Urtikarija kao rijetka nuspojava polietilen glikola-3350 kod djeteta: prikaz slučaja

Polyethylene glycol electrolyte (PEG-3350) solution is usually used for bowel emptying before co-lonoscopy in adults. It has also been reported to be safe in children. It is thought that bowel irrigation with this solution can be a useful treatment alternative for poisoning with slow releasing drugs, swallowed packaged substances, enteric coated drugs, drugs not binding to charcoal, and heavy metals in children. Due to high molecular weight of PEG-3350, its absorption from the intestinal mucosa is very low (0.2%). Therefore, it is less likely to have side effects. A three-year-old girl bit and ate one-third of an alkali battery and was brought to our pediatric emergency unit. Vital signs and results of physical examination and laboratory investigations were normal. Irrigation of the bowels with PEG-3350 solution given orally at a rate of 20 mL/kg/h was initiated. Upon excretion of feces of normal appearance in the sixth hour, irrigation was continued. Since rashes and itching started throughout her body in the thirtieth hour after administration of 9 L PEG-3350, the irrigation was discontinued and the patient was administered antihistamines. Rashes and itching regressed within one hour of its discontinuation. This suggested that they were due to the irrigation solution. There are five adult cases of allergic reactions to PEG-3350 reported in the literature. The case presented is the first pediatric patient developing allergic reaction to PEG-3350.Otopina polietilen glikola (PEG-3350) najčešće se primjenjuje za pražnjenje crijeva prije kolonoskopije u odraslih osoba, a opisuje se kao sigurno sredstvo i u djece. Smatra se da ispiranje crijeva ovom otopinom može biti korisna alternativa za liječenje otrovanja lijekovima sa sporim otpuštanjem, progutanim pakovanjima nekih tvari, lijekovima sa zaštitnom ovojnicom za probavni sustav, lijekovima koji se ne vežu na ugljen te teškim metalima u djece. Zbog velike molekularne težine vrlo mali dio PEG-3350 (0,2%) se apsorbira iz crijevne sluznice pa su stoga nuspojave manje vjerojatne. Djevojčica u dobi od tri godine zagrizla je i progutala jednu trećinu alkalne baterije pa je dovedena u našu hitnu pedijatrijsku službu. Vitalni znaci kao i rezultati fizikalnog pregleda i laboratorijskih pretraga bili su normalni. Započeto je ispiranje crijeva otopinom PEG-3350 peroralno, 20 mL/kg/h. Nakon što je dijete imalo stolicu normalnog izgleda u šestom satu, ispiranje je nastavljeno. Međutim, nakon što je djevojčica primila 9 L PEG-3350, u tridesetom satu davanja otopine nastupio je osip i svrbež po čitavom tijelu pa je ispiranje crijeva prekinuto i djetetu su dani antihistaminici. Osip i svrbež su se povukli unutar jednog sata od prestanka ispiranja otopinom PEG-3350. U literaturi je opisano pet slučajeva alergijskih reakcija na PEG-3350 u odraslih osoba. Ovaj prikaz opisuje prvi slučaj alergijske reakcije na PEG-3350 u djeteta

Evaluation of nutritional status in pediatric intensive care unit patients: The results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Analysis of intestinal and nasopharyngeal microbiota of children with meningococcemia in pediatric intensive care unit: INMACS-PICU study

This article belongs to the Special Issue Pediatric Diagnostic Microbiology.Microbiota composition might play a role in the pathophysiology and course of sepsis, and understanding its dynamics is of clinical interest. Invasive meningococcal disease (IMD) is an important cause of community-acquired serious infection, and there is no information regarding microbiota composition in children with meningococcemia. In this study, we aimed to evaluate the intestinal and nasopharyngeal microbiota composition of children with IMD.[Materials and Methods]: In this prospective, multi-center study, 10 children with meningococcemia and 10 age-matched healthy controls were included. Nasopharyngeal and fecal samples were obtained at admission to the intensive care unit and on the tenth day of their hospital stay. The V3 and V4 regions of the 16S rRNA gene were amplified following the 16S Metagenomic Sequencing Library Preparation.[Results]: Regarding the alpha diversity on the day of admission and on the tenth day at the PICU, the Shannon index was significantly lower in the IMD group compared to the control group (p = 0.002 at admission and p = 0.001, on the tenth day of PICU). A statistical difference in the stool samples was found between the IMD group at Day 0 vs. the controls in the results of the Bray–Curtis and Jaccard analyses (p = 0.005 and p = 0.001, respectively). There were differences in the intestinal microbiota composition between the children with IMD at admission and Day 10 and the healthy controls. Regarding the nasopharyngeal microbiota analysis, in the children with IMD at admission, at the genus level, Neisseria was significantly more abundant compared to the healthy children (p < 0.001). In the children with IMD at Day 10, genera Moraxella and Neisseria were decreased compared to the healthy children. In the children with IMD on Day 0, for paired samples, Moraxella, Neisseria, and Haemophilus were significantly more abundant compared to the children with IMD at Day 10. In the children with IMD at Day 10, the Moraxella and Neisseria genera were decreased, and 20 different genera were more abundant compared to Day 0.[Conclusions]: We first found alterations in the intestinal and nasopharyngeal microbiota composition in the children with IMD. The infection itself or the other care interventions also caused changes to the microbiota composition during the follow-up period. Understanding the interaction of microbiota with pathogens, e.g., N. meningitidis, could give us the opportunity to understand the disease’s dynamics.This study was supported by the Eskisehir Osmangazi University Scientific Research Grant (2018/11046).Peer reviewe

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Cyanide intoxication by apricot kernels: A case report and literature review

WOS: 000482761300009Acute cyanide intoxication is a serious healthcare problem due to its potentially life threatening and fatal toxic effects. Ingestion of cyanide containing foods is an important source of cyanide poisoning and apricot kernels contain significant amounts of such cyanogenic compounds. Herein we report a previously healthy 4-year-old boy admitted to our emergency department with complaints of vomiting and sudden onset of unconsciousness after ingestion of apricot kernels. He was diagnosed as acute cyanide poisoning and treated with a specific antidote; hydroxocobalamin. Our report concludes with previous cases of cyanide poisoning after ingestion of apricot kernels and a quick look at sources, manifestations and treatment of acute cyanide poisoning