Prematüre Bebeklerde Kan Transfüzyonu Öncesi ve Sonrası Eritrosit Kurşun ve Civa Düzeylerinin Incelenmesi

The frequency of anemia is very high in very low birth weight (VLBW) infants in neonatal intensive care unit (NICU). Eighty percent of infants require at least one red blood cell (pRBC) transfusion because of repeated blood samplings for laboratory analysis, anemia of prematurity, infections, and bone marrow suppression due to antibiotics. In addition to several unfavorable effects of blood transfusions, heavy metal load via pRBC transfusions is not a well known entity. The aim of this study is to determine pre-and post-transfusion RBC lead and mercury levels in infants and the relation to pRBC units? lead and mercury levels. This prospective study was conducted between July 2011 and March 2013 in NICU of Hacettepe University Ihsan Dogramaci Children?s Hospital. VLBW infants who needed pRBC transfusion for the first time are included in the study. Two blood samples were obtained to determine RBC lead and mercury levels before and after the transfusion. Also pRBC units lead and mercury levels were determined. The quantity of transfused lead and mercury was calculated according to transfused volume and pRBC unit?s lead and mercury levels. The results were compared with the exposure reference values. Eighty infants met the inclusion criteria. The mean gestational age was 28.4±2.3 weeks and birth weight was 1083±256 g. Mean time for the first pRBC transfusion was 8.5 days after birth (8-22 days). Lead could not be determined in four samples and mercury in two of the pRBC samples due to hemolysis. Lead was measureable in all pRBC units and mercury was detected in 69.2%of them. The average lead and mercury levels in a pRBC unit were 16.3±10.8 µg/l and 3.75±3.23 µg/l respectively. The rate of infants who receive lead above the reference dose was 69.7%. Twenty seven percent of the infants received mercury above the reference dose set by Enviromental Protection Agency and 1.3%set by World Health Organization. In 68 enrolled infants whose pRBC unit, pre- and post-transfusion lead levels are obtained, average pre- and post transfusion RBC lead levels were 10,6±10.3 µg/l and 13±8.5µg/l respectively (p0.05). There was a weak correlation between the mean difference in pre-and post transfusion mercury levels and the amount of mercury delivered by PRBC units (r=0.28, p0.05). Transfüzyon sonrası ve öncesi ortalama eritrosit civa düzeyi farkı ile eritrosit süspansiyonlarıyla verilen kurşun dozu arasında düşük derecede korelasyon vardı (r=0.28, p=<0.05). Sonuç olarak, eritrosit süspansiyonlarının kurşun ve civa konsantrasyonları çok yüksek olmasa da bebeklerin önemli bir kısmında yaşamın kritik evresinde toksik dozda kurşun ve civa verilmektedir. Eritrosit süspansiyonları transfüzyon sonrası eritrosit kurşun düzeylerinde anlamlı yükselmeye neden olurken, eritrosit civa düzeylerinde anlamlı bir fark oluşturmamıştır

Evaluation of babies with viral lower respiratory tract infections in neonatal intensive care unit

Giriş: Alt solunum yolu enfeksiyonları (ASYE); tüm dünyada çocukluk çağında hastaneye yatış gerektiren ve mortaliteye sebep olan nedenlerin başında gelmektedir. Bu çalışmanın amacı; viral ASYE tanısıyla yenidoğan yoğun bakım ünitesinde (YYBÜ) izlenen hastaların özelliklerinin değerlendirilmesi, viral etkenlerin ortaya konulması ve risk faktörlerinin araştırılmasıdır. Gereç ve Yöntem: Bu çalışmada; bir üniversite hastanesinde 3. basamak YYBÜ’ye Ocak 2018 ve Mart 2020 tarihleri arasında takip ve tedavi için yatırılıp viral ASYE tanısı koyulan hastaların özellikleri ve solunum yolu viral paneli sonuçları geriye dönük olarak incelendi. Hastalar RSV (+) saptananlar ve RSV-dışı viral etken saptanalar olmak üzere iki gruba ayrıldı ve gruplar karşılaştırıldı. Bulgular: Çalışmaya 24 hasta dahil edildi. SYVP sonuçlarında 6 (%25) hastada RSV-A, 8 (%33,3) hastada RSV-B, 10 (%41,6) hastada RSV dışı viral etkenler saptandı. RSV saptanan hastalar ile RSV dışı etkenlerin saptandığı hastalar arasında sosyo demografik özellikler açısından fark bulunmazken; RSV saptanan grupta akciğer grafisinde infiltrasyon varlığı (pnömoni) daha fazla, solunum ya da oksijen desteği alma oranı daha yüksek ve ortalama yatış süresi daha uzun olarak saptandı (p değerleri sırasıyla 0,001, 0,001 ve 0,017). Yatış süresi ile C-reaktif protein düzeyi arasında pozitif yönde, orta düzeyde korelasyon saptandı (r=0,558, p=0,005). Sonuç: YYBÜ’de viral ASYE’de en sık etken RSV olarak bulunmuştur. Bu nedenle YYBÜ’de çalışanların hijyen kurallarına çok dikkat etmeleri ve ziyaretçilerin de bu konuda ciddi şekilde eğitildikten sonra YYBÜ ortamına alınmaları vurgulanmalıdır. Viral ASYE düşünülen hastalarda erken tanı-tedavi yapılabilmesi ve hastalığın yayılımının önlenebilmesi için viral testlere ulaşımın artırılması ve testlerin yaygınlaştırılması önem arz etmektedir.Introduction: Lower respiratory tract infections (LRTIs) are one of the leading cause of hospitalization and mortality in childhood worldwide. The aim of this study was to evaluate the characteristics of the patients hospitalized in the neonatal intensive care unit (NICU) with the diagnosis of viral LRTI, to reveal the viral agents and to investigate the risk factors. Materials and Methods: In this study; the characteristics and the respiratory tract viral panel results of the patients who were hospitalized in the NICU of a university hospital between January 2018 and March 2020 with the diagnosis of viral LRTI were examined retrospectively. The patients were divided into two groups as RSV (+) and non-RSV viral agents, and the groups were compared.Results: 24 patients were included in the study. RSV-A was detected in 6 (25%), RSV-B in 8 (33.3%), and non-RSV viral agents in 10 (41.6%) patients. There were no significant difference between the sociodemographic features of RSV (+) group and non-RSV group. However presence of infiltration on chest radiography (pneumonia) was more common, the rate of receiving respiratory or oxygen support was higher and hospitalization duration was longer in RSV (+) group compared to non-RSV group (p values 0.001, 0.001 and 0.017, respectively). There was a positively, moderate level correlation between hospitalization duration and C-reactive protein (r = 0.558, p=0.005). Conclusions: RSV was the most common agent in viral LRTI in NICU, it should be emphasized that the staff in the NICU should pay close attention to the hygiene rules and that the visitors should be taken into the NICU after they are educated on this issue. It is important to increase the access to viral tests and provide wider use in order to make early diagnosis and treatment in viral LRTI and to take the necessary measures for preventing spread of the disease

A Turkish Bcs1L Mutation Causes Gracile-Like Disorder

A full-term growth-restricted female newborn (1790 g), presented with lactic acidosis (12.5 mmol/L) after birth. She had renal tubulopathy, cholestasis and elevated serum ferritin concentration (2819 ng/ml). Two similarly affected sisters had died before 3 months of age. Mitochondrial disorder was suspected since the disease resembled the Finnish GRACILE syndrome, caused by a homozygous mutation (c.232A>G) in BCS1L. Thus, we sequenced the BCS1L gene, encoding the assembly factor for respiratory chain complex III. The patient had a homozygous mutation (c. 296C>T; p.P99L), for which both parents were heterozygous. In four previously published patients of Turkish origin, the same homozygous mutation resulted in complex III deficiency, tubulopathy, encephalopathy, and liver failure. The p.P99L mutation seems to be specific to Turkish population and leads to GRACILE-like or Leigh-like condition. Assembly defects in complex III should be investigated in the affected tissues, since fibroblasts may not exhibit the deficiency.WoSScopu

Investigation of Behçet's Disease and Recurrent Aphthous Stomatitis Frequency: The Highest Prevalence in Turkey

Background: The Recurrent Aphthous Stomatitis (RAS) is the most frequently observed painful pathology of the oral mucosa in the society. It appears mostly in idiopathic form; however, it may also be related with systemic diseases like Behçet’s Disease (BD). Aims: Determining the prevalence of RAS and BD in the Northern Anatolian Region, which is one of the important routes on the Antique Silk Road. Study Design: Cross-sectional study. Methods: Overall, 85 separate exemplification groups were formed to reflect the population density, and the demographic data of the region they represent. In the first stage, the individuals, who were selected in random order, were invited to a Family Physician Unit at a certain date and time. The dermatological examinations of the volunteering individuals were performed by only 3 dermatology specialists. In the second stage, those individuals who had symptoms of BD were invited to our hospital, and the Pathergy Test and eye examinations were performed. Results: The annual prevalence of RAS was determined as 10.84%. The annual prevalence was determined to be higher in women than in men (p=0.000). It was observed that the prevalence was at the peak level in the 3rd decade, and then decreased proportionally in the following decades (p=0.000). It was also observed that the aphtha recurrence decreased in the following decades (p=0.048). The Behçet’s prevalence was found to be 0.60%. The prevalence in women was found to be higher than in men (0.86% female, 0.14% male; p=0.022). Conclusion: While the RAS prevalence ratio was at an average value when compared with the other societies; the BD prevalence was found as the highest ratio in the world according to the literature