Does chest compression during cardiopulmonary resuscitation provide sufficient cerebral oxygenation?

Background/aim: Some of the patients suffering from cardiac arrest (CA) remain in a chronic unconscious state in intensive care units (ICUs). The primary aim of this study was to evaluate the efficacy of chest compression (CC) on cerebral oxygenation during cardiopulmonary resuscitation (CPR). As a secondary goal, we attempted to determine the effects of regional cerebral oxygen saturation (rSO2) values on consciousness and the survival rate using the Full Outline of Unresponsiveness (FOUR) scoring method. Materials and methods: This observational preliminary study was carried out with 20 patients with CA who were hospitalized in ICUs. The rSO2 values measured by near-infrared spectroscopy were recorded during CA. FOUR scoring was used to determine the neurological status, severity of disease, and degree of organ dysfunction in survivors. Results: Return of spontaneous circulation (ROSC) was gained in 8 (40%) of 20 patients. Maximum rSO2 values were higher in survivors than in nonsurvivors (P = 0.005). The mean FOUR score before CA was 11.50 ± 0.8 in survivors, whereas this value was 7.87 ± 0.7 for 1 week after ROSC (P < 0.0001). There was a significant positive correlation between the minimum and mean rSO2 values and the mean 1-week FOUR scores in survivors (r = 0.811, r = 0.771 and P = 0.015, P = 0.025, respectively). Conclusion: Our results suggest that the maximum rSO2 values affect ROSC while the minimum and mean rSO2 values affect the post-cardiac arrest neurological outcome.

Severe Carbamazepine Intoxication in Children: Analysis of a 40-Case Series.

BACKGROUND We compared the factors that might impact the severity and the prognosis of carbamazepine (CBZ) intoxication in children, as well as the efficacy levels of the treatment options. MATERIAL AND METHODS Demographic information and clinical and laboratory findings for 40 patients were evaluated retrospectively. Predictive parameters for the development of serious complications were studied. RESULTS Median age of patients was 14 years; 65% of the patients were female. The most common pathological clinical finding and laboratory abnormality were inability to awaken the patient and hyperglycemia (45% and 60%, respectively). The incidences of convulsion, coma, and respiratory failure were 14 (35%), 10 (25%), and 3 (7.5%), respectively. The Glasgow Coma Scale (GCS) scores and pH levels at emergency service admission were significantly lower in the severe intoxication group and the ICU admission group, and body temperature and serum glucose and lactate levels were significantly higher in these groups. A significantly negative correlation was found between the serum CBZ level and the GCS score, but the serum CBZ level was found to be significantly positively correlated with the lactate level. CONCLUSIONS According to our study, the GCS score at admission to hospital, the serum CBZ, glucose, pH, and lactate levels, and body temperature might be useful in predicting serious CBZ intoxication and prognosis in pediatric cases. We conclude that invasive treatment methods, such as hemodialysis or albumin-enhanced continuous venovenous hemodialysis, should be used in patients who do not respond to supportive treatment.

Reliability of spot-check transcutaneous hemoglobin measurement in children.

BACKGROUND: This study investigated the correlation between spot-check transcutaneous hemoglobin (Hb) and simultaneously measured venous Hb in children. METHODS: Two hundred and seventeen children weighing 10-30 kg in whom complete blood count had been obtained for any reason were enrolled in this study. Demographic characteristics and vital signs were recorded. Prior to taking blood samples, transcutaneous Hb, heart rate, oxygen saturation, and perfusion index were measured using a probe connected to the subject's thumb. To determine the reliability of the transcutaneous measurement versus venous blood measurement performed via an autoanalyzer device, interclass correlation coefficient (ICC) was calculated. The correlation between the two measurements was evaluated on Bland-Altman analysis. RESULTS: A total of 59.4% of the patients were boys. The average age was 53 months (range, 6-132 months). Average bodyweight was 16 kg (range, 10-25 kg). Mean venous Hb, hematocrit, and transcutaneous Hb were 11.94 ± 1.15 g/dL, 35.8 ± 3.2%, and 12.42 ± 1.24 g/dL, respectively. The ICC for the reliability of the transcutaneous measurements versus venous blood measurements was r = 0.67 (95%CI: 0.5776-0.7526). The correlation between the two sets of measurements was good, as evaluated by the Bland-Altman analysis. CONCLUSION: There is good correlation between transcutaneous and venous blood measurements of Hb. In the future, transcutaneous measurement, as a non-invasive method, may be an alternative for the measurement of Hb in childhood.

The frequency of Hashimoto thyroiditis in children and the relationship between urinary iodine level and Hashimoto thyroiditis.

The aim of this study was to determine the frequency of thyroid autoimmunity in second grade primary school students and to examine the relationship between iodine and Hashimoto thyroiditis (HT). This was a cohort study performed with 1000 students. Urinary iodine levels, antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg) antibodies were determined in all children. Children with anti-TPO or anti-Tg antibody positivity or with goiter were summoned for detailed examinations. In total, 36 cases (3.6%) were diagnosed as HT. The goiter frequency was found in 17.5% of the whole cohort. Additionally, iodine deficiency was found in 64.2% of all children. The median urinary iodine excretion was determined as 132 microg/L (range 382 microg/L) in the HT group, whereas it was 73 microg/L (range 390 microg/L) in children with goiter but without HT and 81 microg/L (range 394 microg/L) in normal children. The urinary iodine level of HT cases was significantly higher than the other two groups (p < 0.001). HT was also determined in 2% of patients with low urinary iodine levels, in 6.2% of patients with normal urinary iodine levels, and in 7.5% of patients with high urinary iodine levels. Our data demonstrates the close relationship between excessive iodine levels and autoimmunity.

Metastatic melanoma causing recurrent intussusception and perforation of small bowel: case reports and literature review.

AIM: To present cases of recurred jejuno-jejunal intussusception and jejunal perforation due to melanoma. MATERIALS & METHODS: Case 1: A 43-year-old male under treatment for malignant melanoma was presented with abdominal pain and distention. Ten centimeter intussuscepted jejunum was resected. Second exploration was done due to failure to pass gas and stool. The reintussusception was detected and resection of reintussuscepted jejunum was performed. Case 2: A 63-year-old male was presented with abdominal pain. Abdomen computed tomography showed free air in the abdomen suggesting intestinal perforations. Perforated area at 80 cm in the jejunum sutured. CONCLUSION: We present the seemingly first report of reintussusception of resected segment in a very short time. Surgeons should be aware of both intussusception and perforation in metastatic melanoma.

Investigation of oxidant and antioxidant pathway changes in acute rheumatic fever.

AIM: The purpose of this study was to investigate the role of oxidant stress in the clinical process and pathogenesis of acute rheumatic fever (ARF). MATERIAL AND METHODS: The study included 33 children with ARF and 20 healthy control subjects. The diagnosis of ARF was established according to the Jones Criteria. Malondialdehyde (MDA), reduced glutathione (GSH), alpha-tocopherol, ascorbic acid, retinol and beta-carotene levels were measured as markers of oxidative stress together with some antioxidant markers. RESULTS: Our study includes 33 (19 male, 14 female) children with ARF and 20 (11 male, 9 female) healthy control subjects. The mean age ranged between 5-16 years and 5-15 years in the study and control groups, respectively. MDA was measured as 2.1 +/- 0.9 nmol/mL in the control group, 3.3 +/- 2.7 nmol/mL in the study group before treatment, and 2.1 +/- 1.2 nmol/mL after treatment. Blood GSH levels were 48.2 +/- 12.7 mg/dL in the control group, 24.7 +/- 16 mg/dL in the study group before treatment, and 40.6 +/- 21.3 mg/dL in the study group after treatment. MDA and GSH levels prior to the treatment were found to be significantly high and low as compared with the levels of the control group, respectively (P < 0.05, P < 0.001). After treatment, statistically important decrements and increments were determined in the levels of MDA (P < 0.05) and GSH (P < 0.01), respectively. Furthermore, alpha-tocopherol, retinol and beta-carotene levels prior to treatment in the study group, were significantly lower in comparison with control group levels (P = 0.05, P < 0.05, P < 0.01, respectively). CONCLUSION: We suggested that tissue damage in ARF may not only occur in the presence of increased oxidative stress, but also as a consequence of decreased antioxidant markers.

Varicella-associated purpura fulminans and multiple deep vein thromboses: a case report.

Varicella-associated purpura fulminans is a rare syndrome associated with substantial morbidity and mortality. General supportive care, heparinization, and plasma infusions are the mainstays of treatment. A patient aged 8 years and 8 months with purpura fulminans and multiple deep vein thromboses after varicella infection because of deficiencies of proteins C and S is presented in this case report.

Computation of Nevanlinna characteristic functions derived from generating functions of some special numbers.

In the present paper, firstly we find a number of poles of generating functions of Bernoulli numbers and associated Euler numbers, denoted by n(a,B) and n(a,E) , respectively. Secondly, we derive the mean value of a positive logarithm of generating functions of Bernoulli numbers and associated Euler numbers shown as m(2π,B) and m(π,E) , respectively. From these properties, we find Nevanlinna characteristic functions which we stated in the paper. Finally, as an application, we show that the generating function of Bernoulli numbers is a normal function.

A note on [Formula: see text]-Bernstein polynomials and their applications based on [Formula: see text]-calculus.

Nowadays [Formula: see text]-Bernstein polynomials have been studied in many different fields such as operator theory, CAGD, and number theory. In order to obtain the fundamental properties and results of Bernstein polynomials by using [Formula: see text]-calculus, we give basic definitions and results related to [Formula: see text]-calculus. The main purpose of this study is to investigate a generating function for [Formula: see text]-Bernstein polynomials. By using an approach similar to that of Goldman et al. in (SIAM J. Discrete Math. 28(3):1009-1025, 2014), we derive some new identities, relations, and formulas for the [Formula: see text]-Bernstein polynomials. Also, we give a plot generating function of [Formula: see text]-Bernstein polynomials for some selected p and q values.

Reliability of Pro-adrenomedullin and Interleukin 1ß in Predicting Severity of Community-Acquired Pneumonia in Pediatric Patients.

OBJECTIVES: Community-acquired pneumonia (CAP) in children is one of the most important causes of mortality and morbidity in developing countries. Therefore, it is very important for clinicians to detect the presence and severity of pneumonia. Proadrenomedullin (Pro-ADM) and Interleukin-1ß (IL-1ß) are thought to have potential for CAP evaluation in children. We sought to investigate the value of Pro-ADM and IL-1ß levels for severity assessment and outcome prediction in children with CAP. METHODS: A total of 66 hospitalized CAP patients were included in a prospective observational study. Complete blood count, serum C-reactive protein (CRP), Pro-ADM and IL-1ß levels were studied in blood samples obtained from the patients upon admission. Respiratory Clinical Score (RCS) was performed to determine the respiratory distress and severity. RESULTS: The comparison of data with laboratory-severity groups: serum CRP, Pro-ADM and IL-1ß levels increased in parallel with the disease severity. Pro-ADM was the best biomarker for severity stratification. Logistic regression analysis revealed that RCS >6 points and Pro-ADM values >1.75 nmol/L combination had the most significant results (OR: 15.38, 95% CI 1.35-166.66, p=0.027). Moreover, a relationship was found between the high serum levels of IL-1ß and requirement of intervention procedures in patients with pleural effusion. CONCLUSIONS: Serum Pro-ADM and IL-1ß levels may offer additional risk/severity stratification in children with CAP. In addition, they may be helpful in predicting the development of complications, requirements for ntensive care unit admission, and intervention procedures.

Knowledge Levels and Attitudes of People Living in the City Centre of Nevsehir on Organ Donation and Transplantation.

OBJECTIVE: The purpose of this descriptive study was to determine the knowledge levels and attitudes of people living in Nevsehir on organ donation (OD) and transplantation. METHODS: Data were collected using a questionnaire administered to 414 people residing in Nevsehir between February and May 2016. The primary and secondary endpoints of the present study were to determine the attitudes and knowledge levels of participants on OD and transplantation, respectively. RESULTS: Four hundred and fourteen people between the ages 20 and 65 years participated. In total, 8.9% of the participants correctly answered the question 'What is necessary for donating an organ?' and 31.4% of them correctly answered the question 'What is brain death?' Moreover, 53.1% of the participants stated that they wanted to receive reliable information on OD from OD centres. There was a close relationship between high education level and the willingness to donate organs (p<0.05). Further, 94.7% of the participants stated that they did not want to donate organs: 22.9% of them explained that their decision was because of their religious beliefs and 19.6% stated that their families did not allow it. It was observed that people who accepted organs from others were more willing to donate organs to their relatives (p<0.05). CONCLUSION: People living in Nevsehir do not have sufficient knowledge on OD; they had various concerns on the issue and wanted to receive information from OD centres. Exemplification and internalisation methods can be used in educational schedules to increase the OD.

A new generalization of Apostol type Hermite-Genocchi polynomials and its applications.

By using the modified Milne-Thomson's polynomial given in Araci et al. (Appl Math Inf Sci 8(6):2803-2808, 2014), we introduce a new concept of the Apostol Hermite-Genocchi polynomials. We also perform a further investigation for aforementioned polynomial and derive some implicit summation formulae and general symmetric identities arising from different analytical means and generating functions method. The results obtained here are an extension of Hermite-Bernoulli polynomials (Pathan and Khan in Mediterr J Math 12:679-695, 2015a) and Hermite-Euler polynomials (Pathan and Khan in Mediterr J Math 2015b, doi:10.1007/s00009-015-0551-1) to Apostol type Hermite-Genocchi polynomials defined in this paper.

The Effects of Dexamethasone and L-NAME on Acute Lung Injury in Rats with Lung Contusion.

The therapeutic efficiency of an anti-inflammatory agent, dexamethasone (DXM), and a nitric oxide synthase (NOS) inhibitor, Nitro-L-arginine methyl ester (L-NAME), in lung tissue injury after lung contusion was investigated. Serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), YKL-40, an inflammatory peptide, inducible NOS (iNOS), and Clara cell protein 16 (CC-16) were evaluated. Immunohistochemical analyses were also performed, and the lung tissue was examined histopathologically. The study consisted of eight groups of Sprague-Dawley rats (n = 10 in each group), weighing 250-300 g: (1) control, (2) contusion, (3) control + DXM, (4) contusion + DXM, (5) control + L-NAME (6) contusion + L-NAME, (7) control + DXM + L-NAME, and (8) contusion + DXM + L-NAME. A previously developed lung contusion model was used, in addition to the control group. The rats were administered DXM and L-NAME intraperitoneally (i.p.) at doses of 15 and 60 mg/kg/day, respectively. DXM and L-NAME administration decreased the iNOS level in the contusion groups. DXM increased the levels of YKL-40 and IL-10 in both the control and contusion groups, with higher levels in the contusion groups. L-NAME increased the serum level of IL-10 in the lung contusion groups. DXM increased the synthesis of CC-16 in the control and contusion groups. The combined use of a high-dose steroid and NOS inhibitor resulted in the death of the rats. Steroids can increase the level of cytokines, such as YKL-40 and IL-10, and the synthesis of CC-16 and prevent pneumonia, ALI/ARDS, and sepsis in lung contusion.

A lethal danger in the home: turpentine poisoning.

Turpentine is an oleoresin obtained from various species of pine. In turpentine poisoning, various signs and symptoms of toxicity may develop, including hematuria, renal failure, loss of vision, chest pain, vomiting, severe coughing, gastroesophageal hemorrhage, hypotension, swelling of the throat and even death. We report a case of turpentine ingestion in a 9-year-old boy. The patient was admitted to our clinic with suspected intoxication after accidentally drinking from a glass that held a turpentine oil preparation used by his father for hair care. The patient displayed no significant signs and symptoms other than bradycardia and hypotension. Laboratory investigations revealed no abnormalities. The patient was hospitalized for close monitoring and observation. During a two-and-a-half-day observation period, hypotension was corrected with administration of dopamine and intravenous fluids. In this report, we wish to draw attention to the dangerous effects of plant-derived drugs.

Rapidly progressive renal disease as part of Wolfram syndrome in a large inbred Turkish family due to a novel WFS1 mutation (p.Leu511Pro).

Wolfram syndrome, also named "DIDMOAD" (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), is an inherited association of juvenile-onset diabetes mellitus and optic atrophy as key diagnostic criteria. Renal tract abnormalities and neurodegenerative disorder may occur in the third and fourth decade. The wolframin gene, WFS1, associated with this syndrome, is located on chromosome 4p16.1. Many mutations have been described since the identification of WFS1 as the cause of Wolfram syndrome. We identified a new homozygous WFS1 mutation (c.1532T>C; p.Leu511Pro) causing Wolfram syndrome in a large inbred Turkish family. The patients showed early onset of IDDM, diabetes insipidus, optic atrophy, sensorineural hearing impairment and very rapid progression to renal failure before age 12 in three females. Ectopic expression of the wolframin mutant in HEK cells results in greatly reduced levels of protein expression compared to wild-type wolframin, strongly supporting that this mutation is disease-causing. The mutation showed perfect segregation with disease in the family, characterized by early and severe clinical manifestations.

A case of acute disseminated encephalomyelitis mimicking leukodystrophy.

Acute disseminated encephalomyelitis (ADEM) is a monophasic, immune-mediated demyelinating disorder that can follow immunizations or more often infections including rubeola, rubella, varicella, herpes zoster, mumps, Mycoplasma pneumoniae, or, more commonly, other nonspecific upper respiratory tract infections. Documentation of a preceding illness is not required to make this diagnosis. This report examines the case of a 9-month-old male patient presenting with the features of an acute leukodystrophy following innoculation with the mixed vaccine Pentaxim (Sanofi Pasteur, Lyon- France) while suffering from a lower respiratory tract infection, and who was eventually diagnosed as ADEM. The case is presented as a reminder that ADEM can sometimes be linked to lower respiratory tract infection and vaccination, and that the features in such cases can be confused with leukodystrophy.

Stroke and dilated cardiomyopathy associated with celiac disease.

Celiac disease (CD) is manifested by a variety of clinical signs and symptoms that may begin either in childhood or adult life. Neurological symptoms without signs of malabsorption have been observed for a long time in CD. In this report, an 8-year-old girl with CD presented with rarely seen dilated cardiomyopathy and stroke. The girl was admitted with left side weakness. Her medical history indicated abdominal distention, chronic diarrhea, failure to thrive, and geophagia. On physical examination, short stature, pale skin and a grade 2 of 6 systolic murmur were detected. Muscle strength was 0/5 on the left side, and 5/5 on the right side. Coagulation examinations were normal. Tests for collagen tissue diseases were negative. Factor V Leiden and prothrombin GA20210 mutations were negative. Tandem mass spectrophotometry and blood carnitine profiles were normal. Brain magnetic resonance imaging and cerebral angiography showed an infarction area at the basal ganglia level. Examinations of serologic markers and intestinal biopsy revealed CD. We emphasize that in differential diagnosis of ischemic stroke, CD should be kept in mind.

New coagulant agent (ankaferd blood stopper) for open hemorrhages in hemophilia with inhibitor.

The treatment of hemophilia A patients with inhibitor could be very expensive. Ankaferd blood stopper (ABS) is a unique folkloric medicinal plant extract, which has historically been used in Turkish traditional medicine as a hemostatic agent. In this article, a 16-year-old boy was presented with uncontrolled bleeding, despite the treatment of factor VIII, rVIIa, factor VIII inhibitor bypass activity (FEIBA), cyclophosphamide, and prednisolone at circumcision site that resolved with ABS in minutes. Our patient with hemophilia A and inhibitor is the first clinical pediatric case.

Treatment of chronic immune thrombocytopenic purpura with rituximab in children.

OBJECTIVE: To evaluate the rituximab treatment in children with chronic immune thrombocytopenic purpura METHODS: This study included ten children with chronic immune thrombocytopenic purpura, which were nonresponsive to Steroid (S), IVIG and anti-D treatments. Rituximab was given with a dosage of 375 mg/m2 weekly for 4-6 weeks. Initial platelet count was less than 30x109/L and responses were assessed in follow-up. The patients' groups were categorized as complete remission (CR);a platelet count > or = 150x109/L, partial remission (PR);a platelet count ranging from 50x109/L to 150x109/L, minimal remission (MR); a platelet count ranging from 30x109/L to 50x109/L and no response (NR); a platelet count less than 30x109/L. RESULTS: Of our patients, four female and six male, their ages ranged from 39 mth to 13 yr and the mean age was 83.4 +/- 44.58 mth. None of the patients was splenectomized. The follow-up period after rituximab treatment ranged between 12 to 42 mth and the mean follow-up period was 25.10 +/- 13.03 months. While on this treatment, we had a CR in two patients, a PR in one, a MR in three, but no response in four. The patients in CR/PR are still being followed as in remission and they have 40 mth of mean follow-up period. The three patients in MR had a decrease in values of platelets earliest in one mth and the latest in four mth. Adverse effects of rituximab, such as itching and scraps that were not clinically significant were observed in three patients during rituximab infusion. There were no increase in infections after rituximab in any patient. CONCLUSION: CR was found in 20% of our patients, PR in 10% and MR in 30% with rituximab. On this treatment, while some series had good outcomes with this treatment (72%-100%, remission ratios), but many series, such as ours, had a poor response rate contrast to many reported case series in the literature. This condition may be associated with the age of our most patients who were young at the time of commenced rituximab. However, we believe that more studies are required to elucidate the reasons for different results in different case series reported in literature.