The Pediatric Tracheostomy Practice During COVID-19 Pandemic at a PICU

Introduction:To evaluate pediatric tracheostomies performed at a tertiary care pediatric intensive care unit (PICU) before and after the Coronavirus disease-2019 (COVID-19) pandemic.Methods:A total of 57 pediatric tracheostomy patients performed at a tertiary care PICU were included. Prognostic scores including pediatric risk of mortality 2, pediatric index of mortality 2 and pediatric logistic organ dysfunction scores, the family education process and time to home discharge were evaluated according to time of tracheostomy (pre-pandemic vs. after pandemic) and responsible surgeon (pediatric surgeon vs. otolaryngologist). MedCalc® Statistical Software version 19.7.2 (MedCalc Software Ltd, Ostend, Belgium; https: //www.medcalc.org; 2021) was used for statistical analysis.Results:A non-significant tendency for higher rate of pediatric surgery-based tracheostomies was noted after the pandemic (76.0 vs. 24.0%, p=0.134). No significant difference was noted between tracheostomies performed before vs. after the COVID-19 pandemic and those performed by otolaryngologists vs. pediatric surgeons in terms of prognostic scores and time to home discharge.Conclusion:Our findings emphasize the maintenance of high quality patient care for pediatric tracheostomy patients in accordance with standardized tracheostomy protocols and policies during the pandemic period with no significant difference between tracheostomies performed before and after the COVID-19 pandemic and those performed by pediatric surgeons vs. otolaryngologists in terms of prognostic scores and time to home discharge

Investigation of Meaning of Leisure Activities and the Satisfaction with Life of Students in the Faculty of Sport Sciences: An Example of Akdeniz University

Aim: It is known that recreational activities have positive effects on people's emotions, thoughts, morale and many other issues. The aim of this study was to measure students’ participation in recreational activities, life satisfaction and the meaning of leisure activities to the students in the Faculty of Sport Sciences at Akdeniz University.Method: A total of 252 students (60.3% male, 39.7% female) participated in the study. As data collection instruments, Turkish version (Köker, 1991) of Life Satisfaction Scale (LSS), which was developed by Diener et al. (1985), and Turkish version (Gürbüz et al., 2007) of Leisure Meanings Inventory (LMI) (Esteve et al., 1999) were used. SPSS Package program was used in the study. ANOVA was used in the data analysis.Findings: According to the findings of Leisure Meanings Inventory by classes, there was a statistically significant difference (p <0.005) among the groups. . This difference appears to be between sophomores and juniors when examined on a class-by-class basis. According to the findings of Leisure Meanings Inventory with regard to departments, it was noted that there was very little difference between them, although there was a difference in the averages. This difference was not statistically significant though. There was no statistically significant difference between groups regarding class and department variables according to the findings of Life Satisfaction Scale.Conclusion: The results of this study showed that there was a significant difference between sophomores and juniors while there was no significant difference between freshmen and seniors according to the LMI averages. There was no significant difference between the mean scores of LSS among the classes

Late-presenting Congenital Diaphragmatic Hernia: Case Report

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm. It becomes evident as a result of the entrance of the abdominal organs into the chest cavity. Generally, respiratory symptoms appear in the first few hours or days of life in affected newborns. Events diagnosed after one month are considered as late-onset CDH and these constitute 5-25% of all diaphragmatic hernia cases. In late diagnosed cases, left posterolateral CDH is seen most commonly (79.4%), and 65% of patients show symptoms within one year. The most common symptom and evidence are vomiting and dyspnea. During the infancy period, respiratory complaints are seen frequently while in the older ones gastrointestinal complaints are seen more often. In this article, we present a case of a 9-year-old patient who presented with the complaint of cough only and was diagnosed with diaphragmatic hernia. The patient was admitted to our emergency department with a preliminary diagnosis of pneumonia. In the physical examination of the patient, it became evident that breath sounds were decreased in the left hemithorax. Chest X-ray showed left hemithorax opacity and suspicious intestinal appearance. The patient was diagnosed with diaphragm hernia after ultrasonograhphy and thorax tomography. The patient was transferred to the pediatric surgery department and operated. Patients with CDH may not always be diagnosed at an early stage and may come up with different clinical symptoms at different ages. It is more difficult to diagnose in late-onset cases and it is important to make differential diagnosis. This case report was presented due to rarity of late onset CDH with only complaint of cough

Comparison of the Eosinophil Count to C – reactive protein, Leukocyte Count, and Neutrophil Count for the detection of bacterial infection in ill-appearing children with fever admitted to the Emergency Department

Introduction. From late 19th century to the present day, several authors have investigated the value of low eosinophil count as a biomarker of bacterial infection. In this study, we examined the value of eosinopenia for diagnosing bacterial infection in ill-appearing children admitted to the pediatric emergency department. Methods. Retrospective review of the medical records of children age 1 month to 14 years who appeared ill on admission to the emergency department (ED). Data collected included; C-reactive protein (CRP) level leukocyte, neutrophil, eosinophil counts, results of microbiological tests, radiologic evaluation, and treatment given in the ED. Final outcome data were also collected. Results. In total, 878 met our case definition and inclusion criteria. 521 patients had confirmed or presumed bacterial infection and 355 patients had presumed or confirmed viral infection. Nineteen patients died; all had bacterial infections. Neutrophil, eosinophil counts and CRP level were independent risk factors for bacterial infection in the multivariate analysis (p0.05). The sensitivities of the leukocyte, neutrophil, and eosinophil counts and CRP level were 57.5%, 62.9%, 61%, and 57.1%, respectively. The specificities of them were 59.1%, 63.3%, 67%, and 77.4%, respectively. Conclusion. In our study population, although the accuracies of eosinophil, neutrophil counts, and CRP level were not enough, they had similar in distinguishing viral from bacterial infection in ill appearing febrile children. By comparison the leukocyte count had limited predictive value

Comparison of early characteristics of multisystemic inflammatory syndrome and Kawasaki disease in children and the course of Kawasaki disease in the pandemic

Abstract Introduction Multisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. In this study, the clinical findings, organ involvements, similarities, and differences in laboratory and imaging of the children with MIS-C and KD at the time of admission will be revealed in detail, and the treatment methods and follow-up results will be revealed. Material and method Our study was a single-center study and included pediatric patients who were treated with a diagnosis of MIS-C between March 2020 and July 2023 in the pediatric cardiology, pediatric emergency, pediatric infection, and pediatric intensive care clinics at Celal Bayar University and who were treated with a diagnosis of KD (complete/incomplete) between January 2015 and July 2023. MIS-C diagnosis was made according to the Turkish Ministry of Health COVID-19 guidelines. Sociodemographic characteristics, clinical, laboratory, and echocardiography findings, treatments given, and clinical course of all patients included in the study were evaluated. Results The median age was 30 months (7–84) in KD and 96 months (6-204) in MIS-C, and it was significantly higher in the MIS-C group (p = 0.000). Symptom duration was significantly longer in the MIS-C group (p = 0.000). In terms of clinical features, gastrointestinal syndrome findings (nausea, vomiting, abdominal pain) and respiratory findings (dyspnea) were significantly higher in the MIS-C group (p = 0.007, p = 0.000, p = 0.002, respectively). Regarding cardiovascular system involvement, coronary involvement was significantly higher in the KD group. However, valvular involvement, left ventricular systolic dysfunction, and pericardial effusion were significantly higher in the MIS-C group (p = 0.000, p = 0.001, p = 0.003, p = 0.023, respectively). In terms of laboratory findings, white blood cell count was higher in KD (p = 0.000), absolute lymphocyte count, platelet level, blood sodium, and albumin levels were lower in MIS-C group (p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.003, respectively), ferritin and troponin levels were significantly higher in MIS-C group. These results were statistically significant (p = 0.000, p = 0.000, respectively). D-dimer and fibrinogen levels were high in both groups, and no significant statistical difference was detected between the two groups. There was no significant difference between the two groups regarding the length of hospitalization and mortality, but steroid use was significantly higher in the MIS-C group (p = 0.000). Conclusion In conclusion, this study has demonstrated the similarities and differences between MIS-C and KD regarding clinical findings, organ involvement, and laboratory and imaging results. The results of our study have important implications in terms of contributing to the data in the existing literature on these two diseases and for the correct diagnosis and better management of pediatric patients presenting with these disorders. What is known Multisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. What is new Although MIS-C and KD have many similarities, their symptoms, disease processes, possible complications, and treatment regimens may differ

The use of Pleth Variability Index (PVI) for the assessment of patients with dehydration in the pediatric emergency department

Objective:There is not a non-invasive, valid, and reliable criterion yet that can be used to determine the degree of dehydration and responsiveness to fluid treatment. In the literature, Pleth Variability Index (PVI) has been studied as one of the additional tools that can be used to determine the degree of dehydration. Studies on this topic have been conducted mainly on patients who are connected to mechanical ventilators. This study was conducted to assess the feasibility of PVI measurement in paediatric patients who breathe spontaneously, are dehydrated moderately and need fluid repletion.Materialand Methods:For this purpose, PVI, blood gas (pH, HCO3, lactate), and body weights of the patients were measured before and after fluid replacement. The delta (Δ) values were calculated by taking the difference between the values before and after fluid therapy, and the correlation was examined.Results:After one hour of fluid treatment, weight, physical examination, blood gas (bicarbonate, lactate, pH) values improved significantly compared to pre-fluid levels, and high PVI values were found to decrease significantly. However, no significant correlation was found between PVI change (ΔPVI) and other variables (Δ kilo, pH, lactate, bicarbonate), which are used to determine the degree of dehydration.Conclusion:According to the findings of our study, PVI alone does not provide adequate and reliable data in children who are dehydrated moderately and breathe spontaneously.Keywords:Pediatric, Dehydration, Pleth Variability Index</p

Çocuklarda Kayısı Çekirdeği Yenmesi Sonrası Siyanür Zehirlenmesi

Cyanide is one of the strongest and lethal poisons. Cyanide leads to tissue hypoxia and lactic acid accumulation. Hydroxocobalamin is a safe, fast and effective antidote that could be used, especially in children. In this paper, we presented four cases of cyanide poisoning caused by apricot seed ingestion. Three of the patients were transferred to the paediatric intensive care unit, and hydroxocobalamin was given, and their conditions improved rapidly. This study aimed to draw attention to cyanide poisoning caused by apricot seed ingestion and to hydroxocobalamin use as an antidote.Siyanür en güçlü ve en ölümcül zehirlerden biridir. Siyanür doku hipoksisine ve laktik asid oluşumuna neden olur. Hidroksikobalamin, özellikle çocuklarda kullanılabilecek güvenli, hızlı ve etkin bir antidottur. Biz bu yazıda kayısı çekirdeği alımına bağlı siyanür zehirlenmesi olan dört olgu sunduk. Üç hastamızda ciddi zehirlenme bulguları ile çocuk yoğun bakım ünitesine alındı ve andidot olarak hidroksikobalamin verilerek, hızlı düzelme sağlandı. Amacımız; kayısı çekirdeği yenmesine bağlı siyanür zehirlenmesine ve antidot olarak hidroksikobalamin kullanımına dikkat çekmekti