RESUMO
This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027). Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: ⢠Children with COVID-19 mainly present with fever and cough, as in adults. ⢠COVID-19 may specifically threaten children with underlying chronic diseases. What is New: ⢠Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. ⢠Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children.
Assuntos
COVID-19 , Adulto , Humanos , Criança , Feminino , Idoso , Masculino , COVID-19/epidemiologia , SARS-CoV-2 , Vacinas contra COVID-19 , Pacientes Ambulatoriais , Tosse , Pacientes Internados , Turquia/epidemiologia , Prevalência , Obesidade , Doença CrônicaRESUMO
BACKGROUND: The present study aimed to assess the efficacy of non-invasive ventilation (NIV) on the clinical course, oxygenation, need for invasive mechanical ventilation (IMV), and outcomes for children with pulmonary edema after drowning. METHODS: We conducted a retrospective chart review. Children who were referred to the pediatric emergency department due to drowning-related pulmonary edema and underwent NIV between May 2014 and October 2020 were included. Demographics, vital signs, clinical findings, and results of laboratory and radiologic investigations were recorded. Patients were divided into six groups using the Szpilman classification system. The need for IMV, the need for pediatric intensive care unit admission, and the length of NIV treatment and stay in the pediatric intensive care unit were recorded for each patient. RESULTS: Twenty-five patients were enrolled. According to the Szpilman classification, 13 (52.0%) patients were evaluated as grade 3 and 12 (48.0%) as grade 4. All patients were treated with bi-level positive airway pressure in the spontaneous / timed mode. A significant increase in oxygen saturation (SpO2) and SpO2/fraction of inspired oxygen ratios was observed from the beginning of NIV treatment and this increase was also observed for the second and fourth hours. There was a decrease in respiratory rate at the fourth hour of NIV treatment. No patient subsequently deteriorated to require IMV. CONCLUSIONS: We have reported a favorable clinical course of drowning patients who underwent early use of NIV in the pediatric emergency department. Management of drowning patients with pulmonary edema by NIV with close follow-up can be successfully applied in selected cases.
Assuntos
Afogamento , Ventilação não Invasiva , Edema Pulmonar , Insuficiência Respiratória , Humanos , Criança , Respiração Artificial/métodos , Ventilação não Invasiva/métodos , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Estudos Retrospectivos , Progressão da Doença , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapiaRESUMO
OBJECTIVE: Isolated facial injuries are less common among pediatric trauma patients. The literature has focused on, especially, fractures in facial injuries. There is a limited number of studies evaluating all facial injuries in childhood. The study aims to evaluate the clinical characteristics of maxillofacial injuries and to identify patients who require further intervention. METHODS: The data from pediatric patients with maxillofacial injury (<18 years) between January 2011 and December 2015 were collected. Demographic characteristics, trauma mechanisms, concomitant injuries, treatments, hospitalization, and follow-up results were recorded. RESULTS: The median age of the patients (N = 2926) was 5.0 years (2.0-10.0 years), and 63.1% were boys. Falls and motor vehicle accidents were the leading mechanism of injury. The most common injury types were lacerations (49.3%) and fractures (15.5%). One hundred thirty (0.4%) patients had concomitant injuries. Surgical treatment was performed in only 3.4% of the patients, and the mortality rate was 0.6%. Patients with concomitant injuries had more hospitalization rates, surgical treatment, and organ dysfunction. All patients who underwent cardiopulmonary resuscitation and resulted in mortality were in the concomitant injury group. CONCLUSIONS: Isolated facial injuries are unlikely to be life-threatening, and basic interventions are sufficient in most of the maxillofacial injuries. The primary issue in maxillofacial injuries is to recognize and manage concomitant injuries that can lead to organ dysfunction and mortality.
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Traumatismos Maxilofaciais , Fraturas Cranianas , Acidentes por Quedas , Acidentes de Trânsito , Criança , Pré-Escolar , Humanos , Masculino , Traumatismos Maxilofaciais/epidemiologia , Traumatismos Maxilofaciais/terapia , Estudos RetrospectivosRESUMO
OBJECTIVES: Endotracheal intubation is an essential skill for the pediatric airway management. Although direct laryngoscopy (DL) is the standard method, several videolaryngoscopes (VLs) have been recently enhanced as an alternative especially for difficult intubations. We aimed to compare McGrath MAC (McG) and Storz C-MAC PM (ST) VLs with DL in terms of intubation success rate, time to intubation (TTI), and duration of obtaining glottis view of intubation attempts performed by pediatric residents on different pediatric airway manikins. METHODS: The pediatric residents with no experience in videolaryngoscopy were included. After a brief demonstration, intubation attempts with 3 randomly handled different devices with 6 different blades were performed on a child manikin, an infant manikin, a Pierre-Robin sequence infant manikin, and a child manikin with cervical immobilization sequentially. RESULTS: Fifty pediatric residents were enrolled. The attempts of DL on child manikin and attempts of all devices on child with cervical immobilization simulation were completely successful. For the attempts on both infant manikin and Pierre-Robin sequence infant manikin, the success rate of McG was significantly lower than ST and DL (P = 0.011 and P = 0.001). In the child manikin, McG and ST had prolonged TTI compared with DL (P = 0.016 and P = 0.001). For the child with cervical immobilization simulation, TTI of DL was significantly shorter than McG and ST (P = 0.011 and P = 0.001). Time to intubation of McG was significantly longer than DL and ST for the attempts on both 2 infant manikins. The rate of Cormack-Lehane grade I glottis view was similar for the attempts on both 2 child airway simulations. For infant manikin and Pierre-Robin sequence infant simulation, the rate of Cormack-Lehane grade I of ST was higher than attempts of DL and McG. CONCLUSIONS: The attempts of pediatric residents on infant normal airway and Pierre-Robin sequence infant airway simulations resulted with enhanced glottis view by the utilization of Storz C-MAC PM, but both 2 VLs did not provide the improvement of intubation success rate and TTI compared with DL on these 4 different pediatric manikins. Further clinical studies of different VLs in different clinical courses are required for a reliable utilization in children.
Assuntos
Laringoscópios , Criança , Glote , Humanos , Lactente , Intubação Intratraqueal , Laringoscopia , Manequins , Gravação em VídeoRESUMO
BACKGROUND: Scorpion envenomation is a common medical emergency in many countries, including Turkey. Severe systemic symptoms occur more easily in children and mortality rates are higher. The aim of this study is to describe the clinical effects and predictive factors affecting the clinical severity of scorpion envenomations in Western Turkey. METHODS: Two hundred one children (138 mild cases, 34 moderate, and 29 severe) with scorpion envenomation aged between 1 month and -17 years were included in the study. The patients' demographic and laboratory characteristics were compared among clinical severity subgroups. RESULTS: The patients' median age was 7 (4-11) years. The median age of the severe group was significantly lower than that of the mild and moderate groups (p < 0.001). Seventeen patients (8.5%) developed myocarditis, while no pulmonary edema was observed in any case. Leukocyte, neutrophil and platelet (PLT) counts, and plateletcrit (PCT) and glucose levels increased significantly with the severity of envenomation (p < 0.001). PLT counts and PCT levels exhibited positive correlation with leukocyte and neutrophil counts (p < 0.001, r = 0.781, r = 0.638, r = 0.772, and r = 0.629, respectively). Supraventricular tachycardia developed in 1 (5.9%) patient, and dilated cardiomyopathy in another (5.9%). No mortality occurred in any case. CONCLUSION: Increased PLT counts and PCT levels may be helpful in evaluating clinical severity in patients with scorpion sting envenomation. The possibility of myocarditis development in children should be remembered and cardiac enzymes should be checked, even if patients are asymptomatic and cardiac enzymes are normal on admission.
Assuntos
Miocardite , Picadas de Escorpião , Criança , Serviço Hospitalar de Emergência , Humanos , Lactente , Picadas de Escorpião/epidemiologia , Turquia/epidemiologiaRESUMO
ABSTRACT: Acquired coagulopathy is a rare but challenging diagnosis for pediatric emergency physicians. Although the coagulopathy usually presents with mild skin and mucosal hemorrhages, it also can lead to life-threatening events. Thus, accurate interpretation of hints obtained from a detailed history, physical examination, and laboratory findings is essential for the prompt diagnosis and management. This case demonstrates an uncommon cause of coagulopathy; celiac disease that presented with spontaneous bruises and ecchymosis in an adolescent.
Assuntos
Doença Celíaca , Contusões , Adolescente , Criança , Equimose , Humanos , Exame FísicoRESUMO
OBJECTIVE: The objective of this study was to evaluate physical examinations, imaging, and laboratory analyses individually and combined using innovative statistical analysis methods for the accurate diagnosis of pediatric appendicitis. METHODS: Patients admitted to hospital with symptoms of abdominal pain whose pediatric appendicitis scores greater than 3 were included in the study. Clinical, radiologic, and laboratory findings and as a new biomarker calprotectin (CPT) concentrations were evaluated individually and combined using artificial neural networks (ANNs), which revealed latent relationships for a definitive diagnosis. RESULTS: Three hundred twenty patients were evaluated (190 appendicitis [43 perforated] vs 130 no appendicitis). The mean ± SD age was 11.3 ± 3.6 years and 63% were male. Pediatric appendicitis scores, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin (PCT) and CPT concentrations were higher in the appendicitis group; however, only WBC and ANC were higher in first 24 hours of pain. White blood cells and CRP were diagnostic markers in patients whose appendix could not be visualized using ultrasonography (US). On classic receiver operating characteristic (ROC) analysis, the areas under the curve (AUCs) were not strong enough for differential diagnosis (WBC, 0.73; ANC, 0.72; CRP, 0.65; PCT and CPT, 0.61). However, when the physical examination, US, and laboratory findings were analyzed in a multivariate model and the ROC analysis obtained from the variables with ANN, an ROC curve could be obtained with 0.91 AUC, 89.8% sensitivity, and 81.2% specificity. C-reactive protein and PCT were diagnostic for perforated appendicitis with 0.83 and 0.75 AUC on ROC. CONCLUSIONS: Although none of the biomarkers were sufficient for an accurate diagnosis of appendicitis individually, a combination of physical examination and laboratory and US was a good diagnostic tool for pediatric appendicitis.
Assuntos
Apendicite , Adolescente , Apendicite/diagnóstico por imagem , Biomarcadores , Proteína C-Reativa/análise , Criança , Humanos , Contagem de Leucócitos , Masculino , Redes Neurais de Computação , Exame Físico , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , UltrassonografiaRESUMO
OBJECTIVES: Trauma can induce the release of high-mobility group box 1 (HMGB1), which plays an important role in the activation of coagulation. In this study, we aimed to evaluate the role of HMGB1 in the early diagnosis of acute traumatic coagulopathy (ATC), disseminated intravascular coagulation, and clinical course. MATERIALS AND METHODS: One hundred pediatric trauma patients and 50 healthy controls were enrolled. Demographic data, physical examination results, trauma scores, International Society on Thrombosis and Hemostasis score, laboratory values, transfusion requirements, and needs for mechanical ventilation were recorded. Blood samples for HMGB1 were assessed by an enzyme-linked immunosorbent assay. RESULTS: Thirty-five patients had ATC and 3 patients had overt disseminated intravascular coagulation. In trauma patients, HMGB1 levels were statistically higher than those in the control group (P<0.001). There was a positive correlation between HMGB1 levels and D-dimer levels (r=0.589, P<0.001). ATC patients had higher plasma HMGB1 levels than those without ATC (P=0.008). High HMGB1 levels were associated with the duration of mechanical ventilation, need for intensive care unit observation, length of hospital stay, and mortality. CONCLUSION: This study showed the early increase of HMGB1 in pediatric trauma cases and demonstrated the significant association of high HMGB1 levels with the development of ATC, disseminated intravascular coagulation, trauma severity, clinical outcome, and mortality.
Assuntos
Biomarcadores/sangue , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/epidemiologia , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/epidemiologia , Proteína HMGB1/sangue , Centros de Traumatologia/estatística & dados numéricos , Transtornos da Coagulação Sanguínea/diagnóstico , Estudos de Casos e Controles , Criança , Pré-Escolar , Coagulação Intravascular Disseminada/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Turquia/epidemiologiaRESUMO
BACKGROUND: The ketogenic diet (KD) has been frequently used for the patients with drug-resistant epilepsy in recent years. The management of these patients in emergency departments (EDs) has some difficulties due to the special needs of KD. We aimed to determine the characteristics and the management of the patients on the KD in the pediatric ED setting. METHODS: Patients who were on the KD and admitted to the ED were included in the study. Demographic, clinical, and laboratory data of all patients were retrospectively reviewed and recorded. RESULTS: There were 105 emergency admissions of 27 patients. The median age of all patients was 55.0 (IQR: 29.0-91.0) months. The most common symptom was vomiting (43.8%). Four patients had upper gastrointestinal bleeding, and one patient had hyperammonemic acute hepatic failure while receiving KD. Of the patients, 41.9% had seizure-related ED admission. Infections were present in 41.9% of the ED visits. The frequency of status epilepticus was significantly lower in the patients who were on the KD for more than 6â¯months (pâ¯<â¯0.01). In 42.9% of all ED admissions, dextrose containing maintenance fluids was administered mistakenly; although ketosis rate was lower, no seizure was observed in this group. CONCLUSION: The patients on the KD can be admitted to EDs with intercurrent illnesses or adverse effects of the KD. For accurate management, emergency physicians must be aware of the common reasons for ED admission of these patients and the effects of the KD.
Assuntos
Dieta Cetogênica/efeitos adversos , Epilepsia Resistente a Medicamentos/dietoterapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Criança , Pré-Escolar , Epilepsia Resistente a Medicamentos/complicações , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Estado Epiléptico/epidemiologia , Estado Epiléptico/etiologia , Estado Epiléptico/prevenção & controle , Resultado do TratamentoRESUMO
OBJECTIVE: An electrical injury (EI) is an emergency that causes high morbidity and mortality each year. The aim of this study was to define the epidemiological, clinical, and laboratory factors that might predict severe patients and cardiac arrest in pediatric EI cases. METHODS: All of the patients' medical files were reviewed retrospectively through a 2-year period for the demographic, clinical, and laboratory findings. The patients were classified into the severe injury group or the mild injury group. The SPSS (Chicago, Ill) software was used to analyze the data. RESULTS: Among the 38 patients, 18 patients (47.4%) were in the mild group, and 20 patients (52.6%) were in the severe group. Low-voltage injuries were observed in 35 (92.1%) of the patients. Most of the severe patients were injured with low voltage (75%) and in household settings (85%). Plug and sockets were the most observed source of the injuries in all of the patients, whereas water-related injuries were most prevalent in the severe group. The source of injury was different in the mild and severe groups (P = 0.009). In the severe group, 13 patients (34.2%) were resuscitated after cardiopulmonary arrest. In the multivariate analysis of the demographic data, the most predictive parameters for cardiac arrest and the clinical severity in EIs are the factors of electrical cables and water. CONCLUSIONS: Electrical injuries are a significant concern in the pediatric population. Our results showed that low voltage and household electricity could cause morbidity and mortality.
Assuntos
Traumatismos por Eletricidade/epidemiologia , Parada Cardíaca/epidemiologia , Adolescente , Reanimação Cardiopulmonar/estatística & dados numéricos , Criança , Pré-Escolar , Traumatismos por Eletricidade/complicações , Feminino , Parada Cardíaca/etiologia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologiaRESUMO
Luc abscess is an uncommon suppurative complication of otitis media. Unfamiliarity of this complication leads to delayed diagnosis and treatment. This abscess is usually benign. Infection in the middle ear spreads via anatomic preexisting pathways, and this process results with subperiosteal pus collection. Conservative treatment with drainage under empirical wide spectrum antibiotic is efficient. Here,we present a 9-year-old boy who had left facial swelling after a period of otalgia, diagnosed as Luc abscess without mastoiditis.
Assuntos
Abscesso/etiologia , Mastoidite/etiologia , Otite Média Supurativa/complicações , Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos , Criança , Diagnóstico Diferencial , Drenagem , Dor de Orelha/diagnóstico , Dor de Orelha/etiologia , Dor de Orelha/terapia , Humanos , Masculino , Mastoidite/diagnóstico , Mastoidite/terapia , Otite Média Supurativa/diagnóstico , Otite Média Supurativa/terapia , Otoscopia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The aim of this study was to define the epidemiological, clinical, and laboratory manifestations of scorpion envenomation and to identify factors that are predictive of severe cases. METHODS: The medical files of 41 scorpion envenomation cases were reviewed retrospectively. The cases were classified as mild-moderate or severe. The epidemiological, clinical, and laboratory findings of patients were recorded. RESULTS: There were 27 patients (65.9%) in the mild-moderate group and 14 patients (34.1%) in the severe group. The median age of all patients was 48 months. The most common systemic finding was cold extremities (41.5%). In all patients, the most commonly observed dysrhythmia was sinus tachycardia (34.1%). Two patients (4.9%) had pulseless ventricular tachycardia and died. Pulmonary edema and myocarditis were observed in 9 patients (22%). Median values of leukocyte and glucose levels were markedly increased in the severe group. Additionally, the mean thrombocyte level (540,857 ± 115,261 cells/mm(3)) in the severe group was significantly increased compared with the mild-moderate group (391,365 ± 150,017 cells/mm(3)). Thrombocyte levels exhibited a positive correlation with leukocyte and glucose values and a negative correlation with patient left ventricular ejection fraction. Multivariate analysis of laboratory parameters indicated that the most predictive factor for clinical severity is thrombocytosis (odds ratio 23.9; 95% CI: 1.6-353.5, P = .021). CONCLUSIONS: Although our results share some similarities with those of other reports, thrombocytosis was markedly increased in the severe group and served as the most predictive laboratory factor of clinical severity.
Assuntos
Picadas de Escorpião/etiologia , Animais , Antivenenos/uso terapêutico , Criança , Pré-Escolar , Eletrocardiografia , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Picadas de Escorpião/tratamento farmacológico , Picadas de Escorpião/epidemiologia , Venenos de Escorpião/intoxicação , Escorpiões , Índice de Gravidade de Doença , Trombocitose/etiologia , Turquia/epidemiologiaRESUMO
OBJECTIVE: The aim of this study was to determine the association between the use of intravenous N-acetylcysteine (NAC) and hepatic healing in pediatric intensive care unit (PICU) patients with non-acetaminophen-induced hepatic injury, except for acute liver failure. METHODS: The data of patients who received intravenous NAC as adjuvant therapy for transaminase levels more than sixfold normal values during their PICU stay between 2010 and 2014 were retrospectively collected from the medical records database. The patients who did not receive NAC with elevated transaminase levels during their PICU stay between 2014 and 2018 were also collected as the standard of care (SOC) cohort. RESULTS: More than 50% of the liver injuries were secondary to acute hypoxia, hypotension, sepsis, and inflammation. The median number of elevated transaminase period (ETP) days of the NAC and SOC groups were 5 (IQR: 4) and 4 (IQR: 4), respectively (p = 0.17). There was no significant difference between the groups in terms of minimum and maximum laboratory values during ETP. There was no significant difference in terms of ETP and maximum ALT levels between the NAC and SOC groups in the hypoxia-hypotension subgroup. CONCLUSION: This study did not show an association between indirect measures of hepatic healing and post-insult use of NAC in pediatric liver injury in the PICU setting.
Assuntos
Acetilcisteína/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas , Falência Hepática Aguda/tratamento farmacológico , Acetaminofen , Analgésicos não Narcóticos/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Criança , Cuidados Críticos , Feminino , Humanos , Falência Hepática Aguda/etiologia , Masculino , Estudos Retrospectivos , Transaminases/sangue , Resultado do TratamentoRESUMO
BACKGROUND: Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI. METHODS: The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded. RESULTS: The median age of the 136 children was 9 (IQR: 5-14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2-8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively). CONCLUSION: Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.
Assuntos
Contusões , Lesão Pulmonar , Traumatismo Múltiplo , Pneumotórax , Adolescente , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Humanos , Masculino , Pneumotórax/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVES: To evaluate the factors associated with intensive care requirement and mortality in pediatric myocarditis. METHODS: Children aged 28 days to 18 years who were diagnosed with acute myocarditis in a pediatric emergency department between January 2010 and September 2020 were enrolled in the study retrospectively. Demographic and clinical features, cardiac biomarkers, and imaging findings were evaluated. Length of hospital stay, need for hospitalization in the pediatric intensive care unit (PICU), treatments, and survival outcomes were recorded. To define the severity of disease, three groups were created and the data were compared in terms of clinical, laboratory, and imaging findings. The patients treated in the pediatric ward were compared with those hospitalized in the PICU. Ventricular dysfunction was defined in patients with a left ventricular ejection fraction (LVEF) of <50% and these patients were compared with those who had an LVEF of >50%. Also, survivor and non-survivor patients were compared. RESULTS: A total number of 62 patients with a median age of 8 years were included. Chest pain and tachycardia were the most common findings on physical examination. The mean LVEF was 59.3 ± 13.0% at admission. Of the patients, 17 were hospitalized in the PICU (27.4%). Chest pain was more common in patients hospitalized in the pediatric ward (p<0.001), and hypotension, vomiting, arrhythmia, were more common and LVEF was lower in patients in the PICU (p = 0.017, p = 0.008, p = 0.006, and p = 0.025, respectively). The children treated in the PICU were younger than those in the pediatric ward (p = 0.009). Troponin I levels were significantly higher in the pediatric ward (p = 0.035), and brain natriuretic peptide (BNP) levels were higher in patients in the PICU (p = 0.012). Death occurred in four patients. Hypotension and vomiting were significantly more common in non-survivors (p = 0.020 and 0.004, respectively). Inotropes and intravenous immunoglobulin (IVIG) were more commonly used in non-survivors (p = 0.001 and p = 0.015, respectively). BNP levels were higher in non-survivors (p = 0.008), and troponin I levels were not different between survivors and non-survivors (p = 0.260). CONCLUSION: In pediatric acute myocarditis, lower LVEF, increased BNP, as well as the presence of hypotension and arrhythmia were found to be related to intensive care requirement. Hypotension and vomiting were found to be more common in non-survivors. Due to the possibility of rapidly worsening disease, physicians should be alert to the presence of these findings.
Assuntos
Hipotensão , Miocardite , Arritmias Cardíacas , Biomarcadores , Dor no Peito , Criança , Hospitalização , Humanos , Miocardite/diagnóstico , Estudos Retrospectivos , Volume Sistólico , Troponina I , Função Ventricular Esquerda , VômitoRESUMO
PURPOSE: Status epilepticus is one of the most common neurological emergencies in pediatric emergency departments. Although there are different approaches to treatment in the literature, early control of seizure activity is the most important factor determining prognosis. The purpose of this study was to evaluate the effect of early midazolam infusion on seizure duration. METHOD: This retrospective study included 150 episodes of 135 patients aged one month to 18 years old with status epilepticus. All patients were treated according to the local hospital protocol for SE, which included early midazolam infusion. Demographic data, medical history, applied treatments during SE, and seizure durations were recorded. RESULTS: The median age of the patients (58.7% male) was 2.7 years (1.0-6.0 years). The most common identified etiologies were remote symptomatic etiologies, and generalized tonic-clonic seizure was the most common seizure type. The pediatricians had selected intravenous midazolam for 130 patients (86.7%) as the first-line therapy in emergency services. In 55 patients given continuous midazolam infusion, the cumulative bolus of midazolam was 0.5 mg/kg (0.4-0.7 mg/kg), and the median peak rate of midazolam infusion was 0.2 mg/kg/h (0.2-0.4 mg/kg/h). The median duration between the start of midazolam infusion and the complete cessation of SE was 15.0 min (9.0-25.0 min). The early-midazolam infusion group had shorter seizure duration after initiation of midazolam infusion (p = 0.020). CONCLUSION: The current study shows that aggressive management of SE with early initiation of midazolam infusion was associated with a shorter seizure duration in SE patients.
Assuntos
Moduladores GABAérgicos/farmacologia , Midazolam/farmacocinética , Estado Epiléptico/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Moduladores GABAérgicos/administração & dosagem , Moduladores GABAérgicos/efeitos adversos , Humanos , Lactente , Masculino , Midazolam/administração & dosagem , Midazolam/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Background: Lower respiratory tract infections (LTRIs) are the most common cause of pediatric emergency department visits and are associated with significant morbidity and mortality. The aim of this study was to evaluate the soluble urokinase plasminogen activator receptor (suPAR) levels in pediatric patients with LRTIs and to investigate the correlation of suPAR with disease severity. Methods: This is a prospective case-control study of children with LTRIs. Demographic data, diagnoses, vital signs, disease severity scores, length of hospital stay, laboratory findings, and viral polymerase chain reaction results for nasopharyngeal aspirates were recorded. Blood samples for suPAR were collected and assessed by enzyme-linked immunosorbent assay. Results: There were 94 patients with LTRIs and 32 children in the control group. Patients were further subdivided into 2 groups based on diagnosis of acute bronchiolitis (n: 31, 33%) or pneumonia (n: 63, 67%). The median levels of suPAR were significantly higher in patients with LTRIs than in healthy controls (4.3 and 3.5 ng/mL, respectively; P = 0.003). There was an association between suPAR levels and disease severity in pneumonia patients. suPAR values were higher in patients with severe pneumonia than mild pneumonia (5.5 and 3.6 ng/mL, respectively; P < 0.001). Conclusion: We have shown that suPAR levels increased in patients with LTRIs and suPAR values were higher in patients with severe pneumonia than mild pneumonia. Further studies with large case series are needed to clarify the role of suPAR levels in children with LTRIs.
RESUMO
In the present study, the carbon supported Pd, PdAg and PdAgNi (Pd/C, PdAg/C and PdAgNi/C) electrocatalysts are prepared via NaBH4 reduction method at varying molar atomic ratio for formic acid electrooxidation. These as-prepared electrocatalysts are characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM), inductively coupled plasma mass spectrometry (ICP-MS), N2 adsorption-desorption, and X-ray electron spectroscopy (XPS), cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS), chronoamperometry (CA), and lineer sweep voltammetry (LSV). While Pd50Ag50/C exhibits the highest catalytic activity among the bimetallic electrocatalyst, it is observed that Pd70Ag20Ni10/C electrocatalysts have the best performance among the all electrocatalysts. Its maximum current density is about 1.92 times higher than that of Pd/C (0.675â¯mAâ¯cm-2). Also, electrochemical impedance spectroscopy (EIS), chronoamperometry (CA) and lineer sweep voltammetry (LSV) results are in a good agreement with CV results in terms of stability and electrocatalytic activity of Pd50Ag50/C and Pd70Ag20Ni10/C. The Pd70Ag20Ni10/C catalyst is believed to be a promising anode catalyst for the direct formic acid fuel cell.
RESUMO
At present, commercial pure Titanium (Ti) and microstructured pre-alloyed Titanium-Nickel (TiNi) powders are employed as a sensitive electrochemical hydrogen peroxide (H2O2) sensor. Surface characterization of these materials are performed by x-ray diffraction (XRD) and scanning electron microscopy (SEM). The electrochemical characterization is achieved via cyclic voltammetry (CV), chronoamperometry (CA), and electrochemical impedance spectroscopy (EIS) on Ti and TiNi modified glassy carbon electrode (GCE). The electrochemical behavior of H2O2 at the pure Ti/GCE and microstructure pre-alloyed TiNi/GCE are studied by CV in 0.1â¯M phosphate buffer solution (PBS) containing as the supporting electrolyte. In addition, CA is employed for the determination of H2O2 at the applied potential of 0â¯V vs. Ag/AgCl. The sensor has a linear response range of 0.5-17.5â¯mM with a sensitivity of 280⯵Aâ¯mM-1â¯cm-2. Moreover, the limit of detection (LOD) and limit of quantification (LOQ) are 0.5⯵M and 1.7⯵M, respectively. The electrochemical sensor exhibits fast and selective responses to H2O2 concentration. The applicability of the sensor is checked using a hair coloring as a real sample with satisfactory results.