Retrospective Typology of Paediatric Emergency Visits in 1 Year in Sakarya, Turkey

ABSTRACT Objectives: To determine the characteristics of paediatric emergency department (PED) visits by newborn (age ≤ 28 days). Methods: Retrospective study consisted of newborns who presented to PED of Sakarya University Maternity and Pediatric Hospital during 2014. We studied the electronic data consisted of admission date, date of birth, emergency department diagnosis at discharge (International Classification of Diseases 10th revision code) and the outcome. Results: A total of 5708 neonates visited PED with an average age of 7.9 ± 5.9 days of age and prevalence of males (56.1%). The major diagnoses were jaundice, respiratory system problems, excessive crying of infant, and feeding problems of newborn and prematurity. Hospitalization was necessary for 35.9% neonates. There were 2912 neonates were between 0 and 8 days of age. The major diagnoses of this group were jaundice, excessive crying of infant, feeding problems of newborn, upper respiratory infections, and fever of newborn. Most of the neonates were discharged home from the PED (59.3%). Conclusion: Most PED visits were because of non-serious diseases, mainly insufficient briefing during discharge and limitations of primary care.

Calcitriol Reduces Albuminuria and Urinary Angiotensinogen Level in Renal Transplant Recipients.

BACKGROUND: Although nonhuman animal models have strongly suggested that vitamin D suppresses the renin-angiotensin system (RAS) and albuminuria, human data are largely lacking. The aim of this study was to examine the relationship between 25-hydroxyvitamin D [25-(OH)D] level and albuminuria and urinary angiotensinogen (UAGT) level in renal transplant recipients (RTRs). We also planned to investigate the effect of calcitriol treatment on albuminuria and UAGT level in these patients. METHODS AND RESULTS: A total of 124 nondiabetic RTRs participated in this study. UAGT level was positively correlated with the urinary albumin-creatinine ratio (UACR) in all patients (r = 0.855; P < .001). The mean UACR (P = .036) and UAGT/urinary creatinine (UCr) level (P = .02) were significantly higher in RTRs with low 25-(OH)D than in RTRs with normal 25-(OH)D level. RTRs with low 25-(OH)D level were randomized to receive either 0.25 µg/d calcitriol (n = 40) or placebo (n = 40). All of the parameters were assessed again 12 months later in both groups. The mean UACR (P = .014) and UAGT/UCr level (P = .012) were significantly lower in the calcitriol group than in the placebo group at the end of the study. CONCLUSIONS: Low 25-(OH)D status may be related to the elevation in albuminuria and UAGT, and calcitriol may have a beneficial effect on albuminuria through the inhibition of intrarenal RAS in RTRs.

Management of Chenopodium polyspermum toxicity with plasma exchange and hemodialysis.

A 45-year-old male patient was admitted to our emergency department complaining of fatigue, headache, mild confusion, nausea, and vomiting. He had had Type 2 diabetes mellitus for 10 years that was managed with insulin injections. Two days before the onset of symptoms, he had consumed the natural herb Chenopodium polyspermum to regulate his blood glucose levels. Upon examination, he was found to be experiencing tenderness in the upper left abdominal area, icteric sclera, and pallor conjunctivas. Laboratory tests revealed that he was anemic and had increased levels of indirect bilirubin, lactic dehydrogenase, and creatinine in blood. Direct and indirect Coombs tests were negative, and fragmented erythrocytes were observed in peripheral blood smears. The best supportive care was provided, and therapeutic plasma exchange (TPE) treatments were administered. TPE was performed five times and hemolytic findings improved. The patient then developed chronic renal failure and was transferred to the dialysis program and discharged. In this article, we present a case with hemolytic and renal toxicity induced by the ingestion of Chenopodium polyspermum that was managed with TPE and hemodialysis.

Evaluation of oxidative and nitrosative stress in hemodialysis patients.

AIM: Oxidative/nitrosative stress has long been demonstrated in hemodialysis patients. It is associated with numerous complications such as atherosclerosis and related cardiovascular disturbances. However, the factors influencing oxidative/nitrosative status have not been characterized extensively in these patients. Therefore, the present study was designed to investigate the alteration of oxidative/nitrosative stress parameters and total antioxidant status. METHODS: Forty-one hemodialysis patients and 41 healthy subjects were enrolled in the present study. Serum myeloperoxidase, nitrotyrosine and total antioxidant capacity were determined. RESULTS: Serum myeloperoxidase and nitrotyrosine were significantly higher in the haemodialysis patients compared to the healthy subjects (P<0.05) while total antioxidant capacity was lower (P<0.01). CONCLUSION: According to the results of this study, oxidative and nitrosative stress is increased in haemodialysis patients, therefore these alterations should be considered in the treatment of these patients.

Impaired fibrinolytic and blunted nitric oxide response to phlebotomy in cigarette smoking healthy blood donors.

This study was designed to investigate the effects of smoking on endothelial function in 88 healthy blood donors: 48 smokers and 40 non-smokers. Two markers of endothelial dysfunction, plasminogen activator inhibitor-1 (PAI-1) and nitric oxide (NO) levels, were measured at baseline and after phlebotomy. It has been proposed that phlebotomy acutely activates the renin-angiotensin-aldosterone system, thereby activating endothelial activity and increasing PAI-1 and NO expression. At baseline there were no significant differences between smokers and non-smokers in terms of PAI-1 expression and NO levels. After phlebotomy, both PAI-1 and NO levels were significantly increased in both groups. The increase in PAI-1 was more pronounced in smokers and the increase in NO was more pronounced in non-smokers. These findings suggest that smoking causes endothelial dysfunction, even in healthy smokers, which may remain silent until a clinically evident disorder develops.

Brucellosis-induced immune thrombocytopenia mimicking ITP: a report of seven cases.

Brucellosis continues to be an important cause of fever in underdeveloped countries and in rural areas of developed world. It is a multisystemic disease, associated with wide variety of symptoms. A wide variety of symptoms, including haematological abnormalities, such as anaemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation and leucopoenia could be seen, all of which are more common than usually thought. In this short study, we present a relatively uncommon haematological manifestation that of isolated thrombocytopenia mimicking idiopathic thrombocytopenic purpura, which we observed in seven of 114 patients who were diagnosed with brucellosis in our hospital over a 2-year period. Having given brucellosis treatment with rifampicin and doxycycline, complete remission was achieved and thrombocyte count returned to normal in all cases.