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

Alzheimer hastalığında enfeksiyon etkenlerinin rolü.

İletişimi sürdürebilmek için öncellikle iletişimi kurmak ve sağlam temellere dayandırmak gerekir. Hastanın hekimi hekiminde hastayı anlayabilmesi, iletişimin sürekliliği olması ve hataları önlemek açısından önemlidir. (McWhinney ve Freeman, 2009: 115). Hekimin etkili olabilmesi için hastalığa hasta yönünden bir bakış açısı kazanması gerekir (Teutsch, 2003). İletişim becerileri etkili dinleme, ifade etme, kendini açma, beden dilini anlama, kendini ortaya koyabilme gibi konularda yoğunlaşmaktadır. (McKay vd., 1995:3-161). Bir hekimin hastası ile iletişimi ona sadece adını, yaşını yada rahatsızlıklarını sormaktan ibaret değildir. İletişim becerileri sadece hekim hasta bağlamında değil aynı zamanda kurum içi ve diğer kurumlarla olan ilişkilerde de önemli bir yere sahiptir

Hepatit B virüsü: Biyolojisi ve yaşam siklusu

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Hepatitis B virus (HBV) is still one of the major reasons of the liver disease and it increases the risk of the development of chronic hepatitis, cirrhosis and hepatocellular carcinoma as late-term complications. HBV is partially double-stranded DNA virus that is a member of the Hepadnaviridae virus family. HBV genome contains a small (3.2 kb) covalently closed circular DNA (cccDNA) that is transcribed to generate four known transcripts (3.5 kb, 2.4 kb, 2.1 kb and 0.7 kb size). These transcripts are encoded to produce polymerase, HBcAg, HBeAg, HBsAg (L, M, S surface proteins) and HBx that have defined roles in HBV life cycle and liver injury. Currently, available treatments for chronic hepatitis B are interferon (IFN) monotherapies (conventional IFN-α and Peg-IFN-α) or nucleos(t)ide analogues (lamivudine, adefovir, telbivudine, entecavir and tenofovir). None of currently approved drugs are curative for HBV infection since they rarely achieve virus eradication. New anti-HBV agents targeting different molecules involved in HBV infection and replication are needed to achieve curative treatments. To understand the HBV biology and life-cycle in detail is of critical importance for developing new anti-HBV agents to identify possible future targets for drugs. The aim of this review was to highlight the HBV replication and life cycle.Hepatit B virüsü (HBV) hala karaciğer hastalığının başlıca nedenlerinden biridir ve uzun dönemde görülen komplikasyonlar olan kronik hepatit, siroz ve hepatosellüler karsinomanın gelişme riskini arttırır. HBV kısmi çift-sarmallı Hepadnaviridae ailesine ait bir virüstür. HBV genomu bilinen 4 farklı transkripti oluşturan 3.2 kb’lık süpersarmal yapısında kovalent bağlı kapalı sirküler DNA (cccDNA)’yı içerir. Bu transkriptler HBV yaşam siklusunda ve karaciğer hasarında belirli rol oynayan polimeraz, HBcAg, HBeAg, HBsAg (L, M ve S yüzey proteinleri) ve HBx proteinlerini sentezletirler. Günümüzde kronik hepatit B tedavisi için interferon tedavisi (klasik IFN –α ve Peg-IFN-α) veya nükleoz(t)id analogları (lamivudin, adefovir, telbivudin, entekavir ve tenofovir) kullanılmaktadır. Bu onaylı ilaçların hiçbirisi, nadiren virusun eradikasyonuna yol açtıklarından, HBV enfeksiyonu için küratif değildirler. HBV enfeksiyonu ve replikasyonunda yer alan farklı molekülleri hedefleyen yeni anti-viral ajanlara ihtiyaç vardır. Gelecek ilaç hedeflerinin belirlenmesi, yeni sınıf anti-viral ilaçların geliştirilmesi için HBV biyolojisi ve yaşam siklusunu anlamak kritik önem taşımaktadır. Bu derlemede amaç HBV replikasyonu ve yaşam siklusunu vurgulamaktır

The predictive value of first-day bilirubin levels in the early discharge of newborns

Background: TORCH Early discharge of newborns due to social, economic and medical reasons increases the rate of readmissions, especially for hyperbilirubinemia. Therefore, identification of high-risk neonates for subsequent hyperbilirubinemia is paramount. This study aimed to investigate the level of total serum bilirubin (TSB), which could be used to predict neonatal hyperbilirubinemia at the first day of birth. Methods: Venous blood samples were obtained from 300 newborns during the postpartum period (i.e. 24±6 hours) to determine the blood group, direct Coombs test, TSB and direct bilirubin levels (DBL). Neonates were followed-up for 5 days, and TSB and DBL were recorded in 90 newborns presented with jaundice according to the Kramer's scale within 120±6 hours of birth. Results: In total, 23.3% of the studied newborns (N=90) required phototherapy. The cut-off value of TSB to determine high-risk newborns for subsequent hyperbilirubinemia at the first day of birth was 6.50 mg/dl with positive and negative predictive values of 19.75% and 97.72%, respectively. At this point, the sensitivity and specificity were 76.19% and 76.70%, respectively. Conclusion: According to the results of this study, TSB cut-off point of 6.5 mg/dl at the first day of birth could predict the risk of subsequent hyperbilirubinemia in healthy, term infants with early discharge. Since TSB cut-off point is economic and available, use of this method is recommended in all healthcare centers

The Relationship Between the Methods of Male Circumcision Procedures Used in the Past and the Prevalence of Viral Hepatitis

Amaç: Bu çalışma, geçmişte sünnet yapılma şekli ve hepatit B yüzey antijeni (HBsAg), anti-HBs ve anti-hepatit C virüsü (HCV) pozitifliği arasındaki ilişkinin incelenmesi amacı ile dizayn edilmiştir. Gereç ve Yöntemler: Viral Hepatitle Savaşım Derneği'nce hayata geçirilen "Toplum Hepatit Farkındalık Aktiviteleri" kapsamında, tüm Türkiye genelinde sağlık ocaklarına başvuran gönüllü katılımcılar HBsAg, anti-HBs ve anti-HCV pozitifliği açısından taranmıştır. Katılımcıların hepatit B virüsü ve HCV pozitifliği analizleri için kan örneklerinin alındığı sırada, geçmişteki sünnet prosedürü ile ilgili standart anket formu yüz yüze görüşme metodu ile her katılımcı için doldurulmuştur.Bulgular: HBsAg, anti-HBs ve anti-HCV pozitiflik oranları sırası ile %3,6, %9,8 ve %0,6 olarak bulunmuştur. HBsAg pozitifliği sünneti geleneksel, sağlık personeli tarafından yapılmayan grupta sağlık personeli tarafından sünnet edilen gruba göre anlamlı olarak yüksek bulunmuştur (%3,3 vs %5,3, p=0,003). Gruplar arasında anti-HBs ve anti-HCV pozitifliği açısından anlamlı bir ilişki saptanmamıştır (%0,6 vs %0,8, p=0,533). Sonuç: Sünnet, Türkiye gibi islam ülkelerinde, kültürel ve dini geleneklere dayanan oldukça yaygın bir uygulamadır. Türkiye'de, toplu sünnet ve geleneksel berberler gibi sağlık personeli olmayan kişilerce yapılan sünnet, viral enfeksiyonların bulaşma riski ile birlikte, hala önemli sağlık sorunlarından biridir. Sonuçlar, viral hepatit bulaşında önleyici önlemler almaya yardımcı olabilir.Objective: The study was designed to evaluate the relationship between the methods of circumcision procedures used in the past and hepatitis B surface antigen (HBsAg), anti-HBs and anti-hepatitis C virus (HCV) positivity.Materials and Methods: Within the scope of &quot;Public Hepatitis Awareness Activities&quot; executed by the Viral Hepatitis Society, volunteer participants who were admitted to primary healthcare centers across the Turkey, were screened for HBsAg, anti-HBs and anti-HCV positivity. A standard questionnaire form regarding their circumcision procedure in the past was applied via face-to-face interview method to each participant while their blood samples were collected for the analysis of hepatitis B virus and HCV positivity. Results: HBsAg, anti-HBs and anti-HCV positivity rates were 3.6%, 9.9% and 0.6% respectively. HBsAg positivity was significantly higher in group of participants who have been circumcised by a traditional non-medical person than in the other group of subjects who have been circumcised by a health professional (3.3% vs 5.3%, p=0.003). Conclusion: Circumcision is a widespread practice based on the existing cultural and religious traditions in islamic countries like Turkey. Mass circumcision and circumcision performed by traditional nonmedical persons like barbers is still one of the important health-care problems with the risk of transmission of viral infections in Turkey. The results will help to take measures for preventing viral hepatitis transmission