Publications by authors named "Faruk Ekinci"

25 Publications

  • Page 1 of 1

An Alternative Central Venous Access Route for Pediatric Patients with Chronic Critical Illness: The Transhepatic Approach.

Indian J Pediatr 2022 Jun 24. Epub 2022 Jun 24.

Department of Pediatric Intensive Care, Balcali Hospital, Medical Faculty Cukurova University, Adana, Turkey.

Objective: To evaluate the safety and functionality of the transhepatic approach as an alternative route for central venous catheterization in pediatric patients with chronic critical illness.

Methods: The study included data of 12 chronic critically ill pediatric patients who underwent central venous catheterization with transhepatic approach. The indications, procedure details, mean patency time, and catheter-related complications were retrospectively analyzed.

Results: A total of 16 central venous catheters were placed through the transhepatic approach. A 5F port catheter was used in eight attempts, a 5F PICC in two attempts, and an 8-14F Hickman-Broviac catheter in six attempts. All procedures were performed with technical success. The mean patency time of the catheters was 132.1 d (range: 12-540 d). In the long-term follow-up, catheter-related sepsis was detected in a patient, and six catheters lost functionality due to malposition.

Conclusion: The transhepatic approach is a safe and functional alternative route for central venous access in chronic critically ill pediatric patients requiring long-term vascular access. The procedure using ultrasonography and fluoroscopy can be performed with high technical success. In the long-term follow-up, Dacron felt cuff tunneled catheters placed in the subcostal space with a transhepatic approach remained functional for a long time.
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http://dx.doi.org/10.1007/s12098-022-04219-8DOI Listing
June 2022

A Rare Complication of Central Venous Catheterization Interventions: Subdural Effusion.

Indian J Crit Care Med 2022 Mar;26(3):384-386

Department of Radiology, Cukurova University Faculty of Medicine, Adana, Turkey.

Central venous catheterization interventions are used in various clinics for diagnostic and treatment purposes. Establishing vascular access is a difficult and critical step, especially in critically ill pediatric patients. Complications include ventricular arrhythmia, air embolism, carotid artery puncture, cardiac tamponade, pneumothorax, hemothorax, artery-vein laceration, thoracic duct injury, and catheter malposition can be observed in patients after central venous catheterization interventions. In this case report, a pediatric case was discussed, in which a central venous catheter was inserted without the usage of imaging methods and without confirming the location and was used, even though no blood return was obtained. It was aimed to draw attention to subdural effusions and spinal canal interventions, which is a rare complication of central venous catheterization interventions.

How To Cite This Article: Misirlioglu M, Horoz OO, Yildizdas D, Ekinci F, Yontem A, Pehlivan UA. A Rare Complication of Central Venous Catheterization Interventions: Subdural Effusion. Indian J Crit Care Med 2022;26(3):384-386.
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http://dx.doi.org/10.5005/jp-journals-10071-24132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015927PMC
March 2022

Treatment of Candida urinary tract infections with micafungin in children.

Pediatr Int 2022 Jan;64(1):e15033

Department of Pediatric Infectious Diseases, Çukurova University Faculty of Medicine, Adana, Turkey.

Background: Candida urinary tract infections (UTIs) are common nosocomial infections among critically ill patients hospitalized in pediatric intensive care Units (PICU). We aimed to report outcomes of critically ill pediatric patients who received micafungin for hospital acquired Candida UTIs. We analyzed treatment success rates and success rates among different Candida species.

Methods: This retrospective cohort study included patients who received micafungin for Candida UTI as first choice in our PICU between January 2017 and July 2018. Data, including demographic and clinical features, were retrospectively collected from medical files of the patients. Treatment efficacy was defined as resolution of clinical symptoms and a negative culture for Candida at day 14 after initiation of micafungin treatment.

Results: Twenty-four pediatric patients (median age 5.72 years, range, 2 months-16 years) were included in the present study. Fourteen (58.3%) patients had urinary catheters at the time of Candida isolation. Resolution of symptoms and a negative culture at day 3 of micafungin treatment were achieved in 17 (70.8%) and 14 (58.3%) patients, respectively. Moreover, 19 (79.2%) patients had a normal urine analysis and negative culture 14 days after initiation of micafungin treatment. Treatment responses did not statistically differ between Candida species.

Conclusions: Micafungin is safe and efficacious in critically ill pediatric patients with Candida UTIs. Its efficacy in our pediatric population was as comparable to that observed in adult studies, therefore, it should be considered as an effective therapeutic option in Candida UTIs of critically ill pediatric patients.
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http://dx.doi.org/10.1111/ped.15033DOI Listing
January 2022

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Pediatric Acute Respiratory Distress Syndrome.

Turk Thorac J 2021 Jul;22(4):274-278

Department of Pediatric Intensive Care, Cukurova University, Faculty of Medicine, Adana, Turkey.

Objective: Acute respiratory distress syndrome (ARDS) is a clinical picture that indicates severe acute hypoxemic respiratory insufficiency. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are convenient, uncomplicated, and inexpensive parameters that can be used in detecting the severity of the disease. The prognostic role of NLR and PLR in patients with pediatric ARDS is unknown. The aim of this study was to investigate if there was any relationship between initial hematological parameters and the stages of ARDS, duration of mechanical ventilation and the length of intensive care stay in pediatric ARDS.

Material And Methods: Of 34 patients diagnosed with ARDS, 5 excluded, a total of 29 patients who were followed in our pediatric intensive care unit between 2016 and 2018 were retrospectively enrolled. Patients were retrospectively registered in terms of demographical features, disease severity scores (PIM2, PRISM III, PELOD scores), lymphocyte, neutrophil and platelet counts and NLR, PLR values in complete blood count during intensive care unit stay and on the day of discharge, the stages of ARDS, duration of mechanical and the length of intensive care stay.

Results: There was a significant relationship between NLR values and ARDS stages on the first day of the admittance (P = .003). There was a moderate correlation between NLR and PELOD scores on the day of admittance and it was statistically significant (r = 0.45, P = .026). There was no correlation between mechanical ventilation time and the length of intensive care stay and NLR-PLR values. Platelet-to-lymphocyte ratio was not identified as a prognostic factor in our study.

Conclusion: In diagnosis of the severity of ARDS with severe acute hypoxemic respiratory insufficiency, NLR is a convenient and inexpensive parameter that can only be calculated by complete blood count.
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http://dx.doi.org/10.5152/TurkThoracJ.2021.20087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975371PMC
July 2021

Evaluation of Pediatric Brain Death and Organ Donation: 10-Year Experience in a Pediatric Intensive Care Unit in Turkey.

Turk Arch Pediatr 2021 Nov;56(6):638-645

Department of Pediatric Neurology, Çukurova University School of Medicine, Adana, Turkey.

Objective: We aimed to investigate the rate of brain death (BD) determinations and organ donations (OD) in our tertiary pediatric intensive care unit (PICU), and to report the data on the demographic pattern and supplementary descriptive data on BD declarations.

Methods: The study was designed as a retrospective, single-center, descriptive cohort study. We evaluated all children who were determined to meet the criteria for BD in our tertiary PICU between January 2011 and December 2020.

Results: During study period, BD was identified in 24 patients among 225 total deaths (10.7%). Their median age was 85 months (8-214) and the male-to-female ratio was 1 : 1. The most common diagnosis was meningoencephalitis in 25%, followed by traumatic intracranial hemorrhage (16.7%). The median time from admission to PICU until BD diagnosis was 6.5 days. The time from the first BD physical examination to the declaration of BD was 27.5 hours. There was no statistically important difference between donors and non-donors. The apnea test (AT) was the most performed ancillary method (100%), followed by electroencephalogram (EEG) (66.7%), and magnetic resonance angiography or computed tomography angiography (MRA/ CTA) (54.2%). Hyperglycemia developed in 79.2% of the cases, and 70.8% developed diabetes insipidus (DI). Five patients (20.8%) were organ donors in study group. In the study, 13 solid organ and 4 tissue transplantations were performed after OD.

Conclusion: Awareness of the incidence and etiology may contribute to the timely diagnosis and declaration of brain death, and with the help of good donor care, may help in increasing OD rates in the pediatric population.
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http://dx.doi.org/10.5152/TurkArchPediatr.2021.21130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8849511PMC
November 2021

The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey.

Int J Clin Pract 2021 Dec 14;75(12):e14978. Epub 2021 Nov 14.

Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey.

Aim Of The Study: Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey.

Methods: This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey.

Results: A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003).

Conclusions: The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.
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http://dx.doi.org/10.1111/ijcp.14978DOI Listing
December 2021

Acquired Bartter-like Syndrome Presenting with Polyuria and Reversible Hypokalemia Associated with Colistin Use in a Critically Ill Pediatric Patient.

Indian J Crit Care Med 2021 Jul;25(7):822-824

Department of Pediatric Intensive Care, Cukurova University, Faculty of Medicine, Adana, Turkey.

We report a case of an acquired Bartter-like syndrome (BLS) after 3 days of treatment initiation and improved after discontinuation of colistin therapy in pediatric intensive care unit. A 2-month-old girl with spinal muscular atrophy type 1 who had respiratory distress received colistin therapy with a dose of 5 mg/kg/day for complex isolation from endotracheal aspirate on the 12 day follow-up. Polyuria (6 mL/kg/hour) in the presence of normal blood pressure and hypokalemic metabolic alkalosis were developed on the 3 day of colistin treatment. Colistin was stopped on the 4 day, and 2 days after discontinuation of colistin, polyuria improved dramatically. Her metabolic alkalosis and hypokalemia discontinued after 2 and 4 days, respectively. There are very few reports about colistin-induced BLS. The onset of polyuria, hypokalemia, and metabolic alkalosis during treatment with colistin and resolution after interruption suggest a causative relationship. Yavas DP, Ekinci F, Horoz OO, Gundeslioglu OO, Atmis B, Yildizdas D. Acquired Bartter-like Syndrome Presenting with Polyuria and Reversible Hypokalemia Associated with Colistin Use in a Critically Ill Pediatric Patient. Indian J Crit Care Med 2021;25(7):822-824.
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http://dx.doi.org/10.5005/jp-journals-10071-23898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286381PMC
July 2021

Frequency and Causes of Delirium in Pediatric Intensive Care Unit: A Prospective Observational Study.

Indian J Crit Care Med 2021 Jun;25(6):715-719

Department of Pediatric Intensive Care, Cukurova University Medicine Faculty, Adana, Turkey.

Background: The number of studies evaluating delirium and its frequency in critically ill infants, children, and adolescents is increasing day by day. The primary objective of this study was to evaluate all patients hospitalized in our pediatric intensive care unit (PICU) in terms of pediatric delirium, to determine the frequency and risk factors of pediatric delirium.

Patients And Methods: The patients included in this study had been hospitalized in the PICU between November 1, 2018, and August 31, 2019, and were followed up for more than 48 hours.

Results: Delirium was detected in 14 patients (9.9%) through regular evaluations. The Pediatric Index of Mortality 2 (PIM2) scores and the length of stay in the PICU were higher in patients with delirium ( = 0.03 and = 0.01, respectively). The use of respiratory support, sedation-analgesia, vasoactive and corticosteroid treatments, and physical restraints were higher in patients with delirium and were statistically significant ( <0.05). Following admission to the PICU, psychosocial interventions were implemented for 76.1% of the whole cohort. Delirium developed in only five (4.5%) of the 108 patients who underwent psychosocial interventions, while it was detected in nine (26.5%) of the 34 patients who did not receive psychosocial interventions ( = 0.001). The psychosocial intervention was associated with a lower likelihood of delirium (odds ratio [OR], 0.237; = 0.044). An increasing number of days in the PICU was independently associated with increasing odds of delirium (OR, 1.095; = 0.037 for each day).

Conclusions: We observed that the risk factors associated with delirium were similar to previous studies. Additionally, psychosocial intervention before delirium symptoms developed was associated with a lower risk of developing delirium. However, multicenter randomized controlled trials are needed on this subject.

How To Cite This Article: Yontem A, Yildizdas D, Horoz OO, Frequency and Causes of Delirium in Pediatric Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2021;25(6):715-719.
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http://dx.doi.org/10.5005/jp-journals-10071-23857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286413PMC
June 2021

Reply to: Clinical utility of the pediatric respiratory rate-oxygenation index.

Eur J Pediatr 2021 11 23;180(11):3421-3422. Epub 2021 May 23.

Division of Pediatric Intensive Care Unit, Faculty of Medicine, Çukurova University, Sarıçam, Adana, Turkey.

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http://dx.doi.org/10.1007/s00431-021-04127-7DOI Listing
November 2021

Bedside sonographic assessments for predicting predialysis fluid overload in children with end-stage kidney disease.

Eur J Pediatr 2021 Oct 30;180(10):3191-3200. Epub 2021 Apr 30.

Faculty of Medicine, Division of Pediatric Nephrology, Çukurova University, Sarıçam, Adana, Turkey.

Although the number of studies evaluating methods to predict fluid overload is increasing, the assessment of fluid status in children on dialysis is still fraught with inaccuracies. We aimed to evaluate the predictive capability of lung ultrasounds and the inferior vena cava collapsibility index (cIVC) in predialysis overhydration in children with end-stage kidney disease. Ten children with end-stage kidney disease who were on an intermittent hemodialysis program were included. The hydration status of the patients was clinically evaluated. Moreover, 30 predialysis and 30 postdialysis lung ultrasound, cIVC, and bioimpedance spectroscopy (BIS) measurements were performed. The median age of the participants was 14 (IQR, 13-15) years, and two (20%) were male. There was a strong positive correlation between the predialysis total number of B-lines and predialysis fluid overload (r=0.764, p<0.001). Additionally, there was a moderate negative correlation between predialysis cIVC and predialysis fluid overload (r=-0.599, p=0.002). Although the moderate correlation was determined between the postdialysis fluid overload and total number of B-lines, no correlation was determined using cIVC. Receiver operating characteristic curves demonstrated that the total number of B-lines and cIVC could successfully predict the predialysis fluid overload (relative hydration >7% derived from the BIS; AUROC 0.82 and 0.80, respectively). When both evaluations were combined, if either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and ≤23.5, respectively), it was detected in 16 out of 17 sessions (sensitivity 94%). If either one was outside the corresponding cutoff range (total number of B-lines >10.5 and cIVC ≤18.2), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions. Conclusion: Randomized controlled studies are needed to prove the reliability of the combined use of lung ultrasounds and cIVC in the assessment of predialysis fluid overload. What is Known: • The association of chronic fluid overload with increased morbidity and mortality raises the need for optimal determination of fluid overload in pediatric patients who are dialysis-dependent at a young age. • The linear correlation between the total number of B-lines on lung ultrasound images and fluid overload by weight has been shown. What is New: • This study evaluates the lung ultrasound and inferior vena cava collapsibility index combined in predicting fluid overload in dialytic children. • If either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and cIVC ≤18.2, respectively), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions.
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http://dx.doi.org/10.1007/s00431-021-04086-zDOI Listing
October 2021

Point-of-care ultrasound assessment of the inferior vena cava distensibility index in mechanically ventilated children in the operating room

Turk J Med Sci 2021 06 28;51(3):1071-1079. Epub 2021 Jun 28.

Department of Anesthesiology and Reanimation, Medical Faculty, Çukurova University, Adana, Turkey

Background And Aim: Point-of-care ultrasound imaging of the inferior vena cava distensibility index is a potential indicator for determining fluid overload and dehydration in the mechanically ventilated patients. Data on inferior vena cava distensibility index and inferior vena cava distensibility variability are limited in mechanically ventilated pediatric patients. That is why our aim in this study was to measure inferior vena cava distensibility index and to obtain mean values in pediatric patients, ventilated in the operating room before the ambulatory surgical procedure started.

Materials And Methods: This crosssectional study was performed between February 2019 and February 2020. Ultrasonographic measurements were performed in a total of 125 children.

Results: In a period of 13 months, the measurements were performed in a total of 125 children, of which 120 (62.5% male) met the criteria and were included in the study. Overall inferior vena cava distensibility index (%): mean ± SD: 6.8 ± 4.0, median (min–max): 5.7 (1.4–19.6), IQR: 3.8–8.7. Overall inferior vena cava distensibility variability (%): mean ± SD: 6.5 ± 3.7, median (min–max): 5.5 (1.4–17.8), IQR: 3.7–8.4.

Conclusion: Our study is the largest series of children in the literature in which inferior vena cava distensibility index measurements were investigated.
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http://dx.doi.org/10.3906/sag-2006-300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283460PMC
June 2021

Point-of-care ultrasound use in pediatric intensive care units in Turkey.

Turk J Pediatr 2020 ;62(5):770-777

Department of Pediatrics, Division of Pediatric Critical Care Medicine, Çukurova University Faculty of Medicine, Adana, Turkey.

Background: Point-of-care ultrasound is commonly used in pediatric intensive care units in recent years. The aim of this study was to find an answer to the question `where are we now in Turkish pediatric intensive care units for point-of-care ultrasound use?`.

Methods: This was a multicenter, descriptive study in which we developed an online survey. We asked 45 questions about point-of-care ultrasound using fields and training status of clinicians in pediatric intensive care units.

Results: A total of 29 units responded to the questions completely. Of all included units 41.4% were in public hospitals, 6.9% in city hospitals (public-private partnership) and 51.7% in university hospitals. The most common use of point-of-care ultrasound was central venous catheter insertion. Lung ultrasound use rates for detection of pleural effusion, evaluation of pneumothorax, and diagnosis of pneumonia were 93.1%, 86.2%, and 34.5%, respectively. Critical care echocardiography use rate was 79.3%. In 89.7% of the units, intensive care specialists had been specifically trained for the use of point-of-care ultrasound.

Conclusions: Our study showed that point-of-care ultrasound was not only used for central venous catheterization but also for widespread fields in pediatric intensive care units. With an experienced team, it is possible to perform rapid, noninvasive and repeatable ultrasonographic assessment of patients. In our view point-of-care ultrasound is the new stethoscope of critical care physicians.
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http://dx.doi.org/10.24953/turkjped.2020.05.008DOI Listing
August 2021

A rare cause of pediatric acute pancreatitis: Perindopril intoxication.

Turk J Emerg Med 2020 Oct-Dec;20(4):199-201. Epub 2020 Oct 7.

Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey.

Acute pancreatitis is a reversible inflammatory condition of the pancreas. It usually develops on the basis of trauma, structural abnormalities, and chronic systemic diseases. A definitive causal correlation between a drug and acute pancreatitis is quite difficult for clinicians. Drugs play a vital role in the etiology in approximately 10% of children with pancreatitis. More than 50 drugs including angiotensin-converting enzyme inhibitors have been reported to cause pancreatic damage. There was no pediatric case report developed pancreatitis following perindopril use. A pediatric case of pancreatitis following perindopril intake was presented in this article to emphasize pancreatitis, which is one of the complications that may occur after drug intake.
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http://dx.doi.org/10.4103/2452-2473.297465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549519PMC
October 2020

Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children.

Eur J Pediatr 2021 Apr 19;180(4):1099-1106. Epub 2020 Oct 19.

Faculty of Medicine, Division of Pediatric Intensive Care Unit, Çukurova University, Sarıçam, Adana, Turkey.

The primary objective of this study was to evaluate whether pediatric respiratory rate-oxygenation index (p-ROXI) and variation in p-ROXI (p-ROXV) can serve as objective markers in children with high-flow nasal cannula (HFNC) failure. In this prospective, single-center observational study, all patients who received HFNC therapy in the general pediatrics ward, pediatric intensive care unit, and the pediatric emergency department were included. High-flow nasal cannula success was achieved for 116 (88.5%) patients. At 24 h, if both p-ROXI and p-ROXV values were above the cutoff point (≥ 66.7 and ≥ 24.0, respectively), HFNC failure was 1.9% and 40.6% if both were below their values (p < 0.001). At 48 h of HFNC initiation, if both p-ROXI and p-ROXV values were above the cutoff point (≥ 65.1 and ≥ 24.6, respectively), HFNC failure was 0.0%; if both were below these values, HFNC failure was 100% (p < 0.001).Conclusion: We observed that these parameters can be used as good markers in pediatric clinics to predict the risk of HFNC failure in patients with acute respiratory failure. What is Known: • Optimal timing for transitions between invasive and noninvasive ventilation strategies is of significant importance. • The complexity of data requires an objective marker that can be evaluated quickly and easily at the patient's bedside for predicting HFNC failure in children with acute respiratory failure. What is New: • Our data showed that combining p-ROXI and p-ROXV can be successful in predicting HFNC failure at 24 and 48 h of therapy.
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http://dx.doi.org/10.1007/s00431-020-03847-6DOI Listing
April 2021

Sedation and Analgesia Practices in Pediatric Intensive Care Units: A Survey of 27 Centers from Turkey.

J Pediatr Intensive Care 2021 Nov 18;10(4):289-297. Epub 2020 Sep 18.

Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey.

The management and monitoring of sedoanalgesia are important measures in improving the efficacy of procedures and mechanical ventilation, as well as reducing adverse effects and preventing withdrawal syndrome, and delirium in pediatric intensive care units (PICUs). As there is an ongoing need to clarify the best approach to sedoanalgesia in PICUs, we aimed to analyze the current approaches in sedation, analgesia, withdrawal, and delirium practices among PICUs in Turkey. Twenty-seven PICUs completed the survey. Only 9 (33.3%) and 13 (48.1%) centers had a written protocol for analgesia and sedation, respectively. Paracetamol and a combination of midazolam and fentanyl were preferred in 51.8 and 40% of the PICUs for postoperative periods, respectively, and 81.4% of the units preferred ketamine for short-term interventions. For prolonged sedation in mechanically ventilated children, a combination of benzodiazepines and opiates were the most preferred first-line agents with a very high percentage of 81.4%, whereas ketamine and dexmedetomidine accounted for 62.9 and 18.5%, respectively, as second-line options. Although sedative and analgesic agent preferences were comparable with the relevant literature, we should focus on developing a standardized, evidence-based algorithm for sedation and analgesic drugs.
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http://dx.doi.org/10.1055/s-0040-1716886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8561803PMC
November 2021

Pulmonary embolism complicated the course of anti-N-methyl-D aspartate receptor encephalitis in a pediatric intensive care unit setting: a case report.

Postgrad Med 2021 Jan 4;133(1):102-107. Epub 2020 Aug 4.

Department of Pediatric Neurology, Cukurova University Faculty of Medicine , Adana, Turkey.

Introduction: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, an autoimmune neurological disorder resultant from the autoantibodies directed to the NR1 subunit of the NMDAR, is mainly characterized by neuropsychiatric symptoms, including behavior changes, paranoia, delusions, epileptic seizures, movement disorders, aphasia, insomnia, dysautonomia, and altered consciousness. Pulmonary embolism (PE) presents with pleuritic chest pain, hemoptysis, and respiratory distress by obstruction of the pulmonary circulation. Unlike adults, pediatric PE usually related to obvious risk factors, including central venous line, malignancy, lupus erythematosus, renal disease, congenital thrombophilia, surgery, and major trauma. Besides, PE has rarely been encountered in adult patients with anti-NMDAR encephalitis even in the absence of these risk factors.

Case Presentation: A 16-year-old male patient, with acute psychosis, epileptic seizure, and altered consciousness, was diagnosed as having anti-NMDAR encephalitis and treated by intravenous immunoglobulin and high-dose pulse intravenous methylprednisolone. During follow-up, on the 11 day of hospitalization, the disease course was complicated by the occurrence of pulmonary embolism, presenting with acute onset respiratory distress and the need for supplementary oxygen treatment. PE improved with low-molecular-weight heparin treatment.

Conclusion: Pulmonary embolism should be kept in mind as a possible cause of respiratory insufficiency in pediatric anti-NMDAR encephalitis patients along with altered consciousness, breathing instability, hypersalivation, status epilepticus or dystonia, and their treatment.
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http://dx.doi.org/10.1080/00325481.2020.1801031DOI Listing
January 2021

Is there any relationship between initial hematological parameters and severity of scorpion envenomation?

Turk J Pediatr 2020 ;62(3):394-404

Divisions of Pediatric Emergency, Çukurova University Faculty of Medicine, Adana, Turkey.

Background And Objectives: Most cases of severe scorpion envenomation occur in children and are associated with significant morbidity and mortality. Excessive systemic inflammatory response, which leads to multiple organ involvement, is an emerging challenge during severe envenomation. The aim of this study was to investigate if there was any relationship between initial hematological parameters and severe envenomation in pediatric patients presenting with scorpion envenomation.

Method: This study was performed retrospectively, at the pediatric emergency unit and pediatric intensive care unit of the Çukurova University Medical School in Turkey. Two hundred and fifty-seven cases with scorpion envenomation, and a control group consisting of one hundred and fifteen healthy children were included in the study.

Results: White blood cell, neutrophil, lymphocyte, platelet, neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR) and PDW values of patients were higher than the controls (p < 0.05). Mean NLR was 3.8 ± 4.7 in patients. Patients were analyzed with the help of the decision tree model, and it was seen that in patients who had applied to hospital in less than an hour after the scorpion sting, 87.5% of the patients whose NLR value was between the 0.519-1.969 interval (below 2.1 which we found as the cut-off value) did not need to be hospitalized in the intensive care unit, 54.1% of the patients whose NLR value was higher than 1.969 needed to be hospitalized at the intensive care unit.

Conclusions: Severe envenomation is associated with mortality and morbidity in children. Our findings showed that NLR seems to be a useful tool in predicting severe envenomation.
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http://dx.doi.org/10.24953/turkjped.2020.03.006DOI Listing
August 2021

Levetiracetam Treatment-Associated Acute Rhabdomyolysis in an Adolescent.

J Pediatr Intensive Care 2020 Jun 14;9(2):139-140. Epub 2020 Jan 14.

Department of Pediatrics, Division of Pediatric Neurology, Cukurova University Faculty of Medicine, Adana, Turkey.

Etiology of rhabdomyolysis includes hereditary muscle enzyme deficiencies, trauma, viral infections, excessive exercise, hypothyroidism, and medications such as colchicine, lithium, and statins. Several studies have reported that various antiepileptic drugs may induce rhabdomyolysis. Levetiracetam is one of the antiepileptic drugs implicated in the etiology of rhabdomyolysis. Herein, we present a case of rhabdomyolysis in an adolescent treated with levetiracetam. We wanted to draw attention to the increasing trend of levetiracetam-associated rhabdomyolysis frequency in pediatric patients.
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http://dx.doi.org/10.1055/s-0039-1700951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186017PMC
June 2020

A homozygote frameshift mutation in OCLN gene result in Pseudo-TORCH syndrome type I: A case report extending the phenotype with central diabetes insipidus and renal dysfunction.

Eur J Med Genet 2020 Jun 30;63(6):103923. Epub 2020 Mar 30.

Department of Medical Genetics, Cukurova University Faculty of Medicine, Adana, Turkey. Electronic address:

Intrauterine infections with the pathogens, including toxoplasmosis, other (syphilis, varicella, mumps, parvovirus, and HIV), rubella, cytomegalovirus, and herpes simplex (TORCH) in susceptible individuals during pregnancy, result in microcephaly, white matter disease, cerebral atrophy, and calcifications in the fetus. Pseudo-TORCH syndrome is an umbrella term, consisting of several syndromes, resultant from different genetic alterations and pathogenetic mechanisms. Band-like calcification with simplified gyration and polymicrogyria (BLC-PMG) is one of these conditions, resultant from biallelic mutations in the OCLN gene, located in the chromosome 5q13.2. OCLN gene encodes occludin, a tight junction protein, which is expressed in the endothelia. The absence of occludin in the developing brain subsequently results in abnormal blood-brain barrier, thus immune-cell mediated tissue damage and cortical malformation. Herein, we present a pediatric patient who had progressive microcephaly, spasticity, multi-drug resistant epilepsy, PMG and intracranial band-type calcifications, accompanied by central diabetes insipidus and renal dysfunction. Whole exome sequencing revealed a homozygote W58Ffs*10 (c.173_194del) frameshift mutation in the OCLN gene. Of 34 BLC-PMG cases with demonstrable OCLN mutations, only three had renal manifestations, which is responsible for the majority of the demises. This is the first case diagnosed as having central diabetes insipidus and responded to desmopressin treatment to the best of our knowledge, however, this clinical improvement could not prevent the patient from renal dysfunction. The patient deceased at four years of age from sepsis, therefore early diagnosis, optimal follow-up for renal involvement and infection prevention measures are necessary for the patients with BLC-PMG.
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http://dx.doi.org/10.1016/j.ejmg.2020.103923DOI Listing
June 2020

The relationship of abdominal perfusion pressure with mortality in critically ill pediatric patients.

J Pediatr Surg 2019 Sep 13;54(9):1731-1735. Epub 2018 Dec 13.

Department of Pediatric Intensive Care Unıt, Çukurova University, School of Medicine, Adana, Turkey. Electronic address:

Purpose: To the best of our knowledge, in the literature, there is no data regarding clinical utility of the abdominal perfusion pressure (APP) in critically ill children. Thus, in the present study, we aimed to investigate the clinical utility of APP in predicting of survival in critically ill children with IAH.

Design: A prospective cohort study of patients between 1 month to 18 years who had risk for intra-abdominal hypertension from June 2013 to January 2014.

Setting: Pediatric intensive care unit (PICU) at a tertiary university hospital.

Patients: Thirty-five (16 female) PICU patients who had risk for the development of IAH were included. Serial intraabdominal pressure (IAP) and mean arterial pressure (MAP) measurements were performed. Abdominal perfusion pressure was calculated using the formula (MAP-IAP).

Measurements And Main Results: Overall mortality rate was 49% (n = 17). The mortality rate in patients with IAP mean ≥10 mmHg (n = 27, 77%) was 55% (n = 15), while 53% (n = 16) in patients with IAP max ≥10 mmHg (n = 30, 86%) and 47% (n = 7) in patients with IAP min ≥ 10 mmHg (n = 15, 43%). Overall mean APP was 58 ± 20 mmHg. Logistic regression analysis revealed that decrease in minAPP was associated with increased risk for mortality (Odds ratio for each 1 mmHg decrease in APP was 1.052 [CI 95%, 1.006-1.100], p < 0.05). ROC curve analysis revealed that, in predicting mortality, area under curve for minAPP was 0.765. The optimal cut-off point for APP was obtained as 53 mmHg with the 77.8% sensitivity and 70.6% specificity using the IU method.

Conclusions: Our findings showed that APP seems to be a useful tool in predicting mortality. Interventions to improve APP may be associated with better outcomes in critically ill PICU patients.

Level Of Evidence: Level II.

Type Of Study: Diagnostic.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.10.105DOI Listing
September 2019

Myocarditis and Early Markers of Cardiac Response Associated with Scorpion Stings in Children.

Wilderness Environ Med 2018 Dec 23;29(4):471-478. Epub 2018 Sep 23.

Department of Pediatric Emergency, School of Medicine, Çukurova University, Adana, Turkey (Drs Gökay, Kendir, Nalbant, and Prof Ylmaz).

Introduction: A clinical course ranging from mild local findings to life-threatening systemic findings may occur after scorpion stings. The purpose of this study was to identify priority markers indicating scorpion sting-related cardiac involvement.

Methods: Our study was performed between July 2014, and September 2015 in the Çukurova University medical faculty pediatric emergency department, in Adana, Turkey. Patients admitted with scorpion sting-related cardiac involvement and a control group consisting of patients with no scorpion sting-related cardiac involvement were included in the study. Troponin I at time of presentation and at 6 and 24 h, N-terminal prohormone of brain natriuretic peptide (NTproBNP), ejection fraction as determined by echocardiography at 24 h, and peak and end of T wave (Tp-e) and Tp-e/QTc ratios with echocardiography at 24 h were evaluated.

Results: A patient group consisting of 7 cases of scorpion envenomation-related myocarditis and a control group of 30 cases of scorpion intoxication without myocarditis findings were enrolled. Statistically significantly high glucose, white blood cell values, creatine kinase MB, troponin I, and NTproBNP values were identified in the scorpion sting-related myocarditis group (P<0.05). Ejection fractions determined by echocardiography at time of presentation were significantly lower in the patients with myocarditis compared with the control group (P<0.05). A statistically significant difference was identified between Tp-e/corrected QT interval (QTc) ratios investigated in DI and V2 derivations in patient and control group echocardiograms (P<0.05).

Conclusions: We think that use can be made of NTproBNP in addition to echocardiography and troponin I in the early diagnosis of scorpion sting-related myocarditis and that Tp-e and Tp-e/QTc ratios identified via echocardiography can be used as early markers; however, further studies with larger numbers are needed to confirm this.
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http://dx.doi.org/10.1016/j.wem.2018.06.013DOI Listing
December 2018

Urticaria as a Rare Side Effect of Polyethylene Glycol-3350 in a Child: Case Report.

Acta Clin Croat 2018 Mar;57(1):187-189

Çukurova University, School of Medicine, Department of Pediatric Emergency, Adana, Turkey.

Polyethylene glycol electrolyte (PEG-3350) solution is usually used for bowel emptying before colonoscopy in adults. It has also been reported to be safe in children. It is thought that bowel irrigation with this solution can be a useful treatment alternative for poisoning with slow releasing drugs, swallowed packaged substances, enteric coated drugs, drugs not binding to charcoal, and heavy metals in children. Due to high molecular weight of PEG-3350, its absorption from the in-testinal mucosa is very low (0.2%). Therefore, it is less likely to have side effects. A three-year-old girl bit and ate one-third of an alkali battery and was brought to our pediatric emergency unit. Vital signs and results of physical examination and laboratory investigations were normal. Irrigation of the bowels with PEG-3350 solution given orally at a rate of 20 mL/kg/h was initiated. Upon excretion of feces of normal appearance in the sixth hour, irrigation was continued. Since rashes and itching start-ed throughout her body in the thirtieth hour after administration of 9 L PEG-3350, the irrigation was discontinued and the patient was administered antihistamines. Rashes and itching regressed within one hour of its discontinuation. This suggested that they were due to the irrigation solution. There are five adult cases of allergic reactions to PEG-3350 reported in the literature. The case presented is the first pediatric patient developing allergic reaction to PEG-3350.
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http://dx.doi.org/10.20471/acc.2018.57.01.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400351PMC
March 2018

A Relationship Between Clinical and Laboratory Characteristics in Children With Severe Scorpion Envenomation in Çukurova, Turkey.

Pediatr Emerg Care 2020 07;36(7):338-344

Department of Pediatric Intensive Care, School of Medicine, Çukurova University, Adana, Turkey.

Objective: Scorpion stings are an important health problem in many parts of the world. The aim of this study was to retrospectively examine cases of scorpion stings to evaluate their epidemiological, clinical, and laboratory features and to determine strategies that can reduce morbidity and mortality in these cases.

Methods: Scorpion stings experienced by children between 2007 and 2013 were retrospectively reviewed. The patients were categorized into groups based on severities of toxicities, and demographic, clinical, and laboratory features were compared between the groups.

Results: The mean ± SD age of the 189 patients with scorpion stings was 83.43 ± 59.62 months. There was a significant difference between the clinical stages and the age distribution of the cases (P < 0.05). White blood cell counts differed significantly between the groups (P < 0.05). There was not a significant difference in mean platelet volume and platelet distribution width between the groups, but plateletcrit and low platelet count were significantly different between stage 1 and stage 3 cases (P < 0.05). Glucose, creatinine kinase-myoglobin binding, and troponin I were also significantly different (P < 0.05). The mortality rate was 0%.

Conclusions: People living in regions where scorpion stings are frequent should be informed about preventive measures against these stings, cases of scorpion stings should be monitored in appropriate centers, and staff offering care to these cases should be educated about treatment methods. In addition, treatment protocols should be determined in accordance with regions where the stings occur and studies should be performed to describe prognostic indicators.
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http://dx.doi.org/10.1097/PEC.0000000000001483DOI Listing
July 2020

Treatment of severe leptospirosis with therapeutic plasma exchange in a pediatric patient.

Turk J Pediatr 2018 ;60(5):566-570

Department of Pediatrics, Division of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Adana, Turkey.

Ekinci F, Yıldızdaş RD, Horoz ÖÖ, Alabaz D, Tolunay İ, Petmezci E. Treatment of severe leptospirosis with therapeutic plasma exchange in a pediatric patient. Turk J Pediatr 2018; 60: 566-570. Leptospirosis is a common zoonotic disease caused by spirochetes of the genus Leptospira. Although it is mostly a tropical disease, some case reports have been published from temperate regions of the world. The disease presents with a wide spectrum; from asymptomatic self limited disease to a fatal illness characterized by multi-organ involvement. An 8-year-old girl presented with a 5-day history of fever, myalgia, fatigue, vomiting and diarrhea. She developed anuria, hypotension and became unconscious one day after admission and was referred to our pediatric intensive care unit for further evaluation and treatment. Initial physical examination revealed fever, jaundice, diffuse petecchiae on whole body, hepatomegaly and severe hypotension. Laboratory investigations showed elevated liver enzymes and bilirubin levels, elevated creatinine and creatine kinase levels and trombocytopenia. The diagnosis of Leptospirosis was detected by rapid IgM test and confirmed by microscopic agglutination test later. She was treated with mechanical ventilation, wide spectrum antibiotics, positive inotropic agents and penicillin G plus two days of continuous renal replacement therapy and five sessions of therapeutic plasma exchange performed daily. She recovered completely and was transferred to the pediatric ward on the 14th day of hospitalization. The exact role of therapeutic plasma exchange has not been well documented yet, it seems to have benefical effects on clinical and laboratory findings and survival as we observed in our patient and learned from experiences in adult patients presented as case reports.
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http://dx.doi.org/10.24953/turkjped.2018.05.015DOI Listing
June 2019
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