RESUMEN
BACKGROUND: Two earthquakes on 6 February 2023 destroyed 10 cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. METHOD: Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. RESULTS: A total of 903 injured children (median age 11.62 years) were evaluated. Mean TUR was 13 h (interquartile range 32.5, max 240 h). Thirty-one of 32 patients with a TUR of >120 h survived. The patient who was rescued after 10 days survived. Two-thirds of the patients were given 50 mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% at 3000-4000 mL/m2 BSA and only 2% at >4000 mL/m2 BSA. A total of 425 patients had surgeries, and 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively. Crush-AKI developed in 314 patients (36% of all patients). In all, 189 patients were dialyzed. Age >15 years, creatine phosphokinase (CK) ≥20 950 U/L, TUR ≥10 h and the first-day IVF volume <3000-4000 mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. CONCLUSIONS: These are the most extensive pediatric kidney disaster data obtained after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.
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Lesión Renal Aguda , Síndrome de Aplastamiento , Terremotos , Humanos , Niño , Femenino , Masculino , Adolescente , Síndrome de Aplastamiento/terapia , Síndrome de Aplastamiento/complicaciones , Lesión Renal Aguda/terapia , Lesión Renal Aguda/etiología , Preescolar , Pronóstico , Tasa de Supervivencia , Estudios de Seguimiento , Diálisis Renal , Desastres , Lactante , Estudios RetrospectivosRESUMEN
Hüsrevoglu-Esen F. Altuner-Torun Y, Karakükçü Ç, Köse S, Sehriyaroglu A, Kafadar D, Esen A, Köse M. Gelsolin levels in patients with bronchiolitis. Turk J Pediatr 2018; 60: 286-289. Bronchiolitis is the leading cause of hospitalization in infants. Biomarkers can show severity of the disease and help in clinical management. In this study, the aim was to determine the clinical predictiveness of plasma gelsolin levels (pGSN) in acute bronchiolitis. From December 2013 to May 2014, 52 patients with bronchiolitis (aged < 24 months) were included in this study. Baseline clinical characteristic, complete blood count, C-Reactive Protein, plasma gelsolin levels, chest X-rays were obtained in all patients. The patients were divided into three groups as mild, moderate and severe based on clinical findings. There was no significant difference in pGSN levels between the control group and 3 study groups according to their clinical scores such as mild, moderate and severe bronchiolitis (p > 0.05). Recent studies reported that pGSN levels can be used as a biomarker in sepsis, inflammation and injuries. In this study, we have demonstrated that pGSN level is not a predictive biomarker of bronchiolitis and its severity. Hence, we hypothesized that pGSN levels can be used in bacterial infections rather than viral infections as a biomarker.
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Biomarcadores/sangre , Bronquiolitis/sangre , Gelsolina/sangre , Recuento de Células Sanguíneas/estadística & datos numéricos , Proteína C-Reactiva , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Childhood sarcoidosis is a very rare granulomatous disorder with an unknown etiology. Stage 1 disease is the most common whereas stages 2, 3, and 0 are rare in children. OBJECTIVE: To evaluate thoracic findings of pediatric pulmonary sarcoidosis on MRI and to compare them with CT findings. METHODS: Between August 2010 and May 2015, seven consecutive pediatric patients (four male, three female; age range: 8-18 years, mean age: 13.5 ± 3.01 years) who were diagnosed with sarcoidosis were enrolled in our study prospectively. Inclusion criterion was patients with stages 1-4 sarcoidosis who underwent contrast enhanced chest CT for initial diagnosis or follow-up evaluation of thoracic findings and exclusion criteria were patients with stage 0 disease with extra-pulmonary manifestations (n = 4). RESULTS: Two patients who recovered from stage 2 to stage 0 were interpreted as normal. Five patients had abnormal findings on chest CT, including hilar/mediastinal lymphadenopathy (n = 5, 71%), nodules larger than 3 mm (n = 4, 57%), ground glass opacity (n = 4, 57%), thickening of the pleura/fissure (n = 3, 42%), interlobular septal thickening (n = 2, 28%), atelectasis (n = 1, 14%), consolidation (n = 1, 14%), bronchiectasis (n = 1, 14%), intraparenchymal and subpleural cysts (n = 1,14%), fibrotic bands (n = 1, 14%), and enlarged pulmonary artery (n = 1, 14%). Findings that were detected on CT but not observed by lung MRI were nodules <3 mm (n = 4, 57%), mild bronchiectasis and mild ground glass opacity (n = 1, 14%), and subpleural and intraparenchymal cysts (n = 1, 14%). The sensitivity and specificity of MRI were 85.2% and 100%, respectively. There was no statistically significant difference between lung MRI and CT in detecting the thoracic findings in stages 1, 2, and 4 sarcoidosis (P = 0.1336, 95%Cl). CONCLUSION: Contrast-enhanced lung MRI with fast imaging sequences is a highly sensitive imaging modality and comparable with CT in evaluating both lung and cardiac abnormalities in pediatric sarcoidosis. Given there is no associated ionizing radiation, chest MRI is a promising imaging modality in this pediatric patient population. Pediatr Pulmonol. 2017;52:494-499. © 2016 Wiley Periodicals, Inc.
Asunto(s)
Sarcoidosis Pulmonar/diagnóstico por imagen , Adolescente , Niño , Medios de Contraste , Femenino , Gadolinio , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía Torácica , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. AIMS: To compare the effect of nebulized 7% HS/salbutamol and 3% HS/salbutamol to 0.9% saline/salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. STUDY DESIGN: Prospective, double-blinded randomized clinical study. METHODS: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A - 0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. RESULTS: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). CONCLUSION: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis.