Use of Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Primary Spontaneous Pneumothorax (PSP) in Children.

INTRODUCTION: This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature. METHODS: The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study. RESULTS: The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months. CONCLUSION:  Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.

Congenital central hypoventilation syndrome with hirschsprung's disease due to PHOX2B gene mutation in a Turkish infant.

The association of congenital central hypoventilation syndrome (also known as Ondine's curse) and Hirschsprung's disease is termed Haddad syndrome, which is an extremely rare disorder. Recent studies have described that the PHOX2B gene mutation was responsible for congenital central hypoventilation syndrome. We report a term newborn male infant with clinical manifestations of recurrent hypoventilation with hypercapnia and bowel obstructions. These clinical manifestations were compatible with congenital central hypoventilation syndrome and Hirschsprung's disease. PHOXB direct sequencing showed a heterozygous in-frame duplication of 21 bp leading to an expansion of +7 alanines within the 20 alanine stretch of the PHOX2B gene and confirmed our diagnosis. In addition to a high index of clinical suspicion, testing for PHOX2B mutation can assist iq the diagnosis of congenital central hypoventilation syndrome and in the prediction of disease progression. Infants presenting with congenital central hypoventilation syndrome should also be screened for Hirschsprung's disease.

Knowledge level on the management of pediatric burn patients among physicians working in the emergency department.

BACKGROUND: Prognosis of burned child is heavily influenced by how they are treated in the first 24 h. This study aimed to assess the degree of knowledge of emergency department physicians about the pediatric burn patients. METHODS: The study included 229 physicians (80 emergency medicine specialists, 84 pediatricians, and 65 general practitioners). The questions were organized into six categories, each based on the Turkish Ministry of Health's Burn Treatment Algorithm, American Burn Association criteria, and current literature: 1 - Etiology and Degree of Burn, 2 - Emergency Medical Intervention, 3 - Calculation of Burn Area and Fluid-electrolyte Treatment, 4 - Indications for Hospitalization in Burn Treatment Units, 5 - Judicial and Medical Liability, and 6 - Training Sufficiency and Demand for Burn Injury Training. Questionnaire form was sent to the participants through the WhatsApp application. The outcomes were rated as 75-100% good, 50%-75% moderate, and <50% poor. RESULTS: The overall knowledge level of physicians about pediatric burns was moderate, with a score of 57.65±10.13 (emergency medicine specialists: 60.11, pediatricians: 57.56, and general practitioners: 54.75). Emergency medical intervention scores (35.02±22.43) and burn treatment units and hospitalization indications scores (38.6±18.96) were both low. Despite having a statistically significant higher medical intervention score than the pediatricians and general practitioners, the knowledge level of the emergency medicine specialists was poor. CONCLUSION: As result, physicians practicing in the emergency department have a poor knowledge level about pediatric burns. Hence, pediatric burn education should be provided to all emergency department physicians.

Comparison of Ventilator-Associated Pneumonia in Patients Admitted to Intensive Care for COVID-19 Versus Other Reasons: A Single-Centered Study.

OBJECTIVE: COVID-19 patients in intensive care usually need invasive mechanical ventilation due to advanced respiratory failure. Deep lym- phopenia, immunosuppressive agents, long-term mechanical ventilation, and sedation may lead to ventilator-associated pneumonia; an impor- tant cause of morbidity and mortality. This study evaluates the frequency, clinical features, causative pathogens, and outcomes of ventilator-asso ciated pneumonia in COVID-19 patients who require mechanical ventilation. METHODS: The files of patients hospitalized in our hospital's intensive care clinic between March 25, 2020, and January 15, 2021, in the first 2 peaks due to COVID-19 and other reasons were retrospectively reviewed. RESULTS: We found ventilator-associated pneumonia rate in COVID-19 patients as 52.2%, which was statistically significantly higher than in non-COVID patients (33.5%). Purulent sputum, leukocyte, and procalcitonin levels were found to be significantly higher in both groups develop- ing ventilator-associated pneumonia. However, fever levels were found to be significantly normal in both groups; 97.1% and 87%, respectively. High fever was observed in only 2.9% of COVID-19 patients who developed ventilator-associated pneumonia. We determined a mortality rate of 17 (100%) in the diabetes patients in the COVID-19 group, which was statistically significantly higher than in non-COVID-19 patients at 9 (64.3%). The mortality rate (86.1%) in those with COVID-19 was statistically significantly higher than in those without COVID-19 (64.9%). CONCLUSIONS: Ventilator-associated pneumonia is more common in COVID-19 patients treated with mechanical ventilation than in non- COVID patients. The predictive value of fever in the diagnosis is very low, and agent production together with increased purulent sputum will be more valuable in terms of diagnosis.

Congenital granular cell tumor.

Congenital granular cell tumor or congenital epulis is a rare benign soft tissue lesion in newborns. It usually arises from the mucosa of the gingiva, either from the maxillary or mandibular alveolar ridge, and may cause respiratory or feeding problems. We reported a case of a 1-hour-old female newborn with a congenital granular cell tumor in the anterior maxillary alveolar ridge. The lesion was causing a feeding problem and was excised under general anesthesia when the newborn was 1 day old.

Inguinal hernias containing the uterus: a case series of 7 female children.

BACKGROUND: Hernia uteri inguinale (HUI), or uterus-containing inguinal hernia, is an extremely rare condition in which the uterus and uterine adnexa are found in the inguinal hernial sac in female infants. The uterus may be free within the sac adherent to the wall by adhesions or a true sliding component. However, in true sliding-type HUI, one of the walls of the hernia sac is formed by the uterus itself. PATIENTS AND METHODS: The medical records for all female children with inguinal hernia who were operated from 1999 through 2010 were reviewed retrospectively (n = 3100). RESULTS: Among these patients, we identified seven cases of HUI in infants with a normal female karyotype. The incidence of HUI was 0.23%. Patients were discharged on the postoperative 1st day with no complications. CONCLUSIONS: Surgeons should be aware of the possibility of presence of the uterus or another organ in the hernial sac in phenotypic female children, and sliding components should be replaced carefully into the abdomen to prevent any damage.

Effects of glutamine in critical illness.

OBJECTIVES: Under normal physiological conditions, glutamine is synthesized in large amounts by the human body and is considered nonessential. It has been hypothesized that glutamine may become a conditionally essential amino acid in patients with catabolic disease. The objective of this study is to investigate the prognostic effect of glutamine. METHODS: For this study, we selected 48 patients from the intensive care unit. Group I consisted of 33 patients whose treatment included glutamine. We placed the remaining 15 patients in group II, and they did not receive glutamine in their treatment. We retrospectively investigated treatment time, leucocyte levels and outcome. We carried out the study between January 2002 and January 2003 in Konya Governmental Hospital, Turkey. RESULTS: The average duration of hospital stay in the glutamine group was 8 +/- 1.2 days, 58% of them leaving hospital with surrogate. However, in the group whose treatment did not include glutamine, 42% of them left the hospital surrogate, their average hospital stay being 12 +/- 3 days. In the group receiving glutamine in the treatment, there was a prominent decrease in leukocyte levels compared to the other group, and hospitalization times were shorter but there was no statistically significant difference in mortality or survival rates. CONCLUSIONS: Glutamine may decrease the catabolism. It may also have a positive effect on treatment time and the consequences of therapy in critically ill patients.