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Abstract

Malpractice has gained an alarming dimension especially along with the introduction of compulsory professional liability insurance On the other hand it is quite difficult to say that malpractice is discussed by considering all responsible determinants According to individual focused approach the error is caused by single individual so the solution can be achieved by punishing the individual It is known that this approach does not reduce errors and adversely affect services due to high compensations and increased insurance premiums In Turkey malpractice is simply considered in the customer seller relationship context and individual focused approach is adopted However it is well established that this ldquo;blame culture rdquo; has negative effects on service provided social perception of the profession and job satisfaction Beside recognizing individual professional responsibilities basically it should be stressed that declaring healthcare workers as mainly responsible would not be fair In addition it violates right to health because of increasing the preventable errors and harms Turk Arch Ped 2011; 46: 6 11

Keywords

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Yenidoğanlarda hipoksik iskemik ansefalopati evresi ile eritropoietin düzeyleri arasındaki ilişki: Tedavide kullanılabilir mi? Özgün Araştırma

Öz

Özet Amaç: Yenidoğan hipoksik iskemik ansefalopatisi ciddi bir hastalığa ve ölüme sebep olmasına rağmen günümüzde etkin bir tedavisi yoktur Eritropoietin hipoksik iskemik beyin zedelenmesinden sonra işlevsel olarak iyileşme sağladığı gösterilmesine rağmen uygulama zamanı ve uygun doz uygulaması tam olarak ortaya çıkarılamamıştır Bu çalışmanın amacı asfiktik yenidoğanlarda hipoksinin şiddeti ve serum eritropoietin seviyesini karşılaştırmak ve bu ilişkinin klinik kullanım açısından önemini değerlendirmektir nbsp; Gereç ve Yöntem: Eritropoietin düzeylerini doğum sonrası 0 12 24 36 ve 48 saatlerde enzim immün yöntemi ile dört grupta ölçtük Bu gruplar 1 evre 1 n=11 ; 2 evre 2 n=9 ; 3 evre 3 hipoksik iskemik ansefalopatisi olan yenidoğanlar n=8 ve sağlıklı kontrol grubundan n=10 oluşmakta idi Bulgular: Kontrol grubunda eritropoietin düzeyinin geometrik ortalaması 5 mU mL idi Eritropoietin seviyeleri 0 ve 12 saatte grup 2 ve 3 rsquo;de kontrol ve grup 1 rsquo;e göre; 24 ve 36 saatlerde ise grup 3 rsquo;de diğer gruplara göre istatistiksel olarak anlamlı derecede yüksekti p=0 01 Kontrol ve hipoksik iskemik ansefalopati gruplarında 48 saatte fark yoktu p gt;0 05 Çıkarımlar: Bu sonuçlara göre zamanında doğan yenidoğanlarda rekombinan insan eritropoietin tedavisinin orta derece hipoksik iskemik ansefalopatide 12 saat ağır olgularda 24 saat sonra kullanılması gerektiğini düşünmekteyiz Türk Ped Arş 2010; 45: 334 8 Anahtar sözcükler: Eritropoietin hipoksik iskemik ansefalopati yenidoğan

Anahtar Kelimeler

• Eritropoietin, hipoksik-iskemik ansefalopati, yenidoğan

References

1. Florio P, Abella R, Marinoni E, et al. Biochemical markers of perinatal brain damage. Front Biosci 2010; 2: 47-72.
2. Chang YC, Huang CC. Perinatal brain injury and regulation of transcription. Curr Opin Neurol 2006; 19: 141-7.
3. Strunk T, Härtel C, Schultz C. Does erythropoietin protect the preterm brain? Arch Dis Child Fetal Neonatal Ed 2004; 89: 364-6.
4. Juul S. Erythropoietin in the central nervous system, and its use to prevent hypoxic-ischemic brain damage. Acta Paediatr Suppl 2002; 91: 36-42.
5. Van der Kooij MA, Groenendaal F, Kavelaars A, Heijnen CJ, van Bel F. Neuroprotective properties and mechanisms of erythro- poietin in in vitro and in vivo experimental models for hypoxia/ischemia. Brain Res Rev 2008; 59: 22-33.
6. Buemi M, Cavallaro E, Floccari F, et al. Erythropoietin and the brain: from neurodevelopment to neuroprotection. Clin Sci 2002; 103: 275-82.
7. Zhu C, Kang W, Xu F, et al. Erythropoietin improved neurologic outcomes in newborns with hypoxic-ischemic encephalopathy. Pediatrics 2009;124:218-26.
8. Noguchi CT, Asavaritikrai P, Teng R, Jia Y. Role of erythropoi- etin in the brain. Crit Rev Oncol Hematol 2007; 64: 159-71.

9. Maiese K, Li F, Chong ZZ. Erythropoietin in the brain: can the promise to protect be fulfilled? Trends Pharmacol Sci 2004; 25: 577-83.
10. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencphalographic study. Archives of Neur 1976; 33: 696-705.
11. McPherson RJ, Juul SE. Recent trends in erythropoietin-medi- ated neuroprotection. Int J Dev Neurosci 2008; 26: 103-11.
12. Ehrenreich H, Aust C, Krampe H, et al. Erythropoietin: novel approaches to neuroprotection in human brain disease. Metab Brain Dis 2004; 19: 195-206.
13. Grow J, Barks JD. Pathogenesis of hypoxic-ischemic cerebral injury in the term infant: current concepts. Clin Perinatol 2002; 29: 585-602.
14. Sirén AL, Knerlich F, Poser W, Gleiter CH, Brück W, Ehrenreich H. Erythropoietin and erythropoietin receptor in human ischemic/hypoxic brain. Acta Neuropathol 2001; 101: 271-6.
15. Yu X, Lin CS, Costantini F, Noguchi CT. The human erythropoietin receptor gene rescues erythropoiesis and developmental defects in the erythropoietin receptor null mouse. Blood 2001; 98: 475-7.
16. Dame C, Bartmann P, Wolber E, Fahnenstich H, Hofmann D, Fandrey J. Erythropoietin gene expression in different areas of the developing human central nervous system. Brain Res Dev Brain Res 2000; 125: 69-74.
17. Matsuda S, Okano M, Yamagishi K, Nagao M, Ueda M, Sasaki R. A novel site of erythropoietin production. Oxygen-dependent produc- tion in cultured rat astrocytes. J Biol Chem 1994; 269: 19488-93.
18. Juul SE, Yachnis AT, Rojiani AM, Christensen RD. Immunohistochemical localization of erythropoietin and its receptor in the developing human brain. Pediatr Dev Pathol 1999; 2: 148-58.
19. Fahnenstich H, Dame C, Allera A, Rosskamp R, Kowalewski S. Erythropoietin as a biochemical parameter for fetal hypoxia. Klin Padiatr 1995; 207: 326-30.
20. Juul SE, Stallings SA, Christensen RD. Erythropoietin in the cerebrospinal fluid of neonates who sustained CNS injury. Pediatr Res 1999; 46: 543-7.
21. Kakuya F, Shirai M, Takase M, et al. Relationship between erythropoietin levels both in cord serum and amniotic fluid at birth and abnormal fetal heart rate records. Pediatr Int 2002;44:414-9.
22. Heinze S, Sitka U. Erythropoietin as a marker of perinatal risk. Z Geburtshilfe Neonatol 1998; 202: 111-4.
23. Ruth V, Autti-Rämö I, Granström ML, Korkman M, Raivio KO. Prediction of perinatal brain damage by cord plasma vaso- pressin, erythropoietin, and hypoxanthine values. J Pediatr 1988; 113: 880-5.
24. Wen TC, Rogido M, Genetta T, Sola A. Permanent focal cerebral ischemia activates erythropoietin receptor in the neonatal rat brain. Neurosci Lett 2004; 355: 165-8.
25. Spandou E, Papoutsopoulou S, Soubasi V, et al. Hypoxia-ischemia affects erythropoietin and erythropoietin receptor expression pat- tern in the neonatal rat brain. Brain Res 2004; 1021: 167-72.
26. Castillo-Meléndez M, Yan E, Walker DW. Expression of erythro- poietin and its receptor in the brain of late-gestation fetal sheep, and responses to asphyxia caused by umbilical cord occlusion. Dev Neurosci 2005; 27: 220-7.
27. Gonzalez FF, Abel R, Almli CR, Mu D, Wendland M, Ferriero DM. Erythropoietin sustains cognitive function and brain volume after neonatal stroke. Dev Neurosci 2009; 31: 403-11.
28. Bernaudin M, Marti HH, Roussel S, et al. A potential role for erythropoietin in focal permanent cerebral ischemia in mice. J Cereb Blood Flow Metab 1999; 19: 643-51.
29. Kumral A, Ozer E, Yilmaz O, et al. Neuroprotective effect of erythropoietin on hypoxic-ischemic brain injury in neonatal rats. Biol Neonate 2003; 83: 224-8.
30. Sun Y, Calvert JW, Zhang JH. Neonatal hypoxia/ischemia is associated with decreased inflammatory mediators after erythropoietin administration. Stroke 2005; 36: 1672-8.
31. Brines ML, Ghezzi P, Keenan S, et al. Erythropoietin crosses the blood-brain barrier to protect against experimental brain injury. Proc Natl Acad Sci U S A 2000; 97: 10526-31.