The Comparison of Reported Ingested Paracetamol Dose with Serum Blood Concentrations and Their Relationship with N-Acetylcysteine Administration: A Retrospective Study of 117 Patients

Introduction:We aimed to compare the patient reported ingested and blood paracetamol concentrations (BPC) and to investigate the indications for N-acetylcysteine (NAC) administration in referred patients.Methods:This is a retrospective study of acute paracetamol intoxications (API) at the tertiary paediatric emergency department (ED) between June 2015-June 2019. We evaluated the demographics, cause of intoxications, reported doses (mg/kg), BPCs (8/4/12/16 and/or 24th hours). Indications of antidote usage and referral to ED were accepted as BPC >150 mg/kg.Results:Overall, we reviewed 117 cases of acute API. The mean age was 8.97 (±6.0) years, and 68.3% were female. The reported ingested of paracetamol (RIP) median dose was 2725 mg (mean 138±51.9 mg/kg). Adolescents had a significantly higher RIP than that of younger subjects (p150 mg/kg, physicians at the first healthcare facility tended to administer activated charcoal (90.9%), gastric lavage (68%) and intravenous NAC (48%). The referring healthcare facility physicians-initiated NAC particularly for patients who reported ingesting >150 mg/kg (p=0.001).Conclusion:RIP doses should not be used to determine the need for NAC. The antidote should be used in centres where BPCs are not available or in a group of patients who cannot be transferred to a referral centre within the first eight hours

Çölyak hastalarında KIDMED indeksi (akdeniz diyeti kalite indeksi) ile beslenme şekli ve içeriğinin değerlendirilmesi

Amaç: Çölyak hastalığı her yaş grubunda tanı konulabilen, beslenmenin hastalığın prognozunda mutlak bir yere sahip olduğu, ömür boyu diyet uygulamayı gerektiren otoimmün ince bağırsak hastalığıdır. Çalışmamızın amacı, çölyaklıların Akdeniz diyetine uyumunu değerlendirmektir. Yöntem: Çalışmamız prospektif olarak tasarlanmış olup; çalışmaya Aralık 2016 – Kasım 2018 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Çocuk Hastanesi Çocuk Gastroenteroloji polikliniğinde çölyak tanısı ile takipli, başka bir kronik hastalığı olmayan, en az bir yıldır glutensiz diyet uygulayan, 7-18 yaş arası 60 çölyaklı ve Ege Üniversitesi Tıp Fakültesi Çocuk Hastanesi Genel Pediatri polikliniğine başvuran, 7-18 yaş aralığında, eşlik eden kronik bir hastalığı olmayan 100 olgudan oluşan kontrol grubu dahil edildi. Tüm olguların yaş, cinsiyet, boy, kilo SDS'leri değerlendirildi. Ayrıca; iki grubun KIDMED indeksi (Akdeniz Diyeti Kalite İndeksi) incelenip, TANITA SC-330 ile vücut yağ analizi yapılmıştır. KIDMED indeksi; Akdeniz diyetinin özelliklerini içeren 16 sorudan oluşan bir anketle değerlendirilir. Ankette süt ve süt ürünleri tüketim sıklığını, meyve–sebze tüketimini, ayaküstü gıda (fast-food) tüketim sıklığını, zeytin yağı tüketimini, balık tüketimini sorgulayan sorular mevcuttur. Anketin sonucu ≥8 puan iyi uyum, 4-7 puan arası orta (geliştirilmesi gerekli), ≤3 puan kötü diyet kalitesi olarak değerlendirildi. Bulgular: Hasta grubunun %70'i kız, %30'u erkek; kontrol grubunun ise %55'i kız %45'i erkekti. Hasta grubun medyan yaşı 12.55 (7.06/18.04) yıl, kontrol grubunun ise 14.15 (7.56/17.98) yıldı. Hasta grup ile kontrol grubu ağırlık SDS'leri karşılaştırıldığında, hasta grubun ağırlık SDS'si daha düşük olup, istatistiksel olarak anlamlı bulunmuştur (p=0.001). Boy SDS'leri değerlendirildiğinde, çölyak grubunun boy SDS'si daha düşük bulunmuştur (p=0.002). Total vücut yağı karşılaştırıldığında, hasta grupta kontrol grubuna göre anlamlı olarak daha düşük saptanmıştır (p=0.007). Kontrol grubunun %29'unun KIDMED indeks sonucu kötü diyet kalitesi gösterirken, çölyak grubunda bu oran %13.3 bulunmuştur iv (p=0.034). Olgular yaş grubuna göre ≤11 ve >11 olmak üzere 2 gruba ayrıldığında; çölyaklılarda >11 yaş grubunda KIDMED indeksi iyi olanların anlamlı olarak daha fazla olduğu görülmüştür (p=0.048). TTG IgA'nın cut off değer 10 U/ml olup, çalışmamızda en az bir yıldır glutensiz diyet uygulamakta olan çölyaklıların 37'sinde (%61,66) TTG IgA 10 U/ml 'nin altındaydı ve diyete uyumluydu. EMA IgA üzerinden verilere baktığımızda; %81,6'sında EMA IgA negatif / (+) pozitif bulunmuş ve diyete uyum oranı %81,6'ya ulaşmıştır. Spearman's korelasyon analizi ile değerlendirildiğinde; çölyak antikorları ile KIDMED skoru arasında anlamlı bir sonuç saptanmamıştır. Sonuç: Sağlıklı yaşamak adına belirli bir çerçevede diyet yapmak zorunda olan çölyaklılarla, özel bir diyeti olmayan sağlıklı çocukların KIDMED indeksi üzerinden Akdeniz diyeti uygulamaları değerlendirildiğinde; Çölyaklı grupta Akdeniz diyetine uyumun daha fazla olduğu saptanmıştır.Aim: Celiac disease is an autoimmune small intestinal disease that can be diagnosed in all age groups, where nutrition has an absolute place in the prognosis of the disease and requires a lifelong diet. The aim of our study is to evaluate the adaptation of celiac patients to Mediterranean diet. Materyal and Methods: Our study was designed prospectively; The study included 60 patients aged between 7-18 years who were followed-up with the diagnosis of celiac in Ege University Medical Faculty Hospital Pediatric Gastroenterology outpatient clinic between December 2016 and November 2018, and between the ages of 7-18 years who admitted to the General Pediatric Polyclinic of Ege University Medical Faculty Hospital. The control group consisted of 100 patients with no accompanying chronic disease. Age, gender, height and weight SDS of all cases were evaluated. Also; KIDMED index of two groups was examined and body fat analysis was performed with TANITA SC-330. KIDMED index (Mediterranean Diet Quality Index); It is evaluated with a questionnaire consisting of 16 questions containing the characteristics of the Mediterranean diet. There are questions about the frequency of consumption of milk and milk products, the consumption of fruits and vegetables, the frequency of fast-food consumption, the consumption of olive oil and the consumption of fish. The results of the questionnaire were evaluated as ≥8 points good fit, 4-7 points medium (development required), uyum 3 points poor diet quality. Results: 70% of the patient group is female and 30% is male; 55% of the control group was female and 45% was male. The median age of the patient group was 12.55 (7.06 / 18.04) and the control group was 14.15 (7.56 / 17.98). When the weight, height and total body fat values of the patient group and control group were compared, it was found that the values of the patient group were statistically significantly lower. While KIDMED index result of 29% of the control group was consistent with poor diet quality, this rate was 13.3% in the patient group (p = 0.034). When the patients were divided into two groups as ın11 and> 11 according to the age group, it was seen that the ones with good KIDMED index were significantly higher in the age group> 11 years. Discussion: In this study, it is observed that the adaptation of the celiacs to the Mediterranean diet increases as the age increases. Due to the small number of patients, a larger patient group is needed to support this result

The Effects of Prehospital Care on Outcome in Pediatric Diabetic Ketoacidosis

Objective: Despite the guidelines, significant variations can be encountered in initial therapy for pediatric diabetic ketoacidosis (DKA) in the prehospital setting. These variations occur mostly in fluid administration, insulin dosing, route of administration, and other aspects of the initial resuscitation and stabilization. the aim was to identify the effect of transport care on outcomes in children with DKA admitted to the emergency department (ED). Methods: Patients admitted to a tertiary-care pediatric ED between 2015-2019 with a diagnosis of DKA were retrospectively identified. Details of pre-pediatric ED care, including transport modality, patient demographics, clinical features, laboratory evaluation, fluid therapy, insulin dosing, and short-term outcome were recorded. Results: the study cohort included 147 episodes of DKA in 136 patients aged 9 months-21 years. Emergency Medical Service (EMS) transported only 37.4% of cases. EMS utilization rate was significantly higher (p=0.003) in severe cases, most of whom were >10 years (p=0.04). During transport 85% received intravenous fluid bolus. Use of fluids other than normal saline was significantly higher when transport time was >30 minutes (p=0.001). Acute kidney injury and cerebral edema developed in 21.7% and 7.4% of episodes, respectively. These complications were more common in the EMS transport group. Pediatric intensive care admission rate was also higher in the EMS compared to the non-EMS group (p=0.01) Conclusion: Parents did not call the ambulance for most cases although a higher complication rate occurred in EMS patients. EMS providers and referral facilities should improve their knowledge of pediatric DKA