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Objective:  Magnesium sulfate (MgSO 4 ) provides effective fetal neuroprotection. However, there is conflicting evidence regarding the association between antenatal MgSO 4 exposure and patent ductus arteriosus (PDA). Thus, herein, we aimed to evaluate the association between antenatal MgSO 4 exposure and PDA., Study Design:  Preterm infants born between 24 0/7 and 31 6/7 weeks of gestation were included in this retrospective study. Infants who died within the first 72 hours of life and those with significant congenital anomalies were excluded from the study. Echocardiographic and clinical assessment parameters were used to define PDA and hemodynamically significant PDA (hsPDA). Treatments were planned according to the standard protocols of the unit. The following data were collected from hospital medical records: perinatal characteristics, neonatal outcomes, detailed PDA follow-up findings, and maternal characteristics including MgSO 4 exposure and doses., Results:  Of the 300 included infants, 98 (32.6%) were exposed to antenatal MgSO 4 . hsPDA rates were similar in the infants exposed and not exposed to antenatal MgSO 4 , when adjusted for antenatal steroid administration, gestational age, and birth weight (OR: 1.6, 95% CI: 0.849-3.118, p  = 0.146). The rates of PDA ligation and open PDA at discharge were similar between the groups. A cumulative MgSO 4 dose of >20 g was associated with an increased risk of hsPDA (crude OR: 2.476, 95% CI: 0.893-6.864, p  = 0.076; adjusted OR: 3.829, 95% CI: 1.068-13.728, p  = 0.039). However, the cumulative dose had no effect on the rates of PDA ligation or open PDA at discharge. Rates of prematurity-related morbidities and mortality were similar between the groups., Conclusion:  Although antenatal MgSO 4 exposure may increase the incidence of hsPDA, it may not affect the rates of PDA ligation or open PDA at discharge. Further studies are required to better evaluate the dose-dependent outcomes and identify the MgSO 4 dose that not only provides neuroprotection but also has the lowest risk of adverse effects., Key Points: · Antenatal exposure of MgSO4 may cause PDA.. · Antenatal MgSO4 exposure may not increase the rates of PDA ligation or open PDA at discharge.. · Further studies are required to better evaluate the dose-dependent outcomes and optimal MgSO4 dose.., Competing Interests: None declared., (Thieme. All rights reserved.)

In the neonatal intensive care units (NICU), epicutaneo-caval catheters (ECCs) are common alternative vascular routes. Pericardial effusion (PCE) and cardiac tamponade (CT) are rare but serious complications in infants with ECCs. It may be asymptomatic or present with a variety of significant clinical signs, including dyspnea, bradycardia, sudden asystole, and hypotension. If untreated, PCE can be fatal. This report presents, three cases of ECC-associated PCE/CT during NICU stay. All three patients were born before 30 weeks of gestation and weighed less than 1500 g. Echocardiography was used for diagnosis all patients. PCE/CT was detected incidentally in one patient and after hemodynamic deterioration in the other two. In one patient, CT was developed due to catheter malposition, and the other two patient, the catheter tip was found in the right atrium. PCE did not recur in any of the patients after pericardial fluid was drained and the catheters were removed. No PCE/CT-related deaths were observed. In all three patients, X-ray was used to evaluate the location of the catheter tips. However, after clinical deterioration, echocardiography showed that in the first two cases the tips were actually in the right atrium. Real-time ultrasound was suggested with strong evidence to evaluate the location of the catheter tip and to detect secondary malapposition. PCE/CT should be considered in the presence of unexplained and refractory respiratory distress, abnormal heart rate and blood pressure, and metabolic acidosis in a neonate with ECC. Early diagnosis and prompt pericardiocentesis are essential to reduce mortality and improve prognosis. Prospective studies with educational interventions should be designed to demonstrate that the use of point-of-care ultrasound (POCUS) can be easily acquired and may reduce complications., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Continuous kidney replacement therapy (CKRT) use has increased in recent years, but anticoagulation is a challenge for neonates. Regional citrate anticoagulation (RCA) is rarely preferred in neonates because of citrate accumulation (CA) and metabolic complications. We aimed to demonstrate the efficacy and safety of RCA in neonates. We retrospectively analyzed the medical records of 11 neonates treated with RCA-CKRT between 2018 and 2023. The initial dose of RCA was 2.1-3 mmol/l, and then, its dose was increased according to the level of ionized calcium (iCa +2 ) in the circuit and patients. The total/iCa +2 ratio after-treatment > 2.5 was indicated as CA. We evaluated to citrate dose, CA, circuit lifespan, and dialysis effectivity. The median gestational age was 39 (36.4-41.5) weeks, the median body weight (BW) was 3200 (2400-4000) grams, and the mean postnatal age was 4 (2-24) days. The most common indication for CKRT was hyperammonemia (73%). All neonates had metabolic acidosis and hypocalcemia during CKRT. Other common metabolic complications were hypophosphatemia (90%), hypokalemia (81%), and hypomagnesemia (63%). High dialysate rates with a median of 5765 ml/h/1.73 m 2 allowed for a rapid decrease in ammonia levels to normal. Four patients (36.3%) had CA, and seven (63.7%) did not (non-citrate accumulation, NCA). Mean BW, median postnatal age, biochemical parameters, coagulation tests, and ammonia levels were similar between the CA and NCA groups. Low pH, low HCO 3 , high lactate, and SNAPPE-II scores could be associated with a higher T/iCa ratio., Conclusion:  RCA was an efficient and safe anticoagulation for neonates requiring CKRT. Metabolic complications may occur, but they could be managed with adequate supplementation., What Is Known: • Continuous kidney replacement therapy (CKRT) has become popular in recent years due to its successful treatment of fluid overload, electrolyte imbalance, metabolic acidosis, multi-organ failure, and hyperleucinemia/hyperammonemia associated with inborn errors of metabolism. • The need for anticoagulation is the major difficulty in neonatal CKRT. In adult and pediatric patients, regional citrate anticoagulation has been shown to be effective., What Is New: • RCA is an effective and safe anticoagulation method for neonates who require CKRT. • Electrolyte imbalances and metabolic acidosis could be managed with adequate supplementation and appropriate treatment parameters such as citrate dose, blood flow rate, and dialysate flow rate., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study is to examine the effect of green investments on air quality for developed and developing European countries. In this context, the short- and long-term effects of green investments on air quality were examined by panel generalized method of moments (GMM) and panel causality method. As a result of the GMM analysis, it has been determined that green investments negatively affect the air quality for both developed European countries and developing European countries in the short term, but this effect turns positive in developed countries in the long term. As a result of the panel causality analysis, two-way causality was determined between air quality and green investments., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

We present a case of oral myiasis in a 15-year-old boy with tuberculosis meningitis. The diagnosis was based on the visual presence of wriggling larvae about 1 cm in size and on the microscopic features of the maggots, especially those relating to stigmatic structures. The larvae were identified as third-stage larvae of Sarcophaga sp.

Unlabelled: This study aimed to determine the prevalence of anti- Toxoplasma gondii antibodies in haemodialysis patients with chronic renal failure (CRF)., Methods: One hundred and seventy three haemodialysis patients, and 40 healthy controls, were studied for the prevalence of anti-Toxoplasma gondii antibodies by a micro enzyme-linked immunosorbent assay (ELISA). Anti-T. gondii IgG antibodies were detected in 97 (56.06%) haemodialysis patients and 8 (20%) controls with a statistical significance. In addition, anti-T. gondii IgM antibodies were detected in 1.73% of patients, but none of the controls. In conclusion, a high percentage of positivity for Toxoplasma antibodies in patients with CRF undergoing haemodialysis was noticed, thus parasitological surveys of CRF patients should be periodically performed to prevent the possible dissemination of toxoplasmosis through the dialysis procedure.

Purpose: Cryptogenic epilepsy, defines a group of epilepsy syndromes for which an aetiology is unknown but an underlying brain disease is suspected. We selected patients in this subgroup of epilepsy and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA). We investigated the probable relationship between Toxoplasma gondii and cryptogenic epilepsy., Methods: We selected 50 patients with cryptogenic epilepsy, 50 patients with known cause epilepsy and 50 healthy volunteers and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by ELISA., Results: The sero-positivity rate for anti-Toxoplasma IgG antibodies among cryptogenic epilepsy patients (52%) was found to be higher than healthy volunteers (18%) and known cause epilepsy patients (22%) with statistical significance, (X(2)=18.095, P<0.01)., Conclusion: There might be a causal relationship between chronic toxoplasmosis and the aetiology of cryptogenic epilepsy.

A 52 year-old male patient with idiopathic hepatic cirrhosis complaining of diarrhea and weakness was accepted to the gastroenterology clinic. In order to find out the causative etiologic agent of diarrhea, stool samples were examined by different methods and stained using modified Kinyoun's acid-fast stain. Following examination, approximately 9 microns diameter, acid-fast variable wrinkled spheres were seen and diagnosed as Cyclospora cayetanensis. Confirmation of the diagnosis was established by fluorescent microscope (380 to 420 nm excitation filter), which showed bright green to intense blue autofluorescent oocysts. It has been shown that, Cyclospora cayetanensis is a coccidian parasite mainly found in immunocompromised patients and that it may be the agent of prolonged diarrhea. Only three cyclosporiosis cases have been previously reported in our country; all three cases were AIDS patients. We report here a further case of Cyclospora cayetanensis infection in a patient with hepatic cirrhosis and we consider that this is the first case, which was reported in hepatic cirrhosis.