The Evaluation of Transported Children to Pediatric Intensive Care Unit: Indications, Problems, and Outcomes.

OBJECTIVE: Critically ill children often require transport to tertiary centers where higher levels of care can be provided. In this study, we aimed to evaluate the reasons for transport, complications that occurred during transport, and the clinical outcomes of the patients transferred to our tertiary pediatric intensive care unit (PICU). METHODS: This retrospective study was conducted in a tertiary pediatric hospital with 250 beds and 20 tertiary PICU beds. RESULTS: During the study period, 108 patients were transferred to our PICU. The mean age was 75.0 ± 70.5 months (range, 1-211 months), and 59 were female. Most patients (82.4%) were transported by land; 17.6% were transported by air ambulance. Fourteen patients were referred for liver transplantation, and 7 patients were referred because of a need for extracorporeal membrane oxygenation support and heart transplantation or left ventricular assist device placement. Two patients were transported by air while on extracorporeal membrane oxygenation. Complications occurred in 25% of patients. CONCLUSION: Vital signs were assesed, and certain critical interventions such as intravenous fluids and respiratory support were provided more frequently during air transport, possibly due to the fact that physicians were always present during air transport. Quality improvement of transport teams and multicenter and nationwide studies on PICU transport are needed.

The Clinical Significance of Uric Acid and Complement Activation in the Progression of IgA Nephropathy.

BACKGROUND/AIMS: The aim of this study is to investigate the utility of clinical [age, gender, mean arterial pressure (MAP)] and laboratory parameters [eGFR, hemoglobin (Hgb), serum levels of creatinine, uric acid, albumin, proteinuria, hematuria] and also histopathological lesions (Oxford classification parameters, crescents, intensity and pattern of staining for C3, C1Q, IgA, IgG, IgM) as progression markers in patients with IgA Nephropathy (IgAN). METHODS: A total of 111 IgAN patients with a follow-up period >1 year or who reached kidney failure [GFR category G5 chronic kidney disease (CKD)] <1 year were investigated. Primary endpoint was the development of kidney failure or eGFR decline ≥50% from the baseline. Kaplan-Meier and Cox proportional hazards analyses were performed. RESULTS: Mean follow-up period was 33±29 months. Thirty-seven (33.3%) patients progressed to kidney failure and 4 (3.6%) patients developed eGFR decline ≥50% from the baseline after a median of 23 and 65 months, respectively. In multivariate Cox regression analysis, baseline levels of Hgb (HR:0.782, 95% CI 0.559-0.973, p=0.037), serum uric acid (HR:1.293, 95% CI 1.023-1.621, p=0.046), eGFR (HR:0.966, 95% CI 0.947-0.984, p=0.004) and intensity of C3 staining (HR:1.550, 95% CI 1.198-1.976, p=0.049) predicted primary endpoint. Serum uric acid level was associated independently with T score (ß=0.303, p=0.005) in patients with eGFR>30 ml/min/m2. CONCLUSIONS: Hyperuricemia and the deposition of C3 are independent risk factors for IgAN progression.

Saccharomyces cerevisiae fungemia due to an unexpected source in the pediatric intensive care unit.

BACKGROUND: Saccharomyces cerevisiae is one of the microorganisms commonly used as a probiotic. Although it is primarily known as non-pathogenic, it may cause fungemia, particularly in immunocompromised patients or children with a history of long-term hospital stay. CASE: A 6-month-old boy with a history of ventriculostomy, ventriculoperitoneal shunt implantation, and external drainage due to an intracranial mass and hydrocephalus was admitted to the pediatric intensive care unit (PICU) on postoperative day 14 due to respiratory distress and intubated on admission. He was started on broad spectrum antibiotics on day 25 of the admission due to fever and clinical deterioration. Culture of the central venous catheter (CVC) yielded S. cerevisiae, the CVC was removed, and the patient was started on caspofungin. We noticed that a patient near this patient was on a probiotic preparation containing S. boulardii for diarrhea before PICU admission. His fever subsided on day 2 of caspofungin, and laboratory findings normalized on follow-up. CONCLUSIONS: Probiotics should not be used in PICUs because of the high risk for CVC-related sepsis in critically ill children.

Clinical features and outcomes of children admitted to the pediatric intensive care unit due to posterior reversible encephalopathy syndrome.

OBJECTIVE: The aim of this study is to analyze the clinical features, neuroimaging findings and outcomes of the children admitted to our tertiary pediatric intensive care unit (PICU) due to posterior reversible encephalopathy syndrome (PRES). METHODS: This was a retrospective study where the hospital records of children admitted to PICU due to PRES between January 1, 2011 and January 1, 2021 were reviewed. RESULTS: We enrolled 14 patients with a median age of 8 years (IQR 2.2-14.2) to study. Eight (57 %) patients were male. All patients had comorbid illnesses such as hemophagocytic lymphohistiocytosis in 3, Β-cell acute lymphoblastic leukemia in 2, and different diagnosis in other patients as one one. Three patients had cardiac arrest, 9 patients had seizures, 5 patients had SE, 12 patients had altered mental status, 8 patients had hypertensive crisis, 1 patient had visual impairment. Thirteen patients had occipital involvement, 11 had parietal involvement, 4 had temporal involvement, 1 had thalamic involvement, 2 had cerebellar involvement, 1 had involvement of the corpus callosum, 1 had brainstem involvement, 1 had hippocampus involvement and 1 had involvement of the basal ganglia. Fourteen patients had supratentorial involvement while 3 had infratentorial involvement. Electroencephalogram was performed for 7 patients, out of which 6 revealed encephalopathy. Median PICU LOS was 19.5 days (IQR 13.2-49.2, minimum 2 - maximum 84 days). Five patients had neurologic sequelae. Four (28.5 %) patients died and ten patients survived. CONCLUSION: Co-occurence of hypertension and seizures should prompt consideration of PRES and urgent neuroimaging, particularly in patients on immunosuppressants or chemotherapeutics. Hypertension should be addressed aggressively in patients with PRES. Electroencephalographic monitoring should be performed if there is suspicion of SE or nonconvulsive SE. Despite its usually good prognosis, PRES can cause serious morbidity and mortality with delay in diagnosis or treatment.

Giant juvenile fibroadenoma of the breast: a clinical case. / Fibroadenoma gigante juvenil de mama: presentación de un caso clínico.

Juvenile giant fibroadenoma is a benign breast tumor and rare variant of the fibroadenomas. Clinical presentation is usually a painless, solitary and unilateral breast mass. It accounts for 0.5%-2% of all fibroadenomas and exact etiology is not known; however, hormonal influences are thought to be contributing factors. We present a case of a 20 cm diameter giant juvenile fibroadenoma of the breast in a 14-year-old girl. The patient was suffering from a painless, progressively enlarging mass for 1 year. Ultrasound revealed fibroadenoma and total surgical excision was performed. The patient is doing well in ten months of follow up.

El fibroadenoma gigante juvenil es un tumor de mama benigno y una variante rara de los fibroadenomas. La presentación clínica suele ser una masa tumoral indolora en la mama, aislada y unilateral. Representa entre el 0,5% y el 2% de todos los fibroadenomas y se desconoce su etiología precisa. Sin embargo, se cree que las hormonas son factores contribuyentes. En este artículo presentamos el caso de un fibroadenoma gigante juvenil de 20 cm de diámetro en la mama de una niña de 14 años. La paciente tenía una masa tumoral indolora, que se había agrandado progresivamente durante 1 año. La ecografía reveló la presencia de un fibroadenoma y se realizó una excisión quirúrgica. Tras diez meses de seguimiento, la paciente se encuentra bien.

Fibroadenoma gigante juvenil de mama: presentación de un caso clínico / Giant juvenile fibroadenoma of the breast: a clinical case

El fibroadenoma gigante juvenil es un tumor de mama benigno y una variante rara de los fibroadenomas. La presentación clínica suele ser una masa tumoral indolora en la mama, aislada y unilateral. Representa entre el 0, 5% y el 2% de todos los fibroadenomas y se desconoce su etiología precisa. Sin embargo, se cree que las hormonas son factores contribuyentes. En este artículo presentamos el caso de un fibroadenoma gigante juvenil de 20 cm de diámetro en la mama de una niña de 14 años. La paciente tenía una masa tumoral indolora, que se había agrandado progresivamente durante 1 año. La ecografía reveló la presencia de un fibroadenoma y se realizó una excisión quirúrgica. Tras diez meses de seguimiento, la paciente se encuentra bien.

Juvenile giant fibroadenoma is a benign breast tumor and rare variant of the fibroadenomas. Clinical presentation is usually a painless, solitary and unilateral breast mass. It accounts for 0.5%-2% of all fibroadenomas and exact etiology is not known; however, hormonal influences are thought to be contributing factors. We present a case of a 20 cm diameter giant juvenile fibroadenoma of the breast in a 14-year-old girl. The patient was suffering from a painless, progressively enlarging mass for 1 year. Ultrasound revealed fibroadenoma and total surgical excision was performed. The patient is doing well in ten months of follow up.