BACKGROUND:In the first 24 h after surgery, it is necessary to evaluate the patient responses to pain, analgesia and patient satisfaction to prevent complications related to the pain management process. AIM:To evaluate patients' outcomes (pain qualities, side effects of the pain management, pain treatment satisfaction, non-pharmacological pain treatment methods, predictors of pain management satisfaction and percentage of pain relief) according to the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) in the first 24 h. DESIGN:Cross-sectional study. METHODS:The study sample was comprised of 700 patients, who were surgically treated at the surgical clinics of a university hospital and completed the first postoperative 24 h. The data was collected through the "Patient Information Form" and the "Turkish version of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R)". RESULTS:The medians of the lowest and the worst postoperative pain severity level were 3.0 and 7.0, respectively. Patients experienced severe pain in 60 % of the first postoperative 24 h and reported that 70 % of their pain eventually decreased. A positive and significant correlation was found between pain interference, pain-affected mood/emotions, the severity of pain-related side effects, the least and worst pain severity levels and severe pain, and the percentage of time experienced with severe pain. CONCLUSIONS:Most of the patients experienced severe pain, which restricted their daily life activities and led to negative emotions. Acute postoperative pain may negatively affect patient outcomes and delay postoperative recovery during the early period. Therefore, pain should be managed in the early period to prevent physical and psychological side effects.

PURPOSE:Mastectomy is one of the most painful surgical procedures. Postoperative pain guidelines recommend transcutaneous electrical nerve stimulation (TENS) as a reliable non-pharmacological analgesic method. The aim of this study was to investigate the effects of TENS on postoperative pain and outcomes in patients undergoing modified radical mastectomy (MRM).DESIGN:A single-center, single-blind, prospective, randomized-controlled study.METHODS:This single-center, single-blind, randomized-controlled study included a total of 80 patients who underwent MRM at general surgery clinic of a tertiary center were included. The pain management of the patient outcomes were evaluated using the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR).FINDINGS:The pain levels of the intervention group were lower than the control group. There were significant improvements in the patient outcomes such as mobilization, position, sleep, anxiety, and fear in the intervention group.CONCLUSIONS:Our study results suggest that TENS reduces MRM pain. Thus, TENS can be recommended as a useful analgesic method in MRM.

BACKGROUND:To evaluate the predictability of clinical and radiological findings in the diagnosis of malrotation.METHODS:Between 2010 and 2020, children with presumptive diagnosis of malrotation were included. The demographic features, clinical and radiological findings, operative findings and outcome were recorded. The upper gastrointestinal series (UGIS) were evaluated by two radiologists. All parameters were correlated with surgical findings to evaluate the predictability.RESULTS:Seventy patients were included. The presenting symptom was bilious vomiting in 29 cases (41.4%), and atypical symptoms (non-bilious vomiting, food refusal, etc.) in 40 cases (57%). One of the cases (1.6%) was asymptomatic and diagnosed incidentally during UGIS. 52 cases had abdominal X-ray and 14 (26.9%) of them were normal. Doppler ultrasonography (US) (n=20) revealed evidence of malrotation in 13 cases (65%). The location of duodenojejunal junction (DJJ) in UGIS was compatible with malrotation in 33 cases. 48 (61%) cases underwent surgical exploration; 35 cases had malrotation and seven cases had midgut volvulus. Median followup time was one year (0.5-7 years). Volvulus has recurred in one case and another case operated for volvulus died because of short bowel syndrome. The statistical analysis for predictability revealed that bilious vomiting (sensitivity: 57.1%, specificity: 82.1%), Doppler US (sensitivity: 92.3%, specificity: 75%) and right-sided DJJ in UGIS (sensitivity: 96.8%, specificity: 75%) have highest predictability.CONCLUSIONS:The bilious vomiting, Doppler US findings and right-sided DJJ have the highest predictability to confirm the diagnosis. However, presenting with atypical symptoms and having atypical or normal findings in UGIS do not rule out malrotation.

Objective: To investigate the effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy (CP) from a parental perspective. Methods: The study included 209 children with CP aged between 5 and 13 years (mean age, 8.06 +/- 2.41 years; girls, 45.5%) and their parents. Fatigue, gross motor function, and participation status were evaluated with the Pediatric Quality of Life (PedsQL), Gross Motor Function Classification System (GMFCS), and the Assessment of Life Habits (Life-H) questionnaire, respectively. The effects of fatigue, gross motor function, and gender on participation were investigated with linear regression analysis. Results: According to parental reports, 79.9% of the children had fatigue. Children in all GMFCS levels experienced fatigue. Fatigue and GMFCS levels were dependent variables, and therefore only simple linear regression analyses were performed. Fatigue explained 38-43% of the variances in daily activities, social roles, and total Life-H scores, while gross motor function explained 48-65% of the variances in scores (p < 0.001). Gender had no effect on participation scores (p > 0.05). Conclusion: More than two thirds of the school-aged children with CP had fatigue. Fatigue and poor gross motor function had a negative effect on participation in daily activities and social roles. (c) 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

Objective: Coronavirus disease-2019 (COVID-19) is a highly contagious infection whose possible transmission routes are airborne droplets, close contact with an infected person or contaminated surface, blood, or saliva. These possible routes of transmission are closely related to the work conditions of dentists. The present study assessed the anxiety levels of dentists and related factors during the COVID-19 pandemic using the Beck Anxiety Inventory (BAI).Materials and Methods: A questionnaire consisting of 33 questions on the anxiety levels of dentists related to infection COVID-19 was used. The questionnaires were sent to dentists via online platforms. Mann-Whitney U and Kruskal-Wallis tests were used to compare quantitative variables.Results: In total, 260 dentists were included in the study. The median (minimum -maximum) BAI score of participants was 28 (19-75), which displayed moderate anxiety. There was a statistically significant difference between the genders in terms of BAI scores (p < 0.001). No statistically significant difference was found between ages (p=0.79). Of the participants, 64.6% (n=168) stated that the level of income decreased, and 69.2% stated that safe working conditions decreased. Conclusions: During the COVID-19 pandemic, dentists were one of the most affected groups by the pandemic due to dental settings. Gender and the presence of chronic disease were the main factors that negatively affected the anxiety level of dentists. As the developments regarding the pandemic are updated daily, dentists should follow them and update their information through various platforms.

Objective:Uric acid (UA), a known danger signal released from injured cells, is a valuable sign of inflammation. We aimed to evaluate the association of serum UA levels before the start of conditioning regimens with the risk of hepatic sinusoidal obstruction syndrome (SOS) development after hematopoietic stem cell transplantation (HSCT).Materials and Methods:Two hundred and twenty-two children who underwent allogeneic HSCT at the Pediatric BMT Unit of Hacettepe University between 2000 and 2014 were included in this retrospective study. Serum UA levels were measured before conditioning as an indicator of the pre-transplant inflammatory status of the patients. Patients with and without a diagnosis of SOS were compared regarding primary diagnosis, previously described risk factors for SOS, and pre-conditioning serum UA.Results:SOS was diagnosed in 42 patients who had higher pre-conditioning serum UA levels compared to those who did not. Pre-transplant serum creatinine, gamma-glutamyl transferase, bilirubin, ferritin, and C-reactive protein levels did not differ significantly among patients with and without SOS; however, serum albumin was lower in the patients who developed SOS. Receiver operating characteristic analysis revealed that a pre-conditioning UA level higher than 3.32 mg/dL was predictive of SOS. When applied to a multivariate model, only pre-conditioning UA and albumin levels remained significant risk factors for SOS (UA: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.26-5.12, p=0.009; albumin: OR, 0.45, 95% CI, 0.22-0.95, p=0.037).Conclusion:Our results suggest that pre-conditioning serum UA is an independent risk factor for SOS, and it might be used as an early predictor of hepatic SOS together with previously described clinical and laboratory parameters.

BACKGROUND:This study reports the feasibility, validity and reliability of the Turkish versions of the Esophageal-Atresia-Quality-of-Life (EA-QOL) questionnaires, which were originally developed in Sweden and Germany. METHODS:After translation from Swedish to Turkish and cognitive debriefings, 51 families of children aged 2 to 7 years (parent-report, 17-items) and 54 families of children 8 to 17 years (child and parent-report, 24-items) responded to the EA-QOL questionnaires and a validated generic HRQOL-instrument (PedsQL4.0). Medical records of patients and questionnaires were used to obtain clinical data. The Turkish version of the EA-QOL questionnaires were evaluated for feasibility (<5% missing item responses), reliability (internal consistency/retest reliability for 3 weeks) and validity (known-groups/concurrent/convergent). Level of significance was p<0.05. RESULTS:Feasibility of the Turkish version of the EA-QOL questionnaires was good. Internal consistency of all scales was satisfactory, as were the level of agreements of EA-QOL scores between the field- and retest study. Known-group and concurrent validity were achieved since the EA-QOL questionnaires showed that esophageal symptoms and feeding difficulties were negatively associated with EA-QOL total scores in both age specific versions (child-and parent report), and respiratory symptoms in the version for EA children 2 to 7 years (parent-report). A higher number of respiratory symptoms decreased the EA-QOL total scores in both age groups (parent-report, p<0.05). Correlations between the EA-QOL total scores and PedsQL-4.0 total scores supported convergent validity. CONCLUSION:The Turkish version of the EA-QOL questionnaires are feasible, valid and reliable to assess condition-specific HRQOL in EA children.

AIM:Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. METHODS:Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fistula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. RESULTS:Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p < 0.05). The rates of primary anastomosis and tensioned anastomosis were similar in both groups (p > 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the requirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) CONCLUSION: The data in the TEAR demonstrated that preserving the AV during EA repair led to no significant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory complications.

Objective: Purpose of this study is to determine validity and reliability of the Physical Activity Self-efficacy scale for Turkish children (PASSC). Methods: The study was conducted as a methodological epidemiological study in the province of Ankara. The study aimed to reach all fourth grades (9-11 years) in the selected six schools (n=641). Six hundred and seven students participated in the first stage of the study and 499 students in the second (test-retest) which was carried out two weeks later. In the study, personal information form and data collection tool including PASSC were used. The data were analyzed using SPSS 18 and AMOS programmes. Results: Among the children who participated in the first stage of the study; 53.0% were male and 36.2% were from schools with low socioeconomic level. Results from the confirmatory factor analysis for boys showed: p<0.001, chi(2)/sd=2.6, RMSEA=0.07 and GFI=0.95, and for girls: p<0.001, chi(2)/SD =2.4, RMSEA=0.07 and GFI=0.95. The Cronbach's alpha value was determined as 0.84 for boys and 0.81 for girls in the validity and reliability analyzes for the PASSC. The analyzes which were performed for boys and girls seperately led to a model consisting of a single factor with no modification requirement. Conclusion: The PASSC which was adapted into Turkish for boys and girls was a valid and reliable assessment tool.

Background/aim Body esteem (BE) is defined as the self-evaluation of one’s own body or appearance. The Body Esteem Scale for Adolescents and Adults (BESAA) consists of three subscales: BE-appearance, BE-weight, and BE-attribution. Though initially developed for adolescents and adults, the use of the scale has recently increased in health-related research on children. This study aimed to assess the validity and reliability of the Turkish version of the BESAA for children. Materials and methods The participants in the study were 4th grade children (aged 9–10 years) in Ankara, Turkey. The validity of the scale was evaluated through exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability were assessed using Cronbach’s alpha and Spearman’s rho correlation coefficient, respectively. Results The Turkish version of the BESAA for children includes BE-weight, BE-appearance, and BE-attribution subscales. The scale demonstrated good model fit statistics (chi-square/df = 3.41, P < 0.001) and good internal consistency for BE-weight (α = 0.85), BE-appearance (α = 0.76), and BE-attribution (α = 0.69). According to our findings, test-retest reliability of the three subscales was in the moderate/acceptable range for children (r = 0.57–0.68, P < 0.01). Conclusion The Turkish version of the BESAA can be used to measure BE in terms of appearance, weight, and attribution in children.

Aim This research was conducted to reveal the current situation on information requirements of the families of the mainstreaming students and sources they obtained information. Method The research is a cross-sectional study and the population consisted of parents whose children need special education and who are in schools located in Altındağ, Yenimahalle, and Çankaya districts of Ankara, which are at low, middle, and high levels, respectively, according to the socioeconomic development. Sample selection was not made. A survey was distributed to 1,151 families of the mainstreaming students in 72 elementary schools in the selected districts, and 404 questionnaires that had been returned were evaluated. A questionnaire developed by the researchers was used as the data collection form. Results A total of 75.1% of families are mothers and 24.9% are fathers. In total, 26.5% of families stated that they did not have sufficient information about the diagnosis of their child, 64.2% of the families stated that they want to be informed about adaptation to school life, 25.1% about daily life activities, nutrition, and care skills, and 48.2% of families stated that they are not in cooperation with health care professionals, whereas 57.8% of the families who have sufficient information about the diagnosis of the child are in cooperation with health care professionals; this rate was found to be 31.4% in those who do not have information. Among the health care professionals, where families receive information about the diagnosis of the child, physicians are the most frequently received occupational group, with 82.3%. The rate of receiving information from nurses was found to be 3.4%. Conclusion Families of mainstreaming students have need for information regarding the diagnosis of the child. The nurse group has a very low rate among the sources they get information from. It can be said that families do not cooperate adequately with health care professionals.

Background/Aims: Pediatric intestinal pseudo-obstruction (PIPO) is the most severe form of intestinal dysmotility in children. This study aims to present the cases of PIPO to discuss its diagnosis, management, and prognosis. Materials and Methods: We retrospectively analyzed the medical records of the patients with PIPO between 2010 and 2018. Results: A total of 7 patients were included. The admission age was 3 days-10 years. The complaints were abdominal distention and constipation in all the patients. All the patients had passed meconium in the first 48 hours of their life. An upper gastrointestinal (GI) series revealed slow transit in 6 patients and malrotation in 2 patients. Full-thickness rectum biopsies revealed normal ganglion cells. Neurological examination revealed postinfectious pandysautonomy in 1 patient. Furthermore, 2 patients are under follow-up with ileostomy and TPN, 1 patient is with enteral feeding and ileostomy, and 3 patients are stable with pyridostigmine, enemas. Moreover, 1 patient died because of sepsis. The prognosis was not significantly correlated with initial presentation time, lag time, and presence of extraintestinal manifestations (p>0.05). The prognosis was significantly better when fewer number of operations were performed (p=0.029) Conclusion: PIPO is a broad-spectrum disease group that is difficult to diagnose and treat. It is mandatory to rule out the secondary causes of diagnosis. Medical and surgical treatments are used to support the nutritional status, prevent sepsis, and restore the intestinal motility. The prognosis was better when the secondary causes were identified and fewer operations were performed.

3M syndrome is characterized by severe pre- and postnatal growth retardation, typical facial features, and normal intelligence. Homozygous or compound heterozygous mutations in either CUL7, OBSL1, or CCDC8 have been identified in the etiology so far. Clinical and molecular features of 24 patients (23 patients and a fetus) from 19 unrelated families with a clinical diagnosis of 3M syndrome were evaluated and genotype-phenotype correlations were investigated with the use of DNA sequencing, chromosomal microarray, and whole exome sequencing accordingly. A genetic etiology could be established in 20 patients (n = 20/24, 83%). Eleven distinct CUL7 or OBSL1 mutations, among which eight was novel, were identified in 18 patients (n = 18/24, 75%). Ten patients had CUL7 (n = 10/18, 56%) while eight had OBSL1 (n = 8/18, 44%) mutations. Birth weight and height standard deviation scores at admission were significantly (p < 0.05) lower in patients with CUL7 mutation compared to that of patients with OBSL1 mutation. Two patients with a similar phenotype had a de novo 20p13p deletion involving BMP2. No genetic etiology could be established in four patients (n = 4/28, 17%). This study yet represents the largest cohort of 3M syndrome patients from a single center in Turkey. Microdeletions involving BMP2 may cause a phenotype similar to 3M syndrome with some distinctive features. Larger cohort of patients are required to establish genotype-phenotype correlations in 3M syndrome.