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Item Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey(FRONTIERS MEDIA SA, 2022-01-01) Kiral, Eylem; Kirel, Birgul; Havan, Merve; Keskin, Mehmet; Karaoglan, Murat; Yildirim, Ahmet; Kangin, Murat; Talay, Mehmet Nur; Urun, Tuba; Altug, Umit; Kesici, Selman; Tufan, Erennur; Kacmaz, Ebru; Bozan, Gurkan; Azapagasi, Ebru; Uysal Yazici, Mutlu; Ozturk, Zeynelabidin; Yesilbas, Osman; Karaguzel, Gulay; Kaya, Gulay; Barlas, Ulkem; Duyu, Muhterem; Boyraz, Merve; Sevketoglu, Esra; Akcay, Nihal; Hancili, Suna; Guven, Ayla; Dursun, Oguz; Tekerek, Nazan Ulgen; Ozcifci, Gokcen; Yazici, Pinar; Turanli, Eda; Kendirli, Tanil; Kahveci, Fevzi; Yetimakman, Ayse Filiz; Citak, Agop; Sik, Guntulu; Bingol, Ibrahim; Aygun, Fatih; Durak, Cansu; Yilmaz, Resul; Bugrul, Fuat; Sari, Yusuf; Tekguc, Hakan; Albayrak, Hatice; Yener, Nazik; Agin, Hasan; Soydan, Ekin; Yildizdas, Dincer; Dilek, Semine Ozdemir; Yalindag, Nilufer; Incekoy-Girgin, Feyza; Alacakir, Nuri; Tutunculer, Filiz; Arslanaoglu, Mehmet Ozgur; Aydin, Can; Bilgin, Muzaffer; Simsek, Enver; Dinleyici, Ener CagriIntroductionThere have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection. MethodsThis is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year. ResultsThe percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabetes (p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission. DiscussionThe frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemicItem Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey(JAYPEE BROTHERS MEDICAL PUBLISHERS PVT LTD, 2019-01-01) Kockuzu, Esra; Bayrakci, Benan; Kesici, Selman; Citak, Agop; Karapinar, Bulent; Emeksiz, Serhat; Anil, Ayse Berna; Kendirli, Tanil; Yukselmis, Ufuk; Sevketoglu, Esra; Paksu, Sukru; Kutlu, Onur; Agin, Hasan; Yildizdas, Dincer; Keskin, Halil; Kalkan, Gokhan; Hasanoglu, Arzu; Yazici, Mutlu Uysal; Sik, Guntulu; Kilinc, Arda; Durak, Fatih; Perk, Oktay; Talip, Mey; Yener, Nazik; Uzuner, SelcukObjectives:To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was <= 7.10, and critical PCO2 >= 60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.Item Intrathecal baclofen use in the management of tetanus related spasm: A case report(TURKISH J PEDIATRICS, 2019-01-01) Sik, Guntulu; Aydoseli, Aydin; Citak, AgopTetanus is an infectious disease of the central nervous system with high mortality rates characterized with respiratory distress and tonic muscle spasms. The most common cause of mortality is cardiovascular complications (40\%) and respiratory distress (15\%). Despite vaccination programs, tetanus remains to be a significant healthcare issue in developing nations. Prolonged sedation and administration of muscle relaxants prolongs the period on mechanical ventilation and duration of hospitalization in severe tetanus cases. However, intrathecal baclofen (ITB) therapy might shorten the duration of stay at intensive care units, improve patient outcomes, and constitute a treatment option alternative to paralytic agents and sedation. In this manuscript, we present a 12-years-old case diagnosed with tetanus and treated with ITB upon observation of spasms refractory to high dose sedation and muscle relaxants.Item Sustained hyperferritinemia in a child with macrophage activation syndrome secondary to systemic juvenile idiopathic arthritis - perforinopathy: case based review(TURKISH J PEDIATRICS, 2018-01-01) Cakan, Mustafa; Aktay-Ayaz, Nuray; Gemici, Hakan; Annayev, Agageldi; Citak, Agop; Akcay, Arzu; Ozturk, GulyuzSystemic juvenile idiopathic arthritis is a subtype of juvenile idiopathic arthritis and characterized by arthritis and many systemic features like fever, rash, hepatosplenomegaly, lymphadenopathy and serositis. Macrophage activation syndrome is the most dreadful complication of systemic juvenile idiopathic arthritis and can cause mortality and morbidity if not recognized and treated early and aggressively. Hemophagocytic lymphohistiocytosis (HLH) is characterized by diminished or absent activities of natural killer cells and cytotoxic T lymphocytes leading to cytokine storm and uncontrolled activation of T cells and macrophages. Primary (familial) HLH is a group of autosomal recessive disorders caused by mutations in the perforin and other related genes and distinctive for onset during early infancy and high rate of mortality. Secondary HLH may be caused by infectious, oncologic and rheumatologic disorders. The term Perforinopathy is used to describe cases with classical familial HLH and also for cases with familial HLH gene mutations but not following a classical familial HLH course. Herein we report a case of chronic perforinopathy in which clinical symptoms started with systemic juvenile idiopathic arthritis and severe macrophage activation syndrome that needed plasma exchange and extracorporeal membrane oxygenation during acute period and ongoing interleukin-1 blockage for sustained hyperferritinemia.Item Double Aortic Arch Mimics the Clinical Characteristics of Severe Reactive Airway Disease in a Pediatric Patient(GEORG THIEME VERLAG KG, 2020-01-01) Yesilbas, Osman; Kus, Hazar Dogus; Sik, Guntulu; Citak, Agop; Temur, Bahar; Yozgat, Can Yilmaz; Temur, Hafize Otcu; Cakir, Erkan; Yozgat, YilmazReactive airway disease is a prevalent condition that can be detected in the early infancy period. The condition might also deteriorate into asthma in some cases. If infants do not respond to the treatment of persistent wheeze and coughing, other rare causes should be investigated. The complete form of vascular ring is an extremely uncommon congenital cardiovascular abnormality. Double aortic arch constitutes the most significant portion of the complete vascular ring anomalies. Clinical manifestations of the anomaly are mainly respiratory due to the tracheal compression and mimicking the conditions of asthma. There have not been many reports about the clinical presentations of double aortic arch being remarkably similar to the same clinical manifestations of asthma in the literature. As far as we can be sure, there have not been any reported cases about severe reactive airway disease that caused a patient to have a life-threatening condition in the pediatric intensive care unit. Herein, we present a 5-month-old girl who had double aortic arch. Her anatomical aberration was diagnosed by three-dimensional computed tomography angiography of thorax, and the anomaly mimicked the clinical characteristics of life-threatening severe reactive airway disease.Item The clinical characteristics and prognosis of pertussis among unvaccinated infants in the pediatric intensive care unit(TURKISH PEDIATRICS ASSOC, 2020-01-01) Sik, Guntulu; Demirbuga, Asuman; Annayev, Agageldi; Citak, AgopAim: To evaluate the clinical characteristics, risk factors, and prognosis of pertussis in the pediatric intensive care unit. Material and Methods: Patients who were hospitalized in pediatric intensive care unit between January 2017 and January 2019 and diagnosed as having pertussis were retrospectively evaluated. Samples were taken from tracheal aspirate material in intubated patients and nasopharyngeal swabs in the other patients. Samples for Bordetella pertussis were studied using multiplex real-time polymerase chain reaction. Results: Eighteen patients were admitted to our pediatric intensive care unit with a diagnosis of pertussis. Ten patients were female (55.5\%), and all patients were unvaccinated. The median age was 40 (range, 38-47.5) days and the median intensive care unit stay was 9 (range, 5-14) days. All patients had respiratory distress, 14 patients had cough (77.7\%), four patients had fever (22.2\%), and three patients had convulsions (16.6\%). Seven patients were intubated. Three patients died of multiple organ failure and cardiogenic shock despite extracorporeal treatment. Respiratory syncytial virus was found in two patients and rhinovirus was found in one patient. The median leukocyte count was significantly higher in non-survivors than in survivors. Blood exchange was performed in three patients due to hyperleukocytosis. Pulmonary hypertension was the most common cardiac pathology detected in echocardiographic examinations. Conclusion: We found that high leukocyte count, viral co-infection, and severe pulmonary hypertension were associated with mortality and morbidity in pertussis.Item Retrospective Analysis of Demographic, Epidemiologic, and Clinical Characteristics of Poisoning in Pediatric Intensive Care Unit(BEZMIALEM VAKIF UNIV, 2020-01-01) Sik, Guntulu; Demirbuga, Asuman; Annayev, Agageldi; Deliceo, Elif; Tufan, Ali Evren; Citak, AgopObjective: Poisonings are significant causes of preventable morbidities and mortalities in pediatric patients hospitalized in pediatric intensive care units. In this study, we aimed to evaluate demographic and epidemiologic features, interventions, treatments, clinical course, and prognosis of patients hospitalized in pediatric intensive care unit for poisoning retrospectively. Methods: The recordings of 172 patients admitted to the pediatric intensive care unit with acute poisoning between 2015 and 2019 were evaluated retrospectively. Results: A total of 172 patients were admitted to our pediatric intensive care unit with the diagnosis of poisoning. Eighty-eight of them (51.2\%) were girl. The average age was 5.8 +/- 5.6 years, and mean length of stay was 2.9 days. It was noted that 72.1\% of patients with poisoning were accidental, whereas 27.9\% of them were suicidal. Majority of suicidal patients were girls (89.5\%), and the mean age was 13.1 +/- 4.9 years. However, only 36.2\% of patients with accidental poisoning were girls and the mean age was 3.1 +/- 2.6 years. Patients with poisoning were most commonly seen during spring. The most common cause of poisoning was drugs (76.7\%). Poisoning with multiple drugs were seen in 36 patients (20.9\%). Central nervous system drugs were the most common cause (32.7\%). Nausea-vomiting (17.4\%), altered mental status (12.7\%), and abdominal pain (7.5\%) were the most common symptoms. Thirteen patients required invasive mechanical ventilation. Five patients were treated with hemodialysis and eight patients treated with plasma exchange. Conclusion: Poisonings are important part of pediatric intensive care unit hospitalization. Accidental poisoning is common especially in children under five years of age. Taking preventive measures, educating parents about home accidents, storing medications in safe and locked places and keeping them out of reach of children can reduce the rate of accidental poisoning.Item Extracorporeal membrane oxygenation for the support of pediatric patients with acute fulminant myocarditis(TURKISH J PEDIATRICS, 2019-01-01) Sik, Guntulu; Annayev, Agageldi; Demirbuga, Asuman; Deliceo, Elif; Aydin, Selim; Erek, Ersin; Demir, Halil Ibrahim; Citak, AgopAcute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of children with severe acute myocarditis who are resist to medical treatment is not well known. We studied the clinical courses of patients with acute fulminant myocarditis supported by extracorporeal membrane oxygenation (ECMO). We performed a retrospective chart review of six children with acute fulminant myocarditis who were treated with ECMO. Demographic information, clinical and vital signs, as well as laboratory results were investigated. The median age of 63 months (13-140 months), the mean ECMO duration was 164 hours (79-402 hours), and median intensive care unit stay was 24 days. The most common symptoms were chest pain (66\%) and fever (66\%). Severe arrhythmia were seen in two patients. One patient received extracorporeal cardiopulmonary resuscitation. In two patients, right femoral arteries and right femoral veins were used, in others, right common carotid artery and right internal jugular veins were used. Five patients (83.3 \%) survived to discharge. ECMO can be used effectively in pediatric patients with acute fulminant myocarditis to support the circulation while awaiting myocardial recovery. Timely use of ECMO can improve the survival rate and may be associated with better outcomes.Item Viral Infections Among Patients with Acute Lower Respiratory Tract Infections in the Pediatric Intensive Care Unit(AVES YAYINCILIK, IBRAHIM KARA, 2020-01-01) Sik, Guntulu; Demirbuga, Asuman; Annayev, Agageldi; Cabiri, Asli; Deliceo, Elif; Citak, AgopObjective: We aimed to determine the frequency of viral pathogen and clinical characteristics of patients hospitalized in the pediatric intensive care unit with the diagnosis of acute lower respiratory tract infection. Material and Methods: Eighty patients with laboratory-confirmed viral infections among children admitted to the pediatric intensive care unit (PICU) between November 2016 and September 2017 with a suspicion of viral infection were included. Diagnosis was made using a respiratory viral panel including adenovirus (AV), metapneumovirus (MV), parainfluenza virus (PIV) 1, PIV 2, PIV 3, PIV 4, influenza virus (IV) A and IVB, rhinovirus (RV), respiratory syncytial virus (RSV) A and RSV B, and multiplex polymerase chain reaction (PCR). Tracheal aspiration specimens were obtained from intubated patients and nasopharyngeal swab specimens were obtained from the remaining patients. Results: A total of 514 children were admitted to our PICU. Of 123 patients with lower respiratory tract infection, specimens from a nasopharyngeal swab or tracheal aspiration were obtained and tested using a viral infection panel and multiplex PCR. Mean age of the patients was 6.1 +/- 3.6 months, 60\% (n= 48) of the children were boys. Ninety-three positive results were obtained from 80 patients. The most common viral pathogens were RSV (A + B) (n= 36, 45\%), RV (n= 26, 32.5\%), PIV 1 (n= 7, 8.7\%), AV (n=6, 7.5\%), human MV (n= 5, 6.296), IVA (n= 4, 5\%), and IVB (n= 4, 5\%). The most common dual infection was RV and RSV B. Viral pathogen detection was the highest in december (n= 15) and february (n= 13). High-flow oxygen therapy was needed in 57.5\% of patients, and 12.5\% had non-invasive mechanical ventilation. Twenty-seven (33.7\%) patients had to be intubated due to insufficient ventilation with noninvasive methods. The most commonly detected viral pathogen among the intubated patients was RSV B. The average intensive care length of stay for all children was 10.1 +/- 3.6 days. Conclusion: Viral infections are common among critically ill children in PICUs. Hospital length of stay, morbidity, and mortality increase with underlying chronic diseases or dual infections. Early diagnosis of viral infections decreases unnecessary antibiotic use.Item Clinical and laboratory predictors of survival for pediatric patients on non-postcardiotomy extracorporeal membrane oxygenation (ECMO)(TURKISH J PEDIATRICS, 2020-01-01) Sik, Guntulu; Demirbuga, Asuman; Annayev, Agageldi; Temur, Bahar; Aydin, Selim; Demir, Halil Ibrahim; Erek, Ersin; Citak, AgopExtracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmonary failure who do not respond to conventional therapy