A feasibility study of Online Mellow Bumps: A Turkish pilot study of an online group-based antenatal parenting intervention.

BACKGROUND: As a result of the COVID-19 pandemic, Mellow Parenting proposed online strategies for some of their interventions. One such intervention was Mellow Bumps - becoming Online Mellow Bumps. The objective of this study was to evaluate the implementation of antenatal parenting intervention Mellow Bumps in an online format and determine if this can be done safely and without detriment to pregnant women in Turkey. METHOD: The study used an exploratory study design to investigate routine evaluation data collected pre- and post-intervention. Outcomes were online feasibility, mental health symptoms (depression, anxiety and stress), maternal subjective well-being, perceived quality of relationship with baby, maternal confidence and maternal social connectivity. 128 mums-to-be took part in the intervention between January 2021 and May 2021 from a total of 21 different provinces in Turkey. RESULTS: 57 pre- and post-intervention responses were eligible for analysis. This gives a response rate of 44.5% for evaluation, though the intervention completion rate was high at 89.5%, suggesting the intervention is engaging and accessible. Improvements were found for maternal stress levels, maternal subjective well-being and perceived relationship with baby. Improvements were also found for maternal confidence and maternal social connectivity. CONCLUSIONS: This is the first study to evaluate the antenatal parenting intervention Mellow Bumps in an online format, namely Online Mellow Bumps. The online format makes the programme accessible for at-risk mothers and families, with the potential to continue reaching wider audiences beyond the pandemic who otherwise might struggle to access support. The findings show that the online group can be effective in improving mental health symptoms and mental well-being, supporting expectant mothers before the baby is born. Future research using a control group, a larger and more inclusive sample, and assessing the longer-term effects on parent and child would be beneficial.

Vulnerabilities of Syrian refugee children in Turkey and actions taken for prevention and management in terms of health and wellbeing.

BACKGROUND: The Syrian crisis, which started in March 2011, has resulted in the displacement of 6.3 million refugees predominantly to neighboring countries in addition to the internal displacement of 6.2 million people. Turkey is the country hosting the largest number of refugees in the world with 3.6 million Syrian refugees 46 % of which are under 18 years old. OBJECTIVE: The purpose of this article is to conduct a narrative review and analyze the vulnerabilities of refugee children in Turkey from the lens of the Sustainable Development Goals (SDG), more specifically SDG Goal 3: Good Health and Wellbeing, with a specific focus on Syrian refugee children. Moreover, this article explores the actions taken to prevent and mitigate issues that arise from these vulnerabilities. METHOD: This narrative review article collected data from various primary and secondary sources on the Turkish refugee framework including national and international legislation, governmental and non-governmental data and reports, and scientific papers. RESULTS: Syrian refugee children in Turkey are facing a variety of risks in terms of their health and wellbeing including communicable and non-communicable diseases, post-traumatic stress disorder, depression, family violence, child labor, and child marriage. The measures taken for prevention and response by governmental and non-governmental entities are multilateral and aim to address issues from multiple perspectives including medical, psychosocial, child protection, and legal. CONCLUSIONS: The interventions and restructuring of the health system in Turkey contribute to the SDG number 3 for refugee children. The existence of a legal system which enables refugee access to health, protection, and other social services is key to achieve this goal. However, the existing system could be improved especially through solidifying the legal basis and centralizing the implementation for child and refugee protection. The engagement of all stakeholders to improve the health and wellbeing of refugee children remains vital.

Halofuginone Alleviates Burn-Induced Hepatic and Renal Damage in Rats.

The aim of this study was to evaluate the possible protective effects of halofuginone on burn-induced oxidative injury of the liver and kidney. For the induction of burn, backs of Wistar albino rats were shaved and exposed for 10 seconds to water bath at 90°C, whereas rats in the control group were exposed for 10 seconds at 25°C. Rats were then administered either saline (1 ml/kg) or halofuginone (100 µg/kg/day) intraperitoneally and decapitated at the 24th hour (early burn) or on the 7th day (late burn). Serum concentrations of creatinine, blood urea nitrogen, alanine aminotransferase, and aspartate aminotransferase were determined. Renal and hepatic tissue samples were used for microscopic analysis, and glutathione, malondialdehyde, and myeloperoxidase activity and chemiluminescence levels were measured. Halofuginone treatment improved renal functions in late burn group and hepatic functions in early burn group as demonstrated by decreased serum creatinine, blood urea nitrogen, and alanine aminotransferase levels. Increased serum lactate dehydrogenase level measured in late phase was reduced by halofuginone treatment. Generation of reactive oxygen metabolites measured by chemiluminescence, indicating burn-induced renal and hepatic oxidative injury in both the early and late burn groups, was reduced by halofuginone. Increased hepatic malondialdehyde levels accompanied with high microscopic damage scores were reversed by halofuginone in early burn group, while depleted renal glutathione levels were replenished. The present findings demonstrate that halofuginone preserved renal and hepatic functions and alleviated oxidative tissue damage insulted by burn trauma, suggesting an anti-inflammatory and antioxidant potential for halofuginone in providing protection against burn-induced renal and hepatic injury.

Inguinal Hernia Containing Uterus, Fallopian Tube, and Ovary in a Premature Newborn.

A female infant weighing 2,200 g was delivered at 34 weeks of gestation by vaginal delivery. She presented with an irreducible mass in the left inguinal region at 32 days of age. An ultrasonography (US) was performed and an incarcerated hernia containing uterus, fallopian tube, and ovary was diagnosed preoperatively. Surgery was performed through an inguinal approach; the uterus, fallopian tube, and ovary were found in the hernia sac. High ligation and an additional repair of the internal inguinal ring were performed. Patent processus vaginalis was found during contralateral exploration and also closed. The postoperative course was uneventful. After one year of follow-up, there have been no signs of recurrence.

Comparison of uroflow parameters in children with pure constipation versus constipation plus lower urinary tract symptoms.

OBJECTIVE: The aim of this study was to compare uroflow parameters of patients with pure constipation against those with constipation plus lower urinary tract symptoms (LUTS) and a control group (no constipation). MATERIALS AND METHODS: During August 2012 to March 2014 three groups of patients were enrolled into the study: group C (constipation only), group CL (LUTS plus constipation) and group N (control: no constipation or LUTS). Dysfunctional elimination syndrome (DES) scores, uroflowmetry/electromyography (uroflow-EMG) findings, postvoiding residual urine (PVR) and rectal diameter were measured and compared between groups. RESULTS: Groups C, CL and N comprised 80, 100 and 30 patients, respectively. Average DES scores were 12.6, 18.7 and 4.9, respectively. Voided volume (as a percentage of expected bladder capacity) was 104%, 89% and 101%; and average maximum flow rate was 21.1 ml/s, 36.4 ml/s and 28.1 ml/s, respectively. Pelvic floor muscle activity during voiding was seen in 40.0%, 42.0% and 6.7% of patients in groups C, CL and N, respectively; and pathological PVR was seen in 26.3%, 55.0% and 3.3% of patients in the respective groups. Average rectal diameter was measured as 38.6 mm, 36.4 mm and 28.1 mm in groups C, CL and N, respectively. CONCLUSION: This study found that abnormal voiding parameters are present in patients with constipation even if LUTS are not present. Therefore, it is important that all patients presenting with constipation have their voiding function evaluated.

Comparison of biofeedback therapy in children with treatment-refractory dysfunctional voiding and overactive bladder.

OBJECTIVE: To evaluate and compare the effectiveness of biofeedback therapy (BF) in children with treatment refractory overactive bladder (OAB) and dysfunctional voiding (DV). METHODS: This study was performed between April 2012 and March 2014. Patients with treatment refractory OAB and DV were included. All patients had 3 months of BF. Patients' urologic system symptoms and uroflow parameters before BF and 3 months after BF and response rates were compared. RESULTS: Forty-five patients completed the study. Significant improvement was seen in urinary tract infections, urge incontinence, fractionated voiding, constipation, voided volume, maximum flow rate (Qmax), average flow rate (Qave), and postvoiding residue for patients with DV and in urinary tract infection, frequency, urge incontinence, Qmax, Qave, voiding time, and postvoiding residue for patients with OAB. Overall, better results were observed in patients with DV. CONCLUSION: BF is an effective treatment modality in children with treatment refractory OAB and DV; however, patients with DV show better improvement.

The effect of dorsal dartos flaps on complication rates in hypospadias repair: a randomised prospective study.

AIM: This study prospectively analysed the effect of using a dartos flap on the complication rates of TIPU (tubularised incised plate urethroplasty) in hypospadias repair. MATERIAL AND METHODS: Patients having TIPU repair for hypospadias at our university hospital between January 2010 and August 2013 were prospectively divided into two groups. Group 1 had TIPU repair with dorsal dartos flap, whereas group 2 had flapless repair. At the end of the follow-up period (mean 23.3 m, median 20.2), complication rates were compared between two groups. RESULTS: There were 107 patients in each group. The overall complication rate was 9.3%. The complication rates were 12.1% in group 1 (6 glans dehiscence and 7 fistula) and 6.5% in group 2 (2 glans dehiscence and 5 fistula). The differences between complication rates and fistula were statistically insignificant (p = 0.2511 and p = 0.7710, respectively). CONCLUSION: Our prospective and randomised study found that the use of dartos flaps in hypospadias offers no statistically significant advantage over flapless repair for complication rates.

The effect of untethering on urologic symptoms and urodynamic parameters in children with primary tethered cord syndrome.

OBJECTIVE: To evaluate urinary system symptoms (USSs) and urodynamic parameters (UPs) before and after untethering in children with primary tethered cord syndrome (pTCS). METHODS: USSs and UPs of patients undergoing untethering for pTCS during the period January 2008-July 2012 were evaluated preoperatively and at the postoperative third and 12th months. For analysis, patients were separated into 4 groups according to the presence of USSs: group 1, USSs preoperative positive and postoperative negative; group 2, USSs preoperative positive and postoperative positive; group 3, USSs preoperative negative and postoperative positive; group 4, USSs preoperative negative and postoperative negative. Preoperative and postoperative USSs and UPs were compared. RESULTS: Forty patients (average age, 7.2 years, follow-up of 2.8 years) were included. There were 13 patients in group 1, 11 in group 2, 3 in group 3, and 13 in group 4. All patients showed improvement when preoperative and postoperative USSs and UPs were compared. There was no correlation between USSs and UPs, both preoperatively and postoperatively. USSs and UPs at the postoperative third and 12th months were similar. Patients with no USS showed the most significant improvement in UP after untethering. CONCLUSION: Our study has demonstrated that untethering in patients with pTCS improves urologic symptoms and UPs. However, there is no correlation between improvement in symptoms and urodynamic findings. Urodynamic changes are similar at the postoperative third and 12th months. As the most significant improvement was seen in patients without USSs, it is important that these patients undergo urodynamic studies preoperatively and postoperatively.

Solid pseudopapillary tumor of the pancreas: a rare entity.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm in children that mainly occurs in young females. We herein report a rare case of SPT arising from the tail of the pancreas. A 13-year-old girl was admitted to our clinic with abdominal pain and anorexia. A mass was palpated on the physical examination. A 90x72 mm, encapsulated, heterogeneous mass with solid and cystic components was defined on computerized tomography (CT). Distal pancreatectomy was performed during the operation. Histopathological examination revealed that the tumor was a SPT with negative surgical margins. A six-month follow-up after surgical resection showed no evidence of recurrent disease. SPT should always be considered in the differential diagnosis in a young female with a palpable mass.

Horner's syndrome as a rare complication of tube thoracostomy: case reports and review of literature.

Horner's Syndrome (HS), caused by the interruption of the oculosympathetic pathway, is a rare yet morbid complication of tube thoracostomy. However, literature regarding HS secondary to tube thoracostomy is limited to case reports, with little comprehensive information available. We report two cases and review all cases from the published literature to assess the outcome of this complication. HS secondary to tube thoracostomy leaves sequelae in 45.8% of patients. Immediate removal or repositioning of the tube does not affect prognosis. Therefore, precautions must be taken to avoid this complication.

Foreign body aspiration in children: the value of diagnostic criteria.

OBJECTIVE: Foreign body aspiration (FBA) is a serious problem in children. While bronchoscopy should be performed in all patients with aspiration; patients without aspiration should be carefully excluded to avoid an unnecessary bronchoscopy. In this study we analyzed the details of our series, complication rates and compared the diagnostic findings between patients with an aspirated FB and those without. We also calculated the sensitivities, specificities, positive predictive values and negative predictive values of clinical history, symptoms, physical examination findings and radiological findings in patients with suspected FBA (sFBA). Finally, we evaluated the validity of our bronchoscopy indications in these patients. METHODS: We reviewed the data of 207 patients who underwent rigid bronchoscopy for sFBA. We used clinical history, symptoms, physical examination and radiological findings as diagnostic findings. Complication rates in addition to these four diagnostic criteria constitute our indications for performing a rigid bronchoscopy. RESULTS: After excluding 15 patients with radiopaque FB or previous fiberoptic bronchoscopy, 138 of 192 patients had an aspirated foreign body. The sensitivity and specificity of clinical history, symptoms, physical examination findings and radiological findings were 90.5% and 24.1%, 97.8% and 7.4%, 96.4% and 46.3, and 71.7% and 74.1% respectively. There was only one major complication which caused moderate neurological sequelae. There was no mortality and no thoracotomy or tracheotomy requirement in this group. CONCLUSIONS: While symptoms, physical examination findings and clinical history had high sensitivities, radiological findings had the highest specificity. Low specificities of clinical history, symptoms and physical examination findings were due to our expanded bronchoscopy indication, which aimed to include all patients with foreign body aspiration. Our low complication rate facilitated the expansion of bronchoscopy indications, even for patients with slight clinical suspicion.

Esophageal smooth muscle reactivity is impaired in chronic reflux esophagitis by both receptor- and nonreceptor-mediated mechanisms.

AIM: Esophagitis is associated with an impaired esophageal peristalsis. A few studies have been aimed at understanding the pathophysiology of abnormal peristaltic activity. The mechanism of impaired esophageal smooth muscle reactivity in the chronic gastroesophageal reflux (GER) model is investigated in vitro for the first time. MATERIALS AND METHODS: The chronic GER rat model was created by partial gastric outlet obstruction. The histopathological findings related to esophagitis were evaluated. Smooth muscle strips of the tunica muscularis mucosa of esophagus were studied in standard organ chambers. Carbachol- and KCl-induced contractile responses and serotonin- and papaverine- induced relaxant responses in both reflux and sham-operated control groups were determined. RESULTS: Histopathologically, chronic reflux esophagitis was observed in all specimens of the reflux group. Contractile (carbachol- and KCl-induced) smooth muscle responses were significantly decreased in the reflux group. When compared to control group, relaxant response of smooth muscle to serotonin was also significantly decreased in the reflux group. However, there was no difference in papaverine-induced relaxant responses between 2 groups. CONCLUSIONS: Our study describes the effects of chronic GER on rat esophageal smooth muscle contractility in vitro. We found that both receptor- (carbachol, serotonin) and nonreceptor-mediated (KCl) esophageal smooth muscle reactivity were impaired in chronic reflux esophagitis. These changes may correspond to the functional motor abnormalities of the esophagus seen in patients with chronic reflux esophagitis.

Testicular biopsy during orchidopexy procedure: does it have an adverse effect on fertility?

INTRODUCTION: The aim of this study is to evaluate the effect of the gonadal biopsy procedure on fertility and histology of the experimentally created undescended testis. MATERIALS AND METHODS: Thirty Wistar-Albino rat litters were divided into three groups. In the first two groups, undescended testes were obtained by dividing the right gubernaculum in the first 48 h and the third group constituted the sham group. When the rats were 30 days old, orchidopexy was performed in the first group (O), whereas orchidopexy and testicular biopsy were performed in the second group (OB). After the fertility study all rats were sacrificed at week 11 and testicular weights, mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were measured. RESULTS: One testis in the O group and three testes in the OB group were atrophied and these rats were excluded from the study. Testicular weights, MSTD and MTBS values of the operated side in the O and OB groups were lower than those in the sham group. There was a statistically significant difference between the MSTD values of the ipsilateral testes in the OB group and sham group (p<0.05). MTBS values of the ipsilateral testes in the O and OB groups were <8. There was no difference in all parameters in the contralateral testes between all groups (p>0.05). All the evaluated rats were fertile. While there was no difference in number of fetuses and fertility scores between the O and OB group, however, the differences were significant between each of these groups and the sham group (p<0.05). CONCLUSION: Testicular biopsy in the unilateral undescended testis model results in limited histological changes without affecting the fertility.

Epidermal growth factor and bombesin act synergistically to support intestinal adaptation in rats with massive small bowel resection.

Intestinal adaptation is the most important event in short bowel syndrome following a massive small bowel resection. Effects of various growth factors and their synergism have been well documented in intestinal adaptation. This study aimed to compare the effect of two different trophic agents, epidermal growth factor (EGF) and bombesin (BBS), on intestinal adaptation following massive intestinal resection. Sprague-Dawley male rats were assigned to one of four groups after a 75% small bowel resection. Either EGF (90 microg/kg), BBS (10 microg/kg), EGF+BBS, or bovine serum albumin (BSA) were injected subcutaneously three times a day. The animals were killed 10 days after the operation. Weight loss and morphologic parameters such as mucosal thickness, villus height, crypt depth, villus-to-crypt ratio, and muscularis propria height were measured. In the EGF+BBS group, mucosal thickness was found to be significantly increased compared with the other study groups (p<0.05). Similarly, villus height was significantly increased only in the EGF+BBS group (p<0.05). In the BBS group, both villus height and mucosal thickness showed a slight increase, but the values were not statistically significant compared with the vehicle-treated group. There were no significant differences in any of the remaining parameters between the groups. The results of this study indicate that the gut hormones EGF and BBS act synergistically in facilitating the adaptive response of the remnant ileum to massive intestinal resection.

Effects of Stamm gastrostomy on gastric emptying rate in rats.

AIM: Although frequency of gastroesophageal reflux (GER) increases after gastrostomy, the role of gastric emptying in GER has not been evaluated. In this study, we examined the effects of Stamm gastrostomy on gastric emptying rate in rats and whether Stamm gastrostomy induces GER or not. METHODS: Sprague-Dawley rats were divided into three groups. Stamm gastrostomy was done in the first group (SG). Sham operation was carried out in group 2 and the 3rd group served as control. Gastric emptying was assessed using both liquid and solid meals in each group at postoperative 14th day. For solid meal emptying, after fasting of 16 h, the rats were fed for 3 h and gastric emptying rate was measured at the fifth hour. Methylcellulose was used for emptying of liquids and it was given after the animals were fasted for 16 h and gastric emptying rate was measured 30 min later. Histological evaluation for GER was performed in all groups. RESULTS: GER was observed pathophysiologically in 5 of the 7 rats in SG group. Gastric emptying rates of liquid and solid meals were found to be similar in control, SG or sham groups. CONCLUSION: Surgical gastrostomy does not affect the gastric emptying of solid and liquid meals in rats. Other mechanisms should be considered in the development of GER observed following gastrostomy.

The roles of free oxygen radicals, nitric oxide, and endothelin in caustic injury of rat esophagus.

PURPOSE: The authors aimed to find out the roles of free oxygen radicals, nitric oxide (NO), and endothelin (ET) in caustic injury of rat esophagus. METHODS: Forty-five Wistar albino rats were used to form 6 groups. The study groups are summarized as 1, sham (S; n = 7); 2, sham + L-arginine (SA; n = 7); 3, sham + L-NAME (SN; n = 7); 4, injury (I; n = 8); 5, injury + L-arginine (IA; n = 8); 6, injury + L-NAME (IN; n = 8). Normal saline in the sham groups and 50% NaOH in the caustic injury groups were administered to the distal esophagus. Free oxygen radicals and NO were detected by chemiluminescence from tissue samples, and they were correlated with histologic examinations. Tissue ET was measured also with immunohistochemistry. RESULTS: The injury was verified histologically. Free oxygen radical levels were found to be increased as well as NO and ET with the caustic injury (P <.05). L-arginine caused a histologic increase in the injury that was close to statistical significance (P =.08). L-NAME showed no significant effect. CONCLUSIONS: Free radicals, NO, and ET increase in the early phase of caustic esophageal injury. Understanding their early interactions during the caustic injury may help in future therapeutic strategies.

Effects of hyperbaric oxygen therapy on caustic esophageal injury in rats.

BACKGROUND/PURPOSE: Caustic esophageal burn is a serious problem in pediatric surgery. Even though many clinical and experimental studies had been performed, the complication rate could not be reduced to a satisfying level. In this study, the authors evaluated the effects of hyperbaric oxygen (HBO) therapy in caustic esophageal burn in rats. METHODS: Rats were divided into 4 groups, and caustic burn at the distal esophagus was created by applying 50% NaOH for 3 minutes in all groups. The first and third groups did not receive HBO therapy. HBO therapy was applied to the second group for 2 days and to the fourth group for 28 days. To evaluate the effects of short-term HBO therapy, the first 2 groups were compared for ulceration, inflammation, and submucosal vascular thrombosis after 2 days. The third and fourth groups were compared for the long-term effects of HBO therapy. Rats in these groups were killed after 28 days and compared for the collagen content, weight, and mortality rate. RESULTS: In the second group, which received 2 days of HBO therapy, ulcer depth and vascular thrombosis were significantly lower than these in the first group (P =.022 and P =.020, respectively). The fourth group, which received 4 weeks of HBO therapy, had a significantly reduced mortality rate, weight loss, and collagen score and hydroxyproline level if compared with the third group (P =.035; P =.016; P =.028; and P =.033, respectively). CONCLUSIONS: These results indicate that HBO therapy is useful in caustic esophageal burn both in short-term and long-term use.

[Foreign body aspiration in children]. / Cocuklarda yabanci cisim aspirasyonu.

OBJECTIVES: The aim of this study was to present the demographic data of our patients who underwent bronchoscopy for suspected aspiration of a foreign body. We also assessed the sensitivity and specificity of history, symptoms, physical examination, and radiological findings in these patients. PATIENTS AND METHODS: One-hundred and two patients underwent bronchoscopy for suspected foreign body aspiration during a 23-month period. Bronchoscopy was performed under general anesthesia with a rigid bronchoscope. RESULTS: A foreign body was detected in 78 patients. The male-to-female ratio was 1.7:1, the mean age was 30.4 months, and the median age was 18 months. Nut and sunflower seeds were the most common types of foreign bodies. There were three minor complications and no death in our series. No tracheotomy or thoracotomy were required. The sensitivity and specificity of history, symptoms, physical examination, and radiological findings for suspected foreign body aspiration were 100% and 4.2%, 97.4% and 8.4%, 89.7% and 37.5%, 76.8% and 50%, respectively. CONCLUSION: A chocking crisis is an absolute indication for bronchoscopy. Our low complication rate allowed us to perform bronchoscopy more liberally in patients with suspected foreign body aspiration. The sensitivity of history, symptoms, and physical findings were very high, whereas the specificity of history and symptoms were very low.

Epididymitis in infants with anorectal malformation.

OBJECTIVE: To document the characteristics of epididymitis in boys with anorectal malformations. METHODS: Sixty-six boys with anorectal malformation were treated between January 1990 and January 2000, in our center. Four of these boys experienced epididymitis attacks. The first three patients had rectourinary fistula and the fourth had a low type anorectal malforation without a rectourinary fistula. RESULTS: Patients were followed up for seven to nine years and epididymitis did not recur after the definitive operation in the first three patients. The fourth patient had four other episodes of epididymitis postoperatively and no reason for these episodes could be found during the further urological evaluation. Two patients had urinary tract infection and one patient had urinary tract contamination during their episodes of epididymitis. CONCLUSION: The cause of the epididymitis can be anorectal malformation with rectourethral fistula itself or another urogenital anomaly that is associated with anorectal malformation. There is a relationship between urinary tract infection and epididymitis in these patients.

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula.

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children.