Sinem Sarı Gökay

Point-of-care lung ultrasound in children with community acquired pneumonia

Objectives To present lung ultrasound findings in children assessed with suspected pneumonia in the emergency department and to show the benefit of lung ultrasound in diagnosing pneumonia in comparison with chest X‐rays. Methods This observational prospective study was performed in the pediatric emergency department of a single center. Point of care lung ultrasound was performed on each child by an independent sonographer blinded to the patients clinical and chest X‐ray findings. Community acquired pneumonia was established as a final diagnosis by two clinicians based on the recommendations in the British Thoracic Society guideline. Results One hundred sixty children with a mean age of 3.3 ± 4 years and a median age of 1.4 years (min–max 0.08–17.5 years) were investigated. Final diagnosis in 149 children was community‐acquired pneumonia. Lung ultrasound findings were compatible with pneumonia in 142 (95.3%) of these 149 children, while chest X‐ray findings were compatible with pneumonia in 132 (88.5%). Pneumonia was confirmed with lung ultrasound in 15 of the 17 patients (11.4%) not evaluated as compatible with pneumonia at chest X‐ray. While pneumonia could not be confirmed with lung ultrasound in seven (4.6%) patients, findings compatible with pneumonia were not determined at chest X‐ray in two of these patients. When lung ultrasound and chest X‐ray were compared as diagnostic tools, a significant difference was observed between them (p = 0.041). Conclusions This study shows that lung ultrasound is at least as useful as chest X‐ray in diagnosing children with community‐acquired pneumonia.

Myocarditis and Early Markers of Cardiac Response Associated with Scorpion Stings in Children

INTRODUCTION A clinical course ranging from mild local findings to life-threatening systemic findings may occur after scorpion stings. The purpose of this study was to identify priority markers indicating scorpion sting-related cardiac involvement. METHODS Our study was performed between July 2014, and September 2015 in the Çukurova University medical faculty pediatric emergency department, in Adana, Turkey. Patients admitted with scorpion sting-related cardiac involvement and a control group consisting of patients with no scorpion sting-related cardiac involvement were included in the study. Troponin I at time of presentation and at 6 and 24 h, N-terminal prohormone of brain natriuretic peptide (NTproBNP), ejection fraction as determined by echocardiography at 24 h, and peak and end of T wave (Tp-e) and Tp-e/QTc ratios with echocardiography at 24 h were evaluated. RESULTS A patient group consisting of 7 cases of scorpion envenomation-related myocarditis and a control group of 30 cases of scorpion intoxication without myocarditis findings were enrolled. Statistically significantly high glucose, white blood cell values, creatine kinase MB, troponin I, and NTproBNP values were identified in the scorpion sting-related myocarditis group (P<0.05). Ejection fractions determined by echocardiography at time of presentation were significantly lower in the patients with myocarditis compared with the control group (P<0.05). A statistically significant difference was identified between Tp-e/corrected QT interval (QTc) ratios investigated in DI and V2 derivations in patient and control group echocardiograms (P<0.05). CONCLUSIONS We think that use can be made of NTproBNP in addition to echocardiography and troponin I in the early diagnosis of scorpion sting-related myocarditis and that Tp-e and Tp-e/QTc ratios identified via echocardiography can be used as early markers; however, further studies with larger numbers are needed to confirm this.

Urticaria as a Rare Side Effect of Polyethylene Glycol-3350 in a Child: Case Report

SUMMARY – Polyethylene glycol electrolyte (PEG-3350) solution is usually used for bowel emptying before colonoscopy in adults. It has also been reported to be safe in children. It is thought that bowel irrigation with this solution can be a useful treatment alternative for poisoning with slow releasing drugs, swallowed packaged substances, enteric coated drugs, drugs not binding to charcoal, and heavy metals in children. Due to high molecular weight of PEG-3350, its absorption from the intestinal mucosa is very low (0.2%). Therefore, it is less likely to have side effects. A three-year-old girl bit and ate one-third of an alkali battery and was brought to our pediatric emergency unit. Vital signs and results of physical examination and laboratory investigations were normal. Irrigation of the bowels with PEG-3350 solution given orally at a rate of 20 mL/kg/h was initiated. Upon excretion of feces of normal appearance in the sixth hour, irrigation was continued. Since rashes and itching started throughout her body in the thirtieth hour after administration of 9 L PEG-3350, the irrigation was discontinued and the patient was administered antihistamines. Rashes and itching regressed within one hour of its discontinuation. This suggested that they were due to the irrigation solution. There are five adult cases of allergic reactions to PEG-3350 reported in the literature. The case presented is the first pediatric patient developing allergic reaction to PEG-3350.

Uncontrolled Agitation and Flushed Face Due to Tropicamide: A Missed Diagnosis

Introduction: Topical ophthalmic drugs that are not used in appropriate doses may lead to overdose symptoms.Case Report: A 2-month-old boy presented to the emergency department with extreme agitation, flushed face, mydriasis, cataract in the left eye, dry oral mucosa, spasticity in all extremities, and wheezing. It was learned that the patient had been receiving eye drops containing tropicamide at repeated doses before ophthalmologic evaluation. Pheniramine maleate and methylprednisolone were given to counter the drug-related side-effects or allergic reactions to the eye drop. At the follow-up, his symptoms and findings had become exacerbated, and he was admitted to the pediatric intensive care unit due to shock and drug-related anticholinergic toxicity.Conclusion: This case illustrates the importance of recognizing toxidromes at differential diagnosis and is the first reported pediatric case with tropicamide-induced anticholinergic syndrome