Romatizmal mitral yetmezlikli hastalarda sol ventrikül sistolik ve diyastolik fonksiyonlarının geleneksel ve doku doppler yöntemleri ile değerlendirilmesi

Mitral yetmezlikli (MY) hastalarda, sol ventrikül fonksiyonlarının bozulduğunun erkensaptanmasında doku Doppler görüntülemelerinin (DDG) geleneksel yöntemlerden daha iyisonuç verdiği ileri sürülmektedir. Ancak çocukluk yaş grubundaki hastaların ameliyataverilme zamanını gösteren doku Doppler değerleri henüz belirlenmemiştir. Bu çalışmanınamacı, sol ventrikül fonksiyon bozukluğunun erken farkedilmesi açısından sağlıklı vedeğişik ağırlıklı MY'li çocuklardan geleneksel ve DDG yöntemleri ile elde edileceksonuçları karşılaştırmaktır.Hafif-orta derecede MY bulunan 20 hasta (grup 2), ağır derecede MY bulunan 10 hasta(grup 3) ve sağlıklı 30 çocuk (grup 1) çalışmaya dahil edilmiştir. Gruplar arasında yaş,vücut alanı, kan basıncı, kalp hızı gibi sonuçları etkileyecek parametreler açısından anlamlıbir farklılık mevcut değildir. Ekokardiyografik incelemeler Hawlett-Packard Sonos 5500ekokardiyografi cihazı ve 2.5 MHz'lik proplar kullanılarak yapılmıştır. MY'ninderecelendirilmesi jet alanının sol atriyuma oranı ve rügürjitan fraksiyonu kullanılarakyapılmıştır. Ejeksiyon fraksiyonu, fraksiyonel kısalma, pre-ejeksiyon periyodu (PEP),ejeksiyon zamanı (ET), PEP/ET oranı, aortik peak flow velosite, aortik peak velositeintegral, akselerasyon zamanı, aortik distansibilite, kardiyak indeks, interventrikülerseptumun kalınlaşma yüzdesi, sol ventrikül arka duvarının sistolik kalınlaşma yüzdesi, solventrikül sistol-sonu meridyonal duvar stresi, çembersel kısalmanın ortalama hızı, ortalamaakselerasyon açısından gruplar arasında anlamlı bir farklılık bulunmamıştır (P>0.05).Grup 3'te miyokard performans indeksleri (MPI) ve Tei indeksleri kontrol grubuna göreanlamlı bir artış göstermiş ve bulunan değerler normal değerlerden daha yüksekbulunmuştur. Geleneksel ve DDG ile bakılan izovolumik kontraksiyon ve relaksasyonzamanları, E ve A dalga velositeleri. E/A oranı, E-dekselerasyon zamanı, DDG ile bakılanEm /Am oranı, heriki yöntem ile değerlendilen E/Em oranı grup 3'te kontrol grubundananlamlı olarak farklı olduğu saptanmış ancak saptanan değerler literatürde bildirilennormal değerler arasında olduğu görülmüştür. Sonuçlarımız, tek bir DDG'nin LVfonksiyon bozukluğunun başlangıcını yeterince ortaya koyamadığı ve seri şekildeyapılacak takip incelemelerine gereksinim duyulduğu şeklindeki literatür bilgisinidesteklemiştir. Ameliyat sonrası gelişebilecek mortaliteyi öngörebilecek doku Dopplerdeğerlerinin tesbit edilebilmesi için çok sayıda vaka ile yapılacak çalışmalara ihtiyaçvardır.It has been suggested that tissue Doppler imaging give for beter results in the earlydetection of left ventricular dysfunction in patients with mitral regürgitation thanconventionel methods. However, tissue Doppler values indicating operation time have notstill determined in childhood. The aim of this study is to compare the findings obtained byconvansiyonel and tissue Doppler methods among health controls and patients with mitralregürgitation in point of earlier detection of LV dysfunction in patients with mitralregurgitation.Twenty patients(group 2) with mild-modarete mitral regurgitation, 10 patients (group 3)with severe mitral regurgitation and 30 healthy children (group 1) were included into thestudy. There were no significant differences between the groups in terms of suchparameters as age, body surface area, blood pressure and heart rate, which can affect theresults. Echocardiographic investigations were performed using Hawlett-Packard Sonos5500 Echocardiography Device and 2.5 MHz transducer. Severity of mitral regurgitationwas carried out using the proportion of regurgitation jet field to left atrium andregurgitation fraction. No significant differences were found between the groups as toejection fraction, fractional shortening, preejection period (PEP), ejection time (ET), ratioof PEP/ET, aortic peak velocity, aortic peak velocity integral, acceleration time, aorticdistensibility, cardiac index, percentage of thickening of interventricular septum,percentage of systolic thickening of left ventricular posterior wall, left ventricular end-systolic meridional wall stress, avarage rate of circumferential shortenning and meanacceleration (P>0.05).In group 3, myocardial perfomance indexes and Tei indexes displayed significantincrease compared with control group, and detected values were found to be higher thannormal values. In group 3 isovolumic contraction and relaxation times investigated by thehelp of conventional and tissue Doppler imaging, E and A wave velocities, ratio of E/A, Edecceleration time, Em/Am ratio investigated by tissue Doppler and E/Em ratioinvestigated by both methods were found to be significantly different according to thecontrols in this group, but values determined were found to be in normal ranges expressedin literature. Our results display consistency with the data in literature that only a singletissue Doppler evaluation can not shed light on the initiation of left ventricular functiondecrease, and follow up examinations to be serially performed are required. To determinetissue Doppler values to predict mortality developed post-operatively, further studies areneeded to be performed with numerous cases

Valproic Acid-induced Priapism In A Child

A complete or partial involuntary erection that occurs in absence of a sexual stimulation and lasts longer than four hours is defined as priapism. Etiology usually includes sickle cell disease or hematologic malignancies. Less common causes include trauma, spinal cord injury, medications, congenital syphilis, parotitis, Fabry’s disease and retroperitoneal sarcoma. Priapism is a urologic emergency that varies by ischemic and non-ischemic episodes. Ischemic injury to cavernous tissues leads to erectile dysfunction. Early recognition of priapism, determination of the type and the treatment are crucial in preventing potential long-term complications caused by priapism. With this case of priapism caused by a treatment with valproic acid, it was aimed to point out priapism which is a urologic emergency

Evaluation of children with acute gastroenteritis in Konya region

Introduction: Acute gastroenteritis is a major cause of pediatric morbidity and mortality around the world. It remains a frequent reason for infection-related admissions to emergency units among all age groups. Epidemiologic knowledge about etiology of gastroenteritis in a certain area allows early and correct diagnosis. The current study aimed at evaluating the prevalence of bacterial, viral, and parasitic pathogens in children with gastroenteritis who admitted to pediatric emergency unit. Methods: The demographic, clinical and laboratory data of 450 children with acute gastroenteritis, within the age range of 0 months to 18 years who admitted to Pediatric Emergency Department of Meram Faculty of Medicine from September 2018 to September 2019 were retrospectively analyzed.Results: While 31.10% of the patients had etiological agents, 68.90% of the patients could not be identified. The identified pathogens were 2.10% bacteria, 82.20% virus, 15.70% parasite. The most common pathogen was Rotavirus with a rate of 72.90%. This was followed by E. histolytica with 15.00% and Adenovirus with 9.30%. Rotavirus was most frequently detected at the age of 2 years, and E. histolytica was most frequently detected at the age of 5 years. Rotavirus was most common in the winter season [33.7%]. 7.10% of the patients were hospitalized. The average length of hospital stay was 3.34 ± 2.19 days.Conclusion: Rotavirus, E. histolytica and Adenovirus were the most prevalent agents of diarrhea in children aged 0 month to 18 years who admitted to emergency unit in this study

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

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

Goldenhar Sendromu Goldenhar Sendromu Astım - Kardiyolojik Hastalık Profillendirmesi ve Hava Kalitesi Değerlendirmesi

Amaç: Gastrointestinal sistem kanaması çocukluk çağında her yaşta karşımıza çıkabilen ve ağızdan anüse kadar her yerinde görülebilen önemli bir çocuk acil sorunudur. Bu çalışmada çocuk acil kliniğimize gastrointestinal kanama ile başvuran hastaların epidemiyolojik ve laboratuvar özelliklerini ve kanamanın etiyolojik nedenlerini araştırmayı amaçladık.. Yöntem: Çocuk Acil kliniğine Ocak 2016-Ocak 2017 tarihleri arasında başvuran, gastrointestinal kanama tanısı almış 18 yaş altı hastaların, kayıtları ve yatış dosyaları retrospektif olarak incelendi. Hastaların yaş, cinsiyet, geliş yakınmaları, kullandığı ilaçlar, laboratuvar bulguları, aldıkları tanılar, tedavi yöntemleri, endoskopi ve kolonoskopi bulguları incelendi. Bulgular: Çocuk acil kliniğine son bir yılda başvuran hastaların 47'si gastrointestinal kanama tanısı aldı. Bunların 24'ü (%51,1) üst, 23'ü (%48,9) alt gastrointestinal kanama idi. Hastaların %40,4'ünde (n: 19) hematemez, %14,9'unda (n: 7) melena ve %44,7'sinde (n:21) hematokezya tespit edildi. Melena ile başvuranların istatistiksel anlamlı olarak (p:0,02) en fazla 5 yaş altında (n:4, %57,1) olduğu görüldü. Hastaların 20'sinde (%42,6) ilaç kullanım hikayesi mevcuttu. İlaç kullanım hikayesi olan 20 hastanın 18'nin (%90) istatistiksel anlamlı olarak non-steroid anti-inflamatuar ilaç kullandığı tespit edildi. Helicobacter pylori pozitif tespit edilen 12 hastanın 6'sı (%50) istatistiksel anlamlı olarak gastrit tanısı aldı. Helicobacter pylori pozitif tespit edilen 12 hastanın 6'sının (%50) istatistiksel anlamlı olarak hematemez ile başvurduğu görüldü. Sonuç: Bu çalışmada gastrit ve peptik ülserin gastrointestinal kanamanın en sık nedenleri olduğu görüldü. Gastrointestinal kanamaları risk faktörlerine göre değerlendirildiği zamannon-steroid anti-inflamatuar kullanımı ve Helicobacter pylori enfeksiyonunun mukozal lezyonlar ile ilişkisi ortaya koyuldu. Bu nedenle hastaların çocuk acil kliniklerinde özenle değerlendirilip yakın izleme alınması aynı zamanda hasta yakınlarının akılcı ilaç kullanımı konusunda bilgilendirilmesi gerekmektedir.Objective: Gastrointestinal bleeding (GB) is an important emergency problem that can be seen at any age and every part of gastrointestinal system from mouth to anus. In this study, we aimed to investigate demographic, epidemiologic, clinical and laboratory characteristics of patients with GB who admitted to emergency department. Method: The records of patients >18 years who admitted to pediatric emergency department with GB were reviewed retrospectively. The age, gender, complaints, drug history, laboratory findings, diagnoses, treatment modalities, endoscopy and colonoscopy findings were recorded. Results: 47 were found to be folllowed up with the diagnosis of GB in our department. 24 (51.1%) of these were upper and 23 (48.9%) lower GB. Hematemesis was detected in 40.4% (n:19), melena in 14.9% (n:7) and hematochezia in 44.7% (n:21) of them. Patients who applied with melena were mostly >5 years (n:4, 57.1%) which was statistically significant. Twenty of the patients (42.6%) had drug usage history. 18 (90%) were found to use non-steroidal anti-inflammatory drugs. 6 of the 12 Helicobacter pylori positive (50%) patients were diagnosed as gastritis with statistical significance. 6 patients (50%) with positive Helicobacter pylori were found to have a statistically significant complaint of hematemesis. Conclusion: In this study, gastritis and peptic ulcer were the most common causes of GB. The assessment of GB according to risk factors, revealed that, non-steroidal anti-inflammatory drug usage and Helicobacter pylori infection were associated with mucosal lesions. Therefore, patients admitted to pediatric emergency departments should be evaluated carefully and informed about rational drug usage

Effects of Isolated Viral Pathogens and Treatment Strategies in the Course of Acute Bronchiolitis

Giriş ve Amaç: Akut bronşiyolit süt çocukluğunda ve 2 yaşından küçük çocuklarda, genellikle viral etkenlere bağlı gelişen ve hastaneye yatışın majör sebeplerinden olan bir alt solunum yolu enfeksiyonudur. Çalışmamızın amacı akut bronşiolit nedeniyle hastanede yatan çocuklarda izole edilen laboratuvar bulguları ve uygulanan tedavi yöntemlerinin hastaların yatış sürelerine etkisini araştırmaktır.Yöntem ve Gereçler: Bu amaçla Konya Eğitim ve Araştırma Hastanesi Çocuk Kliniğinde Aralık 2013 - Mayıs 2014 tarihleri arasında bronşiyolit tanısıyla yatarak takip edilen 95 hastanın dosyaları retrospektif olarak incelendi.Bulgular: En fazla izole edilen viral patojenler respiratuvar sinsityal virüs (%21.8) ve rinovirüs idi (%21.8). Sadece rinovirüs üreyen grupla üreme olmayan grup arasında yatış süreleri açısından anlamlı bir fark bulunamazken, sadece RSV-A üreyen ve RSV-ARinovirüs birlikte üreyen grupta hastanede yatış süreleri anlamlı derecede uzun bulundu. İnhale bronkodilatatör, ipratropium bromid, hipertonik salin tedavisi uygulanan ve uygulanmayan hasta grupları arasında yatış süreleri açısından anlamlı fark saptanmazken, inhale streoid alan olguların yatış süresi almayanlara oranla daha uzun bulundu. İmmunglobulin E (Ig E) düzeyi yüksek ölçülen hastaların ortalama yatış süreleri, normal olanlara göre anlamlı olarak uzundu. Anne sütü alan ve almayan gruplar arasında ve sigara ile temas öyküsü olan ve olmayan gruplar arasında yatış süreleri açısından anlamlı fark saptanmadı.Tartışma ve Sonuç: Sonuç olarak, RSV ve rinovirüs hala akut bronşiyolitin majör sebepleridir. İnhale steroid tedavisi almak, yüksek Ig E düzeyi ve bronşiolit sebebinin RSV olması hastanede yatış süresini uzatmaktadır.Introduction: Acute bronchiolitis, is predominantly a viral disease, part of the spectrum of lower respiratory tract diseases, and is a major cause of illness and hospitalization in infants and children younger than 2 years of age. The aim of the present study was to determine the effects of treatment protocols, other laboratory results, and isolated viral agents on the duration of hospitalization.Methods: Data of 95 children who were hospitalized with the diagnosis of bronchiolitis at the pediatrics clinic of KonyaTraining and Research Hospital between October 2013 and May 2014 were reviewed retrospectively.A Results: The most frequently seen agents were respiratory syncytial virus (RSV) and rhinovirus with an equal rate of 21.8%. When patients with no isolation were compared with patients with only rhinovirus isolated, no significant difference was found in hospitalization length. However, hospitalization duration was significantly longer in patients with RSV-A infection and RSV-A and rhinovirus, than in patients with no virus isolation. While hospitalization length was not affected by receiving inhaled bronchodilator treatment, ipratropium bromide or hypertonic saline, the duration was longer in patients receiving inhaled corticosteroid compared with patients who didn't receive inhaled corticosteroid. The mean hospitalization durationwas significantly longer in patients with higher immunoglobulin E (IG E) levels. Smoke exposure and receiving breast milk in the first 6 months of life didn't influencethe length of stay in hospital.Discussion and Conclusion: In conclusion, receiving inhaled corticosteroid, high Ig E level and bronchiolitis due to RSV infection prolonged hospital stay