The diagnostic value of ischaemia-modified albumin in acute abdominal pain.

AIM: The differential diagnosis of paediatric patients admitted to the emergency department presenting with acute abdominal pain may be difficult. This study aims to investigate the diagnostic value of ischaemia-modified albumin (IMA) in the differential diagnosis of acute abdominal pain in children and in distinguishing surgical from non-surgical cases. METHODS: The study was conducted with a total of 152 subjects who provided informed consent, including 112 patients admitted to the paediatric emergency department and paediatric surgical clinic and 40 healthy control subjects. Blood samples were collected after initial examination to determine IMA, white blood cell (WBC) and C-reactive protein (CRP) values. RESULTS: Mean IMA values of patients with acute appendicitis (AA), perforated appendicitis (PA) and non-specific abdominal pain were significantly higher compared to the control group. Mean IMA values of the AA and PA cases were also significantly higher compared to the group with non-specific abdominal pain. No significant difference was determined in mean IMA between the AA and PA groups. WBC and CRP levels of the AA and PA groups were significantly higher compared to the group with non-specific abdominal pain. CONCLUSION: Our study shows that IMA, together with WBC and CRP, may be a biomarker capable of assisting the differential diagnosis of acute abdominal pain in children and distinguishing surgical from non-surgical cases.

Mortality risk factors in war-related pediatric burns: A comparative study among two distinct populations.

INTRODUCTION: Previously, the majority of wars were fought on remote battlefields between opposing armies due to conflicts preventing civilians from sustaining war-related burn injuries (WRBI). In recent years, WRBI has had a tremendous harmful impact on the pediatric population. This study aimed to investigate the demographics, causes, mechanisms of burns, surgical procedures, the major and minor risk factors affecting mortality, and outcomes of pediatric WRBI amidst the Syrian refugees and the Turkey neighborhood population, treated at our Burn Center. METHODS: Out of the 852 filled records, the retrospective cohort was performed with inclusion of 707 pediatric burn patients, 469 Turkey, and 238 Syrian participants, with age 0-17 years. Included in the study were patients admitted to our institution from December 2013 to May 2016, with at least 12 months of consistent follow-up. Independent variables of each patient collected data included age, gender, weight, ethnicity, locations patients coming from, season and reason of burn, type of burn, grade of burn, burnt body regions, total body surface area (TBSA), body surface area (BSA), burnt surface area (BuSA), time delay until admission, and presence of infection at time of admission. The dependent variables were hospitalization periods, surgical procedures of escharotomy, fasciotomy, and grafting, recorded final patient status, and mortality. RESULTS: Syrian children with WRBI (direct-blastic, indirect-unintentional) suffered from higher BSA (mean=0.91m2, p=0.001) than the Turkish children with non-intentional burns (0.89m2, p=0.001), P=0.001. There was a significant relationship between causes of burns, such as hot liquids, fire/flames and blastic injuries among the Syrian (52.9%, 27.3%, p=0.000) and the Turkish (86.4%, 7.6% P=0.000) populations, respectively. Although most of the Turkey residents suffered more from hot liquid burns than the Syrians (86.4% vs 52.9%), the majority of mortality occurred with fire/flames and blastic injuries, which was higher among the Syrians (10.10%, p=0.001) than the Turkish (2.80% p=0.001). Mortality corresponded with complex and third-degree burns, ranking higher in the Syrian (100%) than in the Turkish (23.3%), which, in turn, related to hospital length of stay (Syrian mean: 9.79, p=0.001; Turkish mean: 7.83, p=0.839). CONCLUSION: Our analysis showed that flame/fire and blast burns were severe and fatal in more pediatric Syrian victims than the Turkey residents due to the severity of war inflicted burned wounds, the living conditions at the refugee camps, and the tent cities. Our present study is significant as our data would alert authorities to predict pediatric WRBI risk factors, burn survivals and casualties, and thus plan strategies to promote training programs for burn management of two distinct populations to reduce risk factors of burn mortality. Burnt surface area (BuSA) is a new parameter we derived to predict mortality risk factors in WRBI.

The Diagnostic Value of Irisin in Pediatric Patients with Acute Abdominal Pain.

OBJECTIVES: Diagnosis of pediatric patients presenting to the Emergency Department with acute abdominal pain is not always easy. The purpose of this study was to investigate the effectiveness of irisin, a peptide hormone with reactivity shown in the appendix and neutrophils, in the differential diagnosis of pediatric patients with acute abdominal pain. METHODS: 162 subjects consenting to participate, including 112 patients presenting to the Pediatric Emergency and Pediatric Surgery clinics with acute abdominal pain and 50 controls, were enrolled in the study. Blood was collected from all patients following initial examination for irisin, WBC, and CRP investigation. RESULTS: Mean irisin levels in cases of acute appendicitis (AA) and perforated appendicitis (PA) were statistically significantly higher compared to nonspecific abdominal pains and the control group. No statistically significant difference was observed in irisin levels between AA and PA cases. WBC and CRP levels were also significantly higher in cases of AA and PA compared to nonspecific abdominal pains. CONCLUSIONS: Differential diagnosis of acute abdominal pains in children and deciding on surgery are a difficult and complex process. Our study shows that irisin can be a useful biomarker in differentiating AA and PA from other acute abdominal pains in children.

Unusual side effect of cannabis use: acute abdomen due to duodenal perforation.

BACKGROUND: The chronic use of synthetic cannabinoids (SCs) which has become an increasingly prevalent problem can rarely cause gastric and duodenal ulcer because of their effects on gastric secretion and emptying. Since peptic ulcer disease (PUD) is a rarely seen entity in patients who consult to the emergency service with complaints of abdominal pain, most of the physicians do not suspect of this clinical diagnosis. Perforation is a mortal complication of PUD, and early diagnosis and emergency surgery are life-saving procedures. CASE PRESENTATION: A 16-year-old male patient was referred to our emergency service from another center with abdominal distension, complaints of abdominal pain, and bilious vomiting. His medical history revealed that he had been regularly using bonsai for the past 3 years. Plain abdominal radiograms of standing position revealed subdiaphragmatic free air, then we performed laparotomy which disclosed perforation of the first part of the duodenum. Surgical intervention with omental patch and primary closure (Graham patch) was successful. The patient who underwent nasogastric decompression and received antibiotherapy had not experienced any complication during the postoperative follow-up period. CONCLUSION: Herein, as an unusual manifestation, a patient who developed duodenal perforation following chronic SC use has been reported. In adolescent patients admitted with PUD or its complications to the emergency services, it is important to inquire for the use of addictive substances which are increasingly prevalent in order to determine the etiology.

Diagnostic Value of White Blood Cell and C-Reactive Protein in Pediatric Appendicitis.

Background. Acute appendicitis (AA) associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of WBC and CRP in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group. Methods. Appendectomized patient groups were constructed based on the results of histological evaluation. The area under a receiver operating characteristic (ROC) curve (AUC) was performed to examine diagnostic accuracy. Results. When WBC and CRP were used in combination, based on cut-off values of ≥13.1 × 10(3)/µL for WBC counts and ≥1.17 mg/dL for CRP level, diagnostic parameters were as follows: sensitivity, 98.7%; specificity, 71.3%; PPV, 50.6%; NPV, 99.5%; diagnostic accuracy, 77.6%; LR(+), 3.44; LR(-), 0.017. AUC values were 0.845 (95% CI 0.800-0.891) for WBC and 0.887 (95% CI 0.841-0.932) for CRP. Conclusions. For complicated appendicitis, CRP has the highest degree of diagnostic accuracy. The diagnosis of appendicitis should be made primarily based on clinical examination, and obviously more specific and systemic inflammatory markers are needed. Combined use of cut-off values of WBC (≥13100/µL) and CRP (≥1.17 mg/L) yields a higher sensitivity and NPV for the diagnosis of complicated appendicitis.

A Very Rare Cause of Anal Atresia: Currarino Syndrome.

Currarino syndrome (triad) is an extremely rare condition characterized by presacral mass, anorectal malformation, and sacral bone deformation. The complete form of this syndrome displays all three irregularities. Herein, we report a male case who was admitted to our hospital with symptoms of urinary system infection and persistent constipation 2 years after colostomy operation performed with the indication of rectovestibular fistula and anal atresia, diagnosed as Currarino syndrome based on imaging modalities. In a patient who was admitted because of the presence of anal atresia, in order to preclude potential complications, probable concomitancy of this syndrome should not be forgotten. Early diagnosis is important for the prevention of meningitis, urinary tract infections, and malignant change.

Unusual Histopathological Findings in Childhood Appendectomy Specimens.

The purpose of this study was to find the unusual findings in the childhood appendectomy specimens and their incidence. The clinicopathological data of 1,306 patients whose ages ranged from 3 to 16 were retrospectively collected. Histopathological findings in appendectomy specimens taken from patients who had a prediagnosis of appendicitis were obtained. Incidental appendectomies were not included in the research. Unusual findings were reevaluated in the histopathological assessment of appendectomy specimens. The number of patients whose pathological findings are considered unusual is 25 (1.91 %). Nine of the patients were girls and 16 of them were boys. Their ages ranged from 6 to 15. Pathological results revealed that there were 16 (1.22 %) cases of parasitosis, 3 (0.23 %) cases of granulomatosis, 3 (0.23 %) cases of eosinophilic appendicitis, 2 (0.15 %) cases of carcinoid tumors, and 1 (0.08 %) case of appendiceal non-Hodgkin's lymphoma. All patients underwent a standard appendectomy. Uncommon histopathological findings in childhood appendectomy specimens are more common than those in adulthood. This kind of certain unexpected lesions of the appendix may require advanced diagnostics, careful clinical care, follow-up for years, and a multidisciplinary approach. Therefore, histopathological examinations of appendectomy specimens must be performed routinely.