• ÖZ

Many types of supraglottic airway devices (SAD) including the traditional LMA (Laryngeal Mask Airway) are commonly used as conduits for intubation in pediatric patients with difficult airway. The aim of this study was to evaluate the feasibility of four types of commonly used neonatal and infant sized SADs as conduits of intubation. Fiberoptic-guided tracheal intubation with uncuffed, cuffed and armored uncuffed endotracheal tubes (ETT) sized between 2.5 and 4.5 through four commonly used types of size 1 and 1.5 SADs (i-gel, LMA-classic, LMA-supreme, LMA-proseal) were performed by two investigators on an infant manikin. The investigators scored two main outcomes with a 5-point scale: 1) passage of ETT during intubation through the SAD, and 2) passage of SAD over the ETT during SAD removal. The differences between the study groups were evaluated using the Bonferroniadjusted Mann-Whitney U test and p<0.0083 was considered as statistically significant according to Bonferroni correction. i-gel sizes 1 and 1.5 both performed better as conduits for fiberoptic-guided intubation compared with LMA-proseal, LMA-classic and LMA-supreme with most of the uncuffed ETTs investigated (p<0.0083). We found i-gel sizes 1 and 1.5 easily feasible to use even with uncuffed ETTs with an inner diameter of 3.5 mm and 4.5 mm, respectively. i-gel was the only SAD that was feasible for use as a conduit for armored ETTs. The passage of cuffed ETTs was problematic with all types of studied SADs. In conclusion; the choice of i-gel as a conduit for intubation could be safer than LMA-classic, LMA-supreme and LMA-proseal.

• ÖZ

Adolescence is a long period involving many physical and psycho-social changes experienced during transition from childhood to adulthood. In this period, behaviors such as curiosity and risk-taking are common, and cigarette smoking initiation is one of those behaviors. In this study, it was aimed to find out whether chronic diseases are an effective factor or not in the cigarette smoking initiation of adolescents. One-hundred adolescents with Type 1 Diabetes Mellitus (T1DM) and 50 adolescents with Congenital Adrenal Hyperplasia (CAH) aged 12 and above under follow-up at the Pediatric Endocrinology Clinic and 100 healthy adolescents within the same age group who applied to the Adolescent Outpatient Clinic were included in the study. A survey was applied to all of these adolescents, which had been developed by researchers and contained questions about their socio-demographic features and cigarette smoking. Fourteen (5.6%) of the 250 adolescents were smokers. The rate of those who tried, but quitted cigarette smoking was found as approximately 20%. Cigarette smoking rate of those with T1DM was 1%, of those with CAH was 4%, and of the healthy adolescents was 11%. Cigarette smoking was significantly lower in those with a chronic disease (2%) than those who were healthy (11%). Adolescents’ parents and friends had an effect on the cigarette smoking initiation, and adolescents smoked their first cigarette generally because of curiosity. It was seen in this study that the adolescents with a chronic disease less frequently smoked cigarettes than the healthy adolescents, the rate of cigarette smoking in parents of cigarette smoking adolescents was very high, and their parents and friends had an effect on cigarette smoking initiation of adolescents.

• ÖZ

Digoxin is widely used in the treatment of congestive heart failure and some arrhythmias. Digoxin toxicity may occur easily because digoxin has a narrow therapeutic index. This retrospective study was conducted to evaluate the clinical signs and symptoms of toxic serum digoxin levels in neonates. Medical reports of the neonates who had serum digoxin concentrations >2 nanogram/milliliter (ng/ml) were reviewed in terms of patient demographics, serum digoxin concentrations, signs and symptoms of digoxin toxicity, serum digoxin and electrolyte levels, renal function tests, electrocardiograms, echocardiography, and treatments applied. Digoxin toxic levels were identified in the 13 neonates. Of the 13 neonates with digoxin toxic level, 9 (69%) were term and 8 (62%) were female. Twenty-three percent (3/13) of newborn infants were symptomatic. Symptomatic patients had statistically significantly higher serum digoxin levels, at 7.76±2.76 (5.4-10.8) ng/ml, than asymptomatic patients, at 3.31±1.09 (2.02-4.95) (p=0.036). Symptoms related to toxic digoxin levels were observed in the three neonates with plasma digoxin levels >5 ng/ml. Gastrointestinal and central nervous system symptoms were the major clinic findings. Despite high digoxin levels, no digoxin-related arrhythmia was observed on electrocardiography, other than sinus bradycardia. Two premature neonates were treated with digoxin-specific antibody Fab fragments (DigiFab®) and hypokalemia developed in both of them. Our data suggests that symptoms related with digoxin toxic levels were observed in neonates with plasma digoxin levels >5 ng/ml. Serum digoxin levels should be measured in case of signs and symptoms of digoxin toxicity or risk factors for such toxicity.

• ÖZ

Biotin-thiamine-responsive basal ganglia disease is characterized by seizures, dystonia and encephalopathy attacks, with an acute-subacute onset in childhood. It causes cerebral damage especially with caudate head and putamen involvement and may lead to severe sequelae and even death if left untreated. We report a patient with the neonatal form of biotin-thiamine-responsive basal ganglia disease who presented with encephalopathy and lactic acidosis in the neonatal period together with the diagnostic magnetic resonance imaging (MRI) clues. MRI in the neonatal period revealed bilateral involvement of the putamen, thalamus, and perirolandic cortical regions. However, MRI obtained at 32 months revealed involvement of the caudate nuclei in addition to the putamen and thalami. The neuroimaging findings of our patient and relevant literature indicate that patients with biotin-thiamine-responsive basal ganglia disease who are symptomatic in the neonatal period have putamen, thalami, and perirolandic cortical involvement. However, these patients do not have caudate involvement, unlike the patients who present in childhood.