Does Accident Remind Us of Negligence - or Does Negligence Remind Us of Accident? - Case Report

In this study, a child case who was admitted to the hospital with a history of falling from a height, and forensic medical consultation was requested due to a conflict between severe clinical findings and history, will be presented and attention will be drawn to the fact that abuse and neglect can underlie every accident, especially in children. A 3-year-old girl was referred to the hospital by her refugee family with a history of falling from a height of 4 meters onto a concrete floor at noon. The case with twin spouses; it was found that he was unconscious, scalp left temporo-parietal edema, abrasions on the left forehead, and hematoma on the eyelids. In your examinations; right femur fracture, left parietal bone fracture, left orbital superior bone fracture, parenchymal hemorrhage adjacent to the left lateral ventricle and contusion in the left lung were detected. In Intensive Care; it was found that he was intubated and sedated, his general physical appearance and development were normal, he was found to be normal in terms of hygiene, and his genital area examination was normal. Childhood physical traumas are situations that need to be investigated thoroughly, may be caused by neglect and abuse, and a multidisciplinary approach should be exhibited. In this regard, child health professionals; they can play important roles in many stages, from prevention, reporting and treatment to child protection and monitoring services

Retrospective Analysis of Cases with Guillain-Barré Syndrome in Pediatric Intensive Care Unit

Introduction: The aim of this study was to evaluate treatment approaches towards Guillain-Barré syndrome and treatment response in patients with Guillain-Barré syndrome admitted to the pediatric intensive care unit. Methods: We retrospectively evaluated patients aged between 1 month and 18 years who were admitted to our pediatric intensive care unit between January 2006 and January 2016 with the diagnosis of Guillain-Barré syndrome. Results: A total of 27 patients (10 girls; 37%) were included in this study. The mean age of the patients was 6.24 years (IQR: 4.07-10.03). Nine patients (33.3%) had a Hughes functional grading scale score of 3, 16 (59.3%) had 3 and 2 (7.4%) had 5. Electrophysiological studies were performed in 22 cases (81.4%) and acute inflammatory demyelinating polyneuropathy was detected in 10 cases (45.5%), acute motor axonal neuropathy in 9 cases (40.9%), and acute motor and sensory axonal neuropathy in 1 case (4.5%). Two (9.1%) patients were evaluated as normal. All the patients were administered intravenous immunoglobulin (IVIG). In 12 (52.17%) patients, plasmapheresis was performed for a median of 8 sessions (5-9) before IVIG. Mechanical ventilation was required in 6 patients (22.2%) and was performed for a median of 24 days (5-41). The mean period of time of the first supported sitting was 6 (3-10) days and the mean period of time of the first walking with aid was 9 (7-15) days. Conclusion: Although there have been studies claiming that plasmapheresis was more successful, it has been generally accepted that plasmapheresis and IVIG have the same efficacy. Under the conditions of our country, we believe that both plasmapheresis and IVIG can be safely used at experienced units in patients with Guillain-Barré syndrome who need intensive care treatment

Cardiogenic Shock and Lung Injury as a Complication of Defibrillation

Local burns, embolism, and arrhythmia are the most common side effects observed after electrical shock treatments. However, systolic function may be rarely affected and pulmonary edema may develop. The cases of pulmonary edema after electrical shock treatments have been reported since 1960s and the proposed mechanism is the inadequacy of the left atrium cuff and ventricle. It was learned that a 7-year-old-girl without any known disease except vesicoureteral reflux had a ventricular fibrillation during general anesthesia induction and defibrillation at 2 joule/kg was attempted. It was also learned that the procedure was delayed and the patient was diagnosed with a long QT (QTc: 0.47 ms) and had respiratory distress and circulatory disturbances after four hours. Pulmonary edema and heart failure was determined, and due to hipoxemia (SpO2 <88%) not getting any better with non-invasive ventilation, the patient was intubated and followed with mechanical ventilation. A thermodilution catheter was inserted into the femoral artery and a low cardiac index (CI): 1.58 L/min/m2, elevated extravascular lung water index (EVLWI): 18 mL/kg and high pulmonary vascular permeability index (PVPI): 7.6 were determined. The patient was treated by mechanical ventilation and vasoactive/inotropic management and discharged at the fifth day of hospitalization without any sequela. Having high EVLWI with high PVPI suggest that the pulmonary edema mechanism may also be caused by alveolocapillary membrane damage, which is not accompanied by heart failure alone. This case is presented to show that it is the first child in the literature and that the results of transpulmonary thermodilution can also give information about lung function as well as cardiac function

Pediatric Fulminant Leptospirosis Complicated by Pericardial Tamponade, Macrophage Activation Syndrome and Sclerosing Cholangitis

Background: Leptospirosis is a zoonotic infectious disease caused by pathogenic spirochetes of the genus Leptospira. Although it is usually asymptomatic and self-limited, severe potentially fatal illness accompanied by multi-organ failure may occur. Case Report: Here we report an unusual case of severe leptospirosis successfully treated with continuous venovenous hemofiltration (CVVHF) and therapeutic plasma exchange (TPE). The patient presented with pericardial tamponade, renal failure and macrophage activation syndrome, and later suffered prolonged jaundice and sclerosing cholangitis during hospitalization in the pediatric intensive care unit (PICU). To the best of our knowledge, sclerosing cholangitis due to leptospirosis has not been reported in the literature. Conclusion: Leptospirosis should be kept in mind in the differential diagnosis of sepsis and septic shock with fever, thrombocytopenia, jaundice and renal failure. TPE and CVVHF should start early after the diagnosis of leptospirosis with multiorgan failure

Peroxisomal disorder characterized with severe cerebral dysgenesis and hypotonia

Very long chain fatty acids accumulate in many tissues and organs in the peroxisomal disorders due to defects in fatty acid metabolism. Although the disease may be manifested as severe symptoms causing early death due to hypotonia, poor feeding, respiratory problems, cerebral dysgenesis, liver and kidney dysfunctions, it may be presented as late onset with mild symptoms. We presented a 4 months-old male infant with peroxisomal disorder diagnosed by dysmorphic facial appearance, hypotonia since birth, feeding difficulties, respiratory distress, severe cerebral dysgenesis and increased very long chain fatty acids due to its rarity

A Rare Case of Tacharhytmia Presenting with Cardiomyopathy: Permanent Junctional Reciprocating Tachycardia

Permanent junctional reciprocating tachycardia is a rare type of supraventricular tachycardia. Incessant tachycardia may result in dilated cardiomyopathy and the patients may have a diagnosis of idiopathic dilated cardiomyopathy. A 53-day-old female infant was brought to the hospital with sweating, rapid breathing, and rapid heartbeat. She was admitted to the intensive care unit with a suspicion of myocarditis. Electrocardiography showed a heart rate of 220/min consistent with narrow QRS complex tachycardia and negative p waves in inferior leads (II, III, and aVF). Medical treatment provided control of the tachycardia episode. In this report, we conclude that patients with a diagnosis of dilated cardiomyopathy should be thoroughly investigated in terms of reversible arrhythmia causes

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