Assesment of Upper Gastrointestinal Bleeding in the Pediatric Emergency Department

Introduction:Upper gastrointestinal bleeding is an important emergency problem that can occur at any age in childhood and requires urgent treatment for the underlying cause. Etiological causes of gastrointestinal bleeding vary by age and geographic region. In this study; we aimed to investigate the demographic characteristics, etiological causes, endoscopic intervention results, and the relationship between analgesic/antipyretic drug use and bleeding in patients admitted to the pediatric emergency department with upper gastrointestinal bleeding.Methods:The records of patients aged 1 month to 18 years who presented to our pediatric emergency department with upper gastrointestinal bleeding between January 2017 and 2019 were retrospectively reviewed. Demographic features, complaints at admission, etiological reasons, endoscopy findings, diagnoses, and antipyretic/analgesic drug use were recorded.Results:There were 108 patients presenting with upper gastrointestinal bleeding, and 53.7% of the patients were male. The mean age was 76.7±58.3 months. Hematemesis was present in 100 patients. Symptoms of the patients; vomiting was present in 82.4%, upper respiratory tract infection in 36.1%, fever in 29.6%, and abdominal pain in 25.9%. There were 52 patients with a history of antipyretic and/or analgesic drug use. An endoscopic examination was performed in 74 patients. In patients who underwent endoscopic examination; pathological changes were detected in 26 of 32 patients who used drugs and 30 of 42 patients who did not use drugs.Conclusion:In patients presenting to the pediatric emergency department with upper gastrointestinal bleeding, the bleeding is usually acute and self-limiting, but requires prompt diagnosis and treatment. Approximately half of the patients in our study had a history of antipyretic/analgesic drug use in etiology. When the endoscopic findings of drug users and non-users were compared, no statistically significant difference was observed in terms of pathological findings

Covid-19 Vaccine Acceptance Among Parents: Are They Willing to Vaccinate Their Children?

Purpose: The aim of this study was to evaluate the willingness of parents to allow their children to receive a COVID-19 vaccine and the factors affecting the decision. Materials and Methods: This study was conducted as a prospective, cross-sectional and descriptive survey study. A survey consisting of questions about the COVID-19 vaccination was conducted with parents. Results: The study included 592 parents, 180 (30.4%) male, and the mean age was 34.14±7.42 years. There were 257 (43.4%) parents would vaccinate their children. A high level of education of parents (p=0.022), a high monthly income of the family (p=0.006), and male gender (p=0.002) were associated with high willingness to vaccinate their children. Two hundred twenty two parents stated that their decision may change depending on whether the vaccine is of domestic or foreign origin, and 215 (96.85%) of them stated that they would prefer domestic vaccines. The most frequent reasons for vaccine hesitancy or refusal to their children were: fear of possible side effects and it being a foreign vaccine. Conclusion: The hesitancy or refusal of parents to vaccinate their children with the COVID-19 vaccine is high. Public health authorities should inform the public about the importance of vaccination and domestic vaccine production should be encouraged

Relationship of Cystatin C, Hs-CRP, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with isolated oligohydramnios

Objectives: We evaluated inflammatory parameters in pregnant women with isolated oligohydramnios. Material and methods: This prospective cross-sectional study enrolled 54 pregnant with isolated oligohydramnios (IO) and 54 matched by gestational week, healthy pregnant with normal amniotic fluid. Maternal plasma levels of cystatin C, hs-CRP, neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), and pregnancy outcomes were compared between two groups. Results: Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than that in the control group (p < 0.05). In the IO group, the rate of primary cesarean section, fetal distress, neonates with meconium-stained, and need for neonatal intensive care unit was higher, and Apgar scores were significantly lower than those in the control group (p < 0.05). There was no significant difference between the groups for meconium-stained neonate rates and the intensive care unit's need in the late-term (410/7–416/7 weeks). Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than the control group (p < 0.05). Cystatin C was positively correlated with the need for neonatal intensive care and negatively correlated with Apgar scores. The PLR was positively correlated with the rate of meconium-stained neonates (p < 0.05). Cystatin C and hs-CRP had significant value in predicting IO (p < 0.05). Conclusions: Maternal serum levels of Cystatin C and hs-CRP may support the diagnosis and prediction of perinatal outcomes as possible biochemical markers in IO cases. In particular, a high level of cystatin C may indicate the need for neonatal intensive care and low Apgar scores. In addition, late-term IO may show similar results in meconium and neonatal intensive care needs compared to without oligohydramnios

The use of calcium channel blockers as tocolytics may adversely affect pregnancy outcomes: a randomized clinical trial

Objectives: To investigate the effect of calcium channel blockers in tocolytic therapy on obstetric outcomes. Material and methods: For our study, as a retrospective case control study, data were obtained from hospital records. During 2018, there were 65 patients hospitalized with a diagnosis of preterm labor and were treated with calcium channel blockers used as tocolytics (nifedipine, nicardipine) and these patients constituted the study group. Pregnant women with systemic disease were excluded from the total of 1552 patients who were followed and who gave birth in 2018. After exclusion to equalize the samples, we chose 65 healthy pregnant women from the remaining 646 healthy pregnancies using a simple random number table and these patients formed the control group. The obstetric and neonatal results of both groups were compared. Results: There was no difference between the groups in terms of birth week, pre-term labor rate, low birth weight, and delivery type. While birth weights were significantly lower, the need for neonatal intensive care and the number of infants weighing 2500–3000 g were higher in the study group (p < 0.05). When the results of pregnancies that gave birth at term weeks and were not administered steroids were compared, the birth weight was lower and the number of infants weighing 2500–3000 g was higher in the study group. Conclusions: The use of calcium channel blockers in pregnancy may adversely affect birth weight gain and the need for intensive care

The role of cystatin C, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in the evaluation of kidney function in women with preeclampsia

Objective: We aimed to compare the diagnostic efficiency of cystatin C with traditional kidney markers in preeclampsia and to evaluate the relationship of these markers with neutrophil-lymphocyte and thrombocyte-lymphocyte ratios. Materials and methods: 14 severe preeclampsia, 48 mild preeclampsia and 79 patients with healthy pregnancy who presented to our obstetrics and gynecology clinic within one year were compared. These three groups were compared in terms of demographic characteristics, physical findings, serum urea, creatinine, cystatin C levels, and neutrophil-lymphocyte and platelet-lymphocyte ratios. Results: The mean serum cystatin C, creatinine and uric acid levels were higher in the severe preeclampsia group compared with the mild preeclamptic and healthy pregnancies (p < 0.001). While cystatin C values increased as the week of gestation increased in the mild preeclampsia group, there was no relation with the gestational week in the control group and the severe preeclampsia group. However, the highest cystatin C values were in the severe preeclampsia group, regardless of the week (p < 0.05). The area under the ROC curve was statistically significant for cystatin C, uric acid and creatinine, but of these three values, cystatin C had the highest sensitivity and specificity. Neutrophil-lymphocyte ratio (NLR) was significantly higher in the severe preeclampsia group than healthy pregnancies, but the level was not significant compared to mild preeclampsia. There was no difference between the groups in terms of platelet-lymphocyte ratio. Conclusion: It can be suggested that cystatin C level reflects renal functions better than uric acid and creatinine in preeclampsia. Cystatin C can be used as a prognostic marker in preeclamptic pregnancies, and rising levels may be valuable for predicting severe preeclampsia. Especially with advancing gestational week, the increase in cystatin C level may indicate an association with the development of preeclampsia. NLR levels may be a parameter correlating with severity in severe preeclampsia. (c) 2021 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Relationship of inflammatory and metabolic parameters in adolescents with PCOS: BMI matched case-control study

Objective: Polycystic ovary syndrome (PCOS) begins in adolescence and has cardiovascular and metabolic components in later years. Cystatin C and high-sensitivity C-reactive protein (hs-CRP) levels and neutrophil-lymphocyte and platelet-lymphocyte ratios are associated with metabolic and inflammatory events. Here, we evaluated inflammatory and metabolic parameters in normal and overweight adolescents with PCOS. Materials and methods: This prospective case-control study enrolled 90 adolescents with PCOS and 100 matched by age and BMI healthy adolescents classified as either normal weight (NW) and overweight (OW). Groups were compared based on inflammatory and metabolic parameters (serum cystatin C, hs-CRP, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lipids, fasting blood glucose-insulin (FBG-FI), HOMA-IR levels, waist circumference [WC], and waist-hip ratio [WHR]).The relationship between the parameters were compared and predictive abilities were evaluated. Results: Cystatin C, hs-CRP, NLR, triglyceride (TG), FBG-FI, HOMA-IR, WC, and WHR were significantly higher in those with PCOS. The NW PCOS group had significantly higher TG, cystatin C, hs-CRP, and NLR versus OW controls. The highest HOMA-IR values were observed in OW PCOS (p < .05). Cystatin C and hs-CRP sensitivity and specificity were significant (p < 0.05). Cystatin C and hs-CRP were positively correlated with other metabolic parameters. Conclusion: Independent of BMI, inflammatory and metabolic parameters are significantly higher in adolescents with PCOS compared to controls and even worse in those who are also OW.Therefore, adolescents with PCOS should be encouraged to maintain healthy lifestyles and weights to avoid metabolic risks. Hs-CRP and cystatin C could be promising markers to predictive of future metabolic risks