Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an 1-year experience

BACKGROUND

Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated.

METHODS

This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients' sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated.

RESULTS

In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively).

CONCLUSION

The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

The Use of Human Milk for Therapeutic Purposes Other Than Nutrition

Human milk is a popular treatment method applied as a traditional, natural pharmacotherapy that has been going on for many years in many societies. Due to its low cost, widespread and easy use, and lack of undesirable effects, breast milk also has the potential to play a role in evidence-based treatment for tertiary people as well as infant and maternal health. Scientific databases were searched for Literature search from January 1995 to December 2021, including Ovid, PubMed, Google Scholar, Science Direct, ResearchGate, Web of Science Core Collection (Clavirate), and a total of 45 articles from 142 articles written in English were included in the study. According to the results of the current studies reviewed, there is a general conclusion about the positive effects of human milk in the treatment of tertiary persons in addition to the prevention and treatment of common maternal and infantile diseases. Human milk can be used as a different alternative in further studies, especially based on anti-tumoral and cancer studies. In addition, an accessible, safe, and suitable alternative treatment for the treatment of allergic skin and mucous tissue damage in infants and mothers may be suitable for societies with limited access to treatment.

Does iron therapy have a place in the management of all breath-holding spells?

BACKGROUND

Aim of this study was to analyze the effect of iron therapy in children with breath-holding spells, irrespective of their hemoglobin level.

METHOD

All of the children were evaluated in terms of age, sex, age at onset of the attack, attack frequency, type of breath-holding spell, family pedigree, laboratory values. All enrolled patients were given iron at the dose of 4 mg/kg/day as a single daily dose for 3 months. Patients were called for follow-up appointments 1 and 3 months after the initiation of treatment to record the frequency and severity of spells.

RESULTS

The mean age of the patients was 12.50 ± 9.51 months. Patients were divided into two groups according to the hemoglobin level. The frequency of anemia in children with spells was recorded as 27%. Out of 100 patients treated with iron, 43% showed complete remission at the end of 1 month. At the end of the 3 months, percentage of complete responders increased to 80%. After three-month of iron treatment, 96.2% of the anemic and 73.97% of the non-anemic patients were spell-free. Eight children had mild adverse effects after iron therapy that did not require dose modification.

CONCLUSIONS

This study confirmed that iron therapy reduces spell frequency regardless of anemia in all breath-holding spells. A three-month empiric iron therapy should be offered to all children with spells.

Breastfeeding While Pregnant: A Country-Wide Population Study

Background: There are no national data on the prevalence of breastfeeding during pregnancy (BDP) in the world. Also, there is no consensus for the BDP. Aim: The purpose was to determine the prevalence of breastfeeding status in pregnant mothers having children younger than 24 months of age and to evaluate the associated sociodemographic factors and characteristics of the last-born child and current pregnancy through two consecutive national health survey. Methods: Data from the 2012 and 2017 Jordan Family Health and Population Survey were merged. Individual, household, and community-level factors associated with BDP were analyzed by using complex sample multivariate logistic regression. Results: Two surveys enrolled 6,858 women having at least one child younger than 24 months and 8.8% (weighted count: 603) of them got pregnant also. Of the pregnant women, 8.9% continued breastfeeding their last-born children. Being younger than 12 months positively affected breastfeeding compared to last-born child aged 12-23 months. Multivariate analysis revealed that BDP was associated positively with wealth index (richest vs. poorest) and postnatal care for the last-born child within 2 months (presence vs. absence), whereas negatively with bottle use (presence vs. absence), traditional contraceptive methods (abstinence/withdrawn vs. modern, lactational amenorrhea vs. modern), short interpregnancy interval (months), and current pregnancy duration (months) in Jordan. Conclusions: The prevalence for BDP differs according to some maternal, last-born infant, and current pregnancy characteristics. Prospective cohort studies are necessary to evaluate the impact of BDP on "mother, last-child, and future-child," and to detect the duration and prevalence of BDP in different countries.

Increasing the Awareness of Autism Spectrum Disorder with Training of Pre-School Teachers and School Counselors in Turkey

Training programs for the awareness of autism for professions are supported under the leadership of the United Nations. Misinformation can cause socially destructive results as that which is incorrect is assumed to be known correctly. This study included a total of 308 participants comprising 226 (73.4%) preschool teachers and 82 (26.6%) school counselors. The basic questions related to the awareness and knowledge of autism spectrum disorder (ASD) were selected based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). It was attempted to categorize the questions into four fields: (1) social interaction, (2) social communication and speech, (3) limited interest pattern with stereotypical and ritualistic behaviors, and (4) comorbidities, etiological characteristics, and the relationship between vaccinations and autism. The results of the study indicate that the awareness of ASD, including core symptoms, was extremely lacking in preschool teachers and school counselors. Moreover, they had extreme prejudice to information known to be incorrect.

Characteristics of persistent diaper dermatitis in children with food allergy

BACKGROUND/OBJECTIVES

Diaper dermatitis is often caused by irritant contact occurring beneath the diaper of an infant, and it is aggravated by factors such as dampness, friction, urea, and feces. Food-allergic patients are known to exhibit various skin lesions ranging from urticaria to eczema. This study aims to determine the relationship between persistent diaper dermatitis and food allergy.

METHODS

A retrospective chart review was conducted of pediatric patients with a diagnosis of persistent diaper dermatitis between August 2015 and November 2017.

RESULTS

The study included 157 patients diagnosed with persistent diaper dermatitis (67 male, 72 female; median age: 13 months). Diaper dermatitis was more common and included the whole perineum in children who had multiple food allergies (P = 0.001). In children with multiple food allergies, the course of diaper dermatitis was more severe, and the condition did not respond to topical treatment (P = 0.025). A longer elimination diet was required for patients with Type I reactions and persistent diaper dermatitis (P = 0.018). In patients with Type II and mixed reactions, diaper dermatitis was more diffuse and covered the whole perineum (P = 0.025). In patients with Type II and mixed reactions, diaper dermatitis was more severe and did not respond to topical treatment (P = 0.025).

CONCLUSIONS

Persistent diaper dermatitis lasting longer than a month may be associated with food allergy. The diaper rash may also be the only indicator of the food allergy. Elimination of the responsible food may allow these patients to recover from persistent diaper dermatitis.