Circumcision in children: postoperative analgesic efficiency of transversus abdominis plan block vs caudal epidural block: a prospective observational study

Background and objective: Circumcision is one of the most common operations and can cause postoperative pain, fear, and anxiety for children. This study aims to compare the effects of transversus abdominis plane (TAP) block and caudal epidural (CE) anesthesia on postoperative analgesia after circumcision in providing postoperative pain control. Methods: Eighty boys aged 1 to 14 years who underwent elective circumcision surgery under general anesthesia either with USG-guided TAP block or with CE block for postoperative analgesia were enrolled consecutively to this prospective observational study equally in each group. Postoperative pain scores and need for rescue analgesia were recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in mean age and Aldrete scores (p > 0.05). Body mass index (BMI) of the caudal block group was statistically lower than the TAP group (p < 0.05). While there was no statistically significant difference between the groups in 30th-minute VAS values (p > 0.05), the CE block group’s 1st, 2nd, 4th, 8th, 12th, 18th, and 24th hour VAS values were statistically lower than the TAP block group’s (p < 0.05). Conclusion: USG-guided TAB block under general anesthesia was not associated with lower postoperative pain scores and delayed rescue analgesia need compared with CE block in patients who underwent elective circumcision surgery. CE block provided superior analgesia than the USG-guided TAP block after elective circumcision surgery in this study

EVALUATION OF FACTORS AFFECTING DENTAL ANXIETY IN ADOLESCENTS

Objectives: Dental anxiety determines the frequency of dental treatment availed with long-term implications in oral health maintenance. The aim of this study is to investigate the effects of sociodemographic data, dental anxiety levels of parents, family functionality, perceived family support and other associated factors on dental anxiety of adolescents. Materials and Methods: 213 adoloscents who applied to the Pediatric Dental Clinic and their parents were included in the study and their sociodemographic data were recorded. The Corah Dental Anxiety Scale was applied to the adolescents and their parents to determine dental anxiety and the Perceived Family Support Scale was applied to measure the perceived family support of the adolescents. Regarding the family functionality, the parents answered the Family Assessment Device. Results: The avarage dental anxiety level of the adolescents was 8.87±3.10. The family functions were unhealthy in terms of roles, and affective involvement. According to the multiple regression analysis, the predictors of dental anxiety levels were family functionality, maternal educational level, previous application to the dentist, having negative experience in the past, the choosing of a dental treatment center, and training regarding dental treatment. Conclusions: Clinicians should consider that socio-cultural characteristics, family functionality and support may affect dental anxiety, and the improvement of the physical environment may be effective in reducing dental anxiety during dental treatment of adolescents

The Acute Effects of Velocity Loss During Half Squat Exercise on Jump Performance

The velocity loss (VL) approach during squat exercise may increase the post-activation potentiation enhancement effect on squat jump performance. If this method succeeds, then different conditions of VL should be researched before its implementation to the field. This study hypothesized that squat jump performance would be increased after different volumed VL conditions during half-squat exercise. Eighteen resistance-trained men (mean [M] ± standard deviation [SD]; age: 24.00±3.53 years; body mass: 78.37±5.53 kg; height: 179.35±7.04 cm; one-repetition maximum (1RM) half squat: 110.85±11.92 kg) voluntarily performed squat jump under unloaded and four different VL conditions (R6: six repetitions, Ruf: repetitions until failure, VL10: velocity loss thresholds 10%, VL20: velocity loss thresholds 20%) after a set of half-squat exercises at 80% of one-repetition maximum separated by at least 72 hours. The results revealed that subjects demonstrated significantly better squat jump performance in VL10, VL20, and R6 conditions than the unloaded and Ruf conditions (

Successful treatment of bilateral open calcaneal fractures with concomitant lower extremity injuries: A case report

Open calcaneal fractures are high morbidity injuries and the risk of complications depends on the concomitant injuries, on the size and the position of the traumatic wound. A 53-year-old male patient with bilateral open calcaneal fractures and associated concomitant lower extremity injuries such as subtalar dislocation, talonavicular dislocation and open distal tibial metaphyseal fracture was immediately operated by percutaneous Kirschner wire fixation combined with external fixators. He was able to walk with full weight bearing without any assistance at the end of the first postoperative year. Early aggressive debridement and irrigation followed by fixation with percutaneous Kirschner wires and external fixator can supply bony alignment in open comminuted calcaneal fractures associated with concomitant lower extremity injuries and should be considered for the healthy and active patients before primary arthrodesis

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels &gt;2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p &lt; 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Insulin need and determinants of insulin usage in diabetes mellitus during pregnancy

Aim: We aimed determinants of insulin usage in pregnant women with impaired carbohydrate metabolism (ICM).Methods: We collected 164 pregnant women in any trimester who were referred to endocrinology unit due to suspicion of ICM by obstetricians. Diagnostic laboratory criteria were as follows: fasting glucose ≥126 mg/dl in first trimester; 1 hour 50 g challenge test glucose ≥180 mg/dl; any value exceeding threshold during OGTT (fasting glucose ≥92 mg/dl, 1 hour glucose ≥180 mg/dl, 2 hour glucose ≥153 mg/dl). Those with previous diagnosis of DM were also included. Insulin therapy was initiated in case of measurements exceeding target values (at least 2 fasting glucose ≥95 mg/dl and either 1 hour or 2 hour postprandial glucose ≥140 mg/dl ≥120 mg/dl, respectively) despite medical nutrition therapy.Results: Mean and s.d. values were: age 31.4 ± 4.7 years, gestational age (GA) at initial visit to endocrinology unit 25.9 ± 5.2 weeks, GA at initiation of insulin 26.7 ± 7.8 weeks, number of pregnancies 2.3 ± 1.4, TSH 1.76 ± 1.21 mIU/l, and hemoglobin A1c 5.82 ± 1.06%. Insulin users (n = 90) had higher fasting glucose (P = 0.001), 2 hour OGTT-glucose level (P = 0.004), and hemoglobin A1c (P = 0.001) at diagnosis in comparison to non-insulin users (n = 74). Insulin users who gave birth before 36 weeks had higher hemoglobin A1c than those after 36 weeks (6.32 ± 1.68% vs 5.62 ± 1.68%, P = 0.014). GA at diagnosis was positively correlated with GA at insulin initiation (r = 0.634, P = 0.001). GA at diagnosis was significantly lower in subjects who gave birth before 36 weeks in comparison to those after 36 weeks (22.0 ± 7.8 weeks vs 26.2 ± 5.6, P = 0.01). There was a positive correlation in-between (r = 0.466, P = 0.002). GA at insulin initiation was positively correlated delivery date (before vs after 36 weeks) (r = 0.510, P = 0.006). Insulin dosage was negatively correlated with delivery date (final total dosage: r = −0.453, P = 0.016). GA at insulin initiation was negatively correlated with initial basal insulin dose (r = −0.283, P = 0.007). Insulin dosage increased significantly from baseline to final visit (basal: 2.53 ± 2.38 vs 3.73 ± 3.97 U, bolus: 2.27 ± 3.45 vs 5.20 ± 6.12 U, total 4.80 ± 3.88 vs 11.98 ± 12.09 U). A positive correlation was detected between initial and final total insulin dosage (r = 0.643; P = 0.001).Conclusion: Pregnant women need basal insulin more frequently than bolus insulin. Insulin userswith higher hemoglobin A1c level and those who need higher insulin dosage are at higher risk for delivery before 36 weeks. Early insulin initiation avoids delivery before 36 weeks. Basal insulin demand is higher in women who were initiated insulin at an earlier GA.</p