Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study

BACKGROUND

Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5.

METHODS

Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group.

RESULTS

A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old.

CONCLUSION

MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country.

Pediatric kidney care experience after the 2023 Turkey/Syria earthquake

BACKGROUND/AIMS

Two earthquakes on February 6th, 2023 destroyed ten cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death.

METHOD

A web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were asked.

RESULTS

903 injured children (median age: 11.62 years) were evaluated. Mean TUR was 13 h (Interquartile range-IQR: 32.5), max 240 h). 31 of 32 patients with a TUR of >120 h survived. The patient who rescued after ten days survived.Two-thirds of the patients were given 50 mEq/L sodium-bicarbonate in 0.45% sodium-chloride solution on admission day. 58% of patients were given intravenous fluid (IVF) at a volume of 2000-3000 mL/m2 body surface area (BSA), 40% of 3000-4000 mL/m2 BSA, and only 2% of >4000 mL/m2 BSA. 425 patients had surgeries, 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively.Crush-AKI developed in 314 patients (36% of all patients). 189 patients were dialyzed. Age > 15 years, creatine phosphokinase (CK)≥20 950 U/L, TUR≥10 h, and the first-day IVF volume < 3000-4000 mL/m2 BSA were associated with Crush-AKI development. 22 deaths were recorded, 20 of 22 occurred in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived.

CONCLUSIONS

This is the most extensive pediatric kidney disaster data after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20 950 U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000 mL/m2 BSA were also asscoiated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Reduction in Retinal Ganglion Cell Layer, Inner Plexiform Layer, and Choroidal Thickness in Children With Autism Spectrum Disorder

PURPOSES

The aim of this study was to evaluate the retinal nerve fiber layer (RNFL), choroidal layer, inner plexiform layer (IPL), and ganglion cell layer (GCL) in patients with autism spectrum disorder (ASD).

METHODS

In this study, we measured the thickness of the RNFL, GCL, IPL, and choroidal thickness using a spectral optical coherence tomography (OCT) device and we compared the results between the children diagnosed with ASD and healthy controls. Correlation between the Childhood Autism Rating Scale (CARS) and the OCT data was evaluated.

RESULTS

Both ASD and control group consisted of 40 subjects (30 males and 10 females). Of the children in the ASD group, 29 had normal intelligence and 11 had mild intellectual disability (MID). The mean age of patients in the ASD group and control groups were 9.77 ± 3.37 years and 9.85 ± 3.97 years (p = 0.928). There was a statistically significant difference between the ASD group and the control group in the nasal and nasal-superior sectors of the RNFL layers in the left eye when all the lower layers of RNFL were assessed. In both eyes, the children with ASD had considerably lower mean choroidal thicknesses than the controls. When compared to the controls, the GCL and IPL volumes in the individuals with ASD were considerably lower in both eyes. Compared to the MID group, the left GCL volume of the nasal-inferior group was noticeably higher. A significant correlation was found between CARS scores and left GCL left IPL.

CONCLUSIONS

In contrast to RNFL in the ASD group, significant reductions in IPL, GCL, and choroidal thickness were observed in both eyes. It is thought that GCL may be a much more important biomarker than RNFL in terms of representing the structural deterioration in the brain. In addition, these results may form the basis for a new perspective on the use of OCT for the diagnosis and clinical course of autism.

Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: A multicenter study

INTRODUCTION

Neuropsychiatric (NP) involvement is a restricted area in juvenile-onset systemic lupus erythematosus (jSLE).

AIM

To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population.

METHODS

This study was based upon 24 referral centers' SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses.

RESULTS

A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002-7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785-68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049-1.186), P: 0,001 were associated with increased risk for neurologic sequelae.

CONCLUSION

We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed.

Scapholunate Ligament Partial Tears; Tear Localization, Extrinsic Ligament Injury Association and Conservative Treatment Responses Prior to Instability: Cross-Sectional Study

PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.

A rare entity in a pediatric patient: coexistence of emphysematous cystitis and emphysematous pyelonephritis

BACKGROUND

Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are rare urinary tract infections. They have a wide spectrum of clinical manifestations; ranging from asymptomatic to septic shock at presentation. In children, EC and EPN are rare complications of urinary tract infections (UTIs). Their diagnosis is based on clinical manifestations, laboratory results and characteristic radiological findings of gas within the collecting system, renal parenchyma and/or perinephric tissue. Computed tomography is the best radiological option in the diagnosis of EC and EPN. Despite the availability of various treatment modalities including medical and/or surgical treatment alternatives, these life-threatening conditions have high mortality rates reaching up to 70 percent.

CASE

Urinary tract infection was detected in the examinations of an 11-year-old female patient suffering from lower abdominal pain, vomiting and dysuria for two days. Air was detected in the bladder wall on X-ray. EC was detected in the abdominal ultrasonography. Air formations in the bladder lumen and calyces of both kidneys in abdominal computed tomography confirmed the presence of EPN.

CONCLUSIONS

Individualized treatment should be instituted according to the severity of EC and EPN, and the overall health condition of the patient.

COVID-19 in pediatric nephrology centers in Turkey

BACKGROUND

There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey.

METHODS

This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry.

RESULTS

Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10-15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period.

DISCUSSION

COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients' susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage.

Determination of Factors Affecting Hypertension Awareness, Compliance to Treatment and Blood Pressure Control

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertension is one of the most common chronic diseases and is a global public health problem. Hypertension is associated with conditions such as heart diseases, stroke, kidney disease, premature death and disability and creates a significant burden in the field of health and economy (1,2). According to the World Health Organization's hypertension data of Turkey, it was stated that 16.9 million people in the population of 2017 have hypertension and the awareness rate is 51.9% (3).

Purpose

This descriptive and cross-sectional study was conducted to determine the factors affecting hypertension awareness, compliance to treatment, and blood pressure control.

Methods

The population of the research consisted of individuals living X city in Turkey. Participants were reached at the information activity held in the city square as part of the Hypertension awareness day on May 17, 2017. In addition, it was said that those who want to participate in the study in their family/environment can apply to the Cardiology Polyclinic of XX University Hospital Heart Center. The research was completed on 30 October 2017 with 542 people. The data were collected with a questionnaire designed in line with the literature and the Hypertension Compliance Assessment Scale (4). The Cronbach α value of the scale is 0.82. The descriptive statistics and multivariate linear regression analysis were used to evaluate of the data (5,6).

Results

The mean age of the participants was 62.66 (±13.86) years, 72.1% were male, 50.7% primary school, 22.5% is a high school graduate. The mean systolic blood pressure of the participants was 129.00 (±19.83) and diastolic blood pressure was 77.36 (±12.45) mmHg. It was determined that 26.5% of the individuals who did not have a known hypertension had a systolic blood pressure of 140 and above, and 15.8% had a diastolic blood pressure of 90 and above. While 31.1% (n=168) of the participants measure their blood pressure only when they are sick, 10.2% (n=55) measure their blood pressure every day.

It was observed that 83.7% (n=18) of the participants complied with hypertension treatment. The participants' compliance score for hypertension treatment was found to be 5.08 (±2.32).

In Table 1, the characteristics of the participants' lifestyles are presented.

In Table 2, Multivariate analysis findings related to compliance with hypertension treatment are given. The regression model applied for hypertension treatment compliance was found to be statistically significant (F:14.814, p&lt;0.001). According to the model, 18% of participants' compliance with hypertension treatment is explained by the independent variables in the model.

Conclusion(s)

Regular health check-ups and regular exercise are independent variables that affect treatment compliance in hypertension. It was found that the majority of individuals who did not have any known hypertension had systolic blood pressure above 140 mmHg.

Temporal Trends in the Epidemiology of HIV in Turkey

OBJECTIVE

The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016.

METHODS

Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and the Chi square test was used to determine temporal changes.

RESULTS

A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. The most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with a CD4 T cell count of <350 cells/mm3. Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy.

CONCLUSION

The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at a young age. The late diagnosis was found to be a challenging issue. Despite the unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.

Evaluation of non-infectious complications of peritoneal dialysis in children: a multicenter study

BACKGROUND

Peritoneal dialysis (PD) is the most common kidney replacement therapy in children. Complications associated with PD affect treatment success and sustainability. The aim of this study was to investigate the frequency of PD-related non-infectious complications and the predisposing factors.

METHODS

Retrospective data from 11 centers in Turkey between 1998 and 2018 was collected. Non-infectious complications of peritoneal dialysis (NICPD), except metabolic ones, in pediatric patients with regular follow-up of at least 3 months were evaluated.

RESULTS

A total of 275 patients were included. The median age at onset of PD and median duration of PD were 9.1 (IQR, 2.5-13.2) and 7.6 (IQR, 2.8-11.9) years, respectively. A total of 159 (57.8%) patients encountered 302 NICPD within the observation period of 862 patient-years. The most common NIPCD was catheter dysfunction (n = 71, 23.5%). At least one catheter revision was performed in 77 patients (28.0%). Longer PD duration and presence of swan neck tunnel were associated with the development of NICPD (OR 1.191; 95% CI 1.079-1.315, p = 0.001 and OR 1.580; 95% CI 0.660-0.883, p = 0.048, respectively). Peritoneal dialysis was discontinued in 145 patients; 46 of whom (16.7%) switched to hemodialysis. The frequency of patients who were transferred to hemodialysis due to NICPD was 15.2%.

CONCLUSIONS

Peritoneal dialysis-related non-infectious complications may lead to discontinuation of therapy. Presence of swan neck tunnel and long duration of PD increased the rate of NICPD. Careful monitoring of patients is necessary to ensure that PD treatment can be maintained safely.

Don't Let Our Operating Theatre to Be Desert

PURPOSE OF THE STUDY The purpose of this study is to reveal the waste of water by medical staff hand scrubbing preoperatively in the operation theatre, draw attention to the water consumption with small precautions. The study compares motion-sensitive sensor tap with an uncensored classic tap, to assess the difference of water consumption during hand scrubbing. MATERIAL AND METHODS The presented study compared two groups; hand scrubbing with sensory tap was enrolled as group A and classic tap with running water was enrolled as group B. Three participants were included in each group. Operation faucets with a motion-sensitive sensor and timekeeper were used in group A. Running water from a tap in 10 seconds was measured with the help of a measuring cup. The water amount after 3 minutes of washing was also measured. The difference between the two obtained data was compared. The obtained data were also multiplied to the global surgical data. RESULTS Measurements were performed with a measuring cup and it was measured that 1,250 ml of water is running from faucets in 10 seconds. In group A, faucets were open for 23 seconds whereas in group B faucets were open for 180 seconds. In group A, water utilization was 2,875 ml per person (8,625 ml for three), in group B was the water utilization of 22,500 ml per person (67,500 ml for three). Regarding this data for a single operation, the consumption difference between the two groups was measured as 58,875 ml. The total count of major surgery worldwide per year is reported to 321,500,000. When this number is multiplied with the obtained data, it is calculated that the total amount of water to be saved between the two groups is 18,928,313 m3. That is equal to one year of water consumption of a city with 125,000 inhabitants. CONCLUSIONS In conclusion, as healthcare professionals, it is possible to save enough water as a medium-sized city by changing our handwashing habits in the operation rooms. As a result, water-conserving systems and hand scrubbing education can be very effective in using the natural resources economically and protecting these resources. Key words: water, operation theatre, washing.

Venom allergy and knowledge about anaphylaxis among beekeepers and their families

BACKGROUND

Beekeepers and their families are at an increased risk of life-threatening anaphylaxis due to recurrent bee-sting exposures.

OBJECTIVE

The aim of this study is to evaluate the demographic features, previous history of anaphylaxis among beekeepers and their family members, and their knowledge about the symptoms and management of anaphylaxis.

METHODS

A standardized questionnaire was administered to beekeepers during the 6th International Beekeeping and Pine Honey Congress held in 2018, in Mugla, Turkey. Additionally, food-service staff from restaurants were surveyed as an occupational control group about their knowledge about anaphylaxis.

RESULTS

Sixty-nine beekeepers (82.6% male, mean age 48.4±12.0 years) and 52 restaurant staff (46.2% male, mean age 40.5±10.0 years) completed the questionnaire. Awareness of the terms 'anaphylaxis' and 'epinephrine auto-injector' among the beekeepers were 55.1% and 30.4% and among the restaurant staff were 23.1% and 3.8%, respectively. Of the beekeepers, 74% were able to identify the potential symptoms of anaphylaxis among the given choices; 2.9% and 5.8% reported anaphylaxis related to bee-stings in themselves and in their family members, respectively. None of the restaurant staff had experienced or encountered anaphylaxis before but 3.8% of their family members had anaphylaxis and those reactions were induced by drugs.

CONCLUSION

It is essential that implementation of focused training programs about anaphylaxis symptoms and signs as well as practical instructions of when and how to use an epinephrine auto-injector will decrease preventable morbidities and mortalities due to bee-stings in this selected high-risk population of beekeepers and their family members, as well as other fieldworkers under risk.

The effect of probiotics on prevention of upper respiratory tract infections in the paediatric community - a systematic review

Prevention of acute upper respiratory tract infections (URTIs) is becoming an increasingly important concept in public health application due to the increase in antibiotic resistance. Probiotics have been shown to have some effect on prevention in various reviews. In this study we aimed to re-asses the effect of probiotics as there has been a substantial increase in literature regarding the effects and safety of probiotics in the paediatric population. Two major databases were systematically searched to identify clinical trials eligible for inclusion. Study selection, data extraction and quality assessment were carried out by two reviewers. This review comprises 33 randomised controlled trials (RCTs) applied to a paediatric population with high-quality methodology. The primary outcome for this review was the incidence of respiratory tract infections. Secondary outcomes were severity of symptoms, missed days of school, incidence of antibiotic use and safety of prebiotic use. This review showed that probiotics have an impact on decreasing the incidence of URTIs and the severity of symptoms. The use of probiotics is extremely safe and as studies increase in evaluation of the effect of probiotics more and more show a significant beneficiary effect. Although still a long way from becoming a unanimous treatment modality, the small positive changes that probiotics have on URTIs is important to consider and the use of probiotics should be encouraged more.

The Evaluation of Results of Repair using All-Soft Suture Anchor in the Treatment of Chronic Tendinous Mallet Finger Surgery

PURPOSE OF THE STUDY The purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors. MATERIAL AND METHODS In this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up. RESULTS Mean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period. CONCLUSIONS All-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage. Key words: tendinous mallet finger, hand surgery, all-soft anchor. Level of evidence: Level-4, Retrospective case-control study.

The use of nitrofurantoin for children with acute cystitis caused by extended-spectrum Β-lactamase-producing Escherichia coli

BACKGROUND

Acute cystitis in children caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) is on the rise. Treatment of these is usually parenteral treatment. The aim of this study was to investigate the clinical and microbiological efficacy of oral nitrofurantoin treatment in children with lower urinary tract infection (UTI) caused by ESBL-producing E. coli.

METHODS

Fifty children with lower UTI due to ESBL-producing E. coli were prospectively studied. Demographic data, clinical condition, laboratory values, treatment regimens, and complications of the patients were recorded. Urine samples were obtained by transurethral catheterization or clean catch; urine bags were not used for specimen collection for culture. Patients with lower UTI due to ESBL-producing E. coli and found to be susceptible to nitrofurantoin were given oral nitrofurantoin. Patients were re-evaluated 3-4 days after the end of treatment. Renal scintigraphy was performed 1-3 months after the end of treatment.

RESULTS

A total of 50 pediatric patients (48 females and 2 males) were enrolled into study. The mean age was 7.5 ± 3.96 years (range, 1-17 years). The duration of nitrofurantoin treatment was 10 days. Bacteriological response was observed in 49 of 50 patients (98%). No patient had symptoms after treatment. No significant side-effect was observed in any of the patients. All patients had normal serum creatinine values. Renal scintigraphic study, which was performed in all patients 1-3 months after completion of treatment, demonstrated the non-scarring in 48 of 50 patients (96%).

CONCLUSIONS

UTIs due to ESBL-producing E. coli are a serious problem because of the bacteria's multidrug antibiotic resistance pattern. This study suggests that oral nitrofurantoin treatment could be a good alternative for lower UTI caused by ESBL-producing E. coli in pediatric patients.

Are calculated ratios and red blood cell and platelet distribution width really important for the laryngeal cancer and precancerous larynx lesions

Introduction

In this research, it is planned to investigate the differences in neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, reticulocyte distribution width, and platelet distribution width values of groups of benign laryngeal lesion, precancerous laryngeal lesion, and laryngeal squamous cell carcinoma and among patients with different stages of tumors in laryngeal carcinoma and precancerous laryngeal lesion groups, and whether these values carry a prognostic features.

Materials and Methods

The investigated parameters determined from preoperative blood samples of patients have been compared among the groups and in the subgroups according to severity of illness in laryngeal carcinoma and precancerous laryngeal lesion groups. Also, the laryngeal carcinoma and precancerous laryngeal lesion groups were divided into two subgroups as good and poor prognosis and were compared with patients having good prognosis requiring no additional treatment during the follow-up, and the statistical significance of the differences was examined.

Results

On comparison, statistically significant differences were only observed between the gross larynx carcinoma group and other lesions. Apart from that, when the values were evaluated in terms of prognosis, no significant statistical results were found in any of the values.

Conclusion

Despite the significant statistical results seen in the gross tumors, it is known that there are more objective methods for identifying those lesions in clinical use. We conclude that caution should be exercised when using these new hematological parameters, which can be affected by many factors.

An Effective Technique in Treatment of Femoral Neck Fractures - Ostheosynthesis under Double Fluoroscopic Guidance

PURPOSE OF THE STUDY The most commonly used technique for fixation of the femoral neck fractures is percutaneous osteosynthesis with cannulated screw under fluoroscopy guidance. Osteosynthesis performed under single-fluoroscopic guidance requires continuous repositioning the fluoroscope to obtain biplane imaging. This study aimed to evaluate whether there is a statistically significant difference between the osteosynthesis procedures performed under guidance of single-fluoroscopy and double fluoroscopy with respect to radiation emission safety and treatment parameters for fixation of femoral neck fractures. MATERIAL AND METHODS This retrospective study included 35 patients operated for femoral neck fracture between December 2013 and October 2017. Osteosynthesis was performed in 21 of these patients using cannulated screw under guidance of single-fluoroscopy whereas other 14 patients underwent same type of osteosynthesis assisted by double-fluoroscopy. The parameters of these two groups such as duration of surgery preparation, duration of the surgery, duration of radiation exposure, collo-diaphyseal angle and Harris hip score values were recorded. RESULTS No significant difference was found between the groups regarding time for surgery preparation (p > 0.05). On the other hand, duration of surgery and overall duration of radiation exposure were found 14 (p < 0.05) and 15 (p < 0.05) minutes shorter in the double-fluoroscopy group, respectively. No significant difference was found between the groups in terms of collo-diaphyseal angle and Harris hip score values (p > 0.05). CONCLUSIONS Use of double-fluoroscopy significantly reduces time of surgical duration and also level of radiation exposure in surgery of femoral neck fractures. Key words:double fluoroscopy, femoral neck fractures, radiation, osteosynthesis, cannulated screw.

Acute Total Ulnar Collateral Ligament Injuries of Thumb - Primary Repair with Mini Soft Suture Anchor (JuggerKnot™)

PURPOSE OF THE STUDY We aimed to investigate the functional outcomes and complications of a new approach, the primary UCL repair using JuggerKnot™ Soft Anchor-1.0 mm Mini (Zimmer-Biomet). MATERIAL AND METHODS This study included a total of 12 patients with acute UCL injury who were operated with primary repair with JuggerKnot™ Soft Anchor-1.0 mm Mini between January 2012 and September 2016. All patients were operated on using the same surgical technique. The thumb pinch and grip strengths, articular range of motion, and Glickel functional score were recorded for all patients. The pinch grip strength and articular range of motion were compared with the intact side. Early and late postoperative complications were recorded. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). The grip strength and the pinch strength were 94.3% and 92.27%, respectively, of the contralateral side. Articular range of motion attained the same level as the contralatereal side in all patients at the final visit, and no patient suffered from any complication. The patients returned to work at a mean of 5.45 weeks, and the Glickel score was good in 1 patient and excellent in the remainder 11 patients. CONCLUSIONS Surgical repair using the JuggerKnot™ Soft Anchor-1.0 mm is an effective alternative treatment method for acute total ulnar collateral ligament (UCL) rupture. Key words:ulnar collateral ligament, acute total injury, thumb, soft suture anchor, JuggerKnot™.

Cerebral arterial thrombosis in a child with nephrotic syndrome

Nephrotic syndrome (NS) in childhood may be associated with thromboembolic complications, mainly in venous origin. However, arterial thrombosis may also be seen as a very rare and life-threatening complication. Herein, we described a case of steroid-resistant NS who did not respond to full-dose steroid treatment for 8 weeks and was complicated by neurological findings. The renal biopsy was consistent with focal segmental glomerulosclerosis. His cerebral magnetic resonance angiography showed the sudden termination of M3 branch of the left middle cerebral artery which corresponded with subacute infarction in the left frontoparietotemporal area. Thrombosis panel yielded the results of hyperhomocysteinemia (46.1 μmol/L, range: 5-15 μmol/L) and heterozygous methylene tetrahydrofolate reductase mutation (C677T, A1298C). After that, the patient was given medical therapy including anticoagulant treatment. Improvement in the neurological outcome was determined on the 1^st month of follow-up examinations.

Bochdalek hernia and intrathoracic ectopic kidney: Presentation of two case reports and review of the literature

Bochdalek hernia is a congenital abnormality with high morbidity and mortality characterized by passage of the abdominal organs into the thoracic cavity through a diaphragmatic defect. Intrathoracic location of abdominal organs such as kidneys is very rare, with a reported incidence of only 0.25% in the literature. Herein, we present two cases of Bochdalek hernia with a herniation of intra-abdominal organ such as kidney that was treated in our clinic and compare this rare case with those in the literature. In both cases, the functionally normal kidneys were left in situ during diaphragmatic repair. No complications were observed during the postoperative period, and 10- and 1-year follow-ups. In cases with Bochdalek hernia associated with an intrathoracic ectopic kidney, the functionally normal ectopic kidneys were left in situ during repair of the diaphragmatic defect without complications.

Differentially regulated ADAMTS1, 8, and 18 in gastric adenocarcinoma

OBJECTIVE

The aim is to investigate the expression status of ADAMTS1,8, and 18 proteases in gastric cancer (GC) and lymphatic metastasis.

BACKGROUND

A disintegrin and metalloprotease with thrombospondin motifs (ADAMTS) is a new protease family, and has important biological functions such as hemostasis, extracellular matrix remodeling and regulation of angiogenesis.

METHODS

The immunostaining status of ADAMTS1,8, and 18 were investigated in formalin-fixed paraffin-embedded samples of 25 patients who underwent curative resection for GC.

RESULTS

The immune reactivity scores (IRS) of ADAMTS1, 8, and 18 were significantly higher in the cancerous gastric tissue in comparison to non-cancerous gastric tissue (p < 0.001). In addition, IRS scores of these three ADAMTS proteases were higher in the metastatic lymph nodes compared with healthy lymph nodes (p < 0.001). The expression status of the three ADAMTSs in cancerous gastric tissue was correlated with stage of tumor. Additionally, ADAMTS1 expression and ADAMTS8 expression in cancerous gastric tissue were found to correlate with grade and tumor size, respectively.

CONCLUSION

This study showed that ADAMTS1, 8, and 18 are highly expressed in GC and its nodal metastases, suggesting  important roles of these proteases in carcinogenesis and lymphatic metastasis. The findings from the present study indicate that these proteases may be promising candidates for novel and alternative treatments in GC (Tab. 3, Fig. 3, Ref. 27).

The Effect of Incorrect Foot Placement on the Accuracy of Radiographic Measurements of the Hallux Valgus and Inter-Metatarsal Angles for Treating Hallux Valgus

PURPOSE OF THE STUDY Accurate radiographic measurements are crucial in treating hallux valgus (HV). This three-dimensional deformity should not be evaluated from one joint on one plane. However, in practice, surgeons measure the deformity only on transverse dorsoplantar radiographs. We determined the amount of error associated with positioning the foot incorrectly on radiographs. MATERIAL AND METHODS To simulate incorrect positions of the foot in radiographic evaluation, we designed an angled device that can move in transverse and frontal plane. In four patients with symptomatic HV, we took weight-bearing radiographs of the involved foot in seven different positions. These 28 radiographs were given identifying but meaningless labels. On each radiograph, six surgeons blinded to the position of the radiograph measured the HV angle (HVA) and the inter-metatarsal angle (IMA) and state the treatment plan according to five treatment options were given to participants. RESULTS Inter-observer agreement was high for measurements of HVA and IMA in all positions (interclass correlation coefficients, 0.96 and 0.88, respectively). However, intra-observer agreement was poor for HVA (intra-observer agreement, 0.17) but good for IMA (intra-observer agreement, 0.64). According to the measurements in different positions, intra-observer treatment choices revealed moderate results (ICC: 0.524). Clinical Relevance Radiographic measurements are very important on the treatment decisions of hallux valgus. The foot position can influence the measurement accuracy and can cause incorrect decisions. In this study, we evaluated the impact of foot positions on measurements of hallux valgus angle and inter-metatarsal angle. Additionally, we evaluated the incorrect foot positioning on treatment decisions. Moreover, we analyzed intra-observer and inter-observer agreements of these angles in various positions. CONCLUSIONS We recommend that measurements of IMA are more reliable than those of HVA for managing hallux valgus in terms of false weight bearing radiographs taken in different positions. Positional changes during foot radiographs could lead clinicians to perform incorrect HVA and IMA measurements. This could change the treatment option. HVA measurements were more affected with foot positioning. It is important to take full weight bearing foot radiographs in correct technique. Key words: hallux valgus, radiology, data accuracy.

Effect of ultra high temperature ceramics as fuel cladding materials on the nuclear reactor performance by SERPENT Monte Carlo code

Ultra High Temperature Ceramics (UHTCs) have low density and high melting point. So they are useful materials in the nuclear industry especially reactor core design. Three UHTCs (silicon carbide, vanadium carbide, and zirconium carbide) were evaluated as the nuclear fuel cladding materials. The SERPENT Monte Carlo code was used to model CANDU, PWR, and VVER type reactor core and to calculate burnup parameters. Some changes were observed at the same burnup and neutronic parameters (keff, neutron flux, absorption rate, and fission rate, depletion of U-238, U-238, Xe-135, Sm-149) with the use of these UHTCs. Results were compared to conventional cladding material zircalloy.

A morphometric study of the protective effect of cryotherapy on oral mucositis in cancer patients treated with 5-fluorouracil

We investigated cytological changes in oral mucosa smears from patients treated with cryotherapy to determine whether cryotherapy prevented mucositis caused by 5-fluorouracil (5-FU) therapy. Patients with gastrointestinal malignancies were divided into four groups; control patients before 5-FU therapy, patients after 5-FU therapy without cryotherapy, patients with cryotherapy before 5-FU therapy and patients with cryotherapy after 5-FU therapy. Oral mucosa samples from all patients were assessed at the beginning and on day 14 of chemotherapy. We used exfoliative cytology to evaluate cellular changes in the oral mucosa that were caused by 5-FU. Smears from each patient were stained using the Papanicolaou method and analyzed using stereology. Smears were taken from each group before and after 5-FU infusion. We found that nuclear volume was decreased significantly in cells of the 5-FU therapy after cryotherapy patients compared to the 5-FU therapy before cryotherapy patients. We also found significantly decreased cytoplasmic volumes in the 5-FU therapy after cryotherapy patients compared to the 5-FU therapy before cryotherapy patients. The results of cytomorphometric estimations revealed that cryotherapy may be used to prevent damage to oral tissue and may decrease the frequency and duration of oral mucositis caused by 5-FU.

Melatonin Modulates the Immune System Response and Inflammation in Diabetic Rats Experimentally-Induced by Alloxan

Diabetes mellitus (DM) is a metabolic disease, which causes an increase in the proinflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin 1β (IL-1β), and also proliferation of monocyte chemotactic protein. In the present study, the potential effects of melatonin on proinflammatory cytokines, hematological values, and lymphoid tissues were investigated in diabetic rats. In the study, 36 male rats were randomly divided into 4 groups as follows: Control, Mel (melatonin), DM, and DM-Mel. For 15 days, an isotonic saline solution was given to the Control and DM groups; melatonin was administered to the Mel and DM-Mel groups intraperitoneally. At the end of the study, all animals were sacrificed by drawing the blood from their hearts under deep anesthesia. Samples of the spleen, thymus, and lymph nodes were fixed in 10% formaldehyde for histologic analysis. Increases in proinflammatory serum cytokine concentrations, mast cells, and total white blood cell counts as well as tissue destruction in the lymphoid organs were determined in the DM group via biochemical, hematological, and histologic analyses. However, the findings for the DM-Mel group revealed decreases in serum IL-1β concentration and mast cell densities, and destructions in lymphoid tissues by the melatonin administration. The present study suggests that melatonin treatment may control immune system regulation and inhibit the production of proinflammatory cytokines and tissue mast cell accumulation by preventing the destruction of lymphoid organs in the diabetic process.

Saccharomyces boulardii CNCM I-745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea

Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3rd day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, P<0.001). The effect of S. boulardii (diarrhoea-free children) was observed starting at 48 h. After 72 h, only 27.3% of the children receiving probiotic still had watery diarrhoea, in contrast to 48.5% in the control group (P<0.001). The duration of diarrhoea was significantly reduced in the probiotic group in hospital, ECU and outpatient settings (P<0.001, P<0.01 and P<0.001, respectively). The percentage of diarrhoea-free children was significantly larger after 48 and 72 h in all settings. The mean length of hospital stay was shorter with more than 36 h difference in the S. boulardii group (4.60±1.72 vs 6.12±1.71 days, P<0.001). The mean length of ECU stay was shorter with more than 19 h difference in the probiotic group (1.20±0.4 vs 2.0±0.3 days, P<0.001). No adverse effects related to the probiotic were noted. Because treatment can shorten the duration of diarrhoea and reduce the length of ECU and hospital stay, there is likely a social and economic benefit of S. boulardii CNCM I-745 in adjunction to oral rehydration solution in acute infectious gastroenteritis in children.

Modelling study on production cross sections of 111In radioisotopes used in nuclear medicine

Radiopharmaceuticals are radioactive drugs used for diagnosis or treatment in a tracer quantity with no pharmacological action. The production of radiopharmaceuticals is carried out in the special research centers generally using by the cyclotron systems. Indium-111 is one of the most useful radioisotopes used in nuclear medicine. In this paper, we calculated the production cross sections of 111In radioisotope via 111–114Cd(p,xn) nuclear reactions up to 60 MeV energy. In the model calculations, ALICE/ASH, TALYS 1.6 and EMPIRE 3.2 Malta nuclear reaction code systems were used. The model calculation results were compared to the experimental literature data and TENDL-2014 (TALYS-based) data.

Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients

OBJECTIVES

The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods.

METHODS

We enrolled 32 kidney transplant patients. Smears were obtained from the buccal mucosa transplant patients before and 12 months after kidney transplantation. Smears from each individual were stained using the Papanicolaou method and were analyzed using a stereological method.

RESULTS

Statistically, the nuclear volumes and cytoplasmic volumes in the cells of buccal mucosa were markedly higher after kidney transplantation (P < .05). There was a decreased positive cell density in the oral epithelial cells after kidney transplantation compared with before renal transplantation (P < .05).

CONCLUSIONS

These findings suggest that there are alterations in the oral epithelial cells after kidney transplantation, which are detectable by microscopy and cytomorphometry.

Clinical comparison of weight- and age-based strategy of dose administration in children receiving intravenous busulfan for hematopoietic stem cell transplantation

Bu, combined with TDM-guided dosing, is associated with fewer graft failures/relapses and lower toxicity in pediatric HSCT. We aimed this retrospective study for comparison of weight- and age-based dosing in terms of clinical outcomes such as time to engraftment, early complications, EFS, OS, and toxicity profiles in children receiving iv Bu. Sixty-one children who underwent HSCT from April 2010 to February 2013 by means of a Bu-based conditioning regimen and completed 100 days after transplantation at Ankara Children?s Hematology and Oncology Hospital Bone Marrow Transplantation Unit were enrolled in this study. SOS and neutropenic fever occurred more frequently in the weight-based dosing group. We found a statistically significant correlation between Bu dose and the incidence of SOS (r = 0.26, p = 0.04). Multivariate analysis showed only weight-based dosing of Bu was a significant predictor of SOS (HR = 9.46; p = 0.009). However, no relationship was found between two groups in terms of hemorrhagic cystitis, engraftment syndrome, acute or chronic GvHD, time to engraftment, chimerism, TRM, OS, and EFS rates. Weight-based dosing of Bu may cause higher incidence of SOS and early infectious complications at the places where TDM of Bu cannot be performed.

A study on the criticality of modified neutron transport equation by using alternative scattering phase functions

PN approximation is known as a proper method to solve neutron transport equation when literature is taken into consideration. Generally, conventional scattering function is used to solve criticality and diffusion problems in Legendre polynomial approximation. In this study, instead of conventional scattering function, Henyey-Greenstein (HG) and Anlı-Gungor phase functions (AG) are used in slab geometry transport equation and some critical thicknesses of the slab are calculated as an application with Legendre polynomial (PN) approximation and Marshak boundary condition. Results obtained from HG and AG scattering functions are compared and the correlations and discrepancies between the two functions are presented in the tables.

Quantifying the financial losses of rangeland degradation due to reduced milk yield in the rangelands of Erzurum Province in Turkey

This study estimated the financial losses associated with lower milk yields in the relatively poor rangeland conditions of the Erzurum Province in Turkey and the factors contributing to the lower milk yields associated with the state of the rangelands, the type of grazing livestock and the demographics of the farmers. The study was conducted in 11 villages in Erzurum Province in 2006 and 2007. The following variables were considered in the study: year, number of milking days in grazing season, age and level of education of the farmers, cattle breed, supplementary feeding during the grazing period, lactation number of the cows, rangeland condition, stocking rate of the rangelands, altitude, the proportion of small ruminants in the herd and the percentage of bare ground of the rangelands. According to the least-squares regression analysis, altitude, stocking rate, the number of milking days in the grazing season and the percentage of bare ground had negative effects on milk yield, whereas all other factors significantly increased milk yield. It was estimated that a 10% deterioration in rangeland condition would result in a reduction in daily milk yield of 1.23 kg per cow, 62 kg ha–1 of rangelands and 1255 kg per farm in a 120-day grazing period. It was also found that the use of concentrate supplements during the grazing season was not cost-effective.

Plasma exchange therapy for severe gastrointestinal involvement of Henoch Schönlein purpura in children

OBJECTIVES

The aim of this report is to evaluate the plasma exchange as a choice for the management of life-threating gastrointestinal system (GIS) involvement in Henoch-Schönlein purpura (HSP) when refractory to conventional therapies.

METHODS

We retrospectively reviewed the medical records of HSP patients who had plasma exchange therapy due to massive GIS involvement. We reported age, gender, initial HSP presentation, etiological or triggering factors and disease course. Treatment modalities, side effects and their outcomes were noted.

RESULTS

We reported 7 cases of childhood HSP with severe gastrointestinal involvement refractory to common immunosuppression with systemic steroid and cytotoxic therapy. All patients gave inadequate response to pulse methyl prednisolone or oral prednisolone therapy with ongoing GIS bleeding and severe abdominal pain. Therefore, pulse cyclophosphamide was added to the treatment. Two patients received additional intravenous immunoglobulin (IVIG) therapy. Gastrointestinal manifestations continued and plasma exchange was performed. All patients improved after plasma exchange treatment.

CONCLUSIONS

Treatment of GI involvement in HSP with plasma exchange has been mainly based on case reports. According to our data, we propose that, plasma exchange may be a safe and efficient management choice in paediatric HSP patients with massive GIS involvement that are refractory to other therapies.

Cost effectiveness of caspofungin vs. voriconazole for empiric therapy in Turkey

Invasive fungal infections from febrile neutropenia are associated with significant cost and mortality. The mainstay of treatment has been liposomal amphotericin B, however, echinocandins and azoles have shown promise as alternative treatments. Data on clinical efficacy exist, however, data incorporating pharmacoeconomic considerations are required in Turkey. The aim of this study was to investigate the cost effectiveness of caspofungin vs. voriconazole in empiric treatment of febrile neutropenia in Turkey. A decision analytic model was utilised, built upon two randomised-controlled trials and supplemented with expert panel input from clinicians in Turkey. A five-point composite outcome measure was utilised and sensitivity analyses were performed to demonstrate the robustness of the model. The base case scenario resulted in caspofungin being preferred by TL2,533, TL29,256 and TL2,536 per patient treated, successfully treated patient and patient survival, respectively (approx. USD1414, 16 328 and 1415); sensitivity analyses did not change the outcome. Monte Carlo simulation highlighted a 78.8% chance of favouring caspofungin. The result was moderately sensitive to treatment duration and acquisition cost of the antifungal agents compared. This is the first pharmacoeconomic study comparing caspofungin to voriconazole within Turkey, resulting in an advantage towards caspofungin. The study will aid in formulary decision-making based on the clinical and economic consequences of each agent in the Turkish health care setting.