Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey

Objectives: Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. Methods: In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). Results: A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p < 0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p = 0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p = 0.008). Conclusions: Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials

Lomber ponksiyon sonrası paraparezi ile belirti veren aemofili A olgusu

Besides large intra-joint bleedings that are frequently observed in Hemophilia A, bleeding may also rarely occur in spinal joints. Additional to traumatic or spontaneous hematomas, cord suppression may be occured due to various reasons such as epidural tumor and infections, myelosclerosis and bone tissue suppression that occurs to the enlargement in the bone marrow because of hemolytic anemia and thalassemia. In the present study a 6 months old male who developed paraparesis as a result of spinal compression of a hematoma that occurred after lumbar puncture and then diagnosed with Hemophilia A presented on account of the present case, our aim is to emphasize that perispinal hematoma may lead to paraparesis and that paraparesis may develop due to neurological retention that is rarely seen in children with Hemophilia A.Hemofili A da büyük eklem içi kanamalar sık görülmesinin yanısıra, nadiren spinal eklemlerde de oluşabilir. Travmatik ya da spontan hematomların yanısıra kordun baskılanması, epidural tümor ve infeksiyonlar, myeloskleroz, hemolitik anemi ve talasemi gibi kemik iliğinde büyüme yaparak kemik dokuyu bastıran pek çok nedenlerle oluşabilir. Bu çalışmada lomber ponksiyon sonrası gelişen hematomun yaptığı spinal kompresyon sonucu paraparezi gelişen 6 aylık erkek olgunun yapılan incelemesi ile ilk Hemofili A tanısı konulması üzerine sunuldu. Amacımız bu vaka ile perispinal hematomun parapareziye yol açabileceğini ve hemofili A olgularında görülen nörolojik gerilemenin buna bağlı olabileceğini vurgulamaktır

Effects of high-dose methylprednisolone therapy on lymphocyte subtypes in patients with acute immune thrombocytopenic purpura Turk J Haematol 2005;22(4): 185-189

ABSTRACT The aim of this study was to determine the effect of high-dose methylprednisolone (HDMP) on lymphocyte subtypes, CD4/CD8 ratio and clinical efficacy of the treatment in children with acute immune thrombocytopenic purpura (ITP). The study consisted of 21 children (aged between 1.5-14 years) with ITP treated with HDMP for 7 days. Absolute lymphocyte count, CD4+ and CD8+ T lymphocyte levels were examined on peripheral blood and CD4/CD8 ratio was calculated before and after HMTP treatment (on 0 and 8 th days) in all subjects. There was no statistically significant difference for age and sex between the study and the control group. A significant reduction was observed in the percentage of CD4+ lymphocyte (39.0 ± 7.5% vs 29.3 ± 8.1%, p= 0.001), CD8+ lymphocyte (27.1 ± 7.2% vs 23.7 ± 8.3%, p= 0.03), CD4+/CD8+ (1.5 ± 0.5 vs 1.3 ± 0.4, p= 0.02) and the absolute number of CD4+ lymphocyte count (1694.99 ± 1019 vs 1199.12 ± 612, p= 0.038). These findings indicated that HDMP treatment may cause a decrease in the percentage of CD4+ and CD8+ T-lymphocyte and ratio of CD4+/CD8+ lymphocyte in patients with acute ITP. We suggest that the effectiveness of steroids may depended upon the suppression of CD4 T-lymphocyte and sequential monitoring of circulating lymphocyte subtypes may be used to predict the clinical effects of steroid treatment

ACUTE LYMPHOBLASTIC LEUKEMIA PRESENTING WITH CUTANEOUS INVOLVEMENT

Primary cutaneous involvement in B-cell lymphoblastic leukemia is rare in childhood. We present a case of 2-year-old girl admitted to our hospital because of left scapular skin lesion and left axillary mass. She was looked pale and weak. Left axillary lymph node pachage of 5 cm diameter and left scapular skin lesion was revealed by physical examination. Complete blood count revealed 124.000/mm3 white blood cell count. Peripheral blood smear showed 99% lymphoblasts. Bone marrow aspiration revealed 95% blastic cells with immunophenotype and morphological characteristics of pre-B type acute lymphoblastic leukemia with L1 subtype. ALL St Jude Total XIII remission induction treatment protocol was started. Skin lesion disappeared after 15th day of the cytotoxic therapy. On the follow up, she was on remission and continued to maintenance chemotheraphy for 6 months. We would like to highlight that a small growing cutaneous lesion could be the presenting form of acute lymphoblastic leukemia

A case of Wilms' tumor with spinal cord involvement

Wilms' tumor is the most common renal tumor of childhood. However, spinal cord involvement has rarely been reported in children with Wilms' tumor. In this article, we report a 5-year-old boy with Wilms' tumor who had the unusual presentation of spinal cord involvement. Our purpose is to emphasize that spinal cord involvement may be seen in children with Wilms' tumor. (J Pediatr Neurol 2003; 1(1): 47-50)