Papilledema Due to Mirtazapine

Background: Mirtazapine is a tetracyclic antidepressant that enhances both noradrenergic and serotonergic transmission. The most common cause of papilledema is increased intracranial pressure due to brain tumor. Also it may occur as a result of idiopathic intracranial hypertension (IIH, pseudo tumor cerebri). Moreover, papilledema may also develop due to retinitis, vasculitis, Graves’ disease, hypertension, leukemia, lymphoma, diabetes mellitus and radiation. Case Report: In this article, a patient who developed papilledema while under treatment with mirtazapine (30 mg/day) for two years and recovered with termination of mirtazapine treatment was discussed to draw the attention of clinicians to this side effect of mirtazapine. Conclusion: Idiopathic intracranial hypertension and papilledema due to psychotropic drugs has been reported in the literature. Mirtazapine may rarely cause peripheral edema. However, papilledema due to mirtazapine has not been previously reported. Although papilledema is a very rare side effect of an antidepressant treatment, fundoscopic examinations of patients must be performed regularly

SERTRALİNE BAĞLI ANJİOÖDEM

To editor, Selective serotonin reuptake inhibitors (SSRIs) are reliable drugs (Kostev et al, 2014). Only one angioedema case due to sertraline was reported (Dadic-Hero et al, 2011). In this case, angioedema has also developed with both sertraline and escitalopram (another SSRI). Cross-allergic reactions might be seen in similar drugs. Case Sertraline (25 mg/day) treatment was started 51-year-old male patient with a diagnosis of depression. He called after 3 hours later first dose with complaints of swelling of the lips and tongue and sent his own photo. Thereupon dermatology consultation was requested. In dermatological examination angioedema (Quincke's edema) was diagnosed. Because it couldn’t find another reason, sertraline treatment was terminated. Edema was decreased treatment with antihistaminic. After 2 weeks, sertraline (12.5 mg/day) was started again and 3-4 hours after taking the first dose of sertraline, he sent his own photo with complaints of the same symptoms. Sertraline treatment was terminated due to repeated angioedema. Amitriptyline (10 mg/day) treatment was started and angioedema didn’t occur although the dose of it was increased to 100 mg/day. In our case, angioedema was not developed with amitriptyline, a tricyclic antidepressant (TCA). It has been reported that amitriptyline might be used in the treatment of angioedema (Guarneri et al, 2014). It may be appropriate to plan a medication from a different group when allergic reactions occur. Sincerely

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality