Evaluation of cardiac arrhythmia in pediatric patients with Left Ventricular Assist Device (L-VAD).

OBJECTIVE: Pediatric heart failure is an important cause of morbidity and mortality in childhood. Left ventricular assist devices (L-VAD) are used for bridging to transplantation in patients with indications for heart transplantation. PATIENTS AND METHODS: The children included in the study were patients who underwent implantation of an L-VAD due to advanced heart failure at Ege University Faculty of Medicine Hospital between January 2009 and January 2023. RESULTS: Of the 33 patients who underwent L-VAD implantation, 16 (48.5%) were female and 17 (51.5%) were male. The median age at surgery was 13 years (IQR, 9.5-15). The median weight was 44 kg (IQR, 25.65-52), the median height was 158 cm (IQR, 134.5-168.5), and the median body surface area was 1.37 m2 (IQR, 0.95-1.51). All patients who underwent L-VAD implantation had an echocardiographic diagnosis of dilated cardiomyopathy. The patients underwent a median of 16 (IQR, 9-21) ECGs, and the median number of 24-hour Holter ECGs obtained was 3 (IQR, 2-5). Arrhythmias that occurred after L-VAD implantation were classified as atrial and ventricular. Ventricular arrhythmia included ventricular tachycardia (VT) lasting for more than 30 seconds (sustained VT), VT lasting for less than 30 seconds (nonsustained VT), and ventricular fibrillation. Atrial arrhythmias included atrial flutter, atrial fibrillation, supraventricular tachycardia, and atrial ectopic tachycardia. During the follow-up, atrial or ventricular arrhythmias were observed in 11 (33%) patients. The most common rhythm disturbances before L-VAD implantation were ventricular arrhythmias, while after the surgery, atrial arrhythmias were found to be the most frequent. A total of 5 patients underwent cardioversion (n=2) or defibrillation (n=3) due to arrhythmia. CONCLUSIONS: In patients undergoing L-VAD implantation, rhythm disorders that could normally lead to hemodynamic instability are frequently encountered. In these rhythm disorders, medical therapy should be attempted before resorting to cardioversion or defibrillation, and subsequently, more aggressive treatment methods should be considered.

The household garbage in the western coast region of Turkey and its relationship with the socio-economic characterstics.

The aim of this study is to detect the daily amount of household garbage generated from districts within the limits of municipality of Aydin, the amount and contents of recyclable materials and to evaluate the effect of socioeconomic state. In this cross sectional survey, garbage was collected for one day from all of the districts, weighed both totally and after separation into groups. The districts were assessed according to literacy, drinking water sources and toilet indexes. For each district, three indexes were calculated viz. literacy, water and sewage index. Points between 1-3 were given and by adding points of each index, socioeconomic development (SED) score was calculated for each district. The daily amount of garbage produced was 0.91 +/- 0.74 kg/person and recyclable material was 0.08 +/- 0.13 kg/person (6.4%). A significant corelation was found between SED point and amount of recyclable materials (p < 0.05). There was a positive, strong and significant correlation between workplaces in the districts and recyclable garbage (r = 0.597, p < 0.05). In further analysis, number of workplaces increased the daily amount of garbage by 9.9 times (p < 0.001; 95% confidence Interval: 4.538-15.189), whereas population 0.6 times (p < 0.05; 95% confidence interval: 0.407-0.708).

A population-based study on awareness of stroke in Turkey.

Stroke is the second most common cause of mortality and a major cause of long-term disability of adults in most countries. This study was performed to determine the level of knowledge and awareness regarding risk factors and warning signs of stroke in a selected sample. This cross-sectional study was carried out in Aydin between November and December 2005, utilizing a study sample of 920 people registered at urban health centers. The questionnaire, prepared by the investigators, was administered by 20 trained students utilizing face-to-face interviews at participants' homes. Two-thirds of the participants knew the organ effected by stroke. The participants reported that stroke was a consequence of occlusion (28.0%) or bleeding (18.0%) in brain arteries. Paralysis/weakness of one side of the body (37.1%), speech impairment (26.8%) and numbness of one side of the body (14.2%) were reported as three major stroke warning signs. Sixty-four percent of the participants knew at least one of these risk factors. Their primary sources of information were family and friends. Our study showed the great need for increasing awareness of risk factors and warning signs for stroke, perhaps utilizing community based education programs and the mass media.

Measurement of selected indoor physical environmental factors in hairdresser salons in a Turkish City.

OBJECTIVES: The purpose of this study was to determine electromagnetic fields, electric fields, humidity, temperature, and illumination levels in hairdresser salons located in the downtown area of Aydin, Turkey. Also some health problems which could be related with the occupational factors are evaluated. MATERIALS AND METHODS: The study was carried out in 30 hairdresser salons, all of which had been registered within the past 5 years. Electric and electromagnetic fields, illumination, temperature and humidity measurements were determined for hairdryers, hood hairdryers and depilatory heaters in the participating salons. A brief questionnaire about characteristics and the health status of hairdressers and workplace conditions was prepared and administered to the hairdressers at the salons. RESULTS: The mean electric fields of hairdryers, hood hairdryers and depilatory heaters were determined as 518 +/- 74, 1,123 +/- 199, and 648 +/- 146 in V/m, respectively, at 5 cm from the surface of each device. These appliances generate mean electromagnetic fields in excess of 0.25 microT at 5 cm: hand-held hairdryers, 5.0 +/- 0.7 microT; hood hairdryers, 1.6 +/- 0.3 microT; and depilatory heaters 1.9 +/- 0.6 microT. Total average of cumulative electric and electromagnetic fields, measured at a distance of 90 cm from the surface of these three devices was calculated to be 98.8 V/m and 0.5 microT, in the participating salons. CONCLUSIONS: This preliminary study suggests that physical environmental factors in the salons may be contributing to the health problems of the hairdressers, and the electrical equipment in the workplaces may have cumulative electric and electromagnetic effects.

Spontaneous corynebacterium discitis in a patient with chronic renal failure.

STUDY DESIGN: Case report describing spontaneous Corynebacterium diptheria discitis in a patient with chronic renal failure. OBJECTIVES: To describe this very rare form of discitis and the results of surgical and antibiotic therapy. SETTING: University Department of Neurosurgery, Turkey. CASE REPORT: A 55-year-old man with chronic renal failure presented with acute low-back pain. Lumbar magnetic resonance imaging (MRI) suggested discitis and osteomyelitis at the L5-S1 level. The L5-S1 disc was operated upon and the discectomy material was sent for pathological and microbiological analysis. RESULTS: Pathological examination revealed infection and bacterial culture grew C. diptheria. The patient was prescribed combination antibiotic therapy with vancomycin, a third-generation cephalosporin, and rifampicin. Clinical status improved after 8 weeks of therapy. Lumbar MRI revealed remission of the discitis and osteomyelitis after 10 months of follow-up. CONCLUSION: Chronic renal failure patients with low-back pain should be investigated for spinal infection. These individuals are prone to low-grade infection in the form of discitis or osteomyelitis. Corynebacterium subspecies rarely cause spontaneous discitis. This case is interesting because of the unusual causal organism and the occurrence of discitis in the setting of chronic renal failure.

Disseminated Nocardia asteroides and coinfection with Trichophyton rubrum in a renal transplant recipient.

Disseminated Nocardia infection has a high mortality and morbidity rate in solid organ transplant recipients, even when appropriate antibiotics are given. In this report a renal transplant recipient is described, who developed disseminated Nocardia asteroides infection with lung, eye, and brain involvement, in addition to coinfection with Trichophyton rubrum.

Acute abdomen caused by Salmonella typhimurium infection in children.

Salmonella spp. infections can be particularly challenging when they manifest as acute abdominal problems and lead to emergency surgery. Examples of such serious conditions are Salmonella-related intestinal perforation, gallbladder involvement, salpingitis, and peritonitis. Mesenteric lymphadenitis associated with Salmonella typhimurium mimics acute appendicitis and can make it difficult to establish a timely and definitive diagnosis in young patients who present with right lower abdominal pain. Paralytic ileus is a fairly common manifestation of Salmonella infection at all ages, but complete intestinal obstruction requiring surgical intervention is very rare. Because of the nature of the diagnostic process, a significant number of patients with Salmonella infection present with acute abdomen and undergo needless operations. This report describes the cases of 2 pediatric patients who underwent surgery to address persistent pain in the right lower abdominal quadrant and complete intestinal obstruction, respectively. The first patient had inflamed mesenteric lymph nodes that caused appendicitislike symptoms, and the second had dense adhesions between the mesentery and the terminal segments of the ileum that led to intestinal blockage. Serology results showed that both patients' titers for BO ("B and O agglutinating [BO]") antibodies rose to 1:640 in the week after their admission to hospital, a pattern and level that is indicative of S typhimurium infection. J Pediatr Surg 36:1849-1852.

Primary tuberculosis in the gluteal muscle of a patient with chronic renal failure. A rare presentation.

Patients suffering from chronic renal failure (CRF) are at increased risk for contracting tuberculosis (TB) due to their impaired immunity. In this patient group, extrapulmonary involvement is more common than the pulmonary form of TB, and symptoms tend to be milder and less distinctive than those seen in the general population. Pyomyositis secondary to TB is relatively rare. We report a case of TB pyomyositis in the setting of CRF. The nonspecific symptoms that are typical of CRF patients with TB make it particularly difficult to establish the diagnosis in this patient group. In order to avoid diagnostic delays, which may increase the risk of complications and mortality, TB should be kept in mind in any case of ongoing fever and infection that does not respond to seemingly appropriate therapy. In addition, TB should always be suspected in endemic areas, even in the absence of osseous involvement.