The effectiveness of the flip technique in vertical ductal stenting.

Background: In this study, the flip technique was compared with the classical method in terms of procedural success and procedure time during ductal stent implantation (DSI) via the carotid artery in patients whose pulmonary blood flow is dependent on the vertical type of ductus arteriosus (DA). Methods: Between January 2019 and June 2023, 40 patients (24 males, 16 females; mean age: 15.9±15.4 days; range, 1 to 68 days) with vertical ductus-dependent pulmonary circulation who underwent patent DA stent implantation via the carotid artery were included in the study. Patients were divided into two groups: those who underwent the flip technique (Group 1) and those who did not undergo the flip technique (Group 2). Data were retospectively compiled by reviewing patient files and catheter images. Results: Demographic findings were similar in the groups. The distribution of the DA in terms of tortuosity index was also similar in the groups. The procedure was successful in 18 (90%) patients in Group 1 and 20 (100%) patients in Group 2. There was no procedure-related mortality in both groups. The frequency of procedure-related complications was similar. Procedure duration was 53.6±18.4 min in Group 1 and 41.5±9.1 min in Group 2; the difference was significantly lower in Group 2 (p=0.028). The shorter follow-up in Group 2 was attributed to the flip method starting to be used later in the clinic. During follow-up, stent dilatation was required in two patients in Group 1 and one patient in Group 2, and a second stent implantation was needed in one patient in Group 2. No significant difference was observed between the two groups in terms of reintervention. Conclusion: The success rate of DSI using the carotid artery access is high with both the classical and the flip method in patients with vertical DA. However, the use of the flip technique could be preferred in terms of operator habituation, ergonomic use of the catheter, guidewires, and shorter procedure time.

The Usability of Platelet Mass Index Thresholds to Assess the Repeated Platelet Transfusion Requirements in Neonates.

To evaluate the usability of platelet mass index (PMI) thresholds to assess the repeated platelet transfusion requirements in neonates who have received transfusion within the previous six days. This is a retrospective cross-sectional study conducted with neonates who received prophylactic platelet transfusion. The PMI was calculated as platelet count (× 1000/mm3) × mean platelet volume (MPV) (fL). Platelet transfusions were divided into two groups as first (Group 1) and repeated transfusions (Group 2). The increment and percentage of increment in platelet counts, MPV and PMI after transfusion were compared between the two groups. The amounts of changes were calculated as: (Post-transfusion) - (Pre-transfusion values). The percentages of changes were calculated as: ([Post-transfusion - Pre-transfusion values]/Pre-tansfusion values) × 100. Eighty three platelet transfusions were analyzed in 28 neonates. The median gestational age and birth weight were 34.5 (26-37) weeks, and 2225 (752.5-2937.5) grams, respectively. There were 20 (24.1%) transfusions in Group 1, and 63 (75.9%) transfusions in Group 2. There were no differences in the amounts of changes in platelet counts, MPV and PMI between the groups (p > 0.05). When the percentages of changes were analyzed, it was found that the platelet counts and PMI in Group 1 increased to a greater extent compared to Group 2 (p = 0.026, p = 0.039, respectively), but no significant difference was found in MPV between the groups (p = 0.081). The lower percentage of change in PMI in Group 2 was associated with the lower percentage of change in platelet counts. Being transfused with adult platelets did not affect platelet volume of the neonates. Therefore, PMI thresholds can be used in neonates with a history of platelet transfusion.

Noninvasive Hemoglobin Measurement Reduce Invasive Procedures in Thalassemia Patients.

This study was conducted to investigate the agreement between laboratory hemoglobin (LabHb) measured in venous blood and noninvasive, spectrophotometric hemoglobin (SpHb) measurement and the usability of SpHb measurement in the transfusion decision-making in patients with thalassemia whose hemoglobin (Hb) was monitored by taking blood samples at frequent intervals and who were transfused. Cardiac pulse, oxygen saturation, Pleth variability index (PVI), and SpHb values were measured in patients who came to the hematology outpatient clinic for a control visit and whose Hb levels were planned to be measured. Venous blood samples were taken for LabHb measurement, which we accept as the gold standard. Cohen's kappa value was calculated for the agreement between SpHb measurements and LabHb values. The relationship and predictability between both measurement methods were evaluated by Pearson correlation analysis, a modified Bland-Altman plot and the linear regression model. In the study conducted with a total of 110 children with thalassemia, a moderate level of agreement between the two measurement methods (kappa = 0.370, p < 0.0001) and a significantly high correlation between the two tests (r = 0.675) were found. The mean bias between the differences was found to be 0.3 g/dL (-1.27 to 1.86 g/dL). The sensitivity and the specificity of SpHb in identifying patients who needed transfusions (Hb <10.0 g/dL) were calculated as 92.2 and 57.1%, respectively. Our results suggest SpHb measurement may be used to screen anemia in hemodynamically stable hemoglobinopathy patients and even for transfusion decision-making with combination clinical findings.

Investigation of the Sensitivity and Specificity of Laboratory Tests Used in Differential Diagnosis of Childhood Brucellosis.

Objectives  Childhood brucellosis is a common public health problem in developing countries. The diagnosis of brucellosis based on nonspecific symptoms is an ongoing problem for physicians, especially in endemic areas. In this study, it is aimed to discuss the efficacy of frequently used test methods in the differential diagnosis of brucellosis. Methods The records of 332 patients admitted to pediatric clinic on suspicion of brucellosis were retrospectively analyzed. Patients with brucellosis were included in the positive group (n = 262) and those without brucellosis were included in the negative group (n = 70). Results  As a result of biochemical analysis of the cases, median alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) values were significantly higher in the positive group than that in the negative group (p<0.05). There was no significant difference between median white blood cell, neutrophil, lymphocyte, neutrophil to lymphocyte ratio, hemoglobin, and platelet values between groups (p>0.05). Receiver operating curves were plotted to compare predictive values of CRP (area under curve (AUC): 0.635, p= 0.001), ESR(AUC:0.701, p<0.001), AST(AUC: 0.595, p=0.015), ALT(AUC:0.604, p=0.007), and GGT(AUC:0.593, p=0.016) in 332 patients with suspected brucellosis. Conclusions Increased levels of AST, ALT, GGT, CRP, and ESR may have a complementary role in the differential diagnosis of childhood brucellosis. However, all of these markers should be evaluated with clinical findings due to their low specificity and sensitivity.

Does B12 deficiency lead to change in brain metabolites in pediatric population? A MR spectroscopy study.

OBJECTIVES: The aim of this study is to examine metabolite changes in different brain regions of the children with vitamin B12 deficiency disease using MR spectroscopy. METHODS: Eighteen children with serum vit. B12 deficiency and 12 healthy volunteer children were included in the study. All children were examined with single-voxel spectroscopy examination via 1.5-Tesla MRI. The spectra were obtained from the left frontal periventricular white matter, left lentiform nucleus and left cerebellar hemisphere. The comparisons between patient group and control group were made with ratios calculated as NAA/Cr, Cho/Cr, mI/Cr, and Glx/Cr. All brain images were also examined in terms of brain atrophy, abnormal brain parenchyma intensity changes, or myelination status. RESULTS: The children were between 3 months and 16 years old in the patient group, and between 3 months and 15 years old in the control group. There were no statistical differences in terms of metabolite ratios in the three different brain regions between the patients and control group. In two patients, periventricular white matter hyperintensities were observed. In four patients, brain atrophy was detected. DISCUSSION: MR spectroscopy examination demonstrated that there were no statistical differences in terms of all metabolite ratios in left frontal periventricular white matter, left lentiform nucleus and left cerebellar hemisphere.

Evaluation of selenium levels and mean platelet volume in patients with simple febrile convulsion.

OBJECTIVE: This study aimed to evaluate serum selenium levels and mean platelet volume in children who experience simple febrile convulsion. METHODS: The study comprised 42 patients diagnosed with simple febrile convulsions and a control group of 30 healthy children. Blood samples were taken following a febrile convulsion. Selenium levels in the serum of both the patients and control subjects were measured with the hydride formation method on an atomic absorption spectrometry device and mean platelet volume was evaluated. FINDINGS: When the mean values of the febrile convulsion patients were compared with those of the control group, the mean selenium levels and thrombocyte count were found to be statistically significantly low (P=0.002, P=0.01 respectively) and the mean platelet volume values were statistically significantly high (P=0.002). CONCLUSION: While low serum selenium levels cause the onset of a febrile seizure in patients with simple febrile convulsion, it is thought that the increased mean platelet volume shows infection activity causing febrile convulsion.