A proposed framework for advancing acute kidney injury risk stratification and diagnosis in children: a report from the 26th Acute Disease Quality Initiative (ADQI) conference.

Acute kidney injury (AKI) in children is associated with increased morbidity, reduced health-related quality of life, greater resource utilization, and higher mortality. Improvements in the timeliness and precision of AKI diagnosis in children are needed. In this report, we highlight existing, novel, and on-the-horizon diagnostic and risk-stratification tools for pediatric AKI, and outline opportunities for integration into clinical practice. We also summarize pediatric-specific high-risk diagnoses and exposures for AKI, as well as the potential role of real-time risk stratification and clinical decision support to improve outcomes. Lastly, the key characteristics of important pediatric AKI phenotypes will be outlined. Throughout, we identify key knowledge gaps, which represent prioritized areas of focus for future research that will facilitate a comprehensive, timely and personalized approach to pediatric AKI diagnosis and management.

Epidemiology of acute kidney injury in children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference.

The nephrology and critical care communities have seen an increase in studies exploring acute kidney injury (AKI) epidemiology in children. As a result, we now know that AKI is highly prevalent in critically ill neonates, children, and young adults. Furthermore, children who develop AKI experience greater morbidity and higher mortality. Yet knowledge gaps still exist that suggest a more comprehensive understanding of AKI will form the foundation for future efforts designed to improve outcomes. In particular, the areas of community acquired AKI, AKI in non-critically ill children, and cohorts from low-middle income countries have not been well studied. Longer-term functional outcomes and patient-centric metrics including social determinants of health, quality of life, and healthcare utilization should be the foci of the next phase of scholarship. Current definitions identify AKI-based upon evidence of dysfunction which serves as a proxy for injury; biomarkers capable of identifying injury as it occurs are likely to more accurately define populations with AKI. Despite the strength of the association, the causal and mechanistic relationships between AKI and poorer outcomes remain inadequately examined. A more robust understanding of the relationship represents a potential to identify therapeutic targets. Once established, a more comprehensive understanding of AKI epidemiology in children will allow investigation of preventive, therapeutic, and quality improvement interventions more effectively.

Relationship of hemoxygenase-1 and prolidase enzyme activity with oxidative stress in papillary thyroid cancer.

AIM: Recent studies associate thyroid cancer with oxidative stress. We aim to clarify the relation between papillary thyroid cancer, oxidative stress, hemoxygenase-1, prolidase enzymes and investigate the availability of these enzymes as markers for diagnosis, success of treatment, and follow-up. METHODS: Thirty-one patients with papillary thyroid carcinoma and 25 healthy control subjects were included in this study. Hemoxygenase-1, prolidase (oxidant stress indicator), malondialdehyde, protein carbonyl, and superoxide dismutase (an indicator of antioxidant defense system) were measured pre-operatively and 30 days after thyroidectomy. RESULTS: There was a significant decrease in serum levels of malondialdehyde and superoxide dismutase (p <0.001 for both) after thyroidectomy in papillary thyroid carcinoma group. In addition, there was a significant difference in the postoperative serum levels of prolidase, malondialdehyde, protein carbonyl, and superoxide dismutase between papillary thyroid carcinoma and control groups (p =0.024, p <0.001, p =0.002, and p =0.016, respectively) beside significant difference of malondialdehyde, protein carbonyl, hemoxygenase-1, and superoxide dismutase pre-operative serum levels (p <0.001, p =0.003, p =0.006, and p =0.025, respectively). CONCLUSION: When the unquestionable role of oxidative stress in the pathogenesis of cancer is considered, in the future it is expected to associate parametric changes in the serum of patients caused by oxidative stress to papillary thyroid cancer. Hippokratia 2016, 20(1): 55-59.

Diagnostic value of terminal ileum biopsies in patients with abnormal terminal ileum mucosal appearance.

OBJECTIVE: To investigate the necessity of obtaining routine ileal biopsy during colonoscopy in the patients with abnormal terminal ileum mucosal appearance if the inflammatory bowel disease is not considered. MATERIAL AND METHODS: A retrospective analysis was performed for 57 patients who were referred to a private hospital for colonoscopy between January 2008 and February 2009, in whom terminal ileum intubation was achieved and an abnormal appearance was observed. RESULTS: There were 33 men and 24 women; the mean age was 44.12±11.42 years. In 22 patients, the abnormality was ulcers and/or erosions. In 10 patients, there were mucosal nodularity and in 24, the finding was erythema. The time to reach to ileum from cecum was 28.78±24.30 s. The mean length of the examined ileum was 12.93±6.05 cm. There was no difference between groups according to distance covered in the ileum for diagnostic yield, but going further than 2 cm was important. CONCLUSION: There should be no need to obtain routine biopsy in patients with abnormal terminal ileum mucosa appearance, when inflammatory bowel disease is not considered. In these patients, histopathology also reveals non-specific ileitis. Furthermore, in these patients, the macroscopic pathological diagnosis overlaps the histopathology, and it has a low diagnostic yield and lower clinical significance.

Use of infliximab in treatment of acute pancreatitis.

OBJECTIVE: The aim of this study was to investigating the effects of infliximab in severe necrotizing pancreatitis. METHODS: Forty male Wistar rats were randomly divided into five groups evenly. Necrotizing pancreatitis was induced in group I and II by retrograde injection of 3% taurocholate into common pancreaticobiliary duct. In group III and IV saline was introduced instead of taurocholate to mimic pressure effect. Infliximab (8mg/kg) was infused through tail vein in group I and III and saline was infused in group II and IV just before laparotomy. Group V underwent sham laparotomy. Serum amylase activity, serum and tissue sialic acid, carbonyl content, malondialdehyde, total antioxidant activity (TAA) and pancreatic histopathology were assessed. RESULTS: In group I serum sialic acid, malondialdehyde, carbonyl content and amylase activity were significantly lower than in group II (p<0.01). There were no significant differences for serum TAA between group I and II (p>0.05). Tissue sialic acid and malondialdehyde in group I were significantly lower than in group II (p<0.01). But tissue TAA in group I was significantly higher than in group II (p<0.01). Carbonyl content of group I was not significantly different from group II (p>0.05). Histopathologically, pancreatic sections of group II demonstrated extensive acinar and fat necrosis, hemorrhage, and inflammation. In group I Infliximab improved histopathological changes (p0.05). CONCLUSION: Administration of infliximab resulted in a significant improvement in biochemical and histopathological alterations in acute necrotizing pancreatitis(Tab. 3, Ref. 43).

Omitting of bougie appears to be safe for the performance of the fundal wrap at laparoscopic Nissen fundoplication.

AIM: Some operative techniques in fundoplication seem to increase the incidence of obstructive symptoms. Some authors believe that using intraesophageal bougie and preparing a short and floppy valve in laparoscopic Nissen fundoplication will help to decrease any possible tight crus repair and wrap and so it is effective to decrease the prevalence of postoperative dysphagia. The aim of this study is to show that there is no absolute benefit of routine insertion of a bougie during laparoscopic Nissen fundoplication in relation to post-operative dysphagia. METHODS: All patients who underwent laparoscopic Nissen fundoplication by a single surgeon between January 2001 and August 2011 were reviewed retrospectively. Esophageal bougie intubation was performed in none of the 154 patients. The operation technique, the duration of the operation, hospital stay and the improvement of the symptoms were assessed. The patients who had esophagitis with Barrett's esophagus and who had hiatal hernia that could not get benefit from medical therapy, were selected for the surgery. Laparoscopic Nissen fundoplication with cruroraphy were done in all patients. RESULTS: Ninety-six of the patients were female and 58 were male. The mean symptom duration was 3.6±0.6 years. The only complication was dysphagia. In eighth week, dysphagia resolved in all patients. CONCLUSION: Laparoscopic Nissen fundoplication can be safely performed without the routine use of an esophageal bougie and it does not increase the postoperative dysphagia rate.

Modified RIFLE criteria in critically ill children with acute kidney injury.

A classification system has been proposed to standardize the definition of acute kidney injury in adults. These criteria of risk, injury, failure, loss, and end-stage renal disease were given the acronym of RIFLE. We have modified the criteria based on 150 critically ill pediatric RIFLE (pRIFLE) patients to assess acute kidney injury incidence and course along with renal and/or non-renal comorbidities. Of these children, 11 required dialysis and 24 died. Patients without acute kidney injury in the first week of intensive care admission were less likely to subsequently develop renal Injury or Failure; however, 82% of acute kidney injury occurred in this initial week. Within this group of 123 children, 60 reached pRIFLEmax for Risk, 32 reached Injury, and 31 reached Failure. Acute kidney injury during admission was an independent predictor of intensive care; hospital length of stay and an increased risk of death independent of the Pediatric Risk of Mortality (PRISM II) score (odds ratio 3.0). Our results show that a majority of critically ill children develop acute kidney injury by pRIFLE criteria and do so early in the course of intensive care. Acute kidney injury is associated with mortality and may lead to increased hospital costs. We suggest that the pRIFLE criteria serves to characterize the pattern of acute kidney injury in critically ill children.

A study to assess the colour stability of acetal resins subjected to thermocycling.

The purpose of this study was to compare colour stability of pink and white acetal resin with one conventional poly (methylmethacrylate) resin. Five specimen disks 50 +/- 0.1 mm in diameter and approximately 1.0 mm thick were prepared from each material. The discs were hydrated for a period of 30 days in distilled water and were then desiccated to a constant weight. Total of fifteen specimens were thermocycled for 100 and 300 hours (4000-12000 cycle) between water baths of 5-55 degrees C. Changes from baseline colour readings were recorded at each interval. Data were analysed with descriptive statistic, repeated measured analysis of variance and single factor analysis of variance. The colour changes for all materials at 100 hours were in the categories of slight, based upon the National Bureau of Standard System (NBS) for expressing colour difference. At 300 hours, the colour changes of materials were significantly different (p = 0.0001). All the materials tested showed clinically acceptable discolouration values.

The attitude of complete denture wearers towards denture adhesives in Istanbul.

The purpose of using denture adhesives is to subjectively benefit denture-wearers with improved fit and comfort of their dentures and to improve their chewing ability and confidence. The purpose of this study was to investigate the approach and thought of complete denture wearers to denture adhesives and to see why they had tried denture adhesive, and their reasons for its current use or non-use through a questionnaire. One hundred and fifteen patients attending the Marmara University, Dental School for new denture treatment were surveyed. In the survey, there were 62 females (54%) and 53 males (46%). Nearly half of these patients (53%) were in the 61-70-year age group with a mean age of 64 years. One hundred and six (92%) patients had never tried denture adhesive. Most patients (73%) who did not use denture adhesives managed their dentures well, but a significant number 101 (87%) did not know that denture adhesives existed. Nine (8%) had tried denture adhesives, and none of the patients were currently using them. Those who ceased using denture adhesive complained mainly that it did not improve the fit and chewing ability significantly. The outcome of this survey demonstrated that the knowledge of the patients is not enough on denture adhesives in Istanbul as it is still generally believed by the practitioners that the prescription of a denture adhesive is a sign of failure of the dentist.

Congenital eventration of the diaphragm in children: 25 years' experience in three pediatric surgery centers.

Eventration of the diaphragm is generally defined as an abnormal elevation of all or a portion of an attenuated but otherwise intact diaphragmatic leaf. Previous studies have indicated that eventration is a relatively rare condition, which can be symptomatic and requires surgery. We aimed to evaluate our patients with diaphragmatic eventration, and to discuss their characteristics in the light of the relevant literature. We retrospectively analyzed age, sex, incidence, location of the eventration, symptoms, associated anomalies, surgical technique, complications and survival in our patients. Between 1974 and 1999, 33 patients were treated in the Pediatric Surgery Departments of Ege University, SSK Children's Hospital and Behçet Uz Children's Hospital, 18 of them boys and 15 girls. The ages of our patients ranged from three days to 12 years. All of the patients had at least one of the respiratory symptoms such as cough, respiratory distress and fever; 3 newborns were admitted with severe respiratory distress while children belonging to higher age groups had symptoms of acute or recurrent pulmonary infections and failure to thrive. The eventration was right-sided in 22, 11 eventrations were left-sided. Diagnosis was performed with the help of a number of radiological studies such as fluoroscopic investigation, contrast study of the upper gastrointestinal system, direct X-ray graphies of the thorax, CT scan and ultrasonography, as necessary. Surgery was performed via thoracotomy in 20 patients and the 12 other patients underwent laparotomy for plication. One patient underwent thoracoabdominal plication. Two patients died because of cardio-respiratory complications in the early postoperative period and the rest of them survived to annual follow-ups. In conclusion, diaphragmatic eventration is an important condition which can eventually be mortal. Early diagnosis is necessary and plication is the treatment of choice.

Oral hygiene habits, denture cleanliness, presence of yeasts and stomatitis in elderly people.

The purpose of this study was to determine oral hygiene habits, denture cleanliness, presence of yeasts and denture stomatitis in elderly people. Seventy complete denture wearers were investigated clinically and mycologically. Subjects were evaluated according to, presence of denture stomatitis, presence of yeasts, denture cleanliness, frequency of denture brushing and denture cleaning methods. Swabs were taken from the palate investigated mycologically in order to identify the yeast colonies. No statistical relationship was found between denture stomatitis and frequency of denture brushing and denture cleaning methods. However, there was a statistically significant relationship between denture stomatitis, yeasts' presence and denture cleanliness.

Dental caries prevalence, tooth brushing and periodontal status in 150 young people in Istanbul: a pilot study.

OBJECTIVE: To evaluate periodontal conditions, prevalence and determination of dental caries and oral health behaviours in a group of young people in Istanbul. DESIGN: Subjects were orally examined and questioned. SETTING: A high school in Istanbul. SUBJECTS: One hundred of fifty students. RESULTS: This study showed that 28 per cent of teenagers had adequate oral hygiene. These findings suggest that 72 per cent of the subjects needed oral hygiene education and required restorative dental care. CONCLUSIONS: The present study showed that dental treatment need is very high in the sample group. Strong co-operation should be set up between families, schools, communities, regulators and legislators in order to develop and implement comprehensive oral health promotion programmes.

The effect of intraperitoneal paclitaxel administration on colonic anastomosis.

BACKGROUND/AIMS: The effect of intraperitoneal administration of chemotherapeutic agents on colonic anastomosis are still under investigation. In this study the effects of intraperitoneally administered paclitaxel on rat colonic anastomosis was investigated. METHODOLOGY: After colonic anastomosis, 3 mL of isotonic saline was administered intraperitoneally to rats in control group (Group 1, n = 20). The study group (Group 2, n = 20), paclitaxel 3 mg/kg diluted with isotonic saline was administered intraperitoneally after colonic anastomosis. Rats were sacrificed on 14th day and mean body weight, mean anastomosis bursting pressure and the histopathology of the anastomosis site of the two groups were compared. RESULTS: Mean body weight was approximately the same with the preoperative values at 14th day in both groups. Anastomosis bursting pressure in paclitaxel group (127 +/- 3 mm Hg) was found to be similar to control group (133 +/- 5 mm Hg) (P > 0.05). Mucosal layer formation in the anastomosis line was complete on the 14th day in both groups. CONCLUSIONS: As a result intraperitoneal paclitaxel administration was found to be safe as it did not reduce the anastomotic strength and not delay wound healing.

Comparison of the effects of various anticancer agents on intestinal anastomosis after intraperitoneal administration.

In this study, the effects of intraperitoneal 5-fluorouracil (5-FU), cisplatinum (Cis), adriamycin (Adr), and methotrexate (MTX) administration on rat intestinal anastomosis were compared. Cis and MTX led to significant weight loss in the first 5 days compared with the control group. Within 14 days all rats except the MTX group nearly reached their preoperative weight. No remarkable weight loss or systemic toxicity was observed among the 5-FU and Adr groups. The anastomosis bursting pressure (ABP) at 1 week was significantly lower than that of the control group (P < 0.01 and P < 0.005, respectively). On day 14 the anastomosis bursting pressure in the Cis group was similar to that of the control group but was significantly lower in the MTX group (P < 0.002). Histopathologically, MTX avoided the development of a mucosal layer at the anastomosis site and led to ulcer formation in some of the rats. The ABPs at 7 and 14 days were similar to those in the control group. Neither of the agents had any significant mechanical or histopathologic adverse effects on anastomosis. According to the results of our study, MTX impaired the healing of the anastomosis, and we thus conclude that the intraperitoneal administration of this agent is not safe. On the other hand, Cis showed a detrimental effect on the anastomosis, particularly in the early phase, but this effect disappeared in the late phase. Cis thus should not be administered in the early postoperative phase. As a result, 5-FU and Adr were found to be the safest agents as they did not delay wound healing and did not reduce the anastomotic strength.

The use of a stent-resin-bonded splint combination to stabilize a free gingival autograft.

This article describes the use of a resin-bonded retainer in combination with an acrylic resin stent to stabilize a free gingival graft. This retainer also prevents migration of muscle attachment after surgery to deepen a section of the vestibule where the oral mucosa closely approached the gingival margin. The acrylic resin stent is attached to the resin-bonded retainer by means of an integrally cast metal framework. After surgery, the retainer is attached to the occlusal two thirds of the buccal surfaces of maxillary molar teeth by using the acid-etched resin bonding technique. The stent effectively retains the graft, is simple to fit, and does not cause any permanent damage to the enamel. It has none of the disadvantages of conventional removable acrylic resin stents.

Hydatid cyst of the pancreas: a case report with 5 years' follow-up.

Primary hydatid disease of the pancreas is rare. The authors report a 3-year-old girl who had a cystic mass in the head of the pancreas with no other viscera involved. At laparatomy the entire endocyst was totally extracted from the surrounding pancreatic parenchyma. The postoperative course was uneventful. She is currently disease-free with a follow-up of 5 years. Only four other pediatric cases have been reported in the English literature.

The use of polytetrafluoroethylene (Gore-Tex) grafts in reconstruction of the urinary bladder.

The safety and histopathologic effects of polytetrafluoroethylene (Gore-Tex) grafts in reconstruction of the urinary bladder were examined. Following partial excision of the bladder Gore-Tex was placed, and the rats were sacrificed at days 7, 14 and 30. Gore-Tex did not cause urine infection, and there was no peritonitis or sepsis in any of the rats. Inflammation around the Gore-Tex diminished after four weeks. Some mononuclear cells and exudate were observed on the inner surface of the Gore-Tex. There was no inflammation or fibrosis in the mucosa and muscular layers of the remaining bladder. In this study the Gore-Tex graft was found to be an infection resistant, urine impermeable material, with no adverse effects on the urinary bladder. Gore-Tex is suggested as a safe material for the reconstruction of the urinary bladder.

Congenital prepubic sinus: possible variant of dorsal urethral duplication.

Congenital prepubic sinus is a rare anomaly of the urinary tract. There have been few cases in the literature since the first report by Campbell et al in 1987. We present three male cases with this anomaly.