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Akbaba B, Yiğit H, Güngör E, Kaynak MO, Kahya HH, Birbilen AZ, Kesici S, Düzova A, Bayrakçı B, Tekşam Ö. After the Türkiye Earthquake: The Experience of a Pediatric Emergency Department in a University Hospital Distant from the Disaster Area. Prehosp Disaster Med 2024:1-8. [PMID: 38680063 DOI: 10.1017/s1049023x24000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Earthquakes rank among the most deadly natural disasters, and children are particularly affected due to their inherent vulnerability. Following an earthquake, there is a substantial increase in visits to emergency services. These visits stem not only from patients seeking care for physical traumas resulting from the earthquake and its subsequent complications, but also from individuals affected by the circumstances created by the disaster. STUDY OBJECTIVE This study aims to determine the characteristics and outcomes of children who presented to the pediatric emergency department (PED) after the earthquake and to evaluate children who had crush injuries at a referral tertiary university hospital away from the earthquake area. METHODS The medical records of children who presented to the PED from the earthquake area from February 6 through March 7, 2023 were retrospectively reviewed. Children rescued from under rubble were categorized as Group 1, those affected by earthquake conditions as Group 2, and patients seeking medical attention due to the follow-up of chronic illnesses were considered as Group 3. Patient data, including sociodemographic characteristics, time period under rubble (TPR), laboratory findings, and details of medical and surgical procedures, developing acute kidney injury (AKI), and the requirement for hemodialysis were recorded. RESULTS A total of 252 children were enrolled in the study, with 52 (20.6%) in Group 1, 180 (71.4%) in Group 2, and 16 (6.0%) in Group 3. The median age was six (IQR = 1.7-12.1) years. In the first group (n = 52), 46 (85.2%) children experienced crush injuries, 25 children (46.3%) developed crush syndrome, and 14 of them (14/25; 56.0%) required dialysis. In the second group, the most common diagnoses were upper respiratory tract infections (n = 69; 37.9%), acute gastroenteritis (n = 23; 12.6%), simple physical trauma (n = 16; 8.8%), and lower respiratory tract infections (n = 13; 7.1%). For children in the third group, pediatric neurology (n = 5; 33.3%), pediatric oncology (n = 4; 25.0%), and pediatric nephrology (n = 3; 18.8%) were the most frequently referred specialties. CONCLUSION Crush injuries, crush syndrome, and AKI were the most common problems in the early days following the earthquake. Along with these patients, children who were affected by the environmental conditions caused by the earthquake, as well as children with chronic illnesses, also accounted for a significant portion of visits to the PED, even if they were distant from the disaster area.
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Affiliation(s)
- Burcu Akbaba
- Division of Pediatric Emergency Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hande Yiğit
- Division of Pediatric Emergency Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Emre Güngör
- Division of Pediatric Emergency Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Mustafa O Kaynak
- Division of Pediatric Emergency Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hafize H Kahya
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ahmet Z Birbilen
- Division of Pediatric Emergency Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Selman Kesici
- Division of Pediatric Intensive Care and Life Support Center, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ali Düzova
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Benan Bayrakçı
- Division of Pediatric Intensive Care and Life Support Center, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Özlem Tekşam
- Division of Pediatric Emergency Care, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Tastemel Ozturk T, Düzova A, Oygar PD, Baltu D, Ozcilingir Hakverdi P, Lacinel Gurlevik S, Kurt-Sukur ED, Aykan HH, Ozen S, Ertugrul I, Kesici S, Gulhan B, Ozaltin F, Ozsurekci Y, Cengiz AB, Topaloglu R. Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience. Pediatr Nephrol 2024; 39:867-877. [PMID: 37676500 DOI: 10.1007/s00467-023-06125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Data on the characteristics of acute kidney injury (AKI) in pediatric COVID-19 and MIS-C are limited. We aimed to define the frequency, associated factors and early outcome of AKI in moderate, severe or critical COVID-19 and MIS-C; and to present a tertiary referral center experience from Türkiye. METHODS Hospitalized patients ≤ 18 years of age with confirmed COVID-19 or MIS-C at İhsan Doğramacı Children's Hospital, Hacettepe University, between March 2020-December 2021 were enrolled. The characteristics of AKI in the COVID-19 group were investigated in moderate, severe and critically ill patients; patients with mild COVID-19 were excluded. RESULTS The median (Q1-Q3) age in the COVID-19 (n = 66) and MIS-C (n = 111) groups was 10.7 years (3.9-15.2) and 8.7 years (4.5-12.7), respectively. The frequency of AKI was 22.7% (15/66) in COVID-19 and 15.3% (17/111) in MIS-C; all MIS-C patients with AKI and 73.3% (11/15) of COVID-19 patients with AKI had AKI at the time of admission. Multivariate analyses revealed need for vasoactive/inotropic agents [Odds ratio (OR) 19.233, p = 0.002] and presence of vomiting and/or diarrhea (OR 4.465, p = 0.036) as independent risk factors of AKI in COVID-19 patients; and need for vasoactive/inotropic agents (OR 22.542, p = 0.020), procalcitonin and ferritin levels as independent risk factors of AKI in the MIS-C group. Age was correlated with lymphocyte count (r = -0.513, p < 0.001) and troponin level (r = 0.518, p < 0.001) in MIS-C patients. Length of hospital stay was significantly longer in both groups with AKI, compared to those without AKI. Mortality was 9.1% in the COVID-19 group; and was associated with AKI (p = 0.021). There was no mortality in MIS-C patients. AKI recovery at discharge was 63.6% in COVID-19 survivors and 100% in MIS-C patients. CONCLUSIONS Independent risk factors for AKI were need for vasoactive/inotropic agents and vomiting/diarrhea in moderate, severe or critical COVID-19 patients; and need for vasoactive/inotropic agents and severe inflammation in MIS-C patients. Our findings suggest that inflammation and cardiac dysfunction are associated with AKI in MIS-C patients; and the association with age in this group merits further studies in larger groups. Early outcome is favorable; long-term follow-up for kidney functions is needed.
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Affiliation(s)
- Tugba Tastemel Ozturk
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ali Düzova
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
| | - Pembe Derin Oygar
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Demet Baltu
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Sibel Lacinel Gurlevik
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Eda Didem Kurt-Sukur
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Hayrettin Hakan Aykan
- Division of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
- Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Seza Ozen
- Division of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ilker Ertugrul
- Division of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Selman Kesici
- Life Support Center, Hacettepe University, Ankara, Türkiye
- Division of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Bora Gulhan
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Fatih Ozaltin
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Yasemin Ozsurekci
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ali Bulent Cengiz
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Gülçek ÖN, Gülhan B, Kesici S, Kurt Şükür ED, Hayran M, Ozaltin F, Duzova A, Bayrakçı B, Topaloglu R. Long-term kidney follow-up after pediatric acute kidney support therapy for children less than 15 kg. Pediatr Nephrol 2023; 38:3811-3821. [PMID: 37195543 PMCID: PMC10189211 DOI: 10.1007/s00467-023-06013-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND In small children, acute dialysis (pediatric acute kidney support therapy (paKST)) is increasingly used; however, it is challenging for many reasons. We compared clinical characteristics and predictors of long-term outcomes of patients < 15 kg on peritoneal dialysis (PD), hemodialysis (HD), and continuous kidney replacement therapy (CKRT). METHODS Patients with history of paKST (CKRT, HD, PD) weighing < 15 kg and ≥ 6 months of follow-up at Hacettepe University were included. Surviving patients were evaluated at last visit. RESULTS 109 patients (57 females) were included. Median age at paKST was 10.1 months (IQR: 2-27 months). In total, 43 (39.4%) patients received HD, 37 (34%) PD, and 29 (26.6%) CKRT. 64 (58.7%) patients died a median 3 days (IQR: 2-9.5 days) after paKST. Percentages of patients using vasopressor agents, with sepsis, and undergoing mechanical ventilation were lower in those who survived. After mean follow-up of 2.9 ± 2.1 years, 34 patients were evaluated at mean age 4.7 ± 2.4 years. Median spot urine protein/creatinine was 0.19 (IQR: 0.13-0.37) and 12 patients (35.3%) had non-nephrotic proteinuria. Three patients had estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73m2 and 2 (6%) had hyperfiltration. In total 22 patients (64.7%) had ≥ 1 kidney risk factor (elevated blood pressure/hypertension, hyperfiltration, eGFR < 90 ml/min/1.73m2, and/or proteinuria) at last visit. Among 28 patients on paKST < 32 months, 21 had ≥ 1 risk factor (75%), whereas among 6 patients who had paKST ≥ 32 months, one patient had ≥ 1 risk factor (16.7%), (p = 0.014). CONCLUSIONS Patients on paKST who undergo mechanical ventilation and vasopressor treatment should be followed-up more closely. After surviving the acute period, patients on paKST need to be followed-up closely during the chronic stage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ömer Nazım Gülçek
- Faculty of Medicine, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Bora Gülhan
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye.
| | - Selman Kesici
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Eda Didem Kurt Şükür
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University, Ankara, Türkiye
| | - Fatih Ozaltin
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
- Nephrogenetics Laboratory, Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
- Department of Bioinformatics, Institute of Health Sciences, Hacettepe University, Ankara, 06100, Türkiye
| | - Ali Duzova
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Benan Bayrakçı
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University, Ankara, Türkiye
| | - Rezan Topaloglu
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Hacettepe University, Sihhiye, Ankara, Türkiye
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Saritas Nakip O, Pektezel MY, Terzi K, Kesici S, Bayrakci B. Optic nerve sheath diameter and pulsatility index for the diagnosis and follow-up in pediatric traumatic brain injury: a prospective observational cohort study. Childs Nerv Syst 2023; 39:2467-2477. [PMID: 37099137 DOI: 10.1007/s00381-023-05959-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/13/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Invasive neuromonitoring could be difficult in children with traumatic brain injury (TBI). This study aimed to determine whether noninvasive intracranial pressure (nICP), calculated via pulsatility index (PI) and optic nerve sheath diameter (ONSD) had correlated with each other and patient outcome. METHODS All moderate-severe TBI patients were eligible. Patients with a diagnosis of intoxication that did not affect the mental status or cardiovascular system were enrolled as controls. The PI measurements were routinely performed bilaterally on the middle cerebral artery. A software (QLAB's Q-Apps) was used to calculate PI, which further placed the ICP equation of Bellner et al. Linear probe with a 10 MHz frequency transducer to measure ONSD, which further placed the ICP equation of Robba et al. All measurements were performed by a point-of-care ultrasound certified pediatric intensivist under the supervision of a neurocritical care specialist, before and 30 min after a hypertonic saline (HTS) infusion for every 6 h when the patient's mean arterial pressure, heart rate, body temperature, hemoglobin, and blood CO2 levels were within normal ranges. The secondary outcome was the effect of hypertonic saline (HTS) on nICP. Delta-sodium values of each HTS infusion were calculated as a difference between pre- and post-measurements. RESULTS Twenty-five TBI patients (200 measurements) and 19 controls (57 measurements) were included. Median nICP-PI and nICP-ONSD on admission were significantly higher in the TBI group (11.03 (9.98-12.63), p = 0.004, and 13.14 (12.27-14.64), p < 0.001, respectively). Median nICP-ONSD of severe TBI patients were higher than moderate TBI patients (13.58 (13.14-15.71) and 12.30 (9.83-13.14), respectively, p = 0.013). The median nICP-PI was the same across the type of injury (falls and motor vehicle accidents), while the median nICP-ONSD of the motor vehicle accident group was higher than falls. The first nICP-PI and nICP-ONSD measurements in PICU and admission pGCS were negatively correlated (r = - 0.562, p = 0.003 and r = - 0.582, p = 0.002, respectively). The mean nICP-ONSD during the study period and admission pGCS and GOS-E peds score significantly correlated. However, the Bland-Altman plots showed significant bias between the two methods of ICP except after 5th dose of HTS. All nICP values significantly decreased in time, and it was most obvious after the 5th dose of HTS. No significant correlations were found between delta sodium levels and nICP. CONCLUSION Noninvasive estimation of ICP is helpful for the management of pediatric severe TBI patients. nICP driven by ONSD is more consistent with clinical findings of increased ICP but not useful as a follow-up tool in acute management because of slow circulation of CSF around the optic sheath. The correlation between admission GCS scores and GOS-E peds score favors ONSD as a good candidate for determining disease severity and predicting long-term outcomes.
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Affiliation(s)
- Ozlem Saritas Nakip
- Pediatric Critical Care Medicine and The center for life support practice and reasearch, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
- Department of Pediatric Intensive Care Unit, Dr. Sami, Ulus Children's Hospital, Babür St. No: 44 (06080), Altındağ, Ankara, Turkey.
| | - Mehmet Yasir Pektezel
- Department of Neurology, Division of Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Department of Neurology, Intensive care unit, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | - Kivanc Terzi
- Pediatric Critical Care Medicine and The center for life support practice and reasearch, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Pediatric Critical Care Medicine and The center for life support practice and reasearch, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Pediatric Critical Care Medicine and The center for life support practice and reasearch, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Misirlioglu M, Yildizdas D, Ekinci F, Ozgur Horoz O, Tumgor G, Yontem A, Talay MN, Kangin M, Tufan E, Kesici S, Yener N, Kinik Kaya HE, Havan M, Tunc A, Akçay N, Sevketoglu E, Durak F, Ozel Dogruoz A, Ozcan S, Perk O, Duyu M, Boyraz M, Uysal Yazici M, Ozturk Z, Çeleğen M, Bukulmez A, Kacmaz E, Cagri Dinleyici E, Dursun O, Koker A, Bayraktar S, Talip Petmezci M, Nabaliyeva A, Agin H, Hepduman P, Akkuzu E, Kendirli T, Ozen H, Topal S, Ödek Ç, Ozkale M, Ozkale Y, Atay G, Erdoğan S, Konca C, Yapici G, Arslan G, Besci T, Yilmaz R, Gumus M, Oto A, Dalkiran T, Mercan M, Çoban Y, Ipek S, Gungor S, Arslankoylu AE, Alakaya M, Sari F, Yucel A, Yazar A. Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey. Front Pediatr 2023; 11:1179721. [PMID: 37601138 PMCID: PMC10436004 DOI: 10.3389/fped.2023.1179721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Malnutrition 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 Method In 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. Results Of 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). Conclusion Timely 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.
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Affiliation(s)
- Merve Misirlioglu
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Mehmet Nur Talay
- Department of Pediatrics, Health Sciences University, Gazi Yasargil Training and Research Hospital, Diyarbakir, Türkiye
| | - Murat Kangin
- Department of Pediatric Intensive Care, Faculty of Medicine, Medipol University, Istanbul, Türkiye
| | - Erennur Tufan
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Selman Kesici
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Nazik Yener
- Department of Pediatric Intensive Care, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Hatice Elif Kinik Kaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Merve Havan
- Department of Pediatric Intensive Care, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Ali Tunc
- Department of Pediatrics, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Nihal Akçay
- Department of Pediatric Intensive Care, University of Health Sciences Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Esra Sevketoglu
- Department of Pediatric Intensive Care, University of Health Sciences Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Fatih Durak
- Department of Pediatric Intensive Care, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Aysenur Ozel Dogruoz
- Department of Pediatric Intensive Care, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Serhan Ozcan
- Department of Pediatric Intensive Care, Ankara City Hospital, Ankara, Türkiye
| | - Oktay Perk
- Department of Pediatric Intensive Care, Ankara City Hospital, Ankara, Türkiye
| | - Muhterem Duyu
- Department of Pediatric Intensive Care, Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Merve Boyraz
- Department of Pediatric Intensive Care, Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Mutlu Uysal Yazici
- Department of Pediatric Intensive Care, Health Sciences University Ankara, Dr. Sami Ulus Obstetrics Child Health and Diseases Training and Research Hospital, Ankara, Türkiye
| | - Zeynelabidin Ozturk
- Department of Pediatric Intensive Care, Health Sciences University Ankara, Dr. Sami Ulus Obstetrics Child Health and Diseases Training and Research Hospital, Ankara, Türkiye
| | - Mehmet Çeleğen
- Department of Pediatric Intensive Care, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Aysegul Bukulmez
- Department of Pediatric Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Ebru Kacmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Ener Cagri Dinleyici
- Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Oguz Dursun
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Alper Koker
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Suleyman Bayraktar
- Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Türkiye
| | - Mey Talip Petmezci
- Department of Pediatric Intensive Care, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Türkiye
| | - Aygul Nabaliyeva
- Department of Pediatric Intensive Care, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Türkiye
| | - Hasan Agin
- Department of Pediatric Intensive Care, University of Health Sciences Izmir, Dr. Behcet Uz Child Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Pinar Hepduman
- Department of Pediatric Intensive Care, University of Health Sciences Izmir, Dr. Behcet Uz Child Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Emine Akkuzu
- Department of Pediatric Intensive Care, Isparta City Hospital, Isparta, Türkiye
| | - Tanil Kendirli
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Hasan Ozen
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Sevgi Topal
- Department of Pediatric Intensive Care, Erzurum Regional Training and Research Hospital, ErzurumTürkiye
| | - Çağlar Ödek
- Department of Pediatric Intensive Care, Faculty of Medicine, Uludag University, Bursa, Türkiye
| | - Murat Ozkale
- Department of Pediatric Intensive Care, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Teaching and Medical Research Center, Adana, Türkiye
| | - Yasemin Ozkale
- Department of Pediatric Intensive Care, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Teaching and Medical Research Center, Adana, Türkiye
| | - Gürkan Atay
- Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Seher Erdoğan
- Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Capan Konca
- Department of Pediatric Intensive Care, Adiyaman Training and Research Hospital, Adiyaman, Türkiye
| | - Guler Yapici
- Department of Pediatric Intensive Care, Adiyaman Training and Research Hospital, Adiyaman, Türkiye
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Tolga Besci
- Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Resul Yilmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Selcuk University, Konya, Türkiye
| | - Meltem Gumus
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Selcuk University, Konya, Türkiye
| | - Arzu Oto
- Department of Pediatric Intensive Care, University of Health Sciences Bursa High Specialization Hospital, Bursa, Türkiye
| | - Tahir Dalkiran
- Department of Pediatric Intensive Care, Necip Fazil City Hospital, Kahramanmaras, Türkiye
| | - Mehmet Mercan
- Department of Pediatrics, Necip Fazil City Hospital, Kahramanmaras, Türkiye
| | - Yasemin Çoban
- Department of Pediatric Intensive Care, Faculty of Medicine, Mugla University, Mugla, Türkiye
| | - Sevcan Ipek
- Department of Pediatric Intensive Care, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Türkiye
| | - Sukru Gungor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Türkiye
| | - Ali Ertug Arslankoylu
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ferhat Sari
- Department of Pediatric Intensive Care, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Aylin Yucel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Türkiye
| | - Abdullah Yazar
- Department of Pediatric Intensive Care, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Türkiye
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6
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Basaran O, Batu ED, Kaya Akca U, Atalay E, Kasap Cuceoglu M, Sener S, Balık Z, Karabulut E, Kesici S, Karagoz T, Ozsurekci Y, Bilginer Y, Cengiz AB, Ozen S. The Effect of Biologics in the Treatment of Multisystem Inflammatory Syndrome in Children (Mis-C): A Single-Center Propensity-Score-Matched Study. Children (Basel) 2023; 10:1045. [PMID: 37371276 DOI: 10.3390/children10061045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition characterized by excessive inflammation that can arise as a complication of SARS-CoV-2 infection in children. While our understanding of COVID-19 and MIS-C has been advancing, there is still uncertainty regarding the optimal treatment for MIS-C. In this study, we aimed to compare the clinical and laboratory outcomes of MIS-C patients treated with IVIG plus corticosteroids (CS) to those treated with IVIG plus CS and an additional biologic drug. We used the propensity score (PS)-matching method to assess the relationships between initial treatment and outcomes. The primary outcome was a left ventricular ejection fraction of less than 55% on day 2 or beyond and/or the requirement of inotrope support on day 2 or beyond. We included 79 MIS-C patients (median age 8.51 years, 33 boys) followed in our center. Among them, 50 children (25 in each group) were allocated to the PS-matched cohort sample. The primary outcome was observed in none of the patients in the IVIG and CS group, while it occurred in eight patients in the IVIG plus CS and biologic group (p = 0.04). MIS-C is a disorder that may progress rapidly and calls for extensive care. For definitive recommendations, further studies, including randomized control trials, are required.
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Affiliation(s)
- Ozge Basaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ummusen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Muserref Kasap Cuceoglu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Seher Sener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Tevfik Karagoz
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ali Bulent Cengiz
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
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7
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Gün E, Gurbanov A, Nakip ÖS, Yöntem A, Aslan AD, Botan E, Kahveci F, Özcan S, Azapağası E, Emeksiz S, Yazıcı MU, Kesici S, Horoz ÖÖ, Erdeve Ö, Bayrakçı B, Yıldızdaş RD, Kendirli T. Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. Turk J Med Sci 2023; 53:791-802. [PMID: 37476891 PMCID: PMC10388067 DOI: 10.55730/1300-0144.5642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/14/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical features, modality, complications, and effecting factors on the survival of children weighing up to 10 kg who received continuous renal replacement therapy (CRRT). METHODS This study was a retrospective observational study conducted in five pediatric intensive care units in tertiary hospitals in Turkey between January 2015 and December 2019. RESULTS One hundred and forty-one children who underwent CRRT were enrolled in the study. The median age was 6 (range, 2-12)months, and 74 (52.5%) were male. The median weight of the patients was 6 (range, 4-8.35) kg and 52 (36.9%) weighed less than 5 kg. The most common indication for CRRT was fluid overload in 75 (53.2%) patients, and sepsis together with multiorgan failure in 62 (44%). The overall mortality was 48.2%. DISCUSSION Despite its complexity, CRRT in children weighing less than 10 kg is a beneficial, lifesaving extracorporeal treatment modality.
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Affiliation(s)
- Emrah Gün
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem Saritaş Nakip
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Yöntem
- Department of Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ayşen Durak Aslan
- Department of Pediatric, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Edin Botan
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serhan Özcan
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Ebru Azapağası
- Department of Pediatric Intensive Care, Faculty of Medicine, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Mutlu Uysal Yazıcı
- Department of Pediatric Intensive Care, Faculty of Medicine, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Özden Özgür Horoz
- Department of Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ömer Erdeve
- Department of Neonatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Benan Bayrakçı
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Rıza Dinçer Yıldızdaş
- Department of Pediatric Intensive Care, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Tanil Kendirli
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Turkey
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8
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Katlan B, Kesici S, Bayrakci B. Intravenous Lipid Emulsion Treatment for Calcium-Channel Blocker Intoxication: Pediatric Case Series and Review of the Literature. Pediatr Emerg Care 2023; 39:120-124. [PMID: 35344530 DOI: 10.1097/pec.0000000000002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Calcium-channel blocker (CCBs) intoxication remains the most lethal among all other drug overdoses (Arroyo and Kao. Pediatr Emerg Care 2009;25:533-538). This study aimed to describe the use and efficacy of intravenous lipid emulsion treatment in our CCB overdose patients in tandem with a comprehensive literature investigation. CASE REPORTS Hereby we report 4 adolescent patients who arrived to the pediatric emergency department after intentional CCB ingestions. All patients were hospitalized in pediatric intensive care unit because of hypotension, and they were initially treated with fluid boluses, glucagon, calcium infusion, vasopressors, inotropes and insulin. Intravenous lipid emulsion (dose: 20% lipid emulsion given as a 1.5-mL/kg bolus followed by 0.25-0.5 mL/kg/min for 30-60 minutes) treatment was given to all patients unresponsive to initial treatments. Hemodynamic instability improved immediately after intravenous lipid emulsion treatment. All patients were discharged with complete recovery at the sixth day of pediatric intensive care unit admission. CONCLUSIONS Intravenous lipid emulsion therapy stands as a salvage treatment for CCB intoxications with cardiovascular failure unresponsive to standard supportive treatments.
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Affiliation(s)
- Banu Katlan
- From the Departmant of Intensive Care Medicine, Life Support Center, Hacettepe University Ihsan Doğramaci Children's Hospital, Ankara, Turkey
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9
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Sık G, Inamlık A, Akçay N, Kesici S, Aygun F, Kendırlı T, Atay G, Sandal O, Varol F, Ozkaya PY, Duyu M, Bırbılen AZ, Ozcan S, Arslan G, Kangın M, Bayraktar S, Altug U, Anıl AB, Havan M, Yetımakman AF, Dalkıran T, Zengın N, Oto A, Kıhtır HS, Gırgın Fİ, Telhan L, Yıldızdas D, Yener N, Yukselmıs U, Alakaya M, Kılınc MA, Celegen M, Dursun A, Battal F, Sarı F, Ozkale M, Topal S, Kocaoglu C, Yazar A, Alacakır N, Odek C, Yaman A, Cıtak A. Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study. Pediatr Res 2023:10.1038/s41390-023-02518-0. [PMID: 36813951 PMCID: PMC9946280 DOI: 10.1038/s41390-023-02518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. METHODS A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. RESULTS The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. CONCLUSIONS In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. IMPACT MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
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Affiliation(s)
- Guntulu Sık
- Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
| | - Aysegul Inamlık
- grid.411117.30000 0004 0369 7552Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Nihal Akçay
- grid.414177.00000 0004 0419 1043Department of Pediatric Intensive Care, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selman Kesici
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
| | - Fatih Aygun
- grid.506076.20000 0004 1797 5496Department of Pediatric Intensive Care, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Tanıl Kendırlı
- grid.7256.60000000109409118Department of Pediatric Intensive Care, Ankara University, Ankara, Turkey
| | - Gurkan Atay
- grid.417018.b0000 0004 0419 1887Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Sandal
- Department of Pediatric Intensive Care, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fatih Varol
- grid.414850.c0000 0004 0642 8921Department of Pediatric Intensive Care, Sancaktepe Şehit Prof. MD İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yazıcı Ozkaya
- grid.8302.90000 0001 1092 2592Department of Pediatric Intensive Care, Ege University, Izmir, Turkey
| | - Muhterem Duyu
- Department of Pediatric Intensive Care, Goztepe Prof. MD Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ahmet Ziya Bırbılen
- Department of Pediatric Intensive Care, Gaziantep Cengiz Gökçek Gynecology and Pediatrics Hospital, Gaziantep, Turkey
| | - Serhan Ozcan
- grid.449874.20000 0004 0454 9762Department of Pediatric Intensive Care, Ankara Yıldırım Beyazıt University, Ankara Children’s Hospital, Ankara, Turkey
| | - Gazi Arslan
- grid.21200.310000 0001 2183 9022Department of Pediatric Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey
| | - Murat Kangın
- Department of Pediatric Intensive Care, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Suleyman Bayraktar
- grid.413752.60000 0004 0419 1465Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Umit Altug
- Department of Pediatric Intensive Care, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Ayşe Berna Anıl
- Department of Pediatric Intensive Care, Tepecik Training and Research Hospital, Izmır Katip Çelebi University, Izmir, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care, Mersin City Hospital, Mersin, Turkey
| | - Ayse Filiz Yetımakman
- grid.411105.00000 0001 0691 9040Department of Pediatric Intensive Care, Kocaeli University, Kocaeli, Turkey
| | - Tahir Dalkıran
- Department of Pediatric Intensive Care, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Neslihan Zengın
- grid.411688.20000 0004 0595 6052Department of Pediatric Intensive Care, Manisa Celal Bayar Unıversity, Manisa, Turkey
| | - Arzu Oto
- Department of Pediatric Intensive Care, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Hasan Serdar Kıhtır
- grid.413819.60000 0004 0471 9397Department of Pediatric Intensive Care, Antalya Training and Research Hospital, Antalya, Turkey
| | - Feyza İnceköy Gırgın
- grid.16477.330000 0001 0668 8422Department of Pediatric Intensive Care, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Leyla Telhan
- grid.411781.a0000 0004 0471 9346Department of Pediatric Intensive Care, Medipol University, Istanbul, Turkey
| | - Dincer Yıldızdas
- grid.98622.370000 0001 2271 3229Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Nazik Yener
- grid.411049.90000 0004 0574 2310Department of Pediatric Intensive Care, Samsun 19 Mayıs University, Samsun, Turkey
| | - Ufuk Yukselmıs
- grid.414850.c0000 0004 0642 8921Department of Pediatric Intensive Care, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Alakaya
- grid.411691.a0000 0001 0694 8546Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Mehmet Arda Kılınc
- Department of Pediatric Intensive Care, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Celegen
- Department of Pediatric Intensive Care, Afyonkarahisar Tarining and Research Hospital, Afyon, Turkey
| | - Adem Dursun
- grid.513116.1Department of Pediatric Intensive Care, Kayseri City Hospital, Kayseri, Turkey
| | - Fatih Battal
- grid.412364.60000 0001 0680 7807Department of Pediatric Intensive Care, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ferhat Sarı
- grid.14352.310000 0001 0680 7823Department of Pediatric Intensive Care, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Murat Ozkale
- grid.411548.d0000 0001 1457 1144Department of Pediatric Intensive Care, Dr Turgut NOYAN Hospital, Baskent University, Adana, Turkey
| | - Sevgi Topal
- Department of Pediatric Intensive Care, Erzurum Bölge Training and Research Hospital, Erzurum, Turkey
| | - Celebi Kocaoglu
- Department of Pediatric Intensive Care, Konya City Hospital, Konya, Turkey
| | - Abdullah Yazar
- grid.411124.30000 0004 1769 6008Department of Pediatric Intensive Care, Necmettin Erbakan University, Konya, Turkey
| | - Nuri Alacakır
- grid.411693.80000 0001 2342 6459Department of Pediatric Intensive Care, Trakya University, Edirne, Turkey
| | - Caglar Odek
- grid.34538.390000 0001 2182 4517Department of Pediatric Intensive Care, Bursa Uludağ University, Bursa, Turkey
| | - Ayhan Yaman
- grid.508740.e0000 0004 5936 1556Department of Pediatric Intensive Care, Istınye University Liv Hospital, Istanbul, Turkey
| | - Agop Cıtak
- grid.411117.30000 0004 0369 7552Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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10
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Ozturk Z, Kesici S, Ertugrul İ, Aydin A, Yilmaz M, Bayrakci B. Resuscitating the resuscitation: A single-centre experience on extracorporeal cardiopulmonary resuscitation. J Paediatr Child Health 2023; 59:335-340. [PMID: 36453833 DOI: 10.1111/jpc.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 10/11/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of venoarterial extracorporeal membrane oxygenation (ECMO) during active cardiopulmonary resuscitation or in patients with intermittent return of spontaneous circulation. This study aimed to describe the demographic characteristics and outcomes of patients undergoing ECPR to identify survival-associated factors. METHODS The study was conducted in an extracorporeal life support centre of a tertiary hospital in Turkey and included all patients who underwent ECPR for in-hospital cardiac arrest between April 2013 and June 2021. Complications included bleeding, neurological injury, renal failure, hepatic failure, limb ischemia and bloodstream infections. The primary outcomes were survival of ECMO and survival to discharge. Neurological outcomes were assessed using the Pediatric Cerebral Performance Category Scale for children and the Category of Cerebral Performance Scale for adults. RESULTS The study included 26 patients (24 paediatric, 2 adults), 22 (85%) of them had cardiac pathology. Bleeding was the most common complication. Twelve (46%) patients survived ECMO, 9 (35%) survived to discharge. Sex, age, primary diagnosis, cardiac arrest rhythm and ECMO duration were not significantly associated with the primary outcomes. Bleeding, neurological injury and renal failure were associated with poorer survival to discharge. The neurological outcomes of all survivors to discharge were good. CONCLUSIONS ECPR is not commonly accessible. Sharing the experience of the few treating centres to date is crucial to accumulating sufficient knowledge about its efficiency and raising clinician awareness. This limited single-centre experience demonstrated the utility of ECPR.
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Affiliation(s)
- Zeynelabidin Ozturk
- Department of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlker Ertugrul
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Aydin
- Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Yilmaz
- Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
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11
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Nakip ÖS, Kesici S, Terzi K, Orhan D, Bayrakcı B. Fatal thrombotic microangiopathy in an infant with COVID-19: a case report. Turk J Pediatr 2023; 65:667-671. [PMID: 37661682 DOI: 10.24953/turkjped.2022.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND While macrovascular thrombosis is common in adult COVID-19 patients, thrombotic microangiopathy as a part of endothelitis might play an important role in severe organ dysfunction. Thrombocytopenia-associated multiple organ failure (TAMOF) is a thrombotic microangiopathy syndrome that is associated with endothelial damage. Herein, we aim to report a pediatric TAMOF case related to SARS-CoV-2 infection which has been scarcely reported to date. CASE A 7-month-old boy who became severely ill after being infected with SARS-CoV-2 required advanced critical care treatments such as continuous renal replacement therapy, therapeutic plasma exchange, and extracorporeal membrane oxygenation. A heart and lung biopsy obtained during sternotomy showed thrombotic microangiopathy. Despite early plasma exchange, mortality was inevitable because of severe liver failure. CONCLUSIONS This case report implies that SARS-CoV-2 infection could cause TAMOF in children. To the best of our knowledge, this is the second SARS-CoV-2-induced pediatric TAMOF case. More studies are needed to determine alternative treatments for patients with TAMOF who are resistant to conventional therapies.
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Affiliation(s)
- Özlem Sarıtaş Nakip
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
| | - Selman Kesici
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
| | - Kıvanç Terzi
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Benan Bayrakcı
- Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
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12
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Baltu D, Oral NA, Kesici S, Topaloğlu R, Özcebe Oİ, Aksu T, Orhan D, Özaltın F. Hemoglobin cast nephropathy: a rare but serious complication of hemolysis in a pediatric patient. Turk J Pediatr 2023; 65:874-880. [PMID: 37853979 DOI: 10.24953/turkjped.2022.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Intravascular hemolysis is a serious and rare condition in children and causes the release of hemoglobin and heme into circulation, which have proinflammatory properties. These substances lead to inflammation, oxidative stress, apoptosis, and organelle dysfunction that lead to acute kidney injury (AKI). We report a pediatric case diagnosed with hemolysis-associated hemoglobin cast nephropathy due to autoimmune hemolytic anemia. CASE A 4-year-old boy, who was admitted to another hospital with complaints of fever and dark urine for one day, developed anemia and kidney failure in the follow-up, was referred to our hospital. In physical examination, pallor and icterus on the sclera were noted. The patient had low hemoglobin and haptoglobin levels concomitant with high levels of serum lactate dehydrogenase, urea and creatinine. A peripheral blood smear showed marked spherocytes without schistocytes. A kidney biopsy was performed due to ongoing overt hemolysis and dialysis requirement, which showed findings consistent with hemoglobin cast nephropathy. Although the initial polyspecific direct antiglobulin test (DAT) was negative, due to persistent intravascular hemolysis DAT was studied monospecifically and showed IgM antibody positivity. Therefore, a diagnosis of autoimmune hemolytic anemia was made, and corticosteroid treatment was started. Hemolysis immediately ceased and the need for erythrocyte transfusion and dialysis disappeared. CONCLUSIONS Acute kidney injury associated with hemoglobin cast nephropathy is an extremely rare condition in childhood. Although the initial course is severe and potentially life-threatening, the prognosis is favorable with the treatment of the underlying cause and management of AKI. Therefore, pediatricians should be aware of this rare clinical entity during clinical practice.
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Affiliation(s)
- Demet Baltu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
| | - Nihan Avcu Oral
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
| | - Selman Kesici
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
| | - Rezan Topaloğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
| | - Osman İlhami Özcebe
- Department of Internal Medicine, Hematology Unit, Hacettepe University Faculty of Medicine, Ankara
| | - Tekin Aksu
- Division of Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Fatih Özaltın
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
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13
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Ardicli B, User IR, Tigli T, Ozcan HN, Oguz B, Haliloglu M, Kesici S, Ozsurekci Y, Cengiz AB, Ceyhan M, Ertugrul I, Ekinci S. Favourable outcomes of conservatively managed acute abdomen associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic. ANZ J Surg 2023; 93:108-114. [PMID: 36409168 DOI: 10.1111/ans.18162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/26/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUNDS Abdominal pain is one of the most common symptoms of multisystem inflammatory syndrome in children (MIS-C). Abdominal pain can vary from mild to severe and may present as acute abdomen. Severe abdominal pain in patients with MIS-C should be differentiated from surgical causes of acute abdomen to prevent unnecessary surgery. METHODS The diagnosis of MIS-C was based on WHO and CDC recommended criteria. Records of children treated for MIS-C between September 2020 and January 2021 were reviewed retrospectively. RESULTS In a short time, we encountered seven patients who were diagnosed with MIS-C and showed acute abdomen findings. There were four male and three female patients. The median age was 9 years. Fever, abdominal pain and distension were present in all. The median duration of symptoms was 4 days. Five patients had general abdominal tenderness mimicking acute abdomen. Three patients had right lower quadrant tenderness mimicking acute appendicitis. After the initiation of immunomodulatory therapy and antibiotics, the physical examination findings were improved step by step in all. The median time to initiate oral feeding was 2 days. The median length of hospitalization time was 8 days. CONCLUSION Serial abdominal examinations performed by the same surgeon enabled us to follow these patients conservatively and thus avoid unnecessary surgical intervention.
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Affiliation(s)
- Burak Ardicli
- Department of Medical and Surgical Research, Hacettepe University, Institute of Health Sciences, Ankara, Turkey.,Faculty of Medicine, Department of Paediatric Surgery, Hacettepe University, Ankara, Turkey
| | - Idil Rana User
- Department of Medical and Surgical Research, Hacettepe University, Institute of Health Sciences, Ankara, Turkey.,Faculty of Medicine, Department of Paediatric Surgery, Hacettepe University, Ankara, Turkey
| | - Tunc Tigli
- Faculty of Medicine, Department of Paediatric Surgery, Hacettepe University, Ankara, Turkey
| | - H Nursun Ozcan
- Faculty of Medicine, Department of Radiology, Division of Paediatric Radiology, Hacettepe University, Ankara, Turkey
| | - Berna Oguz
- Faculty of Medicine, Department of Radiology, Division of Paediatric Radiology, Hacettepe University, Ankara, Turkey
| | - Mithat Haliloglu
- Faculty of Medicine, Department of Radiology, Division of Paediatric Radiology, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Faculty of Medicine, Department of Paediatrics, Division of Intensive Care Unit, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- Faculty of Medicine, Department of Paediatrics, Division of Paediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Ali Bulent Cengiz
- Faculty of Medicine, Department of Paediatrics, Division of Paediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Mehmet Ceyhan
- Faculty of Medicine, Department of Paediatrics, Division of Paediatric Infectious Diseases, Hacettepe University, Ankara, Turkey
| | - Ilker Ertugrul
- Faculty of Medicine, Department of Paediatrics, Division of Paediatric Cardiology, Hacettepe University, Ankara, Turkey
| | - Saniye Ekinci
- Department of Medical and Surgical Research, Hacettepe University, Institute of Health Sciences, Ankara, Turkey.,Faculty of Medicine, Department of Paediatric Surgery, Hacettepe University, Ankara, Turkey
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14
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Ozsurekci Y, Aykac K, Demir OO, Ilbay S, Kesici S, Karakaya J, Cengiz AB. Methylprednisolone use in children with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2. Pediatr Int 2023; 65:e15603. [PMID: 37615374 DOI: 10.1111/ped.15603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness and optimal use of corticosteroids in children with severe coronavirus disease 2019 (COVID-19) pneumonia, for which effective treatment is still lacking with respect to this population. METHODS We conducted a retrospective study and included patients (aged < 18 years) with severe COVID-19 pneumonia and/or acute respiratory distress syndrome (ARDS) who received standard doses (2-4 mg/kg/day) and high doses (>250 mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid treatments with a propensity score and compared the side effects of different MPZ doses and patient survival. RESULTS Fifty-nine patients were included: 61% were male, the median age was 8, interquartile range (IQR) 2-15) years. The overall survival was 84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and 92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p = 0.67). The demographic, clinical, and laboratory data did not differ significantly after propensity score matching, apart from bradycardia, which was a prominent feature of the high-dose group. The clinical and radiological response rates on day 7 were higher and the need for invasive mechanical ventilation (IMV) was lower in the high-dose group. CONCLUSION The patients with high-dose MPZ had better clinical and radiological responses than those with standard-dose MPZ, although the mortality rate did not differ between standard and high-dose regimens of MPZ.
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Affiliation(s)
- Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Kubra Aykac
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Osman Oguz Demir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Sare Ilbay
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Selman Kesici
- Hacettepe University Faculty of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Jale Karakaya
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
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15
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Saritas Nakip O, Kesici S, Bozkurt BS, Ozsurekci Y, Demirbilek H, Bayrakci B. Incidence and Risk Factors of Hyperglycemia in Severe Multisystem Inflammatory Syndrome in Children: A Retrospective Case-Control Study. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1758744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Objective Multisystem inflammatory syndrome in children (MIS-C) patients might be at risk for hyperglycemia and associated complications. Herein, we aimed to determine the incidence of hyperglycemia, understanding the underlying risk factors in MIS-C patients.
Methods All MIS-C patients were retrospectively evaluated and compared according to the presence of hyperglycemia and the need of insulin. Inflammatory markers and body mass index Z-scores were also compared.
Results The median age of the patients with hyperglycemia was higher than those without (p = 0.001). Disease severity scores of patients with hyperglycemia were higher. Procalcitonin levels of patients with hyperglycemia were higher, while ferritin, CRP, and interleukin-6 levels were not. BMIs of patients with hyperglycemia were higher (p = 0.01) but BMI Z-scores were similar (p = 0.055). There was a positive correlation between BMIs and CRP (r: 0.31, p = 0.015). There was a positive correlation between procalcitonin (r: 0.431, p = 0.001) and CRP (r: 0.279, p = 0.029) and maximum PG.
Conclusion Hyperglycemia is a common feature of MIS-C patients and is associated with the severity of the inflammation. As a novel finding, high CRP and procalcitonin should be considered as predictive markers for impaired glucose homeostasis in MIS-C patients.
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Affiliation(s)
- Ozlem Saritas Nakip
- Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Betul Seda Bozkurt
- Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Yasemin Ozsurekci
- Pediatric Infectious Disease, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Huseyin Demirbilek
- Pediatric Endocrinology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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16
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Kahraman AB, Karakaya B, Yıldız Y, Kamaci S, Kesici S, Simsek-Kiper PO, Kurt-Sukur ED, Bayrakcı B, Haliloglu G. Two tales of LPIN1 deficiency: from fatal rhabdomyolysis to favorable outcome of acute compartment syndrome. Neuromuscul Disord 2022; 32:931-934. [PMID: 36195520 DOI: 10.1016/j.nmd.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 12/31/2022]
Abstract
LPIN1 deficiency is an autosomal recessive disease caused by biallelic mutations in LPIN1, where impaired fatty acid metabolism leads to stress in skeletal muscle, resulting in severe rhabdomyolysis, often triggered by fever, exercise, fasting, and anesthesia. It is the second most common cause of severe, recurrent episodes of rhabdomyolysis in early childhood which can result in serious morbidity and mortality. To date, 71 patients have been published in 20 clinical studies in the form of case series. We describe two previously unreported cases, one with a novel LPIN1 mutation that resulted in mortality, and another, to the best of our knowledge, with the first reported compartment syndrome managed with a favorable outcome in this disorder. Recognition of the complications including ventricular arrythmias, acute renal failure and compartment syndrome on the severe end of the spectrum may change the outcome and prognosis of this devastating condition.
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Affiliation(s)
- Ayca Burcu Kahraman
- Department of Pediatrics, Division of Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara TR06230, Turkey.
| | - Bekir Karakaya
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yılmaz Yıldız
- Department of Pediatrics, Division of Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara TR06230, Turkey
| | - Saygin Kamaci
- Department of Orthopedics and Travmatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Division of Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Eda Didem Kurt-Sukur
- Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakcı
- Division of Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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17
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Celik NB, Tanyildiz M, Yetimakman F, Kesici S, Bayrakci B. Comparison of high flow oxygen therapy versus noninvasive mechanical ventilation for successful weaning from invasive ventilation in children: An observational study. Medicine (Baltimore) 2022; 101:e30889. [PMID: 36181066 PMCID: PMC9524993 DOI: 10.1097/md.0000000000030889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Post-extubation respiratory failure is associated with a poor prognosis due to increased ventilator-associated pneumonia, and longer length of stay in the ICU and hospital. In this study, we aimed to evaluate the efficacy of high-flow nasal cannula (HFNC) and noninvasive mechanical ventilation (NIMV) on extubation success in children. A total of 48 patients, aged between 1 month and 18 years, who were weaned to either NIMV or HFNC were included. Patients who had tracheostomy or were not weaned and underwent unplanned extubation were excluded. Age, gender, anthropometric parameters, Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, oxygenation index, mechanical ventilation length of stay (LOS), HFNC/NIMV LOS, Modified Downes-Silverman score (MDS), and venous blood gas parameters, pediatric intensive care unit (PICU) LOS were recorded. 24 patients were extubated to NIMV, and 24 patients to HFNC. HFNC LOS and NIMV LOS were similar (P = .621). The failure rates at the 48th hour of HFNC and NIMV were 33% (n = 8), and 33% respectively (n = 8) (P = 1.0). PICU LOS and mortality rate was also similar (P = .06, P = .312 respectively). MDS decreased significantly in both groups (P < .001, P = .02 respectively). Changes in blood gas parameters and MDS within the first 48-hour of device application were similar between the 2 groups. HFNC is not inferior to NIMV in patients with extubation difficulty or those expected to have such difficulty in terms of treatment success, PICU LOS, and mortality. Therefore, HFNC appears to be a weaning technique alternative to NIMV after extubation.
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Affiliation(s)
- Nur Berna Celik
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Tanyildiz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Filiz Yetimakman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
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18
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Gürlevik SL, Günbey C, Ozsurekci Y, Kesici S, Gocmen R, Temucin Ç, Özen S, Cengiz AB, Yalnızoglu D. Neurologic manifestations in children with COVID-19. Eur J Paediatr Neurol 2022; 39:118-119. [PMID: 35781422 PMCID: PMC9190175 DOI: 10.1016/j.ejpn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sibel Laçinel Gürlevik
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey.
| | - Ceren Günbey
- Hacettepe University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Selman Kesici
- Hacettepe University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Ankara, Turkey
| | - Rahsan Gocmen
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Çağrı Temucin
- Hacettepe University University Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Seza Özen
- Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Dilek Yalnızoglu
- Hacettepe University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
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19
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Celegen M, Kesici S, Yavuz S, Celegen K, Bayrakci B. Are platelet indices promising ratios for predicting pediatric septic shock prognosis? BRATISL MED J 2022; 123:444-448. [PMID: 35576547 DOI: 10.4149/bll_2022_069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of the present study was to determine the prognostic value of thrombocytopenia, platelet indices (MPV/PLT and PDW/PLT) in children with septic shock. BACKGROUND Septic shock is one of the major causes of mortality among children worldwide. METHODS A retrospective analysis was made of children admitted to the pediatric intensive care unit between November 2010 and December 2019. Two hundred four children were included; they were diagnosed with septic shock according to the international pediatric sepsis consensus conference criteria. The MPV/platelet ratio and PDW/platelet ratios were estimated as the MPV and PDW values divided by the platelet count on the first three days of hospitalization. The clinical outcome was 28-day mortality. RESULTS MPV/PLT and PDW/PLT ratios were found to be significantly higher in the non-survivors than survivor (p≤0.001). In the multivariate logistic regression analysis, higher MPV/platelet ratios at 72h (OR: 7.41; 95% CI: 1.25-43.7; p=0.027) and PDW/platelet ratios at 72h (OR: 2.9; 95% CI: 1.13-7.50; p=0.027) were significant risk factors for mortality. CONCLUSIONS Platelet indices are useful laboratory parameters in septic shock. MPV/PLT and PDW/PLT ratios can be promising reliable markers for 28-day mortality in children with septic shock (Tab. 4, Fig. 1, Ref. 29).
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Nakip OS, Kesici S, Terzi K, Bayrakci B. Apnea Test on Extracorporeal Membrane Oxygenation: Step Forward with Carbon Dioxide. J Extra Corpor Technol 2022; 54:83-87. [PMID: 36380825 PMCID: PMC9639689 DOI: 10.1182/ject-83-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/07/2022] [Indexed: 06/16/2023]
Abstract
Apnea test must be performed to confirm brain death in patients meet clinical criteria. But the increment of carbon dioxide is generally not achievable because of the diminished production of carbon dioxide and additional sweep in extra corporeal membrane oxygenation (ECMO). We report three children with congenital heart disease treated with ECMO and had brain death during follow-up. All met clinical criteria but apnea test cannot be achieved in classical way because of prolonged duration and hemodynamic compromise. Therefore, we used external carbon dioxide to achieve desired levels of oxygen and carbon dioxide safely. Because of the lack of protocols for pediatric patients on ECMO, apnea test with exogenous carbon dioxide may be a reliable and rapid test in such patients. Especially cardiac patients, in whom classical apnea test can cause rapid deterioration, exogenous carbon dioxide may serve as an alternative.
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Affiliation(s)
- Ozlem Saritas Nakip
- Address correspondence to: Ozlem Saritas Nakip, Department of Pediatric Intensive Care, Hacettepe University Faculty of Medicine, İhsan Doğramacı Children’s Hospital, Altındağ, Ankara, 06230, Turkey. E-mail:
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21
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Katlan B, Kesici S, Karacanoğlu D, Oygar PD, Ünal Yüksekgönül A, Şener S, Aykan HH, Özsurekçi Y, Özen S, Bayrakci B. Early is superior to late plasma exchange for severe multisystem inflammatory syndrome in children. J Clin Apher 2022; 37:281-291. [PMID: 35174897 DOI: 10.1002/jca.21971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) can be life threatening in severe cases because of uncontrolled inflammation and multi-organ failure. In this study, we report the effect of plasma exchange in the treatment of MIS-C and to emphasize the effect of its early application on outcome. METHOD In this retrospective observational study, the medical records of children with severe MIS-C admitted to pediatric intensive care unit (PICU) between April 2020 and January 2021 were reviewed. Severe MIS-C patients were treated according to protocol consisting of plasma exchange (PE), intravenous immune globulin, steroids, and anakinra which we called the "PISA" protocol referring to the initials. The patients were divided into two groups as early plasma exchange (E-PE) and late plasma exchange (L-PE) according to the elapse time between hospital admission and the administration of PE. Groups were compared in terms of outcome variables. Primary study outcome was 28-day mortality. Secondary outcome variables were acute phase response time, length of immunomodulatory treatment, frequency of patients requiring mechanical ventilation (MV) and inotropic support, length of inotropic support and MV, length of hospital and PICU stays. RESULTS Eighteen pediatric patients with MIS-C were included in the study. Seventeen (95%) of the patients presented with decompensated shock and required inotropic support. One of the 17 patients needed extracorporeal membrane oxygenation support (ECMO) PISA protocol was used in all patients. There was no mortality in the E-PE group while the mortality rate was 20% in the L-PE group. Acute phase reactant response was faster in the E-PE group and immunomodulatory treatments could be reduced earlier; the frequency of patients requiring inotropic and mechanical ventilation (MV) support was lower in the E-PE group; the duration of inotropic support, duration of MV, and length of stay in hospital and PICU were significantly shorter in the E-PE group. CONCLUSION We suggest that in selected cases, timely administration of PE is a beneficial rescue therapy for MIS-C related hyperinflammation presenting with severe cardiovascular collapse.
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Affiliation(s)
- Banu Katlan
- Department of Pediatric Critical Care Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Life Support Practice and Research Center, Hacettepe University, Ankara, Turkey
| | - Dilek Karacanoğlu
- Department of Pediatric Critical Care Medicine, Hacettepe University, Ankara, Turkey
| | - Pembe Derin Oygar
- Department of Pediatric Infection Diseases, Hacettepe University, Ankara, Turkey
| | | | - Seher Şener
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | | | - Yasemin Özsurekçi
- Department of Pediatric Infection Diseases, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Life Support Practice and Research Center, Hacettepe University, Ankara, Turkey
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22
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Gümeler E, Katlan B, Parlak Ş, Kesici S, Bayrakcı B, Oğuz KK. Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. Turk J Pediatr 2022; 64:882-891. [DOI: 10.24953/turkjped.2022.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Kiral E, Kirel B, Havan M, Keskin M, Karaoglan M, Yildirim A, Kangin M, Talay MN, Urun T, Altug U, Kesici S, Tufan E, Kacmaz E, Bozan G, Azapagasi E, Uysal Yazici M, Ozturk Z, Yesilbas O, Karaguzel G, Kaya G, Barlas U, Duyu M, Boyraz M, Sevketoglu E, Akcay N, Hancili S, Guven A, Dursun O, Ulgen Tekerek N, Ozcifci G, Yazici P, Turanli E, Kendirli T, Kahveci F, Yetimakman AF, Citak A, Şik G, Bingol I, Aygun F, Durak C, Yilmaz R, Bugrul F, Sari Y, Tekguç H, Albayrak H, Yener N, Agin H, Soydan E, Yildizdas D, Dilek SO, Yalindag N, Incekoy-Girgin F, Alacakir N, Tutunculer F, Arslanaoglu MO, Aydin C, Bilgin M, Simsek E, Dinleyici EC. Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey. Front Pediatr 2022; 10:926013. [PMID: 35844756 PMCID: PMC9277100 DOI: 10.3389/fped.2022.926013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/31/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection. METHODS This is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year. RESULTS The percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabetes (p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission. DISCUSSION The frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemic; however, need to evaluate the potential effects of SARS-CoV-2 on the increased percentage of new onset Type 1 diabetes.
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Affiliation(s)
- Eylem Kiral
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Birgul Kirel
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Merve Havan
- Pediatric Intensive Care Unit, Mersin City Hospital, University of Health Sciences, Mersin, Turkey
| | - Mehmet Keskin
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Murat Karaoglan
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Ahmet Yildirim
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Murat Kangin
- Pediatric Intensive Care Unit, Gazi Yasargil Training and Research Hospital, University of Heath Sciences, Diyarbakir, Turkey
| | - Mehmet Nur Talay
- Pediatric Intensive Care Unit, Gazi Yasargil Training and Research Hospital, University of Heath Sciences, Diyarbakir, Turkey
| | - Tuba Urun
- Pediatric Intensive Care Unit, Gazi Yasargil Training and Research Hospital, University of Heath Sciences, Diyarbakir, Turkey
| | - Umit Altug
- Pediatric Intensive Care Unit, Sanliurfa Training and Research Hospital, University of Heath Sciences, Sanliurfa, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erennur Tufan
- Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Kacmaz
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Gurkan Bozan
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ebru Azapagasi
- Pediatric Intensive Care Unit, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mutlu Uysal Yazici
- Pediatric Intensive Care Unit, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Zeynelabidin Ozturk
- Pediatric Intensive Care Unit, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Osman Yesilbas
- Pediatric Intensive Care Unit, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gulay Karaguzel
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical Universit, Trabzon, Turkey
| | - Gulay Kaya
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical Universit, Trabzon, Turkey
| | - Ulkem Barlas
- Pediatric Intensive Care Unit, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Muhterem Duyu
- Pediatric Intensive Care Unit, Prof. Dr. Süleyman Yalcin City Hospital, Medeniyet University, Istanbul, Turkey
| | - Merve Boyraz
- Pediatric Intensive Care Unit, Prof. Dr. Süleyman Yalcin City Hospital, Medeniyet University, Istanbul, Turkey
| | - Esra Sevketoglu
- Pediatric Intensive Care Unit, Bakirköy Dr Sadi Konuk Research and Training Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Nihal Akcay
- Pediatric Intensive Care Unit, Bakirköy Dr Sadi Konuk Research and Training Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Suna Hancili
- Department of Pediatric Endocrinology, Zeynep Kamil Women and Children Diseases Traning and Research Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Ayla Guven
- Department of Pediatric Endocrinology, Zeynep Kamil Women and Children Diseases Traning and Research Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Oǧuz Dursun
- Pediatric Intensive Care Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nazan Ulgen Tekerek
- Pediatric Intensive Care Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gokçen Ozcifci
- Van Training and Research Hospital, University of Heath Sciences, Van, Turkey
| | - Pinar Yazici
- Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Eda Turanli
- Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Tanil Kendirli
- Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayse Filiz Yetimakman
- Pediatric Intensive Care Unit, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Agop Citak
- Pediatric Intensive Care Unit, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Guntulu Şik
- Pediatric Intensive Care Unit, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Bingol
- Pediatric Intensive Care Unit, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fatih Aygun
- Pediatric Intensive Care Unit, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Cansu Durak
- Pediatric Intensive Care Unit, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Resul Yilmaz
- Pediatric Intensive Care Unit, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Fuat Bugrul
- Department of Pediatric Endocrinology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Yusuf Sari
- Pediatric Intensive Care Unit, Firat University Faculty of Medicine, Elazig, Turkey
| | - Hakan Tekguç
- Pediatric Intensive Care Unit, Dr. Burhan Nalbantoglu Hospital, Lefkosa, Cyprus
| | - Hatice Albayrak
- Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Nazik Yener
- Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hasan Agin
- Pediatric Intensive Care Unit, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Ekin Soydan
- Pediatric Intensive Care Unit, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Dincer Yildizdas
- Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Semine Ozdemir Dilek
- Department of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Nilufer Yalindag
- Pediatric Intensive Care Unit, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Feyza Incekoy-Girgin
- Pediatric Intensive Care Unit, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Nuri Alacakir
- Pediatric Intensive Care Unit, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Filiz Tutunculer
- Department of Pediatric Endocrinology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Mehmet Ozgur Arslanaoglu
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Can Aydin
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Enver Simsek
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ener Cagri Dinleyici
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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24
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Gurlevik SL, Ozsurekci Y, Sağ E, Derin Oygar P, Kesici S, Akca ÜK, Cuceoglu MK, Basaran O, Göncü S, Karakaya J, Cengiz AB, Özen S. The difference of the inflammatory milieu in MIS-C and severe COVID-19. Pediatr Res 2022; 92:1805-1814. [PMID: 35352005 PMCID: PMC8963396 DOI: 10.1038/s41390-022-02029-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) may have a severe course in children. Multisystem inflammatory syndrome in children (MIS-C) is the post-COVID complication characterized by an exaggerated inflammation, observed in children. However, data on the underlying pathophysiology are sparse. We therefore aimed to assess the cytokine and chemokine profiles of children with MIS-C and compare these to life-threatening severe SARS-CoV-2 and healthy controls (HCs) to shed light on disease pathophysiology. METHODS Samples of 31 children with MIS-C, 10 with severe/critical COVID-19 and 11 HCs were included. Cytokine and chemokine profiles were studied and compared in between groups. RESULTS Most cytokines and chemokines related to IL-1 family and IFN-γ pathway (including IL-18 and MIG/CXCL9) and IL-17A were significantly higher in the MIS-C group when compared to the severe/critical COVID-19 group and HCs. IP-10/CXCL10 and IL-10 were higher in both MIS-C patients and severe/critical COVID-19 compared to HCs. CONCLUSION Our results suggest that IL-1 and IFN-γ pathways play an important role in the pathophysiology of MIS-C. IMPACT This study defines a pattern of distinctive immune responses in children with MIS-C and in patients with severe/critical COVID-19. As the COVID-19 pandemic continues, biomarkers to identify MIS-C risk are needed to guide our management that study results may shed light on it.
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Affiliation(s)
- Sibel Lacinel Gurlevik
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Sağ
- grid.413783.a0000 0004 0642 6432Pediatric Rheumatology Unit, Ankara Training and Research Hospital, Ankara, Turkey ,grid.14442.370000 0001 2342 7339Pediatric Rheumatology Unit, Translational Medicine Laboratories, Hacettepe University, Ankara, Turkey
| | - P. Derin Oygar
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozge Basaran
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sultan Göncü
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- grid.14442.370000 0001 2342 7339Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Bülent Cengiz
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Pediatric Rheumatology Unit, Translational Medicine Laboratories, Hacettepe University, Ankara, Turkey. .,Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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25
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Derinoz-Guleryuz O, Uysal-Yazici M, Udurgucu M, Karacan C, Akça H, Ongun EA, Ekinci F, Duman M, Akça-Çaglar A, Vatansever G, Bilen S, Uysalol M, Akcan-Yıldız L, Saz EU, Bal A, Piskin E, Sahin S, Kurt F, Anil M, Besli E, Alakaya M, Gültekingil A, Yılmaz R, Temel-Koksoy O, Kesici S, Akcay N, Cebisli E, Emeksiz S, Kılınc MA, Köker A, Çoban Y, Erkek N, Gurlu R, Eksi-Alp E, Apa H. The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey. Int J Clin Pract 2021; 75:e14978. [PMID: 34669998 DOI: 10.1111/ijcp.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
AIM OF THE STUDY Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. METHODS This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. RESULTS A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). CONCLUSIONS The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.
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Affiliation(s)
| | - Mutlu Uysal-Yazici
- Department of Pediatric Intensive Care, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Muhammed Udurgucu
- Department of Pediatric Intensive Care, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Candemir Karacan
- Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Halise Akça
- Department of Pediatric Emergency, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ebru Atike Ongun
- Department of Pediatric Intensive Care, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Murat Duman
- Department of Pediatric Emergency, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayla Akça-Çaglar
- Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Goksel Vatansever
- Department of Pediatric Emergency, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sevcan Bilen
- Department of Pediatric Emergency, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Metin Uysalol
- Department of Pediatric Emergency, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Leman Akcan-Yıldız
- Department of Pediatric Emergency, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Eylem Ulas Saz
- Department of Pediatric Emergency, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Alkan Bal
- Department of Pediatric Emergency, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Etem Piskin
- Department of Pediatric Intensive Care, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Sabiha Sahin
- Department of Pediatric Emergency, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Funda Kurt
- Department of Pediatric Emergency, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Murat Anil
- Department of Pediatric Emergency, Faculty of Medicine, İzmir Demokrasi University, Izmir, Turkey
| | - Esen Besli
- Department of Pediatric Emergency, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ayse Gültekingil
- Department of Pediatric Emergency, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Resul Yılmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Ozlem Temel-Koksoy
- Department of Pediatric Intensive Care, Konya Training and Research Hospital, Konya, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nihal Akcay
- Department of Pediatric Intensive Care, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdem Cebisli
- Department of Pediatric Intensive Care, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Mehmet Arda Kılınc
- Department of Pediatric Intensive Care, Diyarbakir Children Hospital, Diyarbakir, Turkey
| | - Alper Köker
- Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Yasemin Çoban
- Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Nilgün Erkek
- Department of Pediatric Emergency, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ramazan Gurlu
- Department of Pediatric Emergency, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Emel Eksi-Alp
- Department of Pediatric Emergency, İstanbul University, Istanbul, Turkey
| | - Hursit Apa
- Department of Pediatric Emergency, Dr. Behçet Uz Children's Hospital, University of Health Sciences, Izmir, Turkey
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26
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Lacinel Gurlevik S, Aksu T, Ozen S, Kesici S, Gumruk F, Ozsurekci Y. Hemophagocytosis in bone marrow aspirates in multisystem inflammatory syndrome in children. Pediatr Blood Cancer 2021; 68:e28931. [PMID: 33619863 DOI: 10.1002/pbc.28931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Sibel Lacinel Gurlevik
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tekin Aksu
- Department of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Gumruk
- Department of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abstract
OBJECTIVE Carbon monoxide (CO) is a gas, which is produced by incomplete combustion of hydrocarbon-containing substances, and causes significant tissue and organ damage in the common event of CO poisoning. This study aims to evaluate the demographic, clinical, and laboratory characteristics of patients diagnosed with CO poisoning in the emergency department and to determine the factors associated with severe course in the acute phase of poisoning. METHODS A total of 331 patients diagnosed with CO poisoning in Hacettepe University Children's Hospital, Pediatric Emergency Unit, between January 2004 and March 2014 were included in the study. Their demographic characteristics, presenting complaints, physical examination findings, Glasgow Coma Scale scores, carboxyhemoglobin, leukocyte, hemoglobin, troponin T, pH and lactate levels, type of treatment (normobaric or hyperbaric oxygen), intensive care unit admissions, and outcome of poisoning were investigated. RESULTS Ninety-three patients were given hyperbaric oxygen. Fifty-one patients were admitted to the pediatric intensive care unit, 18 patients have had a severe clinical course, and 6 patients have died. The risk factors associated with severe disease course were determined to be low Glasgow Coma Scale score, high leukocyte count, and high troponin T levels at presentation. CONCLUSIONS Glasgow Coma Scale score, leukocyte count, and troponin T level may be beneficial in predicting clinical outcomes and tailoring therapy in children with CO poisoning.
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Affiliation(s)
| | | | - Selman Kesici
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozlem Teksam
- From the Division of Pediatric Emergency Medicine
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28
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Ozsurekci Y, Gürlevik S, Kesici S, Kaya Akca U, Oygar PD, Aykac K, Karacanoglu D, Saritas Nakip O, Ilbay S, Katlan B, Cengiz AB, Basaran Ö, Cura Yayla BC, Karakaya J, Bilginer Y, Bayrakci B, Ceyhan M, Özen S. POS1249 MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN DURING THE COVID-19 PANDEMIC IN TURKEY: FIRST REPORT FROM THE EASTERN MEDITERRANEAN. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The severity of COVID-19 symptoms can range from mild to severe. Severe COVID-19 cases with excessive hyperinflammation have many overlap features with multisystem inflammatory syndrome in children (MIS-C).Objectives:We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with MIS-C and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country.Methods:Children (aged <18 years) who diagnosed with MIS-C and severe/critical pediatric cases with COVID-19, were admitted to hospital between 26 March and 3 November 2020 were enrolled in the study.Results:A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only 3 deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral.Conclusion:Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count seem good diagnostic parameters for MIS-C cases.Disclosure of Interests:None declared
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29
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Aksoy E, Öztoprak Ü, Çelik H, Özdemir FMA, Özkan M, Kayılıoğlu H, Danış A, Kucur Ö, Kesici S, Uysal Yazıcı M, Azapağası E, Taşcı Yıldız Y, Ceylan N, Şenel S, Yüksel D. Acute necrotizing encephalopathy of childhood: a single-center experience. Turk J Med Sci 2021; 51:706-715. [PMID: 33754655 PMCID: PMC8203168 DOI: 10.3906/sag-2102-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Acute necrotizing encephalopathy is a rare type of acute encephalopathy characterized by multi-ocal brain lesions
and associated severe neurological findings and various organ dysfunctions may accompany it. Materials and Methods Patients with acute necrotizing encephalopathy of childhood diagnosed by pediatric neurology and pediatric intensive care at Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital between 2007 and 2020 were included in this study. Results Nine patients (six females, three males) with a mean age of 4.05 ± 1.94 years (age range 1–6.5) were included in this study. The interval range between fever and encephalopathy in patients was 1–4 days. Influenza A (3H1N1, one untyped) was detected in four patients, influenza B in three patients, and no cause was found in two patients. Major clinical findings other than febrile encephalopathy in all patients were a hemodynamic shock in seven patients, seizures in six patients, vomiting in five patients, dystonia in three patients, and flaccid paralysis in the upper extremity in one patient. Despite all our treatment approaches, including plasmapheresis, moderate to severe neurological sequelae was observed in all of our patients, who survived even with significant radiological improvement. Three patients for whom we could not perform plasmapheresis died. Conclusion Our study revealed that thalamic involvement increased as the interval shortened, and brainstem involvement increased in patients over four years of age. The presence of persistent vomiting accompanying encephalopathy during the parainfectious period and plasmapheresis treatment being a treatment option that could prevent mortality were cautionary for our study.
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Affiliation(s)
- Erhan Aksoy
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ülkü Öztoprak
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Halil Çelik
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatih Mehmet Akif Özdemir
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehbare Özkan
- Department of Pediatric Neurology, VM Medical Park Pendik Hospital, İstanbul, Turkey
| | - Hülya Kayılıoğlu
- Department of Pediatric Neurology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Ayşegül Danış
- Department of Pediatric Neurology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Özge Kucur
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mutlu Uysal Yazıcı
- Department of Pediatric Intensive Care, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ebru Azapağası
- Department of Pediatric Intensive Care, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yasemin Taşcı Yıldız
- Department of Pediatric Radiology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Saliha Şenel
- Department of Pediatrics, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Deniz Yüksel
- Department of Pediatric Neurology, Faculty of Medicine, Dr Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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30
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Terzi K, Kesici S, Özsürekci Y, Bayrakci B. Periorbital erythema is a common cutaneous manifestation in COVID-19. Clin Exp Dermatol 2021; 46:1316-1317. [PMID: 33872412 PMCID: PMC8251188 DOI: 10.1111/ced.14694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- K Terzi
- Pediatric Intensive Care Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
| | - S Kesici
- Pediatric Intensive Care Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
| | - Y Özsürekci
- Department of Pediatric Infectious Diseases, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
| | - B Bayrakci
- Pediatric Intensive Care Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
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Katlan B, Kesici S, Bayrakci B. Concomitant use of surfactant and extra-corporeal membrane oxygenation for COVID-19 in an 8-year-old boy. Minerva Cardiol Angiol 2021; 69:620-621. [PMID: 33823571 DOI: 10.23736/s2724-5683.21.05374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Banu Katlan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey -
| | - Selman Kesici
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Serdaroglu E, Kesici S, Bayrakci B, Kale G. Diffuse Alveolar Damage Correlation with Clinical Diagnosis of Pediatric Acute Respiratory Distress Syndrome. J Pediatr Intensive Care 2021; 10:52-57. [PMID: 33585062 PMCID: PMC7870331 DOI: 10.1055/s-0040-1714127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022] Open
Abstract
Diffuse alveolar damage (DAD) is one of the pathological hallmarks of acute respiratory distress syndrome (ARDS). We aimed to compare pathological findings of DAD with clinical ARDS criteria. We re-evaluated 20 patients whose clinical autopsy revealed DAD. Total 11/20 patients with DAD (55%) met the 1994 American-European Consensus Conference and 7/17 (41%) met the 2012 Berlin clinical criteria. DAD showed only moderate correlation with current clinical ARDS definition. Oxygenation index (OI), seems to be the most valuable tool in predicting pulmonary damage severity, though OI is not listed in either of the previous definitions. We support the recommended use of OI by 2015 consensus conference.
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Affiliation(s)
- Esra Serdaroglu
- Department of Pediatric Critical Care, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Critical Care, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Critical Care, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Gulsev Kale
- Department of Pediatric Pathology, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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33
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Olgac A, Kasapkara ÇS, Kilic M, Emine Derinkuyu B, Azapagasi E, Kesici S, Biberoğlu G, Ozyazici A, Karaca M, Haberle J. A rare urea cycle disorder in a neonate: N-acetylglutamate synthetase deficiency. ARCH ARGENT PEDIATR 2020; 118:e545-e548. [PMID: 33231058 DOI: 10.5546/aap.2020.eng.e545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 11/12/2022]
Abstract
Urea cycle disorders (UCD), are genetically inherited diseases that may have a poor outcome due to to profound hyperammonemia. We report the case of a baby girl diagnosed as N-acetylglutamate synthase (NAGS) deficiency. The patient was evaluated due to diminished sucking and hypotonicity. Physical examination showed hepatomegaly. Complete blood count, biochemical values and blood gas analyses were normal, acute phase reactants were negative. Further laboratory analyses showed no ketones in blood and highly elevated ammonia. Metabolic tests were inconclusive. Emergency treatment was initiated immediately and she was discharged on the 15th day of admission. NAGS deficiency was confirmed by DNA-analysis. She is now without any dietary restriction or other medication, except N-carbamylglutamate (NCG). NAGS deficiency is the only UCD which can be specifically and effectively treated by NCG. Early recognition of disease will lead to early treatment that may prohibit devastating effects of hyperammonemia.
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Affiliation(s)
- Asburce Olgac
- Division of Pediatric Metabolism, Dr. Sami Ulus Maternity and Children's Health and DiseasesTraining and Research Hospital, Ankara, Turkey.
| | - Çiğdem S Kasapkara
- Division of Pediatric Metabolism, Dr. Sami Ulus Maternity and Children's Health and DiseasesTraining and Research Hospital, Ankara, Turkey
| | - Mustafa Kilic
- Division of Pediatric Metabolism, Dr. Sami Ulus Maternity and Children's Health and DiseasesTraining and Research Hospital, Ankara, Turkey
| | - Betul Emine Derinkuyu
- Division of Pediatric Radiology, Dr. Sami Ulus Maternity and Children's Health and DiseasesTraining and Research Hospital, Ankara, Turkey
| | - Ebru Azapagasi
- Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Gürsel Biberoğlu
- Division of Pediatric Metabolism and Nutrition, Gazi University Hospital, Ankara, Turkey
| | - Ahmet Ozyazici
- Division of Neonatology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Meryem Karaca
- Division of Pediatric Metabolism, Harran University Hopsital, Sanliurfa, Turkey
| | - Johannes Haberle
- Division of Metabolism, University Children's Hospital, Zurich, Switzerland
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Akca UK, Kesici S, Ozsurekci Y, Aykan HH, Batu ED, Atalay E, Demir S, Sag E, Vuralli D, Bayrakci B, Bilginer Y, Ozen S. Kawasaki-like disease in children with COVID-19. Rheumatol Int 2020; 40:2105-2115. [PMID: 32936318 PMCID: PMC7492688 DOI: 10.1007/s00296-020-04701-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Children with Coronavirus disease 2019 (COVID-19) are being reported to have manifestations of hyperinflammatory states and/or Kawasaki-like disease. In this study, we investigated children with typical and atypical Kawasaki disease (KD) likely to be associated with COVID-19. We have reported four children with Kawasaki-like disease probably associated with COVID-19. The clinical features were consistent with incomplete KD in three patients. SARS-CoV-2 RT-PCR was positive in one and the serology was positive in one patient with negative RT-PCR. Corticosteroids, anakinra, intravenous immunoglobulin (IVIG), and acetylsalicylic acid were used in the treatment. Three patients recovered after the treatment while one patient died. The literature review revealed 36 articles describing 320 children with Kawasaki-like disease associated with COVID-19. SARS-CoV-2 RT-PCR was negative in 120 (65.5%) of 183 patients while the serology was positive in 130 (83.8%) of 155 patients. The therapeutic options have included IVIG, acetylsalicylic acid, tocilizumab, anakinra, enoxaparin, and methylprednisolone. Pediatric COVID-19 cases may present with atypical/incomplete Kawasaki-like disease. Thus, pediatricians need to be aware of such atypical presentations resembling KD for early diagnosis of COVID-19.
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Affiliation(s)
- Ummusen Kaya Akca
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hayrettin Hakan Aykan
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Atalay
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dogus Vuralli
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Affiliation(s)
- Selman Kesici
- Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Affiliation(s)
- Sinan Yavuz
- Division of Pediatric Critical Care Medicine Department of Pediatrics Faculty of Medicine Hacettepe University Ankara Turkey
- Pediatric Intensive Care Unit Hacettepe University İhsan Doğramacı Children’s Hospital Altındağ/Ankara Turkey
| | - Selman Kesici
- Division of Pediatric Critical Care Medicine Department of Pediatrics Faculty of Medicine Hacettepe University Ankara Turkey
| | - Benan Bayrakci
- Division of Pediatric Critical Care Medicine Department of Pediatrics Faculty of Medicine Hacettepe University Ankara Turkey
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Yetimakman AF, Kesici S, Bayrakci B, Esquinas AM. Defining the effect of medical treatment on respiratory needs in patients with Type 1 spinal muscular atrophy. J Pediatr 2020; 223:227. [PMID: 32376261 DOI: 10.1016/j.jpeds.2020.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ayse Filiz Yetimakman
- Department of Pediatric Intensive Care Medicine, Kocaeli University, Kocaeli, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
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Kesici S, Kenç Ş, Yetimakman AF, Bayrakci B. Predicting Outcome in Mechanically Ventilated Pediatric Patients. J Pediatr Intensive Care 2020; 9:92-98. [DOI: 10.1055/s-0039-3400962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022] Open
Abstract
AbstractTo apply and determine whether standardized mortality scores are appropriate to predict the risk of mortality in mechanically ventilated pediatric patients, 150 patients were retrospectively evaluated. Pediatric risk of mortality (PRISM) III-24 and pediatric index of mortality (PIM)-2 scores were unable to discriminate survivors and nonsurvivors; the observed mortality rate was lower than expected mortality rates. Oxygenation index (OI) was calculated at 0, 12, 24, and 72 hours of ventilation. OI-12 and OI-72 were found to be higher in nonsurvivors. PRISM III-24 and PIM-2 scores failed to predict mortality risk in mechanically ventilated pediatric patients. OI can be used to predict degree of respiratory failure and mortality risk.
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Affiliation(s)
- Selman Kesici
- Pediatric Intensive Care Unit, İhsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Şenay Kenç
- Department of Pediatric Gastroenterology, İnönü University, Malatya, Turkey
| | | | - Benan Bayrakci
- Pediatric Intensive Care Unit, İhsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
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Abstract
Kesici S, Ünal Ş, Kuşkonmaz B, Aytaç S, Çetin M, Gümrük F. Fanconi anemia: a single center experience of a large cohort. Turk J Pediatr 2019; 61: 477-484. Fanconi anemia (FA) is an inherited disease, characterized by congenital malformations, short stature, progressive bone marrow failure and predisposition to leukemia and solid tumors. The aim of this study was to evaluate the clinical and prognostic features of FA patients followed in a single center. The charts of FA patients were reviewed 35 years retrospectively and a total of 175 patients were included in the study in which 51.4% of patients were male. The mean age at diagnosis was 6.3±4.1 years. The incidence of microcephaly was 92.6%, skin findings were 88.0%, eye abnormality was 74.3%, thumb and radius abnormality was 53.1%, urinary system abnormality was 30.9%, skeletal system abnormality other than thumb and radius was 18.9%, genital system abnormality was 11.4%, cardiovascular system abnormality was 11.4%, ear and hearing abnormalities were 9.7% and gastrointestinal system abnormality was 5.7%. Short stature was present in 75.4% of the patients. Of the 175 patients 167 (95.4%) developed bone marrow failure during follow-up and the mean age of bone marrow failure was 7.1 ±3.7 years (1 month-old-19.8 years). The first clinical symptom was thrombocytopenia in 83.4% of patients. Malignancy developed in a total of 23 (13.1 %) patients (20 leukemia, 3 solid tumors) during follow-up. Of 175 patients, 35 (20%) underwent hematopoietic stem cell transplantation. Fatality rate among patients who underwent hematopoietic stem cell transplantation was 31.4% (11/35) and fatality rate among other patients was 63.4% (83/131; p < 0.05). Of 94 patients who deceased, death was due to bleeding in 44.7%, infection in 34%, leukemia progression in 16.0% and graft versus host disease in 5.3%. In terms of the number of patients included, this study is one of the largest cohorts with a remarkable duration of follow-up time. Hematopoietic stem cell transplantation was found to have a good impact on sur vival of patients.
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Affiliation(s)
- Selman Kesici
- Divisions of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara
| | - Şule Ünal
- Divisions of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara
| | - Barış Kuşkonmaz
- Divisions of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara
| | - Selin Aytaç
- Divisions of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara
| | - Mualla Çetin
- Divisions of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara
| | - Fatma Gümrük
- Divisions of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara
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40
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Affiliation(s)
| | - Selman Kesici
- Pediatric Intensive Care Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
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41
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Yetimakman AF, Kesici S, Bayrakci B. Plasma Filtration Versus Centrifugation in Pediatric Therapeutic Plasma Exchange: Should the Diagnosis Define the Method? †. Ther Apher Dial 2019; 24:85-89. [PMID: 31066994 DOI: 10.1111/1744-9987.12835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/21/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022]
Abstract
Therapeutic plasma exchange (TPE) is used for a variety of illnesses in critically ill pediatric patients. Although both centrifugation and filtration are known to be effective methods, to our knowledge, clinical results for TPE by these methods are not compared in pediatric patient populations. One hundred patients who had TPE for a variety of diagnoses were included in the study. In 55 patients plasma exchange was implemented by centrifugation and in 45, by filtration. These two groups were further divided into subgroups according to admittance diagnoses. The demographic information, admittance Pediatric Risk of Mortality scores, Pediatric Logistic Organ Dysfunction (PELOD) scores before beginning of therapy and PELOD at the end of therapy, durations of ventilatory support, pediatric intensive care unit and hospital stay, and outcomes were compared. Although the survival was significantly better in filtration group, it included more patients with neurologic diagnoses. Filtration group standard mortality rate was 0.6. In both groups, the PELOD scores after the termination of TPE were significantly decreased compared to that before beginning of TPE. Within thrombotic microangiopathy and hemophagocytic lymphohistiocytosis subgroups, median PELOD scores before treatment were higher in centrifugation patients but survival was similar with both methods. Both methods of TPE are alike in decreasing PELOD scores. In the filtration group, survival benefit of TPE is evident. In thrombotic microangiopathy patients, despite higher PELOD scores in the centrifugation group, survival is similar for both methods. These findings should be retested in randomized studies and the underlying physiology awaits to be uncovered.
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Affiliation(s)
- A Filiz Yetimakman
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
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Kurt F, Kendirli T, Gündüz RC, Kesici S, Akça H, Şahin Ş, Kalkan G, Derbent M, Tuygun N, Ödek Ç, Gültekingil A, Oğuz S, Polat E, Derinöz O, Tekin D, Tekşam Ö, Bayrakcı B, Suskan E. Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2019; 60:488-496. [PMID: 30968623 DOI: 10.24953/turkjped.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kurt F, Kendirli T, Gündüz RC, Kesici S, Akça H, Şahin Ş, Kalkan G, Derbent M, Tuygun N, Ödek Ç, Gültekin-Keser A, Oğuz S, Polat E, Derinöz O, Tekin D, Tekşam Ö, Bayrakcı B, Suskan E. Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2018; 60: 488-496. The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% of the patients were males, and 44% were younger than one year of age. The witnessed arrest rate was 75.8% (138/182) and the rate of bystander CPR was 13.9% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1- 15) min, while it was 15 (5-40) min for the remaining patients (p < 0.001). The ROSC rate was 94.9% in patients who underwent CPR for less than 20 min and 22% in patients requiring CPR longer than 20 min (p < 0.001). Survival to hospital discharge was 14.3%. Of these patients, 57.7% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results.
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Affiliation(s)
- Funda Kurt
- Division of Pediatric Emergency Medicine, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Ankara University Faculty of Medicine
| | - Ramiz Coskun Gündüz
- Department of Pediatrics, Ankara Children's Hematology Oncology Training and Research Hospital
| | - Selman Kesici
- Division of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Halise Akça
- Division of Pediatric Emergency Medicine, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Şanlıay Şahin
- Department of Pediatrics, Ankara Children's Hematology Oncology Training and Research Hospital
| | - Gökhan Kalkan
- Division of Pediatric Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Derbent
- Division of Pediatric Emergency Medicine, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Nilden Tuygun
- Division of Pediatric Emergency Medicine, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Çağlar Ödek
- Division of Pediatric Intensive Care Unit, Department of Pediatrics, Ankara University Faculty of Medicine
| | - Ayşe Gültekingil
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara Turkey
| | - Sinan Oğuz
- Division of Pediatric Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emine Polat
- Department of Pediatrics, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara Turkey
| | - Okşan Derinöz
- Division of Pediatric Emergency Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Division of Pediatric Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Tekşam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara Turkey
| | - Benan Bayrakcı
- Division of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emine Suskan
- Division of Pediatric Emergency Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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Abstract
OBJECTIVE Intravenous immunoglobulin and plasma exchange are proven treatments for Guillain-Barré syndrome. Despite these treatments, the prognosis for severe Guillain-Barré syndrome is still not satisfactory. This article seeks for a logical timing for plasma exchange-intravenous immunoglobulin synergy, which may improve outcome in severe Guillain-Barré syndrome requiring mechanical ventilation. STUDY DESIGN This study is an open-label study. Nine pediatric severe Guillain-Barré syndrome patients requiring mechanical ventilation were treated with novel treatment strategy named as "zipper method." In this method, following diagnosis of Guillain-Barré syndrome, plasma exchange was started immediately. In the first session of plasma exchange, one and a half volume of patients' plasma was removed by using 5% albumin as replacement solution. At the end of the plasma exchange session, 0.4 g/kg intravenous immunoglobulin infusion was started immediately. Second plasma exchange session was applied with one volume change after 24 hours from the end of the intravenous immunoglobulin infusion. Each plasma exchange session was followed by intravenous immunoglobulin infusions. This plasma exchange-intravenous immunoglobulin cycle was repeated for 5 times. RESULTS Among the 9 patients, the mean mechanical ventilation duration was 7 (5-14) days and the mean hospital stay was 18 (10-30) days. Medical Research Council sum score was increased in all patients, especially after the third session. All patients survived and all patients were able to walk unaided on the 28th day of admission. CONCLUSION The zipper method as a novel treatment modality seems to reduce mortality, speed up weaning from mechanical ventilation, and shorten hospital stay, with excellent outcome in severe Guillain-Barré syndrome patients, who require intensive care. This technique stands as a promising immunomodulation strategy for various scenarios.
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Affiliation(s)
- Selman Kesici
- 1 Pediatric Intensive Care Unit, Dr. Sami Ulus Education and Research Hospital, Ankara, Turkey.,4 Pediatric Intensive Care Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
| | - Murat Tanyıldız
- 2 Pediatric Intensive Care Unit, Mersin City Hospital, Mersin, Turkey
| | - Filiz Yetimakman
- 3 Pediatric Intensive Care Unit, Şanlıurfa Children's Hospital, Şanlıurfa, Turkey
| | - Benan Bayrakci
- 4 Pediatric Intensive Care Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey
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44
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Yetimakman AF, Kesici S, Tanyildiz M, Bayrakci B. Continuous Renal Replacement Therapy for Treatment of Severe Attacks of Inborn Errors of Metabolism. J Pediatr Intensive Care 2019; 8:164-169. [PMID: 31402993 DOI: 10.1055/s-0039-1683991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/21/2019] [Indexed: 12/29/2022] Open
Abstract
Severe metabolic crises in children with inborn errors of metabolism can result in mortality or severe morbidities where continuous renal replacement therapy (CRRT) can be lifesaving . Clinical data, the pediatric risk of mortality (PRISM) scores calculated in the first 24 hours, and pediatric logistic organ dysfunction (PELOD) scores calculated in the last 24 hours before CRRT, were studied . Overall, CRRT was successful in restoring metabolic balance in 72% of patients. PELOD scores before CRRT were lower in survivors ( p = 0.02). Despite numerous comorbid factors, CRRT can be used effectively in management of metabolic crises. Early intervention with this therapy before occurrence of complications must be targeted.
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Affiliation(s)
- Ayse Filiz Yetimakman
- Division of Pediatric Intensive Care, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatrics, Pediatric Intensive Care Unit, Dr. Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
| | - Murat Tanyildiz
- Division of Pediatric Intensive Care, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Division of Pediatric Intensive Care, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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45
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Kockuzu E, Bayrakcı B, Kesici S, Cıtak A, Karapınar B, Emeksiz S, Anıl AB, Kendirli T, Yukselmis U, Sevketoglu E, Paksu Ş, Kutlu O, Agın H, Yıldızdas D, Keskin H, Kalkan G, Hasanoglu A, Yazıcı MU, Sık G, Kılınc A, Durak F, Perk O, Talip M, Yener N, Uzuner S. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey. Indian J Crit Care Med 2019; 23:263-269. [PMID: 31435144 PMCID: PMC6698354 DOI: 10.5005/jp-journals-10071-23177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was ≤7.10, and critical PCO2 ≥60 mm Hg. Conclusion Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them. How to cite this article Kockuzu E, Bayrakcı B, Kesici S, Cıtak A, Karapınar K, Emeksiz S, et al. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs During the Winter Season in Turkey. Indian J Crit Care Med 2019;23(6):263–269.
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Affiliation(s)
- Esra Kockuzu
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakcı
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Clinic of Pediatric Intensive Care Unit, Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Agop Cıtak
- Department of Pediatric Intensive Care Unit, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Bulent Karapınar
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serhat Emeksiz
- Clinic of Pediatric Intensive Care Unit, Ankara Pediatric Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayşe Berna Anıl
- Clinic of Pediatric Intensive Care Unit, Ankara Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ufuk Yukselmis
- Clinic of Pediatric Intensive Care Unit, Kartal Lutfi Kırdar Education Research Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- Clinic of Pediatric Intensive Care Unit, Bakırkoy Sadi Konuk Education Research Hospital, Istanbul, Turkey
| | - Şukru Paksu
- Department of Pediatric Intensive Care Unit, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Onur Kutlu
- Department of Pediatric Intensive Care Unit, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Agın
- Clinic of Pediatric Intensive Care Unit Dr. Behcet Uz Education Research Hospital, Izmir, Turkey
| | - Dincer Yıldızdas
- Department of Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Halil Keskin
- Department of Pediatric Intensive Care Unit, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Gokhan Kalkan
- Department of Pediatric Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Arzu Hasanoglu
- Department of Pediatric Intensive Care Unit, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Mutlu Uysal Yazıcı
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guntulu Sık
- Clinic of Pediatric Intensive Care Unit, Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Arda Kılınc
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Fatih Durak
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mey Talip
- Clinic of Pediatric Intensive Care Unit, Bakırkoy Sadi Konuk Education Research Hospital, Istanbul, Turkey
| | - Nazik Yener
- Department of Pediatric Intensive Care Unit, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Selcuk Uzuner
- Department of Pediatric Intensive Care Unit, Bezmialem University Faculty of Medicine, Istanbul, Turkey
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Yuksel D, Oguz KK, Azapagası E, Kesici S, Cavdarli B, Konuskan B, Topaloglu H. Uncontrolled inflammation of the nervous system: Inherited CD59 deficiency. Neurol Clin Pract 2018; 8:e18-e20. [PMID: 30564502 DOI: 10.1212/cpj.0000000000000511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/29/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Deniz Yuksel
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
| | - Kader Karli Oguz
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
| | - Ebru Azapagası
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
| | - Busranur Cavdarli
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
| | - Bahadir Konuskan
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
| | - Haluk Topaloglu
- Department of Pediatric Neurology (DY) and Pediatric Intensive Care Unit (EA, SK), University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital; Departments of Radiology (KKO) and Pediatric Neurology (BK, HT), Faculty of Medicine, Hacettepe University; and Ankara Numune Training and Research Hospital (BC), Genetic Diseases Diagnosis Center, Ankara, Turkey
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Kesici S, Yılmaz Keskin E, Chiang SC, Kasapkara ÇS, Sekine T, Akçaboy M, Fettah A, Bryceson YT. First Report of an SH2D1A Mutation Associated with X-Linked Lymphoproliferative Disease in Turkey. Turk J Haematol 2018; 35:200-202. [PMID: 29391328 PMCID: PMC6110441 DOI: 10.4274/tjh.2017.0445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Selman Kesici
- Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Clinic of Pediatric Intensive Care, Ankara, Turkey
| | - Ebru Yılmaz Keskin
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Isparta, Turkey
| | - Samuel C.C. Chiang
- Karolinska University Hospital Huddinge, Karolinska Institute, Center for Hematology and Regenerative Medicine, Department of Medicine, Stockholm, Sweden
| | - Çiğdem Seher Kasapkara
- Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Clinic of Pediatric Metabolism and Nutrition, Ankara, Turkey
| | - Takuya Sekine
- Karolinska University Hospital Huddinge, Karolinska Institute, Center for Hematology and Regenerative Medicine, Department of Medicine, Stockholm, Sweden
| | - Meltem Akçaboy
- Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Clinic of Pediatrics, Ankara, Turkey
| | - Ali Fettah
- Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Clinic of Pediatric Hematology and Oncology, Ankara, Turkey
| | - Yenan T. Bryceson
- Karolinska University Hospital Huddinge, Karolinska Institute, Center for Hematology and Regenerative Medicine, Department of Medicine, Stockholm, Sweden
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Kukul MG, Ciki K, Karadag-Oncel E, Cengiz AB, Kuskonmaz B, Tavil B, Kesici S. A fatal Clostridium perfringens infection with hemolysis after chemotherapy in an adolescent. ARCH ARGENT PEDIATR 2018; 115:e92-e95. [PMID: 28318191 DOI: 10.5546/aap.2017.eng.e92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/20/2016] [Indexed: 11/12/2022]
Abstract
Gas gangrene, clostridial myonecrosis, is one of the most serious infectious diseases, characterized by rapidly progressive destruction of deep soft tissues and production of gas within the tissues. We presented a case of fatal spontaneous gas gangrene due to Clostridium perfringens in a patient with acute lymphoblastic leukemia during remission induction chemotherapy phase.
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Affiliation(s)
- Musa G Kukul
- Department of Pediatrics, Faculty of Medicine, Hacettepe University
| | - Kısmet Ciki
- Department of Pediatrics, Faculty of Medicine, Hacettepe University
| | - Eda Karadag-Oncel
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University.
| | - Ali B Cengiz
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University
| | - Baris Kuskonmaz
- Department of Pediatrics, Pediatric Hematology, Faculty of Medicine, Hacettepe University
| | - Betul Tavil
- Department of Pediatrics, Pediatric Hematology, Faculty of Medicine, Hacettepe University
| | - Selman Kesici
- Department of Pediatrics, Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University
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49
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Yetimakman AF, Kesici S, Tanyildiz M, Bayrakci US, Bayrakci B. A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy. J Intensive Care Med 2017; 34:985-989. [PMID: 28820041 DOI: 10.1177/0885066617724339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. MATERIALS AND METHOD A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors. RESULTS The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8. CONCLUSION The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.
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Affiliation(s)
- Ayse Filiz Yetimakman
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Dr Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
| | - Murat Tanyildiz
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Selda Bayrakci
- Department of Pediatric Nephrology, Ankara Children's and Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
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50
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Yazici MU, Kesici S, Demirbilek H, Tanyıldız M, Gumustas M, Bayrakci B. Reversible Dilated Cardiomyopathy Due to Combination of Vitamin D-Deficient Rickets and Primary Hypomagnesemia in an 11-Month-Old Infant. J Pediatr Intensive Care 2017; 7:46-48. [PMID: 31073467 DOI: 10.1055/s-0037-1602803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022] Open
Abstract
Vitamin D-deficient rickets is still an important and common health problem in developing countries. Since calcium is an essential ion for cardiac muscle contraction, calcium deficiency caused by rickets can cause secondary dilated cardiomyopathy. This situation can be exacerbated by coexisting hypomagnesemia. Here, we report a case of dilated cardiomyopathy due to hypocalcemia induced by vitamin D-deficient rickets and accompanying primary hypomagnesemia in an infant whose cardiomyopathy was successfully treated by replacement of calcium, vitamin D, and magnesium. In addition to genetic causes, viral infections, and idiopathic factors, metabolic abnormalities are important etiologic factors in pathogenesis of dilated cardiomyopathy and since they are treatable, prompt diagnosis of these disorders is crucial.
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Affiliation(s)
- Mutlu Uysal Yazici
- Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
| | - Hüseyin Demirbilek
- Department of Pediatric Endocrinology and Metabolism, Hacettepe University, Ankara, Turkey
| | - Murat Tanyıldız
- Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
| | - Mehmet Gumustas
- Department of Pediatric Cardiology, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
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