Vitamin D levels in newborns and association with neonatal hypocalcemia.

OBJECTIVE: Vitamin D has many important functions in our body. Especially in intrauterine and early infancy periods, Vitamin D plays a major role in bone development, growth, and the maturation of tissues such as lung and brain. Fetus is dependent on the mother in terms of Vitamin D and maternal Vitamin D deficiency results in a Vitamin D deficient newborn. The purpose of this study was to determine the levels of Vitamin D in newborns and to investigate the association between Vitamin D status of the baby and neonatal hypocalcemia. METHOD: Vitamin D, calcium, and parathyroid hormone levels of 750 infants, born between 1 January 2014 and 30 June 2015 and followed in Ondokuz Mayis University Neonatal Intensive Care Unit were analyzed retrospectively. Blood levels of Vitamin D were checked within 3 days after birth. A 25(OH)D3 level of <10 ng/ml indicated severe, levels between 10 and 20 ng/ml, which indicated moderate and levels between 20 and 30 ng/ml indicated mild Vitamin D deficiency. Serum calcium levels below 8 mg/dl in term infants and below 7 mg/dl in preterm infants were accepted as hypocalcemia. Hypocalcemia that developed within the first week after birth was defined as early, while hypocalcemia after one week were defined as late hypocalcemia. RESULTS: A total of 44% of the infants in the study were girls, while 56% were boys; 38% were term and 62% were preterm. Average 25(OH)D3 level of all infants was 11.4 ± 10.2 (0-153) ng/ml. Only 30 (4%) infants had normal (>30 ng/ml) 25(OH)D3 levels; 68 (9%) had mild, 234 (31%) had moderate and 418 (56%) had severe vitamin D deficiency. No correlation was found between Vitamin D levels and gender, mother's age, gestational week or birth weight. In 79 (17.2%) preterms, neonatal hypocalcemia was observed. Vitamin D levels of the premature infants who had early neonatal hypocalcemia were statistically significantly lower when compared with those who did not have early neonatal hypocalcemia (p = .02). No significant difference was found between the Vitamin D levels of the term infants who had early neonatal hypocalcemia and those who did not (p= .29). No significant difference was found between the Vitamin D levels of the infants who had late neonatal hypocalcemia and those who did not (in preterm p = .27; in term p = .29). CONCLUSIONS: Although lack of Vitamin D is preventable and curable, it is an important health problem for newborns in Turkey. In our study, 56% of the infants were found to have severe lack of Vitamin D and lack of Vitamin D was found to be associated with early neonatal hypocalcemia in preterm newborns. However, long-term effects of lack of Vitamin D in infancy are not fully known. In order to be able to prevent neonatal Vitamin D deficiency, 1200 IU/day vitamin D was supplemented to mothers from the 12th gestational week to 6th month of the birth, which was put into effect by the Ministry of Health in 2011, and should be applied by all health workers.

Evaluation of Postoperative Anti-nociceptive Efficacy of Intrathecal Dexketoprofen in Rats.

BACKGROUND: Some studies have suggested that the intrathecal use of cyclooxygenase enzyme inhibitors provides an anti-nociceptive effect. Therefore, the occurrence of side effects seen in systemic usage can be eliminated. AIMS: The primary objective of this experimental, randomized, controlled trial was to test the hypothesis asserting that intrathecal dexketoprofen trometamol would demonstrate an analgesic effect during postoperative period. STUDY DESIGN: Animal experimentation. METHODS: Forty rats were randomized into 4 groups 7 days after intrathecal catheterization; the following drugs were given through catheter lumens: Group Lidocaine (Group L): Lidocaine 20 µg; Group Lidocaine-Morphine (Group LM): Lidocaine 20 µg and morphine 0.5 µgr; Group Lidocaine-Dexketoprofen (Group LD): Lidocaine 20 µg and dexketoprofen trometamol 100 µg; and Group Dexketoprofen (Group D): Dexketoprofen trometamol 100 µg. Paw incision was achieved under ether inhalation. To measure analgesic potential, hot plate and tail immersion tests were used as nociceptive tests during the postoperative period. RESULTS: The mean reaction times detected in groups during hot plate and tail immersion tests were shortest in Group L at 15, 30, 45, 60, 75, 90, 105, and 120 minutes after start of surgery (p<0.01, all others). In the groups using dexketoprofen, as in the morphine group, longer reaction times were detected than in the lidocaine group at all measurement times except 120 minutes (p<0.01). CONCLUSION: Intrathecal dexketoprofen in the optimal perioperative pain management is effective, and can be administered as an adjuvant in clinics after neurotoxicity studies in animals, and effective dose studies in volunteers.

Assessment of different folic acid supplementation doses for low-birth-weight infants.

AIM: The adequacy of 50 mcg folic acid supplementation given to low-birth-weight babies was investigated. The folate levels of the mothers and infants, and breastmilk, and the optimum dose for folic acid supplementation were also investigated. MATERIAL AND METHODS: After obtaining blood from 141 low-birth-weight infants on the 1st day of life for serum and red cell folate levels, the infants were randomly allocated into three groups according to the folic acid supplement dose. Forty-six infants were given 25 µg/d folic acid, 39 were given 50 µg/d folic acid, and 44 were given 75 µg/d folic acid. Folic acid could not be given to 12 infants. Follow-up blood samples were obtained at the end of folic acid supplementation. Maternal samples for red cell and serum folate levels and breast milk folate levels were obtained within the first 48 hours and the samples for measuring breastmilk folate level were obtained on the 3rd day postnatally. The feeding modes of the infants, maternal folic acid intake, and details of neonate intensive care unit course were recorded. RESULTS: The mean birth weight and gestational age of the infants were found as 1788.2±478.4 g and 33.5±2.9 weeks, respectively. The mean serum and red cell folate levels on admission were found as 21.2±12.2 ng/mL and 922.7±460.7 ng/mL, respectively. The mean maternal serum and red cell folate levels and the mean breast milk folate levels were found as 12.3±7.5 ng/mL, 845.5±301.4 ng/mL, and 30.6±33.0 ng/m, respectively. The breast milk folate levels of mothers who were supplemented with folic acid during pregnancy were significantly higher compared with mothers who were not supplemented with folic acid (p<0.001). Infants who were supplemented with folic acid had higher follow-up serum folate levels compared with the basal level in all groups, but there was no statistically significant difference between the groups. CONCLUSION: This study showed that the folic acid doses of 25, 50, and 75 µcg/d affected serum folate levels similarly. We can conclude that the dose of 25 µcg/d is adequate for low-birth-weight infants.

[Effect of intravenous dexketoprofen use on postoperative analgesic consumption in patients with lumbar disc surgery]. / Lomber disk cerrahisi uygulanan olgularda intravenöz deksketoprofen kullaniminin ameliyat sonrasi analjezik tüketimine etkisi.

OBJECTIVES: The objective of this study was to evaluate the postoperative analgesic effect of a preemptive, single-dose intravenous dexketoprofen administration in patients undergoing lumbar microdiscectomy. METHODS: A total of 50 ASA I-II patients candidate to laminectomy were included in this study. They were divided in two groups. Patients in Group A were given 50 mg (2 mL) dexketoprofen and those in Group K 2 mL normal saline intravenously by a blinded anesthesia physician, 10 minutes before the start of intervention. All cases underwent general anesthesia. All patients received postoperative patient-controlled analgesia with tramadol. The VAS scores 1, 4, 8, 16 and 24 hours following the operation, sedation and patient satisfaction scores and tramadol consumption were evaluated. RESULTS: VAS scores recorded during the first 8 postoperative hours and total tramadol amounts were lower, and the patient satisfaction scores higher, in patients given dexketoprofen than control group. Sedation scores and side effects were similar in both groups. CONCLUSION: Single-dose preemptive intravenous dexketoprofen provides effective analgesia especially in the first 8 postoperative hours, reducing tramadol use.

Comparison of LMA CTrach and Video Laryngoscope in Endotracheal Intubation.

OBJECTIVE: In this study, our objective was to compare the Cormack and Lehane (C-L) sight scores of direct laryngoscopy in endotracheal intubation with the endoscopic sight scores of the LMA CTrach and video laryngoscope. We also compared the success of endoscopy with the LMA CTrach and video laryngoscopy, intubation time, and its effects on haemodynamic and stress responses. METHODS: The study included 100 patients, with American Society of Anesthesiologists (ASA) scores I-III and aged 18-65, who will undergo elective surgery. Patients were randomly divided into two groups: Group C and Group V. The patients in both groups underwent direct laryngoscopy with a Macintosh laryngoscope, and their C-L scores were recorded. In Group C, the patients were intubated with the LMA CTrach, and in Group V, the patients were intubated with a video laryngoscope. Patients' haemodynamic parameters, oxygen saturation, end-tidal carbondioxide, and endoscopic sight scores were recorded. RESULTS: The demographic characteristics and the ASA classifications of the groups were similar. When endoscopic sight scores were compared with C-L, better sight was obtained in the LMA CTrach group; no significant difference was detected in Group V. Regarding the success of the intubation, no significant difference was detected between groups. However, when intubation times were compared, there was a significant difference between groups. The intubation time was longer in Group C. There was no difference between groups in terms of the percentage changes of haemodynamic parameters, oxygen saturation, and end-tidal carbondioxide values of the patients. CONCLUSION: In this study, when endoscopic sight scores were compared, better visualization was obtained in the LMA CTrach group. Therefore, in cases where intubation is difficult to apply in patients, the LMA CTrach can be an alternative application.

Neonatal morbidity and mortality of late-preterm babies.

OBJECTIVE: To analyze neonatal morbidity and mortality rates of late-preterms and to compare them with their term counterparts in a tertiary care unit in Turkey. STUDY DESIGN: The study included 252 late-preterm newborns (34 0/7--36 6/7 weeks' gestational age), admitted to Neonatal Intensive Care Unit in the first 24 h of life between January 2005 and June 2007 and 252 newborns born in the same hospital in the same period of time. Babies with major congenital and/or chromosomal abnormalities were excluded. RESULTS: The mortality rate was 2.3% in late-preterms. None of the term newborns died. Compared to terms, late-preterms were 11 times more likely to develop respiratory distress, 14 times more likely to have feeding problems, 11 times more likely to exhibit hypoglycemia, 3 times more likely to be readmitted and 2.5 times more likely to be rehospitalized. Late-prematurity, being large for gestational age, male gender, and cesarean delivery were significant risk factors for respiratory distress. CONCLUSION: Late-preterms have significantly higher risk of morbidity and mortality compared with term newborns. Greater concern and attention is required for the care of this ignored, at-risk population.

Violence towards workers in hospital emergency services and in emergency medical care units in Samsun: an epidemiological study.

BACKGROUND: The aim of this study was to determine the frequency of exposure to some form of violence during the previous 12 months and the State-Trait Anxiety levels of emergency medical care (EMC) and emergency service (ES) workers in Samsun. METHODS: A cross-sectional study was conducted in all EMC (5) units and ES (4) in Samsun, between April 1 and April 30, 2004. A self-administered questionnaire was sent to all of the workers (n=320). RESULTS: Of the workers, 280 (87.5%) completed the survey. A total of 202 (72.1%) participants reported that they had witnessed some form of violence. ES workers (75.9%) were more often exposed to violence than EMC workers (62.3%) (c2=5.08, p<0.05). The multivariate analysis demonstrated that age, gender and anxiety regarding repetition of exposure to violence were related with higher state anxiety point, while anxiety regarding repetition of exposure to violence was related with higher trait anxiety point. CONCLUSION: This evidence clearly indicates that violence in ES and EMC units is a common concern. The necessary framework for the reduction and elimination of violence in the workplace should be provided.

Emergency service use by older people in Samsun, Turkey.

During the first 50 years of the 21st century, the world population aged 65 and older is expected to triple. Proper care of the older patient is one of the major priorities of many health care systems. In this descriptive study, patients treated and transported by 112 Emergency Help and Rescue Service in Samsun Province during the year 2004 were surveyed through review of command center records. All patients who were 65 years of age and older were included in the study. Collected data included patient sex and age, number of patients accessing emergency medical service (EMS) per hours of the day and per season, clinical diagnosis, and patient outcomes. In all, 2210 patients aged 65 years and older were identified; this group accounted for 24.5% of all records reviewed (n=9015). The rate of EMS use was highest in those older than 65 years of age (26 of 1000/y). Similar associations of ambulance transportation with older age and off-hour presentation were noted, as was increased usage during colder months of the year. Cardiovascular, neurologic, and respiratory problems were the 3 most frequent reasons for use of EMS. In almost three fourths of cases, outcome was recorded as transport to the hospital. Data presented here highlight the need for continued monitoring of EMS usage patterns so that planners will be prepared to accommodate the needs of the increasingly aging population.