Protocol: A systematic review and meta-analysis of the role of fetal and infantile environmental exposure in etiopathogenesis of infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is one of the hallmark pediatric surgical diseases. However, its etiology remains incompletely understood. By systematically reviewing the literature, we aim to clarify the effect of the effect of occupational and environmental factors and role of nitric oxide (NO) metabolism in the etiopathogenesis of IHPS. The systematic review is drafted with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). Systematic literature search will be performed for the period 2000 (Jan) to 2020 (Dec) in the databases: MEDLINE, EMBASE, PubMed. The systematic search will cover the literature in English and Turkish language and will be limited to studies on human subjects. Four investigators will independently search the databases (MEDLINE, EMBASE, PubMed) according to the defined search strategy. The full-text of the selected articles will be screened independently by four reviewers, against the inclusion criteria. Descriptive data will be extracted from each study regarding: study details, methods, participants, outcomes and calculations of association for potential further statistical analysis. If meta-analysis could not be undertaken, systematic approach to analyzing the findings of included multiple studies will be described. Heterogeneity will be assessed by quantifying the inconsistency across studies using I2 statistic. Statistical analysis will be performed using Comprehensive Meta-Analysis Version 3.0 software. The p values lower than 0.05 will be considered statistically significant for all analyses

Transitional Care for Patients with Congenital Colorectal Diseases:An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

Background: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. Methods: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. Results:In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. Conclusion: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. Level of Evidence: III.</p

The Role Bronchoscopy In The Diagnosis Of Airway Disease In Children

Bronchoscopy is endoscopic examination of airways that allows both diagnostic and interventional procedures in the evaluation of airway disease in children. It can be performed with either rigid or flexible instruments, depending on the particular needs of patients and skills of bronchoscopist. In addition to visualization of airways, bronchoscopy enables to obtain specimens form lungs and distal airways. Bronchoalveolar lavage (BAL) yields samples from surfaces of the alveoli and aids differential diagnosis of various pulmonary disease. Foreign body removal and examination of anatomy and dynamics of airways are also common indications of bronchoscopy in children. Improvement in the technology, endoscopic instrumentation allows detailed evaluation and interventional manipulation of airway lesions in small children. Although bronchoscopy is considered as a safe procedure, obstruction of airway may challenge and require special endoscopic skills with appropriate instrumentation. This review is aimed to outline the role of bronchoscopy in diagnosis airway disease in children.Wo

A Comment on the Pulmonary Contusion Model Reply

Soyer, Tutku/0000-0003-1505-6042WOS: 000384412600015PubMed: 25785764

Estrogen Treatment in Children

WOS: 000269529000006Estrogen treatment is rarely indicated during childhood. A limited number of patients requires either topical or systemic estrogens in selected cases. Labial adhesions in which the labia minora fused over the vestibule is the most common indication for topical estrogen treatment in children. Although the most accepted theory of labial adhesions is low estrogen levels, the use of topical estrogen treatment is still controversial. The systemic application of estrogen is used in girls with hypogonadism. Either in hypo or hypergonadotropic hypogonadism, low doses of estrogen treatment is initiated at pubertal age as a replacement treatment, to mimic normal puberty. In Turner syndrome, which is an example of hypergonadotropic hypogonadism, estrogen treatment should be also initiated at pubertal age in addition to growth hormone replacement. Although in girls, 'constitutional growth and pubertal delay' is not observed as frequently as in boys, very low doses of estrogen therapy for a short duration can be considered to induce normal puberty. Another indication of systemic estrogen treatment is for tall stature in carefully selected cases to fuse epiphysis. Though topical estrogen treatment in labial adhesions is preferred and used by many practitioners, systemic use of this hormonal therapy is only constituted by pediatric endocrinologists. In this chapter, our aim is to discuss the estrogen treatment in children with special emphasis on indications, treatment doses and results

Gastroesophageal reflux in children with asthma and the effect of antireflux treatment on asthma

Çocukluk çağındaki astım ve gastroözefageal reflü arasındaki ilişki uzun süredir bilinmekle birlikte, astımlı çocuklarda gastroözefageal reflünün tanı ve tedavisi halen tartışmalıdır. Çocuklarda astım-reflü ilişkisini ortaya koymak ve antireflü tedavinin sonuçlarını incelemek amacıylyapılan çalışmalar konuyu aydınlatmaya yeterli değildir. Bu derlemede, astım-reflü ilişkisi ve antireflü tedavinin etkinliğini değerlendiren çalışmaların sonuçlarının sunulması amaçlanmaktadır.Although, the relationship between asthma and gastroesophageal reflux has been known for years, diagnosis and treatment of asthma triggered gastroesophageal reflux is still controversial. The studies that aimed to evaluate the relation of asthma and reflux and results of antireflux treatment are insufficient to explain the topic. The aim of this review is to present the results of studies about asthma, reflux and efficacy of antireflux treatment

Intraabdominal infections

Intraabdominal infeksiyonlar (İAİ) akut apandisit gibi basit bir abdominal infeksiyondan ciddi sonuçları olan barsak infarktına kadar uzanan heterojen bir grup cerrahi alan infeksiyonunu tanımlar. İAİ’lar toplumdan kaynaklı veya sağlık bakımı ile ilişkili olabilir. İAİ olan hastalarda erken tanı, kaynak kontrolü ve uygun amprik tedavi ile morbidite ve mortalite önlenebilir. Bu yazıda erişkin ve çocuklarda gözlenen İAİ’ların tanı ve tedavi özellikleri güncel rehberler ışığında derlenmeye çalışılmıştır.Intraabdominal infections (IAI) defined a heteregous group of surgical site infections ranging from a simple abdominal infection such as acute appendicitis, to an intestinal infarct with severe consequences. IAI may be seen either community acquired or health-care related. Mortality and morbidity can be prevented by early diagnosis, source control and appropriate ampric treatment. It is aimed to review the diagnostic and treatment features of IAI in adults and children with the light of current guidelines

Peritoneal dialysis in the two very low birth weight premaure infants

Periton diyalizi, akut böbrek yetmezliği tedavisinde yenidoğanlarda da önemli bir seçenektir. Çok küçük prematüre bebeklerin teknik güçlükler, infeksiyona bağlı yüksek mortalite, düşük kilo alımı ve komplikasyonlar nedeniyle periton diyalizi için uygun aday olup olmadıkları ise tartışmalıdır. Burada, akut böbrek yetmezliği nedeniyle periton diyalizi uygulanan ve kaybedilen iki prematüre bebek aracılığıyla, çok düşük doğum ağırlıklı bebeklerde periton diyalizi uygulamasının ve teknik zorlukların sunulması amaçlanmıştır.Peritoneal dialysis is considered an important treatment choice also for newborns with renal failure. Very small premature newborns have not been considered good candidates for peritoneal dialysis because of technical feasibility and high morbidity from infection, poor weight gain, and complications from inadequate dialysis. Herein two premature infants with acute renal failure requiring peritoneal dialysis who died despite the succesful treatment are presented to discuss the peritoneal dialysis treatment and its technical difficulties in very low birth weight babie

Primary repair in complete testicular rupture: Case report

Testis rüptürü künt veya penetran skrotal travma sonrasında ortaya çıkan ürolojik bir acil olup, sıklıkla adölesan ve genç erişikinlerde görülmektedir. Testis travması sonrası fizik incelemede skrotumun aşırı şiş, duyarlı ve ekimotik olması, testis rüptürünü diğer akut skrotum nedenlerinden ayırd edilmesini zorlaştırmaktadır. Tanı ve tedavinin gecikdiği durumlarda testis rüptürü testiküler atrofi, infertilite ve gonadal yetmezlik gibi durumlara yol açmakta ve çoğu kez o testisin kaybıyla sonuçlanmaktadır. Kaza ile düşme sonrası komplet testis rüptürü gelişen 13 yaşındaki erkek olgu, çocuklarda komplet testis rüptürünün tanı özellikleri ve tedavi yöntemlerini irdelemek üzere sunulmuştur.Testicular rupture is an urologic emergency that presents after blunt or penetrating scrotal trauma and commonly seen among adolescents and young adults. Since physical examination revealed swollen, tender and ecchymotic scrotum after testicular trauma, it could be difficult to differentiate testicular rupture from other causes of acute scrotum. In case of delayed diagnosis and treatment, testicular rupture causes testicular atrophy, infertility, hypogonodal state and usually results with the loss of that testicule. We report a 13-year-old male who developed complete testicular rupture after an accidental fall, to evaluate the diagnostic features and treatment modalities of complete testicular rupture in children

Selective inhibition of nitric oxide synthase causes increased muscle thickness in rat esophagus

Soyer, Tutku/0000-0003-1505-6042WOS: 000360120200007PubMed: 25783303Aim: Achalasia is a primary motor dysfunction of esophagus which can be created experimentally by nitric oxide synthase (NOS) inhibition. Although several theories have been suggested, mechanism of increased esophageal muscle thickness in achalasia is still unclear. An experimental study was performed to evaluate the esophageal muscle thickness after selective inhibition of NOS in rats. Materials and methods: Wistar albino rats (n = 18) weighing 150-200 g of both sexes were included in the study. After anesthetization with ketamine hydrochloride, esophageal body and distal esophagus were sampled in control group (CG, n = 6). In sham group (SG, n = 6), intraperitoneal saline (1 ml) injection was performed for 21 days. L-NAME (L-nitroarginin metyl ester, selective inhibitor of NOS) group (LNAMEG, n = 6) received 100 mg/kg/d L-NAME intraperitoneally for 21 days. The esophageal body and distal esophagus were removed for histopathological analysis in each group. All samples were evaluated for total and circular muscle thickness with hemotoxylene-eosine (HE) staining. Results: None of the samples showed pathologic finding in esophageal mucosa. There was no difference between CG and SG for total and circular muscle thickness in esophageal body and distal esophagus. LNAMEG had higher median levels of both total and circular muscle thickness than CG and SG in esophageal body (P < 0.05). However, in distal esophageal segments, only total muscle thickness was statistically higher in LNAMEG than CG and SG (P < 0.05). Conclusion: Selective inhibition of NOS causes increased total smooth muscle thickness in esophageal body and distal esophagus. However, this effect could not detected in circular muscle in the distal esophagus. We suggest that NOS inhbition not only increases esophageal peristalsis but also causes muscle hypertrophy in esophagus. (C) 2015 Elsevier Inc. All rights reserved