Thymic gene expression analysis reveals a potential link between HIF-1A and Th17/Treg imbalance in thymoma associated myasthenia gravis.

Myasthenia gravis (MG) is an immune-mediated disease frequently associated with thymic changes. Increased T helper 17 (Th17) cell activity and dysfunctional regulatory T (Treg) cells have been demonstrated in subgroups of MG. On the other hand, hypoxia-inducible factor 1 (HIF-1) has been shown to regulate the Th17/Treg balance by inducing Th17 differentiation while attenuating Treg development. To identify the underlying mechanisms of different thymic pathologies in MG development, we evaluated thymic samples from thymoma-associated myasthenia gravis (TAMG), MG with hyperplasia (TFH-MG) and thymoma without MG (TOMA) patients. Differential gene expression analysis revealed that TAMG and TFH-MG cells are associated with different functional pathways. A higher RORC/FOXP3 ratio provided evidence for Th17/Treg imbalance in TAMG potentially related to increased HIF1A. The hypoxic microenvironment in thymoma may be a driver of TAMG by increasing HIF1A. These findings may lead to new therapeutic approaches targeting HIF1A in the development of TAMG.

Timing for extraction of permanent first molars in school aged children: a pilot study.

Extraction of permanent first molars (P1Ms) could create gaps, tipping and/or rotating of neighboring teeth, which depend on the extraction timing. This study evaluated the outcomes of P1Ms extraction in children who were classified based on their permanent second molar's (P2Ms) dental calcification at the time of extraction. In this retrospective study, the evaluations were made for 406 panoramic radiographs (PRs) of children aged 7-14 years who had single P1M extracted. Twenty-nine children having pre- and post-treatment PRs were selected based on the inclusion criteria. First, 2 groups were formed based on the extraction time by using the pre-treatment PRs; Early extraction group (EE) (n = 15) including Nolla Grades 5-6-7, and late extraction group (LE) (n = 14) including Nolla Grades 8-9-10 for P2Ms. Then, the inclination degrees of neighbouring teeth on extraction side and contralateral quadrant (non-extraction) side were measured by using the post-extraction PRs. Mann-Whitney U test was employed, and the statistical significance was set at p < 0.05. The mesial tipping tendency of P2M was significant towards the extraction side both at EE or LE calcification grades of P2Ms (p > 0.05). The mesial inclination degrees of maxillary P2Ms showed no statistically significant difference between the two sides of LE group. The ideal extraction time should be determined according to the dental age to plan an appropriate occlusal maintenance.

Evaluation of the relationship between pain inflammation due to dental caries and growth parameters in preschool children.

OBJECTIVES: To evaluate the relationship between pain inflammation due to dental caries and growth parameters, sleep disturbances, and oral health-related quality of life (OHRQoL) in preschool children before/after dental treatment and compare the results with the control group. MATERIALS AND METHODS: Study (pain inflammation due to caries) and control groups were included in this prospective clinical trial. The Child Sleep Habits Questionnaire (CSHQ) assessing sleep disturbances and the Early Childhood Oral Health Impact Scale (ECOHIS) assessing OHRQoL were applied in the corresponding time intervals to the study and control groups, respectively: baseline (T0study), 7 days after treatment (T1study), and following 6 months (T2study); baseline (T0control), and the following 6 months (T2control). Biochemical growth parameters (insulin-like growth factor-1 and insulin-like growth factor binding protein-3) and anthropometric measurements (standard deviation score of height, weight, and body mass index) were obtained at T0study, T2study, and T0control. Mann-Whitney U and the Student t-tests were used for statistical analyses. The significance level was set at p < 0.05. RESULTS: Data on 45 children (mean age: 55.6 ± 10.37 months) were analyzed. T2study was statistically higher than T0study for the anthropometric measurements and biochemical growth parameters (p < 0.05). T0study was statistically higher than T0control for biochemical growth parameters (p < 0.05). CSHQ and ECOHIS scores were found statistically significant at T0study than T0control (p < 0.05). Statistical scores of CSHQ and ECOHIS in T2study were significantly reduced compared to T0study (p < 0.05). CONCLUSION: Children's growth parameters, sleep disturbances, and OHRQoL improved after the elimination of pain and inflammation. CLINICAL RELEVANCE: This study's novelty is the observation of drastically increased growth parameters and reduced sleep disturbances following dental treatment.

Fathering styles in a traditional culture and its association with marital relationship: A latent profile analysis with a nationally representative sample.

This study had two main objectives. The first goal was to examine fathers' parenting styles in a society with traditional patriarchal values. The second goal was to understand the extent to which marital relationship variables (i.e., marital satisfaction and spousal support) are related with the identified fathering profiles. The theoretical and empirical underpinnings of the "parenting styles" literature that form the foundation of the research on parent-child dynamics are still mainly based on data collected only from mothers. This weakness of the literature on fathering typologies is further accompanied by the scarcity of data on fathers' parenting practices from non-Western contexts. To achieve the study aims, a latent profile analysis based on warmth and control dimensions of parenting was performed using a nationally representative sample of 1070 urban fathers in Turkey. Using scores on six parenting behavior variables (i.e., warmth, punishment, inductive reasoning, positive parenting, discipline and teaching responsibilities, time and talking together), results revealed four fathering profiles: "authoritative" (30%), "average" (45%), "uninvolved" (16%), and "disciplining-distant" (8%). Furthermore, the results showed that the fathering profiles significantly differed from each other on the marital satisfaction and spousal support scores. Results highlight the importance of investigating fathering behaviors and their predictors in different cultures.

The management of children aged 0-5 years with suspected foreign body aspiration: a prospective study.

INTRODUCTION: A simple algorithm for bronchoscopy was prepared in very young children. METHODS: The patients aged 0-5 years who were applied with bronchoscopy because of suspected foreign body aspiration (FBA) analysed. RESULTS: Evaluations were made of 89 patients, as 55 (61.7%) in the FBA (+) group and 34 (38.3%) in the FBA (-) group. FBA was determined most in the 1-2 years age group (28 patients, 50.9%, p = 0.04) due to organic hard foodstuffs (94.5%, p < 0.001). The parameters found to be significant were witnessing the event (OR 12.133, 95% CI 3.147-46.774, p < 0.001) and not obtaining unilateral respiratory sounds (OR 7.556, 95% CI 2.681-21.292, p < 0.001). The most significant diagnostic finding was the determination of unilateral hyperventilation on X-ray (OR 16.730, 95% CI 4.541-61.632, p < 0.001). The operating time and length of stay in hospital was significantly shorter in the FBA (-) patients (p < 0.001). CONCLUSION: The presence of a witness, not obtaining unilateral respiratory sounds, and unilateral hyperventilation seen on X-ray are indications for bronchoscopy. In FBA (-) patients applied with bronchoscopy, the complication rate associated with the procedure is low, and the operating time and length of stay in hospital are short.

The relationship between ethmoidal foramina and orbital fat herniation.

BACKGROUND: The aims of this study are to determine the incidence and more frequent localizations of orbital fat tissue herniation accompanying dehiscences in the medial orbital wall and to investigate the relationship between orbital fat tissue herniations and the anterior and posterior ethmoidal foramina. METHODS: One thousand two hundred patients who had undergone computed tomography with a preliminary diagnosis of sinusitis and who had no previous facial, orbital, paranasal sinus surgeries or history of trauma were retrospectively analyzed. The localization of the ethmoidal foramina and orbital fat tissue herniations were marked. In patients with orbital fat tissue herniation, the relationship between the localization of orbital fat tissue herniation and the anterior and posterior ethmoidal foramina was investigated. RESULTS: The incidence of orbital adipose tissue herniation in our study was 7.9%. Of the 98 herniations on the bilateral medial orbital wall, 60 were in zone 3, and the most common herniation site was zone 3. A statistically significant difference was noted between the localization zone of the anterior ethmoidal foramen and the localization zones of orbital fat tissue herniations (Fisher's exact test, p < 0.001). DISCUSSION: Zone 3 is the weakest area of the medial orbital wall, and zone 3 is the most prone to herniation of fat tissue. The association of orbital fat tissue herniations with the anterior ethmoidal foramen is extremely common. Being cognizant of this finding may help a surgeon better estimate the anatomical view to be met before functional endoscopic sinus surgery as well as to minimize the risk of possible orbital complications, especially anterior ethmoidal artery injury.

The relationship between ethmoidal foramina and orbital fat herniation.

Background/aim: The aims of this study are to determine the incidence and more frequent localizations of orbital fat tissue herniation accompanying dehiscences in the medial orbital wall and to investigate the relationship between orbital fat tissue herniations and the anterior and posterior ethmoidal foramina. Material and methods: One thousand two hundred patients who had undergone computed tomography with a preliminary diagnosis of sinusitis and who had no previous facial, orbital, paranasal sinus surgeries or history of trauma were retrospectively analyzed. The localization of the ethmoidal foramina and orbital fat tissue herniations were marked. In patients with orbital fat tissue herniation, the relationship between the localization of orbital fat tissue herniation and the anterior and posterior ethmoidal foramina was investigated. Results: The incidence of orbital adipose tissue herniation in our study was 7.9%. Of the 98 herniations on the bilateral medial orbital wall, 60 were in zone 3, and the most common herniation site was zone 3. A statistically significant difference was noted between the localization zone of the anterior ethmoidal foramen and the localization zones of orbital fat tissue herniations (Fisher's exact test, p < 0.001). Conclusion: Zone 3 is the weakest area of the medial orbital wall, and zone 3 is the most prone to herniation of fat tissue. The association of orbital fat tissue herniations with the anterior ethmoidal foramen is extremely common. Being cognizant of this finding may help a surgeon better estimate the anatomical view to be met before functional endoscopic sinus surgery as well as to minimize the risk of possible orbital complications, especially anterior ethmoidal artery injury.

ADAM10 expression in gastric adenocarcinoma: Results of a curative gastrectomy cohort.

OBJECTIVE: Gastric cancer is among the most common human cancers with high mortality rates. ADAM10, a member of the ADAM (a disintegrin and metalloproteinase) family has also been found to be associated with gastric carcinoma and has been suggested as a potential therapeutic target. Here, we investigated the association of ADAM10 expression with prognosis in gastric adenocarcinoma patients that underwent gastric resection with D2 lymph node dissection. METHODS: Total 86 consecutive patients that underwent resection for gastric adenocarcinoma were included. Immunohistochemical ADAM10 expression and its association with clinicopathological parameters were analyzed. Univariate and multivariate analyses and survival analyses were performed using SPSS ver.22. RESULTS: High grade tumors, advanced stage tumors and diffuse type tumors showed significantly worse prognosis. A statistically significant association between ADAM10 expression and overall survival (OS) was observed in the univariate analysis, however, this association did not maintain its significance in the multivariate analysis. No statistically significant association was found ADAM-10 expression and clinicopathological parameters. CONCLUSION: Immunohistochemical ADAM10 expression may be used as a prognostic marker in gastric adenocarcinoma, however, introduction of a standardized immunohistochemical scoring system seems to be necessary for evaluation of ADAM10 staining.

Temporomandibular dysfunction assessment in children treated with the Hall Technique: A pilot study.

BACKGROUND: The Hall technique (HT) involves the placement of stainless steel crowns for treating asymptomatic carious primary teeth without tooth preparation or caries excavation. AIM: To investigate whether temporomandibular dysfunction (TM-D) manifests in children after HT. DESIGN: Healthy children (age: 5-9 years) with dentin caries were treated with HT in a university clinic, and TM-D signs and symptoms were monitored in this cohort clinical trial. The primary outcome was TM-D signs recorded using the clinical dysfunction index (Di) at pre-treatment: 0-, 1-, 3-, 6-, and 12-month follow-up visits. The secondary outcome was TM-D symptoms recorded using a questionnaire. The Di and symptoms were compared over time using McNemar's tests. RESULTS: Thirty-nine children were followed for 12 months after HT treatment. Four children were detected as having dysfunction signs throughout the study: muscle pain on palpation and clicking. The symptoms 'hearing a sound within the jaw joint' or 'bite felt uncomfortable or unusual' were reported by another four children. The Di and TM-D symptoms were not significantly different between pre-treatment and follow-up visits (P > .05). CONCLUSIONS: The HT does not seem to be connected to TM-D. Alternative TM-D assessment tools for studying non-persistent symptoms more comprehensively might be useful for future studies.

In vitro effects of novel type M-V-O derivatives on Xanthine Oxidase.

Xanthine Oxidase (XO) is related with different diseases such as vascular, gout, nephropathy and renal stone diseases that are relevant to high uric acid levels and oxidative stress. Some common natural inhibitors of xanthine oxidase are known as rosmarinic acid and apigenin. With this study, we aimed to determine inhibitory effects of originally synthesized new generation transition metal vanadates on Xanthine Oxidase (XO) from bovine milk. Because, Xanthine oxidase inhibitors are typically used in the treatment of gout and nephropathy and renal stone diseases linked to hyperuricaemia. We found considerable IC50 constants for inhibition of XO. Among the synthesized compounds, Cu‒V‒O was found to be the most active (IC50 = 7.119 mM) for inhibition of XO.

Infected colloid cyst.

INTRODUCTION: Colloid cysts are the most common pathologic lesions of the third ventricle. Although they are histologically benign, they may grow and can cause the hydrocephalus. A 5-year-old male patient underwent to surgery with the diagnosis of colloid cyst. In operation, after the anterior transcallosal approach, the cyst was punctured by syringe and obviously pus aspirated. CONCLUSION: Colloid cysts mostly remain silent and detected incidentally. Although it is rarely defined, rhinorrhea, hypopituitarism, diabetes insipidus, spasmodic torticollis, drop attack, aseptic meningitis, and coexistence with neurocysticercosis have been reported, but this is the first reported case of an infected colloid cyst.

Is there a relation between genetic susceptibility with cancer? A study about paraoxanase (PON1) enzyme activity in breast cancer cases.

Human serum paraoxonase 1 (PON1, EC 3.1.1.2) is a high density lipoprotein (HDL)-associated antioxidant enzyme that not only decreases oxidative stress, but it is also implicated in development of many cancers. Genetic information provides a means of identifying people who have an increased risk of cancer, thus this knowledge of cancer genetics helps to identify the ability to characterize malignancies leading to the development of new therapeutic approaches. Because of this reason, in this preliminary study we aimed to investigate the role of human serum PON1 enzyme activity and phenotypic distribution in 32 breast cancer (BC) patients (age range 28-82) and 35 cancer free (CF) control group (age range 21-67). PON1 enzyme was prepared from the serum pool of BC patients using hydrophobic interaction chromatography on L-tyrosine-9-aminophenanthrene-coupled Sepharose 4Bgel. The PON1 enzyme activity towards paraoxon substrate was quantified spectrophotometrically. The basal activity of PON1 was statistically decreased in cancer cases compared to the control group. In addition, individuals were classified according to phenotyping of human PON1 Q and R types. In the cohort of BC patients, an increase in the frequency of the PON homozygote Q (AA) genotype was observed (31% in the BC group versus 14% in the CF controls). The frequency of the PON heterozygote QR (AB) genotype was 34.5% in the patients with BC and 37% in the CF group. The same trend was observed in PON homozygote R (BB) genotype frequency (BC cases 34.5% versus controls 49%). We determined that the kinetic parameters of the purified enzyme by Lineweaver-Burk method. We obtained Km and Vmax values of 0.227 mM and 62 U/mL min for the BC enzyme, compared with 0.775 mM and 206 U/mL min for the CF control enzyme. As a conclusion, it is clear from our results that while the PON1 AA allele frequency in BC cases is much higher, that of BB allele is much lower, in comparison with the control group. The most significant finding of this study is AA allele activity which is low in BC cases was found high. We concluded that decreased AA allele PON1 activity might have a relation with BC.

Physical Education Lessons and Activity Status of Visually Impaired and Sighted Adolescents.

BACKGROUND This study investigated participation in physical education and sports lessons of visually impaired adolescents and their sighted peers and compared their physical activity levels. MATERIAL AND METHODS A total of 22 visually impaired children of mean age 13.59±1.14 years and 31 sighted children aged 13.61±0.50 years participated in the study. A questionnaire prepared for this study was used to investigate participation of visually impaired adolescents and their sighted peers in physical education and sports lessons at school and the problems they encounter while doing sports. The Turkish version of the International Physical Activity Questionnaire - short-form (IPAQ-SF) was used to evaluate the physical activity level of the subjects. RESULTS The results of our study suggest that physical activity levels of visually impaired children and their sighted children were similar (p>0.05). Totally blind children had lower IPAQ scores than those with low vision (p<0.05), and girls were less active physically than boys (p<0.05). There were few differences in physical education lessons of the groups, in taking part in sports-related organizations, and future plans. CONCLUSIONS Children in secondary school, especially visually impaired children, need to be more motivated and more encouraged to take part in various sports or physical activities.

A new affinity method for purification of bovine testicular hyaluronidase enzyme and an investigation of the effects of some compounds on this enzyme.

In this study, a new affinity gel for the purification of bovine testicular hyaluronidase (BTH) was synthesized. L-Tyrosine was added as the extension arm to the Sepharose-4B activated with cyanogen bromide. m-Anisidine is a specific inhibitor of BTH enzyme. m-Anisidine was clamped to the newly formed Sepharose-4B-L-tyrosine as a ligand. As a result, an affinity gel having the chemical structure of Sepharose-4B-L-tyrosine-m-anisidine was obtained. BTH purified by ammonium sulfate precipitation and affinity chromatography was obtained with a 16.95% yield and 881.78 degree of purity. The kinetic constants K(M) and V(Max) for BTH were determined by using hyaluronic acid as a substrate. K(M) and V(Max) values obtained from the Lineweaver-Burk graph were found to be 2.23 mM and 19.85 U/mL, respectively. In vitro effects of some chemicals were determined on purified BTH enzyme. Some chemically active ingredients were 1,1-dimethyl piperidinium chloride, ß-naphthoxyacetic acid and gibberellic acid. Gibberellic acid showed the best inhibition effect on BTH.

Differential in vitro inhibition studies of some cerium vanadate derivatives on xanthine oxidase.

In this preliminary study, a new series of some cerium vanadate derivatives have been investigated as new type of inhibitors of xanthine oxidase (XO; E.C 1.17.3.2). XO is a superoxide-producing enzyme found normally in serum and the lungs, and its activity is concerned with several important health problems such as gout, severe liver damage, vascular dysfunction and injury, oxidative eye injury and renal failure. In this study, we present a critical overview of the effects of these novel type agents on XO with comparing the efficacy and safety profiles of allopurinol, the efficient classical inhibitor of XO.

A new measurement method in Graf technique: prediction of future acetabular development is possible in physiologically immature hips.

BACKGROUND: Universal ultrasound screening has led to overtreatment and higher follow-up rates than are found with clinical examination alone because of high incidence of physiologically immature hips (type IIa) in the first weeks of life. The ability to predict future acetabular development in physiologically immature hips (type IIa) would therefore help to reduce overtreatment and unnecessary follow-up. METHODS: We described the γ-angle to assess the femoral head coverage by the acetabular roof, which is measured between the baseline defined by Graf and the cartilaginous edge line connecting the inferior point of the iliac bone (lower limb) to the medial corner of the acetabular labrum. We retrospectively analyzed ultrasonographic findings of infants with developmental dysplasia of the hip diagnosed in our hospital and infants with normal hips screened in our hospital. Group 1 (35 hips) consists of type IIa hips at initial examination and went on to develop into dysplastic hips at follow-up. Group 2 (279 hips) consists of type IIa hips at initial examination and went on to develop into normal hips (type I) at follow-up. RESULTS: The γ-angles of type IIa hips that developed into type I hip at follow-up ranged between 77 and 82. The γ-angles of type IIa hips that developed into hip dysplasia ranged between 72 and 78. All type IIa hips that had γ-angles >78 degrees developed into normal hips. We also observed that all type IIa hips that had γ-angles <77 degrees developed into dysplasia. CONCLUSIONS: The amount of cartilage mass covering the femoral head, which is a part of the acetabular roof, can therefore provide information about future acetabular development. This paper describes a new method of measurement (the γ-angle) that assesses the extent of the cartilage coverage of the femoral head, which can predict acetabular development. Its use would decrease the rates of unnecessary follow-up and treatment. LEVEL OF EVIDENCE: Level II (development of diagnostic criteria on the basis of consecutive patients).

Isolated Transverse Process Fractures: Should We Offer Lumbar Corset or Not?

Background The aim of this study is to emphasize the need to be careful in terms of internal organ injuries in patients with isolated transverse process fracture (ITPF), and to investigate the effectiveness of corset use in controlling acute pain. Methods This is a retrospective study including 72 patients with only transverse process fractures secondary to trauma, who were admitted to the Emergency Department of Sakarya University Research and Training Hospital between January 2020 and October 2022. The radiological diagnoses were collected from spinal vertebral computed tomography images. Twelve patients were excluded from the study due to exclusion criteria. Sixty patients with ITPF were included in the comparison group. All patients were divided into two groups. The group with no lumbar corset (LC) included those who were discharged with analgesic and muscle relaxant treatment without a brace (n = 33). The LC+ group (n = 27) included those who received rigid lumbosacral orthosis in addition to analgesic and muscle relaxant treatment. Pain levels of all cases in both groups were evaluated with Visual Analog Scale scores on the day of trauma, the first week, the first month, and the sixth month. Results A total of 25 cases had one ITPF, 25 had two, 17 had three, and five patients had four or more ITPFs. The hospitalization rate was the highest among patients with four or more ITPFs (40%). Although the hospitalization rates according to the number of ITPFs were not statistically significant (p = 0.528), there was a clinical significance regarding increasing hospitalization rates with the increasing number of ITPFs. The hospitalization rates were 12%, 16%, 17.6%, and 40% in patients with one, two, three, and four or more ITPFs, respectively. Conclusion ITPFs should be treated conservatively. Concomitant organ injuries must be ruled out before treatment. Medical treatment without a lumbar corset could be used as a cost-effective choice.

Bilateral Concha Bullosa Within Concha Bullosa: Unique Middle Concha Variation.

The middle nasal turbinate is an important anatomical formation located on the lateral nasal wall. Concha bullosa can be defined as the presence of an air gap inside the turbinate. It is the most common middle nasal turbinate variation. It is often asymptomatic, but can sometimes cause nasal obstruction. In this study, an asymptomatic patient with concha bullosa within concha bullosa in both middle turbinates, which has not been reported before in the literature, is presented. Laryngoscope, 134:3516-3518, 2024.

Unconventional mobility, conventional trauma: a comparative analysis of e-scooter-related fractures.

PURPOSE: The present research aimed to compare the different types of fractures to those caused by e-scooter use as well as reveal the severity of e-scooter injuries via an epidemiological analysis of fractures over the course of 6 months. METHODS: This retrospective study assessed medical records of patients with fractures or dislocations admitted to a Turkish level three trauma centre emergency orthopaedic department between June 2021 and January 2022. Using a two-group design, the first group encompassed all fractures and dislocations treated, while the second focused on e-scooter-related cases. Comparative analysis covered fracture patterns and factors within the e-scooter group, like demographics, injury mechanism, and timing. Surgical need and types were explored for e-scooter injuries. RESULTS: Among 4481 upper extremity fractures, finger fractures (27.47%) and distal radius fractures (25.37%) were common, while e-scooter-related cases exhibited radius and ulna shaft fractures (23.07%). Of 2400 lower extremity fractures, toe fractures (30.2%) and metatarsal fractures (19.66%) predominated, with e-scooter-related injuries largely featuring metatarsal fractures (30%). The surgery rate in all patients was 8.92%, whereas the surgery rate specifically for e-scooter injuries was 48.2%. Significantly greater occurrence of lower extremity fractures was evident in e-scooter-related injuries compared to upper extremities (p = 0.011). Collisions involving stationary or moving objects were linked to injuries in the lower extremities, whereas falls were primarily associated with injuries in the upper extremities. Treatment included surgery (48.2%) and conservative management (52.8%), with ORIF (35.7%) and CRIF (10.7%) utilised. CONCLUSION: E-scooter-related fractures and dislocations are typically more severe, often requiring surgery, compared to other fractures during the same period. The study emphasises the link between injury type and increased risk of lower extremity fractures or dislocations.

Effect of intravenous lipid therapy in critically ill pediatric patients with calcium channel blocker toxicity.

BACKGROUND: Overdose with calcium-channel blockers (CCBs) still maintain their importance with a high lethality rate after exposure. We report the intravenous lipid emulsion therapy (ILE) therapy in our CCB overdose patients. METHODS: We retrospectively analyzed the records of 6 patients with CCB intoxication from Batman Training and Research Hospital PICU between March 2021 and September 2022. Patients aged 0-18 years who received ILE treatment for CCB poisoning were included. RESULTS: All six patients ingested CCB with the intention of committing suicide and were followed up in the pediatric intensive care unit (PICU). All patients received ILE therapy due to hemodynamic instability despite intravenous fluid boluses, calcium, glucagon, insulin-dextrose, and vasoactive agents. Vasoactive-Inotropic Score (VIS) decreased after ILE treatment. All patients were transferred from the PICU after recovery. CONCLUSIONS: ILE therapy should be kept in mind as a salvage therapy in hemodynamically unstable CCB poisoning cases that do not respond to initial and advanced options.