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Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aims: Hyperammonemia causes severe mortality and morbidity when left unnoticed. We aimed to compare the number of ammonia test requests before and after establishing the Department of Pediatric Metabolism (DPM) in a clinic of pediatrics. Methods: The study was conducted retrospectively between 15/11/2022-16/11/2023. Study data were evaluated before (pre-group) and after (post-group) the establishment of DPM. Results: Two hundred eighty-five admissions were assessed in the study. There were 99 admissions in the pre-group and 186 in the post-group. There were 17 admissions for different reasons in the pre-group and 29 in the post-group. The most common reasons for admission were elevated transaminases, seizures, vomiting and metabolic acidosis. Definitive diagnosis was made in 16 (17.6%) patients admitted in the pre-group and 39 (23.8%) in the post-group. The most common diagnoses were genetic syndromes, mitochondrial diseases and organic acidemias. Twenty-one patients were diagnosed with inherited metabolic diseases (IMDs). Mitochondrial diseases were the most commonly diagnosed IMD (8(38%)). From the 15 pediatric subunits, ammonia test was requested from 8 in the pre-group and 13 in the post-group. In the pre-group, the pediatric subunit where ammonia was requested the most was the Pediatric Neurology Polyclinic (n=25 (25.3%)). In the post-group, the subunit that required the highest number of ammonia tests was the DPM (68(23.9%)). In the ROC analysis conducted for the predictive power of the initial ammonia level in requesting a control ammonia test, the area under the curve is 0.927, and the p-value is 0.001. For the cut-off value of 60.3 µmol/l, the sensitivity was 90.9%, and the specificity was 88.6%. Conclusion: After DPM was established, there was an increase in ammonia test requests, in the diversity of reasons for requesting ammonia testing from admissions, and in IMD diagnosis. DPM had a positive effect on pediatricians’ awareness of hyperammonemia. [ABSTRACT FROM AUTHOR]

Aim: The use of minimally invasive procedures in low-risk congenital heart surgeries has increased recently. Compared to traditional median sternotomy, minimally invasive techniques offer better cosmetic results and provide more satisfaction to both the patient and their parents. Partial anomalous pulmonary venous return (PAPVR) can be safely repaired using these techniques. Material and Methods: The perioperative data of right-sided PAPVR patients who were operated on with minimally invasive approaches in our clinic between March 2019 and January 2023 were reviewed retrospectively. The perioperative data of the patients’ including type of surgery, cardiopulmonary bypass duration, cross-clamp duration, postoperative cardiac rhythm, total operation duration, total drainage, total intensive care unit duration and total hospital stay duration were obtained. The results were compared with the data in the current literature. Results: During the study period, 14 patients underwent surgical repair. Five (36%) of them were female and nine (64%) were male. Patients underwent right infra-axillary vertical thoracotomy (RIAVT) and right anterolateral thoracotomy (RALT) had mean ages of 48±26.6 and 42±18.2 months, respectively. High venosum type atrial septal defect (ASD) was detected in 12 (85.7%) of the patients. The most frequently used surgical treatment was the double patch technique which was used in 12 patients (85.7%). This was followed by single patch repair in one patient (7.1 %). The Warden procedure was used in one patient (7.1%) who was operated on with the RIAVT technique. Patients’ cross-clamp, cardiopulmonary bypass (CPB), and total operation durations were comparable to those reported in the medical literature. Conclusion: RIAVT and RALT are two of the frequently used minimally invasive surgical techniques in congenital heart surgery. After gaining sufficient experience, both of these methods can be safely applied to PAPVR repair. [ABSTRACT FROM AUTHOR]

Copyright of Mediterranean Nursing & Midwifery is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Fluid replacement and insulin infusion are the cornerstones of treatment of diabetic ketoacidosis, but the optimal volume, rate of infusion, and electrolyte content of fluid replacement have been controversial. The aim of this study was to investigate the effects of treatment on pH, bicarbonate (HCO3), anion gap, chloride, and potassium levels as well as time to resolution of acidosis in children with diabetic ketoacidosis. Material and Methods: Ninety-six episodes with diabetic ketoacidosis between January 2015-December 2017 were evaluated. Results: The mean resolution time of acidosis was 13.4±7.1 hours. Anion gap was returned to normal in 68 (70.8%) episodes at the 4th hour of treatment with a mean of 11±4.2 mmol/L. Episodes with potassium phosphate (KPO4) replacement resulted in a faster increase in pH and a significantly shorter resolution time of acidosis (p<0.001). Acidosis persisted at the 16th hour of treatment in episodes with lower pH, lower serum bicarbonate (HCO3) and higher white blood cell (WBC) counts on admission (p<0.001, p=0.003 p=0.033, respectively). Hyperchloremia (Cl/Na ratio > 0.79) was observed in 97% of cases after 8 hours of treatment. Conclusion: Although the value of the anion gap in predicting acidosis is controversial, severe DKA episodes and high white blood cell count at admission; potassium replacement with high amounts of chloride and KCl containing fluids given during treatment have been associated with a longer recovery time of acidosis. [ABSTRACT FROM AUTHOR]

Copyright of Ümraniye Pediatri Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Nowadays, the utility of positron emission tomography/computed tomography (PET/CT) is well established in nasopharyngeal carcinoma (NPC). The incidence of NPC in the West population, especially in children, is very low. We present the first Italian case of a pediatric patient with NPC followed up with 18F-fluorodeoxyglucose (18F-FDG) PET/CT scan in addition to the standard follow-up imaging methods, including CT and magnetic resonance imaging. The 18F-FDG PET/CT scan was helpful in discriminating between metastatic and benign osseous lesions, thereby helping clinicians to determine the most appropriate therapeutic regimen. These findings support the clinical utility of 18F-FDG PET/CT in the diagnostic work-up of pediatric patients with NPC. [ABSTRACT FROM AUTHOR]

Objective: Cathelicidin is a crucial antibacterial peptide that is produced in the urinary system and is induced by vitamin D. In order to distinguish between lower and upper urinary tract infections (UTIs), the association between cathelicidin levels and vitamin D levels was examined in this study. Material and Methods: We analyzed complete blood count, biochemistry profile, C reactive protein (CRP), 25 hydroxyvitamin D, serum cathelicidin levels of pre-treatment children aged 0-18 years who were diagnosed with a UTI in the Pediatric Emergency Room. Results: A total of 72 children (36 healthy and 36 patients) were included in the study. The mean age of the participants was 83.8±66.22 months, with 40 (56%) female and 32 (44%) male. Our patient group had higher white blood cell, neutrophil, and CRP levels than our control group (p=0.050). There was no significant difference in cathelicidin levels (5.7±3.7; 9.6±10.9; p=0.810) or vitamin D levels (23.3±9.5; 25.9±12.5; p=0.795) between patients with lower and upper UTI. We found a positive correlation between vitamin D and cathelicidin levels in the control group (r=0.346, p=0.030). There was no statistically significant difference in cathelicidin levels between patients with upper UTI and the control group (p=0.054). Conclusion: Although there was no significant relationship between vitamin D and cathelicidin levels in children with urinary tract infections, a weak but positive correlation exists between vitamin D and cathelisidin in healthy children. [ABSTRACT FROM AUTHOR]

Copyright of Izmir Katip Celebi University Faculty of Health Sciences Journal / İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi is the property of Izmir Katip Celebi University, Faculty of Health Sciene Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Stunting is a condition that is of concern to health in the world. Toddlers who are stunting experience a major impact on their future life such as health, intelligence, and child development. Complementary food for ASI (called as MP-ASI) is food given to toddlers from the age of 6 months which is useful for fulfilling the needs and nutrition of toddlers besides the consumption of breast milk. However, some toddlers receive MP-ASI at the age of > 6 months, so toddlers tend to experience malnutrition which can result in stunting. Therefore, this study aims to determine the relationship between the age at first giving MP-ASI and the incidence of stunting in toddlers. Methods: This research is an analytic observational study with a cross sectional approach. The samples used were toddlers recorded in the medical records of the Purwantoro I Health Center who met the inclusion and exclusion criteria. The sample in this study was taken using purposive sampling, amounting to 100 toddlers. The independent variable is the age at which complementary feeding was first given and the dependent variable is the incidence of stunting. Data analysis used the Spearman test with the SPSS version 25. Results: In this study, the number of both genders were the same, namely 50 toddlers. Most of the first age of complementary feeding was 6 months with a total of 75 toddlers, the most toddlers were 48-59 months with a total of 67 toddlers. It was found that the highest Z-score category for TB/Age was <-2 SD with 49 toddlers. These results were analyzed using the Spearman test and obtained a significance value of 0.297 (sig. 2 tailed > 0.05)Conclusion: There is no significant relationship between the age of first complementary feeding and stunted in toddlers aged 12-59 months in working area of Puskesmas Purwantoro I. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare the sociodemographic characteristics of children with upper extremity fractures with those of children without upper extremity fractures. Materials and Methods: A total of 161 participants (age:11.24±2.95, female:53, male:108), 100 of whom were admitted to the orthopedics and traumatology clinic in 2022 with upper extremity fractures and 61 without upper extremity fractures, were included in the study. Participants; age, height, weight, mother's education level, mother's age, father's education level, father's age and monthly income of the family were recorded. Fracture and recurrent fracture rates of the participants who were members of a family whose monthly income was below the minimum wage and those who were included in a family with a monthly income above the minimum wage were compared. Results: The age, height and weight of the participants without upper extremity fractures were greater than those with upper extremity fractures (p<0.01). The body mass index of those with upper extremity fractures was lower than those without upper extremity fractures (p=0.001). While the number of upper extremity fractures in the participants who were members of families with a monthly income below the minimum wage was 79 (63.70%), the number of fractures in the participants who were members of families with an income above the minimum wage was 21 (56.80%) (p=0.44). In addition, when those with upper extremity fractures were evaluated independently from those without upper extremity fractures; While the number of recurrent upper extremity fractures was 7 (33.3%) in the participants who grew up in families with an income above the minimum wage, the number of recurrent upper extremity fractures was 11 (13.9%) in the participants who grew up in families with an income above the minimum wage (p= 0.04). Conclusion: Low body mass index may increase the rate of upper extremity fractures in children. For this reason, families should be informed about the possibility of physical development of children at risk for upper extremity fractures. In addition, the rate of recurrent upper extremity fractures is higher in children of families with a relatively high monthly income. Families with relatively high incomes should be made aware of the safety measures to be taken against accidents in their living spaces. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate the relationship between body mass index (BMI) and physical activity among pediatric individuals and their parents. Materials and Methods: The study was conducted on 434 pediatric individuals aged 3-16 years and their parents. The weight, height, BMI and weekly physical activity of pediatric individuals without insulin resistance were recorded. In addition, parent' attitudes towards sugary and processed foods for children were evaluated. Results: As a result of the study, it was found that 230 of 434 pediatric individuals were underweight, 146 were normal, 46 were mildly obese, and 12 were obese according to BMI classification. It was found that 190 of the mothers were obese and 110 of the fathers were obese. BMI and weekly physical activity numbers were compared between pediatric individuals and their parents and a significant difference was found (p<0.05). It was found that 112 of the mothers did not pay attention to their children's consumption of sugary and processed foods. Conclusion: As a result of the study, it was found that there was a relationship between pediatric individuals and their parents in terms of BMI and number of weekly physical activities. In this respect, this study revealed that parents should pay maximum attention to prevent obesity in children. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Patients in pediatric intensive care units are more likely to develop serious nosocomial infections due to comorbidities, longer and more invasive procedural treatments, and the development of immunosuppression. We described Candida infections, management, morbidity and mortality in critically ill pediatric patients. Materials and Methods: A retrospective single-center study includes patients aged 1 month-18 years treated against candidemia from January to December 2021. This included those who had blood cultures of Candida species growth. We excluded patients with infection Candida in endotracheal aspiration and/or urinary specimens, etc. The demographic characteristics, medical histories, comorbidities, length of stay, need for mechanical ventilation supports, laboratories, relationship use of catheters and total parenteral nutrition, treatment periods, antifungal response/ resistance, duration of treatment and adverse effects, morbidities/mortalities. Results: In this study, the total mortality rate was 40.7%, and the mortality rate due to candidemia was detected at 44.4%, but the correlation between candidemia and mortality was not significant (p=0.975). However, 18.5% of them are caused by nosocomial. The mortality risk did not change for subtypes (p=0.975). No significant correlation was found when mortality (p=0.07) and central venous catheter infection (p=0.563) were compared using total parenteral nutrition. Conclusion: In our study, in which 27 patients were followed up for nosocomial candidemia, the rate of candidemia was found to be higher in patients with comorbidity, long-term mechanical ventilation support, central venous catheter use, long hospital stay, parenteral nutritional support, and high Pediatric Risk of Mortality III score. C. parapsilosis was detected most frequently in our Candida subtype unit with a rate of 59.3%. The fluconazole 8 (29.6%), amphotericin B 18 (66.7%) and voriconazole 1 (3.7%) patients were initiated. At this treatment time, only 4 (14.8%) patients developed organ failure. In our study, we detected a total mortality rate of 40.7%. However, 18.5% of them were caused by nosocomial candidemia. Considering all these reasons, we believe that our risk factors, diagnosis, treatment, follow-up, and management process will contribute to the literature. [ABSTRACT FROM AUTHOR]

Objective: Echocardiography is a very useful tool for the diagnosis and evaluation of pulmonary hypertension (PH). This study was planned to investigate whether echocardiographic (ECHO) data of patients with PH are effective in the follow-up and course of treatment. Methods: A retrospective analysis of the data from 26 PH patients was performed. Analyses were performed on the data of the patients, including their demographics and ECHO findings. The ECHO measurements of the patients were labeled as 0 (beginning of the PH specific therapy), 1 (on the 15th day of the therapy), 2 (one month after the previous echocardiogram). Results: The left ventricle ejection fraction (EF) (p=0.05) and fractional shortening (FS) (p=0.038) values in ECHO2 were significantly higher than those in ECHO1 . Aortic velocity-time integral1 (VTI1 ) was significantly higher than aortic VTI0 (p=0.001; p<0.01), and tricuspid annular plane systolic excursion2 (TAPSE2 ) was significantly higher than TAPSE0 (p=0.046). Moreover, right ventricular ejection time1 (RVET1 ) was significantly higher than RVET0 (p=0.034), and left ventricular ejection time1 (LVET1 ) was significantly higher than LVET0 (p=0.003). Conclusions: This study provides information on ECHO parameters that improve during the initial stages of therapy. Based on the results of our study, even at the beginning of treatment, there were increases in right and left ventricular filling, EF, and FS. Clinical deterioration of PH can be detected early/before the clinical status of the patient worsens with detailed examinations using echocardiography. [ABSTRACT FROM AUTHOR]

Introduksjon: Internasjonalt er traume en av hovedårsakene til dødsfall hos barn, men i Norge er antall barn innlagt på grunn av traume betydelig redusert de siste tiårene. Per i dag er svært lite forskningsbasert kunnskap tilgjengelig relatert til situasjoner der barn dør i barneintensivavdeling som følge av et traume. Forskning som omhandler pårørende til barn innlagt i sykehus generelt, viser at pårørende har behov for profesjonalitet i møte med helsevesenet, samtidig som personlig omsorg og ivaretagelse fra sykepleiere har stor betydning. Hensikt: Undersøke hvordan sykepleiere ivaretar pårørende når barnet dør i en barneintensivavdeling som følge av et traume. Metode: Studien er av kvalitativt design. Det er gjennomført tre fokusgruppeintervju med totalt 14 deltagere. Intervjuene er analysert ved bruk av systematisk tekstkondensering. Resultater: Resultatene omfatter tre hovedtema med tilhørende subgrupper. Det prosessuelle tidsperspektivet tar for seg hvordan sykepleierne arbeider med pårørende for å hjelpe dem gjennom prosessen. Kommunikasjon i kriser handler om hvordan kommunisere med pårørende som befinner seg i en unntakstilstand, mens teamarbeid inkluderer pasientnær samhandling mellom sykepleiere og tverrfaglig mellom ulike behandlere, samt oppfølging fra kommunen. Konklusjon: Studien underbygger viktigheten av at sykepleiere aktivt må inkludere pårørende fra barnets innleggelse til avslutning av behandling, slik at pårørende ser at alt blir gjort for å redde barnet. Kommunikasjon og et bevisst forhold til bruk av tid er essensielt for å fremme forståelse hos pårørende og gi dem muligheten til å forsone seg med situasjonen. ENGLISH ABSTRACT Caring for relatives when children die due to trauma: a qualitative study from a nursing perspective Introduction: On an international level trauma is one of the main causes of mortality and morbidity among children. In Norway, however, the number of children admitted due to trauma has been significantly reduced in recent decades. There is minimal research- based knowledge related to situations where children die from trauma in a pediatric intensive care unit. Research on the care for relatives to hospitalized children show that professionalism within the healthcare system is very important to the relatives. In addition to this, care and attention from nurses is also of great importance. Purpose: The purpose of this study is to investigate how nurses work when it comes to caring for relatives when a child dies in the pediatric intensive care unit due to trauma. Methods: The study has a qualitative design. Three focus group interviews were conducted with a total of 14 participants. The interviews were analyzed using systematic text condensation. Results: The results included three main themes with associated subgroups. The procedural time perspective addresses how nurses work with relatives to help them through the process. Communication in crises consists of communication with relatives who are in a state of emergency, while teamwork includes patient-centered interaction between nurse colleagues, an interdisciplinary team, as well as follow-up from the municipality. Conclusion: The study findings support the importance of nurses actively including relatives from the child’s hospitalization to the end of treatment. This gives relatives reassurance that the treatment team is doing everything they can to save the child. To promote understanding among relatives and give them the opportunity to reconcile the situation, a conscious choice regarding use of time and communication is essential. The treatment team must focus on the future in addition to the situation here and now. This will help them facilitate the mourning process, within the structures of a pediatric intensive care ward as well as through the health service in general.

Aims: Vitamin D deficiency is a risk factor for autoimmune diseases such as diabetes mellitus. This study aimed to investigate the association between Diabetic ketoacidosis (DKA) and vitamin D levels and the impact of vitamin D on the duration of DKA and pediatric intensive care unit length of stay in Turkish pediatric patients. Methods: The study was a retrospective study conducted between January 2014 and March 2018. The study population was children under 18 admitted to the pediatric intensive care unit (PICU) with DKA. Results: The study included 130 patients, 51.5% of them were females. We found vitamin D deficiency in 39.2%(n=51) and vitamin D insufficiency in 33.1% (n=43) of the patients. Most of the patients with severe acidosis had low vitamin D levels (44/59) and % 45.8 of them (27/59) had vitamin D deficiency. Duration of diabetic ketoacidosis, length of pediatric intensive care unit stay, and hospitalization stay were longer in patients with low vitamin D levels but were not statistically significant. Conclusions: This study is the first study evaluating the association between vitamin D and diabetic ketoacidosis in Turkey. Although there is no association between vitamin D deficiency and the duration of diabetic ketoacidosis and the severity of acidosis, vitamin D deficiency is substantially common in patients with diabetic ketoacidosis.

Objectives: Accessory spleen, also known as “splenule”, is the presence of splenic tissue in ectopic localisations. The presence of splenule is important, especially in patients planned for splenectomy, as it may cause refractory symptoms. The aim of the present study is to define the frequency of splenule(s) in children (0-17 years) who received non-contrast and contrast enhanced computed tomography (NECT and CECT) protocols in the emergency department. Material and methods: 748 children (aged 0 to 17 years) who were admitted to the emergency department between May 2015 – September 2022 and had NECT and CECT abdominal scans were included in the study. Patients whose CT protocols were incomplete and cases with traumatic splenic injury and / or cases with poor image quality and patients with a history of splenectomy or hematologic pathology were excluded from the study (n: 100). A total of 648 patients were included in the cohort. NECT and CECT scans of all patients were assessed; the localisation of splenules as well as the antero-posterior (AP), medio-lateral (ML) and cranio-caudal (CC) dimensions of each splenule were measured. Results: A total of 648 cases with 467 males (72.1%) and 181 females (27.9%) were included in the study. Splenules were observed in 131 (20.2%) cases. More than one splenule was observed in 21 of these 131 cases. A total number of 159 splenules were observed in total, with a mean volume of 0,72 ±0,95 ml. The most common location was found to be the splenic hilus (n=55, 41.9%). Conclusion: Our study have stated that splenules are common anatomical variants, seen at a rate of 20,2% in this age cohort. A cross-sectional imaging should be performed to determine the presence, location, and number of the splenules before a planned splenectomy.

Aims: Vitamin D deficiency is a risk factor for autoimmune diseases such as diabetes mellitus. This study aimed to investigate the association between diabetic ketoacidosis (DKA) and vitamin D levels and the impact of vitamin D on the duration of DKA and pediatric intensive care unit length of stay in Turkish pediatric patients. Methods: The study was a retrospective study conducted between January 2014 and March 2018. The study population was children younger than 18 years old admitted to the pediatric intensive care unit (PICU) with DKA. Results: The study included 130 patients, 51.5%(n=67) of whom were females. We found vitamin D deficiency in 39.2% (n=51) and vitamin D insufficiency in 33.1% (n=43) of the patients. Most of the patients with severe acidosis had low vitamin D levels (44/59) and % 45.8 of them (27/59) had vitamin D deficiency. Duration of diabetic ketoacidosis, length of pediatric intensive care unit stay, and hospitalization stay were longer in patients with low vitamin D levels but not statistically significant (?). Conclusions: This study is the first study evaluating the association between vitamin D and diabetic ketoacidosis in Turkey. Although there is no association between vitamin D deficiency and the duration of diabetic ketoacidosis and the severity of acidosis, vitamin D deficiency is substantially common in patients with diabetic ketoacidosis. [ABSTRACT FROM AUTHOR]

The Pediatric Quality of Life (PedsQL) Inventory is a tool used to measure Health Related Quality of Life (HRQoL) in children aged 2 to 18 years. The aim of the present study was to investigate the feasibility and reliability of the Romanian version of two PedsQL modules, the Generic Core and the Multidimensional Fatigue Scales, in children with inflammatory bowel disease (IBD). Children diagnosed with IBD in our clinic and their parents completed a total of 26 Romanian version PedsQL forms, while a control group of healthy children and their caregiver filled in 86 identical online forms. We compared total and dimensional scores between controls and subjects, along with age, sex, and active versus inactive disease differences. The results indicated that the PedsQL total and summary scores differentiated between subjects and controls, with lower HRQoL and higher levels of fatigue being reported in children with chronic IBD. The Romanian version of the PedsQL was found to be feasible and reliable, with good internal consistency higher than 0.70 and minimum missing responses. However, the limited number of participants meant that clinical activity severity indices correlated poorly with fatigue and generic scores. Further validation of these models requires larger, multi-centric studies. [ABSTRACT FROM AUTHOR]

Objective: Nosocomial infections are an important preventable cause of increased morbidity and mortality in critically ill children. Our study compared the clinical features, laboratory data, and prognostic variables of nosocomial infections (NI) in children in the tertiary pediatric intensive care unit (PICU). Methods: A retrospective evaluation of 48 pediatric patients aged 1 month to 18 years who had been admitted between February 2022 and January 2023 at University of Health Sciences Türkiye, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital was performed. Children with NI were included. Demographic clinical and outcome data were analyzed. Results: Twenty-seven patients (56.3%) were males. The median age was 32 months, and the length of stay in the PICU was 25 days (7-114). Respiratory diseases (50%) were the most common reasons for admission to the PICU, followed by sepsis (22.9%) and trauma (12.5%). The mortality rate was 18.8%. The requirement for renal replasman treatment was significantly higher in the non-survival group (p=0.017). Patients had similar prolonged PICU stay rates and requirements of mechanical ventilation, plasma exchange, and inotropic agents (p=0.472, p=0.320, p=0.432, p=0.068). Procalcitonin (PCT) (p=0.015), and procalcitonin/albumin ratio (PAR) (p=0.016) were also higher in the non-survival group than those in the survival group. Receiver operating characteristic (ROC) curves were used to predict mortality with PCT and PAR. According to ROC analysis, the cut-off values for PCT and PAR were found to be 1.705 (p=0.015), and 0.538 (p=0.016) respectively. Conclusion: Risk factors that cannot be changed, such as the underlying disease, should be considered in patients. Other modifiable risk factors for NIs will likely be the focus of efforts to enhance patient care. [ABSTRACT FROM AUTHOR]

Objective: It was aimed to evaluate the relationship between imaging techniques and clinical and laboratory parameters in paediatric COVID-19 patients. Methods: Our study included 187 patients under the age of 18 whose diagnosis of COVID-19 was confirmed by PCR test. Demographic, clinical, laboratory and radiological imaging findings of the patients were reviewed retrospectively from their file records. Results: 57.2% of the patients were male and the mean age was 110.1±67.4 months. A pulmonary finding associated with COVID-19 was detected in 21 (12%) of 175 patients who underwent Posterior-anterior (PA) chest X-ray. The most common findings were consolidation (n=16; 9.1%), bilateral ground-glass appearance (n=11; 6.3%), and atelectasis (n=5; 2.9%), respectively. Computed lung tomography was performed in 67 of the patients. The presence of a pulmonary finding associated with COVID-19 was detected in 28 (41.8%) of these patients. The three most common findings were consolidation (n=16; 23.9%), bilateral ground glass appearance (n=16; 23.9%), and atelectasis (n=15; 22.4%), respectively. It was determined that for patients with imaging findings on PA X-ray needed more paediatric intensive care, the length of their hospital stay was longer, comorbid diseases were present, their cough and tachypnea complaints were more pronounced (p<0.05). As the disease severity increased, especially in patients <1 year of age, the frequency of significant findings increased in both imaging methods (p<0.05). Conclusion: We think that imaging methods can be performed when necessary in children with suspected COVID-19 and can provide preliminary information about the course and severity of the disease. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to evaluate children with ''neurogenic bladder'' diagnosis in terms of anxiety and depression. Material and Methods: Thirty-three pediatric patients with neurogenic bladder followed in Adana City Training and Research Hospital Pediatric Urology and Nephrology outpatient clinics from May 2023 to July 2023 and 20 healthy controls who were age and sex-matched, from public schools located in the same geographic area were included in the study. All participants were requested to complete the Hospital Anxiety and Depression Scale, Conners' Parent Rating Scale and Turgay DSM-IV Disruptive Behavior Disorders Rating Scale. Results: Global score of the CPRS reported by parents, was higher in patients than controls (p=0.012). CPRS Hyperactivity/Impulsivity and Anxiety subscale scores of the patients were significantly higher than controls. Global score of the CPRS reported by parents, was higher in patients with CKD than without (p=0.033). CPRS- Learning problems subscale of the patients with CKD was also higher than the patients without (p=0.023). DSM-IV Total score and the DSM-IV inattention score was higher in patients with CKD than without. Hospital Anxiety and Depression Scale-anxiety subscale reported by children was higher in patients without wheelchair dependence than the patients with (p=0.002). CPRS-conduct disorder and CPRS-Hyperactivity/ Impulsivity subscale scores of the patients without wheelchair dependence was higher than the patient with (p=0.016, p=0.009). DSM-IV hyperactive/impulsive subscale score of the patients without wheelchair dependence was higher than the patients with (p=0.043). Conclusion: Children with NB are at risk for physical, neurocognitive, psychosocial, and family challenges. Anxiety and depression symptoms should not be underestimated. For long-term appropriate management of such vulnerable patients psychological support is required. [ABSTRACT FROM AUTHOR]

Objective: Juvenile idiopathic arthritis (JIA) is a childhood rheumatic disease that causes joint inflammation and tissue damage. Non-infectious uveitis is the most common extra-articular manifestation of JIA.The aim of this study is to evaluate the risk factors that play a role in occurrence and recurrence of uveitis and, to determine the relationship between arthritis and uveitis activity in patients with JIA. Material and Methods: This retrospective, cross sectional study included JIA patients with/without uveitis from a referral center in Turkey. The Juvenile Arthritis Disease Activity Score was used to evaluate the disease activity and calculated for arthritis and uveitis separately. Results: Uveitis was seen in 26 (13.3%) of 195 JIA patients. Of 26 JIA associated uveitis (JIA-U) patients, 19 (73%) had an oligoarticular subtype. The median age at diagnosis of JIA with uveitis was younger than without uveitis (p=0.015). Oligoarticular JIA was found to be associated with recurrence of uveitis (p=0.021). The occurrence age of arthritis and uveitis was significantly younger in patients with recurrent uveitis (p=0.041, p=0.002, respectively). The median JADAS27 score at the onset of uveitis was lower in the recurrent group (p=0.038). Conclusion: Early age is a significant risk factor for occurrence and recurrence of uveitis. It is important to remember that, during the disease course, patients with low disease activity may also develop uveitis. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Izmir Katip Celebi University Faculty of Health Sciences Journal / İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi is the property of Izmir Katip Celebi University, Faculty of Health Sciene Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Sakarya Tıp Dergisi is the property of Sakarya Tip Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

When Words Matter Most: Conveying Serious Health Information to Parents

Copyright of Aydin Dental Journal is the property of Aydin Dental Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Neuroblastoma is one of the common tumors of childhood. The demonstration of new factors such as isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2) mutations will be important in the diagnosis and treatment. IDH1 and IDH2 mutations have been found in many types of cancer, such as malignant gliomas, acute myeloid leukemias, chondrosarcoma, and thyroid carcinoma. This study aimed to investigate the presence of IDH1 or IDH2 mutations in patients with neuroblastoma and to determine whether these mutations were different in terms of age, clinical findings, and response to treatment. Methods: Biopsy specimens of 25 patients with pediatric neuroblastoma patients were evaluated for IDH mutations. The clinical and laboratory features of the patients with/without mutation were retrospectively analyzed from a hospital database. Results: A total of 25 patients for whom genetic analysis could be performed were included in the study (60% male, n=15). The mean age was 32.2±25.9 months (3 days-96 months). IDH1 mutation was detected in 8 (32%) and IDH2 mutations in 5 (20%) patients. These mutations showed no statistically significant relationship with age, tumor localization, laboratory results, stage, and prognosis. However, in the case of IDH mutation, patients were diagnosed at the advanced stage. Conclusions: This study demonstrated the relationship between neuroblastoma and IDH mutation for the first time. Because to the fact that the mutation is very heterogeneous, it would be appropriate to conduct a larger series of patients in terms of the impact of the clinical significance of each mutation on the diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursology is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim Hydatid disease (Echinococcosis) is a common zoonosis in countries that are involved in livestock such as our country. Our study aims to evaluate pediatric cases with hydatid disease over the last decade in our region and to determine the significance of initial clinical and laboratory findings in distinguishing ruptured hydatid cyst cases. Materials and Methods A retrospective analysis was made on demographic characteristics, presenting symptoms, physical examination, laboratory and radiological findings, and treatments of children with hydatid disease who were treated in our hospital and followed up regularly between January 2011 and December 2020. Results The study sample of 42 cases included 19 (45.2%) girls, with a median age of 125.5 (34-209) months. The most common symptom was abdominal pain (50%), and the most common physical examination finding was decreased breath sounds (23.8%). Thirty-five (83.3%) patients had single organ involvement and 7 (16.7) patients had multiple organ involvement. Cysts were detected in the right lobe of the liver in 24 (75%) of hepatic hydatid cysts and the left lobe in 7 (58.3%) of pulmonary hydatid cysts. The median size of the cysts was 57.5 (12-140) mm. The initial IHA titer, eosinophil count, eosinophil percentage, and sedimentation value were statistically significantly higher in patients with ruptured cysts than in those without rupture (p= 0.002, p= 0.003, p= 0.003, p= 0.02, respectively). Conclusions Initial pathological examination findings and at initial laboratory findings such as high IHA titer, eosinophil count, eosinophil percentage, sedimentation value can be used to distinguish rupture cases.

Objective: A particular electroencephalography parameter known as the bispectral index (BIS) is one of the objective methods used to assess sedative and hypnotic effects. The aim of this study is to monitor the level of consciousness of patients who underwent sedation-analgesia in pediatric intensive care unit (PICU) and to evaluate how their sedation levels were affected by painful procedures by examining BIS and Ramsey Sedation Scale (RSS). Method: This prospective observational study was held 43 pediatric patients who were hospitalized in the 24-bed university-affiliated tertiary PICU. BIS, RSS and vital signs were recorded both before and after the endotracheal suctioning procedure. Patients were divided into two groups according to the chosen analgesic which was fentanyl or morphine. Percentage change (BIS, electromyography activity, signal quality index, RSS score, heart rate, oxygen saturation) of before/after endotracheal suctioning was calculated. Results: The increase in BIS value, increase heart rates and decrease RSS of patients with endotracheal suctioning were found to be significant (p<0.01, p=0.01, p<0.001 respectively). Percentage changes were compared between two groups and there was no significant difference between morphine and fentanyl group. Conclusion: Even in patients receiving strong analgesic agents like opioids, any painful procedures such as endotracheal suctioning increase the BIS values of the patients and disrupt their comfort. Continuous BIS value tracing may be more beneficial than clinical scoring systems on sedation monitoring and patient comfort. We also suggest further studies with different groups of analgesic agents should be conducted. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Clinic Journal of Medical Sciences is the property of Hayat Saglik ve Sosyal Hizmetler Vakfi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Mersin Üniversitesi sağlık Bilimleri Dergisi is the property of Mersin University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Stenotrophomonas maltophilia (S. maltophilia) is a resistant gram-negative rod that can often cause serious infections, especially in patients with long hospital stays and using broad-spectrum antibiotics. In this study, clinical data, and mortality-related risk factors of patients with S. maltophilia bacteremia were evaluated. Materials and Methods: Patients with S. maltophilia bacteremia included in this study and evaluated retrospectively, when hospitalized between 2013 and 2018 in our pediatric wards and intensive care units. Results: A total of 67 patients had 100 S. maltophilia bacteremia in 70 different episodes. Sixty percent (n=40) of the cases were male and their median age were 9 months. Sixty-nine percent (n=46) of the cases were admitted in intensive care units. The most common comorbidity was malignancy. All bacteremias were healthcare associated, and 55% (n=55) were catheter-related. In the total of 70 episodes; 57% (n=37) of the patients had central venous catheters, 47% (n=33) were entubated. Fourty-seven percent (n=33) of the patients had broad spectrum antibiotic use over 14 days. In the blood cultures, 98% of S. maltophilia-producing strains were sensitive to trimethoprim-sulfamethoxazole. Ciprofloxacin and trimethoprim-sulfamethoxazole combination therapy had used for treatment. The mortality rate in the first 30 days was 16% (n=11). Mechanical ventilation was found to be significant (p<0.05) as a predisposing factor related to mortality. Conclusion: Stenotrophomonas maltophilia is the causative pathogen in healthcare associated bloodstream infections especially in intensive care unit. In our study, 69% of the cases were admitted in the intensive care unit and mechanical ventilation status increased mortality. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Academics / Sağlık Akademisyenleri Dergisi is the property of Journal of Health Academics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study is to determine the non-pediatric dosage form (NPDF) of medications used in the general pediatric service. Material and Methods: This retrospective, descriptive study was carried out by examining the archive documents of patients under the age of 12 who had received medication therapy in the last 6 months in the general pediatric service of a university hospital. Results: The median age [interquartile range (IQR)] of the 238 patients included in the study was 2 years (1-6), and 130 (54.6%) of them were female. The most common diagnoses in patients are diabetes mellitus (10%), upper respiratory tract infections (8.4%) and pneumonia (6.9%), NPDF medications use was detected in 96 (40.3%) of the patients. Out of a total of 729 medications used by the patients, 106 (14.5%) were classified as NPDF medications. The most commonly used active ingredients among NPDF medications are allopurinol (6.3%), captopril (5%), phenobarbital (5%), furosemide (4.2%) and azathioprine (4.2%). NPDF medications were most frequently included in the cardiovascular system (26%), the digestive system (23%) and the nervous system (16%). Of the NPDF drugs, 57% were used in the 0-2 age group, 24% in the 3- 6 age group, and 19% in the 7-12 age group. There was no statistically significant difference in the distribution of NPDF drugs among patients in these age groups (p>0.05). Conclusion: It has been observed that NPDF medications are widely used in patients hospitalized in the general pediatric service. Especially the medications in the cardiovascular system group are drugs that are often used by manipulating their dosage forms. Evidence-based guidelines for the manipulation of medications are needed to improve the safety of pediatric medication therapy. [ABSTRACT FROM AUTHOR]

Purpose: Thyroid carcinoma is the most common carcinoma that originated from endocrine tissue in pediatric patients. Pediatric thyroid carcinomas are more prone to reveal lymph node or lung metastasis and recurrence. In this study, clinical, pathological and genetic features that may be related with resistant differentiated thyroid carcinoma in pediatric patients were investigated. Materials and Methods: Thirty-nine pediatric patients who were 18 years old and below and were given 131I Radioactive Iodine (RAI) therapy were included to the study. 131I RAI therapy was planned in accordance with the American Thyroid Association (ATA) Guideline. Clinical and postoperative pathological features of patients were retrospectively determined and the patients who received single or multiple RAI therapy due to resistant disease compared statistically in terms of these features. Genetic analysis was also made in the patients who received multiple therapies. Results: Thirty-one patients were female and 8 patients were male. Thirty-four patients had papillary thyroid carcinoma, 4 had follicular thyroid carcinoma and 1 had mixed papillary-oncocytic carcinoma of patients. Eight patients received multiple I-131 RAI therapy cycles due to resistant disease. Any clinical, pathological feature and genetic mutation that would indicate resistant disease was not found in these patients. Conclusion: Although pediatric thyroid carcinoma is rarely seen, it has an increasing incidence in recent years. We were not able to reveal any feature related to resistant disease in our limited group. Clinical, pathological and genetic characteristics related to poor prognosis must be investigated with larger study groups. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical, laboratory and capillaroscopic findings of pediatric patients with Raynaud's phenomenon. Material and Methods: Ninety-five pediatric patients who were diagnosed with Raynaud's phenomenon between January 2014 and January 2021, were retrospectively examined. The demographic data, laboratory parameters and capillaroscopic findings of the patients were recorded. The capillaroscopic findings of the patients were classified as normal, nonspecific abnormalities and scleroderma pattern. Results: Primary Raynaud's phenomenon was present in 84 (88.5%) patients, and secondary Raynaud's phenomenon was present in 11 (11.5%). Arthralgia, arthritis, rash and recurrent fever were significantly more common in secondary Raynaud's phenomenon (p=0.001, p=<0.001, p=0.01, p=0.035, respectively). Antinuclear antibody positivity >1/320 was significantly higher in the patients with secondary Raynaud's phenomenon (p=0.01). Of the 40 patients who had capillaroscopy performed, 2 had a scleroderma pattern, 19 had nonspecific changes, and 19 had normal nailfold capillaroscopic findings. Capillary irregularity, tortuous capillaries and increased branching were significantly higher in the secondary Raynaud's phenomenon cases (p=0.015, p=0.015, p=0.003, respectively). Conclusion: Having antinuclear antibody titer >1/320 and detection of capillary irregularity, tortuous capillaries and increased branching may be useful in distinguishing primary and secondary Raynaud's phenomenon. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Current Nursing Research / Güncel Hemşirelik Araştırmaları Dergisi is the property of Journal of Current Nursing Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Ege University Nursing Faculty (JEUNF) is the property of Journal of Ege University Nursing Faculty (JEUNF) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Izmir Katip Celebi University Faculty of Health Sciences Journal / İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi is the property of Izmir Katip Celebi University, Faculty of Health Sciene Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: In the beginning of March 2020 with first case of COVID-19 reported in Turkey, measures that were assumed to decrease the spread of SARS-CoV-2 were taken quickly. Use of personel protective equipments and limiting number of people contacting with the patients were some of the most important precautions. Although these precautions protected medical student from risk of infection, they limited their practical learning oportunities and probably negatively effected their education. Aim of our study was to measure the effect of pandemic on medical education of grade 6 medical students. Materials and Methods: We had 6th grade medical students that finished their education between July 2020 and June 2021 fill out a questionnaire that measures their self-esteem on evaluation and procedural practice in pediatric patients and presents their subjective opinions on this period and their solution suggestions with closed and open ended questions. Results: Forty nine grade 6 student was included in the study. Their self-esteem was average (general competency in pediatric patients was 2.31±0.94 and general self reported competency in clinical practices was 2.65±1.42). The practice they feel most confident was hand washing (4.44±1.16), and the practice the feel least confident was establishment of vascular access (1.94±1.09). When they were asked to evaluate their self-competency in pediatric patients from 1 to 5,the procedure they most frequently observed was establishment of vascular access (74%) and least frequently observed was lumbar puncture (12%). Most frequently performed procedure was urinary catheterization (20%). 80.9% them stated that they felt unlucky to be 6th grade in COVID-19 pandemic and they would like to have more opportunities to contact with the patients with personal protective equipment (PPE). Conclusion: Education of 6th grade medical students affected negatively with decreasing number and diversity of patients and limited opportunity to evaluate patients and observe and perform procedures. Improvements should be made in pediatric departments to increase possibility of student to encounter patients and continue hands on learning with the right precautions. [ABSTRACT FROM AUTHOR]

Hydatid cyst is a parasitic disease caused by Echinococcus granulosus and transmitted to humans mostly through canine feces. Although it can settle in every organ in the body, the most frequently involved organ in children is the lung. As well as being asymptomatic, pulmonary hydatid cyst may cause complaints such as chest pain, cough, shortness of breath, and hemoptysis. Hydatid cyst treatment is primarily surgical. With the rupture of the cyst during the operation, anaphylactic shock and even death can be seen. In case of sudden onset of tachycardia and decrease in mean arterial pressure during hydatid cyst operation, the possibility of anaphylaxis should be kept in mind after excluding other possibilities. We think that keeping in mind that anaphylaxis may develop in patients who will undergo surgery for hydatid cyst and being prepared for this will have a significant positive effect on mortality and morbidity. In this case report, we aimed to present our anesthesia experience of anaphylactic reaction following cyst rupture during surgical excision of lung hydatid cyst. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)