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    Cardiac troponin-I as a marker of myocardial dysfunction in children with septic shock
    (EMH Swiss Medical Publishers, 2004) Gürkan, Fuat; Alkaya, Asuman; Ece, Aydın; Haspolat, Yusuf Kenan; Boşnak, Mehmet; Bilici, Meki; Kervancıoğlu, Mehmet; Arıtürk, Zuhal
    Objectives: Cardiac depression is well known in severe sepsis and septic shock. Our aim was to investigate the incidence of myocardial ischaemia as shown by cardiac troponin I (cTnI) levels in patients with septic shock and to evaluate the correlation with myocardial dysfunction measured by echocardiography. Methods: The study was performed in the paediatric intensive care unit in Dicle University Hospital, Turkey, between January 2001 and December 2002. Patients in septic shock, with a mean age of 6.4 +/- 2.8 months, were simultaneously submitted to a two-dimensional echocardiogram and biochemical investigation on admission. Results: The mean serum cTnI level of the patients was 3.1 +/- 2.6 ng/ml (0.01-9.80 ng/ml) and the mean LVEF value was calculated as 48% +/- 11%. 21 patients (75%) had a cTnI level >/=0.6 ng/ml, and 15 patients (54%) had a LVEF <0.5. For cTnI levels >/=0.6 ng/ml, sensitivity and specificity were 93.3% and 46.2%, and positive and negative predictive values were 66.7% and 85.7% respectively. For cTnI values >/=2.0 ng/ml, sensitivity and specificity were 86.7% and 76.9%, and positive and negative predictive values were 81.3% and 83.3%, respectively. There was a statistically significant relationship between LV dysfunction and cTnI positivity (r2 = 0.316, p = 0.002). No significant difference was found for the cTnI levels >/=0.6 ng/ml between non-survivors and survivors (p >0.05). Conclusion: Myocardial ischaemia and cell injury seem to be common in patients with septic shock and correlate with left ventricular dysfunction. Measurement of cTnI may be an easy and practical tool for monitoring cardiac damage in critically ill septic patients.
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    Interferon-alpha therapy in idiopathic thrombocytopenic purpura
    (Japan Pediatric Society, 2001) Dikici, Bünyamin; Boşnak, Mehmet; Kara, İsmail Hamdi; Doğru, Ömer; Alkaya, Asuman; Haspolat, Yusuf Kenan
    Background: Acute idiopathic thrombocytopenic purpura (ITP) represents the most frequent hemorrhagic diathesis in childhood. Up to 30% of patients with ITP are regarded as refractory to standard therapy. The rare mortality from acute ITP in childhood is almost exclusively due to intracranial hemorrhage. This complication occurs in less than 1% of ITP patients. This study was designed to evaluate the effect of alpha-interferon (IFN-alpha) in eight patients whom did not respond to conventional therapy. Method: In spite of conventional therapies, the patient whose platelet count could not be increased to 50;10(9)/L were accepted as refractory ITP. Eight of these patients whose platelet count lower than 20;10(9)/L were included in the prospective cohort study. Interferon alpha 2b 5 MU/m(2) was administered subcutaneously three times a week, totalling 12 times in a month. According to the platelet count on the 28th day of therapy, we grouped the patients into three categories. After 60 days, the survey was re-evaluated according to the platelet count. Results: The mean age of children was 3.5+/-2.5 (ranged between 3.5 and 9) years. Six of them were boys and two were girls. There was no response in one patient, partial response in one, and good response in six patients on the 28th day of therapy. The maximum rise in platelet count was observed from 7 to 14 days after the initiation of interferon. The median platelet count which was 15+/-5;10(9)/L before therapy, raised to 60+/-12;10(9)/L after therapy. However, on the 60th day of therapy, there were only two patients who had a platelet count over 100;10(9)/L. Conclusion: In our study, we did not observe the long-term benefit of IFN-alpha therapy in refractor ITP in childhood. However, in good responding patients, platelet levels were increased in a short time. Alpha-interferon may be alternative therapy for patients whom had a platelet count below 20;10(9)/L and not responding to standard therapy, or for patients whom immunosuppressive therapy is contraindicated.
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    Septik şoklu hastalarda serum troponin I ve myoglobin düzeyleri ile sol ventrikül ejeksiyon fraksiyonunun karşılaştırılması
    (Dicle Üniversitesi, Tıp Fakültesi, 2001) Alkaya, Asuman; Gürkan, Fuat
    Acil tedavi edilmesi gereken bir durum olan sepsis ve septik şokta kalp fonksiyonları açık bir şekilde etkilenmektedir. Bu çalışmada, sepsisli hastaların kan troponin I düzeyleri ile ekokardiyografik incelemelerinde sol ventrikül ejeksiyon fraksiyonu (LVEF) karşılaştırılarak, troponin Fmn sepsiste kardiyak zedelenmenin göstergesi olarak kullanılıp kullanılamayacağı araştırıldı. Ocak 2001 - Haziran. 2001 tarihleri arasında DÜTF Çocuk Sağlığı Hastalıkları Kliniği Bebek servisi yoğun bakım ünitesinde takip edilen 18 sepsis tanısı almış hasta çalışmaya alındı. Hastaneye kabulden sonraki ilk altı saat içinde troponin I düzeyleri bakılması için kan alındı. Hastalardan alınan kanda rutin biyokimya yanısıra myoglobin düzeyleri de çalışıldı. Aynı süre içerisinde ekokardiyografı ile LVEF ölçümleri yapıldı Çalışmada sepsisli hastalarda troponin I değerleri ortalama olarak 3.23 ± 2.84 ng/ml (0.01-9.17) bulundu. LVEF ile karşılaştırıldığında troponin 1 düzeyi yüksek olan hastalarda LVEF değerlerinin anlamlı olarak düşük olduğu görüldü. Myoglobin ile troponin I arasında anlamlı bir korelasyon görülürken, benzer ilişki myoglobin ile LVEF arasında saptanmadı. Hastanede eksitus oranlan troponin I düzeyleri yüksek olan hastalarda fazla iken, aynı durum EYEF'İ düşük olan hastalar için söz konusu değildi Bu nedenle troponin Enin sepsiste kardiak etkilenmeyi göstermede daha sensitif ve spesifik erken bir biyokimyasal uösterı>e olabileceği kanısına varıldı.