Troponin-T value as a prognostic marker in neonates diagnosed with neonatal encephalopathy and receiving hypothermia treatment

OBJECTIVE

The aim of this study was to investigate the effect of Troponin-T levels on the prognosis of neonatal encephalopathy (NE).

PATIENTS AND METHODS

The study included one hundred and eleven newborns diagnosed with NE and receiving hypothermia treatment. The cases were separated into 2 groups according to the SARNAT classification as Stage 2 or Stage 3. The groups were compared in respect of anthropometric characteristics, APGAR scores, and biochemical parameters. The cases were also separated into 3 groups according to the Troponin-T levels and were compared with respect to the clinical course.

RESULTS

The serum Troponin-T (p=0.012), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p<0.0001), and lactate levels (p=0.04) in the Sarnat Stage 3 group were statistically significantly higher than in the Sarnat stage 2 group. A significant positive correlation was determined between the Troponin-T level and the total duration of respiratory support (r=0.20, p=0.03). A significant positive correlation was determined between the ALT/AST ratio and the length of stay in hospital (r=0.29, p=0.001), duration of intubation (r=0.32, p=0.01), and total duration of respiratory support (r=0.36, p<0.001). A statistically significant difference was determined in mortality rates between the 3 subgroups of Troponin-T levels; Group 1: 2.8%, Group 2:5.4%, and Group 3: 15.8%. (p=0.04, χ²=4.74). A cut-off value of 164 ng/L for Troponin-T was determined to predict mortality with 77% sensitivity and 67% specificity (AUC=0.73, p=0.023). When the groups were compared according to Troponin-T level, a statistically significant difference was determined in respect of length of stay in hospital (p=0.03, χ²=6.95) and total duration of oxygen support (p=0.01, χ²=9.12).

CONCLUSIONS

The serum Troponin-T level can be evaluated as a prognostic marker in cases followed up with a diagnosis of NE and receiving hypothermia treatment. There is a need for further prospective studies with larger samples on this subject.

Cytokine release syndrome in Crimean-Congo hemorrhagic fever: can IL-1 receptor antagonist levels be a guide in its treatment?

OBJECTIVE

Crimean-Congo Hemorrhagic Fever (CCHF) is a potentially fatal zoonotic viral disease involving fever and hemorrhage. Our aim was to investigate the relationship between interleukin (IL)-1 and IL-1 receptor antagonist (RA) levels in patients with CCHF and the course of the disease and mortality, as well as to contribute to the literature at a time when new therapeutic protocols are being investigated.

PATIENTS AND METHODS

Sixty-one patients with CCHF were admitted to our hospital's infectious diseases ward between March and September 2022, and 40 healthy people were included in the control group in our study. The patients were divided into mild/moderate (n=35) and severe (n=26) CCHF groups depending on the clinical course. The patients with CCHF were also divided into surviving and exitus groups. IL-1 and IL-1RA levels were measured from blood specimens using the ELISA method.

RESULTS

Significant elevation in IL-1 and IL-1RA levels was observed in CCHF cases with a severe manifestation compared to those with moderate disease. Both patient groups' IL-1 and IL-1RA levels were also significantly higher than those of the control group. In addition, IL-1 and IL-1RA levels were significantly higher among the exitus patients compared to the surviving CCHF patients. The laboratory values of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine phosphokinase (CK), platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were also significantly higher among the patients with severe manifestations compared to the moderate severity patient group, and in the exitus patients compared to the survivors. However, platelet count and fibrinogen levels were lower in the patients with a severe manifestation compared to the moderate severity group and in the exitus patients compared to the survivors. White blood cells (WBC) were higher in exitus patients than in survivors.

CONCLUSIONS

IL-1 and IL-1RA levels were elevated in all the CCHF patients, while the higher values in patients with a fatal course suggest that the inflammatory process is very severe and that IL-1 receptor antagonists may be needed in the treatment.

Sleep quality and glycemic control in children and adolescents with type 1 diabetes mellitus

OBJECTIVE

This study aimed to investigate the frequency of sleep disorders, and the relationship between glycemic control and sleep characteristics in diabetic children and adolescents.

PATIENTS AND METHODS

Sixty-one patients followed for at least one year for type 1 diabetes mellitus (T1DM) aged 6-16 years old, and eighty-three group-matched healthy controls were included in the study. Time in range (TIR) and hypoglycemia episode numbers were recorded using the freestyle libre sensor data. The sleep characteristics were evaluated using the Sleep Disturbance Scale for Children (SDSC) validated survey. The diabetic patients were trichotomized according to SDSC scores, as low, medium, and high score groups.

RESULTS

Sleep duration, SDSC total score, and subgroup scores except for sleep hyperhidrosis (3.11±1.53 vs. 2.16±0.85, p<0.001, respectively) were similar (p>0.05) between the diabetic and control group. According to the survey, 1.6% of diabetic cases and 6.1% of the control group had clinically significant sleep disturbances (p>0.05). Duration of diabetes (DD) was lower (p=0.01), and the level of HbA1C was higher (p=0.02) in the high-score group than the others. Regression analysis revealed that TIR was the only independent determinant for the SDSC score (β=-1.27, t=-1.90; p=0.012).

CONCLUSIONS

Sleep habits and problems should be routinely evaluated in diabetic children and adolescents.

Influence of resveratrol application with pulp-capping materials on the genetic expression levels of stem cells

AIM

To evaluate in a laboratory setting the response of human mesenchymal stem cells (MSCs) to pulp-capping materials with and without resveratrol (RSV).

METHODOLOGY

Five materials, Calcimol LC, Life, TheraCal LC, ProRoot MTA and Biodentine, were prepared according to the manufacturers' instructions. Human MSCs were then exposed to these materials, with and without RSV, for 24 h (n = 8). Cell viability was evaluated using the MTT assay, and total cell death was quantified by annexin V-FITC staining with flow cytometry. The expression levels of the IL-8, IL-10, HBD-2 and BCL-2 genes were investigated using real-time polymerase chain reaction (RT-PCR). Data obtained from MTT test were analysed using one-way anova, and Tukey's multiple-comparison test. The paired Student t test was employed to compare the effects of materials on gene expression (significance level of 5%).

RESULTS

The group cell viabilities were Calcimol LC 53%, Life 43%, TheraCal LC 78%, ProRoot MTA 75% and Biodentine 78%. Calcimol LC and Life exhibited significant differences compared with the control groups (P < 0.05). The percentages of necrotic/late apoptotic cells associated with Calcimol LC and TheraCal LC were greater than in the other materials. However, when RSV was added to wells containing materials, cell viability increased to Calcimol LC 63%, Life 52%, TheraCal LC 82%, ProRoot MTA 91% and Biodentine 96%, and the percentages of early apoptotic and late apoptotic/necrotic cells decreased. Calcimol LC + RSV and Life + RSV differed significantly from the control group (P < 0.05). The expression of IL-8 gene was high for all materials, ProRoot MTA caused significant overexpression, and the addition of RSV reduced the expression of IL-8 in the Calcimol LC, TheraCal LC and ProRoot MTA groups and led to increased expression of IL-10 in the Calcimol LC, Life and Biodentine groups. HBD-2 and BCL-2 exhibited increased expression in ProRoot MTA with RSV (P < 0.05).

CONCLUSIONS

The addition of RSV exerted a protective effect on MSCs and regulated the inflammatory process by altering the expression levels of pro- and anti-inflammatory genes.

Childhood pneumococcal meningitis: may it begin with diarrhea and proceed with cerebral infarct?

Pneumococcal meningitis does continue to be an important cause of mortality and morbidity in childhood despite widespread vaccination. It develops thorough invasion of the meninges by the agent via bloodstream. It may manifest typical signs of meningeal irritation and even the symptoms not belonging to the central nervous system, such as diarrhea. The diagnosis is made by microscopic evaluation and culture of cerebrospinal fluid (CSF) obtained by lumbar puncture. Despite the treatment, the risk of occurrence of cerebral and neurologic complications is high. A two-month old baby girl was presented to our outpatients' clinic because of fever and diarrhea; she was diagnosed with pneumococcal meningitis and developed cerebral infarct during surveillance. The reason why we presented this patient is to highlight that meningitis due to pneumococ, one of the most common causing agents in childhood meningitis, may have clinical presentations other than expected. Key words: Pneumococcal meningitis; cerebral infarct; infant.  DOI: 10.3329/bjms.v10i1.7320 Bangladesh Journal of Medical Science Vol.10 No.1 Jan 2010 pp.52-56

Encephalomyelopathy in a child with acute lymphoblastic leukemia who had received radiotherapy and intrathecal chemotherapy

Encephalomyelopathy is a rare complication of chemotherapy and radiotherapy , and it is a serious cause of morbidity and mortality in the children with Acute Lymphoblastic Leukemia (ALL).A fifteen years old girl, who was diagnosed with ALL 3 years ago, developed CNS relapse 2 years after diagnosis and undertook CNS relapse protocol ( 2400 cGy cranial + 1500 cGy spinal radiotherapy, meanwhile intrathecal chemotherapy with MTX + ARA-C + Prednisone 5 times). Eight months later from radiotherapy, firstly right hemiparesy consequently quadriplegia and quadriparestesia developed, stool and urine incontinence occured, respiration problems started and progressively increased, so she exitus due to respiration deficiency. Key Words: Leukemia; Encephalopmyelopathy; Radiation Myelitis.DOI: 10.3329/bjms.v9i3.6481Bangladesh Journal of Medical Science Vol.09 No.3 July 2010, pp.174-176