Newborn treated with continuous renal replacement therapy for citrulinemia-type 1

Introduction: Hyperammonemia occurs as a result of the inability to convert ammonia, a metabolic toxin, into urea due to a block in the urea cycle, and there resulting neurotoxicity is responsible for the pathogenesis. Case Presentation: Our patient was 7 days old when followed up in an external center for 3 days with a preliminary diagnosis of neonatal sepsis. Lethargy, vomiting, tachypnea, and convulsions, which are frequently seen in the first neonatal forms of urea cycle disorders, were also present in our patient. He was referred to us as a result of high ammonia levels when he was examined in terms of congenital metabolic diseases. He was intubated due to the rapid development of respiratory failure. When he was admitted to our intensive care unit with hyperammonemia, light reflex could not be obtained, and widespread cutis marmaratus was developed. Continuous renal replacement therapy was started in our patient and administered intermittently for 120 hours. The glucose infusion rate was followed by high fluid. When it orally tolerated, it is supported with sodium benzoate and sodium stearyl fumarate to reduce ammonia. Nutrition was limited to protein with Basic P. Conclusion: After staying in the intensive care unit for 30 days, our patient was discharged with the recommendation of outpatient follow-up by the pediatric metabolism physician. When our patient came for his check up after two months,there was no nystagmus and no seizures

Comparative review of biochemistry and cell anatomy of the hepatic tissue in rats administered some anti hypertensive drug for a long time

The adverse biochemical and structural effects of antihypertensive drugs over a long period (clonidine, methyldopa, rilmenidine, amlodipine, ramipril) on hepatic tissue has been examined in this study. The results are considered to be beneficial for the identification of indications and contraindications in hypertensive patients. Severe bile duct proliferation, portal inflammation, interface hepatitis, focal necrosis and hepatocyte degeneration were demonstrated in the clonidine and amlodipine groups, which had higher oxidant parameters, aspartate aminotransferase, alanine amino transferase and lactate dehydrogenase activity and a higher amount of 8-OH Gua. In the group receiving rilmenidine, all the histopathological findings were the same as those in the clonidine and amlodipine groups, except for bile duct proliferation and interface hepatitis. On histopathological examination of the cell anatomy, it was shown that methyldopa and ramipril caused mild liver damage. While clonidine and amlodipine gave rise to severe liver damage, rilmenidine caused moderate damage, and methyldopa and ramipril led to mild loss of liver function.Colegio de Farmacéuticos de la Provincia de Buenos Aire

He gets to work in his SVA book instead : A practical research study that examines how cooperative working methods can benefit newly arrived students' participation and regular learning in Swedish teaching

Today, quality reviews of education for newly arrived students show major deficiencies in the Swedish school system. The newly arrived students do not get equal opportunities to achieve goals as other students in the classroom. Thus, an intervention study has started at two primary schools in central Sweden, where the purpose is to investigate whether cooperative methods can benefit students' participation and vocabulary learning in Swedish teaching. Therefore, the questions in this study are “in what ways can cooperative learning contribute to the participation of newly arrived students in Swedish teaching?” and “does cooperative learning have any visible effect on newly arrived students' vocabulary learning in Swedish?”. To answer the study questions a qualitative research method was conducted, with structured classroom observations, in two different primary schools. The participants in the study werefive newly arrived students in fourth and sixth grade. The results were analyzed using three theories, such as social constructivism, a participation model and vocabulary learning as a theoretical concept.   The analysis of the results showed that there are several advantages for the newly arrived students' communicative and linguistic development in cooperative learning, at the same time as it opens up for an increased participation in Swedish lessons. Didactically, the results of the study imply that the work with cooperative teaching methods leads to a progression in vocabulary learning and participation. This can be modeled in different ways, by grouping the newly arrived students in mixed groups or with other newly arrived students. What is further made visible in the study is that the newly arrived students are more active and involved when they are allowed to work and use the language in playful environments

Non-alcoholic fatty liver disease in obese children and the relationship between metabolic syndrome criteria

Aim: To investigate metabolic syndrome (MetS) and MetS criteria, and to establish whether metabolic syndrome criteria were associated with non-alcoholic fatty liver disease (NAFLD) in obese children

Biochemically and histopathologically comparative review of thiamine's and thiamine pyrophosphate's oxidative stress effects generated with methotrexate in rat liver

PubMed: 23197226Background: Oxidative liver injury occurring with methotrexate restricts its use in the desired dose. Therefore, whether or not thiamine and thiamine pyrophosphate, whose antioxidant activity is known, have protective effects on oxidative liver injury generated with methotrexate was comparatively researched in rats using biochemical and histopathological approaches. Material/Methods: Thiamine pyrophosphate+methotrexate, thiamine+methotrexate, and methotrexate were injected intraperitoneally in rats for 7 days. After this period, all animals' livers were excised, killing them with high-dose anesthesia, and histopathologic and biochemical investigations were made. Result: Biochemical results demonstrated a significant elevation in level of oxidant parameters such as MDA and MPO, and a reduction in antioxidant parameters such as GSH and SOD in the liver tissue of the methotrexate group. Also, the quantity of 8-OHdG/dG, a DNA injury product, was higher in the methotrexate group with high oxidant levels and low antioxidant levels, and the quantity of 8-OHdG/dG was in the thiamine pyrophosphate group with low oxidant levels and high antioxidant levels. In the thiamine and control groups, the 8-OHdG/dG rate was 1.48±0.35 pmol/L (P>0.05) and 0.55±0.1 pmol/L (P<0.0001). Thiamine pyrophosphate significantly decreased blood AST, ALT and LDH, but methotrexate and thiamine did not decrease the blood levels of AST, ALT and LDH. Histopathologically, although centrilobular necrosis, apoptotic bodies and inflammation were monitored in the methotrexate group, the findings in the thiamine pyrophosphate group were almost the same as in the control group. Conclusions: Thiamine pyrophosphate was found to be effective in methotrexate hepatotoxicity, but thiamine was ineffective. © Med Sci Monit, 2012

Odkształcenie aorty, jej rozszerzalność oraz moduł elastyczny wiążą się z obecnością i nasileniem zwapnień w tętnicach wieńcowych

Background: An association between aortic stiffness and atherosclerosis has been previously demonstrated by pulse wave velocity. Whether echocardiographically assessed aortic stiffness also correlates with the extent of atherosclerosis has not yet been established. Aim: To evaluate the association between echocardiographically measured aortic stiffness and atherosclerosis. Methods: A total of 162 patients (mean age 54 &#177; 9 years, age range 36-83 years, 102 male and 60 female) at high risk of atherosclerosis underwent transthoracic echocardiography and sphygmomanometer-based brachial blood pressure measurement for aortic stiffness parameters (strain, distensibility and elastic modulus), and multidetector computed tomography for the presence and quantity of coronary artery calcium (CAC). Results: It was found that aortic strain and distensibility were significantly lower in patients with CAC than in patients without CAC (7.6 &#177; 2.7% vs 9.3 &#177; 3.4%, p < 0.001 and 3.0 &#177; 1.1 mm Hg-1.10-3 vs 3.9 &#177; 1.7 mm Hg-1.10-3, p < 0.001, respectively). However, elastic modulus E(p) was significantly higher in patients with CAC than in patients without CAC (7.9 &#177; 3.8 N/m2 vs 6.0 &#177; 2.5 N/m2, p = 0.001). In addition, aortic strain and distensibility, and elastic modulus, were found to be significant predictors of the presence and quantity of CAC in multivariate logistic and linear regression analyses (all p < 0.05). Conclusions: Echocardiographically measured aortic stiffness is positively, significantly and independently associated with atherosclerosis. Kardiol Pol 2010; 68, 12: 1353-1359Wstęp: Zależność między sztywnością aorty i miażdżycą udokumentowano za pomocą prędkości fali tętna. Dotychczas nie ustalono, czy sztywność aorty oceniana echokardiograficznie także koreluje z nasileniem miażdżycy. Cel: Celem pracy była ocena związku między mierzoną echokardiograficznie sztywnością aorty i miażdżycą. Metody: W grupie 162 pacjentów wysokiego ryzyka miażdżycy (w wieku średnio 54 &#177; 9 lat, zakres 36-83 lata, 102 mężczyzn i 60 kobiet) przeprowadzono przezklatkowe badanie echokardiograficzne, badanie ciśnienia tętniczego na tętnicy ramiennej z użyciem sfigmomanometru w celu oceny parametrów sztywności ścian aorty (odkształcenie, rozszerzalność i moduł elastyczny) oraz wielorzędową tomografię komputerową, aby ocenić obecność i liczbę zwapnień w tętnicach wieńcowych (CAC). Wyniki: Wykazano, że wartości odkształcenia i rozszerzalności aorty były znacząco niższe u pacjentów z CAC w porównaniu z osobami bez CAC (odpowiednio 7,6 &#177; 2,7% v. 9,3 &#177; 3,4%, p < 0,001 oraz 3,0 &#177; 1,1 mm Hg-1.10-3 v. 3,9 &#177; 1,7 mm Hg-1.10-3, p < 0,001). Natomiast moduł elastyczny E(p) był istotnie wyższy u pacjentów z CAC niż u osób bez CAC (7,9 &#177; 3,8 N/m2 v. 6,0 &#177; 2,5 N/m2, p = 0,001). Ponadto odkształcenie i rozszerzalność aorty oraz moduł elastyczny stanowiły istotne czynniki predykcyjne obecności i liczby CAC w wieloczynnikowej analizie logistycznej, a także w analizie regresji liniowej (wszystkie p < 0,05). Wnioski: Sztywność ściany aorty mierzona echokardiograficznie wykazuje niezależny, dodatni i statystycznie istotny związek z miażdżycą. Kardiol Pol 2010; 68, 12: 1353-135

Mortality Risk Factors Among Critically Ill Children With Acute COVID-19 in PICUs: A Multicenter Study From Turkish Pediatric Critical COVID-19 and MIS-C Study Group

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality

Assessment of left ventricular function by tissue Doppler imaging in patients with ankylosing spondylitis

Ankylosing spondylitis (ASp)is a chronic, inflammatory and systemic disease affecting pericardium, myocardium and the conduction system of the heart. In this study, we aimed to analyse left ventricular systolic and diastolic functions using tissue Doppler imaging (TDI). 30 patients with ASp and 30 healthy volunteers having the similar demographic characteristics were included. Left ventricular systolic and diastolic functions were assessed by using two dimensional (2D) echocardiography, M-mode, pulsed-wave (PW) and tissue Doppler echocardiography. The peak systolic velocity (Sm), early diastolic myocardial peak velocity (m), late diastolic myocardial peak velocity (Am), isovolumic acceleration (IVA), myocardial precontraction time (PCTm), myocardial contraction time (CTm), myocardial relaxation time (RTm), and myocardial performance index (MPI) were measured at septal and lateral mitral annulus. In conventional echocardiography, end-diastolic interventricular septum and posterior wall diameters were higher in patients with ASp than the control group. The ratio of E/A was significantly lower and deceleration time was significantly prolonged in patients with ASp, but mitral E and A velocities, isovolumic relaxation time and MPI were similar in patient and control group (P&gt;0.05). Left ventricular lateral and septal wall tissue Doppler echocardiography showed that Em, Em/Am ratio and CTm were significantly lower, IVRTm was longer and MPI was higher in patients with ASp. No significant differences were detected between the groups for IVA, Sm, Am, PCTm, PCTm/CTm ratio (P&gt;0.05). We have demonstrated that in patients with ASp, diastolic functions were impaired but systolic functions were preserved by using TDI

Fatal Adenovirus Pneumonia Despite Extracorporeal Life Support Treatments

Adenovirus is an important etiological agent of lower respiratory tract infections in all age groups. Its infections are very difficult to distinguish from other viruses and bacterial agents by clinical and laboratory findings. Although adenovirus is rarely causes acute respiratory distress syndrome, it has higher morbidity and mortality compared to other viruses. In this manuscript, an adenovirus infection in a pediatric patient with preliminary diagnosis of bacterial pneumonia by clinical and laboratory findings has been presented. Pneumonia has rapidly progressed to acute respiratory distress syndrome and the patient died despite extracorporeal life support treatments

Fatal Adenovirus Pneumonia Despite Extracorporeal Life Support Treatments

Adenovirüs alt solunum yolu enfeksiyonlarının tüm yaşlarda önemli bir etkenidir. Klinik ve laboratuvar olarak diğer virüs ve bakteriyel enfeksiyon-lardan ayrımı oldukça zordur. Akut solunum sıkıntısı sendromuna nadiren sebep olsa da diğer etkenlerle karşılaştırıldığında daha yüksek morbidite ve mortaliteye sahiptir. Bu makalede klinik ve laboratuvar bulguları ile bakteriyel pnömoni ön tanısı alan ve hızlı bir şekilde akut solunum sıkın-tısı sendromuna ilerleyen çocuk hastada, vücut dışı destek tedavilerine rağmen ölümcül seyreden adenovirüs enfeksiyonundan bahsedilmiştir.Adenovirus is an important etiological agent of lower respiratory tract infections in all age groups. Its infections are very difficult to distinguish from other viruses and bacterial agents by clinical and laboratory find-ings. Although adenovirus rarely causes acute respiratory distress syn-drome, it has higher morbidity and mortality compared to other viruses. In this article, an adenovirus infection in a pediatric patient with prelim-inary diagnosis of bacterial pneumonia by clinical and laboratory find-ings has been presented. Pneumonia has rapidly progressed to acute respiratory distress syndrome and the patient died despite extracorpor-eal life support treatments