Associations Between Transcranial Doppler Flow Velocities, Laboratory Parameters, and Clinical Features in Turkish Children With Sickle Cell Disease

OBJECTIVE

Stroke is one of the major complications of sickle cell disease (SCD). Stroke features either occlusion of, or stenosis at, the origin of one of the large intracerebral arteries, the internal carotid artery (ICA), and/or the middle cerebral artery (MCA).

PURPOSE

We sought correlations between cerebral blood flow velocities and the laboratory and clinical findings of patients with SCD.

MATERIALS AND METHODS

Fifty-three pediatric SCD patients (39 with HbSS, 14 with HbSβ0) were analyzed. The mean patient age was 12.9±3.9 years. The control group contained 24 healthy individuals. The time-averaged maximum mean velocity (TAMMV) and resistive index (RI) of the MCA, the TAMMVs of the ICA and vertebral artery (VA), and the diameter of the VA were estimated through transcranial Doppler ultrasonography using a 2.5 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. We evaluated the relationships between the TAMMVs, laboratory parameters, and clinical findings.

RESULTS

The mean±SD MCA TAMMV was 161.2±35.4 cm/s in patients with HbSS and 185.8±62.9 cm/s in patients with HbSβ0. The mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 168.5±43.9 cm/s, 0.63±0.06, 116.8±25.5 cm/s, 69.2±18.5 cm/s, and 3.5±0.61 mm for all SCD patients, respectively. In the control group, the mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 103.8±28.8 cm/s, 0.53±0.04, 96.4±27.8 cm/s, 40.3±12.1 cm/s, and 3.4±0.6 mm, respectively. Although the differences were not significant, TAMMVs were higher in HbSβ0 patients taking hydroxyurea; those with hemoglobin levels <8 g/dL, ferritin levels >1000 ng/dL, mean platelet volume >12 fL, or red cell distribution width >18%; or required chelation, or were below the third percentiles of weight and height. The TAMMV was significantly higher only in SCD patients who complained of headache.

CONCLUSIONS

High ferritin and low hemoglobin levels, a high mean platelet volume, a high red cell distribution width, low weight (below the third percentile), and a short height (below the third percentile) may be associated with elevated cerebral blood flow velocities and an increased stroke risk in children with SCD. Children with such features should be closely followed-up through transcranial Doppler ultrasonography examination.

Assessment of PELOD-2 and PIM-3 scores of children coming from the war in Syria

OBJECTIVES

Since the civil war in Syria began, millions of Syrians have left the country and been forced to migrate to other countries. Turkey is the country with the most refugees hosting 3.6 million refugees. This study aimed to compare the PIM-3 score, PELOD-2 score, PELOD-2 predicted death rate (PDR), mortality rates, demographic data, and outcomes of patients admitted to pediatric intensive care units between refugee children living in Turkey, pediatric patients brought directly from the border by the emergency services, and the general Turkish population.

METHODS

This was a retrospective study performed between February 2018 and February 2019 at Hatay State Hospital, very close to the Syrian border. The study included 158 patients. Patients were divided into three groups: Turkish citizens, those living in Turkey as refugees, and those brought from the border.

RESULTS

Of the patients, 57 were Turkish citizens, 33 were refugees, and 68 were brought from the border. For patients, the mean PIM-3 score was 25.62±27.70, the PELOD-2 score was 8.03±4.72, and PELOD2-PDR was 16.07±23.45. The median scores for PIM-3, PELOD-2, and PELOD2-PDR of patients brought from the Syrian border were higher compared with Turkish citizens and refugees. There was no significant difference between refugees and Turkish citizens. Of the patients, 27 died, with the distribution being 15% Turkish citizens, 26% refugees, and 59% brought from the border. The mortality of patients transported from the border was statistically significant (P=0.03).

CONCLUSION

We consider that the source of the difference between patients brought from the border and those living in Turkey may be associated with the continuing war beyond our borders and children experiencing insufficient care conditions. In conclusion, it is not just weapons that cause death in war, and children unfortunately suffer because of this situation.

COBALAMIN C DEFICIENCY WITH INFANTILE SPASM AND CUTANEOUS FINDINGS: A UNIQUE CASE

Cobalamin C (CbIC) deficiency is a rare disorder of vitamin B12 metabolism which results from impaired conversion of both its active forms methylcobalamin and adenosylcobalamin. Early onset cblC typically presents in the first year of life with hypotonia, lethargy, seizures, microcephaly, hydrocephalus, developmental delay and other multisystem involvement including hematologic, ocular, renal, hepatic and cardiac symptoms. We report a case of a female infant with cblC deficiency who presented with seizures, developmental delay and hypopigmented cutaneous lesions. To our knowledge, the patient is the first diagnosed with cblC deficiency who had skin hypopigmentation.

Adjunctive use of mitomycin C in endoscopic revision dacryocystorhinostomy

OBJECTIVES

Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the surgeon's ability to achieve good nasal and lacrimal mucosa apposition. The aims of this study were to assess the long term safety and efficacy of intra-operative use of adjunctive mitomycin C (MMC) treatment in endoscopic revision DCR surgery over 12-24 (mean 17) months.

METHODOLOGY

This was a prospective, nonrandomized consecutive case series that included 20 adult patients (20 eyes) with failed primary external DCR who underwent revision surgery under assisted local anaesthesia. During revision endoscopic DCR, intra-operative adjunctive MMC (0.2 mg/mL) was applied to the osteotomy site of the lacrimal sac and scar tissue surrounding the surgical osteum for 5 minutes.

RESULTS

The surgical success rate was determined based on the patency of the nasolacrimal system by irrigation and resolution of patient symptoms. Endoscopic revision DCR surgery with MMC was successful in 90% of cases (18 of 20 cases). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed.

CONCLUSIONS

Adjunctive intra-operative MMC application with endoscopic DCR surgery had a good success rate in patients with nasolacrimal duct obstruction that required revision surgery. Further large, double blind, placebo controlled, randomized studies are needed to confirm these findings.

Determination of suitable timing, frequency and sample size of body condition scoring for herd management in Holstein herds

Abstract. In this study, 11 526 body condition scores obtained from 1 033 lactations of 696 Holstein cows raised in 17 dairy herds enrolled in Izmir Holstein Breeders Association were used. Several scoring schedules according to days in milk (DIM) such as weekly, bi-weekly, 3- weekly, 4-weekly, 6-weekly, 8-weekly and 12-weekly were compared. As a results of this study, it was advised more frequent scoring (weekly) in the first 4-weeks and less frequent scoring (8-weekly) in the mid and the late parts of lactation. Since scoring each cow, especially in large dairies, is time consuming and high labour cost process, a group of cows reflecting group performance can be scored. For example, in the 4-weekly scheme, percentages of cows needed for each DIM group were 5 % of the number of cows available for the first 305 days of lactations. Number of cows to be scored is high at the beginning of lactation and this number decreased towards end of lactation.

Estimates of genetic parameters for test day milk yields of a Holstein Friesian herd in Turkey with random regression models

Abstract. Genetic parameters for test day milk yields of Holstein Friesian cows have been estimated using a random regression model (RRM). Data consisted of 1487 monthly test day milk yield records of cows calving between 1987 and 1993 in Sarmısaklı Farm, Turkey. Data were restricted to have at least 150d and at maximum 308d length of first lactations. Additive genetic and permanent environmental (co)variances were modeled with the same order polynomial regressions. Residual (measurement) error variance was assumed to be constant throughout lactation. The quadratic (k=3) order orthogonal polynomial regression was found to be sufficient. Heritability estimates for test day milk yields were high at the middle of the lactation and ranged from 0.07 to 0.32. Genetic correlations of milk yields between consecutive test days were high, but decreased as the interval between tests days increased. Genetic correlations ranged from 0.51 to 0.99. Residual error variance was estimated 13.77 kg.

Growth curve analysis for body weight and dry matter intake in Friesian, Limousin x Friesian and Piemontese x Friesian cattle

Abstract. In this study, body weight and dry matter intake from birth to 460 days of age of Friesian (F), Limousin x Friesian (LixF) and Piemontese x Limousin (PixF) cattle fed individually under intensive feeding system were analyzed. Growth curve parameters of body weight and dry matter intake were investigated by using Gompertz model. No significant differences between genotypes were found in growth curve parameters for dry matter intake while there was significant genotype effect on integration constant, absolute weight gain at birth, degree of maturity at birth and absolute body weight gain from birth to 6 months of age for body weight. Mean values of growth parameters for body weight in F, LixF and PixF were: mature weight 744, 801 and 743 kg; integration constant 2.97, 3.02 and 2.81; maturity rate per day 0.0045, 0.0042 and 0.0047; age at inflection point 245, 270 and 227 days; weight of inflection point 274, 295 and 273, respectively. Body weight at birth for F, LixF and PixF were 38.6, 44.4 and 49.1. Absolute body weight gain from birth to 6 months of age for F, LixF and PixF were 24.8, 21.9 and 25.3. PixF exhibited higher maturity rate and reaching mature weights younger than F and LixF. Mature weight for body weight had positive phenotypic correlations with mature weight parameter for dry matter intake whereas there was a negative phenotypic correlation between mature weight for body weight and maturity rate for dry matter intake in all genotypes. The result shows that increasing intake is a result of body weight increased. On the other hand feed intake rate decreased as body weight increased. Considering the development period, from birth to 6 months of age, there was significant difference between genotypes for absolute body weigh gain and absolute dry matter intake whereas these parameters did not differ significantly between 6 and 16 months.

The effect of short-term fasting on performance traits and rectal temperature of broilers during the summer season

1. The present study was conducted to determine if detrimental effects of high temperature on broiler performance could be overcome by short-term fasting and to examine the effect of food withdrawal on the responses of two commercial strains (S1 and S2). 2. An experimental design was used with three feeding groups and two strains. Birds in the control (C) group were fed ad libitum during the experimental period (0 to 6 weeks), while feed was withdrawn in the other groups between 10:00 and 16:00 h during weeks 5 and 6 (F1) or week 6 (F2), respectively. After standard brooding for the first 3 weeks temperature and humidity varied according to outside climate between 4 and 6 weeks of age. 3. Feeding strategy significantly affected body weight at week 6 (BW6) and daily weight gain during week 6 (DWG5-6). F2 gave the best results in BW6 and DWG5-6. Strain effect was significant on DWG4-5 and DWG5-6; S1 had higher DWG4-5 and S2 gained more at the last stage. S1C broilers had greater BW6 than S2C but the S2 strain gave a better response to short-term fasting compared with S1 and this resulted in significant strain by feeding interaction effect on BW6 and DWG5-6. 4. It was shown that short-term fasting was an effective method for controlling rectal temperature (RT) of broilers at 5 and 6 weeks of age. 5. Total food consumption (FCO-6), food conversion ratio (FCRO-6), mortality, and carcase characteristics were not affected by short-term fasting in the experimental conditions. 6. In conclusion, it can be recommended that broiler producers may practise 6 h of fasting during the hot period of the day without any adverse effect on slaughter weight and FCR when the birds are close to the average slaughter weight and a heat wave is expected. Strain differences in RT measurements also indicate the importance of choosing strains to be used in hot and warm climate conditions with attention to the thermoregulation ability of broilers.

Variation in organic acids content during ripening of pickled white cheese

Nine organic acids (formic, pyruvic, lactic, acetic, orotic, citric, uric, propionic, and butyric) were analyzed during ripening of pickled White cheese for 12 mo by high-performance liquid chromatography with a reverse phase C18 (120x 5-mm) column and UV detector. The level oftotal organic acids showed an increase along the ripening period, but its composition varied during the process. Initially, lactic acid accounted for 95% of the total, after 9 and 12 mo of ripening, butyric acid constituted 20 and 27% of the total, respectively. Each organic acid presented a characteristic pattern of change during ripening. Discriminant analysis classified cheeses according to their age. Stepwise regression analysis allowed estimation of the ripening time of samples according to their organic acid levels.

Posterior leukoencephalopathy syndrome in poststreptococcal acute glomerulonephritis

Reversible posterior leukoencephalopathy syndrome is an increasingly recognized brain disorder most commonly associated with hypertension, toxemia of pregnancy, or the use of immunosuppressive agents. Its clinical features include headache, decreased alertness, mental abnormalities, such as confusion, diminished spontaneity of speech, changed behavior ranging from drowsiness to stupor, seizures, vomiting, and abnormalities of visual perception like cortical blindness. Magnetic resonance imaging shows edematous lesions primarily involving the posterior supratentorial white matter and corticomedullary junction. We describe a 7-year-old uremic girl who developed neurological symptoms of posterior leukoencephalophaty syndrome during the course of acute poststreptococcal glomerulonephritis. Since the symptoms first appeared 24 h after a hypertensive crisis and the patient was uremic at the time of symptoms, we decided to report this patient to discuss the differential diagnosis of neurological symptoms developing during the course of acute poststreptococcal glomerulonephritis.

J incision in neck dissections

Metastasis in the neck lymph system of primary tumours of the head and neck is frequently seen. In order to prevent this metastasis, neck dissection is carried out by various types of skin incisions. In this study, types of skin incision used in neck dissections were defined, and the advantages, disadvantages and results of J incisions, which have been performed on 320 radical neck dissection patients in our clinic between 1985-1996, were compared with those of other incision types.

Effect of tibial dyschondroplasia on carcase part weights and bone characteristics

1. The effect in broilers of tibial dyschondroplasia (TD) on carcase part weights and bone characteristics was investigated by studying the progeny of 10 sires and 40 dams. The correlations between TD and bone variables were also estimated. 2. The incidence of TD was 59% at 42 d of age. There were no significant differences in slaughter weight of birds with and without TD. However, in females, breast weight was heavier in affected birds. Neck plus back weight of birds with TD was significantly heavier than in birds without TD. 3. Breast blister frequency of birds was independent of the presence of TD. 4. Birds with TD had longer bones than birds without TD. However, TD had no effect on tibiotarsus weight, width, ratio of tibiotarsal to body weight and ash. A negative correlation was observed between TD score and bone ash percentage.