Effect of perinatal factors on time of first stool passage in preterm newborns: An open, prospective study

Background:

Delayed passage of first stool by a newborn after birth might be an initial sign of clinical problems, such as meconium ileus, meconium plug syndrome, and intestinal atresia. Successful treatment of these conditions depends on early diagnosis, so it is imperative to note the time of first stool passage.

Objective:

The aim of this study was to assess the timing of first stool passage by preterm newborns in relation to antenatal exposure to magnesium sulfate (MgSO₄) and a glucocorticoid (betamethasone) and to other perinatal factors, such as gestational age, respiratory distress syndrome (RDS), and time of first enteral feeding.

Methods:

The subjects in this prospective, open study were preterm newbornswho were born before 37 weeks' gestation and admitted to the neonatal intensive care units of Baskent University, Adana Teaching and Research Center, and Inonu University, Turgut Ozal Medical Center, between June 2003 and August 2004. Effects of antenatal exposure to MgSO₄ and glucocorticoid on the timing of first stool passage were assessed by comparing findings in exposed newborns to findings in an equal-sized group of gestational-age-matched subjects, derived from the study cohort, who were not exposed. Relationships between time of first stool passage and both gestational age and time of first enteral feeding were assessed.

Results:

Two hundred premature newborns (112 males, 88 females) were included in the study. The median age at the time of first stool passage was 16 hours, and 187 (93.5%) passed their first stool by 72 hours after birth. Delayed passage of first stool was noted in 33 (16.5%) newborns. One hundred sixty-eight (84.0%) newborns passed stool before enteral feeding was started. Gestational age and time to first enteral feeding were both significantly correlated with time of first stool passage (gestational age: r = −0.259, P < 0.001; first enteral feeding: r = 0.168, P = 0.017). Time of first stool passage was significantly later in 46 newborns with RDS than in 46 gestation al-age-matched newborns without RDS (mean [SD], 44.7 [39.7] vs 20.5 [18.4] hours, respectively; P < 0.05). The newborns whose mothers had received MgSO₄ for tocolysis passed their first stool significantly later than gestational-age-matched controls (mean [SD], 26.5 [26.9] vs 11.3 [12.1] hours, respectively; P < 0.05). Antenatal exposure to betamethasone was not significantly correlated with timing of first stool passage.

Conclusions:

The results suggest that delayed passage of first stool in thesepreterm newborns was associated with gestational immaturity, delayed first enteral feeding, and RDS. Antenatal maternal exposure to MgSO₄ was associated with later first stool passage in these preterm newborns, whereas antenatal exposure to betamethasone was not.     

Is adequate and balanced nutrition during pregnancy more effective than iron and folic acid supplements?

To provide instruction for pregnant women regarding adequate and balanced nutrition and determine whether iron and folic acid supplementation is essential. The research was an experimental clinical intervention. The study was conducted between March 2004 and May 2005 with 80 pregnant volunteers. The study participants were in their 16th to 24th weeks of pregnancy; all participants were healthy, carried only one fetus, and successfully completed their pregnancy. All participants were instructed about adequate and balanced nutrition. Until the participants gave birth, 40 (Group 1) consumed an iron-rich diet that was equivalent to the inclusion of a supplement containing 100 mg Ferro III plus 0,35 mg folic acid; the other group (Group 2) was also instructed in proper nutrition and was given by a gynecologist 1 tablet (100 mg) Ferro III hydroxide polymaltose complex and iron pharmaceutical with 0,35 mg folic acid (Maltofer Fol). In both groups, before and after the instruction, consumption frequency was noted, and the levels of serum ferritin, serum iron, total iron-binding capacity, folic acid, and vitamin B12 in the blood were determined at monthly intervals. Between the two groups, no statistical difference was found with regard to age, number of pregnancies, weight before pregnancy, body mass index (BMI) before pregnancy, and weight of the newborn (p>0,05). At the end of the study, the hemoglobin, hematocrit, and serum ferritin levels decreased considerably in both groups compared to the initial values (p<0.01). No statistically significant difference in serum ferritin levels could be found between the two groups (p>0,05). The comparison of Group I and Group II in terms of nutritional status (average energy and food consumption) in the pre-instruction and post-instruction periods revealed that intake of total protein, heme protein, dietary fiber, folic acid, carotene, vitamins A, B1, B2, B6, C, and B12, potassium, calcium, phosphorus, iron, and zinc was higher in Group I in the post-instruction period (p=0.000); no statistically significant change in nutritional status during pregnancy was observed in Group II. Conclusion: Medical diet programs with iron sources are examined in association with food consumption. Assessment of hematological results suggests that, during pregnancy, each patient should receive a specific dose, rather than a routine dose, of iron and folic acid.     

Differences in the body composition and biochemistry in women grouped as normal-weight, overweight and obese according to body mass index and their relation with cardiometabolic risk

Morbidity of obesity-related diseases tends to increase due to a rise in the body mass index (BMI). We aimed to investigate how the body composition and biochemical parameters change while BMI increases in adult women were categorized as so: as normal weight, overweight and obese. Our objectives are to study the effects of those changes in the development of metabolic disturbances and to find out which parameters are the most sensitive to predict cardiometabolic risks. Three hundred and twenty two records of adult women (mean age: 38.62±12.71 year) who admitted to our unit concerning about losing or preserving their weights, were analyzed in the study. All patients had undergone anthropometric measurements and body composition analyses as well as some biochemical tests. Body composition analyses were performed by means of the Bioelectrical Impedance Analyzer (BIA). Increase in BMI significantly increased the body fat, blood sugar, insulin, triglyceride and uric acid levels. BMI and circumference of the waist were significantly and negatively correlated with the ratio of body water and lean mass/fat mass. However they were positively correlated with the ratio of fat mass and basal metabolism. Furthermore, it was also found that BMI and circumference of the waist were significantly and positively correlated with level of fasting blood sugar, insulin, triglyceride, homeostasis model assessment insulin resistance (HOMA-IR), uric acid and fibrinogen levels, and negatively correlated with high density lipoprotein (HDL) cholesterol level. In multiple regression analyses, circumference of waist measurements was significantly correlated with insulin, triglyseride and HDL, whereas the correlation between BMI and these parameters was not found significant. Total body fat mass (as %) showed significant correlation only with HDL-C level. It could be said that obesity which is a disorder that causes many health complications and affects the quality of life in the short and long term could be prevented or cured by keeping negative environmental conditions under control. According to our results, visceral adipose tissue (VAT) measurement was thought to be more related for metabolic and cardiovascular disorders rather than BMI. We also propose to test fasting blood glucose, insulin, triglyceride, HDL, fibrinogen, homocystein (HOM) levels along with VAT measurements to predict more truly about not only global cardiometabolic risk but also dementia in later life.     

Cerebrospinal fluid pressures in subacute sclerosing panencephalitis

Increased intracranial pressure can rarely be the initial symptom in subacute sclerosing panencephalitis (SSPE). We examined cerebrospinal fluid (CSF) pressures and their correlation with clinical features in 58 patients with SSPE. CSF pressure varied between 50 and 500 mmH2O, mean 210.9+/-103.7 mmH2O. Twenty-five (42%) patients had pressures above 200 mmH2O and 15/58 (25%), above 250 mmH2O. There was no correlation between CSF pressure and neurological disability, spasticity, or clinical stage. Frequent myoclonia and shorter interval between measles and onset of SSPE were associated with CSF pressure >200 mmH2O (p=0.035). The causes of high pressure in certain SSPE patients is unknown but may include the effect of myoclonic jerks or inflammatory reaction. Because these patients may be unable to express symptoms, increased intracranial pressure should be considered in the presence of irritability or frequent myoclonia.     

Reactive arthritis following tetanus vaccination: a case report

We report a case of reactive arthritis following tetanus vaccination. A healthy 55-year-old woman presented with pain and acute swelling of the right knee two days after receiving a tetanus vaccination. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor and human leukocyte antigen B-27 were negative. Her arthritis improved with the administration of nonsteroidal anti-inflammatory drugs. One week later the knee swelling and pain had settled. Reactive arthritis may occur after tetanus vaccination.     

Chanarin-Dorfman Syndrome: Clinical Features of a Rare Lipid Metabolism Disorder

Abstract:   Chanarin-Dorfman syndrome (CDS) is a very rare neutral lipid metabolism disorder with multisystem involvement. In order to not underdiagnose the cases, screening of lipid vacuoles in neutrophils from peripheral blood smears in patients with ichthyosiform erythroderma is needed. Few case reports revealing ultrastructural findings of skin and especially liver in that disorder were observed. Here we discuss clinical and electron microscopic findings of two siblings with CDS.     

Neuroimaging Findings in Hyperargininemia

In hyperarginenemia, there is a defect in argininase enzyme, which is a catalyzer of urea cycle. Though the pathogenesis of neuronal damage in hyperargininemia is not clear, high serum and cerebrospinal fluid arginine levels can be directly related with neuronal damage. In this study, our aim was to assess brain magnetic resonance images and magnetic resonance spectroscopy (MRS) patterns of two siblings with hyperarginenemia. We acquired single voxel MRS from the white matter to show the myelination pattern and to figure out any abnormal peak of metabolite stored due to enzymatic defect. We observed mild cerebral and cerebellar atrophy and infarct at bilateral posterior putamen and insular cortex localization on conventional images and elevated choline/creatine ratios and abnormal peak at 3.8 ppm, most likely representing arginine deposition. To the best of our knowledge, this is the first article revealing the brain MRS pattern of hyperargininemia. We reported the clinical and imaging findings of patients and discuss the correlation.     

Protective Effects of Vitamin E Forms (Alpha-tocopherol, Gamma-tocopherol and d-alpha-tocopherol Polyethylene Glycol 1000 Succinate) on Retinal Edema During Ischemia–reperfusion Injury in the Guinea Pig Retina

Purpose: The purpose of this study is to provide evidence that free radical damage is a component of retinal ischemia–reperfusion (I/R) injury, and to determine whether alpha-tocopherol, gamma-tocopherol and d-alpha-tocopherol polyethylene glycol 1000 succinate (TPGS) can protect the retina from this injury. Methods: The right eyes of 40 male guinea pigs weighing 500–600 g were used. The animals were randomly assigned to group 1 (control), group 2 (I/R), group 3 (I/R plus alpha-tocopherol), group 4 (I/R plus gamma-tocopherol) and group 5 (I/R plus TPGS). Groups 3, 4 and 5 received four subcutaneous injections at six-hour intervals for total dosage of 800 IU/kg alpha-tocopherol, 1000 IU/kg gamma-tocopherol and 750 IU/kg TPGS, respectively. The first dose of each substance was administered 5 minutes before retinal ischemia. Retinal ischemia was induced for 90 minutes, then followed by reperfusion for 24 hours. Injections of three substances were repeated at 6, 12 and 18 hours during reperfusion. The animals were killed at 24 hours of reperfusion. Sagittal sections of 4 μm were cut and stained with hematoxylin and eosin for light microscopic evaluation. The average thickness (edema) of the inner plexiform layer for each eye was measured in sagittal sections near the optic nerve and expressed in microns. Results: All the three substances showed statistically significant protection against the formation of retinal edema during ischemia–reperfusion injury. The mean thickness of the inner plexiform layer were 15.0, 25.44, 19.81, 21.38 and 20.88 μm in control, I/R, I/R plus alpha-tocopherol, I/R plus gamma-tocopherol and I/R plus TPGS groups, respectively. The results showed that the thickness of the inner plexiform layer in group 1 (control) was significantly lower than the other groups (p<0.001). The inner plexiform layer was thicker in the I/R group than with I/R plus alpha-tocopherol (p<0.001), I/R plus gamma-tocopherol (p<0.001) and I/R plus TPGS (p<0.01). The inner plexiform layer was not thicker in the I/R plus TPGS group than in the I/R plus alpha-tocopherol and I/R plus gamma-tocopherol groups. Compared to the I/R plus alpha-tocopherol group, the inner plexiform layer was significantly thicker in the I/R plus gamma-tocopherol group (p<0.01). Conclusions: The results from these experiments indicate that vitamin E forms have protective effects on the retina during retinal ischemia–reperfusion injury, but, the effects of alpha-tocopherol and TPGS appear to be much greater than that of gamma-tocopherol.     

Risk Factors for Recurrence and Death After Primary Surgical Treatment of Malignant Phyllodes Tumors

Background: Malignant phyllodes tumor (MPT) is a rare but aggressive breast malignancy. The aim of this study was to evaluate parameters that influence outcome in patients with MPT.Methods: Fifty women were diagnosed with MPT of the breast and treated between August 1971 and July 2000. All medical records were reviewed retrospectively. The Cox regression model was used for multivariate analysis.Results: Tumors were classified as borderline (6%), low grade (32%), or high grade (62%). The median patient age was 46 years (range, 14–77 years). The median tumor diameter was 3.5 cm (range, 1.5–18 cm). Twenty-two patients had wide local excision (WLE), and 28 patients had mastectomy. The median follow-up was 91 months (range, 12–360 months). Local recurrence (LR) occurred in 16 patients (32%) an average of 26 months after surgery (median, 17 months; range, 3–72 months). Distant metastasis occurred in 13 patients (26%) at an average of 53.4 months (median, 36 months; range, 4–177 months). Sixteen (32%) patients have died of their disease. LR was significantly increased with stromal overgrowth (P < .0001), large tumor size (P = .0177), and surgical margins <1 cm (P = .0120), but not with WLE (P = .5099). Stromal overgrowth was the only independent variable predictive of systemic metastasis (P < .0001) and patient survival (P < .0001).Conclusions: Stromal overgrowth in MPT carries a grave prognosis. Close surgical margins and large tumor size, but not type of operation, significantly increased LR. Either WLE with adequate margins or mastectomy is an appropriate treatment for patients with MPT.