Evaluating patient outcomes in postoperative pain management according to the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R).

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.

Environmental exposure in the etiology of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.

PURPOSE: To investigate the occupational and environmental factors in the etiology of infantile hypertrophic pyloric stenosis (IHPS). METHODS: Protocol was drafted according to the PRISMA guidelines and registered on PROSPERO (CRD42020152460). A search for a combination of terms related to IHPS, fetus and neonates, and environmental exposure was performed for studies published between 2000 and 2020 in the EMBASE, Pubmed, and MEDLINE databases. RESULTS: Overall, 2203 abstracts were identified and 829 were screened. The full text of the selected articles (N = 98) was assessed for eligibility. Fifteen studies were included in quantitative synthesis. IHPS risk was significantly lower in black and Hispanic mothers than in white mothers [OR 0.47 (95% CI 0.44-0.51, p < 0.001), OR 0.85 (95% CI 0.77-0.94, p = 0.002), respectively]. Lower maternal education level and maternal smoking were risk factor for IHPS. We further observed a non-significant association between maternal folic acid usage and IHPS risk. Data were insufficient to evaluate occupational exposure. CONCLUSION: This review provides an understanding of the role of environmental exposures in IHPS etiology. Lower maternal educational level, maternal smoking, and white ethnicity are associated with a significantly increased risk of IHPS, while folic acid use seems non-significantly associated with IHPS risk. LEVEL OF EVIDENCE: III.

The cause of dysphagia in patients with esophageal atresia: a systematic review and meta-analysis.

PURPOSE: Dysphagia is the most common symptom in patients with esophageal atresia (EA) of all ages. There is no study addressing the direct relation between dysphagia and surgical results. Therefore, a systematic review was performed to define the relationship between surgical complications and dysphagia in patients with EA. METHODS: The systematic review was drafted under PRISMA guidelines. Systematic literature search was performed for the period 2000 (Jan) to 2019 (Dec)-20 years-in the databases: MEDLINE, EMBASE, and PubMed. Statistical analysis was performed using Comprehensive Meta-Analysis Version 3.0 software. RESULTS: Among 767 articles, 486 abstracts were screened for the inclusion criteria. The full-texts of 64 articles were assessed for eligibility. The sub-group analysis could be performed in 4 articles for anastomotic strictures. Heterogeneity was calculated by I2 statistic as 18,487 and pooled odds ratio was measured under the fixed effect model (Q = 3.68; P = 0.298, I2 = 18,487). There was no significant relationship with an odds ratio of 1.37 between anastomotic stricture (AS) and dysphagia (95% CI 0.631-2.973, p = 0.426). There was no publication bias for the data (Begg's test, p = 0.496; Egger's tests, p = 0.335). CONCLUSION: This meta-analysis did not reveal a significant relationship between AS and dysphagia in children with EA. Since many other factors contribute to dysphagia, comprehensive variable information such as detailed standardized registry systems for rare diseases for pooling analysis is needed regarding other potential factors including surgical complications.

Effects of Transcutaneous Electrical Nerve Stimulation on Mastectomy Pain, Patient Satisfaction, and Patient Outcomes.

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.

Further defining the clinical and molecular spectrum of acromesomelic dysplasia type maroteaux: a Turkish tertiary center experience.

Acromesomelic dysplasia type Maroteaux (AMDM, OMIM #602875) is an autosomal recessive disorder characterized by severe short stature, shortened middle and distal segments of the limbs, redundant skin of fingers, radial head subluxation or dislocation, large great toes and cranium, and normal intelligence. Only the skeletal system appears to be consistently affected. AMDM is caused by biallelic loss-of-function variants in the natriuretic peptide receptor B (NPRB or NPR2, OMIM #108961) which is involved in endochondral ossification and longitudinal growth of limbs and vertebrae. In this study, we investigated 26 AMDM patients from 22 unrelated families and revealed their genetic etiology in 20 families, via Sanger sequencing or exome sequencing. A total of 22 distinct variants in NPR2 (14 missense, 5 nonsense, 2 intronic, and 1 one-amino acid deletion) were detected, among which 15 were novel. They were in homozygous states in 19 patients and in compound heterozygous states in four patients. Parents with heterozygous NPR2 variants were significantly shorter than the control. Extra-skeletal abnormalities, including global developmental delay/intellectual disability, nephrolithiasis, renal cyst, and oligodontia were noted in the patient cohort. The high parental consanguinity rate might have contributed to these findings, probably associated with other gene variants. This study represents the largest cohort of AMDM from Turkey and regional countries and further expands the molecular and clinical spectrum of AMDM.

Eating disorders and needs of disabled children at primary school.

AIM: The aim of this study was to provide current information on the eating disorders, needs and confronted problems of children with disabilities during their school hours at primary schools. BACKGROUND: Eating disorders and needs of disabled children are important in their participation in school life, cognition, and academic achievement. RESULTS: In this study, It was aimed to reach all children with disabilities attending at 72 primary schools located in low, medium and high socio-economic districts in Ankara, capital of Turkey; 404 parents voluntarly accepted to participate in the study. This study has revealed that students with disabilities experienced eating disorders such as forget to eat foods at feeding time, cannot go to canteen to buy food, have sucking and/or chewing problems, lack of self-care skills and need support while eating at schools. The percentage of children who had breakfast at school was 18.1%. The percentage of those who indicated that their child had lunch at school was 59.0%. The children from low socio-economic district had the highest percentage of adequate nutrition at schools in the last week. Families whose children having lack of self-care skills (50.0%), were picky eaters (38.5%), having lack of appetite (42.1%), experienced from constipation frequently (50.0%), have reflux problem (29.0%) considered that their children needed feeding supports at school. CONCLUSION: Families whose children having eating disorders at schools considered that their children needed feeding supports. Fulfilling the needs of children with disability and providing them support as positive discrimination would ensure healthy development and participation in school life and generate positive effects on their academic achievement. The school health policies have to encompass nutritional needs of vulnerable children to benefit from right to education in an adequate and effective manner.

The validity and reliability of the Turkish version of the Body Esteem Scale for Adolescents and Adults (BESAA) for children

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 9­10 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 = 0.57­0.68, 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.

Further expanding the mutational spectrum and investigation of genotype-phenotype correlation in 3M syndrome.

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.

Body image dissatisfaction among school children in Turkey and its potential effect on body esteem.

BACKGROUND: This study aimed to validate the Turkish version of Collins` Body Figure Perceptions and Preferences (BFPP) scale. The second aim of this study was to investigate the relationship between body image dissatisfaction (BID) and body esteem (BE), and between body mass index (BMI) and BID, among Turkish children. METHODS: A descriptive cross-sectional study was conducted among 2066 4th grade children (mean age was 10.06 ± 0.37 years) in Ankara, Turkey. The Feel-Ideal Difference (FID) index from Collins` BFPP was used to assess the degree of BID. FID ranges from -6 to +6, with scores below or above 0 indicating BID. Collins` BFPP`s test-retest reliability was evaluated in a subset of 641 children. The Turkish version of the BE Scale for Adolescents and Adults was used to evaluate the children` BE. RESULTS: More than half of the children were dissatisfied with their own body images (57.8% of girls vs. 42.2% of boys, p < .05). The lowest BE score in both genders was among adolescents who desired to be thinner (p < .01). The criterion-related validity of Collins` BFPP, in relation to BMI and weight, was at an acceptable level in girls (BMI rho= 0.69, weight rho= 0.66) and boys (BMI rho= 0.58, weight rho= 0.57), and was statistically significant in all cases (p < .01). The test-retest reliability coefficients of Collins` BFPP were found to be moderately high for both girls (rho=0.72) and boys (rho=0.70). CONCLUSIONS: Collins` BFPP scale is a reliable and valid tool for Turkish children aged 9-11 years. This study demonstrates that more Turkish girls than boys were dissatisfied with their bodies. Children who were affected by overweight/obesity and underweight had a higher BID than those with a normal weight. It is important to evaluate adolescents` BE and BID in addition to their anthropometric measurements during their regular clinical follow-up.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future.

BACKGROUND: The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. METHODS: Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future'). RESULTS: The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y. CONCLUSIONS: Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

The effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy: A parental perspective.

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.

Evaluation of the predictability of clinical and radiological findings in the diagnosis of malrotation.

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.

Feasibility, Reliability, and Validity of the Turkish Version of the Esophageal-Atresia-Quality-of-Life Questionnaires to Assess Condition-Specific Quality of Life in Children and Adolescents Born with Esophageal Atresia.

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.

Protocol: A systematic review and meta-analysis of the role of fetal and infantile environmental exposure in etiopathogenesis of infantile hypertrophic pyloric stenosis.

Infantile hypertrophic pyloric stenosis (IHPS) is one of the hallmark pediatric surgical diseases. However, its etiology remains incompletely understood. By systematically reviewing the literature, we aim to clarify the effect of the effect of occupational and environmental factors and role of nitric oxide (NO) metabolism in the etiopathogenesis of IHPS. The systematic review is drafted with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). Systematic literature search will be performed for the period 2000 (Jan) to 2020 (Dec) in the databases: MEDLINE, EMBASE, PubMed. The systematic search will cover the literature in English and Turkish language and will be limited to studies on human subjects. Four investigators will independently search the databases (MEDLINE, EMBASE, PubMed) according to the defined search strategy. The full-text of the selected articles will be screened independently by four reviewers, against the inclusion criteria. Descriptive data will be extracted from each study regarding: study details, methods, participants, outcomes and calculations of association for potential further statistical analysis. If meta-analysis could not be undertaken, systematic approach to analyzing the findings of included multiple studies will be described. Heterogeneity will be assessed by quantifying the inconsistency across studies using I2 statistic. Statistical analysis will be performed using Comprehensive Meta-Analysis Version 3.0 software. The p values lower than 0.05 will be considered statistically significant for all analyses.

The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the Turkish Esophageal Atresia Registry.

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.

Information Requirements and Sources of Families of Mainstreaming Students Elementary Education Model in Respect of Socioeconomic Development Levels.

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 Altindag, 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.

The Short Form Health Survey (SF-36): translation and validation study in Afghanistan.

BACKGROUND: Quality of life is defined as the subjective perception of one's own well-being within a sociocultural context. SF-36 is commonly used to check the health status of the general population in many countries. AIMS: To validate the Persian (Dari) version of the Short Form Health Survey (SF-36) in Herat. METHODS: The Persian (Dari) version of SF-36 was culturally adapted. A total of 1259 healthy individuals aged ≥ 18 years participated in the study between November 2016 and April 2017. Construct validity of SF-36 was evaluated through exploratory factor analysis. The extraction was performed by principal component analysis from the polychoric correlation matrix estimated by a 2-step method with varimax rotation. Internal consistency and test-retest reliability were assessed by Cronbach's α SPSS version 23.0 and R version 3.1.3 were used in the analysis. RESULTS: The last version of SF-36 including 27 items in 8 factors explained 86.48% of the variance. The Kaiser-Meyer-Olkin value was 0.391 and Bartlett's test showed statistical significance (P < 0.001). Confirmatory factor analysis revealed that the final model demonstrated good fit statistics (P < 0.001), root mean square error of approximation=0.056, goodness-of-fit index=0.963, and adjusted goodness-of-fit index=0.953). Cronbach's α for the 8 subscales was 0.753-0.933. All subscales of SF-36 had good internal consistency reliability and good test-retest reliability. CONCLUSIONS: We showed that our Dari version of SF-36 is suitable to evaluate quality of life in adults in Herat City. This scale will be useful for health researchers in the future.

New scoring system to predict foreign body aspiration in children.

PURPOSE: To propose a new scoring system to predict foreign body aspiration (FBA) in children. METHODS: Children who underwent bronchoscopy for FBA were evaluated for age, sex, history of aspiration, physical examination, radiological findings and results of bronchoscopy retrospectively. A new proposed FBA scoring including statements about history, physical and radiological findings were applied to all patients to define a total score. The results of each statement and total FBA score were compared according to bronchoscopy findings. The sensitivity and specificity of FBA score and cut-off values of total FBA score to predict positive cases were evaluated. RESULTS: Totally 720 patients with a male to female ratio of 227:133 were included. FBA was noted in 52.1% (n=375) of cases. When the scoring system compared with the existence of foreign body (FB), the patient history had no statistical significance to predict positive cases (p>0.05). The existence of FB was significantly associated with physical examination, radiological findings and total FBA score (p<0.001). The revised scoring system without history parameters had range of total scores 0 to 5. The total scores were obtained by sum of physical findings and radiological parameters and the cut-off value of 2 had the highest diagnostic performance with sensitivity and specificity of 77.9% and 74.8% to predict FBA in children. CONCLUSION: Our results suggest that the proposed scoring system can be utilized to predict FBA in children. The total score higher than 2 is predictive for FBA. Although, physical and radiologic findings are strong parameters for positive bronchoscopy, the history of FBA has no diagnostic utility. LEVEL OF EVIDENCE: Level III (retrospective comparative study) STUDY TYPE: Diagnostic study.

Challenges in management and prognosis of pediatric intestinal pseudo-obstruction.

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.

Prevalence of childhood obesity and related parental factors across socioeconomic strata in Ankara, Turkey.

BACKGROUND: Among low- and middle-income nations, the highest prevalence of child overweight and associated metabolic disorders has been found in Middle Eastern and Eastern European countries. Obesity has been on the rise in Turkey and past research has shown regional variations among adults. However, the prevalence of childhood obesity in different socioeconomic groups in the largest metropolitan areas in the country has not been reported. AIMS: This study aimed to investigate the prevalence of child obesity with a population-representative, SES-stratified random sample with objective measures of body mass index (BMI) in the capital city of Turkey. METHODS: Weight status was measured by the WHO growth curve and analyzed by socioeconomic status (SES), sex, and parental factors in a population-representative sample of 2066 parent-child dyads. Chi-square and logistic regression were conducted. RESULTS: Rates of overweight and obesity were 21.2% and 14.6% (35.8% combined) but significantly higher in high (24.5% and 18.9%) vs. low SES (20.1% and 13.8%) (P = 0.02). Boys were at higher risk for obesity than girls, especially in high vs. low SES (Odds Ratio [OR] = 3.0 [95% CI: 1.4-6.5] vs. 1.7 [95% CI: 1.2-2.5]). Having both parents being overweight or obese increased the risk for obesity, particularly in medium and high SES (OR = 5.8 [95% CI: 2.3-14.1]) and 6.3 (95% CI: 1.5-26.2). CONCLUSIONS: Higher maternal education was a risk factor in low-to-medium but not high SES. In Ankara, child overweight and obesity appears to be 1.5 times more prevalent than national estimates. Higher SES may signify greater exposure to an obesogenic environment and greater obesity risk.