Duran Karabel

Determining the Independent Risk Factors and Mortality Rate of Nosocomial Infections in Pediatric Patients

The objective of this study was to determine the rate, independent risk factors, and outcomes of healthcare-associated infections in pediatric patients. This study was performed between 2011 and 2014 in pediatric clinic and intensive care unit. 86 patients and 86 control subjects were included in the study. Of 86 patients with nosocomial infections (NIs), there were 100 NIs episodes and 90 culture growths. The median age was 32.0 months. The median duration of hospital stay of the patients was 30.0 days. The most frequent pathogens were Coagulase-negative Staphylococcus, Acinetobacter spp., Klebsiella spp., and Candida spp. Unconsciousness, prolonged hospitalization, transfusion, mechanical ventilation, use of central venous catheter, enteral feeding via a nasogastric tube, urinary catheter, and receiving carbapenems and glycopeptides were found to be significantly higher in NIs patients. Multivariate logistic regression analysis showed prolonged hospitalization, neutropenia, and use of central venous catheter and carbapenems as the independent risk factors for NIs. In the univariate analysis, unconsciousness, mechanical ventilation, enteral feeding, use of enteral feeding via a nasogastric tube, H2 receptor blockers, and port and urinary catheter were significantly associated with mortality. In the multiple logistic regression analysis, only mechanical ventilation was found as an independent predictor of mortality in patients with NIs.

Management of intestinal bleeding with single‐dose cyclophosphamide in Henoch–Schönlein purpura

In these case series, we report on six children (3 girls, 3 boys) aged 5–13 years with Henoch–Schönlein purpura (HSP) who developed severe gastrointestinal (GI) bleeding resistant to both 2 mg/kg or pulse (10–30 mg/kg) i.v. methylprednisolone. All patients responded to single‐dose (500 mg/m2) i.v. cyclophosphamide (CPA) and none of them developed new GI bleeding after CPA treatment. No patients required surgical intervention. Single high‐dose CPA may be beneficial in HSP with severe GI involvement, in which bleeding is non‐responsive to high‐dose steroids.

Children with food refusal: An assessment of parental eating attitudes and their styles of coping with stress

Background: In this study, we aimed to assess the eating attitudes and stress coping styles of parents whose children presented to the clinic complaining of food refusal. Methods: The parents of 31 children aged ≥3 years, presented to the clinic with the complaint of food refusal. The control group consisted of 30 healthy children with no prior history of food refusal, and their parents. In both groups, birth features, body mass indexes (BMIs), eating attitudes and stress coping styles of the parents were assessed. The parents of both groups were studied, in part utilizing the eating attitudes test (EAT), and the coping styles of stress scale (CSSS). Results: Our study found that body weights and BMI values of the fathers in the study group were significantly lower than fathers in the control group. There was no significant difference in EAT scores between the two groups; however, where the childrens body weight and height for age percentile was under 25%, the parents had significantly lower EAT scores. When CSSS scores were assessed, the optimistic approach score of the mother and the self‐confident score of the father were found to be significantly high in both groups. Conclusion: The parental perception and definition of eating problemsdoes not necessarily indicate the presence of an eating disorder in a child. In fact, the eating attitudes of the fathers were related to the low percentile weight and height values of the children, and a childs food refusal was not dependent on the stress coping style used by the parent.

Two pediatric Henoch-Schönlein purpura cases whose severe gastrointestinal hemorrhage treated by cyclophosphamide

Henoch-Schonlein purpura (HSP) is a vasculitis, that involves various organ systems and show different clinical picture. It can be presented with purpura-like skin rash, abdominal pain, arthritis and renal involvement. Rarely, severe skin, gastrointestinal (GIS) and renal involvement occur and can lead to early or late complications. In this paper, it was aimed to report, two HSP children with severe GIS involvement as recurrent intestinal hemorrhage, which did not respond to high dose intravenous steroids, but successfully treated by intravenous cyclophosphamide. One of our patients had also severe necrotic skin lesions that necessitate skin grafting and the other had severe renal involvement as nephrotic syndrome. Intravenous cyclophosphamide may be useful in children with HSP, when severe GIS involvement not respond to high dose steroids.

Una causa infrecuente de convulsión afebril: gastroenteritis por rotavirus

La gastroenteritis por rotavirus es la mas frecuente de las diarreas infecciosas y ocasiona una importante morbimortalidad en los ninos pequenos, ademas de deshidratacion grave y desequilibrios electroliticos; los signos extraintestinales son infrecuentes. Recientemente se han comunicado convulsiones afebriles asociadas con gastroenteritis por rotavirus, sin encefalopatia, deshidratacion, desequilibrio electrolitico o hipoglucemia. Comunicamos el caso de un paciente con convulsiones durante una gastroenteritis por rotavirus, una infeccion habitual en nuestro pais (Turquia), con diversas manifestaciones clinicas, entre ellas, las convulsiones, que pueden verse no solo en los ninos con enfermedades neurologicas o sistemicas sino tambien en los ninos sanos. Rotavirus is the most common infectious diarrhea that causes important mortality and morbidities in small children, severe dehydration and electrolyte imbalance. Extraintestinal signs are rare in rotavirus infections. Recently, afebrile seizures associated with rotavirus gastroenteritis but without encephalopathy, dehydration, electrolyte imbalance or hypoglycemia have being reported. In this article, the fact that rotavirus, which is seen commonly in our country, can be confronted with various clinical manifestations was emphasized by reminding that it can be seen not only in infants with neurologic and systemic disease but also in healthy infants.