Soft tissue infection caused by Burkholderia cepacia in a child with polyarteritis nodosa

Burkholderia cepacia belongs to a family of Burkholderia species previously described as Pseudomonas cepacia, especially in patients suffering from cystic fibrosis. There are also many studies about this agent in the last decade due to their life-threatening infections and ability to invade mucosal and cellular surfaces. Here, we report a case of soft tissue infection caused by B. cepacia in a child with an underlying condition of polyarteritis nodosa. Her complaints started at two months of age and she was on cyclosporine therapy. She was treated several times because of soft tissue infections especially in her extremities. The most common causative agents were Pseudomonas spp. and Escherichia coli, but recently, another soft tissue infection accompanied by fever and signs of sepsis had developed. All blood, urine and tissue (debrided from the necrotic area) specimens were incubated. Empirical antibiotherapy with clindamycin was started and cyclosporine therapy was discontinued. B. cepacia was grown in the tissue specimen culture and was only susceptible to carbapenems. Meropenem therapy was administered throughout 14 days with a daily dosage of 60 mg/kg, and she was treated successfully at least in this attack of soft tissue infection, which caused more severe sepsis and tissue damage than the previous infections with other agents

Pediatric Diabetic Ketoacidosis: A Retrospective Study on Triggering Factors and Complications in a Turkish Intensive Care Unit

Aim: Diabetic ketoacidosis (DKA) is a critical, potentially life-threatening complication of diabetes mellitus (DM) in children, characterized by hyperglycemia, acidosis, and ketonemia/ketonuria. Despite its known risk factors and mortality rates, few studies have focused on the pediatric population, especially in specific regions under standard treatment protocols. This study investigated the demographic, clinical, and laboratory characteristics of children with DKA, identified its triggering factors, the factors affecting DKA severity and its complications, as well as evaluating the outcomes of a standardized treatment protocol in a Turkish pediatric intensive care unit (PICU). Materials and Methods: In this single-center retrospective study at Göztepe Prof. Dr. Süleyman Yalçın City Hospital’s PICU, we included 115 children diagnosed with DKA between 2015 and 2022, following the DKA Treatment Protocol of the Turkish Society of Pediatric Emergency and Intensive Care Medicine and the International Society for Pediatric and Adolescent Diabetes guidelines. We analyzed the patients’ demographic, clinical, and laboratory characteristics, treatment outcomes, and their complications using SPSS 25.0. Results: The sample primarily consisted of female patients and those newly diagnosed with DM, with a median age of 110 months. The mortality rate was low at 0.87%, with one death due to sepsis-induced multiple organ failure. DKA severity (lower GCS, younger age, electrolyte imbalance, acidosis, complications) correlated with longer PICU stays and recoveries in the children. The findings also highlighted the standardized treatment protocol's effectiveness in managing DKA and reducing complications. Conclusion: This study underscores the importance of early diagnosis, standardized treatment protocols, and comprehensive care in pediatric DKA management. It emphasizes the need for ongoing education and awareness among healthcare providers and caregivers in order to prevent DKA and its severe outcomes. Further multicenter studies are necessary to extend these findings to the broader pediatric population and refine DKA management strategies

Severe head trauma in children: Analysis of 68 cases in light of current guidelines

Aim: To assess the characteristics of severe head trauma in the pediatric age group and to analyze its results under the currentguideline.Material and Methods: Eighty pediatric patients (<18 years) admitted to our hospital with the diagnosis of severe head trauma andtreated by neurosurgery and the pediatric intensive care unit (ICU) between 2014 and 2018 were analyzed retrospectively. Of these,68 patients who met the study criteria were selected. Besides the demographic data of the patients, the presenting neurologic, clinic,radiologic and laboratory findings were recorded. Then the association between these variables and 1-year Glasgow Outcome Scale(GOS) scores was analyzed.Results: There is a correlation between the presenting GCS scores and 1-year GOS scores of the patients when grouped as favorable(4-5) and unfavorable (1-3). Regarding the other admission findings, the patients with hypothermia, the patients with hyperglycemia,the patients to whom CPR was applied, the patients with pupillary areflexia, the patients with hypoxia and the patients with neurologicaldeterioration have lower 1-year GOS scores. There was no difference between the gender, age, type of injury, type of trauma (isolatedhead trauma or multiple trauma), presence of shock on admission, having hematoma surgery, having decompressive craniectomy,treatment with ICP monitoring and 1-year GOS scores. The overall mortality rate was 29.4% (20 patients), and the rate of poorprognosis (GOS 1-3) was 48.5% (33 patients).Conclusion: Children with severe head trauma should be treated at centers that are experienced in the field per updated guidelines.Since the morbidity and mortality rates of severe head trauma are still high, efforts toward improving preventive measures shouldalso be considered

Internal carotid artery dissection following blunt head trauma: a pediatric case report and review of the literature

Background. Internal carotid artery dissection (ICAD) is a rare but potentially devastating complication after trauma in the pediatric age group. The diagnosis of traumatic dissection is difficult and is usually recognized only when ischemic symptoms appear. We report a pediatric patient with ICAD due to blunt cerebrovascular injury (BCVI). Case. A 14-year-old boy suffered major trauma due to a motor vehicle accident. When the first aid team reached the accident site, he was intubated because of his low Glasgow Coma Score (GCS) and then transported to the nearest emergency department. Cranial computed tomography (CT) showed multiple fractures at the skull base and independent bone fragments in both carotid canals. On the 6th day; a brain magnetic resonance imaging (MRI) was performed to detect diffuse axonal injury. There was a loss of signal in the left internal carotid artery (LICA) tract but the limitation of diffusion was not associated with the same side, conversely there was a limitation of diffusion on the other side, affecting a very large area. CT angiography was performed in order to detect a filling defect and showed dissection in the LICA. The patient did not have any specific neurological symptoms associated with ICAD. Low-dose aspirin was utilized as anticoagulant therapy. On the 25th day of admission, the patient`s GCS was 14, neurologic examination showed no difference between the right and left sides. He was discharged on the 55th day of the accident and was walking without support. Conclusion. Our patient was a rare case in pediatrics due to having a clinically silent form of ICAD. It is very difficult to diagnose ICAD dissection during the early phase in cases with BCVI accompanied by multiple trauma. Even in the absence of typical neurological deficit, the possible presence of ICAD should be explored in patients with cranial fractures encompassing the skull base

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines

Çocukluk çağı lösemilerinde mikroRNA ekspresyonunun lösemi tipi, tedaviye yanıt ve prognoz ile ilişkisinin değerlendirilmesi

Çocukluk yaş grubunda lösemiler %30.2 oranı ile en sık görülen malign hastalıktır. Çocukluk çağı lösemilerinde bazı klinik ve laboratuvar göstergeleri kullanılarak risk gruplandırması ve buna göre tedavi planlaması yapılmaktadır. Aynı yaş ve risk grubundaki hastalarda tedaviye yanıt ve prognozda kişisel farklılıklar gözlenebilmektedir. Prognoz ve tedaviye yanıtta görülen kişisel farklılıkların altında genetik nedenler ileri sürülmektedir. Son yıllarda kanser ve genetik ilişkisine ait yapılan çalışmalarda son derece güncel ve yeni keşfedilen moleküller olan mikroRNA'lar (miRNA) karşımıza çıkmaktadır. miRNA'lar büyüklüğü 19-25 nükeotid arasında değişen, etkisini messenger RNA (mRNA) üzerinden gösteren küçük endojen RNA kümesidir. miRNA'nın en önemli fonksiyonu hedef mRNA'ların fonksiyonunu etkileyerek olmaktadır. Her özgün miRNA hedef mRNA'larını tanıdıktan sonra; translasyonun baskılanması ya da mRNA'nın parçalanması yolu ile işlev görmektedir. miRNA ekspresyonundaki bozukluklar, hedef mRNA'nın fonksiyonunu etkilediği ve dolayısıyla üretilen protein ya da gen ürünlerinin ifadesinde değişikliğe yol açmaktadır. Bu araştırmaya yeni tanı almış 60 akut lösemili çocuk olgu ve 15 kontrol olgusu alındı. Olgular Ege Üniversitesi Pediatrik Hematoloji Bilim Dalı ve Ege Üniversitesi Pediatrik Onkoloji Bilim Dalı, Dokuz Eylül Üniversitesi Hematoloji Bilim Dalı ile Dr. Behçet Uz Çocuk Hastanesi Onkoloji ve Hematoloji Kliniğinden seçildi. Çalışmaya alınan bütün gruplar içinden 3'ü (%5), yapılan RNA izolasyonu işlemi sonrasında, mikroarray çalışmasında yeterli düzeyde sinyalizasyon vermediği için çalışma dışı bırakıldı. Sonuç olarak hasta grubundan 43, kontrol grubundan 14 olgu ile çalışmaya devam edildi. CLC Main Workbech Versiyon 5.5 Softwatre® programı kullanılarak istatistiksel değerlendirme yapıldı. Mean değerine göre fold change değeri ± 2 kat ve daha fazla ekspresyon farkı gösteren miRNA`lar çalışmaya alındı. FDR correction (doğrulama) p değeri <0.05 olan miRNA'lar anlamlı kabul edildi. Hasta grubunda tanıda ortalama yaş 7.2± 4.8, kontrol grubunda ise 6.6± 5.1 olarak saptandı. Hasta grubu akut lenfoblastik lösemi (ALL) ve akut myeloblastik lösemi (AML) olmak üzere iki ana grubu ayrıldı. Hasta grubunun %74'ü (43 olgu) ALL, %26'sı ise (15 olgu) AML grubundandı. Kız erkek dağılımına bakıldığında hasta grubunda kız/erkek oranı 1 ( ALL:0.9, AML:1.1), kontrol grubunda ise 0.8 olarak saptandı. Hasta ve kontrol grubundan elde edilen her bir kemik iliği ve periferik kan örneklerinden güncel miRNA database sistemi Sanger miRBase V16 son versiyonuna baglı kalınarak 1136 çeşit miRNA değerlendirildi. Günümüze kadar miRNA hastalık ilişkisine yönelik yapılan çalışmalarda en geniş taranan miRNA profili çalışmamıza aitti. Lösemide periferik kan örneklerinin doğru miRNA profili yansıtmadığı saptandı. Lösemi tipi, subtipleri, risk grubu, prognoz (eksitus ve relaps olma) ve çeşitli sitogenetik alt tiplerle miRNA ekspresyon profillerinin ilişkisi değerlendirildi ve belirgin ayrımlar olduğu görüldü. Anlamlılık gösteren bazı miRNA'ların, lösemilerle ilişkisinin ilk kez çalışmamızda ortaya konduğu görüldü. Anlamlı miRNA'ların hedef genlerinin lösemi ile ilişkileri ortaya kondu

Evaluation of Patients Diagnosed with Brain Death in Paediatric Critical Care

Aim:We aimed to investigate the rate of brain death (BD) determinations and organ donations in our tertiary pediatric intensive care unit (PICU), and to report the data on demographic pattern and supplementary descriptive data on the BD declarations.Materials and Methods:Age and gender of the cases were recorded, and also clinical conditions causing BD were grouped and recorded under six headings including; traumatic brain injury (TBI), brain neoplasm, cardiac arrest, intracranial haemorrhage, central nervous system infection and other causes. The time from the PICU admission to the diagnosis of BD, the time from suspicion of BD to final diagnosis, duration of survival after diagnosis of BD, confirmatory tests used, whether apnea test is performed, and inherent alterations (diabetes insipidus, hyperglycaemia, hypothermia) that occurred following diagnosis of BD were recorded. Organ donation rate, the name and number of organs harvested were determined.Results:Twenty-three patients were diagnosed with BD. The mean age of the patients diagnosed with BD was 5.5±4.9 years. The causative mechanism leading to BD was classified into six groups, out of which the most common diagnosis was TBI with a rate of 39.3%. The meantime from PICU admission to BD diagnosis was 5.7±5.5 days. The time period from suspicion of BD to the final diagnosis was 1.6±0.7 days and the meantime to develop cardiac arrest after diagnosis of BD was 13.1±21.6 days in non-donor cases. The most commonly used confirmation test was brain computed tomography angiography with 82.6%. The most common alteration that follow BD was diabetes insipidus (56.5%). Four patients became organ donors (17.4%).Conclusion:Patients with severe TBI are the most likely candidates for BD declaration and suitable for organ donation for children in need. Early diagnosis and good donor care are of great importance, especially for paediatric patients waiting for organ transplants