Mean platelet volume (MPV) may simply predict the severity of sepsis in preterm infants.

BACKGROUND: To evaluate the efficacy of serial mean platelet volume (MPV) measurements in diagnosis and followup of sepsis and to compare its effectiveness with C-reactive protein (CRP) and interleukin-6 (IL-6) in sepsis. METHODS: Preterm infants, whose gestational age and weight were matched to each other, were grouped as control (n = 100) and sepsis (n = 91). Platelet indices (MPV, PDW, platelet count), CRP, and IL-6 levels were measured for the control group and on the day of diagnosis (1st day), 3rd, and 7th days of the sepsis group. RESULTS: There were significant differences between the control and sepsis group in terms of platelet count and MPV/PDW levels (p < 0.05). No significant changes were found in either platelet count or MPV and PDW of infants between early and late onset sepsis, nor between culture proven and non proven sepsis, nor among different infectious agents (gram positive/negative and fungal infections) (p > 0.05). Additionally, non-survivors with sepsis had higher levels of MPV and PDW during sepsis episodes on consecutive days (p < 0.05), in contrast to lower platelet counts in non-survivors (p < 0.05). Moreover, a positive correlation was found between MPV and IL-6 and CRP. A MPV value of 10.35 fL was identified as the cut off value in patients probably resulting in sepsis with a sensitivity of 97.8% and specificity of 78.7% (AUC = 0.949; p < 0.001), and a MPV value of 10.75 fL was determined as the cut off value in patients possibly resulting in death at diagnosis with a sensitivity of 95.2% and a specificity of 84.9% (AUC = 0.944; p < 0.001). CONCLUSIONS: The mean platelet volume can be used in addition to CRP and IL-6 at both diagnosis and follow-up of sepsis and the response of antimicrobial treatment.

The role of serum N-terminal pro-brain natriuretic peptide in transient tachypnea of the newborn.

BACKGROUND AND OBJECTIVES: Transient tachypnea of the newborn (TTN), also known as wet lung disease, is a common cause of respiratory distress in the newborn. It has been demonstrated that, in alveolar type II cell cultures of the rat, receptors affected by the natriuretic peptides are expressed and that atrial natriuretic peptide (ANP) reduced amiloride-sensitive Na+ transport in these cells with a pattern similar to that in renal tubules, thereby inhibiting Na+ re-absorption in a concentration-dependent manner. Brain natriuretic peptide (BNP) is known to act on these receptors and it is suggested that it may be involved in fluid absorption by the lungs. The present study aimed to investigate the role of BNP in the pathogenesis of transient tachypnea of the newborn. PATIENTS AND RESULTS: Serum NT-proBNP (N-terminal-proBNP) level measurements of 43 infants diagnosed with transient tachypnea of the newborn were compared to those of 29 healthy neonates. There were no statistically significant differences in NT-proBNP level between the study group and the control group. CONCLUSIONS: NT-proBNP has no role in the pathophysiology of transient tachypnea of the newborn. Other factors which may potentially be involved in this etiology should be investigated.

Syndrome of inappropriate antidiuretic hormone secretion refractory to treatment in a newborn with alobar holoprosencephaly.

Alobar holoprosencephaly (AHP) is a serious malformation of the central nervous system characterized by complete failure of cleavage of the prosencephalon resulting in fusion of the cerebral hemispheres and a massive single ventricular midline fluid collection. Secretion of inappropriate antidiuretic hormone syndrome (SIADH) is a disorder of fluid-electrolyte balance caused by the inability to suppress the secretion of antidiuretic hormone (ADH) resulting in the development of hyponatremia. Coexistence of both of these entities has not been described in the literature. We report a newborn infant with AHP who had resistant SIADH refractory to treatment, to draw attention to the coexistence of these entities and to contribute to the literature with the management of this challenging condition.

Mesenchymal stem cell therapy in necrotizing enterocolitis: a rat study.

We evaluated the potential therapeutic use of exogenous human bone marrow-derived mesenchymal stem cells (hBM-MSCs) in an experimental rat model of necrotizing enterocolitis (NEC). Thirty-six newborn Sprague-Dawley rats were randomly divided into three groups: NEC, NEC + hBM-MSC, and a control (control and control + hBM-MSC). NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. After NEC was induced, iron-labeled hBM-MSCs were administered by intraperitoneal injection. All pups were killed on the fourth day following injection, and the terminal ileum was excised for a histopathological and immunohistochemical evaluation. The pups in the NEC + hBM-MSC group showed significant weight gains and improvements in their clinical sickness scores (p < 0.01). Bowel damage severity observed in the histopathological evaluation was significantly lower in the NEC + hBM-MSC group than that in the NEC group (p = 0.012). The number of MSCs homing to the bowel was significantly higher in the NEC + hBM-MSC group than that in the control + hBM-MSC group. In conclusion, this is the first study that has evaluated the effectiveness of hBM-MSCs in a neonatal rat NEC model. MSCs reduced histopathological damage significantly.

C5a, a complement activation product, is a useful marker in predicting the severity of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal emergency, predominantly affecting low-birth weight, premature infants. Early clinical signs of NEC are nonspecific and the laboratory findings are not fully reliable. Its severe morbidities and rapid progression require the application of new biomarkers for early diagnosis and intervention. The complement activation product, C5a (anaphylatoxin) has been reported to be a contributing factor leading to mesenteric ischemia/reperfusion injury which is a predisposing factor in the pathogenesis of NEC. Therefore, our aim was to evaluate the efficacy of serial C5a measurements in the diagnosis and follow-up of NEC. Preterm infants, whose gestational age and weight matched each other, were grouped as controls (n = 23) and NEC (n = 22). Serum levels of C5a, serum amyloid-A (SAA), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were measured on the third day of life for the control group and on the day of diagnosis (1st day), 3rd and 7th days of the NEC group. C5a, SSA, CRP, and IL-6 levels were significantly higher in the NEC patients compared to the control group (P < 0.05) in the follow-up. Additionally, serum levels of C5a were found to be more accurate than the other parameters for the prediction of death and requirement for surgery at the time of diagnosis (P < 0.05). In conclusion, C5a may be useful as a new marker for both diagnosis and follow-up of infants with NEC in combination with clinical and radiographical findings.

Nifedipine for the treatment of preterm labor in twin and singleton pregnancies.

PURPOSE: To investigate the outcomes of singleton and twin pregnancies that were complicated by spontaneous preterm labor and received nifedipine tocolysis. METHODS: We identified the following subjects from a computerized, hospital database: 58 singleton and 32 twin pregnancies that were between 24 and 34 weeks of gestation, admitted for spontaneous preterm labor without rupture of the membranes, and receiving tocolysis with nifedipine. Data were analyzed using the Chi-square test, the Mann-Whitney test, and the Kaplan-Meier survival analysis. RESULTS: Spontaneous, preterm delivery occurred in 31.1% cases of singleton and 81.3% of twin pregnancies. Although the 22% of the mothers of twins did not have cervical changes upon admission, 37% of twins were delivered within 48 h. Mean for delivery weeks from admission to 36 weeks was significantly less for twin than it was for singleton gestations (32.3 ± 1.0 vs. 35.0 ± 0.5 weeks, respectively; Mantel-Cox X (2) = 41.118; p < 0.001). The maternal side effects were not significantly different between the groups. No serious cardiovascular complication had been found in either group. CONCLUSIONS: Tocolysis with nifedipine is effective and safe for use in both singleton and twin gestations.

Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies.

PURPOSE: To determine whether timing or type of delivery affects the incidence of transient tachypnea of the newborn (TTN) in late preterm and term pregnancies. METHODS: The cases of 85 newborns delivered at Fatih University Hospital and diagnosed with TTN between January 2006 and March 2009 were reviewed. For every newborn with TTN, four infants who were not transferred to the neonatal intensive care unit (n = 340) were randomly selected and adjusted for year of delivery. Findings for delivery type (cesarean [CS] + labor, elective CS [ECS], vaginal), gestational age at delivery, and other relevant parameters were compared in the TTN and control groups. RESULTS: Forty-five (53%) of the 85 TTN newborns were premature and 73 (86%) were delivered by CS. Multivariate regression analysis identified male gender, CS delivery, lower gestational age, absence of PROM as risk factors for onset of TTN. In the CS + labor and ECS subgroups, the risk of TTN was significantly higher for babies delivered prior to 38 weeks' gestation than for those delivered at 38 weeks or later (OR = 8.13 and 95%CI = 3.58-18.52 vs. OR = 7.14 and 95%CI = 2.81-18.18, respectively; p < 0.001 for both). However, there was no increased risk of TTN in either of these subgroups when babies delivered at 38 weeks' gestation were compared with those delivered at ≥39 weeks (p > 0.05). At all gestational ages investigated in the study, infants delivered vaginally were less likely to develop TTN than those delivered via CS + labor or ECS. CONCLUSIONS: Lower gestational age, CS delivery, and male sex are independent risk factors for TTN. Performing ECS no earlier than 38 weeks' gestation may decrease the risk of TTN. Labor before CS is not sufficient to decrease the frequency of TTN, even after 37 weeks of gestation, whereas vaginal birth appears be protective against TTN.

A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice.

In this study, we aimed to make a comparison between chromosomal effects caused by conventional phototherapy and intensive phototherapy in jaundiced newborns. The study group included 83 newborns with gestation age of > or =35 weeks, and on days 3-10 after birth. Newborns were divided into four groups on the basis of total serum bilirubin (TSB) levels upon admission and need for phototherapy. The intensive group (n=19) consisted of newborns who received light-emitting diode (LED) phototherapy, the conventional group (n=23) consisted of newborns who received conventional phototherapy, the jaundiced control group (n=21) consisted of newborns whose TSB levels were higher than 10mg/dL (average = 13.7 + /-1.5 mg/dL) on admission and who did not receive phototherapy, and the non-jaundiced control group (n=20) consisted of newborns whose TSB levels were less than 5 mg/dl (average = 3.6 +/- 0.8 mg/dL). TSB level of the intensive group at admission was 20.2 +/- 1.3 mg/dL, whereas the level of conventional group was 19.6 +/- 1.5 mg/dL. Blood samples were taken from all infants on admission to determine sister chromatid exchange (SCE1) frequency. Blood sampling was repeated on discharge (SCE2) of infants who had received phototherapy. Demographic information, hospitalization details and the rate of decline in TSB were recorded, and frequencies of SCE1 and SCE2 were compared. There was no difference in demographic information among the four groups. SCE1 frequencies in 50 metaphases were evaluated in the intensive, conventional, jaundiced control and non-jaundiced control groups, and the SCE1 frequency was determined as 9.37/cell, 9.54/cell, 9.23/cell and 6.17/cell, respectively. The SCE1 frequency of the jaundiced groups (intensive, conventional and newborns-with-jaundice control group) was significantly higher than that in the non-jaundiced control group (p = 0.001). There was no significant difference between the intensive group and the conventional group in SCE2 frequency (13.5/cell vs. 13.55/cell, p = 0.39). SCE2 frequency was higher than SCE1 frequency in both the intensive and conventional groups (p = 0.001). A strong correlation was found between admission TSB and SCE1 frequency (p = 0.001; r = 0.79). The rate of decline in TSB was higher in the intensive group compared with the conventional group (0.26mg/(dLh) vs. 0.14 mg/(dLh); p = 0.001). We found that intensive and conventional phototherapies similarly increase SCE frequency in newborns. There was a strong, positive correlation between the TSB-on-admission level and SCE1 frequency. In the light of this study, we may conclude that intensive and conventional phototherapies may have an effect on chromosomes in jaundiced newborns. TSB levels higher than 10mg/dL are, too, reported hazardous on chromosomes. Further studies are warranted to elucidate this relationship.

[Treatment of trigeminal neuralgia with thermorhizotomy]. / Traitement de la névralgie trigéminale par thermorhizotomie.

Percutaneous radiofrequency (RF) thermorhizotomy of the trigeminal nerve is an effective treatment for trigeminal neuralgia. Long-term efficacy is proportional to the degree of postoperative hypoesthesia. The advantage is the topographic selectivity of the thermolesion, provided the electrode tip is placed accurately. This requires precise x-ray guidance and neurophysiological testing. In addition to the indication in idiopathic trigeminal neuralgia, especially for elderly patients with precarious conditions, thermorhizotomy is particularly useful for treating patients with trigeminal neuralgia due to multiple sclerosis. It can also be applied to symptomatic neuralgias, but only when the main components are of the paroxysmal and/or the allodynic types ; the thermorhizotomy method could aggravate permanent components, especially when burning pain predominates; it could also increase preexisting trophic disturbances, particularly keratitis.

[Treatment of trigeminal neuralgia with glycerol injection at the gasserian ganglion]. / Traitement de la névralgie trigéminale par injection de glycérol au niveau du ganglion de Gasser.

Gasserian ganglion neurolysis with glycerol injected percutaneously through the foramen ovale continues to be widely used. Its long-term efficacy on pain is proportional to the degree of postoperative hypoesthesia. The advantage is low cost. The disadvantage is essentially the difficulty in controlling diffusion outside the Meckel cavity. Subsequently its effects are somewhat random and potential complications are difficult to prevent reliably.

Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes.

BACKGROUND: The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. METHOD: All studies that had a minimum 5 years or more (> or =5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student's t-test, Chi-square followed by Pearson's risk analysis tests were used. Kaplan-Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. FINDINGS: Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. CONCLUSIONS: The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.

Factors that influence the decision for hyperbaric oxygen therapy (HBOT) in cases of carbon monoxide poisoning: a retrospective study.

Carbon monoxide poisoning (COP) is one of the most common types of potentially fatal poisoning throughout the world. Hyperbaric oxygen therapy (HBOT) is an effective and quick response modality that clears symptoms and prevents sequelae. HBOT should be administered within 4-6 hours after poisoning. The aim of this study was to contribute COP treatment protocols by retrospectively examining the results of COP cases who were administered HBOT according to clinical and laboratory findings at the Emergency Department.

L'intoxication au monoxyde de carbone (ICO), potentiellement létale, est une des intoxications les plus courantes au monde. L'OHB permet de réverser rapidement les symptomes d'ICO et d'en prévenir les séquelles. Elle doit être réalisée dans les 4 à 6 heures suivant l'intoxication. Le but de cette étude est de contribuer à l'amélioration des protocoles d'OHB en cas d'ICO après examen rétrospectif des dossiers recueillis dans un service d'accueil des urgences.

Moderate hypernatremic dehydration in newborn infants: retrospective evaluation of 64 cases.

OBJECTIVES: This study was carried out to assess the incidence, presenting complaints, risk factors, and methods for prevention of hypernatremic dehydration among term and near-term breastfeeding infants. METHODS: We retrospectively evaluated term and near-term (> or =35 weeks of gestation) neonates admitted to our neonatology department, during a four-year period with serum sodium concentrations of > or =146 mEq/L. A detailed maternal and infant history and examination including presenting complaints, risk factors, feeding problems, and weight loss, if present, were registered. RESULTS: Among 1150 neonates admitted to our unit, 64 (5.6%) had serum sodium concentrations of >145 mEq/L, in whom 43 of them had sodium concentrations of >149 mEq/L. The most common presenting complaint was jaundice in 30 patients (48%). Forty-one (95%) of the 43 patients described a more than 7% weight loss and there was a positive correlation between serum sodium and urea and creatinine concentrations, and a negative correlation between serum sodium and glucose concentrations in these patients (p < 0.05). There was no difference between patients with sodium >149 mEq/L and <149 mEq/L with respect to maternal age, parity, educational level, hospital stay, type of delivery, and anesthesia and also with respect to seasons (p > 0.05). CONCLUSIONS: Weight loss in an infant of greater than 7% from birth weight increases the risk of hypernatremia, a weight loss limit that is lower than the previously reported 10%. This indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible interventions to correct problems and improve milk production and transfer.

Nitrogen recovery by urea hydrolysis and struvite precipitation from anthropogenic urine.

Human urine is a source of nutrients and has a significant potential for recycle of nitrogen. Recently, much research focused on separate collection and treatment of human urine. Recovery of nutrients from human urine requires hydrolysis of urea into ammonia and subsequent removal of ammonia and sometimes phosphorus. This study attempted to evaluate urea hydrolysis of human urine in both untreated fresh samples and urease added urine samples. Recovery of nutrients by struvite precipitation on pre-hydrolysed samples was also assessed on undiluted and 1:1 diluted samples. Results of urea hydrolysis on untreated urine samples indicated that the process was slow and pH exerted a significant effect on the process. No hydrolysis occurred above pH 10. From pH 2 to 7.5, 25% of urea could be hydrolysed in 30 d. Urease added hydrolysis with the enzyme doses 25-49 mg L(-1) was a rapid process providing complete conversion into ammonia in 1.5 h. Struvite precipitation conducted on enzyme hydrolysed urine sample proved to be an efficient process and ammonia removals up to 95% were obtained. Struvite precipitation also provided 50% organic nitrogen removal.

Paranasal sinus computed tomographic findings of children with chronic cough.

OBJECTIVE: Chronic cough is a frequent problem in the practice of clinical pediatrics, and sinusitis is a common etiologic factor. In this study, our aim was to determine the prevalence of sinus abnormalities in pediatric patients presenting with chronic cough. METHODS: Forty-two patients, ranging from 3 to 16 years of age from both sexes completed the study. Paranasal sinuses were examined by coronal paranasal sinus limited computed tomographic scan. The CT scan findings were categorized as no disease, minimal, moderate and severe sinusitis. RESULTS: The most frequent symptoms after cough were rhinorrhea, sniffling, and halitosis. We found sinus abnormalities in 66.6% and no abnormality in 33.3% of the children. Age and sex were not important factors in sinus disease. There was no correlation between sinus findings and any of symptoms. The most common anatomical abnormalities were concha bullosa, paradoxical middle turbinate, Haller's cells, and deviated nasal septum. These abnormalities were not correlated with sinus disease. CONCLUSION: Paranasal sinus abnormalities are common among pediatric patients with chronic cough and imaging studies of the sinuses should be considered in these children.

The frequency and etiology of anemia among children 6-16 years of age in the southeast region of Turkey.

The frequency and etiology of anemia were investigated in 2,913 children between six and 16 years of age in Sanliurfa, in the southeast region of Turkey. Anemia was found in 142 (7.8%) children in the 6-11 years of age group, and in 16 (1.5%) in the 12-16 years of age group; in total, in 158 (5.4%) children. Causes were iron deficiency in 93 (58.9%) children, beta-thalassemia heterozygosity in 10 (6.3%) children, chronic disease that causes anemia of inflammation in 30 (19.0%) children, and intestinal parasitic infections in 17 (10.8%) children. In eight (5.1%) children, the cause of anemia could not be determined. The study's results showed that iron deficiency anemia and chronic and parasitic disease are important problems in schoolchildren of Sanliurfa, while beta-thalassemia and hemoglobinopathies have less importance.

Juvenile rheumatoid arthritis presented with thrombocytopenia.

Leukopenia and thrombocytopenia are rare findings in systemic onset juvenile rheumatoid arthritis (S-JRA), and if present, bone marrow (BM) examination is necessary to exclude malignant diseases. We report here a 13.5-year-old boy with S-JRA who had severe thrombocytopenia and mild leukopenia, without arthritis, at the onset of the disease. BM was hypercellular with increased numbers of myeloid precursors and megakaryocytes. After treatment with acetylsalicylic acid, leukocyte and platelet counts returned to normal levels, and after two months chronic arthritis developed.

Bernard-Soulier Syndrome Like Platelet Defect in a Patient with Noonan Syndrome; A Case Report.

Noonan's Syndrome (NS) is characterized by dismorphic facial features, short stature, short or webbed neck, congenital heart defects and testicular abnormalities. Various bleeding disorders in Noonan Syndrome have been reported. Bernard-Soulier Syndrome (BSS) is a rare congenital bleeding disorder characterized by thrombocytopenia and giant platelets. There is not any reported case of Noonan syndrome associated with BSS in literature. We report here a four-year-old male patient with Noonan Syndrome and BSS like platelet defect.