Explanatory variables and nomogram of a clinical prediction model to estimate the risk of caesarean section after term induction.

The aims of this study were to identify the explanatory variables associated with failure of induction of labour (IOL) and to designate nomograms that predict probability. This retrospective study included 1328 singleton term pregnant women (37-42 weeks). The penalised maximum likelihood estimation (PMLE) method was used instead of traditional logistic regression. Of the 25,678 deliveries that occurred during the study period, 1328 (5.1%) women underwent term delivery. Of those, 1125 (84.7%) had successful vaginal deliveries and 203 (15.3%) had failed vaginal deliveries following use of a dinoprostone slow-release vaginal insert. Explanatory variables were discovered that were associated with delivery failure in term pregnancy undergoing induction of labour with an unfavourable cervix, and a nomogram that predicted probability was developed.IMPACT STATEMENTWhat is already known on this subject? The caesarean rate has continued to climb worldwide over the past decade. Most caesarean sections are performed because of suspected foetal distress or failure to progress. In absolute numbers, most caesarean deliveries are performed in women with a term pregnancy with a foetus in cephalic presentation. Despite these numbers, predicting the mode of delivery by which these women will deliver remains a challenge.What do the results of this study add? Five explanatory variables were strongly associated with failure of dinoprostone delivery of term pregnancies: nulliparity, induction time, premature rupture of membranes, Bishop score and foetal genderWhat are the implications of these findings for clinical practice and further research? The developed nomograms enable fast and easy implementation in clinical practice. After external validation and proof of generalisability, the present model could be used in obstetric clinical management.

Urinary kidney injury molecules in children with febrile seizures.

OBJECTIVE: Hypoxia occurs following convulsions, and hypoxia is one of the most common causes of acute renal damage. The aim of this study was to investigate urinary levels of kidney injury molecules, including neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-ß-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP) in children with febrile seizures (FS) for the first time. METHODS: The study included 28 children with FS and 34 age and gender matched healthy children. Serum biochemistry and blood gases were measured in the serum samples. Estimated glomerular filtration rate (eGFR) was calculated. NGAL, NAG, L-FABP, and creatinine (Cr) were measured in the urine samples. The ratios of kidney injury markers to urinary Cr were used for comparisons. RESULTS: There were no significant differences in eGFR and serum chemistry values between the FS and the control group (p > 0.05). Hypoxia was detected in 67.9% of the FS patients. The FS group had significantly higher urinary kidney injury molecules to Cr ratios compared to the controls, including NGAL/Cr (17.9 ± 9.8; 6.7 ± 4.0, respectively; p < 0.001), NAG/Cr (0.55 ± 0.29; 0.21 ± 0.16, p < 0.001), and L-FABP/Cr (4.85 ± 2.93; 1.74 ± 1.16, p < 0.001). CONCLUSION: Increased urinary NGAL/Cr, NAG/Cr, and L-FABP/Cr values, in patients with FS compared to healthy controls, suggest a possible subclinical renal damage in these patients.

Hepatitis A Vaccine Effectiveness and Seropositivity Among 1- to 18-Year-Old Children: 10-Year Results.

OBJECTIVE: The aim of the study was to examine and compare hepatitis A seropositivity in children. MATERIALS AND METHODS: The study included patients aged 0-18 years who presented to our hospital and were examined for hepatitis A virus serology between 2009 and 2018. Patients were separated into 2 groups: those who presented before (group I) or after (group II) September 2012, when the mandatory hepatitis A vaccination program came into effect in Turkey. RESULTS: In total, 34 809 patients were evaluated: 20 111 (57.8%) males and 14 698 (42.2%) females, with a mean age of 8.2 ± 5.3 years. Anti-hepatitis A virus immunoglobulin M positivity was observed in 3.3% of patients, most often in January and from January to April when the region experiences more rainfall. Anti-hepatitis A virus immunoglobulin M positivity decreased dramatically in group II compared to group I (0.26% vs. 7.42%, P < .001). Anti-hepatitis A virus immunoglobulin G positivity was observed in 53.8% of all patients. A statistically significant increase was determined in anti-hepatitis A virus immunoglobulin G seropositivity in group II compared to group I (81.9% vs. 42.1%, P < .001). CONCLUSION: Hepatitis A virus infection in Turkey decreased dramatically following improvements to infrastructure and sanitation and implementation of the vaccination program. This study is the most comprehensive report of hepatitis A seropositivity in Turkey to date.

Continuous veno-venous hemodiafiltration in neonates with maple syrup urine disease.

INTRODUCTION: Herein, we aimed to discuss our experience in 16 newborn patients with Maple syrup urine disease (MSUD) who were treated with urgent renal replacement therapy (RRT). METHODS: The patients underwent continuous veno-venous hemodiafiltration (CVVHDF) or peritoneal dialysis (PD) as renal replacement therapy. RESULTS: Eleven (68.75%) patients underwent CVVHDF and five (31.25%) underwent peritoneal dialysis. The median leucine reduction rate per hour was 2.56% (1.75-7.6) in the CVVHDF group, 0.78% (0.54-1.83) in the PD group, and was significantly higher in the CVVHDF group (p = 0.001). Posttreatment plasma leucine levels were found to be 198 (20-721) µmol/L in the CVVHDF group and 600 (250-967) µmol/L in the PD group, and CVVHDF was found to be significantly lower (p = 0.08). Complications such as hypotension, electrolyte imbalance, and filter obstruction occurred in the CVVHDF group. CONCLUSION: This study showed that CVVHDF is more effective than PD for rapidly eliminating elevated leucine levels caused by MSUD in the newborn and it is not associated with increased complication rates.

Evaluation of Term Newborn Patients With Hypernatremic Dehydration.

AIM: We aimed to evaluate the demographic, clinical, and laboratory findings and the management of newborns with hypernatremic dehydration (HDH). MATERIALS AND METHODS: A total of 85 term newborns with serum sodium (Na) levels higher than 145 mEq/L who admitted to our hospital between January 2011 and December 2018 were included in this study. RESULTS: Among all cases, 54.1% were female infants with the mean birth weight, weight loss ratio, and median age at diagnosis of 3095 ± 540 g, 13.6 ± 10%, and 8 (2-24) days, respectively. The most common presenting complaints were breastfeeding difficulties (90.5%), fever (63.5%), decreased urination (43.5%), jaundice (22.3%), and convulsion (15.3%). The mean sodium and potassium, and median blood urea and creatinine levels on admission were 167.9 ± 13.4 mEq/L, 5.4 ± 2.8 mmol/L, 213 mg/dL (11-476 mg/dL), and 2.4 mg/dL (0.52-9.96 mg/dL), respectively. There was metabolic acidosis in 67% and acute renal failure in 74.4% of patients, while peritoneal dialysis was performed in 12 of them. There was a positive correlation between weight loss ratio and admission age, serum urea, and creatinine levels; there was a negative correlation between weight loss and blood pH. Eight patients died (9.4%). CONCLUSIONS: In our study, serum urea, creatinine, potassium, metabolic acidosis levels, convulsion, and dialysis requirements at the time of admission of the newborns with HDH were found to be higher in those who died compared to those who survived. Convulsion was a presenting complaint, and it was also observed during the treatment.

Antibiotic resistance in childhood urinary tract infections: A single-center experience.

AIM: Urinary tract infections are the most common genitourinary tract disease in children, and inappropriate antibiotic and/or dose selection increase the likelihood of resistance. The aim of this study was to determine the prevalence of urinary tract infection pathogens, patterns of resistance to antibiotics, and empirical treatment options. MATERIAL AND METHODS: Between January 2013 and December 2017, urine culture and antibiogram results of pediatric patients aged 0 days to 16 years were analyzed retrospectively. Antibiotic susceptibilities were determined using disc diffusion according to methods of the Clinical and Laboratory Standards Institute. RESULTS: Of the 1326 children with culture growth, 1070 (80.6%) were female and 256 (19.3%) were male. The most common microorganism found was (1138, 85.8%) E. Coli, followed by Klebsiella spp. (71, 5.3%), Enterobacter spp. (44, 3.3%), and Proteus spp. (28, 2.1%). High frequency of resistance to ampicillin, ampicillin-sulbactam, amoxicillin-clavulanate, cefuroxime axetil, as TMP-SMX was detected in all microorganisms, whereas resistance to amikacin, meropenem, imipenem, ertapenem, fosfomycin, and nitrofurantoin was low. CONCLUSION: E. coli was the most common causative agent of urinary tract infections in childhood. High resistance to ampicillin, ampicillin-sulbactam, amoxicillin-clavulanate, cefuroxime axetil, and TMP-SMX was detected in all agents in our center.