Ultrasonographic Confirmation of Endotracheal Tube Position in Neonates.

OBJECTIVE: To compare endotracheal tube tip-to-carina distance obtained by ultrasonography vs. that obtained by chest X-ray in neonates. METHODS: After endotracheal intubation of 40 neonates, chest X-ray and, within one hour, ultrasonography was obtained for each patient for measurement of endotracheal tube tip-to-carina distance. RESULTS: Means of endotracheal tube tip-to-carina distances were not significantly different by both modalities (mean difference 0.157 cm, P= 0.06). In addition, an intraclass correlation was observed between them (r2= 0.61, 95% CI= 0.26, 0.79). CONCLUSION: Ultrasonography and chest X-ray are equally accurate for determination of endotracheal tube tip-to-carina in infants. As ultrasonography is more easily available and is safer than X-ray, it may be a better modality for confirming proper placement of endotracheal tube in neonates.

Tacrolimus related hypertrophic cardiomyopathy in liver transplant recipients.

BACKGROUND: Recently there are a number of reports on the cardiotoxicity of tacrolimus in post-transplant patients. There is no protocol for cardiovascular evaluation in these patients. This study was performed to evaluate the cardiotoxicity of tacrolimus in liver transplant recipients. METHODS: We evaluated 63 post-liver transplant patients who received tacrolimus. They were evaluated for cardiovascular complications by physical examination, electrocardiographic and echocardiographic examinations within three and six months following liver transplantation. Serum tacrolimus levels were checked by ELISA. For comparison, we selected 50 post-liver transplant patients who received no tacrolimus and evaluated them for cardiovascular function identically. RESULTS: Among 63 patients, 42 were male (66.7%) and 21 were female (33.3%); 70% of the patients were adults, and 19 (30%) were within the pediatric age group. The cardiovascular examinations, electrocardiogram and echocardiography of all patients three months post-transplantation were normal except for two children who developed tacrolimus related cardiac complications. Both had high serum tacrolimus levels. No adults developed cardiovascular complications. In the control group, the results of the cardiovascular evaluations were normal in all cases. CONCLUSION: The cardiovascular toxicity of tacrolimus, such as hypertrophic cardiomyopathy, may be observed in pediatric patients. Therefore, we recommend routine regular cardiovascular evaluation of children after liver transplantation.

Does the history before blood transfusion identify donors who are glucose-6-phosphate dehydrogenase (G-6-PD) deficient?

The incidence of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in Iran is around 10-14.9%. G-6-PD deficiency is an X-linked recessive disorder that is more prevalent in males. In our area, 80% of blood donors are males. At present, pre-donation data are relied on for detecting diseases in Shiraz blood banks and the donors' blood is not routinely screened for G-6-PD deficiency. Transfusion of such blood may induce hemolysis in recipients, especially in premature neonates and in neonates having exchange transfusion. Four hundred and fifty blood bags in a blood bank of Shiraz from male donors were enrolled in this cross-sectional study. The blood samples were tested with fluorescent spot test for G-6-PD deficiency. G-6-PD-deficient donors were identified, and if they agreed, were asked to participate in the study. Each volunteer filled out a questionnaire. From 450 blood bags, 27 bags were G-6-PD deficient (6%). Only 19 donors could be traced who volunteered to participate in the study. Two donors (10%) had positive past history of hemolysis. Ten donors (52.6%) had positive family history of hemolysis (red urine and jaundice) when exposed to fava beans, mothballs, aspirin or other drugs. Nine donors had a male member in the family with hemolysis and one had a female relative with hemolysis. Five donors (26.3%) had positive history of neonatal jaundice. According to this study, 52% of donors had a positive family history of hemolysis, but only 10% had positive history of hemolysis themselves; therefore, addition of past history and family history of hemolysis has a good predictive value in detection of the G-6-PD-deficient donors.