Lead and cadmium exposure in children living around a coal-mining area in Yatağan, Turkey

The study was designed to determine asymptomatic lead poisoning prevalence and cadmium exposure of preschool children living in a coal-mining area in Yata?an, Mugla, Turkey. The research was conducted between May and June 2002. The study included 236 children (53.4% female and 46.6% male) who were identified among the healthy children between the ages of 6 months and 6 years, using a systematic sampling method, from the records of the local medical centre of Yata?an. Assessments of the levels of blood lead and cadmium were performed by an atomic absorption spectrophotometer, in the Department of Biophysics, Cerrahpa?a Medical Faculty. The mean age of females and males were 49+/-18 and 43+/-19 months, respectively. The mean blood lead level was 33.8+/-15.6 microg/dL in females and 38.8+/-16.0 microg/dL in males. The mean blood lead level of the males was significantly higher than the females (P<0.05). Correlation analysis showed a statistically significant negative correlation between blood lead level and age in both sex groups (r= -0.367, P<0.001). The blood lead level was found to be > 10 microg/dL in 95.7% and >20 microg/dL in 87.6% of all children. The mean blood cadmium level of all children was 1.31+/-0.72 microg/dL. The blood cadmium level was found to be >0.5 microg/dL, which is considered to be toxic, in 85% of all children. The difference in blood cadmium levels between sexes was not significant. A statistically significant negative correlation was found between blood cadmium level and age of all children (r= -0.382, P<0.001). Although it is not possible to understand from this study what proportion of the biological lead and cadmium burden results from mining waste and what proportion comes from other sources, such as paint and gasoline residue deposited in soil and air, these results do indicate that asymptomatic lead poisoning and cadmium exposure are significant problems in children living in the Yata?an area. In conclusion, environmental lead measurements (house dust, soil, drinking water and air) must be performed, the results must be compared with the normal limits, and precautions must be taken if necessary in the Yata?an area. Future public health research efforts should focus on reducing the excessive levels of lead and cadmium in the environment.     

Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this study we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.     

Evaluation of risk factors associated with femoral pseudoaneurysms after cardiac catheterization

BACKGROUND: Femoral pseudoaneurysm (FPA) is one of the common complications of percutaneous catheterization procedures performed via the femoral artery. The aim of this research was to evaluate factors associated with FPA of sufficient clinical significance that they required surgical treatment after diagnostic or interventional cardiac catheterization. METHODS: We evaluated 41,322 transfemoral catheterization procedures performed in our center within 7 years. Among all procedures, 630 FPAs developed that required surgical repair. Eighty-five cases were managed by compression with duplex guidance. As a case-control group, 1260 patients were selected from the patients who had been catheterized during the same time period but did not develop FPA. Two controls were selected for each study patient, matched according to age, sex, and catheterization day. Body mass index, hypertension, diabetes mellitus, catheter diameter, coronary artery disease, atherosclerosis, and number of cases performed per day in a particular room were evaluated as risk factors by using multivariate techniques. RESULTS: Femoral pseudoaneurysm required operative repair in 1.1% (n = 398) of patients who underwent cardiac catheterization for diagnostic purposes and in 4.7% (n = 232) of patients after cardiac interventional procedures. Factors found to be independently predictive of FPA were hypertension (P = .011; odds ratio, 1.52), diabetes mellitus (P = .035; odds ratio, 1.11), coronary artery disease (P = .022; odds ratio, 1.21), larger (> or = 28 kg/m2) body mass index (P < .001; odds ratio, 2.21), larger number of cases (> or = 18) performed per day in a particular room (P < .001; odds ratio, 2.39), and larger (> or = 7F) catheter diameter (P < .001; odds ratio, 2.82). CONCLUSIONS: Due to the development of technology and experience, more and more diagnostic and interventional catheterization procedures are performed on a daily basis. In our study, a high volume of cases in a particular room and use of large catheters were important risk factors for FPA complications. When these situations are combined with other risk factors (such as obesity, diabetes mellitus, hypertension, and arteriosclerosis), giving particular attention to local compression therapy would be more crucial to decrease the FPA rate.     

Blood pressure changes after aortic coarctation surgery performed in adulthood

OBJECTIVE: The aim of this study was to assess the effect of aortic coarctation surgery in adult patients on arterial blood pressure in the early postoperative period. METHODS: Ninety-three adult patients (61 male, 32 female) aged 15-43 years who had operation since 1962 for aortic coarctation in Siyami Ersek Cardiovascular Surgery Center were retrospectively evaluated. Tube graft interposition was done in 31 patients; resection and end-to-end anastomosis were performed in 32 patients; 24 patients had undergone pathchplasty; and 6 patients by-pass shunting performed. The effect of surgery on the blood pressure was investigated. RESULTS: The mean systolic and diastolic blood pressure significantly reduced after operation (systolic 193.6 +/- 33.7 mmHg vs 147.4 +/- 22.0 mmHg, diastolic 99.8 +/- 17.9 mmHg vs 82.0 +/- 10.8 mmHg). From 93 patients (all with hypertension) 54 (58%) became normotensive after operation according to VIth Joint National Committee classification. The number of normotensive patients after operation was 28 (of 37) for 15-19 years age group, 14 (of 23) for the 20-24 years age group, 4 (of 16) for 25-29 years age group, 6 (of 11) for 30-34 years age group, and 2 (of 6) for the over 35 years old age group. CONCLUSION: The diastolic and systolic blood pressures reduce significantly in the adult patients operated for aortic coarctation. On the other hand, persistent hypertension seemed to increase in the older age groups in spite of the surgery.     

Role of potassium channels in the frequency-dependent activity of regenerating nerves

After a peripheral nerve injury, ion channel organization and the electrical properties of nerve fibers drastically change during the regeneration process. The present study was designed to compare the frequency-dependent characteristics of regenerating nerves in the presence of 4-aminopyridine (4-AP) and tetraethylammonium (TEA). The results showed that increasing the stimulus frequency produced a greater impulse blockade (frequency-dependent block--FDB) and distinct hyperpolarizing afterpotentials (HAPs) in regenerating nerves. In particular, regenerating sciatic nerves 15 days post-crush (dpc) were more sensitive to the frequency-dependent stimulations than 38-dpc and intact nerves in the presence or absence of drugs. The frequency-dependent effects of TEA on the compound action potentials (CAPs) appeared when TEA was applied to 4-AP-treated nerves. This shows that TEA-sensitive channels may not be masked by the myelin. 4-AP was here found to have more pronounced frequency-dependent effects on regenerating nerves than on intact nerves. Delayed depolarization (in 38-dpc: 22.6 +/- 1.3 mV and 47.52 +/- 3.63 ms, in intact: 12.0 +/- 1.9 mV and 88.51 +/- 4.72 ms) elicited by 4-AP resulted in an increase in FDBs and HAP amplitudes. These results suggest that 4-AP-sensitive channels may play important roles in frequency-dependent nerve conduction. Consequently, regenerating or myelin damaged nerves are more sensitive to repetitive firing with or without drug. An understanding of the frequency-dependent properties of regenerating nerves may be of value in the treatment of the nerve diseases.     

Brachial artery cannulation facilitates lower ministernotomy cardiac surgery

BACKGROUND: Lower ministernotomy has become a more popular approach for many heart operations. However, cannulation of the ascending aorta may cause serious complications. Femoral and brachial arteries have been used for alternative arterial cannulation sites. MATERIALS AND METHODS: The lower ministernotomy approach was used in 65 patients. Ascending aortic cannulation was performed in group 1 (n = 38), femoral cannulation in group 2 (n = 12), and brachial cannulation in group 3 (n = 15) patients. Brachial artery diameter was measured preoperatively by Doppler ultrasound in the preoperative period. RESULTS: Average cross-clamp time for femoral and brachial artery cannulated patients was significantly shorter than in patients in group 1 (31 +/- 9 and 35 +/- 6 minutes, respectively) (p = 0.034). Total cardiopulmonary bypass (CPB) time was 56 +/- 11 minutes for group 1, 39 +/- 7 minutes for group 2, and 41 +/- 5.4 minutes for group 3 (p = 0.041). Operation time was 112 +/- 24, 88 +/- 12, and 91 +/- 11 minutes for the groups 1, 2, and 3, respectively. There was also statistically significant difference between group 1 and group 3 comparisons with regard to CPB time (p = 0.041). Difficult exposure from many cannulas impedes access and lengthens the operation in group I. Superficial wound infection developed in seven patients in group 1, one patient in group 2, and one patient in group 3. CONCLUSION: Cannulation of the brachial artery is superior to the femoral due to possible infection and lymph leakage with the latter and both are superior to central cannulation when lower ministernotomy is performed. By avoiding the difficulties of central aortic cannula placement the operative time is decreased and possible wound edge is protected as lesser exposure is required.     

Neuraminidase produces dose-dependent decrease of slime production and adherence of slime-forming, coagulase-negative staphylococci

BACKGROUND: Slime is one of the important structures of certain bacterial strains involved in nonspecific adherence. This study was conducted to determine the role of neuraminidase on slime formation and adherence of slime-forming coagulase-negative staphylococci to inert surface. METHODS: Quantitative biofilm and qualitative bacterial adherence assays were performed with increasing concentrations of neuraminidase extracted from Clostridium perfringens-treated bacteria in polystyrene plates and polypropylene tubes. RESULTS: Slime production of slime-forming, coagulase-negative staphylococci was significantly decreased dose dependently at > or =100 mU/mL (p <0.001). Bacterial adherence to smooth surface was impeded at > or =100 mU/mL of neuraminidase treatment and adherence results were comparable with slime production assay results. CONCLUSIONS: Sialic acid may be a constituent molecule of slime and involved in bacterial adherence to inert surface. These results represent new insight into the mechanism of slime production and adherence of slime-forming, coagulase-negative staphylococci to inert surface.     

Breastfeeding patterns, beliefs and attitudes among Kurdish mothers in Diyarbakir, Turkey

AIM: The aim was to rapidly assess existing breastfeeding patterns, beliefs and attitudes in the province of Diyarbakir, a socio-economically disadvantaged region of Turkey. METHODS: A cross-sectional survey exploring demographic and breastfeeding patterns was carried out among 921 mothers with children 6-18 mo of age. Results were quantitatively analysed. Focus group interviews dealing with beliefs and attitudes were separately carried out among 107 mothers and analysed by qualitative content analysis. RESULTS: Nearly all mothers had breastfed their infants at some time, but exclusive breastfeeding was rare. About 62.2% of the mothers had waited for at least 24 h before initiating breastfeeding. Almost half of the infants received sweetened water as a first feeding. There was agreement on the superiority of breastfeeding and awareness of its contraceptive effect. Early introduction of sugared water, water and supplementary feeds was considered desirable. Working in the fields and pregnancy were considered situations counteracting breastfeeding. CONCLUSION: The attitude to breastfeeding was highly positive, but more information is needed to encourage the use of colostrum, discourage early supplementation and promote exclusive breastfeeding during the first 6 mo of life.