Search

Background: Although intracranial pressure (ICP) monitoring is the gold standard method for measuring intracranial pressure after traumatic brain injury, optic nerve sheath diameter (ONSD) measurement with ultrasound (US) is also used in the evaluation of ICP., Objective: To investigate the association between a series of OSND measurements by US and changes in clinical presentation of the patient., Methods: Prospective study including 162 patients with traumatic brain injury. Age, sex, cerebral CT findings, ONSD levels by US at minutes 0, 60, and 120, Glasgow Coma Scale (GCS) within same period, change of consciousness, treatment, and mortality data were reviewed. The association of ONSD levels with GCS, change of consciousness, treatment, and mortality was evaluated., Results: There was no difference in ONSD changes in the patients' sample within the period (p=0.326). ONSD significantly increased in patients who died (p<0.001), but not in those who survived (p=0.938). There was no significant change in ONSD of the patients who received anti-edema therapy (p=801), but significantly increased ONSD values were found in those who received anti-edema therapy (p=0.03). Patients without change of consciousness did not have any significant change in ONSD (p=0.672), but ONSD values increased in patients who consciousness became worse, and decreased in those who presented a recovery (respectively, p<0.001, p=0.002). A negative correlation was detected between ONSD values and GSC values measured at primary, secondary, and tertiary time periods (for all p<0.001)., Conclusions: ONSD follow-up may be useful to monitor ICP increase in patients with acute traumatic brain injury.

This study was conducted with mothers living in Ankara and registered in the year 2019 with the Immunization Services Unit of the Provincial Directorate of Health as cases of vaccine refusal. This qualitative study used semi-structured interviews to understand how mothers decide about child vaccination and the attitudes, perceptions, and beliefs underlying these decisions. A total of 23 interviews were conducted by two of the authors between March and September 2019. Each of the 23 participants had at least one child aged five years or younger and were living in Ankara. The study shows that mothers with vaccine hesitancy constitute a heterogeneous group whose members have differing levels of hesitation and concern about the vaccination of their children. It is also observed that the most important factor that affects their decisions is related to trust., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum-tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth., Study Design: Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2)., Results: A total of 167 infants (22-42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants < 34 weeks of gestational age and 56.8 vs. 45.0% in infants > 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of <34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group)., Conclusion: The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of <1,500 g. Therefore, more studies are needed to determine the optimal ETT insertion depth., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: Population growth is an important public health problem with economic, social, cultural and political consequences. The aim of the study was to determine the reproductive behaviour and perspectives on fertility of women in Sanliurfa, the city with the highest fertility rate in Turkey., Methods: The quantitative dimension of the study was carried out using a mixed methods approach in which 300 women were interviewed and a questionnaire was completed; the qualitative dimension was carried out through in-depth individual interviews with 14 women, using a semi-structured interview form. Analysis of the qualitative data was done using a content analysis technique., Results: The median number of children was three (range 0-10). Women with no or a low level of education tended to have a greater number of children. Preference for a particular sex of child was one reason behind the higher number of children. These two factors were main causes of an increased number of children. Women with no or a low level of education (odds ratio [OR] 9.1) and women who expressed a preference for a male child (OR 5.9) had more children compared with other women. Participants regarded a male child as more valuable than a female child and that having many children strengthened the family. Parents regarded their sons as insurance for their old age. Having an induced abortion was perceived as a sin., Conclusion: The results showed that cultural norms and values significantly affected fertility rates.

Neonatal diabetes mellitus (NDM) is a rare form of monogenic diabetes presenting within the first 6 months of life. INS gene promoter mutations have been shown to cause both remitting/relapsing and permanent NDM. We, herein, present three interesting patients with INS gene promoter mutations. Two cousins with an identical homozygous c.-331C > G mutation presented with NDM. The first cousin had nonremitting diabetes and still requires multidose insulin injections at the current age of 6.1 years. However, the other cousin's diabetes remitted at the age of 9 months, and she is still in remission at the age of 3 years with no medication or dietary intervention required (latest HbA1c was 4.9%). The third patient had NDM also due to a homozygous INS promoter c.-331C>A mutation. Her diabetes remitted at the age of 2 months and relapsed at the age of 2.6 years with severe diabetic ketoacidosis (DKA). Distinct clinical phenotype and relapse with severe DKA in one of the three cases suggest that INS promotor mutations can cause a heterogeneous phenotype and even cases exhibiting remission can relapse unpredictably. Therefore, as the age of relapse is unpredictable, close follow-up and family education on diabetes symptoms are essential for cases with remitting/relapsing diabetes due to INS gene mutations., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Many interventions have been designed to increase breast milk (BM) consumption among preterm and critical-term infants in neonatal units. The aim of this study was to determine the trends in the usage of BM in a neonatal unit and the risk factors for insufficient breast-milk feeding at discharge., Methods: This retrospective study included newborn infants who hospitalized in the neonatal unit during two periods in different years, a 15-month period in 2012-2013 and in 2017-2018. The primary outcomes were the availability of BM within 24 h after delivery and the status of infant feeding at discharge., Results: During two periods of the study, a total of 3,018 infants were included in the study. The rate of BM expression within the first 24 h after delivery was 92.9%, and it was found that the first period of the study, caesarean section delivery, very low birth weight, being first-time mother, and young maternal age were each independently associated with the delayed initiation of BM expression (P < 0.05). At discharge, 87.6% of the infants had been feeding with BM. Multiple births, the delayed initiation of BM expression, and the length of hospital stay were associated with inadequate BM feeding at discharge (P < 0.001)., Conclusion: This study showed that interventions supporting BM feeding, which have recently been carried out, made improvements to the initiation of BM expression among mothers whose babies were admitted to the neonatal unit, and in the rate of BM feeding among infants at discharge., (© 2020 Japan Pediatric Society.)

Purpose: To compare the efficacy of intravitreal aflibercept and laser photocoagulation in the treatment of retinopathy of prematurity (ROP)., Methods: The files of patients who were diagnosed as having type 1 ROP or aggressive posterior ROP (APROP) and treated with laser photocoagulation and 1 mg/0.025 mL of intravitreal aflibercept were retrospectively analyzed. The patients' birth weight, gestational age, detection week of the disease, zone, stage, presence of plus disease and rubeosis, regression of ROP, re-treatments administered during the follow-up, and spherical equivalent values obtained at the corrected sixth month were recorded., Results: The study included 27 eyes of 15 patients who underwent laser photocoagulation and 24 eyes of 12 patients who received intravitreal aflibercept. Retinal vascularization was in zone II in all eyes in the laser photocoagulation group and zone 1 in 22 eyes (91.7%) in the intravitreal aflibercept group (P < .05). In the laser photocoagulation group, 25 eyes (92.6%) had stage 3 ROP and 2 eyes (7.4%) had stage 2 ROP. In the intravitreal aflibercept group, 14 eyes (58.3%) had stage 3 ROP and 10 eyes (41.7%) had APROP (P < .05). Treatment was established at a postmenstrual age of 37.6 ± 2.5 weeks in the laser photocoagulation group and 34.2 ± 2.4 weeks in the intravitreal aflibercept group (P < .05). The regression rates after treatment were 92.6% and 100%, respectively (P > .05). In the intravitreal aflibercept group, laser photocoagulation was performed on 10 eyes (41.6%) during follow-up visits. Spherical equivalents were measured as +1.10 ± 2.30 and +1.50 ± 2.41 diopters, respectively (P < .05) at the corrected sixth month., Conclusions: Intravitreal aflibercept is an effective treatment for ROP. However, it requires more additional treatments than laser photocoagulation during the follow-up visits. [J Pediatr Ophthalmol Strabismus. 2020;57(1):54-60.]., (Copyright 2020, SLACK Incorporated.)

Background: Serum bilirubin levels beyond the physiological limits, may lead to alterations in autonomic regulation in a newborn infant. Heart rate variability (HRV), is a noninvasive and quantitative marker of the activity of the autonomic nervous system (ANS). To date, few studies have demonstrated the undesirable effects of severe unconjugated hyperbilirubinemia (UHB) on autonomic functions, and only one study has used HRV as a marker of the autonomic activity. However, the relationship between altered cardiac autonomic functions and UHB by using the HRV derived from 24-hour Holter electrocardiography (ECG) recording has not been investigated previously., Objective: We aimed to assess whether a relationship exists between severe UHB and cardiac autonomic dysfunction by evaluating HRV via 24-hour Holter ECG recording., Methods: This single-center, prospective, case-control study was conducted on 50 full-term newborn infants with severe UHB requiring phototherapy and 50 healthy infants as controls. HRV assessment was performed by using 24-hour Holter ECG recording., Results: There was no significant difference in terms of mean average heart rate, mean maximum heart rate and mean RR duration between the groups. However, mean minimum heart rate was significantly lower in the study group. When 24-hour time and frequency domain parameters were compared, time and frequency domain parameters rMSDD as well as high frequency (HF), which represent parasymphathetic activity, were significantly higher in the study group. Furthermore, low frequency to high frequency (LF/HF) ratio, that serves as an indicator of sympathovagal balance, was significantly lower in the study group., Conclusion: Severe UHB may cause cardiac autonomic dysfunction in favor of parasympathetic predominance in jaundiced neonates.

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains., Competing Interests: The authors declare no conflict of interest.

Background: Pilonidal sinus disease was first described by Mayo in 1833 as "a cyst that contains hair." Although surgical treatment of the lesions can have successful outcomes, it also can be associated with relatively high rates of post-operative infectioins and recurrence. Many studies have demonstrated that triclosan-coated sutures (TCS) decrease surgical site infections., Objective: The goal of this randomized parallel-arm double-blind clinical trial was to investigate the ability of antibiotic prophylaxis, and secondarily of antibiotic-coated sutures, to prevent post-operative infections in the surgical management of pilonidal sinus disease., Patients and Methods: The initial trial protocol aimed to compare early infections in patients who did and did not undergo antibiotic prophylaxis (AP(+) vs. AP(-)). A secondary goal was to compare the effects of TCS and conventional sutures (CS) on early infectious complication rates in the two groups. The AP(-) arm had to be terminated prematurely because of an unacceptably high rate of infectious complications., Results: A total of 80 micro-organisms were recovered from 74 patients (69.8%). Methicillin-susceptible coagulase-negative staphylococci were the most common isolates (30%). The most frequently detected anaerobic micro-organism was Actinomyces israelii (7.5%). The TCS and CS groups had similar rates of micro-organism growth (65.8% vs. 75.0%). There was no significant difference in the occurrence of wound dehiscence. Over the six-month follow-up, there were two recurrences, both in the TCS group. The difference was not significant., Conclusions: We believe that antibiotic prophylaxis is necessary in patients scheduled for Karydakis flap repair. In our study, TCS tended to be associated with a lower rate of infection, but this trend did not achieve statistical significance. Anaerobic micro-organisms dominated the infective isolates.

Background: Splenectomy after combined colosplenic trauma or iatrogenic splenic injury during colorectal surgery associates with worse short- and long-term outcomes, including reduced survival in patients with colorectal cancer. Splenic autotransplantation may improve the outcomes of such patients. Omental splenic transplantation is the standard procedure but may be difficult when performing laparoscopic colorectal surgery or when total or subtotal omentectomy is required. This animal model study was performed to evaluate the impact of splenic autotransplantation to the groin area on colonic wound healing., Methods: Thirty rats were divided into three groups of ten animals. One group underwent colon anastomosis and sham splenectomy, the second underwent colon anastomosis and splenectomy, and the third underwent colon anastomosis, splenectomy, and intramuscular autotransplantation of the spleen. On postoperative day 7, anastomotic healing was evaluated by measuring bursting pressure and hydroxyproline levels. The third group was subjected to scintigraphy before sacrifice to assess whether the transplant was functional., Results: The mortality rates of the sham, splenectomized, and transplanted animals were 0 %, 30 %, and 20 %, respectively: the splenectomized animals had significantly lower mean bursting pressures than the other two groups (p = 0.002). The mean hydroxyproline levels of the three groups were 467.4, 335.3, and 412.7 mg hydroxyproline/g protein, respectively (p = 0.0856). Nine of the ten transplanted animals (90 %) had splenic activity on scintigraphy., Conclusions: Splenectomy impaired the healing of the colonic anastomosis. This effect was largely reversed by splenic autotransplantation. Intramuscular autotransplantation to the groin area appears to be feasible and effective.

Objective: The effect of the specialty of physicians who perform endoscopy on preoperative wait-time of colorectal cancer patients was evaluated., Material and Methods: Data from 86 patients who have been operated with a diagnosis of colorectal cancer from January 2011-February 2013 regarding age, sex, tumor location, colonoscopy date, surgery date, the expertise and institution of the endoscopist were retrospectively examined. The time between colonoscopy and surgery was accepted as the pre-operative wait time (PWT)., Results: Out of 86 patients, 24 (27.9%) colonoscopies were performed by general surgeons (GS), and 62 (72.1%) by gastroenterologists (GE). When patients who underwent colonoscopy in other centers were extracted, the PWT for our center was 20.4±10.8 days. When grouped according to specialties, the PWT of patients who had their colonoscopy performed by GS was significantly shorter than patients who underwent colonoscopy by GE at the same center (p<0.05). Patient's age, sex and location of the tumor had no effect on PWT (p>0.05)., Conclusion: The preparation time for surgery in colorectal cancer patients is influenced by the specialty of the physician performing the procedure. In order to standardize this period, a common flow diagram after endoscopy should be established for patients with suspected malignancy.