The Turkish journal of pediatrics最新文献

Background: The term 'pseudo-outbreak' refers to a condition in which a microorganism is found in cultures at a greater rate than expected due to contamination of materials that would normally be sterile. This situation cannot be clinically correlated with the infection suggested by the culture results. This can be confusing depending on the patient's clinical condition, especially in intensive care units (ICU). The pseudo-outbreak with Escherichia coli in patients in ICUs will be discussed in this study to emphasize the importance of strict adherence to microbiology policies and procedures.

Methods: In September 2022, growths of Escherichia coli were found in the endotracheal aspirate cultures of six children and eighteen adults in the ICU.

Results: The identification of the same microbial agent in 24 patients prompted an investigation into a potential outbreak. The infection control committee compiled a comprehensive patient list to facilitate the assessment. Given that the healthcare personnel and infrastructure of each ICU were distinct and functioned independently, the possibility of cross-contamination within these units was deemed unlikely. Consequently, attention was directed toward the microbiology laboratory as a potential source of the outbreak. A thorough review of culture processing steps and laboratory equipment was conducted. This investigation revealed that the saline solution used for the passage of endotracheal aspiration cultures was contaminated, suggesting a laboratory-associated contamination event as the probable cause.

Conclusions: By strictly adhering to the latest protocols, the disinfection and sterilization chain can ensure the safe use of both invasive and non-invasive medical equipment. This manuscript aims to raise awareness among pediatricians and pediatric infectious disease specialists regarding the occurrence of pseudo-outbreaks. A pseudo-outbreak is indicative of a disruption in the sterilization chain.

Background: Acute intoxication-type inborn errors of metabolism (IEMs) present significant challenges in pediatric care. Prompt recognition and appropriate management are essential to prevent serious complications and reduce mortality. Recent studies increasingly highlight the use of quick response (QR) code-based tools to facilitate rapid intervention, particularly in emergency departments and primary healthcare settings. In this study, the effectiveness of a newly developed QR code-based algorithm, designed to support the accurate recognition and effective management of acute intoxication-type IEMs and, indirectly, to reduce sequelae and mortality, was evaluated for the first time.

Methods: This study included 113 pediatric residents from two centers, one with (Group 1, n=77) and one without (Group 2, n=36) a mandatory pediatric metabolism rotation. All participants completed a scenario-based simulation with 10 clinical questions on a standardized patient case of acute intoxication-type inborn errors of metabolism, both before and after using the QR code-based algorithm. The algorithm, developed in accordance with international guidelines, was accessed via mobile devices. Pre- and post-intervention responses were compared using appropriate statistical tests. The effectiveness of the QR code in guiding the management of a simulated patient was analyzed.

Results: Of the participants, 73 (64.6%) were female and 40 (35.4%) male; the median age was 28.0 years. Forty-two residents (37.2%) had previous experience in a pediatric metabolism unit. Correct identification of urgent treatment increased from 77.9% to 97.3% (p.

Objective: This study aimed to determine whether children diagnosed with attention deficit hyperactivity disorder (ADHD) continue to receive this diagnosis during adolescence and young adulthood, and to examine the relationships between autistic traits, psychological resilience, emotion regulation levels, and the continuity of diagnosis.

Methods: In the initial evaluations conducted between 2012 and 2013, 121 children diagnosed with ADHD began medication treatment. From this group, 20 participants aged 13 to 25 who agreed to participate in the second evaluation, conducted between 2020 and 2022, were included in this study. The presence of ADHD in their second evaluation was determined using the DSM-5 criteria. Psychiatric comorbidities in adolescents were screened using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version, 2016 Turkish Adaptation of the DSM-5, while for adults, the DSM-5 criteria were utilized. Parents completed the Social Responsiveness Scale and the Family Assessment Device, while the young participants completed the Child and Youth Resilience Measure and the Difficulties in Emotion Regulation Scale.

Results: Among the participants, 10 individuals (50%) continued to have an ADHD diagnosis, exhibiting lower psychological resilience and significantly more autistic traits. No difference in emotional dysregulation was observed between those with and without an ADHD diagnosis, and a negative relationship between autistic traits and psychological resilience was identified.

Conclusion: The continuity of an ADHD diagnosis during adolescence and young adulthood may be associated with psychological resilience and autistic traits. However, the limited number of participants and the cross-sectional design highlight the need for larger longitudinal studies to further explore the cause-and-effect relationships.

Background: Isolating microorganisms from blood cultures is the gold standard for identifying the cause of sepsis. However, contamination of the blood culture is a significant barrier to the blood culture's utility. In this study, we aimed to evaluate the impact of blood culture bundles on the incidence of contamination in the neonatal intensive care unit (NICU).

Methods: A prospective research to compare pre-bundle and bundle periods was created. During the bundle period, a bundle for blood culture sampling was implemented. The numbers of unnecessary antibiotic days and hospital stay following a false positive blood culture were used to calculate costs.

Results: A total of 320 neonatal blood culture procedures were included. The rate of blood culture contamination was 3.8% in the bundle and 12.5% in the pre-bundle period, this was significantly higher in the pre-bundle period (p.

Background: This study aims to assess Turkish pediatricians' knowledge and attitudes regarding respiratory syncytial virus (RSV) infection and its current immunization strategies.

Methods: From May 10 to June 4, 2024, we invited 1603 pediatricians who subscribed to the website of The Turkish Pediatrics Atelier via e-mail to respond to an online questionnaire. A total of 401 pediatricians responded.

Results: Of pediatricians, 11% stated that they routinely use chest X-ray (CXR) for diagnosing RSV illness. When managing RSV-positive patients, while 44.4% of pediatricians indicated that they need a CXR if there are lung auscultation findings, the rate of routine CXR usage was 22.7%. While most pediatricians (74.8%) stated that they prefer nebulized salbutamol and/or corticosteroid; 43.4% used hypertonic saline; and 22.7% used nebulized epinephrine as a treatment option. While 60.3% of pediatricians had no information about the maternal RSV vaccine; 58.1% stated that they would recommend it to only willing women; 16% stated that they would not recommend it; and 25.9% indicated that they would recommend it to every pregnant individual. While most pediatricians (79.8%) had knowledge about nirsevimab; 14% indicated that it was not approved in children worldwide; 49.1% stated that it is more effective than palivizumab; and 37.9% indicated that they would start administrating it immediately after its approval and availability in Türkiye.

Conclusions: The use of CXR and administration of non-evidence-based therapies in diagnosing and managing RSV illness were relatively high. Additionally, there is a notable gap in knowledge and awareness regarding the maternal RSV vaccine and nirsevimab.

Background: Tension gastrothorax is a rare life-threatening condition that occurs when the stomach is herniated into the thoracic cavity, most often through the congenital left posterolateral diaphragmatic defect, causing a mediastinal shift when distended with gas and fluid.

Case presentation: A previously healthy 2-year-old boy was admitted with acute abdominal pain, vomiting and dyspnea. Chest X-ray was initially interpreted as hydropneumothorax, but after careful observation the decision was made to insert a nasogastric tube and to perform a computerized tomography scan to confirm the suspicion of tension gastrothorax. Laparotomy was performed the following day, organs were repositioned into the abdomen and reconstruction of the left hemidiaphragm was conducted.

Conclusion: When symptoms of respiratory distress occur in an otherwise healthy child, tension gastrothorax should be on the list of differential diagnosis. It is important to recognize distinct radiographic features of this life-threatening condition in order to promptly manage it. Initial placement of nasogastric tube for decompression should be followed by the reduction of the organs into the abdomen and diaphragmatic repair.

Background: Inflammatory myofibroblastic tumors (IMTs) are rare neoplasms in children. Traditionally, surgical resection has been the primary treatment modality with limited efficacy reported for conventional chemotherapy and radiation therapy. Recently, targeted therapies have emerged as potential options for selected cases. This study aimed to evaluate the demographic, clinical, laboratory, and radiological characteristics, as well as treatment outcomes, in children diagnosed with IMTs.

Methods: This study involved a retrospective review of medical records for eight children diagnosed with IMTs between 1990 and 2022. We collected demographic, clinical, laboratory, and radiological data, as well as treatment outcomes. Data on tumor characteristics, surgical procedures, and chemotherapy or targeted therapy treatments were extracted.

Results: The mean age at diagnosis was 9 years. None presented with metastatic disease at the time of diagnosis. Anaplastic lymphoma kinase (ALK) positivity was identified in tumor tissue from five patients. Among the six patients who underwent surgical resection, three achieved negative surgical margins. Of the three patients with positive surgical margins, one underwent re-resection, local and metastatic recurrences were noted in another, and one was started on crizotinib. A patient with an inoperable tumor at diagnosis was initiated on crizotinib and achieved complete remission. Ceritinib was administered to a patient with YWHAE-ROS fusion, resulting in more than 90% reduction in tumor volume. The median follow-up time was 67.5 months. The five-year overall survival and event-free survival rates for the cohort were 85.7% and 72.9%, respectively.

Conclusions: While surgical resection remains the cornerstone of treatment for IMTs, favorable outcomes can be achieved with chemotherapy and targeted therapies in selected cases. Increasing the utilization of targeted therapies may be beneficial, particularly through molecular studies aimed at minimizing the side effects associated with conventional chemotherapy.

Background: In children admitted to the pediatric intensive care unit (PICU), early detection of risk factors and alarming indicators improves the prognosis and may even save lives. Several prognostic markers and scores have been studied in children who are seriously ill. Recently, surface triggering receptor expressed on myeloid cells-1 (sTREM1) has been studied in many infectious and non-infectious settings; however, there is little information on critically ill children. Our aim is to evaluate the sTREM1 level in critically ill children and assess its prognostic role.

Method: A prospective observational study was conducted in a tertiary care hospital. 70 critically ill children and 50 healthy controls were enrolled in the study. Demographic, clinical, and laboratory data were obtained. sTREM1 level was assessed on admission to the PICU. Patients with conditions affecting immunity were excluded. The primary outcome was to assess the level of sTREM1 in both patients and controls. Secondary outcomes were mortality, morbidities as sepsis, need for mechanical ventilation, and PICU stay.

Results: The level of sTREM1 was significantly higher in patients than in controls (850 pg/mL, interquartile range [IQR] 510.0- 1375.0 vs. 67.5 pg/mL, IQR 40.0- 85.0; p.

Objective: We aimed to identify and compare systemic juvenile idiopathic arthritis (sJIA) patients receiving treatment with either glucocorticoids and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or biologic drugs.

Methods: This was a retrospective cross-sectional study. sJIA patients (n=138) were categorized into two groups: Group A (n=51) consisted of individuals who received only glucocorticoids and/or csDMARDs, while Group B (n=87) included those who received at least one biologic drug.

Results: Group B patients exhibited a higher prevalence of macrophage activation syndrome (MAS) (p=0.001) at presentation. C-reactive protein (CRP) levels and systemic Juvenile Arthritis Disease Activity Scores (sJADAS) at diagnosis were significantly higher in Group B (p.