Restrictive blood transfusion strategy is better than liberal transfusion strategy with regard to the hemodynamic and laboratory values during the early period. PI also provides valuable information regarding the efficacy of PRBC transfusion in clinical practice.

Zehirlenmeler çocuk yoğun bakım üniteleri ve hastane yatışlarında önlenebilir morbidite ve mortalitenin önemli bir kısmını oluşturmakla beraber yoğun bakım gerektiren zehirlenmeler hakkında bilgi sınırlıdır. Bu çalışmada Erciyes Üniversitesi Tıp Fakültesi Çocuk Yoğun Bakım Ünitesi'nde tedavi edilen zehirlenme olgularının değerlendirilmesi amaçlanmıştır. Yöntemler: 2009-2015 yılları arasında akut zehirlenme nedeniyle yoğun bakım ünitesine kabul edilen 186 hastanın kayıtları geriye dönük olarak incelendi. Bulgular: Olguların yaş aralığı 14 ay-17 yaş arasında değişmekteydi ve kız/erkek oranı 1,6:1 idi. Zehirlenmelerin çoğunluğunun evde (%87,6) ve oral yolla (%91,4) gerçekleştiği belirlendi. Olguların %59,1'inin kaza ile, %28,5'inin özkıyım amaçlı, ve %12,4'ünün önerilen tedavinin yanlış uygulanması sonucu zehirlendiği gözlendi. Olguların yaklaşık üçte ikisi (%60,2) ilaç ilişkili iken %39,8'i ilaç dışı maddelerle gerçekleşti. İlaç ilişkili zehirlenmelerde santral sinir sistemi ilaçları (%27,6) en sık rastlanan ajan iken ilaç dışı etkenlerden en çok korozif maddeler gözlendi. Bu çalışmada mortalite oranı %5,4 olarak bulundu. İlaç dışı maddelerle mortalite (%4,3) ilaç ilişkili mortaliteden (%1,1) daha yüksekti. Sonuç: Potansiyel toksinler, bunların saklanma koşulları ve evde güvenliği sağlayacak genel önlemler konusunda toplumun farkındalığının arttırılması ile birlikte sağlık politikalarında, endüstriyel aşamada ve düzenlemeler yapılması gerekmektedir. Anahtar Kelimeler: Zehirlenme, çocuk, yoğun bakım Introduction: Although poisonings represent a significant number of preventable causes of morbidity and mortality admissions to hospital and pediatric intensive care unit, data about poisonings requiring pediatric intensive care unit care level are limited. The aim of this study was to evaluate poisoned patients who were treated in the Pediatric Intensive Care Unit at Erciyes University Faculty of Medicine. Methods: The records of 186 patients admitted to the pediatric intensive care unit due to acute poisoning between 2009 and 2015 were retrospectively evaluated. Results: The poisoned patients were aged between 14 months-17 years and the female to male ratio was 1.6:1. Most poisonings occurred at home (87.6%) via the oral route (91.4%). It was noted that 59.1% of poisoning cases were accidental, whereas 28.5% were suicidal and 12.4% were a result of a therapeutic error. Nearly two-thirds (60.2%) of cases were drug-related, while 39.8% were non-drug-related. Central nervous system drugs (27.6%) were the most common agent in drug-related poisoning, however, corrosive substances were the most common in nondrug-related poisoning. The overall mortality rate in this study was 5.4%. Mortality from non-drug poisoning (4.3%) was higher than from drug-related causes (1.1%). Conclusion: The results of this study emphasize the need for regulations in industrial and health policies related to the aim of increasing awareness of potential toxins, appropriate storage of potential toxins, and general precautions to promote safety at home.

The index findings suggest that serum SPD is the most sensitive biomarker in diagnosis of VAP and it can be used as an early and organism specific marker for Acinetobacter baumannii and Pseudomonas aeruginosa.

Severe combined immunodeficiency (SCID) is an inherited disease with profoundly defective T cells, B cells, and natural killer (NK) cells. X-linked SCID (X-SCID) is its most common form. In this report, we describe a 4-month-old male with X-SCID who presented invagination and also showed hemophagocytic lymphohistiocytosis (HLH). The patient was admitted to our hospital with fever, cough, vomiting, monoliasis, and hepatosplenomegaly in postoperative period at the age of 3 months. The laboratory finding revealed no detectable T cells and hypogammaglobulinemia despite normal B-cell counts. Diagnosis of X-SCID was established by DNA analysis of the interleukin (IL)-2 receptor gamma chain gene (IL2RG); namely, we detected the novel mutation in the splicesite of exon 5 (c.595-1G>T). The patient died due to infection at the age of 4 months. Also, this case is the first report that describes the patient with X-SCID with presented invagination.

A 13-year-old male patient presented with a complaint of swelling of the left eye starting 3 days ago. Bullous lesion and purulent discharge were present on his left eyelids. Bacillus anthracis was shown in culture and diagnosis was confirmed. Oculocutaneous anthrax is a rare condition, but the diagnosis should be considered in patients with a painless necrotizing ulcer.

BACKGROUND: Pediatric head trauma is the most common presentation to emergency departments. Increased intracranial pressure (ICP) may lead to secondary brain damage in head trauma and early diagnosis of increased ICP is very important. Measurement of optic nerve sheath diameter (ONSD) is a method that can be used for determining increased ICP. In this study, we aimed to evaluate the relationship between optic nerve sheath diameter (ONSD) and Rotterdam computer tomography scores (RCTS) in pediatric patients for severe head trauma. METHODS: During January 2017-April 2018, medical records and imaging findings of children aged 0-18 years who underwent computed tomography (CT) imaging for head trauma (n=401) and non-traumatic (convulsions, respiratory disorders, headache) (n=255) complaints, totally 656 patient were evaluated retrospectively. Patients' age, sex, presentation and trauma type (high energy-low energy) were identified. Non-traumatic patients with normal cranial CT findings were considered as the control group. CT findings of traumatic brain injury were scored according to Rotterdam criteria. Patients were divided into groups according to their age as follows: 0-3 years, 3-6 years, 6-12 years and 12-18 years. RESULTS: In our study, tomographic reference measurements of the ONSD in pediatric cases were presented according to age. There was a statistically significant difference between ONSD of severe traumatic patients and the control group. Correlation between RCTS and ONSD was determined and age-specific cutoff values of ONSD for severe traumatic scores (score 4-5-6) were presented. CONCLUSION: In our study, reference ONSDs of the pediatric population for CT imaging was indicated. Our study also showed that ONSD measurement is a parameter that can be used in addition to the RCTS to determine the prognosis of the patient in severe head trauma, by reflecting increased intracranial pressure.

No abstract

ÖZ Amaç: Bu çalışmada kronik solunum yetmezlikli hastaların tedavisinde tüm dünyada giderek yaygınlaşan evde mekanik ventilasyon (EMV) uygulaması hakkındaki deneyimleri paylaşmak ve karşılaşılan sorunlara dikkat çekmek amaçlanmıştır. ABSTRACT Objective: In this study it was aimed to share experiences and to draw attention to the problems about home mechanical ventilation (HMV) which is used in the treatment of patients with chronic respiratory failure and is increasingly becoming widespread all over the world. Materials and Methods: The medical records of the patients having HMV due to chronic respiratory failure between January 2009 and March 2016 at Erciyes University Medical Faculty Pediatric Intensive Care Unit were retrospectively analyzed. Results: Twenty nine patients (14 males, 15 females) with a median age of 29 months (8.5-127.5) to start HMV application were included in this study. The median hospitalization time of the patients was 75 days (44-115) and the median follow up time after discharge was 110 days (52.5-510). Twenty-five (86.2%) patients had been followed up due to neurologic diseases, 4 patients (13.8%) due to lung diseases. Twenty five (86.2%) patients (13 males, 12 females) with a median age of 17 month (8-93) received invasive mechanical ventilation and 4 (13.8%) patients (2 males, 2 females) with a median age of 162 month (73.5-189) received non-invasive mechanical ventilation. Conclusion: In our country pediatric intensive care bed capacity is limited and HMV is a good option for alleviating the burden of chronic patients.