Aeroallergen sensitisation patterns of children aged 5 years and younger with asthma and/or allergic rhinitis in Istanbul.

AIM OF THE STUDY: The purpose of the study was to determine the aeroallergen sensitisation patterns of children aged 5 years and younger with asthma (AS) and/or allergic rhinitis (AR) in Istanbul, Turkey. METHODS: This cross-sectional observational study was conducted between January and December 2018 in the outpatient clinic of a hospital department of pediatric allergy. Patients, who had regular outpatient controls, full clinical and laboratory records, positive skin prick test results, and were willing to participate in the study, were included. RESULTS: In total, 148 children aged 5 years or younger who had positive skin prick test results were included in the study. The male/female ratio and the mean age at onset of symptoms were 87/61 and 2.13±1.33 (0.4-4.5) years, respectively. Of the 148 patients, 63 (42.6%) had AS, 11 (7.4%) AR, and 74 (50.0%) had both AS and AR. The age of the patients, age at symptom onset, male/female ratio, number of allergen sensitivities, total IgE levels, total eosinophil levels, and skin prick test results for aeroallergens did not differ between the patients with AS, AR, and AS+AR. House dust mite (HDM) was the most common aeroallergen in patients, while the cockroach was the least common aeroallergen. The severity of asthma and control levels were not found to be associated with aeroallergen sensitisation in children. CONCLUSION: One out of every four atopic children aged 5 years or younger is sensitised to aeroallergens. The most common sensitisation is to house dust mites. Weed aeroallergen may be related to severity of asthma in children aged 5 years or younger in Istanbul. We speculate that HDM and weed allergens could be used in the diagnostic or treatment strategies for the management of asthmatic children aged 5 years or younger.

Histopathological Examination of Explanted Liver After Transplantation in Patients With Cryptogenic Cirrhosis.

OBJECTIVES: Cryptogenic cirrhosis is a common indication for liver transplantation. Diagnosis is made after exclusion of other causes of cirrhosis. In this study, the aim was to evaluate patients with cryptogenic cirrhosis after histopathological examination of explanted liver. MATERIALS AND METHODS: A retrospective histopathological chart review of 117 patients with cryptogenic cirrhosis who had liver transplantation between November 2009 and June 2014 was performed. Age, sex, operative features, survival rates, and preoperative and postoperative diagnosis were evaluated. RESULTS: During the study period, 123 liver transplantations were performed for these 117 patients. Deceased donor liver transplantations were performed in 23 (18.7%) of the cases. Retransplantations were performed in 5 patients. Median age was 48 years, and female-to-male ratio was 41:76. Hepatosteatosis were observed in 29 patients. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis were observed in 20 (12%) and 9 (7.7%) of these patients, respectively. Autoimmune hepatitis was observed in 2 patients. The definitive cause of cirrhosis was unclear in 68 (58%) of the patients. Incidental malignant and premalignant lesions were observed in 15 patients. CONCLUSIONS: Histopathological examination of the explanted liver after liver transplantation in those patients with cryptogenic cirrhosis may significantly help to diagnose the cause of cirrhosis, such as nonalcoholic steatohepatitis or autoimmune hepatitis, with using the scoring system developed by the International Autoimmune Hepatitis Workgroup. In addition, incidental malignant or premalignant lesions may be observed.

Impact of valve surgery on serum osteopontin levels in patients with mitral regurgitation.

OBJECTIVE: Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). METHODS: Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. RESULTS: Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. CONCLUSION: Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.

The evaluation of cord blood interleukin-1ß levels in normal and caesarean deliveries.

OBJECTIVE: The aim of this prospective study was to establish the cord blood interleukin 1ß (IL-1ß) levels and asphyxia enzymes in term newborns and their relationship between delivery modes. We investigated whether cord blood level of IL-1ß could be used as a reliable marker for detecting hypoxic stress and to determine the optimal cut-off level for IL-1ß. METHODS: The study was designed prospectively. Cord blood samples were obtained at the time of delivery from 75 noninfected full-term neonates for the purpose of measuring cord blood levels of IL-1ß. Women were classified into three groups according to the mode of delivery (20 vaginal delivery, 29 urgent caesarean section (with foetal distress) and 26 elective caesarean section). All cases were followed-up by hospitalization. Umbilical cord sampling was carried out for IL-1ß, umbilical artery gas parameters and other asphyxia enzymes at the time of delivery. Cord blood IL-1ß was measured by enzyme-linked immunosorbent assay. The perinatal outcomes of the cases were recorded after birth. Demographic characteristics, neonatal outcomes and laboratory findings were compared in all the three groups. RESULTS: IL-1ß levels showed statistically significant difference between groups (p < 0.01). The relationship was found between IL-1ß cord blood levels and the mode of delivery. IL-1ß levels of urgent caesarean section group were significantly higher than elective caesarean section and normal delivery group (p:0.001 and p:0.001, respectively). Normal delivery levels were significantly higher than the elective caesarean group (p:0.001). CONCLUSION: Urgent section (foetal distress) and vaginal delivery (labour) were each associated with elevated IL-1ß cord blood levels in noninfected full-term neonates, while only elective caesarean section was associated with decreased IL-1ß levels. For the evaluation of newborns at high risk for perinatal hypoxic stress, cord blood IL-1ß levels may lead the way. On the other hand, the mode of delivery may be associated with the effects on the immune system. Further investigations with larger patient groups are required to confirm our results.

An analysis of the factors affecting the transition period to professional roles for newly graduated nurses in Turkey.

BACKGROUND: For the majority of newly graduated nurses, the transition to professional roles in their lives may be stressful. Common reasons for this include feelings of insufficiency with regard to clinical skills, fears of making mistakes, increased responsibilities and insufficient guidance. AIM: To identify the factors affecting the transition period of newly graduated nurses. METHODS: This study was designed and carried out as a descriptive and a cross-sectional study of three cohorts of newly graduated students. The study was implemented at a military education and research hospital in Ankara, Turkey. The population consisted of 234 (89%) of newly graduated nurses. For evaluating data, the SPSS 15.0 program was used. The paired samples t-test and the Mann-Whitney U-test were employed to compare the participants' perceptions about the transition period based on certain variables. RESULTS: It is found that 54.7% of nurses surveyed have the intent to quit the profession. More than half of the participants stated that their expectations were met through working with a preceptor nurse (58.73%). Furthermore, almost half of the newly graduated nurses experienced and expressed disappointment in the first year of their professional lives. CONCLUSIONS: The findings indicate that newly graduated nurses experience some difficulty during this period of transition, but assistance from experienced nurses facilitates the transition period. IMPLICATIONS FOR NURSING PRACTICE AND RESEARCH: In order to increase work quality and satisfaction levels of new graduates, support programs must be initialized and their effectiveness must be evaluated regularly by clinical administrators and educators.

Right-lobe living-donor liver transplantation in adult patients with acute liver failure.

BACKGROUND: Right-lobe living-donor liver transplantation (RLDLT) is an excellent option to reduce donor shortages for adult patients with acute liver failure (ALF). The aim of this study was to evaluate the etiologies and outcomes of 30 consecutive adult patients who underwent emergency RLDLT for ALF. METHODS: Between January 2007 and September 2011, we examined data from medical records of patients with ALF who underwent RLDLT. RESULTS: Their mean age was 32.2 ± 13.05 years. The etiologies of ALF were acute hepatitis B (n = 11; 36.6%), hepatitis A (n = 4; 13.3%), drug intoxication (n = 4; 13.3%), pregnancy (n = 2; 6.7%), hepatitis B with pregnancy (n = 1; 3.3%), mushroom intoxication (n = 1; 3.3%), and unknown (n = 7; 23.3%). The mean hepatic coma grade (Model for End-Stage Liver Disease score) was 34.13 ± 8.72. The 43 (48.7%) postoperative complications were minor (grades I-II) and 44 (51.3%) were major (grades III-V). Reoperation was required in 14 of 30 (47%) recipients (grades IIIb-IVa). Deaths occurred owing to pulmonary (n = 2), cardiac (n = 1), septic (n = 2), or encephalopathic (n = 4) complications. The mean durations of intensive care unit stay and postoperative hospitalization were 3.2 ± 2.3 and 29.5 ± 23 days, respectively. The survival rate was 70%. The mean follow-up duration was 305 days (range, 1-1582). CONCLUSION: Liver transplantation is potentially the only curative modality, markedly improving the prognosis of patients with ALF. The interval between ALF onset and death is short and crucial because of the rapid, progressive multiorgan failure. Thus, RLDLT should be considered to be a life-saving procedure for adult patients with ALF, requiring quicker access to a deceased-donor liver graft and a short ischemia time.

Living donor liver transplantation for alveolar echinococcus is a difficult procedure.

Surgical resection is the best treatment for early stage alveolar echinococcosis of the liver. In the stages that are not appropriate for resection and when the case develops complications, a liver transplant can be a lifesaver. The liver transplants of alveolar echinococcosis are technically difficult because of prior operation, interventional radiological procedures, and large mass. Despite such difficulty, living donor liver transplantation can save one's life.

Liver transplantation following blunt liver trauma.

Due to developing medical technology worldwide, an increasing number of liver transplantations are performed for various indications. Liver transplantation has a limited but important role in specific life-threatening liver trauma cases, when initial therapeutic options fail to control the bleeding or when liver failure ensues. Herein we have reported a patient who required liver transplantation at 18 days after blunt liver trauma with acute liver failure. This case report suggested that liver transplantation is a potential treatment modality for a selected group of patients including pedratric cases who experience acute or subacute liver failure secondary to blunt trauma.

Living donor liver transplantation in the absence of inferior vena cava: a case report.

Because of difficulties in the supply of cadaveric organs, of living donor liver transplantations are performed in increasing numbers. Congenital hepatic fibrosis associated with fibrosis and atrophy of the inferior vena cava were present in a potential recipient of living donor liver transplantation. This case report documented living donor liver transplantation as a treatment modality for a patient with absence of the inferior vena cava due to chronic liver failure.

Urine endothelin-1 levels as a predictor of renal scarring in children with urinary tract infections.

AIMS: Endothelin-1 (ET-1) contributes to renal fibrogenesis in several manners such as increasing collagen synthesis in mesangium, decreasing extracellular matrix (ECM) degradation by mesangial cells and stimulating mesangial contraction. The aim of our study was to investigate whether urine level of ET-1 (uET-1) could represent a useful biomarker of renal scarring and if so, to determine the optimal cutoff level for uET-1 to predict a renal scar. METHODS: 44 children with renal scarring and 32 children without renal scarring were enrolled in the study. Urine ET-1 was measured by enzyme-linked immunosorbent assay. RESULTS: Mean uET-1 level was significantly higher in the scar group than in controls (2.75 ± 1.35 fmol/ml vs. 0.68 ± 0.41 fmol/ml, p = 0.001). The optimal cut-off level was 1.064 fmol/ml for uET-1 to predict renal scarring. Using this cut-off point, sensitivity and specificity were 97.73% and 93.91%, respectively. AUC was found 0.975 (95% CI 0.917 - 0.996) for uET-1. Mean urine Endothelin-1/Creatinine ratio (uET-1/Cr) was also significantly higher in the scar group than in the control group (4.04 ± 2.29 fmol/mg Cr vs. 1.09 ± 0.67 fmol/mg Cr, p = 0.0001). Using 1.67 fmol/mgCr as optimal cut-off level, sensitivity and specificity were 95.45% and 84.09%, respectively. AUC was 0.945 (95% CI 0.875 - 0.982) for uET-1/Cr. CONCLUSION: Our study suggests that both uET-1 and uET-1/Cr can be used for prediction of renal scarring in children with normal renal function. Measuring urine level of ET-1 can help us to avoid unnecessary DMSA studies if the patient's uET-1 level is found to be under the determined cut-off point.

Exertional rhabdomyolysis after influenza A (H3N2) infection in a basketball player boy.

A 14-year-old professional basketball player developed symptoms of influenza which was subsequently confirmed to be caused by influenza A (H3N2). He was given a 5-day course of oseltamivir. Two days after completing the course, he resumed basketball and developed rhabdomyolysis associated with acute renal failure and disseminated intravascular coagulation. This appears to be the first report of exercise-induced rhabdomyolysis associated with influenza A (H3N2).

[Some hematologic values of Peking ducks]. / Einige hämatologische Werte bei Peking-Enten.

This work has been done to investigate physiological values of some hematological parameters of peking ducks. For this purpose 20 healthy peking ducks have been studied. Total red (R.B.C.) and white (W.B.C.) blood cell counts by routine methods in Thoma hemocytometers after diluting with Natt-Herrick solution, packed cell volume (P.C.V. = Htc) by the microhematocrit centrifuge method, hemoglobin (Hb) by the cyanmethaemoglobin method were carried out. Blood films were stained by Pappenheim's method and the percentage of neutrophils, lymphocytes, eosinophils, basophils, and monocytes was estimated on a differential count of 200 cells. The mean values have been found as follows: R.B.C. = 3,835 x 10(6)/mm3, W.B.C. = 15.950/mm3, Hb = 12 g%, P.C.V. = 36,15%, neutrophils = 62,10%, lymphocytes = 30,95%, basophils = 5,8%, eosinophils = 0,6% [corrected], monocytes = 0,6%.

The strengths and weaknesses of Turkish bone-setters.

Twelve bone-setters and 20 clients of bone-setters were interviewed to gather information about the nature and popularity of these traditional health services. The results suggest a high degree of confidence in the bone-setter's art, though this is not always well founded.

Reflections: waiting for death--a nursing response to a family grieving for a victim of terrorism.

This article is written from the perspective of the primary care nurse in Turkey and describes the emotional states of three sisters, one of whom was a nurse, while denying and then awaiting the death of their brother. He was shot by terrorists in the frontal lobe and was in intensive care.