RESUMEN
Objective: Late neonatal hypocalcemia (LNH) is a common metabolic problem associated with hypoparathyroidism, high phosphate intake and vitamin D deficiency, often presenting with seizures. In this cross-sectional study, we aimed to evaluate the role of vitamin D deficiency in LNH in Turkey and to describe the characteristics of affected newborns. Methods: Conducted with a cross-sectional design and with the participation of 61 neonatal centers from December 2015 to December 2016, the study included term neonates with LNH (n=96) and their mothers (n=93). Data were registered on the FAVOR Web Registry System. Serum samples of newborns and mothers were analyzed for calcium, phosphate, magnesium, albumin, alkaline phosphatase, intact parathyroid hormone (iPTH) and 25 hydroxyvitamin D [25(OH)D] levels. Results: The median (range) onset time of hypocalcemia was 5.0 (4.0-8.0) days of age, with a male preponderance (60.4%). The median (range) serum 25(OH)D levels of the neonates and their mothers were 6.3 (4.1-9.05) and 5.2 (4.7-8.8) ng/mL, respectively. The prevalence of vitamin D deficiency (<12 ng/mL) was high in both the neonates (86.5%) and mothers (93%). Serum 25(OH)D levels of the infants and mothers showed a strong correlation (p<0.001). While the majority (93.7%) of the neonates had normal/high phosphorus levels, iPTH levels were low or inappropriately normal in 54.2% of the patients. Conclusion: Vitamin D deficiency prevalence was found to be high in LNH. Efforts to provide vitamin D supplementation during pregnancy should be encouraged. Evaluation of vitamin D status should be included in the workup of LNH.
Asunto(s)
Hipocalcemia/epidemiología , Enfermedades del Recién Nacido/epidemiología , Deficiencia de Vitamina D/epidemiología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Masculino , Prevalencia , Turquía/epidemiologíaRESUMEN
AIM: The aim of this study was to evaluate the pulmonary functions of preschool children born late-preterm. MATERIAL AND METHODS: Children aged between 3-7 years who were born at 340/7-366/7 weeks' gestation represented the target sample. Patients with a diagnosis of congenital cardiac, pulmonary and/or muscle diseases were excluded. Respiratory symptoms were evaluated using the modified asthma predictive index and International Study of Asthma and Allergies in Childhood criteria for children aged under and over 6 years, respectively. Skin prick tests were performed. Age-matched healthy controls were chosen according to the criteria proposed by the American Thoracic Society. Lung functions were evaluated using impulse oscillometry study in both groups. Data were recorded in the SPSS program. RESULTS: A total of 139 late-preterms and 75 healthy controls participated in the study. The mean gestational week of the late-preterms was 35.3±0.9 weeks. The main admission diagnosis to neonatal intensive care unit was respiratory distress. In the postdischarge period, 54.1% were hospitalized for pulmonary infections at least once, and 57.8% were passive smoking currently. Aeroallergen sensitivity was detected as 25.8% in the late-preterm group; 34.5% and 15.1% were diagnosed as having asthma and non-asthmatic atopy, respectively. Impulse oscillometry study parameters of R5, R10, and Z5 were higher and X10 and X15 were lower in late-preterms than in controls (p<0.05). Late-preterms with and without respiratory distress in the postnatal period revealed no statistical differences for any parameters. CONCLUSIONS: Our findings suggest that presence of increased peripheral airway resistance in late-preterms as compared to term-born controls.
RESUMEN
BACKGROUND: This study examined potential risk factors for and consequences of simple minor neurological dysfunction (SMND), in a group of very low-birthweight newborns followed until preschool age. METHODS: This was a prospective longitudinal study. Children with birthweight <1500 g were assessed at 4-6 years of age. Twenty-eight children with normal neurological examination and 35 children with SMND were included in the final analysis. Risk factors for the development of SMND and its association with certain neuropsychiatric conditions were studied. RESULTS: Based on neonatal data, in children with SMND, Apgar score at 1 min (6.13 ± 2.37 vs 7.66 ± 1.04, P = 0.008) and at 5 min (8.63 ± 1.29 vs 9.45 ± 0.65, P = 0.019) was lower, duration of hospital stay was longer (45.8 ± 21.8 vs 35.1 ± 18.2 days, P = 0.037), and the frequency of sepsis was higher (73.5 vs 25%, P < 0.001). Sepsis was found to be an independent risk factor for SMND (OR, 7.6; 95% CI: 2.2-26.0; P = 0.001). The children with SMND had lower intelligence quotient and higher prevalence of hyperactivity and refraction error. CONCLUSION: Postnatal sepsis was the single most important risk factor for the development of SMND, and these children with SMND are at great risk for certain neuropsychiatric conditions. Preventive strategies, particularly for sepsis in the neonatal period, and early diagnosis and rehabilitation of future neuropsychiatric disorders are needed for better management of these cases.
Asunto(s)
Enfermedades del Prematuro , Recién Nacido de muy Bajo Peso , Sepsis Neonatal/complicaciones , Enfermedades del Sistema Nervioso/etiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Recien Nacido Prematuro , Modelos Logísticos , Masculino , Enfermedades del Sistema Nervioso/diagnóstico , Pruebas Neuropsicológicas , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children. METHODS: Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5-20 Hz, resistance (R5-R20), reactance (X5-X20), impedans (Z5) and resonant frequency were measured on IOS. RESULTS: Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P < 0.05). Mean R5, R10 and Z5 were statistically higher in late-preterm children who had been hospitalized for pulmonary infection compared with the control group (P < 0.05). Mean R5, R10, R15, R20 and Z5 were significantly higher, and mean X10 and X15 significantly lower in late-preterm children with passive smoking compared with late-preterm children without passive smoking and controls (P < 0.05). CONCLUSION: Children born late preterm had signs of peripheral airway obstruction on IOS-based comparison with healthy term-born controls. Besides the inherent disadvantages of premature birth, hospitalization for pulmonary infection and passive smoking also seemed to adversely affect lung function in children born late preterm.
Asunto(s)
Obstrucción de las Vías Aéreas/fisiopatología , Recien Nacido Prematuro , Pulmón/fisiopatología , Oscilometría/métodos , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Masculino , Estudios ProspectivosRESUMEN
INTRODUCTION: There are contradictory results about the effects of exercise and sildenafil on cognitive functions. AIM: To investigate the effects of sildenafil pretreatment and chronic exercise on anxiety and cognitive functions. METHOD: Wistar rats (n=42) were divided as sedentary and exercise groups. A moderate-intensity swimming exercise was performed for 6 weeks, 5 days/week, 1h/day. Some of the rats were administered orogastrically with sildenafil (25mg/kg/day) either acutely or chronically. Exposure to cat odor was used for induction of stress. The level of anxiety was evaluated by elevated plus maze test, while object recognition test was used to determine cognitive functions. Brain tissues were removed for the measurement of myeloperoxidase (MPO), malondialdehyde (MDA), nitric oxide levels, lucigenin-enhanced chemiluminescence, and for histological analysis. RESULTS: Increased MPO and MDA levels in sedentary-stressed rats were decreased with sildenafil applications. Chronic exercise inhibited the increase in MPO levels. Increased nitric oxide and lucigenin chemiluminescence levels in sedentary-stressed rats, were diminished with chronic sildenafil pretreatment. The time spent in the open arms of the plus maze was declined in sedentary-stressed rats, while chronic sildenafil pretreatment increased the time back to that in non-stressed rats. Acute sildenafil application to exercised rats prolonged the time spent in open arms as compared to non-treated exercise group. The time spent with the novel object, which was decreased in sedentary-stressed rats, was increased with sildenafil pretreatment. Our results suggest that sildenafil pretreatment or exercise exerts a protective effect against acute stress and improves cognitive functions by decreasing oxidative damage.
Asunto(s)
Cognición/efectos de los fármacos , Cognición/fisiología , Terapia por Ejercicio/métodos , Psicotrópicos/farmacología , Citrato de Sildenafil/farmacología , Estrés Psicológico/terapia , Enfermedad Aguda , Animales , Trastornos de Ansiedad/fisiopatología , Trastornos de Ansiedad/terapia , Modelos Animales de Enfermedad , Conducta Exploratoria/efectos de los fármacos , Conducta Exploratoria/fisiología , Hipocampo/efectos de los fármacos , Hipocampo/fisiopatología , Masculino , Malondialdehído/metabolismo , Óxido Nítrico/metabolismo , Peroxidasa/metabolismo , Condicionamiento Físico Animal/fisiología , Condicionamiento Físico Animal/psicología , Distribución Aleatoria , Ratas Wistar , Reconocimiento en Psicología/efectos de los fármacos , Reconocimiento en Psicología/fisiología , Estrés Psicológico/fisiopatología , Natación/fisiología , Natación/psicología , Resultado del TratamientoRESUMEN
BACKGROUND: There are several studies that have shown an increased risk of premature birth and developmental abnormalities with in vitro fertilization (IVF); however, the data on preterm mortality and morbidity are limited. AIM: Our aim is to investigate whether IVF had an effect on the mortality and morbidity in neonates admitted to the neonatal intensive care unit. METHODS: A total of 940 term and preterm babies who were admitted to the intensive care unit over a period of 2 years were enrolled. Of these, 121 babies were born after IVF and 810 were born after a natural conception and 9 were born after ovulation induction. Of these, 112 preterm babies were born after IVF and 405 preterm babies were born after a natural conception. RESULTS: In the IVF group, the gestational age and birth weight were significantly lower than in the non-IVF group. Additionally, in the IVF group, multiple births were significantly higher than in the non-IVF group. IVF pregnancies increase preterm delivery but did not increase preterm mortality, and preterm morbidity did not differ among groups, except for intraventricular hemorrhage (IVH). Gestational age was shown to be the primary risk factor for IVH using a logistic regression analysis. Also when newborns at gestational age <32 weeks were compared using regression analysis, gestational age was the major risk factor for IVH. CONCLUSION: IVF appears to be associated with premature delivery and the known risks associated with prematurity.
Asunto(s)
Fertilización In Vitro/estadística & datos numéricos , Mortalidad Infantil , Recien Nacido Prematuro , Peso al Nacer , Femenino , Hospitales Universitarios , Humanos , Lactante , Recién Nacido , Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal , Trabajo de Parto Prematuro , Embarazo , Factores de Riesgo , Turquía/epidemiologíaRESUMEN
BACKGROUND: There have been many studies that have investigated the risk factors of mortality in preterm infants, but none has shown an association between preterm mortality and exposure to heavy metals or trace elements. The aim of this study was therefore to measure the levels of toxic metals (lead, cadmium) and trace elements (zinc, iron, copper) in meconium samples and elucidate their association with preterm mortality. METHODS: Metals and trace elements were measured in the meconium of 304 preterm infants using a flame atomic absorption spectrophotometer. RESULTS: The level of heavy metals and trace elements in non-surviving infants was significantly higher than in surviving infants. Moreover, the level of heavy metals and trace elements in non-surviving infants whose gestational age was <30 weeks (n = 11) was significantly higher than in surviving infants (n = 12). Receiver operating characteristic curve analysis showed that gestational age and meconium lead level predicted early mortality in premature newborns. Furthermore, this curve analysis showed that, when comparing meconium lead level and gestational age, meconium lead level had a similar effect on mortality as gestational age. CONCLUSION: Meconium lead level and gestational age are associated with increased mortality risk in preterm neonates.
Asunto(s)
Cadmio/toxicidad , Plomo/toxicidad , Meconio/química , Efectos Tardíos de la Exposición Prenatal/mortalidad , Oligoelementos/toxicidad , Cadmio/análisis , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Plomo/análisis , Masculino , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/diagnóstico , Estudios Prospectivos , Curva ROC , Espectrofotometría Atómica , Oligoelementos/análisisRESUMEN
BACKGROUND: Although the effects of cardiac troponin I (cTnI) have been documented in infants, the associations among the value of maternal and cord blood total homocysteine (Hcy) levels, cord blood cTnI and the score for neonatal acute physiology and perinatal extension II (SNAPPE-II) values in infants have not been documented. The aim of this study was to determine the value of maternal total Hcy (mtHcy) and cord blood total Hcy (ctHcy) levels, cTnI and SNAPPE-IIas predictive factors of morbidity in newborns. METHODS: Maternal and cord blood samples were routinely collected for analysis from all prospective participating volunteers. In this casecontrol study, both hospitalized (n = 71) and non-hospitalized (n = 148) newborns were identified and followed until discharge. RESULTS: Regression analysis revealed that pre-eclampsia, gestational age, mtHcy and SNAPPE-II values were significantly and independently associated with morbidity. Cord blood pH, ctHcy levels, SNAPPE-II values, and pre-eclampsia were associated with mtHcy levels. A similar association was found among cTnI, cord blood pH, mtHcy levels and ctHcy levels. The specificity and sensitivity values of mtHcy in predicting newborn morbidity were 62% and 78%, respectively,while the specificity and sensitivity values of SNAPPE-II in predicting newborn morbidity were 96% and 97%,respectively. CONCLUSIONS: Elevated mtHcy levels were associated with cTnI, SNAPPE-II values, cord blood gas, and neonatal morbidities. These results suggest that SNAPPE-II may be an early predictor of morbidity after delivery and that elevated mtHcy levels may be an early prenatal biomarker of morbidity in newborns.
Asunto(s)
Sangre Fetal/química , Homocisteína/sangre , Enfermedades del Recién Nacido/diagnóstico , Recién Nacido/sangre , Troponina I/sangre , APACHE , Femenino , Humanos , Enfermedades del Recién Nacido/sangre , Recien Nacido Prematuro/sangre , Masculino , Preeclampsia/sangre , Embarazo , Pronóstico , Curva ROC , Análisis de RegresiónRESUMEN
BACKGROUND: The aim of the present study was to determine, using the score for neonatal acute physiology and perinatal extension II (SNAPPE-II), whether there is an association with acute renal failure (ARF) and whether it is possible to identify newborns at risk for ARF prior to a rise in creatinine in newborns. METHODS: Information on postnatal risk factors and SNAPPE-II on the first day of life (non-ARF group, n= 475; ARF group, n= 78) were collected. Renal failure was defined as serum creatinine level >1 mg/dL and >1.3 mg/dL (for ≥ 33 weeks and < 33 weeks, respectively) after 48 h of life. RESULTS: In newborns with ARF (n= 78), the median (range) of SNAPPE-II and mortality rate were significantly higher than those of the control group. Patent ductus arteriosus (PDA), disseminated intravascular coagulation (DIC), SNAPPE-II, and resuscitation were identified as independent predictors of ARF in infants on forward stepwise logistic regression. Sepsis, respiratory distress syndrome, ARF, DIC, and SNAPPE-II were identified as independent predictors of mortality in infants on the same analysis. CONCLUSIONS: SNAPPE-II on the first day of life was significantly higher among babies with ARF, suggesting a positive association between higher scores and the development of ARF and mortality, but based on receiver operating characteristic curve results, SNAPPE-II at admission did not enhance the assessment of risk for ARF prior to a rise in creatinine.
Asunto(s)
Lesión Renal Aguda/mortalidad , Índice de Severidad de la Enfermedad , Lesión Renal Aguda/sangre , Lesión Renal Aguda/diagnóstico , Creatinina/sangre , Conducto Arterioso Permeable/complicaciones , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Pronóstico , Curva ROC , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The aim of this study was to investigate the genotypic distribution of organic anion transporting polypeptide 2 (OATP-2) gene mutations and the relationship with hyperbilirubinemia of unknown etiology. Polymerase chain reaction, restriction fragment length polymorphism, and agarose gel electrophoresis techniques were used for detection of OATP-2 gene mutations in 155 newborn infants: 37 with unexplained hyperbilirubinemia, 65 with explained hyperbilirubinemia, and 53 without hyperbilirubinemia. In the OATP-2 gene, we identified AâG transitions at nucleotide positions 388 and 411 and observed six polymorphic forms. The 388/411-411 mutation was the most common form (43%) in subjects with hyperbilirubinemia of unknown etiology. Male sex [odds ratio (OR): 3.08] and two polymorphic forms of the OATP-2 gene [the 388/411-411 AâG mutation (OR: 3.6) and the 388-411 mutation (OR: 2.4)] increased the risk of neonatal hyperbilirubinemia. In male infants with the 388 AâG mutation of the OATP-2 gene, the levels of unconjugated bilirubin in plasma were significantly increased compared with those observed in females. The polymorphic forms of 388 nucleotide of the OATP-2 gene were identified as risk factors for hyperbilirubinemia of unknown etiology.
Asunto(s)
Hiperbilirrubinemia Neonatal/genética , Transportador 1 de Anión Orgánico Específico del Hígado/genética , Polimorfismo de Nucleótido Simple , Estudios de Casos y Controles , Femenino , Deficiencia de Glucosafosfato Deshidrogenasa/complicaciones , Humanos , Hiperbilirrubinemia Neonatal/enzimología , Hiperbilirrubinemia Neonatal/etiología , Recién Nacido , Modelos Logísticos , Masculino , Mutación , Oportunidad Relativa , Factores Sexuales , TurquíaRESUMEN
The aim of this study is to describe the health status, health care received, and their impact on the quality of life in patients with hemophilia. Patients with severe factor VIII or IX deficiency without inhibitors or other chronic disease were enrolled. Turkish version of the Hemophilia-Specific Quality of Life Index (Haemo-QoL) questionnaire was administered to the pediatric patients aged 4 to 16 years and Haem-A-QoL to the adult patients. Joints were evaluated according to the World Federation of Hemophilia (WFH) orthopedic joint scores.Thirty-nine children/adolescents and 31 adult patients were enrolled. Mean Haemo-QoL scores were 39.6 +/- 15.0 for the children and mean Haem-A-QoL 47.4 +/- 14.1 for the adult patients, respectively. Internal consistency reliability was generally sufficient. Total Cronbach's alpha coefficient was >.70 (range .77-.96) in all the age groups. Mean total WFH orthopedic joint scores were 1.83 +/- 2.7, 4.9 +/- 4.96, and 6.94 +/- 6.15 in 4-7, 8-12, and 13-16-year-old groups, respectively. They were more impaired in the adult patients (16.23 +/-14.12). These results show that the Turkish version of the Haemo-QoL and Haem-A-QoL are reliable instruments to measure the quality of life in the pediatric and adult patients with severe hemophilia. When compared to the Haemo-QoL scores of an international multicenter West European study of children, quality of life in the Turkish patients were more impaired in the subscales of physical health, feeling, view, school and sport, and treatment as well as more impaired WFH joint scores. The authors recommend primary factor prophylaxis and encouraging the patients to learn home treatment to improve joint scores and quality of life.
Asunto(s)
Hemartrosis/diagnóstico , Hemofilia A/diagnóstico , Adolescente , Adulto , Niño , Preescolar , Atención a la Salud , Estado de Salud , Hemartrosis/psicología , Hemofilia A/psicología , Humanos , Calidad de Vida , Encuestas y Cuestionarios , TurquíaRESUMEN
We conducted this study to investigate the efficacy of the silicon gel application on the nares in prevention of nasal injury in preterm infants ventilated with nasal continuous positive airway pressure (NCPAP). Patients (n=179) were randomized into two groups: Group 1 (n=87) had no silicon gel applied to nares, and in Group 2 (n=92), the silicon gel sheeting was used on the surface of nares during ventilation with NCPAP. Nasal injury developed in 13 (14.9%) neonates in Group 1 and 4 (4.3%) newborns in Group 2 (OR:3.43; 95% CI: 1.1-10.1; P<0.05). The incidence of columella necrosis was also significantly higher in the Group 1 (OR: 6.34; 95% CI: 0.78-51.6; P<0.05). We conclude that the silicon gel application may reduce the incidence and the severity of nasal injury in preterm infants on nasal CPAP.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Nariz/lesiones , Silicio/administración & dosificación , Administración Tópica , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Geles , Humanos , Recién Nacido , Recien Nacido Prematuro , Necrosis , Estudios Prospectivos , Heridas y Lesiones/etiología , Heridas y Lesiones/prevención & controlRESUMEN
Cytomegalovirus (CMV) infections are commonly seen in humans and are usually mild or asymptomatic. However, these infections have significant medical risks in pregnant women, newborns and immunocompromised patients. Seronegative subjects and infants acquire CMV through infected blood products or direct contact with infected people. The use of seronegative blood products for selected patients, as in newborns and/or immunosuppressed patients has vital importance in medical management. Providing seronegative blood in countries where the prevalence of CMV is high (>90%), is difficult since this requires screening of a great number of blood donations. The aim of this study was to detect the CMV seroprevalence among voluntary blood donors in Kocaeli (located at northwestern region of Turkey) and to determine whether the screening procedure was cost-effective. CMV-IgG was investigated by a commercial ELISA method (AXSYM, Abbott, USA) in 1264 blood donors who were voluntarily admitted to donate blood for newborns between January to December 2006. In 1229 (97.2%) of these donors CMV-IgG was found positive while it was negative in 35 (2.8%). It was estimated that CMV-IgG screening was not cost-effective to provide seronegative blood donations because of the high rate of seropositivity in Kocaeli as well as other regions of Turkey, so it would be more favorable to apply alternative methods such as leukocyte reduction.
Asunto(s)
Donantes de Sangre , Transfusión Sanguínea/normas , Infecciones por Citomegalovirus/prevención & control , Citomegalovirus/inmunología , Huésped Inmunocomprometido , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Infecciones por Citomegalovirus/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Recién Nacido , Masculino , Tamizaje Masivo/economía , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Seroepidemiológicos , Turquía/epidemiología , Adulto JovenRESUMEN
Our aim was to compare intrapleural streptokinase (SK) treatment and simple tube drainage in the treatment of children with complicated parapneumonic pleural effusion. A retrospective review of medical records included patient demographics, clinical presentation, biochemical and microbial studies of pleural effusion, radiographic evaluation of chest tube drainage, use of fibrinolytic agents and type of surgical intervention. During the 2.5-year period (1999-2002), 53 children (29 M, 24 F) with complicated parapneumonic effusions or empyema were identified. Closed tube drainage and antibiotic treatment were administered to patients with a diagnosis of complicated parapneumonic effusion (n = 24) until October 2000; after that time point, intrapleural streptokinase was added to this regimen (n = 29). The median age at the time of presentation was 2.5 years (range: 5 months-14.6 years). There were no significant differences in terms of clinical outcomes between the two groups. The average length of hospital stay was 19.1 +/- 5.5 and 21.9 +/- 11.2 days for the drainage and streptokinase groups, respectively; the time to afebrile state after admission was 5.8 +/- 4.1 and 7.6 +/- 7.5 days. The percentage of patients who eventually required surgical intervention was 8.3% for the drainage group and 20.6% for the streptokinase group. In conclusion, in the treatment of complicated parapneumonic effusions or empyema, the adjunctive treatment with intrapleural SK does not significantly reduce durations of fever, chest tube drainage and hospital stay, and the need for surgery, regardless of the stage of the disease, compared to simple closed tube drainage.
Asunto(s)
Antibacterianos/uso terapéutico , Empiema Pleural/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Neumonía/tratamiento farmacológico , Estreptoquinasa/uso terapéutico , Adolescente , Niño , Preescolar , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Drenaje , Empiema Pleural/complicaciones , Empiema Pleural/fisiopatología , Femenino , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Mortalidad Hospitalaria , Humanos , Lactante , Tiempo de Internación , Masculino , Registros Médicos , Neumonía/complicaciones , Estudios Retrospectivos , Estreptoquinasa/administración & dosificación , Estreptoquinasa/efectos adversosRESUMEN
In our country, tricyclic antidepressants are usually present in most of the homes. Myocardial depression and ventricular arrhythmia are the severe side effects in tricyclic antidepressant overdose. A 4-year-old boy was brought to our hospital after taking 70 mg/kg of amitriptyline. On arrival, the patient was comatose (Glasgow Coma Score was 3), had a shallow breathing pattern with bradycardia (HR <30/min), and hypotension. He was intubated and resuscitated with multiple doses of adrenaline and sodium bicarbonate. He was infused with a bolus of 20 mg/kg of normal saline for hypotension. After 30 minutes, ventricular fibrillation was detected. Lidocaine and bicarbonate were not effective in converting the rhythm to normal, therefore, synchronized cardioversion was used. After cardioversion, the rhythm converted to ventricular tachycardia. Because ventricular tachycardia did not resolve, we administered a load of less than 2 g of magnesium sulfate for 30 minutes followed by a continuous infusion of 3 mg/min. After magnesium sulfate infusion, a normal cardiac rhythm was achieved. Magnesium sulfate is a very effective treatment in intractable arrhythmias caused by high-dose amitriptyline intoxication.
Asunto(s)
Amitriptilina/envenenamiento , Antidepresivos Tricíclicos/envenenamiento , Sulfato de Magnesio/uso terapéutico , Taquicardia Ventricular/inducido químicamente , Taquicardia Ventricular/tratamiento farmacológico , Preescolar , Humanos , Masculino , Resultado del Tratamiento , TurquíaRESUMEN
OBJECTIVE: Tonsil and adenoid hypertrophy may cause recurrent tonsillitis and upper airway obstruction in children. A reduced dietary intake and failure to gain weight is frequently reported by parents of children with a history of recurrent acute tonsillitis and adenotonsiller hypertrophy. The purpose of this prospective study was to evaluate whether surgical treatment of adenotonsillar hypertrophy affects the circulating concentrations of insulin-like growth factor-1 (IGF-1) and IGF-binding protein 3 (IGFBP-3) along with IGF-1 SDS and IGFBP-3 SDS's adjusted to age which are more important in evaluating growth in childhood. METHODS: Thirty-eight prepubertal children 24 boys and 14 girls participated in this study. The mean age at surgery was 6.66+/-1.84 years (range 4-10 years). Weight, height, IGF-1 and IGFBP-3 levels and standard deviation scores were evaluated before and 12-18 months after adenotonsillectomy (T&A). RESULTS: The number of infections in a year reduced from 8.6+/-4.4 to 0.37+/-0.68 after operation. The mean weight standard deviation score (SDS) increased significantly after T&A (p<0.01). The mean IGFBP-3 level increased from 1912+/-511.5 to 2989+/-1125ng/ml (p<0.001) and IGFBP-3 SDS increased from -3.0+/-0.58 SDS to -1.96+/-1.27 SDS (p: 0.001). However, the mean serum IGF-1 level increased from 80.3+/-48.5 to 116.8+/-105.9ng/ml (p: 0.135), and IGF-1 SDS increased from -1.36+/-0.51 SDS to -1.31+/-1.14 SDS (p: 0.701), which were both not statistically significant. CONCLUSIONS: We have demonstrated postoperative weight gain and significant increase in IGFBP-3 concentrations and IGFBP-3 SDS, accompanying significant decrease in the number of tonsillitis episodes after adenotonsillectomy.
Asunto(s)
Adenoidectomía/estadística & datos numéricos , Tonsila Faríngea/cirugía , Hormona del Crecimiento/sangre , Tonsilectomía/estadística & datos numéricos , Tonsilitis/patología , Tonsilitis/cirugía , Tonsila Faríngea/patología , Niño , Preescolar , Femenino , Humanos , Hipertrofia/patología , Hipertrofia/cirugía , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Periodo Posoperatorio , Prevalencia , Recurrencia , Síndromes de la Apnea del Sueño/epidemiología , Tonsilitis/epidemiologíaRESUMEN
AIM: The aim of this study is to interpret purified protein derivative (PPD) induration sizes with respect to the number of Bacillus Calmette-Guérin (BCG) scars. METHODS: We have considered 1879 school children between the ages of 7 and 14 years from seven primary schools in Kocaeli, Turkey. Children were injected with 5TU 0.1 mL PPD and induration sizes were measured at 72 h. Number of BCG scars, PPD application dates and induration sizes were recorded for each pupil. This study was also evaluated further for 312 households. RESULTS: The mean diameter of PPD induration size for 0, 1, 2 and 3 BCG vaccination scars were 1.43 mm (95% confidence interval (CI): 0.84-2.02), 6.39 mm (95% CI: 5.91-6.87), 10.46 mm (95% CI: 10.04-10.88) and 11.35 mm (95% CI: 9.36-13.34), respectively. Furthermore, 90% and 95% percentiles of PPD induration 0, 1, 2 and 3 vaccinations were 10 and 12 mm, 16 and 19 mm, 17 and 19 mm and 19.2 and 20 mm, respectively. There was evidence for a linear trend across from 0 to 3 BCG vaccinations, indicating that mean induration size increases with the number of vaccination scars. The size of indurations directly correlated with the number of vaccination scars, PPD induration size of children with no vaccination scar was quite small and it was generally less than 5 mm. CONCLUSION: This study shows the importance of the number of BCG scars in the determination of PPD induration size limit when tuberculosis infection is evaluated.
Asunto(s)
Vacuna BCG/administración & dosificación , Cicatriz/patología , Prueba de Tuberculina , Tuberculosis/prevención & control , Adolescente , Vacuna BCG/inmunología , Niño , Cicatriz/epidemiología , Femenino , Humanos , Esquemas de Inmunización , Masculino , Piel/patología , Turquía/epidemiología , Vacunación/estadística & datos numéricosRESUMEN
In addition to premarital screening programs, education of the general population is important in preventing hemoglobinopathies. The aim of the present study was the education of university students. Short questionnaires were applied before and after a prepared lecture. A 20-minute audiovisual education was provided including the clinical characteristics and inheritance of thalassemia and sickle cell anemia (SCA) as well as the importance of carrier screening. The attendance to 42 lectures was low (n= 1348 = 5%). Seventy-four percent of the students had heard of thalassemia. The percentage of the students who had some accurate knowledge was 25% for thalassemia and 11.7% for SCA. Following the lecture, these numbers increased to 86.2% and 72.1% for thalassemia and SCA, respectively. Only 13.6% of the students were aware of the risk of being carriers, but this increased to 78.6% following the lecture; 92.4% learned that these hemoglobinopathies were inherited and 78.8% learned that consanguineous marriages would increase the risk. Education on hemoglobinopathies must be integrated into the curricula of middle schools and high schools.
RESUMEN
It has been reported that gentamicin causes natriuresis, magnesuria and calciuria in neonates. The aim of this study was to determine the acute effects of trough and peak levels of gentamicin on the values of serum creatinine (SCr), urine albumin/urine creatinine (UA/UCr), fractional excretion of sodium and potassium (FENa, FEK) and urine calcium/urine creatinine (UCa/UCr) in preterm neonates treated with gentamicin for suspected infection. Baseline levels of serum and urine Cr, Na and K and urine albumin and Ca levels together with trough and peak gentamicin levels were measured in 61 preterm neonates at the start of the therapy, on the day of the third gentamicin dose and 48-72 h after the cessation of the gentamicin therapy. Therapeutic trough and peak levels were recorded in 56 (91.8%) and 39 (63.9%) of the preterm neonates, respectively, whereas high trough (>2 mg/dl) and peak (>9.99 mg/dl) levels were recorded in five (8.1%) and 11 (18%) of the 61 preterm neonates, respectively. Trough and peak levels of gentamicin were positively correlated with SCr, UA/UCr, FENa, FEK and UCa/UCr values. The UA/UCr, FENa and UCa/UCr values recorded during treatment were statistically significantly different from sub-therapeutic, therapeutic and high peak gentamicin levels. Gentamicin was found to have a serum peak level-dependent microalbuminuric, natriuric and calciuric effect in preterm neonates. Based on these results, we suggest that when the monitoring of serum gentamicin levels is not possible, the monitoring of UA/UCr, FENa and UCa/UCr can be useful as a noninvasive alternative.
Asunto(s)
Antibacterianos/efectos adversos , Gentamicinas/efectos adversos , Recien Nacido Prematuro/fisiología , Glomérulos Renales/efectos de los fármacos , Túbulos Renales/efectos de los fármacos , Albuminuria/orina , Antibacterianos/farmacocinética , Calcio/orina , Creatinina/sangre , Creatinina/orina , Relación Dosis-Respuesta a Droga , Femenino , Gentamicinas/farmacocinética , Humanos , Recién Nacido , Pruebas de Función Renal , Glomérulos Renales/fisiología , Túbulos Renales/fisiología , Masculino , Potasio/orina , Sodio/orinaRESUMEN
Premature infants<1500 g were randomly assigned to study and control groups. In the study group, 42 premature infants received recombinant human erythropoietin (r-Hu EPO) 750 U/kg per week subcutaneously from day 5 to 40 and enteral iron supplementation of 2 to 6 mg/kg/d beginning on day 14 provided that they were receiving at least 50% energy intake orally. In the control group, 51 infants received the same dose of enteral iron supplementation beginning at the end of the fourth week. At the end of a 12-week monitoring period, r-Hu EPO combined with early enteral iron reduced transfusion needs only in the subgroup<1000 g. r-Hu EPO and early iron treatment had no effect on the development of severe retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia. We suggest that r-Hu EPO combined with early enteral iron is both effective and safe in infants<1000 g.