Current treatment of acute bronchiolitis

Akut viral bronşiyolit iki yaş altı çocuklarda en sık görülen alt solunum yolu infeksiyonu olup, altı aydan küçük çocuklarda hastaneye yatırılma nedenlerinin başında gelmektedir. Bu yaygın hastalığın tedavisinde dünyaca kabul edilen en iyi yaklaşım hava yolu bakımı, yeterli hidrasyonun sağlanması ve oksijenasyonla sınırlıdır. Tedavide bronkodilatörler, epinefrin ve steroidlerin kullanımı konusunda akıl karıştırıcı sonuçlar ve yaklaşımlar mevcuttur. Ülkemizde de tedavisi konusunda tam bir uzlaşma sağlanamamıştır. Bu yazıda, akut bronşiyolitte tedavi yaklaşımları son çalışmaların ışığında gözden geçirilmiştir.The most common lower repiratory tract infection in infants younger than two years is acute viral bronchiolitis that is leading cause of hospitalisation under six months of age. Little worldwide consensus exists about the best management strategies for this common disease are caring airway, maintenance of adequate hydration and oxygenation. Managements and the results in the use of bronchodilators, epinephrine and corticosteroids for bronchiolitis are conflicting. There is considerable controversy regarding ıts management in our country too. Here we review the treatment of acute bronchiolitis with the guidance of the recent literature

A case of acute myeloid leukemia presenting with deep venous thrombosis

Çocuklarda görülen venöz tromboz çoğunlukla kateterizasyon, enfeksiyöz hastalıklar, kalıtsal trombofili ve metabolik hastalıklar gibi altta yatan bir risk faktörü ile ilişkilidir. Kanser çocukluk çağında görülen primer venöz trombozların önemli bir nedenidir ve çocukluk çağı venöz tromboz olgularının beşte birinden sorumludur. Bu yazıda ilk başvuru bulgusu derin ven trombozu olan ve takibinde akut myeloid lösemi (AML) tanısı konulan 13 yaşında kız hasta sunulmuştur.Deep venous thrombosis is mostly associated with an underlying risk factor such as venous catheter, infectious diseases, hereditary thrombophilia and metabolic diseases. Cancer is one of the most common primary disorders in pediatric venous thrombosis, accounting for one-fifth of children with thrombotic events. Here we report a 13-year-old female patient who is diagnosed as deep vein thrombosis due to acute myeloid leukemia

Comparison of Hemogram Parameters in Febrile Seizures Types

Aim: Febrile seizures (FS) are among the most common neurological emergencies duringchildhood and clinically classified into two types, being simple febrile seizures (SFS) andcomplicated febrile seizures (CFS). The differentiation between FS types is important, in thatthey are associated with different morbidity and mortality risks and it is based on the clinicalcharacteristics of each seizure, however there is currently no laboratory test that can guide thisdifferentiation. In this study, the relationship between FS types and hemogram parameters wasevaluated and potential use of these parameters in differential diagnosis was investigated.Material and Methods: This retrospective study included a total of 133 patients whose firstFS met the criteria of an FS, and whose hemogram results were available. The AmericanAcademy of Pediatrics criteria were used to confirm the diagnosis. The patients were dividedinto two groups as SFS and CFS.Results: Hemoglobin (Hb), hematocrit (HCT), mean platelet volume (MPV), neutrophillymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) differed significantly betweentwo groups (p<0.001, p=0.002, p=0.033, p<0.001, p<0.001, respectively), while no significantdifference was identified in total blood count parameters. Moreover, MPV was significantlyhigher in CFS group than in SFS group.Conclusion: This is one of the few studies investigating the potential relationship betweenhemogram parameters and FS types in children. We believe that, although they do not ensurea clear differentiation, Hb, MPV, NLR and PLR may be useful to clinicians in differentiatingbetween FS types, particularly in patients with an unclear seizure history

Comparison of Hemogram Parameters in Febrile Seizures Types

Aim: Febrile seizures (FS) are among the most common neurological emergencies duringchildhood and clinically classified into two types, being simple febrile seizures (SFS) andcomplicated febrile seizures (CFS). The differentiation between FS types is important, in thatthey are associated with different morbidity and mortality risks and it is based on the clinicalcharacteristics of each seizure, however there is currently no laboratory test that can guide thisdifferentiation. In this study, the relationship between FS types and hemogram parameters wasevaluated and potential use of these parameters in differential diagnosis was investigated.Material and Methods: This retrospective study included a total of 133 patients whose firstFS met the criteria of an FS, and whose hemogram results were available. The AmericanAcademy of Pediatrics criteria were used to confirm the diagnosis. The patients were dividedinto two groups as SFS and CFS.Results: Hemoglobin (Hb), hematocrit (HCT), mean platelet volume (MPV), neutrophillymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) differed significantly betweentwo groups (p<0.001, p=0.002, p=0.033, p<0.001, p<0.001, respectively), while no significantdifference was identified in total blood count parameters. Moreover, MPV was significantlyhigher in CFS group than in SFS group.Conclusion: This is one of the few studies investigating the potential relationship betweenhemogram parameters and FS types in children. We believe that, although they do not ensurea clear differentiation, Hb, MPV, NLR and PLR may be useful to clinicians in differentiatingbetween FS types, particularly in patients with an unclear seizure history

Neck stiffness in Guillaine-Barre syndrome subsequent to cytomegalovirus infection

Guillain-Barre syndrome is an acute inflammatory demyelinating polyradiculoneuropathy that can be seen at any age. The classic symptoms such as flaccid paralysis and areflexia are not always predominant in children. In this study, we presented a 3-year-old girl with Guillain-Barre syndrome associated with cytomegalovirus infection who referred with showed atypical symptoms including neck stiffness

Sitomegalovirüs enfeksiyonunu takiben gelişen Guillaine-Barre sendromunda ense sertliği

Guillain-Barre sendromu her yaşta görülebilen akut inflamatuar demiyelinizan bir poliradikülopatidir. Çocuklarda flask paralizi ve arefleksi gibi klasik semptomlar her zaman belirgin olmayabilir. Bu çalışmada, ense sertliği benzeri atipik bulgular gösteren 3 yaşındaki bir kız hastada sitomegalovirusa bağlı Guillain-Barre sendromu sunuldu.Guillain-Barre syndrome is an acute inflammatory demyelinating polyradiculoneuropathy that can be seen at any age. The classic symptoms such as flaccid paralysis and areflexia are not always predominant in children. In this study, we presented a 3-year-old girl with Guillain-Barre syndrome associated with cytomegalovirus infection who referred with showed atypical symptoms including neck stiffness

Evaluation of allergic sensitization and gastroesophageal reflux disease in children with recurrent croup

Background

Subakut Sklerozan Panensefalit’li Olgularımızın Klinik ve Radyolojik Bulgularının Değerlendirilmesi

Amaç: Subakut sklerozan panensefalit (SSPE) merkezi sinir sisteminde kızamık virüsünün geç komplikasyonu olarak ortaya çıkan bir yavaş virüs enfeksiyonudur. Bu çalışmada SSPE’li hastalarımızın klinik ve radyolojik özelliklerini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya, Harran Üniversite¬si Çocuk Nöroloji Kliniği ve Bülent Ecevit Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Kliniğinde takip edilen toplam 19 SSPE hastası alındı. Hastalar yaş, cins, kızamık öyküsü, başvuru şikayetleri, klinik evre ve beyin manyetik rezonans görüntüleme (MRG) bulguları açısından değerlendirildi. Bulgular: Hastaların %68.4’ü (n=13) erkek, %31.6’sı (n=6) kızdı. Hastaların başvuru anında %31.5’inde (n=6) atonik ve miyoklonik nöbet, %20’sinde (n=4) mental ve davranış değişikliği gözlendi. Beyin MRG’ sinde en fazla tutulum gösteren alanlar kortikal, subkortikal ve periventriküller beyaz cevher bölgeleri idi. Olguların %36.8’inde (n=7) normal beyin MRG bulguları tespit edildi. Tartışma: SSPE’ nin endemik olarak görüldüğü bölgelerde yaşayan çocuklarda atonik ve miyoklonik nöbet, kişilik değişikliği, saldırgan davranış ya da içine kapanma gibi psikiyatrik bulguların varlığı hastalık için uyarıcı olmalıdır. Bununla birlikte, hastalığın erken evrelerinde beyin MRG bulgularının yüksek oranda normal olabileceği göz önünde bulundurulmalıdır.Aim: Subacute sclerosing panencephalitis (SSPE) is a slow virus infection, arising in the central nervous system in the form of late complication of measles virus. In this study we aimed to research the clinical and radiological features of our patients with SSPE. Material and Method: The study was attended by 19 patients with SSPE being followed-up in the Child Neurology Clinic of the Medical Faculty of Harran University. Patients were assessed as per the following aspects, including age, gender, measles case, complaints resulting in the application, findings from clinical phase and magnetic resonance imaging (MRI) of brain. Results: While 68.4% (n = 13) of the patients were male, remaining 31.6% (n = 6) thereof were female. At the time of application, atonic and myoclonus seizures were seen among 31.5% (n = 6) of the patients, and mental and behavioral changes were seen among 20% (n = 4) thereof. In MRI of brain, involvement was seen the most in cortical, sub-cortical, and periventricular white matter fields. Among the findings from MRI of brain, those detected as normal were 36.8% (n = 7) of the total. Discussion: At places where SSPE is seen as endemic, presence of such psychological findings among children, including atonic and myoclonic seizures, personality changes, aggressive behaviors, or autism, should be considered as a warning. Meanwhile, it should further be considered that, MRI of the brain at the earlier stages of the disease may bring forth normal findings in high ratios

Batı Karadeniz Bölgesinde Yer Alan Hastanelerin Acil Servislerinin Çocuk Hastalara Uygunluğunun Değerlendirilmesi

Amaç: Acil servislerde, doğru ve zamanında yapılan tıbbi müdahale hayat kurtarmakta, en küçük gecikme ise geri dönüşü mümkün olmayan sonuçlara yol açabilmektedir. Bu çalışmada Batı Karadeniz bölgesinde yer alan hastane acil servislerinin çocuk hastalara uygunluğunun, personel sayılarının, bilgi, ilaç ve teknik donanım eksikliklerinin belirlenmesi amaçlanmıştır. Yöntemler: Çalışmanın yapıldığı tarihte yer alan 20 adet kamu ve özel hastane acil servislerinde çalışan sorumlu hekim, hemşire veya sağlık memurlarına anket formları yöneltildi. Ankete katılanlara, çalışan personel sayısı, acilde bakılan çocuk hasta sayısı, acil servis mimarisi, radyolojik açıdan imkanları, triyaj durumları, yapılabilen girişimler, alınan kurslar ve eğitimler, resüsitasyon ilaç ve ekipmanları ile ilgili toplam 37 soru yöneltildi. Bulgular: Ankete katılan hastanelerin %80'inde poliklinik şartlarında işlemleri yapılabilecek çocuk hastalar tüm acil başvurularının %50'sinden fazlasını oluşturmaktaydı. Yirmi hastanenin sadece 5 tanesinde gece çocuk doktoru mevcuttu, geri kalan hastanelerde pratisyen hekimler görev yapmaktaydı. Sonuç: Ambulanslar taşıdıkları çocuk hasta eğer bir risk altında ise stabilizasyon için en yakın hastanedeki acil servisten yardım alabilmektedirler, bunun için acilservislerdeki tüm personele periyodik olarak çocuk acil eğitimi verilmelidir.Introduction: Timely and accurate medical interventions in emergency departments save lives while a minimal delay may cause irreversible. The aim of this study was to define the appropriateness of the emergency departments at the hospitals in the Western Black Sea region for pediatric patients and to identify the number of personnel and the level of knowledge, and to determine the insufficiency of medicine and technical equipment. Methods: A questionnaire consisting of 37 questions which evaluated the number of personnel working, the number of pediatric patients examined in the emergency department, architectural design of the emergency department, radiological facilities, triage conditions, interventions that can be performed, courses received, medicine, and equipment for resuscitation, was distributed to the physicians and nurses/medical operators in charge, working in the emergency departments at 20 public and private hospitals that were in operation at the time of the study. Results: In 80% of the hospitals included in the survey, pediatric patients that could be treated in outpatient clinics constituted more than 50% of the emergency admissions. Overnight pediatrician coverage was present in only 5 out of 20 hospitals; general practitioners were on duty at the remaining hospitals. Conclusion: Ambulance personnel can receive medical support from the closest hospital to stabilize the patient when there is a pediatric patient transport at risk. Therefore, all personnel in emergency departments should receive periodic pediatric emergency training