The role of metabolic diseases in neonatal convulsions.

OBJECTIVE: The neonatal period is the most vulnerable time for the development of seizures, particularly in the first weeks after birth. These seizures often signify serious malfunction or damage to the immature brain and constitute a neurological emergency, necessitating urgent diagnosis and management. This study was performed to identify the etiology of convulsions during the neonatal period and to determine the rate of congenital metabolic disease. PATIENTS AND METHODS: A total of 107 term and preterm infants 0-28 days old who were treated and followed-up in the neonatal intensive care unit of our hospital between January 2014 and December 2019 were analyzed retrospectively based on data obtained by scanning the hospital information system and patient files. RESULTS: The study population included 54.2% male infants, and 35.5% of infants were born by caesarean section. Birth weight was 3,016 ± 560 (1,300-4,250) g, mean length of gestation was 38 (29-41) weeks, and mean maternal age was 27.4 ± 6.1 (16-42) years. Of the infants, 26 (24.3%) were preterm and 81 (75.7%) were term deliveries. Examination of family history revealed 21 (19.6%) cases with consanguineous parents and 14 (13.1%) cases with a family history of epilepsy. Hypoxic ischemic encephalopathy was the most common etiology of the seizures (34.5%). Burst suppression was detected on amplitude integrated electroencephalography in 21 (56.7%) monitored cases. Although subtle convulsions were most common, myoclonic, clonic, tonic and unclassified convulsions were also observed. The convulsions appeared during the first week of life in 66.3% of cases and during the second week or later in 33.7%. Fourteen (13.1%) patients examined by metabolic screening due to suspected congenital metabolic disease had a different congenital metabolic diagnosis. CONCLUSIONS: Although hypoxic ischemic encephalopathy was the most common cause of neonatal convulsions in our study, congenital metabolic diseases with autosomal recessive inheritance were detected at a high rate.

The relationship between Vitamin A and Vitamin E levels and neonatal morbidities.

OBJECTIVE: In the neonatal period, diseases such as respiratory distress syndrome, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, patent ductus arteriosus hypoxic-ischemic encephalopathy, and hyperbilirubinemia are frequently seen, despite being differently affected by the gestational age. This study aims to examine the relationship between morbidities in the neonatal period and serum vitamin A and vitamin E levels. PATIENTS AND METHODS: In this prospective cohort study, patients who were treated and followed up in the Neonatal Intensive Care Unit between August 2020 and September 2021 were evaluated. RESULTS: 381 patients, 202 male (53%) and 179 female (47%), were included in the study. The mean birth weight was 2642.13±835.91 g (minimum 480 g, maximum 4285 g) and the mean gestational week was 35.3±3.8 (minimum 24 weeks, maximum 42 weeks). The weight of 332 patients (87.2%) was above 1500 g in whom there was a significant increase in respiratory distress, hypoxic-ischemic encephalopathy, and hyperbilirubinemia correlated with a decrease in the vitamin E levels (p=0.001, 0.02, and 0.001, respectively). In infants over 32 weeks of age, there was a significant increase in respiratory distress, hypoxic-ischemic encephalopathy, and hyperbilirubinemia correlated with a decrease in the vitamin E levels (p=0.001, 0.02, and 0.001, respectively). No significant relationship was found between vitamin A levels and neonatal morbidities regardless of the birth weight or gestational age. CONCLUSIONS: We believe that our study may provide convenience to pediatricians and neonatologists in terms of the relationship between vitamin A and E levels and neonatal morbidities in neonates.

Ventilator-associated pneumonia in patients using HME filters and heated humidifiers.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a clinical form of hospital-associated pneumonia, which may develop within 48 h in patients on mechanical ventilation who had no pre-existing pneumonia at the time of intubation. OBJECTIVE: The objective of this study was to compare the incidence of VAP among patients who started receiving treatment with heat and moisture exchanger (HME) filters and heated humidifiers (HHs) for mechanical ventilation. METHODS: Patients who were on the first day of intubation, did not have pre-intubation pneumonia, presented to the healthcare centre with no infections at the time of presentation, were not on antibiotic treatment for pulmonary infections and did not have evidence of infiltration with chest radiography were included in the study. Data were evaluated using Fischer's exact, Mann-Whitney's U and t tests. RESULTS: The patients in the HME filter and HHs groups had a mean age of 47.9 ± 2.2 and 44.5 ± 2.1 years, respectively. Infiltration on chest radiography was identified on day 6.33 for the patients in the HME filter group and on day 5.8 in the HHs group. Patients using HME filters and HHs did not differ significantly with regard to the day of mechanical ventilation and number of days hospitalized (p > 0.5). Comparison of the two groups with regard to presence of fever during the first 24 h, however, demonstrated higher than expected values for the patients using HHs, with a significant difference (p = 0.001). CONCLUSION: There were no significant differences between the groups on HME filters and heated humidifiers in terms of infection development; although pulmonary radiography showed delayed average days to infiltration development for subjects using HME filters.

[Laparoscopic radical prostatectomy. Experiences with 145 interventions]. / Die laparoskopische radikale Prostatektomie. Erfahrungen mit 145 Eingriffen.

Encouraged by the groups in Paris, we performed 145 laparoscopic radical prostatectomies between June 1999 and the end of November 2000. The indication for laparoscopic prostatectomy is the same as for open surgery: an organ-confined cancer. Previous abdominal surgery, transurethral resection, and/or relative adiposity are not considered to be contraindications for this laparoscopic procedure. The mean operating time was 255 min; the last 60 procedures took an average of 200 min. In no case was it necessary to convert to open surgery. Worthy of note was the low blood loss of 185 ml on average so that in 98% of the patients no blood transfusion was required. After completing the learning curve, the average indwelling catheter time was only 5.5 days. The postoperative complication rate was 11.7%, consisting mainly of minor complications. Also with regard to continence and potency, the results were representative. Postoperatively, 75%, 86%, 92%, and 93% of the patients were continent after 3, 6, 9, and 12 months, respectively. In our opinion, laparoscopic radical prostatectomy is an alternative to open prostatectomy, offering a number of advantages for the patient and surgeon as well.