A Significant Association in Paediatric Emergency Department, Cerebral Sinovenous Thrombosis and Ulcerative Colitis: Review of Literature

ABSTRACT Objective: To discuss cerebral sinovenous thrombosis (CSVT), an important mortality and morbidity factor, developing in the progression of ulcerative colitis (UC) in childhood age, in the light of the literature. Methods: A search of PubMed and Google Scholar database was conducted on April 2014. This study retrospectively investigates the cases diagnosed with UC with complication of CSVT below 18 years of age between years 1971 and 2014. The cases were analysed with respect to age, gender, disease duration and treatment, potential risk factors, clinical findings, location of thrombosis, thrombolytic therapeutical applications, and clinical progressions. Results: Twenty-four paediatric patients aged 5 and 18 years were included in the study. Cerebral sinovenous thrombosis had developed during active disease period in 23 (95.8%) patients. The most common complaints were headache (79.1%) and emesis (29.1%). The most frequently detected risk factors for CSVT were anaemia (58.3%) and thrombocytosis (45.8%). Inherited thrombotic disorders were encountered in 10 (41.6%) of the cases. The most common location sites for CSVT were the transverse (33.3%) and the sigmoid (33.3%) sinuses. It had been discovered that 19 (79.2%) of the cases were healed completely without a sequelae, whereas neurological sequelae remained in three (12.5%) of the cases and two (8.3%) of the cases died. Conclusion: In the presence of a prior diagnosis of UC and emergency presentation with emesis, headache, mood changes and particularly seizure, the presence of CSVT should certainly be considered.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85 percent; interassay variation: 3.45-8.22 percent) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH4, and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95 percent confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH4 were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.