Muhammet Sukru Paksu

Old agent, new experience: colistin use in the paediatric Intensive Care Unit—a multicentre study

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.

The influence of valproic acid treatment on hair and serum zinc levels and serum biotinidase activity.

Some of the side effects that develop during long-term valproic acid (VPA) treatment are similar to symptoms of zinc and partial biotinidase deficiencies. This situation suggests an association between these side effects and biotinidase and/or zinc deficiencies. In 32 pediatric patients (22 females, 10 males) receiving VPA treatment, hair and serum zinc levels and serum biotinidase activity (BA) were measured prior to and in the 3rd and 6th months of treatment. Also, serum VPA levels were measured in the 3rd and 6th months of treatment. The mean serum and hair zinc levels were found to be reduced in the 3rd and 6th months of treatment as compared with the pre-treatment values, while the mean serum BA was lower than the pre-treatment values in the 3rd month of treatment, but returned to initial values in the 6th month of treatment. In the 3rd and 6th months of treatment, patients complaining about hair loss had lower hair and serum zinc levels and serum BA but greater mean serum VPA than those who did not. However, the differences between parameters were not statistically significant. Our findings suggest that hair loss in patients can be attributed to zinc and BA depletion within the first 3 months, and to zinc depletion only by the 6th month.

Foreign body aspiration in childhood: evaluation of diagnostic parameters.

Background Foreign body aspiration (FBA) is one of the most important preventable causes of childhood mortality and morbidity. Objective The aim of this study was to define the clinical and radiological features of FBA and investigate the diagnostic value of various parameters used to diagnose FBA. Methods The medical records of 147 children who were admitted to the hospital with a diagnosis of suspected FBA were examined. The sensitivity and specificity of the parameters used for the diagnosis of FBA and their predictive values were calculated. Results Of the patients, 75.5% were younger than 3 years, and 61.2% were male. Peak incidence was found in 18 months. A negative bronchoscopy rate of 19.7% was found, and 92.6% of these patients were younger than 3 years. The parameter with the highest diagnostic value was the presence of aspiration history (the sensitivity and positive and negative predictive values were 97%, 89%, and 80%, respectively). No significant difference was found in the classic triad of FBA (sudden onset of cough, wheezing, and unilaterally decreased breath sounds) between patients with and without FBA. The specificity and positive predictive value of the classic triad were high, and the sensitivity and negative predictive value were low (85% and 78%, and 13% and 19%, respectively). Conclusions Especially, male children younger than 3 years have an increased risk of FBA. Neither clinical symptoms nor the radiological findings alone are sufficiently specific and sensitive in diagnosing FBA. The most important factor for diagnosis is the presence of aspiration history.

Gluconeogenesis Defect Presenting With Resistant Hyperglycemia and Acidosis Mimicking Diabetic Ketoacidosis

Fructose-1,6-diphosphatase (FDPase) enzyme deficiency is a rare inherited metabolic disease. Affected patients usually present with metabolic crisis including hypoglycemia, acidosis, ketonuria, and hyperuricemia. A previously healthy 8-month-old male infant presented with fever, vomiting, and hypoactivity. He had tachycardia, tachypnea, and a tendency to sleep. The patient had signs of severe dehydration and shock. Laboratory findings revealed significant lactic acidosis, hyperuricemia, hyperglycemia, elevated liver enzyme level, and hyperlipidemia. The urine analysis had evidence of glycosuria and ketonuria. Hyperuricemia, lactic acidemia, and hyperglycemia persisted despite insulin infusion, adequate hydration, and perfusion. Consequently, peritoneal dialysis was started. About 12 hours after dialysis, his metabolic derangements were normalized, and clinical status was improved dramatically. His metabolic disease workup was compatible with FDPase deficiency. Here, we described a metabolic attack of FDPase deficiency presented with hyperglycemia mimicking diabetic ketoacidosis.

Bilateral reexpansion pulmonary edema associated with pleural empyema: a case report

Reexpansion pulmonary edema is an uncommon complication following rapid reexpansion of the lungs. The risk increases with a prolonged duration of pulmonary collapse, the amount of drained liquid or air, and with decreased time of draining. Treatment is supportive. In general, the prognosis is favorable. A nine-year-old boy was presented with fever, cough, and respiratory distress. Pneumonia and left-sided pleural empyema were determined and a chest tube was emplaced. Clinical deterioration occurred in just a few minutes following chest tube insertion. His chest radiography revealed a pulmonary edema in the left lung. Despite mechanical ventilation, antibiotics, and diuretic treatment, no significant improvement occurred. Acute respiratory distress syndrome and multiple organ dysfunctions developed in the follow-up. The patient died on day 5 of hospitalization. In this report, a complicated reexpansion pulmonary edema with a lathal outcome in a 9-year-old child is presented.

Management of subglottic hemangioma with propranolol

Subglottic hemangioma is a rare but life- threatening condition which requires intervention. It generally starts proliferating in the first and second months of lifespan and whether there is a respiration problem or not, it causes biphasic stridor. Its diagnosis generally requires direct laryngoscopy or direct screening through bronchoscopy. This case report presents a 45-day-old girl who had subglottic hemangioma presenting with wheezing and stridor. Our case took propranolol with a dose of 2 mg/kg/day and within 48 h after the start of the treatment, obstructive symptoms started to alleviate considerably.

Is Serum Cystatin C a Better Marker than Serum Creatinine for Monitoring Renal Function in Pediatric Intensive Care Unit

In critically ill patients, mild to moderate reductions in glomerular filtration rate are not instantly followed by parallel changes in serum creatinine (SCr). The aim of this study was to identify a value of serum cystatin C (cys-C) level as a marker for monitoring renal function in critically ill pediatric patients. Creatinine clearance was used to estimate glomeruler filtration rate (eGFR). The correlation between the inverse of serum cys-C and eGFR (r = -0.70, p < 0.0001) was better than the correlation between the inverse of SCr and eGFR (r = -0.27, p = 0.008). Serum cys-C was found to be superior to SCr to predict renal impairment (area under the curve for cys-C, 0.932 and for SCr, 0.658). It can be concluded that cys-C is superior to SCr for the detection of renal impairment in critically ill children.

Iatrogenic tracheal rupture in a child: case study and review of literature.

Tracheal rupture is rare in childhood, and optimal treatment is not clear. A 14-year-old boy was admitted to a local hospital after sudden loss of consciousness. He underwent endotracheal intubation and was referred to our hospital. The patients history revealed that he had voluntarily inhaled butane gas. The physical examination was consistent with coma and cardiogenic shock, and the chest radiograph showed pulmonary edema. The patient was admitted to the intensive care unit, and diuretic and inotropic therapy was started. In the third hour of monitoring of the patient under mechanical ventilation, subcutaneous emphysema and pneumothorax at the right hemithorax were observed without deterioration of the vital functions. Thoracic computed tomography scan findings were consistent with tracheal rupture. The patient was monitored conservatively without surgery. On the fifth day of hospitalization, his tube was removed, and he was discharged on the 12th day with a positive prognosis. In this study, a tracheal rupture case after endotracheal intubation is presented in which the patient recovered completely with conservative therapy.

Intracardiac thrombus case caused by blunt trauma due to child abuse

Intracardiac thrombus is a rare condition in children, although there has recently been an increase in case reports in the literature. We here report an asymptomatic intracardiac thrombus caused by blunt trauma due to child abuse in a 4-year-old girl. On the echocardiogram, one can see pericardial fluid surrounding all of the heart, and a mobile mass, a thrombus of 5.8 × 9 mm in diameter, was observed in the right atrium and on the free border of the tricuspid valve. The thrombus and pericardial fluid disappeared on the follow-up echocardiogram performed after the 10-day heparin therapy.

Reliability of spot-check transcutaneous hemoglobin measurement in children.

This study investigated the correlation between spot‐check transcutaneous hemoglobin (Hb) and simultaneously measured venous Hb in children.