Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Therapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causingmorbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), GuillainBarre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible

A Child with 3p Deletion Syndrome Who Recovered from Influenza-Related Acute Respiratory Distress Syndrome

Influenza virus can cause serious complications, especially in patients with comorbid illnesses. Acute respiratory distress syndrome (ARDS) is among the most common causes of influenza-related morbidity and mortality. Herein we present the case of a boy with a genetic disorder who recovered from influenza-related ARDS. A 3-year-old boy with 3p deletion syndrome was admitted for refractory cough and fever. During his follow-up, sudden respiratory failure concomitant with ARDS occured. He was transferred to the pediatric intensive care unit (PICU) and intubated. Broad-spectrum anti-biotherapy and oseltamivir were administered. Nazopharnygeal swab polymerase chain reaction (PCR) analysis revealed H1N1. Venitalition parameters were set according to that recommended for ARDS. On the ninth day of his admission, the patient was discharged from PICU. Appropriate ventilation strategies together with early oseltamivir therapy improves outcomes of influenza-related ARDS

Shear wave elastography of parotid glands in pediatric patients with HIV infection

ObjectivesParotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.Materials and methodsThis single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann-Whitney U test were used in statistical analysis.ResultsStiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.ConclusionsPG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner

Comparative evaluation of liver, spleen, and kidney stiffness in HIV-monoinfected pediatric patients via shear wave elastography

Background/aim: This study aimed to evaluate the stiffness of the liver, spleen, and kidneys in HIV-monoinfected children via shear wave elastography (SWE)

Necrotizing Pneumonia in a Diabetic Child Successfully Treated with Pneumonectomy

Diabetic patients may experience more severe Staphylococcus aureus-related respiratory tract infections such as necrotizing pneumonia (NP). A 13-year-old girl with uncontrolled diabetes mellitus was admitted to pediatric intensive care unit (PICU) with diabetic ketoacidosis and respiratory distress. Her initial evaluation revealed diffuse pneumonic infiltration that progressed to NP within days. She was intubated and placed on mechanical ventilator (MV) support. Positive inotropes and broad-spectrum antibiotics were initiated. Methicillin-resistant S. aureus was isolated from blood and pleural specimen cultures. In spite of aggressive medical treatment, infection could not be controlled and lobectomy was performed. However, the patient was fistulized and right total pneumonectomy was performed on the 16th and 29th days of PICU admission. She gradually got better and was weaned from MV. On the 59th day, she was discharged oxygen-free from the hospital. Early surgical intervention should be considered for the treatment of NP resistant to medical therapy

Evaluation of Candida species and antifungal susceptibilities among children with invasive candidiasis

Aim: Non-albicans Candida species and resistant microorganisms have been more commonly isolated in invasive candidiasis in recent years. The aim of this study was to evaluate the distrubution of Candida spp and antifungal resistance in our clinic

Salvage Use of Tigecycline for Severely Ill Children

Objective: Tigecycline has a wide spectrum antimicrobial activity including multi-drug resistant and extended drug resistant nosocomial Gram-negative bacteria. Although its pediatric use has not been approved, clinicians are sometimes obligated to choose tigecycline as salvage therapy. In this study, we present our clinical experience regarding tigecycline use in children

Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care center

Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital