Neonatal Kolestaz Olgularının Geriye Dönük Değerlendirilmesi

Amaç: Neonatal kolestaz, hayatın ilk aylarında başlayan, safra yapımı veya ekskresyonunda bozulma sonucu direkt bilirubin artışı ve sarılıkla seyreden bir durumdur. Hastalara erken ve doğru tanı konulması tedavi başarısı ve prognoz açısından önemlidir. Bu çalışmada, neonatal kolestaz nedeniyle izlenmiş hastaların; demografik özellikleri, etiyolojik faktörleri, klinik bulguları, tedavi ve son durumlarını incelemeyi ve karaciğer nakli yapılan olguların etiyolojik faktörlerini belirlemeyi amaçladık. Yöntemler: Çalışmaya, Ocak 2005-Ocak 2018 yılları arasında neonatal dönemde (<6 ay) kolestaz tanısı alıp kliniğimizde en az altı ay süreyle takip edilen hastalar dahil edildi. Hastaların klinik seyirleri ve son durumları dosya kayıtlarından geriye dönük olarak incelenerek kaydedildi. Bulgular: Çalışmaya alınan 131 hastada (%61,1 erkek) sarılığın başlangıç yaşı ortanca 6 gündü (aralık: 1-180 gün). Hastaların 99’u (%75,6) intrahepatik kolestaz, 32’si (%24,4) ekstrahepatik kolestaz grubundaydı. İntrahepatik kolestaz grubunda; en sık total parenteral nütrisyon ilişkili kolestaz (%27,3), ekstrahepatik kolestaz grubunda en sık biliyer atrezi (%71,9) tespit edildi. Başlıca diğer nedenler; sistemik (%19,1), metabolik (%12,2), herediter kolestatik hastalıklar (%9,9) ve enfeksiyöz (%7,6) nedenlerdi. Biliyer atrezi hastalarında Kasai portoenterostomi zamanı ortanca 64 gündü (aralık: 28- 180 gün). En yüksek (%44) mortalite oranı sistemik hastalık ilişkili kolestaz olgularındaydı. Karaciğer nakli (n=21, %16) en sık biliyer atrezili hastalara uygulandı. Sonuç: Neonatal kolestazda erken tanı ve zamanında tedavi; mortalite, morbidite ve optimal prognoz için çok önemlidir. Akolik dışkı varlığı, matürite, sarılığın erken başlangıcı ve yüksek gama-glutamil transferaz seviyeleri biliyer atreziyi düşündürmelidir. Erken cerrahi gerektiren biliyer atrezi ve tedavisi mümkün olan metabolik hastalıkların tanısı önemli olup karaciğer nakli bu hasta gruplarında sağkalım oranını artıran bir tedavi yöntemidir

The investigation of the course of intracranial of optic nerve and histological analysis

Amaç: Nervus opticus (Cr2) görme duyusu ile ilgili özel somatik afferent lifler içeren, yoğun lif sayısı ile karmaşık çaprazlara sahip ve önemli komşulukları olan kraniyal bir sinirdir. Kendisinden veya çevre yapılardan kaynaklanan birçok problemlerin görülebilmesi nedeniyle Cr2 veya komşu yapılara cerrahi operasyonlar sık yapılabilmektedir. Bu nedenle bu yapının anatomisinin bilinmesi önemlidir. Gereç ve Yöntem: Çalışmamızda; 20 adli otopsi kadavralarına ait toplam 40 adet Cr2’nin intrakraniyal parçası ve 20 adet chiasma opticum (CO) incelendi ve doku örnekleri alındı. Cr2’nin intrakraniyal seyri ayrıntılı olarak not alındı, olabilecek varyasyon tipleri araştırıldı. Daha sonra alınan doku örnekleri Hematoksilen&Eozin ile boyanarak histolojik incelemesi yapıldı. Bulgular: Makroskopik olarak; Cr2’lerin optik kanaldan başlayarak CO’yu oluşturana kadar birbirine yaklaştığı ve seyri sırasında a. cerebri anterior’lar ile yakın temas halinde olduğu gözlemlendi. İncelenen kadavralarda atrofik veya hipoplazik Cr2’ye rastlanmadı. Yapılan ölçümlerde; Cr2’nin intrakraniyal uzunluğu sağda 11.1±1.02 mm, solda ise 9.9±0.92 mm olarak bulundu. CO’nun her iki yanında yakın komşuluk halinde a. carotis interna’lar bulunmaktaydı. CO’nun genişliği 12.68±0.95 mm, ön-arka uzunluğu 8.75±1.05 mm, yüksekliği ise 4.32±0.25 mm olarak ölçüldü.Objective: Optic nerve (Cr2) mediates sense of vision and has a large number of fibers and also it has important relationships. Due to many problems resulting from the Cr2 itself or related structures, this nerve or the related structures may be frequently operated. That is why the knowledge of the Cr2 is essential. Material and methods: In our study intracranial parts of 40 Cr2’s and also optic chiasmas (CO) from 20 forensic autopsy cadavers were taken and examined and also tissue samples were obtained. The intracranial course of Cr2’s and CO’s were carefully noted. Possible types of variations were investigated. Then tissue samples were stained with Hematoxylin-Eosin for histological investigation. Results: Macroscopically, atrophic or hypoplasic Cr2’s were not found in the examined cadavers. The measurements revealed that the intracranial length of Cr2 was 11.1±1.02 mm right and 9.9±0.92 mm left. CO’s were in close relation with internal carotid arteries on each side. We found that the width, anteroposterior length and the height of CO were 12.68±0.95 mm, 8.75±01.15 mm and 4.32 ±0.25 mm respectively. Microscopically, intrapial width and intrapial height of the Cr2’s were measured as 3.69±0.27 mm and 2.85 ±0.19 mm respectively. The intrapial width of CO’s was found to be 11.67± 0.92 mm. The intrapial height in the median line of CO’s was 2.62±0.17 mm

A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules

Tatli, Ozgur/0000-0003-0263-7630; BAYDIN, AHMET/0000-0003-4987-0878; Turedi, Suleyman/0000-0002-6500-3961WOS: 000389517200004PubMed: 27450389Introduction: the aim of this study was to evaluate patients presenting to the emergency department (ED) with wrist trauma using physical examination findings and functional tests and to identify findings with high sensitivity and specificity among the parameters assessed in patients with fracture in the wrist. the ultimate objective was thus to establish a reliable and widely usable clinical decision rule for determining the necessity of radiography in wrist trauma. Methods: This prospective, multicenter study was performed in 8 hospitals. the relation between radiologically determined fracture and clinical findings consisting of physical examination findings and functional tests was assessed in terms of whether or not these were markers of radiography requirement, with the aim of identifying predictive values for fracture. Results: A total of 603 eligible trauma patients presented to the participating EDs during the study period. Fracture was identified in 24.5% of patients (n= 148). the 4-way combination with the highest sensitivity was identified as axial compression and the positive distal radioulnar drawer test, and pain with radial deviation and dorsal flexion. Sensitivity at distal ulna palpation was added as a fifth parameter, and sensitivity and negative predictive value thus increased to 100%. Conclusion: With their 100% sensitivity and 100% negative predictive values, the Karadeniz wrist rules may represent a clinical decision rule that can be used in practice in EDs. If all 5 findings are negative, there is no indication for wrist radiography. (C) 2016 Elsevier Inc. All rights reserved

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

© 2022 Lippincott Williams and Wilkins. All rights reserved.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