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1.
Pediatr Emerg Care ; 40(7): e89-e93, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38718420

RESUMEN

METHODS: This study was designed as a cross-sectional, observational, retrospective study. The variables of the study were paracetamol overdose, demographic information, poisoning mechanisms, clinical, laboratory findings, and clinical progression of the cases. The cases compared in whom treatment was initiated within the first 8 hours after poisoning and those in whom it was not. χ 2 , t test, and logistic regression analyses were conducted at appropriate facilities. RESULTS: Three hundred forty-eight cases were included in the study. N-AC treatment was initiated within the first 8 hours after poisoning in 322 cases (92.5%), and 26 cases received N-AC treatment after 8 hours after poisoning. Liver toxicity developed in 6 cases (1.7%), and indications for liver transplantation were met in 36 cases (10.3%). Among the 26 cases for which treatment was not initiated within the first 8 hours, 18 cases (69.2%) had indications for liver transplantation ( P < 0.01). It was found that N-AC within the first 8 hours reduced the risk by 43 times ( P = 0.02) and being older than 6 years, being admitted to the intensive care unit, and having alanine aminotransferase values above 1000 U/L increased the risk significantly ( P = 0.009, P = 0.005, P < 0.001). When a receiver operating characteristic curve was plotted for the 4th-hour blood acetaminophen level to predict liver transplantation, a value of 684.5 µg/mL emerged with 89% sensitivity and 93% specificity (area under the curve, 0.951). CONCLUSIONS: As a result, this study demonstrates the protective effect of early-initiated N-AC therapy on liver toxicity in pediatric acetaminophen poisoning cases. It also highlights a significant impact of gastrointestinal decontamination methods.


Asunto(s)
Acetaminofén , Acetilcisteína , Enfermedad Hepática Inducida por Sustancias y Drogas , Humanos , Acetaminofén/envenenamiento , Estudios Retrospectivos , Femenino , Masculino , Estudios Transversales , Niño , Preescolar , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Acetilcisteína/uso terapéutico , Lactante , Analgésicos no Narcóticos/envenenamiento , Sobredosis de Droga , Antídotos/uso terapéutico , Trasplante de Hígado , Adolescente , Hígado
2.
Childs Nerv Syst ; 39(12): 3551-3560, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37010582

RESUMEN

BACKGROUND: Optic nerve sheath diameter (ONSD) measurement is a noninvasive method that can be used for intracranial pressure monitoring. Several studies have investigated normal ONSD values in children, but no general consensus has been reached yet. OBJECTIVES: The aim of our study was to reveal normal ONSD, eyeball transverse diameter (ETD), and ONSD/ETD values on brain computed tomography (CT) in healthy children aged 1 month to 18 years. METHODS: Children admitted to the emergency department with minor head trauma and had normal brain CT were included in the study. The demographic characteristics of the patients (age and sex) were recorded, and the patients were divided into four age groups: 1 month to 2 years, 2 to 4 years, 4 to 10 years, and 10 to 18 years. RESULTS: The images of 332 patients were analyzed. When the median values of all measurement parameters (right and left ONSD, ETD, and ONSD/ETD) were compared between the right and left eyes, no statistically significant differences were found. When the same parameters were compared according to age group, the ONSD and ETD values differed significantly (values of males were found to be higher), but the ONSD proximal/ETD and ONSD middle/ETD values did not differ significantly. CONCLUSION: In our study, normal ONSD, ETD, and ONSD/ETD values were determined according to age and sex in healthy children. As the ONSD/ETD index did not statistically significantly differ according to age and sex, diagnostic studies for traumatic brain injuries can be performed using the index.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Hipertensión Intracraneal , Masculino , Humanos , Niño , Presión Intracraneal/fisiología , Nervio Óptico/diagnóstico por imagen , Ojo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía
3.
Turk J Pediatr ; 64(4): 648-657, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36082639

RESUMEN

BACKGROUND: High-flow nasal cannula (HFNC) therapy is a relatively new method used in patients with respiratory distress. The aim of the study was to evaluate the outcomes and to determine the baseline predictors of HFNC treatment failure in children with acute respiratory distress/failure in the pediatric emergency department. METHODS: Children with respiratory distress/failure aged 1 month to 18 years who underwent HFNC therapy with the pre-established protocol were retrospectively analyzed. HFNC therapy was used in respiratory and non-respiratory pathologies. HFNC failure was defined as the need for escalation to non-invasive ventilation or invasive mechanical ventilation. HFNC responders and non-responders were compared based on baseline clinical data. RESULTS: Of the 524 cases (median age:13 months; 292 males / 232 females), 484 (92.4%) had respiratory tract and 40 (7.6%) had non-respiratory tract pathologies. HFNC therapy was unsuccessful in 62 (11.8%) patients. The success rates were 81% and 55% in respiratory and non-respiratory diseases, respectively. In children with respiratory system pathologies, the pre-treatment venous pCO2 level (p: 0.045; OR: 0.958; 95%CI: 0.821-0.990) and the clinically important radiological finding on chest X-ray (lobar infiltration, atelectasis, pleural effusion) (p: 0.045; OR: 3.262; 95%CI: 1.178-9.034) were the most significant parameters in predicting HFNC failure. In children with non-respiratory pathologies, the pre-treatment venous lactate level (p: 0.008; OR: 1.558; 95%CI: 1.125-2.158) was a significant predictor of HFNC failure. There were no cases of pneumothorax or any other reported adverse effects related to HFNC therapy. CONCLUSIONS: HFNC treatment is a safe oxygen therapy in children with respiratory distress/failure due to various etiologies in the emergency department. The lower venous pCO2 level increases and the clinically important radiological finding on chest radiograph decreases the success of HFNC treatment in respiratory pathologies. The higher venous lactate level is a predictor of HFNC treatment failure in non-respiratory pathologies.


Asunto(s)
Ventilación no Invasiva , Síndrome de Dificultad Respiratoria , Insuficiencia Respiratoria , Cánula , Niño , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Lactatos , Masculino , Oxígeno , Terapia por Inhalación de Oxígeno/métodos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos , Insuficiencia del Tratamiento
4.
Am J Emerg Med ; 56: 28-32, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35358945

RESUMEN

INTRODUCTION: The phenomenon of pulsus paradoxus (PP) develops at varying rates in relation to the severity of the disease in obstructive respiratory tract disease. The Pleth Variability Index (PVI) is the measurement value of perfusion index changes that occur with ventilation, which are determined during at least one respiratory cycle. Therefore, noninvasive measurement of PVI can help in the measurement of PP. The current study aims to determine the role of PVI measurements before and after bronchodilator therapy during admission to the hospital in children with obstructive respiratory tract disease. METHODS: Age, gender, Pulmonary Index Score (PIS), and PVI data of patients aged 2-18 years who applied to the pediatric emergency department with signs of obstructive respiratory tract disease were recorded in triage. The PVI and PIS scores of the patients, who were divided into three groups according to their clinical severity scores, were recorded before and after bronchodilator treatment, and they were compared to the PVI values according to the disposition results. RESULTS: A total of 133 patients were included in this prospective, single-center study. The PVI values before and after treatment were significantly higher in patients with severe disease compared to the mild and moderate groups (p < 0.001). Post-treatment PVI values were significantly lower than pre-treatment values in all clinical severity groups (p < 0.001). While a total of 95 (71.43%) patients were discharged from the emergency department, 31 (23.31%) patients were admitted to the relevant department, and seven (5.26%) patients were admitted to the pediatric intensive care unit. The PVI values before and after treatment were significantly higher in the hospitalized group compared to the group discharged from the emergency department (p < 0.001). The areas under the ROCs were 0.940, 0.865, and 0.843 for the PVI measurements in patients with severe disease, moderate disease, and hospitalization (p< 0.001). CONCLUSIONS: Automated PVI measurement can be used as a noninvasive, rapid, and objective tool in the emergency department triage of patients admitted to the pediatric emergency department with signs of asthma attack or reactive respiratory tract disease.


Asunto(s)
Asma , Trastornos Respiratorios , Asma/terapia , Broncodilatadores/uso terapéutico , Niño , Servicio de Urgencia en Hospital , Humanos , Estudios Prospectivos , Triaje/métodos
6.
Arch Pediatr ; 29(1): 56-60, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34848131

RESUMEN

BACKGROUND: Beta-blocker (BB) intoxications are common in both childhood and adulthood. In the case of poisoning, bradycardia, hypotension, ventricular dysrhythmias, mental status changes, seizures, hypoglycemia, and bronchospasm may occur. Effects on the cardiovascular system are commonly seen, but hypoglycemia is not frequently observed in clinical practice. In this study, we aimed to answer the question, "Is hypoglycemia more commonly observed in BB intoxications than in other intoxications?" METHOD: This was a case-control study conducted in a pediatric emergency department of a university hospital. The case group (Group 1) consisted of cases with BB poisonings and the control group (Group 2) consisted of cases with selective serotonin receptor inhibitor (SSRI) poisonings. Data were obtained from patient files. We recorded the blood glucose levels (BGLs) of all patients on admission to the emergency department and at the 1-, 6-, and 24-h follow-up. The amounts of BBs received by the cases were compared with the specific toxic doses of each drug. The data obtained were analyzed using the Statistical Package for the Social Sciences 22 (SPSS.22) program. Mean and standard deviation for numerical values and frequency for categorical data are reported; at test, chi-square test, and ANOVA tests were used for the analysis. RESULTS: The study comprised 40 patients (Group 1) and 40 controls (Group 2). The mean serum BGLs of patients in Group 1 at admission and at the 1-, 6-, and 24-h follow-up were 107.2 ± 46.3 mg/dl, 86.3 ± 20.1 mg/dl, 88.6 ± 28.4 mg/dl, and 86.5 ± 23.7 mg/dl, respectively. The mean values of Group 2 cases were 100 ± 39.5 mg/dl, 92.1 ± 30 mg/dl, 91±28 mg/dl, and 127.8 ± 60.7 mg/dl, respectively, at admission and at the 1-, 6-, and 24-h follow-up (p = 0.4, p < 0.001, p = 0.7, and p < 0.001, respectively). The mean BGLs of patients who were exposed to propranolol at admission and at the 1-, 6-, and 24-h follow-up were significantly lower than those of the patients who had taken different BBs in Group 1. No linear correlation was found between the percentage of exposure to BB toxic doses and BGLs. CONCLUSION: Our study showed that the BGLs of patients receiving BBs could be lower, but they were not at a level that would have serious consequences. Nevertheless, the BGLs of all cases of intoxication should be monitored closely.


Asunto(s)
Antagonistas Adrenérgicos beta/toxicidad , Glucemia , Sobredosis de Droga , Hipoglucemia/inducido químicamente , Antagonistas Adrenérgicos beta/efectos adversos , Adulto , Glucemia/efectos de los fármacos , Estudios de Casos y Controles , Niño , Sobredosis de Droga/epidemiología , Servicio de Urgencia en Hospital , Femenino , Humanos , Hipoglucemia/epidemiología , Masculino , Estudios Retrospectivos , Inhibidores Selectivos de la Recaptación de Serotonina/toxicidad
7.
Pediatr Pulmonol ; 56(12): 3674-3681, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34516721

RESUMEN

We describe the demographic, clinical, radiological, and laboratory findings of 422 children (0-18 year-of-age) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to a pediatric emergency department between March 23, and July 23, 2020. We compared the characteristics of SARS-CoV-2-positive patients to SARS-CoV-2-negative patients. SARS-CoV-2 infection was confirmed in 78 (18.4%). Fever (51.2%) and cough (43.5%) were the most commonly reported signs in the SARS-CoV-2-positive patients. Isolated rhinorrhea (7.2%) was reported only in the SARS-CoV-2-negative group (p = .0014). Patients with SARS-CoV-2 infection were classified according to severity, with the percentages of asymptomatic, mild, moderate, severe, and critical cases determined to be 29.5%, 56.4%, 12.9%, 1.2%, and 0%, respectively. Of the 422 children, 128 (30.3%) underwent nasopharyngeal polymerase chain reaction testing for other respiratory viral pathogens; 21 (16.4%) were infected with viral pathogens other than SARS-CoV-2. Only one patient (4.7%) with confirmed coronavirus disease 2019 (COVID-19) disease was coinfected with respiratory syncytial virus and rhinovirus. The results indicate lower median white blood cell, neutrophil, and lymphocyte counts, lower lactate dehydrogenase, d-dimer, and procalcitonin levels in the SARS-CoV-2-positive group (p ≤ .001). Our findings confirm that COVID-19 in children has a mild presentation. In our cohort, no patient with SARS-CoV-2 infection had isolated rhinorrhea.


Asunto(s)
COVID-19 , Tos , Hospitalización , Humanos , Laboratorios , SARS-CoV-2
8.
Turk J Emerg Med ; 21(3): 104-110, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34377866

RESUMEN

OBJECTIVES: We aimed to compare the demographic and clinical characteristics between pediatric cardiac arrest patients treated in Gaziantep at South-eastern Anatolian region and Izmir at Aegean Shore. MATERIALS AND METHODS: We retrospectively reviewed sociodemographic characteristics, laboratory parameters, and clinical outcomes of pediatric patients that underwent cardiopulmonary resuscitation due to prehospital cardiac arrest at two pediatric emergency departments in Izmir Hospital of Health Sciences University and Gaziantep Cengiz Gökçek Kadin Dogum ve Çocuk Hospital of Health Ministry between August 2017 and August 2018. RESULTS: The present study included 188 patients (112 patients from Gaziantep and 76 patients from Izmir). All patients arrived at the hospital through emergency medical services. The median age was lower (14 days vs. 15 months; P < 0.001), and the proportion of Syrian refugees was higher in patients from Gaziantep (78.6% vs. 7.9%; P < 0,001). In both centers, respiratory failure was the most common etiology. In patients from Gaziantep, pH levels were lower (median: 7.10 vs. 7.24), and lactate levels were higher (median: 6 mmol/L vs. 3.6 mmol/L; P < 0.001). The mortality rate was higher among patients from Gaziantep (27.7% vs. 7.9%; P = 0.001). CONCLUSIONS: The rate of Syrian refugees among children who were brought to emergency department due to pre-hospital cardiac arrest was much higher in Gaziantep compared to Izmir. Syrian children were significantly younger and had more severe tissue hypoxia, resulting in a higher mortality rate.

10.
Turk J Pediatr ; 63(1): 59-67, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33686827

RESUMEN

BACKGROUND: The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated. METHODS: This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed. RESULTS: During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p < 0.001). Most procedures were performed on children aged one or older (p < 0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p < 0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics. CONCLUSION: This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.


Asunto(s)
Enfermedad Crítica , Servicios Médicos de Urgencia , Ambulancias , Niño , Enfermedad Crítica/terapia , Servicio de Urgencia en Hospital , Humanos , Estudios Prospectivos
11.
Vascular ; 29(3): 461-467, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32962558

RESUMEN

OBJECTIVES: The aim of this study was to investigate and compare the severity of kidney damage following lower limb ischemia-reperfusion and direct kidney ischemia-reperfusion. METHODS: Thirty Sprague Dawley male rats were randomly divided into three groups; lower extremity ischemia-reperfusion group (Group 2), renal ischemia-reperfusion group (Group 3) and control (anesthesia and median laparotomy only) (Group 1). In group 3, 1-h ischemia was performed on the kidney and in group 2, 1-h ischemia was performed on the left lower extremity. This procedure was followed by reperfusion for 24 h. Renal tissues were removed after the reperfusion period and the groups were evaluated for glutathioneperoxidase activity, malondialdehyde and GSH levels, and furthermore, their histolopathological scores were calculated. RESULTS: Renal malondialdehyde levels were significantly higher in Group 2 and Group 3 than they were in the Control group. There was no significant difference in renal malondialdehyde levels between Group 2 and Group 3. Kidney glutathione (GSH) levels were statistically lower in Group 2 and Group 3 than in the Control group. No statistically significant difference was found between Group 2 and Group 3 regarding their GSH levels. In histological evaluation, there was no statistically significant difference between Group 2 and Group 3 in terms of kidney damage score. CONCLUSIONS: This study has identified that lower extremity ischemia induces remote kidney damage with similar features to kidney injury, occurring after direct kidney ischemia-reperfusion.


Asunto(s)
Lesión Renal Aguda/patología , Riñón/irrigación sanguínea , Riñón/patología , Extremidad Inferior/irrigación sanguínea , Daño por Reperfusión/patología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/metabolismo , Animales , Modelos Animales de Enfermedad , Glutatión/metabolismo , Glutatión Peroxidasa/metabolismo , Riñón/metabolismo , Masculino , Malondialdehído/metabolismo , Ratas Sprague-Dawley , Daño por Reperfusión/etiología , Daño por Reperfusión/metabolismo , Índice de Severidad de la Enfermedad
12.
Arch. Clin. Psychiatry (Impr.) ; 47(5): 130-134, Sept.-Oct. 2020. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1180708

RESUMEN

Abstract Background: Thoughts about suicide are quite common in adolescent. While such thoughts can be caused by many reasons, the most well-known of these are mood disorders. There are studies related to coexistence of thyroid pathologies and mood disorders in adult. Objectives: In this study, we aimed to investigate the difference of thyroid hormone levels in between adolescents with suicide attempt history and normal population. Methods: The study was prospective and was designed as a case-control study. Demographic characteristics of the patients were obtained and Serum fT3, fT4 and TSH levels were examined. Results: 222 cases were included in the study, including 101 cases and 121 controls. As for TSH levels, the mean serum levels of the whole group was 1.96 ± 1.08 mU/L, while the mean serum levels of the control group was 2.33 ± 1.5 mU/L and the mean serum levels of the case group was 0.50 ± 0.3 mU/L which revealed that the mean serum levels of the case group was significantly lower (p<0.01). Conclusion: It was found that serum TSH levels were significantly lower in case group than control group and the individuals with subclinical hyperthyroidism had more suicide attempts than the ones in control group.

13.
Ann Clin Psychiatry ; 32(2): 106-113, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32384132

RESUMEN

BACKGROUND: Psychiatric disorders are the most common cause of suicide attempts. Some studies have shown there is a relationship between low vitamin D levels and psychiatric disorders. In this study, we examined the relationship between suicidal behavior and vitamin D levels in adolescents. METHOD: This study included 215 patients who presented to the pediatric emergency department due to a suicide attempt (patient group) and 200 healthy individuals (control group). Demographic and clinical features of both groups were recorded, and serum vitamin D, calcium, and phosphorus levels were measured. The groups were compared in terms of these factors. All data were analyzed using the SPSS 20.0 (SPSS Inc., Illinois, USA) software program. RESULTS: The mean vitamin D level was 19.4 ± 10 ng/mL in the control group and 12.3 ± 6 ng/mL in the patient group (t = 8.8 and P = .01). The mean serum total calcium level was 9.9 ± 0.3 mg/dL in the control group and 9.4 ± 0.5 mg/dL in the patient group (P < .01). CONCLUSIONS: Vitamin D deficiency, which is a treatable condition, may be one of the causes of suicidal behavior in adolescents. Therefore, we believe that physicians who treat adolescents should consider vitamin D levels in routine examinations.


Asunto(s)
Intento de Suicidio/estadística & datos numéricos , Vitamina D/análisis , Adolescente , Calcio/análisis , Calcio/sangre , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Factores de Riesgo , Intento de Suicidio/psicología , Turquía , Vitamina D/sangre
14.
Pediatr Int ; 62(12): 1339-1345, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32469101

RESUMEN

BACKGROUND: The aims of this study were to evaluate the outcomes of patients with severe bronchiolitis who received preemptive high-flow nasal cannula (HFNC) treatment according to the authors' protocol, and to identify potential baseline characteristics that might predict patients who will not benefit from HFNC. METHODS: This was a retrospective chart review of patients with severe bronchiolitis, who received preemptive HFNC treatment according to the authors' protocol and who were admitted to the pediatric emergency department between January 1, 2015, and December 31, 2016. RESULTS: Eighty-four patients in total were enrolled over the 2 year period. Twenty-three patients (27.3%) failed HFNC. Of these, four responded to non-invasive mechanical ventilation and 19 required subsequent invasive ventilation. According to logistic regression analysis, existence of a chronic condition, significant tachycardia, existence of dehydration, and a venous pH <7.30 at admission were found to be predictors of HFNC failure. There were no cases of pneumothorax or any other reported adverse effects related to HFNC therapy. CONCLUSIONS: Preemptive HFNC treatment, complying with a preestablished protocol, might be a safe way to support patients with severe bronchiolitis in high-volume, resource-limited pediatric emergency departments. The existence of a chronic condition, significant tachycardia, dehydration, and a venous pH <7.30 at admission could be risk factors for preemptive HFNC treatment failure in severe bronchiolitis.


Asunto(s)
Bronquiolitis/terapia , Servicio de Urgencia en Hospital , Ventilación no Invasiva/métodos , Terapia por Inhalación de Oxígeno/métodos , Cánula , Enfermedad Crónica/epidemiología , Deshidratación/epidemiología , Femenino , Recursos en Salud/estadística & datos numéricos , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Taquicardia/epidemiología , Insuficiencia del Tratamiento
15.
Turk Gogus Kalp Damar Cerrahisi Derg ; 28(1): 127-133, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32175153

RESUMEN

BACKGROUND: The aim of this study was to compare the effect of lower extremity ischemia reperfusion on the liver and the effect of ischemiareperfusion on the liver itself in a rat model. METHODS: Thirty Sprague-Dawley male rats were randomly divided into three groups including 10 in each group: sham (Group 1), lower limb ischemia-reperfusion (Group 2), and liver ischemia-reperfusion (Group 3). In Group 2, one hour of left lower limb ischemia was performed. In Group 3, one hour of ischemia in the liver was performed, followed by 24 hours of reperfusion. After reperfusion, the liver tissues were removed, and the groups were evaluated biochemically and histologically. RESULTS: The liver malondialdehyde levels were significantly higher in Groups 2 and 3 than in the sham group (p<0.001). In Group 2, the malondialdehyde levels were significantly higher than in Group 3 (p=0.019). The glutathione levels in the liver were significantly lower in Groups 2 and 3 than in the sham group (p<0.001). However, the glutathione levels were significantly higher in Group 2 than in Group 3 (p=0.005). In the histological evaluation, although the liver damage score was higher in Group 3 than in Group 2 (p=0.015), there was no significant difference between the two groups in TUNEL(+) cell number (p>0.05). CONCLUSION: Reperfusion injury in the liver after lower limb ischemiareperfusion is as important as ischemia-reperfusion injury which is specifically induced in the liver. This should be taken into account, particularly in reperfusion surgeries following vascular trauma or in cases of leg tourniquets to stop bleeding after lower limb vascular trauma.

17.
Ann Vasc Surg ; 65: 271-281, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31927058

RESUMEN

BACKGROUND: It has been experimentally shown that reperfusion injury occurs in many remote organs after ischemia-reperfusion (I/R) of the lower extremity. However, which distant organ is affected more after I/R of the lower extremity has not been investigated. In this study, we investigate which remote organ is predominantly affected after lower extremity I/R. METHODS: Twenty male Sprague-Dawley rats were randomly divided into 2 groups: sham (group 1) and lower extremity I/R (group 2). In group 2, 1 hr of ischemia of the left lower extremity was followed by 24 hr of reperfusion of the limb. After reperfusion, the lung, liver, kidney, heart, and small intestine tissues were harvested in both groups. RESULTS: In the I/R group, the malondialdehyde levels were significantly higher in the heart and small intestine tissues than those in other tissues (P < 0.05). In addition, in the I/R group, the glutathione and glutathione peroxidase activities were also higher in the heart tissues than those in other tissues (P < 0.05). However, these results were not significant because the malondialdehyde, glutathione, and glutathione peroxidase levels of the heart tissues in the control group were higher than those of the other tissues. Therefore, no statistically significant difference was found between the tissues in terms of the histological damage score we created and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling-positive cell numbers. CONCLUSIONS: There was no difference in the severity of reperfusion injury between the tissues we examined after lower extremity I/R. This suggests that every distal organ should be carefully monitored after lower extremity I/R.


Asunto(s)
Intestino Delgado/irrigación sanguínea , Isquemia/terapia , Riñón/irrigación sanguínea , Hígado/irrigación sanguínea , Extremidad Inferior/irrigación sanguínea , Pulmón/irrigación sanguínea , Miocardio , Daño por Reperfusión/etiología , Reperfusión/efectos adversos , Animales , Biomarcadores/metabolismo , Modelos Animales de Enfermedad , Glutatión/metabolismo , Glutatión Peroxidasa/metabolismo , Intestino Delgado/metabolismo , Intestino Delgado/patología , Isquemia/fisiopatología , Riñón/metabolismo , Riñón/patología , Hígado/metabolismo , Hígado/patología , Pulmón/metabolismo , Pulmón/patología , Masculino , Malondialdehído/metabolismo , Miocardio/metabolismo , Miocardio/patología , Ratas Sprague-Dawley , Flujo Sanguíneo Regional , Daño por Reperfusión/metabolismo , Daño por Reperfusión/patología , Daño por Reperfusión/fisiopatología
18.
Ann Clin Psychiatry ; 32(2): 106-113, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31990969

RESUMEN

BACKGROUND: Psychiatric disorders are the most common cause of suicide attempts. Some studies have shown there is a relationship between low vitamin D levels and psychiatric disorders. In this study, we examined the relationship between suicidal behavior and vitamin D levels in adolescents. METHOD: This study included 215 patients who presented to the pediatric emergency department due to a suicide attempt (patient group) and 200 healthy individuals (control group). Demographic and clinical features of both groups were recorded, and serum vitamin D, calcium, and phosphorus levels were measured. The groups were compared in terms of these factors. All data were analyzed using the SPSS 20.0 (SPSS Inc., Illinois, USA) software program. RESULTS: The mean vitamin D level was 19.4 ± 10 ng/mL in the control group and 12.3 ± 6 ng/mL in the patient group (t = 8.8 and P = .01). The mean serum total calcium level was 9.9 ± 0.3 mg/dL in the control group and 9.4 ± 0.5 mg/dL in the patient group (P < .01). CONCLUSIONS: Vitamin D deficiency, which is a treatable condition, may be one of the causes of suicidal behavior in adolescents. Therefore, we believe that physicians who treat adolescents should consider vitamin D levels in routine examinations.


Asunto(s)
Intento de Suicidio/estadística & datos numéricos , Vitamina D/análisis , Adolescente , Calcio/análisis , Calcio/sangre , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Factores de Riesgo , Intento de Suicidio/psicología , Turquía , Vitamina D/sangre
19.
Int J Pediatr Adolesc Med ; 6(3): 109-114, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31700969

RESUMEN

BACKGROUND: Every year, more than one million children lose their lives due to preventable accidents. Poisoning is the most common among these accidents. OBJECTIVE: In this study, we investigated the demographic and clinical characteristics of poisoning cases referred to the pediatric emergency department. METHODS: The cases (0-18 years old) related to complaints of intoxication in the pediatric emergency department between January 1, 2017, and December 31, 2017, were examined retrospectively. RESULTS: The study included 453 patients, with 202 (46.4%) female and 233 (53.6%) male patients. The mean age of the patients was 51.12 months. The most frequent poisoning agents were 211 (46.6%) household cleaning products and 172 (38%) drugs. When the mechanism of poisoning was examined, it was determined that 377 (83.2%) cases were accidental and 47 (10.4%) cases were suicide attempts. It was observed that 286 (45.8%) items were not in original packaging and 95% of those in original packaging were not locked. CONCLUSION: To avoid childhood poisoning that may have widespread and serious consequences, the poisonous products should be sold with locked covers and kept in places where children cannot reach them.

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