Congenital Toxoplasmosis: A Case Study

Acute toxoplasmosis infections that develop during pregnancy can be detrimental to the developing fetus. Although the etiology may derive from various factors, the primary cause of these maternal infections is the consumption of contaminated meat or water. The transmission of the infection to the fetus may result in devastating neurological and ocular disorders. In this article, we present a case of congenital toxoplasmosis that occurred on the 3rd live birth of a 37 year old mother's 4th pregnancy. During the pregnancy, the mother received Spiramycin as she was (+) for Toxoplasma IgM. In the initial evaluation of the neonate, there were no findings associated with toxoplasmosis. A CSF (cerebrospinal fluid) sample was taken and the patient was followed-up, a re-evaluation was conducted as the patient's PCR analysis was positive; the diagnosis was confirmed by the presence of chorioretinitis and intracranial calcification. In conclusion, congenital toxoplasmosis is an insidious disease with a slow progression. Physical examination findings may not be apparent during the early neonatal period. These patients should be carefully examined, periodically followed up, and their bodily fluids should be tested

Enteral Feeding in Premature Infants

Neonatology practice has seen remarkable advancements in the past three decades. This has enabled the survival of premature infants born at smaller gestational weeks. Accordingly, the relatively high premature survival rate has lead to an increase in the incidence and severity of short-medium and long term morbidities. A critical approach in preventing such morbidities in premature infants is well-planned nutritional management. Application of proper feeding models that consider current premature problems as well as personal dynamics will provide significant short and long-term advantages for the infants' progression throughout life. This article discusses practical applications such as identifying the needs of premature infants during extrauterine life, choices in feeding practice, and adaptation of necessary interventions for current problems faced by infants

Clinical and Cytokine Profile of Children With COVID-19: A Report From Turkey

Background We aimed to analyze the expression of infection-related biomarkers and inflammatory cytokines in laboratory-confirmed cases and compare the differences between clinically severe and non-severe ones. Method We randomly selected 35 patients who were hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19). Blood serum was obtained at the time of admission to the hospital, on the third to the fifth day, and at the time of discharge. Result The median age of our patients was 56.5±69.7 months (range: 1-205 months). The mean pro-B-type natriuretic peptide (pro-BNP) was significantly higher at the time of admission than on the third to the fifth day of illness. The mean pro-B-type natriuretic peptide levels at three time points were significantly higher in patients with severe cases than in mild-moderate cases. However, there was no significant difference between the clinical severity with regard to the cytokine levels at disease onset and recovery. Conclusion In the study, it was shown that cytokines play an important role in the pathogenesis of COVID-19. Therefore, it may be beneficial to use agents such as tocilizumab in the treatment

Yenidoğan sepsisinde tam kan sayımı parametrelerinin tanısal değeri

Objective: This study was planned to determine whether complete blood count parameters and scores based on complete blood count can be used as a diagnostic marker in neonatal sepsis. Methods: This retrospective study included 70 patients with neonatal sepsis (Group 1) and 65 healthy neonates (Group 2) with similar age, sex, birth weight, and gestational age. The demographic data, blood culture results, clinical and laboratory findings were obtained from the medical records. Scores based on complete blood count such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), basophil-to-lymphocyte ratio (BLR) and monocyte-to-lymphocyte ratio (MLR) were calculated by dividing the number of neutrophils, platelets, eosinophils, basophils and monocytes by the number of lymphocytes, respectively. Results: There were no significant differences between the groups in terms of demographic characteristics such as age, gender, birth weight, type of delivery and gestational week. C-reactive protein level was significantly higher in the neonatal sepsis group (p 0.05). While NLR was significantly higher (2.19±1.39 vs 1.44±1.07, p<0.001), ELR was significantly lower (0.08±0.07 vs 0.09±0.05, p=0.007) in neonatal sepsis group. NLR was positively correlated while ELR, lymphocyte, platelet, eosinophil and monocyte counts were negatively correlated with CRP (p<0.05). According to the results of ROC curve analysis, CRP, NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts were significant parameters for the diagnosis of neonatal sepsis. Cut-off values were 6.09 mg/L for CRP (sensitivity 88.57%, specificity 100%, AUC: 0.964, p <0.001), 1.01 for NLR (sensitivity 78.57%, specificity 63.08%, AUC: 0.727, p <0.001, 0.079 for ELR (sensitivity 64.29%, specificity 56.92%, AUC: 0.634, p = 0.007), 4.66x109/L for neutrophil count (sensitivity 68.57%, specificity 61.54%, AUC: 0.683, p<0.001), 4.33x109/L for lymphocyte count (sensitivity 65.71%, specificity 60.00%, AUC: 0.668, p=0.001), 259.00x109/L for platelet count (sensitivity 62.86%, specificity 58.46%, AUC: 0.659, p=0.001), 0.27x109/L for neutrophil count (sensitivity 61.42%, specificity 69.23%, AUC: 0.708, p<0.001) and 1.33x109/L for monocyte count (sensitivity 62.86%, specificity 56.92%, AUC: 0.647, p=0.003) Conclusion: Although their sensitivities and specificities lower than CRP; NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts can be accepted as adjunctive data that contribute to the diagnosis of neonatal sepsis. In particular, NLR seems to be the most useful complete blood count parameter in the diagnosis of neonatal sepsis with the highest sensitivity and specificity

The bedside practice of sonographic guided internal jugular vein access in critically ill premature infants

BACKGROUND: Intrahospital transport, general anesthesia, and the prolonged duration of the central venous catheterization (CVC) in unfavorable conditions pose a significant risk to a critically-ill premature infant. We aimed to demonstrate a minimalized and safe manner of CVC in this patient population. METHODS: We worked on a prospective study in 51 critically-ill premature infants in which a 22 Gauge catheter was put in one of the central thoracic veins with the guidance of sonography as a bedside procedure. Of the patients, 27 (53%) were extremely premature, and 21 (41%) were extremely low birth weight infants (ELBW). The mean gestational age was 29±5 weeks, and the mean weight at the time of the procedure was 1655±1028 grams. While no anesthetic and sedative drugs were administered to ELBW infants during procedures, in the remainder of the cohort, procedures were carried out only under sedoanalgesia. RESULTS: Vascular access was achieved in 48 (94%) of the patients after a mean number of 1.47±0.75 attempts. Body heat loss of the patients at the end of the procedures was not statistically significant (P=0.164). However, ELBW infants lost their body heat significantly more than the rest of the cohort (P=0.032). We experienced clinically insignificant common carotid artery puncture in three patients and hemothorax in one patient. CONCLUSIONS: CVC of critically ill premature infants can be safely and successfully achieved in incubators using sonography guidance, protecting them from hypothermia and anesthetic drugs

Evaluation of cases with infantile hemangioma requiring treatment

Aim: Infantile hemangiomas are the most common benign vascular tumours in infants. In this study, we aimed to evaluate the effectiveness of propranolol therapy in patients with infantile hemangioma. Materials and methods: This study included patients with infantile hemangiomas in the age range of 0 to 24 months who received propranolol therapy between September 2015 and 2019. Hemangioma activity score, ultrasonography imaging and photographic evaluations were performed before and at 6 months of treatment. Parental satisfaction with the results of treatment was recorded. Results: Our study included 85 patients with infantile hemangioma requiring treatment. Twenty patients were boys and 65 were girls. The mean age at starting treatment was 7.2±5.9 months (median: 5.0). While the average lesion area measured by ultrasonography before treatment was 209.7±207.5 mm2, it reduced to 105.1±145.7 mm2 (p<0.001) after treatment. Similarly, while the mean hemangioma activity score was 3.8±0.9 before treatment, it decreased significantly to 1.3±0.8 after the treatment (p<0.001). A noticeable improvement in photographic evaluation with the treatment was observed in infantile hemangiomas of the patients and 82% of the families were satisfied with the results of the treatment. Conclusions: The results of the study suggested that propranolol therapy used in the treatment of infantile hemangioma is an effective treatment option according to the photographic comparison, ultrasonography data, and hemangioma activity score evaluations

Evaluation of cases with infantile hemangioma requiring treatment

Aim: Infantile hemangiomas are the most common benign vascular tumours in infants. In this study, we aimed to evaluate the effectiveness of propranolol therapy in patients with infantile hemangioma. Materials and methods: This study included patients with infantile hemangiomas in the age range of 0 to 24 months who received propranolol therapy between September 2015 and 2019. Hemangioma activity score, ultrasonography imaging and photographic evaluations were performed before and at 6 months of treatment. Parental satisfaction with the results of treatment was recorded. Results: Our study included 85 patients with infantile hemangioma requiring treatment. Twenty patients were boys and 65 were girls. The mean age at starting treatment was 7.2±5.9 months (median: 5.0). While the average lesion area measured by ultrasonography before treatment was 209.7±207.5 mm2, it reduced to 105.1±145.7 mm2 (p<0.001) after treatment. Similarly, while the mean hemangioma activity score was 3.8±0.9 before treatment, it decreased significantly to 1.3±0.8 after the treatment (p<0.001). A noticeable improvement in photographic evaluation with the treatment was observed in infantile hemangiomas of the patients and 82% of the families were satisfied with the results of the treatment. Conclusions: The results of the study suggested that propranolol therapy used in the treatment of infantile hemangioma is an effective treatment option according to the photographic comparison, ultrasonography data, and hemangioma activity score evaluations

Diagnostic value of complete blood count parameters in neonatal sepsis

Amaç: Bu çalışma tam kan sayımı parametrelerinin ve tam kan sayımına dayalı skorların yenidoğan sepsisinde tanısal biyo-belirteç olarak kullanılıp kullanılamayacaklarını belirlemek amacıyla planlanmıştır. Yöntemler: Retrospektif olarak planlanan bu çalışmaya, yenidoğan sepsisi tanısı almış 70 hasta (Grup 1) ve hasta grubuyla benzer yaş, cinsiyet, doğum ağırlığı ve doğum haftasında olan 65 sağlıklı yenidoğan (Grup 2) olarak çalışmaya alındı. Demografik veriler, kan kültürü sonuçları, klinik ve laboratuvar bulguları tıbbi kayıtlardan elde edildi. Nötrofil/lenfosit oranı (NLO), trombosit/lenfosit oranı (TLO), eozinofil/lenfosit oranı (ELO), bazofil/lenfosit oranı (BLO) ve monosit/lenfosit oranı (MLO) gibi tam kan sayımına dayalı skorlar, sırasıyla nötrofil, trombosit, eozinofil, bazofil ve monosit sayısının lenfosit sayısına bölünmesiyle hesaplandı. Bulgular: Yaş, cinsiyet, doğum tartısı, doğum şekli ve gebelik haftası gibi demografik özellikler bakımdan gruplar arasında fark yoktu (p>0,05). C-reaktif protein düzeyi yenidoğan sepsisi grubunda anlamlı olarak yüksekti (p0,05). NLO yenidoğan sepsisi grubunda anlamlı olarak yüksek iken (2,19±1,39 vs 1,44±1,07, p 0.05). While NLR was significantly higher (2.19±1.39 vs 1.44±1.07, p<0.001), ELR was significantly lower (0.08±0.07 vs 0.09±0.05, p=0.007) in neonatal sepsis group. NLR was positively correlated while ELR, lymphocyte, platelet, eosinophil and monocyte counts were negatively correlated with CRP (p<0.05). According to the results of ROC curve analysis, CRP, NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts were significant parameters for the diagnosis of neonatal sepsis. Cut-off values were 6.09 mg/L for CRP (sensitivity 88.57%, specificity 100%, AUC: 0.964, p <0.001), 1.01 for NLR (sensitivity 78.57%, specificity 63.08%, AUC: 0.727, p <0.001, 0.079 for ELR (sensitivity 64.29%, specificity 56.92%, AUC: 0.634, p = 0.007), 4.66x109/L for neutrophil count (sensitivity 68.57%, specificity 61.54%, AUC: 0.683, p<0.001), 4.33x109/L for lymphocyte count (sensitivity 65.71%, specificity 60.00%, AUC: 0.668, p=0.001), 259.00x109/L for platelet count (sensitivity 62.86%, specificity 58.46%, AUC: 0.659, p=0.001), 0.27x109/L for neutrophil count (sensitivity 61.42%, specificity 69.23%, AUC: 0.708, p<0.001) and 1.33x109/L for monocyte count (sensitivity 62.86%, specificity 56.92%, AUC: 0.647, p=0.003) Conclusion: Although their sensitivities and specificities lower than CRP; NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts can be accepted as adjunctive data that contribute to the diagnosis of neonatal sepsis. In particular, NLR seems to be the most useful complete blood count parameter in the diagnosis of neonatal sepsis with the highest sensitivity and specificity

The effect of natural surfactants on the development of postoperative intraabdominal adhesion

Background/aim: The development of postoperative adhesion after abdominal surgery is sometimes a severe problem. Our study investigates the effectiveness of exogenous surfactant application in preventing adhesion development in the experimental adhesion model. Materials and methods: This randomized-controlled interventional study was carried out in the animal laboratory of Kahramanmaraş Sütçü İmam University between March 1 and March 31, 2020. An experimental intra-abdominal adhesion model was established in 24 adult female rats by cecal abrasion. Rats were randomly divided into four groups. Groups I, II, and III were taken intraperitoneally as beractant, poractant, and calfactant applied groups, respectively. Group IV was the control group. Relaparotomy was performed in all groups on the 15th postoperative day, and intra-abdominal adhesions were scored macroscopically according to the Canbaz scoring system. In addition, the cecal regions were evaluated microscopically and scored according to the Zühlke microscopic classification system. The scores of the groups were compared statistically. Results: The Zühlke adhesion development score was significantly lower in the exogenous surfactant applied groups. In addition, when the surfactant-applied groups were compared among themselves, it was seen that the adhesion score in the beractant group was significantly better than the other surfactant types (p < 0.01). Conclusion: Our study results showed that prophylactic intraperitoneal surfactant application significantly reduced postoperative adhesion development, particularly beractant