Arzu Oto

Background: In the pediatric population, gastrointestinal (GIS) cancers are rare, and paraneoplastic syndromes associated with these malignancies are even more uncommon. Observations: A 15-year-old patient with a clinical presentation of microangiopathic hemolytic anemia (MAHA) resistant to plasma exchange was found to have metastatic adenocarcinoma in a biopsy of a supraclavicular lymphadenopathy. Subsequent endoscopy revealed gastric signet ring cell carcinoma. Conclusions: This case highlights that malignancy should be suspected in pediatric patients with MAHA who are unresponsive to plasma exchange and have normal ADAMTS-13 activity.

Background/aim: Colchicine poisoning has been associated with systemic toxicity, multiple organ dysfunction syndrome (MODS), and mortality. In the present study, the demographic, clinical, and laboratory characteristics of pediatric colchicine poisoning cases and the incidence of organ failure are investigated to identify potential risk factors associated with MODS. Materials and methods: Included in this retrospective multicenter cohort study were pediatric patients admitted to 28 tertiary-care pediatric intensive care units with a diagnosis of colchicine poisoning. Demographic data, clinical and laboratory findings, and clinical outcomes were extracted from medical records. MODS was defined as dysfunction involving at least two organ systems. Multivariable logistic regression analysis was performed to identify the variables independently associated with MODS. Results: Of the 150 patients included in the study, 40% were younger than 5 years and 52% were older than 13 years. Gastrointestinal symptoms were most prominent, with nausea and vomiting observed in 64.7%, abdominal pain in 36.7%, and diarrhea in 24%. Overall, 66% developed no organ failure, while single-organ failure occurred in 7.3% and 26.7% developed MODS. The coagulation system was most frequently affected (26%), followed by the hematological (19.3%) and immunological (18%) systems. Multivariable logistic regression analysis identified the baseline PRISM III score, ingested colchicine dose per kilogram of body weight, and initial sodium, creatinine, and aspartate aminotransferase (AST) levels as independent predictors of MODS. Conclusion: MODS can develop at ingestion doses lower than 0.5 mg/kg, which have historically been considered safe. Higher ingested doses and elevated PRISM III scores were associated with MODS, although these findings are derived from retrospective observational data and should not be interpreted as causal or as direct clinical recommendations. Further prospective studies are needed to clarify relevant doses, interventions, and prognostic factors in pediatric colchicine poisoning associated with MODS.

Background: The Glasgow Coma Scale has been a standard tool for assessing consciousness in trauma patients for five decades, but its utility is limited by the omission of brainstem reflexes such as pupillary response. Objective: This study aimed to compare the prognostic accuracy of the Pediatric Glasgow Coma Scale (pGCS) and the Pediatric Glasgow Coma Scale – Pupils Score (pGCS-P) in predicting mortality and functional outcomes among pediatric patients with traumatic brain injury (TBI). Methods: This single-center observational cohort study was conducted from May 2022 to May 2023 at Bursa Training and Research Hospital, Health Sciences University, Turkey. Pediatric patients (age .05). Conclusions: In pediatric patients with TBI, the prognostic accuracy of the pGCS with pupil response (pGCS-P) was comparable to that of the pGCS alone for predicting mortality and UFOs. Incorporation of the pupil score did not significantly improve prognostic discrimination in this cohort.

Earthquake-induced Crush Syndrome and subsequent acute kidney injury are important issues that affect morbidity and mortality. Fasciotomies prolong the length of stay in intensive care unit in patients with Compartment Syndrome due to the complications it causes. Infections and delayed wound healing are two common complications among these. Therefore, early closure of fasciotomy wounds is recommended. Although different treatments can be applied for treatment of wounds, data on this subject in pediatric patients are insufficient. We report the case of a 15-year-old girl who developed acute renal failure due to crush syndrome after being trapped in the wreckage for 9 hours and undergoing fasciotomy procedures for four locations, in the left extremity, two in the thigh and two in the cruris. Hemodialysis, antihypertensive, and antibiotic treatment were administered during the intensive care follow-up due to acute kidney injury, hypertension, and sepsis. With negative pressure therapy, silver alginate wound dressing, and hyperbaric oxygen therapy, all wounds epithelialized within two months. However, rehabilitation for drop foot syndrome caused by nerve cuts in the left extremity continues.

Background: Immature granulocytes can be measured easily in a complete blood count by new automated hemolytic analyzers and have recently been studied as bio‐markers in many infectious/inflammatory diseases. This study aims to investigate whether immature granulocyte percentage (IG%) would enable greater discrimination than conventionally utilized laboratory values in terms of early clinical prediction in instances with respiratory syncytial virus (RSV) bronchiolitis. Methods: A prospective observational cohort study involved 149 individuals with RSV bronchiolitis. Complete blood count (including IG%), C‐reactive protein, and procalcitonin (PCT) assays were performed. Results: Sixty‐two (42%) RSV bronchiolitis patients responded well to outpatient therapy; 60 (40%) were admitted to the hospital, and 27 (18%) required pediatric intensive care unit (PICU) follow up. Inpatients had a higher platelet count than outpatients, and PICU patients had a higher platelet lymphocyte ratio (PLR). Pediatric intensive care unit patients had greater PCT levels than outpatients, and their IG% was higher than that of both inpatient and outpatient groups. In the receiver operating characteristic analysis examining the usefulness of parameters in predicting PICU hospitalization, PLR, PCT, and IG% produced statistically significant findings, with IG% having the highest area under the curve (0.730). Conclusions: Immature granulocyte percentage was the biomarker that best differentiated PICU patients from other patient groups when compared with traditional acute phase reactants. Immature granulocytes may help to determine the severity of infection/inflammation at an early stage of the disease.

Osmanlı’dan Cumhuriyet Türkiye’sine geçiş döneminde Hale Asaf (1905-1938) ve Mihri Rasim (Müşfik) (1886-1954) kendilerini sanatçı olarak tarif eden öncü kadınlardır. Saraya yakın, eğitimli bir zümrenin mensubu olduklarından resim ve müzik dersleri alarak eğitim görmüş ve çok dilin konuşulduğu bir çevrede yetişmişlerdir. Mihri Rasim (Müşfik) sanatçı ve eğitmen olarak ikonik bir figürdür. Kendini portre ressamı olarak yetiştiren Mihri İtalya, Fransa ve Amerika’da sanatçı kimliği ile var olmuş, Bernard Shaw, Thomas Edison, Franklin Roosevelt gibi ünlülerin portrelerini yapmış, İnas Sanayi Nefise Mektebi’nin kuruluşuna ön ayak olmuş, bir dönem müdire olarak çalışmış ve Batılı anlamda sanat eğitimi vermiştir. Meşrutiyet Dönemi’nde ortaya çıkan, özgürlük isteyen güçlü kadın hareketinin sözcüsü olmuştur. Yeğeni Hale Asaf Cumhuriyet Dönemi’nde Batılılaşma hedefi ile Avrupa’ya yollanan sanatçı kuşağı arasında yer almıştır. Paris ve Roma’da sanat çevresi ile erkenden tanışmış, Müstakil Ressamlar ve Heykeltraşlar Topluluğu’nun (1929) kurucularından olmuştur. Cumhuriyet Türkiyesi’nde Mihri ve Hale kendini ressam olarak tanımlayan öncü kadınlardır. Bu çalışmanın amacı; Hale ve Mihri’nin sanatçı kimliklerini oluşturdukları çevreyi, dönemin özelliklerini, sanatçı olarak başlattıkları mücadeleyi ele almaktır. Türkiye sanat tarihindeki yerlerine feminist eleştirel bir açıdan bakmayı denemektir. Cumhuriyet Dönemi sanatçıları olan Mihri ve Hale’yi incelemek için literatür araştırması yapılmış, haklarında yazılmış araştırma, tez ve makaleler incelenmiştir.

Objective: While Multiple Life-threatening Conditions (MLCs) admitted to the Pediatric Intensive Care Unit represent a substantial healthcare burden, the risk factors, epidemiological data, and clinical manifestations of these cases have yet to be systematically and comprehensively documented. Material and Methods: This study was conducted in the Pediatric Intensive Care Unit at Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January 1, 2017, and January 1, 2022. The study included 31 males (35.4%) and 17 females (64.6%) with an average age of 4.7 ± 4.1 years. MLCs were classified into nine groups, including Foreign Body Aspiration (FBA), Blunt Trauma (BT), Asphyxia (ASP), Firearm Injury (FI), Sharp and Penetrating Object Injury (SPOI), Electric Injury (EI), Sports-Related Injury (SRI), Animal Bite Injury (ABI), and Home Accident (HA). Results: Foreign Body Aspiration (FBA) was the most prevalent type of MLC in this study (29.1%). The average hospital stay for FBA cases in the general ward was 3 days (range: 1-11 days), and in the Pediatric Intensive Care Unit was 2 days (range: 1-8 days). Blunt Trauma (BT) cases had an average hospital stay of 4 days (range: 1-12 days) in the general ward and 3 days (range: 1-10 days) in the Pediatric Intensive Care Unit. Surgical intervention was required for 29.1% of patients (n=14). The mean cost of treating a case in our study was calculated to be 5744 ₺ (approximately US$308.57). The majority of MLCs were attributed to FBA (n=14, 43%), followed by BT (n=9, 18%), and ASP (n=8, 16%). Conclusion: The predominance of Multiple Life-threatening Conditions (MLCs) in the Pediatric Intensive Care Unit, with Foreign Body Aspiration (FBA) being the most common cause, underscores the need for heightened awareness and prevention efforts. Understanding the risk factors, clinical presentations, and healthcare costs associated with these cases is essential for healthcare professionals and policymakers in their pursuit of reducing the incidence of MLCs.

Objectives: Hyponatremia is known to increase mortality and morbidity in adult patients. However, the significance of hyponatremia in critically ill pediatric patients is unknown, unlike in adults. We tried to determine the prevalance of hyponatremia in critically ill children and whether the severity of hyponatremia contributes to hospital stay and mortality. Methods: The results of 190 patients who met the inclusion criteria and were admitted to the pediatric intensive care unit between April 2014 and April 2017 were analyzed. Results: Eighty-six (45.3%) patients developed hyponatremia at the time of hospitalization, and Hospital‑Acquired Hyponatremia (HAH) developed in 46 (24.2%) patients during the hospitalization. Fifty-eight (30.5%) patients were normonatremic. The patients in the HAH group were significantly more septic (p = 0.015). The duration of intensive care hospitalization was significantly longer in the HAH group (p < 0.001) and significantly less in the normonatremic group (p = 0.008). Total mortality was 41% (n = 78). There was no difference between the groups regarding mortality (p = 0.4). However, the degree of hyponatremia was associated with mortality. Mortality was 24.1% in mildly hyponatremic patients, 45.6% in moderate patients, and 58.8% in severe patients (OR: 2.636, 95% CI: 1.189-5.842; OR: 4.490, 95% CI:1.439-14.008, p = 0.01). We discovered that as hyponatremia severity increased, so did the length of stay in the intensive care unit, the need for invasive ventilation, and the need for vasoactive drugs (p = 0.009, p = 0.018, and p = 0.006, respectively). Conclusions: Unlike adults, the prognostic value of hyponatremia in terms of mortality has not been determined in critically ill children. However, as the severity of hyponatremia increased, it was seen that the length of stay in the intensive care unit and mortality increased.

Objectives: Very few studies have been conducted to identify the conditions that cause poisoning in pediatric patients needing intensive care, both by age group and toxic agent factor. This study will support the development of strategies for poisoning prevention measures by comparing the data in our region with other data in the world. Methods: This study is a single-centered, retrospective study. The baseline status of acute poisoning was defined in pediatric patients aged one month to 18 years who required intensive care hospitalization between November 2017 and March 2022. Results: There were 148 patient admissions due to acute poisonings (5.2% of all admissions, 69.6% females, median age: 13.6 months). Our study revealed that acute poisoning in children is caused mainly by pharmacological (88.5%), oral intake (97.3%) and at home (85.8%). It was observed that intoxication peaked at two different ages; the first peak was at preschool (33.1%), and the second peak was at adolescence (58.7%). In the univariate analysis, females (odds ratio [OR]=4.1), adolescents (OR=167.6), psychiatric drug users (OR=55.5), and multiple drug intoxications (OR=3.6) were associated with more suicides. Being adolescents and using psychiatric medication contributed significantly to suicide attempts in multivariate analysis (OR=145.3 and OR=37.9). None of our patients died. Conclusions: Preventing both poisoning and suicide attempts is the most critical priority. However, we suggest prevention strategies should be strengthened even if mortality is not observed. Furthermore, our study shows that suicide attempts are very likely to be repeated, especially if an underlying psychiatric illness exists.