Objective: This study aimed to compare the efficacy of direct and videolaryngoscopy procedures performed by pediatric residents who had limited experience of direct endotracheal intubation and had not previously used video laryngoscopes in a normal airway child manikin. Material and Methods: The endotracheal intubations performed by pediatric residents with a direct laryngoscope and Storz C-MAC videolaryngoscope on a pediatric manikin with a normal airway were compared. Theoretical and practical training was given before the study. In the first attempt, the success of the intubation procedure, glottis visual duration, and endotracheal tube insertion time were determined. Practitioners grouped the glottis image between 1-4 according to the Cormack-Lehane Staging (Stage 1 ideal image). After the intervention, the participants scored one to ten points on direct and videolaryngoscopy (1 not useful, 10 very useful). Results: The success of direct and videolaryngoscopy of 51 pediatric residents on the same manikin was 48 out of 51 (94%) for each method (p> 0.05). Glottis visual duration was similar in both methods (p>0.05); tube insertion and total intubation time were shorter in the video laryngoscope group (p<0.05); glottis image was better in the video laryngoscope group according to Cormack-Lehane Classification (p<0.05). Participants’ rating was higher on videolaryngoscope (p<0.05). Conclusion: Users with limited endotracheal intubation experience use Video laryncoscope more effectively than direct laryngoscope in children with normal airway model after training. Cite this article as: Anıl AB, Anıl M, Durak F, et al. Comparison of direct and video laryngoscope endotracheal intubations by pediatric residents: A study of a child model with normal airway. Turk Arch Pediatr 2021; 56(3): 224-9.

OBJECTIVES: We aimed to compare the demographic and clinical characteristics between pediatric cardiac arrest patients treated in Gaziantep at South-eastern Anatolian region and Izmir at Aegean Shore. MATERIALS And METHODS: We retrospectively reviewed sociodemographic characteristics, laboratory parameters, and clinical outcomes of pediatric patients that underwent cardiopulmonary resuscitation due to prehospital cardiac arrest at two pediatric emergency departments in Izmir Hospital of Health Sciences University and Gaziantep Cengiz Gökçek Kadın Doğum ve Çocuk Hospital of Health Ministry between August 2017 and August 2018. RESULTS: The present study included 188 patients (112 patients from Gaziantep and 76 patients from Izmir). All patients arrived at the hospital through emergency medical services. The median age was lower (14 days vs. 15 months; P < 0.001), and the proportion of Syrian refugees was higher in patients from Gaziantep (78.6% vs. 7.9%; P < 0,001). In both centers, respiratory failure was the most common etiology. In patients from Gaziantep, pH levels were lower (median: 7.10 vs. 7.24), and lactate levels were higher (median: 6 mmol/L vs. 3.6 mmol/L; P < 0.001). The mortality rate was higher among patients from Gaziantep (27.7% vs. 7.9%; P = 0.001). CONCLUSIONS: The rate of Syrian refugees among children who were brought to emergency department due to pre-hospital cardiac arrest was much higher in Gaziantep compared to Izmir. Syrian children were significantly younger and had more severe tissue hypoxia, resulting in a higher mortality rate.

Background. Myxedema coma is a rare, but life-threatening endocrinological emergency. Myxedema is characterized by altered mental status, and is accompanied by hypotension, bradycardia, hypothermia, bradypnea, hyporeflexia, hyponatremia, and hypoglycemia, all stemming from reduced metabolism due to severe hypothyroidism. Additionally, patients may exhibit signs of low cardiac output, edema in the extremities, peripheral circulatory disturbances, shock, and the development of pericardial and pleural effusions, ultimately leading to confusion and coma. We present a successfully treated case of severe myxedema coma with recurrent pericardial effusion and hypotensive shock. This case is characterized by an unusual clinical presentation and required a distinct treatment strategy highlighting its exceptional rarity. Case. A 2-year-old boy with Down syndrome presented with recurrent pericardial effusion attributed to medication non-adherence. The critically-ill patient, experiencing a severe cardiogenic shock required mechanical ventilation and inotropic infusions in the pediatric intensive care unit. Elevated thyroid stimulating hormone (TSH), and low free T4 (fT4) and free T3 (fT3) levels prompted consideration of myxedema coma. Upon reviewing the patient’s medical history, it was ascertained that he had an ongoing diagnosis of primary hypothyroidism, and exhibited non-adherence to the prescribed treatment regimen and failed to attend scheduled outpatient clinic appointments for follow-up assessments. The treatment plan, devised by the pediatric endocrinology team, included the peroral administration of L-thyroxine (L-T4) at a dose of 50 micrograms per day. After beginning regular oral L-T4 treatment, a gradual improvement in the patient’s condition was observed. Notably, by the 15th day of oral therapy, the patient had made a full recovery. Contrary to the recommended intravenous treatment for myxedema coma, this patient was successfully treated with oral levothyroxine, due to the unavailability of the parenteral form in Türkiye. Conclusions. This case report presents an instance of non-adherence to L-T4 therapy, which subsequently progressed to severe myxedema coma. Changes in neurologic status and hemodynamic instability in a patient with a history of hypothyroidism should raise the concern of nonadherence and, though rare, myxedema coma should be in the differential diagnosis.

Background/aim: This study aimed to investigate the clinical features, laboratory findings, treatment approaches, and follow-up strategies employed in the management of pediatric patients with levothyroxine poisoning. Materials and methods: This multicenter retrospective study included patients aged ≤18 years who presented with acute, single-episode levothyroxine ingestion to the pediatric emergency departments of six tertiary care centers between 2010 and 2023. Clinical data, laboratory findings, symptom onset and severity, and treatment modalities were extracted from medical records. Thyroid function tests (TFTs) were interpreted according to the age-specific reference ranges of each center. Treatment decisions, including gastric decontamination and pharmacologic therapy, were evaluated based on documented clinical indications. Results: A total of 45 patients were included in the study. The median age was 3.83 years (interquartile range [IQR]: 2.2–6.1). Levothyroxine ingestion was accidental in 80% (n = 36) of cases and intentional (suicidal) in 20% (n = 9). The median ages for accidental and suicidal ingestions were 3.0 years (IQR: 2.0–4.2) and 15.0 years (IQR: 13.7–16.9), respectively (p < 0.001). The median total ingested levothyroxine dose was 500 μg (IQR: 212.5–1112.5). Symptoms were reported in 33.3% (n = 15) of patients, with tachycardia being the most common (100%, n = 15), followed by hypertension (26.7%, n = 4) and agitation (20.0%, n = 3). The median levothyroxine dose among symptomatic patients was 1100 μg (IQR: 450–2250), significantly higher than that of asymptomatic patients 312.5 μg (IQR: 187.5–750) (p = 0.003). TFTs were abnormal in 51.1% (n = 23) of patients. Treatment was initiated in 55.6% (n = 25) of patients; activated charcoal was administered to 51.1% (n = 23), and gastric lavage to 26.7% (n = 12). Among the three patients with moderate symptoms, one received propranolol, methimazole, and corticosteroids, whereas the other two were treated with propranolol alone. An asymptomatic patient with markedly abnormal TFTs received corticosteroids. No fatal outcomes were reported. Conclusion: Levothyroxine poisoning in children is generally asymptomatic. When symptoms do occur, they are typically mild to moderate in severity, and the overall prognosis is favorable.