Microsievert Wide-Volume Versus Spiral Computed Tomography Using an Automatic Exposure Control System in the Diagnosis of Foreign Body Aspiration in Children.

BACKGROUND: Foreign body aspiration (FBA) in childhood is a life-threatening condition that necessitates prompt management to prevent devastating complications. Different imaging methods are used in the diagnosis of FBA. OBJECTIVE: The aim of this study was to compare the diagnostic value and dose of microsievert wide-volume computed tomography (µSv-WV-CT) with multidetector computed tomography using an automatic exposure control system (MDCT-AEC) in children with FBA. MATERIAL AND METHODS: In this single-center cross-sectional study, 102 cases diagnosed with FBA between September 2013 and September 2021 were retrospectively evaluated. The patients were divided into 2 groups according to the diagnostic modality used: group A, µSv-WV-CT (2016-2021) and group B, MDCT-AEC (2013-2021). The diagnostic performance and radiation dose of the 2 groups were statistically compared. RESULTS: The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the 2 groups was similar. The mean effective radiation dose of group A was 34.89 ± 0.01 µSv, which was significantly lower than that of group B (179.75 ± 114.88 µSv) ( P < 0.001). CONCLUSION: In children with suspected FBA, µSv-WV-CT at a lower radiation dose had similar diagnostic performance to MDCT-AEC.

Roflumilast as a Potential Therapeutic Agent for Cecal Ligation and Puncture-Induced Septic Lung Injury.

PURPOSE/AIMS: This study focused on delineating the possible effects of roflumilast (ROF), a selective phosphodiesterase 4 (PDE4) inhibitor, in rats with cecal ligation and puncture (CLP)-induced polymicrobial sepsis, and investigated whether ROF can act as a protective agent in sepsis-induced lung damage. MATERIAL AND METHODS: Four experimental groups were organized, each comprising eight rats: Control, Sepsis, Sepsis + ROF 0.5 mgkg-1, and Sepsis + ROF 1 mgkg-1 groups. A polymicrobial sepsis model was induced in the rats by cecal ligation and puncture under anesthesia. Twelve hours after sepsis induction, the lungs were obtained for biochemical, molecular, and histopathological analyses. RESULTS: In the sepsis group's lungs, the TNF-α, IL-1ß, and IL-6 mRNA expression levels peaked in the sepsis group's lung tissues, and ROF significantly decreased these levels compared with the sepsis group dose-dependently. ROF also significantly decreased MDA levels in septic lungs and increased antioxidant parameters (SOD and GSH) compared with the sepsis group. Histopathological analysis results supported biochemical and molecular results. CONCLUSIONS: ROF, a PDE4 inhibitor, suppressed the expression levels of pro-inflammatory cytokines, alleviated lung damage (probably by blocking neutrophil infiltration), and increased the capacity of the antioxidant system.

Early administration of milrinone ameliorates lung and kidney injury during sepsis in juvenile rats.

BACKGROUND: A sepsis model was created, induced by cecal ligation and puncture (CLP), in juvenile rat groups. Milrinone (MIL), which is known to have a modulatory effect on pro-inflammatory cytokines, was administered to the designated rat groups in the early period before severe sepsis developed. The study was aimed at investigating the possible protective effects of milrinone on the lung and kidney tissues of rats in the late phase of sepsis. METHODS: The rat pups were divided into seven groups with six animals in each group: (1) healthy rats who received no drug; (2) CLP-S12 (sacrificed at hour 12); (3) CLP-S24 (sacrificed at hour 24); (4) CLP-MIL1-S12 (administered with 0.5 mg/kg milrinone at hour 1 and sacrificed at hour 12); (5) CLP-MIL1-S24 (administered with 0.5 mg/kg milrinone at hour 1 and sacrificed at hour 24): (6) CLP-MIL12-S24 (administered with 0.5 mg/kg milrinone at hour 12 and sacrificed at hour 24), (7) and CLP-MIL1,12-S24 (administered with 0.5 mg/kg milrinone at hours 1 and 12 and sacrificed at hour 24). RESULTS: Significant differences were found between the early and late administration of milrinone in terms of both molecular and histopathological results. The results showed that the tissues were significantly preserved in the groups in which milrinone had been started in the early period compared to the sepsis control groups and the groups in which milrinone had been started in the late period. CONCLUSIONS: In addition to the positive inotropic effects of milrinone, its immunomodulatory properties that result in decreased cytokine storm can be beneficial during early period of sepsis.

Fluid Rate Is Important As Much As Fluid Tonicity: An Experimental Study.

OBJECTIVE: There is no study evaluating the effect on plasma osmolality of both fluid tonicity and high fluid rate at the same time. The aim of this experimental study was to determine the change in the plasma osmolality by different fluid tonicity and rate, and to suggest the safest and the most appropriate fluids based on the plasma osmolality for medical situations requiring fluid therapy with high or maintenance rates. MATERIALS AND METHODS: The rats were randomly divided into seven groups (six rats in each group): [D5] D5 administered at 100 ml/kg/24h; [D5150] D5 administered at 150 ml/kg/24h; [D5(½)100] D5 0.45% NaCl administered at 100 ml/kg/24h; [D5(½)150] D5 0.45% NaCl administered at 150 ml/kg/24h; [D5(1)100] D5 0.9% NaCl administered at 100 ml/kg/24h; [D5(1)150] D5 0.9% NaCl administered at 150 ml/kg/24h; [Control group] non-treated control rats. Intracardiac blood samples were collected from all the groups at the end of 24 h. RESULTS: [D5(1)150] and [D5(½)100] were the group closest to the control group in terms of both sodium (P = .937; P = .699, respectively) and effective osmolality (P = 1, P = .818, respectively). CONCLUSION: Our results showed that 0.9% NaCl and 0.45% NaCl solutions might be the safest and the most appropriate fluids to maintain normal plasma osmolality in medical situations requiring fluid therapy with high or maintenance rates, respectively.

Syringe-Free, Long-Axis in-Plane Versus Short-Axis Classic out-of-Plane Approach for Ultrasound-Guided Internal Jugular Vein Catheter Placement in Critically Ill Children: A Prospective Randomized Study.

OBJECTIVE: Although pediatric central venous catheterization is performed using ultrasound guidance, it is still a challenge. This study aimed to investigate the efficacy of the syringe-free, long-axis in-plane approach and compared the short-axis classic out-of-plane approach for ultrasound-guided central venous catheter placement in critically ill pediatric patients. DESIGN: Prospective randomized study. SETTING: Single institution, tertiary university hospital, pediatric care unit. PARTICIPANTS: The study comprised 60 patients ages three months to 15 years. INTERVENTIONS: Participants were randomly divided into two equal groups. Group I (n = 30) incorporated patients who underwent the long-axis, syringe-free in-plane approach, and group II (n = 30) incorporated patients who underwent the short-axis out-of-plane approach. MEASUREMENTS AND MAIN RESULTS: Performing time, number of needle passes, number of skin punctures, first-pass success rate, and related complications were evaluated. There were no differences between the two groups in terms of demographics and vein-related measurements (p > 0.05). Performing time was statistically shorter in group I compared with group II (32 [25-38] v 58 [42-70] s; p < 0.001). There was no statistical difference between first-pass success rates between groups (group I 86.6% v group II 80%; p = 0.731). There were no significant differences between the groups in the number of needle passes and skin punctures (p = 0.219 and 0.508, respectively). Complications occurred in both groups, but there was no significant difference (4/30 v 7/30; p = 0.317). CONCLUSIONS: The syringe-free, long-axis in-plane approach can be a safe and fast alternative for pediatric catheterization.

Acute-on-Chronic Liver Failure in Children: A Single-Center Experience.

OBJECTIVES: Acute-on-chronic liver failure and its outcomes have not yet been evaluated in detail in children. We aimed to evaluate the etiology, acute events, and prognostic factors of acute-on-chronic liver failure in children. MATERIALS AND METHODS: Pediatric patients (age 2-18 years) diagnosed with acute-on-chronic liver failure between April 2014 and April 2020 were evaluated retrospectively. Acute-on-chronic liver failure was defined as the presence of acute hepatic insult in previously diagnosed or undiagnosed chronic liver disease causing jaundice (total serum bilirubin ≥5 mg/dL) and coagulopathy (international normalized ratio of ≥2.0) and clinical and/or radiological ascites and/or hepatic encephalopathy within 4 weeks. Acute-on-Chronic Liver Failure Research Consortium and Chronic Liver Failure-Sequential Organ Failure Assessment scores were calculated for patients at first admission and at end of day 5 or before liver transplant. RESULTS: Our study included 29 patients. Underlying chronic liver diseases were mostly autoimmune hepatitis (51.72%) and Wilson disease (27.58%), with flare-ups of these diseases also the most common acute events (48.28% and 27.58%, respectively). Seven patients (24.14%) received liver transplants. At first admission, Acute-on-Chronic Liver Failure Research Consortium and Chronic Liver Failure-Sequential Organ Failure Assessment cut-off scores to predict liver transplant were 7.5 and 6.5; at end of day 5 or before transplant, cut-off scores were 8.5 and 7.5, respectively. The 8.5 cut-off score on day 5 was the most specific and sensitive to predict liver transplant. International normalized ratio cut-off of 3.04 predicted transplant requirement with maximum sensitivity and specificity. CONCLUSIONS: Wilson disease and autoimmune hepatitis were the most common underlying chronic and acute events of acute-on-chronic liver failure in children. Although an Acute-on-Chronic Liver Failure Research Consortium score ≥ 8.5 best predicted liver transplant, for patients with scores ≥ 7.5 and being followed in a nontransplant center, patient referral to a transplant center is appropriate.

Neuroprotective effect of roflumilast under cerebral ischaemia/reperfusion injury in juvenile rats through NLRP-mediated inflammatory response inhibition.

This study aims to investigate the protective effect of roflumilast, a phosphodiesterase (PDE)-4 enzyme inhibitor, and demonstrate its possible role in the development prevention of cerebral ischemia/reperfusion injury (CI/RI) after stroke induced by carotid artery ligation in juvenile rats. The rats were randomly divided into five groups: healthy group without any treatment, healthy group administered with 1 mg/kg roflumilast, CI group not administered with roflumilast, CI group administered with 0.5 mg/kg roflumilast, and CI group administered with 1 mg/kg roflumilast. In the CI groups, reperfusion was achieved 2h after ischemia induction; in the roflumilast groups, this drug was intraperitoneally administered immediately after reperfusion and at the 12th hour. At the end of 24h, the rats were sacrificed and their brain tissues removed for examination. The mRNA expressions obtained with real-time PCR of IL-1ß, TNF-α, and NLRP3 significantly increased in the CI/RI-induced groups compared with the control group, and this increase was significantly lower in the groups administered with roflumilast compared with the CI/RI-induced groups. Moreover, ELISA revealed that both IL-1 ß and IL-6 brain levels were significantly higher in the CI/RI-induced groups than in the controls. This increase was significantly lower in the groups administered with roflumilast compared with the CI/RI-induced groups. Histopathological studies revealed that the values closest to those of the healthy group were obtained from the roflumilast groups. Nissl staining revealed that the Nissl bodies manifested normal density in the healthy and roflumilast-administered healthy groups, but were rare in the CI/RI-induced groups. Roflumilast treatment increased these decreased Nissl bodies with increasing doses. Observations indicated that the Nissl body density was close to the value in the healthy group in the CI/RI-induced group administered with 1 mg/kg roflumilast. Overall, roflumilast reduced cellular damage caused by CI/RI in juvenile rats, and this effect may be mediated by NLRP3.

Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey.

OBJECTIVES: To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. MATERIALS AND METHODS: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. RESULTS: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was ≤7.10, and critical PCO2 ≥60 mm Hg. CONCLUSION: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them. HOW TO CITE THIS ARTICLE: Kockuzu E, Bayrakci B, Kesici S, Citak A, Karapinar K, Emeksiz S, et al. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs During the Winter Season in Turkey. Indian J Crit Care Med 2019;23(6):263-269.

Early Transient Neonatal Cyanosis Related to Interatrial Right-to-Left Shunting at an Altitude of 1890 Meters: A Report of Five Cases.

BACKGROUND: We report five term neonates born at an altitude of 1890 meters with transient early neonatal cyanosis due to right-to-left shunting at atrial level through patent foramen ovale. CASE PRESENTATION: The five neonates with no clinical sign or symptom other than marked cyanosis were examined in two neonatal units of Erzurum city. Hematologic and radiologic examinations were normal. Partial oxygen pressure (PO(2)) in the arterial blood samples was lower than 45 mmHg in all of the patients, and did not increase more than 15 mmHg in any of the patients after inhalation of 100% oxygen. Echocardiography revealed normal intracardiac structure. The right-to-left interatrial shunt at diastole was detected through a patent foramen ovale in all of these infants. By only observation with no treatment, diastolic right-to-left shunt disappeared in 40.15±9.52 hours. Oxygen saturation was increased from 69.80±9.55 percent to 90.40±8.80 percent. The patients were discharged from the hospital at 5.6±0.4 days of life. Follow up for 6 months revealed no clinical problem in any of the cases. CONCLUSION: Transient cyanosis can be seen in the very early neonatal period because of interatrial right-to-left shunting in some healthy term neonates born at an altitude of 1890 meters. Decreased right atrial compliance due to relative hypoxia at that altitude can be speculated to be the causative mechanism.

The effect of vitamin D treatment on serum adiponectin levels in children with vitamin D deficiency rickets.

OBJECTIVE: Adiponectin and its receptors are known to be expressed in osteoblasts and may have important functions in normal bone cells. The aim of this study was to investigate the effect of vitamin D therapy on serum adiponectin levels in children with vitamin D deficiency rickets (VDDR). METHODS: 21 patients with VDDR were included in the study. Patients were treated with 300,000 U D3 (IM) and calcium lactate (50mg/kg/ day, PO, for 10 days). Anthropometric parameters and serum biochemical markers including calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), intact parathormone (iPTH), 25-hydroxyvitamin D (25(OH)D), and adiponectin levels were measured before and after one month of therapy. RESULTS: Weight and length, but not BMI, increased significantly after treatment. Serum 25(OH)D level increased significantly after treatment, while serum adiponectin level decreased (4.21±1.84 vs 52.73±17.63 ng/ml, p<0.000; 150.1±66.14 vs 84.29±9.06 mg/ml, p<0.000, respectively). No significant correlations were found between serum adiponectin and 25(OH)D levels before and after treatment or between delta adiponectin concentrations and delta 25(OH)D levels. CONCLUSION: Serum adiponectin levels are increased in patients with VDDR, a finding which is probably related to increased osteoblastic activity.

Acute hydrocephalus caused by mumps meningoencephalitis.

Hydrocephalus is a rare complication of mumps. We report an 8.5-year-old boy with acute hydrocephalus associated with mumps meningoencephalitis.