Evaluation of renal arterial resistive index in patients with extrahepatic cholestasis.

OBJECTIVE: Biliary obstruction has been shown to cause acute renal failure. The Renal Resistive Index (RRI) has been recognized to be an important index for evaluating changes in renal plasma flow and renal damage in cholestatic patients. We aimed to investigate the effects of cholestasis on renal hemodynamics in patients with extrahepatic cholestasis by RRI. PATIENTS AND METHODS: The prospective study included patients with extrahepatic cholestasis due to benign biliary stricture, choledocholithiasis, or periampullary tumor between January 1, 2022, and December 31, 2022. Renal and liver function tests, as well as renal doppler ultrasound for RRIs, were conducted before and after cholestasis treatment. RESULTS: Patients who experienced cholestasis resolution after treatment showed lower cholestasis enzymes and bilirubin values and higher glomerular filtration rates compared to pre-treatment values. RRI values significantly decreased in patients with resolved cholestasis compared to pre-treatment levels (p=0.009). Patients with malignant cholestasis had higher RRI values than those with benign cholestasis (p=0.006). Bilirubin levels were higher (p=0.001), and glomerular filtration rates were lower (p=0.046) in patients with malignant cholestasis compared to those with benign cholestasis. CONCLUSIONS: Acute renal injury in cholestatic patients can be demonstrated non-invasively by RRI and is reversible once cholestasis has resolved. Patients with benign cholestasis had lower RRI values than those with cholestasis due to periampullary tumors.

Comparison of the side effects of antivirals in chronic hepatitis B patients: a single-center experience.

Background and study aim: Entecavir (ETV), Tenofovir Disoproxil Fumarate (TDF), and Tenofovir Alafenamide (TAF) have been approved for treating Chronic Hepatitis B (CHB) and recommended due to their high safety profile and high resistance barriers. This study aimed to evaluate the kidney functions, bone, and metabolic parameters in CHB patients receiving ETV, TDF, and TAF treatment. Patients and methods: In this retrospective cohort study, a total of 469 CHB patients who were treated with TDF (n = 256), ETV (n = 184), or TAF (n = 129) for at least six months between March 2012 and March 2022, were enrolled. Results: No significant difference was observed between three groups regarding ALT normalization, HBV DNA suppression, and HBs Ag seroconversion (p = 0.15, p = 0.26, p = 0.72). After the treatment, there was a significant decrease in GFR values in the TDF, ETV, and TAF groups (p<0.01, p = 0.01, p = 0.01, respectively). No significant improvement was observed in the GFR values after TAF treatment in 77 patients who had switched from TDF to TAF (p = 0.51). Moreover, no significant decrease in bone mineral densities was observed in the TDF, ETV, and TAF groups (p = 0.24, p = 0.41, p = 0.95, respectively). There was no significant difference between the three groups in metabolic parameters (serum glucose, lipid profile, calcium and phosphorus levels, etc.) when the data were adjusted for underlying comorbidities. Conclusions: ETV, TDF, and TAF are comparably safe and effective antiviral agents against CHB.

Comparison of pre-incision and single-stepped clear corneal incision in phacoemulsification surgery.

AIM: To compare postoperative keratometric corneal refractive changes after phacoemulsification surgery between pre-incision and single stepped clear corneal incision techniques. PATIENTS AND METHODS: This prospective clinical study included 40 eyes of 40 patients who underwent clear corneal cataract surgery. Twenty eyes were operated using pre-incision technique (Group A), and 20 eyes using single-stepped incision technique (Group B). Corneal refractive power was measured by keratometry before the surgery and one week, one month, and three months postoperatively. NCSS (Number Cruncher Statistical System), 2007&PASS (Power Analysis and Sample Size), and 2008 SS (Statistical Software, Utah, USA) was used for the statistical analysis. RESULTS: The mean preoperative keratometric corneal power in the pre-incision group was 44.24±1.59 and 44.70±1.26 in the single stepped incision group. After three months postoperatively, it was 44.15±1.57 in the pre-incision group and 44.77±1.39 in the single stepped incision group. There was no significant difference in the keratometric corneal refractive changes between Group A and Group B, three months after surgery (p > 0.05). CONCLUSIONS: Using pre-incision and single stepped clear corneal incision techniques in phacoemulsification surgery showed no difference on corneal refractive power changes. Pre-incision technique can be used for smoother corneal incision in cataract surgery especially for the beginners.

Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey.

OBJECTIVES: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. METHODS: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). RESULTS: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p<0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p=0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p=0.008). CONCLUSIONS: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials.

Hypertonic saline treatment in children with cerebral edema.

OBJECTIVE: To compare the efficacy and side effects of hypertronic saline and mannitol use in cerebral edema. DESIGN: Retrospective study. SETTING: Pediatric intensive care unit. SUBJECTS: 67 patients with cerebral edema. METHODS: Patients with cerebral edema treated with either mannitol or hypertronic saline (HS) (Group II: n = 25), and both mannitol and HS (Group III: n = 20) were evaluated retrospectively. Cerebral edema and increased intracranial pressure were based on the clinical and/or radiological (CT, MR) findings. When treating with both mannitol and HS (Group IIIA), if patients serum osmality was greater than 325 mosmol/L, mannitol was stopped and patients were treated with only HS (Group IIIB). All patients were closely monitored for fever, pulse, blood pressure, central venous pressure (CVP), oxygen saturation, volume of fluid intake and urine output. Mannitol was given at a dose of 0.25-0.5 g/kg while the hypertonic saline was given as 3% saline to maintain the serum-Na within the range of 155-165 mEq/L. RESULTS: There was no statistically significant difference in terms of Glasgow coma scale, age, gender, and etiologic distribution between the groups. And also distribution of the other treatments given for cerebral edema is not significiant. Mannitol was given for a total dose of 9.3 +/-5.0 (2-16) doses in Group I, and 6.5 +/-2.8 (2-10) doses in Group III. Hypertonic saline was infused for 4-25 times in Group II. Although there was no statistically significant difference in the highest serum Na and osmolarity levels of the groups, duration of comatose state and mortality rate were significantly lower in Group II and Group III A B. Patients who received only HS were subdivided according to their serum Na concentrations into 2 groups as those between 150-160 mEqL and those between 160-170 mEqL. The duration of comatose state and mortality was not different in patients with serum-Na of 150-160 mEqL and in patients with 160-170 mEqL in the hypertonic saline receiving patients. Four patients in the group II developed hyperchloremic metabolic acidosis and 2 patients in the group I had hypotension. As two patients in group II had diabetes insipidus and one patient had renal failure in group I, the treatment was terminated. The causes of death were septic shock, ventilator associated pneumonia with acute respiratory distress syndrome, progressive cerebral edema and cerebral edema with pulmonary edema. Multivariate analysis showed that age, gender, cause of cerebral edema, electrolyte imbalance, hyperglycemia and hyper-ventilation had no significant impact on outcome. CONCLUSION: Hypertonic saline seems to be more effective than mannitol in the cerebral edema.

Iron status and its relationship with lipid peroxidation in patients with acute myocardial infarction.

AIM: The aim of this study was to investigate iron status and its relationships with lipid peroxidation in patients with acute myocardial infarction (MI). METHODS: The study included 30 male patients aged between 32 and 73 years (mean 55 +/- 6) with acute MI. We measured the levels of plasma iron, transferrin (TF), ferritin (FER), ceruloplasmin (CER), cardiac enzymes, and erythrocyte malondialdehyde (e-MDA) in patients with acute MI on the admission and 1st, 3rd, 5th, 7th, 15th, 45th post MI day and investigated the variations of these parameters in acute MI. RESULTS: The e-MDA level started to increase on the admission day and showed a peak value on the post MI 1st day (88 +/- 23 and 98 +/- 26 nmol/g Hb, respectively). Afterwards, the e-MDA level minimally changed until post Ml 45th day, which showed a minimum level (57 +/- 13 nmol/g Hb) (p < 0.05). In addition, the iron concentration of serum reached its maximum level on the 1st post Ml day (99 +/- 30 mg/dl, p < 0.05) and relatively decreased after the 3rd day. Courses of MDA and iron levels were similar. The FER level started to increase from the admission day of the patients (230 +/- 375 mg/dl), showed a mean peak value on the 3rd day (296 +/- 568 mg/dl) and decreased to a minimum level on the 45th day (121 +/- 85 mg/dl) (p < 0.05). Contrarily, the TF level started to decrease on the 1st day (221 +/- 44 mg/dl), decreased minimum level on the 3rd day (211 +/- 37 mg/dl) and continued approximately the same level until the 45th day (244 +/- 45 mg/dl) (p < 0.05). The CER level started to increase from the first day of admission of the patients (43 +/- 12 mg/dl), reached a maximum level on the 7th day (59 +/- 12 mg/dl) and similar levels were observed until the 15th day. On the 45th day, the CER level was higher than on the first day (52 +/- 13 mg/dl) (p < 0.05). CONCLUSION: There was an association of higher iron status with increased lipid peroxidation in patients with myocardial infarction.