Çocuk Acil Servise Son 5 Yılda Gelen Zehirlenmeler: 1734 Olgunun Değerlendirilmesi

Amaç: Çocukluk çağı zehirlenmeleri ani olarak ortaya çıkan, ciddi morbidite ve mortaliteye yol açabilen önlenebilir önemli bir toplum sağlığı sorunudur. Bu çalışmada, son beş yıl içerisinde zehirlenme nedeniyle çocuk acil servisimize başvuran hastalar değerlendirilmiştir. Gereç ve Yöntem: 1 Ocak 2013 ve 31 Aralık 2017 tarihleri arasında zehirlenme nedeniyle Mersin Üniversitesi Tıp Fakültesi Hastanesi Çocuk Acil Servisine getirilen 1734 çocuk hastanın dosya kayıtları retrospektif olarak incelendi. Olgular yaş, cinsiyet, zehirlenme nedeni, zehirlenmeye neden olan farmakolojik ajanlar ve tedavileri yönünden değerlendirildi. Bulgular: Beş yıl içerisinde acil servise getirilen çocuk hastaların %0,68’i zehirlenmelerdi. Zehirlenme nedeniyle gelen olguların 1020’si (%58,8) kız ve 714’ü (%41,2) erkekti (kız/erkek: 1,4). Hastaların yaş ortalamaları 9,68 ± 2,85 yıl (5 ay-18 yıl) olup; kızların yaş ortalaması erkeklerden yüksek bulundu (sırasıyla 12,61 ± 2,7 yıl ve 8,14 ± 3,7 yıl, p=0.07). En sık zehirlenme nedeni ilaçlar (n=1031; %59,4) olup, en sık gözlenen ilaç grubu analjeziklerdi (n=374; %21,5). Olguların 571’i (%32,9) özkıyım girişimi nedeniyle getirilmişti. Olguların 1157’si (%66,2) Acil Serviste, 190’ı (%10,9) Çocuk Sağlığı ve Hastalıkları servisinde, 62’si (%3,5) Çocuk Yoğun Bakım servisinde ve 325’i (%18,7) Çocuk Cerrahisi servisinde tedavi edildi. Sonuç: Bu çalışmada elde edilen bulgular, zehirlenme nedeniyle acil servise getirilen çocuklarda en sık nedenin ilaçlar olduğunu göstermektedir. Bu olguların kayda değer bir kısmı özkıyım girişimidir. Çevre, aile, ilaç üreticileri ve hekimler tarafından alınacak tedbirler sayesinde çocukluk çağı zehirlenmelerinin önüne geçilmesi mümkün olacaktır

Relationship of Hemoglobin Concentration at Admission and Need for Erythroyte Transfusion During Hospitalization with Mortality in Pediatric Critical Care Patients

Introductıon: This study aimed to investigate the relationship of hemoglobin concentration at admission to pediatric intensive care unit and erythrocyte transfusion during hospitalization with mortality. Methods: In this prospective study, we included 260 patients who were admitted to a 12-bed pediatric intensive care unit in a one-year period. Demographic characteristics, admission etiologies, length of stay in the pediatric intensive care unit, mechanical ventilation rates, pediatric risk of mortality III and pediatric logistic organ dysfunction scores, complete blood count on admission and erythrocyte transfusion during hospitalization were recorded prospectively. Results: Of the 260 cases, 34 were exitus. The mortality rate was 13%. The mean hemoglobin concentration of patients who were exitus was lower than that of patients who survived (10.55±2.45 g/dL vs. 10.55±2.45 g/dL, p=0.011). Although platelet levels were lower in patients who were exitus than in survivors, the difference was not statistically significant (320.352±181.731/mm3 vs. 352.231±174,129/mm3 p=0.325). The mortality rate in transfused patients was higher than in patients who were not transfused. (40.2% vs. 1.6%, p<0.001). Conclusion: Hemoglobin concentration at admission in patients who die in pediatric intensive care unit is significantly lower than in those who survive. In this study, increased mortality risk in patients admitted to pediatric intensive care unit was found to be associated with the presence of anemia and need for erythrocyte transfusion

Psikososyal Stres Faktorleriyle Tetiklenen Erken Baslangicli Konversiyon Bozuklugu Olarak Astazi-Abazi Olgusu 2

Conversion disorder is defined as the loss or change of motor, sensory, and autonomic nervous system-related functions that cannot be explained completely with organic causes. The etiology of the disease may be explained by psychoanalytic theory, learning theory, sociocultural factors, and some traumatic life events besides genetic and neurobiological factors. The onset is usually between late childhood and early adulthood. The disorder occurs after a high rate of psychosocial stressors and the symptoms can vary. While astasia, as one of the possible complaints in conversion disorder, is defined as not being able to stand due to loss of motor power or sensory loss; abasia is identified as patients having no apparent motor problem but not being able to walk properly. Both conditions can be of organic as well as the psychogenic origin. In this paper, the clinical signs of a seven-year-old boy who was admitted to emergency service of Mersin University Faculty of Medicine with the complaints of astasia and abasia but was found to have conversion disorder is presented. The results of the medical examinations and the possible psychosocial stress factors behind these symptoms, as well as the treatment process of the case, were shared. With this report, we is aimed to draw attention to the importance of early diagnosis of the disorder, the necessity of an interdisciplinary approach in the treatment process, and the handling of psychosocial factors leading to somatic symptoms