COMPARISON OF APOLIPOPROTEIN E GENE POLYMORPHISM AND PLASMA LIPID AMOUNTS IN OBESE AND DISLIPIDEMIC TURKISH CHILDREN

Amaç: Apolipoprotein E gen polimorfizmi ile lipid metabolizması arasındaki ilişkipopulasyon çalışmalarında ortaya konulmuştur. Obez olan çocuklarda apolipoproteinE gen polimorfizmi ile plazma lipid düzeyleri arasındaki ilişki ve obezite ilebirlikte olan dislipidemilerde apolipoprotein E gen polimorfizmi araştırılmıştır.Yöntemler: İnsülin bağımlı diyabeti, karaciğer ve böbrek yetmezliği bulunmayan,plazma lipid düzeyini etkileyecek ilaç kullanmayan, primer obezitesi bulunan 57 çocukve normal kilolu 18 çocuk olmak üzere toplam 75 çocuğun plazma lipid düzeylerinebakılmış ve apolipoprotein E (Apo E) gen polimorfizmi polimeraz zincir reaksiyonu ileanaliz edilmiştir.Bulgular: Obez çocuklarda Apo AI düzeyleri yüksek saptanmıştır. Obez ve obezolmayan grupta E2/E3 dağılımı sırasıyla %10,5, %27,8; E3/E3 dağılımı sırasıyla %80,7,%61; E3/E4 dağılımı sırasıyla %7, %5,6 olarak bulunmuştur. Obez olan grupta E4/E4fenotipi, obez olmayan grupta E2/E4 fenotipi görülmemiştir. Obez olan grupta E2/E4dağılımı %1,8, obez olmayan grupta E4/E4 fenotip dağılımı %5,6 bulunmuştur. Allelsıklıkları obez ve obez olmayan grupta sırasıyla epsilon 2 (ε2) alleli için %6,1, %14;epsilon3 (ε3) alleli için %89,5, %78; epsilon 4 (ε4) alleli için %4,4, %8 olarak benzerbulunmuştur. Bütün gruplarda en sık allelin ε3 olduğu görülmüştür.Sonuç: Apo E allel ve fenotip dağılımının obez ve sağlıklı çocuklarda benzer olduğugözlenmiştir. Obez çocuklarda total kolesterol, Apo B, Apo AI ortalama düzeyi, obezolmayan çocuklara göre daha yüksek bulunmuş, trigliserid düzeyleri obez olan gruptaobez olmayan gruba göre belirgin yükseklik göstermiştir. Objective: The relationship between Apolipoprotein E (Apo E) gene polymorphismand lipid metabolism was presented by the population studies. The aim of this studywas to search the relationship between Apo E gene polymorphism and plasma lipidlevels in obese children and to search Apo E gene polymorphism in dislipidemiascoexisting with obesity. Methods: Seventy five children (57 were primary obese, 18 were normal weight) wereanalysed by polymerase chain reaction for Apo E gene polymorphism and plasmatriglyceride, HDL, LDL and Apo B amounts were evaluated. Excluding criterias for thestudy group are insulin dependent diabetes mellitus, hepatic and renal failure andmedication because of they might affect the lipid concentration in plasma.Results: The Apo AI levels were significantly elevated in obese children. HDL, LDLand Apo B levels were nearly at the same levels while triglycerides levels were muchhigher in obese group than non-obese group, but the difference was not foundstatistically significant. In obese and non-obese group the E2/E3 distribution was10.5% and 27.8%; E3/E3 was 80.7% and 61% and E3/E4 was 7% and 5.6% respectively.The E4/E4 phenotype was not determined in obese group while the E2/E4 phenotypewas not seen in non-obese group. E2/E4 distribution was 1.8% in obese children andE4/E4 distribution was 5,6% in non-obese children . Allele frequencies in obese andnon-obese children for epsilon 2 (ε2) were found as 6.1% and 14%; for epsilon 3 (ε3)89.5% and 78% and for epsilon 4 (ε4) 48% and 4% respectively. There was no significantdifference between the groups according to allele frequency (p>0.05). The ε3 was foundthe most frequent allele in all the groups.Conclusion: Apo E allele and phenotype distribution were found similar in obese andnon-obese children. The Apo AI levels were significantly elevated in obese children

Isolated Fourth Ventricle Associated with Treated Hydrocephalus and Chiari type 2 Malformation

Isolated fourth ventricle is a rare condition seen as a result of anatomical or functional occlusion of the inlet and outlet holes of the fourth ventricle. It may be seen in cases with Chiari type 2 malformation, too. We report a 20-month-old boy with isolated fourth ventricle presenting with weakness in his arms. He had been treated for myelomeningocele and hydrocephalus in the neonatal period and followed for Chiari type 2 malformation. The isolated fourth ventricle developed in the presence of a well-functioning lateral ventricle shunt. He was treated with a new shunt into the fourth ventricle

Cervical Spinal Cord Injury in Patients with Cervical Canal Stenosis without Radiologic Evidence of Trauma: Evaluation of 15 Consecutive Cases

Objective: Cervical spinal canal stenosis is a well-known risk factor for spinal cord injury. In some patients, spinal cord injury is the first symptom of spinal stenosis. Therefore, some authors recommend preventive decompression of the spinal canal in asymptomatic patients with spinal stenosis. In this study, we aimed to determine the outcome of patients with spinal cord injury associated with cervical spinal canal stenosis and the rate of previously asymptomatic patients.Material and Methods: Data of 15 consecutive patients were evaluated. Improvement of neurological deficits during followup was accepted as good outcome and mortality and unchanging neurological deficits were accepted as worse outcome.Results: All patients were male, aged between 44 and 85 years. High-energy traumas caused injury in 7 of the cases and low-energy traumas in the others. Nine cases had central cord injury and 6 had other types of traumas. Only 2 patients had been diagnosed with minor symptoms associated with cervical canal stenosis before trauma, while the other patients had been asymptomatic. One patient did not consent to undergo an operation and two others could not be operated because of their general status; the latter 2 patients died. The other 12 patients were decompressed 0 to 40 days after trauma. Two other patients with severe transverse-type cord injury also died postoperatively. The other patients were followed for 1 to 48 months (22.7±17.7 months). In 2 patients, neurological deficits had not improved on last follow-up. Deficits had completely or partly improved in the other patients, including the one who had not accepted the operation. Central cord injury had a significantly better prognosis than other types (p=0.0019). Age, cervical canal diameter, and motor and sensory scores of the American Spinal Injury Association scale, type of trauma, and level of spinal cord injury were not significantly different in the patients with good and worse prognosis.Conclusion:The rate of asymptomatic patients before trauma was very high in patients with spinal cord injury associated with cervical spinal canal stenosis. Therefore, the treatment decision must be carefully assessed in asymptomatic cervical spinal stenosis patients. Catastrophic consequences of spinal trauma may be seen in patients with cervical spinal canal stenosis even in asymptomatic patients. Central cord syndrome had a good prognosis in these patients. Other types of injuries such as transverse and motor types had a worse outcome

Clinical Outcomes and Factors Affecting the Outcome of Decompressive Craniectomy: Analysis of 50 Cases

Objective: Decompressive craniectomy (DC) is used as the last-stage method in the treatment of increased intracranial pressure (ICP). However, clinical outcomes reported in the literature are contradictory.Methods: Medical records were retrospectively reviewed for 50 increased ICP cases that had been diagnosed and undergone DC at our hospital between February 2011 and February 2017. The patients’ characteristics such as age, sex, presence of comorbidities, pre- and postoperative Glasgow Coma Scale (GCS) scores, blood pressure, hemoglobin values, radiological findings, DC time, width of craniectomy, length of stay in the intensive care unit (ICU), and Glasgow Outcome Scale (GOS) were recorded. According to their outcome, the patients were divided into two groups with good (GOS = 4-5) and poor (GOS = 1-3) prognosis, respectively, according to their last examination. It was evaluated whether these parameters showed significant differences between the groups and between the deceased patients and survivors.Results: A total of 50 patients (35 male and 15 female) had been treated with DC. The mean age was 40.5±22.2 years. Head trauma was the etiology of increased ICP in 68% of the cases (n=34). The median of preoperative GCS was 6 (range: 3-15), and the mean midline shift on admission was 10.3±5.1 mm. Seventy-two percent of the cases (n=36) were treated with DC on the day of admission from the emergency department. The median of postoperative GCS was 7 (range: 3-15). The patients were followed up for a mean of 24.4 days in the ICU, and 30 patients were lost after a mean of 24.6 days. The survivors were followed up for a mean of 7.4±12.5 months. Factors affecting survival periods were age of the patient, short edge length of the DC (not long edge) and early postoperative GCS score after the DC. The comparison between survivors and deceased patients showed that the mean age of survivors was significantly lower than that of deceased patients (p=0.047). Postoperative GCS scores after DC were significantly lower in the patients who had died (p=0.0001).Conclusion: Age, short edge length of the craniectomy and postoperative neurological status are factors affecting surgical outcomes. These factors can play a role in selecting patient candidates who have to receive DC

Spontaneous Acute Subdural Hematoma due to Intracranial Hypotension Secondary to Lumboperitoneal Shunt: A Case Report and Review of the Literature

Objective:To report a rare case with spontaneous intracranial acute subdural hematoma due to overdrainage of cerebrospinal fluid after lumboperitoneal shunting and to review the literature on this topic.Case report: A 53-year-old lady with spontaneous acute subdural hematoma developing 3 years after lumboperitoneal shunting for treatment of benign intracranial hypertension is reported. She was treated with shunt removal and hematoma evacuation.Material and Methods: We found 16 cases with intracranial bleeding developing spontaneously or after mild head injury after lumboperitoneal shunting. The characteristics of the patients were recorded, the outcome was given according to the Glasgow Outcome Scale, and a Glasgow Outcome Scale score from 1-3 was accepted as worse outcome. The factors affecting outcome were evaluated.Results: There were 10 females and 7 males aged 59.7±15.1 years. In most cases, the primary disease treated by lumboperitoneal shunting was hydrocephalus or benign intracranial hypertension. In 12 of the cases, the bleeding happened into the subdural space and in 5 into other compartments (intracerebral or subarachnoid bleeding). Five of the cases died, and 62.5% had a worse outcome. The only factor affecting outcome was the time span from lumboperitoneal shunting to intracranial bleeding. This time was significantly shorter in the patients with worse outcome (3.7 versus 38.6 months).Conclusions: Lumboperitoneal shunting may cause serious complications such as intracranial bleeding due to overdrainage of cerebrospinal fluid via shunt. Patients with lumboperitoneal shunting must be followed very closely for development of intracranial hypotension especially during the first few months after shunting

Microsurgical Clipping of Anterior Circle of Willis Aneurysms: A Retrospective Study

Objective: The surgical outcomes of anterior circle of Willis aneurysms were evaluated.Material and Methods: Between March 2015 and December 2016, 38 patients were operated and followed up for aneurysms. There were 15 female and 23 male patients with a mean age of 47 years (range: 17-78). Of the patients, 35 were diagnosed with subarachnoid hemorrhage (SAH). Of these patients, 54.2% (n=19) were operated within the first 24 hours. All patients were operated by the same surgeon with sylvian dissection. All clinical data in the hospital charts and outpatient records and radiological investigations stored in the archive were evaluated retrospectively.Results: The most commonly seen aneurysm was on the anterior communicating artery (44.8%). After that, aneurysms on the middle cerebral artery (31.6%), posterior communicating artery (13.2%), internal cerebral artery bifurcation (7.8%), and distal anterior cerebral artery were seen, respectively. There was a significant correlation between the location of the aneurysm and the mean age (p=0.009). All patients were followed in the intensive care unit after operation. After surgery, vasospasm was observed in 26.3% of patients. Patients with high SAH grade developed vasospasm significantly more frequently (p=0.03). Neurological examinations at discharge were normal in 17 patients with SAH and 3 patients without SAH. Four patients were discharged with minimal neurological deficit and 2 patients with severe deficit. Eight patients with World Federation of Neurosurgical Societies (WFNS) grade 4-5, 2 patients with grade 3, and 2 patients with grade 1-2 were lost. Postoperative Glasgow Coma Scale and SAH WFNS grades were found to be determinants for dying.Conclusion: Despite the development of endovascular techniques in the treatment of aneurysm, microsurgical clipping remains the first choice method to treat anterior system aneurysms. Closure of the aneurysm is the treatment priority. It is well known that early surgery reduces mortality and morbidity

Sudden Onset of Tetraparesis During Taking of Magnetic Resonance Imaging in a Patient with Undiagnosed Cervical Spinal Stenosis: A Case Report

Objective: To report a case with sudden-onset tetraparesis during taking magnetic resonance imaging (MRI).Case report: A 73-year-old man was referred with complaints of paresis of his arms and legs. His tetraparesis had developed suddenly while an MRI was performed 10 days before. He had a severe tetraparesis with 0/5 motor strength in his legs and 2/5 motor strength in his arms. On the MRI, a serious spinal stenosis at C3-4 and C4-5 levels and a faint myleopathic signal of the spinal cord at the level of the C4-5 disc space were seen. After posterior decompression, the patient’s tetraparesis improved gradually and he could walk independently and perform his daily activities with mild spasticity after 13 months.Conclusion: It is known that sudden neurological deficits may be seen in cervical trauma in patients with cervical spinal stenosis due to spondylosis. However, this case who did not have a trauma history showed us that a long period of positioning the neck beyond the patient’s control, even during the execution of MRI, may cause sudden deterioration

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Impact of process parameters on drying of dolomite ore by microwave energy

Microwave drying tests on dolomite ore were carried out in order to determine the effect of process parameters and variables on its drying mechanism. Dolomite ore was crushed under 2 mm particle size with water to bring the moisture content to about 5% and then was fed into a microwave oven. The time-dependent moisture removal rate and surface temperature changes were determined at different microwave oven powers (180, 600 and 800W). The very low capacities of industrial microwave ovens are a handicap for activities requiring high capacities such as mining. The rate of moisture removal was taken into consideration in evaluating the results. The optimum experimental conditions for drying were carried out at 800W for 8 minutes. This results in the removal of 33% of the moisture from the dolomite ore