The medical records of 16 patients diagnosed as intracardiac thrombus were searched. The size, location and outcome of thrombus together with demographic data of patients were assessed. The median age of the patients was 2.2 years. Six patients were newborn and two patients were infant. The median size of thrombus was 9 mm. The localization was right atrium in seven, right ventricle in five, left ventricle in one, pulmonary artery in one, and superior vena cava in two patients. There was prematurity in five, ciyanotic congenital heart disease in one, blood culture positivity in three, malignancy in four, nephrotic syndrome in one, indwelling catheters in 10, and acquired or genetic thrombophilia in six patients as risk factors. In the treatment, the first choice was tissue plasminogen activator in two patients, heparin infusion in one patient and low molecular weight heparin in remaining 12 patients. In nine patients, therapy included parenteral antimicrobials together with anticoagulants. The result was complete resolution in 15 patients and in one patient thrombus was surgically removed. The median time was 16 (2-70) days for 50% resolution and 26 (3-93) days for complete resolution. There was a statistically significant (P = .027 and r = 0.5) correlation between the size and the complete resolution time. There was no anticoagulant therapy related major complication. In patients with intracardiac thrombus, selection of anticoagulant therapy may decrease the risk of complications. Surgery is rarely required and thrombolytics are not usually necessary for resolution of thrombus.

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Despite major advances in intensive care, sepsis continues to be a major cause of morbidity and mortality. Vitamin D is involved in various physiologic functions, including cellular responses during infection and inflammation. The aim of this study was to evaluate diagnostic value of 25-hydroxyvitamin D in childhood sepsis because it can be fatal if diagnosis delayed. The study included 40 children with sepsis and 20 children without sepsis (control group). We included only the patients with high probable sepsis, judged by clinical and laboratory findings, including positive blood culture. Blood samples were collected from patients with sepsis before treatment (pre-treatment group) and 48-72 hours later (post-treatment group). Treatment varied from ampicillin-sulbactam to cephalosporin. Blood samples were collected from control group once on admission. Serum 25-hydroxyvitamin D levels were significantly higher in sepsis (pre-treatment group) than control group (74 ± 8 ng/ml vs. 28 ± 12 ng/ml, p = 0.01) and the serum 25-hydroxyvitamin D levels were decreased to 44 ± 5 ng/ml (p = 0.01) after treatment. Moreover, we found significant positive correlation between 25-hydroxyvitamin D and each of well-know sepsis markers, C-reactive protein, tumor necrosis factor-α and interleukin-6. A cut-off point of 20 ng/mL for serum 25-hydroxyvitamin D showed 84% sensitivity and 76% specificity for sepsis diagnosis. This is the first study evaluating the diagnostic role of vitamin D in pediatric sepsis, thereby suggesting that serum 25-hydroxyvitamin D level can be used as a diagnostic marker for sepsis with high sensitivity and specificity.

Aim To evaluate thiol/disulphide homeostasis as a new indicator of oxidative stress in AKI patients and to determine the effect of HD on antioxidant balance and oxidative stress through plasma thiols. Methods This study was performed in patients aged between 12 months and 18 years prospectively who underwent hemodialysis due to AKI and were followed up for a year in a 22-bed tertiary pediatric intensive care unit. 20 patients and 39 controls were included. Results No difference was present between the groups in terms of age and gender. Median values of plasma native thiol, total thiol, and percent thiol were significantly lower in AKI group both before and after dialysis when compared to control group. The median dynamic disulphide values were significantly lower in the AKI group of predialysis compared to the controls. When pre- and postdialysis values were compared, disulphide values were statistically higher after dialysis. When pre- and postdialysis native thiol, dynamic disulphide, total thiol, and percent thiol median values were compared, postdialysis values were significantly higher than the predialysis values. There was a positive correlation between albumin, total thiol, and native thiol values before dialysis in the patient group. Conclusion AKI patients have low levels of thiol species showing the presence of oxidative stress and hemodialysis has a positive effect on thiol/disulphide balance. This new method may be an inexpensive and simple tool suitable for clinical studies and can be used in routine screening as a useful indicator to show oxidative stress.

Objective:To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children.Methods:A total of 140 children, including 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) children, who were admitted consecutively from March to August 2013 were evaluated prospectively. Data regarding the indication for echocardiography and therapeutic approaches used were documented. For evaluating disease severity, the Pediatric Risk of Mortality Score III (PRISM) was ascertained. The correlation between PRISM score and the requirement of echocardiographic evaluations were analyzed.Results:Patients ages were between 45 days to 18 years. The male-to-female ratio was 1.33. In 35.4% patients who underwent echocardiographic evaluation, no definitive alteration occurred in treatment approach, whereas in the remaining 64.6% patients, decisive or supplemental information was gathered. Echocardiography was indicated in 88% MV children and 46.2% SB children. Echocardiographic evaluation was necessary in MV children and there was a positive correlation between the PRISM score and the requirement of echocardiographic assessment (p<0.001).Conclusion:Echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. Basic training for intensivists in this procedure is crucial and needs to be improved and supported in critically ill.

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Çocuk hastalar için yürütülen evde bakım hizmetlerinin durumunu ve sonuçlarını değerlendirmek, böylece hastaların tıbbi gereksinimlerini belirleyerek daha kaliteli bir hizmet sunumu için yapılabileceklere ışık tutmaktır. Gereç ve Yöntemler: Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve Araştırma Hastanesi Evde Sağlık Hizmetleri Birimine (ESHB) kayıtlı olan ve en az bir yıldır izlemde olan çocuk hastalar çalışmaya dahil edildi. ESHB'nin kayıt defteri ve bilgisayar kayıtları esas alınarak Kasım 2012-Aralık 2013 tarihleri arasında geriye dönük taranarak elde edilen veriler kaydedilerek tanımlayıcı istatistikleri yapıldı. Bulgular: Çalışmaya toplam 63 hasta dahil edildi. Hastaların yaş ortalaması 8.87±4.6 olarak tespit edildi. Hastaların % 58.7'si serebral palsi (SP) ve motor mental retardasyon (MMR) tanıları ile takipliydi. Hastaların %34.9 (n=22)'unun trakeostomisi mevcuttu. On üç hasta (%20.6) kronik solunum yetersizliği nedeniyle ev tipi ventilatör kullanıyordu. Ev tipi ventilatör, nasal kanül veya maske ile oksijen, nasogastrik sonda, perkütan enteral gastrostomi (PEG), tekerlekli sandalye v.b. en az bir tıbbi cihaza bağımlı hasta oranı %71.4(n=45)'di. Doktor ziyaret sayısı bir hasta için ortalama 1.89±1.23 (ortanca:2) kez/yıl olarak tesbit edildi. Evde bakım hizmetinde görevli doktor dışı sağlık personeli ziyaret sayısı ise her hasta için ortalama 13.7±14.8 (ortanca:10) kez/yıl olarak hesaplandı. Çalışmamızda hastaların birincil olarak bakımı ile ilgilenen kişi %95.2 oranında anneydi. Sonuç: Evde bakım hizmetleri sayesinde özel sağlık bakım ihtiyaçları olan çocukların eve taburculuğu kolaylaşmakta ve hastane yatışlarının azalması maddi ve sosyal açıdan birçok avantajı beraberinde getirmektedir. Eksikliklerin belirlenmesi gelecekte daha kaliteli hizmet verilmesini sağlayacaktır. Bu hizmetin özellikle çocuk yaş grubunda kapsamlı bir ekip ile sosyal hizmetleri de içine alacak şekilde geliştirilmesi gereklidir.

of 12 M (3-84 M). Children with bloody diarrhoea acquired tolerance earlier, median age 8 M (5-23 M), than the group with cutaneous symptoms, median age 14 M (4-84 M), p = 0.005.It's safe and beneficial, both for children and parents, to perform OFC from 6 to 12 M.