated Pediatric Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcomes.

Background and Objective: The aim of this multicenter retrospective study was to determine the clinical characteristics, treatment approaches and the course of pediatric acute respiratory distress syndrome (PARDS) which developed associated with the influenza virus in the 2019-20 season

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality