Optic nerve ultrasonography in the evaluation of the relationship between arachnoid cyst and headache.

AIM: This study is aimed to show the difference between optic nerve sheath diameter (ONSD) values in migraine patients with and without arachnoid cysts from migraine patients and control groups, and to evaluate the relationship with the arachnoid cyst size on magnetic resonance imaging (MRI) and their clinical severity. METHODS: This cross-sectional study included pediatric patients who were previously diagnosed with migraine and the control group. The patients consist of 3 groups. The first group was 24 patients with arachnoid cysts on brain magnetic resonance imaging (MRI) who met the diagnostic criteria for migraine (group 1); the second group was 20 patients with only headache without arachnoid cysts or other findings on brain magnetic resonance imaging (MRI) (group 2); the third group was completely healthy 20 control group. Demographic data of the patients, the onset of headache time, clinical severity, electroencephalography (EEG) findings, optic nerve sheath diameter (ONSD) measurements by ultrasonography, and the volume of arachnoid cyst on brain MRI were determined and compared. RESULTS: The optic nerve sheath diameter (ONSD) value was the highest in group 1 and the lowest in the control group (p: 0.001). The clinical severity was statistically different between the groups (p: 0.038). Accordingly, the majority of the clinical severity of group 1 was determined in grades 3 and 4. A weak positive correlation was found between the arachnoid cyst size on MRI and the ONSD measurement (r = 0.410, p = 0.047). The ONSD value statistically significantly increased with clinical severity in group 1 (p: 0.003). CONCLUSION: The reliability of the optic nerve sheath diameter (ONSD) measurements in determining the increase of the intracranial pressure was shown in previous studies. This is the first study in the literature presenting that the intracranial pressure effects of arachnoid cysts can be demonstrated by ONSD. We have considered that arachnoid cysts detected in headaches can create a compression effect and cause the pain to intensify.

Characteristics and outcomes of critically ill children transported by ambulance in a Turkish prehospital system: a multicenter prospective cohort study.

BACKGROUND: The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated. METHODS: This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed. RESULTS: During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p < 0.001). Most procedures were performed on children aged one or older (p < 0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p < 0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics. CONCLUSION: This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.

Is there any relationship between initial hematological parameters and severity of scorpion envenomation?

BACKGROUND AND OBJECTIVES: Most cases of severe scorpion envenomation occur in children and are associated with significant morbidity and mortality. Excessive systemic inflammatory response, which leads to multiple organ involvement, is an emerging challenge during severe envenomation. The aim of this study was to investigate if there was any relationship between initial hematological parameters and severe envenomation in pediatric patients presenting with scorpion envenomation. METHOD: This study was performed retrospectively, at the pediatric emergency unit and pediatric intensive care unit of the Çukurova University Medical School in Turkey. Two hundred and fifty-seven cases with scorpion envenomation, and a control group consisting of one hundred and fifteen healthy children were included in the study. RESULTS: White blood cell, neutrophil, lymphocyte, platelet, neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR) and PDW values of patients were higher than the controls (p < 0.05). Mean NLR was 3.8 ± 4.7 in patients. Patients were analyzed with the help of the decision tree model, and it was seen that in patients who had applied to hospital in less than an hour after the scorpion sting, 87.5% of the patients whose NLR value was between the 0.519-1.969 interval (below 2.1 which we found as the cut-off value) did not need to be hospitalized in the intensive care unit, 54.1% of the patients whose NLR value was higher than 1.969 needed to be hospitalized at the intensive care unit. CONCLUSIONS: Severe envenomation is associated with mortality and morbidity in children. Our findings showed that NLR seems to be a useful tool in predicting severe envenomation.

Lung Ultrasound Findings and Bronchiolitis Ultrasound Score for Predicting Hospital Admission in Children With Acute Bronchiolitis.

OBJECTIVES: The purposes of this study were to determine the benefit of the bronchiolitis ultrasound score (BUS) in predicting hospital admission in children with acute bronchiolitis and to characterize lung sonography findings. METHODS: This prospective observational study was performed in an academic pediatric emergency department. Children younger than 24 months presenting to the emergency department, diagnosed with acute bronchiolitis by 2 independent pediatricians were included in the study. Lung ultrasound was performed by a single sonographer, who was blinded to as much clinical information as possible. In addition, the treating physicians were blinded to the lung ultrasound findings. Logistic regression analysis models were used to identify admission predictors. Receiver operating characteristic analysis was used to evaluate the predictive value for effects of the BUS and the modified Bronchiolitis Severity Score on admission. RESULTS: The median age of the 76 patients diagnosed with acute bronchiolitis was 6 months (interquartile range, 3.6-10 months). Forty-two (55.3%) of the 76 patients enrolled were admitted. Lung ultrasound was compatible with acute bronchiolitis in 74 patients (97%). A significant correlation was determined between modified Bronchiolitis Severity Score and BUS in children with acute bronchiolitis (r = 0.698, P < 0.001). The most effective parameter in determining admission on logistic regression analysis, independently of other variables, was BUS (P = 0.044; adjusted odds ratio, 1.859; 95% confidence interval, 1.016-3.404). Bronchiolitis ultrasound score values of 3 or greater exhibited 73.81% sensitivity and 73.53% specificity, whereas BUS values of 4 or greater exhibited 50% sensitivity and 91.18% specificity. CONCLUSIONS: Point-of-care lung ultrasound can accurately detect pulmonary anomalies in children with acute bronchiolitis, has a close correlation with clinical findings, and is a useful tool in predicting hospital admission.

Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study.

Background Cerebral edema is a fatal complication that can occur in children with diabetic ketoacidosis (DKA). Its clinical signs are generally not explicit, and subclinical cerebral edema can occur. This study is one of the few longitudinal studies conducted to identify cerebral edema in patients with DKA by measuring the optic nerve sheath diameter (ONSD). The aim of this study was to investigate cerebral edema in children with DKA with serial measurement of ONSD, which is an early and reliable indicator of cerebral edema, and to monitor changes in ONSD during therapy. Methods The study was conducted by measuring ONSD ultrasonographically at baseline and during the course of therapy in patients with DKA. All participants were diagnosed and received therapy at our unit between May 2016 and June 2017. The study was registered with the Clinical Trials database, with a study number of NCT02937441. Measurements were obtained while the patients were in the supine position with their eyes closed, and axial transbulbar images of both eyes were obtained with a 6-15-MHz linear probe. Results The ONSD values of children with DKA changed during the treatment, reaching the highest values at 12-16 h of therapy, and the greatest ONSD was observed in children who had moderate and severe DKA. Conclusions During treatment of children with DKA, it is possible to predict cerebral edema by measuring ONSD, and this may contribute to clinical management, especially fluid treatment.

MyD 88 Polymorphisms in Children Diagnosed with Sepsis.

BACKGROUND: Myeloid differentiation primary response gene 88 (MyD 88) is an intracellular adapter protein that mediates the early immune response to pathogens. Toll-like receptors (except TLR-3) induce the immune response through a MyD 88-dependent signal pathway. AIMS: We aimed to investigate the MyD 88 polymorphisms that play important roles in the immune response in septic children and to evaluate whether or not they were risk factors in the development of sepsis. STUDY DESIGN: Case-control study. METHODS: Sixty-five patients diagnosed with sepsis in the Pediatric Intensive Care Unit during the period from April 2010 to January 2012 were included as the study group. Sixty-five children without sepsis were included as controls. After DNA was obtained from blood samples in the study and control groups, MyD 88 polymorphisms were analyzed. According to the genotype and allele frequencies, the distributions of MyD 88 polymorphisms [Single nucleotide polymorphism (SNP) - 938 C/A (rs4988453), MyD 88 SNP 1944 C/G (rs4988457)] were analyzed in both the study and control groups. RESULTS: The C/C genotype of MyD 88 SNP -938 was significantly more common than the C/A genotype in the patient group (p=0.002). No statistically significant difference in the frequency of the MyD 88 SNP 1944 genotype was found between the study and control groups (p=0.272). CONCLUSION: Gene polymorphism studies could elucidate our understanding of sepsis in terms of prevalence and the management of treatment. It was shown in this study that children with the MyD 88 SNP -938 C/C genotype had a greater tendency toward sepsis. However, additional studies should be performed.