Analytical performance evaluation of sensitive and old generation reagent in routine practical use: estradiol experience.

Evaluation of the analytical performance of tests in medical laboratories is important. Total Error (TE) and sigma analysis have been used as a quantitative indicator of quality for many years. The aim of this study is to evaluate the analytical performance of Beckman Coulter Access Estradiol (E2) and Sensitive E2 reagents. Analytical performance of two reagents were evaluated with TE, six sigma and measurement uncertainty values. Two Beckman Coulter Unicel DxI-800 autoanalyzers (A1 and A2) included in the study. Quality control data between December 2017 and December 2019 were used. CLIA-2019 values were used for total allowable error (TEa) limits. Uncertainty values were calculated with ISO/TS 20914. The median TE of the old generation and sensitive E2 reagent were 27.46% (between 13.49 and 48.88) and 11.16% (between 7.08 and 24.81), respectively (p < .005) The process sigma results were below 3 sigma in all months with the old reagent, whereas with the new reagents it was seen to be above 3 sigma in 11 of 12 months for both autoanalyzers. Uncertainty of old reagent is higher than new reagent. Imprecisions decrease as concentration increases with both reagents. The uncertainty values of low concentration levels are greater than high concentration levels. In conclusion, in both auto analyzers, Sensitive E2 reagent was found to have better performance than old reagent in terms of TE, process sigma and measurement uncertainty. We believe that the sensitive E2 reagent still needs further improvement for patients who have low E2 levels.

The role of maternal serum catestatin in the evaluation of preeclampsia and fetal cardiac functions

Objective: To compare the maternal serum catestatin (CST) levels in pregnant women with preeclampsia (PE) and with normal blood pressure and evaluate the relationship between the maternal serum CST levels and fetal cardiac functions. Materials and Methods: This cross-sectional study was conducted on 27 women with early-onset PE (EOPE), 28 women with late-onset PE (LOPE), and 28 healthy pregnant women. Maternal serum CST levels were measured using the enzyme-linked immunosorbent assay kits. Fetal cardiac functions were evaluated using the cardiac Doppler. Results: Maternal serum CST levels were lower in the EOPE group; however, no statistically significant difference was found between the groups. Compared with the other two groups, a statistically significant difference was found in the fetal E/A ratio and myocardial performance index (MPI) values of the EOPE group (p=0.013, p=0.002, p=0.005, p<0.001, respectively). The fetal E/A ratio was positively correlated with the maternal serum CST levels in both the PE and control groups (p<0.001, p<0.001). The fetal isovolumetric relaxation time and MPI values were negatively correlated with maternal serum CST levels in both the PE and control groups (p<0.001, p=0.001, p<0.001, and p=0.002, respectively). Conclusion: Lower CST levels are associated with fetal cardiovascular dysfunction, thus CST can be a critical biochemical marker in fetal cardiac function evaluation.

Reference change value and measurement uncertainty in the evaluation of tumor markers.

The use of measurement uncertainty among clinical laboratories becomes widespread. Measurement uncertainty can be reported with the result, as well as be used in certain reference change value (RCV) calculation equations. RCV is especially recommended for use in tests with a low individuality index. In our study, we calculated the measurement uncertainty of AFP, CA 125, CA 15-3, CA 19-9, CEA tumor markers with the ISO TS 20914:2019. We compared results with limits. Two Beckman Coulter DXI-800 (Minnesota, USA) autoanalysers' results were used. We calculated the RCV values using the classical Fraser method, logarithmic Lund Method, and Clinical Laboratory Standards Institute (CLSI) method as Minimal Difference (MD). We found the same permissible measurement uncertainty limit as 15.97% for all five tumor markers. The highest RCV value was found as 90% upstream for AFP test with Lund logarithmic approach, the lowest RCV value was found as 12% for CEA with MD, all other RCV results were between these two values. We do not recommend the use of MD, as values for Biological variation are not used in the MD approach. We also recommend using the logarithmic approach, although it gives higher results. There are also clinical studies on the significance of tumor markers in a follow-up that show different results. These differences may be because the studies are conducted with different systems. Therefore, each laboratory needs to calculate its own RCV values. We also recommend informing the clinicians about the tests with high measurement uncertainty.

Maternal serum sortilin levels in gestational diabetes mellitus.

OBJECTIVE: To evaluate the serum sortilin levels in pregnant women with gestational diabetes mellitus (GDM) and to compare the results with normoglycemic healthy pregnant women and observe the relationship between serum sortilin levels and biochemical parameters. METHODS: This case-control study consisted of 55 pregnancies with GDM and 32 healthy singleton pregnancies matched for maternal and gestational age. The maternal serum levels of sortilin were measured with enzyme-linked immunosorbent assay and compared between groups. RESULTS: Sortilin levels were significantly higher in GDM group (5.52 ± 3.19 ng/mL versus 3.30 ± 1.47 ng/mL, p < .001). Pairwise comparisons showed that both the diet group and insulin group had significantly higher serum sortilin levels than the control group (p: .022 and p: .002, respectively). Maternal serum sortilin levels were significantly positively correlated with serum insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR) and glycated hemoglobin values (r: 0.277, p: .012, r: 0.306, p: .005, r: 0.267, p: .012, respectively). CONCLUSIONS: Serum sortilin levels were significantly higher in women with GDM compared to the control group and were positively correlated with insulin, HOMA-IR and glycated hemoglobin levels. The present results point to the role of sortilin in glucose homeostasis and suggest that it may be a novel marker for GDM.

Oxidative Stress and Serum S100B Levels in Adolescents with First-Episode Drug-Naive Unipolar Depression.

BACKGROUND: Unipolar depression is common among adolescents and has high recurrence rates. Studies conducted with adults show that oxidative stress plays a role in etiology of depression but studies with adolescent patients are limited. In addition, baseline S100B level in adult patients with depression is considered as a marker of response to treatment. The purpose of this study was to measure the levels of serum S100B, Malondialdehyde (MDA), total oxidant status (TOS), and total antioxidant status (TAS), which have not been previously investigated in adolescent patients with first-episode, drug-naive unipolar depression, and to investigate the relationship of these parameters with disease severity and patient-specific variables. SUBJECTS AND METHODS: This study was conducted with 37 adolescents diagnosed with unipolar depression and 37 healthy peers. Participants were asked to fill out the Beck Depression Scale, Screen for Child Anxiety Related Disorders, and suicide probability questionnaires. After this procedure, 5 cc blood was collected from the adolescents and serum S100B, MDA, TOS, and OSI levels measured. RESULTS: Serum S100B, MDA, TOS, and OSI levels were higher and TAS level was lower in patients than their healthy peers. There was no relationship between the patients' severity of depression or suicide probability and these parameters. The serum S100B, MDA, TOS, and OSI levels of female patients were higher than their healthy peers, but the TAS level was not different. Male patients had higher TOS and OSI levels and lower TAS levels than their healthy peers. CONCLUSIONS: The results show that increased serum S100B, MDA, TOS and OSI levels may contribute to etiology of depression regardless of gender. The gender-specific increase in S100B and MDA levels, which were significantly increased in female adolescent patients but not in males, should be supported by further follow-up studies.

Hyperbaric oxygen therapy affects insulin sensitivity/resistance by increasing adiponectin, resistin, and plasminogen activator inhibitor-I in rats

Background/aim: Hyperbaric oxygen therapy (HBOT) causes insulin sensitivity, but the reason for this is not known yet. The aim of the present study was to investigate the effect of HBOT on insulin sensitivity via resistin, plasminogen activator inhibitor-I (PAI-I), and adiponectin. Materials and methods: The study was designed using HBOT and control groups, with eight rats in each group. After 20 days of HBOT under 2.5 atmospheres for 90 min, the fasting insulin (FI), resistin, PAI-I, homeostatic model assessment of insulin resistance scores (HOMA­IR), quantitative insulin sensitivity check index (QUICKI), fasting plasma glucose (FPG), triglyceride, and high-density lipoprotein cholesterol (HDL-C) in the plasma were measured. The resistin, PAI-I, and adiponectin mRNA expression levels were also measured in the adipose tissue. Results: Compared to the control group, the FI, FPG, and HOMA-IR scores were significantly lower in the HBOT group, whereas the HDL-C and QUICKI scores were found to be higher. In addition, the resistin, adiponectin, and PAI-I mRNA expression levels were also higher in the HBOT group. Conclusion: The present study demonstrated that the HBOT had regulated the FI, FPG, and HDL-C associated with metabolic syndrome and diabetes mellitus. Moreover, the study showed that HBOT causes insulin sensitivity by raising adiponectin.

Serum nesfatin-1, ghrelin, and lipid levels in adolescents with first episode drug naïve unipolar depression.

Background: Major depressive disorder (MDD) is a mental health and emotional disorder that affects children and adolescents worldwide. This study aimed to evaluate serum nesfatin-1, ghrelin, and lipid levels as biological markers of adolescent MDD and their relationship with the severity of depression-anxiety and suicide risk in MDD. Methods:This study included 37 drug naïve adolescents between the ages of 12 and 18 who were diagnosed with a first episode MDD according to the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) and DSM-V diagnostic criteria. Thirty-three healthy adolescents between the ages of 12 and 18 were included as the control group. The Children's Depression Inventory (CDI), Screen for Child Anxiety Related Disorders (SCARED), and Suicide Probability Scale (SPS) were used to evaluate the subjects in the MDD and control groups. In the first stage, serum nesfatin-1, ghrelin, and lipid levels were compared between the adolescents diagnosed with MDD and the control group. Next, the correlations between these levels and the CDI, SCARED, and SPS scores were evaluated. Results: Nesfatin-1 levels were significantly lower in the MDD group than the control group (p < 0.001) A positive correlation was found between the nesfatin-1 levels and the SPS scores. Conclusions: This is the first study to evaluate nesfatin-1 levels in adolescent depression, suggesting that nesfatin-1, ghrelin, total cholesterol, and low-density lipoprotein cholesterol (LDL) levels can be used as biomarkers in child-adolescent MDD. However, it is evident that further studies with larger samples and post-treatment measurements are needed.

The prognostic significance of serum troponin T levels in Crimean-Congo hemorrhagic fever patients.

Crimean-Congo Hemorrhagic Fever (CCHF) is a disease transmitted by the Crimean-Congo hemorrhagic fever virus (CCHFV), characterized by severe fever and hemorrhage and with a reported fatality level of 3-30%. Cerebral hemorrhage, gastrointestinal hemorrhage, severe anemia, shock, myocardial infarction, pulmonary edema, and pleural effusion may be seen as causes of death. Cardiac troponin T (cTn-T) is a biochemical marker with high sensitivity and specificity in myocardial injury. The purpose of this study was to determine the prognostic significance of serum troponin T levels in CCHF patients. Patients hospitalized with a diagnosis of CCHF and whose serum cTn-T was investigated were examined retrospectively. Patients were divided into two groups on the basis of presence or absence of hemorrhage. Data were subjected to statistical analysis. One hundred thirty-five CCHF patients and 72 control subjects were included. Hemorrhage was present in 48 (35.6%) patients. Mean serum cTn-T level was 17.3 ± 28.0 ng/L in the patients with hemorrhage, 9.98 ± 5.97 ng/L in the non-hemorrhage patients (P = 0.001) and 6.6P = 2.6 ng/L in the control samples (P < 0.001). At a cTn-T level cut-off point of 9 ng/L, area under the ROC curve was 0.797 (95%CI: 0.730-0.854), sensitivity 83.0%, specificity 87.5%, PPD 95.7%, and NPV 60.3%. At logistic regression analysis, a rise in cTn-T level above 14 ng/L increased the probability of hemorrhage in CCHF patients approximately threefold. An increased troponin T level may be a prognostic risk factor for hemorrhage in CCHF patients. This marker should therefore be borne in mind in determining treatment strategy in these patients. J. Med. Virol. 89:408-412, 2017. © 2015 Wiley Periodicals, Inc.

The effect of duration of nasal obstruction on mean platelet volume in patients with marked nasal septal deviation.

Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. This study aimed to investigate the effect of age on mean platelet volume in patients with marked nasal septal deviation. We made a retrospective study of patients with marked nasal septal deviation between January 2012 and May 2014. The patients were divided into four groups according to duration of nasal obstruction (less than 10, 10-20, 20-30 and more than 30 years). The groups were compared with each other in terms of mean platelet volume, platelet distribution width, platelet count in preoperative hemogram. This study was performed on 356 male and 139 female patients. Mean age was 33.9 ± 12.3 years. It was determined that the platelet count, mean platelet volume did not constitute statistically significant difference between groups (p > 0.05). Nevertheless, it was determined that as the duration of nasal obstruction elongated the mean platelet volume value increased and platelet count values decreased. Mean values of platelet distribution width constituted statistically significant difference between all groups (p = 0.026). Patients with marked nasal septum deviation should be subjected to surgery as soon as possible because of the increase in mean platelet volume and platelet distribution width values which are related to increase in the risk of cardiopulmonary complications of nasal obstruction.

Elevated Serum Levels of SCUBE1, a Marker for Coagulation, in Patients with Breast Cancer.

Breast cancer (BC) is the most common cancer among women and a major cause of death. Signal Peptide-Cub-Epidermal growth factor domain-containing protein-1 (SCUBE1) is secreted under hypoxia and inflammatory conditions from platelet alpha granules. Its biological function is uncertain, although it may be a procoagulant substance in cancer patients. SCUBE1 is useful for identifying thrombotic diseases, including cancers and acute coronary syndromes. D-dimer reflects the relationship between coagulation activation and fibrinolysis; namely, thrombosis and D-dimer levels are closely linked. This is the first investigation of the potential diagnostic and prognostic value of SCUBE1 levels in patients with BC. Fifty patients and 33 age-matched and body mass index-matched healthy controls were enrolled. Blood samples were collected before chemotherapy regimens commenced. Serum SCUBE1 and D-dimer levels were measured before adjuvant chemotherapy and were compared to the healthy controls. SCUBE1 levels were determined using an enzyme-linked immunosorbent assay (ELISA) method. SCUBE1 and D-dimer levels were significantly higher in patients than in the controls (p = 0.03 and p < 0.001, respectively). A cut-off value of 1.55 ng/mL for SCUBE1 was associated with 62% sensitivity and 72.7% specificity and with positive predictive value of 77.5% and negative predictive value of 55.8%. Two patients with high SCUBE1 and D-dimer levels also developed pulmonary embolism. SCUBE1 may indicate hypercoagulability in patients with BC and thus help identify patients at greater risk of thrombosis and requiring anti-thrombosis treatment. SCUBE1 may also be used as an assistant test for identifying patients at risk of BC.

Prevalence of Metabolic Syndrome in Patients with Mucosal Lichen Planus: A Case-Control Study.

BACKGROUND: Previous reports have demonstrated an association between chronic inflammation with metabolic syndrome (MS) and cardiovascular risk factors. AIM: As lichen planus (LP) is a chronic inflammatory disease, the purpose of this study was to assess the prevalence of MS, dyslipidemia, insulin resistance and obesity in LP patients. METHODS: A total of 79 patients with LP and 79 controls were examined in this case-control study. Both groups were evaluated for the presence of MS, dyslipidemia, obesity and insulin resistance, and other cardiovascular risk factors. Erythrocyte sedimentation rate, fibrinogen and C-reactive protein were measured as inflammation markers. RESULTS: The prevalence of MS was significantly higher in the patients with LP than in controls (26.6 vs. 12.7%; P = 0.045). It was also significantly higher in LP patients with mucosal involvement than without (34.5 vs. 8.3%; P = 0.032). Among the MS criteria, mean fasting blood glucose and diastolic blood pressure were also significantly higher in LP patients than in controls (P = 0.012 and P = 0.021, respectively). No significant differences between LP patients and controls were observed with respect to prevalence of dyslipidemia and insulin resistance (P = 0.866 and P = 1.000, respectively). However, duration of disease was significantly longer in patients with insulin resistance than in those without (P = 0.034). CONCLUSIONS: The patients with LP, particularly those with mucosal involvement, have a higher prevalence of MS, which is associated with a risk for cardiovascular diseases and diabetes mellitus.

The effect of adjuvant chemotherapy on plasma TAT and F 1+2 levels in patients with breast cancer.

INTRODUCTION: Increased thromboembolic disorders and chemotherapy-induced thromboembolic events are well known phenomena in patients with breast cancer. Antithrombin III (AT III) inactivates thrombin, resulting in increased thrombin-antithrombin (TAT) levels. Activated factor X cleaves prothrombin and thrombin, resulting in increased levels of prothrombin fragment 1+2 (F 1+2). Increased TAT and F 1+2 levels show coagulation activation. The aim of this study was to examine plasma levels of TAT and F 1+2 and the effect of anthracycline-based chemotherapy on plasma TAT and F 1+2 in patients with operable breast cancer. MATERIALS AND METHODS: Seventy patients and 30 age-matched healthy controls were enrolled. Levels of TAT and F 1+2 were investigated before and after adjuvant chemotherapy. Basal levels (pre-chemotherapy) of TAT and F 1+2 in patients were compared with those in healthy controls and patient levels after 3 cycles of chemotherapy. Levels of TAT and F 1+2 were determined using the ELISA method. RESULTS: TAT and d-dimer levels were significantly higher in patients, (P: 0.02 and P<0.001, respectively). Post-chemotherapy F 1+2 levels were higher than basal levels (P: 0.02). F 1+2 levels were higher in patients, although the difference was not statistically significant (P: 0.52). There was no difference between basal and post-chemotherapy TAT levels. DISCUSSION: In conclusion, while higher post-chemotherapy F 1+2 levels suggest that the cumulative effect of chemotherapy increases the risk of thrombosis, TAT and d-dimer levels indicate that the effect of the cancer further increases the risk of thrombosis in patients with operable breast cancer.

Unusual foreign body in the larynx: a bee.

Foreign body lodgement in the larynx is a rare situation. Our review of the literature revealed no living foreign body in larynx except for laryngeal leeches and anisakiasis. In this article, we report a patient with unusual laryngeal foreign body lodgement: a bee which presented with sudden odynophagia and stinging sensation in throat. The bee was detected on the laryngeal mucosa in indirect laryngoscopic examination and removed immediately under general anesthesia in apneic period. In this case report, we describe the importance of detailed anamnesis and laryngeal examination even if the patient has no severe symptoms.

Comparison of Transoral/Transnasal Endoscopic-Guided Adenoidectomy with Endoscopic Nasopharyngeal Inspection at the End of Curettage Adenoidectomy.

The purpose of this study was to evaluate the efficacy of transoral or transnasal endoscopic-guided adenoidectomy compared with endoscopic nasopharyngeal inspection at the end of curettage adenoidectomy. A prospective case series of patients who had adenoidectomy. A total of 27 girls and 34 boys (age range 2.5-18 years) in whom adenoidectomy with or without tonsillectomy procedure was planned were included in the study. The cases were divided into three groups. Group 1 Transoral endoscopic-guided adenoidectomy performed patients. Group 2 Transnasal endoscopic-guided adenoidectomy performed patients. Group 3 Transnasal endoscopic nasopharyngeal exploration performed at the end of the conventional curettage adenoidectomy. The study was completed on 61 children. Mean age and sex frequency were not significant different between the groups. Mean operative time were 11.6 ± 2.9, 15.6 ± 4.4 and 9.7 ± 2 min, respectively (p > 0.05). On the other hand, significant differences were observed in operative time between group 1 and group 2 (p < 0.05), and between group 2 and group 3 (p < 0.05). Transnasal endoscopic examination at the end of curettage adenoidectomy is an appropriate method to assess the residual adenoid tissue after conventional curettage adenoidectomy. Also, operative time of this method is shorter than transoral or transnasal endoscopic-guided adenoidectomy. We recommend transnasal endoscopic inspection in all patients after conventional curettage adenoidectomy.

[Nasal foreign bodies: an analysis of 130 patients]. / Burunda yabanci cisim: 130 hastanin degerlendirilmesi.

OBJECTIVES: This study aims to investigate clinical manifestations and treatment protocols in patients with a diagnosis of nasal foreign bodies. PATIENTS AND METHODS: We retrospectively evaluated 130 patients (72 males, 58 females; mean age 3.65±2.31 years; range 15 month to 72 years) who were diagnosed with nasal foreign bodies and received treatment between November 2008 and July 2013. Age and sex of the patients, type of foreign body, side of presentation, signs and symptoms, management practices, and outcomes were recorded. RESULTS: Most of the patients were children between the ages of 2 and 5 (n=113, 86.9%). The most common foreign bodies were small plastic toys (43.8%), nut, walnut, corn, bean and the other seed grains (29.2%). Foreign bodies were detected in the right nasal passage in 74 patients (56.9%), left nasal passage in 54 patients (41.6%) and both nostrils in two patients (1.5%). Of the patients, 92.3% were admitted to our clinic within 24 hours. CONCLUSION: Nasal foreign bodies are frequent encountered in the emergency setting of ear, nose, and throat diseases. Although they are not life-threatening conditions, they require urgent intervention, as they may lead to several complications in the long-term. Parents and caregivers of children should keep objects which can be put into the nose away and be instructed that they should consult a physician in case of nasal foreign bodies.

Life-threatening angiomyxoma of the larynx.

BACKGROUND: Angiomyxoma is a benign proliferative mesenchymal tumor and a very rare mass in the larynx. There is not enough information about the etiology, clinical finding, treatment and prognosis of laryngeal angiomyxoma. CASE DETAILS: A 52 years old man presented with respiratory distress. Also, he had suffered from dysphagia, dysphonia, cough, and obstructive sleep apnea in the supine position for 6 months. He was operated on via transoral approach under general anesthesia with orotracheal intubation. The mass was encapsulated and completely removed. The histopathologic diagnosis was reported as angiomyxoma. CONCLUSION: Angiomyxoma should be considered in the differential diagnosis of the larynx masses. The treatment of angiomyxomas of the larynx is surgical. The mass can be usually excised intraorally or endoscopically.

Evaluation of middle ear pressure in the early period after adenoidectomy in children with adenoid hypertrophy without otitis media with effusion.

OBJECTIVE: Our aim was to analyze the changes in middle ear pressure in the early period after adenoidectomy in children with adenoid hypertrophy without otitis media with effusion. METHODS: This prospective, descriptive study was performed on 64 patients (with normal tympanic membranes and tympanograms) undergoing adenoidectomy or adenotonsillectomy. All patients were operated by single experienced team using curettage technique. First tympanometry was done on the day before surgery. Tympanometry was repeated on the first-, third-, and seventh-day after the operation. Patients are separated into two groups according to age as patients younger than 6 years (Group A) and patients older than 6 years (Group B). All data were separately evaluated for each ear using Jerger Classification. RESULTS: Of the 64 patients included in the study, 35 were male and 29 were female, and the average age was 91.01 ± 37.4 (35-178) months. Pathological decreases in the middle ear pressures of at least one ear were determined in 48 (75%) patients on the first postoperative day and in 10 (15.6%) patients on the third postoperative day. Middle ear pressures returned to preoperative values by the seventh postoperative day except in two patients. There were statistically significant differences (p<0.0001) among preoperative and first, third, and seventh postoperative day mean middle ear pressure. There were no statistically significant differences between Groups A and B in terms of tympanometry values of both ears obtained preoperatively and on the first, third, and seventh postoperative day. CONCLUSION: In our study, temporary eustachian dysfunction and aural fullness occur in the early period after adenoidectomy and/or adenotonsillectomy. This situation may be due to post-surgery clots and edema in nasopharynx. We consider that tubal orifice can be exposed to surgical trauma as adenoidectomy surgeries are done by curettage technique. There is a need for comparative studies using microdebrider or laser adenoidectomy accompanied by an endoscope.

Pediatric Tracheotomy: A 5-Year Experience in Düzce University Medical Faculty.

OBJECTIVE: Tracheotomy is one of the oldest surgical procedures. Pediatric tracheotomy indications have changed in recent decades. Currently, tracheotomy is performed because of prolonged intubation, upper airway obstruction, neuromuscular, and craniofacial anomalies instead of acute airway infections. This study aims to present our experience regarding indications and complications of tracheotomy in pediatric patients. METHODS: We retrospectively evaluated 17 pediatric patients who underwent tracheotomy because of prolonged intubation, increased pulmonary secretions, and upper respiratory tract obstruction from June 2010 to June 2015. The patients' age, gender, tracheotomy indications, duration of intubation, complications, and actual clinical condition were recorded. RESULTS: Tracheotomy was performed on 17 pediatric patients in our clinic. Discharged patients were followed with a 3-month routine check. Six patients (35.29%) had died because of a primary disease during follow-up, and one (5.88%) of them was a one-day-old newborn who had anomalies that were incompatible with life. In one patient, emergency tracheotomy was performed because of a tracheal trauma. None of the patients has been decannulated except one (5.88%). One (5.88%) patient had an accidental decannulation, while another had bleeding in the operation field. The total minor complication rate was 11.76%, and no major complication was observed. Two (11.76%) of the discharged patients underwent re-operation for widening of the tracheotomy stoma during their routine visit. CONCLUSION: Currently, tracheotomy in pediatric patients is mostly performed for prolonged intubation and upper respiratory tract obstruction for which intubation is not possible. Tracheotomy enables the discharge of these patients after training their families.

When should automatic Auditory Brainstem Response test be used for newborn hearing screening?

OBJECTIVES: The aim of this study was to investigate the referral rate and when automatic Auditory Brainstem Response (aABR) should be used for newborn hearing screening. METHODS: The present study enrolled 2933 healthy full-term infants and 176 infants with perinatal risk factors. Hearing screening using Transient Evoked Otoacoustic Emissions (TEOAEs) was performed in newborns for the first time 5 days after birth except perinatal risk factors infants. The TEOAE was repeated to neonates failing to pass at the 15th day after birth. Neonates failing to pass the second TEOAE, repeated the test again at the 30th day after birth. Neonates failing to pass the third TEOAE were referred for the second stage screening using aABR. In addition, neonates with risk factors were tested with aABR directly. RESULTS: In this research, 85 (2.9%) infants who could not pass the TEOAE and 176 infants exposed to perinatal risk factors, underwent the aABR test. In the aABR, 14 (7.9%) of 176 infants exposed to perinatal risk factors and 10 (11.7%) of 85 infants who could not pass the TEOAE failed to pass. As a result, hearing loss was detected in only 10 (0.34%) of 2933 healthy full-term infants. CONCLUSION: TEOAE should be performed at least twice in healthy full-term infants before aABR, because aABR is to be performed by specially trained personnel and takes a long time. In view of these results, it is our opinion that infants without perinatal risk factors should undergo TEOAE screening test and infants who did not pass control screening tests and have perinatal risk factors should absolutely undergo aABR test. But it should be remembered that TEOAE can cause a problem to miss auditory neuropathy in infants without perinatal risk factors.