The role of patient’s systemic characteristics and plateletcrit in developing toxic anterior segment syndrome after uneventful phaco surgery: A case–control study

Purpose

To compare the systemic and ocular characteristics and laboratory findings of patients developing toxic anterior segment syndrome (TASS) after uneventful phaco surgery with unaffected subjects undergoing the same surgery in the same session.

Design

A retrospective case–control study.

Methods

The study group consisted of 26 eyes of 26 patients who underwent uneventful phaco surgery and who went on to develop TASS, while the control group included 39 subjects who had routine phaco surgery in the same session by the same surgeon. The sterilization stages of reusable instruments, disposable instruments, and compositions were recorded. The preoperative systemic diseases, complete blood count parameters, glycosylated hemoglobin (HbA1c), biochemical parameters, thyroid hormone profiles, and the surgical features were compared between the two groups.

Results

Type 2 diabetes mellitus (DM), systemic hypertension (HT), hyperlipidemia, chronic ischaemic heart disease, and chronic renal failure were significantly more common in the TASS group (p < 0.05). Proliferative diabetic retinopathy was also more frequent in the TASS group (p = 0.003). Mean HbA1c% values, white blood cell count, neutrophil/lymphocyte ratio, platelet counts, platelet distribution width, and plateletcrit parameters were significantly higher in the TASS group (p < 0.05). Multivariate logistic regression analysis revealed that a high plateletcrit level (p = 0.001, odds ratio [95% CI]; 22.27 [3.36–147.76]) and systemic HT (p = 0.044, odds ratio [95% CI]; 7.13 [1.05–48.12]) are independently associated with the development of TASS.

Conclusion

Although TASS may arise as a result of insufficient sterilization of instruments or intraocular solutions, patient factors may also contribute to its development. Systemic vascular disorders such as uncontrolled type 2 DM, systemic hypertension, and hyperlipidemia may increase the risk of TASS after uneventful phaco surgery. Abnormal parameters associated with systemic inflammation, such as higher plateletcrit level, may facilitate the development of TASS. These findings may be a predicting factor of TASS development for uneventful cataract surgeries.

     

Effect of Pretransplant Infections on Clinical Outcomes in Live-Donor Liver Transplant Recipients

Owing to impaired immune function, surgical procedures, and multiple hospitalizations, patients with end-stage liver disease are at risk for numerous infectious complications while waiting for transplantation. Infection in transplant recipients remains the main cause of mortality and morbidity, despite advances in surgical techniques and the development of new repressive agents. The purpose of this study is to examine the infections that develop during the pretransplantion period in live donor liver transplant recipients and their effect on post-transplant clinical outcomes.The retrospective analysis of adult live donor liver transplant recipients in the last 4 years was conducted at Ankara University Hospital, a 1900-bed tertiary-care university hospital, in Ankara, Turkey. Demographic characteristics, preoperative infections, and clinical outcomes were analyzed. Patients were divided into 2 groups according to whether they had developed an infection before transplantation. The diagnoses were based on clinical, laboratory, and microbiological findings. Statistical analyses were performed using Stata version 9.0 (StataCorp, College Station, Tex., United States), and P < .05 were considered statistically significant.In univariate analyses, having diabetes mellitus or a pretransplant infection, the number of pretransplant infection attacks, the need for a reoperation, and developing a post-transplant infection were the statistically significant factors associated with 1-year mortality (P < .001, χ² test). In multivariate analyses, diabetes mellitus (Odds ratio [OR] = 7.44, 95% confidence interval [CI], .03–45.79; P = .013), reoperation (OR = .33, 95% CI, .25–2.20; P < .001), having a pretransplantation infection (OR = 12.47, 95% CI, .011–87.67; P = .013), and the number of pretransplantation infection attacks (OR = .028, 95% CI, .013–.47; P < .001) were found to be statistically significant risk factors for 1-year mortality.Our study showed the effect of pretransplantation infections on post-transplant morbidity but not on rejection or mortality. According to the situation of patients, manageable pretransplantation infection is not an absolute contraindication for liver transplantation. Awareness of the increased risk for post-transplant infections and fast-acting antimicrobial coverage are the most important facts for patient survival.     

Pneumorrhachis associated with bronchial asthma, subcutaneous emphysema and pneumomediastinum

Pneumorrhachis is defined as the presence of air in the epidural space or subarachnoid space. The air may migrate along fascial planes from the posterior mediastinum, through the neural foramina, and into the epidural space. Pneumorrhachis is rare, and even more so in the paediatric population. Pneumorrhachis in itself usually is asymptomatic, does not tend to migrate and reabsorbs spontaneously. The combination of pneumomediastinum with epidural pneumorrhachis without thoracic trauma has rarely been reported in the literature. The present case report describes the presence of pneumomediastinum, subcutaneous emphysema, and pneumorrhachis in a child asthmatic patient who had a history of fever, violent cough.     

Use of a novel haemostatic agent: ankaferd blood stopper in conjunctival incisions

Background: To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, ankaferd blood stopper, in a rat conjunctival incision model. Methods: Twenty Wistar albino rats were divided into two equal groups (A, B). Limbal incisions of 90–120° were performed in both eyes of all rats. In group A, bleeding at the site of incision was controlled by the administration of ankaferd blood stopper to the right eyes and balanced salt solution to the left eyes. In group B, bleeding was controlled by the application of ankaferd blood stopper to the right eyes and cautery to the left eyes. Time to haemostasis was recorded. After a 4‐week period, conjunctival vascularity and postoperative adhesion between Tenon's capsule and sclera were assessed. Additionally, eyes were enucleated and evaluated histopathologically. Results: In group A, the mean bleeding times were 15.2 and 66.7 s for right and left eyes, respectively (P = 0.002). In group B, the mean bleeding times were 17.6 and 17.5 s for right and left eyes, respectively (P = 0.939). Cautery was found to cause significantly more adhesion (P = 0.04). Histopathological examination of the conjunctiva and scleral revealed no statistically significant difference between the samples. Conclusions: Given the ease of use and lack of histopathological side‐effects in the conjunctival incision model, ankaferd blood stopper is promising for use in ophthalmic surgery. Ankaferd blood stopper is a potent haemostatic agent. Its use in ophthalmic surgery should be investigated further in a larger cohort of patients and tested in clinical and experimental models.     

Premature ventricular contractions in normal children

Premature ventricular contractions (PVCs) are frequently seen in children with normal cardiac findings. The purpose of this study was to evaluate the characteristics and the prognosis of PVCs in children with normal heart. This study included 149 children with PVC who did not have systemic or cardiac disease. Their median age at diagnosis was 10 years (range 1 month to 17 years). Seventy-six children (51%) were symptomatic. Most of the patients had unifocal PVC, whereas 5 (3.1%) of them had multifocal PVCs. The patients were evaluated by repeated Holter recordings and exercise test. In the first Holter monitoring recordings, PVCs were in the form of isolated PVC in 122 (82%) patients, couplet-triplet in 14 (9%) patients and nonsustained ventricular tachycardia in 13 (9%) patients. The exercise test was performed in 105 (70.5%) patients. The frequency of PVCs decreased and disappeared in 65 (61.9%) children, increased in 8 (7.6%), and were unchanged during exercise in 32 (30.5%). There was no difference between the groups according to exercise response regarding PVC quantity. Fifty-two of 149 children (35%) were followed up for a median period of 22 months. After follow-up, PVCs of 25 of the 52 patients (48.1%) decreased and disappeared. We did not find any correlation between the frequency of PVC and treatment, age, gender or the PVC frequency decrease with exercise. In conclusion, PVCs in normal children have benign prognosis and during follow-up a considerable percent show improvement.     

Screening for retinopathy of prematurity in a tertiary care newborn unit in Turkey: frequency, outcomes, and risk factor analysis

PURPOSE: To report the frequency, risk factors, and outcomes of screening for retinopathy of prematurity (ROP). METHODS: Data of neonates with a gestational age of 34 weeks or less were analyzed and the predictors on the development of ROP were determined by using logistic regression analysis. RESULTS: Of the 318 neonates, the frequency of ROP was 37.1% for any stage and 7.2% for stage 3 or greater. Treatment was needed in 16.1% of neonates with ROP. No treatment was required in neonates with a gestational age of greater than 32 weeks. Oxygen therapy, sepsis, gestational age of 32 weeks or less, and birth weight of less than 1,250 g were determined as the independent risk factors. CONCLUSIONS: Although frequency of ROP in Turkey is similar to that in the United States, the rate of severe ROP necessitating treatment seems to be higher in Turkey. Neonates with a gestational age of 32 weeks or less, a birth weight of less than 1,250 g, sepsis, and oxygen therapy may have a greater risk of developing ROP and screening should be intensified in the presence of these risk factors.     

Giant axonal neuropathy: diffusion-weighted imaging features of the brain

Giant axonal neuropathy is a rare autosomal recessive childhood disorder characterized by a peripheral neuropathy and features of central nervous system involvement. Magnetic resonance imaging (MRI) of an 11-year-old boy with giant axonal neuropathy revealed high signal intensity in the white matter of the cerebrum and cerebellum on T(2)-weighted imaging. An apparent diffusion coefficient map revealed increased apparent diffusion coefficient values in the periventricular, deep, and cerebellar white matter, basal ganglia, and thalamus. Increased apparent diffusion coefficient values in distinct locations suggest increased mobility of water molecules in the brain of a patient with giant axonal neuropathy. This finding could indicate a myelin disorder such as demyelination. Diffusion-weighted imaging should be performed to reveal apparent diffusion coefficient changes and determine brain involvement in patients with giant axonal neuropathy.     

Urinary stone disease in the first year of life: is it dangerous?

Purpose

We have evaluated the clinical, radiological and metabolic features of infantile urolithiasis (UL).

Materials and methods

We have reviewed the medical records of 93 children who were diagnosed as having UL before 1 year of age. We recorded patient demographics, the age at diagnosis, presenting symptoms, family history, the localizations and dimensions of stones, urinary metabolic examinations, as well as physical, laboratory, and radiologic findings. Our secondary objective was to compare some features of this group with those of older children with UL followed-up in the same clinic which were previously reported.

Results

We evaluated 93 children referred to our pediatric nephrology clinics. A family history of UL was 56.2 % in the study group. Resolution of stones was observed in 30.1 % of the cases. Urinary tract infections (UTIs) were detected in 65.9 % of females and 46.2 % of males. At least one urinary metabolic abnormality was found in 79.5 % of all the children. Most commonly seen metabolic abnormality was hypercalciuria. In all patients stones were located in kidneys except one infant who had an ureteral stone together with a kidney stone. Fifteen (16.1 %) children had an accompanying systemic disorder.

Conclusions

Among pediatric urinary stone diseases infantile UL can be regarded as a separate clinical entity. Coexistence of systemic disorders and anatomic anomalies at high frequencies may indicate a role of distinct pathogenetic mechanisms. In addition, high rates of UTIs and metabolic abnormalities in this age group justify screening for these parameters during follow-up of these children.