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.

The role of endothelin-1 and endothelin receptor antagonists in allergic rhinitis inflammation: ovalbumin-induced rat model.

OBJECTIVE: Desloratadine is a biologically active metabolite of loratadine which is indicated for the treatment of allergic rhinitis. Bosentan is a dual endothelin receptor antagonist used to treatment of pulmonary artery hypertension (PAH). In this study, we aimed to determine the role of endothelins in allergic rhinitis (AR) and the effects of endothelin receptor antagonists in AR rat models through comparison with desloratadine. METHODS: In total, 20 adult Sprague-Dawley rats were used in this study. An ovalbumin-induced allergic rhinitis model was formed in three study groups except for the control group. Bosentan (100 mg/kg/day) was given to the bosentan-treated group for 7 days and desloratadine (10 mg/kg/day) was administered to the antihistaminic-treated group for 7 days. Nasal symptom scorings and histopathological examinations of the nasal tissues were carried out. Serum IgE levels and ET-1 and TNF-alpha mRNA expression levels were analysed. Between group comparisons for nasal symptoms, histopathological analysis, and molecular analyses were performed with a one-way ANOVA and Duncans multiple comparison tests. Significance was accepted at p smaller than 0.05. RESULTS: Bosentan inhibited nasal symptom more significantly than desloratadine. The IgE level, ET-1 and TNF-alpha mRNA expression levels statistically increased in the allergic rhinitis group when compared to other groups. Conversely, the bosentan-treatment group showed a significant recovery from the same parameters. The deterioration in histopathological parameters reached the highest levels in the allergic rhinitis group. The histopathological findings were close to those of the control group in the bosentan and antihistaminic-treated group. CONCLUSIONS: ET-1 is one of the mediators that impact AR development and ET-1 antagonists can be useful for symptom control and for decreasing allergic inflammation in AR patients.

Giant cervical myoma associated with urinary incontinence and hydroureteronephrosis.

Cervical leiomyomas compromise fewer than 5% of all uterine leiomyomas. Cervical myomas exacerbates surgical difficulties, such as poor operative field, difficult suture repairs, and blood loss. When performing myomectomy for cervical myomas, care must be taken to avoid injuries to neighboring structures in the pelvic cavity.These structures include the bladder in front of the cervix, the rectum behind the cervix, and the uterine arteries and ureters on both sides. Myomectomy for cervical myoma is empirically difficult and frequently problematic. The authors report a case of giant cervical myoma presenting with urinary incontinence.

The lung endothelin system: a potent therapeutic target with bosentan for the amelioration of lung alterations in a rat model of diabetes mellitus.

PURPOSE: The aim of this study is to show the effect of a new mechanism on endothelin (ET) receptors in the physiopathology of diabetes-related pulmonary injury. We tested the hypothesis that dual ET-1 receptor antagonism via bosentan can reverse diabetes-induced lung injury. METHODS: The rats (24 male) were separated into four groups: group 1 (HEALTHY): Control group; group 2 (DM): Streptozotocin 60 mg/kg (i.p.); group 3 (DM + BOS-1): Diabetes + bosentan 50 mg/kg per-os; group 4 (DM + BOS-2): Diabetes + bosentan 100 mg/kg per-os. The bosentan treatment was initiated immediately after the onset of STZ-induced diabetes and continued for 6 weeks. RESULTS: In the treatment group, SOD activity was significantly increased, although GSH and MDA levels and TNF-α and TGF-ß gene expression were decreased. Bosentan 50 mg/kg and bosentan 100 mg/kg showed a significantly down-regulatory effect on ET-1, ET-A, and ET-B mRNA expression. CONCLUSIONS: In conclusion, increased endothelin levels in the lung associated with diabetes may be one cause of endothelial dysfunction, cytokine increase, and oxidant/antioxidant imbalance in the pathogenesis of complications that may develop during diabetes. With its multiple effects, bosentan therapy may be an effective option against complications that may develop in association with diabetes.

Palliative stoma creation: comparison of laparoscopic vs conventional procedures.

BACKGROUND: The creation of a stoma is an established therapeutic concept for the palliation of non-resectable rectal carcinomas and advanced tumours infiltrating the pelvis. MATERIALS AND METHODS: In two prospective country-wide multicentre studies, each conducted over a similar period of time, the peri-operative course and postoperative short-term outcomes of laparoscopic vs laparotomy-based stoma construction were compared. RESULTS: A total of 90 patients underwent palliative laparoscopic construction; 550 patients received a stoma via a laparotomy. The intra-operative complication rate was lower after open surgery than after laparoscopic surgery (2.7 vs 5.6%; p = 0.15), although the difference was not significant. With regard to general (30.9 vs 15.6%; p = 0.003) and also specific postoperative complications (13.8 vs 5.6%; p = 0.029), however, a significant advantage of the laparoscopic approach was seen. Furthermore, mortality in the laparoscopic group was also significantly lower (4.4 vs 14.0%; p = 0.011). CONCLUSION: Palliative stoma done via laparoscopy had significantly better outcomes in terms of postoperative morbidity and mortality in comparison with the open surgical procedure.

Effects of postpartum uterine curettage on maternal well-being in severe preeclamptic patients.

PURPOSE: We assessed the effect of postpartum uterine curettage on maternal recovery time in severe preeclamptic patients. METHOD: Fifty-six pregnant women with the diagnosis of severe preeclampsia in their third trimester were enrolled in the study. Uterine curettage was performed in the early postpartum period on 31 randomly selected patients and curettage was not performed in the remaining 25 patients. Prepartum mean arterial pressure (MAP) values, quantitative platelet counts, presence of proteinuria tested semiquantatitively, lactic dehydrogenase (LDH), aspartate transferase (AST), alanine transferase (ALT), and uric acid levels were determined. FINDINGS: In the group that underwent curettage, we observed a faster drop in the mean arterial pressures monitored at two-hour intervals, especially after the sixth postpartum hour (p < 0.05). Average urine output recorded at four-hour intervals in the postpartum period was significantly higher in the curettage group compared to the non-curettage group (p < 0.05). The difference in the platelet counts of both groups was not significant at the 12th postpartum hour, however, at 24 hours, platelet counts in the curettage group were higher. In the postpartum period at the 12th and 24th hours there was no difference between the two groups with regard to LDH, AST, and ALT values (p > 0.05). RESULTS: In our study we have observed that uterine curettage performed in the postpartum period had favorable effects on blood pressure, platelet count, and urinary output and also helped in faster recovery from severe preeclampsia. We, therefore, consider that postpartum uterine curettage is useful for patients with severe preeclampsia that require faster recovery.

Intrathecal epinephrine in combined spinal-epidural analgesia for labor: dose-response relationship for epinephrine added to a local anesthetic-opioid combination.

BACKGROUND: The purpose was to investigate the dose-response relationship for intrathecally administered epinephrine added to a local anesthetic-opioid combination in combined spinal-epidural analgesia for labor, in order to evaluate analgesia and side-effects. PATIENTS AND METHODS: The subjects were 100 consecutive ASA I or II parturients at 37 weeks' gestation, who received combined spinal-epidural analgesia during labor. Each woman was randomly assigned to one of five groups that received 2-mL volumes of different spinal solutions. The control group received an intrathecal injection of bupivacaine 2.5 mg and fentanyl 25 microg only. The others received epinephrine 12.5, 25, 50 or 100 microg added to this intrathecal regimen. Maternal arterial pressure, heart rate and pain scores were recorded before and 5, 10, 15 and 30 min after intrathecal injection. Level of sensory blockade, motor blockade score, duration of intrathecal analgesia, side effects, fetal heart rate, and 1- and 5-min Apgar scores were also assessed. RESULTS: Compared to the control group, all four epinephrine groups had significantly longer duration of intrathecal analgesia, but the durations were similar. The frequencies of side effects were similar in all five groups. CONCLUSION: The results suggest that adding epinephrine to a combination of standard intrathecal doses of bupivacaine and fentanyl in combined spinal-epidural analgesia for labor significantly prolongs spinal analgesia. Of the four epinephrine doses tested, the lowest one (12.5 microg) was optimal for this clinical setting.

Evaluation and importance of asymptomatic bacteriuria in pregnancy.

OBJECTIVES: This study was undertaken to determine the incidence of asymptomatic bacteriuria (ASB) during pregnancy and its prevalance in the three trimesters. SUBJECTS AND METHODS: One hundred and ten pregnant women in their first trimester attending the antenatal outpatient clinic with no urinary tract complaints were included in the study. After perineal cleaning, urine samples were obtained from all patients for culture and microscopic evaluation. Approximately 1 ml urine was sampled using the mid-stream catch technique. Patients with bacterial counts over 100,000 with the mid-stream catch technique were considered to have asymptomatic bacteriuria. Patients fulfilling the criteria for bacteriuria were treated with either penicillin or cephalosporine for one week, depending on the in-vitro sensitivity test results. RESULTS: ASB rate in the study group was 8.1%. E. coli was isolated as the pathogenic organism in 77.77% of the cases with ASB. ASB was found to be more frequent in patients over age 25 and the average age of pregnant women with ASB was 29.89 +/- 5.80 (p < 0.05). Average duration of gestation in the group with ASB was 28.11 +/- 2.26 weeks. ASB rate in the group age 35 and over was 22.22% (p < 0.05). ASB was diagnosed in nine patients; one of these patients was in the first trimester, two were in the second trimester, and six in the third trimester. Clustering in the third trimester was found to be statistically significant (p < 0.05). CONCLUSION: ASB distribution in the first, second, and third trimesters was 0.9%, 1.83%, and 5.6%, respectively. There was a significant relationship between advanced maternal age and incidence of ASB. Women with no bacteriuria in their initial examination in the first trimester developed bacteriuria in the later trimesters. We, therefore, suggest that it would be prudent to screen pregnant women for bacteriuria in the second and third trimesters.

Food-borne botulism cases in Van region in eastern Turkey: importance of electromyography in the diagnosis.

OBJECTIVES: Food-borne botulism is an acute form of poisoning that results from ingestion of a toxin produced by Clostridium botulinum. Botulism toxin causes its major effect by blocking neuromuscular transmission in autonomic and motor nerve terminals. METHODS: In this study, we present the features of eleven cases of food-borne botulism admitted to our hospital in 2001. All of the cases were caused by home-prepared foods; green beans. In these cases, the main symptoms and signs were generalized muscular weakness, dry mouth, dysphagia, disponea and diplopia. Electrophysiological studies were performed on four patients. RESULTS: Motor conduction studies showed that compound muscle action potentials were decreased with normal latencies and conduction velocities. The needle electromyography showed signs of denervation potentials like fibrillation and positive waves in four patients. Repetitive nerve stimulation with high frequency (20 Hz) induced an increment close to 100% in the amplitudes in 2 of 4 patients. CONCLUSION: Although toxin could not be detected in the patients, the electromyographic findings supported our diagnosis. We concluded that electromyography has an important role in diagnosis of botulism, especially in the condition that serologic tests are negative or cannot be performed.