White Tears: A Phenomenological Study of Perinatal Loss

Perinatal loss is a traumatic experience for parents. This research was conducted to evaluate the experiences and needs of parents after perinatal loss. An interpretative phenomenological study was carried out between January 2021 and July 2022 with 6 parental pairs (12 people in total, 6 mothers and 6 fathers) who experienced a perinatal loss. Participants were reached by snowball sampling method. Data were collected using semi-structured audio recording interviews that were transcribed and analyzed using thematic analysis. The themes of this study were determined as "attributing meaning to loss", "fragmented parenting roles and expectations", "changing relationships", "expectations from healthcare professionals", and "emotional responses". Five sub-themes were created from the emotional responses theme which included. These are sadness and pain, denial, anger, guilt and fear. In the study, it was concluded that the experience of perinatal loss may have negative consequences on the psychological health of the parents. Therefore, specific, professional, adequate nursing support and continuity of support are needed to help parents cope with perinatal losses.

Determining Knowledge and Opinions of Neonatal Intensive Care Unit Nurses on Wet-Nursing and Human Milk Banks: A Cross-Sectional Study in Türkiye

BACKGROUND

Wet nursing and human milk banks are vital sources of human milk for infants unable to breastfeed.

RESEARCH AIM

This study aims to determine the knowledge and opinions of neonatal intensive care unit nurses regarding wet-nursing and human milk banks in Türkiye.

METHODS

This descriptive cross-sectional study was conducted with 219 neonatal intensive care unit nurses using an online survey comprising 20 questions. The data were collected between August and September 2021.

RESULTS

Among the participants, 64.4% (n = 141) expressed that they would be a wet-nurse and 59.8% (n = 131) would search for a wet-nurse if necessary. Some, 47.0% (n = 103) of participants did not know if there were any human milk banks in Türkiye, 53.9% (n = 118) would like to be a donor if human milk banks were established, and 71.7% (n = 157) stated that the establishment of human milk banks should be supported. Religious concerns were the basis for reluctance to donate milk to human milk banks for 60% (n = 51) of the participants. Knowledge was greater and opinions about wet-nursing and human milk banks were more positive for participants with higher education, more time in the neonatal intensive care unit, or work at a tertiary care center.

CONCLUSION

The approaches of neonatal intensive care unit nurses towards personally being wet-nurses and milk sharing were generally positive, although more information about human milk banks is needed. Religious beliefs are an important consideration when providing information about milk sharing.

A quantum ruler for orbital magnetism in moiré quantum matter

For almost a century, magnetic oscillations have been a powerful "quantum ruler" for measuring Fermi surface topology. In this study, we used Landau-level spectroscopy to unravel the energy-resolved valley-contrasting orbital magnetism and large orbital magnetic susceptibility that contribute to the energies of Landau levels of twisted double-bilayer graphene. These orbital magnetism effects led to substantial deviations from the standard Onsager relation, which manifested as a breakdown in scaling of Landau-level orbits. These substantial magnetic responses emerged from the nontrivial quantum geometry of the electronic structure and the large length scale of the moiré lattice potential. Going beyond traditional measurements, Landau-level spectroscopy performed with a scanning tunneling microscope offers a complete quantum ruler that resolves the full energy dependence of orbital magnetic properties in moiré quantum matter.

Do Attitude, Awareness and Intention to Perform Female Genital Mutilation or Cutting for Their Daughters of Women Healthcare Providers Differ from Mothers in Somalia?

Aim

This study aimed to determine whether there were differences in attitude, awareness, and intention to perform female genital mutilation or cutting for their daughters in the future between female healthcare providers and mothers.

Methods

A comparative cross-sectional study design was used.

Results

A total of 508 women were included in the study. Of the participants, 68.7% (n = 349) were mothers (Group I) who visited the hospital and 31.3% (n = 159) were women healthcare professionals (Group II) [27% (n = 137) nurses and 4.3% (n = 22) doctors]. It was found that 8 (1.6%) of the participants did not have FGM/C and the FGM/C ratio was lower in group II (95%) than in group I (100%) (p < 0.001). In group I, 99.7% (n = 299) of the participants and 30.6% (n = 19) of those in group II reported intending to perform FGM for their daughters in the future (p < 0.001). The reasons for FGM/C most cited by participants were a traditional rite of passage into womanhood (78%), religious requirement (69.3%), and preservation of their virginity until marriage (59.3%). "Stop FGM" was given as a message on FGM/C by 60% of the participants (n = 79) who answered (n = 127, 100%) to open-ended questions.

Conclusion

The results of this study show that female health professionals with higher education and monthly income had less positive perception of their FGM/C and less intention to allow their daughters to undergo FGM/C.

Triangle technique: An effective tool for improving nursing students' ability to calculate safe pediatric medication dosages

Calculating the correct medication dosage for pediatric patients can be difficult for nurses to determine, as the pediatric dose is typically a small fraction of the adult dosage. This study aims to examine the impact of the Triangle Technique on the ability of nursing students to calculate low and high safe dosage ranges in children. To evaluate how this educational tool could improve a nurse's skill in this area, a quasi-experimental pre-/post-test research design was employed including one hundred fifty-eight third-year nursing students. The Pediatric Medication Administration Form and Pediatric Safe Dosage Calculations Quiz (PSDCQ) were used to measure the effectiveness of the Triangle Technique. While <50% (n < 79) of students gave correct answers to each question in PSDCQ before this intervention, all of the participants (N = 158, 100%) gave a correct answer to one question, and >89.2% (n > 141) of the students correctly answered the other four questions of PSDCQ. The change in scores (pre-PSDCQ median score = 0, IQR = 60; post-PSDCQ median score = 100, IQR = 0) post-intervention was statistically significant (z = 10.633, p ≤ .001), indicating that this teaching technique was effective for improving students' ability to calculate pediatric safe dose ranges. Nursing students (n = 144, 91.1%) were satisfied with using Triangle Technique. Using the Triangle Technique can increase nursing students' understanding of how they calculate safe pediatric medication dosages.

Development of a Sensitive Method for Cadmium Determination in Fish Tissue and Drinking Water Samples by FAAS Using SQT In Situ Atom Trapping

A sensitive and robust trap method was developed for the determination of cadmium (Cd) by using a slotted quartz tube. Using this method at a sample suction rate of 7.4 mL/min for 4.0 min collection, a 1467-fold increase in sensitivity was obtained compared to the flame atomic absorption spectrometry method. Under the optimized conditions, a limit of detection of 0.075 ng mL^-1 was obtained for the trap method. The interference effects of hydride-forming elements, transition metals, and some anions on the Cd signal were investigated. The developed method was evaluated by analyzing "Sewage Sludge-industrial origin (BCR no: 146R)", "NIST SRM 1640a Trace elements in natural water", and "DOLT: 5 Dogfish Liver". There was a good agreement between the certified and found values at the 95% confidence level. This method was applied successfully for the determination of Cd in drinking water and some fish tissue samples (liver, muscle, and gill) obtained from Muğla province.

Quantifying the impact of COVID-19 on immigration in receiving high-income countries

Previous studies have examined the impact of COVID-19 on mortality and fertility. However, little is known about the effect of the pandemic on constraining international migration. We use Eurostat and national statistics data on immigration and ARIMA time-series models to quantify the impact of COVID-19 on immigration flows in 15 high-income countries by forecasting their counterfactual levels in 2020, assuming no pandemic, and comparing these estimates with observed immigration counts. We then explore potential driving forces, such as stringency measures and increases in unemployment moderating the extent of immigration change. Our results show that immigration declined in all countries, except in Finland. Yet, significant cross-national variations exist. Australia (60%), Spain (45%) and Sweden (36%) display the largest declines, while immigration decreased by between 15% and 30% in seven countries, and by less than 15% in four nations where results were not statistically significant. International travel restrictions, mobility restrictions and stay-at-home requirements exhibit a relatively strong relationship with declines in immigration, although countries with similar levels of stringency witnessed varying levels of immigration decline. Work and school closings and unemployment show no relationship with changes in immigration.

Projections of adult skills and the effect of COVID-19

In this paper, we project Skills in Literacy Adjusted Mean Years of Schooling (SLAMYS) for the working age population in 45 countries and quinquennial time periods until 2050 according to various population scenarios. Moreover, we integrate the effect of school closures due to the COVID-19 pandemic on these projections. Adult skills are projected using the cohort components method. They can help in assessing the potential consequences of the recent trends for the adult population, particularly the workforce, whose skills are essential for the jobs contributing to economic growth and development outlooks. Our projections are novel as they take into account both the amount of schooling and quality of education and also consider the changes in adult skills through lifetime. Projections show that the adult skills gap between countries in the Global North and countries in the Global South will likely continue to exist by 2050, even under very optimistic assumptions-but may widen or narrow depending on the demographic development trajectories specific to each country. Moreover, the loss of learning due to school closures during the COVID-19 pandemic further exacerbates inequalities between countries. Particularly, in countries where schools have been closed for a prolonged period of time and the infrastructure for effective online schooling is lacking, the skills of cohorts who were in school during the pandemic have been severely affected. The fact that the duration of school closures has been longer in many low- and middle-income countries is a serious concern for achieving global human capital equality. The impact of the COVID-19 pandemic is projected to erase decades-long gains in adult skills for affected cohorts unless policies to mitigate learning loss are implemented immediately.

Effects of comorbid disorders on reward processing and connectivity in adults with ADHD

ADHD is a neurodevelopmental disorder with a long trajectory into adulthood where it is often comorbid with depression, substance use disorder (SUD) or obesity. Previous studies described a dysregulated dopaminergic system, reflected by abnormal reward processing, both in ADHD as well as in depression, SUD or obesity. No study so far however tested systematically whether pathologies in the brain's reward system explain the frequent comorbidity in adult ADHD. To test this, we acquired MRI scans from 137 participants probing the reward system by a monetary incentive delay task (MIDT) as well as assessing resting-state connectivity with ventral striatum as a seed mask. No differences were found between comorbid disorders, but a significant linear effect pointed toward less left intrastriatal connectivity in patients depending on the number of comorbidities. This points towards a neurobiologically impaired reward- and decision-making ability in patients with more comorbid disorders. This suggests that less intrastriatal connectivity parallels disorder severity but not disorder specificity, while MIDT abnormalities seem mainly to be driven by ADHD.

Excessive screen time and lower psychosocial well-being among preschool children

OBJECTIVE

Too much screen time is a common and severe threat to child health and excessive screen exposure exists in the early childhood population in Turkey. We aimed to investigate the associations between excessive screen time and psychosocial well-being in a sample of Turkish preschool children.

METHODS

Mothers and their healthy children aged 2-5 years who applied to general pediatric outpatient clinics for well-child examinations were enrolled in this descriptive cross-sectional study. Children with a daily screen time of less than 1 h (low) or more than or equal to 4 h (excessive) were included. Psychosocial well-being was assessed using the parent version of the Strengths and Difficulties Questionnaire.

RESULTS

In all, 220 mother-child pairs participated in this study. Emotional symptoms, conduct problems, peer relationship problems, and total difficulties scores were significantly higher in the children with excessive screen time (p<0.05), while the hyperactivity-inattention and prosocial scores were not different between the low and excessive screen time groups (p>0.05). After adjusting for potential confounders, the children with excessive screen time had significantly increased odds ratios for having conduct and peer relationship problems (OR [95% CI]: 2.62 [1.11-6.19], p = 0.028 and 2.57 [1.25-5.26], p = 0.010, respectively).

CONCLUSION

Turkish preschool children with excessive screen time were significantly more likely to have poor psychosocial well-being. Preschool children with behavioral problems should be evaluated for excessive screen time.

Evaluation of the metal concentrations of wild mushroom species with their health risk assessments

The ability of mushrooms to accumulate heavy metals has increased concerns over their toxic effects on human health in recent years. The aim of this study was to determine the metal contents (Zn, Fe, Co, Mn, Cu, Pb, Ni, and Cd), daily intake of metal (DIM) and health risk index (HRI) values of nineteen different mushroom species (edible, inedible, and poisonous) collected from Uzungol, Trabzon (Turkey). Although the area where mushrooms were collected has the status of "Natural Park," there has been an excessive human settlement in recent years. Elemental analyses have shown that Fe, Mn, Cu, Zn, Co, Cd, Pb, and Ni concentrations in mushrooms were in the following ranges: 49.0-1713.0, 3.0-425.0, 3.0-154.0, 16.0-134.0, 0.17-1.79, 0.28-7.88, 0.07-5.68, and 0.24-6.82 mg/kg dry weight, respectively. As a result of DIM analysis, while it was determined that the daily consumption of Hygrophorus pudorinus, Meripilus giganteus, and Sarcodon imbricatus was safe for all the metals examined, HRI analysis showed that only M. giganteus and S. imbricatus can be consumed safely. The content of Cd was found to be above the legal limits determined by the competent authorities. According to Pearson correlation analysis, the correlations between Fe-Pb, Cu-Zn, Cd-Co, Pb-Co, Cd-Fe, Co-Fe, Cd-Pb, and Fe-Mn pairs were statistically significant (p < 0.01). Although the data obtained from this study did not provide clear data on environmental pollution in the area where the samples were collected, it was concluded that the competent authorities should take measures regarding possible environmental pollution at this location.

HIV care in Istanbul, Turkey: How far is it from the UNAIDS 90-90-90 targets?

The prevalence of human immunodeficiency virus (HIV) infection is low but it is steadily increasing in Turkey. In the current study, we aimed to assess the status of HIV infection management with the proposed 90–90–90 targets in a large HIV cohort in Istanbul, Turkey. The cohort included 2382 patients (2082 male, 300 female, mean age was 36.3 ± 11.3 years). Mean CD4 cell count was 399 cells/mm3 and HIV-RNA level was 576,235 copies/ml. According to the modeling by the Modeling tool of European Center for Diseases Control Software, 72 and 74% of all HIV patients had been diagnosed in 2016 and 2017, respectively (the first target). Among 2382 patients, 2191 (92%) were on antiretroviral therapy (the second target). The third target of virally suppressing those on treatment was achieved among 70.2% of the patients. The current study suggests that both the fraction of those living with undiagnosed HIV and the proportion of those on treatment who are virally suppressed should be targeted to sustain optimal HIV care. Efforts should continue to surpass the targets of 90–90–90.

Mechanical dissipation via image potential states on a topological insulator surface

Joule energy loss due to resistive heating is omnipresent in today's electronic devices whereas quantum-mechanical dissipation is largely unexplored. Here, we experimentally observe a suppression of the Joule dissipation in Bi₂Te₃ due to topologically protected surface states. Instead, a different type of dissipation mechanism is observed by pendulum atomic force microscopy, which is related to single-electron tunnelling resonances into image potential states that are slightly above the Bi₂Te₃ surface. The application of a magnetic field leads to the breakdown of the topological protection of the surface states and restores the expected Joule dissipation process. Nanomechanical energy dissipation experienced by the cantilever of the pendulum atomic force microscope provides a rich source of information on the dissipative nature of the quantum-tunnelling phenomena on the topological insulator surface, with implications for coupling a mechanical oscillator to the generic quantum material.

The Differences Between Preterm and Term Birth Affecting Initiation and Completion of Toilet Training Among Children: A Retrospective Case-Control Study

PURPOSE

This study seeks to investigate the possibility the existence of a difference in terms of start and end dates of toilet training between term and preterm children as well as the possible determining factors.

MATERIALS AND METHODS

This study was conducted as a 5-year retrospective case (children born preterm-(32 to <37 weeks) - and control (children born at term (>37 weeks + 1 day)) study. The data were collected with a form consisted of questions about demographic data (12 questions) and toilet traning features (10 questions) through face-to-face interviews with the mothers. A chi-square test and logistic regression analysis were conducted to examine the data. Odds ratio was used as a measure of the relation between levels of the dependent variable. p< .01 and p< .05 values were assumed to be statistically significant.

RESULTS

The study examined a total of 133 children including 59 preterm children and 74 children born at term including 60 (45.1%) boys and 73 (54.9%) girls. The possibility of starting toilet training at or before 24 months was found to be 6.4 times greater in full-term children than preterm children (OR=6.493). The logistic regression analysis, which aimed at identifying any variables that might affect end date of toilet training, found that despite the tendency to consider preterm   birth as a factor prolonging the duration of toilet training, the difference was not found to be statistically significant (p= .07).

CONCLUSION

This study compared full-term and preterm children in terms of start and end dates of toilet training and found that preterm children start toilet training later than full-term children. Based on the results of the study, it is possible to say that preterm birth, gender and birth order affect start date of toilet training. However there is no difference between term and preterm babies on the end date of toilet training.

Assessment of the 24th Week Success of Anti-Retroviral Therapy in the Action against HIV in Istanbul Database: Results from a Region with Increasing Incidence

We aimed to assess the 24-week virological and immunological success of the treatment of treatment-naive and treatment-experienced patients included in the Action against HIV in Istanbul (ACTHIV-IST) database. The ACTHIV-IST database was screened retrospectively from January 2012 to January 2014. The data for these patients such as age, sex, treatment-naive or treatment-experienced status, date of diagnosis, date of commencing antiretroviral therapy, antiretroviral therapy regimen, CD4+ cell count, and viral load before and after therapy were analyzed. In the 24th week of antiretroviral therapy, there were 40 (17.9%) and 29 (14.1%) virological and immunological failures, respectively. Virological failure (VF) was associated with a baseline viral load > 100,000 copies (p = 0.004). A CD4+ cell count lower than 200 cells/μl was not found to be associated with VF (p = 0.843). Immunological failure was substantially rare in patients with a baseline CD4+ cell count > 200 cells/μl (p = 0.005). Although an HIV-RNA ≤ 100,000 copies/ml was protective against VF in the 24th week, in individuals with an HIV-RNA > 100,000 copies/ml, VF was 3.2 times more likely to occur. Baseline VF was the most predictive parameter to estimate 24th week virological success and VF. VF is an important prognostic parameter resulting in CD4+ cell depletion, AIDS-related events, and increased mortality.

A novel assessment tool for clinical care of patients with autoinflammatory disease: juvenile autoinflammatory disease multidimensional assessment report

OBJECTIVES

To develop and test a new multidimensional questionnaire for assessment of children with auto-inflammatory disease (AID) such as FMF, PFAPA, HIDS, TRAPS in standard clinical care.

METHODS

The juvenile auto-inflammatory disease multidimensional assessment report (JAIMAR) includes 16 parent or patient-centered measures and four dimensions that assess functional status, pain, therapeutic compliance and health-related quality of life (physical, social, school, emotional status) with disease outcome. It is proposed for use as both a proxy-report and a patient self-report, with the suggested age range of 8-18 years for use as a self-report.

RESULTS

250 children with FMF were included in the study. Total of 179 forms were filled up by parents and patients, and 71 forms were filled up by parents having children less than 8 years. Completing and scoring the JAIMAR can be done in 15 minutes. For the JAIMAR's dimensions, the Cronbach's alpha coefficient for internal consistency was between 0.507-0.998. There was a significant and a positive correlation between the test-retest scale scores (ICC=0.607-0.966). Concerning construct validity, all factors loadings were above 0.30. For the criterion validity, the correlation level between each dimension and the related scale ranged from medium (r=0.329, p<0.0001) to large (r=0.894, p<0.0001). The parents' proxy-reported and children's self-reported data were outstandingly concordant (r=0.770-0.989).

CONCLUSIONS

The development of the JAIMAR introduces a new and multi-dimensional approach in paediatric rheumatology practice. It is a new tool for children with auto-inflammatory dis-ease and it may help enhance their quality of care.

Changes in HIV demographic patterns in a low prevalence population: no evidence of a shift towards men who have sex with men

OBJECTIVES

This study aimed to examine the changes in HIV demographics over time in an exceptionally low prevalence population, with particular emphasis on men who have sex with men (MSM).

METHODS

A total of 1292 newly diagnosed HIV-positive patients registered in the ACTHIV-IST Study Group database between 2000 and 2014 were included. The changes occurring over time in the characteristics of patients at the time of initial admission were examined retrospectively.

RESULTS

A gradual increase in the total number of newly diagnosed patients was evident during the study period; however, it was not possible to show an increase in the proportion of MSM within the study population (p=0.63). There was a male predominance throughout the study (85% vs. 15%), with further increases in the proportion of males in recent years. The mean age was lower at the end of the study (p<0.05) and there was an increase in the number of unmarried patients (p<0.05).

CONCLUSIONS

Sexual preference patterns of HIV patients in extremely low prevalence populations may be different, possibly due to an early phase of the epidemic. Nevertheless, MSM still represent a target subgroup for interventions, since they account for a substantial proportion of cases and a resurgent epidemic may be expected among this group in later phases of the epidemic.

Effectiveness of the training material in drug-dose calculation skills

AIM

The aim of study was to evaluate the effectiveness of the training material based on low-level environmental fidelity simulation in drug-dose calculation skills in senior nursing students.

METHODS

A quasi-experimental design with one group. The sample included senior nursing students attending a nursing school in Turkey in the period December 2012-January 2013. Eighty-two senior nursing students were included in the sample. Data were obtained using a data collection form which was developed by the researchers. A paired-sample t-test was used to compare the pretest and post-test scores.

RESULTS

The difference between the mean pretest score and the mean post-test score was statistically significant (P < 0.05).

CONCLUSION

This study revealed that the training material based on low-level environmental fidelity simulation positively impacted accurate drug-dose calculation skills in senior nursing students.

Epidemiological profile of naive HIV-1/AIDS patients in Istanbul: the largest case series from Turkey

The aim of the study was to report the epidemiological profile of HIV-1 positive patients from, Istanbul, Turkey, which has one of the lowest HIV-1/AIDS prevalences in Europe. The patients were followed by ACTHIV-IST group which was established by the Infectious Diseases Departments of five teaching hospitals (three university hospitals and two public hospitals) in Istanbul, Turkey. The HIV-1 positive patients were added to the standard patient files in all of the centers; these files were then transferred to the ACTHIV-IST database in the Internet. A total of 829 naiv-untreated HIV-1 positive patients were chosen from the database. The number of male patients was 700 (84.4%) and the mean age of the patients was 37 years (range, 17-79). In our study group 348 (42%) of the patients were married and 318 (38.7%) of the patients were single. The probable route of transmission was heterosexual intercourse in 437 (52.7%) patients and homosexual intercourse in 256 (30.9%) patients. In 519 (62.6%) patients the diagnose was made due to a screening test and in 241 (29.1%) patients, the diagnose was made due to an HIV-related/non-related disease. The mean CD4+ T cell number in 788 of the patients was 357.8/mm(3) (±271.1), and the median viral load in 698 of the patients was 100,000 copies/mL (20-9,790,000). In Turkey, the number of HIV-1 positive patients is still low and to diagnose with a screening test is the most common way of diagnostic route.

The invisible part of the iceberg: qualitative aspects of childhood vasculitis

OBJECTIVES

The aim of this study was to develop a multidimensional assessment instrument named 'Juvenile Vasculitis Multidimensional Assessment Report' (J-VAMAR) to measure all the domains of the vasculitis. In this qualitative study, it is primarily aimed to enrich the item generation for the J-VAMAR.

METHODS

Twelve children with vasculitis and their mothers (n=12) were enrolled in this study. The data were collected using both a demographic data form and a semi-structured interview form. The study was performed on individual patient face-to face interview. Data were analysed by grounded theory and the N Vivo 9 software program.

RESULTS

Four categories were obtained. These categories were (i) physical effects of the illness, (ii) emotional effects of the illness, (iii) social effects of the illness and (iv) experienced challenges related to treatment process. In the physical effect category severe pain, physical limitations, weakness and fatigue; in emotional effect category thought of death, hopelessness and dissatisfaction about body image; in the social effects category decrease in academic performance, absenteeism to school and concealing the sickness from friends were the most common features. In the fourth category, subjects complained of lifelong drug use and frequency of daily drug consumptions.

CONCLUSIONS

These results provide evidence-based data for the assessment of children with vasculitis by several domains including physical, emotional and social aspects as well as treatment protocols. The study provides the basis and/or justification for selecting the domains that the developing multidimensional instrument should include.

Crigler-Najjar syndrome type I in a Turkish newborn caused by a novel mutation and Gilbert type genetic defect

Crigler-Najjar syndrome (CNS), caused by deficiency of bilirubin uridine diphosphate glucuronosyltransferase (UGT) 1A1, is a rare and autosomal recessive inherited disorder characterized by severe unconjugated nonhemolytic hyperbilirubinemia since birth. We present a girl with CNS type I caused by a novel mutation and Gilbert type genetic defect. Gilbert's Syndrome (GS) and CNS type I both involve abnormalities in bilirubin conjugation secondary to deficiency of bilirubin UGT. The combined defects even in benign genetic forms were shown to cause more serious clinical disease. The patient has been treated with daily home-based phototherapy for more than nine months and considered as a candidate for liver transplantation.

Observational study comparing long-term safety and efficacy of Deferasirox with Desferrioxamine therapy in chelation-naïve children with transfusional iron overload

OBJECTIVES

An observational study was conducted to explore postmarketing safety and efficacy of Deferasirox (DFX) in comparison with conventional Desferrioxamine (DFO) in chelation-naïve children with transfusional iron overload.

METHODS

Transfusion-dependent children (aged ≤ 5 yr) who had serum ferritin above 1000 μg/L and had been prescribed either first-line DFX or DFO for at least 12 months to maintain serum ferritin between 500 and 1000 μg/L were included. Initial DFX dose was 20 mg/kg/d for 7 d a week, and DFO dose was 25-35 mg/kg/d subcutaneously, given for 5 d a week. Dose adjustments were based on serum ferritin changes and safety markers. The primary efficacy endpoint was change in serum ferritin from baseline. The effect of transfusional iron loading rate (ILR) and different doses of chelators on serum ferritin was also assessed.

RESULTS

A total of 111 patients were observed for a median of 2.29 yr on DFX (n = 71) and 2.75 yr on DFO (n = 40). Absolute change in serum ferritin from baseline to the last available observation was not significant with DFX (91 μg/L, P = 0.5) but significantly higher with DFO (385 μg/L, P < 0.005). ILR and DFX doses had a major impact on serum ferritin changes in DFX cohort. The height- and weight-standard deviation scores did not differ significantly in both cohorts during the study. Fluctuations in liver enzymes and non-progressive increase in serum creatinine were the most common adverse events (DFX; 9.8%, 18.0% and DFO; 5.0%, 7.5%, respectively).

CONCLUSION

DFX is well tolerable and at least as effective as DFO to maintain safe serum ferritin levels and normal growth progression in chelation-naïve children.

The relationship between the myocardial T2* value and left ventricular volumetric and functional parameters in thalassemia major patients

PURPOSE

Cardiac involvement in thalassemia major (TM) is mainly characterized by left ventricular dysfunction caused by iron overload. Cardiovascular magnetic resonance imaging (MRI) including myocardial T2* measurement is becoming increasingly popular for quantitatively evaluating myocardial iron overload. The aim of this study was to evaluate the relationship between the myocardial T2* value and left ventricular functional parameters and to examine the associations between the degree of cardiac iron load and various clinical parameters.

MATERIALS AND METHODS

A retrospective analysis of 47 patients (25 males and 22 females; mean age, 23.0±5.4 years) with TM was performed. Myocardial iron load was assessed by T2* measurements, and volumetric functions were analyzed using the steady state free precession sequence. RESULTS In patients with myocardial iron deposition (T2* < 20 ms), the mean left ventricular ejection fraction (LVEF) was 64.73±4.94%. The LVEF of patients with myocardial siderosis was significantly lower than that of patients without myocardial siderosis (r=0.35, P = 0.014). Inverse and significant correlations between both the left ventricular (LV) end-systolic volume index and the LV end-diastolic volume index and the myocardial T2* value (r=-0.32, P = 0.027 and r=-0.29, P = 0.046, respectively) were observed. There was an inverse correlation between the myocardial T2* value and the liver iron concentration (r=-0.31, P = 0.037). Cardiac T2* was not associated with serum ferritin levels, pre-transfusion hemoglobin levels or the annual red cell consumption rate.

CONCLUSION

Myocardial iron load assessed by cardiac MRI (T2*) is associated with deterioration in left ventricular function. Thalassemia major patients with myocardial siderosis may have LVEF values within normal limits, but this result must be interpreted cautiously.

The relationship between the myocardial T2* value and left ventricular volumetric and functional parameters in thalassemia major patients

PURPOSE

Cardiac involvement in thalassemia major (TM) is mainly characterized by left ventricular dysfunction caused by iron overload. Cardiovascular magnetic resonance imaging (MRI) including myocardial T2* measurement is becoming increasingly popular for quantitatively evaluating myocardial iron overload. The aim of this study was to evaluate the relationship between the myocardial T2* value and left ventricular functional parameters and to examine the associations between the degree of cardiac iron load and various clinical parameters.

MATERIALS AND METHODS

A retrospective analysis of 47 patients (25 males and 22 females; mean age, 23.0±5.4 years) with TM was performed. Myocardial iron load was assessed by T2* measurements, and volumetric functions were analyzed using the steady state free precession sequence. RESULTS In patients with myocardial iron deposition (T2* < 20 ms), the mean left ventricular ejection fraction (LVEF) was 64.73±4.94%. The LVEF of patients with myocardial siderosis was significantly lower than that of patients without myocardial siderosis (r=0.35, P = 0.014). Inverse and significant correlations between both the left ventricular (LV) end-systolic volume index and the LV end-diastolic volume index and the myocardial T2* value (r=-0.32, P = 0.027 and r=-0.29, P = 0.046, respectively) were observed. There was an inverse correlation between the myocardial T2* value and the liver iron concentration (r=-0.31, P = 0.037). Cardiac T2* was not associated with serum ferritin levels, pre-transfusion hemoglobin levels or the annual red cell consumption rate.

CONCLUSION

Myocardial iron load assessed by cardiac MRI (T2*) is associated with deterioration in left ventricular function. Thalassemia major patients with myocardial siderosis may have LVEF values within normal limits, but this result must be interpreted cautiously.

Scanning electron microscopic features of the ovine interdigital sinus

This article describes the scanning electron microscopic (SEM) features of the ovine interdigital sinus. The lumen was filled with a dense secretory material and quite a number of hairs embedded in the luminal content. For SEM purposes, the sinus was divided into three parts: base, body and neck. At the cut surface, the wall exhibited significant folds which were almost absent in the base, the very short blind end of the sinus. The wall had three layers: epidermis, dermis and fibrous capsule. Stratified epithelium with a prominent keratin layer faced the lumen. The inner surface was similar to the skin surface; however, it was coarser due to folds. The fibrous capsule was composed mainly of dense connective tissue, constituting the outermost layer of the wall. The dermis contained common skin structures including sebaceous glands, hair follicles, arrector pili muscles and apocrine glands. Sebaceous glands appeared as groups of bubbles if they were not collapsed. Apocrine glands generally appeared as a group of coiled tubules. They frequently exhibited apocrine blebs, which is a feature of apocrine secretion. SEM was able to locate some secretory vesicles in the lumen of apocrine tubules which is frequently filled by secretory content. Thus, the apocrine tubules exhibited classical features of apocrine secretion.

The Scanning Electron and Light Microscopic Structure of Bovine Tactile Hair

Bovine tactile hairs in skin samples from the lateral side of the upper lip were examined using scanning electron and light microscopy. The root of these hairs has a variable length and is surrounded by a large sinus located between the internal and the external dermal sheath. With a prominent thickness, the external dermal sheath forms the external wall of the tactile hair and contains many nerves some of which extend into trabeculae. Trabeculae projecting from the internal dermal sheath and attaching to the external dermal sheath with two or more branches are present in the entire sinus. The trabeculae are interconnected by connective tissue sheets that support the integrity of the trabecular organization. The sinus surfaces as well as trabeculae are lined by endothelia. As a result, the bovine tactile hair is truly a cavernous type of tactile hair with a well organized microscopic anatomy. Thus, the bovine tactile hair most likely plays an important role in relatively immobile and insensitive bovine lips.