Postinfectious Bronchiolitis Obliterans

Childhood bronchiolitis obliterans (BO) is an uncommon complication that is characterized clinically by persistent and continuous obstructive respiratory symptoms, and has been described secondary to various etiologic factors, including drugs, exposure to toxic fumes, allergic reactions, collagen vascular disease or infections. BO occurs most commonly in children after an episode of acute bronchiolitis and is considered a long-term sequela of viral infection. Postinfectious Bronchiolitis Obliterans (PIBO) is characterized by persistent airway obstruction with functional and radiological evidence of small airway involvement that is in general unresponsive to bronchodilator treatment. Although the condition is relatively rare, and its exact incidence is unknown, it is important to keep it in mind. PIBO is complication of lower respiratory tract epithelial injury, and is often misdiagnosed, delaying recognition and potential treatment. A PIBO diagnosis is usually based on a few factors, including a good medical history, positive clinical findings, and lung function test and imaging results, although biopsy and histopathology remain as the optimum diagnostic approach. There have to date been few studies proposing treatments for the condition, and no accepted protocol exists in literature. There is usually a fixed airway obstruction in PIBO. Various treatment approaches have been extrapolated from studies of post bone marrow transplantations and lung transplant BO. The clinical course is variable, and good supportive therapy is essential, with anti-inflammatory therapy often being employed

Periyodik Sistem Konusu ve Analojilerle Öğretim Modeli: Yöntem, Cinsiyet ve Motivasyon Faktörlerinin Öğrenci Başarısına Etkisi

In this study, the topic of periodic system was taught by teaching with the analogies model. The effects of the teaching method, students’ gender and motivation on the 8th grade students’ (n=51) achievement were investigated. The topic of periodic system was taught with the help of analogical worksheets that were appropriately designed for the phases of the Teaching with Analogies Model. Tools used to gather data were the Periodic System Achievement Test and the Students’ Motivation towards Science Learning Questionnaire. Pairedsamples t test and two-way 2x2 ANOVA were used for the analyses of data. The students that have a medium motivation level were seemed to progress more when compared with the students having a high-level motivationBu çalışmada Periyodik Sistem konusunun analojilerle öğretiminin, öğrenci cinsiyetinin ve fen motivasyonu düzeyinin ortaokul sekizinci sınıf öğrencilerinin (n=51) başarısına olan etkisi araştırılmıştır. Periyodik sistem konusu, araştırmacılar tarafından Analojilerle Öğretim Modelinin aşamalarına uygun olarak tasarlanmış analojik çalışma yaprakları kullanılarak öğretilmiştir. Verilerin toplanması için Periyodik Sistem Başarı Testi ve Fen Öğrenimine Yönelik Motivasyon Ölçeği kullanılmıştır. Fen Öğrenimine Yönelik Motivasyon Ölçeği öğrencilerin motivasyon düzeyini (düşük, orta ve yüksek) belirlemek için öğretim öncesinde bir defa uygulanmıştır. Periyodik Sistem Başarı Testi ise ön-test ve son-test olarak öğretim sürecinde iki kez uygulanmıştır. Veri analizinde ilişkili gruplar için t-testi ve iki-yönlü 2x2 ANOVA sınamaları kullanılmıştır. İlişkili gruplar t-testi sonucunda, başarı testinin ön-test ve son-test puan ortalamaları arasında istatistiksel olarak anlamlı bir fark bulunmuştur. Bu bulgu, öğretim yönteminin öğrencilerin başarısını anlamlı bir şekilde arttırdığını göstermektedir. ANOVA sınaması sonucunda, orta ve yüksek düzey motivasyona sahip öğrencilerin başarıları arasında orta düzey motivasyona sahip öğrenciler lehine anlamlı bir fark belirlenmiştir. Bu sonuç, orta düzey motivasyona sahip öğrencilerin analojilerle öğretimden daha fazla istifade ettiklerine işaret etmektedir

Use of Flexible Bronchoscopy in Foreign Body Aspiration

Objective:Foreign body aspiration remains a serious health problem with a potential for severe consequences, and acute and chronic problems in children. It therefore demands immediate intervention. Rigid bronchoscopy has long been the method of choice for foreign body removal but is now being replaced by flexible bronchoscopy which offers reduced trauma and the ability to access distal bronchial regions. In the presented study we assessed the patients who underwent flexible bronchoscopy for foreign body removal in our clinic.Methods:We reviewed the records of 20 patients who underwent flexible bronchoscopy due to suspected foreign body aspiration and had a foreign body removed in our clinic. Patients were analyzed in terms of sociodemographic data, foreign bodies removed, method of foreign body removal, foreign body location and time to diagnosis.Results:Our study group included nine females and 11 males. The removed foreign body was organic in 19 of the 20 patients and inorganic in one patient. Hard organic food, such as hazelnuts, peanuts, seeds, almonds, and raw corn kernel were identified in 12 patients, a piece of fishbone in one patient and a piece of gelatin in another. The pieces of soft organic food identified were apple in one patient, egg in one patient, and boiled corn kernel in one patient and removed by suction. The foreign body was removed using forceps in nine patients, and a basket was used successfully in seven patients.Conclusion:Foreign bodies can be removed with minimal complication using flexible bronchoscopy, basket, and forceps in children

Chest Imaging Findings in Hospitalized Children with H1N1 Influenza

Objective: The aim was to review the radiological findings and to find new prognostic factors that determine the need for pediatric intensive care unit (PICU) in children with swine-origin influenza (H1N1) virus infection. Methods: Chest X-ray (CXR) and computed tomography (CT) findings of 18 children with laboratory-confirmed H1N1 infection (9 boys, 9 girls) with a median age of 34 (1–216) months were retrospectively evaluated. Results: CXRs were performed in 15 (83.3%) and thorax CT in 7 (38.8%) children. Abnormal findings were detected in 60% of the patients who underwent CXR and 85.7% of the patients who underwent thorax CT. Radiological findings were mostly diffuse, bilateral, and asymmetric. Ground-glass opacity (GGO) (66.6%) was the leading abnormality and was followed by reticulation (38.8%), nodules (27.7%), consolidation only (16.6%), tree-in-bud pattern (11.1%), consolidation with GGO (5.5%), and septal lines (5.5%). Lymphadenopathy (22.2%), air trapping (5.5%), and parenchymal band (5.5%) were other recorded findings. CXR was found to be insufficient to detect subpleural nodules, lymphadenopathies, and sometimes GGO. Only existence of nodules (p=0.04) affected the need for PICU admission. Conclusion: The most common radiological findings in children with H1N1 infection were bilateral, asymmetric GGO with or without associated multifocal areas of consolidation. CXR was insufficient to detect subpleural nodules, lymphadenopathies, and sometimes GGO. The existence of nodules is a bad prognostic factor in determining the need for PICU admission

Inherited Human ITK Deficiency Impairs IFN-γ Immunity and Underlies Tuberculosis

Inborn errors of IFN-γ immunity can underlie tuberculosis (TB). We report three patients from two kindreds without EBV viremia or disease but with severe TB and inherited complete ITK deficiency, a condition associated with severe EBV disease that renders immunological studies challenging. They have CD4+ αβ T lymphocytopenia with a concomitant expansion of CD4-CD8- double-negative (DN) αβ and Vδ2- γδ T lymphocytes, both displaying a unique CD38+CD45RA+T-bet+EOMES- phenotype. Itk-deficient mice recapitulated an expansion of the γδ T and DN αβ T lymphocyte populations in the thymus and spleen, respectively. Moreover, the patients\u27 T lymphocytes secrete small amounts of IFN-γ in response to TCR crosslinking, mitogens, or forced synapse formation with autologous B lymphocytes. Finally, the patients\u27 total lymphocytes secrete small amounts of IFN-γ, and CD4+, CD8+, DN αβ T, Vδ2+ γδ T, and MAIT cells display impaired IFN-γ production in response to BCG. Inherited ITK deficiency undermines the development and function of various IFN-γ-producing T cell subsets, thereby underlying TB

Incidence of SARS-CoV-2 in people with cystic fibrosis in Europe between February and June 2020

Background Viral infections can cause significant morbidity in cystic fibrosis (CF). The current Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic could therefore have a serious impact on the health of people with CF (pwCF). Methods We used the 38-country European Cystic Fibrosis Society Patient Registry (ECFSPR) to collect case data about pwCF and SARS-CoV-2 infection. Results Up to 30 June 2020, 16 countries reported 130 SARS-CoV-2 cases in people with CF, yielding an incidence of 2.70/1000 pwCF. Incidence was higher in lung-transplanted patients (n=23) versus non-transplanted patients (n=107) (8.43 versus 2.36 cases/1000). Incidence was higher in pwCF versus the age-matched general population in the age groups <15, 15-24, and 25-49 years (p<0.001), with similar trends for pwCF with and without lung transplant. Compared to the general population, pwCF (regardless of transplantation status) had significantly higher rates of admission to hospital for all age groups with available data, and higher rates of intensive care, although not statistically significant. Most pwCF recovered (96.2%), however 5 died, of whom 3 were lung transplant recipients. The case fatality rate for pwCF (3.85%, 95% CI: 1.26-8.75) was non-significantly lower than that of the general population (7.46%; p=0.133). Conclusions SARS-CoV-2 infection can result in severe illness and death for pwCF, even for younger patients and especially for lung transplant recipients. PwCF should continue to shield from infection and should be prioritized for vaccination

Inhaled therapy in children

Aerosol ilaçlar, solunum yolu hastalıklarının ve sistemik hastalıkların tedavisinde kullanılan oral veya parenteral uygulanan ilaçların yerini almaya başlamaktadır. Aerosol yolla ilaç uygulamasının başlıca avantajları, noninvazif olması, oral tedavi ile karşılaştırıldığında etkinin daha hızlı başlaması, oral ve enjeksiyon tedavisine göre yan etkilerinin daha az olması ve enjeksiyona bağlı ağrının oluşmamasıdır. Aerosol yolla akciğerlere uygulanabilen terapötik ilaçlar arasında antibiyotikler, mukolitikler, kısa ve uzun etkili bronkodilatörler, antikolinerjikler, steroid ve nonsteroid antiinflamatuar ilaçlar sayılabilir. Günümüzde, aerolize ilaç uygulaması amacıyla kullanımda olan araçlar üç kategoride sınıflandırılabilir: nebülizerler, ölçülü doz inhalerler (ÖDİ) ve kuru toz inhalerler (KTİ). Ülkemizde de çeşitli tipte inhaler ilaçlar bulunmaktadır. Çocuklarda en etkili inhalasyon yönteminin seçimi, çocuğun yaşına ve klinik durumuna bağlıdır. Seçilen uygun yönteme göre çocukların tedaviye uyumu artırılabilmekte ve hastalık seyri olumlu yönde değiştirilebilmektedir.Aerosol medications are replacing oral and injected drugs that are used in the treatment of respiratory and other diseases. There are many advantages of aerosolized drug delivery to the lung. This route of administration is non-invasive, provides a faster onset of action for some drugs compared to oral therapy, avoiding the side-effects associated with oral and injection therapy and the pain associated with injection therapy. Many therapeutic drugs are being administered to the lung by aerosols. They include antibiotics, mucolytics, short and long&amp;#8211;acting bronchodilators, anticholinergics, steroidal antiinflamatory drugs, non-steroidal antiinflamatory drugs. Many new devices are now available for delivering aerosolized medications. The current methods to deliver therapeutic aerosols can be classified in three categories: nebulizers, pressurized metered dose inhalers (pMDI&amp;#8217;s) and dry powder inhalers (DPT&amp;#8217;s). Various types of inhalers have become available in our country. The most efficient method of delivering aerosol to children depends on the age and clinical condition of the child

Acute and chronic changes in massive Barium Sulfate aspiration in an infant who subsequently was diagnosed with severe Gastro-esophageal Reflux

The barium is often used in radiocontrast examinations of the digestive system because of mucosal absorption is limited. Massive barium aspiration is a rare complication, especially when there is no anatomic or neurological deficit. The depending on barium concentration can cause various lung effects. When the literature is reviewed, barium aspiration may be asymptomatic or lethal in massive amounts. Rarely, large amounts of barium sulphate are aspirated into the lung, there is no literature study how often this is happening. We present a case of massive barium aspiration in this subject. The case is related to a patient&rsquo;s diagnostic esophagography who complaints swallowing problems. The massive barium aspiration couldn&rsquo;t notice because of the absence of acute symptoms and surgical operation of gastrointestinal tract which the patient had undergone previously. When the patient applied our Pediatric Chest Diseases Polyclinic after three months, as a result of the examinations and deep research it was understood that the case was about massive barium aspiration. The patient was directed to our center because there was a radiological appearance of bone density signs on chest X-ray. Such a complaint was not reported by the family neighter in his biography, nor was written in the epicrisis. We will share acute and chronic changes in the lungs, diagnosis and treatment approaches of this case. The infant who has ileostomy was previously operated because of necrotizing enterocolitis. And also still has severe gastro-esophageal reflux and under conservative and medical treatment, a possible fundoplication surgery is planning

Yalova ili ve çevresinde görev yapan hekimlerin ve hemşirelerin etik duyarlılıkları

YALOVA İLİ VE ÇEVRESİNDE GÖREV YAPAN HEKİMLERİN VE HEMŞİRELERİN ETİK DUYARLILIKLARI Araştırma, hekim ve hemşirelerin etik duyarlılık durumlarının tanımlanması amacıyla, “Ahlaki Duyarlılık Anketi – ADA” kullanılarak metodolojik ve tanımlayıcı olarak planlandı ve gerçekleştirildi. Araştırmanın evrenini, Yalova İli ve çevresindeki Devlet Hastaneleri, Özel Hastaneler ve Sağlık Ocaklarında görev yapan hekim ve hemşireler oluşturmaktadır. Örneklem grubunu ise yaptığımız araştırmaya katılmayı kabul eden 70 Hekim ve 130 Hemşire oluşturmaktadır. Verilerin toplanmasında literatür doğrultusunda hazırlanan “Bireysel Bilgi Formu” ve Kim Lutzen tarafından geliştirilen, Türkçe geçerlik güvenirliği Hale Tosun tarafından yapılan, “Moral Sensitivity Questionnaire – MSQ” (Ahlaki Duyarlılık Anketi- ADA) kullanıldı. Veri analizinde; frekans, standart hata, medyan, yüzdelik oran, ortalama, minimum ve maksimum değerler, Kruskal Wallis ( א² ) ve Mann Whitney ( Z ) testi, Cronbah’s Alpha teknikleri kullanıldı. Araştırmanın sonucunda; MSQ’nun iç tutarlılığının çalışmamız için 0,839 olduğu, ADA’dan elde edilen sonuçlara göre; Hekimlerde, yaşın ilerlemesiyle oryantasyonun azaldığı, bekar hekimlerde otonominin yüksek olduğu, acil serviste görev yapan hekimlerin dahili bilimlerde görev yapanlara göre daha fazla çatışma yaşadığı, Hemşirelerde, yaşın ilerlemesiyle bütüncü yaklaşımın arttığı belirlendi. Sağlık Ocağında çalışan hemşirelerde etik duyarlılığın, özel hastanelerde çalışanlardan daha fazla olduğu, mesleğini isteyerek seçen hemşirelerde bütüncü yaklaşımın ve otonominin daha fazla olduğu saptandı. Anahtar Kelimeler : Hemşire, Hekim, Etik, Etik Duyarlılık, Duyarlılık THE ETHICS SENSITIVITY OF THE DOCTORS AND NURSES WORKING IN YALOVA AND ITS REGION SUMMARY This research is planned and realized in order to identify the cases of ethical sensitivities of doctors and nurses with “Ethical Sensitivity Questionnaire-ESQ” as a methodogoligal define. This research’s population is formed from the doctors and the nurses who work in State Hospitals, Private Hospitals and Village Clinics in Yalova city and surroundings. Sample group is formed from 200 (two hundreds) people; 130 nurses and 70 General Practitioner and Specialist Doctors graduated from high school, two year degree and university who accept this research.. Data are collected by using “Individual Information Form” that is prepared direction of literature and “Moral Sensitivity Questionnaire - MSQ” formed by Kim Lutzen. MSQ is a likert type measure device that is formed total 30 (thirty) items and 6 (six) inferior dimensions (Autonomy – Suppling Benefit – Totalitarian Approach – Conflict – Practice – Orientation). In data analysis; Frequency, Standardized Error, Normal Frequency Curve, Percentage Proportion, Medium, Minimum and Maximum values, Kruskal Wallis (א ² ) and Mann Whitney ( Z ) tests, Cronbah’s Alpha techniques are used. At the result of the research it is determined that MSQ’s inner consistency is 0.839, According to the results of survey ADA; It was found out that, the orientation diminishes with ageing among doctors, the autonomy of the single doctors is higher, the conflict between the doctors working in emergency services is higher than the doctors working in internal services. Key Words : Nurse, Doctor, Ethical, Ethical Sensitivity, Sensitivity