Nail disorders in children, a clinical study

Introduction: Aims of the study to investigate the frequency and the nature ofnail disorders in children significant clinical data is available. Nail disorders although common in children in some parts of our country. This study was carried out to document the clinical and demographic pattern of nail disorders in a dermatology outpatient clinic of a pediatric hospital in Ankara, Turkey. Material and Methods: All consecutive patients a total of 3000 children from age 0-16 were admitted to dermatology outpatient clinic of Ankara Pediatric Hematology and Oncology Education and Research Hospital during January 2011 to December 2011 were studied and retrospectively evaluated for age, gender, drug use, diseases, systemic or genetic disorders and demographic features. Diagnostic evaluation results were noted and patients were categorized for demographic features and diagnosis. Results: These 133 patients (M: F 58:75, %44 vs 56, respectively) were under 16 years of age and have 17 different dermatological disorders related with nail symptoms. Fifty three of (39,8%) these patient were under 2 years of age, 31 (23.3%) were between 3-5 years, 30 (22.5%) were between 6-11 years old, 19 of 133 (14%), 2 were between 11-16 years of age. Through all of ages and independent of gender the most etiologies of nail disorders were, onychomadesis, paronychia, onycholysis, onychomycosis and systemic nail presentation of systemic dermatosis. Conclusion: Nail disorders are different in children than in adults. In our study, the first 5 years of age was found in 53% of nail disorders. Nail disorders are uncommon but may be seen as a part of a systemic disease and may be associated with cosmetic and psychologic problem

Türkiye'nin doğu ve güneydoğu bölgesinde hepatoselüler karsinomalı vakaların klinik ve epidemiyolojik özellikleri: çok merkezli retrospektif çalışma

Objective: In this multicenter retrospective study, we aimed to investigate the epidemiological and clinical characteristics of patients with hepatocellular cancer (HCC) in the Eastern and Southeastern Anatolian regions of Turkey. Material and Methods: This study included 218 patients from 7 centers-Dicle University (n=96), Yüzüncü Yıl University (n=30), İnönü University (n=28), Fırat University (n=24), Gaziantep University (n=20), Atatürk University (n=19), and Harran University (n=1) hospitals. Information about patients was obtained through pre-prepared forms. Diagnosis of HCC was made histologically or with a combination of clinical, radiological, and laboratory findings. Results: The mean age of the patients was 57.67±12.03 with a male-to-female ratio of 5.8:1. Etiologically, 45% of the study group had HBV infection alone, 29% had HDV co-infection, 15% had HCV infection and 10% were idiopathic cases with unknown etiology. Cirrhotic background was present in 94% of the patients and 89% of cases had an advanced stage disease according to the Okuda classification. Alpha-fetoprotein levels were over 300 ng/ml in 81% of the patients. Conclusion: Hepatitis B virus infection followed by hepatitis delta virus infections appeared to be the leading etiological factors for HCC cases in our region. HBsAg carriage continues to be an important risk factor for HCC in Turkey. The fact that most of the HCC cases are in the late stages of disease, makes it necessary to use effective diagnosis and treatment methods with efficient screening and monitoring programs in our country

Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae

Evaluation of Maternal and Fetal Stress Hormones During the Process of Birth

Objective: This study aims to determine whether mode of delivery is associated with the endocrine stress response in mother and newborn. Study Design: This prospective observational study was conducted with 86 women with a normal singleton pregnancy who delivered healthy infants between 37 and 41 weeks of gestation in a tertiary center. Study groups included; (1) women undergoing normal vaginal delivery with epidural anesthesia, (2) women undergoing vaginal delivery with immersion in water for pain relief during labor, (3) women delivered through elective caesarean section without labor. After delivery, thyroid stimulating hormone, cortisol, insulin, prolactin and Beta-endorphin levels were measured in maternal and umbilical cord serum and their relationships between modes of delivery were investigated. Results: It was found that the concentrations of cortisol and beta-endorphin after vaginal delivery with immersion in water group in both mothers and infants were higher than other two modes of delivery and these differences were statistically significant. Umbilical cord concentration of cortisol was the lowest in the caesarean section group. Conclusions: Maternal and fetal stress response was found to be associated with the mode of delivery and labor

The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women

Objectives: To assess the effects on neonatal and maternal outcomes of different pushing positions during the second stage of labor in nulliparous women.Methods: This prospective study included 102 healthy, pregnant, nulliparous women who were randomly allocated to either of two positions: a squatting using bars (n=51), or a supine position modified to 45 degree of semi-fowler (n=51) during the second stage of labor. Duration of the second stage of labor, maternal pain, postpartum blood loss, abnormal fetal heart rate patterns that required intervention, and newborn outcomes were compared between the two groups.Results: The trial showed that women who adopted the squatting position using bars experienced a significant reduction in the duration of the second stage of labor; they were less likely to be induced, and their Visual Analog Scale score was lower than those who were allocated the supine position modified to 45 degree of semi-fowler during second stage of labor (p<0.05). There were no significant differences with regard to postpartum blood loss, neonatal birth weight, Apgar score at one and five minutes, or admission to the Neonatal Intensive Care Unit.Conclusions: In healthy nulliparous women, adopting a squatting position using bars was associated with a shorter second stage of labor, lower Visual Analog Scale score, more satisfaction, and a reduction in oxytocin requirements compared with adopting the supine position. For Turkish women, the squatting position is easy to adopt as it is more appropriate in terms of Turkish social habits and traditions