The Role of Bronchoscopy in Childhood Foreign Body Aspirations: A 3-year Experience

Introduction:The purpose of our retrospective study was to define the clinical and radiological features of patients with aspirated foreign bodies, characterize the incidence of foreign body aspiration (FBA) and to compare the results of early and late bronchoscopy.Methods:We reviewed the medical records of patients who were admitted to the pediatric emergency department of our center due to FBA between 2016 and 2018.Results:Forty-four patients (M/F 30/14) aged 38.7±44.1 months (mean ± standard deviation, range: 5-191) were enrolled in this study. The most common symptoms were cough (42/44) and wheezing (20/44). No foreign body was detected in eight patients (18%). Regarding the types of foreign bodies, an organic material was observed in 27 (61.4%) patients with FBA, and a nonorganic material was observed in 9 (20.5%) patients. The mean age of patients with organic FBA was significantly lower than that of patients with non-organic FBA (26±18 vs. 93±67 months, p=0.005).Conclusion:Bronchoscopy is an efficient diagnostic tool for patients with suspected FBA because it is associated with low complication risk and reduces the risks of delayed FBA diagnosis and treatment

Clinical and Cytokine Profile of Children With COVID-19: A Report From Turkey

Background We aimed to analyze the expression of infection-related biomarkers and inflammatory cytokines in laboratory-confirmed cases and compare the differences between clinically severe and non-severe ones. Method We randomly selected 35 patients who were hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). Blood serum was obtained at the time of admission to the hospital, on the third to the fifth day, and at the time of discharge. Result The median age of our patients was 56.5±69.7 months (range: 1-205 months). The mean pro-B-type natriuretic peptide (pro-BNP) was significantly higher at the time of admission than on the third to the fifth day of illness. The mean pro-B-type natriuretic peptide levels at three time points were significantly higher in patients with severe cases than in mild-moderate cases. However, there was no significant difference between the clinical severity with regard to the cytokine levels at disease onset and recovery. Conclusion In the study, it was shown that cytokines play an important role in the pathogenesis of COVID-19. Therefore, it may be beneficial to use agents such as tocilizumab in the treatment

The Role of Natural Antioxidants Against Reactive Oxygen Species Produced by Cadmium Toxicity: A Review

Cadmium (Cd) is a significant ecotoxic heavy metal that adversely affects all biological processes of humans, animals and plants. Exposure to acute and chronic Cd damages many organs in humans and animals (e.g. lung, liver, brain, kidney, and testes). In humans, the Cd concentration at birth is zero, but because the biological half-life is long (about 30 years in humans), the concentration increases with age. The industrial developments of the last century have significantly increased the use of this metal. Especially in developing countries, this consumption is higher. Oxidative stress is the imbalance between antioxidants and oxidants. Cd increases reactive oxygen species (ROS) production and causes oxidative stress. Excess cellular levels of ROS cause damage to proteins, nucleic acids, lipids, membranes and organelles. This damage has been associated with various diseases. These include cancer, hypertension, ischemia/perfusion, cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, insulin resistance, acute respiratory distress syndrome, idiopathic pulmonary fibrosis, asthma, skin diseases, chronic kidney disease, eye diseases, neurodegenerative diseases (amyotrophic lateral sclerosis, Parkinson’s disease, Alzheimer’s disease, and Huntington disease). Natural antioxidants are popular drugs that are used by the majority of people and have few side effects. Natural antioxidants play an important role in reducing free radicals caused by Cd toxicity. Our goal in this review is to establish the relationship between Cd and oxidative stress and to discuss the role of natural antioxidants in reducing Cd toxicity

Evaluation of oxidative stress biomarkers in acute mercury intoxication

Introduction: Very few studies have evaluated the association between mercury exposure and oxidative stress in humans, particularly in children. Aim: This is the first report where we aimed to determine the oxidative stress status of children who were accidentally exposed to elemental mercury. Materials and methods: In the present study, the study group was composed of 86 randomly selected children poisoned by mercury; the control group was composed of 78 children who had no history of mercury exposure. At admission, blood samples were collected. Blood superoxide dismutase activity, catalase enzyme activity, and glutathione peroxidase activity were measured by Fridovich, Beutler, and Lawrence Burk methods respectively, and the results were given as U/g Hb. Malondialdehyde level was measured by Ohkawa methods, and the results were given as mmol/ml. Results: Catalase activity was significantly lower in the patient group compared to the control group (1.28±0.62 vs. 3.90±0.86 U/g Hb, p=0.010). In exposed children, SOD activity was significantly higher than the controls (5936±810 vs. 2226±464 U/g Hb, p=0.03), while the GSH-Px activity was significantly lower (13.01±3.21 vs. 34.97±7.32 U/g Hb, p=0.013). The MDA levels of the mercury group were significantly higher than the MDA levels of the control group (2.85±0.84 vs. 2.05±0.79 mmol/ml, p=0.04). Conclusions: The results of the present study showed that acute mercury poisoning causes an alteration of oxidative stress status in children exposed to elemental mercury

Evaluation of Oxidative Stress Biomarkers in Patients with Henoch-Schönlein Purpura

Introduction: Henoch-Schönlein Purpura (HSP) is a systemic vasculitic syndrome characterized by non-thrombocytopenic purpura, arthritis/arthralgia, abdominal pain, and glomerulonephritis. The pathogenesis of HSP has not been clearly identified. Oxidative damage has a role in the pathogenesis of most cases. Aim: This study aimed to evaluate changes of oxidative stress by studying parameters like superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) in an attempt to identify the role of oxidative stress in HSP from another perspective. Materials and methods: This study enrolled 23 pediatric patients (ten girls and thirteen boys) diagnosed with HSP who were under follow-up at Sutcu Imam University School of Medicine Department of Pediatrics between 2014 and 2016 and twenty healthy children as the control group. The parents of all subjects gave informed consent to participate in the study. In the HSP group, the beginning season of the illness and the systemic involvement during follow-up were determined. Blood specimens were obtained at presentation before any treatment was started. SOD, CAT activities, and MDA values in erythrocyte and plasma samples were compared between the patient group and the healthy children. Results: Twenty-three patients with HSP (13 males, 10 females) and 20 healthy children participated in this study. The mean age of the HSP cases was 8.21±3.78 years (range 2-16 years) and of the controls was 8.6±4.2 (range 3-14 years). The mean MDA value was 2.95±0.71 nmol/ml in the patient group and 2.67±0.66 nmol/ml in the control group (p=0.787). The mean level of the CAT enzyme was 1.32±0.35 U/g Hb in the patient group and 7.8±1.74 U/g Hb in the control group (p=0.001). The mean levels of the SOD enzyme were 3.06±0.85 U/g Hb in the patient group and 0.97±0.36 U/g Hb in the control group (p=0.001). Conclusions: Although high MDA levels support the role of lipid peroxidation in the pathogenesis of HSP, statistical significance was not reached owing to a limited number of our patients. The reduced CAT enzyme activity is consistent with the findings of previous reports. This finding supports the notion that oxidative stress can play a role in the pathogenesis of HSP

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

COVID-19 Hastalığı ile İlişkili Çoklu Sistemik İnflamatuvar Sendrom Tanılı Çocuk Olguların Değerlendirilmesi

Giriş: Nisan 2020 yılında, SARS-CoV-2 enfeksiyonu geçiren bazı çocuklarda ateş, karın ağrısı, inotrop desteği gerektiren hipotansiyon ve miyokardiyal disfonksiyona yol açan COVID-19 hastalığı ile ilişkili Çoklu Sistemik İnflamatuvar Sendrom(Multisystem Inflammatory Syndrome in Children-MIS-C) olarak adlandırılan hastalık tanımlanmıştır.Bu çalışmada ülkemizde görülen MIS-C tanılı olguların değerlendirilmesi amaçlanmıştır. Materyal-Metod: Bu çalışmada retrospektif olarak Nisan2020-Ağustos2020 tarihleri arasında birden fazla merkezde MIS-C tanısıyla izlenen olguların sosyodemografik, klinik, laboratuvar bulgularıyla tedavi rejimleri ve izlem sonuçları irdelendi. Bulgular: Çalışmaya alınan 29 olgunun 16'sı(%55.2) erkekti ve ortanca yaşları 66 ay(2-208 ay) idi. Olguların 7'si fazla kilolu(vücut kitle indeksi persentili >=%85) olarak değerlendirildi. On bir olguda SARS-CoV-2 RT-PCR pozitifliği, 12'sinde antikor testlerinde pozitiflik saptanırken 4 olguda PCR ve antikor testlerinde pozitiflik görüldü. İki olgunun ise PCR negatif gelmekle birlikte COVID-19 tanılı olguyla temas öyküsü mevcuttu. Olguların tamamında ateş, 22'sinde (%75.9) gastrointestinal semptomlar ve yorgunluk, 20'sinde(%69) döküntü, 17'sinde(%58.6) bulbar konjoktivit ve el-ayaklarda renk değişikliği, 16'sında (%55.2) dudaklarda fissür, 14'ünde (%48.3) kas ağrısı ve çilek dil mevcuttu.Ateş süresinin ortanca değeri 7 (3-17gün) gün saptandı.Olguların 21'inde (%72.4) dehidratasyon, 14'ünde (%48.3) taşikardi, 11'inde hipotansiyon (%37.9) saptandı.Laboratuvar bulgularından ortanca lökosit sayısı 6365 mm³ (3300-31220 mm³), ortanca lenfosit sayısı 1135(570-5800 mm³), ortanca trombosit sayısı 160500 mm³ (46000-747000 mm³) saptandı. Ortalama CRP değeri 165±102 mg/L, ESH değeri 62.6±31.4 mm/s saptandı.Tedavide; olguların 23'üne (%79.3) IVIG, 15'ine (%51.7) asetil salisik asit, 11'ine (%37.9) steroid, 8'ine (%27.6) antikoagülan tedavi uygulandı.Antiviral tedavi 7 (%24.1) olguya uygulandı. 2 olguya tocilizumab tedavisi verildi.Ortanca yatış süreleri 10 gün(1-27) saptanırken 9 olguda yoğun bakım ihtiyacı geliştiği görüldü.3 olgu entübe edildi ve 2 olguda exitus gelişti.Sonuç: MIS-C; yeni tanımlanan, kesin bir tedavisi olmayan hayati tehlikeye neden olabilen organ tutulumu ve şok gelişimine yol açabilecek bir hastalıktır.Çalışmamızda MIS-C olgularında, 3 günden uzun süren ateş, gastrointestinal şikayetler ve yorgunluk en sık görülen yakınmalar olarak belirlendi.COVID-19 pandemi döneminde bu yakınmalarla gelen çocuklarda MIS-C akılda tutulmalı; hızlı tanı ve agresif tedavinin klinik olumlu etkileri unutulmamalıdır

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality