Pediatric case of a penetrating lumbar spinal injury.

PURPOSE: Penetrating spinal injuries are generally extremely rare and are seldom encountered in pediatric patients. The non-compliance of pediatric patients with physical examination can sometimes delay diagnosis and treatment. Here, we present a case of a child who had a fall and suffered penetrating spinal trauma due to a small glass fragment. CASE REPORT: A penetrating foreign body was detected in the lumbar spinal region of a 2-year-old patient with complaints of increased restlessness on physical activity followed by difficulty in walking. The patient was operated on and followed up without any complications in the perioperative and late postoperative periods. CONCLUSION: A detailed physical examination is necessitated in the pediatric age group because of insufficient anamnesis. The high number of patients per physician, especially in societies having a low socioeconomic standard, prevents detailed examinations, and unnecessary examinations may cause delays in diagnosis. However, one must note that the skin findings of pediatric patients can be very helpful, especially in pediatric neurosurgery, and examination should not be neglected.

Prevalence and related factors of eating disorders in pregnancy: a systematic review and meta-analysis.

PURPOSE: To reveal the prevalence of eating disorders (EDs) and related factors in pregnancy. METHODS: The search was performed in PubMed, EBSCOhost, Web of Science, Scopus, Google Scholar, and Ovid databases search up to April 3, 2022, using the keywords combination of "(eating disorders OR anorexia nervosa OR bulimia nervosa OR binge eating disorder) AND (pregnancy OR pregnant)". Two researchers independently extracted data from the articles using a standard form. We evaluated the quality of the studies according to the Joanna Briggs Institute assessment tools. RESULTS: The prevalence of EDs in pregnant women in the 11 studies involving 2,369,520 pregnant women was ranging between 0.5 and 10.6%. The prevalence of EDs in pregnant women was 4.3% (95% confidence interval 2%-9%; I2 = 99.5%). The prevalence of anorexia nervosa and binge eating disorder during pregnancy shows a statistically significant increase compared to pre-pregnancy, and the prevalence of bulimia nervosa during pregnancy decreases. The prevalence of EDs is higher in pregnant women under 30 years of age, secondary school graduates, married, and with normal BMI. Half of the pregnant women with EDs had anxiety and about one-third of pregnant women had depression. Excessive exercise is observed in 0.7% of pregnant women, fasting in 0.3%, laxative or diuretic use in 0.1%, and self-induced vomiting in 0.6%. CONCLUSIONS: This study is important as it is the first systematic review and meta-analysis to reveal the global prevalence of EDs in pregnant women and related factors. Continuing routine screening tests to detect EDs during pregnancy may contribute to taking special preventive measures for risk groups and protecting mother-child health. TRIAL REGISTRATION: PROSPERO registration number (CRD42022324721), date of registration: 10/05/2022.

They Are Not All the Same: Defenders of Ethnically Victimized Adolescents.

Developing a comprehensive understanding of adolescents' defending behaviors in peer victimization incidents is crucial, as these behaviors are instrumental in preventing victimization in schools. Despite recent efforts to examine various defender subgroups and their characteristics, the heterogeneity in defending behaviors within the context of ethnic victimization remains unclear. To address this gap in knowledge, the current study examined naturally occurring subgroups of defenders in ethnic victimization incidents and investigated whether these subgroups differ in their socio-cognitive skills, class norms, and social status within peer relationships. The sample included adolescents in Sweden (N = 1065; Mage = 13.12, SD = 0.41; 44.5% females). Cluster analysis yielded four distinct subgroups: victim-oriented defenders (41.3%), hybrid defenders (23.5%), bully-oriented defenders (9.8%), and non-defenders (25.4%). Hybrid and victim-oriented defenders had higher levels of perspective taking skills and positive attitudes toward immigrants than non-defenders. All three defender subgroups perceived their classroom climate as more socially cohesive than non-defenders. All four subgroups did not significantly differ in their peer status. These findings emphasize the importance of fostering inclusive class norms and implementing classroom practices that facilitate the development of perspective taking skills among students. Such effort can enhance adolescents' active defending behaviors in instances of ethnic victimization.

The effect of the information-motivation-behavioral skills (IMB) model variables on orthorexia nervosa behaviors of pregnant women.

PURPOSE: This study aims to test the effect of the components of the Information-Motivation-Behavioral Skills Model on Orthorexia Nervosa (ON) behavior of pregnant women and health outcomes using a hypothetical model. METHODS: The study is cross-sectional research and was carried out with 350 pregnant women who had the Non-Stress Test in the obstetrics outpatient clinic of a university hospital. The participants were selected using the convenience sampling method. The data were collected with a questionnaire. Data were analyzed using the structural equation model. RESULTS: It was found that 26.6% of pregnant women had an ON tendency. High information for obsession with obsession with healthy eating causes more ON behaviors (ß = - 0.25, p < 0.001). The higher motivation for obsession with healthy eating obsession (ß = 0.73, p < 0.01) and a higher tendency to ON behaviors (ß = - 0.16, p < 0.05) are associated with better health outcomes. CONCLUSION: Our findings show that high levels of information and motivation about the obsession with healthy eating effect ON tendency and health outcomes. The findings are significant in that they lead and guide the interventions for the detection, prevention, and treatment of ON during pregnancy. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Determination of ventriculoperitoneal shunt dysfunction using optic nerve sheath diameter measurement on CT scan in pediatric patients with hydrocephalus.

PURPOSE: We aimed to evaluate whether optic nerve sheath diameter (ONSD) measurement by computed tomography (CT) can be a diagnostic criteria for the detection of ventriculoperitoneal shunt dysfunction among children whose fontanels are still open. METHODS: Patients with a ventriculoperitoneal shunt who were currently showing clinical and radiological signs of acute hydrocephalus depending on the shunt dysfunction were included in this study. The study was designed to compare the preoperative and postoperative ONSDs of three groups of patients divided according to their ages: group 1, patients aged < 4 months; group 2, patients aged 4-18 months; and group 3, patients aged > 18 months. RESULTS: We included 138 patients (mean age, 35.18 ± 51.01 months). Among the patients, 46.4% were females and 53.6% were males. ONSD measurements in the preoperative period were < 2.86 ± 0.59 in group 1, 3.93 ± 0.82 in group 2, and 5.40 ± 0.81 in group 3 and those in the postoperative period were 2.02 ± 0.38 in group 1, 2.72 ± 0.62 in group 2, and 3.64 ± 0.81 in group 3. Right, left, and mean ONSDs increased significantly in the three groups and were found to be statistically significant. CONCLUSION: ONSD measurement in CT has been evaluated as an appropriate finding that can be used especially in acute hydrocephalus, when clinical and radiological findings are not diagnostic.

Estimation of bone mineral density with hounsfield unit measurement.

OBJECTIVE: Although dual-energy x-ray absorptiometry (DXA) remains the gold standard for the measurement of bone mineral density (BMD), degenerative spine and spinal instrumentation yields inaccurate results, warranting the need for optional methods. METHODS: Surgical options depend on the BMD of the patients, and to accommodate this need, we compared Hounsfield unit (HU) measurements obtained from computed tomography (CT) scans with the T-scores obtained from DXA scans to inquire whether HU measurements can screen for BMD. In this study, we also evaluated the relationship between body mass index and spontaneous fractures. RESULTS: Based on the findings described in this study, we provide evidence that HU measurements obtained from CT scans can predict BMD. CONCLUSIONS: This, therefore, allows HU measurements to be used as an effective diagnostic method in lieu of DXA scans when deciding on appropriate management of therapy for patients with spinal instrumentation or degenerative spines.

Can the Human Tail Cause Arteriovenous Hemangioma?

INTRODUCTION: "Human tail" is a congenital, benign anomaly in which a protrusion in the lumbosacrococcygeal caudal region is covered with skin. Arteriovenous hemangioma is a benign vascular lesion that may be congenital or acquired. We present a case in which a human tail was present with pathological findings of arteriovenous hemangioma. CASE REPORT: A 6-month-old girl was born with a curved tail-shaped protrusion along her waistline. The distal portion was purple and had a solid consistency; the proximal portion was of normal skin color and had a soft consistency. No other abnormality was observed in the spinal area. Microscopic examination revealed congested, proliferated vascular structures in the fibrous stroma distally located under the multilayered squamous epithelium. In the proximal area, mature lipomatous tissue was observed. The lesion was diagnosed as arteriovenous hemangioma. CONCLUSION: Our patient presented with the classic "human tail" appearance at an early age and in the lumbosacral region. Because of the pathological findings, surgery for the congenital anomaly had to be performed with extra caution.

Pediatric Orbital Roof Intradiploic Meningioma Operated by Eyebrow Incision.

INTRODUCTION: Primary intradiploic meningiomas account for <1% of all osseous calvarial lesions and are categorized as bone tumors. They are frequently observed in the frontotemporal region of the calvarium, anterior cranial fossa, and orbit. We present a case of intradiploic meningioma of the orbital roof, which is rarely observed in the pediatric age-group; it was surgically treated with a unique minimally invasive approach. CASE PRESENTATION: A 16-year-old male with chief complaints of headache on the right side for approximately 1 year was presented to our clinic. Cranial MRI revealed an intradiploic mass with homogeneous, hypointense contrast patterns on the T1W and T2W images of the right orbital roof. A skin incision was made through the right eyebrow, and the frontal sinus anterior wall was opened by craniotomy. Gross total resection was achieved by reaching the tumor present in the orbital roof. The mass was characterized as psammomatous meningioma by a pathological examination. DISCUSSION/CONCLUSION: In cranial oncologic surgery, lesion localization and possible pathological diagnosis are essential for the determination of the correct surgical technique. In particular, in pediatric cases, selecting a method that will reduce the need for transfusion, shorten the surgical time, minimize the chances of facial deformity, and facilitate postoperative care will ensure compliance with the correct and appropriate treatment process.

The Use of Rotterdam CT Score for Prediction of Outcomes in Pediatric Traumatic Brain Injury Patients Admitted to Emergency Service.

INTRODUCTION: Rotterdam CT score for prediction of outcome in traumatic brain injury is widely used for patient evaluation. The data on the assessment of pediatric traumatic brain injury patients with the Rotterdam scale in our country are still limited. In this study, we aimed to evaluate the use of the Rotterdam scale on pediatric trauma patients in our country and assess its relationship with lesion type, location and severity, trauma type, and need for surgery. METHODS: A total of 229 pediatric patients admitted to the emergency service due to head trauma were included in our study. Patients were evaluated in terms of age, gender, Glasgow Coma Scale (GCS), initial and follow-up Rotterdam scale scores, length of stay, presence of other traumas, seizures, antiepileptic drug use, need for surgical necessity, and final outcome. RESULTS: A total of 229 patients were included in the study, and the mean age of the patients was 95.8 months. Of the patients, 87 (38%) were girls and 142 (62%) were boys. Regarding GCS at the time of admission, 59% (n = 135) of the patients had mild (GCS = 13-15), 30.6% (n = 70) had moderate (GCS = 9-12), and 10.5% (n = 24) had severe (GCS < 9) head trauma. The mean Rotterdam scale score was calculated as 1.51 (ranging from 1 to 3) for mild, 2.22 (ranging from 1 to 4) for moderate, and 4.33 (ranging from 2 to 6) for severe head trauma patients. Rotterdam scale score increases significantly as the degree of head injury increases (p < 0.001). DISCUSSION: With the adequate use of GCS and cerebral computed tomography imaging, pediatric patients with a higher risk of mortality and need for surgery can be predicted. We recommend the follow-up of pediatric traumatic brain injury patients with repeated CT scans to observe alterations in Rotterdam CT scores, which may be predictive for the need for surgery and intensive care.

Pediatric Spinal Traumas.

INTRODUCTION: Although childhood trauma is a major cause of morbidity and mortality, the incidence of spinal trauma is significantly lower in children than in adults. Existing studies on pediatric spinal trauma (PST) largely concern cervical trauma because of its frequency of incidence. We aimed to obtain more information by examining all types of spinal trauma, and evaluating factors such as age, trauma type, injury type, and American Spinal Injury Association score and comparing them with data from the literature. METHODS: We retrospectively reviewed 30 pediatric trauma patients with spinal pathology confirmed by spinal imaging. RESULTS: The mean age was 166.4 months. Mean age for each mechanism of injury was: 142.7 months for a simple fall, 149.0 months for injury involving a foreign object, 163.5 months for a fall from a height, and 181.6 months for traffic accidents. There was no statistically significant difference in mean age for different mechanisms of injury (p = 0.372). The levels of the spinal injuries were: lumbar 53.3% (16), thoracic 26.6% (8), and cervical 20.0% (6). Mean age for each level of spinal injury was 113.3 months for the cervical area, 172.2 months for the thoracic area, and 183.3 months for the lumbar area. Mean age was found to be statistically significant (p = 0.000). DISCUSSION: PST is uncommon and the type of trauma and the spinal level affected varies with age. Cervical trauma predominates at younger ages, but adult-like traumas begin to occur with increasing age. It should be considered that the risk of developing neurological deficits is higher in pediatric patients than in adults, and the risk of multisystem injury is also high.

Intracerebral hematoma at the basal ganglia following lumbar puncture.

BACKGROUND: In patients with normal pressure hydrocephalus (NPH), lumbar puncture (LP) is an effective method for assessing both the diagnosis as well as the possible efficacy of ventriculoperitoneal shunting based on symptom improvement. However, it should be considered that there exists a low risk of complications and that these risks may result in morbidity and mortality. We present a patient who developed hematoma in the basal ganglia following LP. CASE DESCRIPTION: A 56-year-old man presented with progressive dementia, ataxia, and urinary incontinence for 8 months. The patient received LP. He had no history of coagulopathy and had NPH findings on cranial magnetic resonance imaging. On the second day after LP, he complained of headache and had left hemiparesis, and intracerebral hematoma was observed at the basal ganglia, posterior to the lentiform nucleus. CONCLUSIONS: Although intracerebral hematoma after LP is one of the rare complications to be more cautious about, particularly in patients with a history of chronic disease or chronic changes in imaging, a history of previous cerebrovascular events and recurrent LPs with probably less cerebrospinal fluid drainage should be planned. Moreover, it should be considered that intracerebral hematoma may develop in patients with clinical deterioration, and good clinical follow-up is required.

Sociodemographic and culture results of paediatric burns.

Paediatric burn wounds are challenging conditions to manage for both the doctors and patients and can cause several complications entailing a complicated treatment and recovery process. This study aims to evaluate sociodemographic conditions and antibiogram culture results of paediatric burn wounds. Our study retrospectively evaluated 419 paediatric patients with burns regarding age, gender, burn area and degree, total days spent in hospital, surgical history, final condition, additional disease history, previous attempts, and culture results with their antibiotic resistances, haemogram results, C-reactive protein results, sociocultural conditions, burned region of the body, and structure of the burn. The prominent observations were an increased rate of incidence in male patients and patients with low socioeconomic conditions, the highest incidence of burns from scalding and domestic accidents, and the highest incidence of third-degree burns. Furthermore, even though the most encountered burn types were extremity burns, the burn types with the highest culture growth ratio were the perineum burns. The dominant culture growth bacterial group was coagulase-negative staphylococcus, and the ratio of medication resistance was 67.8%. It is imperative to raise awareness regarding domestic accidents to prevent paediatric burn wounds. The mortality risk can be reduced by carefully monitoring multiple organ involvement and providing timely treatment. Moreover, appropriate wound care is warranted to avoid infection from skin flora.

Comparison of ependymomas and medulloblastomas located in the posterior cranial fossa: An anatomical and histopathological study.

Posterior fossa tumors (PFTs) include medulloblastomas, atypical teratoid/rhabdoid tumors, pilocytic astrocytomas, ependymomas, and brainstem gliomas. We evaluated patients with surgery at our clinic, comparing epidemiological, clinical, radiological, and pathological characteristics of medulloblastoma and ependymoma to identify factors that might assist preoperative diagnosis, help to develop treatment algorithms, and have prognostic value after surgery. Pediatric patients from 0 to 16 and young adults from 16 to 29 years of age with surgery for pathologically confirmed ependymomas or medulloblastomas between January 2014 and January 2020 were eligible. The study included 19 patients, seven with ependymoma (37%) and 12 with medulloblastoma (63.2%). The ependymoma patients were 5.29 ± 5.85 years of age, the medulloblastoma patients were 11.58 ± 8.17 years of age, and 16 patients (84%) were children.Fifteen patients (79%) presented with signs of increased intracranial pressure and four (21%) presented with cerebellar findings. MRI found that 74% (14) of the PSTs were located in the midline, including six of the seven ependymomas (86%) and eight of the 12 medulloblastomas (67%). Enhancement was significantly greater in medulloblastomas compared with ependymomas (p = 0.022). In according to pathology results; synaptophysin, NSE, chromogranin and 50% GFAP positivity were observed in medulloblastoma. Ependymomas were S100 (43%) and vimentin (29%) positive. Ependymoma patients were younger than medulloblastoma patients and more were female. There were no significant differences in the clinical findings, but ependymomas were larger and had greater rates of enhancement and spinal metastasis compared with medulloblastomas.

Meckel-Gruber Syndrome: A Case Who Lived for 5 Months.

The Meckel-Gruber syndrome is a rare, congenital, and lethal malformation characterized by typical manifestations such as encephalocele, polycystic kidneys, and polydactyly. Herein, we present a case of a patient with the typical triad as well as facial, ocular, liver, and genital abnormalities who lived for almost 5 months.

Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture.

OBJECTIVE: Many studies in the literature related to the investigation of the sensitivity and specificity of ultrasound examinations in lateral malleolar fractures is limited. The aim of this study is to investigate the sensitivity and specificity of ultrasound examinations performed by emergency physicians in fractures who are presented to the emergency department with blunt lateral malleolar trauma. METHOD: Patients over 18years of age who were admitted to the ED with lateral malleolar tenderness were enrolled to this study with convenience sampling. Ultrasonographic examination was performed by emergency physicians. Following the ultrasound examination, a two-sided X-ray was performed. In the case of inconsistency between the US exam and the X-ray evaluated by the emergency physician, a CT was performed on the patients. The X-ray or CT imaging evaluation of an orthopedic surgeon was accepted as the gold standard. RESULTS: A hundred-twenty patients were included in the study. Fractures in the lateral malleolus were detected in 47 patients. The sensitivity of X-ray in the diagnosis of lateral malleolar fractures was 92.8%, (95% CI, 79.4-98.1) and the specificity was 100% (95% CI, 89.5-100), while the sensitivity of US exam was 100% (95% CI, 94.1-100), and the specificity was 93% (95% CI, 85-97.6). X-ray gave false negative results in 3 patients, whereas US gave false positive results in 5 patients. CONCLUSION: In patients admitted to ED with lateral malleolus tenderness, the sensitivity of the ultrasound examination performed by emergency physicians regarding diagnosis of lateral malleolar fracture is higher than X-ray.

Choroid Plexus Papilloma and Factor XIII Deficiency: Case Report.

Factor XIII deficiency is a rare hemorrhagic disorder that can cause spontaneous intracranial hemorrhage and bleeding after surgery. The diagnosis of factor XIII deficiency is difficult before surgical interventions, because coagulation parameters are normal in these patients. Important clinical findings are postsurgical bleeding and recurrent spontaneous intracranial hematomas. These findings should raise the clinical suspicion of factor XIII deficiency. Therefore, diagnosis of factor XIII deficiency is very important for neurologists and neurosurgeons in terms of reducing mortality and morbidity. We present an 8-month-old female patient who developed subdural hematoma after ventriculoperitoneal shunt surgery but not bleeding after choroid plexus papilloma due to FXIII deficiency.

Work stress and obsessive-compulsive symptoms in nurses and office workers: a comparative study.

Objectives. This study aims to compare the work stress and obsessive-compulsive symptoms of nurses and office workers and to determine the relationship between work stress and obsessive-compulsive symptoms.Methods. A total of 127 nurses and 127 office workers participated in the cross-sectional study and comparative study. Data were collected using the perceived work stress scale and the Maudsley obsessive-compulsive inventory.Results. Nurses had higher work stress scores (p = 0.003) in general than office workers. In particular, nurses with a low (p < 0.039) and average (p < 0.007) economic status, nurses who had been employed for 1-10 years (p < 0.001) and nurses working 40 h per week (p < 0.042) had higher work stress scores than office workers. There was no difference (p > 0.05) between obsessive-compulsive symptom scores. There was a positive significant relationship (p < 0.001) between work stress and obsessive-compulsive symptom scores of nurses and office workers. Work stress explains 6.1% of the obsessive-compulsive symptoms in nurses and 12.4% in office workers.Conclusion. The results of this study concluded that work stress of nurses is higher than that of office workers and work stress affects the obsessive-compulsive symptoms in both groups.

The Prognostic Nutritional Index and Mortality in Patients With Ventriculoperitoneal Shunt Infection.

The objective of this study was to investigate the relationship between mortality and the prognostic nutritional index (PNI) in the pediatric patient group with ventriculoperitoneal shunt (VPS) infection. A total of 63 pediatric patients with a VPS infection and positive cerebrospinal fluid (CSF) culture were retrospectively registered. The CSF specimens were analyzed to conduct culture and microscopic evaluation. A total of 44.4% of the cases were men and 55.6% of the cases were women. Patients were divided into 2 groups (survivor and non-survivor patients). When survivor and non-survivor patients were compared, it was found that CSF leukocytes, CSF glucose, CSF protein, CSF/blood glucose ratio, lymphocyte, albumin, and PNI levels were lower in the non-survivor patients' group. Nevertheless, blood glucose and CRP (C-reactive protein) were significantly higher in the non-survivor patients' group than in the survivor patients' group. In our investigation, we suggested that low PNI was related to high mortality in cases of VPS infection.

Reliability and Quality of Online Patient Education Videos for Spina Bifida.

BACKGROUND: There is a growing trend among patients and their families to seek medical information online. Among the world's most popular websites, YouTube is ranked second. Our aim was to assess the reliability and quality of YouTube videos on spina bifida. METHODS: Researchers searched the YouTube platform using 3 search keywords in February 2022. These were spina bifida, spina bifida treatment, and spina bifida surgery. The content of the first 35 videos for each search term was evaluated using the DISCERN scale. Two independent neurosurgeons with 6 years of experience in pediatric neurosurgery evaluated the content of the videos. RESULTS: Of the total 105 videos, 58 met the inclusion criteria and were evaluated. Of these videos, 3 (6.5%) received a score between 3 and4. This suggests that the video is reliable but missing important information. Only one (2.1%) of the videos had a mean score of >4, which refers to a high-quality source of information. It has been found that the popularity of the video was not correlated with whether it was broadcasted by health professionals or whether it has surgical content. The correlation between video popularity and DISCERN score was not significant (P = 0.361/0.401 based on the number of views; P = 0.459/0.606 based on the number of likes). CONCLUSION: Based on the results of this study, patients and their families will generally encounter low-quality educational content on YouTube when searching for information about spina bifida. Since videos on spina bifida are insufficient, we recommend to universities, hospitals, and academic societies publish reliable video education content to support and optimize patient education, in line with approved tools such as DISCERN.