Protective Effects of Hypericum perforatum and Quercetin in a Rat Model of Ischemia/Reperfusion Injury of Testes

Purpose This study aimed to compare the protective effects of Hypericum perforatum (Hp) and quercetin, a flavonoid, against ischemia/reperfusion (I/R) injury in rat testes. Materials and Methods This study included 28 male Wistar albino rats that were divided into four groups. Except for the sham group, torsion was created by rotating both testes at an angle of 720 degrees clockwise for 2 hours. The Hp and quercetin groups received 25 mg/kg Hp and quercetin intraperitoneally 30 minutes before detorsion, respectively. Orchiectomy was performed for the measurement of markers of oxidative stress and histopathological examination. Results In the Hp and quercetin groups, malondialdehyde (MDA) and nitric oxide (NO) levels and total oxidant capacity were significantly lower, the glutathione level and total antioxidant status were significantly higher, and Johnsen's testis biopsy scores were significantly higher than in the torsion/detorsion group (p=0.001). The markers of oxidative injury were significantly lower (p=0.001) and total antioxidant status was significantly higher (p=0.001), except for glutathione (p=0.62) in the Hp group than in the quercetin group. Johnsen's score between Hp and quercetin groups was not significantly different (p=0.80). Conclusion Both Hp and quercetin have protective effects against I/R injury of the testes, but the protective effect of Hp was found to be stronger than that of quercetin

Protective effects of sildenafil and resveratrol on ovarian ischemiareperfusion injury in rats

Aim: This study investigated the protective effects of sildenafil (SIL) and resveratrol (RSV) on ovarian ischemia-reperfusion (I/R) injury. Materials and methods: Forty-Eight Wistar albino rats were divided equally into groups: control (sham), ischemia (2 h ischemia), I/R (2 h ischemia+2 h reperfusion), I/R+RSV (10 mg/kg intraperitoneally), I/R+SIL (1.4 mg/kg intraperitoneally), and I/R+RSV+SIL. RSV and SIL were administered 30 min before the end of the ischemia period, and reperfusion was carried out for 2 h. The ovaries were then removed and evaluated histopathologically for mean histopathological damage score (MHDS) and anti-inducible nitric oxide (NO) synthase (iNOS) antibody. Malondialdehyde (MDA) level, glutathione (GSH) activity, total antioxidant status (TAS), total oxidant status (TOS), and NO level were measured. Results: Histopathological findings such as enema, inflammation, haemorrhage, and congestion were detected in the ischemia and I/R groups. Compared with controls, these groups had significantly higher MHDSs. Compared with the ischemia and I/R groups, the treatment groups had significantly decreased MHDSs. iNOS immunostaining was most evident in the ischemia and I/R groups, and TOS and MDA and NO levels were significantly increased, whereas GSH activity and TAS were significantly decreased compared with those in controls. TOS and MDA and NO levels were significantly decreased, and GSH activity and TAS were significantly increased in the treatment groups. Conclusion: RSV and SIL decreased histopathological and biochemical damage and exerted protective effects on I/R-induced ovarian damage. SIL and RSV act simultaneously to reduce tissue injury. © 2017, Scientific Publishers of India, All rights reserved

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Determination of normal anal position index using a modified technique in Turkish neonates

Aim: This study was aimed to determine the normal position of the anus using the anal position index (API) in an attempt to develop a more sensitive method for measuring API. To investigate API in a wide range of neonates, both term and preterm infants were included in the present study. Materials and Methods: API was determined by measuring the anus-fourchette (FA) and anus-coccyx (AC) distance in female neonates and the anus-scrotum and AC distance in male neonates. API is defined as the ratio of the FA (scrotum) distance to the AC distance. A digital caliper was used for all measurements. The FA or scrotum and coccyx-fourchette or -scrotum distances were measured using digital calipers. Results: A total of 267 neonates (females, 143; males 124) were included in this study. Of these, 36 were borderline premature infants (birth at 35-37 weeks gestation) and 231 were term infants (birth at 38-42 weeks gestation). The mean API was 1.06 ± 0.04 in female and 0.90 ± 0.08 in male neonates. When premature infants were analyzed separately, the mean API was 1.12 ± 0.08 in female and 0.99 ± 0.09 in male neonates. No significant difference in API values was observed between term and preterm neonates (P < 0.05). Conclusions: API values that differ from the previous studies were identified in the present study. We believe our modified method allows for more accurate measurements of the API in newborns. According to our method, the anus should be considered as anteriorly located if API is <1 in female and < 0.9 in male neonates. In addition, the present study is the first to measure API using digital calipers. Digital calipers were found to be convenient and are useful in determining the API with high accuracy (to within 0.01 cm)

Determination of normal anal position index using a modified technique in Turkish neonates

Aim: This study was aimed to determine the normal position of the anus using the anal position index (API) in an attempt to develop a more sensitive method for measuring API. To investigate API in a wide range of neonates, both term and preterm infants were included in the present study. Materials and Methods: API was determined by measuring the anus-fourchette (FA) and anus-coccyx (AC) distance in female neonates and the anus-scrotum and AC distance in male neonates. API is defined as the ratio of the FA (scrotum) distance to the AC distance. A digital caliper was used for all measurements. The FA or scrotum and coccyx-fourchette or -scrotum distances were measured using digital calipers. Results: A total of 267 neonates (females, 143; males 124) were included in this study. Of these, 36 were borderline premature infants (birth at 35-37 weeks gestation) and 231 were term infants (birth at 38-42 weeks gestation). The mean API was 1.06 ± 0.04 in female and 0.90 ± 0.08 in male neonates. When premature infants were analyzed separately, the mean API was 1.12 ± 0.08 in female and 0.99 ± 0.09 in male neonates. No significant difference in API values was observed between term and preterm neonates (P < 0.05). Conclusions: API values that differ from the previous studies were identified in the present study. We believe our modified method allows for more accurate measurements of the API in newborns. According to our method, the anus should be considered as anteriorly located if API is <1 in female and < 0.9 in male neonates. In addition, the present study is the first to measure API using digital calipers. Digital calipers were found to be convenient and are useful in determining the API with high accuracy (to within 0.01 cm)

Evaluation of a series of patients operated for adhesive intestinal obstructions

The risk of bowel obstruction after laparotomy in infants and children, especially in developing countries, has not been well researched. Objectives: The aim of this study was to perform a detailed analysis of adhesions and the risk factors for adhesion-associated intestinal obstruction after laparotomy in children. Methods: This retrospective study involved patients who were operated between January 1990 and January 2001 on for postoperative adhesive intestinal obstruction (AIO). Results: During a 11-year period, a total of 45 patients aged 6 days to 14 years (mean 7.75 years) were operated on after 1341 laparotomies. The incidence of AIO was 3.35%. Six (13.3%) patients were urgently operated on while 29 (64.4%) patients were operated on in the first 3 days. The patients were operated on at 6th postoperative day at the earliest and at 10 years at the latest. Each of two children with midgut volvulus (relative risk 50%) and jejunal atresia (relative risk 27.7%) were operated on twice. The mortality and morbidity rates were found to be 2.2% (1 patient) and 22.2%, respectively. AIO was most commonly observed after operations involving the pelvic area (77.7%). Appendectomy, trauma, invagination, and megacolon surgeries were the most common postoperative causes of AIO. Conclusion: This study showed that adhesions in children occurred more commonly after lower abdominal surgery. The risks were closely related to the site and type of the first surgery. Although the risk of having adhesions was very high in the first years, it also persists in the following years

Fibroepithelial polyp of vagina in a two-year-old girl and review of the literature

Fibroepithelial polyp of vagina (FEPV) is a mucosal polypoid lesion with a fibro vascular stalk and oedematous or hypocellular stroma covered by squamous epithelial surface. FEPV is extremely rare before menarche and after menopause. This article describes a two year old girl with a vaginal polyp and the histological analysis of which revealed to be a FEPV. Surgical excision of the mass was performed, and in 1 year of follow-up no recurrence was detected. A review of the literature showed that there were four cases of FEPV in neonatal girls. While these reported cases were neonatal, our case is the first case of FEPV in a two year old girl

Four Neonatal Complex Ovarian Cyst Cases with Uncommon Complications

With the wide common use of ultrasound, ovarian cysts of the fetus and neonate are more often detected. A case series of four infant with uncommon complications of antenatal ovarian cysts were presented. In the first case; autoamputated ovarian tissue was determined and disappeared during the follow up. The second and third case went under surgery. Histopathological results were reported as a torsional autoamputated hemorrhagic necrotic tuba-ovarian cyst. Abdominal ascites was determined postnatally due to rupture of neonatal ovarian cyst in the fourth case. The treatment approaches for ovarian cysts poses a therapeutic dilemma for the pediatrician and the pediatric surgeon. It has to be decided which patient should be referred for surgical therapy and which might be treated conservatively

An Unusual Localization of the Umbilicus in a Neonate

We report the case of a male neonate with a low-set umbilicus. Physical examination revealed an appropriately grown term infant with no unusual findings, except ectopically placed umbilical cord at the level of the bladder in the hypogastric zone. The infant underwent detailed investigations that revealed no associated malformation. To the best of our knowledge, this is the first case with very distinct localization of the umbilicus without any congenital abnormalities