Intravenous immunoglobulin in hemolytic disease of the newborn: A moving target in time.

Background: Alloimmune hemolytic disease of the newborn (AIHDN) results in hemolysis, anemia, hyperbilirubinemia with the potential for brain damage. Intravenous immunoglobulin (IVIG) has been investigated as an alternative low-risk procedure for the treatment of AIHDN in addition to traditional treatment methods such as phototherapy and exchange transfusion (ET). Aim: To evaluate the effectiveness of IVIG therapy in decreasing ET needs based on risk factors and clinical outcomes. Materials and Methods: Charts of neonates born >30 weeks of gestation who underwent phototherapy and were administered IVIG therapy due to AIHDN between January 2013 and July 2018 were retrospectively reviewed. Results: Sixty-three neonates were included in our study. Forty-three of them (68.3) % were full-term infants. ABO incompatibility (n = 33, 52.4%) was the major cause of AIHDN (n = 63). Additional risk factors for jaundice were found to coexist in 95.2% (n = 60) of the infants. Fifteen infants (23.8%) required ET, mostly due to Rh incompatibility (n = 11, 73.3%). Mortality was observed in 3.2% (n = 2) of the patients, 1.6% (n = 1) of whom were related to ET. Serum albumin value was found to be negatively correlated with the requirement for ET (r = 0.713, P < 0.001), whereas serum bilirubin albumin ratio was positively correlated (r = 0.489, _P < 0.001). Nine (14.3%) infants needed a simple transfusion during the hospitalization period, whereas five (7.9%) infants had readmission for simple transfusion after discharge. Apnea was the only complication seen in one (1.6%) patient. Conclusion: IVIG treatment should be considered due to its relative benefits when compared to exchange transfusion. In addition to its safety, it is a less complicated treatment modality with low side effect rates. It may be justified for elective use in neonates suffering from AIHDN, who will require ET with a risk of mortality by decreasing the peak of total serum bilirubin levels.

Effect of a galactagogue herbal tea on breast milk production and prolactin secretion by mothers of preterm babies.

BACKGROUND AND OBJECTIVES: Poor breast milk production is the most frequent cause of breastfeeding failure in preterm babies. The aim of our study is to evaluate the effect of herbal tea mixture containing stinging nettle (Natal, Hipp) on breast milk production and serum prolactin levels of mothers, and weight gain of preterm babies. MATERIALS AND METHODS: We enrolled mothers and their babies who were less than 37 gestational week and less than 2000 g, fed with orogastric tube without any contraindication of enteral feeding in neonatal intensive care unit between November 2010 and June 2011. The mothers of treatment group (n = 32) were consuming commercially available herbal mixture tea for 1 week. The mothers control group (n = 21) received only the same advice on supportive measures as group I. Mothers in the placebo group (n = 32) were given fruit tea for 1 week. The daily breast milk production of mothers and weight gain of preterm babies were recorded. Also, serum prolactin levels of the mothers were measured. RESULTS: Increase of the milk production from the first to the seventh day was more prominent in mothers using herbal tea mixture. Increased rate in the amount of milk was 80% in the treatment, 34.3% in the placebo and 30% in the control group (P = 0.000). There was no statistically significant difference in weight gain of babies between the two groups, due to formula feeding in case of insufficient breast milk. Serum prolactin levels of the mothers at the beginning and on the seventh day showed no significant difference. CONCLUSIONS: In mothers with premature babies and who are treated in neonatal intensive care unit, consumption of galactogogue herbal tea will increase lactation and prevent lack of human milk without any adverse effect.

Association between the oxidative status, Vitamin D levels and respiratory function in asthmatic children.

AIM: We studied the relationship between plasma concentrations of oxidative system markers, vitamin D, and respiratory functions in children with asthma. MATERIALS AND METHODS: Ninety one children aged 6-17 years with stable asthma seen in the clinic had the serum concentrations of oxidative system markers [total antioxidant capacity (TAC), total oxidative status (TOS), paraoxonase-1 activity (PON-1), and 25-hydroxyvitamin D3] and respiratory functions were measured. RESULTS: There was no statistical correlation between TAC and age and FEV1. There was a significant positive correlation between TAC and 25(OH)D3 (r = 0.214, P = 0.021), TAC and TOS (r = 0.218, P = 0.007), TAC and PON-1 (r = 0.230, P = 0.028), TAC and IgE (r = 0.194, P = 0.033), and inverse correlation between TAC and PEF (r = -0.208, P = 0.024). In the backward multiple regression analysis, 25(OH)D3 (t = 2.613, P = 0.011), age (t = -2.158, P = 0.034), TOS (t = 2.158, P = 0.000), and OSI index (t = -13.859 P = 0.000) maintained an independent relationship with TAC (r = 0.858, r2 = 0.737, F = 21.436, P = 0.000). CONCLUSION: Oxidative stress correlates with the serum vitamin D concentrations. Clinical trials are required to confirm that increasing serum 25OHD may improve asthma control, as measured by clinical and oxidative stress markers.

Risk factors in retained fetal lung fluid syndrome.

OBJECTIVE: Antenatal, postnatal follow-ups and laboratory findings of the cases with retained fetal lung fluid syndrome were evaluated to detect prognostic factors. STUDY DESIGN: This study was conducted at Zeynep Kamil Maternity and Children's Training and Research Hospital including infants retained fetal lung fluid syndrome. Patients were divided into 3 groups according to duration of the clinical symptoms. Cases whose clinical findings resolving within first 24 hours constituted Group 1 (n = 31), cases with clinical findings persisting between 24 and 72 hours constituted Group 2 (n = 95) and cases with symptoms persisting >72 hours constituted Group 3 (n = 10). Antenatal and postnatal clinical data and laboratory findings of the patients were evaluated retrospectively. RESULT: Pneumothorax, pulmonary hypertension, antibiotic use frequency and hospitalization periods were found to be prolonged in the patients admitted due to retained fetal lung fluid syndrome who were delivered with elective caesarean section, with low birth weight and gestational age, requiring intubation and invasive ventilation within first 12 hours, having low hemoglobin and blood chloride levels. CONCLUSIONS: Low blood chloride level can be a laboratory finding predicting whether malignant tachypnea develops or not in retained fetal lung fluid syndrome. Cut-off chloride value for malignant tachypnea can be determined with new studies which will be performed in the future.

Comparison of intermittent versus continuous vancomycin infusion for the treatment of late-onset sepsis in preterm infants.

BACKGROUND: Vancomycin a frequently used antimicrobial for the treatment of late-onset neonatal sepsis. It can be infused either intermittently or continuously, however, there is no consensus on the optimal dosing regimen. AIM: To evaluate microbiological outcomes, clinical response and adverse events of vancomycin when administered via continuos intravenous infusion. METHODS: The files of preterm infants (<34 weeks), who received either intermittent (group I, n = 41) or continuous (group II, n = 36) vancomycin infusion for the treatment of late-onset sepsis, were investigated retrospectively. Clinical and demographic features were recorded. RESULTS: Clinical improvement rates, Töllner scores and microbiological outcomes did not differ significantly between groups. At 48th hour of vancomycin infusion, 52.8% of infants achieved therapeutic concentrations of vancomycin in group II compared with 34.1% of patients in group I (p = 0.002). Thirty-nine percent of infants in group I had supratherapeutic concentrations of vancomycin at 48th hour compared with 5.6% in group II (p = 0.002). Dose adjustment rate in group I did not differ than group II (65.9% vs. 52.8% respectively, p = 0.3). However, when we subdivide group I into two according to dosing intervals, dose adjustment rates were more common in infants with a gestational age <29 weeks for whom intermittent infusion was performed in 18 hours intervals (92.9% vs 51.9% , p = 0.014). CONCLUSION: In preterm infants, continuous and intermittent infusions of vancomycin have similar clinical efficacies. Continuous infusion is well-tolerated and require less blood sampling compared to intermittent infusion especially in infants less than 29 weeks of gestational age.

Effects of two plant growth regulators, indole-3-acetic acid and ß-naphthoxyacetic acid, on genotoxicity in Drosophila SMART assay and on proliferation and viability of HEK293 cells from the perspective of carcinogenesis.

In this study, the mutagenic and recombinogenic effects of indole-3-acetic acid (IAA), a plant growth regulator naturally synthesized in plants but produced synthetically, and ß-naphthoxyacetic acid (BNOA), a synthetic plant growth regulator widely used in agricultural regions, were investigated using the somatic mutation and recombination test (SMART) in Drosophila wings. The effect of the same plant growth regulators against the proliferation and viability of a human immortalized embryonic kidney HEK293 cells which is at the early stage of carcinogenesis were also examined with MTT and trypan-blue exclusion assays. For the SMART assay, two different crosses were used: a standard and a high-bioactivation (HB) cross, involving the flare-3 and the multiple wing hairs markers. The HB cross involved flies characterized by an increased cytochrome P-450-dependent bioactivation capacity, which permits the more efficient biotransformation of promutagens and procarcinogens. In both crosses, the wings of the two types of progeny, inversion-free marker heterozygotes and balancer heterozygotes, were analyzed. The results show that IAA and BNOA are not mutagenic or recombinogenic in the wing cells of Drosophila. Furthermore, neither plant growth regulator affected the proliferation rate of HEK293 cells; however, both of them induced cell death at high concentrations.

Heavy metal monitoring of marine algae from the Turkish Coast of the Black Sea, 1998-2000.

Concentrations of Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn were determined in macroalgae samples collected from the Turkish Coast of the Black Sea. Certain algae species were chosen among the green, brown and red algae species at Sile and Sinop sampling stations from 1998 to 2000. In general, as regards the influence of the collection sites on the whole metal accumulation, Sinop is considered to be more polluted than Sile. The concentrations of the heavy metals in Cystoseira barbata algae are compared with previous studies in the same stations. The results showed that all metal levels have gradually decreased during past years. At the same time, Cd, Co, Cr, Cu, Fe, Ni and Pb levels in the present study are lower than in Bosphorus and Marmara Sea algae. However, Mn and Zn concentrations are higher than Bosphorus but lower than at Marmara. According to these findings the heavy metal pollution decreased in Turkish Coast of the Black Sea during the years investigated.

Distribution coefficients (Kd) and desorption rates of 137Cs and 241Am in Black Sea sediments.

The distribution coefficients (Kd) and desorption rates of 137Cs and 241Am radionuclides in bottom sediments at different locations in the Black Sea were studied under laboratory conditions. The Kd values were found to be 500 for 137Cs and 3800 for 241Am at the steady state and described exponential curves. Rapid uptake of the radionuclides occurred during the initial period and little accumulation happened after four days. The desorption rates for 137Cs in different bottom sediments were best described by a three-component exponential model. The desorption half-times of 137Cs ranged from 26 to 50 d at the slow components. However, the desorption rate of 241Am described one component for all sediment samples and desorption half-time was found to be 75 d. In general, the results showed that the 241Am radionuclide is more effectively transferred to bottom sediment and has longer turnover time than 137Cs under Black Sea conditions.

Heavy metals in organisms and sediments from Turkish Coast of the Black Sea, 1997-1998.

During the period 1997-1998, macroalgae, sea snail, mussel, fish and sediment samples were collected at different stations of the Turkish Black Sea coast in order to establish the concentration of selected heavy metals. Heavy metals analyzed were Cd, Co, Cr, Ni, Zn, Fe, Mn, Pb and Cu. The results showed that the Turkish Black Sea coast is facing heavy metal pollution. The metal concentrations in macroalgae, sea snail, mussel and sediment samples are very high. However, Cd, Pb and Cu concentrations in anchovy fish decreased, while Co, Fe, Zn, Cr, Mn and Ni contents had changed when compared previous data. The metal levels in macroalgae did not follow the same pattern as concentrations in sediments at the same station. On the other hand, concentrations of Cd, Co, Cr, Zn, Fe, Mn and Cu in sea snail, mussel and fish samples were related to sediment data in the examined stations.

Generic values for soil-to-plant transfer factors of radiocesium.

There is a need for soil-to-plant transfer factors of radionuclides that take into account all possible crops on all soil varieties to support dose assessment studies. Because only limited experimental data exist for worldwide soil systems, such values should necessarily have a generic character. This paper describes a generic system for 137Cs, mainly based on a reference soil-to-plant transfer factor which depends solely on soil properties such as nutrient status, exchangeable K-content, pH and moisture content. Crops are divided into crop groups, cereals serving as reference group. The transfer of other crop groups can be calculated by multiplying data for cereals by a conversion factor. Existing data present in the IUR (International Union of Radioecologists) databank and in large part the work of a FAO (Food and Agriculture Organisation)/IAEA(International Atomic Energy Agency)/IUR project on tropical systems provided the basis for the derivation of the conversion factors and reference values.

Experimental studies on the biokinetics of 134Cs and 24Am in mussels (Mytilus galloprovincialis).

The biokinetics of 134Cs and 241Am in mussel species contaminated through water pathway has been studied under laboratory conditions. At equilibrium, the concentration factors for 134Cs and 241Am in small and large mussels were 2.80 and 2.57 and 200 and 150, respectively. The concentration factor of 134Cs in soft parts of the mussels was significantly high than whole body and shell tissue. However, the concentration factors of 241Am in soft parts and shell tissue samples were found to have similar rates. The depuration kinetics of the radionuclides were described by two-component exponential models. The biological half-lives at slow components between small and large mussels did not change significant, and were found to be 46.8-46.5 and 72.2-75.3 days for 134Cs and 241Am. The depuration kinetics of 134Cs and 241Am in soft parts described a single-component exponential model and the biological half-lives were found to be 29.4 and 41.1 days, respectively.

Bioaccumulation of cesium-137 by biota in different aquatic environments.

Macroalgae, isopods and fish species were exposed to 137Cs in brackish and sea water conditions for 18 days to determine radionuclide concentration factors. The concentration factors of 137Cs in brown shrimp and polychaete species were also investigated under brackish water conditions. At equilibrium, the concentration factors in macroalgae, isopod, fish, brown shrimp and polychate samples were found to be 2.5, 33, 2, 16 and 11 at 16 degrees C in brackish water conditions, respectively. The accumulation rate in macroalgae species was influenced by temperatures between 6 degrees C and 16 degrees C. The bioaccumulation of 137Cs in isopods at low salinity regime was increased significantly. At the same time, the bioaccumulation rate in macroalgae species also showed slight increase at low salinity. On the other hand, the bioaccumulation rate of 137Cs in the fish species in sea water was higher than in brackish water.

Natural effective half-life of 137Cs in tea plants.

Contamination levels and variation of 137Cs in tea plant leaves from 1986-1992 were determined over the coast line of the Eastern Black Sea region in Turkey. The decrease of 137Cs radionuclide concentration in tea plant leaves may be described by a double exponential function with 94.8% activity lost with a Teff of 125 d and 5.2% activity lost with a Teff of 1,114 d.