Effects of Vasoactive Drug Use on Hemodynamics in Critical Disease Pediatic Patients

Introduction:The fact that critically ill pediatric patients have hemodynamic and metabolic characteristics different from that in adults plays a key role in the selection of vasoactive agent. The aim of this study was to compare the effects of vasoactive agent and agent groups on hemodynamics in order to effectively regulate impaired hemodynamics in critically ill pediatric patients, to provide early diagnosis, time-sensitive and targeted treatment and reduce side effects. Methods:Disease severity, vital signs, renal function, and laboratory data of 103 patients aged 1 to 18 years, who were treated in the pediatric intensive care unit and administered one or more vasoactive agents, were evaluated.Results:The average Pediatric Risk of Mortality (PRISM III-24) score in the dobutamine group was significantly higher than in the adrenalin-dobutamine group (p=0.048), and no statistically significant difference was observed between the other groups (p>0.05). There was a statistically significant difference in the mean cardıac apex beat between dopamine, dobutamine, dopamine-dobutamine and dopamine-adrenaline groups (p=0.0001, p=0.0001 p=0.007 and p=0.011, reespectively). A statistically significant difference was observed in systolic blood pressure (SAB) between dopamine-dobutamine, dopamine-adrenaline and dopamine-dobutamine-adrenaline groups (p=0.003, p=0.00 and p=0.005, respectively). The S0 lactate levels in the adrenaline group were found to be statistically significantly higher than those in dopamine and adrenaline-dobutamine and dopamine-dobutamine-adrenaline groups (p=0.048, p=0.036 and p=0.045. There was a significant difference in S4 lactate values between dopamine-adrenaline and adrenaline-dobutamine groups and between dobutamine and adrenaline groups (p=0.045 and p=0.047, respectively). There was no statistically significant difference in the average central venous oxygen saturation (ScVO2) between dopamine, dobutamine, dopamine-dobutamine, dopamine-adrenaline, adrenaline-dobutamine, dopamine-dobutamine-adrenaline, dopamine-dobutamine-adrenaline-noradrenaline and adrenaline groups (p>0.05). A statistically significant difference was observed between the mean amounts of urine S0, S24 and S48 in the dobutamine group (p=0.002). The average S0 urine volume in the dobutamine group was found to be statistically significantly lower than the average S24, S48 urine volume (p=0.01 and p=0.03, respectively). No statistically significant difference was observed between the other times and groups (p>0.05).Conclusion:Blood lactate levels were significantly higher in the adrenaline group than in the other groups, while no significant difference was found in cardiac apex beat, SAB, ScVO2 and amount of urine between the groups. This elevation was limited to the first 4 hours, and the use of adrenaline together with dopamine and/or dobutamine significantly reduced the incidence of hyperlactatemia compared to the use of adrenaline alone. The use of dobutamine alone significantly increased the amount of urine within hours

Çocukluk çağında nadir görülen bir akciğer kitlesi olgu sunumu: Plöropulmoner blastoma

Plöropulmoner blastoma çocukluk çağında oldukça nadir görülen malign tümörlerden biridir. Tüm primer akciğer malignitelerindeki insidansı %0.25- 0.5 arasındadır. Sıklıkla 6 yaş altında görülür ve özellikle akciğer parankimi, mediasten ve plevradan kaynaklanır. Genellikle tek taraflı soliter akciğer kitlesi şeklinde görülür. Bu olgu sunumunda ateş, solunum sıkıntısı, hışıltı, karın ağrısı, kilo kaybı gibi nonspesifik bulgularla başvuran, tek taraflı akciğer kitlesi saptanan ve plöropulmoner blastoma tanısı konulan 3.5 yaşındaki bir erkek olgu sunulmuştur. Sonuç olarak çocukluk çağında tek taraflı solit akciğer kitlesi tespit edilen olgularda nadir görülen plöropulmoner blastoma tanısı da akılda tutulmalıdır.Pleuropulmonary blastoma is a malignant lung tumor affecting children. Pleuropulmonary blastoma is a rare entity having an incidence between 0.25-0.5% of all primary lung malignancies that occurs exclusively in children younger than 6 years. The tumor usually originates from pulmonary parenchyma, mediastin and pleura and especially presents as a solitary pulmonary mass in unilateral lung. In this case report, we present a 3.5-year-old boy who was admitted with fever, dyspnea, wheezing, abdominal pain, weight loss and was diagnosed as pleuropulmonary blastoma. As pleuropulmonary blastoma is rarely seen in childhood, relevant literature on pleuropulmonary blastoma is reviewed

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15-136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202-10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8-15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15-136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202-10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8-15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals