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    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) Kockuzu, Esra; Bayrakci, Benan; Kesici, Selman; Citak, Agop; Karapinar, Bulent; Emeksiz, Serhat; Talip, Mey
    Objectives: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.
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    Critically ill children with pandemic influenza (H1N1) in pediatric intensive care units in Turkey
    (Lippincott Williams & Wilkins, 2012) Kendirli, Tanil; Demirkol, Demet; Yildizdas, Dincer; Anil, Ayse Berna; Asilioglu, Nazik; Karapinar, Bulent; Erkek, Nilgun; Sevketoglu, Esra; Dursun, Oguz; Arslankoylu, Ali Ertug; Bayrakci, Benan; Bosnak, Mehmet; Koroglu, Tolga; Horoz, Ozgur Ozden; Citak, Agop; Kesici, Selman; Ates, Can; Karabocuoglu, Metin; Ince, Erdal
    Objectives: To outline the epidemiologic features, clinical presentation, clinical courses, and outcomes in critically ill children with pandemic influenza in pediatric intensive care units. Design: Retrospective, observational, multicenter study. Setting: Thirteen tertiary pediatric intensive care units in Turkey. Patients: Eighty-three children with confirmed infection attributable to pandemic influenza detected by reverse-transcriptase polymerase chain reaction assay between November 1 and December 31, 2009 who were admitted to critical care units. Interventions: None. Measurements and Main Results: During a 2-month period, 532 children were hospitalized with pandemic influenza and 83 (15.6%) needed critical care. For the 83 patients requiring critical care, the median age was 42 (range, 2-204) months, with 24 (28.9%) and 48 (57.8%) of patients younger than 2 and 5 yrs, respectively. Twenty (24.1%) patients had no underlying illness, but 63 (75.9%) children had an underlying chronic illness. Indications for admission to the pediatric intensive care unit were respiratory failure in 66 (79.5%), neurologic deterioration in six (7.2%), and gastrointestinal symptoms in five (6.0%) patients. Acute lung injury was diagnosed in 23 (27.7%), acute respiratory distress syndrome was diagnosed in 34 (41%), and 51 (61.4%) patients were mechanically ventilated. Oseltamivir was used in 80 (96%) patients. The mortality rate for children with pandemic influenza 2009 was 30.1% compared to an overall mortality rate of 13.7% (p = .0016) among pediatric intensive care unit patients without pandemic influenza during the study period. Also, the mortality rate was 31.7% in patients with comorbidities and 25.0% in previously healthy children (p = .567). The cause of death was primary pandemic influenza infection in 16 (64%), nosocomial infection in four (16%), and primary disease progression in five (20%) patients. The odds ratio for respiratory failure was 14.7 (95% confidence interval, 1.85-111.11), and odds ratio for mechanical ventilation was 27.7 (95% confidence interval, 0.003-200). Conclusions: Severe disease and high mortality rates were seen in children with pandemic influenza. Death attributable to pandemic influenza occurred in all age groups of children with or without underlying illness. Multiple organ dysfunction syndrome is associated with increased mortality, and death is frequently secondary to severe lung infection caused by pandemic influenza. (Pediatr Crit Care Med 2012; 13:e11-e17)
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    Hyperferritinemia in the critically ill child with secondary hemophagocytic lymphohistiocytosis/sepsis/multiple organ dysfunction syndrome/macrophage activation syndrome: what is the treatment?
    (Bmc, 2012) Demirkol, Demet; Yildizdas, Dincer; Bayrakci, Benan; Karapinar, Bulent; Kendirli, Tanil; Koroglu, Tolga F.; Dursun, Oguz; Erkek, Nilgun; Gedik, Hakan; Citak, Agop; Kesici, Selman; Karabocuoglu, Metin; Carcillo, Joseph A.
    Introduction: Hyperferritinemia is associated with increased mortality in pediatric sepsis, multiple organ dysfunction syndrome (MODS), and critical illness. The International Histiocyte Society has recommended that children with hyperferritinemia and secondary hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS) should be treated with the same immunosuppressant/cytotoxic therapies used to treat primary HLH. We hypothesized that patients with hyperferritinemia associated secondary HLH/sepsis/MODS/MAS can be successfully treated with a less immunosuppressant approach than is recommended for primary HLH. Methods: We conducted a multi-center cohort study of children in Turkish Pediatric Intensive Care units with hyperferritinemia associated secondary HLH/sepsis/MODS/MAS treated with less immunosuppression (plasma exchange and intravenous immunoglobulin or methyl prednisolone) or with the primary HLH protocol (plasma exchange and dexamethasone or cyclosporine A and/or etoposide). The primary outcome assessed was hospital survival. Results: Twenty-three children with hyperferritinemia and secondary HLH/sepsis/MODS/MAS were enrolled (median ferritin = 6341 mu g/dL, median number of organ failures = 5). Univariate and multivariate analyses demonstrated that use of plasma exchange and methyl prednisolone or intravenous immunoglobulin (n = 17, survival 100%) was associated with improved survival compared to plasma exchange and dexamethasone and/or cyclosporine and/or etoposide (n = 6, survival 50%) (P = 0.002). Conclusions: Children with hyperferritinemia and secondary HLH/sepsis/MODS/MAS can be successfully treated with plasma exchange, intravenous immunoglobulin, and methylprednisone. Randomized trials are required to evaluate if the HLH-94 protocol is helpful or harmful compared to this less immune suppressive and cytotoxic approach in this specific population.
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    Noninvasive ventilation in cancer children with acute respiratory failure
    (Elsevier Science Bv, 2017) Yilmaz, Sema; Yildizdas, Riza Dincer; Dursun, Oguz; Karapinar, Bulent; Kendirli, Tanil; Demirkol, Demet; Citak, Agop; Kupesiz, Alphan; Tekguc, Hakan; Duyu, Muhterem; Yazici, Pinar; Yukselmis, Ufuk; Odek, Caglar; Yaman, Ayhan; Bayraktar, Suleyman; Sik, Guntulu; Cakir, Fatma Betul
    Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/ FiO2 ratios were (164.22 +/- 37.24) and (126.80 +/- 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.