Keywords Vitamin D intoxication . Alendronate . The zone of provisional calcification Dear editor, We read the article of Bereket and Ertogan [1], reporting a 3-month-old boy with vitamin D intoxication, who was treated with alendronate, with great interest. Here we present a 7-year-old male with acute vitamin D intoxication, who was treated with oral alendronate.A 7-year old male child was admitted to our Pediatric Emergency Unit with symptoms of anorexia, nausea, vomiting, polydipsia, polyuria and constipation. In history, he was administered 300,000 units of oral vitamin D (cholecalciferol) daily for 15 days by an internist, who suspected vitamin D deficiency. Above mentioned symptoms had occurred at the end of 15 days. The physical examination on admission revealed impaired turgor of the skin and dryness of the oral mucosa consistent with moderate dehydration. The rest of the examination was unremarkable. On admission, laboratory findings are shown in Table 1. The patient was admitted to the ward and emergency treatment was initiated with IV hydration (2,500 mL/m 2 /d, additional 20 mEq/l potassium chloride), furosemide (1 mg/kg/dose, every 6 h). Dietary calcium and vitamin D intake were restricted. A repeat serum calcium level was 14.8 mg/dL on the following day. Urinary calcium/creatinine ratio was initially high. Renal ultrasonography was reported as normal. Alendronate sodium 5 mg/d given by mouth was added to treatment after obtaining informed consent from the father. Serum calcium was still 14.3 mg/dL on the 3rd day of admission, the dose of alendronate was increased to 10 mg/d. Calcium levels decreased gradually in the following days. Then serum calcium dropped to 10.3 mg/dL on the 16th day and treatment was discontinued without any relapse. No side effects were noted with this treatment. Serum calcium levels remained normal thereafter. Urinary calcium/creatinine ratio decreased gradually to normal levels on 2nd month. Renal ultrasound examination at 2nd month after the admission did not show any evidence of nephrocalcinosis or other abnormalities. A radiographs of the hand taken on the admission, at 1 and 2 months after the admission did not show metaphyseal sclerosis. Laboratory values and treatment during follow-up are shown in Table 1.It is known that rapid normalization of serum calcium level and maintaining of normocalcemia are necessary to prevent acute complications and prolonged hypercalciuria and nephrocalcinosis [6]. Relative potency of alendronate to inhibit bone resorption is 10-20 times higher than that of pamidronate [7]. Although pamidronate has been used in children with vitamin D intoxication [2,4], studies examining the efficacy of oral alendronate in children are limited. In literature, we found one case report which represented efficacy of alendronate in hypervitaminosis D [1]. There is currently little information to guide clinicians as to duration of treatment and what criteria should be used to indicate termination of the treatment. In our study normalization of serum calcium le...

M ultisystem inflammatory syndrome in children (MIS-C) guidance has been issued by the World Health Organization and by the Centers for Disease Control and Prevention. 1,2 Pediatric acute ischemic stroke and thromboembolic conditions have been reported as rare complications of COVID-19 or MIS-C. [3][4][5] Venous thromboembolism has not been reported in children with no underlying disease who have undergone enoxaparin prophylaxis after recovery from MIS-C. This previously healthy 9-year-old boy without any history of head trauma arrived at the hospital obtunded, nonverbal, with a left-sided hemiparesis and leftsided central facial paralysis. He had fever, nausea, vomiting, diarrhea, and tenesmus for 5 days. His parents had been ill with SARS-CoV-2 infection about a month prior.

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‐1β, 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 β 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.

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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.

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Objective After the poliomyelitis eradicated, Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis in healthy child. It is one of the neuromuscular disorders required treatment to pediatric intensive care unit. Aim of this study is to present the three-year's experience of caring for patients with GBS admitted the PICU in the university hospital. Materials and MethodsPatients who were admitted to the PICU with diagnosed GBS between March 2016 and March 2019 were evaluated retrospectively.Results Twenty-two patients were diagnosed with GBS during study period. Seven of them needed PICU in 8 admissions, and they formed the study group. Four of them were female and 3 of them were male. They were 3 to12 years old. All of them were admitted in the PICU because of respiratory distress symptoms. The paralysis followed a nonspecific respiratory or gastrointestinal infection by 3 to 7 days, and ascending progress was present. Intravenous immunoglobulin infusion was administered in all patients. Five of them need to plasmapheresis and mechanical ventilator support. Stay to PICU length was 2 to 87 days and hospitalization length was14 to 98 days. All of them were discharged, and became able to walk unaided. Conclusion Our results show that PICU follow-up is very important in children with GBS. Although duration of mechanical ventilation, and hospitalization length is long, prognosis is good with effective management strategies. Keywords Guillain-Barre syndrome; plasmapheresis; intravenous immunoglobulin; pediatric intensive care unit Öz Amaç Poliomiyelit eradike edildikten sonra akut flask paralizinin sğlıklı çocuklardaki en sık nedeni Guillain-Barre Sendromu (GBS) olmuştur. GBS, çocuk yoğun bakım (ÇYB) ünitesinde tedavi olmayı gerektiren nöromusküler hastalıklardan birisidir. Bu çalışmanın amacı, GBS tanısı ile ÇYB ünitesinde yatırılarak tedavi edilen hastalarla ilgili bir üniversite hastanesinin üç yıllık deneyimini sunmaktır. Gereç ve Yöntemler Mart 2016 ve Mart 2019 tarihleri arasında GBS tanısı ile ÇYB ünitesinde takip edilen hastalar retrospektif olarak değerlendirildi. Bulgular Çalışma süresi boyunca 22 hasta GBS tanısı aldı. Bu hastalardan 7 tanesinin ÇYB ünitesinde takip edilmesi gerekti. Bu 7 hastanın 8 yatışı çalışma grubunu oluşturdu. Dört tanesi kız, 3 tanesi erkek idi. Yaşları 3 ile 12 yıl arasındaydı. Hastaların tümü solunum sıkıntısı semptomları ile ÇYB ünitesine yatırıldı. Hastalarda asendan paralizinin başlangıcından 3 ile 7 gün önce nonspesifik bir solunum yolu enfeksiyonu veya gastrointestinal enfeksiyon vardı. Tüm hastalara intravenöz immunoglobulin infüzyonu verildi. Beş hasta yatışında plazmaferez tedavisine ve mekanik ventilasyon desteğine ihtiyaç duyuldu. ÇYB ünitesinde yatış süresi 2 ile 87 gün ve hastanede yatış süresi 14 ile 98 gün idi. Hastaların hepsi taburcu edildi ve yardımsız yürüyebildi. Sonuç Sonuçlarımız, GBS tanılı hastalarda ÇYB takibinin çok önemli olduğunu gösterdi. Mekanik ventilatörde kalma süresi ve hastanede yatış süresi çok uzun olmasına rağmen, etkil...

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