Agop Citak - Academia.edu (original) (raw)

Papers by Agop Citak

Indian Journal of Pediatrics, Oct 1, 2010

Airway pressure release ventilation (APRV) is a relatively new mode of mechanical ventilation. Th... more Airway pressure release ventilation (APRV) is a relatively new mode of mechanical ventilation. The use of this model of ventilation in pediatrics has been limited. The authors describe their experience with this mode of ventilation in a series of pediatric hypoxemic respiratory failure patients. Three patients with acute hypoxemic respiratory failure (AHRF) were treated with APRV, when oxygenation did not improve with pressure control ventilation (PCV). The mean age of the patients was 5.8± 1.3 months. Fractional oxygen concentration decreased from 0.97±0.02 for PCV to 0.68±0.12 for APRV, peak airway pressure fell from 36.6±11.5 cm H 2 O for PCV to 33.3± 5.7 cm H 2 O for APRV, mean airway pressure increased from 17.9 ± 5.9 cmH 2 O for PCV to 27± 2.6 cmH 2 O for APRV and release tidal volume increased from 8.3±1.5 mL/kg for PCV to 13.2±1.1 mL/kg for APRV after 1 h. APRV may improve oxygenation in pediatric AHRF when conventional mechanical ventilation fails. The APRV modality may provide better oxygenation with lower peak airway pressure.

Critical Care, 2008

Introduction In order to find out the frequency rates of domestic and wild animal bites as well a... more Introduction In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration between

İstanbul Tıp Fakültesi Dergisi, 2015

Hemolitik Üremik Sendrom (HÜS) mikroanjiopatik hemolitik anemi, trombositopeni ve akut böbrek yet... more Hemolitik Üremik Sendrom (HÜS) mikroanjiopatik hemolitik anemi, trombositopeni ve akut böbrek yetersizliği ile tanımlanan bir tablodur. Çocuklarda HÜS etiyolojisinde Shiga toksin üreten Escherichiacoli'nin (STEC) neden olduğu HÜS en sık görülen formudur.Avrupa ülkelerinde akut böbrek yetersizliği etiyolojisinde en sık neden olarak belirtilen HÜS ülkemizde aynı sıklıkla görülmemektedir. Ancak 2011 yılında Almanya'da yaşanan Escherichiacoli (E.coli) gastroenteriti ve HÜS salgını sonrasında aynı yıl ülkemizde diyare sonrası gelişen HÜS vakalarında artış saptadık. Bu retrospektif çalışmada amacımız bu salgın sırasında diyare öyküsü ile başvuran HÜS tanılı hastalarımızın klinik özellikleri ve prognozunun belirlenmesidir. Gereç ve Yöntem: İkibinonbir yılında 9 HÜS hastası izlendi. Tam kan sayımı, periferik kan yayması, kan üre, kreatinin, elektrolitler, kompleman C3, direkt coombs testi, idrar, kan ve dışkı kültürleri ve akciğer grafisi yapıldı. Bulgular: Ortalama yaş 5,8±4,2 (3ay-12 yaş) yaştı. Altı hastada anüri mevcuttu ve ilk idrar çıkışı başvurudan 2-7 gün sonra görüldü. Ortalama hastanede yatış süresi 17,66±13,77 (8-52) gündü. İyileşme sürecinde ilk olarak trombosit sayısı yükseldi. Anürik hastalarda idrar çıkışı trombosit sayısının yükselmeye başlamasından hemen sonra görüldü. Ortalama oligüri ve anüri süresi sırasıyla 7±3 (3-10) ve 4±5 (1-14) gündü. Sonuç: Çalışmamızın sonuçları, serum C3 düzeyi düşük olan, hayati organ tutulumu gösteren, böbrek yetersizliği uzun süren ve dışkıda verotoksin negatif olan hastaların atipikHÜS nedenleri açısından tetkikleri tamamlanmamış olsa bile atipikHÜS gibi kabul edilerek tedavi edilmesinin uygun olacağını düşündürmektedir.

Istanbul Medical Journal, Jan 24, 2019

Open Forum Infectious Diseases, 2015

Journal of Pediatric Infection, Mar 16, 2020

Özgün Araştırma / Original Investigation Öz Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde... more Özgün Araştırma / Original Investigation Öz Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yatan hastalarda viral patojen sıklığının ve hastaların klinik özelliklerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Kasım 2016-Eylül 2017 tarihleri arasında çocuk YBÜ'ye yatan, viral enfeksiyon şüphesiyle viral solunum paneli gönderilen ve pozitif saptanan 80 hasta çalışmaya dahil edildi. Solunum panelinde adenovirüs (ADV), metapnömovirüs (MPV), parainfluenza virüs (PIV) 1, PIV 2, PIV 3, PIV 4, influenza virüs (IV) A ve IVB, rinovirüs (RV), respiratuvar sinsityal virüs (RSV) A ve RSV B multipleks polimeraz zincir reaksiyonu (PCR) ile çalışıldı. Örnekler entübe olmayan hastalarda nazofarengeal sürüntüden, entübe olan hastalarda trakeal aspirasyon materyalinden alındı. Bulgular: Kasım 2016-Eylül 2017 tarihleri arasında YBÜ'ye toplam 514 hasta yatırıldı. Alt solunum yolu enfeksiyonu tanısıyla yatan 123 hastada nazofarengeal sürüntü veya trakeal aspirasyon materyalinden örnek alınarak Multipleks PCR ile viral enfeksiyon paneli çalışıldı. Ortalama yaş 6.1 ± 3.6 aydı, hastaların %60 (n= 48)'ı erkekti. Seksen hastada 93 pozitiflik saptandı. On üç (%16) hastada çift etken pozitifliği vardı. En sık saptanan viral ajanlar 36 (%45) hastada RSV (A + B), 26 (%27.9) hastada RV, 7 (%7.5) hastada PIV 1, 6 (%6.4) hastada ADV, 5 (%5.3) hastada human MPV, 4 (%4.3) hastada IVA, 4 (%4.3) hastada IVB idi. Çift etken pozitifliğinde en sık RV ve RSV B pozitifliği saptandı. En çok viral etken pozitifliği saptanan aylar aralık (n= 15) ve şubattı (n= 13). Hastaların %57'sine yüksek akımlı

American Journal of Nephrology, 1998

Acute hyperammonemia is an emergent cause of central nervous system dysfunction for which renal r... more Acute hyperammonemia is an emergent cause of central nervous system dysfunction for which renal replacement therapy is advocated. We report the successful use of continuous venovenous hemodiafiltration in this metabolic emergency, and report the calculated ammonia clearances for both continuous venovenous hemofiltration and hemodiafiltration.

Critical Care Medicine, 2010

Objective-To describe survival outcomes for pediatric patients supported with extracorporeal memb... more Objective-To describe survival outcomes for pediatric patients supported with extracorporeal membrane oxygenation for severe myocarditis and identify risk factors for in-hospital mortality. Design-Retrospective review of Extracorporeal Life Support Organization registry database. Setting-Data reported to Extracorporeal Life Support Organization from 116 extracorporeal membrane oxygenation centers. Patients-Patients <=18 yrs of age supported with extracorporeal membrane oxygenation for myocarditis during 1995 to 2006. Interventions-None. Measurements and Main Results-Of 19,348 reported pediatric extracorporeal membrane oxygenation uses from 1995 to 2006, 260 runs were for 255 patients with a diagnosis of myocarditis (1.3%). Survival to hospital discharge was 61%. Seven patients (3%) underwent heart transplantation and six patients survived to discharge. Of 100 patients not surviving to hospital discharge, extracorporeal membrane oxygenation support was withdrawn in 70 (70%) with multiple organ failure as the indication in 58 (83%) patients. In a multivariable model, female gender (adjusted odds ratio, 2.3, 95% confidence interval, 1.3-4.2), arrhythmia on extracorporeal membrane oxygenation (adjusted odds ratio, 2.7, 95% confidence interval, 1.5-5.1), and renal failure requiring dialysis (adjusted odds ratio, 5.1, 95% confidence interval, 2.3-11.4) were associated with increased odds of in-hospital mortality. Conclusion-Extracorporeal membrane oxygenation is a valuable tool to rescue children with severe cardiorespiratory compromise related to myocarditis. Female gender, arrhythmia on extracorporeal membrane oxygenation, and need for dialysis during extracorporeal membrane oxygenation were associated with increased mortality.

Istanbul Medical Journal, 2019

SUMMARY Amitriptyline intoxication is a frequent and life threatening cause of referral to pediat... more SUMMARY Amitriptyline intoxication is a frequent and life threatening cause of referral to pediatric emergency departments.The most serious side effects are seen on the central nervous and cardiovascular systems. In patients with severe poisoning, cardiac conduction disorders, supraventricular tachycardia,ventricular dysrhythmias, and hypotension may occur. Eighteen months old girl was admitted to our intensive care unit for hypotension and ventricular fibrillation after receiving amitriptyline tablets of unknown amount. Adenosine, defibrillation, magnesium sulfate, and lidocaine was applied to the patient. With these treatments the patient was discharged completely recovered (CAYD 2014; 1(1):39-42).

The Turkish Journal of Pediatrics, 2020

Extracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmon... more Extracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmonary failure who do not respond to conventional therapy; only a few studies have been conducted in Turkey. We present the experience of pediatric ECMO with the aim of showing factors affecting mortality. We retrospectively reviewed our ECMO database to identify patients who received ECMO from October 2015 to March 2018. Our population comprised 30 pediatric patients. The mean patient age was 41.31±53.35 months and 17 (56.7%) patients were male. The median duration of ECMO support was 8.9 (6.6-10.8) days. The rates of successful ECMO weaning and survival to discharge were 70.0% (n=21) and 66.7% (n=20), respectively. Indications for ECMO were respiratory failure (40.0%), cardiac failure (33.3%), and sepsis (26.7%). We found that pre-cannulation values of pH (p=0.034), leukocytes (p=0.029), C-reactive protein (p=0.045), creatinine (p=0.047), chloride (p=0.001) and post-cannulation pH (p=0.0001), bicarbonate (p=0.014), lactate (p=0.002), chloride (p=0.0001) were associated with mortality. The results showed that preexisting sepsis and renal conditions contributed to poor outcomes. Indications, ECMO onset time, and pre-and post-cannulation laboratory values such as leukocytes, CRP, creatinine, bicarbonate, lactate, and chloride are factors that affect outcomes.

Türk Pediatri Arşivi, 2020

The known about this topic Pertussis is a vaccine-preventable disease. The causative agent is Bor... more The known about this topic Pertussis is a vaccine-preventable disease. The causative agent is Bordetella pertussis. It frequently leads to pneumonia in infants. It may cause severe disease in unvaccinated infants. Contribution of the study Among patients admitted to intensive care unit, severe pertussis occurs more frequently in infants who are too young to be protected with active immunization. Maternal immunization and the cocoon strategy may provide success to protect this age group. Severe pulmonary hypertension on echocardiographic examination and presence of leukocytosis in laboratory tests are associated with poor prognosis.

Therapeutic Apheresis and Dialysis, 2020

In 2019, the American Society for Apheresis (ASFA) published a categorized list of indication for... more In 2019, the American Society for Apheresis (ASFA) published a categorized list of indication for therapeutic apheresis by using a evidence based approach. The guidelines of ASFA are the main reference in decision making regarding indications in pediatric and adult patient. When taking indications in consideration, it can be seen that number of diseases which can be treated with TPE has increased significantly over years (4). Decision to implement apheresis in pediatric patient usually rely on results of adult patient studies. Although features of apheresis procedure are technically identical in both adults and children, differences in vascular access and extra-corporeal volume cause difficulties in pediatric patients. Even though there are many studies on plasma exchange, indications, and technical problems in adult patients, there is limited resource for pediatric population(1,5). Aim of the study was to characterize clinical indications, complications, and treatment outcomes in critically ill children who received TPE treatment in our institution. We would like to expand existing limited data regarding pediatric TPE with our results. Materials and Methods This retrospective comparative study was conducted in PICU with 15 bed capacity over 4 years-period. 135 patients under age of 18 years who were admitted to PICU between 2015 and 2019 and treated with TPE were included. The study was approved by local research ethics committee. Due to observational nature of the study, informed consent was waived. Following data was collected using detailed form: patient's age, gender, diagnosis, underlying disease and comorbidity, chronic illness, PRISM score, TPE indication, total TPE sessions, treatment complications, need for invasive/non-invasive mechanical ventilation, treatment outcomes, length of stay in PICU, and mortality. We also recorded patients received TPE alone and those who received TPE in combination with other extracorporeal treatment (CRRT, ECMO). All patients were classified according to ASFA 2019 guidelines including a list of evidence based indications for TPE in which four categories were formed based on the quality of published evidence and strength of recommendations. A venous catheter was placed to either jugular or femoral veins. We performed plasma exchange by using configuration method in our center. TPE was performed via using Fresenius COM-TEC apheresis devices (Fresenius, Germany). Fresh frozen plasma was used as replacement fluid and 5% albumin was used as replacement in case of allergic reaction to plasma. We aimed to exchange 1 to 1.5 times of estimated plasma volume. In small children (usually <10 kg) whom extracorporeal volume exceed 10% of their total blood volume, the

European Journal of Heart Failure Supplements, 2006

Journal of Pediatric Infection, 2020

Öz Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla y... more Öz Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yatan hastalarda viral patojen sıklığının ve hastaların klinik özelliklerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Kasım 2016-Eylül 2017 tarihleri arasında çocuk YBÜ'ye yatan, viral enfeksiyon şüphesiyle viral solunum paneli gönderilen ve pozitif saptanan 80 hasta çalışmaya dahil edildi. Solunum panelinde adenovirüs (ADV), metapnömovirüs (MPV), parainfluenza virüs (PIV) 1, PIV 2, PIV 3, PIV 4, influenza virüs (IV) A ve IVB, rinovirüs (RV), respiratuvar sinsityal virüs (RSV) A ve RSV B multipleks polimeraz zincir reaksiyonu (PCR) ile çalışıldı. Örnekler entübe olmayan hastalarda nazofarengeal sürüntüden, entübe olan hastalarda trakeal aspirasyon materyalinden alındı. Bulgular: Kasım 2016-Eylül 2017 tarihleri arasında YBÜ'ye toplam 514 hasta yatırıldı. Alt solunum yolu enfeksiyonu tanısıyla yatan 123 hastada nazofarengeal sürüntü veya trakeal aspirasyon materyalinden örnek alınarak Multipleks PCR ile viral enfeksiyon paneli çalışıldı. Ortalama yaş 6.1 ± 3.6 aydı, hastaların %60 (n= 48)'ı erkekti. Seksen hastada 93 pozitiflik saptandı. On üç (%16) hastada çift etken pozitifliği vardı. En sık saptanan viral ajanlar 36 (%45) hastada RSV (A + B), 26 (%27.9) hastada RV, 7 (%7.5) hastada PIV 1, 6 (%6.4) hastada ADV, 5 (%5.3) hastada human MPV, 4 (%4.3) hastada IVA, 4 (%4.3) hastada IVB idi. Çift etken pozitifliğinde en sık RV ve RSV B pozitifliği saptandı. En çok viral etken pozitifliği saptanan aylar aralık (n= 15) ve şubattı (n= 13). Hastaların %57'sine yüksek akımlı oksijen tedavisi, %12'sine noninvaziv mekanik ventilasyon uygulandı.

Turkish Archives of Pediatrics/Türk Pediatri Arşivi, 2019

Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care u... more Aim: Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and Methods: In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results: One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-neg...