The role of plasma N-terminal pro-B-type natriuretic peptide in predicting the severity of transient tachypnea of the newborn

Background/Aim

Transient tachypnea of the newborn (TTN) is a consequence of inadequate neonatal lung fluid clearance. Natriuretic peptides play an important role in the regulation of extracellular fluid volume. The aim of the study was to investigate the relation between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and TTN, and to find out its role in predicting disease severity.

Methods

A prospective controlled study involving 67 infants with TTN and 33 controls ≥ 34 weeks gestational age was conducted. Study and control groups were compared for plasma NT-proBNP levels measured on the 6th, 24th, 72nd and 120th hours of life. Cardiac systolic functions were evaluated by echocardiography.

Results

NT-proBNP levels were significantly higher in neonates with TTN compared to controls at 6th, 24th, 72nd and 120th hours (p < 0.001). NT-proBNP levels at 24th and 72nd hours were significantly higher in infants with prolonged tachypnea (p = 0.007 and p = 0.03) and in those who required respiratory support (p = 0.006 and p < 0.001). Tachypnea duration was correlated with NT-proBNP levels at 24 h (r = 0.41, p = 0.001). At a cut-off value of 6575 pg/ml, NT-proBNP had a sensitivity of 85% and specificity of 64% to predict mechanical ventilation requirement. Cardiac systolic functions were normal in all TTN patients.

Conclusion

Plasma NT-proBNP levels are increased in neonates with TTN. Measurement of plasma NT-proBNP can be useful for predicting infants who will have prolonged tachypnea and mechanical ventilation requirement.     

Abdominal mass secondary to actinomyces infection: an unusual presentation and its treatment

Abdominal actinomycosis may appear as an abdominal mass and/or abscess. This mass can mimic a malignant tumour. The diagnosis and management of abdominal actinomycosis will be discussed through a review of the literature and a case report from our own institution. The patient was a 17-year-old boy who presented with abdominal discomfort and a palpable right lower quadrant mass defined on CT scan. He underwent en bloc resection of the mass for a presumed diagnosis of tumour of uncertain type with intestinal involvement. The diagnosis was reversed, when histology revealed filamentous organisms consistent with actinomyces. He was treated with high dose penicillin for several weeks and was discharged from the hospital taking penicillin orally. Preoperative diagnosis of abdominal actinomycosis is difficult. An accurate diagnosis is always obtained in a histological or microbiological examination, often requiring surgical resection. Recognition is important because successful treatment requires combined surgery and prolonged penicillin treatment.     

Prognostic importance of tumor angiogenesis in breast carcinoma with adjuvant chemotherapy

Tumor angiogenesis is believed to be related to prognostic factors involved in tumor development and metastasis. Using immunohistochemical methods, we evaluated tumor angiogenesis in 42 early invasive breast cancer patients (T1-2, NO-1-2, M0). Four patients received tamoxifen, 25 patients received CAF or CA, and 15 patients received CMF as adjuvant therapy. The median follow-up was 47 (range 24-119) months. Ten patients (43.5%) in the node-positive group and 2 patients (10.5%) in the node-negative group relapsed (p = 0.019). The mean microvessel count (MVC) was 60.3 3.05 per 200x field (range: 16-95). MVCs of postmenopausal and premenopausal patients were 50.13 +/- 5.74 and 68.64 +/- 4.11, respectively, in the axillary lymph node (ALN)-negative patient group (p = 0.04). Staining was moderate to strong in 13 (68%) ALN-negative and in 17 (74%) ALN-positive patients (p > 0.05), and was also moderate to strong in 82% of premenopausal patients and in 50% of postmenopausal patients (p = 0.037). There was no significant relationship between angiogenesis and p53, nor was angiogenesis significantly associated with the patient ER status and tumor size. No significant correlations were found between OS/DFS and Factor VIII staining or p53 (log rank test, p > 0.05). Of all ALN-negative patients with increased angiogenesis, one patient of the CMF group relapsed, but no recurrence occurred in patients undergoing anthracycline-based chemotherapy (p > 0.05). On the other hand, of all ALN-positive patients with increased angiogenesis, 5/14 patients treated with anthracylcine and 2/2 CMF-treated patients relapsed (p = 0.175). Despite the statistical insignificance, anthracycline-based adjuvant chemotherapy appears to be more effective than CMF as regards relapse prevention particularly in early ALN-positive breast cancer patients with increased angiogenesis. Additional studies are necessary to demonstrate the clinical importance of angiogenesis.     

Effects of probucol in hyperlipidemic rabbit liver: a preliminary ultrastructural study

Probucol is a lipid-lowering agent with an antioxidant effect; however, its influence on the liver remains unclear. The effects of probucol on hyperlipidemic rabbit liver are investigated to add a structural data on its therapeutical profile. Local albino rabbits were divided into three groups. 1) Hyperlipidemic group: fed with 1% cholesterol (150 g/kg/day) enriched chow for 2 months. 2) Probucol treated group: group 1 + intraperitoneal probucol (10 mg/kg/day) administration for 15 days. 3) Control group fed with normal chow. The blood lipid profile was investigated biochemically. Liver samples were examined electronmicroscopically. Within the parenchymal cells of group 1, the amount of rough surfaced endoplasmic reticulum was increased, its cisterna was dilated displaying a moderately electron dense substance in it and showed close apposition with the condensed mitochondria. In group 2, smooth surfaced endoplasmic reticulum was in extensive amounts filling almost all of the cytoplasm, displayed a reticular, degenerated appearance and was in close relation with the condensed, degenerated mitochondria. Probucol may cause degenerative changes on the liver parenchyme at the subcellular level. It alters the structure of these cells mainly acting on the smooth surfaced endoplasmic reticulum and the mitochondria that are known to be involved in cellular detoxification.     

Prognostic importance of COX-2 expression in patients with colorectal cancer

A relationship between cyclooxygenase-2 (COX-2) expression and the pathogenesis of colorectal cancer has been reported in recent studies. Moreover, it has been indicated that COX-2 expression may have a prognostic role in colorectal cancer patients. In this study, we investigated the prognostic significance of COX-2 expression in 83 patients with colorectal cancer. COX-2 expression was assessed using immunohistochemical methods and was evaluated by grading both staining intensity and staining extension. The relationships between COX-2 expression and clinicopathological features of the patients and patient survival were evaluated. There was no relationships between COX-2 expression and tumor size (tm < 3 cm or tm > or = 3 cm), tumor histopathological differentiation (poorly differentiated or moderately + well differentiated), number of metastatic lymph nodes (< 4 or 3 > or = 4), histopathology of the tumor, localization of the tumor (colon or rectum), distant metastasis, and vascular invasion of the tumor. In the multivariate analysis, COX-2 expression was not found as an independent prognostic factor. We demonstrated that COX-2 expression was not correlated with clinicopathological characteristics of colon carcinoma and disease outcome.     

Tenascin C levels in patients with mild and severe preeclampsia

Objective: To determine the serum tenascin-C (TN-C) levels in cases with mild and severe preeclampsia.

Methods: Pregnant women were divided into three groups, namely healthy pregnants (Group 1, n?=?20), pregnants with mild preeclampsia (Group 2, n?=?20) and pregnants with severe preeclampsia (Group 3, n?=?20). The groups were formed so as to match each other in terms of gestational week. From each pregnant woman, pre- and post-delivery blood samples were obtained to measure serum TN-C levels. The data were evaluated using the Kruskall–Wallis variance analysis. For the obtained values of p?<?0.05, the groups were compared in pairs. A p value of <?0.017 was accepted as significant.

Results: In Groups 1, 2 and 3, the prepartum TN-C levels were 5.02?±?0.4?µg/ml, 12.8?±?2.9?µg/ml and 33.8?±?11.7?µg/ml, and in the postpartum TN-C levels were 4.7?±?0.1?µg/ml, 11.7?±?1.8?µg/ml and 50.6?±?33.8?µg/ml, respectively. There was a significant difference between the groups in terms of the prepartum and postpartum TN-C levels (p?<?0.017, Mann–Whitney U [MWU] test). There was also a significant difference in the prepartum TN-C levels between Groups 2 and 3 (p?<?0.017, MWU test).

Conclusions: The prepartum and postpartum TN-C levels were significantly higher in mild and severe preeclampsia than those in healthy pregnants.     

Association of sleep duration with socio‐economic status and behavioural problems among schoolchildren

Aim: In this population‐based study, we aimed to determine the total sleep duration (TSD), its association with socio‐economic status (SES) and behavioural symptoms among schoolchildren. Methods: A cross‐sectional study was performed among schoolchildren in Istanbul. A structured questionnaire evaluating the sleep schedule variables was filled out by their parents. SES was determined according to the Turkish SES scale. Results:  The mean age of 2669 children was 8.2 ± 2.4 years, and 51% of the students were girls. The mean TSD was 10.20 ± 1.04, and the mean bedtime was 21.57 ± 0.56 (both in hours, minutes ± SD). Boys tended to go bed later (p = 0.004) and slept less than girls (p = 0.02). The duration of sleep disruptions increased (p < 0.001), whereas TSD decreased with age (p < 0.001). Multiple linear regression revealed that waking time and TSD decreased significantly (p < 0.05) with higher SES among both girls and boys. Sleep fragmentation was associated with habitual snoring, parasomnias, daytime sleepiness and conduct symptoms. Conclusion: Decreased total sleep duration is more prominent in boys, older children and children among higher socio‐economic status. Insufficient sleep attributed to shortened total sleep duration by age and higher socio‐economic status might have a negative effect on both sleep hygiene and psychological well‐being in schoolchildren.     

Primary antibody deficiencies in Turkey: molecular and clinical aspects

Primary antibody deficiencies (PAD) are the most common subtype of primary immunodeficiencies, characterized by increased susceptibility to infections and autoimmunity, allergy, or malignancy predisposition. PAD syndromes comprise of immune system genes highlighted the key role of B cell activation, proliferation, migration, somatic hypermutation, or isotype switching have a wide spectrum from agammaglobulinemia to selective Ig deficiency. In this study, we describe the molecular and the clinical aspects of fifty-two PAD patients. The most common symptoms of our cohort were upper and lower respiratory infections, bronchiectasis, diarrhea, and recurrent fever. Almost all patients (98%) had at least one of the symptoms like autoimmunity, lymphoproliferation, allergy, or gastrointestinal disease. A custom-made next-generation sequencing (NGS) panel, which contains 24 genes, was designed to identify well-known disease-causing variants in our cohort. We identified eight variants (15.4%) among 52 PAD patients. The variants mapped to BTK (n?=?4), CD40L (n?=?1), ICOS (n?=?1), IGHM (n?=?1), and TCF3 (n?=?1) genes. Three novel variants were described in the BTK (p.G414W), ICOS (p.G60*), and IGHM (p.S19*) genes. We performed Sanger sequencing to validate pathogenic variants and check for allelic segregation in the family. Targeted NGS panel sequencing can be beneficial as a suitable diagnostic modality for diagnosing well-known monogenic PAD diseases (only 2–10% of PADs); however, screening only the coding regions of the genome may not be adequately powered to solve the pathogenesis of PAD in all cases. Deciphering the regulatory regions of the genome and better understanding the epigenetic modifications will elucidate the molecular basis of complex PADs.

     

Correction to: Primary antibody deficiencies in Turkey: molecular and clinical aspects

Immunologic Research -     

External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

Purpose

To investigate the reliability of intra-atrial electrocardiogram (ECG) use for external jugular vein (EJV) catheterization.

Materials and Methods

Patients undergoing open heart surgery in Suleyman Demirel University Hospital between February and June 2006 were included in the study. Using a sterile Seldinger technique, a triple lumen polyurethane central venous catheter was introduced (Certofix® Trio V 720, length 20 cm, 7 French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava.

Results

In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation.

Conclusion

Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.