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The aim of the study was to evaluate depression, state and trait anxiety scores and visual reaction times, and to define the impact of these variables on each other in swimmers and track and field athletes. One hundred athletes participated in this study including 25 female and 25 male national level swimmers and track and field athletes. Application of Spielberger’s State-Trait Anxiety Inventory, Beck Depression Inventory (BDI) and Donder’s Reaction Time Test to all participants revealed no significant relationship among obtained data except for a correlation between state and trait anxiety and depression scores (r =0.53, r=0.73 respectively, p<0.001). The mean trait anxiety score in female athletes was higher than that in males (42.60 ± 8.04 and 38.66 ± 7.13 respectively, p<0.05), whereas no gender differences were found for simple, choice or recognition reaction times and depression or state anxiety scores. Even though clinical depression and anxiety may affect the reaction times in patients, these results suggest that there is no correlation between anxiety and depression scores and reaction times in healthy athletes. [ABSTRACT FROM AUTHOR]

Perforation of the tympanic membrane occurs frequently as a result of infection, external trauma, and high-level impulsive sound pressure, such as that associated with an explosion. Many different surgical techniques can be used to repair the tympanic membrane and ossicles. Clinical operations such as tympanoplasty are undertaken to repair the damaged tympanic membrane and ossicles, thus improving hearing and reducing the chance of infection. The membrane is repaired or replaced with the use of graft materials, either from the patient's body or from artificial sources. The selection of graft material is very important because, as much as possible, it must exhibit the same dynamic behavior as the natural membrane. To compare various allograft materials, investigators developed a model of the ear on which different graft materials can be replaced. Three different membrane materials - irradiated allograft dura (Tutoplast Dura; IOP Inc., Costa Mesa, Calif), irradiated allograft fascia lata (Tutoplast Fascia Lata; IOP Inc.), and irradiated allograft fascia temporalis (Tutoplast Fascia Temporalis; IOP Inc.) - were used. Vibration responses of these membrane materials produced by defined sound signals with different frequencies were recorded by a small strain gauge; the spectra of sound for various corresponding input signals were recorded, and the results were compared with those of the sample graft material. Tutoplast Fascia Lata accomplished the best dynamic performance in vitro. Additional clinical and experimental data are needed, however, to determine which of these materials provides the best audiological and clinical performance. [ABSTRACT FROM AUTHOR]

The treatment of total columellar defects is very difficult, and there is not any first choice in reconstruction of these defects. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. We report a pediatric patient with a defect involving the entire columella. Reconstruction of the defect was accomplished with laterally based bilateral nostril sill flaps. An acceptable cosmetic result was obtained. This method can be done as a single-stage operation with an excellent color and texture match. We think that this method leads to good aesthetic results, and should be considered for total columellar reconstruction. [ABSTRACT FROM AUTHOR]

Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism, often presenting with neurological symptoms. We present the results of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) of the brain in a 16-month-old male patient with classic neurological and laboratory findings for MMA. MRI demonstrated the hyperintensity within globi pallidi both on T2-weighted image and DWI during the acute episode of metabolic acidosis. [ABSTRACT FROM AUTHOR]

Introduction: There are several studies in the literature about pathological fractures but almost no information about patients whose pathological fracture caused by a malignant lesion misdiagnosed and treated as a simple fracture. The aim of this study was to investigate patient and fracture characteristics, and outcomes in cases where fractures occurred in the presence of a malign pathology but were treated as simple fractures., Patients and Methods: Cases of malign bone lesions between 2000 and 2020 were retrospectively reviewed. Patients with a final diagnosis of malign bone lesion but whose pathological fractures were treated ignoring the underlying malign bone disease were included. Demographic, clinical and outcome data were collected from patient's medical records and analyzed., Results: Six patients met the inclusion criteria. Three of the patients were female and the cohort mean age was 56.8 ± 21.8 years at the time of admission. Patient diagnoses were: renal cell carcinoma metastasis (n = 1); colon cancer metastasis (n = 1); chondrosarcoma (n = 2); osteosarcoma (n = 1); and undifferentiated pleomorphic sarcoma of bone (n = 1). In all cases surgical management differed from those that should have been applied if the pathological fracture had been identified. Furthermore, surgical management after definitive histological diagnosis were more aggressive compared to if the malignancy had been identified at first admission. All patients died after a mean follow-up of 16.67 ± 11.7 months and the complication rate was 100%., Conclusion: When a pathological fracture is misdiagnosed and managed as a simple bone fracture, outcomes are extremely poor. In these situations, remedial surgery is more extensive, with increased complication rates and there is poor life expectancy., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2022. Published by Elsevier Ltd.)

Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can result in persistent loss of taste and smell. This study was performed to assess acoustic reflex threshold (ART) in patients with taste disorders caused by SARS-CoV-2., Material and Methods: This retrospective study enrolled 11 patients (9 men, 2 women; average age = 22.3 years) with a history of COVID-19 and had complaints of taste disorder and sensitivity to loud sounds. The control group consisted of 13 healthy participants (10 men, 3 women; average age = 23.4 years). Anamnesis, neuro-otological, ear, nose and throat, and eye examinations, as well as a taste test, pure tone audiometry, speech discrimination test, and impedance audiometry were performed in all participants., Results: All participants in the study group had a negative taste test result. In addition, ART values were significantly higher in the study group than the control group at all frequencies., Conclusions: SARS-CoV-2 could be a neurotropic virus that can cause facial nerve neuropathy.

Purpose: The aim of this study was to present our experience of treating humerus fracture sustained during arm wrestling., Methods: Data of patients treated in our clinic with the diagnosis of humeral shaft fracture due to arm wrestling between 2000 and 2020 was retrospectively reviewed. Data collected included age, sex, dominant arm, history of professional or experienced participation, type and laterality of fracture, presence of radial nerve palsy, other surgical complications, management (surgical or conservative), duration of union defined as the time from injury until callus was evident on the radiograph, and the range of motion of the elbow joint at the last follow-up., Results: Nineteen patients with humeral shaft fracture as a result of the arm wrestling were included. All had right arm fracture and all had right as the dominant side. All of the fractures were spiral at the distal third of the humerus and medial butterfly fragment was present in eleven (57.9%). Seven (36.8%) were treated surgically. Five (26.3%) had radial nerve palsy on admission. At last follow-up, no patient had neural deficit and none had significant loss of range of movement., Conclusion: Arm wrestling is an important cause of humerus shaft fracture. The dominant side is invariably affected. In this series all fractures were spiral type and occurred in the distal third of the humerus. One quarter of patients experienced radial nerve palsy, which can resolve spontaneously. Satisfactory results can be obtained with both conservative and surgical treatment., Level of Evidence: IV., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objectives: This study was aimed to evaluate the effectiveness of the new graft technique-modified one-piece nasal cap with alar strut graft in rhinoplasty; both for aesthetical appearance and nasal functions., Methods: Forty-two patients, who underwent primary rhinoplasty operation with the new graft technique, were evaluated visually by photographing and functionally by the Cottle test and rhinomanometry measurement., Results: All of the patients had sufficient nasal vision; also nasal valve angles became wider and Cottle tests were negative in all patients after surgery. Postoperative nasal airflow values (both left and right) were significantly higher, and airway resistance (left, right, and total) values were significantly lower than preoperative values., Conclusion: With the new graft technique, the authors obtained both satisfying aesthetic results and intended functional improvement. This technique may be an alternative to combination of multiple graft techniques; with advantages of practical performing and less complication risks., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

Background: Musculus depressor septi nasi and its tendon, the dermocartilaginous ligament, play an important role in external nasal valve and nasal respiration. If the ligament is cut during septorhinoplasty operations, nasal functions of the nose and facial expressions are affected. Therefore, the aim of this study was to investigate the role of M. depressor septi nasi in nasal respiration at open rhinoplasty operations using rhinomanometry and electromyography., Methods: The study included 29 patients who had only external nasal deformity (nasal hump deformity). All patients underwent open rhinoplasty. The dermocartilaginous ligament of the patients in the study group (DCL + group) was repaired but not in the control group (DCL - group). Rhinomanometry and electromyography were applied to all patients preoperatively and postoperatively., Results: In the DCL - group, right and left nasal airflow values were significantly lower in post-op (562.92 cm 3 /s and 548.57 cm 3 /s), whereas right, left, and total nasal resistances were significantly lower in pre-op (0.28 Pa/cm 3 /s, 0.22 Pa/cm 3 /s, and 0.11 Pa/cm 3 /s). Statistically significant differences were not found between rhinomanometric measurements in pre-op and post-op values of the DCL + group. Post-op right, left and mean values of M. depressor septi nasi amplitude in the DCL + group (2.05 mV, 2.0 mV, 2.02 mV) were significantly higher than those in the DCL - group (1.52 mV, 1.61 mV, 1.57 mV)., Conclusion: Repair of the dermocartilaginous ligament during open rhinoplasty operations enhances nasal respiratory functions by expanding the external nasal valve through M. depressor septi nasi and allows the nose to participate in mimic movements., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Congenital nephrotic syndrome is a term used to describe a condition in babies who develop severe proteinuria and hypoalbuminaemia within their first three months of life. They generally have oedema and ascites from birth which, because of increased intra-abdominal pressure, can result in an umbilical hernia. The report presents a five-month old infant with congenital nephrotic syndrome who had spontaneous umbilical hernia rupture with evisceration. The approach to umbilical hernias is usually conservative, but in selected cases elective surgery may be indicated.

Purpose: We aimed to evaluate the autonomic nervous system activity in children with overactive bladder (OAB) syndrome., Methods: Included in the study were 40 children with overactive bladder and 28 healthy controls. Autonomic tests were performed on all participants, including heart rate interval variation (RRIV), heart rate response to valsalva maneuver, and sympathetic skin response (SSR)., Results: Mean valsalva rates in the overactive bladder and control groups were 1.53 ± 0.29 and 1.30 ± 0.18, respectively, a statistically significant difference (P < 0.001). Also significantly different were deep breathing RRIV values of the study and control groups: 56.65 ± 14.66 and 47.92 ± 10.15, respectively (P = 0.008). No statistical differences were found in SSR when OAB patients were compared with controls (P > 0.05)., Conclusions: This study demonstrated a parasympathetic hyperactivity in children with OAB, results suggesting a dysfunction in their autonomic nervous systems. Neurourol. Urodynam. 36:673-676, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: Asthma is a chronic inflammatory disorder of the airways which results in chronic hypoxia. Chronic hypoxia and inflammation can affect renal tubular function., Objectives: The aim of this study was to investigate renal tubular function and early kidney injury molecules such as urinary N-acetyl-betaglucosaminidase (NAG) and kidney injury molecule-1 (KIM-1) excretion in children with asthma., Methods: Enrolled in the study were 73 children diagnosed with asthma and 65 healthy age- and gender-matched control subjects. Urine pH, sodium, phosphorus, potassium, microalbumin, creatinine, NAG, KIM-1, and serum creatinine, sodium, phosphorus were evaluated. The diagnosis of asthma and classification of mild or moderate were done according to the Global Initiative for Asthma guidelines., Results: Serum sodium, phosphorus, creatinine, and urinary microalbumin were within normal levels in the both groups. Urinary pH, sodium, potassium, phosphorus, microalbumin, and KIM-1 excretions were similar between the control and study groups. Tubular phosphorus reabsorption was within normal limits in two groups. Urine NAG was elevated in the study group (P = 0.001). Urinary KIM-1 and NAG levels were positively correlated (r = 0.837; P = 0.001). When children with mild and moderate asthma were compared, all of the parameters were similar (P >0.05)., Conclusions: This study showed that chronic asthma can lead to subtle renal impacts. We suggest that in children with asthma, urinary NAG level is a more valuable parameter to show degree of renal tubular injury than markers such as microalbumin and KIM-1. Chronic hypoxy and inflammation probably contributes to these subclinical renal effects., (© The Author(s) 2016.)

We report three paediatric cases of Kawasaki disease (KD). Erythema multiforme (EM) was the presenting cutaneous feature in two patients, with young age (43 days old), macular rash and meningitis in the third patient. Diagnosis of KD was difficult due either to initial misdiagnosis of drug eruption, incomplete presentation, or the young age of the patient. Clinicians should be aware of these cutaneous presentations to prevent KD complications.

Objective: To compare the correlation of 2 commonly used and validated voiding questionnaires (ICIQ-CLUTS and Akbal's) according to the physician's clinical impressions. Also, we investigated the reliability of these instruments in children with lower urinary tract symptoms (LUTS)., Materials and Methods: Akbal's questionnaires and ICIQ-CLUTS forms were completed by children between 5 and 18 years old with and without LUTS and by their parents. The data were classified into 3 age groups (5-9, 10-13, 14-18). The reliability of Akbal and ICIQ-CLUTS was investigated by using Cronbach's α (≥0.7 is indicated acceptability). The total scores of the tools were compared with the physician's clinical impression (Kendall's tau b-test)., Results: A total of 154 children (LUTS: n = 88, controls: n = 66) were prospectively enrolled into the study. The reliability of both instruments was excellent (Cronbach's alpha scores; Akbal = 0.811, ICIQ-CLUTS children version: 0.728 and ICIQ-CLUTS parental version: 0.746). When we compared by Kendal tau, Akbal was better correlated with physician's clinical impression. In addition, the children version of ICIQ-CLUTS was better correlated than parental version., Conclusion: The results of our study provide that both tools are reliable and objective to grade the LUTS in pediatric population. Although both surveys were significantly correlated with clinical impression, the consistency of Akbal's questionnaire is found superior than that of ICIQ-CLUTS., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Amikacin (AK) is frequently used on the treatment of Gram-negative infections on neonates, but its usage is restricted because of nephrotoxicity. In this study, on neonatal rats, we aimed to investigate the effects of erythropoietin and vitamin E on AK induced nephrotoxicity. A total of 35 newborn Wistar Albino rats were divided into four groups: (1) injected with saline (serum physiological was administered to placebo controls), (2) injected with AK (1200 mg/kg), (3) injected with AK + vitamin E (150 mg/kg), (4) injected with AK + erythropoietin (EPO) (300 IU/kg/day). In renal tissue, AK levels were significantly high in all groups except the control. Tissue malondialdehyde (MDA) and nitric oxide (NO) levels were statistically higher in AK -treated group than the control. MDA and NO levels were significantly decreased with the administration of vitamin E and EPO. Glutathione peroxidase (GPX) levels were statistically low in AK group compared with the controls. The levels of GPX, in vitamin E group, were increased significantly. However, superoxide dismutase and catalase levels were not significantly different in none of the groups. Insulin-like growth factor-1 values in AK, EPO and vitamin E groups were significantly higher than the control group. Histomorphological changes such as tubular epithelial necrosis were seen in AK treated group. Histopathological improvements observed with EPO and vitamin E administration. AK nephrotoxicity is related to oxidative stress and is supported with biochemical and histopathological findings. Vitamin E and EPO, as antioxidants, can be useful renoprotective agents for ameliorating AK induced nephrotoxicity in neonates.

This study investigates the preventive effect of caffeic acid phenethyl ester (CAPE) on pancreatic damage induced by vancomycin (VCM) in rats. Rats were equally divided into three groups: group I (control), group II (only VCM-treated group) and group III (VCM + CAPE-treated groups). VCM was intraperitoneally administered at a dose of 200 mg kg(-1)twice daily for 7 days. CAPE was administered orally at 10 µM mL(-1) kg(-1) dose once daily for 7 days. The first dose of CAPE administration was performed 24 h prior to VCM injection. Blood and pancreas tissue samples were removed and collected after the study. Serum alkaline phosphatase (ALP), amylase, γ-glutamyl transferase (GGT) and lipase activities were determined. Pancreas tissue samples were evaluated with the light microscope. Group II significantly increased serum ALP, amylase, GGT and lipase activities when compared with the control group. Group III significantly decreased serum ALP, amylase, GGT and lipase activities when compared with group II. In histopathological examination, it has been observed that there was a significant pancreatic damage in group II. CAPE exerted prominent structural protection against VCM-induced pancreatic damage and this effect was statistically significant. CAPE caused a marked reduction in the extent of pancreatic damage. We have concluded that it may play an important role in the VCM-induced pancreatic damage and reduce the pancreatic damage both at the biochemical and histopathological aspects., (© The Author(s) 2013.)

Reversible corpus callosum splenial (CCS) lesions are rare findings and usually detected incidentally. We presented a case of 15-year-old boy with a diagnoses of nephrotic syndrome. He was referred for neuropsychiatric symptoms following dose reduction on steroid treatment. Brain magnetic resonance imaging (MRI) revealed a focal lesion in the CCS, hyperintense on T2 and FLAIR and hypointense on T1 images with diffusion restriction on apparent diffusion coefficient map. Follow-up MRI 3 weeks later showed complete resolution of the lesion. It was probably result of focal intramyelinic edema due to excytotoxic mechanisms and/or arginine-vasopressin release., (Copyright © 2014 by the American Society of Neuroimaging.)

Background: Obesity is an important health issue, the prevalence of which is increasing in childhood. The aim of this study was to examine urinary renal injury markers in order to determine the renal effect of obesity and its comorbidities in a pediatric population., Methods: Eighty-four obese children and 64 healthy control subjects were enrolled in the study. We checked their urine using N-acetyl-beta-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and microalbumin as renal injury markers. Associations of renal damage markers with hypertension, an impaired glucose tolerance test, and insulin resistance were assessed., Results: Obese individuals had higher urinary NAG and KIM-1 values compared to those of healthy controls (p = 0.027, p = 0.026). There was no difference in urinary NGAL between obese and lean subjects (p = 0.885). Urinary renal injury markers were not statistically different in the obese group when checked for impaired glucose tolerance, insulin resistance, and hypertension (p > 0.05)., Conclusions: This study shows that urinary NAG and KIM-1 could be used as a screening method for detection of early renal damage in obese children.

Pediatric nephrogenic adenoma (NA) is an uncommon benign metaplastic lesion occurring in the urothelium. Herein we report a case of NA of the urinary bladder in a 14-year-old boy. The patient presented with macroscopic hematuria and had a history of ureteral surgery and long-term smoking. NA should be considered in the differential diagnosis of any urinary tract tumor in the pediatric population., (© 2014 Japan Pediatric Society.)

Background: Urolithiasis is a common condition in pediatric populations in Turkey. The role of oxidative stress in renal stone formation in pediatric patients has not been reported to date. The aim of this study was to assess oxidative stress in childhood urolithiasis., Methods: Seventy-four children diagnosed with urolithiasis and 72 healthy control subjects were enrolled in the study. Kidney stone formers were evaluated by analysis of metabolic conditions related to urolithiasis, such as hypercalciuria, hyperoxaluria, hypocitraturia and hyperuricosuria. Urine total antioxidant status (TAS), and total oxidant status (TOS) were measured, and oxidative stress index (OSI) was calculated as an indicator of the degree of oxidative stress., Results: Among the stone formers, metabolic analyses revealed that 30 % had hypercalciuria, 45 % had hypocitraturia, 6 % had hyperoxaluria and 40 % had hyperuricosuria. Elevated levels of the renal tubular damage marker urinary N-acetyl- beta-D-glucosaminidase (NAG) was elevated in 25 % of the patient group, but microalbuminuria was not detected. Total oxidant status and total antioxidant status were significantly higher in stone formers than in the controls (p = 0.023 and 0.004, respectively). In addition, urinary NAG was significantly correlated with TOS (r = 0.427, p = 0.019)., Conclusions: The results of this study show that oxidative stress may play an important role in the pathogenesis of pediatric stone formers.

Extensive volar injuries are common and devastating because of the long-term adhesion potency. The gliding effect of the adipose tissue is essential in preventing tendon adhesions after injury. In this study, we present the results of performing adipofascial flaps for the reconstruction of soft tissue defects following wrist trauma. The study included 15 patients. Adipofascial flaps were performed for immediate coverage of the tissue defect in 2 patients and for late adhesion-related problems in 13 patients. Flap dimensions varied from 8 × 14 to 8 × 20 cm. All but one of the flaps and skin grafts survived uneventfully. None of the patients, whether immediate or late, required another operation to address further adhesion problems. Since adipofascial flaps provide a gliding surface, they are a good choice for immediate coverage of soft tissue defects in the wrist that are not suitable for skin grafting alone as well as for late adhesion-related problems., (© 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.)

Objective: To investigate whether the child's and the parents' reports about lower urinary tract symptoms (LUTS) are reliable and correlate with each other., Materials and Methods: A validated questionnaire, the International Consultation on Incontinence Questionnaire Pediatric Lower Urinary Tract Symptoms, including both children and parent versions, was completed by children (age 5-18 years) with and without LUTS (control) and their parents without assistance. All children were investigated with detailed history, bladder diary, urinalysis, and flowmetry with postvoid residual urine volume measurement. The data were stratified into 3 age groups (5-9, 10-13, and 14-18 years). The reliability of both versions was evaluated using Cronbach's α and ≥0.7 indicated acceptability. The correlation between the children's and parents' reports for each question was evaluated using Spearman correlation coefficients. The receiver operating characteristic curve was used to define the cutoff points, and the sensitivity and specificity were calculated. The principal component analysis method was used to explain the construct validity., Results: A total of 272 children (147 with and 125 without LUTS) and their parents completed the questionnaire. The children and parent versions of the questionnaire were both reliable (Cronbach's α 0.709 and 0.710, respectively). The sensitivity and specificity was 82.4% and 80.0% for the children version and 87.8% and 78.4% for the parent version, respectively. The reliability and acceptability of the children's reports were insufficient for the 5-9 year age group, and the parents' answers were unreliable for the 10-13 year age group. The correlation between the parent and children reports was the lowest for the 10-13 year age group., Conclusion: The alteration in the reliability in the different age groups suggests that the combination of the parent and children versions is most appropriate for screening children with LUTS., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives. We aimed to determine the relationship between insulin resistance and serum 25-hydroxyvitamin D (25-OHD) levels in obese children and their nonobese peers. Materials and Methods. Included in the study group were 188 obese children (aged 9-15 years), and 68 age- and gender-matched healthy children of normal weight as control group. Anthropomorphic data were collected on patients and fasting serum glucose, insulin, serum lipids, alanine aminotransaminase (ALT) and 25-OHD were measured. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated in both groups. Results. The levels of 25-OHD in the obese group were significantly lower than those of the nonobese (P = 0.002). HOMA-IR, triglycerides, low-density lipoprotein, and ALT levels in the obese group were significantly higher than values of control group (P < 0.001 and P = 0.002, resp.). In the obese group, vitamin D deficiency, insufficiency, and sufficiency (25-OHD < 10 ng/dl, < 20, >10 ng/dl; > 20 ng/dl, resp.) were not correlated with HOMA-IR (r : -0.008, P = 0.935). HOMA-IR was negatively correlated with BMI, BMI SDS, and BMI%, and triglycerides, low-density lipoprotein, and ALT levels (P < 0.001). Conclusion. The insulin resistance of the obese subjects who were vitamin D deficient and insufficient did not statistically differ from those with vitamin D sufficiency. Low 25-hydroxyvitamin D levels were not related with higher insulin resistance in obese children and adolescents. In obese subjects, insulin resistance was affected more from BMI, BMI SDS, and BMI% than from 25-hydroxyvitamin D levels.