Carbon monoxide (CO) poisoning is one of the most common types of poisoning causing death worldwide. In our country, it occurs particularly during winter as a result of leak from stove or water heater, or as result of inhalation during a fire. Although most poisonings occur accidentally, some cases are suicide attempt. As CO is a substance that is not visible and has no taste or smell and is therefore difficult to detect, the gas can be a “silent killer” that is not noticed until effects develop. CO reacts with oxygen, creating carboxy hemoglobin (COHb), which leads to tissue hypoxia. In addition, it has direct effect of causing cellular damage. Although symptoms of acute poisoning are most commonly observed in patients admitted to emergency rooms, effects of chronic exposure to CO can also seen. Clinically, although it affects all organ systems, involvement of central nervous system (CNS) and cardiovascular system is predominant. Most common poisoning symptoms are weakness, dizziness, headache, nausea, and nonspecific flu-like symptoms, like vomiting. Depending on severity of exposure, seizures, syncope, and arrhythmia may also be observed. In pregnant women, fetus can be harmed with relatively low level of COHb. Poisoning in infants has a more severe course than seen in other age groups. Symptoms must be associated with cause of poisoning, and careful anamnesis and treatment must be conducted quickly. Oxygen is the antidote for CO. It is administered through a mask in the form of normobaric oxygen therapy or through specific devices in the form of hyperbaric oxygen therapy. In this review, clinical data and current diagnostic and therapeutic approaches concerning CO poisoning are discussed.

GİRİŞZehirlenme vücuda zararlı olabilecek maddelerin ağız, solunum, damar yolu veya cilt gibi yollardan alınmasıdır (1) . Aşılar ve gelişmiş medikal tedavilerle infeksiyonların azalmasından sonra zehirlenmeler çocukluk çağında kazalar ve tümöral hastalıklarla beraber en önemli mortalite nedenlerini oluşturmak-tadır. Acil başvurularda trafik kazaları, düşme ve yanıklardan sonra zehirlenmeler çocukluk çağı kazaları

Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged <18 years who were admitted to two paediatric intensive care units. Demographic data and reason for hospitalization were recorded. In addition, vital signs, haemogram parameters, and biochemistry results were recorded at 0 h and after 24 h of CRRT. Patients were compared according to whether they underwent CRRT or TPE; mortality between the two treatment groups was also compared. Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p < 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE.

ÖzetAmaç: Talaseminin dünyadaki en yaygın genetik hastalık olduğu düşünülmek-tedir. Gerek hastalık, gerekse tekrarlayan transfüzyonlar nedeniyle birçok sistemde komplikasyon ortaya çıkmaktadır. Bu çalışma; üzerinde daha az durulan böbrek glomerüler hasarının beta talasemi majorlü hastalarda mevcut olup olmadığının saptanması ve glomerüler hasarı saptarken üre, kreatinin, kreatinin klirensinin erken böbrek hasarı göstergeçlerinden olan sistatin c, B2 mikroglobulin ile kıyaslanması amacıyla yapıldı. Gereç ve Yöntem: Bu çalışma beta talasemi major tanısıyla çocuk hematoloji polikliniğimizce düzenli takip edilen hastalarda prospektif olarak yapılmıştır. Bulgular: Üre ile kreatinin klirensi ve sistain C arasında istatistiksel olarak anlamlı bir iliş-ki bulunmamaktadır(p>0.05). Kreatinin ile kreatinin klirensi arasında negatif yönde, %53.7 düzeyinde ve istatistiksel olarak ileri düzeyde anlamlı bir iliş-ki bulunmaktadır (p:0.002; p<0.01). Kreatinin ile sistain C ve Beta 2 mikroglobulin düzeyleri arasında istatistiksel olarak anlamlı bir ilişki bulunmamaktadır (p>0.05). Sistain C ile β-2 mikroglobulin arasında pozitif yönde, %86.1 düzeyinde ve istatistiksel olarak ileri düzeyde anlamlı bir ilişki bulunmaktadır (p:0.001; p<0.01). Tartışma: Literatürde GFR>40 ml/dk/1.73 m² olduğun-da kreatinin ile β-2 mikroglobulin ve sistatin c arası ilişkinin azaldığı belirtilmiştir. Bizim çalışmamız da bu literatür sonuçlarıyla benzerlik göstermekte-dir. Ancak renal parametrelerin birbiriyle korelasyonu hakkında kesin sonuç-lara varmak için daha geniş populasyonda yapılacak daha fazla sayıda çalış-malara ihtiyaç vardır. Anahtar KelimelerSistatin C; Böbrek; Talasemi; Beta 2-Mikroglobulin Abstract Aim: Thalassemia is accepted to be the most common genetic disease in the world. This study was performed to establish whether there was a glomerular renal damage, which was usually a less mentioned subject in patients with Beta Thalassemia Major, and to compare urea, creatinine and creatinine clearance with early indicators of kidney damage as Cystatin-C and β-2 microglobulin as on determining the glomerular damage. Material and Method:This study was prospectively performed in patients, who were regularly followed in the children hematology outpatient clinic with a diagnosis of Beta Thalassemia Major. Results: There was no statistically significant difference between urea and levels of creatinine clearance and Cystatin-C. There was a statistically negative relationship between creatinine and creatinine clearance at an advanced level as 53.7% (p: 0.002, p<0.01). There was not any significant relationship between Cystatin-C and levels of creatinine and B-2 microglobulin. There was a significant high positive relationship between Cystatin-C and B-2 microglobulin at level of 86.1% (p: 0.001; p<0.01). Discussion: The results of our study were also similar to the literature. However, new studies are required to carry out in wider populations in order to reach definite conclusions about correlation of renal parameters with each other.

A B S T R A C TPurpose: The exact etiology of febrile seizures (FS) is still unclear. However, it is thought that cytokine network activation may have a causative role. Therefore, this study aimed to evaluate the levels of interleukin-12 (IL-12) as a proinflammatory cytokine, interleukin-10 (IL-10) as an anti-inflammatory cytokine, and interferon-β (IFNβ), a marker of toll-like receptor-3 activation as a host response to viruses. These cytokine levels were analyzed in the cerebrospinal fluid (CSF) of children after a FS. Methods: With the approval of the Human Research Ethics Committee, 76 patients with FS, who underwent lumbar puncture (LP) for the exclusion of central nervous system (CNS) infection, and who didn't have CSF pleocytosis, were included in the study. The control group consisted of 10 patients with similar ages, with an acute febrile illness and who required LP to exclude CNS infection. The analyses were made by the enzymelinked immunoassay method. Results: Age, gender distribution and CSF IL-12 and IFN-β levels did not differ, but CSF IL-10 levels were significantly lower in the FS group as compared to the control group (0.78 ± 4.5 pg/ml, versus 27 ± 29 pg/ml, p < 0.0001). Conclusion: The low-level of CSF IL-10, considering its anti-inflammatory properties, may play a role in the etiopathogenesis of FS.

Background: Tal et al. severity score (TSS) and Modified Wood’s Clinical Asthma Score (M-WCAS) are used to evaluate the severity of the disease in children with bronchiolitis. It has recently been suggested that there is a relationship between bronchiolitis severity and hyponatremia. Aims and Objective: This study aimed to evaluate the relationship between both of scores and hyponatremia in children with bronchiolitis. Materials and Methods: This prospective observational study included 172 patients (age range: 1-24 months) admitted to the hospital with bronchiolitis diagnosis. Demographic and clinical features of patients were recorded, and the TSS and the M-WCAS were calculated. These values and their components were compared with serum sodium (Na) results obtained at hospital admission. Results: Of the 172 patients, 114 (66.3%) were male, and the mean age was 5.5 ± 4.6 months. The mean TSS and M-WCAS of the patients were 6.73±1.9, and 3.34±1.4, respectively. Hyponatremia (Na<135mEq/L) was detected in 30 (17.4%) patients. When the TSS and M-WCAS of patients with and without hyponatremia were compared, there was no statistically significant difference (p = 0.517; p = 0.662, respectively); however, there was a significant relationship between hyponatremia and low oxygen saturation levels (p= 0.026). Conclusion: No relationship was found between hyponatremia and TSS & M-WCAS. However, the relationship between hyponatremia and hipoxia suggests that hyponatremia is likely to increase with the severity of the disease.

ÖZAmaç: Damar içi kateter yerleştirilmesi gerek yoğun bakım üniteleri gerekse servislerde hasta çocukların yönetiminde giderek artan sıklıkta kullanılmaktadır. Çalışmada amaç, çocuk yoğun bakım hastalarında kateter yerleştirilmesi ile ilişkili komplikasyonlar ve risklerin değerlendirilmesidir. Gereç veYöntemler: 15 Ekim 2016 ile 15 Haziran 2017 tarihleri arasında Okmeydanı Eğitim ve Araştırma Hastanesi, Çocuk Yoğun Bakım Ünitesinde yatan 262 hastanın dosyası geriye dönük incelendi. Kateter takılan hastaların demografik bulguları, kateter takılma endikasyonları, takılma yeri ve kalış süresi, kateter takılma sırasında ve sonrasında gelişen komplikasyonlar, enfeksiyon oranları ve kateterin çekilme nedeni incelendi.Bulgular: Hastaların 123'üne toplam 148 adet kateter yerleştirildi. Kateterlerin 57'si (%38,5) kız, 91'i (%61,5) erkek hastaya takıldı. Hastaların yaş dağılımları 3 gün ile 17 yaş arasında olup ortalama kateter takılma yaşı 4,0±5,0 yıldı. Hastaların tartıları 2,2 ile 75 kilogram arasında idi. Hastaların 115'inde (%77,7) başvuru anında enfeksiyon vardı. Takılma nedenlerinden en sık üç neden 83 (%56,1) hastada damar yolu bulunamaması, 26'sında (%17,6) hemodiyaliz uygulanması ve 39'unda (%26,4) ilaç ve sıvı tedavisi idi. Hastalara takılan kateterlerin 94'ü (%63,5) femoral ve 54'ü (%36,5) jugulerdi. Kateterlerin 112'si (%75,7) acil şartlarda takıldı. Hastaların 3'ünde (%2,1) enfeksiyon dışı komplikasyon gözlendi. Kateter takılma sırasında ölen hastamız olmadı. Hastaların 2'sinde (%1,4) kateter sepsisi gelişti. Bin kateter gününe düşen kateter enfeksiyon sıklığı ise 1,6 olarak hesaplandı. Kateterlerin 124'ü (%83,8) gereksinimin ortadan kalkması nedeniyle çekildi. Sonuç: Çocuk hastalarında önem taşıyan kateterin tecrübeli kişiler tarafından yerleştirilmesi ve bakımı ile komplikasyon oranları azaltılabilmektedir. ABSTRACT Objective: Intravascular catheters are being increasingly used both in intensive care units and inpatient care for the management of children. Herein, we aimed to determine the risk factors and the complications associated with the intravascular catheter placement. Material and Methods: The medical records of 262 patients hospitalized in Okmeydanı Training and Research Hospital's Pediatric Intensive Care Department between October 2016 and June 2017 were evaluated retrospectively. The demographic data, indications for catheterization, the location and duration of catheterization, the complications including the rate of infection, and the reasons for removing the catheters were evaluated.Results: A total of 148 intravascular catheters were placed for 123 patients. We found that 57 catheters (38.5%) had been used in female and 91 (61.5%) in male patients. The age range was 3 days to 17 years and the weight range 2.2 to 75 kilograms. The mean age at catheter insertion was 4.0±5.0 years. Signs of infection at presentation were present in 115 patients (77.7%). The reasons for catheterization were lack of vascular access in 83 (56.1%) patients, hemodialysis in 26 (17.6%) patients and replacement of dr...

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